Farabaugh Amy, Mischoulon David, Schwartz Faye, Pender Maribeth, Fava Maurizio, Alpert Jonathan
Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Depress Anxiety. 2007;24(6):433-9. doi: 10.1002/da.20174.
A key component of how depression may impact personality pathology involves an understanding of how cognition and dysfunctional attitudes may change as a result of experiencing a depressive state, and how these changes may affect reporting of personality disorder symptoms. This study examines whether dysfunctional attitudes are related to the stability of personality disorder diagnoses. The sample comprised 64 outpatients who were treatment responders following an 8-week acute treatment phase for major depressive disorder (MDD), met criteria for remission throughout a 26-week continuation phase, and completed a personality disorder assessment Structured Clinical Interview for DSM-III-R Axis II Disorders (SCID-II) at the beginning and end of each treatment phase. The Dysfunctional Attitude Scale (DAS) was given to patients at the beginning of the continuation phase. We found that following successful treatment of the MDD, individuals with stable personality disorder diagnoses (e.g., meeting criteria for a personality disorder at both the beginning and endpoint of continuation treatment) had greater severity of dysfunctional attitudes (P =.001) at the beginning of the continuation treatment compared to those who never met criteria for a personality disorder during continuation treatment. Though there was no significant relationship between DAS scores and the stability of a Cluster A or Cluster B personality disorder diagnosis, there was a significant relationship between DAS scores and the stability of a Cluster C personality disorder diagnosis (P <.001). Outpatients who had a stable Cluster C personality disorder diagnosis had higher scores on the DAS at the beginning of continuation treatment compared to outpatients who never met criteria for a Cluster C diagnosis. This finding suggests that dysfunctional attitudes that persist beyond remission of MDD may be a marker for certain personality disorders that are stable across long-term treatment.
抑郁症可能影响人格病理学的一个关键因素，涉及理解认知和功能失调态度如何因经历抑郁状态而改变，以及这些改变如何影响人格障碍症状的报告。本研究考察功能失调态度是否与人格障碍诊断的稳定性相关。样本包括64名门诊患者，他们在重度抑郁症（MDD）8周的急性治疗阶段后对治疗有反应，在26周的延续治疗阶段全程符合缓解标准，并在每个治疗阶段开始和结束时完成了人格障碍评估——《DSM-III-R轴II障碍的结构化临床访谈》（SCID-II）。在延续治疗阶段开始时，对患者进行功能失调态度量表（DAS）测试。我们发现，MDD成功治疗后，在延续治疗开始时，人格障碍诊断稳定的个体（例如，在延续治疗开始和结束时均符合人格障碍标准）与在延续治疗期间从未符合人格障碍标准的个体相比，功能失调态度更严重（P = 0.001）。虽然DAS得分与A类或B类人格障碍诊断的稳定性之间没有显著关系，但DAS得分与C类人格障碍诊断的稳定性之间存在显著关系（P < 0.001）。与从未符合C类诊断标准的门诊患者相比，C类人格障碍诊断稳定的门诊患者在延续治疗开始时DAS得分更高。这一发现表明，MDD缓解后仍持续存在的功能失调态度可能是某些在长期治疗中稳定的人格障碍的一个标志。
