G H Sergievsky Center, College of Physicians and Surgeons, Columbia University, New York, NY, USA.
Eur J Neurol. 2012 Oct;19(10):1349-54. doi: 10.1111/j.1468-1331.2012.03774.x. Epub 2012 May 29.
There is growing study of the psychiatric features of essential tremor. Depressive symptoms occur in a considerable number of patients. Yet their impact, as a primary factor, has received almost no attention. We assessed whether, independent of tremor severity, patients with more depressive symptoms have more perceived tremor-related disability, lower tremor-related quality of life, and poorer compliance with tremor medication.
On the basis of their Center for Epidemiological Studies Depression Scale score, we stratified 70 essential tremor patients into three groups: 41 with minimal depressive symptoms, 24 with moderate depressive symptoms, and five with severe depressive symptoms. Importantly, the three groups had similar tremor severity on neurological examination. We assessed self-reported tremor-related disability, tremor-related quality of life (Quality of Life in Essential Tremor) (QUEST) score, and medication compliance.
Cases with minimal depressive symptoms had the lowest QUEST scores (i.e., highest quality of life), cases with moderate depressive symptoms had intermediate scores, and those with severe depressive symptoms had the highest QUEST scores (i.e., lowest quality of life) (P < 0.001). Depressive symptoms were a stronger predictor of tremor-related quality of life than was the main motor feature of essential tremor (ET) itself (tremor). Self-reported medication compliance was lowest in cases with severe depressive symptoms and highest in cases with minimal depressive symptoms.
The physical disability caused by the tremor of ET has traditionally been regarded as the most important feature of the disease that causes distress, and it has received the most attention in the management of patients with this disease. Our data indicate that this may not be the case.
越来越多的研究关注原发性震颤的精神特征。相当数量的患者存在抑郁症状。然而，作为一个主要因素，它们的影响几乎没有得到关注。我们评估了是否在不考虑震颤严重程度的情况下，抑郁症状更严重的患者感知到的震颤相关残疾更多、震颤相关生活质量更低、以及对震颤药物的依从性更差。
根据他们的流行病学研究抑郁量表评分，我们将 70 名原发性震颤患者分为三组：41 名轻度抑郁症状、24 名中度抑郁症状和 5 名重度抑郁症状。重要的是，三组患者在神经检查中震颤严重程度相似。我们评估了自我报告的震颤相关残疾、震颤相关生活质量（原发性震颤生活质量问卷）（QUEST）评分和药物依从性。
轻度抑郁症状组的 QUEST 评分最低（即生活质量最高），中度抑郁症状组的 QUEST 评分居中，重度抑郁症状组的 QUEST 评分最高（即生活质量最低）（P < 0.001）。抑郁症状是预测震颤相关生活质量的更强因素，而不是原发性震颤（ET）的主要运动特征（震颤）（P < 0.001）。自我报告的药物依从性在重度抑郁症状组最低，在轻度抑郁症状组最高。
ET 震颤引起的身体残疾传统上被认为是导致痛苦的疾病的最重要特征，在这种疾病患者的管理中得到了最多的关注。我们的数据表明情况可能并非如此。
