A prospective study of psychiatric and psychological aspects of Cushing's syndrome
A prospective study of psychiatric and psychological aspects of Cushing's syndrome
复制标题
DOI：
10.1046/j.1365-2265.1996.8690878.x
复制
发表时间：
1996-12-01
影响因子：
3.2
通讯作者：
Faragher, B
中科院分区：
文献类型：
--
作者：
Kelly, WF;Kelly, MJ;Faragher, B
目的：库欣综合征是一种伴有精神和心理障碍的疾病。本研究的目的是确定精神疾病的程度，在治疗前和治疗后的库欣综合征。设计和患者与库欣综合征患者被确定为一项前瞻性研究。对照组选择分泌GH或PRL的垂体腺瘤。其目的是重新评估患者后，库欣综合征已treated. MEASURENTS精神症状进行了测量和分类，使用目前的状态检查（PSE），并分析了Catego程序。采用汉密尔顿评定量表（HRS）测量抑郁。Crown-Crisp体验指数用于测量常见的精神神经症状（焦虑、恐惧症、强迫症、躯体、抑郁和歇斯底里量表）。艾森克人格量表被用来评估外向性和神经质。皮质醇、促肾上腺皮质激素和其他激素通过常规方法测量。参数和非参数测试，在适当的。结果Catego分析的精神评级显示，只有8例43例活动性库欣综合征（19%）是正常的。精神科诊断如下：20例（46%）神经症性抑郁症，1例（2%）可能神经症性抑郁症，6例（14%）反应性抑郁症，8例（19%）非特异性神经症症状。对3名同时患有抑郁症的患者进行了其他疑似精神病的Catego评分。这43例活动性库欣综合征患者中没有一个有精神分裂症或躁狂症、强迫性神经症或病理性焦虑的评级。对照组13例（87%）正常，1例肢端肥大症患者有焦虑状态，1例泌乳素瘤患者有神经症性抑郁，25例患者治疗后皮质醇水平显著降低，可重新评估现状检查（88%恢复正常），精神病学正常的百分比从19增加到68（卡方（2）= 11.7，1 d.f.，P < 0.01）。库欣综合征治疗后，抑郁的汉密尔顿量表评分显示显著改善（平均从9.2降至2.4，n = 36，P < 0.001）。Crown-Crisp经验指数数据显示焦虑、躯体症状和抑郁症状明显改善（n = 25，P < 0.05）。艾森克人格量表评估显示，神经质评分显着改善（n = 26 P = 0.016），但没有显着变化的外向性（P = 0.5）或谎言得分（P = 0.6）。结论大多数库欣综合征患者有显着的精神病理，通常是抑郁症。当皮质醇水平恢复正常时，抑郁和焦虑的分数有了显着的改善。对库欣综合征患者的管理应包括对心理和精神疾病的仔细评估。
OBJECTIVE Cushing's syndrome is associated with psychiatric and psychological disturbances. The aim of this study was to ascertain the extent of mental illness in patients before and after treatment for Cushing's syndrome.DESIGN AND PATIENTS Patients with Cushing's syndrome were identified for a prospective study. Control patients were selected with pituitary adenomas secreting GH or PRL. The aim was to reassess patients after Cushing's syndrome had been treated.MEASUREMENTS Psychiatric symptoms were measured and classified using the Present State Examination (PSE), and analysed on the Catego Programme. The Hamilton Rating Scale (HRS) was used to measure depression. The Crown-Crisp Experiential Index was used to measure common psychoneurotic symptoms (anxiety, phobia, obsession, somatic, depression and hysteria scales). The Eysenck Personality Inventory was used to assess extroversion and neuroticism. Cortisol, ACTH, and other hormones were measured by conventional methods. Parametric and non-parametric tests were used where appropriate.RESULTS Catego analysis of psychiatric ratings showed only 8 patients of 43 with active Cushing's syndrome (19%) were normal. Psychiatric diagnoses were obtained as follows: neurotic depression in 20 (46%), possible neurotic depression in 1 (2%), reactive depression in 6 (14%), and non-specific neurotic symptoms in 8 (19%). Additional Catego ratings of suspected other psychoses were made for 3 patients who were also depressed. None of these 43 patients with active Cushing's syndrome had ratings of schizophrenia or mania, obsessional neurosis or pathological anxiety. In the control group 13 (87%) were normal, 1 patient with acromegaly had an anxiety state and one patient with a prolactinoma had neurotic depression.It was possible to reassess the Present State Examination after treatment in 25 patients, when cortisol levels had been substantially reduced (to normal in 88%), the percentage rated as psychiatrically normal increased from 19 to 68 (chi(2) = 11.7, 1 d.f., P < 0.01). Hamilton Rating Scale scores for depression showed significant improvements after treatment for Cushing's syndrome (mean decrease from 9.2 to 2.4, n = 36, P < 0.001). Crown-Crisp experiential index data showed significant improvements in anxiety, somatic symptoms, and depression (n = 25, P < 0.05). Eysenck Personality Inventory assessments showed a significant improvement in neuroticism score (n = 26 P = 0.016), but no significant change in extroversion (P = 0.5) or lie score (P = 0.6).CONCLUSIONS Most patients with Cushing's syndrome had significant psychiatric pathology, usually depressive illness. As cortisol levels were returned to normal there were significant improvements in scores for depression and anxiety. Management of patients with Cushing's syndrome should include careful assessment of psychological and psychiatric illness.