Christian Klesse

Unipolar Depression: Diagnostic and Therapeutic Recommendations From the Current S3/National Clinical Practice Guideline

BACKGROUND Depressive disorders are among the most common illnesses and reasons for obtaining health care. Their diagnosis and treatment are still in need of improvement. In Germany, a new S3/National Clinical Practice Guideline has been developed for this purpose. METHODS The existing guidelines on unipolar depression from Germany and other countries were synoptically compared and supplemented with systematic literature searches. After 14 consensus conferences, a total of 107 evidence-based recommendations were issued. RESULTS Unipolar depression should be diagnosed in accordance with ICD-10 criteria. Screening questionnaires are useful aids to diagnostic classification. When a treatment is chosen, shared decision-making with the patient is essential. Mild depressive episodes can be treated initially by watchful waiting for 14 days. For moderate depressive episodes, pharmacotherapy and psychotherapy are equally effective treatment options. For severe depression, a combination of pharmacotherapy and psychotherapy is recommended. If 4 to 6 weeks of acute therapy are insufficiently effective, lithium augmentation is recommended, rather than combination antidepressant therapy or a switch to another antidepressant. After remission, maintenance therapy should be continued for 4 to 9 months. In recurrent depression, pharmacotherapy and/or psychotherapy, where appropriate, should be continued for at least two years. Specific recommendations are given for patients who have somatic or mental comorbidities or are acutely suicidal, and recommendations are also given for coordination of care. CONCLUSION This guideline is a comprehensive set of evidence- and consensus-based recommendations for the diagnosis and treatment of unipolar depression. An improvement in the care of patients with unipolar depression will require broad implementation of the guideline, both in the inpatient and outpatient setting.

Entwicklung der S3- und Nationalen Versorgungs- Leitlinie Depression

ZusammenfassungDepressive Störungen zählen zu den häufigsten Beratungsanlässen und Erkrankungen in der Versorgung. Obwohl sie gut behandelbar sind, besteht – trotz der Fortschritte in den vergangenen Jahren – weiterhin Optimierungsbedarf hinsichtlich der Diagnostik und Therapie. Die Implementierung evidenz- und konsensusbasierter Leitlinien ist eine geeignete Maßnahme, um die Versorgung depressiver Patienten zu verbessern. Zurzeit wird für Deutschland eine evidenzbasierte Leitlinie Depression erarbeitet. Um ihre Akzeptanz und weite Verbreitung sicherzustellen, wird diese Leitlinie im Konsens aller relevanten Akteure verabschiedet. Zukünftige Aufgabe ist es, eine an Leitlinien orientierte Diagnostik und Behandlung regelhaft in der Versorgung zu verankern.AbstractDepressive disorders rank among the most frequent causes of consultation and diseases in health care. Although they are treatable, there is further need to optimize diagnostics and therapy, despite sizable progress in recent years. The implementation of evidence- and consensus-based guidelines is an appropriate measure to improve care for depressive patients. An evidence-based guideline for depression is currently being developed for Germany. In order to ensure its acceptance and a wide dissemination, this guideline will be adopted in consensus by all relevant health care providers in this field. According to this, it is a future challenge to anchor guidelinebased diagnostics and treatment in routine care.Depressive disorders rank among the most frequent causes of consultation and diseases in health care. Although they are treatable, there is further need to optimize diagnostics and therapy, despite sizable progress in recent years. The implementation of evidence- and consensus-based guidelines is an appropriate measure to improve care for depressive patients. An evidence-based guideline for depression is currently being developed for Germany. In order to ensure its acceptance and a wide dissemination, this guideline will be adopted in consensus by all relevant health care providers in this field. According to this, it is a future challenge to anchor guideline-based diagnostics and treatment in routine care.

Entwicklung der S3- undNationalen Versorgungs-Leitlinie Depression

ZusammenfassungDepressive Störungen zählen zu den häufigsten Beratungsanlässen und Erkrankungen in der Versorgung. Obwohl sie gut behandelbar sind, besteht – trotz der Fortschritte in den vergangenen Jahren – weiterhin Optimierungsbedarf hinsichtlich der Diagnostik und Therapie. Die Implementierung evidenz- und konsensusbasierter Leitlinien ist eine geeignete Maßnahme, um die Versorgung depressiver Patienten zu verbessern. Zurzeit wird für Deutschland eine evidenzbasierte Leitlinie Depression erarbeitet. Um ihre Akzeptanz und weite Verbreitung sicherzustellen, wird diese Leitlinie im Konsens aller relevanten Akteure verabschiedet. Zukünftige Aufgabe ist es, eine an Leitlinien orientierte Diagnostik und Behandlung regelhaft in der Versorgung zu verankern.AbstractDepressive disorders rank among the most frequent causes of consultation and diseases in health care. Although they are treatable, there is further need to optimize diagnostics and therapy, despite sizable progress in recent years. The implementation of evidence- and consensus-based guidelines is an appropriate measure to improve care for depressive patients. An evidence-based guideline for depression is currently being developed for Germany. In order to ensure its acceptance and a wide dissemination, this guideline will be adopted in consensus by all relevant health care providers in this field. According to this, it is a future challenge to anchor guidelinebased diagnostics and treatment in routine care.Depressive disorders rank among the most frequent causes of consultation and diseases in health care. Although they are treatable, there is further need to optimize diagnostics and therapy, despite sizable progress in recent years. The implementation of evidence- and consensus-based guidelines is an appropriate measure to improve care for depressive patients. An evidence-based guideline for depression is currently being developed for Germany. In order to ensure its acceptance and a wide dissemination, this guideline will be adopted in consensus by all relevant health care providers in this field. According to this, it is a future challenge to anchor guideline-based diagnostics and treatment in routine care.

Usefulness scale for patient information material (USE) - development and psychometric properties

BackgroundOne economical way to inform patients about their illness and medical procedures is to provide written health information material. So far, a generic and psychometrically sound scale to evaluate cognitive, emotional, and behavioral aspects of the subjectively experienced usefulness of patient information material from the patient’s perspective is lacking. The aim of our study was to develop and psychometrically test such a scale.MethodsThe Usefulness Scale for Patient Information Material (USE) was developed using a multistep approach. Ultimately, three items for each subscale (cognitive, emotional, and behavioral) were selected under consideration of face validity, discrimination, difficulty, and item content.The final version of the USE was subjected to reliability analysis. Structural validity was tested using confirmatory factor analysis, and convergent and divergent validity were tested using correlation analysis. The criterion validity of the USE was tested in an experimental design. To this aim, patients were randomly allocated to one of two groups. One group received a full version of an information brochure on depression or chronic low back pain depending on the respective primary diagnosis. Patients in the second group received a reduced version with a lower design quality, smaller font size and less information.Patients were recruited in six hospitals in Germany. After reading the brochure, they were asked to fill in a questionnaire.ResultsAnalyzable data were obtained from 120 questionnaires. The confirmatory factor analysis supported the structural validity of the scale. Reliability analysis of the total scale and its subscales showed Cronbach’s α values between .84 and .94. Convergent and divergent validity were supported. Criterion validity was confirmed in the experimental condition. Significant differences between the groups receiving full and reduced information were found for the total score (p<.001) and its three subscales (cognitive p<.001, emotional p=.001, and behavioral p<.001), supporting criterion validity.ConclusionsWe developed a generic scale to measure the subjective usefulness of written patient information material from a patient perspective. Our construct is defined in line with current theoretical models for the evaluation of written patient information material. The USE was shown to be a short, reliable and valid psychometric scale.

Die Diskriminationsleistung des Beck-Depressions-Inventars (BDI) hinsichtlich depressiver Störungen bei Patienten mit einer körperlichen Erkrankung

Zusammenfassung. Hintergrund: Depressive Storungen und koronare Herzkrankheit (KHK) treten haufig gemeinsam auf. Zur Erkennung depressiver Storungen bieten sich Screeningfragebogen an. Fragestellung: Die vorliegende Studie untersuchte die Diskriminationsleistung des Beck-Depressions-Inventars (BDI) und von vier theoretisch abgeleiteten BDI-Subskalen bei der Erkennung depressiver Storungen und depressiver Anpassungsstorungen bei KHK-Patienten. Methodik: 153 KHK-Patienten, die sich in der Hospital Anxiety and Depression Scale (HADS) als psychisch belastet beschrieben haben, wurden durch ein klinisches Interview diagnostiziert und fullten das BDI aus. Die Daten wurden in Receiver-Operating-Characteristics-Analysen ausgewertet. Ergebnisse: Bei 60 Patienten wurde eine affektive Storung bzw. eine depressive Anpassungsstorung diagnostiziert. In Reliabilitatsanalysen wies das BDI als Gesamtinstrument im Vergleich zu den vier BDI-Subskalen die hochste interne Konsistenz und die hochste Diskriminationsleistung auf....

Leitlinien bei psychischen Erkrankungen am Beispiel der Depression

Unterschiedliche Behandlungstraditionen, Schulausrichtungen und berufspolitische Interessen haben die Fertigstellung der S3-Leitlinien »Unipolare Depression « zu einem anspruchsvollen Vorhaben gemacht. Es ist allen Beteiligten Respekt zu zollen, dass es zu einem allgemein akzeptierten Konsens gekommen ist, der die Basis fur eine erfolgreiche Implementierung der Leitlinien und damit einer zu erwartenden Verbesserung der Versorgung depressiv Kranker darstellt. Die Tatsache, dass der Gemeinsame Bundesausschuss der Versorgung von depressiven Patienten inzwischen prioritare Bedeutung zumisst, lasst erhoffen, dass sich die organisatorischen und finanziellen Rahmenbedingungen der Depressionsbehandlung in absehbarer Zeit verbessern. Dies sollte die Umsetzung der S3-Leitlinien eher ermoglichen, als es im Moment z. B. durch die sehr geringe Finanzierung der ambulanten Depressionsbehandlung in psychiatrisch-psychotherapeutischen Praxen oder die schwer nachvollziehbare Trennung in stationare Akut- und Rehabilitationsbehandlung moglich ist.

Entwicklung der S3- und Nationalen Versorgungs-Leitlinie Depression@@@Development of national guidelines for depression

ZusammenfassungDepressive Störungen zählen zu den häufigsten Beratungsanlässen und Erkrankungen in der Versorgung. Obwohl sie gut behandelbar sind, besteht – trotz der Fortschritte in den vergangenen Jahren – weiterhin Optimierungsbedarf hinsichtlich der Diagnostik und Therapie. Die Implementierung evidenz- und konsensusbasierter Leitlinien ist eine geeignete Maßnahme, um die Versorgung depressiver Patienten zu verbessern. Zurzeit wird für Deutschland eine evidenzbasierte Leitlinie Depression erarbeitet. Um ihre Akzeptanz und weite Verbreitung sicherzustellen, wird diese Leitlinie im Konsens aller relevanten Akteure verabschiedet. Zukünftige Aufgabe ist es, eine an Leitlinien orientierte Diagnostik und Behandlung regelhaft in der Versorgung zu verankern.AbstractDepressive disorders rank among the most frequent causes of consultation and diseases in health care. Although they are treatable, there is further need to optimize diagnostics and therapy, despite sizable progress in recent years. The implementation of evidence- and consensus-based guidelines is an appropriate measure to improve care for depressive patients. An evidence-based guideline for depression is currently being developed for Germany. In order to ensure its acceptance and a wide dissemination, this guideline will be adopted in consensus by all relevant health care providers in this field. According to this, it is a future challenge to anchor guidelinebased diagnostics and treatment in routine care.Depressive disorders rank among the most frequent causes of consultation and diseases in health care. Although they are treatable, there is further need to optimize diagnostics and therapy, despite sizable progress in recent years. The implementation of evidence- and consensus-based guidelines is an appropriate measure to improve care for depressive patients. An evidence-based guideline for depression is currently being developed for Germany. In order to ensure its acceptance and a wide dissemination, this guideline will be adopted in consensus by all relevant health care providers in this field. According to this, it is a future challenge to anchor guideline-based diagnostics and treatment in routine care.