Nordic Journal of Psychiatry最新文献

Background: Recent studies have suggested that psychedelics such as lysergic acid diethylamide (LSD) and psilocybin might benefit patients with mental illness. This revival calls for revisiting the field's past experiences with these agents. From 1960 to 1973, many patients were treated with LSD and/or psilocybin at the Department of Psychiatry at Frederiksberg Hospital in Denmark. Here, we analyze the case material/medical records of 324 of these patients. Specifically, we aimed to estimate whether patients who applied for reparatory compensation (applicants; n = 93) as per the Danish LSD Damages Law had worse responses and were more affected by adverse events related to psychedelic treatment than those who did not (non-applicants; n = 231).

Materials and methods: Data from the LSD archive at Frederiksberg City Archives were reviewed, and data regarding patient characteristics and LSD/psilocybin treatment (dose, effect, and adverse events) were extracted. Data were compared between applicants and non-applicants using independent samples t-tests, Mann-Whitney U tests, chi-square tests, and Fisher's exact tests, as appropriate.

Results: Applicants were treated with higher LSD doses (median LSD dose-index: 31 vs. 21, p = 0.040) and received more treatments (median: 14 vs. 10, p = 0.005) than the non-applicants. Treatment responses did not differ significantly between applicants and non-applicants. Flashbacks were registered for a larger fraction of the applicants compared to non-applicants (18.2% vs. 5.2%, p < 0.001).

Conclusions: The high incidence of flashbacks should be taken into account in future clinical studies examining psychedelic treatment of patients with mental disorders.

Background: The aim of the study was to investigate the empirical validity of the Chinese Brief Cognitive Test (C-BCT) and examine the correlation between cognitive symptoms and functional outcomes in people with schizophrenia.

Methods: Patients with schizophrenia (n = 145) together with 723 healthy controls underwent testing with C-BCT and MATRICS Consensus Cognitive Battery (MCCB). Clinical staff measured Positive and Negative Syndrome Scale (PANSS) and Personal and Social Performance (PSP) Scale for patients. One-way analysis of covariance was conducted to compare cognitive performance across groups. The correlation between C-BCT performance and PANSS and PSP was examined using the Pearson product moment correlation. The Global Deficit Score (GDS) was used to identify the severity of cognitive impairment. The generalized linear model was used to analyze the effects of age, sex and education.

Results: The four scales of C-BCT alongside composite scaled score (Css) demonstrated statistical differences between groups with partial eta squared scores between 0.049 and 0.171. Composite scaled score was weakly correlated with each scale of the PANSS (r-value ranged from -0.242 to -0.190), and weakly correlated with PSP. In addition to Digit Span Task, scales of C-BCT had different correlations with PANSS and PSP. There were differences in GDS among patients with different employment status (p < .05). 55.9% of the patient sample had been identified as cognitive impaired using C-BCT.

Conclusions: The C-BCT exhibits good empirical validity in Chinese patients with schizophrenia. Information processing speed, executive function, attention/vigilance, and overall cognitive performance were differently related to clinical symptoms and social function.

Highlights: Cognitive impairment is one of the core symptoms and dimensions of schizophrenia.The Chinese Brief Cognitive Test (C-BCT) is a simplified cognitive assessment tool based on the Chinese cultural environment.The C-BCT has good empirical validity in Chinese patients with schizophrenia, and can evaluate neurocognition in Chinese patients with schizophrenia in a shorter time.The C-BCT may be helpful for clinicians and researcher because of its convenience and efficiency.

Purpose: Recovery orientation is a useful framework for mental health care. To advance the application of a recovery-oriented approach, psychometrically sound evaluation instruments are required. The INSPIRE measure, which includes the sub-scales of Support and Relationship, evaluates staff support for personal recovery. This study aimed to investigate the psychometric properties of the Finnish translation of the INSPIRE measure.

Material and methods: The data (N = 98) was gathered from service users of different mental health services. We conducted an exploratory factor analysis of the INSPIRE measure to examine the factorial validity and used Cronbach's alpha to assess the internal consistency of the identified factors. We also calculated floor and ceiling effects to evaluate the measure's sensitivity.

Results: The results indicated that the five-factor model for the Support sub-scale, as outlined by the CHIME framework of personal recovery, was not supported by the data. Instead, factor analysis indicated a two-factor model for the Support sub-scale. For the Relationship sub-scale, the original one-factor model was supported, and internal consistency was found to be good. However, we detected a ceiling effect in the items of the INSPIRE measure, which may compromise its reliability.

Conclusion: The original factor structure of the INSPIRE Support sub-scale could not be verified in the Finnish sample, although the internal consistency was satisfactory. The psychometric properties of the Finnish translation of the INSPIRE measure yielded mixed results, highlighting the need for further international studies to enhance the measure's feasibility and reliability.

Introduction: The hepatic cytochrome P450 system includes the polymorphic CYP2D6 gene. CYP2D6 ultra rapid metabolizers (UMs) were 10-fold more common in suicide victims than in the general population in a previous study. The aim of this study was to investigate if the occurrence of the CYP2D6 UM genotype differs between subjects with and without previous suicide attempt in patients treated for depression in secondary psychiatric care.

Material and methods: The study "Genes, Depression and Suicidality" (GEN-DS) included 407 subjects treated for depression in secondary psychiatric care between 2012 and 2021. Subjects were genotyped for CYP2D6, interviewed according to a semi-structured protocol and diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th ed (DSM-IV-TR).

Results: Of the 407 subjects, 128 subjects (31.4%) had a history of one or more suicide attempt. Two (1.6%) in the suicide attempt group were categorized as UMs, as compared to 9 (3.2%) in the non-suicide attempt group. There was no statistical significance between the groups (p = 0.27, Fisher's exact test). Bipolar disorder, personality disorders, substance use disorders and lifetime presence of psychotic symptoms were more common in suicide attempters.

Conclusion: Based on our results, CYP2D6 UMs are not over-represented among suicide attempters in depressed patients treated in secondary psychiatric care. Analysis of CYP2D6 genotype can be useful for optimizing pharmacological treatment in depression but genotyping does not seem relevant for the clinical assessment of suicidality in difficult-to-treat depression.

Purpose: Patients with severe depression often transition from outpatient secondary mental health services to primary care before full recovery, risking relapse and rehospitalisation. However, evidence to ensure a safe transition is limited. This study aimed to explore how patients with severe depression experienced their intensive outpatient treatment, how they perceived their upcoming transition to primary care, and which elements they considered essential for relapse prevention.

Materials and methods: Twelve patients with severe depression from an intensive outpatient clinic were interviewed. Data were analysed using interpretative phenomenological analysis.

Results: Patients valued safety and psychiatric expertise during their outpatient treatment. Individually delivered sessions were preferred over group-based formats. As discharge approached, many still felt vulnerable and worried about relapse, particularly due to the loss of contact with psychiatric professionals and pressure from the job centre to return to work. Patients suggested relapse prevention elements, including tailored outpatient treatment addressing individual needs before discharge, flexible return-to-work approaches and the possibility of access to psychiatric professionals after discharge with continuity of care from a familiar psychiatric professional, as well as digital self-monitoring tools with clinical feedback.

Conclusions: The results highlight the need for outpatient services tailored to individual, patient-centred needs, ensuring continuity of care from secondary to primary care via familiar psychiatric professionals, and providing flexible return-to-work support. A well-coordinated transition, developed collaboratively with the patient and cross-sectoral professionals, is essential. Post-discharge, continued contact with known psychiatric professionals, supported by self-monitoring tools with clinical feedback, may prevent relapse of severe depression.

Purpose: Although anxiety disorders are common worldwide and often associated with significant impairment, many cases remain undetected and thus untreated. A lack of adequate screening partly explains this treatment gap, and easy-to-use screening instruments are needed to capture more than one type of anxiety disorder. The aim was to evaluate the psychometric properties of one such promising instrument: the Adult Anxiety Scale, AAS-15, intended to measure social anxiety disorder (social phobia), generalized anxiety disorder, and panic disorder. Materials and methods: The Swedish version of the AAS-15 was evaluated in a community sample (N = 1066, mean age 22.93 years, 64.4% women). Results: The psychometric properties were found to be good. Internal consistency ranged from very good to excellent, and a confirmatory factor analysis supported a three-factor model consistent with the three anxiety disorder dimensions that it purported to assess. Conclusion: This evaluation of the AAS-15 supports the view of the scale as a useful tool for assessing social anxiety disorder, generalized anxiety disorder, and panic disorder. With strong psychometric properties, quick and easy administration, and coverage of the most common types of anxiety disorders in adults, the AAS-15 is a valuable addition to standardized assessment and anxiety screening in a variety of healthcare settings.

Objective: Erotomania is a rare delusional disorder marked by the persistent, unfounded belief that another person is in love with the affected individual. While antipsychotic medications may alleviate the intensity of delusions, the core belief often persists, leading to significant emotional distress and potential behavioral risks. The aim of this study was to illustrate the potential therapeutic role of electroconvulsive therapy (ECT) in the treatment of chronic, treatment-resistant erotomania.

Materials and methods: We present a case report of a patient with a lifelong erotomanic delusion, centered on the same individual, which persisted unchanged despite multiple pharmacological treatments. The patient underwent a course of ECT, and clinical observations were documented throughout the treatment process. In addition to symptom monitoring, we explored the cognitive mechanisms potentially involved in the therapeutic response, with particular attention to belief updating and cognitive flexibility.

Results: ECT led to a marked reduction in the patient's conviction regarding the erotomanic delusion, alongside improvements in emotional regulation and daily functioning. These changes appeared to be sustained over time. The treatment was well tolerated, with no significant adverse effects reported.

Conclusions: This case suggests that ECT may be a viable option for patients with severe, treatment resistant erotomania. Beyond symptomatic relief, ECT may facilitate the recalibration of maladaptive beliefs by enhancing cognitive flexibility, supporting the view that belief updating mechanisms play a key role in the resolution of persistent delusions. Further studies are needed to systematically evaluate ECT's efficacy in delusional disorders.

Introduction: The aim of this study is to determine the prevalence of misophonia in patients diagnosed with bipolar disorder (BD), examine its relationship with autism spectrum symptoms and emotion regulation skills, and compare it with a healthy control group.

Methods: The study included 105 patients diagnosed with BD in remission for at least three months and 105 age-, gender-, and education-matched healthy controls. All participants completed the sociodemographic data form, Hamilton Depression Rating Scale, Young Mania Rating Scale, Revised Amsterdam Misophonia Scale, Emotion Regulation Skills Questionnaire, and Autism Spectrum Quotient.

Results: Misophonia symptoms were statistically significantly more prevalent in the healthy control group (63.8%) than in the BD group (48.6%) (p = 0.026). Among BD patients with misophonia symptoms, a history of suicide attempts and higher autistic traits were statistically significantly more common (p = 0.026, p = 0.003, respectively). No statistically significant relationship was found between the severity of misophonia and autism traits (r = 0.200; p = 0.159) or emotion regulation skills (r = -0.178; p = 0.210). Multivariate regression analyses identified suicide attempt history and autistic traits as significant predictors of misophonia severity.

Conclusion: Misophonia symptoms were more prevalent in control group, contrary to our hypothesis. BD patients exhibited pronounced emotion regulation deficits, which worsened with increased autistic traits. Misophonia symptoms were statistically significantly associated with adverse psychiatric outcomes in BD patients. These findings highlight the importance of assessing misophonia, emotion regulation, and autistic traits collectively in clinical settings, and suggest that addressing misophonia symptoms in treatment planning may enhance patient functioning.

Background: Health anxiety (HA) is characterized by excessive worries about having a serious illness, persisting even after medical reassurance. The COVID-19 pandemic, with widespread media coverage and lockdowns, may induce or exacerbate HA. During a pandemic, treatment options can be limited by lockdowns and social distancing, making remote, internet-delivered therapies particularly useful for individuals isolating due to health worries. This study aimed to assess the effectiveness of an internet-delivered Acceptance and Commitment Therapy (iACT) for COVID-19-related HA.

Methods: In a Danish university hospital, an uncontrolled national implementation project was conducted. Patients self-referred were assessed via video, and those eligible (≥18 years) received 12 weeks of iACT. The primary outcome was HA symptoms measured by the Whiteley-6-R Index. Secondary outcomes included somatic symptoms, depression, anxiety, quality of life, and life satisfaction. Changes from baseline to post-treatment were analyzed using paired t-tests and Cohen's d for effect size.

Results: Out of 223 screened patients, 105 were eligible for enrollment, and 67 responded to post-treatment questionnaires. Significant improvements were observed across all outcomes, particularly for HA (d = 1.40) and anxiety (d = 0.80), along with better quality of life (d = 0.65) and life satisfaction (d = 0.64).

Conclusions: Implementation of self-referral and internet-delivered treatment into routine care was feasible and seemed to be effective in treating COVID-19-related HA. However, for self-referred participants, the poor eligibility and motivation may be a limitation when implementing this online treatment during a pandemic. In addition, collecting data in routine care may be a challenge.

Trial registry numbers: Approved by the Danish Data Protection Agency (ID no. 790861).

Introduction: Globally, many adolescents suffer from mental health problems and related stigma. Assessing mental health stigma among youth is crucial to addressing this problem. The aim of this study was to examine the psychometric properties of a modified version of the Attitudes About Mental Illness and its Treatment (AAMIT) instrument and to describe attitudes according to the instrument, among Swedish adolescents.

Methods: A total of 2,079 adolescents in lower and upper secondary high schools on Gotland, Sweden, responded to the instrument. Exploratory and confirmatory factor analyses and assessment of internal consistency were conducted. The adolescents' views on the instrument were analysed through qualitative content analysis of open-ended comments.

Results: Exploratory factor analysis suggested a three-factor model, with seven items in total. The internal consistency of the subscales was found to be acceptable, with alpha values at 0.72-0.80. Mean scores on the subscales indicated a low prevalence of negative attitudes overall. However, 34.7% of the participants agreed with the stereotype that people with mental health problems are unpredictable, and 25.5% agreed that it is difficult to talk to people with such conditions. Negative attitudes were more prevalent among boys and adolescents with a foreign background. Many participants, nonetheless, found it difficult to evaluate the item statements, and a substantial proportion selected the 'don't know' response option.

Conclusion: Findings indicate a need for inclusive mental health education throughout the general population, youth involvement in attitude assessment design, and further validation of the AAMIT instrument before its application in future research.