Anxiety Disorders: Lépine JP

Bandelow B, Zohar J, Hollander E, Kasper S, Möller HJ, Anonymous00037, Zohar J, Hollander E, Kasper S, Möller HJ, Bandelow B, Allgulander C, Ayuso-Gutierrez J, Baldwin DS, Buenvicius R, Cassano G, Fineberg N, Gabriels L, Hindmarch I, Kaiya H, Klein DF, Lader M, Lecrubier Y, Lépine JP, Liebowitz MR, Lopez-Ibor JJ, Marazziti D, Miguel EC, Oh KS, Preter M, Rupprecht R, Sato M, Starcevic V, Stein DJ, van Ameringen M, Vega J. · Department of Psychiatry and Psychotherapy, University of Gottingen, Gottingen, Germany. · World J Biol Psychiatry. · Pubmed #18949648 No free full text.

Abstract: In this report, which is an update of a guideline published in 2002 (Bandelow et al. 2002, World J Biol Psychiatry 3:171), recommendations for the pharmacological treatment of anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) are presented. Since the publication of the first version of this guideline, a substantial number of new randomized controlled studies of anxiolytics have been published. In particular, more relapse prevention studies are now available that show sustained efficacy of anxiolytic drugs. The recommendations, developed by the World Federation of Societies of Biological Psychiatry (WFSBP) Task Force for the Pharmacological Treatment of Anxiety, Obsessive-Compulsive and Post-traumatic Stress Disorders, a consensus panel of 30 international experts, are now based on 510 published randomized, placebo- or comparator-controlled clinical studies (RCTs) and 130 open studies and case reports. First-line treatments for these disorders are selective serotonin reuptake inhibitors (SSRIs), serotonin-noradrenaline reuptake inhibitors (SNRIs) and the calcium channel modulator pregabalin. Tricyclic antidepressants (TCAs) are equally effective for some disorders, but many are less well tolerated than the SSRIs/SNRIs. In treatment-resistant cases, benzodiazepines may be used when the patient does not have a history of substance abuse disorders. Potential treatment options for patients unresponsive to standard treatments are described in this overview. Although these guidelines focus on medications, non-pharmacological were also considered. Cognitive behavioural therapy (CBT) and other variants of behaviour therapy have been sufficiently investigated in controlled studies in patients with anxiety disorders, OCD, and PTSD to support them being recommended either alone or in combination with the above medicines.

Lépine JP. · Assistance Publique Hôpitaux de Paris, Service de Psychiatrie, Hôpital Fernand Widal, Paris, France. · J Clin Psychiatry. · Pubmed #12562112 No free full text.

Abstract: Anxiety disorders are the most prevalent of psychiatric disorders, yet less than 30% of individuals who suffer from anxiety disorders seek treatment. Prevalence of anxiety disorders is difficult to pinpoint since even small changes in diagnostic criteria, interview tools, or study methodology affect results. Analyses of the largest prevalence studies of psychiatric illnesses in the United States find that anxiety disorders afflict 15.7 million people in the United States each year, and 30 million people in the United States at some point in their lives. Currently, the European Study of Epidemiology of Mental Disorders and the World Health Organization World Mental Health 2000 studies are underway. These studies, which share a similar methodology, will facilitate future worldwide comparisons of the prevalence of anxiety disorders. Anxiety disorders impose high individual and social burden, tend to be chronic, and can be as disabling as somatic disorders. Compared with those who have other psychiatric disorders, people with anxiety disorders are high care utilizers who present to general practitioners more frequently than to psychiatric professionals, placing a strain upon the health care system. The economic costs of anxiety disorders include psychiatric, nonpsychiatric, and emergency care; hospitalization; prescription drugs; reduced productivity; absenteeism from work; and suicide.

Ballenger JC, Davidson JR, Lecrubier Y, Nutt DJ, Kirmayer LJ, Lépine JP, Lin KM, Tajima O, Ono Y. · Medical University of South Carolina, Department of Psychiatry and Behavioral Sciences, Charleston 29425-0742, USA. · J Clin Psychiatry. · Pubmed #11434419 No free full text.

Abstract: OBJECTIVE: To provide primary care physicians with a better understanding of transcultural issues in depression and anxiety. PARTICIPANTS: The 4 members of the International Consensus Group on Depression and Anxiety were James C. Ballenger (chair), Jonathan R. T. Davidson, Yves Lecrubier, and David J. Nutt. Five faculty invited by the chair also participated: Laurence J. Kirmayer, Jean-Pierre Lepine, Keh-Ming Lin, Osamu Tajima, and Yutaka Ono. EVIDENCE: The consensus statement is based on the 5 review articles that are published in this supplement and the scientific literature relevant to the issues reviewed in these articles. CONSENSUS PROCESS: Group meetings were held over a 2-day period. On day 1, the group discussed the review articles, and the chair identified key issues for further debate. On day 2, the group discussed these issues to arrive at a consensus view. After the group meetings, the consensus statement was drafted by the chair and approved by all attendees. CONCLUSION: The consensus statement underlines the prevalence of depression and anxiety disorders across all cultures and nations while recognizing that cultural differences exist in symptom presentation and prevalence estimates. In all countries, the recognition of depression by clinicians in the primary care setting is low (generally less than 50%), and the consensus group recommends a 2-step process to aid the recognition and diagnosis of depression. In line with the low recognition of depression and anxiety disorders is the finding that only a small proportion of patients with depression or anxiety are receiving appropriate treatments for their condition. Biological diversity across ethnic groups may account for the differential sensitivity of some groups to psychotropic medication, but this area requires further investigation.

Lépine JP, Pélissolo A. · Department of Psychiatry, Hôpital Lariboisière Fernand Widal, Paris, France. · Depress Anxiety. · Pubmed #10875048 No free full text.

Abstract: Social anxiety disorder (social phobia) is a disabling psychiatric condition, characterized by a fear of negative evaluation by others. Epidemiological studies have shown a high prevalence of the condition in the general population; the disorder is more common in women than in men. Social anxiety disorder has a typical onset during adolescence and a chronic course; remission rarely occurs without therapeutic intervention. Comorbid psychiatric conditions such as depression and alcoholism commonly occur in patients with preexisting social anxiety disorder, and increase the burden of the condition. Two subtypes of social anxiety disorder have been identified: "nongeneralized" and "generalized"; the latter form causes greater disability and is more often associated with comorbidity. The socioeconomic impact of social anxiety disorder on both sufferers and the community is considerable. For a person with social anxiety disorder, quality of life is greatly reduced; work, social, and personal relationships are all affected. Social anxiety disorder demands increased recognition, so that sufferers receive the treatment they need, in order to improve their quality of life through better social functioning.

Musa CZ, Lépine JP. · Hôpital Lariboisière-F. Widal, Assistance Publique Hôpitaux de Paris, Service de psychiatrie adulte, 200 rue du Fbg Saint Denis, 75475 Paris cedex 10, France. · Eur Psychiatry. · Pubmed #10713803 No free full text.

Abstract: Cognitive theories of social phobia have largely been inspired by the information-processing models of anxiety. They propose that cognitive biases can, at least partially, explain the etiology and maintenance of this disorder. A specific bias, conceived as a tendency to preferentially process socially-threatening information, has been proposed. This bias is thought to intervene in cognitive processes such as attention, memory and interpretation. Research paradigms adopted from experimental cognitive psychology and social psychology have been used to investigate these hypotheses. The existence of a bias in the allocation of attentional resources and the interpretation of information seems to be confirmed. A memory bias in terms of better retrieval for threat-relevant information appears to depend on specific encoding activities.

Lara C, Fayyad J, de Graaf R, Kessler RC, Aguilar-Gaxiola S, Angermeyer M, Demytteneare K, de Girolamo G, Haro JM, Jin R, Karam EG, Lépine JP, Mora ME, Ormel J, Posada-Villa J, Sampson N. · Department of Psychiatry, Autonomous University of Puebla, Puebla, Mexico. · Biol Psychiatry. · Pubmed #19006789 No free full text.

Abstract: BACKGROUND: Although it is known that childhood attention-deficit/hyperactivity disorder (ADHD) often persists into adulthood, childhood predictors of this persistence have not been widely studied. METHODS: Childhood history of ADHD and adult ADHD were assessed in 10 countries in the World Health Organization World Mental Health Surveys. Logistic regression analysis was used to study associations of retrospectively reported childhood risk factors with adult persistence among the 629 adult respondents with childhood ADHD. Risk factors included age; sex; childhood ADHD symptom profiles, severity, and treatment; comorbid child/adolescent DSM-IV disorders; childhood family adversities; and child/adolescent exposure to traumatic events. RESULTS: An average of 50% of children with ADHD (range: 32.8%-84.1% across countries) continued to meet DSM-IV criteria for ADHD as adults. Persistence was strongly related to childhood ADHD symptom profile (highest persistence associated with the attentional plus impulsive-hyperactive type, odds ratio [OR]=12.4, compared with the lowest associated with the impulsive-hyperactive type), symptom severity (OR=2.0), comorbid major depressive disorder (MDD; OR=2.2), high comorbidity (>or=3 child/adolescent disorders in addition to ADHD; OR=1.7), paternal (but not maternal) anxiety mood disorder (OR=2.4), and parental antisocial personality disorder (OR=2.2). A multivariate risk profile of these variables significantly predicts persistence of ADHD into adulthood (area under the receiving operator characteristic curve=.76). CONCLUSIONS: A substantial proportion of children with ADHD continue to meet full criteria for ADHD as adults. A multivariate risk index comprising variables that can be assessed in adolescence predicts persistence with good accuracy.

Fayyad J, De Graaf R, Kessler R, Alonso J, Angermeyer M, Demyttenaere K, De Girolamo G, Haro JM, Karam EG, Lara C, Lépine JP, Ormel J, Posada-Villa J, Zaslavsky AM, Jin R. · Department of Psychiatry and Clinical Psychology, St George Hospital University Medical Centre, PO Box 166378, Beirut-Achrafieh 1100-2807, Lebanon. · Br J Psychiatry. · Pubmed #17470954 links to  free full text

Abstract: BACKGROUND: Little is known about the epidemiology of adult attention-deficit hyperactivity disorder (ADHD). AIMS: To estimate the prevalence and correlates of DSM-IV adult ADHD in the World Health Organization World Mental Health Survey Initiative. METHOD: An ADHD screen was administered to respondents aged 18-44 years in ten countries in the Americas, Europe and the Middle East (n=11422). Masked clinical reappraisal interviews were administered to 154 US respondents to calibrate the screen. Multiple imputation was used to estimate prevalence and correlates based on the assumption of cross-national calibration comparability. RESULTS: Estimates of ADHD prevalence averaged 3.4% (range 1.2-7.3%), with lower prevalence in lower-income countries (1.9%) compared with higher-income countries (4.2%). Adult ADHD often co-occurs with other DSM-IV disorders and is associated with considerable role disability. Few cases are treated for ADHD, but in many cases treatment is given for comorbid disorders. CONCLUSIONS: Adult ADHD should be considered more seriously in future epidemiological and clinical studies than is currently the case.

Nutt DJ, Kessler RC, Alonso J, Benbow A, Lecrubier Y, Lépine JP, Mechanic D, Tylee A. · University of Bristol, Bristol, United Kingdom. · J Clin Psychiatry. · Pubmed #17288507 No free full text.

Abstract: OBJECTIVE: To provide an overview of the importance of the data generated by the European Study of the Epidemiology of Mental Disorders (ESEMeD), which found that prevalence and burden of mood and anxiety disorders were high and that care of individuals with mental disorders was suboptimal. Thus, ESEMeD data, based on 21,425 noninstitutionalized adults from Belgium, France, Germany, Italy, the Netherlands, and Spain who underwent computer-assisted personal interviews, confirmed previous findings from epidemiologic studies performed in other locations. In addition, how this large and unique dataset may be utilized for maximum benefit to patients is outlined. PARTICIPANTS: The co-chairmen David J. Nutt, M.D., Ph.D., and Ronald C. Kessler, Ph.D., invited 6 faculty members to participate: Jordi Alonso, M.D., Ph.D.; Alastair Benbow, M.B., M.R.C.P.I.; Yves Lecrubier, M.D.; Jean-Pierre Lépine, M.D.; David Mechanic, Ph.D.; and André Tylee, M.D. EVIDENCE: The consensus statement is based on the 6 review articles published in this supplement, which include ESEMeD data and data from pertinent scientific literature. CONSENSUS PROCESS: The faculty met over a 2-day period: day 1 included discussion of the review articles, during which the chairmen identified issues for further debate; day 2 included discussion of key issues to arrive at a consensus view. The consensus view was drafted by the chairmen and approved by all attendees. CONCLUSIONS: ESEMeD provides a very important opportunity to improve knowledge on the epidemiology of mood and anxiety disorders. Despite a decade of educational initiatives, the diagnosis and treatment of mood and anxiety disorders remain suboptimal. Lack of awareness and stigma surrounding mental illness, variations in physicians' ability to diagnose and treat psychiatric conditions, and physician time pressures all contribute to the problem. Future education initiatives should include patients, primary care physicians, employers, and health policy influencers. Patients with mood and anxiety disorders may benefit from targeted antidepressant treatment, which should optimize the chance of patients' receiving appropriate therapy. In addition, depending on the patients' circumstances, psychotherapy, counseling, or social support may also be initiated.

Alonso J, Lépine JP, Anonymous00364. · Health Services Research Unit, Institut Municipal d'Investigació Mèdica-Institut Municipal d'Assistència Sanitària (IMIM-IMAS), Barcelona, Spain. · J Clin Psychiatry. · Pubmed #17288501 No free full text.

Abstract: The European Study of the Epidemiology of Mental Disorders (ESEMeD) is the first large-scale survey to collect data comprehensively on the prevalence, risk factors, disability, and use of health care services associated with mood, anxiety, and alcohol-related disorders throughout Europe. Findings from the ESEMeD study are updated using a modified version of the Composite International Diagnostic Interview 3.0 in order to achieve the maximum diagnostic accuracy. The study is based on a sample of 21,425 noninstitutionalized adults, representative of an overall population of more than 212 million from Belgium, France, Germany, Italy, the Netherlands, and Spain. In total, 25.9% of participants reported a lifetime presence of any mental disorder, and 11.5% had experienced a mental disorder during the past 12 months. Females, younger participants, the unmarried, and the unemployed were more at risk, and comorbidity was prevalent. Associated levels of disability and reductions in quality of life exceeded levels seen in patients with chronic physical conditions. Nevertheless, only 36.8% of participants with a mood disorder and 20.6% with an anxiety disorder sought help from health care services; of these, 20.7% received no treatment. ESEMeD data provide an epidemiologic basis for reform of mental health policy within Europe.

Fernández A, Haro JM, Martinez-Alonso M, Demyttenaere K, Brugha TS, Autonell J, de Girolamo G, Bernert S, Lépine JP, Alonso J. · Paediatrics, Obstetrics, and Gynaecology, and Preventive Medicine Department, Universitat Autònoma de Barcelona, and Research and Sant Joan de Déu Mental Health Services, Spain, and Hôpital Fernand Widal, Paris, France. · Br J Psychiatry. · Pubmed #17267936 links to  free full text

Abstract: The aims of this study are to describe the adequacy of treatment for anxiety and depressive disorders in Europe and how itdiffers between providers, using data from the ESEMeD study. The overall proportion of adequate treatment was 45.8% (57.4% in the specialised sector and 23.3% in the general medical care sector). Between-country differences were found in treatment adequacy in the specialised setting. Organisational and political aspects may explain these findings.

Lépine JP, Gasquet I. · Hôpital Fernand Widal, Assistance Publique-Hôpitaux de Paris, INSERM U 705 CNRS UMR 7157, Université Denis Diderot, Paris. · Bull Acad Natl Med. · Pubmed #17195398 No free full text.

Abstract: Over the past 20 years, hypnotic drug use has diminished in France, while consumption of anxiolytics and neuroleptics has remained stable and antidepressant use has risen. Data from the ESEMeD survey (European Study of Epidemiology of Mental Disorders) conducted in 2002 in Germany, Belgium, Spain, France, Netherlands and Italy showed that use of anxiolytics during the previous year (including recurrent use) was less frequent in Germany than elsewhere. Belgium and France had a higher prevalence of antidepressant consumption. Among depressed patients, fewer than one-third reported antidepressant use (no difference among the countries), while one-third said they used anxiolytics (higher rate in France). One-quarter of patients with anxiety stated they used a benzodiazepine (lower rate in Germany). Age, psychiatric disorders and neurological disorders were strongly associated with benzodiazepine use. Factors strongly associated with antidepressant use were age (bell-shaped curve), female sex, and psychiatric disorders.

Faytout M, Tignol J, Swendsen J, Grabot D, Aouizerate B, Lépine JP. · Adult Psychiatry Service, Hôpital Charles Perrens, Bordeaux, France. · Eur Psychiatry. · Pubmed #17101266 No free full text.

Abstract: This naturalistic, prospective investigation examined the role of fear of negative evaluation and the personality trait of harm avoidance in the anxiety levels of treated social phobia patients. One hundred and fifty-seven patients with DSM-IV social phobia were assessed before starting treatment and were then followed for up to two years. As expected, greater fear of negative evaluation and higher scores of harm avoidance were associated with greater anxiety at the 6 month follow-up, and harm avoidance remained a significant predictor at 24 months. However, no evidence was found for an interaction between the personality and cognitive variables examined. The findings are discussed in terms of the relative independence of these factors, as well as their potential implications for the treatment of this disorder.

Bernal M, Haro JM, Bernert S, Brugha T, de Graaf R, Bruffaerts R, Lépine JP, de Girolamo G, Vilagut G, Gasquet I, Torres JV, Kovess V, Heider D, Neeleman J, Kessler R, Alonso J, Anonymous00079. · Sant Joan de Déu-Serveis de Salut Mental, Fundació Sant Joan de Déu, Dr Antoni Pujades 42, 08830, Sant Boi de Llobregat, Spain. · J Affect Disord. · Pubmed #17074395 No free full text.

Abstract: BACKGROUND: Precise knowledge of the epidemiology of suicidality provides necessary information for designing prevention programs. The aims of the present study were to investigate the prevalence and correlates of suicidal ideas and attempts in the general population of Europe. METHODS: The European Study on the Epidemiology of Mental Disorders (ESEMED) is a cross-sectional household survey carried out in a probability representative sample of non-institutionalised adults (aged 18 years or older) of six European countries (Belgium, France, Germany, Italy, the Netherlands and Spain). The Composite International Diagnostic Interview (CIDI 3.0) was administered to 21,425 individuals. RESULTS: Lifetime prevalence of suicidal ideation was 7.8% and of suicidal attempts 1.3%. Being women, younger and divorced or widowed were associated with a higher prevalence of suicide ideation and attempts. Psychiatric diagnoses were strongly related to suicidality. Among them, major depressive episode (Rate ratio 2.9 for lifetime ideas and 4.8 for lifetime attempts), dysthymia (RR 2.0 and 1.6), GAD (RR 1.8 and 2.3 for lifetime), PTSD (RR 1.9 and 2.0) and alcohol dependence (RR 1.7 and 2.5) were the most important. Population attributable risks for lifetime suicidal attempt was 28% for major depression. LIMITATIONS: Information about suicidal ideas and attempts was self reported, psychiatric diagnoses were made using fully structured lay interviews rather than clinician-administered interviews. CONCLUSIONS: In spite of meaningful country variation in prevalence, risk factors for suicidality are consistent in the European countries. Population prevention programmes should focus on early diagnosis and treatment of major depression and alcohol abuse and in those individuals with recent appearance of suicidal ideas.

Gasquet I, Nègre-Pagès L, Fourrier A, Nachbaur G, El-Hasnaoui A, Kovess V, Lépine JP. · INSERM U669, Maison des adolescents, 97, boulevard de Port-Royal, 75679 Paris cedex 14, France. Direction de la Politique Médicale (DAM), Assistance Publique - Hôpitaux de Paris, Paris. · Encephale. · Pubmed #15959446 No free full text.

Abstract: INTRODUCTION: The use of psychotropic drugs is high in France and has increased over the last two decades. To date, no national study evaluating psychotropic drug use in the context of the diagnosis of psychiatric disorders has been performed. Such data has now been generated in the ESEMeD/MHEDEA 2000 study, which has allowed comparison of the situation in France with that in five other European countries (Germany, Belgium, Spain, the Netherlands and Italy). OBJECTIVES: 1) To describe the declared use of psychotropic drugs (globally and by therapeutic class) in order to evaluate annual prevalence, treatment duration and demographic factors associated with use. 2) To estimate the proportion of subjects with an anxiety disorder, mood disorder or alcohol-related disorder (abuse or dependence) that have been appropriately treated with an antidepressant or anxiolytic drug. 3) to evaluate the proportion of psychotropic drug users who fulfil diagnostic criteria for these three classes of psychiatric disorder. METHODS: This was a transversal survey carried out between 2001 and 2003 of non-institutionalised subjects aged 18 or over in the general population of Germany (n = 3,555), Belgium (n = 2,419), Spain (n = 5,473), France (n = 2,894), the Netherlands (n = 2,372) and Italy (n = 4,712). In France, the sampling source used was a randomly generated list of telephone numbers. Subjects were interviewed at home by professional interviewers. The WMH-CIDI questionnaire was used. RESULTS: In France, 21% of subjects interviewed (n = 580) had taken at least one psychotropic drug during the year. For 19%, this was an anxiolytic or hypnotic (AX-HY), for 6.0% an antidepressant (AD), for 0.8% an antipsychotic (AP) and for 0.4% a mood regulating drug (TY).The distribution of users of AX-HY according to treatment duration was the following: 44% (1 to 15 days), 13% (16 to 30 days), 14% (1 to 3 months), 6.7% (3 to 6 months) and 23% (> 6 months). For users of ADs, the distribution was: 21% (1 to 15 days), 7.8% (16 to 30 days), 18% (1 to 3 months), 12% (3 to 6 months) and 42% (> 6 months). For subjects fulfilling diagnostic criteria for a mood disorder in the previous year or over their lifetime, 43% and 29% respectively had taken an AX-HY in the last twelve months and 29% and 16% an AD. For those who fulfilled diagnostic criteria for an anxiety disorder in the previous year or over their lifetime, the use of an AX-HY, in the last twelve months, concerned 43% and 30% of subjects respectively, whilst that of AD concerned 16% and 14%. For previous year or lifetime alcohol-related disorders, AX-HY use, in the last twelve months, concerned 63% and 22% of subjects respectively and use of ADs 9.3% and 7.2%. Amongst users of AX-HY in the last twelve months, a previous year or lifetime diagnosis of mood disorders was made for 16% and 39% of subjects respectively. Amongst users of ADs, the respective prevalence was 31% and 64%. A twelve-month and lifetime diagnosis of anxiety disorders was identified in 22% and 37% of users of AX-HY and among 27% and 50% of users of AD respectively. A twelve-month and lifetime diagnosis of alcohol-related disorders was found in 2.5% and 6.6% of users of AX-HY and among 1.1% and 7.8% of users of AD respectively. 68% of users of AX-HY had fulfilled none of these diagnostic criteria in the previous 12 months and 46% had never fulfilled them in their lifetime. With respect to AD users, the proportion who did not meet these diagnostic criteria in the previous 12 months was 56%, compared to 20% over their lifetime.Comparison of the French data from the study with those of the entire European sample showed that the annual prevalence of AX-HY and AD use was higher in France with mean treatment durations that were shorter. For antipsychotics and mood regulators, no clear differences were observed between France and the six countries of the study taken together. DISCUSSION: Over the last two decades, use of AX-HY seems to have decreased in France, even though it remains higher than that observed in the other European countries participating in this study. This high use can be explained in part by the observation that, in around half the cases, it corresponds to occasional use. In contrast, the use of antidepressants has increased. In subjects with recent mood disorders or anxiety disorders, the use of AX-HY remains higher than that of antidepressants. Finally among users of AX-HY, only half of them had presented a mood disorder, anxiety disorder or alcohol use disorder during their lifetime, whereas this proportion rose to 80% for users of antidepressants.

Lépine JP, Gasquet I, Kovess V, Arbabzadeh-Bouchez S, Nègre-Pagès L, Nachbaur G, Gaudin AF. · INSERM U705, CNRS, UMR 7157, Universités Paris 5 et 7. · Encephale. · Pubmed #15959445 No free full text.

Abstract: INTRODUCTION: ESEMeD is the first international epidemiological study using a random sampling method that has allowed the prevalence of psychiatric disorders in France to be measured with precision and compared directly with that observed in other European countries. OBJECTIVES: 1) To determine the 12 month and lifetime prevalence of mood -disorders, anxiety disorders and alcohol-related disorders. 2) To estimate the comorbidity between these disorders. 3) To evaluate potential demographic risk factors for these disorders. METHODS: This was a transversal survey carried out between 2001 and 2003 of non-institutionalised subjects aged 18 or over in the general population of Germany (n = 3,555), Belgium (n = 2,419), Spain (n = 5,473), France (n = 2,894), the Netherlands (n = 2,372) and Italy (n = 4,712). In France, the sampling source was a randomly generated list of telephone numbers. Subjects were interviewed at home by professional interviewers. The WMH-CIDI questionnaire was used. RESULTS: The participation rate was 46% for France and 61% for all six countries combined. The 12 month and lifetime prevalence rates observed were respectively 6.0% and 21,4% for major depressive episodes, 1.6% and 7.9% for dysthymia, 2.1% and 6.0% for the generalised -anxiety disorders, 1.2% and 3.0% for panic disorders, 0.6% and 1.8% for agoraphobia, 2.2% and 3.9% for post-traumatic stress disorder, 1.7% and 4.7% for social phobia, 4.7% and 11,6% for specific phobia, 0.5% and 4.1% for alcohol abuse and 0.3% and 1.6% for alcohol dependence.Mood disorders and anxiety disorders were significantly more frequent in women, whilst alcohol-related disorders were more frequent in men. The prevalence of all three types of disorder was lower in elderly subjects and in those living in a rural environment. Mood disorders and alcohol-related disorders were more frequent in individuals living alone and mood disorders more frequent in those without paid employment. 38% of subjects with mood disorder also presented an anxiety disorder or an alcohol-related disorder. The comorbidity of mood and anxiety disorders was more frequent in women, younger subjects and those living alone. The comorbidity rate in subjects with anxiety disorders was 26% and did not differ between genders. For alcohol-related disorders, there was a striking difference in comorbidity rate between men and women: 26% in the former and 67% in the latter. CONCLUSION: This study underlines the high prevalence of mood disorders, anxiety disorders and alcohol-related disorders in France and demonstrates a high degree of comorbidity between them. For this reason, it is important to evaluate and take into account potential comorbidity in the management of individuals with psychiatric disorders.

Musa C, Kostogianni N, Lépine JP. · Service de Psychiatrie du Professeur Lépine, Hôpital Lariboisière-Fernand Widal, 200 rue du Faubourg Saint Denis, 75475 Paris cedex 10, France. · Encephale. · Pubmed #15738853 No free full text.

Abstract: BACKGROUND: The Fear of Negative Evaluation scale (FNE: Watson and Friend, 1969) is the measure most commonly used to determine the degree to which people experience apprehension at the prospect of being negatively evaluated. Although the development of the FNE preceded the inclusion of social anxiety disorder (or social phobia) in the diagnostic classification system, it is widely used as a measure of cognitive symptoms because the feature tapped by this measure is at the core of recent cognitive models of social-anxiety. According to these models, socially anxious individuals divide their attention between the internal representations of their social self (negative images and "felt sense") and external cues that could be taken as a sign of negative evaluation by others. The FNE was validated in a student and patient population in English speaking countries. The English version demonstrates adequate empirical validity. It shows excellent internal consistency and one-factor structure. Test retest reliability is satisfying. It is proved to be sensible to change after treatment. It is well correlated with other measures of social anxiety demonstrating good convergent validity. However, divergent and discriminate validity have been a subject of controversy. The aim of the present study was to assess the psychometric properties of the French version of the FNE in order to obtain a valid instrument measuring the cognitive component of social anxiety. METHOD: The social anxiety group consisted of 88 patients referred to our clinic for cognitive-behavioural group therapy. All met ICD-10 criteria for social phobia (generalized subtype) as determined by the Composite International Diagnostic Interview (social phobia section). Additional axis-I diagnostic information was obtained using the Mini International Neuropsychiatric Interview (MINI: Lecrubier et al., 1997) for ICD-10. The non-patient control group consisted of 80 participants who didn't respond to social anxiety CIDI criteria. All participants were rated by the assessor on the Liebowitz Social Anxiety Scale (LSAS) and completed the following self-report questionnaires: the Fear of Negative Evaluation questionnaire (FNE), the State-Trait-Anxiety Inventory (STAI A-B), and the Beck Depression Inventory (BDI 13). RESULTS: The internal consistency is very good with Kuder-Richardson 20 coefficient of 0,94 corresponding to coefficients found in the validity studies of the original version of the FNE. One factor Anova tests showed that our two groups of subjects differed significantly on the FNE [F (1.166)=282.26, p<0.001]. Patients had a mean score of 25.6 with a standard deviation of 4.1 and the non patient control subjects had a mean score of 12.1 with a standard deviation of 6.1. This result confirms the empirical validity of the instrument. In the patient sample, the FNE was significantly correlated with the LSAS total score (r=0.55; p<0.001). This result indicates good convergent validity. However, the FNE was also significantly correlated with the BDI-13 (r=0.48; p<0.001) and the STAI B (r=0.47; p<0.001). However because high levels of general anxiety and depression are common among patients with social anxiety disorder, substantial correlations between measures of social anxiety and measures of general anxiety and depression should be probably expected. A multiple regression analysis shows a significant association of the FNE with the LSAS (Beta=0.39, p<0.001) and the STAIB (Beta=0.28, p<0.01) We explored the unidimensionality of the scale by using a principal component analysis of tetrachoric correlation suitable for dichotomic items. One sole factor with an eigenvalue superior to 1 emerged. We deduce therefore that our results are in favour of the unidimensionality of the French version of the FNE. CONCLUSION: The present study shows that the French version of the FNE has good psychometric properties and differentiates social phobic patients from the non-clinical control subjects. Given the importance that models of social anxiety attribute to cognitive processes and the importance of cognitive techniques in its treatment, we consider that the French version of the FNE is an adequate and valid questionnaire to be used in research and therapy.

Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lépine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbabzadeh-Bouchez S, Autonell J, Bernal M, Buist-Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martínez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacín C, Romera B, Taub N, Vollebergh WA, Anonymous00252. · No affiliation provided · Acta Psychiatr Scand Suppl. · Pubmed #15128387 No free full text.

Abstract: OBJECTIVE: Comprehensive information about access and patterns of use of mental health services in Europe is lacking. We present the first results of the use of health services for mental disorders in six European countries as part of the ESEMeD project. METHOD: The study was conducted in: Belgium, France, Germany, Italy, the Netherlands and Spain. Individuals aged 18 years and over who were not institutionalized were eligible for an computer-assisted interview done at home. The 21 425 participants were asked to report how frequently they consulted formal health services due to their emotions or mental health, the type of professional they consulted and the treatment they received as a result of their consultation in the previous year. RESULTS: An average of 6.4% of the total sample had consulted formal health services in the previous 12 months. Of the participants with a 12-month mental disorder, 25.7% had consulted a formal health service during that period. This proportion was higher for individuals with a mood disorder (36.5%, 95% CI 32.5-40.5) than for those with anxiety disorders (26.1%, 95% CI 23.1-29.1). Among individuals with a 12-month mental disorder who had contacted the health services 12 months previously, approximately two-thirds had contacted a mental health professional. Among those with a 12-month mental disorder consulting formal health services, 21.2% received no treatment. CONCLUSION: The ESEMeD results suggest that the use of health services is limited among individuals with mental disorders in the European countries studied. The factors associated with this limited access and their implications deserve further research.

Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lépine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbabzadeh-Bouchez S, Autonell J, Bernal M, Buist-Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martínez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacín C, Romera B, Taub N, Vollebergh WA, Anonymous00250. · No affiliation provided · Acta Psychiatr Scand Suppl. · Pubmed #15128385 No free full text.

Abstract: OBJECTIVE: Comorbidity patterns of 12-month mood, anxiety and alcohol disorders and socio-demographic factors associated with comorbidity were studied among the general population of six European countries. METHOD: Data were derived from the European Study of the Epidemiology of Mental Disorders (ESEMeD), a cross-sectional psychiatric epidemiological study in a representative sample of adults aged 18 years or older in Belgium, France, Germany, Italy, the Netherlands and Spain. The diagnostic instrument used was the Composite International Diagnostic Interview (WMH-CIDI). Data are based on 21 425 completed interviews. RESULTS: In general, high associations were found within the separate anxiety disorders and between mood and anxiety disorders. Lowest comorbidity associations were found for specific phobia and alcohol abuse-the disorders with the least functional disabilities. Comorbidity patterns were consistent cross-nationally. Associated factors for comorbidity of mood and anxiety disorders were female gender, younger age, lower educational level, higher degree of urbanicity, not living with a partner and unemployment. Only younger people were at greater risk for comorbidity of alcohol disorder with mood, anxiety disorders or both. CONCLUSION: High levels of comorbidity are found in the general population. Comorbidity is more common in specific groups. To reduce psychiatric burden, early intervention in populations with a primary disorder is important to prevent comorbidity.

Alonso J, Angermeyer MC, Bernert S, Bruffaerts R, Brugha TS, Bryson H, de Girolamo G, Graaf R, Demyttenaere K, Gasquet I, Haro JM, Katz SJ, Kessler RC, Kovess V, Lépine JP, Ormel J, Polidori G, Russo LJ, Vilagut G, Almansa J, Arbabzadeh-Bouchez S, Autonell J, Bernal M, Buist-Bouwman MA, Codony M, Domingo-Salvany A, Ferrer M, Joo SS, Martínez-Alonso M, Matschinger H, Mazzi F, Morgan Z, Morosini P, Palacín C, Romera B, Taub N, Vollebergh WA, Anonymous00249. · No affiliation provided · Acta Psychiatr Scand Suppl. · Pubmed #15128384 No free full text.

Abstract: OBJECTIVE: To describe the 12-month and lifetime prevalence rates of mood, anxiety and alcohol disorders in six European countries. METHOD: A representative random sample of non-institutionalized inhabitants from Belgium, France, Germany, Italy, the Netherlands and Spain aged 18 or older (n = 21425) were interviewed between January 2001 and August 2003. DSM-IV disorders were assessed by lay interviewers using a revised version of the Composite International Diagnostic Interview (WMH-CIDI). RESULTS: Fourteen per cent reported a lifetime history of any mood disorder, 13.6% any anxiety disorder and 5.2% a lifetime history of any alcohol disorder. More than 6% reported any anxiety disorder, 4.2% any mood disorder, and 1.0% any alcohol disorder in the last year. Major depression and specific phobia were the most common single mental disorders. Women were twice as likely to suffer 12-month mood and anxiety disorders as men, while men were more likely to suffer alcohol abuse disorders. CONCLUSION: ESEMeD is the first study to highlight the magnitude of mental disorders in the six European countries studied. Mental disorders were frequent, more common in female, unemployed, disabled persons, or persons who were never married or previously married. Younger persons were also more likely to have mental disorders, indicating an early age of onset for mood, anxiety and alcohol disorders.

Musa C, Lépine JP, Clark DM, Mansell W, Ehlers A. · Department de Psychiatrie, Lariboisière F-Widal Hospital, Paris, France. · Behav Res Ther. · Pubmed #12914806 No free full text.

Abstract: Studies using the modified Stroop colour naming task have provided results consistent with the hypothesis that social phobia is associated with an attentional bias towards negative social-evaluative words. However, these results could also have arisen as a consequence of non-attentional processes. For this reason, the present study uses a modified version of MacLeod et al.'s (J. Abnorm. Psychol. 95 (1986) 15) dot-probe task, which provides a more direct measure of attention. Patients with social phobia (n=28), patients with social phobia and a concurrent depressive disorder (n=33), and non-patients (n=40) were presented with word pairs each consisting of a neutral word and a threat word. The results indicated that patients with social phobia show an attentional bias towards social-threat words while non-patients tend to avoid social-threat words. Patients with social phobia and a concurrent depressive disorder behaved like non-patients, indicating that concurrent depression abolishes the attentional bias. Physical threat words were also included in the study. The main analysis indicated that social phobia is also associated with an attentional bias to physical threat. However, a post hoc analysis (which requires replication) suggested that the physical threat bias might have arisen because some social phobia patients also had another anxiety disorder in which physical concerns are likely to have been prominent. Overall, the results emphasise the importance of assessing comorbidity when investigating attentional biases.

Angst J, Gamma A, Gastpar M, Lépine JP, Mendlewicz J, Tylee A, Anonymous00003. · Zurich University Psychiatric Hospital, Lenggstrasse 31, P O Box 68, 8029 Zurich, Switzerland. · Eur Arch Psychiatry Clin Neurosci. · Pubmed #12451460 No free full text.

Abstract: BACKGROUND: While there is ample evidence that the prevalence rates for major depressive disorder (MDD) in the general population are higher in women than in men, there is little data on gender differences as regard to symptoms, causal attribution, help-seeking, coping, or the consequences of depression. METHOD: The large DEPRES Study dataset covering representative population samples of six European countries (wave I: 38,434 men and 40,024 women; wave II: 563 men and 1321 women treated for depression) was analyzed for gender differences. RESULTS: In wave I marked gender differences were found in the six-month prevalence rate for major depression but less so for minor depression; the gender differences for major depression persisted across all age groups. Even after stratification by clinically significant impairment and paid employment status, men reported fewer symptoms than women; as a consequence, men reached the diagnostic threshold less often. In wave II there were clear gender differences in causal attribution and in coping. Men coped by increasing their sports activity and consumption of alcohol and women through emotional release and religion. Women felt the effects of depression in their quality of sleep and general health, whereas men felt it more in their ability to work. LIMITATIONS: The second wave of the study comprises treated depressives only and may be less representative than the first wave.

Olié JP, Elomari F, Spadone C, Lépine JP. · Service Hospitalo-Universitaire, CH Sainte-Anne, 1, rue Cabanis, 75014 Paris-Université Paris V, France. · Encephale. · Pubmed #12386542 No free full text.

Abstract: The consumption of antidepressant seems to be in France higher than in comparable countries, as well as the overall consumption of healthcare and medications. In Western countries, in recent years, the use of antidepressants has regularly increased, mainly due to the use of serotoninergic antidepressants. In France, in a week, the prevalence of antidepressant use in the overall population increased from 1.7% in 1992 to 3% in 1995. This survey addressed the overall population in the form of a representative sample focusing on subjects who indicated, at the time they were consulted, that they were taking an antidepressant. The study aimed to determine the circumstances of prescription: prescriber file, reason for prescription, type of medication prescribed, match between the prescription and the product indications stated in the marketing authorization, prescription duration and reason for discontinuing treatment. Methodology - The first stage consisted in forwarding a letter to a panel of 44 000 subjects aged 15 years or more and representative of the French population. The aim was to achieve a cross-sectional description of the population taking antidepressants. The response rate was 82% (36 036 subjects). The subjects who stated that they were taking an antidepressant were re-contacted by telephone by an interviewer trained in the use of the Composite International Diagnostic Interview - lifetime (CIDI), exploring depression and anxiety diseases with a view to potential diagnosis as per DSM criteria. Longitudinal follow-up over 8 months from the initial screening was evaluated using a monthly questionnaire on the time course of antidepressant consumption. Results - Out of 20 000 households, comprising 44 000 people aged over 15 years, 1 333 people were taking an antidepressant or had taken one in the previous 4 weeks. The sex ratio of the antidepressant consumers was 3 women to 1 man, amplifying the known sex ratio with respect to depressive disorders. The mean age of the subjects taking an antidepressant at time t was 51 years. Lifestyle and socioprofessional category did not seem to influence antidepressant consumption. Somatic comorbidity was present in 60% of antidepressant consumers. Among the consumers of antidepressants at time t, 45% were taking a selective serotonin reuptake inhibitor (SSRI). The two products most widely prescribed in that class were fluoxetine (30% of the subjects taking an antidepressant at time t) and paroxetine (10% of the subjects taking an antidepressant at time t). The other SSRIs accounted for the remaining 5%. Thirty-nine percent of the consumers were taking a tricyclic antidepressant: clomipramine in 16% of cases, amitriptyline in 14%, and other tricyclic antidepressants in 9%. Lastly, 20% of the consumers were taking an antidepressant that was neither an SSRI nor a tricyclic antidepressant. Only 4% of the patients were concomitantly taking 2 antidepressants: single-agent therapy is in line with the recommendations of the various expert groups. In the survey, 9 antidepressant prescriptions out of 10 were written by an open-care practitioner, and 1 out of 10 by a hospital physician. For 60% of the subjects, the antidepressant treatment was prescribed by a general practitioner. General practitioners prescribe less tricyclic antidepressants and more SSRIs than specialists. The main reason for prescription reported by the patient was depression (57% of cases); followed by a state of anxiety or stress (15% of cases). In 10% of cases, the consumer stated that the reason for treatment was not psychological. Sixty-two percent of subjects presented with, or had presented with, a mood disorder as per M-CIDI (major depression, mood disorder, or a combination of the two) and 14% an isolated anxiety disorder. Twenty-five percent of the subjects on antidepressants did not fulfill all the M-CIDI criteria for any diagnosis. Among the people receiving antidepressants, 54% had a CIDI diagnosis in strict compliance with the marketing authorization indications for the product considered. One quarter (25%) presented with a diagnosis of a characterized psychiatric disease, outside of the marketing authorization indications for the product taken. This finding reflects misuse or use on the basis of published data not incorporated in the marketing authorization. The dosages were in line with those stated in the marketing authorization for the disease considered in almost 99% of cases for the subjects on paroxetine and fluoxetine, but for only 22% of cases for the subjects on tricyclic antidepressants. Tricyclic antidepressants would therefore appear to be frequently inappropriately in terms of proportions that would be ineffective: half of the subjects on clomipramine were taking a dose less than or equal to one third of the minimum recommended dose. Conclusion - This survey shows that the point-prevalence of antidepressants in the global population in France is about 3.5%. Women consume more antidepressants than men. SSRIs are the most widely prescribed antidepressants. The survey findings point out the discrepancies between official indications, such as the ones issued by the regulatory authorities, and the physicians' prescribing practices.

Pélissolo A, André C, Pujol H, Yao SN, Servant D, Braconnier A, Orain-Pélissolo S, Bouchez S, Lépine JP. · Service de psychiatrie, Hôpital Fernand-Widal, Assistance Publique-Hôpitaux de Paris, France. · Acta Psychiatr Scand. · Pubmed #11939958 No free full text.

Abstract: OBJECTIVE: This study investigated the personality traits of social phobics using the Temperament and Character Inventory (TCI). METHOD: A sample of 178 social phobics was assessed with the TCI, and compared with controls. The patients were classified into two groups, according to the absence (SP group) or to the presence (SP+D group) of depression. RESULTS: We found significant elevated scores for harm avoidance (HA) in social phobics when compared with controls (16.2 +/- 2.7), in both the SP (26.2 +/- 3.5), and the SP+D (28.9 +/- 4.7), groups. Lower self-directedness scores were found in the SP and in the SP+D groups when compared with the controls. Patients with the generalized type of social phobia had higher HA scores as compared with other social phobics. CONCLUSION: The personality profile obtained in these social phobics, whatever their depressive symptomatology, reflects a dramatically anxious and avoidant temperament associated to an immature character.

Lépine JP. · Service de Psychiatrie, Hĵpital Fernand Widal, Paris, France. jean-pierre.lé · J Clin Psychiatry. · Pubmed #11434418 No free full text.

Abstract: Studies of the prevalence of depression and anxiety disorders have shown that there is a high prevalence of comorbidity of these 2 disorders. The resulting disability and burden affect not only the individual in terms of decreased productivity, but the level of health care utilization is also increased. The objective of this article is to look at the epidemiology, disability, and global burden of depression and anxiety across the different nations of the world. This article will concentrate on the results from the Cross-National Collaborative Group. The transcultural trends in prevalence and disability presented here must be viewed in the light of the limitations of the study, such as methodology and population sampling, uniformity in the method of clinical assessment, and the collection and processing of data. New studies of depression and anxiety among different cultures are currently in progress in the form of the European Study of Epidemiology on Mental Disorders (ESEMeD), which is closely linked to the World Health Organization (WHO) World Mental Health 2000 initiative. The methodology for ESEMeD is similar to that of the WHO World Mental Health 2000 study, which will facilitate comparisons between the results for Europe and the rest of the world. Results of these studies are awaited with anticipation.

Pélissolo A, Gourion D, Notides C, Bouvard M, Lépine JP, Mouren-Siméoni MC. · Department of Psychiatry, Hôpital Fernand-Widal, AP-HP, 200 rue du Faubourg Saint-Denis, F75010 Paris, France. · Eur Psychiatry. · Pubmed #11246287 No free full text.

Abstract: Many hypotheses have been made to explain the high rate of benzodiazepine consumption in France, including a general cultural and/or familial tendency to use certain types of psychotropic drugs. This study explored the association between lifetime medication use by parents and their children. Two hundred and twenty-one young patients (158 boys and 63 girls) consulting at a child and adolescent psychiatry department, six to 16 years of age (mean = 9.7 years), were screened for lifetime use of psychotropic drugs using a structured interview. Parents were asked about their own consumption, as well as their children's. Lifetime consumption rates (at least once) were 22.2% in boys and 20.6% in girls, and 19.6% in children less than 11 years old. Higher rates were found in patients with emotional disorders (anxiety disorders and depression). In parents, 45.1% of mothers and 24.1% of fathers reported using medications at least once. A significant association was found between child and parental medication use: 34.1% of children had positive lifetime consumption when their mothers also used medications at least once versus only 13.6% in other children (odds ratio = 3.31 [1.68-6.50]; P = 0.001). The most significant association was found between medication use by girls and their mothers (odds ratio = 12.1 [2.38-61.5]; P = 0.003). These data point to the existence of a family pattern of psychotropic drug consumption, especially in females.