三例抑郁症病例报告
摘要
抑郁症(Depression)是一种以显著而持久的情绪低落为核心症状的精神疾患,具有高患病率、高复发率、高致残率和疾病负担沉重等特征。其病因复杂,涉及遗传、神经内分泌、生化、社会心理等多方面因素,临床伴随症状多,治疗时间长、根治难度大,是精神卫生领域的重要疾病之一。对于一些临床典型或特例的诊疗体会及时总结,有利于诊治的个体化,规范治疗方案。本文报道浙江大学医学院附属第一医院就诊的三例病人的诊断治疗过程并综述5-HTT基因多态性与抑郁症及其治疗关系的研究进展。
Depression is a kind of mood disorders with the core symptoms of significant and lasting depression, with a high prevalence rate, high recurrence rate, high rate of disability and disease burden. The causes are complex and involve genetic, neuroendocrine, biochemical, psychosocial and other factors. The clinical symptoms varied and long course of treatment is needed. The difficulties in curing make depression an important field of mental diseases. To diagnose, take treatment and consultation in time for some special cases and summing up the clinical experience would be beneficial to carry out individual and standard treatment. This paper reported the process of diagnosis and treatment of 3 cases in The First Affiliated Hospital of clinical medicine college of Zhejiang University, and reviewed the relationship between 5-HTT gene polymorphism and the treatment of depression.
Depression is a kind of mood disorders with the core symptoms of significant and lasting depression, with a high prevalence rate, high recurrence rate, high rate of disability and disease burden. The causes are complex and involve genetic, neuroendocrine, biochemical, psychosocial and other factors. The clinical symptoms varied and long course of treatment is needed. The difficulties in curing make depression an important field of mental diseases. To diagnose, take treatment and consultation in time for some special cases and summing up the clinical experience would be beneficial to carry out individual and standard treatment. This paper reported the process of diagnosis and treatment of 3 cases in The First Affiliated Hospital of clinical medicine college of Zhejiang University, and reviewed the relationship between 5-HTT gene polymorphism and the treatment of depression.
引文
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4. Kraft JB, Slager SL, McGrath PJ, Hamilton SP.Sequence analysis of the serotonin transporter and associations with antidepressant response. Biol Psychiatry,2005 Sep 1; 58:374-381.
5. Benedetti, F., Barbini, B., Lucca, A.,Campori, E., Colombo, C., Smeraldi,E.,1997. Sleep deprivation hastens the antidepressant action of fluoxetine. Eur. Arch. Psychiatry Clin. Neurosci.247,100-103.
6.沈渔邮,精神病学(第五版),人民卫生出版社,2009.
7. Berlanga C, Flores-Ramos M.Different gender response to serotonergic and noradrenergic antidepressants. A comparative study of the efficacy of citalopram and reboxetine.J Affect Disord.2006;95(1-3):119-23.
8.张玉琦,李克等,抑郁症自杀行为遗传流行病学对照研究,中国神经精神疾病杂志2005年第31卷第1期.
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卫生与预防医学2006年第17卷第4期.
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19.刘小兵,张雅红,艾司西酞普兰与帕罗西汀治疗抑郁症对照研究,临床精神医学杂志2009年第19卷第3期
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22.杜兴水,卢金奎,西酞普兰与舍曲林治疗老年抑郁症对照研究,临床精神医学 杂志2009年第19卷第3期.
23. Ackerman DL, Greenland S. Multivariate meta-analysis of controlled drug studies for obsessive-compulsive disorder[J]. JClin Psychopharmacol 2002; 22(3): 309-317.
24. Fabre LF, Putman HP. A fixed-dose clinical trial of fluoxetine in outpatients with major depression[J]. J Clin Psychiatry,1987,48(3):406-408.
25.杜晓红,邹瑜驰,杜松妹,百忧解分散片对老年人抑郁症的疗效观察,全科医学临床与教育2008年7月第6卷第4期
26. Kent JM. SnaRIs, NaSSAs, and NaRIs:new agent s for the treatment of depression[J].Lancet,2000,355(9207):911918
27. ZHAO Qingxia, Comparative study of mirtazapine tablets and venlafaxine in the treatment of depression, Practical Pharmacy And Clinical Remedies,2009, Vol.12,No.3.
28. Benkert O,Muller M,Szegedi A. An overview of clinical efficacy of mirtazapine [J].Hum Psychopharmacol,2002,17(suppl 1):s23
29. GambiF, De BerardisD, CampanellaD, et al. Mirtazapine treatment of generalized anxiety disorder:a fixed dose,open label study[J].J Psychopharmacol,2005,19(5):483487
30. Tollef son GD,Sanger TM,LuY, Thieme ME. Dpressive sigus and symptoms in schizophrenia:a prospective blinded trial of olazapine and haloperidol[J].Arch Gen Psychiatry,1998,55 (3):250
31.陈静,陆峥.非典型抗精神病药治疗难治性抑郁症[J].上海精神医学杂志,2004,16(5)
32. Kech PE,J x, St rakowski SM,McElroy SL. The efficacy of atypical antipsychotics in the treatment of depressive symptoms,hostility and sceicidality in patient s with schizophrenia[J]. J Clin Psychiatry,2000,61 (3):4
33.鞠红珍,迟翠玲,梁红蕾,利培酮并帕罗西汀治疗有精神病性症状抑郁症的随机对照研究,精神医学杂志2009年第22卷第3期.
34. Dirmaier J,Harfst T,Koch U,Therapy goals in inpatient psycho-therapy:differences between diagnostic groups and psychotherapeutic orientations[J].ClinPsychol Psychother,2006,13:3446
35. KostersM, Burlingame GM, Nachtigall C, et all. A metaanalytic review of the effectiveness of inpatient group psychotherapy[J].Group Dynamicsl 2006,10: 146163.
36.许又新,赵旭东,我国心理治疗的现状和对策,中国心理卫生杂志1997年第11卷第1期.
37.沙维伟,张玉梅,张晓斌,周宏辉,刘进文,改良电抽搐与抗抑郁药对抑郁症患者血清脑源性神经营养因子影响的对照研究,中国神经精神疾病杂志 2009年第35卷第6期.
38. Gonul AS,Akdeniz F,Taneli F,Effect of treatment on serum brainderived neurotrophic factor levels in depressed patients[J].EurArch Psychiatry Clin Neurosci,2005;255(6):381386
39. Fink M. Convulsive therapy:a review of the first 55 years. J Affect Disord.2001; 63:1215
40.徐秋杰,许毅,经颅磁刺激与治疗强迫症,国外医学精神病学分册,2005,32(2)：8791
41.邹慧莉,赵广宇,宿长军,李柱一,快速眼动睡眠剥夺对中枢5-羟色胺缺失小鼠orexin阳性神经元活性的影响,神经解剖学杂志第25卷第3期,2009年5月.
42. Kometain SG, Schneider RK. Clinical Features of Treatment-Resistant Depression. J Clin Psychiatry,2001; 62(suppl 16):18-25.
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2.高树贵,刘少文,5-羟色胺转运体基因与情感性精神障碍,国外医学精神病学分册,第32卷第1期,2005.
3. Kalman J, Palotas A, Juhasz A, Rimanoczy A, Hugyecz M, Kovacs Z, Galsi G, Szabo Z, Pakaski M, Feher LZ, Janka Z, Puskas LG. Impact of venlafaxine on gene expression profile in lymphocytes of the elderly with major depression-evolution of antidepressants and the role of the "neuro-immune" system. Neurochem Res,2005; 30:1429-1438.
4. Kraft JB, Slager SL, McGrath PJ, Hamilton SP.Sequence analysis of the serotonin transporter and associations with antidepressant response. Biol Psychiatry,2005 Sep 1; 58:374-381.
5. Benedetti, F., Barbini, B., Lucca, A.,Campori, E., Colombo, C., Smeraldi,E.,1997. Sleep deprivation hastens the antidepressant action of fluoxetine. Eur. Arch. Psychiatry Clin. Neurosci.247,100-103.
6.沈渔邮,精神病学(第五版),人民卫生出版社,2009.
7. Berlanga C, Flores-Ramos M.Different gender response to serotonergic and noradrenergic antidepressants. A comparative study of the efficacy of citalopram and reboxetine.J Affect Disord.2006;95(1-3):119-23.
8.张玉琦,李克等,抑郁症自杀行为遗传流行病学对照研究,中国神经精神疾病杂志2005年第31卷第1期.
9.陆林,刘协和,朱昌明,季刚,抑郁性神经症和重型抑郁症人格特征和生活事件的对照研究,中国临床心理学杂志1998年第6卷第4期
10.张朝辉,陈佐明,宋景贵,躯体化障碍与抑郁症人格特征对比研究,临床心身疾病杂志 2008年1月第14卷第1期.
11.丁迎,郭毅,马奎,肖勤,大学生精神分裂症与抑郁症的人格特征分析,公共
卫生与预防医学2006年第17卷第4期.
12.沈剑文,梁志健,抑郁症的生物学病因和抗抑郁药的研究进展,药学服务与研究,2007Apr；7(2)
13.杨坤,谢光荣,贺达仁,抑郁症病因学研究及其哲学思考,临床心身疾病杂志2006年9月第12卷第5期.
14. Mitchell AJ, Subramaniam H. Prognosis of depression in old age compared to middle age:a systemnatic review of comprarative studies. Am J Psychiatry,2005; 162:1588-1601.
15.江开达,《抑郁障碍防治指南》(中国精神障碍防治指南),北京大学医学出版社,2003
16. Gelenberg AJ. The search for knowledge:developing the American Psychiatric Association's practice guideline for major depressive disorder. J Clin Psychiatry. 2008 Oct;69(10):1658-9
17.江开达.精神药理学[M].北京：人民卫生出版社,2007,4202421.
18. Kennedy SH, Andersen HF, Lam RW. Efficacy of escitalop ram in the treatment of major dep ressive disorder compared with conventional selective serotonin reup take inhibitors and venlafaxine XR:ameta2analysis[J]. Psychiatry Neurosci,2006, 31:1222131.
19.刘小兵,张雅红,艾司西酞普兰与帕罗西汀治疗抑郁症对照研究,临床精神医学杂志2009年第19卷第3期
20. Sanchez C, Bergqvist PB, Brennum LT, et al. Escitalop ram, the S(+) enantiomer of citalop ram, is a selective serotonin reup take inhibitorwith potent effects in animal models p redictive of antidep ressant and anxiolytic activities[J]. Psychopharmacology (Berl),2003,167:3532362.
21. Murphy GM Jr, Hollander SB, Rodrigues HE, Kremer C, Schatzberg AF. Effects of the serotonin transporter gene promoter polymorphism on mirtazapine and paroxetine efficacy and adverse events in geriatric major depression. Arch Gen Psychiatry,2004;61:1163-1169.
22.杜兴水,卢金奎,西酞普兰与舍曲林治疗老年抑郁症对照研究,临床精神医学 杂志2009年第19卷第3期.
23. Ackerman DL, Greenland S. Multivariate meta-analysis of controlled drug studies for obsessive-compulsive disorder[J]. JClin Psychopharmacol 2002; 22(3): 309-317.
24. Fabre LF, Putman HP. A fixed-dose clinical trial of fluoxetine in outpatients with major depression[J]. J Clin Psychiatry,1987,48(3):406-408.
25.杜晓红,邹瑜驰,杜松妹,百忧解分散片对老年人抑郁症的疗效观察,全科医学临床与教育2008年7月第6卷第4期
26. Kent JM. SnaRIs, NaSSAs, and NaRIs:new agent s for the treatment of depression[J].Lancet,2000,355(9207):911918
27. ZHAO Qingxia, Comparative study of mirtazapine tablets and venlafaxine in the treatment of depression, Practical Pharmacy And Clinical Remedies,2009, Vol.12,No.3.
28. Benkert O,Muller M,Szegedi A. An overview of clinical efficacy of mirtazapine [J].Hum Psychopharmacol,2002,17(suppl 1):s23
29. GambiF, De BerardisD, CampanellaD, et al. Mirtazapine treatment of generalized anxiety disorder:a fixed dose,open label study[J].J Psychopharmacol,2005,19(5):483487
30. Tollef son GD,Sanger TM,LuY, Thieme ME. Dpressive sigus and symptoms in schizophrenia:a prospective blinded trial of olazapine and haloperidol[J].Arch Gen Psychiatry,1998,55 (3):250
31.陈静,陆峥.非典型抗精神病药治疗难治性抑郁症[J].上海精神医学杂志,2004,16(5)
32. Kech PE,J x, St rakowski SM,McElroy SL. The efficacy of atypical antipsychotics in the treatment of depressive symptoms,hostility and sceicidality in patient s with schizophrenia[J]. J Clin Psychiatry,2000,61 (3):4
33.鞠红珍,迟翠玲,梁红蕾,利培酮并帕罗西汀治疗有精神病性症状抑郁症的随机对照研究,精神医学杂志2009年第22卷第3期.
34. Dirmaier J,Harfst T,Koch U,Therapy goals in inpatient psycho-therapy:differences between diagnostic groups and psychotherapeutic orientations[J].ClinPsychol Psychother,2006,13:3446
35. KostersM, Burlingame GM, Nachtigall C, et all. A metaanalytic review of the effectiveness of inpatient group psychotherapy[J].Group Dynamicsl 2006,10: 146163.
36.许又新,赵旭东,我国心理治疗的现状和对策,中国心理卫生杂志1997年第11卷第1期.
37.沙维伟,张玉梅,张晓斌,周宏辉,刘进文,改良电抽搐与抗抑郁药对抑郁症患者血清脑源性神经营养因子影响的对照研究,中国神经精神疾病杂志 2009年第35卷第6期.
38. Gonul AS,Akdeniz F,Taneli F,Effect of treatment on serum brainderived neurotrophic factor levels in depressed patients[J].EurArch Psychiatry Clin Neurosci,2005;255(6):381386
39. Fink M. Convulsive therapy:a review of the first 55 years. J Affect Disord.2001; 63:1215
40.徐秋杰,许毅,经颅磁刺激与治疗强迫症,国外医学精神病学分册,2005,32(2)：8791
41.邹慧莉,赵广宇,宿长军,李柱一,快速眼动睡眠剥夺对中枢5-羟色胺缺失小鼠orexin阳性神经元活性的影响,神经解剖学杂志第25卷第3期,2009年5月.
42. Kometain SG, Schneider RK. Clinical Features of Treatment-Resistant Depression. J Clin Psychiatry,2001; 62(suppl 16):18-25.
1.郭超,丁玉强,多巴胺和5-羟色胺神经元发育的基因调控途径,Chinese Journal of Nature, Vol.31 No.3.
2.张雪梅,颜寿琪,5-羟色胺转运体研究进展,生理科学进展,1997年28卷第4期.
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