Detecting depressive and anxiety disorders in distressed patients in primary care; comparative diagnostic accuracy of the Four-Dimensional Symptom Questionnaire (4DSQ) and the Hospital Anxiety and Depression Scale (HADS)

BACKGROUND: Depressive and anxiety disorders often go unrecognized in distressed primary care patients, despite the overtly psychosocial nature of their demand for help. This is especially problematic in more severe disorders needing specific treatment (e.g. antidepressant pharmacotherapy or specialized cognitive behavioural therapy). The use of a screening tool to detect (more severe) depressive and anxiety disorders may be useful not to overlook such disorders. We examined the accuracy with which the Four-Dimensional Symptom Questionnaire (4DSQ) and the Hospital Anxiety and Depression Scale (HADS) are able to detect (more severe) depressive and anxiety disorders in distressed patients, and which cut-off points should be used. METHODS: Seventy general practitioners (GPs) included 295 patients on sick leave due to psychological problems. They excluded patients with recognized depressive or anxiety disorders. Patients completed the 4DSQ and HADS. Standardized diagnoses of DSM-IV defined depressive and anxiety disorders were established with the Composite International Diagnostic Interview (CIDI). Receiver Operating Characteristic (ROC) analyses were performed to obtain sensitivity and specificity values for a range of scores, and area under the curve (AUC) values as a measure of diagnostic accuracy. RESULTS: With respect to the detection of any depressive or anxiety disorder (180 patients, 61%), the 4DSQ and HADS scales yielded comparable results with AUC values between 0.745 and 0.815. Also with respect to the detection of moderate or severe depressive disorder, the 4DSQ and HADS depression scales performed comparably (AUC 0.780 and 0.739, p 0.165). With respect to the detection of panic disorder, agoraphobia and social phobia, the 4DSQ anxiety scale performed significantly better than the HADS anxiety scale (AUC 0.852 versus 0.757, p 0.001). The recommended cut-off points of both HADS scales appeared to be too low while those of the 4DSQ anxiety scale appeared to be too high. CONCLUSION: In general practice patients on sick leave because of psychological problems, the 4DSQ and the HADS are equally able to detect depressive and anxiety disorders. However, for the detection of cases severe enough to warrant specific treatment, the 4DSQ may have some advantages over the HADS, specifically for the detection of panic disorder, agoraphobia and social phobi

Two-year follow up study of a Chinese high risk “prodromal” group

Theme: Advancing Psychiatric Care in the Emerging World: East meets Wes

Self-relevance of patients with schizophrenia

Background: Delusion of reference is the most common psychotic symptoms (International Pilot Study of Schizophrenia, WHO 1973). This involves misjudgment of self-relevance nature of external information. Determination of another person’s eye gaze direction is critical in social interaction and has often been the theme of reference delusion. The current study aims at exploring the involvement of cognitive functions and psychopathology in the mechanisms of increase sense of self-relevance in patients with delusion of reference using eye-gazing task. Methods: Three groups of participants matched with age, gender and level of education were recruited. These were patients with schizophreniaspectrum disorders with delusion of reference (SAPS item 14≥4), patients matched with diagnosis and were in remission, and healthy subjects. All participants had normal or corrected-to-normal visual acuity. Patients were assessed with Scale for the Assessment of Positive Symptoms (SAPS), the Scale for the Assessment of Negative Symptoms (SANS), the Peters Delusions Inventory (PDI), the Ideas of Reference Interview Schedule (IRIS), the Beck Depression Inventory (BDI), digit span and digit symbol coding. All healthy control subjects were assessed with the same tools except SAPS and SANS. All participants performed the eye-gazing task programmed with E-prime Professional 2.0. The whole task has six blocks and each block contains 30 photographs of one model taken facing straight to camera with different gaze directions (0° and 10°,15°,20°,25° and 30° to the left and right). All stimuli was presented randomly and each lasted for 200ms, and then followed by a fixation cross until the participants respond. The next trial starts after the response of participants. The participants were instructed to decide if they had a sense of being looked at for each trial. The response accuracy and response time of participants were recorded automatically by the E-prime program. Results: Fourteen patients, nine patient control and eight healthy control participants were recruited. There were no significant differences in digit span performance among the three groups, but normal controls performed better than patients in digit symbol coding. At 10°, 15° and 30° gaze aversion, patients with active symptoms were more likely to report a sense of being looked at than healthy participants. No differences were found between patient control and healthy participants. Relationship between accuracy rate at all gaze angles and clinical and cognitive functions were analysed for all three groups. For patients, significant correlation was found between accuracy rate and PDI at gaze angle 25° (r=-0.695, p=0.006). The accuracy rates were also correlated with total score of IRIS at gaze angle 15° (r=-0.638, p=0.014) and 25° (r=-0.868, p<0.0001). Significant correlations between BDI and accuracy rates of gaze angle 15° (r=0.654, p=0.011), 25° (r=0.896, p<0.0001) and 30° (r=0.652, p=0.012) were also found. No significant relationships were found for other groups. Discussion: Patients with delusion of reference are more likely to misjudge self-relevance of ambiguous eye gazing direction. This is a valid task to demonstrate the increase sense of self-relevance in patients. Results suggested the accuracy of judgment was not relating to attention, short term memory or processing speed. Lack of correlation of symptom severity and accuracy but significant correlation with PDI and total score of IRIS suggested this state is more related to the pervasiveness of the reference idea than the severity. Relationship between BDI and accuracy suggested the importance of mood in the mechanisms of self-relevance

Tackling stigma and promoting recovery through art: The graffiti project

Stigmatizing attitudes and misconceptions about people with severe mental illnesses such as psychosis, severely affect the lives of individuals with these conditions. Research suggests that members of the general public who have more knowledge about mental illness and more personal contact with those affected, are less likely to endorse stigmatising attitudes. Service users themselves also place great importance on social contact with peers as an essential part of their recovery. A school-based project aimed at tackling stigma and facilitating contact between service users and peers within the North East of England is described in detail. The graffi ti project brought together young service users and pupils from a local school to plan, design and paint a run-down subway. Throughout the project, pupils were engaged in regular workshops by professionals from an Early Intervention service in order to discuss their proposed art work but to also learn more about psychosis. The completed subway now includes messages about mental health for passing commuters as well as creating a visual display outlining some of the young people’s personal experiences. The project was evaluated using a pre- and post-questionnaire of the students understanding and knowledge of psychosis, whilst a focus group discussion took place after completion of the subway. Qualitative data are presented from both of these methods and clearly outlines just how successful this project has been in tackling stigma and promoting recovery in the local community