[Reliability of diagnostic instruments: investigating the psychiatric DSM-III checklist applied to community samples]. / Confiabilidade de instrumentos diagnósticos: estudo do inventário de sintomas psiquiátricos do DSM-III aplicado em amostra populacional.

This study focused on the reliability of the DSM-III inventory of psychiatric symptoms in representative general population samples in three Brazilian cities. Reliability was assessed through two different designs: inter-rater reliability and internal consistency. Diagnosis of lifetime (k = 0.46) and same-year generalized anxiety (k = 1.00), lifetime depression (k = 0.77), and lifetime alcohol abuse and dependence (k = 1.00) was consistently reliable in the two methods. Lifetime diagnosis of agoraphobia (k = 1.00), simple phobia (k = 0.77), non-schizophrenic psychosis (k = 1.00), and psychological factors affecting physical health (1.00) showed excellent reliability as measured by the kappa coefficient. The main reliability problem in general population studies is the low prevalence of certain diagnoses, resulting in small variability in positive answers and hindering kappa estimation. Therefore it was only possible to examine 11 of 39 diagnoses in the inventory. We recommend test and re-test methods and a short time interval between interviews to decrease the errors due to such variations.

Double-blind comparison of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia.

The purpose of this study was to compare the efficacy and tolerability of venlafaxine and amitriptyline in outpatients with major depression with or without melancholia. This was an 8-week, multicentre, randomized, double-blind, parallel-group comparison of venlafaxine and amitriptyline. Outpatients with DSM-IV major depression, a minimum score of 20 on the 21-item Hamilton Depression Rating Scale (HAM-D), and depressive symptoms for at least 1 month were eligible. Patients were randomly assigned to venlafaxine or amitriptyline, both drugs titrated to a maximum of 150 mg/day until study day 15. The primary efficacy variables were the final on-therapy scores on the HAM-D, Montgomery-Asberg Depression Rating Scale and Clinical Global Impression severity scales. Data were evaluated on an intent-to-treat basis using the LOCF method. One hundred and 16 patients were randomized, and 115 were evaluated for efficacy. Both drugs showed efficacy in the treatment of depression with or without melancholia. No significant differences were noted between treatments for any efficacy parameter. However, significantly (p < 0.05) more patients in the amitriptyline group had at least one adverse event. These results should support the efficacy and tolerability of venlafaxine in comparison with amitriptyline for treating major depression with or without melancholia.

Knowledge and attitudes of primary health care personnel concerning mental health problems in developing countries: a follow-up study.

Within the context of a World Health Organization coordinated collaborative study health workers in six developing countries were assessed 18 months after their training for improvement in their knowledge and attitude towards mental health problems and their management. The approaches to training varied between study areas, but the degree of improvement following the training, was of equal magnitude in all countries. The training process has formalized the recognition by the health workers that treatment of mental health problems is an integral part of their work.

The WHO collaborative study on strategies for extending mental health care, III: Evaluative design and illustrative results.

Teams in seven developing countries have adopted a common research design to evaluate new community mental health care services. The nature of the intervention programs varied considerably according to the characteristics of each area. Observations made before the intervention and 18 to 24 months after showed significant changes in the attitudes, knowledge, and diagnostic accuracy of health staff and in community attitudes and reactions. A considerable number of individuals with serious mental disorders received effective care for the first time.

The classification of psychiatric disorder. A reliability study in the WHO collaborative study on strategies for extending mental health care.

Altogether 26 psychiatrists and other mental health workers, from Colombia, Brazil, Sudan, Egypt, India and the Philippines tried to reach agreement on the classification of 10 case histories, using the International Classification of Diseases (8th revision). The exercise was part of the WHO Collaborative Study on Strategies for Extending Mental Health Care. Conventions, mistakes, differences of opinion and a lack of rules are discussed as causes for disagreement.