Acta Psychiatrica Scandinavica最新文献

{"title":"Risk of Dementia in Patients Suffering From Psychosis—A Danish Register-Based Cohort Study","authors":"Simone Normark,&nbsp;Marie Kim Wium-Andersen,&nbsp;Merete Osler,&nbsp;Ida Kim Wium-Andersen","doi":"10.1111/acps.13828","DOIUrl":"https://doi.org/10.1111/acps.13828","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>To investigate the association of psychosis with subsequent risk of dementia and to explore any impact of age at psychosis onset.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Using the Danish National health registries, a total of 39,022 patients with a diagnosis of psychosis and a matched sample of 195,109 individuals without psychosis were included in the study. All individuals were born between 1910 and 1959 and were a minimum of 18 years of age in 1969. The risk of being diagnosed with dementia was analyzed using Cox proportional hazard regression with adjustment for sociodemographic variables and alcohol use disorder. Analyses were stratified by age of psychosis onset (&lt; 45/45+ years) and age at follow-up in three categories (60–70, 70–80, and 80 or above).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>During mean 16.8 years of follow-up, 18,653 (12.55%) of all individuals developed dementia. Patients with psychosis had a higher risk of dementia at all ages of follow-up, with the highest risk estimate at follow-up before age 70 (hazard ratio (HR) adjusted 4.44 CI (4.01–4.91)). However, the risk also varied with age at psychosis onset, being highest at late-onset (adjusted hazard ratio: 5.16 (95% confidence interval: 4.59–5.81)).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Patients with psychosis had a higher risk of developing dementia than individuals without psychosis. The risk varied with age at psychosis onset and age at follow-up.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"180-186"},"PeriodicalIF":5.0,"publicationDate":"2025-06-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13828","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Risk of Dementia After Electroconvulsive Therapy: A Cohort Study on the Population of Wales","authors":"George Kirov,&nbsp;Emily Simmonds,&nbsp;Tyler Kaster,&nbsp;Valentina Escott-Price","doi":"10.1111/acps.70005","DOIUrl":"https://doi.org/10.1111/acps.70005","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Electroconvulsive therapy (ECT) is the most effective therapy for severe or treatment-resistant depression. A common short-term side effect is memory problems, and it is important to know whether ECT increases the risk for dementia later in life. Major psychiatric disorders are associated with an increased risk for developing dementia, making the analysis of dementia risk challenging. A small number of previous studies indicate that ECT does not increase this risk. We wanted to examine the association between ECT and subsequent risk of dementia in the population of Wales, UK.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>We analysed the electronic health records of the Welsh population. We selected 110,774 people aged between 35 and 65 on 1.1.1995 who had no prior diagnosis of dementia and had been hospitalised with diagnoses of affective disorders. Of those, 1010 received at least one course of ECT between 1995 and 2024 before a diagnosis of dementia.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The 110,774 persons were followed up until the end of the study period in 2024, or the date of dementia diagnosis, or the date of death, for a mean of 24.5 (SD = 6.3) years. 15.4% of the ECT group developed dementia, compared to 13.1% for the non-ECT-treated individuals. After controlling for age, sex, social deprivation status, physical comorbidities, history of alcohol abuse, the number of psychiatric hospitalisations and the age when they first occurred, the hazard ratio for dementia was not increased in the ECT group: HR = 0.888, 95% CI: 0.757–1.044, <i>p</i> = 0.15.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Though crude analyses found a greater risk of dementia among those receiving ECT, once confounders were accounted for, we failed to find a statistically significant risk for dementia among those who received ECT. Our findings strengthen the conclusions of previous reports and provide further reassurance for people considering this treatment.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"270-277"},"PeriodicalIF":5.0,"publicationDate":"2025-06-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.70005","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144930077","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Three Distinct Pathways to First Episode Mania and Psychosis: Latent Class Analysis of Antecedent Psychopathology","authors":"Mete Ercis,&nbsp;Alessandro Miola,&nbsp;Javier Ortiz-Orendain,&nbsp;Vanessa K. Pazdernik,&nbsp;Tamahara Gonzalez-Campos,&nbsp;Manuel Gardea-Resendez,&nbsp;Peggy M. Gruhlke,&nbsp;Ian M. Michel,&nbsp;Jennifer L. Vande Voort,&nbsp;Alastair J. McKean,&nbsp;Aysegul Ozerdem,&nbsp;Mark A. Frye","doi":"10.1111/acps.13826","DOIUrl":"https://doi.org/10.1111/acps.13826","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Despite the classic Kraepelinian dichotomy between bipolar disorder (BD) and schizophrenia (SZ), contemporary evidence suggests shared antecedent risk factors and similarities in the early course. This study aimed to identify distinct trajectories leading to first-episode mania (FEM) and first-episode psychosis (FEP) by examining antecedent psychopathology, including psychiatric diagnoses, symptoms, substance use, and psychotropic medication exposure.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Individuals born after 1985 who resided in Olmsted County, Minnesota, USA, and had FEM/FEP were identified through the Rochester Epidemiology Project. Latent class analysis (LCA) was used to identify subgroups based on antecedent psychopathology incorporating 57 dichotomous antecedent measures before FEM/FEP.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 202 individuals (BD <i>n</i> = 73, SZ <i>n</i> = 129; 26.7% female, mean age 20.8 ± 3.7 years) were included. A 3-class LCA model optimally fits the data. Class 1 (Neurodevelopmental, 29.7%) had a high prevalence of neurodevelopmental disorders, behavioral symptoms, and ADHD medication use. Class 2 (Depressive-Anxious, 31.2%) included depressive and anxiety disorders, mood-related symptoms, and SSRI/SNRI use. Class 3 (Minimal Psychiatric Morbidity, 39.1%) had a low prevalence of antecedent diagnoses and symptoms, with comparable substance use to other classes. There were significant diagnostic differences, with SZ being more common in the Neurodevelopmental (71.7%) and Minimal Psychiatric Morbidity (70.9%) classes, while BD was more common in the Depressive-Anxious class (<i>p</i> = 0.007). Neurodevelopmental and Minimal Psychiatric Morbidity classes had higher proportions of males (85.0% and 82.3%, respectively) compared to the Depressive-Anxious class (50.8%, <i>p</i> &lt; 0.001). The Neurodevelopmental class showed an earlier age at first mental health visit (9.5 ± 5.5 years) and a longer antecedent illness duration (10.8 ± 6.1 years) than the other classes (<i>p</i> &lt; 0.001).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>This study identified three distinct pathways to FEM and FEP, offering a transdiagnostic perspective on the antecedent illness trajectories of BD and SZ. Future research should validate these categories that are more inclusive than the classic BD versus SZ dichotomy and explore their potential for predicting illness course and guiding personalized early interventions.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"278-289"},"PeriodicalIF":5.0,"publicationDate":"2025-06-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144929838","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Immortal Time Bias, Confounding by Indication, and Antidepressant Pooling","authors":"Itsuki Terao","doi":"10.1111/acps.13827","DOIUrl":"10.1111/acps.13827","url":null,"abstract":"","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 4","pages":"318-319"},"PeriodicalIF":5.0,"publicationDate":"2025-05-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144726065","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Motor Dexterity Deficits in Individuals With First-Episode Psychosis and Their First-Degree Relatives","authors":"Manuel Sevilla-Ramos,&nbsp;Valentina Ladera,&nbsp;Ricardo García-García,&nbsp;Rosa Ayesa-Arriola","doi":"10.1111/acps.13821","DOIUrl":"https://doi.org/10.1111/acps.13821","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Motor dexterity deficits have been observed both before and during first-episode psychosis (FEP), suggesting this may be a potential endophenotype for schizophrenia spectrum disorders. We aimed to compare motor dexterity performance in FEP patients, their first-degree relatives, and controls. We also investigated whether sociodemographic, premorbid, clinical, and cognitive factors contribute to motor dexterity.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>The sample included 133 FEP patients, 244 of their first-degree relatives (146 parents, 98 siblings), and 202 controls. Motor dexterity was assessed using the Grooved Pegboard Test as part of a neuropsychological battery assessing verbal and visual memory, processing speed, working memory, executive function, attention, and theory of mind. Raw scores were converted to <i>Z</i>-scores. Intelligence quotient and global cognitive function were estimated. Group comparisons were made using analysis of covariance with post hoc tests. Age, sex, and years of education were included as covariates. Multiple linear regression models examined associations between motor dexterity and other variables within each group.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was a significant group difference on the Grooved Pegboard Test (<i>F</i> = 16.25, <i>p</i> &lt; 0.001). FEP patients (M = −1.26) and their parents (M = −1.14) scored lowest, while siblings (M = −0.30) and controls (M = −0.22) scored highest. The FEP group also scored lowest on other cognitive tests (<i>p</i> &lt; 0.001). A positive association between global cognitive function and Grooved Pegboard performance was found in all groups (<i>β</i> = 0.47–0.84, <i>p</i> &lt; 0.001). Group-specific associations with age, sex, education, intelligence, executive function, attention, and processing speed were also observed (<i>p</i> &lt; 0.05).</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>Motor dexterity deficits were observed in FEP patients and their parents, which may reflect underlying genetic liability or result from the disorder itself. The preserved motor dexterity in unaffected siblings challenges a strict endophenotypic interpretation and suggests a potential protective effect. Motor dexterity deficits were associated with broader cognitive impairment, intelligence quotient, attention, processing speed, and executive function.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"216-227"},"PeriodicalIF":5.0,"publicationDate":"2025-05-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13821","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768049","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Antidepressant Remission and Manic Switch in Bipolar Depression: A Propensity Score Analysis","authors":"Paul A. Vöhringer,&nbsp;Sergio A. Barroilhet,&nbsp;Bárbara A. Palma,&nbsp;Roy H. Perlis","doi":"10.1111/acps.13822","DOIUrl":"https://doi.org/10.1111/acps.13822","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Objective</h3>\u0000 \u0000 <p>Antidepressants remain among the most widely used class of drugs in treating bipolar disorder, despite their minimal efficacy in randomized clinical trials and concern for association with manic episodes. This study sought to evaluate the outcomes of antidepressant treatment in bipolar depression in a large naturalistic cohort study, STEP-BD, in terms of symptomatic remission as well as emergence of mania, using a propensity score (PS) analysis to reduce indication bias.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Propensity scores were developed to estimate the probability of antidepressant exposure using multivariate logistic regression models; these scores were then used to match antidepressant-exposed and non-exposed individuals. Cox regression models were used to estimate hazard ratios for manic switch and time to remission, adjusted for these scores in the matched population.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Total sample included 2166 individuals, of whom 1085 were exposed to AD and 1081 were unexposed to AD; mean follow-up duration was 182.5 (SD: 44.6) days (median = 126, ICR: 87.4). Cox regression models for manic switch with antidepressant exposure versus non-exposure yielded an unadjusted hazard ratio (HR) of 0.93 (95% CI 0.67–1.14) and PS-adjusted HR of 0.77 (95% CI 0.51–1.08), neither of which was statistically significantly different from 1. Probability of symptomatic remission was also not significantly associated with antidepressant exposure, with unadjusted and PS-adjusted HR of 1.15 (95% CI 0.97–1.37) and 1.02 (95% CI 0.87–1.23), respectively.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>With PS adjustment, there was no evidence of increased likelihood of manic switch or achievement of symptomatic remission associated with antidepressant use in bipolar depression. Our results underscore the ongoing need to identify alternative strategies for effective treatment of bipolar depression.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"228-235"},"PeriodicalIF":5.0,"publicationDate":"2025-05-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144768092","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of Obstetric Complications in Subjects at Clinical High Risk for Psychosis: A Systematic Review and Meta-Analysis","authors":"Inmaculada Baeza,&nbsp;Jordina Tor,&nbsp;Elena de la Serna,&nbsp;Gisela Sugranyes,&nbsp;Fàtima Crispi,&nbsp;Montserrat Izquierdo-Renau,&nbsp;Marta del Olmo,&nbsp;Montserrat Dolz,&nbsp;Clemente García-Rizo","doi":"10.1111/acps.13816","DOIUrl":"https://doi.org/10.1111/acps.13816","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Exposure to obstetric complications (OCs) increases the risk of developing psychosis and schizophrenia in offspring. However, studies with subjects at clinical high risk for psychosis (CHR) have reported inconsistent results. We conducted a systematic review and meta-analysis to evaluate the prevalence of OCs among CHR subjects and controls and examine their impact on the transition to psychosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Four databases (Web of Science, PubMed, Latindex, and Dialnet) were systematically searched for articles published between 1995 and June 6, 2024. The risk of bias was assessed using the Newcastle–Ottawa scale. Articles providing data on OCs in CHR subjects were included.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>A total of 6037 records were retrieved through systematic and citation searches. Nine articles met the inclusion criteria for our systematic review and provided data for meta-analysis. A total of 555 CHR participants were included. Meta-analysis showed a significantly higher prevalence of OCs in CHR subjects versus controls: RR = 1.45 (95% CI: 1.16, 1.81), (<i>Z</i> = 3.27, <i>p</i> = 0.0011). Data from three longitudinal studies assessed transition to psychosis and our meta-analysis found a trend toward an increased risk of transition in CHR subjects with a history of OCs compared to others: RR = 2.05 (95% CI: 0.98, 4.26), <i>Z</i> = 1.91, <i>p</i> = 0.056.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>CHR for psychosis was associated with OCs, though their role in the transition to psychosis requires further study. OCs should be recorded and analyzed in CHR individuals, considering their potential clinical implications.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 2","pages":"81-93"},"PeriodicalIF":5.3,"publicationDate":"2025-05-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13816","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144524731","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The Safety of 12-Weekly Monitoring of Neutrophil Count in Long-Term Clozapine Patients","authors":"David Taylor,&nbsp;Siobhan Gee,&nbsp;Marinka Helthuis,&nbsp;Ebenezer Oloyede","doi":"10.1111/acps.13818","DOIUrl":"https://doi.org/10.1111/acps.13818","url":null,"abstract":"<div>\u0000 \u0000 \u0000 <section>\u0000 \u0000 <h3> Introduction</h3>\u0000 \u0000 <p>Clozapine is the only truly effective treatment for refractory schizophrenia, but its use is constrained by the requirements for frequent monitoring of neutrophil counts. In the UK during the COVID-19 pandemic, the frequency of clozapine blood monitoring was reduced in some units from 4-weekly to 12-weekly. We aimed to investigate the outcomes of reduced monitoring in long-term clozapine patients.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>This was an anonymous, retrospective, observational cohort study. No restrictions were applied regarding care setting (i.e., outpatients or inpatients). All patients who registered for reduced frequency haematological monitoring from 1 March 2020 to 1 November 2022 were included and followed up till 1 August 2024. The primary outcome was death resulting from clozapine-induced agranulocytosis (CIA). Secondary outcomes were the proportion of patients with mild to moderate neutropenia during the follow-up period and the proportion of patients who reverted to standard monitoring during the study period.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Amongst 1025 patients, there were no cases of agranulocytosis over 3365.9 patient-years of 12-weekly blood monitoring (incident rate 0.0 per 100 person-years). There were 43 episodes of mild neutropenia (so-called amber results—1.5–2.0 × 10⁹/L) or neutropenia (red results &lt; 1.5 × 10⁹/L), an overall incident rate of 1.28 per 100 person-years. During follow-up, 41 patients (4%) reverted permanently to standard 4-weekly monitoring, and 157 patients (15%) temporarily interrupted reduced frequency monitoring but restarted 12-weekly monitoring before the end of the follow-up period. In total, 42 patients (4%) died during the observation period—no death was related to agranulocytosis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Reducing the frequency of clozapine haematological monitoring to 12-weekly was safe in a group of long-term patients. No cases of agranulocytosis occurred and no deaths due to agranulocytosis were recorded. Most patients remained on extended-interval monitoring.</p>\u0000 </section>\u0000 </div>","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 3","pages":"187-192"},"PeriodicalIF":5.0,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13818","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144767603","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Reaching ADHD Treatment Targets?","authors":"Søren Dalsgaard,&nbsp;Maj-Britt Posserud,&nbsp;Kamilla W. Miskowiak,&nbsp;Kenneth K. C. Man","doi":"10.1111/acps.13815","DOIUrl":"https://doi.org/10.1111/acps.13815","url":null,"abstract":"&lt;p&gt;In a recent epidemiological study, Grøntved et al. present important results on the temporal changes of the rates in prevalence and incidence of ADHD diagnosis and use of ADHD medication in Denmark over the past two decades [&lt;span&gt;1&lt;/span&gt;]. The authors have applied stringent, robust, and sound methods in analyzing individual-level data available from the Danish nationwide registers. Their main findings include consistent increases in the prevalence and incidence of diagnosis of ADHD and corresponding increases in pharmacological treatment across sex and age groups from 2000 to 2022. The most notable increase in recent years is observed in young adult women. They found that 3.03% of the total population living in Denmark was given a clinical diagnosis of ADHD or had received treatment with ADHD medication in 2022. Among children and adolescents aged 6–18 years, it was 4.0%; in adults aged 18–27 years, it was 7.1%; in adults aged 27–35 years, it was 6.1%; and in adults aged 35–50 years, it was 3.5%, all as observed in 2022.&lt;/p&gt;&lt;p&gt;The study offers valid and precise estimates of the number of individuals diagnosed with ADHD or treated with ADHD medications within the entire Danish population and of the increases in those rates over a 20-year period. Such high-quality population-based estimates of the yearly prevalence and incidence of ADHD are much needed, as these measures of occurrence focus on the absolute risk, answering the question “What is the actual percentage?” Many articles in news media [&lt;span&gt;2, 3&lt;/span&gt;] and also some scientific studies [&lt;span&gt;4&lt;/span&gt;] only focus on the relative increase in number of diagnosed or treated over a certain time period, not on the prevalence rate. Similarly, a former Minister of Health in Denmark [&lt;span&gt;5&lt;/span&gt;], and some governmental reports from authorities have raised concerns about the relative increase in the use of ADHD medication, while others have reported incorrect prevalence rates of clinical diagnoses of ADHD, as they have relied on too simplistic methodologies [&lt;span&gt;6&lt;/span&gt;]. The study by Grøntved et al. overcomes such methodological limitations and reports valid and less biased estimates of the rates of prevalence and incidence of ADHD diagnosis and treatment. This is important, because in order to evaluate whether there is reason for concerns about over-diagnosing or overtreatment of ADHD, one needs to compare the rates of diagnoses and use of ADHD medication with the expected occurrence of the disorder.&lt;/p&gt;&lt;p&gt;Studies on the underlying occurrence of ADHD in the population suggest that 6%–7% of all children and adolescents fulfill diagnostic criteria for the disorder [&lt;span&gt;7&lt;/span&gt;], and the occurrence in the population seems to have been stable for several decades [&lt;span&gt;8, 9&lt;/span&gt;]. In adults, 4%–5% of the population fulfill diagnostic criteria for ADHD [&lt;span&gt;10&lt;/span&gt;]. These studies also show that children and adolescents fulfilling diagnostic criteria for ADHD are less common in g","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"152 1","pages":"3-5"},"PeriodicalIF":5.3,"publicationDate":"2025-04-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13815","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144191263","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Editorial on: The Underappreciated Importance of Mania","authors":"Susan L. McElroy,&nbsp;Mark A. Frye,&nbsp;Balwinder Singh","doi":"10.1111/acps.13814","DOIUrl":"https://doi.org/10.1111/acps.13814","url":null,"abstract":"&lt;p&gt;In this issue of Acta Psychiatrica Scandinavica, Drs. Manchia, Miola, Tondo, and Baldessarini [&lt;span&gt;1&lt;/span&gt;] provide an important study of individuals with unipolar mania (UPM), defined by these authors as mania or hypomania without depressive episodes. In their study, Manchia and colleagues identified 63 consecutive individuals with UPM and compared them over the long term (up to 9.18 years) to 1210 patients with regular bipolar disorder (mania or hypomania with depressive episodes; BD) recruited from expert mood disorder centers across Italy. Compared with regular BD, the authors found that UPM was uncommon (4.5% of all BD cases over 18.2 years of risk), more common in men, predominantly BD type I (only 0.314% had unipolar hypomania), associated with more psychosis but less suicidality, and associated with greater use of antipsychotics, lithium, and mood-stabilizing anticonvulsants but much less use (27% less) of antidepressants. Over a mean follow-up of 9.18 years, the rate of UPM decreased, suggesting that some of these patients will eventually develop a first depressive episode.&lt;/p&gt;&lt;p&gt;Many of these findings have been noted in earlier, mostly cross-sectional studies using various definitions of UPM. For example, in a 2023 meta-analysis of 21 studies, UPM was similarly uncommon and associated with male gender and psychotic features, but with fewer suicide attempts [&lt;span&gt;2, 3&lt;/span&gt;]. Other findings have included higher rates of hyperthymia, good sleep quality, and morning chronotype in UPM than in regular BD [&lt;span&gt;2-4&lt;/span&gt;].&lt;/p&gt;&lt;p&gt;We were particularly interested in three issues arising from this important article.&lt;/p&gt;&lt;p&gt;First is regarding the prevalence of UPM. Many studies have suggested that UPM is a relatively uncommon form of BD. Thus, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) found that, using three definitions of UPM, 5.0%–7.2% of individuals from the U.S. with BD type I never had depression [&lt;span&gt;5&lt;/span&gt;]. However, evidence exists that UPM may be more common in low-income versus high-income countries. Thus, a study from Ethiopia found 41.7% of participants had UPM [&lt;span&gt;6&lt;/span&gt;], while a study from Tunisia found a rate of 56.6% [&lt;span&gt;7&lt;/span&gt;]. Although these differences in prevalence rates could be due to methodological issues, including use of different definitions of UPM, one wonders if there are cultural differences regarding the etiology and recognition of BD, particularly manic symptoms. If such cultural issues exist, it would be important to understand them.&lt;/p&gt;&lt;p&gt;Second is the finding that morning chronotype may be more common in UPM while evening chronotype appears to be more common in regular BD. Our group indeed found that evening chronotype was more common among individuals participating in a BD biobank, and that it was associated with more depressive episodes than participants with non-evening chronotypes [&lt;span&gt;8&lt;/span&gt;]. Circadian rhythm dysfunction has been implicated in t","PeriodicalId":108,"journal":{"name":"Acta Psychiatrica Scandinavica","volume":"151 6","pages":"651-652"},"PeriodicalIF":5.3,"publicationDate":"2025-04-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/acps.13814","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143896867","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}