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.
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.
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
Psychotic and mixed affective episodes are prevalent in the course of bipolar disorder. Despite many studies on the implications of psychotic mania (PM), psychotic depression (PD) and mixed affective episodes (MAE), relatively little is known about the relationship between the three subtypes. The present study aimed to investigate whether the occurrence of PM, PD and MAE were associated with one another.
This is a nationwide register-based, historical prospective cohort study. Data was obtained from the Danish Psychiatric Central Research Register. Subjects were defined as all individuals assigned with an ICD-10 diagnosis of bipolar disorder between January 1st 1994 and December 31st 2010. Potential associations among psychotic and mixed affective episodes were tested by means of logistic regression.
We identified 14,529 individuals with bipolar disorder with lifetime incidences of PM, PD and MAE of 19%, 15% and 17% respectively. We detected significant associations between PM and MAE (Adjusted Odds Ratio (AOR)=1.26, p=0.003), PD and MAE (AOR=1.24, p=0.001), and PM and PD (AOR=1.28, p=0.005).
Diagnoses were assigned as part of routine clinical practice.
According to this register-based study, PD, PM and MAE are all associated with one another. This knowledge should be taken into consideration by clinicians when monitoring patients with bipolar disorder and by nosologists when defining the criteria and potential subtypes for mixed affective episodes for the upcoming DSM-5 and ICD-11.
Severe unipolar depression can be classified as either psychotic depression (PD) or non-psychotic depression (non-PD). A number of biological and clinical differences have been detected between PD and non-PD, but it remains unknown whether risk factors for the two subtypes also differ. The aim of the present study was therefore to investigate whether a number of potential risk factors influenced the risk of developing PD and non-PD to different extents.
This is a register-based historical prospective cohort study following all 2.4 million individuals born in Denmark between 1955 and 1990. During follow-up 2183 and 9101 individuals were registered in the Danish Psychiatric Central Research Register with PD and non-PD respectively. The association between risk factors and the development of PD and non-PD was estimated by survival analysis (Poisson regression) and expressed as incidence rate ratios (IRR).
The most consistent finding of the study was that of a general overlap in familial and environmental risk factors for PD and non-PD. However, a parental history of bipolar disorder was a risk factor for PD (mother, IRR=1.66, p=0.003. Father, IRR=1.56, p=0.040) and not for non-PD (mother, IRR=0.92, p=0.430. Father, IRR=1.08, p=0.552). Conversely, a positive family history of schizophrenia was associated with neither PD nor non-PD LIMITATIONS: Diagnoses were assigned as part of routine clinical practice.
Our findings justify the distinction between PD and non-PD in the current diagnostic manuals. Furthermore, the fact that parental bipolar disorder and not schizophrenia was a risk factor for PD supports the Kraepelinian dichotomy.
Attention deficit hyperactivity disorder (ADHD) is a common mental disorder associated with factors that are likely to increase mortality, such as oppositional defiant disorder or conduct disorder, criminality, accidents, and substance misuse. However, whether ADHD itself is associated with increased mortality remains unknown. We aimed to assess ADHD-related mortality in a large cohort of Danish individuals.
By use of the Danish national registers, we followed up 1·92 million individuals, including 32,061 with ADHD, from their first birthday through to 2013. We estimated mortality rate ratios (MRRs), adjusted for calendar year, age, sex, family history of psychiatric disorders, maternal and paternal age, and parental educational and employment status, by Poisson regression, to compare individuals with and without ADHD.
During follow-up (24·9 million person-years), 5580 cohort members died. The mortality rate per 10,000 person-years was 5·85 among individuals with ADHD compared with 2·21 in those without (corresponding to a fully adjusted MRR of 2·07, 95% CI 1·70-2·50; p
Comment In: Lancet. 2015 May 30;385(9983):2132-325726517
Abstract Objective. Screening for a major depressive episode (MDE) in high-risk groups of patients within the primary care setting has been suggested by several Central Health Organizations. The objective of this study was to investigate whether patients rated as "psychiatric cases" by their general practitioner (GP) were likely to suffer from MDE and therefore qualified for systematic diagnostic screening. Design. Cross-sectional survey of primary care patients assessed through depression screening questionnaires and GP consultations. Setting. A total of 676 general practices in Denmark, Finland, Norway, and Sweden. Subjects. A total of 8879 unselected primary care patients. Main outcome measures. Sensitivity, specificity, and Youden Index of the GPs' diagnoses of depression and psychiatric caseness versus patients' MDE status. Results. The proportion of primary care patients receiving a false-positive diagnosis of depression by their GP ranged from 12.4% to 25.2% depending on country. The corresponding numbers for the false-negative diagnoses were 0.5-2.5%. Among patients with MDE, GPs recognize the disease in 56-75% of cases. However, GPs recognize as many as 79-92% of patients with MDE as "psychiatric cases". Conclusions. This report confirms that misclassifications of MDE are common in the primary care setting. In addition, it shows that psychiatric caseness is a valid marker for the presence of MDE in primary care patients. This relationship should be considered in future screening recommendations.
Denmark has been pioneering international psychiatric register research for decades. In this article we review central publications, by Danish and international authors, based on data from the Danish Psychiatric Central Research Register and other related registers.
Our aim was to describe the history, development and achievements of psychiatric research, based on the Danish national registers. The studies considered in this review can be categorized as follows: i) health service research, mainly studies on prevalence and incidence, ii) studies on the outcome of mental disorders, iii) studies on the aetiology of mental disorders.
Studies based on Danish registers have provided significant contributions to international psychiatric research. The major advantage of the registers is that they cover the entire population, which makes the conduction of nationwide population-based studies possible. Furthermore, all information in the registers is connected to each citizen's unique personal identification number, which enables linkage between various registers and biobanks. Such linkage studies have provided important knowledge on the aetiology of mental disorders. Despite inherent limitations about internal and external validity, the Danish national registers have been extremely valuable to international psychiatric research and will continue to play an important role in years to come.
Unit for Psychiatric Research, Aalborg Psychiatric Hospital, Aalborg University Hospital, Aalborg, Denmark; Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark; Depression Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
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.
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).
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
Psychotic depression (PD) is a prevalent, severe, under-diagnosed and often inadequately treated mental disorder, which has received disproportionally little attention by clinicians, researchers and the pharmaceutical industry. Consequently, the evidence base for optimal clinical practice regarding PD is limited. The aim of this study was to investigate the degree of consensus among international treatment guidelines on PD and to determine whether a potential lack of consensus would be reflected in the clinical practice of Danish psychiatrists.
1. Review and comparison of international guidelines on the treatment of PD. 2. Questionnaire based survey regarding Danish psychiatrists' treatment of PD.
The nine international treatment guidelines considered in the review have contrasting opinions on the optimal treatment for PD: 6 of 9 suggest antidepressant (AD)+antipsychotic (AP) combination therapy, 3 of 9 recommend AD monotherapy and 5 of 9 find electroconvulsive therapy (ECT) equally appropriate as first line treatment. The 113 surveyed psychiatrists displayed the same lack of consensus. Their preferred treatment was either AD+AP combination therapy (42%), AD monotherapy (31%) or ECT (21%). The first line choices of ADs and APs were tricyclic antidepressants (51%) and quetiapine (62%), respectively.
The survey data are subjected to a potential selection bias as the respondents are likely to represent the more informed fraction of psychiatrists.
Our results indicate that both treatment algorithms and clinical practice regarding PD are highly heterogeneous. This finding emphasizes the need for further studies on the treatment of psychotic depression.
In bipolar disorder, treatment with antidepressants without concomitant use of mood stabilisers (antidepressant monotherapy) is associated with development of mania and rapid cycling and is therefore not recommended. The present study aimed to investigate the psychopharmacological treatment patterns in bipolar disorder over time, with a focus on antidepressant monotherapy.
Cohort study with annual cross-sectional assessment of the use of psychotropic medications between 1995 and 2012 for all Danish residents aged 10 years or older with a diagnosis of bipolar disorder registered in the Danish Psychiatric Central Research Register. Users of a given psychotropic medication were defined as individuals having filled at least one prescription for that particular medication in the year of interest.
We identified 20 618 individuals with bipolar disorder. The proportion of patients with bipolar disorder using antidepressants, atypical antipsychotics and anticonvulsants increased over the study period, while the proportion of patients using lithium, typical antipsychotics and benzodiazepines/sedatives decreased. The proportion of patients treated with antidepressant monotherapy decreased from 20.5% in 1997 to 12.1% in 2012, and among antidepressant users, the proportion in monotherapy decreased from 47.7% to 23.9%, primarily driven by a decrease in the use of tricyclic antidepressants.
The results show an increase in the proportion of patients with bipolar disorder being treated with antidepressants in the period from 1997 to 2012. However, in accordance with international treatment guidelines, the extent of antidepressant monotherapy decreased during the same period.