The role of screening tools in diagnosing neuropathic pain.

Neuropathic pain affects 6-8% of the general adult population. It is reported by 27% of chronic pain patients and 40% of cancer patients, yet there is no standardized diagnostic test for neuropathic pain. A number of screening tools have been developed based on verbal pain descriptors, with or without limited clinical examination, to identify individuals with neuropathic pain. Over the past decade these neuropathic pain screening tools have been validated in a wide range of pain populations, as well as translated into many languages, to discriminate between neuropathic and non-neuropathic pain. We describe here the five most commonly used neuropathic pain screening tools and discuss current assessment guidelines, the use of screening tools in novel clinical contexts and their potential use in personalized therapy.

[Screening for depression in nursing homes: validity of the WHO (Five) Well-Being Index]. / Der WHO-5-Fragebogen zum Wohlbefinden als Screeninginstrument für Depression bei Altenheimbewohnern.

OBJECTIVE: Depression is common in nursing home residents, but is still underrecognized. Screening for depression could be a first step to increase recognition rates within this high-risk group. Therefore, we investigated the validity of the WHO (Five) Well-Being Index (WHO-5) for early detection of depression in nursing home residents. METHODS: The Structural Clinical Interview for DSM-IV (SCID) was used as the gold standard for the validation of the WHO-5. The diagnoses covered in this assessment were both current major depression as well as minor depression according to DSM-IV research criteria. RESULTS: In our sample of 92 nursing home residents in Munich aged 65-97 years, (73.9% female, 26.1% male) 14.1% fulfilled the criteria of major depression and again 14.1% fulfilled the criteria of minor depression in the SCID. Overall diagnostic validity (area under the ROC curve) of the WHO-5 was .90 (95% confidence interval: .84- .97). The best cut-off-point according to Youden's index yielded a sensitivity of .92 and a specificity of .79. CONCLUSIONS: The diagnostic accuracy of the WHO-5 in our study is promising. The WHO-5 might be an efficient screening tool for nursing home residents, but results have to be replicated in a larger sample.

[Prevalence of mental disorders in the elderly long-term unemployed. Comparison of results of the project KompAQT and the German National Health Interview and Examination Survey]. / Prävalenz psychischer Störungen bei älteren Langzeitarbeitslosen - Ein Vergleich von Ergebnissen aus dem Projekt KompAQT mit Daten aus dem Bundesgesundheitssurvey.

OBJECTIVE: Unemployed persons have a higher risk for mental disorders. There is some evidence that this risk is even greater for the elderly longterm unemployed. This study assesses the prevalence of mental disorders in this group. METHODS: This pilot study was conducted within a programme for assisting long-term unemployed subjects to re-enter the workforce. 12-month prevalences for mental disorders according to ICD-10 were calculated using the DIA-X Structured Clinical Interview. Prevalence rates were compared to those of the German National Health Interview and Examination Survey, Mental Health Supplement in the community. Prevalence rates were adjusted concerning sex, age and family status. RESULTS: Compared to the prevalence rate in the general population, prevalence rates for the elderly long-term unemployed were elevated only for mood disorders. 12-month prevalence rates were 32.18% for depressive disorders and 37.58% for dysthymia. There are some methodological limitations like selectivity of the sample that may influence the validity of the results. CONCLUSIONS: The risk for depressive disorder in elderly long-term unemployed persons should be investigated with adequate methods in a larger representative sample.

Screening for depression in the older long-term unemployed.

BACKGROUND: Misdiagnosis and undertreatment of depression in older, long-term unemployed people may not only pose a serious medical problem, but may also be an obstacle for their vocational reintegration. Screening for depression could be a first step to increasing treatment rates within this high-risk group. Therefore, the WHO-5 Well-Being Index was tested for its validity in unemployment offices. METHODOLOGY: Three hundred and sixty-five participants in a German programme for the vocational reintegration of long-term unemployed people were screened with the WHO-5 Well-Being Index. In 104 of these subjects, ICD-10 diagnoses were made using DIA-X Structured Clinical Interview. RESULTS: Using the DIA-X data as a gold standard, the WHO-5 Well-Being Index obtained satisfactory results for sensitivity (82.5%) and specificity (70.3%) as a screening tool for affective disorders when used with an adjusted cut-off-point of < or = 12. While none of the 18.5% male participants diagnosed with major depression received treatment, half of the 24% of female participants with major depression received treatment. CONCLUSION: Screening with the WHO-5 within unemployment offices is useful to detect people with depressive disorders. Many of them do not receive optimal treatment and can be motivated to seek professional help. Reducing depression by better treatment will also increase the chances of reemployment.