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Haas S, Sørensen MJ, Lundby L, Pedersen AG. Injection of freshly collected autologous adipose tissue into non-healing wounds after closed incision pilonidal surgery. Tech Coloproctol 2020; 24:1301-1306. [PMID: 32648140 DOI: 10.1007/s10151-020-02276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Accepted: 06/20/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Chronic non-healing wounds are a major problem after closed incision pilonidal surgery. Freshly collected autologous adipose tissue injected into perianal fistulas in patients with Crohn's disease seems to promote healing. We investigated this technique in patients with non-healing wounds after cleft-lift surgery for pilonidal sinus disease (PSD). METHOD In a prospective interventional pilot study conducted at our institution autologous adipose tissue from the abdominal wall was harvested, and injected into chronic non-healing PS wounds after surgical revision, healing rate being the primary outcome. The wounds were left open. Patients were followed every 2 to 3 weeks until complete healing (skin coverage, no undermining). RESULTS 7 male patients were included (mean age 24 ± 0,6 SD years) and complete healing was achieved in 6 patients (86%). Median time to healing was 90 days (range 36-403 days ) and mean follow-up time was 388± 45 days. All patients reported major symptom relief shortly after the procedure. The mean operation time was 80 ± 23 minutes and the mean amount of freshly collected adipose tissue injected was 27.4± 12 ml. There were no complications. CONCLUSIONS Freshly collected autologous adipose tissue injected into chronic non-healing pilonidal wounds seems safe and efficient.
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Affiliation(s)
- S Haas
- Department of Surgery, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NØ, Denmark.
| | - M J Sørensen
- Department of Surgery, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NØ, Denmark
| | - L Lundby
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - A G Pedersen
- Department of Surgery, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NØ, Denmark
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Elfeki H, Sørensen MJ, Pedersen AG, Lundby L, Haas S. Injection of freshly collected autologous adipose tissue for treatment of a non-healing sacrococcygeal pilonidal disease patient - a video vignette. Colorectal Dis 2019; 21:1341. [PMID: 31389100 DOI: 10.1111/codi.14806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Accepted: 07/23/2019] [Indexed: 01/18/2023]
Affiliation(s)
- H Elfeki
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Surgery, Mansoura University Hospital, Mansoura, Egypt
| | - M J Sørensen
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
| | - A G Pedersen
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
| | - L Lundby
- Department of Surgery, Aarhus University Hospital, Aarhus, Denmark
| | - S Haas
- Department of Surgery, Randers Regional Hospital, Randers, Denmark
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Kilburn TR, Sørensen MJ, Thastum M, Rapee RM, Rask CU, Arendt KB, Thomsen PH. Rationale and design for cognitive behavioral therapy for anxiety disorders in children with autism spectrum disorder: a study protocol of a randomized controlled trial. Trials 2018; 19:210. [PMID: 29609630 PMCID: PMC5879814 DOI: 10.1186/s13063-018-2591-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 03/13/2018] [Indexed: 12/05/2022] Open
Abstract
Background Autism spectrum disorder (ASD) is found in approximately 1% of the population and includes core symptoms that affect general and social development. Beside these core symptoms, it is suggested that up to 60% of children with ASD suffer from comorbid anxiety disorders which may further affect educational, social and general development as well as quality of life. The main goal of this study is to examine the effectiveness of a manualized cognitive behavioral therapy (CBT) anxiety program adapted for children with ASD. Methods This study is a randomized controlled trial (RCT). Fifty children with ASD and anxiety, aged 7 to 13 years, will be randomly assigned to group CBT or a wait-list control (WL) condition. The design will follow a two (CBT and WL) by two (pre–post assessment) mixed between–within design. The control group will receive intervention after the waitlist period of 13 weeks. Primary outcomes are diagnostic status and severity of the anxiety disorders, measured with The Anxiety Disorder Interview Schedule for DSM-IV, Parent and Child Versions. Secondary outcomes are parent and child ratings on questionnaires on the child’s level of anxiety and impact on everyday life. Additional outcomes entail information gathered from parents, child and teachers on the child’s behavior and negative self-statements, together with social and adaptive skills. Follow-up data will be collected 3 months after intervention. Discussion This study aims to evaluate the effectiveness of a manualized CBT program in Danish children with ASD and anxiety within a mental health clinic setting. The hypothesis is that training anxiety reduction skills will decrease anxiety in children, as well as ensure better psychosocial development for the child in general. Trial registration https://ClinicalTrials.gov (NCT02908321). Registered 19th of September 2016. Electronic supplementary material The online version of this article (10.1186/s13063-018-2591-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tina R Kilburn
- Research Unit, Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark.
| | - Merete Juul Sørensen
- Unit C for School-aged Children, Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Mikael Thastum
- Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark
| | - Ronald M Rapee
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Charlotte Ulrikka Rask
- Research Unit & Unit C for School aged Children, Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Kristian Bech Arendt
- Department of Psychology and Behavioural Science, Aarhus University, Aarhus, Denmark
| | - Per Hove Thomsen
- Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
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Würtz AML, Høstrup Vestergaard C, Rytter D, Sørensen MJ, Christensen J, Vestergaard M, Bech BH. Prenatal exposure to antipsychotic medication and use of primary health care system in childhood: a population-based cohort study in Denmark. Clin Epidemiol 2017; 9:657-666. [PMID: 29238228 PMCID: PMC5716673 DOI: 10.2147/clep.s145524] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Antipsychotic (AP) medication is increasingly used for many health conditions. Prenatal exposure to AP medication has been associated with several adverse outcomes, but the findings remain inconsistent. Purpose We aimed to investigate prenatal exposure to AP medication and the use of primary health care system in childhood. Subjects and methods All live-born singletons in Denmark during 1997-2012 were identified in the nationwide Danish National Patient Register and followed until December 31, 2013 (n = 963,010). Information on prenatal exposure to AP medication was obtained from the Danish Register of Medicinal Product Statistics. Contacts to the general practitioner (GP) were used as a proxy for the overall health of the children. Negative binomial regression was used to calculate incidence rate ratios (IRRs) and 95% confidence intervals (CIs) for the association between prenatal exposure to AP medication and number and type of GP contacts, excluding routine well-child visits and vaccinations. The models were adjusted for sex and birth date of the child, maternal age, parity, cohabitation status, income, education, smoking status, diagnosis of substance abuse, severe psychiatric disorder, depression and epilepsy as well as the use of antiepileptic drugs, antidepressants, benzodiazepines and insulin. Results The prenatally AP-exposed children had 7% more GP contacts than unexposed children, IRR: 1.07 (95% CI: 1.03, 1.11). The association was slightly stronger among children of mothers with no diagnosis of severe psychiatric disorder (IRR: 1.08, 95% CI: 1.04-1.13) than among children of mothers with severe psychiatric disorder (IRR: 1.03, 95% CI: 0.96-1.11), but the difference was not statistically significant. We found no difference between prenatally AP-exposed children and their unexposed siblings, IRR: 1.00 (95% CI: 0.97-1.04) for total contacts. Conclusion Children of women using AP medication in pregnancy had more GP contacts in childhood than children of mothers not using AP medication. However, this might be explained by confounding from maternal behavior and mental illness.
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Affiliation(s)
- Anne Mette Lund Würtz
- Research Unit for General Practice.,Section for Epidemiology, Department of Public Health, Aarhus University
| | | | - Dorte Rytter
- Section for Epidemiology, Department of Public Health, Aarhus University
| | | | | | - Mogens Vestergaard
- Research Unit for General Practice.,Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Bodil Hammer Bech
- Research Unit for General Practice.,Section for Epidemiology, Department of Public Health, Aarhus University
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Nielsen ES, Hellfritzsch M, Sørensen MJ, Rasmussen H, Thomsen PH, Laursen T. Off-label prescribing of psychotropic drugs in a Danish child and adolescent psychiatric outpatient clinic. Eur Child Adolesc Psychiatry 2016; 25:25-31. [PMID: 25724547 DOI: 10.1007/s00787-015-0699-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Accepted: 02/18/2015] [Indexed: 11/30/2022]
Abstract
This study aimed to describe the level of off-label treatment with psychotropic drugs at a child and adolescent psychiatric outpatient clinic in Denmark. We performed a cross-sectional study assessing records on patients treated with medicine at two outpatient clinics at the child and adolescent psychiatric ward, on 1 day in 2014. Prescriptions of drugs from ATC group N05-N06 were classified according to label status. Six hundred and fifteen drug prescriptions distributed on nine different drugs were prescribed to 503 children eligible for this study. Overall results showed that 170 of the 615 prescriptions were off-label, which corresponds to 27.6 %. Attention deficit hyperkinetic disorder (ADHD) drugs were prescribed 450 times (73.2 %) of which 11 prescriptions were off-label (2.4 %). Other psychotropic drugs comprised 165 (26.8 %) prescriptions and of these 159 (96.4 %) were off-label. With 106 prescriptions, melatonin was the most prescribed of these drugs; all prescriptions were off-label. The main reasons for classifying prescriptions as off-label were age and indication of treatment. This cross-sectional study reveals that medical treatment of children with other psychotropic drugs than ADHD drugs is usually off-label. ADHD drugs were, as the only drug group, primarily prescribed on-label. Although off-label prescription may be rational and even evidence based, the responsibility in case of, e.g. adverse drug reactions is a challenge, and clinical trials in children should be incited.
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Affiliation(s)
- Eva Skovslund Nielsen
- Department of Biomedicine: Pharmacology and Clinical Pharmacology, Aarhus University Hospital and Aarhus University, Aarhus C, Denmark.
| | - Maja Hellfritzsch
- Department of Biomedicine: Pharmacology and Clinical Pharmacology, Aarhus University Hospital and Aarhus University, Aarhus C, Denmark
| | - Merete Juul Sørensen
- Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Helle Rasmussen
- Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Per Hove Thomsen
- Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Torben Laursen
- Department of Biomedicine: Pharmacology and Clinical Pharmacology, Aarhus University Hospital and Aarhus University, Aarhus C, Denmark
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Christensen J, Pedersen HS, Kjaersgaard MIS, Parner ET, Vestergaard M, Sørensen MJ, Olsen J, Bech BH, Pedersen LH. Apgar-score in children prenatally exposed to antiepileptic drugs: a population-based cohort study. BMJ Open 2015; 5:e007425. [PMID: 26359281 PMCID: PMC4567672 DOI: 10.1136/bmjopen-2014-007425] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES It is unknown if prenatal exposure to antiepileptic drugs (AEDs) increases the risk of low Apgar score in offspring. SETTING Population-based study using health registers in Denmark. PARTICIPANTS We identified all 677 021 singletons born in Denmark from 1997 to 2008 and linked the Apgar score from the Medical Birth Register with information on the women's prescriptions for AEDs during pregnancy from the Danish Register of Medicinal Product Statistics. We used the Danish National Hospital Registry to identify mothers diagnosed with epilepsy before birth of the child. Results were adjusted for smoking and maternal age. RESULTS Among 2906 children exposed to AEDs, 55 (1.9%) were born with an Apgar score ≤7 as compared with 8797 (1.3%) children among 674 115 pregnancies unexposed to AEDs (adjusted relative risk (aRR)=1.41 (95% CI 1.07 to 1.85). When analyses were restricted to the 2215 children born of mothers with epilepsy, the aRR of having a low Apgar score associated with AED exposure was 1.34 (95% CI 0.90 to 2.01) When assessing individual AEDs, we found increased, unadjusted RR for exposure to carbamazepine (RR=1.86 (95% CI 1.01 to 3.42)), valproic acid (RR=1.85 (95% CI 1.04 to 3.30)) and topiramate (RR=2.97 (95% CI 1.26 to 7.01)) when compared to unexposed children. CONCLUSIONS Prenatal exposure to AEDs was associated with increased risk of being born with a low Apgar score, but the absolute risk of a low Apgar score was <2%. Risk associated with individual AEDs indicate that the increased risk is not a class effect, but that there may be particularly high risks of a low Apgar score associated with certain AEDs.
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Affiliation(s)
- Jakob Christensen
- Department of Neurology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Erik Thorlund Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Mogens Vestergaard
- Research Unit for General Practice, Department of Public Health, Aarhus, Denmark
| | - Merete Juul Sørensen
- Regional Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Aarhus, Denmark
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Bodil Hammer Bech
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lars Henning Pedersen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
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Sørensen MJ, Kjaersgaard MIS, Pedersen HS, Vestergaard M, Christensen J, Olsen J, Parner E, Pedersen LH, Bech BH. Risk of Fetal Death after Treatment with Antipsychotic Medications during Pregnancy. PLoS One 2015; 10:e0132280. [PMID: 26162087 PMCID: PMC4498617 DOI: 10.1371/journal.pone.0132280] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 06/11/2015] [Indexed: 11/18/2022] Open
Abstract
Background Antipsychotic medications are increasingly used during pregnancy. Nevertheless, fetal risks are still not fully studied. It is currently unclear whether the antipsychotic treatment might induce a higher risk of fetal death. We aimed to determine if use of antipsychotic medication during pregnancy is associated with an increased risk of spontaneous abortion or stillbirth. Methods In a historical cohort study, we identified all clinically recognized pregnancies registered in the nationwide Danish registries from 1997 to 2008 (N = 1,005,319). Exposure was defined as any prescription of antipsychotic medications redeemed by the pregnant women during the exposure window, and recorded in the Danish National Prescription Register. Outcome was defined as any spontaneous abortion or stillbirth recorded in the Danish National Hospital Register and the Danish Medical Birth Register respectively. Results Women exposed to antipsychotic medications during pregnancy had a 34% higher risk of spontaneous abortion (adjusted relative risk = 1.34; 95% confidence interval = 1.22; 1.46) compared to unexposed women, but a similar risk compared to women exposed prior to (but not during) pregnancy (adjusted relative risk = 1.04; 95% confidence interval = 0.93; 1.17). The risk of spontaneous abortion was not increased in exposed pregnancies when compared to unexposed pregnancies in the same women (adjusted hazard ratio = 1.11; 95% CI = 0.94; 1.31). A twofold higher risk of stillbirth was found in women exposed to antipsychotic medications compared with unexposed women (relative risk = 2.27; 95% confidence interval = 1.45; 3.55) and compared with women exposed only prior to pregnancy (relative risk = 2.06; 95% confidence interval = 1.01; 4.19). Conclusions The increased risk of spontaneous abortion found in women treated with antipsychotic medications during pregnancy is most likely due to confounding factors. The risk of stillbirth was twofold higher in pregnancies exposed to antipsychotic medication during pregnancy. Treatment with antipsychotic medications during pregnancy requires careful consideration.
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Affiliation(s)
- Merete Juul Sørensen
- Regional Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
- * E-mail:
| | | | | | - Mogens Vestergaard
- Research Unit for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
- Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jacob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Erik Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lars Henning Pedersen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
- Institute of Clinical Medicine—Obstetrics and Gynaecology, Aarhus University, Aarhus, Denmark
| | - Bodil Hammer Bech
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
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Bro SP, Kjaersgaard MIS, Parner ET, Sørensen MJ, Olsen J, Bech BH, Pedersen LH, Christensen J, Vestergaard M. Adverse pregnancy outcomes after exposure to methylphenidate or atomoxetine during pregnancy. Clin Epidemiol 2015; 7:139-47. [PMID: 25657597 PMCID: PMC4317061 DOI: 10.2147/clep.s72906] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE To determine if prenatal exposure to methylphenidate (MPH) or atomoxetine (ATX) increases the risk of adverse pregnancy outcomes in women with attention deficit/hyperactivity disorder (ADHD). MATERIALS AND METHODS This was a population-based cohort study of all pregnancies in Denmark from 1997 to 2008. Information on use of ADHD medication, ADHD diagnosis, and pregnancy outcomes was obtained from nationwide registers. RESULTS We identified 989,932 pregnancies, in which 186 (0.02%) women used MPH/ATX and 275 (0.03%) women had been diagnosed with ADHD but who did not take MPH/ATX. Our reference pregnancies had no exposure to MPH/ATX and no ADHD diagnosis. Exposure to MPH/ATX was associated with an increased risk of spontaneous abortion (SA; ie, death of an embryo or fetus in the first 22 weeks of gestation) (adjusted relative risk [aRR] 1.55, 95% confidence interval [CI] 1.03-2.36). The risk of SA was also increased in pregnancies where the mother had ADHD but did not use MPH/ATX (aRR 1.56, 95% CI 1.11-2.20). The aRR of Apgar scores <10 was increased among exposed women (aRR 2.06, 95% CI 1.11-3.82) but not among unexposed women with ADHD (aRR 0.99, 95% CI 0.48-2.05). CONCLUSION MPH/ATX was associated with a higher risk of SA, but our study indicated that it may at least partly be explained by confounding by indication. Treatment with MPH/ATX was however associated with low Apgar scores <10, an association not found among women with ADHD who did not use MPH/ATX.
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Affiliation(s)
- Søren Pauli Bro
- Research Unit and Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | | | - Erik Thorlund Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Merete Juul Sørensen
- Regional Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Aarhus, Denmark
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Bodil Hammer Bech
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lars Henning Pedersen
- Section for Epidemiology, Department of Public Health, Aarhus University, Aarhus, Denmark ; Department of Clinical Medicine - Obstetrics and Gynecology, Aarhus University, Aarhus, Denmark
| | - Jakob Christensen
- Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark ; Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Mogens Vestergaard
- Research Unit and Section for General Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
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Kilic D, Pedersen H, Kjaersgaard MIS, Parner ET, Vestergaard M, Sørensen MJ, Olsen J, Bech BH, Christensen J, Pedersen LH. Birth outcomes after prenatal exposure to antiepileptic drugs-A population-based study. Epilepsia 2014; 55:1714-21. [DOI: 10.1111/epi.12758] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2014] [Indexed: 11/30/2022]
Affiliation(s)
- Demet Kilic
- Department of Neurology; Aarhus University Hospital; Aarhus Denmark
| | - Henrik Pedersen
- Research Unit for General Practice; Department of Public Health; Aarhus University; Aarhus Denmark
| | | | - Erik Thorlund Parner
- Section for Biostatistics; Department of Public Health; Aarhus University; Aarhus Denmark
| | - Mogens Vestergaard
- Research Unit for General Practice; Department of Public Health; Aarhus University; Aarhus Denmark
- Section for General Medical Practice; Department of Public Health; Aarhus University; Aarhus Denmark
| | - Merete Juul Sørensen
- Regional Center for Child and Adolescent Psychiatry; Aarhus University Hospital; Risskov Denmark
| | - Jørn Olsen
- Section for Epidemiology; Department of Public Health; Aarhus University; Aarhus Denmark
| | - Bodil Hammer Bech
- Section for Epidemiology; Department of Public Health; Aarhus University; Aarhus Denmark
| | - Jakob Christensen
- Department of Neurology; Aarhus University Hospital; Aarhus Denmark
- Department of Clinical Pharmacology; Aarhus University Hospital; Aarhus Denmark
| | - Lars Henning Pedersen
- Section for Epidemiology; Department of Public Health; Aarhus University; Aarhus Denmark
- Department of Obstetrics and Gynecology; Aarhus University Hospital; Aarhus Denmark
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Bech BH, Kjaersgaard MIS, Pedersen HS, Howards PP, Sørensen MJ, Olsen J, Parner ET, Pedersen LH, Vestergaard M, Christensen J. Use of antiepileptic drugs during pregnancy and risk of spontaneous abortion and stillbirth: population based cohort study. BMJ 2014; 349:g5159. [PMID: 25150301 PMCID: PMC4141333 DOI: 10.1136/bmj.g5159] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
Abstract
OBJECTIVE To determine whether use of antiepileptic drugs during pregnancy may increase the risk of spontaneous abortion or stillbirth. DESIGN Population based cohort study. SETTING Register based study in Denmark, 1997-2008. PARTICIPANTS 983,305 pregnancies identified in the Danish medical birth register and the Danish national hospital discharge register from 1 February 1997 to 31 December 2008 were linked to the Danish Register of Medicinal Product Statistics to obtain information on use of antiepileptic drugs. MAIN OUTCOME MEASURES Risk ratio of spontaneous abortion and stillbirth after use of antiepileptic drugs during pregnancy, estimated by using binomial regression adjusting for potential confounders of maternal age, cohabitation, income, education, history of severe mental disorder, and history of drug misuse. RESULTS Antiepileptic drugs were used in a total of 4700 (0.5%) pregnancies. 16 out of 100 pregnant women using antiepileptics and 13 out of 100 pregnant women not using antiepileptics experienced a spontaneous abortion. After adjusting for potential confounders pregnant women using antiepileptics had a 13% higher risk of spontaneous abortions than pregnant women not using antiepileptics (adjusted risk ratio 1.13, 95% confidence interval 1.04 to 1.24). However, the risk of spontaneous abortion was not increased in women with an epilepsy diagnosis (0.98, 0.87 to 1.09), only in women without a diagnosis of epilepsy (1.30, 1.14 to 1.49). In an analysis including women with at least two pregnancies with discordant antiepileptic drug use (for example, use in the first pregnancy but not in the second), the adjusted hazard ratio for spontaneous abortion was 0.83 (0.69 to 1.00) for exposed pregnancies compared with unexposed pregnancies. Stillbirth was identified in 18 women who used antiepileptic drugs (unadjusted risk ratio 1.29, 0.80 to 2.10). CONCLUSION Among women with epilepsy and when analysing the risk in antiepileptic drug discordant pregnancies in the same woman, we found no overall association between the use of antiepileptic drugs during pregnancy and spontaneous abortions. Therefore unmeasured confounding may explain the slight increased risk for spontaneous abortion with any antiepileptic drug use (among women both with and without epilepsy). We found no association between antiepileptic drug use during pregnancy and stillbirth, but the statistical precision was low.
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Affiliation(s)
- Bodil Hammer Bech
- Section for Epidemiology, Department of Public Health, Aarhus University, DK 8000 Aarhus C, Denmark
| | | | - Henrik Søndergaard Pedersen
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Penelope P Howards
- Department of Epidemiology, Rollins School of Public Health, Atlanta, GA, USA
| | - Merete Juul Sørensen
- Regional Center of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Jørn Olsen
- Section for Epidemiology, Department of Public Health, Aarhus University, DK 8000 Aarhus C, Denmark
| | - Erik Thorlund Parner
- Section for Biostatistics, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Lars Henning Pedersen
- Section for Epidemiology, Department of Public Health, Aarhus University, DK 8000 Aarhus C, Denmark Department of Clinical Medicine-Obstetrics and Gynaecology, Aarhus University, Aarhus, Denmark
| | - Mogens Vestergaard
- Research Unit for General Practice and Section for General Medical Practice, Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark Department of Clinical Pharmacology, Aarhus University Hospital, Aarhus, Denmark
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Sørensen MJ, Grønborg TK, Christensen J, Parner ET, Vestergaard M, Schendel D, Pedersen LH. Antidepressant exposure in pregnancy and risk of autism spectrum disorders. Clin Epidemiol 2013; 5:449-59. [PMID: 24255601 PMCID: PMC3832387 DOI: 10.2147/clep.s53009] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Both the use of antidepressant medication during pregnancy and the prevalence of autism spectrum disorder have increased during recent years. A causal link has recently been suggested, but the association may be confounded by the underlying indication for antidepressant use. We investigated the association between maternal use of antidepressant medication in pregnancy and autism, controlling for potential confounding factors. Methods We identified all children born alive in Denmark 1996–2006 (n=668,468) and their parents in the Danish Civil Registration System. We obtained information on the mother’s prescriptions filled during pregnancy from the Danish National Prescription Registry, and on diagnoses of autism spectrum disorders in the children and diagnoses of psychiatric disorders in the parents from the Danish Psychiatric Central Register. In a cohort analysis, we estimated hazard ratios of autism spectrum disorders in children exposed to antidepressant medication during pregnancy compared with children who were not exposed, using Cox proportional hazards regression analysis. Furthermore, we estimated the risk for autism spectrum disorder in a sibling design. Results Children exposed prenatally to antidepressants had an adjusted hazard ratio of 1.5 (95% confidence interval [CI] 1.2–1.9) for autism spectrum disorder compared with unexposed children. Restricting the analysis to children of women with a diagnosis of affective disorder, the adjusted hazard ratio was 1.2 (95% CI 0.7–2.1), and the risk was further reduced when exposed children were compared with their unexposed siblings (adjusted hazard ratio 1.1; 95% CI 0.5–2.3). Conclusion After controlling for important confounding factors, there was no significant association between prenatal exposure to antidepressant medication and autism spectrum disorders in the offspring.
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Affiliation(s)
- Merete Juul Sørensen
- Regional Centre of Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
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12
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Kjaersgaard MIS, Parner ET, Vestergaard M, Sørensen MJ, Olsen J, Christensen J, Bech BH, Pedersen LH. Prenatal antidepressant exposure and risk of spontaneous abortion - a population-based study. PLoS One 2013; 8:e72095. [PMID: 24015208 PMCID: PMC3756033 DOI: 10.1371/journal.pone.0072095] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Accepted: 07/08/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE To estimate the risk of spontaneous abortion after use of antidepressant medication during pregnancy. METHODS From the Danish Medical Birth Registry and the Danish National Hospital Registry, we identified all pregnancies leading to in- or outpatient contacts in Denmark from February 1997 to December 2008. The Danish Registry of Medicinal Product Statistics provided information on the women's prescriptions for antidepressants during pregnancy. We obtained information on women who were diagnosed with depression from the Danish Psychiatric Central Registry. Adjusted relative risks (aRR) of spontaneous abortion were estimated according to exposure to antidepressants or maternal depression using binomial regression. RESULTS Of the 1,005,319 pregnancies (547,300 women) identified, 114,721 (11.4%) ended in a spontaneous abortion. We identified 22,061 pregnancies exposed to antidepressants and 1,843 with a diagnosis of depression with no antidepressant use, of which 2,637 (12.0%) and 205 (11.1%) ended in a spontaneous abortion, respectively. Antidepressant exposure was associated with an aRR of 1.14 (95% confidence interval (CI) 1.10-1.18) for spontaneous abortion compared with no exposure to antidepressants. Among women with a diagnosis of depression, the aRR for spontaneous abortion after any antidepressant exposure was 1.00 (95% CI 0.80-1.24). No individual selective serotonin reuptake inhibitor (SSRI) was associated with spontaneous abortions. In unadjusted analyses, we found that mirtazapine, venlafaxine, and duloxetine were associated with spontaneous abortions among women with depression but we had no information on potential differences in disease severity and only few pregnancies were exposed in the population. CONCLUSION We identified a slightly increased risk of spontaneous abortion associated with the use of antidepressants during pregnancy. However, among women with a diagnosis of depression, antidepressants in general or individual SSRI in particular were not associated with spontaneous abortions. Further studies are warranted on the newer non-SSRI antidepressants, as we had insufficient data to adjust for important confounding factors.
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Affiliation(s)
| | - Erik Thorlund Parner
- Department of Public Health, Section for Biostatistics, Aarhus University, Aarhus, Denmark
| | - Mogens Vestergaard
- Research Unit for General Practice, Aarhus University, Aarhus, Denmark
- Department of Public Health, Section for General Practice, Aarhus University, Aarhus, Denmark
| | - Merete Juul Sørensen
- Regional Center for Child and Adolescent Psychiatry, Aarhus University Hospital, Risskov, Denmark
| | - Jørn Olsen
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Pharmacology, Aarhus University, Aarhus, Denmark
| | - Bodil Hammer Bech
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
| | - Lars Henning Pedersen
- Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Aarhus University, Aarhus, Denmark
- * E-mail:
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Christensen J, Grønborg TK, Sørensen MJ, Schendel D, Parner ET, Pedersen LH, Vestergaard M. Prenatal valproate exposure and risk of autism spectrum disorders and childhood autism. JAMA 2013; 309:1696-703. [PMID: 23613074 PMCID: PMC4511955 DOI: 10.1001/jama.2013.2270] [Citation(s) in RCA: 753] [Impact Index Per Article: 68.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
IMPORTANCE Valproate is used for the treatment of epilepsy and other neuropsychological disorders and may be the only treatment option for women of childbearing potential. However, prenatal exposure to valproate may increase the risk of autism. OBJECTIVE To determine whether prenatal exposure to valproate is associated with an increased risk of autism in offspring. DESIGN, SETTING, AND PARTICIPANTS Population-based study of all children born alive in Denmark from 1996 to 2006. National registers were used to identify children exposed to valproate during pregnancy and diagnosed with autism spectrum disorders (childhood autism [autistic disorder], Asperger syndrome, atypical autism, and other or unspecified pervasive developmental disorders). We analyzed the risks associated with all autism spectrum disorders as well as childhood autism. Data were analyzed by Cox regression adjusting for potential confounders (maternal age at conception, paternal age at conception, parental psychiatric history, gestational age, birth weight, sex, congenital malformations, and parity). Children were followed up from birth until the day of autism spectrum disorder diagnosis, death, emigration, or December 31, 2010, whichever came first. MAIN OUTCOMES AND MEASURES Absolute risk (cumulative incidence) and the hazard ratio (HR) of autism spectrum disorder and childhood autism in children after exposure to valproate in pregnancy. RESULTS Of 655,615 children born from 1996 through 2006, 5437 were identified with autism spectrum disorder, including 2067 with childhood autism. The mean age of the children at end of follow-up was 8.84 years (range, 4-14; median, 8.85). The estimated absolute risk after 14 years of follow-up was 1.53% (95% CI, 1.47%-1.58%) for autism spectrum disorder and 0.48% (95% CI, 0.46%-0.51%) for childhood autism. Overall, the 508 children exposed to valproate had an absolute risk of 4.42% (95% CI, 2.59%-7.46%) for autism spectrum disorder (adjusted HR, 2.9 [95% CI, 1.7-4.9]) and an absolute risk of 2.50% (95% CI, 1.30%-4.81%) for childhood autism (adjusted HR, 5.2 [95% CI, 2.7-10.0]). When restricting the cohort to the 6584 children born to women with epilepsy, the absolute risk of autism spectrum disorder among 432 children exposed to valproate was 4.15% (95% CI, 2.20%-7.81%) (adjusted HR, 1.7 [95% CI, 0.9-3.2]), and the absolute risk of childhood autism was 2.95% (95% CI, 1.42%-6.11%) (adjusted HR, 2.9 [95% CI, 1.4-6.0]) vs 2.44% (95% CI, 1.88%-3.16%) for autism spectrum disorder and 1.02% (95% CI, 0.70%-1.49%) for childhood autism among 6152 children not exposed to valproate. CONCLUSIONS AND RELEVANCE Maternal use of valproate during pregnancy was associated with a significantly increased risk of autism spectrum disorder and childhood autism in the offspring, even after adjusting for maternal epilepsy. For women of childbearing potential who use antiepileptic medications, these findings must be balanced against the treatment benefits for women who require valproate for epilepsy control.
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Affiliation(s)
- Jakob Christensen
- Department of Neurology, Aarhus University Hospital, Norrebrogade 44, DK-8000 Aarhus C, Denmark.
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14
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Abstract
BACKGROUND Standardised diagnostic interviews are used increasingly in child and adolescent psychiatry; yet little is known about the attitudes towards such interviews among parents, children and staff members. In this study, we have aimed to assess (1) the K-SADS-PL's acceptability to parents and children (2) the usefulness of the interview as perceived by the staff. METHODS Following the implementation of a semi-structured diagnostic interview in the standard assessment, parents, children, and staff were asked to fill in, anonymously, a brief questionnaire enquiring about their impression of the interview. RESULTS Parental satisfaction with the parent interview was very high. Parental satisfaction with the child interview was high as well, although a small group of children were reported to be more sad/hyperactive or difficult immediately after the interview. However, these were found among the younger children only, and mainly children with conduct problems. Most children found that the interview was a good or fairly good way to talk about how they felt, but more than half the children found the interview boring to some extent, and a few felt worse after the interview than they did before. The staff found the interview to be useful in most cases, primarily for diagnostic purposes. CONCLUSIONS Semi-structured diagnostic interviews are well accepted by parents and children, and have good face validity among staff members. To young children with many conduct difficulties the interview may seem overwhelming, and future work should focus on ways of making diagnostic interviews more engaging for children.
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Affiliation(s)
- Merete Juul Sørensen
- Psychiatric Hospital for Children and Adolescents, Aarhus University Hospital, Harald Selmersvej 66, 8240, Risskov, Denmark
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Tabori-Kraft J, Sørensen MJ, Kaergaard M, Dalsgaard S, Thomsen PH. Is OPTAx useful for monitoring the effect of stimulants on hyperactivity and inattention? A brief report. Eur Child Adolesc Psychiatry 2007; 16:347-51. [PMID: 17476552 DOI: 10.1007/s00787-006-0571-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/23/2006] [Indexed: 10/23/2022]
Abstract
PURPOSE The purpose of this study was to investigate whether OPTAx, an objective measurement of hyperactivity, impulsivity and inattention can be used to measure the positive clinical effect of stimulants found in children with hyperkinetic disorder (HKD) or attention deficit disorder without hyperactivity. METHOD A total of 22 boys and one girl, with ages ranging between 7-12 years, diagnosed with HKD or attention deficit disorder without hyperactivity and receiving treatment with stimulants were tested with OPTAx, with and without stimulants. The main parameters investigated were: displacement, area, accuracy, variability, errors of commission and errors of omission. RESULTS OPTAx showed a significant improvement on all parameters during stimulant treatment compared with no treatment. The improvement measured by OPTAx was supported by clinical assessment, which found that 95% of the children improved much or very much on the Clinical Global Assessment Scale during stimulant treatment. CONCLUSIONS The objective parameters of the OPTAx reflected the clinical improvement found in children with HKD or attention deficit disorder without hyperactivity during stimulant treatment. This suggests a greater role for objective measurements such as OPTAx in daily clinical practise.
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Affiliation(s)
- Janne Tabori-Kraft
- Psychiatric Hospital for Children and Adolescents, Aarhus University Hospital, Harald Selmers vej 66, 8240, Risskov, Denmark
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Thomsen PH, Sørensen MJ. [Evidence for psychopharmacological treatment of depression in children and adolescents?]. Ugeskr Laeger 2007; 169:1289-94. [PMID: 17437688] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Depression in children and adolescents is relatively prevalent and may have serious consequences. Treatment of depressive disorders may be psychotherapeutic or psychopharmacological. A systematic literature search was performed and the evidence for a psychopharmacological treatment of depressive disorders in children and adolescents was described. Emphasis is put on treatment with selective serotonin reuptake inhibitors as these are the best-documented agents in the treatment of depression in children and adolescents.
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Affiliation(s)
- Per Hove Thomsen
- Arhus Universitetshospital, Børne- og Ungdomspsykiatrisk Hospital, Risskov.
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17
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Sørensen MJ, Thomsen PH. [What evidence is there for treating depression in children and adolescents with cognitive therapy?]. Ugeskr Laeger 2007; 169:1294-9. [PMID: 17437689] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Depression in children and adolescents is relatively prevalent and may have serious consequences. Treatment of depressive disorders may be psychotherapeutic or psychopharmacological. A systematic literature search was performed, and the evidence for treatment of depressive disorders in children and adolescents with cognitive behavioural therapy is described.
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Abstract
The aim was to test this in a nationwide register study of diagnoses used in child and adolescents psychiatry in Denmark. A larger number of different diagnoses were expected to be applied after the introduction of the 10th version of the International Classification of Diseases (ICD-10). Reflecting the time trend, we particularly expected an increase in the number of neuropsychiatric diagnoses. From the Danish Psychiatric Central Register data were drawn on clinical discharge diagnoses. All patients aged 0-15 years examined at psychiatric hospitals from 1995-2002 were included; 22,469 children and adolescents with a first contact were registered. The most frequent discharge diagnoses were pervasive development disorders (PDD; 11.9%), adjustment disorders (10.6%), conduct disorder (9.5%), emotional and anxiety disorders (7.6%), hyperkinetic disorders (7.3%), and specific developmental disorders (7.3%). We found a significant increase in the number of neuropsychiatric and affective diagnoses and a significant decrease in the number of adjustment, conduct and anxiety diagnoses during the study period. Of the 22,469 diagnoses, 45% were only partly specified according to ICD-10. Thirty-four per cent had diagnoses unspecified on the four-character level (Fxx.9) and 11% had Z-diagnoses. A larger number of different diagnoses and an increase in the use of neuropsychiatric diagnoses were seen after the introduction of ICD-10. Many diagnoses were only partly specified; consequently, a more detailed specification of the ICD-10 is still required.
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Affiliation(s)
- Lene Ruge Møller
- Psychiatric Hospital for Children and Adolescents, Aarhus University Hospital, Harald Selmersvej 66, Risskov, 8240, Denmark
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Sørensen MJ, Thomsen PH. [Depression in children and adolescents]. Ugeskr Laeger 2006; 168:679-82. [PMID: 16494806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
This article reviews the recent literature on depression in children and adolescents. We describe the current knowledge about clinical presentation, epidemiology, prognosis and risk factors with a focus on the differences from depression in adults.
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Abstract
With regard to internalizing disorders we wanted to describe: 1) a possible change in diagnoses over time; 2) a possible corresponding change in causes for referral; 3) correspondence of hospital diagnosis with causes for referral. For 70 randomly selected records/year (n=560), referral papers were examined and compared with register-data on all 8-13-year-old children examined in the study period (1995-2002). The hospital-based frequency increased for depressive disorders and obsessive-compulsive disorder (OCD) and decreased for anxiety disorders. A corresponding increase occurred for depressive and OCD symptoms as cause for referral. Agreement between referral causes and subsequent clinical diagnoses was modest. In most cases (68%) referred for internalizing symptoms, a clinical diagnosis within the internalizing spectrum was given. The increase in the diagnoses of depressive disorder and OCD seems partly due to an increase in patients referred for these disorders. Referrers identify internalizing disorders reliably but child psychiatric examination leads to more precise diagnoses.
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Abstract
OBJECTIVE DSM-IV is the most widely used diagnostic classification system in research, whereas ICD-10 is more widely used clinically. Knowledge of differences is essential when research findings are implemented in daily clinical practice. We examined differences between the two diagnostic systems regarding three major child psychiatric diagnostic categories. METHODS A total of 199 consecutively referred, child psychiatric patients were interviewed with a semistructured diagnostic interview (K-SADS-PL) including questions covering specific ICD-10-DCR criteria, and diagnosed according to both diagnostic systems. RESULTS Differences were found regarding the diagnoses major depressive disorder/depressive episode and attention deficit hyperactivity disorder/disturbance of activity and attention. In both cases, more children met DSM-IV-TR criteria than ICD-10-DCR criteria. The diagnosis, oppositional defiant disorder, proved interchangeable between the two diagnostic systems. CONCLUSION Differences between diagnostic systems must be taken into account when research findings using one diagnostic system are implemented with children diagnosed by another diagnostic system.
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Affiliation(s)
- Merete Juul Sørensen
- Psychiatric Hospital for Children and Adolescents, Harald Selmersvej 66, 8240, Risskov, Denmark
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Sørensen MJ, Frydenberg M, Thastum M, Thomsen PH. The Children's Depression Inventory and classification of major depressive disorder: validity and reliability of the Danish version. Eur Child Adolesc Psychiatry 2005; 14:328-34. [PMID: 16220217 DOI: 10.1007/s00787-005-0479-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/10/2005] [Indexed: 10/25/2022]
Abstract
The study examines the validity and reliability of the Danish version of the Children's Depression Inventory (CDI) in a child psychiatric population. Participants were 149 child psychiatric patients aged 8-13 and their parents. After diagnostic interview with the Kiddie-Schedule for Affective Disorders and Schizophrenia, the children completed the CDI. A subgroup of 44 children repeated the CDI after 2 weeks. The psychometric properties of the Danish CDI were similar to those reported for the English version. CDI is moderately correlated with other measures for depressive disorder, but the instrument is not sufficiently reliable or valid to be used as a single diagnostic or screening measure in a child psychiatric population.
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Affiliation(s)
- Merete Juul Sørensen
- Psychiatric Hospital for Children and Adolescents, Harald Selmersvej 66, 8240 Risskov, Denmark.
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Sørensen MJ, Nissen JB, Mors O, Thomsen PH. Age and gender differences in depressive symptomatology and comorbidity: an incident sample of psychiatrically admitted children. J Affect Disord 2005; 84:85-91. [PMID: 15620389 DOI: 10.1016/j.jad.2004.09.003] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2004] [Revised: 09/24/2004] [Accepted: 09/27/2004] [Indexed: 12/01/2022]
Abstract
BACKGROUND Studies indicate that major depressive disorder (MDD) is frequent in children but that it may be missed. This study determines the incidence of hospital-treated MDD based on the frequency of MDD in child psychiatric patients, and analyses effects of age and gender on depressive symptoms and psychiatric comorbidity. METHODS One hundred ninety-nine consecutive child psychiatric patients were interviewed using a semi-structured diagnostic interview (K-SADS-PL). Comorbidity and symptoms were compared across age and gender. RESULTS Current or partly remitted MDD was found in 42 children (21%). Thirty-eight (90%) had comorbid psychiatric disorder(s). Onset of the comorbid disorder was prior to onset of depression in 74% of cases. No significant gender-differences were found, but anhedonia, hypersomnia and decreased ability to concentrate were more frequent in the older age group. In contrast, feelings of worthlessness were more frequent in the younger age group. The number of melancholic symptoms was significantly associated with older age. CONCLUSION MDD is frequent in child psychiatric patients aged 8-13 years. Age-but not gender-had significant effects on melancholy score and the prevalence of specific symptoms. Results suggest that MDD may be underdiagnosed in clinical samples unless careful examined with diagnostic interview.
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Affiliation(s)
- Merete Juul Sørensen
- Psychiatric Hospital for Children and Adolescents, Harald Selmersvej 66, 8240 Risskov, Denmark.
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Vestergaard ET, Powell SG, Sørensen MJ. [Klinefelter's syndrome and depression]. Ugeskr Laeger 2004; 166:4380-1. [PMID: 15587634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/01/2023]
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