The long-term psychological effect of fatal accidents at sea on survivors: a cross-sectional study of North-Atlantic seamen.

OBJECTIVE: This study aimed to ascertain whether disasters at sea had an enduring traumatic effect on psychological functioning, accident proneness, and on their interest to continue working at sea. METHOD: Crew members of selected sea-disasters were contacted. The chosen disasters were of differing severity and in some cases fatalities had occurred. The disasters had taken place on average 8 years previously. Those who agreed to participate were interviewed in a semi-structured interview. They also answered the CIDI; DIS; GHQ-30; IES, and PTSS-10. One hundred-and-twelve seamen who had been in disasters were compared with a comparison group consisting of 59 peers who had not been in a disaster. RESULTS: Survivors of fatal disasters experienced more long-lasting negative effects than did others where lives were not lost. They had more frequently unpleasant intrusive thoughts on the IES (p < 0.01) compared with their peers. On the DIS, they also more frequently experienced heightened arousal (p < 0.001), sleep problems (p < 0.01), and nightmares (p < 0.01). The duration of PTSD symptoms from the time of the disaster was on average 18 months. Over 33% of the disaster group had experienced some PTSD symptoms within the past 12 months. Disaster survivors had not quit seamanship as frequently as non-disaster seamen. CONCLUSION: The most severe and long-lasting symptoms were found among those who had been in disasters where one or more crew members had perished. Loss of life in disasters therefore seems significant in the process of creating or extending the endurance of symptoms of psychological vulnerability.

Anxiety disorders: a result of long-term chronic fatigue--the psychiatric characteristics of the sufferers of Iceland disease.

OBJECTIVE: In order to clarify the lifetime likelihood of developing psychiatric disorder following the Akureyri disease, we have investigated 55 well documented cases of the Akureyri disease. MATERIALS AND METHODS: All participants were interviewed and diagnosed as to psychiatric disorders according to DSM-III. RESULTS: Of the 55 subjects included in this analysis 53 were women. The mean age of the participants was 67.7 years. The most common problem was agoraphobia with panic attacks 12.7% (P < 0.0001); agoraphobia without panic attacks 21.8% (P < 0.0001); social phobia 14.5% (P < 0.001); simple phobia 18.1% (P < 0.05); schizophrenia 3.6% (P < 0.01); and alcohol dependence 5.4% (P < 0.05). CONCLUSION: Prolonged chronic fatigue most commonly results in anxiety disorders. Following the infection, the more serious psychiatric disorders do not seem to play a major role in the long run.

Connection between smoking and back pain--findings from an Icelandic general population study.

The association between pain in general, back pain and smoking was studied in a sample of subjects from the general public (n = 862). The results show that smoking men had pain problems more frequently than women (p < 0.0001). In comparison with non-smokers, smokers were found to have back pains more frequently (p < 0.01). Male smokers were also found to have a higher frequency of intervertebral disc problems than female smokers (p < 0.009). The frequency of disc problems encountered by the smoking subjects indicates a possible connection between smoking and back pain.

[Neuropsychiatric manifestations in an unselected group of patients with systemic lupus erythematosus in Iceland.].

INTRODUCTION: There has been substantial difference in the reported frequency of neuropsychiatric manifestations in systemic lupus erythematosus (SLE). This difference can at least partly be explained by methodological difference, especially in case identification. MATERIAL AND METHODS: A retrospective study in a group of 65 unselected SLE patients was performed. The study consisted of two parts: 1) a neuropsychiatric evaluation which included a review of the patient's charts and a neurological interview, 2) a structured psychiatric interview, i.e. the Diagnostic Interview Schedule. RESULTS: In part one 37 patients or 57% had positive findings, while in part two the number was 32 pa nottients or 49%. Overall, 46 patients or 71% had experienced one or more neuropsychiatric manifestations. The most prevalent manifestations in part one were headache and psychoses, and in part two simple phobia, agarophobia, social phobia and generalized anxiety. Approximately 25% of the patients were treated solely outside hospitals. CONCLUSION: The unselected nature of this study gives a picture probably more representative of the true neuropsychiatric involvement in systemic lupus erythematosus than previous studies of selected patient populations.

Psychiatric disorders among subjects with systemic lupus erythematosus in an unselected population.

The prevalence of lifetime psychiatric disorders was investigated among all known systemic lupus erythematosus (SLE) patients in Iceland. The participation rate was 81%. Over 49% of the subjects received a lifetime psychiatric diagnosis. The number of diagnoses per person was 2.3. The most common disorder among those with a disorder was phobia (56%), followed by generalized anxiety (12%). Agoraphobia with and without panic, simple, social phobia, and alcohol abuse were found to be more common among the SLE patients in comparison with a population sample (p < 0.02; p < 0.0001; p < 0.001; p < 0.0001; p < 0.05, respectively). A possible explanation of the high rate of phobia may be related to the nature of clinical disfiguring facial skin rashes which may lead to social withdrawal.

The qualitative difference of visions and visual hallucinations: a comparison of a general-population and clinical sample.

Our objective was to analyze the frequency and quality of visions in a general-population sample compared with those experienced among schizophrenics. A sample group from the general population (n = 862) was compared with a group of schizophrenic patients (n = 19). Significant and qualitative differences were found in visions experienced by schizophrenic patients compared with subjects in the population sample. Women were more likely to experience visions of relatives than were men. The general population most commonly experienced visions of people, whereas schizophrenics were more likely to experience other phenomena. A qualitative difference thus exists in the type of visions experienced by schizophrenics compared with visions experienced by subjects from the general public.

Period prevalence rates of specific mental disorders in an Icelandic cohort.

This paper presents the 1-month, 6-month and 1-year prevalence rates for mental disorders in a random sample of people born in Iceland in 1931 and interviewed at the age of 55-57 years. The diagnoses were made according to DSM-III, on the basis of the National Institute of Mental Health's Diagnostic Interview Schedule (DIS) used by trained lay interviewers. The period prevalence rates were found to be similar to those obtained by other studies using the DIS as a survey instrument. The highest rates were among the widowed, separated or divorced. The 1-year symptom-free rates were high for alcohol abuse and alcohol dependence, 74% and 71%, respectively. For depressive disorders, the 1-year symptom-free rate was only 50% and for the anxiety disorders, 50%-65%. The most common psychiatric disorders had a chronic course.

Prevalence of seasonal affective disorder in Iceland.

OBJECTIVE: To investigate seasonal patterns in mood and behavior and estimate the prevalence of seasonal affective disorder (SAD) and subsyndromal seasonal affective disorder (S-SAD) in the Icelandic population. PARTICIPANTS AND SETTING: A random sample generated from the Icelandic National Register, consisting of 1000 men and women aged 17 to 67 years from all parts of Iceland. It represents 6.4 per million of the Icelandic population in this age group. DESIGN: The Seasonal Pattern Assessment Questionnaire, an instrument for investigating mood and behavioral changes with the seasons, was mailed to a random sample of the Icelandic population. The data were compared with results obtained with similar methods in populations in the United States. MAIN OUTCOME MEASURES: Seasonality score and prevalence rates of seasonal affective disorder and subsyndromal seasonal affective disorder. RESULTS: The prevalence of SAD and S-SAD were estimated at 3.8% and 7.5%, respectively, which is significantly lower than prevalence rates obtained with the same method on the east coast of the United States (chi 2 = 9.29 and 7.3; P < .01). The standardized rate ratios for Iceland compared with the United States were 0.49 and 0.63 for SAD and S-SAD, respectively. No case of summer SAD was found. CONCLUSIONS: Seasonal affective disorder and S-SAD are more common in younger individuals and among women. The weight gained by patients during the winter does not seem to result in chronic obesity. The prevalence of SAD and S-SAD was lower in Iceland than on the East Coast of the United States, in spite of Iceland's more northern latitude. These results are unexpected since the prevalence of these disorders has been found to increase in more northern latitudes. The Icelandic population has remained remarkably isolated during the past 1000 years. It is conceivable that persons with a predisposition to SAD have been at a disadvantage and that there may have been a population selection toward increased tolerance of winter darkness.

The lifetime prevalence of anxiety disorders in Iceland as estimated by the US National Institute of Mental Health Diagnostic Interview Schedule.

The lifetime prevalence of anxiety disorders was estimated in a study of the prevalence of mental disorders in Iceland. The survey instrument was an Icelandic translation of the US National Institute of Mental Health Diagnostic Interview Schedule. The cohort consisted of one half of those born in the year 1931. The participation rate was 79.3%. The overall prevalence of anxiety disorders was 44%, with phobia effecting 18%. The most common anxiety disorder was generalized anxiety, which had a prevalence of 22% and was more common among women. Simple phobia was the most common of the phobic disorders (8.8%), followed by agoraphobia without panic (3.8%), and social phobia (3.5%). The female-male ratio for anxiety disorders was 2:1. Of those with simple phobia, the most common items were a fear of heights (41%); claustrophobia (34%); being on public transportation (31%); the fear of being in crowds and speaking in front of others (28%); of being alone (24%); of insects (22%); of bad weather (21%); and of being in water (aquaphobia) (20%). In addition, 17% of the respondents listed phobias not cited in the DSM-III, and of those with the most common phobic disorder, only 9% had consulted a physician because of this condition. Post-traumatic stress disorder was found to affect women exclusively. Comorbidity shows a mean of at least 3 additional diagnoses.

Mini-Mental State Examination scores: gender and lifetime psychiatric disorders.

The Mini-Mental State Examination was taken by 862 subjects from the general population, all born in 1931 and 55 to 57 years of age at the time of the study. These responses were analyzed in detail to obtain normative data for the test, and comparisons were made between the members of the group who had lifetime histories of psychiatric disorder and those who did not. Comprehensive comparisons were also made of the geometric diagram included in the test with the aim of finding nonpathological variations within correct geometric drawings. Apart from providing normative data, findings show a difference in the final score for the sexes, depending on whether Serial 7s are chosen or a word is spelled backwards. The men received a higher score on Serial 7s and the women a higher score on spelling a word backwards. A pretest choice is recommended in that the Serial 7s be selected for men, but omitted for women. Both gender differences and a psychiatric diagnosis correlate with the naming of two digits in a MMS subscore category.

The lifetime prevalence of psychosexual dysfunction among 55 to 57-year-olds in Iceland.

In this study, the largest Nordic study of its kind, investigated psychosexual dysfunction among subjects aged 55-57 years. The cohort included 862 subjects of both sexes and all were interviewed using the Diagnostic Interview Schedule (DIS). Results showed that 122 subjects had a lifetime diagnosis of psychosexual dysfunction. The lifetime prevalence of psychosexual dysfunction was 14.4%; of inhibited sexual desire, 9.8%; of inhibited sexual excitement, 3.5%; of inhibited orgasm, 2.1%; and of functional dyspareunia, 1.3%. Of the subjects with psychosexual dysfunction, 73% were women. The frequency was highest in those who had never married. Separated subjects had rates intermediate between the married and the never-married. The majority (76%) of affected subjects had only one dysfunction. However, 57% of them had received another psychiatric diagnosis at some time. Subjects with psychosexual dysfunction were less frequently diagnosed as suffering from alcohol abuse and dependence and social phobia than subjects with no psychosexual dysfunction.

Pain and pain problems among subjects with systemic lupus erythematosus in Iceland.

This population study includes the majority of all systemic lupus erythematosus (SLE) patients in Iceland (n = 65). The study lists various self-rated pain descriptions both from a 54-item pain questionnaire and from the somatisation section of the Diagnostic Interview Schedule (DIS). Results show SLE patients to have significantly more joint and chest pain than does another patient group; to use analgesics more frequently; to have been in hospital more often during the past 10 years and to believe they know the reason for their pain. Also listed are factors that patients have found to increase and decrease SLE pain.

Lifetime prevalence of specific mental disorders among people born in Iceland in 1931.

The lifetime prevalence rates are presented for mental disorders in a random sample of people born in Iceland in 1931, interviewed at the age of 55-57 years. The diagnoses are made according to DSM-III, on the basis of the National Institute of Mental Health's diagnostic Interview Schedule (NIMH-DIS) used by trained lay interviewers. The most common diagnoses were alcohol abuse and dependence, generalized anxiety disorder, phobic disorders, dysthymic disorder and major depressive episode. Disorders more common in men were antisocial personality, alcohol abuse and alcohol dependence. Disorders more common among women were major depressive episode and generalized anxiety disorder. Alcohol abuse was more prevalent among those living in rural areas, but dependence was more prevalent in the urban area, where panic disorder is also more frequent. Widowed, separated and divorced people had most of the highest prevalences: tobacco-use disorder, alcohol abuse and dependence, dysthymia and generalized anxiety disorder. Except for a very high rate of alcohol abuse and dependence and a low rate of substance abuse disorders, the prevalence rates are similar to those obtained in North American studies using the NIMH-DIS as a survey instrument. The DSM-III criteria for alcohol abuse or dependence may be less applicable to Iceland than to North America, because of differences in what is culturally regarded as acceptable use of alcohol.

The frequency of depressive symptoms in a general population with reference to DSM-III.

The frequency with which symptoms of depression are found among subjects with either a lifetime diagnosis of depression or dysthymia and among subjects with no psychiatric disorders, are analysed. The data is derived from a large study (n = 862) on the lifetime prevalence of mental disorders which was conducted in Iceland. The survey instrument was the NIMH-Diagnostic Interview Schedule (DIS). Results from 379 subjects are reported in this study, these subjects have either experienced a Major Depressive Episode (n = 46), dysthymia (n = 32) or have no psychiatric disorder (n = 301). The frequency of symptoms are grouped together in hierarchical tables and displayed and analysed. In the hierarchical groupings of symptoms, males were found to report more grave symptoms of suicide than were females, both in the depression and dysthymic groups. In a comorbidity correlation between these and other disorders, sex differences emerged in the diagnosis of Tobacco Dependence, with women exhibiting higher frequencies of dependence when found in the depressed group.

Comparison of the General Health Questionnaire and the Cornell Medical Index Health Questionnaire.

This study compares the 30-item version of the General Health Questionnaire (GHQ) and the psychiatric section of the Cornell Medical Index Health Questionnaire (CMI-MR) using normative data from a sample of the general population and data from general practice patients where clinical assessment by a psychiatrist is used as a criterion of psychiatric caseness. In this study the CMI-MR has a slightly better overall performance as a screening test. It appears that the CMI-MR errs in the direction of false negatives when the symptoms are recent and related to situational stress, but the GHQ has a tendency to miss cases with symptoms of long standing.

Hysterical neurosis, conversion type: clinical and epidemiological considerations.

This paper considers data on hysterical neurosis, conversion type from the Monroe County (New York) Cumulative Psychiatric Case Register, from the Psychiatric Case Register in Iceland, and from a psychiatric consultation service in a university teaching general hospital in Monroe County (New York) during the period 1960 to 1969. The rate of hysterical neurosis, conversion type in Monroe County during this period was 22 per 100,000 per year, whereas in Iceland it was 11 per 100,000 per year. It was highest for women, non-whites and those of low social economic status. The rate of hysterical neurosis, conversion type and "probable" hysterical neurosis, conversion type combined among patients seen in psychiatric consultation was 4.5%. The most often noted diagnostic criteria were inconsistency with somatic process and precipitation of symptoms by psychological stress. Most patients had more than one conversion symptom at the same time. Pain was the most common symptom. The majority of patients had an accompanying organic or functional illness.