多少认知疗法、针对哪些患者能够预防抑郁症复发？
How much cognitive therapy, for which patients, will prevent depressive relapse?
作者信息
Jarrett Robin B, Vittengl Jeffrey R, Clark Lee Anna
机构信息
Department of Psychiatry, The University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Dallas, TX 75390-9149, United States.
出版信息
J Affect Disord. 2008 Dec;111(2-3):185-92. doi: 10.1016/j.jad.2008.02.011. Epub 2008 Mar 21.
BACKGROUND
Although clinicians accept that relapse is probable when successful acute phase pharmacotherapy is discontinued, less is known about when to stop versus continue successful cognitive therapy. This report describes the development of "translational tools" to bridge the gap between research and practice on this and similar decisions that practitioners make daily. We aim to provide patients, clinicians, and public health administrators' practical tools to facilitate informed decisions about when to stop versus continue cognitive therapy with responders who presented with recurrent major depressive disorder (MDD).
METHOD
Data are drawn from a randomized clinical trial [Jarrett, R.B., Kraft, D., Doyle, J., Foster, B.M., Eaves, G.G., Silver, P.C., 2001. Preventing recurrent depression using cognitive therapy with and without a continuation phase: a randomized clinical trial. Arch. Gen. Psychiatry, 58, 381-388] showing that continuation-phase cognitive therapy (C-CT; [Jarrett, R.B., 1989. Cognitive therapy for recurrent unipolar depressive disorder: The continuation/maintenance phase]) reduced relapse more over 8 months than an assessment-only control, for responders to acute phase cognitive therapy (A-CT; [Beck, A.T., Rush, A.J., Shaw, B.F., Emery, G., 1979. Cognitive therapy of depression. New York, Guilford Press]). We provide tools to translate the additional finding that, over 2 years, responders to A-CT for recurrent depression with higher residual symptoms were more likely to require C-CT to avoid relapse/recurrence than responders with lower or no residual symptoms.
RESULTS
To measure residual symptoms we provide the specific scores from six readily available measures of depressive symptom severity taken at the last acute phase session and their associated probabilities of relapse or recurrence over 8, 12, and 24 months.
CONCLUSIONS
These tools can aid individual patient and providers in making informed decisions when they decide to continue versus discontinue cognitive therapy.
LIMITATIONS
The results are limited to a 20-session trial of A-CT for recurrent depression conducted by highly experienced therapists and require replication.
背景
尽管临床医生承认，成功的急性期药物治疗停药后复发很可能发生，但对于何时停止或继续成功的认知疗法却知之甚少。本报告描述了“转化工具”的开发，以弥合研究与实践之间在这一问题以及从业者日常做出的类似决策上的差距。我们旨在为患者、临床医生和公共卫生管理人员提供实用工具，以便就是否停止或继续对复发性重度抑郁症（MDD）缓解者进行认知疗法做出明智决策。
方法
数据取自一项随机临床试验[贾勒特，R.B.，克拉夫特，D.，多伊尔，J.，福斯特，B.M.，伊夫斯，G.G.，西尔弗，P.C.，2001年。使用有或无延续阶段的认知疗法预防复发性抑郁症：一项随机临床试验。《普通精神病学文献》，58，381 - 388]，该试验表明，对于急性期认知疗法（A - CT；[贝克，A.T.，拉什，A.J.，肖，B.F.，埃默里，G.，1979年。抑郁症的认知疗法。纽约：吉尔福德出版社]）的缓解者，延续阶段认知疗法（C - CT；[贾勒特，R.B.，1989年。复发性单相抑郁症的认知疗法：延续/维持阶段]）在8个月内比仅进行评估的对照组更能减少复发。我们提供工具来转化另一项发现，即在2年时间里，复发性抑郁症A - CT缓解者中，残留症状较高者比残留症状较低或无残留症状者更有可能需要C - CT来避免复发/再发。
结果
为了测量残留症状，我们提供了在最后一次急性期治疗时从六种易于获得的抑郁症状严重程度测量方法中得出的具体分数，以及它们在8、12和24个月内复发或再发的相关概率。
结论
这些工具可以帮助个体患者和医疗服务提供者在决定继续或停止认知疗法时做出明智决策。
局限性
结果仅限于由经验丰富的治疗师进行的为期20次治疗的复发性抑郁症A - CT试验，需要重复验证。
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