The impact of comorbid posttraumatic stress disorder on short-term clinical outcome in hospitalized patients with depression
The impact of comorbid posttraumatic stress disorder on short-term clinical outcome in hospitalized patients with depression
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DOI：
10.1176/appi.ajp.162.5.970
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发表时间：
2005-05-01
影响因子：
17.7
通讯作者：
Roy-Byrne, PP
中科院分区：
文献类型：
--
作者：
Holtzheimer, PE;Russo, J;Roy-Byrne, PP
目的：创伤后应激障碍（PTSD）常与其他精神疾病共病，但往往未被认识。PTSD合并症的影响尚不清楚，特别是在严重精神疾病患者中。方法：从1995 ~ 2000年住院的精神科重度抑郁症患者中，选取587例合并PTSD的抑郁症患者与587例不合并PTSD的抑郁症患者进行对照研究。临床结果进行了评估与半结构化，医生管理的电池。两组之间的差异进行了检查，精神疾病的整体负担作为协变量进入analysis.Results：相对于抑郁症患者没有PTSD，抑郁症患者PTSD，在出院时，更大的精神症状的严重程度和更高水平的抑郁症和敌意。抑郁症患者合并PTSD也有显着较高的率出院违背医嘱（比值比= 6.10，95%CI 2.96 - 12.57）。结论：PTSD合并症与短期临床结果较差，更大的可能性出院违背医嘱的严重抑郁症精神科住院患者。更好地认识PTSD合并症可能会改善这些患者的整体护理。
Objective: Posttraumatic stress disorder ( PTSD) is often comorbid with other psychiatric disorders but often goes unrecognized. The effects of PTSD comorbidity are unclear, especially in patients with severe mental illness. The authors assessed short-term clinical outcome in severely depressed psychiatric inpatients with and without comorbid PTSD.Method: From patients hospitalized between 1995 and 2000, all patients with depression and comorbid PTSD (N = 587) were selected and matched with depressed patients without PTSD ( N = 587). Clinical outcome was assessed with a semistructured, physician-administered battery. Differences between the two groups were examined, with overall burden of psychiatric illness entered as a covariate in the analyses.Results: Relative to depressed patients without PTSD, depressed patients with PTSD had, at discharge, greater psychiatric symptom severity and higher levels of depression and hostility. Depressed patients with comorbid PTSD also had a significantly higher rate of being discharged against medical advice ( odds ratio = 6.10, 95% CI 2.96 - 12.57).Conclusions: PTSD comorbidity correlates with poorer short-term clinical outcome and greater likelihood of discharge against medical advice in severely depressed psychiatric inpatients. Better recognition of PTSD comorbidity may improve overall care of these patients.