Department of Psychiatry, University of Pennsylvania Philadelphia, PA 19104, USA.
J Consult Clin Psychol. 2010 Jun;78(3):409-19. doi: 10.1037/a0019267.
Psychotherapy-pharmacotherapy combinations are frequently recommended for the treatment of chronic depressive disorders. Our aim in this novel reanalysis of archival data was to identify patient subgroups on the basis of symptom trajectories and examine the clinical significance of the resultant classification on basis of differential treatment effects to psychotherapy (cognitive behavioral analysis system of psychotherapy), pharmacotherapy (nefazodone), and their combination.
We selected data for 504 patients diagnosed with chronic depression from archival data of a clinical trial (N = 681) and analyzed treatment courses (as assessed by the Hamilton Rating Scale for Depression) using growth mixture models, a contemporary exploratory analysis technique.
Three patient subgroups were identified from the typical patterns of change of depression severity during 12-week acute-phase treatment. Within these patient subgroups, differential treatment effects were evident: combination treatment clearly outperformed the 2 monotherapies in the largest patient subgroup, characterized by moderate depression severity, but not in the remaining 2 subgroups, characterized by low and severe depression at baseline. Patient characteristics prior to initiation of treatment enabled allocation of 61% of patients to these subgroups.
Research on patient subgroups with different change patterns may support classifications of patients that indicate which treatment is most effective for which type of patient.
心理治疗与药物治疗的联合应用常被推荐用于慢性抑郁障碍的治疗。本研究旨在通过对档案数据的重新分析，基于症状轨迹识别患者亚组，并根据不同治疗效果（认知行为分析系统心理疗法、奈法唑酮）和联合治疗的差异来检验这种分类方法的临床意义。
我们从一项临床试验的档案数据中选择了 504 名被诊断为慢性抑郁症的患者的数据（N=681），并使用增长混合模型（一种现代的探索性分析技术）对治疗过程（通过汉密尔顿抑郁评定量表评估）进行分析。
从 12 周急性治疗期间抑郁严重程度的典型变化模式中，我们确定了三个患者亚组。在这些患者亚组中，治疗效果存在差异：在以中度抑郁为特征的最大患者亚组中，联合治疗明显优于两种单药治疗，但在其余两个以基线时轻度和重度抑郁为特征的亚组中则不然。治疗开始前的患者特征使 61%的患者能够被分配到这些亚组中。
对具有不同变化模式的患者亚组进行研究，可能有助于对患者进行分类，以确定哪种治疗对哪种类型的患者最有效。
