单双相抑郁患者的情感气质特征及其与抗抑郁治疗反应的关系

Characteristics of affective temperaments and their relations with antidepressant treatment responses in unipolar depression and bipolar depression patients

目的探索单相抑郁、双相I型和双相II型抑郁患者情感气质特征的差异及其与抗抑郁治疗反应的关系。方法收集广州医科大学附属脑科医院和暨南大学第一附属医院的住院和门诊患者,包括332例单相抑郁患者、116例双相I型患者和152例双相II型患者,所有患者均处于重性抑郁发作期。在为期6周的半自然临床试验中,所有患者均接受抗抑郁药治疗,完成情感气质问卷中文版(TEMPS-A)和汉密尔顿抑郁量表17项版(HAMD-17)评定。比较治疗4、6周末不同气质类型为主导气质患者HAMD-17评分减分率。结果双相I型患者旺盛情感气质评分高于单相抑郁患者和双相II型患者[(9.91±4.53)分vs.(8.20±4.34)分vs.(8.53±4.14),F=6.562,P=0.002];而双相II型患者环性气质评分高于单相抑郁患者[(10.05±5.02)分vs.(7.47±5.22)分,F=12.89,P<0.01]。治疗6周后,情感旺盛气质主导组HAMD-17评分减分率高于情感旺盛气质非主导组(F=6.44,P=0.011)。结论单双相抑郁患者的情感旺盛气质和环性气质的特征有所差异,旺盛情感气质可能可以作为处于重性抑郁发作期的情感障碍患者抗抑郁治疗反应的预测因子。

Objective To explore the differences in affective temperaments between unipolar depression,bipolar I disorder and bipolar II disorder patients,and to find relations between affective temperaments and responsesto antidepressant treatment in the major affective disorders. Methods In a semi - naturalistic six - week trial,332 patients with unipolar depression,116 patients with bipolar I disorder and 152 patients with bipolar II disorder suffering from a major depressive episode were treated with antidepressant treatment（and a mood stabilizer only for bipolar patients）. All of the patients were recruited from the Guangzhou Brain Hospital and the First Affiliated Hospital of Jiˊnan University. Their affective temperaments were assessed by the Chinese TEMPS - A（Temperament Evaluation of Memphis Pisa Paris and San Diego - Auto questionnaire）and the severity of depression by the Hamilton Depression Scale- 17 item（HAMD - 17）. Primary outcome measures were score - reducing rate of HAMD - 17 at the 4th and 6th week compared with baseline. Results Patients with bipolar I disorder score was significantly higher than patients with unipolar depression and patients with bipolar II disorder on the hyperthymic temperament subscale（F = 6. 562,P = 0. 002）. Patients with bipolar II disorder score was significantly higher than unipolar depression disorder patients on the cyclothymic temperament subscales（F = 12. 89,P ＆lt; 0. 01）. The score - reducing rate of HAMD - 17 at the 6th week in patients with dominant hyperthymic temperament was better than patients without the dominant hyperthymic temperament（F = 6. 44,P = 0. 011）. Conclusion The hyperthymic temperament may be overrepresented inpatients with bipolar I disorder,while the cyclothymic temperament may be overrepresented in patients with bipolar II disorder. The hyperthymic temperament was measured by TEMPS - A may be assist in predicting antidepressant treatment response in patients with major affective disorders suffering a major depressive episode.