Clinical characteristics and treatment outcome in a representative sample of depressed inpatients - Findings from the Munich Antidepressant Response Signature (MARS) project
Clinical characteristics and treatment outcome in a representative sample of depressed inpatients - Findings from the Munich Antidepressant Response Signature (MARS) project
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DOI：
10.1016/j.jpsychires.2008.05.002
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发表时间：
2008-01-01
影响因子：
4.8
通讯作者：
Lucae, Susanne
中科院分区：
文献类型：
--
作者：
Hennings, Johannes M.;Owashi, Toshimi;Lucae, Susanne
抑郁症是一种常见且通常难以治疗的临床病症，患者表现出治疗反应不足和症状持续存在的比率很高。我们报告的特点，一个有代表性的样本抑郁症住院患者参加了慕尼黑抗抑郁反应签名（MARS）项目。842例因重度抑郁发作、复发性或双相抑郁症而入住精神病医院的住院患者，在人口统计学因素、临床病史和HPA轴失调程度方面进行了彻底的特征分析，并通过联合dex/CRH试验进行了评估，并研究了这些因素对治疗结果的预测价值。80.8%的患者对治疗有反应（即，症状严重程度改善至少50%）和57.9%达到缓解（即，在平均11.8周的治疗期后出院时几乎没有残留的抑郁症状）。回归分析确定早期部分缓解（2周内）是实现缓解的最重要的阳性预测因子。当前事件中先前无效的治疗试验和移民背景的存在是治疗结果的有效阴性预测因子。此外，缓解者的特征是最初失调的HPA轴更明显的正常化。我们可以证明，绝大多数患有抑郁症的住院患者在住院期间都能从抗抑郁治疗中获益。然而，相当多的患者未能达到缓解。我们证明，该亚组的特征可以通过一组人口统计学、临床和神经内分泌变量来预测治疗早期的不利结果。(c)2008爱思唯尔有限公司保留所有权利。
Depression is a common and often difficult-to-treat clinical condition with a high rate of patients showing insufficient treatment response and persistence of symptoms. We report the characteristics of a representative sample of depressed inpatients participating in the Munich Antidepressant Response Signature (MARS) project. Eight hundred and forty-two inpatients admitted to a psychiatric hospital for treatment of a major depressive episode, recurrent or bipolar depression were thoroughly characterized with respect to demographic factors, clinical history, and the degree of HPA-axis dysregulation evaluated by means of combined dex/CRH tests, and the predictive value of these factors for treatment outcome is investigated. 80.8% of patients responded to treatment (i.e., improvement in symptom severity of at least 50%) and 57.9% reached remission (i.e., near absence of residual depressive symptoms) at discharge after a mean treatment period of 11.8 weeks. Regression analysis identified early partial response (within 2 weeks) as the most important positive predictor for achieving remission. Previous ineffective treatment trials in the current episode and presence of a migration background are potent negative predictors for treatment outcome. In addition, remitters were characterized by a more pronounced normalization of an initially dysregulated HPA-axis. We could show that a large majority of inpatients suffering, from depression benefits from antidepressant treatment during hospitalization. However, a considerable number of patients failed to achieve remission. We demonstrated that this subgroup can be characterized by a set of demographic, clinical and neuroendocrine variables allowing to predict unfavorable outcome at an early stage of treatment. (c) 2008 Elsevier Ltd. All rights reserved.