The European Journal of Psychiatry

Prevalence rates of at risk, problematic and pathological gambling in Switzerland

Background and Objectives: Few studies have assessed pathological gambling in Switzerland. We employed the National Opinion Research Center DSM Screen for Gambling Problems (NODS) to assess prevalence of gambling problems in German- and Italian-speaking Switzerland. Methods: A random sample of 4997 individuals participated in a computer-assisted telephone interview in 2007 and 1388 of the individuals who refused to participate on the telephone interview completed a paper questionnaire. The total sample included 6385 participants (52% women); the return rate was 52.2%. Results: Among the general population over 18 years of age, 2% engaged in lifetime at-risk gambling, 0.5% in problematic and 0.3% in pathological gambling. We found past-year prevalence rates of 0.7% of at-risk gambling, 0.1% for problematic and 0.02% for pathological gambling. Conclusions: These rates are at the lower end of international statistics and are lower than rates in previous Swiss studies. This may be due to measures to reduce false positive diagnoses in our study. Large differences between lifetime and past-year prevalence rates indicate that problematic and pathological gambling are not necessarily progressive and chronic disorders.

Antipsychotic effects on cognition in schizophrenia: A meta-analysis of randomised controlled trials

Background and Objectives: Several studies have shown an improved performance on neuropsychological tests among patients treated with atypical antipsychotics compared to traditional ones. Here we present a meta-analysis of various randomised control trials with the aim of exploring whether patients treated with atypical agents obtain better results than those treated with traditional ones. Methods: The studies to be included were located electronically in November 2008 via the Medline database. A systematic review and a meta-analysis were undertaken; effect sizes were combined according to the random effects model. The effects of several moderating variables were evaluated. Results: The results, based on 18 independent studies (N = 1808), indicate that in terms of the global cognitive index atypical antipsychotics offer minor benefits compared to typical agents as regards the cognitive function of patients, the mean effect size being 0.17 (95% CI 0.04 - 0.29). This observed effect was similar across the studies despite differences in their quality, the dose of haloperidol, the duration of treatment, pharmaceutical industry support, or the atypical antipsychotic used (all p > 0.05). Conclusions: The results suggest that compared to typical antipsychotics, atypical drugs produce a slight improvement in the global cognitive index, and several cognitive domains show a slight improvement in the neuropsychological performance of patients. We encourage further research on the relative effectiveness of several atypical antipsychotics.

Patterns of healthcare utilization in patients with generalized anxiety disorder in general practice in Germany

Background and Objectives: To describe patterns of healthcare utilization among patients with generalized anxiety disorder (GAD) in general practitioner (GP) settings in Germany. Methods: Using a large computerized database with information from GP practices across Germany, we identified all patients, aged > 18 years, with diagnoses of, or prescriptions for, GAD (ICD-10 diagnosis code F41.1) between October 1, 2003 and September 30, 2004 ("GAD patients"). We also constituted an age- and sex-matched comparison group, consisting of randomly selected patients without any GP encounters or prescriptions for anxiety or depression (a common comorbidity in GAD) during the same period. GAD patients were then compared to those in the matched comparison group over the one-year study period. Results: The study sample consisted of 3340 GAD patients and an equal number of matched comparators. Mean age was 53.2 years; 66.3% were women. Over the 12-month study period, GAD patients were more likely than matched comparators to have encounters for various comorbidities, including sleep disorders (odds ratio [OR] = 6.75 [95% CI = 5.31, 8.57]), substance abuse disorders (3.91 [2.89, 5.28]), and digestive system disorders (2.62 [2.36, 2.91]) (all p <0.01). GAD patients averaged 5.6 more GP encounters (10.5 [SD = 8.8] vs 4.9 [5.7] for comparison group) and 1.4 more specialist referrals (2.3 [2.9] vs 0.9 [1.7]) (both p <0.01). Only 58.3% of GAD patients received some type of psychotropic medication (i.e., benzodiazepines, antidepressants, and/or sedatives/hypnotics). Conclusions: Patients with GAD in GP practices in Germany have more clinically recognized comorbidities and higher levels of healthcare utilization than patients without anxiety or depression.

Self-rated health, psychosocial functioning, and other dimensions of adolescent health in Central and Eastern European adolescents

Background and Objectives: Although studied extensively among adults, self-rated health (SRH) has not received the same research attention among adolescents. It has been suggested that SRH in adolescents may be a function of adolescents' overall sense of functioning and may reflect psychosocial functioning more so than in adults. The rating of health as poor by adolescents might be a somatic expression of life distress and may be connected with risky behaviors. Therefore, the purpose of this study was to investigate self-rated health (SRH) in Central and Eastern European (CEE) adolescents and determine its association with psychosocial functioning and other dimensions of adolescent health. Methods: A survey was administered to 3,123 students in 34 secondary schools across CEE which included measures of SRH, psychosocial functioning (loneliness, hopelessness, shyness, perceptions of social status, self-rated happiness, and perception of physical attractiveness), and other dimensions of adolescent health (height/weight, physical activity, eating breakfast, sleep). Results: More girls (19.4 %) than boys (11.3 %) rated themselves as "not healthy" and this was true in each of the six countries. Significant predictors of SRH in the logistic regression model were gender, country of residence, hopelessness, shyness, subjective social status-society, self-rated happiness, perception of physical attractiveness, vigorous physical activity, eating breakfast, overweight status, and usually get 7-8 hours or more sleep a night. Conclusions: SRH appears to be associated with psychosocial functioning and other dimensions of adolescent health in CEE youth.

Clinical evaluation of children testing positive in screening tests for attention-deficit/hyperactivity disorder: A preliminary report

Background and Objectives: Screening tests are of great diagnostic value in attention-deficit/hyperactivity disorder (ADHD), however final diagnosis relies on a clinical examination by an expert. The objective of the present study was to clinically evaluate children who had been screened positive for ADHD through both a parent and a teacher questionnaire. Methods: Parent interview and child behavior checklist and clinical assessment were used to confirm the preliminary diagnosis in 42 children aged 8 years, who have been screened positive for ADHD out of 1,708 children, in a large, two-setting screening study conducted in Crete, Greece. Results: The diagnosis of ADHD was confirmed for 31 children (74%). In the remaining 11 children, ADHD manifestations were attributed to other primary disorders. None of the 42 children was classified as lacking symptoms suggesting ADHD. Among the 31 children with confirmed ADHD, only 2 had been diagnosed prior to the screening test. Conclusions: Although clinical evaluation is the golden standard for diagnosis of ADHD, two-setting screening questionnaires by parent and teacher are useful tools in identifying children who need further investigation and intervention.

A review on the use of NEO-PI-R validity scales in normative, job selection, and clinical samples

Background and Objectives: In this study we review the use of the Positive Presentation Management (PPM) and Negative Presentation Management (NPM) scales, two NEO-PI-R derived measures originally devised to control for biased and distorted responses. These scales have been used with normative, job selection and clinical samples, in cross-sectional and experimental studies. Methods: Web-based and manual searches in personality and psychological assessment journals were conducted, and information on the PPM and NPM scales was systematically recorded. Means, standard deviations and reliability coefficients were summarized and compared between three types of samples: normative, job selection and clinical. Results: Five studies were performed with normative samples (33%), 3 with employment samples (20%) and 7 with clinical samples (47%). Cross-sectional designs were most common (60%), although there were also experimental studies (40%). Reported reliability coefficients were lower than usually accepted. There were differences in mean PPM and NPM scores in regard to the study sample background. Conclusions: There were some discrepancies when reporting PPM and NPM results across the reviewed studies. Normative and employment samples scored higher in PPM than clinical samples. Clinical samples scored higher in NPM than normative and employment samples The PPM and NPM scales could be useful in applied situations, although parallel sources of information should be taken into account to detect distorted responses to the questionnaire. However, the results on these scales should be systematically reported in future studies.