BackgroundReliable diagnosis is a cornerstone of medical practice, yet concerns about diagnostic reliability have long haunted psychiatry. In the 1970s, the US–UK Diagnostic Project revealed striking international discrepancies in diagnostic practice. Although operationalized diagnostic criteria were introduced to improve reliability, contemporary evidence indicates that substantial problems persist. To investigate this, we conducted a large-scale international study of diagnostic reliability among medical doctors using standardized clinical case vignettes.Material and methodsIn this cross−sectional study, medical doctors working in adult psychiatry across 19 countries from two continents assigned ICD−10 diagnoses to written cases. Each doctor was randomly assigned two of nine available cases. Inter−rater reliability among medical doctors was assessed using Krippendorff’s α. Diagnostic variability at case-level was quantified using Shannon entropy. We also calculated diagnostic accuracy as concordance with predefined best-estimate reference diagnoses.ResultsA total of 1,038 medical doctors provided 1,902 diagnostic assessments across nine cases. Inter−rater reliability among medical doctors was modest (Krippendorff’s α = 0.48), indicating that diagnostic agreement between two doctors occurred in roughly 55% of cases. Overall diagnostic accuracy was 66%, with the lowest accuracy observed for cases depicting schizophrenia spectrum disorders. Diagnostic disagreements followed systematic patterns, with schizophrenia cases frequently misclassified as OCD, personality disorder, or bipolar disorder.ConclusionsDiagnostic inter−rater reliability among medical doctors remains limited, even under standardized conditions. The observed patterns of misclassification suggest that the variability in diagnostic assessments reflects systematic differences in clinical interpretation rather than random error, pointing to challenges in assessing psychopathology as well as ambiguities in psychiatric classification.

Severe mental illness (SMI), such as schizophrenia, is associated with high physical health morbidity, extensive healthcare utilization, and substantial economic costs. This naturalistic study examined changes in resource utilization, measured as direct costs, following a psychosocial health promotion program (MINT) across social services and physical and psychiatric healthcare. Resource utilization patterns for 77 participants were assessed using the Resource Utilization of Mental Illness (RUMI) instrument during the 6-month intervention and a 6-month follow-up. Data were collected on physical and psychiatric care, social services, and contacts with the justice system. We observed significant changes in both costs and patterns of resource utilization. As anticipated, costs related to social services were unchanged. Total costs increased during the intervention period and decreased at follow-up. Costs associated with physical and psychiatric healthcare decreased during the intervention and continued to decrease during follow-up. At a profession-specific level, significant differences were observed in primary care visits: costs associated with physician visits decreased during the intervention and increased at follow-up, whereas costs related to nurse visits increased during both the intervention and follow-up. Overall, these findings suggest that the MINT intervention may modify patients' patterns of resource utilization across services in ways that better align with patients' needs.

Autism Spectrum Disorder (ASD) occurs in 1-1.5

Abstract Background Major depressive disorder (MDD) is highly prevalent across Europe. While evidence-based treatments exist, many people with MDD have their condition undetected and/or untreated. This study aimed to assess the cost-effectiveness of reducing treatment gaps using a modeling approach. Methods A decision-tree model covering a 27-month time horizon was used. This followed a care pathway where MDD could be detected or not, and where different forms of treatment could be provided. Expected costs pertaining to Germany, Hungary, Italy, Portugal, Sweden, and the UK were calculated and quality-adjusted life years (QALYs) were estimated. The incremental costs per QALY of reducing detection and treatment gaps were estimated. Results The expected costs with a detection gap of 69% and treatment gap of 50% were €1236 in Germany, €476 in Hungary, €1413 in Italy, €938 in Portugal, €2093 in Sweden, and €1496 in the UK. The incremental costs per QALY of reducing the detection gap to 50% ranged from €2429 in Hungary to €10,686 in Sweden. The figures for reducing the treatment gap to 25% ranged from €3146 in Hungary to €13,843 in Sweden. Conclusions Reducing detection and treatment gaps, and maintaining current patterns of care, is likely to increase healthcare costs in the short term. However, outcomes are improved, and reducing these gaps to 50 and 25%, respectively, appears to be a cost-effective use of resources.

It is well known that antipsychotic drugs (APDs) are more effective in reducing symptoms in women than in men, and that women are more sensitive to the side effects of APDs. Therefore, it is of great importance that sex differences in drug responses are considered already in the early stages of drug development. In this study, we investigated whether sex-specific differences could be observed in response to the commonly prescribed APDs olanzapine and risperidone using the conditioned avoidance response (CAR) test. To this end we tested the effect of 1.25 and 2.5 mg/kg olanzapine and 0.25 and 0.4 mg/kg risperidone using female and male Wistar rats in the CAR test. Whereas there were no significant differences between the female and male rats in response to either dose of olanzapine administration, an injection of 0.4 mg/kg risperidone significantly suppressed avoidance more in female rats than in male rats. In addition, we found that the estrous cycle of the female rats did not have a significant effect on the avoidance response. In conclusion, we show that there are sex-specific differences as well as similarities between female and male rats in the CAR test and novel APDs should be tested on female and male rats in the future.

Background Patients with ‘underlying’ autism spectrum disorder (ASD) constitute a significant minority in adult out-patient psychiatry. Diagnoses of previously unrecognised ASD are increasing in adults. Characteristics of patients with autism within adult out-patient psychiatry have not been sufficiently explored, and there have not been any systematic comparisons of characteristics between patients with and those without autism within adult out-patient psychiatric populations. Aims To examine psychiatrically relevant characteristics in autistic adult psychiatric out-patients, and to compare the characteristics with non-autistic adult psychiatric out-patients. Method We assessed 90 patients who were referred to a Swedish psychiatric out-patient clinic and screened for ASD during 2019–2020. Sixty-three patients met the DSM-5 criteria for ASD or ‘subthreshold’ ASD. The 27 who did not meet the criteria for ASD were used as a comparison group. Assessments were made with structured and well-validated instruments, including parent ratings of developmental history. Results No differences were found between the groups regarding self-reported sociodemographic variables. The ASD group showed a higher number of co-occurring psychiatric disorders than the non-ASD group ( t (88) = 5.17, 95% CI 1.29–2.91, d = 1.19). Functional level was lower in the ASD group ( t (88) = −2.66, 95% CI −9.46 to −1.27, d = −0.73), and was predicted by the number of co-occurring psychiatric disorders. Conclusions The results underscore the need for thorough assessment of psychiatric disorders in autistic patients in adult psychiatric services. ASD should be considered as a possible ‘underlying’ condition in adult psychiatry, and there is no easy way of ruling out ASD in this population.

Background The prevalence of self-reported suicidal ideation, suicide attempts and non-suicidal self-injury (NSSI) remains unclear among adults with autism unrecognised in childhood who attend psychiatric services. Aims We aimed to estimate the prevalence of suicidal ideation, suicide attempts and NSSI; identify factors associated with suicide attempts and NSSI; and describe NSSI in this group. Method Sixty-three new patients at an adult psychiatric out-patient clinic (57% women, mean age 32 years) who met full (n = 52) or subthreshold (two A criteria and minimum of two B criteria; n = 11) DSM-5 criteria for autism spectrum disorder were included in the study. Clinical assessments included overall diagnostic review, Paykel's questions on passive and active suicidality, evaluation of NSSI with the Functional Assessment of Self-Mutilation, and results of cognitive tests. One follow-up of medical records was made. Results In this sample of psychiatric out-patients identified as first having autism in adulthood, almost a third (31%) of patients reported suicidal ideation during the past month, 86% had lifetime suicidal ideation and 25% reported at least one suicide attempt. Factors associated with suicide attempts included hazardous or harmful alcohol use and/or drug-related problems, and severity of depression. A total of 44% reported NSSI. Factors associated with NSSI were female sex, history of suicidal plans and antisocial personality disorder. Substance or alcohol use were often overlooked, especially in women. Conclusions Suicidal ideation, suicide attempts and NSSI were very common in adults with autism who were recently referred to an out-patient psychiatric service. Suicidal ideation and NSSI were more common than suicide attempts. Clinicians should always consider suicidal ideation and NSSI in adult psychiatric patients with autism.

In May 2020, the WPA established an Ad­visory Committee for Responses to Emergencies (ACRE), by bringing together the leaders of the larger Member Societies to provide practical and concrete aid to Member Societies in need. The group aimed at fostering education, information collection, and the development of local, national and international strategies to cope with the mental health consequences of emergencies. The aid was given in many parts of the world, including Asia, America and other regions1-4. Following Russia's invasion of Ukraine in February 2022, and due to the grave concerns about the well-being of Ukrainian people, particularly psychiatric patients and staff, the ACRE set up a sub-committee, chaired by the WPA President-Elect, to plan and implement support to Ukrainian psychiatrists and the Ukrainian Psychiatric Associations by actively providing humanitarian and medical aid through WPA Member Societies5. Presently, there are approximately 6.6 million Ukrainian people displaced within the country, and almost equal numbers of refugees in Europe, some of them reaching other continents6. A close collaboration was established between the WPA and the leadership of the European Psychiatric Association (EPA) (President: P. Falkai; President-Elect: G. Dom; Secretary General: J. Beezhold) as well as the EPA Council of National Psy­chiatric Associations (Chair: J. Samochowiec)7. The war in Ukraine affects both the phys­ical and mental health of Ukrainian peo­­ple. Supporting mental health of the popula­tion as well as providing support for persons with mental ill health is key. Therefore, one of the main goals of the ACRE sub-committee was to establish a WPA online trauma resource center, under the leadership of R. Ng (Interim WPA Secretary General and WPA Secretary for Education). The EPA, whose national psychiatric as­sociations are also Member Societies of the WPA, made available a repository of literature on treatment of people with trauma. Furthermore, a series of webinars, Help for Helpers, specially designed for people work­ing in war conditions, was created by men­tal health professionals. The goal was to provide knowledge to the public on how to help traumatized family members, friends and neighbors. The WPA online trauma resource cen­ter was established as a central point to collect and provide evidence-based materials and resources in Ukrainian, Russian and other languages, to help psychiatrists and other individuals to respond to the mental health challenges that people from Ukraine are currently facing. In creating this resource center, the WPA and its Scientific Sections established collaborations with a number of professional organizations in addition to the EPA, including the European College of Neuropsycho­pharmacology (ECNP)8 and Mental Health First Aid (MHFA)9, 10, to bring together relevant self-help materials to support those in need. The WPA educational trauma resource center can be visited at www.wpanet.org/ukraine-resources. In this center, readers are provided with a one-stop station where they can find a quick overview of the existing educational materials offered by the various organizations. They can then click on the relevant links and be re-directed to the educational materials in the webpages of the organizations. The materials include written guidelines, resource packages, videos, and webinars for mental health professionals on delivering psychological sup­­-port and crisis intervention to refugees and displaced people. There are also self-help online materials for war victims, refugees, and their caregivers. Supplementing the online resources in the trauma resource center, the WPA website also hosts an educational portal in which there are over 20 free webinars and learning modules covering a diverse range of mental health topics, that can be readily accessed by mental health professionals supporting war victims, refugees, and displaced persons. Finally, there is a list of volunteer organizations in Europe that provide free online consultations and support to Ukrainian people in need. The WPA educational trauma resource center is updated as we receive more and new information. If you wish to contribute any relevant resources developed by your own organization, please contact the WPA Secretariat ([email protected]). WPA Member Societies have also provided direct help to Ukraine. Moreover, they have helped refugees in the receiving countries with psychiatric aid. Specialized psychiatric services for women and children with a focus on Ukrainian families have been established. Many Member Societies have appealed to numerous governmental and non-governmental organizations, as well as to pharmaceutical companies, to increase their awareness of psychiatric patients' needs in Ukraine, including their demand for psychotropic drugs. Almost all European national psychiatric societies have undertaken numerous relevant activities11, 12. The EPA and the Polish Psychiatric Association regularly invite the WPA to attend their meetings with the two Ukrainian Psychiatric Associations, as well as with the neighboring European countries' psychiatric associations, to continually discuss the needs regarding humanitarian and medical aid in Ukraine. The transfer to Ukraine of several medical supplies, including psy­chotropic drugs, was provided by the cen­tral office of Lundbeck in Europe, stimulated by the WPA. A series of medication transports to Ukrainian hospitals, based on the lists provided by the Ukrainian Psychiatric Associations, were organized by the local Lundbeck subsidiary. The primary needs are for antipsychotic medications in the form of short-acting intramuscular injections and long-acting injections. The Polish Psychiatric Association pur­chased electric generators and delivered them to Lviv, to be then transferred to other psychiatric hospitals in Ukraine, including Odessa, Chernihiv, Mykolaiv, Zaporizzhia, and Ivano-Frankivsk regions. The transfer of ambulances for community psychiatry in Lviv region is on the way. Moreover, the Association sent basic equip­ment, sleeping mats, bedding, mattresses, backpacks, clean­ing products, personal hy­giene products, tools for renovation and con­struction, as well as psychiatric medicat­ions through the Polish Agency for Materials and Strategic Reserves. The other main goal of the WPA ACRE sub-committee is to offer economic support through donations from WPA Member Societies. The EPA's Fund for Ukraine supports Ukrainian psychiatric units and patients for the purchase of medications, equipment and other needed materials. The WPA plans to use its own fund to help psychiatrists in Ukraine in reconstructing their services during and after the war. Generous donations have been made by the American Psychiatric Association, the Royal Australian and New Zealand College of Psychiatrists, the Japanese Society of Psychiatry and Neurology, the Mexican Psychiatric Association; the German Association for Psychiatry, Psychotherapy and Psychosomatics; the Croatian Psychiatric Association, the Hungarian Psychiatric Association, the Finnish Psychiatric Association, the Italian Psychiatric Association, the French Psychiatric Associations, and the Polish Psychiatric Association. Donations have also come from individual psychiatrists around the world. If you wish to donate to the WPA fund for this purpose, you can do this using the link www.wpanet.org/post/call-for-donations-to-supply-medications-for-mentally-ill-patients-in-ukraine.

Purpose Serious mental illnesses (SMIs) exert a considerable financial burden on health-care systems. In this study, the resource utilization in mental illness (RUMI) tool was developed and employed to evaluate resource utilization in patients with SMI. Materials and methods Data from 107 patients with SMI treated in four psychiatric outpatient clinics in Sweden were collected. The relationships between costs for physical and psychiatric care, social services, and the justice system, to self-reported health and quality of life, educational level, Global Assessment of Functioning (GAF), the Clinical Global Impressions scale score (CGI), and body mass index (BMI) were studied. Results Sixteen out of 107 patients accounted for 74% of the total costs. The mean and median cost for 6 months included in the survey for social services, family and social welfare and healthcare, psychiatric and physical treatment interventions, mean 8349 EUR, median 2599 EUR per patient (currency value for 2021). Education and psychosocial function (GAF) were both negatively correlated with costs for the social services (education, r=-0.207, p < 0.014; GAF, r=-0.258, p < 0.001). CGI was correlated with costs for physical and psychiatric healthcare (r = 0.161, p < 0.027), social services support (r = 0.245, p = 0.002) and total cost (r = 0.198, p = 0.007). BMI correlated with costs for psychiatric and physical health settings interventions (r = 0.155, p < 0.019) and for somatic and psychiatric medicines (r = 0.154, p < 0.019). Conclusion The RUMI scale was acceptable and enabled estimation of resource utilization in a comparable manner across different care settings. Such comparable data have potential to provide a basis for budgeting and resource allocation.

Relatively little has been published about the prevalence of autism in adults with psychiatric disorders. In this study, all new patients referred to an adult psychiatric outpatient clinic in Sweden between November 2019 and October 2020 (n = 562) were screened for autism spectrum disorders using the Ritvo Autism and Asperger Diagnostic Scale Screen (RAADS-14). Out of the 304 (58%) responders, 197 who scored above the cut off (14) were invited to participate in an in-depth assessment. Twenty-six of the 48 that participated in the assessment met criteria for ASD and an additional eight had subthreshold ASD symptoms. We estimated the prevalence of ASD in this population to at least 18.9%, with another 5–10% having subthreshold symptoms.

Affective and anxiety diagnoses are common in older people with intellectual disability (ID). The aim was to describe support and social services for older people with ID and affective and/or anxiety diagnoses, also to investigate in this study group the association between support and social services and frailty factors in terms of specialist healthcare utilisation, multimorbidity, polypharmacy, level of ID and behavioural impairment. Data was selected from four population-based Swedish national registries, on 871 identified persons with affective and/or anxiety diagnoses and ID. Multivariate regression analysis was used to investigate associations between frailty factors during 2002-2012 and social services in 2012. People with multimorbidity who frequently utilised specialist healthcare were less likely to utilise residential arrangements. Those with polypharmacy were more likely utilise residential arrangements, and receive personal contact. People with moderate, severe/profound levels of ID were more likely to utilise residential arrangements and to pursue daily activities.

Distal radius fractures (DRF) are associated with increased risk of subsequent fractures and physical decline in older adults. This study aims to evaluate the risk cognitive decline following DRF and potential for timely screening and intervention. A cohort of 1046 individuals 50–75 years of age with DRF were identified between 1995 and 2015 (81.5% female; mean age 62.5 [± 7.1] years). A control group (N = 1044) without history of DRF was matched by age, sex, and fracture date (i.e., index). The incidence of neurocognitive disorders (NCD) in relation to DRF/index was determined. Group comparisons were adjusted by age and comorbidity measured by the Elixhauser index. The DRF group had a greater incidence of NCD compared to the control group (11.3% vs. 8.2%) with a 56% greater relative risk (HR = 1.56, 95% Cl: 1.18, 2.07; p = 0.002) after adjusting for age and comorbidity. For every 10-year age increase, the DRF group was over three times more likely to develop a NCD (HR = 3.23, 95% Cl: 2.57, 4.04; p < 0.001). DRF in adults ages 50 to 75 are associated with increased risk of developing neurocognitive disorders. DRF may represent a sentinel opportunity for cognitive screening and early intervention. Distal radius fractures (DRF) have been associated with greater risk of future fractures and physical decline. This study reports that DRF are also associated with greater risk of developing neurocognitive disorders in older adults. Timely intervention may improve early recognition and long-term outcomes for older adults at risk of cognitive decline.

AbstractBackgroundDespite well-established guidelines for managing major depressive disorder, its extensive disability burden persists. This Value of Treatment mission from the European Brain Council aimed to elucidate the nature and extent of “gaps” between best-practice and current-practice care, specifically to:1.Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model and2.Recommend policies intending to better meet patient needs (i.e., minimize treatment gaps).MethodsAfter agreement upon a set of relevant treatment gaps, data pertaining to each gap were gathered and synthesized from several sources across six European countries. Subsequently, a modified Delphi approach was undertaken to attain consensus among an expert panel on proposed recommendations for minimizing treatment gaps.ResultsFour recommendations were made to increase the depression diagnosis rate (from ~50% episodes), aiming to both increase the number of patients seeking help, and the likelihood of a practitioner to correctly detect depression. These should reduce time to treatment (from ~1 to ~8 years after illness onset) and increase rates of treatment; nine further recommendations aimed to increase rates of treatment (from ~25 to ~50% of patients currently treated), mainly focused on targeting the best treatment to each patient. To improve follow-up after treatment initiation (from ~30 to ~65% followed up within 3 months), seven recommendations focused on increasing continuity of care. For those not responding, 10 recommendations focused on ensuring access to more specialist care (currently at rates of ~5–25% of patients).ConclusionsThe treatment gaps in depression care are substantial and concerning, from the proportion of people not entering care pathways to those stagnating in primary care with impairing and persistent illness. A wide range of recommendations can be made to enhance care throughout the pathway.

Objectives: This study investigates specialist healthcare visits of older people with intellectual disability ID having affective and anxiety diagnoses in comparison with the general population, as well as across different levels of ID, behavioural impairment, and living in special housing in Sweden. Method: The study is a retrospective national-register-based study from 2002-2012 of people with ID 55 years and older (n = 7936) and a control group the same size matched by birth year and sex from the general population at the end of study. The study groups comprised those with affective (n = 918) and anxiety (n = 825) diagnoses who visited specialist healthcare, including data about living in special housing at the end of study in 2012. Results: Older people with ID and with affective and anxiety diagnoses have a higher risk of inpatient and unplanned visits to psychiatric and somatic healthcare than the general population. The average length of stay in inpatient psychiatric healthcare was higher in older people with ID and anxiety diagnoses than in the general population. Within the ID group, more inpatient and unplanned visits were made by those with moderate and severe levels of ID, behavioural impairment, and living in special housing. Conclusion: Older people with ID and affective and anxiety diagnoses are more likely to have inpatient and unplanned visits for specialist healthcare than the general population. Future research should explore the quality of healthcare services delivered by healthcare providers to older people with ID and with affective and anxiety diagnoses.

Background: Long-term pharmacological maintenance therapy is often essential among people with bipolar disorder to reduce the need for inpatient care. Sex-specific responses to maintenance therapies are expected but remain largely unknown. Here, we examined for sex-specific associations between common maintenance therapies for bipolar disorder with inpatient rehospitalizations following patients' index discharges during 2006–2014. Methods: Population-based data on maintenance therapies and rehospitalizations were extracted from Swedish national registries. We adopted the within-individual design to compare the time on- vs. off- maintenance therapy for males and females, respectively. Extended stratified Cox proportional hazards regression models were employed to quantify the rate of rehospitalization as a function of common maintenance drugs and other important time-varying control variables. Results: Our primary analysis included 22,681 bipolar disorder rehospitalizations by 6,400 males and 9,588 (60.0%) females over an observation time of 62,813 person-years. The time spent on- vs. off- maintenance lithium, lamotrigine, quetiapine, or olanzapine was statistically significant upon adjustment among either sex for reducing the rate of bipolar rehospitalizations. Adjusted sex-specific statistically significant associations were also observed. Among females, the time on- (vs. off-) long-acting injectable risperidone reduced the rate of bipolar rehospitalizations by 73% (56–84%), carbamazepine by 44% (18–62%), aripiprazole by 29% (13–42%), and valproate by 23% (11–33%); whereas among males, ziprasidone by 65% (41–79%). Conclusion: The effectiveness of most maintenance therapies is generally comparable and uniform among both males and females. Despite some statistically significant sex-specific associations, estimates for each drug were fairly consistent between sexes.

Bipolar disorder has long been associated with increased risks for suicidality; though factors associated with dying by suicide remain obscure. Here, we retrospectively examine the associations between the different phases of bipolar illness and other common comorbidities with death by suicide in the 120 days following each discharge for Swedes first admitted as inpatients for bipolar disorder during the years 2000-2014. Data on admissions and suicide deaths were extracted from the Swedish National Patient Register and the Cause of Death Register, respectively. ICD-10 diagnostic codes were used to define the phases: depressive, manic, mixed, and other; and the comorbidities: specific substance use disorders, attention deficit hyperactivity disorder, and personality disorders. Extended Cox regressions were employed to model the time to death by suicide as a function of the bipolar phases, comorbidities, and other important control variables. Our analysis included 60,643 admissions by 22,402 patients over an observation time of 15,187 person-years. Overall, 213 (35.7%) of all suicides occurred within 120 days of discharge. Upon adjustment and compared to the depressive phases, manic phases were significantly associated with a far lower hazard of dying by suicide (HR 0.34, 95% CI: 0.21-0.56, p < 0.001), though mixed phases were not (HR 0.92, 95% CI: 0.48-1.73, p = 0.957). With regard to comorbidity, only sedative use disorder remained significantly associated with dying by suicide upon adjustment (HR 2.08, 95% CI: 1.41-3.06, p = 0.001). Vigilant monitoring of patients post discharge and of prescription practices are recommended.

Current mental health services across the world remain expert-centric and are based on traditional workflows, mostly using impractical and ineffective electronic record systems or even paper-based ...

Little is known regarding the burden of comorbidities among older people with intellectual disability (ID) who have affective and anxiety disorders. Therefore, we aimed to investigate the occurrence and risk of psychiatric and somatic comorbidities with affective and/or anxiety disorders in older people with ID compared to the general population. This population study was based on three Swedish national registers over 11 years (2002–2012). The ID group was identified in the LSS register, which comprises of data on measures in accordance with the Act Concerning Support and Service for Persons with Certain Functional Impairments (n = 7936), and a same-sized reference cohort from the Total Population Register was matched by sex and year of birth. The study groups consisted of those with affective (n = 918) and anxiety (n = 825) disorder diagnoses. The information about diagnoses were collected from the National Patient Register based on ICD-10 codes. The rate of psychiatric comorbidities with affective and anxiety disorders was approximately 11 times higher for people with ID compared to the general reference group. The two most common psychiatric comorbidities occurred with affective and anxiety disorders were Unspecified non-organic psychosis and Other mental disorders due to brain damage and dysfunction and to physical disease (8% for each with affective disorders and 7 and 6% with anxiety disorders, respectively). In contrast, somatic comorbidity comparisons showed that the general reference group was 20% less likely than the ID cohort to have comorbid somatic diagnoses. The most commonly occurring somatic comorbidities were Injury, poisoning and certain other consequences of external causes (49 and 47% with affective and anxiety disorders, respectively) and Signs and symptoms and abnormal clinical and laboratory findings not elsewhere classified (44 and 50% with affective and anxiety disorders, respectively). Older people with ID and with affective and anxiety diagnoses are more likely to be diagnosed with psychiatric comorbidities that are unspecified, which reflects the difficulty of diagnosis, and there is a need for further research to understand this vulnerable group. The low occurrence rate of somatic diagnoses may be a result of those conditions being overshadowed by the high degree of psychiatric comorbidities.

People with intellectual disability (ID) have high prevalence of psychiatric disorders, but even higher rates of prescription of psychotropic drugs. Using Swedish national registers, we identified a group of older people with ID and diagnosis of mood disorders (ICD-10 codes F32-F39) and/or anxiety (ICD-10 code F4) during 2006–2012 (n = 587) and a referent group of people from the general population with the same diagnoses during the same time period (n = 434). For both groups, we collected information on prescription of anxiolytics, hypnotics and sedatives, antidepressants, and GABA-agonists. Among those with a diagnosis of anxiety, people with ID were more likely than those in the general population to be prescribed anxiolytics (Relative Risk 1.32 [95% Confidence Interval 1.19–1.46]) and GABA-agonists (1.10 [1.08–1.31]). Moreover, among those with anxiety but without mood disorders, ID was associated with increased prescription of antidepressants (1.20 [1.03–1.39]). Within the ID cohort, behaviour impairment and MSP (i.e. moderate, severe, or profound) ID was associated with increased prescription of anxiolytics, both among those with anxiety (1.15 [1.03–1.30] for behaviour impairment and 1.23 [1.10–1.38] for MSP ID) and among those with mood disorders (1.14 [0.97–1.35] for behaviour impairment and 1.26 [1.04–1.52] for MSP ID). Moreover, MSP ID was associated with increased prescription of GABA-agonists among those with anxiety (1.23 [1.10–1.38]). The excess prescription of anxiolytics but not antidepressants may suggest shortages in the psychiatric health care of older people with intellectual disability and mood and anxiety disorders.

Background: Life expectancy is reduced by 19 years in men and 17 in women with psychosis in Sweden, largely due to cardiovascular disease. Aim: Assess whether a psychosocial health promotion intervention improves cardiometabolic risk factors, quality of life, and severity of illness in patients with psychotic disorders more than treatment as usual. Methods: A pragmatic intervention trial testing a manual-based multi-component health promotion intervention targeting patients with psychosis. The Swedish intervention was adapted from IMPaCT therapy, a health-promotion program based on motivational interviewing and cognitive behavioral therapy, designed to be incorporated into routine care. The intervention group consisted of 119 patients and the control group of 570 patients from specialized psychosis departments. Outcome variables were assessed 6 months before intervention during the run-in period, again at the start of intervention, and 12 months after the intervention began. The control group received treatment as usual. Results: The intervention had no significant effect on any of the outcome variables. However, BMI, waist circumference, systolic BP, heart rate, HbA1c, general health, and Clinical Global Impressions Scale score improved significantly during the run-in period before the start of the active intervention (observer effect). The multi-component design meant that treatment effects could only be calculated for the intervention as a whole. Conclusion: The results of the intervention are similar to those of the U.K. IMPaCT study, in which the modular health-promotion intervention had little effect on cardiovascular risk indicators. However, in the current study, the run-in period had a positive effect on cardiometabolic risk factors. (C) 2019 Published by Elsevier B.V.