Pede Vishal B, Jaiswal Suyog Vijay, Sawant Vishal A
Department of Psychiatry, HBT Medical College and Dr. RN Cooper Municipal General Hospital, Mumbai, Maharashtra, India.
Ind Psychiatry J. 2017 Jul-Dec;26(2):121-127. doi: 10.4103/ipj.ipj_19_18.
The definitive diagnosis of depression calls for fulfillment of certain criteria in terms of symptoms, severity, and duration, but subthreshold cases are not uncommon. These may evolve to become clinically diagnosable depression preceded by prodrome. The current study was conducted to study prodromal and residual symptoms in depression.
Eighty follow-up patients of depressive episode (F32, International Classification of Diseases-10) in remission defined by Hamilton Depression Rating Scale score <8 were interviewed. A symptom was identified as prodromal if it appeared at any time before the period of onset of symptoms sufficient to fulfill the criteria to make a diagnosis of depressive episode. Clinical Interview for Depression and Related Syndromes was used to identify the presence of symptoms. Statistical analysis was done with McNemar test and Pearson's Chi-square test using SPSS software version 20.0.
The mean age of patients was 41.25 (±8.58) years and the sample was predominately female patients (80%). All the eighty patients had at least one prodromal symptom. The mean duration of prodrome was 115 (±64.46) days. Irritability (45%), insomnia (45%), and reduced energy (43.8%) were the most frequent prodromal symptoms. Frequency of irritability was comparable in prodromal and residual phases of depression ( = 0.074) and significantly associated with a positive family history of depression ( = 0.004).
Prodrome is present in most cases of depression lasting from weeks to months. Prodrome is frequented by irritability, anxiety, sleep problems, and fatigability. Irritability is associated with genetic loading of depression and likely to present as residual symptom if it is present in prodromal phase.
抑郁症的确诊需要在症状、严重程度和持续时间方面满足一定标准，但亚阈值病例并不少见。这些病例可能会在出现前驱症状后演变为临床可诊断的抑郁症。本研究旨在探讨抑郁症的前驱症状和残留症状。
对80例汉密尔顿抑郁量表评分<8分的缓解期抑郁发作（国际疾病分类-10，F32）随访患者进行访谈。如果一种症状出现在足以满足抑郁发作诊断标准的症状发作期之前的任何时间，则将其识别为前驱症状。使用抑郁症及相关综合征临床访谈来识别症状的存在。使用SPSS 20.0软件进行McNemar检验和Pearson卡方检验进行统计分析。
患者的平均年龄为41.25（±8.58）岁，样本以女性患者为主（80%）。所有80例患者至少有1种前驱症状。前驱症状的平均持续时间为115（±64.46）天。易激惹（45%）、失眠（45%）和精力减退（43.8%）是最常见的前驱症状。易激惹在抑郁症前驱期和残留期的发生率相当（P = 0.074），且与抑郁症家族史阳性显著相关（P = 0.004）。
大多数抑郁症病例存在前驱症状，持续数周数月。前驱症状常表现为易激惹、焦虑、睡眠问题和疲劳。易激惹与抑郁症的遗传负荷相关，如果在前驱期出现，可能会作为残留症状出现。
