老年期抑郁的异质性与诊疗方案
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摘要
老年期抑郁指年龄大于65岁后发生的抑郁,包括老年期首次起病的抑郁,以及年轻时发病持续到老年期的复发性抑郁。抑郁则不仅指抑郁症(major depressive disorder,MDD),也包括各种类型的其它抑郁。老年期抑郁不少患者合并脑退行病变或者脑血管性损害等器质性疾病,还受到躯体疾病、环境因素、既往抑郁发作等其它因素的影响。本文将讨论老年期抑郁的异质性特点,区分各种老年期抑郁与相应的诊疗方案,为临床研究与诊治提供参考。
Late-life depression refers to depression that occurs after the age of 65,including that first episode occuring in old age and recurrent depression from young age. Depression includes not only major depressive disorder,but also various types of depression.Some patients with late-life depression have organic basis such as brain degeneration or cerebrovascular impairment,some are affected by physical diseases,environmental factors,previous depression episodes and other factors. Here the heterogeneity of late-life depression was discussed,the corresponding diagnosis and treatment process was suggested.
Late-life depression refers to depression that occurs after the age of 65,including that first episode occuring in old age and recurrent depression from young age. Depression includes not only major depressive disorder,but also various types of depression.Some patients with late-life depression have organic basis such as brain degeneration or cerebrovascular impairment,some are affected by physical diseases,environmental factors,previous depression episodes and other factors. Here the heterogeneity of late-life depression was discussed,the corresponding diagnosis and treatment process was suggested.
引文
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[2]Sjoberg L,Karlsson B,Atti AR,et al.Prevalence of depression:comparisons of different depression definitions in population-based samples of older adults[J].Journal of Affective Disorders,2017,221:123-131.
[3]Subramaniam M,Abdin E,Sambasivam R,et al.Prevalence of depression among older adults-results from the well-being of the singapore elderly study[J].Annals of the Academy of Medicine,Singapore,2016,45(4):123-133.
[4]Forlani C,Morri M,Ferrari B,et al.Prevalence and gender differences in late-life depression:a population-based study[J].Am J Geriatr Psychiatry,2014,22(4):370-380.
[5]Goldberg DP,Lam TP,Minhas F,et al.Primary care physicians’use of the proposed classification of common mental disorders for ICD-11[J].Family Practice,2017,34(5):574-580.
[6]Bao C,Mayila M,Ye Z,et al.Forecasting and analyzing the disease burden of aged population in China,based on the 2010 global burden of disease study[J].Int J Environ Res Public Health,2015,12(7):7172-7184.
[7]Vaughan L,Corbin AL,Goveas JS.Depression and frailty in later life:a systematic review[J].Clinical Interventions in Aging,2015,10:1947-1958.
[8]McKinney BC,Sibille E.The age-by-disease interaction hypothesis of late-life depression[J].Am J Geriatr Psychiatry,2013,21(5):418-432.
[9]Castilla-Puentes RC,Habeych ME.Subtypes of depression among patients with Alzheimer’s disease and other dementias[J].Alzheimers Dement,2010,6(1):63-69.
[10]Valkanova V,Ebmeier KP,Allan CL.Depression is linked to dementia in older adults[J].The Practitioner,2017,261(1800):11-15.
[11]Mallo SC,Ismail Z,Pereiro AX,et al.Assessing mild behavioral impairment with the mild behavioral impairment-checklist in people with mild cognitive impairment[J].JAD,2018,66(1):83-95.
[12]Ho C,Feng L,Fam J,et al.Coexisting medical comorbidity and depression:multiplicative effects on health outcomes in older adults[J].International Psychogeriatrics,2014,26(7):1221-1229.
[13]Casey DA.Depression in older adults:a treatable medical condition[J].Primary Care,2017,44(3):499-510.
[14]Paris J.The mistreatment of major depressive disorder[J].Canadian Journal of Psychiatry Revue Canadienne de Psychiatrie,2014,59(3):148-151.
[15]Moller HJ,Bandelow B,Volz HP,et al.The relevance of‘mixed anxiety and depression’as a diagnostic category in clinical practice[J].European Archives of Psychiatry and Clinical Neuroscience,2016,266(8):725-736.