Thase M E, Simons A D, Reynolds C F
University of Pittsburgh School of Medicine, Western Psychiatric Institute and Clinic, PA 15213.
Psychopharmacol Bull. 1993;29(2):293-301.
Correlates of outcome were studied in a sample of 142 unmedicated patients with major depressive disorder treated with cognitive behavior therapy (CBT) in outpatient (n = 110) or inpatient (n = 32) protocols. Outpatients received up to 20 sessions of therapy over 16 weeks; inpatients received up to 20 sessions over 4 weeks. Across all three protocols, nonresponse was associated with unemployment, higher levels of pretreatment severity, and an abnormal electroencephalographic (EEG) sleep profile. Chronicity was associated with poor outcomes in male outpatients, whereas high scores on a measure of dysfunctional attitudes were associated with a trend for poor outcome only in female patients. Among inpatients, male gender, diagnostic comorbidity, and elevated urinary free cortisol levels also were associated with poor outcome. Although a majority of the unmedicated patients experienced full or partial remissions, our findings suggest that assessments of both clinical (e.g., severity, chronicity, and comorbidity) and psychobiological (EEG sleep and adrenocortical function) factors may identify those depressed patients who are less likely to benefit from CBT alone. Such patients may be preferentially responsive to treatment with pharmacotherapy, either alone or, in more complicated cases, in combination with psychotherapy.
在142例未接受药物治疗的重度抑郁症患者样本中，研究了认知行为疗法（CBT）治疗结果的相关因素。这些患者采用门诊（n = 110）或住院（n = 32）治疗方案接受CBT治疗。门诊患者在16周内接受多达20次治疗；住院患者在4周内接受多达20次治疗。在所有三种治疗方案中，治疗无反应与失业、治疗前严重程度较高以及脑电图（EEG）睡眠模式异常有关。慢性病程与男性门诊患者的不良治疗结果相关，而功能失调性态度量表得分高仅与女性患者不良治疗结果的趋势相关。在住院患者中，男性、诊断合并症以及尿游离皮质醇水平升高也与不良治疗结果相关。尽管大多数未接受药物治疗的患者实现了完全或部分缓解，但我们的研究结果表明，对临床因素（如严重程度、慢性病程和合并症）和心理生物学因素（EEG睡眠和肾上腺皮质功能）的评估可能有助于识别那些单独接受CBT治疗获益可能性较小的抑郁症患者。此类患者可能对单独药物治疗或在更复杂的情况下对药物治疗与心理治疗联合治疗反应更佳。
