Læknablaðið : fylgirit - 01.08.2003, Blaðsíða 24

I ABSTRACTS / 27TH NORDIC PSYCHIATRIC CONGRESS
S-ll/2 Thursday 14/8,11:00-12:30
Mental disorders among elderly in primary care,
Linköping study
María Ólafsdóllir, MD, PhD, General Practitioner, Ass. Professor, University of Iceland,
The Primary Care, Reykjavík, Mávahrauni 1, 220 Hafnarfjörður, Iceland. Skoog I.
Marcusson J.
nuiria. olafsdottir@simnet. is
Aims: To describe the prevalence of mental disorders among elder-
ly patients in primary care and to compare diagnoses from psychi-
atric interview with information in medical records.
Method: Randomized patients aged 70 years and above attending a
primary care centre (N=350) were studied with a psychiatric exami-
nation and their medical records studied.
Results: The prevalence of mental disorder according to the psychi-
atric interview was 33% (16% dementia, 17% other mental dis-
orders). Only 49% of these had any psychiatric diagnoses in case
records and 17-38% received specific treatments. The frequency of
psychiatric symptoms among those with no mental disorder was
between 1-66%. Patients with mental disorders were more often
females, had more visits to a doctor, and more diagnoses in medical
records.
Condusions: Mental disorders and symptoms are common among
the elderly in primary care. More effort should be made to increase
the recognition rate.
S-ll/3 Thursday 14/8, 11:00-12:30
Specialist consultations: Are they a useful service for the
patients and their general practictioners?
Ingrid Ostby-Dcgluni, MD, Innlandet Hospital Health Authority, Sanderud, Pb 68,2312
Ottestad, Norway
Background: A central task for the specialist service in psychiatry is
to make consultations of patients referred from the general
practitioners (GP). Such consultations usually take place at the
psychiatric outpatient department, and they are regularly followed
by a written feedback with diagnostic considerations and treatment
recommendations. The Collaborative Working Group on Shared
Mental Health Care in Canada have summarised three opportuni-
ties for better collaboration as seen from GPs’ point of view (1) The
aim of this study is describing patients’ and GPs’ experience in this
service and mapping change in mental symptom load and predic-
tive factors for being satisfied.
Mcthods: In a rural area of 80.000 inhabitants in Norway all
patients referred from GPs during 1997-1999 who received four or
less sessions (N=160) were eligible. Ninety-one (57%) patients re-
turned a completed questionnaire and a SCL-90-R form. Thirty-
eight (79%) GPs gave their opinions on 128 (80%) written feed-
backs from consultations. Analyses were performed by means of
paired t-test (changes in SCL-90-R from consultation to follow-up)
and logistic regression (predictive factors for being satisfied)
Rcsults: Global Symptom Index (GSI) was reduced from mean 1.6
at consultation to 1.1 at follow-up (Mean difference 0.5, SD 0.7,
95% CI: 0.3-0.7, p<0.001) Patients’ work/sick leave status was found
to be predictive factor for the patients experience of the consul-
tations to be “of great/very great use” (OR 4.5, 95% CI: 1.6-12.1,
p=0.003). No predictive factors for GPs’ satisfaction were found.
Conclusion: When treatment capacity is limited, patients going to
work may benefit most from time-limited consultations by the
specialist services.
References
1. Can J Psychiat 2002; 47: Suppl 1: Shared Mental Health Care: A Bibliography
and Overview. April 2002.
Funding Source Supported by funding from Sanderud Hospital, grants from Josef and
Haldis Adresen’s Legacy, Solveig and Johan P. Sommer’s Legacy and Dr. Dedichens
Institute for Psychiatric Research. Travel expences funded by Pfizer
S-lll/1 Thursday 14/8,11:00-12:30
Psychodynamic investigation: From clinical case study to
neurobiology
Halldóra Ólafsdóttir, Psychiatrist, Landspítali University Hospital, Reykjavík, Iceland.
Hulda Guðmundsdóttir, Group Analyst, Landspitali, University Hospital, Reykjavik
halldola@landspitali. is
Objectives: To give a brief overview over the development of a
psychodynamic investigation and the methodological difficulties
the field has been facing within psychiatry. Are there novel research
possibilities in the field?
Description: Psychodynamic investigation is increasingly being
disregarded both within psychiatry and psychology as “unscien-
tific” and being replaced with somatic therapies and/or cognitive
and/or behavioral therapies, that claim better scientific data for
their results. Unlike pharmacological trials for depression and
CBT/IPT for depression, that rely on very selected patients in
short-term trials, psychodynamic treatments are by nature long-
term and often set up for complicated psychological problems that
are difficult to prove with the “golden standard” RCT methodo-
logy.
Tlie clinical practitioner is being put in a “double-bind situa-
tion”. In spite of the “lack of evidence” he may still rely heavily on
psychodynamic theory and treatment methods in his clinical work,
especially in complicated and treatment resistant cases. To illustrate
the point there will be a short presentation of a case of treatment
resistant depression that after 6 years of different somatic, suppor-
tive, and cognitive approaches responded excellently to psycho-
dynamic group treatment that lasted only 9 months and in full
remission at 1 year follow up. Hulda Gudmundsdottir, group ana-
lyst, will descripe her understanding of the “blind spots and double
binds” of the more biological/cognitive approach to this particular
case.
Innovative approaches by using neuroimaging and other “hard
biological data” to prove scientifically the results of psychodynamic
treatments are currently being tested and some will be presented in
this symposium.
Conclusion: Unless psychodynamically oriented clinicians are able
to prove the results of their treatment approaches and their theories
in a more modern scientific way the field is in danger of being
replaced prematurely by other methods. That would be at a cost to
24 LÆKNABLAÐIÐ I FYLGIRIT 48 2003/89