Demyttenaere K
University Hospitals Gasthuisberg, Leuven, Belgium.
Int Clin Psychopharmacol. 1998 Feb;13 Suppl 2:S19-25.
Compliance with medical advice has always been a problem and there has always been discussion on who is to blame for noncompliance: the illness, the physician, the patient or the drug? A consensus between the physician's beliefs, views and representations of the nature and the etiology of the depression and of the treatment options on the one hand and the patient with his individual life story on the other is probably the best guarantee of reasonable compliance. In particular, a physician-patient consensus about the emotional meaning of the illness is essential: patients should be given the opportunity to express their feelings about the illness and what it signifies, and physicians should respond with feedback using the patient's concepts and emotional expression. Within this context of dialogue, patients may signal their resistance to and potential noncompliance with the physician's views. An empathic model of understanding can be used in the initial stages of the consultation. Finding an equilibrium between the cognitive-informational aspects of depressive illness and treatment on one hand and affective-motivational aspects on the other is a key factor in antidepressive treatment. Physicians should indeed always try to overcome the gap between the affective (empathy, motivational aspects) and the instrumental dimensions (correct diagnosis, adequate treatment) of their behavior.
遵循医嘱一直是个问题，对于不遵医嘱该归咎于谁也一直存在讨论：疾病、医生、患者还是药物？一方面是医生对抑郁症的本质、病因及治疗选择的信念、观点和认知，另一方面是患者独特的人生经历，两者之间达成共识可能是合理遵循医嘱的最佳保障。特别是，医患之间就疾病的情感意义达成共识至关重要：应给予患者表达其对疾病及其意义感受的机会，医生应使用患者的概念和情感表达给予反馈。在这种对话背景下，患者可能会表明他们对医生观点的抵触和潜在的不遵医嘱。在咨询的初始阶段可采用共情理解模式。在抑郁症及治疗的认知信息方面与情感动机方面之间找到平衡是抗抑郁治疗的关键因素。医生确实应始终努力弥合其行为在情感（共情、动机方面）与工具维度（正确诊断、适当治疗）之间的差距。
