G. Persson

A PROSPECTIVE POPULATION STUDY OF PSYCHOSOCIAL RISK FACTORS FOR LATE ONSET DEMENTIA

The role of psychosocial risk factors in the development of late onset, severe dementia was examined in a longitudinal prospective study of a representative sample followed from 70 to 79 years of age. Subjects with any signs of dementia at the age of 70 were excluded. Eighteen risk factors occurring before the age of 70 were studied, five from childhood and youth, five from adult age and eight from the age of 65–70. Thirty‐eight subjects developed dementia, and they were compared to the other 326 subjects. Death of a parent before the age of 16, previous arduous manual work, physical illness in the spouse after the age of 65 and serious illness in a child after the age of 65 made independent contributions to the prediction of dementia. There was a dose‐‐response relationship: in subjects without exposure 3% developed dementia, in subjects with exposure to one or two risk factors 8% developed dementia, and in subjects with exposure to three or more risk factors 20% developed dementia. The association with psychosocial risk factors was similar in the aetiological subgroups Alzheimers disease and vascular dementia. There was no association with education or alcohol abuse. We suggest that the associations between psychosocial risk factors and dementia are due to the effects of stress, but other interpretations are also possible. The results should be regarded as preliminary until confirmed by others.

Prevalence of mental disorders in a 70-year-old urban population

The prevalence of mental diseases and abnormalities in a representative, systematic sample of 70‐year‐olds in Gothenburg, Sweden, is presented. Out of 460 selected subjects, 392 (85.2 %) took part and the responders and non‐responders were similar in several respects. A case was defined by cut‐off points on symptom and/or sign rating scales and diagnoses were defined operationally but as closely as possible to the ICD‐classification.

Life event ratings in relation to sex and marital status in a 70-year-old urban population.

A subsample of 151 subjects from the population study “70‐year‐olds in Gothenburg” were given a questionnaire for life event ratings to be returned by mail. The 24 life events to be rated were events that are fairly common in advanced age. The ratings were in most cases similar for men and women. Some events, pertaining to children, were given more weight by the women, while “loss of sexual ability or interest” was given greater weight by the men. Single women gave less weight to events that could not happen to them. It thus seems that events that cannot happen to yourself are seen as less important than events that can. Married women who had never worked outside their homes attributed more weight to some events than married women who had worked outside their homes. Men and women attributed similar weight to the event “becoming mentally ill”, which event was given more weight than the event “becoming somatically ill”. The results do not explain the higher incidence of neurosis among the women in the population.

Five‐year mortality in a 70‐year‐old urban population in relation to psychiatric diagnosis, personality, sexuality and early parental death

In 1971–1972 a systematic, representative sample of 70‐year‐olds living in Gothenburg, Sweden, was studied. The study included a psychiatric examination, during which the subjects were questioned concerning important aspects of their life history, and mental symptoms during the previous month. Any mental signs observed were recorded. Symptoms and signs were rated on rating scales, and summed up in diagnoses. The subjects also filled in three different personality inventories. The examination was performed in 166 men and 226 women. In 1976–1977 we ascertained from parish records which subjects had died before reaching the age of 75. Thirty‐two men and 23 women had died. Associations between the psychiatric variables and mortality were studied.

Effects of four treatment methods on social phobic patients not suitable for insight-oriented psychotherapy.

ABSTRACT– Forty‐two social phobic men and women, rated unsuitable for insight‐oriented psychotherapy, received one of four randomly assigned types of treatment for 3 months. All patients received basal therapy (B) in the form of standardized information, self‐exposure instructions, and anxiolytic medication. One group received this treatment only, with monthly appointments. The others, in addition, received either therapist‐directed prolonged exposure in vivo, in some cases supplemented with exposure in imagination (PE), dynamically oriented supportive therapy (ST) or relaxation therapy (R). There was a 9 months’ follow‐up period. The phobia variables were more improved in the PE and ST groups than in the R and B groups at the termination of treatment. Although improvement had deteriorated somewhat in the PE group during follow‐up, the improvement in target phobia was better than in the other groups. There were almost no improvements in the R and B groups. ST and PE groups also showed improved social function while the global rating showed most improvement in the PE group. The B group was not improved at all and the R group only showed a short‐lived drop in muscular tension.

Prevalence of mental disorders in an urban sample examined at 70, 75 and 79 years of age

ABSTRACT– The prevalence of mental disorders in a representative sample of old people in Gothenburg, Sweden, was studied at 70, 75 and 79. The study comprised 392 subjects at 70, 302 subjects at 75 and 203 at 79. A case was defined by cut‐off points on symptom and sign rating scales, and diagnoses were defined operationally as closely as possible to the ICD‐classification. The total psychiatric morbidity was 21.9, 24.2 and 31.0% in the three age groups. The prevalence of schizophrenic and paranoid syndromes was 0.5, 1.7 and 2.5% and of affective disorders 1.0, 2.3 and 0.5%. The prevalence of dementias of psychotic degree was 1.3, 2.3 and 6.9% and of asthenic neuroses corresponding to dementias of mild‐moderate degree 2.3, 4.0 and 9.4%. The prevalence of anxiety, depressive and obsessive‐compulsive neuroses of moderate‐severe degree was 6.6, 4.6 and 3.9% and of mild degree 7.9, 6.0 and 5.9%. The prevalence of active alcoholism in men was 4.2, 3.4 and 3.0% and in women 0.0% in all age groups. Current treatment was reported by 67–85% of subjects with psychoses, about one half of them in psychiatric services, and by 35–65% of subjects with neuroses, about one fifth of them in psychiatric services.

Effects of four treatment methods on agoraphobic women not suitable for insight-oriented psychotherapy.

ABSTRACT– Seventy‐three agoraphobic women rated unsuitable for insight‐oriented psychotherapy, entered one of four randomly assigned types of treatment for 3 months. All patients received basal therapy in the form of standardized information, self‐exposure instructions and anxiolytic medication. One group received this treatment only at monthly appointments (B). The others, in addition, received either therapist‐directed prolonged exposure in vivo (PE), dynamically oriented supportive therapy (ST) or relaxation therapy (R). There was a 9‐month follow‐up period. All groups were about equally improved at the termination of treatment, with some advantage for PE and ST. At follow‐up the ST group was more improved than the other groups, R was least improved, and PE showed some deterioration between the termination of treatment and the follow‐up. ST, which took into account the overall adjustment as well as the symptoms, was thus the most successful treatment, but the superiority of the treatment did not manifest itself until at the end of the follow‐up period.

Lithium side effects in relation to dose and to levels and gradients of lithium in plasma

The relation between lithium dose, lithium concentrations, and lithium gradients in plasma and the side effects tremor, nausea, abdominal pains, and loose bowels was studied in 19 subjects. Rapidly dissolving lithium carbonate tablets were used.

Subclinical Dementia: Relevance of Cognitive Symptoms and Signs

In 1971 and 1972, a representative sample of 70-year-old people (n = 392) from a population study was rated with regard to psychiatric symptoms and signs. Subjects showing evidence of dementia of any degree, including slight and questionable, were excluded (n = 18). The remaining 374 subjects were followed longitudinally for 9 years. Thirty-eight subjects developed severe dementia during this period. They were compared to those who did not with regard to 19 reported and 17 observed items concerning general psychopathology, seven reported items concerning sleep, and a global rating of mental health. Five items correlated with the development of severe dementia: number of remembered dreams per week, latency of speech, speed of speech, difficulties in finding words, and memory for recent events. A stepwise logistic regression procedure demonstrated that a low frequency of remembered dreams, a reduced memory for recent events, and difficulties in finding words made independent contributions to the prediction of dementia. There were no differences with regard to affective items. There were no differences between the subjects who developed senile dementia of the Alzheimer type and those with multi-infarct dementia. The results thus support the hypothesis that symptoms pertaining to cognitive functions are the first to appear in the development of dementia. (J Geriatr Psychiatry Neurol 1992;5:172–178).

PLASMA LITHIUM LEVELS AND SIDE EFFECTS DURING ADMINISTRATION OF A SLOW RELEASE LITHIUM SULPHATE PREPARATION (LITHIUM LIPETT C) AND LITHIUM CARBONATE TABLETS

Lithium lipett C (ACO Läkemedel, Sweden), a new lithium sulphate preparation with slow release achieved by dissolution in fat which releases 90% of its lithium content within less than 4 hours when treated with intestinal juice was compared with lithium carbonate tablets.