Outpatients with psychotic disorders need physical health-promoting treatment: A cross-sectional multisite study.

Introduction: Impaired quality of life (QoL) and premature death in patients with primary non-affective psychotic disorders is related to lifestyle-induced comorbidities. Current municipal health-promoting treatment and care do not embrace the challenges of living with psychotic disorders. Aim: This cross-sectional study aimed to identify the proportion of outpatients diagnosed with primary psychotic disorders who need health-promoting treatment and care, and who receive municipal health-promoting interventions. Methods: Of 206 eligible invited outpatients from three psychiatric services clinics in Southern Denmark, 165 participated. Demographic and health characteristics, and use of alcohol, cannabis, drugs, and cigarettes were identified via a screening tool. Blood test information, body measurements, and medication status were extracted from the outpatients' medical records. The need for health promotion was assessed based on body mass index (BMI), and use of alcohol, cannabis, drugs, and cigarettes. Results: Seventy-three percent of outpatients needed health promotion, of whom 61 % were not offered municipal health-promoting treatment and care. Thirty-six percent had one or more somatic comorbidities, including diabetes mellitus (15 %) and cardiovascular disease (10 %); 41 % smoked a mean (SD) of 19 (10) cigarettes daily. Mean (SD) BMI was 34 (8) kg/m2 for women and 29 (7) kg/m2 for men. Conclusion: The majority of outpatients with non-affective psychotic disorders need health-promoting interventions, but only about 40 % of these patients receive such municipal health-promoting treatment and care. Future studies should clarify the impact of these interventions on the health status, QoL, and life expectancy of these patients.

How come Denmark is planning to increase the annual budget for psychiatry by almost 20 percent?

In Denmark, a 10-year plan for psychiatry has been agreed on. The content of the plan was developed in collaboration between the Danish Health Authority and the Danish Authority for Social Services and Housing, and it involved many stakeholders. Recently, the government presented a planned investment that would increase the overall budget in Danish regions and municipalities by almost 20 percent over a 10-year period. Epidemiological research demonstrating shortened life expectancy and high levels of burden of disease for people with mental disorders contributed to emphasizing the need for improvement of psychiatric services. User organizations, trade unions, and scientific societies in the field of mental health were unified in a common organization, called the Psychiatry Alliance, and this alliance agreed on common action points and acted together to influence politicians. An assertive approach toward politicians and media was pivotal, and being a first mover and presenting tentative budgets was very influential.

Obstructive hydrocephalus caused by colloid cyst presenting as a schizophrenia-like psychosis.

This report presents a young woman with psychotic symptoms that were highly suspicious of schizophrenia. Previous attempts of antidepressant therapy of mood symptoms had been ineffective. However, she also presented with discrete signs of an underlying neurological condition, and as a part of the diagnostic workup, neuroimaging revealed ventriculomegaly. She was diagnosed with obstructive hydrocephalus and experienced full remission of psychotic symptoms after neurosurgical intervention with a ventriculoperitoneal shunt. This atypical presentation of obstructive hydrocephalus underlines the importance of neuroimaging in psychiatric differential diagnostics. Otherwise, this young woman had been diagnosed with schizophrenia, instead of organic delusional disorder secondary to a neurological condition, with possible irreversible damage to brain tissue as a consequence.

Use of antipsychotics and benzodiazepines in connection to minimising coercion and mechanical restraint in a general psychiatric ward.

BACKGROUND: Decrease in coercive measures can lead to increased exposure to antipsychotics and benzodiazepines. This is not desirable as these drugs are associated with harmful side effects and reduced life expectancy. AIM: To quantify and compare the use of antipsychotic and anxiolytic medications in connection with the implementation of a programme to reduce coercion and restraint. METHODS: Observational study in a general psychiatric ward comparing psychopharmacological treatment after implementation of non-pharmacological interventions to reduce coercion and mechanical restraint with a historical reference cohort from the same ward. RESULTS: Data from 101 admissions after implementation of interventions were compared with data from 85 admissions in a historical reference cohort. Mean defined daily doses of antipsychotics, benzodiazepines or the total amount of both showed no difference before and after implementation of the programme. Standardised regression coefficients (ß) from a mixed effects linear regression model, adjusted for age, gender, length of admission, involuntary admission and history of substance abuse showed that neither total dose of antipsychotics (adjusted ß: .05, 95% confidence interval (CI): -0.20 to 0.31), total dose of benzodiazepines (adjusted ß: -.13, 95%CI: -.42 to 0.16) nor total amount of both drugs (adjusted ß: .00, 95%CI: -.26 to 0.21) increased after implementation. CONCLUSION: Decrease in coercive measures from 2013 to 2016 has not lead to significant increases in the use of antipsychotic medication or benzodiazepines. The interventions are useful in establishing restraint-free wards, and careful monitoring of the psychopharmacological treatment is important for patient safety.