Depression and anxiety in individuals with amyotrophic lateral sclerosis -: Epidemiology and management
Depression and anxiety in individuals with amyotrophic lateral sclerosis -: Epidemiology and management
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DOI：
10.2165/00023210-200721040-00003
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发表时间：
2007-01-01
期刊：
影响因子：
6
通讯作者：
Kuebler, Andrea
中科院分区：
文献类型：
--
作者：
Kurt, Anja;Nijboer, Femke;Kuebler, Andrea
肌萎缩性侧索硬化症（ALS）是一种致命的运动神经元疾病，无法治愈。考虑到这种疾病的破坏性，受影响的患者抑郁和焦虑的发生率很高是可以预料的。文献综述显示，ALS患者的抑郁症患病率从0%到44%不等，但根据DSM-IV标准使用结构化访谈的研究发现，这一比例高度一致，为9-11%。ALS患者的焦虑患病率从0%到30%不等。抑郁和焦虑似乎并不总是恰当地解决ALS的方面，因为只有少数参考文献关于心理和药物干预。此外，抗抑郁药物治疗通常没有持续监测，其有效性仍未得到评估。回顾文献和我们自己的经验表明，缺乏心理护理，据我们所知，没有针对ALS患者的具体心理干预方法。关于ALS患者抑郁症的药物治疗，临床专家普遍认为SSRIs和TCAs有帮助，但目前还没有这些药物在ALS患者中的对照临床研究。如果治疗假性嗜睡或失眠同时需要抗胆碱能作用，则可以开TCAs。焦虑通常用抗焦虑药来治疗，但同样没有关于这些药物在ALS患者中的系统研究。对于心理干预，我们建议采用认知行为方法，该方法必须整合到干预计划中，包括教授适当的应对策略和重新评估技能，并鼓励参与仍然可行和愉快的活动。我们建议抑郁症和焦虑症的治疗应该包括认知行为疗法和药物干预。应严格监测药物治疗的有效性。到目前为止，没有临床试验可以让我们推荐药物治疗而不是心理治疗，反之亦然；然而，来自其他患者群体的证据，如被诊断为重度抑郁症的老年患者，表明两种疗法的结合也有可能改善als患者的抑郁和焦虑
Amyotrophic lateral sclerosis (ALS) is a fatal motor neuron disease with no curative treatment. Considering the devastating nature of the disease, a high prevalence of depression and anxiety in affected patients would be expected. A review of the literature shows prevalence rates for depression in ALS patients ranging from 0% to 44%, but studies using the structured interview according to DSM-IV criteria find highly consistent rates of 9-11%. Prevalence rates for anxiety in ALS range from 0% to 30%. Depression and anxiety appear to be not always properly addressed aspects of ALS, as there are only a few references in the literature about psychological and pharmacological interventions. Additionally, pharmacological antidepressant therapy is often not continuously monitored and its effectiveness remains unevaluated. A review of the literature and our own experiences show that there is a lack of psychological care and, to our knowledge, there is no specific psychological intervention method for ALS patients. Concerning pharmacological treatment of depression in patients with ALS, there is broad consensus among clinical experts that SSRIs and TCAs are helpful, but there have been no controlled clinical studies of these medications in ALS patients. TCAs can be prescribed if anticholinergic effects are desired simultaneously for treating pseudohypersalivation or insomnia. Anxiety is usually treated with anxiolytics, but again there have been no systematic studies of these drugs in patients with ALS. For psychological intervention we suggest a cognitive behavioural approach, which has to be integrated into an intervention programme that includes teaching of appropriate coping strategies and reappraisal skills and encourages engagement in activities that are still practicable and pleasant. We propose that the treatment of depression and anxiety should involve both cognitive behavioural therapy and pharmacological intervention. Pharmacological treatment should be strictly monitored for effectiveness. To date, no clinical trials are available that would allow us to recommend pharmacotherapy over psychotherapy or vice versa; however, evidence from other patient groups, such as elderly patients diagnosed with major depressive disorder, suggests that a combination of both therapies has the potential to also improve depression and anxiety in patients with ALS.-