Interaction 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 University Hospital Department of Psychiatry S-221 85 Lund Professor HUGH L. FREEMAN The British Journal of Psychiatry 17 Belgrave Square GB-London SWIX 8PG Dr. ANNIKA FRANCK HOLMKVIST University Hospital Department of Psychiatry S-221 85 Lund Dr. SOREN NIELZEN University Hospital Department of Psychiatry S-221 85 Lund With 23 Figures and 12 Tables ISBN-13:978-3-642-73995-8 DOl: 10.1 007/978-3-642-73993-4 e-isbn-13:978-3-642-73993-4 This work is subject to copyright. All rights are reserved, whether the whole or part of the material is concerned, specifically the rights of translation, reprinting, re-use of illustrations, recitation, broadcasting, reproduction on microfilms or in other ways, and storage in data banks. Duplication of this publication or parts thereof is only permitted under the provisions of the German Copyright Law of September 9, 1965, in its version of June 24, 1985, and a copyright fee must always be paid. Violations fall under the prosecution act of the German Copyright Law. Springer-Verlag Berlin Heidelberg 1989 Softcover reprint of the hardcover 1 st edition 1989 The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant protective laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. 2125/3130-543210 - Printed on acid-free paper
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 cooperative 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 international 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 insufficient 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 "Interaction 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..... Implications for Future Research H. L. FREEMAN. Subject Index.... 145 150 155
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 Bickel, H. 29 Bolwig, T. G. 16 Carlsson, A. 67 Consoli, S. M. 112 Corten, Ph. 52 Ermann, M. 74 Fog, R. 71 Freeman, H. L. 145, 150 Goldberg, D. 7 Gotestam, K. G. 119 Hafner, H. 29 Helmchen, H. 12 Hippius, H. 89 McClelland, R. J. 25 Naber, D. 89 Ottosson, J.-O. 1 Ribourdouille, M. 52 Rorsman, B. 48 Sand, E.A. 135 Tienari, P. 80