Asunto(s)
Proteína C9orf72/genética , Demencia Frontotemporal/complicaciones , Levodopa/administración & dosificación , Manía/inducido químicamente , Demencia Frontotemporal/tratamiento farmacológico , Demencia Frontotemporal/genética , Humanos , Masculino , Manía/complicaciones , Persona de Mediana Edad , Expansión de Repetición de TrinucleótidoRESUMEN
BACKGROUND: Antipsychotics are often used to treat neuropsychiatric symptoms in dementia, but the evidence for effect is limited. Antipsychotics have been associated with increased risk of adverse events and mortality in patients with dementia, leading to safety regulations worldwide. OBJECTIVE: To investigate time trends in use of antipsychotics and other psychotropic drugs in dementia care. METHODS: The study included longitudinal data on all Danish residents ≥65 years. The study population was defined on January 1 of each year from 2000-2012. Data included prescriptions, discharge diagnoses, and somatic and psychiatric comorbidities. Multivariate time trend analyses of psychotropic drug use in patients with dementia within 4-year age bands were performed. RESULTS: Overall, among patients with dementia the prevalence of antipsychotic drug use decreased from 31.3% in 2000 to 20.4% in 2012. The decreasing use of antipsychotics was accompanied by decreasing use of anxiolytics and hypnotics/sedatives, but an increase in the use of antidepressants from 43.3% in 2000 to 53.8% in 2012. These changes were significant across almost all age groups. Treatment intensity among patients using antipsychotics increased as the annual median number of defined daily doses (DDD) increased from 33.3 to 42.0 DDD. CONCLUSIONS: The changing patterns of psychotropic drug use may be caused by warnings against use of antipsychotics. Further research is needed to explore the implications for patient safety.
Asunto(s)
Ansiolíticos/uso terapéutico , Antidepresivos/uso terapéutico , Antipsicóticos/uso terapéutico , Demencia/tratamiento farmacológico , Prescripciones de Medicamentos/estadística & datos numéricos , Hipnóticos y Sedantes/uso terapéutico , Anciano , Anciano de 80 o más Años , Demencia/epidemiología , Dinamarca , Femenino , Hogares para Ancianos , Humanos , Estudios Longitudinales , Masculino , Análisis Multivariante , Casas de Salud , Sistema de RegistrosRESUMEN
BACKGROUND: It is unknown whether young adults with bipolar disorder are able to benefit from early intervention combining optimised pharmacological treatment and group psychoeducation. The aim of the present report was to compare the effects of early intervention among patients with bipolar disorder aged 18-25 years to that of patients aged 26 years or older. METHODS: Patients were randomised to early treatment in a specialised outpatient mood disorder clinic versus standard care. The primary outcome was risk of psychiatric re-hospitalisation. RESULTS: A total of 158 patients with mania/bipolar disorder were included among whom 29 (18.4%) were between 18 and 25 years and 129 patients were 26 years or older. For both age groups, the point estimate of the hazard ratio of re-hospitalisation was insignificantly decreased for patients treated in the mood disorder clinic versus standard treatment but more so for patients between 18 and 25 years (HR 0.33, 95% CI 0.10-1.07; p=0.064) than for patients 26 years or older (HR 0.68, 95% CI 0.40-1.14, p=0.14). Younger adults treated in the mood disorder clinic used mood stabilisers and antipsychotics more in contrast to those treated in standard care. The differences between the estimates of effects did not reach significance in tests of interactions (p>0.2). LIMITATIONS: The study was based on a post hoc subgroup analysis and due to the small number of patients aged 18-25 years, type II errors cannot be excluded. CONCLUSIONS: Although not statistically different, the observed differences of the point estimates was surprisingly larger for young adults suggesting that young adults with bipolar disorder may benefit even more than older adults from early intervention combining pharmacological treatment and group psychoeducation.
Asunto(s)
Trastorno Bipolar/terapia , Intervención Médica Temprana , Adolescente , Adulto , Factores de Edad , Antimaníacos/uso terapéutico , Antipsicóticos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Terapia Combinada , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Psicoterapia de Grupo , Adulto JovenRESUMEN
BACKGROUND: Little is known about whether treatment in a specialised out-patient mood disorder clinic improves long-term prognosis for patients discharged from initial psychiatric hospital admissions for bipolar disorder. AIMS: To assess the effect of treatment in a specialised out-patient mood disorder clinic v. standard decentralised psychiatric treatment among patients discharged from one of their first three psychiatric hospital admissions for bipolar disorder. METHOD: Patients discharged from their first, second or third hospital admission with a single manic episode or bipolar disorder were randomised to treatment in a specialised out-patient mood disorder clinic or standard care (ClinicalTrials.gov: NCT00253071). The primary outcome measure was readmission to hospital, which was obtained from the Danish Psychiatric Central Register. RESULTS: A total of 158 patients with mania/bipolar disorder were included. The rate of readmission to hospital was significantly decreased for patients treated in the mood disorder clinic compared with standard treatment (unadjusted hazard ratio 0.60, 95% CI 0.37-0.97, P = 0.034). Patients treated in the mood disorder clinic more often used a mood stabiliser or an antipsychotic and satisfaction with treatment was more prevalent than among patients who received standard care. CONCLUSIONS: Treatment in a specialised mood disorder clinic early in the course of bipolar disorder substantially reduces readmission to a psychiatric hospital and increases satisfaction with care.
Asunto(s)
Atención Ambulatoria/métodos , Trastorno Bipolar/terapia , Hospitalización/estadística & datos numéricos , Hospitales Psiquiátricos , Evaluación de Resultado en la Atención de Salud/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Adolescente , Adulto , Anciano , Atención Ambulatoria/economía , Instituciones de Atención Ambulatoria , Antimaníacos/uso terapéutico , Antipsicóticos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Trastorno Bipolar/economía , Dinamarca , Femenino , Estudios de Seguimiento , Costos de la Atención en Salud , Hospitalización/economía , Humanos , Masculino , Persona de Mediana Edad , Alta del Paciente , Educación del Paciente como Asunto , Psicoterapia de Grupo/métodos , Recurrencia , Tiempo de Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Little is known on whether centralised and specialised combined pharmacological and psychological intervention in the early phase of severe unipolar depression improve prognosis. The aim of the present study was to assess the benefits and harms of centralised and specialised secondary care intervention in the early course of severe unipolar depression. METHODS: A randomised multicentre trial with central randomisation and blinding in relation to the primary outcome comparing a centralised and specialised outpatient intervention program with standard decentralised psychiatric treatment. The interventions were offered at discharge from first, second, or third hospitalisation due to a single depressive episode or recurrent depressive disorder. The primary outcome was time to readmission to psychiatric hospital. The data on re-hospitalisation was obtained from the Danish Psychiatric Central Register. The secondary and tertiary outcomes were severity of depressive symptoms according to the Major Depression Inventory, adherence to medical treatment, and satisfaction with treatment according to the total score on the Verona Service Satisfaction Scale-Affective Disorder (VSSS-A). These outcomes were assessed using questionnaires one year after discharge from hospital. RESULTS: A total of 268 patients with unipolar depression were included. There was no significant difference in the time to readmission (unadjusted hazard ratio 0.89, 95% confidence interval 0.60 to 1.32; log rank: χ(2)â=â0.3, d.f.â=â1, pâ=â0.6); severity of depressive symptoms (mood disorder clinic: median 21.6, quartiles 9.7-31.2 versus standard treatment: median 20.2, quartiles 10.0-29.8; pâ=â0.7); or the prevalence of patients in antidepressant treatment (73.9% versus 80.0%, pâ=â0.2). Centralised and specialised secondary care intervention resulted in significantly higher satisfaction with treatment (131 (SD 31.8) versus 107 (SD 25.6); p<0.001). CONCLUSIONS: Centralised and specialised secondary care intervention in the early course of severe unipolar depression resulted in no significant effects on time to rehospitalisation, severity of symptoms, or use of antidepressants, but increased patient satisfaction. TRIAL REGISTRATION: ClinicalTrials.gov NCT00253071.
Asunto(s)
Trastorno Depresivo/terapia , Cooperación del Paciente , Sistema de Registros , Adulto , Antidepresivos/administración & dosificación , Dinamarca , Trastorno Depresivo/psicología , Femenino , Hospitalización , Humanos , Persona de Mediana Edad , Índice de Severidad de la Enfermedad , Factores de TiempoRESUMEN
BACKGROUND: In unipolar, and bipolar affective disorders, there is a high risk of relapse that increases as the number of episodes increases. Naturalistic follow-up studies suggest that the progressive development of the diseases is not prevented with the present treatment modalities. It is not known whether centralised and specialised secondary care intervention initiated early after the onset of the diseases can prevent the progression and thereby improve the prognosis. METHODS: Two randomised clinical multi-centre trials comparing a centralised and specialised outpatient intervention program consisting of combined pharmacological and psychological intervention with standard decentralised psychiatric treatment. Patients discharged from their first, second, or third hospitalisation due to a manic episode or bipolar disorder (trial 1) or to a single depressive episode or recurrent depressive disorder (trial 2) were randomised. Central randomization for both trials were stratified for the number of hospitalisations and treatment centre. The primary outcome measure for the two trials is time to re-hospitalisation with an affective episode. DISCUSSION: These trials are the first to evaluate the effect of a centralised and specialised intervention in patients with early severe affective disorders. The trials used a pragmatic design comparing a specialised mood disorder clinic intervention with decentralised, non-specialised standard psychiatric treatment. TRIAL REGISTRATION: ClinicalTrials.gov: NCT00253071.
Asunto(s)
Antidepresivos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Trastorno Depresivo/tratamiento farmacológico , Psicoterapia , Trastorno Bipolar/psicología , Terapia Combinada , Trastorno Depresivo/psicología , Humanos , Proyectos de Investigación , Tamaño de la Muestra , Índice de Severidad de la EnfermedadRESUMEN
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.
Asunto(s)
Trastorno Bipolar/terapia , Trastorno Depresivo/terapia , Antidepresivos/uso terapéutico , Trastorno Bipolar/tratamiento farmacológico , Trastorno Bipolar/prevención & control , Trastorno Depresivo/tratamiento farmacológico , Trastorno Depresivo/prevención & control , Medicina Basada en la Evidencia , Humanos , Servicio Ambulatorio en Hospital , Pacientes Ambulatorios , Psicoterapia , Resultado del TratamientoRESUMEN
Depression is a common disorder with painful symptoms and, frequently, social impairment and decreased quality of life. The disorder has a tendency to be long lasting, often with frequent recurrence of symptoms. The risk of relapse and the severity of the symptoms may be reduced by correct antidepressant medication. However, the medication is often insufficient, both in respect to dosage and length of time. The reasons for incorrect medication are many, with lack of adherence to treatment being the most important. Although some patients taking antidepressant medication experience side effects, this may not be the most frequent reason for immature discontinuation of treatment. Other reasons for decreased adherence have been investigated in recent years. The patient's beliefs about the disorder and beliefs about antidepressants, including lack of conviction that the medication is needed and fear of dependence of antidepressant medicine, have a great influence on adherence to treatment.
Asunto(s)
Antidepresivos/administración & dosificación , Actitud Frente a la Salud , Trastorno Depresivo Mayor/tratamiento farmacológico , Trastorno Depresivo Mayor/psicología , Cooperación del Paciente , Educación del Paciente como Asunto , Esquema de Medicación , HumanosRESUMEN
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.
RESUMEN
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.
Asunto(s)
Trastorno Bipolar/diagnóstico , Trastorno Bipolar/psicología , Trastorno Depresivo/diagnóstico , Trastorno Depresivo/psicología , Estado de Salud , Pacientes Ambulatorios , Satisfacción Personal , Calidad de Vida , Adulto , Dinamarca/epidemiología , Femenino , Humanos , Masculino , Encuestas y CuestionariosRESUMEN
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.
Asunto(s)
Trastorno Bipolar/psicología , Trastorno Bipolar/terapia , Trastorno Depresivo/psicología , Trastorno Depresivo/terapia , Servicios de Salud Mental/normas , Satisfacción del Paciente , Adulto , Áreas de Influencia de Salud , Dinamarca/epidemiología , Femenino , Humanos , Masculino , Persona de Mediana Edad , Encuestas y CuestionariosRESUMEN
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.