帕金森氏病与抑郁.pptx
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卒中、帕金森病与抑郁,华中科技大学同济医学院协和医院神经科王涛,8/28/2019,1,神经疾病与精神疾病,大脑的疾病“Madnessisachronicform-affectingthatpartofthebrainwhichistheseatofthe华m中科in技d大”学同济医学院附属协和医院BenjaminRush(1812)来之不易的共识:
mentaldiseasesarediseasesofthebrain我国的神经精神科(1942)-许英魁教授中华神经精神科杂志8/28/2019,2,现实基础,脑实质的损伤可以产生精神症状精神分裂症和情感障碍中,脑实质损害的证据嗅觉改变、影像学表现及遗,华中科技大学同济医学院附属协和医院传学特质一个边缘交叉学科的复兴-神经精神医学(Neuropsychiatry),8/28/2019,3,躯体共病(MedicalCo-morbidity),抑郁,心梗,卒中,关节炎,糖尿病华中科技大学同济医学院附属协和医院,帕金森病,阿尔茨海默氏病,肿瘤,慢性疼痛,8/28/2019,4,Adaptedfrom:
WPA/PTDEducationalProgramonDepressiveDisorders.GavardJA,etal.DiabetesCare.1993;16(8):
1167-1178.,躯体疾病伴发抑郁的患病率,8/28/2019,5,帕金森病与抑郁,共病?
合并?
固有华中症科技状大学?
同济医学院附属协和医院,8/28/2019,6,PD临床特征,运动症状(DA神经元减少50%以上)运动减少/运动不,能华中科技大学同济医学院附属协和医院,僵直静止性震颤姿势平衡障碍,非运动症状(累及胆碱能、肾上腺素能、5-HT、GABA)精神:
抑郁,焦虑,,认知损害,幻觉,淡漠,睡眠紊乱,自主神经:
便秘,血压偏低,多汗,性功能障碍,排尿障碍,流涎,感觉障碍:
麻木,疼痛,痉挛,不安腿综合征,嗅觉障碍,ZiemssenT.Non-motordysfunctioninParkinsonsdisease.ParkinsonismandRelatedDisorders13(2007)323332,8/28/2019,7,DilleyM.AdvancesinPsychiatricTreatment(2006),vol.12.23-34.http:
/apt.rcpsych.org/,8/28/2019,8,AsystematicreviewofprevalencestudiesofdepressioninParkinsonsdisease.ReijndersJS,EhrtU,WeberWE,AarslandD,LeentjensAF.DepartmentofPsychiatry,MaastrichtUniversityHospital,Maastricht,TheNetherlands.PrevalenceratesofdepressivedisordersinParkinsonsdisease(PD)varywidelyacrossstudies,rangingfrom2.7%tomorethan90%.Theaimofthissystematicreviewwastocalculateaverageprevalencesofdepressivedisorderstakingintoaccountthedifferentsettingsanddifferentdiagnosticapproachesofstudies.UsingMedlineonPubmed,asystematicliteraturesearchwascarriedoutforstudiesofdepressioninParkinsonsdisease.Atotalof104articleswereincludedandassessedforquality;51articlesfulfilledthequalitycriteria.Multiplepublicationsfromthesamedatabasewerenotincludedinthemeta-analysis.Intheremaining36articles,theweightedprevalenceofmajordepressivedisorderwas17%ofPDpatients,thatofminordepression22%anddysthymia13%.Clinicallysignificantdepressivesymptoms,irrespectiveofthepresenceofaDSMdefineddepressivedisorder,werepresentin35%.Instudiesusinga(semi)structuredinterviewtoestablishDSMcriteria,thereportedprevalenceofmajordepressivedisorderwas19%,whileinstudiesusingDSMcriteriawithoutastructuredinterview,thereportedprevalenceofmajordepressivedisorderwas7%.Populationstudiesreportlowerprevalenceratesforbothmajordepressivedisorderandtheclinicallysignificantdepressivesymptomsthanstudiesinothersettings.ThissystematicreviewsuggeststhattheaverageprevalenceofmajordepressivedisorderinPDissubstantial,butlowerthangenerallyassumed.2007MovementDisorderSociety,华中科技大学同济医学院附属协和医院,PD的抑郁患病率-荟萃分析,PD中抑郁障碍的患病率2.7%90%原因:
取样方法、诊断标准和方法,对符合标准报告的荟萃分析:
重性抑郁17%,轻度抑郁22%,心境恶劣13%无论是否符合DSM-IV定义的抑郁障碍,,有明显抑郁临床症状者35%社区研究中的患病率相对较低,8/28/2019,9ReijndersJS.MovDisord.2008Jan30;23
(2):
183-9,IncreasedriskofdevelopingParkinsonsdiseaseforpatientswithmajoraffectivedisorder:
aregisterstudy.NilssonFM,KessingLV,BolwigTG.DepartmentofPsychiatry,06233,Rigshospitalet,Blegdamsvej9,UniversityofCopenhagen,DK-2100Copenhagen,Denmark.OBJECTIVE:
ToinvestigatewhetherpatientswithadiagnosisofaffectivedisorderareatanincreasedriskofdevelopingParkinsonsdiseasecomparedwithmedicallyillcontrolgroups.METHOD:
Bylinkageofpublichospitalregistersfrom1977to1993,threestudycohortswereidentified:
patientswithaffectivedisorderepisodes(maniaordepression)andpatientswithosteoarthritisordiabetes.TimetothefirstdiagnosisofParkinsonsdiseasewasestimatedwiththeuseofsurvivalanalysis.RESULTS:
Atotalof164385patientsenteredthestudybase.TheriskofbeinggivenadiagnosisofParkinsonsdiseasewassignificantlyincreasedforpatientswithaffectivedisorder,oddsratio2.2(CI95%1.7-2.8)comparedwithosteoarthritis,anddepressivedisorders,oddsratio2.2(CI95%1.7-2.9)comparedwithosteoarthritis.CONCLUSION:
ThisstudysupportsthehypothesisofacommonaetiologyformajoraffectivedisorderandParkinsonsdisease.ActaPsychiatrScand.2002Sep;106(3):
202-11MajordepressivedisorderinParkinsonsdisease:
aregister-basedstudy.NilssonFM,KessingLV,SrensenTM,AndersenPK,BolwigTG.DepartmentofPsychiatry,Rigshospitalet,UniversityofCopenhagen,Denmark.fmnrh.dkOBJECTIVE:
ToinvestigatewhetherpatientswithParkinsonsdisease(PD)wereatanincreasedriskofdevelopingmajordepressioncomparedwithpatientshavingothermedicalillnesseswithacomparabledegreeofdisability.METHOD:
CaseregisterlinkagestudyofDanishPsychiatricCentralRegister(DPCR)andDanishNationalHospitalRegister(DNHR).Threestudycohortswereidentified:
allpatientswithPD,osteoarthritis,anddiabetes.Therateofdischargediagnosisofdepressiononre-admissionwasestimatedusingcompetingrisksmodelsinsurvivalanalyses.Theratesfor