Treatment of subsyndromal depressive symptoms in middle-aged and older adults with schizophrenia: effect on functioning.
Treatment of subsyndromal depressive symptoms in middle-aged and older adults with schizophrenia: effect on functioning.
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中老年精神分裂症亚综合征抑郁症状的治疗：对功能的影响。
DOI：
10.1002/gps.2318
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发表时间：
2010
影响因子：
4
通讯作者：
Zisook,Sidney
中科院分区：
文献类型：
--
作者：
Kasckow,John;Lanouette,Nicole;Patterson,Thomas;Fellows,Ian;Golshan,Shahrokh;Solorzano,Ellen;Zisook,Sidney
研究背景抑郁亚综合征（Subsyndromalsymptomsofdepression，SSD）是精神分裂症患者常见的临床症状. SSRI似乎有助于缓解40岁及以上患有SSD的精神分裂症患者的抑郁症状。目前尚不清楚SSRI是否有助于改善这一人群的功能。我们假设，用SSRI西酞普兰治疗这一人群将导致社会，精神和身体功能的改善以及药物管理和生活质量的改善。MethodsParticipants是198名年龄在40岁以下的精神分裂症或情感性精神障碍的成年人，他们符合亚综合征抑郁症的研究标准，基于有两个或更多的9个DSM-IV症状的严重抑郁发作，持续至少2周，并且汉密尔顿抑郁评定量表（HAM-D 17）评分> 8。患者被随机分配接受西酞普兰或安慰剂的灵活剂量治疗，以增加其当前稳定1个月的抗精神病药物。在基线和12周试验结束时，使用以下功能量表评估受试者：（1）社交技能表现评估（SSPA），（2）药物管理能力评估（MMAA），（3）医学结局研究SF-12量表的精神和身体组成部分，和（4）海因里希斯生活质量量表（QOLS）。协方差分析（ANCOVA）用于比较西酞普兰和安慰剂治疗组的终点评分之间的差异，控制了研究中心和基线评分。ANCOVA也被用来比较上述终点评分的差异在respondersversusnon-responders（responders =那些有抑郁症状减少> 50%）。ResultsOverall，西酞普兰组有显着较高的SSPA，精神功能SF-12，和生活质量量表（QOLS）评分相比，安慰剂组。对MMAA或身体功能SF-12评分无影响。应答者的终点精神SF-12和QOLS评分显著优于非应答者。西酞普兰的抑郁症状介导的西酞普兰对精神功能的影响，但不是对生活质量.ConclusionsCitalopram增强抗精神病药物治疗中老年精神分裂症和亚综合征抑郁症患者出现改善社会和心理健康功能，以及生活质量。因此，临床医生在用SSRI药物治疗精神分裂症患者时，监测这些方面的功能是很重要的。版权所有© 2009约翰威利父子有限公司。
BackgroundSubsyndromal symptoms of depression (SSD) in patients with schizophrenia are common and clinically important. SSRI's appear to be helpful in alleviating depressive symptoms in patients with schizophrenia who have SSD in patients age 40 and greater. It is not known whether SSRI's help improve functioning in this population. We hypothesized that treating this population with the SSRI citalopram would lead to improvements in social, mental and physical functioning as well as improvements in medication management and quality of life.MethodsParticipants were 198 adults ⩾ 40 years old with schizophrenia or schizoaffective disorder who met study criteria for subsyndromal depression based on having two or more of the nine DSM‐IV symptoms of a major depressive episode, for at least 2 weeks, and a Hamilton depression rating scale (HAM‐D 17) score ⩾ 8. Patients were randomly assigned to flexible‐dose treatment with citalopram or placebo augmentation of their current antipsychotic medication(s) which was stable for 1 month. Subjects were assessed with the following functional scales at baseline and at the end of the 12‐week trial: (1) social skills performance assessment (SSPA), (2) medication management ability assessment (MMAA), (3) mental and physical components of the medical outcomes study SF‐12 Scale, and (4) the Heinrichs quality of life scale (QOLS). Analysis of covariance (ANCOVA) was used to compare differences between endpoint scores of the citalopram and placebo treated groups, controlling for site and baseline scores. ANCOVAs were also used to compare differences in the above endpoint scores in respondersversusnon‐responders (responders = those with > 50% reduction in depressive symptoms).ResultsOverall, the citalopram group had significantly higher SSPA, mental functioning SF‐12, and quality of life scale (QOLS) scores compared to the placebo group. There was no effect on MMAA or physical functioning SF‐12 scores. Responders had significantly better endpoint mental SF‐12 and QOLS scores compared to non‐responders. Response to citalopram in terms of depressive symptoms mediated the effect of citalopram on mental functioning, but not on the quality of life.ConclusionsCitalopram augmentation of antipsychotic treatment in middle aged and older patients with schizophrenia and subsyndromal depression appears to improve social and mental health functioning as well as quality of life. Thus it is important for clinicians to monitor these aspects of functioning when treating this population of patients with schizophrenia with SSRI agents. Copyright © 2009 John Wiley & Sons, Ltd.