Psychosocial research on mobbing is currently being carried out in a number of countries, mainly in Europe. Mobbing is defined as an extreme social stressor at workplaces. In this article, its serious mental and psychosomatic health consequences are demonstrated and discussed. A factor analysis of symptom statistics collected through answers from a study representative of the entire Swedish workforce showed post-traumatic stress disorder (PTSD) as the plausible diagnosis. In addition, 64 patients subjected to mobbing at their work places are diagnosed with the co-operation of a rehabilitation clinic specializing in the treatment of chrome PTSD. The statistical analysis of these 64 diagnoses shows a severe degree of PTSD, with mental effects fully comparable with PTSD from war or prison camp experiences.

Mobbing at work and the development of post-traumatic stress disorders.

Objective: The authors ‘ goal was to explore the historical, political, and social forces that have played a major role in the acceptance of the idea of trauma as a cause of the specific symptoms of posttraumatic stress disorder (PTSD) and to discuss the impact that current research findings have had on some ofthe initial conceptualizations ofthe disorder. Method: The conceptual origins of PTSD are described, and the literature on the prevalence, longitudinal course, phenomenology, and neurobiology of PTSD is reviewed. Results: Paradoxically, there are a series of findings that support the idea that PTSD is a distinct diagnostic entity, but these are different from those originally developed from psychosocial theory and stress research. �j clusions: PTSD has been a controversial diagnosis and is again at a vulnerable point. It is imperative that the field address how current findings challenge the original conceptualizations of this disorder so that the next generation of conceptual issues can be formulated. (Am J Psychiatry 1995; 152:1705-1713)

Conflict between current knowledge about posttraumatic stress disorder and its original conceptual basis

We present a systematic review of prospective cohort studies. Our aim was to assess prognostic factors associated with functional recovery of patients with whiplash injuries. The failure of some patients to recover following whiplash injury has been linked to a number of prognostic factors. However, there is some inconsistency in the literature and there have been no systematic attempts to analyze the level of evidence for prognostic factors in whiplash recovery. Studies were selected for inclusion following a comprehensive search of MEDLINE, EMBASE, CINAHL, the database of the Dutch Institute of Allied Health Professions up until April 2002 and hand searches of the reference lists of retrieved articles. Studies were selected if the objective was to assess prognostic factors associated with recovery; the design was a prospective cohort study; the study population included at least an identifiable subgroup of patients suffering from a whiplash injury; and the paper was a full report published in English, German, French or Dutch. The methodological quality was independently assessed by two reviewers. A study was considered to be of 'high quality' if it satisfied at least 50% of the maximum available quality score. Two independent reviewers extracted data and the association between prognostic factors and functional recovery was calculated in terms of risk estimates. Fifty papers reporting on twenty-nine cohorts were included in the review. Twelve cohorts were considered to be of 'high quality'. Because of the heterogeneity of patient selection, type of prognostic factors and outcome measures, no statistical pooling was able to be performed. Strong evidence was found for high initial pain intensity being an adverse prognostic factor. There was strong evidence that for older age, female gender, high acute psychological response, angular deformity of the neck, rear-end collision, and compensation not being associated with an adverse prognosis. Several physical (e.g. restricted range of motion, high number of complaints), psychosocial (previous psychological problems), neuropsychosocial factors (nervousness), crash related (e.g. accident on highway) and treatment related factors (need to resume physiotherapy) showed limited prognostic value for functional recovery. High initial pain intensity is an important predictor for delayed functional recovery for patients with whiplash injury. Often mentioned factors like age, gender and compensation do not seem to be of prognostic value. Scientific information about prognostic factors can guide physicians or other care providers to direct treatment and to probably prevent chronicity.

Prognostic factors of whiplash-associated disorders: a systematic review of prospective cohort studies.

Central post-stroke pain (CPSP) is a neuropathic pain syndrome characterized by constant or intermittent pain in a body part occurring after stroke and associated with sensory abnormalities in the painful body part. This study describes CPSP prospectively during the first year after stroke and characterizes the cerebrovascular lesions and neurological signs associated with the CPSP syndrome. Two hundred and sixty-seven consecutively admitted patients younger than 81 years were examined in the first week, at 1, 6 and 12 months after stroke. Sensibility to touch (cotton wool), temperature (20°C and 40°C), and pinprick was studied using the contralateral face and extremity as control. A CT scan was done 8 (median) days (range: 1–34 days) after stroke. Two hundred and seven (78%) patients surviving at least 6 months who were able to communicate reliably formed the basis of the study. Abnormal sensory signs were found at least once in 87 (42%) patients. CPSP was found in 16 (8%) patients of whom all but 1 patient also had evoked dysesthesia or allodynia. Further 1 patient had persistent evoked dysesthesia but denied pain. CPSP was not related to sex or age. In patients with single acute cerebral lesions there were no relation between size or location of the lesions and the presence of CPSP. The pain was light in 6 (3%) patients and moderate to severe in 10 (5%) patients. The pain quality was usually lacerating or aching. Fifteen (94%) patients had decreased temperature, touch and pain sensibility and 9 (56%) reported allodynia to cold stimulation and another 9 (56%) patients reported this to touch. Pain onset was within 1 month after stroke in 10 (63%) patients, between 1 and 6 months in 3 (19%) patients and more than 6 months after stroke in 3 (19%) patients.

Incidence of central post-stroke pain

ContextThe prevalence of medical disorders is high among substance abuse patients,
yet medical services are seldom provided in coordination with substance abuse
treatmentObjectiveTo examine differences in treatment outcomes and costs between integrated
and independent models of medical and substance abuse care as well as the
effect of integrated care in a subgroup of patients with substance abuse–related
medical conditions (SAMCs)DesignRandomized controlled trial conducted between April 1997 and December
1998Setting and PatientsAdult men and women (n = 592) who were admitted to a large health maintenance
organization chemical dependency program in Sacramento, CalifInterventionsPatients were randomly assigned to receive treatment through an integrated
model, in which primary health care was included within the addiction treatment
program (n = 285), or an independent treatment-as-usual model, in which primary
care and substance abuse treatment were provided separately (n = 307) Both
programs were group based and lasted 8 weeks, with 10 months of aftercare
availableMain Outcome MeasuresAbstinence outcomes, treatment utilization, and costs 6 months after
randomizationResultsBoth groups showed improvement on all drug and alcohol measures Overall,
there were no differences in total abstinence rates between the integrated
care and independent care groups (68% vs 63%, P =
18) For patients without SAMCs, there were also no differences in abstinence
rates (integrated care, 66% vs independent care, 73%; P = 23) and there was a slight but nonsignificant trend of higher costs
for the integrated care group ($36796 vs $32409, P
= 19) However, patients with SAMCs (n = 341) were more likely to be abstinent
in the integrated care group than the independent care group (69% vs 55%, P = 006; odds ratio [OR], 190; 95% confidence interval
[CI], 122-297) This was true for both those with medical (OR, 338; 95%
CI, 168-680) and psychiatric (OR, 210; 95% CI, 104-425) SAMCs Patients
with SAMCs had a slight but nonsignificant trend of higher costs in the integrated
care group ($47081 vs $42795, P = 14) The incremental
cost-effectiveness ratio per additional abstinent patient with an SAMC in
the integrated care group was $1581ConclusionsIndividuals with SAMCs benefit from integrated medical and substance
abuse treatment, and such an approach can be cost-effective These findings
are relevant given the high prevalence and cost of medical conditions among
substance abuse patients, new developments in medications for addiction, and
recent legislation on parity of substance abuse with other medical benefits

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Integrating primary medical care with addiction treatment: a randomized controlled trial.

Previous studies claiming that psychosocial factors do not primarily influence the course of recovery from common whiplash have all been conducted on patient groups referred by medical physicians because of acute symptoms days to weeks after the injury. These designs may falsely underestimate the role of psychosocial predictors in the course of common whiplash. We studied 107 subjects consecutively admitted to the Municipality of Oslo Emergency Service hours after sustaining a whiplash injury. Acute assessment included clinical examination, a questionnaire about preaccident health problems, assessment of acute emotional response to the injury (Impact of Event Scale (IES)), and visual analogue scale (VAS) assessment of the acute pain. Four weeks after the injury 93% of the subjects filled in a questionnaire about their symptoms including VAS-rated neck pain. A significant correlation between acute VAS neck pain and IES scores were found. At 4 weeks 42% of the subjects still reported significant pain proble...

Acute emotional response to common whiplash predicts subsequent pain complaints: A prospective study of 107 subjects sustaining whiplash injury

The effect of major railway accidents on the psychological health of train drivers—II. A longitudinal study of the one-year outcome after the accident

The effect of major railway accidents on the psychological health of train drivers—I. Acute psychological responses to accident

The first Norwegian evaluation of the DSM-III system of classification occured in 1980. A Norwegian translation of the diagnostic criteria was published as part of a textbook in psychiatry in 1984. The Mini DSM-III (Quick reference) was published in 1985. The DSM-III system has been generally well accepted in Norway and is currently used in most research projects besides the ICD system. Several training courses have been arranged for senior psychiatrists and psychologists. Introduction to the DSM-III system is also part of the obligatory training course for psychiatric residents in Norway.



From 1987 Norway will use a clinical modification of the ICD-9 system of classification. This modification applies 5 digit coding and includes diagnostic categories found in the DSM-III system but not in the 4 digit ICD-9 version.



The DSM-III system of classification represents a major step forward in psychiatric classification. However, revisions are necessary to increase clinical validity. Although Norwegian psychiatry has been inspired by the DSM-III system, Norway remains committed to the ICD systems. The goal must be to make further revisions of the DSM-III and ICD systems, and in the end unite the strengths of these two systems of psychiatric classsification.

DSM-III and Norway. History, attitudes and future.

Comorbidity of substance use disorders with physical and mental disorders was investigated among 1249 consecutive psychiatric consultation patients admitted to six general hospitals in Finland. Of the patients 354 (28%) were diagnosed with substance use disorders (ICD-10), of which 22% were due to use of at least two different types of psychoactive substances. Alcohol dependence (117/226) in male patients and acute drug intoxication (49/128) at a similar rate as alcohol dependence (44/128) in female patients were the most common clinical conditions. With few exceptions, all substance use disorders were comorbid and in 63% of affected patients comprised a "triple diagnosis" (i.e., physical, mental, and substance use diagnoses concurrently). Poisonings and personality disorders in both sexes, digestive system diseases in men, and injuries in women were related to substance use disorders. Conclusions for service provision were: (1) the high level of co-occurrence of physical and mental disorders with substance use disorders calls for comprehensive, multi-disciplinary assessment of any substance use problems ascertained in psychiatric consultations; (2) poisoning with substance use involvement and mental comorbidity was the most common combined clinical condition justifying provision of addiction psychiatric emergency consultations in general hospitals; (3) polydrug use indicating severe problems and complex treatment needs should be identified; and (4) psychiatric referrals of patients with physical alcohol-related disorders should be ensured in general hospitals.

UF Malt

Papers

Acute emotional response to common whiplash predicts subsequent pain complaints: A prospective study of 107 subjects sustaining whiplash injury

The effect of major railway accidents on the psychological health of train drivers—II. A longitudinal study of the one-year outcome after the accident

The effect of major railway accidents on the psychological health of train drivers—I. Acute psychological responses to accident

DSM-III and Norway. History, attitudes and future.

Physical and Mental Comorbidity of Substance Use Disorders in Psychiatric Consultations