Objective: Literature data support the effect of psychoeducation combined with pharmacological, chronobiological and somatic interventions, also during the acute treatment of major depressive episodes, having as primary objective the management of cognitive dysfunction to avoid the protraction of the depressive episode and worsening of patient's health. As a matter of fact, the result of the antidepressant treatment is conditioned by different variables including the persistence of cognitive distortion, even in the absence of severe depressive symptoms. The aim of the present study was to investigate the persistence of cognitive distortion in a sample of inpatients hospitalized for a major depressive episode, and to detect any possible effect of a psychoeducational intervention. Method: The sample includes 60 patients hospitalized in the Mood Disorders Unit of San Raffaele-Turro Hospital in Milan for a Major Depressive Episode (DSM IV-TR). In the context of the Individual Rehabilitative Program (PRI), the patients take part to a psychoeducational group therapy session when their clinical conditions allow them to do so, i.e., when they obtain at least a 50% reduction of the score on the 21-item Hamilton depression rating scale (HDRS), compared to baseline. At the beginning of the antidepressant treatment, the patients were tested with the HDRS and the Depressive Differential Test (DD). The latter shows a high level of sensibility and specificity that render it a reliable tool for the diagnosis and quantification of the severity of depression. A DD score <0 indicates the presence of a cognitive distortion. The same evaluation was repeated when patients were about to be discharged, an event that occurred only when they had obtained complete symptom remission, defined as a HDRS score less or equal to 8. Results: At discharge the global sample presented a final HDRS mean score of 5.3 ± 3.21, but 51.6% of the sample still showed cognitive distortion, with an average Depressive Differential score of-6.84 ± 19.5 (normal value > 0). The independent variables significantly conditioning the persistence of cognitive distortion were: not taking part to psychoeducational intervention, presence of personality disorders, and length of hospitalization (Tab. V). An Analysis of Covariance for repeated measurers demonstrated a significant effect of participation to the psychoeducational program on the variation of Depressive Differential scores over time (p = 0.004), taking into account the influence of the severity of the depressive episode measured at the beginning with HDRS (Fig. 2). Outcome at three months after discharge was evaluated in a subsample of 52 patients. Relapse rate was 19.23% with an average time-to-relapse of 6.1 ± 2.5 weeks. A survival analysis using Cox Proportional Hazard model indicated that axis II codiagnosis (p = 0.049) and duration of hospitalization (p = 0.042) were significantly associated to higher risk of relapse (Tab. VI). Conclusion: Considering our results, psychoeducation combined with acute-phase antidepressant treatment contributes to the reduction of cognitive distortion, which is the core of the residual symptomatology during antidepressant treatment.
|Translated title of the contribution||Effect of psychoeducation combined with acute antidepressant treatment on the persistence of cognitive distortion in patients suffering from mood disorders|
|Number of pages||12|
|Journal||Italian Journal of Psychopathology|
|Publication status||Published - Jun 2009|
ASJC Scopus subject areas
- Psychiatry and Mental health
- Clinical Psychology