The initial prodrome in schizophrenia: searching for naturalistic core dimensions of experience and behavior.

The scientific exploration of prepsychotic detection and intervention in psychosis has just commenced. To identify developing psychosis at prodromal stages, it is important to learn how patients and families perceive initial prodromes naturalistically. We must understand better what we are going to detect, because the essential components of this phase, particularly the subjective experiences, remain unsettled. In a series of 19 first episode DSM-IV schizophrenia patients, we explore prodromal phenomena in depth and identify potential core dimensions. On the basis of our findings, we describe experiences and behaviors that appear to be essential components of initial prodromes. The subjects reported serious difficulties interpreting and talking about prodromal experiences at the time these occurred, causing delayed identification. We report detailed reasons for this, pointing out vulnerable aspects of at-risk assessments. From eight proposed groups of experiences, two are highlighted as tentative core dimensions: "disturbance of perception of self" and "extreme preoccupation by and withdrawal to overvalued ideas." Four potential dimensions of prodromal behavior are also identified: (1) quit school, university, or job, or major school truancy, (2) marked and lasting observable shift of interests, (3) marked and lasting social passivity, withdrawal, or isolation, and (4) marked and lasting change in global appearance or behavior. We argue that the findings, the phenomena, and their significance in prodromes are valid because they are logical and coherent in light of clinical experience as well as the empirical literature of a full century.

Confirmatory and disconfirmatory family communication as predictor of offspring socio-emotional functioning. A 10 to 14 year follow-up of children at risk.

Forty-nine families from the University of Rochester Child and Family Study were followed up 10 to 14 years after initial assessment. Two inclusion criteria were applied: at least one of the parents should have been hospitalized for a functional psychiatric disorder before initial assessment and the male index offspring should be 18 years or older at follow-up. Family communication was observed by the Consensus Rorschach procedure and coded with the Confirmation-Disconfirmation Coding System. Offspring childhood social competence was rated by peers, teachers and parents. Outcome measures included the Denver Community Mental Health Questionnaire, the Global Assessment Scale and hospitalization for a psychiatric disorder. Results showed that the family's level of confirmation and disconfirmation communication during Consensus Rorschach at initial testing predicted offspring interpersonal functioning and hospitalization for psychiatric disorders. These findings were not due to the initial social competence or IQ of the child, the level of functional impairment in parents or their social class.

[Treatment of suicide attempters in a somatic hospital. Is psychosocial support offered in addition to somatic treatment?]. / Behandling av selvmordsforsøkere i et somatisk sykehus. Gis det kun somatisk behandling eller ytes også psykososial hjelp?

The study examined whether patients admitted to a somatic hospital following an attempted suicide were offered psycho-social assessment and care in addition to somatic treatment. The medical records of 81 patients involving a total of 90 admissions following a suicide attempt during a period of one year were scrutinized. 1/3 of the medical records showed no evidence of a talk between the patient and a health professional about the attempted suicide. Patients staying in hospital for less than 24 hours were less likely to have had such a talk than those who stayed longer. No other variable, not even the patients' negative attitude towards hospital care was associated with the talk variable. Without an anamnesis where suicide-related themes are approached the health professional can neither judge the danger of a new suicide attempt nor the need for psycho-social help.

Competence in children at risk for psychopathology predicted from confirmatory and disconfirmatory family communication.

The relationship between confirmation/disconfirmation in parental and family communication and offspring social competence was examined in 59 families in which at least one of the parents had been hospitalized for a functional psychiatric disorder. Communication samples were obtained using the Consensus Rorschach procedure both with parental couples and with parent-child family units. The communication was analyzed using the Confirmation-Disconfirmation Coding System (CONDIS). The competence at school of 7-and 10-year-old boys was rated by both peers and teachers. Competence at home was rated by the parents. The results indicated that the more competent the high-risk children were, both at school and at home, the more their family communicated in confirmatory ways and the less they communicated in disconfirmatory ways. Furthermore, although the parental couple CONDIS score and the family CONDIS score were modestly correlated, each contributed separately to the prediction of offspring competence. These communication data were not significantly related to parental psychopathology, neither severity of parental impairment nor the diagnosis of the patient-parent.

Mental distress during winter. An epidemiologic study of 7759 adults north of Arctic Circle.

The prevalence of mental distress in a general population north of the Arctic Circle at 69 degrees N was studied over 4 midwinter months. Within the framework of a health survey for coronary heart disease, 3 questions about depression, coping problems and insomnia were posed. They were answered by 7759 people randomly assigned to a survey date from November to February. The extreme lack of daylight in December and January taken into consideration, the prevalence of mental distress found, 14% in men and 19% in women, is remarkably low compared with previous epidemiologic research. Except for insomnia in women, which was most prevalent in December, no significant relationship between month of survey and any of the 3 symptoms were found. Thus, the findings cast some doubt upon the importance of daylight for mental distress in the general population.

Prevalence of reported sleeplessness in northern Norway in relation to sex, age and season.

As part of a comprehensive population health survey in the municipality of Tromsø, north of the Arctic Circle, men between 20 and 54 years and women between 20 and 49 years were presented a questionnaire containing questions about sleeplessness and its possible association with season. Of the 14,667 respondents, 41.7% of the women and 29.9% of the men said they were sometimes bothered by insomnia. Insomnia not associated with any special time of the year was reported by 16.9% of women and 16.2% of men; insomnia in the "dark period" (midwinter insomnia) was reported by 17.6% of women and 9.0% of men; insomnia in the midnight-sun period or in spring or autumn was much less common. Difficulty falling asleep was the most common type of insomnia, especially in winter and summer. Overall, the frequency of insomnia increased with increasing age, but with some notable differences with regard to type (initial insomnia showed little relation to age, whereas middle and late insomnia increased markedly with age) and seasonal type (insomnia in the midnight-sun period decreased with age, whereas the other seasonal types increased with age).

Short-term dynamic psychotherapy. I. The Oslo group's form to score outcome, the reliability testing of this form and observer characteristics.

The aim of short-term dynamic psychotherapy is, through working with a central conflict and transference reactions, to obtain lasting changes based on cognitive and emotional understanding of the main dynamics of the central conflict, called insight. The aim of the present study was to construct a follow-up form that was easy to handle, could score different outcome of short-term dynamic psychotherapy, as for instance symptom relief, change in social functioning and better insight, and was reliable. Sufficient reliability was established with a reliability coefficient between 0.756 and 0.564 for eight result variables. Percentage agreement was estimated in addition. As a total only 10% of the scores differed more than +/- 1 from a consensus score on a scale from zero, no change, to 7, recovered. The therapist was a reliable observer of his/her own patients. The sex of the observer did not influence percentage agreement. High-formal training in psychotherapy tended to give higher percentage of agreement compared to low-formal training.

Short-term dynamic psychotherapy. III. A 5-year follow-up of 36 neurotic patients.

36 patients of 39 (92%) were followed up 2 years after the end of short-term dynamic psychotherapy. 33 of these 36 patients (92%) were again followed up 5 years after the end of treatment. Changes had occurred between the two follow-up times that to some extent might be due to spontaneous remission and further therapy, but this could not explain all changes. The same patient characteristics that were related to outcome at the 2-year follow-up were related to outcome at the 5-year follow-up. This replication of findings strengthens the results.

Short-term dynamic psychotherapy. IV. Comparison of recorded changes in 33 neurotic patients 2 and 5 years after end of treatment.

Changes for 33 neurotic patients treated with short-term dynamic psychotherapy were compared as measured at 2 and 5 years after end of treatment. There were changes both in symptoms and in degree of insight as measured by a dynamic variable between the two follow-up points. Some of these changes could be due to spontaneous remission and further therapy, but this could not explain all changes. Dynamic changes measured at 2-year follow-up persisted throughout the whole follow-up period. Some patients with mere symptom relief at 2-year follow-up got their symptoms back while others changed dynamically. Thus effect of short-term dynamic psychotherapy may occur even after 2 years after the end of treatment.

Short-term dynamic psychotherapy. V. Global assessment scale as an instrument for description and measurement of changes for 33 neurotic patients.

Global assessment scale (GAS) has not been tested out on a group of neurotic out-patients earlier. The patients in this study were selected for short-term dynamic psychotherapy by defined selection criteria and were thus a fairly homogeneous group of patients. It could be demonstrated that GAS could be used as a supplement for describing patient characteristics both at the start of treatment and at the 5-year follow-up. GAS could further be used for measuring change for this patient population after short-term dynamic psychotherapy. GAS could not be used as a predictor for dynamic change at the 5-year follow-up.

Short-term dynamic psychotherapy. II. Prognostic value of characteristics of patients studied by a 2-year follow-up of 39 neurotic patients.

39 out-patients, 19 men and 20 women with a neurotic personality structure, evaluated by at least 2 therapists, were treated with short-term dynamic psychotherapy. 33 patients were followed up 2 years after the end of treatment with a semi-structured, problem-oriented interview, scored by 3 therapists according to a follow-up form developed for the study. Sufficient reliability was demonstrated for the follow-up form. 11 of 36 patients (31%), followed up 2 years after the end of treatment, obtained a high score on the dynamic result variable, and 24 (67%) on symptom relief. It could be established that these changes were mostly due to the therapy given. Variables pertaining patients' ability to relate to another person correlated with outcome. This is consistent with what Malan found in his two studies.