The impact of medical comorbidity on acute treatment in major depressive disorder
The impact of medical comorbidity on acute treatment in major depressive disorder
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DOI：
10.1176/appi.ajp.160.12.2122
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发表时间：
2003-12-01
影响因子：
17.7
通讯作者：
Fava, M
中科院分区：
文献类型：
--
作者：
Iosifescu, DV;Nierenberg, AA;Fava, M
目的：探讨医学共病对重度抑郁症患者抗抑郁治疗急性期的影响。方法：384例符合DSM-III-R重性抑郁症标准的门诊患者，采用氟西汀20mg /d进行8周开放治疗。作者使用累积疾病评定量表来衡量医疗共病的负担，并使用17项汉密尔顿抑郁评定量表来评估抑郁症状的变化。结局指标为治疗反应（评分降低大于或等于50%）和临床缓解（试验结束时评分小于或等于7）。结果：与氟西汀应答者相比，无应答者的累积疾病评定量表得分明显更高，并且更多的累积疾病评定量表类别得到认可。与接受抗抑郁药物治疗后病情缓解的受试者相比，未获得缓解的受试者的累积疾病评定量表得分明显更高，并且更多的累积疾病评定量表类别得到认可（即，更多的器官受到医学疾病的影响）。最终汉密尔顿抑郁量表得分与累积疾病评定量表总分和累积疾病评定量表认可的类别数直接相关。结论：内科疾病总负担和受内科疾病影响的器官系统数量对重度抑郁症治疗急性期临床转归具有显著负向预测价值。
Objective: The authors investigated the impact of medical comorbidity on the acute phase of antidepressant treatment in subjects with major depressive disorder.Method: A total of 384 outpatients meeting DSM-III-R criteria for major depressive disorder enrolled in 8-week open treatment with fluoxetine, 20 mg/day. The authors used the Cumulative Illness Rating Scale to measure the burden of medical comorbidity and the 17-item Hamilton Rating Scale for Depression to assess changes in depressive symptoms. The outcome measures were response to treatment (greater than or equal to50% reduction in score) and clinical remission (score less than or equal to7 at the end of the trial).Results: Compared to responders to fluoxetine, nonresponders had significantly higher Cumulative Illness Rating Scale scores and a greater number of Cumulative Illness Rating Scale categories were endorsed. Compared to subjects who achieved remission with antidepressant treatment, those who did not achieve remission had significantly higher Cumulative Illness Rating Scale scores and a greater number of Cumulative Illness Rating Scale categories were endorsed (i.e., more organs were affected by medical illness). The final Hamilton depression scale score was directly correlated with the total Cumulative Illness Rating Scale score and the number of Cumulative Illness Rating Scale categories endorsed.Conclusions: The total burden of medical illness and the number of organ systems affected by medical illness had a significantly negative predictive value for clinical outcome in the acute phase of treatment in major depressive disorder.