周全性老年評估個案報告：一位合併重鬱症及修格蘭氏症候群的66歲老年女性

Comprehensive Geriatric Assessment of a 66-Year-Old Female Patient with Major Depressive Disorder and Sjögren's Syndrome: A Case Report

魏宇祥(Yu-Hsiang Wei) ； 林玟玓(Wen-Ti Lin) ； 顏啟華(Chi-Hua Yen)

《台灣老年醫學暨老年學會雜誌》 15卷1期 (2020/02) Pp. 39-53

https://doi.org/10.29461/TGGa.202002_15(1).0004

摘要

修格蘭氏症候群（Sjögren's syndrome）是一種慢性自體免疫疾病，在全球的盛行率為0.1%至4.8%不等，而臺灣的研究則約為0.16%。臨床症狀以外分泌腺體侵犯為主要症狀，如口乾、眼睛乾澀、或是唾液腺腫大等；腺體外器官如皮膚、關節、神經或是內分泌系統也可能受到影響，而這些身體上的不適，除了病患生活品質變差外，有些研究發現亦會造成焦慮或是憂鬱症。本個案為一位於半年前確診重度憂鬱症之六十六歲女性病患，近半年因出現口腔乾燥、上腹部不適、眼睛乾燥等症狀，造成病患憂鬱症狀加劇，並產生自我傷害的意圖。住院後發現除憂鬱症之外，病人亦被診斷有修格蘭氏症候群及亞臨床甲狀腺低下。周全性老年評估發現患者因上述疾病，導致近期功能急速下降以及營養狀況不佳。透過跨領域的醫療團隊介入，針對重度憂鬱症合併亞臨床甲狀腺低下和修格蘭氏症候群的案例，提供個人化的建議、對新診斷開立相關用藥、原有身心科藥物進行劑量調整、再加上飲食衛教，最終成功協助病患控制疾病，改善生活品質。

關鍵字

周全性老年評估 ； 重度憂鬱症 ； 亞臨床甲狀腺低下 ； 修格蘭氏症候群

並列摘要

Sjögren's syndrome is a chronic autoimmune disease mainly affecting exocrine glands with a prevalence ranging from 0.1% to 4.8%. In Taiwan, the prevalence is about 0.16% according to a study. Clinical manifestations are mainly sicca symptoms such as xerostomia, dry eyes, or salivary glands swelling. In extraglandular manifestations, skin, joint, nerves, or endocrine systems might also be affected. These physical discomforts not only worsen patients' quality of life but also trigger anxiety or depression as in some cases. In this paper, we presented a 66-year-old female patient with newly diagnosed major depressive disorder during out-patient follow-up that began six months ago. She had multiple somatic complaints like xerostomia, epigastric discomfort, and dry eyes and profound depression led to the attempt of self-harm during these 6 months, We conducted a comprehensive geriatric assessment which revealed a decreased score on Lawton-Brody IADL scale and malnutrition. New medication was then administered and individualized treatment plan developed and implemented for the elderly patient with major depressive disorder, subclinical hypothyroidism, and Sjögren's syndrome. With further medication adjustment and diet education, we were able to help the patient have a better treatment of diseases and quality of life.

並列關鍵字

comprehensive geriatric assessment ； major depressive disorder ； subclinical hypothyroidism ； Sjögren's syndrome