作者：Marlene Busko
出處：WebMD醫學新聞
November 17, 2008(紐奧良) —新研究認為，負面思考可能是心衰竭病患發生憂鬱的重要因素。
肯塔基大學的研究者發現，心衰竭病患的憂鬱症狀有超過三分之一以上與負面思考有關，與社會人口統計學因素、抗憂鬱治療及心衰竭嚴重度無關。
主要研究作者Rebecca Dekker向Medscape Psychiatry表示，心衰竭病患的憂鬱診斷和治療都被低估。為了這些病患憂鬱之攸關生死的後果，我們得更努力辨識和加以治療。
本研究發表於美國心臟學會2008科學會議。
根據Dekker小姐表示，針對負面思考的治療可以幫助減少此類病患的憂鬱症狀，但是需要後續研究以確認這類介入有多大的效果。
同時，她表示，醫師必須知道，心衰竭病患出現負面思考如「我對家庭是一個負擔」或者「我是一個失敗者」時，都處於憂鬱症狀的高風險，必要時需進行篩檢、治療其憂鬱。
【嚴重問題】
臨床憂鬱是心衰竭病患的嚴重問題，影響將近20%的此類病患，也是發病率和死亡率的一個獨立預測因素。
為了確認負面思考的程度，以及這種思考模式是否為心衰竭病患憂鬱症狀的獨立預測因素，研究者進行了橫斷面研究；他們招募了154名心衰竭病患、平均年紀61歲，這些病患來自單一個門診心衰竭中心。
使用Crandell認知量表測量負面思考，那是一個有45個問題的問卷，測量有關個人、世界、未來與關係的負面思考；使用貝克憂鬱量表(BDI)測量憂鬱症狀。
負面思考的平均程度為60 ± 26，高於無憂鬱的健康控制組的45 ± 8；研究對象中有三分之一有臨床嚴重憂鬱症狀(BDI > 13)。與其他病患相比，有憂鬱症狀的病患的負面思考程度更高。
研究者控制年紀、性別、婚姻狀態、左心室射出分率、血管張力素轉化酶(ACE)抑制劑的使用後，負面思考可解釋38%的憂鬱症狀。
【計畫進行RCT】
根據此結論，研究者計畫進行隨機控制試驗來檢測一種減少心衰竭住院病患負面思考的介入方式。Dekker小姐表示，這將是首次對心衰竭住院病患之床邊認知治療，與其對於負面思考、憂鬱症狀及無心臟事件存活的研究。
研究作者報告沒有相關宣示。
美國心臟學會2008科學會議：摘要5635。發表於2008年11月12日。
AHA 2008: Negative Thinking Predicts Depression in Heart-Failure Patients
By Marlene Busko
Medscape Medical News
November 17, 2008 (New Orleans, Louisiana) — Negative thinking may play a major role in the development of depression in patients with heart failure, new research suggests.
Researchers at the University of Kentucky, in Lexington, found negative thinking accounts for more than a third of depressive symptoms in patients with heart failure, independent of sociodemographic factors, antidepressant therapy, and severity of heart failure.
"Depression is underdiagnosed and undertreated in patients with heart failure," lead study author Rebecca Dekker, told Medscape Psychiatry. "Given the life-or-death consequences of depression in these patients, we need to do a better job of not only recognizing depression but treating it."
The study was presented here at the American Heart Association 2008 Scientific Sessions.
According to Ms. Dekker, treatments that target negative thinking may help reduce depressive symptoms in this patient group, but further research is needed to determine how such interventions would affect outcomes.
In the meantime, "clinicians need to recognize that patients with heart failure who express negative thoughts such as 'I'm a burden to my family' or 'I'm a failure' are at higher risk for depressive symptoms and need to be screened and, if necessary, treated for depression," she said.
Significant Problem
Clinical depression is a significant problem in heart-failure patients, affecting approximately 20% of this patient group, and is an independent predictor of morbidity and mortality.
To determine the preponderance of negative thinking and whether this thought pattern independently predicts depressive symptoms in patients with heart failure, the researchers performed a cross-sectional study. They recruited 154 heart-failure patients, with a mean age of 61 years, from a single outpatient heart-failure center
Negative thinking was measured using the Crandell Cognitions Inventory, a 45-item questionnaire that measures negative thoughts about the self, the world, the future, and relationships.
Depressive symptoms were measured using the Beck Depression Inventory (BDI).
The mean level of negative thinking was 60 ± 26, which is higher than the reported mean of 45 ± 8 for nondepressed, healthy controls.
One-third of the study subjects had clinically significant depressive symptoms (BDI > 13). Patients with depressive symptoms had substantially higher levels of negative thinking than other patients.
Negative thinking alone explained 38% of the variance in depressive symptoms, after researchers controlled for age, sex, marital status, left ventricular ejection fraction, and angiotensin-converting enzyme (ACE)–inhibitor use.
RCT Planned
As a result of the findings, the investigators plan to conduct a randomized controlled trial to test an intervention designed to reduce negative thinking in patients hospitalized with heart failure.
"This will be the first study to test the effects of a 'brief' bedside cognitive therapy session on negative thinking, depressive symptoms, and cardiac event-free survival in hospitalized heart-failure patients," said Ms. Dekker.
The study authors report no relevant disclosures.
American Heart Association 2008 Scientific Sessions: Abstract 5635. Presented November 12, 2008.
[ 本帖最後由 goodcat1111 於 2008-11-25 10:18 編輯 ] |
|
