Relapse Prevention in Major Depressive Disorder After Successful Acute Electroconvulsive Treatment: a 6-month Double-blind Comparison of Three Fixed Dosages of Escitalopram and a Fixed Dose of Nortriptyline - Lessons from a Failed Randomised Trial of the Danish University Antidepressant Group (DUAG-7).

INTRODUCTION: Electroconvulsive treatment (ECT) is an effective treatment for severe depression but carries a risk of relapse in the following months. METHODS: Major depressive disorder patients in a current episode attaining remission from ECT (17-item Hamilton Depression Rating Scale (HAM-D17) score≤9) received randomly escitalopram 10 mg, 20 mg, 30 mg or nortriptyline 100 mg as monotherapies and were followed for 6 months in a multicentre double-blind set-up. Primary endpoint was relapse (HAM-D17≥16). RESULTS: As inclusion rate was low the study was prematurely stopped with only 47 patients randomised (20% of the planned sample size). No statistically significant between-group differences could be detected. When all patients receiving escitalopram were compared with those receiving nortriptyline, a marginal superiority of nortriptyline was found (p=0.08). One third of patients relapsed during the study period, and one third completed. DISCUSSION: Due to small sample size, no valid efficacy inferences could be made. The outcome was poor, probably due to tapering off of non-study psychotropic drugs after randomisation; this has implications for future study designs. ClinicalTrials.gov Identifier: NCT00660062.

A follow-up study of postpartum psychoses: prognosis and risk factors for readmission.

OBJECTIVE: The aim of this study was to describe the prognosis and risk factors for the first readmission after postpartum psychosis. METHOD: Linking the Danish Medical Birth Register and the Danish Psychiatric Central Register from 1 January 1973 to 31 December 1993 revealed 1173 women diagnosed with a psychosis within 91 days of delivery. The relative risk (RR) of readmission was estimated using Cox proportional hazard regression models. RESULTS: An increased risk of readmission was found for women with a diagnosis of schizophrenia (RR = 2.4, 95% CI = 1.9-3.1) and for women with a history of previous psychiatric admission (RR = 1.8, 95% CI = 1.5-2.1) compared to first-admitted women with other functional psychoses. Unmarried women also showed an increased risk of readmission, and only preterm delivery was associated with a reduced risk of readmission. CONCLUSION: Preterm delivery predicts the best prognosis after postpartum psychosis. The majority of readmissions were related to the psychopathology of the patient and to lack of social support.

[Puerperal psychoses. Clinical diagnoses and relative risk of admission after parturition]. / Puerperalpsykoser. Kliniske diagnoser og relativ risiko for indlaeggelse efter fødsel.

Previous studies have suggested that the risk of psychosis, especially affective psychosis, is greatly increased during the first 30 days following delivery. The aim of our study was to replicate these findings. Linking The Danish Medical Birth Register and The Danish Psychiatric Central Register from January Ist 1973 to December 31st 1993 has revealed 1253 admissions diagnosed as psychosis within 91 days after delivery. The admission rate following delivery was compared to the admission rate among non-puerperal women in the general, Danish female population. The relative risk of all admissions was only slightly increased, RR = 1.09 (CI, 1.03-1.16). The admission rate concerning first admissions was greatly increased, RR = 3.21 (CI, 2.96-3.49) whereas the admission rate concerning readmissions was reduced, RR = 0.66 (CI, 0.61-0.72. In conclusion, childbirth is a strong risk factor for first admission with psychosis, but the risk is less increased than previously assumed.

Post-partum psychoses. Clinical diagnoses and relative risk of admission after parturition.

BACKGROUND: Previous studies have suggested that the risk for psychosis, especially affective psychosis, is highly increased during the first 30 days after delivery. The aim of our study was to replicate these findings. METHOD: Linking The Danish Medical Birth Register and The Danish Psychiatric Central Register from 1 January 1973 to 31 December 1993 revealed 1253 admissions diagnosed as psychosis within 91 days after delivery. The admission rate after delivery was compared with the admission rate among non-puerperal women in the general Danish female population. RESULTS: The relative risk of all admissions was only slightly increased, RR = 1.09 (95% CI 1.03-1.16). The admission rate concerning first admissions was highly increased, RR = 3.21 (95% CI 2.96-3.49) whereas the admission rate concerning readmissions was reduced, RR = 0.66 (95% CI 0.61-0.72). CONCLUSIONS: Childbirth is a strong risk factor for first admission with psychosis, but the risk may be less increased than previously assumed.

[Psychoses during the puerperium. Review of the literature]. / Psykoser i puerperiet. En litteraturundersøgelse.

More than half of the psychoses which develop a few weeks after delivery are manic depressive psychoses. A very limited fraction are schizoaffective psychoses. Up to one fourth are difficult to classify on account of dominating symptoms such as disturbances of consciousness and schizophrenic symptoms. No organic etiology has been found for these disturbances of consciousness. In British investigations, the hypothesis has been presented that these psychoses with atypical symptomatology represent a less serious variant of manic depressive psychoses. This question can only be solved by investigations concerning the etiology of manic depressive psychoses. In the present article, the hypothesis is presented that these psychoses may be reactive psychoses. Investigations concerning the etiology of reactive psychoses are necessary.