A Correlative Study Of The Risk Factors In The Treatment-resistant Depression

Objective: To research the correlation risk factors of the treatment- resistant depression's neuroendocrinal(HPT axis function), clinical phenomenological and psychosocial factors. The etiology and pathogenesis of TRD were studied to improve the Early Diagnosis of TRD and to provide the basic evidence for the comprehesive intervention treatment on TRD.Methods: According to the Thase ME's diagnostic criteria, there are 60 patients with treatment- resistant depression in the test group, and 60 patients with non- treatment- resistant depression in the control group. To know their family history,attack times,the duration of current episode,psychotic symptoms,combidity,residual symptoms And to evaluate their stress and personality traits, all the patients were investigated with the general questionnaire, case history questionnaire, LES and EPQ, and their thyroid hormone was detected. 1∶1 matched case control study was conducted. The data was analyzed by single and multivariate conditional logistic regression.Result: Single factor analysis shows, attack times,family history and residual symptoms of TRD are more than of NTRD(P<0.001). Block scores of HAMD (10.55±1.534) in TRD are higher than in NTRD(9.00±1.878) (P<0.001),sleep disord scores of HAMD in TRD(3.10±0.877) are lower than in NTRD(3.45±0.832 )(P<0.001). Total scores of HAMD in TRD are higher than in NTRD(P<0.05). There were no differences in T3,T4,TSH between TRD and NTRD(P>0.05). There were no differences in combidity and psychotic symptoms between TRD and NTRD(P>0.05). Negative LEU value of TRD is higher than of NTRD(P<0.001). There were differences in E dimension value of EPQ,P dimension value of EPQ,and N dimension value of EPQ between TRD and NTRD (P<0.001). According to the result of multivariate conditional logistic regression , attack times,residual symptoms,negative LEU value,the duration of current episode,block scores of HAMD are the risk factors of treatment- resistant depression.Conclusion:1.The family history of depression is the risk factor of TRD. 2. TSH,T3,T4 (among the normal clinical value edge )of the TRD group have no difference compared with their of the control group. 3. TRD has close relationship with residual symptoms. 4. The curative effect on TRD is closely related with negative life events. 5.The personality flaw trait(higher P dimension value, higher N dimension and lower E dimension ) is one of the signal risk factor of TRD.6 TRD has relationship with illness severity,block symptom is characteristic symptom of TRD,attack times and the longer duration of current episode are the risk factors of TRD.7 According to the result of multivariate conditional logistic regression , attack times,residual symptoms,negative LEU value,the longer duration of current episode,block symptoms are the risk factors of treatment- resistant depression.