A Cardiovascular Risk Optimization Program in People With Schizophrenia: A Pilot Randomized Controlled Clinical Trial

BACKGROUND

Cardiovascular disease is one of the leading causes of premature death in people with schizophrenia. Some modifiable factors that have been implicated include unhealthy lifestyle, medication side effects, and physical comorbidities. The goal of this study was to assess the efficacy of a 6-month, multifactorial cardiovascular risk intervention to reduce cardiovascular risk (CVR) in people with schizophrenia.

METHODS

We conducted a 2-arm, parallel, randomized clinical trial in a regional mental health center. Participants with at least 1 poorly controlled cardiovascular risk factor (CVRF) (hypertension, diabetes mellitus, hypercholesterolemia, or tobacco smoking) were randomly assigned to the intervention group or to a control group. The subjects in the intervention group received a patient-centered approach that included promoting a healthy lifestyle, pharmacological management of CVRFs, psychotropic drug optimization, and motivational follow-up [Programa d'optimització del RISc CArdiovascular (PRISCA)]. The main outcome was change in CVR as assessed using the Framingham-REGICOR function, after 6 months compared with the baseline in both groups.

RESULTS

Forty-six participants were randomly assigned to the PRISCA group (n=23) or the control group (n=23). The most prevalent CVRFs at baseline were hypercholesterolemia (84.8%) and tobacco smoking (39.1%). The PRISCA group showed a significant reduction in the REGICOR score (-0.96%; 95% CI: -1.60 to -0.32, P=0.011) after 6 months (relative risk reduction of 20.9%), with no significant changes in the control group (0.21%; 95% CI: -0.47 to 0.89, P=0.706). In the PRISCA group, low-density lipoprotein cholesterol also decreased significantly (-27.14 mg/dL; 95% CI: -46.28 to -8.00, P=0.008).

CONCLUSION

A patient-centered, multifactorial cardiovascular risk intervention improved CVR in people with schizophrenia after 6 months, which was achieved mainly by improving the lipid profile.

A Brief Psychoeducation Intervention to Prevent Rehospitalization in Severe Mental Disorder Inpatients

ABSTRACT

The efficacy of medium- to long-term psychoeducation in preventing relapse and hospitalization in people with severe mental disorders (SMDs) is robust. However, the evidence is inconclusive in brief interventions and individual modalities. The aim of this randomized clinical trial in SMD inpatients is to analyze the efficacy of a brief psychoeducation intervention added to treatment-as-usual, in improving the rehospitalization rate at 3 and 6 months after discharge. Fifty-one SMD inpatients were randomized to the intervention ( n = 24) or control group ( n = 27). Low insight and poor medication adherence were the most prevalent risk factors at admission. No significant differences were observed in the rehospitalization rate at 3 and 6 months after discharge. On the overall sample, the number of previous hospitalizations was a rehospitalization predictor at 3 (odds ratio [OR], 1.25; 95% confidence interval [CI], 1.01-1.56; p = 0.04) and 6 months (OR, 1.85; 95% CI, 1.17-2.91; p = 0.009). SMD people require multimodal and persistent approaches focused on insight and medication adherence to prevent rehospitalizations.

El sentido de coherencia y las habilidades para la vida como factores protectores en personas con prediabetes

OBJETIVO

analizar el sentido de coherencia y las habilidades para la vida y su relación con el cumplimiento del estilo de vida saludable.

MÉTODO

estudio observacional transversal en personas con prediabetes atendidas en atención primaria, quienes respondieron a un cuestionario con variables sociodemográficas y hábitos saludables y a los cuestionarios de sentido de coherencia y habilidades para la vida. Se realizó un análisis descriptivo, bivariante y un modelo de regresión múltiple.

RESULTADOS

los y las participantes con mayor sentido de coherencia son quienes presentan mayores habilidades para la vida (Pearson = 0.470; p ⩽ 0.001) y mantienen un estilo de vida más saludable (B:1.24; p = 0.001). Una mayor puntuación de las habilidades de la vida se relaciona con un estilo de vida saludable (Pearson = 0.355, p < 0.001). El sentido de coherencia predice el estilo de vida saludable (BB = 0.21, p = 0.001).

CONCLUSIÓN

las personas con prediabetes con un mayor sentido de coherencia y más habilidades para la vida realizan conductas más saludables con relación a la dieta, al ejercicio físico y al hábito tabáquico. Las personas con mayor sentido de coherencia tienen mayor probabilidad de seguir el estilo de vida saludable.

Metabolic impact of a nutrition education program for the promotion of fruit and vegetable consumption with people with severe mental disorders (DIETMENT)

OBJECTIVES

The aim of this study is to determine the metabolic impact of a nutrition education program on metabolic parameters and the presence of metabolic syndrome (MetS).

RESULTS

Seventy-four patients were included (mean age, 48.7 years [Standard deviation, SD: 10.8], 55.4% men). The diagnoses of SMD were 37.8% schizophrenia and related disorders; 29.7% bipolar disorder; 25.7% depressive disorder; 4.1% personality disorders; and 2.7% obsessive compulsive disorders. Thirty-seven individuals were distributed in both the intervention group (IG) and the control group (CG). In the IG the presence of MetS was 56.3% and in the CG 46.7%, with no statistically significant difference (p = 0.309). At the end of the study, glomerular filtrate decreased in the IG, body mass index and abdominal perimeter increased in both groups, and there were no changes in metabolic parameters between the groups. Between the baseline and the end of the study, there was no increase in the number of patients diagnosed with MetS (14 at both points); and in the CG the increase was from 8 to 12 (p = 0.005). An intervention based on fruit and vegetable intake could prevent progression to MetS in individuals with SMD, decreasing the likelihood of cardiovascular disease. Trial registration The trial was retrospectively registered on International Standard Randomised Controlled Trial Number (ISRCTN) Register on 11 March 2022 (ISRCTN12024347).

[Introduction of rapid streptococcal antigen test: can its use improve adherence to antibiotic therapy?]

OBJECTIVE

To evaluate the influence of the result of a rapid streptococcal antigen test in paediatric pharyngotonsillitis infections, in terms of improvement of antibiotic therapy adherence.

DESIGN

Randomized community clinical trial with two study groups.

LOCATION

Primary Care Centers in Central Catalonia.

PARTICIPANTS

Patients aged from 3 to 15 years, who were attended at paediatric consultations on suspicion of pharyngotonsillitis caused by an infection between November 2010 and February 2011 (both included), were included in the study on a consecutive basis. 557 patients met the inclusion criteria and 519 were evaluated.

INTERVENTION

The control group received the usual diagnostic-therapeutic algorithm. Rapid streptococcal antigen test was additionally performed to experimental group participants and it was indicated the more convenient treatment.

MAIN MEASUREMENTS

Antibiotic adherence, non-adherence causes and socio-demographic risk factors were evaluated via telephone survey.

RESULTS

Antibiotics were prescribed to 65.6% and paediatricians of the control group were more likely to prescribe antibiotic than the ones in the intervention group (88.5% vs 45.5%, p< 0.0001). 64.8% followed doctor's treatment orders, being failure following medication scheduling the main cause of non-adherence (25.6%). Medication adherence was higher in the experimental group (68%) than in the control group (62.9%) but no significant differences were found.

CONCLUSION

Rapid strep test, complementing the use of Centor Criteria avoids unnecessary antibiotics prescriptions, but had not been proven to be effective in increasing medication adherence.

Multimorbidity patterns of chronic conditions and geriatric syndromes in older patients from the MoPIM multicentre cohort study

OBJECTIVES

To estimate the frequency of chronic conditions and geriatric syndromes in older patients admitted to hospital because of an exacerbation of their chronic conditions, and to identify multimorbidity clusters in these patients.

DESIGN

Multicentre, prospective cohort study.

SETTING

Internal medicine or geriatric services of five general teaching hospitals in Spain.

PARTICIPANTS

740 patients aged 65 and older, hospitalised because of an exacerbation of their chronic conditions between September 2016 and December 2018.

PRIMARY AND SECONDARY OUTCOME MEASURES

Active chronic conditions and geriatric syndromes (including risk factors) of the patient, a score about clinical management of chronic conditions during admission, and destination at discharge were collected, among other variables. Multimorbidity patterns were identified using fuzzy c-means cluster analysis, taking into account the clinical management score. Prevalence, observed/expected ratio and exclusivity of each chronic condition and geriatric syndrome were calculated for each cluster, and the final solution was approved after clinical revision and discussion among the research team.

RESULTS

740 patients were included (mean age 84.12 years, SD 7.01; 53.24% female). Almost all patients had two or more chronic conditions (98.65%; 95% CI 98.23% to 99.07%), the most frequent were hypertension (81.49%, 95% CI 78.53% to 84.12%) and heart failure (59.86%, 95% CI 56.29% to 63.34%). The most prevalent geriatric syndrome was polypharmacy (79.86%, 95% CI 76.82% to 82.60%). Four statistically and clinically significant multimorbidity clusters were identified: osteoarticular, psychogeriatric, cardiorespiratory and minor chronic disease. Patient-level variables such as sex, Barthel Index, number of chronic conditions or geriatric syndromes, chronic disease exacerbation 3 months prior to admission or destination at discharge differed between clusters.

CONCLUSIONS

In older patients admitted to hospital because of the exacerbation of chronic health problems, it is possible to define multimorbidity clusters using soft clustering techniques. These clusters are clinically relevant and could be the basis to reorganise healthcare circuits or processes to tackle the increasing number of older, multimorbid patients.

TRIAL REGISTRATION NUMBER

NCT02830425.

[Implementation of simplified diagnostic method Apnealink™Air® to diagnose sleep apnea by general practioners of primary care]

OBJECTIVES

To assess diagnosis and therapeutic decisions-making by General Practitioners (GP) using ApnealinkTM® (AL) in patients with high suspicion of obstructive sleep apnea (OSA), in comparison with conclusions of Hospital Sleep Unit (HSU) specialists based on home respiratory polygraphy (PGR) results.

METHODS

This study involved patients previously selected by HSU for sleep testing by PGR. After it, patients were offered to complete AL test. PGR was checked at HSU; AL was checked by hemoglobin desaturation index of 4% (4% ODI), (4% AL) and 3% (3% ODI) patients with positive test to proceed with CPAP; and those with negative test for further testing. Automatically adjusted 4% AL, was considered valid as it was demonstrated to be equivalent to manual AL. Results were compared by automatically adjusted 3%AL against PGR results.

RESULTS

48 patients were collected. 43 had AL valid test, 45 had PGR valid study, and 41 had both valid test. 27 patients (62,8%) had positive 4% AL (OR 5,51, p < 0,05), that showed AHI ≥ 15/h at 3% AL test; and 19 patients (42,2%) had a positive PGR test. 31 (72%) patients had a positive 3% AL. AL had shown to be a good screening method of SAHS.

CONCLUSIONS

There is equivalence between the decisions of GP and HSU. AL is a good diagnostic tool and screening method for OSA in primary care when it is used in patients with high suspicion of moderate-severe OSA.

Childhood trauma in schizophrenia spectrum disorders and intensity of psychotic symptoms

Introduction

The relationship between history of childhood trauma (CT) and current schizophrenic symptoms is complex and controversial. Most of the studies report more positive psychotic symptoms (PPS) in psychotic patients who had suffered CT. Findings for negative psychotic symptoms (NPS) are mixed: most authors do not find differences or even find less.

Objectives

The purpose of this study is to evaluate and describe the types of CT suffered by patients diagnosed with schizophrenia spectrum disorders (SSD), and to analyse the relationship between history of CT and the present-time intensity of PPS and NPS.

Methods

We conducted a cross-sectional study of 45 adult patients with a SSD. Instruments: Childhood Trauma Questionnaire, short form (CTQ-SF) for measuring CT and Positive and Negative Syndrome Scale (PANSS) to assess the PPS and NPS of psychosis.

Results

77.8% of the patients reported having suffered any kind of CT. By types of trauma: 48.9% reported emotional abuse, 28.9% physical abuse, 40.0% sexual abuse, 55.6% emotional neglect and 46.7% physical neglect. A lineal correlation between CTQ-SF and PANSS+/- scores was performed. Neither total PANSS+ nor any particular PANSS+ items correlate with CTQ scores. A significant inverse lineal association of moderate intensity exists between total PANSS− score and CT intensity (ρ = −0.300, p = 0.045)

Conclusions

In line with previous research, our study has found inverse correlation between NPS and CT. In contrast, no association was found between PPS and CT. Our sample was mostly composed by chronic patients, which might explain the differences with the previous literature.

Disclosure

No significant relationships.

Childhhood Trauma in Schizophrenia Spectrum Disorders: Dissociative, Psychotic Symptoms, and Suicide Behavior

Current evidence suggests a high prevalence of childhood trauma (CT) among adult patients diagnosed with schizophrenia spectrum disorders. Exposure to CT might lead to clinical differences eventually observed in these patients. We present a cross-sectional study with 54 patients with schizophrenia spectrum disorder (schizophrenia and schizoaffective disorder). We obtained sociodemographic data, as well as data on CT, dissociation, suicide history, and intensity of positive and negative psychotic symptoms. More than 75% of the patients reported a history of CT. We observed a link between CT and suicidal behavior. Patients showed high rates of dissociation. Dissociative experiences were related to CT, both in terms of intensity of trauma and number of traumas experienced. All CT forms except emotional neglect showed direct correlations with dissociative experiences. We found no correlation between intensity of CT and intensity of positive psychotic symptoms, yet we observed a moderate inverse correlation with negative psychotic symptoms.

Underdiagnosis of psychiatric disorders in people with intellectual disabilities: Differences between psychiatric disorders and challenging behaviour

BACKGROUND AND PURPOSE

The purpose of this study was to assess the level of mental disorders and challenging behaviour in individuals with intellectual disability (ID) supported by specialized services, but without a prior psychiatric diagnosis, and to compare the levels of different disorders depending on the severity of ID.

METHODS

This is a cross-sectional study (N = 142) of population with ID. Inclusion criteria were the following: adult patients with ID and with no previous psychiatric diagnosis prior to this survey. The Wechsler Adults Intelligence Scale-II, the Psychiatric Assessment Schedule for Adults with Developmental Disability checklist and clinical interview, the Diagnostic Assessment for the Severely Handicapped scale and the Inventory for Client and Agency Planning were the assessment tools.

RESULTS

A previously undiagnosed mental disorder was found in 29.6% of the sample. The most prevalent mental disorders were major depressive and anxiety disorders. An association between psychiatric comorbidity and challenging behaviour was found only for mild/moderate ID, especially for affective disorders.

CONCLUSIONS

The presence of a psychiatric as well as a medical comorbidity is associated with severe ID, unlike challenging behaviour. Clinical limitations of the study have been discussed.

OMENTAL INFARCTION: SURGICAL or CONSERVATIVE TREATMENT? A CASE REPORTS and CASE SERIES SYSTEMATIC REVIEW

BACKGROUND

Omental infarction (OI) is an infrequent cause of acute abdominal pain and there is no consensus on whether conservative or surgical treatment is the best strategy when performing positive CT diagnosis.

OBJECTIVES

To assess which of the two treatments is the most commonly adopted and compare outcomes in terms of success rate in resolution of symptoms and hospital length of stay.

ELIGIBILITY CRITERIA

Case report and case series of patients with abdominal pain and positive diagnosis by CT of omental infarction.

DATA SOURCES

PubMed, Science Direct and Google Scholar in combination with cross-referencing searches and manual searches of eligible articles from January 2000 to June 2018.

PARTICIPANTS

Patients older than 18 years of age.

METHODS

Patient characteristics and results were summarized descriptively. Categorical variables were assessed by chisquare test or Fischer's exact test, and continuous variables by the Wilcoxon-Mann-Whitney or Kruskal-Wallis test. Risk factors for failure of the conservative management were identified using multivariate logistic regression.

RESULTS

90 articles were included in the final analysis (146 patients). 107 patients (73.3%) received conservative treatment with a failure rate of 15.9% (patients needing surgery) and 39 patients (26.7%) received surgery as first treatment. The mean hospital length of stay was 5.1 days for the conservative treatment group and 2.5 days for the surgery group with statistically significant differences (p = 0.00). Younger age and white blood cells count ≥12000/μl were predictive factors of conservative treatment failure.

CONCLUSIONS

Although conservative treatment is effective in most patients, surgery has advantages in terms of hospital length of stay.

Optimization of Antipsychotic and Benzodiazepine Drugs in Patients with Severe Mental Disorders in an Intensive Case Management Program

The Intensive Case Management (ICM) model is a community-based program for people with severe mental illness that may reduce hospitalization and increase retention in care. The aims of this study were to analyze changes in the antipsychotic and benzodiazepine dosage in 106 patients who participated in an Individualized Service Program based on the ICM model for at least 6 months and to assess the change in the number of patients taking a high or very high dose of an antipsychotic drug and the number receiving antipsychotic polytherapy. Both the average daily dose of antipsychotic and benzodiazepine drugs and the number of patients with high doses of antipsychotic and more than one antipsychotic drug decreased significantly. Implementing the ICM program in patients with severe mental illness could help to decrease adverse drug effects and health care expenditures.

Social Networking App Use Among Primary Health Care Professionals: Web-Based Cross-Sectional Survey

Background

Several studies have been conducted to analyze the role social networks play in communication between patients and health professionals. However, there is a shortage of studies in relation to communication among primary health professionals, in a professional context, using the various mobile phone apps available.

Objective

The objective of our study was to explore mobile phone social networking app use among primary health care professionals for work-related purposes, by comparing the most widely used apps in the market.

Methods

We undertook a cross-sectional study using an anonymous Web survey among a convenience sample of 1635 primary health care professionals during August and September 2017.

Results

Of 483 participants in the survey, 474 (98.1%, 95% CI 97.1%-99.4%) were health professionals who commonly accessed social networking sites and 362 (74.9%, 95% CI 71.1%-78.8%) accessed the sites in a work-related context. Of those 362 respondents, 219 (96.7%, 95% CI 94.8%-98.5%) preferred WhatsApp for both personal and professional uses. Of the 362 respondents who used social networking sites in a work-related context, 276 (76.2%, 95% CI 71.9%-80.6%) rated social networking sites as useful or very useful to solve clinical problems, 261 (72.1%, 95% CI 67.5%-76.7%) to improve their professional knowledge, and 254 (70.2%, 95% CI 65.5%-74.9%) to speed up the transmission of clinical information. Most of them (338/362, 94.8%, 95% CI 92.5%-97.0%) used social networking sites for interprofessional communications, and 204 of 362 (56.4%, 95% CI 51.2%-61.5%) used them for pharmacological-related consultations.

Conclusions

Health professionals frequently accessed social networking sites using their mobile phones and often for work-related issues. This trend suggests that social networking sites may be useful tools in primary care settings, but we need to ensure the security of the data transfer process to make sure that social networking sites are used appropriately. Health institutions need to increase information and training activities to ensure the correct use of these tools.

[Smoking Prevalence in High School Students in the Barcelona Region (De Osona District)]

The socio-cultural setting influences youth smoking and its prevalence presumibly has decreased.

OBJECTIVES

To assess smoking prevalence in high school students, as well as the environmental influence on its onset in the Osona Disrtict of Barcelona (ODB), and to determine whether it has decreased.

MATERIAL AND METHODS

A cross-sectional study was conducted on high school students in the ODB. In the anonymous questionnaire it was sked asked about smoking and the influence of the social and cultural setting on its onset.

RESULTS

A total of 842 students participated, with 714 questionnaires completed, of which 705 were included as valid. A total of 203 (93.5%) students lived in an urban setting. There were 159 smoker students and 62% were women. The smokers were 70 (44%) christians, 3 (1.9%) muslims, 14 (8.%) students with other religions, and 72 (45.3%) non-denominational students. It was detected that 529 (76.3%) of the students consumed alcohol consumers, and 308 (46.5%) consumed other substances. There were 40 (61%) students that suffered a disease, and also 334 students who had ill relatives. There were 207 (29.4%) fathers and 152 (22%) mothers who smoked and 214 (59%) students declared family smoking. Finally 582 (82.6%) had smoker friends. Among fathers, 212 (30.1%), had high level studies, 331 (48.7%) had mid- level studies, and 137 (20.1%) fathers had primary studies. Among mothers, it was 279 (39.6%), 294 (41.7%), and 116 (16.5%). respectively. Being a smoker was associated with alcohol (P=.000) and other substances consumption (P=.000), being non-denominational (P=.000), did not to suffer any disease (P=.043), with having mother (P=.001), father (P=.005), brother or sister (P=.006), and family members (P=.016) who smoked, and smoker friends (P=.000).

CONCLUSIONS

smoking prevalence in high school students in the ODB is high, but has decreased. Smoking was associated with alcohol and consumption of other substances, being non-denominational, and with friends, parents, and relatives who smoked. It is necessary to establish prevention programs addressed to teenagers, parents and teachers.

Is the severe pain after Milligan-Morgan hemorrhoidectomy still currently remaining a major postoperative problem despite being one of the oldest surgical techniques described? A case series of 117 consecutive patients

INTRODUCTION

Surgery is the only curative method of hemorrhoidal disease. Currently the Milligan-Morgan hemorrhoidectomy is still considered the "gold standard", since it is the best performing technique. However, postoperative pain remains a major problem. We analize the postoperative analgesic requirements for this procedure in 117 patients.

PRESENTATION OF CASES

Between 2012 and 2013, 117 consecutive patients undergoing Milligan-Morgan hemorroidectomy, with an analysis of sex, age, total vascular anal cushions removed, hospital stay, complications, and relation with postoperative analgesic requirements. Patients with documented allergy to NSAIDs or pyrazolones were excluded. Additionally 23 patients undergoing Milligan-Morgan hemorrhoidectomy associated to internal lateral sphincterotomy were also analyzed.

RESULTS

The mean age of patients was 51.7 years. The 50.8% were women and 49.2% men. In 33.3% of cases, one vascular anal cushion was removed, 2 in 39.3%, and 3 in 27.4%. The average stay for the 3 groups was 2.0days. An analgesic dose average of 4.1 by day was given, with opioid requirements in 22.2% of cases. It was statistically significant that as more anal cushions were eliminated was higher the opioids need. No significant difference of opioids use was found regarding patients undergoing sphincterotomy as additional procedure.

DISCUSSION

Postoperative pain after a Milligan-Morgan hemorrhoidectomy currently remains a problem for colorectal surgery teams. This involves the use of opioids comparable to other major surgeries, finally causing not negligible days of admission charge. A protocolized analgesic treatment, as we actually do in our center, should be implemented after a Milligan-Morgan hemorrhoidectomy for improving the postoperative period pain management.

Cumulative effects of childhood traumas: polytraumatization, dissociation, and schizophrenia

The study objective was to measure and compare the presence of childhood trauma and dissociative symptoms in a convenience sample of healthy controls and a probabilistic sample of outpatients with a diagnosis of schizophrenia. Patients reported more childhood trauma and more polytraumatization than the controls, and had a higher average dissociation score. In both cases and controls, the presence of childhood trauma was related to the intensity of the dissociation observed. Childhood trauma, clinical dissociation and schizophrenia are closely related, particularly when the patient has been the victim of more than one type of abuse.

[Influence of meteorological and chronological factors in epilepsy]

INTRODUCTION

The professionals who deal with medical emergencies observe peaks in the incidence of epileptic seizures. Some epileptic patients attribute their seizures to climatic and seasonal changes. AIMS. To analyse the relationship between meteorological, calendar-related and circadian variables and the appearance of epileptic seizures.

PATIENTS AND METHODS

A retrospective study was conducted in a residential home for persons with intellectual disability.

RESULTS

The 16 residents who were studied presented 855 epileptic attacks, including 159 in peaks or clusters, over the period 2009-2012. The predominance of seizures observed in autumn and during the fourth quarter of the year is not significant (p > 0.05). There is no statistically significant relation between the presence of epileptic seizures and the phases of the moon or days of the week. Most epileptic seizures (87.2%) occur during the daytime (p < 0.001). Findings showed that 36.3% occur in the morning between 08:00 and 10:59. There is no statistical correlation between the number of epileptic seizures and the atmospheric pressure, rainfall, degree of humidity or mean temperature (p > 0.05).

CONCLUSIONS

The appearance of peaks or clustering of epileptic seizures was observed. Their presence shows a marked circadian component. The influence of meteorological factors, the phases of the moon and seasons of the year on epilepsy is not significant.

Is major depression adequately diagnosed and treated by general practitioners? Results from an epidemiological study

OBJECTIVES

The aim of this study was to (1) to explore the validity of the depression diagnosis made by the general practitioner (GP) and factors associated with it, (2) to estimate rates of treatment adequacy for depression and factors associated with it and (3) to study how rates of treatment adequacy vary when using different assessment methods and criteria.

METHODS

Epidemiological survey carried out in 77 primary care centres representative of Catalonia. A total of 3815 patients were assessed.

RESULTS

GPs identified 69 out of the 339 individuals who were diagnosed with a major depressive episode according to the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) (sensitivity 0.22; kappa value: 0.16). The presence of emotional problems as the patients' primary complaint was associated with an increased probability of recognition. Rates of adequacy differed according to criteria: in the cases detected with the SCID-I interview, adequacy was 39.35% when using only patient self-reported data and 54.91% when taking into account data from the clinical chart. Rates of adequacy were higher when assessing adequacy among those considered depressed by the GP.

CONCLUSION

GPs adequately treat most of those whom they consider to be depressed. However, they fail to recognise depressed patients when compared to a psychiatric gold standard. Rates of treatment adequacy varied widely depending on the method used to assess them.