Specialist inpatient treatment benefits patients with refractory affective disorders
MedWire News: Specialist, multidisciplinary inpatient treatment is effective for reducing depression among patients with severe and treatment-resistant affective disorders, UK research shows.
"Many general adult psychiatrists do not have sufficient expertise, experience or access to resources to manage effectively severe and resistant affective disorders," observe Anthony Cleare (King's College London, UK) and team.
They add: "Studies to date on the effectiveness of treatment for treatment-resistant depression (TRD) have typically used patients failing one or two antidepressant treatments, ie, relatively mild TRD. Few studies have reported on more severely resistant patients, and there is also little data on the effectiveness of inpatient treatment for TRD."
For the current study, the researchers studied the outcomes of 225 patients admitted to the National Affective Disorders Unit at the South London and Maudsley NHS Foundation Trust between 2001 and 2008.
Patients admitted to the unit receive a comprehensive multidisciplinary assessment that takes over 4-6 weeks and involves medical, psychological, occupational, nursing, and couple therapy.
Of the patients, 58.0% had unipolar depression, 23.7% had bipolar disorder, and 18.3% had other disorders, such as schizoaffective disorder, obsessive compulsive disorder, and substance misuse.
At the time of admission, most of the patients had already received electroconvulsive therapy, lithium augmentation, and more than 10 prior treatment trials. All of the patients had a Hamilton Depression Rating Scale (HDRS) score of 16 or higher on admission.
Although the patients were highly treatment-resistant on admission, analysis of the data revealed that 69% showed a clinical response, defined as at least a 50% reduction in HDRS Hamilton score.
Furthermore, 51 (50%) of 102 patients continued to sustain a full response at the time of discharge, particularly those with bipolar disorder, and 71% continued to sustain at least a partial response at discharge.
The researchers also found that 57% of patients said they were "very much" or "much" improved, and 24% said that they were "slightly" improved at discharge. These patient ratings at discharge were similar to referrer ratings, the researchers note.
Cleare and team conclude: "The outcomes reported demonstrate that specialist, multidisciplinary inpatient treatment can be effective for patients with the most disabling and intractable depressive disorders. However, there are few such highly specialised treatment services presently available."
They add: "The model of integrated, multimodal therapy delivery may also be applicable to less specialist inpatient units in deciding how best to organise treatment for this common patient population, and may also be applicable on an outpatient basis: both suggestions would require evaluation."
MedWire (www.medwire-news.md) is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Mark Cowen