Health Worlds

First, the purpose and significance
1, the elderly often occurs nervous system diseases nervous system disease is also easily associated with comorbid depression or anxiety disorders
- Cerebrovascular Disease and Stroke- Epilepsy, mental patient, Nanfang Hospital, Southern Medical University, Hong Jun
- Primary headache
2, makes the disease, delayed healing of comorbidity significantly increased the burden of disease and rehabilitation results.2, nervous system disease with features of depression and anxiety disorders
3, neurological depression / anxiety somatization common performance
4, depression and anxiety status of the Preliminary Investigation and Identification
5, depression treatment goals
6, neurological treatment of depression and anxiety disorders
7, antidepressant drug-drug interactions1, the study reported post-stroke depression (PSD) variation of incidence and prevalence of large
2, studies suggest that 1 month after stroke is the peak incidence, but there are also studies that stroke is 3 to 6 months after the onset of the peak
3, the Community Research: PSD in the acute phase of stroke was 33%, 34% of chronic phase
4, hospital research: PSD in the acute phase of stroke was 36%, recovery was 32%, 34% of chronic phase
5, our study found, PSD at 1 month after stroke was 39%, 3 to 6 months was 53%, 24% 1 year
Cognitive impairment associated with depression and anxiety disorders
1, depression more common in pre-or e


arly dementia, a study that depression is a precursor of dementia symptoms or risk factors
2, depression, dementia, cerebrovascular disease were the conversion rate is 2 times of those without depression
3, dementia associated with the prevalence of depression in up to 75%, generally about 30% to 50%
4, VaD or VCI's depressive symptoms occur in approximately 40% to 60%
5, cerebrovascular disease prevalence rate of depression is about 26% cumulative
Parkinson's disease (PD) with depression and anxiety disorders
1, PD patients with depression prevalence rate of 8% to 76%, an average of 25% to 40%
2, about 40% of patients with anxiety disorders
3, research suggests that depression and anxiety disorders may precede the onset of symptoms in patients with movement
Multiple sclerosis (MS) with depression and anxiety disorders
1, the lifetime prevalence rate of nearly 50%, which is 3 times the general population
2, Community Survey found that 41% of patients with depression, of which 29% were moderate - severe depression
3, on 3000 patients over the age of 16 MS patients causes of death survey, 15% of patients die from suicide
4, epidemiological survey showed that 35.7% of patients with a variety of anxiety, of which 18.6% generalized anxiety, panic attack 10%
Epilepsy with depression and anxiety disorders
1, the prevalence of depression was 50% to 55%
2, hospitalized patients, the control well, 10% incidence of depression, the prevalence was 20%, who were poorly controlled, and 6O% 2O%
3, epilepsy patients with interictal anxiety disorder prevalence rate of 10% to 25%
Primary headache disorder with depression and anxiety
1, the primary headache clinic patients found that 27% of the patients had moderate - severe depression, which was 17.1% among migraine, transformed migraine was 36.1%, tension-type headache (TTH) was 28.3%;
2, migraine patients with depression lifetime prevalence rate of about 30% to 80%, which is 3-4 times the general population. At the same time, tend to have anxiety disorders such as panic and forced;
3, migraine with aura and migraine into those associated with a higher rate. Frequency of depression onset and chronic TTH incidence of anxiety disorders with up to 2 / 3;
4, juvenile chronic headache survey, depression 30% (21% depression), anxiety disorders 36%, a high suicide risk by 20%
Epidemiological Implications
1, cerebrovascular disease and stroke, cognitive impairment, Parkinson's disease, multiple sclerosis, epilepsy, primary headache associated with a high proportion of depression and anxiety, the treatment of related diseases in more complex and difficult to extend the duration of disease, while increasing burden of disease;
2, therefore, it is necessary neurological depression and anxiety commonly associated with identification and treatment of patients.1, depression - to various causes significant and persistent low mood for the main features of a class of mood or affective disorder;
2, anxiety disorders - a nervous heart, had a premonition that something seemed to occur and more difficult to cope with adverse situations unpleasant emotions;
3, the consensus that depression and anxiety, depression and anxiety disorders
a) the severity of moderate or more than patients can afford, or self-adjustment capability, and its impact on life and social function, but not necessarily reach or meet the specific psychiatric disorders in the diagnostic criteria.
4, the study found a number of neurological diseases caused by changes in neural structure and function, and affective disorders occur in the natural course of change in similar, depression and anxiety can produce a similar performance.
5, which explains the high incidence of nervous system disease status of depression and anxiety disorders
Three The main clinical manifestations of depression- Interest waned, a pleasant sense of loss, continuous fatigue2 physical symptoms: aches and pains, loss of appetite, gastrointestinal symptoms
3 symptoms of anxiety or agitation
4 memory loss, inability to concentrate attention
The main clinical manifestations of anxiety disorders
1, excessive anxiety
- Anxiety: Often, no reason at all upset
- Nervous: often feel nervous and can not relax
2, excessive worry
- Always feel uneasy, over-worry about the little things
D stroke anxiety disorder with depressive features
PSD Although common, but patients often have aphasia, cognitive impairment and not be ignored or tell or identification
1, the studies suggest that PSD is a direct result of brain damage, and prompted the front of the dominant hemisphere and the hemisphere more prone to damage PSD, but no part of correlation analysis
2, "vascular depression" is an important cause of depression in old age, accounting for about 1 / 3, with the frontal lobe and the bottom section of the main parts of the white matter lesions, vascular lesions and the "silent stroke" on
Dementia associated with the characteristics of depression and anxiety disorders
1, the SVD of subcortical VaD or VCI depression in patients with long duration, refractory. Outstanding performance: poor initiating, psychomotor retardation and easy with executive dysfunction
2, AD of depression associated with prolonged course with obstacles to the decreasing trend1, the common psychomotor retardation, apathy, lack of interest, reduction of body language, autonomic nervous symptoms easily confused with depression
2, common insomnia, poor attention, fatigue, tremor, anxiety and autonomic symptoms of anxiety and confusion and easy. Excessive worry may be an important differential point
3, PD patients may have significant emotional upheaval, sustained a few minutes several times a day. The treatment of patients with advanced "switch" phenomenon, depression, anxiety, making diagnosis difficult.
MS and epilepsy with the characteristics of depression and anxiety disorders
MS patients with depression may be related to lesion location (frontal, temporal lobe) and inflammation
1, psychomotor retardation, sleep disorders, cognitive changes and fatigue are common to the performance of MS and depression
2, depression more common in relapse and during treatment with hormone
The relationship between depression and epilepsy is two-way, multiple and complex causes
1, for epileptic seizures and depression after the onset of performance, but more found in interictal period.
2, the left temporal lobe epilepsy and epileptic foci are prone to depression.- The main reference for the more common sleep problems, fatigue, body pain and uncertain position
- Easy and nervous system symptoms of primary disease interaction, attention to differential2, dizziness6, limb or joint pain9, abdominal painV depression and anxiety state identification and diagnosis
1, asking if the following emotional symptoms:2 asked whether the following physical symptoms: 6, memory loss, inability to concentrate
7 appetite and body weight
8 palpitation, shortness of breath, sweating
9, asked whether the concept of suicide
a) low self-esteem and self-blame, suicidal ideas, etc.
Third, the volume of the table should be used2, his rating scale:Note that scale score merely reflects the severity of clinical symptoms, diagnosis, diagnostic criteria still need to refer to the relevant- Non-psychiatric physicians generally give symptomatology or syndrome diagnosis, do not advocate jumping to the diagnosis of psychiatric disorders
Depression, anxiety disorders diagnosed according to the Chinese Classification and Diagnostic Criteria of Mental Disorders Version 3 (CCMD-3), or DSM-IV
Nervous system disease with depression and anxiety disorder treatment goals
1, to relieve symptoms and achieve clinical cure (Remission)
2 and improve the quality of life
3, recovery of social function
4, prevention of recurrence1, the acute phase: positive control symptoms, as far as possible to achieve clinical cure, treatment for 6 to 8 weeks. 4 to 8 weeks if the treatment is invalid, the mechanism should switch to other drugs.
2, the consolidation phase: the maintenance of effective drug dose acute phase, continuous treatment for 4 to 6 months.
3, maintenance treatment: the first issue of the maintenance treatment of 6 to 8 months, if necessary, as appropriate,1, note that the treatment of anxiety antidepressant treatment to avoid conflict with the primary disease or conflict
2, medication at the same time, attention to psychological treatment (explained, cognitive therapy, etc.) and family and social support
Three neurological drug treatment of depression and anxiety disorders- First-line antidepressants, the clinical cure rate is high
- Adaptation: all types of depressive disorder, depression with anxiety, severe, refractory depression is effective- Ban and MAOIs, other combination of 5-HT
3, NaSSA
1, mechanism of action: increase NTH and 5-HT transmission, block 5-HT2, 5-HT3 receptor antagonist adrenergic neuron synaptic a2 - receptor;
2, adaptation: depression with anxiety, agitation or insomnia in patients
3, rapid onset: 1 to 2 weeks
4, on behalf of Drug: Mirtazapine
4, adverse reactions
1, excessive sedation, weight gain, etc.
5, in addition to outside AD, PD, stroke, epilepsy and cognitive impairment in MS and other often. Treatment of the anxiety associated with depression should avoid the use of TCAs significantly affect cognitive function and other drugs, SSRI and SNRI should select drugs
6, stroke and cerebrovascular disease are associated with depressive disorders are persistent and refractory characteristics, treatment course should be long.
7, more evidence that the TCAs and the role of antidepressants in the dual-channel can be effective in preventing migraine and tension-type headache, but little evidence of other antidepressants
Total Results
1, nervous system disease with a high proportion of depression and anxiety
2, the treatment of depression and anxiety can3, depression / anxiety treatment goal is complete elimination of symptoms, to achieve clinical cure



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