The World Health Organization somatoform disorders schedule. A preliminary report on design and reliability

The World Health Organization (WHO) Somatoform Disorders Schedule (SDS) is a highly standardized instrument for the assessment of somatoform disorders according to the tenth revision of the International Classification of Diseases (ICD-10) and the fourth edition of the Diagnostic and Statistical Manual (DSM-IV). The SDS was produced in the framework of the WHO International Study of Somatoform Disorders and tested for its reliability in Brazil, India, Italy, the USA and Zimbabwe. A sample of 180 patients from general psychiatry, primary care and general medical settings were interviewed with the SDS within a three-day interval by nonclinician and clinician interviewers. The agreement between the two interviews was tested using the intraclass correlation coefficients (ICC) and kappa statistic. The test-retest reliability of the SDS was found to be very good (the ICC for all the centres was 0.76; overall kappa value for SDS questions was 0.58; one-third of SDS questions had a kappa value of 0.60 or higher). The field test results of the SDS indicated that the instrument may be administered in larger studies by non-clinician interviewers without compromising the ability to document the prevalence of somatoform disorders in different cultures.

Mutagenic potential and modulatory effects of the medicinal plant Luehea divaricata (Malvaceae) in somatic cells of Drosophila melanogaster: SMART/wing

Luehea divaricata is a native plant of the Brazilian Cerrado, known as "açoita-cavalo". It is used as a popular herbal medicine in the treatment of dysentery, bleeding, arthritis, tumors, ulcers, and gangrenous wounds. Considering that herbal medicines sometimes provoke tumors and/or may prevent mutational events, it is important to study the action of these natural drugs on DNA. Aqueous extract of the bark of L. divaricata was evaluated at three different concentrations (0.10, 0.30, 0.50 mg/mL), individually and in combination with the neoplastic drug doxorubicin (DXR), by the somatic mutation and recombination test (SMART/wing) in Drosophila melanogaster. Distilled water was included as a negative control. The mutation frequency in the treatments with L. divaricata extract alone was not significantly higher than in the negative control for standard (ST) and high bioactivation (HB) crosses. When L. divaricata extract was combined with DXR, there was a significant reduction in the frequency of spots when compared to DXR alone, in both crosses. Further studies with other experimental models would be useful to confirm that L. divaricata extract is not harmful and that it could be used in the prevention of cancer.

The reliability of the Brazilian version of the Composite International Diagnostic Interview (CIDI 2.1)

The objective of the present study was to determine the reliability of the Brazilian version of the Composite International Diagnostic Interview 2.1 (CIDI 2.1) in clinical psychiatry. The CIDI 2.1 was translated into Portuguese using WHO guidelines and reliability was studied using the inter-rater reliability method. The study sample consisted of 186 subjects from psychiatric hospitals and clinics, primary care centers and community services. The interviewers consisted of a group of 13 lay and three non-lay interviewers submitted to the CIDI training. The average interview time was 2 h and 30 min. General reliability ranged from kappa 0.50 to 1. For lifetime diagnoses the reliability ranged from kappa 0.77 (Bipolar Affective Disorder) to 1 (Substance-Related Disorder, Alcohol-Related Disorder, Eating Disorders). Previous year reliability ranged from kappa 0.66 (Obsessive-Compulsive Disorder) to 1 (Dissociative Disorders, Maniac Disorders, Eating Disorders). The poorest reliability rate was found for Mild Depressive Episode (kappa = 0.50) during the previous year. Training proved to be a fundamental factor for maintaining good reliability. Technical knowledge of the questionnaire compensated for the lack of psychiatric knowledge of the lay personnel. Inter-rater reliability was good to excellent for persons in psychiatric practice.

Evaluation of the PAHO/WHO training program on the detection and treatment of depression for primary care nurses in Panama

OBJECTIVE

This study evaluated the efficacy of a training program developed by Pan American Health Organization/World Health Organization (PAHO/WHO) for primary care nurses aimed at improving their capacity to detect and manage depression.

METHOD

Changes in knowledge and clinical practice were assessed in a group of primary care nurses in Panama who underwent the program. They were compared with a group of controls.

RESULTS

Nurses who underwent the training program showed a statistically significant improvement in knowledge and detection of depressive disorders. In addition, they increased their notification of patients with depression to the primary care physician. No change was noted in the control group.

CONCLUSION

The results point to the benefit of the PAHO/WHO training program for primary care nurses in the care of major depression. Further studies are required to confirm these results.

Medically unexplained somatic symptoms in different cultures. A preliminary report from phase I of the World Health Organization International Study of Somatoform Disorders

The World Health Organization has recently launched an international study of somatoform disorders in different cultures. Five centres representing distinct cultures participated in phase I of the project, the main objective of which was to test the cross-cultural applicability and reliability of instruments for the assessment of somatoform disorders. The analysis of the assessed somatic symptoms showed that various aches and pains in different parts of the body represented cross-culturally the most frequent symptoms for which there was no medical explanation. Such symptoms may indicate the presence of an underlying mental disorder but can also represent a means for culture-specific expression of psychosocial distress. This bears particular significance for health professionals in primary and general medical care, who are most likely to encounter patients presenting with multiple, persistent and medically unexplained somatic symptoms.

Day care centres as an institution for health promotion among needy children: an analytical study in São Paulo, Brazil

OBJECTIVE

To evaluate the role of day care centres in the nutritional state of children belonging to a low-income population, comparing the nutritional state of the children in the day care centres with children in the same population who were given other types of day care.

DESIGN

Analytical cross-sectional study.

SETTING

Public day care centres/primary health care.

PARTICIPANTS

Children aged 0-6 yr attending in 4 public day care centres (n=446) and sample of population obtained during vaccination campaign (n=1626).

MEASUREMENT

Nutritional evaluation was conducted through weight and height measurements, using as a standard the NCHS (USA) table and Gomez and Waterlow methodology. The type of daily care received by the children was assessed through a questionnaire answered by the responsible persons during the vaccination campaign.

RESULTS

The nutritional status of children attended in the day care centers was better than children of the same community receiving other types of daily care (OR=0.48; CI 95%=0.36-0.65;P>0.0001). The improvement was related to more than 1 year of enrollment in the day care (OR=0.74; CI 95%=0.57-0.96;P=0.02).

Human psychopharmacology of hoasca, a plant hallucinogen used in ritual context in Brazil

A multinational, collaborative, biomedical investigation of the effects of hoasca (ayahuasca), a potent concoction of plant hallucinogens, was conducted in the Brazilian Amazon during the summer of 1993. This report describes the psychological assessment of 15 long-term members of a syncretic church that utilizes hoasca as a legal, psychoactive sacrament as well as 15 matched controls with no prior history of hoasca ingestion. Measures administered to both groups included structured psychiatric diagnostic interviews, personality testing, and neuropsychological evaluation. Phenomenological assessment of the altered state experience as well as semistructured and open-ended life story interviews were conducted with the long-term use hoasca group, but not the hoasca-naive control group. Salient findings included the remission of psychopathology following the initiation of hoasca use along with no evidence of personality or cognitive deterioration. Overall assessment revealed high functional status. Implications of this unusual phenomenon and need for further investigation are discussed.

The epidemiology of psychotropic use in the city of São Paulo

This is a cross-sectional community study conducted to assess the one-year prevalence of psychotropic use in the city of São Paulo. A representative stratified sample of the city was drawn from three sub-districts selected on the basis of their health indicators (Ramos & Goihman, 1989). The probability of a psychiatric disorder was estimated by means of the Adult Psychiatric Morbidity Questionnaire (QMPA) developed by Santana (1982). The total sample comprised 1742 subjects: 11.7% of males and 24.6% of females were probable cases in the QMPA, at the cut-off point 7/8. The overall psychotropic consumption was 101.6 persons/1000 inhabitants. The rate of psychotropic use was higher for females (142.3 persons/1000 inhabitants) than males (50.0 persons/1000), a difference statistically significant (chi(2) = 18.0, 1 df, P < 0.001). The highest rate of consumption was for tranquillizers (80.4/1000 inhabitants) and the general physician was found to be the leading prescriber (46.9%), being followed by cardiologists (15.3%). A log-linear model was constructed to study the combined effect of sociodemographic factors on the probability of being a tranquillizer user. Women were found to take more tranquillizers than men, consumption increased with age, and the positives in the QMPA were more likely to be users than were the negatives. The higher the family income per capita the higher the risk of being a tranquillizer user. These findings applied regardless of the sub-district, marital status, and migration status of the subjects. These results are discussed in the light of the alternative possible interventions by general practitioners.