Starkstein Sergio E, Merello Marcelo, Jorge Ricardo, Brockman Simone, Bruce David, Petracca Gustavo, Robinson Robert G
School of Psychiatry and Clinical Neurosciences, University of Western Australia, Western Australia, Australia.
Mov Disord. 2008 Mar 15;23(4):538-46. doi: 10.1002/mds.21866.
The validity, sensitivity, and specificity of depressive symptoms for the diagnosis of major depression, minor depression, dysthymic disorder, and subsyndromal depression in Parkinson's disease (PD) were examined. A consecutive series of 173 patients with PD attending a Movement Disorders Clinic underwent a comprehensive psychiatric and neurological assessment. The symptoms of loss of interest/pleasure, changes in appetite or weight, changes in sleep, low energy, worthlessness or inappropriate guilt, psychomotor retardation/agitation, concentration deficits, and suicide ideation were all significantly associated with the presence of the DSM-IV depressed mood criterion for major depression. The symptoms of changes in appetite, changes in sleep, low energy, low self-esteem, poor concentration, and hopelessness were all significantly associated with the presence of the DSM-IV criterion of sad mood for dysthymic disorder. Thirty percent of our sample met DSM-IV diagnostic criteria for major depression, 20% met diagnostic criteria for dysthymic disorder, 10% met diagnostic criteria for minor depression, and 8% met clinical criteria for subsyndromal depression. Patients with either major or minor depression had significantly more severe deficits in activities of daily living, more severe cognitive impairments, and more severe Parkinsonism than patients with either dysthymic disorder or no depression. This study provides validation to the DSM-IV diagnostic criteria for major depression and dysthymic disorder for use in PD. The categories of minor and subsyndromal depression may need further validation.
研究了帕金森病（PD）中抑郁症状对重度抑郁症、轻度抑郁症、恶劣心境障碍和亚综合征性抑郁症诊断的有效性、敏感性和特异性。连续纳入173例在运动障碍门诊就诊的PD患者，对其进行了全面的精神和神经学评估。兴趣/愉悦感丧失、食欲或体重变化、睡眠改变、精力不足、无价值感或不适当的内疚感、精神运动迟缓/激越、注意力缺陷和自杀观念等症状均与重度抑郁症的DSM-IV抑郁情绪标准的存在显著相关。食欲改变、睡眠改变、精力不足、自尊低下、注意力不集中和绝望等症状均与恶劣心境障碍的DSM-IV悲伤情绪标准的存在显著相关。我们样本中的30%符合重度抑郁症的DSM-IV诊断标准，20%符合恶劣心境障碍的诊断标准，10%符合轻度抑郁症的诊断标准，8%符合亚综合征性抑郁症的临床标准。与患有恶劣心境障碍或无抑郁症的患者相比，患有重度或轻度抑郁症的患者在日常生活活动方面的缺陷明显更严重，认知障碍更严重，帕金森症状也更严重。本研究验证了DSM-IV中用于PD的重度抑郁症和恶劣心境障碍的诊断标准。轻度和亚综合征性抑郁症的类别可能需要进一步验证。
