Preventing recurrent depression using cognitive therapy with and without a continuation phase -: A randomized clinical trial
Preventing recurrent depression using cognitive therapy with and without a continuation phase -: A randomized clinical trial
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DOI：
10.1001/archpsyc.58.4.381
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发表时间：
2001-04-01
影响因子：
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通讯作者：
Silver, PC
中科院分区：
文献类型：
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作者：
Jarrett, RB;Kraft, D;Silver, PC
背景：当患者学习和使用相关技能时，认知治疗（CT）可以减少抑郁症的复发和复发。停止 CT 后报告的复发率差异很大。决定 CT 何时具有预防作用的因素仍不清楚。我们开发了持续阶段 CT (C-CT) 来教授急救人员预防复发的技能。鉴于复发性单相抑郁病史，这是第一个针对 CT 应答者比较 CT 与不采用持续期的随机试验。方法：年龄为 18 至 65 岁的复发性 DSM-IV 重度抑郁症 (MDD) 患者 (n=156) 接受了 20 次急性期 CT (A-CT)。未接受药物治疗的反应者（即没有 MDD 且汉密尔顿抑郁量表 17 项评分小于或等于 9；n=84）被随机分配至 8 个月（10 次）的 C-CT 或对照（无 CT 评估）。随访又持续了 16 个月。一位不知道分配情况的临床医生评估了复发和复发（即 DSM-IV MDD）。结果 在 8 个月的时间内，C-CT 比对照显着降低了复发估计（10% vs 31%）。在超过 24 个月的时间里，包括无 CT 随访在内，A-CT 后期的发病年龄和缓解质量均与病情分配相互作用，从而影响效果的持久性。在早发性 MDD 患者中，C-CT 显着降低了复发率和复发率估计值（对照组为 16%，对照组为 67%）。当患者在 A-CT 后期出现不稳定缓解时，C-CT 显着降低了复发率和复发率，达到 37%（对照为 62%）。结论：研究结果表明，8 个月的 C-CT 显着降低了复发 MDD 风险最高的患者的复发率和复发率。风险因素影响 C-CT 的必要性。
Background: Cognitive therapy (CT) may reduce depressive relapse and recurrence when patients learn and use the associated skills. Reported relapse and recurrence rates after CT discontinuation vary widely. The factors that determine when CT is preventive remain unidentified. We developed continuation-phase CT (C-CT) to teach responders skills to prevent relapse. This is the first randomized trial comparing CT with and without a continuation phase in responders to CT who were vulnerable, given their history of recurrent unipolar depression.Methods: Patients aged 18 to 65 years (n=156) with recurrent DSM-IV major depressive disorder (MDD) entered 20 sessions of acute-phase CT (A-CT). Unmedicated responders (ie, no MDD and 17-item Hamilton Rating Scale for Depression score less than or equal to9; n=84) were randomized to either 8 months (10 sessions) of C-CT or control (evaluation without CT). Follow-up lasted an additional 16 months. A clinician blind to assignment evaluated relapse and recurrence (ie, DSM-IV MDD).Results Over an 8-month period, C-CT significantly reduced relapse estimates more than control (10%, vs 31%). Over 24 months, including the CT-free follow-up, age of onset and quality of remission during the late phase of A-CT each interacted with condition assignment to influence durability of effects. In patients with early-onset MDD, C-CT significantly reduced relapse and recurrence estimates (16% vs 67% in control). When patients had unstable remission during late A-CT, C-CT significantly reduced relapse and recurrence estimates to 37% (vs 62% in control).Conclusions: Findings suggest that 8 months of C-CT significantly reduces relapse and recurrence in the highest-risk patients with recurrent MDD. Risk factors influenced the necessity for C-CT.