How Effective Is Algorithm-Guided Treatment for Depressed Inpatients? Results from the Randomized Controlled Multicenter German Algorithm Project 3 Trial

被引:35
作者
Adli, Mazda [1 ,13 ]
Wiethoff, Katja [1 ]
Baghai, Thomas C. [2 ]
Fisher, Robert [3 ]
Seemueller, Florian [4 ]
Laakmann, Gregor [5 ]
Brieger, Peter [6 ]
Cordes, Joachim [7 ]
Malevani, Jaroslav [7 ]
Laux, Gerd [8 ]
Hauth, Iris [9 ]
Moeller, Hans-Juergen [5 ]
Kronmueller, Klaus-Thomas [10 ]
Smolka, Michael N. [11 ]
Schlattmann, Peter [12 ]
Berger, Maximilian [1 ]
Ricken, Roland [1 ]
Stamm, Thomas J. [1 ]
Heinz, Andreas [1 ]
Bauer, Michael
机构
[1] Charite, Dept Psychiat & Psychotherapy, Campus Charite Mitte,Charitepl 1, D-10117 Berlin, Germany
[2] Univ Regensburg, Dept Psychiat & Psychotherapy, Regensburg, Germany
[3] East London NHS Fdn Trust, City & Hackney Ctr Mental Hlth, Donald Winnicott Ctr, London, England
[4] Kbo Lech Mangfall Klin Garmisch Partenkirchen, Dept Psychiat & Psychotherapy, Garmisch Partenkirchen, Germany
[5] Ludwig Maximilians Univ Munchen, Dept Psychiat & Psychotherapy, Munich, Germany
[6] Kbo Isar Amper Klinikum, Dept Psychiat & Psychotherapy, Munich, Germany
[7] Heinrich Heine Univ Dusseldorf, Dept Psychiat & Psychotherapy, Dusseldorf, Germany
[8] Inst Psychol Med, Haag, Germany
[9] St Josephs Hosp, Dept Psychiat & Psychotherapy, Berlin, Germany
[10] LWL Klinikum Gutersloh, Dept Psychiat & Psychotherapy, Gutersloh, Germany
[11] Tech Univ Dresden, Univ Klinikum Carl Gustav Carus, Dept Psychiat & Psychotherapy, Dresden, Germany
[12] Friedrich Schiller Univ Jena, Dept Med Stat Informat & Documentat, Jena Univ Hosp, Jena, Germany
[13] Fliedner Klin Berlin, Ctr Psychiat Psychotherapy & Psychosomat Med, Berlin, Germany
关键词
treatment algorithms; antidepressants; treatment-resistant depression; medical decision making; German Algorithm Project; PRIMARY-CARE PATIENTS; PSYCHIATRY WFSBP GUIDELINES; PHARMACOLOGICAL-TREATMENT; BIOLOGICAL TREATMENT; MAJOR DEPRESSION; WORLD FEDERATION; DISORDER; AUGMENTATION; REMISSION; OUTPATIENTS;
D O I
10.1093/ijnp/pyx043
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background: Treatment algorithms are considered as key to improve outcomes by enhancing the quality of care. This is the first randomized controlled study to evaluate the clinical effect of algorithm-guided treatment in inpatients with major depressive disorder. Methods: Inpatients, aged 18 to 70 years with major depressive disorder from 10 German psychiatric departments were randomized to 5 different treatment arms (from 2000 to 2005), 3 of which were standardized stepwise drug treatment algorithms (ALGO). The fourth arm proposed medications and provided less specific recommendations based on a computerized documentation and expert system (CDES), the fifth arm received treatment as usual (TAU). ALGO included 3 different second-step strategies: lithium augmentation (ALGO LA), antidepressant dose-escalation (ALGO DE), and switch to a different antidepressant (ALGO SW). Time to remission (21-item Hamilton Depression Rating Scale <= 9) was the primary outcome. Results: Time to remission was significantly shorter for ALGO DE (n = 91) compared with both TAU (n = 84) (HR = 1.67; P =.014) and CDES (n = 79) (HR = 1.59; P = .031) and ALGO SW (n = 89) compared with both TAU (HR = 1.64; P = .018) and CDES (HR = 1.56; P = .038). For both ALGO LA (n = 86) and ALGO DE, fewer antidepressant medications were needed to achieve remission than for CDES or TAU (P < .001). Remission rates at discharge differed across groups; ALGO DE had the highest (89.2%) and TAU the lowest rates (66.2%). Conclusions: A highly structured algorithm-guided treatment is associated with shorter times and fewer medication changes to achieve remission with depressed inpatients than treatment as usual or computerized medication choice guidance.
引用
收藏
页码:721 / 730
页数:10
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