Personality pathology and outcome in recurrently depressed women over 2 years of maintenance interpersonal psychotherapy
Personality pathology and outcome in recurrently depressed women over 2 years of maintenance interpersonal psychotherapy
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DOI：
10.1017/s0033291703001661
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发表时间：
2004-05-01
影响因子：
6.9
通讯作者：
Kupfer, DJ
中科院分区：
文献类型：
--
作者：
Cyranowski, JM;Frank, E;Kupfer, DJ
背景。关于人格病理学对抑郁症急性治疗结果影响的经验数据好坏参半，部分原因是在患者处于活跃情绪发作时评估类似人格模式带来的挑战。据我们所知，以前没有研究检验过人格病理对维持治疗结果的影响。维持治疗是指为预防抑郁症缓解患者复发而提供的长期治疗。对125名急性情绪发作持续缓解后和进入维持治疗前的复发性抑郁症妇女进行DSM-III-R人格障碍（SCID-II）的结构化临床访谈。然后在维持人际心理治疗1年和2年后重复SCID-II访谈。在维持前评估中，21.6%的样本符合SCID-II型人格障碍标准。共病人格病理与发病年龄较早、既往抑郁发作较多、更需要辅助药物治疗以缓解急性情绪发作有关。共病人格病理学预测，在2年的维持治疗过程中，抑郁复发率更高，复发时间更短。值得注意的是，在那些没有抑郁的患者中，持续的人格病理水平在两年的维持治疗过程中稳步下降。结果强调了对人格障碍固有的发作性情绪障碍和发作间人际功能障碍进行早期有效干预的必要性。未来的维持治疗试验需要阐明情景性情绪障碍和人格功能之间的关系。
Background. Empirical data on the impact of personality pathology on acute treatment outcome for depression are mixed, in part because of challenges posed by assessing trait-like personality patterns while patients are in an active mood episode. To our knowledge, no previous study has examined the effect of personality pathology on maintenance treatment outcome. By maintenance treatment we refer to long-term treatment provided to prevent depression recurrence among remitted patients.Method. Structured Clinical Interviews for the DSM-III-R Personality Disorders (SCID-II) were obtained on a sample of 125 recurrently depressed women following sustained remission of the acute mood episode and prior to entering maintenance treatment. SCID-II interviews were then repeated following 1 and 2 years of maintenance interpersonal psychotherapy.Results. At the pre-maintenance assessment, 21.6% of the sample met SCID-II personality disorder criteria. Co-morbid personality pathology was related to an earlier age of onset, more previous depressive episodes, and a greater need for adjunctive pharmacotherapy to achieve remission of the acute mood episode. Co-morbid personality pathology predicted both higher rates of depression recurrence and a shorter time to recurrence over the 2-year course of maintenance treatment. Notably, among those patients who remained depression-free, continuous levels of personality pathology steadily declined over the 2-year course of maintenance therapy.Conclusions. Results highlight the need for early and effective intervention of both episodic mood disorder and inter-episode interpersonal dysfunction inherent to the personality disorders. Future maintenance treatment trials are needed to clarify the relationship between episodic mood disorder and personality function over time.