Treatment profiles in a Danish psychiatric university hospital department.

BACKGROUND: Despite concerns about rising treatment of psychiatric patients with psychotropic medications and declining treatment with psychotherapy, actual treatment profiles of psychiatric patients are largely unknown. AIMS: To describe patterns in the treatment of patients in a large psychiatric university hospital department. METHODS: A descriptive mapping of treatment of in- and outpatients in a psychiatric department at Aarhus University Hospital Risskov, Denmark. Information was collected by healthcare staff using a 25-item survey form. The p-value was calculated with a chi-squared test and p < 0.05 was considered significant. The study was preceded by a pilot study on 41 patients. RESULTS: Over a 1 month period, a total of 343 consecutive patients were assessed and hereof 200 were included in the age range 18-90 years (mean 53.76); 86 men and 114 women. One-hundred and eighty-eight patients (94%) used psychotropic medication, 37 (19%) as monotherapy, and 148 (74%) in combination with non-pharmacological therapy. Ninety-seven (49%) had psychotherapy and 104 (52%) social support. Among inpatients, 21 (64%) had physical therapy, and 10 (30%) electroconvulsive therapy. In total, 163 (82%) had non-pharmacological therapy. Fifty-two (26%) patients had monotherapy, and 148 (74%) polytherapy. Mean number of treatment modalities used per patient was 2.07 for all patients and 3.23 for inpatients. CONCLUSIONS: In this department, polytherapy including non-pharmacological modalities is applied widely across all settings and patient categories. However, psychotropic medication clearly dominates as the most frequently applied treatment.

Incidence of eating disorders in Danish psychiatric secondary healthcare 1970-2008.

OBJECTIVE: Is an increased focus on eating disorders during the past few decades reflected by increasing occurrence in the psychiatric health service system. METHOD: All first-time diagnoses of eating disorders identified in the Danish Central Psychiatric Research Register 1970-2008 constitute the present research database. Age-standardized rates per 100,000 inhabitants were calculated and autoregressive models were fitted for males and females separately as well as for in- and outpatients. RESULTS: The incidence of eating disorders diagnosed in Danish psychiatric secondary healthcare has increased considerably during a nearly 40-year period of observation both within the general category of eating disorders and also specifically for anorexia nervosa. The steepest increase is seen within females aged 15-19 years, where the highest incidences are also found. Anorexia nervosa constitutes the vast majority of all eating disorders. Throughout the time interval investigated, the number of males, however, is negligible compared to females. Most patients are seen in outpatient services, increasing towards recent years. However, the number of patients being treated as inpatients has increased linearly through the entire four decenniums investigated. CONCLUSIONS: Changes in registration principles, public awareness and higher acceptance of mental disorders in the public is the most obvious explanation for the incidence increase of anorexia nervosa and other eating disorders. This study does not answer whether there has been an increase in true incidence in the population.

Risk factors for conversion from unipolar psychotic depression to bipolar disorder.

OBJECTIVES: Patients with unipolar psychotic depression (PD) are at high risk of developing bipolar disorder (BD). This conversion has important implications for the choice of treatment. This study, therefore, aimed to identify risk factors associated with diagnostic conversion from PD to BD. METHODS: We conducted a population-based, historical prospective cohort study by merging data from Danish registers. Patients assigned an ICD-10 diagnosis of PD between 1 January 1995 and 31 December 2007 were identified in the Danish Central Psychiatric Research Register and were followed until the development of BD, death, loss to follow-up, or 31 December 2007. Potential risk factors for conversion to BD, also defined through various Danish registers, were tested in multiple logistic regression analyses with risk expressed as adjusted odds ratios (AOR). RESULTS: We identified 8,588 patients with PD, of whom 609 (7.1%) developed BD during follow-up. The following characteristics were significantly associated with diagnostic conversion from PD to BD: early onset of PD [AOR = 0.99 (per year of increasing age), p = 0.044], recurrent depression [AOR = 1.02 (per episode), p = 0.036], living alone (AOR = 1.29, p = 0.007), receiving a disability pension (AOR = 1.55, p < 0.001), and the highest educational level being a technical education (AOR = 1.55, p < 0.001), short-cycle higher education (AOR = 2.65, p < 0.001), or medium-cycle higher education (AOR = 1.75, p < 0.001). CONCLUSIONS: Diagnostic conversion to BD was prevalent among patients with PD. The following characteristics were significantly associated with this conversion: early onset of PD, recurrent depression, living alone, receiving a disability pension, and the highest educational level being a technical education, short-cycle higher education, or medium-cycle higher education.

Changes in treated incidence of borderline personality disorder in denmark: 1970-2009.

OBJECTIVES: To investigate whether there are any trends in treated incidence of borderline personality disorder (BPD) in Danish psychiatric hospitals based on different diagnostic systems from 1970 to 2009. METHODS: All patients diagnosed with BPD for the first time as a main or an auxiliary diagnosis treated in in- or outpatient facilities in Danish psychiatric hospitals were identified through the Danish Psychiatric Central Research Register. Age-standardized, sex-specific, and standardized rates were calculated for the International Classification of Diseases (ICD), Eighth Revision, diagnostic period from 1970 to 1993 and the ICD-10 diagnostic period from 1994 to 2009. RESULTS: The incidence for BPD in females as a main or an auxiliary diagnosis increased linearly from 1970 to 2009 (ß = 0.69 per 100 000 per year [95% CI 0.66 to 0.73]). The rates for males also increased linearly from 1970 to 1993 (ß = 0.37 [95% CI 0.30 to 0.43]) followed by a linearly decrease (ß = -0.22 [95% CI -0.29 to -0.15]) in the ICD-10 period from 1994 to 2009. The increase in females with BPD after the mid-1990s is smaller when controlling for outpatients mandatorily registered from 1995. CONCLUSION: The lack of defined criteria for BPD in ICD-8 may have been interpreted broadly to mean Kernberg's overarching concept of borderline personality organization, resulting in similar rates for males and females. However, in ICD-10, clinicians using the more narrow criteria for emotionally unstable personality disorder (borderline type), tended to diagnose BPD more commonly in women. These results suggest the importance of using specific criteria in diagnosing. They also suggest the importance of stability in the diagnostic criteria for BPD and other disorders.

Objectifs : Rechercher s'il y a des tendances dans l'incidence du trouble de la personnalité limite (TPL) traité dans des hôpitaux psychiatriques danois selon différents systèmes diagnostiques, de 1970 à 2009. Méthodes : Tous les patients ayant reçu un diagnostic de TPL pour la première fois comme diagnostic principal ou auxiliaire et traités comme patients externes ou hospitalisés d'hôpitaux psychiatriques danois ont été identifiés grâce au registre danois central de recherche en psychiatrie. Les taux normalisés selon l'âge, le sexe, ont été calculés avec la Classification internationale des maladies (CIM), 8e révision, pour la période diagnostique de 1970 à 1993 et la CIM-10 pour la période diagnostique de 1994 à 2009. Résultats : L'incidence du TPL chez les femmes comme diagnostic principal ou secondaire a augmenté de façon linéaire de 1970 à 2009 (ß = 0,69 par 100 000 par an [IC à 95 % 0,66 à 0,73]). Les taux chez les hommes ont aussi augmenté de façon linéaire de 1970 à 1993 (ß = 0,37 [IC à 95 % 0,30 à 0,43]), suivis d'une décroissance linéaire (ß = ­0,22 [IC à 95 % ­0,29 à ­0,15]) dans la période utilisant la CIM-10 entre 1994 et 2009. L'augmentation du TPL chez les femmes est plus faible après le milieu des années 1990, après contrôle pour les patients externes obligatoirement inscrits depuis 1995. Conclusion : L'absence de critères définis du TPL dans la CIM-8 peut avoir été interprétée sommairement comme équivalant au concept déterminant de Kernberg sur l'organisation de personnalité limite, donnant suite à des taux semblables pour les hommes et les femmes. Cependant, dans la CIM-10, les cliniciens utilisant des critères plus ciblés pour le trouble de personnalité émotionnellement instable (de type limite) tendaient à diagnostiquer le TPL plus souvent chez les femmes. Ces résultats suggèrent l'importance d'utiliser des critères diagnostiques spécifiques. Ils suggèrent aussi l'importance de la stabilité des critères diagnostiques du TPL et d'autres troubles.

The association between physical morbidity and subtypes of severe depression.

BACKGROUND: Physical illness and depression are related, but the association between specific physical diseases and diagnostic subtypes of depression remains poorly understood. This study aimed to clarify the relationship between a number of physical diseases and the nonpsychotic and psychotic subtype of severe depression. METHODS: This is a historical prospective cohort study. The study population consisted of all patients diagnosed with ICD-10 severe depression, either nonpsychotic or psychotic subtype, in Danish psychiatric hospitals between 1994 and 2008. The patients' history of physical disease was assessed using the Danish National Patient Register. Using logistic regression it was investigated whether specific physical diseases were associated with relative increased risk for subsequent development of either the nonpsychotic or psychotic depressive subtype. RESULTS: A total of 24,173 patients with severe depression were included in the study. Of those, 8,260 (34%) were of the psychotic subtype. A history of the following physical diseases, as opposed to their absence, increased the relative risk for subsequent development of the nonpsychotic compared to the psychotic depressive subtype [adjusted incidence odds ratio (AIOR) nonpsychotic vs. psychotic]: ischemic heart disease (AIOR = 1.3, p < 0.001), hypertension (AIOR = 1.2, p = 0.008), stroke (AIOR = 1.2, p = 0.042) and chronic lower pulmonary disease (AIOR = 1.2, p = 0.005). The total load of physical disease also increased the relative risk of nonpsychotic depression [AIOR = 1.05 (per disease), p = 0.001]. CONCLUSIONS: This study revealed that, in severe depression, a history of physical disease increased the relative risk of the nonpsychotic rather than the psychotic subtype.

Determinants of poor dental care in patients with schizophrenia: a historical, prospective database study.

BACKGROUND: Oral health status is poor and a disregarded health issue among patients with schizophrenia that is associated with the risk for additional social stigmatization and potentially fatal infections. METHOD: A historical, prospective database study of dental visits, utilizing the Danish National Patient Registry, of 21,417 patients with ICD-10-diagnosed schizophrenia in the year 2006 and of 18,892 patients for the 3-year period of 2004-2006 was conducted. Multiple logistic regression analyses were used to identify risk factors for lack of dental care. RESULTS: Only 43% of patients with schizophrenia (9,263/21,417)--compared to an annual dental visit rate of 68% in the general adult Danish population (2,567,634/3,790,446)-visited the dentist within 12 months in 2006 (OR = 2.8; 95% CI, 2.7-2.9; P < .0001). Moreover, only 31% of schizophrenia patients complied with a regular annual dental check-up visit between 2004 and 2006. Nonadherence to annual dental visits was consistently predicted by substance abuse diagnosis, involuntary legal status, living in an institution, admission to a psychiatric facility for a minimum of 30 days, and male sex, whereas clozapine treatment, atypical antipsychotic treatment, at least monthly outpatient visits, and age > 50 years were associated with a lower risk for inappropriate dental care. CONCLUSIONS: Patients with schizophrenia visit dentists much less frequently than the general population in the same country. Health professionals should pay more attention to the dental health care of patients with schizophrenia, actively encourage patients to regularly visit the dentist, and establish a formal collaboration with dentists to improve the dental health aspects of this disadvantaged patient group.

Antipsychotics associated with the development of type 2 diabetes in antipsychotic-naïve schizophrenia patients.

Diabetes mellitus occurs in schizophrenia patients at higher rates than in the general population. Reasons for this elevated risk are poorly understood and have not been examined prospectively in antipsychotic-naïve, first-episode patients. This study aims to determine which antipsychotics are associated with diabetes development in antipsychotic-naïve schizophrenia patients. All antipsychotic-naïve patients diagnosed with schizophrenia in Denmark between 01 January 1997 and 31 December 2004, followed until 31 December 2007, allowing for >or=3 years follow-up, unless death or diabetes onset occurred. Risk factors for the time to diabetes onset were assessed, including antipsychotics taken for at least 180 defined daily doses in the first year after first antipsychotic prescription ('initial treatment'). Risk factors for diabetes incidence were assessed, including antipsychotic use within 3 months before diabetes onset or study end ('current treatment'). Of 7139 patients, followed for 6.6 years (47,297 patient years), 307 developed diabetes (annual incidence rate: 0.65%). Time to diabetes onset was significantly shorter in patients with higher age (hazard ratio (HR): 1.03, confidence interval (CI): 1.02-1.03) and those with 'initial' treatment of olanzapine (HR: 1.41, CI: 1.09-1.83), mid-potency first-generation antipsychotics (FGAs) (HR: 1.60, CI: 1.07-2.39), antihypertensive (HR: 1.87, CI: 1.13-3.09), or lipid-lowering drugs (HR: 4.67, CI: 2.19-10.00). Significant factors associated with diabetes within 3 month of its development included treatment with low-potency FGAs (odds ratio (OR): 1.52, CI: 1.14-2.02), olanzapine (OR: 1.44, CI: 1.98-1.91), and clozapine (OR: 1.67, CI: 1.14-2.46), whereas aripiprazole was associated with lower diabetes risk (OR: 0.51, CI: 0.33-0.80). In addition to general diabetes risk factors, such as age, hypertension, and dyslipidemia, diabetes is promoted in schizophrenia patients by initial and current treatment with olanzapine and mid-potency FGAs, as well as by current treatment with or low-potency first-generation antipsychotics and clozapine, whereas current aripiprazole treatment reduced diabetes risk. Patients discontinuing olanzapine or mid-potency FGA had no increased risk of diabetes compared with patient not treated with the drugs at anytime.