Randomized comparative study of group versus individual cognitive behavioural therapy for obsessive compulsive disorder.

OBJECTIVE: The primary aim of the study was to compare the effectiveness of group and individual cognitive behaviour therapy (CBT) for obsessive compulsive disorder (OCD). METHOD: One hundred and ten out-patients with OCD were randomly assigned to 15 sessions of either group CBT or individual CBT. Outcome measures were administered before and after treatment, as well as at 6- and 12-month follow-ups. The study was supplemented by a meta-analysis of accomplished comparative studies of group vs. individual CBT for OCD. RESULTS: Large and stable pre-post effect sizes were found for both treatment conditions in the study (d = 1.06-1.24 on the Yale-Brown Obsessive Compulsive Scale). There were no significant between-group differences in outcome at any data point (ds= -0.13 to 0.15). The meta-analysis of four accomplished comparative studies (including the present one) found a between-group mean effect size of (d= 0.15 favouring individual over group CBT at posttreatment (95% confidence interval, -0.12, 0.42). CONCLUSION: The results of this study suggest that OCD can be treated effectively with a group format of CBT, thus sparing some therapist resources, although the four accomplished comparative studies do not rule out the possibility of a small superiority of individually conducted CBT.

Congenital malformations, stillbirths, and infant deaths among children of women with schizophrenia.

BACKGROUND: Women with schizophrenia have increased exposure to risk factors for congenital malformations, stillbirths, and infant deaths among their children. However, the occurrence of these outcomes is unknown. METHODS: The risks of stillbirth and infant death among 2230 children of women with schizophrenia were compared with the risks among 123 544 children in the general population. The risk of congenital malformations among 746 children of women with schizophrenia were compared with the risk among 56 106 children in the general population. The year of birth, the sex of the child, the mother's age, and parity were included in the analyses as potential confounders. We had no information about socioeconomic status, smoking status, substance abuse, or psychotropic medication use. RESULTS: Children of women with schizophrenia had increased risk of postneonatal death (relative risk [RR], 2.76; 95% confidence interval [CI], 1.67-4.56). This was largely explained by an increased risk of sudden infant death syndrome (RR, 5.23; 95% CI, 2.82-9.69). There was no statistically significant increased risk of stillbirth (RR, 1.51; 95% CI, 0.94-2.40) or neonatal death (RR, 1.26; CI, 0.77-2.06). Children of women with schizophrenia had a marginally statistically significant increase in the risk of congenital malformations (RR, 1.70; 95% CI, 1.04-2.77). CONCLUSIONS: Children of women with schizophrenia have a considerable increased risk of death caused by sudden infant death syndrome. However, the results should be interpreted in the light of failure to adjust for socioeconomic status, substance abuse, smoking status, and psychotropic medication use.

Adverse pregnancy outcome in schizophrenic women: occurrence and risk factors.

Low birth weight and preterm birth are important predictors of infant mortality and morbidity, and may increase the risk of schizophrenia. These adverse outcomes of pregnancy could be associated, therefore, with increased risk in children genetically predisposed to schizophrenia. The aim of this review was to describe the occurrence of risk factors for low birth weight, preterm birth, and perinatal death among schizophrenic women, and to describe the incidence of those adverse pregnancy outcomes among schizophrenic women. Smoking, substance abuse, and low socioeconomic status are associated with fetal growth retardation, preterm birth, and perinatal death, and also with schizophrenia. Therefore, increased incidence of adverse pregnancy outcome should be expected in schizophrenic women. The available evidence suggests that schizophrenic women are at increased risk of delivering infants with low birth weight, but the existing studies are of small statistical power. Preterm birth and perinatal death have only been investigated little among schizophrenic women. An important focus of future research should be to establish the risk of adverse pregnancy outcome, and to study the association between the suspected risk factors and pregnancy outcome in schizophrenic women. In clinical work with pregnant schizophrenic women, efforts should be made to prevent exposure to suspected risk factors like smoking, substance use, and socioeconomic problems. This could possibly decrease the mortality and morbidity, including the risk of schizophrenia in the offspring, and clarify the importance of environmental and genetic factors in the etiology of schizophrenia.

Obstetric complications in women with schizophrenia.

It is not known whether schizophrenic women have increased incidence of complications during pregnancy and delivery. Data from the Danish Medical Birth Register were used to compare 2212 births to 1537 schizophrenic women in Denmark with a random sample of all deliveries in Denmark during 1973-1993 (122931 births to 72742 women). The schizophrenic women had fewer antenatal care visits. They were at lower risk of pre-eclampsia, but tended to have lower Apgar scores. There were no other differences in the incidence of specific complications such as placenta previa, placental abruption, and abnormal fetal presentation. Schizophrenic women were at increased risk of interventions such as Cesarean section, vaginal assisted delivery, amniotomy, and pharmacological stimulation of labor. There were no important differences between the deliveries to schizophrenic women who gave birth before and after their first admission to a psychiatric department. These results show no evidence that schizophrenic women have a greater frequency of specific obstetric complications than non-schizophrenic women. Nevertheless, they are at increased risk for interventions during delivery.

[Prolonged pseudodementia after treatment with tricyclic antidepressive agents and electroconvulsive therapy]. / Langvarig pseudodemens efter behandling med tricykliske antidepressiva og elektrostimulationsbehandling.

We present a case of a 62-year-old woman who developed severe and prolonged cognitive impairment after combined electro-convulsive therapy and tricyclic antidepressant drug therapy. The literature on the interaction between ECT and antidepressant drugs is sparse, and does not explain the severe cognitive impairment in our patient.

[Incidence of alcohol abuse among patients with emergency admissions to a psychiatric department. Evaluation based on clinical and biochemical markers]. / Forekomst af alkoholmisbrug hos patienter modtaget akut på psykiatrisk afdeling. Vurdering ud fra kliniske og biokemiske markører.

Alcoholism and drug abuse were investigated in psychiatric patients, who were acutely admitted to a general psychiatric ward at Silkeborg Hospital in Denmark during a six month period. Several standardized diagnostic systems and assessment instruments were applied: ICD-8 and DSM-III diagnoses and the WHO Alcohol Use Disorder Identification Test (AUDIT) and Short Michigan Alcoholism Screening Test (SMAST). Furthermore, several biochemical markers were studied, including carbohydrate-deficient-transferrin (CDT), gamma-glutamyltransferase (GGT), and S-ethanol. Finally, thin layer chromatography of the urine was used to detect drugs abuse. A diagnosis of Alcoholism (code 303) was obtained in 39% of the included patients, while 13% were considered drug abusers (main and subsidiary diagnosis). These findings are in accordance with several previously published Danish studies and illustrate that alcohol abuse is a common diagnosis among acutely admitted patients to a psychiatric department situated outside the metropolitan areas in Denmark. When comparing alcohol abuse as assessed by clinical information and by biochemical markers, only CDT and GGT gave estimates similar to clinical evaluations. CDT was positive in 41% of the patients. Taking ICD-8 diagnoses of alcoholism as "golden standards" the sensitivity and specificity of the marker was 0.67 and 0.74, respectively. Although this is not as high as previously found values, these figures suggest CDT to be a useful biological marker in the delineation of alcohol related problems in psychiatric patients.

Preterm birth and intra-uterine growth retardation among children of women with schizophrenia.

BACKGROUND: There is conflicting evidence about the frequency of adverse pregnancy outcomes among women with schizophrenia. AIMS: To investigate the risk of preterm birth, low birth weight and intra-uterine growth retardation among women with schizophrenia. METHOD: A total of 2212 births to 1537 women with schizophrenia in Denmark were compared with a random sample of all deliveries in Denmark in 1973-1993 (122,931 births to 72,742 women). RESULTS: The children of women with schizophrenia were at increased risk of preterm delivery (relative risk = 1.46, 95% CI = 1.19-1.79), low birth weight (relative risk = 1.57, 95% CI = 1.36-1.82) and small for gestational age (relative risk = 1.34, 95% CI = 1.17-1.53). CONCLUSIONS: Women with schizophrenia are at increased risk of adverse pregnancy outcome. This may be associated with an increased mortality and general morbidity and risk of schizophrenia in their children.