Bipolar Disorder: Kessing LV

Licht RW, Vestergaard P, Kessing LV, Larsen JK, Thomsen PH, Anonymous00236. · Mood Disorders Research Unit, Aarhus University Psychiatric Hospital, Risskov, Denmark. · Acta Psychiatr Scand Suppl. · Pubmed #12974784 No free full text.

Abstract: A subcommittee under the Danish Psychiatric Association and the Child and Adolescent Psychiatric Association in Denmark have recently developed national guidelines for the psychopharmacological treatment with lithium and antiepileptic drugs, and the present translation aims at contributing to the international discussion on the development of proper guidelines for the treatment of bipolar disorder. Among the antiepileptic drugs, the report deals with valproate, carbamazepine and lamotrigine and to a lesser extent with oxcarbazepine, gabapentin and topiramate. The various drugs will be reviewed, outlining the scientific evidence for mood-stabilizing properties and discussing major side effects, the most important interactions with other drugs and practical use. Special considerations during pregnancy and lactation, during treatment of children and adolescents and during treatment of the elderly will also be presented. Antidepressants and antipsychotics are beyond the scope of the report, but due to the mood-stabilizing properties of at least some of the atypical antipsychotics, these agents will be brought into some focus in connection with the overall treatment guidelines for the different phases of bipolar disorder given at the end of this report.

Kessing LV, Hansen HV, Hougaard E, Hvenegaard A, Albaek J. · Rigshospitalet, Psykiatrisk Klinik, København Ø. · Ugeskr Laeger. · Pubmed #17484846 No free full text.

Abstract: The present article is based on a Health Technology Assessment Report (HTA, available with an English summary at www.cemtv.dk) on preventive out-patient treatment of affective disorders. The article briefly reviews the course of depressive disorder and bipolar affective disorder and reviews the best available treatment modalities including shared care models, prophylactic pharmacotherapy and prophylactic combination therapy involving pharmacotherapy and psychological treatment.

Christensen MV, Kessing LV. · Rigshospitalet, Copenhagen, Denkark. · Nord J Psychiatry. · Pubmed #16635925 No free full text.

Abstract: The aim was to investigate whether personality traits predict onset of the first depressive or manic episode (the vulnerability hypothesis) and whether personality might be altered by the mood disorder (the scar hypothesis). A systematic review of population-based and high-risk studies concerning personality traits and affective disorder in adults was conducted. Nine cross-sectional high-risk studies, seven longitudinal high-risk studies and nine longitudinal population-based studies were found. Most studies support the vulnerability hypothesis and there is evidence that neuroticism is a premorbid risk factor for developing depressive disorder. The evidence for the scar hypothesis is sparse, but the studies with the strongest design showed evidence for both hypotheses. Only few studies of bipolar disorder were found and the association between personality traits and bipolar disorder is unclear. Neuroticism seem to be a risk factor by which vulnerable individuals can be identified, thus preventing the development of depressive disorder. A connection between personality traits and development of bipolar disorder, and evidence of a personality-changing effect of affective episodes need to be further investigated.

Kessing LV, Andersen PK. · Department of Psychiatry, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK 2100, Copenhagen Ø, Denmark. · Curr Psychiatry Rep. · Pubmed #16318818 No free full text.

Abstract: Findings from several studies have suggested that the risk of recurrence increases with the number of previous episodes in depressive and bipolar disorders. However, a comprehensive and critical review of the literature published during the past century shows that in several previous studies, a progressive course of episodes may have been falsely shown, mainly because of various kinds of biases and because these studies have not considered individual heterogeneity in their analyses. Nevertheless, four recent studies, including two nationwide register studies from Denmark, a prospective 15-year multicenter study from the United States, and a prospective lifelong study from Zurich, Switzerland, generally have taken these drawbacks and pitfalls into account in the design and handling of data. In all four studies, an effect of episodes was found in depressive (four studies) and bipolar (three studies) disorders. It is concluded that the average risk of recurrence increases with the number of episodes in depressive and in bipolar affective disorders. Nevertheless, the course of illness in unipolar and bipolar disorders is heterogeneous, and the effect of previous episodes and its interrelation with other risk factors on the risk of relapse and recurrence warrants additional research.

Hansen HV, Kessing LV. · H:S Rigshospitalet, Neurocentret, Psykiatrisk Klinik, København. · Ugeskr Laeger. · Pubmed #15929328 No free full text.

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Kessing LV. · Psykiatrisk Afdeling, Rigshospitalet, DK-2100 København Ø. · Ugeskr Laeger. · Pubmed #19210937 No free full text.

Abstract: The paper presents new research results on the pathogenesis of depression and mania and future perspectives on diagnosis and treatment. On the one hand, we know that depression most often develops in the interplay between genes and the environment; and, on the other hand, that depression and mania may be induced suddenly by deep brain stimulation of the subthalamic areas. Ongoing studies aim to identify biomarkers for depression and mania, and results from recent research suggest that neuroticism, abnormal response to the DEX-CRH test, increased frontotemporal serotonine 2A binding, abnormal emotional processing and deceased executive function may be candidates for such biomarkers. These biomarkers may help to improve diagnosis and treatment in the future.

Kessing LV. · Psykiatrisk Center, Rigshospitalet, Afsnit 6233, DK-2100 København Ø. · Ugeskr Laeger. · Pubmed #19014720 No free full text.

Abstract: Psychosis in affective disorder is prevalent as 15-20% of depressive patients and approximately 50% of manic patients present with psychotic features. Psychosis in conjunction with affective disorder has a poor prognosis. It is particularly so for depression where psychosis is associated with an increased risk of recurrence, development of bipolar disorder and suicide. It is still being debated whether these conditions reflect independent illness entities and their relationship to schizoaffective disorder and schizophrenia is also unresolved.

Kessing LV, Søndergård L, Forman JL, Andersen PK. · Department of Psychiatry, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK 2100 Copenhagen, Denmark. · Arch Gen Psychiatry. · Pubmed #18981345 No free full text.

Abstract: CONTEXT: It has been suggested that lithium may have neuroprotective abilities, but it is not clear whether lithium reduces the risk of dementia. OBJECTIVE: To investigate whether continued treatment with lithium reduces the risk of dementia in a nationwide study. DESIGN: An observational cohort study with linkage of registers of all patients prescribed lithium and diagnosed as having dementia in Denmark from January 1, 1995, through December 31, 2005. SETTING: We identified all patients treated with lithium in Denmark within community psychiatry, private specialist, and general practices and a random sample of 30% of the general population. Subjects A total of 16,238 persons who purchased lithium at least once and 1,487,177 persons from the general population who did not purchase lithium. Main Outcome Measure Diagnosis of dementia or Alzheimer disease during inpatient or outpatient hospital care. RESULTS: Persons who purchased lithium at least once had an increased rate of dementia compared with persons not exposed to lithium (relative risk, 1.47; 95% confidence interval, 1.22-1.76). For persons who continued to take lithium, the rate of dementia decreased to the same level as the rate for the general population. The rate of dementia decreased early after the consumption of lithium tablets corresponding to 1 prescription (typically 100 tablets) and stayed at a low level, although with a slight increase according to the number of subsequent prescriptions. The association between the number of prescriptions for lithium and dementia was unique and different from the association between the number of prescriptions for anticonvulsants and dementia. All findings were replicated in subanalyses with Alzheimer disease as the outcome. CONCLUSIONS: Continued lithium treatment was associated with reduction of the rate of dementia to the same level as that for the general population. Methodological reasons for this finding cannot be excluded, owing to the nonrandomized nature of data.

Vinberg M, Bennike B, Kyvik KO, Andersen PK, Kessing LV. · Department of Psychiatry, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark. · Psychiatry Res. · Pubmed #18977033 No free full text.

Abstract: Dysfunction in the hypothalamic-pituitary-adrenal (HPA) axis has been proposed as a biological endophenotype for affective disorders. In the present study the hypothesis that a high genetic liability to affective disorder is associated with higher cortisol levels was tested in a cross-sectional high-risk study. Healthy monozygotic (MZ) and dizygotic (DZ) twins with (High-Risk twins) and without (Low-Risk twins) a co-twin history of affective disorder were identified through nationwide registers. Awakening and evening salivary cortisol levels were compared between the 190 High- and Low-Risk twins. The 109 High-Risk twins had significantly higher evening cortisol levels than the 81 Low-Risk MZ twins, also after adjustment for age, sex, and the level of subclinical depressive symptoms. No significant difference was found in awakening cortisol levels between High-Risk and Low-Risk twins. In conclusion, a high genetic liability to affective disorder was associated with a higher evening cortisol level, but not with awakening cortisol level. Future prospective family, high-risk and twin studies are needed to decide whether abnormalities in the HPA axis can be identified as an endophenotype of affective disorder.

Kessing LV. · Department of Psychiatry, University of Copenhagen, Rigshospitalet, Denmark. · Acta Psychiatr Scand. · Pubmed #18241307 No free full text.

Abstract: OBJECTIVE: To investigate the prevalence of mixed episodes during the course of illness in bipolar disorder. METHOD: A total of 1620 patients with an ICD-10 diagnosis of bipolar affective disorder at the first psychiatric contact were identified in a period from 1994 to 2003 in Denmark and the prevalence of mixed, depressive and hypomanic/manic episodes were calculated at each episode. RESULTS: The prevalence of mixed episodes increased from the first episode to the tenth episode, however, only for women (6.7% of the first episodes leading to psychiatric care compared with 18.2% of the tenth episodes). For men, the prevalence of mixed episodes was constantly low. At all episodes, the presence of a current mixed episode increased the risk substantially of getting a future mixed episode. CONCLUSION: Clinicians should pay more attention to mixed episodes, especially among women, as they may represent an increasing treatment challenge as the illness progress.

Søndergård L, Lopez AG, Andersen PK, Kessing LV. · Department of Psychiatry, University Hospital of Copenhagen, Rigshospitalet, Copenhagen, Denmark. · Bipolar Disord. · Pubmed #18199245 No free full text.

Abstract: OBJECTIVES: This study investigated the association between continued mood-stabilizing treatment (lithium and anticonvulsants) in bipolar disorder (BD) and the risk of suicide. METHODS: Using linkage of national registers, the association between continued mood-stabilizing treatment and suicide was investigated among all patients discharged nationwide from hospital psychiatry as an in- or outpatient in a period from 1995 to 2000 in Denmark with a diagnosis of BD. RESULTS: A total of 5,926 patients were included in the study and among these 51 patients committed suicide eventually during the study period. Although the rate of suicide was higher during periods when patients purchased anticonvulsants (293 suicides per 100,000 person-years) than during periods with lithium (136 suicides per 100,000 person-years), the suicide rate decreased with the number of prescriptions in a rather similar way for patients first treated with lithium and patients first treated with anticonvulsants: patients who continued treatment with mood-stabilizing drugs had a decreased rate of suicide compared to patients who purchased mood stabilizers once only [rate ratio for anticonvulsants = 0.28, 95% confidence interval (CI) = 0.19-0.41; rate ratio for lithium = 0.20, 95% CI = 0.10-0.38]. Further, the rate of suicide decreased consistently with the number of additional prescriptions. Switch to or augmentation with lithium to patients initiated on anticonvulsants was associated with a significantly reduced rate of suicide (rate ratio = 0.28, 95% CI = 0.20-0.40), whereas a switch to or augmentation with anticonvulsants to patients first started on lithium showed no additional effect on the suicide rate. CONCLUSIONS: Although continued treatment with anticonvulsants and continued treatment with lithium was associated with a rather similar reduction in the rate of suicide, the results suggest that treatment with lithium may have some superiority in relation to prevention of suicide.

Kessing LV, Jensen HM, Christensen EM. · Department of Psychiatry, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark. · Psychopathology. · Pubmed #18187963 No free full text.

Abstract: BACKGROUND: The aim of the study was to investigate whether patients with bipolar depression and patients with recurrent depressive disorder present with different subtypes of depressive episode as according to ICD-10. SAMPLING AND METHODS: All patients who got a diagnosis of bipolar affective disorder, current episode of depression, or a diagnosis of recurrent depressive disorder, current episode of depression, in a period from 1994 to 2002 at the first outpatient treatment or at the first discharge from psychiatric hospitalization in Denmark were identified in a nationwide register. RESULTS: Totally, 389 patients got a diagnosis of bipolar disorder, current episode of depression, and 5.391 patients got a diagnosis of recurrent depressive disorder, current episode of depression, at first contact. Compared with patients with a diagnosis of recurrent depressive disorder, patients with bipolar disorder, current episode of depression, were significantly less often outpatients (49.4 vs. 68.0%), significantly more often got a diagnosis of severe depression (42.7 vs. 23.3%) or a diagnosis of depression with psychotic symptoms (14.9 vs. 7.2%). The rate of subsequent hospitalization was increased for patients with bipolar disorder, current episode of depression, compared with patients with a current depression as part of a recurrent depressive disorder (HR = 1.50, 95% CI = 1.20-1.86). CONCLUSIONS: The results consistently indicate that a depressive episode is severer and/or more often associated with psychotic symptoms when it occurs as part of a bipolar disorder than as part of a recurrent depressive disorder.

Kvist K, Gerster M, Andersen PK, Kessing LV. · Department of Biostatistics, Institute of Public Health, University of Copenhagen, Copenhagen, Denmark. · Stat Med. · Pubmed #17994608 No free full text.

Abstract: For recurrent events there is evidence that misspecification of the frailty distribution can cause severe bias in estimated regression coefficients (Am. J. Epidemiol 1998; 149:404-411; Statist. Med. 2006; 25:1672-1684). In this paper we adapt a procedure originally suggested in (Biometrika 1999; 86:381-393) for parallel data for checking the gamma frailty to recurrent events. To apply the model checking procedure, a consistent non-parametric estimator for the marginal gap time distributions is needed. This is in general not possible due to induced dependent censoring in the recurrent events setting, however, in (Biometrika 1999; 86:59-70) a non-parametric estimator for the joint gap time distributions based on the principle of inverse probability of censoring weights is suggested. Here, we attempt to apply this estimator in the model checking procedure and the performance of the method is investigated with simulations and applied to Danish registry data. The method is further investigated using the usual Kaplan-Meier estimator and a marginalized estimator for the marginal gap time distributions. We conclude that the procedure only works when the recurrent event is common and when the intra-individual association between gap times is weak.

Trajkovska V, Vinberg M, Aznar S, Knudsen GM, Kessing LV. · Neurobiology Research Unit and Center for Integrated Molecular Brain Imaging, Copenhagen University Hospital, Section 9201, Blegdamsvej 9, 2100 Copenhagen, Denmark. · J Affect Disord. · Pubmed #17920693 No free full text.

Abstract: BACKGROUND: Depression has been associated with decreased blood BDNF concentrations; but it is unclear if low blood BDNF levels are a state or a trait marker of depression. METHODS: We investigated blood BDNF concentrations in a twin population including both subjects highly predisposed and protected against affective disorder. Whole blood assessed for BDNF concentrations and correlated to risk status, neuroticism, and number of stressful life events. RESULTS: Between the groups, we found no significant difference in whole blood BDNF levels. Women at high-risk for depression who had experienced three or more recent stressful events (n=26) had decreased whole blood BDNF levels compared to high-risk women with two or less recent stressful events (n=35), 21.6+/-7.0 vs. 18.5+/-4.1 ng/ml, respectively, (p<0.05). No such association was found in low-risk women or in men. In men, however, low neuroticism scores and two or less recent stressful events were associated with decreased whole blood BDNF levels (n=50, p<0.05). LIMITATIONS: The cross-sectional design limits the possibility of drawing firm conclusions on causatility of the findings. CONCLUSION: The genetic risk of developing depression does not translate directly into whole blood BDNF levels. In females who are genetically disposed for depression and subjected to recent stressful life events whole blood BDNF levels are lower.

Vinberg M, Kessing LV. · Rigshospitalet, Affektiv Forskningsenhed, København Ø. · Ugeskr Laeger. · Pubmed #17484838 No free full text.

Abstract: There is consensus that genetic factors are the most important risk factor for both bipolar and unipolar disorders. Concerning other risk factors there seems to be complex interactions between biological, psychological and sociological factors. For bipolar disorder, suggestive findings have been provided concerning pregnancy and stressful life events and female gender and stressful life events are the most reliable factors for unipolar disorder. Clinical and research recommendations are given in order to create strategies for the prevention of affective disorders.

Bech P, Hansen HV, Kessing LV. · Psychiatric Research Unit, Frederiksborg General Hospital, Hillerod, Denmark. · Psychother Psychosom. · Pubmed #17053337 No free full text.

Abstract: OBJECTIVE: To analyse the internalising and externalising dimensions of affective states in depressed (unipolar) and bipolar patients approximately 2 years after discharge from psychiatric hospitals in Denmark. METHOD: The 42-item symptom scale based on the Beck Depression Inventory was used for the measurement of both the internalising dimension of affective symptoms (depression including suicidal ideas, anxiety and asthenia) and the externalising dimension (mania). To supplement the latter dimension, the WHO-5 questionnaire was included. These questionnaires were mailed to a large population of patients with depressive (unipolar) or bipolar disorders, representative of patients treated in hospital settings in Denmark, approximately 2 years after discharge from hospital. RESULTS: In total, 244 unipolars and 214 bipolars were included in the study. Mokken analysis showed that depressive (unipolar) patients could be measured more validly than bipolar patients on the internalising subscales of depression, anxiety and asthenia. On the externalising dimension of psychological well-being (WHO-5), both groups of patients could be validly measured. Approximately 2 years after discharge from hospital, around 36% of the unipolars and 19% of the bipolars had a moderate to severe depression. In a control group of healthy subjects, 4% had a moderate to severe depression. Less than 5% even in the bipolar group of patients were hypomanic. CONCLUSION: Approximately 2 years after discharge from psychiatric hospitals in Denmark, depressive (unipolar) patients scored significantly higher than bipolar patients on the internalising dimension and suicidal ideas, and significantly lower on the externalising dimension of psychological well-being.

Christensen MV, Kyvik KO, Kessing LV. · Department of Psychiatry, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark. · Psychol Med. · Pubmed #16734950 No free full text.

Abstract: BACKGROUND: Patients may present with cognitive impairment in the euthymic phase of affective disorder, but it is unclear whether the impairment is prevalent before onset of the illness. The aim of the present study was to examine the hypothesis that genetic liability to affective disorder is associated with cognitive impairment. METHOD: In a cross-sectional high-risk case-control study, healthy monozygotic (MZ) and dizygotic (DZ) twins with (High-Risk twins) and without (the control group/Low-Risk twins) a co-twin history of affective disorder were identified through nationwide registers. Cognitive performance of 203 High-Risk and Low-Risk twins was compared. RESULTS: Healthy twins discordant for unipolar disorder showed lower performance on almost all measures of cognitive function: selective and sustained attention, executive function, language processing and working and declarative memory, and also after adjustment for demographic variables, subclinical symptoms and minor psychopathology. Healthy twins discordant for bipolar disorder showed lower performance on tests measuring episodic and working memory, also after adjustment for the above-mentioned covariables. The discrete cognitive impairment found seemed to be related to genetic liability, as the MZ High-Risk twins showed significant impairment on selective and sustained attention, executive function, language processing and working and declarative memory, whereas the DZ High-Risk twins presented with significantly lower scores only on language processing and episodic memory. CONCLUSIONS: The hypothesis that discrete cognitive impairment is present before the onset of the affective disorder and is genetically transmitted was supported. Thus, cognitive function may be a candidate endophenotype for affective disorders.

Kessing LV, Hansen HV, Bech P. · Department of Psychiatry, Rigshospitalet, University Hospital of Copenhagen, Copenhagen, Denmark. · Clin Pract Epidemol Ment Health. · Pubmed #16712717 links to  free full text

Abstract: BACKGROUND: There is increasing evidence that attitudes and beliefs are important in predicting adherence in depressive and bipolar disorders. However, such attitudes and beliefs on mood stabilizers have not been analysed by socio-demographic and clinical variables. METHODS: The Mood Stabilizer Compliance Questionnaire (MSQC) was mailed to a large population of patients with depressive or bipolar disorder representative of patients treated at their first contacts to hospital settings in Denmark. RESULTS: Of the 1005 recipients, 49.9 % responded to the letter and among these 256 indicated that they previously had been or currently were in treatment with a mood stabilizer. A large proportion of the patients (40 to 80 %) had non-correct views on the effect of mood stabilizers. Older patients consistently had a more negative view on the doctor-patient relationship, more non-correct views on the effect of mood stabilizers and a more negative view on mood stabilizers. There was no difference in the attitudes and beliefs according to the type of disorder (depressive or bipolar), the number of psychiatric hospitalisations or according to the type of the current doctor (general practitioner, private psychiatrist, community psychiatry doctor, hospital doctor, other doctor). CONCLUSION: There is a need of improving knowledge and attitudes toward diagnosis and treatment especially among elder patients as this may add to improve the prognosis of depressive and bipolar disorders.

Kessing LV, Hansen HV, Bech P. · Department of Psychiatry, Rigshospitalet, DK 2100 Copenhagen, Denmark. · Nord J Psychiatry. · Pubmed #16635935 No free full text.

Abstract: Prior studies have found contradictory results regarding the association between course of illness and quality of life among patients with depressive disorder or bipolar disorder. Questionnaires about quality of life and affective symptoms (the EQ-5D, EQ-5D-VAS, WHO (Five) well-being index and the BDI-42) were mailed to a large population of outpatients with depressive or bipolar disorder representative of patients treated in hospital settings in Denmark. Among the 1005 recipients, 49.9% responded to the letter. Depressive disorder was associated with poorer general health (EQ-5D, EQ-5D-VAS) and well-being (WHO (Five) well-being index) and more depressive and anxiety symptoms compared with bipolar disorder. Similarly, more psychiatric admissions were associated with poorer general health and well-being and more depressive and anxiety symptoms. However, when adjusting for the effect of depressive symptoms, the associations between number of admissions and general health, and between numbers of admissions and well-being, lost significance. Thus, depressive symptoms seem to be the strongest predictor of general health and well-being in both disorders. As the response rate to the questionnaire was relatively low, the findings should be interpreted with caution.

Kessing LV. · Department of Psychiatry, University of Copenhagen, Rigshospitalet and Department of Psychiatric Demography, University of Aarhus, Psychiatric Hospital, Risskov, Denmark. · Int Psychogeriatr. · Pubmed #16524490 No free full text.

Abstract: BACKGROUND: It is currently not known whether elderly men and women present with different subtypes of depression and mania/bipolar disorder. The aim of this study was to compare the prevalence of subtypes of a single depressive episode and mania/bipolar disorder according to the ICD-10 for elderly men and women in a nationwide sample of all out- and inpatients in psychiatric settings. METHODS: All patients older than 65 years who received a diagnosis of a single depressive episode and mania/bipolar disorder in the period from 1994 to 2002 at the end of their first outpatient treatment or at their first discharge from psychiatric hospitalization in Denmark were identified in a nationwide register. RESULTS: A total of 9837 patients aged more than 65 years received a diagnosis of a single depressive episode (69.9% were women) and 443 a diagnosis of mania/bipolar disorder (61.6% were women) at the end of their first contact with psychiatric health care. Slightly more women than men received a diagnosis of mild (70.8%) or moderate depression (67.4%) compared to severe depression (65.9%). Men more often presented with a single depressive episode with comorbid substance abuse or comorbid somatic illness. No gender differences were found in the prevalence of depression with or without melancholic or psychotic symptoms. Men more often presented with mania/bipolar disorder with comorbid substance abuse. CONCLUSIONS: The distributions of the subtypes of a single depressive episode or mania/bipolar disorder are remarkably similar for male and female patients aged over 65 years with first contact with the psychiatric health-care system.

Kessing LV, Hansen HV, Ruggeri M, Bech P. · Dept. of Psychiatry, Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen Ø, Denmark. · Soc Psychiatry Psychiatr Epidemiol. · Pubmed #16456641 No free full text.

Abstract: BACKGROUND: Patients' satisfaction with care may be an important factor in relation to adherence to treatment and continued psychiatric care. Few studies have focused on satisfaction in patients with depressive and bipolar disorders. METHOD: A comprehensive multidimensional questionnaire scale, the Verona Service Satisfaction Scale-Affective, was mailed to a large population of patients with depressive or bipolar disorders representative of outpatients treated at their first contact to hospital settings in Denmark. RESULTS: Among the 1,005 recipients, 49.9% responded to the letter. Overall, patients were satisfied with the help provided, but satisfaction with the professionals' contact to relatives was low. Younger patients (age below 40 years) were consistently more dissatisfied with care especially with the efficacy of treatment, professionals' skills and behaviour and the information given. There was no difference in satisfaction between genders or between patients with depressive disorder and patients with bipolar disorder. CONCLUSION: There is a need to strengthen outpatient treatment for patients discharged from a psychiatric hospital diagnosed of having affective disorders, focusing more on information and psychoeducation for patients and relatives.

Kessing LV. · Department of Psychiatry, University of Copenhagen, Rigshospitalet, Denmark. · Bipolar Disord. · Pubmed #16411981 No free full text.

Abstract: OBJECTIVE: To investigate differences in diagnostic subtypes of bipolar disorder as according to ICD-10 between patients whose first contact with psychiatric health care occurs late in life (over 50 years of age) and patients who have first contact earlier in life (50 years of age or below). METHODS: From 1994 to 2002 all patients who received a diagnosis of a manic episode or bipolar disorder at initial contact with the mental healthcare system, whether outpatient or inpatient, were identified in Denmark's nationwide register. RESULTS: A total of 852 (49.6%) patients, who were over age 50, and 867 patients, who were 50 or below, received a diagnosis of a manic episode or bipolar disorder at the first contact ever. Older inpatients presented with psychotic symptoms (35.4%) significantly less than younger inpatients (42.6%) due specifically to a lower prevalence of manic episodes with psychotic symptoms. Conversely, older inpatients more often presented with severe depressive episodes with psychotic symptoms than younger inpatients (32.0% versus 17.0%). Among outpatients, no significant differences were found between patients older than 50 years and patients 50 years of age or younger. However, a bimodal distribution of age at first outpatient contact was found with an intermode of 65 years and outpatients older than 65 years more often presented with severe depressive episodes with psychosis. CONCLUSIONS: Bipolar patients who are older at first psychiatric hospitalization (>50 years) present less with psychotic manic episodes and more with severe depressive episodes with psychosis than younger patients. The distribution of age at first outpatient contact is bimodal with an intermode of 65 years and outpatients older than 65 years more often present with severe depressive episodes with psychosis.

Christensen MV, Kessing LV. · Department of Psychiatry, Rigshospitalet, University Hospital of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark. · Clin Pract Epidemol Ment Health. · Pubmed #16212656 links to  free full text

Abstract: BACKGROUND: The relationship between life stressors, coping and affective disorder is interesting when predicting onset of a affective disorder and relapse of mood episodes. METHODS: A literature review of cross-sectional and longitudinal studies concerning coping and affective disorder in adults including a Medline and Embase search was conducted. RESULTS: 11 cross-sectional studies and 17 longitudinal studies concerning affective disorder and coping were found, among these, two studies include patients with bipolar disorder exclusively. Only four studies elucidate whether emotion-oriented and/or avoidance coping styles are associated with a higher risk of developing affective disorder, so this hypothesis remains unclear. Most studies shows that emotion-oriented and avoidance coping strategies are associated with relapse of depressive episodes. Conversely, problem-focused and task-oriented coping seem to be associated with a good outcome. CONCLUSION: There is a gap between coping theory and clinical use of coping and the clinical relevance of coping is, though promising, still unclear. In future research it is recommended to concentrate on development of a semi-structured interview combining coping style, life events and personality traits.

Kessing LV, Hansen HV, Demyttenaere K, Bech P. · Department of Psychiatry, Rigshospitalet University Hospital of Copenhagen, Copenhagen, Denmark. · Psychol Med. · Pubmed #16116946 No free full text.

Abstract: BACKGROUND: There is increasing evidence that attitudes and beliefs are important in predicting adherence to treatment and medication in depressive and bipolar disorders. However, these attitudes have received little study in patients whose disorders were sufficiently severe to require hospitalization. METHOD: The Antidepressant Compliance Questionnaire (ADCQ) was mailed to a large population of patients with depressive or bipolar disorder, representative of patients treated in hospital settings in Denmark. RESULTS: Of the 1005 recipients, 49.9% responded to the letter. A large proportion of the patients (40-80%) had erroneous views as to the effect of antidepressants. Older patients (over 40 years of age) consistently had a more negative view of the doctor-patient relationship, more erroneous ideas concerning the effect of antidepressants and a more negative view of antidepressants in general. Moreover, their partners agreed on these negative views. Women had a more negative view of the doctor-patient relationship than men, and patients with a depressive disorder had a more negative view of antidepressants than patients with bipolar disorder. The number of psychiatric hospitalizations or the type of treating physician (general practitioner, psychiatrist in private practice, community psychiatrist, hospital psychiatrist, other doctor) did not affect attitudes and beliefs. CONCLUSION: Lack of knowledge about affective disorder and its treatment and a critical attitude, especially among older patients, may add to an adverse prognosis of depressive and bipolar disorders.

Kessing LV, Søndergård L, Kvist K, Andersen PK. · Department of Psychiatry, University Hospital of Copenhagen, Rigshospitalet, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark. · Arch Gen Psychiatry. · Pubmed #16061763 links to  free full text

Abstract: CONTEXT: Prior observational studies suggest that treatment with lithium may be associated with reduced risk of suicide in bipolar disorder. However, these studies are biased toward patients with the most severe disorders, and the relation to sex and age has seldom been investigated. OBJECTIVE: To investigate whether treatment with lithium reduces the risk of suicide in a nationwide study. DESIGN: An observational cohort study with linkage of registers of all prescribed lithium and recorded suicides in Denmark during a period from January 1, 1995, to December 31, 1999. SETTING: All patients treated with lithium in Denmark, ie, within community psychiatry, private specialist practice settings, and general practice. PARTICIPANTS: A total of 13 186 patients who purchased at least 1 prescription of lithium and 1.2 million subjects from the general population. MAIN OUTCOME MEASURE: All suicides identified on the basis of death certificates completed by doctors at the time of death. RESULTS: Patients who purchased lithium had a higher rate of suicide than persons who did not purchase lithium. Purchasing lithium at least twice was associated with a 0.44 reduced rate of suicide (95% confidence interval, 0.28-0.70) compared with the rate when purchasing lithium only once. Further, the rate of suicide decreased with the number of prescriptions of lithium. There was no significant interaction between continued lithium treatment and sex and age regarding the suicide rate. CONCLUSION: In a nationwide study including all patients treated with lithium, it was found that continued lithium treatment was associated with reduced suicide risk regardless of sex and age.