[Contact with patients with psychogenic somatic diseases].
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Biomedical subjects
Publications and source records attributed to E Kringlen.
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Several methods have been used to treat anxiety disorder. In phobic conditions and in obsessive compulsive disorders, exposure therapy is most effective. In exposure therapy, the relevant evoking stimuli are presented repeatedly to the patient. This method does not suit all patients, however. For favourable results, certain exclusion criteria must be observed. In addition, the treatment procedure must be followed systematically.
We studied the incidence of psychopathologic disorder in offspring of monozygotic twins discordant for schizophrenia. The original material was based on a complete national sample of twins who were hospitalized for functional psychosis in Norway. A comparison of adult offspring of schizophrenic monozygotic twins with offspring of their nonpsychotic cotwins showed that although there are more schizophrenic and schizophreniclike cases in the first group, an observation that may be ascribed to environmental factors, the difference is not statistically significant.
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Eye movement dysfunctions (EMDs), detectable during smooth pursuit, occur in a majority of schizophrenics and in 45% of their first-degree relatives. Previous data suggest that they represent a biologic marker for schizophrenia. To determine the mode of transmission of the schizophrenia-EMD complex, the eye movements of offspring of monozygotic and dizygotic twins were recorded. One group of twins was discordant for schizophrenia; the other group for manic depression or reactive psychosis. The data suggest that EMDs and at least some schizophrenias can be considered expressions of a single underlying trait that is transmitted by an autosomal dominant gene.
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Attention is drawn to studies which throw doubt upon the importance of nutrition and smoking in the etiology of coronary heart disease (CHD). The main part of the review deals with psychosocial research in the field of CHD. A number of studies show that there is a clearcut association between life style, life events, social class, economic cycles, culture and CHD. The modern coronary epidemic is related to the economic boom which the US experienced during the 1940-60s and which followed a decade later in Western Europe. The later decline of CHD is related to the economic stagnation that took place in the US at the end of the 1960s. Obviously, risk factors must be seen in a cultural perspective, and the moderating effects of social support should be taken into account.
After briefly reviewing the main findings of twin research in functional psychoses, the author focuses the attention on neglected aspects of twin research, such as the study of co-twins of monozygotic (MZ) subjects with functional psychosis, and the study of life histories of discordantly affected twins. Through a thorough investigation of the nonpsychotic co-twins of MZ subjects, one might be able to identify vulnerability factors. By studying the life course of the twins in a pair, discovery of environmental etiological factors are possible. By including twins with both schizophrenic, manic-depressive and reactive psychotic symptomatology, one should be able to discover whether the environmental factors are of a specific kind.
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In this review of depression research the author has focused the attention on twin and adoption studies, although problems of classification, epidemiology, and biological and environmental factors related to depression are also touched upon. It is being noted that the available studies in the area are few, the number of twins in the various samples is small and the diagnostic classifications vary. Of particular interest are the results presented by Bertelsen et al. because of the large systematic sample. A summary of the studies that are based upon sampling through twin registers, i.e. the Scandinavian investigations, employing a relatively strict concept of manic depressive psychosis (bipolar disorder), gives a mean concordance of 50% in MZ twins and 15% in DZ twins. Whereas genetical factors seem to play a significant role in the etiology of severely depressed subjects, there is no evidence that hereditary factors are of importance in the neurotic or reactive depressions, since concordance is low in both MZ and DZ. The available adoption studies are also few and replications are definitely necessary before one can arrive at firm conclusions. Mendlewicz & Rainer reported more psychopathology of an affective nature in the biological parents of the adoptees with bipolar illness than in the social parents. In contrast, von Knorring et al. did not observe an increase in affective psychopathology in the biological parents of adoptees with affective disorder. Noteworthy is the excess of affective psychoses in the social parents. The author holds the view that any speculation with regard to genetic transmission is premature. Although the findings from the various investigations are not unambiguous, twin and adoption studies support the notion that genetic factors play a considerable role in bipolar disorder, whereas non-bipolar depression is basically environmentally determined.
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