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OBJECTIVE: In order to prevent suicidal behaviour among adolescents and young adults it would be valuable to know if altering the conditions of their upbringing could reduce their suicidal behaviour. The study surveys possible risk factors. METHOD: Population-based registers covering children born in Denmark in 1966 at the age span of 14-27 years and their parents for: health, education, family dissolution, suicidal behaviour, substance abuse, criminality and unemployment. A discrete-time proportional hazard modelling was used to analyse the longitudinal observations. RESULTS: First-time suicide attempts were associated with parental psychiatric disorder, suicidal behaviour, violence, child abuse and neglect. Increased risks were also found among adolescents and young adults who suffered from psychiatric disorder or physical handicap, had been legally imprisoned, were addicted to drugs, or without graduation, vocational training or employment. CONCLUSION: Stigmatization, social exclusion, and mental disorders in the adolescents or young adults and parents increased risks for attempted suicide. Language: en

This paper reviews studies on the diagnostic profile of committed psychiatric patients. Most studies find that schizophrenia is the commonest diagnosis among these patients. The percentage of schizophrenics among committed patients varies, but many studies find figures between 30% and 50%. Comparison of commitments internationally is, however, problematic, and various sources of error and methodologic problems are discussed. These include limited representativity in the individual study, the risk of selection bias due to lack of drop-out analyses, and poor external validity. Attempts to reduce the number of commitments must be based on knowledge of the main target group among committed patients. This seems to be patients with schizophrenia and, therefore, ensuring optimal treatment of these patients in both an inpatient and an outpatient setting is essential.

The Danish Mental Health Act does not prevent serious suicide attempts in patients with severe schizophrenia and a lack of compliance to medication. A case in which outpatient involuntary treatment could have prevented a very serious suicidal attempt is presented. In Denmark, outpatient involuntary treatment is only allowed under very extraordinary conditions.

A revision of the Danish Mental Health Act is planned to take place in 2005-2006. The Ministry of Health requires investigation into whether extralegal coercive measures take place in psychiatric wards. Extralegal coercion refers to restrictions and rules not included in the current Mental Health Act and considered by patients to be coercion.Twenty-two psychiatric patients participated in four group interviews directed by two physicians at four University Hospitals in Copenhagen, Denmark. The patients were asked to define what they perceived as extralegal coercion, house rules and psychiatric treatment.The majority of patients perceived lack of single rooms, restrictions on leaving the ward and shielding, i.e., being confined to one's room, to be extralegal coercion. A few also found the pressure to take medication and collection of clothes items to be extralegal coercion. Rules on smoking, clothing, day and night routines, the use of radio and TV, drugs, alcohol, visits, eating and the use of telephones were considered not extralegal coercion but necessary house rules. House rules should be clear and stated in writing. Restrictions on the use of money and locking of the front door at night were accepted in certain situations, hence not considered to be extralegal coercion.Extralegal coercion does occur in psychiatric wards but in certain situations is accepted if documented. House rules are considered to be necessary and not extralegal coercion. Increased use of compulsory protocols for documenting coercive measures was not considered to be necessary, but documentation in patients' files was useful alternative.

Today drug therapy of dementia in elderly patients is possible. Owing to a huge increase in the number of elderly people throughout the Western world in the coming years, evidence-based treatment of dementia in this group is needed. The article reviews double-blind, randomized trials on the effect in dementia of donepezil, galantamine, rivastigmine and memantine up to 2003. A total of 27 studies were included. Donepezil, galantamine, rivastigmine and memantine improve cognition and the global level of functioning in mild to moderate Alzheimer's disease (AD). Most evidence exists for donepezil and galantamine. The effect of rivastigmine is best documented in Lewy body dementia (LB). Galantamine, memantine and donepezil may improve cognition in vascular dementia (VD). Galantamine may improve behavioural psychological symptoms of dementia (BPSD). No solid evidence for drug therapy in severe dementia exists. Elderly patients with mild to moderate AD should be offered drug therapy. One should also consider expanding the indication of dementia treatment to LB and VD. An international consensus on what primary efficacy variables to use is needed.

The study is a nation-wide investigation of the occurrence of coercive measures towards non-hospitalised elderly (+65 years) with dementia in Denmark. These measures include the use of alarm and tracking systems, use of physical force and protective devices, detention of the elderly in their own homes, and forced movement to another domicile e.g. nursing home. These types of coercive measures are regulated in the Danish jurisdiction, but not systematically recorded.A questionnaire was sent to all counties in Denmark concerning occurrence of the coercive measurements mentioned above.All 14 counties reported a very low use of all types of coercion with only a total of 123 incidents reported in all in 2001.This modest number gives rise to concern about lack of sufficient care towards elderly with dementia. The autonomy of the demented is important, but must not overrule basic care with the aim of ensuring dignified living conditions and safety from harm. The jurisdiction in this area is complicated and sometimes unclear.

The Danish Mental Health Act of 1989 emphasized that the use of coercion should be recorded. The National Board of Health has published statistics on this issue since 1990. This study investigates the use of coercive measures at all Danish psychiatric departments from 1990 to 1998.The official statistics published by The National Board of Health was collected and analyzed.There was an increase in the use of forced medication and mechanical restraint. No increase was found in the use of involuntary commitment or detention.Some of the increase found as regards forced medication and mechanical restraint could be due to problems in recording the correct number of episodes. The Mental Health Act does not take into account problems concerning elderly with dementia. Extralegal coercion or hidden coercion can take place outside a psychiatric ward, for instance in nursing homes or somatic departments. More empirical studies in this area are needed before the decision to record extralegal coercion is taken.