Vidje Hansen

Diagnosing comorbidity in psychiatric hospital: challenging the validity of administrative registers.

BackgroundThis study will explore the validity of psychiatric diagnoses in administrative registers with special emphasis on comorbid anxiety and substance use disorders.MethodsAll new patients admitted to psychiatric hospital in northern Norway during one year were asked to participate. Of 477 patients found eligible, 272 gave their informed consent. 250 patients (52%) with hospital diagnoses comprised the study sample. Expert diagnoses were given on the basis of a structured diagnostic interview (M.I.N.I.PLUS) together with retrospective checking of the records. The hospital diagnoses were blind to the expert. The agreement between the expert’s and the clinicians’ diagnoses was estimated using Cohen’s kappa statistics.ResultsThe expert gave a mean of 3.4 diagnoses per patient, the clinicians gave 1.4. The agreement ranged from poor to good (schizophrenia). For anxiety disorders (F40-41) the agreement is poor (kappa = 0.12). While the expert gave an anxiety disorder diagnosis to 122 patients, the clinicians only gave it to 17. The agreement is fair concerning substance use disorders (F10-19) (kappa = 0.27). Only two out of 76 patients with concurrent anxiety and substance use disorders were identified by the clinicians.ConclusionsThe validity of administrative registers in psychiatry seems dubious for research purposes and even for administrative and clinical purposes. The diagnostic process in the clinic should be more structured and treatment guidelines should include comorbidity.

Acute psychiatric admissions from an out-of-hours Casualty Clinic; how do referring doctors and admitting specialists agree?

BackgroundOver the last decades there has been an increasing pressure on the acute psychiatric wards in Norway. The major contributor to psychiatric acute admissions at the University Hospital of North Norway in the city of Tromsø in 2001 was the GP-based Tromsø Casualty Clinic, only open out-of-hours. We explored all acute psychiatric referrals from Tromsø Casualty Clinic in 2001. The purpose of the study was to characterize the admissions and assess the agreement between the referring doctors and the hospital specialists according to the need for hospitalization, agreement on application of the law and the diagnostic evaluation to assess whether the admissions were appropriate.MethodsRetrospective, record based, descriptive study comprising 101 psychiatric acute referrals from the Tromsø Casualty Clinic to the psychiatric acute wards at the University Hospital of North Norway.ResultsThe specialists accepted all referrals except one, they mostly agreed upon the diagnoses suggested by the referring doctors and they mostly confirmed the application of the law.Seventy-five percent of the admissions took place during weekends, public holidays or nighttimes. Diagnoses of psychoses or suicidal attempts accounted for 76 % of the total referrals. Substance abuse was noted for 43 %, and in 22 % of all admissions the patients had stopped taking their psychopharmacological medication. The police assisted the referring doctors in one third of all admissions, and was the legal representative in 52 out of 59 involuntary admissions. Thirty percent of the admissions were first- time admissions. Thirty-two percent of the hospital stays lasted for three days or less. Median length of stay was 6.5 days.ConclusionThe casualty clinic physicians and the hospital specialists mostly agreed in their evaluation of patients indicating that most of the admissions were appropriate. The police was more often involved in the involuntary admissions than intended in the law. The proportion of patients with substance abuse was significant. Alternative treatment strategies should be developed for non-psychotic patients in need of short-term stays.

The factor structure and psychometric properties of the Clinical Outcomes in Routine Evaluation--Outcome Measure (CORE-OM) in Norwegian clinical and non-clinical samples.

BackgroundThe Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) is a 34-item instrument developed to monitor clinically significant change in out-patients. The CORE-OM covers four domains: well-being, problems/symptoms, functioning and risk, and sums up in two total scores: the mean of All items, and the mean of All non-risk items. The aim of this study was to examine the psychometric properties of the Norwegian translation of the CORE-OM.MethodsA clinical sample of 527 out-patients from North Norwegian specialist psychiatric services, and a non-clinical sample of 464 persons were obtained. The non-clinical sample was a convenience sample consisting of friends and family of health personnel, and of students of medicine and clinical psychology. Students also reported psychological stress. Exploratory factor analysis (EFA) was employed in half the clinical sample. Confirmatory (CFA) factor analyses modelling the theoretical sub-domains were performed in the remaining half of the clinical sample. Internal consistency, means, and gender and age differences were studied by comparing the clinical and non-clinical samples. Stability, effect of language (Norwegian versus English), and of psychological stress was studied in the sub-sample of students. Finally, cut-off scores were calculated, and distributions of scores were compared between clinical and non-clinical samples, and between students reporting stress or no stress.ResultsThe results indicate that the CORE-OM both measures general (g) psychological distress and sub-domains, of which risk of harm separates most clearly from the g factor. Internal consistency, stability and cut-off scores compared well with the original English version. No, or only negligible, language effects were found. Gender differences were only found for the well-being domain in the non-clinical sample and for the risk domain in the clinical sample. Current patient status explained differences between clinical and non-clinical samples, also when gender and age were controlled for. Students reporting psychological distress during last week scored significantly higher than students reporting no stress. These results further validate the recommended cut-off point of 1 between clinical and non-clinical populations.ConclusionsThe CORE-OM in Norwegian has psychometric properties at the same level as the English original, and could be recommended for general clinical use. A cut-off point of 1 is recommended for both genders.

Suicidality related to first-time admissions to psychiatric hospital

BackgroundThe epidemiology of suicidality shows considerable variation across sites. However, one of the strongest predictors of suicide is a suicidal attempt. Knowledge of the epidemiology of suicidal ideas and attempts in the general population as well as in the health care system is of importance for designing preventive strategies. In this study, we will explore the role of the psychiatric hospital in suicide prevention by investigating treated incidence of suicidal ideation and attempt, and further, discern whether sociodemographic, clinical and service utilization factors differ between these two groups at admission.MethodsThe study was a prospective cohort study on treated incidence in a 1-year period and 12-month follow-up. The two psychiatric hospitals in northern Norway, serving a population of about 500,000 people, participated in the study. A total of 676 first-time admissions were retrospectively checked for suicidality at the time of admission. A study sample of 168 patients was found eligible for logistic regression analysis to elucidate the risk profiles of suicidal ideators versus suicidal attempters. GAF, HoNOS and SCL-90-R were used to assess symptomatology at baseline.Results52.2% of all patients admitted had suicidal ideas at admission and 19.7% had attempted suicide. In the study sample, there were no differences in risk profile between the two groups with regard to sociodemographic and clinical factors. Males who had made a suicide attempt were less likely to have been in contact with an out-patient clinic before the attempt. The rating scales not measuring suicidality directly showed no differences in symptomatology.ConclusionThe findings provide evidence for the importance of the psychiatric hospital in suicide prevention. About half of the admissions were related to suicidality and the similar risk profiles found in suicidal ideators and suicidal attempters indicate that it is the ideators who mostly need treatment that get admitted to the hospital, and should be evaluated and treated with equal concern as those who have attempted suicide.

The effect of gender in diagnosing early schizophrenia

BackgroundStudies of diagnostic practice confirm that there is a diagnostic delay in diagnosing women with schizophrenia compared to diagnosing men. The aim of the present study was to investigate the diagnostic practice of Norwegian and Russian psychiatrists when it comes to early psychosis, emphasising gender differences. We wanted to study the association between patient gender as such and diagnostic decision-making among psychiatrists.Materials and methodsPsychiatrists in Norway and the Archangels region in Russia were invited to participate in a study of diagnostic practice, and received a written case description of a patient with early psychosis symptoms that could be interpreted as schizophrenia. They were, however, not informed that 50% of them received a female case description and 50% a male case description. Apart from the patient being described as “he” or “she” the stories were identical. Effects of patient gender, clinician gender, age and main area of interest were estimated using logistic regression analysis.ResultsA total of 467 psychiatrists answered the questionnaire. We found that schizophrenia diagnosis was given significantly more often to the male case than to the female case. Our finding remained significant after adjustment for country, clinician gender, age and main area of interest, and is unlikely to be explained by known biases.ConclusionPatient gender in itself affects clinicians’ diagnostic practice regarding schizophrenia, as schizophrenia diagnosis is given significantly more often to a male case description than to a female one, the descriptions being otherwise identical.

Seasonal affective disorder and latitude of living

AIM Since the importance of latitude of living for the prevalence of Seasonal Affective Disorder (SAD) is unclear, the study aims to test the latitude hypothesis by comparing SAD in two rather similar groups of students living at latitudes far apart. METHODS Two groups of students, 199 in Tromsø, Norway (690 N) and 188 in Ferrara, Italy (440 N) were asked to fill in the Seasonal Pattern Assessment Questionnaire. RESULTS Global Seasonality score (GS-score) was significantly higher in Italian than in Norwegian students, in females and in students with sleeping-problems. Norwegian students had significantly higher SAD prevalence in winter and in spring. Most people in both countries felt worst in October and November, and the prevalence of Autumn SAD was not significantly different between the two countries. CONCLUSIONS The hypothesis that SAD is linked to amount of environmental light and latitude of living was not supported.

Excess in the spring and deficit in the autumn in birth rates of male schizophrenic patients in Italy: Potential role of perinatal risk factors

Objective. The aim of this study was to evaluate whether there were different seasonal variations of births in an Italian population of patients with schizophrenia, with other psychotic disorders, and with personality disorders than in the general population. Methods. Birth dates of 1270 patients admitted to one university psychiatric unit in Rome between 1990 and 2003, with a diagnosis of schizophrenia, other psychotic disorder (OPD) and personality disorder/cluster A (PD) were analyzed according to seasonal variation. Results. A significant excess of births in spring (with a peak in May) and a deficit in autumn (with a trough in October) was found in the sample of male schizophrenics (n = 506). No statistically significant variations were found in either the sample of female schizophrenics (n = 88) or in the combined sample with OPD and PD (n = 676). Conclusions. The findings serve to strengthen the existing hypotheses that schizophrenia is related to environmental factors acting on the development of the central nervous system intrauterinely.

Improvement in mental health over time in Northern Norway

Abstract.Background:There are very few prospective studies of mental distress in the general population. Two studies of general health in Finnmark county in northern Norway, performed 9 years apart, contained questions about depression and sleeping problems, which made it possible to study change in mental distress over time in the general population.Methods:In a self-administered questionnaire, the subjects were asked about depression and sleeping problems, both generally and related to the dark period in winter, at two points in time: in 1987/88 and 1996/97. The persons participating in the two surveys were partly the same and partly new individuals. More than 12,000 persons responded in 1987/88 and more than 7,000 people in 1996/97. The cohort that answered questions about sleeping problems and depression at both time-points consisted of 3,318 and 3,682 persons, respectively.Results:The prevalence of depression and sleeping problems, both generally and related to winter,decreased significantly in the course of the 9-year time-span. The decrease was also true for the cohort that answered at both time-points, except for sleeping problems related to winter, which were unchanged. The pattern of changes was identical for both genders and all age groups.Conclusions:Mental health in the general population seems to have improved during the period studied. The findings are also relevant for the discussion of the validity of the concept Seasonal Affective Disorder, and the presumed connection to light-deprivation.

First-admission schizophrenic patients northern Norway, 1980-95: Sex differences in diagnostic in practice

Several studies of first-contact incidence studies of schizophrenia suggest a significant excess of males. We wanted to investigate the clinical diagnostic process in a cohort of first-episode schizophrenic patients to search for possible implications for epidemiologic research. All first-ever admitted schizophrenic patients in the two northernmost counties in Norway (Troms and Finnmark, covering 250,000 inhabitants) with three or more admissions during the period 1980? 95 (60 females and 91 males with a total of 1326 admissions) were included in the study. Norway shifted diagnostic system from ICD-8 to ICD-9 in 1987. The impact of this shift on the diagnostic process was also studied. Our study shows that females had a significantly longer period than did males from first admission until the first diagnosis of schizophrenia (2.6 years and 3.4 admissions versus 1.6 years and 2.3 admissions). Thirtythree per cent of the females received the diagnosis at first admission, and 47% of the males. Females received the diagnosis of personality disorder significantly more often than males before the first diagnosis of schizophrenia. The schizophrenia diagnosis remained unchanged in 79% of the cases; stability was even higher (90 %) for those diagnosed at first admission. Our conclusion is that diagnostic practice in the course of schizophrenia showed a significant sex difference, both in diagnostic distribution and in latency period before first schizophrenia diagnosis. The total latency period decreased after the introduction of new guidelines in 1987, but the sex difference in latency period persisted.Several studies of first-contact incidence studies of schizophrenia suggest a significant excess of males. We wanted to investigate the clinical diagnostic process in a cohort of first-episode schizophrenic patients to search for possible implications for epidemiologic research. All first-ever admitted schizophrenic patients in the two northernmost counties in Norway (Troms and Finnmark, covering 250,000 inhabitants) with three or more admissions during the period 1980? 95 (60 females and 91 males with a total of 1326 admissions) were included in the study. Norway shifted diagnostic system from ICD-8 to ICD-9 in 1987. The impact of this shift on the diagnostic process was also studied. Our study shows that females had a significantly longer period than did males from first admission until the first diagnosis of schizophrenia (2.6 years and 3.4 admissions versus 1.6 years and 2.3 admissions). Thirtythree per cent of the females received the diagnosis at first admission, and 47% of the males. Females receiv...