Department of Psychiatry and Human Behavior, Brown Medical School, Providence, RI 02905, USA.
Compr Psychiatry. 2013 Feb;54(2):91-6. doi: 10.1016/j.comppsych.2012.06.010. Epub 2012 Aug 14.
Symptomatic remission has been defined as a complete or near-complete absence of symptoms. Just as the distinction between remitters and nonremitters among treatment responders has clinical significance, the distinction between a complete and near-complete absence of symptoms itself might be important. Recent studies have reported a high frequency of residual symptoms in patients who are presumably in remission, and this raises questions about how residual symptoms are defined. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services project, we compared the prevalence of residual symptoms based on different cutoff scores on 2 self-report measures of depression and then determined the association between residual symptoms and indices of psychosocial morbidity. We administered the 17-item Hamilton Rating Scale for Depression to 274 psychiatric outpatients diagnosed as having DSM-IV major depressive disorder who were in ongoing treatment. The patients completed the Clinically Useful Depression Outcome Scale (CUDOS) and Quick Inventory of Depressive Symptomatology (QIDS) and measures of psychosocial functioning and quality of life. We examined the frequency of residual symptoms in the 142 patients scoring in the remission range on the Hamilton Rating Scale for Depression. For both the CUDOS and QIDS, the threshold to define symptom presence strongly impacted on the prevalence of residual symptoms. The association between residual symptoms, psychosocial functioning, and quality of life varied according to the threshold used to define the symptoms. On the QIDS, a cutoff of 1 was a more valid indicator of the presence of residual symptoms than a cutoff of 2, whereas on the CUDOS, we recommend a cutoff of 2 be used to indicate the presence of residual symptoms. Examination of the frequency of specific symptoms suggests that the choice of scale might impact on which residual symptoms are considered the most frequent in treatment remitters.
症状缓解被定义为完全或几乎完全没有症状。正如治疗应答者中缓解者和非缓解者之间的区别具有临床意义一样，症状完全或几乎完全不存在本身的区别也可能很重要。最近的研究报告称，在假定处于缓解期的患者中存在较高频率的残留症状，这引发了关于如何定义残留症状的问题。在罗德岛改善诊断评估和服务项目的这项报告中，我们比较了基于两种抑郁自评量表的不同截断分数的残留症状的患病率，然后确定了残留症状与心理社会发病率指标之间的关系。我们对 274 名被诊断为 DSM-IV 重性抑郁障碍且正在接受持续治疗的精神科门诊患者使用 17 项汉密尔顿抑郁评定量表进行了评估。患者完成了临床有用的抑郁结局量表（CUDOS）和抑郁症状快速清单（QIDS）以及心理社会功能和生活质量的测量。我们检查了在汉密尔顿抑郁评定量表上评分处于缓解范围内的 142 名患者中残留症状的频率。对于 CUDOS 和 QIDS，定义症状存在的阈值强烈影响残留症状的患病率。残留症状与心理社会功能和生活质量之间的关系因用于定义症状的阈值而异。在 QIDS 上，与使用 2 作为截断值相比，使用 1 作为截断值更能有效指示残留症状的存在，而在 CUDOS 上，我们建议使用 2 作为截断值来指示残留症状的存在。对特定症状频率的检查表明，量表的选择可能会影响被认为是治疗缓解者中最常见的残留症状。
