Psychiatric diagnosis and criminal record determine the courts' decisions.

INTRODUCTION: Section 69 of the Danish Penal Code implies the possibility of sentencing also non-psychotic offenders to treatment when this is considered expedient. The aim of this study was to analyse which factors influence the courts' decisions to sentence offenders to psychiatric treatment instead of punishment. MATERIAL AND METHODS: The psychiatric statements of the Danish Medico-Legal Council from 1 April 2005 to 31 December 2007 were screened retrospectively to sample all cases processing non-psychotic offenders under Section 69. Analyses were performed using logistic regression with a verdict of a measure of psychiatric treatment as the response variable as opposed to punishment; the following reference variables were used as the main explanatory variables: demographic data, diagnosis, prior and present charges, and psychiatric history. The selection of the material thus ensures diagnostic validity. RESULTS: A psychiatric diagnosis is clearly the most decisive factor associated with a psychiatric treatment measure, but also psychiatric history and prior offences have a significant impact. The present charge only has limited influence. CONCLUSION: Section 69 of the Danish Penal Code is still used as intended, i.e, treatment measures are given according to psychiatric needs and take into consideration the offender's criminal behaviour. FUNDING: This study received funding from the Ministry of Health and the Health Foundation (Helsefonden). TRIAL REGISTRATION: The Danish Data Protection Agency has approved the study. Approval from the Danish Data Protection Agency was obtained (file no. 2012-41-1272).

Simple scoring of the Clock-Drawing test for dementia screening.

INTRODUCTION: This study assessed five scoring methods of the Clock-Drawing test (CDT). MATERIAL AND METHODS: A total of 72 out-patients and 29 healthy controls were assessed three times. At Visit 1, diagnostic procedure and assessments were performed with the Clinical Global Impressions (CGI) and Global Deterioration Scale (GDS), and the CDT and the Mini Mental State Examination (MMSE) were done blinded by a nurse. At Visit 2, CDT and MMSE were repeated, and at Visit 3 the CDT, CGI and the GDS were repeated. The CDTs were then rated by physicians and nurses using five different methods of scoring. Receiver-operating characteristics curve analyses were used to assess the CDT's suitability as a screening tool. Correlations between the five CDTs, other scales and predictive values were calculated. The extent to which three-word recall could improve the predictive values was analysed. RESULTS: Correlations between the CDTs and the other scales were good. The predictive values were almost identical (positive values: 93-97%; negative values: 70-74%). Three-word recall improved the values. Rates of dementia in general practice and corresponding predictive values were estimated which resulted in markedly lower positive values around 60% for a rate of dementia of 20%, and 40% for a rate of dementia of 10%. CONCLUSION: As predictive values were nearly identical, the shortest scoring manual (0 to 1) seems preferable. FUNDING: The study was partly funded by Novartis Pharma A/S. TRIAL REGISTRATION: Scientific Ethical Committee, 2003-2-17.

[Mini mental state examination. Validation of new Danish version]. / Mini mental state examination. Validering af en ny dansk udgave.

INTRODUCTION: The Mini Mental State Examination (MMSE) is widely used in Denmark, but often in non-validated versions. In 2000 a cross-sectional workgroup decided on a new common version of the MMSE with a corresponding manual, which is validated for the first time in the present study. MATERIALS AND METHODS: The study was performed from April 2003 until August 2005 in four psycho-geriatric departments. The participants (65+ years) were assessed on three consecutive occasions (week 0, 1 and 26) with the MMSE (nurse), and global scales as well as diagnostically with ICD-10 (psycho-geriatrician). RESULTS: 101 persons were included, 29 were healthy, non-demented; 82 participants were assessed at visit two, 90 at visit three, but only 88 ratings were useable. The best cut-off value for the MMSE was > or = 26. Inter-rater and test-retest (r=0.91) correlations of the MMSE were high as were the correlations to the global scales. However, there were considerable variations in mean score (+/-SD) as well as median score and range in relation to CGI and GDS values. The MMSE score is independent of sex and educational level. CONCLUSION: The MMSE also proved to be a robust scale in the present Danish version. It achieved excellent inter-rater and test-retest reliability. A cut-off value of = 26 proved better than 24 which was preferred hitherto. However, the ranges of the MMSE scores are so dispersed within the same global degree of severity that the MMSE should not generally be used to describe the severity of dementia disorders.