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Journal ArticleDOI

Estimation of psycholeptic and psychoanaleptic medicine use in an adult general population sample using the Anatomical Therapeutic Chemical classification.

01 Dec 2008-International Journal of Methods in Psychiatric Research (John Wiley & Sons, Ltd.)-Vol. 17, Iss: 4, pp 220-231

TL;DR: It is concluded that considerable proportions of individuals with current PM use exist although lower than may be expected on the basis of the number of Individuals with mental disorder in the general population.

AbstractLittle is known about psycholeptic and psychoanaleptic medicine (PM) use in the general population. This study presents prevalence data about PM use. The sample included 4310 individuals aged 20–79 from a general population health examination in a northern German area (participation proportion: 68.8%; Study of Health in Pomerania, SHIP). Medicines taken during the past seven days were assessed from the medicine packages or self-reports and classified according to the Anatomical Therapeutic Chemical (ATC) classification developed by the World Health Organization. In total, 6.3% of the sample reported PM intake, 8.7% of the women and 4.7% of the men. During the past 12 months prior to the health examination, 49.2% of the individuals with PM use consulted a general practitioner but not a neurologist or a psychiatrist. Among the study participants with PM use, 88.8% had one or more mental disorders during lifetime according to a screening questionnaire. It is concluded that considerable proportions of individuals with current PM use exist although lower than may be expected on the basis of the number of individuals with mental disorder in the general population. Copyright © 2008 John Wiley & Sons, Ltd.

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Journal ArticleDOI
TL;DR: It is demonstrated that utilization of CDs shows demographical and institutional differences, which could be of help to improve surveillance of CDs as well as to train prescribers and patients.
Abstract: Objective: Use of drugs that may lead to abuse or dependence are subject to controlled prescriptions (CPs) in many countries, and these are closely monitored by health authorities. According to national regulations in Turkey, CPs may be red coloured (RCPs) or green coloured (GCPs). The aim of this study was to evaluate the use of such drugs in Istanbul. Study Design: Retrospective case-control study. Material and Methods: During the study period (01/01-31/12 2009), 502874 CPs were reported. Among these, 4000 CPs each month were randomly selected and evaluated. Results: The majority of GCPs were issued to women (55.6%), while the majority of RCPs were issued to men (68.4%). GCPs were most frequently prescribed by physicians working in private hospitals (33.6%) while RCPs by physicians working in university hospitals (39.7%). GCPs were mostly prescribed by psychiatrists (37.6%) while for RCPs were child and adolescent psychiatrists (35.9%). Psycholeptics (ATC code N05) were the most prescribed controlled drugs (CDs) (43.8%). Methylphenidate (53.9%) was the mostly prescribed on RCPs and alprazolam (39.6%) was on GCPs. Conclusion: We demonstrate that utilization of CDs shows demographical and institutional differences. These data could be of help to improve surveillance of CDs as well as to train prescribers and patients. Turkish Baslik: Kontrole Tabi Ilaclarin Kullanimi: Retrospektif Bir Calisma Anahtar Kelimeler: Kontrole tabi receteler, Kontrole tabi ilaclar, Narkotikler, Psikotrop ilaclar, Kirmizi ve Yesil receteler Amac: Kotuye kullanilma ya da bagimliliga yol acma riski tasiyan ilaclar pek cok ulkede kontrole tabidir ve kullanimlari saglik otoriteleri tarafindan yakindan izlenmektedir. Turkiye'deki ulusal duzenlemelere gore, cogu kontrole tabi ilac (KTI) kirmizi recete (KR) ya da yesil recete (YR) formatinda islem gormektedir. Calismada, Istanbul'da bu formatta islem goren KTI'lerin kullaniminin arastirilmasi amaclanmistir. Gerec ve Yontemler: Calisma periyodu boyunca (01/01-31/12 2009), 502 874 kontrole tabi recete (KTR) Istanbul Saglik Mudurlugu'ne ulastirilmistir. Bu receteler arasindan, her ay icin rastgele secilen 4 000 KTR arastirmada incelenmistir. Bulgular: YR'lerin daha cok kadinlara (%55.6), KR'lerin daha cok erkeklere (%68.4) yazildigi saptandi. YR'lerin en sik ozel hastanelerde (%33.6), KR'lerin en sik universite hastanelerinde (%39.7) yazildigi saptandi. YR'lerin en fazla psikiyatri (%37.6), KR'lerin en fazla cocuk ve ergen psikiyatrisi (%35.9) uzmanlari tarafindan yazdigi saptandi. Psikoleptiklerin (ATC kodu: N05), (%43.8) en cok recetelenen KTI oldugu saptandi. En sik recete edilmis olan KTI'lerin KR'lerde metilfenidat (%53.9), YR'lerde alprazolam (%39.6) oldugu saptandi. Sonuc: KTI kullaniminin demografik ve kurumsal farkliliklar gosterdigi bu arastirmayla ortaya konmus oldu. Bu bilgilerin, KTI takip sistemlerinin gelistirilmesinde ve bu ilaclari yazan ya da kullanan kisilere yonelik etkinliklerde yol gosterici olmasi beklenmektedir.

4 citations


References
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Journal ArticleDOI
02 Jun 2004-JAMA
TL;DR: Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases and careful consideration needs to be given to the value of treating some mild cases, especially those at risk for progressing to more serious disorders.
Abstract: Context Little is known about the extent or severity of untreated mental disorders, especially in less-developed countries. Objective To estimate prevalence, severity, and treatment of Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) mental disorders in 14 countries (6 less developed, 8 developed) in the World Health Organization (WHO) World Mental Health (WMH) Survey Initiative. Design, Setting, and Participants Face-to-face household surveys of 60463 community adults conducted from 2001-2003 in 14 countries in the Americas, Europe, the Middle East, Africa, and Asia. Main Outcome Measures The DSM-IV disorders, severity, and treatment were assessed with the WMH version of the WHO Composite International Diagnostic Interview (WMH-CIDI), a fully structured, lay-administered psychiatric diagnostic interview. Results The prevalence of having any WMH-CIDI/DSM-IV disorder in the prior year varied widely, from 4.3% in Shanghai to 26.4% in the United States, with an interquartile range (IQR) of 9.1%-16.9%. Between 33.1% (Colombia) and 80.9% (Nigeria) of 12-month cases were mild (IQR, 40.2%-53.3%). Serious disorders were associated with substantial role disability. Although disorder severity was correlated with probability of treatment in almost all countries, 35.5%.to 50.3% of serious cases in developed countries and 76.3% to 85.4% in less-developed countries received no treatment in the 12 months before the interview. Due to the high prevalence of mild and subthreshold cases, the number of those who received treatment far exceeds the number of untreated serious cases in every country. Conclusions Reallocation of treatment resources could substantially decrease the problem of unmet need for treatment of mental disorders among serious cases. Structural barriers exist to this reallocation. Careful consideration needs to be given to the value of treating some mild cases,. especially those at risk for progressing to more serious disorders.

2,850 citations


Journal ArticleDOI
TL;DR: The design and development of the CIDI is described and the current field testing of a slightly reduced "core" version is described, allowing investigators reliably to assess mental disorders according to the most widely accepted nomenclatures in many different populations and cultures.
Abstract: • The Composite International Diagnostic Interview (CIDI), written at the request of the World Health Organization/US Alcohol, Drug Abuse, and Mental Health Administration Task Force on Psychiatric Assessment Instruments, combines questions from the Diagnostic Interview Schedule with questions designed to elicit Present State Examination items. It is fully structured to allow administration by lay interviewers and scoring of diagnoses by computer. A special Substance Abuse Module covers tobacco, alcohol, and other drug abuse in considerable detail, allowing the assessment of the quality and severity of dependence and its course. This article describes the design and development of the CIDI and the current field testing of a slightly reduced "core" version. The field test is being conducted in 19 centers around the world to assess the interviews' reliability and its acceptability to clinicians and the general populace in different cultures and to provide data on which to base revisions that may be found necessary. In addition, questions to assess International Classification of Diseases , ninth revision, and the revised DSM-III diagnoses are being written. If all goes well, the CIDI will allow investigators reliably to assess mental disorders according to the most widely accepted nomenclatures in many different populations and cultures.

2,408 citations


Journal ArticleDOI
TL;DR: Despite an increase in the rate of treatment, most patients with a mental disorder did not receive treatment and continued efforts are needed to obtain data on the effectiveness of treatment in order to increase the use of effective treatments.
Abstract: Background Although the 1990s saw enormous change in the mental health care system in the United States, little is known about changes in the prevalence or rate of treatment of mental disorders. Methods We examined trends in the prevalence and rate of treatment of mental disorders among people 18 to 54 years of age during roughly the past decade. Data from the National Comorbidity Survey (NCS) were obtained in 5388 face-to-face household interviews conducted between 1990 and 1992, and data from the NCS Replication were obtained in 4319 interviews conducted between 2001 and 2003. Anxiety disorders, mood disorders, and substance-abuse disorders that were present during the 12 months before the interview were diagnosed with the use of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Treatment for emotional disorders was categorized according to the sector of mental health services: psychiatry services, other mental health services, general...

1,582 citations


Journal ArticleDOI
TL;DR: Epidemiological data on a wide range of mental disorders from community studies conducted in European countries are presented to determine the availability and consistency of prevalence, disability and treatment findings for the EU, highlighting considerable future research needs for coordinated EU studies across all disorders and age groups.
Abstract: Epidemiological data on a wide range of mental disorders from community studies conducted in European countries are presented to determine the availability and consistency of prevalence, disability and treatment findings for the EU. Using a stepwise multimethod approach, 27 eligible studies with quite variable designs and methods including over 150,000 subjects from 16 European countries were identified. Prevalence: On the basis of meta-analytic techniques as well as on reanalyses of selected data sets, it is estimated that about 27% (equals 82.7 million; 95% CI: 78.5–87.1) of the adult EU population, 18–65 of age, is or has been affected by at least one mental disorder in the past 12 months. Taking into account the considerable degree of comorbidity (about one third had more than one disorder), the most frequent disorders are anxiety disorders, depressive, somatoform and substance dependence disorders. When taking into account design, sampling and other methodological differences between studies, little evidence seems to exist for considerable cultural or country variation. Disability and treatment: despite very divergent and fairly crude assessment strategies, the available data consistently demonstrate (a) an association of all mental disorders with a considerable disability burden in terms of number of work days lost (WLD) and (b) generally low utilization and treatment rates. Only 26% of all cases had any consultation with professional health care services, a finding suggesting a considerable degree of unmet need. The paper highlights considerable future research needs for coordinated EU studies across all disorders and age groups. As prevalence estimates could not simply be equated with defined treatment needs, such studies should determine the degree of met and unmet needs for services by taking into account severity, disability and comorbidity. These needs are most pronounced for the new EU member states as well as more generally for adolescent and older populations.

1,341 citations


Journal ArticleDOI
TL;DR: Results confirm and extend results from other national studies using the same assessment instruments with regard to prevalence, co-morbidity and sociodemographic correlates, covering a broader range of DSM-IV disorders.
Abstract: Background. The German National Health Interview and Examination Survey (GHS) is the first government mandated nationwide study to investigate jointly the prevalence of somatic and mental disorders within one study in the general adult population in Germany. This paper reports results from its Mental Health Supplement (GHS-MHS) on 4-week 12-month, and selected lifetime prevalence of a broad range of DSM-IV mental disorders, their co-morbidity and correlates in the community.Methods. The sample of the GHS-MHS (n=4181; multistage stratified random sample drawn from population registries; conditional response rate: 87·6%) can be regarded as representative for the German population aged 18–65. Diagnoses are based on fully structured computer assisted clinical interviews (M-CIDI), conducted by clinically trained interviewers.Results. 12-month prevalence for any DSM-IV study disorder is 31% (lifetime: 43%; 4-week: 20%) with anxiety disorders, mood disorders and somatoform syndromes being the most frequent diagnoses. Retrospective age of onset information reveals that most disorders begin early in life. Co-morbidity rates among mental disorders range from 44% to 94%. Correlates of increased rates of mental disorders and co-morbidity were: female gender (except for substance disorders), not being married, low social class, and poor somatic health status. Health care utilization for mental disorders depended on co-morbidity (30% in ‘pure’, 76% in highly co-morbid cases) and varied from 33% for substance use disorders to 75% for panic disorder.Conclusions. Results confirm and extend results from other national studies using the same assessment instruments with regard to prevalence, co-morbidity and sociodemographic correlates, covering a broader range of DSM-IV disorders [i.e. somatoform disorders, all anxiety disorders (except PTSD), mental disorders due to substance or general medical factor, eating disorders]. Intervention rates were higher than in previous studies, yet still low overall.

985 citations


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