[Mental health among refugees. Connection between symptoms, traumatization and exile]. / Psykisk helse blant flyktninger. Samspill mellom symptomer, traumatisering og eksil.

Traumatization and psychiatric symptoms among 346 refugees admitted to the outpatient unit at the Psychosocial Centre for Refugees from 1992 to 1996 were registered and analysed by means of systematic, clinical interviews. More than 50% reported exposure to physical torture, and more than 50% had also been involved in serious war actions. Most patients had experienced many forms of persecution. Approximately 10% of the patients had employment in their host country and 20-30% attended school or participated in language courses. Almost 40% were neither employed nor engaged in any kind of studies. 50% were diagnosed as having post-traumatic stress disorder. The relationship between demographic background, traumatization and exile situation, and symptoms and social dysfunction is illustrated by case histories.

Mental disorder among refugees and the impact of persecution and exile: some findings from an out-patient population.

BACKGROUND: Refugees have long been considered at risk for mental disorder. We sought to characterise this risk in an out-patient refugee sample by analysing the relationship between psychiatric symptoms and dysfunction, and between symptoms and the socio-demographic background and stressors specific to this refugee sample. METHOD: A consecutive sample of 231 refugee patients referred to the psychiatric out-patient unit at the Psychosocial Centre for Refugees, University of Oslo, was examined with a semi-structured interview guide, Brief Psychiatric Rating Scale (BPRS), Hopkins Symptom Check-List (HSCL-25) and a check-list for post-traumatic symptoms (PTSS-10). Global Assessment of Function (GAF) scores were obtained; and the data were analysed using nine predictor variables. RESULTS: It was found that 46.6% of the patients had a post-traumatic stress disorder according to the criteria for DSM-III-R as the main diagnosis, while the mean GAF score for the patients was 57.3. Analysis of the GAF and BPRS data did not reveal any predictor of psychotic behaviour. However, torture emerged as an important predictor of emotional withdrawal/retardation. Also, age, gender and no employment or education predicted for anxiety/depression, while refugee status and no employment or school predicted for hostility/aggression. CONCLUSIONS: The results confirm earlier findings that refugees constitute a population at risk for mental disorder. Past traumatic stressors and current existence in exile constitute independent risk factors. However, stressors other than those discussed here appear to be important also, particularly with regard to psychotic symptoms.

[German medicine during the Nazi regime--cooperation and resistance]. / Tysk medisin under nazismen--samarbeid og motstand.

The author reviews the collaboration between the medical profession and the Nazis in Germany during the period 1933-45, based mainly on recent literature. As several authors have pointed out, the medical profession became extensively involved in the implementation of a sterilisation programme, the practice of the racial laws, the exclusion of Jews from the medical practice, the Euthanasia Programme and the performance of painful and dangerous experiments on prisoners. Although the resistance to Nazism was weak and did not succeed in preventing the atrocities, it deserves historical attention. The resistance seems to have been motivated by an alternative ideology, such as Socialism, Christianity and Humanism. There were also some protests based on principles of medical ethics. Passive neutrality through "internal exile" seemed to have been difficult, and heroic resistance was rare, but did occur.

[Norwegian psychiatry and Nazism. A historical project of current interest]. / Norsk psykiatri og nazismen. Et historisk prosjekt med ny aktualitet.

In 1945 the Ministry of Justice appointed a committee to conduct a psychiatric examination of Norwegian Nazis. This was done after a proposal from the Norwegian Psychiatric Association on the initiative of Professor Langfeldt, who at that time was head of the Department of Psychiatry at the University of Oslo. An investigation based on a crosscheck between membership of the Nazi party and the Norwegian case register for psychoses for the period 1926-1940 showed 30% more psychoses among the Nazis than in the population as a whole. Other studies tended to support the view that there was a high prevalence of deviant personalities among the Nazis. A study of 340 "front combatants" (not representative of the whole group of 8,000) showed no increase in psychopathology. They had a higher level of intelligence and education than the mean of young Norwegian males. Many of them belonged to strong pro-Nazi families. The studies of pro-Nazi women, especially the very young who had been involved in sexual relationships with German soldiers, are not representative. The findings seem to indicate that many of them lacked family support and had social problems. The studies are discussed in a historical perspective, with some comments about their relevance today.

[Medicine and human rights]. / Medisin og menneskerettigheter.

Medicine's task to promote health without inflicting harm is parallel to the two dimensions of human rights-"the positive rights", meaning the right of fulfillment of certain basic needs, and "the negative rights", meaning protection from harmful violations. A historical review shows that the practice of medicine has been an integral part of every civilization in human history, but that the ideas of human rights are a more recent invention of the human mind. In spite of old philosophical traditions about the unique value of the human being, the idea that all human beings are created equal and born with the same rights has only been truly recognized in recent centuries, and has been elaborated through conventions and declarations in national and international political institutions after World War II. At the crossroads between human rights and medicine, five points are high-lighted: the extensive prevalence of man-made disease, the relationship between medical diagnoses, ethics and law, the connection between healing and moral rehabilitation, the relationship between health, psychology and fair trials in society, and the role of physicians in conflicts of loyalty.

[Mental health among Norwegian immigrants to America. Ornulv Odegård's migration research in a historical perspective]. / Psykisk helse blant norske Amerika-emigranter. Ornulv Odegårds migrasjonsforskning i historisk perspektiv.

Norway has a past history as a country of emigration, and in these earlier days, medicine and psychiatry had to cope with the effects of migration. A review of the scientific literature shows much concern about the high prevalence of psychoses. However, many of the conclusions were based on oversimplified methodology. The interpretation of the findings was greatly influenced by the theories of degeneration and racial hygienics. The same way of thinking was found among some Norwegian psychiatrists. Odegård's study, Migration and Insanity, from 1932, was a big step forward in design and methodology. His findings are still highly relevant in migration research.

Eating behaviour, drug use, psychopathology and parental bonding in adolescents in Norway.

A 12-item version of the Eating Attitudes Test (EAT-12) was constructed and applied at 1-year intervals in a non-referred cohort of 1193 adolescents in Norway aged 13-18 years. Eight percent of the girls scored beyond the chosen cut-off point of 9/10 the first time and 9% the second time. Factor analysis demonstrated 3 factors--dieting, bulimia and food preoccupation and oral control. Both the total scores on the EAT-12 and the 3 different factor scores showed a significant relationship between eating behaviour and smoking, level of alcohol consumption, alcohol intoxication, psychopathology and parental bonding.

Adolescents and benzodiazepines: prescribed use, self-medication and intoxication.

In a longitudinal study of 1230 people aged 13-18 years from the Greater Oslo Area, the past-year prevalence of anxiolytic or hypnotic use was 10%, which is higher than previously reported. The majority gave therapeutic reasons as a motive for using these drugs. However, most of the use was unprescribed. The parents, and especially the mother, were the most important suppliers. A minority gave intoxication as a motive for using these drugs. In this group, the suppliers were mainly peers and the illegal market. Neither the unprescribed nor the prescribed therapeutic use show any association with use of drugs such as alcohol and cannabis. There is, however, a strong association between the unprescribed use of benzodiazepines by young people and by their parents. This suggests a pattern of learning and role modelling, which must be regarded as problematic for public health policy. Those who use the drugs to become intoxicated have particularly poor mental health, and they use many other drugs as well. This group probably runs a special risk of developing more serious drug abuse.

Role modelling and cigarette smoking: vulnerable working class girls? A longitudinal study.

Risk factors for the onset of cigarette smoking were examined by means of a prospective longitudinal study in 1230 Norwegian adolescents aged 12-18. In particular the importance of role modelling was focused. The findings revealed that the age period between 12 and 15 is most important when it comes to the initiation of smoking. Among those who initiate smoking, the incidence rates of quitting is low, indicating that most of the initiators quickly seem to develop a relatively stable smoking habit. Smoking initiation can be divided into two stages. The first, experimental one, is predicted by peer modelling and low socioeconomic status (SES). The second, establishing a regular pattern of use, is predicted by modelling of parental smoking and the interaction between female sex and low SES. Studying the characteristics of the regular smokers cross-sectionally, peer modeling showed the strongest correlates. Studying the predictors of the transitions longitudinally, the more complex picture described above was uncovered. This indicates that the complexity of the role modelling process can only be simulated adequately by means of prospective research methods and by paying attention to such parameters as gender, age, SES and stage in the smoking acquisition process.

[Psychosocial consequences of organized violence. Experiences from Latin America]. / Psykososiale konsekvenser av organisert vold. Noen inntrykk fra Latin-Amerika.

The health consequences of organized violence are well documented (increasing from many parts of the world). We review experiences reported from Latin-America based on literature, contact with human rights organizations and participation in conferences in (Santiago de) Chile and Costa Rica, with special focus on: the destructive psychosocial influence of a repressive society; the development of torture methods; the development of therapeutic methods; the serious psychological implications of "impunity". In Central America joint strategies have been developed for preventive and therapeutic work connected to the effects of war-traumas and terror. Psychiatrists and psychologists from Western countries involved in treatment of refugees in exile can mutually benefit from the experiences of colleagues who have death with the problems in countries where prosecution and oppression have taken place. Within this framework professionals are challenged to take a firm stand against human right violations.

[Psychosocial problems among refugees in Norway]. / Psykososiale problemer blant flyktninger i Norge.

172 patients were examined and treated by the Psychosocial Team for Refugees in Norway from 1 January 1986 to 15 November 1988. The patients came from 21 countries, the majority from Iran, Chile and Vietnam. Various reactive conditions dominated the clinical picture, and 53 patients had posttraumatic stress disorder, which was the most frequently occurring single diagnosis. The patient group had been exposed to a number of overwhelming experiences and at least half had been tortured. The therapists identified separation and loss, traumatic experiences and social isolation in exile as the factors of greatest importance for the development of the patients' conditions. 46% of the patients were found to have improved at the end of the treatment.

[Clinical experiences with refugees in need of treatment. Reflections on psychosocial problems of people living in exile]. / Klinisk erfaring med behandlingstrengende flyktninger. Refleksjoner omkring psykososiale problemer hos mennesker som lever i eksil.

In the light of experiences from the Psychosocial Team for Refugees in Norway, the authors describe factors of importance for understanding the personal meaning of the exile. We point to the implication of different traumatic events associated with flight and exile, and to the psychosocial consequence of such traumatization. We consider this to be important basic knowledge for doctors and other health workers engaged in preventive and curative work with refugees.

Patterns of drug use and sensation-seeking among adolescents in Norway.

The relationship between personality and drug use was investigated by studying patterns of sensation-seeking behaviour and drug use among adolescents. A questionnaire was distributed to a sample of 1027 Norwegian senior high school students aged 16 to 19 in the greater Oslo area. The response rate was 97%. The sensation-seeking subscores showed moderate to strong association with the use of the different drugs. A canonical correlation analysis yielded 3 significant variates: in the drug use domain the first dimension correlated with the use of legal drugs and inhalants, the second with cannabis and tranquillizers and the third with tobacco. In the sensation-seeking domain the first dimension was almost synonymous with the disinhibition scale, the second with experience-seeking, and the third correlated highly negatively with thrill-, adventure- and experience-seeking. The results support the assumption that a strong link exists between sensation seeking and drug use. They further show the importance of taking different subdimensions of the sensation-seeking trait into account for prevention and treatment of drug use and abuse.