Farabaugh Amy, Fava Maurizio, Mischoulon David, Sklarsky Katie, Petersen Timothy, Alpert Jonathan
Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA 02114, USA.
Compr Psychiatry. 2005 Jul-Aug;46(4):266-71. doi: 10.1016/j.comppsych.2004.10.005.
The aim of the study was to examine whether comorbid anxiety disorders influence depressed patients' likelihood of meeting criteria for a personality disorder (PD) and whether comorbid anxiety disorders influence the stability of the PDs in patients with remitted depression.
The initial sample consisted of 373 outpatients who met criteria for major depressive disorder (MDD) (by Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition-Patient Edition) and who were enrolled in the 8-week acute treatment phase of a study of fluoxetine for MDD. Sixty-four subjects who responded to fluoxetine treatment in the acute phase met criteria for remission throughout a 26-week continuation phase during which they remained on fluoxetine with or without cognitive behavioral therapy. Stability of PDs was defined as meeting criteria for a PD at both beginning and end point of the continuation treatment phase.
Before fluoxetine treatment, anxious depressed patients (defined as meeting criteria for MDD as well as at least one comorbid anxiety disorder) were significantly more likely to meet criteria for any comorbid PD diagnosis compared with depressed patients without comorbid anxiety disorders. In particular, there was a significant relationship between the presence of Cluster A and C PDs and the presence of anxious depression at baseline before antidepressant treatment. After successful treatment of MDD, we found a significant relationship between anxious depression diagnosed at baseline and the stability of a Cluster C PD diagnosis.
Anxious depression may place patients at greater risk of having a PD diagnosis, especially one from Cluster A or C. Once the depression remits, patients who initially met criteria for anxious depression may be more likely to maintain a Cluster C PD diagnosis compared with patients initially diagnosed with MDD alone.
本研究旨在探讨共病焦虑症是否会影响抑郁症患者符合人格障碍（PD）标准的可能性，以及共病焦虑症是否会影响缓解期抑郁症患者PD的稳定性。
初始样本包括373名符合重度抑郁症（MDD）标准的门诊患者（通过《精神障碍诊断与统计手册》修订第三版-患者版的结构化临床访谈确定），他们参加了一项关于氟西汀治疗MDD的8周急性期治疗研究。在急性期对氟西汀治疗有反应的64名受试者在26周的延续期内符合缓解标准，在此期间他们继续接受氟西汀治疗，同时或不接受认知行为疗法。PD的稳定性定义为在延续治疗阶段的开始和结束时均符合PD标准。
在氟西汀治疗前，与无共病焦虑症的抑郁症患者相比，伴有焦虑的抑郁症患者（定义为符合MDD标准以及至少一种共病焦虑症）更有可能符合任何共病PD诊断标准。特别是，A组和C组PD的存在与抗抑郁治疗前基线时伴有焦虑的抑郁症的存在之间存在显著关系。在成功治疗MDD后，我们发现基线时诊断的伴有焦虑的抑郁症与C组PD诊断的稳定性之间存在显著关系。
伴有焦虑的抑郁症可能使患者有更高的PD诊断风险，尤其是来自A组或C组的PD。一旦抑郁症缓解，与最初仅诊断为MDD的患者相比，最初符合伴有焦虑的抑郁症标准的患者可能更有可能维持C组PD诊断。
