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Biomedical subjects

Norman Sartorius

Publications and source records attributed to Norman Sartorius.

At least 19 recordsLinked to original sources
PubMed2007

Access to diagnostic evaluation and treatment for dementia in Europe.

This paper reviews and discusses existing barriers to diagnosis and treatment for patients with dementia in Europe as well as approaches to overcome these barriers. The barriers to care are manifold, being present at all levels in each society and between countries in Europe. Multilevel and multifaceted strategies are needed to improve diagnosis and treatments for all patients with cognitive complaints. A multidisciplinary approach based on close collaboration between GPs and specialised memory clinics may be the ideal model for early accurate diagnosis and subsequently early pharmacological and psychosocial interventions. For all healthcare professionals, there should be specialised training in dementia and frequently updated practice guidelines to provide the framework for standards of care. Culture-sensitive strategies to promote public knowledge and destigmatize dementia are essential. Policy makers and authorities should be made aware of the benefits of early access to diagnosis and treatment.

Delivery of Health Care, Integrated↗
PubMed2006

Newer antidepressant drug use in East Asian psychiatric treatment settings: REAP (Research on East Asia Psychotropic Prescriptions) Study.

AIMS: Antidepressant use in East Asia is poorly documented. We compared patients given newer and older antidepressants to test the hypothesis, suggested in the literature, that use of newer antidepressants is associated with treatment settings rather than specific diagnostic categories. METHODS: We compared rates of use of older (pre1990) vs. newer antidepressants among 1898 patients identified as antidepressant treated at 21 centres in five East Asian countries (China, Japan, Korea, Singapore, Taiwan) in 2003. Demographics, treatment setting and clinical factors associated with preferential use of newer drugs were tested in univariate and multivariate analyses. RESULTS: Newer antidepressants were included in the treatment regimens of 67.5% (N = 1282/1898) of study subjects. Prescription for newer antidepressants was significantly associated with younger age (z = -4.55, d.f. = 1888, P < 0.001), hospitalization [odds ratio (OR) 1.32, 95% confidence interval (CI) 1.07, 1.64, P < 0.01] and treatment within psychiatric hospitals (OR 1.59, 95% CI 1.27, 2.00, P < 0.001). On multivariate analyses, treatment with newer antidepressants was independently associated with younger age (P < 0.001), country (P < 0.001) and treatment within private hospitals (P < 0.001), but not with sex or diagnosis of affective or anxiety disorders (all P > 0.1). CONCLUSION: Demographic factors and treatment settings appear to influence antidepressant choice more than clinical factors such as diagnosis.

Adult↗
PubMed2006

Training primary care physicians in Chile in the diagnosis and treatment of depression.

OBJECTIVES: This study evaluated the results of a brief 2-day educational training program for Chilean primary care physicians that measured changes in knowledge, attitudes and practice. This World Psychiatric Association (WPA) program was adopted to overcome diagnostic and treatment problems that are found among primary care practitioners. METHODS: 37 primary care physicians from two cities in Chile and 2589 patients participated. Physician's knowledge, attitudes and clinical practice were assessed 1 month prior and 1 month following the training program. In addition, the patients that visited the clinic during a typical week completed depression symptom self-ratings, including the Zung and a DSM-IV/ICD-10 major depression checklist at both times. RESULTS: The results suggested that, with this group of Chilean doctors, the WPA program was effective in improving knowledge about depression and in changing some disorder-related attitudes. In addition, it had some limited impact on actual clinical practice, although the rate of diagnosis remained stable and the post-training agreement between physician diagnosis and patient self-report remained low. The physicians seemed more confident in treating patients and demonstrated increased use of antidepressant agents. CONCLUSION: The inclusion of primary care physicians is a central component of any initiative to reduce the treatment gap and lag of depression, but their competence to play a crucial role remains limited. Further training of primary care physicians to improve the management of major depression continues to be needed.

Adolescent↗
PubMed2006

The impact of antistigma education on the attitudes of general practitioners regarding schizophrenia.

The aim of this study was to examine the views and attitudes of general practitioners (GP) with respect to schizophrenia, and the changes in their attitudes after antistigma education. A total of 106 GPs working in 71 health institutions were included in the study. A questionnaire of 16 items, focussing on doctors' views and attitudes towards schizophrenia, was applied. Questions were about the views and attitudes of doctors towards general myths related to schizophrenia. Doctors were asked to select one of two responses: 'I agree' or 'I disagree', for statements such as 'schizophrenic patients cannot work' and 'schizophrenic patients are aggressive and dangerous'. After completing the questionnaire, all the GPs were given a single session of antistigma education. The questionnaire was repeated 3 months after training meetings in a subsample of 54 GPs which represented the whole sample in terms of gender, age, and years in medical practice. The authors found statistically significant, positive changes on five items out of the 16 items in the post-test survey when compared to attitudes before training, including items about the treatability of schizophrenia, harmfulness and untrustworthiness of schizophrenic patients. The authors' findings suggest that one antistigma education session, supported by the distribution of related documents, can improve GPs attitudes towards schizophrenia.

Adult↗
PubMed2005

Training Latin American primary care physicians in the WPA module on depression: results of a multicenter trial.

BACKGROUND: In order to improve care for people with depressive disorders and to reduce the increasing burden of depression, the American Regional Office of the World Health Organization has launched a major region-wide initiative. A central part of this effort was directed to the primary care system where the diagnosis and treatment of depression are deficient in many countries. This study evaluated the materials developed by the World Psychiatric Association in a training program on depression among primary care physicians by measuring changes in their knowledge, attitudes, and practice (KAP). METHOD: One hundred and seven physicians and 6174 patients from five Latin American countries participated in the trial. KAP were assessed 1 month before and 1 month following the training program. In addition, the presence of depressive symptoms was measured in patients who visited the clinic during a typical week at both times using the Zung Depression Scale and a DSM-IV/ ICD-10 major depression checklist. RESULTS: The program slightly improved knowledge about depression and modified some attitudes, but had limited impact on actual practice. There was no evidence that the diagnosis of depression was made more frequently, nor was there an improvement in psychopharmacological management. The post-training agreement between physician diagnosis and that based on patient self-report remained low. The physicians, however, seemed more confident in treating depressed patients after training, and referred fewer patients to psychiatrists. CONCLUSIONS: Traditional means of training primary care physicians in depression have little impact on clinical practice regardless of the quality of the teaching materials.

Adolescent↗
PubMed2005

Pathways to psychiatric care in Eastern Europe.

BACKGROUND: There has been almost no research into mental health services in Eastern Europe. A pathways study is a quick and useful starting point, requiring few resources. AIMS: To improve understanding of prior care-seeking and treatment of new patients seen at mental health services. METHOD: Pathways diagrams were drawn showing the routes of care-seeking for 50 new patients in eight centres. Patterns of care-seeking, durations and previous treatments were compared for ICD-10 diagnostic groups. RESULTS: The diagnoses varied according to the organisation of services. Major pathways included general practitioners, direct access and hospital doctors. General practitioners have a limited role as 'gatekeeper' in centres in Albania, Croatia, Macedonia, Romania and Serbia-Montenegro, and rarely prescribed treatment, except sedatives, for mental disorders. CONCLUSIONS: Findings highlight areas that require attention if aspirations for community-oriented mental health care are to be realised, particularly integration of mental health into primary care.

Adult↗
PubMed2005

Schizophrenia practice guidelines: international survey and comparison.

BACKGROUND: Schizophrenia guidelines differ considerably in methodology and content. AIMS: To systematically compare national schizophrenia guidelines from different countries. METHOD: An international survey was conducted on guideline development and a methodological comparison was made using a validated guideline appraisal instrument (the Appraisal Guideline Research and Evaluation Europe). RESULTS: The methodological quality of many schizophrenia guidelines was at best moderate. Few guidelines had included key stakeholders in their development process. Although pharmacotherapy recommendations were similar, there were strong variations in the type of psychosocial interventions recommended. CONCLUSIONS: The methodological quality of guidelines has a strong influence on their applicability. However, the lack of financial means to develop and implement guidelines is a serious problem. Independent international organisations could contribute to defining a core set of unbiased schizophrenia treatment recommendations. In countries with a shortage of resources, this could be a basis for adaptation to different cultural and economic backgrounds in collaboration with stakeholders.

Antipsychotic Agents↗