title: Dysfunctional cognitions of depressive inpatients and their relationship with treatment outcome.
abstract: BACKGROUND
  Dysfunctional cognitions can contribute to depression and its maintenance. They may be related to a higher relapse rate and a longer duration of the depressive episode. The relevance of dysfunctional cognitions for acute inpatient treatment of unipolar depression is examined in this study and its variability by cognitive behavioural therapy (CBT).
  
  
  METHODS
  222 patients suffering from Major Depressive Disorder (MDD) were evaluated during their inpatient treatment by assessing admission and discharge depression scores and their relationship to dysfunctional cognitions, using the Dysfunctional Attitude Scale (DAS). The relationship between dysfunctional cognitions and treatment outcome was examined. Primary outcome measures were the Hamilton-Rating-Scale (HRSD) and the Beck Depression Inventory (BDI).
  
  
  RESULTS
  Higher age, depression severity at admission, comorbid personality disorders and recurrent depressive disorders are related with higher DAS-scores at admission. DAS-Scores declined during treatment but to a lower extend than depressive symptom scales (effect size dDAS-G t1-t2 = .31; dHRSD t1-t2 = 2.88; dBDI t1-t2 = 1.38). Higher DAS-scores at admission correlated negatively with the improvement of depressive symptoms during treatment (HRSD: r = -.62; p < .01; BDI: r = -.54; p < .01) and remission rates (HRSD: r = -.65; p < .01; BDI: r = -.48; p < .01). CBT did not additionally reduce DAS-scores compared to pharmacotherapy only.
  
  
  CONCLUSIONS
  Dysfunctional cognitions are relatively stable compared to other depressive symptoms and are associated with poorer treatment outcome even in combined treatment of antidepressant medication and CBT during inpatient treatment. Changes of dysfunctional cognitions seem to be a long-term treatment goal, especially because of their association with comorbid personality disorders and recurrent depressive disorders.
authors: Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin. Electronic address: stephan.koehler@charite.de.
authors: Stephan
authors: S
authors: Köhler
authors: Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin. Electronic address: theresa.unger@hu-berlin.de.
authors: Theresa
authors: T
authors: Unger
authors: Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin. Electronic address: sabine.hoffmann@tww-berlin.de.
authors: Sabine
authors: S
authors: Hoffmann
authors: Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin. Electronic address: arthur.mackert@tww-berlin.de.
authors: Arthur
authors: A
authors: Mackert
authors: Kliniken im Theodor-Wenzel-Werk, Department of Psychiatry and Psychotherapy, Berlin. Electronic address: barbara.ross@tww-berlin.de.
authors: Barbara
authors: B
authors: Ross
authors: Humboldt-University, Department of Psychology, Berlin. Electronic address: Fydrich@hu-berlin.de.
authors: Thomas
authors: T
authors: Fydrich
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D003072:Cognition Disorders / Q000150:complications / Q000188:drug therapy* / Q000628:therapy*; D015928:Cognitive Behavioral Therapy; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000150:complications / Q000188:drug therapy* / Q000628:therapy*; D005260:Female; D006801:Humans; D007297:Inpatients / Q000523:psychology; D008297:Male; D008875:Middle Aged; D010554:Personality Disorders / Q000150:complications / Q000628:therapy; D010555:Personality Inventory; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
chemical_list: D000928:Antidepressive Agents