本帖最後由 lsc0019 於 2009-5-31 01:11 編輯
作者：Janis Kelly
出處：WebMD醫學新聞
May 8, 2009 — 新研究結果顯示，相較於沒有憂鬱症狀的女性，疑似罹患心肌缺血且有體憂鬱症狀者預後較差；然而，那些有心臟血管疾病（CVD）以及認知/情感憂鬱症狀者顯然沒有這樣的問題。
來自聖地牙哥VA醫學中心的研究作者Thomas Rutledge博士向Medscape精神學表示，憂鬱與心血管疾病之間有許多重疊的地方，要區分一位病患是否是憂鬱的，或是他只是有該疾病更嚴重的症狀是困難的。憂鬱與CVD症狀最常重疊的一部份是體感覺，例如疲倦。
我們的發現顯示，當對CVD病患篩檢是否有憂鬱症狀時，可能要很謹慎，至少在預測接下來的事件或是死亡時，要考慮病患報告的特定症狀，不僅僅是他們是否在臨床上是憂鬱的，或是在症狀評估上得到最高的分數。
他附帶表示，同樣的，憂鬱的體感覺特徵與CVD嚴重度有關，這些無法在典型的影像檢驗中發現，這可以解釋為什麼憂鬱症在預測CVD進展上是如此地穩固。
這項研究發表在5月號的一般精神學誌。
【治療CVD病患的憂鬱症仍然有爭議】
Rutledge博士以及第一作者Sarah E. Linke與其同事們使用女性缺血性症候群評估（WISE）研究的數據來比較憂鬱面向作為懷疑心肌缺血女性，CV相關死亡事件，例如中風、心肌梗塞（MI）以及鬱血性心衰竭的預測因子。總共收納了550位女性，後續追蹤平均5.8年。
三項因子主要要件分析（PCA）顯示CAD預後可以由體感覺/情感症狀或是食慾症狀預測，但並非由認知/情感症狀；兩項因子分析結果顯示，體症狀預測較差的預後（勝算比為1.63），但是認知/情感症狀不會。
這些發現即使在校正CVD事件與狀況病史、試驗前CAD（冠狀動脈血管疾病）嚴重度後，仍然是相同的。作者寫到，雖然體症狀與憂鬱及生理疾患之間的重疊部分不能夠被忽視，但體症狀的預測能力並不完全是因為試驗前更嚴重的生理疾病所造成。
過去希望透過治療憂鬱症的努力大部分被證實是令人失望的，但是這些研究者表示區分認知與體症狀之間的差異，可能有治療上的意義。
Rutledge博士表示，首先應該治療憂鬱症，且首重其對於生活品質所帶來的負面影響，其次為對心血管健康有任何的好處。治療CVD病患的憂鬱症狀仍是個有爭議的領域，在這個時候我們有的是比較多的問題，但沒有什麼答案。精神學家已經知道憂鬱表現差異很大，且可以選擇對特定型式症狀比較有好處的藥物治療；這樣的方法是否對CVD健康事件有任何的好處，目前仍然未知。
Rutledge博士表示，對心臟科醫師而言，他們有時候會推定CVD病患的憂鬱只是代表他們病得更重了，這些醫師必須學到，在WISE研究中，憂鬱的體症狀特徵是更重要的，這可能再次強化評估CVD病患憂鬱症狀的可行性。
這項研究由國家心臟、肺臟與血液機構、國家研究資源中心、Gustavus and Louis Pfeiffer研究基金會與Cedars-Sinai女性團體、西賓州仕女醫院協助協會以及Edythe廣泛專贈給女性心臟研究的經費贊助。作者們表示沒有相關資金上的往來。
Somatic Depressive Symptoms Predict Worse CVD Outcomes in Women
By Janis Kelly
Medscape Medical News
May 8, 2009 — Women with suspected myocardial ischemia who also have somatic depressive symptoms are likely to have worse outcomes than women without depression. However, those with cardiovascular disease (CVD) and cognitive/affective depressive symptoms do not appear to share this increased risk, new research shows.
"There is a heavy overlap in symptoms between depression and cardiovascular disease, which often makes it difficult to tell whether a person is depressed or simply experiencing more severe symptoms of their disease. The most common overlap in symptoms between depression and CVD is in somatic features such as fatigue," study author Thomas Rutledge, PhD, from the San Diego VA Medical Center, told Medscape Psychiatry.
"Our findings suggest that when screening for depression in CVD patients, it might be prudent, at least in terms of predicting subsequent events or mortality, to consider the specific symptoms patients are reporting, not just whether or not they are clinically depressed or have a higher score on a symptom inventory,"
It is also possible, he added, that the somatic features of depression are picking up on aspects of CVD severity that are not found on typical imaging tests, which could explain why depression is such a robust predictor of CVD progression
The study is published in the May issue of Archives of General Psychiatry.
Treatment of Depression in CVD "Controversial"
Dr. Rutledge, along with first author Sarah E. Linke and colleagues, used data from the Women's Ischemia Syndrome Evaluation (WISE) study to compare symptom dimensions of depression as predictors of CV-related death and events such as stroke, myocardial infarction (MI), and congestive heart failure in women with suspected myocardial ischemia. A total of 550 women were followed for a median of 5.8 years.
Three-factor principal components analyses (PCA) showed CVD prognosis could be predicted by association with somatic/affective symptoms or appetitive symptoms, but not by cognitive/affective symptoms. Two-factor analysis showed that somatic symptoms predicted a worse prognosis (odds ratio, 1.63) but cognitive/affective symptoms did not.
"These findings persisted in models adjusted for a history of CVD events and conditions as well as for [coronary artery disease] CAD severity at baseline. Thus, the predictive ability of somatic symptoms was not entirely attributable to increased somatic symptoms due to more severe physical disease at baseline, although an overlap of somatic symptoms between depression and physical illness cannot be dismissed," the authors write.
Previous attempts to improve CVD outcomes by treating depression have been largely disappointing, but these researchers suggest differentiating between cognitive and somatic symptoms may have treatment implications.
"Depression should be treated first and foremost for its devastating effects on quality of life and secondarily for any possible benefits for [cardiovascular] health,” Dr. Rutledge said. "The treatment of depression in CVD is still a controversial area, with more questions than answers at this point. Psychiatrists already know depression presentations vary a great deal and can select pharmacological approaches that are better suited to certain kinds of symptoms. Whether such an approach would have any impact on health events in CVD isn’t known."
Dr. Rutledge suggested that for cardiologists, who sometimes assume depression in CVD is just a marker for a sicker patient, learning that the somatic features of depression were more important in the WISE group might reinforce the usefulness of assessing depression in patients with CVD.
This study was supported by the National Heart, Lung, and Blood Institute, the National Center for Research Resources, the Gustavus and Louis Pfeiffer Research Foundation, the Women's Guild of Cedars-Sinai Medical, the Ladies Hospital Aid Society of Western Pennsylvania, and the Edythe Broad Endowment for Women's Heart Research. The authors report no disclosures.
Arch Gen Psychiatry. 2009;66:499-507. |
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