Time to relapse after short- or long-term treatment of severe premenstrual syndrome with sertraline.

CONTEXT: The duration of treatment after achieving a satisfactory response is unknown in the treatment of premenstrual syndrome. This information is needed in view of the improvement provided by medication vs the adverse effects and costs of drugs. OBJECTIVE: To compare rates of relapse and time to relapse between short- and long-term treatment with sertraline hydrochloride administered in the luteal phase of the menstrual cycle. DESIGN: Eighteen-month survival study with a randomized double-blind switch to placebo after 4 or 12 months of sertraline treatment. SETTING: Academic medical center. PARTICIPANTS: One hundred seventy-four patients with premenstrual syndrome or premenstrual dysphoric disorder. MAIN OUTCOME MEASURE: Relapse, defined as symptoms returning to the entry criterion level as assessed with daily ratings. RESULTS: The relapse rate was 41% during long-term treatment compared with 60% after short-term sertraline therapy, with a median time to relapse of 8 months vs 4 months (hazard ratio, 0.58; 95% confidence interval, 0.34-0.98; P = .04). Patients with severe symptoms at baseline were more likely to experience relapse compared with patients in the lower symptom severity group (hazard ratio, 2.02; 95% confidence interval, 1.18-3.41; P = .01) and were more likely to experience relapse with short-term treatment (P = .03). Duration of treatment did not affect relapse in patients in the lower symptom severity group (P = .50). Patients who demonstrated remission were least likely to experience relapse (hazard ratio, 0.22; 95% confidence interval, 0.10-0.45; P < .001). Further analysis comparing relapse in the first 6 months of placebo treatment in each group yielded similar results. CONCLUSIONS: The relapse rate was significantly greater after short-term treatment compared with long-term treatment. The relapse rate was also high during extended drug treatment. Subjects with severe symptoms at baseline were most likely to experience relapse, and relapse occurred more swiftly regardless of treatment duration. These findings suggest that the severity of symptoms at baseline and symptom remission with treatment should be considered in determining the duration of treatment. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT00318773.

Assessment of anxiety and depression in primary care: value of a four-item questionnaire.

CONTEXT: Standard questionnaires (eg, Primary Care Evaluation of Mental Disorders [PRIME-MD], Hopkins Symptom Checklist [HSCL]) can be used to assess anxiety and depression in patients. However, such survey tools are typically lengthy and are therefore not used often in primary care. OBJECTIVE: To determine the value of a four-item anxiety and depression screening questionnaire as a diagnostic assessment tool in family practice. METHODS: Two self-administered patient questionnaires-PRIME-MD and 25-item HSCL-were provided to a random sample of adult patients at three family practices in Philadelphia, Pa. A subset of patients who endorsed at least one of four anxiety and depression stem items in the PRIME-MD questionnaire were interviewed using the PRIME-MD clinician evaluation guide. The HSCL anxiety and depression clusters were used as the standard measures of emotional symptomatology. Sensitivity and specificity for the four stem items to detect evidence of anxiety or mood disorders were established using the structured interview as the diagnostic gold standard. RESULTS: A total of 211 patients participated in the present study. Lowest levels of emotional symptomatology were seen in patients who did not endorse any of the stem items, while highest levels were seen in patients who endorsed anxiety and depression items. Findings were statistically significant (P<.0001). Endorsement of at least three of the four stem items differentiated best between patients with and without an anxiety or mood disorder (P<.001), achieving high sensitivity (78%) and specificity (95%). CONCLUSION: A four-item screening tool based on PRIME-MD anxiety and depression stem questions can alert family physicians to potential anxious or depressive symptomatology in the patient and the need for continued evaluation and possible treatment.

Adolescent health services and contraceptive use.

A pilot study of a health services program for never-pregnant high-school students, which stresses development of incentives for personal involvement in their own health care, reports a low incidence of unintended pregnancy among girls who requested contraceptives. The social and emotional characteristics of those who continued contraceptive use are compared with the small group who had uninteneded pregnancies.

PIP: In 1973, the Family Planning Services of the University of Pennsylvania developed a pilot project which encouraged high school students to manage their reproductive behavior over a period of time by providing them with educational and emotional incentives. Educational incentive was provided by a series of classroom discussions which emphasized attitudes, personal relationship, and family planning information. Emotional support was provided by encouraging students to request, for free, contraceptives and gynecological services at the hospital. Regular clinic visits were encouraged and dropouts were followed up. The study consisted of 161 never-pregnant high school black girls, 14-18 years old; the majority belonged to low-income families (62%). On clinic visits, students filled out emotional assessment forms. Results of the project showed that of the 161 students, only 10% had unintended pregnancies, and this was attributed to misunderstanding or misuse of the contraceptives. Also noted was the concern for regular clinic visits and support during the initial phase of contraceptive use. Older girls were also found to be more likely to have unintended pregnancies than younger girls. Results of the emotional assessment, using the SCL-90 and the Hopkins Symptoms Checklist, showed that the girls who got pregnant had the highest scores in depression and somatic dimensions than the rest of the study. The findings indicate that given the proper incentives, adolescents who become sexually active are capable of using contraceptives effectively. It is implied that although society does not sanction adolescent use of contraceptives, teenagers who are on the throes of sexual activity should at least be given the opportunity to protect themselves.