| A. Objective:To get the message of the disease construction, therapy, and the diversity of the follow up rate in the psychological clinic of the general hospital during the year of 1992 and 2002. Also we put emphasis on analyzing the difference of drug treatment, follow up rate and average frequency of visiting clinic concerning on the most common disease of depression, general anxiety disorder (GAD), panic disorder and obsessive-compulsive disorder (OCD).B. Material and Method:1. Material:We selected the all 178 cases of the first visit cases in the psychological clinic of the Shanghai First People's Hospital during the time from Jan First to Dec 31st in 1992, and also the all 863 cases of the first visit cases in the psychological clinic of the Shanghai First People's Hospital during the time from Jan First to Dec 31st in 2002.2. Method:We applied the patients with questionnaire investigation and made their clinical psychological diagnosis. The symptom checklist (SCL-90) which we used to evaluate the patients includes the items of total score, obsession factor score(OBS), depression factor score(DEP),and anxiety factor score(ANX), etc. We made the initial diagnosis according to Chinese classification and diagnostic criteria of mental disorders (CCMD-3). Then we planed individual follow up protocol and began follow up work. We recorded the patient's situation about follow up or loss of follow up, checked the patient's original diagnosis when he returned visit. We also recorded the detailed information of every patient's drug application and the improvement of his psychological situation. In the end, we estimated the therapeutic efficacy for different drugs. We supposed the patients to return visit at our psychological clinic at different spot time (one month, six month, one year, three year, five year). 3. Data Processing and Statistical Analysis:All statistical analyses were carried out using SAS 9.13 software. Mean±standard deviation presented the continuous variance in the statistical delineation. Absolute number+relative percentage presented the separated variance in the statistical delineation. We applied t-test in group comparison between two groups in the statistical test. F test(analysis of variance) was used in group comparison among more than two groups. We also used chi square test in group comparison including separated variance. If the simple size was larger than 40 and the theoretical number was larger than 5, we should apply non-remedy chi square test. If the simple size was larger than 40 and the theoretical number was between one and five, we should apply remedy chi square test. If the simple size was less than 40 and the theoretical number was less than 5, the exact probability test should be taken.C. Result:1. There were 178 cases of the first visit cases in the psychological clinic of the Shanghai First People's Hospital during the year of 1992. There were 863 cases of the first visit cases in the psychological clinic of the in Shanghai First People's Hospital during the year of 2002. There were 1278 cases of the return visit cases in the psychological clinic of the Shanghai First People's Hospital during the year of 1992. There were 7939 cases of the return visit cases in the psychological clinic during the year of 2002. During these ten years, we can see that the number of the patients visiting at psychological clinic has been increasing significantly.2. The general demographic character:In the year of 1992, the age of the first visit cases in the psychological clinic was from nine years old to seventy-seven years old, the mean age was thirty-nine(38.89±15.78). And these cases included eighty-nine male (50%) and eighty-nine female (50%). We can imply from the statistical results that during the year of 1992 the age of the first visit cases in the psychological clinic was mainly concentrated from twenty years old to forty years old. In the year of 2002, the age of the first visit cases in the psychological clinic was from nine years old to eighty-five years old, the mean age was forty-three(43.03±17.57). And these cases included three hundred and thirty-four male (38.70%) and five hundred and twenty-nine female (61.30%). The number of female patients was more than the number of male patients. We can imply from the statistical results that during the year of 2002 the age of the first visit cases in the psychological clinic was relatively dispersed in each age section, but a little more concentrated from forty years old to sixty years old.3. Neverthless in the year of 1992 or in the year of 2002, the first visit cases in the psychological clinic were more often diagnosed with the most common disease of depression, GAD, panic disorder and OCD. From the statistical results, we can see that the constituent ratio of depression rose in some degree in the year of 2002 comparing the constituent ratio of depression in the year of 1992, that is, from 33.65% to 52.95%. But the constituent ratio of GAD and OCD declined a little the year of 2002 comparing the constituent ratio of GAD and OCD in the year of 1992, that is, the constituent ratio of GAD declined from 30.77% to 23.44%, the constituent ratio of OCD declined from 18.27% to 6.42%. The result showed statistical significance comparing constituent ratio of the diseases between these two years, P<0.01. The constituent ratio of bipolar affective disorder was very low, about 1.69% in the year of 1992 and 0.12% in the year of 2002. Another point we must know was that the constituent ratio of schizophrenia and other psychiatric disorder was high, about 7.30% in the year of 1992 and 5.10% in the year of 2002.4. In 1992, the psychological doctors got used to prescribe traditional tricyclic antidepressant (TCA) and benzodiazepines (BDZ) to treat the patients with the most common disease of depression, GAD, panic disorder and OCD. However, in 2002, the psychological doctor selected new type selective serotonin reuptake inhibitor (SSRI) instead of traditional drugs gradually. We got statistical significance in comparing between these two kind of drugs (P<0.05).5. The follow up rate of the patients with the most common disease of depression, GAD, panic disorder and OCD at different spot time (one month, six month, one year, three year, five year)decreased gradually by the passing time. There was no significant difference in the comparison of the follow up rate between the year of 1992 and the year of 2002, at different spot time (one month, six month, one year, three year, five year). There was also no significant difference in the comparison of the follow up rate and effective power among these four kinds of disease at different spot time (one month, six month, one year, three year, five year).However, we found that the follow up rate and effective power of drug treatment in the patients with panic disorder at the spot time of five year were higher than the others. Also we could see that the effective power of drug treatment in the patients with depression at the spot time (one month, six month, one year) was higher in 2002 than that in 1992.6. We standardized the times that the patients with the most common disease of depression, GAD, panic disorder and OCD visited our psychological clinic at different spot time to the average monthly visit times, and we can see the patients visited our clinic more often during acute phase, but the patients'average monthly visiting times decreased gradually by the passing time. During the first month, the patient with OCD visited our psychological clinic more often than patients with other disorder. But this was not the same as the patients with depression, and they visited our psychological clinic relatively less times. During the five years, the patients with OCD visited our psychological clinic least often than patients with other disorder.D. Conclusions:1. The psychological counseling clinic in general hospital in Shanghai was firstly set up in the late eighty decade last century. It has been developing very quickly during these twenty years. This phenomenon indicated the people's great increasingly demand on the psychological consultation with the quick development of our society. No matter the number of person-time of the first visit patient or the number of person-time of the whole year, it has been distinguished increasing up by the passing day.2. In our study, we can imply that neurosis and affective disorder account the extremely most cases in the psychological counseling clinic in general hospital. For the reason that the most clinical doctors and the general people have been focus on depression day by day, we found that the constituent ratio of depression disorder was more increased in the first visit patient in the year of 2002.3. It is obvious that there has been a great change in the field of drug treatment during these ten years. In old days, the psychological doctors got used to prescribe traditional tricyclic antidepressant (TCA) like imipramine, clomipramine, doxepin and amitriptyline, etc. Nowadays, the psychological doctors select new type selective serotonin reuptake inhibitor (SSRI). There was a gradual transition from traditional tricyclic antidepressant (TCA) to new type selective serotonin reuptake inhibitor (SSRI). Nevertheless, it is well known that the patient's compliance to the doctor's prescription is always poor. To overcome this difficulty, we suggest that we should emphasis on the basic communication between the doctors and the patients in the course of psychological counseling. In another way, we may publicize the correlated knowledge of the most common disease of depression, GAD, panic disorder and OCDr to the patients. Then we can eliminate the patients'consideration and elevate their compliance. |
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