Psychiatric disorders in low birthweight young adults. Prevalence and association with assessments at 11 years.

OBJECTIVE: To compare mental health of 136 young adults without neurosensory handicaps born with low birthweight (LBW, birthweight less than 2,000 g) with 132 adults with normal birthweight (NBW). METHOD: A cohort of moderate LBW and NBW young adults were assessed with the Mini-International Neuropsychiatric Interview (MINI) at 19 years and the Children Assessment Schedule (CAS) at 11 years of age. RESULTS: At 19 years of age, 44 out of 136 (32%) LBW young adults were diagnosed with a psychiatric disorder compared to 10% NBW (OR: 2.8; 95% CI: 1.1, 4.5, P=0.02). Among the LBW young adults, affective-, anxiety-, ADHD- and antisocial personality disorders were most common, and nine subjects (20%) had more than one diagnosis. Of 97 LBW subjects examined both at 11 and 19 years of age, 54 (56%) were mentally healthy though out adolescence. This was half as many as for controls (OR: 0.6; 95% CI: 0.3 to 0.9). CONCLUSION: Moderate LBW was associated with an increased risk of psychiatric disorders in young adulthood. Only half of LBW young adults stayed healthy throughout adolescence.

Neonatal outcomes in offspring of women with anxiety and depression during pregnancy. A linkage study from The Nord-Trøndelag Health Study (HUNT) and Medical Birth Registry of Norway.

BACKGROUND: The presence of mental disorder during pregnancy could affect the offspring. AIMS: To examine the effects of anxiety disorder and depression in pregnant women on neonatal outcomes, and to compare neonatal outcomes between offspring of attendees and non-attendees in a general population-based health survey. METHOD: Pregnant women (n = 680) were identified from the population-based health study of Nord-TrØndelag County (HUNT-2) by linkage with the Medical Birth Registry of Norway. The women rated themselves on the Hospital Anxiety and Depression Rating Scale (HADS). Outcome variables were gestational length, birth weight, and Apgar scores. RESULTS: HADS-defined anxiety disorder during pregnancy was associated with lower Apgar score at one minute (score < 8; odds ratio = 2.27; p = .03) and five minutes (score < 8; odds ratio = 4.49; p = .016). No confounders were identified. Anxiety disorder and depression during pregnancy was not associated with low birth weight or preterm delivery. Offspring of non-attendees had a lower birth weight (77 g; t = 3.27; p = 0.001) and a shorter gestational length (1.8 days; t = 2.76; p = 0.006) than that of offspring of attendees, a difference that may be explained by a higher load of psychosocial risk factors among the non-attendees. CONCLUSION: In our study that may be biased towards the healthier among pregnant women, anxiety disorder or depression during pregnancy were not strong risk factors for adverse neonatal outcomes although low Apgar score in offspring of women with anxiety disorder may indicate poor neonatal adaptation.

Screening for postnatal depression. Validation of the Norwegian version of the Edinburgh Postnatal Depression Scale, and assessment of risk factors for postnatal depression.

OBJECTIVE: The Edinburgh Postnatal Depression Scale (EPDS) is a self-rating scale developed to screen for postnatal depression. The aim of this study was to validate a Norwegian translation of the EPDS, study its psychometric properties, and identify risk factors for postnatal depression. METHOD: EPDS was filled in by 411 women at 6-12 weeks postpartum. Of these, 100 were interviewed using the Mini International Neuropsychiatric Interview for DSM-IV major and minor depressive disorders. RESULTS: When using a cut-off of 11 on the EPDS, 26 of 27 women with major depression were identified (sensitivity 96%, specificity 78%). An aggregate point prevalence of 10.0% of major and minor depression was found. A one-factor model accounted for 46.6% of the variance. Strongest risk factors for postpartum depression were previous depression, depression in current pregnancy, and current somatic illness. LIMITATIONS: Women screened using the EPDS who had a score above threshold, yet did not attend the diagnostic interview could cause the point prevalence of depression to be higher than indicated here. CONCLUSION: The Norwegian translation of EPDS functions equally well as other translations as a screening tool for postnatal depression. The risk factors that were found are compatible with other studies.

[Periodic limb movements in sleep--can and should this condition be treated?]. / Periodiske beinbevegelser under søvn--kan og skal de behandles?

BACKGROUND: Periodic limb movements in sleep (PLMS) may occur in up to 6% of the general population and is more common in the elderly. MATERIAL AND METHODS: Based on relevant literature and recent guidelines from the American Academy of Sleep Medicine, we present an overview of symptoms, diagnostic examinations and treatment of periodic limb movements in sleep, including its relation to restless legs. A short case history is also presented. RESULTS: Patients with periodic limb movements in sleep may or may not have other symptoms, such as insomnia and excessive daytime sleepiness. Polysomnography is necessary for the diagnosis. Only patients who meet specific diagnostic criteria should be treated pharmacologically. Our patient was examined by polysomnography and actigraphy before and during pharmacological treatment. INTERPRETATION: The concept and treatment of periodic limb movements in sleep is controversial.

[Cognitive therapy has been shown to be effective in panic disorder]. / Kognitiv terapi har visat god effekt på panikångest.

Cognitive therapists suggest panic disorder to result from 'catastrophic' misinterpretation of bodily sensations. The patient suffering from panic disorder consistently misinterprets normal anxiety responses, such as racing heart, breathlessness or dizziness, as indicating impending disaster. Cognitive therapists, who challenge the traditional view of anxiety as 'free-floating' and irrational, argue that the patient's anxiety is an understandable response to their misinterpretations, and advocate a treatment method based on the patient's specific cognitive make-up and on the principle of collaborative empiricism. The patient is gently guided to identify and challenge idiosyncratic cognitions, and to consider alternative interpretations of danger signs. The article provides an outline of the treatment method and its empirical support.

[Phototherapy. An alternative for seasonal affective disorders or sleep disorders]. / Lysbehandling. Et alternativ ved psykiske lidelser med sesongvariasjon eller søvnforstyrrelser.

Although clinicians have observed for centuries that som depressed patients become worse in the winter, it was first in 1984 that Norman Rosenthal and co-workers described a syndrome which they called seasonal affective disorder (SAD), characterised by winter depression, lethargy and a craving for carbohydrate. Phototherapy was proved to be an effective treatment right from the start. Recently it has been reported that not only depression, but also panic disorder and obsessive compulsive disorders may exhibit a seasonal pattern and thus benefit from phototherapy. Phototherapy may also benefit patients suffering from "sun-downing", a syndrome of confusion and agitation in the evening in persons with Alzheimer's disease. Based on the observation that bright light may both elevate brain serotonin and ameliorate sleep abnormalities, the authors report the results of phototherapy for treatment of non-seasonal depressions, either alone or in combination with antidepressants or sleep deprivation.

[Phototherapy of jet lag, night work and sleep disorders]. / Lysbehandling ved jet lag, nattarbeid og søvnlidelser.

Jet lag, complaints associated with night work, and certain sleep disorders may be caused by misalignment between the endogenous circadian rhythm and the sleep/wake cycle. The authors discuss how light influences and regulates the circadian rhythm. The endogenous circadian rhythm is generated by the suprachiasmatic nucleus, and the effect of light is mediated to this nucleus directly via the retinohypothalamic tract. The effect is dependent on the timing of the light exposure relative to the nadir of the endogenous rhythm, which usually is located at about 5:00 AM. Exposure to bright light before nadir induces a phase delay, whereas a phase advance is obtained with exposure to light after nadir. The paper describes how bright light treatment can be used to reduce the effects of jet lag and of night work, sleep phase disturbances and early morning awakenings. Melatonin administration is an alternative treatment for the same type of disorders, and is also discussed in the article.

Can disulfiram potentiate the dexamethasone suppression test in depressive patients?

Transient DST non-suppression during disulfiram-treatment was fortuitously observed in a depressed patient. A disulfiram-potentiated DST (DSTd) was constructed by giving 800 mg disulfiram on the dexamethasone and postdexamethasone days. DST and DSTd were compared intraindividually in 21 patients and 14 controls. Disulfiram-potentiation was significant in constantly depressed patients, and in questionable controls due to possible subclinical depression or somatic factors which may cause 'false-positive' results. It did not occur in depressed patients during marked improvement or long-term recovery, and not in accurately screened controls. DSTd was significantly correlated with depression ratings, whereas DST was not.

[Inadequate treatment of affective disorders]. / Inadekvat behandling av affektive lidelser.

Inadequate treatment of mood (affective) disorders is related to the mind/body dualism, desinformation about methods of treatment, the stigma of psychiatry, low funding of psychiatric research, low educational priority, and slow acquisition of new knowledge of psychiatry. The "respectable minority rule" has often been accepted without regard to the international expertise, and the consequences of undertreatment have not been weighed against the benefits of optimal treatment. The risk of chronicity increases with delayed treatment, and inadequately treated affective disorders are a leading cause of suicide. During the past 20 years the increase in suicide mortality in Norway has been the second largest in the world. Severe mood disorders are often misclassified as schizophrenia or other non-affective psychoses. Atypical mood disorders, notably rapid cycling and bipolar mixed states, are often diagnosed as personality, adjustment, conduct, attention deficit, or anxiety disorders, and even mental retardation. Neuroleptic drugs may suppress the most disturbing features of mood disorders, a fact often misinterpreted as supporting the diagnosis of a schizophrenia-like disorder. Treatment with neuroleptics is not sufficient, however, and serious side effects may often occur. The consequences are too often social break-down and post-depression syndrome.

[Affective disorders. Drug treatment and electroconvulsive therapy]. / Affektive lidelser. Medikamentell behandling og elektrokonvulsiv terapi.

Optimal treatment of mood disorders and prevention of suicide requires biological and psychosocial methods, therapeutic alliance and psycho-education. In moderate unipolar depression an antidepressant may be sufficient, if necessary potentiated by another antidepressant or triiodothyronine. In moderate bipolar depression lithium or carbamazepine are preferred. In severe unipolar and bipolar depression the combination of an antidepressant and lithium (or carbamazepine) or electroconvulsive therapy (ECT) is indicated, in psychotic depression neuroleptics, too. Non-selective monoamine oxidase inhibitors (MAOIs) are the most potent antidepressants. Moderate acute mania and mixed state may respond to lithium, carbamazepine or valproate only. In severe cases a neuroleptic and lithium are combined, or these drugs may be combined with carbamazepine or valproate. Electroconvulsive therapy is preferable in acute mixed states with marked confusion or depression. In chronic mixed state and rapid cycling, withdrawal of antidepressants and neuroleptics should be tried. Most patients will need a combination of lithium and carbamazepine or valproate. Added to these drugs, antidepressants are less risky. Adding thyroxin may stabilize rapid cycling. The combination of lithium and an antidepressant is the most potent prophylaxis in unipolar disorder and bipolar disorder dominated by depression.

Electroconvulsive therapy and cerebral computed tomography. A prospective study.

Cerebral computed tomography (CT) was performed before and after right-sided electroconvulsive therapy (ECT) in 40 patients aged 26-87 years with major affective disorders. Nine patients with a concomitant definite or possible non-acute organic brain disorder were included. Several patients had long seizure durations, maximum 6.5 min, caused by hyperventilation-induced hypocapnia. Twenty-nine patients received at least 16 treatments (maximum 46). No CT changes occurred following ECT. A questionable dilatation of the left temporal horn in a 69-year-old hypertensive man who recovered completely without side effects after 3 ECT sessions was probably unrelated to the ECT. Provided sufficient oxygenation, even relatively long ECT series and seizures lasting several minutes do not cause any brain damage visible on CT.

Influence of ACTH 4-10 and unilateral ECT on primary and secondary memory in depressive patients.

Primary and secondary memory were tested in depressive patients by means of immediate free recall of lists of words in a double blind intraindividual cross-over comparison between ACTH 4-10 in a single s.c. dose and placebo, in connection with the second and third unilateral electroconvulsive treatment (ECT). The results of the study did not show any memory facilitating effect of ACTH 4-10 in immediate recall from primary and secondary memory, after ECT. The results indicate a negative effect of ECT on delayed recall from secondary memory 120 min after ECT.

The DTES - drug taking evaluation scale. A simple scale for the evaluation of drug taking behaviour.

This paper describes a clinically based scale elaborated for the evaluation of drug taking behaviour. The scale is a composite scale that included subscales for drug taking behaviour, social functioning, social identity and belonging and mental health. The scale is used in different evaluation projects from surveys to treatment research, and the experiences as well as reliability testing are described. Finally, the paper contains a manual for the use of the scale.

Evaluation of drug taking behaviour. Some theoretical and methodological considerations.

Evaluation of treatment modalities of drug dependence has specific theoretical and methodological difficulties. Ideological and invested interests also complicate the literature. This paper analyses the situation on different levels, concentrating on controversies about theoretical concepts, and problems connected to the variability of drug taking populations. Some suggestions are given.

Flashbacks: a personal follow-up.

During the period 1971-1973, it was found that 53 out of 91 young drug abusers in a psychiatric hospital had experienced flashbacks. This applied to as many as 50 out of the 65 patients who had used LSD, but also to abusers of organic solvents and cannabis. As many as 38% of the patients were found to be severely incapacitated by their flashbacks. On a personal follow-up 1 1/2-4 years after the first therapeutic contact, 35 patients were still troubled by flashbacks. On the whole reactions were less intense than at the time of the first contact. No relation between the flashbacks and protracted psychotic development could be established. The overall clinical and social course was worse for patients with flashbacks than for the rest of the population. Patients still bothered by flashbacks used drugs and alcohol as sedatives to a greater extent than the rest.