Zimmerman Mark, McGlinchey Joseph B, Posternak Michael A, Friedman Michael, Boerescu Daniela, Attiullah Naureen
Department of Psychiatry and Human Behavior, Brown University School of Medicine, Rhode Island Hospital, Providence, RI 02905, USA.
J Clin Psychiatry. 2005 Sep;66(9):1134-8. doi: 10.4088/jcp.v66n0908.
We recently derived a cutoff on a self-report scale corresponding to the most commonly used definition of remission in depression treatment studies (i.e., Hamilton Rating Scale for Depression [HAM-D] score < or = 7). However, recent research has suggested that use of this cutoff on the HAM-D to define remission is overinclusive. The goal of the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project was to examine how many depressed patients in ongoing treatment who are considered to be in remission by a self-report equivalent of the HAM-D definition of remission nonetheless do not consider themselves to be in remission.
Five hundred thirty-five psychiatric outpatients treated for a DSM-IV major depressive episode were asked whether they considered themselves to be in remission and completed the Clinically Useful Depression Outcome Scale (CUDOS), a measure of the severity of the DSM-IV symptoms of depression. The study was conducted from August 2003 until July 2004.
Nearly one quarter of the patients who met the remission threshold on the CUDOS (55/249) did not consider themselves to be in remission. Among the CUDOS remitters, the total score on the CUDOS was significantly lower (p < .001) in patients who considered themselves to be in remission than in patients who did not indicate that they were in remission. Examination of specific symptoms revealed greater appetite disturbance and hypersomnia in the patients who did not think they were in remission.
Our results suggest that heterogeneity of clinical status exists even among patients who are minimally depressed and considered to be in remission according to contemporary definitions on symptom severity scales.
我们最近在一个自评量表上得出了一个临界值，该临界值对应于抑郁症治疗研究中最常用的缓解定义（即汉密尔顿抑郁量表[HAM-D]评分≤7）。然而，最近的研究表明，使用这个HAM-D临界值来定义缓解存在过度包含的问题。罗德岛改善诊断评估与服务方法（MIDAS）项目本报告的目的是研究在接受治疗的抑郁症患者中，有多少根据HAM-D缓解定义的自评等效值被认为处于缓解状态的患者却不认为自己处于缓解状态。
535名因DSM-IV重度抑郁发作接受治疗的精神科门诊患者被问及他们是否认为自己处于缓解状态，并完成了临床有用的抑郁结果量表（CUDOS），这是一种测量DSM-IV抑郁症状严重程度的量表。该研究于2003年8月至2004年7月进行。
在CUDOS上达到缓解阈值的患者中，近四分之一（55/249）不认为自己处于缓解状态。在CUDOS缓解者中，认为自己处于缓解状态的患者的CUDOS总分显著低于（p<.001）不表明自己处于缓解状态的患者。对特定症状的检查发现，不认为自己处于缓解状态的患者食欲紊乱和嗜睡情况更严重。
我们的结果表明，即使在根据症状严重程度量表的当代定义被认为处于缓解状态的轻度抑郁症患者中，临床状态也存在异质性。
