Thase M E, Simons A D, Reynolds C F
Department of Psychiatry, University of Pittsburgh School of Medicine, Pa, USA.
Arch Gen Psychiatry. 1996 Feb;53(2):99-108. doi: 10.1001/archpsyc.1996.01830020013003.
To test the hypothesis that depressed patients with selected neurobiologic disturbances are less responsive to psychotherapy, we examined responses to cognitive behavior therapy in relation to electroencephalographic sleep profiles.
Under a prospective, case-control design, 90 outpatients with probable or definite endogenous major depression (Schedule for Affective Disorders and Schizophrenia and Research Diagnostic Criteria) were stratified into abnormal and normal sleep subgroups (on the basis of an empirically validated electroencephalographic sleep profile) and more severe and less severe depression subgroups (on the basis of pretreatment Hamilton scores). Response to 16 weeks of treatment was analyzed for both intention-to-treat and completers (n = 82) samples. Outcomes during a 36-month prospective follow-up were assessed with survival analyses.
Abnormal sleep profiles and higher pretreatment depression severity were independently associated with poorer outcomes on several analyses. The association between sleep abnormality and cognitive behavior therapy response was not significant in the completers analyses, however, largely because of differential attrition. During follow-up, pretreatment depression severity was predictive of relapse and a lower recovery rate, whereas sleep abnormality was predictive of a lower recovery rate and a higher risk of recurrence.
Depressed patients characterized by higher severity and/or an abnormal electroencephalographic sleep profile were relatively less responsive to cognitive behavior therapy. These associations are hypothesized to result from a constellation of neurophysiologic disturbances that interfere with the acquisition, application, and implementation of the skills emphasized in cognitive behavior therapy.
为了验证患有特定神经生物学紊乱的抑郁症患者对心理治疗反应较差这一假设，我们研究了认知行为疗法的反应与脑电图睡眠特征之间的关系。
在一项前瞻性病例对照设计中，90名可能或确诊为内源性重度抑郁症的门诊患者（根据情感障碍和精神分裂症日程表以及研究诊断标准），根据经验验证的脑电图睡眠特征分为睡眠异常和正常亚组，并根据治疗前汉密尔顿评分分为抑郁程度较重和较轻的亚组。对意向性治疗样本和完成治疗者样本（n = 82）进行了为期16周治疗的反应分析。采用生存分析评估了36个月前瞻性随访期间的结果。
在多项分析中，睡眠特征异常和治疗前抑郁程度较高均与较差的结果独立相关。然而，在完成治疗者分析中，睡眠异常与认知行为疗法反应之间的关联并不显著，这主要是由于不同的损耗率。在随访期间，治疗前抑郁程度可预测复发和较低的康复率，而睡眠异常可预测较低的康复率和较高的复发风险。
以较高严重程度和/或脑电图睡眠特征异常为特征的抑郁症患者对认知行为疗法的反应相对较差。据推测，这些关联是由一系列神经生理紊乱导致的，这些紊乱会干扰认知行为疗法中强调的技能的习得、应用和实施。
