The treatment of psychotic depression: Is there consensus among guidelines and psychiatrists?
The treatment of psychotic depression: Is there consensus among guidelines and psychiatrists?
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DOI：
10.1016/j.jad.2012.07.036
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发表时间：
2013-02-20
影响因子：
6.6
通讯作者：
Ostergaard, Soren Dinesen
中科院分区：
文献类型：
--
作者：
Leadholm, Anne Katrine K.;Rothschild, Anthony J.;Ostergaard, Soren Dinesen
背景：精神病性抑郁(PD)是一种普遍、严重、诊断不足、治疗不充分的精神障碍，临床医生、研究人员和制药行业对其重视程度极低。因此，帕金森病最佳临床实践的证据基础是有限的。本研究的目的是调查国际上对帕金森病治疗指南的共识程度，并确定丹麦精神病学家的临床实践是否会反映出潜在的共识缺失。方法：1.对国际帕金森病治疗指南的回顾和比较。关于丹麦精神科医生治疗PD的问卷调查。结果：综述中考虑的9个国际治疗指南对PD的最佳治疗有不同的意见：9个指南中有6个建议抗抑郁药(AD)+抗精神病药物(AP)联合治疗，3个建议AD单一治疗，5个建议将电休克治疗(ECT)作为一线治疗。113名接受调查的精神病学家也表现出同样的缺乏共识。他们更喜欢AD+AP联合治疗(42%)、AD单一治疗(31%)或ECT(21%)。ADS和AP的一线选择分别是三环类抗抑郁药(51%)和奎硫平(62%)。限制：调查数据存在潜在的选择偏差，因为受访者可能代表更多的精神病学家。结论：我们的结果表明，关于帕金森病的治疗算法和临床实践都具有高度的异质性。这一发现强调了进一步研究精神病抑郁症治疗的必要性。(C)2012爱思唯尔B.V.保留所有权利。
Background: Psychotic depression (PD) is a prevalent, severe, under-diagnosed and often inadequately treated mental disorder, which has received disproportionally little attention by clinicians, researchers and the pharmaceutical industry. Consequently, the evidence base for optimal clinical practice regarding PD is limited. The aim of this study was to investigate the degree of consensus among international treatment guidelines on PD and to determine whether a potential lack of consensus would be reflected in the clinical practice of Danish psychiatrists.Methods:1. Review and comparison of international guidelines on the treatment of PD.2. Questionnaire based survey regarding Danish psychiatrists' treatment of PD.Results: The nine international treatment guidelines considered in the review have contrasting opinions on the optimal treatment for PD: 6 of 9 suggest antidepressant (AD)+ antipsychotic (AP) combination therapy, 3 of 9 recommend AD monotherapy and 5 of 9 find electroconvulsive therapy (ECT) equally appropriate as first line treatment. The 113 surveyed psychiatrists displayed the same lack of consensus. Their preferred treatment was either AD+AP combination therapy (42%), AD monotherapy (31%) or ECT (21%). The first line choices of ADs and APs were tricyclic antidepressants (51%) and quetiapine (62%), respectively.Limitations: The survey data are subjected to a potential selection bias as the respondents are likely to represent the more informed fraction of psychiatrists.Conclusions: Our results indicate that both treatment algorithms and clinical practice regarding PD are highly heterogeneous. This finding emphasizes the need for further studies on the treatment of psychotic depression. (C) 2012 Elsevier B.V. All rights reserved.