失眠伴抑郁焦虑病例分享课件
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病例一
辅助检查：头颅MRI+A、EEG、ECG、 甲功等检查正常；SAS中度焦虑、SDS、 MMSE正常。
诊断：焦虑症 治疗：赛乐特20mg qd、阿普唑伦0.2mg
bid，0.8mg hs，配合支持性心理治疗和放 松训练。 ∆一周后，发作性头晕等明显减少，睡眠改善、 紧张、焦虑情绪减轻
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
失眠与精神障碍
失眠病人 (n = 811)
40% 的失眠病人有一种 或多种精神障碍
抑郁症或恶劣心境: 23% 焦虑障碍: 24% 酒滥用: 7% 药物滥用: 4%
Ford DE, Kamerow DB. JAMA. 1989;262:1479-1484.
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
病例二
有高血压10多年，长期服降压药；有睡眠呼吸暂 停综合症，夜间使用辅助呼吸机
查体：表情抑郁，没有笑容，觉得自己高兴不起来， 对周围事物不感兴趣，主动叙述症状，易激惹，认 为身体不适与自己想得太多及失眠有关，无幻觉、 妄想。BP：150/90mmhg，内科及神经科检 查（－）
辅助检查：实验室检查（－）、泌尿系B超（－）、 SAS轻度焦虑、SDS中度抑郁
体会
失眠是焦虑症、抑郁症患者常见的主诉 睡眠障碍是多种精神疾病的诊断标准之一，
对失眠患者应进行心理评估以防漏诊 赛乐特可以同时治疗焦虑、抑郁，从根本上
解决失眠症状
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
失眠常伴有其它疾病
以孤立症状出现的原发性失眠仅占总失眠人数的10%–20% *共病性失眠占总失眠人数的80%–90%
精神疾病
失
50%
眠
及
共
病
性
疾
病
*共病性：失眠并伴有其他疾病
其它疾病, 药物 等 25%
其它睡眠相关 疾病 10%
原发性失眠 15%
National Institutes of Health State of the Science Conference Statement. Sleep. 2005;28:1049-1057.
失眠是精神障碍患病的危险因子
失眠患者发生抑郁的比率是非失眠患者的3倍
发生焦虑的比率是非失眠患者的2倍
20
15.9%
15
13.7%
N = 979.
以往有失眠 以往没有失眠
随访3.5-年中的新发病例 (%)
10
5
4.6%
7.1%
7.1% 4.7%
4.1%
0
重性抑郁
各种焦虑症
酗酒/酒精依赖
0.6%
药物滥用/依赖
给赛乐特治疗缓解，1/2-1/3维持至今。
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
Ford DE, Kamerow DB. JAMA. 1989(Sept);262(11):1479-1484
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
QA1.一般来说，您一周内会有多少位门诊病人? QA2.平均在一周内，您所有门诊病人中有多少位抑郁症病人 ? QA3.在您的所有门诊抑郁症病人中有多少比例的病人同时伴有失眠 ?
抑郁伴失眠者 门诊抑郁患者数 全部门诊患者数
97
24% 2319% 18
精神科
70 39%
2729% 20
85
15% 12% 13 10
病例二
刘X 男 70岁 2007年8月14日初诊
主诉：失眠、疲乏、无力3个月 现病史：
∆3个月前因家事不开心，睡不着觉，辗转难眠， 多梦易醒，早醒，夜尿增多
∆白天疲乏无力，头昏眼花，不想说，不想动， 整天闷闷不乐，怕吵，没有耐心，易发脾气
∆对以前的爱好毫无兴趣
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
病例一
欧XX 女 69岁 剧作家 2005年5月8日初诊
主诉：失眠10个月，加重2周 现病史： ∆10个月前因写作压力出现难以入睡，浅睡易醒，
睡眠时间减少，间断服舒乐安定1－2片，症状 改善，能坚持写作。 ∆6个月前因经常熬夜，入睡困难加重；烦躁不安， 记忆力下降，难以集中注意力写作，严重时坐立 不安，走来走去；出现发作性头晕、耳鸣、心慌、 出汗、经常有快晕过去的感觉。
病例二
诊断：抑郁症、睡眠呼吸暂停综合症、高血 压I级
治疗：赛乐特20mg qd 舒必利50mg qd 继续服降压药，夜间使用呼吸机
∆1周后，睡眠有改善，易激惹减少，血压正常 ∆4周后，抑郁情绪改善、主动性增强 ∆8周后，睡眠正常，兴趣爱好恢复， SAS、
SDS正常。停舒必利，赛乐特维持至今
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
Breslau N et al. Biol Psychiatry. 1996;39:411-418.
Please see important safety information on accompanying slides and full prescribing information.
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
病例一
∆4周后，感觉头脑清醒很多，无头晕等发作，停白天 阿普唑伦，睡前改0.4mg。
∆6周后，感觉头脑不够灵活，睡得不够踏实，SAS正 常。阿普唑伦改0.2mg hs。
∆2个月后，睡眠基本恢复正常，偶尔服半片阿普唑伦， 重新开始写作。
∆赛乐特维持治疗1年逐渐停药， ∆半年后睡眠、头晕复发，但症状较初次患病轻，再次
病例分享
广东省人民医院神经科 袁彦伯
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
病例一
∆开始出现紧张、担忧：担心睡不着、担心痴呆、担心 担心晕过去、担心中风，多次打120急诊；但到了急 诊室症状很快缓解，检查无异常；担心儿子晚归被打 劫、被绑架，两次打110报警。
∆2周前失眠加重，服3－4片舒乐安定睡1－2个小时， 有时整天都不睡，频发头晕而急诊。
平时身体健康，性格开朗，习惯夜间工作，白天睡觉 查体：表情焦虑、重复祥述症状、求医心切，有自知
心理科
神经科
=78%
=74%
ห้องสมุดไป่ตู้
=77%
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
失眠的发病率
- 成年人在过去的12个月内有失眠症状
总计
57%
上海 62%
北京 60%
广州 68%
Q1. 请问在过去的12个月里，您有没有遇到过睡眠问题 ?
南京 49%
天津 44%
杭州 62%
基数: 所有受访者 总计 : 2657
（包括睡眠呼吸暂停综合症、不宁腿综合症）
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
力，无幻觉、妄想；神经科及内科检查无异常。
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
门诊75％抑郁障碍患者伴有失眠
120
100
80
60
40
20
0
失眠 抑郁
86
23% 2017% 15
Total (n=210)
=75%
102
78
23% 15% 18 12
24% 2418% 18
77
24% 18 18% 14
BJ (n=70)
=67%
SH (n=73)
=75%
GZ (n=67)
=77%
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
辅助检查：头颅MRI+A、EEG、ECG、 甲功等检查正常；SAS中度焦虑、SDS、 MMSE正常。
诊断：焦虑症 治疗：赛乐特20mg qd、阿普唑伦0.2mg
bid，0.8mg hs，配合支持性心理治疗和放 松训练。 ∆一周后，发作性头晕等明显减少，睡眠改善、 紧张、焦虑情绪减轻
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
失眠与精神障碍
失眠病人 (n = 811)
40% 的失眠病人有一种 或多种精神障碍
抑郁症或恶劣心境: 23% 焦虑障碍: 24% 酒滥用: 7% 药物滥用: 4%
Ford DE, Kamerow DB. JAMA. 1989;262:1479-1484.
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
病例二
有高血压10多年，长期服降压药；有睡眠呼吸暂 停综合症，夜间使用辅助呼吸机
查体：表情抑郁，没有笑容，觉得自己高兴不起来， 对周围事物不感兴趣，主动叙述症状，易激惹，认 为身体不适与自己想得太多及失眠有关，无幻觉、 妄想。BP：150/90mmhg，内科及神经科检 查（－）
辅助检查：实验室检查（－）、泌尿系B超（－）、 SAS轻度焦虑、SDS中度抑郁
体会
失眠是焦虑症、抑郁症患者常见的主诉 睡眠障碍是多种精神疾病的诊断标准之一，
对失眠患者应进行心理评估以防漏诊 赛乐特可以同时治疗焦虑、抑郁，从根本上
解决失眠症状
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
失眠常伴有其它疾病
以孤立症状出现的原发性失眠仅占总失眠人数的10%–20% *共病性失眠占总失眠人数的80%–90%
精神疾病
失
50%
眠
及
共
病
性
疾
病
*共病性：失眠并伴有其他疾病
其它疾病, 药物 等 25%
其它睡眠相关 疾病 10%
原发性失眠 15%
National Institutes of Health State of the Science Conference Statement. Sleep. 2005;28:1049-1057.
失眠是精神障碍患病的危险因子
失眠患者发生抑郁的比率是非失眠患者的3倍
发生焦虑的比率是非失眠患者的2倍
20
15.9%
15
13.7%
N = 979.
以往有失眠 以往没有失眠
随访3.5-年中的新发病例 (%)
10
5
4.6%
7.1%
7.1% 4.7%
4.1%
0
重性抑郁
各种焦虑症
酗酒/酒精依赖
0.6%
药物滥用/依赖
给赛乐特治疗缓解，1/2-1/3维持至今。
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
Ford DE, Kamerow DB. JAMA. 1989(Sept);262(11):1479-1484
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
QA1.一般来说，您一周内会有多少位门诊病人? QA2.平均在一周内，您所有门诊病人中有多少位抑郁症病人 ? QA3.在您的所有门诊抑郁症病人中有多少比例的病人同时伴有失眠 ?
抑郁伴失眠者 门诊抑郁患者数 全部门诊患者数
97
24% 2319% 18
精神科
70 39%
2729% 20
85
15% 12% 13 10
病例二
刘X 男 70岁 2007年8月14日初诊
主诉：失眠、疲乏、无力3个月 现病史：
∆3个月前因家事不开心，睡不着觉，辗转难眠， 多梦易醒，早醒，夜尿增多
∆白天疲乏无力，头昏眼花，不想说，不想动， 整天闷闷不乐，怕吵，没有耐心，易发脾气
∆对以前的爱好毫无兴趣
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
病例一
欧XX 女 69岁 剧作家 2005年5月8日初诊
主诉：失眠10个月，加重2周 现病史： ∆10个月前因写作压力出现难以入睡，浅睡易醒，
睡眠时间减少，间断服舒乐安定1－2片，症状 改善，能坚持写作。 ∆6个月前因经常熬夜，入睡困难加重；烦躁不安， 记忆力下降，难以集中注意力写作，严重时坐立 不安，走来走去；出现发作性头晕、耳鸣、心慌、 出汗、经常有快晕过去的感觉。
病例二
诊断：抑郁症、睡眠呼吸暂停综合症、高血 压I级
治疗：赛乐特20mg qd 舒必利50mg qd 继续服降压药，夜间使用呼吸机
∆1周后，睡眠有改善，易激惹减少，血压正常 ∆4周后，抑郁情绪改善、主动性增强 ∆8周后，睡眠正常，兴趣爱好恢复， SAS、
SDS正常。停舒必利，赛乐特维持至今
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
Breslau N et al. Biol Psychiatry. 1996;39:411-418.
Please see important safety information on accompanying slides and full prescribing information.
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
病例一
∆4周后，感觉头脑清醒很多，无头晕等发作，停白天 阿普唑伦，睡前改0.4mg。
∆6周后，感觉头脑不够灵活，睡得不够踏实，SAS正 常。阿普唑伦改0.2mg hs。
∆2个月后，睡眠基本恢复正常，偶尔服半片阿普唑伦， 重新开始写作。
∆赛乐特维持治疗1年逐渐停药， ∆半年后睡眠、头晕复发，但症状较初次患病轻，再次
病例分享
广东省人民医院神经科 袁彦伯
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
病例一
∆开始出现紧张、担忧：担心睡不着、担心痴呆、担心 担心晕过去、担心中风，多次打120急诊；但到了急 诊室症状很快缓解，检查无异常；担心儿子晚归被打 劫、被绑架，两次打110报警。
∆2周前失眠加重，服3－4片舒乐安定睡1－2个小时， 有时整天都不睡，频发头晕而急诊。
平时身体健康，性格开朗，习惯夜间工作，白天睡觉 查体：表情焦虑、重复祥述症状、求医心切，有自知
心理科
神经科
=78%
=74%
ห้องสมุดไป่ตู้
=77%
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
失眠的发病率
- 成年人在过去的12个月内有失眠症状
总计
57%
上海 62%
北京 60%
广州 68%
Q1. 请问在过去的12个月里，您有没有遇到过睡眠问题 ?
南京 49%
天津 44%
杭州 62%
基数: 所有受访者 总计 : 2657
（包括睡眠呼吸暂停综合症、不宁腿综合症）
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
力，无幻觉、妄想；神经科及内科检查无异常。
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.
门诊75％抑郁障碍患者伴有失眠
120
100
80
60
40
20
0
失眠 抑郁
86
23% 2017% 15
Total (n=210)
=75%
102
78
23% 15% 18 12
24% 2418% 18
77
24% 18 18% 14
BJ (n=70)
=67%
SH (n=73)
=75%
GZ (n=67)
=77%
As the only big agricultural village in Tianding Township, some achievements have been made through the beneficial exploration of villagers' autonomy in family planning for more than a y ear.