蒙哥马利-Åsberg 抑郁评定量表的预处理因子结构作为艾司西酞普兰治疗非精神病性重度抑郁症印度患者反应的预测因子。

Pre-treatment factor structures of the Montgomery and Åsberg Depression Rating scale as predictors of response to escitalopram in Indian patients with non-psychotic major depressive disorder.

机构信息

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.

出版信息

Asian J Psychiatr. 2017 Aug;28:154-159. doi: 10.1016/j.ajp.2017.04.029. Epub 2017 May 15.

DOI:10.1016/j.ajp.2017.04.029

PMID:28784374

Abstract

BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

摘要

背景

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。

方法

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。

结果

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）。