A Psychosocial Treatment for Atypical Depression

描述（由申请人提供）：在临床研究文献中，非典型抑郁症（AD）的社会心理干预相对被忽视，尽管有证据表明，AD的特点是发病年龄更早，指数发作时间更长，症状严重程度更高，对某些类型的抗抑郁药反应较差，复发和复发的风险增加。此外，阿尔茨海默氏症患者患共病焦虑症和社交功能障碍的风险更大，这两种疾病都被认为是严重抑郁症病程的不良预后指标。尽管有初步证据表明，AD患者对标准CBT治疗抑郁症有反应，但仍有相当比例的患者对治疗无反应。因此，针对阿尔茨海默病的治疗方法的改进显然是有必要的。本研究提出了一种针对阿尔茨海默病的量身定制的社会心理干预方法，该方法基于针对重度抑郁症的行为激活原理和针对社交焦虑的认知行为群体疗法。这项工作将包括3个阶段：1)开发阶段，重点是干预措施的概念化和设计；2)初始试点阶段，进行初步的治疗修订；3)开放试验阶段，以全面试点干预措施，审查可行性和可接受性，并为未来的治疗发展建立初步的治疗前后效应量。我们建议招募40名具有非典型特征的DSM-IV重度抑郁症患者进行拟议的治疗发展研究。

DESCRIPTION (provided by applicant): Psychosocial interventions for atypical depression (AD) have been relatively ignored in the clinical research literature, despite evidence to suggest that AD is marked by earlier age of disorder onset, greater length of index episode, greater symptom severity, poorer response to certain classes of antidepressants, and increased risk for relapse and recurrence. Moreover, those with AD are at greater risk for a comorbid anxiety disorder as well as impairment in social functioning, both of which have been identified as poor prognostic indicators for course of major depression. Although there is preliminary evidence to suggest that individuals with AD respond to standard CBT for depression, a substantial percentage of patients remain treatment non-responders. Thus, improvements in treatments targeted toward AD are clearly warranted. This application proposes the development of a tailored psychosocial intervention for AD, based upon principles of behavioral activation for major depression and cognitive-behavioral group therapy for social anxiety. This work will consist of 3 phases: 1) A development phase focused on intervention conceptualization and design, 2) An initial pilot phase to conduct a preliminary treatment revision, and 3) An open trial phase in order to fully pilot the intervention, examine feasibility and acceptability, and to establish a preliminary pre- to post-treatment effect size for future treatment development. We propose to recruit 40 individuals with DSM-IV MDD with atypical features for the proposed treatment development study.