Ruhe Henricus G, Mocking Roel J T, Figueroa Caroline A, Seeverens Paulien W J, Ikani Nessa, Tyborowska Anna, Browning Michael, Vrijsen Janna N, Harmer Catherine J, Schene Aart H
Department of Psychiatry, Radboud University Medical Centre, Nijmegen, Netherlands.
Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, Netherlands.
Front Psychiatry. 2019 Mar 28;10:145. doi: 10.3389/fpsyt.2019.00145. eCollection 2019.
An interesting factor explaining recurrence risk in Major Depressive Disorder (MDD) may be neuropsychological functioning, i.e., processing of emotional stimuli/information. Negatively biased processing of emotional stimuli/information has been found in both acute and (inconclusively) remitted states of MDD, and may be causally related to recurrence of depression. We aimed to investigate self-referent, memory and interpretation biases in recurrently depressed patients in remission and relate these biases to recurrence. We included 69 remitted recurrent MDD-patients (rrMDD-patients), 35-65 years, with ≥2 episodes, voluntarily free of antidepressant maintenance therapy for at least 4 weeks. We tested self-referent biases with an emotional categorization task, bias in emotional memory by free recall of the emotion categorization task 15 min after completing it, and interpretation bias with a facial expression recognition task. We compared these participants with 43 never-depressed controls matched for age, sex and intelligence. We followed the rrMDD-patients for 2.5 years and assessed recurrent depressive episodes by structured interview. The rrMDD-patients showed biases toward emotionally negative stimuli, faster responses to negative self-relevant characteristics in the emotional categorization, better recognition of sad faces, worse recognition of neutral faces with more misclassifications as angry or disgusting faces and less misclassifications as neutral faces (0.001 < < 0.05). Of these, the number of misclassifications as angry and the overall performance in the emotional memory task were significantly associated with the time to recurrence ( ≤ 0.04), independent of residual symptoms and number of previous episodes. In a support vector machine data-driven model, prediction of recurrence-status could best be achieved (relative to observed recurrence-rate) with demographic and childhood adversity parameters (accuracy 78.1%; 1-sided = 0.002); neuropsychological tests could not improve this prediction. Our data suggests a persisting (mood-incongruent) emotional bias when patients with recurrent depression are in remission. Moreover, these persisting biases might be mechanistically important for recurrence and prevention thereof.
一个解释重度抑郁症（MDD）复发风险的有趣因素可能是神经心理功能，即对情绪刺激/信息的处理。在MDD的急性状态和（尚无定论的）缓解状态中均发现了对情绪刺激/信息的负性偏向处理，并且可能与抑郁症的复发存在因果关系。我们旨在研究缓解期复发性抑郁症患者的自我参照、记忆和解释偏向，并将这些偏向与复发情况相关联。我们纳入了69例年龄在35 - 65岁、有≥2次发作、自愿停用抗抑郁维持治疗至少4周的缓解期复发性MDD患者（rrMDD患者）。我们通过情绪分类任务测试自我参照偏向，在完成情绪分类任务15分钟后通过自由回忆测试情绪记忆偏向，并用面部表情识别任务测试解释偏向。我们将这些参与者与43名年龄、性别和智力相匹配的从未患过抑郁症的对照组进行比较。我们对rrMDD患者随访2.5年，并通过结构化访谈评估复发性抑郁发作情况。rrMDD患者表现出对情绪负性刺激的偏向，在情绪分类中对与自我相关的负性特征反应更快，对悲伤面孔的识别更好，对中性面孔的识别较差，更多地将中性面孔误分类为愤怒或厌恶的面孔，而较少将其误分类为中性面孔（0.001 < < 0.05）。其中，误分类为愤怒的次数以及情绪记忆任务中的总体表现与复发时间显著相关（ ≤ 0.04），独立于残留症状和既往发作次数。在一个支持向量机数据驱动模型中，利用人口统计学和童年逆境参数（准确率78.1%；单侧 = 0.002）能够最好地实现（相对于观察到的复发率）复发状态的预测；神经心理测试并不能改善这一预测。我们的数据表明，复发性抑郁症患者在缓解期存在持续的（与情绪不一致的）情绪偏向。此外，这些持续的偏向可能在复发及其预防中具有重要的机制性意义。
