Depression is not a consistent syndrome: An investigation of unique symptom patterns in the STAR*D study.
Depression is not a consistent syndrome: An investigation of unique symptom patterns in the STAR*D study.
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DOI：
10.1016/j.jad.2014.10.010
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发表时间：
2015-02-01
影响因子：
6.6
通讯作者：
Nesse, Randolph M.
中科院分区：
文献类型：
--
作者：
Fried, Eiko I.;Nesse, Randolph M.
DSM-5涵盖了重度抑郁症（MDD）的广泛症状。症状通常加起来的总和分数，和阈值之间的健康和抑郁的个人区分。潜在的假设是，所有诊断为MDD的患者都有类似的病情，并且总分准确反映了这种病情的严重程度。为了验证这一假设，我们在“缓解抑郁症的序贯治疗替代方案”（星星 *D）研究中检查了DSM-5抑郁症症状模式的数量。我们调查了星星 *D第一个治疗阶段开始时3,703名抑郁症门诊患者报告的独特症状特征的数量。总的来说，我们确定了1,030个独特的症状特征。在这些配置文件中，864个配置文件（83.9%）由5名或更少的受试者认可，501个配置文件（48.6%）仅由1名受试者认可。最常见的症状特征显示频率仅为1.8%。控制整体抑郁症的严重程度并没有减少所观察到的异质性的量。将症状二分以构建症状特征。入组星星 *D的许多受试者报告了处方药物可能影响症状表现的医学状况。所有符合一种诊断标准的个体之间的显著症状差异使人们对MDD作为一种特定的一致性综合征的地位提出了质疑，并为记录治疗疗效的困难提供了潜在的解释。我们认为，对个体症状、其模式及其因果关系的分析将提供在仅依赖总分的研究中无法发现的见解。
The DSM-5 encompasses a wide range of symptoms for Major Depressive Disorder (MDD). Symptoms are commonly added up to sum-scores, and thresholds differentiate between healthy and depressed individuals. The underlying assumption is that all patients diagnosed with MDD have a similar condition, and that sum-scores accurately reflect the severity of this condition. To test this assumption, we examined the number of DSM-5 depression symptom patterns in the "Sequenced Treatment Alternatives to Relieve Depression" (STAR*D) study. We investigated the number of unique symptom profiles reported by 3,703 depressed outpatients at the beginning of the first treatment stage of STAR*D. Overall, we identified 1,030 unique symptom profiles. Of these profiles, 864 profiles (83.9%) were endorsed by five or fewer subjects, and 501 profiles (48.6%) were endorsed by only one individual. The most common symptom profile exhibited a frequency of only 1.8%. Controlling for overall depression severity did not reduce the amount of observed heterogeneity. Symptoms were dichotomized to construct symptom profiles. Many subjects enrolled in STAR*D reported medical conditions for which prescribed medications may have affected symptom presentation. The substantial symptom variation among individuals who all qualify for one diagnosis calls into question the status of MDD as a specific consistent syndrome and offers a potential explanation for the difficulty in documenting treatment efficacy. We suggest that the analysis of individual symptoms, their patterns, and their causal associations will provide insights that could not be discovered in studies relying on only sum-scores.
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影响因子：
10.6
作者：
Hek, Karin;Demirkan, Ayse;Lahti, Jari;Terracciano, Antonio;Teumer, Alexander;Cornelis, Marilyn C.;Amin, Najaf;Bakshis, Erin;Baumert, Jens;Ding, Jingzhong;Liu, Yongmei;Marciante, Kristin;Meirelles, Osorio;Nalls, Michael A.;Sun, Yan V.;Vogelzangs, Nicole;Yu, Lei;Bandinelli, Stefania;Benjamin, Emelia J.;Bennett, David A.;Boomsma, Dorret;Cannas, Alessandra;Coker, Laura H.;de Geus, Eco;De Jager, Philip L.;Diez-Roux, Ana V.;Purcell, Shaun;Hu, Frank B.;Rimm, Eric B.;Hunter, David J.;Jensen, Majken K.;Curhan, Gary;Rice, Kenneth;Penman, Alan D.;Rotter, Jerome I.;Sotoodehnia, Nona;Emeny, Rebecca;Eriksson, Johan G.;Evans, Denis A.;Ferrucci, Luigi;Fornage, Myriam;Gudnason, Vilmundur;Hofman, Albert;Illig, Thomas;Kardia, Sharon;Kelly-Hayes, Margaret;Koenen, Karestan;Kraft, Peter;Kuningas, Maris;Massaro, Joseph M.;Melzer, David;Mulas, Antonella;Mulder, Cornelis L.;Murray, Anna;Oostra, Ben A.;Palotie, Aarno;Penninx, Brenda;Petersmann, Astrid;Pilling, Luke C.;Psaty, Bruce;Rawal, Rajesh;Reiman, Eric M.;Schulz, Andrea;Shulman, Joshua M.;Singleton, Andrew B.;Smith, Albert V.;Sutin, Angelina R.;Uitterlinden, Andre G.;Voelzke, Henry;Widen, Elisabeth;Yaffe, Kristine;Zonderman, Alan B.;Cucca, Francesco;Harris, Tamara;Ladwig, Karl-Heinz;Llewellyn, David J.;Raikkonen, Katri;Tanaka, Toshiko;van Duijn, Cornelia M.;Grabe, Hans J.;Launer, Lenore J.;Lunetta, Kathryn L.;Mosley, Thomas H., Jr.;Newman, Anne B.;Tiemeier, Henning;Murabito, Joanne
通讯作者：
Murabito, Joanne
影响因子：
17.7
作者：
Keller, Matthew C.;Neale, Michael C.;Kendler, Kenneth S.
通讯作者：
Kendler, Kenneth S.
影响因子：
6.9
作者：
Fried, E. I.;Nesse, R. M.;Sen, S.
通讯作者：
Sen, S.
DOI：
10.1146/annurev-clinpsy-050212-185608
发表时间：
2013-01-01
期刊：
ANNUAL REVIEW OF CLINICAL PSYCHOLOGY, VOL 9
影响因子：
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作者：
Borsboom, Denny;Cramer, Angelique O. J.
通讯作者：
Cramer, Angelique O. J.
影响因子：
25.8
作者：
Judd, Lewis L.;Schettler, Pamela J.;Fiedorowicz, Jess G.
通讯作者：
Fiedorowicz, Jess G.