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The use of the PHQ as follow-up instrument for MDD in the primary care setting


Academic year: 2021

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Affeetioe disorders and ant~depre~sam~

/n=2/, delirium /n=l/) reoccured after IFN-a dosing has been

replaced. In the medical history of the patients we found 9 cases of psychiatric diseases: depressive disorders (n=5), somatoform disorder (n=l), agoraphobia without panic attack (n=3). In all the cases of depressions the previous mood disorders recurred during the IFN-a treatment. Patients with former agoraphobia developed panic attacks and depressive symtoms, The psychiatric sequeles oceured earlier in patients with positive medical history (mean: 2.9 months) than in other patients (mean: 6.6 months). All of the 37 patients received psychopharmacotherapy: antidepressives (n=31), anxiolytics (n=4), antidepressives plus anxiolytics (n=20), antipsychotics (n=3). In 6 cases (16,2%) the IFN-a were stopped, 7 patients (18,9%) underwent a dose reduction and 21 patients (56,7%) could continue the therapy with primary dose. 3 patients were lost from follow-up. All patients who were dropped out of IFN-a treatment fully recovered from psychiatric syndromes (delirium/n=2/, depression/n=3/, p a n i c / n = l / ) .

Conclusions: Depressions were found to be the most frequent psychiatric complication, but other syndromes (especially anxiety disorders) also occured. Our results present that previous mental disorders can hasten the outbreak of the IFN-a induced psychi- atric symptoms. Psyehopharmacotherapies proved to be effective, therefore dose reduction or drop-out of IFN-a was avoidable in the majority of cases. These results show the necessity of the collaboration between physicians and psychiatrists in the case of all IFN-a treated patients. The examination of CNS effects of the IFN-a can contribute the research of the cytokine network, especially its role in the pathophysiology of mental disorders.

JP.1.093J The use of the PHQ as follow-up instrument for MDD in the primary care setting

K. Demyttenaere 1 , W. Pitcher 2, A. Albert 3, D. Wagemans 4, P. De C o c k 4 *.

irlz. Gasthuisbe N, Liaisonpsyc~iat~ Leuoen,

Belgium; 2C,H,~, PsyeJ~iatry, Li@e, Belgium; SUnioers~ty

of Liege, Bio-gta~:ixtics, Li@e, Belgium; "~Pfizer n.o, Medical,

Brussels, Belgium

Objeetlve: Validation of the PI-IQ (Patient Health Questionnaire) as follow-up instrument in primary care.

Methods: We included 643 patients with clinical diagnosis of Major Depressive Disorder (MDD). At baseline the PI-IQ - a self report version of the PRIME-hAD with items identical to those of the DSM-IV (ref 1) - w a s completed (ref 2). Other PHQ-modules were also completed. After inclusion patients were treated with an SSRI and followed during 12 weeks (3 visits). The PHQ was validated using the SCL-90 (commonly used as follow-up scale for depression, anxiety and somatization). Evolution of depression and comorbidities on the PHQ and SCL-90 were studied, together with their impact on work, family and social life.

Resets: 643 (71,7% female, average age 49,9 years) pa- tients completed the stu@. All PHQ and SCL-90 scores (de- pression, anxiety, somatization) decreased significantly over time (p<0.0001). The more severe the depression, the higher the PI-IQ scores at baseline and the faster the decrease over time. A @LMM- analysis showed that men had lower PI-IQ depression scores at baseline than women (p=0.002) but their recovery was slower (p=0.006). The same was seen at the SCL-90: men had lower SCL- 9 0 depression scores (_p=0.004) but their scores decreased slower (p=0.007). However, after 12 weekz of treatment similar scores were obtained for both sexes. Older patients had systematically lower depression scores (1:)=0.012). The PI-IQ and SCL90 scores

were standardised on a 0-100 scale in order to compare. The evolution over time of the scales was practically the same for the sections "depression" (Table 1) and "anxiety". For somatization there was a slightly different evolution: SCL-90 had lower somatic end-score~ than PHQ. Nigher scores on PHQ and SCL-90 for depression, anxiety and somatic disease all resulted in higher Sheehan 4, 5 and 6-scores. The scores decreased over time (p<0.0001). In older patients (p<0.0001) and patients living alone a significant slower decrease was seen on the Sheehan 4 whereas evolution of Sheehan 5 and 6 (impact on social and family life) did not depend on a W covariate. The strongest evolution on all scales was seen after 4 weeks of treatment with further reduction of the scores after 8 weeks and remained stable during further treamaent.

Baseline Week 4 Week 8 Week 12 SOL-90 rnearckSD 100 79.5+30.2 67.94-32.0 65.04-32.1 PHQ mearcESD 100 7 9 . 5 4 - 2 1 . 8 69.34-24.9 64.84-23.9

Conclmion: The PHQ and SCL-90 show a comparable evolu- tion over time, meaning that the PHQ entails comparable moni- toring capacity for follow-up on depression and comorbidities as the SCL-90.


[1] S'pltzer P,, Kroenke K etal. Validation and. utility of Self-report version of PRINIE-MD: the PHQ primary a r e study. JAMA 282: 1737-44,1999

[2] Demyttenaete K~ Pit&or Wet al. Diagnosis of depression by primary care physician and the patient. Poster presentation ECNP congress 2003.

Reduction of the brain Iz~I-ADAM binding is related to ~ e plasma drug level in amitriptyline treated subjects

R. Uebelhack 1 , L. Franke 1 *, M. Plotkin 2, I-I. Amthauer 2, R. Felix 2.

1 C~ar~d -Univers#d'tsmedXzXn Berlin, Departmem

of Psychiatr3{,


Berlin, Germany; ) C h a r i t y -

Univers#a'tsmedizin Berlin, .~adiology Clinic, 13357 Berlin,


Bael%mmma& The classical antidepressant amitriptyline (At) is a strong inhibitor of serotonin (5HT) uptake in platelets or brain synaptosomes. I-Iowever, the percentage of serotonin transporter (5HTT) inhibition in the brain of patients during a typical course of At treatment is unknown.

Objeetiw: To test the inhibiting effect of At in brain regions with high or low density of 5HTTs in oioo using the new high affinity radioligand 123I-ADAM and SPECT. A second aim was to assess the relationship between lz3I-ADAM binding reduction and plasma At levels and 5HT uptake inhibition in platelets.

Material and Metl~ds: Eleven normotensive and non- medicated subjects (5 healthy controls and 6 psychiatric patients according to ICD-10 criteria) were investigated twice, before and after 7 days of At administration (50 mg/day). SPECT images were obtained 4h post injection of lz3I-ADAM. Regions of in- terest (ROI) were drawn manually in areas corresponding to the midbrain, frontal cortex and cerebellum. The measured activities


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