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改善临床抑郁症认知功能障碍和功能能力的药物和非药物干预措施——系统评价。

Pharmacological and non-pharmacological interventions to improve cognitive dysfunction and functional ability in clinical depression--a systematic review.

机构信息

Discipline of Psychiatry, University of Adelaide, Adelaide, Australia.

Discipline of Psychiatry, University of Adelaide, Adelaide, Australia.

出版信息

Psychiatry Res. 2014 Sep 30;219(1):25-50. doi: 10.1016/j.psychres.2014.05.013. Epub 2014 May 14.

Abstract

Cognitive dysfunction is of clinical significance and exerts longstanding implication on patients׳ function. Pharmacological and non-pharmacological treatments of cognitive dysfunction are emerging. This review evaluates pharmacological and non-pharmacological treatments of cognitive impairment primarily in the domains of memory, attention, processing speed and executive function in clinical depression. A total of 35 studies were retrieved from Pubmed, PsycInfo and Scopus after applying inclusion and exclusion criteria. Results show that various classes of antidepressants exert improving effects on cognitive function across several cognitive domains. Specifically, studies suggest that SSRIs, the SSRE tianeptine, the SNRI duloxetine, vortioxetine and other antidepressants such as bupropion and moclobemide may exert certain improving effects on cognitive function in depression, such as in learning and memory and executive function. Class-specific cognitive domains or specific dose-response relationships were not identified yet. The few non-pharmacological studies conducted employing cognitive orientated treatments and cognitive remediation therapy show promising results for the improvement of cognitive impairment in depression. However, several methodological constraints of studies limit generalizability of the results and caution the interpretation. Future direction should consider the development of a neuropsychological consensus cognitive battery to support the discovery, clinical assessment, comparison of studies and registration of new agents in clinical depression.

摘要

认知功能障碍具有临床意义,并对患者的功能产生长期影响。目前已经出现了针对认知功能障碍的药理学和非药理学治疗方法。本综述评估了抑郁症患者认知障碍的药理学和非药理学治疗方法,主要涉及记忆、注意力、处理速度和执行功能等认知领域。在应用纳入和排除标准后,从 Pubmed、PsycInfo 和 Scopus 中检索到 35 项研究。结果表明,各种类别的抗抑郁药在多个认知领域都能改善认知功能。具体来说,研究表明,SSRIs、SSRE 噻奈普汀、SNRI 度洛西汀、文拉法辛和其他抗抑郁药,如安非他酮和吗氯贝胺,可能对抑郁症患者的认知功能(如学习和记忆以及执行功能)有一定的改善作用。但尚未确定特定药物类别或特定剂量-反应关系。为数不多的采用认知定向治疗和认知矫正治疗的非药理学研究显示出改善抑郁症患者认知障碍的前景,但研究中的一些方法学限制限制了结果的普遍性,需要谨慎解释。未来的研究方向应考虑开发一种神经心理学共识认知测试,以支持在抑郁症中发现、临床评估、比较研究和新药物的注册。

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