Prognostiske prediktorer og langtidsforløpet for nevroser og andre psykiske lidelser: 20 års follow-up fra en psykiatrisk spesialistpraksis

Den psykiatriske solopraksis gir muligheter for utvikling av et nÆrt lege-pasientforhold. Vestfold er Norges minste fylke med en befolkning på ca. 174 000 i 1960 stigende til ca. 187 000 i 1980. Forfatteren har arbeidet som psykiatrisk spesialist i Vestfold i hele dette tidsrommet og har således hatt muligheter for å følge mange av pasientene gjennom et langt avsnitt av deres liv. Han har på den måten fått et inntrykk av langtidsforløpet ved psykiske lidelser og likeledes en formening om hvilke kategorier pasienter sorn klarer seg godt eller dårlig. Hensikten med denne undersøkelsen er å objektivisere forløpet og dokumentere bakgrunnsfaktorer med relasjon til prognosen. Ifølge Strømgren (1980) er dette to av flere mulige målsettinger for longitudinelle studier, som ellers stort sett har hatt sitt utgangspunkt i hospitaliserte pasienter og som oftest i endogene psykoser. Foreliggende arbeid omhandler imidlertid et diagnostisert uselektert poliklinisk klientell, og diagnostisk består materialet hovedsaklig av nevroser, men med innslag av psykoser, krisereaksjoner, karakteravvik og misbruksproblematikk.

Forfatteren er takknemlig for finansiell støtte fra Anders Jahres fond til vitenskapens fremme og for verdifull veiledning ved dosent dr. med. Ole Bratfos.     

Drikkemønstre hos førstegangsklienter ved århusianske alkoholambulatorier i 1972 og 1982

Danskernes alkoholforbrug er større end tidligere og forbrugsmønstret har ændet sig. Rere kvinder og et tiltagende antal unge bruger alkohol. Disse ændringer afspejles kun i nnge grad i sammensætningen af alkoholambulatorieklienteler. Journalerne på hhv. 200 og 234 førstegangsklienter ved århusianske alkoholambula-torier fra finansåret 1972/73 og kalenderåret 1982 er gennemgået. Specielt savnes behandlingssøgende unge, og man finder fortsat mange med misbrug af blandede alkoholtyper. Som helhed er det fortsat de svært belastede, der søger behandling 5–7 år efter, at et overforbrug er udviklet.

Povl Munk-Jørgensen er under uddannelse til speciallæge i psykiatri og har gennem flere år vaeret engageret i alkoholistbehandlingsarbejdet.

Rudolf Kaldau, der som Rut Kristensen, er under uddannelse til ahen praktiserende læge har ligeledes vaeret beskæftiget inden for dette område.

Vi takker vore rådgivere og medarbejdere: overlæge, dr. med. A. Dupont, overlæge C. J. Hansen, sekretær B. Jensen, overlæse. P. Liisbers, sekretær M. Mortensen og programmør S. Skadhede.

Projektet har modtaget støitte fra Statens lægevidenskabelige forskningsråd DK (12–4313).

During the 25 years from 1955 to 1980 an increase in the annual average consumption of alcohol was registered from about 41 to 11.71 (measured in litres of absolute alcohol per inhabitant 15 years and above). The increase from 1972 to 1980, however, has been from 10.31 to 11.71 only. Nowadays it is more common among females and younger people to drink alcohol than previously, and the consumption of beer and wine has increased.

In the present work the following hypotheses have been tested

1. the changed consumption pattern in society is shown in the composition of the clientele in an out-patient clinic for alcoholics and

2. the clients treated in a clinic without connection to a psychiatric hospital show a different abuse pattern from that of those treated in a clinic connected to a psychiatric hospital.

All case records of first referrals during the fiscal year 1972/73 and the calendar year 1982 in two out-patient clinics were examined. The two clinics were the one (R) connected to the Psychiatric hospital in the northern part of Aarhus, DK (250 000 inhabitants), and a clinic (M) established in a 1979 branch of a small somatic hospital. 170 males and 30 females were referred to the R-clinic in 1972/73 and in 1982 the corresponding numbers were 103 males and 35 females. 71 males and 25 females were first referred to the M-clinic in 1982. By comparing the 1972/73-material with the total 1982-material it is seen that significantly fewer from the latter had an abuse of mixed alcohol types and that more of the 1982-clients preferred beer or wine only, though there was no significant difference between the two 1982-clienteles (R and M). Of the 1972/73-material 15% were intoxicated or had a withdrawal syndrome at their first appearance at the clinic, and this was the case with 19.2% of the 1982-clients. Regarding the 1982-clients there was a marked difference between the two clienteles, since of the M-clients 8.3% were intoxicated at their first appearance at the clinic and of the R-clients 26.1%. There was no difference in average age between the three populations (R-1972/73, R-1982, and M-1982) as regards the groups of intoxicated (incl. clients with withdrawal syndrome) and the group of alcoholics who were sober at first appearance to the clinic. The preferred type of consumption, i.e. beer only or mixed alcohol types, did not influence the condition (intoxicated or sober) at first appearance at the clinics in 1972/73 or in 1982. On development of alcohol abuse the average age was significantly higher for females than for males in 1982.

The average duration of years passing from developing an excessive consumption of alcohol to the time of treatment in the clinics is between 5.3 and 7.1 years.

It may be concluded that first referred clients had almost the same drinking patterns in 1982 as ten years before. By establishing more out-patient clinics within the same area it seems that different clienteles are treated.     

Pasienters møte med en psykiatrisk poliklinikk: En pilotundersøkelse fra Dikemark Sykehus,Avdeling 6, Møllergt. 43, Oslo 1

Gjennomføiring av etterundersøikelser ut fra vår kliniske situasjon burde være en selvføilge i vårt psykiatriske arbeid. I vår poliklinikk som inntil 1976 var en «etter-vernsavdeling» (oppfølging av pasienter etter utskrivning fra Dikemark sykehus) ga sektoriseringen av Oslo psykiatrien oss nye typer av henvendelser fra hjemmene, primzrhelsetjenesten og sosialkontorene. Denne artikkel beskriver våre overveielser og praktiske vanskeligheter rned en slik undersøkelse på toppen av vårt vanlige arbeid.     

Betablokkere i psykiatrien En litteraturoversikt og en egen undersnørkelse

Denna översikt över betablockerarnas användning inom psykiatrin är för-fattad av På Hartvig (t.v.) och Svein Fjerdingstad(r.h.). PåHartvig är sedan 1970 overlege vid Telemark sentralsjukehus, psykiatrisk sjukehusavdeling och sedan 1974 formann i Den norske lcøegeforenings spesialitetskomite ipsykiatri. Svein Fjerdingstad tjanstgjorde 1971–73 som reservelege vid Telemark sentralsjukehus men arbetar fn. som distriktslege i Sauherad og Bø.     

Om neurosebehandling med kombineret psykoterapi og elektroshockbehandling: Klinisk og neurofysiologisk bedømt

Hut mycket skall vuxenpsykiatern ingripa i situationer där vårdnadsfrågor aktualiseras? Det är en av de frägor överläkaren Wolfgang Rutz i Visby diskuterar i vidstående artikel, som bygger på ett föredrag vid 1977 års nedicinska riksstämma i Stockholm.     

Militárpsykiatrien i fredstid Om organisation,midler og mål

Peter Arup Fischer (bilden) har varit del-tidsanställd vid militärpsykiatriska avdel-ningen i Köpenhamn och är sedan augusti 1972 t. f. överläkare vid Fredriksbergs Hospitals psykiatriska avdelning. Sedan febr. 1973 ar han klinisk lektor i psykiatri.     

Metodeutvikling ved etterundersøkelse av kvinner med alkoholproblemer

Artikkelen beskriver de vansker som er forbundet med langtidsstudier av en så stigmatisert pasientgruppe som kvinnelige alkoholmisbrukere er. Hovedvekten er lagt på beskrivelse av kontaktetablering, metodeutvikling og aweining mellom forskningsmessige og etiske hensyn.

Forfatteren er spesialist i psykiatri. Hun var i tidsrommet 1976–81 overlege ved Blå Kors Sosialbygg, Bergen, som mottar klienter med alkoholproblemer til avrusning og videreformidling i behandlingsapparatet. De siste to årene hat forfatteren vært NAVF- stipendiat rned henblikk på å gjøre en personlig etterundersøkelse av kvinnelige alkoholmisbrukere.

The article presents some of the ethical, practical and methodological problems of a personal, long-term follow-up study of 53 women treated for alcohol dependence.

The author describes the problems of establishing contact with this client group. Passive avoidance is the most frequent response to a written request about a research interview. This is an understandable reaction to any kind of research involving sensitive personal matters. But, especially in this group, it also means activation of feelings of shame as well as fantasies about being exploited or controlled. To overcome this difficulty, the researcher has to go and see the informant in her home. In a face-to-face situation, the researcher and the client have an opportunity to discuss more directly the clients feelings and the ethics involved. Following this procedure, 80% of the identified women were willing to participate in the follow-up interview.

The actual patient group is socially unstable and difficult to trace by the public census. The necessity of gaining access to informal information on their actual living place, is stressed.

Most of the interviews took place in the clients' home. This interview situation facilitated an atmosphere of openness and self-reflection on the part of the clients. On the other hand, it also created a tendency which favored small talk on everyday problems. Thus the interview situation put demands upon the researcher to keep a delicate balance between the necessary control of the interview versus a spontaneous conversation, the needs of the client to talk for her own sake versus the researcher's scientific curiosity, and professional distance versus personal closeness.

If the researcher is an experienced clinician, a follow-up interview in many cases will have positive therapeutical implications for the actual client group.

Planning for the possibility of follow-up studies as part of the administrative organization of the treatment, patient consent can be obtained for using a stable contact person in her social network as a helper in the process of longer term follow-up and, thus, will facilitate the present studies.     

Mørder,notitser og personalia

The Millon Clinical Multiaxial Inventory (MCMI) has become an important and commonly used instrument to assess personality functioning. Several studies report significant changes on MCMI personality disorder scales after psychological treatment. The aim of the study was to investigate whether pre–post-treatment changes in 39-session psychodynamic group psychotherapy as measured with the MCMI reflect real personality change or primarily reflect symptomatic state changes. Pre–post-treatment design included 236 psychotherapy outpatients. Personality changes were measured on the MCMI-II and symptomatic state changes on the Symptom Check List 90-R (SCL-90-R). The MCMI Schizoid, Avoidant, Self-defeating, and severe personality disorder scales revealed substantial changes, which could be predicted from changes on SCL-90-R global symptomatology (GSI) and on the SCL-90-R Depression scale. The MCMI Dependent personality score was the only MCMI personality scale showing significant change when the SCL-90-R Depression change score was included as a covariate. Splitting patients into those with and without personality disorders did not change the results. Observed changes on MCMI-II personality disorder scales in short-term psychotherapy reflect change in symptomatic state. The MCMI-II Base Rate cut-off points probably include too many patients, justifying the introduction of new scoring procedures in the MCMI-III.     

Notitser,Møder og Personalia

Willi, J.: Der Gemeinsame Rorschach-Versuch. Diagnostik von Paar- und Gruppenbeziehungen. 1973. 191 sid. Verlag Hans Huber Bern. Fr. 46: / DM 41:—. Anm.: Greta Deines.

Agnete Diderichsen og Joachim Israel (red.): Sexologi. Hans Reitzel. København 1973. 413 s. Dkr. 98.50. Anm.: John Birger Sørensen.     

Recidivforebyggelse ved manio-depressiv sygdom Problemer og strategier før og nu

Schou M. Relapse prevention in manic-depressive illness. Previous and present problems and strategies.

Introduction of prophylactic or relapse-preventive lithium treatment was based on the observation of individual patients, followed by studies of small groups, by studies of larger groups observed for many years, and, finally, by placebo-controlled double-blind studies. Today problems are quantitative rather than qualitative. We must study not only monotherapy but also treatment combinations. There are ethical problems to face and problems concerning the sequence of treatments, double-blind trials, random allocation of treatments, multicenter studies, duration of trials, and the choice of variables. Patient and family assessments of the quality of treatment outcome are significant variables.