Executive dysfunction predicts nonresponse to fluoxetine in major depression
Executive dysfunction predicts nonresponse to fluoxetine in major depression
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DOI：
10.1016/s0165-0327(99)00157-3
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发表时间：
2000-10-01
影响因子：
6.6
通讯作者：
Rosenberg-Thompson, S
中科院分区：
文献类型：
--
作者：
Dunkin, JJ;Leuchter, AF;Rosenberg-Thompson, S
背景资料：功能性脑成像研究显示，抑郁症患者的前额皮质和基底神经节的特定区域存在代谢减退或灌注不足。对抑郁症认知功能的研究表明，一些但不是所有的受试者都表现出与额叶皮质下功能障碍一致的认知缺陷，尽管这种异质性的原因尚不清楚。在这项研究中，我们探讨了这种异质性抑郁症受试者之间的关系，认知功能和治疗结果。方法：抑郁症患者在接受氟西汀治疗前接受完整的神经心理测验。结果如下：在年龄、教育成就、既往抑郁发作次数和估计的病前智商方面，氟西汀应答者和非应答者之间无显著差异。然而，在控制了抑郁症严重程度的基线组差异后，无应答者在执行功能的几个预处理指标上的表现明显不如应答者。局限性：结果基于主要为女性受试者的小样本，导致统计功效低，对男性抑郁症受试者样本的概括性较低。结论：研究结果表明，轻微的前额叶功能障碍的主题与重性抑郁症可能是预测池反应与特定的药物。执行功能的评估可能在治疗前识别可能对特定药物有反应的受试者中发挥特殊作用。(C)2000 Elsevier Science B.V.保留所有权利。
Background: Functional brain imaging studies of major depression have consistently revealed hypometabolism or hypoperfusion in specific regions of the prefrontal cortex and basal ganglia. Studies of cognitive functioning in major depression have suggested that some bur not all subjects exhibit cognitive deficits that are consistent with frontal-subcortical dysfunction, although the reasons for this heterogeneity are unclear. In this study, we explored this heterogeneity among depressed subjects by examining the relationship between cognitive functioning and treatment outcome. Method: Subjects with major depression were administered a complete neuropsychological test battery prior to treatment with fluoxetine. Results: There were no significant differences between responders and nonresponders to fluoxetine in terms of age, educational achievement, number of past episodes of depression, and estimated premorbid IQ. However, nonresponders performed significantly worse than responders on several pretreatment measures of executive functioning, after controlling for baseline group differences in depression severity, Limitations: The results are based on a small sample of primarily female subjects, resulting in low statistical power and less generalizability to samples of male subjects with depression. Conclusions: The findings suggest that subtle prefrontal dysfunction in subjects with major depression may be predictive of pool response with particular medications. Assessment of the executive functions may play a particular role in pretreatment identification of subjects likely to respond to specific medications. (C) 2000 Elsevier Science B.V. All rights reserved.