title: Prospective evaluation of specialist inpatient treatment for refractory affective disorders.
abstract: BACKGROUND
  Little data exist to inform the treatment of severe and resistant affective disorders. We report here the effectiveness of specialist multimodal inpatient treatment for refractory affective disorders.
  
  
  METHODS
  Prospective evaluation of 225 consecutive patients admitted to the National Affective Disorders Unit between 2001 and 2008.
  
  
  RESULTS
  Patients were highly treatment-resistant: most had already received ECT, lithium augmentation and over 10 prior treatment trials. Even so, sequential assessment with the Hamilton Depression Rating Scale found that 69% showed a clinical response (≥ 50% reduction in Hamilton score) to intensive therapy during admission; 50% continued to sustain a full response and 71% at least a partial response on discharge. Patients' self-ratings (57% very much or much improved, 24% slightly improved) and relative and referrer reports (75% and 68% respectively rated patients as improved) gave similar levels of improvement.
  
  
  CONCLUSIONS
  This was an observational study, without any untreated control group. The generalisability of the findings is limited by the highly specialised nature of the unit.
  
  
  CONCLUSIONS
  Most patients with depression highly resistant to prior treatment respond to specialist and intensive multimodal inpatient therapy.
authors.affiliation: King's College London, Institute of Psychiatry, Department of Psychological Medicine, Section of Neurobiology of Mood Disorders, London SE5 8AZ, UK.
authors.forename: Sarah C
authors.initials: SC
authors.lastname: Wooderson
authors.forename: Mario F
authors.initials: MF
authors.lastname: Juruena
authors.forename: Abebaw
authors.initials: A
authors.lastname: Fekadu
authors.forename: Clodagh
authors.initials: C
authors.lastname: Commane
authors.forename: Catherine
authors.initials: C
authors.lastname: Donaldson
authors.forename: Mary
authors.initials: M
authors.lastname: Cowan
authors.forename: Moya
authors.initials: M
authors.lastname: Tomlinson
authors.forename: Lucia
authors.initials: L
authors.lastname: Poon
authors.forename: Kalypso
authors.initials: K
authors.lastname: Markopoulou
authors.forename: Lena
authors.initials: L
authors.lastname: Rane
authors.forename: Jacek
authors.initials: J
authors.lastname: Donocik
authors.forename: Catherine
authors.initials: C
authors.lastname: Tunnard
authors.forename: Brendan
authors.initials: B
authors.lastname: Masterson
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Cleare
mesh_terms: D000928:Antidepressive Agents / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000628:therapy; D016009:Chi-Square Distribution; D003131:Combined Modality Therapy; D003866:Depressive Disorder / Q000628:therapy; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000188:drug therapy / Q000628:therapy*; D010348:Patient Care Team; D011446:Prospective Studies; D011567:Psychiatric Department, Hospital; D011569:Psychiatric Status Rating Scales; D012017:Referral and Consultation; D013038:Specialization; D018709:Statistics, Nonparametric; D017211:Treatment Failure; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000928:Antidepressive Agents