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早期精神病性障碍中抑郁的识别与管理

Recognition and management of depression in early psychosis.

作者信息

Bashir Zainab, Griffiths Sian Lowri, Upthegrove Rachel

机构信息

Assertive Outreach Team and Psychiatric Intensive Care Unit, Birmingham and Solihull Mental Health Foundation Trust, UK.

Institute for Mental Health, University of Birmingham, UK.

出版信息

BJPsych Bull. 2022 Apr;46(2):83-89. doi: 10.1192/bjb.2021.15.

Abstract

AIMS AND METHOD

Depression in first-episode psychosis (FEP) is highly prevalent and associated with poor outcomes; it has become increasingly recognised and adopted in national and international guidelines for psychosis. Using a 26-item questionnaire, this study aimed to explore if this shift has led to greater recognition among UK psychiatrists, and more effective management of depression in FEP.

RESULTS

Of the 297 respondents, 54.4% observed depression occurring in chronic psychosis, with the least number of respondents (17.7%) identifying depression occurring frequently during FEP. Although there was reasonable agreement in the use of antidepressants as a first-line treatment for depression (70% prescribing antidepressants), there was uncertainty around assessing depression and delineating from psychosis symptoms, and particularly negative symptoms.

CLINICAL IMPLICATIONS

Evidence-based treatments for comorbid depression in psychosis will lead to clearer national guidelines, allowing for optimal management of depression in early psychosis, potentially leading to improved outcomes for these individuals.

摘要

目的与方法

首发精神病(FEP)中的抑郁极为普遍且与不良预后相关;它在国家和国际精神病学指南中已得到越来越多的认可与采用。本研究使用一份包含26个条目的问卷,旨在探究这一转变是否已使英国精神科医生对此有了更高的认识,以及对FEP中的抑郁进行更有效的管理。

结果

在297名受访者中,54.4%观察到慢性精神病中出现抑郁,而识别出FEP期间频繁出现抑郁的受访者最少(17.7%)。尽管在将抗抑郁药用作抑郁的一线治疗方面存在合理的共识(70%开具抗抑郁药),但在评估抑郁以及与精神病症状尤其是阴性症状进行区分方面存在不确定性。

临床意义

针对精神病中共病抑郁的循证治疗将产生更明确的国家指南,从而实现对早期精神病中抑郁的优化管理,这可能会改善这些个体的预后。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/29b9/9074150/71341fcaa7ff/S2056469421000152_fig1.jpg

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