A Correlative Study Of Psychosociology, Electrophysiology And Immunology Of Depression In Late Life

Objective: This study attempted to explore clinical phenomenological, psychosocial, neuroendocrinoimmunological and psychophysiological characteristics of elderly depressed patients so as to diagnose and treat them at the early stage and understand the cause of depression in late life.Methods: 33 elderly people (aged over 60)(elderly people group) and 30 younger adults (aged from 18 to 50)(younger adult group) with the first episode of depression diagnosed according to CCMD-3, and elderly healthy people (aged over 60)(control group) were investigated. All subjects were interviewed in semi-structured manner with common data and case history questionaire, HAMD, KAMA, LES, EPQ, MMSE, SSRS, and measured event-related potentials and serum level of cytokine.Results: 1.Clinical phenomenology showed: (1) The rates of anxiety, agitation, hypochondriac symptom, hypomnesia, gastroenteric symptom and somatic disease were significantly higher in elderly people group than younger adult group. (2) A few patients in both group complained of emotional symptoms. Most patients had incomplete insight and sought psychiatric treatment long time after the onset. (3) Elderly people group had more severe anxiety ,somatic symptoms, sleeping problem and somatic anxiety than younger adult group.(4) The recent prognosis was worse in elderly people group than younger adult group. 2. Psychosocial factors showed: (1) The rates of psychiatric family history, somatic diseases, risk factors for vascular disease and long-term difficulties weresignificantly higher in elderly people group than control group. The score of MMSE was significantly lower in elderly people group than control group and younger adult group. The rates of somatic disease and risk factors for vascular disease were significantly higher in elderly people group than younger adult group. (2) The scores of negative life events and problem on social intercourse were significantly higher in elderly people group than control group. The score of problem on working and learning aspects was significantly higher in younger adult group than elderly people group. (3) There were lower score of social support and its use in elderly people group than control group, and lower score of subjective support and the use of social support in elderly people group than younger adult group. (4) The score of neuroticism was significantly higher in elderly people group than control group. Most patients in elderly people had personality of neuroticism. 3. Electrophyiological test showed: (1) N2 and P3 latency in elderly people group were significantly longer than those in control group. (2) In elderly depressed patients, N2 and P3 latency were positively related to psychomotor retardation item of HAMD, but negatively related to score of MMSE. (3) Elderly depressed patients who remained symptomatic after 6 weeks of antidepressant treatment had longer P300 latency and higher score of psychomotor retardation item of HAMD compared with those who achieved remission. 4. Immunological aspects showed: (1) The serum levels of IL-1beta,IL-2, sIL-2R and IL-6 were significantly higher in elderly people group than control group. (2) The serum level of IL-6 was positively related to the scores of HAMD, HAMA, cognitive problem and somatic anxiety. (3) There was not significantly difference in serum levels of IL-4, TNF- alpha, IFN- Y ,the number and classification of white blood cells between elderly people group and control group .Conclusion: 1. It was very difficult to diagnose depression in late life because of elderly depressed patients with somatic symptoms and disease, comorbidity of anxiety and depression, and cognitive impairment. Elderly depressed patients came to medical departments without seeking psychiatric help because of the lack of obvious emotional complains and incomplete insight so as to postpone the diagnosis and treatment of depression in late life. 2. The risk factors for vascular disease may be one of risk factors of the onset of depression in late life. Elderly people with chronic stres...