Siddiqi Shan H, Chockalingam Ravikumar, Cloninger C Robert, Lenze Eric J, Cristancho Pilar
SIDDIQI, CHOCKALINGAM, CLONINGER, LENZE, and CRISTANCHO: Department of Psychiatry, Washington University School of Medicine in St Louis, St Louis, MO.
J Psychiatr Pract. 2016 May;22(3):193-202. doi: 10.1097/PRA.0000000000000150.
The goal of this study was to investigate the utility of the Temperament and Character Inventory (TCI) in predicting antidepressant response to repetitive transcranial magnetic stimulation (rTMS).
Although rTMS of the dorsolateral prefrontal cortex is an established antidepressant treatment, little is known about predictors of response. The TCI measures multiple personality dimensions (harm avoidance, novelty seeking, reward dependence, persistence, self-directedness, self-transcendence, and cooperativeness), some of which have predicted response to pharmacotherapy and cognitive-behavioral therapy. A previous study suggested a possible association between self-directedness and response to rTMS in melancholic depression, although this was limited by the fact that melancholic depression is associated with a limited range of TCI profiles.
Nineteen patients with a major depressive episode completed the TCI before a clinical course of rTMS over the dorsolateral prefrontal cortex. Treatment response was defined as ≥50% decrease in scores on the Hamilton Rating Scale for Depression (Ham-D). Baseline scores on each TCI dimension were compared between responders and nonresponders through analysis of variance. Pearson correlations were also calculated for temperament/character scores in comparison with percentage improvement in Ham-D scores.
Eleven of the 19 patients responded to rTMS. T-scores for persistence were significantly higher in responders than in nonresponders (P=0.022). Linear regression revealed a correlation between persistence scores and percentage improvement in Ham-D scores.
Higher persistence scores predicted antidepressant response to rTMS. This may be explained by rTMS-induced enhancement of cortical excitability, which has been found to be decreased in patients with high persistence. Personality assessment that includes measurement of TCI persistence may be a useful component of precision medicine initiatives in rTMS for depression.
本研究旨在探讨气质与性格问卷（TCI）在预测重复经颅磁刺激（rTMS）抗抑郁反应中的效用。
尽管背外侧前额叶皮质的rTMS是一种既定的抗抑郁治疗方法，但对反应预测因素知之甚少。TCI测量多种人格维度（回避伤害、寻求新奇、奖赏依赖、坚持性、自我导向、自我超越和合作性），其中一些维度已被证明可预测药物治疗和认知行为治疗的反应。先前的一项研究表明，自我导向与忧郁症患者对rTMS的反应之间可能存在关联，尽管这一关联受到忧郁症与有限范围的TCI特征相关这一事实的限制。
19名患有重度抑郁发作的患者在接受背外侧前额叶皮质rTMS临床治疗前完成了TCI。治疗反应定义为汉密尔顿抑郁量表（Ham-D）评分降低≥50%。通过方差分析比较反应者和无反应者在每个TCI维度上的基线评分。还计算了气质/性格得分与Ham-D评分改善百分比之间的Pearson相关性。
19名患者中有11名对rTMS有反应。反应者的坚持性T分数显著高于无反应者（P = 0.022）。线性回归显示坚持性得分与Ham-D评分改善百分比之间存在相关性。
较高的坚持性得分可预测对rTMS的抗抑郁反应。这可能是由于rTMS诱导的皮质兴奋性增强，而高坚持性患者的皮质兴奋性已被发现降低。包括测量TCI坚持性在内的人格评估可能是rTMS治疗抑郁症精准医学计划的一个有用组成部分。
