Untangling Therapeutic Ingredients of a Personalized Intervention for Patients with Depression and Severe COPD  

Oleh:

Alexopoulos, George S. ; Kiosses, Dimitris N. ; Sirey, Jo Anne ; Kanellopoulos, Dora ; Seirup, Joanna K.

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The American Journal of Geriatric Psychiatry (keterangan: ada di ClinicalKey) vol. 22 no. 11 (Nov. 2014), page 1316-1324.
Topik: clinical trial; COPD; disability; dyspnea; geriatric depression; personalized intervention

Ketersediaan

Perpustakaan FK Nomor Panggil: A35.K Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Objective We developed a personalized intervention for depressed patients with COPD (PID-C) aimed to mobilize patients to participate in the care of both conditions. We showed that PID-C reduced depressive symptoms and dyspnea-related disability more than usual care over 28 weeks. This study focused on untangling key therapeutic ingredients of PID-C. Design Randomized controlled trial. Setting Community. Participants 138 patients who received the diagnoses of COPD and major depression after screening 898 consecutive admissions for acute inpatient pulmonary rehabilitation. Intervention Nine sessions of PID-C compared with usual care over 28 weeks. Measurements Primary outcome measures were the 17-item Hamilton Depression Rating Scale and the Pulmonary Functional Status and Dyspnea Questionnaire–Modified. Other measures were adherence to rehabilitation exercise (=2 hours per week) and adherence to adequate antidepressant prescriptions. Results Low severity of dyspnea-related disability and adherence to antidepressants predicted subsequent improvement of depression. Exercise and low depression severity predicted improvement of dyspnea-related disability. Conclusions PID-C led to an interacting spiral of improvement in both depression and disability in a gravely medically ill population with a 17% mortality rate over 28 weeks and an expected deterioration in disability. The interrelationship of the course of depression and dyspnea-related disability underscores the need to target adherence to both antidepressants and chronic obstructive pulmonary disease rehabilitation. PID-C may serve as a care management model for depressed persons suffering from medical illnesses with a deteriorating course.

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