John Annie P, Singh Nagendra Madan, Andrade Chittaranjan
College of Nursing, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Department of Psychopharmacology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
Indian J Psychiatry. 2016 Oct-Dec;58(4):425-431. doi: 10.4103/0019-5545.196710.
Patients are educated about their illness and its treatment at the time of diagnosis. However, little is known about how much of this education is retained and how it influences knowledge about, attitudes toward, and experiences with medication in antidepressant-naive patients with depression.
Antidepressant-naive outpatients with International Classification of Diseases-10 dysthymia or mild to moderate depression, who were advised antidepressant monotherapy, were randomized to control ( = 22) or intervention ( = 17) groups. Control patients received treatment as usual, and intervention patients received, in addition, a face-to-face, individualized, 10-min education session about the nature of depression, antidepressant treatment, efficacy and adverse effects of the prescribed drug, and plan of management. Knowledge about the illness and its treatment were assessed at baseline (before the educational intervention) and 6 weeks later. At follow-up, experiences with treatment were also evaluated. The study was double-blind.
At baseline, patients had poor knowledge about their illness and its treatment (most patients could not even name their diagnosis); however, few held unfavorable attitudes toward their prescribed medicines. At follow-up, there were modest improvements in both sets of outcomes. There were no differences between intervention and control groups in knowledge and attitude outcomes at baseline and end-point. Drug compliance did not differ between groups. However, importantly, intervention patients experienced a significantly larger number of adverse events than controls (mean, 3.5 vs. 1.7, respectively).
For ethical reasons, patients need to be educated about their illness and its treatment. However, such education may be a two-edged sword, with an increased nocebo effect as the most salient consequence. Failure to identify benefits in our study may have been the result of a Type 2 error. This study provides a wealth of information on a large number of issues related to knowledge, attitudes, and experiences of depressed, mostly low-income outpatients in relation to education about depression and its treatment, and future research can build on the findings of this study. We also provide an extensive discussion on directions for further research.
在确诊时，患者会接受关于其疾病及其治疗的教育。然而，对于这种教育有多少被记住，以及它如何影响初治抑郁症患者对药物的知识、态度和用药体验，我们知之甚少。
建议接受抗抑郁药物单药治疗的初治门诊患者，诊断为国际疾病分类第10版中的恶劣心境或轻度至中度抑郁症，被随机分为对照组（n = 22）或干预组（n = 17）。对照组患者接受常规治疗，干预组患者除常规治疗外，还接受一次为期10分钟的面对面、个性化教育课程，内容包括抑郁症的本质、抗抑郁治疗、所开药物的疗效和不良反应以及治疗计划。在基线（教育干预前）和6周后评估关于疾病及其治疗的知识。在随访时，还评估了治疗体验。该研究为双盲研究。
在基线时，患者对其疾病及其治疗的知识掌握较差（大多数患者甚至说不出自己的诊断）；然而，很少有人对所开药物持负面态度。在随访时，两组结果均有适度改善。在基线和终点时，干预组和对照组在知识和态度结果方面没有差异。两组之间的药物依从性没有差异。然而，重要的是，干预组患者经历的不良事件明显多于对照组（平均分别为3.5次和1.7次）。
出于伦理原因，需要对患者进行关于其疾病及其治疗的教育。然而，这种教育可能是一把双刃剑，最显著的后果是无安慰剂效应增加。在我们的研究中未能发现益处可能是Ⅱ类错误的结果。本研究提供了大量与抑郁症患者（大多为低收入门诊患者）关于抑郁症及其治疗的教育相关的知识、态度和体验等诸多问题的信息，未来的研究可以基于本研究的结果展开。我们还对进一步研究的方向进行了广泛讨论。
