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Diószegi J, Rihmer Z, Torzsa P, Pál L, Czifra Á, Gonda X, Sándor J. Psychiatric health care need in Hungary identified by the short screening algorithm of depression and suicide risk used in general medical practices. Sci Rep 2023; 13:14249. [PMID: 37652947 PMCID: PMC10471575 DOI: 10.1038/s41598-023-41437-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 08/26/2023] [Indexed: 09/02/2023] Open
Abstract
Suicides are often related to depression. General medical practices (GMPs) should play a role in screening depression. We aimed to test the screening algorithm of Rihmer and Torzsa for depression and suicide and determine the prevalence and number of patients in the nationwide representative Hungarostudy 2002 population, and to estimate the corresponding extra health care need in an average GMP and in the Hungarian population in addition to patients who are already cared for by specialized care. The short version of the Beck Hopelessness Scale (BHS) and the Hungarian version of the short form of the Beck Depression Inventory (BDI-9) were used to screen for suicide risk and depression. The prevalence of suicidal thoughts and depression was determined and findings were extrapolated to an average GMP of 1,600 adults and to the population over 25 years of age. This screening would generate a considerable extra psychiatric care to organize and implement in an average GMP and throughout the country. Our findings show that with easily administered screening instruments a significant number of patients likely to have depression can be identified at the primary care level, arguing for the establishment of the extra psychiatric care capacity in Hungary.
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Affiliation(s)
- Judit Diószegi
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary.
| | - Zoltán Rihmer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Balassa utca 6, Budapest, 1082, Hungary
- National Institute of Mental Health, Neurology and Neurosurgery, Amerikai út 57, Budapest, 1145, Hungary
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Stáhly u. 7-9, Budapest, 1085, Hungary
| | - László Pál
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
| | - Árpád Czifra
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Balassa utca 6, Budapest, 1082, Hungary
| | - János Sándor
- Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
- ELKH-DE Public Health Research Group, Department of Public Health and Epidemiology, Faculty of Medicine, University of Debrecen, Kassai út 26, Debrecen, 4028, Hungary
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Hargittay C, Eöry A, Márkus B, Mohos A, Ferenci T, Vörös K, Rihmer Z, Gonda X, Torzsa P. Severity of depressive but not anxiety symptoms impacts glucose metabolism among patients with type 2 diabetes in primary care. Front Med (Lausanne) 2022; 9:944047. [PMID: 35966882 PMCID: PMC9366081 DOI: 10.3389/fmed.2022.944047] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 07/04/2022] [Indexed: 11/21/2022] Open
Abstract
Background Data from primary care regarding the prevalence of symptoms of depression and anxiety, and their effect on glycemic control among people with diabetes is lacking in Hungary. The recently introduced Patient Health Record (PHR) requires family doctors to screen for depressive symptoms. Objectives We aimed to investigate the prevalence of depressive and anxiety symptoms among patients with type 2 diabetes in the general practice, and the relationship between these affective disorders and glycated hemoglobin (HbA1c) level. Methods We included 338 consecutive patients with type 2 diabetes from six primary care practices in this cross-sectional study. A self-administered questionnaire (patient history, anthropometric, socioeconomic, laboratory parameters), the Beck Depression Inventory (BDI) and the Hamilton Anxiety Scale (HAM-A) were used. Results The mean age of the sample was 64.0 ± 11.5 (years ± SD), 61% of participants were female. The prevalence of depressive symptoms was 21%, mainly moderate/severe symptoms (13%). Anxiety symptoms were more common (35%). We found significant univariate association between the depressive symptoms and HbA1c (p = 0.001), suicide attempt (p < 0.001), anxiety (p < 0.001), micro- and macrovascular complication (p = 0.028 and p < 0.001), education (p = 0.001) and place of residence (p = 0.002). In multivariate analysis, however, only BDI score had significant (p = 0.03191) association with glycemic control. Conclusion Among primary care patients with type 2 diabetes, the prevalence of depressive symptoms was less frequent than anxiety symptoms. More severe depressive symptoms were associated with worse glycemic control.
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Affiliation(s)
- Csenge Hargittay
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Ajándék Eöry
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Bernadett Márkus
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - András Mohos
- Department of Family Medicine, Faculty of Medicine, University of Szeged, Szeged, Hungary
| | - Tamás Ferenci
- Physiological Controls Research Center, Óbuda University John von Neumann Faculty of Informatics, Budapest, Hungary
- Department of Statistics, Corvinus University of Budapest, Budapest, Hungary
| | - Krisztián Vörös
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Zoltán Rihmer
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
| | - Xenia Gonda
- Department of Psychiatry and Psychotherapy, Faculty of Medicine, Semmelweis University, Budapest, Hungary
- International Centre for Education and Research in Neuropsychiatry, Samara State Medical University, Samara, Russia
- *Correspondence: Xenia Gonda,
| | - Péter Torzsa
- Department of Family Medicine, Faculty of Medicine, Semmelweis University, Budapest, Hungary
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Stubbs B, Vancampfort D, Solmi M, Veronese N, Fornaro M. How common is bipolar disorder in general primary care attendees? A systematic review and meta-analysis investigating prevalence determined according to structured clinical assessments. Aust N Z J Psychiatry 2016; 50:631-9. [PMID: 26764372 DOI: 10.1177/0004867415623857] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE There are mounting calls for bipolar disorder to be managed in primary care, yet the exact prevalence remains unclear. We conducted a meta-analysis to investigate the prevalence of bipolar disorder in general primary care attendees without other comorbid psychiatric diagnosis. METHOD We systematically searched major electronic databases from inception till 03/2015. Articles were included that reported the prevalence of bipolar disorder determined in line with structured clinical assessment in primary care settings. Two independent authors conducted searches, completed methodological appraisal and extracted data. A random effects meta-analysis and meta-regression were performed. RESULTS Sixteen studies were included accounting for 425,691 participants (mean age = 41.1 years [standard deviation = 7.2 years] 33.3% males). Overall, the global prevalence of bipolar disorder was 1.9% (95% confidence interval = [0.6, 5.4]). The prevalence of bipolar disorder in studies recording a current diagnosis was 3.7% (95% confidence interval = [1.9, 6.0]) and 0.7% (95% confidence interval = [0.2, 1.5]) in studies considering a 12-month period. A diagnosis of bipolar disorder appeared higher in North America (3.7%, 95% confidence interval = [0.9, 8.1]) compared to Europe (0.8%, 95% confidence interval = [0.3, 1.5]). Meta-regression suggests that a more recent publication date (co-efficient = 0.089, 95% confidence interval = [0.0173, 0.1654], z = 2.19, p = 0.01, R(2) = 0.21) and younger age of participants (co-efficient -0.0851, 95% confidence interval = [-0.1696, 0.005], z = -1.97, p = 0.04, R(2) = 0.24) moderated a higher prevalence of bipolar disorder. CONCLUSION The global prevalence of bipolar disorder in primary care is 1.9%, with potentially higher prevalence rates in North America compared to Europe. A more recent study publication date is a significant predictor of higher prevalence of bipolar disorder. Potential reasons/drivers of this are considered within the text.
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Affiliation(s)
- Brendon Stubbs
- Health Service and Population Research Department, Institute of Psychiatry, King's College London, London, UK Physiotherapy Department, Maudsley Hospital, South London and Maudsley NHS Foundation Trust, London, UK
| | - Davy Vancampfort
- UPC KU Leuven, Department of Neurosciences, KU Leuven, Kortenberg, Belgium Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
| | - Marco Solmi
- Department of Neurosciences, University of Padova, Padova, Italy
| | - Nicola Veronese
- Geriatrics Section, Department of Medicine, University of Padova, Padova, Italy
| | - Michele Fornaro
- New York Psychiatric Institute, Columbia University, New York, NY, USA
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Carvalho AF, Nunes-Neto PR, Castelo MS, Macêdo DS, Dimellis D, Soeiro-de-Souza MG, Soczynska JK, McIntyre RS, Hyphantis TN, Fountoulakis KN. Screening for bipolar depression in family medicine practices: prevalence and clinical correlates. J Affect Disord 2014; 162:120-7. [PMID: 24767016 DOI: 10.1016/j.jad.2014.03.040] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2013] [Revised: 03/15/2014] [Accepted: 03/17/2014] [Indexed: 11/15/2022]
Abstract
BACKGROUND To compare individuals in primary care (PC) who screen positive for bipolar depression to those who screened positive for unipolar depression on mental health care ouctomes, PC service utilization, medical comorbidities, suicidal ideation, health-related quality of life (HRQoL) and psychosocial functioning. METHODS In this cross-sectional study, participants (N=1197) answered self-reported measures of depressive symptoms (Center for epidemiologic studies depression scale), HRQoL (World Health Organization Quality of Life instrument-Abbreviated version), medical comorbidity (functional comorbidity index) and functioning (Functional Assessment Short test). Participants were partitioned into 'bipolar' and 'unipolar' depression groups based on a predefined cutoff on the Brazilian mood disorder questionnaire. RESULTS The prevalence of bipolar depression was in PC was 4.6% (95% CI: 3.4-5.8). Participants with bipolar depression were more likely to endorse suicidal ideation, present with more medical comorbidities, report a worse physical HRQoL and have a higher rate of PC services utilization as compared to participants who screened positive for unipolar depression. Only six (10.9%) participants were recognized by the general practitioner as having a diagnosis of bipolar depression. LIMITATIONS The cross-sectional design prevents firm causal inferences from being drawn. A positive screen for BD does not substantiate the actual diagnosis. Co-morbid mental disorders were not accessed. CONCLUSIONS Bipolar depression is common and under-recognized in Brazilian PC services. A positive screen for bipolar depression was associated with worse clinical outcomes and greater PC service utilization.
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Affiliation(s)
- André F Carvalho
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Fortaleza, Ceará, Brazil.
| | - Paulo R Nunes-Neto
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Milena S Castelo
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Clinical Medicine, Faculty of Medicine, Fortaleza, Ceará, Brazil
| | - Danielle S Macêdo
- Psychiatry Research Group, Faculty of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil; Department of Physiology and Pharmacology, Federal University of Ceará, Fortaleza, Ceará, Brazil
| | - Dimos Dimellis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Márcio G Soeiro-de-Souza
- Mood Disorders Unit (GRUDA), Department and Institute of Psychiatry, School of Medicine, University of Sao Paulo (IPq-HC-FMUSP), Brazil
| | - Joanna K Soczynska
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, ON, Canada
| | - Roger S McIntyre
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada; Mood Disorders Psychopharmacology Unit (MDPU), University Health Network, University of Toronto, ON, Canada; Department of Pharmacology, University of Toronto, Toronto, ON, Canada
| | - Thomas N Hyphantis
- Department of Psychiatry, School of Medicine, University of Ioannina, Ioannina, Greece
| | - Konstantinos N Fountoulakis
- 3rd Department of Psychiatry, School of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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Cerimele JM, Chwastiak LA, Dodson S, Katon WJ. The prevalence of bipolar disorder in general primary care samples: a systematic review. Gen Hosp Psychiatry 2014; 36:19-25. [PMID: 24144521 PMCID: PMC3877721 DOI: 10.1016/j.genhosppsych.2013.09.008] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2013] [Revised: 09/17/2013] [Accepted: 09/18/2013] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To obtain an estimate of the prevalence of bipolar disorder in primary care. METHODS We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses method to conduct a systematic review in January 2013. We searched seven databases with a comprehensive list of search terms. Included articles had a sample size of 200 patients or more and assessed bipolar disorder using a structured clinical interview or bipolar screening questionnaire in random adult primary care patients. Risk of bias in each study was also assessed. RESULTS We found 5595 unique records in our search. Fifteen studies met our inclusion criteria. The percentage of patients with bipolar disorder found on structured psychiatric interviews in 10 of 12 studies ranged from 0.5% to 4.3%, and a positive screen for bipolar disorder using a bipolar disorder questionnaire was found in 7.6% to 9.8% of patients. CONCLUSION In 10 of 12 studies using a structured psychiatric interview, approximately 0.5% to 4.3% of primary care patients were found to have bipolar disorder, with as many as 9.3% having bipolar spectrum illness in some settings. Prevalence estimates from studies using screening measures that have been found to have low positive predictive value were generally higher than those found using structured interviews.
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Affiliation(s)
- Joseph M. Cerimele
- University of Washington School of Medicine Dept. of Psychiatry and Behavioral Sciences, Seattle WA
| | - Lydia A. Chwastiak
- University of Washington School of Medicine Dept. of Psychiatry and Behavioral Sciences, Seattle WA,Harborview Medical Center, Seattle WA
| | - Sherry Dodson
- University of Washington School of Medicine Health Sciences Library
| | - Wayne J. Katon
- University of Washington School of Medicine Dept. of Psychiatry and Behavioral Sciences, Seattle WA
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Töreki A, Andó B, Keresztúri A, Sikovanyecz J, Dudas RB, Janka Z, Kozinszky Z, Pál A. The Edinburgh Postnatal Depression Scale: translation and antepartum validation for a Hungarian sample. Midwifery 2012; 29:308-15. [PMID: 22417756 DOI: 10.1016/j.midw.2012.01.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2011] [Revised: 12/12/2011] [Accepted: 01/15/2012] [Indexed: 11/15/2022]
Abstract
OBJECTIVE the Edinburgh Postnatal Depression Scale (EPDS) is an important screening instrument routinely used during the peripartum period for the identification of depression. The purpose of the study was to assess the validity of the 10-item EPDS in screening for antepartum depression (APD) in Hungary. DESIGN validation study carried out between July and December 2010. SETTING Department of Obstetrics and Gynecology, University of Szeged, Hungary. PARTICIPANTS 219 women attending a routine check-up at 12 weeks antepartum. INTERVENTIONS participants completed the newly translated Hungarian version of the EPDS and underwent a clinical assessment with the Structured Clinical Interview for DSM-IV disorders (SCID-I). MEASUREMENT AND FINDINGS seven (3.2%) of the mothers were diagnosed with major antepartum depression and 15 persons (6.85%) with minor depression on the basis of the SCID. Internal consistency of the EPDS was satisfactory (Cronbach α coefficients ≥0.728). The best cut-off on the Hungarian version of the EPDS for major depression was 8/9, with a sensitivity of 71.4%, and a specificity of 91.5%. The area under the ROC curve was found significant for combined depression as well and at a cut-off of 6/7 indicated a sensitivity of 81.8% and a specificity of 83.2%. KEY CONCLUSIONS the EPDS showed acceptable validity despite a considerable scatter in the total scores in our sample. IMPLICATION FOR PRACTICE the EPDS is a reliable instrument for the screening of depressive disorders, especially major depressive disorder in early pregnancy among Hungarian women.
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Affiliation(s)
- Annamária Töreki
- Department of Obstetrics and Gynecology, University of Szeged, Semmelweis u. 1., Szeged, Hungary.
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Bödecs T, Máté O, Horváth B, Kovács L, Rihmer Z, Sebestyen B, Gonda X, Sándor J. Barriers of antenatal folate-supplementation: The role of depression and trait-anxiety on periconceptional folate-intake. Int J Psychiatry Clin Pract 2010; 14:102-8. [PMID: 24922469 DOI: 10.3109/13651500903434479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract Objective. The aim of the research was to reveal the effect of antenatal depressive symptoms and trait-anxiety on folate supplementation. Higher levels of depression, and trait-anxiety were hypothesized to be associated with insufficient folate intake among pregnant women in early pregnancy. Methods. Level of depressive symptoms, trait-anxiety, self-esteem, social capital, self-related health, and demographic factors (age, number of siblings, marital, educational, employment, and socioeconomic-status) were established among 185 Hungarian women in the first trimester of their pregnancies. Depressive symptoms and trait-anxiety were evaluated with the Short Hungarian Version of the Beck Depression Inventory and the Hungarian version of the Spielberger State-Trait Anxiety Inventory form Y (STAI-Y). Results. The higher levels of both trait-anxiety and self-esteem decreased the folate-intake significantly, OR=0.925 (95%CI=0.863-0.991; P=0.026) and OR=0.897 (95%CI=0.808-0.996; P=0.041) while depressive symptoms did not have an effect on it. The lower level of education (less than 8 elementary years) had similar effects (OR=0.228 [95%CI=0.064-0.817], P=0,023). The lack of trust had a significant role too (P=0.043): those, who were distrustful with other people, also had a lower chance of supplementation (OR=0.620; 95%CI=0.390-0.986). Conclusions. The way to increase the openness towards folate-supplementation leads through the treatment of psychological disturbances and the restoration of social trust.
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Affiliation(s)
- Tamás Bödecs
- Department of Health Visiting, Institute of Public Health, Recreation and Health Promotion, Faculty of Health Sciences, University of Pécs, Szombathely Campus, Hungary
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Lazary J, Lazary A, Gonda X, Benko A, Molnar E, Hunyady L, Juhasz G, Bagdy G. Promoter variants of the cannabinoid receptor 1 gene (CNR1) in interaction with 5-HTTLPR affect the anxious phenotype. Am J Med Genet B Neuropsychiatr Genet 2009; 150B:1118-27. [PMID: 19725030 DOI: 10.1002/ajmg.b.31024] [Citation(s) in RCA: 55] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Anxiety is a polygenic condition, and the recently discovered Endocannabinoid System (ECS) is one plausible candidate. Experimental data suggest that the ECS can modulate several neurotransmitter systems, including the serotonergic system, which itself plays a significant role in anxiety. However, to date there is no evidence of gene-gene interactions; indeed genetic studies focusing separately on the two systems provide conflicting data. Thus, the aim of our study was to analyze the interaction of the promoter regions of the serotonin transporter (SLC6A4) and cannabinoid receptor 1 (CNR1) genes on anxiety. We genotyped 706 individuals for the 5-HTTLPR in the SLC6A4 promoter and 4 SNPs located in the CNR1 promoter region. Anxiety was measured by the State-Trait Anxiety Inventory (STAI-S, STAI-T), the anxiety subscale of TEMPS-A (TEMPS-Anx), and the Brief Symptom Inventory (BSI-Anx). Significant 5-HTTLPR x CNR1 promoter-promoter interaction was observed using STAI-T (P = 0.0006) and TEMPS-Anx (P = 0.0013). The risk of high anxiety scores on BSI-Anx was 4.6-fold greater in homozygous 'GG' rs2180619 in combination with homozygous 'SS' 5-HTTLPR (P = 0.0005) compared to other genotypes. The effect of previously described "TGC" haplotype in the alternative promoter of CNR1 depended both on the conventional promoter polymorphism and the 5-HTTLPR. Our haplotype and putative transcription binding profile analyses strongly suggest that certain constellations of CB1-receptor and 5-HTT promoters yield extremely high or low synaptic 5-HT concentrations, and these are associated with an anxious phenotype. In conclusion, genetically determined serotonergic and endocannabinoid dysfunctions could lead to a vulnerability causing anxiety disorders and possibly depression.
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Affiliation(s)
- Judit Lazary
- Department of Pharmacology and Pharmacotherapy, Semmelweis University, Budapest, Hungary
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Bödecs T, Horváth B, Kovács L, Diffellné Németh M, Sándor J. Prevalence of depression and anxiety in early pregnancy on a population based Hungarian sample. Orv Hetil 2009; 150:1888-93. [DOI: 10.1556/oh.2009.28712] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Hazánkban nem történt átfogó vizsgálat a várandósság alatti depresszió és szorongás gyakoriságának feltérképezésére.
Célkitűzés:
A szerzők a hiányzó adatok megállapításán túl célul tűzték ki azok szociodemográfiai összefüggéseinek vizsgálatát is.
Módszer:
Szombathely 10 védőnői körzetében populációs alapú monitoringot hoztak létre minden nőről, aki 2008. február 1. és 2009. február 1. között került terhességi nyilvántartásba. Háromszázhét fő kora terhességi várandóson a depressziót a rövid Beck-depresszió-kérdőívvel, a szorongást a Spielberger-féle vonásszorongás-kérdőívvel mérték.
Eredmények:
A várandósok 17,9%-a (95%MT: 13,0–21,5%) jelzett depressziós tüneteket, 1,0%-uk súlyos depressziót mutatott. A szorongásos tüneteket mutatók aránya 14,6% (95%MT: 10,7–18,6%) volt, míg 4,2% kifejezetten szorongott. Szignifikánsan magasabb szintű depressziót és szorongást jeleztek a szakmunkás képesítésnél kevesebbel rendelkezők, a legalacsonyabb jövedelműek és a munkahellyel nem rendelkezők. Ezenfelül szignifikánsan magasabb depressziót jeleztek a 18 évnél fiatalabbak és az élettársi kapcsolatban élők.
Következtetések:
A vizsgált mintában a kora terhességi depresszió és szorongás prevalenciája lényegében megegyezik a fejlett piacgazdaságú országokban megfigyelhető gyakoriságokkal.
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Affiliation(s)
- Tamás Bödecs
- 1 Pécsi Tudományegyetem, Egészségtudományi Kar Népegészségtani, Rekreációs és Egészségfejlesztési Intézet, Védőnői Tanszék Szombathely Jókai út 14. 9700
| | - Boldizsár Horváth
- 2 Pécsi Tudományegyetem, Egészségtudományi Kar Ápolás és Betegellátás Intézet, Szülésznői Tanszék Szombathely
| | - Lajos Kovács
- 3 Szombathelyi Egészségügyi Központ Vasútegészségügyi Kht. Szombathely
| | - Marietta Diffellné Németh
- 1 Pécsi Tudományegyetem, Egészségtudományi Kar Népegészségtani, Rekreációs és Egészségfejlesztési Intézet, Védőnői Tanszék Szombathely Jókai út 14. 9700
| | - János Sándor
- 4 Pécsi Tudományegyetem, Egészségtudományi Kar Népegészségtani, Rekreációs és Egészségfejlesztési Intézet, Népegészségtani és Epidemiológiai Tanszék Pécs
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Torzsa P, Rihmer Z, Gonda X, Szokontor N, Sebestyen B, Faludi G, Kalabay L. Family history of suicide: a clinical marker for major depression in primary care practice? J Affect Disord 2009; 117:202-4. [PMID: 19211149 DOI: 10.1016/j.jad.2009.01.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 01/09/2009] [Accepted: 01/09/2009] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to investigate the family history of suicide among primary care patients with or without current major depressive episode (MDE). METHODS This study was performed in 2 GP practices in Budapest on 255 consecutively investigated primary care attendees. The diagnosis of current MDE (symptomatic MDE or MDE in partial remission) was made by the Hungarian version of the Primary Care Evaluation of Mental Disorders (PRIME-MD). Family history of suicide was rated as positive where the patients reported at least one first or second degree relative with completed suicide. RESULTS Out of the 255 consecutively investigated patients 45 (17.6%) have had current MDE and 24 (9.4%) have had positive family history of suicide. The family history of suicide was significantly more common among patients with current MDE than among those without it (26.6% vs 5.7%, p=0.0001). Fifty percent of patients with, and 14.3% of patients without family history of suicide have had current MDE (p=0.0001). LIMITATION Small sample size, and lacking data on fully remitted major depressives as well as on comorbid psychiatric and medical disorders. CONCLUSION History of completed suicide among first or second degree relatives could be a good and simple clinical marker for current and lifetime MDE in primary care patients.
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Affiliation(s)
- Peter Torzsa
- Department of Family Medicine, Kutvolgyi Clinical Center, Semmelweis University, Faculty of Medicine, Kutvolgyi ut 4, 1125 Budapest, Hungary
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Luciano Devis JV, Fernández Sánchez A, Serrano-Blanco A, Pinto-Meza A, Palao Vidal DJ, Mercader Menéndez M, Haro Abad JM. [Cooperation between primary care and mental health services]. Aten Primaria 2009; 41:131-40. [PMID: 19303666 DOI: 10.1016/j.aprim.2008.05.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Accepted: 05/28/2008] [Indexed: 10/20/2022] Open
Abstract
PURPOSE To find out the current coordination/cooperation level of primary care (PC) with the adult mental health centres (AMHC), the addiction treatment centres (ATC) and children and adolescent mental health centres (CAMHC) of Catalonia (Spain). Differences in coordination between urban and non-urban areas were also evaluated. DESIGN Cross-sectional descriptive study. SETTING Eighty PC centres representing the seven health regions of Catalonia. PARTICIPANTS Selection was by means of a multi-staged and stratified sampling method. A total of 356 of the 618 PC physicians who agreed to participate completed a survey evaluating different aspects of coordination with the specialised mental health services. RESULTS The PC physicians indicated that the availability of AMHC was worse than that provided by ACT and CAMHC. However, the reports on the state of the referred patients and the training courses in mental health offered by the AMHC were more frequent. There were no significant differences in availability or training in mental health between urban and non-urban areas. CONCLUSIONS The cooperation between the PC and the specialised mental health services of Catalonia is optimal in some aspects, but patient waiting time needs to be reduced for first visits to the AMHC and training activities offered by the CAMHC and the ACT need to be increased.
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Affiliation(s)
- Juan Vicente Luciano Devis
- Unidad de Investigación y Desarrollo, Sant Joan de Déu, Servicios de Salud Mental, Sant Boi de Llobregat, Barcelona, España.
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12
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Shepherd RM, Edelmann RJ. Social phobia and the self medication hypothesis: A case study approach. COUNSELLING PSYCHOLOGY QUARTERLY 2007. [DOI: 10.1080/09515070701571756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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13
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Abstract
This paper provides a critical review of the prevalence of social phobia in European countries, a description of associated disability and burden and of clinical correlates and risk factors associated with social phobia. On the basis of a comprehensive literature search we identified 21 community studies and two primary care studies. The median lifetime and 12-month prevalence rates of social phobia in community samples referring to DSM-III-R and DSM-IV criteria were 6.65% and 2.0%, respectively. Younger individuals showed the highest rates, and women were more frequently affected than men. Social phobia was shown to be a persistent condition with a remarkably high degree of comorbid conditions, associated impairment and disability. Research deficits lie in a lack of data for most EU countries and in a lack of studies in children and the elderly. No data are available addressing met and unmet needs for intervention and costs, and data for vulnerability and risk factors of malignant course are scarce.
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Affiliation(s)
- Lydia Fehm
- Department of Psychology, Humboldt-University Berlin, Rudower Chaussee 18, D-12489 Berlin, Germany.
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14
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Wittchen HU, Jacobi F. Size and burden of mental disorders in Europe--a critical review and appraisal of 27 studies. Eur Neuropsychopharmacol 2005; 15:357-76. [PMID: 15961293 DOI: 10.1016/j.euroneuro.2005.04.012] [Citation(s) in RCA: 785] [Impact Index Per Article: 41.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Epidemiological data on a wide range of mental disorders from community studies conducted in European countries are presented to determine the availability and consistency of prevalence, disability and treatment findings for the EU. Using a stepwise multimethod approach, 27 eligible studies with quite variable designs and methods including over 150,000 subjects from 16 European countries were identified. Prevalence: On the basis of meta-analytic techniques as well as on reanalyses of selected data sets, it is estimated that about 27% (equals 82.7 million; 95% CI: 78.5-87.1) of the adult EU population, 18-65 of age, is or has been affected by at least one mental disorder in the past 12 months. Taking into account the considerable degree of comorbidity (about one third had more than one disorder), the most frequent disorders are anxiety disorders, depressive, somatoform and substance dependence disorders. When taking into account design, sampling and other methodological differences between studies, little evidence seems to exist for considerable cultural or country variation. Disability and treatment: despite very divergent and fairly crude assessment strategies, the available data consistently demonstrate (a) an association of all mental disorders with a considerable disability burden in terms of number of work days lost (WLD) and (b) generally low utilization and treatment rates. Only 26% of all cases had any consultation with professional health care services, a finding suggesting a considerable degree of unmet need. The paper highlights considerable future research needs for coordinated EU studies across all disorders and age groups. As prevalence estimates could not simply be equated with defined treatment needs, such studies should determine the degree of met and unmet needs for services by taking into account severity, disability and comorbidity. These needs are most pronounced for the new EU member states as well as more generally for adolescent and older populations.
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Affiliation(s)
- Hans-Ulrich Wittchen
- Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany.
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15
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Abstract
OBJECTIVE To summarize epidemiological studies providing data on prevalence, incidence, comorbidity, natural course, risk factors and consequences of social phobia (SP). METHOD Data from cross-sectional studies and prospective longitudinal studies in particular are considered. RESULTS These studies portray SP as a frequent mental disorder, which begins typically in early adolescence, and is highly comorbid with other anxiety disorders, as well as secondary depression and substance abuse disorders. Several possible risk factors have already been identified for the onset and unfavorable course of SP; some of them have been tested in prospective longitudinal studies. SP is a chronic disorder when compared with other mental disorders and when subclinical symptomatic levels are considered. Impairment caused by SP is considerable and increases over a patient's life span. The negative impact of SP is not only reflected in subjective well-being and reduced quality of life but also in social role functioning, and it impacts negatively on career progression. CONCLUSION Prospective longitudinal studies in representative samples drawn from the general population provide information that allows the overall direct and indirect costs of the disorder (treatment costs, disability, social welfare) to be determined, and enables an improvement in long-term care strategies as well as preventive efforts to be established.
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Affiliation(s)
- H-U Wittchen
- Department of Clinical Psychology and Psychotherapy, Dresden University of Technology, Chemnitzer Str. 46, Dresden, Germany.
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16
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Abstract
OBJECTIVES Multiple relationships between anxiety, allergic symptoms, and treatment difficulties have been observed. The aim of the present study was to estimate the prevalence of anxiety disorders in outpatients with various allergic diseases, to identify diagnostic cues or possible risk factors, and to test the usefulness of self-administered questionnaire screening at the allergy clinic. METHODS Six hundred forty-six (646) consecutive patients with rhinoconjunctivitis (59.3%), asthma (26.8%), or "other" allergy (13.9%), aged 16 to 65 years, completed self-administered questionnaires in six outpatient allergy clinics; 60 of the respondents also participated in structured psychiatric interviews. Anxiety was measured with the Spielberger State-Trait Anxiety. RESULTS According to the interviews, STAI-T > 52 predicted with 86% accuracy a current psychiatric diagnosis, without differentiating between anxiety and depression. Using this threshold, the rate of anxiety and/or depressive disorders is estimated as 19% (95% CI: 15.9-22.1) in our unselected allergic outpatient sample; 46% of these patients never received any psychopharmacological treatment, indicating that anxiety related disorders are underdiagnosed and undertreated. Risk indicators were female gender; asthma; perennial symptoms; sleep problems; nonspecific allergy triggers like strong emotions; stressful situations; and considerable limitation in everyday activities attributed to the allergic symptoms. CONCLUSIONS Our findings confirm a high rate of anxiety and/or depressive disorders in patients visiting the allergy clinic. Self-administered questionnaires such as STAI-T provide reliable help for the identification of these frequent psychiatric problems.
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Affiliation(s)
- Adrienne Stauder
- Semmelweis University, Faculty of Medicine, Institute of Behavioural Sciences, Budapest, Hungary.
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17
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Rihmer Z, Szádóczky E, Füredi J, Kiss K, Papp Z. Anxiety disorders comorbidity in bipolar I, bipolar II and unipolar major depression: results from a population-based study in Hungary. J Affect Disord 2001; 67:175-9. [PMID: 11869765 DOI: 10.1016/s0165-0327(01)00309-3] [Citation(s) in RCA: 72] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
BACKGROUND The aim of this study was to analyze the lifetime comorbidity between DSM-III-R anxiety disorders in separate subgroups of patients with major depression, bipolar II and bipolar I disorder in a community sample of a Hungarian population. METHODS Randomly selected subjects (aged between 18 and 64 years, N=2953) were interviewed by the Diagnostic Interview Schedule (DIS) which generated DSM-III-R diagnoses. RESULTS The prevalence of generalized anxiety disorder, agoraphobia and simple phobia was the highest among bipolar II patients (20.8, 37.5 and 16.7%, respectively), social phobia was most prevalent in (nonbipolar) major depression (17.6%), while the rate of panic disorder was the same in the (nonbipolar) major depressive and bipolar II subgroups (12.4 and 12.5%, respectively). Bipolar I patients showed a relatively low rate of comorbidity. CONCLUSIONS The findings support previous results on the particularly high rate of lifetime comorbidity between anxiety disorders and unipolar major depression and particularly bipolar II illness. LIMITATIONS Underestimation of the prevalence of bipolar II disorder by the diagnostic methodology used, resulting in a small number of bipolar II cases, lack of analysis of data by gender, no data on obsessive-compulsive disorder.
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Affiliation(s)
- Z Rihmer
- National Institute for Psychiatry and Neurology, POB 1, Budapest 27, 1281 Hungary.
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18
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Abstract
Social phobia is a common condition, with current prevalence estimates in the range of 4% to 6% and a lifetime risk of 7% to 13%. It has an early onset and, without appropriate intervention, it has a disproportionately higher risk for persistence compared with other anxiety disorders. Presentation differs between age groups; the disorder in teenagers and in those in their early 20s tends to look different in terms of types of problems and the associated distress to that expected in the 30s and 40s age groups, when these individuals have already endured 20 years of suffering and disability. There is an increased risk for depression and substance abuse disorders even in adolescence, in addition to an increased risk for psychosocial impairment and disability resembling that experienced by depressed outpatients. This finding is particularly true in cases affected by generalized SP, which might have slightly different etiologic pathways than the nongeneralized type. Social phobia is in itself a disabling disorder, and individuals who develop comorbid conditions have a more severe level of disability. Early recognition, diagnosis, and treatment of SP could minimize sufferers' problems throughout their subsequent lives, preventing the development of comorbidity and a worsened prognosis. Developing models for early recognition and treatment should improve the outcome for the patient, as well as reduce future demand on health care resources. Epidemiologic studies, with their methodologic strengths and unique methods, can be instrumental in this respect. They may, for example, provide time-efficient, simple screening tools for use by physicians or even patients, based on the existing diagnostic instruments used in epidemiologic surveys. They may provide further guidance in making treatment decisions and developing treatment algorithms by offering criteria, which with additional vulnerability and risk factors, will lead to more severe, chronic, and comorbid course in a given case.
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Affiliation(s)
- H U Wittchen
- Department of Clinical Psychology and Psychotherapy, Technical University of Dresden, Dresden, Germany.
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19
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Dingemans AE, van Vliet IM, Couvée J, Westenberg HG. Characteristics of patients with social phobia and their treatment in specialized clinics for anxiety disorders in the Netherlands. J Affect Disord 2001; 65:123-9. [PMID: 11356235 DOI: 10.1016/s0165-0327(00)00238-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Social phobia frequently occurs in the general population but is probably underreported due to comorbid disorders which mask the social phobia. Another reason might be that patients do not consult their general pratitioner due to embarrassment or an estimation of their condition. There are several treatments available for social phobia, but not enough is known about the efficacy of the different treatments strategies. METHODS A retrospective, medical record-based study was carried out in four outpatient clinics specializing in treatment of anxiety disorders to investigate the characteristics of 64 patients with a DSM-IV axis diagnosis of social phobia who seeked help for their problems. Therapies for social phobia within these clinics and differences between these clinics were evaluated. RESULTS Men with a high educational level tended to seek more help and comorbid disorders tended to cause more impairment in functioning. Further, there is a large delay between onset and therapy attendance (mean 14 years). Finally, there was consistency in the treatment of social phobia in these four clinics which consisted of cognitive behavioral therapy and/or medication. LIMITATIONS The study is retrospective and based on medical records which means there was no objective measurement of the effectiveness of the therapies. CONCLUSIONS Seventy-five percent of patients improved after treatment independent of the kind of therapy, the occurrence of comorbid disorders and the type of social phobia.
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Affiliation(s)
- A E Dingemans
- Academic Hospital Utrecht, Department of Psychiatry, HP A00.241, P.O. Box 85500, 3508 GA Utrecht, The Netherlands
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20
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Abstract
There is an important discrepancy between animal models of anxiety and human anxiety patients: while experimental animals are usually unstressed, patients usually have a long history of stress. Stressful life events not only contribute to the development and/or maintenance of mood disorders in humans but also affect the efficacy of anxiolytic treatment in both animals and humans. The effects are not trivial: sometimes stress may totally abolish the effects of certain anxiolytics. Therefore, the relationship between stress exposure and anxiolytic efficacy should be an important area of research and drug development. There are several benefits that may be derived from similar studies: (i) the effect of stress may unravel yet unknown aspects of the mechanism of action of different drugs; (ii) the relevance of laboratory studies would increase; and (iii) laboratory findings may provide cues regarding the clinical use of drugs.
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Affiliation(s)
- J Haller
- Institute of Experimental Research, P.O. Box 67, Budapest 1450, Hungary.
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21
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Lecrubier Y, Wittchen HU, Faravelli C, Bobes J, Patel A, Knapp M. A European perspective on social anxiety disorder. Eur Psychiatry 2000; 15:5-16. [PMID: 10713797 DOI: 10.1016/s0924-9338(00)00216-9] [Citation(s) in RCA: 64] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Epidemiologic surveys conducted across Europe indicate that the lifetime prevalence of social anxiety disorder in the general population is close to 7%. The disorder in adulthood rarely presents in its 'pure' form and 70-80% of patients have at least one other psychiatric disorder, most commonly depression. Social anxiety disorder is a risk factor for the development of depression and alcohol/substance use or dependence, especially in cases with an early onset (< 15 years). Individuals with social anxiety disorder have significant functional impairment, notably in the areas of initiation and maintenance of social/romantic relationships and educational and work achievement. The economic consequences of social anxiety disorder are considerable, with a high level of diminished work productivity, unemployment and an increased utilisation of medical services amongst sufferers. Effective treatment of social anxiety disorder would improve its course and its health and economic consequences.
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Affiliation(s)
- Y Lecrubier
- Inserm, Hôpital de la Salpêtrière, Paris, France
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22
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Haller J, Fuchs E, Halász J, Makara GB. Defeat is a major stressor in males while social instability is stressful mainly in females: towards the development of a social stress model in female rats. Brain Res Bull 1999; 50:33-9. [PMID: 10507469 DOI: 10.1016/s0361-9230(99)00087-8] [Citation(s) in RCA: 175] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Social stress models appear useful in elucidating the interrelationship between stress, mood disorders, and drug efficacy. However, reliable social stress models for females are virtually lacking. The aim of this study was to determine stress-related consequences of (a) defeat in aggressive encounters and (b) social instability, in male and female rats. Defeat in male and female subjects was induced by aggressive male residents and female residents made aggressive by surgery (mediobasal hypothalamic lesion [MBHL]), respectively. Aggressiveness of resident males and resident MBHL females was remarkably similar. Alternating isolation and mixed-sex crowding phases with membership rotation were used to induce social instability. Aggression was kept low in the latter paradigm by manipulating crowding group composition. Defeat stress reduced weight gain, and increased both adrenals and plasma corticosterone in males. Only adrenal weight was affected in females. Social instability reduced weight gain, and induced thymus involution, adrenal hypertrophy and elevated plasma corticosterone levels in females. Only weight gain and thymus weights were affected in males. It is concluded that defeat stresses males more than females, while social instability is more stressful for females than for males, if aggressive contacts are low. It is suggested that the social instability model is a good model of social stress in females.
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Affiliation(s)
- J Haller
- Institute of Experimental Medicine, Budapest, Hungary.
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23
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Bodlund O, Andersson SO, Mallon L. Effects of consulting psychiatrist in primary care. 1-year follow-up of diagnosing and treating anxiety and depression. Scand J Prim Health Care 1999; 17:153-7. [PMID: 10555244 DOI: 10.1080/028134399750002566] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022] Open
Abstract
OBJECTIVE Epidemiological screening of anxiety and depressive disorders in primary care and evaluation of how these patients are identified and treated. Follow-up after 1 year of psychiatric consultation/liaison (C/L) and educational activities. SUBJECTS AND DESIGN In the baseline study 374 unselected and consecutive patients, and in the follow-up study 254 patients (response rate 94.5% and 90.3%, respectively) answered the screening instrument HAD scale (Hospital Anxiety and Depression scale). The HAD results were compared to clinical diagnosis and treatment according to the medical records. Differences after 1 year were analysed. RESULTS At follow-up the prevalence of anxiety had increased from 11.8% to 16.5% (p < 0.05), and of depression from 3.7% to 4.7% (NS) according to HAD. Also, at the follow-up more cases of anxiety disorders were clinically diagnosed--13% vs 8%--as well as an increased number of cases of depressive disorders--7.9% vs 4.0%. The agreement between HAD diagnosis and clinical judgement had increased significantly (p < 0.001) for anxiety disorders from 37% to 70%, and for depression from 20% to 45%. Treatment prevalence had also improved (p < 0.001) at the follow-up for anxiety disorders from 33% to 55% and for depression from 47% to 80%. In total, 4.0% of the baseline and 11.4% of the follow-up population were treated for anxiety and/or depression. CONCLUSIONS Anxiety and depressive disorders are prevalent in primary care. However, only a minority of these patients are identified and treated. Psychiatric consultant support seems to be effective in improving GP's diagnostic and therapeutic skills thus enabling these widespread disorders to be identified at an early stage and properly treated.
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Affiliation(s)
- O Bodlund
- Department of Psychiatry, Umeå University, Sweden
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24
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Szádóczky E, Papp ZS, Vitrai J, Ríhmer Z, Füredi J. The prevalence of major depressive and bipolar disorders in Hungary. Results from a national epidemiologic survey. J Affect Disord 1998; 50:153-62. [PMID: 9858075 DOI: 10.1016/s0165-0327(98)00056-1] [Citation(s) in RCA: 144] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
In order to estimate the prevalence of affective disorders in Hungary a sample of the Hungarian adult population (18-64 years) selected at random was interviewed using the Diagnostic Interview Schedule (DIS) which generated DSM-III-R diagnoses. The lifetime rate for Major Depressive Disorder (MDD) was 15.1%, and for Bipolar Disorders (BD) 5.1%. The female-to-male ratio was 2.7 for MDD and nearly equal for BD. The 1-year and 1-month period prevalence rates were 7.1% and 2.6% for MDD and 0.9% and 0.5% for manic episodes. A higher rate of divorced or separated persons was found among individuals with a lifetime diagnosis of MDD. Besides these, the lifetime diagnosis of BD coexisted with higher rates of the never-married state. The highest hazard rate for the development of BD or MDD was in the range 15-19 years but in MDD another peak was also found in the range 45-50 years. The first peak was characteristic of the recurrent, and the other one of the single form of MDD. Insomnia, loss of energy, decreased interest, concentration problems were the most common symptoms during the depressive episode, independent of polarity. Higher rates of lifetime diagnosis of dysthymia and all kinds of anxiety disorder were revealed among persons with MDD. BD was associated with GAD (Generalized Anxiety Disorder), and panic disorder more often than chance.
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Affiliation(s)
- E Szádóczky
- Department of Psychiatry, The University of Haynal Imre Health Science, Budapest, Hungary
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