Time trends in incidence rates of venous thromboembolism in a large cohort recruited from the general population.

Changes in the incidence of venous thromboembolism (VTE) during the last two decades have not been extensively studied. Therefore, we studied time trends in the incidence rates (IRs) of deep vein thrombosis (DVT) and pulmonary embolism (PE) in a cohort of 26,855 subjects, aged 25-97 years, enrolled in the Tromsø study in 1994/1995. The subject were followed-up throughout 2012, and all symptomatic, objectively confirmed, incident VTEs were identified using multiple sources (hospital discharge-, radiology procedure- and autopsy registry) and validated by review of medical records. Age-adjusted biennial IR per 100,000 person years (PY) with 95% confidence intervals (CI) were calculated using Poisson regression. Between January 1996 and December 2012, 693 VTEs occurred during 368,150 PY of follow up. The IR of VTE increased from 158 (95% CI 116-199) in 1996/1997 to 201 (95% CI 160-243) in 2010/2011. There was a marked increase in the rates of PE (with/without concurrent DVT) ranging from 45 (95% CI 23-67) in 1996/1997 to 113 (95% CI 82-144) in 2010/2011, whereas the rates of isolated DVT decreased (112, 95% CI 77-146 in 1996/1997 and 88, 95% CI 61-115 in 2010/2011). Despite advances in prophylaxis, the IR of VTE has increased slightly during the last 15 years, mainly due to an increase in PE. Although the introduction of better diagnostic tools to some extent may explain the increase in PE rates, our findings suggest that there is still a need for improvement in risk factor management and prevention strategies of first time VTE.

Frequency of psychological and somatic symptoms in patients with major depressive disorder.

Major depressive disorder (MDD) is one of the most commonly encountered psychiatric disorders in primary care. Depression is primarily a psychological illness; however, patients usually present with somatic symptoms. This pattern of presentation quite often poses a risk for patients with MDD due to the fact that general practitioners commonly attribute the cause of somatic symptoms to organic illnesses, thereby misdiagnosing patients. The current study focuses on the frequency of psychological and somatic symptoms in patients with major depressive disorder. The study is a cross-sectional survey using non-probability purposive sampling technique. The authors administered a self-developed questionnaire on 900 patients (male and female) diagnosed with major depressive disorder based on Diagnostic and Statistical Manual of Mental Disorders-IV-TR (DSM-IV-TR). The data was analyzed using Statistical Package for Social Sciences-10 (SPSS-10). Females presented with a higher frequency of somatic symptoms as compared to psychological symptoms, whereas males presented with a higher frequency of psychological symptoms as compared to somatic symptoms. These findings emphasize the imperative need for health care professionals to have a thorough understanding of major depressive disorder. The disabling effects of depression can be minimized and prognosis of such patients improved to the point of remission if depression is promptly diagnosed without ambiguity, and intensively treated based on the physician's comprehensive knowledge of the symptomatology of major depressive disorder.

Comparison of risperidone, olanzapine and quetiapine: effects on body weight, serum blood glucose and prolactin.

Schizophrenia is a chronic illness with a lifetime prevalence of 1% and with serious physical, social and economic consequences. Over the past decade, atypical antipsychotic medications have become the first-line treatment for schizophrenia (Breier et al, 2005).

A 12-year follow-up of a sample of patients dependent upon heroin.

Heroin addiction is a chronic, relapsing and remitting condition. Each year 2-5% of addicts discontinue drug use permanently and 1-2% die, mostly of overdose (Robins, 1993). A study of 129 opiate-addicted patients on a monthly maintenance regimen found that those with a family history of opium use had an earlier age at onset (Chaudhry et al, 1991). Long-term follow-up studies of people who misuse opiates have revealed that opioid dependence appears to run a chronic, relapsing and remitting course with a significant mortality (10-15%) over 10 years (Robson, 1992). Metrebian et al (1998) reported that long-term heroin abstinence was associated with less criminality, psychological distress and morbidity; Hser et al (2001) reported it was associated with higher employment rates.

Anxiety and depressive symptoms in patients with conversion disorder.

OBJECTIVE: To determine symptom pattern of conversion disorder and its association with co-existent anxiety and depressive symptoms. DESIGN: Descriptive, cross-sectional study. PLACE AND DURATION OF STUDY: The study was conducted in the Department of Psychiatry, Services Hospital, Lahore from August 2003 to January 2004. MATERIALS AND METHODS: One hundred patients, suffering from conversion disorder, diagnosed on the basis of DSM-IV criteria, were assessed for severity of anxiety and depressive symptoms by using hospital anxiety and depression scale (HADS). A semi-structured interview was used for demographic details. RESULTS: Anxiety was seen to be present in 35% of cases, depression in 29% and 31% of the patients had both anxiety and depressive symptoms. Overall co-morbidity of anxiety and depressive symptoms in conversion disorder was high i.e. 95% and only 5% of the patients were without any co-morbid anxiety and depressive symptoms. A significant association was found between depressive and sensory symptoms (p=<0.05) in patients with conversion disorders. CONCLUSION: The patients with a diagnosis of conversion disorder need to be managed for anxiety and depressive symptoms appropriately for better outcome.

Treatment outcome of schizophrenia co-morbid with obsessive-compulsive disorder.

OBJECTIVE: To evaluate the pharmacological treatment outcome of schizophrenia, co-morbid with obsessive-compulsive disorder by comparing the effects of typical neuroleptic, atypical neuroleptic and a combination of typical with anti-obsessional drugs on positive and negative symptoms of schizophrenia and obsessional symptoms. DESIGN: A quasi-experimental study. PLACE AND DURATION OF STUDY: The study was conducted at the Department of Psychiatry, Postgraduate Medical Institute and Services hospital, Lahore from September 2002 to July 2003. SUBJECTS AND METHODS: The sample consisted of 39 patients suffering from schizophrenia co-morbid with obsessive-compulsive disorder. They were divided in three groups according to the pharmacological treatment given by the treating psychiatrists. Sample was assessed at the start of treatment and twelve weeks later. RESULTS: Patients receiving typical neuroleptics and anti-obsessional drugs showed better outcome (p <.05) both in psychotic (pre-intervention mean scores of positive scale of PANSS 26.90 as compared to postinterventional mean scores 19.00) and obsessional symptoms (pre-intervention mean scores on Padua Inventory 165.00 compared to 84.00 postinterventional mean scores) than those receiving typical and atypical neuroleptics alone. CONCLUSION: Treatment outcome of schizophrenia co-morbid with obsessive-compulsive disorder shows better results if anti-obsessional drugs are added to the neuroleptics.