重度抑郁症的躁狂症状:预后影响和治疗问题。

IF 4.9 2区 医学 Q1 CLINICAL NEUROLOGY Journal of affective disorders Pub Date : 2024-10-22 DOI:10.1016/j.jad.2024.10.104
Paolo Olgiati, Siegfried Kasper, Joseph Zohar, Daniel Souery, Stuart Montgomery, Panagiotis Ferentinos, Dan Rujescu, Raffaella Zanardi, Gernot Fugger, Raffaele Ferri, Mariangela Tripodi, Bernhard T Baune, Chiara Fabbri, Julien Mendlewicz, Alessandro Serretti
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引用次数: 0

摘要

背景:混合型抑郁症(MXD)是指在重度抑郁发作中出现(低)躁狂症状,在双相情感障碍和单相情感障碍中都很常见,但其预后和治疗意义仍不明确。本研究旨在探讨低躁狂症状、治疗反应和自杀念头缓解之间的关系:我们分析了 1243 名患有重度抑郁障碍(MDD)的成年人,他们是在一项关于耐药性抑郁症的自然研究中被招募的。通过结构化访谈和临床评定量表(包括青年躁狂评定量表(YMRS)和蒙哥马利-阿斯伯格抑郁评定量表(MADRS))收集横截面和回顾性数据;采用单变量和多变量方法进行统计分析:651名患者(45%)出现躁狂症状,307名患者(25%)对治疗有反应。限制因素:研究缺乏前瞻性临床评估:研究缺乏前瞻性临床评估和治疗随机化:躁狂症状在单相抑郁症中很常见;对其进行评估对于识别治疗挑战性病例和选择最佳药物治疗方案至关重要。
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Hypomanic symptoms in major depressive disorder: Prognostic impact and treatment issues.

Background: Mixed depression (MXD), defined as (hypo)manic symptoms occurring within major depressive episodes, is common in both bipolar and unipolar disorders, but its prognostic and treatment implications remain unclear. This study aimed to examine the relationship between hypomanic symptoms, treatment response and remission of suicidal thoughts.

Methods: We analyzed 1243 adults with major depressive disorder (MDD), recruited for a naturalistic study on treatment-resistant depression. Data were gathered cross-sectionally and retrospectively through structured interviews and clinical rating scales including the Young Mania Rating Scale (YMRS) and Montgomery-Asberg Depression Rating Scale (MADRS); statistical analyses were performed using univariate and multivariate methods.

Results: Hypomanic symptoms were present in 651 patients (45 %), while 307 patients (25 %) responded to treatment. Both treatment responders (p < 0.0001) and those who achieved remission from suicide ideation (p = 0.0085) showed lower hypomanic (YMRS) scores. Multivariate analysis showed that hypomanic symptoms were negatively linked to treatment response (O.R. 0.71-0.87), while bipolar spectrum markers such as age at illness onset (O.R. 1.00-1.03) and MDD recurrence (O.R. 0.47-0.89) predicted remission from suicidal thoughts. Medications commonly used to treat bipolar disorder showed some benefits, with dopamine/serotonin antagonists improving suicide ideation (p < 0.0001) and mood stabilizers being associated with reduced hypomanic symptoms (p = 0.0003).

Limitations: The study lacked prospective clinical assessments and treatment randomization.

Conclusion: Hypomanic symptoms are common in unipolar depression; their assessment is essential to identify challenging-to-treat cases and select the best pharmacological options.

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来源期刊
Journal of affective disorders
Journal of affective disorders 医学-精神病学
CiteScore
10.90
自引率
6.10%
发文量
1319
审稿时长
9.3 weeks
期刊介绍: The Journal of Affective Disorders publishes papers concerned with affective disorders in the widest sense: depression, mania, mood spectrum, emotions and personality, anxiety and stress. It is interdisciplinary and aims to bring together different approaches for a diverse readership. Top quality papers will be accepted dealing with any aspect of affective disorders, including neuroimaging, cognitive neurosciences, genetics, molecular biology, experimental and clinical neurosciences, pharmacology, neuroimmunoendocrinology, intervention and treatment trials.
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