Mental disorders among Yugoslav medical students. L EriB ¦á, Z RadovanoviB ¦á and I JevremoviB ¦á BJP 1988, 152:127-129. Access the most recent version at DOI: 10.1192/bjp.152.1.127
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British Journal of Psychiatry (1988), 152, 127—129
Brief Reports
Mental Disorders among Yugoslav Medical Students The mental health of 523 medical students was examined one month after enrolment and two years later. The point prevalence rates of all mental disorders were 16.1 % and 17.5% respectively. The incidence rate was 5.3% per year, with neuroses being the most frequent diagnoses (3.5%). The assessment ofpsychiatric morbidity in Yugoslavia,
sufficiently
as well as in many other countries, has been very much hampered due to the use of different, inconsistent, or poorly reproducible methodological
both healthy and psychiatrically disturbed students, the
improved
through
continuous
contacts
with
validity of the GHQ was successfully tested in the population of medical students (Radovanovii@ & Eric, 1983).
approaches. For this reason, we adopted the two
As for the SPI, the large inter-observer variation between
stage diagnostic
led us to engage the psychiatrist who was most experienced
procedure
proposed
six psychiatrists
by Goldberg
(1972) and Goldberg et a! (1970). The aim of our investigation was to assess the frequency
and pattern
of mental
disorders
in student
in a pilot study (Radovanovié et a!, 1980)
mental health.
A total of 492 students (94.1% of the original group)
in a
were included in the second examination.
Of the 31 students
defined group of students, as revealed by two
who were not re-examined, seven had had a psychiatric
consecutive
diagnosis on enrolment (three neuroses, one personality disorder, and three other mental disorders).
cross-sectional
studies.
Method
Results
The study population consisted of students who were
The prevalence of all psychiatric disorders was similar in the
enrolled at the Schcol of Medicine, University of Belgrade,
two cross-sectionalstudies(TableI). However,there were
in September 1979. Of the total of 540 students, 523(96.9%) were included in the study. No one refused to participate,
changes within the four broad groups ofdiagnostic
but 17 students were not included, due either to absence
frequent groups of psychiatric disorders: the ratio of neuroses to the group of other non-psychotic mental dis orders (codes 302-316, ICD—9) increased from 1.05 to 2.85. The decrease in the frequency of the other non-psychotic
or to poor
knowledge
of the language
(foreigners).
The investigationtook placeone month after enrolment, in October
1979. Each student was individually
approached
mental disorders was related, in the main, to adjustment
and interviewedat his or her convenience. Epidemiological
categories.
The differences were due to variations in the two most
data was obtained by a group of students
reactions.
The prevalence
rate of this category
of mental
in their final year of medical studies who applied a specificallydesigned questionnaire. The same group of
impairment decreased to less than a third - from 4.0% (21/523) to 1.2% (6/492).
students administered the 60-item version of the General
Most of the students examined remained in the same diagnostic category: 85.6% (421/492)of the students on both occasions were either healthy (375) or mentally
Health Questionnaire(GHQ)(Goldberg, 1972),whichwas used as a screeningtool. Immediately
after the presumptive
diagnosis
disturbed (46).
had been
assessedby the GHQ, the participants with positivescores were referred to a psychiatrist (LjE), who applied the
turned out to be healthy on the second examination,
Standardised
calculation
Psychiatric
Interview
(SPI) (Goldberg
et al,
1970)without having been informed of the results of the screening test. Exactly the same procedure was repeated two years later, in the autumn of 1981. The students who did not attend lectures because they had failed the exams were approached in the spring of 1982. Those participants who failed again in the spring term were asked by post when and where they could be approached and re-examined. As this procedure took time, the incidence rates were computed by the use
Although
31 students
originally
assessed as disturbed
of the incidence rate took no account of these.
On the basis of 40 individuals who were healthy on enrolment but found to be psychiatricallyimpaired when re-examined, the incidence rate was 4.1% per year (40 cases:
11 690 person-months). However, taking new diagnostic entities as a criterion, rather than just a shift from health
to a mental impairment, the rate was 5.3% (Table I). For the most part, the new diagnoses were related to
neuroticconditions(37of 58(64%)), followedby the group of other non-psychotic mental disorders (15 (26%)),
of person-months of observation, each student contributing
personality
disorders
(4 (7%)),
and psychoses
(2 (3%)).
to the denominator with the number of months of follow-up.
Discussion
The methodologicaldifficultiesof usingthe citedinstru ments had been assessed and overcome previously. After
The total prevalence of psychiatric disorders on both
the translation and interpretation of terms had been
occasions
127
was within
the range
given by Kidd (1965)
ERK@ET AL
128..,..
TABLE I
Prevalence andincidence ofpsychiatric disorders DiagnosisSexFirst
exa
er
Rate per Cases I Cases! Prevalence Cases! Prevalence person-monthsnce year: studentsmination rate: %Second studentsamination rate: %Incide
%PsychosesM
0.2NeurosesM
F M+F—
3.5Personality
F 33/305 M+F7/21840/5233.2
—¿
—¿
—¿â€”
—¿1/206
1/286 0.4 2/4920.5 0.41/5789
10.8 44/286 7.713/206 57/4926.3
15.4 11.610/5653
1/8098
0.2
2/138870.2 27/7168 37/128212.1
4.5
disordersM 1.4 F 4/305 1.3 4/286 1/7978 0.2 M+F2/218 6/5230.9 1.23/206 7/4921.5 1.43/5757 4/137350.6
0.4Other mentaldisordersM
F 1.4AllM
29/305
9.5
17/286
13/7398
5.9
2.1
M+F9/21838/5234.1 7.33/20620/4921.5 4.12/5511 15/129090.4 42/7424 F 21.6 65/286 22.7 6.8 66/305 M+F18/218 86/49210.2 17.56/5651 58/130753.4 5.3 84/5238.316.121/206
1. New diagnostic entities.
for the student population
(1—20%). Our rates were
somewhat higher than those reported from most countries. However, international comparisons are very much limited by enormous methodological differences, relating particularly to the procedure of
case identification. It is hardly possible to find an examination comprising a similarly conceptualised two-stage
case
detection
procedure.
Even
if it is
possible (Smith et al, 1963), any comparison is usually hampered by the differences that exist among the student populations examined or instruments used. The overall frequency of mental disorders in our study was somewhat higher at -the second examina tion, but the difference was not significant (@=0.27; d.f.=1).
The absence of psychotic disorders on enrolment was a consequence of a previously applied selection procedure which excluded candidates with serious psychiatric impairment. Two students who developed
psychoses were classified as cases of latent schizo phrenia (295.5, ICD—9)and an unspecified non organic psychosis (298.9). For all but one of the 17 neurotics who did not remain in the same diagnostic
category,
were originally healthy and 12 who had other mental disorders developed neuroses, reflecting (with 20 who were neurotics on both occasions) a marked increase of this condition on re-examination. The group of other non-psychotic mental disorders diminished
as almost half (17/38) of the students
with these diagnoses upon enrolment overcame the adjustment reactions and turned out to be healthy at the second examination. In view of the procedure used, our results on disease occurrence might be most readily compared with the findings reported
by Smith et al (1963).
These authors estimated the incidence rate of psychiatric disturbance to be 4.7% per year in a sample of 86 male freshmen. Our male students
experienced a lower incidence rate (2.7% per year). The difference might be influenced, at least partially,
by unequal intervals between the pairs of points in time in these studies. As minor psychiatric disorders are mostly short-term in character, particularly among students, the estimated cumulative incidence
should be inversely related to the interval between cross-sectional
studies.
the initial
disorder was mild and transient, completely dis appearing in time (12 students) or, occasionally, being followed by adjustment reactions or physio logical malfunction (in three cases and one case respectively). On the other hand, 25 students who
References GOLDBERG,D. P. (1972) The Detection of Psychiatric Illness by
Questionnaire: A Technique for the Identification and Assessment of Non-Psychotic Psychiatric Illness. London: Oxford
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MEDICAL STUDENTS
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&
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(1983)
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of
the
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Ljubomir Erie, MD, DiplPsychiat, DSc, Professor of Psychiatry and Head, Institute of Psychiatry KBC ‘¿Dedinje' Belgrade; *Zoran RadovanoviC, MD, DiplEpidemiol,DTPH(Lond), DSc, Professor of Epidemiology and Head, Institute of Epidemiology; Ivana JevremoviC, MD, DiplEpidemiol,DSc, Institute of Epidemiology; Belgrade *Correspondence: Institute of Epidemiology, Faculty of Medicine, Vifegradska 26, 11000 Belgrade, Yugoslavia
British Journal of Psychiatry (1988), 152, 129—131
Mephentermine
Dependence with Psychosis A Case Report
Dependence on mephentermine, a widely used sympathomimetic pressor agent, is so far unreported, although misuse of inhalers is recognised. A case of mephentermine dependence associated with chronic psychosis is reported here. Psychosis initially surfaced with chronic dexamphetamine abuse, but was sustained for 3 years by mephentermine. After a period of remission lasting for 4 years, the patient again developed psychosis on restarting abuse of mephentermine, which lasted for 5 years. Mephentermine, close structural
a sympathomimetic amine with a similarity to methamphetamine, is
used mainly as a pressor agent in various hypotensive states (Weiner, 1985). It has both alpha and beta adrenergic activity, acts mainly indirectly by releasing noradrenaline from adrenergic nerve endings, and has a slight stimulating effect on CNS (Reynolds, 1982). Although its potential for amphetamine type dependence is recognised (Reynolds, 1982), there are no reported cases of mephentermine dependence.
There are only two earlier reports of mephentermine misuse without evidence of dependence (Greenberg & Lustig, 1966; Angrist et a!, 1970). Both reported short-lasting acute paranoid psychosis, similar to amphetamine psychosis, following ingestion of the contents of mephentermine inhalers. We report a case of mephentermine dependence associated with
chronic psychosis. This is probably the first reported case of mephentermine
dependence.
Case report Dr P, a 37-year-old male medical practitioner,
was admitted
in October 1985 with a history of injecting Mephentine@ (30mg intramuscularly, 4—5 times daily) for about 5 years. According to the patient he injected Mephentine “¿to get relief from feelings of boredom, nervousness, desperation and worries about the future―.Within 20—30minutes of injecting Mephentine he experienced relief from these feelings and also felt relaxed and euphoric for a few hours. Hence, he took injections regularly at least four times a day, and up to six times on some days. In spite of being a doctor, when desperate due to lack of privacy he took injections surreptitiously, without any antiseptic precautions, in the toilet, and sometimes even through clothing.
*Mephentermine
injection
(Pharmacopoeia
of India,
3rd edn,
1985). Trade name —¿ Mephentine injection (Wyeth). It contains 15 mg and 30 mg per ml of mephentermine
base as mephentermine
sulphate IP. Made in India by Geoffrey Manners & Company Ltd.
