Assessment of quality of life in patients with prostate cancer.
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Humans↗
Biomedical subjects
S Opjordsmoen
Publications and source records attributed to S Opjordsmoen.
The duration criteria of delusional disorder in modern classification.
This article briefly reviews the duration criteria for delusional disorder in current diagnostic systems. Furthermore, a sample of 72 first-admitted patients with delusional disorder, personally re-examined after a mean of 10 and 27 years, has been analysed as to duration of delusional symptoms. One third of the sample displayed delusions for less than 6 months at admission. During the observation period one half of these patients (one sixth of the total sample), displayed delusional symptoms for less than 6 months, recovered fully, and functioned excellently at follow-up, while patients with a total duration of delusions for more than 6 months functioned worse. This report adds further support to setting up a dividing line of 6 months for the separation of acute from persistent delusional disorder.
Adolescent↗
Outcome in delusional disorder in different periods of time. Possible implications for treatment with neuroleptics.
The effect of neuroleptics in the treatment of schizophrenia is well established. Some reports indicate that at least pimozide may be effective in delusional disorder as well. In this article a long-term follow-up study of 72 first-admitted patients with delusional disorder is described. Outcome in patients admitted during 1946-1948 was compared with that of patients admitted during 1958-1961. We did not find a more favourable outcome in the group admitted after the introduction of neuroleptics. This contradicts our earlier finding for patients with schizophrenic psychoses, indicating that neuroleptics generally may be more effective for schizophrenics than for patients with delusional disorder. Controlled drug trials in delusional disorder are strongly needed.
Adolescent↗
[Is there any connection between structural brain changes and schizophrenia?].
Schizophrenia is a heterogeneous disorder. Structural brain abnormalities have been found in a subgroup, but the underlying mechanisms are not fully understood. In some patients the changes in the brain are diffuse, in others more focal, and no single site has been found to be responsible for the illness. The brain lesions are commonly believed to be present before the onset of the illness, and are mainly non-progressive. They may act as non-specific markers of developmental and/or perinatal abnormalities associated with the disease. However, the abnormalities vary from patient to patient, and are non-specific. It is uncertain whether they are primary or secondary events in the course of the illness.
Brain↗
Delusional disorder: the predictive validity of the concept.
A sample of 72 first-admitted patients with delusional disorder was personally re-examined after a mean of 10 years, and 42 of them after an average of 27 years. The mean observation period for all patients from admission to last follow-up was 20 years (3-39). There was a trend that patients with delusions of jealousy did better on course variables, but similar outcomes were revealed in groups with delusions of jealousy, persecution and a mixed group with different main delusions. Duration of symptoms prior to admission was a significant predictor of outcome, indicating dividing lines of 1 and 6 months at 10-year follow-up and 3 and 6 months at long-term follow-up. Based on the data, a minimal duration of 6 months is proposed for persistent delusional disorder.
Adolescent↗
Long-term clinical outcome of schizophrenia with special reference to gender differences.
A sample of 94 first-admitted schizophrenics and 47 patients with schizophreniform disorder (DSM-III) was personally re-examined after a mean of 10 years (by Retterstöl), and 110 of the patients after a mean of 31 years (by the author). Nearly half of the patients were admitted in 1946-1948 (long-term) and the remaining in 1958-1961 (short-term). Average outcome was significantly more favourable for short-term than for long-term patients. Single marital status and no, minimal or mild psychosocial stressor at onset (Axis IV) predicted poor long-term outcome. At 10-year follow-up there was no difference between men and women in clinical outcome. No substantial change was revealed in men at last follow-up, whereas on average women had clearly deteriorated.
Adult↗
Delusional psychoses associated with unpatriotic conduct during World War II: a long-term follow-up study.
Of a large sample of patients with paranoid psychoses consecutively admitted to the Psychiatric Department, University of Oslo, during a period after World War II, 10 patients (6.3%, 9 women and 1 man) became ill through accusations of unpatriotic conduct during the war. The psychosis seemed precipitated in connection with legal procedures against the patient in 3 cases, and against close relatives in 2 patients. In 2 cases mixed precipitating events were present, while the psychosis in 3 cases had a connection with the woman being intimate with occupation soldiers. Discharge diagnosis according to DSM-III was schizophrenia (n = 2), schizophreniform disorder (n = 4), schizoaffective disorder (n = 1), major depressive disorder (n = 1), mania (n = 1), and atypical psychosis (n = 1). The patients have been followed up twice, with a mean 31 years of observation. Course and outcome varied, mostly according to the diagnosis. Most patients had a favorable global outcome, although they had a tendency to keep up their social isolation. None of the patients felt they had done anything wrong or regretted their behavior during the war.
Adult↗
Fatherhood, impending or newly established, precipitating delusional disorders. Long-term course and outcome.
Psychopathological reactions to fatherhood are probably not so infrequent as they would seem from psychiatric literature. In a material of paranoid psychoses, impending or newly established fatherhood was considered the main precipitating factor in 4 patients (i.e. 2.4%), compared with 7% of the female psychoses precipitated by pregnancy, childbirth or nursing. Two of the men were bachelors, insecure and inhibited, feeling compromised or helpless in the new situation. Two men were married, passive, avoidant in their personality, strongly dependent on their wives. The course and outcome varied according to the diagnoses; 2 cases having a favorable and 2 an unfavorable course and outcome. Physicians, including psychiatrists, should bear in mind that fatherhood is a possible precipitating factor for paranoid psychoses in male patients.
Adult↗
Unipolar delusional depression. Outcome in reactive versus endogenous types.
A sample of 83 first-admitted patients with delusional depression were diagnosed according to DSM-III, ICD-9 and reactive and endogenous types. They were followed up twice after a mean of 10 and 18.5 years. As to background, course and outcome variables DSM-III schizoaffective patients were closely related to affective patients. A small difference between reactive and endogenous type was accounted for by the endogenous subgroup of DSM-III schizoaffective patients. The study provides evidence for dismissing the reactive-endogenous distinction in terms of psychotic depressive disorder, but in terms of schizodepressive disorder the issue is less clarified based on course and outcome.
Adult↗
Paranoid (delusional) disorders in the light of a long-term follow-up study.
A large sample of first-admitted hospitalized patients with delusional psychoses were personally followed up after a mean of 10 and 30 years. At last follow-up 42% showed good overall functioning and 44% were in ordinary work. Patients with affective disorder according to DSM-III had most homogeneous and favorable outcome, while a striking heterogeneity of outcome was noticed in schizophrenia, schizophreniform and paranoid disorder. Along with other reports the study showed that precipitating events indicated favorable prognosis for patients with schizophreniform, schizoaffective and paranoid disorder. Moreover, in the total sample the findings indicated that short duration of symptoms prior to admission was a good prognostic sign, indicating that early intervention is important for delusional patients.
Adult↗
Erotomania--erotic self-reference psychosis in old maids. A long-term follow-up.
The concept of erotomania is discussed and the literature surveyed. The aim of the study is to present a long-term personal follow-up evaluation of cases with erotomania-like symptoms. In a material of 1,802 consecutively admitted patients, 6 (0.3%) presented symptoms suggestive of erotomania. They have been personally followed up 2 or 3 times by the authors over a period of 22-35 years. Our sample was characterized by avoidant and/or paranoid premorbid personality traits with difficulties in establishing relationships, and life-long social isolation. However, the overall clinical outcome was not hopeless. Neuroleptics may be of benefit, and our findings indicate the need for psychosocial treatment to increase the life quality in these patients.
Adult↗
Delusional disorders. I. Comparative long-term outcome.
Of 301 first-admitted patients with delusional psychoses, 94 met DSM-III criteria of schizophrenia (S), 53 paranoid disorder (PD), 47 schizophreniform disorder (SFD), 35 schizoaffective disorder (SAD), 54 major affective disorder (AD), and 18 other disorders (OD). Retterstöl selected the patients and personally interviewed them after 5-18 years, and later the author interviewed them after 22-39 (mean 30) years. At last follow-up good functioning was noticed in 42%, moderate symptoms in 22%, severe defect in 20%, and very severe defect in 16%; 40% were still delusional. On average S patients did poorest, and OD patients slightly better. AD patients had superior outcome, while PD, SFD and SAD patients showed an intermediate position, but a little closer to AD than to S. However, heterogeneous course and outcome was noticed in all diagnostic groups.
Adult↗
Delusional disorders. II. Predictor analysis of long-term outcome.
A sample of 301 patients with delusional psychoses was personally followed up an average of 10 years after first admission (by Retterstöl), and 30 years after admission (by the author). Using a multivariate technique the following significant predictors of outcome emerged: discharge diagnosis according to DSM-III (accounted for most of the total variance), marital status, and Axis V at 10-year outcome, and diagnosis, marital status, and gender at 30-year outcome. No significant difference of outcome was found between patients living in urban and rural areas in bivariate or multivariate analyses. Women did slightly better than men at 10-year follow-up, but at 30-year follow-up men did significantly better. These results may be consistent with the hypothesis that other factors than those occurring during the premorbid period are manifest in the later course of the disorder. However, Axes IV and V proved useful, stressing the necessity of working with social as well as psychopathological issues when patients are treated.
Adaptation, Psychological↗
Long-term course and outcome in unipolar affective and schizoaffective psychoses.
Of 301 first-time admitted patients with delusional psychoses, 50 met DSM-III criteria for major depressive disorder (MDD), 33 schizoaffective disorder, depressive type (SADD), and 94 schizophrenia. At personal follow-up after 3-39 (mean 22) years, the SADD group was recorded in between on course and outcome variables, but closer to MDD. The findings in MDD and SADD were respectively: remission 66% vs. 42%, personality disorders 14% vs. 12%, anxiety disorder or alcohol abuse 2% vs. 6%, psychosis 18% vs. 36% (with bipolar development in 2% vs. 6%, paranoid disorder 2% vs. 3%, schizophrenia 4% vs. 3%). Chronic psychosis was recorded in 10% vs. 27%. No significant outcome difference was found between early onset MDD and SADD cases and those who fell ill at a higher age. The assumption that antidepressants may induce mania could not be confirmed. Normal premorbid personality seemed to predict a favourable course.
Adult↗
[Drug therapy of paranoid conditions].
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Adult↗
Hypochondriacal psychoses: a long-term follow-up.
From a large series of delusional subjects 23 patients demonstrated hypochondriacal delusions as the main delusion during the long-term course of approximately 30 years. An extensive study of these cases reveals that the majority had abnormal premorbid personality, especially somatization, paranoid and/or avoidant traits. Previous and/or precipitating somatic illnesses, if present, were not very serious. The hypochondriacal preoccupation diminished in the long term, but the overall prognosis varied, as the patients did not belong to a uniform diagnostic category. Implications for the clinician in diagnosing and treating are discussed, and the importance of early detection of correct diagnostic category is stressed.
Adolescent↗
Long-term course and outcome in delusional disorder.
Out of 301 first-time admitted patients with delusional psychoses, 71 met Kendler's criteria of delusional disorder (DD) and 137 met the ICD-9 criteria of schizophrenia (S). DD was subdivided according to operational criteria into reactive delusional disorder (RDD) with precipitating factors (n = 31) and non-RDD (n = 40). At follow-up after 22-39 years, 20 RDD patients, 21 non-RDD patients and 85 S patients were personally interviewed. The delusions had faded in 61% of DD cases, were unchanged in 17%, and more prominent in another 17%. Recovery was recorded in 37%, mild defect in 32%, moderate impairment in 10%, and severe impairment in 22% of DD patients. Outcome was more favourable in DD compared with S, in RDD compared with non-RDD, and in non-RDD compared with S. The study supports distinctions between DD and S, RDD and non-RDD, and non-RDD and S based on course and outcome.
Adult↗
Toward an operationalization of reactive paranoid psychoses (reactive delusional disorder).
Reactive psychoses are relatively often diagnosed in Norway, although they are not operationalized in any classificatory system and the reliability may be questioned. The aim of this study was to define a group of reactive paranoid psychoses and compare its long-term outcome to the group of nonreactive paranoid psychoses and to paranoid schizophrenia. Approximately 200 out of 301 delusional subjects earlier studied by Retterstöl have recently been interviewed semistructurally, making a total follow-up period of 22-38 years. Diagnoses at discharge have been assessed retrospectively before the present interview, with a polydiagnostic approach. Based upon Kendler's criteria of delusional disorder and influenced by Jaspers, the concept of reactive delusional disorder has been operationalized. Results from the first 125 interviews show 31 cases of Kendler's delusional disorder, of which 16 are diagnosed as reactive delusional disorder. Outcome in this group is most favorable, and especially good outcome is found in acute reactive delusional disorder.
Adjustment Disorders↗