From the Mood Disorders Psychopharmacology Unit, University Health Network, Canada; Institute of Medical Science (Drs. McIntyre and Rosenblat, Ms. Lee, and Mr. Pan), Department of Psychiatry (Drs. McIntyre, Rosenblat, and Mansur), and Department of Pharmacology (Dr. McIntyre), University of Toronto; Paik Institute for Clinical Research, Inje University (Republic of Korea) (Dr. J Lee); Department of Psychiatry, Samsung Seoul Hospital, Sungkyunkwan University, School of Medicine (Republic of Korea) (Dr. J-G Lee); Department of Psychiatry, College of Medicine, Imam University (Saudi Arabia) (Dr. Alageel).
Harv Rev Psychiatry. 2018 Sep/Oct;26(5):241-249. doi: 10.1097/HRP.0000000000000171.
After participating in this activity, learners should be better able to:• Characterize cognitive dysfunction in patients with major depressive disorder.• Evaluate approaches to treating cognitive dysfunction in patients with major depressive disorder.
Cognitive dysfunction is a core psychopathological domain in major depressive disorder (MDD) and is no longer considered to be a pseudo-specific phenomenon. Cognitive dysfunction in MDD is a principal determinant of patient-reported outcomes, which, hitherto, have been insufficiently targeted with existing multimodal treatments for MDD. The neural structures and substructures subserving cognitive function in MDD overlap with, yet are discrete from, those subserving emotion processing and affect regulation. Several modifiable factors influence the presence and extent of cognitive dysfunction in MDD, including clinical features (e.g., episode frequency and illness duration), comorbidity (e.g., obesity and diabetes), and iatrogenic artefact. Screening and measurement tools that comport with the clinical ecosystem are available to detect and measure cognitive function in MDD. Notwithstanding the availability of select antidepressants capable of exerting procognitive effects, most have not been sufficiently studied or rigorously evaluated. Promising pharmacological avenues, as well as psychosocial, behavioral, chronotherapeutic, and complementary alternative approaches, are currently being investigated.
在参与此活动后，学习者应能够：
描述重度抑郁症患者的认知功能障碍。
评估治疗重度抑郁症患者认知功能障碍的方法。
认知功能障碍是重度抑郁症（MDD）的核心精神病理学领域，不再被认为是一种伪特异性现象。MDD 中的认知功能障碍是患者报告结果的主要决定因素，迄今为止，现有针对 MDD 的多模式治疗对其的针对性不足。在 MDD 中，支持认知功能的神经结构和子结构与支持情绪处理和情感调节的结构重叠，但又不相同。一些可改变的因素影响 MDD 中认知功能障碍的存在和程度，包括临床特征（例如，发作频率和疾病持续时间）、合并症（例如，肥胖和糖尿病）和医源性人工制品。有可与临床生态系统兼容的筛查和测量工具可用于检测和测量 MDD 中的认知功能。尽管有一些能够发挥认知作用的选择性抗抑郁药，但大多数药物都没有得到充分研究或严格评估。目前正在研究有前途的药理学途径，以及心理社会、行为、时间治疗和补充替代方法。
