1. Purpose and significance
(1) Neurological disorders occur frequently in the elderly and neurological disorders are prone to concomitant or co-morbid depression and anxiety disorders.
Cerebrovascular disease and stroke, cognitive dysfunction, Parkinson’s disease, multiple sclerosis, epilepsy, primary headache
(2) Co-morbidity makes the disease persistent and significantly increases the burden of disease and the outcome of recovery.
2. Summary
(1) Epidemiology
(2) Characteristics of depression and anxiety disorders associated with neurological diseases
(3) Common somatization of depressive/anxiety states in neurology
(4) Initial examination and recognition of depressive and anxiety states
(5) Treatment goals of depressive disorders
(6) Treatment of neurological depressive and anxiety disorders
(7) Drug interactions of antidepressants
3. Epidemiology
Cerebrovascular disease and post-stroke depression and anxiety disorders
(1) The incidence and prevalence of post-stroke depression (PSD) reported in various studies are highly variable.
(2) Some studies suggest that the peak incidence is 1 month after stroke, but some studies suggest that the peak incidence is 3-6 months after stroke
(3) Community studies: 33% for PSD in the acute phase of stroke and 34% in the chronic phase
(4) Hospital studies: 36% in the acute phase, 32% in the recovery phase and 34% in the chronic phase of stroke
(5) In our study, PSD was found to be 39% at 1 month, 53% at 3-6 months and 24% at 1 year after stroke.
Cognitive dysfunction with depression and anxiety disorders
(1) Depressive disorders are mostly seen in the pre-dementia or early dementia period, and some studies suggest that depression is a prodromal symptom or risk factor for dementia
(2) The rate of conversion to dementia is twice as high in patients with cerebrovascular disease who are depressed as in those without depression
(3) The prevalence of dementia with depression can reach 75%, generally about 30% to 50%.
(4) The prevalence of depressive symptoms in people with VaD or VCI is about 40% to 60%.
(5) The cumulative prevalence of depression in cerebrovascular disease is about 26%.
Parkinson’s disease (PD) with depressive and anxiety disorders
(1) The prevalence of depressive disorders in PD patients ranges from 8% to 76%, with an average of 25% to 40%.
(2) About 40% of patients have anxiety disorders
(3) Some studies suggest that depression and anxiety disorders may precede motor symptoms in patients
Multiple sclerosis (MS) with depressive and anxiety disorders
(1) Lifetime prevalence is nearly 50%, three times that of the general population
(2) A community questionnaire study found that 41% of patients were depressed, of which 29% were moderately to severely depressed.
(3) Investigation of the cause of death of 3,000 MS patients over 16 years old showed that 15% of them died of suicide.
(4) Epidemiological findings showed that 35.7% of patients had a combination of anxiety, of which 18.6% had generalized anxiety and 10% had panic attacks.
Epilepsy with depression and anxiety disorders
(1) The prevalence of depression was 50% to 55%.
(2) In hospitalized patients, the prevalence of depression was 10% and 20% in well-controlled patients, and 2O% and 60% in poorly controlled patients, respectively
(3) The prevalence of interictal anxiety disorder in patients with epilepsy ranged from 10% to 25%.
Primary headache with depression and anxiety disorder
(1) The primary headache outpatient survey found that 27% of patients had moderate-to-severe depression, including 17.1% in migraine, 36.1% in transformed migraine, and 28.3% in tension-type headache (TTH).
(2) The lifetime prevalence of depressive disorders in migraineurs is about 30% to 80%, which is 3-4 times higher than that of the general population. Also, susceptible to anxiety disorders such as panic and obsessive-compulsive.
(3) Those with migraine with aura and transformed migraine have a higher rate of concomitant attacks. (3) The prevalence of depression and anxiety disorders is higher in migraineurs with aura and transformed migraineurs, and up to 2/3 in those with frequent and chronic TTH.
(4) In a survey of adolescents with chronic headache, 30% had depressive disorders (21% for depression), 36% had anxiety disorders, and 20% were at high risk of suicide
4.Characteristics of depressive and anxiety disorders associated with neurological disorders.
(1) depressive disorder – a class of mood or affective disorders caused by various causes with significant and persistent depression as the main characteristic.
(2) anxiety disorder – a kind of internal tension and anxiety, foreboding seems to happen some kind of adverse situation and difficult to cope with the unpleasant emotions.
5.The main clinical manifestations of depression disorder
(1) core symptoms
Depressed mood, loss of interest, loss of pleasure, persistent fatigue
(2) Other symptoms.
(1) sleep disorder
(2) Somatic symptoms: various pains, loss of appetite, gastrointestinal symptoms
(3) Anxiety or agitation symptoms
(4) Memory loss and difficulty concentrating
6.The main clinical manifestations of anxiety disorders
①Excessive anxiety
②Anxious: often, for no reason, feel upset
③Tension and anxiety: often feel tense and cannot relax
④ Excessive worry
⑤ always feel distracted and overly worried about trivial matters
7. Identification and diagnosis of depression and anxiety states
(1) Ask if the following emotional symptoms are present.
Depressed mood; lack of pleasure and interest; anxiety such as restlessness
(2) Ask if the following somatic symptoms are present.
Sleep disturbance; headache, dizziness; tiredness, fatigue, fatigue; memory loss, inattention; appetite and weight problems; panic, shortness of breath, excessive sweating