Strong evidence demonstrates a genetic susceptibility to suicidal behaviour and a relationship between suicide and mental disorders. The aim of this study was to test for association between suicide and five selected genetic variants, which had shown association with suicide in other populations.
We performed a nationwide case-control study on all suicide cases sent for autopsy in Denmark between the years 2000 and 2007. The study comprised 572 cases and 1049 controls and is one of the largest genetic studies in completed suicide to date. The analysed markers were located within the Serotonin Transporter (SLC6A4), Monoamine Oxidase-A (MAOA) and the Tryptophan Hydroxylase I and II (TPH1 and TPH2) genes.
None of the genetic markers within SLC6A4, MAOA, TPH1 and TPH2 were significantly associated with completed suicide or suicide method in the basic association tests. Exploratory interaction test showed that the minor allele of rs1800532 in TPH1 has a protective effect for males younger than 35 years and females older than 50 years, whereas for the oldest male subjects, it tended to be a risk factor. We also observed a significant interaction between age-group and the 5-HTTLPR genotype (with and without rs25531) in SLC6A4. The long allele or high expression allele tends to have a protective effect in the middle age-group.
We only analysed a limited number of genetic variants.
None of the analysed variants are strong risk factors. To reveal a better understanding of the genes involved in suicide, we suggest future studies should include both genetic and non-genetic factors.
BACKGROUND: Few studies have examined samples of people with cannabis-induced psychotic symptoms. AIMS: To establish whether cannabis-induced psychotic disorders are followed by development of persistent psychotic conditions, and the timing of their onset. METHOD: Data on patients treated for cannabis-induced psychotic symptoms between 1994 and 1999 were extracted from the Danish Psychiatric Central Register. Those previously treated for any psychotic symptoms were excluded. The remaining 535 patients were followed for at least 3 years. In a separate analysis, the sample was compared with people referred for schizophrenia-spectrum disorders for the first time, but who had no history of cannabis-induced psychosis. RESULTS: Schizophrenia-spectrum disorders were diagnosed in 44.5% of the sample. New psychotic episodes of any type were diagnosed in 77.2%. Male gender and young age were associated with increased risk. Development of schizophrenia-spectrum disorders was often delayed, and 47.1% of patients received a diagnosis more than a year after seeking treatment for a cannabis-induced psychosis. The patients developed schizophrenia at an earlier age than people in the comparison group (males, 24.6 v. 30.7 years, females, 28.9 v. 33.1 years). CONCLUSIONS: Cannabis-induced psychotic disorders are of great clinical and prognostic importance.
The aim of this study was to examine changes in the distribution of causes of death and mortality rates among psychiatric patients visiting a psychiatric emergency room (PER), to determine clinically useful predictors for avoiding premature mortality among these patients and to discuss possible interventions.
The study was designed as a historical prospective record linkage study of patients with at least one visit to a Danish PER in 1995-2007. Five consecutive 3-year cohorts of individuals aged 20 to
Tønder, Distriktspsykiatrisk Center, København, Videnscenter for Socialpsykiatri, og Arhus Universitetshospital, Psykiatrisk Hospital i Arhus, Afdeling for Psykiatrisk Demografi, Risskov. jag@psykiatri.aaa.dk
INTRODUCTION: A Crisis Home programme inspired by the principles of the Assertive Community Treatment (ACT) model in U.S. psychiatry, in which adult psychiatric patients, as an alternative to admission to hospital, spend some time in a private family has been implemented at the Community Mental Health (CMH) Centre in Tonder. MATERIALS AND METHODS: Procedures and schedules from the Crisis Home programme, Madison, were analysed. Data obtained at the start and end of each patient's stay were supplemented with register data on the consumption of mental hospital benefits. Qualitative data were obtained through focus group interviews. RESULTS: From 1 July 2001 to 30 June 2003, 41 patients made a total of 96 stays in a Crisis Home. Eight of the patients made more than 3 stays. Seventeen (41.5%) of the patients were attached to the CMH Centre's ACT team. These patients accounted for 43.8% of the stays. The average duration of the stays was 4.4 days. The number of patient readmissions after the first stay in a Crisis Home showed a downward tendency. The patients, the Crisis Home families and the associated professionals were all very satisfied with the programme. DISCUSSION: The possibility to stay in a Crisis Home has the potential to ameliorate the condition and reduce the risk of readmission of patients suffering from severe mental illness. We suggest that a stay in a Crisis Home represents an improvement in quality of the total treatment package; however, further documentation, including of the health economic aspects, will require a randomised trial.
The efficacy of psychoeducation is well documented in the treatment of relapse prevention of schizophrenia, and recently also in bipolar disorder; however, for recurrent depression only few controlled studies focusing on the efficacy of psychoeducation have been conducted.
This randomized study tests the efficacy of treatment-as-usual supplemented with a psychoeducative programme for patients with recurrent depression, treated at Community Mental Health Centres (CMHC) in Denmark. The primary outcome measurements concern was decline in consumption of psychiatric inpatient services and decline in Beck's Depression Inventory (BDI).
Eighty patients were randomized, either to the psychoeducative programme (consisting of eight sessions, each of 2?hours duration) and 2-year outpatient follow-up (42 cases), or only to 2-year outpatient follow-up (38 controls). The patients were monitored during 2 years after randomization. Data were collected from interviews including BDI, drug treatment and social measurements, and register data concerning use of psychiatric services.
At 2-year follow-up, a significant reduction in the consumption of psychiatric inpatient services and in BDI was found; however, it was uniform for case and control patients. Drop-out/non-compliance was significantly more frequent among patients randomized to the control group. Furthermore, during follow-up the case group got a significant stronger attachment to the Labour market than the control group.
The primary hypothesis could not be confirmed. Secondary outcome measurements concerning drop-out/non-compliance and attachment to the Labour market were significantly in favour of cases.
The proposed revision of the ICD-10 category of 'acute and transient psychotic disorders' (ATPDs), subsuming polymorphic, schizophrenic or predominantly delusional syndromes, would restrict their classification to acute polymorphic psychotic disorder, reminiscent of the clinical concepts of bouffée délirante and cycloid psychosis.
We selected all subjects aged 15-64 years (n = 5,426) who were listed in the Danish Psychiatric Central Register with a first-admission diagnosis of ATPDs in 1995-2008 and estimated incidence rates, course and outcome up to 2010.
Although about half of ATPD patients tended to experience transition to another category over a mean follow-up period of 9.3 years, acute polymorphic psychotic disorder fared better in terms of cases with a single episode of psychosis and temporal stability than the subtypes featuring schizophrenic or predominantly delusional symptoms. Acute polymorphic psychotic disorder was more common in females, while cases with acute schizophrenic features predominated in younger males and evolved more often into schizophrenia and related disorders.
These findings suggest that acute polymorphic psychotic disorder exhibits distinctive features and challenge the current approach to the classification of ATPDs.
The purpose of this study was to investigate the increased risk for pulmonary embolism (PE) in patients with manic-depressive psychosis/bipolar disorder (BD). Affective patients show increased mortality compared with the background population.
A register study was carried out in which somatic and psychiatric information in 25,834 BD patients and 117,815 controls was extracted from The Danish Psychiatric Central Research Register, The National Register of Patients, The Danish Central Person Register and The Danish Register of Causes of Death, with similar information about patients with schizophrenia and anxiety for comparison.
Patients with BD had a significantly increased occurrence of PE [increased incidence rate ratio (IRR)=1.61; 95% confidence interval (CI) (1.38, 1.88)]. An association was also found in schizophrenic patients [IRR=1.78; 95% CI (1.27, 2.51)] and in anxiety patients [IRR=1.49; 95% CI (1.10, 2.02)].
Increased occurrence of PE in patients with BD is one of the explanations of increased mortality in the affective patient group. A similar finding in females with schizophrenia and females with anxiety suggests 'mental disorder' as the risk factor for PE. The causes for the increased occurrence of PE in BD patients (and other diagnostic groups) need further investigation.
Depression is associated with coronary artery disease, and atherosclerosis seems to play a central role in this relation. In several studies, multislice computed tomography (CT) has been applied for detection and quantification of coronary artery calcification (CAC) in relation to depression. To our knowledge, only one previous study has investigated the relation between CAC and depression in an unselected population.
A total of 617 persons were randomly selected from the background population. The participants underwent CT of the heart and were screened for depression by use of the Major Depression Inventory questionnaire. Quantification of CAC was performed using the Agatston method. The Mann-Whitney U test, Spearman's correlational analysis, and logistic regression were used to assess the association between depression and CAC.
The median Agatston score was not significantly different in subjects with depression than in those without depression (p = 0.783), and depression scores did not correlate significantly with Agatston scores (r = 0.023; 95% CI: -0.056-0.102; p = 0.573). This was also the case when correlational analyses were stratified by sex or age. Furthermore, after the exclusion of an outlier, no significant association between CAC and depression was found in either the unadjusted or adjusted logistic regression model, OR = 1.00 (95% CI: 0.88-1.14; p = 0.994) and OR = 1.04 (95% CI: 0.92-1.18; p = 0.529), respectively.
Depression was not associated with CAC in an unselected middle-aged population, although a trend-level association was found in men (p = 0.086).
To examine the temporal stability of the category 'acute and transient psychotic disorders' (ATPDs), ICD-10 Classification of Mental and Behavioural Disorders, including subtypes characterised by polymorphic, schizophrenic and predominantly delusional features.
We checked the readmission patterns of all patients aged 15-64 years (n = 5426), whether admitted to hospital or treated as outpatients, who were enrolled for the first time in the Danish Psychiatric Register with a diagnosis of ATPDs between 1995 and 2008.
An increasing number of cases with ATPDs changed diagnosis in subsequent admissions after 1, 2 and 5 years, mainly either to schizophrenia and related disorders or affective disorders. In their last admission, on average after 7.3 years, there were 2429 patients listed with ATPDs, accounting for an overall stability of 44.8%. Females were less likely than males to develop another diagnosis. Among the ATPD subtypes, polymorphic psychotic disorder without schizophrenic symptoms had a higher stability than those featuring schizophrenic or predominantly delusional features.
The low diagnostic stability of ATPDs reflects the lack of clearly defining features and argues against their validity as a distinct category.
Prevalence of mental disorders at work is commonly reported on the subclinical level. Data on clinical caseness as to ICD-10 among employees is scarce.
(i) To establish the prevalence of psychiatric morbidity in the Danish workforce in large enterprises based on a self-report measure. (ii) To verify the screening results by use of a structured diagnostic interview. (iii) To analyze associations with demographics and work- and health-related characteristics.
A two-phase design study was carried out in three Danish counties. Ten large enterprises within private and public sectors participated. A questionnaire was administrated to 1,500 employees. The Present State Examination (PSE) interview was conducted with selected respondents according to their scores on Symptom Checklist 90-revised (SCL-90R) and CAGE.
Nine hundred and seventy six (65%) employees responded. A large proportion (28.6%) was identified as sub-cases and 77 as cases as to ICD-10. Absenteeism and work dissatisfaction were associated with ICD-10 diagnoses.
Common mental disorders caseness as to ICD-10 provides evidence for the clinical nature of occupational mental health phenomena. There were strong associations between some demographic and work- and health-related factors.
