Faculty Bibliography

Depressive disorders are a public health problem. They occur frequently, and it is highly likely that their prevalence will grow in the years to come. Depressive disorders can have severe consequences in terms of suffering, disability, and increased mortality, particularly if left untreated. They are present in all cultural settings and present a major difficulty for the normal functioning of patients' families. A large proportion of people with depressive disorders do not get treatment, and a major reason depressive disorders go unrecognized is that they often present mainly physical symptoms. The fact that depression often co-occurs with physical illness further complicates the diagnosis and treatment of depressive disorders. Better undergraduate education of medical students and general education for the public in understanding and treating depressive disorders could considerably improve the prognosis of patients suffering from these illnesses

BACKGROUND: Poorly defined cohorts and weak study designs have hampered cross-cultural comparisons of course and outcome in schizophrenia. AIMS: To describe long-term outcome in 18 diverse treated incidence and prevalence cohorts. To compare mortality, 15- and 25-year illness trajectory and the predictive strength of selected baseline and short-term course variables. METHODS: Historic prospective study. Standardised assessments of course and outcome. RESULTS: About 75% traced. About 50% of surviving cases had favourable outcomes, but there was marked heterogeneity across geographic centres. In regression models, early (2-year) course patterns were the strongest predictor of 15-year outcome, but recovery varied by location; 16% of early unremitting cases achieved late-phase recovery. CONCLUSIONS: A significant proportion of treated incident cases of schizophrenia achieve favourable long-term outcome. Sociocultural conditions appear to modify long-term course. Early intervention programmes focused on social as well as pharmacological treatments may realise longer-term gains

Clinicians are aware that many patients with dementia, including Alzheimer's disease (AD), experience psychotic, depressive, and behavioral symptoms, over the course of the illness, but, until recently such symptoms have elicited little interest or research support. This article presents the consensus statement of the International Psychogeriatric Association 1996 consensus conference on the behavioral and psychological symptoms of dementia, including definition, symptoms, conclusions, and implications for research and treatment.

BACKGROUND: Data on the two-year pattern of course of illness have been collected in the WHO study of the Determinants of Outcomes of Severe Mental Disorder (DOSMD). These data are reanalysed using recursive partitioning, a method not yet applied to psychiatric data to test the hypothesis that subjects from participating centres in developing countries had better outcomes than those in developed countries. METHOD: Subjects were those from the DOSMD study for whom two-year follow-up data were available (n = 1056). The classification and regression trees recursive partitioning technique was used to examine the predictor variables associated with the outcome variable two year pattern of course. RESULTS: Pattern of course was best predicted by centre, but two developed centres (Prague and Nottingham) grouped with the developing country centres excluding Cali, having better outcomes than in the remaining developed country centres and Cali. Type of onset (insidious v. non-insidious) was the next strongest predictor, but its effect differed across these two centre groupings. Effects for some groups were modified by other predictor variables, including age, child and/or adolescent problems, and gender. CONCLUSIONS: The predominant predictor effects on two-year pattern of course continued to be centre and type of onset, but complex interactions between these variables and other predictor variables are seen in specific centre groupings not strictly defined by 'developing' and 'developed'.