Depression und Response: Der Einfluss von Persönlichkeit und Kognition

Zusammenfassung

Anliegen Ein Einfluss der Persönlichkeit und / oder des kognitiven Status auf die Response bei depressiven Patienten wird diskutiert. Methode Depressive, stationäre Patienten wurden bei Entlassung in Responder und Nonresponder eingeteilt und bezüglich kognitiver Leistungsfähigkeit und Persönlichkeit untersucht. Ergebnisse Vorläufige Ergebnisse weisen auf einen positiven Einfluss bestimmter Persönlichkeitsfaktoren, insbesondere der Extraversion, sowie des Aktivierungsniveaus auf die Response hin. Schlussfolgerung In der Depressionsbehandlung sollten Persönlichkeit und Kognition berücksichtigt werden.

Abstract

Objective Despite effective pharmacologic and therapeutic strategies some patients do not sufficiently benefit from antidepressive treatment. The influence of personality and cognition onto response in depressive inpatients shall be explored. Methods Depressive inpatients were rated concerning depressive pathology immediately after admission as well as at discharge. In addition, prior to discharge, cognitive performance and personality traits were measured. The sample was divided into responders and nonresponders by the reduction of depressive symptoms from admission to discharge. For the assumption of response, a reduction of minimum 50 % was defined. Results Preliminary results suggest an impact of personality traits onto response in depressive patients, particularly extraversion seems to have a salutary effect. Furthermore, significant differences between responders and nonresponders were shown concerning alertness. Conclusions In the treatment of non-response depression, cognitive and personality traits should be taken in account by using multimodal strategies.

Depression - Persönlichkeit - Kognition - Response

depression - personality - cognition - response

Literatur

• 1 Kampf-Sherf O, Zlotogorski Z, Gilboa A. et al . Neuropsychological functioning in major depression and responsiveness to selective serotonin reuptake inhibitors antidepressants.  J Affect Disord. 2004;  82 453-459
• 2 Majer M, Ising M, Kunzel H. et al . Impaired divided attention predicts delayed response and risk to relapse in subjects with depressive disorders.  Psychol Med. 2004;  34 1453-1463
• 3 Mulder R T. Personality pathology and treatment outcome in major depression: a review.  Am J Psychiatry. 2002;  159 359-371
• 4 Brieger P, Ehrt U, Marneros A. Frequency of comorbid personality disorders in bipolar and unipolar affective disorders.  Compr Psychiatry. 2003;  44 28-34
• 5 Casey P, Birbeck G, McDonagh C. et al . Personality disorder, depression and functioning: results from the ODIN study.  J Affect Disord. 2004;  82 277-283
• 6 Mulder R T, Joyce P R, Luty S E. The relationship of personality disorders to treatment outcome in depressed outpatients.  J Clin Psychiatry. 2003;  64 259-264
• 7 Skodol A E, Stout R L, McGlashan T H. et al . Co-occurrence of mood and personality disorders: a report from the Collaborative Longitudinal Personality Disorders Study (CLPS).  Depress Anxiety. 1999;  10 175-182
• 8 Souery D, Oswald P, Massat I. et al . Clinical factors associated with treatment resistance in major depressive disorder: results from a European multicenter study.  J Clin Psychiatry. 2007;  68 1062-1070
• 9 Trivedi M H, Kleiber B A. Algorithm for the treatment of chronic depression.  J Clin Psychiatry. 2001;  62 Suppl 6 22-29
• 10 Kool S, Schoevers R, de Maat S. et al . Efficacy of pharmacotherapy in depressed patients with and without personality disorders: a systematic review and meta-analysis.  J Affect Disord. 2005;  88 269-278
• 11 Petersen T, Hughes M, Papakostas G I. et al . Treatment-resistant depression and Axis II comorbidity.  Psychother Psychosom. 2002;  71 269-274
• 12 Mulder R T. Depression and personality disorder.  Curr Psychiatry Rep. 2004;  6 51-57
• 13 Zimmermann P, Fimm B. Testbatterie zur Aufmerksamkeitsprüfung (TAP). Version 1.7. Psytest. 2002
• 14 Ilmberger J. Deutsche Version des California Verbal Learning Test. München; Institut für medizinische Psychologie der Universität München 1988
• 15 Heller K A, Kratzmeier H, Lengfelder A. Matrizen-Test-Manual, Band 1. Ein Handbuch mit deutschen Normen zu den Standard Progressive Matrices von J. C. Raven. Göttingen; Beltz 1998
• 16 Reitan R M, Wolfson D. Trail-Making-Test. Aus: The Halstead-Reitan Neuropsychological Test Battery. Tucson; Neuropsychology Press 1985
• 17 Fydrich T, Renneberg B, Schmitz B. et al .Strukturiertes Klinisches Interview für DSM-IV, Achse II: Persönlichkeitsstörungen. Göttingen; Hogrefe 1997
• 18 Fahrenberg J, Hampel R, Selg H. FPI-R. Das Freiburger Persönlichkeitsinventar. 7., überarbeitete und neu normierte Auflage. Göttingen; Hogrefe 2001
• 19 Pukrop R, Steinmeyer E M, Woschnik M. et al . Persönlichkeit, akzentuierte Wesenszüge und Persönlichkeitsstörungen. Ein Beitrag zur dimensionalen Diagnostik von Persönlichkeitsstörungen.  Nervenarzt. 2002;  73 247-254
• 20 Kronmüller K T, Mundt C. Persönlichkeit, Persönlichkeitsstörungen und Depression.  Nervenarzt. 2006;  77 863-878
• 21 Kirsch I, Deacon B J, Huedo-Medina T B. et al . Initial severity and antidepressant benefits: a meta-analysis of data submitted to the Food and Drug Administration.  PLoS Med. 2008;  5 (2) e45
• 22 Heerlein A, Richter P, Gonzalez M. et al . Personality patterns and outcome in depressive and bipolar disorders.  Psychopathology. 1998;  31 15-22
• 23 Janowsky D S. Introversion and extroversion: implications for depression and suicidality.  Curr Psychiatry Rep. 2001;  3 444-450
• 24 Jylha P, Isometsa E. The relationship of neuroticism and extraversion to symptoms of anxiety and depression in the general population.  Depress Anxiety. 2006;  23 281 -289
• 25 Quilty L C, De Fruyt F, Rolland J P. et al . Dimensional personality traits and treatment outcome in patients with major depressive disorder.  J Affect Disord. 2008;  108 (3) 241-250
• 26 Ranjith G, Farmer A, McGuffin P. et al . Personality as a determinant of social functioning in depression.  J Affect Disord. 2005;  84 73-76
• 27 Pflug B. Zur Bedeutung der Gesamtpersönlichkeit in der Somato- und Psychotherapie im Langzeitverlauf affektiver Erkrankungen. In: Boeker H, Hell D, Hrsg Therapie der affektiven Störungen. Psychosoziale und neurobiologische Perspektiven. Stuttgart; Schattauer 2002: 246-264
• 28 Hirschfeld R M, Russell J M, Delgado P L. et al . Predictors of response to acute treatment of chronic and double depression with sertraline or imipramine.  J Clin Psychiatry. 1998;  59 669-675
• 29 Morse J Q, Pilkonis P A, Houck P R. et al . Impact of cluster C personality disorders on outcomes of acute and maintenance treatment in late-life depression.  Am J Geriatr Psychiatry. 2005;  13 808 - 814
• 30 Meyer B, Pilkonis P A, Proietti J M. et al . Attachment styles and personality disorders as predictors of symptom course.  J Personal Disord. 2001;  15 371-389
• 31 Candrian M, Farabaugh A, Pizzagalli D A. et al . Perceived stress and cognitive vulnerability mediate the effects of personality disorder comorbidity on treatment outcome in major depressive disorder: a path analysis study.  J Nerv Ment Dis. 2007;  195 729-737
• 32 Markowitz J C, Skodol A E, Petkova E. et al . Longitudinal effects of personality disorders on psychosocial functioning of patients with major depressive disorder.  J Clin Psychiatry. 2007;  68 186-193
• 33 Kool S, Schoevers R, Duijsens I J. et al . Treatment of depressive disorder and comorbid personality pathology: combined therapy versus pharmacotherapy.  Tijdschr Psychiatr. 2007;  49 361-372
• 34 Gallagher P, Robinson L J, Gray J M. et al . Neurocognitive function following remission in major depressive disorder: potential objective marker of response?.  Aust N Z J Psychiatry. 2007;  41 54-61
• 35 Marcos T, Portella M J, Navarro V. et al . Neuropsychological prediction of recovery in late-onset major depression.  Int J Geriatr Psychiatry. 2005;  20 790-795
• 36 Alexopoulos G S, Kiosses D N, Murphy C. et al . Executive dysfunction, heart disease burden, and remission of geriatric depression.  Neuropsychopharmacology. 2004;  29 2278-2284
• 37 Nebes R D, Pollock B G, Houck P R. et al . Persistence of cognitive impairment in geriatric patients following antidepressant treatment: a randomized, double-blind clinical trial with nortriptyline and paroxetine.  J Psychiatr Res. 2003;  37 99-108
• 38 Bogner H R, Bruce M L, Reynolds 3rd C F. et al . The effects of memory, attention, and executive dysfunction on outcomes of depression in a primary care intervention trial: the PROSPECT study.  Int J Geriatr Psychiatry. 2007;  22 (9) 922-929
• 39 Sneed J R, Keilp J G, Brickman A M. et al . The specificity of neuropsychological impairment in predicting antidepressant non-response in the very old depressed.  Int J Geriatr Psychiatry. 2008;  23 (3) 319-323
• 40 Potter G G, Kittinger J D, Wagner H R. et al . Prefrontal neuropsychological predictors of treatment remission in late-life depression.  Neuropsychopharmacology. 2004;  29 2266-2271