Ninot G
Laboratoire Epsylon, universités Montpellier, Montpellier, France.
Rev Mal Respir. 2011 Jun;28(6):739-48. doi: 10.1016/j.rmr.2010.11.005. Epub 2011 May 17.
COPD does not only affect the respiratory function of a patient. It also affects his/her cognitive and affective functions. These effects can be seen particularly in the incidence of anxiety and depressive disorders at different periods during the stage of the illness. This review of the literature suggests some contemporary definitions of these disorders, their link to COPD, and procedures for their assessment during clinical practice.
The neurocognitive functions and the emotional resources of the patient are disturbed by the insidious development of COPD and the disabling effects that follow. The prevalence stands at 50% for anxiety disorders and 33% for depressive disorders. These symptoms deteriorate dyspnoea, reduce the exercise tolerance of patients, intensify the effects of fatigue, increase emotional instability, alter compliance, favor risk behavior in relation to health, and affect communication with caregivers. These symptoms also increase the annual number of exacerbations and hospitalizations. For practical purposes, while a semidirective clinical interview remains the better method to highlight the symptoms, the auto-questionnaire "hospitalization anxiety depression" has proved to be a reliable and sensitive tool.
In patients who do not suffer from a major depressive or anxiety disorder (from a source external to COPD) anxiety and depressive symptoms reveal a lack of comprehension of the illness, difficulties in adjusting psychologically to the illness, misunderstanding and solitude. Except for serious cases, in which resort to medication is necessary, psychological support is a solution, therapeutic education, acceptance, behavior control through rehabilitation and development of the patient-caregiver relationship and networks.
Anxiety and depressive disorders occur at any time in the life of a patient suffering from COPD. Health professionals should not neglect the signs, thinking them inevitable, attributing them to the personality of the patient, the natural evolution of the illness, or ageing. Therapeutic solutions exist.
慢性阻塞性肺疾病（COPD）不仅会影响患者的呼吸功能，还会影响其认知和情感功能。这些影响尤其体现在疾病阶段不同时期焦虑和抑郁障碍的发生率上。本文献综述提出了这些障碍的一些当代定义、它们与COPD的关联以及临床实践中对其进行评估的程序。
COPD的隐匿发展及其后续的致残效应会扰乱患者的神经认知功能和情感资源。焦虑障碍的患病率为50%，抑郁障碍为33%。这些症状会使呼吸困难恶化，降低患者的运动耐量，加剧疲劳影响，增加情绪不稳定性，改变依从性，助长与健康相关的风险行为，并影响与护理人员的沟通。这些症状还会增加每年急性加重和住院的次数。出于实际目的，虽然半指导性临床访谈仍是突出症状的更好方法，但“住院焦虑抑郁”自评问卷已被证明是一种可靠且敏感的工具。
在未患有重度抑郁或焦虑障碍（非COPD所致）的患者中，焦虑和抑郁症状表明对疾病缺乏理解、心理上难以适应疾病、存在误解和孤独感。除了严重病例需要药物治疗外，心理支持是一种解决办法，包括治疗性教育、接纳、通过康复控制行为以及发展患者与护理人员的关系和社交网络。
焦虑和抑郁障碍在COPD患者生命中的任何时候都可能出现。卫生专业人员不应忽视这些症状，认为它们不可避免，或将其归因于患者的个性、疾病的自然演变或衰老。存在治疗方案。
