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Objective:To explore the risk factors of the incidence of arrhythmia and the prediction of baseline ventricular late potential in patients with first depression episode.Methods:The cohort study was used to observe the relationship between the baseline status of ventricular late potential, the severity of baseline depression symptoms, the extent of remission of depressive symptoms within the treatment duration and arrhythmia incidence in the 3 years progress. For the assessment of the severity of depression symptoms, 17 version of Hamilton depression scale was used to evaluate the baseline ventricular late potential, and DMS lab3.0 ECG platform late potential analysis system was used to determine the assessment (CardioScan 12 NET version). The first depression patients with positive ventricular late potential were followed up for 3 years. The changes of the severity of ventricular late potential and depression symptoms were investigated, and the correlation with the subsequent course of arrhythmia was investigated.SPSS 20.0 software package was used for statistical distraction, chi square test was used for count data, independent samples t test was used for normal distribution measurement data, Mann-Whitney U test was used for non-normal distribution count data, and logistic regression method was used to calculate relative risk( RR). Results:According to the 3-year follow-up of 400 first-episode depression patients, 22.25% (89/400) had malignant arrhythmia. The incidence of malignant arrhythmia was 39.46% (58/147) in ventricular late potential positive group and 12.25% (31/253) in ventricular late potential negative group, and the difference was statistically significant(χ 2=9.578, P<0.01). Logistic regression analysis showed that positive ventricular late potential at baseline (compared with negative ventricular late potential at baseline, RR=10.78, 95% CI=8.34-13.80), having a family history of arrhythmia (compared with no family history of arrhythmia, RR=5.23, 95% CI=2.41-9.85), had a higher severity of depression at baseline (compared with lower severity of depression at baseline, RR=1.73, 95% CI=1.25-2.85), poor first-time efficacy and more repeated hospitalizations (compared with good first-time efficacy and less hospitalizations, RR=1.11, 95% CI=1.04-1.17), and age of onset< 20 (compared with age of onset≥20, RR=1.07, 95% CI=1.02-1.93) were the risk factors of malignant arrhythmia in patients with first-episode depression(all P<0.05). Conclusion:The incidence of arrhythmia is very high in those patients with baseline positive late ventricular potential. Positive late ventricular potential, family history of arrhythmia, younger onset age and poor therapeutic effect were the relative risk of arrhythmia in the patients with depression.
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Objective To investigate the difference of Wechsler's cognitive test and its influencing factors in first-episode depression patients with and without sleep disorder.Methods 156 patients with de-pression were divided into two groups according to their sleep conditions,including sleep disorder group(n=77)and non-sleep disorder group(n=79).Wechsler Intelligence Scale(WAIS)and Wechsler Memory Scale(WMS)were used to assess the cognitive function,while Hamilton Depression Scale(HAMD-17) were used to assess depressive symptoms.Results (1)Sleep disorders group had lower scores on verbal IQ (95.51±16.45),performance IQ(90.94±13.87),FIQ scores(92.48±15.49)than those in the non-sleep disorder group((105.59±15.20),(96.19±13.62),(101.20±14.70)respectively),the differences were statistically significant(P<0.05).Sleep disorder group had lower scores in immediate memory(10.47 ± 3.88),short-term memory(49.87±14.35)and memory quotient(87.90±18.25)than those in the non-sleep disorder group((11.86±3.47),(56.52±13.03),(97.27±18.76)respectively),the differences were statisti-cally significant(all P<0.05).(2)Multivariate linear regression analysis showed that education and age ex-plained 24% of variance in verbal IQ(F=21.258,P<0.01).Education,sleep disorder factors explained 12.9% of variation in performance IQ(F=9.825,P<0.01).Education,sleep disorder factors explained 22.3% of variance in total IQ(F=22.847,P<0.01).Education,age,sleep disorder factors explained 28.4%of variation in short-term memory(F=23.850,P<0.01).Education and age explained 20.4% of variation in immediate memory(F=18.10,P<0.01).Education and sleep disorder factors explained 21.9% of variation in memory quotient(F=26.162,P<0.01).Conclusion The intelligence and memory impairment in first-epi-sode depression patients with sleep disorders is more serious,and the education,sleep disorder and age are the most important factors.
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Objective To compare the cognitive functions between patients with treatment-resistant depression and first-episode depression. Methods A total of 80 major depressive disorder patients admitted in our hospital from March 2015 to December 2016 were included in this study. The patients were divided into treatment-resistant depression group (n=40) and first-episode depression group (n=40). Another 40 healthy individuals were used as the control group. The basic data of patients were collected, and Hamilton depression scale (HAMD)-17 was used to assess the severity of the disease. The performing functions were assessed by trail marking test and stroop color-word test. The attention functions were assessed by digital span test. Memory functions were assessed by Hopkins verbal learning test revise (HVLT-R). After treatment for 6 months, cognitive functions were assessed again in first-episode depression group. Results Compared with control group, the scores of trail marking test (TMT) increased, while the scores of digital span test, stroop color-word test, stroop color-colorword test, HVLT-R reduced in treatment-resistant depression group and first-episode depression group ( P<0.05). The scores of TMT, HAMD-17 were lower in first-episode depression group than those of treatment-resistant depression group (P < 0.05). There were no significant differences in other indexes between groups. After six months treatment, the trail marking test score and HAMD-17 reduced, but digital span test, stroop color-word test increased in first-episode depression group (P<0.05). Conclusion The cognitive function damages severely in patients with treatment-resistant depression and first-episode depression, but there is no obvious difference in severity between two groups of patients.
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Objective To explore the significance of serum cytokine interferon-gamma (IFN-γ) ,interleukin-4(IL ) ,transforming growth factor-beta 1 (TGF-β1) ,interleukin-9 (IL-9) ,interleukin-17 (IL-17) in detection of youth first-episode depression .Methods Ninety cases of youth first-episode depression as the experimental group were equally divided into 3 groups according to different disease courses(2 years)and other 30 normal persons served as the control group .The levels of serum cytokines were measured by ELISA .The level of each cytokine and Hamilton Depression Scale (HAMD) score were per-formed the Spearman correlation analysis .Results The IL-9 level in the 6 months to 2 years group and > 2 years group was high-er than that in the control group (P2 years group(P<0 .05);the IL-4 level was positively correlated with the depressive mood (P<0 .05) .Conclusion Different cytokines play different roles in youth first-episode depres-sion ,cytokines may involve in the occurrence and development of depression .
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Objective:To explore the differences of the early response time between transcranial magnetic stimulation (rTMS ) and modified electroconvulsive therapy (MECT )in patients with first-episode depression.Methods:Totally 65 first-episode patients aged 18 -45 year were enrolled in the study.The diagnoses were made according tothe Diagnostic and Statistical Manual of Mental Disorders,Fourth Edition (DSM-Ⅳ)criteria for depression.The patients randomly received rTMS(n =33)or MECT (n =32).All patients received co-therapy of escitalopram (10 -20 mg /day).Stimulation (20 Hz)was performed five times a week for four weeks and,a total of 20 consecutive working days over the left dorsolateral prefrontal cortex(DLPFC).MECT group received MECT treatment 3 times a week for 3 weeks,a total of eight times.The Hamilton Depression Rating Scale-24 items (HAMD)was used to assess the severity of clinical symptoms and reduction rates.Results:Compared with the pa-tients in MECT group,the patients in rTMS group showed a less reduction rates [(25.0.±3.1),(34.4 ±7.7), (52.2 ±7.8),(69.1 ±8.3),vs(28.2 ±5.4),(38.8 ±5.1 ),(57.7 ±6.8),(75.4 ±8.6),Ps <0.05]in the first four weeks and the suicidal behavior scores reduced less in rTMS group in the first two weeks (P <0.05).Conclu-sion:It suggests that both rTMS at 20 Hz and MECT combined with escitalopram could improve the first-episode depression within a week.While the efficacy of rTMS combined with escitaloprm slightly less than MECT com-bined with essitaloprm in rapid response and reducing the suicide risk of acut period.
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Objective To explore the characteristics of cognitive impairment and its influence factors in first-epi?sode depression patients with sleep disorder. Methods Three hundred and eighteen patients with first-episode depres?sion and two hundreds and forty-three healthy controls were recruited. The patients were divided into two group accord?ing to the sleeping situation: 202 patients with sleep disorder and 116 patients without. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was used to evaluated the cognitive function of all subjects, including immediate memory, visual span, speech function, attention and delayed memory. The 17 item Hamilton Depression Scale (HAMD-17) was used to evaluate patients’symptoms. Results The scores of immediate memory, visual span, speech function, delayed memory and the whole scale in the depression patients with sleep disorder were significantly lower than the patients without sleep disorder and the controls (P<0.05). Compared with the controls, the patients without sleep disor?der had lower scores of immediate memory, language function, delayed memory and the whole scale (P<0.05). Multiple linear regression showed that in the depression patients with sleep disorder, the RBANS score was related with the cogni?tive factors in HAMD (β=6.29, P=0.04);immediate memory was related with age (β=-0.24, P=0.04);visual span was re?lated with sleeping factor in HAMD (β=2.33, P=0.01);speech function was related with marriage (β=-5.74, P=0.01) and sleeping factor in HAMD (β=-1.20, P=0.03). In the depression patients with sleep disorder, speech function of RBANS was related with age (β=-0.32, P=0.04);attention was related with retardation factor in HAMD (β=2.52, P=0.01). Con?clusion The first-episode depression patients with sleep disorders have cognitive function damage in many aspects. The depressive symptoms (sleep changes, cognitive disorders, retardation and so on), age and marital status may be the influ?encing factors on cognitive impairment in first-episode depression patients with sleep disorder.
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Objective To explore the cell metabolism of the bilateral hippocampus effected by the inflammatory factor of blood serum in the development of the depression.Methods Using Proton magnetic resonance spectroscopy 1 H-MRS technology to detect multiple metabolic indices of the bilateral hippocampus of 20 first episode depression patients and 20 healthy persons,and detecting the levels of IL-6,IL-2,IL-10 in blood serum were detected.Finally the correlation between them was analyzed.Results Compared with the healthy group,the values of Glx/Cr and NAA/ Cr were reduced in left hippocampus (Glx/Cr: (0.82±0.48),t=2.69,P＜0.05 ; NAA/Cr: (1.12 ±0.44),t =2.81,P＜ 0.05) and the value of Cho/ Cr was increased in left hippocampus ((2.49± 0.78),t =2.36,P＜0.05),but only the value of Glx/ Cr were reduced in right hippocampus ((0.84 ± 0.47),t =2.43,P＜ 0.05),and the other metabolic indices changed unobvious.The depressive group had the significantly higher levels of IL-6,IL-2 in blood serum(IL-6: (12.47±3.19) ng/L,t=4.53,P＜0.05 ; IL-2: (29.44±5.72) ng/L,t=2.44,P＜0.05),but no significant difference was found in the IL-10 level in blood serum.The Glx/ Cr of bilateral hippocampus level was negatively correlated to the IL-6 and IL-2 level in blood serum(left:(IL-6: r=-0.555,P＜0.05;IL-2: r=-0.624,P＜0.05) ;right:(IL-6: r=-0.575,P＜0.05; IL-2: r=-0.523,P＜0.05)).The NAA/ Cr of left hippocampus level was negatively correlated to the IL-6 and IL-2 level in blood serum(IL-6: r=-0.582,P＜0.05;IL-2: r=-0.607,P＜0.05).The Cho/Cr of left hippocampus level was negatively correlated to the IL-6 and IL-2 level in blood serum(IL-6: r=0.601,P＜0.05; IL-2: r=0.552,P＜0.05).Conclusion The abnormal of glutamic acid system in bilateral hippocampus maybe the important performance and the potential originating link,the changes of the inflammatory cytokines level maybe the factor of these abnormal changes.
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Object To explore the difference of overgeneral autobiographical memory (OGM) between first-episode and recurrent depressive patients,and whether the overgeneral autobiographical memory can affect the symptoms of depression or not.Methods 34 first-episode depression patients and 31 recurrent depression patients were enrolled.All patients were measured by autobiographical memory test (AMT),Hamilton Depression Scale-17 (HAMD-17) and Beck depression rating scale(BDI).Results ①The OGM score was higher in recurrent depressive group than that in first-episode group (respectively,(3.90 ± 1.65),(3.10± 1.57),t =2.035,P＜0.05).②The positive OGM score was higher in recurrent depressive group than that in first-episode group(respectively,(2.40± 1.36),(1.70± 1.08),t =2.308,P＜ 0.05).③The correlation coefficient (r value) between the total score of OGM and total score of BDI,total score of HAMD,two subfactors (cognitive disorder and slow)scores of HAMD in recurrent depressive group were 0.497,0.552,0.631,and 0.553 respectively,which significantly correlated.Conclusion Compared with first-episode depressive patients,the OGM in recurrent depressive patients is more severe.The OGM can increase the symptoms of depression,the cognitive disorder and slow.
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Objective To investigate the damaging traits of cognitive function in first episode depression patients with the assessment of neuropsychological status ( RBANS) and Stroop Color-word Test. Methods Two hundred and thirty first-episode depression patients as experimental group and one hundred and seventy-eight health person as control were evaluated separately by repeatable battery for the RBANS and Stroop Color-word Test. Results In Stroop Color-word Test,the time required for completing the words,color,double-word,two-color in depression patients ( (14.37 ±6.65)s,(21. 58 ±8. 70) s,( 16. 56 ±8. 23)s, (37. 88 ± 13. 67) s) were longer than the control group ((12.38 ±3.34)s, (18.01 ±5.51) s, (14. 17 ±4. 37) s, (32. 87 ± 10.28) s). The difference between the two groups was found in cognitive function in first episode depression patients (P ＜ 0.05). The scores of color interference and meaning interference were no difference between the two groups (P＞0.05) . The patients'scores of the RBANS test in all items( (72.19 ± 17.22), (80.89 ± 15.29), (82.00 ± 16.37) , (98.74 ± 17.01) ,(82.09 ± 14.62) )were significantly poorer than those in healthy controls. Compared with control group, scores of the scales were significant difference between two groups. Pearson correlation analysis showed that RBANS total score and five factors had no correlation with HAMD total score and factors. It positively correlated with education level (P＜0.05) ,but not with sex (P＞0.05). Immediate memory,verbal function,delayed memory in five factors and RBANS total score negatively correlated with age and course of disease respectively, but breadth of vision,attention were not did(P＜0.05). Conclusion First-episode depression patients suffer from more serious and comprehensive damage of cognitive function such as memory,attention,executive function.
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Objective:To study the efficacy and safety of mirtazapine and paroxetine in patients with first-episode climacteric depression. Methods:A 8-week double-blind study was conducted with 90 female patients suffered with climacteric first-episode depression. Subjects were randomly assigned to either mirtazapine (n=45) or paroxetine (n=45). All subjects were evaluated with Hamilton Rating Scale for Depression-17 (HAMD-17), Hamilton Rating Scale for Anxiety,and Treatment Emergent Symptom scale (TESS) at baseline, the end of week 1, 4 and 8 after treatment. The study had lasted for 8 weeks.Results:The response rate between two groups (mirtazapine 88.9% vs paroxetine 82.2%) was similar. There were significant differences on the scores of HAMD between the two groups at the end of 1st and 8th week, and HAMA at the 1st week after treatment(21.3?3.5/25.2?2.9,18.2?3.2/21.5?2.4,t=-2.367、-3.514,P=0.042、0.032;7.2?3.5/9.8?2.3,t=-3.258,P=0.035). Mirtazapine had increased food appetite(15.6%), body weight(13.3%), hydropsia(8.9%), dry mouth(6.7%), sleep disorder and nausea(4.4%). Meanwhile paroxetine had dry mouth(22.2%), sleep disorder(20.0%), nausea(17.8%), tremor(15.6%), restlessness/agitation(13.3%) and sexual disturbance(11.1%).Conclusion:Mirtazapine has rapid response, strongly antidepressive effect in female climacteric first-episode patients and less side-effects.