| 1. |
- Bodlund, Owe
(author)
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[Anxiety and depression as a hidden problem in primary health care. Only one case in four identified].
- 1997
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In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 94:49, s. 4612-4, 4617
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Journal article (peer-reviewed)abstract
- Of 374 unselected primary care patients assessed with the Hospital Anxiety and Depression (HAD) scale, 11.8 per cent rated themselves as suffering from anxiety, and 3.7 per cent as depressed. Clinically, 8 per cent were diagnosed as cases of anxiety, and 4 per cent as cases of depression, but agreement was very poor between these cases and those elicited with the HAD scale, only 25 per cent of the latter being identified by the primary care physicians. One third of the patients with a clinical diagnosis of anxiety and 47 per cent of those with diagnosed depression were offered appropriate treatment, usually medication with a selective serotonin re-uptake inhibitor (SSRI) and consultation with a medical social worker. The results were consistent with the expected prevalences, thus indicating anxiety and depression to be markedly under-diagnosed and under-treated, and suggest that there is a manifest need of consultation facilities and of further education among primary care physicians.
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| 2. |
- Bodlund, Owe, et al.
(author)
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Effects of consulting psychiatrist in primary care. 1-year follow-up of diagnosing and treating anxiety and depression.
- 1999
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In: Scandinavian Journal of Primary Health Care. - 0281-3432 .- 1502-7724. ; 17:3, s. 153-7
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Journal article (peer-reviewed)abstract
- OBJECTIVE: Epidemiological screening of anxiety and depressive disorders in primary care and evaluation of how these patients are identified and treated. Follow-up after 1 year of psychiatric consultation/liaison (C/L) and educational activities. SUBJECTS AND DESIGN: In the baseline study 374 unselected and consecutive patients, and in the follow-up study 254 patients (response rate 94.5% and 90.3%, respectively) answered the screening instrument HAD scale (Hospital Anxiety and Depression scale). The HAD results were compared to clinical diagnosis and treatment according to the medical records. Differences after 1 year were analysed. RESULTS: At follow-up the prevalence of anxiety had increased from 11.8% to 16.5% (p < 0.05), and of depression from 3.7% to 4.7% (NS) according to HAD. Also, at the follow-up more cases of anxiety disorders were clinically diagnosed--13% vs 8%--as well as an increased number of cases of depressive disorders--7.9% vs 4.0%. The agreement between HAD diagnosis and clinical judgement had increased significantly (p < 0.001) for anxiety disorders from 37% to 70%, and for depression from 20% to 45%. Treatment prevalence had also improved (p < 0.001) at the follow-up for anxiety disorders from 33% to 55% and for depression from 47% to 80%. In total, 4.0% of the baseline and 11.4% of the follow-up population were treated for anxiety and/or depression. CONCLUSIONS: Anxiety and depressive disorders are prevalent in primary care. However, only a minority of these patients are identified and treated. Psychiatric consultant support seems to be effective in improving GP's diagnostic and therapeutic skills thus enabling these widespread disorders to be identified at an early stage and properly treated.
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| 3. |
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| 4. |
- Bodlund, Owe, et al.
(author)
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Transsexualism--general outcome and prognostic factors : a five-year follow-up study of nineteen transsexuals in the process of changing sex.
- 1996
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In: Archives of Sexual Behavior. - 0004-0002 .- 1573-2800. ; 25:3, s. 303-16
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Journal article (peer-reviewed)abstract
- Nineteen transsexuals, approved for sex reassignement, were followed-up after 5 years. Outcome was evaluated as changes in seven areas of social, psychological, and psychiatric functioning. At baseline the patients were evaluated according to axis I, II, V (DSM-III-R), SCID screen, SASB (Structural Analysis of Social Behavior), and DMT (Defense Mechanism Test). At follow-up all but 1 were treated with contrary sex hormones, 12 had completed sex reassignment surgery, and 3 females were waiting for phalloplasty. One male transsexual regretted the decision to change sex and had quit the process. Two transsexuals had still not had any surgery due to older age or ambivalence. Overall, 68% (n = 13) had improved in at least two areas of functioning. In 3 cases (16%) outcome were judged as unsatisfactory and one of those regarded sex change as a failure. Another 3 patients were mainly unchanged after 5 years. Female transsexuals had a slightly better outcome, especially concerning establishing and maintaining partnerships and improvement in socio-economic status compared to male transsexuals. Baseline factors associated with negative outcome (unchanged or worsened) were presence of a personality disorder and high number of fulfilled axis II criteria. SCID screen assessments had high prognostic power. Negative self-image, according to SASB, predicted a negative outcome, whereas DMT variables were not correlated to outcome.
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| 5. |
- Bodlund, Owe, et al.
(author)
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Validation of the self-report questionnaire DIP-Q in diagnosing DSM-IV personality disorders : a comparison of three psychiatric samples.
- 1998
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In: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447. ; 97:6, s. 433-9
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Journal article (peer-reviewed)abstract
- The DSM-IV section of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q) was used to screen for personality disorders in 448 subjects from three clinical samples (general and forensic psychiatric patients and candidates for psychotherapy) and a sample of 139 healthy volunteers. Differences between the samples with regard to patterns of personality pathology in relation to concurrent Axis I disorders and sociodemographic variables were analysed. The prevalence of personality disorders according to DIP-Q was 14% among the healthy volunteers, compared to 59% in the general psychiatric sample, 68% in the forensic psychiatric sample and up to 90% among psychotherapy candidates. Moreover, from a dimensional perspective (i.e. the number of fulfilled Axis II criteria), all clinical groups differed significantly from the control group in all specified personality dimensions and clusters. Dimensional DIP-Q cluster scores also discriminated significantly between the three clinical samples. Unexpectedly, the odds ratio for an Axis II disorder was nearly five times higher among psychotherapy applicants than among general psychiatric patients, independent of concomitant Axis I disorders, gender or age. The strongest association between DIP-Q score and Axis I disorders was found for depressive disorders, which more than doubled the odds ratio for a personality disorder diagnosis. This association could result from high true comorbidity, but could also be due to the fact that a concomitant depressive state can increase self-reported personality difficulties. The high prevalence among psychotherapy candidates may to some extent reflect help-seeking exaggeration of problems. These are aspects to consider when using the DIP-Q, which overall appears to discriminate well between different samples.
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| 6. |
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| 7. |
- Sundbom, Elisabet, et al.
(author)
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Prediction of outcome in transsexualism by means of the Defense Mechanism Test and multivariate modeling : a pilot study.
- 1999
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In: Perceptual and Motor Skills. - 0031-5125 .- 1558-688X. ; 88:1, s. 3-20
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Journal article (peer-reviewed)abstract
- To elaborate the predictive value of the projective method using the Defense Mechanism Test in a 5-yr. follow-up study of 16 transsexuals, all subjects were approved for sex reassignment surgery and had completed the baseline assessments and the 5-yr. follow-up evaluation. Furthermore, we intended to create an outcome model based on the test data for prior patients wherein new consecutive applicants for sex change could be tested to predict the outcome in individual cases. Outcomes after five years showed that 62% of the transsexuals were judged as improved in a variety of areas of psychosocial functioning, 19% were unchanged, and 19% were worsened. Firstly, the analysis of the test data confirmed differences between the improved transsexuals and those who were not. Secondly, sex differences were found, with female-to-male transsexuals having a better outcome and being more homogeneous than their male counterparts. Thirdly, there was good correspondence in prediction of outcome between the model based on the Defense Mechanism Test and a clinical judgment made by a psychiatrist for two new applicants for sex reassignment surgery. It appears the Defense Mechanism Test has a predictive ability for patients with gender-identity disorder.
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