自我报告的内脏感觉功能障碍可预测重度抑郁症患者疲劳残留症状负担：一项观察性研究。
Dysfunctional self-reported interoception predicts residual symptom burden of fatigue in major depressive disorder: an observational study.
机构信息
Faculty of Health Sciences, Brandenburg Medical School Theodor Fontane, Neuruppin, 16816, Germany.
Department of Psychiatry and Psychotherapy I, Ulm University and Center for Psychiatry Südwürttemberg, Ravensburg, 88214, Germany.
出版信息
BMC Psychiatry. 2023 Sep 13;23(1):667. doi: 10.1186/s12888-023-05168-y.
BACKGROUND
Fatigue is a core symptom of major depressive disorder (MDD) and is frequently refractory to antidepressant treatment, leading to unfavorable clinical/psychosocial outcomes. Dysfunctional self-reported interoception (i.e., maladaptive focus on the body's physiological condition) is prevalent in MDD and could contribute to residual symptom burden of fatigue. Therefore, we explored (a.) cross-sectional correlations between both dimensions and investigated (b.) prospective associations between interoceptive impairments at admission and symptom severity of fatigue at the end of hospitalization.
METHODS
This observational, exploratory study included 87 patients suffering from MDD who completed self-rating scales, the Multidimensional Assessment of Interoceptive Awareness, Version 2 (MAIA-2), and the Multidimensional Fatigue Inventory (MFI-20), at the beginning and end of hospitalization. Bivariate correlations (r) and hierarchical regression analyses were performed.
RESULTS
The cross-sectional analysis showed moderate to large negative correlations between the MAIA-2 and MFI-20 dimensions except for the Not-Distracting scale. Symptoms of general, physical, and mental fatigue at the end of hospitalization were predicted by reduced body Trusting (β = -.31, p = .01; β = -.28, p = .02; β = -.31, p = .00, respectively). Increased Body Listening (β = .37, p = .00), Not-Worrying (β = .26, p = .02), and diminished Attention Regulation (β = -.32, p = .01) predicted higher mental fatigue.
CONCLUSIONS
Diminished body confidence at baseline identified patients at risk for post-treatment fatigue and could therefore serve as a target for improving antidepressant therapy. Body-centered, integrative approaches could address treatment-resistant fatigue in MDD. However, clinicians may also consider the potential adverse effect of increased Body Listening and Not-Worrying on mental fatigue in psychotherapeutic and counselling approaches. Due to the exploratory nature of this study, the results are preliminary and need to be replicated in pre-registered trials with larger sample sizes.
背景
疲劳是重度抑郁症（MDD）的核心症状，并且经常对抗抑郁治疗有反应，导致不利的临床/心理社会结果。在 MDD 中，自我报告的内脏感知功能障碍（即对身体生理状况的适应不良关注）很普遍，并且可能导致疲劳症状负担的残留。因此，我们探讨了（a）这两个维度之间的横断面相关性，并研究了（b）入院时内脏感知障碍与住院结束时疲劳症状严重程度之间的前瞻性关联。
方法
这项观察性探索性研究包括 87 名患有 MDD 的患者，他们在入院时和住院结束时完成了自我评估量表，多维内脏感知意识评估量表 2 版（MAIA-2）和多维疲劳量表 20 版（MFI-20）。进行了双变量相关性（r）和分层回归分析。
结果
横断面分析显示，MAIA-2 和 MFI-20 维度之间存在中等至较大的负相关，除了不分散注意力量表外。住院结束时的一般、身体和精神疲劳症状由降低的身体信任（β=-0.31，p=0.01；β=-0.28，p=0.02；β=-0.31，p=0.00，分别）预测。增加的身体聆听（β=0.37，p=0.00），不担忧（β=0.26，p=0.02）和注意力调节减少（β=-0.32，p=0.01）预测更高的精神疲劳。
结论
基线时身体信心下降可识别出治疗后疲劳风险较高的患者，因此可作为改善抗抑郁治疗的目标。以身体为中心的综合方法可以解决 MDD 中的治疗抵抗性疲劳。但是，临床医生也可能考虑身体聆听增加和不担忧对心理疲劳的潜在不利影响，在心理治疗和咨询方法中。由于这项研究的探索性质，结果是初步的，需要在更大样本量的预先注册试验中进行复制。
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