Ten-year prospective follow-up study of the naturalistic course of dysthymic disorder and double depression
Ten-year prospective follow-up study of the naturalistic course of dysthymic disorder and double depression
复制标题
DOI：
10.1176/appi.ajp.163.5.872
复制
发表时间：
2006-05-01
影响因子：
17.7
通讯作者：
Rose, S
中科院分区：
文献类型：
--
作者：
Klein, DN;Shankman, SA;Rose, S
目的：本研究的目的是描述10年的过程和结果的心境恶劣disorder.Method：作者进行了一个自然的，前瞻性的，纵向随访的97名成年人早发性心境恶劣障碍和45名成年人非慢性重性抑郁症从连续入院几个门诊设施。获得了90%队列的随访数据。在基线、30、60、90和120个月时进行评估。措施包括纵向间隔随访评估和汉密尔顿抑郁量表。结果：Kaplan-Meier估计的恢复率为73.9%，中位恢复时间为52个月。在康复的患者中，估计复发进入另一个慢性抑郁期的风险为71.4%。慢性抑郁症的复发有多种形式，并不局限于心境恶劣。尽管如此，慢性和非慢性抑郁症之间的区别在随访期间相对稳定。混合效应模型表明，心境恶劣障碍患者经历了一个显着较慢的速度，随着时间的推移，症状的改善，并表现出显着更大的抑郁症在10年的时间点，与非慢性重性depress.Conclusions：心境恶劣障碍的患者有一个漫长的过程，并与复发的高风险。慢性抑郁症发作的性质随时间而变化，这表明DSM-IV中慢性抑郁症的各种表现并不代表不同的疾病。然而，慢性和非慢性形式的抑郁症之间的区别是相对稳定的，并可能在遗传和神经生物学研究的亚型提供了一个有用的基础。
Objective: The purpose of this study was to describe the 10-year course and outcome of dysthymic disorder.Method: The authors conducted a naturalistic, prospective, longitudinal follow-up of 97 adults with early-onset dysthymic disorder and 45 adults with nonchronic major depressive disorder selected from consecutive admissions to several outpatient facilities. Follow-up data were obtained for 90% of the cohort. Assessments were conducted at baseline, 30, 60, 90, and 120 months. Measures included the Longitudinal Interval Follow-Up Evaluation and the Hamilton Depression Rating Scale.Results: The Kaplan-Meier estimated recovery rate from dysthymic disorder was 73.9%, with a median time to recovery of 52 months. Among patients who recovered, the estimated risk of relapse into another period of chronic depression was 71.4%. Chronic depressive relapses took a variety of forms and were not limited to dysthymia. Nonetheless, the distinction between chronic and nonchronic forms of depression was relatively stable over the follow-up period. Mixed-effects models indicated that patients with dysthymic disorder experienced a significantly slower rate of improvement in symptoms over time and exhibited significantly greater depression at the 10-year point, compared to patients with nonchronic major depression.Conclusions: Dysthymic disorder has a protracted course and is associated with a high risk of relapse. The nature of chronic depressive episodes varies over time within individuals, indicating that the various manifestations of chronic depression in DSM-IV do not represent distinct disorders. However, the distinction between chronic and nonchronic forms of depression is relatively stable and may provide a useful basis for subtyping in genetic and neurobiological research.