• <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 ?

    Comparison of the effectiveness of duloxetine in depressed patients with and without a family history of affective disorders in first-degree relatives

    2015-12-08 10:55:22ShiliangWANGMincaiQIANHuaZHONGGuohuaSONGMeijuanLURuiFENGLeiZHANGJianliangNIWeiCHEN
    上海精神醫(yī)學 2015年4期
    關鍵詞:洛西汀漢密爾頓家族史

    Shiliang WANG, Mincai QIAN, Hua ZHONG, Guohua SONG, Meijuan LU, Rui FENG, Lei ZHANG, Jianliang NI,Wei CHEN,*

    ?Original research article?

    Comparison of the effectiveness of duloxetine in depressed patients with and without a family history of affective disorders in first-degree relatives

    Shiliang WANG1,2, Mincai QIAN2, Hua ZHONG2, Guohua SONG2, Meijuan LU2, Rui FENG1, Lei ZHANG1, Jianliang NI3,Wei CHEN1,*

    family history; depressive disorders; duloxetine; China

    1. Introduction

    Previous studies have shown that heritability of depression ranges from 40 to 70%.[1-3]A positive family history of depression may reflect both genetic heritability and common environmental factors.[4]The genetic profile and clinical course of depressed patients with a positive family history of affective disorders may be different from that of depressed patients without a positive family history.[5]Given these differences,it is reasonable to hypothesize that a family history of affective disorders may be one of the factors that predicts the effectiveness of different antidepressant medications, but previous research about this issue has been inconclusive.[6-8]To address this issue, the current study compares the treatment response to duloxetine of depressed patients with and without a positive family history of affective disorders.

    2. Methods

    2.1 Subjects

    The enrollment process is shown in Figure 1. All participants were inpatients or outpatients with depression at the Huzhou Third People’s Hospital or at the Sir Run Run Shaw Hospital (both in Zhejiang Province, China) admitted from November 1, 2013 to August 1, 2014 who were treated by seven participating clinicians (SW, HZ, GS, ML, RF, LZ, WC). When comparing the treatment effect in patients with and without a positive family history of affective disorders, it was necessary to remove the confounding effect of different types of treatment, so we only included patients treated with duloxetine, currently the most commonly used antidepressant at our two centers. Of the 108 depressed patients treated with duloxetine in the correct age range(18-65), 93 agreed to participate and 77 (68 inpatients and 9 outpatients) met the inclusion and exclusion criteria (below).

    All enrolled participants met the following inclusion criteria: a) met the diagnostic criteria for depression according to International Classification of Diseases,10thversion (ICD-10);[9]b) 18 to 65 years of age; c)had a score of 18 or over on the 17-item Hamilton Depression rating scale (HAMD-17);[10]d) were able to provide sufficient information about their first-degree relatives (i.e. parents, children, and siblings); and e)signed the informed consent form for this study. The exclusion criteria were: a) pregnant or lactating; b) use of any antidepressant within four weeks of enrollment;c) a history of serious heart, liver or kidney disorder,cancer, hematonosis, or epilepsy; d) any other comorbid mental or substance abuse disorder; or f) had psychotic symptoms as part of the depressive episode.

    2.2 Classification of probands’ family history of affective disorder

    In our study, a positive family history of affective disorders was defined as ‘any first-degree relative whohad bipolar disorder, depression, or other affective disorders’. By interviewing the patients and their guardians, all first-degree relatives of the proband (i.e.,parents, sibs, and adult children) were enumerated. A total of 297 first-degree relatives of the 77 probands with depression were considered: 11 patients had two first-degree relatives, 26 patients had three first-degree relatives, 18 patients had four first-degree relatives, and 22 patients had fi ve or more first-degree relatives. The 37 patients in the group with a positive family history had 154 first-degree relatives and the 40 patients in the group without a positive family history had 143 first-degree relatives. Among all of these first-degree relatvies 41 (13.8%) had previously been diagnosed with an affective disorder (n=33) or were suspected of having suffered from an affective disorder based on the history (n=8). Most of these individuals (n=30) were interviewed and the presence or absence of a current or prior affective disorder was determined based on ICD-10 criteria; for the 11 first-degree relatives who had passed away or could not be interviewed due to other reasons, a retrospective diagnosis was made based on the description of the informants. Based on this method,37 of the 77 participating patients (48%) had a family history of affective disorders and 40 (52%) did not.

    Figure 1. Flowchart of the study

    2.3 Treatment

    All the enrolled patients were prescribed only duloxetine (trade mark name: Cymbalte, produced by Eli Lilly, 60 mg per capsule). The starting dosage for each patient was 60 mg/d (after breakfast) and the dosage was gradually increased to 120 mg/d over two weeks.Patients with sleeping disturbance were prescribed benzodiazepines at bedtime if necessary for a maximum of three weeks. All participating patients were followed up for 12 weeks.

    Participants who met any of the following criteria were terminated from this study: a) emergence of a serious physical illness; b) emergence of mania or hypomania; c) the patient or guardian withdrew consent; or d) the researcher advised the patient to drop out of this study due to their condition (e.g.,suicidal or could not use the medication as directed).

    2.4 Assessments

    Five questionnaires were administered to all participants at baseline and at the end of the 2nd, 4th, 6th, 8th, and 12thweek after enrollment. a) Two questionnaires were completed by research clinicians who were blind to the family history status of the patients: Chinese versions of the HAMD-17 and the Hamilton anxiety scale (HAMA).[10]Previous studies have confirmed the reliability and validity of these scales.[10]In the current study, the inter-rater reliability of the total scores for these measures between the two raters (based on simultaneous evaluation of fi ve patients) was excellent(kappa>0.80). b) Side effects were assessed by the seven treating clinicians (who were not blind to the family history status of the patients) using the Rating Scale for Side Effects (SERS).[10]c) Two self-completion instruments were also administered to participants: the Beck Depression Rating Scale (BDI)[10]and the Snaith-Hamilton Pleasure Scale (SHAPS).[11]The BDI[10]includes 13 items rated on four-level (0-3) Likert scales with a total score of 0 to 39; a total score of ‘0-4’ indicates‘almost no depressive symptoms’; ‘5-7’ indicates ‘mild depressive symptoms’, ‘8-15’ indicates ‘moderate depressive symptoms’, and ’16 or over’ indicates ‘serious depressive symptoms’. The test-retest reliability of the BDI total score is excellent (rs=0.92) and its correlation with the HAMD total score is good (r=0.57). SHAPS[11]includes 14 items rated on 4-point Likert scales(1=strongly agree, 2=agree, 3=disagree, 4=strongly disagree); higher total scores (range 14-56) reflect greater levels of anhedonia. The internal consistency of SHAPS is excellent (Cronbach’s alpha=0.93) and the testretest reliability is fair (kappa=0.64).

    Routine blood and urine tests, liver and kidney function tests, and electrocardiography (EKG) were conducted at the baseline and at the end of 4th, 8th, and 12thweek of treatment.

    2.5 Statistical analysis

    The data was analyzed using SPSS 16.0 software.Repeated measures analysis of variance (ANOVA) was used to compare the changes of HAMD-17, HAMA,SHAPS, and BDI scores over time between depressed patients who did and did not have a family history of affective disorders. Comparisons of scores between the two groups of patients at each specific time were made using t-tests. Comparison of baseline characterisitics used t-tests or Mann-Whitney tests for continuous and ranked variables and Chi-square tests of Fisher’s exact tests for categorical data. This was an intent-to-treat(ITT) analysis: only one patient dropped out during the 12-week course of treatment (due to development of a hypomanic episode); the last observed values of the evaluation scales (at two weeks) for this patient were carried forward (LOCF). For the purpose of this study,‘effective treatment’ was defined as a >50% drop in the total HAMD-17 score from baseline at the end of the trial (i.e., 12 weeks);[12]and ‘remission’ was defined as a final HAMD-17 score of less than 7.[10]Logistic regression was used to identify factors associated with the effectiveness and remission rate of duloxetine. The statistical significance level was set at p<0.05 (twosided).

    The study was approved by the Ethics Committee of Huzhou Third People’s Hospital.

    3. Results

    3.1 Pre-treatment comparison of the two groups of depressed patients

    Among the 37 patients with a family history of affective disorder 23 (62.2%) were being treated for their first episode of illness while among the 40 patients without a positive family history 29 (72.5%) were being treated for their first episode of illness (X2=0.94,p=0.333). As shown in Table 1, depressed patients with a family history of affective disorders had an earlier age of onset,a longer total duration of illnesses and a longer duration of the current episode. As shown in Table 2, at the time of the baseline assessment (prior to starting treatment),patients with a family history of affective disorders had significantly higher levels of clinician-assessed total anxiety and psychic anxiety, and significantly more severe self-reported anhedonia.

    3.2 Treatment efficacy

    With the exception of the patient who dropped out after 2 weeks of treatment due to a hypomanic episode,all enrolled patients took 60 mg/d of duloxetine during the first two weeks of treatment and 120 mg/d during the subsequent 10 weeks of treatment, so the mean dosage over the 12 weeks was 110 mg/d.

    The results of the treatment with duloxetine in the two groups of patients are shown in Figure 2 and Table 3. With the sole exceptions of significant differences at baseline in the HAMA and SHAPS total scores (shown inTable 2), there were no significant differences between the two groups in any of the four outcome scales at any of the six assessment times. The repeated measures analysis of variance for the total scores of the four measures shows a dramatic improvement over time but no differences by group and no significant timeby-group interaction effects. That is, a family history of affective disorders is not related to the change in scores of any of these measures during 12 weeks of treatment with duloxetine.

    Table 1. Comparison of baseline demographic and clinical characteristics of patients with depression with or without a history of affective disorders in first-degree relatives

    Table 2. Comparison of baseline mean (sd) clinical assessment scores in patients with depression with or without a history of affective disorders in first degree relatives

    Figure 2. Comparison of outcome measures over the 12-week duloxetine treatment period in patients with depression with (n=37) or without (n=40) a history of affective disorders in first-degree relatives

    Table 3. Comparison of mean (sd) outcome measures before and after duloxetine treatment in patients with depression with (n=37) or without (n=40) a history of affective disorders in first-degree relativesa

    Using a >50% decrease in baseline HAMD-17 scores as the cutoff for effective treatment, at the end of week 12, 28 of the 37 patients (75.7%) with a family history of affective disorders were effectively treated and 31 of the 40 patients (77.5%) without a family history of affective disorders were effectively treated (X2=0.04,p=0.850).Using a HAMD-17 score <7 as the threshold for remission,the remission rates in patients with and without a family history of affective disorders were 54.1% (20/37) and 57.5% (23/40), respectively (X2=0.09,p=0.761).

    As shown in Table 4, after adjusting for other factors in logistic regression, a family history of affective disorders was not significantly associated with the effectiveness or the rate of remission of 12 weeks of treatment with duloxetine. With the exception of a borderline significant association between a lower baseline HAMD-17 total score and remission (OR=0.87,95%CI=0.75-1.00), none of the other factors considered(e.g., age, gender, marital status, age of onset, duration of illness, and number of episodes) were significantly associated with the effectiveness or remission rate after 12 weeks of treatment with duloxetine.

    Table 4. Logistic regression of association between demographic and clinical factors of 77 patients with depression and the effectiveness (> 50% reduction in baseline HAMD-17 total score) and remission(final HAMD-17 under 7) of 12 weeks of treatment with duloxetinea

    3.3 Adverse effects and use of adjunctive medication

    As shown in Table 5, about half of the participants in both groups reported one or more adverse effects during the 12 weeks of treatment. Most of the adverse effects occurred during the early stage of the treatment and were mild to moderate; none of them were severe enough to require removal from the trial. Among the reported adverse effects, only the incidence of sexual dysfunction was significantly different between the two groups; it was more common in the group without a positive family history. None of the blood tests,urine tests, liver and kidney function tests, or EKG examinations conducted at the end of the 4th, 8th, and 12thweek for treatment were abnormal.

    Adjunctive treatment with benzodiazepines for sleep (only used in the first 3 weeks of treatment)was provided to 81.1% (30/37) of the patients with a positive family history of affective disorders but to only 52.5% (21/40) of the patients without a positive family history (X2=5.80,p=0.016). Among the 30 patients in the positive family history group given benzodiazepines 13 used alprazolam, 8 used clonazepam, 5 used lorazepam,and 4 used oxazepam. Among the 21 patients without a family history of affective disorders given benzodiazepines 9 used alprazolam, 7 used clonazepam,2 used lorazepam, and 3 used oxazepam. Among the patients who used benzodiazepines, the mean duration of use in patients with a positive family history of affective disorders was 16.7 (3.7) days, while that in patients without a positive family history was 17.2 (2.4)days (t=0.55,p=0.583).

    Table 5. Comparison of incidence (n, %) of adverse effects in patients with depression with and without history of affective disorders in first-degree relatives

    4. Discussion

    4.1 Main findings

    Similar to the STAR*D study,[13]we found that depressed patients with a family history of affective disorders had an age of onset that is, on average, about 6 years earlier than depressed patients without a family history.We also found that depressed patients with a positive family history had a longer duration of illness, more prominent psychic anxiety, and more severe anhedonia.Other reports have suggested that depressed patients with a positive family history for affective disorders also have more severe social dysfunction and a greater risk of suicide than depressed patients without a family history,[14]a finding that highlights the clinical importance of identifying patients with a positive family history. The differences may be more evident in treatment-resistant patients: a multicenter study from Europe[15]reported that among 538 patients who were not responsive to antidepressant treatment, those with a positive family history of major depression had more severe levels of the core symptoms of depression.

    The association between a family history of affective disorders and treatment efficacy among patients with depressive disorders is controversial. We found no difference in the effectiveness of 12 weeks of treatment with duloxetine between patients with and without a family history, both when assessing the result as a continuous measure (i.e., change in HAMD-17 total score) and as a dichotomous variable (i.e., whether or not treatment was ‘effective’). Retrospective studies from Japan also found no association between a family history of affective disorders and the effectiveness of treatment for depression with sertraline[6]or fluvoxamine.[16]One report from the STAR*D study[17]found that patients with a positive family history respond to antidepressants more quickly than those without a family history, but in our study both the magnitude and the rate of response was almost identical in both groups. However, a 12-week trial comparing depressed pediatric patients with and without a family history of affective disorders found that those with a family history were more responsive to antidepressant treatment, even after adjusting for age, race, number of episodes, comorbidity, and so forth.[18]

    In our study, significantly more patients with a family history of affective disorders were prescribed benzodiazepines by their treating clinicians during the early phases of treatment (81% v. 53%). The primary goal of using benzodiazepines was to help with sleep,but their more frequent use in those with a positive family history may be related to the higher levels of anxiety at the outset of the study among patients with a positive family history.

    We also found significantly more frequent reports of sexual dysfunction during treatment in patients without a family history of affective disorders (35% v. 14%).Further studies with larger samples will be need to determine whether or not this was a statistical artifact or a real difference that has a biological etiology.

    4.2 Limitations

    In some cases the determination of whether or not a patient had a positive family history of affective disorders depended on the patient’s report of family members’ prior behavior, so there may have been some misclassification. The lack of significant differences in the various measures of effectiveness and side effects between groups may have been related to the small sample size (i.e., a ‘type II’ error) but the very small magnitude of the differences suggests that there was,in fact, no difference in the treatment outcomes for the two groups. However, given the very large confidence intervals for the reported odds ratios in the logistic regression models of factors associated with effective treatment and remission, the failure to find any significant correlates of the effectiveness and remission rate of treatment with duloxetine may be the result of the small sample size. Further studies with larger samples and more rigorous methods of assessing family history of affective disorders are needed to confirm these results.

    4.3 Significance

    Despite the relatively small sample and the inability to be certain about the classification of the family history status, the very similar clinical results between the two groups throughout the 12 weeks of treatment provides reasonably robust support for the contention that a positive family history of affective disorders does not influence the effectiveness of acute treatment with duloxetine. Further studies are need to determine whether or not this is generally true for all antidepressants, whether or not it is true for children as well as adults, and whether or not it remains true for chronic depression.

    Conflict of interest

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

    Funding

    The study was funded by the General Program of the National Natural Science Foundation (81371490), the Open Fund of the Zhejiang Key Research Laboratory for Cognitive Disorder Evaluation Technology(PD11001005002008), and the Program of Health and Family Planning Commission of Zhejiang Province Foundation (2011KYA029).

    Ethics approval

    The study was approved by the Ethics Committee of Huzhou Third People’s Hospital.

    Informed consent

    All participants and their legal guardians provided signed informed consent to participate this study.

    1. Liu XH, Xu YF, Jiang KD, Zhao LY, Jiang SD. [A preliminary study on the genetic effects and genetic mode of firstepisode depression].Zhong Hua Jing Shen Ke Za Zhi. 2005;38(1): 7-10. Chinese

    2. Qi SG, Dong XH, Zhang YB, An BF. [Gender differences in the genetic effect of unipolar depression].Zhong Hua Jing Shen Ke Za Zhi. 2007; 33(9): 562-564. Chinese. doi: http://dx.chinadoi.cn/10.3969/j.issn.1002-0152.2007.09.016

    3. Jiang KD. [Depression Prevention Guide]. Beijing: Peking University Medical Press; 2007. Chinese

    4. Valdez R, Yoon PW, Qureshi N, Green RF, Khoury MJ. Family history in public health practice: genomic tool for disease prevention and health promotion.Annu Rev Public Health.2010; 31: 69-87.doi: http://dx.doi.org/10.1146/annurev.publhealth.012809.103621

    5. Talati A, Weissman MM, Hamilton SP. Using the high-risk family design to identify biomarkers for major depression.Philos Trans R Soc Lond B Biol Sci.2013; 368(1615):20120129. doi: http://dx.doi.org/10.1098/rstb.2012.0129

    6. Sugawara H, Sakamoto K, Harada T, Ishigooka J. Predictors of efficacy in lithium augmentation for treatment-resistant depression.J Affect Disord. 2010; 125(1-3): 165-168. doi:http://dx.doi.org/10.1016/j.jad. 2009.12.025

    7. Morishita S, Kinoshita T. Predictors of response to sertraline in patients with major depression.Hum Psychopharmacol.2008; 23: 647-651. doi:http://dx.doi.org/10.1002/hup.969

    8. Duggan C, Sham P, Minne C, Lee A, Murray R. Family history as a predictor of poor long-term outcome in depression.Br J Psychiatry. 1998; 173: 527-530

    9. World Health Organization.International Statistical Classification of Disease and Related Health Problems, 10th Revision.Geneva: World Health Organization; 1992

    10. Zhang MY. [Psychiatric Rating Scale Manual]. Changsha:Hunan Science and Technology Press; 1998. Chinese

    11. Liu WH, Wang LZ, Zhu YH, Li MH, Chan RC. Clinical utility of the Snaith- Hamilton- Pleasure scale in the Chinese seゆngs.BMC Psychiatry. 2012; 12: 184. doi: http://dx.doi.org/10.1186/1471- 244X-12-184

    12. Li J, Xu XF, Wang G, Gao CG, Zhao JP, Tang MN, et al.[Exploratory study of optimal treatment plan for treatmentresistant depression].Zhong Hua Jing Shen Ke Za Zhi. 2009;42(1): 17-20. Chinese. doi: http://dx.chinadoi.cn/10.3760/cma.j.issn.1006-7884.2009.01.006

    13. Nierenberg AA, Trivedi MH, Fava M, Biggs MM, Shores-Wilson K, Wisniewski SR, et al. Family history of mood disorder and characteristics of major depressive disorder:a STAR*D (sequenced treatment alternatives to relieve depression) study.J Psychiatr Res. 2007; 41(3-4): 214-221.doi: http://dx.doi.org/10.1016/j.jpsychires.2006.02.005

    14. Holma KM, Melartin TK, Holma IA, Paunio T, Isomets? ET.Family history of psychiatric disorders and the outcome of psychiatric patients with DSM-IV major depressive disorder.J Affect Disord. 2011; 131(1-3): 251-259. doi: http://dx.doi.org/10.1016/j.jad.2010.12.016

    15. Serreゆ A, Chiesa A, Calati R, Sentissi O, Akimova E, Kasper S, et al. Family history of major depression and residual symptoms in responder and non-responder depressed patients.Compr Psychiatry. 2014; 55(1): 51-55. doi: http://dx.doi.org/10.1016/j.comppsych. 2013.08.002

    16. Morishita S, Arita S. Possible predictors of response to fluvoxamine for depression.Hum Psychopharmacol. 2003;18(3): 197-200. doi: http://dx.doi.org/10.1002/hup.469

    17. Husain MM, Rush AJ, Wisniewski SR, McClintock SM, Fava M, Nierenberg AA, et al. Family history of depression and therapeutic outcome: findings from STAR*D.J Clin Psychiatry. 2009; 70(2): 185-195

    18. Tao R, Emslie G, Mayes T, Nakonezny P, Kennard B, Hughes C.Early prediction of acute antidepressant treatment response and remission in pediatric major depressive disorder.J Am Acad Child Adolesc Psychiatry. 2009; 48(1): 71-78. doi:http://dx.doi.org/10.1097/CHI. 0b013e318190043e

    , 2015-07-09; accepted, 2015-08-15)

    Shiliang Wang obtained his bachelor’s degree in medicine from Hubei Yunyang Medical College(now renamed as Hubei College of Medicine and Pharmacology) in 2006 and began work in the psychiatry department of Huzhou Third People’s Hospital. He is currently an attending doctor in his department and is enrolled as a master’s degree candidate in Zhejiang University. His main research interest is depressive disorders.

    比較度洛西汀治療一級親屬情感障礙家族史陽性或陰性的抑郁癥患者的療效

    王士良,錢敏才,鐘華,宋國華,陸梅娟,馮銳,張磊,倪建良,陳煒

    家族史;抑郁癥;度洛西汀;中國

    Background:It remains unclear whether or not a positive family history of affective disorders predicts the effectiveness of antidepressant treatment of depression.AimAssess the relationship of a family history of affective disorders to the efficacy of duloxetine in the treatment of depressive disorder.Methods:Seventy-seven patients with depressive disorder (as defined by the 10th edition of the International Classification of Diseases, ICD-10) were enrolled in the study and treated with standard doses of duloxetine for 12 weeks. Among these patients 37 had a family history of affective disorder in first-degree relatives and 40 did not. The Hamilton Depression rating scale (HAMD-17), Hamilton Anxiety rating scale (HAMA), Side Effects Rating Scale (SERS), Snaith-Hamilton Pleasure Scale (SHAPS), and Beck Depression Inventory (BDI) were assessed at baseline and at the end of the 2nd, 4th, 6th, 8th, and 12thweek after enrollment. Repeated measures analysis of variance and logistic regression were used to analyze the association between a family history of affective disorders and the efficacy of duloxetine.Results:Patients with a positive family history of affective disorders had an earlier age of onset, a longer duration of illness, a higher level of psychic anxiety, and more prominent anhedonia. Repeated measures analysis of variance showed a significant improvement in the severity of depression over the 12 weeks but no differences in the magnitude or speed of improvement between the two groups. Treatment was considered effective (i.e., drop in baseline HAMD-17 total score of >50%) in 75.7% of those with a family history of affective disorders and in 77.5% of those without a family history (X2=0.04,p=0.850).Conclusion:Family history of affective disorders is not associated with the effectiveness of duloxetine in the acute treatment of depressive disorder.

    [Shanghai Arch Psychiatry. 2015, 27(4): 237-245.

    http://dx.doi.org/10.11919/j.issn.1002-0829.215080]

    1Department of Psychiatry, Zhejiang University School of Medicine affiliated Sir Run Run Shaw Hospital and the Collaborative Innovation Center for Brain Science, Hangzhou, Zhejiang Province, China

    2Huzhou Third People’s Hospital, Huzhou, Zhejiang Province, China

    3Zhejiang Provincial Tongde Hospital, Hangzhou, Zhejiang Province, China

    *correspondence: srrcw@zju.edu.cn

    A full-text Chinese translation of this article will be available at http://dx.doi.org/10.11919/j.issn.1002-0829.215080 on Oct 26, 2015.

    背景:陽性情感障礙家族史能否預測抗抑郁藥療效尚不清楚。目的:評估情感障礙家族史與度洛西汀治療抑郁癥的療效之間的相關性。方法:研究納入符合國際疾病分類第10版中抑郁癥定義的77例患者,采用標準劑量的度洛西汀治療12周。其中37例患者有情感障礙家族史(一級親屬中),另外40例家族史陰性。采用漢密爾頓抑郁量表 (Hamilton Depression rating scale, HAMD-17)、漢密爾頓焦慮量表(Hamilton Anxiety rating scale, HAMA)、抗抑郁藥副反應量表 (Side Effects Rating Scale, SERS)、斯奈思-漢密爾頓快感量表 (Snaith-Hamilton Pleasure Scale, SHAPS) 和貝克抑郁自評量表 (Beck Depression Inventory, BDI) 在基線與納入研究后第2、4、6、8、12周末對患者進行評估。采用重復測量方差分析和logistic回歸分析情感障礙家族史與度洛西汀療效之間的相關性。結果:情感障礙陽性家族史的患者發(fā)病較早,病程較長,精神性焦慮水平更高,而且快感缺乏更加突出。重復測量方差分析顯示經過12周治療抑郁癥嚴重程度顯著改善,但兩組之間的改善幅度或速度沒有顯著差異。情感障礙家族史陽性的患者中有75.7%治療有效(即HAMD-17總分較基線下降>50%),而家族史陰性的患者有77.5%有效 (X2=0.04,p=0.850)。結論:情感障礙家族史與度洛西汀對抑郁癥的急性期治療的療效不相關。

    本文全文中文版從2015年10月26日起在

    http://dx.doi.org/10.11919/j.issn.1002-0829.215080可供免費閱覽下載

    猜你喜歡
    洛西汀漢密爾頓家族史
    鄭瑞丹:重視詢問慢性乙型肝炎患者的肝癌家族史
    肝博士(2022年3期)2022-06-30 02:48:32
    度洛西汀治療對抑郁癥患者血清神經遞質及神經功能相關因子的影響
    攜帶線粒體12S rRNA基因突變的新生兒母系家族史分析
    湯顯祖家族墓后的家族史
    藝術品鑒(2017年9期)2017-09-08 02:22:48
    鹽酸度洛西汀聯合神經妥樂平治療糖尿病痛性神經病變的效果分析
    匹維溴胺聯用度洛西汀治療腸易激綜合征69例
    中心突出,邊緣失語:溫州家族史研究綜述
    一類特殊三正則圖漢密爾頓回路存在性的證明
    鹽酸度洛西汀治療抑郁癥的臨床療效和安全性
    夢境追蹤
    故事會(2007年1期)2007-03-07 03:07:24
    午夜福利视频1000在线观看| 国内精品一区二区在线观看| 男人舔奶头视频| 午夜福利视频1000在线观看| 伦精品一区二区三区| 免费高清视频大片| 老司机福利观看| 国产三级在线视频| 国内精品久久久久久久电影| 国产一级毛片七仙女欲春2| 国产淫片久久久久久久久| 国产亚洲精品久久久久久毛片| 一级毛片久久久久久久久女| 欧美激情久久久久久爽电影| 日韩欧美精品免费久久| 亚洲经典国产精华液单| 亚洲最大成人av| 国产熟女欧美一区二区| 欧美黑人欧美精品刺激| 国产v大片淫在线免费观看| 亚洲人成网站在线播放欧美日韩| 成人无遮挡网站| 国产男靠女视频免费网站| 女的被弄到高潮叫床怎么办 | 毛片女人毛片| 12—13女人毛片做爰片一| 好男人在线观看高清免费视频| 精品乱码久久久久久99久播| 亚洲精品成人久久久久久| 一进一出抽搐gif免费好疼| 日韩中文字幕欧美一区二区| 真人一进一出gif抽搐免费| 伦理电影大哥的女人| 51国产日韩欧美| 日本色播在线视频| 一卡2卡三卡四卡精品乱码亚洲| 国产av在哪里看| 精品久久久久久成人av| 精品久久国产蜜桃| 亚洲成人免费电影在线观看| 给我免费播放毛片高清在线观看| 午夜福利在线观看免费完整高清在 | 亚洲av不卡在线观看| 久久久成人免费电影| av专区在线播放| 俄罗斯特黄特色一大片| 免费看光身美女| 久久九九热精品免费| 无遮挡黄片免费观看| 又黄又爽又刺激的免费视频.| 中亚洲国语对白在线视频| 日韩欧美精品v在线| 国产在线男女| 偷拍熟女少妇极品色| 国产一级毛片七仙女欲春2| 亚洲av免费高清在线观看| 午夜福利高清视频| 别揉我奶头~嗯~啊~动态视频| 欧美精品啪啪一区二区三区| 久久婷婷人人爽人人干人人爱| 亚洲精品影视一区二区三区av| 最近最新中文字幕大全电影3| 极品教师在线免费播放| 久久这里只有精品中国| 亚洲图色成人| 黄片wwwwww| 免费在线观看日本一区| 99热只有精品国产| 国产熟女欧美一区二区| 美女被艹到高潮喷水动态| 精品人妻熟女av久视频| or卡值多少钱| 亚洲成人免费电影在线观看| 在线免费十八禁| 久久精品影院6| 在线观看免费视频日本深夜| 99热这里只有是精品50| 欧美日韩亚洲国产一区二区在线观看| 欧美精品国产亚洲| 国产精品野战在线观看| 极品教师在线免费播放| 午夜精品久久久久久毛片777| 97超视频在线观看视频| 国产一区二区三区视频了| 热99re8久久精品国产| 最近中文字幕高清免费大全6 | 亚洲性久久影院| 国产成人aa在线观看| 最后的刺客免费高清国语| 国产精品一区二区三区四区久久| 亚洲精品一区av在线观看| 可以在线观看毛片的网站| 午夜爱爱视频在线播放| 精品人妻熟女av久视频| 成人av在线播放网站| 毛片一级片免费看久久久久 | 国内精品久久久久久久电影| av女优亚洲男人天堂| a级毛片免费高清观看在线播放| 久久久成人免费电影| 欧美+亚洲+日韩+国产| 亚洲图色成人| 午夜老司机福利剧场| 国产精品三级大全| 久久中文看片网| 美女大奶头视频| 日韩,欧美,国产一区二区三区 | bbb黄色大片| 尤物成人国产欧美一区二区三区| 天天一区二区日本电影三级| 精品久久久久久,| 亚洲国产欧美人成| 在线免费十八禁| 成年女人毛片免费观看观看9| 看黄色毛片网站| 日本黄色视频三级网站网址| 搡女人真爽免费视频火全软件 | 欧美日韩国产亚洲二区| 精品一区二区三区人妻视频| 亚洲综合色惰| 亚洲精华国产精华精| 乱系列少妇在线播放| 国内精品久久久久精免费| 一级黄色大片毛片| 无遮挡黄片免费观看| 人人妻,人人澡人人爽秒播| 亚洲国产高清在线一区二区三| 亚洲中文字幕日韩| 免费av不卡在线播放| 又黄又爽又免费观看的视频| 免费观看精品视频网站| 亚洲精品456在线播放app | 成人国产综合亚洲| 国产精品一区二区性色av| 天堂√8在线中文| av专区在线播放| 久9热在线精品视频| 国产高清视频在线观看网站| 少妇高潮的动态图| 成人鲁丝片一二三区免费| 我要搜黄色片| 搡老岳熟女国产| 成人精品一区二区免费| 成人亚洲精品av一区二区| 国产精品久久视频播放| 88av欧美| 少妇人妻一区二区三区视频| 亚洲成人免费电影在线观看| 啦啦啦韩国在线观看视频| 黄色丝袜av网址大全| 很黄的视频免费| 免费搜索国产男女视频| 长腿黑丝高跟| 日韩精品有码人妻一区| 亚洲专区中文字幕在线| 国产精品久久久久久久电影| 国产午夜福利久久久久久| 亚洲av成人精品一区久久| 日韩 亚洲 欧美在线| 一个人观看的视频www高清免费观看| 亚洲经典国产精华液单| 精品久久久久久久久久免费视频| 日本a在线网址| 动漫黄色视频在线观看| 又黄又爽又免费观看的视频| 18+在线观看网站| 麻豆av噜噜一区二区三区| 美女cb高潮喷水在线观看| 九九热线精品视视频播放| 成人国产麻豆网| 两个人的视频大全免费| 欧美不卡视频在线免费观看| 中文字幕av在线有码专区| 成人综合一区亚洲| 麻豆av噜噜一区二区三区| 可以在线观看的亚洲视频| 日韩av在线大香蕉| 深爱激情五月婷婷| 亚洲精品粉嫩美女一区| 国产免费av片在线观看野外av| 搡女人真爽免费视频火全软件 | 国产毛片a区久久久久| 97超级碰碰碰精品色视频在线观看| 欧美性猛交黑人性爽| 久久精品人妻少妇| 亚洲在线自拍视频| 1024手机看黄色片| 变态另类丝袜制服| 精品人妻视频免费看| 女同久久另类99精品国产91| 色尼玛亚洲综合影院| 丝袜美腿在线中文| 亚洲中文字幕日韩| 可以在线观看毛片的网站| 日本欧美国产在线视频| 麻豆国产97在线/欧美| 国产男靠女视频免费网站| 欧美绝顶高潮抽搐喷水| 禁无遮挡网站| 免费高清视频大片| 日日撸夜夜添| 男女边吃奶边做爰视频| 日本精品一区二区三区蜜桃| 欧美性猛交黑人性爽| 国产精品久久久久久精品电影| 成人av一区二区三区在线看| 观看免费一级毛片| 嫁个100分男人电影在线观看| 乱人视频在线观看| 国产黄a三级三级三级人| 国产精品国产三级国产av玫瑰| 日韩中字成人| 日本免费一区二区三区高清不卡| 美女免费视频网站| 我的女老师完整版在线观看| 91精品国产九色| 免费人成视频x8x8入口观看| 一进一出好大好爽视频| 波多野结衣高清无吗| 成人国产综合亚洲| 啦啦啦韩国在线观看视频| 国产亚洲精品久久久com| 91麻豆精品激情在线观看国产| 日韩精品青青久久久久久| 成人av一区二区三区在线看| .国产精品久久| 国产精品亚洲一级av第二区| 成人国产综合亚洲| 亚洲精华国产精华液的使用体验 | 18禁黄网站禁片午夜丰满| 久99久视频精品免费| 天堂√8在线中文| 精品一区二区免费观看| 一区二区三区激情视频| 中文亚洲av片在线观看爽| 18+在线观看网站| 99久国产av精品| 精品人妻熟女av久视频| 亚洲性夜色夜夜综合| 久久精品综合一区二区三区| 一a级毛片在线观看| 一区二区三区免费毛片| 村上凉子中文字幕在线| 特级一级黄色大片| 日韩欧美在线二视频| 国产高清有码在线观看视频| av在线观看视频网站免费| 老女人水多毛片| 国产真实乱freesex| 色综合站精品国产| 婷婷精品国产亚洲av在线| 中文字幕免费在线视频6| 精品久久国产蜜桃| 亚洲精品一区av在线观看| 精品不卡国产一区二区三区| 大又大粗又爽又黄少妇毛片口| 99热这里只有是精品50| 中国美白少妇内射xxxbb| 老师上课跳d突然被开到最大视频| 欧美色欧美亚洲另类二区| 99久国产av精品| 国产aⅴ精品一区二区三区波| 日日夜夜操网爽| 成人综合一区亚洲| 国产av麻豆久久久久久久| 日日摸夜夜添夜夜添av毛片 | 成年人黄色毛片网站| 桃红色精品国产亚洲av| 禁无遮挡网站| 亚洲最大成人手机在线| 51国产日韩欧美| 国产美女午夜福利| 久久国内精品自在自线图片| 亚洲成人久久爱视频| 成人av在线播放网站| 性欧美人与动物交配| 欧美高清成人免费视频www| 日本五十路高清| 国产男人的电影天堂91| 中亚洲国语对白在线视频| 欧美色欧美亚洲另类二区| 国产久久久一区二区三区| 黄色丝袜av网址大全| 日日摸夜夜添夜夜添av毛片 | 久久久久久九九精品二区国产| 国产免费av片在线观看野外av| 偷拍熟女少妇极品色| 免费在线观看成人毛片| 国内精品久久久久精免费| 日韩精品中文字幕看吧| 婷婷精品国产亚洲av| 精品一区二区三区人妻视频| 精品久久久久久久久亚洲 | 中文字幕免费在线视频6| 色综合色国产| 91麻豆精品激情在线观看国产| 亚洲欧美日韩卡通动漫| 国产v大片淫在线免费观看| 一个人看的www免费观看视频| 国产蜜桃级精品一区二区三区| 日日干狠狠操夜夜爽| 亚洲美女搞黄在线观看 | 99久久成人亚洲精品观看| 国内精品久久久久精免费| 人妻夜夜爽99麻豆av| 国产精品人妻久久久影院| 男插女下体视频免费在线播放| 免费看日本二区| 小蜜桃在线观看免费完整版高清| 1000部很黄的大片| 国产精品国产三级国产av玫瑰| 少妇裸体淫交视频免费看高清| 国产人妻一区二区三区在| 久久久久久久亚洲中文字幕| 国产精品1区2区在线观看.| 99久久精品热视频| 日本 欧美在线| 精品午夜福利视频在线观看一区| 可以在线观看毛片的网站| 12—13女人毛片做爰片一| 波多野结衣高清作品| 久久天躁狠狠躁夜夜2o2o| 精品久久久久久久久久免费视频| 国产极品精品免费视频能看的| 国产黄a三级三级三级人| 精品无人区乱码1区二区| 国产探花在线观看一区二区| 日本免费一区二区三区高清不卡| 深夜精品福利| 国内精品宾馆在线| 国产精品一区二区免费欧美| 女同久久另类99精品国产91| 久久99热这里只有精品18| 免费人成视频x8x8入口观看| 精品人妻一区二区三区麻豆 | 久久精品国产亚洲av香蕉五月| 久久久久久久久大av| 观看美女的网站| 国产美女午夜福利| 国产大屁股一区二区在线视频| 真人做人爱边吃奶动态| 91在线观看av| 动漫黄色视频在线观看| 老师上课跳d突然被开到最大视频| 看免费成人av毛片| avwww免费| 欧美成人一区二区免费高清观看| 色尼玛亚洲综合影院| 国产视频一区二区在线看| 黄色女人牲交| 精品久久久久久久末码| 极品教师在线视频| 国产伦一二天堂av在线观看| 国产男靠女视频免费网站| 色综合站精品国产| 桃红色精品国产亚洲av| 亚洲欧美日韩高清在线视频| 国产精品一区二区性色av| 亚洲av日韩精品久久久久久密| 99精品久久久久人妻精品| 亚洲第一电影网av| 全区人妻精品视频| 天堂√8在线中文| 国产中年淑女户外野战色| 18+在线观看网站| 午夜福利在线在线| 国产精品爽爽va在线观看网站| 久久久色成人| 国产色婷婷99| 成人毛片a级毛片在线播放| or卡值多少钱| 极品教师在线视频| .国产精品久久| 黄色女人牲交| 欧美黑人巨大hd| 中文字幕免费在线视频6| 国产亚洲精品久久久久久毛片| 丰满的人妻完整版| 日韩欧美一区二区三区在线观看| 天美传媒精品一区二区| 欧美xxxx性猛交bbbb| 国产精品美女特级片免费视频播放器| 免费黄网站久久成人精品| 亚洲av成人精品一区久久| h日本视频在线播放| www日本黄色视频网| 中亚洲国语对白在线视频| 国产精品永久免费网站| 在线天堂最新版资源| 久久久久久久午夜电影| 国产亚洲av嫩草精品影院| 精品一区二区三区av网在线观看| 成人av一区二区三区在线看| 中文字幕熟女人妻在线| 蜜桃久久精品国产亚洲av| 三级男女做爰猛烈吃奶摸视频| 91av网一区二区| 性插视频无遮挡在线免费观看| 又黄又爽又刺激的免费视频.| 中文字幕av成人在线电影| 极品教师在线免费播放| videossex国产| 天堂影院成人在线观看| 国产精品一区二区性色av| 国产成人福利小说| 很黄的视频免费| 欧美不卡视频在线免费观看| 深夜精品福利| 在线免费观看不下载黄p国产 | 看免费成人av毛片| 色哟哟哟哟哟哟| 国产成人福利小说| 久久草成人影院| 亚洲经典国产精华液单| 我的女老师完整版在线观看| 国产人妻一区二区三区在| 最近最新中文字幕大全电影3| 老司机深夜福利视频在线观看| 精华霜和精华液先用哪个| 国产黄色小视频在线观看| 亚洲欧美激情综合另类| 午夜视频国产福利| 久久欧美精品欧美久久欧美| 超碰av人人做人人爽久久| 国产精品一区www在线观看 | 日本与韩国留学比较| 亚洲va在线va天堂va国产| 亚洲成av人片在线播放无| 2021天堂中文幕一二区在线观| 一个人观看的视频www高清免费观看| 色av中文字幕| 午夜福利高清视频| 国产伦人伦偷精品视频| 国产高清三级在线| 亚洲自拍偷在线| 久9热在线精品视频| 免费看光身美女| 免费不卡的大黄色大毛片视频在线观看 | 此物有八面人人有两片| 欧美性猛交╳xxx乱大交人| 色尼玛亚洲综合影院| 日韩人妻高清精品专区| 国产黄色小视频在线观看| 精品久久久久久久久久久久久| 免费在线观看影片大全网站| 舔av片在线| 级片在线观看| 91午夜精品亚洲一区二区三区 | 中文字幕人妻熟人妻熟丝袜美| 不卡视频在线观看欧美| 国产精品免费一区二区三区在线| 如何舔出高潮| 午夜免费成人在线视频| 人妻少妇偷人精品九色| av在线蜜桃| 欧美成人性av电影在线观看| 成人美女网站在线观看视频| 午夜福利欧美成人| 国产精品美女特级片免费视频播放器| 亚洲精品一卡2卡三卡4卡5卡| 国国产精品蜜臀av免费| 欧美极品一区二区三区四区| 一区二区三区高清视频在线| 久久亚洲真实| 午夜视频国产福利| 久久久成人免费电影| 国产精品一区二区三区四区久久| 一级av片app| 国产一级毛片七仙女欲春2| 久久久久久国产a免费观看| 人妻久久中文字幕网| 一区二区三区高清视频在线| 亚洲精品影视一区二区三区av| 在线观看舔阴道视频| 长腿黑丝高跟| 亚洲av不卡在线观看| 日韩欧美 国产精品| а√天堂www在线а√下载| 亚洲人成网站高清观看| 午夜免费成人在线视频| 男人和女人高潮做爰伦理| 黄色配什么色好看| 亚洲精品粉嫩美女一区| 国产精品一区二区免费欧美| 3wmmmm亚洲av在线观看| 成人二区视频| 色在线成人网| 中文字幕精品亚洲无线码一区| av在线蜜桃| 最后的刺客免费高清国语| 亚洲经典国产精华液单| 国产伦人伦偷精品视频| 小蜜桃在线观看免费完整版高清| 88av欧美| 高清在线国产一区| 精品人妻视频免费看| 午夜精品久久久久久毛片777| 伦理电影大哥的女人| 国产精品日韩av在线免费观看| 国产av一区在线观看免费| 国产午夜精品久久久久久一区二区三区 | 亚洲欧美日韩高清专用| 日韩精品中文字幕看吧| 成人特级av手机在线观看| 亚洲人成网站高清观看| 一a级毛片在线观看| 久久久国产成人免费| 一区二区三区激情视频| 久久午夜福利片| 免费av不卡在线播放| 听说在线观看完整版免费高清| 精品国内亚洲2022精品成人| 99热网站在线观看| 亚洲av电影不卡..在线观看| 少妇人妻一区二区三区视频| 18禁黄网站禁片午夜丰满| 成人特级黄色片久久久久久久| 亚洲国产精品成人综合色| 在线播放无遮挡| 欧美一区二区国产精品久久精品| 免费在线观看日本一区| 99热网站在线观看| 午夜久久久久精精品| 男女做爰动态图高潮gif福利片| 欧美丝袜亚洲另类 | 性插视频无遮挡在线免费观看| 欧美人与善性xxx| 亚洲无线在线观看| 亚洲三级黄色毛片| 亚洲熟妇熟女久久| 一本精品99久久精品77| 最新中文字幕久久久久| 亚洲一区高清亚洲精品| 成人国产一区最新在线观看| 国产精品嫩草影院av在线观看 | 久久中文看片网| 黄色丝袜av网址大全| av国产免费在线观看| 国产视频内射| 亚洲真实伦在线观看| 中文字幕精品亚洲无线码一区| 日本免费一区二区三区高清不卡| 成人性生交大片免费视频hd| 久久精品91蜜桃| 欧美成人性av电影在线观看| 欧美+日韩+精品| 欧美一区二区亚洲| 国产探花极品一区二区| 黄色视频,在线免费观看| 国产精品永久免费网站| 色噜噜av男人的天堂激情| 高清毛片免费观看视频网站| 国产精品乱码一区二三区的特点| 久久久精品欧美日韩精品| 国产伦精品一区二区三区四那| 亚洲国产欧洲综合997久久,| 中文在线观看免费www的网站| 日本精品一区二区三区蜜桃| 亚洲av成人精品一区久久| 亚洲av免费在线观看| 国产又黄又爽又无遮挡在线| 91麻豆精品激情在线观看国产| 乱码一卡2卡4卡精品| 我的女老师完整版在线观看| 直男gayav资源| 久久精品国产亚洲av香蕉五月| 中文字幕人妻熟人妻熟丝袜美| 亚洲18禁久久av| 久久国产精品人妻蜜桃| 一进一出好大好爽视频| 精品久久久噜噜| 亚洲内射少妇av| 免费一级毛片在线播放高清视频| 亚洲国产欧美人成| 免费观看精品视频网站| 亚洲av成人av| 可以在线观看毛片的网站| 国产av不卡久久| 欧美最黄视频在线播放免费| 精品乱码久久久久久99久播| 亚洲男人的天堂狠狠| 日韩欧美精品v在线| 成人鲁丝片一二三区免费| av中文乱码字幕在线| 韩国av在线不卡| 97碰自拍视频| 又爽又黄无遮挡网站| 日韩精品有码人妻一区| 亚洲国产精品久久男人天堂| 黄片wwwwww| 成人亚洲精品av一区二区| 久久精品久久久久久噜噜老黄 | 成人二区视频| 草草在线视频免费看| 中文在线观看免费www的网站| 五月玫瑰六月丁香| 99热精品在线国产| 狂野欧美激情性xxxx在线观看| 中文资源天堂在线| 91在线精品国自产拍蜜月| 伦理电影大哥的女人| 一边摸一边抽搐一进一小说| 1000部很黄的大片| 一级黄片播放器| 亚洲欧美日韩无卡精品| 日本三级黄在线观看| 亚洲18禁久久av| 日日摸夜夜添夜夜添小说| 免费大片18禁| 国产精品98久久久久久宅男小说| 国产成人影院久久av| 国产高潮美女av| 色视频www国产| 国产免费av片在线观看野外av| 真实男女啪啪啪动态图|