Recognition and treatment of patients with sleep problems in general health care

The form, frequency and burden of sleep problems in general health care in the WHO Collaborative Study on psychological Problems are presented in this same issue. This study was conducted in 5,438 primary care patients belonging to 15 centres in 14 countries after 25,916 patients were screened with the GHQ-12. Diagnoses according to the International Classification of Diseases (ICD-10) were obtained from the Composite International Diagnostic Interview (CIDI-PHC). The presence of difficulties failing asleep, staying asleep, waking too early or sleeping too much were assessed by the CIDI, General practitioners (GPs) gave their opinion on the existence of a psychological problem and/or a physical disease and indicated what therapeutic intervention was proposed to patients they recognized as psychological cases. The existence of sleep problems increased the recognition of patients with psychiatric disorders by their GP. No specific subtype of sleep problems influences recognition. The existence of a somatic disease had little influence on the identification of sleep problems as psychological cases. Sleep problems were not frequently expressed as a main presenting complaint. In such a case the recognition rare of patients with ICD-10 diagnosis was unchanged bur a sedative treatment was offered more frequently. Overall, 85.9% of patients with sleep problems and recognized as cases were offered treatment, 53.9% drug treatment. The most frequent treatment consumed was stimulants, tonics or vitamins while the most frequently prescribed were antidepressants, hypnotic and anxiolytics with rather similar proportions. Drug consumption was substantially lower than drug prescription.