The initial Global Burden of Disease study found that depression was the fourth leading cause of disease burden, accounting for 3.7% of total disability adjusted life years (DALYs) in the world in ...1990.
To present the new estimates of depression burden for the year 2000.
DALYs for depressive disorders in each world region were calculated, based on new estimates of mortality, prevalence, incidence, average age at onset, duration and disability severity.
Depression is the fourth leading cause of disease burden, accounting for 4.4% of total DALYs in the year 2000, and it causes the largest amount of non-fatal burden, accounting for almost 12% of all total years lived with disability worldwide.
These data on the burden of depression worldwide represent a major public health problem that affects patients and society.
Introduction: Few studies have examined the clinical, neuropsychological and pharmacological factors involved in the functional outcome of bipolar disorder despite the gap between clinical and ...functional recovery.
Methods: A sample of 77 euthymic bipolar patients were included in the study. Using an a priori definition of low versus good functional outcome, based on the psychosocial items of the Global Assessment of Functioning (GAF, DSM‐IV), and taking also into account their occupational adaptation, the patients were divided into two groups: good or low occupational functioning. Patients with high (n = 46) and low (n = 31) functioning were compared on several clinical, neuropsychological and pharmacological variables and the two patient groups were contrasted with healthy controls (n = 35) on cognitive performance.
Results: High‐ and low‐functioning groups did not differ with respect to clinical variables. However, bipolar patients in general showed poorer cognitive performance than healthy controls. This was most evident in low‐functioning patients and in particular on verbal memory and executive function measures.
Conclusions: Low‐functioning patients were cognitively more impaired than highly functioning patients on verbal recall and executive functions. The variable that best predicted psychosocial functioning in bipolar patients was verbal memory.
Abstract Objective To provide empirical evidence of the effect of subthreshold symptomatology (both depressive and manic) on psychosocial functioning, neurocognition and quality of life in bipolar ...disorder. Methods A total of 133 participants were enrolled for this study (bipolar patients, n = 103; healthy controls, n = 30). Patients were divided into two groups according to their levels of subthreshold symptomatology: the subsyndromic group was constituted by those patients with upper levels of subthreshold symptomatology (HDRS ≥ 4 and YMRS ≥ 3) and the asymptomatic group represented the patients with lower scores (HDRS ≤ 3 and YMRS ≤ 2). All participants were administered a comprehensive neuropsychological battery. Moreover the patients answered the SF-36 (Quality of Life, QoL) and were interviewed with the WHODAS-2 (Psychosocial functioning and disability). One-way ANOVA were used in order to compare the differences between the three groups. Results The analyses revealed that both patients groups, albeit free of acute symptoms of mania or depression, differed in terms of functioning and disability assessed with the WHODAS-2. Specifically, the total global score of disability was higher for the subsyndromic group indicating more impairment (p = 0.008). The same pattern of impairment was found for three of its domains: “understanding and communicating” (p = 0.013); “self-care” (p = 0.035) and “getting along with others” (p = 0.024). The subsyndromic group also scored lower when compared to their counterparts in the Mental Component of QoL of the SF-36 (p = 0.045). Finally, in the neuropsychological performance verbal learning and memory was found to be impaired regardless the levels of subthreshold symptomatology, suggesting that this variable is a robust indicator of neuropsychological impairment in BD patients. Conclusions This report presents empirical data suggesting a moderate impact of subthreshold symptoms on functioning/disability and QoL and a discrete impact on neuropsychological impairment.
Functioning and Disability in Bipolar Disorder Sanchez-Moreno, J.; Martinez-Aran, A.; Tabarés-Seisdedos, R. ...
Psychotherapy and psychosomatics,
01/2009, Letnik:
78, Številka:
5
Journal Article
Recenzirano
Background: Bipolar disorder has generally been regarded as having a better functional outcome than schizophrenia. However, studies have suggested low functioning in bipolar patients even when they ...are in clinical remission. Our aim was to determine the degree of functioning and disability in bipolar patients. Secondly, we reviewed factors potentially associated with the low functioning of bipolar patients. Method: The authors conducted an extensive Medline and Pubmed search of the published literature from 1980 up to December 2007, using a variety of search terms to find relevant articles. Bibliographies of retrieved papers were further analysed for publications of interest. Articles that reported clinically significant findings on functioning and disability, and research reports were reviewed in detail. Results: From these articles, we determined that bipolar disorder is associated with significant impairment in work, family and social life, beyond the acute phases of the illness. The aspects that appear to increase the risk of low functioning and disability in bipolar patients are mainly subsyndromal symptoms and neurocognitive impairment, among others. Conclusions: Suitable pharmacological and psychological interventions may improve the level of functioning and reduce the disability in bipolar patients. Potential targets to be considered for intervention should be residual symptoms, comorbid conditions and neurocognitive deficits. Further research is required to better identify the factors that best predict functioning in bipolar patients.
To identify the cross-national prevalence of psychotic symptoms in the general population and to analyze their impact on health status.
The sample was composed of 256,445 subjects (55.9% women), from ...nationally representative samples of 52 countries worldwide participating in the World Health Organization's World Health Survey. Standardized and weighted prevalence of psychotic symptoms were calculated in addition to the impact on health status as assessed by functioning in multiple domains.
Overall prevalences for specific symptoms ranged from 4.80% (SE = 0.14) for delusions of control to 8.37% (SE = 0.20) for delusions of reference and persecution. Prevalence figures varied greatly across countries. All symptoms of psychosis produced a significant decline in health status after controlling for potential confounders. There was a clear change in health impact between subjects not reporting any symptom and those reporting at least one symptom (effect size of 0.55).
The prevalence of the presence of at least one psychotic symptom has a wide range worldwide varying as much as from 0.8% to 31.4%. Psychotic symptoms signal a problem of potential public health concern, independent of the presence of a full diagnosis of psychosis, as they are common and are related to a significant decrement in health status. The presence of at least one psychotic symptom is related to a significant poorer health status, with a regular linear decrement in health depending on the number of symptoms.
The disease burden from exposure to lead resulting in mild mental retardation (due to IQ point decreases) and cardiovascular outcomes (due to increases in blood pressure) was estimated at a global ...level. Blood lead levels were compiled from the literature for 14 geographical regions defined by the World Health Organization according to location and adult and child mortality rates. Adjustments were applied to these levels, where appropriate, to account for recent changes relating to the implementation of lead-reduction programs and the lower levels seen in rural populations. It is estimated that mild mental retardation and cardiovascular outcomes resulting from exposure to lead amount to almost 1% of the global burden of disease, with the highest burden in developing regions. This estimate can be used to assess the magnitude of the benefits that could be accrued by increasing the global coverage of lead-reduction programs.
Nuevo R, Van Os J, Arango C, Chatterji S, Ayuso‐Mateos JL. Evidence for the early clinical relevance of hallucinatory‐delusional states in the general population.
Objective: To analyze, in a general ...population sample, clustering of delusional and hallucinatory experiences in relation to environmental exposures and clinical parameters.
Method: General population‐based household surveys of randomly selected adults between 18 and 65 years of age were carried out. Setting: 52 countries participating in the World Health Organization’s World Health Survey were included. Participants: 225 842 subjects (55.6% women), from nationally representative samples, with an individual response rate of 98.5% within households participated.
Results: Compared with isolated delusions and hallucinations, co‐occurrence of the two phenomena was associated with poorer outcome including worse general health and functioning status (OR = 0.93; 95% CI: 0.92–0.93), greater severity of symptoms (OR = 2.5 95% CI: 2.0–3.0), higher probability of lifetime diagnosis of psychotic disorder (OR = 12.9; 95% CI: 11.5–14.4), lifetime treatment for psychotic disorder (OR = 19.7; 95% CI: 17.3–22.5), and depression during the last 12 months (OR = 11.6; 95% CI: 10.9–12.4). Co‐occurrence was also associated with adversity and hearing problems (OR = 2.0; 95% CI: 1.8–2.3).
Conclusion: The results suggest that the co‐occurrence of hallucinations and delusions in populations is not random but instead can be seen, compared with either phenomenon in isolation, as the result of more etiologic loading leading to a more severe clinical state.
There is growing recognition of the importance of both functioning and quality of life (QoL) outcomes in the treatment of depressive disorders, but the meta-analytic evidence is scarce. The objective ...of this meta-analysis of randomized controlled trials (RCTs) was to determine the absolute and relative effects of psychotherapy, pharmacotherapy and their combination on functioning and QoL in patients with depression.
One hundred and fifty-three outcome trials involving 29 879 participants with depressive disorders were identified through database searches in Pubmed, PsycINFO and the Cochrane Central Register of Controlled Trials.
Compared to control conditions, psychotherapy and pharmacotherapy yielded small to moderate effect sizes for functioning and QoL, ranging from g = 0.31 to g = 0.43. When compared directly, initial analysis yielded no evidence that one of them was superior. After adjusting for publication bias, psychotherapy was more efficacious than pharmacotherapy (g = 0.21) for QoL. The combination of psychotherapy and medication performed significantly better for both outcomes compared to each treatment alone yielding small effect sizes (g = 0.32 to g = 0.39). Both interventions improved depression symptom severity more than functioning and QoL.
Despite the small number of comparative trials for some of the analyses, this study reveals that combined treatment is superior, but psychotherapy and pharmacotherapy alone are also efficacious for improving functioning and QoL. The overall relatively modest effects suggest that future tailoring of therapies could be warranted to better meet the needs of individuals with functioning and QoL problems.
•Regional frequency analysis of extreme annual rainfall data series has been done.•Several quality control methods were previously applied for validating the datasets.•A multifractal approach was ...used to characterize validated daily rainfall data.•Homogeneous regions were delimitated using the multifractal properties of rainfall.•This work shows a new tool based on multifractality to form homogeneous regions.
In this work, a regional frequency analysis of extreme annual rainfall data in Malaga (Southern Spain) has been performed. Rainfall records have been validated, applying various quality control tests as a pre-requisite before their use, ensuring their reliability and discarding anomalous data. For grouping the stations into potential homogeneous regions, the multifractal properties of daily rainfall data series recorded at 72 locations have been studied. The scaling of the rainfall moments has been analyzed and the empirical moments scaling exponent functions have been obtained. The corresponding multifractal values have been used to group stations into regions, resulting some of them homogeneous.
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