Specific immunotherapy with SQ standardized grass allergen tablets in asthmatics with rhinoconjunctivitis.

BACKGROUND: The best way to prevent allergy symptoms is to treat the allergic condition. Specific immunotherapy with grass allergen tablets 75,000 SQ-T (Grazax, Phleum pratense, ALK-Abelló) is safe and efficacious in rhinoconjunctivitis patients. As rhinoconjunctivitis often co-exists with asthma, we aimed to confirm safety and efficacy in grass allergic subjects with asthma and rhinoconjunctivitis. METHODS: A randomized, double-blind, placebo-controlled, multicentre trial was performed 10-14 weeks prior to and during the grass pollen season 2004. About 114 subjects were randomized 2 : 1 to grass allergen tablets or placebo. The primary end points were average asthma medication and symptom scores during the grass pollen season, and secondary variables were average rhinoconjunctivitis symptom and medication scores during the grass pollen season. Additionally, number of well days was defined post hoc. RESULTS: Differences in asthma medication and symptom scores between the treatment groups were negligible. The mean difference in asthma medication score was below 0.1 and 0.3 for asthma symptom score [a single inhalation of salbutamol (200 microg) was scored 2]. No serious adverse events were reported. A reduction in rhinoconjunctivitis symptom score of 37% (P = 0.004) and a 41% (P = 0.036) reduction in medication score was found in the grass pollen season for subjects treated with the grass allergen tablet compared with placebo. Well days increased by 54% (P = 0.002). CONCLUSIONS: Self-administration of the grass allergen tablet was safe. The treatment did not impair asthma control and confirmed considerable symptom prevention and reduced medication use. It addresses the allergic condition and represents a baseline treatment for grass pollen allergy.

[Patients' evaluation of coercion in a psychiatric department. Interview studies in psychiatric departments for adult patients at the Hillerød hospital]. / Patienternes vurdering af tvang på psykiatrisk afdeling. Interviewunders gelse på de voksenpsykiatriske afdelinger ved Hillerød Sygehus.

During an 11 month period, use of coercion was prospectively registered in a psychiatric department. Of all patients who had been subjected to coercion 36% were (n = 86) interviewed subsequently. Eleven percent of the interviewed patients did not know, that they had been submitted to coercion, 22% did not know the reason and 30% did not agree with the motivation for the decision. Forty-seven percent were satisfied with the information they had been given concerning how to complain of their treatment, 50% were satisfied with their adviser and 70% were satisfied with their overall admission. Sixty-five percent accepted that there should be a law allowing the use of coercion in psychiatry.

[The use of coercion at psychiatric departments for adults, Hillerød hospital. A descriptive study of the period 10 January 1991-31 August 1992]. / Tvangsudøvelse på de voksenpsykiatriske afdelinger, Hillerød Sygehus. En deskriptiv undersøgelse i perioden 1.10.1991-31.8.1992.

The study describes the type and amount of coercion used during 11 months of 1992. Four hundred and fourty-one cases were included. Young patients i.e. 10 to 29 years old, demented patients and patients suffering from organic psychoses were, overall, more often subjected to coercive measures. When looking at each type of coercion separately, it was found that detainment, compulsive treatment and fixation were especially used on the young and on patients suffering from schizophrenia. However, fixation used as a protective measure was mainly used on the demented and the 60 to 79 year-old patients.

[Compulsory procedures at the Psychiatric Department, Frederiksberg Hospital, before and after introduction of the new psychiatric legislation. 3. Compulsory medication]. / Tvang udføort på psykiatrisk afdeling, Frederiksberg Hospital, før og efter indførelsen af den nye psykiatrilov. 3. Tvangsmedicinering.

The purpose of this investigation was to register if the new Danish law concerning commitment and compulsory procedures in psychiatry from 1.10.1989 caused changes in the extent of forced medications. During the period: 1.1.1988-30.9.1991 all compulsory procedures in the department of psychiatry, Frederiksberg Hospital, were registered. The number of patients medicated by force was unchanged, but after the law reform significantly fewer patients were medicated with depotpreparations and the duration of forced medication was significant longer. Twenty-three patients complained about the forced medication, one before and 22 after the law reform. For 18 patients the complaints put off administration of the forced medication, and they waited a total of 251 days for the complaints board to make a decision. The complaints board only agreed with one patient. The law reform has increased the public security for the psychiatric patients but did not as intended prevent or limit forced medication.

[Compulsory admissions to Frederiksberg Hospital after introduction of the new psychiatric legislation compared with the period just before the change of the law]. / Tvangsindlaeggelse på Frederiksberg Hospital efter den nye psykiatrilovs indførelse sammenlignet med perioden umiddelbart før lovaendringen.

The new Danish Act on confinement and other means of compulsion in psychiatry came into force October 1st, 1989. To investigate changes connected with the new act all involuntary commitments to the psychiatric department of the hospital of Frederiksberg, with a catchment area of 85,000 inhabitants, were prospectively registered during 23 months before, 25 months after the new legislation. Information about the commitment was obtained from the admission papers and the case records. The patients were asked to participate in an interview. Both before and after the new act there were about 35 commitments per year. There was a trend towards an increasing number of women being committed by reason of threat to the patient's health after the new act. No significant changes were observed regarding age, condition at admission, diagnoses, duration of hospitalization or condition at discharge. A little more than half of the committed patients participated in the interviews. The new act stressed the rights of the patients. In spite of this the patients did not express any increase in their understanding of or satisfaction with their hospitalization.

[Use of restraints in a psychiatric department, Frederiksberg Hospital, before and after introduction of the new psychiatric law. Restraining devices]. / Tvang udført på psykiatrisk afdeling, Frederiksberg Hospital, før og efter indførelsen af den ny psykiatrilov. Tvangsfikseringer.

The purpose of this investigation was to register if the new Danish law concerning commitment and compulsory procedures in psychiatry from 1.10.1989 caused changes in the use of restraints. During the period 1.2.1988-30.9.1991 all compulsory procedures in the Department of Psychiatry, Frederiksberg Hospital, were registered. A total of 145 patients were restrained during 167 admissions. No changes were registered in the number of restraints in connection with the law reform, but the duration of the fixations increased by 42%. The number of medications given forcibly in connection with the restraints increased significantly. One of the purposes of the the law reform was to reduce the number and duration of restraints. This purpose has not been fulfilled.

[Compulsory procedures in the psychiatric department, Frederiksberg Hospital, before and after introduction of the new psychiatric legislation]. / Tvang udført på psykiatrisk afdeling, Frederiksberg Hospital, før og efter indførelse af den nye psykiatrilov.

Registration of compulsory procedures in a psychiatric department before and after the reform of the Danish law concerning commitment and compulsory procedures in psychiatry. The purpose of this investigation was to register if the law reform 01.10.1989 caused changes in the extent of compulsory procedures in a psychiatric department. The study was prospective. During the period: 01.02.1988-30.09.1991, all compulsory procedures in the department of psychiatry, Frederiksberg Hospital, were registered. A total of 289 patients had been subjected to compulsory procedures during 336 admissions. The compulsory procedures registered were: incarceration in the department, forced medication and restraint by a belt. The total number of admissions with compulsory procedures increased after the law reform. The number of incarcerations increased. No changes were registered in the number of restraints and forced medications in connection with the law reform but, two years after, increases of 37% and 74% respectively were registered. One of the main purposes of the law reform was to limit and, if possible, to prevent compulsory procedures. This purpose has not been fulfilled. The increase in the extent of compulsory procedures in the latter part of the observation period is probably caused by factors such as increase bed occupancy and decrease in resources.

[Compulsory admissions at the Frederiksberg hospital during the period 1 Nov 1987 to 30 Sep 1989. 1. Characteristics of the compulsory admissions and the admitted persons]. / Tvangsindlaeggelser på Frederiksberg Hospital i perioden 1. nov. 1987 til 30. sep. 1989. 1. Karakteristik af tvangsindloeggelserne og de tvangsindlagte.

During a period of 23 months from 1 Nov. 1987 to 30 Sep. 1989, before the new Danish legislation came into force, there were 64 compulsory commitments to the Psychiatric Department in Frederiksberg Hospital. These comprised 3.6% of all the admissions which corresponds to the national average in Denmark. Equally many were admitted on health grounds (yellow admission papers) and on account of danger (red admission papers). Women were admitted more frequently than men. The distribution corresponds to the sex distribution of all psychiatric admissions in Frederiksberg and reflects a sex distribution in the municipality with preponderance of women as compared with the national Danish average. On the Danish national basis, the majority of these admissions are men. One fourth of the admission papers did not contain an adequate description of the reasons for presuming mental illness and/or the danger or health criteria. There is thus reason to encourage meticulous care in completion of the medical certificates in cases of compulsory commitment. On discharge from hospital, 14% had a "non-psychotic" diagnosis, which corresponds to the national Danish average. One month after discharge from hospital, 40% were attending outpatient treatment in the department and one year later, 38% of those followed-up were receiving outpatient treatment. In more than one third, compulsory commitment was thus followed by a prolonged period of voluntary treatment. 33% were readmitted during the subsequent year and this was compulsory in 13%.

[Compulsory admissions at the Frederiksberg hospital during the period 1 November 1987 to 30 September 1989. 2. Patients' assessment and experiences of the admissions]. / Tvangsindlaeggelser på Frederiksberg Hospital i perioden 1. nov. 1987 til 30. sep. 1989. 2. Patienternes vurdering og oplevelse af tvangsindloeggelser.

The object of this prospective, descriptive investigation was to illustrate how the committed patients assessed and experienced the actual compulsory commitment and their assessment of the Danish legislation concerning mental illness by means of an interview investigation on discharge. During the period of investigation of 23 months, there were 64 compulsory admissions. Of these, 31 were on account of danger (red admission papers) and 33 on health grounds (yellow admission papers). Thirty-three (52%) patients were interviewed and of these 13 were admitted on account of danger and 20 on health grounds. Twenty-two (67%) of the patients did not realise that they were undergoing compulsory admission until the police came to fetch them. The majority considered that the functions of the police (68%), admission staff (55%) and the remainder of the staff (79%) had been good or satisfactory. 46% did not know who had demanded admission and did not ask the interviewer. 30% were satisfied with information about complaints. 42% were satisfied with the function of the supervisory committee but just under 30% did not realise that it existed. 61% considered that compulsory admission could have been avoided if other help had been offered. 61% were satisfied with the hospitalization. 64% considered that it is necessary to have legislation which permits compulsory admission. Relatively more of the patients admitted with red admission papers expressed satisfaction with, and accept of, their own compulsory admission and accept of compulsory admission in general. The present investigation will form a basis for comparison of the conditions under the new Danish legislation concerning mental illness.

Quantifying depressive symptomatology: inter-rater reliability and inter-item correlations.

In this study an evaluation of the inter-rater reliability of the Hamilton Depression Rating Scale, the Melancholia Scale and the Montgomery-Asberg Depression Rating Scale has been carried out. Furthermore, the inter-item correlations of these scales have been investigated in relation to diagnostic ratings. It was found that the quantitative scales had satisfactory inter-rater relationship. Only low agreement was found between the quantitative and diagnostic scales, as expected, while there was high agreement between the quantitative scales. The relevance of introducing new scales and the definition of major depression are discussed.

[Increased use of resources at psychiatric departments after the introduction of legislation on limitation of liberty and other forms of restriction in psychiatry. A prospective 3-month study]. / Oget ressourceforbrug på psykiatrisk afdeling efter indførelse af lov om frihedsberøvelse og anden tvang i psykiatrien. En prospektiv 3 måneders undersøgelse.

The Danish legislation on restriction of liberty and other forms of compulsion in psychiatry was introduced on 1.10.1989. This legislation has involved an increased workload for psychiatric departments. A prospective investigation during a period of three months in an acute closed admission department in Frederiksberg Hospital revealed, as minimum figures, increased weekly working time for the caring staff of 28 1/2 hours, for doctors 6 1/4 hours and one hour for secretaries. In addition, the department registered an increased bed-day employment resulting from the new legislation. As the department has not received any new resources of note, this time must be taken from the time available for therapeutic work for all of the patients. Unless new resources are awarded to psychiatry, it is to be feared that the general psychiatric service will deteriorate.