Sotsky S M, Glass D R, Shea M T, Pilkonis P A, Collins J F, Elkin I, Watkins J T, Imber S D, Leber W R, Moyer J
Department of Psychiatry and Behavioral Sciences, George Washington University Medical Center, Washington, DC 20037.
Am J Psychiatry. 1991 Aug;148(8):997-1008. doi: 10.1176/ajp.148.8.997.
The authors investigated patient characteristics predictive of treatment response in the National Institute of Mental Health (NIMH) Treatment of Depression Collaborative Research Program.
Two hundred thirty-nine outpatients with major depressive disorder according to the Research Diagnostic Criteria entered a 16-week multicenter clinical trial and were randomly assigned to interpersonal psychotherapy, cognitive-behavior therapy, imipramine with clinical management, or placebo with clinical management. Pretreatment sociodemographic features, diagnosis, course of illness, function, personality, and symptoms were studied to identify patient predictors of depression severity (measured with the Hamilton Rating Scale for Depression) and complete response (measured with the Hamilton scale and the Beck Depression Inventory).
One hundred sixty-two patients completed the entire 16-week trial. Six patient characteristics, in addition to depression severity previously reported, predicted outcome across all treatments: social dysfunction, cognitive dysfunction, expectation of improvement, endogenous depression, double depression, and duration of current episode. Significant patient predictors of differential treatment outcome were identified. 1) Low social dysfunction predicted superior response to interpersonal psychotherapy. 2) Low cognitive dysfunction predicted superior response to cognitive-behavior therapy and to imipramine. 3) High work dysfunction predicted superior response to imipramine. 4) High depression severity and impairment of function predicted superior response to imipramine and to interpersonal psychotherapy.
The results demonstrate the relevance of patient characteristics, including social, cognitive, and work function, for prediction of the outcome of major depressive disorder. They provide indirect evidence of treatment specificity by identifying characteristics responsive to different modalities, which may be of value in the selection of patients for alternative treatments.
作者在国立精神卫生研究所（NIMH）抑郁症协作研究项目中调查了预测治疗反应的患者特征。
239名符合研究诊断标准的重度抑郁症门诊患者进入一项为期16周的多中心临床试验，并被随机分配接受人际心理治疗、认知行为治疗、丙咪嗪联合临床管理或安慰剂联合临床管理。研究了治疗前的社会人口统计学特征、诊断、病程、功能、人格和症状，以确定抑郁症严重程度（用汉密尔顿抑郁量表测量）和完全缓解（用汉密尔顿量表和贝克抑郁量表测量）的患者预测因素。
162名患者完成了整个16周的试验。除了先前报道的抑郁症严重程度外，六个患者特征预测了所有治疗的结果：社会功能障碍、认知功能障碍、改善期望、内源性抑郁症、双重抑郁症和当前发作的持续时间。确定了不同治疗结果的显著患者预测因素。1） 低社会功能障碍预示着对人际心理治疗的反应更好。2） 低认知功能障碍预示着对认知行为治疗和丙咪嗪的反应更好。3） 高工作功能障碍预示着对丙咪嗪的反应更好。4） 高抑郁症严重程度和功能损害预示着对丙咪嗪和人际心理治疗的反应更好。
结果表明患者特征，包括社会、认知和工作功能，与重度抑郁症的预后预测相关。它们通过识别对不同治疗方式有反应的特征，为治疗特异性提供了间接证据，这可能对选择替代治疗的患者有价值。
