Clément Jean-Pierre
Pôle universitaire de psychiatrie du sujet âgé, Centre Hospitalier Esquirol, Limoges, France.
Psychol Neuropsychiatr Vieil. 2004 Sep;2 Suppl 1:S69-72.
Extensive research has been achieved on the old age depression during the last decades. Specific clinical features and management have been reported. Indirect clinical and behavioural indicators, and even biological ones should be considered for the detection of depression. Cognitive assessment must be promoted in standard practice to differentiate depression from incipient dementia, but also in depression occurring in long stay care, vascular depression and in the depression-executive dysfunction syndrome. Distinction between recurrent depressive episode and late-onset depression has to be clarified. Therapeutic strategies have to be reconsidered in duration, according to the trend toward chronicity of late life depression. They remain based on the use of pluri-aminergic antidepressants. Depressive disorder in the elderly is associated with hippocampus dysfunction, but other biological variables should be taken into account according to a dynamic stress-vulnerability model.
在过去几十年里,针对老年抑郁症已经开展了广泛的研究。已经报道了其具体的临床特征和治疗方法。在抑郁症的检测中,应考虑间接的临床和行为指标,甚至生物学指标。在标准实践中必须加强认知评估,以区分抑郁症与早期痴呆症,同时也用于区分长期护理机构中发生的抑郁症、血管性抑郁症以及抑郁-执行功能障碍综合征。复发性抑郁发作和晚发性抑郁症之间的区别必须加以明确。根据晚年抑郁症的慢性化趋势,治疗策略的持续时间必须重新考虑。这些策略仍然基于使用多胺能抗抑郁药。老年人的抑郁症与海马体功能障碍有关,但根据动态应激易感性模型,还应考虑其他生物学变量。