The aim of this study was to investigate women who had first-episode psychosis within 1 year afte... more The aim of this study was to investigate women who had first-episode psychosis within 1 year after parturition. The Danish Psychiatric Central Register and the Danish Medical Birth Register were linked to identify all women admitted for the first time to a psychiatric department in Arhus County with a psychotic episode. Fifty cases were found, giving a frequency of first-episode psychosis within 1 year after delivery of 1 per 1000. First-episode psychotic disease within the first month postpartum occurred in 1 case per 2000 deliveries. The age distribution corresponded to that of the background population, but the cases were primiparous more often than expected. The socioeconomic status was equal to that of a matched control group of obstetric patients. Birth complications did not occur more frequently than expected, but the probands had a higher risk of preterm delivery than the controls. The clinical picture of the index episode was that of manic-depressive psychosis in nearly half of the cases, but no cases of schizophrenia were found. Sixty percent of the patients had a picture of severe depression, and 20% suffered from manic disorder. The follow-up, 7 to 14 years later, was carried out by interviewing the general practitioners. Forty percent of the women had not preserved full working capacity due to mental disorder. Moreover, the follow-up pointed to schizophreniform symptoms at the index episode as a predictor of incapacity to work. Recurrences were very common (60%), especially of the nonpuerperal type, and half of the recurrences belonged to the manic-depressive disorders.(ABSTRACT TRUNCATED AT 250 WORDS)
Psychotic depression is a severe and underdiagnosed psychiatric disorder, which differs from non-... more Psychotic depression is a severe and underdiagnosed psychiatric disorder, which differs from non-psychotic depression biologically, clinically, therapeutically and prognostically. Due to the differences in treatment and the higher risk of suicidal behaviour, the correct diagnosis is crucial. Patients with psychotic depression have an increased risk of a new episode and readmission. Treatment of psychotic depression takes place during hospitalisation and is either ECT or a combination of antidepressant treatment and antipsychotics, which is summarised in this review.
Antidepressants are widely used. All antidepressants are associated with side effects, and in thi... more Antidepressants are widely used. All antidepressants are associated with side effects, and in this review we therefore find it reasonable to reassess the indication for long-term use at least once a year. After remission of a depressive episode treatment should be continued for 6-9 months, and treatment should be continued longer for two years or more in the presence of risk factors for new depressive episodes. Antidepressants should be discontinued slowly and with caution in order to reduce the risk of discontinuation symptoms.
Benzodiazepines (BZ) are widely used for anxiety across psychiatric diagnoses, but for the last d... more Benzodiazepines (BZ) are widely used for anxiety across psychiatric diagnoses, but for the last decades regulation has been increasingly tight due to problems with tolerance, addiction, withdrawal symptoms and cognitive side effects. Some guidelines claim that BZ only work for a few weeks, and that BZ cause traffic accidents, increased mortality and dementia. In Denmark, the use of BZ has been substantially reduced. In this article it is argued, that not all patients habituate, that most of the epidemiological findings are hampered by confounding, and that there still is a role for long-term use of BZ in the treatment of anxiety.
Most patients treated with electroconvulsive therapy (ECT) develop cognitive and motor aspects of... more Most patients treated with electroconvulsive therapy (ECT) develop cognitive and motor aspects of delirium afterwards. These symptoms are often self-limiting, lasting 10 to 20 minutes. However, about 10% of these patients develop a state characterised by confusion, restlesness, repetitive movements, lack of response to commands and amnesia regarding the period. This state, called emergence delirium, usually has a short duration but may persist for hours. In the present case a 50-year-old woman had 18 ECT treatments for severe depression. She experienced excellent effects as regards the depressive symptoms, but postictally she developed all the above-mentioned symptoms of delirium, which lasted for several hours. The ECT continued, and the patient was successfully treated for the condition with administration of i.v. diazepam (5 mg) shortly after the end of each seizure.
A systematic review of the literature on modafinil as adjunctive treatment to antidepressants in ... more A systematic review of the literature on modafinil as adjunctive treatment to antidepressants in patients with major depression and residual symptoms of fatigue and drowsiness is presented. Several open-labelled studies have shown good results on treatment with modafinil. However, only a few randomised controlled clinical trials exist. These have methodological weaknesses and their results are contradictory. If modafinil is used in highly selected patients with severe fatigue its potential interactions with antidepressants must be borne in mind. Furthermore, discontinuation of the drug should be tried after a couple of months, as one study suggests that the effect wears off. In addition, the drug is rather expensive.
ObjectiveStudies on metabolic syndrome (MetS) in younger patients with depression are few. We exa... more ObjectiveStudies on metabolic syndrome (MetS) in younger patients with depression are few. We examined the prevalence and progression of MetS in first‐time hospitalized patients with depression during 1 year of follow‐up. Furthermore, we explored putative risk factors of MetS.MethodWe evaluated MetS and its components in first‐time hospitalized patients with depression (N = 52) and healthy controls (N = 50) (18–45 years). Physical activity, aerobic fitness, sleeping disturbances, smoking and dietary habits, and psychopharmacological treatment were recorded at baseline for all participants and after 1 year for the patients.ResultsPatients had significantly higher waist circumference (WC) and lower high‐density lipoproteins compared with healthy controls (P < 0.05). Patients had higher prevalence of MetS, but this was not significant when adjusted for age. Patients had significant increase in WC and triglycerides and a non‐significant increase in the prevalence of MetS. Antipsychot...
Preoperative anxiety is a common phenomenon. It is therefore necessary to investigate whether qua... more Preoperative anxiety is a common phenomenon. It is therefore necessary to investigate whether quantitative self-reporting anxiety scales can be helpful in the anaesthetic clinic and research. The aim of this study was to compare the state trait anxiety inventory (STAI), symptoms checklist 92 (SCL 92), the subscales anxiety and phobic anxiety, and a visual analogue scale for anxiety (VAS). Thirty-eight women consecutively referred for elective breast surgery filled in the rating scales the day before the operation. A statistically significant correlation was found between STAI, SCL 92, anxiety, and VAS. The patients' STAI and SCL 92 anxiety scores were markedly higher than that of the background population. In this study the STAI scale, SCL 92 anxiety, and VAS measure all essential features of the phenomenon. SCL 92 anxiety is nevertheless considered to be the most appropriate rating scale, because it has been validated in a Danish population.
The aim of this study was to investigate women who had first-episode psychosis within 1 year afte... more The aim of this study was to investigate women who had first-episode psychosis within 1 year after parturition. The Danish Psychiatric Central Register and the Danish Medical Birth Register were linked to identify all women admitted for the first time to a psychiatric department in Arhus County with a psychotic episode. Fifty cases were found, giving a frequency of first-episode psychosis within 1 year after delivery of 1 per 1000. First-episode psychotic disease within the first month postpartum occurred in 1 case per 2000 deliveries. The age distribution corresponded to that of the background population, but the cases were primiparous more often than expected. The socioeconomic status was equal to that of a matched control group of obstetric patients. Birth complications did not occur more frequently than expected, but the probands had a higher risk of preterm delivery than the controls. The clinical picture of the index episode was that of manic-depressive psychosis in nearly half of the cases, but no cases of schizophrenia were found. Sixty percent of the patients had a picture of severe depression, and 20% suffered from manic disorder. The follow-up, 7 to 14 years later, was carried out by interviewing the general practitioners. Forty percent of the women had not preserved full working capacity due to mental disorder. Moreover, the follow-up pointed to schizophreniform symptoms at the index episode as a predictor of incapacity to work. Recurrences were very common (60%), especially of the nonpuerperal type, and half of the recurrences belonged to the manic-depressive disorders.(ABSTRACT TRUNCATED AT 250 WORDS)
Psychotic depression is a severe and underdiagnosed psychiatric disorder, which differs from non-... more Psychotic depression is a severe and underdiagnosed psychiatric disorder, which differs from non-psychotic depression biologically, clinically, therapeutically and prognostically. Due to the differences in treatment and the higher risk of suicidal behaviour, the correct diagnosis is crucial. Patients with psychotic depression have an increased risk of a new episode and readmission. Treatment of psychotic depression takes place during hospitalisation and is either ECT or a combination of antidepressant treatment and antipsychotics, which is summarised in this review.
Antidepressants are widely used. All antidepressants are associated with side effects, and in thi... more Antidepressants are widely used. All antidepressants are associated with side effects, and in this review we therefore find it reasonable to reassess the indication for long-term use at least once a year. After remission of a depressive episode treatment should be continued for 6-9 months, and treatment should be continued longer for two years or more in the presence of risk factors for new depressive episodes. Antidepressants should be discontinued slowly and with caution in order to reduce the risk of discontinuation symptoms.
Benzodiazepines (BZ) are widely used for anxiety across psychiatric diagnoses, but for the last d... more Benzodiazepines (BZ) are widely used for anxiety across psychiatric diagnoses, but for the last decades regulation has been increasingly tight due to problems with tolerance, addiction, withdrawal symptoms and cognitive side effects. Some guidelines claim that BZ only work for a few weeks, and that BZ cause traffic accidents, increased mortality and dementia. In Denmark, the use of BZ has been substantially reduced. In this article it is argued, that not all patients habituate, that most of the epidemiological findings are hampered by confounding, and that there still is a role for long-term use of BZ in the treatment of anxiety.
Most patients treated with electroconvulsive therapy (ECT) develop cognitive and motor aspects of... more Most patients treated with electroconvulsive therapy (ECT) develop cognitive and motor aspects of delirium afterwards. These symptoms are often self-limiting, lasting 10 to 20 minutes. However, about 10% of these patients develop a state characterised by confusion, restlesness, repetitive movements, lack of response to commands and amnesia regarding the period. This state, called emergence delirium, usually has a short duration but may persist for hours. In the present case a 50-year-old woman had 18 ECT treatments for severe depression. She experienced excellent effects as regards the depressive symptoms, but postictally she developed all the above-mentioned symptoms of delirium, which lasted for several hours. The ECT continued, and the patient was successfully treated for the condition with administration of i.v. diazepam (5 mg) shortly after the end of each seizure.
A systematic review of the literature on modafinil as adjunctive treatment to antidepressants in ... more A systematic review of the literature on modafinil as adjunctive treatment to antidepressants in patients with major depression and residual symptoms of fatigue and drowsiness is presented. Several open-labelled studies have shown good results on treatment with modafinil. However, only a few randomised controlled clinical trials exist. These have methodological weaknesses and their results are contradictory. If modafinil is used in highly selected patients with severe fatigue its potential interactions with antidepressants must be borne in mind. Furthermore, discontinuation of the drug should be tried after a couple of months, as one study suggests that the effect wears off. In addition, the drug is rather expensive.
ObjectiveStudies on metabolic syndrome (MetS) in younger patients with depression are few. We exa... more ObjectiveStudies on metabolic syndrome (MetS) in younger patients with depression are few. We examined the prevalence and progression of MetS in first‐time hospitalized patients with depression during 1 year of follow‐up. Furthermore, we explored putative risk factors of MetS.MethodWe evaluated MetS and its components in first‐time hospitalized patients with depression (N = 52) and healthy controls (N = 50) (18–45 years). Physical activity, aerobic fitness, sleeping disturbances, smoking and dietary habits, and psychopharmacological treatment were recorded at baseline for all participants and after 1 year for the patients.ResultsPatients had significantly higher waist circumference (WC) and lower high‐density lipoproteins compared with healthy controls (P < 0.05). Patients had higher prevalence of MetS, but this was not significant when adjusted for age. Patients had significant increase in WC and triglycerides and a non‐significant increase in the prevalence of MetS. Antipsychot...
Preoperative anxiety is a common phenomenon. It is therefore necessary to investigate whether qua... more Preoperative anxiety is a common phenomenon. It is therefore necessary to investigate whether quantitative self-reporting anxiety scales can be helpful in the anaesthetic clinic and research. The aim of this study was to compare the state trait anxiety inventory (STAI), symptoms checklist 92 (SCL 92), the subscales anxiety and phobic anxiety, and a visual analogue scale for anxiety (VAS). Thirty-eight women consecutively referred for elective breast surgery filled in the rating scales the day before the operation. A statistically significant correlation was found between STAI, SCL 92, anxiety, and VAS. The patients' STAI and SCL 92 anxiety scores were markedly higher than that of the background population. In this study the STAI scale, SCL 92 anxiety, and VAS measure all essential features of the phenomenon. SCL 92 anxiety is nevertheless considered to be the most appropriate rating scale, because it has been validated in a Danish population.
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