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Biomedical subjects

U F Malt

Publications and source records attributed to U F Malt.

86 records · Page 5Linked to original sources
PubMed1989

The three-year biopsychosocial outcome of 551 hospitalized accidentally injured adults.

The negative biological, psychological and social outcomes following accidental injuries were assessed after three years in 551 adults by questionnaires, medical records and information from the National Insurance Offices. Fifty-four percent reported at least one negative outcome. Some reduction of physical function was reported by 31.8% and worsened bodily health by 26.0%. In about half of these cases reduced life quality was the main problem. Of the persons 18.9% claimed worsened psychological health and 18.2% decreased capacity for work as an effect of the injury. It is concluded that accidental injuries are an important source of morbidity and reduced life quality in society and that the long-term outcomes are best conceived within a biopsychosocial frame of reference.

Accidents↗
PubMed1989

A long-term psychosocial follow-up study of burned adults.

A clinical psychiatric follow-up study of 70 burned adults was performed 3-13 years after the burn injury. The majority of patients had minor injuries. Twenty-three percent suffered from definite psychosocial problems at follow up. Patients with severe injuries more often had problems (44%) than patients with minor injuries (16%). Outcome was not related to premorbid psychopathology except for patients with more severe injuries. A combination of variables describing length of hospital stay, the presence of scars, premorbid psychopathology, experiencing death threat when injured and deviant behaviour during the hospital stay was found to be the best predictor of negative psychosocial outcome (positive predicting power 83%; sensitivity 94%).

Accidents↗
PubMed1989

The validity of the General Health Questionnaire in a sample of accidentally injured adults.

The 20-item version of the General Health Questionnaire (GHQ) was given to 110 accidentally injured adults during the hospital stay. The patients were asked to rate their mental state prior to the accident. They also filled in the GHQ twice during a follow-up period of 28 months. All patients were twice examined by a psychiatrist who was blind to the patients' GHQ response. The overall values for sensitivity and specificity were good during the follow-up period and only slightly better using Chronic scoring procedure (80%-80%). The optimal cutting point for case screening varied across the different time-periods (2/3 pre-accident, 3/4 follow-up). Patients with permanently higher case-scores at follow-up than at pre-accident were among those severely affected by the injuries from a psychosocial point of view. The nine subjects who scored as a case at each of the three points of time all qualified for a DSM-III diagnosis. Sixty-three percent of the patients with a case score on two occasions qualified for a DSM-III diagnosis. The study indicates that GHQ-20 would be a useful measure of the psychosocial state of trauma patients seen in the course of rehabilitation.

Accidents↗
PubMed1989

The Late Effect of Accidental Injury Questionnaire (LEAIQ).

The Late Effect of Accidental Injury Questionnaire (LEAIQ) is a self-report questionnaire constructed to assess the biological, psychological and social effects of traumatic injuries. The LEAI covers current civil and employment status (4 questions); possible negative or positive consequences of the injury (20 questions) symptoms of post-traumatic distress (24 questions); aspects of the accident situation and the emotional impact of the trauma considered to be of relevance for the development of post-traumatic stress disorder and litigation behaviour (3 questions). The last part of the LEAIQ deals with the patient's opinion about the hospital treatment and follow-up control and self-perceived current medical or social needs (4 questions). Preliminary data on reliability and validity are reported from two studies investigating a total of 640 accidentally injured adults. The data indicate that the LEAIQ is easy to fill in for the patients and provides fairly good estimates of the frequency of the long-term biological, psychological and social effects in a sample of accidentally injured adults. The data on sensitivity and negative predictive power further suggest that the LEAIQ should be suitable in clinical practice as a first-step instrument for screening late effects of trauma.

Accidents, Traffic↗
PubMed1986

DSM-III and Norway. History, attitudes and future.

The first Norwegian evaluation of the DSM-III system of classification occurred in 1980. A Norwegian translation of the diagnostic criteria was published as part of a textbook in psychiatry in 1984. The Mini DSM-III (Quick reference) was published in 1985. The DSM-III system has been generally well accepted in Norway and is currently used in most research projects besides the ICD system. Several training courses have been arranged for senior psychiatrists and psychologists. Introduction to the DSM-III system is also part of the obligatory training course for psychiatric residents in Norway. From 1987 Norway will use a clinical modification of the ICD-9 system of classification. This modification applies 5 digit coding and includes diagnostic categories found in the DSM-III system but not in the 4 digit ICD-9 version. The DSM-III system of classification represents a major step forward in psychiatric classification. However, revisions are necessary to increase clinical validity. Although Norwegian psychiatry has been inspired by the DSM-III system, Norway remains committed to the ICD systems. The goal must be to make further revisions of the DSM-III and ICD systems, and in the end unite the strengths of these two systems of psychiatric classification.

Attitude of Health Personnel↗
PubMed1986

Philosophy of science and DSM-III. Philosophical, idea-historical and sociological perspectives on diagnoses.

The validity of a classification system is primarily a question of philosophical premise. DSM-III is from this point of view a theoretical classification system based on hypotheses currently considered reliable and interesting and which--as presupposed--could not be rejected by empirical methods. The relevance or validity of this empirical approach depends on the aim of the DSM-III. An empirical approach may facilitate communication but can only have limited success as a help for planning treatment of psychiatric disorders where motives and meaning are important factors. The choice of hypotheses and the empirically derived concepts used to construct the classification system neglects other important ways of comprehension. Although aspects of rational philosophy may be found in the DSM-III system too, important ways of comprehension like the metaphysical approach is lacking. It is showed how this fact reflects a philosophical trend in the Western world following the Renaissance. By considering the Myth of Faust it is demonstrated how a metaphysical comprehension of life would lead to a different understanding of states of mind currently assumed to be a reflection of individual psychopathology according to empirical or rational comprehension. Thus in the end the validity of a classification system depends on the basic philosophical assumptions chosen. A choice which may be determined more by irrational and cultural forces than conscious contemplation. The content of DSM-III or ICD is also influenced by professional interests; the needs of the society and international political factors.(ABSTRACT TRUNCATED AT 250 WORDS)

Humans↗
PubMed1986

Teaching DSM-III to clinicians. Some problems of the DSM-III system reducing reliability, using the diagnosis and classification of depressive disorders as an example.

Experiences from teaching DSM-III to more than three hundred Norwegian psychiatrists and clinical psychologists suggest that reliable DSM-III diagnoses can be achieved within a few hours training with reference to the decision trees and the diagnostic criteria only. The diagnoses provided are more reliable than the corresponding ICD diagnoses which the participants were more familiar with. The three main sources of reduced reliability of the DSM-III diagnoses are related to: poor knowledge of the criteria which often is connected with failure of obtaining diagnostic key information during the clinical interview; unfamiliar concepts and vague or ambiguous criteria. The two first issues are related to the quality of the teaching of DSM-III. The third source of reduced reliability reflects unsolved validity issues. By using the classification of five affective case stories as examples, these sources of diagnostic pitfalls, reducing reliability and ways to overcome these problems when teaching the DSM-III system, are discussed. It is concluded that the DSM-III system of classification is easy to teach and that the system is superior to other classification systems available from a reliability point of view. The current version of the DSM-III system, however, partly owes a high degree of reliability to broad and heterogeneous diagnostic categories like the concept major depression, which may have questionable validity. Thus, the future revisions of the DSM-III system should, above all, address the issue of validity.

Depressive Disorder↗
PubMedDate not supplied

Consultation-Liaison psychiatric service delivery: results from a European study.

The reported findings of the European Consultation-Liaison Workgroup (ECLW) Collaborative Study describe consultation-liaison service delivery by 56 services from 11 European countries aggregated on a C-L service level. During the period of 1 year (1991), the participants applied a standardized, reliability tested method of patient data collection, and data were collected describing pertinent characteristics of the hospital, the C-L service, and the participating consultants. The consultation rate of 1% (median; 1.4% mean) underscores the discrepancy between epidemiology and the services delivered. The core function of C-L services in general hospitals is a quick, comprehensive emergency psychiatric function. Reasons to see patients were the following. deliberate self-harm (17%), substance abuse (7.2%), current psychiatric symptoms (38.6%), and unexplained physical complaints (18.6%) (all means). A significant number of patients are old and seriously ill. Mood disorders and organic mental disorders are most predominant (17.7%). Somatoform and dissociative disorders together constitute 7.5%. C-L services in European countries are mainly emergency psychiatric services and perform an important bridge function between primary, general health, and mental health care.

Adult↗
PubMedDate not supplied

Further evolution of a literature database: the international use of a common software structure and methodology for the establishment of national consultation/liaison databases.

Every day there are 6000-7000 papers published in science. Since the C-L psychiatrist may be asked to consult on a patient with any medical illness, and who may be on any medical drug, methods need to be developed to review the recent literature and have an awareness of current findings. At the same time, teachers need to develop a current listing of seminal papers for trainees and practitioners of this subspecialty of psychiatry. Experts chosen because of their writings and acknowledged contributions to their subspecialty interests have sifted through thousands of articles to select the ones they regard as the most important for trainees in C-L psychiatry. In addition, certain countries--Spain, Portugal, Germany, Mexico, Australia and Brazil are developing national databases of C-L literature not only for their own use, but also to bring them to the attention of other parts of the world. This fifth iteration of the C-L literature database has especially targeted the period of 1996-1999--the millennium issue--in order to have easier access to contemporary essential studies on common problems. Part II of this issue describes the seminal cardiac drug-psychotropic drug interactions that the C-L psychiatrist may encounter in the most common medical disease in the United States--coronary heart disease--with advise to the practitioner as to their management. The use of the Internet and institutional Intranets is described.

Databases, Bibliographic↗
PubMedDate not supplied

Physical and mental problems attributed to dental amalgam fillings: a descriptive study of 99 self-referred patients compared with 272 controls.

OBJECTIVE: The physical and mental symptomatology of 99 self-referred patients complaining of multiple somatic and mental symptoms attributed to dental amalgam fillings were compared with patients with known chronic medical disorders seen in alternative (N = 93) and ordinary (N = 99) medical family practices and patients with dental amalgam fillings (N = 80) seen in an ordinary dental practice. METHOD: The assessments included written self-reports, a 131-item somatic symptom checklist; Eysenck Personality Questionnaire, the General Health Questionnaire, and Toronto Alexithymia Scale. RESULTS: The dental amalgam sample reported significantly more physical symptoms from all body regions. Self-reports suggested that 62% suffered from a chronic anxiety disorder (generalized anxiety disorder or panic). Forty-seven percent suffered from a major depression compared with 14% in the two clinical-comparison samples and none in the dental control sample. Symptoms suggesting somatization disorder were found in 29% of the dental amalgam sample compared with only one subject in the 272 comparison subjects. One third of the dental amalgam patients reported symptoms of chronic fatigue syndrome compared with none in the dental control sample and only 2 and 6%, respectively, in the two clinical comparison samples. The dental amalgam group reported higher mean neuroticism and lower lie scores than the comparison groups. CONCLUSION: Self-referred patients with health complaints attributed to dental amalgam are a heterogeneous group of patients who suffer multiple symptoms and frequently have mental disorders. There is a striking similarity with the multiple chemical sensitivity syndrome.

Adult↗
PubMedDate not supplied

Phobic anxiety changes the function of brain-gut axis in irritable bowel syndrome.

OBJECTIVE: Disease severity in the irritable bowel syndrome (IBS) is highly influenced by psychiatric comorbidity. The mechanism of this influence is generally unknown, even if the brain-gut axis seems to be involved. Recent research has indicated that IBS patients have aberrant perception of visceral stimuli in the CNS. We compared IBS patients with and without comorbid phobic anxiety to see if the comorbid disorder influenced brain information processing of auditory stimuli, and looked for possible consequences with respect to visceral sensitivity thresholds and disease severity. METHODS: Eleven female patients with IBS with comorbid phobic anxiety disorder were compared with 22 age-matched female IBS patients without such comorbidity. The groups were compared with respect to event-related potentials (ERP), auditory-presented words with emotional contents, barostat-assessed visceral sensitivity thresholds, and symptom levels the last week before assessment. RESULTS: The comorbid group had a significantly enhanced first negative ERP wave (N1) to all stimuli, indicating increased use of brain attentional resources. It also had increased visceral threshold for the sensation of gas, and reduced gas-stool and gas-discomfort tolerances compared with the noncomorbid group. Enhanced N1 amplitude at the frontal electrode and reduced gas-stools tolerance significantly predicted subjective gas complaints, explaining 47% of the symptom variation. CONCLUSIONS: The study suggests an association between information processing in the frontal brain and visceral sensitivity characteristics in IBS patients, and indicates that subjective disease-related symptomatology is predicted by brain perceptual characteristics. The findings indicate that an interaction between IBS-related and anxiety-related hyperreactivity in the frontal brain may constitute a psychophysiological mechanism for the contribution of psychiatric comorbidity to severity and duration of the irritable bowel syndrome.

Adult↗
PubMedDate not supplied

European consultation-liaison services and their user populations: the European Consultation-Liaison Workgroup Collaborative Study.

The authors identified variations in the characteristics of patients referred to 56 consultation-liaison (C-L) services in 11 European countries. The authors found differences in the types of patients referred to the services, and there were significant differences between countries. The first difference lays in whether services saw patients for deliberate self-harm and for substance abuse. German psychosomatic C-L services saw virtually no such patients, although in other C-L services these patients constituted one-quarter to one-third of the patients referred. The second difference lays in the remaining group of referred patients. This group is best characterized by two dimensions. One describes the severity of psychopathology -- ranging from organic mental conditions to somatization. The other describes the clarity of the physical diagnosis -- ranging from patients referred by surgical wards to those referred by general medicine and neurology wards.

Adult↗