Longitudinal Study On Cognitive Function Of Adolescents With Major Depressive Disorder Based On Multi-dimensional Test

Objective:1.To explore the characteristics of cognitive function and its relationship with clinical symptoms in adolescent patients with major depressive disorder by combining psychological assessment and electrophysiological level;2.To explore the effect of psychotherapy on cognitive function of adolescents with major depressive disorder.Methods:From October 2020 to January 2022,58 first-episode adolescent patients with major depressive disorder（MDD）and 30 healthy controls（HC）were enrolled in the outpatient clinic of Department of Mental Health,first Hospital of Shanxi Medical University.The general demographic data of the subjects were collected by the case report form compiled by the research group,the clinical symptoms were evaluated by Hamilton Depression scale（HAMD-24）and Hamilton anxiety scale（HAMA-14）,and the neurocognitive function was evaluated by repetitive neuropsychological assessment test（RBANS）and event-related potential（ERP）.The social cognitive function was evaluated by emotional Intelligence scale（EIS）,interpersonal response Index（IRI）and Attribution style questionnaire（ASQ）.58 patients with first-episode adolescent MDD were randomly divided into two groups:drug treatment group（n=28）and drug combined with psychotherapy group（n=30）.Antidepressants mainly sertraline were used for drug treatment.Cognitive behavioral therapy was used in psychotherapy.The above indicators were collected again after eight weeks of intervention.The data were analyzed by SPSS22.0 software,P<0.05.There was statistical significance.Results:1.General data and clinical characteristics:1)There were no significant difference in sex,age between MDD group and HC group（P>0.05）.2)The total scores of HAMD-24 and HAMA-14 in MDD group were significantly higher than those in HC group（P<0.001）.2.The cognitive function characteristics of adolescent MDD patients:Baseline1)Neurocognitive function characteristics:A.RBANS:the overall score,delayed memory and speech function of MDD group were significantly lower than those of HC group.B.ERP:compared with HC group,the related components of P300 in MDD group were significantly abnormal.The latency of N1（P<0.05）,N2（P<0.01）,P3a and P3b（P<0.001）were significantly prolonged,and the latency of P2 were significantly prolonged（P<0.05）.The amplitude of P3b decreased significantly（P<0.01）.No obvious abnormality was found in MMN and P50 components.2)Social cognitive function characteristics:A.IRI（empathy）:the scores of empathy care,fantasy and personal pain in the MDD group were significantly higher than those in the HC group（P<0.05）.B.ASQ（attribution）:the score of MDD group was significantly lower than that of HC group in the persistence dimension of positive events,and significantly higher than that of HC group in the persistence dimension of negative events.C.EIS（emotional intelligence）:the scores of self-emotional management and emotional utilization in the depression group were significantly lower than those in the HC group.3.Analysis of the relationship between cognitive function and clinical symptoms in adolescent patients with MDD:1)The relationship between cognitive function and the severity of depression:the dimension of fantasy was positively correlated with the severity of depression（r=0.445,P<0.01）.There was a negative correlation between the dimension of self-emotional management and the severity of depression（r=0.523,p<0.01）.The dimension of emotional utilization was negatively correlated with the severity of depression（r=0.357,P<0.05）.2)The relationship between cognitive function and the severity of anxiety:both self-emotional management and emotional utilization were negatively correlated with the severity of anxiety（r₁=-0.357,,P<0.05;r₂=-0.344,P<0.05）.4.Comparison of the efficacy of two treatment methods in adolescent MDD patients:1)the total score of HAMD-24 at 8 weeks showed that the remission rate（32%）and response rate（48%）in the drug group were significantly lower than those in the combined group（80%）and（92%）（P<0.01）.2)the total score of HAMA-14 at 8 weeks showed that the remission rate（56%）and response rate（56%）in the drug group were significantly lower than those in the combination group（84%）and（84%）（P<0.05）.5.Effect of psychotherapy on cognitive function of adolescent MDD patients:1)Neurocognitive functionA.RBANS:there was no significant change in all dimensions of RBANS before and after treatment in the drug group（P>0.05）.The scores of the combined group increased significantly after treatment in the dimensions of overall score（P<0.01）,immediate memory（P<0.01）and delayed memory（P<0.05）.B.ERP:after treatment,the latency of P3a in P300 group was significantly prolonged,and the amplitudes of N1 was significantly decreased.After treatment,the latency of N1 and P3b in the combined group was significantly shortened（P<0.05）,and the amplitudes of P3a and P3b were significantly increased（P<0.01）.No significant changes were found in MMN and P50 components before and after treatment.2)social cognition function:A.IRI（empathy）:there was no significant change in the scores of all dimensions in the drug group before and after treatment.The scores of fantasy,empathy care and personal pain in the combined group decreased significantly after treatment（P<0.05）.B.ASQ（attribution）:there was no significant change in the scores of all dimensions in the drug group after treatment.The scores of immanence,integrity and persistence of negative events in the combined group decreased significantly after treatment（P<0.05）.C.EIS（emotional intelligence）:there was no significant change in the scores of all dimensions in the drug group after treatment.The scores of self-emotional management（P<0.01）and emotional perception（P<0.05）in the combined group increased significantly after treatment.Conclusion:1.The characteristics of neurocognitive function in adolescent patients with MDD are mainly reflected in the impairment of memory function and speech function,while the characteristics of social cognitive function are more involved in virtual characters and plots,more sensitive in social communication,more likely to produce uncomfortable emotions such as uncertainty,anxiety and shyness,and weaker ability of self-emotional control.The attribution style of negative things is more inclined to persistent attribution,thinking that the same reason will lead to the same results in other situations in the future,and that they are not good at managing their own emotions,and they are not easy to be adjusted when they are in negative emotions.I’m not good at using my emotions.2.The empathy ability of adolescent MDD patients to characters in film,television and literary works is positively correlated with the severity of depression,while the ability to manage,regulate and use their emotions is negatively correlated with the severity of depression and anxiety.3.For adolescent patients with MDD,the efficacy of drug therapy combined with standard cognitive behavioral therapy for depression and anxiety is better than that of drug therapy alone.4.Drug therapy combined with standard cognitive behavioral therapy can improve the neurocognitive function,especially the memory function of this group.In terms of social cognitive function,it has a positive effect on empathy,attribution and emotional management.5.Empathy and emotion management may be important cognitive intervention targets for adolescent patients with MDD.