Salvo Lilian, Saldivia Sandra, Parra Carlos, Rodríguez Román, Cifuentes Manuel, Acevedo Paola, Díaz Marcela, Ormazabal Mitza, Guerra Ivonne, Navarrete Nicol, Bravo Verónica, Castro Andrea
Programa Doctorado en Salud Mental, Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile.
Departamento de Psiquiatría y Salud Mental, Facultad de Medicina, Universidad de Concepción, Concepción, Chile.
Rev Med Chil. 2017 Mar;145(3):335-343. doi: 10.4067/S0034-98872017000300007.
Depression is considered the second leading cause of disability worldwide.
To describe the clinical characteristics and the evolution of major depressive disorder (MDD) in secondary care. To evaluate the association between socio-demographic and clinic variables with the first or recurrent major depressive events (MDE).
Clinical features, treatment, remission and duration of MDE were evaluated during a follow up lasting 12 months in 112 participants aged 44 ± 15 years (79% women). Patients were assessed as outpatients every three months at three psychiatric care centers of Chile. Clinical interviews were carried out using DSM-IV diagnostic criteria checklists and the Hamilton Depression Scale was applied.
Most patients were referred from primary care. The mean time lapse for referral to the secondary level was 10.8 months. Most patients had episodes that were recurrent, severe, with a high rate of psychosis, with suicide attempts and melancholic features and with psychiatric and medical comorbidities. Remission rate was 27.5%. In only 16 % of patients, the episode lasted six months or less. The group with recurrent episodes had different age, sex and clinical features.
MDD treated at the secondary care level is severe and its symptoms are intense. The time lapse prior to referral was prolonged. Primary care management and referral of these patients should be studied more closely.
抑郁症被认为是全球第二大致残原因。
描述二级医疗中重度抑郁症（MDD）的临床特征及演变。评估社会人口统计学和临床变量与首次或复发性重度抑郁发作（MDE）之间的关联。
对112名年龄为44±15岁（79%为女性）的参与者进行了为期12个月的随访，评估了MDE的临床特征、治疗、缓解情况及病程。在智利的三个精神科护理中心，每三个月对患者进行一次门诊评估。使用DSM-IV诊断标准清单进行临床访谈，并应用汉密尔顿抑郁量表。
大多数患者由初级医疗转诊而来。转诊至二级医疗的平均时间间隔为10.8个月。大多数患者发作具有复发性、重度、高精神病发生率、有自杀企图及抑郁特征，且伴有精神和躯体共病。缓解率为27.5%。仅16%的患者发作持续6个月或更短时间。复发性发作组具有不同的年龄、性别和临床特征。
在二级医疗中治疗的MDD病情严重且症状强烈。转诊前的时间间隔较长。应更密切地研究这些患者的初级医疗管理和转诊情况。
