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Despite extensive clinical concern about rates of obesity in patients
with schizophrenia, there is little evidence of the extent of this
problem at a population level.
To estimate levels of obesity in a national population sample by
comparing patients with schizophrenia with matched controls.
We calculated levels of obesity for each patient with schizophrenia from
the national Primary Care Clinical Informatics Unit database (n=4658)
matched with age, gender and neighbourhood controls.
We demonstrated a significant increased obesity hazard for the
schizophrenia group using Cox regression analysis, with odds ratio (OR)
of 1.94 (95% CI 1.81–2.10) (under the assumption of missing body mass
index (BMI) indicating non-obesity) and OR=1.68 (95% CI 1.55–1.81) where
no assumptions were made for missing BMI data.
People with schizophrenia are at increased risk of being obese compared
with controls matched by age, gender and practice attended. Priority
should be given to research which aims to reduce weight and increase
activity in those with schizophrenia.
Little is known about the presentation and management of seasonal affective disorder (SAD) in primary care.
To determine the use of health care services by people suffering from SAD.
Following a screening of patients consulting in primary care, 123 were identified as suffering from SAD. Each was age— and gender-matched with two primary care consulters with minimal seasonal morbidity yielding 246 non-seasonal controls. From primary care records, health care usage over a 5-year period was established.
Patients with SAD consulted in primary care significantly more often than controls and presented with a wider variety of symptoms. They received more prescriptions, under went more investigations and had more referrals to secondary care.
Patients with SAD are heavy users of health care services. This may reflect the condition itself, its comorbidity or factors related to the personality or help-seeking behaviour of sufferers.
Studies of light therapy have not been conducted previously in primary care.
To evaluate light therapy in primary care.
Fifty-seven participants with seasonal affective disorder were randomly allocated to 4 weeks of bright white or dim red light. Baseline expectations for treatment were assessed. Outcome was assessed with the Structured Interview Guide for the Hamilton Depression Scale, Seasonal Affective Disorder Version.
Both groups showed decreases in symptom scores of more than 40%. There were no differences in proportions of responders in either group, regardless of the remission criteria applied, with around 60% (74% white light, 57% red light) meeting broad criteria for response and 31% (30% white light, 33% red light) meeting strict criteria. There were no differences in treatment expectations.
Primary care patients with seasonal affective disorder improve after light therapy, but bright white light is not associated with greater improvements.
There are no large published studies of the prevalence of seasonal affective disorder (SAD) among UK populations.
To determine the prevalence of SAD among patients attending a general practitioner (GP).
Patients aged 16–64 consulting their GPs in Aberdeen during January were screened with the Seasonal Pattern Assessment Questionnaire (SPAQ). SPAQs were also mailed to 600 matched patients, who had not consulted their GP during January. Surgery attenders who fulfilled SPAQ criteria for SAD were invited for interview to determine whether they met criteria for SAD in DSM–IVand the Structured Interview Guide for the Hamilton Rating Scale for Depression– Seasonal Affective Disorder Version (SIGH–SAD).
Of 6161 surgery attenders, 4557 (74%) completed a SPAQ; 442 (9.7%) were SPAQ cases of SAD. Rate of caseness on the SPAQ did not differ between surgery attenders and non-attenders. Of 223 interviewed SPAQ cases of SAD, 91 (41%) also fulfilled DSM–IVand SIGH–SAD criteria.
There is a high prevalence of SAD among patients attending their GPs in January in Aberdeen; this is likely to reflect a similar rate in the community.
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