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产生抑郁的主要原因多涉及认知扭曲、生活中缺少令人愉快的事、人际间关系等问题,它从多方面影响冠心病发生、发展。
抗抑郁药物治疗、心理社会干预以及运动疗法是冠心病合并抑郁症的主要治疗方法。
S ADHART和E NR I CHD试验是目前针对冠心病合并抑郁患者进行药物及非药物治疗的最客观、权威的研究。
关键词: 冠心病;抑郁症Abstract: M aj or dep ressi on has a cl ose ass ociati on with cor onary heart disease,and is regarded as another i m portant risk fact or of is2 che m ic heart disease.The maj or reas ons f or dep ressi on have cognitive dist orti ons,inter pers onal p r oble m s and l ow rates of leisure activities. It affects the generati on and devel opment of cor onary heart disease in many ways.Phar macol ogical treat m ent f or dep ressi on,p sychol ogical in2 terventi on and exercise therapy are maj or for m s of therapy f or cor onary heart disease with maj or dep ressi on.Key words: cor onary heart disease;maj or dep ressi on 抑郁症是一种常见的心理/精神疾患,在普通人群中有较高的发病率。
大量研究表明,抑郁症与冠心病之间存在密切联系,并被认为是心血管系统尤其是缺血性心脏病的另一种重要危险因素。
近年来,人们对冠心病的传统危险因素(如吸烟、缺乏体力活动、高血压、高血脂、高血糖等)日益重视,并采取了多种药物/3通讯作者:郭艺芳非药物手段进行干预,在很大程度上改善了冠心病的防治水平,但对于防治抑郁症在冠心病一、二级预防中的重要性尚未引起足够重视。
充分重视冠心病患者的心理健康状况,早期识别、积极干预冠心病患者所伴发的抑郁症,对于进一步提高冠心病的防治水平具有重要意义。
1 抑郁症对冠心病患者预后的影响研究表明,对于急性冠状动脉综合征(ACS)康复期的患者,不仅精神障碍史与其不良预后密切相关,而且轻微的抑郁症状,比如Beck抑郁量表(BD I)评分≥10分,也提示预后不良。
急性心肌梗死时伴发的抑郁症状和死亡率之间存在线性关系[123]。
然而,轻微和严重的抑郁症状对患者预后的影响又有所不同。
Les pérance等[4]研究显示抑郁症状的改善仅对BD I评分10～13分即轻微抑郁患者的预后(5年心脏病复发率、心源性和非心源性死亡率)是独立的影响因素。
在此类患者中,抑郁症状改善越明显,长期预后越好。