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- von Knorring, Anne-Liis, 1945-
(författare)
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Adoption studies on psychiatric illness : epidemiological, environmental and genetic aspects
- 1983
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study is to evaluate the outcome of adoptions and to study the gene-environment influences on psychiatric illness as well as sick-leave patterns. The material consists of 2 966 adopted persons born between 1917 and 1949, their 5 932 adoptive parents and 5 438 identified biological parents.Adopted persons had a higher incidence of personality disorders and substance abuse than non-adopted controls. Adopted men also had an increased incidence of neuroses. Adopted women had an increased sick-leave because of somatic complaints, especially upper respiratory tract infections and abdominal complaints of short duration. Somatization i.e. more than 2 sick-leaves/year because of somatic complaint together with nervous complaints was more frequent among adopted women. Women with somatization could be separated into 2 types according to the pattern of sick-leave. Type 1 ("high frequency") had frequent sick-leaves for psychiatric, abdominal and back complaints. They also had a high frequency of alcohol abuse. Type 2 ("diversiform") had more diverse complaints and had fewer sick-leaves because of nervous complaints.High frequency somatizers had biological fathers with teenage onset of criminality and frequent registrations for alcohol abuse. Diversiform somatizers had the same genetic background as adopted men with petty criminality or male limited alcoholism.No specific genetic influences on treated depression or substance abuse were found in this study. However, a non-specific vulnerability of the biological mother influenced on the risk of depression and substance abuse among adopted women.There were some indications that placement in the adoptive home between 6 and 12 months of age was associated with reactive neurotic depression in adult life. Otherwise early negative experiences in term of unstable placements before adoption did not significantly influence on psychiatric illness in adulthood.Affective disorders in the adoptive father were associated with treatment for depressions or substance abuse in the adoptee. Low social status in the part of the adoptive father increased the risk of somatization of both types in the adoptee.
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| 3. |
- Armelius, Bengt-Åke, 1944-, et al.
(författare)
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Borderline diagnosis from hospital records : reliability and validity of Gunderson's diagnostic interview for Borderlines (DIB)
- 1985
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Ingår i: Journal of Nervous and Mental Disease. - 0022-3018 .- 1539-736X. ; 173:1, s. 32-4
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Tidskriftsartikel (refereegranskat)abstract
- Two trained and experienced clinical psychologists and two nontrained students rated the sections in Gunderson's Diagnostic Interview for Borderlines (DIB) on the basis of hospital records for 16 patients (DIB-R). The results showed that both reliability and validity, i.e., correlations with an actual interview, were unexpectedly high, around .80 for the trained judges and around .55 for the nontrained judges. The conclusion is that the DIB may be used for retrospective diagnosis of borderline patients from hospital records.
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| 4. |
- Eisemann, Martin, 1950-
(författare)
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Psychosocial aspects of depressive disorders
- 1985
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The objective of this study was to elucidate the possible importance of factors from the social environment for the development of depression. As a theoretical framework, Engel's biopsychosocial model (Engel, 1980), based on systems theory, has been applied. Proceeding from the single individual (characterized by experience, personality, behaviour) as the highest level of the organismic hierarchy the following system levels have been taken into account: dyads, family, community, culture-subculture.The depressive patients (n=lll) showed to be living in a narrowed social network and to lack confiding relationships compared with a non-psychiatric control sample (n=98). The personality characteristics (e.g. anxiety, detachment, suspicion) of the patients were related to experienced loneliness, contact difficulties, social network features and leisure activities. By means of a discriminant analysis 83% of the subjects could be correctly classified. In a study of perceived parental rearing, depressives showed to have experienced lack of emotional warmth. As regards social class an overrepresentation of social class III in the subgroups of unipolar, bipolar and unspecified depression was observed.Finally, implications for treatment are discussed in favour of a combination of drug and cognitive psychotherapy. Future research strategies are also suggested.
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| 5. |
- Kullgren, Gunnar, 1948-
(författare)
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Clinical studies on the borderline concept with special reference to suicidal behavior
- 1987
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The diagnostic concept of borderline personality has had various meanings throughout the last decades. From current clinical practice and research two principally different concepts have emerged: The syndrome concept of borderline personality disorder ( BPD ) as identified by the DSM-III or the Diagnostic Interview for Borderline (DIB) and the psychodynamic concept of borderline personality organization (BPO) as defined from the structural Interview (SI) by Otto Kernberg.In the first part of the present study, the DIB, the SI and a percept-genetic test called Defense Mechanism test (DMT) have been utilized in a clinical study on psychiatric inpatients. In the second part completed suicides are studied among patients with borderline personality disorder.Inter-rater reliability was satisfactory for the DIB both when utilized as a clinical interview and as a chart scoring instrument. Previous research findings concerning descriptive validity of the BPD concept were further supported. Fairly reliable scorings of personality organization could be made from the SI. BPO turned out to be a very inclusive concept and a subgroup (46%) also met criteria for BPD. By means of the DMT specific psychodynamic features were identified among patients with BPD which discriminated them from patients with other personality disorders or schizophrenic disorder. It is concluded, that there is empirical support to consider BPD a valid diagnostic entity. BPO should be conceptualized as a level of personality functioning rather than a diagnostic category and its validity remains to be proven.Patients with BPD were not seriously overrepresented in a material of 145 psychiatric patients, suicided during inpatient care or shortly after discharge 1961 to 1980. The number and proportion of borderline patients, however, increased for every five- years-period. In an analysis of cases suicided during inpatient treatment, repressive/rejective behavior from staff was frequently observed. Risk factors were identified in comparative studies. Male sex, extensive earlier hospitalization, repressive/rejective staff behavior and frequent previous suicide attempts were associated with completed suicides. A specific pattern of psychological variables was identified among suicided borderline patients including antisocial traits, drug abuse and a less intense interpersonal attachment.
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| 6. |
- Lindqvist, Per, 1949-
(författare)
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Violence against a person : the role of mental disorder and abuse : a study of homicides and an analysis of criminality in a cohort of patients with schizophrenia
- 1989
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Interpersonal violence is a matter of growing concern. Where the safety of the common man is concerned, the dangerousness of mental patients, the ongoing de-institutionalization within psychiatry, and the role of alcohol is disputed. In order to analyze the significance of abuse and mental disorder in violent behaviour, this subject was approached from two different perspectives; from a specific violent offence - homicide - examining the mental status of the offenders, and from individuals with a specific mental disorder - schizophrenia -and assessing the rate of criminal offence amongst them.Homicides in northern Sweden and in Stockholm, legally characterized as murder, manslaughter or assault and causing another’s death, and homicides followed by the offenders’ suicide, were studied. Medicolegal autopsy records, police reports, pretrial psychiatric reports and court records were collected and scrutinized.The criminal records of 644 persons, discharged from hospitals in Stockholm with a diagnosis of schizophrenia, were studied. The relative risk of criminal offence was analyzed by indirect standardization using the general population as a standard. Violent offenders were further examined from psychiatric records.In the homicide material, 16 females and 160 males killed 94 men, 78 women, and 15 children. Forty percent of all surviving offenders were abusers without a major mental disorder, 39% were mentally disordered, 11% committed suicide, and 10% were considered "normal". The abusers and their victims were older, often socially and mentally deteriorated, and well known to each other. The victim was the prime aggressor in half of the cases. Killings by mentally disordered persons and by those who committed suicide were characterized by intimacy between offender and victim; one third were also abusers. Multiple homicides and child murder were mainly seen among homicide-suicice cases. The "normal" offenders were more often of foreign origin and two thirds of the victims initiated the violence by physical attacks. Relatively more of the homicides in northern Sweden concerned intimate parties, use of firearms, and cases of homicide-suicide, as compared to homicides in Stockholm where drug abuse was more prevalent. Sixteen offenders (9%) in the homicide sample had schizophrenia (all males), while 38 subjects (6%) in the cohort of schizophrenics had committed a violent offence. No homicide was recorded and most of the offences were of minor severity. The rate of violent offence was four times higher in the study group as compared to the general population.Most homicides involved closely related persons with separation and dependence as the dominating psychological theme, especially in homicide- suicide cases. Intoxication was regularly seen among the abusers but not among the non-abusers. The acute effect of alcohol intoxication may be of lesser importance in violence as compared to the long-term effects of abuse. Schizophrenics do not impress as a particularly dangerous group. Prevention by psychiatry is difficult; most offenders did not have any contact with psychiatry prior to the act.
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| 7. |
- Olsson, Tommy, et al.
(författare)
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Hypercortisolism revealed by the dexamethasone suppression test in patients with acute ischemic stroke
- 1989
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Ingår i: Stroke. - : American Heart Association. ; 20:12, s. 1685-1690
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Tidskriftsartikel (refereegranskat)abstract
- Using the dexamethasone suppression test, we studied the activity of the hypothalamicpituitary-adrenal axis within the first week after onset in 62 patients with acute ischemic stroke. Compared with two control groups (one comprising 25 elderly patients with various acute medical disorders and the other comprising 33 80-year-old volunteers), stroke patients had higher postdexamethasone cortisol levels (p=0.08 and /?=0.001, respectively). By multiple regression analysis, high postdexamethasone cortisol levels in the stroke patients were significantly associated with proximity of the lesion to the frontal pole of the brain (p=0.008) and with disorientation (p=0.03), whereas no association with major depression was seen. Many stroke patients are exposed to hypercortisolism, which may have negative consequences upon organ functions. The extent to which dexamethasone administration suppresses cortisol levels seems to be determined mainly by the site of brain lesion and cannot be used as an indicator of major depression early after stroke.
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| 8. |
- Perris, Hjördis, 1940-
(författare)
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A multifactorial study of life events in depressed patients
- 1982
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study was an attempted elucidation of the possible pathogenic role of life events in the onset and development of depression. Although several authors seem to agree that the impact of life events should be seen in relation to the person experiencing them, no comprehensive studies have been published so far where life events have been analysed in relation to the vulnerability of the individual who becomes depressed. The present study was inspired by Freud’s concept of ”Ergänzungsreihe”, and was based on the general assumption that biological as well as psychological and social factors contribute greatly to modifying an individual’s vulnerability to external events.To test this hypothesis the occurrence of life events was studied by means of a semistructured interview in a consecutive series of 206 depressed patients of both sexes treated as in- or outpatients, and the results have been analysed in relation to a series of variables which could be assumed to be of importance in modifying the vulnerability of the patients. The main hypothesis was that the more vulnerable the individual was in relation to each of the investigated factors, the fewer events would be necessary to produce a depressive breakdown and the more negative would be the experience of such events. Biological, psychological and clinical variables were taken into account in different parts of the present study.The results support the view that the impact of life events should be seen idiosyncratically and in relation to the specific vulnerability of each individual. Furthermore the study illustrates a fruitful approach for further studies aimed at a closer understanding of the role of external events in the development of a depressive illness.
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| 9. |
- Sandman, Per-Olof, 1950-, et al.
(författare)
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Verbal communication and behaviour during meals in five institutionalized patients with Alzheimer-type dementia
- 1988
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Ingår i: Journal of Advanced Nursing. - : John Wiley & Sons. - 0309-2402 .- 1365-2648. ; 13:5, s. 571-578
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Tidskriftsartikel (refereegranskat)abstract
- Five institutionalized patients with Alzheimer-type dementia were observed (video-recorded) during meals. The aim was to assess their meal behaviour and social interaction. The results showed that when the patients ate without the participation of staff, the two least demented patients became 'caregivers' in the group and helped the three most demented patients to eat. When two mental nurses joined the group, the patients dropped their roles as helpers. The conversation in the group could be characterized as incomplete, with short sentences and a lot of breaks. Sixty-three per cent of all comprehensible utterances concerned food and eating and almost all conversation concerned the present.
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| 10. |
- Sigvardsson, Sören, 1936-
(författare)
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Alcohol abuse and criminality : a cross-fostering study of gene-environment interaction
- 1982
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The subjects consists of all persons born out of wedlock in Stockholm during the years 1930 through 1949 and who were placed in non-related adoptive homes by the age of three years (N = 1 753, or 862 men and 913 women).Data are obtained from official records.Results. Alcohol abuse cannot be regarded as a homogeneous trait distributed in the population according to one single dimension — severity. Rather two types of alcohol abuse was demonstrated in this cohort. Type 1 abuse, accounting for about 75 % of registered abuse covered the entire range from mild to severe abuse. Provided that there was a genetic predisposition to that type of abuse, the severity in expression was mainly determined by environmental factors. Type 2 abuse, on the other hand, was highly heritable over the entire range of social backgrounds. Given the predisposition to that type of abuse, the risk was increased ninefold in the adopted away sons regardless of postnatal influences.There were clear sex-differences concerning alcohol abuse. Type 1 abuse was common in both men and women whereas type 2 abuse was transmitted primarily from fathers to sons. Also as regards type 1 abuse, men and women reacted differently to postnatal stress.Different genetic and environmental antecedents influenced the development of criminality depending on whether or not there was associated alcohol abuse. The analyses indicated that most registered criminality, especially severe and recidivistic forms, were secondary to alcohol abuse.Adoptees registered for criminality but not for alcohol abuse had usually committed only a small number of petty offences. Their biological parents were also characterized by petty criminality and little alcohol abuse.In conclusion, the results demonstrated genetic heterogeneity, sex-specificity, and heterogeneity in postnatal antecedents in the development of alcohol abuse and criminality. This means that unittary definitions and models of alcohol abuse and criminality have outlived their utility. In the case of alcohol abuse a first prerequisite is an inborn ability to drink to such an extent that it gives rise to social or medical problems. Apparently, not all people seem to have this ability. All evidence indicates that genetic factors play an important role in this inability. Secondly, among those people who are able to drink alcoholic beverages there may be genetically determined differences, for instance, some people may be more prone to develop dependence than others.Implications. Alcohol abuse can indirectly be prented by changing environmental conditions that increase the risk. Any plans, however, that are directly aimed at decreasing alcohol abuse must primarily focus on the reduction of the distribution and consumption of alcohol as well as on changes in drinking habits. Concerning criminality, the only implication that seems to be firmly warranted is that prevention of alcohol abuse will result in a reduction of criminality, especially of recurrent and severe forms. If genetic factors can indeed be shown contribute to liability to criminality, the ancient and venerable jurisprudence of society, resting on the concept of penalty and penance, will appear utterly out- of-date and primitive.
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