A Correlative Study Of Psychosocial Clinic Characteristic And Psychophysiological Mechanisms In Dysthymic Disorder

Objective: The aim of the present case-control study was to investigate clinicalphenomenology, psychosocial related risk factors and the function of autonomic nervousand immune systems for patients with dysthymic disorder(DD); find out the psychological-physiological mechanisms of DD so we can improve the identification diagnostic leveland provide the basis for comprehensive intervention.Methods: In DSM-IV,51patients with dysthymic disorder (dysthymic disorder group,DD),57major depressive patients(major depressive group, MD), and50normal controls(normal group, NC) were investigated. All patients were interviewed in general conditionquestionnaire, history questionnaire, HRSD, HAMA, PHI, TAS20-C, CTO-SF, FES-CV;and analysed the short-term heart rate variability(5minutes), fasting blood samples werealso analyzed with high-sensitivity assays for CRP.Results:1. Clinical phenomenology and psychosocial related risk factors:(1).Compared with MD group, DD group’s onset age is younger, had more incentives(P<0.05or P<0.01); the HRSD total sore, factor sores of weight loss, diurnal variation,slow, sleep disorders and hopeless of DD group is lower than MD group, but gained higherscores in factor anxiety/somatization of HRSD, the HAMA total sore and factor somaticanxiety (P<0.05or P<0.01).(2).DD group gained higher scores in the factor somatization(14.97±2.89), anxiety(15.56±3.00), psychopathic deviate(0.62±3.56)and hypomania ofPHI(10.71±4.08) than the MD group(1.95±5.10,12.52±4.72,8.19±3.22,8.29±4.19,P<0.05or P<0.01).(3).DD group gained higher total score and factorⅠ(22.23±2.99),Ⅱ(15.69±2.79)and total score(59.69±5.91) of TAS-20-C than MD(9.11±4.32,13.82±2.57,55.17±6.91)and NC group(14.33±3.48,10.60±3.52,42.93±8.59, P<0.05orP<0.01).(4).The scores of all factors of CTQ-SF in DD group were higher than NC group,also gained higher scores in the factor of sexual abuse, emotional neglect and physicalneglect than MD group(P<0.05or P<0.01).(5).DD and MD group all had family function deficits; the contradiction of DD group is higher than MD group, the cohesion, emotionalexpression and success of DD group were lower than MD group(P<0.05or P<0.01).(6).The TAS-20-C factor Ⅰwas correlated with emotional abuse, physical neglect, cohesion,contradiction and independence(r=0.351,0.310,0.290,-0.393,0.351,0.274, P<0.01orP<0.05); factorⅡ was correlated with physical neglect and emotional expression(r=0.262,-0.251, P<0.05);The TAS-20-C total score was correlated with emotional abuse, physicalneglect, cohesion, emotional expression, contradiction, success and controlling (r=0.740,0.282,0.323,-0.332,-0.303,0.291,-0.271,0.230, P<0.01or P<0.05).2. The HRV, hs-CRP and related factors (1).The SDNN(65.16±31.41)ms, PNN50(11.12±14.33)%and HF(121.73±77.95)ms2of DD group were significantly lower, theVLF (522.51±301.41)ms2and LF/HF(4.15±1.09) were higher than MD and NC groups;the serum hs-CRP level(2.89±3.69) mg/l were higher than other two groups(1.21±1.69,1.03±0.90, P<0.05or P<0.01).(2).Compared with nonalexithymic group, alexithymicgroup’s SDNN(58.12±31.05ms)was lower, and the LF/HF(5.21±3.06)was higher; thehs-CRP level of alexithymic group was higher than the nonalexithymicgroup(1.36±1.27mg/l, P<0.05); the TAS-20-C total score was correlated with somatization,anxiety, psychopathic deviate and hypochondria (r=0.251,0.401,0.472,0.431, P<0.01orP<0.05); the factor Ⅰwas correlated with somatization, anxiety, psychopathic deviate,hypochondria and hypomania(r=0.381,0.441,0.586,0.422,-0.402, P<0.01); thefactorⅡ was correlated with anxiety and psychopathic deviate hypomania(r=0.314,0.308,P<0.05).(3).The somatization and anxiety were correlated with SDNN, VLF, LF andhs-CRP level (r=-0.261/-0.270,0.392/0.272,0.363/0.282,0.341/0.232, P<0.05orP<0.01);the hs-CRP level in serum were correlated with SDNN, RMSSD, SDSD, VLF, LF,HF and LF/HF(r=-0.469,-0.453,-0.447,0.264,0.461,-0.514,-0.100, P<0.05or P<0.01).3. Multiple regression analysis: the variables of factor somatization and anxiety ofHRSD, factorⅠ and factor Ⅱo f TAS-20-C, emotional neglect, anxiety factor of PHI andLF/HF were eventually included in the multiple regression equation.Conclusion:1. There is differences in clinical phenomenology between dysthymic disorder andmajor depressive disorder patients, DD patients showed more anxiety.2. DD patients have more psychosocial intermediation. Childhood abuse-familyenvironment-alexithymic three connected with and influence each other, and correlative with the quality of neurosis susceptible.3. When meet stress events, DD patients are more likely to be anxiety, led to reducedHRV, increased serum hs-CRP level, the two are closely related, and the disease can lead topatients ’psychological and social function have further damage.4. DD is a kind of a social-psychological-neural-immune disorder, the risk factorsincluding psychological-social-physiology, DD and MD may be two fundamentallydifferent diseases, DD patients should be using the bio-psycho-social intervention totreat.