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

(1)抑郁类型与预后的关系我们前瞻性地研究了抑郁类型与预后的关系。研究对象为1999年12月1日至2000年5月31日在九州大学医院心身内科就诊的初诊患者。157例患者符合DSM-IV关于重度抑郁障碍、恶劣心境障碍、适应障碍伴抑郁情绪和抑郁障碍的诊断标准。在这些患者中，有65名患者在6个月内完成了充分的治疗。采用汉密尔顿抑郁量表(HAM-D)和Zung抑郁自评量表在基线评估后1、3、6个月进行随访评估。所有类型的抑郁症患者在3个月后HAM-D评分均有显著下降，6个月后进一步改善。我们讨论了在心身内科治疗抑郁症患者的意义。内科心身内科治疗抑郁症患者的成本-效果我们的治疗费用在从未接受治疗的门诊抑郁症患者中高于接受过治疗的患者。然而，前者的结果好于后者。因此，在未接受治疗的抑郁症患者中，心身治疗的成本-效果比接受过治疗的患者更高。我们认为，抑郁症的早期正确诊断和治疗可带来更高的成本-效果。

(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.