Risk factors of major infections in schizophrenia. A nationwide Danish register study.

BACKGROUND: Risk of infections is elevated in patients with schizophrenia. Predicting their occurrence is essential, as infections in this group of patients are associated with prolonged hospital admission and increased mortality. The objective of the current investigation was to identify the potential risk factors of major infection after diagnosis with schizophrenia. METHODS: This national prospective observational cohort study included 7788 people with schizophrenia born in Denmark between 1975 and 1990. Socio-demographic, psychiatric and health related data were obtained from Danish national registers. The Cox regression model was used for data analyses. Crude and adjusted hazard ratios (HRs) with 95% confidence intervals (95%CIs) are presented. RESULTS: The most significant risk factors associated with the development of major infections included young age, female gender, medical comorbidity and substance abuse. A history of treatment with antipsychotics preceding the diagnosis was negatively associated with such morbidity. CONCLUSION: This study reports several factors that might increase the risk of infections in individuals with schizophrenia. Early intervention towards infections should be considered in the subpopulation of schizophrenia patients who are at increased risk of infections.

[Suicide among patients with apoplexy. An epidemiological study]. / Selvmord hos patienter med apopleksi. En epidemiologisk undersøgelse.

The purpose of this study was, on the basis of a cohort of patients with a discharge diagnosis of stroke (ICD8 code: 430-438) diagnosed in the period 1.4.1973-31.12.1989 in a representatively selected area of Denmark (County of Funen), to estimate whether or not the risk of suicide in stroke patients was increased compared to the background population, i.e. the total population of the County of Funen. The patients were followed for causes of death until end of 1989. Standard Mortality Ratios for suicide standardized for age and sex in male and female stroke patients were calculated. A total of 37,869 stroke patients were included in the study, 140 committed suicide in the study period (80 females and 60 males). Standard Mortality Ratio for suicide was significantly increased for all stroke patients. For women below 49 years and from 50-59 years Standard Mortality Ratios were 1376 and 1378 respectively. For men below 49 years and from 50-59 years Standard Mortality Ratios were 656 and 580 respectively. The suicides did not occur at any specific time-point after the stroke. The results of this study emphasize the need, concurrently with improvements in prevention and treatment of stroke, to improve the care of patients suffering from the impairment of a stroke. This is a continuous process, and studies are needed in order to decide how this is best done.

[Risk factors for suicide in patients with disseminated sclerosis]. / Risikofaktorer for selvmord hos patienter med dissemineret sklerose.

The purpose of the present study was to describe risk factors for suicide in patients with multiple sclerosis (MS). The study is based on available information about MS-patients identified in the Danish MS Registry with onset of disease in the period 1950-1985. In order to characterize MS suicides with respect to risk factors comparisons were made for male and female suicides, and for various groups of MS suicides according to disability status. The male suicides were characterized by a tendency to commit suicide in the age interval 40-49 years, the use of a violent method, previous suicidal behaviour, previous mental disorder, recent deterioration of MS, and moderate disability. For women the characteristics were less distinct. Patients with a severe course of MS had been subjected to more risk factors before the suicide. Careful counselling and good information to MS-patients are advocated.

[Sexual function in patients with disseminated sclerosis. A 5-year follow-up study]. / Seksuel funktion hos patienter med dissemineret sklerose.

Sexual dysfunction is known to occur in multiple sclerosis (MS). The purpose of the study is to describe the change in sexual function and symptoms in a five year follow-up study. Forty-nine patients (27 females, 22 males) with definite MS were interviewed and examined. The number of patients with sexual dysfunction increased significantly (p = 0.004) and involved females and males equally. Males usually had one or two symptoms, while females frequently had two or more symptoms. It is concluded that the risk of sexual dysfunction increases over time. Further studies concerning treatment possibilities are needed.

Risk factors for suicide in multiple sclerosis.

BACKGROUND: The purpose of the present study was to identify risk factors for suicide in patients with multiple sclerosis (MS). METHODS: The study is based on available information about MS patients identified in the Danish MS Registry (DMSR) with onset in the period 1950-1985. We compared the MS suicides with the 1950-1985 onset cohort patients in the DSMR as to distribution of age at onset, presenting symptoms, and time from onset to diagnosis. We reviewed sociodemographic data, age of onset, the course of the disease, recent deterioration, type of deterioration, Kurtzke Disability Status Scale (DSS) score, previous mental disorder, type of mental disorder, previous suicide attempts, expression of suicidal intentions, circumstances at suicide, and suicide method for all MS patients who had committed suicide. In order to characterize MS suicides with respect to risk factors, comparisons were made for male and female suicides and for various groups of MS suicides according to disability status. RESULTS: The male suicide patients were characterized by a tendency to commit suicide in the age interval 40-49 years, by the use of a violent suicide method, by previous suicidal behaviour, by a previous mental disorder, by recent deterioration of MS, and by a moderate disability. For women the characteristics were less distinct. Patients with a severe course of MS had been subjected to more risk factors before the suicide than patients with a moderate course of the disease. CONCLUSION: Careful counselling and good information on all aspects of the disease, especially in the first stages and at time of progression, could be an instrument of prevention of suicides in MS patients. Furthermore, recognition and treatment of depression and pain is important.

Sexual function in multiple sclerosis. A 5-year follow-up study.

Sexual dysfunction is known to occur in multiple sclerosis (MS). The purpose of the study is to describe the change in sexual function and symptoms in a longitudinal study. Forty-nine patients (27 females, 22 males) with definite MS were interviewed and examined with 5 years interval. The number of patients with sexual dysfunction increased significantly (p = 0.009) and involved females and males equally. Males usually had 1 or two symptoms of sexual dysfunction, while females frequently had 2 or more symptoms. It is concluded that the risk of sexual dysfunction increases over time. Further studies in treatment possibilities are needed.

Mortality in patients with Parkinson's disease.

INTRODUCTION: After the introduction of L-dopa the mortality rate in Parkinson's disease (PD) patients has changed, but is still higher than in the background population. MATERIAL & METHODS: Mortality, age at death and cause of death in a group of PD patients compared with the background population were studied. The diagnosis on the death certificate were registered. The material consisted of 458 patients who in a period 1.4.1973-31.10.1991 were registered as having PD. RESULTS: Death in the period amounted to 253 patients. Median age of death was 77.29 years for men and 79.11 years for women. In the background population the median age at death was 80.69 years for men and 84.37 years for women. The SMR for men was 1.92 and for women 2.47. Infections, in particular lung infections, and heart diseases were the most common causes of death. Seventy percent of the death certificates had PD as a diagnosis. CONCLUSION: It is likely that several factors can influence the changed mortality of PD: more effective treatment, changing diagnostic practice, and inter-disease competition.

[Psychosocial aspects of disseminated sclerosis]. / Psykosociale aspekter ved dissemineret sklerose.

Using multiple sclerosis as a model, it is demonstrated how a chronic neurological disorder has psychosocial consequences during the period between onset and diagnosis, at the time of diagnosis, and in the post-diagnostic period. The impact of the disorder on self-esteem, civil status, habitation, economy, social and leisure activities and need for help is described. It is concluded that it will increasingly be expected that the physician has knowledge of these relations.

The use of non-medical/alternative treatment in multiple sclerosis. A 5 year follow-up study.

Forty-nine patients (22 males, 27 females) were examined and interviewed with 5 years interval in order to determine the extent of the use of non-medical (alternative) treatment and whether the use influenced the natural course of multiple sclerosis (MS). Using clinical course, Kurtzke Disability Status scale, bladder and bowel function, neuropsychological tests, psychological tests, divorce and self-assessment score as parameters, it was found that non-medical treatment did not alter the course of MS. To confirm this result a clinical trial in a controlled design is needed. The use of non-medical treatment declined over the 5 years from 55% to 27%. The use of non-medical treatment could be interpreted as an indicator of psycho-social difficulties in MS patients.

Effect of pregnancy on the prognosis for multiple sclerosis. A 5-year follow up investigation.

INTRODUCTION: The purpose of the study was to evaluate the effect of pregnancy and childbirth on the longterm prognosis for women with multiple sclerosis (MS). METHOD AND MATERIAL: A cohort of 39 women with definite MS were identified on 1.1.1986 using a reproducible selection method. The investigation was initiated in 1986 when handicap was evaluated by Kurtzke Disability Status Score (DSS). At a 5-year follow up 4 had died and 6 could not participate. There were 29 women in the investigation of whom 7 were childless, 10 had onset of MS at least 6 months after last childbirth, and 12 had onset of MS before or in connection with childbirth. Age and disease duration of the group was uniform. RESULT: At follow up the DSS significantly deteriorated (p = 0.008). The deterioration was seen particularly for childless women (p = 0.03) and women with onset of MS before or in connection with childbirth (p = 0.005). CONCLUSION: On the basis of this prospective investigation and the literature, it may be concluded that it is unlikely that pregnancy and childbirth have an influence on the longterm prognosis for MS. However, the conclusion must be interpreted with caution as the number of patients is small.

Attempted suicide and contact with the primary health authorities.

In a study describing suicide attempters' approach to the health and social welfare authorities prior to a suicide attempt, it was found that one-fourth of the patients seeking help requested therapeutic consultations and only a few asked for medicinal treatment. Forty-four percent had taken newly prescribed medicine for the parasuicide. It is concluded that the availability of psychological support and a more restrictive prescription of medicine could have a preventive effect on parasuicidal behaviour. Patients suffering from depression and pain have more often than other patients been in contact with their general practitioner prior to the suicide attempt. Postgraduate courses for practitioners on depression diagnostics and suicidal behaviour are proposed as a measure in suicide prevention.

Suicide in patients with Parkinson's disease. An epidemiological study.

The purpose of this study was to estimate the risk of suicide for patients with Parkinson's disease (PD) in Denmark compared with that in the background population. The study involved 458 patients with a PD diagnosis, 226 men and 232 women. The follow-up period to either death or end of follow-up on December 31, 1990 was 0 to 17 years, mean 5.7 years. Deaths in the follow-up period amounted to 254, 135 men and 119 women. Two women committed suicide. The number of expected suicides was 1.06 for men and 0.55 for women, a total of 1.62. Neither for men nor for women was the difference between expected and observed suicides statistically significant.

Multiple sclerosis: the impact on family and social life.

In a cross-sectional study of 117 randomly selected patients (52 men, 65 women) with definite multiple sclerosis, it was found that 76 percent were married or cohabitant, 8 percent divorced. Social contacts remained unchanged for 70 percent, but outgoing social contacts were reduced for 45 percent. Ninety-five percent lived in own house or flat and 70 percent received disablement pension. More than half of the patients (56.4 percent) were dependent on help from close relatives, most frequently spouse. The need for help, the risk of divorce, loss of contact with relatives, difficulty in going out, need for structural changes in home and need for pension became greater with increasing physical handicap. No significant differences between gender were found. It is concluded that patients and relatives are under increased social strain, when multiple sclerosis progresses to a moderate handicap (Kurtzke Disability Rating Scale, 3-5).

Suicides in men with IDDM.

OBJECTIVE: To investigate the occurrence of suicide in men with insulin-dependent diabetes mellitus (IDDM). RESEARCH DESIGN AND METHODS: A cohort of all Danish men born between 1949 and 1964 (including 1964) who were diagnosed with IDDM before age 20 (n = 1,682) was ascertained earlier. Follow-up from diagnosis to death or 1 January 1991 was based on record linkage with the Danish Civil Registration System and was supplemented with information from death certificates obtained from the Danish National Registry of Deaths. From published vital statistics, cause-specific standardized mortality ratios (SMRs), adjusted for age and calendar time, were calculated. RESULTS: Among the 168 deaths recorded during follow-up, 15 took place in connection with the onset of IDDM and have been excluded. Of the remaining 153 deaths, 12 were officially classified as suicides (SMR 12/7.48 = 1.6, 0.05 < P < 0.1); as for the age-group of 20-24 years, SMR was 2.98, P < 0.05. Furthermore, all deaths officially classified as attributable to unknown causes (n = 28) and accidents (n = 22) were reviewed with respect to unrecognized suicides; as for deaths of unknown causes, three could be reclassified as probable suicides and two as possible suicides, whereas one of the deaths caused by accident could be reclassified as possible suicide. CONCLUSIONS: Young men with IDDM may confer a higher risk of suicide than expected. Furthermore, suicide may represent an underestimated cause of death among patients with IDDM.

Attempted suicide, depression and physical diseases: a 1-year follow-up study.

In the period January 1, 1990 to March 31, 1991 a sample of suicide attempters admitted to the Department of Psychiatry, Odense University Hospital, underwent a structured interview. In the study 52% of the patients interviewed were found to suffer from a somatic disease, and 21% were daily on analgesics for pain. Patients that suffered from a somatic disease differed from other suicide attempters in depression score, age, pain and the presence of psychosis. Fewer of the somatically ill suicide attempters had a psychosis. Patients complaining of pain were more often depressed and abused medicine. Statistically, the risk of repetition of parasuicide for patients with a somatic disease but without depression was significantly less. The 7 patients committing suicide were older and a tendency was found towards painful somatic diseases and depression as risk factors for suicide.

Suicide in patients with motor neuron disease.

The aim of the present study was to assess, through an epidemiological study, whether suicide risk is increased in patients with motor neuron disease (MND). The study involved 116 patients with MND. In the study period 92 patients died, 47 males and 45 females. No patients committed suicide. The number of expected suicides was 0.27 for males and 0.12 for females, a total of 0.38. The difference between observed and expected suicides was not statistically significant for males and females.

Suicide and patients with neurologic diseases. Methodologic problems.

OBJECTIVE: The suicide risk in patients with many neurologic diseases has been reported to be greater than that in the general population. Studies on the subject are, however, often encumbered with methodologic problems. We appraised these problems and, based on an evaluation, reappraised knowledge of the suicide risk in patients with specific neurologic diseases. DATA SOURCE: Using the computerized database MEDLINE, we identified all published reports with the key words suicide, attempted suicide, and neurologic diseases. STUDY SELECTION: We assessed and reviewed studies concerning the most common neurologic diseases for methodologic problems in the study design. DATA EXTRACTION: The following methodologic problems emerged during our review: (1) choice of study type, ie, autopsy study or follow-up study; (2) choice of study population; (3) choice of control groups; (4) epidemiologic/statistical methods used; and (5) validity of statistics reported. DATA SYNTHESIS: We analyzed the methodologic problems in studies of patients with multiple sclerosis, epilepsy, Huntington's chorea, spinal cord lesions, cranial trauma, brain tumors, Parkinson's disease, vascular disorders, and migraine. In most of the studies, the methods used gave rise to uncertainty about the conclusion presented. CONCLUSION: An increased suicide risk was found in patients suffering from multiple sclerosis and spinal cord lesions as well as in selected groups of patients with epilepsy. In other neurologic diseases, the suicide risk may be increased, but the results are uncertain due to the methodologic problems in the study design.

Suicide and multiple sclerosis: an epidemiological investigation.

In a nationwide investigation the risk of death by suicide for patients with multiple sclerosis (MS) was assessed using records kept at the Danish Multiple Sclerosis Registry (DMSR) and the Danish National Register of Cause of Death. The investigation covers all MS patients registered with DSMR with an onset of the disease within the period 1953-85, or for whom MS was diagnosed in the same period. Fifty three of the 5525 cases in the onset cohort group committed suicide. Using the figures from the population death statistics by adjustment to number of subjects, duration of observation, sex, age, and calendar year at the start of observation, the expected number of suicides was calculated to be nearly 29. The cumulative lifetime risk of suicide from onset of MS, using an actuarial method of calculation, was 1.95%. The standard mortality ratio (SMR) of suicide in MS was 1.83. It was highest for males and for patients with onset of MS before the age of 30 years and those diagnosed before the age of 40. The SMR was highest within the first five years after diagnosis.