Susanne Fischer, PhD, Rebecca Strawbridge, MSc, Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Andres Herane Vives, MD, DPM, MSc, Universidad Católica del Norte, Coquimbo, Chile and Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Anthony J. Cleare, BSc, MBBS, FRCPsych, PhD, Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
Susanne Fischer, PhD, Rebecca Strawbridge, MSc, Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Andres Herane Vives, MD, DPM, MSc, Universidad Católica del Norte, Coquimbo, Chile and Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Anthony J. Cleare, BSc, MBBS, FRCPsych, PhD, Department of Psychological Medicine, Centre for Affective Disorders, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Br J Psychiatry. 2017 Feb;210(2):105-109. doi: 10.1192/bjp.bp.115.180653. Epub 2016 Dec 1.
Many patients with depressive disorders demonstrate resistance to psychological therapy. A frequent finding is hypothalamic-pituitary-adrenal (HPA) axis alterations. As cortisol is known to modulate cognitive processes, those patients may be less likely to profit from psychological therapy.
To conduct a systematic review and meta-analysis on cortisol as a predictor of psychological therapy response.
The Cochrane Library, EMBASE, MEDLINE and PsycINFO databases were searched. Records were included if they looked at patients with any depressive disorder engaging in psychological therapy, with a pre-treatment cortisol and a post-treatment symptom measure.
Eight articles satisfied our selection criteria. The higher the cortisol levels before starting psychological therapy, the more symptoms patients with depression experienced at the end of treatment and/or the smaller their symptom change.
Our findings suggest that patients with depression with elevated HPA functioning are less responsive to psychological therapy.
许多患有抑郁症的患者对心理治疗表现出抵抗。常见的发现是下丘脑-垂体-肾上腺（HPA）轴的改变。由于皮质醇已知可以调节认知过程，因此这些患者可能不太可能从心理治疗中获益。
对皮质醇作为心理治疗反应预测因子进行系统回顾和荟萃分析。
检索了 Cochrane 图书馆、EMBASE、MEDLINE 和 PsycINFO 数据库。如果记录中包含任何患有抑郁障碍的患者接受心理治疗，且有治疗前皮质醇和治疗后症状测量值，则将其纳入。
八项符合我们选择标准的文章。开始心理治疗前皮质醇水平越高，治疗结束时患者的抑郁症状越严重和/或症状变化越小。
我们的研究结果表明，HPA 功能升高的抑郁症患者对心理治疗的反应较差。
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