A study sample consisting of 51 patients suffering from acute and transient psychotic disorder (ATPD) (ICD-10) on initial examination was evaluated at 1-year follow-up. The findings show a diagnostic change in half of the patients (48%), most often to schizophrenia (15%) and affective disorder (28%). From index admission to follow-up, patients with an unchanged diagnosis of ATPD manage fairly well with regard to psychosocial functioning, and no deteriorating development is observed. In the majority of cases no personality disorder (PD) (ICD-10, 54%; DSM-IV, 71%) is apparent, and the ATPD is not related to any specific PD. With regard to diagnostic stability, no significant demographic, social or clinical predictors were found. The findings highlight the need for validation of the concept of ATPD, and point to the fact that brief psychotic episodes with an acute onset may be an early manifestation of severe mental disorder (schizophrenia and affective disorder).
A study sample of 51 patients with acute and transient psychotic disorder (ATPD) (ICD-10) is presented. The findings suggest that, in hospital settings, ATPD is a non-frequent condition with onset in early adult life and most often associated with female sex, good premorbid social functioning and no or minor/moderate psychosocial stressors. The DSM-IV criteria distribute the patients into three diagnostic categories: schizophreniform disorder (41%), brief psychotic disorder (33%) and psychotic disorder not otherwise classified (25%). A high prevalence (63%) of personality disorders (PD) is revealed after recovery from the psychotic episode. The ATPD is not related to any specific PD, and in a substantial minority (37%) of cases no PD is found. The unspecified category is by far the most frequent PD in patients with ATPD. The sample will be followed up and reassessed.
The interaction between political executives and civil servants rests on a delicate balance between political responsiveness and the duty of civil servants and ministers to respect legal and other normative constraints on executive authority. In Danish central government, this balance is stressed by norms that define the correct behavior when the civil service provides ministers with political advice and assistance. Organizational factors strongly influence civil servants' behavior when they have to balance responsiveness against constraints on their role as political advisers. Moreover, civil servants working closely with ministers pay more attention to legal constraints than their peers among agency officials and specialists. Agency officials and specialists are much more prone to prioritize professional standards. We argue that this pattern can be generalized West European systems.
Between 1946 and 1995, Danish central government had been subject to numerous reorganization initiatives. Based on the assumption of self-interest motivated and risk-averse bureaucrats, these initiatives are analyzed in a long-term historical perspective. It is argued that civil servants both feel a strong incentive to and have good chances of defending the existing organization. This creates a historical bias in favor of whatever organizations were created in the past. Still, the mutual dependence between political executives and their civil servants opens up for bargaining dynamics allowing for mostly incremental change. While ideology has been unimportant in the development of central government organization, broadly shared ideas about reform may account for some instances of radical reform, consistently opposed by Danish civil servants.
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