Dearman S P, Waheed W, Nathoo V, Baldwin R C
Department of Psychiatry, Royal Preston Hospital, Preston, UK.
Aging Ment Health. 2006 Sep;10(5):521-4. doi: 10.1080/13607860600637984.
Approximately 10% of elderly patients in primary care have depression yet it is often under-diagnosed and under-treated. It is unclear exactly how patients are being managed in primary care or what factors are associated with referral to psychiatric services. This study aimed to establish in a naturalistic setting how older depressed patients are managed in primary care; to determine which patients are referred to psychiatric services and the differences between patients referred and those not; in terms of primary care consultation rate and degree of co-morbid illness. Computerised records and referral letters were read for 1089 elderly patients in a large practice in central Manchester, UK. Of the 9% identified as depressed, 90% were managed in primary care alone, a third without antidepressants. More than half of those prescribed antidepressants received tricyclic antidepressants. Suicidal ideation and treatment failure were the principle reasons for referral. Patients referred had a greater psychiatric co-morbidity and had consulted their GP more frequently in the past year. Management of depression in the elderly may be conservative and older antidepressants may be over-prescribed. Increased primary care consultation rate and a greater psychiatric co-morbidity may be associated with referral to psychiatric services.
在初级保健机构中，约10%的老年患者患有抑郁症，但该病常常未得到充分诊断和治疗。目前尚不清楚在初级保健机构中患者是如何接受治疗的，也不清楚哪些因素与转介至精神科服务有关。本研究旨在自然环境下确定初级保健机构中老年抑郁症患者的治疗方式；确定哪些患者被转介至精神科服务以及被转介患者与未被转介患者之间在初级保健咨询率和共病疾病程度方面的差异。对英国曼彻斯特市中心一家大型医疗机构中1089名老年患者的计算机化记录和转诊信进行了查阅。在被确定为患有抑郁症的9%的患者中，90%仅在初级保健机构接受治疗，其中三分之一未使用抗抑郁药。超过一半服用抗抑郁药的患者使用的是三环类抗抑郁药。自杀观念和治疗失败是转诊的主要原因。被转介的患者有更多的精神科共病，且在过去一年中更频繁地咨询过他们的全科医生。老年抑郁症的治疗可能较为保守，而且可能过度开具了较老的抗抑郁药。初级保健咨询率的增加和更多的精神科共病可能与转介至精神科服务有关。
