磁共振成像随机对照试验研究青少年中重度单相抑郁心理治疗后恢复的预测因素：磁共振改善情绪的精神分析和认知治疗（MR-IMPACT）研究方案。
Magnetic resonance imaging of a randomized controlled trial investigating predictors of recovery following psychological treatment in adolescents with moderate to severe unipolar depression: study protocol for Magnetic Resonance-Improving Mood with Psychoanalytic and Cognitive Therapies (MR-IMPACT).
机构信息
Department of Psychiatry, University of Cambridge, Herchel Smith Building for Brain and Mind Sciences, Robinson Way, Cambridge CB2 0SZ, UK.
出版信息
BMC Psychiatry. 2013 Oct 5;13:247. doi: 10.1186/1471-244X-13-247.
BACKGROUND
Major depressive disorders (MDD) are a debilitating and pervasive group of mental illnesses afflicting many millions of people resulting in the loss of 110 million working days and more than 2,500 suicides per annum. Adolescent MDD patients attending NHS clinics show high rates of recurrence into adult life. A meta-analysis of recent research shows that psychological treatments are not as efficacious as previously thought. Modest treatment outcomes of approximately 65% of cases responding suggest that aetiological and clinical heterogeneity may hamper the better use of existing therapies and discovery of more effective treatments. Information with respect to optimal treatment choice for individuals is lacking, with no validated biomarkers to aid therapeutic decision-making.
METHODS/DESIGN: Magnetic resonance-Improving Mood with Psychoanalytic and Cognitive Therapies, the MR-IMPACT study, plans to identify brain regions implicated in the pathophysiology of depressions and examine whether there are specific behavioural or neural markers predicting remission and/or subsequent relapse in a subsample of depressed adolescents recruited to the IMPACT randomised controlled trial (Registration # ISRCTN83033550).
DISCUSSION
MR-IMPACT is an investigative biomarker component of the IMPACT pragmatic effectiveness trial. The aim of this investigation is to identify neural markers and regional indicators of the pathophysiology of and treatment response for MDD in adolescents. We anticipate that these data may enable more targeted treatment delivery by identifying those patients who may be optimal candidates for therapeutic response.
TRIAL REGISTRATION
Adjunctive study to IMPACT trial (Current Controlled Trials: ISRCTN83033550).
背景
重度抑郁症（MDD）是一种使人衰弱且普遍存在的精神疾病，影响着数百万人，导致每年损失 1.1 亿个工作日和超过 2500 例自杀。在 NHS 诊所就诊的青少年 MDD 患者在成年后复发率很高。最近研究的荟萃分析表明，心理治疗并不像以前认为的那样有效。大约 65%的病例有适度的治疗效果，这表明病因和临床异质性可能会阻碍现有治疗方法的更好应用和发现更有效的治疗方法。缺乏针对个体的最佳治疗选择的信息，也没有经过验证的生物标志物来帮助治疗决策。
方法/设计：磁共振改善心理分析和认知治疗的情绪，即 MR-IMPACT 研究，计划确定与抑郁症病理生理学相关的大脑区域，并检查是否存在特定的行为或神经标志物，以预测抑郁青少年亚组的缓解和/或随后的复发，这些青少年是被招募到 IMPACT 随机对照试验（注册号 ISRCTN83033550）的。
讨论
MR-IMPACT 是 IMPACT 实用有效性试验的一个探索性生物标志物组成部分。本研究的目的是确定青少年 MDD 的病理生理学和治疗反应的神经标志物和区域指标。我们预计，这些数据可以通过识别那些可能是治疗反应的最佳候选者的患者，从而实现更有针对性的治疗。
试验注册
IMPACT 试验的辅助研究（当前对照试验：ISRCTN83033550）。
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