Department of Psychiatry, Rutgers-Robert Wood Johnson Medical School, Piscataway, New Jersey.
VA New Jersey Health Care System, Lyons, New Jersey.
Int J Geriatr Psychiatry. 2019 May;34(5):722-729. doi: 10.1002/gps.5077. Epub 2019 Mar 4.
Depression is among the most common and debilitating nonmotor complaints in Parkinson's disease (PD), yet there is a paucity of controlled research to guide treatment. Little research has focused on the extent to which specific depressive symptom profiles may dictate unique clinical recommendations to ultimately improve treatment outcomes. The current study examined the impact of cognitive behavioral therapy (CBT) on different types of depressive symptoms in PD. It was hypothesized that the cognitive (eg, guilt, rumination, and negative attitudes towards self) and behavioral (eg, avoidance and procrastination) symptoms targeted most intensively by the treatment protocol would show the most robust response. The extent to which stabilized antidepressant use moderated specific symptom change was examined on an exploratory basis.
Eighty depressed people with PD participated in a randomized controlled trial of CBT plus clinical management, versus clinical management only. Hamilton Depression Rating Scale (HAMD) and Beck Depression Inventory (BDI) subscale scores, reflecting depressive symptom heterogeneity in PD, were the focus of this investigation.
CBT response was associated with significant improvements in mood, sleep, anxiety, and somatic symptoms (HAMD), and negative attitudes toward self, performance impairment, and somatic symptoms (BDI). As hypothesized, the largest effect sizes were observed for cognitive and behavioral (vs somatic) symptoms of depression. Stabilized antidepressant use moderated the effect of CBT on somatic complaints (HAMD and BDI).
CBT may improve a diverse array of depressive symptoms in PD. Cognitive and behavioral (vs somatic) symptoms showed the greatest change. Combining CBT with antidepressants may help optimize the management of somatic complaints in depression in PD (dPD).
抑郁症是帕金森病（PD）中最常见和最具致残性的非运动性抱怨之一，但缺乏控制研究来指导治疗。很少有研究关注特定的抑郁症状特征可能会决定独特的临床建议，从而最终改善治疗结果。本研究探讨了认知行为疗法（CBT）对 PD 中不同类型抑郁症状的影响。研究假设，治疗方案最集中针对的认知（例如，内疚，沉思和对自己的消极态度）和行为（例如，回避和拖延）症状将表现出最强烈的反应。在此基础上，对稳定使用抗抑郁药对特定症状变化的调节作用进行了探索性研究。
80 名患有 PD 的抑郁患者参加了 CBT 加临床管理与仅临床管理的随机对照试验。汉密尔顿抑郁量表（HAMD）和贝克抑郁量表（BDI）子量表评分反映了 PD 中抑郁症状的异质性，是本研究的重点。
CBT 反应与情绪，睡眠，焦虑和躯体症状（HAMD）以及对自我，表现障碍和躯体症状的消极态度（BDI）的显着改善相关。正如假设的那样，观察到认知和行为（与躯体）抑郁症状的最大效应量。稳定使用抗抑郁药调节了 CBT 对躯体抱怨（HAMD 和 BDI）的影响。
CBT 可能改善 PD 中各种抑郁症状。认知和行为（与躯体）症状变化最大。将 CBT 与抗抑郁药结合使用可能有助于优化 PD 中躯体抱怨（dPD）的管理。
