Self-reported mental health difficulties were of limited use when screening for psychiatric diagnoses in adults born small for gestational age at term.

AIM: Being born small for gestational age (SGA) at term increases the risk of adverse health outcomes. We examined whether self-reported mental health differed between adults born SGA and non-SGA at term and could be used to screen for psychiatric diagnoses. METHODS: We used the Strengths and Difficulties Questionnaire to gather data from 68 participants born SGA and 88 non-SGA controls at a mean age of 26.5 years. Group differences were analysed by linear regression. We calculated the area under the curve and the sensitivity, specificity and predictive values for psychiatric diagnoses. RESULTS: The mean total difficulties score was 1.9 (95% confidence interval 0.4-3.5) points higher for participants born SGA. They also reported more internalising and emotional problems (p < 0.05). The areas under the curve were 0.82 and 0.68 in the SGA and control groups, respectively. Among participants born SGA, the 90th percentile cut-off had a sensitivity of 0.38, a specificity of 0.93 and positive and negative predictive values of 0.75 and 0.71. The 80th percentile cut-off had higher sensitivity and lower specificity. CONCLUSION: Adults born SGA reported more mental health difficulties than non-SGA controls. The low sensitivity using the 90th percentile cut-off suggests that a lower cut-off should be considered.

Exploring levels of TSH and FT4 in patients with chronic fatigue syndrome (CFS), fibromyalgia (FM) and healthy controls did not reveal any associations between fatigue score and level of thyroid hormones.

AIM: The diagnoses of Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM) are highly associated with fatigue and pain, respectively. Physiologically and clinically an effect of thyroid status on fatigue and pain is expected. There may be clinically relevant differences in thyroid hormone axes though within values of reference in both patients with normal thyroid hormones, or in patients with well-regulated thyroid disease. These potential differences are explored in this study. MATERIALS AND METHODS: In the present study, female patients with CFS (n = 49) and FM (n = 58) as well as female healthy controls (n = 53) were included. We explored plasma levels of TSH and FT4 between the groups using Kruskall-Wallis, and the relation between fatigue score and levels of TSH and FT4 by means of Spearman's rho. RESULTS: There were no group differences between CFS patients, FM patients, and healthy controls in levels of TSH and FT4. CONCLUSION: As one might clinically and physiologically expect an association between thyroid function and fatigue, which may be associated with clinical disorders such as CFS and FM, we suggest future studies to examine the field further by exploring the influence of thyroid receptors and responses of the thyroid hormone cascade.

Antidepressive Effectiveness of Amisulpride, Aripiprazole, and Olanzapine in Patients With Schizophrenia Spectrum Disorders: A Secondary Outcome Analysis of a Pragmatic, Randomized Trial (BeSt InTro).

BACKGROUND: Depressive symptoms are frequent in schizophrenia and associated with a poorer outcome. Currently, the optimal treatment for depressive symptoms in schizophrenia remains undetermined. Amisulpride, aripiprazole, and olanzapine all have antidepressive pharmacodynamic properties, ranging from serotonergic affinities to limbic dopaminergic selectivity. Consequently, in a 12-month pragmatic, randomized clinical trial, we aimed to investigate differences in antidepressive effectiveness among amisulpride, aripiprazole, and olanzapine as a secondary outcome, measured by change in the Calgary Depression Scale for Schizophrenia sum score in patients within the schizophrenia spectrum. METHODS: Psychotic patients within the schizophrenia spectrum were included, and effectiveness was analyzed with latent growth curve modeling. RESULTS: Of the 144 patients, 51 (35%) were women, the mean age was 31.7 (SD 12.7), and 39% were antipsychotic naive. At inclusion, 68 (47%) participants had a Calgary Depression Scale for Schizophrenia sum score >6, indicating severe depressive symptoms. Across the 12-month follow-up, there was a depressive symptom reduction in all medication groups, but no statistically significant differences between the study drugs. Separate analyses of the subcohort with elevated depressive symptoms at inclusion also failed to find differences in depressive symptom reduction between study drugs. The reduction in depressive symptoms mainly occurred within 6 weeks after randomization. CONCLUSIONS: There was a reduction in depressive symptoms under treatment with amisulpride, aripiprazole, and olanzapine in acutely psychotic patients with schizophrenia spectrum disorder, but no differences between the drugs.

Are symptoms assessed differently for schizophrenia and other psychoses in legal insanity evaluations of violent crimes?

BACKGROUND: Forensic evaluations of legal insanity include the experts' assessment of symptoms present at the mental state examination (MSE) and the mental state at the time of offense (MSO). Delusions and hallucinations are most important. We explored how often symptoms were recorded in written forensic reports. DESIGN: This exploratory, cross-sectional study included 500 reports of legal insanity written in 2009-2018 from cases of violent crimes in Norway. The first author read all reports and coded symptoms recorded from the experts' assessments of the offenders. Two co-authors repeated this procedure for 50 randomly selected reports. Interrater reliability was calculated with Gwet's AC1. Generalized Linear Mixed Models with Wald tests for fixed effects and Risk Ratios as effect sizes were used for the statistical analyses. RESULTS: Legal insanity was the main conclusion in 23.6% of the reports; 71.2% of these were diagnosed with schizophrenia while 22.9% had other psychotic disorders. Experts recorded few symptoms from MSO, but more from MSE, although MSO is important for insanity. We found a significant association between delusions and hallucinations recorded present in the MSO and legal insanity for defendants with other psychotic disorders, but no association for defendants with schizophrenia. The differences in symptom recordings between diagnoses were significant. CONCLUSION: Few symptoms were recorded from the MSO. We found no association between presence of delusions or hallucinations and legal insanity for defendants with schizophrenia. This may indicate that a schizophrenia diagnosis is more important to the forensic conclusion than the symptoms recorded in the MSO.

Use of assessment instruments in forensic evaluations of criminal responsibility in Norway.

OBJECTIVES: Assessment instruments are often used to enhance quality and objectivity in therapeutic and legal settings. We aimed to explore the use of instruments in Norwegian reports of forensic evaluations of criminal responsibility; specifically, whether this use was associated with diagnostic and forensic conclusions. METHODS: Our study has an exploratory cross-sectional design. We examined 500 reports filed with the Norwegian Board of Forensic Medicine in 2009-2018 regarding defendants indicted for the most serious violent crimes. The first author coded data from all reports according to a registration form developed for this study. Two co-authors then coded a random sample of 50 reports, and inter-rater reliability measures were calculated. The first author coded 41 reports for calculation of intra-rater reliability. Descriptive statistics are presented for the use of assessment instruments, and a generalized linear mixed model (GLMM) was used to estimate associations between the use of instruments and diagnostic and forensic conclusions. RESULTS: Instruments were used in 50.0% of reports. The Wechler's Adult Intelligence Scale (WAIS), Historical Clinical Risk-20 (HCR-20), and the Structured Clinical Interview for DSM disorders (SCID I), were used in 15.8, 13.8, and 9.0% of reports, respectively. The use of instruments increased from 36% in 2009 to 58% in 2015; then decreased to 49% in 2018. Teams of two experts wrote 98.0% of reports, and 43.4% of these teams comprised two psychiatrists. In 20.0% of reports, the diagnostic conclusion was schizophrenia, and in 8.8% it was other psychotic disorders. A conclusion of criminal irresponsibility was given in 25.8% of reports. Instruments were more often used in reports written by teams that comprised both a psychiatrist and a psychologist, compared to reports by two psychiatrists. The use of instruments was strongly associated with both diagnostic and forensic conclusions. CONCLUSION: Instruments were used in 50% of reports on forensic evaluations of criminal responsibility in Norway, and their use increased during the study period. Use of instruments was associated with diagnostic and forensic conclusions.

Association between brain-derived neurotropic factor (BDNF), high-sensitivity C-reactive protein (hs-CRP) and psychiatric symptoms in medicated and unmedicated patients.

BACKGROUND: There is evidence that brain-derived neurotropic factor (BDNF) plays a protective role in the brain. Peripheral levels of BDNF correlate with its concentration in the brain. Previous studies have revealed lower serum BDNF levels in patients with mental illnesses. In most studies serum BDNF correlates negatively with psychiatric disorders and disease severity. Most studies in this field are on psychiatric diagnosis and personality traits. The aim of our study is to explore associations between general psychiatric symptoms, independent of diagnostic groups, and serum BDNF as well as the inflammatory biomarker high-sensitive CRP (hs-CRP). Comparison between the group regularly using psychotropic medication and those not using psychotropic medication is conducted. METHODS: The study is a cross sectional study with 132 participants from a general open inpatient psychiatric ward at the Nordland Hospital Trust, Bodoe, Norway. Participants were assessed on serum levels of BDNF and hs-CRP. Psychiatric symptoms were assessed by a self-rating scale (Symptom check list, SCL-90- R). Multiple linear regression model was used for statistical analyses of associations between levels of BDNF, hs-CRP and symptoms. RESULTS: We found a positive association (p < 0.05), for most SCL-90 symptom clusters with BDNF in the psychotropic medication-free group. No associations were found in the group of patients using psychotropic medication, except one, the paranoid ideation cluster (p 0.022). No associations were found between hs-CRP and symptom clusters. CONCLUSION: We found no relation between symptom clusters and the inflammatory biomarker hs-CRP. Serum BDNF levels were positively associated with intensity of psychiatric symptoms in the group of patients not using psychotropic medication. Our findings are in conflict with several previous studies reporting increased hs-CRP as well as decreased rather than increased BDNF in mental suffering. Patients on psychotropic medication may not require the same upregulation because the medication is modulating the underlying biological pathology.

Differential Effectiveness of Atypical Antipsychotics on Hallucinations: A Pragmatic Randomized Controlled Trial.

BACKGROUND: Most studies investigating antipsychotic effectiveness report either total psychopathology or symptom cluster findings. Studies focusing on a separate symptom, such as hallucinations, a hallmark symptom in schizophrenia, are scarce.Therefore, the current study aims to compare the antihallucinatory effectiveness of 3 pharmacologically different antipsychotics: olanzapine, amisulpride, and aripiprazole. METHODS: The present study is part of the Bergen-Stavanger-Innsbruck-Trondheim study, a 12-month prospective, randomized, pragmatic antipsychotic drug trial in active-phase schizophrenia spectrum disorders. The primary outcome of the present study was change of hallucinations as measured by item P3 (hallucinatory behavior) from the Positive and Negative Syndrome Scale in the subgroup with hallucinations at baseline. Primary analyses were intention to treat. RESULTS: A total of 144 participants were included in the study, where 105 (72%) had a score of 3 or more on the Positive and Negative Syndrome Scale P3 item at baseline, indicating the presence of hallucinations (HALL subgroup).In the HALL subgroup, a significantly less reduction of hallucinations was revealed for participants using olanzapine in weeks 12, 26, 39, and 52 when compared with amisulpride and in weeks 26 and 52 when compared with aripiprazole. In subanalyses for participants never exposed to antipsychotic drugs (antipsychotic-naive) and those who had used antipsychotics before entering the study, antihallucinatory differences were revealed only in the latter group. CONCLUSIONS: A differential antihallucinatory effect of the 3 study drugs was present. The inferior effect of olanzapine seems to be driven by the subgroup of participants exposed to antipsychotic treatment before entering the study.

Strength training restores force-generating capacity in patients with schizophrenia.

Patients with schizophrenia spectrum disorders have impaired skeletal muscle force-generating capacity (FGC) of the lower extremities, that is, one repetition maximum (1RM) and rapid force development, and poor functional performance. We therefore investigated whether 12 weeks of maximal strength training (MST) could (a) restore FGC and functional performance to the level of healthy references, (b) increase patient activation and quality of life, and (c) explore associations between symptom severity, defined daily dose of medication, illness duration, level of patient activation, and improvements in FGC and functional performance. Forty-eight outpatients were randomized to a training group (TG) or control group (CG). TG performed leg press MST 2 day/week at ~ 90% 1RM. The CG received two introductory training sessions and encouragement to train independently. Leg press 1RM, rapid force development, a battery of functional performance tests, Patient Activation Measure-13, and 36-Item Short Form Health Survey were tested. Healthy references performed baseline tests of FGC and functional performance. Thirty-six patients completed the study (TG: 17, CG: 19). TG improved 1RM (28%) and rapid force development (20%, both P < .01) to a level similar to healthy references, while no change was apparent in the CG. TG's improvement in rapid force development was negatively associated with defined daily dose of medication (r = -0.5, P = .05). Both TG and CG improved 30-second sit-to-stand test performance (P < .05) which was associated with improved rapid force development (r = 0.6, P < .05). In conclusion, 12 weeks of MST restored patients' lower extremity FGC to a level similar to healthy references and improved 30-second sit-to-stand test performance.

One-year aerobic interval training in outpatients with schizophrenia: A randomized controlled trial.

Although aerobic interval training (AIT) is recognized to attenuate the risk of cardiovascular disease (CVD) and premature mortality, it appears that it rarely arrives at patients' doorsteps. Thus, this study investigated 1-year effects and feasibility of AIT delivered with adherence support in collaborative care of outpatients with schizophrenia. Forty-eight outpatients (28 men, 35 [31-38] (mean [95% confidence intervals]) years; 20 women, 36 [30-41] years) with schizophrenia spectrum disorders (ICD-10) were randomized to either a collaborative care group provided with municipal transportation service and training supervision (walking/running 4 × 4 minutes at ~90% of peak heart rate; HRpeak ) 2 d wk-1 at the clinic (TG) or a control group (CG) given 2 introductory AIT sessions and advised to continue training. Directly assessed peak oxygen uptake ( V ˙ O 2 peak ) increased in the TG after 3 months (2.3 [0.6-4.4] mL kg-1  min-1 , Cohen's d = 0.33[-4.63 to 4.30], P = 0.04), 6 months (2.7 [0.5-4.8] mL kg-1  min-1 , Cohen's d = 0.42[-4.73 to 4.11], P = 0.02) and 1 year (4.6 [2.3-6.8] mL kg-1  min-1 , Cohen's d = 0.70[-4.31 to 4.10], P < 0.001) compared to the CG. One-year cardiac effects revealed higher HRpeak (7 [2-11] b min-1 , Cohen's d = 0.34[-8.48 to 8.65], P = 0.01), while peak stroke volume tended to be higher (0.9 [-0.2 to 2.0] mL b-1 , Cohen's d = 0.35[-1.62 to 2.01], P = 0.11) in the TG compared to the CG. Conventional risk factors (body weight, waist circumference, blood pressure, and lipids/glucose) remained unaltered in both groups. One-year AIT adherence rates were 15/25 (TG; different from CG: P < 0.001) and 0/23 (CG). AIT was successfully included in long-term collaborative care of outpatients with schizophrenia and yielded improved V ˙ O 2 peak , advocating this model for aerobic capacity improvement and CVD risk reduction in future treatment.

Patients with Fibromyalgia and Chronic Fatigue Syndrome show increased hsCRP compared to healthy controls.

Chronic Fatigue Syndrome (CFS) and Fibromyalgia (FM) are both chronic disorders that have a devastating effect on the lives of the affected patients and their families. Both conditions have overlapping clinical features that partly resemble those of inflammatory disorders. The etiology is still not understood, and it is suggested that the immune system might be a contributing factor. So far, the results are inconclusive. The purpose of this study was to compare the two conditions and investigate the level of the inflammatory marker high-sensitivity CRP (hsCRP) in CFS and FM patients compared to healthy controls. Female participants aged 18-60 years were enrolled in this study. The group consisted of 49 CFS patients, 57 FM patients, and 54 healthy controls. hsCRP levels were significantly higher for both the CFS and the FM groups compared to healthy controls when adjusting for age, smoking, and BMI (p < .001). There was no difference between the two patient groups. The level of hsCRP was affected by BMI but not by age and smoking. Patients with CFS and FM have higher concentrations of hsCRP compared to healthy controls. This remains significant even after adjusting for BMI. CFS and FM cannot be distinguished from each other on the basis of hsCRP in our study.

Biomarkers of Autoimmunity in Acute Psychiatric Disorders.

OBJECTIVE: Previous studies have suggested that autoantibodies associated with systemic autoimmune disorders are more prevalent in patients with psychotic and affective disorders compared with healthy control subjects. However, most positive studies addressing this issue have been limited by small sample sizes and lack of correction for confounding factors. The authors aimed to assess the prevalence of several autoantibodies in patients admitted to acute psychiatric inpatient care and investigate whether patients with psychotic and affective disorders have an increased prevalence of autoantibodies compared with psychiatric patients admitted for other reasons. METHODS: Five hundred eighty-five patients were screened for the presence of antinuclear antibodies (ANA), anticardiolipin and antibeta2-glycoprotein, antithyroid peroxidase (anti-TPO), antitissue transglutaminase IgA, antigliadin deamidated peptide IgG, and rheumatoid factor IgM (RF). Differences in prevalence between patients with nonaffective psychoses (N=105), bipolar disorders (N=78), unipolar depressive disorders (N=146), and other reasons for admission (N=256) were assessed using chi-square tests and logistic regression models. RESULTS: One or more autoantibodies were present in 26.2% of the patients, including ANA (9.4%), RF (9.2%), and anti-TPO (5.6%). Autoantibody prevalence increased with age (odds ratio=1.21, 95% CI=1.09-1.35) and smoking status (odds ratio=1.99, 95% CI=1.04-3.82) but was not associated with a diagnosis of a psychotic or affective disorder. CONCLUSIONS: Autoimmune autoantibodies seem to be equally prevalent in patients with acute psychiatric conditions with and without psychotic and affective disorders. This result challenges the idea that these autoantibodies have specificity for certain psychiatric disorders.

Psychiatric symptoms and risk factors in adults born preterm with very low birthweight or born small for gestational age at term.

BACKGROUND: We aimed to examine psychiatric symptoms in adults born preterm with very low birthweight or born at term small for gestational age compared with normal birthweight peers, and examine associations with perinatal factors and childhood motor and cognitive function. METHODS: In this longitudinal cohort study, one preterm born group with very low birthweight (VLBW: birthweight ≤1500 g), one term-born Small for Gestational Age (SGA: birthweight <10th percentile) group and one term-born non-SGA control group, were assessed at 26 years of age. Primary outcomes were scores on self-reported questionnaires: Achenbach System of Empirically Based Assessment - Adult Self-Report, The Autism-Spectrum Quotient and Peters et al. Delusions Inventory. Exposure variables were perinatal data, while childhood motor and cognitive function were examined as possible early markers. RESULTS: Both the preterm VLBW and the term SGA group reported higher levels of attention, internalizing and externalizing problems compared to the control group. In addition, the VLBW participants reported more critical items and a higher proportion had intermediate level autistic traits, while the SGA participants reported more intrusive behavior. Increasing length of respiratory support and hospital stay in the neonatal period, and motor problems in early adolescence, were associated with adult psychiatric symptoms in the VLBW group. CONCLUSIONS: Psychiatric symptoms were frequent in the preterm VLBW group and also in the term-born SGA group. Those who were sickest as babies were most at risk. Motor problems can possibly serve as an early marker of adult psychiatric symptoms in low birthweight individuals.

Patients with schizophrenia have impaired muscle force-generating capacity and functional performance.

Patients with schizophrenia have impaired physical health. However, evidence of how skeletal muscle force-generating capacity (FGC), a key component of functional performance, may contribute to the impairment is scarce. Thus, the aim of this study was to investigate the patient groups' skeletal muscle FGC and its association with functional performance. Leg-press FGC was assessed along with a battery of functional performance tests in 48 outpatients (28 men, 34 ± 10 years; 20 women, 36 ± 12 years) with schizophrenia spectrum disorder (ICD-10, F20-29), and compared with 48 healthy age- and gender-matched references. Results revealed reduced one-repetition maximum (1RM) in men (-19%, P < .01) and a trend toward reduction in women (-13%, P = .067). The ability to develop force rapidly was also impaired (men: -30%; women: -25%, both P < .01). Patients scored worse than healthy references on all physical performance tests (stair climbing: -63%; 30-second sit-to-stand (30sSTS): -48%; six-minute walk test (6MWT): -22%; walking efficiency: -14%; and unipedal stance eyes open: -20% and closed: -73%, all P < .01). 1RM correlated with 6MWT (r = .45), stair climbing (r = -.44), 30sSTS (r = .43), walking efficiency (r = .26), and stance eyes open (r = .33) and closed (r = .45), all P < .01. Rapid force development correlated with 6MWT (r = .54), stair climbing (r = -.49), 30sSTS (r = .45), walking efficiency (r = .26), and stance eyes open (r = .44) and closed (r = .51), all P < .01. In conclusion, skeletal muscle FGC and functional performance are reduced in patients with schizophrenia and should be recognized as important aspects of the patient groups' impaired health. Resistance training aiming to improve these components should be considered an important part of clinical treatment.

A comprehensive cardiovascular disease risk profile in patients with schizophrenia.

Patients with schizophrenia are physically inactive and have high prevalence of cardiovascular disease (CVD). Peak oxygen uptake (V̇O2peak ) is one of the strongest predictors for CVD, yet is rarely investigated in this patient population, and how V̇O2peak relates to other conventional CVD risk measures in this population is unclear. We measured treadmill V̇O2peak along with daily physical activity assessed by triaxial accelerometry, body mass index (BMI), waist circumference, blood pressure, lipid profiles, and glucose in 48 outpatients (28 men, 35 ± 10 (SD) years; 20 women, 35 ± 12 years), diagnosed with schizophrenia, schizotypal, or delusional disorders (ICD-10; F20-29). The patients were compared with 48 age- and sex-matched healthy references (±2 years) and normative data from the population. V̇O2peak was 34.5 ± 8.7 mL/kg/min (men) and 26.4 ± 7.0 mL/kg/min (women), which was 27% and 30% lower than healthy references, respectively (both P < 0.01). V̇O2peak was not associated with daily physical activity in men while a weak association was seen in women (steps per day: r2  = 0.26; counts per minute: r2  = 0.25; P < 0.05). BMI (26.0 ± 6.1 kg/m2 ) revealed that patients were moderately overweight with a waist circumference of 103 ± 17 cm. Lipid- and glucose levels, and blood pressure were all within normative range. Our data advocate the utilization of V̇O2peak assessment for CVD risk profile determination in patients with schizophrenia. Daily physical activity was poorly and inconsistently related to V̇O2peak, suggesting increased daily physical activity might not translate into improved V̇O2peak and CVD risk reduction.

Anxiety and Depression Symptoms in a General Population and Future Risk of Bloodstream Infection: The HUNT Study.

OBJECTIVE: We examined whether anxiety and depression symptoms constitute increased risk of bloodstream infection (BSI), as a proxy for sepsis. METHODS: A general population with self-reported anxiety and depression symptoms was followed prospectively for hospital-verified BSI. Using multivariable Cox regression analysis, we estimated hazard ratios (HR) with 95% confidence intervals (CI) of BSI and BSI mortality, with and without statistical adjustment for comorbidities, BMI, and life-style factors that may confound or mediate the associations. RESULTS: During 14.8 years median follow-up of 59,301 individuals, 1578 (2.7%) experienced BSI and 328 (0.55%) participants died within 30 days after a BSI. Severe depression symptoms were associated with a 38% increased risk of BSI, adjusted for age, sex, and education (HR = 1.38, 95% CI = 1.10-1.73). The HR was attenuated to 1.23 (0.96-1.59) after adjustment for comorbidities and to 1.15 (0.86-1.53) after additional adjustment for BMI and life-style factors. For severe anxiety symptoms, the corresponding HRs were 1.48 (1.20-1.83), 1.35 (1.07-1.70), and 1.28 (0.99-1.64). Moderate symptoms of depression and anxiety were not associated with increased BSI risk. The analysis of BSI mortality yielded imprecise results but suggested an increased risk of BSI mortality in participants with moderate depression symptoms. CONCLUSIONS: Severe depression and anxiety symptoms were associated with a moderately increased risk of BSI. The association may, at least in part, be confounded or mediated by comorbidities, BMI, and life-style. Future research should investigate whether interventions targeting improved BMI and life-style may reduce the risk of BSI and sepsis in people with depression and anxiety symptoms.

FT4 and TSH, relation to diagnoses in an unselected psychiatric acute-ward population, and change during acute psychiatric admission.

BACKGROUND: Alteration in thyroid activity is a well-known cause of symptoms mimicking psychiatric disorders. There are reports on altered levels of thyroid hormones in patients with certain psychiatric disorders compared to healthy controls; still, the magnitude and importance of the phenomenon is not known. We wanted to explore the level of thyroid hormones in different diagnostic groups in an acute-psychiatric population. We also wanted to follow any change during their stay. METHODS: Patients aged 18 years and older admitted to a closed, psychiatric inpatient ward were eligible if giving informed consent. For 539 patients representing all main psychiatric diagnostic groups and with equal gender distribution, data for FT4 were available for 539 patients, and data for TSH were available from 538 patients at admittance. For 239 patients, data for FT4 were available at both admittance and discharge, and the corresponding number for TSH was 236 patients. RESULTS: A significantly higher share of patients had higher levels of FT4 and TSH at admittance than expected for healthy individuals. No significant effect of gender or most diagnostic groups was seen. For female patients with substance-use disorder (SUD), the level of TSH was significantly lower than that for all other diagnostic groups. No other difference in the levels of FT4 and TSH was seen between the main diagnostic groups, and the effect in SUD was not seen in males. For the population with available markers at both admittance and discharge, in total, there was a significant reduction of FT4 from admittance to discharge, not followed by any change in TSH. CONCLUSIONS: In acutely admitted psychiatric patients there seems to be an increased FT4 and TSH. FT4 is normalized during the inpatient stay independently of TSH. This indicates somatic effects of psychiatric stress that may be of clinical importance and the phenomenon should be further explored. Mainly different diagnostic groups did not differ in level of FT4 and TSH. Thus future studies on thyroid activity in psychiatric patients should focus on function and level of stress and suffering rather than diagnostic groups.

Cytokine profiles and diagnoses in elderly, hospitalized psychiatric patients.

BACKGROUND: There is a paucity of studies on inflammatory markers in elderly psychiatric patients. Hence, our study was undertaken to investigate cytokines as biomarkers in diagnostically unselected elderly patients admitted to a psychiatric hospital. METHODS: Demographic data, clinical data and blood samples, including 27 cytokines, were collected from 98 patients above 60 years, consecutively admitted to a psychiatric hospital in Tromsø, Norway (69°N). RESULTS: The most common diagnosis was Recurrent depressive disorder (26.5%), the second most common was dementia in Alzheimer's disease (20.4%). The most frequent somatic disease was cardiovascular disease (28%). No statistical association (p < 0.01) was found between cytokines and gender, age, BMI, anti-inflammatory drugs, psychotropic drugs, reason for admittance, smoking, vitamin supplements, alcohol consumption, length of stay, somatic disease (present/not-present) or psychiatric diagnoses. However, when allocating patients to two groups, depression and no depression, we found higher levels of 10 cytokines in the no depression group (FDR-p < 0.0044). Possibly, this could in part be explained by the higher prevalence of cardiovascular disease (CVD) and dementia in the no depression group, as these factors were significant predictors of patients being categorized as not depressed in a logistic regression. In addition, other unknown factors might have contributed to the association between no depression and elevated cytokines. On the other hand, the high level of psychiatric and somatic comorbidity in the study population may have led to increased levels of cytokines in general, possibly diluting the potential effect of other factors, depression included, on the cytokine levels. The size of the study, and particularly the size of the subgroups, represents a limitation of the study, as do the general heterogeneity and the lack of a control group. CONCLUSIONS: There was no significant difference in cytokine levels between various psychiatric diagnoses in hospitalized elderly psychiatric patients. This indicates that previous findings of correlations between cytokines and various psychiatric disorders in highly selected adult cases might not be applicable to elderly psychiatric inpatients. Further immunological studies are needed on gerontopsychiatric patients in general and gerontopsychiatric patients with specific disorders, preferably with patients that are physically healthy. TRIAL REGISTRATION: Retrospectively registered in the ISRCTN registry study, with study ID ISRCTN71047363 .

Use of mechanical and pharmacological restraint over an eight-year period and its relation to clinical factors.

BACKGROUND: Use of restraint and finding the balance between security and ethics is a continuous dilemma in clinical psychiatry. In daily clinic and in planning health-care service, knowledge on the characteristics of restraint situations is necessary to optimize its use and avoid abuse. METHODS: We describe characteristics in the use of pharmacological and mechanical restraint in psychiatric acute wards in a hospital in Middle Norway over an eight-year period. Data on all cases of mechanical and pharmacological restraint from 2004 to 2011 were retrospectively collected from hand-written protocols. Complementary information on the patients was obtained from the hospital patient administrative system. RESULTS: Restraint in acute wards was used on 13 persons per 100,000 inhabitants annually. The percentage of admitted patients exposed to restraint was 1.7%, with a mean of 4.5 cases per exposed patient. Frequency per 100 admitted patients varied from 3.7 (in 2007) to 10 (in 2009). The majority of restraint cases concerned male patients under 50 years and with substance-abuse, psychotic, or affective disorders. Significantly more coercive means were used during daytime compared to night and morning. There was a significant increase in pharmacological coercion during spring and mechanical coercion during summer. CONCLUSIONS: Restraint was used on 1.7% of admitted patients, representing 13 per 100,000 inhabitants per year. Use of restraint was higher during certain periods of the day and was associated with the patient's diagnosis, age, gender, and legal status of hospitalization. There was a marked variation over the years.