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Biomedical subjects

N Sartorius

Publications and source records attributed to N Sartorius.

At least 73 records · Page 4Linked to original sources
PubMed1993

The course and outcome of depression in different cultures: 10-year follow-up of the WHO Collaborative Study on the Assessment of Depressive Disorders.

The World Health Organization's study on depressive disorders in different cultures began in 1972. Cohorts of depressed patients were identified in Basle, Montreal, Nagasaki, Teheran and Tokyo. The patients were assessed using standardized measures of social and clinical functioning. Ten-year follow-up data on clinical course, service contact, suicidal acts and social function outcomes were available for 439 (79%) patients. Over one-third (36%) were re-admitted at least once in the follow-up period, half of whom (18%) had very poor clinical outcome. Twenty-four per cent suffered severe social impairment for over half the follow-up period, and over one-fifth (21%) showed no full remissions. The best clinical course (one or two reasonably short episodes of depression with complete remission between episodes) was experienced twice as frequently in patients with a diagnosis of endogenous (65%) as in those diagnosed as suffering from psychogenic depression (29%). Among all patients, a fifth (22%) had at least one episode lasting for more than 1 year, and 10% had an episode lasting over 2 years during follow-up. Death by suicide occurred in 11% of patients, with a further 14% making unsuccessful suicide attempts.

Canada↗
PubMed1993

Pathways to psychiatric care in Cantabria.

This article delineates the pathways taken in different health areas of Cantabria (Spain) by a series of newly referred patients to the mental health services and explores the influence of sociodemographic, medical and service-related factors on the delays in referral. The work forms part of an ongoing World Health Organization multicentre research programme aimed at exploring and optimizing the quality of mental health care in different centres of the world. We found that, in a rural health area, the majority of newly referred patients establish the first contact with the general practitioner and to a lesser extent with the hospital doctor and from there directly progress to the psychiatric services; in the urban health area there is a greater tendency to contact specialized medical and psychiatric services. Delays in these health areas are remarkably short and are comparable to the ones in other European centres. Our data also show that somatic symptoms are the main presenting problem both at the primary care and at the mental health level; and that, in general, psychotropic drug prescriptions are high both in hospital and in general medical settings, and that women were more often prescribed psychotropic medication than men.

Female↗
PubMed1992

A triaxial classification of health problems presenting in primary health care. A World Health Organization multi-centre study.

Over the past two decades, research in a variety of countries and settings has revealed the extent to which psychological morbidity and social problems constitute an important proportion of primary health care contacts, either in their own right or in association with physical ill-health. The development of appropriate responses, medical and non-medical, to such problems is, in part, hindered by the relatively low level of awareness concerning the significance of such problems and by currently inappropriate methods of describing and classifying health care problems in the primary care setting. There is a pressing need for an appropriate, relatively simple and flexible classification or list of problems presenting in primary care. This study describes the development, under WHO auspices and in an international setting, of a triaxial classification of health problems and the testing and modification of the classification by means of an international case vignette rating exercise. A psychological problem list and a social problem list, together with detailed glossaries, suitably modified in the light of experience derived from the study, are described, and proposals enumerated of possible ways in which these lists might be further developed and used in research and clinical undertakings in primary care.

Cross-Cultural Comparison↗
PubMed1992

Transnational stability of gender differences in schizophrenia? An analysis based on the WHO study on determinants of outcome of severe mental disorders.

Gender-specific analyses of the multinational WHO-Determinants of Outcome-Study (including 1,292 cases from 10 countries) demonstrate the transnational stability of major findings on gender differences in schizophrenia: Male patients have an earlier mean age at onset in all countries. In female patients, the distribution of the age at onset shows a second peak after age 40 years. No gender differences on nuclear symptoms of schizophrenia can be detected, but on uncharacteristic symptoms, particularly some aspects of the illness behaviour, differences appear. This investigation supports the transcultural validity of gender differences found in the German ABC-Schizophrenia-Study and in the Danish-German Psychiatric Case Register studies.

Adult↗
PubMed1992

The International Pilot Study of Schizophrenia: five-year follow-up findings.

A five-year follow-up of the patients initially included in the International Pilot Study of Schizophrenia was conducted in eight of the nine centres. Adequate information was obtained for 807 patients, representing 76% of the initial cohort. Clinical and social outcomes were significantly better for patients in Agra and Ibadan than for those in the centres in developed countries. In Cali, only social outcome was significantly better.

Activities of Daily Living↗
PubMed1992

The neglect of prevention in psychiatry.

The prevention of mental disorders has been neglected but the public health burden now is too high for this to continue. Nearly one half of all mental and neurological disorders are amenable to primary prevention. Effective measures could be applied even in countries with few resources. By and large these measures all rely on available knowledge and commonly involve sectors other than health. This paper calls attention to the opportunities that offer but that have been so far largely unheeded.

Dangerous Behavior↗
PubMed1991

Cross-cultural feasibility, reliability and sources of variance of the Composite International Diagnostic Interview (CIDI). The Multicentre WHO/ADAMHA Field Trials.

The CIDI is a fully standardised diagnostic interview designed for assessing mental disorders based on the definitions and criteria of ICD-10 and DSM-III-R. Field trials with the CIDI have been conducted in 18 centres around the world, to test the feasibility and reliability of the CIDI in different cultures and settings, as well as to test the inter-rater agreement for the different types of questions used. Of 590 subjects interviewed across all sites and rated by an interviewer and observer, 575 were eligible for analysis. The CIDI was judged to be acceptable for most subjects and was appropriate for use in different kinds of settings. Many subjects fulfilled criteria for more than one diagnosis (lifetime and six-month). The most frequent lifetime disorders were generalised anxiety, major depression, tobacco use disorders, and agoraphobia. Percentage agreements for all diagnoses were above 90% and the kappa values were all highly significant. No significant numbers of diagnostic disconcordances were found with lifetime, six-month, and four-week time frames.

Cross-Cultural Comparison↗
PubMed1991

The CIDI-core substance abuse and dependence questions: cross-cultural and nosological issues. The WHO/ADAMHA Field Trial.

The CIDI is a fully standardised, structured interview for the assessment of psychiatric disorders according to DSM-III-R and proposed ICD-10 criteria. The development of this interview has been the collaborative effort of researchers from 18 sites around the world. In a field trial to test the cross-cultural acceptability and reliability of the questions, there was found to be high acceptance and excellent reliability for the substance use questions, problems with the lengthy alcohol section, and difficulties translating relevant substance use concepts into different languages. There is therefore room for further improvement in the substance-related questions. There proved to be differences between ICD-10 and DSM-III-R regarding substance abuse and dependence disorders.

Alcoholism↗
PubMed1990

SCAN. Schedules for Clinical Assessment in Neuropsychiatry.

After more than 12 years of development, the ninth edition of the Present State Examination (PSE-9) was published, together with associated instruments and computer algorithm, in 1974. The system has now been expanded, in the framework of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration Joint Project on Standardization of Diagnosis and Classification, and is being tested with the aim of developing a comprehensive procedure for clinical examination that is also capable of generating many of the categories of the International Classification of Diseases, 10th edition, and the Diagnostic and Statistical Manual of Mental Disorders, revised third edition. The new system is known as SCAN (Schedules for Clinical Assessment in Neuropsychiatry). It includes the 10th edition of the PSE as one of its core schedules, preliminary tests of which have suggested that reliability is similar to that of PSE-9. SCAN is being field tested in 20 centers in 11 countries. A final version is expected to be available in January 1990.

Algorithms↗
PubMed1990

Relatives' expressed emotion and the course of schizophrenia in Chandigarh. A two-year follow-up of a first-contact sample.

A two-year follow-up was conducted of a subsample of the Chandigarh cohort of first-contact schizophrenic patients from the WHO Determinants of Outcome project. The patients were those living with family members who had been interviewed initially to determine their levels of expressed emotion (EE). The interview was repeated for 74% of the relatives at one-year follow-up. A dramatic reduction had occurred in each of the EE components and in the global index. No rural relative was rated as high EE at follow-up. Of the patients included in the one-year follow-up, 86% were followed for two years. In contrast to the one-year findings, the global EE index at initial interview did not predict relapse of schizophrenia over the subsequent two years. However, there was a significant association between initial hostility and subsequent relapse. The better outcome of this cohort of schizophrenic patients compared with samples from the West is partly attributable to tolerance and acceptance by family members.

Attitude to Health↗
PubMed1990

[Human ecology].

Explore the source record for details and available documents.

Ecology↗