A Norwegian psychiatric epidemiological study.

OBJECTIVE: This study reports results of a large-scale epidemiological investigation of the prevalence of mental disorder in Oslo. METHOD: A random sample of Oslo residents age 18-65 years was drawn from the Norwegian National Population Register. A total of 2,066 subjects, 57.5% of the original sample, were interviewed with the Composite International Diagnostic Interview in 1994-1997. The mean age of the interviewed subjects was 39.3 years. RESULTS: The 12-month prevalence of all mental disorders was 32.8%, and the lifetime prevalence was 52.4%. Alcohol abuse/dependence and major depression had the highest lifetime prevalence and 12-month prevalences. All mental disorders were more prevalent in women than in men, with the exception of alcohol and drug abuse/dependence. Severe psychopathology (e.g., three or more diagnoses) was found in 14%-15% of the respondents. The lifetime and 12-month prevalences for all diagnostic categories except drug abuse/dependence were similar to those found in the United States Comorbidity Survey. CONCLUSIONS: Epidemiological data for Oslo show that the lifetime and 12-month prevalences of mental disorder are quite high, with alcohol abuse/dependence and major depression particularly frequent. The rates for women are higher than those for men for all diagnostic categories, except for alcohol and drug abuse/dependence.     

Single case study. A novel psychiatric adjunct to cancer therapy

Confronted with the hazards of a patient unable to cooperate predictably with a 3-day radium implantation procedure as a part of cancer therapy, the authors describe in a case report their solution to an unusual clinical dilemma. The patient displayed adverse responses to psychotropics and nursing care was markedly restricted by radiation exposure limits. Behavioral management of the patient through the interval of radium therapy was successfully effected by the use of closed-circuit television monitoring combined with brief nursing interventions. This novel psychiatric adjunct to cancer therapy averted the threat posed by displacement of the radium implants.     

A study of competence to consent to treatment in a psychiatric hospital.

Sixty patients admitted to an acute treatment ward in a provincial psychiatric hospital were assessed for their competence to consent to psychiatric treatment. A semi-structured interview was used to determine whether they met none, some or all of the four necessary criteria for competence outlined in the Mental Health Act of Ontario. Only 21 of the 60 patients (37%) met all four criteria necessary for a patient to be considered competent to make their own decisions regarding psychiatric treatment. The study outlines the major difficulties in the assessment of competence to consent to psychiatric treatment. Our findings suggest that 74% of patients found incompetent using the current definition in the MHA (Ontario) would fail almost any reasonable test. The implications of these findings are discussed.     

On spatio-temporality. A psychiatric and interdisciplinary study

There is no scientific knowledge without a method, no method without a minimum of theory and no theory without a general frame of reference. The concepts of space and time constitute undoubtedly the most comprehensive frame of reference; it is relevant both to the interior, experienced world of man and to the universe in which he lives. The concepts of space and time, which have emerged from various disciplines such as philosophy, cosmology, physics, biology, neurophysiology, ethology and psychiatry show a certain number of mutual relations and even connections. Characteristically, these concepts fit in with the levels, integrations, communications and self-regulations, all the structural properties, which are emphasized by the model of mental disturbances, created by application of a special systems approach, the "systemal method", to the psychiatric clinic. This structural isomorphism between the mental disturbances and the cognitive concepts of space-time reinforce by feed-back the validity of the systemal method. It also indicates the relevance of the basic sciences to the further development of psychiatry.     

Variables related to the selection of psychiatric residents. II. A replication study

The primary purpose of this study was to attempt to replicate an earlier investigation concerned with the variables related to the selection of psychiatric residents.¹ For that study, a 32-item rating scale, the Resident Applicant Scale (RAS), was developed. The content of the items was based both on discussions with senior faculty members (psychiatrists and clinical psychologists) at Albert Einstein College of Medicine and a review of the literature. The reason for constructing the scale was to determine whether a brief, structured instrument was capable of discriminating between those applicants who were accepted and those who were rejected for residencies on the basis of global, clinical judgments made by psychiatrists using interviews, letters of reference, and past academic record. Fifteen of the 32 items were found to discriminate between the two groups. These items were concerned with such characteristics as creativity, curiosity, general range of knowledge, and intellectual grasp of psychiatry. In addition to their evaluation on the rating scale, the applicants' values and personality characteristics were studied.In order to determine whether the Resident Applicant Scale would continue to discriminate between those applicants who are accepted and those who are rejected and whether the same items would continue to have discriminating power, the present evaluation was undertaken with the following year's applicants for psychiatric residencies at Albert Einstein College of Medicine. A replication of the previous findings would increase the likelihood that there are stable criteria used by a variety of psychiatrists in evaluating applicants for residency training. Personality and value characteristics were again assessed using different measures.     

The PEH. A questionnaire to assess acknowledgment of psychiatric illness.

The aim of this research project was to develop an instrument to measure acknowledgment and denial of illness in hospitalized psychiatric patients. The investigators developed a 23-item, 4-point self report scale, the Patient's Experience of Hospitalization (PEH), and collected validity data from a sample of inpatients. A total of 29 subjects completed the PEH, the Marlowe-Crowne Social Desirability Inventory (MCSD), the MMPI, and a Global Assessment Scale (GAS) report. The patients' psychotherapists also provided GAS scores. Kuder Richardson split-half reliability and point biserial correlations of 18 items were adequate. The PEH total score correlated significantly and positively with the difference between the GAS scores assigned to the patient by the patient and by the therapist, with the patient's self-report GAS score, with MCSD scores and with the MMPI L and K scales, considered to assess crude and subtle defensive denial. Correlations with MMPI clinical scales (symptom reports) were negative, further supporting the idea of the PEH as a measure of denial.     

Neurologic referrals to a psychiatric consultation-liaison service. A study of 199 patients

The findings in a 199 neurology patients referred to a psychiatric consultation-liaison service are analyzed. Neurology referrals differ from general hospital referrals in reasons for referral and in patterns of diagnosis. The most common conversion symptoms seen are pain and pseudoseizures. The psychiatric diagnosis made in those patients with functional pain varies with the site of the pain. These two conversion symptoms, pain and pseudoseizures, have differing ages of onset and prognoses. A number of patients were given no psychiatric diagnosis and the reasons for this are discussed. The incidence of various neurologic diagnoses made in those patients referred to the consultation-liaison service is compared with the incidence of those diagnoses made in consecutive admissions to the neurology ward.     

A model to replace psychiatric hospitals.

A comprehensive system of community treatment in southwest Denver has reduced the need for adult psychiatric inpatient beds to less than 1/100,000 population. Six small, community-based therapeutic environments, crisis intervention, home treatment, social systems intervention, and rapid tranquilization comprise the essential components of this total community care system. The system operates within a framework of citizen participation and community control, the elimination of formal staff offices, and a focus on working in the real-life setting of the client and his family. To evaluate the effectiveness of community care, patients about to be hospitalized were randomly assigned to a psychiatric hospital or to community alternative treatment. Outcome measures at discharge and at follow-up completed by the client himself, treatment staff, and family members indicate that community treatment was more effective than psychiatric hospitalization.     

A comprehensive approach to psychiatric diagnosis.

The author discusses problems of the typological diagnostic system currently used in psychiatry, which focuses primarily on symptoms in classifying psychiatric disorders. He describes a comprehensive diagnostic system that would involve routine evaluation of five patient characteristics: symptoms, circumstances associated with symptoms, previous duration and course of illness, quality of personal relationships, and level of work function. He suggests that such a multivariable approach to psychiatric diagnosis can provide valuable information about the patient to clinicians, researchers, and other mental health workers.     

A cytogenetic study of children with psychiatric disorders.

The development of techniques permitting the visualization of chromosomal cross-bands has greatly enhanced the field of human cytogenetics. It has led to the exact identification of chromosomes and the detection of subtle chromosomal changes characterizing new clinical syndromes.^1–4The G (Giemsa) and Q (Quinacrine mustard) banding techniques are the most widely used. As a relatively simple and replicable procedure, G banding is the method of choice for clinical application. It is attained by staining the chromosome preparation with Giemsa-like stains. The resulting thick dark staining cross-bands that alternate with lighter ones confer distinctive features to each chromosomal pair.By using elongated chromosomes from late prophase or early metaphase instead of the customary late metaphases, the visual resolution is greatly increased, making it feasible to detect chromosomal changes on different groups of patients. The major psychiatric illnesses are important to study with the new techniques because (1) they have a strong genetic component and (2) an association between chromosomal changes and psychiatric disorders has been proposed.A population of children affected with psychiatric disorders was chosen for the present study since extraneous factors such as drugs, chronic physical illness, and institutionalization are less likely to play a role in the nature-nurture interaction.