PMID- 19457299
OWN - NLM
STAT- MEDLINE
DCOM- 20090811
LR  - 20191210
IS  - 1555-2101 (Electronic)
IS  - 0160-6689 (Linking)
VI  - 70
IP  - 7
DP  - 2009 Jul
TI  - The Maudsley Staging Method for treatment-resistant depression: prediction of 
      longer-term outcome and persistence of symptoms.
PG  - 952-7
LID - 10.4088/JCP.08m04728 [doi]
AB  - OBJECTIVE: A recently proposed multidimensional method of staging treatment 
      resistance in depression, the Maudsley Staging Method (MSM), has been shown to 
      predict short-term outcome of treatment. This study tested whether the MSM 
      predicts longer-term clinical outcome. We hypothesized that patients with higher 
      scores on the MSM would experience a worse longer-term outcome in terms of time 
      spent in a depressive episode and level of functional impairment. METHOD: From 
      May through July of 2008, we followed up patients with treatment-resistant 
      depression discharged from an inpatient unit of an affective disorders service; 
      all had MSM scores previously calculated from preadmission clinical data. We used 
      the Longitudinal Interval Follow-up Evaluation (LIFE) chart to determine the 
      monthly symptomatic course of depression blind to initial MSM scores. We employed 
      a regression model to adjust for various confounding factors, including variable 
      duration of follow-up, to determine the independent association of MSM scores 
      with persistence of depressive disorder. RESULTS: We assessed 62 of 80 eligible 
      patients (78%) in a median follow-up duration (interquartile range) of 29.5 
      (19.0-52.5) months. The MSM independently predicted (1) being in an episode for 
      50% or longer of the follow-up duration (OR = 2.11, 95% CI = 1.25 to 3.57), (2) 
      being in an episode at the time of follow-up assessment (OR = 1.89, 95% CI = 1.17 
      to 3.05), (3) being persistently in an episode throughout the follow-up period 
      (OR = 2.01, 95% CI = 1.14 to 3.54), and (4) total months spent in a depressive 
      episode (OR = 1.22, 95% CI = 1.06 to 1.40). The MSM also predicted functional 
      impairment. Antidepressant count and the Thase and Rush model did not 
      independently predict persistence of depression or functional impairment. 
      CONCLUSION: The MSM appears to have reasonable predictive validity regarding the 
      longer-term course of illness, particularly persistence of depressive episodes. 
      The MSM may be a useful, and possibly an improved, alternative to existing models 
      of staging of treatment-resistant depression.
CI  - (c)Copyright 2009 Physicians Postgraduate Press, Inc.
FAU - Fekadu, Abebaw
AU  - Fekadu A
AD  - Institute of Psychiatry, Section of Neurobiology of Mood Disorders, Department of 
      Psychological Medicine and Psychiatry, King's College London, United Kingdom.
FAU - Wooderson, Sarah C
AU  - Wooderson SC
FAU - Markopoulou, Kalypso
AU  - Markopoulou K
FAU - Cleare, Anthony J
AU  - Cleare AJ
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20090519
PL  - United States
TA  - J Clin Psychiatry
JT  - The Journal of clinical psychiatry
JID - 7801243
RN  - 0 (Antidepressive Agents)
SB  - IM
MH  - Antidepressive Agents/*therapeutic use
MH  - Depression/diagnosis/psychology
MH  - Depressive Disorder/*diagnosis/drug therapy
MH  - Depressive Disorder, Major/diagnosis/drug therapy
MH  - Disability Evaluation
MH  - Drug Resistance
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Logistic Models
MH  - Longitudinal Studies
MH  - Male
MH  - Middle Aged
MH  - Outcome Assessment, Health Care/*methods/statistics & numerical data
MH  - Prognosis
MH  - Psychiatric Status Rating Scales
MH  - Psychometrics
MH  - Severity of Illness Index
EDAT- 2009/05/22 09:00
MHDA- 2009/08/12 09:00
CRDT- 2009/05/22 09:00
PHST- 2008/09/20 00:00 [received]
PHST- 2009/01/02 00:00 [accepted]
PHST- 2009/05/22 09:00 [entrez]
PHST- 2009/05/22 09:00 [pubmed]
PHST- 2009/08/12 09:00 [medline]
AID - 10.4088/JCP.08m04728 [doi]
PST - ppublish
SO  - J Clin Psychiatry. 2009 Jul;70(7):952-7. doi: 10.4088/JCP.08m04728. Epub 2009 May 
      19.