National Council of Scientific and Technical Research (CONICET), Ciudad Autónoma de Buenos Aires, Argentina.
Psychiatric Emergencies Hospital Torcuato de Alvear, Ciudad Autónoma de Buenos Aires, Argentina.
Aust N Z J Psychiatry. 2023 Jul;57(7):1023-1030. doi: 10.1177/00048674221133743. Epub 2022 Oct 29.
The aim of this exploratory study was to compare the neurocognitive performance of patients undergoing melancholic and non-melancholic major depressive episodes. Considering potential limitations of the (5th ed.) specifier, we employed an additional tool that has proven useful in identifying melancholia (the Sydney Melancholia Prototype Index).
One hundred forty-one depressed inpatients were classified as melancholic or non-melancholic according to the Sydney Melancholia Prototype Index and the (5th ed.) criteria and compared on a neurocognitive battery selected to assess attention and processing speed, verbal memory, working memory and executive functions. Results were controlled for several potential confounders.
Patients diagnosed as melancholic by the two diagnostic systems displayed lower scores in executive measures, semantic verbal fluency and phonological verbal fluency. On attention and processing speed, patients with melancholia underperformed those with non-melancholic depression only when diagnosed by the Sydney Melancholia Prototype Index. After controlling for confounders, associations between melancholic status and executive dysfunction remained significant for the Sydney Melancholia Prototype Index but not for the (5th ed.) diagnosis.
In this study, melancholia diagnosed by the Sydney Melancholia Prototype Index (but not by the [5th ed.] criteria) was characterized by a greater compromise of tests assessing executive functions than non-melancholic depressions, even after controlling for depressive severity. These preliminary results might contribute to generating hypotheses about differences in the cognitive profile and pathophysiological substrate between melancholic and non-melancholic depressions. Likewise, the pattern of findings supports the hypothesis that the (5th ed.) melancholia specifier might identify more severe forms of depressive episodes rather than a qualitatively different subtype.
本探索性研究旨在比较处于单相抑郁发作的忧郁型和非忧郁型患者的神经认知表现。考虑到（第 5 版）特定标准的潜在局限性，我们使用了一种额外的工具，该工具已被证明可用于识别忧郁症（悉尼忧郁症原型指数）。
根据悉尼忧郁症原型指数和（第 5 版）标准，将 141 名住院抑郁症患者分为忧郁型和非忧郁型，并在选择的神经认知测试套件上进行比较，该套件用于评估注意力和处理速度、言语记忆、工作记忆和执行功能。结果还考虑了几个潜在的混杂因素。
根据两种诊断系统诊断为忧郁型的患者在执行措施、语义言语流畅性和语音言语流畅性方面的得分较低。在注意力和处理速度方面，仅当根据悉尼忧郁症原型指数进行诊断时，忧郁型患者的表现才逊于非忧郁型抑郁症患者。在控制混杂因素后，忧郁状态与执行功能障碍之间的关联在悉尼忧郁症原型指数方面仍然具有统计学意义，但在（第 5 版）诊断方面则没有。
在这项研究中，根据悉尼忧郁症原型指数（而非（第 5 版）标准）诊断的忧郁症在评估执行功能的测试中表现出更大的缺陷，即使在控制抑郁严重程度后也是如此。这些初步结果可能有助于提出关于忧郁型和非忧郁型抑郁症之间认知特征和病理生理基础差异的假设。同样，研究结果支持这样一种假设，即（第 5 版）忧郁症特定标准可能识别出更严重的抑郁发作形式，而不是一种不同质的亚类。
