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首发和复发性抑郁障碍治疗前后认知功能及其相关因素的研究

  • 闫志芳,谢雯

* 通信作者: 谢雯, 单位:安徽省精神卫生中心

摘要


目的:基于重复性成套神经心理状态测验对首发和复发抑郁障碍患者抗抑郁药物治疗前后认知功能特点的探讨,以及其与临床特征和症状严重程度的关系。

方法:选择46例首发抑郁障碍患者、42例复发抑郁障碍患者以及39例正常对照,采用汉密顿抑郁量表( HAMD-24) 评定抑郁情绪的严重程度,用重复性成套神经心理状态评定患者的认知功能。

结果:① 首发组、复发组以及正常对照组在治疗前即刻记忆、言语功能、注意力、延时记忆4个因子及RBANS总分在3 组间差异均有统计学意义(P<0.05)。两两分析发现首发组及复发组在RBANS各因子及RBANS总分均低于正常对照组,差异有统计学意义(P<0.05)。首发组在5个因子及RBANS总分均高于复发组,两组之间在即刻记忆、言语功能、注意力、延时记忆及RBANS总分差异均有统计学意义(P<0.05)。② 治疗8周后首发和复发组与正常对照组三组间在即刻记忆、注意力、延时记忆3个因子及RBANS总分差异均有统计学意义(P<0.05)。首发组及复发组在即刻记忆、延迟记忆及RBANS总分均低于正常对照组,差异有统计学意义(P<0.05),除此之外,复发组在注意因子显著低于正常对照组,差异有统计学意义(P<0.05)。首发组在5个因子及RBANS总分均高于复发组,两组之间在延迟记忆、视觉广度、RBANS总分差异有统计学意义(P<0.05)。③ 首发及复发患者治疗前后两组HAMA总分、HAMD总分、RBANS的各因子分及RBANS总分均有显著性改变,差异有统计学意义(P<0.05)。④ HAMD部分因子分及 HAMD总分与RBANS部分因子分及RBANS总分呈负相关(P<0.05)。

结论:首发和复发抑郁障碍患者不仅存在情绪症状,也存在广泛的认知功能损害,其中复发患者与首发患者相比有更严重的认知功能障碍;新型抗抑郁剂能有效缓解患者抑郁症状,并且能部分改善患者的认知功能;抑郁障碍的认知功能损害与症状严重度呈相关性。

关键词:抑郁症;认知功能;重复性成套神经心理状态测验

ABSTRACT


Objective: Based on the repetitive set of neuropsychological state tests, the characteristics of cognitive function before and after treatment of new antidepressant drugs in patients with first-episode and recurrent depressive disorder, and their relationship with clinical features and severity of symptoms.

Methods: 46 patients with first-episode depressive disorder, 42 patients with recurrent depressive disorder, and 39 normal controls were enrolled. The Hamilton Depression Scale (HAMD-24) was used to assess the severity of depression, and the patient's recognition was assessed with the repeatable battery for the assessment of neuropsychological status.

Results: ① There were significant differences in the memory, speech function, attention, time-lapse memory and RBANS total scores between the first group, the recurrent group and the normal control group ( P < 0.05). Pairwise analysis found that the total scores of RBANS and RBANS in the first and second groups were lower than those in the normal control group, and the difference was statistically significant ( P<0.05). The total scores of the five factors and RBANS in the first group were higher than those in the recurrence group. The immediate memory, speech function, attention, time delay memory and RBANS total scores were statistically significant between the two groups (P<0.05)

Conclusion  s. ② There were significant differences in immediate memory, attention, time-lapse memory and RBANS total scores between the first and recurrent groups after 8 weeks of treatment and the normal control group ( P<0.05). In the first-episode group and the recurrent group, the immediate memory, delayed memory, and total RBANS scores were lower than those in the normal control group, with significant differences (P<0.05).And the attention factor in the recurrent group was significantly lower than that in the normal control group (P<0.05). In addtion the total scores of the five factors and RBANS in the first group were higher than those in the recurrent group. The visual extent, delayed memory, and total RBANS scores were statistically significant between the two groups ( P<0.05). ③ Before and after treatment, patients with primary and recurrent depressive disorder had significant changes in HAMA total score, HAMD total score, RBANS scores and RBANS total scores. The difference was statistically significant ( P < 0.05). ④ The HAMD partial factor score and the HAMD total score are negatively related to the RBANS partial factor score and the RBANS total score ( P<0.05).

Conclusion  : Patients with first-episode and recurrent depressive disorders not only have emotional symptoms, but also have extensive cognitive impairment,and recurrent patients have more severe cognitive dysfunction than first-person patients. New antidepressants can effectively alleviate depressive symptoms and can Partially improve the cognitive function of patients. Cognitive impairment of depressive disorder is associated with severity of symptoms.

Key words: Depressive Disorde / Depressionr; Cognitive Function; Repeatable Battery for The Assessment of Neuropsychological Status

引用本文 / How to Cite This Article

闫志芳,谢雯.首发和复发性抑郁障碍治疗前后认知功能及其相关因素的研究[J]. 国际精神病学杂志, 2019, 46(4): 652-655

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