Strik Jacqueline J, van Praag Herman M, Honig Adriaan
Afdeling Psychiatrie Academisch Ziekenhuis Maastricht.
Tijdschr Gerontol Geriatr. 2003 Jun;34(3):104-12.
In these studies patients with first myocardial infarction (MI) were selected for studies focusing on epidemiology, risk factors and treatment of depression post-MI. Two consecutive cohorts of first MI patients were included. The first cohort was selected between May 1994 and May 1997 (n = 206), and the second between May 1997 and October 1999 (n = 206). All patients were screened every 3 months for depression using the SCL-90 and the Zung (cohort 1) or SCL-90, BDI and HADS (cohort 2) until 12 months post-MI. Patients scoring above the cut-off of one of the questionnaires were interviewed using a standardised interview in order to evaluate whether DSM-IV criteria for major depression were met; patients of the second cohort were also interviewed 1 month post-MI, independently of the score of the questionnaires. Of both cohorts data concerning major cardiac events and increased health care consumption were assessed during a 1 to 6 years follow-up period. Patients with major depression were offered treatment in the double-blind placebo-controlled trial with fluoxetine (n = 54). Depression appeared to be a predictor of increased health care consumption, but not of major cardiac events such as cardiac death and recurrent infarction in first myocardial infarction (MI) patients up to 6 years post-MI. This finding is in contrast to findings in the literature indicating that in patient populations with mixed first and recurrent MI, depression is a risk factor for cardiac mortality. In contrast to depression, symptoms of anxiety do predict cardiac mortality and recurrent MI in patients following first MI independently of other risk factors of cardiac mortality. Recognition of risk factors for post-MI depression may help the cardiologist to identify patients at risk for depression. Examples of such risk factors are, according to our studies, complications during admission, such as arrhythmic disorders and recurrent angina pectoris, and prescription of benzodiazepines. Patients at risk can be screened for depression using a 4-item questionnaire, and, if scoring is positive, be referred for psychiatric evaluation. Although the effectivity of antidepressive treatment in MI patients has as yet not been proven, we found that fluoxetine is a cardiac-safe antidepressive agent, but only in mild depression more effective than placebo. The positive effect of antidepressive treatment on cardiac prognosis has as yet not been shown.
在这些研究中，首次心肌梗死（MI）患者被选入聚焦于MI后抑郁症流行病学、危险因素及治疗的研究。纳入了两个连续队列的首次MI患者。第一个队列在1994年5月至1997年5月间选取（n = 206），第二个队列在1997年5月至1999年10月间选取（n = 206）。所有患者在MI后12个月内每3个月使用症状自评量表90（SCL - 90）和zung量表（队列1）或SCL - 90、贝克抑郁量表（BDI）及医院焦虑抑郁量表（HADS）（队列2）筛查抑郁症。对在任一问卷中得分高于临界值的患者进行标准化访谈，以评估是否符合DSM - IV中重度抑郁症的标准；队列2的患者在MI后1个月也接受访谈，与问卷得分无关。在1至6年的随访期内评估两个队列中有关主要心脏事件及医疗保健消耗增加的数据。重度抑郁症患者被纳入氟西汀双盲安慰剂对照试验（n = 54）。抑郁症似乎是医疗保健消耗增加的一个预测因素，但在首次心肌梗死（MI）患者MI后长达6年的时间里，并非主要心脏事件如心源性死亡和再发梗死的预测因素。这一发现与文献中的发现相反，文献表明在首次和再发MI混合的患者群体中，抑郁症是心脏死亡的一个危险因素。与抑郁症不同，焦虑症状确实可独立于心脏死亡的其他危险因素预测首次MI后患者的心脏死亡和再发MI。识别MI后抑郁症的危险因素可能有助于心脏病专家识别有抑郁症风险的患者。根据我们的研究，此类危险因素的例子包括入院期间的并发症，如心律失常和复发性心绞痛，以及苯二氮䓬类药物的处方。有风险的患者可以使用一个4项问卷筛查抑郁症，如果得分呈阳性，则转诊进行精神科评估。虽然抗抑郁治疗在MI患者中的有效性尚未得到证实，但我们发现氟西汀是一种心脏安全性良好的抗抑郁药，但仅在轻度抑郁症中比安慰剂更有效。抗抑郁治疗对心脏预后的积极作用尚未显现。
