Biomedical subjects

L V Kessing

Publications and source records attributed to L V Kessing.

33 records · Page 2Linked to original sources

PubMed1999

Apolipoprotein E-epsilon 4 frequency in affective disorder.

BACKGROUND: The epsilon 4 allele of apolipoprotein E (APOE) as well as affective disorder have been found to be associated with Alzheimer's disease, but it is unclear whether cognitive impairment in affective disorder or subtypes of affective disorder is mediated by the epsilon 4 allele of APOE. METHODS: The genotype of APOE was analyzed in 106 unipolar patients, 21 bipolar patients, and 46 controls and correlated with cognitive function in the euthymic phase as measured by the Mini-Mental State Examination, the Cambridge Cognitive Examination, the Mattis Dementia Rating Scale, the Gottfries-Bråne-Steen Dementia Rating Scale, and the Global Deterioration Scale. RESULTS: The frequency of APOE-epsilon 4 allele was approximately the same in unipolar patients (.189) and in bipolar patients (.167). Although patients showed more cognitive impairment than controls, no significant overall difference was found between the frequency of APOE-epsilon 4 allele in patients (.185) and controls (.131). In fact, the frequency of APOE-epsilon 4 allele did not correlate with cognitive impairment. It was not possible to identify subgroups of patients with an increased frequency of APOE-epsilon 4 allele, as no association was found with gender, age at onset, the number of affective episodes, the presence of psychotic features, or the prevalence of familial affective disorder. CONCLUSIONS: It seems that cognitive impairment in affective disorder can be attributed to pathways other than the APOE genotype.

Adult↗

PubMed1999

The effect of comorbid alcoholism on recurrence in affective disorder: a case register study.

BACKGROUND: Studies of the effect of comorbid alcoholism on the risk of recurrence in affective disorder have given contradictory results. METHOD: Using survival analysis, the rate of recurrence was calculated in a case register study including all hospital admissions with primary affective disorder in Denmark during 1971-1993. The rate of recurrence was estimated following each new affective episode. RESULTS: In all, 20 350 patients were discharged after first admission with a main diagnosis of affective disorder of depressive or manic/circular type. Among these, 518 patients (2.6%) had an auxiliary diagnosis of alcoholism. Patients with a current auxiliary diagnosis of alcoholism had increased rate of recurrence following the first three affective episodes but not following subsequent episodes compared with patients without auxiliary diagnoses. The effect of alcoholism declined with the number of episodes. In contrast, no effect was found of other auxiliary diagnoses on the rate of recurrence. CONCLUSION: Rehospitalisation data suggest that concurrent alcoholism increases the risk of recurrence of affective episodes during the initial course of unipolar and bipolar disorder but has no effect on recurrence later in the course of the illnesses. LIMITATION: The data relate to re-admissions rather than recurrence. CLINICAL RELEVANCE: The study emphasises that alcoholism has a deteriorating effect on the course of affective disorder.

Alcoholism↗

PubMed1999

The effect of episodes on recurrence in affective disorder: a case register study.

BACKGROUND: The risk of recurrence has been found to increase with the number of episodes in both unipolar and bipolar affective disorder. The present study compared the effect of the number of episodes on the risk of recurrence in the two disorders. METHOD: A case register study including all hospital admissions with primary affective disorder in Denmark during 1971-1993. The effect of the number of prior episodes on the rate of recurrence following the first discharge after 1984 was estimated. A total of 7925 unipolar patients and 2011 bipolar patients were included in the study. RESULTS: The rate of recurrence was, on average, 1.6 times greater for bipolar patients than for unipolar patients. Nevertheless, the effect of the number of episodes was greatest for unipolar patients. Thus, the rate of recurrence increased, on average, 15% with every episode for unipolar patients and 9% with every episode for bipolar patients, when adjusted for differences in age and gender. CONCLUSION: The risk of recurrence increases with every new episode in affective disorder. The effect of episodes is greater for unipolar disorder than for bipolar disorder. LIMITATIONS: The data relate to re-admissions rather than recurrence. CLINICAL RELEVANCE: The study shows that the prognosis worsens more for unipolar than for bipolar patients with each new episode and suggests the relevance of earlier and more sustained intervention.

Aged↗

PubMed1999

The effect of the first manic episode in affective disorder: a case register study of hospitalised episodes.

BACKGROUND: It is poorly understood how the course of illness in depressive patients is affected by a manic episode. METHOD: The course of hospitalised episodes was compared for patients with depressive episodes only, patients who presented with a manic or circular first episode and patients who presented with a depressive first episode and later developed mania. The Danish psychiatric central register was used as a study base, including all hospital admissions with primary affective disorder in Denmark during 1971-1993. RESULTS: A total of 17,447 patients presented with a depressive first episode and 2903 patients with a manic or circular first episode. Among the 17,447 depressive patients, 762 patients presented with mania at later episodes (4.4%). Younger age at onset was associated with increased risk of developing mania. Patients who had a late first manic episode had the same rate of subsequent recurrence as patients with mania at first episode and this rate was higher than the rate of recurrence for patients who remained having depressive episodes only. Time since first manic episode was without importance in relation to the risk of subsequent recurrence. CONCLUSION: Patients who present with depression and later develop mania have from onset the same risk of recurrence as initially bipolar patients. LIMITATION: The data relate to admissions rather than episodes. CLINICAL RELEVANCE: Younger patients who present with depression have increased risk of developing bipolar disorder.

Bipolar Disorder↗

PubMed1999

Dementia in affective disorder: a case-register study.

OBJECTIVE: The aim of the study was to investigate whether patients with affective disorder have increased risk of developing dementia compared to other groups of psychiatric patients and compared to the general population. METHOD: In the Danish psychiatric central register, 3363 patients with unipolar affective disorder, 518 patients with bipolar affective disorder, 1025 schizophrenic and 8946 neurotic patients were identified according to the diagnosis at the first ever discharge from psychiatric hospital during the period from 1970 to 1974. The rate of discharge diagnosis of dementia on readmission was estimated during 21 years of follow-up. In addition, the rates were compared with the rates for admission to psychiatric hospitals with a discharge diagnosis of dementia for the total Danish population. RESULTS: Patients with unipolar and with bipolar affective disorder had a greater risk of receiving a diagnosis of dementia than patients with schizophrenia and those with neurosis. All groups of patients had a higher risk of being given a diagnosis of dementia than gender- and age-matched samples of the general population. CONCLUSION: Patients with affective disorder appear to be at increased risk of developing dementia.

Adult↗

PubMed1999

Recovery from episodes during the course of affective disorder: a case-register study.

OBJECTIVE: The aim of the study was to investigate whether the duration of treated episodes changes during the course of unipolar and bipolar affective disorder. METHOD: The rate of recovery from successive hospitalized episodes was estimated with survival analyses in a case-register study including all hospital admissions with primary affective disorder in Denmark during the period 1971-1993. RESULTS: A total of 9174 patients with recurrent episodes were followed from their first admission. The rate of recovery from hospitalized episodes did not change with the number of episodes in unipolar or bipolar disorder. Furthermore, the rate of recovery was constant across episodes, regardless of the combination of age, gender and type of disorder. Initially in the course of the illness, the rate was a little faster for bipolar than for unipolar patients, but later in the course of the illness the rate of recovery was the same for the two disorders. CONCLUSION: It is concluded that, in modern treatment settings, the duration of affective episodes appears to be stable during the course of unipolar and bipolar disorder.

Adult↗

PubMed1998

Clinical definitions of sensitisation in affective disorder: a case register study of prevalence and prediction.

The observation of a progressive recurrence in affective disorder has been interpreted as a process of sensitisation. The clinical applicability of such a theoretical model was investigated using the Danish case register, which includes all hospital admissions with primary affective disorder in Denmark from 1971 to 1993. A total of 8,737 patients admitted to a psychiatric hospital at least twice constituted the study sample. Information on treatment intervention was not available. Measures describing the initial course of admission episodes were defined in three different ways: 1) a short period between initial episodes 2) decreasing intervals between initial episodes or 3) a combination of 1) and 2). Socio-demographic variables such as gender, age at onset and marital status differentiated between the three types of measures and the measures also demonstrated different effects in predicting the risk of further recurrence. In unipolar disorder, patients with a decreasing interval between episodes had the greatest risk of further recurrence, whereas for bipolar patients, a short period between episodes played a more important role than the sequence of episodes in itself.

Bipolar Disorder↗

PubMed1998

Clinical consequences of sensitisation in affective disorder: a case register study.

Clinically derived measures of the initial course of episodes might reflect a process of sensitisation in affective disorder. However, the clinical consequences of such measures have not been investigated. The predictive effect of measures of the initial course of episodes was investigated in relation to the subsequent risk of alcoholism, dementia, death and suicidal attempts/suicide in a case register study including all hospital admissions with primary affective disorder in Denmark from 1971 to 1993. A total of 8737 patients with more than one episode were included in the analyses. A short period between initial episodes of the illness, reflecting a great intensity of illness, predicted increased risk of subsequent development of dementia, and for unipolar patients, decreased risk of subsequent alcoholism. Surprisingly, a progressive course, with decreasing intervals between initial episodes of the illness, had no predictive effect. Similarly, no predictive effects on the risk of death or suicidal acts could be demonstrated with any measure of the initial course of episodes.

Aged↗

PubMed1998

Predictors of recurrence in affective disorder. A case register study.

BACKGROUND: The risk of recurrence in affective disorder is affected by socio-demographic variables such as gender, age at onset and marital status and by illness related factors as the length of previous episodes and the total duration of the illness. The present study investigated how the effect of these variables changed with the progression of the illness. METHOD: Using survival analysis, the risk of recurrence was estimated in a case register study including all hospital admissions with primary affective disorder in Denmark during 1971-1993. RESULTS: Totally, 20350 first admission patients had been discharged with a diagnosis of affective disorder, depressive or manic/circular type. Initially in the course of the illness, bipolar patients had a substantial greater risk of recurrence compared with unipolar patients. At this time, gender, age and marital status together with the total duration of the illness predicted the risk of recurrence in both unipolar and bipolar illness. Some variables had different predictive effect in the two types of illness. Later, especially the duration of the previous illness predicted the risk of recurrence. CONCLUSION: It seems as initially in the course of affective disorder socio-demographic variables such as gender, age at onset and marital status act as risk factors for further recurrence. Later, however, the illness itself seem to follow its own rhythm regardless of prior predictors. LIMITATION: The data relate to re-admissions rather than recurrence and the findings may be due to decreasing sample sizes during the course of illness. CLINICAL RELEVANCE: The study underscores the importance of the illness process itself.

Adult↗

PubMed1998

Cognitive impairment in the euthymic phase of affective disorder.

BACKGROUND: A review of studies of cognition in the euthymic phase of unipolar and bipolar affective disorder reveals diverging results. METHODS: The study was designed as a controlled cohort study, with the Danish psychiatric case register of admissions used to identify patients and the Danish civil register to identify controls. Patients who were hospitalized between 19 and 25 years ago with an affective diagnosis and who at interviews fulfilled criteria for a primary affective unipolar or bipolar disorder, according to ICD-10, were compared with age- and gender-matched controls. Interviews and assessment of the cognitive function were made in the euthymic phase of the disorder. In all, 118 unipolar patients, 28 bipolar patients and 58 controls were included. Analyses were adjusted for differences in the level of education and for subclinical depressive and anxiety symptoms. RESULTS: Patients with recurrent episodes were significantly more impaired than patients with a single episode and more impaired than controls. Also, within patients the number of prior episodes seemed to be associated with cognitive outcome. There was no difference in the severity of the dysfunction between unipolar and bipolar patients. CONCLUSIONS: Cognitive impairment in out-patients with unipolar and bipolar disorder appears to be associated with the number of affective episodes.

Adult↗

PubMed1998

Recurrence in affective disorder. I. Case register study.

BACKGROUND: In recent years, studies of the risk of recurrence in affective disorder in relation to the number of prior episodes have given contradictory results. METHOD: Survival analysis was used to calculate the rate of recurrence after successive episodes in a case register study including all hospital admissions with primary affective disorder in Denmark during 1971-1993. A total of 20,350 first-admission patients were discharged with a diagnosis of affective disorder, depressive or manic/cyclic type. RESULTS: The rate of recurrence increased with the number of previous episodes in both unipolar and bipolar disorder. Initially, the two types of disorders followed markedly different courses, but later in the course of the illness the rate of recurrence was the same for the two disorders. CONCLUSIONS: The course of severe unipolar and bipolar disorder seems to be progressive in nature despite the effect of treatment.

Adult↗

PubMed1998

Recurrence in affective disorder. II. Effect of age and gender.

BACKGROUND: The risk of recurrence in affective disorder has been found to increase with each new episode. It is unclear whether it is universal without regard to gender, age and type of disorder. METHOD: Survival analysis was used to estimate the risk of recurrence in a case-register study including all hospital admissions with primary affective disorder in Denmark from 1971-1993. In this period 20,350 first-admission patients had been discharged with a diagnosis of affective disorder, depressive or manic/cyclic type. RESULTS: The risk of recurrence increased with the number of previous episodes regardless of the combination of gender, age and type of disorder. Initially in the course of illness, unipolar and bipolar women experienced an equal greater risk of recurrence than men. The risk of recurrence after the first episode was increased for middle-aged and older unipolar women compared with the risk for younger women, while after all other episodes younger age at first episode increased the risk of recurrence. CONCLUSIONS: The course of severe unipolar and bipolar disorder seems to be progressive in nature irrespective of gender, age and type of disorder.

Adult↗

PubMed1995

[Psychiatric morbidity in connection with surgical treatment of epilepsy. A short-term follow-up of patients with amygdalohippocampectomy].

The aim of the study was to examine the occurrence of psychiatric disorders in epilepsy patients who had received surgical treatment, especially amygdalohippocampectomy (AHE), for the relief of medically intractable seizures. Forty-seven subjects, treated during the period 1987-1991 in the Danish epilepsy surgery programme (EPIKIR), entered a retrospective interview study. Of these, 37 had undergone AHE. Preoperative psychiatric morbidity was assessed through interview and available case notes, including a routine psychiatric interview. Postoperative psychiatric morbidity was assessed by the use of the Present State Examination. A total of six subjects (five AHE subjects) developed depressive disorders of various duration and severity after operation. In three subjects this occurred "de novo". No paranoid-hallucinatory psychoses developed within the follow-up period (a minimum of one year), and the presence of psychiatric disorders could not be associated with either lateralization of cerebral dominance of histopathological findings. Thus, depression appears to be the most frequent psychiatric problem following epilepsy surgery. Although the present study mainly deals with AHE, this finding is in accordance with the results of recent findings concerning anterior temporal lobe resection.

Adolescent↗

PubMed1994

[Cerebral changes in manic-depressive patients].

Research in psychiatry with computed tomography, magnetic resonance, single photon emission computed tomography and positron emission tomography has until recently focused on schizophrenia. Results from the latest years suggest some of the same cerebral changes in affective disorder. Structural changes with enlargement of the lateral and third ventricles and broader sulci on the brain surface are frequently found in both patient groups compared to healthy volunteers. Areas with subcortical hyperintensity in the deep white matter and periventricular regions are frequently seen, especially in affective disorder bipolar patients, but seldom in schizophrenics. Functionally, the reduced activity in the prefrontal cortex in the depressive state is the most common finding together with hypoactivity in the left hemisphere. The aetiology and pathophysiological meaning of these brain changes remain unsolved.

Bipolar Disorder↗

PubMedDate not supplied

Predictors of recurrence in affective disorder--analyses accounting for individual heterogeneity.

BACKGROUND: Previous studies suggest that gender, age at onset, and marital status act as risk factors for further recurrence initially during the course of affective disorder but not at a later stage. These studies did, however, not take the individual liability to recurrence into account. METHOD: The effect of predictors of recurrence was estimated with the use of generalised linear mixed models in a case register study including a random sample of all patients admitted with primary affective disorder in Denmark during 1971-1993. RESULTS: In total, 7047 first admission patients with a diagnosis of affective disorder, depressive or manic/circular type were included in the analyses. The study confirmed that the effect of the type of disorder, age at first admission, and never being married decreased during the course of illness even when the individual liability to recurrence was taken into account. No differences in the effect of gender and in the effect of a recent divorce were found between early and later episodes and the effect of a recent death of a spouse seemed to increase during the course of illness. The risk of recurrence increased with every new episode for all sub-groups of patients. CONCLUSION: The effect of some, but not all, predictors of recurrence decline during the course of affective illness. The number of previous episodes predicts recurrence in most subgroups of patients. LIMITATION: The data relate to re-admissions rather than recurrence. CLINICAL RELEVANCE: The study underscores the importance of the illness process itself.

Adult↗