综合医院老年住院患者情感障碍的识别

Recognition of mood disorders in elderly inpatients in a general hospital

摘要:

目的 探讨对综合医院老年病房住院老年患者进行老年综合评估与精神科医师会诊相结合的方式对情感障碍的识别作用。方法 某三级甲等医院老年病房2011年8月至2013年3月收治的≥65岁老年住院患者，在入院时进行包括Zung抑郁自评量表（SDS）和老年抑郁量表（GDS）15项在内的老年综合评估，由老年科医师决定是否进行多学科团队查房及精神科医师会诊。精神科医师根据国际疾病分类第10版（ICD-10）标准诊断情感障碍。结果 研究期间共收治≥65岁老年住院患者281例，年龄（75.2±6.8）岁，男︰女为136︰145，其中49例（17.4%）患者罹患情感障碍，年龄（73.5±6.0）岁，男︰女为16︰33，其中抑郁发作39例，恶劣心境障碍5例，双相情感障碍2例，复发性抑郁2例，未特定抑郁障碍（NOS）1例，情感障碍患病率17.4%。确诊的49例患者中，提请精神科会诊的第一位原因分别为：有相关病史7例，医师注意到患者有情绪问题23例，失眠2例，存在疾病不能解释的躯体症状5例，量表筛查阳性12例。结论 情感障碍是老年住院患者常见的精神疾患，采用老年综合评估与精神科医师会诊相结合的方式有利于识别老年情感障碍，是一种值得推广的老年精神医学服务模式。

Abstract:

Objective To determine the efficacy of comprehensive geriatric assessment combined with psychiatric consultation on the recognition of mood disorders in general hospitals. Methods Elderly inpatients (over 65 years old) admitted to a geriatrics ward in a class AAA general hospital from August 2011 to March 2013 were assessed with comprehensive geriatric assessment [Zung’s Self-rated Depression Scale (SDS) and Geriatric Depression Scale (GDS) -15) at admission. Geriatric interdisciplinary team services and psychiatric consultation were offered when it was necessary. Mood disorders were diagnosed by a psychiatrist according to International Classification of Diseases-10 (ICD-10) criteria. Results Two hundreds and eighty-one patients over 65 years were enrolled during the study. They were 136 males and 145 females, with a mean age of (75.2±6.8) years. Forty-nine out of them were identified with mood disorders (the point prevalence of mood disorders was 17.4%), including 16 males and 33 females, with a mean age of (73.5±6.0) years. Among these 49 patients, 39 were depressive episodes, 5 dysthymic disorders, 2 bipolar disorders, 2 recurrent depressive disorders, and 1 depression disorder not otherwise specified (NOS). For these patients, the primary reasons asking for psychiatric consultation were relevant illness history in 7 patients, abnormal emotion recognized by the doctors in 23 patients, sleep problems in 2 patients, medical unexplained symptoms in 5 patients, and positive results in depression screening scales in 12 patients. Conclusion Mood disorders are very common mental disease in the elderly inpatients. Combining comprehensive geriatric assessment and psychiatric consultation is very efficient in the recognition of mood disorders in the elderly, which is a service model worthy of being popularization in more general hospital settings for geriatric psychological medicine.