ABSTRACT
BACKGROUND: Despite availability of validated screening tests for mood disorders, busy general practitioners (GPs) often lack the time to use them routinely. This study aimed to develop a simplified clinical predictive score to help screen for presence of current mood disorder in low-income primary care settings. METHODS: In a cross-sectional study, 197 patients seen at 10 primary care centers in Santiago, Chile completed self-administered screening tools for mood disorders: the Patient Health questionnaire (PHQ-9) and the Mood Disorder Questionnaire (MDQ). To determine participants' current-point mood disorder status, trained clinicians applied a gold-standard diagnostic interview (SCID-I). A simplified clinical predictive model (CM) was developed based on clinical features and selected questions from the screening tools. Using CM, a clinical predictive score (PS) was developed. Full PHQ-9 and GP assessment were compared with PS. RESULTS: Using multivariate logistic regression, clinical and demographic variables predictive of current mood disorder were identified for a simplified 8-point predictive score (PS). PS had better discrimination than GP assessment (auROC-statistic=0.80 [95% CI 0.72, 0.85] vs. 0.58 [95% CI 0.52, 0.62] p-value <0.0001), but not as good as the full PHQ-9 (0.89 [95% CI 0.85, 0.93], p-value=0.03). Compared with GP assessment, PS increased sensitivity by 50% at a fixed specificity of 90%. Administered in a typical primary care clinical population, it correctly predicted almost 80% of cases. LIMITATIONS: Further research must verify external validity of the PS. CONCLUSION: An easily administered clinical predictive score determined, with reasonable accuracy, the current risk of mood disorders in low-income primary care settings.
Subject(s)
Mood Disorders/diagnosis , Poverty/psychology , Primary Health Care/methods , Adolescent , Adult , Aged , Cross-Sectional Studies , Female , Humans , Interview, Psychological , Male , Middle Aged , Primary Health Care/economics , Reproducibility of Results , Risk Factors , Sensitivity and Specificity , Surveys and Questionnaires , Young AdultABSTRACT
ETHNOPHARMACOLOGICAL RELEVANCE: Cassia occidentalis L. (syn. Senna occidentalis; Leguminosae) has been used as natural medicine in rainforests and tropical regions as laxative, analgesic, febrifuge, diuretic, hepatoprotective, vermifuge and colagogo. Herein, we performed a pre-clinical safety evaluation of hydroalcoholic extract of Cassia occidentalis stem and leaf in male and female Wistar rats. MATERIALS AND METHODS: In acute toxicity tests, four groups of rats (n=5/group/sex) were orally treated with doses of 0.625, 1.25, 2.5 and 5.0 g/kg and general behavior, adverse effects and mortality were recorded for up to 14 days. In subacute toxicity assays, animals received Cassia occidentalis by gavage at the doses of 0.10, 0.50 or 2.5 g/kg/day (n=10/group/sex) for 30 days and biochemical, hematological and morphological parameters were determined. RESULTS: Cassia occidentalis did not produce any hazardous symptoms or death in the acute toxicity test, showing a LD(50) higher than 5 g/kg. Subacute treatment with Cassia occidentalis failed to change body weight gain, food and water consumption and hematological and biochemical profiles. In addition, no changes in macroscopical and microscopical aspect of organs were observed in the animals. CONCLUSIONS: Our results showed that acute or subacute administration of Cassia occidentalis is not toxic in male and female Wistar rats, suggesting a safety use by humans.
