Remission and relapse after the first hospital admission in psychotic depression: a 4-year naturalistic follow-up
Remission and relapse after the first hospital admission in psychotic depression: a 4-year naturalistic follow-up
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DOI：
10.1017/s0033291707000141
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发表时间：
2007-08-01
影响因子：
6.9
通讯作者：
Carlson, Gabrielle A.
中科院分区：
文献类型：
--
作者：
Naz, Bushra;Craig, Thomas J.;Carlson, Gabrielle A.
背景很少有研究调查在首次住院时确诊的严重抑郁症患者的病程。使用萨福克县心理健康项目（SCMHP）的数据，我们调查了具有精神病特征的重性抑郁症（MDD）首次入院队列4年内首次完全缓解和首次复发的时间和预测因素。方法。该队列纳入了87名首次入院的患者，这些患者纵向一致诊断为MDD，具有精神病特征，并对其进行了4年的系统随访。我们采用考克斯回归分析研究了背景、临床和治疗因素以及抗抑郁药（AD）和抗精神病药（AP）使用的时变指数与缓解和复发时间的相关性。到4年随访时，60名受访者（69.0%）已达到完全缓解期（缓解者的中位时间为22周，全样本为54周）。在多变量分析中，较长的缓解时间与首次发作和住院之间的较长潜伏期、较低的院前总体功能评估（GAF）评分和缺乏保险相关，但与药物使用无关。26例缓解者（43.3%）复发（复发者中位时间为50周，所有缓解者中位时间为192周）。无危险因素或随时间变化的药物变量与复发时间显著相关。只有三分之二的样本在4年内至少有一次完全缓解，几乎一半的人随后复发。有效的院前资源预测缓解，但不是复发。随访期间的药物使用与缓解或复发无关。
Background. Few studies have examined the course of illness among severely depressed patients ascertained at first hospitalization. Using data from the Suffolk County Mental Health Project (SCMHP), we investigated the times to and predictors of the first full remission and the first relapse during a 4-year period in a first-admission cohort with major depressive disorder (MDD) with psychotic features.Method. The cohort included 87 county-wide, first-admission patients with a longitudinal consensus diagnosis of MDD with psychotic features who were systematically followed over a 4-year period. We examined the associations of background, clinical and treatment factors, and time-varying indices of antidepressant (AD) and antipsychotic (AP) medication use to time to remission and relapse using Cox regression.Results. By the 4-year follow-up, 60 respondents (69.0 %) had achieved a period of full remission (median time of 22 weeks among remitters and 54 weeks in the full sample). In the multivariable analysis, longer time to remission was associated with longer latency between initial episode and hospitalization, lower pre-hospital Global Assessment of Functioning (GAF) score, and lack of insurance, but not use of medication. Twenty-six remitters (43.3%) relapsed (median time of 50 weeks among those who relapsed and 192 weeks among all remitters). None of the risk factors or time-varying medication variables was significantly associated with time to relapse.Conclusion. Only two-thirds of the sample had at least one full remission by 4 years, and almost half of them subsequently relapsed. Poorer pre-hospital resources predicted remission but not relapse. Medication use over the follow-up was not associated with remission or relapse.