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Select comorbid personality disorders and the treatment of chronic depression with nefazodone, targeted psychotherapy, or their combination.

Maddux, Rachel LU ; Riso, Lawrence P; Klein, Daniel N; Markowitz, John C; Rothbaum, Barbara O; Arnow, Bruce A; Manber, Rachel; Blalock, Janice A; Keitner, Gabor I and Thase, Michael E (2009) In Journal of Affective Disorders 117(3). p.174-179
Abstract
BACKGROUND: Individuals with chronic depression respond poorly to both medication and psychotherapy. The reasons for the poorer response, however, remain unclear. One potential factor is the presence of comorbid Axis II personality disorders (PDs), which occur at high rates among these patients. METHODS: This study examines the moderating influence of co-occurring PDs, primarily in cluster C, among 681 chronically depressed adult outpatients who were randomly assigned to 12 weeks of treatment with nefazodone, a specialized psychotherapy for chronic depression, or their combination. RESULTS: At baseline, 50.4% (n=343) of patients met criteria for one or more Axis II disorders. Following 12 weeks of treatment, patients with comorbid PDs had... (More)
BACKGROUND: Individuals with chronic depression respond poorly to both medication and psychotherapy. The reasons for the poorer response, however, remain unclear. One potential factor is the presence of comorbid Axis II personality disorders (PDs), which occur at high rates among these patients. METHODS: This study examines the moderating influence of co-occurring PDs, primarily in cluster C, among 681 chronically depressed adult outpatients who were randomly assigned to 12 weeks of treatment with nefazodone, a specialized psychotherapy for chronic depression, or their combination. RESULTS: At baseline, 50.4% (n=343) of patients met criteria for one or more Axis II disorders. Following 12 weeks of treatment, patients with comorbid PDs had statistically lower depression scores (M=12.2, SD=+9.2) than patients without comorbid PDs (M=13.5, SD=+8.7). There was no differential impact of a comorbid PD on responsiveness to medication versus psychotherapy. The results did not change when the data were analyzed using an intent-to-treat sample or when individual personality disorders were examined separately. LIMITATIONS: Patients with severe borderline, antisocial, and schizotypal PDs were excluded from study entry; therefore, these data primarily apply to patients with cluster C PDs and may not generalize to other Axis II conditions. CONCLUSIONS: Comorbid Axis II disorders did not negatively affect treatment outcome and did not differentially affect response to psychotherapy versus medication. Treatment formulations for chronically depressed patients with certain PDs may not need to differ from treatment formulations of chronically depressed patients without co-occurring PDs. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Journal of Affective Disorders
volume
117
issue
3
pages
174 - 179
publisher
Elsevier
external identifiers
  • wos:000270245500008
  • pmid:19217168
  • scopus:69249226215
ISSN
1573-2517
DOI
10.1016/j.jad.2009.01.010
language
English
LU publication?
yes
id
74b22c46-5459-43a6-87c3-efe184e5a519 (old id 1302548)
date added to LUP
2009-03-27 14:02:22
date last changed
2017-05-28 03:30:22
@article{74b22c46-5459-43a6-87c3-efe184e5a519,
  abstract     = {BACKGROUND: Individuals with chronic depression respond poorly to both medication and psychotherapy. The reasons for the poorer response, however, remain unclear. One potential factor is the presence of comorbid Axis II personality disorders (PDs), which occur at high rates among these patients. METHODS: This study examines the moderating influence of co-occurring PDs, primarily in cluster C, among 681 chronically depressed adult outpatients who were randomly assigned to 12 weeks of treatment with nefazodone, a specialized psychotherapy for chronic depression, or their combination. RESULTS: At baseline, 50.4% (n=343) of patients met criteria for one or more Axis II disorders. Following 12 weeks of treatment, patients with comorbid PDs had statistically lower depression scores (M=12.2, SD=+9.2) than patients without comorbid PDs (M=13.5, SD=+8.7). There was no differential impact of a comorbid PD on responsiveness to medication versus psychotherapy. The results did not change when the data were analyzed using an intent-to-treat sample or when individual personality disorders were examined separately. LIMITATIONS: Patients with severe borderline, antisocial, and schizotypal PDs were excluded from study entry; therefore, these data primarily apply to patients with cluster C PDs and may not generalize to other Axis II conditions. CONCLUSIONS: Comorbid Axis II disorders did not negatively affect treatment outcome and did not differentially affect response to psychotherapy versus medication. Treatment formulations for chronically depressed patients with certain PDs may not need to differ from treatment formulations of chronically depressed patients without co-occurring PDs.},
  author       = {Maddux, Rachel and Riso, Lawrence P and Klein, Daniel N and Markowitz, John C and Rothbaum, Barbara O and Arnow, Bruce A and Manber, Rachel and Blalock, Janice A and Keitner, Gabor I and Thase, Michael E},
  issn         = {1573-2517},
  language     = {eng},
  number       = {3},
  pages        = {174--179},
  publisher    = {Elsevier},
  series       = {Journal of Affective Disorders},
  title        = {Select comorbid personality disorders and the treatment of chronic depression with nefazodone, targeted psychotherapy, or their combination.},
  url          = {http://dx.doi.org/10.1016/j.jad.2009.01.010},
  volume       = {117},
  year         = {2009},
}