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Dissatisfaction of treatment capacity and of the results of treatment have been two main complaints about the contemporary psychiatric health service. The author tries to sort out what psychiatry itself can do, and what the public authorities can do to reduce the reasons for these complaints. She also shows why psychiatry always has to live with a certain amount of irrational criticism as a part of the essence of its work. In order to reduce the rational criticism, psychiatry can define its obligations more clearly and give priority to certain patient groups, develop subspecialization and more differential treatment, and provide better information to the public. The public authorities can increase the number of professionals in specific programs, and improve the quality of the educational system and research.

95 non alcoholic female employees were personally interviewed and divided into three drinking pattern groups with an increasing level of alcohol consumption: the traditional feminine drinking group (TF) (n = 28), the new feminine drinking group (NF) (n = 37), and the masculine drinking group (M) (n = 30). The groups were compared on family variables which may be regarded as risk factors of alcoholism. The results show an inverse relationship between family risk factors and consumption level, the TF-group having significantly more risk factors than the other two groups. The TF-women more often came from families where the mother and her parents were abstainers, while the father and his parents were more often alcohol abusers or not abstainers. The TF-women were more often attached to their alcoholic fathers as children, while the M-women were more often attached to their mothers. The choice of drinking pattern may be inversely related to the frequency of family risk factors among non alcoholic women.

Two Norwegian psychiatrists classified independently according to DSM-III, 45 patients drawn at random from two populations: one of psychiatric patients (N = 161) and one of super obese surgical patients (N = 71). They interviewed the patients and listened to each other's audio-taped interviews afterwards. In the total group, on axis I the overall agreement was 78 percent (kappa = 0.74). On axis II, the overall agreement was 81 percent (kappa = 0.68). The study shows that by using the DSM-III, two Norwegian psychiatrists obtained good diagnostic reliability.

A random sample of female, nonalcoholic psychiatric outpatients, day and inpatients from one catchment area (n = 65; C group), was compared with female psychiatric patients with a DSM-III alcohol disorder (n = 64; A group). On DSM-III, axis, I, the frequency of additional symptom diagnoses, including depressions, was nearly equal. On axis II, the A group had an additional personality disorder significantly more often (81 vs. 46%), borderline personality disorder being the most frequent (66 vs. 11%). Among patients with depressive disorders, the differences between the A and the C group on axis II were the same. But alcoholic patients suffering from a major depressive disorder more frequently had a borderline personality disorder than other subgroups. The alcohol problems seem to be more related to ongoing personality problems than to episodic, symptomatic disorders. Female psychiatric patients with alcohol problems are diagnostically a heterogeneous group and should not be offered a uniform therapy.

Twenty-six women alcoholics who fulfilled the criteria for a pure borderline personality disorder (BPD) were compared with 16 women alcoholics who also fulfilled the criteria of a schizotypal personality disorder (called mixed borderline disorder, MBD) based on personal interviews including SADS, SIB, Childhood Environment Scale (CES), and the Premorbid Adjustment Scale (PAC). The MBD women had fewer alcoholic relatives, poorer relationships with parents and siblings, a more deviant score on CES and PAC, a higher incidence of nervous children, and a poorer social network. They also reported more losses and a greater frequency of depressive symptoms during childhood and adolescence, earlier contact with psychiatry, and more frequent hospitalizations. They had a higher frequency of a nonalcoholic axis I disorder (mainly depressive and anxiety disorders), as well as a greater frequency of a paranoid personality disorder. The results show that the MBD women were more psychopathologically disturbed and support a possible link between MBD and affective disorders. The findings also indicate that MBD may be a clinical entity that should be differentiated from the pure BPD group both in clinical work and forthcoming research.

97 nonpsychotic consecutive day patients were diagnosed by the axis 1 and 2 in the DSM-III and DSM-III-R system, and their treatment response during their stay was measured by the Health Sickness Rating Scale. The interrater reliability was equally good for both diagnostic systems. On axis 1, there were only minor differences between DSM-III and DSM-III-R. On axis 2, the frequency of schizotypal disorder was reduced by 40% and the frequency of histrionic disorder by two-thirds. The number of schizoid disorders increased from zero to five. Of the DSM-III schizotypals who lost this diagnosis in DSM-III-R (n = 8), 4 got a new diagnosis of schizoid personality and 4 maintained their borderline diagnoses. In DSM-III-R there was a sharper demarcation between patients with severe and nonsevere personality disorder with regard to treatment outcome, indicating an increased validity of these categories. There was also a sharper demarcation between borderline versus histrionic and schizotypal, and between schizotypal and schizoid diagnoses.