Rehabilitative therapy for the elderly chronic somatic disease complicated with depression
- VernacularTitle:老年慢性躯体疾病合并抑郁症的康复治疗
- Author:
Qin XIA
;
Jing WANG
;
Kai ZHENG
- Publication Type:Journal Article
- From:
Chinese Journal of Tissue Engineering Research
2006;10(14):166-168
- CountryChina
- Language:Chinese
-
Abstract:
BACKGROUND: There is a complicated relation between somatic disease and mental disorder. Somatic disease may induce functional disorder of brain, and generate psychiatric symptoms due to the change of psychological and social environment. The proportion of depression in elder people based on the chronic somatic disease is much higher, and thus the fatality of them increases.OBJECTIVE: To investigate the influence of single antidepressant, and therapeutic alliance of psychological and drug treatment on the rehabilitation of patients with elderly chronic somatic disease complicated with depression. DESIGN: Randomized and controlled grouping experiment.SETTING: Department of Senile Disease of Tongji Hospital Affiliated to Huazhong University of Science and Technology.PARTICIPANTS: Totally 102 patients were hospitalized in the Department of Senile Disease of Tongji Hospital Affiliated to Huazhong University of Science and Technology from March 2000 to January 2003, and all the patients had sleep disorder to a different extent, and suffered from symptoms of heart and alimentary tract which could not be explained as organic diseases, and chronic pain or systemic symptom. Their score of Zung scale was ＞ 40 points with average of (48.83±4.15)points. The patients were randomly divided into the drug group (n=46) and the combined treatment group (n=56). Each patient had more than two somatic symptoms in the two groups and more than 81.0% of them had three somatic symptoms. METHODS: According to the different primary diseases in patients of the two groups, regular treatment was given routinely. Oral thymoleptics fluoxetine of 20 mg/d 5-hydroxyltryptamine reuptake restrainer with 20 mg/d was administered, the dose of which could be added to 40 mg/d according to the pathogenetic conditions. At the beginning of the administration of oral antidepressant drugs, the patients in the combined treatment group were The focal point of depression and fear was identified, and the comfort and edge related to the disease was supplied, and the pathogenetic condition and the prognosis were told to the patients objectively. The family and society were encouraged to learn the rehabilitative skill and improve their possible, and the family and society were encouraged to give the patients adequate psychological support and life support. The patient and the family were assisted to establish favorable communication. The feeling of loneliness and isolation was reduced, and the sense of safety was increased. The depression status and the quality of life of the patients in the two groups were evaluated before the treatment and at 2 and 8 weeks after treatment with the Zung scale and the Spitzer quality of life index score (QLI), including 5 aspects: Activity, daily life, health, support and perspective. The highest score was 10 points. The lowest was 0, and the higher the score, the better the quality of life is.MAIN OUTCOME MEASURES: The results of the Zung scale and the QLI score evaluated before the treatment and at 2 and 8 weeks after the treatment.RESULTS: The treatment of the patients in the two groups was all finZung scale in the drug group and the combined treatment group at 2 weeks after the treatment indicated that there was significant difference in comparison with those before the treatment (41.12±2.60,48.83±4.15,t =10.67,P ＜ 0.05); (40.88±3.43,49.03±4.21 ,t=11.24,P ＜ 0.05). There was not significant difference in group comparison. The total points of Zung scale at 8 weeks were significantly decreased (36.11 ±2.87 ), (30.71±3.62),and there was significant difference in comparison with that before the treatment. The combined treatment group was better than the drug group in difference of QLI score at 2 weeks between the drug group and combined treatment group before and after the treatment (5.47 ± 1.33,5.32 ± 1.04,5.55±1.18,5.27±1.35). The QLI score of drug group and combined treat ment group at 8 weeks after treatment began to rise 7.21±0.13 and 8.83 ±0.32 ,respectively, and there was significant difference in comparison withthose before the treatment, and there was also significant difference in group comparison.CONCLUSION: The positive and effective combined therapy of anti-depression significantly improved the somatic symptoms of patients, no complications appeared, and most patients presented optimistic attitude to the prognosis of the primary disease. To identify the depression of elder people in earlier period is very important to promote rehabilitation of the primary disease.
