Executive Functioning at Baseline Prospectively Predicts Depression Treatment Response.
Executive Functioning at Baseline Prospectively Predicts Depression Treatment Response.
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DOI：
10.4088/pcc.16m01949
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发表时间：
2017-02-09
影响因子：
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通讯作者：
Langenecker, Scott A
中科院分区：
文献类型：
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作者：
Dawson, Erica L;Caveney, Angela F;Langenecker, Scott A
目的：迄今为止，治疗反应的现有认知和临床预测因子的强度不足以有意义地影响治疗决策，并且不容易在临床环境中使用。本研究调查了是否临床和认知标记物在三级保健诊所使用可以预测响应通常的治疗在一个为期4至6个月的样本中的75抑郁adultes.METHODS：患者（N = 384）进行了连续测试，在2个半天的诊所作为一个质量改进项目的一部分，在门诊三级保健中心在2003年8月和2007年9月之间;还包括2007年至2009年在诊所接受评估的其他受试者。诊断是根据DSM-IV-TR标准，并完成了居民和参加教师。在计算机神经心理学筛查电池的摄入量访问获得的测试分数是参数去/不去任务和面部情绪知觉任务。在随访时使用9项患者健康问卷（PHQ-9）自我评定评估治疗结局（n = 75）。住院治疗包括精神药物和心理治疗。PHQ-9评分下降预测的基础上，基线PHQ-9评分和教育，神经心理学变量进入第二step.RESULTS：PHQ-9评分下降了46%，在后续（56%应答者）。使用两步多元回归，基线PHQ-9评分（P ≤.05）和教育程度（P ≤.01）是PHQ-9随访评分百分比变化的显著第1步预测因素。在模型的第2步中，更快的处理速度和干扰分辨率（go反应时间）独立地解释了第1步中变量的显著差异（12%的方差，P <0.01），而其他认知和情感技能则没有。该2步模型解释了PHQ-9评分治疗变化方差的28%。处理速度与干扰分辨率也占12%的方差在治疗和后续attration.Conclusions：在诊所使用执行功能评估可能有助于识别个人的认知能力不足的风险，不响应标准治疗。
OBJECTIVE: Existing cognitive and clinical predictors of treatment response to date are not of sufficient strength to meaningfully impact treatment decision making and are not readily employed in clinical settings. This study investigated whether clinical and cognitive markers used in a tertiary care clinic could predict response to usual treatment over a period of 4 to 6 months in a sample of 75 depressed adults.METHODS: Patients (N = 384) were sequentially tested in 2 half-day clinics as part of a quality improvement project at an outpatient tertiary care center between August 2003 and September 2007; additional subjects evaluated in the clinic between 2007 and 2009 were also included. Diagnosis was according to DSM-IV-TR criteria and completed by residents and attending faculty. Test scores obtained at intake visits on a computerized neuropsychological screening battery were the Parametric Go/No-Go task and Facial Emotion Perception Task. Treatment outcome was assessed using 9-item Patient Health Questionnaire (PHQ-9) self-ratings at follow-up (n = 75). Usual treatment included psychotropic medication and psychotherapy. Decline in PHQ-9 scores was predicted on the basis of baseline PHQ-9 score and education, with neuropsychological variables entered in the second step.RESULTS: PHQ-9 scores declined by 46% at follow-up (56% responders). Using 2-step multiple regression, baseline PHQ-9 score (P ≤ .05) and education (P ≤ .01) were significant step 1 predictors of percent change in PHQ-9 follow-up scores. In step 2 of the model, faster processing speed with interference resolution (go reaction time) independently explained a significant amount of variance over and above variables in step 1 (12% of variance, P < .01), while other cognitive and affective skills did not. This 2-step model accounted for 28% of the variance in treatment change in PHQ-9 scores. Processing speed with interference resolution also accounted for 12% variance in treatment and follow-up attrition.CONCLUSIONS: Use of executive functioning assessments in clinics may help identify individuals with cognitive weaknesses at risk for not responding to standard treatments.