European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe
European Psychiatric Association Guidance on psychotherapy in chronic depression across Europe
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DOI：
10.1016/j.eurpsy.2015.12.003
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发表时间：
2016-03-01
影响因子：
7.8
通讯作者：
Padberg, F.
中科院分区：
文献类型：
--
作者：
Jobst, A.;Brakemeier, E. -L.;Padberg, F.
用途：根据定义，慢性抑郁症（CD）患者对标准形式的心理治疗反应较差，更可能是精神资源的高利用者。因此，本指南的目的是提供一个全面的概述，目前的心理治疗CD。有效性的证据是严格审查和建议的临床应用和research given.Methods：我们进行了系统的文献检索，以确定在CD心理治疗的研究，评估检索到的文件，并制定证据表和建议，通过专家和利益相关者之间的共识过程。我们提出了5项建议，可以帮助提供者为这一患者群体选择心理治疗方案。EPA认为心理治疗和药物治疗对CD都有效，并推荐这两种方法。最好的效果是通过心理治疗和药物治疗相结合的治疗，因此，这应该是治疗的选择。美国环保署建议的心理治疗与人际关系的重点（如认知行为分析系统的心理治疗[CBASP]）的治疗CD和个性化的方法根据病人的preferences.Discussion：DSM-5命名的持续性抑郁症（PDD），其中包括CD亚型，一直是一个重要的一步，更有区别的治疗和理解这些复杂的情感障碍。除了恶劣心境，ICD-10仍然没有为抑郁症的慢性过程提供一个单独的实体。急性发作性抑郁症患者和CD患者之间的差异需要在治疗计划中加以考虑。具体的心理治疗的治疗方案，建议患者CD。结论：慢性形式的抑郁症患者应提供量身定制的心理治疗，以解决他们的具体需求和赤字。心理治疗和药物治疗的联合治疗是CD的一线推荐治疗。需要更多的研究来开发更有效的CD治疗方法，特别是在长期内，并确定哪些患者受益于哪种治疗方法。(C)2015年Elsevier Masson SAS。All rights reserved.
Purpose: Patients with chronic depression (CD) by definition respond less well to standard forms of psychotherapy and are more likely to be high utilizers of psychiatric resources. Therefore, the aim of this guidance paper is to provide a comprehensive overview of current psychotherapy for CD. The evidence of efficacy is critically reviewed and recommendations for clinical applications and research are given.Methods: We performed a systematic literature search to identify studies on psychotherapy in CD, evaluated the retrieved documents and developed evidence tables and recommendations through a consensus process among experts and stakeholders.Results: We developed 5 recommendations which may help providers to select psychotherapeutic treatment options for this patient group. The EPA considers both psychotherapy and pharmacotherapy to be effective in CD and recommends both approaches. The best effect is achieved by combined treatment with psychotherapy and pharmacotherapy, which should therefore be the treatment of choice. The EPA recommends psychotherapy with an interpersonal focus (e.g. the Cognitive Behavioural Analysis System of Psychotherapy [CBASP]) for the treatment of CD and a personalized approach based on the patient's preferences.Discussion: The DSM-5 nomenclature of persistent depressive disorder (PDD), which includes CD subtypes, has been an important step towards a more differentiated treatment and understanding of these complex affective disorders. Apart from dysthymia, ICD-10 still does not provide a separate entity for a chronic course of depression. The differences between patients with acute episodic depression and those with CD need to be considered in the planning of treatment. Specific psychotherapeutic treatment options are recommended for patients with CD.Conclusion: Patients with chronic forms of depression should be offered tailored psychotherapeutic treatments that address their specific needs and deficits. Combination treatment with psychotherapy and pharmacotherapy is the first-line treatment recommended for CD. More research is needed to develop more effective treatments for CD, especially in the longer term, and to identify which patients benefit from which treatment algorithm. (C) 2015 Elsevier Masson SAS. All rights reserved.