Section of Psychiatry, Department of Medical Sciences of Communication and Behaviour, University of Ferrara, 44100 Ferrara, Italy.
J Affect Disord. 2010 Aug;124(3):329-34. doi: 10.1016/j.jad.2009.11.019. Epub 2010 Jan 6.
In clinical practice patients with unipolar depression present with a variety of symptom clusters that may combine together in many different ways. However, only few factor analytic studies used general psychopathology scales to investigate the symptom structure of unipolar depression.
The study included 163 consecutive inpatients with an ICD-10 diagnosis of depressive disorder (ICD-10 codes F32 to F33). All patients were assessed with the 18-item version of the Brief Psychiatric Rating Scale (BPRS) within 3days from admission. Exploratory factor analysis with Varimax rotation was performed on BPRS items.
Four factors were extracted, explaining 52% of total variance. They were interpreted as Apathy, Dysphoria, Depression and Psychoticism. The distribution of factor scores was approximately normal for Apathy, while it displayed a slight negative skewness for Depression, a slight positive skewness for Dysphoria, and a marked positive skewness for Psychoticism. Patient sex, family history of depression, lifetime history of suicide attempt, and recent serious family conflict were not associated with any factor. Occupational status, age, and age at onset displayed a positive correlation with Apathy. Duration of illness and number of previous admissions were positively correlated with Dysphoria.
Patients were not administered a structured diagnostic interview, and no detailed assessment of personality disorders was performed; also, patients were recruited only at a single site, which reduces the generalizability of the results.
Our findings suggest that in depressive disorders there are psychopathological dimensions other than depressed mood that are worthy of greater clinical attention and research. Dimensions such as apathy and dysphoria may play an important part in the clinical phenomenology of unipolar depression and deserve systematic and careful assessment in order to provide patients with the best possible treatment and improve clinical outcomes.
在临床实践中，单相抑郁症患者表现出多种症状群，这些症状群可能以多种不同的方式组合在一起。然而，只有少数因子分析研究使用一般精神病理学量表来研究单相抑郁症的症状结构。
该研究纳入了 163 例连续住院的 ICD-10 单相抑郁障碍患者（ICD-10 编码 F32 至 F33）。所有患者在入院后 3 天内接受 18 项Brief 精神病评定量表（BPRS）的评估。采用方差最大正交旋转进行 BPRS 项目的探索性因子分析。
提取出 4 个因子，解释了总方差的 52%。它们被解释为淡漠、烦躁不安、抑郁和精神病性。因子得分的分布在淡漠时接近正态分布，而在抑郁时略呈负偏态，在烦躁不安时略呈正偏态，在精神病性时呈明显正偏态。患者性别、抑郁家族史、终生自杀企图史和近期严重家庭冲突与任何因子均无关。职业状况、年龄和发病年龄与淡漠呈正相关。病程和既往住院次数与烦躁不安呈正相关。
患者未接受结构诊断访谈，未进行详细的人格障碍评估；此外，患者仅在一个地点招募，这降低了结果的普遍性。
我们的研究结果表明，在抑郁障碍中，除了抑郁情绪之外，还有其他值得临床更多关注和研究的精神病理学维度。如淡漠和烦躁不安等维度可能在单相抑郁的临床现象学中起着重要作用，需要进行系统和仔细的评估，以便为患者提供最佳的治疗，并改善临床结局。
