[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.

Opioids and designer drugs.

Despite the increasing use of other illicit drugs, opioid abuse, overdose, and the ensuing medical complications continue to pose management challenges for the emergency physician. Heroin use is increasing as abusers of cocaine seek a drug to prolong cocaine's effects while blunting the postcocaine depression. Clandestine chemists have created newer, more powerful compounds--designer drugs--whose potencies are many-fold that of the presently available opioids. Aggressive airway support and use of naloxone enable the emergency physician to salvage many of these patients, leaving the many medical complications of parenteral and inhalational use as the greatest management challenge.

Zolpidem abuse and dependency in an elderly patient with major depressive disorder: a case report.

OBJECTIVE: Zolpidem is a non-benzodiazepine hypnotic drug for treatment of insomnia. It has been introduced as a lower potential agent for dependency and abusive effects. CASE SUMMARY: In this study, the reported case was a 62 years old female patient suffering simultaneously with Major Depressive Disorder and Opium Dependency. After abrupt discontinuation of zolpidem, 570 mg per day, she exhibited severe withdrawal symptoms, led her to be admitted to emergency department. CONCLUSIONS: Zolpidem has a potency to be abused with high risk of dependency and withdrawal syndromes particularly among elderly patients with comorbid anxiety/depressive symptoms/disorders.

Age at diagnosis in bladder cancer: does opium addiction play a role?

BACKGROUND: Bladder cancer is a major health problem, especially among men. Opium addiction can be an important risk factor. One important question is whether it can affect the age of onset of bladder cancer .We performed this study to evaluate this question. MATERIALS AND METHODS: In a cross-section study, records of patients diagnosed with bladder carcinoma in Shahid Labbafinejad Medical Center, within 1999-2008 were included. Data were extracted from records regarding age at onset, gender, smoking status, and opioid addiction and analyzed with SPSS 13. RESULTS: Within 10 years, 920 cases were diagnosed with bladder cancer of which 97 percent were transitional cell carcinoma. In 698 cases, opium addiction status was recorded in 21.3% (n=149). Age at diagnosis was 59.7±11.51 (median: 60) among opioid addicts which was significantly lower than non- addicts (63.1±13.65, Median: 65) (P<0.001). CONCLUSIONS: Opium addiction can decrease the age of onset of bladder cancer.

Toxicology test-ordering patterns in a large urban general hospital during five years: an update.

Analytical data from the clinical toxicology laboratory of a large urban hospital, the Los Angeles County--University of Southern California Medical Center, are reported for the year 1976 and are compared to similar data previously documented for the year 1972. Drugs assayed, number of tests requested, and number of positive results are collated. Data on 58 assays show that the overwhelming majority of the requests continue to be for those tests that were originally classified as tests with 4-h turn-around time in the patient-focused concept for a clinical toxicology service in 1972. Total workload increased by 70%. The number of patients on whom some toxicologic assay was requested doubled in spite of a decrease in the number of patients admitted to the hospital during this five-year period. The data show that assays for some socially and clinically significant drugs--ethanol diazepam, tricyclics, and phencyclidine--increased disproportionally while others remained relatively constant, or even decreased.

[Recognizing and treating drug addicts. Part 2. Differential diagnosis, therapy]. / Erkennung und Behandlung von Drogen-Abhängigen. Teil 2: Differentialdiagnose, Therapie.

Persons addicted to opiates often have fresh injection scars on the skin directly above the veins in the arms and legs. These appear as well as scars from abscesses and burns, tattoos, advanced tooth decay and signs of chronic hepatitis. An intensive consumption of hallucinogens is often connected to an inclination toward apathy and a loss of contact to reality (amotivational syndrome). It is necessary to have a sufficiently wide spectrum of therapeutic and rehabilitation measures being offered, due to the wide range of variants one can expect in the personality structure and the primary disturbance. The slogan of "therapy instead of punishment" leads nowhere. Long-term in-patient programmes, still presently favoured in our country, are not sufficient and are being increasingly more frequently rejected by the addicts themselves. Out-patient therapy trends, which are both extremely necessary and promising, are to be found in the close co-operation between physicians and specialists in social therapy while utilizing community resources. Two examples for such a programme are discussed (Hesse, Marx). A more concentrated improvement of out-patient therapy and rehabilitation of drug addicts is only possible when the chemical-toxicological diagnosis of addicting substances in urine becomes a routine process in the medical laboratory, e.g. by enzyme immunological methods.

[Clinical features of cocnar addiction]. / Klinicheskie osobennosti koknarovoi narkomanii.

Some peculiarities of clinical manifestations of cocnar addiction were studied in 172 patients of Shimkent narcologic outpatient clinic (South Kazakhstan). A comparison of cocnar addiction with one caused by administration of chemically processed raw opium was made in 302 patients. It was established that cocnar addiction is characterised by slow development, slow progression of the disease. The age of most of such patients was more than 70 years (in group which abused raw opium--less than 40). Cocnar addiction was characterised by longer duration of the disease (up to 33 years), while in case of raw opium abuse its duration was mainly till 5 years. Compared to raw opium abuse stage III of the disease was less frequent, (9.8 and 29.8% respectively). Working capacity was preserved longer in cocnar addiction, and such patients were less inclined to commit criminal actions. The attention is paid to possibility of both "rejuvenation" and increase of the progredient course of cocnar addiction in conditions of its spreading.