A literature search, supplemented by an expert survey and selected reanalyses of existing data from epidemiological studies was performed to determine the prevalence and associated burden of bipolar I and II disorder in EU countries. Only studies using established diagnostic instruments based on DSM-III-R or DSM-IV, or ICD-10 criteria were considered. Fourteen studies from a total of 10 countries were identified. The majority of studies reported 12-month estimates of approximately 1% (range 0.5-1.1%), with little evidence of a gender difference. The cumulative lifetime incidence (two prospective-longitudinal studies) is slightly higher (1.5-2%); and when the wider range of bipolar spectrum disorders is considered estimates increased to approximately 6%. Few studies have reported separate estimates for bipolar I and II disorders. Age of first onset of bipolar disorder is most frequently reported in late adolescence and early adulthood. A high degree of concurrent and sequential comorbidity with other mental disorders and physical illnesses is common. Most studies suggest equally high or even higher levels of impairments and disabilities of bipolar disorders as compared to major depression and schizophrenia. Few data are available on treatment and health care utilization.

This study analyzed the efficacy of electroconvulsive therapy (ECT) in depression by means a meta-analytic review of randomized controlled trials that compared ECT with simulated ECT or placebo or antidepressant drugs and by a complementary meta-analytic review of nonrandomized controlled trials that compared ECT with antidepressants drugs. The review revealed a significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus placebo, ECT versus antidepressants in general, ECT versus TCAs and ECT versus MAOIs. The nonrandomized controlled trials also revealed a significant statistical difference in favor of ECT when confronted with antidepressants drugs. Data analyzed suggest that ECT is a valid therapeutic tool for treatment of depression, including severe and resistant forms.

This study analyzed the efficacy of electroconvulsive therapy (ECT) in depression by means a meta-analytic review of randomized controlled trials that compared ECT with simulated ECT or placebo or antidepressant drugs and by a complementary meta-analytic review of nonrandomized controlled trials that compared ECT with antidepressants drugs. The review revealed a significant superiority of ECT in all comparisons: ECT versus simulated ECT, ECT versus placebo, ECT versus antidepressants in general, ECT versus TCAs and ECT versus MAOIs. The nonrandomized controlled trials also revealed a significant statistical difference in favor of ECT when confronted with antidepressants drugs. Data analyzed suggest that ECT is a valid therapeutic tool for treatment of depression, including severe and resistant forms.A clinical reappraisal of electroconvulsive therapy (ECT) was conducted over the last decade after the observation that a proportion comprised between 20% and 40% of either unipolar or bipolar depressions did not respond satisfactorily to antidepressants (1, 2), despite the availability of more effective competitors for treatment of depression, like the selective serotonin reuptake inhibitors (SSRIs). An estimate of ECT efficacy can be obtained through the meta-analytic method that combines information from independent studies. Meta-analyses can use dichotomous or continuous data, with each type of data presenting advantages and disadvantages (3). Meta-analytic reviews that use continuous data produce reliable standardized weight mean differences, however, a decrease in a psychiatric scale does not necessarily means a clinical remission. A dichotomous measure, such as clinical response or no response, has a considerable advantage over derived statistical parameters because it employs raw data from each individual patients, allowing to know, for example, patients' proportions which achieve response with ECT in comparison other therapeutic tools. The objective of our study was to analyze the efficacy of ECT in depression by means a meta-analytic review of controlled clinical trials published between 1956 and 2003, using dichotomous data. METHODThis study reviews, by means of a MEDLINE search procedure using the key words electroconvulsive therapy and depression, all peer-reviewed publi-cations in English from January 1966 to February 2003. We also manually searched articles published prior to 1966 that might be relevant for our purpose. Among these studies, we selected those comparing ECT with simulated ECT, or placebo or antidepressants drugs. ECT trials conducted without comparison group were excluded from our analyses. Selected studies were classified and separated in nonrandomized controlled trials and randomized controlled trials.Like Janicak et al, (4) we used the studies in which it was possible to individualize each patient's response to treatment, using author's own criterion of response or no response. Basically, the response criterion was defined either as a reduction of at least 50% from baseline to end poin...

Burnout and sleep disorders have relevant bidirectional effects in medical students in the early phase of medical school. Emotional exhaustion and daytime sleepiness showed an important mutual influence. Daytime sleepiness linked unidirectionally with cynicism and academic efficacy.

The students who apply for medical school motivated by illness/death experiences are at a great risk for burnout. We suggest that students who are at risk for emotional exhaustion can be identified at the admission of medical school. Primary prevention strategies for burnout should consider this risk group.

Poor psychological well-being and social relationships can have implications that exceed the doctor's personal well-being. Future doctors with a low quality of life may translate into their poorer performance, impairing patient care.

This study assessed the influence of burnout dimensions and sleep difficulties on the quality of life among preclinicalphase medical school students. Data were collected from 193 students through their completion of the World Health Organization Quality of Life Instrument, the Maslach Burnout Inventory-Student Survey, the Mini-Sleep Questionnaire, the Social Readjustment Rating Scale, and the Beck Depression Inventory. This survey performed hierarchical multiple regressions to quantify the effects of emotional exhaustion, cynicism, academic efficacy, and sleep difficulties on the physical, psychological, social, and environmental components of an individual's quality of life. The influence of confounding variables, such as gender, stress load, and depressive symptoms, were controlled in the statistical analyses. Physical health decreased when emotional exhaustion and sleep difficulties increased. Psychological wellbeing also decreased when cynicism and sleep difficulties increased. Burnout and sleep difficulties together explained 22 and 21 % of the variance in the physical and psychological well-being, respectively. On the other hand, physical health, psychological well-being, and social relationships increased when the sense of academic efficacy increased. Physical and psychological well-being are negatively associated with emotional exhaustion, cynicism, and sleep difficulties in students in the early phase of medical school. To improve the quality of life of these students, a significant effort should be directed towards burnout and sleep difficulties.

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