ABSTRACT
OBJECTIVE: To develop and validate a self-report screening tool for common mental disorders. DESIGN AND SETTING: Sequential development and validation studies in three cohorts of patients in general practice and one cohort of patients in a specialist psychiatry clinic. PARTICIPANTS: 1585 patients in general practice examined cross-sectionally and longitudinally; 46515 patients attending 386 general practitioners nationwide; 364 patients participating in a longitudinal study of psychiatric disorders in general practice; and 522 patients attending a specialist psychiatry clinic. MAIN OUTCOME MEASURES: Performance of the 12 items from the 34-item SPHERE questionnaire against DSM-III-R and DSM-IV diagnoses of psychiatric disorder, self-reported Brief Disability Questionnaire findings, GPs' ratings of patients' needs for psychological care and degree of risk resulting from mental disorder, and patients' and GPs' reports of reasons for presentation. RESULTS: Six somatic and six psychological questions identify two levels (and three types) of mental disorder: patients reporting both characteristic psychological and somatic symptoms (Level 1, Type 1), and patients reporting either psychological symptoms (Level 2, Type 2) or somatic symptoms (Level 2, Type 3). This classification system predicts disability ratings (Level 1, 8.2 "days out of role in the last month" and Level 2, 4.1 and 5.4 "days out of role in the last month" for Types 2 and 3, respectively), rates of lifetime psychiatric diagnoses (Level 1, 63% and Level 2, 59% and 48%, respectively), both patients' and GPs' report of reasons for presentation, and doctors' ratings of risk as a result of mental disorder. There are important and differing sociodemographic correlates for the three types of mental disorders. CONCLUSION: A classification system based on the 12 items from the 34-item SPHERE questionnaire can be used to identify common mental disorders. This system has acceptable validity and reliability, and is suited specifically for general practice settings.
Subject(s)
Depressive Disorder/diagnosis , Mass Screening , Mental Disorders/diagnosis , Patient Care Team , Personality Inventory/statistics & numerical data , Adult , Aged , Anxiety Disorders/epidemiology , Australia/epidemiology , Cross-Sectional Studies , Depressive Disorder/epidemiology , Disability Evaluation , Family Practice , Fatigue Syndrome, Chronic/diagnosis , Fatigue Syndrome, Chronic/epidemiology , Female , Humans , Longitudinal Studies , Male , Mental Disorders/epidemiology , Middle Aged , Needs Assessment , Neurasthenia/diagnosis , Neurasthenia/epidemiology , Psychiatric Status Rating Scales/statistics & numerical data , Psychometrics , Reproducibility of Results , Somatoform Disorders/diagnosis , Somatoform Disorders/epidemiologySubject(s)
Adolescent Behavior , Feeding and Eating Disorders/diagnosis , Feeding and Eating Disorders/psychology , Primary Health Care , Adolescent , Anorexia Nervosa/diagnosis , Anorexia Nervosa/psychology , Australia , Bulimia/diagnosis , Bulimia/psychology , Community Mental Health Services , Depression/diagnosis , Depression/psychology , Family Practice , Humans , Referral and ConsultationABSTRACT
Denervation-induced changes in the synaptic efficacy of single electroreceptors in catfish (Ictalurus nebulosus, Teleostei) were studied in vivo under alfadolone anaesthesia. At 16 degrees C the following effects were found 48 h post-operatively: (1) the average amplitude of the extra-dermally recorded spikes decreased from 100 to less than 20 microV; (2) the average resting discharge decreased from 40 to less than 25 spikes/s; (3) neither the sensitivity nor the frequency characteristic changed. The results indicate that the resting discharge and the modulation mechanism of sensory synapses are controlled by different biochemical mechanisms. The resting discharge seems to be related to the trophic function of the afferent nerve and to its generator region, whereas the modulation mechanism is apparently associated with the receptor cell.
