[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.

Cultural aspects of anxiety disorders in India.

Cultural factors have influenced the presentation, diagnoses, and treatment of anxiety disorders in India for several centuries. This review covers the antecedents, prevalence, phenomenology, and treatment modalities of anxiety disorders in the Indian cultural context. It covers the history of the depiction of anxiety in India and the concept of culture in the classification of anxiety disorders, and examines the cultural factors influencing anxiety disorders in India. We review the prevalence and phenomenology of various disorders, such as generalized anxiety disorder, panic disorder, social anxiety, and phobic disorder, as well as culture-specific syndromes such as dhat and koro in India. Finally, the review examines the wide range of therapeutic modalities practiced in India, such as faith healing, psychotherapy, ayurveda, psychopharmacology, Unani medicine, homeopathy, yoga, meditation, and mindfulness. We conclude by emphasizing the significance of cultural factors in making relevant diagnoses and offering effective and holistic treatments to individuals with anxiety disorders.

Por varios siglos, Ios factores culturales han influenciado la presentación, diagnóstico y tratamiento de Ios trastornos de ansiedad. Esta revisión abarca Ios antecedentes, prevalencia, fenomenología y modalidades terapéuticas de Ios trastornos de ansiedad en el contexto cultural de India. También incluye la historia de la descripción de la ansiedad en India y el concepto de cultura en la clasificación de Ios trastornos de ansiedad, como asimismo examina Ios factores culturales que influyen en Ios trastornos de ansiedad en India. Se revisa la prevalencia y la fenomenología de varios trastornos, como el trastorno de ansiedad generalizada, el trastorno de pánico, la ansiedad social y el trastorno fóbico, como también síndromes culturales específicos en India como el dhat y el koro. Por ultimo, el artículo revisa el amplio rango de modalidades terapéuticas practicadas en India, como la curación por la fe, la psicoterapia, el ayurveda y la psicofarmacología. Se concluye enfatizando en el significado de Ios factores culturales que son relevantes para realizar diagnósticos y ofrecer tratamientos efectivos y holísticos para individuos con trastornos de ansiedad.

Depuis plusieurs siècles, des facteurs culturels influent sur la présentation, le diagnostic et le traitement des troubles anxieux en Inde. Cet article parcourt les antécédents, la prévalence, la phénoménologie et les modalités de traitement des troubles anxieux dans le contexte culturel indien. Il traite de l'histoire de la représentation de l'anxiété en Inde et du concept de culture dans la classification des troubles anxieux et analyse les facteurs culturels influant sur les troubles anxieux en Inde. Nous examinons la prévalence et la phénoménologie des différents troubles, comme les troubles anxieux généralisés, le trouble panique, l'anxiété sociale et les troubles phobiques, ainsi que les syndromes culturels spécifiques comme le syndrome du Dhat et du koro en Inde. Enfin, l'article analyse la large gamme de modalités thérapeutiques pratiquées en Inde, comme la guérison par la foi, la psychothérapie, l'ayurvéda, la psychopharmacologie, la médecine Unani, l'homéopathie, le yoga, la méditation et la pleine conscience. Nous concluons en soulignant l'importance des facteurs culturels dans l'établissement de diagnostics pertinents et en proposant des traitements efficaces et holistiques aux individus ayant des troubles anxieux.