Research in psychiatric treatment and care in the Capital Region of Denmark

In Denmark, psychiatric treatment is primarily a public task and managed by the regional authorities. The Mental Health Services of the Capital Region of Denmark constitute the largest psychiatric hospital in Denmark and treat approximately one third of all patients suffering from mental illness in the country. 

As a university hospital, the Mental Health Services of the Capital Region aim to treat and care for patients on evidence based methods and conduct number of major research projects in adult as well as child- and adolescent psychiatry. The research projects cover both basic research and clinical research with special focus on patient related research. Projects are often multidisciplinary and international collaboration between clinicians, psychologists, neurologists, molecular biologists and biostatisticians. 

Fields of research are many and varied, and especially research into neuropsychiatry, register based research, psychosocial intervention, prevention, rehabilitation and child- and adolescent psychiatry are strong fields of research. Below we have listed a few examples of ongoing research in the Mental Health Services of the Capital Region of Denmark, all of which have the overall goal of furthering knowledge of mental illness and improving treatment and care of people suffering from mental illness. 

Depression and bipolar disorder 
In Denmark, it is possible to conduct clinical, epidemiological and register-based research on an excellent high level due to the homogenous population, low immigration and extensive nation-wide health care and social registers including longitudinal data on all inhabitants on an individual level. 

Based on clinical, epidemiological and register-based data, the Affective Disorder Research Group in the Mental Health Services of the Capital Region of Denmark, chaired by Professor Lars Kessing, has shown that the longitudinal course of illness in depressive disorder and in bipolar disorder (manic-depressive illness) on average is progressive in nature with increasing severity of depressive episodes, increasing risk of recurrence of depressive and manic episodes and with increasing prevalence of cognitive dysfunction for every new affective episode. 

Further, it has been shown that the risk of developing dementia is increased compared to the general population, and that the risk seems to increase with progression of the disorders. Continued treatment with lithium seems to decrease this risk to the level of the general population. The biological basis of the cognitive dysfunction and dementia in affective disorders as well as new treatment possibilities are currently explored in a number of studies.
Center for Neuropsychiatric Schizophrenia Research, CNSR, Mental Health Services of the Capital Region of Denmark, is a multidisciplinary research center which during the later years has achieved a strong international position within research on pathogenetic and pathophysiological mechanisms in the development of schizophrenia - and on the effects of pharmacological interventions on the disturbances.
The studies comprise a large number of different methods (in vivo pharmacology, molecular biology, electrophysiology/psychophysiology, cognition, and, in collaboration with the other national and international collaborators, brain imaging). 

CNSR has achieved an internationally leading position within neuropsychiatric research of cohorts of antipsychotic-naïve first-episode schizophrenic patients. CNSR has, among others, been internationally recognized for our capability to recruit, examine, and follow these "hard-to-get" patients, for demonstrating an association between frontal dopamine D2- as well as serotonin 5-HT2A- receptor binding and psychopathology and treatment response - and for relating neurochemical to structural and functional explanations. 

CNSR houses advanced psychophysiological and neurocognitive laboratories. Since 2009, CNSR has also housed a Lundbeck Foundation Center of Excellence, Center for Clinical Intervention and Neuropsychiatric Schizophrenia Research, CINS. Both the CNSR and CINS are chaired by Professor Birte Glenthøj. 

Assertive treatment of early psychosis 
The OPUS trial included almost 600 patients with first episode psychosis. The patients were randomized to early specialized assertive treatment involving the families or standard treatment. The trial showed significant positive clinical effects of the assertive treatment in psychotic and negative symptoms, substance abuse, user satisfaction, adherence to treatment and reduced use of supported housing and inpatient stay. 

Patients were followed-up after one, two, five and ten years, and the cohort now form the largest and best investigated cohort in the world. In a second OPUS trial, the researchers want to examine the effect of two years versus five years of early specialized assertive treatment. 

The OPUS trial is led by Professor Merete Nordentoft, Mental Health Services of the Capital Region of Denmark, a leading international expert, recognized for her work in early phases of psychosis and president of the International Early Psychosis Association. 

Merete Nordentoft is also the principal investigator for the NEUROCOM trial in which the effect of cognitive remediation in first episode psychosis is evaluated. In a consortium with Professor Patrick McGorry from Melbourne, Australia, Professor Nordentoft recently received funding for a multicentre trial in the prodromal phase aiming to reduce transition to psychosis. 

Can we detect and prevent psychiatric disease in early childhood? 
Most research concentrates on young children, youths and adults, leaving a missing link in our knowledge of early development of mental illness. In the CCC2000 (Copenhagen Child Cohort 2000) project led by Ass. Professor Anne-Mette Skovgaard, researchers investigate the psychopathology in the first years of life. 

Through analysis of register data on more than 6000 Danish children born in 2000, as well as more thorough investigation on smaller groups of children, researchers from the Mental Health Services of the Capital Region of Denmark have shown, for the first time in a general population study, that children as young as 1.5 years may suffer from mental illness as older children do, and that risk factors and predictors of mental illness can be identified in the first ten months of life. 

Knowledge of risk factors and predictors is fundamental to preventing and treating mental illness. It will help improve the diagnosing as well as the treatment of mental illness early on, thus preventing some of the troubles that mental illness can inflict on children and young people. The prevention potential seems substantial for instance concerning early diagnosing of ADHD, a mental disorder with high incidence in which Ass. Professor Kerstin von Plessen conducts research. 

The Danish Bio Bank 
Institute of Biological Psychiatry, directed by Ass. Professor Thomas Werge, is the home of the Danish Bio Bank, a research core facility. Across multiple clinical sites in Denmark, the Bio Bank coordinates molecular genetic and environmental investigations in the attempt to discover the etiological basis of severe psychiatric disorders. 

The institute conducts research in identifying the genetic reasons that may cause psychosis and schizophrenia.  

The Mental Health Services of the Capital Region of Denmark

  • provide treatment to approx. 40 % of all patients with mental illness in Denmark
  • treat approx. 50.000 patients a year
  • have approx. 345.000 visits in the outpatient facilities
  • employ approx. 5000 people
  • have a budget of 2,7 billion kroner (362 million Euros)

    Among the illnesses treated are depression, mania, schizophrenia, eating disorders, Obsessive Compulsive Disorder, anxiety and personality disorders, Posttraumatic Stress Syndrome, dementia and organic mental disorders. 

    Examples of treatment are medical treatment, psychotherapy, environmental therapy, psychoeducation and ECT. Treatment is based on the most recent research and as a university hospital, The Mental Health Services of the Capital Region of Denmark are involved in a large number of national and international research projects.