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首页> 外文期刊>Journal of the American Academy of Child and Adolescent Psychiatry >Impact of physical and sexual abuse on treatment response in the Treatment of Resistant Depression in Adolescent Study (TORDIA).
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Impact of physical and sexual abuse on treatment response in the Treatment of Resistant Depression in Adolescent Study (TORDIA).

机译：身体和性虐待对青少年抵抗性抑郁症治疗中治疗反应的影响（TORDIA）。

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OBJECTIVE: We previously reported that a history of abuse was associated with a poorer response to combination treatment in the Treatment of Resistant Depression in Adolescents study (TORDIA). We now report on the nature and correlates of abuse that might explain these findings. METHOD: Youth who did not benefit from an adequate selective serotonin re-uptake inhibitor (SSRI) trial (N = 334) were randomized to one of the following: an alternative SSRI; an alternative SSRI plus cognitive behavior therapy (CBT); venlafaxine; or venlafaxine plus CBT. Analyses examined the effect of history of abuse on response to the pharmacotherapy and combination therapy. RESULTS: Those without a history of physical abuse (PA) or sexual abuse (SA) had a higher 12-week response rate to combination therapy compared with medication mono-therapy (62.8% versus 37.6%; odds ratio [OR] = 2.8, 95% confidence interval [CI] = 1.6-4.7, p < .001). Those with a history of SA had similar response rates to combination versus medication monotherapy (48.3% versus 42.3%; OR = 1.3, 95% CI = 0.4-3.7; p = .66), whereas those with history of PA had a much lower rate of response to combination therapy (18.4% versus 52.4%, OR = 0.1; 95% CI = 0.02-0.43). Even after adjusting for other clinical predictors, a history of PA moderated treatment outcome. CONCLUSION: These results should be considered within the limitations of a post hoc analysis, lack of detailed assessment of abuse and other forms of trauma, and neuropsychological status. Depressed patients with history of abuse, especially PA may require specialized clinical approaches. Further work is needed to understand by what mechanisms a history of abuse affects treatment response.
机译：目的：我们先前曾报道，在青少年抗药性抑郁症治疗研究（TORDIA）中，滥用史与联合治疗反应较差有关。现在，我们报告可能解释这些发现的滥用的性质和相关性。方法：未从适当的5-羟色胺再摄取抑制剂（SSRI）试验中受益的青少年（N = 334）被随机分配至以下一项：另一种SSRI加认知行为疗法（CBT）;文拉法辛或文拉法辛加CBT。分析检查了滥用史对药物治疗和联合治疗反应的影响。结果：与单一药物治疗相比，无身体虐待（PA）或性虐待（SA）历史的患者对联合疗法的12周缓解率更高（62.8％对37.6％;优势比[OR] = 2.8， 95％置信区间[CI] = 1.6-4.7，p <.001）。患有SA病史的患者与联合用药相比单药治疗的缓解率相近（48.3％vs 42.3％; OR = 1.3，95％CI = 0.4-3.7; p = .66），而患有PA史的患者则低得多联合治疗的反应率（18.4％对52.4％，OR = 0.1; 95％CI = 0.02-0.43）。即使在调整了其他临床预测指标后，PA的病史也会缓解治疗结果。结论：这些结果应在事后分析，对滥用和其他形式的创伤以及神经心理状态缺乏详细评估的范围内考虑。患有虐待史，尤其是PA的抑郁症患者可能需要专门的临床方法。需要进一步的工作，以了解滥用病史通过何种机制影响治疗反应。

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