Seidler Daniel, Altmann Uwe, Schäfer Ralf, Jenett Dörte, Franz Matthias
Medizinische Fakultät, Klinisches Institut für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Düsseldorf.
Institut für Psychosoziale Medizin, Psychotherapie und Psychoonkologie (IPMPP), Universitätsklinikum Jena.
Psychother Psychosom Med Psychol. 2021 Jul;71(7):265-273. doi: 10.1055/a-1300-2995. Epub 2021 Jan 15.
Depression is one of the most common mental disorders. While the general effectiveness of in- and outpatient psychotherapy is proven, different long-term patterns in treatment of symptoms of depression have been described. The aim of the present study was to show different patterns of benefit in the context of inpatient psychodynamic psychotherapy of depressive disorders and to detect predictors of different types of response that help to identify possible non-responders and adjust treatments accordingly.
Data of the naturalistic multicentre intervention study were collected in 15 German psychosomatic hospital units employing a predominantly psychodynamic approach to treatment. The sample includes n=432 patients (women: age 25-45 years) with typical symptoms of depression. The patterns of outcome were identified using a latent state model with a method factor and a latent class analysis; potential course predictors were analysed using regression analysis.
Three long-term patterns of outcome were identified: patients with significant treatment benefit, whose symptom decline was stable even in a 6-month catamnesis (Responders: 76.9%), patients without a significant symptom decrease during treatment and in the follow-up survey (Non-responders: 18.8%), as well as patients with a significant symptom decrease but showing an increase of symptoms in the catamnesis (Backsliders: 4.4%). The severity of baseline depressive symptom load was determined as a predictor for the pattern of Backsliders. Non-responders differed from responders in having had psychosomatic pre-treatments more frequently.
In the case of backsliders, further studies should, for instance, verify whether relapses can be explained by the patient's symptoms, treatment, or social environment. In the case of non-response due to numerous unsuccessful pre-treatments, the question arises whether psychosomatic treatment offers the right setting for these patients or how therapy settings should be modified.
Long-term patterns reported in the literature were partially confirmed. There are indications of an influence of the initial symptom-load severity on the outcome of treatment. It is important to consider how treatment settings can be modified accordingly.
抑郁症是最常见的精神障碍之一。虽然门诊和住院心理治疗的总体有效性已得到证实，但抑郁症症状治疗的不同长期模式已有描述。本研究的目的是展示在抑郁症住院心理动力治疗背景下的不同获益模式，并检测不同类型反应的预测因素，以帮助识别可能的无反应者并相应调整治疗方案。
在15个德国身心医院科室收集了自然主义多中心干预研究的数据，这些科室主要采用心理动力治疗方法。样本包括n = 432名有典型抑郁症状的患者（女性：年龄25 - 45岁）。使用带有方法因素的潜在状态模型和潜在类别分析来确定结果模式；使用回归分析来分析潜在的病程预测因素。
确定了三种长期结果模式：有显著治疗获益的患者，其症状下降即使在6个月的随访中也很稳定（反应者：76.9%）；在治疗期间和随访调查中症状无显著下降的患者（无反应者：18.8%）；以及症状有显著下降但在随访中症状又增加的患者（复发者：4.4%）。基线抑郁症状负荷的严重程度被确定为复发者模式的预测因素。无反应者与反应者的不同之处在于，前者更频繁地接受过身心治疗。
对于复发者，例如，进一步的研究应验证复发是否可以由患者的症状、治疗或社会环境来解释。对于由于多次治疗失败而无反应的情况，就会出现身心治疗是否为这些患者提供了合适的环境，或者治疗环境应如何改变的问题。
文献中报道的长期模式得到了部分证实。有迹象表明初始症状负荷严重程度对治疗结果有影响。考虑如何相应地改变治疗环境很重要。
