重性抑郁发作缓解后8周和2年的疗效及其预测因素

The outcomes and outcome predictive factors of major depressive episodes at 8 weeks and 2 years after discharge.

目的基于对重性抑郁发作疗效的重新定义,重新评价重性抑郁发作暂时缓解后8周和2年后的疗效并探讨其预测因素。方法采用汉密顿抑郁量表24项、贝克躁狂量表以及自编的一般情况量表,对84例经住院系统治疗于出院时已取得暂时缓解(持续缓解时间在1～7周)的抑郁发作患者进行为期2年的开放性、前瞻性的自然观察研究。结果在出院后8周,缓解(持续缓解时间≥8周)、阈下发作、症状残留、复发的患者分别占46.4%(39/84)、10.7%(9/84)、21.4%(18/84)、21.4%(18/84)。出院后2年,完全痊愈、部分痊愈、慢性化或反复发作的患者分别占39.3%(33/84)、25.0%(21/84)、35.7%(30/84)。回归分析显示,出院后8周是否达到缓解与病程有关(P=0.047,OR=0.89,β=-0.12),出院2年后是否保持痊愈状态与出院8周后是否达到缓解(P<0.001,OR=109.97,β=4.70)、治疗依从性好坏(P=0.002,OR=0.23,β=-1.46)有关;出院后8周、2年的疗效与患者的年龄、性别、是否共病、是否存在精神病性症状、发作次数、病情严重程度、家族史、单相或双相抑郁等因素无关(P>0.05)。结论重性抑郁发作急性期的治疗应以持续的缓解为目标;要取得良好的远期疗效,早期、彻底以及全程治疗是关键。

Objective To reevaluate major depressive episodes＇ treatment outcome at 8 weeks and 2 years after transitory remission （ remission time lasted 1 - 7 weeks） based on the redefinition of treatment outcomes for major depressive episodes （MDE） and to explore the predictive factors tbr outcomes. Methods A 2-year open, prospective and natural study was conducted on 84 inpatients with MDE who had achieved transitory remission at discharge and their outcomes were assessed using 24-item Haruilton depression rating scale （HAMD） , Bech-Rafaelsen mania scale （BRMS） and self-made questionnaire. Results At 8 weeks after discharge, 46.4% （39/84） patients remained in remission （remission time lasted 8 weeks or longer）, 10. 7% （9/84） patients experienced subthreshold episode, 21.4% （18/84） patients presented residual symptoms and 21.4% （18/84） patients relapsed. At 2 years after discharge, 39. 3 % （ 33/84 ） patients completely recovered, 25.0% （21/84）patients partially recovered, 35.7% （30/84）patients had a chronic course or frequently recurred. Binary logistic regression analysis showed that remission at 8 weeks after discharge was associated with illness duration（ P = 0. 047 ,OR =0. 89,β = -0. 12） , and recovery at 2 years after discharge was associated with the remission at 8 weeks after discharge （ P 〈 0. 001, OR = 109. 97 ,β = 4. 70 ） and treatment compliance （ P = 0. 002, OR = 0. 23, β = - 1.46 ）. Age, sex, comorbidity, psychotic features, number of episodes, illness severity, family history, unipolar or bipolar disorder didn＇t significantly affect the short-term and long-term treatment outcomes （ P 〉 0. 05 ）. Conclusions Remission should be the treatment goal for patients with acute MDE and good long-term outcomes for patients with MDE depend on an early, complete and whole-course treatment.