27th Nordic Psychiatric Congress

S - Symposia Sessions XX-XXVIII

S - XX / 1 Saturday 16/8, 11:00-12:30
Psychosocial work environment - changes during the last decade?

Odd Steffen Dalgard, Professor, University of Oslo, PO Box 1130, Blindern, 0318 Oslo, Norway

o.s.dalgard@samfunnsmed.uio.no

Objective: To investigate if there has been any change in how people perceive their psychosocial work environment during the last 10 years, and if there has been any change in factors related to mental health.

Methods: Compare data from the first and second Oslo/Lofoten survey with respect to psychosocial work environment and mental health. Mental health is measured by Hopkins Symptom Checklist 25 items. Psychosocial work environment is measured by: Need for concentration, tempo, self-direction, challenge at work, balance between effort and reward, possibility to change work.

Results: The first Oslo/Lofoten survey shows that the most important psychosocial factors related to mental health are: Need for concentration, difficulties with work changes, lack of self-direction and lack of challenge at work. Each of these factors is independently associated with mental health problems when controlling for age, sex and level of education. The results from the second Oslo/ Lofoten survey will be reported and compared with the results from the first survey.



S - XX / 2 Saturday 16/8, 11:00-12:30
Effect of social support on mental health in a longitudinal perspective


Tom Sørensen, Ullevaal Hospital, 0407 Oslo. Inger Sandanger MD Ph.D., Jan Nygård, Odd Steffen Dalgard MD, PhD.

tom.sorensen@psykiatri.uio.no

Background: The buffering effect of social support, with regard to mental health problems, is seen in some, but not all studies. How social support is defined, how mental health is measured, and characteristics of the population influence the results.

Aims: We will here study in which part of the general population, stratified according to their previous mental health, the buffering effect is the case in presence of stress.

Method: A cohort from 1990 (N=2015) was re-interviewed in 2001-02 with the same instruments. Social support was measured as the subjective experience of getting support if needed, with four items relating to Cobb's (1976) definition. Mental health was measured as the last week symptoms of distress (HSCL-25). Stress was measured as life-events, both last year and in the total observation period (10 year). The population is stratified into those with high and those with no (low) symptoms at T1.

Results: The modification of social support on the relationship between symptoms at T2 and life events is presented. Both the social support reported at T1 and at T2 will be used.



S - XX / 3 Saturday 16/8, 11:00-12:30
The effects of migration on mental health


Robert Kleiner, Professor Emeritus, PhD, Department of Sociology, Temple University, 700 Elkins Avenue, Elkins Park, PA 19027, USA. Tom Sørensen MD PhD, Inger Sandanger MD PhD, Jan Nygård, Odd Steffen Dalgard, MD PhD.

RKlei26436@aol.com

Background: The effects of migration on mental health are complex and vary with the context of the migration process.

Aims: We will here look at change in mental health, measured as the subjective experience of well-being, for people who in a ten-year period have either had a stable domicile or moved.

Method: A cohort from 1990 (N=2015) is re-interviewed in 2001-02. The cohort originated from one rural and one urban site. At T2 we will have four groups; a) stable rural (N=494), b) out-migrated from rural (N=156), c) stable urban (308), and d) out-migrated from urban (N=156). The influence of place of upbringing, rural or urban, and earlier migration experience (before T1) will also be taken into account.

Results: Mental health problems in groups of stability and change of domicile will be given.



S - XX / 4 Saturday 16/8, 11:00-12:30
Changes in help-seeking for mental health problems during the last decade


Platou WS, Institute Group of Psychiatry, University of Oslo. Sørensen T, Sandanger I.

wplatou@online.no

Background: Only a small percentage of people with mental health problems ever receive formal treatment, and specialized mental health professionals treat even fewer. The health services have experienced a gross increase of demands for services for mental health problems during later years.

Aims: Have there been changes in prospective professional help-seeking for mental health problems; is the expectation for help increased? If faced with future mental health problems, to whom would people turn for help during the period 1990 to 2001?

Method: The study has analysed two sets of data based on the same questionnaire presented to a cohort of randomly chosen individual Norwegians (n=2015) in 1990 and 2001. Expected assistance for mental health problems was studied with regard to mental health, social support and the urban/rural dimension.

Results: Expectations for help in 2000 was compared with the expectations from 1990, and assessed according to social support and living in an urban or rural area.

Conclusions: The discussion will be about whether a change in attitude towards and expectations of help for mental health problems has grown substantially during the follow-up period, and if social support or area has any modifying effect on whom people would turn to for help.



S - XX / 5 Saturday 16/8, 11:00-12:30
Problems with prediction in mental health follow-up studies


Nygård JF, BSc, Institute of Behavioural Medicine, University of Oslo. Sandanger I, Klungsøyr O.

j.f.nygard@basalmed.uio.no

Background: Numerous studies have found an association of self-reported health, including mental health, on mortality. However, it is uncertain if, and more importantly; why, a self-reported questionnaire as the HSCL-25, should predict long-term mortality. The HSCL-25 is designed to measure "mood of today/last 14 days", and it is shown be sensitive to changes in mental health over time.

Aims: How long after an assessment of mental health, should the assessment predict mortality?

Method: In 1990 a random individual population cohort in an urban and a rural area, N=2015 was interviewed. The cohort has been linked with The Norwegian Population Registry with data on mortality until December 31st 2001. Mortality hazard rates have been calculated by parametric and semi-parametric regression models

Results: The mortality hazard rates were low, and equal in the first three years of follow-up among persons with HSCL-25 score below and above 1.75. In the next seven years, a higher mortality rate was seen in persons with scores above 1.75.

Conclusions: There are selection effects in population-based studies with regard to mortality. The prognostic value of HSCL-25 on mortality did not appear until three years after the assessment.



S - XX / 6 Saturday 16/8, 11:00-12:30
Changes in incidence rates of depression during the1990-2000 period


Sandanger I, MD, PhD, Institutt for medisinske adferdsfag, Universitetet i Oslo, Postboks 1111 Blindern, 0317, Oslo, Norway. Nygård JF, Sørensen T.

inger.sandanger@basalmed.uio.no

Background: In the 1990s, the health and social insurance services have experienced a steep rise in the occurrence of persons with a depression diagnosis. It is, however, uncertain if the morbidity (illness) has increased or if the increase can be explained by more use/acceptance of the use of a depression diagnosis.

Aims: To estimate the change in prevalence and incidence rates of depression from 1990 to 2001.

Method: In 1990 depression was diagnosed by both CIDI, and HSCL-25 in a random individual population cohort in an urban and a rural area, N=2015. The cohort has been reinterviewed in 2001-02 with the same instruments. The cohort has been supplemented with a sample of younger participants from the same areas.

Results: The two-week prevalence in 1990 of ICD-10 depression was 4.3% in women and 0.7% in men. In comparison 19.8% of the women and 9.3% of the men had a HSCL-25 symptom score1.75. Incidence rates for depression were 30.3 per 1000py for women and 4.4 per 1000py for men. The new prevalence and incidence rates will be given.

Conclusions: Whether there is a rise in depression illness will be discussed.



S - XX / 7 Saturday 16/8, 11:00-12:30
Is smoking a risk factor for depression?


Klungsøyr O, Research Fellow, Institute of Behvaioural Medicine, University of Oslo, Norway. Sandanger I, Nygård JF.

ole.klungsoyr@basalmed.uio.no

Background: Smoking is associated with symptoms of anxiety and depression. One interpretation is that people smoke to calm their nerves. However, newer research has shown that young people without nervous problems more often become depressed if they start to smoke.

Aims: Is smoking a risk factor for depression?

Method: A population cohort from 1990 (N=2015) has been reinterviewed in 2001-02 with the same instruments for smoking and depression (the CIDI, the HSCL-25).

Results: The rates of depression and anxiety in non-smokers in 1990 who have later started to smoke, in smokers who have quit, in continuous smokers and non-smokers will be presented.

Conclusions: The evidence for smoking as a risk factor for depression will be discussed.



S - XXI / 1 Saturday 16/8, 11:00-12:30
Cognitive-behavioural understanding and treatment of severe and persistent health anxiety ("hypochondriasis")


Paul M. Salkovskis Professor, Department of Psychology, Institute of Psychiatry, King's College, London and Maudsley Hospital Centre for Anxiety Disorders and Trauma

p.salkovskis@iop.kcl.ac.uk

This workshop aims to provide a strong theoretical understanding and practical clinical introduction to cognitive-behavioural treatment (CBT) as applied to severe and persistent health anxiety, (the clinical diagnosis of "hypochondriasis"). Such CBT has now been shown to be effective in the treatment of hypochondriasis in several randomised controlled trials. The cognitive behavioural theory, which forms the basis of such treatment, suggests that for severe and persistent health anxiety, patients' problems lie not in the physical symptoms and other bodily variations they experience but rather in the way they interpret and react to these symptoms, and the way they respond to other medical information. There are differences between health anxiety and other anxiety disorders, which mean that the emphasis in CBT differs from treatments for anxiety disorders such as panic, having most in common with CBT for obsessional problems. In particular, the importance of helping the patient to develop and test alternative, non-catastrophic interpretations of the problems they are experiencing is emphasised. However, such an approach also needs to avoid the pitfalls involved in the provision of "reassurance", which can actually increase anxiety in vulnerable patients.

In the workshop, participants will be introduced to the details of how to apply the cognitive behavioural theory to treatment. Videotape of actual therapy sessions will be used to demonstrate key points. Such treatment aims to help patients identify and deal with factors which provoke and maintain health concerns and to allow them to re-engage in normal activities.

Key words: Hypochondriasis, Cognitive-behavioural therapy, health anxiety, anxiety disorders, somatic symptoms.



S - XXI / 2 Saturday 16/8, 11:00-12:30
Cognitive-behavioural approaches to the understanding and treatment of OCD


Paul Salkovskis, Department of Psychology, Institute of Psychiatry, de Crespigny Park, Denmark Hill, London SE5 8AF

P.Salkovskis@iop.kcl.ac.uk
Obsessive-compulsive disorder is a severe and disabling anxiety disorder, and may be more common than previously supposed. The last 20 years has seen the development of cognitive components of treatment. The scientific basis for this development is described. The way in which cognitive and behavioural techniques are integrated in cognitive-behavioural therapy is outlined with some clinical examples. A randomised controlled trial in which such treatment was applied to obsessional ruminations is presented. The important implications of this study for the issue of treatment specificity are discussed.


S - XXI / 3 Saturday 16/8, 11:00-12:30
Cognitive group therapy of depression - a pilot study


Pétur Tyrfingsson, Psychologist, Psychiatric Department of the University Hospital, Hringbraut, 101 Reykjavík, Iceland

peturty@landspitali.is

Background: Most research on cognitive therapy of depression focuses on individual treatment. Because of possible cost-effectiveness it is of special interest to investigate the prospects of group therapy, not least in Iceland where such research is practically nonexistent.
Aim: The aim of the study was to find out if it is possible to design, organize and run a cognitive group therapy of depression in the natural setting of the outpatient psychiatric clinic of the University Hospital in Iceland.

Method: A group program for CT of depression was developed and its efficacy tested at the psychiatric outpatient clinic of the University Hospital in Iceland. Practical surroundings ruled out the possibility of assigning a comparison group. Ten participants were recruited among patients seeking treatment. The main condition for participation was a diagnosis of depression according to ICD-10. Beck's Depression Inventory (BDI) and Symptom Checklist 90-R (SCL-90-R) were used to assess treatment results.

Results: Eight participants out of 10 completed the program. Pretreatment mean score of participants on BDI was 24 and post-treatment score was 12. The difference was statistically significant. Mean difference between participants scores on pre- and post-treatment scores on SCL-90-R were statistically different on all relevant subscales.

Conclusion: The results indicate that 1) group administration of Beck's treatment may be of value for depressed patients, 2) that it can be organized in Icelandic settings, 3) that insistent participation can be elicited and patient drop-out should not be a major problem. It is therefore reasonable to develop further this Icelandic version of group-CT of depression for further clinical trials and when the time is up make it available in the outpatient psychiatric clinics in the country and possibly in primary health care.



S - XXI / 4 Saturday, 16/8, 11:00-12:30
Prevention of depression in adolescents


Eiríkur Örn Arnarson, Head of Psychological Health Services, Landspitali - University Hospital, 101 Reykjavík, Iceland. IH Jónsdóttir, HS Guðmundsdóttir, M Ólafsdóttir, JL Birgisdóttir, W Ed Craighead.

eirikur@landspitali.is

Background: Throughout the world, disorders of depression are among the most prevalent psychiatric/psychological diagnoses. The age of onset of first episode of major depression has decreased among recent cohorts, so that the lifetime prevalence is well over 20% by late adolescence.
Aims: To prevent MDE among late adolescents by using a program developed by the presenters. The programme is based on a cognitive-behaviour therapy model of the treatment of MDE and is developed to be used in a preventive sense for an individual who has not yet experienced an episode of depression.

Method: The preventive CBT program with a group of adolescents who are "at risk" for the development for MDE will be described. "At risk" is defined as individuals who have never met criteria for a MDE but who exhibit substantial symptoms of MDE and the presence of a depressive cognitive style. Students aged 14-15, in six school districts in Iceland, were identified by the CDI and CASQ as having significant depressive symptoms and a depressogenic cognitive style, and interviewed on the CAS and found not to have had a previous MDE. They participated in a 14-session CBT program led by a Psychologist. Students met in a group setting at school, twice per week, for 3 weeks and once per week for the remaining 8 weeks.

Results: The students' changes on the CDI and the CASQ during the course, at six and twelve months follow up will be reported as well as interview data (CAS) regarding their psychopathology and ratings of depression and explanatory style.

Discussion: Results of the pilot studies have demonstrated the feasibility of the programme. It has been well received by participants as reflected in a change in the predicted direction on dependent variables in the experimental group.



S - XXI / 5 Saturday 16/8, 11:00-12:30
Psycho-educational cognitive group therapy of mixed emotional disorders - a pilot study


Agnes Agnarsdóttir, Margrét Halldórsdóttir, Jón Friðrik Sigurðsson, Psychologists, Landspítali University Hospital, Reykjavík, Iceland

jonfsig@landspitali.is

Aim: The aim of the study was to assess the effectiveness of a Psycho-Educational Group Therapy based on Cognitive Behavioural Principles for emotional disorders for patients attending an out-patient clinic at the University Hospital in Reykjavik.
Method: A psycho-educational group programme, based on four group sessions (two hours each) and homework assignments. Forty participants diagnosed with emotional disorders (depression and anxiety) were referred from therapists at the out-patient clinic, psychiatrists, psychologists, nurses, and social workers.

Four psychological tests were administered at the beginning and in the end of the treatment programme, Beck Depression Inventory (BDI-II), Beck Hopelessness Scale (BHS), Automatic Thought Questionnaire (ATQ), and Symptom Checklist 90-R (SCL-90-R).

Results: The main results of this pilot study will be described, mean scores on the psychological tests and differences between those who completed the treatment programme and patients on waiting list. Characteristics of those who dropped out will also be described.



S - XXII / 1 Saturday 17/8, 11:00-12:30

Quality of life of patients with schizophrenia: A randomized, naturalistic, controlled trial comparing olanzapine with typical antipsychotics in Brazil


Mauricio S. Lima, MD, Dept de psiqui, Federal University, PO Box 354, Pelotas 96015-000, Brazil. Jair de Jesus Mari, PhD, Anna MN. Costa, MD, Neusa Alexandrini MD, Salomao R Filho, MD, Irismar R de Oliveira, MD, Matthew Hotopf, MD.

At the conclusion of this session, the participant should be able to demonstrate that olanzapine's clinical profile leads to social functioning and quality of life improvement superior to that achieved with conventional treatment.
Objectives: (1) To assess the effectiveness of olanzapine for treating schizophrenia; (2) to test the hypothesis that patients on olanzapine have better quality of life than those on typical antipsychotics (APs).

Method: This was a multicenter, naturalistic, randomized, open study that compared olanzapine with conventional APs, at hospitalization and during a nine-month follow-up. Outcome assessors were blind to the allocated drug and to the objectives of the study. The daily dose of APs was determined by the doctors according to their clinical practice routine.

Results: A total of 198 patients were randomly assigned to olanzapine (n=104) and typical antipsychotics (n=94). Patients on olanzapine showed higher improvement on PANSS negative and general psychopathology subscales. When compared with patients on typical APs, patients treated with olanzapine showed higher improvement in most of the SF-36 domains, with statistically significant differences in the following domains; physical functioning, role physical, and role emotional.

Conclusion: Compared with typical antipsychotics, olanzapine has advantages in a naturalistic setting for treating patients with schizophrenia and improving relevant clinical outcomes, such as negative symptoms and quality of life. These findings are highlighted by the naturalistic approach adopted in this trial, as olanzapine was compared with real-world practices in the use of typical APs.

References

1. Revicki DA, Namjoshi MA, Edgell ET. Health-related Quality of Life measurement in Schizophrenia: a review of previous research and clinical trial results with olanzapine treatment, in Olanzapine (Zyprexa): A Novel Antypshychotic. Edited by Tran PV, Bymaster FP, Tye N, Herrera JM, Breier A, Tollefson GD. Lippincott Williams & Wilkins Healthcare, 2000.

2. Hamilton SH, Edgell ET, Revicki DA, Breier A. Functional outcomes in schizophrenia: a comparison of olanzapine and haloperidol in a European sample. Int Clin Psychopharmacol 2000; 15: 245-55.




S - XXII / 2 Saturday 16/8, 11:00-12:30
TIPS study: Subjective quality of life in first episode psychosis


Melle I, MD, PhD, Ullevaal University Hospital, 0407 Oslo, Norway. Haahr U, Friis S, Johannesen JO, Larsen TK, Opjordsmoen S, Simonsen E, Vaglum P.

ingrid.melle@psykiatri.uio.no

Background: Quality of life (QoL) is a central issue in the study of psychotic disorders, but few studies have evaluated QoL in first episode patients (FEP). How well do instruments developed for chronic patients apply to FEP, how does FEP describe their subjective quality of life, and what is the relationship between subjective QoL and clinical status in the early treatment phase?
Material and method: The TIPS study included consecutive FEP from four Scandinavian health care sectors over four years. QoL was measured with the Lehman Quality of Life Interview (L-QoLI). At start of treatment, 282 patients completed full L-QoLI interviews.

Results: The L-QoLI differentiated well between different subgroups of FEP, and in factor analyses the factor structure found in studies of other patient populations was reproduced. There was a low degree of association between objective and subjective QoL, and between clinical measures and QoL. The presentation will focus on the patients' description of their actual living situation (objective QoL) and perceived well being (subjective QoL), and the relationship between subjective QoL and premorbid functioning and duration of untreated psychotic illness.



S - XXII / 3 Saturday 16/8, 11:00-12:30

Education on mental health is successful: A study on adolscent's attitude towards mental health


Dóra Guðrún Guðmundsdóttir, Project manager, The Icelandic Mental Health, Austurströnd 5, 170 Seltjarnarnesi, Iceland

dora@ged.is
In the summer 2001 gave Geðrækt lectures about mental health foradolescents. The main goal of the lectures was to inform adolescents about mental health.

Aims: This study explored adolescents' knowledge and attitudes towards mental health, mental health problems and mental health promotion and how their attitudes changed after the lecture.

Method: A questionnaire was constructed to measure the knowledge and attitudes. The subjects answered the same questionnaire a week before the lecture and subsequently a week after the lecture. Three hypotheses were proposed: H1: Those people who know someone who has a mental illness have a more positive attitude towards mental health, mental health problems and towards those with mental illness. H2: Education about mental health increases adolescent's knowledge of mental health. H3: Education on mental health reduces prejudices towards those who have mental health problems.

Results: The adolescent's misconceptions and prejudices towards mental ill health were reduced after the lecture. The results support all hypothesis.

Conclusions: From the results we conclude that education on mental health can be a successful strategy. Education can be used to increase understanding and reduce prejudices and misconceptions about mental health and mental illness. The results show that prejudices are synonymous with ignorance.



S - XXII / 4 Saturday 16/8, 11:00-12:30
Sleep, dreams, and well being

Björg Bjarnadóttir, Dr., PhD in Developmental Psychology, Psychologist in Charge, FSA - University Regional Hospital, PS-Ward, Skólastíg 7, 600 Akureyri, Iceland

bbjarna@mi.is

Background: In the early 2003 research into the sleep and dream patterns/habits of modern Icelanders was conducted.
Aims of research: 1) the physical and emotional well being of Icelanders, their sleeping habits; 2) dream patterns, and the main classes of dreams, nightmares being one; 3) how age, sex, and socioeconomic status correlate with above.

Method: A quantitative questionnaire was given to a sample of 1200 Icelanders aged 18 to 85. Gallup in Iceland undertook the task of contacting subjects via phone and provides statistical presentations of the findings.

Results: Responding was 67.5%. Results indicate that: Icelanders sleep well (78%), for about 7 to 8 hours (59.6%), their well being physically and emotionally is high (76 and 78%), and dreams have meaning for them (72%). About 12 % of the population had used sleep medicament and 10% antidepressants, highest in the low socioeconomic groups, among elderly, and those divorced/widowed as accompanied by higher scores for poorer physical and mental well being.

Conclusions: The research indicates sound sleep and dream patterns for Icelanders in relation to good physical and mental well being. It confirms earlier findings of national beliefs into the value of dreams and of general happiness. Special effort is needed in promoting well being among certain socioeconomic groups.



S - XXII / 5 Saturday 16/8, 11:00-12:30
Geðrækt: The Icelandic Mental Health Promotion Project


Dóra Guðrún Guðmundsdóttir, Project Manager, The Icelandic Mental Health Promotion Project, Austurströnd 5, 170 Seltjarnarnesi, Iceland

dora@ged.is

Background: In the year 2000 an ex-service user came up with the idea of starting a project to promote mental health in Iceland. Geðrækt (The Icelandic Mental Health Promotion Project) was founded that year in cooperation with "Landspítalinn", "Geðhjálp" and "Landlæknisembættið".
Aims: The main goals of Geðrækt are to enhance mental health preventions and promotion throughout the society with education. The aim is to raise awareness of mental health, emphasising that everybody possesses a form of mental health.

Method: Geðrækt has given lectures on mental health and mental health promotion in schools, institutions, workplaces, and for non-profit organizations around the country. Geðrækt has published materials to use in life skill education on mental health to help children to be aware of their feelings and how they can cope with their negative feelings. Geðrækt has also participated in a number of projects in cooperation with other organizations, theatres etc.

Results: A study made by Gallup in November 2002 showed that about 50% had heard about "Geðrækt" and one third was aware of what mental health promotion is all about.

Conclusions: From those results we conclude that Geðrækt's education on mental health has been successful in raising people's awareness of mental health and mental health promotion.



S - XXIII / 1 Saturday 16/8, 11:00-12:30
More influence but fewer psychiatrists in Denmark


Søren Bredkjær, President of the Danish Psychiatric Society, Chief Medical Position, Sct. Hans Hospital, Boserupvej 2, DK-4000 Roskilde

soeren.bredkjaer@shh.hosp.dk

Background: Despite improvements in psychiatric teaching, the number of psychiatrists is declining. In fact, 20% of positions for psychiatrists are not occupied. At the same time politicians and the health authorities discuss whether psychiatry belongs to the health or the social sector.
Aims: To inform about the strategy for getting more influence, power, and prestige of the specialty and improving recruitment in Denmark.

Method and results: The main topics in our strategy are: To make a proposal for a national plan for psychiatry in Denmark 2003-2010; To define more closely what the role of the psychiatrists should be and whether there are tasks that could be carried out more appropriately by other professionals; To maintain psychiatry as a part of the health sector with close relationship to the other medical specialties; To improve conditions for scientific positions in psychiatry; To make clinical guidelines for the main diagnostic groups in psychiatry over the next years; To improve the training, supervision and support for psychiatrists.

Conclusions: The influences, power, and prestige of the specialty may depend more on the quality than the quantity of consultants, and there needs to be more debates about these issues.



S - XXIII / 2 Friday 15/8, 11:00-12:30
Current concerns in nordic psychiatry: The Norwegian perspective


Bjarte Stubhaug, President, Norwegian Psychiatric Association

no-psyk@online.no

Norway has been experiencing great changes in the structure and legislation of psychiatry during recent years. The de-institutionalisation process has continued, resulting in lack of hospital beds for the acutely ill patients. Community psychiatry is developing, and many local psychiatric community centres have been established.

There is professional concern that this could weaken hospital psychiatry and research, and that the specialized, research and evidence based psychiatry is losing its position to a more community based psychosocial care.

Hospitals are run as enterprises, with demands of economic balance.

The focus on economical issues is conflicting with professional priorities.

There is lack of psychiatrists, and recruitment has been low.

Drug-related psychiatric disorders are increasing, creating new needs for treatment and care.

Education and continuous professional development must meet the need for new competence.

New health legislation has abolished the function of the psychiatrist as the professional leader of psychiatric services. Non-professionals may have leadership positions that include the professional services.

The role and function of the psychiatrist is changing rapidly and dramatically, towards the function of a medical consultant. Psychiatry as an integrated biopsychosocial field of medicine is being challenged. Professional leadership issues must be resolved.



S - XXIII / 3 Saturday 16/8, 11:00-12:30

Current concerns in Icelandic psychiatry


Sigurður Páll Pálsson, Psychiatrist, Department of Psychiatry, University Hospital, Reykjavík, Iceland

siggipp@centrum.is sigpp@landspitali.is


Background: Compared to other nations the number of psychiatrists is high. Young doctors usually do part of their specialist training programme in Scandinavia, UK or USA. Thus, Icelandic psychiatry is influenced by different cultures, education, research, and experience.
Results:
A. Problems: 1) Increased demands for cuts in hospital beds and use of new medication. 2) Decreasing availability of hospital-beds. 3) Social services and primary health care have neither resources nor experience to take over the responsibility of our clients. 4) Two ministries are responsible for individuals needing long-term service. 5) Prevention programmes are still underdeveloped. 6) Need for more psychiatric nurses and trained personnel. 7) Funding research 8) Strong central administration, only one major hospital and one University. 8) Increasing knowledge of the consequences and high prevalence of psychiatric disorders. Budgeting is in no relation to size of the problems. The patients' voice. Still a fight against stigma and prejudice 9) Continued education needs formalisation, financing and authority defined.
B. Positive aspects: Well-educated psychiatrists, many active in research. Good availability for treatment of alcohol and drug abuse. Concern for the individual.
Conclusions: Psychiatrists need to influence policy makers. Roles and responsibility for different levels of service and education must be clearer.



S - XXIII / 4 Saturday 16/8, 11:00-12:30
What is Swedish psychiatry concerned with?

Hans Ågren, Karolinska Institutet, Neurotec Department, Division of Psychiatry, Huddinge University Hospital, Stockholm, Sweden. President of the Swedish Psychiatric Association.
The old political antagonism of psychiatry-versus-psychology has for some time been laid to rest in Sweden - a common intellectual ground has been found in the realization that nature and nurture go together. However, there are two areas where this harmonization is still incomplete: the conceptualisation of ADHD and its possible treatment with central stimulants has been under attack from sociologists, and certain lay mental advocate groups have managed to get political support in criticizing the increasing use of antidepressants - they have confused addictive potential with discontinuation syndromes.
Other areas of major concern are the vast problems in Sweden with exhaustive-depressive syndromes, where the increasing national sick-leave rate is largely due to perceived work-place stress. Whether exhaustion ("burn-out") is equivalent to a depressive disorder is unclear, as is its proper treatment. As vast a problem is the psychiatric illness behaviour of refugee asylum seekers, where mental problems arising during the extended waiting period before immigrant status is granted has created a heavy burden on psychiatric services all over the country. Areas of debate have also included the use of antagonists and agonists in the continuation treatment of heroine addicts, and programmes providing clean syringes that exist in certain centres.

Psychiatric specialist education and continuing education is under scrutiny by the Swedish Psychiatric Association, looking at the UEMS guidelines and practices in other Nordic countries. The new organisation of IPULS (Institute of Professional Education of Physicians in Sweden) is an important new development, where one single institute will judge and accredit every medical educational activity, whether organized by academia or industry.



S - XXIII / 5 Saturday 16/8, 11:00-12:30
Psychiatric care in Finland - achievements and challenges


Raimo KR Salokangas, Professor of Psychiatry, University of Turku, Dept. of Psychiatry, Kiinamyllynkatu 4-8, 20520, Turku, Finland

raimo.k.r.salonkangas@tyks.fi
The mental health service system has experienced great changes during recent years in Finland. Until the end of the 1970s, the mental health care system was based on a great number of mental institutions and an increasing number of mental health centres. It also had an independent administration. As a result of the reforms inside and outside psychiatry in the 1980s and 1990s, the number of beds in mental hospitals rapidly declined, and the use of psychiatric outpatient care and complimentary services increased. The psychiatric care became fused with the specialised medical care system and suffered from large financial cuts during the economic depression. At the same time, parts of the specialised psychiatric care were transferred to primary care and complimentary services were privatised. At the moment, lack of financial resources, scattered administration, as well as the burn-out of psychiatric personnel and an alarmingly great lack of psychiatrists in the public services constitute the greatest problems of the mental health care system in Finland. The centralising of administration, the combining of separate psychiatric specialities into larger service complexes, the developing of the personnel's working conditions, and the content of psychiatrists' work may help the specialised psychiatric care in its current crisis.



S - XXIII / 6 Saturday 16/8, 11:00-12:30
Current situation of the mental health services in Estonia


Andres Lehtmets, MD, Veiko Vasar MD, PhD

andres.lehtmets@ltkh.ee
Over the last decade the changes in the social sphere of Estonia have been tremendous. As an accession country to the EU the resources spent on social and health care services are still many-fold smaller then in the neighbouring Scandinavian countries; however, the development seems to be more and more oriented to the social welfare model of the North. The mental health services have to struggle alongside with all the rest for the limited financial means. In 2002 the overall budget of the Sickness Fund was nearly 315 million euros, out of which the specialist services received 146. The mental health services spent 5.8 million euros (this figure does not cover the reimbursement of drugs nor the social well-fare services for the long-term mentally ill). The nearly 80 000 outpatient visits and 10 500 treated inpatients resulted in a mean expenditure of 87 euros per case.
As well as limited resources, Estonia is facing a serious shortage of specialists in the mental health field. In 2001 the number of psychiatrists was 170 (1.2 per 10 000 of population), 15 of whom were working in child and adolescent psychiatry. 59% of the psychiatrists were working in outpatient units. There were also 40 clinical psychologists, 9 social workers and 100 nurses with specialization on mental health care. The problem is in the age structure, as many of the doctors are reaching retirement age. The turning point in training was in 2003 when the number of trainee posts was doubled (from 4 to 8); however, there is little progress in increasing the training of mental health nurses.

Early in 2003 the government adopted the Mental Health Basic Document, opening a new horizon for the development of a more elaborated mental health policy. For the time being the main focus in developing the services is on the outpatient sector. At the same time the vast decrease in the number of hospital beds has resulted in the mean stay of 15-18 days (depending on the region) that is clearly not enough to fulfil the role of inpatient services. Another problem area is the child and adolescent psychiatry, where the lack of specialists as well as of clear development strategy is leading to serious deficiencies in providing the services.

Estonian health care services are run on private (still mostly non-profit) hospitals and public money (operated by a Sickness-Fund). This combination makes a great challenge for mental health services in order to be able to compete for the funding and other resources.



S - XXIV / 1 Saturday 16/8, 11:00-12:30
The growing needs for child and adolescent psychiatric care: Ethical and political challenges

Páll Biering, PhD, RN, Eiríksgötu 34, 101 Reykjavík

pb@hi.is
In this paper it is argued that there are two main reasons for the growing needs for children and adolescents psychiatric care. First, there is evidence that mental health problems are increasing among children and adolescents both in developed and developing countries. Second, more and more youth behavior problems and self-destructive behaviors are being defined as medical conditions. This development has two critical aspects that caregivers need to examine before they can respond to it in a way that is clinically holistic, ethical, and empowering for the children and adolescents. One aspect faces the ethical and therapeutic considerations surrounding situations in which the declining mental health of children and adolescents can, to a greater or lesser degree, be understood as the outcome of a dysfunctional family or an unjust social order. The other aspect turns toward questions concerning the disciplinary power that medicine exercises over psychiatric patients. After drawing from medical sociology, psychiatric ethics, and the work of Michel Foucault it is concluded that caregivers need to recognize the socio-cultural nature of children's and adolescents' mental suffering if they want to have a role as empowering advocates. To reach that goal they need to recognize the inevitable power imbalance in the caregiver-patient relationship and seek guidance in postmodern thinking which encourages us to abandon universal theories about the caregiver-patient relationship.


S - XXIV / 2 Friday 16/8, 11:00-12:30

Seven keys to recovery - clients perspective


Elín Ebba Ásmundsdóttir, MSc, Chief Occupational Therapist, University Hospital, Psychiatry and Ass. Prof., University Akureyri, Iceland., Laugavegi 53A, 101 Reykjavik, Iceland

ebba@landspitali.is
Research on recovery and resilience in psychiatric disability is in its infancy. This research aims to explore clients' perspective on recovery in order to improve current polices and practice in mental health services. The study identifies supports and barriers to recovery from clients' perspective. Qualitative research methods, in-dept interviews, group-interviews, and participation observation were used with a diverse cross-section of subjects who consider themselves "survivors" of mental illness. All interviews were audiotaped and analysed according to the hermeneutic-phenomenological approach, grounded theory, and discourse analysis.
Recovery is a unique and personal journey; a way of living, satisfied, hopeful and contributing to society despite limitations caused by illness. Seven keys of recovery were identified, both individual and environmental characteristics which empower recovery. The findings are consistent with international research on recovery which has implications for policy, practice and research. Mental health service outcome measures are needed to generate comparable data across countries. Findings could promote development of services driven by client perspective on recovery. Client- based research provides a unique and challenging vision on the journey of recovery for the mental health system.



S - XXIV / 3 Saturday 16/8, 11:00-12:30
Depressed women and silencing of the self


Bergþóra Reynisdóttir, Psychiatric Nurse Specialist, Liljan ehf, Vallargerði 10, 200 Kópavogi, Iceland

liljan@isl.is

Aim: The aim of the study was to investigate how women who have been diagnosed with depression experience their relationship with health care professionals. Hermeneutic phenomenology was chosen as a methodology for the study. This method aims at exploring, explaining, and presenting how people experience, interpret and give meaning to incidents occurring in their lives. Nine Icelandic women, aged 39-68, participated in the study. Data was collected with interviews and four main themes emerged from the interpretation of the data: 1) understanding emotional disturbance, 2) "silencing the self", 3) prejudice, 4) finding own way out of emotional isolation.
Results: The findings of this study indicate that women's emotion strongly effects their communication with health care professionals. They found it most important that the health care professionals showed them respect and empathy, and that they assisted them to overcome emotional sufferings. All the participants described experience of impersonal communication on behalf of the health care workers, communication in which they were neither heard nor listened to. The women found that decisions concerning their treatment were taken without their consent.

Conclusion: It is concluded that from the perspective of these women, fundamental principles in ethics and communication are not upheld by the health care professionals.

Key words: depression, women, health care professionals, communication, emotional suffering.


S - XXIV / 4 Friday 16/8, 11:00-12:30
The worker role interview - a powerful tool in icelandic work rehabilitation


Elín Ebba Ásmundsdóttir, Chief Occupational Therapist, University Hospital, Psychiatry, Laugavegi 53A, 101 Reykjavík, Iceland

ebba@landspitali.is

A pilot-study using the Worker Role Interview (WRI) was conducted to gather information from clients attending a work-rehabilitation programme in an Icelandic psychiatric centre. The work rehabilitation programme traditionally used a performance-capacity-oriented assessment (PCA) to evaluate clients' work readiness. Clients scoring 90% or higher on the PCA were considered able to re-enter the job market. However, scoring over the cut off of 90% did not result in automatic return to work for the majority of clients. As a result many questions were proposed about the effectiveness of the PCA to predict client ability to re-enter the work force. A pilot study using the Worker Role Interview was conducted with an aim to gain insight into what barriers prevented clients from entering the work force. Ten clients scoring 90% or over on the PCA were interviewed using the WRI. Qualitative methods were used to analyze the data. Results from the WRI indicated that clients failed to join the work force due to a number of psychosocial factors such as lack of personal causation and self-efficacy combined with environmental factors. The WRI provided clients with an opportunity to express their attitudes and opinions towards work. Information gained through the WRI also gave new direction in goal setting for the work rehabilitation programme and validated the need to expand occupational therapy services.



S - XXIV / 5 Saturday 16/8, 11:00-12:30

Psychosocial impact of automatic implantable cardioverter defibrillators on Icelandic patients

Sveinn Eggertsson, Assistant Professor, Anthropology, University of Iceland, Odda við Sturlugötu, Reykjavík, Iceland. Margrét Leósdóttir, Davíð Ottó Arnar, Engilbert Sigurðsson.

sveinne@hi.is
The objective of this study was to assess the psychosocial impact of automatic implantable cardioverter defibrillators (ICD) on Icelandic patients. Interviews were conducted with 11 ICD recipients, who were asked to describe their experiences of having an ICD; how it has affected the quality of their lives, images of self and future aspirations. Most of the people interviewed accepted the presence of the ICD as necessary and positive, giving them a feeling of security. In a general sense the ICD was not a focus of preoccupation for most of the people interviewed, other aspects of their lives, such as ill state of health, social isolation or loss of memory being of greater concern.


S - XXIV / 6 Saturday 16/8, 11:00-12:30

Imagination? - The image-making faculty and clinical assessment


Haukur Ingi Jónasson, MPhil, Psychoanalyst, Union Theological Seminary (Columbia University), Garðastræti 17, 101 Reykjavík, Iceland

haukuringi@hotmail.com
The current reductionistic biochemical trend within psychiatry is of undeniable value. However, it is of vital importance to emphasize within the profession the need to assess mental disturbances as they get manifested in the subjective experience of the patient and work with his/her imagination accordingly. If not, modern psychiatry might run the risk of creating a generation of psychiatrist and mental care workers that are incapable of utilizing the clinical tools provided by human imagination at the cost of both patients and practitioners. The human imagination is defined as the image-making faculty within the individual and its clinical implications are laid out by drawing on sources in medicine, philosophy, dynamic psychiatry, and mystical theology. The method is phenomenological, i.e. the imagination is explored as a structure of experience presenting itself to consciousness. Its clinical function will be examined by using examples from clinical work and the history of psychological healing in Nordic countries. It is concluded that the imagination is a powerful alliance to the psychiatrist/therapist, if and only if,? he/she is skilled enough to make use of it in clinic.


S - XXV / 1 Saturday 16/8, 11:00-12:30

Models for the organization of consultation-liaison psychiatry in the general hospital


Lars Wahlström, MD, överläkare, Psychiatric Dept., Huddinge University Hospital, S-141 86 Stockholm, Sweden

lars.wahlstrom@slpo.sll.se

Background: Different models of consultation-liaison (C-L) psychiatric work have consequences as to which patient populations are targeted, for research as well as for the prestige of psychiatry in the somatic specialties. If C-L psychiatry is to play a role in the future, the organization of activities has to be compatible with the complex problems facing the C-L psychiatrist.
Method: A reflection based upon a recent questionnaire study of the organization of C-L services in Sweden and comparison with the ECLW collaborative study.
Results: There is no common model for how to organize C-L psychiatric activities.

Conclusion: The following themes will be touched upon:
  • The basic importance of personal relations, continuity and accessibility.
  • Probably most units in the Nordic countries are affiliated with the psychiatric departments. What are the advantages and disadvantages of this compared to an affiliation with the general hospital departments or a completely independent status?
  • Which are the consequences of, on the one hand integration, or, on the other hand, a separation of emergency and elective activities?
  • Perspectives on financing.



S - XXV / 2 Friday 16/8, 11:00-12:30

Working with consultation-liaison psychiatry in a neurology clinic


Göran Rydén, MD, Psykiatriska kliniken, SLPO, Huddinge Universitetssjukhus, Psykiatriska kliniken, M56, S-141 86 Stockholm, Sweden

goran.ryden@slpo.sll.se
During the last year, 2002, the psychiatric consultation unit received 64 referrals from the neurologic clinic. 16% of these were solved without seeing the patient; 68% resulted in one consultation. Only a few cases were seen more than 3 times. About one third were emergency referrals.
The most common reasons for referral were depression (25%), anxiety, suicide risk evaluation, psychosis, and somatization. Direct pharmacologic issues were more uncommon. Only one case contained a wish that the patient should be taken over. Compared to the total amount of referrals from the whole of Huddinge University Hospital, the neurologist seems to use the psychiatrist in the evaluation of the patient's problem as whole and presumed elements of somatization and less in direct wishes for different kinds of administrative help.

Among the preliminary diagnoses that were evaluated by the psychiatrist depression was most common (20%) The organic disorders, including delirium states and dementia, were diagnosed in 19%, anxiety in 15% and maladaptive stress disorder in 10%. Somatization is a common symptom but surprisingly few patients had a somatoform disorder. Another unexpected finding was that the difference in diagnostic distribution compared to the hospital as a whole was almost ignorable. GAF was at average 46,4 with considerable difference between the wards (from 35 to 56 at average).

Crucial elements for consultation-liaison work seem to be collegial relations to doctors and nurses at the wards, continuity and that the psychiatrist is easily available.

Two cases are presented as examples of how the consultative work is assessed; one patient with cerebral abscess and panic disorder and one patient with cerebral paralysis and pathologic laughter.



S - XXV / 3 Friday 16/8, 11:00-12:30
Debriefing - is it useful in crisis intervention?

Øivind Ekeberg, Professor, Department of Behavioural Sciences in Medicine, PO Box 1111 Blindern, NO-0317 Oslo, Norway. Erlend Hem.

oivind.ekeberg@basalmed.uio.no

Background: Traumatic events are an important source of psychological morbidity. Psychological interventions such as debriefing have been increasingly used to treat psychological trauma. However, in 1998, a systematic Cochrane review concluded that single session individual debriefing did not reduce psychological distress nor prevent the onset of PTSD. The implication of this is not that psychological debriefing per se is ineffective. A major problem in previous research is that debriefing has been used for different interventions, e.g. in terms of number of sessions and individual or group treatment. An inclusion criterion in the Cochrane review is individual one-session intervention. This kind of intervention is contrary to most clinical thinking: First, assess the trauma. Second, offer treatment accordingly. During the presentation, clinical cases will be presented to illustrate the relationship between the degree of trauma, intervention and outcome.
Conclusion: A flexible and individual strategy is recommended. Future studies of debriefing should utilise individualised designs including screening of psychopathology before intervention, if any, is offered. To assess the effect of one session of debriefing, only subjects who are likely to benefit from such a limited intervention should be included. Accordingly, those who are at greatest risk for PTSD should have more extensive interventions.



S - XXV / 4 Saturday 16/8, 11:00-12:30

Somatoform disorders in primary car. Prevalence and teaching GPs management


Per Fink.
No abstract received.



S - XXVI / 1 Saturday 16/8, 11:00-12:30

Validity of self-report and observer ratings of adult ADHD symptoms in comparison with a semistructured diagnostic interview

Páll Magnússon, Dept. of Child and Adolescent Psychiatry, National University Hospital, Reykjavík, Iceland. Jakob Smári, Dagbjörg Sigurðardóttir, Gísli Baldursson, Jón Sigmundsson, Kristleifur Kristjánsson, Solveig Sigurðardóttir, Stefán Hreiðarsson, Steingerður Sigurbjörnsdóttir, Ólafur Ó. Guðmundsson

Background: In a study of the genetics of ADHD, valid, and reliable instruments were needed to describe phenotypic variations in symptoms of ADHD in the adult relatives of probands diagnosed with the disorder.
Aims: The aim af the study was to evaluate the validity of short checklists intended to tap both current and childhood symptoms.

Method: The subjects (89 females and 37 males, aged 17-77 years) completed DSM-IV based symptom checklists rating their childhood and current symptoms. For each adult relative, informants, most frequently a parent, brother, sister or spouse, completed comparable lists. The validity of self-reported and informant-reported symptoms in childhood and adulthood was evaluated by comparing the results with an external criterion, namely data gathered by experienced clinicians in semistructured diagnostic interviews evaluating both childhood and current symptoms.

Results: For both sexes self-reported symptoms strongly predicted results of the interviews and observer rated symptoms predicted these results moderately, for both childhood and current symptoms.

Conclusion: The results indicate that adults' self-ratings of their current and childhood symptoms of ADHD have acceptable validity when compared with an external criterion.



S - XXVI / 2 Saturday 16/8, 11:00-12:30
Psychometric properties of the Icelandic version of the behavior assessment system for children (BASC)

Sólveig Jónsdóttir, Clinical Child Psychologist, Landspítali-háskólasjúkrahús, Dept. of Child and Adolescent Psychiatry, Dalbraut 12, 105 Reykjavík, Iceland. Sigurlín H. Kjartansdóttir, Jakob Smári.

soljonsd@landspitali.is

Background: The Behavior Assessment System for Children (BASC; Reynolds & Kamphaus, 1992) is a multidimensional measure designed to evaluate the behaviour, emotions and self-perceptions of children and adolescents aged 2 1/2 to 18 years. It measures both adaptive and problematic dimensions, as well as behaviour linked to ADD and ADHD.
Aims: The main objective of this study was to examine the psychometric properties of the Icelandic version of the BASC.

Method: The participants were 137 parents and 18 teachers of 117 children aged 6 to 11. 95 children aged 8 to 11 filled out self-reports.

Results: Reliability was high for all composites and scales and similar to that of the original version. Correlations between parents' and teachers' assessments were in a similar range as in the original version. Teachers rated boys higher than girls on scales measuring hyperactivity, aggression and attention problems. They rated girls higher than boys on scales measuring anxiety, somatization and social skills. Parents' assessment was similar to that of teachers, but there was less difference between sexes.

Conclusions: The Icelandic version of the BASC has good psychometric properties and appears to be a reliable and valid instrument to use to evaluate behaviour and emotions of Icelandic children aged 6 to 11.



S - XXVI / 3 Saturday 16/8, 11:00-12:30
Translation and cross-cultural adaption of diagnostic interviews: need for european consensus statement about standard and validated practices?


Bertrand Lauth, MD, National University Hospital, Department of Child and Adolescent Psychiatry, Dalbraut 12, 105 Reykjavík, Iceland. Páll Magnússon, MSc, Hannes Pétursson, MD, PhD, FRCPsych.

Background: Many North-American instruments have been shown to be relevant for systematic and standardised research in general and clinical populations, and their psychometric properties have been studied in English-speaking populations. However, the application of an instrument in a new cultural group involves more than simply producing text in another language, administering the translated instrument, and comparing the results.
Objectives: To analyse the practical problems of cross-cultural adaptation of diagnostic instruments in child and adolescent psychiatry, based on Icelandic experience with the Kiddie-SADS.

Method: The "Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children" (K-SADS-PL"-Present and Lifetime Version") is a semi-structured diagnostic interview that has been used in numerous clinical, naturalistic follow-up, treatment, psychobiological, family-genetic and epidemiological studies. The process of translation and cross-cultural adaptation of this instrument is described, with issues regarding Semantic Equivalence, Content and Normative Equivalence, Conceptual Equivalence and Criterion Equivalence.

Results: Transfer of validity from one cultural context to another cannot be taken for granted but has to be demonstrated. Concrete examples from Icelandic experience will be described. Different techniques will be discussed to detect and solve construct bias, method bias, and item bias.

Conclusion: There is a need for a European consensus statement about standard and validated practices for translating diagnostic and research instruments.



S - XXVI / 4 Friday 16/8 11:00-12:30
An Icelandic version of the Problem Gambling Severity Index: A Psychometric evaluation


Daníel Þór Ólason Dr., University of Iceland, Department of Psychology, Odda, Sturlugötu, 101 Reykjavík, Iceland. Herdís Finnbogadóttir, Margrét A. Hauksdóttir, Sigríður K. Bárudóttir.

dto@hi.is

Background: In spite of considerably high rates of gambling participation in Iceland there exists little information on the prevalence of problem gambling In Iceland.
Aims: This paper presents a psychometric evaluation of the Problem Gambling Severity Index (PGSI-Ferris & Wynne, 2001) and reports the rate of problem gambling among university students in Iceland.

Method: Students from seven universities in Iceland were surveyed concerning their gambling behaviour. The final sample consisted of 1.266 students (mean age = 26), 35% males and 65% females.

Results: About 75% of the students had gambled at least once during the past 12 months, with gambling more common among males (83%) than females (71%). The nine items from the PGSI were entered into a PC analysis revealing a clear one-factor structure with satisfactory alpha coefficient (0,84). Students were classified into the following gambler sub-types: (1) non-problem gambler (86,3%), (2) low risk gambler (11,4%), (3) moderate risk gambler (1,9%) and (4) problem gambler (0,03%). Finally, comparing the PGSI with a DSM-IV diagnostic measure revealed satisfactory classification accuracy of the PGSI.

Conclusions: The results suggest that the PGSI is a reliable and accurate measure of problem gambling and provides sound basis for future epidemiological studies within the Icelandic population.



S - XXVII / 1 Friday 16/8, 11:00-12:30
A long-term follow-up study of adolescent psychiatric in-patients


Kjelsberg E, MD, Centre for Research and Education in Forensic Psychiatry and Sogn Centre for Child and Adolescent Psychiatry, SSBU, PO Box 26, Vinderen, N-0319 Oslo, Norway

ellen.kjelsberg@psykiatri.uio.no

Background: Little is known about the long-term outcome in adolescent mental disorders.

Aims: To investigate the adult outcome in adolescent psychiatric in-patients.

Method: A total of 1095 patients, close to 86% of all patients admitted to the Adolescent Department at the National Centre for Child and Adolescent Psychiatry in Oslo, Norway, during the years 1963-81 were followed-up 15-33 years later. On the basis of hospital records, all patients were re-diagnosed according to DSM-IV and scored on a variety of background data hypothesised to have predictive power as to later outcome. At follow-up, register linkage to the national registers of disability, criminality, and causes of death were carried out. Survival analysis was used to explore possible predictors of criminality, disability, and death.

Results: 52% of the patients had entered the criminal register at follow-up, close to 39% had received disability pension, and 13.6% were dead. This constitutes markedly increased proportions, compared to age and gender matched groups in the general population. Only about 23% of the patients had avoided entering any of the above registers. Distinct risk factors for the different outcomes were identified.

Conclusions: The study found poor adult outcome, defined as criminal activity, disability, and early death, in a large proportion of adolescent psychiatric in-patients, particularly males with externalising disorders.



S - XXVII / 2 Saturday 16/8, 11:00-12:30
Child psychiatric patients in adulthood: Psychiatric services use, mortality and criminality

Ulf Engqvist, Licentiate of Medicine and Social Worker, Karolinska Institutet, Department of Women and Child Health and Östersunds Hospital, Child and Adolescent Psychiatric Unit, Lillfjällvägen 32, S-831 71 Östersund, Sweden

ulf.engqvist@jll.se

Objective: To describe psychiatric services use, mortality and criminality in a sample of 1420 child psychiatric patients in a Swedish County Council. Observation times vary between 12-33 years.
Method: Examination of hospital records and linkage to official registers.

Results: Slightly more than a third, or 36%, were later admitted to psychiatric care. Connections between diagnoses are weak. 35% were known in national prison and probation administration registers and 2.7 % are deceased, the majority of them due to suicide, overdose of narcotics or accidents. 57 % have a poor outcome, i.e. they have had psychiatric contact and/or developed criminality and/ or are deceased.

Conclusions: A smaller group of adolescents with severe mental illness will be in need of further, often long term, psychiatric care. The majority of the child psychiatry patients, however, have had unspecified mental symptoms that not have been signs of proper mental illness. The risk of premature death and developing later criminality is considerable. Patients admitted to child and adolescent psychiatry due to conduct disorder have a considerable risk for premature death and criminality. Attempted suicide among child and adolescent patients is a poor predictor for a later accomplished suicide.



S - XXVII / 3 Saturday 16/8, 11:00-12:30
Depression in childhood and adolescence and the risk of personality disorder in adulthood

Anne-Liis von Knorring

No abstract received.



S - XXVII / 4 Saturday 16/8, 11:00-12:30
Long term follow-up studies on adolescent onset anorexia nervosa

Bruno Hägglöf, MD, PhD, Professor of Child and Adolescent Psychiatry, Umeå University, SE-901 85 Umeå, Sweden

Bruno.Hagglof@psychiat.umu.se

Background: The purpose of the study was to investigate the long-term outcome of anorexia nervosa with clinical onset before 18 years of age and to analyse possible outcome predictors. A total clinical sample of restrictive type of anorexia nervosa was collected from four clinics in northern Sweden.
Population: Of 91 patients 68 (75 %) participated in two follow-up investigations. The mean age at onset was 14.6 years and at follow-ups 23.5 and 30.1 years.

Methods: All patients participated in semi-structured interviews to assess the psychosocial and medical outcome at the follow-ups. The patients also answered EDI and SCL-90.

Results: Of the patients 85% had recovered, 11% had eating disorder NOS, 3% anorexia nervosa and 1% bulimia nervosa according to DSM IV. One of the 91 patients had died (when receiving i.v. nutrition at hospital) during the follow-up period. All the others still lived. Various social, psychiatric, and somatic outcome results as well as predictive factors will be presented.

Conclusion: Death rate was low and overall outcome good in this group of adolescent onset anorexia nervosa.



S - XXVII / 5 Saturday 16/8, 11:00-12:30
Good outcome in adolescent onset anorexia nervosa after systematic treatment. A follow-up study from a Norwegian county


Inger Halvorsen, Anne Andersen, Child and Adolescent Psychiatrist/Specialist in Clinical Nursing, BUPA, Sykehuset Buskerud HF, BUPA, Sykehuset Buskerud, 3004 Drammen, Norway. Supervisor: Sonja Heyerdahl, Research Leader.

inghalv2@frisurf.no

Background: From 1986 the Child and Adolescent Department, Buskerud Hospital, has applied a systematic treatment of anorexia nervosa (AN) based on close cooperation with parents and the paediatric department. The project is a follow-up study 3,5-14,5 (mean 8,8) years after treatment start.
Aims: To study the outcome of childhood and adolescent onset Anorexia Nervosa (AN) in a group that is representative for patients referred to treatment. The outcome of the eating disorder (ED), other psychiatric problems, social functioning, and life satisfaction will be presented.

Material and Methods: Fifty-one of 55 female anorexia nervosa patients under 18 years referred to treatment in Buskerud County during the period 1986-1998. Mean age at treatment start 14,9 years (±1,8), mean BMI 15,1 (±1,5). Thirty-one (61%) were hospitalised in the paediatric ward in the acute phase of the illness. At follow-up personal interview, measurement of weight/height/bone density and questionnaires to the former patient, parents and one of the siblings were used. Instruments used: EDE, EDI, MINI, Y-BOCS, S-GAF etc.

Results: Forty-two (82%) had no ED at follow-up, 1 had AN, 1 had Bulimia Nervosa and 7 had EDNOS. There was no mortality. Attitudes to eating and body weight were relaxed for 23 (61%) and somewhat strainful for 15 (39%) of those without ED at follow-up. Twenty (41%) had one or more other axis-1 psychiatric diagnoses at follow up. Depression and anxiety disorders were frequent. Only 47% were satisfied with life in general compared with 83% in a population study (HUNT). The Split-Global Assessment of Functioning (S-GAF) ratings were very good (>80) for 26 (53%) on the functioning-scale and for 19 (39%) on the symptom-scale.

Conclusions: Compared with other studies the outcome of the eating disorder was good. The frequency of other psychiatric disorders at follow-up was similar to other studies.



S - XXVIII / 1 Saturday 16/8, 11:00-12:30
Neurologic disease as a risk factor for onset of depression


Flemming Mörkeberg Nilsson MD, Senior Resident, University Hospital of Copenhagen, H.S Amager Hospital, Digevej 110, DK-2300 Copenhagen S, Denmark

fmn@dadlnet.dk

Objective: To investigate the temporal relationships between a range of neurologic diseases and affective disorders.
Methods: Data derived from linkage of the Danish Psychiatric Central Register and the Danish National Hospital Register. Seven cohorts with neurologic index diagnoses and two control group diagnoses were followed for up to 21 years. The incidences of affective disorders in the different groups were compared with control groups, using competing risks to consider the risk of affective disorder and the risk of death in the same analysis.

Results: Affective disorders developed more frequently in dementia, Parkinson's disease, epilepsy, stroke, intra-cerebral haemorrhage, and stroke than in medically ill control groups (diabetes mellitus and osteoarthritis). Multiple sclerosis did not differ from the control groups. The association was found to be strongest for dementia and Parkinson's disease.

Conclusion: In neurologic diseases there seems to be an increased incidence of affective disorders. The elevated incidence was found especially high for dementia and Parkinson's disease (neurodegenerative diseases).



S - XXVIII / 2 Saturday 16/8, 11:00-12:30
Personality traits as predictors of first onset of depression or mania


Maj Vinberg Christensen, PhD Student, Department of Psychiatry Rigshospitalet, Blegdamsvej 9, Denmark. Lars Vedel Kessing.

maj.vinberg@rh.dk

Background: It is of interest to know whether certain personality traits or disorders are predicting onset of the first affective episode, for theoretical reasons and in relation to opportunities for pre-vention and early treatment.
Aims: The personality might be altered by the affective disorder. Therefore it is of relevance to look at longitudinal population-based studies or at high-risk studies of subjects who have not yet developed illness and who are followed prospectively over years.

Method: A systematic review of population-based and high-risk studies concerning personality and affective disorder in adults.

Results: There seems to be some evidence of a higher rate of the personality traits, neuroticism and lower emotional strength in subjects who subsequently will develop depressive disorder. The evidence of a personality changing effect of affective episodes is sparse.

Conclusion: The casual association between personality and affective disorder is still unclear. There is a need for well-designed longer-term population based or high-risk studies.



S - XXVIII / 3 Friday 16/8, 11:00-12:00
The bipolar II personality syndrome

Einar Guðmundsson, MD, Psychiatrist, Psychotherapist, Private Practice, adr: Litli turn, Kringlunni 4, 103 Reykjavík, Iceland

eigu@simnet.is

Background: The author was struck by the similarities of complaints, aside from mood swings, made by Bipolar II patients and started registering these complaints. A crossover with other diseases and personality disorders is common. This led to the question whether it was an oversimplification to think one could suffer from such a disabling disease as Bipolar disorder whithout it affecting the personality structure and the brain in a broader manner.

Aims: To understand how the Bipolar II disease affects the personality, and what personality traits are the most common. Is it a spectrum disease where the worst cases become Bipolar I?

Method: Registration of symptoms led to the development of The Bipolar II Personality Syndrome Checklist which has now been applied to over one hundred patients with the diagnoses of Bipolar II. The list (which will be presented) is made of the patients' subjective complaints.

Results: Symptoms like anxiety, low self esteem, paranoia, extreme hurtfulness, migraine, post partum depression, alcholism, and obsessive traits in the family are amongst the findings which will be presented in greater detail.

Conclusions: Although more research is needed, these results support the author's notion that mood disorders cause multiple symptoms, justifying to be described as a syndrome, and that these disturbances lie in families and are greatly underdiagnosed. If true, these results may lead to rethinking psychyatric diagnoses, especially personality disorders.



S - XXVIII / 4 Saturday 16/8, 11:00-12:30

No increased risk of developing depression in diabetes compared to other chronic illness

Lars Vedel Kessing, Professor, DMSc, Department of Psychiatry, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, 2100 København Ø. Flemming Mørkeberg Nilsson, Volkert Siersma, Per Kragh Andersen.

lars.kessing@rh.dk

Background: Several studies have found that the prevalence of depression in patients with diabetes is higher than in the general population. It is unclear whether patients with diabetes have an increased risk of developing depression compared to patients with other chronic illnesses.

Aims: To investigate whether patients with diabetes have an increased risk of developing depression compared to patients with osteoarthritis.

Methods: In a nationwide case register study, all patients with a discharge diagnosis of diabetes or of osteoarthritis at first admission in a period from 1977 to 1997 were identified. The probability of getting readmitted and discharged with a diagnosis of depression was estimated with competing risks models in survival analysis.

Results: In total, 91507 patients with a diagnosis of diabetes at first discharge and 108487 patients with a diagnosis of osteoarthritis were identified. No difference in the risk of getting readmitted with a diagnosis of depression was found between the two groups of patients. There was no difference in the risk for Type 1 and Type 2 diabetes.

Conclusions: A possible association between diabetes and depression does not seem to be mediated by biological factors but to be due to psychosocial factors related to the burden of illness.

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