Zimmerman M, Mattia J I
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence 02905, USA.
J Clin Psychiatry. 1999 May;60(5):311-4. doi: 10.4088/jcp.v60n0508.
Many studies have established that a large percentage of patients with posttraumatic stress disorder (PTSD) have comorbid major depressive disorder. Other studies have found that patients with PTSD or a history of childhood trauma have an increased rate of psychotic symptoms. In the present report from the Rhode Island Methods to Improve Diagnosis and Services project, we examine whether an association exists between psychotic subtyping of major depressive disorder and PTSD.
Five hundred psychiatric outpatients were interviewed with the Structured Clinical Interview for DSM-IV.
Almost half of the 500 patients had nonbipolar major depressive disorder (N = 235, 47.0%), 45 (19.1%) of whom had PTSD. Nineteen patients had psychotic depression, 216 had nonpsychotic depression. Compared with patients with nonpsychotic depression, the patients with psychotic depression were nearly 4 times more likely to have PTSD (57.9% vs. 15.7%, Fisher exact test, p = .0001).
The results of the present study suggest that the presence of psychosis in psychiatric outpatients with major depressive disorder is associated with concurrent PTSD. It is hypothesized that the poorer longitudinal course of psychotic versus nonpsychotic depression may be due to the underrecognition of PTSD in psychotically depressed patients.
许多研究已证实,很大比例的创伤后应激障碍(PTSD)患者合并有重度抑郁症。其他研究发现,患有PTSD或有童年创伤史的患者出现精神病性症状的几率增加。在罗德岛改善诊断与服务方法项目的本报告中,我们研究了重度抑郁症的精神病性亚型与PTSD之间是否存在关联。
对500名精神科门诊患者进行了《精神疾病诊断与统计手册》第四版(DSM-IV)的结构化临床访谈。
500名患者中近一半患有非双相重度抑郁症(N = 235,47.0%),其中45名(19.1%)患有PTSD。19名患者患有精神病性抑郁症,216名患有非精神病性抑郁症。与非精神病性抑郁症患者相比,精神病性抑郁症患者患PTSD的可能性几乎高出4倍(57.9%对15.7%,Fisher精确检验,p = .0001)。
本研究结果表明,重度抑郁症精神科门诊患者中精神病性症状的存在与并发PTSD有关。据推测,与非精神病性抑郁症相比,精神病性抑郁症较差的纵向病程可能是由于精神病性抑郁症患者中PTSD未被充分认识所致。