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ABSTRACT: Studies performed in recent years in different countries suggest a considerable prevalence of depressive disorders in primary care patients. The aim of our study was the assessment of depressive disorders among primary care patients in Poland.
Three-hundred thirty-three randomly chosen private and public primary care clinics from the whole country took part in the study. In each centre, 20 or 25 patients aged 18-65 years coming for a regular visit were asked to participate in the study. All patients filled in the Beck Depression Inventory (BDI). Additionally, basic demographic data and information on the presence of chronic somatic diseases were collected. Those patients who scored 12 or more points on BDI (cut-offpoint for depression in Poland) were evaluated by a primary care physician for presence of a depressive disorder upon the ICD-10 criteria and subsequently referred for a psychiatric consultation to the nearest psychiatric outpatient clinic for establishing plausible diagnosis of depression.
Out of 7360 patients approached, 7289 (95.5%) agreed to participate. The mean age of the sample was 43.3 +/- 13.2 and 71% were females. Forty one percent of patients (2985) had 12 or more points on the BDI and were referred for a psychiatric evaluation. Only half of them came for a psychiatric consultation. Depressive disorder was recognised in 906 patients. Estimated prevalence of depressive disorders in the whole sample was 23.3%. The patients in whom depressive disorders were confirmed by psychiatric assessment had significantly more often hypertension, ischaemic heart disease, anaemia, stroke and hypothyroidism.
The results obtained show that depressive disorders' prevalence in primary care patients in Poland is significant. The patients who had depressive disorders significantly more often than patients without depression suffered from some somatic diseases. In light of the results, both recognition and adequate treatment of depressive disorders in primary care patients should be regarded as equally important as the recognition and treatment of cardiovascular diseases or other common somatic illnesses.
Wiadomości lekarskie (Warsaw, Poland: 1960) 02/2007; 60(3-4):109-13.
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Martin Dossenbach,
Yulia Dyachkova,
Sebnem Pirildar,
Martin Anders,
Afaf Khalil, Aleksander Araszkiewicz,
Tamara Shakhnovich,
Aly Akram,
Jan Pecenak,
Margaret McBride,
Tamas Treuer
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ABSTRACT: Sexual dysfunction in patients with schizophrenia can reduce quality of life and treatment compliance. This report will compare the effects of selected atypical and typical antipsychotics on sexual function in a large, international population of outpatients with schizophrenia who were treated over 1 year.
Outpatients with schizophrenia, who initiated or changed antipsychotic treatment, and entered this 3-year, prospective, observational study were classified according to the monotherapy prescribed at baseline: olanzapine (N=2638), risperidone (N=860), quetiapine (N=142) or haloperidol (N=188).
Based on patient perception, the odds of experiencing sexual dysfunction during 1 year of therapy was significantly lower for patients treated with olanzapine and quetiapine when compared to patients who received risperidone or haloperidol (all P< or =0.001). Females on olanzapine (14%) or quetiapine (8%) experienced a lower rate of menstrual irregularities, compared to females on risperidone (23%) or haloperidol (29%). Significant discordance was evident between patient reports and psychiatrist perception of sexual dysfunction, with psychiatrists underestimating sexual dysfunction (P< or =0.001).
These findings indicate clinically relevant differences exist in the sexual side effect profiles of these selected antipsychotics. These factors should be considered when selecting the most appropriate treatment for outpatients with schizophrenia.
European Psychiatry 07/2006; 21(4):251-8. · 2.77 Impact Factor
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ABSTRACT: For the assessing the incidence of mood disturbances among the neurological out-patients 3287 of them were examined by 111 neurologists during their routine practice. Early diagnosis, the type of mood disturbances and the depth of depression were estimated by the use of Beck's Depression Inventory, the questionnaire based on The Mini-International Neuropsychiatric Interview and Hamilton Depression Rating Scale, as well. Around half of the patients (50.47%) were suspected on depression, as an early diagnosis. In suspected and diagnosed depressive patients the symptoms as anxiety, low activity precordial pain, headaches, dry mouth, constipation, sleep and appetite troubles were significantly (p < 0.01) more frequent than in euthymic subjects. Among all studied patients the episode of depression were found as a final diagnose in 17.2%, recurrent depressive disorders--in 17.6% and dysthymia--in 2.8% of subjects. In finally diagnosed depressive patients the chronic neurological problems were significantly (p = 0.013) more frequent, as the cause of the visit, than in the euthymic ones. The low mood was equally frequent among the patients with Parkinson's disease, multiple sclerosis and cerebrovascular disorders, as well.
Neurologia i neurochirurgia polska 01/2003; 37 Suppl 1:9-21. · 0.43 Impact Factor
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ABSTRACT: The aim of the study was to assess the effects of short-term risperidone treatment on schizophrenic symptoms and on neuropsychological frontal tests, and to find an association between the improvements in these two kinds of domains. Twenty-two schizophrenic patients treated with risperidone (2-6 mg/day) for 4 weeks were studied. Treatment with risperidone resulted in a significant decrease in the intensity of schizophrenic symptoms and in an improvement in all neuropsychological tests applied. A robust correlation was obtained between the amelioration of negative symptoms and improvements in many neuropsychological tests, specifically with amelioration in the Wisconsin Card Sorting Test (WCST), perseverative errors. Some correlation was also found with the improvement of positive symptoms, specifically with amelioration in the WCST, completed categories. The results may suggest a common neurobiological substrate of negative and cognitive symptoms, reflected in prefrontal cortex pathology and in therapeutic response to atypical antipsychotics.
Neuropsychobiology 02/2002; 46(2):85-9. · 2.67 Impact Factor
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ABSTRACT: To compare the effectiveness and tolerability of olanzapine and other antipsychotic treatments (6 months after enrollment) in Polish patients with schizophrenia participating in the IC-SOHO (the Intercontinental Schizophrenia Outpatient Health Outcomes) study.
IC-SOHO is a 3-year, global, prospective, observational study examining health outcomes in outpatients with schizophrenia undergoing treatment with antipsychotics. Patients were offered enrollment by a psychiatrist if they initiated or changed antipsychotic medication for the treatment of schizophrenia. The study was designed to provide two patient cohorts of approximately equal size: patients who initiated or switched to olanzapine, and patients who initiated or switched to non-olanzapine antipsychotic therapy. Mean changes in positive, negative, cognitive, depressive and overall symptoms from baseline to 6 months, as measured using the CGI scale, were assessed. The incidence of extrapyramidal symptoms and sexual dysfunctions and weight changes were compared.
Out of 7648 patients participating in the IC-SOHO study, 626 patients were enrolled in Poland. After 3 and 6 months of treatment, significantly greater improvement in overall symptoms measured using the CGI scale was observed in patients with olanzapine than in those with other antipsychotics. Response rate at 6 months was significantly higher in the olanzapine group than in the non-olanzapine group. Incidence of extrapyramidal symptoms and sexual dysfunctions was lower in olanzapine group.
After 6 months, olanzapine-treated patients showed greater improvement of clinical status compared with other antipsychotic treatment. Olanzapine treatment was more beneficial for patients; comparing to other antipsychotic treatment less extrapyramidal symptoms and sexual dysfunctions were observed.
Psychiatria polska 38(3):469-84. · 0.19 Impact Factor
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ABSTRACT: The aim of the study was to evaluate the prevalence of depressive disorders in perimenopausal women reporting to gynecologists and to assess a possibility of screening and diagnosing depression in gynecological practice.
The study entailed 2262 female patients of the age of 45-55 attending 120 gynecologists in Poland. Patients were first asked to fill in the Beck's Depression Inventory and next examined by their gynecologists to verify the presence of the basic symptoms of depressive episode according to ICD-10 diagnostic criteria. Patients who obtained 12 points or more in BDI total score were referred for a psychiatric consultation, including the MINI questionnaire. The study was monitored by 'Servier Polska'.
32.5% of women aged 45-55 years visiting gynecologists scored 12 points or more on the BDI scale. Patients with high BDI scores reported long-lasting somatic and emotional symptoms associated with menopause more frequently than patients with low BDI scores. Women with high BDI scores also more frequently experienced gynecological surgery in the past, more frequently attended gynecological clinics, and reported more peri- and postmatal mood disorders. 57% of patients did not visit psychiatrists. Depressive disorders were diagnosed in 76% of patients who came for the psychiatric evaluation.
The study suggests that more than 19% of perimenopausal women attending their gynecologists suffer from depressive disorders. Gynecologists in Poland can diagnose depression accurately and start pharmacological treatment of the disorder in half of the patients.
Psychiatria polska 37(5):811-24. · 0.19 Impact Factor
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ABSTRACT: The primary objective of the study was to evaluate the severity of extrapyramidal symptoms during treatment with olanzapine (10-20 mg) versus perphenazine (8-40 mg) using the Simpson Angus Scale (SAS). The secondary objective was to assess the safety profile and clinical efficacy of the investigated drugs.
A total of 95 patients with schizophrenia who met the criteria for DSM-IV were randomized to a double-blind, 18 week prospective comparative trail conducted in Poland. The tolerance of treatment was assessed with the use of scales: BAS, SAS and UKU. The efficacy of treatment was evaluated with BPRS, PANSS and CGOI scales.
For olanzapine patients, the severity of extrapyramidal symptoms improved after 3 first weeks of treatment, and significantly decreased from the baseline to endpoint. Perphenazine patients showed an increase of extrapyramidal symptoms. The difference of the SAS scores change was statistically significant between olanzapine and perphenazine groups. Akathisia symptoms decreased significantly in the olanzapine group during the treatment period, whereas symptoms of akathisia increased in the perphenazine group. Statistically significant differences of mean change of BAS total score from baseline to endpoint were noted between treatment groups Treatment--emergent adverse events occurred more frequently in patients receiving perphenazine (46%), than in patients receiving olanzapine (17%). The proportion of patients complying with improvement criteria for CGI scale score was statistically greater in the olanzapine group (72.7%) than in the perphenazine group (47.9%). Results of this study showed that the tolerance profile in patients taking olanzapine is superior to perphenazine.
Olanzapine was better tolerated than perphenazine. After olanzapine treatment more subjects fulfilled the criterion of improvement and schizophrenic symptoms were less severe than in patients treated with perphenazine.
Psychiatria polska 37(4):641-55. · 0.19 Impact Factor
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ABSTRACT: The aim of this study was to assess the effect of sertraline on psychopathological symptoms and cognitive functions and in patients with obsessive compulsive disorder (OCD). The investigated group consisted of 25 patients with OCD (12 male, 13 female) aged 17-47 (mean 29 +/- 9) years, duration of illness was 1-15 (mean 4 +/- 2) years. After treatment with sertraline, a significant improvement in OCD symptoms measured by YBOCS and in neuropsychological "frontal" tests were observed. Little correlation was found between the effect of sertraline on OCD symptoms and on cognitive dysfunctions. This may suggest that these two effects may be connected with different pharmacological properties of the drug. The effect of sertraline on OCD symptoms, similarly like other drugs inhibiting serotonin transporter (clomipramine, other SSRI) is associated with its influence on serotonergic system. On the other hand, the effect of sertraline on dopaminergic neurotransmission may be related to its favorable action on cognitive functions connected with the activity of frontal lobe.
Psychiatria polska 36(6 Suppl):289-95. · 0.19 Impact Factor
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ABSTRACT: The aim of this paper is to present and to discuss the results of an investigation conducted among Polish psychiatrists in 2007, especially its part relating to the practice of therapeutic patterns in refractory schizophrenia.
Structured individual interviews were conducted from 100 psychiatrists chosen at random in 9 larger cities in Poland. The interviews were followed by a questionnaire consisting of 52 questions relating to the principles of treatment and a perception of the features of antipsychotics. One part of the interview focused on refractory schizophrenia treatment. The perception of antipsychotics was interpreted with the use of the Pin Points Analysis method.
In-patient schizophrenic patients are treated most often with clozapine (57%), but olanzapine (38%) and risperidone (32%) are the most common in out-patients. Other neuroleptics are prescribed considerably seldom. According to the doctors' declaration, their choices of medicines would be different, if there were no external limitations in drug prescription. In spite of this, the psychiatrists' claim, that their choice of antipsychotics is based on their own knowledge (44%), to a smaller degree it is based on the experts' recommendations (32%) and the currently valid reimbursement rules (24%).
The Refractory schizophrenia treatment that is applied in practice, is generally convergent with the principles of the treatment. Clozapine still has a significant place in therapy. Use of all the remaining atypicals, besides risperidone and the olanzapine, they are limited by the high price for patient.
Psychiatria polska 42(6):859-73. · 0.19 Impact Factor
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ABSTRACT: The aim was to obtain the information regarding the choice of antipsychotic drugs in the treatment of first episode schizophrenia. In particular, the factors influencing doctors' preferences and their opinion about several antipsychotics and the availability of these drugs were evaluated.
The anonymous questionnaire was presented to 100 psychiatrists; 50 of them were in hospital and 50 were in the out-patient practice. The questionnaire consisted of 17 questions regarding the pharmacological treatment of the first schizophrenic episode.
The most frequently prescribed drug was olanzapine (33%), then risperidone (26%), and perazine (25%). In hospitals, risperidone was more frequently administered than perazine (29% and 24% respectively) while in out-patient clinics perazine slightly outnumbered risperidone (25% vs 23%). Fluoxetine was prescribed to 18% of out-patients, but not to hospitalized ones. Doctors performed treatment verification mainly (in 39% of patients) after 4 weeks of therapy. The change of antipsychotics was made more frequently in 28% of those hospitalized than the out-patients (16%) and mainly due to the lack of efficacy. More psychiatrists considered the most important attribute of the drug to be the efficacy toward the negative symptoms (77%) than the positive symptoms (59% of doctors).
Prescription practice of psychiatrists shows the popularity of olanzapine and risperidone in the treatment of the first psychotic episode, but also indicates the strong position of perazine, which results from the current administrative regulations. Three times more psychiatrists think that patients should have an unrestricted (by the law) access to olanzapine or risperidone than to perazine. The most important attribute of an antipsychotic in the first episode schizophrenia turned out to be its efficacy toward the negative symptoms. Psychiatrists admitted that they chose an antipsychotic much more frequently on the basis of their own knowledge than on the basis of experts' opinion or the administrative regulations.
Psychiatria polska 42(6):841-58. · 0.19 Impact Factor
