A prospective study of depressed outpatients who visited the internal psychosomatic medicine

(1)抑郁症类型与预后的关系我们前瞻性地研究了抑郁症类型与预后的关系。受试者从1999年12月1日至2000年5月31日第一次访问九州大学医院心身医学科的门诊患者中招募。157例患者符合DSM-IV诊断标准，包括重度抑郁障碍、心境恶劣障碍、伴抑郁情绪的适应障碍和未另行说明的抑郁障碍。其中，65例患者在6个月内充分完成治疗。采用汉密尔顿抑郁量表（HAM-D）和Zung抑郁自评量表（SDS）分别于治疗后1、3、6个月进行随访。所有类型的抑郁症在3个月后的HAM-D评分均显示出临床显著性下降，并在6个月随访时进一步改善。本文探讨了心身内科治疗抑郁症的意义，心身内科治疗抑郁症的成本-效果分析：门诊未治疗抑郁症患者的治疗费用高于已治疗抑郁症患者。然而，前者的结果优于后者。因此，心身治疗抑郁症的成本效益在未经治疗的患者中高于那些曾经接受过治疗的患者。结论：抑郁症的早期诊断和治疗具有较高的成本效益。

(1) The relationship between the types of depression and the outcomeWe studied prospectively the relationship between the types of depression and the outcome. Subjects were recruited from outpatients visiting for the first time the Department of Psychosomatic Medicine, Kyushu University Hospital from December 1, 1999 to May 31, 2000. One hundred and fifty-seven patients met the DSM-IV diagnosis criteria of major depressive disorder, dysthymic disorder, adjustment disorder with depressive mood and depressive disorder not otherwise specified. Of these, 65 patients adequately completing treatment during the 6 months were available. We conducted follow-up evaluations at 1, 3 and 6 months after the baseline assessment using Hamilton Depression Rating Scale (HAM-D) and Zung Self-rating Depression Scale. All types of depression showed clinically significant decreases on the HAM-D scores at 3 months after and further improvements at 6-month follow-up. We discussed the meaning of treating depressed patients at the internal psychosomatic medicine.The cost-effectiveness in treatment of depressed patients in internal psychosomatic medicineThe costs of our treatment were higher in depressed outpatients who had never been treated than in those who had been treated. However, the outcome was better in the former than in the latter. Thus, the cost-effectiveness of psychosomatic therapy in depression was higher in untreated patients than in those who had ever been treated. We conclude that proper diagnosis and treatment in early stage of depression brought higher cost-effectiveness.