Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability.
Problem-solving therapy and supportive therapy in older adults with major depression and executive dysfunction: effect on disability.
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DOI：
10.1001/archgenpsychiatry.2010.177
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发表时间：
2011-01
影响因子：
--
通讯作者：
Arean, Patricia A.
中科院分区：
文献类型：
--
作者：
Alexopoulos, George S.;Raue, Patrick J.;Kiosses, Dimitris N.;Mackin, R. Scott;Kanellopoulos, Dora;McCulloch, Charles;Arean, Patricia A.
患有抑郁症和执行功能障碍的老年患者代表了具有显著残疾和药物治疗失败的高可能性的人群。研究问题解决疗法（PST）是否比支持疗法（ST）更能减少患有抑郁症和执行功能障碍的老年患者的残疾，以及这种效果是否通过改善抑郁症状来介导。随机对照试验，从2002年12月至2007年11月招募受试者，随访36周。威尔康奈尔和加州大学旧金山分校弗朗西斯科。成年人（>59岁）患有重度抑郁症和执行功能障碍。12个会议的PST修改为老年抑郁症的成年人与执行障碍，或ST.残疾量化的世界卫生组织评估计划II（WHODAS II）-12项表格。653人被提到这项研究，其中221人符合标准，并被随机分配到PST或ST。PST和ST在治疗的前6周内导致残疾的可比改善，但在第9周和第12周，PST参与者的减少更为明显。PST和ST之间的差异在认知功能障碍更严重和既往发作次数更多的患者中更大。减少残疾等于减少抑郁症状。PST在减少抑郁症方面优于ST的治疗优势部分是由于PST更大程度地减少了残疾。虽然残疾在治疗结束后的24周内增加，但PST相对于ST治疗患者的优势得到保留。这项研究表明，PST比ST更有效地减少老年抑郁症和执行功能障碍患者的残疾，其益处在治疗结束后仍保留。这一发现的临床价值是，PST可能是一种治疗选择，在老年患者人群可能是耐药的药物治疗。
Older patients with depression and executive dysfunction represent a population with significant disability and high likelihood of failing pharmacotherapy. To examine whether Problem Solving Therapy (PST) reduces disability more than Supportive Therapy (ST) in older patients with depression and executive dysfunction, and whether this effect is mediated by improvement in depressive symptoms. Randomized controlled trail, with participant recruitment from 12/02-11/07 and follow-up for 36 weeks. Weill Cornell and University of California, San Francisco. Adults (>59 years) with major depression and executive dysfunction. 12 sessions of either PST modified for older depressed adults with executive impairment, or ST. Disability as quantified by the World Health Organization Assessment Schedule II (WHODAS II)-12 item form. 653 individuals were referred to this study, 221 of whom met criteria and were randomized to PST or ST. PST and ST led to comparable improvement of disability in the first 6 weeks of treatment, but a more prominent reduction in PST participants at weeks 9 and 12. The difference between PST and ST was greater in patients with greater cognitive impairment and higher number of previous episodes. Reduction in disability paralleled reduction in depressive symptoms. The therapeutic advantage of PST over ST in reducing depression was in part due to greater reduction of disability by PST. While disability increased during the 24 weeks following the end of treatment, the advantage of PST over ST-treated patients was retained. This study suggests that PST is more effective than ST in reducing disability in older patients with major depression and executive dysfunction, and its benefits were retained after the end of treatment. The clinical value of this finding is that PST may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy.
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影响因子：
17.7
作者：
Alexopoulos, George S.;Murphy, Christopher F.;Hoptman, Matthew J.
通讯作者：
Hoptman, Matthew J.
影响因子：
5.9
作者：
AREAN, PA;PERRI, MG;JOSEPH, TX
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JOSEPH, TX
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2.6
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Gur, RE
影响因子：
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作者：
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通讯作者：
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影响因子：
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作者：
Cronin-Stubbs, D;de Leon, CFM;Evans, DA
通讯作者：
Evans, DA