McFarland Brian R, Klein Daniel N
Psychology Department, Stony Brook University, Stony Brook, NY 11794-2500, USA.
Compr Psychiatry. 2005 Jul-Aug;46(4):246-53. doi: 10.1016/j.comppsych.2004.10.002.
Little is known about long-term treatment use among patients with dysthymia. This paper describes patterns of treatment use by 85 outpatients with dysthymic disorder and a comparison group of 36 outpatients with nonchronic (episodic) major depression in a naturalistic follow-up. Patients with dysthymia had higher rates of treatment use across 7 1/2 years compared with patients with episodic major depression. Baseline variables that predicted which patients with dysthymia dropped out of treatment before recovering from dysthymic disorder included age, ethnicity, Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition Axis II pathology as obtained from informant reports, higher self-reported autonomy, and receiving psychotherapy alone as compared to receiving a combination of psychotherapy and medication. Dysthymic disorder places a significant burden on the mental health services system, yet many outpatients with dysthymia may be receiving inadequate treatment. Younger patients, ethnic minority patients, and patients with personality disorders may be at increased risk of dropping out from treatment for depression. Combination treatments may increase treatment retention.
关于心境恶劣障碍患者的长期治疗使用情况，人们了解甚少。本文描述了85例心境恶劣障碍门诊患者和36例非慢性（发作性）重度抑郁症门诊患者在自然随访中的治疗使用模式。与发作性重度抑郁症患者相比，心境恶劣障碍患者在7年半的时间里治疗使用率更高。预测哪些心境恶劣障碍患者在从心境恶劣障碍中康复之前退出治疗的基线变量包括年龄、种族、从 informant 报告中获得的《精神障碍诊断与统计手册（修订第三版）》轴II病理、较高的自我报告自主性，以及与接受心理治疗和药物联合治疗相比仅接受心理治疗。心境恶劣障碍给心理健康服务系统带来了沉重负担，但许多心境恶劣障碍门诊患者可能接受的治疗不足。年轻患者、少数民族患者和患有精神障碍的患者可能退出抑郁症治疗的风险增加。联合治疗可能会提高治疗依从性。
