Ecological executive function profiles in depression patients before and after treatment

目的 从生态学维度观察抑郁症治疗前后执行功能的变化,并分析生态学执行功能和抑郁症状以及抗抑郁治疗疗效的关系.方法 采用自身对照研究设计,对象为北京大学精神卫生研究所2008年1月至2009年9月住院的符合国际疾病和相关健康问题统计分类第10次修订本(ICD-10)中抑郁发作(F32)或复发性抑郁障碍(F33)诊断标准的33例患者,于治疗前及治疗6周末使用执行功能行为评定量表成人版(BRIEF-A)评估患者的生态学执行功能,汉密尔顿抑郁量表(HAMD)评定抑郁症状严重程度.使用SPSS 17.0统计软件进行比较分析.结果 (1)治疗后BRIEF-A总分[(127 ±27)分比(113±28)分]及转换[(11.7±2.7)分比(10.3±2.6)分]、感情控制[(18.8±4.6)分比(15.8±4.4)分]、自我监控[(9.6±3.0)分比(8.8±2.7)分]等行为管理指数因子分和启动[(15.6±3.7)分比(13.2±3.6)分]、工作记忆[(14.9±3.4)分比(13.3±3.9)分]、计划[(18.3±4.4)分比(16.6±4.4)分]、组织[(12.4±3.8)分比(11.4±3.1)分]等元认知指数因子分较基线时显著降低(t=2.061-4.229,P＜0.05);(2)治疗前HAMD量表总分与BRIEF-A总分和所属各因子分之间未发现差异有统计学意义的相关(r=-0.145-0.220,P＞0.05);(3)治疗前后HAMD减分和BRIEF-A量表行为管理指数所属的抑制因子减分、元认知指数所属的启动因子减分和计划因子减分呈中度相关(r =0.450、0.432、0.403,P＜0.05);(4)以HAMD减分为因变量,以治疗前BRIEF-A量表各因子评分作为自变量进行多元线性回归分析,进入方程的影响因素中工作记忆因子和组织因子和HAMD减分负相关,差异有统计学意义(t=-2.295、-2.488,P＜0.05).结论 抗抑郁症治疗可以显著改善抑郁症患者的生态学执行功能,其恢复程度与抑郁症状的改善呈部分相关.治疗前工作记忆和组织等执行功能水平可能对疗效有预测作用.To explore the ecological executive function profile in depression patients before and after antidepressants treatment and analyze the relationship of ecological executive function and depression symptoms and effect.A total of 33 inpatients diagnosed as depression disorder according to ICD-10 completed the Behavior Rating Inventory of Executive Function-Adult Version (BRIEF-A) and Hamilton Depression Scale (HAMD) before and after a 6-week antidepressant treatment.(1) After treatment, they yielded lower scores significantly on most subscales of BRIEF-A (t = 2.061 - 4.229, P < 0.05), including total score [(127 ± 27) vs (113 ± 28)], shifting [(11.7 ± 2.7) vs (10.3 ± 2.6)], emotion control [(18.8 ± 4.6) vs (15.8 ± 4.4)], monitoring [(9.6 ± 3.0) vs (8.8 ± 2.7)], initiation [(15.6 ± 3.7) vs (13.2 ± 3.6)], working memory [(14.9 ± 3.4) vs (13.3 ± 3.9)], planning [(18.3 ± 4.4) vs (16.6 ± 4.4)], organization [(12.4 ± 3.8) vs (11.4 ± 3.1)], behavioral regulation index (BRI), metacognition index (MI) and global executive composite (GEC). (2) Before treatment, Person's correlation test showed that the total score of HAMD and all subscales of BRIEF-A had no significant correlation respectively (r = -0.145 - 0.220, P > 0.05). (3) After treatment, the deduction of total score of HAMD and the deduction of the scores of inhibiting belonging to behavioral regulation index (BRI) and initiation, planning belonging to metacognition index (MI) had moderate correlations respectively(r = 0.450, 0.432, 0.403, P < 0.05). (4) Multiple regression analysis showed that the scores of working memory, organization and the deduction of total score of HAMD had significantly negative correlations respectively (t = -2.295, -2.488, P < 0.05).The antidepressant treatment can improve ecological executive function of depression patients. And the improvements of ecological executive function and depression symptoms are partially correlated."十一五"国家科技支撑计划; 卫生行业科研专项经费PubMed中文核心期刊要目总览(PKU)中国科技核心期刊(ISTIC)中国科学引文数据库(CSCD)09676-6809