[Organic versus non-organic diseases. A distinction necessary for rational practice]. / Organiske kontra ikke-organiske sykdommer. En distingvering som er nødvendig for å kunne praktisere rasjonelt.

A great many, perhaps the majority, of those who see a doctor present subjective suffering and behaviour disorders that are problematic to classify as illness. This is because no pathobiological foundation for such classification is demonstrated--no matter how thoroughly the patients are examined, or how long they are followed up. Symptomatologically too, organic and non-organic conditions are distinctive. While organic illnesses are characterized by physical and biochemical signs, non-organic disorders manifest only distressing experiences (as pains or anxiety) or undesirable behaviour (as abuse of alcohol)--phenomena that are inseparable from normal sensation, emotion, intentions and actions. As for treatment, the main methods applied in organic illnesses are of a physical and biochemical nature. In cases of subjective suffering or behavioural deviances therapy consists of general relief, correction and sedation--all of the kind we make use of in our everyday lives. If the majority of those who consult a doctor are not really ill, what then, is the alternative? Individual and collective misery? The sole alternative to illness is normal psycho-physiological and behavioural variations. A widely held opinion, however, is that non-organic disorders fulfill the criteria for illness. This means that some kind of pathological substrate is postulated even when we fail to demonstrate its existence. The crucial point, however, is not to solve the problem of whether a person is ill or not, but to underline that we are dealing with two separate categories of phenomena - bio-pathologically and psycho-physiologically founded suffering and dysfunctioning.

A double-blind comparison of zimelidine and desipramine in endogenous depression.

Zimelidine, a specific 5HT uptake inhibitor (final dose 225 mg), and desipramine, mainly a noradrenaline uptake inhibitor (final dose 150 mg), were given in random order to 24 in- and out-patients fulfilling the Research Diagnostic Criteria for Major Depressive Disorder, definite or probable endogenous type, for a 3-week treatment period. Nonresponders were crossed over to the other drug for another 3 weeks. There was a nonsignificant trend towards more overall improvement on desipramine. Some patients in both groups showed very little change during 3 weeks, indicating a bimodal distribution of response to either drug. Several nonresponders improved markedly upon direct crossing over to the other drug. There were few and mild side effects on both drugs, with no significant difference between them. No significant correlation was found between improvement and plasma concentrations of zimelidine, norzimelidine, or desipramine, whereas a significant positive correlation was found between improvement and platelet serotonin uptake inhibition (measured in fresh platelets incubated in diluted plasma from the patients) in zimelidine-treated patients.

The course of narcomania in adolescence. A comparison of young psychiatric in-patients with and without drug abuse.

Eighty-four young drug abusers and 84 non-abusers admitted to a psychiatric ward were followed over a period averaging 3 years after discharge. According to information from the patients and their families, about one third of the abusers had stopped taking drugs and appeared to be well adjusted socially. The remainder had continued their abuse, periodically or continuously. Many of them had a large alcohol consumption. The incidence of delinquency was high, also for those who claimed to have ceased their abuse. Therefore, it seems doubtful that the course is as favourable as stated in the literature. The non-abusers had fared much better, two thirds of them showing satisfactory adjustment. As to prognostic factors, intravenous administration proved to represent a particularly bad sign among the drug abusers, whilst a high alcohol intake was of special significance among the non-abusers.

Comparison of sulpiride and chlorpromazine in psychoses. A double-blind multicentre study.

In a material of 71 patients admitted because of acute or chronic psychoses, 32 were treated with sulpiride (up to 1,800 mg per day) and 39 with chlorpromazine (up to 675 mg). Duration of treatment was from 4 to 8 weeks. The effect of the two preparations was very similar as were the type and frequency of side effects, except that sulpiride did not cause sunrash.