忧郁性抑郁症与非忧郁性抑郁症：一项前瞻性研究。

Melancholic Versus Non-Melancholic Depression: a Prospective Study.

作者信息

Munoli R N, Sharma P S V N, Kongasseri S, Bhandary R P, Praharaj S K

机构信息

Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India.

North West area mental health services, Melbourne, Australia.

出版信息

East Asian Arch Psychiatry. 2020 Mar;30(1):20-27. doi: 10.12809/eaap1852.

DOI:10.12809/eaap1852

PMID:32229643

Abstract

BACKGROUND

The binarian model views melancholia as a distinct depressive class, whereas the unitarian model views it as a more severe expression of depression. This study aims to investigate the sociodemographic, clinical, and course differences between melancholic and non-melancholic depression.

METHODS

This prospective observational study was carried out at Kasturba Hospital, Manipal, India from November 2010 to September 2011. We recruited consecutive inpatients aged 18 to 60 years who have a diagnosis of depressive disorder (based on ICD-10), with or without any psychiatric or physical comorbidities. Patients were categorised into melancholia and non-melancholia using the CORE questionnaire, with scores of ≥8 indicating the presence of melancholic depression. In addition, patients were evaluated using the Hamilton Depression Rating Scale, Hamilton Anxiety Rating Scale, Somatoform Symptom Checklist, Columbia Suicide Severity Rating Scale, Clinical Global Impression, and Presumptive Stressful Life Events Scale at baseline and at 1, 3, and 6 months.

RESULTS

Of 87 inpatients with a diagnosis of depression, 50 met the inclusion criteria and 37 were excluded. Compared with patients with non-melancholic depression, patients with melancholic depression had higher depression score (30.8 vs 23.8, p < 0.001), had higher number of patients with psychotic depression (39.1% vs 7.4%, p = 0.007), had higher overall illness severity score (5.9 vs 4.8, p < 0.001), and had higher number of patients with suicidal ideation and suicidal behaviour. Regarding the course of melancholia, the number of melancholic patients decreased from 23 at baseline to eight at 1 month, three at 3 months, and three at 6 months. Scores of non-interactiveness, retardation, and agitation decrease significantly over 3 months.

CONCLUSIONS

The construct and course of melancholia may be viewed as a part of depression, more in line with severe depression. Melancholia increases the risk for suicidal ideation and suicidal behaviour.

摘要

背景

二元论模型将忧郁症视为一种独特的抑郁类型，而一元论模型则将其视为抑郁症更严重的表现形式。本研究旨在调查忧郁症性抑郁症与非忧郁症性抑郁症在社会人口统计学、临床特征及病程方面的差异。

方法

这项前瞻性观察性研究于2010年11月至2011年9月在印度马尼帕尔的卡斯图尔巴医院开展。我们招募了年龄在18至60岁之间、诊断为抑郁症（基于ICD - 10）的连续住院患者，无论其是否伴有任何精神或躯体合并症。使用CORE问卷将患者分为忧郁症组和非忧郁症组，得分≥8表明存在忧郁症性抑郁症。此外，在基线以及1个月、3个月和6个月时，使用汉密尔顿抑郁评定量表、汉密尔顿焦虑评定量表、躯体形式症状清单、哥伦比亚自杀严重程度评定量表、临床总体印象量表和假定应激性生活事件量表对患者进行评估。

结果

在87名诊断为抑郁症的住院患者中，50名符合纳入标准，37名被排除。与非忧郁症性抑郁症患者相比，忧郁症性抑郁症患者的抑郁得分更高（30.8对23.8，p < 0.001），精神病性抑郁症患者数量更多（39.1%对7.4%，p = 0.007），总体疾病严重程度得分更高（5.9对4.8，p < 0.001），有自杀观念和自杀行为的患者数量更多。关于忧郁症的病程，忧郁症患者数量从基线时的23例降至1个月时的8例、3个月时的3例和6个月时的3例。非互动性、迟缓及激越得分在3个月内显著下降。