Diagnostic accuracy of the primary care screener for affective disorder (PC-SAD) in primary care

Background: Depression goes often unrecognised and untreated in non-psychiatric medical settings. Screening has recently gained acceptance as a first step towards improving depression recognition and management. The Primary Care Screener for Affective Disorders (PC-SAD) is a self-administered questionnaire to screen for Major Depressive Disorder (MDD) and Dysthymic Disorder (Dys) which has a sophisticated scoring algorithm that confers several advantages. This study tested its performance against a ‘gold standard’ diagnostic interview in primary care. Methods: A total of 416 adults attending 13 urban general internal medicine primary care practices completed the PC-SAD. Of 409 who returned a valid PC-SAD, all those scoring positive (N=151) and a random sample (N=106) of those scoring negative were selected for a 3-month telephone follow-up assessment including the administration of the Structured Clinical Interview for DSM-IV-TR Axis I Disorders (SCID-I) by a psychiatrist who was masked to PC-SAD results. Results: Most selected patients (N=212) took part in the follow-up assessment. After adjustment for partial verification bias the sensitivity, specificity, positive and negative predictive value for MDD were 90%, 83%, 51%, and 98%. For Dys, the corresponding figures were 78%, 79%, 8%, and 88%. Conclusions: While some study limitations suggest caution in interpreting our results, this study corroborated the diagnostic validity of the PC-SAD, although the low PPV may limit its usefulness with regard to Dys. Given its good psychometric properties and the short average administration time, the PC-SAD might be the screening instrument of choice in settings where the technology for computer automated scoring is available

Paesaggio, Città, Architettura. Cinque domande a Franco Purini e Laura Thermes

Architects Franco Purini and Laura Thermes answer five questions about current issues involving the landscape, the city, and architecture. When an architect designs a building in a historic city centre, he can choose to operate in three diff erent ways: either dialogue with the context, as seen for example in Vittorio Gregotti’s Bicocca in Milan or Giorgio Grassi’s residential building along Köthenerstrasse in Berlin, or seek dissonance with the environment like Frank Gehry’s Guggenheim Museum in Bilbao or remain neutral. According to Franco Purini the state of emergency of Italian landscape will have to be addressed urgently in coming years, and will require signifi cant restoration work. The timing and modes of this work will be determined by the contemporary dynamics. In the relationship between innovation and tradition, innovation should always prevail and tradition should have a suggestive role. According to Laura Thermes the new defi nes the meaning of the ancient and not the opposite. Today architecture, divided into three parts historically (fi rmitas, utilitas, venustas) and communication, must fi nd a unity that will restore its organic nature