Therapist individuality in the diagnosis and treatment of depression

Langwieler, G.

doi:10.1016/0165-0327(93)90090-7

Cited by 17 publications

(7 citation statements)

References 19 publications

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“…Besides obtaining the correct medical diagnosis, every physician needs to classify patients according to their severity of illness and the burden of comorbid diseases. Due to the fact that criteria for an accurate risk stratification in clinical routine are relatively poor defined, the recognition of patients at high risk depends mainly on the individual experience and skill of the physician [1, 2, 3, 4]. It remains a great challenge for hospital doctors, who are confronted with a wide range of physical and psychiatric symptoms, to discriminate between …”

Section: Introductionmentioning

confidence: 99%

Depression but Not Anxiety Is a Significant Predictor of Physicians’ Assessments of Medical Status in Physically Ill Patients

Meyer¹,

Klemme

Herrmann

2000

Psychother Psychosom

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Background: In a cross-sectional study we investigated associations between self-ratings of anxiety and depression, physical factors and physicians’ assessments of patients’ medical status. Methods: Hospital inpatients (n = 574) consecutively admitted to internal medical wards were evaluated for the presence of anxiety and depressive symptoms using the Hospital Anxiety and Depression Scale (HADS). Physicians were asked for their perception of psychiatric problems in their patients and for their assessments of patients’ severity of illness, functional impairment and 1-year prognosis on 3-point ranking scales. Detailed somatic data including comorbidity and accepted risk factors were taken from the patients’ records. Results: Almost two thirds of all patients with abnormal HADS scores (65.2%) were not identified by their attending physicians as suffering from psychiatric problems. Using multiple-regression models, HADS scores for depression, but not for anxiety, proved to be an independent predictor for the clinicians’ judgements of disease severity [exp(β) = 1.08; 95% confidence interval (CI) 1.03–1.13; p < 0.01] and functional impairment [exp(β) = 1.11; 95% CI 1.05–1.17; p < 0.01]. The estimation of prognosis, however, was only related to physical predictors and showed no association with depressive symptoms or other psychosocial factors. Conclusions: Our data demonstrate that internists’ ratings of severity of illness and functional impairment, but not prognosis, are associated with HADS depression scores, whereas there is no such association with self-rated anxiety.

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Section: Introductionmentioning

confidence: 99%

Depression but Not Anxiety Is a Significant Predictor of Physicians’ Assessments of Medical Status in Physically Ill Patients

Meyer¹,

Klemme

Herrmann

2000

Psychother Psychosom

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“…It refers to theoretical knowledge, i.e. the scientific literature, to experiental knowledge: personal expertise [44] to historical knowledge: information on this particular patient situational knowledge: information on the treatment setting or availability of treatments emotional knowledge: treatment preferences, or traditions interactional knowledge: preferences of the patient, expectational knowledge: probabilistic assumptions on what will happen if what is done. Medicine is always based on decisions under conditions of uncertainty: probabilistic information.…”

Section: Discussionmentioning

confidence: 99%

Results of Controlled Clinical Trials Comparing “Guideline Exposed” and “Guideline Naive” Physicians in the Treatment of Depression, Hypertension,and Diabetes: What can be Learned?

Westram¹

2011

CPSR

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Background: Medical guidelines claim to be evidence based, to report newest scientific information and to be transparent in respect to authorship. They want to optimize treatment, improve patient outcome, and reduce unnecessary costs. It must empirically be tested in randomized controlled trials to which degree these claims are fullfilled in day-to-day practice, and whether "guideline exposed physicians" treat their patients differently and, if so, have better or worse treatment results in comparison to "guideline naïve physicians".Method: Systematic review in the PubMed database of controlled clinical trials comparing "guideline exposed physicians" with "guideline naïve physicians" in the area of depression, hypertension, and diabetes mellitus.Results: Two studies for hypertension, three for diabetes and nine for depression were found. In two studies there was an improvement in treatment outcome in the guideline exposed-group, in one a worsening in treatment outcome and in eleven no differences Conclusions: Effects of treatment guidelines can be tested in controlled clinical trials. Results of such studies for depression, diabetes and hypertension suggest, similar to conclusions from other authors, that guidelines do often not reach their goal but can even have negative consequences. This can be explained in reference to theoretical knowledge on medical decision making. The term "evidence based" should not be used for guidelines which are literature reviews only, but for guidelines which have been empirically tested by controlled trials.

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“…Physicians who conceptualize depression as a biological disorder are more likely to treat with antidepressants, as are those who do not believe patients are not in the position to take part in the decision making process, and that patients in general expect to be treated with medications [10,111]. Shared decision making between physician and patient adds complexity to the drug selection process by emphasizing patient preferences and practice setting [114].…”

Section: Physician Characteristicsmentioning

confidence: 99%

“…All physicians should adhere to the same scientific standard, and therefore a particular patient should receive the same treatment regardless of provider and location [10]. All physicians should adhere to the same scientific standard, and therefore a particular patient should receive the same treatment regardless of provider and location [10].…”

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confidence: 99%

Choice of Treatment with Antidepressants: Influencing Factors

Himmerich

Wranik²

2012

CPD

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Depressive disorders place a large burden on patients and on society. Although efficacious treatment options for unipolar depressive disorders exist, substantial gaps in care remain. In part, the challenge lies in the matching of individual patients with appropriate care. This is complicated by the steady increases in the variety of antidepressants available in the market. The goal of this study is to highlight the decision processes in the selection of antidepressants by clinicians, given that most treatments have similar clinical effectiveness profiles. We conducted a systematic literature review of studies that referred to the decisions surrounding treatment with antidepressants for the treatment of non-psychotic unipolar depression. Our analysis of the literature reveals that the choice of treatment is based on a variety of factors, of which clinical evidence is only one. These factors can be categorized into clinical factors such as illness and treatment characteristics, individual factors such as patient and physician characteristics, and contextual factors such as setting characteristics, decision supports and pharmacoeconomic aspects. Illness characteristics are defined by the type and severity of depression. Treatment characteristics include drug properties, efficacy, effectiveness and favorable as well as unintended adverse effects of the drug. Examples for patient characteristics are co-morbidities and individual preferences, and physician characteristics include knowledge, experience, values and beliefs, and the relationship with the patient. Treatment guidelines, algorithms, and most recently, computational supports and biological markers serve as decision supports.

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Therapist individuality in the diagnosis and treatment of depression

Cited by 17 publications

References 19 publications

Depression but Not Anxiety Is a Significant Predictor of Physicians’ Assessments of Medical Status in Physically Ill Patients

Depression but Not Anxiety Is a Significant Predictor of Physicians’ Assessments of Medical Status in Physically Ill Patients

Results of Controlled Clinical Trials Comparing “Guideline Exposed” and “Guideline Naive” Physicians in the Treatment of Depression, Hypertension,and Diabetes: What can be Learned?

Choice of Treatment with Antidepressants: Influencing Factors

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Therapist individuality in the diagnosis and treatment of depression

Cited by 17 publications

References 19 publications

Depression but Not Anxiety Is a Significant Predictor of Physicians’ Assessments of Medical Status in Physically Ill Patients

Depression but Not Anxiety Is a Significant Predictor of Physicians’ Assessments of Medical Status in Physically Ill Patients

Results of Controlled Clinical Trials Comparing &#x201C;Guideline Exposed&#x201D; and &#x201C;Guideline Naive&#x201D; Physicians in the Treatment of Depression, Hypertension,and Diabetes: What can be Learned?

Choice of Treatment with Antidepressants: Influencing Factors

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Results of Controlled Clinical Trials Comparing “Guideline Exposed” and “Guideline Naive” Physicians in the Treatment of Depression, Hypertension,and Diabetes: What can be Learned?