Department of Psychiatry, Emory University School of Medicine, 1256 Briarcliff Road, Building A, 3rd Floor, Atlanta, GA 30306, USA.
J Psychiatr Res. 2011 Jan;45(1):96-103. doi: 10.1016/j.jpsychires.2010.04.032. Epub 2010 Jun 2.
We conducted a secondary analysis of data from the Prevention of Recurrent Episodes of Depression With Venlafaxine Extended Release (ER) for Two Years (PREVENT) trial to evaluate whether discrepancies between clinician and patient ratings of depression severity were predictive of response, remission, and recurrence during treatment for a depressive episode. Patients who self-rated depression severity in concordance with the clinician ("concordant patients") were defined as having a standardized patient-rated Inventory of Depressive Symptoms-Self Report (IDS-SR₃₀) score minus standardized clinician-rated Hamilton Rating Scale for Depression (HAM-D₁₇) score <1 SD from mean. Non-concordant patients ("underrating patients" [-1 SD], "overrating patients" [+1 SD]) were identified. Cohorts were compared for remission and response on the HAM-D₁₇, Clinician Global Impression--Severity (CGI-S), and IDS-SR₃₀ during acute and continuation therapy and time to recurrence during maintenance therapy. During acute treatment female patients were more likely to overrate their depression severity compared to the clinician; older age predicted overrating during continuation treatment. Overrating patients had a slower onset of response on the HAM-D₁₇ during acute treatment (P=0.004). There were no differences between cohorts for remission or response on the HAM-D₁₇ or CGI-S. Overrating patients at week 10 had lower remission and response rates on the IDS-SR₃₀ during continuation therapy (32% and 50%, respectively; P≤0.001) compared with underrating patients (76%, 77%) or concordant patients (64%, 78%). Patient concordance at the end of continuation therapy did not predict recurrence during maintenance therapy, indicating that patient rating scales may be useful in tracking recurrence during maintenance therapy. Poor agreement between patient- and clinician-ratings of depression severity is primarily a state phenomenon, although it is trait-like for some patients.
我们对预防复发性抑郁用文拉法辛缓释剂（ER）两年（PREVENT）试验的数据进行了二次分析，以评估抑郁严重程度的临床医生和患者评分之间的差异是否可预测治疗期间发作性抑郁的反应、缓解和复发。自我评估与临床医生一致的患者（“一致患者”）被定义为标准化患者自评抑郁症状量表-自我报告（IDS-SR₃₀）评分减去标准化临床医生评定的汉密尔顿抑郁量表（HAM-D₁₇）评分与平均值相差小于 1 个标准差。不一致的患者（“低估患者”[-1 SD]，“高估患者”[+1 SD]）被识别。比较了急性和延续治疗期间 HAM-D₁₇、临床医生总体印象-严重程度（CGI-S）和 IDS-SR₃₀的缓解和反应，以及维持治疗期间复发的时间。在急性治疗期间，女性患者比临床医生更有可能高估其抑郁严重程度；年龄较大预示着延续治疗期间的高估。在急性治疗期间，高估患者 HAM-D₁₇的反应起始较慢（P=0.004）。在 HAM-D₁₇或 CGI-S的缓解或反应方面，各组之间没有差异。在第 10 周时高估的患者在延续治疗期间 IDS-SR₃₀的缓解和反应率较低（分别为 32%和 50%；P≤0.001），而低估患者（76%，77%）或一致患者（64%，78%）。延续治疗结束时患者的一致性并不预示着维持治疗期间的复发，这表明患者评分量表可能有助于跟踪维持治疗期间的复发。患者和临床医生对抑郁严重程度的评估之间的一致性差主要是一种状态现象，尽管对某些患者来说它具有特质。
