Neuropsychological Predictors of the Clinical Response to Cognitive-Behavioral Therapy in Patients with Major Depression
Abstract
Aim of the study was to identify neuropsychological predictors of the clinical response to cognitive behavioral therapy (CBT) in patients with major depression. 19 unmedicated patients underwent neuropsychological testing at baseline and subsequently were assigned randomly to CBT over 3 weeks either as monotherapy or combined with sleep deprivation (SD) therapy (two nights of total SD / week). Hierarchical regression analysis revealed that parameters of declarative verbal memory and a word fluency task predicted the clinical response (percentage improvement of Hamilton depression scores) to CBT monotherapy, whereas no such prediction was obtained in the combination group. The results suggest that certain cognitive performances have a unique predictive value for the response to CBT, which appears to be abolished by additive treatments with cognitive side effects (e. g. SD).
Ziel der Studie war die Identifikation von neuropsychologischen Prädiktoren für das klinische Ansprechen auf kognitive Verhaltenstherapie (KVT) bei Patienten mit Majorer Depression. 19 medikamentös unbehandelte Patienten durchliefen zu Baseline eine neuropsychologische Testbatterie, danach wurde – entsprechend Randomisierung – eine KVT über 3 Wochen entweder als Monotherapie oder als Kombinationsbehandlung mit Schlafentzugstherapie (zwei vollständige Schlafentzüge / Woche) durchgeführt. Eine hierarchische Regressionsanalyse zeigte, dass Parameter des deklarativen Verbalgedächtnisses und einer Wortflüssigkeitsaufgabe signifikante Prädiktoren des Ansprechens (prozentuale Verbesserung der Hamilton-Depressionswerte) auf KVT als Monotherapie waren, während ein entsprechender Vorhersagewert bei der Kombinationsbehandlung nicht hervorging. Die Ergebnisse deuten an, dass bestimmten kognitiven Funktionsleistungen depressiver Patienten ein eigenständiger Vorhersagewert für das Ansprechen auf KVT zukommt, wobei dieser bei additiver Implementierung von Therapien mit bekannten kognitiven Nebenwirkungen (z. B. Schlafentzug) aufgehoben scheint.
References
2011). Cortisol‘s effect on hippocampal activation in depressed patients are related to alterations in memory formation. Journal of Psychiatric Research, 45, 15 – 23.
(1979). Cognitive therapy of depression. New York: Guilford Press.
(2007). The effects of memory, attention, and executive dysfunction on outcomes of depression in a primary care intervention trial: the PROSPECT study. International Journal of Geriatric Psychiatry, 22, 922 – 929.
(2002). Test d2. Aufmerksamkeits-Belastungs-Test (9. Auflage). Göttingen: Hogrefe.
(2006). The neural basis of interindividual variability in inhibitory efficiency after sleep deprivation. Journal of Neuroscience, 26, 7156 – 7162.
(2010). Efficacy of cognitive-behavioural therapy and other psychological treatments for adult depression: meta-analytic study of publication bias. British Journal of Psychiatry, 196, 173 – 178.
(2012). Neuropsychological predictors of response to randomized treatment in obsessive-compulsive disorder. Progress in Neuro-Psychopharmacology & Biological Psychiatry, 39, 310 – 317.
(2011). Integrating neuropsychological functioning into cognitive behavioral therapy: implications for older adults. In , Cognitive Behavioral Therapy with older adults: Innovations across care settings (pp. 317 – 265). New York: Springer.
(2010). Does pretreatment severity moderate the efficacy of psychological treatment of adult outpatient depression? A meta-analysis. Journal of Consult and Clinical Psychology, 78, 668 – 680.
(2000). Executive dysfunction predicts nonresponse to fluoxetine in major depression. Journal of Affective Disorders, 60, 13 – 23.
(2009). Prediction of response to medication and cognitive therapy in the treatment of moderate to severe depression. Journal of Consulting and Clinical Psychology, 77, 775 – 787.
(2002). Therapeutic use of sleep deprivation in depression. Sleep Medicine Reviews, 6, 361 – 377.
(1960). A rating scale for depression. Journal of Neurology, Neurosurgery & Psychiatry, 23, 56 – 62.
(1995). Beck-Depressions-Inventar (BDI). Bern: Huber.
(2000). Kognitive Verhaltenstherapie bei Depressionen. Behandlungsanleitung und Materialien. (5. Auflage). Weinheim: Beltz PVU.
(2007). Effect of flumazenil-augmentation on microsleep and mood in depressed patients during partial sleep deprivation. Journal of Psychiatric Research, 41, 876 – 884.
(2012). Neuropsychologie. In , Handbuch der psychiatrischen Pharmakotherapie (2nd ed., pp 495 – 507). Berlin, Heidelberg: Springer.
(1992). Der Auditiv-Verbale Lerntest (AVLT) in der klinischen und experimentellen Neuropsychologie: Durchführung, Auswertung und Forschungsergebnisse. Zeitschrift für Differentielle und Diagnostische Psychologie, 3, 161 – 174.
(2009). Cognitive impairment in major depression: Association with salivary cortisol. Biological Psychiatry, 66, 879 – 885.
(1983). Leistungsprüfungssystem: L-P-S. Göttingen: Hogrefe.
(2012). Exploring variables associated with change in cognitive behaviour therapy (CBT) for anxiety following traumatic brain injury. Disability and Rehabilitation, 34, 408 – 415.
(1999). Prefrontal dysfunction and treatment response in geriatric depression. Archives of General Psychiatry, 56, 713 – 718.
(2010). Effects of sleep deprivation on cognition. Progress in Brain Research, 185, 105 – 129.
(1961). Pseudodementia. Acta Psychiatrica Scandinavica, 37, 336 – 351.
(2009). Predictors of nonresponse to cognitive behavioural therapy or venlafaxine using glucose metabolism in major depressive disorder. Journal of Psychiatry & Neuroscience, 34, 175 – 180.
(2008). Effects of total sleep deprivation in major depression: overnight improvement of mood is accompanied by increased pain sensitivity and augmented pain complaints. Psychosomatic Medicine, 70, 92 – 101.
(2012). A meta-analysis of cognitive deficits in first-episode Major Depressive Disorder. Journal of Affective Disorders, 140, 113 – 124.
(1995). Neuropsychological assessment. New York: Oxford University Press.
(2007). Randomised controlled trial of interpersonal psychotherapy and cognitive-behavioural therapy for depression. British Journal of Psychiatry, 190, 496 – 502.
(2009). Memory impairment in young women at increased risk of depression: influence of cortisol and 5-HTT genotype. Psychological Medicine, 39, 757 – 762.
(2010). Cognitive impairment in major depression. European Journal of Pharmacology, 626, 83 – 86.
(2010). Evaluation of the Effects of Severe Depression on Global Cognitive Function and Memory. CNS Spectrums, 15, 304 – 313.
(2012). Semantic organizational strategy predicts verbal memory and remission rate of geriatric depression. International Journal of Geriatric Psychiatry, 27, 506 – 512.
(2005). Cognitive function over the treatment course of depression in middle middle-aged patients: Correlation with brain MRI signal hyperintensities. Journal of Psychiatric Research, 39, 129 – 135.
(2012). The puzzle of schizophrenia: tracking the core role of cognitive deficits. Development and Psychopathology, 24, 529 – 536.
(1987). Der Zahlen-Verbindungs-Test ZVT (2. überarbeitete Aufl.). Göttingen: Hogrefe.
(2010). Is memory impairment a rate limiter in cognitive behavioural therapy for chronic schizophrenia? Psychotherapy and Psychosomatics, 79, 129 – 130.
(2000). Comorbidity of mild cognitive disorder and depression.a neuropsychological analysis. European Archives of Psychiatry and Clinical Neuroscience, 250, 186 – 193.
(2007). Persistent cognitive impairment in depression: The role of psychopathology and altered hypothalamic-pituitary-adrenocortical (HPA) system regulation. Biological Psychiatry, 62, 400 – 406.
(2012). Treatment course with antidepressant therapy in late-life depression. American Journal of Psychiatry, 169, 1185 – 1193.
(1998). A review of the neuropsychological effects of commonly used prescription medications. Archives of Clinical Neuropsychology, 13, 259 – 284.
(1995). Time course of prefrontal lobe dysfunction in severely depressed in-patients: a longitudinal neuropsychological study. Psychological Medicine, 25, 79 – 85.
(2012). Associations between subcortical volumes and verbal memory in unmedicated depressed patients and healthy controls. Neuropsychologia, 50, 2348 – 2355.
(2012). Neurocognitive effects after brief pulse and ultrabrief pulse unilateral electroconvulsive therapy for major depression: a review. Journal of Affective Disorders, 140, 233 – 243.
(2008). Verbal memory and treatment response in post-traumatic stress disorder. British Journal of Psychiatry, 193, 254 – 255.
(2009). The relationship between cognitive function and clinical and functional outcomes in major depressive disorder. Psychological Medicine, 39, 393 – 402.
(1997). Strukturiertes Klinisches Interview für DSM-IV Achse I und II (SKID-I und SKID-II). Göttingen: Hogrefe.
(1976). Die Depressionsskala. Weinheim: Beltz.
(1993). Testbatterie zur Aufmerksamkeitsprüfung (TAP). Herzogenrath: Psytest.
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