Department of Mental Health

Sleep Problems and Hospitalization for Self-Harm-Junker et al Self-harm (SH) is one of the most frequent reasons for hospitalization in people under 30 years of age 1 and is the strongest risk factor for suicide. 2 Approximately 7% of those hospitalized following non-fatal SH die by suicide over the following nine years or longer. The etiology of SH is complex. 4-6 Its incidence peaks at age 15-24 and occurs more frequently in females than males. Data from the UK indicate an annual incidence of hospital presentation following self-harm in 15-to 24-year-olds of 0.3% for males and 0.7% for females 7 ; figures from a cohort study of 14to 19-year-old Norwegian high school students indicates that the 5-year incidence of suicide attempts was 3.2% (0.6% per year). 8 The literature is difficult to interpret, as many cases of self-harm do not present to medical services, and of those cases that do, many are not admitted to a hospital bed. Key risk factors for SH include depression symptoms and other psychiatric disorders, 9,10 drug/alcohol misuse, 5 stressful life events, 11,12 and socioeconomic disadvantages. 9 There is growing interest in the role sleep disturbance may play both in the etiology of psychiatric disorders and in suicidal behavior. Sleep difficulties have been reported as being associated with a twofold increased Objectives: To investigate the association between sleeping problems in adolescence and subsequent hospital admission for self-harm (SH). Design: Prospective cohort study, linking health survey information on sleep problems to hospital-based patient records. Setting: Residents of Nord-Trøndelag County, Norway, aged 13-19 years in 1995-97. Patients or Participants: 10,202 adolescents were invited to participate in the Young-HUNT study; 8,983 (88%) completed the health survey. Measurements and Results: 10% of participants reported difficulties initiating sleep, 4% reported early morning wakening. Ninety-eight participants (27% male) were hospitalized following SH over a mean 12 years follow-up. Difficulties initiating sleep/early morning wakening were associated with increased risk of SH (HR 2.11, 95% CI 1.29-3.46, sex-and age-adjusted) compared with no problems, yet coexistent symptoms of combined anxiety/depression explained most of the association with sleep problems (fully adjusted HR 1.19, 95% CI 0.66-2.16). The HR of combined difficulties initiating sleep/early morning wakening differed in those with and without anxiety/depression at baseline (P interaction = 0.03); among those without caseness symptoms of anxiety/depression it was 5.58 (95% CI 2.02-15.40), while in those with caseness symptoms of anxiety/ depression it was 0.82 (95% CI 0.19-3.44).

Background: The onset of bipolar disorder is influenced by the interaction of genetic and environmental factors. We previously found that a large increase in sunlight in springtime was associated with a lower age of onset. This study extends this analysis with more collection sites at diverse locations, and includes family history and polarity of first episode. Methods: Data from 4037 patients with bipolar I disorder were collected at 36 collection sites in 23 countries at latitudes spanning 3.2 north (N) to 63.4 N and 38.2 south (S) of the equator. The age of onset of the first episode, onset location, family history of mood disorders, and polarity of first episode were obtained retrospectively, from patient records and/or direct interview. Solar insolation data were obtained for the onset locations. Results: There was a large, significant inverse relationship between maximum monthly increase in solar insolation and age of onset, controlling for the country median age and the birth cohort. The effect was reduced by half if there was no family history. The maximum monthly increase in solar insolation occurred in springtime. The effect was one-third smaller for initial episodes of mania than depression. The largest maximum monthly increase in solar insolation occurred in northern latitudes such as Oslo, Norway, and warm and dry areas such as Los Angeles, California. Limitations: Recall bias for onset and family history data. Conclusions: A large springtime increase in sunlight may have an important influence on the onset of bipolar disorder, especially in those with a family history of mood disorders.

The onset of bipolar disorder is influenced by the interaction of genetic and environmental factors. We previously found that a large increase in sunlight in springtime was associated with a lower age of onset. This study extends this analysis with more collection sites at diverse locations, and includes family history and polarity of first episode. Data from 4037 patients with bipolar I disorder were collected at 36 collection sites in 23 countries at latitudes spanning 3.2 north (N) to 63.4 N and 38.2 south (S) of the equator. The age of onset of the first episode, onset location, family history of mood disorders, and polarity of first episode were obtained retrospectively, from patient records and/or direct interview. Solar insolation data were obtained for the onset locations. There was a large, significant inverse relationship between maximum monthly increase in solar insolation and age of onset, controlling for the country median age and the birth cohort. The effect was reduce...

Objective: Electroconvulsive therapy (ECT) is regarded by many clinicians as the most effective treatment for treatment-resistant bipolar depression, but no randomized controlled trials have been conducted, to the authors' knowledge. They compared efficacy measures of ECT and algorithm-based pharmacological treatment in treatmentresistant bipolar depression.

Background: The literature on the neuropsychological profiles in Bipolar disorder (BD) depression is sparse. The aims of the study were to assess the neurocognitive profiles in treatment-resistant, acutely admitted BD depression inpatients, to compare the neurocognitive functioning in patients with BD I and II, and to identify the demographic and clinical illness characteristics associated with cognitive functioning. Methods: Acutely admitted BD I (n = 19) and BD II (n = 32) inpatients who fulfilled the DSM-IV-TR criteria for a major depressive episode were tested with the MATRICS Consensus Cognitive Battery (MCCB), the Wechsler Abbreviated Scale of Intelligence, the National Adult Reading Test, and a battery of clinical measures.

Background: There is conflicting evidence regarding the educational level and its importance for social and occupational functioning in bipolar disorder (BD). The aim of this study was to investigate how educational achievement relates to function in BD compared with the general population, and which clinical factors are associated with level of education. Methods: Hospitalized patients with DSM-IV BD (N = 257; 69.3% BD I; 25.7% BD II; 5.1 BD NOS; 51.4% females) were consecutively recruited from mental health clinics throughout Norway and compared with a geographically matched reference sample from the general population (N = 56,540) on levels of education, marital status, income, and disability benefits. Further analyses of association were carried out using logistic regression analyses. Results: A significantly higher proportion of subjects in the BD group than in the reference group was single, had low income, or was disabled. No between-group difference was found in educational level. In the reference group education was inversely correlated with the risk of being disabled, but no such relationship was found in the BD group. Rapid cycling and recurring depressive episodes were the only clinical characteristics associated with low educational level. Limitations: Acutely admitted patients might not be representative for milder forms of disease. Conclusions: Despite similar levels of education, BD patients had lower social and occupational function than the general population, and no association was found between education and disability for BD patients.

Background: The aims of this study were to compare clinical characteristics and educational and occupational functioning in two Bipolar Disorder (BD) samples recruited respectively from acutely admitted inpatients and public outpatient clinics and to investigate if the two BD samples differed in the same way in education and work ability from the general population. Methods: DSM-IV BD patients were consecutively recruited from acute wards throughout Norway (N = 252; 69.8% BD I; 25.0% BD II; 5.2% BD NOS) and from outpatient clinics in the Oslo region (N = 230; 60.4% BD I; 33.5% BD II; 6.1% BD NOS) and demographic and clinical characteristics were compared. A reference sample from the general population (N = 100 869) was used to compare levels of education, marital status and disability benefits. Results: The acute ward sample was older, and had more men, more BD I disorder, more hospitalisations and suicide attempts, longer illness duration, an earlier age of onset and first treatment and used a higher number of antipsychotics, anticonvulsants and lithium than the outpatient sample. Both samples were educated to the same level as their respective reference populations, but received disability benefit and were single to a higher but similar degree. Conclusions: Clinical differences between the BD samples had no consequence for educational achievement and receipt of disability benefit compared to the general population indicating that other factors than severity of illness play a role for education and work abilities in BD patients.

Background: The treatment of depressive phases of bipolar disorder is challenging. The effects of the commonly used antidepressants in bipolar depression are questionable. Electroconvulsive therapy is generally considered to be the most effective treatment even if there are no randomized controlled trials of electroconvulsive therapy in bipolar depression. The safety of electroconvulsive therapy is well documented, but there are some controversies as to the cognitive side effects. The aim of this study is to compare the effects and side effects of electroconvulsive therapy to pharmacological treatment in treatment resistant bipolar depression. Cognitive changes and quality of life during the treatment will be assessed.

Background: In the psychiatric acute and emergency services patients present in severe crisis often complicated by behavioral problems, substance use, and multiple axis 1 diagnoses. In these clinical settings both legal and illegal use of benzodiazepines are difficult to evaluate since benzodiazepines could in some patients be regarded as first line treatment and in other patients as the cause of the acute psychiatric condition. The aims of this study were to evaluate the frequency and clinical effects of both legal and illegal use of benzodiazepines at admittance to a psychiatric acute department. Methods: All patients acutely admitted to a Norwegian acute psychiatric university department serving a catchment area were asked about use of benzodiazepines, other medications and substances before admission.

Background: Patients with brief depressive episodes and concurrent rapidly fluctuating psychiatric symptoms do not fit current diagnostic criteria and they can be difficult to diagnose and treat in an acute psychiatric setting. We wanted to study whether these patients had signs of more epileptic or organic brain dysfunction than patients with depression without additional symptomatology.

Background: Depressive disorders are frequent in epilepsy and associated with reduced seizure control. Almost 50% of interictal depressive disorders have to be classified as atypical depressions according to DSM-4 criteria. Research has mainly focused on depressive symptoms in defined populations with epilepsy (e.g., patients admitted to tertiary epilepsy centers). We have chosen the opposite approach. We hypothesized that it is possible to define by clinical means a subgroup of psychiatric patients with higher than expected prevalence of epilepsy and seizures. We hypothesized further that these patients present with an Acute Unstable Depressive Syndrome (AUDS) that does not meet DSM-IV criteria of a Major Depressive Episode (MDE). In a previous publication we have documented that AUDS patients indeed have more often a history of epileptic seizures and abnormal EEG recordings than MDE patients ). This study aimed to further classify the differences of depressive symptoms at admittance and follow-up of patients with AUDS and MDE.

The emergency room is the interface between community and health care institution. Whether through outreach or in-hospital service, the psychiatrist in the general hospital must have specialized skill and knowledge to attend the increased numbers of mentally ill, substance abusers, homeless individuals, and those with greater acuity and comorbidity than previously known. This Special Section will address those overlapping aspects of psychiatric, medicine, neurology, psychopharmacology, and psychology of essential interest to the psychiatrist who provides emergency consultation and treatment to the general hospital population.