神经系统疾病伴发抑郁焦虑障碍的诊断治疗.ppt

* Stress is a well-known factor in inducing neural sensitization. This phenomenon been suggested as one mechanism for the common overlap of some psychiatric disorders with each other and the observed overlap with certain medical conditions with 焦虑 disorders. Sensitivity to somatic sx in anxious individuals has been hypothesized to be driven via a process referred to in the neurological literature as “kindling” (Weiss and Post,1998; Antelman, 1988), as is cross-sensitization to uncomfortable “psychic” sensations such as fear and 焦虑 and other stress-related conditions. Emerging evidence suggests that uncontrolled 焦虑 is not only exacerbated by stress, but also represents the equivalent of chronic stress ( McEwen, 2003) and in this way may contribute to the cumulative adverse effects of stress. Dysregulation of the hypothalamic-pituitary-adrenal ( HPA) axis is observed in chronic pathological stress conditions and , and severe forms of 焦虑 and depression has been reported to be associated with adverse effects on brain function. These conditions are associated with increased levels stress mediators such as pro-inflammatory cytokines and circulating catecholamines resulting from Dysregulated HPA axis function. These mediators are thought to play an important role in the adverse stress-related long-term health outcomes such as cardiovascular disease, hypertension, obesity, bone demineralization, type II diabetes and immune dysfunction. * * * 抑郁症全病程的治疗 残留症状表现为： 维持治疗的最终目的预防复发 这是著名的Kupfer图，演示了抑郁症从发作到治疗各个阶段的过程。正常人的HAM-D量表评分落在7分以。评分高至17分左右，显示抑郁发作。在急性治疗阶段（6-8周）的治疗目标不仅是使患者对药物或精神治疗有响应，即有效，而且，争取能达到临床治愈。对于慢性抑郁患者来说，也可能在急性期后获得临床治愈。 巩固治疗阶段（3个月左右）的治疗目标是保持持续的临床治愈，预防症状的波动，即复燃。维持治疗阶段（时间较长，因人而异，根据发作次数、疾病性质等不同）的目标是预防复发（即一次新的抑郁发作），并且能够维持长期临床治愈状态。获得初期的临床治愈并且维持巩固是预防复燃复发的最佳方法。 Source: Kupfer DJ. J Clin Psychiatry. 1991;52(suppl 5):28-34. Remission of symptoms is the goal of acute treatment; prevention of relapse and recurrence is the goal of continuation and maintenance treat