[Herman W. Major--"father" of Norwegian psychiatry]. / Herman W. Major--"far" til norsk psykiatri.

Herman Wedel Major (1814-54) is clearly the founding father of Norwegian psychiatry. In 1844, he submitted a proposal for an insane asylum in Norway, emphasising that insanity was a curable disease, not possession by spirits. Included with the proposal were drawings by his brother-in-law, the well-known architect Heinrich Ernst Schirmer (1815-87). The proposal was soon supported by a statement from Peter Willers Jessen (1793-1875), professor and head of Europe's first new psychiatric hospital. Gaustad Hospital was opened in 1855. In 1846, Major submitted a report on the plight of the insane in Norway, and he was the driving force in the drafting of modern legislation on insanity in Norway, the "act relating to treatment and care for the insane", passed in 1848. This was the fourth modern insanity act in Europe, following those in France (1838), Switzerland (1838) and England (1842).--A great lifetime achievement, brought to an end in 1854 when Major, then 40, and his family died in a shipwreck.

Delusional misidentification syndromes.

The editors first describe the principal symptoms of the Capgras delusion, the Frégoli delusion, the delusion of intermetamorphosis and the delusion of subjective doubles before developing the argument that it would be appropriate for international psychiatric diagnostic systems to include these disorders. Furthermore the similarity between them, the reduplicative paramnesias and déjà and jamais vu are pointed out. By stressing a symptom-based approach it is possible to examine psychiatric, neurological and medical cases as arising from the same underlying disturbance in cognition function. The relationship between delusions of misidentification and other delusions is also touched upon.

Differences in diagnosis and long-term course and outcome between monosymptomatic and other delusional disorders.

A presentation is given of a long-term personal follow-up investigation of patients with paranoid psychoses consecutively admitted at the University Psychiatric Department in Oslo. The patients were followed-up for the first time after a period of 5-18 years, and again after 22-39 years. On the basis of the findings, it is suggested that the diagnostic category will best indicate the course and outcome for cases with delusional misidentification syndromes.

[Suicide among young people aged 15-29 years in Oslo. The development in the Nordic countries and regional variations in Norway]. / Selvmord blant unge i alderen 15-29 år i Oslo. Utviklingen i Norden og regionale variasjoner i Norge.

The suicide rate in Norway has doubled during the last 20-25 years. The increase was much higher for the age group 15 to 29 years. Among young men and women between 15 and 29 years in Oslo there was no increase in the suicide rate from the period 1975-1981 to the period 1982-1988. Many of the persons who committed suicide had been treated for mental disorders, had problems with alcohol and drugs or were intoxicated when they did it. At least 27% had attempted suicide before. From the period 1975-1981 to the period 1982-1988 there was no increase in the suicide rate among young people in the two largest cities, Oslo and Bergen, but this rate had doubled in the two southernmost and the three northernmost couties. Nowhere was there an increase in suicides by females in the group aged 15-29 years.

Outcome in delusional disorder in different periods of time. Possible implications for treatment with neuroleptics.

The effect of neuroleptics in the treatment of schizophrenia is well established. Some reports indicate that at least pimozide may be effective in delusional disorder as well. In this article a long-term follow-up study of 72 first-admitted patients with delusional disorder is described. Outcome in patients admitted during 1946-1948 was compared with that of patients admitted during 1958-1961. We did not find a more favourable outcome in the group admitted after the introduction of neuroleptics. This contradicts our earlier finding for patients with schizophrenic psychoses, indicating that neuroleptics generally may be more effective for schizophrenics than for patients with delusional disorder. Controlled drug trials in delusional disorder are strongly needed.

Death due to overdose of antidepressants: experiences from Norway.

During the last 20 years the suicide rate in Norway has doubled. This also applies to suicide by intoxication. Antidepressants comprise a constantly increasing part of the intoxication means used in suicides, as demonstrated in this article. The tricyclic antidepressants amitriptyline and doxepin, the most commonly used antidepressants in Norway, are also the two leading antidepressants causing death by intoxication. Less toxic antidepressants should be prescribed whenever possible.

The Nordic concept of reactive psychosis--a multicenter reliability study.

Reactive psychosis is a common diagnosis in the Nordic countries (Norway, Sweden, Denmark, Finland and Iceland) and in several other parts of the world. In ICD-9 and DSM-III-R, the concept is defined more narrowly than in the Nordic tradition. In this study we examined the interrater reliability of the Nordic concept by the case-summary method between clinicians from 9 university departments in the Nordic countries. The results show that Nordic psychiatrists have a reasonably reliable concept of reactive psychosis, and that this psychosis can be diagnosed as reliably as schizophrenia and affective psychosis.

Suicide in the Nordic countries.

There are great differences in the suicide rates in the closely related Nordic countries. The suicide rates are higher in Finland, especially in males, and Denmark, especially in females, and lower in Norway and Iceland, with Sweden in a middle position. The statistics are found to be comparable. In this article the development from 1880 to the present day is described, and special emphasis is laid on the development from 1960 onwards. Denmark and Finland still keep the top position, while the rise in suicide rates, especially in the age group 15-29 years, has been most marked in Norway. Within the Nordic region Greenland has an extremely high suicide rate, especially in youngsters, while the Faroe islands have a very low rate. Tentative explanations are given for the development of suicide rates in the Nordic countries.

Convergence of American and Scandinavian diagnoses of functional psychoses.

One hundred ninety-nine case summaries of a consecutive sample of functional psychoses, which had been classified by Odegård, were diagnosed independently using DSM-III-R criteria by four experienced psychiatrists. Odegård's classification and DSM-III-R showed high concordance for schizophrenia and affective psychoses. Odegård's concept of reactive psychoses had high concordance with atypical psychoses in DSM-III-R. These findings imply that the results of genetic and follow-up studies from Scandinavia might be relevant for these diagnostic categories in DSM-III-R.

Delusional disorder: the predictive validity of the concept.

A sample of 72 first-admitted patients with delusional disorder was personally re-examined after a mean of 10 years, and 42 of them after an average of 27 years. The mean observation period for all patients from admission to last follow-up was 20 years (3-39). There was a trend that patients with delusions of jealousy did better on course variables, but similar outcomes were revealed in groups with delusions of jealousy, persecution and a mixed group with different main delusions. Duration of symptoms prior to admission was a significant predictor of outcome, indicating dividing lines of 1 and 6 months at 10-year follow-up and 3 and 6 months at long-term follow-up. Based on the data, a minimal duration of 6 months is proposed for persistent delusional disorder.