难治性抑郁症与首发抑郁症认知功能对照研究

目的比较和分析难治性抑郁症（TRD）与首发抑郁症（FED）患者的认知功能损害特点。方法以53例TRD患者（TRD组）和21例FED患者（FED组）作为研究对象,以20名健康志愿者作为正常对照（对照组）。采用17项汉密尔顿抑郁量表（HAMD-17）、汉密尔顿焦虑量表（HAMA）、抑郁自评量表（SDS）和临床大体印象量表-病情严重程度分量表（CGI-SI）评估临床严重程度,韦氏成人智力测定（WAIS）、韦氏记忆量表（WMS）、威斯康星卡分类测试（WCST）和数字划消测验（NCT）评估认知功能,并进行组间比较和分析。结果临床严重程度评估显示,TRD组HAMD-17躯体性焦虑因子评分明显高于FED组,其余因子评分两组间比较差异均无统计学意义。认知功能评估显示,两病例组操作智商得分、WMS记忆商数、长时记忆和短时记忆的图形拼凑和时空定向分测验评分及WCST完成分类数、总应答数、概念化水平百分数、NCT粗分和净分均明显低于对照组;而WCST总用时、错误思考时间、持续性错误数和错误率均显著高于对照组。TRD组图形拼凑、时空定向、数字顺序和视觉再生分测验评分明显低于FED组;TRD组与对照组在WCST错误思考时间、持续性错误数和错误率、概念化水平百分数以及NCT粗分和净分方面的差异较FED组更为显著。结论临床严重程度评估并不能反映TRD的特点。想象力、抓住事物线索能力、手—眼协调能力及记忆、注意功能和工作记忆等认知功能损害可能是TRD的特征性表现。

Comparison study of cognitive function between treatment resistant depression and fist episode depression

Objective To investigate and compare the characteristics of cognitive function between treatment resistant depression (TRD) and first episode depression (FED). Methods Fifty-three patients with TRD (TRD group) and 21 patients with FED (FED group) were enrolled, and another 20 healthy volunteers were served as normal controls (control group). The disease severity was evaluated with Hamilton Depression Scale-17 (HAMD-17), Hamilton Anxiety Scale (HAMA), Self-Rating Depression Scale (SDS) and Clinical Global Impression-Severity Index (CGI-SI), the cognitive function was assessed with Wechsler Adult Intelligence Schedule (WAIS), Wechsler Memory Scale (WMS), Wisconsin Card Sorting Test (WCST) and Number Cancellation Test (NCT), and comparison was conducted among groups. Results The evaluation of disease severity revealed that the score of somatic anxiety factor of HAMD-17 in TRD group was significantly higher than that in FED group, while there was no significant difference in the scores of the other factors between these two groups. The assessment of cognitive function demonstrated that performance intelligence quotient, WMS memory quotient, long and short term memory, WCST number of categories completed, response administered, percent conceptual level responses, NCT correct number and score in TRD group and FED group were significantly lower than those in control group. However, WCST total time, error response time, number of perseverative errors and percent of perseverative errors in TRD group and FED group were significantly higher than those in control group. The scores of picture puzzle, space orientation, number order and vision regeneration in TRD group were significantly lower than those in FED group. Compared with the differences between FED group and control group, the differences between TRD group and control group in WCST error response time, number of perseverative errors, percent of perseverative errors, percent conceptual level responses, NCT correct number and score were more significant. Conclusion Clinical evaluation of disease severity can not reflect the characteristics of TRD. The impairment of imagination, ability to grasp the clues and hand-eye coordination, and working impairment on memory and attention are characterised in TRD.