Mental, physical and functional status in primary care attenders.

OBJECTIVE: The purpose of the present study was to analyze the association, in primary care attenders, between psychiatric disorders, medical comorbidity, and impairment in mental and physical function status. METHODS: The study had a two-stage design. The GHQ-12 was used to screen 1647 patients, and 323 of them were then interviewed using the CIDI-PHC to obtain ICD-10 diagnoses. Severity of mental illness was assessed using the Hamilton scales for anxiety and depression. The DUSOI was used to evaluate the severity of physical illness. The MOS SF-36 was used to assess health related quality of life. RESULTS: The estimated prevalence of ICD-10 psychiatric disorders and subthreshold disorders was 12.4 percent and 18 percent respectively. The most common psychiatric disorders were generalized anxiety, major depression, and neurasthenia. The severity of physical illness did not vary across diagnostic status categories. Significant impairment, both in physical and mental functioning was seen in patients suffering from ICD-10 full-fledged and subthreshold disorders. Severity of impairment increased from sub-threshold cases to full-fledged cases, and among the latter according to the severity of depressive and anxious symptoms, assessed using Hamilton scales. The most frequent psychiatric disorders were associated with significant worsening in health related quality of life, with relevant differences between psychiatric diagnoses regarding the domains affected. Impairment associated with mental disorders was greater than that associated with physical illness. CONCLUSIONS: The results of the present study confirm that ICD-10 psychiatric disorders are common in general practice and are associated with relevant impairment in physical and mental functional status. Psychiatric morbidity is not related to severity of physical illness rated by general practitioner.

DSM-III mental disorders in general medical sector: a follow-up and incidence study over a two-year period.

In three general medical settings (general practice, hospital medical wards and emergency rooms) about 20% of the adult attenders had a DSM-III mental disorder, mainly in the area of affective and anxious disorders. Some of these disorders were quite severe. Of those cases reassessed 1 year and 2 years after the first interview, less than a quarter reached a "no-diagnosis status". The chronicity of most cases dependent on the interplay not only of either relapse or duration of the main disorder but also of comorbidity and incidence of new disorders. A high incidence of more transient disorders in subjects who were well at first assessment was also found.

The response of isolated guinea-pig aorta to amrinone.

1. In helically cut strips of aorta from reserpine-treated guinea-pigs, cumulative concentrations (30 microM, 0.3 mM and 3 mM) of amrinone progressively reduced the basal tone of the preparations and relaxed the smooth muscle contracted by 1 microM noradrenaline or by 20 mM K+. 2. The relaxing effect was completely suppressed by tissue pretreatment with adenosine deaminase (1 U ml-1). 3. Relaxation induced by amrinone was not affected by 50 microM indomethacin or by 0.1 mM 8-phenyltheophylline and was potentiated by 5 microM quinidine. 4. Like amrinone, exogenous adenosine reduced the basal tone of the guinea-pig aorta strips and relaxed the preparations contracted by 1 microM noradrenaline or by 20 mM k+ in a concentration-dependent manner. 5. The relaxing activity of exogenous adenosine was not affected by 50 microM indomethacin, was potentiated by 5 microM quinidine and was partially antagonized by 0.1 mM 8-phenyltheophylline. 6. These results indicate the involvement of endogenous adenosine in the relaxing effect of amrinone on guinea-pig aorta strips, but the specific mechanism of amrinone-adenosine interaction remains to be elucidated.

Possible role of adenosine in the relaxant effect of amrinone on guinea-pig ileum.

In isolated segments of guinea-pig ileum, amrinone (0.3 mM-0.3 M) caused a transient contraction followed by a concentration-dependent relaxation. Theophylline (0.1-0.5 mM) mimicked the effects of amrinone but apparently inhibited relaxation induced by the latter. However the total decrease of muscle tension measured in preparations exposed to amrinone before and after theophylline treatment was quantitatively comparable. Dipyridamole (0.1 microM) potentiated the relaxing effect of amrinone. The stimulatory response of the ileum to high concentrations of adenosine (10-50 mM) was abolished by amrinone. In preparations treated with adenosine deaminase (10 U/ml) the basal tone was decreased and both amrinone and theophylline were ineffective. In rat ileum, amrinone exerted a marked relaxing effect that was abolished by adenosine deaminase. Thus amrinone appears to cause relaxation of intestinal smooth muscle from different species by hindering the stimulatory effect of endogenous adenosine. The possible intracellular localization of the amrinone-adenosine interaction site is discussed.

The role of calcium in amrinone action on intestinal smooth muscle.

In the guinea-pig isolated ileum amrinone (3 microM to 0.3 M) induced transient, dose-dependent contractions which were followed by pronounced relaxation only at the highest amrinone concentrations tested (30 mM to 0.3 M). The contractile effect was potentiated by eserine and abolished by scopolamine. Verapamil, at concentrations (0.1-1 microM) that did not affect basal tension of the preparations or the contractile response to exogenous acetylcholine, selectively reduced amrinone-evoked contraction, while the relaxing component was abolished by verapamil concentrations (5-10 microM) that per se reduced muscle tension as well as acetylcholine-induced contraction. Similarly, when external Ca2+ concentration was reduced from 2.5 to 1.25 and 0.5 mM, the contractile component of amrinone effect was markedly reduced, while relaxation was not significantly altered. Any further decrease of Ca2+ content in the superfusion medium (0.25 to 0 mM) also reduced the relaxing effect of amrinone and the response of the ileum to exogenous acetylcholine. The present results indicate that in guinea-pig ileum amrinone-induced contractions are sustained by acetylcholine release as well as by Ca2+ entry into smooth muscle cells through verapamil-sensitive channels, while other Ca2+ pools may play a role in the relaxing effect of the drug.

Amrinone action on guinea-pig isolated stomach fundus.

In the guinea-pig stomach fundus strips, set in cascade, amrinone (3 microM to 0.3 mM) induced contractions which were followed by relaxation only at the highest amrinone concentrations tested (30 mM to 0.3 M). Contractions were transient and scarcely related to the drug concentration used, whereas relaxation was the most pronounced and concentration-dependent effect. The transient contraction elicited by amrinone was abolished by scopolamine, indicating activation of cholinergic receptors, but it was unaffected by low temperature or hemicholinium-3. The relaxing effect induced by amrinone was unaffected by low temperature, by the receptor inhibitors used (scopolamine, phenoxybenzamine, propranolol, methysergide, pyrilamine) and by indomethacin. It was potentiated by dipyridamole (0.1 microM) and completely suppressed by tissue pretreatment with adenosine deaminase (10 U/ml). Inhibition of this effect was also obtained by reducing Ca2+ concentration in the perfusion fluid or by pretreating the preparations with verapamil. These results indicate the involvement of endogenous adenosine in the relaxing effect of amrinone and the requirement of Ca2+ influx through plasma membrane for this effect.

Chronicity in major depression. A naturalistic prospective study.

In a prospective naturalistic study many of the 120 patients treated for a current major depressive episode continued to meet the criteria for a major depressive episode as defined by DSM-III during the whole follow-up period (from 1 to 4 years). The problem of compatibility between the chronicity of a full depressive syndrome and the definition of the major depression as episodic with possible relapses or recurrences is discussed. A relationship between chronicity and lack of adequate treatment at onset was found.

[Our experience with the effectiveness and tolerance of ibuproxam in rheumatology]. / Nostra esperienza sull'efficacia e tollerabilità dell'ibuproxam in reumatologia.

The tolerance and effectiveness of Ibuproxam were investigated in 54 patients with arthrosis, R.A., ankylosing spondylitis, and fibrositis. Statistically significant reduction of pain at the end of the treatment was accompanied by decreased limitation of joint movement and morning stiffness. Simultaneous investigation of clinical and biological tolerance showed that the drug is infrequently responsible for side-effects that are always of negligible importance. Oesophagogastroduodenoscopy in subjects with a prior history and/or signs of active pathology of the upper digestive tract did not reveal exacerbation or recrudescence of lesions, nor the appearance of acute lesions.