[Conflicting values in evaluation of psychiatric care--a review]. / Värdekonflikter vid utvärdering av psykiatrisk vård--en översikt.

Greater understanding is needed regarding psychiatric disorders and their causes, as well as the effects of psychiatric care. Ethical issues ought to be discussed in terms of both the choice of questions and to the ways in which data are collected. So far, most evaluations of psychiatric care have focused on medical utility, while issues of autonomy and impartiality are sorely lacking. An important challenge for the future is therefore to support the evolution of the search for knowledge into a multidisciplinary activity in which values concerning autonomy and impartiality are also incorporated.

Values and technology assessment in psychiatry.

Economic resources for health care are limited and they should be distributed as fairly and effectively as possible. But the basis for such a distribution is far from clear. What interests are involved? What kind of provision of care is most efficient? How far should the distribution be left to market solutions? What is the proper role of health care politicians and authorities? In technology assessment a promising combination of value premises and empirical knowledge is used in answering such questions. The aim of this introductory article is to explore issues related to values and value conflicts that have implications for technology assessment. Ethical principles are discussed and related to problematic issues in mental health care such as the absence of psychiatry, the abuse of psychiatry, the definition of mental illness, diagnostic activities, treatment decisions, priority setting as well as research and development.

Zuclopenthixol decanoate and haloperidol decanoate in chronic schizophrenia: a double-blind multicentre study.

Zuclopenthixol decanoate (ZPT-D) and haloperidol decanoate (HAL-D) were compared in the maintenance treatment of chronic schizophrenic patients. All patients were treated with either ZPT-D or HAL-D for at least 3 months and were then randomly allocated to treatment with either ZPT-D (100-600 mg every 4 weeks) or HAL-D (38-200 mg every 4 weeks) for 9 months. Sixty-four patients entered the study. Three patients were only assessed at baseline. Four patients in the HAL-D group were withdrawn because of deterioration. One patient in the ZPT-D group committed suicide. Fifty-six patients completed the trial. The assessment programme comprised Clinical Global Impressions by psychiatrists and nurses, the Brief Psychiatric Rating Scale (BPRS), Montgomery-Asberg Depression Rating Scale (MADRS), UKU Side Effect Scale and Simpson-Angus Scale, Ratings were made at baseline and after 12, 24 and 36 weeks of treatment. The severity of illness scores remained almost constant. The only between-group difference was recorded at month 6 in favour of ZPT-D. The BPRS total scores were reduced significantly in both groups with no between-group differences. The depression scores on the MADRS were very low. Both treatments caused few and mild side effects according to the UKU Side Effect Scale and the Simpson-Angus scale, and there were no significant differences between the groups. Both ZPT-D and HAL-D seem to be effective in the maintenance treatment of chronic schizophrenic patients and cause few side effects. The injections of ZPT-D and HAL-D can be given at 4-week intervals.

Antibody reactivity to brain membrane proteins in serum from schizophrenic patients.

Antibody reactivity to rat brain components in sera from schizophrenic patients and healthy controls was determined using ELISA and Western immunoblotting. Crude membranes prepared from striatum, hippocampus and cortex were used as antigens. The degree of ELISA reactivity varied between individuals but no significant difference was seen between the patient and control groups in any of the different preparations. With a blocking-type of ELISA, in which a pool of dopamine receptor antagonists/neuroleptica was used to compete with the antibody binding, inhibition of IgG reactivity was seen in half of the patient and a quarter of the control sera. When the antagonists were added individually, 25% of the patients but none of the controls showed an inhibited IgG response due to haloperidol and sulpiride. In Western immunoblotting there was a complex background pattern overlaid with a variety of individual bands that could not be related to disease. However a few bands specific for the schizophrenic group were found in more than 50% of the patients. The molecular weights of the two most prominent polypeptides were 86 and 68 kD. The three major Ig-classes G, A, and M showed a partly overlapping and variable degree of reactivity in the patient group. By screening, it was found that 3 out of 50 control sera reacted with either the 86 or the 68 Kd polypeptide. The results do not exclude the possibility that schizophrenic patients do have antibodies reactive to the dopamine receptor.

Automated in vitro dissolution rate analysis of potassium in plastic matrix slow release tablets.

A fully automated system for dissolution rate analysis of potassium in slow release tablets is described. Aliquots are removed after 1, 2, and 4 hr from six samples, and potassium is analyzed in a flame photometer at 768 nm. A complete study of six samples takes 5.5 hr. The system may be run overnight. During the time intervals between the removal of aliquots, the system can be used for the determination of the total assay of tablets.