Akiskal H S, King D, Rosenthal T L, Robinson D, Scott-Strauss A
J Affect Disord. 1981 Sep;3(3):297-315. doi: 10.1016/0165-0327(81)90031-8.
Factors associated with chronicity in 137 probands with 2 or more years of low-grade intermittent depression were evaluated in a naturalistic setting. Four groups were tentatively identified and chronicity related to: (1) early onset (less than 25 years) intermittent subsyndromal or dysthymic depressions with positive family history for both unipolar and bipolar illness; (2) a spectrum of 'unstable' characterologic disorders with history for childhood object loss; (3) pre-existing non-affective psychiatric or incapacitating medical disorders, especially in combination; (4) incomplete remission from late-onset primary unipolar episode(s) with strong familial background for affective illness, multiple object losses, alcohol and sedative hypnotic dependence, superimposed incapacitating medical disorders, use of depressant antihypertensive agents, disabled spouses, and 'marital deadlock'. Beneficial effects of thymoleptic drugs and practical psychotherapy occurred in 45% of the total sample and were largely limited to groups 1 and 4. These findings argue against a common clinical stereotype that equates all chronic depressions with character disorder.
在自然环境中，对137名患有两年或更长时间轻度间歇性抑郁症的先证者中与慢性化相关的因素进行了评估。初步确定了四组与慢性化相关的情况：（1）早发（25岁以下）间歇性亚综合征或心境恶劣性抑郁症，双相情感障碍和单相情感障碍均有阳性家族史；（2）一系列具有童年客体丧失史的“不稳定”性格障碍；（3）既往存在的非情感性精神障碍或致残性躯体疾病，尤其是合并存在时；（4）晚发原发性单相发作未完全缓解，有情感性疾病的强烈家族背景、多次客体丧失、酒精和镇静催眠药依赖、叠加的致残性躯体疾病、使用降压镇静剂、配偶残疾以及“婚姻僵局”。抗抑郁药物和实用心理治疗的有益效果在总样本的45%中出现，且主要局限于第1组和第4组。这些发现反驳了一种常见的临床刻板印象，即认为所有慢性抑郁症都等同于人格障碍。
