LESSONS FROM A MOOD DISORDERS UNIT

Specialist treatment centres, such as the Mood Disorders Unit (MDU) at Prince Henry Hospital, Sydney, have developed in response to the high prevalence of mood disorders and their frequent persistence and treat ment resistance. The MDU's assessment and treatment of patients from a state-wide catchment area and its teaching and research effectiveness are reviewed. Of 479 patients assessed between 1985 and 1989, there w ere 304 with primary depressive disorders, of whom 154 were followed u p by clinical assessment at 52 weeks and 231 by telephone interview at 3 1/2 years. At intake, 59% were tertiary referral patients and 88% w ere from outside the local area. Two-thirds were recovered 3 1/2 years later, despite the disorders having been generally severe and protrac ted. Treatment modality was associated primarily with diagnosis, but a lso with age and somewhat with the patient's personality and consultan t psychiatrists' preferences. No consistent predictors of outcome were discerned. Specialist tertiary referral centres, such as the MDU, con tribute significantly to treatment success, especially of difficult ca ses, and enrich teaching and research.