首发抑郁症患者24周治疗疗效和依从性随访研究  

A study of 24 week treatment efficacy and compliance in first - episode depression

作　　者：苏晖[1] 江开达[1] 李飞[1] 郭晓云[2] 张选红[1] 宋立升[1] 徐一峰[1] 

机构地区：[1]上海市精神卫生中心,200030 [2]复旦大学附属华山医院精神科

出　　处：《上海精神医学》2005年第4期209-212,255,共5页Shanghai Archives of Psychiatry

基　　金：WHO首发精神疾病患者的全病程管理合作项目

摘　　要：目的比较全病程病案管理模式和门诊随访模式干预首发抑郁症急性期和巩固期的疗效和治疗依从性。方法前瞻性平行对照研究。符合ICD-10抑郁发作诊断标准的256例患者中,183 例患者接受全病程病例管理服务和门诊随访,73例患者进行门诊随访,对所有患者跟踪随访半年。在患者治疗基线、第8周、第24周评定病情严重程度,在治疗基线和第24周评定患者社会功能及治疗依从性。结果(1)全病程管理组患者治疗第8周和第24周的HAMD17总分和SDSS总分的平均值均显著低于对照组(P<0.01)。(2)全病程管理组患者第8周的有效率和显效率以及第24周的显效率均显著高于对照组(P<0.05),第8周的治愈率和第24周的治愈率、有效率高于对照组,差异无统计学意义(P>0.05)。(3)全病程管理组患者平均复诊次数和平均治疗周数明显高于对照组(P<0.05);治疗不足2个月的人数比例明显低于对照组(P<0.01),治疗3月、4月、5月和6月的患者比例均高于对照组(P<0.05);全病程管理组的乐意服药、打算长期服药以及服药从不忘记的患者比例高于对照组(P<0. 05),服药忘记一周以上比例低于对照组(P<0.05),服用一种药物治疗的患者比例是对照组的三倍(P <0.01)。结论全病程管理模式干预首发抑郁症急性期和巩固期的疗效和治疗依从性优于门诊随访模式。Objective ： To determine the effectiveness of whole course ease management for first episode major depression. Methods： Total 256 first - episode outpatients who meet ICD - 10 criteria for a major depressive episode were admitted to this study. 183 patients were assigned to whole course case management intervention, and 73 patients admitted to usual care. The study lasted 24 weeks. Patients were assessed by Hamilton Depression scale （HAMD17 -item） at baseline, and week 8, week 24 separately. Social Disability Screening Schedule （SDSS） was used to evaluate patient social disability at baseline and finial point and patients treatment compliance were rated at the final point. Results： （ 1 ） ease management intervention patients had a lower HAMD17 total score and SDSS total score than did control group patients at week 8 and week 24 respectively （ P 〈 0.05）. （2） The intervention patients experienced greater rates of depression treatment at week 8 and week 24 P 〈 0.05 ）. （3）The intervention patients had a better visits made and medication adherence than did control group patients at in 24 week follow - up （ P 〈 0.05 ）. The intervention patients were three times as much as control group patients likely to adhere to one antidepressant （ P 〈 0.05 ）. More intervention patients were willing to long time medication （ P 〈 0.05 ）. Conclusion ： whole course case management intervention seems to significantly improve first episode depression outcomes and treatment compliance at acute stage and consolidation.

关 键 词：首发抑郁症 病案管理 依从性 社会功能 抑郁症患者 治疗依从性 治疗疗效 随访研究 首发 病案管理模式 

分 类 号：R749.4[医药卫生—神经病学与精神病学] R544.1[医药卫生—临床医学]