Neimeyer R A, Baker K D, Haykal R F, Akiskal H S
Department of Psychology, University of Memphis, Tennessee 38152, USA.
Bull Menninger Clin. 1995 Fall;59(4):460-71.
This naturalistic study of 352 depressed patients admitted to a mood disorders program in a private psychiatric hospital demonstrated that, for the majority of patients, combining cognitive group therapy with ongoing supportive individual, psychoeducational, milieu, and pharmacological interventions resulted in rapid overall improvement and discharge within a few weeks. Improvement was manifested across cognitive and vegetative factor scores of the Beck Depression Inventory. However, patterns of symptom remission differed for subgroups defined by different lengths of stay. For example, patients hospitalized for 4 weeks showed good initial response, followed by a plateau in improvement, and, finally, continued response. These patients eventually reached the same level of functioning at discharge as did more rapidly responding patients with briefer stays. In contrast, a subset of patients (10% of the sample) hospitalized 5 weeks or more showed less overall improvement (especially in vegetative symptoms), plateauing at a moderately symptomatic level. These data suggest that in a minority of depressed individuals, continuing physiological disturbances may underlie dysthymia or residual depression. However, in contrast to the high rates (20-30%) of chronicity reported from tertiary care settings, these data indicate the relatively good initial treatment response of depressed patients admitted to a private psychiatric hospital.
这项针对一家私立精神病医院情绪障碍项目收治的352名抑郁症患者的自然主义研究表明，对于大多数患者而言，将认知团体治疗与持续的支持性个体治疗、心理教育、环境治疗及药物干预相结合，可在数周内实现整体快速改善并出院。贝克抑郁量表的认知及植物神经因子得分均有改善。然而，根据住院时长划分的亚组，其症状缓解模式有所不同。例如，住院4周的患者最初反应良好，随后改善趋于平稳，最终持续改善。这些患者出院时的功能水平最终与住院时间较短、反应较快的患者相同。相比之下，住院5周或更长时间的一部分患者（样本的10%）整体改善较少（尤其是植物神经症状），在中度症状水平上趋于平稳。这些数据表明，在少数抑郁症患者中，持续的生理紊乱可能是心境恶劣或残留抑郁的基础。然而，与三级医疗机构报告的高慢性率（20%-30%）相比，这些数据表明私立精神病医院收治的抑郁症患者初始治疗反应相对较好。
