CHARACTERISTICS, RECOGNITION AND TREATMENT OF DYSTHYMICS IN PRIMARY-CARE

As part of the WHO-PPGHC study aimed to better understand the form, fr equency and burden of psychiatric conditions in primary care throughou t the world, the clinical characteristics of dysthymic patients consul ting in primary care were examined. A total of 25,916 general health c are attenders at 15 sites in 14 countries were screened using the 12-i tem General Health Questionaire (GHQ-12). Of those screened, 5,438 wer e assessed in detail using a Primary Health Care version of the Compos ite International Diagnostic Interview (CIDI-PHC) in conjunction with among others the Brief Disability Questionnaire (BDQ) and the 28-item General Health Questionnaire (GHQ-28). General practitioners (GPs) gav e their opinion on the existence of a psychological problem and indica ted what therapeutic intervention was proposed to patients they recogn ised as psychological cases. The estimated current prevalence of dysth ymia as defined by the ICD-IO was 2.1%. The social disability was foun d to be substantial in patients with dysthymia (52.2% of patients mode rately or severely disabled) similar to that observed in patients with Depressive Episode (DE) (57.4%). When both conditions were present, t he level of disability was even higher (63.6%). The symptoms presented by dysthymic patients without DE were mostly those specific for the d iagnosis of dysthymia (ie, tearful, hopeless, inability to cope, pessi mism) while these symptoms were less frequent when dysthymia was compl icated by a DE. On the contrary, fatigue and loss of interest were mor e rarely observed in ''pure'' dysthymics. In spite of a lower symptoma tic severity about half of the patients with dysthymia were recognised as cases by their GPs, a proportion similar to those with DE. However , dysthymics without DE were not, in contrast to patients with DE or w ith dysthymia and DE, more treated with drugs than non-depressed patie nts. (C) 1998 Elsevier, Paris.