Survey of psychiatric morbidity in a semi-urban population in Sri Lanka

This paper reports a survey of psychiatric morbidity in a semiurban community (population 7,653) in Sri Lanka. The entire population was first screened by social workers using a standardized interview. Probable cases were then examined by psychiatrists. Each psychiatric disorder identified was rated on four different parameters of severity, and only those rating moderate or severe were labelled as cases. The socio-demographic characteristics of the cases and the population at risk, and the frequency and nature of psychiatric disorders are presented in Tables. The 6-month period prevalence for all psychiatric disorders was 45.5 per 1,000, with psychoses amounting to 6.9 (males 5.5; females 8.4) per 1,000, and neuroses to 25.2 (males 9.9; females 40.6) per 1,000. The large majority of disorders were chronic and had not received psychiatric treatment. The relevance of these surveys in the provision of psychiatric services in developing countries is discussed.     

First admission with puerperal psychosis: 7–14 years of follow-up

The aim of this study was to investigate women who had first-episode psychosis within 1 year after parturition. The Danish Psychiatric Central Register and the Danish Medical Birth Register were linked to identify all women admitted for the first time to a psychiatric department in Århus County with a psychotic episode. Fifty cases were found, giving a frequency of first-episode psychosis within 1 year after delivery of 1 per 1000. First-episode psychotic disease within the first month postpartum occurred in 1 case per 2000 deliveries. The age distribution corresponded to that of the background population, but the cases were primiparous more often than expected. The socioeconomic status was equal to that of a matched control group of obstetric patients. Birth complications did not occur more frequently than expected, but the probands had a higher risk of preterm delivery than the controls. The clinical picture of the index episode was that of manic-depressive psychosis in nearly half of the cases, but no cases of schizophrenia were found. Sixty percent of the patients had a picture of severe depression, and 20% suffered from manic disorder. The follow-up, 7 to 14 years later, was carried out by interviewing the general practitioners. Forty percent of the women had not preserved full working capacity due to mental disorder. Moreover, the follow-up pointed to schizophreniform symptoms at the index episode as a predictor of incapacity to work. Recurrences were very common (60%), especially of the nonpuerperal type, and half of the recurrences belonged to the manic-depressive disorders. Schizophrenia was diagnosed in one case at the follow-up. Cases with exclusively puerperal episodes were rare (4%).     

Experience from the first ACT programme in Denmark. II. Severe mental illness. a register diagnosis

Community psychiatry in Denmark has been criticized because of drop-outs of the patients with severe mental illness. In order to deal with these problems, the first Assertive Community Treatment (ACT) project in Denmark was started in the Tønder region on 1 May 2001. Before starting the clinical study, an epidemiological analysis of severe mental illness was performed. Severe mental illness was defined from register data on the basis of psychosis and high use of psychiatric services. Data concerning drop-out (inactive during a period), death and address were obtained. The point prevalence rate of severe mental illness on 31 December 2000 in Sønderjylland (SJ) county was 1.31/1000. The rate of inactive patients was 0.28/1000. The rates were distributed inhomogeneously between regions. In a 4-year cohort, half of the patients were inactive at least once. The Tønder and Aabenraa regions had homogeneous patterns. In conclusion, the register diagnosis is a target group for ACT. The register diagnosis and the status active/inactive may be used as an unbiased effect parameter.     

Trends in psychiatric hospitalization in Denmark: a 10-year register-based investigation.

Information about all admissions to psychiatric hospitals and departments in Denmark in 1977, 1982 and 1987 and about all resident patients on census days in the same years were extracted from the central psychiatric register. The number of available beds decreased by 43% from 1977 to 1987. The admission rates decreased for all diagnostic groups but schizophrenia, which increased. The group of younger schizophrenic men declined in size, which is alarming if mentally ill homeless people are considered. The census study shows a decrease in all diagnostic groups, most pronounced in the elderly age groups. Patients with neuroses disappear from the available beds in the mental hospitals and departments. The changes in the psychiatric service system from mostly hospitalization to outpatient treatment and community psychiatric treatment require a comprehensive personal registration of treatment regardless of the administrative affiliations of these services.     

Book review

Book review in this article J. Nielsen, J. Achton Nielsen, M. Kastrup & E. Strorngren (eds.): The Samsø Project: a community psychiatric project in a geographically delimited population.     

First admissions for psychiatric disorders. A comparison between the Faroe Islands and Denmark

Historical accounts emphasize a high rate of mental morbidity in the Faroe Islands compared with Denmark. As prerequisites for a comparative investigation are now present, we have compared a 10-year period of first admission rates in both areas. We found a lower rate for the Faroes generally, in particular for women, for the age group 30-64, and also for the majority of diagnostic groups. The group manic-depressive psychosis come closest to Danish conditions, followed by reactive psychosis and alcohol and drug abuse. The greatest difference was found for the groups personal disorders, neuroses, and schizophrenia.     

Prevalence and incidence of mental disorders estimated by a health questionnaire and a psychiatric case register

Some of the limitations and potentialities of the use of a psychiatric case register are briefly indicated. The special opportunities which record-linkage offers in Iceland make it possible to carry out new epidemiological studies which may help us in identifying high risk groups on a broad scale. As indicated in earlier studies, the incidence rate of mental disorders as measured by first psychiatric consultations has not changed with time. The expectancy of consulting a psychiatrist on account of functional psychoses, neuroses or alcoholism is only about 40 % of the expectancy of developing these diseases. Of the population aged 20–49 years, 13.5% have consulted a psychiatrist or been in contact with the institutions reporting to the psychiatric case register. For the estimation of prevalence of mental disorders with a health questionnaire it is necessary to add several questions related to symptoms of alcohol abuse. When this is done, the self-reported prevalence of mental disorders in the population of this most productive age group is approximately 20 %, one half of this being related to alcohol abuse among men. As there are relatively more patients among those not responding to the questionnaire the total prevalence is probably not less than 22 %. Studies based on the psychiatric case register would thus only account for 40–60 % of the total morbidity, depending on whether only contact with psychiatrists or with all the reporting institutions were included.     

Suicide in psychiatric patients in Denmark, 1971-1981. II. Hospital utilization and risk groups

A register-based analysis was made of hospital utilization and time of suicide among psychiatric patients in Denmark. Suicidal schizophrenic patients had long hospitalizations and their suicide frequency was comparatively constant. Patients with reactive psychoses and affective reactions had more often only one hospitalization and few bed/days. Forty percent of the latter group had previously attempted suicide and only one in six was offered outpatient follow-up. The highest age-, sex-, and diagnosis-specific suicide rates were found among middle-aged and elderly men with manic-depressive or reactive psychoses, and neuroses or personality disorders. Some groups of patients with affective reactions had comparatively high suicide rates, whereas those for patients with a main diagnosis of substance abuse corresponded to the average for the whole patient population. The average suicide rates for manic-depressive women corresponded to that for all male patients.     

Personality disorders in people with learning disabilities: a community survey

The prevalence of personality disorders has been determined by studies of both the general population and mental handicap hospitals. The present study attempts to determine the prevalence of personality disorders in a community sample and to check the implications for treatment A community sample of learning disability service users was surveyed by obtaining a rating from a good informant to establish demographic data, level of functioning and the nature of personality disorders, if any, using the ICD-I0 version of the Standardized Assessment of Personality (SAP). Fifty per cent of the sample had personality abnormalities, and 31% had sufficient impairment of the social and occupational domains and personal distress to warrant a diagnosis of personality disorder. These findings are compared with previous studies. Paranoid, schizoid, impulsive and dissocial personality abnormalities were seen to be associated with a high referral rate to psychiatric services and needed considerable therapeutic input The prevalence of personality abnormalities in community populations with a learning disability is high. The SAP is a useful instrument for screening. This sub-population makes significant demands on community psychiatric services.     

Manic-depressive psychosis in children younger than 15 years: a register-based investigation of 39 cases in Denmark.

Using a nationwide psychiatric case register covering a background population of 5.1 million inhabitants, 39 children (23 boys, 16 girls) were identified who got the diagnosis of manic-depressive psychosis between 1970 and 1986 before the age of 15. The frequency of manic-depressive psychosis in this child psychiatric population was 1.2%. The mean age for first-time admission with this diagnosis was 12.7 years. There was no sex difference. Twenty-six of the children got the diagnosis of manic-depressive psychosis during their first admission. Survival analysis was used to describe the prognosis and the diagnostic development of the group. As a whole, the group had a poor prognosis with many readmissions. The most common differential diagnoses were other types of psychosis in boys and oppositional and emotional disorders in girls.     

Population-level prevalence estimate and characteristics of psychiatric disability among Chinese adults

Psychiatric disability is a population health problem, and understanding its magnitude is essential to informing population health policies. This paper aims to describe the prevalence rates, causes, and severity of psychiatric disability in Chinese adults, and to explore daily activities and social functions for people with psychiatric disability. We used the second China National Sample Survey on Disability, comprising 2,526,145 persons from 771,797 households. Identification and classification for psychiatric disability was based on consensus manuals. We used standard weighting procedures to construct sample weights considering the multistage stratified cluster sampling survey scheme. Population weighted prevalence and 95% Confidence Intervals (CI) were evaluated. An estimate of 8 million adults with psychiatric disability was identified. The weighted prevalence rate of psychiatric disability was 8.14 per 1000 people (95% CI, 7.95-8.33). More rural residents suffered from psychiatric disability than their urban counterparts, and more females had psychiatric disability than males. Schizophrenia, schizotypal and delusional disorders accounted for more than half of the psychiatric disability in Chinese adults. People with psychiatric disability had more severe difficulties in most daily activities and social functions than in people with other disabilities. This study demonstrates psychiatric disability causes social burden to the Chinese communities. Strategies including case identification, treatment, and rehabilitation should be developed and countermeasures are warranted for females and rural residents to reduce the burden caused by psychiatric disability.     

Prevalence of mental illness among 70-year-olds domiciled in nine Copenhagen suburbs.

The results of a study on the prevalence of mental diseases and abnormalities among a geographically well-defined group of 70-year-olds, all living in nine suburbs of Copenhagen, are submitted and discussed. The total psychiatric morbidity was found to be 15.5%; 6.4% suffered from psychoses, males preponderating, and 7.4% classified as "neuroses + personality disorders", females preponderating. Only 15% of the pschotic group were institutionalised. Of the entire material, 5% were demented, and this included 1.l% patients who were severley demented. There was a definite preponderance of males. Of the population, 2.6% were living in their homes with senile or arteriosclerotic dementia. About 1% of the population were looked after in their homes despite severe dementia of varying geneses. Hidden morbidity, meaning that the proband had neither been institutionalised nor had consulted a doctor for mental illness within the past 5 years, made up of 15% of the psychotic group and 19.2% of the group "neuroses + personality disorders + alcoholisms". The total hidden morbidity constituted 2.6% of the population or 16.5% of the demonstrated psychiatric morbidity. The prevalence findings are on the whole on a level with those reported from other studies, most of which have been concerned with population groups over 65 years of age.     

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.     

A comparative study of psychiatric outpatient treatment in two geographically defined populations

Asignificant change in the pattern of psychiatric care has taken place over the last decade, including the reorganization of the traditional mental hospitals, the establishment of psychiatric wards in general hospitals, the trend toward outpatient as opposed to inpatient care, and the increasing recognition of the importance of community psychiatry.^1–4 But few attempts have been made to discern whether categories of patients get the same treatment at different types of outpatient clinics. It would be interesting to know if, for example, a psychotic patient will get similar treatment and have a similar chance for admission in a community-oriented clinic and an outpatient clinic affiliated with a hospital.The present investigation was carried out in order to describe the demographic and diagnostic characteristics of psychiatric patients treated at two types of outpatient clinics and to compare the psychiatric service of a clinic affiliated with a psychiatric ward at a general hospital to a clinic forming part of a community psychiatric project. Recent data concerning general information about both these services have been published by Kastrup et al.⁵ and Nielsen.⁶     

Epidemiology of psychiatric disorders in Finland A five-year follow-up

Summary This study reports a five-year follow-up of a random population sample consisting of 1000 persons, who initially underwent a fairly thorough psychiatric examination. The method used at the follow-up consisted of a mail inquiry, the collection of recorded information and, for a certain proportion of the subjects, a psychiatric interview. The factors studied were the prevalence and incidence of psychiatric disorders, recovery and improvement, need for treatment and utilization of treatment services in the population. The total prevalence of psychiatric disorders was 294 per 1000, and the annual incidence 15.2 per 1000. The incidence was found to be associated with certain socio-demographic variables. A need for psychiatric treatment was found in a total of 11.4% of the subjects; in addition, 18.6% were assessed as needing supportive measures. Over the five-year period psychiatric treatment had been received by a total of 18% of the subjects. The most common provider of treatment had been the general practitioner. Psychiatric hospital care during the follow-up period had been received by 3.9% of the subjects.     

浙江省精神病专科医院住院患者治疗费用调查

背景目前很少有关于精神疾病住院患者精神疾病和非精神疾病治疗费用的研究,而这方面的信息对规划精神卫生服务和医疗保险具有重要意义。目的对2010年浙江省精神病专科医院住院患者的住院费用进行评估。方法采用两阶段分层随机抽样方法从浙江省42家精神专科医院中抽出14家精神病院,再从抽出的各家医院中以月份为基本单位系统抽出2010年3个月（3、7、11月）的出院患者进行调查。编制《出院患者住院情况调查表》,收集患者的人口学特征、临床特征及多项住院费用信息。结果共调查住院患者7684例。患者的平均住院时间（四分位数）为30（20-52）d,平均总住院费用为10005（6419．14728）元（1539美元）,平均药费为2512（1161—4182）元,其中65％为非精神科药费,1798（24．3％）例患者入院时伴有需要治疗的一种或多种躯体疾病,包括高血压、白细胞减少、糖尿病和各种感染。患者的精神疾病诊断不同,其躯体疾病合并症不同。经过排除其他混杂因素后,共病躯体疾病患者的住院费用显著增加,但住院时间未增加。对于精神分裂症患者,精神科的药费显著高于非精神科药费,但其他精神疾病患者的花费情况与之相反。结论精神病院住院患者的费用中,躯体疾病的治疗费用占较大比例。在修订精神疾病的补偿措施、建立诊断相关的支付方案以及建立诊断特定的治疗指南时,都需要考虑到精神疾病伴发躯体疾病的高患病率和治疗费用,也需要确保精神科医生的在职培训能使他们及时了解常见躯体疾病的诊断和治疗的新进展。     

内科住院病人精神科会诊213例分析

目的：探讨综合医院内科住院病人精神科会诊的现状。方法：对我院近3年来213例内科住院病人申请科学会诊的临床资料进行回顾性分析。结果：近3年来内科申请精神科会诊的 病例数逐年上升。申请会诊的科室,以神经内科最多,其次为心血管内科、呼吸内科、内分泌科和消化内科,会诊后精神科疾病以器质性精神障碍居多（46．4％）,其次为神经症（32．4％）及精神分裂症（7．0％）。申请会诊的病人中40例（18．8％）转入精神科治疗。结论：内科住院病人常伴发精神障碍,并有逐年增加的趋势,对普通内科医师加强精神科专业知识的培训,将有利于患有各类精神障碍的病人得到及时妥善的治疗。     

Somatic illness in manic-depressive and schizophrenic patients

The study compared the presence of somatic illnesses in manic-depressive (n = 100) and schizophrenic patients (n = 156) in the out-patient psychiatric clinics of three general hospitals. The average age of manic-depressive and schizophrenic patients was 40.7 yr and 39.8 yr respectively and did not differ significantly. The sample consisted of both sexes. Among the manic-depressive patients there were 46 males and 54 females. The schizophrenic sample consisted of 84 (54%) males and 72 (46%) females. The result showed that there was a greater rate of the occurrence of physical illnesses in manic-depressive patients as compared to the schizophrenic patients in respect to all the surveyed systemic disorders except for the gastrointestinal diseases. The cardiovascular, neurological and endocrinological diseases were more frequent in the manic-depressives than in the schizophrenic patients.     

The psychological and physical status of chronic psychiatric inpatients

Our concern for the chronic patients residing in state psychiatric hospitals tals has led to the development of a variety of treatment modalities for these patients in the community and in the hospital.^1–3 Yet there is debate about effectiveness of these treatments, as well as the social, economic, and political impact of community treatment versus hospitalization.^4–6 Despite the fact that treatment strategies should be based on the actual needs of patients, there have been few large surveys of the psychological and medical needs of patients in and out of psychiatric hospitals. Most surverys in this area have assessed mortality and physical illnesses and have found that death rates among psychiatric patients are higher than those among the general population.^7,8This paper will address the needs of the living by presenting the results of a survey of a large number of patients residing in state hospitals. It will describe the frequency of mental and physical disorders, particularly those which may be life-threatening or require staff attention. In addition, it will present estimates of the amount of staff care required for the monitoring and treatment of these disorders.     

Psychiatric comorbidity in juvenile myoclonic epilepsy

OBJECTIVE: To assess the prevalence of psychiatric disturbances among patients with juvenile myoclonic epilepsy (JME). METHODS: Forty-three patients with JME (22 female, 21 male, mean age 32.4+/-13, range 15-63) were assessed by means of the Structured Clinical Interviews for DSM-IV (SCID-I and SCID-II). Current and lifetime psychiatric diagnoses were assigned. RESULTS: Thirty-five percent of the JME patients suffered from one or more psychiatric disorders (Axis I and Axis II). Personality disorders were present in 23% and Axis I disorders in 19%. Altogether, 47% had a psychiatric disorder at any time of their life. CONCLUSIONS: Psychiatric diagnoses are slightly higher than in representative community samples. The substantially increased number of personality disorders in JME patients might be attributed to frontal lobe deficits.