Remisyonda Major Depresif Bozukluk Tanılı Hastalarda Rezidüel Subjektif Bilişsel ve Depresif Belirtilerin Sosyal İşlevsellik ile İlişkisi

Öz

Amaç: Major Depresif Bozuklukta (MDB) remisyon döneminde rezidüel belirtiler hafif şiddette olsa bile yeti yitimine neden olurlar. Bu çalışmada remisyonda olan MDB hastalarında, rezidüel depresif ve rezidüel subjektif bilişsel belirtilerin sosyal işlevsellikle ilişkisi araştırılmıştır. Yöntemler: Çalışmaya öncesinde MDB tanısı almış, düzenli takip edilen ve en az 6 ay süre ile remisyonda olan 51 hasta dahil edilmiştir. Tüm katılımcılara sosyodemografik veri formu, Beck Depresyon Ölçeği, Algılanan Bilişsel Kusur Anketi-Depresyon, Sosyal Uyum Kendini Değerlendirme Ölçeği uygulanmıştır. İstatiksel analizde tanımlayıcı analizler, Pearson Korelasyon Analizi ve lineer regresyon analizi kullanılmıştır. Bulgular: Rezidüel depresif belirti şiddeti sosyal işlevsellik düzeyi ile pozitif korelasyon gösterirken rezidüel subjektif bilişsel belirti şiddeti sosyal işlevsellik düzeyi ile negatif korelasyon gösterdi. Lineer regresyon analizi ile rezidüel depresif ve subjektif bilişsel belirti puanlarının sosyal işlevselliğin yordayıcıları olduğu tespit edildi. Sonuç: Bu çalışmada MDB remisyon döneminde görülen rezidüel depresif ve subjektif bilişsel belirtilerin sosyal işlevselliği olumsuz etkileyebileceği tespit edilmiştir. MDB da remisyon döneminde bilişsel belirtilerin saptanmasında hızlı ve pratik kullanımı olan subjektif bilişsel testler kullanılabilir.

Anahtar Kelimeler

• Depresyon
• remisyon
• rezidüel subjektif bilişsel belirtiler
• rezidüel depresif belirtiler
• psikososyal işlevsellik.

The Correlation Of Residual Subjective Cognitive And Depressive Symptoms with Social Functioning in Remitted Major Depressive Disorder Patients

Abstract

Aim: In Major Depressive Disorder (MDD) residual symptoms cause disability in the remission phase even if they are mild. This study investigated the correlation of residual depressive and residual subjective cognitive symptoms with social functioning in remitted MDD patients. Methods: In the study, 51 patients who had been diagnosed with MDD before, were followed regularly and had been in remission for at least 6 months, were included. The socio-demographic data form, Beck Depression Inventory, Perceived Deficits Questionnaire-Depression, and Social Adaptation Self-evaluation Scale were applied to all participants. In the statistical analysis; descriptive analyses, Pearson’s Correlation Analysis and linear regression analysis were used. Results: Residual depressive symptom severity showed a positive correlation with social functioning level, while residual subjective cognitive symptom severity had a negative correlation with social functioning level. In the linear regression analysis it was determined that residual depressive and subjective cognitive symptom scores were a predictor of social functioning. Conclusion: In the study, it was determined that residual depressive and subjective cognitive symptoms encountered in MDD remission phase might affect social functioning negatively. Rapid and practical subjective cognitive tests can be used in identifying cognitive symptoms in MDD remission phase.

Keywords

• Depression
• remission
• residual subjective cognitive symptoms
• residual depressive symptoms
• psychosocial functioning.

Kaynakça

1. 1. Fava M, Davidson KG. Definition and epidemiology of treatment resistant depression. Psychiatr Clin North Am. 1996; 19: 179-195.
2. 2. Ramana R, Paykel ES, Cooper Z, Hayhurst H, Saxty M, Surtees PG. Remission and relapse in major depression: a two-year prospective follow-up study. Psychol Med. 1995; 25:1161-70.
3. 3. Fava M, Graves LM, Benazzi F, Scalia MJ, Iosifescu DV, Alpert JE, Papakostas GI. A cross-sectional study of the prevalence of cognitive and physical symptoms during long-term antidepressant treatment. J Clin Psychiatry. 2006; 67:1754-9.
4. 4. Basso MR, Bornstein RA. Relative memory deficits in recurrent versus first-episode majör depression on a word-list learning task. Neuropsychology. 1999; 13:557-63.
5. 5. Fossati P. Neural correlates of emotion processing: from emotional to social brain. Eur Neuropsychopharmacol. 2012;22: 487-91.
6. 6. Conradi HJ, Ormel J, de Jonge P. Presence of individual (residual) symptoms during depressive episodes and periods of remission: a 3-year prospective study. Psychol Med. 2011; 41:1165–74.
7. 7. Baune BT, Miller R, McAfoose J, Johnson M, Quirk F, Mitchell D. The role of cognitive impairment in general functioning in major depression. Psychiatry Res. 2010; 176:183-9.
8. 8. Halvorsen M, Høifødt RS, Myrbakk IN, Wang CE, Sundet K, Eisemann M, Waterloo K. Cognitive function in unipolar major depression: a comparison of currently depressed, previously depressed, and never depressed individuals. J Clin Exp Neuropsychol. 2012; 34:782-90. 9. Jaeger J, Berns S, Uzelac S, Davis CS. Neurocognitive deficits and disability in major depressive disorder. Psychiatry Res. 2006; 145:39-48.

9. 10. Hirschfeld RM, Dunner DL, Keitner G, Klein DN, Koran LM, Kornstein SG, et al. Does psychosocial functioning improve independent of depressive symptoms? A comparison of nefazodone, psychotherapy, and their combination. Biol Psychiatry. 2002; 51:123-33.
10. 11. Miller IW, Keitner GI, Schatzberg AF.The treatment of chronic depression, pt 3: psychosocial functioning before and after treatment with sertraline or imipramine. J Clin Psychiatry. 1998; 59:608-19.
11. 12. Hasselbalch BJ, Knorr U, Kessing LV. Cognitive impairment in the remitted state of unipolar depressive disorder: a systematic review. J Affect Disord. 2011; 134:20–31.
12. 13. Cha D. Cognitive Impairment in Major Depressive Disorder: Clinical Relevance, Biological Substrates, and Treatment Opportunities (R. McIntyre, Ed.). Cambridge: Cambridge University Press. 2016; doi:10.1017/CBO9781139860567.
13. 14. Zimprich D, Martin M, Kliegel M. Subjective Cognitive Complaints, Memory Performance, and Depressive Affect In Old Age: A Change-Oriented Approach. Int J Aging Hum Dev. 2003; 57:339–66.
14. 15. First MB, Spitzer RL, Gibbon M, Williams JBW. Structured clinical interview for DSM-IV axis I disorders, clinician version (SCID-CV). Washington, DC: American Psychiatric Press; 1996.
15. 16. Özkürkçügil A, Aydemir Ö, Yıldız M, Danacı AE, Köroğlu E. DSM-IV Eksen I bozuklukları için Yapılandırılmış Klinik Görüşmenin Türkçe’ye uyarlanması ve güvenilirlik çalışması. İlaç ve Tedavi Derg. 1999; 12:233–36.
16. 17. Sullivan MJL, Edgley K, Dehoux E. A survey of multiple sclerosis. Part 1: Perceived cognitive problems and compensatory strategy use. Canadian Journal of Rehabilitation. 1990; 4: 99–105.
17. 18. Fischer JS, LaRocca NG, Miller DM, Ritvo PG, Andrews H, Paty D. Recent developments in the assessment of quality of life in multiple sclerosis (MS). Mult Scler. 1999; 5:251-59.
18. 19. Fehnel SE, Forsyth BH, DiBenedetti DB, Danchenko N, François C, Brevig T. Patient-centered assessment of cognitive symptoms of depression. CNS Spectr. 2016; 21:43-52.
19. 20. Aydemir O, Cokmus FP, Akdeniz, Suculluoglu-Dikici D, Balikci K. Psychometric properties of the Turkish Versions of Perceived Deficit Questionnaire - Depression and British Columbia Cognitive Complaints Inventory. Anatolian Journal of Psychiatry. 2017; 18 :224-30.
20. 21. Bosc M, Dubini A, Polin V. Development and validation of a social functioning scale, the Social Adaptation Self- evaluation scale. Eur Neuropsychopharmacol. 1997; 7: 57 -70.
21. 22. Akkaya C, Sarandöl A, Esen Danacı A, Sivrioğlu Y, Kaya E, Kırlı S. Sosyal Uyum Kendini Değerlendirme Ölçeği (SUKDÖ) Türkçe Formunun Geçerlik ve Güvenilirliği Türk Psikiyatri Dergisi. 2008; 19: 292-99.
22. 23. Beck AT. An inventory for measuring depression. Arch Gen Psychiatry. 1961; 4:561-71.
23. 24. Hisli N. Beck Depresyon Envanterinin üniversite öğrencileri için geçerliği, güvenirliği. Psikoloji Dergisi. 1989; 7:3–13.
24. 25. Bhardwaj A, Wilkinson P, Srivastava C, Sharm M. Cognitive deficits in euthymic patients with recurrent depression. J Nerv Ment Dis. 2010; 198:513–5.
25. 26. Behnken A, Schoning S, Gerss J, Konrad C, de Jong-Meyer R, Zwanzger P, et al. Persistent non-verbal memory impairment in remitted major depression – caused by encoding deficits? J Affect Disord 2010; 122:144–8.
26. 27. Biringer E, Arvid R, Anders L. A review of modern antidepressants’ effects on neurocognitive function. Curr Psychiatry Rev. 2009; 5:164–74.
27. 28. Sadek N, Bona J. Subsendromal symptomatic depression: A new concept. Depress Anxiety. 2000; 12:30-9.
28. 29. Roiser JP, Sahakian BJ. Hot and cold cognition in depression. CNS Spectr. 2013; 18(3):139-49.
29. 30. Nierenberg AA, Keefe BR, Leslie VC, Alpert JE, Pava JA, Worthington JJ, 3rd, et al. Residual symptoms in depressed patients who respond acutely to fluoxetine. J Clin Psychiatry. 1999; 221-5.
30. 31. Rock PL, Roiser JP, Riedel WJ, Blackwell AD. Cognitive impairment in depression : a systematic review and meta-analysis // Psychol Med. 2014; 44: 2029–40.
31. 32. Robinson OJ, Sahakian BJ. Cognitive biomarkers in depression. In H. Lavretsky, M. Sajatovic, & C. F. Reynolds III (Eds.), Late-life mood disorders. Oxford University Press. 2013;606-26.