Severity of depression and response to cognitive behavior therapy.
Severity of depression and response to cognitive behavior therapy.
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抑郁症的严重程度和对认知行为疗法的反应。
DOI：
10.1176/ajp.148.6.784
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发表时间：
1991
期刊：
影响因子：
--
通讯作者：
Harden,T
中科院分区：
文献类型：
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作者：
Thase,ME;Simons,AD;Cahalane,J;McGeary,J;Harden,T
方法根据研究诊断标准，将59例具有内源性特征的抑郁症患者分为重度（汉密尔顿抑郁量表评分≥ 20分; N= 38）和轻度（汉密尔顿评分≤ 19分; N= 21）亚组。患者接受为期16周，20次的认知行为治疗方案。结果进行了评估与汉密尔顿规模，全球调整规模，贝克抑郁Inventory.ResultsThe更严重的组是显着更有症状的1 - 6周的协议，并有显着较低的应答率贝克库存（50%与81%）。然而，两组在三项指标中的任何一项上的终点均无显著差异，且症状改善率相当（即，评分的百分比变化以及严重程度分类和时间之间的相互作用）结论这些结果部分重复了美国国家精神卫生研究所抑郁症治疗合作研究项目的结果，即汉密尔顿量表患者对认知行为治疗的反应较差。分数为20或更多。然而，两组患者的抑郁症状都有明显的临床显著性减轻，在本研究中，较严重患者的反应几乎不能被认为是差的。虽然这些发现并不支持汉密尔顿量表得分大于等于20分是认知行为治疗的相对禁忌症的观点，但更严重的抑郁症患者的症状确实倾向于缓解不完全（特别是在Beck量表上），因此这些患者可能从更强化或延长的治疗过程中获益。
ObjectiveThe authors studied the relationship between clinical severity ofdepression and response to cognitive behavior therapy.MethodFifty-nine outpatients with major depression with endogenous features, according to Research Diagnostic Criteria, were stratified into more severe (score of2O or more on the Hamilton Rating Scale for Depression; N= 38) or less severe(Hamilton score of 1 9 or less; N= 21) subgroups. Patients were treated with a 1 6-week, 20-session cognitive behavior therapy protocol. Outcome was assessed with the Hamilton scale, the Global Adjustment Scale, and the Beck Depression Inventory.ResultsThe more severe group was significantly more symptomatic across the 1 6-week protocol and had a significantly lower response rate on the Beck inventory(50% versus 81%). However, the groups did not significantly differ at end point on any of the three measures, and they showed comparable rates of symptomatic improvement(ie, percent change in scores and interactions between severity classification and time).ConclusionsThese results partially replicate the National Institute of Mental Health‘s Treatment of Depression Collaborative Research Program‘s findings of poorer response to cognitive behavior therapy in patients with Hamilton scale scores of 20 or more. However, both groups experienced robust and clinically significant reductions in depressive symptoms, and the response of the more severe patients in the current study could hardly be considered poor. While these findings do not support the view that a Hamilton scale score of2O or more is a relative contraindication for cognitive behavior therapy, the symptoms ofthe more severely depressed patients did tend to remit less completely(particularly on the Beck inventory) and thus these patients may benefit f rom a more intensive or extended course of therapy.