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Biomedical subjects

N Sartorius

Publications and source records attributed to N Sartorius.

At least 19 recordsLinked to original sources
PubMed1996

The World Health Organization Short Disability Assessment Schedule (WHO DAS-S): a tool for the assessment of difficulties in selected areas of functioning of patients with mental disorders.

The World Health Organization Short Disability Assessment Schedule (WHO DAS-S) is an instrument for clinicians' assessment and rating of difficulties in maintaining personal care, in performing occupational tasks and in functioning in relation to the family and the broader social context due to mental disorders. The WHO DAS-S was developed and underwent preliminarily testing in the context of two international field trials of the multiaxial presentation of ICD-10 for use in adult psychiatry. The instrument was found to be useful, user-friendly and reasonably reliable for use by clinicians belonging to different schools of psychiatry and psychiatric traditions. Further work on the WHO DAS-S should include development of national adaptations of the instrument, studies of concurrent validity of the instrument and modification of the instrument to accommodate changes in the next edition of the International Classification of Impairments, Disabilities and Handicaps (ICIDH).

Disability Evaluation↗
PubMed1996

Long-term follow-up of schizophrenia in 16 countries. A description of the International Study of Schizophrenia conducted by the World Health Organization.

An unexpected finding of the International Pilot Study of Schizophrenia, launched by the World Health Organization (WHO) in 1967, was that patients in countries outside Europe and the United States have a more favourable short- and medium-term course of the disease than those seen in developed countries. Since then, WHO has intensified its schizophrenia research programme and has initiated a set of international studies that have confirmed these initial findings and explored possible reasons for such differences in the course and outcome of schizophrenia. While such work has provided important findings and has generated additional pertinent hypotheses, it did not explain the differences in outcome. The present paper describes a new initiative in which approximately 2500 subjects involved in previous WHO multicentre schizophrenia studies are being followed up for between 15 and 25 years after initial examination. Nineteen research centres in 16 countries are taking part in this work. The research methodology is described.

Adult↗
PubMed1996

Psychiatric assessment instruments developed by the World Health Organization.

Over the past 30 years the World Health Organization (WHO) has produced a number of assessment instruments intended for national and cross-cultural psychiatric research. WHO instruments have been tested and used in many collaborative studies involving more than 100 centres in different parts of the world. This article reviews the main WHO instruments for the assessment of (a) psychopathology, (b) disability, quality of life and satisfaction, (c) services, and (d) environment, and risks to mental health. The principles used in the development of WHO instruments, their translation and their use across cultures and settings are discussed.

Cross-Cultural Comparison↗
PubMed1996

WHO cross-cultural applicability research on diagnosis and assessment of substance use disorders: an overview of methods and selected results.

The cross-cultural applicability of criteria for the diagnosis of substance use disorders and of instruments used for their assessment were studied in nine cultures. The qualitative and quantitative methods used in the study are described. Equivalents for English terms and concepts were found for all instrument items, diagnostic criteria, diagnoses and concepts, although often there was no single term equivalent to the English in the languages studied. Items assuming self-consciousness about feelings, and imputing causal relations, posed difficulties in several cultures. Single equivalent terms were lacking for some diagnostic criteria, and criteria were sometimes not readily differentiated from one another. Several criteria--narrowing of the drinking repertoire, time spent obtaining and using the drug, and tolerance for the drug--were less easy to use in cultures other than the United States. Thresholds for diagnosis used by clinicians often differed. In most cultures, clinicians were more likely to make a diagnosis of drug dependence than of alcohol dependence although behavioural signs were equivalent. The attitudes of societies to alcohol and drug use affects the use of criteria and the making of diagnoses.

Alcoholism↗
PubMed1996

Contextual aspects of mental disorders: a proposal for axis III of the ICD-10 multiaxial system.

After several years of development and testing, the World Health Organization (WHO) has recently completed work on the multiaxial presentation of ICD-10 for use in adult psychiatry. Axis III of the ICD-10 multiaxial system is intended for clinicians' reporting of contextual factors which may influence the diagnosis, treatment or prognosis of mental disorders that are recorded on Axis I. It was tested in two WHO-co-ordinated international field trials and found to be user-friendly, reasonably reliable and useful in routine clinical work, in the training of mental health professionals and in research on mental disorders.

Adult↗
PubMed1996

Depression comorbid with anxiety: results from the WHO study on psychological disorders in primary health care.

The World Health Organization collaborative study on "Psychological Problems in General Health Care" investigated the form, frequency, course and outcome of common psychological problems in primary care settings at 15 international sites. The research employed a two-stage case-finding procedure. GHQ-12 was administered to 25916 adults who consulted health-care services. The second-stage assessment (n = 5438) consisted of the Composite international Diagnostic Interview (CIDI), the Social Disability Schedule, and questionnaires. Possible cases or borderline cases of mental disorder, and a sample of known cases, were followed up at three months and one year. Using standard diagnostic algorithms (ICD-10), prevalence rates were calculated for current disorder (one-month) and lifetime experience disorder. Well-defined psychological problems are frequent in all the general health-care settings examined (median 24.0%). Among the most common were depression anxiety, alcohol misuse, somatoform disorders, and neurasthenia. Nine per cent of patients suffered from a "subthreshold condition" that did not meet diagnostic criteria but had clinically significant symptoms and functional impairment. The most common co-occurrence was depression and anxiety. Comorbidity increases the likelihood of recognition of mental disorders in general health care, and the likelihood of receiving treatment.

Adolescent↗
PubMed1995

Is the lifetime risk of depression actually increasing?

Data from an international study of psychological problems in primary care were examined for evidence of increasing depression risk. At 15 sites, patients aged 15-65 (n = 26,421) were screened with the GHQ-12 and a stratified random sample (n = 5603) selected for psychiatric assessment (Composite International Diagnostic Interview). Initial analyses agreed with earlier cross-sectional studies, finding higher depression risk and earlier onset in recent birth cohorts. Additional analyses suggested that methods effects may explain these findings. First, apparent prevalence increases were nonspecific with similar trends seen across all study sites and for all disorders examined. Second, reporting patterns suggested significant under-counting of past depressive episodes. Respondents of all ages typically reported first onset of depression during the last 5 years. Reported lifetime prevalence was only 2.02 times current prevalence. These findings suggest that depression risk is not rapidly increasing and that true lifetime prevalence is much higher than estimated by cross-sectional surveys.

Adolescent↗
PubMed1995

Recent changes in suicide rates in selected eastern European and other European countries.

Recent major political changes in Eastern European countries might have affected their suicide rates. For this article, suicide statistics available to the World Health Organization were used to compare data from eight Eastern European countries to those from seven countries in Northern or Western Europe. Comparisons were made between 1987 and 1991/92 data using total suicide rates for each country, rates by gender, and rates for the elderly (age 75 and older). The total rates indicated an increase in suicide in Eastern European countries and a decrease in other European countries. The ratio of male-to-female suicides in the Eastern European countries increased during this time as well, more than in other European countries. Among those over the age of 75, however, rates of suicide in Eastern European countries decreased; this pattern was less clear in the European countries chosen for comparison. The article discusses the role of economic, cultural, and health service factors affecting these trends.

Aged↗
PubMed1995

Progress toward achieving a common language in psychiatry, II: Results from the international field trials of the ICD-10 diagnostic criteria for research for mental and behavioral disorders.

OBJECTIVE: In preparing for the publication of ICD-10, the Division of Mental Health of the World Health Organization developed several versions of chapter V, which deals with mental and behavioral disorders. The version for research purposes is called the Diagnostic Criteria for Research (ICD-10 DCR) and gives operational criteria for the diagnosis of mental disorders. This article describes the results of international field trials undertaken to evaluate the draft criteria and refine them further. METHOD: Data were obtained to assess interrater agreement, the confidence with which diagnoses could be made, and the ease of use of the criteria. Additional substudies examined the concordance between ICD-10 DCR, ICD-10 Clinical Descriptions and Diagnostic Guidelines, and other national classification systems (e.g., DSM-IV). The field trials were carried out at 151 clinical centers in 32 countries by 942 clinician/researchers who conducted 11,491 individual assessments of patients. Results for cases assessed by at least two raters are reported here. RESULTS: Most clinician/researchers found the criteria to be explicit and easy to apply. Interrater agreement was high for most diagnostic categories. For some categories, such as those dealing with certain polymorphic psychotic disorders or milder forms of affective disorders, the criteria were rated as somewhat difficult to use, and reliability was lower. Comparison of the results of these field trials with those of the ICD-10 Clinical Descriptions and Diagnostic Guidelines demonstrated that there are increases in interrater agreement when the operational criteria are used. CONCLUSIONS: The use of internationally accepted research criteria enhances the reliability of diagnosis of mental disorders made in research settings worldwide.

Adolescent↗
PubMed1995

New classification for mental disorders with management guidelines for use in primary care: ICD-10 PHC chapter five.

A primary care version of the International classification of diseases (10th revision) chapter five for mental and behavioural disorders (ICD-10 PHC chapter five) has been developed. This provisional version focuses on 24 conditions which are frequently seen in primary care and which can be managed effectively by general practitioners. The classification is accompanied by a flipcard for each of the conditions. The cards have diagnostic guidelines on one side and management guidelines on the other. The latter provide information which should be given to the patient, advice on the content of counselling, the available treatment methods, and indications for specialist referral. This classification system is also supported by diagnostic decision making aids, medication cards, and patient leaflets to facilitate the recognition and management of patients with mental disorders in primary care settings. The draft version of ICD-10 PHC chapter five will be finalized after field trials which will test the applicability and usefulness of the system in different primary care settings in various countries.

Depression↗
PubMed1995

[Classification of mental disorders according to ICD 10].

This paper presents the characteristics and the origin of the International Classification of Diseases as well as its purposes. Particular attention is given to the part of the classification which deals with mental and behavioural disorders. This part of the classification differs from other parts in several respects. First, it is accompanied with definition of each of its categories; second, it is presented in several versions--for the practising clinician, for the research workers, for those working in primary health care--and exists in a uniaxial and a multiaxial version for the classification of disorders in children and in adults. Third, it has been thoroughly tested before its introduction; fourth, it has been developed in several languages simultaneously and now exists in equivalent versions in numerous languages; and fifth, its use is facilitated by an international network of research and training centres.

Adult↗
PubMed1994

A new classification for mental disorders with management guidelines for use in primary care: the ICD-10 PHC.

A Primary Care Version of International Classification of Diseases (10th Revision) Chapter V. for Mental and Behavioural Disorders (ICD-10 PHC) has been developed. This version focuses on 24 conditions which are frequently seen in primary care and which can be managed effectively by general practitioners. The classification is accompanied by flipcards one for each of the conditions. The cards contain diagnostic guidelines on one side and management guidelines on the other. The latter provide information which should be given to the patient, advice on the content of counselling, the available treatment methods, and indications for specialist referral. This classification system is also supported by diagnostic decision making aids, medication cards, and patient leaflets to facilitate the recognition and management of patients in primary care settings. The draft ICD-10 PHC will be finalized after the field trials which will test the applicability and usefulness of the system in different primary care settings in various countries.

Humans↗
PubMed1994

The International Personality Disorder Examination. The World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration international pilot study of personality disorders.

BACKGROUND: One of the aims of the World Health Organization/Alcohol, Drug Abuse, and Mental Health Administration joint program on psychiatric diagnosis and classification is the development and standardization of diagnostic assessment instruments for use in clinical research worldwide. The International Personality Disorder Examination (IPDE) is a semistructured clinical interview compatible with the International Classification of Diseases, Tenth Revision, and the DMS-III-R classification systems. This is the first report of the results of a field trial to investigate the feasibility of using the IPDE to assess personality disorders worldwide. METHODS: The IPDE was administered by 58 psychiatrists and clinical psychologists to 716 patients enrolled in clinical facilities at 14 participating centers in 11 countries in North America, Europe, Africa, and Asia. To determine interrater reliability, 141 of the IPDEs (20%) were independently rated by a silent observer. To determine temporal stability, 243 patients (34%) were reexamined after an average interval of 6 months. RESULTS: The IPDE proved acceptable to clinicians and demonstrated an interrater reliability and temporal stability roughly similar to instruments used to diagnose the psychoses, mood, anxiety, and substance use disorders. CONCLUSION: It is possible to assess personality disorders with reasonably good reliability in different nations, languages, and cultures using a semistructured clinical interview that experienced clinicians find relevant, meaningful, and user-friendly.

Adult↗