Department of Psychiatry, University of Toronto (KSB, BHM, AJF), Toronto, ON; Centre for Mental Health, University Health Network (KSB, AJF), Toronto, ON.
Department of Occupational Science and Occupational Therapy & Rehabilitation Sciences Institute, University of Toronto (DRD), Toronto, ON; Rotman Research Institute (DRD), Baycrest, Toronto, ON.
Am J Geriatr Psychiatry. 2021 Feb;29(2):144-155. doi: 10.1016/j.jagp.2020.06.014. Epub 2020 Jun 20.
This study tested the hypotheses that, in older adults with remitted major depression, a history of psychotic features and poorer neuropsychological performance would be independently associated with poorer everyday functioning, but that neuropsychological performance would explain more of the variance in functioning than history of psychotic features.
This cross-sectional study included 73 patients aged 50 years or older with remitted psychotic major depression or nonpsychotic major depression. The dependent variables were subjective and objective measures of function. The independent variables were history of psychotic features during one or more major depressive episodes in the previous 10 years and neuropsychological performance. Linear regression models examined the association of independent variables with function, controlling for pertinent covariates. Effect sizes were calculated for the magnitude of difference in function between the patient participants and an age- and gender-matched nonpsychiatric group, and distribution of functioning scores were compared between groups.
In separate models, history of psychotic features and poorer processing speed, executive function, and verbal learning were independently associated with poorer participant-reported functioning and performance-based functioning. However, the association of psychotic features with functioning was no longer statistically significant when tested in the same models as neuropsychological measures. Effect sizes of the difference in functioning between patients and the nonpsychiatric group were significantly larger for the remitted psychotic than the remitted nonpsychotic depression group; functioning scores were more heterogeneous in the remitted psychotic depression group.
Patients with remitted psychotic depression exhibit greater, and clinically important, impairment in everyday functioning than those with remitted nonpsychotic depression. Neuropsychological impairment appears to contribute to this relationship.
本研究旨在检验以下两个假设，即对于缓解期的老年重性抑郁患者而言，既往出现精神病性特征和较差的神经心理学表现与较差的日常功能独立相关，但神经心理学表现对功能的解释作用大于既往精神病性特征。
本横断面研究纳入了 73 名年龄在 50 岁及以上、缓解期伴精神病性特征的重性抑郁或不伴精神病性特征的重性抑郁患者。因变量为功能的主观和客观测量指标。自变量为既往 10 年内 1 次或多次重性抑郁发作期间是否出现精神病性特征，以及神经心理学表现。线性回归模型检验了自变量与功能之间的关联，同时控制了相关协变量。计算了患者与年龄和性别匹配的非精神病组之间功能差异的效应大小，并比较了两组之间的功能评分分布。
在单独的模型中，既往精神病性特征以及较差的加工速度、执行功能和言语学习与患者报告的功能和基于表现的功能较差独立相关。然而，当在与神经心理学测量相同的模型中检验时，精神病性特征与功能的关联不再具有统计学意义。与非精神病组相比，缓解期精神病性抑郁患者的功能差异的效应大小显著更大；缓解期精神病性抑郁患者的功能评分更为分散。
与缓解期非精神病性抑郁患者相比，缓解期精神病性抑郁患者的日常功能受损更大，且具有临床意义。神经心理学损害似乎促成了这种关系。
