Anne Vingaard Olesen

Suicide risk in patients hospitalised because of an affective disorder: a follow-up study, 1973-1993

UNLABELLED The aim of this study was to identify risk factors for suicide related to the course of treatment. METHODS All persons in Denmark hospitalised for the first time because of an affective disorder during the period 1973-1993 were included. RESULTS In 53466 patients, suicide was the cause of death in 3141 (6%) cases. The risk of suicide was high both immediately after admission and immediately following discharge. Increased risk was also associated with short duration of affective disorder, a history of multiple admissions, male gender, and increasing age. LIMITATIONS We were not able to distinguish with certainty between manic and depressive episodes in bipolar disorder. Prior suicide attempts could not be included in the analyses. Lack of operationalised diagnostic criteria. CONCLUSIONS Patients hospitalised because of an affective disorder are a highly relevant target group for suicide prevention. There is a need for improvement of preventive measures during admission and at discharge. Likewise, there is a need for preventive measures which can minimize the risk of relapse in affective disorders.

Obstetric complications in women with schizophrenia

It is not known whether schizophrenic women have increased incidence of complications during pregnancy and delivery. Data from the Danish Medical Birth Register were used to compare 2212 births to 1537 schizophrenic women in Denmark with a random sample of all deliveries in Denmark during 1973-1993 (122931 births to 72742 women). The schizophrenic women had fewer antenatal care visits. They were at lower risk of pre-eclampsia, but tended to have lower Apgar scores. There were no other differences in the incidence of specific complications such as placenta previa, placental abruption, and abnormal fetal presentation. Schizophrenic women were at increased risk of interventions such as Cesarean section, vaginal assisted delivery, amniotomy, and pharmacological stimulation of labor. There were no important differences between the deliveries to schizophrenic women who gave birth before and after their first admission to a psychiatric department. These results show no evidence that schizophrenic women have a greater frequency of specific obstetric complications than non-schizophrenic women. Nevertheless, they are at increased risk for interventions during delivery.

Impact of exercise on patients with depression and anxiety

Background: Persons with common mental disorders are at risk of lowered physical activity. Aims: To investigate if patients with depressive and/or anxiety disorders can achieve a level of physical activity meeting public health recommendations, increase their physical fitness and quality of life (QoL) through participation in a physical exercise programme. Methods: In a non-blinded controlled study, 48 patients referred by private psychiatric clinics and private general practices were either treated in an intervention (n=27) or a control group (n=21). The intervention group took part in 20 weeks of group exercise consisting of aerobic training and non-aerobic weight-lifting. All participants were interviewed and tested at baseline, week 20 and at week 32. Results: The intervention group increased in physical activity (120 min/week) and VO2max (0.48 ml O2/min). The VO2max increase was maintained after a 12-week follow-up period. Findings should be conservatively interpreted because of high attrition rate. Conclusions: Patients with anxiety and/or depressive disorders who participated in a structured, supervised exercise programme achieved in accordance with public health recommendations a higher level of physical activity and VO2max. Clinical implications: The clinical implications of the study may be a suggestion of offering physical exercise to milder and moderate severe cases of depression and anxiety.

Regional differences in schizophrenia incidence in Denmark

Schelin EM, Munk‐Jørrgensen P, Olesen AV, Gerlach J. Regional differences in schizophrenia incidence in Denmark. Acta Psychiatr Scand 2000: 101: 293–299.

Moclobemide and clomipramine in reactive depression. A placebo-controlled randomized clinical trial.

ABSTRACT– The purpose of this study was to compare moclobemide and clomipramine in reactive depression according to the Newcastle II classification. Sixty patients were allocated to either 300 mg moclobemide, 150 mg clomipramine or placebo, all divided in 3 daily doses. Improvements occurred over time, but differences between treatments and compared with placebo were never statistically significant. Dizziness, tremor and anticholinergic symptoms were significantly more frequent with clomipramine than with moclobemide and placebo.

The Health-Related Quality of Life for Patients with Myalgic Encephalomyelitis / Chronic Fatigue Syndrome (ME/CFS)

Introduction Myalgic encephalomyelitis (ME)/chronic fatigue syndrome (CFS) is a common, severe condition affecting 0.2 to 0.4 per cent of the population. Even so, no recent international EQ-5D based health-related quality of life (HRQoL) estimates exist for ME/CFS patients. The main purpose of this study was to estimate HRQoL scores using the EQ-5D-3L with Danish time trade-off tariffs. Secondary, the aims were to explore whether the results are not influenced by other conditions using regression, to compare the estimates to 20 other conditions and finally to present ME/CFS patient characteristics for use in clinical practice. Material and methods All members of the Danish ME/CFS Patient Association in 2013 (n=319) were asked to fill out a questionnaire including the EQ-5D-3L. From these, 105 ME/CFS patients were identified and gave valid responses. Unadjusted EQ-5D-3L means were calculated and compared to the population mean as well as to the mean of 20 other conditions. Furthermore, adjusted estimates were calculated using ordinary least squares (OLS) regression, adjusting for gender, age, education, and co-morbidity of 18 self-reported conditions. Data from the North Denmark Health Profile 2010 was used as population reference in the regression analysis (n=23,392). Results The unadjusted EQ-5D-3L mean of ME/CFS was 0.47 [0.41–0.53] compared to a population mean of 0.85 [0.84–0.86]. The OLS regression estimated a disutility of -0.29 [-0.21;-0.34] for ME/CFS patients in this study. The characteristics of ME/CFS patients are different from the population with respect to gender, relationship, employment etc. Conclusion The EQ-5D-3L-based HRQoL of ME/CFS is significantly lower than the population mean and the lowest of all the compared conditions. The adjusted analysis confirms that poor HRQoL of ME/CFS is distinctly different from and not a proxy of the other included conditions. However, further studies are needed to exclude the possible selection bias of the current study.

Readmission risk in schizophrenia: selection explains previous findings of a progressive course of disorder.

BACKGROUND Several studies have investigated the issue of the natural course of schizophrenia. Our study addressed whether there is evidence for progression, potentially deteriorating, over the long-term course of the disorder. METHOD Modern survival analysis techniques were applied to case-register data on the pattern of readmission to in-patient psychiatric facilities. The sample consisted of a total of 8953 persons with schizophrenia. RESULTS No evidence of a progressive course of schizophrenia was found in the present study. The accelerating pattern of the course of schizophrenia described by some authors, including a previous analysis of an almost identical dataset, can be explained by selection. CONCLUSIONS Heterogeneity reflecting the various levels of individual vulnerability may govern the overall individual course of schizophrenia. We hypothesize that the persistent deficit syndrome and negative symptoms are influential determinants of this heterogeneity.

Run Charts Revisited: A Simulation Study of Run Chart Rules for Detection of Non-Random Variation in Health Care Processes

Background A run chart is a line graph of a measure plotted over time with the median as a horizontal line. The main purpose of the run chart is to identify process improvement or degradation, which may be detected by statistical tests for non-random patterns in the data sequence. Methods We studied the sensitivity to shifts and linear drifts in simulated processes using the shift, crossings and trend rules for detecting non-random variation in run charts. Results The shift and crossings rules are effective in detecting shifts and drifts in process centre over time while keeping the false signal rate constant around 5% and independent of the number of data points in the chart. The trend rule is virtually useless for detection of linear drift over time, the purpose it was intended for.

Socioeconomic status and use of postmenopausal hormone replacement therapy among Danish women

Background.  Observational studies on hormone replacement therapy (HRT) have shown cardioprotective effects that have not been replicated in randomized controlled trials, perhaps due to unaccounted confounding by socioeconomic factors. To resolve this discrepancy, we examined the association between socioeconomic status (SES) and HRT use in a large population of Danish postmenopausal women.

Prenatal Risk Factors for Cutaneous Malignant Melanoma: Follow-up of 2,594,783 Danes Born from 1950 to 2002

The incidence of cutaneous malignant melanoma has increased in young adults, specifically in Denmark. In this study, we examined the risk of cutaneous malignant melanoma in relation to prenatal markers of hormone levels and to family-related risk factors. The study was based on a follow-up of 2,594,783 Danes born from 1950 to 2002. Occurrence of possible hormone-related cancers among family members and indicators of abnormal prenatal hormone levels were not associated with cutaneous malignant melanoma risk, whereas family size and mothers age at first birth were significant risk factors for cutaneous malignant melanoma in offspring. (Cancer Epidemiol Biomarkers Prev 2009;18(1):155–61)