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中国视角下的失眠抑郁共病
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Abstract:
失眠症和抑郁症是全球性的重大公共卫生问题，会严重限制社会心理功能和降低生活质量。然而，中国精神卫生现状面临精神障碍患病率高但就诊率低，难治性精神障碍比例高但药物反应差以及精神卫生资源和服务能力不足等问题，因此迫切需要对这个精神卫生疾病进行回顾总结。本综述的目的是简要回顾有关失眠症、抑郁症和失眠抑郁共病的研究以总结中国国情下这些疾病的特点。总的来说，失眠抑郁共病是生物、心理和社会因素共同作用的结果，炎症因子假说、心理社会因素假说、遗传相关性假说、神经生物学机制假说(神经递质系统、神经内分泌系统和神经免疫机制)等机制可充分解释这一现象。阴阳失衡、脏腑失调被认为是其中医病机。具有中国特色的医疗手段——针灸和中草药被证明可通过上述途径治疗失眠抑郁共病，但多项证据表明中西医结合治疗可实现优势互补从而发挥更好的疗效。
Insomnia and depression are major global public health problems that can severely limit psychosocial functioning and reduce quality of life. However, the current state of mental health in China faces high prevalence of mental disorders but low consultation rates, a high proportion of refractory mental disorders but poor medication response, and insufficient mental health resources and service capacity; therefore, there is an urgent need to review and summarize this mental health disorder. The purpose of this review is to briefly review studies on insomnia, depression and insomnia-depression co-morbidity to summarize the characteristics of these disorders in the Chinese context. In general, insomnia-depression co-morbidity is the result of a combination of biological, psychological, and social factors, which can be adequately explained by mechanisms such as the inflammatory factor hypothesis, the psychosocial factor hypothesis, the genetic correlation hypothesis, and the hypothesis of neurobiological mechanisms (neurotransmitter system, neuroendocrine system, and neuroimmune mechanisms). Imbalance of yin and yang and disorder of internal organs are considered to be the mechanism of Chinese medicine. Acupuncture and Chinese herbal medicine, medical tools with Chinese characteristics, have been shown to treat insomnia and depression co-morbidities through the above pathways, but evidence suggests that a combination of Chinese and Western medicine can complement each other’s strengths to achieve better efficacy.
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