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GADIS aims at determining the prevalence of generalized anxiety disorder (GAD) and major depression (MD) in primary care and their impact on the patient’s functioning in Belgium and Luxemburg.
A large scale screening program was conducted at the consultation of general practitioners to detect patients with GAD and MD according to DSM-IV criteria. We collected additional data regarding the use of hypnotic, tranquilizer, antidepressant and analgesic medications. Impact on the patient was assessed with the Sheehan disability scale.
Three hundred GP’s in Belgium and Luxemburg were asked to screen 50 consecutive patients. Of the 13,677 analyzed patients, 8.3% were diagnosed to have GAD and 6.3% MD. Comorbidity was observed in 4.2% of patients. The prevalence was much higher in the French-speaking part of Belgium. GAD and MD were associated with impairment in social, familial and professional functioning. Only a minority of patients with GAD and/or MD was treated with an antidepressant and almost half of subjects with GAD and/or MD were treated with a tranquilizer.
Prevalence rates of GAD and MD in primary care in Belgium are comparable to other countries. GAD and MD are disabling conditions. Antidepressants are still used only in a minority of subjects with GAD and/or MD in primary care in Belgium and Luxemburg. The prevalence of GAD and MD appears to be much higher in French-speaking parts of Belgium.
Different diagnostic interviews are used as reference standards for major depression classification in research. Semi-structured interviews involve clinical judgement, whereas fully structured interviews are completely scripted. The Mini International Neuropsychiatric Interview (MINI), a brief fully structured interview, is also sometimes used. It is not known whether interview method is associated with probability of major depression classification.
To evaluate the association between interview method and odds of major depression classification, controlling for depressive symptom scores and participant characteristics.
Data collected for an individual participant data meta-analysis of Patient Health Questionnaire-9 (PHQ-9) diagnostic accuracy were analysed and binomial generalised linear mixed models were fit.
A total of 17 158 participants (2287 with major depression) from 57 primary studies were analysed. Among fully structured interviews, odds of major depression were higher for the MINI compared with the Composite International Diagnostic Interview (CIDI) (odds ratio (OR) = 2.10; 95% CI = 1.15–3.87). Compared with semi-structured interviews, fully structured interviews (MINI excluded) were non-significantly more likely to classify participants with low-level depressive symptoms (PHQ-9 scores ≤6) as having major depression (OR = 3.13; 95% CI = 0.98–10.00), similarly likely for moderate-level symptoms (PHQ-9 scores 7–15) (OR = 0.96; 95% CI = 0.56–1.66) and significantly less likely for high-level symptoms (PHQ-9 scores ≥16) (OR = 0.50; 95% CI = 0.26–0.97).
The MINI may identify more people as depressed than the CIDI, and semi-structured and fully structured interviews may not be interchangeable methods, but these results should be replicated.
Declaration of interest
Drs Jetté and Patten declare that they received a grant, outside the submitted work, from the Hotchkiss Brain Institute, which was jointly funded by the Institute and Pfizer. Pfizer was the original sponsor of the development of the PHQ-9, which is now in the public domain. Dr Chan is a steering committee member or consultant of Astra Zeneca, Bayer, Lilly, MSD and Pfizer. She has received sponsorships and honorarium for giving lectures and providing consultancy and her affiliated institution has received research grants from these companies. Dr Hegerl declares that within the past 3 years, he was an advisory board member for Lundbeck, Servier and Otsuka Pharma; a consultant for Bayer Pharma; and a speaker for Medice Arzneimittel, Novartis, and Roche Pharma, all outside the submitted work. Dr Inagaki declares that he has received grants from Novartis Pharma, lecture fees from Pfizer, Mochida, Shionogi, Sumitomo Dainippon Pharma, Daiichi-Sankyo, Meiji Seika and Takeda, and royalties from Nippon Hyoron Sha, Nanzando, Seiwa Shoten, Igaku-shoin and Technomics, all outside of the submitted work. Dr Yamada reports personal fees from Meiji Seika Pharma Co., Ltd., MSD K.K., Asahi Kasei Pharma Corporation, Seishin Shobo, Seiwa Shoten Co., Ltd., Igaku-shoin Ltd., Chugai Igakusha and Sentan Igakusha, all outside the submitted work. All other authors declare no competing interests. No funder had any role in the design and conduct of the study; collection, management, analysis and interpretation of the data; preparation, review or approval of the manuscript; and decision to submit the manuscript for publication.
El estudio GADIS pretende determinar la prevalencia del trastorno de ansiedad generalizada (TAG) y la depresión mayor (DM) en atención primaria y sus repercusiones en el funcionamiento del paciente en Bélgica y Luxemburgo.
Se llevó a cabo un programa de detección selectiva a gran escala en la consulta de médicos generales para detectar a los pacientes con TAG y DM según los criterios del DSM-IV. Recogimos datos adicionales acerca del uso de medicamentos hipnóticos, tranquilizantes, antidepresivos y analgésicos. Las repercusiones en el paciente se evaluaron con la Escala de Discapacidad de Sheehan.
Se pidió a 300 médicos generales en Bélgica y Luxemburgo que hicieran una detección selectiva en 50 pacientes consecutivos. De los 13.677 pacientes analizados, se diagnosticó que el 8,3% tenía TAG y el 6,3%, DM. Se observó comorbilidad en un 4,2% de los pacientes. La prevalencia era mucho más alta en la parte de habla francesa de Bélgica. El TAG y la DM se asociaban con deterioro en el funcionamiento social, familiar y profesional. Sólo una minoría de pacientes con TAG, DM o ambos trastomos recibía tratamiento con un antidepresivo y casi la mitad de los sujetos con TAG, DM o ambos trastomos se trataba con un tranquilizante.
Las tasas de prevalencia del TAG y la DM en la atención primaria en Belgica son comparables a otros países. El TAG y la DM son afecciones incapacitantes. Los antidepresivos se utilizan todavía sólo en una minoróa de sujetos con TAG, DM o ambos trastomos en atención primaria en Bélgica y Luxemburgo. La prevalencia del TAG y la DM parece ser mucho más alta en las partes de habla francesa de Bélgica.
Former neuropsychological studies with Chronic
Fatigue Syndrome (CFS) patients evaluated a broad range
of cognitive functions. Several, but not all, reported
subtle attentional and memory impairments suggesting possible
mild cerebral involvement. In this study, a battery of
attentional tests and a verbal memory task were administered
to 20 CFS patients and 22 healthy controls (HC) in order
to clarify the specific nature of attention and memory
impairment in these patients. The results provide evidence
for attentional dysfunction in patients with CFS as compared
to HC. CFS patients performed more poorly on a span test
measuring attentional capacity and working memory. Speeded
attentional tasks with a more complex element of memory
scanning and divided attention seem to be a sensitive measure
of reduced attentional capacity in these patients. Focused
attention, defined as the ability to attend to a single
stimulus while ignoring irrelevant stimuli, appears not
to be impaired. CFS patients were poorer on recall of verbal
information across learning trials, and poor performance
on delayed recall may be due to poor initial learning and
not only to a retrieval failure. (JINS, 1998,
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