Table Of ContentInteraction Between
Mental and Physical
Illness
Needed Areas of Research
Edited by R. Ohman H. L. Freeman
A. Franck Holmkvist S. Nielzen
In Collaboration with Members
of the EMRC Study Group on Mental Illness Research
E. E. Anttinen, R.1. Daly, T. Helgason, H. Hippius,
R. Sadoun and E. A. Sand
With a Foreword by H. Danielsson
Springer-Verlag
Berlin Heidelberg New York
London Paris Tokyo
Professor ROLF OHMAN Dr. ANNIKA FRANCK HOLMKVIST
University Hospital University Hospital
Department of Psychiatry Department of Psychiatry
S-221 85 Lund S-221 85 Lund
Professor HUGH L. FREEMAN Dr. SOREN NIELZEN
The British Journal of Psychiatry University Hospital
17 Belgrave Square Department of Psychiatry
GB-London SWIX 8PG S-221 85 Lund
With 23 Figures and 12 Tables
ISBN-13:978-3-642-73995-8 e-ISBN-13:978-3-642-73993-4
DOl: 10.1 007/978-3-642-73993-4
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European Science Foundation
This volume arises from the work of the Study Group on Mental
Illness, a priority activity of the European Medical Research Councils
(EMRC), which in turn is one of the five Standing Committees of the
European Science Foundation (ESF). The EMRC, like the other
ESF Committees, which cover the natural sciences, space science,
humanities, and the social sciences, brings together the research
councils and academies of 18 European countries. Under the auspices
of EMRC and ESF generally, European scientists work on topics of
common concern, co-ordinate the use of expensive facilities, and
discover and define new endeavours that would benefit from a co
operative approach. Other typical work in the field studied in this
book includes the European Training Programme in Brain and
Behaviour Research, run by the ESF, closely linked with EMRC. In
1987 it brought together 500 young scientists from all over Europe
in its Fellowships and residential courses.
Further information on EMRC and ESF activities can be obtained
from:
European Science Foundation
1 Quai Lezay Marnesia
6700 Strasbourg, France
Foreword
The group of European Medical Research Councils (EMRC) was
formed in 1971 and became a Standing Committee of the European
Science Foundation (ESF) in 1975. EMRC is an association of
medical research councils or equivalent organizations in Western
Europe. The National Institutes of Health, the Israel Academy of
Sciences, and the European Office of WHO are associated with
EMRC and take an active part in its activities. The main aims of
EMRC are to exchange information on the research policies pursued
by its member organizations and to initiate and stimulate inter
national cooperation in biomedical research. Since this research is
highly international in itself, EMRC concentrates its activities on
furthering international collaboration in those fields where it can play
a significant role as a complement of existing channels. Mental illness
research has been judged by EMRC to fulfill these criteria.
After a survey of the activities of the member organizations in
mental illness research, EMRC decided in 1978 to set up a study
group to analyze areas where EMRC could contribute. As a result of
the work of the study group, five workshops have been arranged to
define present knowledge in some specific areas and to delineate
research needs. The present volume contains the proceedings of the
fifth workshop, held in 1987 and dealing with interactions between
mental and physical illness. EMRC hopes that this volume will
contribute both to intensified research and to research cooperation
on mental illnesses.
HENRY DANIELSSON
Chairman of EMRC
Preface
The dichotomy between mental and physical illness has deep roots in
the traditions of academic medicine and in the public view of health
problems in general. The progressive delineation of psychiatry from
somatic medicine, notably neurology and internal medicine, has in
many ways prevented integration of knowledge, as much from a
clinical as from a scientific perspective. The conceptualization of
body-mind interaction has not been truly updated.
Undoubtedly, the development of psychiatry has added diagnostic
and therapeutic qualities with significant impact on our strategies for
ameliorating severe psychiatric illness. During the same period,
however, the area between psychiatry and other medical disciplines
has suffered from lack of interest, priorities, and resources, or even
from neglect. Clinical signs, symptoms, and syndromes which clearly
signal interaction between somatic dysfunction and the mental
process have too often been left aside, untouched by necessary
interdisciplinary discussion, education, critical review, and research.
Psychosomatic states in the form of somatization of anxiety,
aggression and sexuality, chronic pain syndromes, sleep disorders,
and gastrointestinal, dermatological, or gynaecological problems,
illustrate areas where medical professional interest has been insuffi
cient or absent. Many of these problems have been left to paramedical
or even lay intervention. The present wave of "alternative medicine"
(psychologically or somatically orientated) may in fact be to a large
extent a logical consequence of neglect by both the medical profession
and the public health system. The public need for understanding
and acceptance of body-mind interaction has not been adequately
evaluated.
During recent years, in a series of conferences and publications,
the European Medical Research Council (EMRC) has tried to
identify needed areas of research and professional support. With the
background outlined above, it was logical that the topic selected for
the EMRC symposium in 1987 held in Lund, Sweden, was "Inter
action between Mental and Physical Illness." The EMRC has directed
the work through a program committee headed by Tomas Helgason,
VIII Preface
and it has been a pleasure for the local organizers and editors of this
volume to fulfil its intentions.
The EMRC symposium was structured in the form of both
contributions by invited speakers and discussants and by general
discussion among the participants. For purposes of clarity, the
editors have incorporated these contributions and opinions into the
reviews and summarized discussion. This volume should therefore be
seen as a contribution by all participants of the symposium.
The organizers and editors also extend their gratitude to all those
who made this symposium successful. Monica Pardon has skilfully
administered the arrangements, editing, and, correspondence. Tomas
Helgason and the officers of the EMRC undertook the contacts with
the national research organizations during the preparation of the
meeting. Through Henry Danielsson, the Swedish Medical Research
Council provided essential encouragement and financial support.
AB LEO/Pharmacia and AB Essex are also gratefully acknowledged
for promoting the symposium with logistical support and grants.
The Editors
Contents
Psychiatric Consequences of Physical Illness - Clinical Aspects
J.-O. OTTOSSON. With 2 Figures . . . . . . . . . . . .. 1
Discussion of Professor Ottosson's Paper
D. GOLDBERG. With 3 Tables. . . . . . 7
Psychiatric Consequences of Physical Illness - Clinical Aspects:
Discussion
H. HELMCHEN. With 1 Figure . . . . . . . . . . . . . . 12
Epilepsy as a Model for Psychopathology
T. G. BOLWIG. With 2 Tables. . . . . . . . . . . . 16
Epilepsy and Psychiatric Disorder
R. J. MCCLELLAND . . . . . . . . . 25
Physical Morbidity and Mortality in Psychiatric Patients
H. HAFNER and H. BICKEL. With 2 Tables . . . . . . . . . 29
Discussion in Connection with Hafner and Bickel's Paper:
Physical Mortality and Morbidity in Psychiatric Patients
B. RORSMAN. With 1 Table. . . . . . . . . . . . . . . . 48
Hypothesis Concerning "Natural" Mortality in Psychiatry
PH. CORTEN and M. RIBOURDOUILLE. With 1 Figure and 3 Tables 52
Neurobiological Aspects of Psychiatric Consequences
of Physical Illness
A. CARLSSON. With 1 Figure . . . . . . . . . .. .. 67
On the State of Knowledge in Neurobiological Psychiatry
R. FOG. . . . . . . . . . . . . . . . . . . . .. . 71
Psychosocial and Psychosomatic Aspects of AIDS Research
M. ERMANN . . . . . . . . . . . . . . . . . . . . . . 74
x Contents
Psychiatric Consequences of High Technology in Medical Care
P. TIENARI. . . . . . . . . . . . . . . . . . . . . . . 80
Psychiatric Side-Effects of Nonpsychotropic Drugs
D. NABER and H. HIPPIUS. With 1 Figure and 1 Table ... 89
Psychological Contributions to the Causes and Course
of Physical Illness
R. C. B. AITKEN . . . . . . . . . . . . . . . . . 104
Discussion of Aitken's Report on Psychological Contributions
to the Causes and Course of Physical Illness
S. M. CONSOLI . . . . . . . . . . . . . . . . . . . . . 112
Behavioral Aspects of Physical Illness
K. G. GOTESTAM. With 17 Figures . . . 119
Behavioral Aspects of Physical Illness in Children and
Adolescents
E. A. SAND . . . . . . . . . . . . . . . . . . . . .. 135
Summaries of Discussion
H. L. FREEMAN. . . . . ............ 145
Implications for Future Research
H. L. FREEMAN . 150
Subject Index . 155
List of Contributors
You will find the address of each first mentioned author at the
beginning of the respective contribution
Aitken, R. C. B. 104 Hafner, H. 29
Bickel, H. 29 Helmchen, H. 12
Bolwig, T. G. 16 Hippius, H. 89
Carlsson, A. 67 McClelland, R. J. 25
Consoli, S. M. 112 Naber, D. 89
Corten, Ph. 52 Ottosson, J.-O. 1
Ermann, M. 74 Ribourdouille, M. 52
Fog, R. 71 Rorsman, B. 48
Freeman, H. L. 145, 150 Sand, E.A. 135
Goldberg, D. 7 Tienari, P. 80
Gotestam, K. G. 119
