Acta Psychiatrica Scandinavica

Cover image for Vol. 135 Issue 2

Edited By: Ida Hageman

Impact Factor: 6.128

ISI Journal Citation Reports © Ranking: 2015: 9/139 (Psychiatry (Social Science)); 13/142 (Psychiatry)

Online ISSN: 1600-0447

Article of the Month

APRIL 2015

The three presidents of the psychiatric organizations, European Psychiatric Association, World Psychiatric Association and American Psychiatric Association, Professors Wolfgang Gaebel, Dinesh Bhugra and Paul Summergrad, respectively, two of them together with a co-author, generously contributed to the April issue of the Acta Psychiatrica Scandinavica. They offered each of them an editorial comment on the seemingly everlasting challenge to psychiatry: mental illness among homeless people (or homelessness among persons suffering from mental illnesses).

The three editorial comments take their basis in a study by V. Stergiopoulos et al. “Neurocognitive impairment in a large sample of homeless adults with mental illness” published also in the April issue of the Acta Psychiatrica Scandinavica.

It is often argued that homelessness is the responsibility of social welfare services. The high correlation between homelessness and mental illness in study after study performed during decades after decades documents that homelessness is – also a psychiatric responsibility.

Neurocognitive impairment in a large sample of homeless adults with mental illness
V. Stergiopoulous, A. Cusi, T. Bekele, A. Skosireva, E. Latimer, C. Schütz, I. Fernando, S. Rourke

Home is where hearth is
D. Bhugra, A. Ventriglio

Homeless and mentally ill – a mental healthcare challenge for Europe
W. Gaebel, J. Zielasek

Homeless and impaired: the burden of serious psychiatric illness
P. Summergrad

MARCH 2015

Antipsychotic exposure prior to acute myocardial infarction in patients with serious mental illness
WU S-I, Kao K-L, Chen S-C, Juang JJM, Lin C-J, Fang C-K, Wu C-S

Acta Psychiatrica Scandinavica gives priority to the improvement of physical health in mentally ill by publishing reports from studies that may be directly useful to daily clinical work.

In their article “Antipsychotic exposure prior to acute myocardial infarction in patients with serious mental illness” Wu et al. point at a possible “short-term risk effect of antipsychotic exposure on risk of acute myocardial infarction”. Moreover, they also identify potentially vulnerable groups.


The prevalence of pain in bipolar disorder: a systematic review and large-scale meta-analysis
B. Stubbs, L. Eggermont, A.J. Mitchell, M. De Hert, C.U. Correll, A. Soundy, S. Rosenbaum, D. Vancampfort

The February issue of Acta Psychiatrica Scandinavica brings a meta-analysis of pain in bipolar disorder by Stubbs et al. who have collected a group of leading researchers and clinical experts. They conclude that “people with bipolar disorder experience significantly increased level of pain (particularly chronic pain and migraine). The assessment and treatment of pain should form an integral part of the management of bipolar disorder.”

See also: Sleep in patients with remitted bipolar disorders: a meta-analysis of actigraphy studies
P.A. Geoffroy, J. Scott, C. Boudebesse, M. Lajnef, C. Henry, M. Leboyer, F. Bellivier, B. Etain


The practical management of refractory schizophrenia – the Maudsley Treatment REview and Assessment Team service approach
K. Beck, R. McCutcheon, M. A. P. Bloomfield, F. Gaughran, T. Reis Marques, J. MacCabe, S. Selvaraj, D. Taylor & O. D. Howes

It is this editor’s attitude that lack of knowledge is not the major problem in clinical psychiatry; a major problem is the use of existing new knowledge and the implementation of new knowledge without a too long latent period. On this background, the clinical overview article The practical management of refractory schizophrenia – the Maudsley Treatment Review and Assessment Team service approach by Beck and co-workers is chosen as the Acta Psychiatrica Scandinavica article of the month.

How many clinical recommendations do we need? The attitude of this Journal is: as many as possible. By circulating updated recommendations from local, regional, national and international environments, the chances that new knowledge is circulated, highlighted and discussed are high. The present article from the Maudsley focuses on a group of patients who deserves our outmost attention: the persons suffering from a treatment refractory schizophrenia, in this case in a community setting. Moreover, the article focuses on clozapine treatment, illustrating the decreasing reluctance to use clozapine these years.


Do the treasures of ‘big data’ combined with behavioural intervention therapies contain the key to the mystery of large psychiatric issues?
G. Font, L. Brunel, M. Leboyer & L Leboyer

R. Stewart

In the November issue of Acta Psychiatrica Scandinavica, Stewart and Fond discuss how to avoid past mistakes around data gathering, how to design the data collection process to be beneficial for both clinicians and researchers, and the potentials of using routine clinical data for research purposes.

Two highly recommendable and relevant inputs to the ongoing discussion of the future of psychiatric research.


Waiting list may be a nocebo condition in psychotherapy trials: a contribution from network meta-analysis
T.A. Furukawa, H. Noma, D.M. Caldwell, M. Honyashiki, K. Shinohara, H. Imai, P. Chen, V. Hunot & R. Churchill

Only little is known regarding the impact of various control conditions on the evidence for effectiveness of psychotherapeutic interventions in randomized controlled trials (RCTs). In their meta-analysis, published in the September issue of Acta Psychiatrica Scandinavica, Furukawa et al. aimed to investigate systematically how three frequently applied control conditions in psychotherapeutic trials (psychological placebo, no treatment, and waiting list) influence the effect sizes for cognitive-behavior therapies (CBT) in acute depression. Altogether 49 RCTs representing 2730 subjects were meta-analyzed using pairwise as well as network meta-analytic statistics. Primary outcome was treatment response in a dichotomous manner.

The meta-analytic results revealed significant superiority of CBT over the “waiting list” and “no treatment” condition, but only a trend when a “psychological placebo” was used in the control group. These findings indicate that the effect sizes for CBT in depression are substantially influenced by the applied control condition. Moreover, the authors found that more participants in the pooled “no treatment“ study group achieved treatment response compared to those allocated to the “waiting list“. Furukawa et al. provided a possible explanation for this interesting result: The patients assigned to a “waiting list“ are possible “more motivated to remain depressive“ in order to receive their originally desired CBT immediately after termination of the RCT, whereas subjects allocated to “no treatment“ may probably more actively seek to receive other therapeutic options to treat their depressive symptoms. The authors concluded that “waiting list” can be regarded even as nocebo condition inferior to the “no treatment” condition.


Fifty years' development and future perspectives of psychiatric register research
P. Munk-Jørgensen, N. Okkels, D. Golberg, M. Ruggeri & G. Thornicroft

In the August issue of Acta Psychiatrica Scandinavica, Munk-Jørgensen and colleagues discuss the past, present and future of register-based psychiatric research. The article is accompanied by editorial comments from Amaddeo (“The small scale clinical psychiatric case registers”) and Stewart (“The big case register”) respectively. In their article, Munk-Jørgensen et al. review the use of psychiatric registers-based research under five subheadings: health service research, outcome studies, identification of representative clinical cohorts, follow-up of clinical cohorts and linkage to biobanks. This provides a useful overview of the types of studies that can be conducted using register-based data. Finally, the inherent strengths/ limitations of register-based research and future directions for the field are comprehensively discussed.

Also of interest are the following editorials:

The small scale clinical psychiatric case registers
F. Amaddeo

The big case register
R. Stewart

JULY 2014

Cognitive deficits in youth with familial and clinical high risk to psychosis: a systematic review and meta-analysis
E. Bora, A. Lin, S.J. Wood, A.R. Yung, P.D. McGorry & C. Pantelis

A high proportion of patients with psychotic disorders are also suffering from cognitive impairment. However, the causal relation between psychosis and cognitive dysfunction remains elusive. In the July issue of Acta Psychiatrica Scandinavica, Bora and colleagues present a large meta-analysis on cognitive deficits in youth with familial and clinical high risk of psychosis. Their findings of increased prevalence of cognitive dysfunction in both groups are consistent with previous literature. Additionally, they report more severe cognitive impairment when these two risk factors are co-occurring. The authors suggest that future research should include more longitudinal studies, in order to identify mechanisms behind this correlation, as well as predictors for the course and outcome of psychotic disorders.

JUNE 2014

What was learned: studies by the consortium for research in ECT (CORE) 1997-2011

ECT is an effective treatment for severe psychiatric illnesses including unipolar and bipolar depression, psychotic depression, catatonia and delirious mania but remains an underutilized treatment in some countries. In the June issue of Acta Psychiatrica Scandinavica, M. Fink reviews findings from the most comprehensive ECT studies done to date and places them within a historical context. In this review, M. Fink highlights findings in terms of clinical predictors of outcome (e.g. including psychosis, suicide risk, polarity, melancholia, atypical depression and age) and several technical aspects of treatment. The author concludes that ECT is an efficacious treatment for both unipolar and bipolar depression, particularly melancholic or psychotic depression, and rapidly relieves active suicide risk.

Electroconvulsive therapy reappraised

In an accompanying Editorial Comment, T.G. Bolwig discusses the conclusions by M. Fink.

MAY 2014

SPECIAL ISSUE: A Bipolar Maze: A Roadmap through Translational
Guest Editor, Eduard Vieta

Our publisher Wiley has accepted that we instead of selecting one article as ’article of the month’ present the entire May issue to our readers. This because the May issue entitled “The bipolar maze: a roadmap through translational psychopathology” is a special issue which gives examples of the richness and broadness of today’s bipolar research: epidemiology on age at onset, comorbidity, biomarkers, clinical trial methodology, treatment and medication adherence. The issue is edited by guest editor Professor Eduard Vieta, Barcelona, Spain who has also written the opening editorial: The bipolar maze: a roadmap through translational psychopathology.

Povl Munk-Jørgensen, Editor, Acta Psychiatrica Scandinavica

MARCH 2014

Measuring Psychotic Depression
S.D. Østergaard, B.S. Meyers, A.J. Flint, B.H. Mulsant, E.M. Whyte, C.M. Ulbricht, P. Bech, A.J. Rothschild and on behalf of the STOP-PD Study Group

There is a lack of consensus on how to measure the severity of psychotic depression (PD) and the majority of treatment studies only considers improvement in depression and do not take change in psychotic symptoms into account in their definitions of remission or response.

The results of the present analysis of the STOP-PD data, indicate that the HAMD-BPRS rating scale consisting of items covering both the depressive and the psychotic dimension of PD may possess higher psychometric validity compared with the most commonly used depression scale, namely the HAM-D.

The authors found that a composite rating scale consisting of the 6-item Hamilton melancholia subscale (HAM-D6) plus five items from the Brief Psychiatric Rating Scale (BPRS), named the HAMD-BPRS, displayed both clinical and psychometric validity in the measurement of the severity and treatment response of PD. This study brings an additional and important contribution to the evaluation process of quantify psychotic and depressive symptoms, suggesting the usefulness of the HAMD-BPRS as a clinical tool for assessing the severity of psychotic depression

The above article is accompanied by an editorial comment by M. Fava


A profile approach to impulsivity in bipolar disorder: the key role of strong emotions
L. Muhtadie, S. L. Johnson, C. S. Carver, I. H. Gotlib, T. A. Ketter

Impulsivity is a hallmark symptom of bipolar disorder (BD), and previous research has highlighted its association with illness onset and severity. In the February issue of Acta Psychiatrica Scandinavica, Muhtadie and colleagues present a study designed to test which domains of impulsivity are most informative of clinical severity in BD. The investigators adeptly integrate their findings into the impulsivity and BD literature and also suggest potential targets for therapeutic intervention, including the development of effective emotion regulation and impulse control strategies.

Max Martinson, Amber Cardoos, Rosemary Walker, James Doorley, Angela Pisoni, Kelley Durham Depression Clinical & Research Program (DCRP) Massachusetts General Hospital, Harvard Medical School, Boston (MA), USA


DSM-5 criteria for depression with mixed features: a farewell to mixed depression
A. Koukopoulos n, G. Sani

Throughout its history, the DSM has struggled to categorize mixed forms of mood disorders. With its fifth edition, the DSMproposes a new way to diagnose depression with mixed features. Koukopoulos and Sani’s critique of the DSM-5’s proposed criteria for depression with mixed features in the January issue of Acta Psychiatrica Scandinavica argues that the symptoms that the DSM-5 specifies are neither scientifically nor clinically comprehensive.Koukopoulos and Sanipropose a different set of symptoms which they argue are more clinically adept.

Max Martinson, Amber Cardoos, Rosemary Walker, James Doorley, Angela Pisoni, Kelley Durham Depression Clinical & Research Program (DCRP) Massachusetts General Hospital, Harvard Medical School, Boston (MA), USA