综合医院精神科门诊中专科和非专科医师抑郁障碍治疗模式的比较(1)
【摘 要】 目的：比较综合性医院精神科门诊中专科和非专科医生对抑郁障碍的治疗模式，为提高综合医院精神科室的功能提供参考依据。方法：连续收集来自上海市9所综合性医院精神科门诊的抑郁障碍患者297例(专科医师组180例，非专科医师117例)。在入组时和入组后第2周、第4周、第8周、第12周进行汉密顿抑郁量表24项(HAMD24)、汉密顿焦虑量表(HAMA)、自编药物依从性评估量表的评定。依据就诊病例资料，以两组的药物使用情况来评估两组治疗模式的差异。结果：① HAMD减分率显示，在治疗后第8周、第12周两组疗效差异有统计学意义(第8周：显著进步及痊愈率专科组分别为56%、43%，非专科组66%、20%，χ2=29.91， P<0.001；第12周：专科组分别为12%、88%，非专科组38%、54%，χ2=46.46，P<0.01)。两组患者在治疗后第2周、第4周、第8周、第12周HAMD总分及相应因子分减分率上的差异均有统计学意义。②两组均以(选择性5-羟色胺再摄取抑制剂)SSRIs类药物治疗为主；治疗过程中非专科医师组中约有12.7%的患者疗程不满12周，而专科医师组仅为2%(χ2=13.67，P<0.01)；非专科医师组中有24.5%的减药比例，且用药不合理，而专科医师组则为6%(χ2=19.37，P<0.01)。③在12周随访结束时，专科组有62%的患者评价药物无副反应，91%的患者认为疗效好，有78%的患者表示愿意长期服药，非专科组结果则分别为40%、81%、57%(均P<0.05)，且患者依从性随着病情的好转而增强。结论：综合性医院精神科门诊中非专科医师对抑郁障碍的治疗用药存在一定问题，对抑郁障碍足疗程的治疗原则掌握不足，其诊治能力不及专科医师，需加强非专科医师进行系统的精神卫生培训。
, 百拇医药
【关键词】 抑郁障碍；综合性医院；疗效；精神科医生；非精神科医生；横断面研究
中图分类号：R749.4 文献标识码：A 文章编号：1000-6729(2009)006-0388-06
doi:10.3969/j.issn.1000-6729.2009.06.003
Comparison of Treatment Styles for Depression between Psychiatrists and Non- psychiatrists in General Hospitals
LU Zheng1@,ZHU Jun-Juan2,CAI Jun2,LI Yu-Shan1,SHI Shen-Xun3,SHI Yi-Jue4,WANG Chong-Shun5,JIANG You-Qian6,JI Jian-Lin7,ZHU Rong-Shen8,HAN Hong-Yi9,DING Su-Ju10
, 百拇医药
1Tongji Hospital of Tongji University,Shanghai 200065,China 2Shanghai Mental Health Center,Shanghai 200030,China
3Huashan Hospital of Fudan University,Shanghai 200040,China
4Ruijin Hospital of Shanghai jiaotong University School of Medicine,Shanghai 200025,China
5Shanghai First People's Hospital,Shanghai 200233,China 6Shuguang Hospital,Shanghai 200021,China
, 百拇医药 7Zhongshan Hospital of Fudan University,Shanghai 200032,China 8Shanghai Tenth People's Hospital,Shanghai 200072,China
9Shanghai East Hospital,Shanghai 200120,China 10Changhai Hospital of Shanghai,Shanghai 200433,China
@Corresponding author,Email:luzheng@tongji.edu.cn
【Abstract】Objective：By comparing the ability of coping with depressive disorders and evaluating the different therapeutic pattern between psychiatrists and non- psychiatrists in psychiatric clinics of general hospitals,the study is aimed to provide data for improving mental health service in general hospitals.Methods：The subjeds were 297 depressive patients consulting psychiatric clinics from 9 general hospitals in Shanghai,and assessed with the Hamilton Depression Rating Scale(HAMD),Hamilton Anxiety Rating Scale(HAMA),self-made questionnaires in the first interview,two-,four-,eight- and twelve-week flow-up interviews to evaluate therapeutic effects.Results：According to the HAMD score reduction rate,there was great difference betweenpsychiatrists treated group and non- psychiatrists treated group for the curative effect on the depression after 8-week and 12-week treatment(after 8-week:in psychiatrists treated group,the response rate was 56%,and the remission rate was 43%; in non- psychiatrists treated group,the response rate was 66%,and the remission rate was 20%，P<0.001; after 12-week:in psychiatrists treated group,the response rate was 12%,and the remission ratewas 88%; in non- psychiatrists treated group,the response rate was 38%,and the remission rate was 54%，P<0.001).There was significantly statistical difference in HAMD total score reduction rate and some factors score reduction rate between the two groups after 2-,4-,8- and 12-week treatment.Inpatients prescribed with SSRIs antidepressants,12.7%were treated for less than 12 weeks in non-psychiatrists group,while only 2% in psychiatrists group(P<0.001).The proportion of reducing medication was 24.5% in non-psychiatrists group,while only 6% in psychiatrists group(P<0.001).There were statistical differences between the two groups in the patients' evaluation about side-effect,curative effect,whether to be willing to accept medication for long time or not in the 12-week follow-up(P<0.05).In psychiatrists group 62% patientsthought that the side-effect of antidepressants were slight,91% patients thought the curative effect were well,and 78% of them tended to accept medication therapy for long time,while the results in non- psychiatrists group were 40%,81%,and 57% respectively.And the compliance would be improved with the improvement of the therapy.Conclusion：There is great difference in therapeutic pattern coping with depression between psychiatrists and non- psychiatrists.Effective measures should be taken in order to strengthen the management of non- psychiatrists in general hospitals., 百拇医药(陆 峥 朱俊娟 蔡 军 李玉珊 施慎逊 史以珏 王崇顺 蒋有)
, 百拇医药
【关键词】 抑郁障碍；综合性医院；疗效；精神科医生；非精神科医生；横断面研究
中图分类号：R749.4 文献标识码：A 文章编号：1000-6729(2009)006-0388-06
doi:10.3969/j.issn.1000-6729.2009.06.003
Comparison of Treatment Styles for Depression between Psychiatrists and Non- psychiatrists in General Hospitals
LU Zheng1@,ZHU Jun-Juan2,CAI Jun2,LI Yu-Shan1,SHI Shen-Xun3,SHI Yi-Jue4,WANG Chong-Shun5,JIANG You-Qian6,JI Jian-Lin7,ZHU Rong-Shen8,HAN Hong-Yi9,DING Su-Ju10
, 百拇医药
1Tongji Hospital of Tongji University,Shanghai 200065,China 2Shanghai Mental Health Center,Shanghai 200030,China
3Huashan Hospital of Fudan University,Shanghai 200040,China
4Ruijin Hospital of Shanghai jiaotong University School of Medicine,Shanghai 200025,China
5Shanghai First People's Hospital,Shanghai 200233,China 6Shuguang Hospital,Shanghai 200021,China
, 百拇医药 7Zhongshan Hospital of Fudan University,Shanghai 200032,China 8Shanghai Tenth People's Hospital,Shanghai 200072,China
9Shanghai East Hospital,Shanghai 200120,China 10Changhai Hospital of Shanghai,Shanghai 200433,China
@Corresponding author,Email:luzheng@tongji.edu.cn
【Abstract】Objective：By comparing the ability of coping with depressive disorders and evaluating the different therapeutic pattern between psychiatrists and non- psychiatrists in psychiatric clinics of general hospitals,the study is aimed to provide data for improving mental health service in general hospitals.Methods：The subjeds were 297 depressive patients consulting psychiatric clinics from 9 general hospitals in Shanghai,and assessed with the Hamilton Depression Rating Scale(HAMD),Hamilton Anxiety Rating Scale(HAMA),self-made questionnaires in the first interview,two-,four-,eight- and twelve-week flow-up interviews to evaluate therapeutic effects.Results：According to the HAMD score reduction rate,there was great difference betweenpsychiatrists treated group and non- psychiatrists treated group for the curative effect on the depression after 8-week and 12-week treatment(after 8-week:in psychiatrists treated group,the response rate was 56%,and the remission rate was 43%; in non- psychiatrists treated group,the response rate was 66%,and the remission rate was 20%，P<0.001; after 12-week:in psychiatrists treated group,the response rate was 12%,and the remission ratewas 88%; in non- psychiatrists treated group,the response rate was 38%,and the remission rate was 54%，P<0.001).There was significantly statistical difference in HAMD total score reduction rate and some factors score reduction rate between the two groups after 2-,4-,8- and 12-week treatment.Inpatients prescribed with SSRIs antidepressants,12.7%were treated for less than 12 weeks in non-psychiatrists group,while only 2% in psychiatrists group(P<0.001).The proportion of reducing medication was 24.5% in non-psychiatrists group,while only 6% in psychiatrists group(P<0.001).There were statistical differences between the two groups in the patients' evaluation about side-effect,curative effect,whether to be willing to accept medication for long time or not in the 12-week follow-up(P<0.05).In psychiatrists group 62% patientsthought that the side-effect of antidepressants were slight,91% patients thought the curative effect were well,and 78% of them tended to accept medication therapy for long time,while the results in non- psychiatrists group were 40%,81%,and 57% respectively.And the compliance would be improved with the improvement of the therapy.Conclusion：There is great difference in therapeutic pattern coping with depression between psychiatrists and non- psychiatrists.Effective measures should be taken in order to strengthen the management of non- psychiatrists in general hospitals., 百拇医药(陆 峥 朱俊娟 蔡 军 李玉珊 施慎逊 史以珏 王崇顺 蒋有)