Roberto Nuevo

The Continuum of Psychotic Symptoms in the General Population: A Cross-national Study

OBJECTIVE To identify the cross-national prevalence of psychotic symptoms in the general population and to analyze their impact on health status. METHOD The sample was composed of 256,445 subjects (55.9% women), from nationally representative samples of 52 countries worldwide participating in the World Health Organizations World Health Survey. Standardized and weighted prevalence of psychotic symptoms were calculated in addition to the impact on health status as assessed by functioning in multiple domains. RESULTS Overall prevalences for specific symptoms ranged from 4.80% (SE = 0.14) for delusions of control to 8.37% (SE = 0.20) for delusions of reference and persecution. Prevalence figures varied greatly across countries. All symptoms of psychosis produced a significant decline in health status after controlling for potential confounders. There was a clear change in health impact between subjects not reporting any symptom and those reporting at least one symptom (effect size of 0.55). CONCLUSIONS The prevalence of the presence of at least one psychotic symptom has a wide range worldwide varying as much as from 0.8% to 31.4%. Psychotic symptoms signal a problem of potential public health concern, independent of the presence of a full diagnosis of psychosis, as they are common and are related to a significant decrement in health status. The presence of at least one psychotic symptom is related to a significant poorer health status, with a regular linear decrement in health depending on the number of symptoms.

Definitions and factors associated with subthreshold depressive conditions: a systematic review

BackgroundSubthreshold depressive disorders (minor and subthrehold depression) have been defined in a wide range of forms, varying on the number of symptoms and duration required. Disability associated with these conditions has also been reported. Our aim was to review the different definitions and to determine factors associated with these conditions in order to clarify the nosological implications of these disorders.MethodsA Medline search was conducted of the published literature between January 2001 and September 2011. Bibliographies of the retrieved papers were also analysed.ResultsThere is a wide heterogeneity in the definition and diagnostic criteria of minor and subthreshold depression. Minor depression was defined according to DSM-IV criteria. Regarding subthreshold depression, also called subclinical depression or subsyndromal symptomatic depression, between 2 and 5 depressive symptoms were required for the diagnosis, and a minimum duration of 2 weeks. Significant impairment associated with subthreshold depressive conditions, as well as comorbidity with other mental disorders, has been described.ConclusionsDepression as a disorder is better explained as a spectrum rather than as a collection of discrete categories. Minor and subthreshold depression are common conditions and patients falling below the diagnostic threshold experience significant difficulties in functioning and a negative impact on their quality of life. Current diagnostic systems need to reexamine the thresholds for depressive disorders and distinguish them from ordinary feelings of sadness.

Modular Psychotherapy for Anxiety in Older Primary Care Patients

OBJECTIVE To develop and test a modular psychotherapy protocol in older primary care patients with anxiety disorders. DESIGN Randomized, controlled pilot study. SETTING University-based geriatric medicine clinics. PARTICIPANTS Thirty-one elderly primary care patients with generalized anxiety disorder or anxiety disorder not otherwise specified. INTERVENTION Modular form of psychotherapy compared with enhanced community treatment. MEASUREMENTS Self-reported, interviewer-rated, and qualitative assessments of anxiety, worry, depression, and mental health-related quality of life. RESULTS Both groups showed substantial improvements in anxiety symptoms, worry, depressive symptoms, and mental health-related quality of life. Most individuals in the enhanced community treatment condition reported receiving medications or some other form of professional treatment for anxiety. Across both conditions, individuals who reported major life events or stressors and those who used involvement in activities as a coping strategy made smaller gains than those who did not. CONCLUSIONS Results suggest that modular psychotherapy and other treatments can be effective for anxiety in older primary care patients. Results further suggest that life events and coping through increased activity may play a role in the maintenance of anxiety in older adults.

Psychotic symptoms are associated with physical health problems independently of a mental disorder diagnosis: results from the WHO World Health Survey

This study explored whether physical health problems are related to psychotic symptoms independently of a mental disorder diagnosis. A total of 224,254 subjects recruited for the World Health Organization World Health Survey were subdivided into those with both a lifetime diagnosis of psychosis and at least one psychotic symptom in the 12 months prior to the evaluation, those with at least one psychotic symptom in the past 12 months but no lifetime diagnosis of psychosis, and those without psychotic symptoms in the past 12 months and without a lifetime diagnosis of psychosis. The three groups were compared for the presence of medical conditions, health problems, and access to health care. Medical conditions and health problems (angina, asthma, arthritis, tuberculosis, vision or hearing problems, mouth/teeth problems, alcohol consumption, smoking, and accidents), medication consumption, and hospital admissions (but not regular health care visits) were more frequent in individuals with psychotic symptoms but no psychosis diagnosis, compared to those with no symptoms and no diagnosis. The number of medical conditions increased with the number of psychotic symptoms. Given the sample analyzed, this trend seems to be independent from the socio‐economic development of the country or the specific health care system.

Characterization of worry according to severity of anxiety in elderly living in the community.

The goals of this study were to analyse the characteristics of the phenomenon of worry in old age, to analyse differential characteristics of worry in the elderly according to severity of anxiety, and to explore the discriminative ability of different DSM-IV criteria for generalized anxiety disorder (GAD) to reveal the presence of this disorder. Starting from a randomized sample of 97 individuals, those 85 representing three levels of severity of the anxiety were retained: 74 non-clinical, four with sub-threshold anxiety and seven with GAD. They were assessed with different variables typically considered to be relevant for the analysis and characterization of worry. Results indicate that the most remarkable differences in contents of worry as a function of severity of anxiety occurred in the domains of worries about health and personal worries. Furthermore, elderly people with high levels of anxiety worry more frequently, and about more issues, and perceive less control over their worrying. Significant differences between groups in past and present orientation of worry were found. Worries were more frequent in GAD and they were oriented mainly towards the present and minor everyday problems in both GAD and non-clinical people. Moreover, worry about minor things together with the extent to which worry interferes in daily life were the best discriminant variables for GAD, being better than the core DSM-IV GAD criteria. We conclude that this pattern of results suggests that the potential of a specific worry to affect daily well-being and quality of life is strongly related to the presence of a disorder.

Usefulness of the Beck Depression Inventory as a screening method for depression among the general population of Finland

Background: The present paper studies the effectiveness of the Beck Depression Inventory (BDI) as a screening measure for depression in a general population sample from Finland. Methods: The study analysed the Finnish sample of the ODIN study, a multicentre epidemiology study of depression in Europe. From this general population sample, 311 subjects were selected according to their score on the BDI within a larger assessment that included a structured diagnostic interview. Of these, 31.2% were diagnosed with major depression. Results: A cut-off score of 17/18 simultaneously maximized both sensitivity and specificity in the Receiver Operating Characteristic (ROC) curve analysis, with an Area Under the Curve (AUC) of 0.806. Similar results were found across gender, and the AUCs were not significantly different between men and women. Limitations: The results cannot be directly generalized to institutionalized persons, people in clinical settings, or those with range of ages not included in the present study. Conclusions: The Beck Depression Inventory is a valid instrument for the diagnosis of depression among the general population of Finland. As a screening measure, the optimal cut-off score would be 17 or higher.

Evidence for the early clinical relevance of hallucinatory‐delusional states in the general population

Nuevo R, Van Os J, Arango C, Chatterji S, Ayuso‐Mateos JL. Evidence for the early clinical relevance of hallucinatory‐delusional states in the general population.

The role of suicide risk in the decision for psychiatric hospitalization after a suicide attempt.

BACKGROUND Suicide prevention can be improved by knowing which variables physicians take into account when considering hospitalization or discharge of patients who have attempted suicide. AIMS To test whether suicide risk is an adequate explanatory variable for predicting admission to a psychiatric unit after a suicide attempt. METHODS Analyses of 840 clinical records of patients who had attempted suicide (66.3% women) at four public general hospitals in Madrid (Spain). RESULTS 180 (21.4%) patients were admitted to psychiatric units. Logistic regression analyses showed that explanatory variables predicting admission were: male gender; previous psychiatric hospitalization; psychiatric disorder; not having a substance-related disorder; use of a lethal method; delay until discovery of more than one hour; previous attempts; suicidal ideation; high suicidal planning; and lack of verbalization of adequate criticism of the attempt. CONCLUSIONS Suicide risk appears to be an adequate explanatory variable for predicting the decision to admit a patient to a psychiatric ward after a suicide attempt, although the introduction of other variables improves the model. These results provide additional information regarding factors involved in everyday medical practice in emergency settings.

Impact of severity and type of depression on quality of life in cases identified in the community.

BACKGROUND The impact of different levels of depression severity on quality of life (QoL) is not well studied, particularly regarding ICD-10 criteria. The ICD classification of depressive episodes in three levels of severity is also controversial and the less severe category, mild, has been considered as unnecessary and not clearly distinguishable from non-clinical states. The present work aimed to test the relationship between depression severity according to ICD-10 criteria and several dimensions of functioning as assessed by Medical Outcome Study (MOS) 36-item Short Form general health survey (SF-36) at the population level. METHOD A sample of 551 participants from the second phase of the Outcome of Depression International Network (ODIN) study (228 controls without depression and 313 persons fulfilling ICD criteria for depressive episode) was selected for a further assessment of several variables, including QoL related to physical and mental health as measured with the SF-36. RESULTS Statistically significant differences between controls and the depression group were found in both physical and mental markers of health, regardless of the level of depression severity; however, there were very few differences in QoL between levels of depression as defined by ICD-10. Regardless of the presence of depression, disability, widowed status, being a woman and older age were associated with worse QoL in a structural equation analysis with covariates. Likewise, there were no differences according to the type of depression (single-episode versus recurrent). CONCLUSIONS These results cast doubt on the adequacy of the current ICD classification of depression in three levels of severity.

Chronic Fatigue Syndrome at Age 16 Years.

BACKGROUND: In the Avon Longitudinal Study of Parents and Children (ALSPAC) birth cohort, chronic disabling fatigue lasting ≥6 months affected 1.3% of 13-year-olds, was equally common in boys and girls, and became more prevalent with increasing family adversity. METHODS: ALSPAC data were used to estimate the prevalence of chronic fatigue syndrome (CFS) at age 16 years, defined by parental report of unexplained disabling fatigue lasting ≥6 months. We investigated gender and a composite 14-item family adversity index as risk factors. School absence data were obtained from the National Pupil Database. Multiple imputation was used to address bias caused by missing data. RESULTS: The prevalence of CFS was 1.86% (95% confidence interval [CI]: 1.47 to 2.24). After excluding children with high levels of depressive symptoms, the prevalence was 0.60% (95% CI: 0.37 to 0.84). Authorized school absences were much higher (mean difference: 35.6 [95% CI: 26.4 to 44.9] half-day sessions per academic year) and reported depressive symptoms were much more likely (odds ratio [OR]: 11.0 [95% CI: 5.92 to 20.4]) in children with CFS than in those without CFS. Female gender (OR: 1.95 [95% CI: 1.33 to 2.86]) and family adversity (OR: 1.20 [95% CI: 1.01 to 1.42] per unit family adversity index) were also associated with CFS. CONCLUSIONS: CFS affected 1.9% of 16-year-olds in a UK birth cohort and was positively associated with higher family adversity. Gender was a risk factor at age 16 years but not at age 13 years or in 16-year-olds without high levels of depressive symptoms.