Randomised controlled trial of the clinical and cost effectiveness of a specialist team for managing refractory unipolar depressive disorder 英文参考文献.docVIP

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Randomised controlled trial of the clinical and cost effectiveness of a specialist team for managing refractory unipolar depressive disorder 英文参考文献.doc

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Randomised controlled trial of the clinical and cost effectiveness of a specialist team for managing refractory unipolar depressive disorder 英文参考文献

Morrissetal.BMCPsychiatry2010,10:100 /1471-244X/10/100 STUDY PROTOCOL OpenAccess Randomisedcontrolledtrialoftheclinicaland costeffectivenessofaspecialistteamfor managingrefractoryunipolardepressivedisorder RichardMorriss1*,SarahMarttunnen2,AnneGarland3,NeilNixon3,RuthMcDonald4,TimSweeney3, HeatherFlambert3,RichardFox3,CatherineKaylor-Hughes2,MarilynJames5,MinYang6 Abstract Background:Around40percentofpatientswithunipolardepressivedisorderwhoaretreatedinsecondarycare mentalhealthservicesdonotrespondtofirstorsecondlinetreatmentsfordepression.Suchpatientshave 20timesthesuiciderateofthegeneralpopulationandtreatmentresponsebecomeshardertoachieveand sustainthelongertheyremaindepressed.Despitethistherearenorandomisedcontrolledtrialsofcommunity basedservicedeliveryinterventionsdeliveringbothalgorithmbasedpharmacotherapyandpsychotherapyfor patientswithchronicdepressivedisorderinsecondarycarementalhealthserviceswhoremainmoderatelyor severelydepressedaftersixmonthstreatment.Withoutsuchtrialsevidencebasedguidelinesonservicesforsuch patientscannotbederived. Methods/design:Singleblindindividuallyrandomisedcontrolledtrialofaspecialistdepressiondisorderteam (psychiatristandpsychotherapistjointlyassessingandprovidingalgorithmbaseddrugandpsychological treatment)versususualsecondarycaretreatment.Wewillrecruit174patientswithunipolardepressivedisorderin secondarymentalhealthserviceswithaHamiltonDepressionRatingScale(HDRS)score≥16andglobal assessmentoffunction(GAF)≤60after≥6monthstreatment.TheprimaryoutcomemeasureswillbetheHDRS andGAFsupplementedbyeconomicanalysisincudingtheEQ5Dandanalysisofbarrierstocare,implementation andtheprocessofcare.Auditstobenchmarkbothtreatmentarmsagainstnationalstandardsofcarewillaidthe interpretationoftheresultsofthestudy. Discussion:Thistrialwillbethefirsttoassesstheeffectivenessandimplementationofacommunitybased specialistdepressiondisorderteam.ThestudyhasbeenspeciallydesignedaspartoftheCLAHRCNottinghamshire, DerbyshireandLincolnshirejointcollaborationbetw