Studies On Clinical Characters, Cognitive Function And Diffusion Tensor Imaging In Treatment Non-response Depression

Objectives To explore the characters and the relationship on the changes of the symptoms and the cognitive function in non-response depression before and after the antidepressants treatment, by using the prevenient method. To investigate the clinical characters and the predictors of treatment non-response in non-response depression. And to explore what was the unique cognitive function disorder in non-response depression, and whether the changes of the cognitive function were stable in different stations, and the relation between cognitive function and symptoms.Methods 147 major depression patients were admitted, and about 124 patients completed the whole investigation. The severity of the symptoms was assessed at baseline and 1, 2, 4, 6 weekend after the treatment. The cognitive function was assessed at baseline and 6 weekend after the treatment. The assessments included the general status questionnaire, Life Event Scale (LES), Automatic Thoughts Questionnaire (ATQ), Hamilton Depression Scale (HAMD), Hamilton Anxiety Scale (HAMA), the Brief Psychiatric Rating Scale (BPRS), Clinical Global Impression (CGI), Treatment Emergent Symptom Scale (TESS), Tower of Hanoi, Wisconsin Card Sorting Test (WCST), Trial Marking Test (TMT), Verbal Fluency task (VF), Minnesota multiphase personality inventory (MMPI), and the Wechsler Adult Intelligence Scale-Revised in China (WAIS-RC).Results 1) The curative effect was about 86% in group A and B, and about 50% in group C and D. But the ratio of quitting the investigation in group A was high, about 18.69%.2) The symptoms of the response depression patients improved at about one week after the treatment, and two weeks in the non-response depression. The psychogenic anxiety in the non-response depression was 1.2 point less than in the response depression at baseline. More symptoms were remained after the treatment in non-response depression. The symptoms were anxiety/somatization, blockage in HAMD, psychogenic and somatic anxiety in HAMA, anxiety-melancholy, vigorless, and activation in BPRS.3) The non-response depression patients got about 5 points higher T scores in D and Mf of MMPI. The T model was 23/32.4) There were no difference between non-response depression and response depression in the LES, ATQ, WCST, TMT, VF, but the plan and perform time in Tower of Hanoi.5) The indications of WCST, VF, TMT, and Tower of Hanoi improved after the treatment, and showed no difference with the normal control but WCST and VF. The whole patients maybe had the characteristics with stable-traits of the performance in WCST and VF, and with state-traits of the performance in TMT and Tower of Hanoi.6) The course of disease, and the perform time in Tower of Hanoi, the number of raising hand in TMTA, the repeat number in VF in baseline entered the logistic equation of response to the antidepressants.7) There was difference in the symptoms and cognitive function on gender, comorbid with anxiety, the course of disease in major depression patients.Conclusion 1) The psychogenic anxiety in the non-response depression was slight at baseline. More depression and anxiety symptoms were remained after the treatment in non-response depression.2) There was cognitive function disorder primary in frontal lobule in non-response depression. The course of disease, and the perform time in Tower of Hanoi, the number of raising hand in TMTA, the repeat number in VF in baseline were the four indicators of response to the antidepressants.3) Gender, comorbid with anxiety, the course of disease had influence on the symptoms and cognitive function in major depression patients.Objective To investigate whether abnormalities were present in the whole white matter in patients with first episode, treatment-response major depression and treatment-resistant depression by using diffusion tensor imaging which could demonstrate the white matter integrity. Try to find some evidence why the treatment outcome in treatment-resistant depression was poor.Methods 14 first episode, drug-naive, treatment-response major depression patients, 13 treatment-resistant depression patients and 17 healthy volunteers underwent diffusion tensor imaging (DTI). Scans were analyzed by using a rigorous vo~el-wise approach.Results 1)Compared with the healthy volunteers, the key dependent variable, fractional anisotropy, was lower for first episode, drug-naive, treatment-response major depression patients in frontal regions, splenium of corpus callosum, centrum ovale, inferior endo-temporal gyrus, posterior cingulate gyms, anterior commissure, left deep parietal-occipital part, deep temporal-occipital part, infer-parietal lobe, cerebral peduncle, left deep temporal part, etc (P＜0.001).2)As to the treatment-resistant depression patients, FA was lower only in left lingual gurus white matter than the healthy volunteers (P＜0.001).3)Relative to the treatment-resistant depression patients, FA was lower for first episode, drug-naive, treatment-response major depression patients in frontal regions, rostrum and body of corpus callosum, left inferior temporal gyrus, centrum ovale, left deep temporal part, left deep temporal-occipital part, infer-parietal lobe, left lingual gurus, left cerebral peduncle, cerebellar hemisphere white matter, left deep parietal-occipital part, etc.Conclusion 1)The white matter integrity is disconnection in wide spread brain regions in the first episode, drug-naive, treatment-response major depression patients.2) Maybe, FA suggested the treatment response in first episode, drug-naive, treatment-response major depression. The patients with lower FA in wide spread brain regions responded well to the antidepressants, and vice versa.3)FA in the treatment-resistant depression was lower only in the left lingual gurus white matter.