心身疾病的诊断与治疗-1.pptVIP

焦虑抑郁共病 共病指一段时间内同一病人患有两种或两种以上的疾病。但目前许多学者把症状或综合症的重叠也当作共病。 焦虑抑郁共病即患者同时患有焦虑障碍和抑郁障碍，对两组症状独立考虑时均符合相应的诊断标准 焦虑障碍与抑郁症共病显著 使临床表现更为复杂，躯体症状多，反复就医检查，消耗大量的卫生资源 常伴有疑病症状；多数患者在表现出悲观、消沉、疲乏、无能的同时，伴有较明显的忧虑、不安，恐惧，伤感，疑惑等，容易患得患失，反复多虑 共病现象多为慢性病程，反复发作，增加疾病的严重性，自杀危险性升高 焦虑抑郁共病的特点 导致患者的各方面症状加重，治疗困难，预后差，容易转为慢性，功能损害更明显 往往年龄偏大，药物治疗显效较晚。 患者同时在医院的各科就诊。容易产生医源性心理负担；多种药物合并，容易产生药物间的相互干扰，造成耐受和依赖 治疗依从性差；经常比较医生间的诊断与处方药物的差异，擅自改变药物剂量、用法或停药 抑郁和焦虑的共病形式 一个疾病谱的两个极端,其中间是不同程度的共病 抑郁症的药物治疗 1.单胺氧化酶抑制剂：吗氯贝胺 2.杂环类抗抑郁药: 阿米替林 丙咪嗪 多虑平 3.选择性5-HT再摄取抑制剂 氟西汀 氟伏沙明 舍曲林 帕罗西汀 西酞普兰 4.选择性5-HT和及NE再摄取抑制剂 文拉法辛 度洛西汀 5. NE 及特异性5-HT能抗抑郁药: 米氮平 6.选择性NE再摄取抑制剂 ： 瑞波西丁 7. 5-HT平衡抗抑郁药;曲唑酮 8.其他：氟哌噻吨美利曲新 * CNS serotonergic pathways incorporate serotonergic neurons with cell bodies in the upper pons and the midbrain—specifically, the median and dorsal raphé nuclei, caudal locus ceruleus, area postrema, and interpeduncular area. Serotonergic neurons in the brain also project down the spinal cord and modulate the transmission of sensory pain input. These spinal cord tracts are thought to be the site of action for serotonergic antidepressants that have been used to control pain. The largest grouping of noradrenergic neurons occurs in the locus ceruleus of the pons. Projections of the noradrenergic system reach many areas in the forebrain, the cerebellum, and the spinal cord. Norepinephrine is secreted in response to physical and psychological stressors and modulates various brain functions. Serotonin and norepinephrine influence a wide variety of brain functions, including mood, sleep, cognition, regulation of the sympathetic nervous system, sensory perception, temperature regulation, nociception (eg, migraine headache), appetite, and sexual behavior. Frazer A. Norepinephrine involvement in antidepressant action. J Clin Psychiatry 2000; 61 (Suppl 10): 25-30. Hardman JG, et al. Goodman Gilman’s The Pharmacological Basis of Therapeutics. 9th ed. 1996. Kaplan HI, Sadock BJ. Synopsis of Psychiatry: Behavioral Sciences,