PubMed Health⌕ Search

Biomedical subjects

P Bech

Publications and source records attributed to P Bech.

At least 19 recordsLinked to original sources
PubMed2006

Validity and utility of the Japanese version of the WHO-Five Well-Being Index in the context of detecting suicidal ideation in elderly community residents.

OBJECTIVE: The aim of this study is to evaluate the validity and the utility of the Japanese version of the WHO-Five Well-Being Index (WHO-5-J) in the context of detecting suicidal ideation in elderly community residents. METHODS: A sample of 696 subjects aged 70 years or over who completed a set of questionnaires was examined. RESULTS: Cronbach's alpha was 0.87 and Loevinger's coefficient was 0.64. The total score was significantly correlated with the number of cohabitants, the number of physical illnesses, physical functioning, instrumental activities of daily living, and depressive symptoms. Subjects with suicidal ideation had significantly lower scores on the WHO-5-J. The receiver-operating characteristic curve analysis indicated that the scale significantly discriminated the subjects with suicidal ideation. When combined with the assessment of a lack of perceived social support (PSS), a standard cut-off criterion of "a total score < or = 12 or answering 0 or 1 to any of the five items" more appropriately identified elderly subjects with suicidal ideation: sensitivity = 87%, specificity = 75%, negative predictive value = 99%, and positive predictive value = 10%. CONCLUSIONS: In combination with PSS, the scale has predictive utility to detect suicidal ideation in elderly community residents.

Aged↗
PubMed2006

Effective dose of escitalopram in moderate versus severe DSM-IV major depression.

INTRODUCTION: Data from the three available placebo-controlled trials with fixed doses of escitalopram in the acute therapy of DSM-IV major depressive disorder (MDD) were pooled. The hypothesis tested was that escitalopram 10 mg/d might be an effective dose in moderate MDD, whereas escitalopram 20 mg/d might be needed in severe depression. METHODS: The Montgomery-Asberg Depression Scale with all 10 items was used at baseline to differentiate between moderate (score range 22 to 29) and severe (scores > or = 30) major depression. The MADRS (6) was selected as the primary efficacy parameter, using a standardised effect size of 0.40 as indicator of clinically significant response. RESULTS: After 8 weeks of therapy, escitalopram 10 mg was superior to placebo, with a standardised effect size above 0.40 for patients with moderate depression, but not for those with severe depression. In contrast, 20 mg escitalopram was superior to placebo, with a standardised effect size above 0.40 in severe depression, but not in moderate depression. The MADRS (6) showed response (standardised effect sizes above 0.40) for moderate depression after two weeks of treatment with 10 mg escitalopram and in severely depressed patients after 4 weeks with 20 mg escitalopram. CONCLUSION: Escitalopram 10 mg/d was the optimal dose for the treatment of moderate DSM-IV MDD, while escitalopram 20 mg/d was an effective dose in patients with moderate to severe depression.

Antidepressive Agents, Second-Generation↗
PubMed2006

Olanzapine plasma level in relation to antimanic effect in the acute therapy of manic states.

The aim of this study was to evaluate internal as well as external validity of the two most frequently used mania scales, the Young Mania Rating Scale (YMRS) and the Bech-Rafaelsen Mania Scale (MAS), in patients with DSM-IV mania. Mokken analysis was used to evaluate internal validity in which a coefficient of homogeneity of 0.40 or higher indicates that the total score is a sufficient statistic. The external validity was evaluated by plasma-level relationship of olanzapine. In total, 20 patients with DSM-IV mania were analysed, and the coefficient of homogeneity was acceptable for the MAS, but not for the YMRS. In a subgroup of females who over 2 weeks had received a fixed dose of 20 mg olanzapine daily, a significant association was found between MAS scores and plasma levels, but this association was not obtained with the YMRS. In conclusion, the MAS was found superior to the YMRS in regard to both internal and external validity.

Antimanic Agents↗
PubMed2006

Validity of HoNOS in identifying frequently hospitalized patients with ICD-10 mental disorders.

OBJECTIVE: To identify frequently hospitalized patients by using the outcome and severity measure Health of the Nation Outcome Scales (HoNOS) in combination with the International Classification of Diseases (ICD)-10 in patients consecutively admitted to a psychiatric hospital. METHOD: All full-time in-patients and all day-hospital patients were considered. Frequently hospitalized patients were defined as those with 10 or more hospitalizations. RESULTS: The total HoNOS score at admission was found valid to discriminate between frequently and non-frequently hospitalized patients as well as in ranking the ICD-10 diagnosis by severity of symptoms and social problems. Frequently hospitalized patients were predominantly found within the diagnoses of schizophrenia and bipolar affective disorders. In these groups, high HoNOS scores were significantly associated with a longer stay in hospital. Improvement during hospitalization as measured by the HoNOS was significantly better for bipolar than for schizophrenic patients. CONCLUSION: HoNOS was found to be a clinically relevant supplement to ICD-10 in identifying frequently hospitalized patients.

Adult↗
PubMed2006

Mental distress in the Danish general population.

OBJECTIVE: To present data on mental distress in the Danish general population using recently validated Hopkins symptom checklist (SCL) subscales and compare with data from other countries. To evaluate associations between mental distress and biopsychosocial factors. METHOD: Questionnaires were sent to a gender- and age-stratified random sample comprising 2040 Danes. Mean SCL subscale scores were calculated. Cases were defined in accordance with the traditional criteria, and Danish and US raw score cut-offs were compared. A multiple regression model was developed to describe associations between biopsychosocial factors and SCL scores. RESULTS: The response rate was 58%. The Danish mean scores were significantly higher than reported for a US non-patient sample, and Danish raw score cut-offs for caseness were higher. The Danish scores were closer to Nordic mean scores. Age, gender, social status, somatic disorder and traumatic life events in the past year in work life as well as personal life were significantly associated with the level of mental distress. SCL scores were compared with scores on the Major Depression Inventory. CONCLUSION: The SCL mean scores of the Danish general population were relatively high, but similar to data from the Nordic countries. Consequently, interpretation of the Danish SCL requires Danish norms and Danish cut-off scores for caseness.

Adult↗
PubMed2006

Depression assessed over 1-year survival in patients with myocardial infarction.

OBJECTIVE: To estimate the prevalence of ICD-10 depression using a self-reported questionnaire and to examine if depression is associated with increased 1-year mortality in patients with myocardial infarction (MI). METHOD: In total, 763 MI-patients completed the Major Depression Inventory at discharge. Information from hospital notes was collected and patients were followed 1 year for re-admission and mortality through national registries. RESULTS: Seventy-three patients (9.6%) were depressed at discharge. Depression was not a significant independent predictor of mortality; however, there was a significant trend for increasing mortality with increasing severity of the depressive state (P = 0.028). All mortality among depressed patients was in patients with non-Q-wave infarction. CONCLUSION: Ten per cent of MI-patients fulfilled diagnostic criteria for depression at discharge. There was a significant trend for increasing mortality with increasing severity of the depressive episode. All mortality among depressed patients was seen in patients with non-Q-wave infarction. These findings indicate future studies in selected subgroups of MI-patients.

Aged↗
PubMed2006

Dose response to adjunctive light therapy in citalopram-treated patients with post-stroke depression. A randomised, double-blind pilot study.

BACKGROUND: Post-stroke depression affects the outcome of stroke rehabilitation and is observed in approximately 30% of all stroke patients. We investigated whether the addition of light treatment to medical antidepressants influences the course of depression as measured by the Hamilton Depression Scale. METHODS: The effect of a combination of light therapy and citalopram in stroke victims receiving citalopram was examined by use of two different doses of light therapy under double-blind conditions. Altogether, 63 patients were included in the study. The mean age was 74.9 years. RESULTS: After 4 weeks of therapy, the 6-item subscale of the Hamilton Depression Scale showed a statistically significantly larger improvement in patients receiving high-intensity light treatment compared to those treated with medium-intensity light (p < 0.05). CONCLUSION: This pilot study demonstrates a dose response effect of light used as an adjunct therapy to antidepressants in post-stroke patients with major depression.

Aged↗
PubMed2006

The internalising and externalising dimensions of affective symptoms in depressed (unipolar) and bipolar patients.

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.

Adult↗
PubMed2005

Work-related stressors, depression and quality of life in Danish managers.

BACKGROUND: By use of valid questionnaires to investigate work-related stress and distress in Danish managers. METHODS: The survey focused on members of the Danish Association of Managers and Executives who no longer were active (former managers' group). Acting managers (active managers' group) served as controls. Questionnaires measuring stressors at work and general life events were used. For the measurement of distress, scales for depression and quality of life were used. RESULTS: The Mokken analysis proved the validity of the questionnaires, i.e. their summed-up total scores were sufficient statistics. No differences were found between former (n = 1,256) and active managers (n = 942) as to life events. Approximately 20% of former managers were at risk of depression and 12% had developed major depression. Among the specific work-related stressors were role overload, lack of team spirit and lack of social support. The percentage of active managers at risk of or suffering from major depression did not differ significantly from the Danish general population. Approximately 37% of the former managers had a decreased well-being. Alcohol use was found to be significantly associated with depression. CONCLUSION: The study identified specific work-related stressors in managers, 12% of whom developed a major depression.

Adaptation, Psychological↗
PubMed2005

Switching patients from olanzapine or risperidone to a combination treatment using perphenazine plus buspirone: evaluation of antipsychotic efficacy and side-effects, including extrapyramidal effects and weight loss.

In this pilot study, we have investigated the effects of switching from olanzapine or risperidone treatment to low-dose perphenazine combined with buspirone in six schizophrenic patients who had experienced weight gain. We found no relapse as to psychotic symptoms measured by the CGI-S scale and no exacerbation of extrapyramidal side-effects as measured by the Simpson-Angus Scale. In addition, we observed a medium weight reduction of 10.5 kg (range 1-20 kg).

Adult↗
PubMed2005

Psychosocial predictors of depression in patients with acute coronary syndrome.

OBJECTIVE: To describe the prevalence of depression according to ICD-10 criteria using a self-completed questionnaire and to identify psychosocial predictors of depression at discharge in patients with acute coronary syndrome. METHOD: A total of 899 patients with acute coronary syndrome completed the Major Depression Inventory at discharge and a questionnaire regarding previous depression and family history of depression. Information concerning civil status was obtained from the Civil Person Registry. RESULTS: Ninety patients (10%) were depressed according to ICD-10 criteria at discharge with 7.2% having a moderate to severe depression at discharge. Women were significantly more frequently and severely depressed than men. Patients with and without depression reported primarily somatic symptoms of depression. Cardiovascular risk factors or treatment did not differ between patients with and without depression. Previous depression (OR 2.9, 95% CI 1.4-6.0 adjusted) and female gender (OR 2.5, 95% CI 1.5-4.3 adjusted) predicted depression at discharge in a logistic regression model. CONCLUSION: Somatic symptoms of depression are prevalent in patients with acute coronary syndrome. The use of self-completed non-diagnostic questionnaires assessing symptoms of depression therefore is cautioned as patients may wrongly be identified as depressed. In patients with acute coronary syndrome depression is predicted by well-known psychosocial risk factors.

Acute Disease↗
PubMed2005

Validation of the Bech-Rafaelsen Melancholia Scale and the Hamilton Depression Scale in patients with major depression; is the total score a valid measure of illness severity?

OBJECTIVE: Evaluation of antidepressant drug efficacy requires adequate rating scales for measuring the severity of depression. However, to measure the illness severity by such a total score, the scale needs to fulfil criteria of unidimensionality. On this background, we aimed at comparing the unidimensionality of the Bech-Rafaelsen Melancholia Scale (MES) and the 17-item Hamilton Depression Rating Scale (HAM-D(17)). METHOD: A total of 1629 patients aged between 18 and 65 years with a major depressive episode were treated openly with sertraline at a fixed oral dose of 50 mg daily during 4 weeks. The HAM-D(17) and the MES were applied at baseline and at weeks 2 and 4. Unidimensionality was tested with Mokken and Rasch analysis. RESULTS: Unidimensionality of the HAM-D(17) could not be confirmed. However, the 6-item Hamilton Depression Subscale (HAM-D(6)), was accepted by the Rasch analysis both at baseline and after 2 and 4 weeks of therapy. For the MES (as well as for the HAM-D(6)), a Loevinger coefficient of homogeneity above 0.40 (suggesting acceptance) was found at week 4. CONCLUSION: The HAM-D(6) and the MES did fulfil criteria for unidimensionality while the HAM-D(17) did not. Therefore, the extended use of the HAM-D(17) in drug trials may be questioned.

Adolescent↗
PubMed2005

Adjunctive bright light in non-seasonal major depression: results from patient-reported symptom and well-being scales.

OBJECTIVE: In this study, we tested the efficacy of bright light therapy as an adjunct to antidepressant treatment (sertraline) in patients with non-seasonal major depression. METHOD: In a randomized double-blind controlled trial, 102 patients were treated for 5 weeks with either white bright light (10.000 lx, 1 h/day) or red dim light (50 lx, 30 min/day). All patients received sertraline in a dosage of 50 mg daily. The self-assessment scales used were the Major Depression Inventory (MDI), the Psychological General Well-Being Scale (PGWB) and the Symptom Check List (SCL-90R). RESULTS: On all three questionnaires the score differences between baseline and endpoint were greatest in the bright light group. On the SCL-90R, the difference reached statistical significance. Results and effect sizes are compared with results from Danish national population studies applying PGWB and SCL-90R. CONCLUSION: The results advocate the use of bright light as an adjunct treatment of non-seasonal depression.

Age of Onset↗
PubMed2005

Adjunctive bright light in non-seasonal major depression: results from clinician-rated depression scales.

OBJECTIVE: To investigate the use of bright light therapy as an adjunct treatment to sertraline in non-seasonal major depression. METHOD: In a randomised double-blind trial, 102 patients were treated for 5 weeks with either white bright light (10 000 lux, 1 h daily) or red dim light (50 lux, 30 min daily). All patients were treated with sertraline in a fixed dose of 50 mg daily. The clinician-rated depression scales used were the Hamilton Depression Rating Scale (HAM-D17), Hamilton six-item subscale (HAM-D6), Melancholia Scale (MES) and the seven 'atypical' items from the SIGH-SAD. RESULTS: One-hundred and two patients were included in the study. Analyses showed that the reduction in depression scores in the bright light group was statistically significantly larger than in the dim light group on all scales. The scale most sensitive at endpoint was the HAM-D(6), which includes the core symptoms of depression. CONCLUSION: The study results support the use of bright light as an adjunct treatment to antidepressants in non-seasonal depression.

Adult↗
PubMed2005

Modafinil augmentation in depressed patients with partial response to antidepressants: a pilot study on self-reported symptoms covered by the Major Depression Inventory (MDI) and the Symptom Checklist (SCL-92).

Treatment-resistant depression, i.e. partial or non response to antidepressants in spite of various treatment attempts with optimized doses and combinations, is rather common. With residual symptoms such as tiredness, anhedonia and concentration disturbances, the treatment strategy has often been to use monoamino-oxidase inhibitors (MAOIs). Their use, however, is limited due to interaction problems. Modafinil is recently developed wake-promoting drug with only minor side-effects. Pilot studies indicate that it appears to have an augmentation effect in treatment-resistant depression. This open-label study performed in the private psychiatric practice setting is the first to make a comprehensive evaluation of the target patient profile based on patient-reported symptoms. Modafinil in doses of 100-400 mg was administered as augmentation to ongoing antidepressant therapy in patients with partial response and suffering from hypersomnia. The total number of patients was 21 and 43% of these were responders (i.e. had a score reduction of >50% on the Major Depression Inventory (MDI) as well as remitters, i.e. the remission rate was 43%. At endpoint, the responders had psychological distress scores on the Symptom Checklist (SCL-92) on the level of the general Danish population. Baseline characteristics for responders were lower scores on depression, hostility, anxiety, somatization, obsession and psychoticism. Modafinil thus appears to be an appropriate augmentation to antidepressant treatment, leading to a remission rate of 43%. However, the results from this open-label study need ot be confirmed in a placebo-controlled trial.

Antidepressive Agents↗
PubMed2004

Quality of life in the Danish general population--normative data and validity of WHOQOL-BREF using Rasch and item response theory models.

BACKGROUND: The main objective of this study was to investigate the construct validity of the WHOQOL-BREF by use of Rasch and Item Response Theory models and to examine the stability of the model across high/low scoring individuals, gender, education, and depressive illness. Furthermore, the objective of the study was to estimate the reference data for the quality of life questionnaire WHOQOL-BREF in the general Danish population and in subgroups defined by age, gender, and education. METHODS: Mail-out-mail-back questionnaires were sent to a randomly selected sample of the Danish general population. The response rate was 68.5%, and the sample reported here contained 1101 respondents: 578 women and 519 men (four respondents did not indicate their genders). RESULTS: Each of the four domains of the WHOQOL-BREF scale fitted a two-parameter IRT model, but did not fit the Rasch model. Due to multidimensionality, the total score of 26 items fitted neither model. Regression analysis was carried out, showing a level of explained variance of between 10 and 14%. The mean scores of the WHOQOL-BREF are reported as normative data for the general Danish population. CONCLUSION: The profile of the four WHOQOL-BREF domains is a more adequate expression of quality of life than the total score of all 26 items. Although none of the subscales are statistically sufficient measures of their domains, the profile scores seem to be adequate approximations to the optimal score.

Adult↗