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首页> 外文期刊>The journal of clinical psychiatry >The burden of disease for treatment-resistant depression.
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The burden of disease for treatment-resistant depression.

机译：难治性抑郁症的疾病负担。

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Assessing the consequences of specific diseases on global, national, and individual levels is complex. The Global Burden of Disease Study was launched in 1992 to develop objective measures of the burden of disease. Two measures have become widely accepted: disability-adjusted life-years (DALYs) assesses years of life lost due to a disease plus years lived with the disability due to that disease, and years lived with disability (YLDs) is a related measure with greater relevance for diseases that do not routinely produce earlier mortality. When DALYs and YLDs were compared world-wide for 100 disorders, they revealed a huge burden of disease for depression. Indeed, the findings were startling. Neuropsychiatric conditions are by far the world's leader in YLDs, accounting for almost 30%. Unipolar major depressive disorder alone accounted for 11% of global YLDs. The disability of major depressive disorder produces its greatest burden upon women and starts early in life. No separate disability assessments have been compiled for treatment-resistant depression, but of individuals with major depressive disorder, the most severely disabled are those with treatment-resistant depression. The contributions to the morbidity associated with major depressive disorder and treatment-resistant depression include widespread prevalence; relatively early symptom onset; severe underdiagnosis and undertreatment; genetic vulnerabilities and precipitation or accentuation by relatively unavoidable stressors; a longitudinal pattern of frequent recurrences with increasing frequency, severity, and consequences unless treated with maintenance strategies; inadequate prioritization of recurrence prevention among clinicians; and possible suppression of brain neurogenesis, neuronal atrophy, cell death, hippocampal dysfunction, and magnetic resonance imaging changes for those with chronic treatment-resistant depression. Since the patterns of recurrences, cycle acceleration, and increasing severity of treatment-resistant depression are key reasons for its high burden, reducing the burden requires an entire paradigm shift, including emphasis on the prevention of recurrences. Only then will this prevalent, disabling yet treatable disorder lose its ignominious status as a world leader in disease burden.
机译：在全球，国家和个人层面上评估特定疾病的后果非常复杂。全球疾病负担研究于1992年启动，旨在制定客观的疾病负担衡量方法。两项措施已被广泛接受：残疾调整生命年（DALYs）评估由于某种疾病而丧失的生命年数加上该疾病所致的残障者所居住的年数，而残障人士的生存年限（YLDs）则是一个更大的相关衡量标准。与通常不会导致较早死亡的疾病相关。在全球对DALY和YLD进行100种疾病的比较时，他们发现抑郁症的疾病负担很大。确实，这些发现令人震惊。迄今为止，神经精神疾病在YLD中居世界领先地位，约占30％。仅单相性重性抑郁症就占全球YLD的11％。重度抑郁症的残疾给妇女带来最大的负担，并从生命的早期开始。尚无针对难治性抑郁症的单独残疾评估报告，但对于患有严重抑郁症的人，最严重的残疾者是难治性抑郁症患者。与重度抑郁症和难治性抑郁症相关的发病率的贡献包括广泛的流行。症状发作相对较早;严重的诊断不足和治疗不足;遗传脆弱性和相对不可避免的应激源引起的沉淀或加重;除非以维持策略治疗，否则频繁复发的纵向模式会增加频率，严重性和后果;临床医生对预防复发的重视不足;并可能抑制患有慢性耐药的抑郁症患者的脑神经发生，神经元萎缩，细胞死亡，海马功能障碍和磁共振成像改变。由于复发的模式，周期加快和难治性抑郁症的严重程度增加是其高负担的关键原因，因此减轻负担需要整个范式转移，包括强调预防复发。只有这样，这种普遍的，致残而可治疗的疾病才能失去其作为疾病负担世界领导者的地位。

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