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Biomedical subjects

H W van Marwijk

Publications and source records attributed to H W van Marwijk.

13 recordsLinked to original sources
PubMed2001

Antidepressant prescription for depression in general practice in The Netherlands.

OBJECTIVE: To evaluate diagnoses and the prescription of antidepressants drugs for depression, based on data from 1993 to 1998 related to consultations for depression in general practice in the Netherlands. METHOD: An exploratory analysis of data provided by IMS Health. Consecutive annual representative samples of 640 GPs regularly registered data on morbidity and (drug) treatment for specific medical problems in special booklets for a period of one week. The data refer to consultations for depression. The diagnoses were initially based on ICD-9 criteria and later ICD-10 criteria for depression. MAIN OUTCOME MEASURES: Number of diagnoses of depression and number of prescriptions for antidepressants. RESULTS: The number of first consultations for depression rose gradually, from 909 in 1993 (95% CI: 774 to 1043), to 1,482 (CI: 1292 to 1672) in 1998: an increase of 63%. For an individual GP, this represents an increase from 18 to 30 in first consultations for depression. The number of prescriptions for antidepressants also increased, mainly during repeat consultations: a 278% increase, from 3,708 in 1993 to 14,024 in 1998 (CIs: 3,504 to 3,912 and 13,252 to 14,796). Antidepressants were prescribed during the first consultation 564 times in 1993 compared with 1,080 times in 1998. The first contact with a GP for depression led to an antidepressant prescription in 62% of cases in 1993 and 73% in 1998. Although the guidelines issued by the Dutch College of General Practitioners in 1994 recommended tricyclic antidepressants (TCAs) for the treatment of depression, paroxetin, fluoxetin, and mirtazapin (SSRIs) accounted for 56% of the prescribed antidepressants. CONCLUSION: Between 1993 and 1998, GPs in the Netherlands prescribed increasingly more antidepressants, and they prescribed more SSRIs than TCAs. Furthermore, GPs diagnose depression more frequently and the number of repeat consultations has increased.

Antidepressive Agents↗
PubMed1997

A postmarketing study of flunarizine in migraine and vertigo.

This prospective, open multi-centre study on flunarizine focused on the risk/benefit ratio of the use of flunarizine in the prophylaxis of migraine and in the treatment of vertigo, due to disorder of the vestibular system. The assessment of risks focused on the incidence of new events of depression and/or extrapyramidal syndrome during flunarizine treatment. For migraine, flunarizine was compared to propranolol in 686 patients; for vertigo, flunarizine was compared to betahistine in 198 patients. The incidence of depression during follow-up in this study was significantly higher in the flunarizine group than in the propranolol group in the condition of migraine. There were no observations of an extrapyramidal syndrome. There was a suggestion that flunarizine has more benefits than propranolol in the condition of migraine, and that betahistine has more benefit than flunarizine in the condition of vertigo. Differences in dosages could possible explain these differences.

Adult↗
PubMed1997

[Depression in the elderly in family practice].

Depression among the elderly is an important problem in general practice. There is insufficient knowledge of the prevalence of this condition, of possible ways to improve diagnosis and of its course. The questions in this project were: a) how prevalent is depression in the active population of the GP, and which patients are identified as such by the GP, b) how can the depressed elderly patient be diagnosed in daily practice and which signals can be used by the GP to include or exclude the diagnosis, and c) what is the recovery of this condition among the elderly and is recovery related to recognition by the GP? a) The prevalence has been estimated in two studies (n = 384, n = 580) in 1990 en 1992 with self-report questionnaires and interviews. The samples consisted of consecutive elderly attenders of general practices. We used the Zung scale, the Geriatric Depression Scale (GDS) and the Diagnostic Interview Schedule (DIS). b) To improve diagnosis the relationship of various characteristics to depression status at interview in 1992 was analyzed, and we also evaluated whether the 30-item version of the GDS could be shortened for use in daily practice. c) Patients with depression at baseline interview in 1992 were reassessed with the DIS at 6 and 12 months to evaluate the course. a) Many elderly patients indicated depressive complaints on the self-report questionnaires for depression, respectively 11% and 13% for Zung and GDS. One in twelve elderly patients had depression according to the interview in 1992 (46/580). Not all patients who have depressive complaints or depression were recognised by the GPs. b) Vague or gastrointestinal (GI) reasons for visiting the GP or presenting symptoms and female gender were related to depression. To make suspected depression more likely or to exclude depression, 4 questions may suffice. c) At 12 months 72% of the 25 patients with depression at baseline interview were not depressed. Whether patients were depressed at follow-up interviews was not related to recognition by the GP. The conclusion is that vague complaints and GI problems may be a signal for depression in the elderly and a few short questions may make this diagnosis more likely or exclude it. The course of this condition in general practice needs further study.

Aged↗
PubMed1996

[The Depression Recognition Scale: and aid in the diagnosis of depression in family practice].

OBJECTIVE: To assess the reliability, positive predictive value and concurrent validity of a brief and simple interview to diagnose major depression in general practice, the Depression recognition scale (DRS). DESIGN: Descriptive. SETTING: University of Leiden, the Netherlands. METHODS: The DRS was compared with a semi-structured psychiatric interview to assess major depression and with the depression items of the Symptom checklist-90 (SCL-90), a self-rating scale for perceived symptoms. RESULTS: The study consisted of 233 subsequent patients of II general practices who were screened for an interview; 95 patients were actually interviewed, 15 of these patients had a major depression (15/233; 6%). The DRS was also compared with the SCL-90 among 428 other patients. The validity was 0.73 and 0.66 and the internal consistency (Cronbach's alpha) was 0.63 and 0.75, respectively. If the DRS were used only for patients the general practitioner considers mildly depressed (43/233 = 18%), few cases of major depression would be missed (2/15). CONCLUSION: The DRS appears a practical, reliable and valid diagnostic tool.

Adult↗
PubMed1996

[Prescription of antidepressants in family practice].

OBJECTIVE: To evaluate the prescription of antidepressants in general practice. DESIGN: Retrospective observational study. SETTING: Three health centres and one practice with two partners in the Western part of the Netherlands (near Leiden). METHOD: Medication data and daily medical records of general practitioners (GPs) were analysed in the anonymous data set of Registratie network universitaire huisartspraktijken Leiden en Omstreken (RNUH-LEO, with a total of about 23,000 patients) of patients 18 years of age and over, whom the GP issued a first prescription for an antidepressant in the period May 1994-April 1995. For indication 'depression' we also evaluated whether the prescription was repeated and a minimal effective dosage was reached. RESULTS: In one year 218 patients received a first prescription of an antidepressant (9/1,000/year), mostly a classical antidepressant. In 61% the indication 'depression' was found in the medical records. Sixty-three per cent had a repeat prescription after one month. Serotonin reuptake inhibitors were repeated more frequently than classical antidepressants, especially for patients under the age of 65. The minimally effective dosage was reached in 61% of the patients with depression for the classical antidepressants, and for 98% of patients with serotonin reuptake inhibitors. CONCLUSION: Serotonin reuptake inhibitors were not prescribed more frequently than classical antidepressants. The percentage of patients with repeat prescriptions showed that the GPs should pay continued attention to compliance with therapy when prescribing antidepressants. The effective dosage appeared to be reached most often with serotonin reuptake inhibitors.

Adolescent↗
PubMed1996

Health-related quality of life assessments in osteoarthritis during NSAID treatment.

There is some evidence that nabumetone (1000 mg once daily) in comparison with piroxicam (20 mg once daily) in patients with OA in general practice is associated with a lower incidence and less severe occurrence of stomach pain but with more withdrawals due to lack of efficacy. The aim of this analysis was to investigate whether these differences are reflected in health-related quality of life assessments. Patients (n = 198) included in this study were selected in general practice according to a protocol. The patients were randomized and treated for a period of six weeks. Clinical assessments were performed by the general practitioner (CP) during treatment. The Sickness Impact Profile (SIP), the Activities of Daily Living (ADL), and a pain questionnaire were filled out by the patients before and after treatment. As measured with the SIP, the ADL and the pain questionnaire, there were no significant differences between nabumetone and piroxicam. The correlations between (changes in) patient assessments and (changes in) clinical assessments were low. The differences between the two drugs regarding withdrawals and adverse events were not reflected by patient health-related quality of life assessments. There was a low correlation between patient health-related quality of life assessment and clinical assessments. To get a complete picture of the efficacy and safety of a drug, patient health-related quality of life assessments should be a part of a clinical trial.

Adult↗
PubMed1996

Prevalence of depression and clues to focus diagnosis. A study among Dutch general practice patients 65+ years of age.

AIMS: To assess the prevalence of depression in elderly patients presenting in general practice, and to assess which patient characteristics and presenting symptoms are useful clues for predicting depression. DESIGN: Cross-sectional survey based on data collected at the presenting consultation and at a subsequent domiciliary interview. SUBJECTS AND SETTING: 580 of 706 consecutive patients aged 65+ years consulting 13 general practitioners in the Netherlands. METHOD: GPs entered data on presenting symptoms and their assessment of psychological state during the consultation. Formal psychiatric assessment was subsequently done at home using the Diagnostic Interview Schedule (plus additional questions to assess minor depression according to ICHPPC-2-Defined). Major depression and dysthymia were assessed with the Diagnostic Interview Schedule. RESULTS: The estimated prevalence of depression (both major and minor plus dysthymia) was 7.9%, and was very similar whether based on GP assessment or formal validated interview schedule, but the GPs did not identify the same patients as the formal psychiatric assessment. GPs identified only 26% (95% CI 4-71%) of patients with major depression. Clinical clues which could help the GP to suspect underlying depression were female gender, the presentation of vague symptoms, and gastrointestinal symptoms. CONCLUSIONS: Although presentation of symptoms does provide some clues about the likelihood of underlying depression, the sensitivity of GP diagnosis remains low and needs to be improved.

Aged↗
PubMed1995

Evaluation of the feasibility, reliability and diagnostic value of shortened versions of the geriatric depression scale.

BACKGROUND: Many scales have been developed to assess depression, but they are often too lengthy to be of practical use in general practice consultations. AIM: A study was undertaken to investigate the feasibility, reliability and diagnostic value of the geriatric depression scale and its shorter versions for screening in general practice. METHOD: A total of 586 consecutive consulting patients aged 65 years and over were studied in nine general practices in the west of the Netherlands (13 doctors). The 30-item version of the geriatric depression value was compared with the diagnostic interview schedule as a reference test. RESULTS: The reference test indicated a major depression in six patients while 27 patients had a dysthymic disorder (that is, a chronic mild depression). Five per cent of patients required help for 50% of the questions on the geriatric depression scale. The diagnostic value of the 30-item, 15-item, 10-item and four-item versions did not differ significantly, but the one-item version performed no better than chance. Two items discriminated best between patients who were and who were not depressed (P < 0.05), only one of which was included in a previously proposed four-item version of the scale. The reliability of the proposed four-item version was 0.64, the reliability of the other versions ranging from 0.70 to 0.87. CONCLUSION: The results for the different versions of the geriatric depression scale suggest the use of a 10-item or a four-item version. For practical purposes, the smallest subset would be the most desirable: the four-item version. These scales may be better suited for exclusion rather than inclusion purposes. The feasibility of screening for depression in elderly people in a general practice setting is discussed in the light of the results of the study.

Aged↗
PubMed1994

Osteoarthritis pain assessment in family practice.

PURPOSE: The objective is to study the assessment of pain severity, following the conventional family physician routines, in patients with peripheral osteoarthritis. METHODS: The patient's perception of pain and the physician's assessment of the pain were measured by means of questionnaires and were compared in a study population of 198 patients with osteoarthritis. RESULTS: A rather low association was found between a patient's perception of pain and the physician's assessment of pain. CONCLUSIONS: It is an accepted fact that too much treatment can have undesirable effects, and that inadequate management of symptoms seems to be associated with a reduced quality of life in osteoarthritic patients. In the absence of a high correlation between patient's perception and physician's assessment of pain severity, it is concluded that a patients' pain questionnaire could be a very useful instrument for improving the care given to patients with osteoarthritis in family practice.

Adult↗
PubMed1991

[The family physician and depression in the elderly. A pilot study of prevalence of depressive symptoms and depression in the elderly in 2 family practices].

A pilot-study on the prevalence of depressive symptoms and GPs' assessment of depressed mood in elderly attenders of two general practices. The aim of this pilot was to gather information on both depressive symptoms and GP's' assessments of depressive mood in persons over 65 coming for a consultation in two general practices. To assess the prevalence of depressive symptomatology, 87 patients were asked to complete the Zung Self-Rating Depression Scale (ZSDS) and the Geriatric Depression Scale (GDS). Six patients were identified as having depressive symptoms on the ZSDS and seven on the GDS. Information on GP's' assessments of depressive mood was gathered by asking GP's to what extent they thought patients had been depressed recently. With regard to patients identified by the GP's as being mildly or severely depressed, the GP's answered additional questions on diagnostic and therapeutic approaches. The GP's identified eleven out of 87 patients as being mildly depressed, nobody was classified as being severely depressed. Five out of six patients with a ZSDS score of 50 and higher were not identified by the GP's as being mildly depressed. The prevalence of depressive symptoms based on ZSDS-scores was somewhat lower than expected (7.5%).

Aged↗
PubMed1990

[Lithium in the treatment of depressed elderly patients].

In the geriatric department of a Dutch psychiatric hospital the charts of 65 patients treated with lithium for depression were reviewed. We assessed efficacy and adverse effects. The sample included 65 patients, 12 men and 53 women, mean age 77 (64-91) years. A complete or partial response was seen in 30 out of 43 patients (70%) treated with lithium in addition to a cyclic antidepressant. Six out of 22 patients treated with lithium as a sole antidepressant responded completely or partially. During lithium therapy 16 patients suffered from severe adverse effects. In our view and in spite of severe adverse effects, with expert monitoring lithium can be of value in the treatment of (very) old and depressed patients.

Aged↗
PubMed1990

Lithium augmentation in geriatric depression.

In the geriatric department of a Dutch psychiatric hospital the charts of 51 patients treated with lithium in addition to cyclic antidepressants were reviewed. A response was seen in 33 patients (65%). For patients with recurrent depressive episodes, a statistical trend was found towards more responders with more complete responses, compared to patients with first depressive episodes. During lithium augmentation, 10 patients suffered from severe adverse effects 12 times. In spite of adverse effects, with expert monitoring lithium augmentation can, in our opinion, be of value in the treatment of older depressed patients.

Aged↗