Nordic Journal of Psychiatry最新文献

Purpose: Mood disorders frequently coexist with borderline personality pathology (BPP), presenting considerable clinical challenges. Affective temperaments (AT) play a role in modulating mood disorders and influence the manifestation of illness. BPP and AT share common characteristics, such as emotional instability, impulsivity, and difficulties in interpersonal relationships. However, research on the relationship between BPP and AT remains limited. This study employed network analysis to explore the network structure between BPP and AT in a cohort of patients with mood disorders.

Materials and methods: A total of 720 patients with mood disorders (major depressive disorder, n = 267; bipolar affective disorder, n = 453) were included in the analysis. The Personality Assessment Inventory-Borderline Features Scale (PAI-BOR) and the Temperament Evaluation of Memphis, Pisa, Paris, and San Diego-Auto questionnaire short version (TEMPS-A) were utilized. Network analysis was conducted to identify central symptoms and network structures across the five AT dimensions and 24 BPP items.

Results: The BPP and TEMPS-A items were intricately interwoven, with no distinct groupings. The most significant symptoms identified were "Mood shifts" and "Cyclothymic temperament." Additionally, irritable temperament was strongly linked to "Little control over anger," while anxious temperament was closely associated with "Worry about people leaving."

Conclusion: The overlap of BPP and AT in the network, without a clear separation, suggests a significant interconnection between these clinical concepts. The centrality of "Mood shifts" and "Cyclothymic temperament" in this network underscores the importance of targeting these symptoms in the treatment of patients with prominent BPP and AT.

Purpose: People with a severe mental illness (SMI) have a marked reduction in life expectancy which is largely attributable to somatic morbidity. Life expectancy has increased in Global North populations, yet it remains unclear whether people with SMI have benefitted equally from this increase. Our objective was to explore time trends of all-cause and selected cause-specific mortality among all people in Denmark with registered diagnosis codes of SMI: depression, bipolar disorder, or schizophrenia at psychiatric out- and in-patient settings.

Materials and methods: In consecutive yearly cohorts from 2000 to 2018, we examined all-cause and cause-specific mortality in all adults (aged ≥18) with and without diagnosis codes of SMI.

Results: We found that all-cause mortality, and mortality from cardiovascular, cancer, respiratory, infections, trauma, and suicide were consistently elevated in those registered with SMI. While the crude all-cause mortality decreased substantially for all, also in people registered with SMI, after adjustment for sex and age, the mortality relative to people without SMI, remained unchanged or slightly increased for people registered with SMI, particularly among people registered with schizophrenia.

Conclusion: Despite a decrease in crude all-cause mortality, the consistently elevated mortality for people registered with SMI relative to the general population suggests that concerted efforts to reduce health inequity remain important.

Background: This study explores sick leave changes 1-year pre- and post-treatment start for common mental health issues and their associations with self-reported symptoms, functioning, and health changes.

Methods: Ninety-five employed patients, without previous disability benefits, underwent treatment at a public mental health outpatient clinic. Sick leave data was obtained from the Norwegian Labour and Welfare Administration. Symptoms, work/social functioning, and health quality were self-reported at treatment onset and completion.

Results: Twelve months before starting treatment, only 6.3% were on sick leave, contrasting with 69.5% at treatment start. At post-treatment, 25% received work assessment allowance (WAA), 63% were off sick leave, and 12% were on sick leave. Sick leave days exhibited an inverted U-shape for non-WAA recipients. Those on sick leave post-treatment reported less improvement in symptoms and health, while the WAA group showed diminished work functioning enhancement.

Discussion: Evaluating the effect mental health treatment has on sick leave is clearly affected by the timing of assessments. Treatment seems associated with improved sick leave outcomes compared with status at treatment start, but less so when compared with status one year before starting treatment. Also, a large group of patients went on to receive WAA, constituting a group in need of further longitudinal evaluations and interventions.

Purpose: To analyze and interpret why some individuals are resilient to ELS while others are susceptible, resulting in psychiatric outcome later in life, with a focus on the role of DNAm of the NR3C1 gene as a mediating mechanism between ELS and the risk of psychiatric outcomes. We hypothesized that a high level of mental resilience to ELS, expressed as lower incidence of psychiatric outcomes, was associated with attenuated NR3C1 DNAm levels.

Materials and methods: The first authors conducted a systematic search on PubMed to identify primary research studies. Abstract were screened and full-text were reviewed to assess the eligibility for inclusion. Consensus on assessment was reached after discussion of eligibility criteria. Studies were sorted based on whether they investigated the association between ELS and NR3C1 DNAm in 1) individuals exposed compared to unexposed to ELS both without a psychiatric outcome or in 2) individuals exposed to ELS with a psychiatric outcome compared to exposed individuals without a psychiatric outcome.

Results and conclusion: Seven studies met the eligibility criteria. The results were inconsistent; two studies supported our hypothesis, two studies indicated that increased NR3C1 DNAm mediated resilience to ELS, and three studies found no association.

Background: More than 50% of people receiving long-term sickness benefits in Denmark have a common mental illness. At the same time, a significant treatment gap exists where less than 30% receive sufficient care for their mental illness.

Methods: The trial was designed as an investigator-initiated, randomized, two-group parallel superiority trial. Nine hundred participants with a common mental illness were randomly assigned into two groups: (1) IBBIS II, consisting of integrated mental health care and vocational rehabilitation, or (2) service as usual (SAU), at two sites in Denmark. The primary outcome was the difference between the two groups in time to return to work (RTW) at 12 months.

Results: There was no difference between the integrated IBBIS II intervention and SAU in time from baseline to RTW at the 12-month follow-up (Hazard ratio (HR) = 1.16 (95% CI 0.99-1.37), p = 0.07), but there was a tendency that the IBBIS II group had worse outcomes on several exploratory employment measures, including time to return to work at 6-month follow-up (HR = 1.36 (95% CI 1.03-1.55), p = 0.02), and number of weeks in work at 12-month follow-up (incidence rate ratio = 1.14 (95% CI 1.04-1.27), p = 0.008).

Discussion: The integrated employment and health intervention (IBBIS II) was not more effective than SAU in any of the included vocational outcomes and may even have been inferior to SAU on certain outcome measures. Based on these results, it is not recommended that the IBBIS II intervention is widely implemented in countries with service as usual comparable with Denmark.

Trial registration: ClinicalTrials.gov. Registered June 16, 2020, NCT04432129. https://clinicaltrials.gov/ct2/show/NCT04432129?term = IBBIS+II.

Objectives: Considering that the remission rate for major depressive disorder (MDD) in elderly patients is below 50%, there is a compelling requirement for an enhanced comprehension of the underlying mechanisms. Chronic low-grade inflammation has been posited as one potential contributor to treatment-resistant MDD in the elderly. Accordingly, the objective of our study was to explore the longitudinal trends of systemic immune markers in elderly inpatients referred to electroconvulsive therapy due to an episode of treatment resistant unipolar MDD.

Methods: The study encompassed 64 elderly inpatients with unipolar MDD that had failed to respond to therapy in primary health care, and 18 non-depressed controls. Blood samples were collected at pre-treatment, mid-treatment, post-treatment and 12 weeks follow-up. We assessed 27 immune markers via multiplex assays. Depressive symptoms were evaluated using the Hamilton Rating Scale of Depression at these timepoints. For controls, the immune markers and depressive symptoms, were measured at baseline and eight weeks follow-up using identical methods.

Results: At follow-up, patients showed higher concentrations of 23 immune markers compared to controls, although the concentration of 19 immune markers decreased significantly from pre-treatment to follow-up. No differences in immune marker concentrations between treatment responders and non-responders were observed pre- and post-treatment in the patient group.

Conclusion: Our findings suggest that a pro-inflammatory trait persists in elderly after an episode of treatment resistant unipolar MDD. Thus, our study supports that chronic low-grade inflammation may characterise elderly with treatment-resistant unipolar MDD.

Introduction: Earthquakes are natural disasters that can have significant psychological impacts on individuals, particularly children. While physical injuries are often the immediate focus following an earthquake, the psychological effects can be long-lasting and profound. Understanding the psychiatric effects of traumatic experiences in children following earthquakes is crucial for developing effective interventions and support systems.

Method: One hundred fifty three children and adolescents who experienced the earthquake were evaluated in the first year of the earthquake. Depression, anxiety, and post-traumatic stress disorder (PTSD) symptoms were measured using standardized assessment tools. Factors that may be related to psychopathology, such as sleep disturbance, the extent of trauma, and where one lived after the earthquake, were also evaluated. The anxiety, depression and stress levels of the mother and father separately and their relationship with the child's psychopathology were evaluated.

Results: The frequency of depression risk among participants was found to be 24.8%, while the frequency of anxiety risk was 62.8%. The frequency of PTSD risk was 97.4%. Children who migrated to another province after the earthquake had higher scale scores. Parental depression anxiety stress level was positively correlated with children's scale scores. Disruption in sleep patterns increased the risk of depression by 2.38 times. Experiencing the loss of friends in the earthquake increased PTSD score by 6.27.

Discussion: The findings of this study highlight the importance of addressing the psychiatric needs of children following earthquakes. Psychosocial support and access to appropriate treatment should be prioritized to mitigate the long-term psychological effects of traumatic experiences in children.

Background: Reliable gender-sensitive normative data is needed to facilitate mental health research and clinical utility of commonly used symptoms scales. This study establishes Danish gender-stratified norms for the 53-item and 18-item Brief Symptom Inventory (BSI-53, BSI-18), proposed attention deficit hyperactivity disorder (ADHD) symptomatology scales from the BSI-53, and the 10-item Symptom Checklist (SCL-10). This study also examines gender-differences in symptom reporting of the ADHD and SCL-10 scales, and assesses potential bias in recent SCL-10 norms.

Methods: Norms for the BSI-53, BSI-18, two ADHD scales and SCL-10 were established using archived Hopkins Symptom Checklist 90-R (SCL-90R) normative data collected in spring 2000 (n = 1079, age 18-80, 53% female). SCL-10 norms from 2000 were compared with proposed norms collected in spring 2020 (n = 2819, age 18-80, 55% female) during the first COVID-19 lockdown in Denmark, and with first-episode depression patients from 2020 to 2023 (n = 221, age 18-65, 73% female).

Results: The scales showed high internal consistencies (McDonald's ω > 0.81), except for 4-5 item scales (ω > 0.73). Women scored higher on both ADHD scales (Cohen's d = 0.15 and 0.19, p ≤ 0.019). Women scored higher on the SCL-10 in the 2000 population sample (d = 0.22, p < 0.0001) and in patients (d = 0.44, p = 0.004). The average population SCL-10 score in 2000 was lower than 2020 (d = 0.52, p < 0.001).

Conclusion: This study provides gender-stratified Danish mental health norms for multiple symptom scales. The considerable gender differences in the SCL-10 underscore the importance of gender-specific norms. The 2020 SCL-10 norms are biased by COVID-19 distress. Until new normative data is available, the gender-specific norms provided here are recommended.

Purpose: Repetitive TMS (rTMS) has been demonstrated to be an effective treatment of several neuropsychiatric disorders. Its safety and efficacy are well established, and multiple rTMS devices have been approved by both Conformitè Europëenne Mark and U.S. Food and Drug Administration. We aimed to survey TMS practice in Psychiatry in the Kingdom of Denmark and compare it with the international state of the art.

Methods: A survey of rTMS clinical practice in 2023 was sent to all general adult psychiatry departments practicing TMS in the Danish Realm (Denmark = 10, Faroe Islands = 0, Greenland = 0).

Results: Response rate was 100%. rTMS was available in 37% of psychiatric departments and 3 out of 5 Danish Regions. Admission criteria required a diagnosis of unipolar depression with a degree of treatment-resistance or unacceptable side-effects to antidepressant treatment. Common contraindications included: cochlear implants (100%), pacemaker and neurostimulators (80%), other ferromagnetic/implanted devices in head, neck, or thorax (70%), active substance misuse (60%), and electrolytic disturbances (50%). Three rTMS protocols were identified: 10 Hz rTMS delivered over the L-DLPFC, iTBS delivered over the L-DLPFC and 1 Hz rTMS delivered over the right-DLPFC. 383 patients were treated with TMS.

Conclusions: rTMS is unequally available in the public healthcare of the Kingdom of Denmark. Existing strategies for solving inequalities could address such issues. Unipolar depression was the only psychiatric disorder treated with rTMS in 2023. rTMS practice in the Danish Realm considers the use of evidence-based protocols and is consistent with recommendations from international expert guidelines.

Background: Our study aims to reveal the relationship between autistic traits and repetitive behaviors in adolescents diagnosed with obsessive-compulsive disorder and trichotillomania and to compare them to healthy controls.

Method: A total of 100 adolescents, 33 of whom were diagnosed with obsessive-compulsive disorder, 32 of whom were diagnosed with trichotillomania and 35 healthy controls, aged 11-18 years, who applied to a Child and Adolescent Psychiatry Outpatient Clinic between February 2023 and July 2023, were included in the study. Participants were evaluated with the Autism Spectrum Quotient (AQ)-Adolescent, Repetitive Behavior Scale-Revised (RBS-R), Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and Clinical Global Impression Scale-Severity (CGI-S). SPSS 25.0 program was used in the analysis. p < 0.05 was accepted as the significance level.

Results: It was found that adolescents diagnosed with obsessive-compulsive disorder and trichotillomania had higher autistic trait levels compared to healthy controls, while there was no significant difference between the obsessive-compulsive disorder and trichotillomania groups. While stereotypic, routine, sameness, and restricted repetitive behaviors were more common in the obsessive-compulsive disorder and trichotillomania groups as opposed to healthy controls, it was found that compulsive behavior was more common in the obsessive-compulsive disorder group, and self-injurious behavior was more common in the trichotillomania group compared to healthy controls.

Conclusion: The findings of our study indicate that adolescents diagnosed with trichotillomania, similar to those with obsessive-compulsive disorder, have a higher level of autistic traits and repetitive behaviors. The authors believe it is crucial to focus on the social skill difficulties these adolescents may be experiencing.