Liv Mellesdal

Cardiovascular risk in patients admitted for psychosis compared with findings from a population-based study.

Background: Schizophrenia and related psychoses are associated with excess morbidity and mortality from cardiovascular disease (CVD). Single-site studies on CVD-related risk factors in representative samples of acutely admitted inpatients are scarce. Aims: To assess the levels of risk factors related to CVD in patients acutely admitted to hospital for symptoms of psychosis. Methods: Eligible patients aged 18–65 years were included consecutively in the Bergen Psychosis Project (BPP). CVD-related risk factors were recorded at admittance and at discharge or after 6 weeks at the latest. The recordings of 218 patients with psychosis (BPP) were compared with the findings of 50,219 subjects from the population-based Nord-Trøndelag Health Study 1995–97 (HUNT2) survey. Results: Diastolic blood pressures were higher for BPP women and men, whereas body mass indexes (BMIs) and total cholesterol levels were higher in HUNT2 women and men. On categorical measures, smoking was more prevalent in the patients compared with the HUNT2 subjects. Metabolic syndrome was present in 11.8% and 21.9% of BPP women and men, respectively. At discharge or 6 weeks from admission, 3.2% and 18.6% of BPP women and men, respectively, had metabolic syndrome. BMIs and total cholesterol levels had worsened during the inpatient treatment period. Only one patient had a diagnosis corresponding to the CVD risk found, and only four patients received antidiabetics, antihypertensives or lipid-lowering drugs. Conclusions: Some CVD-related risk factors were high in the patients at admission, some worsened and CVD risk factors seem to be suboptimally addressed, which should warrant increased awareness on the topic in clinical practice.

Time to discontinuation of antipsychotic drugs in a schizophrenia cohort: influence of current treatment strategies.

Background Rates of discontinuation of antipsychotic treatment for patients with schizophrenia are high and evidence is limited by selective inclusion and high attrition in randomized controlled trials. Aims To study time to discontinuation of antipsychotic treatment for patients with schizophrenia. Method All patients with schizophrenia (n = 396) discharged between 2005 and 2011 were followed until discontinuation (clinician or patient decided) of antipsychotic treatment or other endpoints. Univariate and multivariate survival analyses (with time on antipsychotic treatment as the dependent variable) using time-dependent variables were performed. Results Clozapine displayed lower risk for all-cause (p < 0.001), clinician-decided (p = 0.012) and patient-decided (p = 0.039) discontinuation versus olanzapine oral treatment in the multivariate Cox regression. Second-generation long-acting injection antipsychotics (LAI) (p = 0.015) and first-generation long-acting injection antipsychotics (p = 0.013) showed significantly lower risks for patient-decided discontinuation than olanzapine oral. Conclusion Higher effectiveness of clozapine and LAI treatment versus oral olanzapine were identified in a clinical cohort of patients with schizophrenia.

Time-dependent effect analysis of antipsychotic treatment in a naturalistic cohort study of patients with schizophrenia.

OBJECTIVE Evidence based treatment of schizophrenia as well as antipsychotic drug utility patterns have changed considerably in recent years and the present study aims to investigate the current level of unplanned hospital readmissions in a cohort of patients with schizophrenia, and to determine the risk-reducing effects of current antipsychotic drug treatment. METHOD An open cohort study included all consecutively discharged patients with schizophrenia in a 3-year period (n=277). The treatment-dependent variables were entered in a multivariate Cox survival analyses with time to unplanned readmission as the dependent variable. RESULTS 11.2% of patients were readmitted within 30 days of discharge, and 44.8% were readmitted within 12 months. Antipsychotic monotherapy reduced the risk of readmission by 74.9%. Treatment in CMHC also had a risk-reducing effect. The prescription rate of clozapine in this sample was 10.1%. DISCUSSION The over-all level of unplanned readmissions was in correspondence with the findings of others. Current antipsychotic drug treatment independently offers strong protection against unplanned readmissions. There may be a potential for further optimalizing antipsychotic drug treatment according to treatment guidelines. CONCLUSIONS Unplanned readmissions are very common for patients with schizophrenia but antipsychotic drug treatment is associated with a strong risk-reducing effect in this regard.

Factors associated with disallowance of compulsory mental healthcare referrals.

Norwegian studies report that a substantial amount of referrals for compulsory mental health care are disallowed at specialist assessment, at a rate that varies with referring agent. Knowledge on factors associated with disallowance could improve the practice of compulsory mental health care. This study aims to examine such factors, placing particular emphasis on the impact of referring agents.

The suicide assessment scale: Psychometric properties of a Norwegian language version

BackgroundRating scales are valuable tools in suicide research and can also be useful supplements to the clinical interview in suicide risk assessments. This study describes the psychometric properties of a Norwegian language version of the Suicide Assessment Scale Self-report version (SUAS-S).MethodsParticipants were fifty-two patients (mean age = 39.3 years, SD = 10.7) with major depression (53.8%), bipolar disorder (25.0%) and/or a personality disorder (63.5%) referred to a psychiatric outpatient clinic. The SUAS-S, the screening section of the Beck Scale for Suicidal Ideation (BSS-5), the Beck Depression Inventory (BDI), Beck’s Hopelessness Scale (BHS), the Symptom Check-List-90 R (SCL-90R) and the Clinical Global Impression for Severity of Suicidality (CGI-SS) were administered. One week later, the patients completed the SUAS-S a second time.ResultsCronbach’s alpha for SUAS-S was 0.88 and the test–retest reliability was 0.95 (95% CI: 0.93– 0.97). SUAS-S was positively correlated with the BSS-5 (r = 0.66; 95% CI: 0.47–0.85) for the study sample as a whole and for the suicidal (r = 0.52) and non-suicidal groups (r = 0.50) respectively. There was no difference between the SUAS-S and the BSS-5 in the ability to identify suicidality. This ability was more pronounced when the suicide risk was high. There was a substantial intercorrelation between the score on the SUAS-S and the BDI (0.81) and the BHS (0.76). The sensitivity and specificity of the SUAS-S was explored and an appropriate clinical cut-off value was assessed.ConclusionsThe study revealed good internal consistency, test–retest reliability and concurrent validity for the Suicide Assessment Scale Self-report version. The discriminatory ability for suicidality was comparable to that of the BSS-5.

Borderline Personality Disorder and Posttraumatic Stress Disorder at Psychiatric Discharge Predict General Hospital Admission for Self-Harm.

We investigated whether posttraumatic stress disorder (PTSD) was predictor of suicidal behavior even when adjusting for comorbid borderline personality disorder (BPD) and other salient risk factors. To study this, we randomly selected 308 patients admitted to a psychiatric hospital because of suicide risk. Baseline interviews were performed within the first days of the stay. Information concerning the number of self-harm admissions to general hospitals over the subsequent 6 months was retrieved through linkage with the regional hospital registers. A censored regression analysis of hospital admissions for self-harm indicated significant associations with both PTSD (β = .21, p < .001) and BPD (β = .27, p < .001). A structural model comprising two latent BPD factors, dysregulation and relationship problems, as well as PTSD and several other variables, demonstrated that PTSD was an important predictor of the number of self-harm admissions to general hospitals(B = 1.52, p < .01). Dysregulation predicted self-harm directly (B = 0.28, p < .05), and also through PTSD [corrected]. These results suggested that PTSD and related dysregulation problems could be important treatment targets for a reduction in the risk of severe self-harm in high-risk psychiatric patients.

Den sårbare tiden etter utskrivelse fra psykiatrisk sykehus – selvmordsrisiko og dokumentasjonspraksis

Tiden like etter utskrivelse fra psykiatrisk dognenhet innebaererforhoyet selvmordsrisiko. Nasjonale retningslinjer for selvmordsforebyggingi psykisk helsevern anbefaler at nar selvmordsrisiko harvaert en problemstilling under oppholdet eller tidligere skal pasienterselvmordsrisikovurderes og det er en fordel med timeavtale hosoppfolgende instans. Hensikten med denne studien var a kartleggedokumentert etterlevelse av disse anbefalingene og identifisering avprediktorer for manglende timeavtale.En journalstudie i Divisjon psykisk helsevern, Haukeland Universitetssykehus,ble gjennomfort for a vurdere i hvilken grad dokumentasjonspraksisi epikriser og overforingsnotat samsvarte medretningslinjeanbefalingene. Opplysninger om selvmordsrisikovurderingog timeavtale ble kartlagt sammen med kjonn, alder, tidligereselvmordsforsok, andre risikofaktorer og mulige beskyttende faktorerfor selvmord, hoveddiagnoser, henvisnings- og mottaksformalitet.Analyser var deskriptiv statistikk og Generalized Estimating Equation.Selvmordsrisikovurdering var dokumentert i nesten alle epikriser/overforingsnotat. Begrunnelser for selvmordsrisikovurderingene vari liten grad dokumentert. Lavere sannsynlighet for dokumentasjon avtimeavtale var knyttet til utskrivelser med rus som hoveddiagnose,schizofrenidiagnose for kvinner, samt a bli henvist til tvangsinnleggelsemen mottatt til frivillig sykehusopphold for kvinner.Dokumentasjonspraksis vedrorende selvmordsrisikovurdering vargod, men vurderingene inneholdt i liten grad utdypende beskrivelserslik retningslinjen anbefaler. Gode beskrivelser gir oppfolgendeinstans viktig informasjon for videre pasientbehandling. Bedret dokumentasjonspraksis kan bidra til okt kontinuitet i helsetjenestetilbudetfor pasientene.