This paper describes the admission and discharge pattern in Danish psychiatric hospitals for first-ever admitted demented patients (290, 293.09, 293.19 ICD-8) aged 65 years and over admitted in the period 1972 to 1988. The results are based on data from the Danish Psychiatric Register. The admission rate, the commitment rate and the length of stay decreased significantly from 1972 to 1988. The readmission frequency did not change during the period. A significantly increasing proportion of the patients were admitted from somatic hospitals, and there was a tendency to a higher discharge rate to somatic hospitals. Two factors may have caused the decline in admission rate, the improvement of the psychogeriatric services in the eighties and the decline in the number of psychiatric beds. The psychiatric hospitals no longer serve as nursing homes for demented patients. The results also seem to indicate that for institutional care for demented patients may have been transferred from the psychiatric hospitals to other services e.g. the somatic departments and nursing homes.
There is an emerging literature linking cognitive ability with a wide range of psychiatric disorders. These findings have led to the hypothesis that diminished 'cognitive reserve' is a causal risk factor for psychiatric disorders. However, it is also feasible that a family history of mental disorders may confound this relationship, by contributing to both a slight impairment in cognitive ability, and an increased risk of psychiatric disorder. On the basis of a large, population-based sample of young adult male conscripts (n=160?608), we examined whether the presence of a family history of a range of mental disorders was associated with cognitive ability, as tested by the Børge Priens Prøve. In those with no individual-level history of mental disorder, a family-level history of a mental disorder was associated with a slight reduction in cognitive ability. In general, this pattern was found regardless of the nature of the psychiatric disorder in the family. Our study suggests that shared familial factors may underpin both cognitive ability and the risk of a wide range of psychiatric disorders. Convergent evidence from epidemiology and genetics suggests that shared genetic factors underpin an unexpectedly diverse range of psychiatric disorders. On the basis of the findings of the current study, we speculate that these same shared genetic factors also contribute to general cognitive ability.
Cites: Scand J Public Health. 2011 Jul;39(7 Suppl):54-721775352
Cardiovascular (CV) co-morbidity is one of the major modifiable risk factors driving the excess mortality in individuals with schizophrenia or bipolar disorder. Population-based studies in this area are sparse.
We used Danish population registers to calculate incidence rate ratios (IRRs) for CV drug use, and mortality rate ratios comparing subjects with schizophrenia or bipolar disorder with subjects with no prior psychiatric hospitalization.
IRRs for CV prescriptions were significantly decreased in patients with schizophrenia or bipolar disorder compared with the general population. Among persons without previous myocardial infarction (MI) or cerebrovascular disease, persons with schizophrenia or bipolar disorder had an up to 6- and 15-fold increased mortality from all causes or unnatural causes, respectively, compared with the general population, being most pronounced among those without CV treatment (16-fold increase). Among those with previous MI or cerebrovascular disease, excess all-cause and unnatural death was lower (up to 3-fold and 7-fold increased, respectively), but was similar in CV-treated and -untreated persons.
The present study shows an apparent under-prescription of most CV drugs among patients with schizophrenia or bipolar disorder compared with the general population in Denmark. The excess of mortality by unnatural deaths in the untreated group suggests that the association between CV treatment and mortality may be confounded by severity of illness. However, our results also suggest that treatment of CV risk factors is neglected in these patients.
Clinically derived measures of the initial course of episodes might reflect a process of sensitisation in affective disorder. However, the clinical consequences of such measures have not been investigated. The predictive effect of measures of the initial course of episodes was investigated in relation to the subsequent risk of alcoholism, dementia, death and suicidal attempts/suicide in a case register study including all hospital admissions with primary affective disorder in Denmark from 1971 to 1993. A total of 8737 patients with more than one episode were included in the analyses. A short period between initial episodes of the illness, reflecting a great intensity of illness, predicted increased risk of subsequent development of dementia, and for unipolar patients, decreased risk of subsequent alcoholism. Surprisingly, a progressive course, with decreasing intervals between initial episodes of the illness, had no predictive effect. Similarly, no predictive effects on the risk of death or suicidal acts could be demonstrated with any measure of the initial course of episodes.
The observation of a progressive recurrence in affective disorder has been interpreted as a process of sensitisation. The clinical applicability of such a theoretical model was investigated using the Danish case register, which includes all hospital admissions with primary affective disorder in Denmark from 1971 to 1993. A total of 8,737 patients admitted to a psychiatric hospital at least twice constituted the study sample. Information on treatment intervention was not available. Measures describing the initial course of admission episodes were defined in three different ways: 1) a short period between initial episodes 2) decreasing intervals between initial episodes or 3) a combination of 1) and 2). Socio-demographic variables such as gender, age at onset and marital status differentiated between the three types of measures and the measures also demonstrated different effects in predicting the risk of further recurrence. In unipolar disorder, patients with a decreasing interval between episodes had the greatest risk of further recurrence, whereas for bipolar patients, a short period between episodes played a more important role than the sequence of episodes in itself.
BACKGROUND: Women with schizophrenia have increased exposure to risk factors for congenital malformations, stillbirths, and infant deaths among their children. However, the occurrence of these outcomes is unknown. METHODS: The risks of stillbirth and infant death among 2230 children of women with schizophrenia were compared with the risks among 123 544 children in the general population. The risk of congenital malformations among 746 children of women with schizophrenia were compared with the risk among 56 106 children in the general population. The year of birth, the sex of the child, the mother's age, and parity were included in the analyses as potential confounders. We had no information about socioeconomic status, smoking status, substance abuse, or psychotropic medication use. RESULTS: Children of women with schizophrenia had increased risk of postneonatal death (relative risk [RR], 2.76; 95% confidence interval [CI], 1.67-4.56). This was largely explained by an increased risk of sudden infant death syndrome (RR, 5.23; 95% CI, 2.82-9.69). There was no statistically significant increased risk of stillbirth (RR, 1.51; 95% CI, 0.94-2.40) or neonatal death (RR, 1.26; CI, 0.77-2.06). Children of women with schizophrenia had a marginally statistically significant increase in the risk of congenital malformations (RR, 1.70; 95% CI, 1.04-2.77). CONCLUSIONS: Children of women with schizophrenia have a considerable increased risk of death caused by sudden infant death syndrome. However, the results should be interpreted in the light of failure to adjust for socioeconomic status, substance abuse, smoking status, and psychotropic medication use.
The Danish Psychiatric Central Register contains information dating from the 19th century; data were collected systematically from 1938. As of 1969 data on psychiatric admissions has been computerized and includes all admissions to psychiatric hospitals and psychiatric wards in general hospitals in Denmark, the Faroe Islands, and Greenland. Since January 1, 1995 information about all psychiatric outpatient contacts has been included. Among the advantages of the register are the close collaboration with the reporting hospitals and departments as well as its organization within the psychiatric epidemiological and social psychiatric research unit, Department of Psychiatric Demography. This has resulted in an intensive utilization of data from the register for research both in the department in other Danish and international research institutes the latter performed in collaboration with the department. Register research ranges from simple studies on prevalence to exploration of the longitudinal course in mental diseases, analyses of secular trends in different groups of disorders and recent linkage studies of risk factors for mental disorders. Recently, large data bases on the basis of data from The Psychiatric Central Register and from a number of other health related registers have been established. A linkage between The Psychiatric Central Register and various social registers is developing as is the development of quality assurance data bases.
The electronic part of the nationwide Danish Psychiatric Central Register is now almost 25 years old. In this period it has proved its high value in administration, planning, treatment of patients, and not least in psychiatric research. Due to its national coverage, the register makes it easy to conduct epidemiological studies, such as analysis of trends, register linkage research, identification of representative cohorts for further analysis and follow-up studies of clinically identified cohorts. After many years of political turmoil, the register now seems to have assumed a more reasonable form, making allowance for both research interest and data protection. A proposed directive on the protection of medical data from the European Community may be a serious threat to the register and will probably eliminate all epidemiological and clinical research based on registers.
The present study tests the hypothesis of a negative association between patients with schizophrenia, manic-depressive psychosis and acute appendicitis. Using the nation-wide Danish case registers the occurrence of acute appendicitis among up to 20,402 inpatients with schizophrenia and up to 10,281 inpatients with manic-depressive psychosis and ten individually matched control persons for each psychiatric patient was investigated. A case-control and follow-up design was applied. Persons who developed schizophrenia had a significantly decreased relative risk of acute appendicitis of 0.49 before and of 0.59 after first psychiatric admission. Similarly the occurrence of manic-depressive psychosis was associated with a decreased relative risk of acute appendicitis of 0.50 before and of 0.70 after first psychiatric admission. One or more unknown factors inversely affect the risk for the subsequent development of psychoses and acute appendicitis. Further studies of this relationship may help to clarify etiological or pathophysiological aspects of schizophrenia and manic-depressive psychosis.
OBJECTIVE: The aim of the study was to investigate whether patients with affective disorder have increased risk of developing dementia compared to other groups of psychiatric patients and compared to the general population. METHOD: In the Danish psychiatric central register, 3363 patients with unipolar affective disorder, 518 patients with bipolar affective disorder, 1025 schizophrenic and 8946 neurotic patients were identified according to the diagnosis at the first ever discharge from psychiatric hospital during the period from 1970 to 1974. The rate of discharge diagnosis of dementia on readmission was estimated during 21 years of follow-up. In addition, the rates were compared with the rates for admission to psychiatric hospitals with a discharge diagnosis of dementia for the total Danish population. RESULTS: Patients with unipolar and with bipolar affective disorder had a greater risk of receiving a diagnosis of dementia than patients with schizophrenia and those with neurosis. All groups of patients had a higher risk of being given a diagnosis of dementia than gender- and age-matched samples of the general population. CONCLUSION: Patients with affective disorder appear to be at increased risk of developing dementia.