The influence of psychiatric comorbidity on the course and outcome in a nationwide representative sample (n = 351) of treatment-seeking substance users over a 28-month period was studied prospectively. The patients were administered the Diagnostic Interview Schedule and a questionnaire on drinking history. At 16 and 28 months after admission the patients returned a questionnaire on drinking history and mental health. In cases of those lacking information on either follow-up (45%), details on drinking status was obtained from informants. Completely abstinent were 16%. Generalized anxiety disorder and/or social phobia at the index admission predicted abstinence during the follow-up [odds ratio (OR) = 0.25], whereas onset of alcoholism among these patients after age 25 years predicted a worse prognosis (OR = 13.5). Also increasing number of social consequences related to abuse (OR = 1.3) and drinking more than the median (OR = 2.1) predicted a poor outcome. The abstinent group had significantly better mental health at follow-up. The patients with comorbid psychiatric disorders at admission were worse at follow-up. Although substance use disorders and comorbid psychiatric disorders have to a certain degree separate courses, there is nevertheless significant interaction between them. Early treatment and recognition of comorbid psychiatric disorders among substance abusers is necessary.
To see, if voluntary admission for treatment in first-episode psychosis results in better adherence to treatment and more favourable outcome than involuntary admission.
We compared consecutively first-admitted, hospitalised patients from a voluntary (n = 91) with an involuntary (n = 126) group as to psychopathology and functioning using Positive and Negative Syndrome Scale and Global Assessment of Functioning Scales at baseline, after 3 months and at 2 year follow-up. Moreover, duration of supportive psychotherapy, medication and number of hospitalisations during the 2 years were measured.
More women than men were admitted involuntarily. Voluntary patients had less psychopathology and better functioning than involuntary patients at baseline. No significant difference as to duration of psychotherapy and medication between groups was found. No significant difference was found as to psychopathology and functioning between voluntarily and involuntarily admitted patients at follow-up.
Legal admission status per se did not seem to influence treatment adherence and outcome.
Recent research has revealed conspicuously few distinctions between young males and females who use cannabis. Such findings may reflect the general slackening of the sex-role pattern in the younger generations. Alternatively, they may reflect distinctive characteristics of the cannabis culture. Using data from a nationwide representative sample (n = 1,478) of young Norwegians (21-24 years old), this study explores whether "traditional" sex differences in respect to mental health and alcohol use are less conspicuous among users than among nonusers of cannabis. The respondents' sex-role-related values and preferences were also studied. Results indicate that the sex differences in mental health did not vary between users and nonusers of cannabis; however, female cannabis users were disproportionately young when they experienced their first intoxication by alcohol. Their level of drinking was also disproportionately high. This implied that the sex difference in alcohol use was smaller among users than among nonusers: male users of cannabis consumed 2.8 times more alcohol than their female counterparts, whereas the corresponding male to female ratio was 3:2 in the nonusers. The extensive use of alcohol in female cannabis users did not reflect mental health problems or a rejection of traditional sex-role characteristics. Cannabis-using males were less typically masculine in their values and preferences than other males, but not more feminine. The measures for sex-role-related preferences did not discriminate between female users and female nonusers of cannabis.
In medical education, teaching methods offering intensive practice without high utilization of faculty resources are needed. We investigated whether simulated patients' (SPs') satisfaction with a consultation could predict professional observers' assessment of young doctors' communication skills.
This was a comparative cross-sectional study of 62 videotaped consultations in a general practice setting with young doctors who were finishing their internship. The SPs played a female patient who had observed blood when using the toilet, which had prompted a fear of cancer. Immediately afterwards, the SP rated her level of satisfaction with the consultation, and the scores were dichotomized into satisfaction or dissatisfaction. Professional observers viewed the videotapes and assessed the doctors' communication skills using the Arizona Communication Interview Rating Scale (ACIR). Their ratings of communication skills were dichotomized into acceptable versus unacceptable levels of competence.
The SPs' satisfaction showed a predictive power of 0.74 for the observers' assessment of the young doctors and whether they reached an acceptable level of communication skills. The SPs' dissatisfaction had a predictive power of 0.71 for the observers' assessment of an unacceptable communication level. The two assessment methods differed in 26% of the consultations. When SPs felt relief about their cancer concern after the consultation, they assessed the doctors' skills as satisfactory independent of the observers' assessment.
Accordance between the dichotomized SPs' satisfaction score and communication skills assessed by observers (using the ACIR) was in the acceptable range. These findings suggest that SPs' satisfaction scores may provide a reliable source for assessing communication skills in educational programs for medical trainees (students and young doctors). Awareness of the patient's concerns seems to be of vital importance to patient satisfaction.
This nation-wide study inquiry concerned the intended future careers of medical students at the end of their studies and those of a cohort of first-year students. More first-year than final-year students hoped to obtain a position as a hospital physical or surgeon with management responsibility and twice as many men as women wanted such a position in both cohorts. High self esteem, having a doctor as father and successful examinations at medical school were associated with a high level of ambition. Compared with first-year students, more final-year students preferred family medicine and internal medicine, and less preferred surgery, psychiatry and social medicine. Plans for specialisation were influenced by the father's education level, successful examinations at medical school, whether they had children or not, and the university of graduation. More women preferred gynaecology, more men preferred surgery. The interest for surgery among female students is high compared with the low share of female surgeons. Assuming that these trends persist, psychiatry, laboratory medicine and social medicine risk insufficient recruitment. The share of women holding clinical professorships will probably remain low, even in a generation with more female than male medical students.
To describe 1-year outcome in a large clinical epidemiologic sample of first-episode psychosis and its predictors.
A total of 301 patients with first-episode psychosis from four healthcare sectors in Norway and Denmark receiving common assessments and standardized treatment were evaluated at baseline, at 3 months, and at 1 year.
Substantial clinical and social improvements occurred within the first 3 months. At 1-year 66% were in remission, 11% in relapse, and 23% continuously psychotic. Female gender and better premorbid functioning were predictive of less severe negative symptoms. Shorter DUP was predictive for shorter time to remission, stable remission, less severe positive symptoms, and better social functioning. Female gender, better premorbid social functioning and more education also contributed to a better social functioning.
This first-episode sample, being well treated, may be typical of the early course of schizophrenia in contemporary centers.
Two hundred Norwegian substance abusers who consecutively applied for treatment in a hierarchical therapeutic community were divided into two different groups according to intake procedures: the intake group (IG) and the nonintake group (No-IG). Using a prospective design, we found that beginners in the program were more often infected with human immunodeficiency virus and that they used amphetamine more frequently and alcohol less frequently than nonbeginners. The type of intake procedure did not influence the percentage of those who started in the program, but it increased the number of clients who completed Phase 1, the 1-year inpatient phase of the program. Twice as many clients in the IG completed Phase 1 compared to those in the No-IG. From a clinical point of view, we conclude that the IG procedure should be offered to all applicants but that the model should be developed more as a role induction strategy, in which learning practical coping skills to adjust to the treatment program is essential.
During the last decades we have seen a new focus on early treatment of psychosis. Several reviews have shown that duration of untreated psychosis (DUP) is correlated to better outcome. However, it is still unknown whether early treatment will lead to a better long-term outcome. This study reports the effects of reducing DUP on 5-year course and outcome.
During 1997-2000 a total of 281 consecutive patients aged >17 years with first episode non-affective psychosis were recruited, of which 192 participated in the 5-year follow-up. A comprehensive early detection (ED) programme with public information campaigns and low-threshold psychosis detection teams was established in one healthcare area (ED-area), but not in a comparable area (no-ED area). Both areas ran equivalent treatment programmes during the first 2 years and need-adapted treatment thereafter.
At the start of treatment, ED-patients had shorter DUP and less symptoms than no-ED-patients. There were no significant differences in treatment (psychotherapy and medication) for the 5 years. Mixed-effects modelling showed better scores for the ED group on the Positive and Negative Syndrome Scale negative, depressive and cognitive factors and for global assessment of functioning for social functioning at 5-year follow-up. The ED group also had more contacts with friends. Regression analysis did not find that these differences could be explained by confounders.
Early treatment had positive effects on clinical and functional status at 5-year follow-up in first episode psychosis.
Some studies in first-episode schizophrenia correlate shorter duration of untreated psychosis (DUP) with better prognosis, suggesting that timing of treatment may be important. A three-site prospective clinical trial in Norway and Denmark is underway to investigate the effect of the timing of treatment in first-episode psychosis. One health care sector (Rogaland, Norway) is experimental and has developed an early detection (ED) system to reduce DUP. Two other sectors (Ullevål, Norway, and Roskilde, Denmark) are comparison sectors and rely on existing detection and referral systems for first-episode cases. The study ultimately will compare early detected with usual detected patients. This paper describes the study's major independent intervention variable, i.e. a comprehensive education and detection system to change DUP in first onset psychosis.System variables and first results from the four-year inclusion period (1997-2000) are described. It includes targeted information towards the general public, health professionals and schools, and ED teams to recruit appropriate patients into treatment as soon as possible. This plus easy access to psychiatric services via ED teams systematically changed referral patterns of first-episode schizophrenia. DUP was reduced by 1.5 years (mean) from before the time the ED system was instituted (to 0.5 years). The ED strategies appear to be effective and to influence directly the community's help-seeking behaviour.
To identify predictors of non-remission in first-episode, non-affective psychosis.
During 4 years, we recruited 301 patients consecutively. Information about first remission at 3 months was available for 299 and at 2 years for 293 cases. Symptomatic and social outcomes were assessed at 3 months, 1 and 2 years.
One hundred and twenty-nine patients (43%) remained psychotic at 3 months and 48 patients (16.4%) remained psychotic over 2 years. When we compared premorbid and baseline data for the three groups, the non-remitted (n = 48), remitted for