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Hylén, U., Särndahl, E., Bejerot, S., Humble, M. B., Hyötyläinen, T., Salihovic, S. & Eklund, D. (2023). Alterations in inflammasome-related immunometabolites in individuals with severe psychiatric disorders. BMC Psychiatry, 23(1), Article ID 268.
Open this publication in new window or tab >>Alterations in inflammasome-related immunometabolites in individuals with severe psychiatric disorders
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2023 (English)In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 23, no 1, article id 268Article in journal (Refereed) Published
Abstract [en]

INTRODUCTION: Psychiatric disorders are common and significantly impact the quality of life. Inflammatory processes are proposed to contribute to the emergence of psychiatric disorders. In addition to inflammation, disturbances in metabolic pathways have been observed in individuals with different psychiatric disorders. A suggested key player in the interaction between inflammation and metabolism is the Nod-like receptor 3 (NLRP3) inflammasome, and NLRP3 is known to react to a number of specific metabolites. However, little is known about the interplay between these immunometabolites and the NLRP3 inflammasome in mental health disorders.

AIM: To assess the interplay between immunometabolites and inflammasome function in a transdiagnostic cohort of individuals with severe mental disorders.

METHODS: Mass spectrometry-based analysis of selected immunometabolites, previously known to affect inflammasome function, were performed in plasma from low-functioning individuals with severe mental disorders (n = 39) and sex and aged-matched healthy controls (n = 39) using a transdiagnostic approach. Mann Whitney U test was used to test differences in immunometabolites between psychiatric patients and controls. To assess the relationship between inflammasome parameters, disease severity, and the immunometabolites, Spearman's rank-order correlation test was used. Conditional logistic regression was used to control for potential confounding variables. Principal component analysis was performed to explore immunometabolic patterns.

RESULTS: Among the selected immunometabolites (n = 9), serine, glutamine, and lactic acid were significantly higher in the patient group compared to the controls. After adjusting for confounders, the differences remained significant for all three immunometabolites. No significant correlations were found between immunometabolites and disease severity.

CONCLUSION: Previous research on metabolic changes in mental disorders has not been conclusive. This study shows that severely ill patients have common metabolic perturbations. The changes in serine, glutamine, and lactic acid could constitute a direct contribution to the low-grade inflammation observed in severe psychiatric disorders.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Comorbidity, Inflammasomes, Inflammation, Mental Disorders, Metabolic pathways, Psychoneuroimmunology
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-105613 (URN)10.1186/s12888-023-04784-y (DOI)000975250300004 ()37076825 (PubMedID)2-s2.0-85152978734 (Scopus ID)
Funder
Knowledge Foundation, 20200017
Available from: 2023-04-21 Created: 2023-04-21 Last updated: 2024-04-08Bibliographically approved
Fresnais, D., Humble, M. B., Bejerot, S., Meehan, A. D. & Fure, B. (2023). Apathy as a Predictor for Conversion From Mild Cognitive Impairment to Dementia: A Systematic Review and Meta-Analysis of Longitudinal Studies. Journal of Geriatric Psychiatry and Neurology, 36(1), 3-17
Open this publication in new window or tab >>Apathy as a Predictor for Conversion From Mild Cognitive Impairment to Dementia: A Systematic Review and Meta-Analysis of Longitudinal Studies
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2023 (English)In: Journal of Geriatric Psychiatry and Neurology, ISSN 0891-9887, E-ISSN 1552-5708, Vol. 36, no 1, p. 3-17Article, review/survey (Refereed) Published
Abstract [en]

BACKGROUND: Apathy is one of the most prevalent neurobehavioral manifestations in mild cognitive impairment (MCI) and is included among the behavioral and psychological symptoms of dementia (BPSD). Studies suggest that the presence of apathy could be associated with increased dementia risk. The role of apathy in conversion from MCI to dementia, and whether apathy could be a relevant predictor for dementia progression, are still matters of investigation.

AIM: To study the relationship between apathy and progression to dementia in individuals with MCI.

METHODS: A systematic literature search in Medline, Embase, Cochrane Library, Epistemonikos, PsychINFO, and CINAHL was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The search included longitudinal studies reporting on the association between apathy and dementia.

RESULTS: The main outcome was pooled unadjusted hazard ratios (HR) of apathy in dementia conversion and included 11 studies with 9504 individuals. There was a significant association between apathy and dementia conversion, HR = 1.54; 95% CI, 1.29, 1.84. Subgroup analysis showed a significant association between apathy and progression to AD.

CONCLUSION: Apathy was associated with an increased risk of conversion to AD and all-cause dementia in patients with MCI. The role of apathy as a marker for incident dementia needs to be investigated in large, high-quality studies.

Place, publisher, year, edition, pages
Sage Publications, 2023
Keywords
Apathy, behavioral disturbance, cognitive impairment, dementia, elderly
National Category
Neurosciences
Identifiers
urn:nbn:se:oru:diva-98668 (URN)10.1177/08919887221093361 (DOI)000786601700001 ()35446723 (PubMedID)2-s2.0-85129677798 (Scopus ID)
Note

Funding agencies:

Örebro University, School of Medical Sciences, Örebro, Sweden

Karlstad Central Hospital, Karlstad, Sweden

Available from: 2022-04-22 Created: 2022-04-22 Last updated: 2023-12-08Bibliographically approved
Bejerot, S., Sigra, S., Welin, E., Eklund, D., Hylén, U. & Humble, M. B. (2023). Rituximab as an adjunctive treatment for schizophrenia spectrum disorder or obsessive-compulsive disorder: Two open-label pilot studies on treatment-resistant patients. Journal of Psychiatric Research, 158, 319-329
Open this publication in new window or tab >>Rituximab as an adjunctive treatment for schizophrenia spectrum disorder or obsessive-compulsive disorder: Two open-label pilot studies on treatment-resistant patients
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2023 (English)In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 158, p. 319-329Article in journal (Refereed) Published
Abstract [en]

In this explorative study, we investigated if an adjunctive treatment with one single dose of the monoclonal antibody rituximab would improve symptoms and function in treatment-resistant patients with schizophrenia spectrum disorder (SSD, n = 9) or obsessive-compulsive disorder (OCD, n = 10), based on the inflammatory hypothesis for mental disorders. Patients were followed for one year. Disability was measured with the Personal and Social Performance score (PSP). At baseline, the mean PANSS score in the SSD group was 99 ± 32 and the mean Y-BOCS score in the OCD group was 27.5 ± 7. Mean PSP scores were 32 ± 10.2 and 42.5 ± 9.9 in the SSD and OCD groups, respectively. Seven had Paediatric Acute-Onset Neuropsychiatric Syndrome (PANS) in retrospect, and 3 SSD patients had schizo-obsessive subtype. 4/8 SSD patients showed a ≥40% reduction in PANSS at endpoint I week 20, however, 7/9 were similarly improved already at week 12. Among the OCD patients, 2/10 showed a ≥35% reduction in Y-BOCS at week 20. Disability was significantly improved only in the SSD group. The percentual decrease of PANSS scores in SSD patients was associated with the increase in immunoglobulin levels week 20 (n = 8: IgG r = 0.85, p = .007; IgA r = 0.79, p = .019; IgM r = 0.73, p = .038). Rituximab was generally well tolerated in these patients. Self-rated improvements since baseline were reported for psychic (p = .021), neurological (p = .059), and autonomic (p < .001) side effects (UKU-SERS-Pat side-effect scale). Anxiety was commonly reported by OCD patients, while an initial increase in psychotic symptoms was seen in a few SSD patients. An RCT is underway to evaluate rituximab in SSD.

Place, publisher, year, edition, pages
Elsevier, 2023
Keywords
B-Cells, Clinical trial, Monoclonal antibody, Neuroinflammation, Obsessive-compulsive disorder, Schizophrenia, Treatment-resistant
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-103171 (URN)10.1016/j.jpsychires.2022.12.003 (DOI)000976718200001 ()36638622 (PubMedID)2-s2.0-85146076210 (Scopus ID)
Funder
Nyckelfonden, OLL-878311 OLL-779081Torsten Söderbergs stiftelse, M84/19The Swedish Brain Foundation, FO2019-0094
Available from: 2023-01-17 Created: 2023-01-17 Last updated: 2024-04-08Bibliographically approved
Humble, M. B., Eklund, D., Fresnais, D., Hylén, U., Sigra, S., Thunberg, P. & Bejerot, S. (2023). Rituximab for treatment-resistant schizophrenia and/or obsessive-compulsive disorder (OCD): functional connectivity and cytokines associated with symptomatic improvements. Paper presented at 31st European Congress of Psychiatry (EPA 2023), Paris, France, March 25-28, 2023. European psychiatry, 66(Suppl. 1), S629-S629, Article ID EPP1035.
Open this publication in new window or tab >>Rituximab for treatment-resistant schizophrenia and/or obsessive-compulsive disorder (OCD): functional connectivity and cytokines associated with symptomatic improvements
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2023 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 66, no Suppl. 1, p. S629-S629, article id EPP1035Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: Immunological mechanisms may contribute to the causation of mental illness. Autoimmunity is most convincingly shown for anti-NMDA-R encephalitis and Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS); disorders that overlap clinically with schizophrenia and OCD. Altered inflammatory cytokine production, glial activation and auto-antibodies have also been associated with schizophrenia and OCD. In these disorders, however, the treatment results with anti-inflammatory or immunomodulating drugs have hitherto been limited and inconsistent. Yet other targets within the immune system may still be effective and new options are warranted for treatment-resistant patients. Rituximab targets B-lymphocytes and is often used in autoimmune disorders such as rheumatoid arthritis, multiple sclerosis and anti-NMDA-R encephalitis.

Objectives: We aimed to investigate whether rituximab is clinically effective, safe and tolerable as add-on therapy in markedly ill, treatment-resistant adult psychiatric patients with schizophrenia or OCD. We also wanted to identify putative mediating mechanisms in treatment responders, such as cytokine changes and functional connectivity (FC).

Methods: In an open pilot study, adults (18-39 years) with treatment-resistant schizophrenia and/or OCD were included. They received an intravenous infusion of rituximab 1000 mg, once at baseline, in addition to their regular psychiatric medication and were followed for 1 year. The main outcome measures were the Positive and Negative Syndrome Scale (PANSS) or Yale-Brown Obsessive Compulsive Scale (Y-BOCS), the Clinical Global Impression-Improvement scale (CGI-I) and the Personal and Social Performance scale (PSP). Treatment response was defined as ≥ 40 % decrease in PANSS or ≥ 35 % decrease in Y-BOCS, and much improved according to CGI-I. Resting-state fMRI was applied at baseline and after 5 months. Plasma cytokines were measured at 0, 3 and 5 months. Cognitive tests and the recently developed PsychoNeuroinflammatory Related Signs and Symptoms Inventory (PNISSI) were used to identify and measure symptoms related to neuro-inflammation and cognitive function.

Results: Nineteen patients were treated with rituximab. 3-5 months after treatment, 6/9 patients with schizophrenia and 1/10 with OCD responded. One schizophrenia patient continues with rituximab every 6 months and has reportedly done well for almost 3 years. No severe side effects were reported apart from recurrent abdominal pain in a schizophrenia patient and one case of post-COVID-19 syndrome. Significant changes of FC were detected in responders only and correlated with PSP changes.

Conclusions: Aberrant B-cell activities may contribute to treatment-resistant schizophrenia and be amenable to treatment with rituximab. However, the results of this pilot study need confirmation in placebo-controlled trials.

Place, publisher, year, edition, pages
Cambridge University Press, 2023
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-109391 (URN)10.1192/j.eurpsy.2023.1309 (DOI)001060676601588 ()
Conference
31st European Congress of Psychiatry (EPA 2023), Paris, France, March 25-28, 2023
Available from: 2023-10-25 Created: 2023-10-25 Last updated: 2024-03-18Bibliographically approved
Bejerot, S., Eklund, D., Hesser, H., Hietala, M. A., Kariis, T., Lange, N., . . . Humble, M. B. (2023). Study protocol for a randomized controlled trial with rituximab for psychotic disorder in adults (RCT-Rits). BMC Psychiatry, 23(1), Article ID 771.
Open this publication in new window or tab >>Study protocol for a randomized controlled trial with rituximab for psychotic disorder in adults (RCT-Rits)
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2023 (English)In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 23, no 1, article id 771Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The role of inflammation in the aetiology of schizophrenia has gained wide attention and research on the association shows an exponential growth in the last 15 years. Autoimmune diseases and severe infections are risk factors for the later development of schizophrenia, elevated inflammatory markers in childhood or adolescence are associated with a greater risk of schizophrenia in adulthood, individuals with schizophrenia have increased levels of pro-inflammatory cytokines compared to healthy controls, and autoimmune diseases are overrepresented in schizophrenia. However, treatments with anti-inflammatory agents are so far of doubtful clinical relevance. The primary objective of this study is to test whether the monoclonal antibody rituximab, directed against the B-cell antigen CD20 ameliorates psychotic symptoms in adults with schizophrenia or schizoaffective disorder and to examine potential mechanisms. A secondary objective is to examine characteristics of inflammation-associated psychosis and to identify pre-treatment biochemical characteristics of rituximab responders. A third objective is to interview a subset of patients and informants on their experiences of the trial to obtain insights that rating scales may not capture.

METHODS: A proof-of-concept study employing a randomised, parallel-group, double-blind, placebo-controlled design testing the effect of B-cell depletion in patients with psychosis. 120 participants with a diagnosis of schizophrenia spectrum disorders (SSD) (ICD-10 codes F20, F25) will receive either one intravenous infusion of rituximab (1000 mg) or saline. Psychiatric measures and blood samples will be collected at baseline, week 12, and week 24 post-infusion. Brief assessments will also be made in weeks 2 and 7. Neuroimaging and lumbar puncture, both optional, will be performed at baseline and endpoints. Approximately 40 of the patients and their informants will be interviewed for qualitative analyses on the perceived changes in well-being and emotional qualities, in addition to their views on the research.

DISCUSSION: This is the first RCT investigating add-on treatment with rituximab in unselected SSD patients. If the treatment is helpful, it may transform the treatment of patients with psychotic disorders. It may also heighten the awareness of immune-psychiatric disorders and reduce stigma.

TRIAL REGISTRATION: NCT05622201, EudraCT-nr 2022-000220-37 version 2.1. registered 14th of October 2022.

Place, publisher, year, edition, pages
BioMed Central (BMC), 2023
Keywords
Clinical trials, Immunology, Inflammation, Magnetic resonance imaging, Monoclonal antibodies, Schizophrenia & psychotic disorders
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-109377 (URN)10.1186/s12888-023-05250-5 (DOI)001095789000002 ()37872497 (PubMedID)2-s2.0-85174826025 (Scopus ID)
Funder
Örebro UniversitySwedish Research Council, 2022-00288The Swedish Brain Foundation, FO2022-0073Torsten Söderbergs stiftelse, MT4/22
Available from: 2023-10-24 Created: 2023-10-24 Last updated: 2024-01-17Bibliographically approved
Humble, M. B. & Bejerot, S. (2022). Inflammasome activation in psychosis: Consequence of peripheral dyslipidaemia or reflection of an inflammatory pathogenesis?. Brain, behavior, and immunity, 101, 284-285
Open this publication in new window or tab >>Inflammasome activation in psychosis: Consequence of peripheral dyslipidaemia or reflection of an inflammatory pathogenesis?
2022 (English)In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 101, p. 284-285Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2022
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-96835 (URN)10.1016/j.bbi.2022.01.018 (DOI)000761263000009 ()35065195 (PubMedID)2-s2.0-85123221275 (Scopus ID)
Available from: 2022-01-31 Created: 2022-01-31 Last updated: 2022-08-24Bibliographically approved
Glans, M., Bejerot, S., Elwin, M. & Humble, M. B. (2022). Symptomatic generalised joint hypermobility and autism spectrum disorder are associated in adults. Paper presented at 30th European Congress of Psychiatry (EPA 2022), (Virtual congress), June 4-7, 2022. European psychiatry, 65(Suppl. 1), S452-S452, Article ID EPV0244.
Open this publication in new window or tab >>Symptomatic generalised joint hypermobility and autism spectrum disorder are associated in adults
2022 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 65, no Suppl. 1, p. S452-S452, article id EPV0244Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: Intriguingly, autism spectrum disorders (ASD) and symptomatic generalised joint hypermobility (S-GJH) (e.g. hypermobility spectrum disorders and Ehlers Danlos Syndrome) share several clinical manifestations including motor difficulties, sensory hypersensitivity and autonomic dysfunction. Moreover, many syndromic forms of ASD manifest a hypermobile phenotype. Despite the increased interest in the area, few systematic studies are available.

Objectives: This large cross-sectional comparative study aimed to examine the association between S-GJH and ASD in adults.

Methods: We assessed GJH by physical examination using the Beighton Scoring System (BSS) and collected data on musculoskeletal symptoms and skin abnormalities amongst 156 adult patients with ASD and 413 adult community controls. A proxy for S-GJH was created by combining a positive BSS with at least one additional musculoskeletal symptom or skin abnormality.

Results: The prevalence of S-GJH was significantly higher amongst patients with ASD than amongst controls (16.7% vs 4.8%, p< .001). A logistic regression model, adjusting for candidate covariates of GJH (age, sex, race), revealed a significant influence of ASD on S-GJH with adjusted odds ratio of 5.4 (95% CI 2.8-10.5, p< .001).

Conclusions: ASD and S-GJH are associated in adults. If recognised, musculoskeletal complications related to S-GJH can be relieved by physiotherapy. Clinicians should be familiar with that symptoms frequently occurring in GJH such as pain, fatigue and orthostatic intolerance may mimic or aggravate psychiatric symptoms (e.g. depression, anxiety). Knowledge about comorbidities may provide clues to underlying aethiopathological factors. Future research to clarify the mechanisms behind this association and to evaluate how comorbid S-GJH affects ASD outcome is warranted.

Place, publisher, year, edition, pages
Cambridge University Press, 2022
Keywords
biomarkers, comordbidity, hypermobility, Autism Spectrum Disorder
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-104982 (URN)10.1192/j.eurpsy.2022.1145 (DOI)000897965701383 ()
Conference
30th European Congress of Psychiatry (EPA 2022), (Virtual congress), June 4-7, 2022
Available from: 2023-03-17 Created: 2023-03-17 Last updated: 2023-03-17Bibliographically approved
Klang, A., Westerberg, B., Humble, M. B. & Bejerot, S. (2022). The impact of schizotypy on quality of life among adults with autism spectrum disorder. BMC Psychiatry, 22(1), Article ID 205.
Open this publication in new window or tab >>The impact of schizotypy on quality of life among adults with autism spectrum disorder
2022 (English)In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 22, no 1, article id 205Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Autism spectrum disorder (ASD) and schizotypal personality disorder can be difficult to distinguish. Deficits in social relationships and social interaction, present in both conditions, are known to impair quality of life. The aim of the present study was to investigate if schizotypal symptoms affect quality of life among adults diagnosed with autism spectrum disorder and to study the association between schizotypy and autistic traits among them.

METHODS: Participants diagnosed with autism spectrum disorder (n = 110) completed questionnaires exploring schizotypy (Schizotypal Personality Questionnaire - Brief Revised (SPQ-BR)), autistic traits (The Ritvo Autism, Asperger Diagnostic Scale-Revised Screen 14 items), anxiety and depression (The Hospital Anxiety and Depression scale) and quality of life (Brunnsviken Brief Quality of Life Scale and the European quality of life index version 5D).

RESULTS: Schizotypy was found to be associated with anxiety, depressive and autistic symptoms, and poor quality of life. Although schizotypy was a predictor for impaired quality of life, this relationship was mediated by symptoms of anxiety and depression, plausibly inherent to autism. Autistic traits were positively associated with all higher order constructs of the SPQ-BR, i.e. positive and negative schizotypy, disorganization and social anxiety, as well as with poor quality of life.

CONCLUSIONS: There is considerable overlap between schizotypy and autism that needs to be considered in research. Prominent schizotypal traits in people with ASD may constitute an endophenotype coinciding with a particularly poor quality of life.

TRIAL REGISTRATION: ClinicalTrials.gov identifier:  NCT03570372 : Internet-based Treatment for Adults with Autism Spectrum Disorder (MILAS).

Place, publisher, year, edition, pages
BioMed Central, 2022
Keywords
Autism spectrum disorder, Quality of life, Schizotypal personality disorder, Schizotypy
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-98149 (URN)10.1186/s12888-022-03841-2 (DOI)000770759200003 ()35305592 (PubMedID)2-s2.0-85126755852 (Scopus ID)
Note

Funding agencies:

Örebro University

Örebro University Hospital Research Foundation Nyckelfonden OLL-785311

Forskningskommitten Region Örebro County OLL-785501 OLL-736321 OLL-833131 OLL-887401

Örebro Regional Council, ALF grant OLL-935396 OLL-879651

Regional Research Council in Mid Sweden RFR-556731

Available from: 2022-03-21 Created: 2022-03-21 Last updated: 2024-01-17Bibliographically approved
Glans, M., Thelin, N., Humble, M. B., Elwin, M. & Bejerot, S. (2022). The Relationship Between Generalised Joint Hypermobility and Autism Spectrum Disorder in Adults: A Large, Cross-Sectional, Case Control Comparison. Frontiers in Psychiatry, 12, Article ID 803334.
Open this publication in new window or tab >>The Relationship Between Generalised Joint Hypermobility and Autism Spectrum Disorder in Adults: A Large, Cross-Sectional, Case Control Comparison
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2022 (English)In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 12, article id 803334Article in journal (Refereed) Published
Abstract [en]

Autism spectrum disorder (ASD) and generalised joint hypermobility (GJH) share a number of clinical manifestations including proprioceptive impairment, motor difficulties, sensory hypersensitivity, and autonomic dysfunction. Clinical observations suggest that GJH is overrepresented in ASD. However, there are currently few systematic studies available. Knowledge about comorbidities may unfold common aetiopathological pathways underlying the association and improve the clinical management. The aim of this large, cross-sectional comparative study is to evaluate the relationship between ASD and GJH in adults. Data on joint hypermobility, symptoms associated with both hypermobility spectrum disorders (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS), lifetime psychiatric diagnoses, psychiatric rating scales for ASD and attention deficit hyperactivity disorder (ADHD), and socio-demographics was collected for 199 individuals with ASD and 419 non-ASD community controls. Logistic regression models adjusting for covariates (age, sex, ethnicity) revealed a significant relationship between ASD and GJH and between ASD and symptomatic GJH, with adjusted odds ratios of 3.1 (95% CI: 1.9, 5.2; p < 0.001) and 4.9 (95% CI: 2.6, 9.0; p < 0.001), respectively. However, the high prevalence of comorbid ADHD in the study sample reduces the generalizability of the results among individuals with ASD without comorbid ADHD. Possibly, an additional ADHD phenotype is the primary driver of the association between ASD and GJH. Furthermore, GJH with additional self-reported symptoms, suggestive of HSD/hEDS, showed a stronger association with ASD than did non-specified GJH, indicating that symptomatic GJH plays a greater role in the relationship than non-specified GJH does. Therefore, the current study underscores the need of careful sample subclassifications. ASD with GJH may represent a novel subgroup of ASD in terms of aetiopathology and clinical presentation. Future research should elucidate the aetiological factors behind the association between ASD and GJH and evaluate how the comorbidity of GJH affects ASD outcomes.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2022
Keywords
Ehlers-Danlos syndrome, adults, autism spectrum disorder (ASD), biomarker, comorbidity [MeSH], connective tissue, joint hypermobility
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-97691 (URN)10.3389/fpsyt.2021.803334 (DOI)000760625600001 ()35211037 (PubMedID)2-s2.0-85125071516 (Scopus ID)
Available from: 2022-02-28 Created: 2022-02-28 Last updated: 2024-01-17Bibliographically approved
Glans, M., Bejerot, S., Humble, M. B., Elwin, M. & Thelin, N. (2021). Association between adult adhd and generalised joint hypermobility, with and without systemic manifestations: A case-control study. Paper presented at 29th European Congress of Psychiatry (EPA Virtual 2021), April 10-13, 2021. European psychiatry, 64(Suppl. 1), S89-S89
Open this publication in new window or tab >>Association between adult adhd and generalised joint hypermobility, with and without systemic manifestations: A case-control study
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2021 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 64, no Suppl. 1, p. S89-S89Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Introduction: There is growing evidence that generalised joint hypermobility (GJH) is associated with several psychiatric conditions. There are no previous studies on adult ADHD.

Objectives: To evaluate, in a large Swedish sample, if generalised joint hypermobility and adult ADHD are associated.

Methods: 431 adults with ADHD and 417 controls were included. GJH was assessed by the Beighton Score, a physical examination, and the 5PQ, a self-report screening tool. Exploratively, reported musculoskeletal symptoms and abnormal skin manifestations suggestive of symptomatic GJH (e.g. Ehlers-Danlos syndrome), were assessed to differentiate this group from the general GJH group. Logistic regressions determined the influence of an ADHD diagnosis and known covariates (age, sex and ethnicity) on GJH and symptomatic GJH respectively.

Results: ADHD was associated to GJH, as defined by the Beighton Score and the 5PQ, with adjusted odds ratios of 4.65 (CI 95% 3.01-7.18, p<.005) and 1.86 (CI 95% 1.39-2.48, p<.005), respectively. Likewise, ADHD and symptomatic GJH were associated withadjusted odds ratios of 6.94 (CI 95% 4.05-11.89, p<.005) and 2.66 (CI 95% 1.94-3.66, p<.005).

Conclusions: GJH and adult ADHD are associated conditions. Symptomatic GJH, defined as additional symptoms of pain and/or skin manifestations, has a considerably stronger link to adult ADHD than unspecific GJH has. GJH may represent a marker of an underlying systemic disorder with physical manifestations in connective tissue as well as behavioural manifestations including hyperactivity, impulsiveness and inattentiveness. Future studies should investigate if this represents a novel subtype of ADHD and if symptomatic GJH affects the ADHD management.

Place, publisher, year, edition, pages
Cambridge University Press, 2021
Keywords
Comorbidity, Hypermobility, ADHD, biomarkers
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-94662 (URN)10.1192/j.eurpsy.2021.263 (DOI)000693665700230 ()
Conference
29th European Congress of Psychiatry (EPA Virtual 2021), April 10-13, 2021
Available from: 2021-09-29 Created: 2021-09-29 Last updated: 2021-09-30Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0001-6726-7787

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