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Highlights from the Nordic Journal of Psychiatry (January - March of 2023)

 

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.



The effects of compulsory admissions on self-harm behaviour in patients with borderline personality disorder


Previous research on patients with borderline personality disorder (BPD) has indicated negative effects, including increased suicidality, from long hospital admissions and paternalism. Still, long-term compulsory admissions have been reported to occur regularly. Less is known about how healthcare personnel perceive these admissions and to what extent they think the use of compulsory care can be diminished. This questionnaire study addresses those questions. The respondents were nurses and psychiatric aides employed at psychiatric hospital wards in Sweden. The questionnaire contained questions with fixed answers and room for comments. Most respondents experienced that more than a week's compulsory admission either increased or had no effect on self-harm behaviour. A majority considered the compulsory admissions to be too long at their wards, with detrimental effects on the patients. Respondents recommended goal-oriented care planning, around three-day-long voluntary admissions, and better outpatient care to reduce compulsory hospital admissions.


Lundahl A, Torenfält M, Helgesson G, Juth N. Patients with borderline personality disorder and the effects of compulsory admissions on self-harm behaviour: a questionnaire study Nord J Psychiatry. 2023 Jan 16;1-8. doi: 10.1080/08039488.2023.2166106. Online ahead of print. PMID: 36645214


Reasons for non-clozapine treatment in prescribing practices for outpatients with schizophrenia


Clozapine is the gold standard for treating treatment-resistant schizophrenia (TRS) although widely underutilised. This audit aimed to evaluate the local antipsychotic (AP) prescribing practices for outpatients with schizophrenia and to assess the spectrum and prevalence of journalised reasons for non-clozapine treatment amongst eligible outpatients. Data on demographics, current and former AP treatments, as well as documented reasons for non-clozapine treatment, was extracted through chart audit. Of the 668 affiliated outpatients with schizophrenia, 43% were treated with AP polytherapy (APP) and 19.6% with clozapine. The most prevalent reason for clozapine discontinuation was related to side effects whereas the most prevalent reason for refusal or omission of clozapine treatment was related to the associated monitoring regimen. The authors conclude that APP prescribing is a highly prevalent practice when treating outpatients with schizophrenia and that clozapine is underutilised in a 'last resort' manner. The blood-monitoring regimen associated with clozapine treatment was found to be an important factor in the underutilization, but that the monitoring constituted a barrier for different reasons. They further conclude that future studies, directly involving both patients and clinicians in the identification and management of the most clinically relevant barriers and their corresponding facilitators, are warranted.


Jakobsen MI, Schaug JP, Nielsen J, Simonsen E. Antipsychotic prescribing practices for outpatients with schizophrenia and reasons for non-clozapine treatment - Data from a Danish quality assessment audit. Nord J Psychiatry 2023 Jan 18;1-10. doi: 10.1080/08039488. 2022.2160878. Online ahead of print. PMID: 36651766


Antidepressant treatment initiation and public sick-leave compensation


This study investigates the association between antidepressant treatment initiation and public sick leave compensation (PLSC) in the following year in Denmark. The study was designed as a register-based prospective cohort study. It included 39,401 adults who had initiated first-time antidepressant monotherapy for depression or anxiety. PLSC was estimated for the year following the incident prescription of various antidepressants for depression or anxiety disorders. It was found that the most frequently prescribed antidepressant medication was SSRIs (66.8%), with sertraline being the leading choice. Compared with sertraline, mirtazapine and mianserin were associated with the highest risks of PSLC in the year following initiation. Compared with sertraline, citalopram, venlafaxine and duloxetine were all associated with increased PSLC. In contrast, fluoxetine and vortioxetine were all associated with lower risk of PSLC compared with sertraline. The authors conclude that antidepressant treatment initiation was associated with PLSC and that the highest risk of PLSC was seen for antidepressants with sedative side effects. Some types of antidepressants were associated with a lower risk of PLSC in the year following treatment initiation.


Soerensen KT, Ishtiak-Ahmed K, Gasse C, Christensen KS Antidepressant treatment initiation and public sick-leave compensation in the following year: a register-based prospective cohort study in Denmark. Nord J Psychiatry 2023 Feb 3;1-9. doi: 10.1080/08039488.2023. 2173289. Online ahead of print. PMID: 36734806


Morbidity and mortality after adolescent eating disorders requiring inpatient care


This retrospective study utilized comprehensive Finnish national register data to examine the course and mortality of eating disorders among Finnish adolescent inpatients. The study population comprised of all subjects admitted for the first time to psychiatric hospital care at age 13-17. In 10-year follow-up, morbidity and mortality were compared between those admitted for eating disorders (ED group) and other psychiatric patients (non-ED group).The authors found of the study population of 17112, 1081 were ED patients (1031 female and 50 male). Mean age was 15 in both ED and non-ED groups, and the mean follow-up time was 7.7 and 8.4 years, respectively. Over 50% of the patients had readmissions during follow-up, the ED group having a higher risk for readmissions. Crude mortality rate (CMR) was 1.5 in the ED group and 2.9 in the non-ED group. Suicide was the most common cause of death: 43.8% in the ED group vs. 52.9% in the non-ED group.The authors conclude that the ED group, psychiatric readmissions were more common, but mortality was not higher than in other psychiatric disorders. They suggest that the prognosis of adolescent onset EDs may improve when treatment is developmentally sensitive.


Tuohisto-Kokko S, Holttinen T, Kaltiala R. Morbidity and mortality after adolescent eating disorders requiring inpatient care Nord J Psychiatry 2023 Mar 24;1-8. doi: 10.1080/08039488.2023.2191007. Online ahead of print. PMID: 36960832 □

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