Fond G, Tinland A, Boucekine M, Girard V, Loubière S, Boyer L, Auquier P
Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France.
Aix Marseille Univ, School of medicine - La Timone Medical Campus, EA 3279: CEReSS - Health Service Research and Quality of life Center, Marseille, France.
Prog Neuropsychopharmacol Biol Psychiatry. 2020 Apr 20;99:109877. doi: 10.1016/j.pnpbp.2020.109877. Epub 2020 Jan 24.
The objectives of the present study were to determine the rates and associated factors of (i) MDD, (ii) antidepressant prescription and (iii) MDD non-remission in homeless subjects with bipolar disorder (BD) or schizophrenia (SZ).
This multicenter study was conducted in 4 French cities. MDD was defined with the section L of the MINI. Unremitted MDD was defined by current antidepressant treatment and current MDD.
700 subjects, mean aged 38 years and 82.5% men were included: 55.4% were diagnosed with MDD but only 10.4% were administered antidepressants. Violent victimization in the past 6 months, alcohol use disorder and current substance abuse disorder were associated with increased rates of MDD. 71.2% antidepressant-treated subjects were unremitted. BD diagnosis and substance abuse disorder were found to be associated with increased risk of unremitted MDD. BD-MDD patients were found to be twice more frequently administered antidepressants than SZ-MDD ones, however the non-remission rates were higher in BD subjects compared to SZ. No antidepressant class and no specific antipsychotic or mood stabilizer has been associated with higher or lower rates of remitted MDD.
MDD seems to be highly prevalent, underdiagnosed and undertreated in BD and SZ homeless subjects. Beyond antidepressants, add-on strategies including complementary agents, lithium, lamotrigine/carbamazepine or anti-inflammatory drugs and the specific care of alcohol and substance use disorders may be recommended to improve the prognosis of this specific population in addition to other interventions including housing and resocialization. Violent victimization is also frequent and should be specifically prevented in this vulnerable population.
本研究的目的是确定双相情感障碍（BD）或精神分裂症（SZ）的无家可归患者中（i）重度抑郁障碍（MDD）、（ii）抗抑郁药处方以及（iii）MDD未缓解的发生率及相关因素。
这项多中心研究在法国4个城市进行。MDD根据MINI的L部分进行定义。未缓解的MDD由当前的抗抑郁治疗和当前的MDD来定义。
纳入了700名受试者，平均年龄38岁，男性占82.5%：55.4%被诊断为MDD，但只有10.4%接受了抗抑郁药治疗。过去6个月内遭受暴力侵害、酒精使用障碍和当前物质使用障碍与MDD发生率增加相关。71.2%接受抗抑郁药治疗的受试者未缓解。BD诊断和物质使用障碍被发现与MDD未缓解风险增加相关。BD-MDD患者接受抗抑郁药治疗的频率是SZ-MDD患者的两倍，然而BD患者的未缓解率高于SZ患者。没有发现任何抗抑郁药类别以及任何特定的抗精神病药或心境稳定剂与MDD缓解率的高低相关。
在BD和SZ的无家可归患者中，MDD似乎高度流行、诊断不足且治疗不足。除了包括住房和重新融入社会等其他干预措施外，除抗抑郁药外，还可推荐包括辅助药物、锂盐、拉莫三嗪/卡马西平或抗炎药物以及对酒精和物质使用障碍的特定护理等附加策略，以改善这一特定人群的预后。暴力侵害也很常见，在这一弱势群体中应特别加以预防。
