BACKGROUND: The prevalence in Norwegian prisons of psychiatric disorders in relation to the treatment potential in the prison health system has not been properly examined. MATERIAL AND METHOD: The prevalence of psychiatric disorders, drug problems and personality disorders was examined in a prison population in the western health region in Norway. Additionally, treatments of these disorders were surveyed. The methods used were structured clinical interviews, self reports and reviews of medical case notes. RESULTS: Psychiatric disorders in need of treatment were found in 18 out of 40 interviewed inmates. Of these 18, 13 actually received treatment with psychoactive medication. Criteria for alcohol and drug addiction or misuse were fulfilled by over 90%. Personality disorders were found in 80% and antisocial personality disorder in more than 60%. INTERPRETATION: The prevalence of psychiatric disorders including personality disorders and drug addiction is high among inmates. Compared to international studies, more of the inmates with psychiatric disorders that we interviewed receive psychoactive medication.
Comment In: Tidsskr Nor Laegeforen. 2004 Aug 26;124(16):207915334117
The level of use of coercive measures in patients diagnosed with a schizophrenia-spectrum disorder at their first contact with the psychiatric services system in Denmark is not known. The aim of the study was to investigate the level of use of coercive measures during first year of contact in this group of patients. Using the longitudinal national registers, the use of coercive measures for each individual was calculated in a 1-year period from 1 January 1999 to 31 December 2001, for patients in Denmark who at their first contact with the psychiatric services system were diagnosed within the schizophrenia-spectrum (F2 in ICD 10); 2222 patients were identified. The mean age was 30.7 years and 63.6% were males; 554 patients (24.9%) experienced use of coercive measures. A total of 222 patients (10.0%) were admitted involuntarily, 308 (13.9%) were detained. Seventy-two patients (3.2%) were treated involuntarily with anti-psychotic medication and 158 (7.1%) with sedative medication. A total of 241 patients (10.8%) were restrained with a leather belt, and 84 patients (3.8%) with a leather belt and strap(s). The mean duration of involuntary admission was 30.3 days. The mean duration of restraint with a leather belt was 2.66 days. This study provides information about the level of use of coercive measures in first-episode schizophrenia-spectrum disorders in Denmark.
The aim of this study is to investigate incidence rates, treatment, and outcome of a total in- and outpatient population of 71 patients (of 18-45 years of age) treated for a first-episode psychosis (DSM-IV) in three catchment areas in Stockholm.
The study is based on the investigation of records and databases and on information by staff members and patients.
The incidence rate was 34.8 per 100,000 inhabitants (aged 18-45 years) and 16.5 per 100,000 inhabitants (total population). Sixty percent were diagnosed with schizophrenia syndromes. At 5-year follow-up, 73 % of the patients in the schizophrenia syndromes group versus 47% of the non-schizophrenia group had a sick pension or were on long-term sick leave. Nine percent of the schizophrenia patients and 39% of the non-schizophrenia psychosis patients were rated as not being in need of treatment. Non-compliance of medication was present in one-third of those patients prescribed neuroleptic medication. Seven percent had never received neuroleptic medication, all of whom were rated as ill at the 5-year follow-up.
Incidence of treated first-episode psychosis is higher than has earlier been found, when exclusively outpatient treated individuals are also included. The social outcome is negative, even in the non-schizophrenia group. Non-compliance with medication and insufficient clinical follow-up may have worsened the results.
The aim of this article is to describe the prevalence of mental disorders in the elderly and how the psychiatric services for these patients ought to be organized in Norway. Geriatric psychiatry is a special branch of psychiatry. Its areas of concern are the assessment and treatment of mental disorders which frequently occur in the elderly. The most prevalent psychiatric disorders are depression and dementia. Functional psychosis and anxiety disorders are less prevalent, but nevertheless disorders causing great concern. Psychiatric morbidity frequently coexists with physical illness. An elderly patient suffering from a mental disorder often has a combination of psychological, social and physical needs. The resources allocated to psychiatric services for old people are scarce. Efforts should be made to establish a special unit for geriatric psychiatry in every county in Norway. Each unit should serve approximately 150-200,000 inhabitants, and should consist of both an in-patients' and an out-patients' clinic. It is recommended that there should be 1 to 1.5 beds per 1000 elderly aged 65 years and over.
The Danish Medico-Legal Council provides the court with statements based on available psychiatric assessment reports to assist the law in the use of the Penal Code sections on mentally disordered offenders.
To analyse the impact of the Council on the courts' choice between punishment and treatment in cases of offenders falling under §69 of the Penal Code, i.e. mentally disordered, although not psychotic offenders.
In 298 cases of defendants who according to the Medico-Legal Council might fall under §69 the recommendations of the assessment reports, the recommendations of the Council and the final verdicts are compared; and assessment reports from forensic psychiatric centres are compared with those from other psychiatrists.
The recommendations of the Medico-Legal Council were often, but not blindly followed by the courts. The probability for the Council to recommend some measure of treatment was about 50% for adult males, and higher for adolescents and for females. In court, however, the two genders as well as adolescents and adults alike all had the same probability, approximately 50%, of being sentenced with treatment instead of punishment. When measured by the final verdict, the Medico-Legal Council is of higher quality than the assessment reports, especially those from outside forensic psychiatry.
The Council serves as a quality assurance of Danish forensic psychiatric assessments, and the Council's statements are by the court considered to represent the state of the art of these assessments.
The treatment of choice for cycloid psychosis has traditionally been electroconvulsive therapy (ECT), but there is a lack of studies on its effectiveness.
The primary aim of this register study was to determine the rates of remission and response after ECT for cycloid psychosis. The secondary aim was to examine possible predictors of outcome.
Data were obtained from the National Quality Register for ECT in Sweden. The study population was patients (n?=?42) who received ECT for acute polymorphic psychotic disorder without symptoms of schizophrenia or for cycloid psychosis between 2011-2015 in 13 hospitals. Remission and response rates were calculated using Clinical Global Impression-Severity (CGI-S) and -Improvement scores, respectively. Variables with possible predictive value were tested using Chi-square and Fisher's exact test.
The response rate was 90.5%. The remission rate was 45.2%. Of 42 patients, 40 improved their CGI-S score after ECT (p?
BACKGROUND: Surveys of serious mental disorders in prisons in the western world show high prevalences; on average 4% with psychosis, 10% with major depression, and 65% with personality disorders among male inmates. A few investigations in Norwegian prisons indicate a similar tendency. MATERIAL AND METHODS: With participation from prisons with 2850 inmates of a national total of 3000 (95%), we recorded prevalence and severity of psychiatric illnesses, other behavioural disorders, and treatment facilities available during the term served. We asked four vocational groups in each prison to reply, independently of each other, to ten semi-structured questions about these items. The groups were: prison management, guards, affiliated primary health services, and affiliated psychiatric services. RESULTS: Guards reported the highest prevalences, followed by the primary health services, then prison management; the lowest prevalence was reported by the psychiatric services. 23.5% of inmates received some kind of treatment for psychiatric disorders. INTERPRETATION: On a national scale, the average prevalence estimates for psychosis and major depression seem somewhat lower than in international surveys. Reasons for the differences in reported estimates among the vocational groups are discussed. The groups seem to have given pragmatic numbers for what they consider to be "first needs".
Comment In: Tidsskr Nor Laegeforen. 2004 Aug 26;124(16):207915334117
BACKGROUND: No apt method has been available to assess and monitor the responsiveness of services in meeting ongoing needs of patients with long-term mental illness. The present study examines the utility of a new metric for such a purpose, the Met Needs Index (MNI), applied to the Camberwell Assessment of Need (CAN). METHODS: The MNI was estimated as an aggregated measure of met need or beneficial outcome, based on annual staff rated CAN-assessments of 321 outpatients (76% psychotic disorders) in psychiatric care during 7 years. Corresponding confidence intervals were estimated with the bootstrap percentile method. RESULTS: The overall MNI was estimated at 0.71 (95% CI 0.69-0.74), indicating that identified needs in general were met during 71% of the intervals between the annual assessments. However, the MNI for specific need domains of the CAN ranged from 0.89 (95% CI 0.84-0.93) for 'food' to 0.11 (95% CI 0.07-0.16) for 'sexual expression', indicating a significant variation in responsiveness of services to different types of need in this patient population. CONCLUSIONS: The MNI seems to be a useful and powerful metric for outcome assessment and monitoring of psychiatric services from a needs assessment approach.