The Maudsley Staging Method for treatment-resistant depression: prediction of longer-term outcome and persistence of symptoms.
J Clin Psychiatry
; 70(7): 952-7, 2009 Jul.
Article
em En
| MEDLINE
| ID: mdl-19457299
ABSTRACT
OBJECTIVE:
A recently proposed multidimensional method of staging treatment resistance in depression, the Maudsley Staging Method (MSM), has been shown to predict short-term outcome of treatment. This study tested whether the MSM predicts longer-term clinical outcome. We hypothesized that patients with higher scores on the MSM would experience a worse longer-term outcome in terms of time spent in a depressive episode and level of functional impairment.METHOD:
From May through July of 2008, we followed up patients with treatment-resistant depression discharged from an inpatient unit of an affective disorders service; all had MSM scores previously calculated from preadmission clinical data. We used the Longitudinal Interval Follow-up Evaluation (LIFE) chart to determine the monthly symptomatic course of depression blind to initial MSM scores. We employed a regression model to adjust for various confounding factors, including variable duration of follow-up, to determine the independent association of MSM scores with persistence of depressive disorder.RESULTS:
We assessed 62 of 80 eligible patients (78%) in a median follow-up duration (interquartile range) of 29.5 (19.0-52.5) months. The MSM independently predicted (1) being in an episode for 50% or longer of the follow-up duration (OR = 2.11, 95% CI = 1.25 to 3.57), (2) being in an episode at the time of follow-up assessment (OR = 1.89, 95% CI = 1.17 to 3.05), (3) being persistently in an episode throughout the follow-up period (OR = 2.01, 95% CI = 1.14 to 3.54), and (4) total months spent in a depressive episode (OR = 1.22, 95% CI = 1.06 to 1.40). The MSM also predicted functional impairment. Antidepressant count and the Thase and Rush model did not independently predict persistence of depression or functional impairment.CONCLUSION:
The MSM appears to have reasonable predictive validity regarding the longer-term course of illness, particularly persistence of depressive episodes. The MSM may be a useful, and possibly an improved, alternative to existing models of staging of treatment-resistant depression.
Texto completo:
1
Bases de dados:
MEDLINE
Assunto principal:
Avaliação de Resultados em Cuidados de Saúde
/
Transtorno Depressivo
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Antidepressivos
Tipo de estudo:
Diagnostic_studies
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Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Female
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Humans
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Male
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Middle aged
Idioma:
En
Revista:
J Clin Psychiatry
Ano de publicação:
2009
Tipo de documento:
Article
País de afiliação:
Reino Unido