Cukor Daniel, Coplan Jeremy, Brown Clinton, Friedman Steven, Cromwell-Smith Allyson, Peterson Rolf A, Kimmel Paul L
Department of Psychiatry and Behavioral Sciences, SUNY Downstate Medical Center, Brooklyn, NY 11203-2098, USA.
Clin J Am Soc Nephrol. 2007 May;2(3):484-90. doi: 10.2215/CJN.00040107. Epub 2007 Apr 4.
Depression is well established as a prevalent mental health problem for people with ESRD and is associated with morbidity and mortality. However, depression in this population remains difficult to assess and is undertreated. Current estimates suggest a 20 to 30% prevalence of depression that meets diagnostic criteria in this population. The extent of other psychopathology in patients with ESRD is largely unknown. The aim of this study was to expand the research on psychiatric complications of ESRD and examine the prevalence of a broad range of psychopathology in an urban hemodialysis center and their impact on quality of life. With the use of a clinician-administered semistructured interview in this randomly selected sample of 70 predominately black patients, >70% were found to have a psychiatric diagnosis. Twenty-nine percent had a current depressive disorder: 20% had major depression, and 9% had a diagnosis of dysthymia or depression not otherwise specified. Twenty-seven percent had a current major anxiety disorder. A current substance abuse diagnosis was found in 19%, and 10% had a psychotic disorder. The mean Beck Depression Inventory score was 12.1 +/- 9.8. Only 13% reported being in current treatment by a mental health provider, and only 5% reported being prescribed psychiatric medication by their physician. A total of 7.1% had compound depression or depression coexistent with another psychiatric disorder. The construct of depression was also disentangled from the somatic effects of poor medical health by demonstrating a unique relationship between depressive affect and depression diagnosis, independent of health status. This study also suggests the utility of cognitive variables as a meaningful way of understanding the differences between patients who have ESRD with clinical depression or other diagnoses and those who have no psychiatric comorbidity. The findings of both concurrent and isolated anxiety suggest that the prevalence of psychopathology in patients with ESRD might be higher than previously expected, and the disorders may need to be treated independently. In addition, the data suggest that cognitive behavioral therapeutic techniques may be especially advantageous in this population of patients who are treated with many medications.
抑郁症已被确认为终末期肾病（ESRD）患者中普遍存在的心理健康问题，且与发病率和死亡率相关。然而，这一人群中的抑郁症仍然难以评估且治疗不足。目前的估计表明，该人群中符合诊断标准的抑郁症患病率为20%至30%。ESRD患者中其他精神病理学的程度在很大程度上尚不清楚。本研究的目的是扩大对ESRD精神并发症的研究，并调查一家城市血液透析中心广泛的精神病理学患病率及其对生活质量的影响。在这个随机抽取的70名主要为黑人患者的样本中，通过临床医生进行的半结构化访谈发现，超过70%的患者有精神疾病诊断。29%的患者目前患有抑郁症：20%患有重度抑郁症，9%被诊断为心境恶劣或未另行说明的抑郁症。27%的患者目前患有重度焦虑症。19%的患者有目前的药物滥用诊断，10%的患者患有精神障碍。贝克抑郁量表平均得分为12.1±9.8。只有13%的患者报告目前正在接受心理健康服务提供者的治疗，只有5%的患者报告医生为其开了精神科药物。共有7.1%的患者患有复合性抑郁症或与另一种精神障碍并存的抑郁症。通过证明抑郁情绪与抑郁症诊断之间存在独特关系，独立于健康状况，抑郁症的结构也与不良医疗健康的躯体影响区分开来。本研究还表明，认知变量作为一种有意义的方式，有助于理解患有临床抑郁症或其他诊断的ESRD患者与无精神疾病合并症患者之间的差异。同时存在和孤立性焦虑的研究结果表明，ESRD患者的精神病理学患病率可能高于先前预期，这些疾病可能需要单独治疗。此外，数据表明认知行为治疗技术在这一接受多种药物治疗的患者群体中可能特别有益。
