Nordic Journal of Psychiatry最新文献

Purpose: This study is the first to examine the prevalence of metabolic syndrome (MetS) and its four components (hypertension, dyslipidaemia, dysglycaemia and obesity) in a population of trauma-affected refugees. We also examined whether MetS was associated with age, sex and medication use.

Materials and methods: Data were collected from a cohort of refugees with PTSD who participated in a randomised controlled trial (RCT) at the Competence Centre for Transcultural Psychiatry (CTP), Denmark. The cohort comprised 110 men and 109 women (mean age = 44 years, SD = 10.4) predominantly from the Middle East, with additional representation from Asia, Africa, and Eastern Europe. MetS was defined according to the Danish medical handbook (fasting glucose was substituted with HbA1c) and Chi-square tests were utilised to examine associations between MetS and age, sex and use of antidepressants and antipsychotics.

Results: Among the 219 participants, the prevalence of MetS was 34.7% with additional 16.0% potentially having MetS. MetS was significantly associated with antidepressant use (p < 0.001), antipsychotic use (p = 0.003), and older age (p < 0.001), but not with sex (p = 0.10). Dyslipidaemia was the most prevalent MetS component (57.5%) and was significantly overrepresented in males (73.8%) compared to females (41.1%) (p < 0.001).

Conclusions: In a cohort of refugees with PTSD, the prevalence of MetS was elevated and associated with older age, and the use of antidepressants and antipsychotics. Among the four MetS components, dyslipidaemia was particularly prevalent in men, highlighting the need for targeted interventions.

Purpose: Repetitive transcranial magnetic stimulation (rTMS) is a treatment option for major depressive disorder (MDD). MDD is a heterogeneous condition with subtypes, including atypical depression (AD). The effectiveness of rTMS for AD remains unknown. In this study, we investigated the effects of rTMS in patients with AD compared to those with MDD in a clinical setting.

Materials and methods: A total of 103 patients with uni- or bipolar depressive episodes, treated with rTMS at the Uppsala Brain Stimulation Unit between April 2017 and October 2023, were included. Participants were categorized as AD (Quick Inventory of Depressive Symptomatology Self Report items 4, 7, and 9 ≥ 3) or MDD. The primary outcomes were response and remission rates based on the total score of Montgomery and Åsberg Depression Rating Scale self-report (MADRS-S). Response was defined as a 50% reduction of the total MADRS-S score and remission as MADRS-S < 10.

Results: Depressive symptoms significantly decreased after rTMS in the whole sample, with the mean MADRS-S score reduced from 34 to 25. The AD group had consistently lower scores on MADRS-S. No significant differences were observed in symptom reduction, response, or remission rates between AD and MDD groups. Response and remission rates were 12.6% and 2.9% for the whole sample, although reasons for treatment termination could not be assessed.

Conclusions: rTMS does not appear to yield specific benefits for AD. Observed response and remission rates were lower than previously reported, highlighting the need for more reports of the actual effectiveness of rTMS.

Purpose: In Sweden, in the wake of deinstitutionalization, in 1995 the responsibility for support regarding accommodation, employment, and an active everyday life for persons with severe mental illness (SMI) became a matter for the municipality's social services. The overall aim of this study was to investigate whether there are differences in functioning and needs among older adults (65+) with severe mental illness (SMI) when divided into Psychosis and Non‑Psychosis groups.

Materials and methods: Data was collected from 5 surveys, and data from national registers. A group of older adults with SMI, with a history of long-term stays in mental hospitals, was identified and divided into two groups: Psychosis diagnosis (N = 222) and Non-Psychotic diagnosis (N = 253).

Results: The level of functioning was significantly lower in the Psychosis group, but at the same time, long periods of institutionalization, regardless of diagnosis category, also contributed to lower functioning scores. Diagnostic group did not explain differences in the proportion of unsatisfied needs; however, the length of institutionalization did.

Conclusions: Although there were diagnostic group differences in functioning, there were no diagnostic group differences in unmet needs, suggesting that social services were responding to individuals' actual level of functioning. In line with the studies by Barton and by Goffman, it can be argued that the long periods of institutionalization were the most decisive factors influencing functional levels.

Purpose: Social Anxiety Disorder (SAD) typically onsets in adolescence. Few studies have targeted delivery of evidence-based interventions for SAD in mental health services for adolescents. In specific, no prior studies have examined group cognitive therapy (CT) for SAD in adolescent services delivered by method-trained staff. We implemented group CT in psychiatric outpatient units to assess its feasibility and effectiveness in routine services.

Materials and methods: In the context of a region-wide implementation program launched by Helsinki University Hospital (HUH), eleven psychiatric nurses and psychologists were trained to deliver group CT for SAD at its outpatient clinics. None of them had prior psychotherapy training. A two-day training workshop and monthly group supervision were arranged. Clinicians treated 13-to-18-year-old adolescents with primary SAD. Dropout rate, completer/dropout analysis, and effects of group CT on SAD symptoms and general psychological distress were assessed.

Results: Of adolescents referred to group CT, 75% completed the intervention. Magnitude of pre-to-post change in SAD symptoms was large (d = 0.85), comparable to findings from studies of group CBT/CT for SAD in adult services. General psychological distress of adolescents decreased somewhat, however, only 20% showed reliable change. The program was maintained in the HUH outpatient clinical services over an 8-year period.

Conclusions: Group-adapted CT for SAD based on the cognitive model of SAD appears feasible for young people. It was transferable to clinical units using a cross-regional implementation model. Our results support further controlled research of group CT for SAD delivered by method-trained staff of routine services.

Purpose: To investigate somatic health burden and self-rated health (SRH) among forensic psychiatric (FP) patients and the concordance between these two health measurements. Additionally, the study evaluates how different binary groupings of SRH responses impact concordance.

Methods: In a cross-sectional study, 67 inpatients from two Danish forensic psychiatric hospitals were assessed. SRH was measured using a single-item question from the validated and widely used SF-12 scale, and clinical evaluation was performed by a general physician using the Clinical Frailty Scale (CFS). SRH responses were dichotomised in two different ways to test concordance with clinical assessment, and detailed somatic health data were collected from consultations with health care professionals and patient records.

Results: Seventy-nine percent of FP patients assessed their own health as "good" or better despite the presence of risk factors such as history of smoking (median pack years = 20) and 25% having hypertension, 84% being overweight, and 55% having metabolic syndrome when assessed by a physician. We found a total of 195 somatic diagnoses with no clear trend in either diagnosis or organ system. Regardless of grouping, concordance between self-reported health and clinician-rated CFS remained low, ranging from 58 to 61%.

Conclusion: This study reveals discrepancies between forensic psychiatric patients' subjective and clinically assessed health. The findings underscore the need to interpret SRH with caution in populations with severe mental illness, where discrepancies between SRH, physician-rated health and diagnoses burden are pronounced. Clinicians and researchers should approach SRH critically to avoid underestimating patients' health risks.

Objective: Suicide rates vary regionally in Finland, with Western Lapland (WL) being a high-risk area. WL is also known for developing the Open Dialogue (OD)-based psychiatric services. This study aimed to compare the characteristics of suicide cases in WL to the rest of Finland to better understand the elevated suicide rate.

Materials and methods: Register-based data on all suicides (n = 4502) in Finland from 2017 to 2022 were used for clustering of demographic and clinical characteristics. Principal Component Analysis was applied for dimensionality reduction, followed by K-means clustering. Logistic regression was used to examine the association between WL and the clusters.

Results: WL recorded 66 suicides, with an average annual rate of 18 per 100,000, compared to 13.5 per 100,000 in the rest of Finland. Five clusters were identified from national data: (1) younger men with low service use, (2) individuals with repeated suicide attempts likely dying by self-poisoning, (3) socially integrated men with internalizing disorders, (4) older men with low service use more likely dying by firearm, and (5) individuals treated for severe mental disorders. WL suicides were more likely to belong to Cluster 4 (OR: 2, 95%CI: 1.2-3.3), with no other significant associations.

Conclusions: The Finnish hospital district providing OD-based psychiatric services had a higher suicide rate among older men using firearms with lower service contact, emphasizing the need for tailored prevention strategies. There was no indication that the region's elevated suicide rate could be explained by a higher rate of suicides in OD service users.

Background: Negative attitudes among mental health professionals toward individuals who self-harm can impact the quality of care and contribute to antipathy and stigma. This study aimed to investigate the psychometric properties of a Danish version of the Self-Harm Antipathy Scale (SHAS-DR), designed to measure mental health professions attitudes toward patients who self-harm.

Methods: The SHAS-D was administered to 261 mental health professionals. Confirmatory factor analysis (CFA) was used to examine dimensionality and structural validity. Internal consistency was evaluated using Cronbach's alpha reliability and McDonald's omega coefficients, and discriminant validity was assessed via factor intercorrelations.

Results: Neither a unidimensional global factor nor the originally proposed six-factor model, based on all 30 items, were supported. Consistent with a previous study, a 17-item three-factor solution and a 19-item five-factor solution showed acceptable model fit. Internal consistency was acceptable for most subscale scores. The three-factor model was superior to the five-factor model in terms of internal consistency and discriminant validity.

Conclusions: The 17-item form of the SHAS-DR, capturing three subscales, is a structurally valid and reliable tool for assessing attitudes toward self-harm in Danish mental health care. The three factors of 'Sympathy and Support', 'Judgmental Perception', and 'Acceptance and Understanding' point to central areas of antipathy and may be important targets for future training and stigma-reduction efforts among mental health care staff working with patients who engage in self-harm.

Objective: Psychosocial support plays a crucial role in gender-affirming treatments. This pilot randomized controlled trial, conducted in Finland, aimed to determine whether early-onset psychotherapy affects the mental distress and well-being of individuals seeking gender-affirming treatment.

Methods: Participants (N = 58) were enrolled from individuals seeking gender-affirming treatment referred to the Gender Identity Clinic at Helsinki University Hospital. Participants were randomized into two groups: early therapy or the standard evaluation process. Evaluations using the General Health Questionnaire-12 items (GHQ-12) and Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) were conducted at baseline and at the end of the evaluation period, approximately one year after enrollment. The effectiveness of the treatment was assessed with analysis of covariance (ANCOVA). In addition, participants reported their experiences through written and oral feedback.

Results: The group that received early-onset psychotherapy showed a significant change in GHQ-12 score compared with the control (p < 0.05). The estimated effect of the intervention was a change of -4.0 (95% Cl -7.9, -0.2), indicating lower mental distress. According to feedback collected from participants, psychotherapeutic support was perceived as significant and was particularly desired at the beginning of the gender-affirming process, where the need for self-reflection was greatest. Additionally, psychosocial support was also desired to aid the transition process.

Conclusions: A complete RCT study with larger intervention and control groups is needed to make definitive conclusions about the effectiveness of early- onset trans- sensitive therapy. However, the results of this pilot trial support the continuation of the current clinical use of trans-sensitive psychotherapy in Finland.

Aims: The Alcohol Use Disorders Identification Test (AUDIT) is a widely used screening instrument for harmful alcohol use. Comorbidity between alcohol use disorders and other mental disorders is common, but there is a shortage of studies investigating AUDIT's diagnostic accuracy in young adult psychiatric patients. The aim of this study was to examine AUDIT's diagnostic accuracy and psychometric properties in young adult psychiatric outpatients.

Methods: In data from two samples of young adults (18-25 years) from general psychiatric outpatient clinics in Sweden, recruited in 2002-2003 (n = 197) and 2012-2016 (n = 283) psychiatric diagnoses were assessed using the Structured Clinical Interview for DSM-IV, axis I disorders, clinical version (SCID-I-CV) or the Mini International Neuropsychiatric Interview (MINI 6.0). Internal consistency of AUDIT, sensitivity, specificity, positive and negative predictive values (PPV and NPV), receiver operator characteristic (ROC) curves, and area under the curve (AUC) were calculated.

Results: The internal consistency of AUDIT was acceptable (Cronbach's alpha = 0.76). For the samples combined the optimal cut-off was 10, sensitivity 87% and specificity 82%, PPV 0.28 and NPV 0.99. For Sample 2002-2003, the optimal cut-off point was nine For Sample 2012-2016, the optimal cut-off point was 10. ROC curves are presented, with an AUC of 0.88 (95% CI= 0.81-0.95) for both samples combined, 81.1% for Sample 2002-2003 (95% CI = 0.63-0.99) and an AUC of 90.6% for Sample 2012-2016 (95% Cl = 0.85-0.96).

Conclusion: The full version of AUDIT is a reliable and valid screening instrument for alcohol use disorders, as shown in two samples of young adult psychiatric outpatients.

Purpose: Alcohol use and daily smoking are common among individuals with schizophrenia spectrum disorder but less is known about their relationship to psychotic symptom profile and severity, and how clozapine use may affect this relationship.

Materials and methods: Among a clinical sample of 276 Finnish outpatients with schizophrenia spectrum disorder (68.8% schizophrenia), the Brief Psychiatric Rating Scale (BPRS) and the Scale for the Assessment of Negative Symptoms (SANS) were used to determine severity of psychotic symptoms. Information regarding alcohol use was collected with questionnaires including the Alcohol Use Disorders Identification Test-Concise (AUDIT-C) and information of smoking. Associations between psychiatric symptoms and substance use were studied using linear regression separately for those with or without clozapine use. Age, gender, marital status, living situation and education were adjusted for in the final analyses.

Results: In the multivariable models, heavy alcohol use and binge drinking were less frequent among participants with clozapine use (n = 115) compared to those without (n = 161). Differences in some symptoms were observed in bivariate analyses when comparing the participants with and without heavy or binge drinking, or daily smoking. Heavy and binge drinking were associated with more severe grandiosity symptoms even after controlling for potential confounders. Daily smoking was associated with more severe hostility, elated mood, unusual thought content and uncooperativeness, but less severe emotional withdrawal.

Conclusions: Symptom profiles and severity differed according to alcohol use or smoking. The possible explanations for the role of clozapine are discussed.