What is the threshold for symptomatic response and remission for major depressive disorder, panic disorder, social anxiety disorder, and generalized anxiety disorder?
What is the threshold for symptomatic response and remission for major depressive disorder, panic disorder, social anxiety disorder, and generalized anxiety disorder?
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DOI：
10.4088/jcp.v67n0914
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发表时间：
2006-09-01
影响因子：
5.3
通讯作者：
Stein, Dan J.
中科院分区：
文献类型：
--
作者：
Bandelow, Borwin;Baldwin, David S.;Stein, Dan J.
目的：无症状缓解是抑郁症和焦虑症治疗的目标，但对于确定个体疾病缓解的阈值尚无共识。在事后分析中，我们试图通过比较临床总体印象量表（CGI）和障碍特异性症状严重程度评定量表的评分来确定这些阈值，这些评分来自所有可用的研究，这些研究使用相同的药物（艾司西酞普兰）治疗重度抑郁症、恐慌症、广泛性焦虑症和社交焦虑症。我们还试图比较艾司西酞普兰对这4种精神疾病的标准化效应量。数据来源和研究选择：2004年3月1日，由H. Lundbeck A/S（哥本哈根，丹麦）或Forest Laboratories， Inc.（纽约，纽约州）赞助的所有随机、双盲、安慰剂对照的急性治疗研究的原始数据发表，其中患者用艾司西酞普兰治疗DSM-IV重度抑郁症（5项研究）、恐慌症（1项研究）、广泛性焦虑症（4项研究）、（2项研究）比较了CGI评分变化的标准化效应大小和代表评估这些障碍的“金标准”的评定量表（分别是Montgomery-Asberg抑郁评定量表、恐慌和广场恐怖量表、汉密尔顿焦虑评定量表和Liebowitz社交焦虑量表）的评分。数据综合：在所有适应症中，艾司西酞普兰治疗在CGI-S和CGI-I上的治疗效果与安慰剂的差异为0.32至0.59，在标准评定量表上的标准化效应大小为0.32至0.50。不同疾病间无显著差异。在CGI得分和标准量表之间发现了中度到高度的相关性。对cgi定义的“反应”和“缓解”进行相应的标准量表评分。结论：标准量表和CGI评分的比较表明，传统的反应定义（即标准量表减少50%）可能过于保守。
Objective: Symptom-free remission is a goal for treatment in depression and anxiety disorders, but there is no consensus regarding the threshold for determining remission in individual disorders. We sought to determine these thresholds by comparing, in a post hoc analysis, scores on the Clinical Global Impressions scale (CGI) and disorder-specific symptom severity rating scales from all available studies of the treatment of major depressive disorder, panic disorder, generalized anxiety disorder, and social anxiety disorder with the same medication (escitalopram). We also sought to compare the standardized effect sizes of escitalopram for these 4 psychiatric disorders.Data Sources and Study Selection: Raw data from all randomized, double-blind, placebo-controlled, acute treatment studies sponsored by H. Lundbeck A/S (Copenhagen, Denmark) or Forest Laboratories, Inc. (New York, N.Y.), published through March 1, 2004, with patients treated with escitalopram for DSM-IV major depressive disorder (5 studies), panic disorder (I study), generalized anxiety disorder (4 studies), or social anxiety disorder (2 studies) were compared with regard to the standardized effect sizes of change in CGI score and scores on rating scales that represent the "gold standard" for assessment of these disorders (the Montgomery-Asberg Depression Rating Scale, the Panic and Agoraphobia Scale, the Hamilton Rating Scale for Anxiety, and the Liebowitz Social Anxiety Scale, respectively).Data Synthesis: In all indications, treatment with escitalopram showed differences from placebo in treatment effect from 0.32 to 0.59 on the CGI-S and CGI-I and standardized effect sizes from 0.32 to 0.50 on the standard rating scales. There were no significant differences among the different disorders. Moderate to high correlations were found between scores on the CGI and the standard scales. The corresponding standard scale scores for CGI-defined "response" and "remission" were determined.Conclusion: Comparison of scores on the standard scales and scores on the CGI suggest that the traditional definition of response (i.e., a 50% reduction in a standard scale) may be too conservative.