RESUMEN
OBJECTIVE: The objective of the study was to investigate whether a combined intervention composed of early detection plus integrated care (EDIC) enhances outcomes in patients with early psychosis compared to standard care (SC). METHODS: ACCESS III is a prospective non-randomized historical control design 1-year study examining the efficacy of EDIC (n = 120) vs. SC (n = 105) in patients aged 12-29 years. Primary outcome was the rate of ≥6 months combined symptomatic and functional remission. Additional outcomes comprised the reduction of DUP and course of psychopathology, functioning, quality of life, and satisfaction with care. RESULTS: In observed cases, 48.9% in the EDIC and 15.2% in the SC group reached the primary endpoint. Remission was predicted by EDIC (OR = 6.8, CI: 3.15-14.53, P < 0.001); younger age predicted non-remission (OR = 1.1, CI: 1.01-1.19, P = 0.038). Linear regressions indicated a reduction of DUP in EDIC (P < 0.001), but not in SC (P = 0.41). MMRMs showed significantly larger improvements in PANSS positive (P < 0.001) and GAF (P < 0.01) scores in EDIC vs. SC, and in EDIC over time in CGI-Severity (P < 0.001) and numerically in Q-LES-Q-18 (P = 0.052). CONCLUSIONS: EDIC lead to significantly higher proportions of patients achieving combined remission. Moderating variables included a reduction of DUP and EDIC, offering psychotherapeutic interventions.
Asunto(s)
Intervención Médica Temprana/estadística & datos numéricos , Atención al Paciente/estadística & datos numéricos , Trastornos Psicóticos/dietoterapia , Adolescente , Adulto , Diagnóstico Precoz , Femenino , Estudios de Seguimiento , Humanos , Modelos Lineales , Estudios Prospectivos , Trastornos Psicóticos/epidemiología , Adulto JovenRESUMEN
For patients with a depressive disorder, the family physician is often the first contact person. The doctor's early diagnosis and rapid initiation of treatment are hence of crucial importance. Because patients usually present with physical symptoms, the physician must actively explore the possibility of a depression; this means that the doctor must specifically ask about the principle symptoms and also explicitly address the subject of suicidal tendencies. The clarification of the course of depression (monophasic, recurrent or bipolar) and the exclusion physical causes are additional elements of the diagnosis. A screening is helpful for making a diagnosis, but does not replace a clinical examination.
Asunto(s)
Trastorno Depresivo/diagnóstico , Médicos de Familia , Trastorno Bipolar/diagnóstico , Trastorno Depresivo/psicología , Diagnóstico Diferencial , Humanos , Recurrencia , Suicidio/psicología , Encuestas y Cuestionarios , Factores de TiempoRESUMEN
Ninety-nine of 118 patients receiving cardiac valve replacements (n = 55) or coronary artery bypass grafts (n = 44) were studied before surgery and again one year after surgery. Psychological, social, and physical variables were assessed. For the 19 subjects not returning for follow-up, medical data collected by their general practitioner were available. The physical results of surgery were good, with over 90% of the patients showing improvement. Mean scores for psychological distress and quality of life improved; however, a bad psychosocial adjustment was present in about 25% of patients at follow-up. Bad psychosocial adjustment was not correlated with surgical results. The preoperative variables most predictive of poor psychosocial outcome were high scores in the general hypochondriasis and irritability subscales of the illness Behaviour Questionnaire, bad psychological adjustment characterized by high anxiety, depression, and global scores on the Symptom Distress Checklist, and ischemic rather than valvular heart disease.