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Objective: To examine to what extent postgraduate training of general practitioners (GPs) with the Intervention Study Primary Care (INSTEL) programme improved detection, diagnosis, and treatment of depression, and whether the course of depression was influenced favourably., Design: Prospective, comparative., Setting: Academic Hospital Groningen, discipline group Psychiatry and General Practice, Groningen, the Netherlands., Method: General practitioners active in ten practices in Groningen and surrounds were trained in recognition and treatment of depression. The first group consisted of ten GPs who had not participated in psychiatrically oriented research before, the second group of seven GPs who had participated in such research. Both before and after the training, a group of patients aged 18-65 years visiting these GPs' office hours were examined by the investigators for presence of depression with the aid of questionnaires. The GPs recorded of each patient whether or not they found him/her depressed, and they mentioned the treatment. The researchers assessed the outcomes of depressed patients shortly after the index consultation and at 3 and 12-month follow-up., Results: Before the training a questionnaire was completed by 1778 patients, of whom 179 were depressed; after the training a questionnaire was completed by 1724 patients, of whom 155 were depressed. Detection and diagnosis of depression improved in the first group of GPs, but not in the second group. Treatment improved for patients in both groups. In terms of symptoms, illness duration, daily functioning, and absence from work patients recovered slightly faster from their depression after the training, although the effects were weak, not always statistically significant (p < 0.05), and mostly limited to the subgroup of recognized depressions with a recent onset. At the 12-month follow-up the pre-post differences were not statistically significant., Conclusion: The postgraduate training with the INSTEL programme appears to be an effective intervention that improves treatment and somewhat speeds up recovery in recent onset cases.

Objective: To establish the prevalence of depression and other psychiatric disorders in the contact population of primary care physicians (PCPs) in several countries., Design: Descriptive., Setting: World Health Organization (WHO), Geneva, Switzerland., Method: The WHO carried out a study in 15 centers in 14 different countries, including the Groningen centre in the Netherlands. This study comprised interviewing 5438 patients with the primary health care version of the 'Composite international diagnostic interview' (CIDI). The PCPs also evaluated their patients' somatic and psychic health., Results: Depression was found to be seen at all centres, according to the CIDI results as well as according to the physicians. Most patients with a depression were treated by the PCPs themselves; only a small proportion were referred. As regards pharmacotherapy, in most centres tranquillizers were prescribed more often than antidepressive agents. Groningen differed from the other centres in that a larger proportion of depressive patients attended the PCPs for a psychological reason for encounter, and in that the patients' somatic health was classified as much better. The Groningen PCPs referred to institutes for mental health care more often than the PCPs in most other centres., Conclusion: Depression was diagnosed in all participating countries, both by PCPs and with the aid of the CIDI results.

This article presents a new development on the field of psychotherapy: Eye-Movement Desensitization and Reprocessing (EMDR). This recently developed procedure promises rapid and effective treatment of anxiety related complaints, including post-traumatic stress disorders (DSM-III-R). In essence the therapist induces a series of rapid and rhythmic eye-movements. EMDR facilitates cognitive changes and lasting decrease of anxiety. As indicated by research and illustrated by case histories, EMDR can be effective in one session. Until now there is no definitive explanation for the effectiveness of this method.

This article addresses the issues of recognition and labelling of psychological disorders (PDs) by general practitioners (GPs), and the association of recognition with management and outcome. Nearly 2000 attenders of 25 GPs were screened with the GHQ and a stratified sample of 296 patients was examined twice, using the Present State Examination (PSE) and Groningen Social Disability Schedule (GSDS). Prevalence rates of PDs according to the GHQ, GP and PSE were 46%, 26% and 15% respectively. For the 1450 'new' patients, i.e. patients who had no PD diagnosed by their GP in the 12 months prior to the enrollment visit, these rates were 38%, 14%, and 10%. GPs missed half of the PSE cases and typically assigned non-specific diagnoses to recognized cases. Depressions were more readily recognized than anxiety disorders, and the detection rates for severe disorders were higher than those for less severe disorders. Recognition was strongly associated with management and outcome. Recognized as compared to non-recognized cases were more likely to receive mental health interventions from their GP and had better outcomes in terms of both psychopathology and social functioning. Initial severity, psychological reasons for encounter, recency of onset, diagnostic category, and psychiatric comorbidity were related to both better recognition and outcome. However, these variables could not account for the association of recognition with management and outcome, but some did modify the association. A causal model of the relationships is presented and possible reasons for non-recognition and for the beneficial effects of recognition are discussed.

The effect of naloxone on a number of experimental shock models, using the anaesthetized rat, was studied with special emphasis on mean arterial blood pressure (MABP) and chance of survival. Only a slight increase in MABP was noted in haemorrhagic shock models whereas survival was not affected. Naloxone was without effect in endotoxin shock (i.p. administration of endotoxin). In endotoxin shock (i.v. administration) naloxone increased MABP especially at a high dose of endotoxin. Although survival time was prolonged, the chance of permanent survival was not improved. Naloxone had practically no effect in anaphylactic shock and intestinal ischaemia shock. It is concluded that if naloxone has any effect it is relatively slight. However, this does not exclude the possibility that naloxone might still be considered as an adjunct to other forms of shock treatment at least in certain types of shock.

The ground state geometry of the protonated form of clonidine was established by CNDO/2 (complete neglect of differential overlap) calculations. For the interplanar angle of this molecule we found a value of about 40 degrees. The interplanar angles of a number of clonidine related derivatives, both bases and protonated forms, were calculated on the basis of the results obtained for clonidine by taking into account the bond lengths and van der Waals radii of the substituents present at the ortho positions of the phenyl ring. The preferred conformations of the free bases and protonated forms were used as inputs for the semi-empirical PPP-MO (Pariser, Parr and Pople molecular orbital) calculation procedure in order to obtain several quantum chemical parameters. Excellent correlations resulted in relating some of the calculated parameters with the experimentally determined pK'a of the molecules. The results show the ability of MO-calculations to predict the basicity in this series of congeneric molecules and furthermore support the reliability of the calculation procedure in providing the quantum chemical parameters reported in this paper.