Nordic Journal of Psychiatry最新文献

Background: Three out of four individuals who complete suicide reside in low- and middle-income countries. More than half of them have an underlying mental health disorder. Of all mental health disorders, bipolar disorder has one of the highest occurrences of suicide. This study aims to assess the prevalence and experiences of suicidal behavior among outpatients with bipolar disorder in Rwanda and identify protective factors and potential interventions.

Methods: This study uses a mixed methods design with quantitative data on the prevalence of suicidal behavior among people with bipolar disorder and qualitative in-depth interviews employing a phenomenological approach.

Results: Among 131 outpatients with bipolar disorder, the prevalence of attempted suicide was 18.3%. Thirteen outpatients participated in qualitative interviews. We found that the mental pain of bipolar disorder triggered suicidal behavior, but that universal themes such as hardship and loneliness were also drivers for suicidal behavior. The stigmatization of both mental health disorders and suicide was found to influence suicidal behavior. Social support, religion, and mental health care services were described as protective factors against suicidal behavior.

Conclusion: The prevalence of suicidal behavior was found to be remarkably lower than global estimates for people with bipolar disorder. This may be due to the strong communal support from religion and family, contrasting with more individualistic societies. The study highlights the need for the de-stigmatization of suicide and mental health disorders and the necessity of improved access to quality mental health care in Rwanda.

Aim: To explore the illness and treatment burden, mental well-being, and received support for illness management among people with schizophrenia and type 2 diabetes.

Materials and methods: 62 Danish adults recruited from psychiatric outpatient clinics participated in this cross-sectional study using a questionnaire compiled for this specific purpose. The questionnaire included measures of burden of illness and treatment (daily impact of diabetes and schizophrenia, treatment burden, diabetes empowerment), mental well-being (general well-being and diabetes distress), and social relations and support (general and illness-specific support). Descriptive analyses of survey data were conducted.

Results: Participants reported daily negative impact from living with schizophrenia and diabetes on their physical health, emotional well-being, sleep, and feelings about their future. However, this negative impact was higher from schizophrenia than type 2 diabetes. 55% of all participants reported high treatment burden, and 74% reported low to moderate diabetes empowerment. Approximately 30% reported high levels of diabetes distress, and 49% reported low general well-being. The support for schizophrenia mainly came from mental health professionals, care coordinators, and family and friends, while diabetes support mainly came from general practitioners and family and friends.

Conclusions: Living with coexisting schizophrenia and type 2 diabetes often involves a high burden of illness and treatment, low diabetes empowerment, high diabetes distress and low general well-being. This study highlights a need for engaging mental health professionals, care coordinators, family and friends in the daily management of coexisting schizophrenia and diabetes in future interventional studies and clinical practice.

Objective: The primary aim of this study was to investigate the potential relationship between treatment expectancy and treatment compliance with patient demographic and treatment outcome of exposure-based CBT (EB-CBT), as reported by youth with OCD, their parents, and therapists. The secondary aim is to investigate the correlation of these factors with obsessive-compulsive symptoms before and after treatment.

Method: This study is a part of the NordLOTS, in which 269 children and adolescents, aged 7-17 years, with a DSM-IV diagnosis of OCD, were treated with a 14-week EB-CBT program. Patients, parents, and therapists rated their expectancy of the treatment, and therapists rated patients' and parents' compliance with treatment. A Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score ≤15 was defined as treatment response. Linear mixed effects models were used to assess associations.

Results: Higher patient-rated treatment expectancy was significantly associated with lower pre-treatment CY-BOCS total score, as well as lower levels of parent-rated externalizing symptoms. Higher therapist-rated treatment expectancy was significantly associated with lower levels of parent-rated externalizing symptoms.

Conclusions: Children and adolescents displaying higher treatment expectancies exhibit milder symptoms of OCD and externalizing symptoms, alongside experiencing more favorable outcomes from EB-CBT.

Clinical trials registration information: This study was registered in Current Controlled Trials; Nordic Long-term Obsessive-compulsive disorder (OCD) Treatment Study (www.controlled-trials.com ISRCTN66385119).

Background: The Measure of Common Characteristics that Complicate Care (C4) is a clinician-administered checklist designed to quantify characteristics that could complicate care in outpatient psychiatry. This study investigated the C4 checklist against disturbance of personality function and early adherence to psychotherapy.

Methods: The recruits for the trial were patients awaiting group psychotherapy in psychotherapy outpatient clinics, who were scored with the C4 and responded to the Level of Personality Functioning Scale-Brief Form (LPFS-BF) questionnaire. We compared differences in case complexity across diagnostic groups and the correlation with the LPFS-BF. Finally, we evaluated the usefulness of the C4 in identifying those who attended ≥ 3 of their first four sessions of psychotherapy by conducting receiver operating characteristic (ROC) curves and linear regression analysis with percentage adherence as a dependent variable.

Results: One hundred and fifty-nine patients with emotional disorders, personality disorders, and PTSD were included. Of these, 86 started their psychotherapy courses during the study and were included in the prediction analysis. C4 scores did not differ between diagnostic groups and were not correlated with the LPFS-BF. ROC analysis indicated poor accuracy (AUC=.46) in screening for early adherence to psychotherapy, as did analyses with the LPFS-BF as a cofactor.

Conclusions: The C4 was not able to predict early adherence to psychotherapy in psychiatric outpatients, and as it also had no correlation with personality functioning, it was not possible to establish external validity. Future studies should investigate case complexity using a more controlled design and examine the outcomes of psychotherapy and adherence.

Background: Rates of alcohol use increase among women, and the gender gap in alcohol use disorder (AUD) is narrowing. Earlier studies indicate that there are differences in a variety of demographic and psychological measures between men and women with AUD. Examining differences between treatment-seeking men and women to target the specific needs and effective interventions for women with AUD is thus of vital importance.

Methods: This explorative study investigated differences in sociodemographic characteristics, psychological distress, personality functioning, and cognitive functioning between men and women seeking treatment for AUD.

Results: Treatment-seeking men and women with AUD differed on a series of mental health measures, personality functioning, and cognitive functioning. Women with AUD experienced the same level of harmful drinking as men with AUD, more psychological distress, more maladaptive personality functioning, and lower general intellectual functioning.

Conclusions: The results indicate that treatment-seeking women with AUD have special needs that should be assessed and addressed in treatment. Further, there is a need for more integrated treatments targeting the high level of comorbidity experienced by women with AUD.

Objective: In October 2022, the psychiatric emergency service PAB (in Danish: Psykiatrisk Akutberedskab) in the Capital Region of Denmark expanded its operations from an off-hours service to a 24/7 operational model. The PAB offers telephone and outreach services for people with psychiatric emergencies on professional request. The aim of this study was to describe the activities and evaluate the perceived usefulness of PAB's 24/7 model.

Materials and methods: This study utilized a quantitative research approach, with data collection conducted during daytime hours of weekdays from October 2022 through September 2023, covering the first year of PAB's 24/7 operations. The on-call psychiatrist documented requisitions from which statistical data have been compiled. The sample is comprised of 830 requisitions.

Results: There was a recognizable demand for PAB in the Capital Region during weekday daytime hours. Most requisitions were made by family physicians and staff at sheltered homes. The majority of requisitions were considered relevant for PAB. Telephone consultations and mobile outreach services were utilized equally. Data from 2022 and 2023 exhibited similar activity patterns.

Conclusions: This brief report concludes that there is a clinically relevant need for PAB in the Capital Region of Denmark. PAB is a competent psychiatric emergency service that provides a qualified mobile crisis assessment with subsequent relevant action, and the strategic collaboration between psychiatrists and law enforcement enhances its efficiency. The clinical benefits derived from extended operational hours justify the associated costs.

Objective: Observational reports of parents and teachers might conflict in the diagnostic process of pediatric Attention-Deficit/Hyperactivity Disorder (ADHD). This study investigates the diagnostic accuracy of parents and teachers in identifying ADHD in children, focusing on the influences of parental education level, child gender, and age.

Methods: Data were derived from the Turkish Epidemiological Survey in Childhood Psychopathologies, encompassing 5,830 children aged 6-13 years. ADHD diagnoses were determined using a semi-structured interview and impairment ratings from both parents and teachers. Both groups completed the ADHD Rating Scale-IV to identify ADHD-related symptoms. Diagnostic accuracy was evaluated by comparing sensitivity, specificity, positive predictive value, and negative predictive value across informants. Parental education was categorized into lower (LEL) and higher education levels (HEL).

Results: Teachers exhibited significantly higher diagnostic accuracy (93.7%) compared to parents (89.9%, p < 0.001), a trend consistent across gender and age groups. Teachers predicted ADHD in girls (95.2%) with greater accuracy than boys (92.1%), and similar patterns were observed for parents (girls: 92.0%, boys: 88.0%, p < 0.001). Parents with HEL demonstrated better diagnostic performance (91.3%) than those with LEL (89.4%, p < 0.05), though both were outperformed by teachers. Accuracy slightly declined in older children (10-13 years), but the differences were statistically insignificant.

Conclusion: The findings highlight teachers' superior ability to predict ADHD, likely due to their comparative observational advantages in structured settings. Parental education and child gender also influenced diagnostic performance. These results underscore the importance of incorporating teacher reports into diagnostic protocols while addressing socio-educational disparities to improve parent-reported accuracy.

Background: Exposure to childhood out-of-home care (OHC, foster family and residential care) is associated with an increased risk of suicide in youth and young adulthood, but the life course and clinical psychiatric implications of this risk have not yet been well elucidated.

Methods: This was a national cohort study generated from linkage of a range of population-based registers, resulting in a national cohort of 838 714 where 24 628 (2.9%) had a history of OHC. The study population, born 1972-1981, was followed from age 18 to age 39-48 years for suicide death and hospitalized self-harm.

Results: Exposure to OHC accounted for 14% of all suicide deaths in the cohort. The age-adjusted Hazard Ratios (HRs) for exposure to OHC on suicide death were 5.04 (95% C.I. 4.50-5.64) for men and 7.21 (6.13-8.48) for women compared with the same gender in the general population. After adjusting for year of birth, childhood SES and parental morbidity these risks were attenuated to 3.39 (2.99-3.85) for men and 4.23 (3.50-5.12) for women. For hospitalized self-harm the adjusted HRs were 4.47 (4.18-4.79) for men and 4.25 (4.00-4.52) for women. These risks remained similarly high from age 18 years to 48 years. Exposure to childhood OHC carried a higher risk of suicide also among psychiatric inpatients, age-adjusted HR 1.70 (1.50-1.94).

Conclusion: Exposure to OHC during childhood is a major predictor for suicide and self-harm in young and middle-aged adults as well as among adult psychiatric patients.

Background: Patients with mental illness often experience difficulties with participating in daily activities. Before discharge, it is therefore essential to assess patients' occupational performance to enable the municipalities to assign appropriate assistance. It is known that insufficient assistance in daily living may negatively affect health and well-being.

Aims: To explore which knowledge the municipalities need to assign appropriate assistance after discharge, the applicability of the knowledge delivered by the assessors and how they generated this knowledge.

Materials and methods: A qualitative interview study with 11 assessing occupational therapists and eight social workers.

Results: Most importantly was the type of occupations where the patients' needed assistance, and the type and amount of assistance. The knowledge delivered by the occupational therapists was in congruence with the municipal demands. However, generating the necessary knowledge was challenging, as the available evidence-based tools were not always found applicable.

Conclusions: The municipalities needed detailed descriptions of the patients' occupational performance to assign the appropriate assistance. The occupational therapists used both standardized and non-standardized assessment tools and faced difficulties in adhering to an evidence-based practice.

Significance: The findings underpin the municipal need for knowledge when assigning assistance and the need for evidence-based assessment tools for the occupational therapists working in mental health hospitals.

Introduction: Energy drinks (EDs) is an umbrella term for a family of beverages which contain high dosages of caffeine. ED consumption is increasing worldwide, and it is possible that excess ED consumption can cause or worsen symptoms of severe mental disorders (SMD) such as schizophrenia and bipolar affective disorder.

Methods: We searched three electronic databases for studies on patients with SMD who had experienced psychotic symptoms following the consumption of energy drinks, as well as patients who developed psychotic symptoms after ED consumption without any prior severe psychiatric disorder. We conducted and reported this systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. We assessed the included case reports with the CARE criteria.

Results: We included 11 publications, all of which were case reports. Two of these described two patients with a primary diagnosis of schizophrenia and three described six patients with a primary diagnosis of bipolar disorder. The remaining eight case reports described eight patients with no prior psychiatric diagnosis. All had experienced deterioration or onset of psychotic symptoms following intake of EDs.

Discussion: ED use may be an emerging clinical challenge in psychiatry. However, it is also possible that EDs are simply a surrogate which indicate the occurrence of other factors associated with psychosis, such as male sex and poor socioeconomic status. Overall, limited research exists on the subject. Future research could aim at quantifying the use of EDs among psychiatric patients, and patients with SMH specifically.