Antidepressant medicationsv.cognitive therapy in people with depression with or without personality disorder

British Journal of Psychiatry - Tập 192 Số 2 - Trang 124-129 - 2008
Jay C. Fournier1, Robert J. DeRubeis1, Richard C. Shelton2, Robert Gallop3, Jay D. Amsterdam4, Steven D. Hollon5
1Department of Psychology, University of Pennsylvania, Philadelphia, Pennsylvania
2Department of Psychiatry, Vanderbilt University, Nashville, Tennessee
3Department of Mathematics and Applied Statistics, West Chester University, West Chester, Pennsylvania
4Department of Psychiatry, University of Pennsylvania, Philadelphia, Pennsylvania
5Department of Psychology, Vanderbilt University, Nashville, Tennessee, USA

Tóm tắt

BackgroundThere is conflicting evidence about comorbid personality pathology in depression treatments.AimsTo test the effects of antidepressant drugs and cognitive therapy in people with depression distinguished by the presence or absence of personality disorder.MethodRandom assignment of 180 out-patients with depression to 16 weeks of antidepressant medication or cognitive therapy. Random assignment of medication responders to continued medication or placebo, and comparison with cognitive therapy responders over a 12-month period.ResultsPersonality disorder status led to differential response at 16 weeks; 66%v.44% (antidepressantsv.cognitive therapy respectively) for people with personality disorder, and 49%v.70% (antidepressantsv.cognitive therapy respectively) for people without personality disorder. For people with personality disorder, sustained response rates over the 12-month follow-up were nearly identical (38%) in the prior cognitive therapy and continuation-medication treatment arms. People with personality disorder withdrawn from medication evidenced the lowest sustained response rate (6%). Despite the poor response of people with personality disorder to cognitive therapy, nearly all those who did respond sustained their response.ConclusionsComorbid personality disorder was associated with differential initial response rates and sustained response rates for two well-validated treatments for depression.

Từ khóa


Tài liệu tham khảo

10.1016/S0893-133X(02)00307-X

10.1007/s00213-004-1913-8

10.1001/archpsyc.1993.01820210073009

10.1037/0022-006X.64.1.81

Cox, 1984, Analysis of Survival Data

Bryk, 1996, Hierarchical Linear Modeling: Applications and Data Analysis Methods

10.1001/archpsyc.1987.01800180050009

Doyle, 1999, Comorbidity in Affective Disorders, 105

10.1001/archpsyc.62.4.417

10.1016/j.jad.2005.05.017

10.1037/0022-006X.63.6.997

10.4088/JCP.v66n0408

10.1001/archpsyc.1989.01810110013002

10.2307/2986113

10.1192/bjp.188.1.13

Hosmer, 1989, Applied Logistic Regression

10.1001/archpsyc.62.4.409

10.1080/136515001300225132

Goldstein, 1987, Models in Educational and Social Research

2000, Practice guideline for the treatment of patients with major depressive disorder (revision), Am J Psychiatry, 157, 49

10.1097/00004714-199502000-00005

Spitzer, 1990, Structured Clinical Interview for DSM–II–R Personality Disorders (SCID–II, Version 1.0)

First, 2001, Structured Clinical Interview for DSM–IV–TR – Axis I Disorders, Research Version, Patient Edition with Psychotic Screen (SCID–I/P W/PSY SCREEN)

Tyrer, 1993, The Nottingham study of neurotic disorder. Effect of personality status on response to drug treatment, cognitive therapy and self-help over two years, Br J Psychiatry, 162, 10.1192/bjp.162.2.219

10.1146/annurev.pu.09.050188.001011

Willett, 1997, In Change and Development: Issues of Theory, Method, and Application, 213

10.1176/jnp.15.4.397

10.1136/jnnp.23.1.56

Thông tin
Thông tin xuất bản

British Journal of Psychiatry

Tập 192 Số 2

124-129

Thông tin tác giả