Akechi T, Okamura H, Nishiwaki Y, Uchitomi Y
Psycho-Oncology Division, National Cancer Center Research Institute East, Chiba, Japan.
Cancer. 2001 Nov 15;92(10):2609-22. doi: 10.1002/1097-0142(20011115)92:10<2609::aid-cncr1614>3.0.co;2-k.
Few longitudinal studies have investigated psychiatric disorders in patients with unresectable nonsmall cell lung carcinoma (NSCLC). This study addressed three questions: 1) Which psychiatric disorders are prevalent among patients with unresectable NSCLC? 2) What is the clinical course of psychological distress? 3) Which factors are associated with this distress, and do any antecedent variables predict subsequent psychological distress?
A series of 129 consecutive patients with newly diagnosed, unresectable NSCLC participated. Psychiatric assessments were conducted by using the Structured Clinical Interview for the Diagnostic and Statistical Manual of Mental Disorders, 3rd edition revised between the time of diagnosis and initial treatment for NSCLC (baseline) and 6 months after diagnosis (follow-up). Potential associated and predictive variables, including sociodemographic, biomedical, and psychosocial factors, were explored.
The most common psychiatric disorder at baseline was nicotine dependence (67%), followed by adjustment disorders (14%), alcohol dependence (13%), and major depression (5%). At follow-up, adjustment disorders were diagnosed in 16% of patients, and major depression was diagnosed in 3% of patients. Thirty-five percent of patients who experienced depressive disorders (adjustment disorders and/or major depression) at baseline continued to experience the same disorders at follow-up. Multivariate analysis revealed that relatively younger age and pain were associated significantly with psychological distress at baseline. Only self-reported anxiety and depression at baseline could predict subsequent psychological distress.
Substance dependence and depressive disorders are common psychiatric disorders in patients with unresectable NSCLC. Although this form of malignant disease often is progressive, depressive disorders do not seem to increase during its clinical course. Pain management is essential for alleviating patients' depressive disorders, and self-rating depression and anxiety seems to be an indicator of subsequent depressive disorders.
很少有纵向研究调查不可切除的非小细胞肺癌（NSCLC）患者的精神障碍。本研究解决了三个问题：1）不可切除的NSCLC患者中哪些精神障碍较为普遍？2）心理困扰的临床过程是怎样的？3）哪些因素与这种困扰相关，是否有任何先行变量可预测随后的心理困扰？
129例新诊断的、不可切除的NSCLC连续患者参与了研究。在NSCLC诊断至初始治疗期间（基线）以及诊断后6个月（随访），使用《精神障碍诊断与统计手册》第三版修订本的结构化临床访谈进行精神评估。探索了潜在的相关和预测变量，包括社会人口统计学、生物医学和心理社会因素。
基线时最常见的精神障碍是尼古丁依赖（67%），其次是适应障碍（14%）、酒精依赖（13%）和重度抑郁症（5%）。随访时，16%的患者被诊断为适应障碍，3%的患者被诊断为重度抑郁症。基线时经历抑郁障碍（适应障碍和/或重度抑郁症）的患者中有35%在随访时仍患有相同障碍。多变量分析显示，相对年轻的年龄和疼痛与基线时的心理困扰显著相关。只有基线时自我报告的焦虑和抑郁可预测随后的心理困扰。
物质依赖和抑郁障碍是不可切除的NSCLC患者中常见的精神障碍。尽管这种恶性疾病通常呈进行性发展，但抑郁障碍在其临床过程中似乎并未增加。疼痛管理对于减轻患者的抑郁障碍至关重要，自我评定的抑郁和焦虑似乎是随后抑郁障碍的一个指标。
