Empirically derived decision trees for the treatment of late-life depression
Empirically derived decision trees for the treatment of late-life depression
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DOI：
10.1176/appi.ajp.2008.07081340
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发表时间：
2008-07-01
影响因子：
17.7
通讯作者：
Reynolds, Charles F., III
中科院分区：
文献类型：
--
作者：
Andreescu, Carmen;Mulsant, Benoit H.;Reynolds, Charles F., III
目的：在文献中报道了几个预测老年抑郁症治疗反应的因素。本分析的目的是开发一个临床上有用的算法，使临床医生预测哪些患者可能会对治疗作出反应，从而指导临床决策making.Method：共461例晚期抑郁症患者进行了治疗结构化条件下长达12周，每周评估与17项汉密尔顿抑郁量表（HAM-D-17）。作者使用信号检测理论开发了治疗反应预测因子的层次结构。作者开发了两个模型，一个最大限度地减少错误的预测未来的响应和一个最大限度地减少错误的预测未来的无应答，为临床医生提供两个临床上有用的治疗algorithm.Results：在第一个模型中，早期症状改善（定义为从基线到第4周的HAM-D-17总分的相对变化），基线焦虑较低，和发病年龄较大的预测反应在12周。在第二个模型中，早期症状改善代表了定制治疗的主要指导，其次是基线焦虑水平，基线睡眠障碍，以及少数患者既往抗抑郁治疗的充分性。我们的两个模型，开发，以帮助临床医生在不同的临床情况下，说明了根据临床特征定制晚年抑郁症治疗的可能性，并证实了早期观察临床状态变化的重要性。
Objective: Several predictors of treatment response in late-life depression have been reported in the literature. The aim of this analysis was to develop a clinically useful algorithm that would allow clinicians to predict which patients will likely respond to treatment and thereby guide clinical decision making.Method: A total of 461 patients with late-life depression were treated under structured conditions for up to 12 weeks and assessed weekly with the 17-item Hamilton Rating Scale for Depression (HAM-D-17). The authors developed a hierarchy of predictors of treatment response using signal-detection theory. The authors developed two models, one minimizing false predictions of future response and one minimizing false predictions of future nonresponse, to offer clinicians two clinically useful treatment algorithms.Results: In the first model, early symptom improvement (defined by the relative change in HAM-D-17 total score from baseline to week 4), lower baseline anxiety, and an older age of onset predict response at 12 weeks. In the second model, early symptom improvement represents the principal guide in tailoring treatment, followed by baseline anxiety level, baseline sleep disturbance, and-for a minority of patients-the adequacy of previous antidepressant treatment.Conclusions: Our two models, developed to help clinicians in different clinical circumstances, illustrate the possibility of tailoring the treatment of late-life depression based on clinical characteristics and confirm the importance of early observed changes in clinical status.