抗抑郁药治疗抑郁症患者的早期改善(early improvement)是在治疗起效前判断疗效以指导换药的症状改善指标,目前最广为使用的定义是治疗第2周17项汉密尔顿抑郁量表(HAMD-17)总分的减分率大于等于20％,然而评估早期改善的量表选择、阈值选择以及早期改善这个概念的含义本身仍有争议.本研究梳理抗抑郁药早期改善概念的发展史,综述评估早期改善的量表以及阈值选定的研究进展,为涉及早期改善的研究的量表选用以及阈值选择提供参考.

强迫症病因尚不明确,神经环路异常是研究热点.正电子发射断层扫描(PET)作为一种新的影像技术,可以在活体状态及整体水平对大脑功能、受体、代谢进行评估.目前基于PET技术的研究结果显示,强迫症患者5-羟色胺转运蛋白结合潜力改变,5-羟色胺能、多巴胺能功能异常;强迫症患者治疗前后脑血流灌注和葡萄糖代谢发生改变.未来研究可联合多种脑成像技术,探索不同亚型﹑不同药物﹑不同治疗方法等对强迫症大脑功能及结构的影响.

Objective To analyze the treatment trajectory and revelant factors of serotonin reuptake inhibitors (SSRIs) in patients with first-episode major depression after single-drug treatment. And to provide ideas for early optimal treatment. Methods This study was a real-world study in which 82 untreated outpa-tients with first-episode depression were enrolled for SSRIs monotherapy. The Eysenck Personality Test (EPQ),the Liebowitz Social Anxiety Scale (LSAS),Yale -Brown Forced Scale (Y-BOCS),Social Function Deficit Scale (SDSS) were used to assess all patients at baseline. Then the patients were treated with SSRIs monotherapy. Patients who did not achieve a HAMD-17 20% reduction rate in the second week switched to receive another SSRIs monotherapy application. Follow-up to the 12th week to analyze treatment trajectory and identify factors associated with treatment trajectory. Results The psychotism personality trait ( B=-0. 287,95%CI=-0. 701~-0. 071,P=0. 009) and age ( B=0. 099,95%CI=0. 014~0. 244,P=0. 017) were related to treatment trajectories. The psychotism personality trait did not directly influence the treatment trajectory but influenced the treatment indirectly through agitation and the effect value was 0. 016,which ac-counted for 10. 76% of the total effect. Social anxiety and avoidance,depression,anxiety,obsessive-compul-sive symptoms and social dysfunction at baseline were not associated with antidepressant efficacy. Conclusion Psychoticism can predict the efficacy of antidepressants treatment as a mediator at the second week of treat-ment.