[Promotion of physical activity in the primary care setting: what is the situation in Switzerland?]. / Promotion de l'activité physique au cabinet médical: où en sommes- nous en Suisse?

If many harmful effects of a sedentary lifestyle on health are well known, we still need to better understand how effectively promoting regular physical activity in the general population. Among the currently explored strategies, screening for sedentary lifestyle and promoting physical activity in the primary care setting seem promising. Despite recommendations from governmental agencies and professional associations in favor of physical activity counseling, this approach has not been widely adopted so far. This article summarizes the steps taken in Switzerland with an aim of developing physical activity counseling in the primary care setting. It describes how the early implication of primary care physicians influenced in a concrete way the development of a project dedicated to that task.

ECT-Induced and Drug-Induced Hypomania.

In a retrospective chart study of 1,057 hospital admissions of endogenous depressives between 1920 and 1981, 139 patients (13%) had received electroconvulsive therapy (ECT), and 12% of them switched to hypomania. Within a subgroup of 524 psychotic unipolar depressives, 79 received ECT and eight (10%) switched to hypomania, whereas among those not treated with ECT only 16 of 445 patients (3.6%) switched to hypomania (p < 0.01). In psychotic bipolar patients the switch rates with and without ECT did not differ significantly (30% vs. 32%). Among untreated unipolar depressives hospitalized between 1920 and 1943, before the introduction of ECT or antidepressants, 3.9% switched to hypomania. Among unipolar patients admitted after 1957 and treated by antidepressants 4% switched to hypomania; among bipolar patients, 31% switched to hypomania. We find no evidence for hypomania being induced by standard antidepressants. Without classifying depressive patients into manic and nonmanic based on the previous history, studies of drug-induced hypomania cannot be conclusive. These observations strongly support the hypothesis of an ECT-induced switch from depression to hypomania.