Faculty Bibliography

AIMS: Antidepressant use in East Asia is poorly documented. We compared patients given newer and older antidepressants to test the hypothesis, suggested in the literature, that use of newer antidepressants is associated with treatment settings rather than specific diagnostic categories. METHODS: We compared rates of use of older (pre1990) vs. newer antidepressants among 1898 patients identified as antidepressant treated at 21 centres in five East Asian countries (China, Japan, Korea, Singapore, Taiwan) in 2003. Demographics, treatment setting and clinical factors associated with preferential use of newer drugs were tested in univariate and multivariate analyses. RESULTS: Newer antidepressants were included in the treatment regimens of 67.5% (N = 1282/1898) of study subjects. Prescription for newer antidepressants was significantly associated with younger age (z = -4.55, d.f. = 1888, P < 0.001), hospitalization [odds ratio (OR) 1.32, 95% confidence interval (CI) 1.07, 1.64, P < 0.01] and treatment within psychiatric hospitals (OR 1.59, 95% CI 1.27, 2.00, P < 0.001). On multivariate analyses, treatment with newer antidepressants was independently associated with younger age (P < 0.001), country (P < 0.001) and treatment within private hospitals (P < 0.001), but not with sex or diagnosis of affective or anxiety disorders (all P > 0.1). CONCLUSION: Demographic factors and treatment settings appear to influence antidepressant choice more than clinical factors such as diagnosis

The term stigma refers to problems of knowledge (ignorance), attitudes (prejudice) and behaviour (discrimination). Most research in this area has been based on attitude surveys, media representations of mental illness and violence, has only focused upon schizophrenia, has excluded direct participation by service users, and has included few intervention studies. However, there is evidence that interventions to improve public knowledge about mental illness can be effective. The main challenge in future is to identify which interventions will produce behaviour change to reduce discrimination against people with mental illness

OBJECTIVES: This study evaluated the results of a brief 2-day educational training program for Chilean primary care physicians that measured changes in knowledge, attitudes and practice. This World Psychiatric Association (WPA) program was adopted to overcome diagnostic and treatment problems that are found among primary care practitioners. METHODS: 37 primary care physicians from two cities in Chile and 2589 patients participated. Physician's knowledge, attitudes and clinical practice were assessed 1 month prior and 1 month following the training program. In addition, the patients that visited the clinic during a typical week completed depression symptom self-ratings, including the Zung and a DSM-IV/ICD-10 major depression checklist at both times. RESULTS: The results suggested that, with this group of Chilean doctors, the WPA program was effective in improving knowledge about depression and in changing some disorder-related attitudes. In addition, it had some limited impact on actual clinical practice, although the rate of diagnosis remained stable and the post-training agreement between physician diagnosis and patient self-report remained low. The physicians seemed more confident in treating patients and demonstrated increased use of antidepressant agents. CONCLUSION: The inclusion of primary care physicians is a central component of any initiative to reduce the treatment gap and lag of depression, but their competence to play a crucial role remains limited. Further training of primary care physicians to improve the management of major depression continues to be needed

This paper reviews and discusses existing barriers to diagnosis and treatment for patients with dementia in Europe as well as approaches to overcome these barriers. The barriers to care are manifold, being present at all levels in each society and between countries in Europe. Multilevel and multifaceted strategies are needed to improve diagnosis and treatments for all patients with cognitive complaints. A multidisciplinary approach based on close collaboration between GPs and specialised memory clinics may be the ideal model for early accurate diagnosis and subsequently early pharmacological and psychosocial interventions. For all healthcare professionals, there should be specialised training in dementia and frequently updated practice guidelines to provide the framework for standards of care. Culture-sensitive strategies to promote public knowledge and destigmatize dementia are essential. Policy makers and authorities should be made aware of the benefits of early access to diagnosis and treatment