[New views on the mystery of schizophrenia. From the crusade against the "evil mother" to recognition of a neuropsychobiological developmental disorder].
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Humans↗
Biomedical subjects
U F Malt
Publications and source records attributed to U F Malt.
Vegetarian diet for patients with rheumatoid arthritis: can the clinical effects be explained by the psychological characteristics of the patients?
In a controlled, single blind clinical trial we have demonstrated recently a beneficial effect of fasting and vegetarian diet in RA. In the present study we compared 53 patients who participated in this clinical trial with 71 other RA patients with regard to some psychological parameters. The patients who participated in the clinical trial differed significantly from other RA patients. Firstly, they had a higher internal score and a lower chance score on the Multi-dimensional Health Locus of Control Scale (MHLCS). Secondly, their belief in the effect of ordinary medical treatment, evaluated by a 10-cm visual analogue scale, was lower, and their belief in the effect of 'alternative', unconventional forms of treatment was higher. Of the patients who were randomized to a vegetarian diet, there was no significant difference between diet responders and diet non-responders with regard to the MHLCS scores. But, diet responders had a significantly lower belief in the effect of ordinary medical treatment compared with diet non-responders. The psychological distress imposed on the patients by changing from an omnivorous diet to a vegetarian diet was monitored during the clinical trial by means of the General Health Questionnaire. Throughout the clinical trial, this variable favoured the vegetarians compared with the omnivorous and the diet responders vs the diet non-responders. We conclude, firstly, that patients with certain psychological characteristics were selected to the clinical trial; secondly, that the MHLCS scores could not explain the clinical improvement, but it may have been influenced by the patients' beliefs in ordinary and 'alternative' forms of treatment; and thirdly, that dietary treatment decreased psychological distress.
Adult↗
Neuropsychological findings in a non-clinical sample of workers exposed to solvents.
The risk of long-term damage to the CNS after exposure to mixed solvents in work environments is controversial. Thirty-six workers were studied who had been exposed to organic solvents for more than 10 years (mean 24.5 years) in a working environment. The workers and unexposed controls were studied with a battery of neuropsychological and cognitive tests. Significant group differences were observed for the Wechsler adult intelligence scale (WAIS) digit span and symbol digit substitution, and on paired associate learning and continuous word recognition. The results suggest that long-term work-related exposure to organic solvents may have chronic toxic effects.
Adult↗
[Mental disorders increase length of stay and use of resources in somatic hospitals].
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Health Resources↗
[Acute psychiatry].
The author discusses psychological assessment and treatment of acute mental disorder in general practice. An initial assessment by telephone may provide the physician with important information about the nature of the problems and the patient's state of mind. Later, the immediate impression upon seeing the patient, and further observation during the consultation, are sources of important clinical information. The paper purports the view that psychological control over the situation is best achieved by means of psychological techniques adjusted to the specific behavioural disturbance in question. Drugs should only be used as one of several secondary options in the treatment of acute psychiatric disturbances with a non-organic etiology.
Acute Disease↗
Social functioning and general well-being in patients treated with clean intermittent catheterization.
Social role function, health perceptions and general well-being were studied longitudinally over 1 yr in 149 males and 153 females performing clean intermittent catheterization (CIC). The evaluation included urological assessments and self-rating instruments (Revised Physical Battery, General Health Questionnaire--28 items, State Anxiety Inventory and CIC Pain and Discomfort Scale). Twenty-six percent reported major improvement in their overall quality of life, while 7% reported a wish to be dead and away from it all. Females with infranuclear lesions and detrusor myopathies scored higher on unpleasant health perceptions, state anxiety and physical discomfort by performing CIC than males. In males, the social role function 1 yr later was predicted by initial anxiety and urinary tract infections, whereas in females by initial anxiety only. Discomfort by CIC was predicted by initial infection in males, and by none or moderate medical comorbidity, initial depression and infection in females.
Adaptation, Psychological↗
The effect of major railway accidents on the psychological health of train drivers--I. Acute psychological responses to accident.
The acute psychological reactions of 101 train drivers to on-the-track accidents were studied by means of clinical interviews and questionnaires (Impact of Event Scale, GHQ-20 and a questionnaire addressing stress symptoms, pre-accident expectancies and worries). More than half of the train drivers reported moderate to high intrusive distress (mean 11.3) within hours to days after the accident but only 1/3 reported symptoms of acute psychophysiological arousal. Intrusive symptoms related to visual impressions were most frequently reported. Avoidance was less prevalent (mean 8.8). Clinical interviews, relationship between pre-accident worries and severity of the acute responses and positive correlation between GHQ-scores relating to the fortnight preceding the accident and IES-intrusion scores, suggest that premorbid variables may influence the stress response. Involvement in more than two previous accidents invoked a feeling of vulnerability and produced stronger acute responses. Post-accident experiences involving various personal contacts did not correlate with the stress responses in this study and only a few drivers experienced such events in a negative way. Denial of the possibility of being involved in accidents was not associated with increased risk of strong acute responses, indicating that denial does not predict poor outcome in healthy persons exposed to situations where possibility of avoiding the event is outside the control of the person.
Accidents, Occupational↗
The effect of major railway accidents on the psychological health of train drivers--II. A longitudinal study of the one-year outcome after the accident.
The psychological impact on 101 train drivers of accidents causing major injuries or death to persons was studied by means of clinical interviews and questionnaires (Impact of Event Scale, General Health Questionnaire and a questionnaire addressing stress symptoms plus past and pre accident expectancies of being involved in accidents). The drivers were examined within hours to a few days after the accident and later at 1 month and 1 year. One month after the accident the symptoms of distress were significantly reduced and most so among the drivers with no preaccident risk experience according to self reports during the acute phase. A minor further reduction of distress was found at 1 year. Drivers with two or more previous accident experiences and those who had worried about being involved in accidents showed highest symptoms of distress at follow-up. Eleven out of 101 drivers reported sick leave more of than 1 week after the accident and this was related to higher intrusion scores. The few drivers who report longterm psychological distress are best predicted by a combination of acute high IES scores, experience of previous accidents and risk expectancy prior to the current accident. The study suggests that premorbid and non-accident related variables are more important for the 1 year psychological outcome of healthy drivers after on-the-track accidents than the stress event itself.
Absenteeism↗
Clean intermittent catheterisation-performing abilities, aversive experiences and distress.
A total of 407 patients participated in a one year follow up study concerning their personal experiences and attitudes towards clean intermittent catheterisation (CIC). Most patients (90%) were able to perform CIC themselves, approximately 70% having no problems with the procedure. However, one third of the patients experienced CIC as aversive with significantly higher distress scores on the general health questionnaire (GHQ-28). Aversion and distress were more often reported by younger patients and females, and by patients with non neuropathic bladders. The patients' physical disabilities and their length of previous CIC experiences did not seem to influence the feelings of aversion. These findings demonstrate the importance of considering the psychological implications of CIC, and the emotional needs of these patients in order to improve compliance and quality of life.
Adaptation, Psychological↗
[Drug therapy of depression in general practice].
The authors advocate use of the Montgomery-Asberg Depression Rating Scale in general practice as a screening instrument for depression. A score of 20 and above for more than two weeks indicates a need for treatment with antidepressant drugs. The treatment should continue with full dosage for at least two months after the patient has been cured. In order to maintain the patient's quality of life, reduce risk of drug-related toxicity and improve compliance, we recommend alfa-2-receptor blocker, a selective 5HT-re-uptake inhibitor or a selective monoamino-oxidase A inhibitor as the first drug choice for treatment of depression by general practitioners. Monitoring serum levels of the drug may be helpful, especially in persons who do not respond to treatment.
Antidepressive Agents↗
Psychological appraisal and emotional response to physical injury: a clinical, phenomenological study of 109 adults.
We studied the cognitive, emotional and behavioral responses at four points of time in a random sample of 109 accidentally injured adults via audio taped semistructured interviews and self-assessment rating scales. Neither the subjects appraisal of death or disability, nor the emotional responses corresponded strongly to the severity of the physical injury sustained or the "objective" threat to life but, instead, reflected, to a large extent, the personal meaning of the injury or the accident. Dissociative responses reported by 17 persons were of short duration and associated with young age and immaturity, and did not predict or a poor longterm post-traumatic psychiatric course. Ratings of intrusion, avoidance and anxiety were more strongly associated with psychopathology than "objective" danger or injury severity. This study indicates that following civilian trauma, the cognitive, emotional and behavioral responses are strongly related to preaccident and accident-independent life circumstances. The findings question the validity of the DSM-IIIR criterion of stressors of PTSD in civilian accidents, and suggest that post-traumatic mental disorders should be evaluated in much the same way as psychiatric disorders after physical illness.
Accidents↗
Coping with accidental injury.
Coping styles and perceptual defense were studied in 20 accidentally injured adult males during hospital stay and 28 months later via clinical psychiatric and surgical examinations, the Comprehensive Psychopathological Rating Scale, Ways of Coping Checklist, Impact of Event Scale, Basic Character Inventory, the Multidimensional Health Locus of Control Scale, State Anxiety Inventory and Defense Mechanism Test. Coping styles, particularly emotion-focused coping, were more strongly correlated with underlying psychopathology than with severity of injury. Coping styles remained stable during the period of study and did not correlate with perceptual defense, state anxiety, personality traits or symptoms of post-traumatic stress. However, six specific coping efforts predicted patients who suffered from short- and long-term negative consequences with a specificity and positive predicting power of 100% and sensitivity of 69%. Results correspond to previous studies of coping with chronic illness, and suggest that somatization following physical trauma is better explained with reference to personal meaning than to a fright-model as suggested in the post-traumatic stress criteria of the DSM-III-R.
Accidents↗
[Modern diseases, social transmission and disease understanding].
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Humans↗
[Schizophrenic patients and the emotional climate in the family. Causes, consequences and treatment of intensely expressed emotions of close relatives].
In recent years it has been shown that the course of schizophrenia is influenced by the attitudes and behaviour of the close relatives with whom the schizophrenic person lives. In particular, there is greater risk of relapse if family members show a high degree of criticism, hostility, or emotional over-involvement in relation to the schizophrenic; these attitudes have been described as high expressed emotion (High EE) and are usually assessed by means of the Camberwell family interview. However, as discussed in this paper, there are still many unsettled questions regarding content, validity, causes, effects, and treatment of High EE.
Attitude to Health↗
Coding guidelines for ICD-9 section on mental disorders and reliability of chart clinical diagnoses.
A major innovation of the ICD-10 draft is provision of diagnostic guidelines. This is assumed to be appropriate for use in clinical situations. In Norway a similar approach was adopted when ICD-9 was introduced as the official classification system in 1987. This was done in order to avoid national diagnostic bias and increase diagnostic reliability. A comparison with the DSM-III criteria was included in the diagnostic guidelines. The effectiveness of this approach was investigated by comparing the chart ICD-9 diagnoses of 104 psychiatric in- and outpatients from 2 teaching hospitals with the diagnoses obtained by using case record rating forms (criterion diagnosis). According to the criterion diagnoses, the base rate of chart diagnoses of schizophrenia and manic-depressive psychosis was too low, and the base rate of reactive psychosis too high. Several chart diagnoses proved to have low reliability, particularly reactive psychosis, paranoid psychosis, depressive neurosis and personality disorders. The study suggests that the provision of extensive diagnostic guidelines does not necessarily alter previous diagnostic practice. Reasons for these findings and the implications for the ICD-10 diagnostic criteria and diagnostic guidelines are discussed.
Adolescent↗
[Classification of anxiety and depression].
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Anxiety Disorders↗
[Goldberg's General Health Questionnaire].
This paper reviews the different applications of the General Health Questionnaire in clinical work and research. Based on extensive experience of different versions of the GHQ, the authors recommend the 20- or 30-item versions, and not the 28-item version, as most suitable for the longitudinal and state assessments of distress, psychopathology and quality of life in medical and psychiatric populations.
Family Practice↗
Disaster psychiatry and traumatic stress studies in Norway. History, current status and future.
The breakthrough of Norwegian disaster psychiatry and traumatic stress studies came when the "Board of Norwegian Doctors of 1957" carried out exceptionally thorough and comprehensive studies of former concentration camp prisoners. These studies convincingly demonstrated that chronic mental illnesses could develop in persons who had a harmonious childhood but who had been subject to extreme physical and psychological stress. During the seventies Norway became the first country in the world to have a University chair of disaster psychiatry. The scope of the field was broadened by the initiation of several studies on traumatic neurosis, industrial disaster and injuries. The support from the Joint Norwegian Armed Forces Medical Services, the University of Oslo, the Norwegian Research Council for Science and the Humanities, and later the Royal Norwegian Council for Scientific and Technical Research, was crucial for this development. Currently stress and disaster psychiatry has become an integrated part of the care of victims who have suffered individual or collective disaster. Disaster psychiatry is taught in medical schools and is part of the obligatory training for residents in psychiatry.
Adaptation, Psychological↗