Norwegian Outpatients Research Articles

Faecal microbiota transplantation (FMT) in Norwegian outpatients with mild to severe myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS): protocol for a 12-month randomised double-blind placebo-controlled trial

IntroductionThe observed alteration of the intestinal microbiota in patients with myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) and the effect of transferring a healthy gut flora from a faecal donor using a...

Sociodemographic factors and use of pain medication are associated with health-related quality of life: results from an adult community mental health service in Norway.

Health-related quality of life (HRQoL) is an important aspect of mental health outcomes. There are few studies on HRQoL in heterogeneous patient populations seeking help at community mental health services. The aims of the study were to compare how HRQoL, measured by the EuroQol five dimensions with five levels (EQ-5D-5L), was distributed compared to other samples from national and international studies, and to explore what factors are associated with HRQoL. In a cross-sectional study, 1379 Norwegian outpatients reported their HRQoL before starting treatment. Associations with demographic variables, job status, socio-economic status, and use of pain medication were examined using multiple regression analysis. Most of the sample, 70% to 90%, reported problems with usual activities, pain/discomfort, and anxiety/depression; 30% to 65% reported that these problems were of a moderate to extreme degree. Forty percent reported problems with mobility, and about 20% reported problems with self-care. The sample's HRQoL was considerably lower than the general population, and comparable to patient-groups from specialist mental health services. Originating from a developing country, lower level of education, lower yearly household income, being on sick leave or unemployed, and using pain medication were associated with lower HRQoL. Age, gender, and relationship status were not associated with HRQoL. This is the first study to simultaneously examine the unique contribution of these variables in one study. The most impacted domains of HRQoL were pain/discomfort, anxiety/depression, and usual activities. Lower HRQoL was associated with several socio-demographic factors and use of pain medication. These findings might have clinical implications and suggest that mental health professionals should routinely measure HRQoL in addition to symptom severity, to identify areas that should be targeted to improve HRQoL.

Challenges of the Treatment of Neuropsychiatric Symptoms Associated with Dementia

medications are associated with a significant risk of mortality and morbidity in older patients with dementia. Guidelines and expert opinion now recommend that, when treating neuropsychiatric symptoms associated with dementia, clinicians use first nonpharmacological interventions; when patients do not respond to these nonpharmacological interventions, clinicians should carefully weigh the potential risks and benefits of antipsychotics and alternative pharmacological treatment (e.g., selective serotonin reuptake inhibitors [SSRIs], cognitive enhancers, or anticonvulsants); if they decide to use an antipsychotic, they should obtain consent from the surrogate decision maker after having informed him or her of the potential risks associated with the use of antipsychotics and they should carefully document the discussion; finally, they should discontinue antipsychotics in non-responders and systematically attempt to discontinue antipsychotics after a few months in responders. Four articles in the current issue 4e7 illustrate the challenges faced by clinicians when engaging in this process and by the field of geriatric psychiatry in general when trying to collect better evidence on which to base clinical algorithms and guidelines. The article by Langballe et al. 4 reports on a longitudinal cohort analysis of 26,940 Norwegian outpatients with dementia who were prescribed cognitive enhancers and either an antipsychotic or other psychotropic medications (antidepressants, benzodiazepines, lithium, or anticonvulsants) for up to seven years. Compared with other psychotropic drugs, antipsychoticswereassociatedwithaboutadoublingofthe risk of mortality both in the short term (during the first 30 days after initiating treatment) and in the long term (during the 2- to 7-year follow-up period). The analysis adjusted for age, sex, doses, and—as a proxy for comorbid physical conditions—drugs used for the treatment of cancer, diabetes, and cardiovascular, lung, or musculoskeletal diseases. Congruent with several previous analyses, 8 haloperidol was associated with a higher mortality risk than risperidone and the risk associated with risperidone was not different from the risk associated with olanzapine or quetiapine. As in previous studies, Langballe et al. 4 found a very high relative increase in the risk of mortality associated with antipsychotic use; the corresponding absolute increase, however, was quite low. During the first 30 days of use, the adjusted hazard ratio (HR) for the use of antipsychotics versus other psychotropic drugs was 2.1, corresponding to about a doubling (110% increase) of the risk. The absolute risk of dying, however, was 1.13% (93 deaths among the 8,214 outpatients treated with an antipsychotic) versus 0.42% (79 deaths among the 18,726 outpatients treated with other psychotropic drugs), yielding an (unadjusted) absolute increase of only 0.71% (1.13%e0.42%). Similarly for the 2- to 7-year follow-up period, the adjusted HR was 1.7 (about a 70% increase) but the

Beliefs about medicines among Norwegian outpatients with chronic cardiovascular disease

ObjectiveTo investigate the beliefs of Norwegian outpatients about medicines, and to explore if some patient-specific factors and drug use are associated with the beliefs.MethodsPatients from an outpatient clinic for chronic...

Factors affecting hope in a sample of fatigued breast cancer outpatients

The aims of this study of women with breast cancer were: to describe the levels of hope and compare hope scores for these patients with a sample from the general Norwegian population; to describe the relationship between hope and fatigue; and finally to evaluate the effect of demographic and clinical characteristics and fatigue on hope. A total of 160 Norwegian outpatients with cancer and fatigue (>2.5 on a 0-10 scale) completed the Herth Hope Index (HHI), Fatigue Questionnaire (FQ), and Self-administered Comorbidity Questionnaire (SCQ). The mean age of the women was 55.3 years (SD = 9.4), 81% lived with someone, and 67% were employed. The most common comorbidities were back pain (42%), osteoarthritis (26%), and headache (19%). The fatigued breast cancer patients reported significantly higher total hope scores than the general Norwegian population (p < .0001). The difference was largest in the individual item "I can see a light in the tunnel," to which the cancer sample reported the highest scores, but they also felt more "scared about the future." Total hope score was negatively correlated with total fatigue (TF), mental fatigue (MF), and chronic fatigue (CF), but not with physical fatigue (PF). Demographic and clinical characteristics were not significantly related to hope, except that patients who were married or living with someone showed significantly higher total hope scores. The higher levels of hope in breast cancer patients compared with the general Norwegian population may reflect a response shift in patients after getting a cancer diagnosis. The fact that a significant relationship was found between total hope scores and living arrangements may indicate that hope is easier to establish when patients have someone to relate to or receive support from. Hope and total fatigue were significantly, but weakly correlated.

Validation of the Seven Minute Screen and Syndrom Kurztest among elderly Norwegian outpatients

Brief cognitive tests represent a first step in the assessment of elderly people referred to outpatient clinics because of cognitive impairment. The aim of this study is to determine sensitivity, specificity and likelihood ratio for a positive result (LR+) for the brief cognitive tests Seven Minute Screen (7MS) and Syndrom Kurztest (SKT) in an outpatient sample of elderly patients with no dementia or mild dementia. Ninety-five patients aged 65 years or more from 10 Norwegian geriatric and psychogeriatric outpatient clinics were included in the study. All the subjects had a Mini-mental State Examination score of 22-30. A consensus diagnosis of dementia according to ICD-10 was established by an expert panel that considered data from a standardized assessment protocol blinded for 7MS and SKT results. Subjects were diagnosed with mild dementia (n = 69) or no dementia (n = 26). Sensitivity for 7MS was 71%, specificity 73% and LR+ was 2.6. Sensitivity for SKT was 65%, specificity 65% and LR+ was 1.9. Sensitivity, specificity and LR+ for 7MS and SKT were unacceptably low in this outpatient sample.