• <tr id="yyy80"></tr>
  • <sup id="yyy80"></sup>
  • <tfoot id="yyy80"><noscript id="yyy80"></noscript></tfoot>
  • 99热精品在线国产_美女午夜性视频免费_国产精品国产高清国产av_av欧美777_自拍偷自拍亚洲精品老妇_亚洲熟女精品中文字幕_www日本黄色视频网_国产精品野战在线观看 ?

    Comorbidity of depressive and anxiety disorders:challenges in diagnosis and assessment

    2014-12-08 06:44:43ZhiguoWUYiruFANG
    上海精神醫(yī)學(xué) 2014年4期
    關(guān)鍵詞:共患現(xiàn)象障礙

    Zhiguo WU, Yiru FANG*

    ?Forum?

    Comorbidity of depressive and anxiety disorders:challenges in diagnosis and assessment

    Zhiguo WU, Yiru FANG*

    depressive disorders, anxiety disorders, comorbidity, diagnosis, assessment, China

    The concurrent presence of a depressive disorder with prominent anxiety symptoms or with an anxiety disorder is common in clinical practice. Studies have shown that more than 70% of individuals with depressive disorders also have anxiety symptoms and 40 to 70% simultaneously met criteria for at least one type of anxiety disorder.[1-4]In China, 69% of patients with depressive disorders[5]have a current anxiety disorder and 60%[6]have had a history of prior anxiety disorder(s). A study of 8487 patients treated in nonpsychiatric outpatient clinics of general hospitals in urban China found that 8.6% of them met the diagnostic criteria of at least one type of anxiety disorder; and among those with anxiety disorders, 49% had a comorbid depressive disorder.[7]And a community-based epidemiological survey in mainland China reported that 63% of individuals with mood disorders had at least one type of anxiety disorder.[8]

    The concurrent presence of anxiety symptoms or anxiety disorders often complicates the treatment of depressive disorders. These individuals are more dysfunctional and disabled than individuals with depression in the absence of anxiety symptoms,and they are more likely to be resistant to standard treatment with antidepressant medication. Therefore,to improve the clinical characterization of depression and the effectiveness of treatments for depressive disorders treating clinicians must simultaneously assess the severity of both depressive and anxiety symptoms and, if both types of symptoms are prominent, revise their standard treatment regimens accordingly.

    1. Challenges in diagnosing comorbid depressive and anxiety disorders in China

    Despite its high prevalence, the diagnosis of comorbid depressive and anxiety disorders in Chinese clinical settings is quite uncommon. There are several reasons for the failure to identify this common comorbid condition in clinical practice in China.

    (a) The clinical presentations of comorbid disorders are more complex than those of‘pure’ disorders.

    (b) Anxiety symptoms can fluctuate over time. A follow-up study of individuals with uncomplicated generalized anxiety disorder(GAD) at baseline found that at the end of three years the diagnosis of 24% of the participants had changed to depressive disorders and that of a further 16% had changed to depressive disorders comorbid with GAD.[9]

    (c) The ‘diagnostic hierarchy’ approach adopted in 1980 with publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III), shifted the clinical decision making paradigm in psychiatry. According to this principle, severe mental disorders were prioritized and coexisting ‘minor’ mental disorders were not diagnosed. This principle has been widely used in psychiatry and in psychiatric training ever since. Therefore,when the diagnosis of a depressive disorder is evident, there is no need to determine whether or not comorbid anxiety disorders are present.

    (d) In the two most commonly used diagnostic systems in clinical practice in China, the Chinese Classification of Mental Disorders(CCMD) and the 10thedition of the International Classification of Disease (ICD-10),standardized diagnostic evaluation using structured questionnaires is not emphasized and the diagnosis of comorbid conditions is not encouraged.

    (e) In the busy, and often hectic, environment of many psychiatric outpatient departments in China, clinicians do not have the time needed to conduct the type of detailed examination needed to identify comorbid psychiatric disorders. In these settings they tend to take the time-saving ‘diagnostic hierarchy’approach, so individuals with depressive disorders are not questioned further about anxiety symptoms. At best, the clinician may identify the concurrent presence of anxiety symptoms (without determining whether or not an anxiety disorder is present) by labeling the condition ‘depression accompanied with anxious symptoms’ or ‘depression accompanied with anxiety’.

    (f) Government run medical insurance reimbursement plans in China (which cover over 90% of the population) prioritize severe diseases, reinforcing the diagnostic hierarchy approach that make a comorbid diagnosis of an anxiety disorder irrelevant if a diagnosis of a depressive disorder is already present.

    (g) Most general hospitals – where many individuals with comorbid depression and anxiety seek treatment – do not yet have departments of psychiatry and the training of clinicians working in the psychiatry departments of general hospitals that do have departments of psychiatry is inadequate. Thus the service provision in non-specialized medical settings for common mental disorder is very limited.Clinicians working in these settings are both unable to identify complex comorbid conditions and, in most cases, would not even recognize the need to refer individuals with comorbid conditions to local specialized psychiatric settings for diagnosis and treatment.[10]

    (h) Stigma prevents many individuals with mental disorders and their family members from seeking professional mental health care.

    To avoid the under-diagnosis of comorbid conditions,some clinicians and most psychiatric researchers in China use foreign diagnostic systems with structural diagnostic instruments (such as the DSM-IV and SCID) to determine diagnoses. However, differences between the Chinese and Western populations should be considered when using these diagnostic systems in China. For example, using DSM-IV Shi and colleagues[5]found that 69% of the patients with depressive disorders in China had concurrent anxiety disorders but the pattern of comorbidity was quite different from that reported in the United States. Compared to results from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study in the United States,[11]the proportion of depressed individuals with comorbid GAD was much higher in China (56.1% in China vs. 20.8% in the US); the proportion with comorbid panic disorder was similar (15.3% in China versus 20.5% in the US); and the proportion with comorbid social anxiety disorder was much lower (3.5% in China versus 29.3% in the US). Such stark contrasts suggest distinct comorbidity patterns in the Chinese and Western populations but they could also reflect problems in the use of western criteria to distinguish different types of comorbid anxiety disorders in individuals with depression from mainland China. There is substantial overlap of the symptoms in some of the subtypes of anxiety disorders and the criteria for some of the anxiety disorders –such as social anxiety disorder and panic attack—do not map well onto clinical presentations in China. These findings cast doubt on the validity of using Western diagnostic systems such as DSM-IV in routine clinical practice in China.

    2. Dimensional assessment of comorbid depressive and anxiety symptoms

    Comorbid mental disorders are common so the rigid application of a diagnostic hierarchy will not adequately identify clinically important differences between patients. These ‘secondary’ disorders can complicate the management of the ‘main’ condition and may result in substantial distress and dysfunction in their own right, so they should not be overlooked when developing a treatment strategy for the patient. The use of a non-hierarchical diagnostic approach, which allows all diagnoses to co-exist is an improvement but such a system will also neglect potentially important subthreshold symptoms. To some extent, using terms like‘subthreshold’, ‘subclinical’ or ‘not otherwise specified(NOS)’ can mitigate the problem, but an alternative approach would be to complement the dichotomous diagnostic approach with dimensional assessments of the severity of different classes of symptoms.

    To address these problems DSM-5 (2013) made a revolutionary amendment to the classification system: in addition to the original binary (‘yes’ or ‘no’) diagnoses,it emphasized the importance of the ‘dimensional assessment’ of mental disorders.[12,13]For instance, ‘with anxious distress’ was added as a specifier for both bipolar and depressive disorders; this specifier allows clinicians to record the presence and severity of sub-threshold but clinically significant anxiety symptoms in individuals who meet criteria for a bipolar or depressive disorder.

    In support of this approach several reports in China[2,14]and elsewhere[1]have shown that depressed individuals who have comorbid subthreshold anxiety symptoms (i.e., a score >7 in the anxiety/somatization factor of the Hamilton Rating Scale for Depression[HAMD-17]) have different clinical characteristics, poorer prognosis, and higher rates of adverse reactions than depressed individuals without comorbid anxiety.[1,2,14]Chinese patients with depression tend to complain about various somatic symptoms instead of their depressed mood so using a dimensional measure of anxiety and somatic symptoms (such as the anxiety/somatization factor of the HAMD-17) to identify comorbid subthreshold anxiety symptoms in individuals with depressive disorders might be particularly important in China. Moreover, GAD is the most commonly co-occurring anxiety disorder with depressive disorders in China,[5]so the use of a dimension measure that assesses the core symptoms of GAD would also facilitate the identification of individuals with comorbid depressive and anxiety disorders.

    Assessing core symptoms of anxiety in depressed individuals can both refine the present diagnosis[15,16]and help predict the subsequent onset of the full-blown anxiety disorder.[17]However, most of the studies in this area have been cross-sectional or retrospective so high-quality longitudinal studies are urgently needed to characterize the different trajectories of individuals with comorbid depression and anxiety and, hopefully,to identify targeted treatments for the different trajectories that result in improved outcomes. In the process of conducting such studies we may find that the current methods for sub-classifying anxiety disorders need to be re-evaluated.

    The dimensional assessment of anxiety in clinical settings in China should help reduce the underdiagnosis of comorbid depression and anxiety disorders,but further work is needed before recommending the widespread implementation of such an approach. There is a wide range of instruments available for assessing the severity of anxiety in China but there has been little work on the validity of the subtypes of anxiety assessed by these instruments. Head-to-head comparisons of the most promising scales in sufficiently large samples of representative community members are needed to select the most appropriate instrument (or to construct a China-specific instrument). When assessing the validity of these promising instruments it is necessary to consider their relevance to the clinical presentation of anxiety in China (i.e., ‘face validity’), the degree to which the identified subtypes are homogeneous subgroups of individuals (i.e., those who have similar biomarkers, treatment responsiveness, and long-term outcomes), and the extent to which the measure is sensitive to clinical changes in the severity of symptoms over time (which is necessary if the instrument is to be used as a measure of treatment efficacy). It is certainly possible that some of the anxiety symptoms are ‘states’ that fluctuate over time while other anxiety symptoms are ‘traits’ that remain relatively stable over time; if true, it will be important to distinguish these two types of anxiety symptoms in Chinese populations.Comprehensive assessment of the validity of different candidate instruments will require well-powered studies in clinical and non-clinical settings that regularly follow individuals (at least every three months) for at least two years.

    3. Conclusion

    Depressive disorders comorbid with anxiety symptoms and anxiety disorders are common in clinical practice in China and pose challenges for treatment. A number of problems limit the identification of comorbid psychiatric conditions in China, so the neglect or under-treatment of anxiety disorders in individuals with depression is widespread. The introduction of dimensional approaches to the assessment of anxiety(and depression) in clinical settings in China should help ameliorate this problem. But before the promulgation of such a major change in the clinical assessment of patients, substantial work will be needed to identify and validate the best instruments for doing this. Both in China and elsewhere much more work is needed to identify distinct comorbid entities that have common biological substrates, treatment responsiveness, and long-term trajectories.

    Conflict of Interest

    The authors report no conflict of interest related to this manuscript.

    Funding

    The preparation of this article was supported by Shanghai Science and Technology Committee Founda-tion (leading program in medicine [western medicine],134119b0400), the National Natural Science Foundation of China (Major Research Plan—‘the neural basis of emotion and memory’, 91232719), the Ministry of Science and Technology of China (‘12th Five-year Plan’ of National Key Technologies R&D Program,2012BAI01B04), the China Ministry of Health (National Key Clinical Disciplines at Shanghai Mental Health Center, OMA-MH 2011-873), and the Shanghai Mental Health Center Foundation (2011-YJ-12).

    1. Fava M, Rush AJ, Alpert JE, Balasubramani GK, Wisniewski SR, Carmin CN, et al. Difference in treatment outcome in outpatients with anxious versus nonanxious depression: a STAR*D report.Am J Psychiatry. 2008; 165(3): 342-351. doi:http://dx.doi.org/10.1176/appi.ajp.2007.06111868

    2. Wu Z, Chen J, Yuan C, Hong W, Peng D, Zhang C, et al.Difference in remission in a Chinese population with anxious versus nonanxious treatment-resistant depression: a report of OPERATION study.J Affect Disord. 2013; 150(3): 834-839.doi: http://dx.doi.org/10.1016/j.jad.2013.03.012

    3. Kessler RC, Merikangas KR, Wang PS. Prevalence,comorbidity, and service utilization for mood disorders in the United States at the beginning of the twenty-first century.Annu Rev Clin Psychol. 2007; 3: 137-158. doi: http://dx.doi.org/10.1146/annurev.clinpsy.3.022806.091444

    4. Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P,van Balkom AJ, et al. Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA).J Clin Psychiatry.2011; 72(3): 341-348. doi: http://dx.doi.org/10.4088/JCP.10m06176blu

    5. Shi SS, Zhang MY, Wu WY, Lu Z, Zhou TX, Zhang HY, et al.[Multi-center study of the clinical features in depression comorbidity with anxiety disorders].Shanghai Arch Psychiatry. 2009; 21(4): 198-202. Chinese. doi: http://dx.doi.org/10.3969/j.issn.1002-0829.2009.04.002

    6. Li Y, Shi S, Yang F, Gao J, Li Y, Tao M, et al. Patterns of comorbidity with anxiety disorders in Chinese women with recurrent major depression.Psychol Med. 2012; 42(6): 1239-1248. doi: http://dx.doi.org/10.1017/S003329171100273X

    7. He YL, Zhang L, Liu ZN, Jia FJ, Ma H, Zeng QZ, et al.[Prevalence of anxiety disorders among outpatients in general hospitals].Zhongguo Xin Li Wei Sheng Za Zhi.2012;126(3): 165-170. Chinese. doi: http://dx.doi.org/10.3969/j.issn.1000-6729.2012.03.002

    8. Phillips MR, Zhang J, Shi Q, Song Z, Ding Z, Pang S, et al.Prevalence, treatment, and associated disability of mental disorders in four provinces in China during 2001-05: an epidemiological survey.Lancet. 2009; 373(9680): 2041-2053.doi: http://dx.doi.org/10.1016/S0140-6736(09)60660-7

    9. Schoevers RA, Deeg DJH, Tilburg WV. Depression and generalized anxiety disorder:co-occurrence and longitudinal patterns in elderly patients.Am J Geriatr Psychiatry. 2005; 13(1):31-39. doi : http://dx.doi.org/10.1176/appi.ajgp.13.1.31

    10. Liu C, Chen L, Xie B, Yan J, Jin TL, Wu ZG. Number and characteristics of medical professionals working in Chinese mental health facilities.Shanghai Arch Psychiatry.2013; 25(5): 277-285. doi: http://dx.doi.org/10.3969/j.issn.1002-0829.2013.05.003

    11. Howland RH, Rush AJ, Wisniewski SR, Trivedi MH, Warden D, Fava M, et al. Concurrent anxiety and substance use disorders among outpatients with major depression:clinical features and effect on treatment outcome.Drug Alcohol Depend. 2009; 99(1-3): 248-260. doi: http://dx.doi.org/10.1016/j.drugalcdep.2008.08.010

    12. Narrow WE, Kuhl EA. Dimensional approaches to psychiatric diagnosis in DSM-5.J Ment Health Policy Econ. 2011; 14(4):197-200

    13. Zimmerman M, Chelminski I, Young D, Dalrymple K, Walsh E, Rosenstein L. A clinically useful self-report measure of the DSM-5 anxious distress specifier for major depressive disorder.J Clin Psychiatry. 2014; 75(6): 601-607. doi: http://dx.doi.org/10.4088/JCP.13m08961

    14. Wu Z, Chen J, Yuan C, Han YH, Tao M, Zhen HB, et al. [Clinical characteristics of treatment-resistant depression with and without anxiety symptoms].Zhong Hua Jing Shen Ke Za Zhi. 2010; 43(4): 196-200. Chinese. doi: http://dx.doi.org/10.3760/cma.j.issn.1006-7884.2010.04.003

    15. Narrow WE, Clarke DE, Kuramoto SJ, Kraemer HC, Kupfer DJ, Greiner L, et al. DSM-5 field trials in the United States and Canada, Part III: development and reliability testing of a cross-cutting symptom assessment for DSM-5.Am J Psychiatry. 2013; 170(1): 71-82. doi: http://dx.doi.org/10.1176/appi.ajp.2012.12070999

    16. Clarke DE, Wilcox HC, Miller L, Cullen B, Gerring J, Greiner LH, et al. Feasibility and acceptability of the DSM-5 Field Trial procedures in the Johns Hopkins Community Psychiatry Programs.Int J Methods Psychiatr Res. 2014; 23(2): 267-278.doi: http://dx.doi.org/10.1002/mpr.1419

    17. Wolitzky-Taylor K, Dour H, Zinbarg R, Mineka S, Vrshek-Schallhorn S, Epstein A, et al. Experiencing core symptoms of anxiety and unipolar mood disorders in late adolescence predicts disorder onset in early adulthood.Depress Anxiety.2014; 31(3): 207-213. doi: http://dx.doi.org/10.1002/da.22250

    Zhiguo Wu is currently a PhD candidate at the Shanghai Jiao Tong University School of Medicine. He works in the Division of Mood Disorders of Shanghai Mental Health Center as an attending psychiatrist.His main research interests are in the clinical presentation, genetics, treatment, and models of service(for example, e-mental health) of mood disorders.

    抑郁障礙共患焦慮:診斷與評(píng)估之挑戰(zhàn)

    吳志國,方貽儒

    抑郁障礙,焦慮障礙,共病,診斷,評(píng)估,中國

    Summary:Comorbid anxiety is common in patients with depressive disorders. It complicates the clinical presentation of depressive disorders and can contribute to treatment resistance. Clinicians can assess the degree of overlap between depressive and anxiety symptoms either by measuring the severity of anxiety symptoms in individuals who meet diagnostic criteria for depression or by determining whether or not an individual with depression simultaneously meets criteria for an anxiety disorder. However, multiple factors in the Chinese clinical setting make it difficult to accurately assess patients with comorbid conditions.The resultant under-diagnosis of comorbid depression and anxiety – the most common type of comorbid psychiatric condition in China – seriously diminishes the effectiveness of treatments for common mental disorders in the country. We argue that the widespread use of valid and reliable dimensional assessment tools in Chinese clinical settings will help improve the diagnosis and treatment of the many individuals who have concurrent depressive and anxiety symptoms.

    [Shanghai Arch Psychiatry. 2014;26(4): 227-231.

    http://dx.doi.org/10.3969/j.issn.1002-0829.2014.04.006]

    Division of Mood Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China*correspondence: yirufang@gmail.com

    A full-text Chinese translation will be available at www.saponline.org on September 25, 2014.

    概述:抑郁障礙共患焦慮是常見的精神病理現(xiàn)象。該現(xiàn)象使抑郁障礙臨床表現(xiàn)復(fù)雜化,并導(dǎo)致治療困難。通過評(píng)定符合抑郁癥診斷標(biāo)準(zhǔn)患者的焦慮癥狀嚴(yán)重程度或者通過確定抑郁癥患者是否同時(shí)符合焦慮癥診斷標(biāo)準(zhǔn),臨床醫(yī)生評(píng)估抑郁癥狀和焦慮癥狀之間的重疊程度。然而,中國臨床醫(yī)療中存在很多因素,往往難以準(zhǔn)確評(píng)估患者的共患情況。在中國對于這種最常見的精神病理共患現(xiàn)象——抑郁障礙共患焦慮——的診斷缺乏嚴(yán)重削弱了國內(nèi)對常見精神障礙治療的有效性。我們認(rèn)為,中國臨床廣泛使用有效可靠的評(píng)估工具將有助于對許多同時(shí)存在抑郁癥狀和焦慮癥狀的患者的診斷與治療。

    本文全文中文版從2014年9月25日起在www.saponline.org可供免費(fèi)閱覽下載

    猜你喜歡
    共患現(xiàn)象障礙
    睡眠障礙,遠(yuǎn)不是失眠那么簡單
    它們離“現(xiàn)象級(jí)”有多遠(yuǎn)
    商周刊(2017年5期)2017-08-22 03:35:13
    跨越障礙
    多導(dǎo)睡眠圖在睡眠障礙診斷中的應(yīng)用
    夫妻同步護(hù)理干預(yù)對二期梅毒共患夫妻心理狀態(tài)及生活質(zhì)量的影響
    癲癇共患ADHD兒童的生態(tài)學(xué)執(zhí)行功能
    你能解釋下面的現(xiàn)象嗎
    猜謎語
    “換頭術(shù)”存在四大障礙
    奇異現(xiàn)象傳真
    奧秘(2014年10期)2014-10-17 19:52:20
    男女国产视频网站| 精品第一国产精品| 亚洲少妇的诱惑av| 欧美精品一区二区免费开放| 亚洲欧美日韩另类电影网站| 国产一区二区三区av在线| 国产老妇伦熟女老妇高清| 久久久久国产网址| 久久青草综合色| 老汉色av国产亚洲站长工具| 两个人看的免费小视频| 另类亚洲欧美激情| 国产亚洲午夜精品一区二区久久| 91成人精品电影| 亚洲综合色惰| 精品亚洲成a人片在线观看| 五月伊人婷婷丁香| 性色av一级| 18在线观看网站| a 毛片基地| 香蕉丝袜av| 国产在视频线精品| 国产成人精品在线电影| 成年动漫av网址| 两个人免费观看高清视频| 久久久久久免费高清国产稀缺| 日本爱情动作片www.在线观看| av福利片在线| 中文字幕另类日韩欧美亚洲嫩草| 99久久精品国产国产毛片| 成年美女黄网站色视频大全免费| 又黄又粗又硬又大视频| 色网站视频免费| 五月天丁香电影| 精品人妻偷拍中文字幕| 久久精品夜色国产| 国产精品国产三级专区第一集| 久久久精品区二区三区| 丝袜脚勾引网站| 国产人伦9x9x在线观看 | 午夜久久久在线观看| 国产女主播在线喷水免费视频网站| 91精品三级在线观看| 中文乱码字字幕精品一区二区三区| 日韩av不卡免费在线播放| 一级黄片播放器| 亚洲色图 男人天堂 中文字幕| 久热久热在线精品观看| 欧美日韩一级在线毛片| 国产深夜福利视频在线观看| 日韩不卡一区二区三区视频在线| 亚洲精品一区蜜桃| 777米奇影视久久| 亚洲视频免费观看视频| 天美传媒精品一区二区| 色94色欧美一区二区| 久久国内精品自在自线图片| av.在线天堂| 国产精品久久久久久精品电影小说| 久久99一区二区三区| 少妇猛男粗大的猛烈进出视频| 久久久久久久久久人人人人人人| 99久国产av精品国产电影| 永久网站在线| 9热在线视频观看99| freevideosex欧美| 亚洲国产欧美日韩在线播放| 菩萨蛮人人尽说江南好唐韦庄| 国产又爽黄色视频| 欧美中文综合在线视频| 亚洲国产精品999| 丰满少妇做爰视频| 美女大奶头黄色视频| 欧美成人精品欧美一级黄| 国产麻豆69| 欧美精品一区二区免费开放| 亚洲国产av影院在线观看| 少妇精品久久久久久久| 激情五月婷婷亚洲| 国产成人精品福利久久| 99久国产av精品国产电影| 汤姆久久久久久久影院中文字幕| 女人被躁到高潮嗷嗷叫费观| 日韩中文字幕视频在线看片| 黄片小视频在线播放| 精品少妇内射三级| 伊人亚洲综合成人网| 欧美成人精品欧美一级黄| 国产一区亚洲一区在线观看| 国产精品国产av在线观看| 免费观看无遮挡的男女| 永久免费av网站大全| 蜜桃国产av成人99| 精品久久蜜臀av无| 日韩欧美一区视频在线观看| 丝袜美足系列| 欧美日韩成人在线一区二区| 亚洲国产精品国产精品| 国产精品一区二区在线不卡| 最近中文字幕2019免费版| 久久精品夜色国产| 国产免费现黄频在线看| 欧美另类一区| 中文字幕人妻丝袜制服| 啦啦啦啦在线视频资源| av又黄又爽大尺度在线免费看| 人人妻人人爽人人添夜夜欢视频| 99久久精品国产国产毛片| 欧美人与性动交α欧美精品济南到 | 99久久中文字幕三级久久日本| 18禁国产床啪视频网站| 欧美人与性动交α欧美软件| 亚洲美女黄色视频免费看| 国产一区有黄有色的免费视频| 午夜免费鲁丝| 成人毛片a级毛片在线播放| 精品99又大又爽又粗少妇毛片| 国产精品免费大片| 欧美日韩综合久久久久久| 啦啦啦啦在线视频资源| 大片电影免费在线观看免费| 欧美人与性动交α欧美精品济南到 | 老汉色av国产亚洲站长工具| 国产av一区二区精品久久| 国产亚洲av片在线观看秒播厂| 日本爱情动作片www.在线观看| 欧美亚洲 丝袜 人妻 在线| 日韩精品免费视频一区二区三区| 9191精品国产免费久久| 日本色播在线视频| 亚洲国产精品999| 久久久久国产精品人妻一区二区| 精品国产一区二区久久| 91精品三级在线观看| 一级a爱视频在线免费观看| 久久午夜综合久久蜜桃| 久久久精品94久久精品| 啦啦啦在线观看免费高清www| 国产一区二区在线观看av| 男人操女人黄网站| 91午夜精品亚洲一区二区三区| 纵有疾风起免费观看全集完整版| 免费少妇av软件| 中文字幕精品免费在线观看视频| 精品一区二区三区四区五区乱码 | 黄片小视频在线播放| 久久精品夜色国产| 2018国产大陆天天弄谢| 亚洲av中文av极速乱| 老女人水多毛片| 一级毛片我不卡| 国产麻豆69| 看十八女毛片水多多多| 日韩av在线免费看完整版不卡| 日日撸夜夜添| 看免费av毛片| 晚上一个人看的免费电影| 制服诱惑二区| 亚洲欧美成人精品一区二区| 亚洲欧美精品综合一区二区三区 | 丰满乱子伦码专区| 久久99一区二区三区| 91成人精品电影| 最近手机中文字幕大全| 亚洲成国产人片在线观看| 午夜福利在线免费观看网站| 中文字幕制服av| 青青草视频在线视频观看| 在线观看免费日韩欧美大片| 国产成人午夜福利电影在线观看| 久久久国产欧美日韩av| 纯流量卡能插随身wifi吗| 校园人妻丝袜中文字幕| 在线观看免费日韩欧美大片| 亚洲欧美成人精品一区二区| 国产乱来视频区| 国产一区二区 视频在线| 亚洲精品日韩在线中文字幕| 一区二区日韩欧美中文字幕| 中文乱码字字幕精品一区二区三区| 午夜激情久久久久久久| 午夜福利网站1000一区二区三区| 国产又爽黄色视频| 老司机影院成人| 久久久精品国产亚洲av高清涩受| 亚洲经典国产精华液单| 老熟女久久久| 王馨瑶露胸无遮挡在线观看| 菩萨蛮人人尽说江南好唐韦庄| 国产有黄有色有爽视频| 国产成人精品一,二区| 下体分泌物呈黄色| www.熟女人妻精品国产| 欧美老熟妇乱子伦牲交| 亚洲精品久久午夜乱码| 成人黄色视频免费在线看| 久久鲁丝午夜福利片| 精品99又大又爽又粗少妇毛片| 王馨瑶露胸无遮挡在线观看| 亚洲成国产人片在线观看| 久久精品国产亚洲av高清一级| 亚洲国产看品久久| 少妇 在线观看| 人人妻人人添人人爽欧美一区卜| 最新中文字幕久久久久| 叶爱在线成人免费视频播放| 国产色婷婷99| 亚洲欧美日韩另类电影网站| 免费观看性生交大片5| 精品一区二区免费观看| 大话2 男鬼变身卡| 欧美变态另类bdsm刘玥| 国产亚洲一区二区精品| av卡一久久| 自拍欧美九色日韩亚洲蝌蚪91| 国产黄色免费在线视频| 欧美激情极品国产一区二区三区| 免费黄频网站在线观看国产| 国产 精品1| 久久97久久精品| 18禁裸乳无遮挡动漫免费视频| 久久久亚洲精品成人影院| 不卡视频在线观看欧美| 成人免费观看视频高清| 国产黄色免费在线视频| 国产极品天堂在线| 观看av在线不卡| 美女国产视频在线观看| 国产亚洲欧美精品永久| 丰满少妇做爰视频| 精品少妇久久久久久888优播| 成年女人毛片免费观看观看9 | 中文字幕av电影在线播放| 日韩av免费高清视频| 日韩中字成人| 亚洲av欧美aⅴ国产| 伦理电影大哥的女人| 日韩精品免费视频一区二区三区| 乱人伦中国视频| 亚洲人成网站在线观看播放| 黄色配什么色好看| 国产熟女欧美一区二区| 91午夜精品亚洲一区二区三区| 欧美人与性动交α欧美精品济南到 | 最新的欧美精品一区二区| 国产熟女欧美一区二区| 国产一区二区三区综合在线观看| 久久久精品免费免费高清| 亚洲国产精品国产精品| 国产精品国产三级国产专区5o| 大片免费播放器 马上看| 青春草亚洲视频在线观看| 亚洲精品乱久久久久久| 美女大奶头黄色视频| 色网站视频免费| 亚洲精品美女久久久久99蜜臀 | 永久网站在线| 大香蕉久久网| 国产又色又爽无遮挡免| 欧美精品高潮呻吟av久久| 晚上一个人看的免费电影| 欧美日韩精品网址| 热re99久久国产66热| 久久久久人妻精品一区果冻| 亚洲成国产人片在线观看| 看非洲黑人一级黄片| 亚洲欧美精品自产自拍| a 毛片基地| 街头女战士在线观看网站| 人体艺术视频欧美日本| av在线老鸭窝| 亚洲欧美一区二区三区国产| 我的亚洲天堂| 亚洲美女视频黄频| 久久精品国产亚洲av高清一级| 国产午夜精品一二区理论片| 国产在线一区二区三区精| 男人爽女人下面视频在线观看| 亚洲精品国产一区二区精华液| 母亲3免费完整高清在线观看 | 男人舔女人的私密视频| 咕卡用的链子| 男女国产视频网站| 午夜av观看不卡| 欧美日韩综合久久久久久| 国产一区有黄有色的免费视频| 91精品国产国语对白视频| 国产精品人妻久久久影院| 久久久亚洲精品成人影院| 1024香蕉在线观看| 精品99又大又爽又粗少妇毛片| av电影中文网址| 国产精品欧美亚洲77777| 一级片免费观看大全| 国产一区二区三区综合在线观看| 九九爱精品视频在线观看| 热99国产精品久久久久久7| 成人影院久久| 26uuu在线亚洲综合色| 你懂的网址亚洲精品在线观看| 婷婷成人精品国产| 亚洲国产欧美网| 人人妻人人爽人人添夜夜欢视频| 性色av一级| 一级毛片我不卡| 国产一区二区 视频在线| 久久这里只有精品19| 满18在线观看网站| 一级爰片在线观看| 天堂俺去俺来也www色官网| 国产综合精华液| 日本vs欧美在线观看视频| 亚洲精品日韩在线中文字幕| 国产精品.久久久| 久久精品aⅴ一区二区三区四区 | 久久韩国三级中文字幕| 啦啦啦在线观看免费高清www| 国产一区二区三区av在线| 欧美xxⅹ黑人| 国产一区二区三区综合在线观看| 亚洲图色成人| 在线免费观看不下载黄p国产| 在线观看免费高清a一片| 国产视频首页在线观看| 亚洲欧美成人综合另类久久久| 男女下面插进去视频免费观看| 欧美日本中文国产一区发布| 一级爰片在线观看| a 毛片基地| 毛片一级片免费看久久久久| 国产视频首页在线观看| 国产男人的电影天堂91| 大码成人一级视频| 激情五月婷婷亚洲| 看免费av毛片| 日韩中文字幕欧美一区二区 | 国产精品嫩草影院av在线观看| 国产成人免费无遮挡视频| 国产片内射在线| 色吧在线观看| 香蕉国产在线看| 在线天堂中文资源库| 国产午夜精品一二区理论片| 国产精品麻豆人妻色哟哟久久| 飞空精品影院首页| 久久久久国产精品人妻一区二区| 久久韩国三级中文字幕| 国产精品女同一区二区软件| 日本欧美国产在线视频| 一区二区三区激情视频| 高清在线视频一区二区三区| 一区福利在线观看| 国产成人精品福利久久| 满18在线观看网站| 91午夜精品亚洲一区二区三区| 国产熟女午夜一区二区三区| 两性夫妻黄色片| 国产一区二区在线观看av| 中文字幕人妻熟女乱码| 捣出白浆h1v1| 高清在线视频一区二区三区| 久久久久久久大尺度免费视频| 国产精品一二三区在线看| 欧美日韩av久久| 在线 av 中文字幕| 美女福利国产在线| av在线播放精品| 久久午夜综合久久蜜桃| 免费久久久久久久精品成人欧美视频| 日本vs欧美在线观看视频| 免费在线观看黄色视频的| av免费观看日本| 十分钟在线观看高清视频www| 午夜av观看不卡| 美女脱内裤让男人舔精品视频| 日韩一区二区视频免费看| 免费少妇av软件| 青春草视频在线免费观看| 亚洲国产毛片av蜜桃av| 91成人精品电影| 热99久久久久精品小说推荐| 日韩视频在线欧美| 久久久国产欧美日韩av| 久久精品国产亚洲av天美| 99久久综合免费| 久久 成人 亚洲| 日日爽夜夜爽网站| 天美传媒精品一区二区| 久久青草综合色| 国产一区亚洲一区在线观看| 国产在视频线精品| 国产成人91sexporn| 久久久久久伊人网av| 日韩制服骚丝袜av| 男人操女人黄网站| 哪个播放器可以免费观看大片| 一本—道久久a久久精品蜜桃钙片| 日韩大片免费观看网站| 在线观看美女被高潮喷水网站| 久久人人爽av亚洲精品天堂| 在线观看美女被高潮喷水网站| 免费播放大片免费观看视频在线观看| 少妇被粗大猛烈的视频| 日韩伦理黄色片| 精品一区二区免费观看| 国产成人91sexporn| 成人国产av品久久久| av在线app专区| 日本91视频免费播放| 极品少妇高潮喷水抽搐| 欧美av亚洲av综合av国产av | 国产成人免费观看mmmm| 精品国产一区二区久久| 久久精品久久久久久噜噜老黄| 99香蕉大伊视频| 欧美精品国产亚洲| 2018国产大陆天天弄谢| 午夜久久久在线观看| 制服人妻中文乱码| 精品少妇久久久久久888优播| 黄色怎么调成土黄色| 精品亚洲成国产av| 女人高潮潮喷娇喘18禁视频| 波多野结衣av一区二区av| 午夜免费观看性视频| 久久毛片免费看一区二区三区| 欧美黄色片欧美黄色片| 老汉色av国产亚洲站长工具| 看免费成人av毛片| 色网站视频免费| 国产免费福利视频在线观看| 国产精品 国内视频| 亚洲美女黄色视频免费看| 亚洲熟女精品中文字幕| 性少妇av在线| av网站在线播放免费| 制服人妻中文乱码| 日日摸夜夜添夜夜爱| 女的被弄到高潮叫床怎么办| 老女人水多毛片| 十八禁高潮呻吟视频| 男人添女人高潮全过程视频| 欧美老熟妇乱子伦牲交| 不卡视频在线观看欧美| 欧美日韩综合久久久久久| 亚洲av日韩在线播放| 日本-黄色视频高清免费观看| 国产黄频视频在线观看| 国产一区二区在线观看av| 国产亚洲欧美精品永久| 综合色丁香网| 丰满少妇做爰视频| 午夜激情av网站| 婷婷色av中文字幕| 国产亚洲av片在线观看秒播厂| 久久婷婷青草| 国产成人精品福利久久| 久久鲁丝午夜福利片| 欧美xxⅹ黑人| 亚洲色图 男人天堂 中文字幕| 十分钟在线观看高清视频www| av不卡在线播放| 欧美av亚洲av综合av国产av | 国产精品女同一区二区软件| 久久人人爽人人片av| 亚洲精华国产精华液的使用体验| 丝袜美腿诱惑在线| 只有这里有精品99| 一级毛片 在线播放| 国产日韩一区二区三区精品不卡| 啦啦啦视频在线资源免费观看| 下体分泌物呈黄色| 精品视频人人做人人爽| av有码第一页| 交换朋友夫妻互换小说| 黄色一级大片看看| 超色免费av| 国产97色在线日韩免费| 国产日韩一区二区三区精品不卡| 男男h啪啪无遮挡| 丝袜脚勾引网站| 巨乳人妻的诱惑在线观看| 1024视频免费在线观看| 久久综合国产亚洲精品| 欧美成人精品欧美一级黄| 韩国精品一区二区三区| 欧美变态另类bdsm刘玥| 亚洲av电影在线进入| 亚洲国产精品一区二区三区在线| 最黄视频免费看| 又黄又粗又硬又大视频| 在线亚洲精品国产二区图片欧美| 国产又爽黄色视频| 五月开心婷婷网| 汤姆久久久久久久影院中文字幕| 一区二区av电影网| 成人影院久久| 美国免费a级毛片| 成人二区视频| 国产淫语在线视频| 看免费成人av毛片| 亚洲人成电影观看| 波多野结衣一区麻豆| 午夜久久久在线观看| 亚洲国产最新在线播放| 日韩免费高清中文字幕av| 蜜桃国产av成人99| 精品人妻在线不人妻| 老司机影院毛片| 美女主播在线视频| 夫妻午夜视频| 性色avwww在线观看| 久热久热在线精品观看| 久热这里只有精品99| 在线天堂最新版资源| 少妇被粗大猛烈的视频| 男女国产视频网站| 不卡av一区二区三区| 亚洲精品国产av蜜桃| 少妇的逼水好多| 国产免费福利视频在线观看| 亚洲美女视频黄频| 两个人看的免费小视频| 日韩 亚洲 欧美在线| 国产成人精品一,二区| videosex国产| 69精品国产乱码久久久| 久久综合国产亚洲精品| 侵犯人妻中文字幕一二三四区| 在线观看免费视频网站a站| 18在线观看网站| 免费在线观看视频国产中文字幕亚洲 | 又粗又硬又长又爽又黄的视频| 又黄又粗又硬又大视频| 新久久久久国产一级毛片| 亚洲中文av在线| 看非洲黑人一级黄片| 91在线精品国自产拍蜜月| 久久久久久免费高清国产稀缺| 亚洲欧美成人精品一区二区| 麻豆av在线久日| 一级片'在线观看视频| 日本av手机在线免费观看| 妹子高潮喷水视频| 十八禁网站网址无遮挡| 欧美日韩成人在线一区二区| 成人影院久久| 妹子高潮喷水视频| 国产精品二区激情视频| 国产黄频视频在线观看| 久久综合国产亚洲精品| 热re99久久精品国产66热6| 人人妻人人爽人人添夜夜欢视频| 国产黄频视频在线观看| 一本大道久久a久久精品| 久久毛片免费看一区二区三区| 成人国产麻豆网| 国产亚洲午夜精品一区二区久久| 亚洲婷婷狠狠爱综合网| 天天躁夜夜躁狠狠躁躁| 国产一区二区激情短视频 | av.在线天堂| 久久久久国产一级毛片高清牌| 啦啦啦在线免费观看视频4| 午夜91福利影院| 精品人妻一区二区三区麻豆| 亚洲人成网站在线观看播放| 成人毛片a级毛片在线播放| 爱豆传媒免费全集在线观看| 婷婷色综合www| 亚洲国产成人一精品久久久| 高清视频免费观看一区二区| 国产黄频视频在线观看| 国产日韩一区二区三区精品不卡| 欧美 亚洲 国产 日韩一| 日本欧美视频一区| 欧美精品一区二区大全| 久久久精品94久久精品| 精品少妇一区二区三区视频日本电影 | 国产精品免费大片| 在线免费观看不下载黄p国产| 1024香蕉在线观看| 国产精品无大码| 亚洲,一卡二卡三卡| 蜜桃国产av成人99| 欧美日韩视频精品一区| 男男h啪啪无遮挡| 亚洲少妇的诱惑av| 最近最新中文字幕大全免费视频 | 哪个播放器可以免费观看大片| 一级毛片我不卡| 欧美老熟妇乱子伦牲交| 亚洲国产av新网站| 女性被躁到高潮视频| 另类亚洲欧美激情| 亚洲熟女精品中文字幕| 天天躁日日躁夜夜躁夜夜| 少妇精品久久久久久久| 久久久久久久久久久久大奶| 精品第一国产精品| 少妇 在线观看| 女人久久www免费人成看片| 久久人人爽av亚洲精品天堂| 晚上一个人看的免费电影| 99精国产麻豆久久婷婷| xxx大片免费视频| 免费黄色在线免费观看| 大香蕉久久网| 色视频在线一区二区三区| 久久毛片免费看一区二区三区| 26uuu在线亚洲综合色| 婷婷成人精品国产| 2022亚洲国产成人精品| 国产无遮挡羞羞视频在线观看| 七月丁香在线播放|