Use of antidepressants by nonpsychiatrists in the treatment of medically ill hospitalized depressed elderly patients.
Use of antidepressants by nonpsychiatrists in the treatment of medically ill hospitalized depressed elderly patients.
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非精神科医生使用抗抑郁药治疗患有内科疾病的住院抑郁老年患者。
DOI：
10.1176/ajp.154.10.1369
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发表时间：
1997
期刊：
影响因子：
--
通讯作者：
Meador,KG
中科院分区：
文献类型：
--
作者：
Koenig,HG;George,LK;Meador,KG
目的本研究的目的是检查非精神科医生在治疗抑郁老年住院患者中使用抗抑郁药物的情况。方法老年精神科医生对在杜克医院接受医疗服务的 60 岁或以上的患者进行评估，他使用结构化精神病学访谈来识别重度或轻度抑郁症。抑郁症患者的医疗记录在入院前、住院期间和出院时均进行了抗抑郁药和苯二氮卓类药物使用情况的审查。出院后，每隔 12 周通过电话联系抑郁症患者 4 次，询问用药情况（中位随访时间 = 45 周）。 结果 在 153 名抑郁症患者中，40.5% 在住院期间或随访期间的某个时间接受过抗抑郁药物治疗，25.5% 只接受苯二氮卓类药物治疗，34.0% 两种药物均未接受治疗。最常用的抗抑郁药是阿米替林（占治疗患者的 45.2%），平均最大剂量为 49 毫克/天。 114 名未经治疗的抑郁症患者中只有 15 名在住院期间开始抗抑郁治疗（其中 9 名使用阿米替林）。在入院前或住院期间未接受抗抑郁药物的 91 名抑郁症患者中，只有 11% 在中位 11 个月的随访期间接受了任何抗抑郁治疗；同样，一半患者接受阿米替林治疗，剂量为 10-30 毫克/天。抗抑郁治疗的强度是根据抑郁症状的严重程度、精神问题史和较高收入来预测的。结论老年抑郁住院患者接受抗抑郁药物治疗的比例相对较低。接受抗抑郁药治疗的患者经常接受剂量不足的具有潜在危险的三环类药物。除非在住院期间发现并治疗抑郁症，否则出院后不太可能得到充分治疗。
ObjectiveThe purpose of this study was to examine antidepressant use by nonpsychiatrists in the treatment of depressed elderly medical inpatients.MethodPatients aged 60 or older who were admitted to medical services at Duke Hospital were evaluated by a geropsychiatrist who used a structured psychiatric interview to identify major or minor depressive disorder. Medical records of depressed patients were reviewed for use of antidepressants and benzodiazepines before admission, during hospitalization, and on discharge. After discharge, depressed patients were contacted four times by telephone at 12-week intervals to inquire about medication use (median follow-up time= 45 weeks).ResultsOf 153 depressed patients, 40.5% received antidepressants at some time during their hospital stay or follow-up period, 25.5% received only benzodiazepines, and 34.0% received neither. The most commonly prescribed antidepressant was amitriptyline (45.2% of treated patients), administered at an average maximum dose of 49 mg/day. Only 15 of 114 untreated depressed patients started antidepressant therapy during hospitalization (nine with amitriptyline). Of 91 depressed patients who did not receive antidepressants either before admission or during hospitalization, only 11% received any antidepressant therapy during the median 11-month follow-up; again, half were treated with amitriptyline at doses of 10–30 mg/day. Intensity of antidepressant therapy was predicted by severity of depressive symptoms, history of psychiatric problems, and higher income.ConclusionsA relatively low proportion of depressed older medical inpatients receive treatment with antidepressants. Patients treated with antidepressants often receive potentially dangerous tertiary tricyclics at inadequate doses. Unless depression is identified and treated during medical hospitalization, it is unlikely to be treated adequately after discharge.