Electroconvulsive Therapy and Risk of Road Traffic Accidents: A Danish Register-Based Cohort Study.

OBJECTIVE: The aim of the study is to examine whether electroconvulsive therapy (ECT) was associated with the subsequent risk of being involved in a road traffic accident. METHODS: A cohort of all 375,435 patients older than 18 years with their first psychiatric hospital contact between 2003 and 2017 in the Danish National Patient Registry was followed for road traffic accidents until December 2018. Associations between ECT and road traffic accidents were examined using Cox regression analyses with multiple adjustments and using propensity score matching on sociodemographic and clinical variables. RESULTS: A total of 8486 patients (0.2%) were treated with ECT. During the median follow-up of 5.9 years, 778 of these patients (12.5%) were involved in a road traffic accident and the unadjusted incidence of road traffic accidents was lower among these patients (incidence rate, 15.5 per 1000 patient-years; 95% confidence interval [CI], 14.5-16.7) compared with patients not treated with ECT (incidence rate, 20.0 per 1000 patient-years; 95% CI, 20.0-20.3). Electroconvulsive therapy was not associated with road traffic accidents in the Cox regression models after adjustment for all covariables (hazard ratio, 1.00; 95% CI, 0.92-1.08) or in the propensity score-matched sample (hazard ratio, 0.91; 95% CI, 0.83-1.08). The HRs did not vary materially with follow-up time or when analyses were stratified on sex, age, or type of hospital contact. CONCLUSIONS: The analysis of Danish National registry data indicates that ECT is not associated with the risk of being involved in major road traffic accidents.

At the Core of Depression: A Diagnostic Interview of the Core Features of Depression.

INTRODUCTION: Valid and reliable methods for diagnosing depression are essential. The present study aimed to test the performance of a new diagnostic interview for depression focusing on the core symptoms of depression. METHOD: We developed a diagnostic interview for depression: the CORE Diagnostic Interview, CORE-DI, which assesses each of the core features of depression on the four dimensions: quality, reactivity, globality, and fluctuations over time. The diagnostic performance of this interview was tested in a clinical study including 83 individuals presenting with various depressive symptoms, who were interviewed independently (1) by means of the CORE-DI and the Mini-International Neuropsychiatric Interview (M.I.N.I.), and (2) by highly skilled specialists in depression representing gold standard diagnoses. RESULTS: We compared the outcome of the CORE-DI, the M.I.N.I., and the diagnosis made by clinicians, respectively, versus the gold standard diagnosis, using diagnostic efficiency statistics. The CORE-DI diagnosed depression with a high specificity (0.91, 95% CI: 0.85-0.97, for International Classification of Diseases [ICD]-10 criteria and 0.88, 95% CI: 0.81-0.95, for Diagnostic and Statistical Manual of Mental Disorders [DSM-5] criteria) compared to both M.I.N.I (specificity 0.44, 95% CI: 0.33-0.55) and clinical diagnoses (specificity 0.76, 95% CI: 0.67-0.85). The sensitivity of the CORE-DI was 0.61 (95% CI: 0.55-0.72) for ICD-10 criteria and 0.67 (95% CI: 0.57-0.77) for DSM-5 criteria. DISCUSSION/CONCLUSION: The CORE-DI increased the specificity of the depression diagnosis substantially compared to clinical diagnoses and the diagnoses obtained by M.I.N.I. The results point to the usefulness of an elaborated and systematic assessment of the core symptoms in the examination of patients with depressive symptoms and thereby indicate a way for further development of specific diagnostic tools for depression in both clinical and research settings. However, it should be noted that the sensitivity of the CORE-DI was modest, and the psychometric properties of the CORE-DI might be different in other settings with higher or lower prevalence or severity of depressive symptoms.

[The effect of psychotherapy on depression]. / Effekten af psykoterapi på depression.

Over the last decades, numerous studies of the efficacy of psychotherapy on major depression have been carried out. They provide evidence of the effectiveness of cognitive therapy and interpersonal therapy in the treatment of mild to moderate depression. The effectiveness of psychotherapy in in-patients and patients with severe depression has not been documented. Maintenance interpersonal therapy may contribute to prevent new episodes in recurrently depressive patients, where promising studies also indicate that cognitive therapy has a preventive effect on future depressions. This calls for larger and better controlled studies.

[A depression rating scale for the ward]. / Depressionsskala for sengeafsnit.

BACKGROUND: The aim of the present study was to develop a quantitative rating scale for depression based on observations in the ward and one that can be administered by the nursing staff. MATERIALS AND METHODS: Based on a literature survey and existing depression rating scales, a new rating scale was developed especially suited for use in inpatient care. The patients were rated simultaneously with the Beck Depression Inventory (BDI) and Clinical Global Impression (CGI). Estimation of construct validity, criterion validity, and item bias was performed with Rasch analysis and analysis of correlation. RESULTS: Statistical analysis revealed that the scale consisted of two sub-scales for mood and behaviour. One item had to be omitted as it was not homogeneous with either of the two sub-scales. DISCUSSION: The present depression rating scales rely on ward observations of patients during admission. This might be the reason why the items concerning behaviour are so strongly represented in this scale. Good correlations were found between the different scales, except for the score on BDI and the sub-scale concerning behaviour. This may be explained by the fact that the BDI is the patient's own judgement of cognitive function and mood. The observations in the ward are to a greater extent built on observation of patient behaviour. It can be used routinely on the psychiatric ward.