[Screening for bipolar disorder in primary care patients with psychological symptoms]. / Cribado para el trastorno bipolar en pacientes de atención primaria que presentan síntomas psicológicos.

OBJECTIVE: To estimate the proportion of positive results in the screening of bipolar disorder (BD) among primary care patients presenting with psychological symptoms, and to analyze their characteristics. DESIGN: Multicenter cross-sectional study. SETTINGS: Nineteen Primary Care clinics in different Spanish regions. PATIENTS: A total of 360 consecutive primary care patients aged 18 to 70, presenting with psychological symptoms. MEASUREMENTS: Screening for BP was performed by means of the Mood Disorders Questionnaire. Data on quality of life (EuroQol-5D) and functional impairment (Sheehan Disability Inventory) were obtained. Data on psychiatric comorbidity and data on the use of psychotropic medication were acquired by review of medical records. RESULTS: Of the patients screened, 11.9% were positive (95%CI: 8.8%-15.7%). Only two patients had a diagnosis of BP in their clinical records and, although more than half received treatment with antidepressants, only two received treatment with mood stabilizers. Positive screening is associated with work, social and family dysfunction, greater perceived stress and poor quality of life. CONCLUSIONS: BD screening in primary care patients with psychological problems leads to a striking proportion of positive results, indicating that there may be a significant prevalence of BP patients, most of them undiagnosed and untreated. Further research is needed to determine the role that Primary Care can or should assume in the screening, diagnosis and management of this disorder.

Follow up of patients who start treatment with antidepressants: treatment satisfaction, treatment compliance, efficacy and safety.

BACKGROUND: Measuring satisfaction with treatment has proved useful to ascertain the treatment features that are most important to the patients, and to explain increased treatment compliance. However, there are few studies that relate satisfaction to other clinical or self-perceived health status indicators. Recent studies have shown the close relationship between satisfaction with treatment, treatment compliance, and effectiveness. This study attempts to design and validate a scale to evaluate satisfaction with antidepressant drug therapy, assess treatment compliance (self-reported, validated questionnaire, drug accountability and electronic monitorization system), assess efficacy in reducing depressive symptoms and safety in patients who initiate antidepressant drug therapy, as well as to establish predictors of satisfaction, compliance and effectiveness with these drugs. METHODS/DESIGN: This is an observational longitudinal study with a cohort of adults initiating treatment with antidepressant drugs. A multi-centre study will be performed in which 20 Primary Care practices from Castilla-La Mancha are expected to participate. An initial interview and follow-up visits at 15 days, 1, 3, 6, 9 and 12 months will be conducted with all study participants. 706 subjects will be studied (95% confidence interval, precision ± 3%, expected rate of non-compliance 50%, expected non-responders and lost to follow up rate 15%). The following measurements will be performed: development and validation of a scale of satisfaction with antidepressant therapy, participant and antidepressant characteristics, treatment compliance evaluation (Haynes-Sackett Test, Morisky-Green Test, drug accountability and Medication Event Monitoring System), depression symptom reduction (Hamilton Depression Rating Scale and Montgomery-Asberg Depression Rating Scale), observation of adverse effects, and beliefs about treatment (The Beliefs about Medicines Questionnaire). DISCUSSION: Antidepressant drugs are an extraordinarily important therapeutic group in the pharmacy composition; economic repercussions and social impact associated to their use is clear. Despite their well-established efficacy in clinical trials, treatment non-compliance is a major obstacle to their effectiveness in clinical practice. The proposed study brings about useful conclusions to improve the results of these drugs. Additionally, devising a scale specifically designed to evaluate satisfaction with antidepressant treatment could be of interest in healthcare outcomes research.

Validation of the Insomnia in the Elderly Scale for the detection of insomnia in older adults.

AIM: The main objective of this study was the validation of a brief support instrument for the diagnosis of insomnia in older adults. METHODS: An observational study was carried out for the evaluation of the Insomnia in the Elderly Scale using the psychiatric interview as the gold standard. Data was collected in a primary care setting in the city of Albacete, Spain. Participants were 926 non-institutionalized older adults aged ≥ 65 years. RESULTS: Sleep characteristics, and the health and sociodemographic status of the participants were assessed. The Insomnia in the Elderly Scale is divided into two subscales for the evaluation of the Diagnostic and Statistical Manual of Mental Disorders, Fouth Edition criteria A and B for insomnia. The area under the receiver operating characteristic curve for subscale A was 0.868. The cut-off point to detect the presence of diagnostic criterion A for insomnia was a score of ≥ 3 (sensitivity: 86.4%; specificity: 69.5%). The area under the receiver operating characteristic curve for subscale B was 0.832. The cut-off point to detect the presence of diagnostic criterion B was a score of ≥ 2 (sensitivity: 86.3%; specificity: 66.4%). CONCLUSIONS: The Insomnia in the Elderly Scale has appropriate psychometric properties. This scale compensates for the lack of validated instruments for use in the population aged 65 years or older. The fact that it is divided into two subscales to separately evaluate the insomnia criteria enables us to detect the presence of each of them. Finally, it has been validated in participants aged 65 years and older, which is the target population for this scale.

The reliability and validity of the daily activities dependence on vision (DADV) scale to evaluate vision related functional limitations.

The purpose was to determine the reliability and validity of the DADV scale to evaluate vision-related functional limitations in persons over 65 years. Cross sectional study was performed to determine the reliability and validity of a questionnaire (9 items). A total of 1387 subjects were selected by random sampling. An analysis of the intra/inter-observer reliability was performed and the convergent validity with the Visual Function Index, 14 items (VF-14) was determined. The number of patients who had some difficulty in performing any of the activities was 223 (19.2%; 95%CI=16.9-21.5). The intraclass correlation coefficient (ICC) of the intra/inter-observer reliability analysis was 0.883 and 0.900, respectively. Factorial analysis demonstrated that one single factor explained 63.2% of the total variance (visual function). The scale showed a high degree of convergent validity (ICC=0.857) with the VF-14. Visual acuity showed a moderate correlation with the DADV score (r=0.366). The Rasch analysis showed a satisfactory model fit for the items. Although the DADV scale is a short questionnaire it showed high correlation with the VF-14 and moderate correlation with visual acuity. The results indicate that the scale has acceptable reliability and is valid to efficiently evaluate visual function.

Effect of plant sterols on the lipid profile of patients with hypercholesterolaemia. Randomised, experimental study.

BACKGROUND: Studies have been conducted on supplementing the daily diet with plant sterol ester-enriched milk derivatives in order to reduce LDL-cholesterol levels and, consequently, cardiovascular risk. However, clinical practice guidelines on hypercholesterolaemia state that there is not sufficient evidence to recommend their use in subjects with hypercholesterolaemia. The main objective of this study is to determine the efficacy of the intake of 2 g of plant sterol esters a day in lowering LDL-cholesterol levels in patients diagnosed with hypercholesterolaemia. The specific objectives are: 1) to quantify the efficacy of the daily intake of plant sterol esters in lowering LDL-cholesterol, total cholesterol and cardiovascular risk in patients with hypercholesterolaemia; 2) to evaluate the occurrence of adverse effects of the daily intake of plant sterol esters; 3) to identify the factors that determine a greater reduction in lipid levels in subjects receiving plant sterol ester supplements. METHODS/DESIGN: Randomised, double-blind, placebo controlled experimental trial carried out at family doctors' surgeries at three health centres in the Health Area of Albacete (Spain). The study subjects will be adults diagnosed with "limit" or "defined" hypercholesterolaemia and who have LDL cholesterol levels of 130 mg/dl or over. A dairy product in the form of liquid yoghurt containing 2 g of plant sterol ester per container will be administered daily after the main meal, for a period of 24 months. The control group will receive a daily unit of yogurt not supplemented with plant sterol esters that has a similar appearance to the enriched yoghurt. The primary variable is the change in lipid profile at 1, 3, 6, 12, 18 and 24 months. The secondary variables are: change in cardiovascular risk, adherence to the dairy product, adverse effects, adherence to dietary recommendations, frequency of food consumption, basic physical examination data, health problems, lipid-lowering medication, physical activity, smoking habits and socio-demographic variables. DISCUSSION: If plant sterol ester supplements were effective a sounder recommendation for the consumption of plant sterols in subjects with hypercholesterolaemia could be made.

Approach to major depression in old people.

BACKGROUND: The difficulty in identifying and distinguishing Major Depressive Disorder (MDD) in primary care is well known. The main objective of this study is to determine the frequency of MDD in persons aged 65 years and older using the Detection of Depression in the Elderly Scale (DDES). A second objective is to determine the convergent validity of the DDES with the Geriatric Depression Scale (GDS). METHODS: A cross-sectional, observational study was carried out of 1,387 subjects aged 65 years and older. The variables considered were: affective state (GDS and DDES), physical and cognitive functional state, health problems and sociodemographic characteristics. RESULTS: Using the DDES we identified MDD in 50 subjects (4.3%). There was a moderate correlation (r = 0.570; p < 0.001) between the DDES and the GDS scores (p < 0.001). According to logistic regression analysis, the variables associated with a probable MDD (DDES +) were: dependence in activities of daily living (OR: 3.3), female gender (OR: 2.3), marital status single/widowed/divorced (OR: 2.0), and the presence of four of more health problems (OR: 2.1). CONCLUSIONS: Using the DDES scale we found a 4.3% prevalence of MDD in a representative sample of older adults. Compared to the GDS, the most commonly used scale, the DDES may be considered a more sensitive screening tool for the identification of MDD in primary care.