Candrian Michele, Farabaugh Amy, Pizzagalli Diego A, Baer Lee, Fava Maurizio
Depression Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts 02114, USA.
J Nerv Ment Dis. 2007 Sep;195(9):729-37. doi: 10.1097/NMD.0b013e318142cbd5.
Although personality disorder (PD) comorbidity has been associated with poor treatment outcome in major depressive disorder (MDD), little is known about mechanisms mediating this link. Converging evidence suggests that maladaptive cognitive patterns, particularly in interaction with stressors, might lead to poor treatment outcome in MDD subjects with PD pathology. The goal of this study was to test the role of PD comorbidity, cognitive vulnerability, and perceived stress in treatment outcome in MDD. Three hundred eighty-four MDD outpatients were enrolled in an 8-week open-label treatment of fluoxetine. Structural equation modeling and path analyses revealed that the effect of PD vulnerability on treatment outcome was fully mediated by increased pretreatment cognitive vulnerability and depression severity, which led to increased stress perception after treatment and poorer antidepressant response. Depressogenic cognitions might be continuously activated by chronic distress in MDD subjects reporting axis II pathology, leading to stress exacerbation and eventually poorer treatment outcome.
尽管人格障碍（PD）共病与重度抑郁症（MDD）的治疗效果不佳有关，但对于介导这种关联的机制却知之甚少。越来越多的证据表明，适应不良的认知模式，尤其是在与应激源相互作用时，可能导致患有PD病理的MDD患者治疗效果不佳。本研究的目的是检验PD共病、认知易损性和感知应激在MDD治疗结果中的作用。384名MDD门诊患者参加了为期8周的氟西汀开放标签治疗。结构方程模型和路径分析表明，PD易损性对治疗结果的影响完全由治疗前认知易损性和抑郁严重程度的增加介导，这导致治疗后应激感知增加和抗抑郁反应较差。报告有轴II病理的MDD患者的慢性痛苦可能会持续激活致抑郁认知，导致应激加剧并最终导致治疗效果更差。
