Ubukata Shiho, Ueda Keita, Fujimoto Gaku, Ueno Senkei, Murai Toshiya, Oishi Naoya
Medical Innovation Center (Ubukata, Oishi) and Department of Psychiatry (Ueda, Fujimoto, Ueno, Murai), Graduate School of Medicine, Kyoto University, Kyoto, Japan.
J Neuropsychiatry Clin Neurosci. 2022 Spring;34(2):158-167. doi: 10.1176/appi.neuropsych.21020046. Epub 2021 Nov 19.
Depression and apathy are common after traumatic brain injury (TBI), and different intervention strategies are recommended for each. However, a differential diagnosis can be difficult in clinical settings, especially given that apathy is considered to be a symptom of depression. In this study, the investigators aimed to isolate apathy from depression among patients with TBI and to examine whether apathy is exclusively associated with the amount of daily activity, as previously reported in the literature.
Eighty-eight patients with chronic TBI completed the Japanese versions of the 21-item Beck Depression Inventory-II (BDI-II) and the Starkstein Apathy Scale (AS). Daily activity was measured with a 24-hour life log. A hierarchical cluster analysis was applied to divide the BDI-II data into separable components, and components' correlations with results of the AS and 24-hour life log scale were evaluated.
The BDI-II and AS revealed that 37 patients (42.0%) had both depression and apathy. BDI-II data were classified into four separate clusters (somatic symptoms, loss of self-worth, affective symptoms, and apathy symptoms). Loss of self-worth and apathy symptoms subscores were significantly positively correlated with total AS score (r=0.32, p=0.002, and r=0.52, p<0.001, respectively). The apathy symptoms subscore was significantly correlated with the amount of daily activity (r=-0.29, p=0.009).
The findings suggest that the BDI-II can differentiate between apathy and depression among patients with TBI, which is essential when selecting intervention options. Moreover, apathy symptoms predicted patients' real-life daily activity.
创伤性脑损伤（TBI）后抑郁和淡漠很常见，针对二者推荐了不同的干预策略。然而，在临床环境中进行鉴别诊断可能很困难，尤其是考虑到淡漠被认为是抑郁的一种症状。在本研究中，研究人员旨在将TBI患者中的淡漠与抑郁区分开来，并检验淡漠是否如先前文献报道的那样仅与日常活动量相关。
88例慢性TBI患者完成了21项贝克抑郁量表第二版（BDI-II）和斯塔克斯坦淡漠量表（AS）的日语版本。通过24小时生活日志测量日常活动。应用分层聚类分析将BDI-II数据分为可分离的成分，并评估各成分与AS结果及24小时生活日志量表的相关性。
BDI-II和AS显示，37例患者（42.0%）同时存在抑郁和淡漠。BDI-II数据被分为四个独立的聚类（躯体症状、自我价值丧失、情感症状和淡漠症状）。自我价值丧失和淡漠症状子得分与AS总分显著正相关（分别为r=0.32，p=0.002和r=0.52，p<0.001）。淡漠症状子得分与日常活动量显著相关（r=-0.29，p=0.009）。
研究结果表明，BDI-II可以区分TBI患者的淡漠和抑郁，这在选择干预方案时至关重要。此外，淡漠症状可预测患者现实生活中的日常活动。
