Nordic Journal of Psychiatry最新文献

Background: The identification of patients in forensic psychiatric care within national health registries has historically posed significant challenges, limiting research to small-scale studies and restricting its scope. This study aims to evaluate the utility of the Danish National Patient Register (DNPR) for research purposes by assessing the criterion concurrent validity of administrative trajectory markers for identifying incident patients receiving forensic psychiatric care.

Methods: We employed a population-wide design, analyzing data from the entire Danish population aged 15 years and older (almost 5 million individuals). Incident forensic psychiatric patients between January and December, 2022, were identified through a trajectory start marker in the DNPR. Validity was assessed by comparing these cases to confirmed cases from the Central Criminal Register (CCR). Test statistics, including sensitivity, specificity, positive predictive value (PPV), and negative predictive value, were calculated.

Results: A total of 323 forensic psychiatric patients were identified in the DNPR, of whom 289 (89.5%) were confirmed as incident cases in the CCR. The sensitivity of any trajectory start marker was .755 (.708-.797), and the PPV was .895 (.856, .926). PPV varied across the five Danish regions and between individual trajectory markers, with the highest PPV (.950) observed among patients sentenced to outpatient psychiatric treatment with the option of hospitalization.

Conclusions: The findings suggest that trajectory markers are a promising approach for reliably identifying incident forensic psychiatric cases within Danish national health registers. Further studies are needed to confirm their validity across different contexts, informing clinical practice and policy decisions in forensic psychiatry.

Objective: Cognitive impairments, including difficulties with learning and memory, are common in mood disorders (MD) and schizophrenia spectrum disorders (SSD), yet cognitive remediation interventions often show limited transfer of improvements to functioning. Fully immersive virtual reality (VR) offers an engaging and ecologically valid cognitive training platform. This study explored the efficacy and feasibility of a one-hour VR-based memory training session utilising the Method of Loci (MoL) for improving memory and self-efficacy in patients with MD or SSD and healthy controls (HC).

Methods: Patients with MD or SSD (n = 20) and HC (HCVR, n = 20) trained MoL memory encoding using a novel VR paradigm, while another HC group (n = 20) used a traditional flashcard-based encoding method. All participants encoded the 50 U.S. states. Memory recall was assessed pre-training, post-training, and one week later. Patients completed self-efficacy questionnaires pre- and post-training and evaluated training engagement and usefulness.

Results: VR-based MoL training significantly improved recall of the 50 U.S. states in patients (pre: 11.65 ± 7.81; post: 33.80 ± 9.35, t = -10.06, p < .001) and HCVR (pre: 20.35 ± 9.41; post: 40.40 ± 5.80, t = -11.78, p < .001), with effects maintained at one-week follow-up. VR-based training outperformed traditional encoding in HC (F(2,76) = 4.17, p = .02, ηp² = .09). Patients reported higher post-training memory self-efficacy and rated the training as highly engaging and useful.

Conclusion: A single VR-based MoL session led to improved memory and self-efficacy in patients with MD or SSD, providing a stepping stone to show patients they can enhance memory using simple mnemonic techniques. This approach may encourage sustained memory training in daily life.

Objective: Limited knowledge exists regarding the prevalence of mental illnesses in physicians and psychologists working in mental health services. In addition, knowledge of the positive or negative impact of lived experience in mental health care professionals is scarce. The study aimed to describe the self-reported prevalence of mental illness amongst psychologists and physicians working in mental health services in Denmark, their perception of impact on their work within mental health services, and their extent of disclosure and treatment-seeking.

Methods: Invitations to an online survey were distributed via e-mail to head consultants of all mental health services in Denmark (n = 29). The association between respondent characteristics and the lifetime mental illness group was assessed in a multivariate logistic regression analysis, with the lifetime mental illness group as outcome.

Results: In total, 393 physicians and psychologists responded to the survey (response rate 67%). The combined lifetime prevalence of mental illness was 32% (n = 124). The respondents generally believed that lived experience with mental illness enhanced insight into mental illness and increased understanding and empathy towards patients. Auto-stigmatization and fear of disclosure were highly prevalent amongst respondents.

Conclusion: The results suggest lived experience with mental illness can be seen as a strength with increased patient understanding and empathy emphasizing that lived experience should not be perceived as a professional barrier. However, lived experience can cause negative impacts which highlights that physicians' health programs should address mental health stigma, and professional associations facilitate more openness and support for members with lived experience.

Background: Health inequities have drawn increasing attention, yet evidence on the moderating role of socioeconomic status (SES) in the relationship between mental disorders and multiple behavioural risks is inconsistent. This study examines the role of SES in the relationship between prior mental disorder diagnoses and later multiple behavioural risks.

Methods: The study was based on registry-linked survey data from 2021-2022 among the Estonian adult population. The analytic sample included 1,561 individuals aged >25. Poisson regression was used to examine associations between mental disorders and behavioural risks. Latent class analysis was used to identify behavioural risk classes, and multinomial logistic regression to assess their relationship with prior diagnoses.

Results: Depression was associated with a higher number of behavioural risks and higher odds of belonging to multiple risk classes, while anxiety was linked to the overweight/obesity class. Lower SES index, secondary education, and medium income were associated with increased behavioural risks compared to higher SES index, education, and income. While the SES index showed no interactions, education and income demonstrated moderating effects. Respondents with medium income and depression had lower risk of behavioural risks and lower odds of belonging to multiple risk classes, compared to the higher-income group. Individuals with anxiety and secondary education had a lower risk of behavioural risks and lower odds of the overweight/obesity category, compared to those with higher education.

Conclusion: These results highlight the relevance of socioeconomic context and the need for further longitudinal research. Findings point to the importance of addressing behavioural risks within psychiatric care.

Purpose: While previous research has linked heightened sensitivity to sensory input to individual diagnoses such as autism spectrum disorder (ASD) or attention-deficit/hyperactivity disorder (ADHD), no large-scale, population-based studies have examined its transdiagnostic associations across a broad spectrum of neurodevelopmental difficulties.

Methods: This study utilized a population-based cohort of 4 424 eight-year-old children from the Northern Ostrobothnia Hospital District in Finland. Parent-reported data on sensory over responsivity (SOR) and neurodevelopmental difficulties were collected via questionnaires. Logistic regression models were used to examine bidirectional associations between SOR and individual developmental difficulties, while exploratory factor analysis was conducted to identify underlying dimensions of neurodevelopmental symptoms.

Results: SOR was reported in 6.4% of children and was significantly more common among those with developmental challenges. Children with any developmental difficulty were 4.7 times more likely to exhibit SOR than those without. ASD showed the strongest association, followed by ADHD related traits, motor difficulties, intellectual disability, Tourette's/tics, and learning difficulties. Factor analysis identified three latent dimensions: (1) Social Communication & Language, (2) Learning & Cognitive Processing, and (3) Attention & Motor Regulation - each of which was statistically significantly associated with SOR.

Conclusions: SOR is a prevalent and clinically significant transdiagnostic feature that cuts across multiple neurodevelopmental domains. Our findings support the conceptualization of SOR as a modality-specific liability factor nested within the proposed neurodevelopmental spectrum of the Hierarchical Taxonomy of Psychopathology (HiTOP) framework. Recognizing SOR as a transdiagnostic marker may improve early identification and guide more tailored interventions for children with diverse developmental profiles.

Objective: This study aimed to evaluate changes in peripheral inflammatory markers before and after electroconvulsive therapy (ECT) in patients with schizophrenia (SCZ), bipolar disorder (manic and depressive episodes), and major depressive disorder, focusing on composite indices less frequently investigated in this context.

Methods: A retrospective analysis was conducted on 154 patients who received ECT. Inflammatory markers included neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), monocyte-to-lymphocyte ratio (MLR), systemic immune-inflammation index (SII), systemic inflammation response index (SIRI), and aggregate index of systemic inflammation (AISI). Pre- and post-ECT values were compared using Wilcoxon's signed-rank tests. Group differences were examined using Kruskal-Wallis and Mann-Whitney U-tests with Bonferroni's correction.

Results: Significant reductions were observed in MLR (median Δ = -0.04) and SIRI (median Δ = -1.01) after ECT (p = .001 and .031, respectively), both with medium effect sizes. NLR, PLR, SII, and AISI did not show significant changes. The magnitude of reduction in MLR and SIRI was greater in patients with bipolar mania and SCZ compared to those with depressive disorders, although these differences emerged primarily in between-group comparisons.

Conclusions: ECT appears to selectively reduce monocyte-related inflammatory markers (MLR, SIRI), with the most substantial decreases seen in bipolar mania and SCZ. These findings support a role for systemic inflammation in severe mood and SCZ-spectrum disorders and suggest that composite hematological indices may serve as useful biomarkers for tracking ECT's immunomodulatory effects.

Purpose of the article: To validate the Lithuanian version of the Brief Negative Symptoms Scale (Lith-BNSS) in a Lithuanian speaking sample.

Materials and methods: We performed a double translation of BNSS from English into Lithuanian. Four clinicians conducted psychometric validation. We checked the internal consistency of the 13 items and six subscales of BNSS. Convergent and discriminant validity were calculated by applying BNSS in clinical practice with other psychometric tools for negative, positive, and depressive symptoms and cognitive deficit assessment. The psychometric tools used were BNNS, Self-assessment of Negative Symptoms Scale (SNS), Positive and Negative Symptoms Scale (PANSS), Montgomery Asberg Depression Rating Scale (MADRS), and Calgary Depression Scale for Schizophrenia (CDSS). We calculated the convergent and discriminant validities using Pearson and Spearman correlations.

Results: We have included 130 patients. Excellent internal consistency was observed for the 13 items (alpha = 0.944) and the six subscales (alpha = 0.874) of BNSS. Good convergent validity is illustrated by strong Pearsons's correlations with the PANSS negative subscale (r = 0.77, p < 0.001) and the PANSS Marder negative factor (r = 0.77, p < 0.001). Adequate discriminant validity is shown by a non-significant correlation with PANSS positive subscore (r = 0.13, p = 0.15), PANSS Marder positive factor (r = 0.14, p = 0.13), CDSS total score (r = 0.02, p = 0.83) and MADRS total score (r = 0.12, p = 0.2).

Conclusions: Lith-BNSS has good psychometric properties and can be used as a valuable addition to the available Lithuanian evaluation tools for negative symptoms of schizophrenia.

Objective: The primary aim of this study was to confirm the internal consistency and factor structure of the Swedish version of the Swanson-Nolan-Pelham scale fourth edition (SNAP-IV) for parents and to examine its clinical utility for identifying children diagnosed with attention deficit/hyperactivity disorder (ADHD).

Materials and methods: Parents of 11-year-old children from a birth cohort in the Halland region of Sweden (N = 981) completed the SNAP-IV assessment. Background data on ADHD diagnoses and medical treatment with stimulants were obtained from the Swedish National Patient Registry. We assessed the factor structure of the SNAP-IV using confirmatory factor analysis with diagonally weighted least squares estimation, and its clinical utility using logistic regression and receiver operating characteristic curve analysis.

Results: A three-factor bifactor S-1 model of the Swedish SNAP-IV where all items load onto a general hyperactivity/impulsiveness factor and items specific to inattentiveness and Oppositional Defiant Disorder (ODD) load onto independent factors fit best and exhibited high internal consistency. Excluding ODD items, a similar two-factor bifactor S-1 model fit well. The SNAP-IV demonstrated robust clinical utility for identifying children diagnosed with ADHD as evidenced by significant associations between clinical diagnoses and the SNAP-IV subscales, as well as excellent classification accuracy for both the inattention and hyperactivity/impulsivity subscales when using continuous values. Taken together, the Swedish version of the SNAP-IV parent form was found to be a useful instrument with good criterion validity for assessing ADHD symptoms in 11-year-old children. The clinical application of cutoffs is discussed.

Purpose: In adolescent psychiatric wards, various interventions have been implemented to reduce the incidence of restrictive practices. These interventions are less studied than in adult psychiatry and the impact often remains unclear. To investigate the significance of the initiatives implemented in an adolescent ward, an explorative retrospective study was performed.

Material and methods: Information about initiatives to reduce the use of restrictive practices was collected from documents on the ward from 2015 to 2022. During this period, the incidence of restrictive interventions was recorded in the region's electronic register. Information on initiatives and incidences of restrictive interventions was compared using descriptive statistics and incidence rates.

Results: In the study period, twenty different initiatives were initiated on the ward. None of the interventions led to a sustained decrease in the number of coercive episodes. However, some of them appeared to reduce the incidence of restrictive interventions temporarily, such as de-escalation courses and Safewards. During the first winter of the COVID-19 pandemic (2020/2021), a high rate of restrictive interventions was observed, coinciding with the cancellation of many ward activities.

Conclusion: Although none of the initiatives implemented led to a permanent reduction in restrictive interventions, the temporary decreases observed following some of the initiatives suggest that increased awareness may have had an effect. This emphasises the necessity for sustained focus on an intervention if the impact is to be maintained.

Aim: Technology is seen as a potential tool to improve the management of diabetes although few studies have examined sensor use within psychiatric populations. This study investigated the integration of glucose sensors for patients' diabetes and severe mental illness.

Methods: The study applied a mixed methods convergent design with focus on glucose monitoring implementation. Quantitative data collected (n = 15) summarized patient characteristics and sensor use over time. Changes in HbA_1c levels were also monitored. Qualitative data was collected using semi-structured interviews and focus groups capturing the experiences of patients (n = 10) and clinicians (n = 7) respectively.

Results: Users utilized data from sensors to facilitate diabetes management although sensor use decreased over time. Analysis from patient interviews constructed three themes: 'Sensor use - improved awareness of blood glucose', 'Sensor use - promoting sharing of glucose readings', and 'Sensor use - increased visibility and public awareness of diabetes'. Focus groups with clinicians described two themes: 'Perceived treatment benefits gained from glucose sensors', and 'Treatment challenges posed by glucose sensors'.

Conclusion: Results indicated that sensors were accepted and meaningfully integrated into clinical practice within this population. Patients and clinicians were largely positive about the integration and usefulness of sensors in diabetes management although some challenges were described.