A nationwide representative sample of treatment-seeking alcoholics: a study of psychiatric comorbidity

In order to elucidate the psychiatric comorbidity of patients in alcohol and other substance use disorder treatment we examined a representative sample of such patients in Iceland (249 men and 102 women). Over 70% of pure alcoholics and over 90% of polysubstance users had comorbid diagnoses, a prevalence higher than in the Epidemiological Catchment Area study in the United States, but similar to clinical studies from North America. The most prevalent disorders were: affective (33%), anxiety (65%), antisocial personality disorder (28%) and psychosexual dysfunction (20%). Pure alcoholics and polysubstance users in studies on psychiatric comorbidity should be separated. Anxiety and affective disorders influence treatment seeking. Findings concerning the impact of psychiatric comorbidity on course should be comparable between North America and Europe.     

Body awareness group therapy for patients with personality disorders. 2. Evaluation of the Body Awareness Rating Scale

The Body Awareness Rating Scale (BARS) was developed to evaluate the treatment process of the Body Awareness Group Therapy. The BARS subscales proved to have high interrater reliability. A factor analysis revealed two factors which seemed to measure one awareness and one movement dimension. The BARS was sensitive to change. As hypothesized, the BARS improvement enlarged with increasing duration of treatment. At discharge the good BARS outcome patients had improved significantly more than the poor BARS outcome ones, both concerning symptoms and global psychopathology.     

Patients with schizophrenia after the acute ward: Seven years' service utilization and clinical course

Vampirism and auto-vampirism have been reported for centuries as very rare features. A relationship between vampirism auto-vampirism and mental disorders has been established, especially with regard to schizophrenia. This case study reports auto-vampirism in a 35-year-old schizophrenic woman. The Present State Examination was used to obtain a valid diagnosis. Auto-vampirism proved to be part of a bizarre delusion of a purification process. This patient reported experiences of depersonalization and auditory commanding hallucinations that made her strive for auto-vampirism. Although rare, auto-vampirism can be detected as a symptom in schizophrenia and can be treated.     

Curriculum factors influencing knowledge of communication skills among medical students

Background  

Communication training builds on the assumption that understanding of the concepts related to professional communication facilitates the training. We know little about whether students' knowledge of clinical communication skills is affected by their attendance of communication training courses, or to what degree other elements of the clinical training or curriculum design also play a role. The aim of this study was to determine which elements of the curriculum influence acquisition of knowledge regarding clinical communication skills by medical students.     

Neurocognition and occupational functioning in patients with first-episode psychosis: a 2-year follow-up study

Neurocognitive deficits are a core feature of schizophrenia that is associated with poor occupational functioning. Few studies have investigated this relationship in patients with first-episode psychosis. The current study examined the characteristics of employed and unemployed patients with first-episode psychosis at baseline and 2-year follow-up, and the predictive value of neurocognition on employment status. One-hundred and twenty-two first-episode psychosis patients were assessed with clinical and neurocognitive measures at baseline. Occupational status was assessed at baseline and 2-year follow-up. Those unemployed at baseline were rated lower on global functioning and were more likely to have a schizophrenia spectrum disorder. Total employment rates were 41% at baseline and 38% at 2-year follow-up. Four employment paths emerged at follow-up, defined as persistently employed, becoming unemployed, entering employment and persistently unemployed. The persistently employed group had the highest global functioning score. For the total sample, baseline employment status and sustained attention predicted employment status at follow-up. For those employed at baseline, better sustained attention, higher global functioning, more positive symptoms and less alcohol use predicted persistent employment at follow-up. For those unemployed at baseline, none of the variables predicted change in employment status. Implications of these results are discussed.     

The relative importance of individual and organizational factors for the prevention of job stress during internship: a nationwide and prospective study

This study aimed to investigate the relative and sequential importance of individual and organizational predictors of job stress associated with medical internship work. All medical students who graduated in Norway over 2 years (n = 631) were surveyed and followed up 1 year later at the end of the hospital internship year. The outcome was job stress as a house officer; predictor variables included individual factors at medical school and work-related factors during internship. A total of 371 (58%) responded at both time points. Adjusted predictors of job stress were: vulnerability (neuroticism) personality trait (beta 1.7 [95% CI, 0.94 to 2.5]); perceived recording skills (beta -0.43 [-0.78 to -0.08]); number of hours of sleep when on call (beta -2.3 [-3.6 to -1.0]); and learning environment on the hospital wards (beta -0.56 [-0.82 to -0.30]) (see table 2). The vulnerability trait was especially important among the female interns. The predictors explained 29% of the total variance in the model; personality contributed 16% of the variance, perceived recording skills 4% and the organizational factors measured in the internship year explained 9%. In terms of prevention, both individual factors (personality trait and perceived skills) and organizational work-related factors (sleep deprivation and learning environment on the wards) should be considered.     

Completion of long-term inpatient treatment of drug abusers: a prospective study from 13 different units

Completion of treatment is an important predictor of favourable outcome. We need more knowledge about predictors of completion in the inpatient psychosocial treatment modality. This prospective study from 13 such programmes follows a consecutive sample of clients (n = 307) from admission to completion/dropout. Instruments: EuropASI, MCMI II, SCL-25. The mean completion rate was 40% (20-71%), with no difference between clients with no ('debutants') or previous ('veterans') inpatient stays. Among 'debutants', the number of years of heroin use was negatively related to completion. Among 'veterans', age and amphetamine use were positively related, while the presence of a personality disorder and number of previous inpatient treatments were negatively related to completion. Specific strategies for involving clients with personality disorders are needed. After three inpatient stays, other types of treatment should be offered.     

Help-seeking for mental health problems among young physicians: is it the most ill that seeks help?

Abstract Objectives The aims of this study were to assess the prevalence of self-reported mental health problems and help-seeking among young physicians, and identify predictors of seeking help. Methods A prospective cohort sample of Norwegian medical students (N=631) were assessed in their final semester (T1), and in the first (T2) and fourth (T3) postgraduate year. The average observation period was 3.6 years. Results The prevalence of mental health problems that needed treatment over the preceding year was observed to have increased from 11% at T2 to 17% at T3. There was no increase in help-seeking. Longitudinally, 34% reported that they needed treatment on one or several occasions. Adjusted predictors of help-seeking were perceived level of mental health problems and a reality weakness personality trait. Conclusion Those who sought help had higher levels of emotional distress than those who did not. However, higher reality weakness scores predicted lower help-seeking and, therefore, may be a risk factor for avoiding necessary care.