Mortality and aggressiveness in a 30-year follow-up study in child guidance clinics in Stockholm

The mortality rate and aggressiveness in a cohort of 2364 former patients of the child guidance clinics in Stockholm were studied during a 30-year follow-up period; 106 died during this observation period. This frequency is significantly higher than the calculated mortality rate in a reference population. In all, 82% of the total deaths were caused by suicide, accidents, or abuse of alcohol or drugs. Among the patients that died of suicide and abuse, more mental disorders, abuse and criminality were found in their parents during the initial evaluation. Significantly more males than females died as a result of accidents and alcohol or drug abuse. Aggressive feelings and acts, both against oneself and others, were overrepresented in the initial contacts with the child guidance clinics. To prevent these deaths, an alternative approach during the first contact with a child psychiatric centre is discussed, as well as more extensive help and intervention at an early stage.     

A 22- to 25-year follow-up study of former child psychiatric patients: a register-based investigation of the course of psychiatric disorder and mortality in 546 Danish child psychiatric patients

A total of 546 children and adolescents, aged 5 to 15 years, who were admitted as in-patients to psychiatric hospitals throughout Denmark betweeen 1970 and 1973, were followed up with regard to later readmissions and mortality. Approximately one-third of the sample had at least one readmission after the age of 18 years; there was no significant difference between male and female subjects. Probands with three selected diagnoses, namely childhood neurosis, conduct disorder and maladjustment reactions, did have a significantly greater general risk of readmission to psychiatric hospital in adulthood than the background population. In total, 24 probands (22 male, and 2 female subjects) died during the study period. Eight subjects had committed suicide. The standard mortality rate was significantly increased.     

The prognosis in early adulthood of child psychiatric patients: a case register study in Denmark

A register-based study of 485 children (0-15 years of age) admitted to a child psychiatric hospital from January 1, 1970 to December 31, 1972 who were followed up on December 31, 1986 showed higher rates of admission to psychiatric hospital in late adolescence or young adulthood (i.e. greater than or equal to 16 years of age) than found in an age-standardized general population. Patients with the childhood diagnosis neurosis (ICD-8 300 + 308.00) were found to have higher rates of admission with personality disorders (ICD-8 301.09-301.39 + 301.82-301.99) but not of other diagnoses including neurotic disorders. Patients with the childhood diagnosis of conduct disorder (ICD-8 301.09-301.99 + 308.01) had a higher risk of admission in adulthood with the diagnosis of personality disorders and drug or alcohol abuse. Girls with adjustment disorder (ICD-8 307 + 308.02-308.06) had higher risks of admission in young adulthood with diagnosis of personality disorders and psychosis. No connection was found between the age at first referral and the incidence of admission after the age of 15 years.     

Inpatient psychiatric adolescents function better than expected after discharge. A follow-up study

In order to evaluate and develop an inpatient program for adolescents, a follow-up study was carried out based on interviews with 58 adolescents discharged from the inpatient unit on average 7 years before. The mental status of these patients had been poor on admission. At the time of follow-up interviews, approximately 30% of patients appeared to have normal, socially varied lives. The results were better for patients whose treatment at the unit had lasted for more than 3 months and had included psychotherapy. Roughly 10% of the patients at the time of follow-up interviews had severe problems. The prognosis was worst for the patients who needed to be transferred from the adolescent unit to adult psychiatric treatment units because of suicidal and violent behavior. Young patients with severe disturbances need an individualized, multidisciplinary treatment approach, including individual psychotherapy and vocational training. The treatment should continue uninterrupted on an outpatient basis.     

Utilization of psychiatric in-patient care among new patients in a comprehensive community-care system: a 3-year follow-up study

Utilization of psychiatric in-patient care among 537 new patients was studied in the Department of Psychiatry in Oulu, Finland, during a 3-year follow-up period. Hospitalization during the second and third years of the follow-up was predicted by hospitalization and number of emergency out-patient contacts during the first year of the study, diagnosis of functional psychosis or personality disorder, and previous in-patient care. In total, 5% of the cohort fulfilled our criteria for ‘revolving-door’ patients. The ‘revolving-door’ phenomenon was associated with in-patient care at the first contact with the psychiatric services and diagnosis of psychosis or personality disorder. In total, 2% of the cohort became long-stay hospital patients, and this was predicted by psychosis diagnosis. The clinical implications of these findings are that increased attention should be paid to the first assessment of new patients and to the interaction between psychiatric services and patients during the first year of care.     

A 10-year follow-up study of tardive dyskinesia.

In a 10-year follow-up study of 44 patients with tardive dyskinesia (TD), the majority (22 or 50%) had no change in their TD severity, 9 (20%) had an improvement and 13 (30%) had a worsening of their TD. Little difference was noted in those patients whose medication was decreased (n = 12) and those whose medication remained unchanged (n = 32). Of the women, 26% showed improvement as compared with 11% of the men. Also, patients whose TD improved had lower present neuroleptic dose than those whose TD worsened. These two factors should be studied in larger patient cohorts.     

Child and adolescent psychiatric patients in adulthood

A total of 142 consecutive patients cared for by child and adolescent psychiatry were followed up to the age of 33-37 years; 49% were treated in adult psychiatry between the ages of 20-25 years, and 20% of these were hospitalized. The frequency of hospitalization was 4-5 times that of a control group. Between the ages of 20-34 years, 32% were admitted some time for inpatient psychiatric care. Psychiatric diagnoses of the patients: schizophrenia 4%, manic-depressive 5%, neurosis and reactive insufficiency 11%, personality disorders and/or abuse diagnosis 12%. Patients with a schizophrenia diagnosis in adulthood needed the most hospitalization. The symptom picture was stable from child and adolescent psychiatric care through to adulthood, but abuse increased with age. The frequency of sick leave was 2.5 times higher among the child and adolescent psychiatric care patients than among the control group. At the age of 34-36 years, 13% of the former patients received disability benefits as compared with 1% for the same age groups in the entire population of Sweden. Twenty-one percent received sentences for criminal offenses from the age of 20-34 years. The number of crimes decreased with increasing age. Nearly 50% were in contact with the social welfare services, 3 times as many as in the control group. A third of the men completed their national military service. A total of 6 men and 1 woman died, indicating an increased mortality rate for men. All deaths except one were related to the mental disorder.     

A 13-year follow-up of an adolescent psychiatric clientele

The objective of the study was to compare development in symptoms, behaviours, treatment and patient satisfaction of a traditional interior and an interior furnished like an ordinary home in a seclusion area. A naturalistic sample of 56 consecutive patients admitted to an acute ward was allocated to two different seclusion areas, one with a traditional interior and one decorated as an ordinary home. Symptoms of psychopathology, therapeutic steps taken, violent episodes, length of patient stay and patient satisfaction were recorded. There were no differences in changes in scores on The Positive and Negative Syndrome Scale for schizophrenia, The Brøset Violence Checklist or the Global Assessment of Function split version scale between the two patient groups. Therapeutic steps taken, number of violent episodes and length of patient stay was also similar. Female patients preferred an ordinary home interior. It was concluded that interior and furnishing like an ordinary home in the seclusion areas created an environment with comparable treatment outcomes to the traditional dismal interior, and had positive effects on many patients’ well-being, at least among the women. The traditional beliefs that a sparsely decorated interior is a method to reduce symptoms of psychopathology and dangerous behaviours were not supported by our data.     

A longitudinal study of mental health problems in a suburban population in Sudan

A psychiatric study of 197 children living in villages outside Khartoum was made in 1964-1965. In 1983, 104 randomly chosen subjects were investigated again. All were interviewed by a psychiatrist and somatically examined. The overall psychiatric impairment was 14% (males, 18%; females, 8%) according to the psychiatric interview; the Self-rating Questionnaire gave a higher figure (28%). The rate of somatic illness was similar: 14% according to the medical doctor, 22% according to the self-rating of the subjects. Childhood data predicted 17% of the variance in adult mental health. Somatic state of health in childhood and traditional type of work by the father were the most important variables. Data from the life situation of the individual explained 67% of the variance in adult mental health.     

A 10-year follow-up study of an adolescent psychiatric clientele and early predictors of readmission

Over a period of 20 years (from 1968 to 1988) all inpatients (n = 839) who were admitted for the first time to the adolescent psychiatric unit in Copenhagen were registered, and 40 social and psychiatric variables were recorded, to investigate early predictors of later readmission. Overall, 44.8% of the patients were readmitted within a certain observation period (range, 1.5-21.5 years). Among a subsample of 488 patients (58%) who could be followed up for more than l0 years after their first admission 26% became heavy users of psychiatric services, defined as long-term inpatients or revolving-door patients. Severe early diagnoses (schizophrenia and affective psychoses) were strongly associated with rapid relapses and frequent readmissions. A statistical estimate of the risk of later heavy use based on 12 independent variables is presented.     

A follow-up study of a child psychiatric clientele with special regard to the diagnosis of psychosis

A 20-year follow-up of a child psychiatric clientele of 322 patients demonstrates that nearly one third have been admitted to psychiatric departments or mental hospitals in adulthood. One tenth belonged to the group with psychoses either as a child or grown-up. While the incidence of manic-depressive psychosis did not differ from a normal population of the same sex and age, the child psychiatric clientele is overrepresented by psychotic patients later on diagnosed as schizophrenia. The outcome of infantile psychosis was in half of the cases chronic psychosis; five of 10 psychosis proto-infantilis patients were diagnosed schizophrenia in adulthood. This result is not in accordance with the modern view that psychosis proto-infantilis is a special disease with no clinical connection to schizophrenia. The clinical entity of infantile psychosis and borderline psychosis seems to be affirmed by a common clinical and diagnostic course into borderline psychosis or schizoid character disorders. Nine patients with psychosis in adulthood did not belong to the group of psychosis in childhood.     

A 10-year follow-up study of an adolescent psychiatric clientele and early predictors of readmission

Over a period of 20 years (from 1968 to 1988) all inpatients (n = 839) who were admitted for the first time to the adolescent psychiatric unit in Copenhagen were registered, and 40 social and psychiatric variables were recorded, to investigate early predictors of later readmission. Overall, 44.8% of the patients were readmitted within a certain observation period (range, 1.5-21.5 years). Among a subsample of 488 patients (58%) who could be followed up for more than 10 years after their first admission 26% became heavy users of psychiatric services, defined as long-term inpatients or revolving-door patients. Severe early diagnoses (schizophrenia and affective psychoses) were strongly associated with rapid relapses and frequent readmissions. A statistical estimate of the risk of later heavy use based on 12 independent variables is presented.     

A 15-year follow-up study of Chinese schizophrenic patients

A cohort of 330 Chinese schizophrenic patients below age 40 were interviewed 5, 10 and 15 years later to determine which variables could predict their outcome. There were 189 males (57%) and 141 females (43%). At the end of 15 years, 48 (15%) died (34 (10%) from suicide). At the end of 5, 10 and 15 years, the percentages of patients still able to work were 55%, 54% and 48%, and still receiving treatment were 45%, 41% and 45% respectively. The patients who were well in 1990 had fewer readmissions. The only variables that consistently predicted outcome was duration of illness. Age and education level were fairly useful in predicting outcome. Sex, family history, work status, marital status, alcohol, drug and suicide history, and such symptoms as thought disorder, affective blunting, depression, delusions and hallucinations were not useful in predicting outcome.     

The reliability of child psychiatric diagnosis. A comparison among Danish child psychiatrists of traditional diagnoses and a multiaxial diagnostic system

The study was conducted to compare an experimental multiaxial diagnostic system (MAS) with traditional multicategorical diagnoses in child psychiatric work. Sixteen written case histories were circulated to 21 child psychiatrists, who made diagnoses independently of one another, using two different diagnostic systems. Diagnostic reliability was measured as percentage of interrater agreement. The highest diagnostic reliability was obtained in psychotic disorders, the lowest in personality disorders. The MAS implied improved diagnostic reliability of mental retardation, somatic disorders and developmental disorders. Adjustment reaction (reactio maladaptiva) was the diagnosis most commonly used, but with varying reliability in both systems. The reliability of the socio-economic and psychosocial axes were generally high.     

A prospective 5-year follow-up study of self-poisoned patients

A 5-year follow-up study of 253 patients discharged after self-poisoning is presented. Repeated acts of self-poisoning occurred mainly in the first year after discharge; 20% and 22% of female and male patients, respectively. This number is a minimum, the migration frequency being high. Very few patients responded to a letter asking them for a follow-up interview, only 56% and 42% of female and male patients, respectively. Five years after discharge 18% of male patients and 11% of female patients had died. The 5-year mortality rate was 73 times the expected value for male patients and 109 times the expected value for female patients.     

A 5-year follow-up study of suicide attempts

Johnsson Fridell E, Öjehagen A, Träskman-Bendz L. A 5-year follow-up study of suicide attempts. Acta Psychiatr Scand 1996: 93: 151–157. Q Munksgaard 1996. Seventy-five patients were admitted to the ward of the Lund Suicide Research Center following a suicide attempt. After 5 years, the patients were followed up by a personal semistructured interview covering sociodemographic, psychosocial and psychiatric areas. Ten patients (13%) had committed suicide during the follow-up period, the majority within 2 years. They tended to be older at the index attempt admission, and most of them had a mood disorder in comparison with the others. Two patients had died from somatic diseases. Forty-two patients were interviewed, of whom 17 (40%) had reattempted during the follow-up period, most of them within 3 years. Predictors for reattempt were young age, personality disorder, parents having received treatment for psychiatric disorder, and a poor social network. At the index attempt, none of the reattempters had diagnoses of adjustment disorders or anxiety disorders. At follow-up, reattempters had more psychiatric symptoms (SCL-90), and their overall functioning (GAF) was poor compared to those who did not reattempt. All of the reattempters had had long-lasting treatment (> 3 years) as compared to 56% of the others. It is of great clinical importance to focus on treatment strategies for the vulnerable subgroup of self-destructive reattempters.     

A long-term follow-up study of adolescent psychiatric in-patients. Part II. Predictors of delinquency

A total of 932 adolescent psychiatric in-patients were followed up 15-33 years after hospitalization by record linkage to the National Register of Criminality. On the basis of the hospital records the patients were rediagnosed according to DSM-IV and scored on data postulated to be predictors of later delinquency. The factors were investigated by Kaplan-Meyer survival analysis and Cox regression. Cox analysis showed that, in males, main diagnosis (relative risk (RR)=2.9, 95% confidence interval (CI)=2.0-4.2), verbal abuse at home (RR=1.5, CI=1.1-2.0), disciplinary problems at school (RR=1.7, CI=1.2-2.5), and violating ward rules during hospitalization (RR=1.6, CI=1.2-2.2) were strong and independent predictors of delinquency. In females, main diagnosis (RR=2.6, CI=1.6-4.2), concurrent psychoactive substance use disorder (RR=2.9, CI=1.9-4.2), verbal abuse at home (RR=1.5, CI=1.0-2.1), and disciplinary problems at school (RR=1.6, CI=1.1-2.5) were strong and independent predictors of delinquency. Among males who violated ward rules and received a diagnosis of disruptive behaviour disorder, psychoactive substance use disorder or personality disorder at index hospitalization, as many as 77.6% had a criminal record at follow-up.     

Children of parents with obsessive-compulsive disorder -- a 2-year follow-up study

OBJECTIVE: To examine the association between parental obsessive-compulsive disorder (OCD) and emotional and behavioural disorders in offspring. METHOD: Demographic, clinical, and diagnostic data were collected from parents with OCD, control subjects, and their respective offspring. Offspring were reassessed at a 2-year follow-up. RESULTS: Probands with OCD and controls were relatively well matched for age, gender, race, educational rating, and marital status. Offspring of OCD probands were at greater risk than offspring of controls for dimensionally measured anxiety, depression, somatization, and social problems. OCD offspring were significantly more likely than control offspring to have lifetime overanxious disorder, separation anxiety disorder, OCD, or 'any anxiety disorder'. Female gender in the parent with OCD, evidence of family dysfunction, and high symptom levels in offspring were predictive of broadly defined OCD at follow-up. CONCLUSION: Children having a parent with OCD are more likely than control offspring to have social, emotional, and behavioural disorders.     

Patients with delusions in a community psychiatric service. A follow-up study

Case records of 546 patients referred for the first time to a community psychiatric service were studied. Fifty-six patients revealed delusions of various types. The female/male ratio was 2:1, and the mean age 57 years. The majority of the paranoid patients belonged to the lowest socio-economic groups. Symptomatology, including type of delusion, treatment given and diagnostic classification is presented. The delusions occurred as part of all major psychotic syndromes with a preponderance of organic and affective psychoses. After 5-20 years of observation a full remission without relapse was seen in only 5%. However, the predictive value of delusions has not been sufficiently established, and the need for prospective studies of course and prognosis of psychoses with delusions is stressed.