General practitioners are the psychiatrists' most important coworkers in the treatment of depressive disorders. A high degree of knowledge about this illness in this group of doctors is of decisive importance. However, the value of postgraduate educational programs for general practitioners has been questioned. The Swedish Committee for the Prevention and Treatment of Depression (PTD) offered an educational program on symptoms, etiology, diagnosis, prevention and treatment of depression to all general practitioners on the Swedish island of Gotland. Lectures on suicide, depressive illness in childhood and in old age and psychotherapy of depressive states were also given. In several control periods data were collected on suicides, referrals to the local psychiatric department, emergency admissions, the quantity of sick leave used and the quantity of inpatient care due to depression. Even the prescription of psychopharmacological drugs on the island was investigated. Overall, the results indicated that general practitioners gratefully accepted the educational program and achieved increasing competence and stringency in treating and preventing depressive states. The program was associated with decreases in the use of psychiatric inpatient care and the sick leave frequency of depressed patients. The possibility of preventing suicides was positively influenced.
Aggressive behaviour by psychiatric inpatients was investigated on the same ward during two separate 6-month periods before and after a 50% decrease in number of beds but without changes in catchment area. Character of the patient group, patient turnover and medical practices as well as total number of staff on duty on the ward was virtually the same during the two periods. It is therefore assumed that differences in aggressive behaviour are mainly explained by effects due to the decreased number of beds per se. It was found that the 50% reduction did not affect the overall aggression frequency. However, inter-patient violence increased while the number of more severe aggressive incidents towards staff members decreased.
Scales for measuring aggressive cognitions and behaviour have mainly been administered by nursing-staff or been self-ratings. During recent years we have made an attempt to construct an observer-scale for aggression analogous to the Hamilton scale for depression. The Social Dysfunction and Aggression Scale (SDAS) consists of 9 items (SDAS-9) covering outward aggression and 2 items (SDAS-2) covering inward aggression. The inter-observer reliability of the SDAS has been found adequate in terms of intra-class coefficients. In a pilot study on 82 inpatients from different centres in Denmark and Sweden the SDAS was compared to three-item scales for outward and inward aggression and to a global scale for outward aggression. The results showed that the SDAS-9 correlated positively with the other outward observer-scales, and the SDAS-2 with the other inward scale. A divergent validity was seen between the outward and inward scales, indicating that it is necessary to measure both dimensions. Preliminary ranks-according-to-frequency scores showed the following order of the nine outward items: irritability, dysphoric mood, social disturbances, nondirected verbal aggressiveness, negativism, directed verbal aggressiveness, physical violence towards staff, physical violence towards things, and physical violence towards persons other than staff.
During the years 1983-1984, an educational program was given to all general practitioners on the island of Gotland. This report evaluates changes in prescription habits from 1982 to 1985. To correct for general trends that occurred simultaneously, the prescription habits were compared to the habits in the rest of Sweden. Both on Gotland and in Sweden as a whole, the use of antidepressants increased from 1982-1985, but significantly more on Gotland. In 1982, the use of antidepressants was low on Gotland, 54% of that in the rest of Sweden. After the educational programs, Gotland reached 77% of the use in the rest of Sweden. In 1982, the use of lithium was 123% of that in the rest of Sweden. After the educational programs, the use of lithium was unchanged, and a small increase of 5.6% was seen in the rest of Sweden. After the educational programs, the prescription of sedatives on Gotland decreased (-8.2%), and an increase of 4.5% was seen in the rest of Sweden. The use of major tranquilizers also decreased significantly (-23%) on Gotland. Even in the rest of Sweden, a significant but much smaller decrease was seen: -13%. On Gotland the frequency of hypnotics remained stable from 1982-1985, and a significant increase was seen in the rest of Sweden.
Aggressive behavior during acute involuntary admission was related to ratings on the Brief Psychopathological Rating Scale, age, sex and global assessment in 38 patients. The best prediction model of aggressive behavior was achieved when predicting more serious incidents occurring during the first 8 days of admission. In this prediction model, high scores of hostility and anxiety, together with low scores of grandiosity significantly and accurately predicted more serious violent behavior.
The Swedish Communicable Diseases Act permits the isolation of an HIV-infected person if there is risk of disease transmission. The purpose is for the patient to receive the support needed to alter his or her attitude and behaviour so that the isolation can be terminated. This study describes the reasons for referral and the psychiatric diagnoses of 34 isolated HIV-infected patients. All patients who were isolated in Stockholm from 1986 to 1993 were included. Psychiatric data were collected from their psychiatric records. The most frequent reason for referral was unprotected sex with a partner who was not informed about the infection. The most common psychiatric diagnosis was amphetamine or opiate abuse. Drug users without delusions and immigrants with adjustment disorders or post-traumatic stress disorder had the shortest treatment periods. All patients belonged to underprivileged groups, were drug users or refugees. More effort is needed to teach these groups about HIV.