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Biomedical subjects

P Munk-Jørgensen

Publications and source records attributed to P Munk-Jørgensen.

At least 19 recordsLinked to original sources
PubMed2001

Determinants for the use of psychotropics among nursing home residents.

PURPOSE: To characterise the prescription pattern of psychotropics in Danish nursing homes and to identify diagnostic, behavioural, cognitive and performance characteristics associated with prevalent psychotropic drug use. METHODS: Prescribed daily medication was recorded from nurses' files. Based on the Anatomical Therapeutical Chemical (ATC) classification index, psychotropics were categorised into neuroleptics, benzodiazepines and antidepressants. Two hundred and eighty-eight residents were diagnosed using the GMS-AGECAT. One hundred and eighteen staff members were interviewed about the residents's Activities of Daily Living (ADL), behavioural problems (Nursing Home Behavior Problem Scale), orientation, communication skills and if the resident had any psychiatric disorder. Multiple logistic regression was used to select the items that determined the use of psychotropics. RESULTS: Fifty-six percent of the residents received a psychotropic, 21% received neuroleptics, 38% received benzodiazepines and 24% received antidepressants. In the multivariate analysis, staff assessment of the resident's mental health was a determinant for the use of all types of specific psychotropics, whereas a GMS-AGECAT diagnosis only determined the use of neuroleptics. Behavioural problems were a determinant for the use of neuroleptics and the use of benzodiazepines irrespective of the psychiatric diagnosis of the resident. Use of antidepressants was associated with male gender and increasing age. CONCLUSIONS: Staff perceptions of psychiatric morbidity and norms have a greater impact on the prescription of psychotropics than standardised clinical criteria.

Activities of Daily Living↗
PubMed2001

Assessment of dementia in nursing home residents by nurses and assistants: criteria validity and determinants.

OBJECTIVES: To describe the criterion validity of nursing home staff's assessment of organic disorder compared with ICD-10 criteria, and to identify determinants of staff assessment of organic disorder. METHOD: Two hundred and eighty-eight residents were diagnosed using the GMS-AGECAT. Nursing staff members were interviewed about the residents' activities of Daily Living, behavioural problems, orientation in surroundings and communication skills, and asked if the resident had an organic disorder. Multiple logistic regression was used to select the items that most strongly determined staff assessment of organic disorder. RESULTS: Sixty-two per cent of the residents were diagnosed by GMS-AGECAT as having organic disorder, 78% of these were correctly identified by the staff. Whether analysed among residents with or without organic disorder, or in the total group of residents, the staff assessment of the presence of organic disorder depended on a limited set of behavioural characteristics of the resident, namely 'going to the toilet in inappropriate places', 'saying things that do not make sense' and impairment in orientation. CONCLUSIONS: Staff comprehension of organic disorder resulted in over- as well as under-labelling of residents, a tendency that will affect communication with medical personnel and may lead to inadequate or wrong medical treatment and to negative performance as well as negative role expectations in everyday life in nursing homes.

Aged↗
PubMed2001

Mental disorders among internal medical inpatients: prevalence, detection, and treatment status.

OBJECTIVE: To determine the prevalence of ICD-10 mental disorders among internal medical inpatients, the relation between mental disorder, age, and gender, and the recognition and referral of the disordered patients. METHOD: 294 consecutive medical inpatients were examined with a two-phase design using the SCAN (Schedules for Clinical Assessment in Neuropsychiatry) for ICD-10 psychiatric diagnoses. Information from questionnaires and interviews with patients, doctors, nurses, and from medical records. RESULTS: The prevalence of current mental disorders was 38.7%, being heavily increased in young patients. Main diagnoses were somatoform disorders (17.6%), phobias (12.9%), substance use disorders (10.9%), and depression (8.3%). Psychiatric consultations were very few. About 38-56% of the cases were recognized by medical doctors and nurses, and only about 20% were in mental health treatment. CONCLUSION: The prevalence of mental disorders among internal medical inpatients is high and increased in young patients and women. Detection and referral are low, and few are treated.

Adult↗
PubMed2001

Anorexia nervosa and cancer risk.

OBJECTIVE: Energy restriction reduces the incidence of malignant tumors in experimental animals, but evidence for a similar effect in humans is lacking. To test the hypothesis in humans, we investigated cancer incidence among patients with anorexia nervosa, who have had an extremely low intake of calories for prolonged periods of their lives. METHODS: Patients with anorexia nervosa (2151 women and 186 men) during 1970-1993 were identified in the population-based Danish Psychiatric Case Register and the National Registry of Patients. The cohort was linked to the Danish Cancer Registry, and cancer incidence among cohort members was compared with that of the general population. RESULTS: The overall cancer incidence among women with anorexia nervosa was reduced by a factor of 0.80 (95% confidence interval 0.52-1.18) below that of the general population on the basis of 25 observed and 31.4 expected cases. Among men, two cases of cancer were observed, both confined to the brain, whereas 0.2 cases were expected. CONCLUSIONS: The finding of a slight reduction in cancer risk among women with anorexia nervosa may support the theory that a low-energy diet may decrease tumor development in humans. However, longer follow-up and control for confounding factors are needed to obtain more convincing evidence.

Adolescent↗
PubMed2001

Empirical weighting of the Standardized Mini Mental State Examination items among nursing home residents.

Missing items in the Mini Mental State examination are dealt with in different ways. The main aims of this study were to calculate a weighted item score for organic disorder on the basis of the item score of the Standardized Mini Mental State Examination (SMMSE) test regardless of the completeness of the test and to compare the criterion validity of the weighted scores with the ordinal scores for the SMMSE test. With a participation of 91%, the study included 100 nursing residents. All residents were tested with the SMMSE test and concurrently diagnosed in accordance with the ICD-10 by a consultant psychiatrist. The two assessments were mutually blinded. Multiple conditional forward logistic regression was used to select the items that most strongly predicted organic disorder as assessed by the psychiatrist. The weighted score had significantly better validity parameters, performed better on a receiver operating curve (ROC), and was better at dichotomizing the population into organic disorder than the commonly used ordinal score. We propose that missing items in the SMMSE should be scored as missing and included in empirical weighting on SMMSE items, which will then be substantially more valid than the SMMSE score itself.

Aged↗
PubMed2001

Epidemiology in neurobiological research: exemplified by the influenza-schizophrenia theory.

BACKGROUND: During recent years the strategy for aetiological research in schizophrenia has been to concentrate on two closely connected directions: the search for the genetic element and the search for environmental factors. Damage to the immature brain during pregnancy and delivery has given us the most interesting results from recent environmental research. AIMS: To examine the validity of the influenza-schizophrenia hypothesis. METHOD: A review of register-based epidemiological studies in Denmark conducted over a 10-year period. RESULTS: The studies reviewed provided strong inferential evidence in favour of the hypothesis, but some methodological problems are unresolved and not all replication studies have been positive. CONCLUSIONS: The brain-damage hypothesis points to possibilities for identifying high-risk individuals at an early stage of life and perhaps establishing specific preventive programmes. There is, however, a great need for closer international collaboration in future research.

Brain Diseases↗
PubMed2000

[Prevalence of depressive disorders among frail elderly, assessed by psychogeriatricians, general practitioners and geriatricians].

UNLABELLED: The prevalence of depressive disorders (D) in 70 years of age or older frail elderly was studied. Two hundred and eleven (81%) recipients of Municipal Home Help Service (frail elderly) in a rural area of Jutland were included and screened by the Geriatric Depression Scale-15 (GDS). If participants had: a) a GDS-score > or = 5 points or/and b) a history of depression, further evaluation was given by: 1) general practitioners (GPs) (implicit criteria), 2) a psycho-geriatrician (ICD-10 criteria), and 3) a geriatrician with the Hamilton Test for Depression. Prevalence rates for D among the evaluators: 15-18%. The diagnostic agreement was only fair. IN CONCLUSION: 18% of the studied population fulfilled the ICD-10 research criteria for depression. The GDS may help GPs in diagnosing depression among frail elderly. False GDS negatives, found among GDS negatives with a history of depression, should be evaluated thoroughly when identifying depression in the target group.

Aged↗
PubMed2000

[Nursing home residents in Northern Jutland].

The purpose of the study was to describe a Danish nursing home population. The study consists of 288 nursing home residents (median age 84.6 years, 68% females). The psychiatric morbidity of the residents was diagnosed with the GMS-AGECAT. The staff was interviewed about the residents' ADL, disturbing behaviour and therapeutic measures. Seventy-one percent had a psychiatric disorder, with organic disorder as the most frequent (61%). Demented residents received significantly less hypnotics, were more often physically restrained and had lower ADL levels compared to other residents. The situation in Denmark can be seen as a paradox. While substantial effort has been made to increase the possibility of choice and to "deinstitutionalize" nursing homes, the majority of the residents are demented and thus not capable of making valid choices.

Activities of Daily Living↗
PubMed2000

[Readmissions for schizophrenia in Denmark 1979-1998].

The aim of the present study was to produce a nation-wide quantitative description of re-admissions for schizophrenia in Denmark in the period 1979-1998. The study is based on anonymous data from the Psychiatric Central Register. All persons with a main diagnosis of schizophrenia are included. The number of re-admissions of schizophrenics has constantly increased since 1979 (approx. 65%), and the number of persons who account for these re-admissions has increased by approximately 55%. Patients who for the first time are diagnosed with schizophrenia have in the first year after the first admission an average risk of re-admission of 50%, a risk that has not decreased during the 20 years studied. The median age of re-admitted patients has increased by five years for males and is almost unchanged for females indicating a continuous need for re-admission of schizophrenic patients, also the older patients. Danish psychiatry has each year contact with approximately 50% of the persons who at least once have been diagnosed with schizophrenia since 1969 and who are still alive. Certain precautions must be taken in the interpretations of general aggregated statistics such as these.

Adult↗
PubMed2000

Psychoactive substance use diagnoses among psychiatric in-patients.

OBJECTIVE: To estimate the prevalence and possible under-diagnosing of substance use disorders and to consider factors that might influence diagnosing of substance use disorders. METHOD: Data collected from case records and PSE interviews of psychiatric in-patients from 12 psychiatric departments in Denmark admitted during October 1996 were compared with data from the Danish Psychiatric Register. RESULTS: A substantially lower prevalence of substance use diagnoses were found in the register (26.1%) than in the research data (50.0%). A high prevalence of co-occurrence between substance use disorders and mental disorders other than substance use disorders was found (37.3%). In the majority of cases knowledge of the substance use disorders was present in the case records, although they had not resulted in a diagnosis. CONCLUSION: The under-diagnosis of substance use disorders is due not only to concealed diagnostic signs and symptoms but also to an under-diagnosis by the psychiatrists, in spite of the fact that information on the substance use was accessible.

Adult↗
PubMed2000

Regional differences in schizophrenia incidence in Denmark.

OBJECTIVE: To examine the regional distribution of schizophrenia incidence in Denmark. METHOD: A cohort consisting of 2441 Danish psychiatric patients, with first-time admissions between January 1, 1978 and December 31, 1982, and diagnosed as having schizophrenia (ICD-8) at least once in a 10-year period of observation was divided into three regional groups by degree of urbanization. RESULTS: Incidence increased for both sexes with increasing urbanization. A diagnostic delay was most pronounced in the least urbanized areas and was most pronounced for women. CONCLUSION: Our study confirms the existence of regional differences in schizophrenia incidence on a national basis. Marked regional differences in diagnostic delay were also demonstrated. A possible explanation could be regional differences in diagnostic procedures, underlining the importance of uniform diagnostic patterns as a means for reliable mapping of psychiatric morbidity and, hopefully, adequate treatment.

Adult↗
PubMed2000

From psychiatric hospital to rehabilitation: the Nordic experience.

Deinstitutionalization and decentralization in psychiatry have by now been the first items of the agenda for more than 30 years. A theory of social psychiatry with social rehabilitation and reintegration was the underlying basis for the activities which should make the change from mainly inpatients to community-based outpatients treatment possible. By means of the National Danish Psychiatric Case Register this paper shows how the process mostly has concentrated on the deinstitutionalization (or reinstitutionalization?) of the old long-stay psychiatric patients. A new but smaller group of long-stay patients has appeared in the statistics. The average age of this group is 40 years compared to the old long-stay patients' average age of 60 years. It is also shown that the readmission rate during the first year after the discharge following the hospitalization during which the schizophrenia diagnosis was given for the first time ever is almost unchanged (with a small increase) for both males and females. So, in Denmark it is on average between 45% and 50% for females and males respectively. A break down on these data on counties shows that the situation varies broadly from a little over 30% for the best (mainly rural counties) to a maximum of 54%. It seems as if social psychiatry in the Nordic countries mainly concentrate on social care and only to a less degree on network, employment and other basic rehabilitation and reintegrative social work. A basis for a successful social integrative work must be a treatment initiated as early as possible with an antipsychotic treatment and maximum of compliance.

Adult↗
PubMed1999

Has deinstitutionalization gone too far?

Modern social psychiatry is aiming at integration of the mentally disordered in the community instead of institutionalization--with or without institutions. No doubt, the majority of mentally disordered patients have benefitted greatly from deinstitutionalized psychiatry. Unfortunately, in the implementation of deinstitutionalized psychiatry, there has widely been a gap between the closure of the mental hospitals and the building up of the decentralized services. Instead of organizing decentralized services and then gradually reducing the capacity of hospital treatment, things happened in many places the other way around. With data from the nationwide Danish Psychiatric Case Register, the author documents a series of negative indicators that have appeared parallel with the deinstitutionalization process. * 100% increase in standard mortality rate of suicides for non-organic psychotic patients * an exponential increase of 6.7% annually in number of criminal mentally disordered * increase in coercive activities in the wards several hundred per cent for some of the measures * increase in bed occupancy rate from approximately 80% to 100% * Acute admission rates between 85% and 90% * No signs of reduction in 1 year readmission rate of first time diagnosed schizophrenics from the very stable 45%-50% which has been seen for almost 20 years. Beyond any doubt, social psychiatric rehabilitation is needed. An increase in the capacity in the psychiatric services and fitting of the treatment models to the patients' needs so that the negative aspects we have seen can be properly handled must be on top of the agenda in the next few years.

Acute Disease↗
PubMed1999

Screening for somatization and hypochondriasis in primary care and neurological in-patients: a seven-item scale for hypochondriasis and somatization.

The aim of this study was to investigate the internal and external validity of the Whiteley Index as a screening instrument for somatization illness. A 14-item version of the Whiteley Index for hypochondriacal traits was given to 99 of 191 consecutive primary care patients, aged 18-65 years, and to 100 consecutive patients, aged 18-60 years, admitted for the first time to a neurological ward. The primary care sample was, in addition, interviewed by means of the SCAN (Schedules for Clinical Assessment in Neuropsychiatry) psychiatric interview. The GPs and the neurologists were asked to rate various characteristics of the patients that might indicate somatization. The internal validity of the Whiteley Index was tested by means of latent structure analysis. On this basis, a reduced seven-item scale (Whiteley-7 scale) and two subscales (i.e., an Illness Conviction and Illness Worrying scale, each with three items) were constructed. All three had a high internal validity fitting into the very restricted Rasch statistical model (p>0.05) and an acceptable transferability between most of the subpopulations investigated. In the primary care population, the Whiteley-7 and the Illness Conviction scales at cut-point 0/1 showed 1.00 and 0.87 sensitivity and 0.65 and 0.87 specificity, respectively, using as "gold standard" the fulfillment of criteria for at least one ICD-10 somatoform disorder, and 0.71 and 0.63 sensitivity and 0.62 and 0.87 specificity, respectively, as gold standard for the fulfillment of criteria for at least one DSM-IV somatoform disorder, excluding the NOS diagnostic group. The Illness Worrying subscale showed less impressive performance in this respect. The agreement between the Whiteley-7 scale including the two subscales and neurologists' rating and the GPs' rating and the somatization subscale on the SCL-90 was modest or worse. It may be concluded that the Whiteley-7 scale and the Illness Conviction subscale had acceptable psychometric profiles, and both seem to be promising screening tools for not only hypochondriasis but also for somatoform disorders in general.

Adolescent↗
PubMed1999

Affective disorders among Greenlandic psychiatric patients.

OBJECTIVE: The aim of this study was to determine the treatment incidence, diagnostic stability and clinical and social outcome of affective disorders in the Greenlandic population. METHODS: A cohort of Greenlanders first hospitalized in 1980-1983 and diagnosed with an affective disorder at least once during the period 7 to 12 years after first admission formed the study population. The manic-depressive patients who were still alive at follow-up were invited for a Present State Examination, and information about clinical and social condition was obtained for the total cohort. RESULTS: The rates of manic-depressive psychoses diagnosed at first admission or later were 6.6 for men and 20.4 for women per 100,000 individuals of over 15 years of age. The unipolar:bipolar ratio was very low, namely 1:3 for men and 1:2 for women. Outcome was relatively poor. CONCLUSION: Manic-depression is a recognizable diagnostic category in Greenland. Extremely low rates of unipolar disorders in both sexes and high rates of bipolar disorders among women were the most marked findings.

Adolescent↗
PubMed1999

Mental disorders in the Greenlandic population. A register study.

In a register study of all psychiatric first hospitalizations (1974-93) of persons born and resident in Greenland rates for all admissions as well as for the separate diagnostic groups, hierarchically organized, were compared with corresponding figures for the population in Denmark. Relative mortality rates for the psychiatric patients compared with the general population were computed for the Greenlandic and Danish populations respectively. No significant differences in the total pattern of hospitalization was found, but Greenlandic men 15-24 years old and Greenlandic women 25-34 years old had significantly higher and older age groups lower first admission rates than Danish men and women, respectively. The rates for affective psychoses were low especially among men in Greenland, whereas the rates for schizophrenia among men were comparatively high. The relative mortality risk compared to the general population was much higher among Danish than Greenlandic psychiatric patients, especially regarding suicide. A probable explanation for that is that the suicide rate in the Green-landic general population is very high.

Adolescent↗
PubMed1998

[Validation of data on commitments to mental hospitals. How many persons were committed annually?].

The purpose was to validate data on commitments from the Danish Psychiatric Case Register and police statistics. From 1 January 1996 to 31 December 1996, 25.8% (437 commitments) of all commitments in Denmark were investigated. In 347 (79.4%) cases the commitment was recorded as such both in the register and police statistics. Thirty (6.9%) commitments could not be found in the register. Sixty (13.7%) admissions were recorded as involuntary by the police but as voluntary in the register. Medical records were available in 53 of these 60 cases and showed that in 46 cases the police record was correct, i.e. the patient had been committed, and in seven cases the register was correct, i.e. the patient had been admitted voluntarily. This difference in correct registration was statistically significant (p < 0.02). The study concludes that police statistics seem more correct than the Psychiatric Case Register. This is mainly due to insufficient reporting by the psychiatric departments to te register. For register data to be used in administration, planning and research, this must be improved.

Commitment of Persons with Psychiatric Disorders↗