Vine R G, Steingart A B
University of Toronto, Baycrest Centre for Geriatric Care, Ontario.
Can J Psychiatry. 1994 Sep;39(7):392-8. doi: 10.1177/070674379403900702.
The objectives of this study were to examine the association of personality disorder with outcome of depression in older patients (age > or = 60) treated in a psychiatric day hospital for depression and to compare the clinical diagnosis of personality disorder at admission with the results of a semi-structured interview at follow-up. Sixty-four patients were followed up for a mean interval of 30 (13-49) months after admission to the psychiatric day hospital and the semi-structured interview, Social Support Scale, Life Events Inventory, Hamilton Depression Rating Scale and Mini-Mental State Examination administered by a psychiatrist blind to the details of the index admission. Forty-nine informants (a close friend or relative) were also interviewed using the semi-structured interview. Axis II diagnoses at the time of admission were determined from patient records. Personality disorder diagnoses were analysed according to DSM-III-R clusters. Twenty-one (33%) patients fulfilled criteria for personality disorder at admission and 23 (36%) at follow-up. There was strong agreement (k = 0.78) between patient and informant semi-structured interview results and moderate agreement (k = 0.41) between diagnosis at admission and at follow-up. Presence of a personality disorder, and in particular a cluster B personality disorder diagnosis was associated with chronic outcome of depression and with impaired social support. Personality is a significant factor in the outcome of depression in the elderly. It remains unclear whether current methods of assessment tap enduring characteristics, or manifestations of affective state.
本研究的目的是探讨在一家精神科日间医院接受抑郁症治疗的老年患者（年龄≥60岁）中，人格障碍与抑郁症预后之间的关联，并比较入院时人格障碍的临床诊断与随访时半结构式访谈的结果。64名患者在入住精神科日间医院并接受半结构式访谈后，平均随访了30（13 - 49）个月，由一名对首次入院细节不知情的精神科医生进行社会支持量表、生活事件量表、汉密尔顿抑郁量表和简易精神状态检查。还对49名 informant（密友或亲属）进行了半结构式访谈。入院时的轴II诊断根据患者记录确定。人格障碍诊断根据DSM-III-R分类进行分析。21名（33%）患者在入院时符合人格障碍标准，23名（36%）在随访时符合。患者与 informant 的半结构式访谈结果之间有很强的一致性（k = 0.78），入院诊断与随访诊断之间有中度一致性（k = 0.41）。人格障碍的存在，特别是B类人格障碍诊断与抑郁症的慢性预后以及社会支持受损有关。人格是老年抑郁症预后的一个重要因素。目前尚不清楚当前的评估方法是挖掘持久特征还是情感状态的表现。
