帕金森氏病与抑郁.pptx

1、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“Madnessis a chronicform-affecting that part ofthe brain whichis the seat ofthe华m中科in技d大”学同济医学院附属协和医院Benjamin Rush(1812)来之不易的共识：mental diseases are diseases of the brain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

2、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（Medical Co-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,Adapted from:WPA/PTD Educational Program on Depressive Disorders.Gavard JA,et al.Diabetes Care.1993;16(8):116

3、7-1178.,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,Ziemssen T.Non-motor dysfunction in Pa

4、rkinsons disease.Parkinsonism and Related Disorders 13(2007)323332,8/28/2019,7,Dilley M.Advances in Psychiatric Treatment(2006),vol.12.23-34.http:/apt.rcpsych.org/,8/28/2019,8,A systematic review of prevalence studies of depression in Parkinsons disease.Reijnders JS,Ehrt U,Weber WE,Aarsland D,Leentj

5、ens AF.Department of Psychiatry,Maastricht University Hospital,Maastricht,The Netherlands.Prevalence rates of depressive disorders in Parkinsons disease(PD)vary widely across studies,ranging from 2.7%to more than 90%.The aim of this systematic review was to calculate average prevalences of depressiv

6、e disorders taking into account the different settings and different diagnostic approaches of studies.Using Medline on Pubmed,a systematic literature search was carried out for studies of depression in Parkinsons disease.A total of 104 articles were included and assessed for quality;51 articles fulf

7、illed the quality criteria.Multiple publications from the same database were not included in the meta-analysis.In the remaining 36 articles,the weighted prevalence of major depressive disorder was 17%of PD patients,that of minor depression 22%and dysthymia 13%.Clinically significant depressive sympt

8、oms,irrespective of the presence of a DSM defined depressive disorder,were present in 35%.In studies using a(semi)structured interview to establish DSM criteria,the reported prevalence of major depressive disorder was 19%,while in studies using DSM criteria without a structured interview,the reporte

9、d prevalence of major depressive disorder was 7%.Population studies report lower prevalence rates for both major depressive disorder and the clinically significant depressive symptoms than studies in other settings.This systematic review suggests that the average prevalence of major depressive disor

10、der in PD is substantial,but lower than generally assumed.2007 Movement Disorder Society,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,8/28/2019,9Reijnders JS.Mov Disord.2008 Jan 30;23(2):183-9,I

11、ncreased risk of developing Parkinsons disease for patients with major affective disorder:a register study.Nilsson FM,Kessing LV,Bolwig TG.Department of Psychiatry,0 6233,Rigshospitalet,Blegdamsvej 9,University of Copenhagen,DK-2100 Copenhagen,Denmark.OBJECTIVE:To investigate whether patients with a

12、 diagnosis of affective disorder are at an increased risk of developing Parkinsons disease compared with medically ill control groups.METHOD:By linkage of public hospital registers from 1977 to 1993,three study cohorts were identified:patients with affective disorder episodes(mania or depression)and

13、 patients with osteoarthritis or diabetes.Time to the first diagnosis of Parkinsons disease was estimated with the use of survival analysis.RESULTS:A total of 164 385 patients entered the study base.The risk of being given a diagnosis of Parkinsons disease was significantly increased for patients wi

14、th affective disorder,odds ratio 2.2(CI 95%1.7-2.8)compared with osteoarthritis,and depressive disorders,odds ratio 2.2(CI 95%1.7-2.9)compared with osteoarthritis.CONCLUSION:This study supports the hypothesis of a common aetiology for major affective disorder and Parkinsons disease.Acta Psychiatr Sc

15、and.2002 Sep;106(3):202-11Major depressive disorder in Parkinsons disease:a register-based study.Nilsson FM,Kessing LV,Srensen TM,Andersen PK,Bolwig TG.Department of Psychiatry,Rigshospitalet,University of Copenhagen,Denmark.fmnrh.dkOBJECTIVE:To investigate whether patients with Parkinsons disease(P

16、D)were at an increased risk of developing major depression compared with patients having other medical illnesses with a comparable degree of disability.METHOD:Case register linkage study of Danish Psychiatric Central Register(DPCR)and Danish National Hospital Register(DNHR).Three study cohorts were identified:all patients with PD,osteoarthritis,and diabetes.The rate of discharge diagnosis of depression on re-admission was estimated using competing risks models in survival analyses.The rates for