Mikkelsen Rie Lambaek, Middelboe Thomas, Pisinger Charlotta, Stage Kurt Bjerregaard
Psychiatric Center Gentofte, Niels Andersens, Hellerup, Denmark.
Nord J Psychiatry. 2004;58(1):65-70. doi: 10.1080/08039480310000824.
A review of the literature revealed high comorbidity of chronic obstructive pulmonary disease (COPD) and states of anxiety and depression, indicative of excess, psychiatric morbidity in COPD. The existing studies point to a prevalence of clinical significant symptoms of depression and anxiety amounting to around 50%. The prevalence of panic disorder and major depression in COPD patients is correspondingly markedly increased compared to the general population. Pathogenetic mechanisms remain unclear but both psychological and organic factors seem to play a role. The clinical and social implications are severe and the concurrent psychiatric disorders may lead to increased morbidity and impaired quality of life. Furthermore, the risk of missing the proper diagnosis and treatment of a concurrent psychiatric complication is evident when COPD patients are treated in medical clinics. Until now only few intervention studies have been conducted, but results suggest that treatment of concurrent psychiatric disorder leads to improvement in the physical as well as the psychological state of the patient. Panic anxiety as well as generalized anxiety in COPD patients is most safely treated with newer antidepressants. Depression is treated with antidepressants according to usual clinical guidelines. There is a need for further intervention studies to determine the overall effect of antidepressants in the treatment of anxiety and depression in this group of patients.
文献综述显示，慢性阻塞性肺疾病（COPD）与焦虑和抑郁状态高度共病，表明COPD患者存在过多的精神疾病发病率。现有研究指出，临床上有显著抑郁和焦虑症状的患病率约为50%。与普通人群相比，COPD患者中惊恐障碍和重度抑郁症的患病率相应显著增加。发病机制尚不清楚，但心理和器质性因素似乎都起作用。临床和社会影响严重，并发的精神障碍可能导致发病率增加和生活质量受损。此外，在医疗诊所治疗COPD患者时，漏诊并发精神并发症并进行适当治疗的风险很明显。到目前为止，仅进行了少数干预研究，但结果表明，治疗并发的精神障碍可改善患者的身体和心理状态。COPD患者的惊恐焦虑和广泛性焦虑用新型抗抑郁药治疗最为安全。抑郁症根据常规临床指南用抗抑郁药治疗。需要进一步的干预研究来确定抗抑郁药对该组患者焦虑和抑郁治疗的总体效果。
