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Diagnosis of depression by the primary care physician and the patient

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S248 PI. Affective disorders and antidepressants

References

[l] Kasper S, Wehr TA, Rosenthal NE (1988) Saisonal abh&lgige De- pressionsformen (SAD) I. Grundlagen und klinische Beschreibung des Syndmns. Nervenarzt 59: 191-g.

[2] Terman M, Terman JS, Quitkin FM, McGrath PJ, Stewart Jw, Rafferty B (1989) Light therapy for seasonal affective disorder: a review of efficacy. Neulropsychopharlnacol 2: l-22.

[3] Kasper S, Hilger E, Willeit M, Neumeister A, Praschak-Rieder N, Hel3elmann B, Habeler A (2001) Drug Therapy. In: Pa-town T, Mag- nusson A (eds.) Seasonal Affective Disorder: practice and research. New York: Oxford University Press, pp 8593.

m PI 173 Diagnosis of depression by the primary care physician and the patient

K. Demytteuaere’ , W. Pitchot2, A. Albert3, L. Zhaug3, P. De Cock4 *. ’ University of Leuven, Psychiatric Department, Leuven, Belgium; ‘University of Lisge, Psychiatric Unit, Lisge, Belgium; 3 University of Lisge, Bio-Statistical department, Lisge, Belgium; 4Pfizer Belgium, Medical Department, Brussels, Belgium

Objective: To evaluate the degree of agreement between the primary care physician (PCP) @SM-IV) aud patient (PHQ) in diagnosing Major Depressive Disorder (MDD).

Methods: Observational study ou patients with clinical diagno- sis of major depression After iuclusiou PCPs completed a list with DSM-IV criteria for MDD, aud then, independently the patients completed the PHQ, a self-report version of PRIME-MD with items identical to the symptoms used in the DSM IV (1). Other PHQ-modules (somatoform disease, panic, anxiety aud alcohol abuse) were used to iuvestigate co morbidity.

Results: In the study 1072 patients (meau age 48,l yr, 315 mau aud 757 women) were considered as evaluable for baseliue- analysis. Among them 969 pts (90%) were diagnosed with MDD by the physician On basis of the patieut’ s self-diaguosis (PHQ) 668 (68%) had MDD. Gender made a siguificaut difference (~~0.04) in the diagnosis made by the patient: 65% of the meu aud 71% of the woman had a self-diaguosis of MDD. Overall agreement betweeu the physician’ s aud patient’ s diagnosis was found to be particularly low. Analysis of the differeut symptoms: in both DSM-IV aud PHQ the same items/symptoms are ques- tioned. A comparison was doue ou the agreement betweeu PCP aud patient for each item. Percentages of agreement (meaning both PCP aud patient agree ou the presence or absence of symp- toms) were calculated (cross-classification in 2x2 tables) together with the percentage of coufirmatiou by the PCP ou presence of symptoms ou PHQ. Agreement rauged from 44% to 97%. Highest agreement-scores were obtained for the symptoms de- pressed mood, loss of iuterest aud fatigue. Lowest agreement was found for weightiappetite (44% agreement) aud suicide/suicidal thoughts (73% agreement). It appeared that PCPs confirmed the presence of suicidal thiukiug in 60% of the patients preseutiug this symptom. Analysis of comorbidity (PHQ) showed that 385 (42%) patients had a somatoform disorder, gender turued out to be a significant risk factor (p=O.OOS) putting women at higher risk thau meu (0R~l.5). Of the 1072 patients, 29% had a panic disorder. Anxiety complaints decreased with age (p=O.O15). Finally, 16% were diagnosed with alcohol abuse. Young meu (piO.0001) living alone (p=O.O021) were particularly at risk of developiug alcoholic disease. Presence of auy of these comorbid disorders euhauced the agreement in diagnosis made by PCP (DSM-IV) aud patient (PHQ) of MDD.

Conclusions: Our results further emphasized the real iuterest of PHQ in the assessment of both depression diagnosis aud symptom severity, as well as a screeuiug iustrumeut for comorbid symptoms. Overall agreement betweeu diagnosis by the physician @SM-IV) aud the patient (PHQ) was low. This was coufinned at the level of the differeut symptoms/items. This fiudiug strongly suggests that a combined assessment, doue by both physician aud patient will iucrease the accuracy of the diagnosis of depression

References

[l] Spitzer R.L., Kroenke K., Williams J.B.W. et al. Validation and utility of a Self-report. Version of PRIME-MD: the PHQ primary care study. JAMA 282: 113144,1999.

m PI 174 Assessment of cerebral regions associated with sexual arousal in depressive women by using functional magnetic resonance imaging

J.-C. Yaii ’

P M.S. Lee’, J.S. Yoou’ , H.K. Kaug2, G.W. Jeoug2, H.J. Kim , S.J. Euu2, T.J. Zheug3. ‘Chonnam National University Hospital, Psychiatry, Kwangju, Republic of Korea; ‘Chonnam National University Hospital, Radiology, Kwangju, Republic of Korea; 3Yan Bian Brain Hospital, Psychiatry, Yan Ji, China

Patients with depressive disorder may have difficulties in sex- ual fuuctiouiug. However, there have beeu few clinical studies ou associated cerebral regions. The purpose of this study was to compare the cerebral regions associated with sexual arousal betweeu the healthy aud depressive women by tMR1 based ou blood-oxygenation-level-depeudeut technique. Niue healthy women (meau (SD) age, 40.3( 11.6)) aud seveu depressive women (meau (SD) age, 41.7(13X): meau (SD) scores of BDI aud HAMD-17, 35.6(7.1) aud 34.9(3.1), respectively) with sexually poteut uuderweut to fuuctioual MRI ou a 1.5T MR scamler (GE Signa Horizon). The tMR1 data were obtained from 7 oblique plaues using gradieut-echo EPI. Sexual stimulation paradigm begau with a 1 miuute rest aud a 4 minute stimulation by au erotic video film. The braiu activation maps aud their quautificatiou were analyzed by the statistical parametric mapping (SPM99) program. The munber of pixels activated by each task was used as index of activation, where the significance of the differences was examined by unpaired t-test. The regions significantly activated by erotic visual stimualtiou in healthy women were middle occipital gyrus, middle temporal gyrus, inferior froutal gyrus, iusula, hypotha- lamus, septal area, anterior ciugulate gyrus, parahippocampal gyrus, thalamus aud amygdala. The regions depressive women showed lower thau 50% activity compared to healthy women were hypothalamus (55.5% vs. 3.0%), septal area (49.6% vs. 8.6%), parahippocampal gyrus (18.2% vs. 5.8%) aud anterior ciugulate gyms (23.5% vs. 11.0%). These prelimiuary results suggest that the activated cerebral regions associated with sex- ual arousal are qualitatively aud quantitatively differeut betweeu healthy aud depressive women In addition, these fiudiugs may assist in uuderstaud ueural mechanisms for sexual dysfuuctiou in patients with depressive disorder. Future studies should eusure that treatment, iucludiug phannacotherapy, may iuflueuce the affected regions in patients with depressive disorder.

References

[l] Park, K., Kang, H.K., Sea, J.J., Kim, H.J., Ryu, S.B., Jeong, G.W., 2001. Blood-oxygenatioll-level-dependent functional magnetic reso- nance imaging for evaluating cerebral regions of female sexual arousal response. Urology 57(6), 1189-l 194.

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