Hopelessness and suicidal ideation in outpatients with treatment-resistant depression: Prevalence and impact on treatment outcome
Hopelessness and suicidal ideation in outpatients with treatment-resistant depression: Prevalence and impact on treatment outcome
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DOI：
10.1097/01.nmd.0000081591.46444.97
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发表时间：
2003-07-01
影响因子：
1.9
通讯作者：
Nierenberg, AA
中科院分区：
文献类型：
--
作者：
Papakostas, GI;Petersen, T;Nierenberg, AA
抑郁和绝望是自杀的危险因素。本研究旨在探讨难治性抑郁症（TRD）门诊患者的自杀意念及绝望程度，并探讨自杀意念及绝望对去甲替林（NT）治疗的影响。89名TRD患者进入为期6周的NT公开试验，在筛查访问期间使用汉密尔顿抑郁评定量表（HAM-D）第3和第30项评估自杀意念和绝望程度。其中40名患者在筛查访问期间还完成了贝克绝望指数（BHI）。在单独的逻辑回归中，BHI和两个HAM-D项目的得分随后被测试为对6周NT试验的临床反应的预测因子，控制抑郁的严重程度。超过一半的患者报告说，他们有死亡的想法或愿望，而且极度绝望。在完成治疗前，更大程度的绝望，反映在HAM-D项目#30的得分上，预测了对NT的反应。超过一半的患者在完成试验后有明显的绝望反应。TRD患者更有可能报告有明显的自杀意念和绝望。此外，NT（一种相对去肾上腺素能的三环类抗抑郁药）为期6周的临床试验，可能对那些对几种抗抑郁药无效且报告有明显绝望感的患者特别有用。
Depression and hopelessness are risk factors for suicide. The purpose of this study was to examine the extent of suicidal ideation and hopelessness in outpatients with treatment-resistant depression (TRD) and to study the impact of suicidal ideation and hopelessness on treatment with nortriptyline (NT). The degree of suicidal ideation and hopelessness was assessed during the screen visit with the use of items #3 and #30 of the Hamilton Depression Rating Scale (HAM-D) in 89 patients with TRD who entered a 6-week open trial of NT. Forty of these patients also completed the Beck Hopelessness Index (BHI) during the screen visit. In separate logistic regressions, the scores from the BHI and the two HAM-D items were then tested as predictors of clinical response to the 6-week trial with NT, controlling for the severity of depression. More than half of patients reported thoughts or wishes of death to self and significant hopelessness. A greater degree of hopelessness before treatment in completers, reflected by the score on the HAM-D item #30, predicted response to NT. More than half of patients with prominent hopelessness who completed the trial responded. Patients with TRD are more likely than not to report prominent suicidal ideation and hopelessness. Furthermore, a full 6-week trial of NT, a relatively noradrenergic tricyclic antidepressant, may be particularly useful in patients who have failed to respond to several antidepressants and also report significant hopelessness.