【摘要】 目的:考察成年抑郁症患者药物与心理治疗疗效的调节变量,为个体化治疗提供借鉴。方法:用系统评价法,评价Pubmed、Psyc INFO和EMbase数据库2017年4月前发表的英文文献。筛选符合既定标准的随机对照试验研究(RCT),评价其质量,寻找调节变量并归类。结果:纳入文献30篇。11篇文献的RCT质量评价为4个"+",25篇文献的统计质量4分,15篇文献的样本量6分。研究已检验社会人口环境、症状严重性、药物/心理治疗偏好、亚型、共病人格特质和障碍、共病情绪反应和障碍、生物共7类调节变量。右前岛叶代谢水平低、脑区阳性连通性、偏好心理治疗、生活事件多、已婚/同居、失业、心理治疗师专业水平高、药物治疗次数多、有早年创伤者心理治疗的效果更好;偏好药物,伴忧郁特征亚型,共病神经质、人格障碍或焦虑症者,药物疗效更优。结论:患者特征是药物与心理治疗的疗效调节变量,提示临床中对该两种治疗进行选择时需考虑患者特征。但证据质量偏低,结果尚待进一步检验。更多还原

【Abstract】 Objective:To facilitate personalized treatment for major depressive disorder(MDD) among adults,a systematic review was conducted to explore the moderators of treatment outcome between pharmacotherapy and psychotherapy.Methods:A systematic search of papers,published in English before April,2017,was conducted in Pubmed,PsycINFO and EMbase.Totally 754 papers were screened in accordance with the predefined inclusive and exclusive criteria.Then the selected literatures were scored according to randomized controlled trial(RCT),statistical,and the sample-size quality criteria,and analyzed to find the moderators.Results:A total of 30 papers were included.Totally 11 got " + " in all four domains in RCT quality,25 got the score of 4 in statistical quality,and 15 got 6 in sample-size quality.And the moderators were tested across 7 categories,namely,social demographic and contextual factors,symptom severity,preference,symptom subtype,comorbid personality traits or disorders,comorbid emotional disorders or emotional reactivity,and biological factors.Hypometabolism of the right anterior insula,positive summed functional connectivity,preference for psychotherapy,a greater number of events,married/co-habiting status,unemployment,therapy sites with better psychotherapists,more prior antidepressant exposures,and childhood trauma might be associated with better outcomes with psychotherapy,while preference for medicine,melancholic features,high levels of neuroticism,comorbid personality disorders,comorbid anxiety emotional disorders predicted better outcomes in pharmacotherapy than in psychotherapy.Conclusion:Patient characters have a moderation effect on outcomes between pharmacotherapy and psychotherapy,thus these characters should be considered in the selection of the two therapies.Due to the limited quantity of these reviewed papers,however,the results should be retested by future studies.更多还原