Department of Psychiatry and Human Behavior, Brown Medical School, and the Department of Psychiatry, Rhode Island Hospital, Providence, RI 02905, United States.
J Affect Disord. 2012 Dec 15;142(1-3):77-81. doi: 10.1016/j.jad.2012.03.044. Epub 2012 Sep 12.
Remission is usually defined as a score below a predetermined cutoff on a symptom severity scale. Depressed patients' global perception of their remission status only partially overlaps with scale-based definitions of remission. Patients' self-perceived remission status is likely to impact on their desire for modification in their treatment. The identification of specific symptoms that distinguish patients who do and do not consider themselves to be in remission could represent the most salient targets of add-on treatment strategies desired by patients. In the present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project, we compared the symptom profiles of patients who were in remission on the Hamilton Rating Scale for Depression (HAMD) who did and did not consider themselves to be in remission.
We interviewed 274 psychiatric outpatients diagnosed with DSM-IV major depressive disorder who were in ongoing treatment. The patients completed the Clinically Useful Depression Outcome Scale (CUDOS).
Approximately half of the patients scoring 7 and below on the HAMD did not consider themselves to be in remission. The mean number of symptoms on the CUDOS was significantly higher in the self-described non-remitters. Almost all symptoms were less frequent in the self-rated remitters, though the absolute frequency of the individual symptoms was related to the threshold used to define symptom presence.
Consistent with the findings of other studies we found high rates of residual symptoms in patients who were considered to be in remission, and patients with residual symptoms typically had more than 1 such symptom. These results raise questions about the strategy of add-on treatments targeting specific individual symptoms.
Remission was defined according to the 17-item version of the HAMD. We focused on the 17-item HAMD because it is the most commonly used measure in antidepressant efficacy trials, and the cutoff used to define remission has been generally accepted. We would anticipate that our findings would be similar in studies of longer versions of the HAMD as well as other depression severity scales such as the Montgomery-Asberg Depression Rating Scale. Self-perceived remission status was based on the patients' response to a single question. The sample was drawn from a single, large, general adult outpatient private practice setting in which the majority of the patients were white, female, and in their 30s and 40s. Generalizability to samples with different demographic characteristics needs to be demonstrated.
缓解通常被定义为症状严重程度量表的分数低于预定的截止值。抑郁患者对其缓解状态的整体感知仅部分与基于量表的缓解定义重叠。患者对自己缓解状态的自我感知可能会影响他们对治疗改变的愿望。识别区分那些认为自己缓解和不认为自己缓解的患者的特定症状，可能代表了患者希望采用附加治疗策略的最显著目标。在罗得岛改善诊断评估和服务（MIDAS）项目的本报告中，我们比较了汉密尔顿抑郁量表（HAMD）缓解且认为自己缓解的患者和不认为自己缓解的患者的症状特征。
我们对 274 名正在接受 DSM-IV 重性抑郁障碍治疗的精神科门诊患者进行了访谈。患者完成了临床有用的抑郁结局量表（CUDOS）。
约一半在 HAMD 上得分 7 及以下的患者不认为自己缓解。在自我描述的非缓解者中，CUDOS 的平均症状数明显更高。几乎所有的症状在自我评定的缓解者中都较少，但个体症状的绝对频率与用于定义症状存在的阈值有关。
与其他研究的结果一致，我们发现，在被认为缓解的患者中存在较高的残留症状率，且有残留症状的患者通常有超过 1 个这样的症状。这些结果引发了对针对特定个体症状的附加治疗策略的质疑。
缓解是根据 HAMD 的 17 项版本定义的。我们专注于 17 项 HAMD，因为它是抗抑郁药疗效试验中最常用的测量方法，并且缓解的截止值已被普遍接受。我们预计，在更长版本的 HAMD 以及其他抑郁严重程度量表（如蒙哥马利-阿斯伯格抑郁评定量表）的研究中，我们的发现也会相似。自我感知的缓解状态基于患者对一个问题的回答。该样本来自一个单一的、大型的、一般的成年门诊私人执业环境，其中大多数患者是白人、女性，年龄在 30 多岁和 40 多岁。需要证明其在具有不同人口统计学特征的样本中的可推广性。
