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Biomedical subjects

M Kastrup

Publications and source records attributed to M Kastrup.

At least 37 records · Page 2Linked to original sources
PubMed1989

The use of case vignettes in studies of interrater reliability of psychiatric target syndromes and diagnoses. A comparison of ICD-8, ICD-10 and DSM-III.

This study is part of the ICD-10 field trials in which the use of case vignettes for interrater agreement has been examined. From our electronic database of 880 consecutively admitted inpatients we selected 24 cases that were transcribed to vignettes covering the first 5 ICD-10 target syndrome of dementia, substance use disorders, schizophrenia, mood and anxiety disorders. ICD-10 was compared with ICD-8 and DSM-III. The results showed that all 3 standard classification systems obtained an acceptable interrater agreement. Among the diagnoses, depressive disorders gave rise to most disagreement between the raters. Discrepancies between the methods of measuring interrater agreement were found when intraclass reliability was compared with consensus calculations for the individual patient.

Humans↗
PubMed1988

Psychiatry and the death penalty.

Mentally ill people are not to be judged by the same rules as the mentally fit. Prisoners evaluated medically unfit for execution must undergo psychiatric treatment until their mental health is restored. Psychiatrists are placed in an ethical dilemma when asked to judge the mental health of prisoners on death row. A high prevalence of psychiatric and neurological disorders are reported on death row. Health professionals have an important role in implementing codes of ethics prohibiting any involvement in the execution process. Resolutions have already been passed by several associations including the World Medical Association, the American Psychiatric Association and Nordic medical associations.

Bioethics↗
PubMed1987

An integration of the DSM-III and ICD-8 by global severity assessments for measuring multidimensional outcomes in general hospital psychiatry.

A multiaxial classification system has been developed in which three ICD-8 derived axes of psychiatric syndromes, personality disorders and somatic syndromes, and two DSM-III axes of psychosocial stressors and social functioning have been included. Global assessment scales were annexed the three ICD-8 axes. This DSM-III/ICD-8 system was used for registration of 880 consequetively admitted psychiatric patients in a general hospital setting. The results showed that six psychiatric syndromes (substance use disorders, schizophrenia, manic-depressive psychosis, reactive psychosis, neurosis, and adjustment reactions) were responsible for 80% of the diagnostic variance. Of these syndromes, manic-depressive psychosis had the highest improvement rate both concerning symptoms and social functioning. Manic-depressive psychosis had also the lowest coefficient of variation in the stay in hospital indicating a high degree of homogeneity in accordance to the diagnose-related group system. However, patients within the categories of reactive psychosis and neurosis who received antidepressants also had a low coefficient of variation, although the neurotics were significantly more depressed than the manic-depressives at discharge from hospital.

Adolescent↗
PubMed1987

Prediction and profile of the long-stay population. A nation-wide cohort of first time admitted patients.

A nation-wide cohort of 12,737 first admitted patients aged 15 years or more to Danish psychiatric institutions was followed in the Danish Case Register for a 10-year period. Long stay patients were delineated as: 1) patients whose first admission lasted for more than 1 year (new long-stay); or 2) patients who later had an admission lasting for more than 1 year (late long-stay). Together they comprised 420 males and 527 females with an incidence rate of 0.22 males and 0.27 females per 1,000. Up to age 65 males dominated, after 65 females dominated. Thirty-three percent of demential disordered and 24 of schizophrenics became long-stay patients. A multiple contingency analysis showed that the variables "age group", "main diagnosis", "size of municipality of residence" and "marital status" were independently associated with the outcome "long-stay". The two long-stay groups differed. New long-stay patients tended to be females, older, suffering from demential disorders and with a total hospital stay shorter than that of the long-stay population. In a multiple contingency analysis the variables "age group" and "main diagnosis" were independently associated with the outcome "new long-stay" and the variables "age groups", "main diagnosis" and "size of municipality of residence" with the outcome "late long-stay".

Adolescent↗
PubMed1987

Who became revolving door patients? Findings from a nation-wide cohort of first time admitted psychiatric patients.

A cohort representing all first-time admissions to Danish psychiatric institutions during the period April 1, 1970 to March 31, 1971 was followed for 10 years in the psychiatric register. The cohort comprised 5,881 males and 6,856 females aged 15 years or above. The revolving door population was delineated as (1) patients with minimum four admissions and no admission or discharge period lasting for more than one fourth of the observation period or (2) patients with minimum four admissions during the first one fourth of the observation period. The incidence rate was 3.14 males and 3.55 females per 1,000. Revolving door patients were younger than others, single or divorced, and lived in larger cities. They were more frequently referred to out-patient aftercare and discharged to their own home. A male diagnostic profile of schizophrenia, demential or organic psychoses, personality disorders and abuse emerged together with a female profile of manic depressive and psychogenic psychosis and neurosis. Twenty-one point nine percent of males and 13.0% of females had more than 10 admissions and 4.5% of males and 3.7% of females spent more than 5 years in hospital. High risk groups were 15-24 years old as 21% and 13% of young males respectively females became revolving door patients, and schizophrenics, as 46% of male and 30% of female schizophrenics became revolving door patients.

Adolescent↗
PubMed1987

The use of a psychiatric register in predicting the outcome "revolving door patient". A nation-wide cohort of first time admitted psychiatric patients.

A nation-wide cohort of all first admitted patients to all Danish psychiatric institutions over a 1 year period and aged 15 years or more was followed for 10 years in the Danish psychiatric register. Revolving door patients were defined as patients with a minimum of four admissions and 1) no admission or discharge period lasting for more than 1/4 of the observation period or 2) at least four admissions over the first 1/4 of the observation period. The revolving door population comprised 1,397 patients with an incidence rate of 0.42 males and 0.32 females per 1,000. Forty-three point five percent belonged to the same diagnostic group at first and last diagnostic assessment ranging from 28.3% in "organic psychosis" to 57.6% in "neurosis". A multiple contingency analysis showed a number of variables at first admission significantly associated with the outcome "revolving door". Many were conditioned by others and the independent variables were "age group", "main diagnosis" and "sex". Patients aged 15-24 years constituted a high risk group among schizophrenics. The 15-24 age group was further at high risk among females with personality disorder or abuse and males with manic depressive and psychogenic psychosis. Living close to a psychiatric institution was in males associated with the outcome independently of age and diagnosis, in females it was restricted to personality disorder. Revolving door patients were significantly younger than others and more likely to suffer from schizophrenia or alcohol/substance abuse.

Adolescent↗
PubMed1987

Integration of DSM-III and ICD-8 to be used in a consultation-liaison psychiatric service. Preliminary experiences.

In 1983 a total of 405 patients received psychiatric supervision in somatic departments in the general hospital. At this supervision, these patients were registered by means of a five-axial diagnostic coding according to the DMS III principle, and this was combined with a quantitative global assessment of the severity of the condition. Reliability testing was undertaken by five supervising physicians with a total of 15 patients. The total number of supervisions constituted one supervision per somatic bed per annum. Women were overrepresented, and medical departments made the greatest use of psychiatric supervision. Reactive conditions dominated parallel with a high relative incidence of alcohol-related conditions. In patients with diagnoses of psychoses, only slight to moderate psychiatric symptoms were encountered. This held true also for personality deviations. 50% of the patients had experienced significant psychosocial stress, but 10% of these were diagnosed as having non-reactive psychoses, 52% of the patients had moderate to pronounced disturbances of social function. Half of the patients supervised in this manner could be investigated or treated in the referring departments. Approximately half of the patients in whom referral to private psychiatric specialists was made did not keep these appointments. Reliability testing in the material shows the employability of the diagnostic armamentarium. All in all, the investigation suggests that extension of the liaison psychiatric service in somatic departments would result in a relative increase in the number of patients who could be treated in the referring department and an increase in the number of psychiatric conditions diagnosed. Establishment of a psychiatric outpatient clinic in the somatic environment appears to be indicated.

Alcoholism↗
PubMed1987

Sex differences in the utilization of mental health services: a nation-wide register study.

A nation-wide investigation of a cohort of first admissions during the period April 1, 1970 to March 31, 1971 to psychiatric institutions was followed in the Danish Psychiatric Register for a 10 year period. The cohort comprised 5,881 males and 6,856 females with an annual incidence rate of 3.14 males and 3.55 females per 1,000. Males were significantly younger than females and more frequently involuntarily admitted. Males predominated among schizophrenics and addictive disorders, females among neurotics and manic-depressive psychotics. Young males required longer hospital stays and more admissions than young females. The opposite was the case among patients over 65 years. Three outcome groups were delineated and the incidence rate calculated to: the "short term" group comprising 1.64 males and 1.90 females per 1,000, the "long-stay" group comprising 0.22 males and 0.27 females per 1,000 and the "revolving door" group comprising 0.42 males and 0.32 females. Multiple contingency analyses showed that only the outcome "revolving door" was independently associated with the sex of the patients with males being a high risk group.

Adolescent↗
PubMed1986

Use of headache rating scales: a multiaxial approach.

The basic principles of the rating scale procedure have been outlined, including the Likert scale, the Guilford criteria for item definitions, and the Guttman and Rasch criteria for item combinations. With these criteria, headache rates among the core symptoms of anxiety and depression. Next, we have discussed one of the prevailing scales for headache, the Waters Headache Questionnaire (WHQ), with a multiaxial approach. The WHQ thus contains a severity axis, a diagnostic axis, and a personality axis. Previous studies on the validity of the WHQ, including factor analysis, have shown that migraine and muscular headaches are not mutually exclusive categories. Studies to validate a two-dimensional diagnostic system of migraine and non-migraine headache by Rasch models are discussed. In the field of personality it was suggested, when using questionnaires like the WHQ, to focus on the concepts of acquiescence and dissimulation. Supplemental axes such as "severity of psychosocial stressors" and "social functioning" or "quality of life" should be considered in future research.

Anxiety↗
PubMed1986

Working conditions of male and female psychiatrists.

The percentage of females among Danish medical graduates has increased from 1% in 1900-10 to 33% in 1980-84. In 1980 women doctors comprised 21% of all Danish medical doctors; the percentage among psychiatrists was 29. The purpose of the study has been to analyse the job-profiles of male and female psychiatrists, and their activities in research, teaching, committees, etc. The job-profiles of males and females differ, females more likely being in less influential positions. Based on an investigation among members of the Danish Psychiatric Association, the working conditions and professional activity of 307 male and female psychiatrists were analysed. Male psychiatrists were found to complete their training at a younger age than females. Among those aged 25-44, 29% of males and 6% of females had reached a position as chief consultant. Males report greater activity in all areas of research, and 35% of females and 17% of males do not research at all. In all age groups and all fields investigated more males take part in organisational activities, while 48% of females and 25% of males report no such activity. No difference was found regarding teaching experience, but men were relatively more often involved in teaching professional groups and women, nursing staff. A significant preponderance of males had their main interest in biological psychiatry, females in psychotherapy.

Adult↗
PubMed1985

Characteristics of a nationwide cohort of psychiatric patients--with special reference to the elderly and the chronically admitted.

The pattern of psychiatric care has changed over the last decades with an extension of outpatient facilities, a decrease in the number of chronically admitted and an increase in the number of shortlasting admissions. A cohort of first time admitted psychiatric patients to Danish institutions in 1970 was followed for 10 years with the purpose to describe the characteristics of the population with multiple admissions. The cohort comprised 12737 patients with 35497 admissions. It was divided into 3 groups, one - 6470 patients - consisting of those with 1 admission, one - 744 - consisting of those continuously admitted to the termination of the study period or their death, and one - 5523 - consisting of those with several admissions. Patients chronically admitted tended to be older, and among them the senile and cerebrovascular disorders were dominating with the non-organic disorders in total comprising less than 10% of the patients. Significantly more females than males were admitted for more than 5 years. Patients with multiple admissions had in total shorter admission periods than the chronically admitted. Males had significantly more admissions than females and 8.2% compared with 3.9% of females had 10 admissions or more.

Adolescent↗