小结
定义
病史和体格检查
关键诊断因素
- 存在的危险因素
- 情绪低落
- 兴趣缺乏
- 功能缺损
其他诊断因素
- 体重改变
- 性欲改变
- 睡眠障碍
- 运动变化
- 精力不足
- 过度自罪
- 注意力不集中
- 自杀观念
- 除外双相情感障碍
- 除外物质滥用/药物副作用
- 除外躯体疾病
- 除外精神分裂症
危险因素
- 出生后状态
- 个人既往病史或家族史中曾有抑郁发作或自杀
- 痴呆
- 皮质类固醇
- 干扰素
- 普萘洛尔
- 口服避孕药
- 共存的内科疾病
- 女性
- 共患精神活性物质滥用
- 人格障碍
- 应激性生活事件
- 肥胖
诊断性检查
首要检查
- 临床诊断
- 生化检查
- 全血细胞计数（FBC）
- 甲状腺功能检测
- 患者健康问卷-2 (PHQ-2)
- 患者健康问卷-9 (PHQ-9)
- 爱丁堡产后抑郁量表 (Edinburgh Postnatal Depression Scale)
- 老年抑郁量表
- 康奈尔痴呆抑郁量表 (Cornell Scale for Depression in Dementia)
需考虑的检查
- 24 小时游离皮质醇
- 维生素 B12
- 叶酸
治疗流程
重度抑郁、非妊娠：精神病、自杀、, 阻碍日常生活活动的严重精神运动迟缓、紧张性抑郁障碍，或严重躁动
中度抑郁症，非妊娠：严重症状、明显的障碍，但没有精神病症状，没有自杀意念，没有严重的精神运动迟缓或躁动。
轻度抑郁症，非妊娠：低至中度严重症状、部分受损、无精神病症状、无自杀意念、无精神运动迟缓或躁动
治疗抵抗性/难治性抑郁症
妊娠
治疗有反应
对治疗有反应
复发性抑郁
撰稿人
作者
Dean F. MacKinnon, MD
Associate Professor
Psychiatry and Behavioral Sciences
The Johns Hopkins Hospital
Baltimore
MD
利益声明
DFM declares that he has no competing interests.
鸣谢
Dr Dean F. MacKinnon would like to gratefully acknowledge Dr Roger S. McIntyre, Dr Tonya Fancher, and Dr Richard Kravitz, the previous contributors to this topic.
利益声明
RSM has received research funds from Stanley Medical Research Institute and National Alliance for Research on Schizophrenia and Depression (NARSAD). RSM is on the advisory board for AstraZeneca, Bristol-Myers Squibb, France Foundation, GlaxoSmithKline, Janssen-Ortho, Solvay/Wyeth, Eli Lilly, Organon, Lundbeck, Biovail, Pfizer, Shire, and Schering-Plough. RSM is on the Speakers Bureau for Janssen-Ortho, AstraZeneca, Eli Lilly, Lundbeck, Biovail, and Wyeth. RSM has received research grants from Eli Lilly, Janssen-Ortho, Shire, and AstraZeneca. RSM has received travel funds from Bristol-Myers Squibb. TF declares that she has no competing interests. RK has received research grants from Pfizer on non-depression-related topics.
同行评议者
Scott McAfee, MD
Director
Residency Training
St Vincent's Hospital
Manhattan
NY
利益声明
SM declares that he has no competing interests.
Dietmar Winkler, MD
Department of Psychiatry and Psychotherapy
Medical University of Vienna
Vienna
Austria
利益声明
DW has received lecture fees from CSC Pharmaceuticals, GlaxoSmithKline, and Pfizer, and has served as a consultant for GlaxoSmithKline.
内容使用需遵循免责声明