randomised controlled trial of the clinical and cost effectiveness of a specialist team for managing refractory unipolar depressive disorder随机对照试验的临床和成本效率的专家团队来管理耐火单极抑郁障碍.pdfVIP

Morriss et al. BMC Psychiatry 2010, 10:100 /1471-244X/10/100 STUDY PROTOCOL Open Access Randomised controlled trial of the clinical and cost effectiveness of a specialist team for managing refractory unipolar depressive disorder 1* 2 3 3 4 3 Richard Morriss , Sarah Marttunnen , Anne Garland , Neil Nixon , Ruth McDonald , Tim Sweeney , Heather Flambert3 3 2 5 6 , Richard Fox , Catherine Kaylor-Hughes , Marilyn James , Min Yang Abstract Background: Around 40 per cent of patients with unipolar depressive disorder who are treated in secondary care mental health services do not respond to first or second line treatments for depression. Such patients have 20 times the suicide rate of the general population and treatment response becomes harder to achieve and sustain the longer they remain depressed. Despite this there are no randomised controlled trials of community based service delivery interventions delivering both algorithm based pharmacotherapy and psychotherapy for patients with chronic depressive disorder in secondary care mental health services who remain moderately or severely depressed after six months treatment. Without such trials evidence based guidelines on services for such patients cannot be derived. Methods/design: Single blind individually randomised controlled trial of a specialist depression disorder team (psychiatrist and psychotherapist jointly assessing and providing algorithm based drug and psychological treatment) versus usual secondary care treatment. We will recruit 174 patients with unipolar depressive disorder in secondary mental health services with a Hamilton Depression Rating