抑郁症神经成像研究的临床转化:预防、诊断和治疗的新取向

抑郁症的预防、诊断和治疗是临床所面临的主要问题,其效果的提升有待超越传统方法,寻求新的方法和技术。其中抑郁症的神经成像转化研究为此提供了一个新的突破口,该研究取向旨在将抑郁症的神经成像基础研究的发现转化为临床运用。文章综述了其在抑郁症的预防、诊断和治疗上的潜在运用价值。未来方向需要更好地促进抑郁症神经成像转化研究的双向自由流通、强调将新的方法转化到日常的临床实践和健康决策上去、促进多学科的合作和相关人才的培养,以及进一步探究转化过程中所面临的特定基础和临床主题。     

老年歧视的特点、机制与干预

目前在全球范围内普遍存在老年歧视和消极的老化态度。2~3岁的幼儿就已经具有了老化的消极刻板印象, 家庭、社会、媒体和图书资料是为人们提供消极老化态度的主要来源, 而缺少代际接触、缺乏对老化知识的了解是人们形成老年歧视的主要原因。老年歧视会影响个体的行为、自我老化接受度、心理健康状况、生活方式以及择业。了解老化知识信息、讨论老龄化问题, 以及与老年人直接接触等方法可以帮助人们改变老化消极刻板印象, 并且代际接触的质量比数量更重要。目前, 老年歧视的研究横向研究多, 纵向研究少; 特点描述、干预研究多, 机制研究较少; 研究方法多样, 测量工具不同, 导致研究结果不同, 各研究间难以进行比较, 如直接测量主观态度的老年歧视调查, 人们表现出更多的积极态度, 而采用间接方法测量时, 人们则表现出更多的消极态度。我国对老年歧视的研究有待进一步深入和扩展。     

计算精神病学：抑郁症研究和临床应用的新视角

抑郁症是一种复杂而异质的精神疾病, 给全球带来沉重的疾病负担。尽管基于症状学的诊断方法已被广泛应用于各领域, 但这种方法并不利于病理机制的探讨。另外, 该诊断方法预测效度较低, 导致其难以准确评估和比较各种治疗方案的疗效。计算精神病学方法则能通过理论驱动和数据驱动两种互补的方法解决上述问题, 从而提高对抑郁症的认识、预防和治疗。理论驱动方法基于经验知识或假设, 利用计算建模方法对数据进行多水平分析; 数据驱动方法则基于机器学习算法分析高维数据, 提高抑郁症诊断和预测的准确性, 进而提高治疗的精准度。理论驱动和数据驱动方法的发展与结合, 以及人才和资源的整合, 将会更有效地推进抑郁症的防治。     

意象对话技术治疗老年抑郁症的疗效观察

采用临床对照方法探讨意象对话技术对老年抑郁症的疗效,170例老年抑郁症患者随机分为2组,在应用5-羟色胺再摄取抑制剂（SSRIs）类抗抑郁药物治疗的基础上采用不同心理治疗方法：意象组采用意象对话技术;CBT 组采用支持性心理治疗和认知行为技术。所有患者随访一年,用汉密尔顿抑郁量表（HAMD）进行评定。结果表明意象对话技术对老年抑郁症的疗效与CB T疗效相当,且见效快,复发率低。利用其躯体出现的症状、感觉进行意象引导处理,可快速消除或减轻其身心痛苦,证实了意象对话技术可以在老年抑郁症中应用。     

不育症临床治疗中的人文关怀

目前临床对抑郁症的诊断仍普遍存在概念不清的现象,甚至抑郁症的诊断有逐渐被泛化的倾向,本文从抑郁症研究历史的角度,通过对抑郁症的概念及分类历史进行回顾,以期能廓清抑郁症相关的一些概念,从而为进一步统一标准、细化抑郁症的研究提供一些启示。     

老年抑郁症心理干预的研究进展

老年抑郁症是老年人所有心理问题之中最常见的一种,其发生与躯体、心理及社会因素密切相关。通过文献检索,查阅老年抑郁症相关文献,综述其临床心理干预方法,对指导老年抑郁患者实施有效地心理干预,维护老年人的心理健康、预防具有重要意义。     

抑郁症的概念及分类研究历史

目前临床对抑郁症的诊断仍普遍存在概念不清的现象,甚至抑郁症的诊断有逐渐被泛化的倾向,本文从抑郁症研究历史的角度,通过对抑郁症的概念及分类历史进行回顾,以期能廓清抑郁症相关的一些概念,从而为进一步统一标准、细化抑郁症的研究提供一些启示.     

执行功能与精神分裂症

执行功能障碍是精神分裂症最重要的认知功能障碍,与精神分裂症其它方面的障碍有着密不可分的关系。文章在相关的认知神经心理学和临床研究的基础上,分别综述了精神分裂症执行功能障碍的特点、研究方法、相关脑机制,执行功能与注意、记忆等一般认知功能间的关系,执行功能与精神症状间的联系及其在诊断、康复、判断预后方面的作用等。对精神分裂症执行功能障碍的认识有助于更深入地理解其病因机制,并有利于临床评价与防治     

医学史视域下中国抑郁症发展研究

运用定性与定量相结合的研究方法从医学史的角度梳理了抑郁症在西方的起源和发展、抑郁症相关病症在中国古代的起源和发展,考察了抑郁症在中国现代的社会文化研究中的主要问题。并且运用文献计量学的方法进行了主题词聚类分析,获得8个聚类,根据每个组的聚类成员,初步得出中国抑郁症研究的8个热点及热度,分别是抑郁症的流行病学调查、社会心理因素分析、药物治疗、病因学、评估诊断、人种学、药理研究、病理研究等。还反思了抑郁症历史研究中存在的若干问题,展望了其历史研究前景。     

下丘脑异常与抑郁症

近年来的研究发现了抑郁模型动物或抑郁症病人下丘脑异常的大量证据, 诸如下丘脑体积及神经元数目的改变, 下丘脑-垂体-内分泌轴的改变, 下丘脑相关激素、受体及其基因、神经肽的改变, 下丘脑与其他脑区功能联系的改变等等。然而, 下丘脑与抑郁症关系的研究所获证据多来自动物实验、或临床间接指标(如病人外周血激素水平等), 或病人脑组织尸检, 缺乏来自病人活体下丘脑异常的直接证据。今后的研究可考虑运用影像学的手段更直接地探索抑郁症患者活体下丘脑的结构特征和功能特征, 以期发现抑郁症的生物学标记及其可靠性指标, 为抑郁症的客观诊断提供依据, 为揭示抑郁症病理机制提供线索。     

Depression in Older Adults

The purpose of this article is to address selected aspects of depression in older adults. Specifically, symptoms, risk factors, diagnosis, and interventions for depression in older adults are reviewed.     

老年人自尊、希望和抑郁关系的纵向研究

为考察老年人自尊、希望与抑郁间的关系,本研究对281名老年人进行为期一年的追踪调查。相关分析及纵向中介分析结果表明:(1)自尊和希望与老年人的抑郁显著负相关,老年人自尊和希望显著正相关。(2)自尊正向预测老年人的希望,老年人的希望负向预测抑郁。(3)希望在自尊对老年人抑郁的影响中起中介作用。本研究结果揭示了希望是自尊对老年人抑郁产生效应的重要机制变量。这些结果对于减缓老年人抑郁,促进老年心理健康具有一定的实践价值。     

The Roles of Social Support and Self-Efficacy in Physical Health’s Impact on Depressive and Anxiety Symptoms in Older Adults

Physical illness may precipitate psychological distress among older adults. This study examines whether social support and self-efficacy moderate the associations between physical health and depression and anxiety. Predictions were tested in 222 individuals age 60 or older presenting for help with worry. Physical health was assessed through self-report (subjective) and physical diagnoses (objective). Objective physical health did not have a significant association with depression or anxiety. Worse subjective physical health was associated with increased somatic anxiety, but not with depression or worry. The relationship between subjective physical health and depressive symptoms was moderated by self-efficacy and social support. As predicted, when self-efficacy was low, physical health had its strongest negative association with depressive symptoms such that as physical health improved, depressive symptoms also improved. However, the moderation effect was not as expected for social support; at high levels of social support, worse physical health was associated with increased depressive affect.     

鳏与寡对老年人抑郁水平的影响:社会网络的调节作用

为了进一步探讨丧偶与抑郁水平之间的关系,讨论社会网络（包括家庭网络和朋友网络）在其中的作用机制,并比较丧偶与抑郁水平的关系及社会网络作用机制的性别差异,本研究对中国老年社会追踪调查（CLASS）2014年调查中7649名老年人（其中丧偶老人2149名,男性715,女性1434;在婚老人5500名,男性3398,女性2102）的数据进行分析。结果发现,丧偶对老年人抑郁水平有消极影响,但影响作用不存在性别差异;男性丧偶老人的朋友网络显著低于男性在婚老人,而女性老年人中无此差异;相对于在婚老人,家庭网络对男性丧偶老人的抑郁水平的缓解作用更大,而在女性样本未发现家庭网络的缓冲作用。应重视丧偶老年人,特别是男性丧偶老年人,家庭网络的建设与维护,从而缓解丧偶对老年人心理健康的消极影响。     

Depression in Older Adults: Pervasive or Preventable?

Depression occurs in as much as 15% of older adults, but it is often undiagnosed and untreated. This article explores topics related to depression in older adults including etiology, diagnosis, screening and treatment options, treatment outcomes, interventions, implications for counselors, and areas for further research.     

The Conceptualization of Anxiety: An Exploratory Study of Japanese American Older Adults

Few empirical studies exist on the mental health of Japanese American older adults. This study focused on how Japanese American older adults conceptualize anxiety. Participants were presented with a checklist, which included anxiety and depression symptoms identified in a previous qualitative study conducted by the authors, as well as symptoms from Generalized Anxiety Disorder in the Statistical Manual of Mental Disorders, Fourth Edition (DSM-IVrpar;. They were asked to imagine a Japanese American older adult who was experiencing anxiety and check off the symptoms he/she would be experiencing. Results indicated that these Japanese American participants conceptualized anxiety by using more depressive symptoms than anxiety symptoms. In addition, contrary to previous research and speculation about how Asian Americans experience psychological distress, participants also checked a larger number of cognitive symptoms as opposed to somatic symptoms. The present data suggest that Japanese American older adults conceptualize anxiety differently from the traditional psychiatric conceptualization of anxiety. Thus, clinicians and researchers should not generalize symptoms of psychological distress developed and researched on nonminority older adults to ethnic minority adults, and should consider such ethnic group differences in their assessment and treatment methods for ethnic minority adults.     

Residual Geriatric Depression Symptoms: A Place for Psychotherapy

Geriatric depression is a relatively commonly occurring mental disorder. A subpopulation of depressed older adults are those who have engaged in or completed pharmacotherapy, yet continue to experience depressive symptoms. We review the prevalence, psychosocial effects, and treatment of residual symptoms of depression in older adults. Data from previous studies conducted by our group are presented to support our contention that residual symptoms of geriatric depression are treatable through psychosocial means.     

Influence of depression on verbal fluency performance

Abstract

Neuropsychologists are often faced with the challenge of assessing older adults who exhibit both cognitive deficits and symptoms of depression. This study examined factors associated with diminished fluency in elderly adults. Three groups were tested: 54 community elderly, 35 institutionalized elderly, and 40 young adults using the Controlled Oral Word Association test. Significant incremental contributions to performance on verbal fluency included age, education, depression, and the interaction term for depression and functional impairment. Diminished verbal fluency was associated with depression among older adults who were not functionally impaired. the results suggest that variables other than cerebral integrity must be taken into consideration when interpreting older adults' performance on fluency tests.     

Overanxious disorder: An examination of developmental differences

Differences between a clinical sample of younger (ages 5 to 11) and older (ages 12 to 19) children meeting DSM-III criteria for overanxious disorder (OAD) were examined. Younger and older children were compared in terms of (1) the rates of OAD diagnoses occurring in the two age groups, (2) sociodemographic characteristics, (3) symptom expression, (4) association with other forms of maladjustment, and (5) self-reported anxiety and depression. The prevalence of OAD diagnoses and sociodemographic characteristics did not differ. Although younger and older OAD children showed similar rates of most specific DSM-III OAD symptoms, older children presented with a higher total number of overanxious symptoms than younger children. Older children more frequently exhibited a concurrent major depression or simple phobia, whereas younger OAD children more commonly had coexisting separation anxiety or attention deficit disorders. Older OAD children reported significantly higher levels of anxiety and depression on self-report measures. Findings indicated that the expression of OAD varies by developmental level.     

Treatment of Depression and Suicide in Older Adults

This article describes a cognitive behavior therapy (CBT) intervention for suicide prevention in older adults. Although many studies have found that CBT interventions are efficacious for reducing depressive symptoms in the elderly, researchers have yet to evaluate the efficacy of such interventions for preventing suicide or reducing suicide risk in older adults. In this article we describe a 12-session CBT protocol for reducing depression, suicide ideation, and other risk factors of late-life suicide. The following aspects of the treatment are described: assessing suicide risk, conceptualizing the problem through a cognitive behavioral framework, developing a safety plan, increasing hope and reasons for living, improving social resources, improving problem-solving skills and efficacy, improving adherence to medical regimen, and relapse prevention. In addition, we review other behavioral and cognitive strategies such as activity scheduling and cognitive restructuring that are commonly associated with CBT interventions for depression. We illustrate the application of these strategies through the use of case examples.