The Study Of Clinical Characteristics In Three Common Chronic Somatic Diseases Comorbid Major Depressive Disorder

Objective: 1.Three chronic somatic diseases comorbid depressive disorder included post stroke comorbid depressive disorder(PSD),coronary heart disease comorbid depressive disorder(CHDD),and type 2diabetes comorbid depressive disorder(T2DD)were selected for this study.The demographic data,clinical,psychological and cognitive characteristics in comorbidity were analyzed to explore the characteristic in these diseases.2.Functional Magnetic Resonance Imaging(f MRI)was utilized to probe the possible differences in pathophysiological between T2DD and T2DM.Methods: 1 Clinical,psychological and cognitive characteristics in somatic diseases comorbid MDD1.1 Patients with PSD,CHDD and T2DD were enrolled in three comorbidity groups.Patients with somatic disease without MDD were collected to divide into three control groups.1.2 Life Event Scale(LES),Eysenck Personality Questionnaire(EPQ),Social support Rating Scale,and Simple coping style Scale were adopted to evaluate and compare the psychological characteristics between the comorbidity group and the control group.The differences in psychological characteristics across the three comorbidity groups were compared.1.3 24-item Hamilton Rating Scale for Depression(HAMD-24),Hamilton Anxiety Rating Scale(HAMA),and Social Disability Screening Schedule(SDSS)were adopted to evaluate and compare the clinical characteristics between the comorbidity group and the control group.PSD,CHDD and T2DD were treated with escitalopram,sertraline and bupropion,respectively.HAMD-24,HAMA and SDSS were evaluated at week 1,2,4 and 8 to observe the symptommatic improvement in the three diseases.The clinical symptoms in the three comorbidity groups were compared at baseline and 8 weeks after treatment,and the antidepressant efficacy of the three diseases was analyzed.The support vector regression(SVR)model was established to predict the treatment efficacy of the three diseases according to the HAMD-24 score at follow-up.1.4 Repeatable Battery for the Assessment of Neuropsychological Status(RBANS),Stroop Color Word Test(SCWT)and Wisconsin Card Sorting Test(WCST)were adopted to evaluate and compare the cognitive characteristics between the comorbidity group and the control group.The cognitive characteristics in the three comorbidity groups were compared at baseline and 8 weeks after treatment.The characteristics of shedding subjects were analyzed for regression analysis.1.5 The correlation analysis of clinical,psychological and cognitive characteristics among the three diseases was conducted.The prediction models of comorbidity risk factors and clinical cure factors of MDD were established.2 Patients with T2DD were recruited into the comorbidity group and patients with T2DM into the control group.The SPM8,DPARSF,REST,and LIBSVM software were utilized to process image data in MATLAB.Global-brain functional connectivity(GFC)was adopted to analyze the images.Support vector machine(SVM)was used to differentiate the patients with T2DD from the patients with T2DM.Results: 1 Clinical,psychological and cognitive characteristics in somatic diseases comorbid MDDA total of 128 patients with PSD and 100 patients with PS,114 patients with CHDD and 109 patients with CHD,and 108 patients with T2DD and 94 patients with T2DM were recruited.1.1 Compared with the control group,the patients in the three diseases comorbidity group experienced more negative life events and less objective support.EPQ-N scores were higher in CHDD patients.Patients with T2DD had low EPQ-E scores,high EPQ-N scores and high EPQ-L scores.Patients with PSD had higher EPQ-N and EPQ-L scores and less positive coping.The age comparison acorss the three diseases comorbidity group was T2DD < PSD < CHDD,T2DD education level was the highest.CHDD experienced more negative life events and was better at using negative coping than PSD.T2DD experienced more work problems than PSD and CHDD,and used more negative coping than PSD.1.2 The severity of depressive characteristics across the three disease groups at baseline was as follows.Anxiety/somatization: CHDD>PSD and PSD>T2DD,weight: CHDD>PSD and T2DD>PSD,cognitive disorder: CHDD>PSD and PSD>T2DD,diurnal variation: CHDD>PSD and T2DD>PSD,sleep disorder: CHDD>PSD and T2DD>PSD,Feeling of despair: PSD>CHDD and PSD>T2DD,retardation: CHDD>T2DD>PSD,HAMA: CHDD>PSD.The HAMA scores were PSD >CHDD > T2DD after 8 weeks of treatment.In SVR model,the coefficient between predicted value and true value for PSD,CHDD,and T2DD(r=0.391,p=0.004,MAE=3.84;r=0.753,p<0.001,MAE=3.56;r=0.350,p=0.017,MAE=4.75)were significantly correlated.The effective rate of PSD,CHDD and T2DD in intentional to treat analysis were 42.96%,50.00%,and 51.85%,respectivly.The cure rate of PSD,CHDD and T2DD in intentional to treat analysis were 40.63%,42.11%,and 37.04%.The effective rate of PSD,CHDD and T2DD in per-protocol analysis were 91.30%,98.28%,and 93.33%.The effective rate of PSD,CHDD and T2DD in per-protocol analysis were 75.36%,82.75%,and 66.67%.No significant difference was observed in the onset or effective time required of antidepressant therapy across the three groups.1.3 PSD was worse than PS in visual span,attention,language,delayed memory,executive function,learning and generalization,and the ability to grasp categorization concepts.CHDD was worse than CHD in terms of general memory,visual span,language,overall attention and word mastery.T2DD was worse than T2DM in terms of general memory,visual span,language,overall attention,word mastery and set shifting.After 8 weeks of treatment,the learning induction and concept plasticity in PSD were improved.The delayed memory,word mastery,visual and auditory attention and concentration in CHDD were improved.In T2DD,extensive impaired memory function,word mastery and speed of set-point transfer were recovered.The cognitive differences across the three disease groups at baseline were as follows.PSD was worse than CHDD and T2DD in terms of language,attention,delayed memory,learning induction,and visual span.T2DD had better concentration and learning induction than PSD.After 8 weeks of treatment,the cognitive differences across the three disease groups were as follows.PSD was worse than T2DD in terms of focus,attentional set shifting,word mastery,executive function,cognitive flexibility and categorization.CHDD had poorer responsiveness and learning induction than T2DD.The drop-out patients with PSD were characterized by milder depression,fewer life events,high camouflage personality,low level social support utilization,and less impaired memory and attention.The risk factors affecting shedding was diurnal variation.The drop-out patients with CHDD were characterized by mild symptoms such as anxiety/somatization,cognitive impairment,diurnal variation and despair,fewer life events,less impaired language,attention,and word mastery.The risk factors affecting drop-out were cognitive impairment symptoms.The drop-out patients with T2DD were characterized by male,less-educated,mild diurnal variation,fewer life events,and less impaired delayed memory.The risk factors affecting drop-out were weight and retardant.1.4 The scores of EPQ-E,HAMA,SDSS,objective support,subjective support,language,delayed memory and executive function were related to the depressive symptoms in patients with PSD.The comorbidity risk model included sleep disorder,language,set shifting and correct response number,and language was an independent factor affecting whether PSD was cured.The scores of EPQ-N,HAMA,SDSS,subjective support,positive coping,attention and set shifting were related to the depressive symptoms in CHDD.Anxiety/somatization,HAMA,EPQ-N,delayed memory and color word interference tasks entered the comorbid risk model correctly,and Cognitive impairment and despair were independent factors affecting whether CHDD was cured.The scores of EPQ-N,EPQ-E,HAMA,SDSS,positive coping,language,reaction speed,executive function,classification,learning and induction ability,and conceptual plasticity were associated with T2DD depressive symptoms.The comorbidity risk model included diurnal variation despair,negative life events,EPQ-N and objective support,and sleep disorder was independent factor affecting whether T2DD was cured.2 A total of 29 patients with T2DD and 32 patients with T2DM were recruited.Patients with T2DD exhibited decreased GFC values in the right fusiform gyrus/hippocampus,bilateral thalamus,and right precuneus/bilateral cuneus/right calcarine compared with patients with T2DM.Dcreased GFC values in the right fusiform gyrus/hippocampuswere positivity correlated with Extraversion scale scores in patients with T2DM after multiple comparison correction by Bonferroni method(r=0.439,p=0.012).Decreased GFC values in the bilateral thalamic could be used to discriminate the patients from the controls with optimal accuracy,sensitivity and specificity(93.10%,93.75% and 93.44%)Conclusion: 1.Significant differences were observed in characteristics of psychological,depressive symptoms and cognition between the three comorbidity groups and control groups.2.The heterogeneity determines the characteristics of psychological,depressive symptoms and cognition in different somatic diseases comorbid depressive disorder.3.The effective rate and cure rate of antidepressant therapy for the three diseases exhibited good result.Significant differences were observed in cognitive function across the three groups at baseline,and the differences altered 8 weeks after treatment.4.Patients with T2DD showed decreased GFC in brain regions related to the default mode network(DMN)and thalamic-cortical network,providing a new insight for the pathophysiology of T2DD.Impaired cognitive function in patients with T2DD may be associated with the dysfunction in DMN.Decreased GFC values in the bilateral thalamus may serve as a potential biomarker to distinguish patients with T2DD from patients with T2DM.