Publications by authors named "Niels Okkels"

18 Publications

  • Page 1 of 1

Fasting gallbladder volume is increased in patients with Parkinson's disease.

Parkinsonism Relat Disord 2021 Apr 30;87:56-60. Epub 2021 Apr 30.

Department of Nuclear Medicine and PET, Aarhus University Hospital, Palle Juul-Jensens Boulevard 165, J220, 8200, Aarhus N, Denmark.

Introduction: Autonomic denervation in patients with Parkinson's disease (PD) and isolated REM-sleep behavior disorder (iRBD) could impede gallbladder function leading to increased fasting gallbladder volume (fGBV) and higher risk of gallstones. We aimed to determine fGBV in patients with PD, iRBD, and healthy controls (HCs).

Methods: We included 189 subjects; 100 patients with PD, 21 with iRBD, and 68 HCs. fGBV was determined from abdominal CT scans, and radiopaque gallstone frequency was evaluated.

Results: Median fGBV was 35.7 ml in patients with PD, 31.8 ml in iRBD, and 27.8 ml in HCs (Kruskal-Wallis test: P = 0.0055). Post-tests adjusted for multiple comparison revealed a significant group difference between patients with PD and HCs (P = 0.0038). In the PD group, 23% had enlarged fGBV (cut-off at mean + 2 x standard deviation (SD) in the HC group). No difference in fGBV was observed between iRBD and the other two groups. The total prevalence of gallstones was 6.4% with no differences between the three groups.

Conclusion: Almost a quarter of patients with PD in our cohort exhibited increased fGBV. This study illuminates a potentially overlooked topic in PD research and calls for more studies on biliary dysfunction.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.parkreldis.2021.04.027DOI Listing
April 2021

Brain-first versus body-first Parkinson's disease: a multimodal imaging case-control study.

Brain 2020 10;143(10):3077-3088

Department of Nuclear Medicine and PET, Aarhus University Hospital, Aarhus, Denmark.

Parkinson's disease is characterized by the presence of abnormal, intraneuronal α-synuclein aggregates, which may propagate from cell-to-cell in a prion-like manner. However, it remains uncertain where the initial α-synuclein aggregates originate. We have hypothesized that Parkinson's disease comprises two subtypes. A brain-first (top-down) type, where α-synuclein pathology initially arises in the brain with secondary spreading to the peripheral autonomic nervous system; and a body-first (bottom-up) type, where the pathology originates in the enteric or peripheral autonomic nervous system and then spreads to the brain. We also hypothesized that isolated REM sleep behaviour disorder (iRBD) is a prodromal phenotype for the body-first type. Using multimodal imaging, we tested the hypothesis by quantifying neuronal dysfunction in structures corresponding to Braak stages I, II and III involvement in three distinct patient groups. We included 37 consecutive de novo patients with Parkinson's disease into this case-control PET study. Patients with Parkinson's disease were divided into 24 RBD-negative (PDRBD-) and 13 RBD-positive cases (PDRBD+) and a comparator group of 22 iRBD patients. We used 11C-donepezil PET/CT to assess cholinergic (parasympathetic) innervation, 123I-metaiodobenzylguanidine (MIBG) scintigraphy to measure cardiac sympathetic innervation, neuromelanin-sensitive MRI to measure the integrity of locus coeruleus pigmented neurons, and 18F-dihydroxyphenylalanine (FDOPA) PET to assess putaminal dopamine storage capacity. Colon volume and transit times were assessed with CT scans and radiopaque markers. Imaging data from the three groups were interrogated with ANOVA and Kruskal-Wallis tests corrected for multiple comparisons. The PDRBD- and PDRBD+ groups showed similar marked reductions in putaminal FDOPA-specific uptake, whereas two-thirds of iRBD patients had normal scans (P < 10-13, ANOVA). When compared to the PDRBD- patients, the PDRBD+ and iRBD patients showed reduced mean MIBG heart:mediastinum ratios (P < 10-5, ANOVA) and colon 11C-donepezil standard uptake values (P = 0.008, ANOVA). The PDRBD+ group trended towards a reduced mean MRI locus coeruleus: pons ratio compared to PDRBD- (P = 0.07, t-test). In comparison to the other groups, the PDRBD+ group also had enlarged colon volumes (P < 0.001, ANOVA) and delayed colonic transit times (P = 0.01, Kruskal-Wallis). The combined iRBD and PDRBD+ patient data were compatible with a body-first trajectory, characterized by initial loss of cardiac MIBG signal and 11C-colonic donepezil signal followed by loss of putaminal FDOPA uptake. In contrast, the PDRBD- data were compatible with a brain-first trajectory, characterized by primary loss of putaminal FDOPA uptake followed by a secondary loss of cardiac MIBG signal and 11C-donepezil signal. These findings support the existence of brain-first and body-first subtypes of Parkinson's disease.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/brain/awaa238DOI Listing
October 2020

Lighting as an aid for recovery in hospitalized psychiatric patients: a randomized controlled effectiveness trial.

Nord J Psychiatry 2020 Feb 11;74(2):105-114. Epub 2019 Oct 11.

Department of Affective Disorders, Aarhus University Hospital Risskov, Aarhus, Denmark.

Artificial indoor lighting can disturb sleep and increase depressive symptoms; both common complaints in psychiatric inpatients. In this trial we aimed to improve sleep in psychiatric inpatients using a circadian lighting environment. Investigator-blinded parallel-group randomised controlled effectiveness trial in an inpatient psychiatric ward with adjustable lighting. Admitted patients received a pre-set circadian lighting environment (intervention group) or lighting as usual (control group). The primary outcome was the Pittsburg Sleep Quality Index (PSQI) and secondary outcomes included the Major Depression Inventory and WHO-5 Well-Being Index. We assessed 74 patients and included 54 (27 treated and 27 controls). Treated patients reported a non-significant change in mean sleep quality by -1.02 points on the PSQI (95% CI: -3.17; 1.12) and controls by -0.59 points (95% CI: -2.52; 1.33), difference -0.43 (95% CI: -3.05; 2.2, -value .74). Similarly, treated patients reported a non-significant change in depressive symptoms and well-being compared to controls. Qualitative data indicated no serious side-effects and no patients in the intervention group were submitted to involuntary measures. Collection of data was non-complete and missing data from self-reported questionnaires amounted to 52.5%. The intervention showed no effect on sleep quality, mood or well-being. The circadian lighting environment was safe in our small and diverse patient sample. The trial integrated well with routine clinical care and our sample reflected the heterogeneity of the target population.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08039488.2019.1676465DOI Listing
February 2020

Urban mental health: challenges and perspectives.

Curr Opin Psychiatry 2018 05;31(3):258-264

Association for the Improvement of Mental Health Programmes (AMH), Geneva, Switzerland.

Purpose Of Review: To provide an update on urban mental health and highlight the challenges that require urgent attention.

Recent Findings: The majority of the world's population live in towns and urbanization is expected to increase in all areas of the world. Challenges to mental health in urban areas include loneliness, violence, high crime rates, homelessness, noise and other pollutants, traffic accidents, drug abuse, and insufficiency of mental health services.

Summary: Urbanization is a global and growing phenomenon that pose significant challenges to mental health and mental health services. Fast and unstructured urbanization, such as that seen in many developing countries, further exacerbates these challenges. There are promising initiatives emerging including initiatives to end homelessness, to improve access to green areas in urban environments, to provide emergency psychiatric services, and to develop new forms of mental health services adjusted to urban settings. Regrettably there are no universally accepted guidelines that would help governments in structuring health services for people with mental illness in towns and help to prevent mental health problems related to rapid urbanization.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/YCO.0000000000000413DOI Listing
May 2018

Treatment profiles in a Danish psychiatric university hospital department.

Nord J Psychiatry 2017 May 23;71(4):289-295. Epub 2017 Jan 23.

f Department of Psychiatry , Odense University Hospital , Odense , Denmark.

Background: Despite concerns about rising treatment of psychiatric patients with psychotropic medications and declining treatment with psychotherapy, actual treatment profiles of psychiatric patients are largely unknown.

Aims: To describe patterns in the treatment of patients in a large psychiatric university hospital department.

Methods: A descriptive mapping of treatment of in- and outpatients in a psychiatric department at Aarhus University Hospital Risskov, Denmark. Information was collected by healthcare staff using a 25-item survey form. The p-value was calculated with a chi-squared test and p < 0.05 was considered significant. The study was preceded by a pilot study on 41 patients.

Results: Over a 1 month period, a total of 343 consecutive patients were assessed and hereof 200 were included in the age range 18-90 years (mean 53.76); 86 men and 114 women. One-hundred and eighty-eight patients (94%) used psychotropic medication, 37 (19%) as monotherapy, and 148 (74%) in combination with non-pharmacological therapy. Ninety-seven (49%) had psychotherapy and 104 (52%) social support. Among inpatients, 21 (64%) had physical therapy, and 10 (30%) electroconvulsive therapy. In total, 163 (82%) had non-pharmacological therapy. Fifty-two (26%) patients had monotherapy, and 148 (74%) polytherapy. Mean number of treatment modalities used per patient was 2.07 for all patients and 3.23 for inpatients.

Conclusions: In this department, polytherapy including non-pharmacological modalities is applied widely across all settings and patient categories. However, psychotropic medication clearly dominates as the most frequently applied treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1080/08039488.2017.1279212DOI Listing
May 2017

Measuring chronic pain.

Pain 2016 07;157(7):1574

Psychiatric Research Unit, Mental Health Centre North Zealand, University of Copenhagen, Denmark.

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1097/j.pain.0000000000000534DOI Listing
July 2016

Traumatic Stress Disorders and Risk of Subsequent Schizophrenia Spectrum Disorder or Bipolar Disorder: A Nationwide Cohort Study.

Schizophr Bull 2017 01 31;43(1):180-186. Epub 2016 May 31.

Clinic for OCD and Anxiety Disorders, Aarhus University Hospital, Risskov, Denmark.

Objective: Traumatic stress disorders are prevalent in patients with schizophrenia and bipolar disorder. However, there is a lack of prospective longitudinal studies investigating the risk of severe mental illness for people diagnosed with traumatic stress disorders. We aimed to assess if patients with acute stress reaction (ASR) or post-traumatic stress disorder (PTSD) are at increased risk of schizophrenia spectrum disorders or bipolar disorder.

Methods: We performed a prospective cohort study covering the entire Danish population including information on inpatient and outpatient mental hospitals over 2 decades. Predictors were in- or outpatient diagnoses of ASR or PTSD. We calculated incidence rate ratios (IRR) with 95% CIs of schizophrenia, schizophrenia spectrum disorder, and bipolar disorder.

Results: Persons with a traumatic stress disorder had a significantly increased risk of schizophrenia (IRR 3.80, CI 2.33-5.80), schizophrenia spectrum disorder (IRR 2.34, CI 1.46-3.53), and bipolar disorder (IRR 4.22, CI 2.25-7.13). Risks were highest in the first year after diagnosis of the traumatic stress disorder and remained significantly elevated after more than 5 years. Mental illness in a parent could not explain the association.

Conclusion: Our findings support an association between diagnosed traumatic stress disorders and subsequent schizophrenia spectrum disorder or bipolar disorder. If replicated, this may increase clinical focus on patients with traumatic stress disorders.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/schbul/sbw082DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5216852PMC
January 2017

Depression and the risk of severe infections: prospective analyses on a nationwide representative sample.

Int J Epidemiol 2016 Feb 26;45(1):131-9. Epub 2015 Dec 26.

Department of Organic Psychiatric Disorders and Emergency Ward, Aarhus University Hospital, Risskov, Denmark.

Background: Preliminary research suggests an association between depression and subsequent increased risk of infections, yet little is known on this topic. This study investigated the association between depression and risk of various types of infections, including temporal and dose-response relationships.

Methods: A prospective population-based study including 976,398 individuals, of whom 142,169 had a history of depression between 1995 and 2012, was conducted using linked Danish registries. Survival analyses were used to estimate the relative risk of infections among those with depression, compared with those without depression, while adjusting for gender and age.

Results: Depression was associated with increased risk of a wide range of infections [incidence rate ratio (IRR) = 1.61, 95% confidence interval (CI) = 1.49-1.74, P = 0.000, for any infection]. There was no evidence of a specific temporal effect but rather a general increased risk of infection subsequent to the onset of depression, as the risk during first year (IRR = 1.67, 95% CI = 1.25-2.22, P = 0.000) remained elevated for the ensuing 11 years and beyond (IRR = 1.61, 95% CI = 1.39-1.85, P = 0.000). Dose-response analyses revealed that the risk of infection increased by 59% (IRR = 1.59, 95% CI = 1.45-1.75, P = 0.000) following a single depressive episode and was elevated even further (IRR = 1.97, 95% CI = 0.92-4.22, P = 0.082) following four or more depressive episodes. However, results did not indicate a perfect linear association.

Conclusions: Findings suggest the presence of depression may confer an increased risk of infection and that this increased susceptibility is not confined to a specific time period following the onset of depression. A dose-response relationship may be present, but more research is needed to further examine and confirm a link between depression and risk of infection.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1093/ije/dyv333DOI Listing
February 2016

[Merits can solve physician shortage].

Ugeskr Laeger 2015 06;177(24):1201

View Article and Find Full Text PDF

Download full-text PDF

Source
June 2015

Publication rate and PhD enrolment following a medical pre-graduate research programme.

Dan Med J 2015 Sep;62(9)

Society for Medical Student Research,Vennelyst Boulevard 9, 8000 Aarhus C, Denmark.

Introduction: In the 1990s, the publication and PhD recruitment rates following the Danish pre-graduate research programme (PGRP) in medicine were 54% and 33%, respectively. Updated estimates are unknown.

Methods: All medical students enrolled in the PGRP at the Faculty of Medicine, Aarhus University (Health), Denmark, during 2003-2012 were included (n = 687). The PGRP files were merged with PhD students' files at Health. A systematic literature search was completed for research students who had enrolled during the 2006-2009 period (n = 227). The factors investigated were student age, sex, PGRP completion time and years in medical school at the time of PGRP initiation. Supervisors were described by sex, title, position and affiliation. Calculations were tested by the chi-squared test; p < 0.05 was considered significant.

Results: A larger proportion of male medical students conducted a PGRP compared to female medical students (28% versus 19%; p < 0.01). Within three and a half years from PGRP initiation, 13% of the research students had enrolled in a PhD programme at Health, and 52% had published ≥ 1 paper with ≥ 1 supervisor. The research student was the first author on 43% of the overall 224 papers, and 90% were original articles. Publication was positively associated with completion of the PGRP in < 18 months and with embarking on a PhD and with having a male main supervisor. PhD recruitment was related to enrolment in the PGRP after fewer years in medical school.

Conclusions: Fast completion of the PGRP and early enrolment in the programme were associated with scientific publishing and PhD recruitment. The publication rate has remained stable over time.
View Article and Find Full Text PDF

Download full-text PDF

Source
September 2015

A nationwide study on delirium in psychiatric patients from 1995 to 2011.

Acta Neuropsychiatr 2014 Aug;26(4):234-9

Department of Organic Psychiatric Disorders and Emergency Ward (Dep. M),Aarhus University Hospital,Risskov,Denmark.

Objectives: Delirium shares symptoms with some mental illnesses. This may lead to misdiagnosis of delirium in psychiatric patients and a risk of inadequate management. Moreover, literature on delirium in psychiatric patients is sparse. The aim was to analyse possible changes in the diagnostic incidence of delirium in psychiatric patients from 1995 to 2011, and to investigate the patients with regard to sex, age, and type of patient.

Methods: All first time ever diagnoses of delirium among psychiatric patients were identified in the nationwide Danish Psychiatric Central Research Register (DPCRR) from 1995 to 2011. The delirium diagnoses include (1) delirium unspecified, (2) delirium with dementia, and (3) drug-related delirium, all in accordance with International Classification of Diseases-10. The incidence rates were age standardised.

Results: A total of 15 680 persons diagnosed with delirium for the first time were identified in the DPCRR between 1995 and 2011. The total incidence rate of delirium has decreased, reaching 8.4/1000 person-years in 2011. In 2011, 2.6% of the demented patients were diagnosed with delirium with dementia. Diagnosis of delirium is significantly more common in men, and the three groups of delirium showed a characteristic age distribution.

Conclusion: Our incidences were markedly lower when compared with previous studies. This suggests a possible underdiagnosis of delirium in psychiatric hospitals and should be investigated further, as delirium is a serious state and identifying the syndrome is important for sufficient treatment.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1017/neu.2013.65DOI Listing
August 2014

How personalized medical data could improve health care.

Prev Med 2014 Oct 9;67:303-5. Epub 2014 Aug 9.

Department of Organic Psychiatric Disorders and Emergency Ward (Dept. M), Aarhus University Hospital, Skovagervej 2, 8240 Risskov, Denmark; Medical Centre Sønderborg, Hospital of Southern Jutland, Sydvang 1, 6400 Sønderborg, Denmark. Electronic address:

We present a redesign of medical test results by placing the information of blood samples in the context of the patient's personal clinical data. We predict that implementing personalized data in the treatment of patients will promote engagement in the treatment, motivate patients to take responsibility and lead to greater satisfaction with the patient-doctor relationship.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1016/j.ypmed.2014.08.008DOI Listing
October 2014

[Medical education must be rethought].

Authors:
Niels Okkels

Ugeskr Laeger 2013 Oct;175(44):2661

View Article and Find Full Text PDF

Download full-text PDF

Source
October 2013

[Examination fanaticism].

Authors:
Niels Okkels

Ugeskr Laeger 2013 Oct;175(41):2438

View Article and Find Full Text PDF

Download full-text PDF

Source
October 2013

A personalized patient page.

Psychiatr Serv 2013 Oct;64(10):1067-8

View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.1176/appi.ps.201300181DOI Listing
October 2013

[Clinical Psychiatric Research School].

Ugeskr Laeger 2013 May;175(19):1364

Afdeling for Organisk Psykiatrisk Sygdom og Akut Modtagelse (Afd. M), Aarhus Universitetshospital, Risskov, Denmark.

View Article and Find Full Text PDF

Download full-text PDF

Source
May 2013

State of psychiatry in Denmark.

Int Rev Psychiatry 2012 Aug;24(4):295-300

Psychiatric Centre Copenhagen, Denmark.

Danish psychiatry has gone through profound changes over the past two to three decades, reducing inpatient-based treatment and increasing outpatient treatment markedly. The number of patients treated has almost doubled, and the diagnostic profile has broadened, now including a substantial number of common mental disorders, in particular depression and anxiety. Furthermore, 'new' diagnostic groups are represented in the treatment statistics with steeply increasing incidences, e.g. attention deficit hyperactivity disorder (ADHD) and eating disorders, especially in the outpatient part of the statistics. Over the same 30 years, the number of available beds has been reduced by 60-70%; however, as the length of stay of inpatients has been reduced markedly, the departments are still able to treat a high number of patients. The financial budgeting of psychiatry is not increasing equivalently to the somatic specialities, handicapping development in psychiatry. Action has been taken to increase research activity in psychiatry. This is facilitated by an increasing interest among medical students and young graduate physicians attracted by the neuropsychiatric paradigm, rapidly implemented in Danish psychiatry.
View Article and Find Full Text PDF

Download full-text PDF

Source
http://dx.doi.org/10.3109/09540261.2012.692321DOI Listing
August 2012