Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India; Department of Community Medicine, Velammal Medical College Hospital & Research Institute, Velammal Village, Madurai-Tuticorin Ring Road, Madurai 625009, Tamil Nadu, India.
Asian J Psychiatr. 2017 Aug;28:154-159. doi: 10.1016/j.ajp.2017.04.029. Epub 2017 May 15.
Major Depressive Disorder (MDD) is a broad heterogeneous construct resolving into several symptom-clusters by factor analysis. The aim was to find the factor structures of MDD as per Montgomery and Asberg Depression Rating Scale (MADRS) and whether they predict escitalopram response.
In a longitudinal study at a tertiary institute in north India, 116 adult out-patients with non-psychotic unipolar MDD were assessed with MADRS before and after treatment with escitalopram (10-20mg) over 6-8 weeks for drug response.
For total 116 patients pre-treatment four factor structures of MADRS extracted by principal component analysis with varimax rotation altogether explained a variance of 57%: first factor 'detachment' (concentration difficulty, lassitude, inability to feel); second factor 'psychic anxiety' (suicidal thoughts and inner tension); third 'mood-pessimism' (apparent sadness, reported sadness, pessimistic thoughts) and fourth 'vegetative' (decreased sleep, appetite). Eighty patients (68.9%) who completed the study had mean age 35.37±10.9 yrs, majority were male (57.5%), with mean pre-treatment MADRS score 28.77±5.18 and majority (65%) having moderate severity (MADRS <30). Among them 56 (70%) responded to escitalopram. At the end of the treatment there were significant changes in all the 4 factor structures (p<0.01). Vegetative function was an important predictor of response (p<0.01, odd's ratio: 1.3 [1.1-1.6] 95% CI). Melancholia significantly predicted non-response (p=0.04).
Non-psychotic unipolar major depression having moderate severity in north Indian patients as per MADRS resolved into four factor-structures all significantly improved with adequate escitalopram treatment. Understanding the factor structure is important as they can be important predictor of escitalopram response.
重度抑郁症（MDD）是一个广泛的异质结构，通过因子分析可分为几个症状群。目的是根据蒙哥马利-阿斯伯格抑郁评定量表（MADRS）找到 MDD 的因子结构，以及它们是否能预测依地普仑的反应。
在印度北部的一家三级研究所进行的一项纵向研究中，对 116 名非精神病性单相 MDD 的成年门诊患者使用 MADRS 进行评估，在 6-8 周内使用依地普仑（10-20mg）进行治疗，以评估药物反应。
对于 116 例患者的治疗前数据，采用主成分分析和方差极大旋转提取的 MADRS 前四个因子结构共解释了 57%的方差：第一个因子“分离”（注意力困难、疲倦、无法感觉）；第二个因子“精神焦虑”（自杀念头和内心紧张）；第三个因子“情绪悲观”（明显悲伤、报告悲伤、悲观思维）和第四个因子“植物性”（睡眠减少、食欲减退）。完成研究的 80 例患者（68.9%）的平均年龄为 35.37±10.9 岁，大多数为男性（57.5%），平均治疗前 MADRS 评分为 28.77±5.18，大多数（65%）为中度严重程度（MADRS <30）。其中 56 例（70%）对依地普仑有反应。治疗结束时，所有 4 个因子结构均有显著变化（p<0.01）。植物性功能是反应的重要预测因子（p<0.01，优势比：1.3[1.1-1.6]95%置信区间）。忧郁显著预测无反应（p=0.04）。
根据 MADRS，印度北部患者的非精神病性单相重度抑郁症为中度严重程度，可分为四个因子结构，所有结构在接受适当的依地普仑治疗后均有显著改善。了解因子结构很重要，因为它们可能是依地普仑反应的重要预测因子。
