Jørgen Aagaard

Predictors of outcome in prophylactic lithium treatment: a 2-year prospective study

The purpose of this study of 133 affective disorder patients consecutively referred to start prophylactic lithium treatment was to identify informative predictors of outcome. Non-adherence to treatment was mainly predicted by substance abuse and many earlier admissions. Non-response among the 78 patients adhering to lithium treatment was mainly predicted by female sex, young age and previously chronic course. The overall response rate was rather poor and an excess mortality rate was found. It is suggested that patients with substance abuse should not be offered prophylactic lithium treatment unless intensive control and support is practicable, and patients with a chronic course need a more effective treatment than lithium can offer.

Five-year mortality in lithium-treated manic-depressive patients.

A hundred and thirty-three affective disorder patients who received prophylactic treatment with lithium were followed prospectively for 5 years and their mortality was recorded. Twenty-two patients died during the period, 13 from natural causes and nine from definite or probable suicide. The observed mortality was significantly greater than the expected overall, and also when natural causes and suicide were considered independently. No patients died from lithium intoxication or lithium-induced side effects. Patients who died from suicide were all bipolars or suffered from affective disorder with uncertain polarity. They were significantly younger than the patients who died from natural causes, they tended to lead isolated lives and they suffered a violent death. The older patients who died from natural causes had often had physical illness and alcohol abuse prior to the start of lithium treatment. The results of the study speak in favour of the establishment of comprehensive treatment programmes possibly in the framework of specialised affective disorder clinics.

Presenting Symptoms, Treatment Delay and Survival in Bladder Cancer

In 212 consecutive patients with bladder tumour, relationships between symptoms, demographic factors, delay before treatment and survival rate were investigated. The presenting symptom was haematuria in 79% of the patients. The interval from onset of symptoms until treatment averaged 28 weeks (median = 15 weeks). The general practitioner delay comprised half of the total delay. Patients with cystitis as the presenting symptom and women with haematuria had the longest doctor delay. The length of delay did not influence the crude survival rate in patients with tumours in the two highest TNM stages. In T1 and T2 tumours, shorter delay tended to give a better survival rate.

Susceptibility in urinary bladder cancer: Acetyltransferase phenotypes and related risk factors

The excess proportion of slow acetylator phenotypes has previously been found among bladder tumour patients. Among 228 bladder tumour patients in the present study, the slow acetylator phenotype was significantly associated to the unskilled worker and T3-T4 tumour, and to a certain extent to tobacco smoking. It is suggested that slow acetylator subjects are more susceptible to bladder tumour development when exposed to arylamines.

An epidemiological case control study of bladder cancer in males from a predominantly rural district

A case-control study was performed on 165 male bladder cancer patients and an equal number of male control persons matched in age and geographic area. Thirty determinants of assumed importance were examined. A multivariate logistic analysis was performed. A significant increment in the relative risk (RR) for bladder cancer was associated with cigarette smoking (RR = 1.89), a history of prostatic surgery (RR = 2.38), nocturia (RR = 2.05), previous venereal disease (RR = 2.42), industrial work (RR = 1.82), work with oil or gasoline (RR = 2.71) and work with various unspecified chemical materials (RR = 1.58).

Augmenting Clozapine With Sertindole A Double-Blind, Randomized, Placebo-Controlled Study

Abstract Clozapine augmentation with antipsychotic drugs is widely used despite sparse evidence supporting this strategy. Sertindole is a nonsedating atypical antipsychotic drug with low affinity for cholinergic receptors, which makes it potentially suitable for augmentation of clozapine. The study design was a 12-week, double-blind, randomized, placebo-controlled study including patients with International Statistical Classification of Diseases, 10th Revision schizophrenia (F20.0–F20.3) and treated with clozapine for at least 6 months who had not achieved sufficient response. Patients were randomized 1:1 to either sertindole 16 mg or placebo, and assessment was done at baseline and after 6 and 12 weeks. Assessment included the Positive and Negative Syndrome Scale, Clinical Global Impression, Udvalg for Kliniske Undersøgelser, World Health Organization Quality of Life Brief, Drug Attitude Inventory, fasting glucose, lipids, and electrocardiogram. Clozapine augmentation with sertindole was not superior to placebo regarding total score or subscale score of the Positive and Negative Syndrome Scale, Clinical Global Impression, World Health Organization Quality of Life Brief, or Drug Attitude Inventory. No increased adverse effects compared with placebo were found. Four patients randomized to sertindole experienced a significant worsening of psychosis, and 2 of them required psychiatric admission. Metabolic parameters were unchanged during the study, but augmentation of clozapine with sertindole was associated with a 12-millisecond (SD, 20-millisecond) QTc prolongation compared with 0 millisecond (SD, 20 milliseconds) in the placebo group (P < 0.03). Augmentation with sertindole showed no benefits compared with placebo. Psychiatrists should be aware that augmentation might not add any benefits for the patients and in some cases worsen psychosis.

A case-control study of female bladder cancer

A case-control study was performed on 47 female bladder cancer patients and 94 female controls matched in age and geographic area. Twenty-five determinants of assumed importance were examined. The bivariate associations revealed a significantly increased relative risk (RR) for bladder cancer associated with use of tobacco, cheroot smoking and saccharin consumption, and some subgroups like never-smokers in combination with use of saccharin. The population attributable risk percentages were estimated. Through a multivariate logistic analysis of selected determinants cheroot consumption was the most pronounced independent variable.

Clinical outcome of assertive community treatment (ACT) in a rural area in Denmark: A case–control study with a 2-year follow-up

Aim: The aim of the present study was to evaluate the effect of assertive community treatment (ACT) in the Tønder Region, South Jutland, where the first Danish ACT team was established to treat patients with severe and persistent mental illness (SMI). Methods: The study compares outcome over a 2-year period between recipients of ACT and standard community mental healthcare. Results: The study included 86 cases and 88 controls. At the time of recruitment, the cases and the controls did not differ significantly in demographic details and eligibility criteria. At the 2-year follow-up, the ACT patients showed a significant reduction in admissions, bed days and day hospital days, and a significant increase in the number of consultations compared with the controls. Adherence to outpatient services was higher in the ACT group. No significant improvements in psychopathology were found after 2 years, but a significant improvement in met needs and fewer unmet needs, indicating better functioning, occurred. Clients’ satisfaction with care (Client Satisfaction Questionnaire, CSQ) was significantly higher among ACT patients than among controls. Conclusion: The treatment of these patients in this ACT service has yielded promising results, suggesting that ACT treatment may be a useful intervention for SMI patients. However, large, rigorous, randomized control trials with ACT are needed in Europe as the existing evidence mainly comes from American studies.

An Epidemiological Study of Bladder Cancer in a Predominantly Rural District

A case-control study was performed on 212 bladder cancer patients (165 male + 47 female) and 259 control persons (165 male + 94 female) matched according to age and geographic area. Twenty-five determinants of assumed importance were examined. Bivariate analysis revealed a significantly increased relative risk (RR) of developing bladder cancer associated with cigarette smoking, cigarillos smoking, pipe smoking, tobacco chewing, industrial work, previous venereal disease, work with petroleum or asphalt, consumption of alcohol, work with oil or gasoline, and work with chemical materials. A multivariate logistic analysis showed that cigarette and cigarillos smoking involved the highest significant risks. An analogous logistic analysis of the negatively associated determinants revealed never smokers and farmers to be the weakest independent variables.

Crisis homes for adult psychiatric patients.

IntroductionInspired by the Crisis Home programme in Madison, we have adapted and evaluated the programme at the Community Mental Health (CMH) Centre in Tønder, Denmark.Material and methodsProcedures and schedules from the Crisis Home programme were applied in this open trial. Questionnaire data concerning satisfaction with the stay and registration data concerning the admissions and bed days two years before and two years after the first stay were obtained.ResultsDuring four years, 52 different patients had a total of 187 stays in a crisis home. Twenty (38.5%) of the patients were attached to the ACT team. The average duration of the stays was 4.0 days. The number of readmissions and bed days after the first stay showed a significant downward tendency for the subgroup of patients with a more severe mental disorder, but not for the whole group. The patients, the crisis homes families and the referrers were very satisfied with the programme and the treatment.ConclusionCrisis home stays represent a quality improvement in the treatment package, especially for patients with a more severe mental disorder. Further documentation will require a controlled study.