沉思对首发抑郁症患者抗抑郁药物治疗效果的影响
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摘要
目的探讨沉思及其亚型冥思与反思对首发抑郁症患者接受抗抑郁药物治疗效果的影响。方法纳入75例首发抑郁症患者,接受抗抑郁药物治疗8周,治疗前后均采用17项汉密尔顿抑郁量表(Hamilton depression scale,HAMD)、沉思反应量表对抑郁症状和沉思进行评估,根据治疗后抑郁症状程度分为治愈组与未治愈组,比较两组在治疗前后的沉思差异以及基线期沉思对治疗效果的影响。结果经重复测量方差分析显示,患者HAMD、沉思以及冥思的分组主效应和时间主效应均有统计学意义(P<0.05),其中治愈组在治疗前后沉思及冥思评分均低于未治愈组,差异有统计学意义(P<0.05);未治愈组与治愈组HAMD、沉思、冥思与反思评分在治疗后均较治疗前降低(P<0.05)。阶层logistic回归分析示,治疗前沉思得分对治疗效果有预测作用(OR=1.008,95%CI:1.017~1.131);冥思得分对治疗效果有预测作用(OR=1.208,95%CI:1.065~1.371)。结论基线期沉思及冥思对首发抑郁症患者接受抗抑郁药物治疗后的疗效有一定程度的预测作用。
Objective To investigate whether baseline rumination and its subtypes predict the non-remitted depression in patients with first-episode depression. Methods Seventy-five patients with first-episode depression were recruited. All subjects were divided into remitted group and non-remitted group according to the severity of their depression after 8 weeks follow up. The measures included the 17-item Hamilton depression Rating Scale (HAMD) and Ruminative Response Scale (RRS). Hierarchical logistic regression models were conducted by using SPSS 19.0. Results Repeated measure ANOVA for the scores of HAMD, RRS and brooding showed that the main effect of time and the main effect of group were significant (P<0.05). The RRS and brooding scores were lower in remitted group than in nonremitted group before and after treatment (P <0.05). HAMD, RRS, brooding and reflection scores in two groups were significantly decreased after treatment (P <0.05). Baseline RRS predicted the non-remitted depression in patients with first-episode depression (OR=1.008, 95%CI: 1.017~1.131) at 8 weeks follow-up. Baseline brooding predicted the nonremitted depression in patients with first-episode depression at 8 weeks follow-up (OR=1.208,95%CI: 1.065~1.371).Conclusion Rumination and its brooding can predict the non-remitted depression in patients with first-episode depression.
Objective To investigate whether baseline rumination and its subtypes predict the non-remitted depression in patients with first-episode depression. Methods Seventy-five patients with first-episode depression were recruited. All subjects were divided into remitted group and non-remitted group according to the severity of their depression after 8 weeks follow up. The measures included the 17-item Hamilton depression Rating Scale (HAMD) and Ruminative Response Scale (RRS). Hierarchical logistic regression models were conducted by using SPSS 19.0. Results Repeated measure ANOVA for the scores of HAMD, RRS and brooding showed that the main effect of time and the main effect of group were significant (P<0.05). The RRS and brooding scores were lower in remitted group than in nonremitted group before and after treatment (P <0.05). HAMD, RRS, brooding and reflection scores in two groups were significantly decreased after treatment (P <0.05). Baseline RRS predicted the non-remitted depression in patients with first-episode depression (OR=1.008, 95%CI: 1.017~1.131) at 8 weeks follow-up. Baseline brooding predicted the nonremitted depression in patients with first-episode depression at 8 weeks follow-up (OR=1.208,95%CI: 1.065~1.371).Conclusion Rumination and its brooding can predict the non-remitted depression in patients with first-episode depression.
引文
[1]许秀峰.中国精神卫生调查心境障碍研究[Z].浙江杭州,2017:74.
[2]HAMLAT E J,CONNOLLY S L,HAMILTON J L,et al.Rumination and Overgeneral Autobiographical Memory in Adolescents:An Integration of Cognitive Vulnerabilities to Depression[J].J Youth Adolescence,2015,44(4):806-818.
[3]肖晶,何路宽,金晓雨,等.抑郁认知易感者认知策略与情绪调节特征[J].中华行为医学与脑科学杂志,2013,22(3):243-245.
[4]RAES F,HERMANS D.On the mediating role of subtypes of rumination in the relationship between childhood emotional abuse and depressed mood:brooding versus reflection[J].Depress Anxiety,2008,25(12):1067-1070.
[5]RUSH A J,KRAEMER H C,SACKEIM H A,et al.Report by the ACNP Task Force on Response and Remission in Major Depressive Disorder[J].Neuropsychopharmacol,2006,31(9):1841-1853.
[6]汪向东,王常林,马弘.心理卫生评定量表手册:增订版[M].北京:中国心理卫生杂志社,1999:101-108.
[7]王芹,朱熊兆,蚁金瑶,等.沉思反应量表中文版在抑郁障碍患者中的运用结果分析[J].神经疾病与精神卫生,2011,11(6):544-546.
[8]沙东想,孙玉军,徐建龙,等.首发与复发抑郁症患者的沉思比较[J].中华行为医学与脑科学杂志,2015,24(9):828-829.
[9]DI SIMPLICIO M,NORBURY R,HARMER C J.Short-term antidepressant administration reduces negative self-referential processing in the medial prefrontal cortex in subjects at risk for depression[J].Mol Psychiatry,2012,17(5):503-510.
[10]LOIS G,WESSA M.Differential association of default mode network connectivity and rumination in healthy individuals and remitted MDD patients[J].Soc Cogn Affect Neur,2016,11(11):1792-1801.
[11]郭俐利,徐成,相洁,等.首发重性抑郁障碍治疗前后静息态脑功能研究[J].中国神经精神疾病杂志,2013,39(11):646-650.
[12]THOMSEN D K,SCHNIEBER A,OLESEN M H.Rumination is associated with the phenomenal characteristics of autobiographical memories and future scenarios[J].Memory,2011,19(6):574-584.
[13]SUMNER J A.The mechanisms underlying overgeneral autobiographical memory:An evaluative review of evidence for the Ca R-FA-X model[J].Clin Psychol Rev,2012,32(1):34-48.
[14]柳艳松,周振和,王志强,等.轻性抑郁症患者抗抑郁药物治疗后概况化自传体记忆的特点[J].中国神经精神疾病杂志,2011,37(1):33-36.
[15]LIU Y,ZHANG F,WANG Z,et al.Overgeneral autobiographical memory at baseline predicts depressive symptoms at followup in patients with first-episode depression[J].Psychiat Res,2016,243:123-127.
[16]SCHOOFS H,HERMANS D,RAES F.Brooding and Reflection as Subtypes of Rumination:Evidence from Confirmatory Factor Analysis in Nonclinical Samples using the Dutch Ruminative Response Scale[J].J Psychopathol Behav Assess,2010,32(4):609-617.
[17]JOORMANN J,DKANE M,GOTLIB I H.Adaptive and Maladaptive Components of Rumination?Diagnostic Specificity and Relation to Depressive Biases[J].Behavior Therapy,2006,37(3):269-280.
[18]LIU Y,YU X,YANG B,et al.Rumination mediates the relationship between overgeneral autobiographical memory and depression in patients with major depressive disorder[J].BMCPsychiatry,2017,17(1):103.
[19]杨娟,章晨晨,姚树桥.高中生沉思与应激性生活事件对抑郁症状的影响:1年追踪研究[J].心理学报,2010,42(9):939-945.
[2]HAMLAT E J,CONNOLLY S L,HAMILTON J L,et al.Rumination and Overgeneral Autobiographical Memory in Adolescents:An Integration of Cognitive Vulnerabilities to Depression[J].J Youth Adolescence,2015,44(4):806-818.
[3]肖晶,何路宽,金晓雨,等.抑郁认知易感者认知策略与情绪调节特征[J].中华行为医学与脑科学杂志,2013,22(3):243-245.
[4]RAES F,HERMANS D.On the mediating role of subtypes of rumination in the relationship between childhood emotional abuse and depressed mood:brooding versus reflection[J].Depress Anxiety,2008,25(12):1067-1070.
[5]RUSH A J,KRAEMER H C,SACKEIM H A,et al.Report by the ACNP Task Force on Response and Remission in Major Depressive Disorder[J].Neuropsychopharmacol,2006,31(9):1841-1853.
[6]汪向东,王常林,马弘.心理卫生评定量表手册:增订版[M].北京:中国心理卫生杂志社,1999:101-108.
[7]王芹,朱熊兆,蚁金瑶,等.沉思反应量表中文版在抑郁障碍患者中的运用结果分析[J].神经疾病与精神卫生,2011,11(6):544-546.
[8]沙东想,孙玉军,徐建龙,等.首发与复发抑郁症患者的沉思比较[J].中华行为医学与脑科学杂志,2015,24(9):828-829.
[9]DI SIMPLICIO M,NORBURY R,HARMER C J.Short-term antidepressant administration reduces negative self-referential processing in the medial prefrontal cortex in subjects at risk for depression[J].Mol Psychiatry,2012,17(5):503-510.
[10]LOIS G,WESSA M.Differential association of default mode network connectivity and rumination in healthy individuals and remitted MDD patients[J].Soc Cogn Affect Neur,2016,11(11):1792-1801.
[11]郭俐利,徐成,相洁,等.首发重性抑郁障碍治疗前后静息态脑功能研究[J].中国神经精神疾病杂志,2013,39(11):646-650.
[12]THOMSEN D K,SCHNIEBER A,OLESEN M H.Rumination is associated with the phenomenal characteristics of autobiographical memories and future scenarios[J].Memory,2011,19(6):574-584.
[13]SUMNER J A.The mechanisms underlying overgeneral autobiographical memory:An evaluative review of evidence for the Ca R-FA-X model[J].Clin Psychol Rev,2012,32(1):34-48.
[14]柳艳松,周振和,王志强,等.轻性抑郁症患者抗抑郁药物治疗后概况化自传体记忆的特点[J].中国神经精神疾病杂志,2011,37(1):33-36.
[15]LIU Y,ZHANG F,WANG Z,et al.Overgeneral autobiographical memory at baseline predicts depressive symptoms at followup in patients with first-episode depression[J].Psychiat Res,2016,243:123-127.
[16]SCHOOFS H,HERMANS D,RAES F.Brooding and Reflection as Subtypes of Rumination:Evidence from Confirmatory Factor Analysis in Nonclinical Samples using the Dutch Ruminative Response Scale[J].J Psychopathol Behav Assess,2010,32(4):609-617.
[17]JOORMANN J,DKANE M,GOTLIB I H.Adaptive and Maladaptive Components of Rumination?Diagnostic Specificity and Relation to Depressive Biases[J].Behavior Therapy,2006,37(3):269-280.
[18]LIU Y,YU X,YANG B,et al.Rumination mediates the relationship between overgeneral autobiographical memory and depression in patients with major depressive disorder[J].BMCPsychiatry,2017,17(1):103.
[19]杨娟,章晨晨,姚树桥.高中生沉思与应激性生活事件对抑郁症状的影响:1年追踪研究[J].心理学报,2010,42(9):939-945.