诊断抑郁症,可能需要查个血.doc

诊断抑郁症，可能需要查个血狼医生 发表于 2014-09-17 10:59美国西北大学医学院的研究者创立了第一种用于诊断成人重症抑郁的血液检测方法，与以往的主观诊断方式不同，它可以为抑郁症提供客观、科学的诊断技术。这项检测通过测量9种血液中的RNA标志物来判断抑郁症，此外，这些标志物的变化也能显示哪些患者会从认知行为治疗中获益。研究结果发表在9月16日的转化精神病学（Translational Psychiatry）期刊上。 “研究结果清楚地表明，你可以通过一种以血液样本为基础的实验室检测，来为诊断抑郁症提供科学客观的依据，这就好像是诊断高血压或高脂血症那样。”发明这种检测方法的伊娃勒代（Eva Redei）这样说，她是西北大学芬伯格医学院的精神病学及行为科学教授。勒代表示：“这项检测将心理健康的诊断方式带入了21世纪，并且提供了针对抑郁症患者进行个体化治疗的可能。”勒代之前也曾进行过青少年抑郁症血液检测的研究。目前的抑郁症诊断方法是基于主观的判断，它所依据的往往是一些特异性不强的症状，例如情绪低落、易疲劳以及食欲改变等，这些症状在很多心理或生理问题当中都会出现。抑郁症的诊断也很依赖于患者自主反馈症状的能力，以及医生解读这些症状的能力。但抑郁症患者往往会对他们的症状轻描淡写，或者并不恰当地描述自己的症状。 “精神健康的问题早在100年前就成为医学的一部分了，那时医生只能通过症状来诊断疾病或者功能障碍。”论文的另一作者大卫莫尔（David Mohr）说，他是芬伯格行为干预技术中心的主任，也是一名预防医学教授。莫尔表示：“这项研究给我们带来了新的希望，使我们在不远的未来可以采用它进行诊断及治疗决策。” “目前我们知道，药物治疗和心理疗法都是有效的，但并不是对所有人都有效。” 莫尔说，“我们知道药物治疗和心理疗法的联合治疗效果会更好，但我们并没有采用有序的方法进行治疗的组合。如果有这样的血液检测，可以使我们更好地选择个体化的治疗方式。”重症抑郁障碍（Major depressive disorder）每年都在影响着6.7%的美国成人群体，而且这个数字还在逐年升高。目前从患者发病到诊断一般有240个月的延迟，而且延迟的时间越长，治疗的难度就会越高。据估计，在基层医疗中约有12.5%的患者存在抑郁问题，但只有一半可能会得到诊断。这项生物学为基础的检测可能会为我们提供更及时和准确的诊断。这项研究纳入了32名患者，年龄从21到79岁不等，他们都在临床观察中被独立地诊断为抑郁症。同时，研究还选取了32个同年龄段的非抑郁症个体作为对照。有一些患者一直在进行着长疗程的抗抑郁治疗，但是抑郁的情况仍未解决。在治疗前的基线数据中，西北大学的科学家发现了9种RNA血液标志物，这些标志物的表达水平在抑郁症患者与对照人群之间差异非常显著。这些标志物有着诊断抑郁症的潜力。在经过18周的认知行为治疗后，特定标志物表达水平的改变可以从所有抑郁症患者中鉴别出哪些患者对治疗的反应更好。研究作者提到，这是第一个成功体现认知行为治疗的生物学“指示剂”。研究中还发现，即使是已经通过治疗得到缓解的抑郁症患者，他们在9种RNA标记物中仍有3种与对照组存在明显差异。这可能表示，这些人仍然存在抑郁的隐患。勒代，以及儿童及青少年精神疾病研究教授大卫劳伦斯斯坦（David Lawrence Stein ）表示，这3种标志物在未来或许能帮助我们达成鉴别抑郁症倾向的目标，甚至在患者没有抑郁发作表现的时候，也可以通过标志物来发现它。莫尔表示：“如果我们可以知道哪些患者更容易出现抑郁症复发，那么我们就能对他们进行更密切的监测。对这部分患者我们可以考虑采用抗抑郁药物的维持剂量持续治疗，或者进行持续的心理治疗，来减少未来抑郁发作的严重性，并延长抑郁发作的间隔。”接下来，勒代计划在更大的人群样本中验证研究结果。她同样希望知道，这项检测是否可以鉴别重度抑郁和双向情感障碍。（编辑：窗敲雨）First blood test to diagnose depression in adultsDate:September 17, 2014Source:Northwestern UniversitySummary:The first blood test to diagnose major depression in adults has been developed, providing the first objective, scientific diagnosis for depression. The test also predicts who will benefit from cognitive behavioral therapy, offering the opportunity for more effective, individualized therapy. The test also showed the biological effects of the therapy, the first measurable, blood-based evidence of the therapys success and showed who is vulnerable to recurring episodes of depression.The first blood test to diagnose major depression in adults has been developed by Northwestern Medicine scientists, a breakthrough approach that provides the first objective, scientific diagnosis for depression. The test identifies depression by measuring the levels of nine RNA blood markers. RNA molecules are the messengers that interpret the DNA genetic code and carry out its instructions.The blood test also predicts who will benefit from cognitive behavioral therapy based on the behavior of some of the markers. This will provide the opportunity for more effective, individualized therapy for people with depression.In addition, the test showed the biological effects of cognitive behavioral therapy, the first measurable, blood-based evidence of the therapys success. The levels of markers changed in patients who had the therapy for 18 weeks and were no longer depressed.This clearly indicates that you can have a blood-based laboratory test for depression, providing a scientific diagnosis in the same way someone is diagnosed with high blood pressure or high cholesterol, said Eva Redei, who developed the test and is a professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. This test brings mental health diagnosis into the 21st century and offers the first personalized medicine approach to people suffering from depression.Redei is co-lead author of the study, which will be published Sept. 16 in Translational Psychiatry.Redei previously developed a blood test that diagnosed depression in adolescents. Most of the markers she identified in the adult depression panel are different from those in depressed adolescents.Decades-Long Search for Biological Depression TestThe search for a biological diagnostic test for major depression has been ongoing for decades.The current method of diagnosing depression is subjective and based on non-specific symptoms such as poor mood, fatigue and change in appetite, all of which can apply to a large number of mental or physical problems. A diagnosis also relies on the patients ability to report his symptoms and the physicians ability to interpret them. But depressed patients frequently underreport or inadequately describe their symptoms.Mental health has been where medicine was 100 years ago when physicians diagnosed illnesses or disorders based on symptoms, said co-lead author David Mohr, a professor of preventive medicine and director of the Center for Behavioral Intervention Technologies at Feinberg. This study brings us much closer to having laboratory tests that can be used in diagnosis and treatment selection.The new blood test will allow physicians for the first time to use lab tests to determine what treatments will be most useful for individual patients.Currently we know drug therapy is effective but not for everybody and psychotherapy is effective but not for everybody, Mohr said. We know combined therapies are more effective than either alone but maybe by combining therapies we are using a scattershot approach. Having a blood test would allow us to better target treatment to individuals.Major depressive disorder affects 6.7 percent of the U.S. adult population in a year, a number that is rising. There is a two-to 40- month delay in diagnosis, and the longer the delay, the more difficult it is to treat depression. An estimated 12.5 percent of patients in primary care have major depression but only about half of those cases are diagnosed. A biologically based test has the potential to provide a more timely and accurate diagnosis.How the Study WorkedThe study included 32 patients, ages 21 to 79, who had been independently diagnosed as depressed in a clinical interview, and 32 non-depressed controls in the same age range. Some of the patients had been on long-term antidepressants but were still depressed. The patients, from Northwestern general internal medicine clinics, also were participating in a previously reported study comparing the effectiveness of face-to-face and telephone-administered cognitive behavioral therapy.At baseline before the therapy, Northwestern scientists found nine RNA blood markers with levels significantly different in the depressed patients from those of controls. These markers were able to diagnose depression.After 18 weeks of therapy (face-to-face and telephone), the changed levels of certain markers could differentiate patients who had responded positively and were no longer depressed (based on a clinical interview and patients self-reported symptoms) from patients who remained depressed. This is the first biological indicator of the success of cognitive behavioral therapy, the study authors said.Fingerprint Predicts Who Will Benefit from TherapyIn addition, the blood test predicts who will benefit from the cognitive behavioral therapy based on a distinct pattern or fingerprint of the levels of the nine marker levels at baseline in patients who recover from depression as a result of the therapy. The blood levels of these markers did not show this pattern in the patients who did not improve with the therapyThis distinction could be used in the future to predict who would respond to the therapy, Redei said.Test Indicates Vulnerability to DepressionThe blood concentration of three of the nine RNA markers remained different in depressed patients and non-depressed controls, even if the depressed patients achieved remission from depression after the therapy. This appears to indicate a vulnerability to depression.These three markers move us towards the ultimate goal of identifying predisposition to depression, even in the absence of a current depressive episode, said Redei, also the David Lawrence Stein Research Professor of Psychiatric Diseases Affecting Children and Adolescents.Being aware of people who are more susceptible to recurring depression allows us to monitor them more closely, Mohr noted. They can consider a maintenance dose of antidepressants or continued psychotherapy to diminish the severity of a future episode or prolong the intervals between episodes.Next Redei p