Department of Clinical Psychology, University of Groningen, Groningen, The Netherlands.
Vanderbilt University, Department of Psychology, Nashville, TN, United States.
J Affect Disord. 2015 Mar 1;173:97-104. doi: 10.1016/j.jad.2014.10.042. Epub 2014 Nov 4.
Personality disorders (PDs) have been associated with a poor prognosis of Major Depressive Disorder (MDD). The aim of the current study was to examine cognitive vulnerability (i.e., dysfunctional beliefs, extremity of beliefs, cognitive reactivity, and rumination) that might contribute to this poor prognosis of patients with PD comorbidity.
309 outpatients with remitted recurrent MDD (SCID-I; HAM-D17 ≤ 10) were included within two comparable RCTs and were assessed at baseline with the Personality Diagnostic Questionnaire-4(+) (PDQ-4(+)), the Dysfunctional Attitude Scale Version-A (DAS-A), the Leiden Index of Depression Sensitivity (LEIDS), the Ruminative Response Scale (RRS), and the Inventory of Depressive Symptomatology-Self Report (IDS-SR).
We found an indication that the PD prevalence was 49.5% in this remitted recurrently depressed sample. Having a PD (and higher levels of personality pathology) was associated with dysfunctional beliefs, cognitive reactivity, and rumination. Extreme 'black and white thinking' on the DAS was not associated with personality pathology. Brooding was only associated with a Cluster C classification (t(308) = 4.03, p < .001) and with avoidant PD specifically (t(308) = 4.82, p < .001), while surprisingly not with obsessive-compulsive PD.
PDs were assessed by questionnaire and the analyses were cross-sectional in nature.
Being the first study to examine cognitive reactivity and rumination in patients with PD and remitted MDD, we demonstrated that even after controlling for depressive symptomatology, dysfunctional beliefs, cognitive reactivity, and rumination were associated with personality pathology. Rumination might be a pathway to relapse for patients with avoidant PD. Replication of our findings concerning cognitive vulnerability and specific PDs is necessary.
人格障碍（PD）与重度抑郁症（MDD）的预后不良有关。本研究的目的是检查认知易感性（即功能失调的信念、信念的极端、认知反应和反刍），这些可能导致合并 PD 的患者预后不良。
在两项可比的 RCT 中，共纳入 309 名缓解后反复发作的 MDD 门诊患者（SCID-I；HAM-D17≤10），并在基线时使用人格诊断问卷-4+（PDQ-4+）、功能失调态度量表 A 版（DAS-A）、莱顿抑郁敏感指数（LEIDS）、反刍反应量表（RRS）和抑郁症状自评量表-自我报告（IDS-SR）进行评估。
我们发现，在这个缓解后反复发作的抑郁样本中，PD 的患病率为 49.5%。患有 PD（和更高水平的人格病理学）与功能失调的信念、认知反应和反刍有关。DAS 上的极端“非黑即白思维”与人格病理学无关。沉思只与聚类 C 分类（t（308）=4.03，p<.001）和特定的回避型 PD 有关（t（308）=4.82，p<.001），而令人惊讶的是，与强迫症 PD 无关。
PD 是通过问卷评估的，分析是横断面的。
作为第一项研究，我们检查了患有 PD 和缓解性 MDD 的患者的认知反应和反刍，我们证明，即使在控制抑郁症状后，功能失调的信念、认知反应和反刍与人格病理学有关。反刍可能是回避型 PD 患者复发的途径。有必要复制我们关于认知易感性和特定 PD 的发现。
