The Declaration of Hawaii and Clarence Blomquist.

The international code of ethics of psychiatry, the Declaration of Hawaii was in the main the achievement of Clarence Blomquist. There were several prerequisites for the success of this work. 1. The unique profile of the education of Clarence Blomquist, combining training to be a specialist in psychiatry with a doctor's degree in practical philosophy. 2. An outstanding competence in analyzing complicated issues and in putting thoughts into words. 3. The courage to challenge the Hippocratic ethics and adapt the principles of ethics to modern health care. 4. A scholarship at the Institute of Society, Ethics and the Life Sciences, Hastings-on-Hudson, New York, where he could test his ideas in an intellectual interdisciplinary atmosphere. 5. Support from the late Professor Leo Eitinger, Norway and Professor Gerdt Wretmark, Sweden, who together with Clarence Blomquist constituted a task force on ethics of the World Psychiatric Association. 6. A continuous backing-up by Dr Denis Leigh, the then secretary general of the World Psychiatric Association. Denis Leigh was convinced that a code of ethics was the only means to reconcile the various member countries on issues of misuse of psychiatry and, in addition, would raise the quality of psychiatric care throughout the world.

Potential side effects of dental amalgam restorations. (I). An oral and medical investigation.

The aim of this study was to explore a possible association between health status and self-reported adverse effects related to dental amalgam restorations. A group of 50 consecutive patients (index group), referred for complaints self-related to dental amalgam restorations, was compared with a control group of individuals matched by age, sex and postal zip code. The patients underwent an oral, stomatognathic, medical and clinical chemistry examination. Mercury levels were examined in blood, urine and hair. The results revealed that somatic diseases were more common in the index group (38% versus 6%). Symptoms related to cranio-mandibular dysfunction were reported by 74% of the patients in the index group versus 24% in the control group, and were diagnosed in 62% and 36%, respectively. The oral health status and the number of amalgam surfaces were similar in the 2 groups. No positive skin patch test to mercury was found in any of the groups. The estimated mercury intake from fish consumption, occupational exposure, and mercury levels in blood and urine were also similar and far below levels, where negative health effects would be expected. The correlation between the number of amalgam surfaces and mercury levels in plasma and urine (r=0.43) indicated a release of mercury from dental amalgam restorations in both groups. Since the mercury levels were similar among index patients and controls, mercury was not a likely cause of the impaired health reported by the patients.

Potential side effects of dental amalgam restorations. (II). No relation between mercury levels in the body and mental disorders.

A group of 50 consecutive patients, referred for self-reported complaints which they related to dental amalgam restorations, was compared with control patients matched by age, sex and postal zip code. All patients were subjected to a psychiatric examination and a set of rating scales and questionnaires, and the symptoms were related to the mercury levels in blood, urine and hair. A psychiatric diagnosis was established in 70% of the patients in the index group versus 14% in the control group. The prevailing symptoms were anxiety, asthenia and depression. Mercury levels in blood, urine and hair were similar among index cases and controls, and were far below critical levels of mercury intoxication. There was no correlation between mercury levels and the severity of the reported symptoms. Therefore, mercury was not a likely cause of the complaints. Instead, the reported symptoms were part of a broad spectrum of mental disorders.

Experimental studies of the therapeutic action of electroconvulsive therapy in endogenous depression. The role of the electrical stimulation and of the seizure studied by variation of stimulus intensity and modification by lidocaine of seizure discharge.

Three methods of electroconvulsive therapy (ECT) were compared in respect of therapeutic effect in 69 attacks of endogenous depression in 65 patients, not previously treated by ECT during the actual period of illness. The treatments were given under barbiturate narcosis, with full muscular relaxation, administration of oxygen and electroencephalographic recording of the seizure discharge. In two methods grand mal seizures were evoked by supraliminal (A) and liminal stimulation (B), in the third (C) lidocaine (3 mg/kg i.v.) was given before the application of liminal stimulation. The seizure discharges in C were markedly shortened and their pattern modified, while between A and B the duration and pattern of the seizures were similar (Table 1). The patients were referred to the three treatments at random and the groups may be regarded as having a similar prognosis (Table 2-5, 7). The therapeutic outcome was estimated by rating several depressive symptoms according to a rating scale worked out for the purpose. The rating was performed before treatment, one week after the fourth treatment (a treatment pause was then made) and one week after the completed series. To obtain more reliable measures the scores for the various symptoms were added together to form a total score, which was then divided into a depression score and a retardation score, presumably measuring mainly depressive mood and psychomotor retardation. Differences in rating scores on two rating occasions were taken as measures of improvement. In addition, a global rating of improvement was made. The rating procedure was double blind. The principal results were: 1. After four treatments (three patients who recovered after three treatments included) the degree of improvement was in the rank order ABC with significant group differences for a few scores. After the completed series of treatments improvement in groups A and B did not differ significantly whereas in group C it was significantly smaller for some scores (Table 9). 2. The total number of treatments was significantly higher in group C than in group A and B, which did not differ significantly between themselves (Table 10). 3. A measure of therapeutic efficiency, improvement per treatment, was computed by dividing the degree of improvement as obtained from the differences in the combined scores and from the global score of improvement, by the number of treatments. After four treatments the improvement per treatment was highest in group A and lowest in group C, although in the comparisons AB and BC most differences did not reach significance. After the completed series the improvement per treatment did not differ significantly in groups A and B whereas in group C it was significantly less (Table 10). 4. In comparison with groups A and B, the total duration of seizure discharges was significantly shorter in group C both after four treatments and, in spite of the higher number of treatments, after the completed series. The improvement per second of seizure discharge was not significantly different in the groups although there was a tendency to a lower effect per second in group B (Table 11). It is concluded from these results that shortening of the seizure discharge decreases the therapeutic efficiency of ECT. Increase of the stimulus intensity, which apparently does not change the seizure discharge, possibly gives a more rapid therapeutic response but does not change the final degree of improvement or the number of treatments required to reach it. The depression-relieving effect of ECT is bound to seizure activity and not, or only slightly, to other effects of electrical stimulation.

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.