Ford Daniel E
Division of General Internal Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland 21287, USA.
Am J Med. 2008 Nov;121(11 Suppl 2):S38-44. doi: 10.1016/j.amjmed.2008.09.012.
Depression and comorbid chronic medical conditions such as coronary heart disease, diabetes mellitus, and osteoarthritis are frequently seen in the primary care setting, and the interaction of these illnesses can complicate diagnostic and treatment efforts. Although the etiologies of these bidirectional associations are not well understood, a number of negative outcomes are apparent, and challenges exist at patient, provider, and healthcare system levels to better recognize and treat depression in patients with chronic medical comorbidity. Such patients are more likely to present with somatic complaints, engage in unhealthy behaviors, harbor unhealthy thoughts or cognitions, and are less likely to comply with therapeutic recommendations. Primary care encounters often represent the only opportunities for these patients to address these issues and obtain the professional attention their depression requires. For clinicians, forging empathetic partnerships with patients, prescribing appropriate treatments, and closely monitoring symptoms and therapeutic progress are invaluable for optimal management of both affective and medical disorders. Further opportunities to improve care also exist at the healthcare system level, such as developing, funding, and implementing multimodal collaborative care models in the primary care setting.
抑郁症与冠状动脉疾病、糖尿病和骨关节炎等慢性合并症在初级保健环境中很常见，这些疾病之间的相互作用会使诊断和治疗工作变得复杂。尽管这些双向关联的病因尚未完全明确，但一些负面结果显而易见，在患者、医疗服务提供者和医疗保健系统层面都存在挑战，以便更好地识别和治疗患有慢性合并症的患者的抑郁症。这类患者更有可能出现躯体不适、采取不健康行为、怀有不健康的想法或认知，并且不太可能遵守治疗建议。初级保健问诊往往是这些患者解决这些问题并获得其抑郁症所需专业关注的唯一机会。对于临床医生而言，与患者建立共情关系、开具适当的治疗方案以及密切监测症状和治疗进展对于情感障碍和躯体疾病的最佳管理至关重要。在医疗保健系统层面也存在进一步改善护理的机会，例如在初级保健环境中开发、资助和实施多模式协作护理模式。
