Clinical Comparative Study Of Women's Major Depression With And Without Psychotic Symptoms

Objective1. Identify the cluster difference between women's major depression with and without psychotic symptoms2. Identify the treatment strategies and the corresponding effects, long-term efficacy of women's major depression with and without psychotic symptoms3. Identify the cerebral blood flow changes in indicators before and after treatment of women's major depression with and without psychotic symptoms4. Identify whether the age and educatio can impact the MD's severity and efficacy5. Study the female MD's sleep dysfunction6. Use the SCL-90 Scale for female MD's studyMethods1. Object1.1 depressive group:148 cases, were sampled from outpatient of Department of Neurology, Qilu Hospital of Shandong University, and all participated in voluntary, standards:①meet the U.S. Diagnostic and Statistical Manual of Mental Disorders 4th edition (DSM-Ⅳ) and the Chinese Classification and Diagnostic Criteria of Mental Disorders 3rd edition (CCMD-3) diagnostic criteria for depression. And meet them on the PMD and NMD diagnostic criteria.②for first visit, Hamilton Depression Rating Scale (Hamilton Depression Rating Scale, HAMD) score not less than 35 points, by two neurologists (including a chief physician) at the same time on mental status examination and in accordance with DSM-IV and CCMD-3, and HAMD score and SCL-90 scale score consistently higher.③when the patient treatment for the first time attack, more than 3 times the number of referral, having not taken antidepressants, and (or) antipsychotics before the first treatment.⑤sex not limited to, age 18 to 70 years old;⑥ethnic Han;⑦agreement with the patient or family members into the group.NMD group of 48 patients (aged 28-62 years, mean 43.7 years±14.4 years) and PMD group of 100 cases. The PMD group were randomly divided into PMD single-agent group of 41 patients (age 22-70 years, mean 47.1 years±6.5 years),and PMD combined of 59 patients (age 31-67 years, mean 52.0 years±10.1 years).Exclusion criteria:①organic or drug or alcohol induced secondary depressive disorder.②depressive episode of the bipolar affective disorder, severe affective disorder, reactive depression and other disease induced depression states.③schizophrenia and other psychotic disorder induced secondary major depressive disorder.④alcohol or other substance dependence.⑤brain and severe physical disease.⑥pregnancy or breast-feeding women。⑦taking other antidepressants patients.1.2 Control group:165 cases, with an average age (47.8±15.3) years, were sampled from students of Shandong University, Employee of Qilu Hospital and examinee of Medical examination center,Qilu Hospital. HAMD score less than 7 points, examination of blood, liver and kidney function normal, and no history of schizophrenia and alcohol/drug dependence, specific exclusion criteria as previous.2. Scale measureHAMD and SCL-90 was administrated to all subjects at the time into the control group, lth month,3th month and 9th month after treatment.3. Transcranial Doppler ultrasonographywe examed patients twice with TCD when the time patient into study and at the end of treatment,, selecting a frequency of 2 MHz TCD probe, conventional detected by the bilateral temporal window. For those who can not be clearly detected through the temporal windows we choose through the eye window, and each artery selecting three probing depth.we measured all patients with blood flow velocity, direction and hemodynamic images of ACA,MCA andPCA. by computer processing, peak systolic flow velocity (Vs), diastolic peak flow velocity (Vd), pulsatility index (PI), resistance index (RI) and other data were collected. Have a definite cerebral vascular stenosis and/or collateral circulation opening up are excluded.4. TreatmentNMD group was given paroxetine 20mg, qd; PMD combined-agent group was given paroxetine 20mg, qd, olanzapine 2.5mg qd; PMD monotherapy group was given olanzapine 2.5mg qd; three groups were given give Carens 1 qn at the same time.5. statisticsAssociation analysis was performed by using SPSS 11.5 software. Measurement datas were shown in the form of mean±tandard deviation (χ±S) and its comparison among groups were conducted by the way of one-way analysis of variance (one-way ANOVA), t-test for independent samples, Pearson-test and Spearman-test for correlation analysis, Ridit-test for efficacy analysis,LSD-tesr for multiple sample means. Enumeration datas were shown in the form of rate and its comparison among groups were conducted by the way of chi-sequare test (χ2 test); P<0.05 was statistically significant.Results1. At the 1st treatment, NMD group and PMD Group's HAMD Scale total score was no statistical difference (total score were 53.12±5.00 and 58.20±6.20 points, P> 0.05)2. In clinical characteristics, HAMD scalescore for the first factor shows, three factor score difference was statistically significant for PMD group and the NMD group of patients-psychomotor retardation, cognitive impairment, a sense of desperation(P<0.05); for the second factor scores, three factor score differences were statistically significan of PMD and NMD patients in self-guilt, suicidal tendencies, hopelessness threet(P<0.05).3. After treatment,1 month,3 months,9 months of time,we scored with HAMD scale on the NMD group, PMD single-agent group, PMD combined-agent group, total score, are statistically significant compared with the self-control Contrast study between groups showed that 9 months treatment later, HAMD Scale score for PMD single-agent group was higher than PMD combined-agent group.4. Compared with the self-control,with regular and proper treatment, cerebral blood flow velocity of ACA,MCA and PCA in NMD group and PMD combined-agent group has gone up, while the PMD monotherapy group's was no statistically significance compared 1st detection, pulsatility index and resistance index before for the three groups before and after treatment there was no a statistically significant difference.5. When into the group PMD vs PMD of older sub-group, NMD group compared with NMD older subgroup, HAMD Scale total score was no significant difference (P> 0.05); in the 1 month,3 months after treatment, HAMD total score differences were statistically significant between MD and MD older group(P<0.05); at 9 months after the treatment HAMD total score was no significant difference of elderly sub-group and non-elderly subgroup (P> 0.05). And the educational level and depression severity have a linear correlation.6. In sleep disorder research, at the first checking with PSQI there was no significant difference between NMD group and PMD group (P> 0.05); compared with healthy controls, NMD and PMD were statistically differents (P<0.05). After treatment, self-control display, NMD group and PMD combined-agent group have a statistically significant difference in the total score and all the main factor (P<0.05); compared with healthy controls, NMD group and PMD combined-agent group were still statistically significant in the two factor "subjective sleep quality" and "daytime dysfunction," and secondary factor of "wake up at night or woke too early".7. SCL-90 scale study showed that in depression and anxiety factors, forced and interpersonal sensitivity significant probability value Sig<0.01;in anxiety factor,interpersonal sensitivity, depression and terror, the significance probability value Sig<0.01.Conclusions:1. For women major depression with or without psychiatric symptoms, severity of the illness is close.2. Compared with NMD patients, PMD showed more severe retardation, cognitive impairment and despair, while the NMD more severe symptoms of depression. In addition, PMD patients had more severe suicidal tendencies.3. PMD group should be chosen paroxetine and olanzapine treatment which is superior to paroxetine alone; for NMD patients,paroxetine alone strategy is more appropriate.4. For women major depression patients, their brain artery of ACA,MCA and PCA blood flow velocity definitely slow down, the reason may be related to vascular spasm. Hemodynamic abnormalities associated with the pathophysiological mechanism of major depression.5. Age had no significant impact on the severity of the illness; in response to medication, the older sub-group of the same good response, but also to achieve significant progress in standards, but a slower onset; the lower level of education go with more severe. Depression.6. Female MD had a comprehensive sleep function decline and after effective treatment, sleep function can be overall improved, but it still remains part of the sleep dysfunction.whether or not accompanied by mental symptoms of sleep can not impact sleep function damage and recovery.7. SCL-90 scale studies have shown that depression correlated significantly with anxiety factors, forced and interpersonal sensitivity,and not correlated with somatization, hostility, terror, paranoia and psychotic; anxiety correlated significantly with interpersonal sensitivity factor, depression and terror, no correlation with hostility, paranoia, psychotic and forced no correlation.