OUTCOME OF PRIMARY CARE DEPRESSIVE DISORDER SUBTYPES

服务业的研究表明，抑郁症很常见，有 初级保健的患病率为15%-20%。当前的诊断类别 用于对这些患者进行分类，并最终指导他们的治疗， 都来自精神病学的专科领域。最新流行病学 研究表明，这些专业派生的类别有限 在初级保健中的适用性，还有其他抑郁障碍 初级保健中的演示文稿不容易与可用的 官方精神病学病因学的类别。 这项建议的具体目标是获得以下方面的纵向结果数据 四种抑郁障碍表现被证实为小学常见 关心。这四种障碍包括之前定义的两种 (发作性轻度抑郁障碍；慢性间歇性 抑郁障碍)和DSM-II分类建议的两个 在该系统下没有很好的定义(混合焦虑、抑郁和 疑似/隐匿性抑郁症)。后两者的明确标准 将开发并测试类别的可靠性和 初级保健提供者的可理解性。这项研究随后进行了一项 纵向设计，通过精神病学获得临床结果数据 在每一次针对性抑郁障碍治疗一年后接受采访 由初级保健提供者确定。结果数据将包括 对通常推荐的抗抑郁药丙咪嗪的治疗反应， 以及一年随访期间的病程和功能状态 时间间隔。 这项研究的重点是抑郁表现，因为他们发生在 初级保健提供者的日常做法。它寻求 为那些将被接受的演示文稿建立有效的类别 由初级保健提供者提供，并将直接与管理和 治疗。

Services research has shown that depressive disorders are common, with a prevalence of 15-20%, in primary care. The diagnostic categories currently in use to classify these patients, and ultimately to guide their treatment, have come from the speciality sector of psychiatry. Recent epidemiologic research has shown that these speciality derived categories have limited applicability in primary care, and that there are other depressive disorder presentations in primary care which do not easily fit into the available categories of the official psychiatry nosology. The specific aim of this proposal is to obtain longitudinal outcome data on four depressive disorder presentations established as common in primary care. The four disorders include two which have been previously defined (RDC episodic minor depressive disorder; RDC chronic intermittent depressive disorder) and two which are suggested by DSM-II categories but which are not well defined under that system (mixed anxiety depression and suspected/masked depression). Explicit criteria for the latter two categories will be developed and tested for reliability and comprehensibility to primary care providers. The study then follows a longitudinal design, obtaining clinical outcome data by psychiatric interview one year after each targeted depressive disorder has been identified by the primary care provider. The outcome data will include treatment response to a commonly recommended anti-depressant, imipramine, as well as course and functional status over the one year follow-up interval. The focus of this research is on depressive presentation as they occur in the routine day-to-day practice of primary care providers. It seeks to establish valid categories for those presentations which will be accepted by primary care providers and which will relate directly to management and treatment.