摘要:

ABSTRACT—While the utilization of outpatient psychiatric care increased steeply in the last few decades, the number of beds in psychiatric hospitals declined continuously in most countries. The future need for psychiatric hospital beds is influenced by changes in psychiatric morbidity, the range of services offered by mental hospitals and the availability of alternative forms of care for the chronically ill. A prospective cohort study conducted in Mannheim showed that currently, at a favourable standard of complementary service provision, one quarter of the schizophrenic patients requiring institutional care for more than one year – schizophrenics are the largest group of mental patients in need of long‐term residential care – still need to be treated in mental hospitals. Beyond this threshold value the costs of alternative care exceed those of a continuous inpatient treatment, and, concurrently with them, the burden upon the people involved grows. Estimates of the future need can be made on the basis of field surveys, utilization data of a population and an analysis of long‐term trends by using case register data. Provided a well‐functioning system of alternative and outpatient mental health services is available, psychiatric bed ratios covering the actual needs in developed countries seem to range from 0.5 to 0.8 per 1000 population over 15 for the short‐stay group and from 0.3 to 0.6 per 1000 for long‐stay patients. The uncertainty inherent in the estimates requires a sufficient degree of flexibility in service planning and a continuous monitoring to make adjustments to changed cond

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb02762.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

ABSTRACT—Platelet serotonin (5‐HT) uptake was determined in 15 underweight anorexia nervosa patients and a control group of 15 healthy individuals. The Vmax (picomoles/108platelets/5 min) was 424 ± 103 in patients and 424 ± 69 in controls. The Km was 1.19 ± 0.2 μM in patients and 1.08 ± 0.17 μM in controls. The differences between the groups were not significant.These findings do not support the hypothesis that serotonin metabolism is disturbed in anorexi

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb02763.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

ABSTRACT—The 24 h serum levels of prolactin (PRL) and thyrotropin (TSH) assessed at ten different time points and the PRL and TSH responses to TRH administration (ΔPRL, ΔTSH) were investigated in 26 inpatients meeting the RDC criteria for an acute major depressive disorder. Fourteen of these patients were reinvestigated in a state of partial or complete remission. Comparison between the patients during both relapse and remission and 23 healthy controls showed no differences in the paramenters reflecting the 24 h PRL levels or ΔPRL. However, significantly lower 24 h TSH levels and ΔTSH were found in the patient group in the acute phase. Antidepressant medication, sedatives or the outcome of the dexamethasone test did not significantly influence the PRL levels or ΔPRL. Both the patient group and the controls revealed normal sleep associated PRL release indicating unaltered serotoninergic and/or dopaminergic neurotransmission regulating the PRL secretion. The present results indicate a selective disturbance affecting the pituitary TSH secretion, and are consistent with our hypothesis that the mechanism behind the decreased TSH levels and the impaired TSH response to TRH in acute major depressive disorder involves a down‐regulation of the pituitary TRH r

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb02764.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

ABSTRACT—In the present study, we have followed a national cohort of physicians, academics and the general population (part of the compulsory census in 1960) for a period of 10 years and identified all cases of suicide during the period 1961 ‐ 1970. Furthermore, we have carried out a retrospective study of suicides among the four major medical specialist groups (general practioners, internists, psychiatrists and general surgeons) and compared these rates with other medical specialists.Results show an elevated standardized mortality ratio (SMR) for suicide among female physicians compared to other academics as well as to the general population. Furthermore, male doctors exhibit an elevated suicide rate only when compared to other academics. Among the various specialists, general surgeons alone exhibited a significantly elevated suicide rate. The study clearly shows that female physicians are more prone to suicide than most other women, but that male physicians are also at risk compared to other male academics. Furthermore, at least in Sweden, general surgeons, not psychiatrists, have the highest suicide rate of all physici

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb02765.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

ABSTRACT—In cranial computed tomography (CT), not only patients with anorexia nervosa but also patients suffering from bulimia, display enlarged external cerebrospinal fluid spaces. This was true for more than one third of the 28 bulimic patients studied, regardless of whether or not they had a past history of anorexia nervosa. As the bulimic patients had a near normal body weight, the observed structural changes cannot be attributed to underweight, as is commonly assumed to be the case in anorectic patients. These findings indicate that, in addition to underweight, other factors have to be considered as causing the morphological brain alterations present in patients with eating disorder

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb02766.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

ABSTRACT—The specific binding of the full agonist [3H] (‐) adrenaline to platelet membranes was measured in 14 drug‐free depressed patients with melancholia. There was an increased number of binding sites (Bmax) with the same apparent affinity (KD) for the radioligand, indicating that platelet α2‐adrenoceptor density in the high affinity state was increased in depressed patients. Long‐term administration of clomipramine was associated with decreases in platelet α2‐adrenoceptor densities which correlated with the duration of treatment. The results support the hypothesis that in endogenous depression there is a dysfunction of the α2‐adrenoceptor and that antidepressant treatment might involve a time‐dependent desensitization proces

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb02767.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

ABSTRACT—Attitudes towards mental illness were measured in a probability sample of 1574 male and female adults, residents of two boroughs in the greater Athens area before the development of community mental health services in the area. The objective of this study was to identify the components of these attitudes, taking into account the fact that public opinions about mental illness influence the utilization of community mental health services and the level of reintegration of the mentally disabled into society.The instrument used to measure attitudinal dimensions was the Cohen and Struening Opinion about Mental Illness (O.M.I.) scale. Factor analysis revealed five attitude dimensions: social discrimination, social restriction, social care, integration, and etiology.Among the socio‐demographic variables age, education, occupational status and place of residence up to 18 years of age affected the factors mainly, reflecting social discrimination and restriction. O.M.I. factor scores underlying the need for social care and reintegration of the mentally ill into society were found to be socially invariant, implying the need for social care and more humane treatment methods for mental patients.Certain population groups responded with rejection or suspicion and considerable fear of the mentally ill, indicating the necessity for the planning of appropriate community mental health intervention programs parallel to the development of community mental health services and psychiatric reforms in Gre

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb02768.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

ABSTRACT—The marital adjustment of patients with psychogenic pain disorder was evaluated and compared with a matched group of patients with other neurotic disorders. Pain patients spouses were found to have better marital adjustment and less psychiatric morbidity than the spouses of neurotic patients. These findings are discussed in terms of the concepts of “sick role homeostasis” and “tertiar

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb02769.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

ABSTRACT—Positive correlations between measures of hypothalamic‐pituitary‐adrenal (HPA)‐axis activity and noradrenergic turnover have been reported in depression. To investigate this relationship the authors measured peak postdexamethasone cortisol levels (8 a.m., 4 p.m. and 11 p.m.) and the 24‐hour urinary 3‐methoxy‐4‐hydroxy‐phenylglycol (MHPG) flow in 84 depressed patients. The results show that there is no positive association between those measures of HPA‐axis and noradrenergic activity. On the contrary, patients with severe non‐suppression (≥10 μg/dl or 277 nmol/l) tended to hav

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb02770.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY

摘要:

ABSTRACT—Since the first publications on a sex reassignment operation in Denmark in the early fifties, the European environment in which sex reassignment surgery (SRS) takes place has changed drastically. However the possibilities differ considerably between one country and another. To get a picture of the European situation a questionnaire was sent out to gender clinics and private practitioners treating transsexuals in 15 European countries. Questions were asked about evaluation of candidates for a treatment program, details of such programs, the legal and financial situation in the different countries and attitudes and place of psychotherapy in the SRS procedure. By and large there seems to be fairly good consensus within those European SRS treatment programs we had the opportunity to evaluat

ISSN:0001-690X    

DOI:10.1111/j.1600-0447.1987.tb02771.x

出版商:Blackwell Publishing Ltd    

年代:1987

数据来源: WILEY