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Jakobsen MI, Grønborg H, Hansen HV, Fink-Jensen A. Clozapine-associated neutropenia following augmentation with sodium valproate. SAGE Open Med Case Rep 2021; 9:2050313X211019791. [PMID: 34104448 PMCID: PMC8170346 DOI: 10.1177/2050313x211019791] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Accepted: 04/26/2021] [Indexed: 12/17/2022] Open
Abstract
Clozapine is gold standard for the management of treatment-resistant schizophrenia. It can offer life-changing symptom reduction where other antipsychotics have failed, and for these patients, treatment with clozapine should be maintained, if in any possible way. However, treatment with clozapine comes with a risk of developing potentially fatal adverse reactions, for example, severe neutropenia or agranulocytosis, in which case, treatment must be discontinued. Here, we present a case of clozapine-related neutropenia that commenced after the addition of sodium valproate. A subsequent re-challenge to clozapine resulted in severe neutropenia and led to the permanent cessation of clozapine treatment. The patient had been tolerating clozapine for more than a year before the addition of sodium valproate. The awareness of an interaction between clozapine and sodium valproate could help reduce the risk of clozapine-induced neutropenia and subsequent clozapine discontinuation.
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Affiliation(s)
- Michelle Iris Jakobsen
- Psychiatry East, Region Zealand Psychiatry, Roskilde, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - H Grønborg
- The Trauma Centre and Acute Admission, Rigshospitalet, Copenhagen, Denmark
| | - H V Hansen
- Psychiatric Outpatient Clinic Strandboulevarden, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
| | - A Fink-Jensen
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.,Psychiatric Centre Copenhagen, Rigshospitalet, Mental Health Services in the Capital Region of Denmark, Copenhagen, Denmark
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Thorlacius-Ussing G, Nielsen JE, Law I, Hansen HV, Birgitte Bo A. Mania triggered by levodopa treatment in a patient with frontotemporal dementia caused by A C9orf72 repeat expansion: A case report. Clin Neurol Neurosurg 2020; 198:106147. [PMID: 32823188 DOI: 10.1016/j.clineuro.2020.106147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 05/22/2020] [Accepted: 08/07/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Gorm Thorlacius-Ussing
- Department of Neurology, Rigshospitalet, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Denmark.
| | - Jørgen E Nielsen
- Department of Neurology, Neurogenetics Clinic, Rigshospitalet, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Ian Law
- Department of Clinical Physiology, Nuclear Medicine and PET, Rigshospitalet, University of Copenhagen, Denmark
| | - Hanne Vibe Hansen
- Department of Neurology, Rigshospitalet, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Andersen Birgitte Bo
- Department of Neurology, Rigshospitalet, Danish Dementia Research Centre, Rigshospitalet, University of Copenhagen, Denmark
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Nørgaard A, Jensen-Dahm C, Gasse C, Hansen HV, Waldemar G. Time Trends in Antipsychotic Drug Use in Patients with Dementia: A Nationwide Study. J Alzheimers Dis 2015; 49:211-20. [DOI: 10.3233/jad-150481] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Ane Nørgaard
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christina Jensen-Dahm
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Christiane Gasse
- National Centre for Register Based Research, Aarhus University, Aarhus, Denmark
| | - Hanne Vibe Hansen
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | - Gunhild Waldemar
- Danish Dementia Research Centre (DDRC), Department of Neurology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
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Abstract
Depression is a common disorder with painful symptoms and, frequently, social impairment and decreased quality of life. The disorder has a tendency to be long lasting, often with frequent recurrence of symptoms. The risk of relapse and the severity of the symptoms may be reduced by correct antidepressant medication. However, the medication is often insufficient, both in respect to dosage and length of time. The reasons for incorrect medication are many, with lack of adherence to treatment being the most important. Although some patients taking antidepressant medication experience side effects, this may not be the most frequent reason for immature discontinuation of treatment. Other reasons for decreased adherence have been investigated in recent years. The patient's beliefs about the disorder and beliefs about antidepressants, including lack of conviction that the medication is needed and fear of dependence of antidepressant medicine, have a great influence on adherence to treatment.
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Kessing LV, Hansen HV, Hvenegaard A, Christensen EM, Dam H, Gluud C, Wetterslev J. Treatment in a specialised out-patient mood disorder clinic v. standard out-patient treatment in the early course of bipolar disorder: randomised clinical trial. Br J Psychiatry 2013; 202:212-9. [PMID: 23349295 DOI: 10.1192/bjp.bp.112.113548] [Citation(s) in RCA: 153] [Impact Index Per Article: 13.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Little is known about whether treatment in a specialised out-patient mood disorder clinic improves long-term prognosis for patients discharged from initial psychiatric hospital admissions for bipolar disorder. AIMS To assess the effect of treatment in a specialised out-patient mood disorder clinic v. standard decentralised psychiatric treatment among patients discharged from one of their first three psychiatric hospital admissions for bipolar disorder. METHOD Patients discharged from their first, second or third hospital admission with a single manic episode or bipolar disorder were randomised to treatment in a specialised out-patient mood disorder clinic or standard care (ClinicalTrials.gov: NCT00253071). The primary outcome measure was readmission to hospital, which was obtained from the Danish Psychiatric Central Register. RESULTS A total of 158 patients with mania/bipolar disorder were included. The rate of readmission to hospital was significantly decreased for patients treated in the mood disorder clinic compared with standard treatment (unadjusted hazard ratio 0.60, 95% CI 0.37-0.97, P = 0.034). Patients treated in the mood disorder clinic more often used a mood stabiliser or an antipsychotic and satisfaction with treatment was more prevalent than among patients who received standard care. CONCLUSIONS Treatment in a specialised mood disorder clinic early in the course of bipolar disorder substantially reduces readmission to a psychiatric hospital and increases satisfaction with care.
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Affiliation(s)
- Lars Vedel Kessing
- Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Blegdamsvej 9, DK 2100 Copenhagen Ø, Denmark.
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Hansen HV, Christensen EM, Dam H, Gluud C, Wetterslev J, Kessing LV. The effects of centralised and specialised intervention in the early course of severe unipolar depressive disorder: a randomised clinical trial. PLoS One 2012; 7:e32950. [PMID: 22442673 PMCID: PMC3307703 DOI: 10.1371/journal.pone.0032950] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 02/02/2012] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Little is known on whether centralised and specialised combined pharmacological and psychological intervention in the early phase of severe unipolar depression improve prognosis. The aim of the present study was to assess the benefits and harms of centralised and specialised secondary care intervention in the early course of severe unipolar depression. METHODS A randomised multicentre trial with central randomisation and blinding in relation to the primary outcome comparing a centralised and specialised outpatient intervention program with standard decentralised psychiatric treatment. The interventions were offered at discharge from first, second, or third hospitalisation due to a single depressive episode or recurrent depressive disorder. The primary outcome was time to readmission to psychiatric hospital. The data on re-hospitalisation was obtained from the Danish Psychiatric Central Register. The secondary and tertiary outcomes were severity of depressive symptoms according to the Major Depression Inventory, adherence to medical treatment, and satisfaction with treatment according to the total score on the Verona Service Satisfaction Scale-Affective Disorder (VSSS-A). These outcomes were assessed using questionnaires one year after discharge from hospital. RESULTS A total of 268 patients with unipolar depression were included. There was no significant difference in the time to readmission (unadjusted hazard ratio 0.89, 95% confidence interval 0.60 to 1.32; log rank: χ(2) = 0.3, d.f. = 1, p = 0.6); severity of depressive symptoms (mood disorder clinic: median 21.6, quartiles 9.7-31.2 versus standard treatment: median 20.2, quartiles 10.0-29.8; p = 0.7); or the prevalence of patients in antidepressant treatment (73.9% versus 80.0%, p = 0.2). Centralised and specialised secondary care intervention resulted in significantly higher satisfaction with treatment (131 (SD 31.8) versus 107 (SD 25.6); p<0.001). CONCLUSIONS Centralised and specialised secondary care intervention in the early course of severe unipolar depression resulted in no significant effects on time to rehospitalisation, severity of symptoms, or use of antidepressants, but increased patient satisfaction. TRIAL REGISTRATION ClinicalTrials.gov NCT00253071.
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Affiliation(s)
- Hanne Vibe Hansen
- Mood Disorder Clinic, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Ellen Margrethe Christensen
- Mood Disorder Clinic, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Henrik Dam
- Mood Disorder Clinic, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Christian Gluud
- Copenhagen Trial Unit (CTU), Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Jørn Wetterslev
- Copenhagen Trial Unit (CTU), Centre for Clinical Intervention Research, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - Lars Vedel Kessing
- Mood Disorder Clinic, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
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Kessing LV, Hansen HV, Christensen EM, Dam H, Gluud C, Wetterslev J. The effects of centralised and specialised combined pharmacological and psychological intervention compared with decentralised and non-specialised treatment in the early course of severe unipolar and bipolar affective disorders--design of two randomised clinical trials. Trials 2011; 12:32. [PMID: 21291564 PMCID: PMC3045900 DOI: 10.1186/1745-6215-12-32] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2010] [Accepted: 02/03/2011] [Indexed: 12/26/2022] Open
Abstract
Background In unipolar, and bipolar affective disorders, there is a high risk of relapse that increases as the number of episodes increases. Naturalistic follow-up studies suggest that the progressive development of the diseases is not prevented with the present treatment modalities. It is not known whether centralised and specialised secondary care intervention initiated early after the onset of the diseases can prevent the progression and thereby improve the prognosis. Methods Two randomised clinical multi-centre trials comparing a centralised and specialised outpatient intervention program consisting of combined pharmacological and psychological intervention with standard decentralised psychiatric treatment. Patients discharged from their first, second, or third hospitalisation due to a manic episode or bipolar disorder (trial 1) or to a single depressive episode or recurrent depressive disorder (trial 2) were randomised. Central randomisations for both trials were stratified for the number of hospitalisations and treatment centre. The primary outcome measure for the two trials is time to re-hospitalisation with an affective episode. Discussion These trials are the first to evaluate the effect of a centralised and specialised intervention in patients with early severe affective disorders. The trials used a pragmatic design comparing a specialised mood disorder clinic intervention with decentralised, non-specialised standard psychiatric treatment. Trial Registration ClinicalTrials.gov: NCT00253071
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Affiliation(s)
- Lars Vedel Kessing
- Mood Disorder Clinic, Psychiatric Centre Copenhagen, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark.
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8
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Fromovich-Amit Y, Biering-Sørensen F, Baskov V, Juocevicius A, Hansen HV, Gelernter I, Hart J, Baskov A, Dreval O, Terese P, Catz A. Properties and outcomes of spinal rehabilitation units in four countries. Spinal Cord 2009; 47:597-603. [PMID: 19172151 DOI: 10.1038/sc.2008.178] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Compare rehabilitation after spinal cord lesions (SCL) in different countries. DESIGN Multicenter comparative study. SETTING Four spinal rehabilitation units, in Denmark, Russia, Lithuania and Israel. SUBJECTS 199 SCL patients. INTERVENTIONS Information was collected about unit properties, rehabilitation objectives, American Spinal Injury Association (ASIA) scale and spinal cord independence measure (SCIM) assessments, and patient data. chi (2)-test, t-test, ANOVA and ANCOVA were used for statistical analysis. MAIN OUTCOME MEASURES Time from lesion onset to admission for rehabilitation (TAR), length of stay in rehabilitation (LOS), SCIM and spinal cord ability realization measurement index (SCI-ARMI) scores, SCIM gain, SCI-ARMI gain and rehabilitation efficiency (RE). RESULTS Differences were found between the units in rehabilitation objectives, facilities and special equipment for rehabilitation. Staff/bed ratio was 1.7 in Lithuania and Denmark, 1.1 in Israel and 0.9 in Russia. Russian patients were the youngest and had the most severe lesions among participating units. Admission SCIM and SCI-ARMI were the lowest in Israel: 25.1+/-17.2 and 34.3+/-17.3. TAR was highest in Russia (12.4 month) and lowest in Israel (2 weeks; P<0.01). LOS was longest in Denmark (176.9 days; P<0.001). SCIM score at the end of rehabilitation was highest in Denmark (67.3+/-23). SCIM gain and SCI ARMI gain were highest in Israel (36.9+/-18.3 and 38.5+/-19.4, respectively) and lowest in Russia (P<0.001). RE was highest in Lithuania and lowest in Denmark (P<0.001). CONCLUSIONS In the participating units, SCL rehabilitation outcomes depend on SCL severity and unit-specific properties. A moderately delayed rehabilitation with long LOS achieved high functioning, and early or slightly delayed rehabilitation combined with shorter LOS achieved high functional gain or efficiency.
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Affiliation(s)
- Y Fromovich-Amit
- The Spinal Department and Medical Management, Loewenstein Rehabilitation Hospital, Ra'anana, Israel
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Kessing LV, Hansen HV, Hougaard E, Hvenegaard A, Albaek J. [Preventive out-patient treatment of affective disorders]. Ugeskr Laeger 2007; 169:1456-9. [PMID: 17484846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/15/2023]
Abstract
The present article is based on a Health Technology Assessment Report (HTA, available with an English summary at www.cemtv.dk) on preventive out-patient treatment of affective disorders. The article briefly reviews the course of depressive disorder and bipolar affective disorder and reviews the best available treatment modalities including shared care models, prophylactic pharmacotherapy and prophylactic combination therapy involving pharmacotherapy and psychological treatment.
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Bech P, Hansen HV, Kessing LV. The internalising and externalising dimensions of affective symptoms in depressed (unipolar) and bipolar patients. Psychother Psychosom 2007; 75:362-9. [PMID: 17053337 DOI: 10.1159/000095442] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To analyse the internalising and externalising dimensions of affective states in depressed (unipolar) and bipolar patients approximately 2 years after discharge from psychiatric hospitals in Denmark. METHOD The 42-item symptom scale based on the Beck Depression Inventory was used for the measurement of both the internalising dimension of affective symptoms (depression including suicidal ideas, anxiety and asthenia) and the externalising dimension (mania). To supplement the latter dimension, the WHO-5 questionnaire was included. These questionnaires were mailed to a large population of patients with depressive (unipolar) or bipolar disorders, representative of patients treated in hospital settings in Denmark, approximately 2 years after discharge from hospital. RESULTS In total, 244 unipolars and 214 bipolars were included in the study. Mokken analysis showed that depressive (unipolar) patients could be measured more validly than bipolar patients on the internalising subscales of depression, anxiety and asthenia. On the externalising dimension of psychological well-being (WHO-5), both groups of patients could be validly measured. Approximately 2 years after discharge from hospital, around 36% of the unipolars and 19% of the bipolars had a moderate to severe depression. In a control group of healthy subjects, 4% had a moderate to severe depression. Less than 5% even in the bipolar group of patients were hypomanic. CONCLUSION Approximately 2 years after discharge from psychiatric hospitals in Denmark, depressive (unipolar) patients scored significantly higher than bipolar patients on the internalising dimension and suicidal ideas, and significantly lower on the externalising dimension of psychological well-being.
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Affiliation(s)
- P Bech
- Psychiatric Research Unit, Frederiksborg General Hospital, Hillerod, Denmark.
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Kessing LV, Hansen HV, Bech P. Attitudes and beliefs among patients treated with mood stabilizers. Clin Pract Epidemiol Ment Health 2006; 2:8. [PMID: 16712717 PMCID: PMC1481603 DOI: 10.1186/1745-0179-2-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2005] [Accepted: 05/19/2006] [Indexed: 12/17/2022]
Abstract
BACKGROUND There is increasing evidence that attitudes and beliefs are important in predicting adherence in depressive and bipolar disorders. However, such attitudes and beliefs on mood stabilizers have not been analysed by socio-demographic and clinical variables. METHODS The Mood Stabilizer Compliance Questionnaire (MSQC) was mailed to a large population of patients with depressive or bipolar disorder representative of patients treated at their first contacts to hospital settings in Denmark. RESULTS Of the 1005 recipients, 49.9 % responded to the letter and among these 256 indicated that they previously had been or currently were in treatment with a mood stabilizer. A large proportion of the patients (40 to 80 %) had non-correct views on the effect of mood stabilizers. Older patients consistently had a more negative view on the doctor-patient relationship, more non-correct views on the effect of mood stabilizers and a more negative view on mood stabilizers. There was no difference in the attitudes and beliefs according to the type of disorder (depressive or bipolar), the number of psychiatric hospitalisations or according to the type of the current doctor (general practitioner, private psychiatrist, community psychiatry doctor, hospital doctor, other doctor). CONCLUSION There is a need of improving knowledge and attitudes toward diagnosis and treatment especially among elder patients as this may add to improve the prognosis of depressive and bipolar disorders.
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Affiliation(s)
- Lars Vedel Kessing
- Department of Psychiatry, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Hanne Vibe Hansen
- Department of Psychiatry, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark
| | - Per Bech
- Psychiatric Research Unit, Frederiksborg General Hospital, Hillerød, Denmark
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Kessing LV, Hansen HV, Ruggeri M, Bech P. Satisfaction with treatment among patients with depressive and bipolar disorders. Soc Psychiatry Psychiatr Epidemiol 2006; 41:148-55. [PMID: 16456641 DOI: 10.1007/s00127-005-0012-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/25/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Patients' satisfaction with care may be an important factor in relation to adherence to treatment and continued psychiatric care. Few studies have focused on satisfaction in patients with depressive and bipolar disorders. METHOD A comprehensive multidimensional questionnaire scale, the Verona Service Satisfaction Scale-Affective, was mailed to a large population of patients with depressive or bipolar disorders representative of outpatients treated at their first contact to hospital settings in Denmark. RESULTS Among the 1,005 recipients, 49.9% responded to the letter. Overall, patients were satisfied with the help provided, but satisfaction with the professionals' contact to relatives was low. Younger patients (age below 40 years) were consistently more dissatisfied with care especially with the efficacy of treatment, professionals' skills and behaviour and the information given. There was no difference in satisfaction between genders or between patients with depressive disorder and patients with bipolar disorder. CONCLUSION There is a need to strengthen outpatient treatment for patients discharged from a psychiatric hospital diagnosed of having affective disorders, focusing more on information and psychoeducation for patients and relatives.
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Affiliation(s)
- Lars Vedel Kessing
- Dept. of Psychiatry, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark.
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Abstract
Prior studies have found contradictory results regarding the association between course of illness and quality of life among patients with depressive disorder or bipolar disorder. Questionnaires about quality of life and affective symptoms (the EQ-5D, EQ-5D-VAS, WHO (Five) well-being index and the BDI-42) were mailed to a large population of outpatients with depressive or bipolar disorder representative of patients treated in hospital settings in Denmark. Among the 1005 recipients, 49.9% responded to the letter. Depressive disorder was associated with poorer general health (EQ-5D, EQ-5D-VAS) and well-being (WHO (Five) well-being index) and more depressive and anxiety symptoms compared with bipolar disorder. Similarly, more psychiatric admissions were associated with poorer general health and well-being and more depressive and anxiety symptoms. However, when adjusting for the effect of depressive symptoms, the associations between number of admissions and general health, and between numbers of admissions and well-being, lost significance. Thus, depressive symptoms seem to be the strongest predictor of general health and well-being in both disorders. As the response rate to the questionnaire was relatively low, the findings should be interpreted with caution.
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Abstract
BACKGROUND There is increasing evidence that attitudes and beliefs are important in predicting adherence to treatment and medication in depressive and bipolar disorders. However, these attitudes have received little study in patients whose disorders were sufficiently severe to require hospitalization. METHOD The Antidepressant Compliance Questionnaire (ADCQ) was mailed to a large population of patients with depressive or bipolar disorder, representative of patients treated in hospital settings in Denmark. RESULTS Of the 1005 recipients, 49.9% responded to the letter. A large proportion of the patients (40-80%) had erroneous views as to the effect of antidepressants. Older patients (over 40 years of age) consistently had a more negative view of the doctor-patient relationship, more erroneous ideas concerning the effect of antidepressants and a more negative view of antidepressants in general. Moreover, their partners agreed on these negative views. Women had a more negative view of the doctor-patient relationship than men, and patients with a depressive disorder had a more negative view of antidepressants than patients with bipolar disorder. The number of psychiatric hospitalizations or the type of treating physician (general practitioner, psychiatrist in private practice, community psychiatrist, hospital psychiatrist, other doctor) did not affect attitudes and beliefs. CONCLUSION Lack of knowledge about affective disorder and its treatment and a critical attitude, especially among older patients, may add to an adverse prognosis of depressive and bipolar disorders.
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Affiliation(s)
- Lars Vedel Kessing
- Department of Psychiatry, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark.
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15
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Hansen HV, Kessing LV. [Adherence to treatment by patients with depression and bipolar affective disorder]. Ugeskr Laeger 2005; 167:1837-41. [PMID: 15929328] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/02/2023]
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16
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Henriksen MG, Jensen MB, Hansen HV, Jespersen TW, Hessov I. Enforced mobilization, early oral feeding, and balanced analgesia improve convalescence after colorectal surgery. Nutrition 2002; 18:147-52. [PMID: 11844646 DOI: 10.1016/s0899-9007(01)00748-1] [Citation(s) in RCA: 95] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE A postoperative regimen using a multimodal approach with enforced mobilization and early oral nutrition has been reported to improve convalescence but has not been compared with other postoperative regimens. METHODS Forty patients undergoing elective colorectal surgery were randomly allocated to an intervention group receiving comprehensive information on the importance of mobilization, balanced anesthesia, and postoperative analgesia including epidural local anesthetics and enforced postoperative mobilization or a control group receiving anesthesia without epidural local anesthetics, postoperative analgesia with epidural morphine, and mobilization without fixed goals. All patients were offered early oral nutrition. The regimens were compared by means of ambulation time and physical activity, voluntary muscle strength, pulmonary function, and body composition. RESULTS The ambulation time improved substantially within 22 h in the intervention group versus 3 h in the control group on day 1 (P = 0.0004) and within 8 h versus 2 h on day 4 (P = 0.0003). The voluntary strength of the quadriceps muscle decreased by 3% in the intervention group versus 15% in the control group on day 7 (P = 0.04). Two months postoperatively, the difference between groups was the same (P = 0.02). CONCLUSION This active per- and postoperative regimen based on a multimodal approach improved ambulation time and muscle function during admission and late convalescence.
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Affiliation(s)
- M G Henriksen
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.
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Biering-Sørensen F, Gregersen H, Hansen HV, Nielsen L, Ranneries P, Rolfsager K, Østergård S. [Multidisciplinary electronic medical record and clinical database all in one. SCIBase]. Ugeskr Laeger 2001; 163:3207-12. [PMID: 11421186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Affiliation(s)
- F Biering-Sørensen
- H:S Rigshospitalet, Neurocentret, klinik for para- og tetraplegi, afdeling TH, og Enterprise Systems.
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Abstract
An increasing number of patients with chronic mental disease are now integrated in society. As a consequence, women with severe psychiatric illness may become pregnant and wish to complete the pregnancy and to give birth to a child. The lack of sensation of reality in these patients and their social situation may result in particular problems in their treatment, and it may be necessary to admit them to a psychiatric ward before delivery. In this paper five cases of pregnant women with severe and chronic psychosis are described. These patients had many problems in common. Thus, they were all schizophrenics with very severe psychopathology, had poor understanding of their own situation, and lacked social networks. All the fathers were non-Danish. Coercion was used in all cases. To help women with severe mental illness to go through pregnancy and childbirth requires close collaboration between psychiatric and obstetric staff and social workers, and this should be organized in an institution with experience in the treatment of this type of patient.
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Affiliation(s)
- H V Hansen
- Department of Psychiatry O, Rigshospitalet, University of Copenhagen, Borgmester Jensens Alle 55, DK-2100 Copenhagen, Denmark
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Biering-Sørensen F, Nielsen K, Hansen HV. Urethral epithelial cells on the surface on hydrophilic catheters after intermittent catheterization: cross-over study with two catheters. Spinal Cord 1999; 37:299-300. [PMID: 10338353 DOI: 10.1038/sj.sc.3100817] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
AIM To count the number of cells on the surface of the two commercial hydrophilic catheters, Lofric and EasiCath used for intermittent catheterization (IC) after 30-60 s in water without the necessity of catheter jelly. PARTICIPANTS Twenty spinal cord lesioned (SCL) individuals. Six were women, and 14 men. METHODS IC was performed on average five times a day (range: 4-10). In a randomised cross-over design all catheterizations were performed either with Lofric or EasiCath in two consecutive 24 h periods. The catheter used for the last catheterization in each 24 h period was fixed, and divided into pieces of 5 cm. From each of these a piece with the length of 5 mm was taken for surface microscopy after staining. The total number of cells was counted without knowledge of the type of catheter. According to the fractionator principle an unbiased estimate of the total number of cells on the surface of the cateter was calculated. RESULTS There was no difference in the number of urethral epithelia cells on the catheters. No granulocytes were identified. The number of cells identified on the catheters were from 30 to > 10 000. No differences related to age, level of SCL, ASIA impairment scale, months since SCL or type of IC were found. There was a trend that women had higher cell counts than men. CONCLUSION No difference was found regarding number of urethral epithelial cells on the surface of the catheters after catheterization. This indicates no difference in urethral trauma between the two catheters.
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Affiliation(s)
- F Biering-Sørensen
- Centre for Spinal Cord Injured, Rigshospitalet, Copenhagen University Hospital, Denmark
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Starklint H, Hansen HV, Kemp M, Leyssac PP, Kemp E, Dieperink H. Long-term cyclosporin A nephrotoxicity in the rat. Evaluation of a morphological scoring system and of co-treatment with isradipine. APMIS 1994; 102:347-55. [PMID: 8024736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Cyclosporin A (CyA) nephrotoxicity was examined in Spraque-Dawley rats given CyA (12.5 (n = 45) or 25 (n = 45) mg/kg/day perorally for 16 weeks. Control rats (n = 45) received CyA vehicle. All rats were given either isradipine (ISRA) 1 or 5 mg/kg/day orally, or isradipine vehicle. Fifteen rats died from interstitial pneumonia caused by Staphylococcus xylosus. A predefined morphological CyA nephrotoxicity scoring system, based on semiquantitative scores for basophilic tubules and for interstitial fibrosis, performed on hematoxylin-eosin-stained tissue, yielded mean scores for basophilic tubules of 0.2 (range 0-1) in controls, 1.4 (range 0-3) in rats given CyA 12.5 mg/kg/day (p < 0.001), and 1.7 (range 0-3) in CyA 25 mg/kg/day rats (p < 0.001 as compared to controls). Rats given CyA were grouped according to their score for interstitial fibrosis: 0.2 (range 0-1) in CyA 12.5 mg/kg/day and 1.7 (range 0-3) in CyA 25 mg/kg/day rats (p < 0.001). When scores for basophilic tubules and interstitial fibrosis were pooled, none of the control rats had a score above 1, while 47% of the low-dose and 95% of the high-dose rats scored above 1. Thus, this CyA nephrotoxicity scoring system provided an easy, efficacious, and reproducible identification of rats with morphological CyA nephrotoxicity, and may be of clinical interest in the assessment of CyA nephrotoxicity. Kidney tissue from rats not treated with isradipine was further investigated with periodic acid-Schiff (PAS) with and without diastase treatment, and with Sirius Red. The latter confirmed the increase in connective tissue following tubular atrophy in CyA-treated rats. PAS reaction disclosed diastase-resistant positivity in the glomerular arterioles (score in controls: mean 0.4, range 0-1, in CyA 12.5 mg/kg/day mean 2.2, range 1-3, p < 0.001 as compared to controls; in CyA 25 mg/kg/day mean 1.1, range 0-2, p < 0.005 as compared to controls, p < 0.05 as compared to CyA 12.5 mg/kg/day). Furthermore, the straight part of the distal tubules of rats given the highest CyA dose contained considerable amounts of glycogen. The significance of this finding is unknown. Renal functional studies confirmed previous results since CyA decreased inulin clearance (Cin) from 1.2 +/- 0.5 to 0.8 +/- 0.3 ml/min/g kidney weight (kW) (p < 0.05), and lithium clearance (CLi) was reduced from 263 +/- 113 to 119 +/- 61 microliters/min/gKW (p < 0.001). Isradipine had no significant effect.
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Affiliation(s)
- H Starklint
- Laboratory of Nephropathology, Odense University Hospital, Denmark
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Rask R, Rasmussen JM, Hansen HV, Bysted P, Svehag SE. Complement C3d,g/Epstein-Barr virus receptor density on human B-lymphocytes estimated by immunoenzymatic assay and immunocytochemistry. J Clin Lab Immunol 1988; 25:153-6. [PMID: 2969415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The density of the C3d,g/Epstein-Barr virus receptor (CR2) on human mononuclear cells (MNC) isolated from CPD stabilized blood, was determined by comparing the concentration of CR2 antigen in extracts from Raji cells, with a known receptor density, with extracts of MNC. The concentration of CR2 was determined by a sandwich ELISA using two mutually non-inhibiting monoclonal anti CR2 antibodies (HB5 and OKB7). The percentage of CR2+ MNC was determined by an immunocytochemical staining method. Analysis of MNC from 20 healthy donors, revealed that the density of CR2 molecules varied from 3,600-7,700 on CR2+ cells, and that the percentage of CR2+ MNC had a mean of 13%.
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Affiliation(s)
- R Rask
- Institute of Medical Microbiology, Odense University, Denmark
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Hansen HV, Koch L. [Amnesty International Danish nurses' group on isolation imprisonment: it is very difficult to consider isolation a link in rehabilitation]. Sygeplejersken 1981; 81:18-9. [PMID: 6914053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hansen HV. [Hopes that UN funds might be used for a center for torture victims]. Sygeplejersken 1981; 81:18. [PMID: 6913215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hansen HV, Christoffersen A. [Research of late results in surviving Argentinian torture victims: psychological harm most dominant after torture]. Sygeplejersken 1981; 81:28-9. [PMID: 6910957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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Hansen HV. [From the Amnesty International Nursing Group: a known Argentinian nurse has disappeared without a trace]. Sygeplejersken 1980; 80:7. [PMID: 6899568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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