Nordic Journal of Psychiatry

Journal Information
ISSN / EISSN : 0803-9488 / 1502-4725
Published by: Informa UK Limited (10.1080)
Total articles ≅ 2,655
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Latest articles in this journal

Raimo Palmu, ,
Published: 23 September 2022
Nordic Journal of Psychiatry pp 1-4;

A higher total score on the General Health Questionnaire (GHQ-12) is associated with a higher likelihood of having suicidal ideation as well as having suicide attempt. The association of GHQ-12 with suicide attempts item by item has not been analyzed earlier. In a population-based sample, aged 18 to 28 years, mental illness was assessed as self-reported during the interview. Participants were also asked to score on two specific questions concerning suicidal ideation as well as attempted suicide. The GHQ-12 total score and each of the 12 item scores of the GHQ-12 were analyzed with regression models to explain suicidality (n = 679). The total score of GHQ-12 differed by suicidality (Bonferroni-corrected p < 0.001). The item 6 (Felt that could not overcome difficulties) and the item 11 (Feeling oneself worthless) were associated with suicidal ideation (OR = 1.66, 95% CI = 1.12–2.47, p = 0.01 and OR = 1.58, 95% CI = 1.04–2.39, p = 0.03, respectively) as well as with suicide attempts (OR = 2.82, 95% CI = 1.54–5.16, p = 0.001 and OR = 3.10, 95% CI = 1.64–5.85, p < 0.001, respectively). The item 7 (Able to enjoy normal day to day activities) was associated with suicide attempts (OR = 0.28, 95% CI = 0.12–0.64, p = 0.003) and made the item-specific difference between those with suicidal ideation w/o suicide attempt (OR = 0.35, 95% CI = 0.14–0.89, p = 0.03). Being able to enjoy normal activities day to day made a difference between suicidal ideation and attempted suicide.
, Yusuf Ezel Yıldırım, Metin Aslan, Filiz Izci
Published: 8 September 2022
Nordic Journal of Psychiatry pp 1-6;

The neutrophil to lymphocyte ratio (NLR), platelet to lymphocyte ratio (PLR), monocyte to lymphocyte ratio (MLR), and monocyte to high-density lipoprotein (MHR) are indicators of inflammation. In this study, we aimed to examine the possible association between NLR, PLR, MLR, and MHR in the same patients with bipolar disorder (BD) during their manic, depressive, and euthymic episodes. The participants of this study consisted of 61 patients with BD, aged between 18 and 65, who were hospitalized with a diagnosis of BD. Patients who were hospitalized during their manic and depressive episodes and medication free for at least 1 month before hospitalization were included. White blood cell, neutrophil, lymphocyte, platelet, and monocyte counts, high-density lipoprotein (HDL) cholesterol, and C reactive protein (CRP) levels were recorded. Leukocytes (p = 0.000), neutrophil (p = 0.009), monocyte counts (p = 0.012), CRP levels (p = 0.026), NLR (p = 0.025), and MHR (p = 0.011) values were significantly higher in their manic episode and depressive episode compared with the values in their remission period. There was no significant difference between manic and depressive episodes in terms of inflammation parameters. Significant positive correlations were found between the number of depressive episodes and patients’ CRP levels (p = 0.031). This study was the first study to examine the inflammatory markers such as NLR, MLR, PLR, and MHR levels in same patients with BD during their three episodes of disorder. Both NLR and MHR values in manic and depressive episodes were higher than euthymic episodes. NLR and MHR were useful inflammatory markers to evaluate inflammation in bipolar patients.
Mustafa Tuncturk, Cagatay Ermis, Dicle Buyuktaskin, Eren Halac, Ekin Sut, Oben Ozkan, Nazan Gundogan, Guldal Unutmaz, R. Ogulcan Ciray, , et al.
Published: 24 August 2022
Nordic Journal of Psychiatry pp 1-7;

This study aimed to determine anthropometric and clinical correlates of persistence to methylphenidate (MPH) treatment in Turkish youth with attention-deficit hyperactivity disorder (ADHD). Data from medical records of 518 children and adolescents with ADHD were recorded between March 2012 and January 2022. Clinical variables of patients persistent to MPH ≥ 2 years were compared with those of the non-persistent group. Children and adolescent age groups were compared using Kaplan–Meier estimates for treatment drop-outs. Cox regression analysis until the treatment drop-out was implemented to calculate hazard ratios (HRs) for gender, age, full-scale IQ, and anthropometric measures. Weight, height, and body mass index (BMI) z-scores were calculated per national guidelines. Persistent and non-persistent study groups had similar full-scale IQ, weight, height, and BMI z-scores at treatment onset. The mean MPH dose was significantly higher in the persistent group compared to the non-persistent counterparts (31.43 ± 10.70 vs. 24.28 ± 9.60 mg/d, p < 0.001, d = 0.70). Compared to children, the adolescents showed earlier treatment drop-outs in males (p < 0.001) but not in females (p = 0.110). Younger age showed a positive effect on treatment persistence. Conversely, baseline BMI and IQ scores were not associated with long-term persistence. Our study demonstrated lower daily doses and older age-onset were associated with early drop-outs in MPH treatment. These findings supported the notion that effective dosing strategies at younger ages could increase the sustainability of the treatment with MPH in the Turkish population.
, Lisa Janet Cohen, , Astrid Prestmo, Kjetil Sørensen, Øyvind Salvesen, , Arne Einar Vaaler, Terje Torgersen
Published: 22 August 2022
Nordic Journal of Psychiatry pp 1-10;

The aim of the present study was to investigate the psychometric validity of the Modular Assessment of Risk for Imminent Suicide (MARIS) questionnaire in relation to recent suicidal ideation and behavior among a sample of patients admitted to an acute psychiatric inpatient department in Norway. The MARIS was completed within the first 24 h after admission by 338 patients and their clinicians. Information on recent suicidal ideation and behavior was extracted from patients’ medical charts. Two out of four MARIS modules, the Suicide Trigger Scale Short-Form (STS-SF; modified version), and the Therapist Response Questionnaire Short-Form (TRQ-SF) demonstrated good internal consistency. The relationships between the STS-SF, addressing symptoms of the suicide crisis syndrome, and the TRQ-SF, exploring therapist emotional responses, and recent suicidal ideation was investigated by logistic regression analysis. In the logistic regression analysis including pre-selected diagnoses, age, and gender as covariates, both STS-SF and TRQ-SF showed significant associations with recent suicidal ideation (inclusive of suicidal behavior in 27% of the patients with suicidal ideation). Both the STS-SF and the TRQ-SF showed concurrent and incremental validity with regard to suicidal ideation. This is the first study showing the cross-cultural validity of the MARIS and supports its clinical utility as a suicide risk assessment tool in inpatient settings. Additionally, this study adds to the literature supporting the value of assessing clinicians’ emotional responses to high risk patients.
Published: 22 August 2022
Nordic Journal of Psychiatry pp 1-8;

Differentiating between autism spectrum disorders (ASD) and borderline personality disorder (BPD) is hampered by diagnostic difficulties as there seems to be a significant overlap in symptoms. A case series of six women with ASD and a previous diagnosis of BPD is presented. In retrospect, the women did not present with significant symptoms until they had developed comorbidity, which clinicians in turn misinterpreted. The missed diagnosis or misdiagnosis had significant implications for their prognosis and current level of functioning. This suggests in line with previous research, that women with higher functioning ASD are more at risk of being overlooked. It is suggested in the literature and supported by this case series that ASD should be ruled out by obtaining a thorough developmental history by an experienced clinician before considering a BPD diagnosis.
, , Ingeborg Ulltveit-Moe Eikenaes, , Theresa Wilberg, , Mona Skjeklesaether Pettersen, , , Merete Selsbakk Johansen, et al.
Published: 19 August 2022
Nordic Journal of Psychiatry pp 1-9;

Patients with personality disorders (PDs) often have insecure attachment patterns and may be especially vulnerable to abrupt treatment changes. Patients with borderline PD (BPD) are often considered vulnerable to treatment interruption due to chronic fear of abandonment. Nonetheless, other PDs are poorly investigated. In the first Covid-19 wave in Norway, in-person treatment facilities and group treatments were strongly restricted from March 12th until May/June 2020. To examine and compare changes in outpatient treatment for patients with avoidant (AvPD) and BPD during the first Covid-19 wave in Norway, and patients’ reactions to these changes. The study is based on a cross-sectional survey distributed to 1120 patients referred to 12 different PD treatment units on a specialist mental health service level within the Norwegian Network for Personality Disorders. The survey included questions on treatment situation, immediate reactions, and changes during the crisis. From 133 responders (response rate 12%), 40 patients reported BPD and 30 AvPD as diagnosis. All patients were followed up from their therapist after March 12th. Almost all patients in both groups expressed satisfaction under the new circumstances. Both groups experienced the same regularity as before, but more AvPD patients reported less than weekly consultations. AvPD patients reported more negative feelings about changes in therapy, and missed the therapy and group members more than the BPD group. After the lockdown, BPD patients received a closer follow-up than AvPD patients, and the latter reported more negative feelings related to change in their treatment situation.
, Malin Gingnell, Janet L. Cunningham, ,
Published: 15 August 2022
Nordic Journal of Psychiatry pp 1-7;

Physiological parameters that predict electroconvulsive therapy (ECT) effectiveness may reflect propagation of the induced epileptic seizure. As an indication of seizure propagation to the diencephalon, we here examined the correlation between prolactin increase after ECT and clinical seizure evaluation parameters, focusing on peak heart rate. As a proxy for peripheral endocrine stress response, we examined the correlation to postictal cortisol increase. Participants were consecutively recruited from clinical ECT patients (n = 131, age 18–85 years). The first ECT session in a series was examined. For each participant, blood serum concentrations of prolactin and cortisol were measured immediately before and within 30 min after the seizure. Physiological parameters were extracted from clinical records: peak heart rate (HR) during seizure, electroencephalography (EEG) seizure duration, and motor seizure duration. Correlations were calculated using non-parametric tests. Serum prolactin increased after ECT and correlated with peak HR, EEG seizure duration, and motor seizure duration. Peak HR during seizure also correlated positively with both EEG seizure duration and motor seizure duration. Correlations were unaffected by age, sex, baseline prolactin levels, antipsychotics, or beta-blocking agents. Serum cortisol increased after ECT but did not correlate with the seizure evaluation parameters, nor with prolactin concentrations. Our findings of a positive correlation between peak HR and prolactin that was independent from the peripheral endocrine stress response might be in line with the idea that tachycardia during ECT seizures reflects seizure propagation to the diencephalon. This supports the practice of monitoring cardiovascular response for ECT seizure evaluation.
, Katrine Gren Voldby,
Published: 5 August 2022
Nordic Journal of Psychiatry pp 1-10;

Stigma affects people with mental illness globally, however, it is proposed that stigma is less prevalent in wealthier countries and that people hold more positive attitudes in Northern and Western Europe. Even so, accounts from surveys in Denmark and Sweden reveal that stigma is very much prevalent. This scoping review aims to shed light on the body of literature regarding mental-health-related stigma in the Nordic Countries and identify knowledge gaps. We searched four electronic databases in December 2017 and again in June 2020. All types of empirical studies (qualitative, quantitative, and mix-methods) examining the stigma of people with mental illness were included. In total, 61 studies were included. Overall, findings from the Nordic countries resemble global findings. Studies are primarily descriptive, and mostly survey studies of attitudes toward people with mental illness in the general population. Few studies focus on discrimination, and those who do, measure intended behavior in hypothetical situations rather than actual acts of discrimination in real-life situations. Studies were mostly conducted on a community or organizational level; no studies were identified on a system level. Experienced stigma and discrimination by patients, but also relatives, were a focus in one-third of the studies. Very few studies of interventions to reduce stigma and discrimination were identified. More studies into stigma on a system or institutional level are needed. Ways to measure acts of discrimination should be invented. Furthermore, interventions to reduce stigma and discrimination should be developed, targeting all levels of society.
André C. Sahl, Henning F. Rognlien, Ole A. Andreassen, Ingrid Melle, Torill Ueland,
Published: 2 August 2022
Nordic Journal of Psychiatry pp 1-7;

Social cognitive impairment is common in schizophrenia, but it is unclear if it is present in individuals with high IQ. This study compared theory of mind (ToM) in schizophrenia participants with low or high IQ to healthy controls. One hundred and nineteen participants (71 healthy controls, 17 high IQ (IQ ≥115), and 31 low IQ (IQ ≤95) schizophrenia participants) were assessed with the Movie for the Assessment of Social Cognition, providing scores for total, cognitive, and affective ToM, along with overmentalizing, undermentalizing, and no-mentalizing errors. IQ was measured with Wechsler Abbreviated Scale of Intelligence; clinical symptoms with the Positive and Negative Syndrome Scale. Healthy controls performed better than the low IQ schizophrenia group for all ToM scores, and better than the high IQ schizophrenia group for the total score and under- and no-mentalizing errors. The high IQ group made fewer overmentalizing errors and had better total and cognitive ToM than the low IQ group. Their number of overmentalizing errors was indistinguishable from healthy controls. Global ToM impairment was present in the low IQ schizophrenia group. Overmentalizing was not present in the high IQ group and appears related to lower IQ. Intact higher-level reasoning may prevent the high IQ group from making overmentalizing errors, through self-monitoring or inhibition. We propose that high IQ patients are chiefly impaired in lower-level ToM, whereas low IQ patients also have impaired higher-level ToM. Conceivably, this specific impairment could help explain the lower functioning reported in persons with intact IQ.
, , Christoffer Polcwiartek, , Christian Torp-Pedersen, Rene Ernst Nielsen, Svend Eggert Jensen, Rubina Attar
Published: 29 July 2022
Nordic Journal of Psychiatry pp 1-8;

This study analyzed time trends in the use of coronary procedures, guideline-based drugs, and 1-year all-cause and presumed cardiovascular mortality (CV) following acute coronary syndrome (ACS) in patients with and without bipolar disorder (BD). Using Danish registries 497 patients with ACS and BD in the period 1996–2016 were matched 1:2 on age, sex and year of ACS to patients without preexisting psychiatric disease. Patients with BD and ACS received fewer coronary angiography (CAG) compared to psychiatric healthy controls (PHC). However, the difference between the populations decreased over time. For percutaneous coronary intervention (PCI) and coronary artery bypass (CABG) no differences in trend over time were found. In general patients with BD redeemed fewer prescriptions of guideline-based tertiary prophylactic drugs compared to PHCs. The difference remains constant over time for all drugs except for acetylsalicylic acid, lipid-lowering drugs and beta blockers, where the difference decreased. The 1-year all-cause mortality gap and the presumed CV mortality gap remained unchanged. Despite improvements in treatment disparities regarding CAG, acetylsalicylic acid, lipid-lowering drugs and beta-blockers, the treatment gap remained unchanged concerning PCI and CABG. Likewise, patients with BD experienced a lower rate of the remaining redeemed prescriptions. The overall crude mortality risk ratio for patients with BD experiencing ACS remained unchanged over the study period compared to PHC.
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