摘要:

Definitions of Delirium Tremens (DT) and related clinical states are discussed together with the concepts of aetiology and pathogenesis in relation to psychiatric disease.The withdrawal theory which considers reduction or cessation of alcohol intake as an important precipitating factor in DT is discussed; this theory is supported by experimental studies of ethanol withdrawal in man and by studies indicating cross dependence between ethanol and several other CNS depressors; the arguments in the literature for and against the withdrawal theory are discussed.Other possible aetiological factors such as type of liquor, hypovitaminosis, liver disease, dysfunction of the adrenals and fat emboli are reviewed, and it is concluded that these factors are unimportant as precipitating or specific aetiological factors in DT.The discussion about treatment of DT is concentrated on drug treatment, and the literature concerning antipsychotics and sedatives is reviewed. It is concluded that barbital, a long‐acting barbiturate, is the most effective treatment; diazepam can be recommended as an acceptable alternative. Finally, practical recommendations concerning treatment are give

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb04479.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

Fifty‐eight ex‐addicts, representing 87 % of a group found to be drug‐free at an earlier 3‐year follow‐up, have been the target group of an interview study, which aimed at elucidating various phases of the drug career. It was found that drug abusers tend to break their drug‐taking habits either early (before 2 years of abuse) or late (after 6 years or more). Those who abandoned the drug career early regarded giving up drugs as easy and had often been supported by relatives and drug‐free friends. Their dominating reason for giving up drugs was adverse drug reactions, or infectious complications. Those who abandoned the career late reported that it had been a difficult process and that they had received little or no support from friends and relatives. To a large extent they had resorted to the aid of outpatient clinics. This group of ex‐addicts gave as their most common reason for giving up drugs: they had grown tired of the life of a street addict. The considerable number of critics of psychiatric inpatient treatment (74 % rated inpatient clinics as moderately important or unimportant) casts doubt on present treatment approaches.A simplified clinical description of the drug career is given, where attention is focussed on three stages within the process

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb04480.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

An analytical description is presented of 942 mentally retarded persons from the county of West Zealand. The prevalence of mental retardation (i.e. persons who were registered with an IQ below 75) was 0.36 %. Almost half of the patients were living in institutions. Of the patients 43 % were women and 57 % men.Important aetiological factors are listed. In almost one third of the patients, similar cases were present among the closcst relatives; 30 % of the patients were born as the fourth or subsequent child in the family; one sixth of the mothers were more than 35 years old at the birth of the handicapped child. Twenty‐two percent of the patients with IQs below 50 had Down's syndrome. Seventeen percent of the patients had epilepsy and 11 % cerebral palsy. In the central institution all patients had psychiatric or somatic complication

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb04481.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

In a double‐blind controlled study lasting 4 weeks 25 newly admitted severely depressed patients were randomly assigned to tryptophan‐nicotinamide or imipramine or tryptophan‐nicotinamideimipramine combination. Nicotinamide was given to reduce peripheral breakdown of tryptophan. Although there were no substantial differences between the three treatments, the efficacy of tryptophannicotinamide tended to diminish after 2 weeks when the dose of tryptophan was increased from 4 g/day to 6 g/day and that of nicotinamide from 1.0 g/day to 1.5 g/day. The therapeutic response of patients treated with tryptophan‐nicotinamide was significantly correlated with the rise in plasma tryptophan. For the tryptophannicotinamide‐imipramine group, however, therapeutic response and rise in plasma tryptophan were negatively correlated, implying that tryptophan levels were too high in some patients. The data suggest that tryptophan‐nicotinamide may be as effective as imipramine in unipolar patients providing the dose is kept within the therapeutic window, and that at low doses it could also potentiate the action of tricyclic antidepressants. Bipolar patients seem to require higher doses of tryptophan than unipol

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb04482.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

Two patients with a psychiatric history of about 20 years, and clinical and neuroradiological signs of normal‐pressure hydrocephalus (NPH) are reported. One had a periodic psychosis subsequent to a tuberculous meningitis, and this overshadowed the slight classical symptoms of NPH. She had received at least 120 treatments with electro‐convulsive therapy. The second patient suffered from a paranoid psychosis; other signs of NPH were moderate though progressive. Both patients showed definite improvement of their NPH symptoms after ventriculo‐atrial shunting, and psychotic symptoms ceased totally. Follow‐up was 5 years for the patient with periodic psychoais. The other patient died from septicaemia 2.5 years after shunting.A large‐scale screening of patients with psychiatric symptoms or dementia, particularly when combined with gait disturbance, should be done by using computerized tomography. Patients suspected of having NPH should then be referred for further examination with the aim of selecting patients suitable for shunting. These measures seem well motivated from humanitarian as well as economic point

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb04483.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

In a study of 18 patients with manic symptomatology and 31 patients with melancholic symptomatology the Bech‐Rafaelsen Mania Scale (BRMS) and the Hamilton Depression Scale (HDS) have been compared. The results showed that the inter‐observer reliability of the BRMS was adequate compared with the HDS. Both scales are constructed for assessing the severity of manic or melancholic states, and no difference was found in the total BRMS or HDS score between the various diagnostic groups, when the patients were classified by an index of the course and symptomatology of their disorder, using the Multi‐axial Classification System for Affective Disorders (MULTI‐CLAD). The homogeneity of the BRMS seemed more adequate than that of the HDS, when each item was correlated to the corresponding total score. Although the homogeneity of the BRMS needs to be evaluated by other statistical models than correlation analysis, our results seem to indicate that the improvement in assessing manic‐melancholic states quantitatively is a matter of redefining items or incorporating new items in the melancholic rather than the manic part of these rati

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb04484.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY

摘要:

The present investigation comprises all deaths in Norwegian psychiatric hospitals 1950–74: 10,413 deaths. Mortality in men declined from 361 per 10,000 before 1950 to 252 per 10,000 in 1969–74 and in women from 324 per 10,000 to 215 per 10,000 during the same periods. In the organic and symptomatic psychoses (mainly senile and arteriosclerotic) mortality ranged from six to ten times that of the general population, whereas in the non‐organic (functional) psychoses mortality was only twice as high as in the general population. This discrepancy in mortality between organic and non‐organic psychoses, which is caused by the somatic disorders with high lethality underlying the organic psychoses, suggests that mortality should be calculated separately for organic and non‐organic psychoses, which is sometimes neglected. An increasing number of hospital admissions with organic, mainly senile, psychoses is to be expected in the future, as well as an increasing proportion of non‐organic patients with slight psychotic symptoms and a low and possibly decreasing mortality.Between 1950 and 1974 radical changes took place in the psychiatric hospitals which could have influenced mortality. Age adjusted death rates from cardio‐vascular diseases were actually higher in 1963–68 than in 1950–62, possibly indicating that an adverse effect of drug therapy on physical activity and somatic fitness had outweighed the stress‐relieving effect. A significant rise in unnatural deaths (suicides and accidents) has been observed particularly since 1963. As in previous investigations from Norway 1926–41, cancer as cause of death was equal to or below the general population in the non‐organic psychoses and somewhat higher i

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1979.tb04485.x

出版商:Blackwell Publishing Ltd    

年代:1979

数据来源: WILEY