| 1. |
- Backlund, Sara, et al.
(författare)
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Sexuella problem är vanliga vid antidepressiv behandling : Vad vet allmänläkarna om denna biverkan, och hur hanteras den?
- 2005
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 102:9, s. 650-653
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Tidskriftsartikel (refereegranskat)abstract
- At least five per cent of the Swedish population is treated with some kind of antidepressant (AD) drug, mostly SSRI's. Sexual adverse effects, mainly loss of libido and anorgasmia or delayed orgasm/ejaculation concern more than 50% of these patients. The antidepressive effects of treatment are generally satisfying, but the sexual side effects may be a reason for non-compliance. This article refers to studies that specifically have investigated sexual adverse effects caused by AD-treatment and strategies to handle and prevent these problems. A questionnaire sent to general practitioners showed that they are well aware of the problem with sexual adverse effect in AD treatment and ascribe it great importance. The knowledge of effects and side effects of newer AD drugs seemed somewhat insufficient. An increased knowledge about these substances and alternative treatment strategies would perhaps make it easier for the physicians to handle or avoid AD induced sexual side effects.
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| 2. |
- Hansson, Maja, 1980-, et al.
(författare)
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Comparison of two self-rating scales to detect depression : HADS and PHQ-9
- 2009
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Ingår i: British Journal of General Practice. - : Royal College of General Practitioners. - 0960-1643 .- 1478-5242. ; 59:566, s. e283-e288
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: More than half of patients with depression go undetected. Self-rating scales can be useful in screening for depression, and measuring severity and treatment outcome. AIM: This study compares the Hospital Anxiety and Depression Scale (HADS) and the Patient Health Questionnaire (PHQ-9) with regard to their psychometric properties, and investigates their agreement at different cut-off scores. METHOD: Swedish primary care patients and psychiatric outpatients (n = 737) who reported symptoms of depression completed the self-rating scales. Data were collected from 2006 to 2007. Analyses with respect to internal consistency, factor analysis, and agreement (Cohen's kappa) at recommended cut-offs were performed. RESULTS: Both scales had high internal consistency (alpha = 0.9) and stable factor structures. Using severity cut-offs, the PHQ-9 (> or =5) diagnosed about 30% more patients than the HADS depression subscale (HADS-D; > or =8). They recognised the same prevalence of mild and moderate depression, but differed in relation to severe depression. When comparing recommended screening cut-offs, HADS-D > or =11 (33.5% of participants) and PHQ-9 > or =10 (65.9%) agreement was low (kappa = 0.35). Using the lower recommended cut-off in the HADS-D (> or =8), agreement with PHQ-9 > or =10 was moderate (kappa = 0.52). The highest agreement (kappa = 0.56) was found comparing HADS-D > or =8 with PHQ-9 > or =12. This also equalised the prevalence of depression found by the scales. CONCLUSION: The HADS and PHQ-9 are both quick and reliable. The HADS has the advantage of evaluating both depression and anxiety, and the PHQ-9 of being strictly based upon the Diagnostic and Statistical Manual of Mental Disorders. The agreement between the scales at the best suitable cut-off is moderate, although the identified prevalence was similar. This indicates that the scales do not fully identify the same cases. This difference needs to be further explored.
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| 3. |
- Hansson, Maja, 1980-, et al.
(författare)
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Patient education and group counselling to improve the treatment of depression in primary care : a randomized controlled trial
- 2008
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Ingår i: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327 .- 1573-2517. ; 105:1-3, s. 235-240
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: The Contactus program for depressed patients in primary care, consists of six lectures about depression, each followed by a group discussion. The aim of this study was to investigate if Contactus can improve treatment outcome in comparison to a control group. METHODS: Forty-six primary care centres in Sweden, each randomly allocated either to the Contactus group or to the control group, included depressed patients, 205 in the Contactus group and 114 in the control group. Besides regular treatment of depression, the Contactus group participated in the educational program. At start and after 6 weeks, patients filled in a questionnaire and the self-reports: HADS (Hospital Anxiety and Depression Scale) and GAF-self (Global Assessment of Functioning). RESULTS: After 6 weeks, clinically depressed patients (HAD-depression score >10) had a mean improvement in HAD-D of 4.6 in Contactus vs. 3.0 in controls (p=0.02), and 72% vs. 47% considered themselves to feel better (p=0.01). Increase in GAF score was 11.8 vs. 5.8 (p=0.04), respectively. According to HADS, 55% in Contactus were responders vs. 29% among controls (p=0.006), and 42% vs. 21% (p=0.02) were in remission. LIMITATIONS: Only 40% of the patients in Contactus and 35% among controls were clinically depressed according to the HADS (>10 points) at inclusion. CONCLUSIONS: Patient education and group counselling contributes significantly to better improvement among depressed patients. Group treatment is inexpensive and could be implemented in the routine care of depressed patients in primary care.
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| 4. |
- Henningsson, Susanne, 1977, et al.
(författare)
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Sex steroid-related genes and male-to-female transsexualism
- 2005
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Ingår i: Psychoneuroendocrinology. - Oxford : Pergamon Press. - 0306-4530 .- 1873-3360. ; 59:5, s. 412-412
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Tidskriftsartikel (refereegranskat)abstract
- Transsexualism is characterised by Lifelong discomfort with the assigned sex and a strong identification with the opposite sex. The cause of transsexualism is unknown, but it has been suggested that an aberration in the early sexual differentiation of various brain structures may be involved. Animal experiments have revealed that the sexual differentiation of the brain is mainly due to an influence of testosterone, acting both via androgen receptors (ARs) and-after aromatase-catalyzed conversion to estradiol-via estrogen receptors (ERs). The present study examined the possible importance of three polymorphisms and their pairwise interactions for the development of male-to-female transsexualism: a CAG repeat sequence in the first exon of the AR gene, a tetra nucleotide repeat polymorphism in intron 4 of the aromatase gene, and a CA repeat polymorphism in intron 5 of the ER beta gene. Subjects were 29 Caucasian male-to-female transsexuals and 229 healthy mate controls. Transsexuals differed from controls with respect to the mean Length of the ER repeat polymorphism, but not with respect to the length of the other two studied polymorphisms. However, binary logistic regression analysis revealed significant partial effects for all three polymorphisms, as well as for the interaction between the AR and aromatase gene polymorphisms, on the risk of developing transsexualism. Given the small number of transsexuals in the study, the results should be interpreted with the utmost caution. Further study of the putative role of these and other sex steroid-related genes for the development of transsexualism may, however, be worthwhile.
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| 5. |
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| 6. |
- Langworth, Sven, et al.
(författare)
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Efficacy and tolerability of reboxetine compared with citalopram: a double-blind study in patients with major depressive disorder.
- 2006
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Ingår i: Journal of clinical psychopharmacology. - Philadelphia : Ovid Technologies (Wolters Kluwer Health). - 0271-0749 .- 1533-712X. ; 26:2, s. 121-7
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Tidskriftsartikel (refereegranskat)abstract
- The objective of this study was to compare efficacy and tolerability of the selective noradrenaline reuptake inhibitor reboxetine with the selective serotonin reuptake inhibitor citalopram, in the treatment of major depressive disorder (MDD). In total, 357 outpatients with MDD were randomized to treatment with reboxetine 8-10 mg or citalopram 20-40 mg per day during 24 weeks. Primary end-point was change from baseline in the Hamilton Depression Rating Scale (HAM-D, 21 items). Sexual function/dysfunction was measured by the Sexual Function scale (SF). Observed case analysis showed that both treatments yielded a gradual reduction of HAM-D scores: reboxetine with -21.4 and citalopram with -22.1 points (NS). LOCF analysis showed a greater reduction of the HAM-D scores with citalopram compared with reboxetine (-19.6 vs. -17.8; P = 0.034). The response rate was 90.3% for reboxetine and 92.7% for citalopram (NS). The most common side effect in the reboxetine group was dry mouth, and in the citalopram group sexual dysfunction. At week 24, anorgasmia was reported by 5.9% of the sexually active women in the reboxetine group vs 39% in the citalopram group. The dropout number was 91 in the reboxetine group, and 54 in the citalopram group. To summarize, both treatments gave a satisfactory antidepressant effect. The side effect profile differed between the groups, with a notably high prevalence of sexual dysfunctions in the citalopram group. The high number of dropouts in the reboxetine group, is considered as a result of the non-titration starting dose of 8 mg reboxetine per day, which gave a high incidence of early side-effects.
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| 7. |
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| 8. |
- Lindström, Ulf, et al.
(författare)
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Professionell utveckling : Så förs ämnet stegvis in i läkarutbildningen i Umeå
- 2008
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Ingår i: Läkartidningen. - 0023-7205 .- 1652-7518. ; 105:12-13, s. 909-913
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Tidskriftsartikel (refereegranskat)abstract
- Since the early 90's a course called Professional Development (PD) runs through all terms of Medical School in Umeå. The course has continuously been reformed on the basis of course evaluations. Today there is a well-reasoned progression in the curricula to synthesize students' actual knowledge level, skills, and attitudes into professionalism. The teaching items and the pedagogical methods in PU all aim to develop the students' reflective stance, gender awareness, empathy, ethical reasoning and consultations skills. Taking communication as an example: During the first terms, theories and small-group training sessions are introduced. By clinical courses, students video-tape their own consultations and get structured feedback in tutor-guided groups. The last terms, role plays on difficult clinical situations are staged for training, but also to challenge attitudes on for instance ethnicity and sexuality. Finally, insights in communication theories and their applicability are examined in a written video case exam.
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| 9. |
- Nordström, Annika, 1956-, et al.
(författare)
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Every third patient in primary care suffers from depression, anxiety or alcohol problems
- 2008
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Ingår i: Nordic Journal of Psychiatry. - : Informa Healthcare. - 0803-9488 .- 1502-4725. ; 62:3, s. 250-255
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Tidskriftsartikel (refereegranskat)abstract
- The aims of the study were to explore the prevalence of patients with depression and anxiety in primary care, its co-occurrence with hazardous/harmful alcohol use, and its relation to gender, age and reason for visit. A questionnaire, including the self-rating Hospital Anxiety and Depression scale and the Alcohol Use Disorder Identification Test, was consecutively distributed to 1800 patients at 11 primary healthcare centres in the county of Västerbotten, Sweden. The response rate was 77.3% (1392 patients), 38% men and 62% women. A total of 31.9% showed symptoms of depression and/or anxiety, with no gender differences. Harmful/hazardous alcohol use was found in 11.9% of the patients, 17.3% in men and 8.8% in women, although the region in Sweden has relatively low alcohol consumption among the population. Age was an important factor. Incidences of the conditions often occurred simultaneously. About half (51%) of those with harmful/hazardous alcohol use also showed symptoms of depression and/or anxiety. The most common causes for patients with symptoms of depression, anxiety or risk consumption of alcohol to seek care were the same as for the general population, namely complaints of pain or infection. Only 7.8% visited the primary care for psychiatric reasons, according to their own given reasons. In all, 38% of the patients showed signs of psychiatric symptoms and/or alcohol problems or a combination of these. The fact that every third patient showed symptoms of depression, anxiety and/or alcohol problems underlines the strategic position for early identification, intervention and treatment within primary healthcare.
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