Showing papers in "Acta Psychiatrica Scandinavica in 1983"

The Hospital Anxiety and Depression Scale.

Abstract: A self-assessment scale has been developed and found to be a reliable instrument for detecting states of depression and anxiety in the setting of an hospital medical outpatient clinic. The anxiety and depressive subscales are also valid measures of severity of the emotional disorder. It is suggested that the introduction of the scales into general hospital practice would facilitate the large task of detection and management of emotional disorder in patients under investigation and treatment in medical and surgical departments.

Psychometric evaluation of an inventory for assessment of parental rearing practices: A Dutch form of the EMBU

Abstract: The EMBU, an instrument which was designed to assess one's memories of parental rearing behaviour, was psychometrically evaluated. Principal component factor analysis of data of a mixed sample of 841 non-institutionalized phobic individuals revealed four factors which were termed Rejection, Emotional warmth, Over-protection and Favouring subject, thereby contributing to the convergent (cross-national) reliability and validity of the structural model of perceived parental behaviour. Besides the utilization of data from aforementioned phobic sample, the scales' internal consistency was assessed in data of five additional samples, which consisted of 277 'normals', 40 agoraphobics, 29 social phobics, 21 height phobics and 38 obsessive-compulsive neurotics, and found to be very satisfactory. In the normal and mixed phobic sample, validity measures were shown to be acceptable and to be independent of the parent's sex. Furthermore, findings suggested that the fact that retrospective data is being measured with the scales does not threaten the reliability and validity of gathered information due to faulty recall or falsified accounts.

The discontinuance of maintenance neuroleptic therapy in chronic schizophrenic patients: drug and social consequences.

Abstract: In a prospective follow-up the outcome of 60 chronic schizophrenic patients who discontinued neuroleptic therapy after remaining stable 12-48 months was compared with controls continuing medication. Not only did the drug-discontinued patients have more relapses (P less than 0.001), but the form of relapse was both more severe and acute, resulting in differences of self-injury (P less than 0.05), anti-social behaviour (P less than 0.01), inpatient admissions (P less than 0.001), and the use of compulsory powers (P less than 0.01). In patients who relapsed, both social and work function was affected adversely for some months. Patients who remained relapse-free without drugs (20%) had a level of work and social function similar to medicated patients. At the end of 18 months the patients who discontinued depot maintenance therapy were found to have been prescribed one-third more neuroleptic drugs than controls, with a possible increase in the risk of long-term tardive dyskinesia.

Lithium and pregnancy. A cohort study on manic-depressive women.

Abstract: By record linkage of a discharge diagnosis registry and a medical birth registry we identified 350 women with manic-depressive disease who had born a child. The total delivery outcome was poorer than expected with a high perinatal death rate and a high malformation rate. Further studies revealed a high rate of perinatal deaths and/or congenital malformations among infants born of women who had used drugs in early pregnancy, and this phenomenon was concentrated to women who had used lithium and to heart defects. The sample is small, however, and there is no statistically significant difference between delivery outcome in women on lithium and in women on other psychotropic drugs. Until better risk estimates are obtained, lithium should not be used in early pregnancy.

Psychological reactions to edentulousness and treatment with jawbone-anchored bridges.

Abstract: Total edentulousness can lead to chewing problems as well as to feelings of insecurity and inferiority and considerable psycho-social problems. For many people a conventional removable denture is unsatisfactory. A new method - osseointegration - involves a titanium screw being operated into the jawbone and the attachment of a fixed bridge. In a controlled study, 26 patients were examined pre- and postoperatively 3 months and then 2 years after the insertion of a jawbone-anchored bridge. The majority of them state that there has been a significant improvement in their lives, that they have regained confidence in themselves, and that, in contrast to a conventional denture, they accept the fixed bridge as part of their body. More attention should be focused on psychological reactions to total edentulousness. Individuals who cannot be rehabilitated by means of conventional prosthetic procedures should be given the opportunity of having a jawbone-anchored bridge inserted. Such treatment means an odontological and psycho-social restitutio ad integrum.

Alcohol-abusing teenage boys: Testing a hypothesis on the relationship between alcohol abuse and social background factors, criminality and personality in teenage boys.

Abstract: – A study material of teenage boys from the general population was used to test the hypothesis on early alcohol abuse suggested by the results of previous prospective studies on selected materials. The results of interviews of 1,004 18-year-old boys from the general population in the Stockholm area support the hypothesis that there is a group (about 4 % during autumn 1980) of boys with a high consumption of alcohol, simultaneous use of drugs and criminal behaviour. As a group these boys had been brought up in emotionally disturbed homes, with alcoholic parents, and they also showed personality features indicating psychopathy. The study provides evidence that results of investigations on selected materials are also relevant to the general population.

Bromocriptine in the prevention of alcohol abuse

Abstract: – – In a double-blind trial comprising 50 chronic alcoholics, randomized in two parallel groups, bromocriptine was compared with placebo on psycho-social variables in the prevention of alcohol abuse for 6 months. The overall effects on the abuse situation, social functioning, social belonging and psychic status were significantly bettered by bromocriptine. Craving was reduced from strong to very mild, indicating a distancing effect of bromocriptine on dependency. Neurotic states and depressive reactions were significantly improved by bromocriptine, as were social situation, motivation and personal insight. Global evaluation of bromocriptine treatment was beneficial in most patients, with a substantial reduction in the number of patients abusing alcohol. Our results indicate that bromocriptine may affect the craving.

Utilization of mental health services over a given period

Abstract: – The utilization of the mental health services was studied over a 2-year period for a cohort of 211 consecutively admitted patients from a catchment area in Oslo A cumulative index for service consumption showed that 10% of the patients used 75% of the service resources A bi-variate and a multi-variate analysis showed how psychopathology and sociodemographic factors contributed to the degree of service consumption

Psychotherapy in Irritable Bowel Syndrome

Abstract: Psychotherapy in the treatment of irritable bowel syndrome. A controlled outcome study. By Jan Svedlund, Department of Psychiatry, Sahlgren's Hospital, University of Goteborg, Sweden. Thesis defended 20th May, 1983. Problem: The irritable bowel syndrome (IBS) often becomes a chronic relapsing condition despite medical treatment. The influence of psychological factors on the course of the disorder has been recognized, but has had little influence on treatment. The aims of the study were to compare the effectiveness of routine medical treatment with combined medical treatment and psychotherapy, to elucidate mechanisms of therapeutic action and to find prognostic factors. Method: 101 IBS-outpatients with at least one year of complaints were randomly aallocated to two treatment groups. All patients received the same medical treatment. The patients in one group (n=50) were given dynamically oriented short term psychotherapy in addition. The psychotherapy was administered in one-hour-sessions weekly during three months and limited to ten sessions. Assessments were made by independent raters, and by self-ratings on three occasions, at intake before assignment to treatment group, three months later after the psychotherapy course and after a one year follow up. Changes in the severity of symptoms, social adjustment and coping ability with problems focused in the therapy were the main criteria of outcome. Results: The patients in both groups improved during treatment but after three months there was a significantly greater improvement in favour of the psychotherapy group. The difference became still more pronounced one year later as the psychotherapy group showed further improvement while the control group showed some deterioration. Global ratings of severity by independent raters showed that almost half of the patients in the psychotherapy group had improved at follow up versus ten per cent in the control group. According to patients' self-ratings two thirds had improved in the psychotherapy group versus 40 percent in the control group. The self-confidence and coping ability had also improved significantly more among patients receiving the combined treatment. Confounding factors such as differences in drug treatment, extra-therapeutic life events, treatments not included in the study, changes in smoking and drinking habits and drop-out rate did not contribute to the different outcomes. The combined treatment approach was applicable to a large proportion of the IBS-patients. Patients with a periodic course were more suitable for psychotherapy and patients with a need for achievement were more suitable for medical treatment only. Patients displaying reactivity during therapy were more successful in the handling of focused problems. Suitability for insight-oriented psychotherapy was more related to coping ability than to symptomatic improvement. Conclusions: Medical treatment gives a short term symptomatic improvement in IBS. By combining medical treatment with psychotherapy the outcome can be essentially improved, not only in short term but also in the long run. The major mechanism of action is probably the acquisition of more effective ways of coping with emotional problems. The result is in agreement with a psychosomatic approach, from which can be stated that treatment is more effective and rational if it considers both somatic and psychological aspects of a disorder, and lends added support to the concept of a psycho-physiological basis for IBS.

Amount of therapist contact and outcome in a multidimensional depression treatment program.

Abstract: An 8-week multidimensional program of behavioral management, cognitive restructuring, and assertiveness training was administered to depressed outpatients either individually with a single therapist (n = 12), in two small groups (n = 11), or one large group (n = 11), or as bibliotherapy (n = 12). A randomly assigned waiting list control group was also included (n = 10). Follow-up assessments were conducted at 18 weeks. Principal findings were that 1) there were no significant pretreatment differences among groups, 2) all treated groups including bibliotherapy improved substantially over the course of treatment, 3) the waiting list control group was unchanged during this same period, 4) there were no significant differences among treated groups at termination or at follow-up, nor did these groups change significantly over the period of follow-up. Thus the effectiveness of this multidimensional program was supported, but its efficacy was not systematically influenced by amount of therapist contact.

Neuropsychiatric symptoms in workers occupationally exposed to jet fuel--a combined epidemiological and casuistic study.

Abstract: Some aircraft personel and airline industry workers are exposed to jet fuel, a mixture of aliphatic hydrocarbons (petroleum 80%) and some organic solvents (petroleum 80%) and some organic solvents (aromatic hydrocarbons 20%). In order to evaluate the possible neuropsychiatric sequeale of such long-term occupational exposure, we examined 30 workers exposed at about 250 mg/m3 for 4-32 years at a jet motor factory. They were compared with two control groups (2 x 30) of matched non-exposed workers. The medical history was first assessed by standardized interviews and examination of medical records kept by the factory physician. The exposed subjects had, after their employment, much more often sought medical advice because of emotional dysfunctions, such as depression and anxiety, than had the control groups (P less than 0.005). When the prevalent mental symptoms, indicative of brain lesion, later were rated by psychiatrists, the exposed workers scored higher than did the controls (P less than 0.001). 14 subjects showing most symptoms were then selected for a thorough neuropsychiatric clinical investigation comprising psychosocial inquiries, psychological testing, personality assessment and neurological/neurophysiological examination. Seven were judged to suffer from mild organic brain syndrome (i.e. "organic neurasthenia") of which one subject was a severe case. The subjects had all undergone a slow but steady personality change over the years--starting from an ordinary strength without neurotic traits and moving towards an asthenic state with fatigue, anxiety and vegetative hyperreactivity. No other cause for this change could be identified as an alternative to the occupational exposure to jet fuel. It is concluded that personality changes and emotional dysfunctions are the foremost effects of such long-term exposure to petroleum products.

The effects of zimeldine and amitriptyline on car driving and psychomotor performance

Abstract: The development of an objective measure of car driving performance, brake reaction time (BRT), is described, and the effects of amitriptyline and zimeldine on this measure are compared in a placebo-controlled, acute, single dose, volunteer study. The effects of treatment on laboratory tests of critical flicker fusion (CFF) threshold, choice reaction time (CRT) and tracking accuracy and on self-assessments of sedation are also examined. At 2 hours post-treatment, amitriptyline produced a significant increase in brake reaction time when compared to both placebo and zimeldine. At 4 hours post-treatment, a significant reduction in "tracking accuracy" and a significant increase in CRT was observed after treatment with amitriptyline, while no such effects were seen with zimeldine. Measures of CFF threshold and self-ratings of sedation also revealed that amitriptyline produced a significant degree of sedation at 4 hours when compared to zimeldine and placebo. In contrast, zimeldine produced elevated CFF threshold, but did not affect self-ratings of sedation. Language: en

Offspring of women with nonorganic psychoses. Development of a longitudinal study of children at high risk.

Abstract: – This article describes the development of a prospective, longitudinal study of 88 “high-risk” offspring of pregnant index women with a history of nonorganic psychoses and 104 offspring of demographically-similar pregnant control women. The maternal psychoses represented the diagnostic categories, Schizophrenia, Cycloid Psychosis, Affective Illness, Psychogenic Psychosis, Postpartum Psychosis and Other (remaining) Psychoses. The first phase of the study began during pregnancy and continued until the offspring reached 2 years of age. Selected characteristics of the mothers, the offspring and their environments were investigated during this project phase.

Psychological function changes among maintenance house painters exposed to low levels of organic solvent mixtures.

Abstract: The adverse psychological effects of long-term exposure to organic solvent mixtures were studied among 219 maintenance house painters. Their mean age was 42 years and the duration of exposure 22 years. 229 reinforcement workers of the same mean age served as a nonexposed reference group. The groups were also matched according to pre-exposure intellectual level. The painters average exposure to white spirit was estimated to be 40 ppm. The maintenance house painters were characterized by defects in short-term visual memory and prolonged simple reaction times. Some slight relationships were found between low test performances and various individual indices of long-term exposure to solvents. The results implied that adverse psychological effects existed even though the exposure level was much lower than the hygienic standard applied for white spirit in many countries.

Acute memory impairment following electroconvulsive therapy. 1. Effects of electrical stimulus waveform and number of treatments.

Abstract: – The literature concerning acute changes in memory functions following electroconvulsive therapy (ECT) varying in stimulus electrode placement is reviewed. While it is clear that verbal memory deficits are greater following dominant unilateral (or bilateral) ECT than nondominant unilateral ECT, a definitive statement regarding nonverbal memory and electrode placement cannot be made due to methodological inadequacies of existing studies. The role of time before and after seizure induction is examined in relation to degree of retrograde amnesia, and possible causes of greater amnesia following bilateral than unilateral ECT are examined. Practical issues related to the choice of electrode placement are discussed.

Prognosis of treated hypochondriasis. A clinical study.

Abstract: Thirty-six patients who had hypochondriacal neurosis for 6 months or longer were treated with individual psychotherapy which focused predominantly on presenting complaints, fears and beliefs. Antianxiety drugs were used at times of anxiety. Sixty-four percent either recovered or improved to the extent that they no longer believed that they had a disease. The improvement was largely maintained on a 2-year follow-up. Good outcome was associated with illnesses of less than 3 years duration, the absence of an additional diagnosis of a personality disorder and there was a nonsignificant trend to belong to a higher social class. Outcome was not associated with age, sex, or severity of initial ratings of anxiety, depression or somatic symptoms. It appears that the prognosis of treated hypochondriacal neurosis is good in a substantial proportion of patients.

The Crichton Visual Analogue Scale for the assessment of behaviour in the elderly

Abstract: A visual analogue scale has been constructed to allow relatives and professionals to rate the behaviour of elderly patients. The scale has been shown to have good inter-rater reliability, test-retest reliability and validity. It is suggested that the scale can provide a quick and convenient initial assessment of the patient either at home or in hospital, and possibly also a measure of change.

Carbamazepine, a possible adjunct or alternative to lithium in bipolar disorder

Abstract: – The effect of carbamazepine in bipolar disorder has been studied by several groups. According to these studies carbamazepine appears to exert a “lithium-like” effect. Twelve patients with lithium-resistant bipolar disorder and without epilepsy were prophylactically treated for 3 years with carbamazepine in an open study. In most patients carbamazepine was added to lithium, neuroleptics and/or antidepressants. Four patients did not complete the minimum treatment period of 6 months required for evaluation. In the remaining eight patients carbamazepine seemed to be effective in four patients, had a possible or slight effect in two, and no effect in the remaining two. It is concluded that carbamazepine can be safely combined with lithium, and that carbamazepine, eventually combined with lithium, can be effective in lithium(-alone)-resistant bipolar disorder.

Dexamethasone suppression test in a pluri‐diagnostic approach: its relationship to psychopathological and clinical variables

Abstract: Using a pluridiagnostic approach, the dexamethasone suppression test (DST) was studied in 67 depressed inpatients in its relationship to diverse clinical variables. The International Classification of Diseases (ICD), the Research Diagnostic Criteria (RDC), the Newcastle Index, the Hamilton Depression Rating scale (HAM-D), and the Bf-s self rating questionnaire were applied. Fifty-two per cent of endogenous depressed (ICD), 51% of major depressive (RDC) and 53% of endogenous depressed (Newcastle) patients demonstrated dexamethasone nonsuppression (DSTN) with a value above 110 nm/l. Six per cent of neurotic depressed (ICD), 9% of minor depressive (RDC) and 23% of neurotic depressed (Newcastle) patients were dexamethasone nonsuppressors. Significantly higher values (after P-correction) for DSTN could be detected in severity ratings as measured with Newcastle (P less than 0.001) and HAM-D global score (P less than 0.001) and also for HAM-D factor 4 (somatic complaints, P = 0.001). All the other evaluated variables did not discriminate between patients with dexamethasone suppression and with nonsuppression.

Kidney function in lithium-treated patients. A literature survey.

Abstract: UNLABELLED Twenty-three studies of the effect of lithium treatment on tubular and glomerular function are reviewed. They include about 1,450 patients from a total population of more than 2,000. One hundred and thirty-two patients were kidney biopsied. In addition, two specific questions are reviewed: 1) Does combined treatment lithium/neuroleptics affect the kidneys adversely? 2) Do different lithium preparations or treatment schedules affect the kidneys differently? CONCLUSIONS In a small proportion of patients long-term lithium treatment causes morphological changes of a tubulointerstitial type and partly irreversible reduction of tubular function. Glomerular function is reduced secondary to tubular atrophy. Combined treatment with neuroleptics does not increase the risk of kidney damage. Types of lithium preparation do not affect kidneys differently. Multiple-dose schedules may be associated with a higher urinary output than one-dose schedule. Reduced renal function may in the future become a problem in an increasing number of patients.

Inpatient violence and the schizophrenic patient. A study of Brief Psychiatric Rating Scale scores and inpatient behavior

Abstract: A correlational analysis of Brief Psychiatric Rating Scale (BPRS) ratings and measures of inpatient violence in 207 schizophrenic patients is presented. Significant correlations were found between BPRS measures of schizophrenic symptomatology and several measures of inpatient violence including assault. BPRS subscales which related to paranoid symptoms were also significantly correlated with inpatient danger-related measures; however, to a lesser degree.

Sodium valproate and biperiden in neuroleptic-induced akathisia, parkinsonism and hyperkinesia. A double-blind cross-over study with placebo.

Abstract: Fifteen psychiatric patients participated in a double-blind cross-over study of the effect of sodium valproate (a GABA mimetic drug), biperiden (an anticholinergic drug) and placebo in neuroleptic-induced akathisia, parkinsonism and hyperkinetic movements. All patients had subjective and objective signs of akathisia, 11 had parkinsonism and 11 hyperkinesia, eight of which were tardive dyskinesia (TD) and three initial hyperkinesia. After a pretreatment washout period of 2 weeks, during which anticholinergic drugs, if any, were replaced by placebo, the patients were treated in three randomized periods of 4 weeks with sodium vaiproate, biperiden and placebo. Compared to placebo, sodium vaiproate (900–2400 mg/day, median 1700) had no significant effect on akathisia and parkinsonism, although akathisia was reduced in four patients (unchanged in 10 and increased in one) and parkinsonism was induced or aggravated in seven patients (unchanged in five and reduced in three). Sodium valproate, however, reduced hyperkinesia score (TD + initial hyperkinesia) from 1.6 to 1.2 (P < 0.05). Biperiden (6–18 mg/day, median 12) significantly reduced akathisia score from 1.4 to 0.6 (P < 0.01) and parkinsonism from 2.0 to 0.6 (P < 0.01), and increased TD score from 2.1 to 3.9 (P < 0.05). None of the drugs induced significant side effects. It is concluded that 1) sodium valproate has no significant effect on akathisia, but a slight beneficial effect in hyperkinetic movements, both TD and initial hyperkinesia, 2) sodium valproate may aggravate parkinsonism without necessarily aggravating akathisia, and 3) anticholinergic drugs like biperiden appear still to be the best treatment for akathisia.

Alcohol-abusing teenage boys. Testing a hypothesis on alcohol abuse and personality factors, using a personality inventory.

Abstract: This is the second part of an investigation of alcohol-abusing teenage boys, focusing on personality. One group of 50 High-consumers and one group of 50 0-consumers were selected from 862 18-year-old boys in the general population summoned to the Regional Recruiting and Replacement Office in Solna. These boys answered a personality inventory (KSP) to test a hypothesis on alcohol abuse and personality factors which might indicate psychopathy. The results support the hypothesis that alcohol-abusing teenage boys have psychopathic personality traits while the non-consuming boys have normal personalities. The study cannot reveal whether the differences in personality were the result of the high alcohol consumption or if the psychopathic personality traits preceded the high consumption. A reasonable hypothesis for further research is that vulnerable boys living under poor social conditions react to their situation with motoric restlessness, impulsiveness and aggressive acting-out behaviour. Due to this their social adjustment as grown ups is poor with consequent alcohol and drug abuse and criminality.

The role of occupational lead exposure in the genesis of psychiatric and behavioral disturbances.

Abstract: In a prospective study of lead neurotoxicity, exposed foundry workers and referents were evaluated using a comprehensive set of neurobehavioral tests. Other performance indexes were used including a questionnaire, physical examination, and nerve conduction testing. Results show increased rates of depression, confusion, anger, fatigue and tension among workers with blood levels over 40 mcg/dl. Other aspects of neurobehavioral function, including verbal concept formation, memory, and visual/motor performance were also impaired. In view of the large number of individuals exposed to lead in their work, specific inquiries should be made of individuals with affectual complaints to clarify the nature of their work and workplace exposure to lead.

The bi-seasonal incidence of some suicides. Experience from Finland by marital status, 1961-1976.

Abstract: The seasonal variation in suicides in Finland is examined by marital status using the individual records for all suicides committed in 1961-1976 and periodic regression analysis. Suicides were usually most frequent in spring or summer, but there was an exceptional secondary concentration of suicides in the autumn period among married and widowed females, which makes the monthly pattern bimodal. Suicides among divorced and widowed males aged 15-44 years showed a unimodal variation with the peak in autumn. While an influence from certain social factors might be entertained, the reasons for the seasonal variation in suicides in general and for this anomalous bimodality in particular remain unknown. Language: en

Psychological distress in parents of children with acute lymphatic leukemia

Abstract: Psychological distress in parents of children with acute lymphatic leukemia was evaluated by means of the Symptom Distress Checklist. This scale was administered twice: within a few days after the child's admission to hospital and 8 months later. Twenty-five consecutive, unselected subjects were compared with controls matched for age, sex, marital status and social class. At the first evaluation the sample presented higher mean scores than the controls for anxiety (P less than 0.005), depression (P less than 0.005), sleep disturbances (P less than 0.005) and obsessions (P less than 0.05). An 8 months' follow-up confirmed the persistence of anxiety (P less than 0.05), sleep disturbances (P less than 0.05) and above all depression (P less than 0.005). Language: en

A long-term follow-up of adolescent anorexia nervosa.

Abstract: Twenty-one female patients between the ages of 15 and 44 years who had suffered from anorexia nervosa between the ages of 11 and 17 were re-evaluated at a mean follow-up of 9.4 years. The continuing psychic impairment of the former patients was apparent both in interviews and questionnaires. Abnormalities were found in 10 to 66% of the patients according to different symptoms and criteria. The outcome was less favourable for patients who had experienced a high initial weight loss and had been subjected to repeated in-patient treatment. Three variables were most significant in terms of poor long-term prognosis: pre-morbid obesity, pre-morbid eating disorders and complications during pregnancy.

Pregnant women with nonorganic psychosis: life situation and experience of pregnancy

Abstract: Eighty-eight index women with a history of nonorganic psychosis and 104 demographically similar control women were interviewed during pregnancy after quickening concerning their experience of pregnancy and their current life situation. The index group, compared with controls, reported a significantly increased frequecy of material-situational problems, interpersonal difficulties and a lack of support for the pregnancy among the spouse and the woman's parents, an initially unplanned and undesired pregnancy, a negative attitude toward the pregnancy after quickening, moderate-to-heavy smoking, nervousness and anxiety, panic about the delivery, and great concern about their own mental health in the near future. No significant difference between groups was found on frequency of typical pregnancy symptoms, the experienced effect of pregnancy on physical health or concerns about the child's health or mothering.

Patterns of neuroleptic use among the institutionalised elderly.

Abstract: A survey was conducted of neuroleptic use amongst the residents of Local Authority homes for the elderly, and elderly patients in geriatric, psychogeriatric and general hospital wards in one of the London boroughs. Some 13% of the residents and patients surveyed were found to have received neuroleptics in the 24 h preceding the survey. Marked variation between homes and between wards and hospitals was observed, although for the sample overall associations were observed between disturbed behaviour and mood and the likelihood of receiving neuroleptics. Issues regarding the use of neuroleptics in the non-psychotic elderly are discussed.