治疗忧郁症减少了老年糖尿病患者的半数死亡率


  November 29, 2007 — 根据美国糖尿病学会出版的12月糖尿病照护(Diabetes Care)期刊的一篇新研究,有糖尿病的年长忧郁病患,若接受额外的忧郁症治疗,相较于未接受此治疗者,5年内的死亡率可以减少一半。
  
  作者结论表示,这些结果指出忧郁症照护处理可以显著减少糖尿病忧郁患者各种原因导致之死亡。
  
  主要作者宾州大学社区家庭医学科助理教授Hillary R. Bogner医师向Medscape精神病学表示,这是个政策宣示,我们需要更多第一线资源照顾和治疗忧郁。
  
  【令人气馁的PROSPECT研究】
  研究者使用「Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT)」这项研究的随机资料,该研究包括了纽约市、宾州和匹兹堡的20家一线照护机构 ,比较一线照护基础的介入对改善忧郁的结果。
  
  最后的研究样本包括了599位忧郁病患,其中396(66.1%)位达到「精神疾病诊断与统计手册第4版(Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV))」中的重度忧郁;因为这些病患中有15位是阙漏值,分析的样本数减为584位病患,平均年纪是70.3岁;这些参与者中,123 (21.2%)位有糖尿病史。
  
  Bogner表示,介入组被转介到训练有素的忧郁照护专家,接受治疗建议、监控病患临床状态、提供适当追踪;这些专家在临床有需要时或定期与病患会面或者通电话,有些案例需要每周一次。
  
  Bogner表示,忧郁症照护专家询问病患有关忧郁症状、药物副作用和遵医嘱程度等问题;基本上,他们发现病患的感觉和症状都有改善,他们也分析病患是否有服药方面的问题,忧郁症照护专家对部分病患提供人际精神疗法。
  
  Bogner表示,介入组中,忧郁症问题的表达和关心可以改善结果,这是一种额外的资源。
  
  Bogner表示,一般照顾组中,医师被告知病患的忧郁诊断,但是未接受特定治疗建议;我们知道一般照顾组的病患中通常接受忧郁症治疗;差异在于没有专业人士对医师提供建议,例如增加药物剂量。
  
  【死亡率减半】
  5年后,110位病患死亡;介入组中有糖尿病的忧郁病患在5年的追踪期之后,比一般照护组的病患的死亡率少了一半 (校正风险比, 0.49);不过研究者未完成实际致死因的分析,他们知道自杀不是主因;只有一件自杀 — 介入组中的一位有忧郁症的糖尿病患;根据Bogner医师所述,心血管疾病是比较可能的因素。
  
  和糖尿病患相比,介入组中无糖尿病忧郁病患的死亡风险和一般照护组相当。
  
  他们指出,虽然有许多有关忧郁症和糖尿病的研究,但就我们的知识,这是第一篇有关忧郁介入试验之糖尿病和死亡率关系的报告。
  
  他们结论表示,研究建议应更加注意治疗糖尿病患的忧郁症,更需注意忧郁和糖尿病的发生率;这些状况显示出现今一线照顾最常见之问题的其中两个,这两个因素是密切相关的;忧郁症是糖尿病的风险因素,有这两个因素之一的糖尿病病患,其忧郁症也会增加;忧郁症也会导致糖尿病患对药物和饮食处方的顺从性变差。
  
  PROSPECT由国家心智健康研究中心(NIMH)所赞助,Bogner、Post和Bruce等医师之参与系由NIMH奖助,作者报告无相关利益冲突。

Treatment for Depression Reduc

By Pauline Anderson
Medscape Medical News

November 29, 2007 — Older depressed patients with diabetes who receive additional intervention for their depression are half as likely to die within 5 years as similar patients who not provided this intervention, according to a new study appearing in the December issue of Diabetes Care, published by the American Diabetes Association.

“These results indicate that a depression care management intervention can significantly reduce all-cause mortality among depressed patients with diabetes,” the authors conclude.

“There’s a policy statement here,” lead author Hillary R. Bogner, MD, assistant professor in the department of family practice and community medicine at the University of Pennsylvania, in Philadelphia, told Medscape Psychiatry. “We need more resources in primary care settings to treat depression.”

A Daunting PROSPECT

The researchers used data from the randomized Prevention of Suicide in Primary Care Elderly: Collaborative Trial (PROSPECT), which included a mix of 20 primary care practices from New York City, Philadelphia, and Pittsburgh and compared a primary care-based intervention with usual care in improving the outcome of depression.

This latest study sample included 599 depressed patients, of whom 396 (66.1%) met Diagnostic and Statistical Manual of Mental Disorders, 4th ed (DSM-IV) criteria for major depression. Because of missing data on 15 of these patients, the sample size for analysis was reduced to 584 patients, whose mean age was 70.3 years. Of these participants, 123 (21.2%) reported a history of diabetes.

The intervention group had access to trained depression care managers, who collaborated with physicians by offering guidelines-based treatment recommendations, monitoring clinical status of patients, and providing appropriate follow-up, said Dr. Bogner. “These managers met with the patients in person or talked with them over the phone when clinically necessary or at scheduled intervals, in some cases as often as once a week. “

The depression care managers asked the patients questions regarding depressive symptoms, medication adverse effects, and adherence to medications, Dr. Bogner said. “Basically, they found out how the patient was feeling and whether their symptoms had improved. They also assessed whether the patient was having any trouble taking medications. For some patients, the depression care managers provided interpersonal therapy.”

The fact that a person trained in depression management was available to address any problems or concerns that arose likely made a difference to the outcome for those in the intervention group, said Dr. Bogner. “It was an extra resource.”

In the usual-care group, physicians were informed of a patient’s depression diagnosis but did not receive specific treatment recommendations, said Dr. Bogner. “We know that patients in the usual-care group were often receiving depression treatment; the difference was that there was nobody in the practice who could make recommendations to the physician, such as increasing the dose” of medication, she said.

Mortality Cut By Half

After 5 years, 110 patients had died. Depressed patients with diabetes in the intervention group were about half as likely to die during that 5-year follow-up as were depressed patients with diabetes receiving usual care (adjusted hazard ratio, 0.49). Although researchers have not completed an analysis of the exact causes of these deaths, they do know that suicide was not a major contributor; there was only 1 suicide — a depressed patient with diabetes who was in the intervention group. According to Dr. Bogner, cardiovascular disease appears to be a likely cause of many of the other deaths.

In contrast to the patients with diabetes, depressed patients without diabetes in the intervention group had about the same risk of dying as similar patients in the usual-care group.

Although there has been much research on depression and diabetes, they write, “To our knowledge, this is the first study to report on the relationship between diabetes and mortality in a depression intervention trial.”

The study suggests more attention should be paid to treating depression in patients with diabetes, they conclude. The need is all the more pressing due to the prevalence of depression and diabetes. These conditions represent 2 of the most common problems seen in primary care settings today, the authors note. The 2 are intimately related; depression is a risk factor for diabetes, and depression is increased by a factor of 2 in patients with diabetes, they write. Depression also contributes to poor adherence to medication and dietary regimens.

PROSPECT was funded by the National Institute of Mental Health (NIMH). Participation of Drs. Bogner, Post, and Bruce was supported by NIMH awards. The authors report no potential conflicts of Interest.

Diabetes Care. 2007;30:3005-3010. Abstract

    
相关报导
单靠筛检与治疗无法预防第二型糖尿病
2017/1/12 上午 11:07:07
别老是坐着 少坐一点对糖尿病有好处
2016/12/9 上午 10:05:25
对于青少年及年轻人 忧郁症是日益增加且致命的威胁
2016/12/2 上午 10:13:01

上一页
   1   2   3   4   5   6   7   8   9   10  




回上一页