Trivedi Madhukar H
Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9119, USA.
J Clin Psychiatry. 2009;70 Suppl 6:26-31. doi: 10.4088/JCP.8133su1c.04.
The goal of treatment for major depressive disorder is remission, but many patients do not achieve complete remission, and few reach sustained remission (ie, recovery). However, systematically using clinical strategies such as implementing measurement-based care tactics and following treatment algorithms can improve the accuracy of ongoing assessment of depressive symptoms, better inform treatment decisions, and make sustained remission more likely. Measurement-based care tactics include using assessment tools to measure medication adherence, side effects, depressive symptoms, and suicide risk. Particularly useful in clinical practice are the Frequency, Intensity, and Burden of Side Effects-Rating (FIBSER) questionnaire; the 9-item Patient Health Questionnaire (PHQ-9); and the 16-item Quick Inventory of Depressive Symptomatology (Clinician-Rated or Self-Report versions; QIDS-C or QIDS-SR). The use of these measurements at regular patient visits can be combined with the use of treatment algorithms so that appropriate treatment selections are made on the basis of assessment tool results at critical decision points in follow-up. This article includes an example of how, at each treatment step, assessments can be made and results used to monitor progress toward remission, efficacy of dosage, and tolerability and to make informed, evidence-based treatment decisions.
重度抑郁症的治疗目标是症状缓解，但许多患者无法实现完全缓解，只有少数患者能达到持续缓解（即康复）。然而，系统地运用临床策略，如实施基于测量的护理策略并遵循治疗算法，可提高对抑郁症状持续评估的准确性，为治疗决策提供更充分的信息，并使持续缓解更有可能实现。基于测量的护理策略包括使用评估工具来衡量药物依从性、副作用、抑郁症状和自杀风险。在临床实践中特别有用的是副作用频率、强度和负担评定问卷（FIBSER）；9项患者健康问卷（PHQ - 9）；以及16项抑郁症状快速清单（临床医生评定版或自我报告版；QIDS - C或QIDS - SR）。在患者定期就诊时使用这些测量方法，可与治疗算法的使用相结合，以便在随访的关键决策点根据评估工具的结果做出适当的治疗选择。本文包含一个示例，说明在每个治疗步骤中如何进行评估，以及如何利用结果来监测症状缓解进展、剂量疗效和耐受性，并做出明智的、基于证据的治疗决策。
