The author gives a comprehensive view of the multi-dimensioned field of ethics, from general medicine to specific forensic psychiatric research. While the Declaration of Helsinki pointed out the possible risks involved in medical research, the CIOMS/WHO Ethical Guidelines from 1993 points out possible beneficial effects of research. The latter also particularly mentions prisoners and other marginal groups in society, which is especially relevant to research in forensic psychiatry.
Six schizophrenic patients with ocular pigment changes demonstrated 21 years ago were followed up over the years. The study focuses on the last study period of 9 years. Five of the six patients received high neuroleptic doses during the relevant 9 years. All six patients demonstrated unchanged pigment deposits in the lens between the two examinations. Three patients, all of whom had received a high total cumulative dosage, demonstrated decreased pigmentation in the corneal structure. The results presented indicate that when severe lenticular and corneal opacities – here defined as degree 3 – have appeared, they do not increase in spite of continuous neuroleptic treatment.
In 1989 an investigation by questionnaire, comprising psychologists and physicians employed at all psychiatric wards in Denmark, concerning individual, supportive psychotherapy for adult psychiatric inpatients was carried out. The questionnaire was answered by 41%. In this group supportive psychotherapy constituted a large amount of the daily work, most therapists were psychoanalytically oriented, and their psychotherapies implied many directive, reality-oriented techniques as well as interpretation. The level of psychotherapeutic education was high, and a need for further education in supportive psychotherapy of psychiatric inpatients was expressed.
The article deals with observed group reactions among survivors, relatives, and hospital staff participating in a crisis intervention program following a bus accident in Norway. The accident involved a group of Swedish schoolchildren (n=27) accompanied by teachers and parents (n=7). Twelve children and three adults died immediately, followed later by the death of the bus driver. The survivors and the dead victims were brought to the regional hospital. The groups gathered were thus the injured children and adults, the relatives of injured and dead victims, or both. The participating hospital staff were mainly members of the intensive care unit, staff from two surgical wards, and personnel from the psychiatric service unit. The group reactions observed were suggestibility and helplessness, a lack of autonomous functioning as individuals followed by group reinforcements of emotional outbursts and subsequently fight/flight reactions and intergroup rivalry, parallel to an idealization of the Norwegian crisis team. Similar reactions were to a lesser extent also seen among members of staff groups. There was a reduction in the hospital's capacity to maintain its ordinary treatment programs during the crisis intervention. A review of the literature shows that little has been published on the dynamics involved in groups of individuals undergoing mourning and crisis reactions, especially on how crisis intervention programs affect the hospital as a social system. Several theoretical models, particularly Bion's work on group dynamics and individual psychodynamic theory, are applied to explain the observed phenomena. Within these frames of reference major group reactions can be interpreted as individual and group regressions, collective projective identification, and group splitting phenomena. The reduction of the hospital work capacity may partly be interpreted as a result of the systemic hospital defence mechanisms being challenged by the crisis intervention program dealing with the emotional reactions in the open rather than suppressing them, as most hospital routines favour following individual crisis reactions. Planning for crisis intervention programs will benefit from taking into consideration the substantial group dynamics among any large number of individuals undergoing a crisis reaction.
Psychosocial intervention for relatives of patients with schizophrenic disorders is important for different reasons. The emphasis on community-based treatment approaches has resulted in an increased burden on non-professional care-givers, mainly the families. The aims of the psychosocial intervention are to give information about manifestations and course of the disorder and to offer emotional support and assistance to families in their care-giving function. Furthermore, the psychosocial intervention can reduce the frequency of new relapses. Psychosocial intervention can be described as educational programmes, training programmes in communication and problem-solving skills, or as supportive. The article presents an overview of the programmes and some guidelines for professional care-givers.
The objectives of the present study were to calculate the incidence of parasuicide among young people (16-19 years) in a representative Norwegian county (Sør-Trøndelag; 250,000 inhabitants), to compare the results with what has been found elsewhere in Europe and to ask whether an association exists between educational status and incidence of parasuicide. A total of 63 young parasuicide patients were registered in medical treatment facilities during the study period (1 October 1988 to 15 July 1990). The male rates were 87 per 100,000 in 1988/89 and 101 per 100,000 in 1989/90, and the female rates were 180 per 100,000 in 1988/89 and 384 in 1989/90. Results from other centres participating in the WHO (Euro) study on parasuicide indicate that the parasuicide rates found in the Nordic areas are of a relatively high rank and that the rates in Sør-Trøndelag are at an average level. The rates of parasuicide among students were significantly lower than those found among non-students. Consequently, school-based programs do not seem to be sufficient in the prevention of suicidal behaviour among young persons.
Nederlandse Vereniging voor Psychotherapie er en ≪paraply≫-forening, der omfatter psykoterapeuter fra alle professioner og teoriretninger i Holland. Foreningen har i år 60 års jubilæum og havde i denne anledning indkaldt enkeltpersoner fra de 12 EC (European Community) lande til en 4 timers konference i Amsterdam den 15. dec. 1990.
This community-based epidemiological survey concerns relationships between social and health factors and depression in a Finnish population aged 60 years or over. A multivariate analysis based on log-linear models is used in this study. The log-linear model showed five interactions for the depressed men and eight for the depressed women surveyed. These indicated that the depressive persons had experienced detrimental events either of an interpersonal nature or concerning health status more often than those who were not depressed. A positive connection between life stress and depression was found even though no cause-and-effect relationship could be defined. Social stress factors seemed somewhat important prior to the onset of depression in the women studied, whereas stressful health factors played a significant role for the men. Despite this, the log-linear models for the selected variables used here did not point to a combination of interactions between a high incidence of current social stress factors and a high incidence of stressful health factors during the six-month period prior to the onset of depression.
In Sweden, with about 8,500,000 inhabitants, it has been estimated that around 200,000 inhabitants have death thoughts every year, about 20,000 make suicide attempts, 2,000 commit suicide, and about 200 of these commit suicide while in psychiatric treatment. During the past 30 years, the suicide rate has been rather stable. However, by means of a birth cohort analysis it has been demonstrated that the risk for suicide in young men 20-24 years old has increased 3.5 times, and the corresponding risk for females 15-19 years old has increased 3 times. The male to female ratio has also decreased, from 3.4 to 2.6. However, suicides are still most common in elderly men. As in many other countries, the number of suicides during psychiatric treatment has increased dramatically from about 30 a year in the beginning of the fifties to around 200 a year. There are many reasons for this. Dramatic decreases in the number of hospital beds in combination with an increasing number of patients admitted and changing patterns...
The association between depressive symptoms and documented general hospital care during an 8-year period was studied in a geographically defined population of 1 040 Finnish persons aged 65 years or more (90% of the eligible elderly). The prevalence of depressive symptoms for the total population was 13.2%. One-quarter of the subjects used 60 hospital days or more in 8 years (high users). The risk of becoming a high user was 1.5 times greater among the depressive elderly than among the others. Depressive symptoms were significantly associated with high use of general hospital care in age-controlled analyses. In men, depressive symptoms were associated with a high use of hospital care even when the effects of somatic morbidity were controlled for. Depressive symptoms can help to identify elderly who are at risk of becoming high users of general hospital care.
Ratings on the Beck Depression Inventory and the Hamilton Rating Scale for Depression were compared among 6 different neurologic diagnostic groups of 114 outpatients. According to the results, depressive symptoms have a similar prevalence in this group as in groups of general medical outpatients and cardiologic inpatients but are more common than in the community. Contrary to the results of some other studies, patients with seizure disorders and cerebrovascular disorders had the lowest ratings. These findings suggest that neurologic diagnostic groups have variable prevalence of affective symptoms even though depression is common in all the different diagnostic groups, according to a brief literature review.
The concentrations of corticotropin-releasing hormone (CRH) and calcitonin gene-related peptide (CGRP) in cerebrospinal fluid (CSF) obtained by suboccipital puncture and in peripheral plasma from patients with common migraine were investigated. There was a significant decrease in the CGRP level in plasma during a migraine attack compared with the levels in a mixed neuropsychiatric group and with the migraine-free period in migraine patients. No alterations were found in the CSF or plasma CRH concentrations during migraine and in an attack-free period. These results exclude the possibility of any significant CRH-induced alteration of the hypothalamic-pituitary axis in migraneous patients and support the suggestion that CGRP has a role in the pathophysiology of migraine.
Referral patterns for psychiatric consultations in a general hospital were analysed on the basis of 670 consecutive referrals. The diagnosis of depressive disorders, especially among the elderly, organic brain syndromes, and substance abuse predominated. The study noted a relative lack of adequate follow-up by psychiatrists, and a considerable discrepancy between consultant's diagnosis and its representation by the referring physician. The study stresses the importance of further research in this field, in particular relating to depressive disorders in the physically ill, and the need for improved training in the diagnosis of organic brain syndromes and substance abuse. It is concluded that early and effective application of psychiatric consultation services could shorten the longer hospital stay of referred patients by detecting and treating psychiatric disorders before they lead to unnecessary investigative procedures, thus saving expense and patient discomfort. Comprehensive patient care would benefit from improvement in consultation services, which represent the most direct form of collaboration between psychiatry and other medical specialties.
