Hedlund Mathilde, Zetterling Maria, Ronne-Engström Elisabeth, Carlsson Marianne, Ekselius Lisa
Department of Neuroscience, Psychiatry, Uppsala University Hospital, Uppsala University, Uppsala, Sweden.
Br J Neurosurg. 2011 Dec;25(6):693-700. doi: 10.3109/02688697.2011.578769. Epub 2011 May 18.
Little is known about the roles that lifetime psychiatric disorders play in psychiatric and vocational outcomes of aneurysmal subarachnoid haemorrhage (SAH).
Eighty-three SAH patients without apparent cognitive dysfunction were assessed using the Structured Clinical Interview for DSM-IV axis I disorders (SCID-I) after their SAH. Diagnoses were assessed for three time periods, 'lifetime before SAH', '12 months before SAH' and '7 months after SAH'.
Forty-five percentage of patients with SAH reported at least one lifetime psychiatric disorder. After SAH, symptoms of depression and/or post-traumatic stress disorder (PTSD) were seen in 41%, more often in those with a psychiatric history prior to SAH (p = 0.001). In logistic regressions, depression after SAH was associated with a lifetime history of major depression, or of anxiety or substance use disorder, as well as with lifetime psychiatric comorbidity. Subsyndromal or full PTSD was predicted by a lifetime history of major depression. After the SAH, 18 patients (22%) had received psychotropic medication and/or psychological treatment, 13 of whom had a disorder. Those with a lifetime history of major depression or treatment with antidepressants before SAH had lower return to work rates than others (p = 0.019 and p = 0.031, respectively). This was also true for those with symptoms of depression and/or PTSD, or with antidepressant treatment after SAH (p = 0.001 and p = 0.031, respectively).
Depression and PTSD are present in a substantial proportion of patients 7 months after SAH. Those with a history of psychiatric morbidity, any time before the SAH, are more at risk and also constitute a risk group for difficulties in returning to work.
关于终生精神疾病在动脉瘤性蛛网膜下腔出血（SAH）患者的精神和职业转归中所起的作用，目前所知甚少。
对83例无明显认知功能障碍的SAH患者在SAH后使用《精神障碍诊断与统计手册》第四版轴I障碍的结构化临床访谈（SCID-I）进行评估。在三个时间段评估诊断情况，即“SAH前终生”、“SAH前12个月”和“SAH后7个月”。
45%的SAH患者报告至少有一种终生精神疾病。SAH后，41%的患者出现抑郁和/或创伤后应激障碍（PTSD）症状，在SAH前有精神病史的患者中更常见（p = 0.001）。在逻辑回归分析中，SAH后的抑郁与重度抑郁、焦虑或物质使用障碍的终生病史以及终生精神共病有关。PTSD的亚综合征或完全型可由重度抑郁的终生病史预测。SAH后，18例患者（22%）接受了精神药物治疗和/或心理治疗，其中13例患有疾病。SAH前有重度抑郁终生病史或接受过抗抑郁药治疗的患者恢复工作的比率低于其他人（分别为p = 0.019和p = 0.031）。对于有抑郁和/或PTSD症状的患者，或SAH后接受抗抑郁药治疗的患者，情况也是如此（分别为p = 0.001和p = 0.031）。
SAH后7个月，相当比例的患者存在抑郁和PTSD。在SAH前任何时候有精神疾病病史的患者风险更高，也是恢复工作困难的风险群体。
