Apathy in First Episode Psychosis Patients : One Year Follow-up and Clinical Characteristics

Negative symptoms are present already during the first episode of psychosis and contribute significantly to functional decline. The limited progress in development of effective treatments for negative symptoms has prompted studies of the different symptoms making up the negative symptom complex, such as apathy. The aim of this thesis was to gain more knowledge about apathy in first episode patients. This study found that at baseline, 50% and at follow up 40%, of all patients were considered clinically apathetic. Thirty percent had enduring high levels of apathy over the first year. This group consisted of significantly more males, a longer duration of untreated psychosis, a greater likelihood of a schizophrenia spectrum diagnosis and they had poorer functioning. Apathy correlated only with the neuropsychological tests for executive function and working memory. This study shows that apathy can be reliably assessed and is a frequent symptom already during the first episode of psychosis and with strong association to poor functioning. As in other brain disorders apathy was associated with poor executive function, implying a possible common underlying mechanism across disorders

Turning the Spotlight on Apathy:Identification and Treatment in Schizophrenia Spectrum Disorders

Among negative symptoms, apathy is central to the impairments in real-life functioning in schizophrenia spectrum disorders (SSD). Thus, optimizing treatment for apathy appears key to improve outcomes. In treatment research, however, negative symptoms are typically studied as a unifactorial construct. We, therefore, aim to shed necessary light on the status of apathy identification and treatment in SSD.</p

Selvmord og alvorlige selvmordsforsøk i forbindelse med akuttinnleggelser i psykisk helsevern - – en gjennomgang av innleggelser over en tiårsperiode ved en akuttpsykiatrisk avdeling i Norge

Forebygging av selvmord er et satsningsområde i norskpsykisk helsevern, og Pasientsikkerhetskampanjen«Forebygging av selvmord» ble rettet spesielt mot akuttpsykiatriskedøgnavdelinger. En høy andel av akuttinnleggelserhar bakgrunn i selvmordsproblematikk, og behandling ogtiltak rettet mot selvmordsforebygging er således en sentralakuttpsykiatrisk oppgave. Forekomst av selvmord knyttet tilakuttpsykiatriske innleggelser har blitt estimert til 0.1–0.4 %.Hovedformålet med denne studien er å analysere alle selvmordog alvorlige selvmordsforsøk med klar selvmordsintensjoni perioden 2005–2014 ved Avdeling for akuttpsykiatri,Oslo Universitetssykehus. Kliniske data fra den siste uken førgjennomførte selvmord eller selvmordsforsøk ble hentet frapasientenes journal. Beskrevne symptomer ble kategorisertetter DSM-5 «anxious distress specifier» for affektive lidelser.I løpet av perioden hadde avdelingen 9170 innleggelser,16 alvorlige selvmordsforsøk og 19 selvmord, som gir enselvmordsrate på 0.2 %. De fleste selvmordene fant stedutenfor avdelingen ved permisjon eller i løpet av 30 dageretter utskrivelse. En stor andel av pasientene i gruppen(85 %) hadde rapportert om selvmordstanker og affektivelidelser var overrepresentert. Halvparten av pasientene vistesymptomer forenlig med alvorlig angst eller agitasjon. Tiltross for vanskene med å predikere selvmord på individnivåmener vi at kombinasjonen av pågående selvmordstanker,agitasjon, depressive symptomer og håpløshet bør viesspesiell oppmerksomhet, og i slike tilfelle bør en vise særligvarsomhet i forbindelse med risikosituasjoner som utgangalene, permisjoner og utskrivelse

Low cholesterol level as a risk marker of inpatient and post-dischargeviolence in acute psychiatry : a prospective study with a focus on genderdifferences

Several studies indicate an association between low levels of serum cholesterol and aggressive behaviour, but prospective studies are scarce. In this naturalistic prospective inpatient and post-discharge study from an acute psychiatric ward, we investigated total cholesterol (TC) and high-density lipoprotein (HDL) as risk markers of violence. From March 21, 2012, to March 20, 2013, 158 men and 204 women were included. TC and HDL were measured at admission. Violence was recorded during hospital stay and for the first 3 months post-discharge. Univariate and multivariate binary logistic regression were used to estimate associations between low TC and low HDL and violence. Results showed that HDL level was significantly inversely associated with violence during hospital stay for all patients. For men, but not for women, HDL level was significantly inversely associated with violence the first 3 months post-discharge. Results indicate that low HDL is a risk marker for inpatient and post-discharge violence in acute psychiatry and also suggest gender differences in HDL as a risk marker for violence

Predictive validity and gender differences in a biopsychosocial model of violence risk assessment in acute psychiatry

Current violence risk assessment methods seem to have reached an upper limit of accuracy. More comprehensive biopsychosocial models may improve on existing methods. Research on gender differences concerning risk factors of violence is scarce and inconclusive. In this prospective study from an acute psychiatric ward, all patients admitted from March 2012 to March 2013 were included. Predictive validity and potential gender differences in a biopsychosocial model of violence risk assessment consisting of a psychosocial checklist (Violence risk screening-10, V-RISK-10), a patient's self-report risk scale (SRS), total cholesterol (TC) and high-density lipoprotein cholesterol (HDL) were examined in an inpatient (N = 348) and a 3-months follow-up (N = 101) sample. Overall increases in explained variances and predictive values were small and non-significant compared to V-RISK-10 alone. In the inpatient sample, HDL contributed significantly to the model for men but not for women. In the follow-up sample, SRS contributed significantly for the whole sample. Results indicated that the biopsychosocial model we tested partially improved accuracy of violence risk assessments in acute psychiatry and that gender differences may exist

Examining the organization and quality of the psychiatric consultative service in Norway

Aim: Patients admitted to somatic departments may face psychiatric challenges, such as suicidal behavior, substance abuse, crisis reactions, or somatoform disorders. Mental disorders can complicate the diagnosis and treatment of a somatic disorder. The Consultation-Liaison Psychiatry Service (CLP) can provide advice and guidance to attending staff in somatic departments. CLP in Norwegian hospitals was last reviewed in 1997. There is insufficient awareness of the service as it currently stands. This specialist field is expanding, and there is a need to examine how the service is organized at present and how it works. Materials and methods: A study of the scope, quality, availability, content, and organization of the psychiatric consultative service was conducted in February–March 2016. The study also examined whether service users and providers were satisfied with the service, the content of the service, and whether they considered the service to be adequate. Results and conclusions: Although CLP has expanded over the last three years, somatic and psychiatric departments wish for its further expansion. The service provision is at an acceptable level during the daytime, but not during weekends and holidays. We found that 20% of all referrals are rejected and that 80–90% of all physicians wanted outpatient services for short-term follow-up and for help with undiagnosed, unclear, unexplained, (indeterminate) conditions. Discussion: The service works satisfactorily during ordinary working hours. There is a need to establish outpatient services and to strengthen the services outside these hours. Collaborative research should be further developed

Predictive validity and gender differences in a biopsychosocial model of violence risk assessment in acute psychiatry

Current violence risk assessment methods seem to have reached an upper limit of accuracy. More comprehensive biopsychosocial models may improve on existing methods. Research on gender differences concerning risk factors of violence is scarce and inconclusive. In this prospective study from an acute psychiatric ward, all patients admitted from March 2012 to March 2013 were included. Predictive validity and potential gender differences in a biopsychosocial model of violence risk assessment consisting of a psychosocial checklist (Violence risk screening-10, V-RISK-10), a patient's self-report risk scale (SRS), total cholesterol (TC) and highdensity lipoprotein cholesterol (HDL) were examined in an inpatient (N=348) and a 3-months follow-up (N=101) sample. Overall increases in explained variances and predictive values were small and non-significant compared to V-RISK-10 alone. In the inpatient sample, HDL contributed significantly to the model for men but not for women. In the follow-up sample, SRS contributed significantly for the whole sample. Results indicated that the biopsychosocial model we tested partially improved accuracy of violence risk assessments in acute psychiatry and that gender differences may exist. Keywords: acute psychiatry, total cholesterol, HDL, self-report, V-RISK-10, biomarkers, screening tool

Lessons learned from a cross-sectional survey among patients and staff in an acute psychiatric unit during an ongoing pandemic outbreak

This current cross sectional survey was carried out amongst patients and staff in an acute psychiatric inpatient unit in the very first weeks of the ongoing pandemic outbreak of COVID-19 in Norway. Most patients found the visiting restrictions difficult, many reported that the pandemic made them feel unsafe, affected their sleep and that they feared transmission from other patients. Among staff, almost half were afraid that they would contract the virus, a majority feared they would bring the virus home and infect their family and one third were concerned that the pandemic compromised the treatment provided for the patients