[Prevalence of psychiatric disorders in French general practice using the patient health questionnaire: comparison with GP case-recognition and psychotropic medication prescription]. / Prévalence des troubles psychiatriques en médecine générale selon le patient health questionnaire: adéquation avec la détection par le médecin et le traitement prescrit.

INTRODUCTION: Psychiatric disorders, mainly depression and anxiety, are frequently encountered in primary care and are a major cause of distress and disability. Nearly half of cases go unnoticed and among those that are recognised, many do not receive adequate treatment. In France, there is limited research concerning the prevalence, detection and management of these conditions in primary care. OBJECTIVES: To estimate the prevalence of psychiatric disorders, overall and for the main psychiatric diagnostic categories, encountered in primary care; to describe general practitioners' (GPs') case identification rate; to examine psychotropic medication prescription according to diagnosis, in a regionally representative sample of GP attenders. METHODS: GP practicing standard general practice in an urban area of the city of Montpellier and a nearby semi-rural region were recruited to participate. The response rate was 32.8% (n=41). Five additional GP almost exclusively offering homeopathy and acupuncture were recruited nonrandomly for convenience purposes. In each GP surgery, consecutive patients entering the waiting room were invited by a research assistant to participate until 25 patients per GP were recruited. Each participant completed self-report questionnaires in the waiting time, including the patient health questionnaire (PHQ), which yields provisional DSM-IV diagnoses. The GP completed a brief questionnaire during the consultation, giving his/her rating of the severity of any psychiatric disorder present and action taken. RESULTS: The patient response rate was 89.8%. In all, 14.9% of patients reached DSM-IV criteria for major depression or anxiety disorder on the PHQ (9.1% for major depression, 7.5% for panic disorder; 6% for other anxiety disorders). For the subthreshold categories, 7.4% met criteria for other depressive disorders, 11.8% for somatoform disorders and 10.9% for probable alcohol abuse or dependence. 66.3% of patients with DSM-IV diagnoses of major depression or anxiety disorder were identified by the GP as having a psychiatric disorder. The identification rate was 51% for all depressive disorders, anxiety and somatoform disorders. Of patients receiving a prescription for anxiolytic or antidepressant medication on the survey day, 80% were classified as cases of psychiatric disorder by the GP. Only 48.8% met criteria for major depression or anxiety disorder on the PHQ. CONCLUSION: This study highlights the frequency of psychiatric disorders in a regional study of French general practice. Overall, prevalence rates were similar to those found elsewhere, except for probable alcohol abuse and dependence, which was considerably higher than in the USA PHQ validation study. As in other countries, GP identified roughly half of psychiatric cases. Furthermore, half of patients treated by anxiolytic or antidepressant medication did not meet the diagnostic criteria on the survey day for which these medications have mainly shown their efficacy. This confirms the French paradox of one of the highest psychotropic medication consumption rates in Europe despite many cases of depression remaining untreated. The PHQ could be a rapid and acceptable diagnostic aid tool for French general practice but first needs to be validated against the diagnosis of mental health professionals in this setting.

Substance use and related problems: a study on the abuse of recreational and not recreational drugs in Northern Italy.

2015 subjects were interviewed at musical events and raves in Northern Italy: average age 25.1, 42% female, 67% work, 42% study, 61% have higher certificate of education. 3.8% used drugs for the first time in the last year, and 60% have been using drugs for over 5 years, age of first use 16.3. In the last year, 26% have tried a mix of drugs, 52% alcohol and drugs, 48% have driven after drinking; drug consumption was: marijuana 58%, hashish 55%, cocaine 24%, popper 12%, hallucinogenic mushrooms 13%, ecstasy 13%, amphetamines 13%, Salvia divinorum 11%, LSD 9%, opium 9%, ketamine 7%, heroin 5%. In the last year, 27% subjects had depression, 25.7% anxiety, 23.7% sleep disorders, 15% financial problems, 13% road accidents, 9% addiction, 6% judicial problems. All problems were correlated to CAGE (Cut, Annoyed, Guilty, Eye-opener) test, drug use and mix drug use; psychological problems were higher for females: anxiety for cocaine, memory and psychosomatic for opium, sleeping disorders for crack, anxiety for popper, hallucinations for LSD and hallucinogenic mushrooms.

Substance abuse among Iranian high school students.

PURPOSE OF REVIEW: In this study, we reviewed data on drug use among high school students in Iran. RECENT FINDINGS: Published epidemiological studies in international and domestic journals show that drug use/abuse is a serious mental health problem in Iran. There is cultural support for opium in Iran and also there is cultural tolerance for tobacco smoking, especially as water pipe smoking in Iranian families. Alcohol, opium and cannabis are the most frequently used illicit drugs, but there are new emerging problems with anabolic steroids, ecstasy and stimulant substances, such as crystal methamphetamine. SUMMARY: There is a serious drug abuse problem among Iranian high school students. It could be due to role modeling by parents - mainly fathers - and also cultural tolerance of some substances. Early onset of tobacco smoking, with a daily use rate between 4.4 and 12.8% in high school students, is an important risk factor for other drug abuse problems. Use of all types of drugs, except prescription drugs, is more prevalent among boys. Alcohol is the most frequently abused substance, with a lifetime rate of at least 9.9%. Lifetime rates of opiate use - mostly opium - was between 1.2 and 8.6% in different parts of the country. As drug abuse is a frequent problem among Iranian high school students, it is necessary to design and implement drug prevention programs to protect them. Such programs, including life skills training and drug education, have been operating in recent years for Iranian students from kindergarten to the university level.

Drug addiction in China.

Drug addiction in China began with the importation of Indian opium by the British in the 16th century and brought severe social and health problems. While drug abuse abated following the establishment of People's Republic of China, modernization and Westernization in the 1980s led to the reemergence of this problem. Drug abuse in China became epidemic, facilitating the spread of HIV/AIDS. The Chinese government has made great efforts to address these problems, focusing both on treatments of drug addiction and on harm-reduction programs. Although the new trends of drug addiction in China pose great public health challenges, these government interventions are likely to successfully stem the problem of drug abuse in the future.

Instances of treatment for opiate and nonopiate drugs in one urban community.

Study was made to learn the extent of drug abuse coming to the attention of treatment personnel in private and public facilities within one urban community during a 1-month period. Reports from 105 facilities indicated alcohol was the major drug of abuse with heroin and nonopiate drugs running a distant second and third, respectively. Of 8,784 requests for treatment in which the use of drugs was seen as a factor, 83% involved alcohol, 9% opiates, 6% nonopiate, nonalcoholic drugs, and 2% unknown drugs.

Sex differences in drug and alcohol use among ethnic groups in Laos, 1965-1975.

Laos in the period 1965-1975 provided an opportunity to study sex differences in drug and alcohol use, as influenced by ethnicity. Several psychoactive substances were locally consumed, including opium, heroin, alcohol, tobacco, betel-areca, and cannabis. Much diversity occurred among the various ethnic groups with regard to male-female use of drugs and alcohol. Trends in these use patterns suggested the existence of certain principles which govern the male-female dimension of drug use. Social changes going on in the society were reflected in choice of substance forms by younger people as compared to their elders (e.g., cigarettes vs pipes or cigars, heroin vs opium, manufactured vs village-produced alcohol). Ecological factors, which contributed to drug availability, also were powerful in determining type of drugs and patterns of use.

Drug abuse in Afghanistan.

1. The two major drugs abused in Afghanistan are hashish and opium. Opium is either smoked or eaten. Hashish is only smoked. 2. Solitary abuse of one single drug, either hashish or opium, is the common feature of drug abuse in Afghanistan. 3. Abuse of other patent drugs as well as multiple drug abuse by the same individual, increasingly common elsewhere, is quite rare. 4. Self-treatment is a major cause of drug abuse in Afghanistan while escape from boredom and lack of work and motivation is another. 5. Hashish as well as opium is commonly abused by people of a low socioeconomical standard. 6. Alcohol, a more recent introduction by the upper class, is becoming popular among city dwellers with major risks involved for the future. 7. Drug abuse in Afghanistan has so far not created problems comparable to those in the West, although there is no guarantee that in future it will not do so. Coercive measures aimed at depriving an individual of his drug of choice may involve the greater risk of drug substitution which will then be an even more difficult problem to manage. 8. Factors involved in prevention as well as cure of the drug-dependent population in Afghanistan have been discussed.

Correlates of illicit drug use in Karen villages in Northern Thailand.

A study was conducted in 31 Karen tribal villages in Northern Thailand in 1999-2000 to address the question of why some villages have a relatively high prevalence of illicit drug use compared with others? Data were gathered from village leaders, residents, and through observations by field workers and the researchers, and included demographic, economic, and infrastructure development, and social and acculturation measures. Overall, few village-level variables were related significantly to drug use in the villages; those that were included: 1) better access to elementary education reported by "high drug" villages (81%) in comparison with "low drug" villages (29%) and 2) high drug villages reported having more alcoholic residents than low drug villages. The findings provide some support for the hypothesis that illicit drug use is positively associated with socioeconomic development, acculturation, and socialization into mainstream attitudes, values, and behaviors.