Dowson Jonathan
Department of Psychiatry, University of Cambridge, Cambridge, UK.
J Affect Disord. 2004 Mar;78(3):279-84. doi: 10.1016/S0165-0327(02)00309-9.
Depressive disorders are common in patients with anorexia nervosa (AN). Although depression with AN has been considered to be mainly secondary to the features of AN, other characteristics of such patients may also be causal, as personality disorders (PDs) often occur with AN and there are indications that PDs are causal factors for some depressive disorders. This study examined associations of the severity of depressive disorders in patients with low weight and a history of full or partial AN, to determine which characteristics of patients with AN are candidates as causal factors for depression in this context.
66 patients of a psychiatric 'low-weight' clinic completed self-report questionnaires. These patients presented with a mean body mass index (BMI) of 17.0 (S.D. 1.4) and their mean lowest BMI after the age of 16 had been 15.2 (S.D. 1.3).
Beck Depression Inventory (BDI) ratings were significantly associated with a range of eating disorder features (including age at presentation but not BMI) and with characteristics of a range of DSM-III-R PDs.
BDI ratings do not reflect clinical heterogeneity of depressive disorders, while self-report data for PD psychopathology can be subject to confounding variables.
The results suggest that, first, features of AN (but not the degree of weight loss), and, second, psychopathology related to some features of all three DSM-III-R PD clusters may have causal roles in relation to depressive disorders in patients with AN and its variants. The findings indicate the need to consider a range of features of PDs in the management of patients with depression and AN.
抑郁症在神经性厌食症（AN）患者中很常见。尽管AN伴发的抑郁症一直被认为主要继发于AN的特征，但这类患者的其他特征也可能是病因，因为人格障碍（PDs）常与AN同时出现，且有迹象表明PDs是某些抑郁症的致病因素。本研究调查了体重低且有完全或部分AN病史患者的抑郁症严重程度之间的关联，以确定在这种情况下AN患者的哪些特征可能是抑郁症的致病因素。
一家精神科“低体重”诊所的66名患者完成了自我报告问卷。这些患者的平均体重指数（BMI）为17.0（标准差1.4），16岁以后的平均最低BMI为15.2（标准差1.3）。
贝克抑郁量表（BDI）评分与一系列饮食失调特征（包括就诊年龄但不包括BMI）以及一系列DSM-III-R PDs的特征显著相关。
BDI评分不能反映抑郁症的临床异质性，而PD精神病理学的自我报告数据可能受到混杂变量的影响。
结果表明，首先，AN的特征（而非体重减轻程度），其次，与所有三个DSM-III-R PD集群的某些特征相关的精神病理学可能在AN及其变体患者的抑郁症中起因果作用。研究结果表明，在抑郁症和AN患者的管理中需要考虑PDs的一系列特征。
