Calabrese Joseph R, Fava Maurizio, Garibaldi George, Grunze Heinz, Krystal Andrew D, Laughren Thomas, Macfadden Wayne, Marin Robert, Nierenberg Andrew A, Tohen Mauricio
University Hospitals Case Medical Center, Case Western Reserve University School of Medicine, Bipolar Disorders Research Center, 10524 Euclid Avenue, 12th Floor, Cleveland, Ohio 44106, USA.
Massachusetts General Hospital, Boston, USA.
J Affect Disord. 2014 Oct;168:439-51. doi: 10.1016/j.jad.2014.06.056. Epub 2014 Jul 10.
There is growing research interest in studying motivational deficits in different neuropsychiatric disorders because these symptoms appear to be more common than originally reported and negatively impact long-term functional outcomes. However, there is considerable ambiguity in the terminology used to describe motivational deficits in the scientific literature. For the purposes of this manuscript, the term "amotivation" will be utilised in the context of mood disorders, since this is considered a more inclusive/appropriate term for this patient population. Other challenges impacting the study of amotivation in mood disorders, include: appropriate patient population selection; managing or controlling for potential confounding factors; the lack of gold-standard diagnostic criteria and assessment scales; and determination of the most appropriate study duration.
This paper summarises the search for a consensus by a group of experts in the optimal approach to studying amotivation in mood disorders.
The consensus of this group is that amotivation in mood disorders is a legitimate therapeutic target, given the magnitude of the associated unmet needs, and that proof-of-concept studies should be conducted in order to facilitate subsequent larger investigations. The focus of this manuscript is to consider the study of amotivation, as a residual symptom of major depressive disorder (MDD) or bipolar depression (BD), following adequate treatment with a typical antidepressant or mood stabiliser/antipsychotic, respectively.
There is a paucity of data studying amotivation in mood disorders. This manuscript provides general guidance on the most appropriate study design(s) and methodology to assess potential therapeutic options for the management of residual amotivation in mood disorders.
对不同神经精神疾病中动机缺陷的研究兴趣日益浓厚,因为这些症状似乎比最初报道的更为常见,且对长期功能结局有负面影响。然而,科学文献中用于描述动机缺陷的术语存在相当大的模糊性。在本手稿中,“无动机”一词将用于情绪障碍的背景下,因为这被认为是针对该患者群体更具包容性/合适的术语。影响情绪障碍中无动机研究的其他挑战包括:合适的患者群体选择;管理或控制潜在的混杂因素;缺乏金标准诊断标准和评估量表;以及确定最合适的研究持续时间。
本文总结了一组专家对研究情绪障碍中无动机的最佳方法达成共识的探索过程。
该专家小组的共识是,鉴于相关未满足需求的程度,情绪障碍中的无动机是一个合理的治疗靶点,应进行概念验证研究以促进后续更大规模的调查。本手稿的重点是考虑将无动机作为重度抑郁症(MDD)或双相抑郁症(BD)的残留症状进行研究,分别在使用典型抗抑郁药或情绪稳定剂/抗精神病药进行充分治疗之后。
研究情绪障碍中无动机的数据很少。本手稿为评估情绪障碍中残留无动机的潜在治疗选择的最合适研究设计和方法提供了一般指导。