Crowell Andrea L, Speanburg Stefanie L, Denison Lydia N, Mayberg Helen S, Kaslow Nadine J
Emory University School of Medicine, Department of Psychiatry and Behavioral Sciences.
Emory University Psychoanalytic Institute.
Psychoanal Psychol. 2019 Oct;36(4):313-320. doi: 10.1037/pap0000249.
Personality psychodynamics have been shown to influence individual responses to psychiatric treatments, including medication. Increasingly, neuromodulation therapies have become available for severe and treatment-resistant depression. This study aims to evaluate patient response to an implanted neurostimulator battery within the framework of relational versus self-definitional personality traits. Relational development is interpersonally oriented and disruptions along this pathway lead to dependency on others for a sense of security and self-worth. Self-definitional development is characterized by autonomy strivings and disruptions lead to self-critical feelings of failing to meet expectations. Patients drawn from a larger study of deep brain stimulation (DBS) for treatment-resistant depression were switched from a non-rechargeable to a rechargeable battery type to maintain stimulation therapy. This switch entailed taking greater personal responsibility for device maintenance and allowed for fewer battery replacement surgeries. Twenty-six patients completed the Depressive Experiences Questionnaire (DEQ) and a questionnaire surveying their preference for DBS battery type. Results show that the DEQ dependency subscale, and more specifically the neediness component of the subscale, is associated with patient preference for the non-rechargeable battery. This suggests that individuals with higher relational needs prefer treatment options that increase contact with and need for medical caregivers and may prioritize this aspect of an intervention over alternative considerations. In contrast, individuals with more self-critical personality traits did not have a battery type preference, indicating that self-definitional needs were not predictive of battery preference. The link between an individual's personality psychodynamics and response to biomedical interventions, including neuromodulation and treatments that incorporate medical devices, deserves further attention.
人格心理动力学已被证明会影响个体对包括药物治疗在内的精神科治疗的反应。越来越多的神经调节疗法可用于治疗重度和难治性抑郁症。本研究旨在在关系型与自我定义型人格特质的框架内评估患者对植入式神经刺激器电池的反应。关系发展以人际为导向，沿此途径的干扰会导致个体在安全感和自我价值感方面依赖他人。自我定义发展的特点是追求自主性，其干扰会导致因未能达到期望而产生自我批评的感觉。从一项关于深部脑刺激（DBS）治疗难治性抑郁症的大型研究中选取的患者，从不可充电电池类型转换为可充电电池类型以维持刺激治疗。这种转换需要患者对设备维护承担更大的个人责任，并且减少了电池更换手术的次数。26名患者完成了抑郁体验问卷（DEQ）以及一项关于他们对DBS电池类型偏好的问卷调查。结果显示，DEQ依赖性子量表，更具体地说是该子量表中的需求性成分，与患者对不可充电电池的偏好相关。这表明关系需求较高的个体更喜欢增加与医护人员接触和需求的治疗选择，并且可能会将干预的这一方面置于其他考虑因素之上。相比之下，具有更多自我批评人格特质的个体没有电池类型偏好，这表明自我定义需求并不能预测电池偏好。个体的人格心理动力学与对生物医学干预（包括神经调节和包含医疗设备的治疗）的反应之间的联系值得进一步关注。
