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Abstract(s)
Introdução:A Perturbação Depressiva Major é caracterizada por humor depressivo, perda
de interesse ou prazer, ideias de culpa ou de autoestima baixa, perturbações do sono e
do apetite, sensação de cansaço e dificuldades de concentração. Para além dos fármacos
antidepressivos, a Psicoterapia Cognitivo-Comportamental é um dos tipos de terapia
psicológica que demonstrou eficácia no tratamento da depressão ligeira a moderada. No
entanto, a eficácia da psicoterapia depende de vários fatores relacionados com o doente,
com as características da depressão e com o próprio terapeuta.
Objetivo: Determinar quais são os fatores que permitem prever se um doente com
depressão vai responder à Terapia Cognitivo-Comportamental.
Métodos: Nesta revisão sistemática da literatura incluímos ensaios aleatorizados
controlados que avaliassem a influência de determinados fatores na resposta da
depressão à Terapia Cognitivo-Comportamental. Fizemos pesquisa na PubMed para
encontrar estudos publicados entre 1999 e novembro de 2019 sobre essa temática. Todos
os títulos e abstracts foram avaliados de forma independente por dois revisores. O risco
de viés foi avaliado segundo a “Revised Cochrane risk-of-bias tool for randomized
trials”. A intensidade dos sintomas depressivos foi o único outcome.
Resultados: Níveis mais elevados de sintomas de perturbação da personalidade
comórbida, uma maior intensidade da aliança do paciente para com o processo
terapêutico, ser casado ou coabitar, volumes maiores do córtex cingulado anterior rostral
direito, baixos níveis de persistência e níveis baixos a moderados de aprendizagem e
memória verbais são fatores preditores da resposta da Perturbação Depressiva Major à
Terapia Cognitivo-Comportamental. Em doentes com doença de Parkinson, a participação
do cuidador no tratamento também é um preditor de resposta.
Discussão: Os possíveis fatores preditores analisados influenciam diretamente o processo
psicoterapêutico porque interferem com a relação que o doente cria com o mesmo, ao
mesmo tempo que afetam a performance do terapeuta, sendo deduzível a sua influência
na resposta ao tratamento. A exceção é o volume do córtex cingulado anterior rostral
direito, que, ao invés de influenciar diretamente a dinâmica terapêutica, pode ajudar a
compreender melhor a anatomia mediadora do tratamento e sugerir alvos neuronais para
aumentar a resposta à Terapia Cognitivo-Comportamental. Conclusões: Os possíveis fatores preditores analisados nos treze estudos diziam respeito
a características do doente, do tratamento, da clínica e respetiva gravidade, anatomia
cerebral e adversidades na infância. Recomendamos que mais estudos sejam realizados
na Europa sobre esta temática.
Introduction: Major Depressive Disorder is characterized by depressed mood, loss of interest or pleasure, ideas of guilt or low self-esteem, disturbances in sleep and appetite, feeling tired and concentration difficulties. In addition to antidepressant drugs, CognitiveBehavioral Psychotherapy is one of the types of psychological therapy that has shown effectiveness in the treatment of mild to moderate depression. However, the effectiveness of psychotherapy depends on several factors related to the patient, the characteristics of depression and the therapist himself. Objective: To determine what are the factors that allow predicting whether a patient with depression will respond to Cognitive Behavioral Therapy. Methods: In this systematic review of the literature, we included randomized controlled trials that assessed the influence of certain factors on the response of depression to cognitive behavioral therapy. We did research at PubMed to find studies published between 1999 and November 2019 on this topic. All titles and abstracts were independently assessed by two reviewers. The risk of bias was assessed according to the “Revised Cochrane risk-of-bias tool for randomized trials”. The intensity of depressive symptoms was the only outcome. Results: Higher levels of symptoms of comorbid personality disorder, greater intensity of the patient's alliance with the therapeutic process, being married or cohabiting, higher volumes of the right rostral anterior cingulate cortex, low levels of persistence and low to moderate levels of verbal learning and memory are predictors of the Major Depressive Disorder response to Cognitive Behavioral Therapy. In patients with Parkinson's disease, the caregiver's participation in treatment is also a predictor of response. Discussion: The possible predictive factors analyzed directly influence the psychotherapeutic process because they interfere with the relationship that the patient creates with him, while they affect the performance of the therapist, being deductible his influence in the response to the treatment. The exception is the volume of the right rostral anterior cingulate cortex, which, instead of directly influencing the therapeutic dynamics, can help to better understand the mediating anatomy of the treatment and suggest neuronal targets to increase the response to CognitiveBehavioral Therapy. Conclusion: The possible predictive factos analyzed in the thirteen studies concerned the patient’s characteristics, treatment, clinic and respective severity, brain anatomy and childhood adversities. We recommend that more studies be carried out in Europe on this subject.
Introduction: Major Depressive Disorder is characterized by depressed mood, loss of interest or pleasure, ideas of guilt or low self-esteem, disturbances in sleep and appetite, feeling tired and concentration difficulties. In addition to antidepressant drugs, CognitiveBehavioral Psychotherapy is one of the types of psychological therapy that has shown effectiveness in the treatment of mild to moderate depression. However, the effectiveness of psychotherapy depends on several factors related to the patient, the characteristics of depression and the therapist himself. Objective: To determine what are the factors that allow predicting whether a patient with depression will respond to Cognitive Behavioral Therapy. Methods: In this systematic review of the literature, we included randomized controlled trials that assessed the influence of certain factors on the response of depression to cognitive behavioral therapy. We did research at PubMed to find studies published between 1999 and November 2019 on this topic. All titles and abstracts were independently assessed by two reviewers. The risk of bias was assessed according to the “Revised Cochrane risk-of-bias tool for randomized trials”. The intensity of depressive symptoms was the only outcome. Results: Higher levels of symptoms of comorbid personality disorder, greater intensity of the patient's alliance with the therapeutic process, being married or cohabiting, higher volumes of the right rostral anterior cingulate cortex, low levels of persistence and low to moderate levels of verbal learning and memory are predictors of the Major Depressive Disorder response to Cognitive Behavioral Therapy. In patients with Parkinson's disease, the caregiver's participation in treatment is also a predictor of response. Discussion: The possible predictive factors analyzed directly influence the psychotherapeutic process because they interfere with the relationship that the patient creates with him, while they affect the performance of the therapist, being deductible his influence in the response to the treatment. The exception is the volume of the right rostral anterior cingulate cortex, which, instead of directly influencing the therapeutic dynamics, can help to better understand the mediating anatomy of the treatment and suggest neuronal targets to increase the response to CognitiveBehavioral Therapy. Conclusion: The possible predictive factos analyzed in the thirteen studies concerned the patient’s characteristics, treatment, clinic and respective severity, brain anatomy and childhood adversities. We recommend that more studies be carried out in Europe on this subject.
Description
Keywords
Depressão Fatores Preditores de Resposta Perturbação Depressiva Major Terapia Cognitivo Comportamental