Department of Psychiatry, University of California, San Francisco, CA 94143, USA.
Am J Psychiatry. 2010 Nov;167(11):1391-8. doi: 10.1176/appi.ajp.2010.09091327. Epub 2010 Jun 1.
The purpose of this study was to determine whether problem-solving therapy is an effective treatment in older patients with depression and executive dysfunction, a population likely to be resistant to antidepressant drugs.
Participants were adults age 60 and older with major depression and executive dysfunction. Problem-solving therapy was modified to be accessible to this population. Participants were randomly assigned to 12 weekly sessions of problem-solving therapy or supportive therapy and assessed at weeks 3, 6, 9, and 12.
Of the 653 individuals referred for this study, 221 met selection criteria and were enrolled in the study. Reduction of depressive symptom severity was comparable for the two treatment groups during the first 6 weeks of treatment, but at weeks 9 and 12 the problem-solving therapy group had a greater reduction in symptom severity, a greater response rate, and a greater remission rate than the supportive therapy group (response rates at week 9: 47.1% and 29.3%; at week 12:56.7% and 34.0%; remission rates at week 9: 37.9% and 21.7%; at week 12: 45.6% and 27.8%). Problem-solving therapy yielded one additional response or remission over supportive therapy for every 4.4-5.6 patients by the end of the trial.
These results suggest that problem-solving therapy is effective in reducing depressive symptoms and leading to treatment response and remission in a considerable number of older patients with major depression and executive dysfunction. The clinical value of this finding is that problem-solving therapy may be a treatment alternative in an older patient population likely to be resistant to pharmacotherapy.
本研究旨在确定问题解决疗法是否对患有抑郁症和执行功能障碍的老年患者有效，这些患者可能对抗抑郁药物有抵抗力。
参与者为年龄在 60 岁及以上、患有重度抑郁症和执行功能障碍的成年人。对问题解决疗法进行了修改，以使其适应该人群。参与者被随机分配到 12 周的问题解决疗法或支持性疗法，并在第 3、6、9 和 12 周进行评估。
在被推荐参加这项研究的 653 人中，有 221 人符合入选标准并被纳入研究。在治疗的前 6 周，两组患者的抑郁症状严重程度减轻情况相当，但在第 9 和 12 周，问题解决治疗组的症状严重程度减轻、反应率和缓解率均高于支持性治疗组（第 9 周的反应率：47.1%和 29.3%；第 12 周：56.7%和 34.0%；第 9 周的缓解率：37.9%和 21.7%；第 12 周：45.6%和 27.8%）。到试验结束时，问题解决疗法比支持性疗法每增加 4.4-5.6 例反应或缓解。
这些结果表明，问题解决疗法在减少老年重度抑郁症和执行功能障碍患者的抑郁症状方面是有效的，并能导致治疗反应和缓解。这一发现的临床价值在于，问题解决疗法可能是一种对可能对抗药物治疗有抵抗力的老年患者群体的治疗选择。
