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药物加耳针治疗更年期抑郁症

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中国组织工程研究 2003年第7期7卷 1225-1226页

作者： Xie Zhen谢珍 First People'Hospital of Shangqiu Shangqiu476100 Henan Province China

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Effects of cognitive therapy on psychological symptoms and social functioning in residual depression

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BRITISH JOURNAL OF PSYCHIATRY 2000年第5期177卷 440-446页

作者： Scott, J Teasdale, JD Paykel, ES Johnson, AL Abbott, R Hayhurst, H Moore, R Garland, A Gartnavel Royal Hosp Acad Ctr Dept Psychol Med Glasgow G12 0XH Lanark Scotland MRC Cognit & Brain Sci Unit Cambridge England Univ Cambridge Inst Publ Hlth MRC Biostat Unit Cambridge CB2 1TN England Univ Manchester Manchester M13 9PL Lancs England

Background About 30% of psychiatric out-patients with major depression demonstrate partial remission. Aims To explore whether the addition of cognitive therapy (CT) had any differential effect on residual symptoms or social adjustment. Method Patients with residual symptoms of major depression (n=158) were randomised to receive clinical management (CM) alone, or CM plus 18 sessions of CT. Subjects' depressive symptoms and social functioning were assessed regularly over 16 months. Results The addition of CT produced statistically significant differential effects on: two out of four measures of overall severity of depression;specific psychological symptoms (guilt, self-esteem and hopelessness);and social functioning (including dependency, interpersonal behaviour and friction). Conclusions In patients showing only partial response to antidepressants, the addition of CT produced modest improvements in social and psychological functioning. The implications for research on the mechanisms of action of CTare discussed. Declaration of interest Supported by grants from the Medical Research Council and an additional grant from the Oxford and Anglia Region.

关键词：认知疗法综合疗法抑郁症更年期/药物疗法抑郁症更年期/心理学抑郁症更年期/治疗随访研究人际关系病人依从精神病状态评定量表治疗结果成年人老年人女(雌)性人类男(雄)性中年人

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Effects of the high-affinity corticotropin-releasing hormone receptor 1 antagonist R121919 in major depression:: the first 20 patients treated

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JOURNAL OF PSYCHIATRIC RESEARCH 2000年第3期34卷 171-181页

作者： Zobel, AW Nickel, T Künzel, HE Ackl, N Sonntag, A Ising, M Holsboer, F Max Planck Inst Psychiat D-80804 Munich Germany

Clinical and preclinical data suggest that unrestrained secretion of corticoctropin-releasing hormone (CRH) in the CNS produces several signs and symptoms of depression and anxiety disorders through continuous activation of CRH1 receptors. This led to the development of drugs that selectively antagonize CRH1 receptors suppressing anxiety-like behavior in rats and also in monkey models of anxiety. These findings led to a clinical development program exploring the antidepressive potential of R121919, a water-soluble pyrrolopyrimidine that binds with high affinity to human CRH1 receptors and is well absorbed in humans. This compound was administered to 24 patients with a major depressive episode primarily in order to investigate whether its endocrine mode of action compromises the stress-hormone system or whether other safety and tolerability issues exist. The patients were enrolled in two dose-escalation panels: one group (n = 10) where the dose range increased from 5-40 mg and another group (n = 10) where the dose escalated from 40 to 80 mg within 30 days each. Four patients dropped out because of withdrawal of consent to participate (three cases) or worsening of depressive symptomatology in one case. We found that R121919 was safe and well tolerated by the patients during the observation period. Moreover, the data suggested that CRH1-receptor blockade does not impair the corticotropin and cortisol secretory activity either at baseline or following an exogenous CRH challenge. We also observed significant reductions in depression and anxiety scores using both, patient and clinician ratings. These findings, along with the observed worsening of affective symptomatology after drug discontinuation, suggests that the pharmacological principle of CRH1-receptor antagonism has considerable therapeutic potential in the treatment and the prevention of diseases where exaggerated central CRH activity is present at baseline or following stress exposure. (C), 2000 Elsevier Science

关键词：促肾上腺皮质激素/血液方差分析抗焦虑药/投药和剂量抗焦虑药/药理学抗焦虑药/治疗应用促肾上腺皮质素释放激素/投药和剂量促肾上腺皮质素释放激素/代谢抑郁症更年期/血液抑郁症更年期/药物疗法抑郁症更年期/代谢抑郁症更年期/尿剂量效应关系药物药物评价氢化可的松/血液氢化可的松/尿精神病状态评定量表嘧啶类/药理学嘧啶类/治疗应用吡咯类/药理学受体促肾上腺皮质素释放激素/拮抗剂和抑制剂受体促肾上腺皮质素释放激素/代谢治疗结果成年人女(雌)性人类男(雄)性中年人

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The use of placebos in unipolar major depression: The current status

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BIOLOGICAL PSYCHIATRY 2000年第8期47卷 745-747页

作者： Rush, AJ Univ Texas SW Med Ctr Dept Psychiat Dallas TX 75235 USA

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Comorbidity of keratosis follicularis (Darier's disease) and bipolar affective disorder: An indication for valproate instead of lithium

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GENERAL HOSPITAL PSYCHIATRY 2000年第2期22卷 128-129页

作者： Ehrt, U Brieger, P Univ Halle Wittenberg Hosp Psychiat & Psychotherapy Halle Germany

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Reboxetine in the treatment of depression in the elderly: Pilot study

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JOURNAL OF GERIATRIC PSYCHIATRY AND NEUROLOGY 1999年第4期12卷 206-210页

作者： Andreoli, V Carbognin, G Abati, A Vantini, G Osped San Giovanii Battista Dept Psychiat Soave Italy Osped Sacro Cuore Dept Geriatr Verona Italy

Elderly patients are particularly susceptible to the potential side effects of current antidepressants due to age-related physiologic changes. We report a pilot study to examine the tolerability of increasing doses of reboxetine, a selective noradrenaline reuptake inhibitor (selective NRI), in elderly depressed patients. Twelve elderly female patients (75-87 years) with either major depression or dysthymia received reboxetine titrated to 8 mg/day over a 4-week period. Tolerability was assessed and included the measurement of vital signs. Electrocardiograms were recorded at baseline and on days 14 and 28. Newly emergent signs and symptoms were recorded throughout the study. Efficacy was assessed using four rating scales, including the Clinical Global Impression (CGI) scale and Hamilton Depression Rating Scale (HAM-D). Eleven patients completed the study, nine received the maximal dose of reboxetine 8 mg/day, and two received maximum doses of reboxetine 6 mg/day due to cardiac rhythm changes in week 3. A total of five patients experienced tachycardia (including two with cardiac rhythm changes in week 3). At the end of the study, seven patients were "much" to "very much" improved on the CGI scale with a concomitant decrease in HAM-D total score of 22% to 41%. Reboxetine was well tolerated by the majority of patients and efficacy outweighed side effects in 75% of patients. Reboxetine 4 mg/day, increasing to 6 mg/day on the basis of individual patient tolerability, may be considered as a safe dose range for testing the efficacy and tolerability of reboxetine in long-term controlled clinical trials in elderly patients with depression.

关键词：抗抑郁药/投药和剂量抑郁症更年期/诊断抑郁症更年期/药物疗法抑郁症更年期/心理学剂量效应关系药物心境恶劣障碍/诊断心境恶劣障碍/药物疗法心境恶劣障碍/心理学吗啉类/投药和剂量个性量表试点项目治疗结果老年人老年人 80以上女(雌)性人类

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Management of anxiety in late life

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JOURNAL OF GERIATRIC PSYCHIATRY AND NEUROLOGY 1998年第4期11卷 194-200页

作者： Flint, AJ Toronto Hosp Gen Div Geriatr Psychiat Program Toronto ON M5G 2C4 Canada Rehabil Inst Toronto Toronto ON Canada

Epidemiologic data are used as a framework to discuss the pharmacologic and cognitive-behavioral management of anxiety disorders in late life. Generalized anxiety disorder (GAD) and phobias account far most cases of anxiety in late life. The high level of comorbidity between GAD and major depression, and the observation that the anxiety usually arises secondarily to the depression, suggests that antidepressant medication should be the primary pharmacologic treatment for many older people with GAD. Most individuals with late-onset agoraphobia do not have a history of panic attacks and the illness often starts after a traumatic event. Exposure therapy is the treatment of choice for agoraphobia without panic. It is uncommon for obsessive-compulsive disorder (OCD) and panic disorder to start for the first time in old age, but these disorders can persist from younger years into late life. Case reports and uncontrolled case series suggest that elderly people with OCD or panic disorder can benefit from pharmacologic and cognitive-behavioral treatments that are known to be effective in younger patients. However, it is not known whether the rate of response among elderly patients is adversely affected by the chronicity of these disorders. The prevalence and incidence of post-traumatic stress disorder in late life are not known. Uncontrolled data support the use of selective serotonin reuptake inhibitors in war veterans with chronic symptoms of post-traumatic stress disorder;other treatments for this condition await evaluation in the elderly.

关键词：老年人/生理学抗抑郁药/治疗应用焦虑症/病因学焦虑症/治疗认知疗法抑郁/并发症抑郁/药物疗法抑郁症更年期/药物疗法药物疗法联合应激障碍创伤后/药物疗法老年人 80以上女(雌)性人类男(雄)性中年人

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