Patients with nonaffective psychosis are at increased risk for heroin use disorders.

BACKGROUND/AIM: It is well-established knowledge that persons with nonaffective psychotic disorders often have problematic use of alcohol, cannabis and stimulants, but heroin use is usually not included. Our aim was to investigate the prevalence of heroin use disorders in patients with nonaffective psychosis. METHODS: As the combination of heroin use and nonaffective psychosis is infrequent, epidemiological studies have to include large populations. The present study is a case count study using information from all psychiatric and social services in Oslo. Prevalence was calculated for four possible scenarios of minimum and maximum case counts and prevalences of nonaffective psychosis. Odds ratios were calculated for the resulting prevalences compared to the minimum and maximum prevalence of heroin use disorder in the general population. RESULTS: We found between 39 and 56 subjects with nonaffective psychoses and comorbid heroin use disorder. The number of individuals with nonaffective psychosis was estimated to be between 692 and 1,730. This corresponds to a prevalence of heroin use disorder of between 2.3 and 8.1%. The odds ratio compared to the general population will range from 1.83 with a prevalence of heroin use disorder in the general population of 1.2% to 9.43 with a prevalence of 0.9%. CONCLUSION: Individuals with nonaffective psychosis are at increased risk of heroin use.

History of Norwegian psychiatry.

Psychiatry as a professional and scientific enterprise developed in Norway in the middle of the 19th century. During the last part of this century, four state asylums were erected, followed by several county asylums during the first part of the 20th century. From the 1870 s, institutions for private care were established, usually in the vicinity of the asylums. During the middle of the 19th century, psychiatry in Norway was influenced by "moral treatment", but during the end of the century somatic ideas prevailed. After the Second World War, Norwegian psychiatry was influenced by Dutch and British social psychiatry, followed by American psychoanalytic-oriented psychiatry during the 1960-70s. Since the 1980s, the climate changed, with more emphasis on classification and drug therapy. The new American DSM-III also influenced Norwegian psychiatry, and cognitive-behavioral therapies became more prevalent. Norwegian psychiatric research has during the last few decades been characterized by epidemiological studies, clinical follow-ups and twin research.

Mood disorders and quality of life. A community study.

BACKGROUND: The aim of the present study was to investigate the association between different quality of life sub-indexes and various mood disorders. To our knowledge, this is the first study of the relationship between quality of life and clinical conditions within the whole realm of mood disorders, past and present. METHODS: More than 2000 persons between 18 and 65 years old from the community were studied. DSM-III-R diagnoses were assessed by the structured interview Composite International Diagnostic Interview (CIDI). Quality of life included seven aspects: Subjective well-being, Self-realization; Contact with friends, Support if ill, Absence of negative life events, Contact with family of origin; Neighbourhood quality, and a composite score; Global quality of life. RESULTS: Reduced quality of life was observed among persons with all kinds of mood disorders the previous year. That was also the case for previous mood disorders, especially bipolar and dysthymic disorder. Those with present psychotic major depression and past bipolar disorder had the most reduced quality of life. Among the sub-indexes, subjective well-being was most affected by mood disorders, followed by negative life events and lack of social support. The relationships did not disappear when controlled for socio-demographic factors and somatic health. LIMITATIONS: We do not know whether our results can be fully generalized to severe patient populations. CONCLUSION: Mood disorders, current as well as in remission, are related to a number of aspects of reduced quality of life.

Socio-demographic conditions, subjective somatic health, Axis I disorders and personality disorders in the common population: the relationship to quality of life.

Quality of life (QOL) was studied in a population of 2,065 subjects in Norway. A broad concept of QOL was applied, including subjective well-being, self-realization, negative life events, and a number of interpersonal relationships. The assessment of QOL, based on interview, was related to a number of socio-demographic variables, subjectively experienced somatic health, the most common Axis I disorders, and all Axis II personality disorders (PDs). The results of multivariate analyses showed that being female and living with a partner in the outskirts of a city and having good physical health are important positive correlates of QOL. Controlling for all these variables, major depression, dysthymic disorder, and somatoform disorders were the Axis I disorders that have a negative statistical effect on global QOL. Specific anxiety disorders did not add to the effects. Among the PDs, avoidant, schizotypal, paranoid, and schizoid PD traits were the most important statistical negative determinants of QOL, followed by borderline, dependent, antisocial, and also self-defeating and narcissistic PDs, restricted to some specific sub-indexes of QOL. The study also showed that our results vary and are sometimes the opposite, depending on the sub-index of QOL examined. The study showed that it is necessary to apply a broad concept of QOL to disclose the real nature or the relationship between mental disorders and QOL. Furthermore, demographic variables, subjectively experienced somatic health, Axis I disorders, and PD traits appeared to be independently associated with QOL.

A genetic study of the acute anxious response to carbon dioxide stimulation in man.

People with panic disorder-agoraphobia and their relatives often react anxiously to CO(2)-enriched gas mixtures. Available data are not suited to disentangle genetic from common environmental causes of familial aggregation of CO(2) reactivity, nor provide quantitative estimations of the sources of trait variation. Three-hundred-forty-six twin pairs belonging to the general population-based Norwegian NIPH Mental Health Study underwent self-assessments of anxiety and of DSM-IV panic symptoms after inhalation of a 35%CO(2)-65%O(2) mixture. Two thresholds were employed - at sample's 75th and 90th percentiles of responses - to define provoked panic attacks and to calculate polychoric correlations. Variance components were estimated by structural equation modelling (SEM). For definitions of responses based on the sum of all 13 panic symptoms, SEM could not discriminate between shared environmental versus genetic causes of familial resemblance for provoked attacks. For definitions of responses based on global anxiety, or on the sums of those symptoms (dyspnea, dizziness, palpitations) with highest variance post-CO(2), the best-fitting models indicated additive genetic factors as the sole causes for within-family resemblance. Best-fit heritability estimates ranged from 0.42 to 0.57. Genetic and idiosyncratic environmental factors explain most of individual differences in reactivity to hypercapnia. Within-family similarities for this trait are largely explained by genetic determinants.

Mental illness in a rural area: a Norwegian psychiatric epidemiological study.

OBJECTIVES: Few epidemiological studies have compared less well-integrated urban areas with well-integrated rural areas with the same methods. The aim of this study was to explore the prevalence of mental disorder in a socially stable demographic western region of Norway and make comparison with previously observed prevalence figures of mental illness in Oslo, the capital of Norway. METHOD: A random sample of the 107,738 residents of Sogn and Fjordane, a western rural region of Norway, age 18-65 years, was drawn from the Norwegian Population Register. A total of 1,080 subjects, 63% of the original sample, were interviewed with the Composite International Diagnostic Interview. RESULTS: The mean age of the subjects was 39.2 years. The 12-month prevalence of mental illness was 16.5% and the lifetime prevalence was 30.9%. Simple phobia and social phobia had the highest 12-month prevalence whereas alcohol abuse and major depression had the highest lifetime prevalence. All mental disorders were more prevalent in women than in men, with the exception of alcohol and drug abuse. Severe psychopathology was found in 2.2% (12 month prevalence) and 5.1% (lifetime prevalence). These observations show that the 12-month and the lifetime prevalence of mental illness in this western area is approximately half the rate of figures observed for Oslo. CONCLUSION: Epidemiological figures for a western rural region of Norway showing 12-month and the lifetime prevalence of mental disorder are considerably lower than figures obtained in studies from the capital of Norway. However, the same basic pattern of mental illness can be observed in the rural as in the urban area of Oslo, with alcohol abuse/dependence and major depression being the most common disorders at both sites. The sex pattern is also the same with higher figures for women both in rural and urban areas with the exception of alcohol and drug abuse being higher in men.

Personality disorders and quality of life. A population study.

The purpose of the study was to investigate the relationship between specific personality disorders (PDs) and specific aspects of quality of life in the common population. The sample consisted of 2053 individuals between 18 and 65 years old. Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition (DSM-III-R), axis I was studied by means of a structured interview (Composite International Diagnostic Interview) and axis II by means of a Structured Interview for DSM-III-R Personality Disorders; sociodemographic variables were taken into account, and broad aspects of quality of life were included. Personality disorders appeared to be more important statistical predictors of quality of life than sociodemographic variables, somatic health, and axis I disorder. Those with avoidant, schizotypal, paranoid, schizoid, and borderline PDs had the strongest and broadest reduction in quality of life, whereas those with histrionic, obsessive-compulsive, passive-aggressive, and sadistic PDs did not show any reduction. A number of specific relationships occurred. Furthermore, the more PDs that existed and the more personality criteria fulfilled, the poorer the quality of life, pointing to the importance of comorbidity and continuity.

Malignant melanoma of the skin: risk, tumour characteristics and mortality in adult twins born in Norway between 1905 and 1945 - a cohort study.

In this cohort study, data on the observed reduced incidence of malignant melanoma (MM) of the skin in twins compared with a control group were related to tumour characteristics and all-cause mortality. The twin cohort consisted of 20 926 individuals and the control group included individuals picked at random and matched to the twin cohort with respect to age, sex and place of birth. The cohorts were linked to the Cancer Registry of Norway and all cases of MM diagnosed from 1960 to 1999 were followed until October 2003. The mean observation time from diagnosis to death or censoring was 10.9 years (SD, +/-8.5 years). The relative risk of MM for the twins was 0.68 [95% confidence interval (CI): 0.55, 0.83]. No statistically significant difference was found in the distribution of histopathological subtypes or pathological stage between the cohorts. The crude all-cause mortality risk for the twin cases was 0.79 (95% CI: 0.58, 1.07). Stratified analysis indicated effect modification by gender on all-cause mortality risk (Breslow-Day test of homogeneity P=0.02). Multivariate analysis was performed separately for men and women. The adjusted mortality risk ratio for male twin cases was 1.11 (95% CI: 0.75, 1.65) and for female twin cases 1.05 (95% CI: 0.61, 1.8). The twins had a lower relative risk of MM compared with the control group, but similar tumour characteristics and all-cause mortality.

Quality of life and anxiety disorders: a population study.

The study of quality of life has increased in importance in the area of mental disorders during the last decade. The aim of the present study was to investigate the effect of specific anxiety disorders on specific quality of life indicators in the common population. More than 2000 individuals between 18 and 65 years old were studied by means of structured interviews. The results showed that social phobia and panic disorder within the past year and lifetime, and generalized anxiety disorder within the past year, had an independent effect on quality of life when controlling for a number of sociodemographic variables, somatic health, and other DSM-III-R Axis I mental disorders. Specific phobias and obsessive compulsive disorder had only a small effect, and agoraphobia showed no effect. The effect was strongest for self-realization and contact with friends, but anxiety disorders also influenced subjective well-being, social support, negative life events, contact with family of origin, and neighborhood quality.

A history of Norwegian psychiatry.

In Norway the building of asylums started in 1855 with the establishment of Gaustad State Asylum. Until the 1950s Norwegian psychiatry was mainly a hospital psychiatry, strongly influenced by the pre-war German tradition. After World War II, it was influenced by British social psychiatry and American psychoanalysis. Psychiatric units in general hospitals were established in the 1960s onwards and outpatient clinics from the 1970s. During the last twenty years Norwegian psychiatry has taken a more biological trend with stronger emphasis on diagnostics and drug treatment. The increase in the number of psychiatrists and especially psychologists has been formidable during the last fifty years.

Genetic and environmental influences on the association between smoking and panic attacks in females: a population-based twin study.

BACKGROUND: Clinical and epidemiological studies have reported an association between lifetime cigarette-smoking and panic attacks. Several explanations for this relationship have been proposed, mostly focusing on direct causal pathways. The objective of this study was to investigate a hypothesis of shared vulnerability by examining whether panic attacks and cigarette-smoking share genetic or environmental liability factors. METHOD: Questionnaire data on 3172 female-female twins (1409 complete pairs), aged 18-31 years, from a population-based Norwegian twin registry, were used to calculate the correlation between genetic factors and the correlation between environmental factors that influence lifetime measures of panic attacks and daily smoking. RESULTS: The best-fitting biometrical twin model suggested that genetic factors influencing panic and smoking were uncorrelated. Shared or familial environmental factors were perfectly correlated, and accounted for 75 % of the association between the phenotypes. The correlation between individual environmental factors influencing the phenotypes was 0.25 (0.07-0.44). In the full model, the genetic correlation was 0.17 (0.00-1.00), and genetic and shared environmental factors respectively accounted for 18 % and 61 % of the co-variance between panic and smoking. CONCLUSION: The results suggest that panic attacks and lifetime smoking have few or no genetic liability factors in common. The shared environmental factors that influence the two phenotypes are identical. Liability to panic attacks in females appears to be more influenced by shared environmental factors than previously indicated by univariate studies.