伴与不伴精神病性症状重度抑郁症的临床对照研究

山东大学学报(医学版) ›› 2011, Vol. 49 ›› Issue (9): 117-.

伴与不伴精神病性症状重度抑郁症的临床对照研究

王学峰1,宋晓1，谭兰2

1. 青岛大学医学院附属乳山市人民医院神经内科，山东乳山 264500；
2. 青岛大学医学院附属青岛市立医院，山东青岛 266071

收稿日期:2011-04-18 出版日期:2011-09-10 发布日期:2011-09-10
作者简介:王学峰(1975- ),男,硕士研究生,主要从事痴呆、脑血管病方面的研究。

Clinical comparison of psychotic major depression and non-psychotic major depression

WANG Xue-feng1, SONG Xiao1, TAN Lan2

1. Department of Neurology, Rushan People′s Hospital Affiliated to Qingdao University Medical College,
Rushan 264500, Shandong, China； 2. Department of Neurology, Qingdao Municipal Hospital Affiliated to
Qingdao University Medical College, Qingdao 266071, Shandong, China

Received:2011-04-18 Online:2011-09-10 Published:2011-09-10

摘要/Abstract

摘要：

目的观察不伴精神病性症状的重度抑郁症(NMD)与伴精神病性症状的重度抑郁症(PMD)的临床表现、治疗方法和治疗效果的异同。方法选取重度抑郁症患者150例，其中PMD组100例、NMD组50例，并设健康组60例作为对照。将PMD组随机分为PMD联合用药组59例、PMD单药组41例；NMD组和PMD单药组服用帕罗西汀，PMD联用组联合服用帕罗西汀、奥氮平，在初次就医、治疗后1、3、9个月四个时刻时进行汉密尔顿抑郁量表(HAMD)评分。结果 ① 初次就医时NMD与PMD的HAMD量表总分分别为(53.22±6.00)分和(58.30±5.20)分(P＞0.05)；PMD组自杀、迟滞、认知障碍因子评分较高；② 9个月后联用组PMD的HAMD评分低于PMD单药组，NMD组低于PMD单药组；③ 入组时进行第一次测评，此时PMD组与NMD组的睡眠障碍严重性无统计学差异(P>0.05)，但均重于健康组(P<0.05)；经过9个月治疗，NMD组和PMD组评分总分、主因子因子评分均有提高(P<0.05)；但在一级因子的“主观睡眠质量”和“白天功能紊乱”、二级因子的“夜间醒来或早醒”上仍有差异。结论 ① PMD与NMD病情严重程度相当；PMD患者迟滞、认知障碍、自杀念头较重，而NMD患者抑郁症状较重；② 帕罗西汀加奥氮平治疗PMD好于单用帕罗西汀；单用帕罗西汀治疗NMD患者较合适；③ 重度抑郁症或者睡眠功能严重受损，经过适当的治疗其睡眠功能可明显恢复，但仍残留部分睡眠障碍；精神症状不影响睡眠功能的障碍程度和恢复程度。

关键词: 精神症状；抑郁症；奥氮平；帕罗西汀；睡眠障碍

Abstract:

Objective To compare psychotic major depression(PMD) and non-psychotic major depression(NMD) in clinical features, and treatment methods and effects. Methods 150 cases of severe depression were divided into the PMD group(100 cases) and the NMD group(50 cases). In the PMD group, 41 patients were treated with a single agent, and the other 59 patients were treated with combined agents. The NMD group and PMD mono-therapy group were treated with paroxetine, while the PMD combination therapy group was treated with a combination of oral paroxetine and olanzapine. All groups were scored with the Hamilton Depression Rating Scale (HAMD) at the 1st visit and after 1,3 and 9 months of treatment. Results ① HAMD total scores in NMD and PMD groups at the 1st visit were (53.22±6.00) and (58.30±5.20), respectively(P＞0.05). The retardation factor, cognitive factor, and suicide factor in the PMD group were higher than those in the NMD group. ②After 9 months of treatment, the HAMD score in the PMD monotherapy group was higher than that in the PMD combination therapy group. The score in the PMD mono-therapy group was higher than in the NMD group. ③At the 1st test with the Pittsburgh Sleep Quality Index(PSQI), NMD and PMD had no significant difference in sleep disorders(P<0.05), while they were statistically different from the healthy controls. After 9 months of treatment, NMD and PMD were statistically improved in total scores and all the main factor scores (P<0.05), and they were still statistically different in first factors “subjective sleep quality” and “daytime dysfunction”, and the secondary factor “wake up at night or wake too early”. Conclusions ①PMD is as serious as NMD. Retardation, cognitive impairment and suicidal thoughts in PMD patients are more obvious than those with NMD，while depression in NMD patients is more obvious.②For PMD, treatment with paroxetine and olanzapine is more effective than paroxetine alone. Compared with PMD patients, paroxetine monotherapy is more suitable for NMD patients.③Major depression has a decline in comprehensive sleep function. After effective treatment, sleep function can be significantly improved, but part of sleep dysfunction still remains. Mental symptoms cannot affect sleep function damage and recovery.

Key words: Psychotic symptoms; Depression; Olanzapine; Paroxetine; Sleep disorders

中图分类号:

R741

王学峰1,宋晓1，谭兰2. 伴与不伴精神病性症状重度抑郁症的临床对照研究[J]. 山东大学学报(医学版), 2011, 49(9): 117-.

WANG Xue-feng1, SONG Xiao1, TAN Lan2. Clinical comparison of psychotic major depression and non-psychotic major depression[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2011, 49(9): 117-.

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