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P Krause,
H U Wittchen,
B Küpper,
D Pittrow,
T Unger,
A M Sharma,
E Ritz,
B Göke,
H Lehnert,
D Tschöpe,
W Kirch,
H Pfister,
P Bramlage, M Höfler
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ABSTRACT: With regard to the management of hypertension and diabetes, HYDRA reveals that doctors report multiple problems in their everyday practice. Being confronted with an average of 73 patients a day, with almost every second having either diabetes or hypertension, frequently associated with multiple comorbid conditions, the core obstacle is the time factor. Doctors do not have sufficient time to perform diagnostic tests and especially no time for non-drug interventions of any type. Further available treatment guidelines are only used in 1 out of 2 doctors. Further they seem not to affect doctors performance significantly.
Fortschritte der Medizin. Originalien. 03/2003; 121 Suppl 1:12-8.
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H U Wittchen,
P Krause, M Höfler,
H Pfister,
E Ritz,
B Göke,
H Lehnert,
D Tschöpe,
W Kirch,
D Pittrow,
A M Sharma,
P Bramlage,
B Küpper,
T Unger
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ABSTRACT: Almost every second patient seeing a primary care doctor suffers from arterial hypertension and about every fifth has diabetes mellitus. These diseases often occur at the same time. They are associated in more than 80% of the cases with other severe concomitant and subsequent diseases (heart attack, stroke, renal failure, neuropathy etc.). The magnitude especially of subsequent and concomitant diseases, the dimension of the personal suffering and the immense diagnostic and therapeutic challenges for the doctors have been massively underestimated so far. The article informs about the prevalence of the above disease, and structure of the problem. Before the background of an extremely high patient load seen by German General Physicians, the mainstay challenge is highlighted how to achieve further improvements of the quality of care on the basis of scientific guidelines alone, without a concomitant change in the system structure.
Fortschritte der Medizin. Originalien. 03/2003; 121 Suppl 1:19-27.
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ABSTRACT: Retrospective clinical studies suggest that patients with pituitary adenoma (PA) have an increased risk of mental disorders. However, empirical evidence for this hypothesis is deficient because of out-dated methodology. Therefore, we investigated the occurrence of mental disorders in 93 patients with PA within a limited time frame of 2 years.
Patients were subjected to a comprehensive, standardized lifetime and cross-sectional psychopathological symptom and diagnostic assessment, including an evaluation of psychosocial conditions and life events (CIDI, SCL-90) during the past years.
We could not find an increased risk of mental disorders as compared with a representative population sample of 481 subjects matched by age and gender.
As for our random sample, neither suffering from any type of PA nor the extent of the pituitary deficiency represent factors having significant effect on the risk of the subject to develop psychopathology as compared with the general population.
Acta Psychiatrica Scandinavica 02/2003; 107(1):60-8. · 4.22 Impact Factor
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H U Wittchen,
E Ritz,
B Göke,
H Lehnert,
W Kirch,
D Pittrow,
P Krause, M Höfler,
T Unger,
P Bramlage,
D Tschöpe,
A Sharma
MMW Fortschritte der Medizin 02/2003; 145(5):43-4.
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ABSTRACT: This study examines the prevalence of depressive syndromes among unselected primary care patients as well as doctors' recognition and treatment rates. This nationwide study included a total of 20,421 patients attending their primary care doctors (n = 633) on the study's target day. Patients received a self-report questionnaire including the depression screening questionnaire (DSQ) to provide diagnoses of depressive disorders according to the criteria of DSM-IV and ICD-10. These data were compared to the doctor's evaluation form for each patient to assess the physician's diagnostic decision, assessment of clinical severity, and treatment choices. The findings confirm the high prevalence of depressive syndromes in primary care settings (11.3%) and underline the particular challenge posed by a high proportion of patients near the diagnosis threshold. Although recognition rates among more severe major depressive patients (59%) as well as treatments prescribed appear to be more favourable than in previous studies, the situation in less severe cases and the high proportion of doctors' definite depression diagnoses in patients who do not fulfill the diagnostic criteria still raise significant concerns.
Der Nervenarzt 08/2002; 73(7):651-8. · 0.68 Impact Factor
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ABSTRACT: We examined the association between parental alcohol use disorders and patterns of alcohol consumption and DSM-IV alcohol use disorders in their offspring in a community-based sample of young adults.
Data are based on baseline and 4-year follow-up data of 2427 respondents aged 14-24 at baseline. Alcohol use and disorders in respondents were assessed using the Munich-Composite-international-Diagnostic-Interview with DSM-IV algorithms. Diagnostic information about parents was collected by family history information from the respondents, and by direct interview with one parent (cohort aged 14 to 17 years only).
Although the association between maternal and paternal alcohol use disorders and non-problematical drinking in offspring was minimal, there was a strong effect for the transition to hazardous use and for alcohol abuse and dependence; the effect of parental concordance for transition into hazardous use was particularly striking. Maternal history was associated with a higher probability of progression from occasional to regular use, whereas paternal history was associated with progression from regular to hazardous use. Parental alcoholism increased the risk for first onset of hazardous use and alcohol dependence between the ages of 14-17, and for an earlier onset of the alcohol outcomes in offspring. The impact of parental alcohol use disorders was comparable for male and female offspring.
Parental alcoholism predicts escalation of alcohol use, development of alcohol use disorders and onset of alcohol outcomes in offspring.
Psychological Medicine 02/2002; 32(1):63-78. · 6.16 Impact Factor
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ABSTRACT: Zusammenfassung
Die Studie berichtet die Stichtags-Prävalenz depressiver Syndrome bei 20.421 unselegierter Patienten, die an einem Stichtag
ihren Hausarzt aufsuchten. Zusätzlich wurde das hausärztliche Erkennungs- und Verschreibungsverhalten ermittelt. Im Rahmen
einer Vorstudie wurden die teilnehmenden Arztpraxen (N=633) mittels Fragebogen charakterisiert. Am Erhebungstag erhielten alle Patienten Fragebögen, darunter den “Depression Screening
Questionaire” (DSQ), um die Diagnose einer depressiven Störung gemäß der Kriterien von DSM-IV oder ICD-10 zu stellen. Diese
Daten wurden mit den Angaben in den Bewertungsbögen der Ärzte verglichen, die diese am Erhebungstag für jeden Patienten ausfüllten.
Die Befunde bestätigen die hohe Prävalenz depressiver Syndrome in der Hausarztpraxis: 11,3% erfüllten die ICD-10-Kriterien
für eine depressive Episode. Obwohl die Erkennungsrate von 59% wie auch die Häufigkeit verordneter Behandlungen tendenziell
höher erscheint als in früheren Studien, so gibt doch die Situation bei den Depressionen leichterer Ausprägung sowie der hohe
Anteil an “Fehldiagnosen” bei Patienten, die deutlich die Falldefinitionskriterien verfehlen, Anlass zur Besorgnis.
Nervenarzt. 01/2002; 73(7):651-658.
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ABSTRACT: To determine incidence and patterns of natural course of cannabis use and disorders as well as cohort effects in a community sample of adolescents and young adults.
Cumulative incidence and patterns of cannabis use and disorders were examined in a prospective longitudinal design (mean follow-up period=42 months) in a representative sample (N=2446) aged 14-24 years at the outset of the study. Patterns of cannabis use, abuse and dependence (DSM-IV) were assessed with the Composite International Diagnostic Interview (M-CIDI).
(1) Cumulative lifetime incidence for cannabis use (at second follow-up): 47%; 5.5% for cannabis abuse, 2.2% for dependence. (2) Men used and abused cannabis more often than women. (3) The majority of the older participants (18-24 years at baseline) had reduced their cannabis use at follow-up, while younger participants (14-17 years at baseline) more often had increased their use and developed abuse or dependence. (4) The younger birth cohort (1977-1981) tended to start earlier with substance (ab)use compared to the older birth cohort (1970-1977). (5) Cannabis use was associated with increasing rates of concomitant use of other licit and illicit drugs.
Cannabis use is widespread in our sample, but the probability of developing cannabis abuse or dependence is relatively low (8%). The natural course of cannabis use is quite variable: about half of all cannabis users stopped their use spontaneously in their twenties, others report occasional or more frequent use of cannabis.
Drug and Alcohol Dependence 12/2001; 64(3):347-61. · 3.38 Impact Factor
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ABSTRACT: The study examines the prevalence of depressive syndromes among unselected primary care attenders, as well as doctors' recognition and treatment rates, in order to examine patient and doctor-related factors associated with poor recognition. This nationwide study included a total of 20421 patients (aged 15-99 years) attending their primary care doctors (n = 633) on the study's target day in April 1999. Patients received a self-report questionnaire, including the Depression Screening Questionnaire (DSQ), to provide diagnoses of depressive disorders according to the criteria of DSM-IV and ICD-10. Doctors completed: (1) a pre-study questionnaire assessing data on doctors' psychosocial, professional and training background, as well as current practices in patients with depression and (2) an evaluation form for each patient seen to assess his diagnostic decision, clinical severity and treatment choices. Taking the DSQ as a yardstick, 4.2% of all primary care attenders fulfilled criteria for a major depressive episode according to DSM-IV; considerably higher rates of 11.3% were obtained using the ICD-10 criteria for mild depressive episodes. Rates of depression were higher in females, increased by age, and were also elevated in those retired, unemployed as well as non-working housemen/wives. Taking the doctors' decision of definite or probable depression, 75% of all DSM and 59% of all ICD-10 diagnoses were recognized by the treating physician. However, doctors also assigned diagnoses of definite depression in an additional 11.7% of patients not meeting either ICD-10 nor DSM-IV criteria. Among correctly identified depression cases doctors decided to prescribe drug treatments in 72.7% (DSM) and 60.8% (ICD). Some 16.2% of DSM and 10.1% of ICD-cases were referred to mental health specialists; non-drug interventions were prescribed for 19.8% (DSM) and 24.9% (ICD), respectively. Multiple logistic regression analyses revealed that recognition is associated with prior treatment episodes, increasing number of depression symptoms, patients higher age, practice experience of treating physician greater 5 years and psychomotor retardation. These findings confirm the high prevalence of depressive syndromes in primary care settings and underline the particular challenge posed by a high proportion of with near-threshold symptomology patients. Although recognition rates among more severe major depressive patients as well as treatments prescribed appear to be more favourable than in previous studies, the situation in less severe cases, and the high proportion of doctors' definite depression diagnoses in patients with depression symptoms that are clearly below even the subthreshold level, raises significant concerns.
International Clinical Psychopharmacology 06/2001; 16(3):121-35. · 2.92 Impact Factor
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[show abstract]
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ABSTRACT: The study examines the prevalence of depressive syndromes among unselected primary care attenders, as well as doctors' recognition and treatment rates, in order to examine patient and doctor-related factors associated with poor recognition. This nationwide study included a total of 20421 patients (aged 15-99 years) attending their primary care doctors (n = 633) on the study's target day in April 1999. Patients received a self-report questionnaire, including the Depression Screening Questionnaire (DSQ), to provide diagnoses of depressive disorders according to the criteria of DSM-IV and ICD-10. Doctors completed: (1) a pre-study questionnaire assessing data on doctors' psychosocial, professional and training background, as well as current practices in patients with depression and (2) an evaluation form for each patient seen to assess his diagnostic decision, clinical severity and treatment choices. Taking the DSQ as a yardstick, 4.2% of all primary care attenders fulfilled criteria for a major depressive episode according to DSM-IV; considerably higher rates of 11.3% were obtained using the ICD-10 criteria for mild depressive episodes. Rates of depression were higher in females, increased by age, and were also elevated in those retired, unemployed as well as non-working housemen/wives. Taking the doctors' decision of definite or probable depression, 75% of all DSM and 59% of all ICD-10 diagnoses were recognized by the treating physician. However, doctors also assigned diagnoses of definite depression in an additional 11.7% of patients not meeting either ICD-10 nor DSM-IV criteria. Among correctly identified depression cases doctors decided to prescribe drug treatments in 72.7% (DSM) and 60.8% (ICD). Some 16.2% of DSM and 10.1% of ICD-cases were referred to mental health specialists; non-drug interventions were prescribed for 19.8% (DSM) and 24.9% (ICD), respectively. Multiple logistic regression analyses revealed that recognition is associated with prior treatment episodes, increasing number of depression symptoms, patients higher age, practice experience of treating physician greater 5 years and psychomotor retardation. These findings confirm the high prevalence of depressive syndromes in primary care settings and underline the particular challenge posed by a high proportion of with near-threshold symptomology patients. Although recognition rates among more severe major depressive patients as well as treatments prescribed appear to be more favourable than in previous studies, the situation in less severe cases, and the high proportion of doctors' definite depression diagnoses in patients with depression symptoms that are clearly below even the subthreshold level, raises significant concerns.
International Clinical Psychopharmacology 06/2001; 16(3):121-35. · 2.92 Impact Factor
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ABSTRACT: Social anxiety disorder (SAD) (also known as "social phobia") is frequently comorbid with major depression, and in such cases, almost always precedes it. This has led to interest in SAD as a possible modifier of the risk and/or course of mood disorders.
Data come from a prospective, longitudinal epidemiologic study of adolescents and young adults (aged 14-24 years) in Munich, Germany. Respondent diagnoses (N = 2548) at baseline and follow-up (34-50 months later) are considered. The influence of SAD at baseline on the risk, course, and characteristics of depressive disorders (ie, major depression or dysthymia) at follow-up is examined.
The baseline prevalence of SAD was 7.2% (95% confidence interval [CI], 6.1%-8.4%). Social anxiety disorder in nondepressed persons at baseline was associated with an increased likelihood (odds ratio [OR] = 3.5; 95% CI, 2.0-6.0) of depressive disorder onset during the follow-up period. Furthermore, comorbid SAD and depressive disorder at baseline was associated with a worse prognosis (compared with depressive disorder without comorbid SAD at baseline). This is exemplified by the greater likelihood of depressive disorder persistence or recurrence (OR = 2.3; 95% CI, 1.2-4.6) and attempted suicide (OR = 6.1; 95% CI, 1.2-32.2).
Social anxiety disorder during adolescence or young adulthood is an important predictor of subsequent depressive disorders. Moreover, the presence of comorbid SAD in adolescents who are already depressed is associated with a more malignant course and character of subsequent depressive illness. These findings may inform targeted intervention efforts.
Archives of General Psychiatry 04/2001; 58(3):251-6. · 12.02 Impact Factor
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MMW Fortschritte der Medizin 03/2001; 143(5):43-4.
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ABSTRACT: This paper examines attitudes and characteristics of service providers for generalized anxiety disorders (GAD) in primary care. Based on a nationwide sample of 558 primary care doctors, the study found: 56.9% of all primary care doctors consider GAD to be an independent disorder, younger doctors more frequently than older ones. On average, they see on average at least 2.3 GAD definite patients a day. 27.4% indicate that they treat GAD differently than they treat depression. Doctors with frequent postgraduate courses on either depression or GAD reveal more favourable competence ratings with regard to recognition/diagnoses and therapy and refer such patients less frequently. Suggested treatments for GAD, however, are diffuse and by and large inconsistent with current research knowledge. Overall these findings suggest that the majority of primary care doctors view GAD as a prevalent independent disorder with special treatment needs.
Fortschritte der Medizin. Originalien. 02/2001; 119 Suppl 1:13-6.
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ABSTRACT: Recognition rates for generalized anxiety disorder (GAS) and depression in primary care and its predictors are reported.
Based on the results of GAD-P study screening questionnaires, the investigators evaluated how many patients were correctly classified by primary care physicians a) as cases with mental disorders and b) as specific disorder cases. Socio-demographic and illness history variables of patients as well as features of physicians were analyzed as predictors of recognition by regression analyzes.
Physicians recognized a mental disorder in more than two thirds of cases with GAS; rates were even higher in patients with comorbid anxiety and depression (85.4%). Recognition of the specific disorder was conspicuously worse in patients with GAS (34.4%) in comparison with patients with depression (64.3%). Only the variables of patients' demographic status and illness (e.g. higher age or, negatively, incident GAS) predicted recognition of a mental disorder.
Generalized anxiety is often recognized as a mental disorder but seldom as the specific diagnosis of GAS. This is especially true for patients without a history of mental disorders (incident cases). Suggestions for a better recognition are discussed in the light of specific psychopharmacologic and psychotherapeutic treatment demands. The risks of chronicity of this disorder as well as the ascertained predictors of good recognition are also discussed.
Fortschritte der Medizin. Originalien. 02/2001; 119 Suppl 1:26-35.
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ABSTRACT: The aim of the study is to develop a comprehensive clinical-epidemiological description of the prevalence of generalized anxiety disorders and depression among primary care patients along with an assessment of physicians recognition rates and prescription behaviour. The paper describes methods and design of the study and provides background information on the sampling process and instruments used as well as characteristics of doctors and patients. The study is based on a nationally representative sample of 558 primary care physicians and over 20,000 patients, who attended physicians' offices on the target day. The first stage of study involved a comprehensive description of the physicians characteristics in terms of psychosocial qualification, and provider aspects as well as attitudes towards GAD and depression. In the second stage, all the patients completed a diagnostic screening questionnaire for GAD and depression. In the third stage all patients were characterized by their physicians in terms of their diagnostic status and their past and current interventions.
Fortschritte der Medizin. Originalien. 02/2001; 119 Suppl 1:5-12.
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ABSTRACT: More than two thirds of all GAD patients are recognized as cases with mental disorders, only one third is correctly diagnosed. The paper shows that this has significant implications. 36%--as compared to 23% of those with major depression--receive no intervention. Of those recognized at least as a case the majority is treated by the GP, 9% are only referred to specialists, in addition to another 20% that are treated by the GP and referred as well. Almost all patients receive medication, however, only few medications that match scientific guidelines for GAD-specific treatments, namely SNRI, behavioural psychotherapy or SSRI. Also the high degree of comedication as well as high prescription rates for sedatives and phytotonics needs highlightening. The findings overall reveal an unsatisfactory picture of current treatment strategies for GAD patients in primary--especially if compared to depression. Treatments of first choice, SNRI (Venlafaxine SR) and behavioural psychotherapy are prescribed to only the minority of GAD sufferers.
Fortschritte der Medizin. Originalien. 02/2001; 119 Suppl 1:36-41.
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ABSTRACT: To estimate the point prevalence of insomnia, recognition and prescription behavior in primary care.
Nationwide sample of 539 primary care settings along with their characterization (stage 1). Standardized assessment of all attenders (N = 19.155 patients) on the NISAS target day using a sleep questionnaire (PSQI) and additional questions to cover psychosocial and additional clinical variables. All patients were evaluated by the primary care doctors using a standardized clinical appraisal questionnaire, including a CGI-rating.
Prevalence insomnia according to DSM-IV was 26.5%. Recognition of presence of any clinically significant sleep disorder was 72%, recognition of insomnia was poor 54.3%. 85.6% of insomnia patients were rated as chronic. Close to 50% of all insomnia cases did not receive a specific insomnia therapy. Herbals, followed by hypnotics and sedatives and antidepressants were the three most frequent treatments applied, psychotherapy was only seldomly indicated.
NISAS provides for the first time nationally representative estimates of interventions for insomnia in primary care. The relatively low treatment rates and the high proportion of chronic patients receiving longterm prescription of benzodiazepines seem to be critical. Priorities for future agenda to improve this situation are discussed.
Fortschritte der Medizin. Originalien. 02/2001; 119(1):9-19.
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ABSTRACT: The investigators evaluated the (target-day) point prevalence and correlates of generalized anxiety and depression in German primary care practices.
The study used a representative national sample of more than 500 primary care practices. On a target day, all primary care patients were examined by questionnaires (GAS-Q and DSQ).
Conservatively estimated, 5.3% of all primary care patients met criteria for generalized anxiety disorder (GAD). Similar prevalence estimations were found for Major Depression. Only 30% of all GAD patients met criteria for depression cross-sectionally. Patients with GAD (whether comorbid with depression or not) were more frequently female, reported an onset of GAD mostly between ages of 25 and 45 years, had increased rates of disability and impairment in major social roles and high utilization rates of all health care resources. They also revealed a predominantly chronic course of illness over a period of several years and an increased suicide rate. The presence of physical illness increased rates of handicap/impairment days in the past month. Associated negative outcomes were found to be similar to those observed in depressive disorders. Patients with GAD reported significantly more frequently sleep, anxiety and depressive problems as primary reasons for contact.
The GAD-P study highlights the significance of GAD in primary care as a condition that occurs at about the same frequency as major depression. Further, the relatively high proportion of pure GAD suggests that the frequency of depression-comorbidity of GAD has previously been overestimated.
Fortschritte der Medizin. Originalien. 02/2001; 119 Suppl 1:17-25.
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ABSTRACT: Objective: To examine the temporal relationships of anxiety and depressive disorders, their risk factors and to explore why people with anxiety develop depression.Method: Data from an original 4–5-year prospective-longitudinal community study (N=3021) of adolescents and young adults with DSM-IV anxiety and depressive disorders identified with the Composite International Diagnostic Interview are used to examine risk factors, as well as course and outcome.Results: (i) Anxiety disorders, except for panic disorder, are almost always primary conditions. (ii) Over the follow-up period, rates of comorbid anxiety-depression increased substantially and resulted in increased impairment and disabilities. (iii) Predictors for first onset of ‘pure’ depressive and ‘pure’ anxiety disorders revealed recognizable differences. (iv) Baseline clinical characteristics of anxiety disorders were significantly associated with an increased risk to develop major depression over the follow-up period.Conclusion: Findings suggest that most anxiety disorders are primary disorders that substantially increase the risk for secondary depression.
Acta Psychiatrica Scandinavica 11/2000; 102(s406):14 - 23. · 4.22 Impact Factor
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ABSTRACT: This article examines the associations between DSM-IV social phobia and parental psychopathology, parenting style, and characteristics of family functioning in a representative community sample of adolescents.
Findings are based on baseline and first follow-up data of 1047 adolescents aged 14 to 17 years at baseline (response rate, 74.3%), and independent diagnostic interviews with one of their parents. Diagnostic assessments in parents and adolescents were based on the DSM-IV algorithms of the Munich-Composite International Diagnostic Interview. Parenting style (rejection, emotional warmth, and overprotection) was assessed by the Questionnaire of Recalled Parental Rearing Behavior, and family functioning (problem solving, communication, roles, affective responsiveness, affective involvement, and behavioral control) was assessed by the McMaster Family Assessment Device.
There was a strong association between parental social phobia and social phobia among offspring (odds ratio [OR], 4.7; 95% confidence interval [CI], 1.6-13.5). Other forms of parental psychopathology also were associated with social phobia in adolescents (depression: OR, 3.6; 95% CI, 1.4-9.1; any anxiety disorder other than social phobia: OR, 3.5; 95% CI, 1.4-8.8; and any alcohol use disorder: OR, 3.0; 95% CI, 1.1-7.8). Parenting style, specifically parental overprotection (OR, 1.4; 95% CI, 1.0-1.9) and rejection (OR, 1.4; 95% CI, 1.1-1.9), was found to be associated with social phobia in respondents. Family functioning was not associated with respondents' social phobia.
Data suggest that parental psychopathology, particularly social phobia and depression, and perceived parenting style (overprotection and rejection) are both associated with the development of social phobia in youth.
Archives of General Psychiatry 10/2000; 57(9):859-66. · 12.02 Impact Factor
