SAMRC Unit on Risk & Resilience, Department of Psychiatry & Neuroscience Institute, Groote Schuur Hospital, University of Cape Town, Anzio Road, Observatory, 7925, Cape Town, South Africa.
Adv Ther. 2022 Apr;39(Suppl 1):13-19. doi: 10.1007/s12325-021-02029-6. Epub 2022 Mar 5.
When conceptualising engagement with treatment, it may be useful to contrast 'disease', which refers to underlying psychobiological dysfunction, with 'illness', which describes the experience of the person with that disease. Knowledge of disease, as well as understanding of illness, including patients' explanatory models of symptoms, may be useful in facilitating shared decision-making. Ideally, physicians are able to integrate evidence-based medicine with values-based medicine by combining the best research evidence with patients' unique needs and preferences. This, in turn, requires taking a systematic approach to the assessment of a range of domains (i.e. symptom profile, clinical subtype, severity and comorbidity) in individuals with depression, and individualising treatment accordingly. While data are now available from a range of randomised clinical trials addressing treatments for depressive symptoms, it is also notable that a decrease in symptom severity does not necessarily correlate with an increase in functioning, which highlights the need to monitor patients for the effect of treatment on a range of outcomes including comorbid anxiety, emotional responsiveness, and sleep quality. Importantly, recent epidemiological data emphasise the importance of persistence with treatment; most patients with major depression who persist with treatment eventually feel helped.
在考虑与治疗的互动时，将“疾病”（指潜在的心理生物学功能障碍）与“疾病”（描述患有该疾病的人的体验）进行对比可能会有所帮助。了解疾病，以及了解疾病，包括患者对症状的解释模型，可能有助于促进共同决策。理想情况下，医生可以通过将最佳研究证据与患者的独特需求和偏好相结合，将循证医学与价值医学相结合。这反过来又要求对抑郁症患者的一系列领域（即症状谱、临床亚型、严重程度和合并症）进行系统评估，并相应地进行个体化治疗。虽然现在有一系列随机临床试验的数据可用于治疗抑郁症状，但值得注意的是，症状严重程度的降低不一定与功能的提高相关，这突出了需要监测患者治疗对一系列结果的影响，包括合并焦虑、情绪反应和睡眠质量。重要的是，最近的流行病学数据强调了坚持治疗的重要性；大多数坚持治疗的重度抑郁症患者最终都会感到有所帮助。
