Bengt Mattsson

A COMPARISON BETWEEN LITHIUM, PLACEBO AND A DIURETIC IN PREMENSTRUAL TENSION

It is well known that the premenstrual phase in most women is accompanied by varying degrees of psychic and/or somatic distress and premenstrual tension is characterized by anxiety, depression, irritability, headache or feeling of swelling. The number of admissions to psychiatric hospitals is reported to increase during the premenstrual phase (Kramp (1970)), and both psychotic and non-psychotic diseases are here represented. A very high percentage of alcoholic women started to drink during the premenstrual phase (Belfer et al. (1971)) and increased suicidal behavior has been reported during this period (Glass e t al. (1971)).

A phenomenological study of fibromyalgia. Patient perspectives

OBJECTIVEnTo describe the way in which the fibromyalgia patients understand the meaning of their illness.nnnDESIGNnQualitative, empirical phenomenological psychological method.nnnSETTINGnA collaborative transdisciplinary interview study of patients described experiences of living with fibromyalgia. No therapeutic relationships existed between patients and researchers.nnnSUBJECTSnEighteen patients with fibromyalgia were interviewed. Ten of the 18 taped interviews were transcribed and analysed.nnnMAIN OUTCOME MEASURESnPatients narratives, described experiences of living with fibromyalgia.nnnRESULTSnThe patients were intensively involved in efforts to get their self-images as ill persons confirmed. Their experience was that the disease started dramatically, with a variety of capriciously appearing symptoms of unknown cause that gave rise to the suffering. The fibromyalgia patients seemed to develop strategies to cope with a precarious self-image and find ways to manage the thought of what the future would bring.nnnCONCLUSIONnThe meaning structures revealed in the patients ways of describing their experiences of living with fibromyalgia seemed to be partially constituted by their efforts to stand forth as afflicted with a disease, which could be a way to help them to manage the demands that they placed upon themselves.

The attitudes of patients and physicians towards placebo treatment--a comparative study.

Placebo treatment in clinical practice can be given either in order to comply with the wishes of the patient, or with the purpose of doing good and not causing harm. In the former instance, the procedure may be in accordance with the interests of the patient, yet be in conflict with the interests of the medical profession. In the latter instance, the procedure presupposes that in most cases the patient has not been informed of the nature of the treatment; this type of procedure may jeopardize a trusting patient-doctor relationship. Therefore, it is of interest to investigate both the extent to which patients and physicians feel they can accept placebo treatment and a paternalistic attitude, and in which particular situations. In order to shed some light on this matter, we compiled a questionnaire built around three case histories which problematize placebo treatment and paternalistic acts. The questionnaire was distributed to 100 patients and 100 physicians. 83 patients and 94 physicians responded. The results show that patients and physicians do not automatically follow specific group interests. Physicians are more inclined to respect the patients option to refuse medical treatment than the patients are inclined to respect a physicians professional autonomy. Patients appear more to be paternalistic in their judgements than physicians, but one cannot rule out the possibility that the answers of the physicians reflect the fact that placebo treatment represent a socially undesirable behaviour. We conclude that theoretical and normative analyses of the perspective of the actors ought to be supplemented by empirical research.(ABSTRACT TRUNCATED AT 250 WORDS)

Dementia day care and its effects on symptoms and institutionalization - a controlled Swedish study

OBJECTIVEnTo examine the effects of Day Care (DC) on demented patients.nnnDESIGNnA prospective non-randomized concurrent-control study.nnnPARTICIPANTSn55 demented patients in DC and 44 controls.nnnSETTINGnSundsvall, an industrial community in northern Sweden.nnnMAIN OUTCOME MEASUREnCognition, ADL-functions, behaviour and institutionalization.nnnRESULTSnMeasurements of cognition, ADL-functions, and behaviour showed no or only small differences between the groups. After one year, 24% of the patients in the DC-group were institutionalized, compared with 44% of the controls. In the control group, the exhaustion of spouse and supervision need were highly correlated to institutionalization (p < 0.001), while high physical nursing load was correlated to institutionalization in the DC-group (p < 0.01).nnnCONCLUSIONnDC postpones institutionalization, probably because of less exhaustion of spouses and decreased supervision need.

Factors associated with consultation length and characteristics of short and long consultations

Consultation length illustrates how general practitioners balance contradictory concerns such as productivity and quality, listening to patients, and handling their own stress. Important factors for consultation length are list size, characteristics of doctors and patients, and character of the problem. The purpose of this study of 463 consultations was to describe factors that are associated with short and long consultations and to examine the relative influence on the consultation length of patients age and sex, character of the problem, continuity, and the doctors speed. A questionnaire was used for both doctors and patients. Short consultations were often made by younger male patients about physical problems, while long consultations often were made by older patients about problems with both psychological and physical dimensions. The doctors speed explained 22.5%, character of the problem 11.6%, and patients age 2.9% of the variation in consultation length.

Urinary Tract Infection in Primary Health Care in Northern Sweden: I. Epidemiology

During a 12-month study at the primary health care (PHC) centre in Vännäs (population 8,000) 632 encounters by 265 individuals because of suspected urinary tract infection (UTI) or control after treatment resulted in 279 episodes of bacteriuria in 185 patients. Nine per cent of the episodes concerned patients with indwelling catheter or incontinence requiring other aids. Symptoms of lower and higher UTI were recorded in 56 and 12%, respectively, whereas one third of the episodes were associated with vague or no symptoms and discovered mainly at planned treatment controls. The annual incidence of bacteriuria recorded increased from 0.5% in the first decade of life to more than 10% in the age group 90-100 years. Male UTI comprised 13% of the episodes, increased after middle age and contributed 40% at greater than or equal to 80 years of age. The risk of recurrence (on average 50% during the year studied) was relatively independent of sex and age. No seasonal variation of UTI was observed except for a peak in late summer due to Staphylococcus saprophyticus confined to females aged 15-64 years and causing 28% of the episodes in August. Although UTI in PHC appears to be similar globally it represents a far more complex patient group than indicated by the UTI drug trials frequently published.

Huntington's chorea in Sweden.

With the aim of finding methods for detecting carriers, Ottosson in the 1950’s began a mapping of all HC families in Sweden (cf. Ottosson (197 l), Ottosson & Rupp (197 1)). This comprehensive material permits comparison with similar materials from other countries concerning prevalence and mutation rate. Since an unusually large number of affected fathers has been reported in juvenile cases (Jones &Phillips (1970)), the sex of in the Swedish material affected parents has also been recorded.

HUNTINGTON'S CHOERA IN SWEDEN

The possibility of reducing the incidence of Huntington’s chorea (HC) depends upon correct diagnosis and the identification of gene carriers among healthy children of affected parents. Establishment of a correct diagnosis is complicated by the occurrence of initial psychiatric symptoms, while motor symptoms appear late or not at all, or are atypical. In this paper the initial symptoms and their development are described with a view to facilitating correct diagnosis at an early stage of the disease.

Features of good consultation in general practice: Is time important?

OBJECTIVEnTo relate specifically defined good consultations (GC) to length of consultation, continuity, patients age and sex, and different doctors.nnnDESIGNnA questionnaire about consultation length, communication and problem character, given to doctors and patients immediately after consultations.nnnMAIN OUTCOME MEASURESnThe number of GCs for different doctors in relation to time, continuity, and patients age and sex were calculated.nnnSETTINGn581 consultations were registered with six male general practitioners working at three different health centres in Umeå, a university town in northern Sweden.nnnRESULTSnA significant difference in the number of GCs was only found between the doctors (p < 0.01). Length of consultation, patients age and sex, and continuity and no impact on the GC frequency.nnnCONCLUSIONnThe doctor as a person and his working style is most important in achieving good consultations in general practice. Length of consultation is less influential.

Changes in psychopathology in relation to EEG variables and visual averaged evoked responses (V. AER) in schizophrenic patients treated with penfluridol or thiothixene

In a study of 28 schizophrenic in‐patients treated with penfluridol or thiothixene, patients were followed with clinical ratings, EEG variables, the mean integrated amplitude (MIA) on both the left and right sides ‐ both with filters with frequency ranges from 7.5 to 13.5 and 0.5 to 25 Hz ‐ as well as its within‐patient variance (WPV) on both sides and with both filters, and also with visual averaged evoked responses (V. AER). Moreover, determinations of plasma levels of the drugs were conducted in a search for possible objective measurements of the effects of the treatment, but also to try to find measurements that would make it possible to predict the outcome of treatment. MIA left/right and WPV left/right were found to be the most promising variables to follow the effect of treatment, which were correlated to factors 1 and 2 of the Mårtens S‐scale. WPV left/right before treatment was correlated to changes in factor 4 of the S‐scale during the trial.