Effects of Comorbidity of Generalized Anxiety Disorder on Executive Functions of Patients with Major Depressive Disorder: A Multi-center Retrospective Case-control Study
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摘要:
目的 探讨共病广泛性焦虑障碍(generalized anxiety disorder, GAD)及不同焦虑水平对抑郁症(major depressive disorder, MDD)患者执行功能的影响。 方法 回顾性收集并分析2014年2月至2016年1月北京协和医院、山西医科大学第一医院、中国医科大学附属第一医院招募的MDD患者及对照人群的临床资料。MDD患者均采用汉密尔顿焦虑量表(Hamilton anxiety scale,HAMA)对焦虑程度进行评定,并依据是否合并GAD,分为MDD+GAD组、MDD-GAD组。3组均采用MATRICS共识认知成套测验(MATRICS consensus cognitive battery, MCCB)评估其执行功能,包括动物流畅性测验(animal fluency test, AFT)、符号编码分测验(brief assessment of cognition in schizophrenia-symbolic coding, BACS-SC)、颜色连线测验(color trail test, CTT)、Stroop色词测验(Stroop color word test,SCWT)。比较3组及不同焦虑水平的MDD患者执行功能差异,采用Spearman法分析HAMA评分与MDD患者执行功能的相关性。 结果 共230例MDD患者及77名精神健康对照者入选本研究。其中MDD+GAD组86例、MDD-GAD组144例。MDD+GAD组和MDD-GAD组AFT、BACS-SC、SCWT正确数目均较对照组少,CTT完成时间较对照组长(P均<0.05);MDD+GAD组AFT正确数目多于MDD-GAD组(P<0.05),CTT、BACS-SC、SCWT结果与MDD-GAD组无显著性差异(P均>0.05)。轻度焦虑患者(7分<HAMA≤14分)AFT、BASC-CS、SCWT正确数目少于中度焦虑(14分<HAMA≤29分)及重度焦虑患者(HAMA>29分)(P均<0.05),中度焦虑与重度焦虑患者之间差异无统计学意义(P均>0.05)。Spearman相关分析结果表明,HAMA评分与AFT(rs=0.26, P<0.001)、BASC-CS(rs=0.26, P<0.001)、SCWT(rs=0.27, P<0.001)正确数目呈正相关,与CTT完成时间无线性相关(rs=-0.11, P=0.106)。 结论 共病GAD可能减轻MDD患者词语流畅功能损害;随焦虑程度加重,MDD患者的词语流畅度、信息处理速度、抑制等执行功能受损得到一定缓解。 Abstract:Objective To analyze the effect of comorbidity of generalized anxiety disorder (GAD) at different levels on executive functions (EFs) of patients with major depressive disorder (MDD). Methods Data of MDD patients and healthy controls in three general hospitals from February 2014 to January 2016 were retrospectively collected. Hamilton anxiety scale (HAMA) was used to evaluate the level of anxiety. MDD patients were grouped into MDD+GAD or MDD-GAD based on the result of the mini-international neuropsychiatric interview (MINI). EFs were evaluated by the animal fluency test (AFT), brief assessment of cognition in schizophrenia-symbolic coding (BACS-SC), color trail test (CTT), and Stroop color word test (SCWT) from MATRICS consensus cognitive battery (MCCB). We compared the EFs of different groups, and then explored the relevance between the level of anxiety and EFs by Spearman analysis. Results A total of 230 MDD patients and 77 healthy controls (G0: HC) were included. There were 86 comorbid with GAD (G1: MDD+GAD), 144 without GAD (G2: MDD-GAD). AFT, BACS-SC, CTT and SCWT results were lower in G1 and G2 than in G0(all P < 0.05). G1 had better AFT results than G2 (P < 0.05), while the difference in the results of BACS-SC, CTT and SCWT were unremarkable between G1 and G2 (all P > 0.05). MDD patients with mild anxiety symptoms (7 < HAMA≤14) had statistically significant lower scores in AFT, BACS-SC and SCWT than those with moderate (14 < HAMA≤29) or severe (HAMA > 29) anxiety symptoms (all P < 0.05), while no significant difference in test results were found between the subgroups of moderate and severe anxiety (all P > 0.05). Spearman analysis showed HAMA scores were relevant with AFT, BACS-SC and SCWT results (AFT: rs=0.26, P < 0.001; BACS-SC: rs=0.26, P < 0.001; SCWT: rs=0.27, P < 0.001), but irrelevant with CTT results (rs=-0.11, P=0.106). Conclusions Comorbidity of GAD may alleviate deficits of verbal fluency in MDD patients. MDD patients with anxiety at a higher level tend to have better executive functions such as verbal fluency, information processing speed, and inhibition. 作者贡献:耿文奇负责数据录入、整理、分析及文章撰写;史丽丽负责指导研究思路及文章撰写;段艳平、李涛、蒋静参与临床诊断与评估;张克让、朱刚、魏镜负责督导研究进程并指导研究思路;于欣负责多中心协调工作。利益冲突: 无 -
表 1 一般临床资料
组别 性别[n(%)] 年龄[M(P25, P75),岁] 受教育年限[M(P25, P75),岁] 男性 女性 MDD+GAD组(n=86) 21(24.42) 65(75.58) 37.5(30, 47) 12(9, 16) MDD-GAD组(n=144) 37(25.69) 107(74.31) 38(29, 47) 12(9, 16) 对照组(n=77) 21(27.27) 56(72.73) 33(25, 43) 16(15, 19) P值 0.917 0.054 <0.001 MDD:抑郁症;GAD:广泛性焦虑障碍 表 2 MDD+GAD组、MDD-GAD组与对照组执行功能比较
组别 AFT(x±s, 个) BACS-SC(x±s, 个) CTT[M(P25, P75),s] SCWT(x±s, 个) MDD+GAD组(n=86) 20.53±6.20 51.52±14.64 34.50(23.75, 55.00) 36.62±11.35 MDD-GAD组(n=144) 18.03±5.57 48.53±15.29 42.50(28.25, 68.00) 34.26±12.10 对照组(n=77) 22.82±6.05 61.91±12.36 32.00(22.00, 52.00) 43.38±14.40 P值 <0.001 <0.001 0.012 <0.001 MDD、GAD:同表 1;AFT:动物流畅性测验;BACS-SC:符号编码分测验;CTT:颜色连线测验;SCWT:Stroop色词测验 表 3 不同焦虑水平的抑郁症患者执行功能差异比较
组别 AFT(x±s, 个) BACS-SC(x±s, 个) CTT[M(P25, P75),s] SCWT(x±s, 个) 轻度焦虑患者(n=41) 15.41±4.82 41.22±15.39 45(32, 84) 30.95±14.54 中度焦虑患者(n=155) 19.32±5.85 50.54±14.54 37(25, 56) 35.77±10.94 重度焦虑患者(n=34) 21.68±5.66 55.76±13.25 41(31, 62) 37.32±11.52 P值 <0.001 <0.001 0.096 0.004 HAMA:汉密尔顿焦虑量表;AFT、BACS-SC、CTT、SCWT:同表 2 -
[1] Ferrari AJ, Charlson FJ, Norman RE, et al. Burden of depressive disorders by country, sex, age, and year: findings from the global burden of disease study [J]. PLoS Med, 2013, 10: e1001547. doi: 10.1371/journal.pmed.1001547 [2] Trivedi MH, Greer TL. Cognitive dysfunction in unipolar depression: Implications for treatment[J]. J Affect Disord, 2014, 152-154: 19-27. doi: 10.1016/j.jad.2013.09.012 [3] Guo X, Meng Z, Huang G, et al. Meta-analysis of the prevalence of anxiety disorders in mainland China from 2000 to 2015[J]. Scie Rep, 2016, 6: 28033. doi: 10.1038/srep28033 [4] Leonard K, Abramovitch A. Cognitive functions in young adults with generalized anxiety disorder[J]. Eur Psychiatry, 2019, 56: 1-7. doi: 10.1016/j.eurpsy.2018.10.008 [5] Lamers F, Van OP, Comijs HC, et al. Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA)[J]. J Clin Psychiatry, 2011, 72: 341-348. doi: 10.4088/JCP.10m06176blu [6] Kircanski K, Lemoult J, Ordaz S, et al. Investigating the nature of co-occurring depression and anxiety: Comparing diagnostic and dimensional research approaches[J]. J Affect Disord, 2016, 216: 123. http://www.sciencedirect.com/science/article/pii/s0165032716303962 [7] 何小婷, 孙宁, 杜巧荣, 等. 伴焦虑症状的抑郁症患者认知功能研究[J]. 中华行为医学与脑科学杂志, 2016, 25: 385-389. doi: 10.3760/cma.j.issn.1674-6554.2016.05.001 [8] Lv X, Si T, Wang G, et al. The establishment of the objective diagnostic markers and personalized medical intervention in patients with major depressive disorder: rationale and protocol[J]. BMC Psychiatry, 2016, 16: 240. doi: 10.1186/s12888-016-0953-z [9] 张明园, 何燕玲. 精神科评定量表手册. 第2版[M]. 长沙: 湖南科学技术出版社, 2015. [10] 于欣. MCCB中国常模手册[M]. 北京: 北京大学医学出版社, 2014. [11] Blanco C, Rubio JM, Wall M, et al. The latent structure and comorbidity patterns of generalized anxiety disorder and major depressive disorder: a national study[J]. Depress Anxiety, 2014, 31: 214-222. doi: 10.1002/da.22139 [12] Pia L, Rune J, Stiles TC, et al. Cognitive Control Functions in Unipolar Major Depression with and without Co-Morbid Anxiety Disorder[J]. Front Psychiatry, 2010, 1: 49. http://www.ncbi.nlm.nih.gov/pubmed/21423456 [13] Deluca AK, Lenze EJ, Mulsant BH, et al. Comorbid anxiety disorder in late life depression: Association with memory decline over four years[J]. Int J Geriatr Psychiatry, 2005, 20: 848-854. doi: 10.1002/gps.1366 [14] Camacho A, Tarraf W, Jimenez DE, et al. Anxious Depression and Neurocognition among Middle-Aged and Older Hispanic/Latino Adults: Hispanic Community Health Study/Study of Latinos (HCHS/SOL) Results[J]. Am J Geriatr Psychiatry, 2018, 26: 238-249. doi: 10.1016/j.jagp.2017.06.002 [15] Liu J, Dong Q, Lu X, et al. Influence of comorbid anxiety symptoms on cognitive deficits in patients with major depressive disorder[J]. J Affect Disord, 2020, 260: 91-96. doi: 10.1016/j.jad.2019.08.091 [16] Austin MP, Mitchell P, Goodwin GM. Cognitive deficits in depression: possible implications for functional neuropathol-ogy[J]. Br J Psychiatry, 2001, 178: 200-206. doi: 10.1192/bjp.178.3.200 [17] Dutke S, StoBer J. Test anxiety, working memory, and cognitive performance: Supportive effects of sequential demands[J]. Cogn Emot, 2001, 15: 381-389. doi: 10.1080/02699930125922 [18] Eysenck MW, Derakshan N, Santos R, et al. Anxiety and cognitive performance: attentional control theory[J]. Emotion, 2007, 7: 336-353. doi: 10.1037/1528-3542.7.2.336 [19] Shi R, Sharpe L, Abbott M. A meta-analysis of the relationship between anxiety and attentional control[J]. Clin Psycholy Rev, 2019, 72: 101754. doi: 10.1016/j.cpr.2019.101754 [20] Jenkins LM, Stange JP, Bessette KL, et al. Differential engagement of cognitive control regions and subgenual cingulate based upon presence or absence of comorbid anxiety with depression[J]. J Affect Dis, 2018, 241: 371-380. doi: 10.1016/j.jad.2018.07.082
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