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Highlights from the Nordic Journal of Psychiatry, Volume 75


The Nordic Journal of Psychiatry, formerly “Nordisk Psykiatrisk Tidsskrift”, is an international journal that publishes excellent psychiatric research with a broad scope. It is the official journal for the eight psychiatric associations in the Nordic and Baltic countries. It is a main source of information about current Nordic psychiatry and related fields, The journal is distributed to members of the Nordic and Baltic Psychiatric Associations as well as to members of Associations for Child and Adolescent Psychiatry. This gives access to all articles published in the journal from 1946.

ECT in clozapine resistant schizophrenia and non-clozapine resistant schizophrenia

There is limited evidence for different treatment strategies in patients with clozapine resistant schizophrenia (CRS). The study wished to determine the effectiveness of ECT in patients with clozapine resistant schizophrenia compared with a group of patients with non-clozapine resistant schizophrenia. Out of a total of 68 patients with schizophrenia, 27 patients had CRS. With 6 ECTs, there was a significant reduction in PANSS positive, negative, general psychopathology, prosocial score and depression symptoms in the CRS and Non-CRS group, but no statistically significant difference was seen between the 2 groups in terms of proportion of patients showing >40% response on PANSS total score. The authors conclude that ECT is an effective augmentation strategy for patients with CRS and it is as effective as when used in patients with non-CRS.

Grover S , Shouan A, Chakrabarti S, Sahoo S, Mehra A. Comparative study of effectiveness of augmentation with ECT in clozapine resistant schizophrenia (CRS) and non-clozapine resistant schizophrenia (Non-CRS). Nord J Psychiatry. 2021 Feb 25;1-17. doi:10.1080/08039488.2021. 877349. Online ahead of print. PMID: 33630681

Follow up on clinical and social situation after involuntary admission of homeless people with psychotic disorders

Mental illness is one of the main reasons for homelessness and some patients do not accept psychiatric treatment. The study examined changes after involuntary admissions of mentally ill homeless people with a longitudinal, naturalistic follow-up of patients who had been involuntarily admitted by the Homeless Outreach Psychiatric Service through 1 year. At baseline, 28 patients were included: 86% of them had been admitted before, 46% had a substance use, and 25% had prior been convicted of a violent crime. 89% of the patients were discharged to the streets. At 12 months, 50% of the patients had symptom reduction, 36% were in psychiatric treatment, and only 14% had acquired permanent housing. No improvements in substance use were observed and 11% of the patients had new convictions after 12 months. During the study period, a total of 24 readmissions distributed on 14 patients was found. The authors conclude that Involuntary admissions can be an effective treatment of psychiatric aspects of mentally ill homeless patients. Unfortunately, a substantial part of these patients was quickly discharged before sufficient treatment, leaving room for improvement. Furthermore, few improvements were seen concerning the patients' social situation. More focus on the coherence between psychiatric and municipality services, targeting the social issues and substance use of homeless patients, is strongly needed.

Vorting AF, Henriksen MG, Nordgaard J. Changes in clinical and social situation after involuntary admission of homeless people with psychotic disorders: a one-year follow-up study. Nord J Psychiatry 2021 Feb 22;1-7. doi: 10.1080/08039488.2021.1881820. Online ahead of print. PMID: 33612065

Does leisure-time physical activity predict future depressive symptoms among depressive patients?

The study investigated whether baseline leisure-time physical activity (LTPA) is associated with future recovery from depression among patients with a depression diagnosis and whether baseline LTPA is associated with total physical activity after five years of follow-up. A total of 258 patients aged ≥35 years with clinically confirmed depression at baseline participated. Blood pressure and anthropometric parameters were measured and blood samples for glucose and lipid determinations were drawn at baseline. LTPA, physical activity, and other social and clinical factors were captured by standard self-administered questionnaires at baseline and the five-year follow-up point. Of the 258 patients, 76 (29%) had DS at follow-up. Adjusted odds ratio (OR) for future DS was 1.43 (confidence interval [CI] 0.69-2.95) for participants with moderate LTPA and 0.92 (CI 0.42-2.00) for participants with high LTPA, compared with low LTPA at baseline. Higher baseline LTPA levels were associated with higher total physical activity in the future. The authors conclude that Baseline LTPA did not affect the five-year prognosis of depression among depressed patients. Because the baseline LTPA level predicted the future total physical activity, it could be included as a part of the overall health management and treatment of depression in clinical practices.

Raatikainen I, Mäntyselkä P, Heinonen A, Vanhala M, Kautiainen H, Koponen H, Korniloff K. Does baseline leisure-time physical activity level predict future depressive symptoms or physical activity among depressive patients? Findings from a Finnish five-year cohort study. Nord J Psychiatry. 2020 Dec 30;1-10. doi: 10.1080/08039488.2020. 1862296. Online ahead of print. PMID: 33380252

Alexithymia as a measure of personality dysfunction in avoidant personality disorder

Avoidant Personality Disorder (AvPD) is heterogenic in terms of symptoms and severity. This study set out to replicate and extend earlier findings showing that there is variation among patients with AvPD in terms of alexithymia and, further, that this variation is especially associated with specific facets of personality functioning and is not explained by measures of depression, symptom severity, or co-occurring personality disorder traits. The study used intake data from a sample of AvPD patients (n = 56) who had been treated in similar outpatient services. Alexithymia was measured using the Toronto Alexithymia Scale (TAS-20). An almost equal distribution of alexithymia groups was found. Alexithymia was associated with higher personality dysfunction. The authors conclude that AvPD is heterogeneous and that alexithymia may be important as an indicator of severity of specific personality dysfunction.

Simonsen S, Eikenaes IUM, Bach B, Kvarstein E, Gondan M, Møller SB, Wilberg T. Level of alexithymia as a measure of personality dysfunction in avoidant personality disorder. Nord J Psychiatry 2020 Nov 4;1-9. doi: 10.1080/08039488.2020.1841290. Online ahead of print. PMID: 33146059


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