Characteristics of mentally ill aged: A comparison of patients with psychogenic disorders and patients with organic brain syndromes.
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As part of a research project, a sample of 50 pairs of twins (21 pairs of identical twins, 16 pairs of nonidentical twins of the same sex, and 13 pairs of male-female twins, n = 100 test persons) was examined between 1963 and 1969 and recently, 20 years later, followed up. The index twins were drawn from among the patients making use of the services of an outpatient clinic; they had been diagnosed as having psychoneurotic, character-neurotic of psychosomatic disorders. The question again looked into was that of nature versus nurture: identical twins displayed significantly higher similarity with regard to both severity of their neuroses and manifestation of neurotic symptoms than did nonidentical twins. The hereditary factor proved to be of greater import for the continuing childhood neuroses than for the subsiding childhood neuroses. Yet a certain hereditary factor effect was observed for the neuroses which first manifest themselves in adulthood. Our findings indicate that the hereditary factor is not more pronounced in childhood than in adulthood; it is equally effective in adults.
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The majority of patients with psychological disorders are seen in primary care. The diagnosis of the general practitioner (GP) influences decisively the subsequent treatment. Our study provides an insight into GP's diagnosis and treatment. 18 GP's and a psychotherapist rated 572 patients using a global diagnostic rating scale and the impairment score (BSS). The GPs noted down their treatment. The patients filled in symptom checklists (SCL-90-R, GHQ-12). Agreement between the doctor and the researchers on mental ill health was modest. GPs identified 51.4% of the patients with psychological disorders. Adjustment disorders were often ignored by GPs. They prescribed psychotherapy for 3.3% of their patients, especially patients with somatoform disorders and with high values in the impairment score. A path analysis shows, that psychotherapists' ratings agree much more with patients' self-assessment than GP ratings.
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