Devanand D P, Nobler M S, Singer T, Kiersky J E, Turret N, Roose S P, Sackeim H A
Late Life Depression Clinic, New York State Psychiatric Institute, College of Physicians and Surgeons of Columbia University, New York 10032.
Am J Psychiatry. 1994 Nov;151(11):1592-9. doi: 10.1176/ajp.151.11.1592.
This study evaluated elderly dysthymic patients in a late life depression clinic and compared their clinical features to previous findings in young adult dysthymic patients.
Of 224 consecutive elderly outpatients, 40 (17.9%) met criteria for dysthymic disorder. A semistructured interview was used to obtain history, the Structured Clinical Interview for DSM-III-R--Patient Version and the Structured Clinical Interview for DSM-III-R Personality Disorders were used to make DSM-III-R diagnoses, and standard rating instruments for depression were administered.
The gender distribution was equal and major stressors were common. The mean age at onset of dysthymia was 55.2 years (SD = 15.4), with an average illness duration of 12.5 years (SD = 14.2). Early onset (before 21 years of age) and secondary dysthymia were rare. A history of major depression earlier during the course of dysthymic illness, comorbid anxiety disorders, and personality disorders were relatively uncommon. Cross-sectionally, cognitive and functional symptoms were more prominent than vegetative symptoms.
Dysthymia is not uncommon among depressed elderly outpatients who present for treatment. Elderly dysthymic patients differ from young adult dysthymic patients, who are mostly female with an early onset and who frequently have comorbid axis I and axis II disorders. Most elderly dysthymic patients do not appear to be young dysthymic patients who simply grew older, and the DSM-III-R subtyping of dysthymia into early/late onset and primary/secondary may not apply to the elderly. Further clinical studies of "pure" dysthymic disorder appear feasible in the elderly, and these are clearly needed.
本研究对一家老年抑郁症诊所中的老年心境恶劣障碍患者进行了评估，并将他们的临床特征与之前对年轻成人心境恶劣障碍患者的研究结果进行了比较。
在224名连续就诊的老年门诊患者中，40名（17.9%）符合心境恶劣障碍的标准。采用半结构化访谈获取病史，使用《精神疾病诊断与统计手册》第三版修订本（DSM-III-R）患者版结构化临床访谈和DSM-III-R人格障碍结构化临床访谈进行DSM-III-R诊断，并使用抑郁标准评定工具。
性别分布均衡，主要应激源常见。心境恶劣障碍的平均起病年龄为55.2岁（标准差=15.4），平均病程为12.5年（标准差=14.2）。早发（21岁之前）和继发性心境恶劣障碍罕见。在心境恶劣病程早期有重度抑郁发作史、共病焦虑障碍和人格障碍相对不常见。横断面来看，认知和功能症状比躯体症状更突出。
心境恶劣障碍在前来治疗的老年抑郁门诊患者中并不少见。老年心境恶劣障碍患者与年轻成人心境恶劣障碍患者不同，后者大多为女性，起病早，且经常有共病的轴I和轴II障碍。大多数老年心境恶劣障碍患者似乎并非只是年龄增长的年轻心境恶劣障碍患者，而且将心境恶劣障碍按照DSM-III-R亚型分为早发/晚发和原发/继发可能并不适用于老年人。对老年人“单纯”心境恶劣障碍进行进一步的临床研究似乎可行，而且显然是必要的。
