抑郁症综述ppt课件

,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,单击此处编辑母版标题样式,单击此处编辑母版文本样式,第二级,第三级,第四级,第五级,*,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*,Click to edit Master title style, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,Click to edit Master title style,Click to edit Master text styles,Second level,Third level,Fourth level,Fifth level,*, Logo,抑郁症,果雷红,抑郁症 果雷红, Logo,临床表现,焦虑,精神运动迟滞或激越,自责自罪,精神病症状,自杀观念及行为,认知症状,心理症状群, Logo临床表现焦虑,临床表现,运动迟滞,睡眠紊乱,晨重夜轻,精力丧失,食欲紊乱,性功能减退,躯体症状群,临床表现运动迟滞睡眠紊乱晨重夜轻精力丧失食欲紊乱性功能减退躯,分类,重 轻性 性抑 抑郁 郁症 症,双相,I,型,/,双相,II,型障碍,经,前,期,心,境,恶,劣,障,碍,季,节,性,情,感,障,碍,分类重 轻性 性抑 抑郁 郁症 症双相I型/双相I,分类,1.重性抑郁症/轻性抑郁症,（,1）重性抑郁症,DSM-III概念:完全发作的抑郁症,ICD-10分轻、中、重三型。,（2）轻性抑郁症,常指恶劣心境和环性心境障碍；,DSM-IV:症状不符合重性抑郁症、病程不符合恶劣心境，持续时间超过2周。,分类1.重性抑郁症/轻性抑郁症,分类,2.经前期心境恶劣障碍,发生率210%；,情感症状：情绪不稳、焦虑、兴趣下降、,易疲劳、注意不集中、进食和睡眠障碍；,躯体症状：乳房涨痛、水肿和头痛；,症状在月经开始或结束时缓解，多数周期出现，每个周期中至少1周无症状；,治疗：妊激素补偿。,分类2.经前期心境恶劣障碍,分类,3.季节性情感障碍,反复发生于某个季节，主要是冬季；,A.连续3年或更长时间，产生3次或更多的心境障碍发作，每年起病于相同的90天内；,B.缓解也发生于每年特定的90天内；,C.季节性发作次数显著多于非季节性发作；,季节性抑郁多见，北欧国家；,与冬季日照时间显著缩短有关；,分类3.季节性情感障碍,分类,4.双相I型/双相II型障碍,（1）双相I型障碍：,躁狂、重性抑郁发作；,躁狂非药物所致；,（2）双相II型障碍：,A.1次或多次抑郁发作；,B.1次或多次轻躁狂发作；,C.无躁狂发作。,分类4.双相I型/双相II型障碍,抑郁症的治疗,抗抑郁药治疗；,心理治疗；,ECT,抑郁症的治疗抗抑郁药治疗；,药物治疗,一线抗抑郁药物:,氟西汀,帕罗西汀,舍曲林,氟伏沙明,西酞普兰,药物治疗一线抗抑郁药物:,抑郁症的维持治疗,（,1,）首次发作的抑郁症,急性期治疗：,46,周；,巩固期治疗：,36,个月；,维持期治疗：,69,个月；,（,2,）治疗期间抑郁症再次发作：,维持期治疗：,23,年；,（,3,）治疗期间发作,3,次或疗效不彻底：,维持期治疗：,5,年，或以上。,抑郁症的维持治疗（1）首次发作的抑郁症,抑郁症的病程和预后,抑郁症首次发作：,自然病程：,613,个月；,2,年,20%,；,复发：第,1,年,1/3,；,5,年,50%,；,慢性：,1/4,，持续,5,年缓解,15%,；,慢性中,10%,终身不能完全缓解；,抑郁症的结局与没有出现药物治疗前相似，累积复发率高、缓解不完全。,抑郁症的病程和预后抑郁症首次发作：,自杀死亡率：,不同国家、地区、人群中差别较大,(高者30/10万左右，低者的5/10万以下）,我国：19.85/10万（19911995，疾病监测）,22.2/10万（1993，精神疾病流调）,城乡差异：很多国家城市高于农村,我国农村多高于城市,自杀死亡率：,性别：多数国家男性高于女性,我国：农村女性高于男性,城市男女大致相等,自杀未遂者均为