Riepe Matthias W
Mental Health and Geriatric Psychiatry, Psychiatry II, Ulm University, Ulm, Germany.
Neuropsychiatr Dis Treat. 2014 Dec 22;11:25-31. doi: 10.2147/NDT.S75450. eCollection 2015.
Little is known about symptom preferences of clinical psychiatrists in the treatment of geriatric depression and preferences for avoiding adverse drug effects. Participants (board-certified psychiatrists) were recruited prior to a lecture on geriatric depression during a continuing education program. An analytic hierarchy process was performed and participants were asked for pairwise comparison of criteria guiding them in appraising therapeutic efficacy, and in avoiding toxicity and adverse events. Of the 61 participants from the continuing education program, 42 (69%) returned their data sheet. Avoidance of cardiotoxicity was regarded as more important than avoidance of hepatotoxicity or hematotoxicity. Concerning adverse events, highest preference was given to avoidance of falls and drug interactions, followed by avoidance of sedation, weight change, and impairment of sexual function. The most important preferences for appraisal of therapeutic efficacy were suicidality over ability to concentrate and sleep. Clinical psychiatrists have a hierarchy of preferences for treatment goals and avoidance of adverse events and toxicity. This raises the question for future research whether these preferences cause differences in prescription patterns in clinical practice even though a multitude of antidepressants are similarly effective when judged with instruments used in clinical trials.
关于临床精神科医生在治疗老年抑郁症时的症状偏好以及避免药物不良反应的偏好，目前所知甚少。在一个继续教育项目中，在一场关于老年抑郁症的讲座之前招募了参与者（获得委员会认证的精神科医生）。进行了层次分析法，并要求参与者对指导他们评估治疗效果以及避免毒性和不良事件的标准进行两两比较。在继续教育项目的61名参与者中，42名（69%）返回了他们的数据表。避免心脏毒性被认为比避免肝毒性或血液毒性更重要。关于不良事件，最优先考虑的是避免跌倒和药物相互作用，其次是避免镇静、体重变化和性功能障碍。评估治疗效果时最重要的偏好是自杀倾向优于注意力集中能力和睡眠。临床精神科医生在治疗目标以及避免不良事件和毒性方面有一个偏好层次。这就引发了未来研究的问题，即尽管在临床试验中使用的工具判断多种抗抑郁药同样有效，但这些偏好是否会导致临床实践中处方模式的差异。
