ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1986.tb10515.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACTVariable rates of staff‐patient interaction were found between three wards, which differed in the degree of programme structure, staff‐patient ratios, and patient chronicity. Highest rates of staff‐patient interaction occurred where a highly structured ward programme operated in a closed ward with chronically disturbed patients, and this was more likely to increase as staff‐patient ratios decreased. The lowest staff‐patient interaction rates occurred in acute, open and closed wards. Further, acute ward patients received negligible attention from nurses in terms of staff‐patient interaction after 10 days followin

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1986.tb02657.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

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

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1986.tb10517.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACTThe validity of a classification system is primarily a question of philosophical premise. DSM‐II is from this point of view a theoretical classification system based on hypotheses currently considered reliable and interesting and which ‐ as presupposed ‐ could not be rejected by empirical methods. The relevance or validity of this empirical approach depends on the aim of the DSM‐III. An empirical approach may facilitate communication but can only have limited success as a help for planning treatment of psychiatric disorders where motives and meaning are important factors.The choice of hypotheses and the empirically derived concepts used to construct the classification system neglects other important ways of comprehension. Although aspects of rational philosophy may be found in the DSM‐III system too, important ways of comprehension like the metaphysical approach is lacking. It is showed how this fact reflects a philosophical trend in the Western world following the Renaissance. By considering the Myth of Faust it is demonstrated how a metaphysical comprehension of life would lead to a different understanding of states of mind currently assumed to be a reflection of individual psychopathology according to empirical or rational comprehension. Thus in the end the validity of a classification system depends on the basic philosophical assumptions chosen. A choice which may be determined more by irrational and cultural forces than conscious contemplation.The content of DSM‐III or ICD is also influenced by professional interests; the needs of the society and international political factors. It is concluded that a philosophical, idea‐historical, sociological and political consciousness is necessary to secure a critical but constructive attitude towards any classification system or theory. Whatever the basic point of view may be the provision of a classification system will always exclude important dimensions of man and life. Progress in psychiatry can only occur when this fact

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1986.tb10518.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACTThe reliability of French psychiatrists using DSM‐III axis I disorders was studied using videotaped semi‐structured diagnostic interviews. 136 psychiatrists with different levels of clinical experience classified 11 cases into six preselected diagnostic categories: Schizophrenia, Major Depressive Episode, Dysthymic Disorder, Cyclothymic Disorder, Other Psychiatric Diagnosis, No Present Psychiatric Diagnosis. A modified Kappa coefficient for multiple observers was used to calculate agreement and thereby estimate reliability. We obtained an overall Kappa of 0.55 for six categories, and when the Dysthymic and Cyclothymic Disorders were combined into one class, i.e. other specific affective disorders, the Kappa value increased to 0.64. The Kappa value for individual categories was best for Schizophrenia and Major Depressive Episode, and poor for Dysthymic and Cyclothymic Disorders. Clinical experience or prior knowledge of DSM‐III criteria did not have a significant effect on reliab

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1986.tb02658.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACT‐ Studies in mice demonstrated that the anticonvulsant profile of chlormethiazole differs from that of diazepam and the barbiturates. Chlormethiazole protects animals from convulsions induced by a wide variety of chemoconvulsants known to block the action of the inhibitory neurotransmitter γ‐aminobutyric acid (GABA), such as bicuculline, picrotoxin, isoniazid and pentetrazol, thus confirming and extending earlier studies on its broad anticonvulsant characteristics. Chlormethizole is particularly potent against isoniazid‐induced convulsions, which are probably induced by reductions of GABA levels in the brain.Chlormethiazole was found to have a weak action on benzodiazepine receptor binding, GABA receptor binding and kainic acid receptor binding. Chlormethiazole inhibited picrotoxin binding at very high concentrations, but lowered the functional effects of picrotoxin at much lower concentrations than those affecting picrotoxin binding. Moreover, chlormethiazole failed to change GABA or glutamate levels in the brain and did not affect glutamic acid decarboxylase (GAD) activities in the rat brain. Muscimol (a GABAAagonist) enhanced the anticonvulsant activity of chlormethiazole against picrotoxin but not against bicuculline‐induced convulsions. Muscimol enhanced the anticonvulsant potency of diazepam against both chemoconvulsants. These data suggest that the anticonvulsant activity of chlormethiazole is not mediated directly through changes in GABA or glutamate levels or by a direct (agonist) action at the GABA or benzodiazepine receptor complex. These findings suggest that chlormethiazole may enhance GABA transmission beyond the GABA receptors, hypothetically at the level of the GABA receptor coupled ionophore (e.g. the chloride ion channel).Applied micro‐iontophoretically, chlormethiazole was found to potentiate the inhibitory responses to GABA, muscimol and glycine, but not to acetylcholine. The potentiation of glycine‐mediated inhibition is unique for chlormethiazole and does not occur with any other known anticonvulsant (barbiturates, benzodiazepine, phenytoin or sodium valproate). Studies in primary cultures, derived from spinal cord neurones, showed that chlormethiazole produces hyperpolarization together with an increase in the threshold for action potential generation. Furtherin vitrostudies indicated that chlormethiazole acts on some types of Ca2+‐dependent chloride ion channels.In vivostudies indicated that the hypnotic effect of chlormethiazole involves primarily an action on the GABA system, as both the GABAAagonist, muscimol, and the inhibitor of GABA aminotransferase, aminooxyacetic acid, markedly enhanced chlormethiazole‐induced hypnosis in mice. Serotonergic (5‐HT‐ergic) or noradrenergic systems appear to play a minor role in the hypnotic action. Chlormethiazole also appears to cause an inhibition of dopaminergic transmission, probably secondary to an action mediated by GABA mechanisms. Thus, chlormethiazole markedly enhanced haloperidol‐induced catalepsy in a similar manner to the GABA agonists, such as muscimol. The inhibition of dopamine activity may play a role in the sedative and hypnotic action of the compound.In conclusion, the available evidence suggests that chlormethiazole enhances GABA‐ergic transmission in the brain, by a mechanism which partly differs from that of the barbiturates and the benzodiazepines. Chlormethiazole appears to act on an allosteric site of the GABAAreceptor complex, which is closely related to chloride‐channel functions (picrotoxin sensitive). Chlormethiazole also enhances glycine‐mediated inhibition. The action on the chloride‐channel function may be relevant for the anticonvulsant property of the drug. It is possible, that at higher doses, chlormethiazole also affects more general functions of GABA which underlie the hypnotic effects of the drug and its actio

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1986.tb10530.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACTTen of 14 schizophrenic patients completed a 6‐week pilot study with a new substituted benzamide, remoxipride. The final median dose was 600 mg/day (range 300–1200) corresponding to a plasma concentration of 5.16 μmol/l (1.55–11.50). Remoxipride reduced the psychotic symptomatology, especially hallucinations and delusions. The total Brief Psychiatric Rating Scale score decreased from 33.5 to 13.0 (P<0.01). Few side effects occurred; four patients had weak extrapyramidal symptoms, and four were slightly sedated. No cardiovascular side effects occurred. Prolactin increased, but apparently less than during sulpiride tre

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1986.tb02659.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACTTwo Norwegian psychiatrists classified independently according to DSM‐III, 45 patients drawn at random from two populations: one of psychiatric patients (N=161) and one of super obese surgical patients (N=71).They interviewed the patients and listened to each other's audio‐taped interviews afterwards. In the total group, on axis I the overall agreement was 78 percent (kappa=0.74). On axis II, the overall agreement was 81 percent (kappa=0.68). The study shows that by using the DSM‐III, two Norwegian psychiatrists obtained good diagnostic reliab

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1986.tb10519.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1986.tb10902.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY

摘要:

ABSTRACTIn a long term follow‐up study of 44 young women with symptoms of alcohol dependence at index year, only 17 (38%) of the interviewed subjects fulfill the DSM‐III criteria for alcohol abuse or dependence the year prior to follow‐up according to the interview material. The reason for this is partly that there has been a change in drinking patterns for 24 women (54%), of which eight are abstainers, seven asymptomatic drinkers and nine having an increased tolerance as the only sign of a possibly pathological alcohol use. Partly, however, the lack of diagnosis can be attrbuted to client denial or substituting drugs for alcohol, and partly due to inadequate criteria. Some of the DSM‐III criteria are sex biased, probably leading to men having a diagnosis at an earlier stage of alcoholism. The concept of degree of alcohol dependece, an appropriate time limit for assessment of diagnosis and the difference between primary and secondary alcoholism, should be specified in future diagnostic criteria for alcohol use di

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1986.tb10520.x

出版商:Blackwell Publishing Ltd    

年代:1986

数据来源: WILEY