日本語AIでPubMedを検索
入院患者における精神病性うつ病。入院患者における精神病性うつ病と非精神病性うつ病の縦断的転帰。臨床重症度における抑うつ症状の役割
Psychotic depression in hospitalized patients: Longitudinal outcomes of psychotic vs. nonpsychotic depression among inpatients: The role of depressive symptoms on clinical severity.
PMID: 32615470 DOI: 10.1016/j.jpsychires.2020.06.002.
抄録
精神病性うつ病は非精神病性うつ病よりも悪い転帰と関連しているにもかかわらず、この重症度の高さは抑うつ症状だけでは説明できないという証拠が増えてきている。我々は、精神病性うつ病と非精神病性うつ病の間の社会統計学的特徴および臨床的特徴、ならびに精神科入院の臨床転帰の違いを評価した。入院後72時間以内と退院前24時間以内に評価したうつ病性入院患者28人を対象とした。Hamilton Depression Rating Scale 17-item（HDRS-17）、Clinical Global Impression（CGI）、Brief Psychiatric Rating Scale（BPRS）、Global Assessment of Functioning（GAF）のスコアを精神病患者と非精神病患者で比較した。入院時と退院時の横断的な比較と、縦断的な比較が行われた。縦断的転帰は、潜在的な交絡因子（性、年齢、発症時年齢、研究年数、躁病/過眠症の既往歴、現在の入院中の電気けいれん療法の既往歴、自殺未遂の既往歴、自殺未遂の回数、および過去の入院歴）を補正した。うつ病性入院患者131人（45.4％）に精神病的特徴が認められた。入院時と退院時のHDRS-17のスコアは両群とも類似していた。しかし、精神病患者では両時点でBPRS、CGI、GAFのスコアが悪化していた。HDRS-17（P=0.75）、CGI（P=0.5）、GAF（P=0.84）の改善は両群で同程度であったが、BPRSの改善は精神病患者の方が大きかった（P<0.001）。精神病入院患者では臨床的・機能的パラメータが悪化していた。それにもかかわらず、両群間で抑うつ症状の重症度に差はなかった。これらの所見は、情動症状の強さにかかわらず、精神病的特徴を伴う抑うつエピソードはより重篤な疾患であるという仮説を補強するものであった。
Even though psychotic depression is related to worse outcomes than nonpsychotic depression, there is increasing evidence that this greater severity is not solely explained by the depressive symptoms. We evaluated the socio-demographic and clinical characteristics, as well as the differences in clinical outcomes of psychiatric hospitalization between psychotic and non-psychotic depression. Two-hundred-eighty-eight depressive inpatients were assessed within 72 h after hospitalization and 24 h before discharge. We compared scores of Hamilton Depression Rating Scale 17-items (HDRS-17), Clinical Global Impression (CGI), Brief Psychiatric Rating Scale (BPRS), and Global Assessment of Functioning (GAF) between psychotic and nonpsychotic patients. Instruments were compared both cross-sectionally - on admission and discharge - and longitudinally. Longitudinal outcomes were corrected for potential confounders (sex, age, age at disease onset, years of study, previous history of mania/hypomania, electroconvulsive therapy in current hospitalization, history of attempted suicide, number of suicide attempts, and previous hospitalizations). One-hundred-thirty-one depressive inpatients (45.4%) presented psychotic features. Both groups showed similar HDRS-17 scores at admission and discharge. However, psychotic patients had worse scores on BPRS, CGI, and GAF at both timepoints. Both groups had similar improvement on HDRS-17 (P = 0.75), CGI (P = 0.5), and GAF (P = 0.84), but psychotic patients had greater improvement on BPRS (P < 0.001). Psychotic inpatients showed worse clinical and functional parameters. Nonetheless, the groups did not differ in depressive symptom severity. These findings reinforce the hypothesis that depressive episode with psychotic features is a more severe form of the disease irrespective of intensity of affective symptomatology.
Copyright © 2020 Elsevier Ltd. All rights reserved.