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N Sartorius

Publications and source records attributed to N Sartorius.

At least 55 records · Page 3Linked to original sources
PubMed1995

Is the lifetime risk of depression actually increasing?

Data from an international study of psychological problems in primary care were examined for evidence of increasing depression risk. At 15 sites, patients aged 15-65 (n = 26,421) were screened with the GHQ-12 and a stratified random sample (n = 5603) selected for psychiatric assessment (Composite International Diagnostic Interview). Initial analyses agreed with earlier cross-sectional studies, finding higher depression risk and earlier onset in recent birth cohorts. Additional analyses suggested that methods effects may explain these findings. First, apparent prevalence increases were nonspecific with similar trends seen across all study sites and for all disorders examined. Second, reporting patterns suggested significant under-counting of past depressive episodes. Respondents of all ages typically reported first onset of depression during the last 5 years. Reported lifetime prevalence was only 2.02 times current prevalence. These findings suggest that depression risk is not rapidly increasing and that true lifetime prevalence is much higher than estimated by cross-sectional surveys.

Adolescent↗
PubMed1995

Recent changes in suicide rates in selected eastern European and other European countries.

Recent major political changes in Eastern European countries might have affected their suicide rates. For this article, suicide statistics available to the World Health Organization were used to compare data from eight Eastern European countries to those from seven countries in Northern or Western Europe. Comparisons were made between 1987 and 1991/92 data using total suicide rates for each country, rates by gender, and rates for the elderly (age 75 and older). The total rates indicated an increase in suicide in Eastern European countries and a decrease in other European countries. The ratio of male-to-female suicides in the Eastern European countries increased during this time as well, more than in other European countries. Among those over the age of 75, however, rates of suicide in Eastern European countries decreased; this pattern was less clear in the European countries chosen for comparison. The article discusses the role of economic, cultural, and health service factors affecting these trends.

Aged↗
PubMed1995

Progress toward achieving a common language in psychiatry, II: Results from the international field trials of the ICD-10 diagnostic criteria for research for mental and behavioral disorders.

OBJECTIVE: In preparing for the publication of ICD-10, the Division of Mental Health of the World Health Organization developed several versions of chapter V, which deals with mental and behavioral disorders. The version for research purposes is called the Diagnostic Criteria for Research (ICD-10 DCR) and gives operational criteria for the diagnosis of mental disorders. This article describes the results of international field trials undertaken to evaluate the draft criteria and refine them further. METHOD: Data were obtained to assess interrater agreement, the confidence with which diagnoses could be made, and the ease of use of the criteria. Additional substudies examined the concordance between ICD-10 DCR, ICD-10 Clinical Descriptions and Diagnostic Guidelines, and other national classification systems (e.g., DSM-IV). The field trials were carried out at 151 clinical centers in 32 countries by 942 clinician/researchers who conducted 11,491 individual assessments of patients. Results for cases assessed by at least two raters are reported here. RESULTS: Most clinician/researchers found the criteria to be explicit and easy to apply. Interrater agreement was high for most diagnostic categories. For some categories, such as those dealing with certain polymorphic psychotic disorders or milder forms of affective disorders, the criteria were rated as somewhat difficult to use, and reliability was lower. Comparison of the results of these field trials with those of the ICD-10 Clinical Descriptions and Diagnostic Guidelines demonstrated that there are increases in interrater agreement when the operational criteria are used. CONCLUSIONS: The use of internationally accepted research criteria enhances the reliability of diagnosis of mental disorders made in research settings worldwide.

Adolescent↗
PubMed1995

New classification for mental disorders with management guidelines for use in primary care: ICD-10 PHC chapter five.

A primary care version of the International classification of diseases (10th revision) chapter five for mental and behavioural disorders (ICD-10 PHC chapter five) has been developed. This provisional version focuses on 24 conditions which are frequently seen in primary care and which can be managed effectively by general practitioners. The classification is accompanied by a flipcard for each of the conditions. The cards have diagnostic guidelines on one side and management guidelines on the other. The latter provide information which should be given to the patient, advice on the content of counselling, the available treatment methods, and indications for specialist referral. This classification system is also supported by diagnostic decision making aids, medication cards, and patient leaflets to facilitate the recognition and management of patients with mental disorders in primary care settings. The draft version of ICD-10 PHC chapter five will be finalized after field trials which will test the applicability and usefulness of the system in different primary care settings in various countries.

Depression↗
PubMed1995

[Classification of mental disorders according to ICD 10].

This paper presents the characteristics and the origin of the International Classification of Diseases as well as its purposes. Particular attention is given to the part of the classification which deals with mental and behavioural disorders. This part of the classification differs from other parts in several respects. First, it is accompanied with definition of each of its categories; second, it is presented in several versions--for the practising clinician, for the research workers, for those working in primary health care--and exists in a uniaxial and a multiaxial version for the classification of disorders in children and in adults. Third, it has been thoroughly tested before its introduction; fourth, it has been developed in several languages simultaneously and now exists in equivalent versions in numerous languages; and fifth, its use is facilitated by an international network of research and training centres.

Adult↗
PubMed1994

A new classification for mental disorders with management guidelines for use in primary care: the ICD-10 PHC.

A Primary Care Version of International Classification of Diseases (10th Revision) Chapter V. for Mental and Behavioural Disorders (ICD-10 PHC) has been developed. This version focuses on 24 conditions which are frequently seen in primary care and which can be managed effectively by general practitioners. The classification is accompanied by flipcards one for each of the conditions. The cards contain diagnostic guidelines on one side and management guidelines on the other. The latter provide information which should be given to the patient, advice on the content of counselling, the available treatment methods, and indications for specialist referral. This classification system is also supported by diagnostic decision making aids, medication cards, and patient leaflets to facilitate the recognition and management of patients in primary care settings. The draft ICD-10 PHC will be finalized after the field trials which will test the applicability and usefulness of the system in different primary care settings in various countries.

Humans↗
PubMed1994

The International Personality Disorder Examination. The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders.

BACKGROUND: One of the aims of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration joint program on psychiatric diagnosis and classification is the development and standardization of diagnostic assessment instruments for use in clinical research worldwide. The International Personality Disorder Examination (IPDE) is a semistructured clinical interview compatible with the International Classification of Diseases, Tenth Revision, and the DMS-III-R classification systems. This is the first report of the results of a field trial to investigate the feasibility of using the IPDE to assess personality disorders worldwide. METHODS: The IPDE was administered by 58 psychiatrists and clinical psychologists to 716 patients enrolled in clinical facilities at 14 participating centers in 11 countries in North America, Europe, Africa, and Asia. To determine interrater reliability, 141 of the IPDEs (20%) were independently rated by a silent observer. To determine temporal stability, 243 patients (34%) were reexamined after an average interval of 6 months. RESULTS: The IPDE proved acceptable to clinicians and demonstrated an interrater reliability and temporal stability roughly similar to instruments used to diagnose the psychoses, mood, anxiety, and substance use disorders. CONCLUSION: It is possible to assess personality disorders with reasonably good reliability in different nations, languages, and cultures using a semistructured clinical interview that experienced clinicians find relevant, meaningful, and user-friendly.

Adult↗
PubMed1994

New versions of World Health Organization instruments for the assessment of mental disorders.

Over the past 3 decades, the development of reliable and cross-culturally applicable diagnostic criteria and instruments for the assessment of mental disorders has been one of the major goals of the WHO mental health programme. The most important step in this endeavour of WHO was the production of the ICD-10 Classification of Mental and Behavioural Disorders and the following instruments: Composite International Diagnostic Interview (CIDI), Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and International Personality Disorder Examination (IPDE). This article outlines the basic characteristics of the latest editions of CIDI, SCAN and IPDE and provides descriptions of their newly developed versions and modules.

Cross-Cultural Comparison↗
PubMed1994

The ICD-10 clinical field trial for mental and behavioral disorders: results in Canada and the United States.

OBJECTIVE: To help evaluate the impact of proposed revisions to the chapter on mental and behavioral disorders for ICD-10, the World Health Organization (WHO) Division of Mental Health organized an international clinical field trial to evaluate draft clinical descriptions and diagnostic guidelines. The authors compare interrater diagnostic reliability results from this field trial for clinicians in Canada and the United States of American with those from all other clinicians worldwide, as well as with those from field trials conducted to evaluate drafts of DSM-III. METHOD: Two or more clinicians at each clinical center independently evaluated each patient, following a study protocol that allowed clinicians to list up to six diagnoses. In Canada and the United States, 96 clinicians completed 1,781 assessments among 491 patients, and elsewhere in the world 472 clinicians completed 7,495 assessments among 1,969 patients. RESULTS: Summary kappa coefficients at two-, three-, and four-character ICD-10 code levels were 0.76, 0.65, and 0.52, respectively, for Canadian and U.S. clinicians and 0.83, 0.75, and 0.62 for clinicians elsewhere. The mean number of diagnoses per assessment for Canadian and U.S. clinicians was 2.1; for clinicians elsewhere it was 1.7. More multiple coding of diagnoses for substance use disorders, mood (affective) disorders, and personality disorders by Canadian and U.S. clinicians accounted for much of the difference in diagnostic coding and in interrater reliability between them and clinicians elsewhere. CONCLUSIONS: Interrater diagnostic reliability in Canada and the United States was similar to that of clinicians worldwide and also to results from the DSM-III field tests. Use of more multiple coding of selected disorders by Canadian and U.S. clinicians may reflect the influence of DSM-III and DSM-III-R, which encourage multiple diagnostic entries and the use of separate multiaxial coding for personality disorders, and may have reduced interrater concurrence for some categories. Further, collaborative development of ICD-10 with DSM-IV has aligned these two systems more closely.

Adult↗
PubMed1994

[The international classification of WHO diseases (ICD-10) and its application in neurology (ICD-10 NA)].

The 10th Revision of the International Disease Classification (ICD-10) was published in English in September 1992 and in French in January 1993. Chapter VI (main code G) deals with diseases of the nervous system. There are 11 chapters covering the main categories of aetiologies. The subdivisions designated by the three-character codes are used to define the main diagnostic categories as divided according to aetiology, localization or symptoms. The three-character codes so formed are the legal basis for codifying causes of death in all the member states of the WHO. Supplementary 4-digit codes can be used for more precise definitions of morbidity; ICD-10 NA, the Application to Neurology, is a detailed classification of diseases of neurological origin or expression, based on the original ICD-10. Thus it also contains a table of inclusion and exclusion terms and a detailed alphabetical index. The inclusion terms are names of diseases, affections or syndromes associated with each ICD code. The exclusion terms are listed so that the disease in question is classified elsewhere. Thus it is easy to find the correct category even for similar or related diseases which may be classified in different chapters of the ICD-10 NA. The coding system of the ICD-10 NA is exactly the same as for the ICD-10 since cross-referencing requires that specialization classifications such as the ICD-10 NA derived from the ICD must have the same 3 and 4 digit codes as those in the original ICD-10. Within these limits, the 5th, 6th and 7th digits of the subdivision codes, and the generalization of multiple coding used to describe both aetiologies and manifestations, have greatly increased the discriminating power and precision of neurological diseases classification based on the parent ICD.

Disease↗
PubMed1993

Progress toward achieving a common language in psychiatry. Results from the field trial of the clinical guidelines accompanying the WHO classification of mental and behavioral disorders in ICD-10.

In preparing for the 10th revision of the International Classification of Diseases (ICD-10), the Division of Mental Health of the World Health Organization organized an international field trial to help evaluate draft clinical descriptions and diagnostic guidelines that were produced to facilitate use of the chapter dealing with mental and behavioral disorders. These clinical guidelines were prepared in equivalent versions in most of the world's widely spoken languages. The field trial aimed to obtain data that would help in assessing whether the classification fits the diagnoses made in different countries, whether it is easy to use, and whether psychiatrists after a short period of familiarization with the classification can reach agreement about their diagnoses and classification. The field trial was carried out at 112 clinical centers in 39 countries by 711 clinicians who conducted 15,302 individual assessments. The trial included joint clinical assessments of patients and case history exercises. The results of the joint assessment part of the trial are reported here. Most clinicians reported that the draft document was easy to use and that the classification provided a good fit for the vast majority of the clinical conditions encountered. While interrater reliability was satisfactory for most categories, some (for example, those dealing with personality disorders) were somewhat difficult to use, and reliability of assignment for those was lower. The trial demonstrated that the ICD-10 chapter dealing with mental and behavioral disorders is on the whole suitable for general use. It provided valuable indications about changes needed for subsequent versions and demonstrated the feasibility of large-scale international research on classification and diagnosis in psychiatry.

Adult↗
PubMed1993

An international study of psychological problems in primary care. Preliminary report from the World Health Organization Collaborative Project on 'Psychological Problems in General Health Care'.

This article describes a large longitudinal multicenter collaborative study that investigated the form, frequency, course, and outcome of psychological problems that were seen in primary health care settings in 15 different sites around the world. The research employed a two-stage sampling design in which the 12-item General Health Questionnaire was administered to 26,422 persons aged 18 to 65 years who were consulting health care services. Of these persons, 5604 were selected for detailed examinations using standardized instruments and were followed up at 3 months and 1 year to provide information on course and outcome. All assessment instruments have been translated into 13 different languages. The project has produced a database that allows for the exploration of the nature of psychological disorders experienced by patients in general medical care and their association with physical illness, illness behavior, and disability over time.

Adolescent↗
PubMed1993

The ICD-10 symptom checklist: a companion to the ICD-10 classification of mental and behavioural disorders.

The ICD-10 Symptom Checklist is a semi-structured diagnostic instrument intended for clinicians' assessment of F0-F6 categories in the ICD-10 Classification of Mental and Behavioural Disorders. The instrument was preliminarily tested at the St. Louis site during its participation in the field trials of the ICD-10 Diagnostic Criteria for Research. The Checklist was found to be a reliable diagnostic tool (overall kappa 0.72) within the constraints of the interviewer/observer reliability study design. More rigorous tests of the psychometric properties of the instrument are necessary.

Female↗
PubMed1993

WHO's work on the epidemiology of mental disorders.

The WHO programme on epidemiology of mental disorders started in the early 1960's with a series of reviews of knowledge. These were followed by activities aiming at four main goals: the standardization of psychiatric diagnosis, classification and statistics; the development of standardized internationally applicable instruments for the assessment of mental patients and of variables relevant to the assessment of mental illness; the conduct of epidemiological studies of mental disorders; and the training relevant to the above goals. The paper provides a description of the activities undertaken to achieve these goals and stresses the importance and usefulness of the collaboration of individuals, experts and institutions all over the world in this effort.

Female↗