扣带回下深部脑刺激治疗难治性抑郁症患者的人格改变。
Personality changes with subcallosal cingulate deep brain stimulation in patients with treatment-resistant depression.
机构信息
From the Department of Psychiatry, University of Calgary, Calgary, Alberta (Ramasubbu, McAusland, Chopra, Clark, Kiss); the Clinical Neurosciences, University of Calgary, Calgary, Alberta (Ramasubbu, McAusland, Clark, Kiss); the Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta (Ramasubbu, McAusland, Chopra, Clark, Kiss); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta (Ramasubbu, Chopra, Clark, Kiss); The Department of Geriatric Psychiatry and Section for Medical Psychology of the Department of Psychiatry and Psychotherapy, University Hospital Bonn, Germany (Bewernick)
From the Department of Psychiatry, University of Calgary, Calgary, Alberta (Ramasubbu, McAusland, Chopra, Clark, Kiss); the Clinical Neurosciences, University of Calgary, Calgary, Alberta (Ramasubbu, McAusland, Clark, Kiss); the Mathison Centre for Mental Health Research & Education, University of Calgary, Calgary, Alberta (Ramasubbu, McAusland, Chopra, Clark, Kiss); the Hotchkiss Brain Institute, University of Calgary, Calgary, Alberta (Ramasubbu, Chopra, Clark, Kiss); The Department of Geriatric Psychiatry and Section for Medical Psychology of the Department of Psychiatry and Psychotherapy, University Hospital Bonn, Germany (Bewernick).
出版信息
J Psychiatry Neurosci. 2021 Aug 10;46(4):E490-E499. doi: 10.1503/jpn.210028. Epub 2021 Jul 1.
BACKGROUND
Deep brain stimulation (DBS) is a promising investigational approach for treatment-resistant depression. However, reports suggesting changes in personality with DBS for movement disorders have raised clinical and ethical concerns. We prospectively examined changes in personality dimensions and antidepressant response to subcallosal cingulate (SCC)-DBS for treatment-resistant depression.
METHODS
Twenty-two patients with treatment-resistant depression underwent SCC-DBS. We used the NEO Five-Factor Inventory for personality assessment at baseline and every 3 months until 15 months post-DBS. We assessed depression severity monthly using the Hamilton Depression Rating Scale.
RESULTS
We found a significant decrease in neuroticism ( = 0.002) and an increase in extraversion ( = 0.001) over time, showing a change toward normative data. Improvement on the Hamilton Depression Rating Scale was correlated with decreases in neuroticism at 6 months ( = 0.001) and 12 months ( < 0.001), and with an increase in extraversion at 12 months ( = 0.01). Changes on the Hamilton Depression Rating Scale over time had a significant covariate effect on neuroticism ( < 0.001) and extraversion ( = 0.001). Baseline openness and agreeableness predicted response to DBS at 6 ( = 0.006) and 12 months ( = 0.004), respectively.
LIMITATIONS
Limitations included a small sample size, a lack of sham control and the use of subjective personality evaluation.
CONCLUSION
We observed positive personality changes following SCC-DBS, with reduced neuroticism and increased extraversion related to clinical improvement in depression, suggesting a state effect. As well, pretreatment levels of openness and agreeableness may have predicted subsequent response to DBS. The NEO Five-Factor Inventory assessment may have a role in clinical decision-making and prognostic evaluation in patients with treatment-resistant depression who undergo SCC-DBS.
背景
深部脑刺激（DBS）是一种有前途的治疗抵抗性抑郁症的研究方法。然而，关于 DBS 治疗运动障碍后人格改变的报告引起了临床和伦理方面的关注。我们前瞻性地研究了扣带回下前部（SCC）-DBS 治疗抵抗性抑郁症患者的人格维度变化和抗抑郁反应。
方法
22 例治疗抵抗性抑郁症患者接受 SCC-DBS。我们使用 NEO 五因素人格量表在基线和 DBS 后每 3 个月进行一次人格评估，直到 15 个月。我们使用汉密尔顿抑郁量表每月评估抑郁严重程度。
结果
我们发现神经质（ = 0.002）随时间显著降低，外向性（ = 0.001）增加，向正常数据转变。汉密尔顿抑郁量表评分的改善与 6 个月（ = 0.001）和 12 个月（ < 0.001）时的神经质降低以及 12 个月时的外向性增加相关（ = 0.01）。汉密尔顿抑郁量表评分随时间的变化对神经质（ < 0.001）和外向性（ = 0.001）有显著的协变量效应。基线开放性和宜人性分别预测 6 个月（ = 0.006）和 12 个月（ = 0.004）时对 DBS 的反应。
局限性
局限性包括样本量小、缺乏假手术对照和使用主观人格评估。
结论
我们观察到 SCC-DBS 后出现积极的人格变化，神经质降低，外向性增加与抑郁改善相关，提示存在状态效应。此外，治疗前的开放性和宜人性水平可能预测随后对 DBS 的反应。NEO 五因素人格量表评估可能在 SCC-DBS 治疗抵抗性抑郁症患者的临床决策和预后评估中发挥作用。
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