Medical Scientist Training Program, Johns Hopkins University School of Medicine, Baltimore, MD; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD.
Am J Geriatr Psychiatry. 2018 Jun;26(6):700-710. doi: 10.1016/j.jagp.2018.01.005. Epub 2018 Jan 31.
On/off motor fluctuations in Parkinson disease (PD) can be associated with extreme mood fluctuations and severe dysphoria. The impact of these affective symptoms may be overlooked in the treatment of motor fluctuations. Our goal was to examine the relationship between motor fluctuations, their treatment status, and suicidality in PD participants.
We analyzed data from the Methods of Optimal Depression Detection in Parkinson's Disease (MOOD-PD) study of 223 individuals with PD. Suicidality was measured using items from four depression scales: Hamilton Depression Rating Scale (HAM-D-17); Montgomery-Åsberg Depression Rating Scale (MADRS); Inventory for Depressive Symptomatology (IDS-C); and the self-rated Beck Depression Inventory (BDI). Multivariable Poisson regression analyses tested whether self-reported motor fluctuations and their treatment status were associated with suicidality while controlling for recognized risk factors.
Thirty-seven participants (16.6%) self-reported suicidality and 89 (39.5%) self-reported motor fluctuations, of whom 21 (23.6%) perceived their fluctuations as untreated. Participants reporting untreated motor fluctuations more frequently had a current depressive disorder (p < 0.001) and endorsed suicidality (p = 0.006) than participants with treated or no fluctuations. They also had significantly higher total scores on the HAM-D-17, MADRS, IDS-C, and BDI depression scales (p < 0.001 for each). Regression analyses showed significant associations between untreated motor fluctuations and higher scores on suicide questions extracted from the HAM-D-17, MADRS, and IDS-C (p < 0.01 for each).
PD patients with untreated motor fluctuations are at increased risk for suicidal thoughts and should be monitored for mood changes as treatment is adapted.
帕金森病（PD）的开-关运动波动可与情绪极端波动和严重的心境恶劣有关。在处理运动波动时，这些情感症状的影响可能会被忽视。我们的目标是研究 PD 患者的运动波动、其治疗状况与自杀意念之间的关系。
我们分析了来自帕金森病最优抑郁检测方法（MOOD-PD）研究的 223 名 PD 患者的数据。使用来自四个抑郁量表的项目来衡量自杀意念：汉密尔顿抑郁评定量表（HAM-D-17）；蒙哥马利-阿斯伯格抑郁评定量表（MADRS）；抑郁症状清单（IDS-C）；以及贝克抑郁自评量表（BDI）。多变量泊松回归分析检验了在控制公认的危险因素后，自我报告的运动波动及其治疗状况是否与自杀意念相关。
37 名参与者（16.6%）自我报告有自杀意念，89 名参与者（39.5%）自我报告有运动波动，其中 21 名（23.6%）认为他们的波动未经治疗。与有治疗或无波动的参与者相比，报告未经治疗的运动波动的参与者更频繁地患有当前的抑郁障碍（p<0.001）和自杀意念（p=0.006）。他们在 HAM-D-17、MADRS、IDS-C 和 BDI 抑郁量表上的总分也明显更高（p<0.001）。回归分析显示，未经治疗的运动波动与 HAM-D-17、MADRS 和 IDS-C 中提取的自杀问题的得分较高之间存在显著关联（p<0.01）。
未经治疗的运动波动的 PD 患者自杀意念的风险增加，应在调整治疗时监测其情绪变化。
