Brakemeier Eva-Lotta, Guhn Anne, Stapel Sarah, Reinhard Matthias A, Padberg Frank
Lehrstuhl für Klinische Psychologie und Psychotherapie, Institut für Psychologie, Universität Greifswald, Greifswald, Deutschland.
Charité - Universitätsmedizin Berlin, Klinik für Psychiatrie und Psychotherapie, Campus Charité Mitte, Berlin, Deutschland.
Nervenarzt. 2023 Mar;94(3):213-224. doi: 10.1007/s00115-023-01448-w. Epub 2023 Feb 28.
The psychotherapy of depressive disorders has become established as a central component of inpatient treatment in psychiatric and psychosomatic hospitals and furthermore constitutes an important component of the residency training in Germany; however, the number of studies examining the effectiveness and efficacy is limited.
This narrative review summarizes the current state of research on inpatient psychotherapy for depressive disorders. The results of meta-analyses as well as practice-based observational studies from routine treatment in Germany, disorder-specific special programs, and side effects of inpatient psychotherapy are summarized.
The number of studies on the efficacy of inpatient psychotherapy of depressive disorders is overall low. The main finding of the largest recent meta-analysis indicates that psychotherapy in clinics and other facilities has a significant effect on depressive symptoms, with small to moderate effect sizes in randomized controlled studies. The effects are mostly maintained even after 9-15 months follow-up. An observational study from routine treatment with a very large sample size reported large pre-post and pre-follow-up effect sizes. It additionally revealed factors that appear to be difficult to change during inpatient psychotherapy, negatively affect treatment success and could be specifically addressed in future trials. Special programs, such as inpatient Interpersonal Psychotherapy (IPT) and the inpatient Cognitive Behavioral Analysis System of Psychotherapy (CBASP) indicate acceptance and efficacy/effectiveness in an initial randomized controlled (IPT) study and in observational (CBASP) studies. Side effects of inpatient psychotherapy were reported by 60-94% of patients with depressive disorders, whereby a perceived dependence on the therapist or the therapeutic setting was identified as a frequent side effect.
Overall, the results of the narrative review reveal that inpatient psychotherapy appears to be meaningful and effective for many patients with depressive disorders. Specific side effects, cost-effectiveness, and the question of differential indications (what works for whom?) should be further investigated.
抑郁症的心理治疗已成为精神科和身心疾病医院住院治疗的核心组成部分，并且在德国也是住院医师培训的重要组成部分；然而，检验其有效性和疗效的研究数量有限。
本叙述性综述总结了抑郁症住院心理治疗的当前研究状况。汇总了荟萃分析的结果以及来自德国常规治疗、特定疾病特殊项目的基于实践的观察性研究以及住院心理治疗的副作用。
关于抑郁症住院心理治疗疗效的研究数量总体较少。最近最大规模的荟萃分析的主要发现表明，诊所和其他机构的心理治疗对抑郁症状有显著影响，在随机对照研究中的效应大小为小到中等。即使在9至15个月的随访后，这些效果大多仍能维持。一项来自常规治疗的观察性研究，样本量非常大，报告了前后及随访前的大效应大小。它还揭示了一些在住院心理治疗期间似乎难以改变的因素，这些因素对治疗成功有负面影响，可在未来试验中专门加以解决。特殊项目，如住院人际心理治疗（IPT）和住院认知行为分析心理治疗系统（CBASP），在一项初步随机对照（IPT）研究和观察性（CBASP）研究中显示出可接受性和疗效/有效性。60%至94%的抑郁症患者报告了住院心理治疗的副作用，其中对治疗师或治疗环境的感知依赖被确定为常见副作用。
总体而言，叙述性综述的结果表明，住院心理治疗对许多抑郁症患者似乎是有意义且有效的。具体的副作用、成本效益以及差异适应症问题（什么对谁有效？）应进一步研究。
