Schotte Chris K W, Van Den Bossche Bart, De Doncker Dirk, Claes Stephan, Cosyns Paul
UZA, University Hospital Antwerp, Department of Psychiatry, Edegem, Belgium.
Depress Anxiety. 2006;23(5):312-24. doi: 10.1002/da.20177.
Effective treatment of severe or chronic unipolar depression requires the combination of pharmacological and psychotherapeutic interventions, and demands a theoretical paradigm integrating biological and psychosocial aspects of depression. Supported by recent research, we propose in our article a biopsychosocial diathesis-stress model of depression. Its basic aim is psychoeducational: to provide therapists, patients, and their environment a constructive conceptual framework to understand depressive complaints, vulnerability, and stress. The core of the model consists of the concept of psychobiological vulnerability, which is determined by risk factors-of a biogenetic, psychological, somatic, and societal nature-and by protective factors. Life events with an idiosyncratic, stress-inducing value interact with this vulnerability, triggering severe or chronic distress that affects the individual's resilience and leads to symptoms of depression. The pathogenesis of depression is symbolized by a negative downward loop, in which interactions among symptoms, vulnerability, and stressors drive the patient toward a depressive condition. Moreover, experiencing recurrent depression influences psychobiological vulnerability, the occurrence of stressors, and tremendously increases the risk of further relapse. The model stresses the self-evident integration of biological and psychological therapeutic interventions that need to focus on symptom reduction and on relapse prevention. Moreover, it offers the patient and therapist a psychoeducational context in which the individual's vulnerability and depressive symptoms can be treated. Finally, applications of the depression model as a therapeutic approach to severe depression in the phases of remoralization, symptom reduction, and relapse prevention are presented.
重度或慢性单相抑郁症的有效治疗需要药物治疗和心理治疗相结合，并且需要一种整合抑郁症生物学和心理社会层面的理论范式。在近期研究的支持下，我们在文章中提出了一种抑郁症的生物心理社会素质-应激模型。其基本目标是进行心理教育：为治疗师、患者及其周围环境提供一个建设性的概念框架，以理解抑郁症状、易感性和应激。该模型的核心由心理生物学易感性概念构成，它由生物遗传、心理、躯体和社会性质的风险因素以及保护因素所决定。具有独特应激诱导价值的生活事件与这种易感性相互作用，引发严重或慢性困扰，影响个体的恢复力并导致抑郁症状。抑郁症的发病机制以一个负向下降循环为象征，其中症状、易感性和应激源之间的相互作用驱使患者走向抑郁状态。此外，经历复发性抑郁症会影响心理生物学易感性、应激源的发生，并极大增加进一步复发的风险。该模型强调生物和心理治疗干预的自然整合，这些干预需要专注于症状减轻和复发预防。此外，它为患者和治疗师提供了一个心理教育背景，在其中个体的易感性和抑郁症状可以得到治疗。最后，介绍了抑郁症模型作为一种治疗方法在重度抑郁症的康复、症状减轻和复发预防阶段的应用。
