Subjective experience and mental side-effects of antipsychotic treatment.

Many schizophrenic patients have a negative attitude towards antipsychotic drugs. This attitude is not only due to lack of insight into the disease, lack of recognition of the beneficial effects of the drugs, and to objective side-effects. The negative attitude is to a high degree due to mental side-effects and a sceptical opinion about antipsychotic medication in general. In a study of 53 chronic schizophrenic out-patients receiving maintenance depot antipsychotic treatment, we found that 60% were positive about the treatment, 32% were ambivalent and 8% had a negative attitude. Only 60% complained of side-effects, even though 94% had objective side-effects. Mental side-effects such as subjective akathisia, dysphoria and emotional indifference were most often observed by the patients, while hypokinesia and hyperkinesia were least noticed by them, but most often observed by the physician. No correlation was found between the patients' subjective assessment of their quality of life and the degree of psychosis and side-effects. With the new atypical antipsychotics this situation seems to be changing. These new drugs are primarily characterized by a lower level of motor extrapyramidal side-effects (EPS), and with fewer motor EPS, fewer mental EPS can be expected. In recent studies comparing the new antipsychotics with haloperidol, better effects have been observed with regard to negative symptoms and depression, and this may at least in part be a reflection of a lower level of mental side-effects of the atypical antipsychotics. This improved clinical profile of new antipsychotics is extremely valuable in the context of an integrated treatment in schizophrenia, consisting of early intervention, psychosocial rehabilitation and family/patient psycho-education.

Subjective experience of treatment, side-effects, mental state and quality of life in chronic schizophrenic out-patients treated with depot neuroleptics.

Attitude towards treatment, side-effects, mental state and quality of life was assessed in 53 chronic schizophrenic out-patients on maintenance treatment with depot neuroleptics. It was found that 60% of the patients viewed depot medication positively, while only 8% viewed it negatively. Only 70% of patients complained about side-effects, even though 94% had scored as having them. Hypokinesia and hyperkinesis were the side-effects least noticed by the patients, but most noticed by the treating physician, while the opposite was the case with psychic side-effects. Only 49% of patients thought they had a psychotic illness, and there was no correlation between the patients' own evaluation of the severity of their illness and their score on the Positive and Negative Symptom Scale (PANSS) or the treating physician's evaluation. Quality of life did not correlate with either side-effect score or PANSS score. The schizophrenic patients' assessment of their condition was therefore in general different both from that of the treating physician and from that determined using rating scales.

[Night calls for general practitioners]. / Henvendelser til lege om natten.

We examined night calls in each of four rural Norwegian municipalities with 6,000-7,000 inhabitants during three months in winter 1992/1993. Most out-of-hours calls were covered by general practitioners on rota. The overall rate of night calls (2300-0700) was 55 per 1,000 inhabitants per year, varying from 39 to 77 in the municipalities (p < 0.01). In 42% of the night calls the patient was advised over the telephone, 23% were seen in the surgery and 34% were visited at home. We found a higher rate of night calls in our material than found in previous studies on the subject. We assume that this difference in the number of night calls can be explained to some extent by the different attitudes signalled by the doctors to their patient populations.

[Severe consequences of delayed diagnosis and treatment of neurosyphilis]. / Svaere følger ved forsinket diagnostik og behandling af neurosyfilis.

A case of full-blown neurosyphilis in a 40 year old university man is demonstrated. The disease was initially misdiagnosed as Creutzfeldt-Jakob disease. Nuclear magnetic resonance scanning supported this diagnosis. One year later the patient was hospitalized owing to increasing neurological deficits. For the first time he was examined for syphilis, and the disease was confirmed by a WR test. Despite lege artis penicillin treatment the patient was left with severe deficits, particularly of the intellect. The old phrase that syphilis can mimic any form of psychopathology is still true, and WR is still the test of choice whenever a neuropsychiatric diagnosis is unclear.

[A piece of fabric as the cause of monoarthritis]. / Interponeret klaedestykke som årsag til monoartrit.

A case of synovitis in the knee of a man aged 20 years is reported. The fragment measured 1 X 1 cm and proved to be material from a pair of jeans. The diagnosis was established by arthroscopy. After transarthroscopic removal of the fragment, the patient recovered.

Reactivity of eleven anti-human leucocyte monoclonal antibodies with lymphocytes from several domestic animals.

Nine commercially available monoclonal antibodies and two monoclonal antibodies from The American Type Culture Collection, raised against various human leucocyte surface antigens, were tested on lymphocytes from cow, sheep, goat, swine, horse, cat, dog, mink, and rabbit as well as man. Four antibodies bound to lymphocytes from some of the animals. These were the antibodies against CD8 and CD4 antigen, the antibody to C3b-receptor, and the antibody to the HLA-DR antigen. The CD8 antigen-reactive antibody reacted with lymphocytes from mink, cat, dog, and sheep, while the CD4 antigen-reactive antibody reacted with lymphocytes from mink. The anti-C3b-R antibody reacted with lymphocytes from horse, swine, dog, and cat, and the anti-HLA-DR reacted with lymphocytes from cow, goat, sheep, horse, dog, cat, and mink.