| Part one Anxiety and depression in patients with chronic physical diseases and associated factorsObjective:(1)To investigate the anxiety and depression state of patients with chronic physical diseases in general hospital.(2)To compare the anxiety and depression state and severity of patients with multiple diseases,circulatory diseases,neurological diseases,digestive diseases,endocrine diseases,urogenital diseases,musculoskeletal diseases,respiratory diseases,cancer and other diseases(including hematological diseases,immune diseases and infectious diseases).(3)To explore the influence of personality characteristics,social supports and life events on anxiety and depression in patients with physical diseases.Methods:(1)This study investigated inpatients and outpatients with chronic physical disease in 57 general hospitals.The demographic data was collected by self-made questionnaire,including gender,age,marital status,education level and monthly income.(2)Patients who met inclusion/exclusion criteria were screened.The inclusion criteria include: age from 12 to 80,Chinese Han nationality,educational level above 5 years,ability to understand and cooperate to complete the assessment,HADS score≥8 and suggested possible depression or anxiety in primary screening.The exclusion criteria include: meeting the diagnostic criteria for any mental disorders according to ICD-10,past history of any mental disorders.There were a total of 2105 valid responses.(3)Collecting clinical data of patients,including diagnosis,course and severity of physical disease.(4)The anxiety and depression state was assessed by SAS and SDS.The personality characteristics was assessed by EPQ,including E,N,P three sub-scales.The social supports was assessed by SSRS,including objective support,subjective support and support availability.The mental stress of life events was assessed by LES,including negative events and positive events.(5)We used non-parametric test for continuous variable,and chi-square test for categorical variable.Then,multivariate ordered logistic regression analysis were used to further explore the relationships between associated factors with anxiety or depression.Results:(1)The proportion of anxiety among the patients with physical diseases was 63.3%(n=1332),most of them were mild(n=630,47.3%)and moderate(n=566,42.5%),and 136(10.2%)were severe.The proportion of depression was 75.1%(n=1580),including 675(42.7%)mild,646(40.9%)moderate,and 259(16.4%)severe.1202(57.1%)patients had both anxiety and depression,accounted for 90.2%(1202/1332)anxious patients and 76.1%(1202/1580)depressive patients.395(18.8%)of the participants had no anxiety/depression,that is 81.2% patients had either anxiety or depression.(2)We found that the proportion of anxiety among patients with different physical diseases varied from 41.0%(multiple diseases)to 80.0%(cancer),depression varied from 61.5%(musculoskeletal diseases)to 84.0%(cancer),and comorbidity anxiety with depression varied from 34.0%(multiple diseases)to76.0%(cancer).(3)The proportion of anxiety was 30.9%(multiple diseases)to 90.0%(digestive diseases);depression was 46.7%(musculoskeletal diseases)to 85.0%(digestive diseases);comorbidity anxiety with depression was 22.8%(multiple diseases)to 85.0%(digestive diseases)among inpatients.(4)The proportion of anxiety was 42.5%(respiratory diseases)to 88.0%(cancer);depression was 69.7%(other diseases)to 88.0%(cancer);comorbidity anxiety with depression was 42.5%(respiratory diseases)to 84.0%(cancer)among outpatients.(5)Among the patients with different diseases,cancer patients had the highest incidence of severe anxiety(18.0%),followed by circulatory diseases(7.9%)and respiratory diseases(7.9%).Patients with multiple diseases had the lowest proportion of anxiety(59.0%).(6)Among the patients with different diseases,cancer patients had the highest incidence of severe depression(28.0%),followed by circulatory diseases(15.6%)and endocrine diseases(15.3%).Patients with musculoskeletal diseases had the lowest proportion of depression(38.5%),followed by multiple diseases(38.2%).(7)Compared with non-anxiety group,the anxiety group had more females,divorced or widowed,highly educated participants,and had lower EPQ-N,EPQ-P,SSRS three sub-scale scores with higher LES two sub-scale scores(p < 0.05).Besides,the diagnose and severity of physical disease had a significant difference between anxiety and no-anxiety groups(p < 0.05).(8)Compared with non-depression group,the depression group had more females,divorced or widowed,and low-income participants,with higher EPQ-E and LES-neg scores,and lower EPQ-N,EPQ-P,three SSRS sub-scales scores.There was also a significant difference in patients with different physical diseases between depression and no-depression groups(p<0.05).(9)Advanced age and female are the risk factors of anxiety;compared with junior high school or below and 3000-5000 monthly income,master degree or above and more than 10000 monthly income are risk factors for anxiety;compared with other diseases,circulatory diseases and cancer are the risk factors of anxiety;low EPQ-E,EPQ-N,EPQ-P,SRSS-sub,SRSS-use score and high LES-neg score were risk factors for anxiety.(10)Female is the risk factor of depression;compared with single and more than 10000 monthly income,divorced/widowed and 1000-3000 monthly income are risk factors for depression;compared with other diseases,neurological diseases,endocrine diseases and cancer are the risk factors of depression;low EPQ-N,EPQ-P,SRSS-ob,SRSS-sub,SRSS-use,LES-pos score and high EPQ-E,LES-neg score were risk factors for anxiety.Conclusions:(1)Patients with chronic physical diseases have a high risk of anxiety,depression and comorbidity anxiety with depression.The incidence of depression is higher than anxiety.Patients with cancer show serious anxiety and depression.The incidence of anxiety and depression in outpatients was generally higher than that in inpatients.(2)Patients with anxiety and depression are mostly female,patients who divorced or widowed,with poor social support and negative life events.(3)Female,cancer,poor social support and negative life events are risk factors for anxiety and depression.Part two Two-dimensional speckle tracking imaging combined with electrocardiogram and myocardial enzymes assessing cardiac injury during acute treatment in patients with mental disordersObjective:(1)To investigate the cardiac injury in patients with mental disorders.(2)To investigate the cardiotoxicity of acute treatment in patients with mental disorders.(3)To evaluate the value of two-dimensional speckle imaging for cardiac injury during acute treatment in patients with mental disorders.Method:(1)The subjects were inpatients and outpatients with mental disorders who received psychotropic drug treatment among the Renmin Hospital of Wuhan University from July 2019 to April 2021.The demographic data was collected by self-made questionnaire,including gender,age,height and weight,then calculating the BSA and BMI.(2)Patients who met inclusion/exclusion criteria were screened.The inclusion criteria include: meeting the diagnostic criteria for schizophrenia or mood disorders according to ICD-10,age from 12 to 60,receiving anti-psychotic drugs and/or anti-depressant drugs treatment,receiving no cardiovascular drug therapy before.The exclusion criteria include: past history of hypertension,cardiac disease and diabetes,patients with serious physical illness,presence of substance abuse or dependence,patients who received electroconvulsive therapy.53 patients were eventually enrolled.Besides,we enrolled 32 normal controls.(3)Clinical data was collected,including disease diagnosis and previous medication.After enrollment,the patients were examined by ECG,myocardial enzyme,blood pressure,routine echocardiography and two-dimensional speckle tracking echocardiography.ECG related indexes analyzed in this study include ECG results,heart rate,QRS interval,PR interval and QTc interval;Myocardial enzyme indexes include creatine kinase isoenzyme,aspartate aminotransferase,creatine kinase,lactate dehydrogenaseα-Hydroxybutyrate dehydrogenase;Blood pressure indicators include: systolic blood pressure,diastolic blood pressure;Conventional echocardiographic indexes include:left atrial diameter,left ventricular end diastolic diameter,right atrial diameter,right ventricular diameter,ventricular septal thickness,ascending aorta diameter,main pulmonary artery diameter,aortic valve systolic velocity,pulmonic valve systolic velocity,left ventricular ejection fraction and E/A;Myocardial strain indexes include:subendocardial myocardial longitudinal strain,middle myocardial longitudinal strain,subepicardial myocardial longitudinal strain,longitudinal strain transmural gradient,left ventricular overall longitudinal strain,subendocardial myocardial circumferential strain,left ventricular middle myocardial circumferential strain,left ventricular subepicardial myocardial circumferential strain,circumferential strain transmural gradient,and left ventricular overall circumferential strain.(4)Patients were followed up one month later,and the types and doses of psychotropic drugs taken during the follow-up period were recorded.(5)The categorical variable data between the patient group and the control group were compared by chi square test,and the continuous variable data were compared by two independent sample t-test(conforming to normal distribution)or two independent sample Mann Whitney U-test(non-normal distribution).The data of the patient group before and after medication were compared by two paired sample t-test(conforming to normal distribution)or two paired sample Mann Whitney U-test(non-normal distribution).Result:(1)There were no significant differences in RVD,AAOD,PVSV and E/A between patients and controls.RAD(31.45±3.73 vs 32.97±2.73,P<0.05)and LVEF(63.13±2.54 vs 64.63±2.47,P<0.05)in patients were significantly lower than controls.LAD(30.08±2.86 vs 28.16±3.45,P<0.05),LVDD(43.75±3.33 vs 39.94±3.7,P<0.05),IVST(9.08±0.83 vs 8.47±1.08,P<0.05),MPAD(20.02±2.74 vs 18.63±2.77,P<0.05)and AVSV(123.13±14.75 vs 111.97±16.16,P<0.05)were significantly higher than controls.(2)There was no significant difference in CS endo、CS mid、CS epi、△LS、△CS 、 GCS between patients and controls.LS endo(21.27±2.74 vs 22.71±2.55,P<0.05),LS mid(18.50±2.50 vs 19.93±2.15,P<0.05),LS epi(16.52±2.46 vs17.76±1.93,P<0.05),GLS(18.76±2.54 vs 20.13±2.17,P<0.05)in patients were significantly lower than controls.(3)There were no significant differences in LAD,RAD,RVD,IVST,AAOD,MPAD,AVSV,PVSV,LVEF and E/A between before treatment and after treatment.After treatment LVDD(42.57±4.26 vs 43.75±3.33,P<0.05)was significantly lower than before treatment.(4)There was no significant difference in LS endo、LS mid、LS epi、CS endo、CS mid、CS epi、△LS、△CS、GLS、GCS between before treatment and after treatment.(5)There were 29 patients with normal ECG before treatment and 9 patients with abnormal ECG after treatment,including 5 cases of sinus arrhythmia,accounting for 17.2%,including 2 cases of sinus bradycardia,2 cases of sinus tachycardia and 1 case of sinus arrhythmia;There were 4 cases of abnormal ST-T segment,accounting for 13.8%,including 2 cases of ST segment elevation,1 case of low T wave and 1 case of ST-T segment change.(6)There was no significant difference in heart rate,QRS interval,PR interval and QTc interval between before and after treatment.(7)There were no significant differences in CK-MB and α-HBDH between before and after treatment;After treatment,AST(18.76±5.32 vs 22.52±8.82,P<0.05),CK(89.56±46.70 vs100.76±60.95,P<0.05)and LDH(164.12±28.10 vs 170.24±52.96,P<0.05)were significantly higher than those before treatment.Conclusion:(1)There is obvious damage to cardiac structure function in patients with mental disorders.(2)Myocardial enzyme is a sensitive index to detect cardiac injury during acute treatment.(3)Acute treatment has no significant damage to myocardial function in patients with mental disorders.Part 3 Analysis of related factors of myocardial injury in psychosisObjective:(1)To explore the effect of treatment on myocardial injury in patients with mental disorders.(2)To investigate whether high dose medication is a risk factor for myocardial injury.(3)To investigate the difference in myocardial injury between patients with schizophrenia and mood disorders during acute treatment.Method:(1)The subjects were inpatients and outpatients with mental disorders who received psychotropic drug treatment among the Renmin Hospital of Wuhan University from July 2019 to April 2021.The demographic data was collected by self-made questionnaire,including gender,age,height and weight,then calculating the BSA and BMI.(2)Patients who met inclusion/exclusion criteria were screened.The inclusion criteria include: meeting the diagnostic criteria for schizophrenia or mood disorders according to ICD-10,age from 12 to 60,receiving anti-psychotic drugs and/or anti-depressant drugs treatment,receiving no cardiovascular drug therapy before.The exclusion criteria include: past history of hypertension,cardiac disease and diabetes,patients with serious physical illness,presence of substance abuse or dependence,patients who received electroconvulsive therapy.55 patients were eventually enrolled.(3)Clinical data was collected,including disease diagnosis and previous medication.After enrollment,the patients were examined by two-dimensional speckle tracking echocardiography.Myocardial strain indexes analyzed in this study include: subendocardial myocardial longitudinal strain,middle myocardial longitudinal strain,subepicardial myocardial longitudinal strain,longitudinal strain transmural gradient,left ventricular overall longitudinal strain,subendocardial myocardial circumferential strain,left ventricular middle myocardial circumferential strain,left ventricular subepicardial myocardial circumferential strain,circumferential strain transmural gradient,and left ventricular overall circumferential strain.(4)Patients were followed up one month later,and the types and doses of psychotropic drugs taken during the follow-up period were recorded.(5)The patients were divided into groups according to the type of drugs,drug dose and disease diagnosis.(6)The categorical variable data between two groups were compared by chi square test,and the continuous variable data were compared by two independent sample t-test(conforming to normal distribution)or two independent sample Mann Whitney U-test(non-normal distribution).The correlative factors of myocardial injury were studied by covariance analysis.Result:(1)There was no significant difference in age.There was a significant difference in gender(18/17 vs 16/4,P<0.05)between anti-psychotic drugs group and anti-depressant drugs group.BSA(1.74±0.19 vs 1.56±0.10,P<0.05)and BMI(23.71±3.63 vs 19.25±2.03,P<0.05)in anti-psychotic drugs group were significantly higher than anti-depressant drugs group.(2)There was no significant difference in LS endo、LS mid、LS epi、CS endo、CS mid、CS epi、△LS、△CS、GLS、GCS between anti-psychotic drugs group and anti-depressant drugs group.(3)There was no significant difference in gender,age and BSA between low-dose group and high-dose group.BMI(20.83±3.28 vs 23.49±3.91,P<0.05)in low-dose group was significantly lower than high-dose group.(4)There was no significant difference in LS endo、LS mid、LS epi、CS endo、CS mid、CS epi、△LS、△CS、GLS、GCS between low-dose group and high-dose group.(5)There was no significant difference in gender,age and BSA between schizophrenia group and mood disorder group.BMI(23.84±4.38 vs 21.16±3.14,P<0.05)in schizophrenia group was significantly higher than mood disorder group.(6)There was no significant difference in LS endo、LS mid、LS epi、CS endo、CS mid、CS epi、△LS、△CS、GLS、GCS between schizophrenia group and mood disorder group.(7)The interaction factors of drug type and drug dose significantly affected LS endo、LS mid、LS epi、GLS during acute treatment.Conclusion:(1)Anti-psychotic drugs,high-dose medication and schizophrenia are related factors for BMI in patients with mental disorders.(2)Patients who take anti-psychotic drugs during acute treatment need to control the total dosage to avoid myocardial injury.(3)During acute treatment,taking anti-psychotic drugs and higher drug dosage cause no more myocardial damage compared with anti-depressant drugs and lower drug dosage alone. |
PDF Full Text Request