Department of Psychiatry, University of Medicine and Dentistry of New Jersey, Robert Wood Johnson Medical School, Piscataway, NJ 08854, USA.
J Consult Clin Psychol. 2012 Aug;80(4):694-9. doi: 10.1037/a0027695. Epub 2012 Mar 12.
The purpose of this study was to examine predictors of treatment response to cognitive-behavioral therapy (CBT) for depression in Parkinson's disease (PD).
The sample comprised 80 depressed (DSM-IV criteria) adults with PD (60% male) and their caregivers who participated in an National Institutes of Health-sponsored randomized-controlled trial of CBT vs. clinical monitoring from April 2007 until July 2010. Individually administered CBT was provided to people with PD for 10 weeks, modified to address the unique needs of the medical population, and supplemented with up to 4 separate caregiver educational sessions. Treatment response was defined a priori as a rating of depression much improved or very much improved on the Clinical Global Impression-Improvement Scale or ≥ 50% reduction in the baseline Hamilton Depression Rating Scale score. It was hypothesized (a priori) that caregiver participation in treatment, motor disability, psychiatric comorbidity, and executive functioning would be significant predictors of response to CBT at end-of-treatment (Week 10) and short-term follow-up (Week 14).
At Week 10, caregiver participation was the only significant predictor of treatment response in the CBT group. At Week 14, both caregiver participation and executive functioning predicted response to CBT. Treatment group, baseline depression severity, executive functioning, motor disability, psychiatric comorbidity, marital status, and caregiver burden were also related to change in depression scores, for all participants, in secondary and exploratory models.
Caregiver participation may enhance acute treatment response to psychosocial interventions for depression in PD. Further research is needed to extend and replicate these findings.
本研究旨在探讨帕金森病（PD）患者接受认知行为疗法（CBT）治疗抑郁的预测因素。
该样本包括 80 名患有 PD（60%为男性）且抑郁（DSM-IV 标准）的成年患者及其照顾者，他们参与了一项由美国国立卫生研究院资助的 CBT 与临床监测的随机对照试验，该试验于 2007 年 4 月至 2010 年 7 月进行。针对 PD 患者的个体 CBT 治疗持续 10 周，治疗进行了修改以满足医疗人群的特殊需求，并辅以最多 4 次单独的照顾者教育课程。治疗反应的定义是根据临床总体印象-改善量表（CGI-I）的评分，患者的抑郁状况为明显改善或非常明显改善，或汉密尔顿抑郁量表（HDRS）基线评分降低≥50%。假设（先验）照顾者参与治疗、运动障碍、精神共病和执行功能将是 CBT 在治疗结束（第 10 周）和短期随访（第 14 周）时的反应的显著预测因素。
在第 10 周，照顾者的参与是 CBT 组治疗反应的唯一显著预测因素。在第 14 周，照顾者的参与和执行功能都预测了 CBT 的反应。治疗组、基线抑郁严重程度、执行功能、运动障碍、精神共病、婚姻状况和照顾者负担也与所有参与者在二级和探索性模型中的抑郁评分变化有关。
照顾者的参与可能会增强 PD 患者接受心理社会干预治疗抑郁的急性反应。需要进一步的研究来扩展和复制这些发现。
