Prevalence of mental disorders among 15-17-year-old male adolescent remand prisoners in Denmark

OBJECTIVE: To determine the past year prevalence of mental disorders of 15-17-year-old adolescent remand prisoners in east Denmark. METHOD: One hundred 15-17-year-old boys from east Denmark consecutively remanded during 1 year were interviewed with diagnostic instruments to obtain ICD-10 diagnoses. All were screened in The Danish Psychiatric Case Register and The Danish Criminal Register. RESULTS: Past year prevalence of 'any mental disorder' was 69%, substance use disorders 41%. Two per cent had schizophrenia and 2% schizotypal disorder. Thirty-six per cent had 'probable personality disorder'. Conduct disorder was found in 31% and 1% had a hyperkinetic disorder. Ten per cent had previous registered psychiatric contact. CONCLUSION: The prevalence of mental disorders was found substantially higher compared with literature of population-based samples. With an association between mental disorders and violence, early detection and treatment of mental disorders in adolescent delinquents is of importance in the prevention of violence.     

Psychiatric disease incidence among Danish Seventh-day Adventists and Baptists

Purpose

Previous studies suggest that religious practice can have a positive effect on mental health, but may also have potential for harm. In Denmark, unique possibilities are available for studying the influence of religious practice on mental health: Denmark is characterized as a secular society and it is possible to follow members of religious societies in nationwide registers. In this study, we follow a cohort of Danish Seventh-day Adventists (SDA) and Baptists in a nationwide psychiatry register and compare the incidence in this cohort with the general population.

Methods

We followed a cohort of 5,614 SDA and 3,663 Baptists in the Danish Psychiatric Central Register, which contained information on psychiatric hospitalizations from 1970 to 2009. Psychiatric disease incidence in the cohort was compared with that in the general Danish population as standardized incidence ratios and within-cohort comparisons were made with a Cox model.

Results

The cohort had decreased incidence of abuse disorders compared to the general population. Furthermore, among Baptists, decreased incidence of unipolar disorders among men and decreased incidence of schizophrenia among women were observed. Surprisingly, we observed an increased incidence rate of unipolar disorder among women.

Conclusions

In this nationwide cohort study with 40 years of follow-up, we observed increased incidence rates of unipolar disorders among women and decreased rates of alcohol- and drug-related psychiatric disorders compared to the general Danish population. We have no mechanistic explanation for the increased incidence of unipolar disorders among women, but discuss several hypotheses that could explain this observation.     

Psychiatric disorders in adults diagnosed as children with atypical autism. A case control study

Summary. The prevalence and types of psychiatric disorders were studied in a clinical sample of 89 individuals with atypical autism (AA) first seen as children, and 258 matched controls from the general population using data from the nationwide Danish Psychiatric Central Register. The average observation time was 36.9 years, and mean age at follow-up 45.3 years. A total of 61 persons with AA (68.5%) had been in contact with psychiatric hospitals during the follow-up period, compared with 10.9% in the comparison group. A whole range of significantly elevated psychiatric disorders was found, so AA is not seen to be associated with any specific mental disorder. Schizophrenia spectrum disorders were the most commonly associated psychiatric disorders, diagnosed at least one time in 34.8% of the AA cases. Our findings underscore that it is important for clinicians working in adult psychiatric services to be aware that AA and a wide range of psychiatric disorders often co-exist. Correspondence: Svend Erik Mouridsen, Department of Child and Adolescent Psychiatry, Bispebjerg University Hospital, 2400 Copenhagen, Denmark     

Psychiatric disorders in the parents of individuals with infantile autism: a case-control study

BACKGROUND: The rates and types of psychiatric disorders were studied in the parents of individuals with infantile autism (IA). SAMPLING AND METHODS: To estimate the prevalence and types of psychiatric disorders, the parents of 115 individuals with IA and the parents of 330 controls from the general population were screened through the nationwide Danish Psychiatric Central Register covering a period of 33 years. The IA individuals had been seen as in-patients at two university clinics of child psychiatry during a 25-year period and had been referred from the entire country of Denmark. RESULTS: Psychiatric disorders were found in 15.7% of mothers with autistic children, which was significantly higher than the 8.2% found in the control group. The only diagnostic category in which a statistically significant overrepresentation could be found was that of personality disorder. A personality disorder diagnosis was found in 7.8% of mothers with autistic children in comparison to 2.1% of mothers in the control group. CONCLUSION: The findings so far suggest that in future studies it is important to pay attention to issues such as relatives examined, control groups and methods of data collection.     

The incidence of eating disorders in a Danish register study: Associations with suicide risk and mortality

Our aim was to characterize the incidence rates and cumulative incidence of anorexia nervosa (AN), bulimia nervosa (BN), and eating disorder not otherwise specified (EDNOS), and examine associations among eating disorder diagnoses, suicide attempts, and mortality. Individuals born in Denmark between 1989 and 2006 were included (N = 966,141, 51.3% male). Eating disorders diagnoses (AN, broad AN, BN, EDNOS) were drawn from the Danish Psychiatric Central Research Register (PCRR) and Danish National Patient Register (NPR). Suicide attempts and deaths were captured in the NPR, the PCRR, and the Danish Civil Registration System (CRS). In females, AN had a peak hazard at approximately age 15 years, BN at 22 years, and EDNOS had an extended peak that spanned 18 years–22 years. Eating disorder diagnoses predicted a significantly higher hazard for death and suicide attempt compared with the referent of individuals with no eating disorders. In males, peak hazard for diagnosis was earlier than in females. The present study represents one of the largest and longest studies of eating disorder incidence and suicide attempts and death in both females and males. Eating disorders are accompanied by increased hazard of suicide attempts and death even in young adults.     

Psychoactive substance use diagnoses among psychiatric in-patients

OBJECTIVE: To estimate the prevalence and possible under-diagnosing of substance use disorders and to consider factors that might influence diagnosing of substance use disorders. METHOD: Data collected from case records and PSE interviews of psychiatric in-patients from 12 psychiatric departments in Denmark admitted during October 1996 were compared with data from the Danish Psychiatric Register. RESULTS: A substantially lower prevalence of substance use diagnoses were found in the register (26.1%) than in the research data (50.0%). A high prevalence of co-occurrence between substance use disorders and mental disorders other than substance use disorders was found (37.3%). In the majority of cases knowledge of the substance use disorders was present in the case records, although they had not resulted in a diagnosis. CONCLUSION: The under-diagnosis of substance use disorders is due not only to concealed diagnostic signs and symptoms but also to an under-diagnosis by the psychiatrists, in spite of the fact that information on the substance use was accessible.     

Formandsberetning: Med særlig omtale af udvalgsarbejdet vedrøSrende dansk psykiatris jremtid

Engberg M. Commitments to mental hospitals in Denmark, 1971-1987.

Age-standardized rates of commitment of mentally ill patients in Denmark from 1971 to 1987 were studied on the basis of information from the Danish nationwide Psychiatric Case Register. A decrease in incidence and age-standardized rates of commitment due to an evenly distributed decrease in incidence rates of both sexes and all age groups was found during the 1970s. Since 1983 the general commitment rate has been stable. Throughout the observation period the relative risk of commitment for men compared with women was increased, and the risk of being evaluated as dangerous was increased for men compared with women. The proportion of schizophrenic patients among the committed has increased, and commitment of patients diagnosed as non-psychotic during the stay in hospital has become less common.     

Obstetric factors, urbanization and psychosis

BACKGROUND: Epidemiologic evidence as early as the 1930s has suggested urbanization is linked to schizophrenia, either by place of admission, place of upbringing, or, more recently, place of birth. In the past decade, obstetric complications have been implicated in the etiology of schizophrenia. METHODS: With appropriate protections for anonymity, the files of the Danish Medical Birth Register were linked with the files of the Danish Psychiatric Case Register. The linkage produced 132 cases of schizophrenia and 69 cases of affective psychosis, who were born in 1973 or later, who entered a Danish psychiatric hospital before 1994. Controls were drawn from a 10% sample of the Medical Birth Register. Analysis was by logistic regression. RESULTS: The risk of hospitalization for schizophrenia was 4.20 times higher (95% CI=2.4-7.4) for those born in Copenhagen versus those born in rural areas of Denmark, and a linear relationship was demonstrated between urbanization of birthplace and risk. There was no difference in risk of hospitalization for affective psychosis for those born in Copenhagen versus rural areas. Obstetric complications had a moderate sized relationship to schizophrenia, but the relationship of urban birth to schizophrenia was unaffected by adjustment for obstetric complications. CONCLUSION: Urban birth is a strong risk factor for schizophrenia, not mediated by obstetric complications, which deserves further exploration.     

Obsessive-compulsive disorder: admission patterns and diagnostic stability

All first-time admissions from 1970 to 1986 with obsessive-compulsive neurosis (OCD) (ICD-8 diagnosis number 300.39) or obsessive-compulsive personality disorder (OCPD) (ICD-8 diagnosis number 301.49) were analyzed based on an extract from the nationwide Psychiatric Case Register in Denmark. All patients with secondary diagnoses other than neurotic disorders or personality disorders (including “neuroses characterogenes”) were excluded from the study. A total of 284 patients were first-time admitted with a main diagnosis of OCD during the period. The sex ratio was 0.67 (males/females). A total of 126 were first-time admitted with a diagnosis of OCPD, with a sex ratio of 1.18 (males/females). Seventy-seven percent of the readmitted patients with a first-time diagnosis of OCD kept a diagnosis within the “emotional spectrum” at the last admission. About half kept OCD as a main diagnosis, whereas only 15% shifted to a severe psychiatric diagnosis such as schizophrenia or manic-depressive psychosis. Of the readmitted patients with OCPD. 13% later developed a diagnosis of manic-depressive psychosis.     

ICD-10 classification in Danish child and adolescent psychiatry--have diagnoses changed after the introduction of ICD-10?

The aim was to test this in a nationwide register study of diagnoses used in child and adolescents psychiatry in Denmark. A larger number of different diagnoses were expected to be applied after the introduction of the 10th version of the International Classification of Diseases (ICD-10). Reflecting the time trend, we particularly expected an increase in the number of neuropsychiatric diagnoses. From the Danish Psychiatric Central Register data were drawn on clinical discharge diagnoses. All patients aged 0-15 years examined at psychiatric hospitals from 1995-2002 were included; 22,469 children and adolescents with a first contact were registered. The most frequent discharge diagnoses were pervasive development disorders (PDD; 11.9%), adjustment disorders (10.6%), conduct disorder (9.5%), emotional and anxiety disorders (7.6%), hyperkinetic disorders (7.3%), and specific developmental disorders (7.3%). We found a significant increase in the number of neuropsychiatric and affective diagnoses and a significant decrease in the number of adjustment, conduct and anxiety diagnoses during the study period. Of the 22,469 diagnoses, 45% were only partly specified according to ICD-10. Thirty-four per cent had diagnoses unspecified on the four-character level (Fxx.9) and 11% had Z-diagnoses. A larger number of different diagnoses and an increase in the use of neuropsychiatric diagnoses were seen after the introduction of ICD-10. Many diagnoses were only partly specified; consequently, a more detailed specification of the ICD-10 is still required.     

Increased incidence of affective disorders, anxiety disorders, and non-natural mortality in women after breast cancer diagnosis: a nation-wide cohort study in Denmark

OBJECTIVE: To investigate whether breast cancer patients have increased incidence of psychiatric admission with affective disorders, anxiety disorders, or non-natural mortality compared with the general female population. METHOD: Register-linkage between nation-wide registries: The Danish Psychiatric Central Register, The Danish Cancer Registry, and The Danish National Register of Causes of Death. A total of 61 709 women registered with primary invasive breast cancer between 1970 and 1993 were included and 356 023 person-years were accrued. RESULTS: The standardized incidence ratio of first-ever psychiatric admission with affective disorder was 1.49 (95% CI: 1.35-1.63) and with anxiety disorder 1.25 (95% CI: 1.06-1.46). The standardized non-natural mortality ratio during the first year after breast cancer diagnosis was 1.54 (95% CI: 1.27-1.87). All analyses were adjusted for age, calendar period, and place of residence. CONCLUSION: Breast cancer patients have significantly increased incidence of psychiatric admission with affective disorders, anxiety disorders, and non-natural mortality.     

Dual Mating Studies in Psychiatry—offspring of inpatients with examples from reactive (psychogenic) psychoses

Studies on the offspring of dual mating psychiatric inpatients present a special high-risk strategy, analogous to the diallele cross methods of plant and animal genetics for Mendelian traits, except that the parents in dual matings have complex phenotypes, and all combinations of disorders may be observed. Previous studies have mainly been on the effects of homotypic parent combinations of schizophrenia or manic-depressive disorders, showing a 2–5-fold increase in the risk for similar disorders in the offspring compared to the risk for offspring of one affected parent. A study on heterotypic parent combinations allowing an exploration of genetic relationships among various disorders has been made possible through the use of the nation-wide Danish Psychiatric Register. All psychiatric inpatients who had offspring with other psychiatric inpatients were identified, yielding a total of 139 couples with non-organic mental disorders. Their 378 offspring were followed well into the risk periods for the major mental disorders. As an example to illustrate the complexities involved in analysis of data from a dual mating study, results for parent combinations involving reactive psychoses are presented.     

The reliability of psychiatric diagnosis in Israel's Psychiatric Case Register

To determine the reliability of psychiatric diagnoses in the Israel Psychiatric Case Register, DSM-III criteria were applied to case record abstracts of first admissions to a large psychiatric hospital in Jerusalem. The DSM-III diagnoses were compared with ICD-8 records diagnoses. Between 40 and 50% of those originally diagnosed as schizophrenia were re-diagnosed into less severe categories. The proportion diagnosed as affective disorder doubled from 21% for ICD-8 diagnoses to 40% for DSM-III diagnoses. The unreliability concerned the diagnoses of schizophrenia and affective disorder. Findings suggest that the introduction of standardized diagnostic criteria in Israel will lead to a substantial increase in the number of cases diagnosed as affective disorder, although difficulties involved in differentiating schizophrenia from the major affective disorders remain. The DSM-III findings suggest a high prevalence of affective disorders among Jews.     

The new asylums in the community: severely ill psychiatric patients living in psychiatric supported housing facilities. A Danish register-based study of prognostic factors, use of psychiatric services, and mortality

Introduction

Reorganization of psychiatric treatment in Denmark involved a declining number of psychiatric long-stay beds and an increasing number of psychiatric supported housing facilities in the community. Very few studies have focused on the population in such facilities.

Methods

Information was generated combining addresses of supported psychiatric housing facilities with information from the Danish Civil Registration System to create a case register of persons living in supported psychiatric housing facilities. Through linkage with the Danish Psychiatric Central Register, we examined predictors of becoming a resident in a psychiatric housing facility, use of psychiatric services around the time of entrance to a supported psychiatric housing facility, and mortality rates for residents in a psychiatric housing facility compared to non-residents and to persons in the general population who never experienced a psychiatric admission.

Results

We identified schizophrenia as the strongest diagnostic predictor of becoming a resident in a supported psychiatric housing facility, followed by organic mental disorders, substance abuse, and affective disorder. In addition, the higher the number of psychiatric bed days, the higher the risk. Compared to the years before the first entrance to a supported psychiatric housing facility, the number of bed days in the year following the first entrance dropped more among residents than among comparable psychiatric patients. Mortality rates were slightly higher among residents in a supported psychiatric housing facility than among comparable psychiatric patients, but more than tenfold higher when compared to the general population of Danes.

Conclusion

The vast majority of persons who became residents in supported psychiatric housing facilities had previously been diagnosed with schizophrenia, schizophrenia-like disorders, and organic mental disorders, and a large proportion had substance abuse and a high use of bed days. Moving into such a facility reduced the number of bed days.     

Trends in psychiatric hospitalization and changes in admission patterns in two counties in Denmark from 1977 to 1989

Summary Based on data from the nationwide Danish Psychiatric Case Register, trends in admission rates and treatment-day rates were studied in two Danish counties between 1977 and 1989. During the observation period, the number of availble beds in the counties investigated decreased from 1.78 to 1.10 per 1000 inhabitants aged 15 years or more. Over the same period, the admission rates decreased by 20% for in-patients and 38% for daypatients. At the same time, treatment-day rates for in-patients decreased by appoximately 50% and treatment-day rates for day-patients by 32%. The decrease was seen in all age groups both for admission rates and treatment-day-rates. Rates for short-term hospitalization showed a steeper decrease than those for long-term hospitalization. For schizophrenia, admission rates increased except among men under 25 years of age, and treatment-day rates decreased in all age groups. Affective disorders, neuroses, personality disorders, and alcohol and drug abuse showed the most pronounced decreases in admission rates and treatment-day rates. The same trend was seen for treatment-day rates for organic disorders. A marked decrease in admission rates was seen in the provincial towns. Treatment-day rates decreased markedly in city areas, and less so in rural areas.     

Validity of diagnoses and other clinical register data in patients with affective disorder

Studies validating the clinical diagnoses of affective disorder recorded in case registers against research diagnostic criteria do not exist. In the present study, a random sample of 100 patients was selected among 21,734 patients who were recorded in the Danish Psychiatric Central Register with a diagnosis of manic-depressive psychosis at their first admission to psychiatric ward in a period from January 1, 1971 to December 31, 1993. Case notes from alt over Denmark were reviewed for all 100 patients and diagnoses were made with the use of OPCRIT. Patients who were still alive were contacted and interviewed face to face or by telephone. In total, 95 out of the 100 patients received an ICD-10 diagnosis of affective disorder computed with OPCRIT and confirmed at the interviews. Other clinical characteristics such as the age at onset and the number of affective episodes estimated from the register corresponded well with information from the case notes and the interviews.     

Psychiatric emergency outreach: a report on the first 2 years of functioning in Copenhagen

The purpose of the study was to evaluate psychiatric emergency outreach after functioning for a period of 2 years in Copenhagen, Denmark. Psychiatric emergency outreach was staffed by a psychiatrist and an ambulance driver, and the target group was defined as mentally ill and persons in severe crisis. For each of 935 calls covering 777 different patients, a registration form with social and clinically relevant data was filled out. After the 2-year period, patients were looked up in the National Cause of Death Register and the National Psychiatric Case Register. A total of 66% were previously registered as psychiatric patients, and in 37% of all calls, the patient had psychotic symptoms. In 25% of the calls, the patient was admitted to psychiatric hospital; 38% of the admissions were involuntary. Forty-eight per cent of the calls were initiated by relatives, friends or neighbours. Suicidal behaviour was frequent. There were significantly more calls in socially deprived areas. Standard Mortality Rates were high for all causes of death (5.00), and especially for suicide (31.98). In conclusion, psychiatric emergency outreach seems to fulfil some of its purpose.     

Psychiatric emergency outreach: A report on the first 2 years of functioning in Copenhagen

The purpose of the study was to evaluate psychiatric emergency outreach after functioning for a period of 2 years in Copenhagen, Denmark. Psychiatric emergency outreach was staffed by a psychiatrist and an ambulance driver, and the target group was defined as mentally ill and persons in severe crisis. For each of 935 calls covering 777 different patients, a registration form with social and clinically relevant data was filled out. After the 2-year period, patients were looked up in the National Cause of Death Register and the National Psychiatric Case Register. A total of 66% were previously registered as psychiatric patients, and in 37% of all calls, the patient had psychotic symptoms. In 25% of the calls, the patient was admitted to psychiatric hospital; 38% of the admissions were involuntary. Forty-eight per cent of the calls were initiated by relatives, friends or neighbours. Suicidal behaviour was frequent. There were significantly more calls in socially deprived areas. Standard Mortality Rates were high for all causes of death (5.00), and especially for suicide (31.98). In conclusion, psychiatric emergency outreach seems to fulfil some of its purpose.     

Evaluating the use and limitations of the Danish National Patient Register in register-based research using an example of multiple sclerosis

Mason K, Thygesen LC, Stenager E, Brønnum‐Hansen H, Koch‐Henriksen N. Evaluating the use and limitations of the Danish National Patient Register in register‐based research using an example of multiple sclerosis.
Acta Neurol Scand: 2012: 125: 213–217.
© 2011 John Wiley & Sons A/S. Background – The Danish National Patient Register, Landspatientregistret (LPR), is a register of all hospital discharges and outpatient treatments in Denmark. Aims – It is increasingly used in research so it is important to understand to what extent this can be used as an accurate source of information. Virtually all patients in Denmark with multiple sclerosis (MS) are reported to the Combined MS Registry (DMSR), so this was used as the standard which the LPR was compared against. Methods – All residents of Denmark are assigned a unique Civil Register (CPR) number; this was used to compare data between registers. The LPR completeness was estimated by the proportion of cases from the DMSR that could be retrieved from the LPR. The LPR validity was estimated by the proportion of cases, listed in the LPR and DMSR, in whom the MS diagnosis could be confirmed as definite/probable/possible by the DMSR. Results – We found that 86.9% of those who were DMSR listed with an approved MS diagnosis were also listed in the LPR with a MS diagnosis. The diagnosis was valid in 96.3% of patients listed in the LPR when compared against the DMSR. Conclusions – The low completeness reduces the usefulness of the LPR in epidemiological MS research, in particular incidence studies. The study also found that the completeness of the LPR could be increased to 92.8% by including LPR records from other departments in addition, but this reduced the validity of the LPR to 95.1%. However, these results cannot uncritically be applied to registration of other diseases in the LPR.     

Psychopharmacological treatment and psychiatric morbidity in 390 cases of suicide with special focus on affective disorders.

OBJECTIVE: The aim of this study was, on the basis of data from health-care registers, to describe the adequacy of psychopharmacological treatment in suicides. METHOD: Data on consecutive suicides in a Danish County (Funen) in the period of 1 April 1991-31 December 1995 were identified in the Danish Psychiatric Central Register, the National Patient Register, the National Health Insurance and Odense University Pharmacoepidemiological Database. RESULTS: Twenty-five per cent of the suicides previously hospitalized due to affective disorders and 3% of the suicides without psychiatric hospitalizations at all, received an apparently adequate treatment with antidepressants the month before suicide. CONCLUSION: The most striking finding was the insufficiency of treatment with antidepressants in the group of suicides without psychiatric hospitalization, in particular in light of the fact that depression is assumed to be present in at least 50% of all suicides.