Mulsant B H, Haskett R F, Prudic J, Thase M E, Malone K M, Mann J J, Pettinati H M, Sackeim H A
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh, PA, USA.
Am J Psychiatry. 1997 Apr;154(4):559-61. doi: 10.1176/ajp.154.4.559.
The adequacy of pharmacologic treatment received by patients with psychotic major depression was evaluated.
The authors systematically assessed the pharmacotherapy received by 187 depressed patients before initiation of ECT and compared the medication trials of those with psychotic (N = 53) and nonpsychotic (N = 134) depression.
Despite a median of four medication trials and median index episode duration of 20 weeks, only two (4%) of the patients with psychotic depression received at least one adequate pharmacotherapy trial. In contrast, 70 (52%) of the patients with nonpsychotic depression received at least one adequate trial. Twenty-five (47%) of the patients with psychotic depression received either no neuroleptic treatment (N = 11) or treatment for less than 3 weeks (N = 14). Only eight (15%) received a daily neuroleptic dose higher than 200 mg of chlorpromazine equivalents.
These findings suggest that many patients with psychotic major depression referred for ECT receive inadequate pharmacotherapy because of either the absence or the inadequate use of neuroleptic medication.
评估伴有精神病性症状的重度抑郁症患者接受药物治疗的充分性。
作者系统评估了187例抑郁症患者在开始电休克治疗（ECT）前接受的药物治疗情况，并比较了伴有精神病性症状（N = 53）和不伴有精神病性症状（N = 134）的抑郁症患者的药物试验情况。
尽管药物试验中位数为4次，中位发作持续时间为20周，但伴有精神病性症状的抑郁症患者中只有2例（4%）接受了至少一次充分的药物治疗试验。相比之下，不伴有精神病性症状的抑郁症患者中有70例（52%）接受了至少一次充分的试验。伴有精神病性症状的抑郁症患者中有25例（47%）未接受抗精神病药物治疗（N = 11）或治疗时间少于3周（N = 14）。只有8例（15%）接受的每日抗精神病药物剂量高于200毫克氯丙嗪等效剂量。
这些发现表明，许多因电休克治疗而转诊的伴有精神病性症状的重度抑郁症患者由于未使用抗精神病药物或使用不当而接受了不充分的药物治疗。
