伴与不伴焦虑症状的难治性抑郁症临床特征的比较

目的 探讨伴焦虑症状的难治性抑郁症的临床特征.方法 将327例难治性抑郁症患者,按照17项汉密尔顿抑郁量表(HAMD17)焦虑/躯体化因子≥7分,分为焦虑组(229例)和无焦虑组(98例),比较2组患者的人口学特征和临床特征;对伴焦虑症状的危险因素进行Logistic回归分析.结果 焦虑组平均年龄、首发年龄、HAMD17总分、汉密尔顿焦虑量表(HAMA)总分高于无焦虑组[(42.58±11.77)岁vs(36.78±11.84)岁,(34.60±11.66)岁vs(30.04±12.60)岁,(27.83±6.93)分vs(23.39±5.59)分,(21.11±6.61)分vs(13.88±4.68)分],差异有统计学意义(P＜0.01).焦虑组和无焦虑组性别(男:女,OR=0.51)、有无强迫症状(OR=3.67)、未成年和成年发病的构成比(OR=0.36)的差异有统计学意义(P＜0.01).年龄(OR=1.05)、HAMD17总分(OR=1.17)、有自杀观念(OR=2.70)和强迫症状(OR=4.59)与难治性抑郁症伴焦虑症状相关(P＜0.05).结论 伴焦虑症状的难治性抑郁症患者具有年龄较大、女性倾向较高、首发年龄较晚、成年发病的倾向较高、抑郁程度更严重、更可能伴强迫症状等特点;年龄、抑郁严重程度、自杀观念和强迫症状可能是难治性抑郁症伴焦虑症状的危险因素.

Clinical characteristics of treatment-resistant depression with and without anxious features

Objective To explore clinical characteristics of anxious treatment-resistant depression (TRD). Methods Three hundred and twenty-seven patients met the International Classification of Diseases, 10th Edition (ICD-10) criteria for depressive episode and definition of treatment-resistant depression were enrolled. A baseline 17-item Hamilton Rating Scale for Depression ( HAMD17 ) Anxiety/Somatization factor score of ≥ 7 or ＜ 7 was considered indicative of anxious or non-anxious TRD. Sociodemographic and clinical data were collected and compared between two groups. Bivariate Logistic regression models were used to assess association between independent variables of interest and co-current anxious symptoms. Results Age, age at first onset, and severity of depression and anxiety in anxious TRD were significantly higher than that in non-anxious TRD [ (42.58 ± 11.77 ) vs. ( 36.78 ± 11.84 ), ( 34.60 ±11.66)vs. (30.04 ±12.60), (27.83 ±6.93) vs. (23.39 ±5.59), (21.11 ±6.61) vs. (13.88±4.68)] (P ＜ 0.01 ). Significant differences among constituent ratio of gender (male vs. female, OR =0.51 ), co-current obsessive-compulsive symptoms ( OR = 3.67), as well as pre-adult onset and adult onset ( OR = 0.36) were identified between the two groups ( P ＜ 0.01 ). Older age ( OR = 1.05 ), more severely depressed (OR = 1.17), co-current suicidal ideation (OR = 2.70) and obsessive-compulsive symptoms ( OR = 4. 59) were significantly associated with anxious TRD ( P ＜ 0.05 ). Conclusions Patients with anxious TRD are more likely to be older and female, and to have older age at first onset, higher depressed severity and co-current obsessive-compulsive symptoms. Older age, higher depressed severity, co-current suicidal ideation and obsessive-compulsive symptoms may be the risk factors of TRD with high level of anxiety.