van Diermen Linda, Vanmarcke Simon, Walther Sebastian, Moens Herman, Veltman Eveline, Fransen Erik, Sabbe Bernard, van der Mast Roos, Birkenhäger Tom, Schrijvers Didier
University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
University Department, Psychiatric Hospital Duffel, Duffel, Belgium; Collaborative Antwerp Psychiatric Research Institute (CAPRI), Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
J Psychiatr Res. 2019 Oct;117:122-128. doi: 10.1016/j.jpsychires.2019.07.009. Epub 2019 Jul 29.
Psychomotor symptoms are core features of melancholic depression. This study investigates whether psychomotor disturbance predicts the outcome of electroconvulsive therapy (ECT) and how the treatment modulates psychomotor disturbance. In 73 adults suffering from major depressive disorder psychomotor functioning was evaluated before, during and after ECT using the observer-rated CORE measure and objective measures including accelerometry and a drawing task. Regression models were fitted to assess the predictive value of melancholic depression (CORE ≥ 8) and the psychomotor variables on ECT outcome, while effects on psychomotor functioning were evaluated through linear mixed models. Patients with CORE-defined melancholic depression (n = 41) had a 4.9 times greater chance of reaching response than those (n = 24) with non-melancholic depression (Chi-Square = 7.5, P = 0.006). At baseline, both higher total CORE scores (AUC = 0.76; P = 0.001) and needing more cognitive (AUC = 0.78; P = 0.001) and motor time (AUC = 0.76; P = 0.003) on the drawing task corresponded to superior ECT outcomes, as did lower daytime activity levels (AUC = 0.76) although not significantly so after Bonferroni correction for multiple testing. A greater CORE-score reduction in the first week of ECT was associated with higher ECT effectiveness. ECT reduced CORE-assessed psychomotor symptoms and improved activity levels only in those patients showing the severer baseline retardation. Although the sample was relatively small, psychomotor symptoms were clearly associated with beneficial outcome of ECT in patients with major depression, indicating that monitoring psychomotor deficits can help personalise treatment.
精神运动症状是忧郁症性抑郁症的核心特征。本研究调查精神运动障碍是否能预测电休克治疗（ECT）的结果，以及该治疗如何调节精神运动障碍。在73名患有重度抑郁症的成年人中，在ECT治疗前、治疗期间和治疗后，使用观察者评定的CORE量表以及包括加速度计和绘画任务在内的客观测量方法对精神运动功能进行评估。采用回归模型评估忧郁症性抑郁症（CORE≥8）和精神运动变量对ECT结果的预测价值，同时通过线性混合模型评估对精神运动功能的影响。CORE定义的忧郁症性抑郁症患者（n = 41）达到缓解的可能性是非忧郁症性抑郁症患者（n = 24）的4.9倍（卡方= 7.5，P = 0.006）。在基线时，CORE总分较高（AUC = 0.76；P = 0.001）、在绘画任务中需要更多认知时间（AUC = 0.78；P = 0.001）和运动时间（AUC = 0.76；P = 0.003）均与更好的ECT结果相关，白天活动水平较低时也是如此（AUC = 0.76），不过在进行多重检验的Bonferroni校正后，差异无统计学意义。ECT第一周CORE评分下降幅度更大与ECT疗效更高相关。ECT仅在那些基线时表现出更严重迟缓的患者中减轻了CORE评估的精神运动症状并改善了活动水平。尽管样本相对较小，但精神运动症状与重度抑郁症患者ECT的良好结果明显相关，这表明监测精神运动缺陷有助于实现个性化治疗。
