抑郁症与自杀

自杀是一种社会现象也是医学问题,自杀意念是抑郁症主要症状之一,抑郁症与自杀之间存在密切的关系,抑郁症患者甚至视自杀为一种解脱.本文从社会文化的角度探讨抑郁症病患自杀的原因与特征,旨在有效识别抑郁症患者的自杀倾向,及早防护,降低抑郁症患者自杀率,同时丰富我国抑郁症研究的医学社会学内容.     

与死神赛跑

抑郁症作为一种精神疾病,最严重时,也是最令患者家属担心的是患者可能出现自杀念头并付诸行动。     

与死神赛跑

抑郁症作为一种精神疾病，最严重时，也是最令患者家属担心的是患者可能出现自杀念头并付诸行动。     

难治性抑郁症的发病机制研究现状

抑郁症是一种高患病率、高致残率及高自杀率的严重精神疾患。在过去10年中,抗抑郁药物研究取得了突飞猛进的进展。然而,在临床上仍约有20%的抑郁症患者最终成为难治性抑郁症病例。难治性抑郁症是一种情感障碍,目前尚无较好的治疗策略。现对有关难治性抑郁症的病因学现状进行文献回顾与总结,了解难治性抑郁症的发病机制,便于从临床治疗角度早期识别该类患者,尽可能及早地给予积极的抗抑郁治疗,以提高临床缓解率。     

难治性抑郁症的发病机制研究现状

抑郁症是一种高患病率、高致残率及高自杀率的严重精神疾患。在过去10年中,抗抑郁药物研究取得了突飞猛进的进展。然而,在临床上仍约有20%的抑郁症患者最终成为难治性抑郁症病例。难治性抑郁症是一种情感障碍,目前尚无较好的治疗策略。现对有关难治性抑郁症的病因学现状进行文献回顾与总结,了解难治性抑郁症的发病机制,便于从临床治疗角度早期识别该类患者,尽可能及早地给予积极的抗抑郁治疗,以提高临床缓解率。     

老年抑郁症患者自杀意念与生活事件、家庭功能及多导睡眠图参数的关系研究

摘要 目的：研究老年抑郁症患者自杀意念与生活事件、家庭功能及多导睡眠图参数的关系并予以分析。方法：选取从2019年1月～2020年10月期间我院收治的154例老年抑郁症患者纳入研究。将其按照是否存在自杀意念分作自杀意念组83例和无自杀意念组71例。比较分析两组生活事件、家庭功能及多导睡眠图参数等方面的差异,并以Spearman相关性分析明确老年抑郁症患者自杀意念与生活事件、家庭功能及多导睡眠图参数的关系。结果：自杀意念组正性事件、负性事件评分均高于无自杀意念组（均P＜0.05）。自杀意念组各项家庭功能评分均高于无自杀意念组（均P＜0.05）。自杀意念组N3期非快速眼动睡眠时间以及N3期非快速眼动睡眠占比均低于无自杀意念组（均P＜0.05）。经Spearman相关性分析可得,老年抑郁症患者自杀意念与各项生活事件评分、家庭功能评分均呈正相关,而与N3期非快速眼动睡眠时间以及N3期非快速眼动睡眠占比呈负相关（均P＜0.05）。结论：老年抑郁症自杀意念与生活事件、家庭功能及多导睡眠图参数密切相关,临床可通过对这些方面的观测来评估老年抑郁症的病情,以预防和减少老年抑郁症患者自杀行为的发生。     

体育运动对抑郁症的干预研究

抑郁症(depression)是一种十分普遍的神经精神疾病,它是先天遗传因素和后天环境因素共同作用的结果,并有其复杂的神经生理和病理机制。抑郁症患者的健康水平和生存质量普遍较低,严重抑郁患者还会有自杀的倾向。目前,药物疗法依然是抑郁症治疗的主要手段,但是长期服药不仅会带来严重的副作用,还会加重患者经济负担,降低治疗依从性。本研究在综述抑郁症的各种诱发因素的基础上,重点探讨了体育运动对抑郁症的干预作用,以及运动干预抑郁症的相关机制,同时还归纳了针对抑郁症的运动干预方案,以期为抑郁症的预防与治疗提供可供参考的方法。     

人体肠道微生物群与抑郁症的相关性研究进展

抑郁症又称抑郁障碍,是一种常见的精神疾病,主要表现为情绪低落、悲观、思维迟缓、以及言语动作减少,迟缓等。抑郁症严重困扰患者的生活和工作,给家庭和社会带来沉重的负担,约15%的抑郁症患者死于自杀。肠道菌群作为寄居在人消化道内的大量微生物,是人体健康和疾病转换过程中的重要环境因素。肠-脑轴是联系大脑和胃肠功能的双向信息调节系统,肠道微生物在生理和病理条件下均能参与肠-脑轴活动,影响大脑功能和某些关联行为。因此,深入研究肠道微生物与抑郁症的相互作用,开发以肠道菌群为靶点的个性化药物,能够为抑郁症的临床预防和治疗提供新的研究思路和方法。     

氯胺酮在麻醉和治疗抑郁症中的研究进展

抑郁症是一种精神障碍性疾病,它的主要症状是持续的情绪低落.根据WHO的研究报告:全世界有大约25％的人患有抑郁症,其中约10％的人是重性抑郁症,也即是说难治性抑郁症.抑郁症严重地影响着人们的正常生活、工作和学习,特别值得注意地,患有重性抑郁症的患者是自杀的高危人群.氯胺酮是临床常用的麻醉药,尤其在小儿麻醉手术中被广泛应用,近几年的研究表明氯胺酮能迅速缓解抑郁症患者症状,且治疗效果持续可达一周.本文将就氯胺酮在手术麻醉和治疗抑郁症过程中的研究进行综述.     

社会竞争失败病因学的抑郁症树鼩模型

抑郁症是一种常见精神疾病,主要表现为持续两周以上的情绪低落。世界卫生组织预测在2030年抑郁症的疾病负担将高居所有疾病、伤残总负担的榜首。抑郁症面临三大难题:1)发病机理不完全清楚,因而缺乏有效的预测预防途径和生物学诊断;2)现有单胺类抗抑郁症药物起效慢,也可能导致患者自杀风险增加;3)缺乏副作用小的非单胺类快速起效抗抑郁症药物。针对这三大难题,长期以来,应用抑郁症啮齿类模型的众多研究并未取得实质性进展,至少部分因素归咎于啮齿类与人类大脑功能的极大种属差异。树鼩是灵长类近亲,具有更接近于人类的大脑功能。本文针对抑郁症发病机理假说、临床表象和抗抑郁症药物疗效等内容,综述了社会竞争失败病因学的抑郁症树鼩模型可能会具有更好的疾病同源性、表象一致性和药物预见性。这一被长期忽视的抑郁症树鼩模型尽管还需要进一步完善,但对其进一步深入研究可能为解决抑郁症的三大难题提供了一条新途径。     

Physicians' Characteristics Associated with Exploring Suicide Risk among Patients with Depression: A French Panel Survey of General Practitioners

Background

General practitioners (GPs) have a key role to play in suicide prevention, but the rates at which they question patients with depression about suicidal thoughts and plans are rather low. Little is known about GPs'' characteristics associated with such inquiries. Our objectives were to describe GPs'' attitudes, perceived barriers, and self-reported practices in this questioning of these patients and to analyze factors associated with these practices.

Methodology

This cross-sectional survey was conducted among participants in a panel of randomly selected French GPs (1249/1431 participated: 87.3%). GPs were interviewed with a standardized questionnaire covering their professional and personal characteristics, attitudes, and practices in exploring the suicide risk of their patients with depression. We built a suicide inquiry score by summing the responses to 5 items and used a multiple linear regression analysis to explore the characteristics associated with this score.

Principal Findings

Most GPs reported inquiring about the presence of suicidal ideation often or very often; less than 30% reported that they frequently explored signs of a specific suicide plan. The mean suicide inquiry score was 12.4 (SD, 2.9; range, 5–20). False ideas, such as thinking that patients who report suicidal ideas do not often commit suicide, were frequent (42.3%). Previous continuing medical education on suicide, participation in a formal mental health network, and patients who committed suicide in the past 5 years were associated with a higher score. Reluctance to question patients about suicide and perception of insufficient skill were associated with a lower score.

Conclusions/Significance

This study showed great variability in French GPs'' practices in exploring suicide risk in patients with depression. Interventions aiming at improving GPs'' initial training and continuing medical education in suicide and/or depression, and their collaboration with mental health specialists should be developed, and their impacts assessed.     

Suicide in General Hospitals

Of 14 medical and surgical patients who committed suicide in a general hospital, there were ten men and four women, ranging in age from 19 to 82. The patients had not made statements of suicidal intent; however, their hospital records showed there had been symptoms of depression and contained indirect references to a preoccupation with suicide. Most of the patients had been depressed because of their illnesses or distressing symptoms.It is important to keep in mind that there are clues that help anticipate suicide. Awareness by hospital staffs of symptoms and subtle signs of depression and of suicidal thoughts in patients is important in reducing the number of suicides in general hospitals. Of preventive and treatment measures, warmth, compassion and commitment to the care of patients by hospital staffs are most important.     

Acutely Suicidal Patients—Management in General Medical Practice

Suicidal crises are best understood as late stages in the progressive breakdown of adaptational behavior in emotionally exhausted patients. The premonitory symptoms of suicide include verbal communications, suicide attempts, symptomatic actions, depression, treatment failure, excessive emotional reactions to specific disease states and panic reactions.Of persons who committed suicide, 75 per cent had seen a physician within six months. To recognize and evaluate suicide danger the physician must not be afraid to question the patient directly about his suicidal plans. The average physician encounters half a dozen suicidal patients a year and will have 10 to 12 suicides in his practice during a long career.In treating suicidal patients, the physician should maintain his medical attitude. The patients need emergency medical care including appropriate drugs. Free communication between patient and physician is very important. This may take some extra time. Patients benefit from emergency psychological support and stimulation toward constructive action. Family, friends, and community agencies should be mobilized to aid the patient. For seriously suicidal patients, consultation is recommended and treatment in hospital is advisable.     

Suicidal Risk Factors of Recurrent Major Depression in Han Chinese Women

The relationship between suicidality and major depression is complex. Socio- demography, clinical features, comorbidity, clinical symptoms, and stressful life events are important factors influencing suicide in major depression, but these are not well defined. Thus, the aim of the present study was to assess the associations between the above-mentioned factors and suicide ideation, suicide plan, and suicide attempt in 6008 Han Chinese women with recurrent major depression (MD). Patients with any suicidality had significantly more MD symptoms, a significantly greater number of stressful life events, a positive family history of MD, a greater number of episodes, a significant experience of melancholia, and earlier age of onset. Comorbidity with dysthymia, generalized anxiety disorder (GAD), social phobia, and animal phobia was seen in suicidal patients. The present findings indicate that specific factors act to increase the likelihood of suicide in MD. Our results may help improve the clinical assessment of suicide risk in depressed patients, especially for women.     

Neuropeptide Y in Frontal Cortex Is Not Altered in Major Depression

Abstract: Previously, we reported a modest but significant reduction in the concentration of neuropeptide Y in frontal cortices from victims of suicide relative to age-matched natural or accidental death control subjects. The reduction in neuropeptide Y appeared to be greatest in a subgroup of victims of suicide for which there was indirect evidence of histories of depression. We pursued these initial findings in the present study by measuring neuropeptide Y concentrations in frontal cortices from natural or accidental death control subjects and from suicide victims in whom a firm diagnosis of major depression was established by psychiatric autopsy. Because several subjects with major depression had a comorbid diagnosis of alcoholism, a group of victims of suicide that had an Axis I diagnosis of alcohol dependence was also studied. No significant differences in neuropeptide Y concentrations were observed between control subjects and victims of suicide with major depression or victims of suicide with alcohol dependence. These findings do not support a role for neuropeptide Y in major depression.     

Suicide and depression in childhood and adolescence

Suicide and depression in children and adolescents are reviewed. The true incidence of suicide in the pediatric population is not known because of under-reporting; suicide is, however, considered as a leading cause of death in this age group. Suicide in young children often reflects an immature comprehension of the state of death, combined with a wish to alter an intolerable living situation or to punish individuals significant in his environment. At age 14 the incidence of suicide increases markedly. These acts of self-destruction reflect a developmental process that follows puberty. During this period the youth experiences an impoverishment of values and controls, as well as an intensification of emotions and needs, resulting in extreme disequilibrium. In the late adolescent, as in the adult, suicide occurs commonly in response to real or imagined loss. Specific guidelines are set out for the assessment and management of the depressed and suicidal youth. Community and medical measures of a prophylactic nature are recommended in the belief that the rising incidence of suicide can be halted through an intensification of efforts on the part of the medical profession.     

Suicidal Ideation and Suicide Attempts in Anxious or Depressed Family Caregivers of Patients with Cancer: A Nationwide Survey in Korea

Purpose

To describe the prevalence of suicidal ideation and suicide attempts in family caregivers (FCs) of patients with cancer and to identify the factors associated with suicidal ideation and suicide attempts in FCs with anxiety or depression.

Methods

A national, multicenter survey administered to 897 FCs asked questions concerning suicidal ideation and suicide attempts during the previous year and assessed anxiety, depression, socio–demographic factors, caregiving burden, patient factors, and quality of life (QOL).

Results

A total of 17.7% FCs reported suicidal ideation, and 2.8% had attempted suicide during the previous year. Among FCs with anxiety, 31.9% had suicidal ideation and 4.7% attempted suicide; the corresponding values for FCs with depression were 20.4% and 3.3%, respectively. Compared with FCs without anxiety and depression, FCs with anxiety or depression showed a higher adjusted odds ratios (aOR) for suicidal ideation (aOR  = 4.07 and 1.93, respectively) and attempts (OR  = 3.00 and 2.43, respectively). Among FCs with anxiety or depression, being female, unmarried, unemployed during caregiving, and having a low QOL were associated with increased odds of suicidal ideation. FCs with anxiety who became unemployed during caregiving constituted a high-risk group for suicide. Being unmarried and having a low QOL with respect to financial matters were associated with increased suicide attempts among FCs with depression.

Conclusion

FCs with anxiety or depression were at high risk of suicide. Interventions to enhance social support and to improve perceived QOL may help prevent suicide and manage suicidal ideation in FCs with anxiety or depression.     

Association between suicide attempts and selective serotonin reuptake inhibitors: systematic review of randomised controlled trials

Objective To establish whether an association exists between use of selective serotonin reuptake inhibitors (SSRIs) and suicide attempts.Design Systematic review of randomised controlled trials.Data sources Medline and the Cochrane Collaboration''s register of controlled trials (November 2004) for trials produced by the Cochrane depression, anxiety, and neurosis group.Selection of studies Studies had to be randomised controlled trials comparing an SSRI with either placebo or an active non-SSRI control. We included clinical trials that evaluated SSRIs for any clinical condition. We excluded abstracts, crossover trials, and all trials whose follow up was less than one week.Results Seven hundred and two trials met our inclusion criteria. A significant increase in the odds of suicide attempts (odds ratio 2.28, 95% confidence 1.14 to 4.55, number needed to treat to harm 684) was observed for patients receiving SSRIs compared with placebo. An increase in the odds ratio of suicide attempts was also observed in comparing SSRIs with therapeutic interventions other than tricyclic antidepressants (1.94, 1.06 to 3.57, 239). In the pooled analysis of SSRIs versus tricyclic antidepressants, we did not detect a difference in the odds ratio of suicide attempts (0.88, 0.54 to 1.42).Discussion Our systematic review, which included a total of 87 650 patients, documented an association between suicide attempts and the use of SSRIs. We also observed several major methodological limitations in the published trials. A more accurate estimation of risks of suicide could be garnered from investigators fully disclosing all events.     

Severe Depressive Mood Changes Following Slow-release Intramuscular Fluphenazine Injection

Sixteen patients in whom schizophrenia was initially diagnosed and who were treated with fluphenazine enanthate or decanoate developed severe depression for a short period after the injection. In five cases this depression is thought to have been responsible for suicide. In 8 out of 10 cases the depression responded to electroplexy (E.C.T.). It is recommended that patients who are treated with fluphenazine should be carefully supervised.     

Association between body mass index and suicide,and suicide attempt among british adults: The health improvement network database

Objective:

To examine the associations between body mass index (BMI) and incidence rate (IR) of suicide attempt and suicide.

Design and Methods:

849,434 British adults were identified from The Health Improvement Network (THIN) database between January 2000 and October 2007. BMI was categorized into six levels: <18.5 (underweight), 18.5‐24.9 (normal weight), 25.0‐29.9 (overweight), 30.0‐34.9, 35.0‐39.9, and ≥40 (obese levels I‐III).

Results:

We identified 3,111 suicide attempts by Read codes and 75 suicides with medical records. The overall IR of suicide attempt was 82.2 cases per 100,000 person‐years. The IR decreased with BMI in men with depression (471.3‐166.0 cases per 100,000 person‐years, P for trend = 0.02) and in men without depression (241.5‐58.0 cases per 100,000 person‐years, P for trend < 0.0001). In women with depression, an L‐shaped relationship was observed, that is, a higher rate in underweight group when compared with reference group (503.2 vs. 282.7 per 100,000 person‐years) and no significant differences in others (231.8‐195.5 cases per 100,000 person‐years). In women without depression, the IR was U‐shaped with BMI (125.2 in underweight, 68.6 in reference, and 48.5‐79.9 cases in overweight and obese I‐III groups per 100,000 person‐years, P for trend < 0.0001). The above trends remained after adjustment for the covariates. Regarding suicide, the overall IR was 2.0 cases per 100,000 person‐years, which tended to decrease with BMI (P = 0.14).

Conclusions:

We concluded an inverse linear association between BMI and suicide attempt among men, an L‐shaped association in nondepressive women, and a U‐shaped association in depressive women were observed. The study also suggested an inverse linear tendency between BMI and suicide.