Nationwide consensus on the clinical management of treatment-resistant depression in Italy: a Delphi panel.

IF 3.6 3区 医学 Q1 PSYCHIATRY Annals of General Psychiatry Pub Date : 2023-11-23 DOI:10.1186/s12991-023-00478-7
Giuseppe Maina, Marina Adami, Giuseppe Ascione, Emi Bondi, Domenico De Berardis, Dario Delmonte, Silvia Maffezzoli, Giovanni Martinotti, Alessandra Nivoli, Elena Ottavianelli, Andrea Fagiolini
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Abstract

Background: Treatment-resistant depression (TRD) is defined by the European Medicines Agency as a lack of clinically meaningful improvement after treatment, with at least two different antidepressants. Individual, familiar, and socio-economic burden of TRD is huge. Given the lack of clear guidelines, the large variability of TRD approaches across different countries and the availability of new medications to meet the need of effective and rapid acting therapeutic strategies, it is important to understand the consensus regarding the clinical characteristics and treatment pathways of patients with TRD in Italian routine clinical practice, particularly in view of the recent availability of esketamine nasal spray.

Methods: A Delphi questionnaire with 17 statements (with a 7 points Likert scale for agreement) was administered via a customized web-based platform to Italian psychiatrists with at least 5 years of experience and specific expertise in the field of depression. In the second-round physicians were asked to answer the same statements considering the interquartile range of each question as an index of their colleagues' responses. Stata 16.1 software was used for the analyses.

Results: Sixty panellists, representative of the Italian territory, answered the questionnaire at the first round. For 8/17 statements more than 75% of panellists reached agreement and a high consensus as they assigned similar scores; for 4 statements the panellists assigned similar scores but in the middle of the Likert scale showing a moderate agreement with the statement, while for 5 statements there was indecision in the agreement and low consensus with the statement.

Conclusions: This Delphi Panel showed that there is a wide heterogeneity in Italy in the management of TRD patients, and a compelling need of standardised strategies and treatments specifically approved for TRD. A high level of consensus and agreement was obtained about the importance of adding lithium and/or antipsychotics as augmentation therapies and in the meantime about the need for long-term maintenance therapy. A high level of consensus and agreement was equally reached for the identification of esketamine nasal spray as the best option for TRD patients and for the possibility to administrate without difficulties esketamine in a community outpatient setting, highlighting the benefit of an appropriate educational support for patients.

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意大利难治性抑郁症临床管理的全国共识:德尔菲小组。
背景:难治性抑郁症(TRD)被欧洲药品管理局定义为治疗后缺乏临床意义的改善,至少使用两种不同的抗抑郁药。TRD的个人、家庭和社会经济负担是巨大的。鉴于缺乏明确的指导方针,不同国家的TRD方法存在很大差异,并且可以获得新的药物来满足有效和快速的治疗策略的需求,了解意大利常规临床实践中关于TRD患者的临床特征和治疗途径的共识非常重要,特别是考虑到最近艾氯胺酮鼻喷雾剂的可用性。方法:通过定制的网络平台,对在抑郁症领域具有至少5年经验和特定专业知识的意大利精神科医生进行德尔福问卷调查,问卷包含17项陈述(7分李克特量表表示一致性)。在第二轮测试中,医生被要求回答同样的问题,考虑到每个问题的四分位数范围作为他们同事回答的指标。采用Stata 16.1软件进行分析。结果:60名代表意大利领土的小组成员在第一轮回答了问卷。对于8/17的陈述,超过75%的小组成员达成了一致意见,因为他们给出了相似的分数;对于4个陈述,小组成员给出了相似的分数,但在李克特量表的中间显示了对该陈述的中度同意,而对于5个陈述,在同意中存在优柔寡断和对该陈述的低共识。结论:德尔菲小组显示,意大利在TRD患者的管理方面存在广泛的异质性,迫切需要针对TRD的标准化策略和治疗方法。对于添加锂和/或抗精神病药物作为增强治疗的重要性,以及同时需要长期维持治疗,获得了高度的共识和同意。对于确定艾氯胺酮鼻腔喷雾剂是TRD患者的最佳选择,以及在社区门诊环境中无困难地使用艾氯胺酮的可能性,也达成了高度的共识和同意,强调了对患者进行适当教育支持的好处。
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来源期刊
CiteScore
6.60
自引率
2.70%
发文量
43
审稿时长
>12 weeks
期刊介绍: Annals of General Psychiatry considers manuscripts on all aspects of psychiatry, including neuroscience and psychological medicine. Both basic and clinical neuroscience contributions are encouraged. Annals of General Psychiatry emphasizes a biopsychosocial approach to illness and health and strongly supports and follows the principles of evidence-based medicine. As an open access journal, Annals of General Psychiatry facilitates the worldwide distribution of high quality psychiatry and mental health research. The journal considers submissions on a wide range of topics including, but not limited to, psychopharmacology, forensic psychiatry, psychotic disorders, psychiatric genetics, and mood and anxiety disorders.
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