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Biomedical subjects

U F Malt

Publications and source records attributed to U F Malt.

At least 55 records · Page 3Linked to original sources
PubMed1997

Relatives' locus of control and expressed emotion in schizophrenia and related psychoses.

OBJECTIVES: Knowledge of what predicts relatives' expressed emotion (EE) may contribute to improved family work in schizophrenia. In the present study we examined locus of control (LOC) beliefs as determinants of EE components. DESIGN: This study is observational, prospective and partly cross-sectional, partly longitudinal (stability of LOC). METHODS: In a Norwegian sample of 47 recently hospitalized patients (schizophrenia or schizophreniform disorder) and 70 relatives, the relatives' EE was assessed by the Camberwell Family Interview and LOC by Levenson's Internality, Powerful Others and Chance scales. RESULTS: Confirmatory multiple regression analyses showed that Chance LOC was positively related to emotional overinvolvement (p < .005). Powerful Others LOC, especially 'wish to ingratiate' items, were positively linked to criticism and, among workers/lower grade employees only, to emotional overinvolvement. Internal LOC was not linked to any EE scale. CONCLUSIONS: This study indicates that LOC beliefs may be determinants of emotional overinvolvement and criticism, and should be taken into account in family work that aims at modifying relatives' EE.

Adult↗
PubMed1997

Psychiatric referrals associated with substance use disorders: prevalence and gender differences. European Consultation-Liaison Workgroup.

A psychoactive substance use disorder (ICD-10) was diagnosed in 28% of 1222 psychiatric referrals in six general hospitals in Finland. In the age group 35 o 50 years, 53% of men and 29% of women had a substance use disorder. In the age group 35 to 50 years, sociodemographic characteristics differentiated men diagnosed with substance use disorders from other male consultation patients, but women with substance use disorders were similar to other female consultation patients. Urgency (i.e., consultation required within the same day) was accentuated in referrals associated with substance use disorders. Of attempted suicides, 65% were related to substance use disorders. Use of sedatives or hypnotics had more frequently induced disorders in women with substance use diagnosis compared to men with diagnosis (30% vs. 13%; p < 0.01). Female consultation patients with substance use disorders more often than respective male patients were current mental health outpatients. In conclusion, the proportion of substance use disorders among psychiatric consultation patients was remarkably higher in the present study (28%) compared with the average provided by the earlier literature (12%), and therefore, at least in Finland, psychiatric assessment of general hospital patients should always include assessment for the presence of substance use disorders. If substance use is only looked for in patients who have social problems typical of advanced misuse, detecting female substance use might be impeded. Relation of attempted suicides to substance use disorders was confirmed. To prevent misuse of prescribed drugs detected particularly in female consultation patients, and to prevent attempted suicides, doctors' attention is called to prescriptions of sedatives and hypnotics.

Adolescent↗
PubMed1996

The European Consultation-Liaison Workgroup (ECLW) Collaborative Study. I. General outline.

Previous C-L psychiatric service research is seriously limited by its parochial nature; very few results can be generalized outside of the hospital in which the original study was performed because of differences in the nature of the hospital and the type of C-L service. This article presents the general outline and methodology of a European multicentered C-L service delivery study effected by the European Consultation-Liaison Workgroup for General Hospital Psychiatry and Psychosomatics (ECLW). The study is unique in its kind as it allows the comparison of very different C-L services; for example, some services are run by C-L psychiatrists, others are run by C-L psychosomaticists and the study encompasses a large variety of different settings. As a result, both common factors in C-L service delivery and specific local patterns can be explored. The overall hypothesis tested in this study was that the most developed services would see (as well as more patients) a wider variety of clinical problems than small services. The implication is that the absence of well-developed C-L services in a general hospital may mean that there are patients with unmet mental health needs. In separate articles the training and reliability testing of the new Patient Registration Form (PRF) and the Institutional and Provider characteristics will be described. The former includes the use of ICD-10 in the general hospital setting. This study is a collaborative effort made by 226 consultants from 56 psychiatric C-L services in 11 countries. Each consultant recorded details of 1 year's caseload leading to a thorough description of 14,717 patients collected between 1991 and 1993. The advanced methodology included a multicentered international approach, rigid training for all participating consultants, and the development and testing of new instruments. This will allow us to assess the impact of important structural and process variables on the outcome of C-L service delivery in several European countries. These results will be reported in papers both in the international and national literature of the participating countries.

Adolescent↗
PubMed1996

The ECLW Collaborative Study: III. Training and reliability of ICD-10 psychiatric diagnoses in the general hospital setting--an investigation of 220 consultants from 14 European countries. European Consultation Liaison Workgroup.

A comprehensive training program for reliable use of the ICD/10 in Consultation-Liaison (C-L) psychiatry was conducted with 220 psychiatrists and psychologists from 14 European countries. The training included rating of written test cases and development of a coding manual to avoid diagnostic pitfalls not addressed in the ICD-10 manual. Following this training, all consultants rated 13 written case histories. One hundred sixty-seven consultants (76%) had a kappa (kappa) of at least 0.70. Only 13 (6%) had a kappa 0.40. The percentage of high reliability raters was evenly distributed among the different countries. Consultants had some problems in the differentiation between adjustment disorders and depressive disorders, and in the classification of disorders where ICD-10 differs from the DSM-III-R system. National biases in diagnostic practice were found with regard to the "case" concept and the role of alcohol in confusional states. Finnish consultants coded "no psychiatric disorder" significantly more often, whereas German and Italian consultants attributed delirious state more often to alcohol than consultants from other European countries. The study demonstrates that it is possible to achieve acceptable interrater reliability in applying the ICD-10 guidelines, through training programs designed for C-L psychiatrists and psychologists. Nevertheless, this first cross-national study shows the importance of addressing differences in national diagnostic practice.

Diagnosis, Differential↗
PubMed1996

Inter-rater reliability of expressed emotion ratings based on the Camberwell Family Interview.

High expressed emotion in relatives has been shown to predict a poorer outcome in a range of disorders and cultures. However, variation in predictive power is considerable, and this could partly be due to low inter-rater reliability. Sixty-nine relatives of 47 acutely admitted schizophrenic patients were interviewed using the Camberwell Family Interview. Audiotapes were assessed by pairs of raters drawn from a group of seven approved raters. Inter-rater reliability was good for criticism, hostility, emotional over-involvement (as a six level scale) and expressed emotion index (EOI cut-off score 2-3); and it was fair, but unsatisfactory, for emotional over-involvement (binary scales), warmth, positive remarks and expressed emotion (EOI cut-off score 3-4). These findings suggest that the warmth scale and the dichotomized versions of the EOI scale should be used with caution. The influence of warmth on the outcome in schizophrenia may have been underestimated because of low reliability.

Adult↗
PubMed1996

Emotional overinvolvement in parents of patients with schizophrenia or related psychosis: demographic and clinical predictors.

BACKGROUND: Parental emotional overinvolvement (EOI) may entail a worse outcome in schizophrenia. In the present study we examined demographic and clinical predictors of EOI. METHOD: The predictors were examined in a Norwegian sample of 41 recently admitted patients (schizophrenia or schizophreniform disorder) and 66 parents. Parents' expressed emotion was assessed by the Camberwell Family Interview. RESULTS: Regression analyses showed that higher EOI was significantly related, on the part of the parent, to being a mother, single, spending more time with the patient; and, on the part of the patient, to no substance misuse, more anxiety-depression, and less uncritical and aggressive behaviour. EOI was not linked to previous hospital admissions. CONCLUSION: Our analyses indicate that characteristics of the parent and of the parent-patient dyad seem to be the most important determinants of EOI. EOI is probably not linked to psychotic relapse, but rather to affective disturbances in the patient.

Anxiety↗
PubMed1996

A new pharmacologic treatment of functional gastrointestinal disorder. A double-blind placebo-controlled study with mianserin.

BACKGROUND: The efficacy of unselected monoamine reuptake inhibitors (tricyclic antidepressants) in the treatment of patients with functional gastrointestinal disorders (FGD) has not been convincingly demonstrated. We investigated the efficacy of an antidepressant (mianserin) with a different receptor profile (combined 5-hydroxytryptamine-2 + 3 and alpha-2 antagonist) in FGD. METHODS: After excluding patients with psychopathology and initial placebo responders from the study, eligible patients (n = 49) were randomized to 7 weeks of double-blind treatment with either mianserin, 120 mg/day, or placebo. Efficacy was assessed by using observer-completed ratings, the Global Improvement Scale, and patient self-ratings, Visual Analog Scale, and Disability Scales. RESULTS: Patients taking mianserin reported less abdominal pain, symptoms of abdominal distress, and functional disability than those given placebo (p < 0.001). The efficacy was significant across different lengths of illness periods and types of functional disorder. There was no major change 4 weeks after tapering. CONCLUSION: Mianserin may be an effective and well-tolerated pharmacologic short-term treatment for functional gastrointestinal disorders in patients with no clinical evidence of psychopathology.

Adolescent↗
PubMed1996

[Long-term treatment and prevention of depression].

Significant gains both for the individual patient and for the community can be made by preventing relapse and new depressive episodes. The depth of depression and the presence of other psychiatric problems are the most significant determinants of the duration of a depressive episode. The number of previous depressive episodes and age at first depression are the most significant determinants of the risk of future depression. However, the presence of interpersonal and social problems, other psychiatric or physical disorders, and the type of depression (e.g. depression as one "pole' in a bipolar disorder, dysthymia) are also factors of importance. The aim of maintenance treatment (i.e., continued treatment after the patient's recovery) is to prevent recurrence of the depressive episode, whereas the purpose of preventive treatment is to impede the occurrence of new depressive episodes.

Antidepressive Agents↗
PubMed1995

Psychosocial factors in women with operable breast cancer. An association to estrogen receptor status?

The association between psychosocial parameters and estrogen receptor (ER) status was evaluated in 85 consecutive breast cancer patients with stage I and II disease. Patients were categorized into those with ER+ and ER- tumours. Life events, emotional control, neuroticism, social support, adjustments to illness, and psychological distress were measured the day before surgery. Group comparisons showed significant differences between the groups as to age, emotional control and distribution of the life event: "experienced another illness/accident/hospitalization during the last year". A multiple regression analysis indicated significant effect for variables "age" and "life event", explaining 19% of the variation in ER level. The variable "emotional control" was positively correlated to age (r = 0.369) and did not contribute in itself. We conclude that none of the factors were associated with ER status when age and personal health data were controlled for. Our study does not support ER status as a possible link between behavioural factors and disease course in breast cancer.

Adult↗
PubMed1995

Can psychological traits predict the outcome of lumbar disc surgery when anamnestic and physiological risk factors are controlled for? Results of a prospective cohort study.

In a prospective study 122 patients with herniated lumbar disc pre-operatively completed psychological questionnaires. Surgical outcome was evaluated 12 months post-operatively mainly by a composite clinical overall score (COS), and by its separate elements. Anxiety (HAD-A scale) and psychosomatic symptoms (MSPQ) had predictive value: fewer symptoms favoured a satisfactory overall outcome, and vice versa. The HAD-A Scale had a predictive power of poor (ppp) and satisfactory (pps) outcome of 28 and 81%, respectively. Correspondingly, for the MSPQ, the ppp and pps were 42 and 85%. Anamnestic and biological variables (including fibrinolytic variables: ECLT and PAI-1) predicted 20% of the outcome. By adding all psychological variables the prediction increased only to 24%, but the HAD-A Scale and the MSPQ were still significant. The results suggest that in order to further improve prediction of outcome, future studies should combine biological variables sensitive to the mental state of the patient, with psychometric assessments.

Adaptation, Psychological↗
PubMed1995

Effectiveness of zuclopenthixol compared with haloperidol in the treatment of behavioural disturbances in learning disabled patients.

BACKGROUND: We compared the efficacy of two neuroleptics with different receptor profiles (zuclopenthixol and haloperidol) in learning disabled patients with behavioural disturbance. METHOD: A double-blind crossover study (2 x 8 weeks; n = 34), interrupted by a two-week single-blind washout period, was employed. Assessments included the Schedule for Handicaps, Behaviour, and Skills (SHBS) and Clinical Global Impression (CGI). RESULTS: The SHBS score was significantly reduced for the zuclopenthixol cohort only. End-point analysis between the two drugs also showed an enhanced effect for zuclopenthixol over haloperidol. CGI scores did not reveal significant differences between the two drugs. CONCLUSION: Zuclopenthixol may be superior to haloperidol for the treatment of behavioural disturbances in mentally retarded subjects.

Adult↗
PubMed1994

[A comparison between lovastatin and pravastatin--effects on lipids, sleep and quality of life in primary hyperlipidemia].

The efficacy and safety of treatment with recommended doses of lovastatin (20, 40 and 80 mg/day) and pravastatin (10, 20 and 40 mg/day) were compared in 48 men and women with primary hyperlipidemia and LDL-cholesterol > or = 4.1 mmol/l following dietary intervention. Each dose was taken for six weeks in this double-blind, parallel, randomized study. Lovastatin was found to reduce LDL-cholesterol by 22-37% and pravastatin by 18-26%. HDL-cholesterol levels increased and triglyceride levels decreased to the same extent in both groups. The number of patients who reported adverse events in the course of the study was small. No clinically significant changes occurred in laboratory tests, nor in sleep scores obtained from a standardized questionnaire. Neither drug had any effect on the responses to a quality of life screening questionnaire, nor were any significant changes in depressive symptoms seen during the 18 weeks of treatment.

Adult↗