Conroy Susan K, Brownlowe Katherine B, McAllister Thomas W
Department of Psychiatry, Indiana University School of Medicine, Indianapolis (Conroy, McAllister); Department of Psychiatry, Wexner Medical Center, Ohio State University, Columbus (Brownlowe).
Focus (Am Psychiatr Publ). 2020 Apr;18(2):150-161. doi: 10.1176/appi.focus.20200004. Epub 2020 Apr 23.
Depression is common among patients with neurologic disorders, and it has long been considered more difficult to treat than depression in the general population. In this review, the authors consider challenges in the diagnosis and treatment of depression among patients with stroke, traumatic brain injury, Parkinson's disease, and multiple sclerosis. For each disorder, the authors discuss the epidemiology and time course of depression as well as review the physiologic and psychological etiologies of depression. In addition, for each disorder, they review screening tools and diagnostic considerations, including differential diagnosis; discuss etiological factors, both neurobiological and psychological; and assess evidence for various depression treatments, including pharmacologic, psychosocial, and neuromodulatory therapies. The evidence suggests that depression is common among patients with neurologic disorders and that it is crucial for general psychiatrists to provide treatment for this population.
抑郁症在神经系统疾病患者中很常见,长期以来人们一直认为它比普通人群中的抑郁症更难治疗。在这篇综述中,作者探讨了中风、创伤性脑损伤、帕金森病和多发性硬化症患者抑郁症诊断和治疗中的挑战。对于每种疾病,作者讨论了抑郁症的流行病学和病程,并回顾了抑郁症的生理和心理病因。此外,对于每种疾病,他们还回顾了筛查工具和诊断注意事项,包括鉴别诊断;讨论神经生物学和心理方面的病因因素;并评估各种抑郁症治疗方法的证据,包括药物治疗、心理治疗和神经调节疗法。证据表明,抑郁症在神经系统疾病患者中很常见,普通精神科医生为这一人群提供治疗至关重要。