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Hylén, U., Eklund, D., Humble, M. B., Bartoszek, J., Särndahl, E. & Bejerot, S. (2020). Increased inflammasome activity in markedly ill psychiatric patients: An explorative study. Journal of Neuroimmunology, 339, Article ID 577119.
Open this publication in new window or tab >>Increased inflammasome activity in markedly ill psychiatric patients: An explorative study
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2020 (English)In: Journal of Neuroimmunology, ISSN 0165-5728, E-ISSN 1872-8421, Vol. 339, article id 577119Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to investigate inflammatory perturbations in 40 patients with severe and complex psychiatric disorders by studying the activity of the NLRP3 inflammasome, with a trans-diagnostic approach. Gene expression of CASP1, NLRP3, PYCARD, IL1B, IL1RN, TNF showed a significant increase in the patient group compared to a matched control group. Plasma levels of IL1Ra, IL-18, TNF, IL-6 and CRP were increased in the patient group. Within the patient group, increased gene expression of inflammatory markers correlated with increased disease severity. The findings support the inflammation hypothesis for markedly ill psychiatric patients across diagnostic groups.

Place, publisher, year, edition, pages
Elsevier, 2020
National Category
Psychiatry Immunology in the medical area
Identifiers
urn:nbn:se:oru:diva-79288 (URN)10.1016/j.jneuroim.2019.577119 (DOI)000510528000013 ()31786499 (PubMedID)2-s2.0-85075532475 (Scopus ID)
Note

Funding Agencies:

Region Örebro County (ALF)  

Region Örebro County (Research Committee)  

Faculty of Medicine and Health, Örebro University 

Available from: 2020-01-21 Created: 2020-01-21 Last updated: 2020-02-18Bibliographically approved
Hesselmark, E. & Bejerot, S. (2019). Clinical features of paediatric acute-onset neuropsychiatric syndrome: findings from a case-control study. BJPsych Open, 5(2), Article ID e25.
Open this publication in new window or tab >>Clinical features of paediatric acute-onset neuropsychiatric syndrome: findings from a case-control study
2019 (English)In: BJPsych Open, E-ISSN 2056-4724, Vol. 5, no 2, article id e25Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Paediatric acute-onset neuropsychiatric syndrome (PANS), an umbrella term that includes PANDAS (paediatric autoimmune neuropsychiatric disorders associated with streptococcal infections) is suggested to be a psychiatric disorder of autoimmune aetiology. PANS is characterised by an acute onset of obsessive-compulsive disorder or restricted eating with multiple comorbid symptoms. The specificity of the PANS criteria is not fully understood.AimsTo describe a cohort of patients with PANS and to determine if PANS features relating to symptoms, onset and course are more common in PANS than in other psychiatric conditions.

METHOD: A case-control study comparing patients with interview-confirmed PANS with patients with suspected PANS and patients with a psychiatric condition but with no suspicion of PANS. Validated and non-validated measures of symptoms, onset and episodic course were used.

RESULTS: Illness in patients with interview-confirmed PANS featured an episodic course and multiple symptoms present at onset compared with the psychiatric controls. However, individuals with interview-confirmed PANS did not present a specific symptom profile.

CONCLUSIONS: PANS may be a distinct clinical entity featuring an acute onset, an episodic course and multiple symptoms at onset.Declaration of interestNone.

Place, publisher, year, edition, pages
Royal College of Psychiatrists, 2019
Keywords
Pediatric acute-onset neuropsychiatric syndrome, diagnostic criteria, obsessive-compulsive disorder, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections
National Category
Medical and Health Sciences Psychiatry
Identifiers
urn:nbn:se:oru:diva-79290 (URN)10.1192/bjo.2019.10 (DOI)31068234 (PubMedID)
Available from: 2020-01-21 Created: 2020-01-21 Last updated: 2020-01-23Bibliographically approved
Popiolek, K., Bejerot, S., Brus, O., Hammar, Å., Landén, M., Lundberg, J., . . . Nordenskjöld, A. (2019). Electroconvulsive therapy in bipolar depression: effectiveness and prognostic factors. Acta Psychiatrica Scandinavica, 140(3), 196-204
Open this publication in new window or tab >>Electroconvulsive therapy in bipolar depression: effectiveness and prognostic factors
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2019 (English)In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 140, no 3, p. 196-204Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Electroconvulsive therapy (ECT) is used in patients with severe forms of bipolar depression. ECT is effective but not all patients respond. The aim of this study was to determine prognostic factors for response to ECT in patients hospitalized for bipolar depression.

METHODS: Data were obtained from several national Swedish registers. All patients with bipolar depression treated with ECT in any hospital in Sweden between 2011 and 2016 for whom information about ECT response was available were included (n = 1251). Response was defined as a score on the Clinical Global Impression - Improvement scale of one or two. Univariate and multivariate logistic regression were conducted to investigate associations between socio-demographic and clinical factors and response.

RESULTS: Response was achieved in 80.2% patients. Older age was associated with higher response rate to ECT. Patients with comorbid obsessive-compulsive disorder or personality disorder, and patients previously treated with lamotrigine had lower response rate.

CONCLUSION: ECT for bipolar depression was associated with very high response rates. The strongest prognostic factors were higher age, absence of comorbid obsessive-compulsive disorder or personality disorder, and less prior pharmacologic treatment.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Inc., 2019
Keywords
Bipolar disorders, bipolar depression, electroconvulsive therapy, prognosis
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-75577 (URN)10.1111/acps.13075 (DOI)000480263900003 ()31334829 (PubMedID)2-s2.0-85070454601 (Scopus ID)
Available from: 2019-08-09 Created: 2019-08-09 Last updated: 2019-11-15Bibliographically approved
Philipsson, A., Sandberg, E., Högström, S., Eriksson, M., Särnblad, S., Ekstav, L., . . . Duberg, A. (2019). ”Just in TIME” - Intervention med dans och yoga för flickor med funktionell magsmärta och IBS. In: : . Paper presented at Barnveckan, Örebro, Sweden, April 1-4, 2019.
Open this publication in new window or tab >>”Just in TIME” - Intervention med dans och yoga för flickor med funktionell magsmärta och IBS
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2019 (Swedish)Conference paper, Poster (with or without abstract) (Refereed)
Abstract [sv]

Bakgrund och syfte

Funktionell magsmärta drabbar många barn i skolåldern, mestadels flickor. Det kan leda till minskad livskvalitet, skolfrånvaro, sämre sömn, försämrade kamratkontakter och ökad vårdkonsumtion. Det vetenskapliga underlaget för interventioner vid långvarig smärta hos barn är begränsat. Dans kan öka rörelseglädje och förbättra kroppskännedom, vilket i sin tur påverkar självtillit och kan öka psykiskt välbefinnande. Yoga kan ge mental avslappning och reducera stressreaktioner. Syftet med studien är att utvärdera effekten av en intervention med dans och yoga på återkommande magsmärta, stress och depressiva symtom samt på funktion i vardagen hos flickor 9-13 år som har funktionell buksmärta och IBS.

Metod

En randomiserad kontrollerad studie genomförs med forskningspersoner som identifieras via diagnosregister samt barnmottagningarna i Västerås och Örebro, samt från primärvården. Interventionen består av dans och yoga med fokus på rörelseglädje, gemenskap och kravlöshet, och utförs som gruppaktivitet två ggr/veckan under 8 månader. Primärt utfall är förändring av magsmärta efter 8 mån. Flickorna följs upp under fem år avseende magsmärta, självskattad hälsa, stress och psykiskt välmående, fysisk aktivitet och skolfunktioner. Vidare studeras kostnad i relation till nytta.

Resultat/(Planerade studier)

Projektet pågår och de första resultaten beräknas publiceras hösten 2019. Projektet utvärderas både kvalitativt, genom intervjuer med flickor och vårdnadshavare, och kvantitativt, genom bland annat analys av smärtdagböcker, upplevd hälsa, stress samt med en hälsoekonomisk analys. Därutöver utvärderas salivkortisol och faeces som objektiva mått. 

Konklusion

Studien förväntas leda till ökad kunskap om icke-farmakologiska insatser för barn samt hur behandlingsinsatser för målgruppen kan breddas med ett kostnadseffektivt alternativ till ”standard care”.

Keywords
Buksmärta, dans, yoga
National Category
Health Sciences Pediatrics
Research subject
Pediatrics
Identifiers
urn:nbn:se:oru:diva-73177 (URN)
Conference
Barnveckan, Örebro, Sweden, April 1-4, 2019
Available from: 2019-03-18 Created: 2019-03-18 Last updated: 2019-04-17Bibliographically approved
Bejerot, S., Hesselmark, E., Mobarrez, F., Wallén, H., Hietala, M. A., Nybom, R. & Wetterberg, L. (2019). Neuromyelitis optica spectrum disorder with increased aquaporin-4 microparticles prior to autoantibodies in cerebrospinal fluid: a case report. Journal of Medical Case Reports, 13(1), Article ID 27.
Open this publication in new window or tab >>Neuromyelitis optica spectrum disorder with increased aquaporin-4 microparticles prior to autoantibodies in cerebrospinal fluid: a case report
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2019 (English)In: Journal of Medical Case Reports, ISSN 1752-1947, E-ISSN 1752-1947, Vol. 13, no 1, article id 27Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Neuromyelitis optica spectrum disorders are severe autoimmune inflammatory diseases of the central nervous system associated with the presence of immunoglobulin G antibodies against the water channel protein aquaporin-4. During exacerbation, specific aquaporin-4 immunoglobulin G may be produced intrathecally. We measured extracellular aquaporin-4 microparticles in the cerebrospinal fluid of a patient who later developed the typical symptoms and signs of a neuromyelitis optica spectrum disorder.

CASE PRESENTATION: A 17-year-old South American girl developed acute severe motor and vocal tics and difficulties in walking, peripheral numbness, muscle pain, and bilateral headache. At age 22, she had a multitude of motor and psychiatric symptoms. Over the years, she fulfilled the diagnostic criteria for anorexia nervosa, depression, sleep disorder, obsessive-compulsive disorder, generalized anxiety disorder, panic disorder, agoraphobia, social anxiety disorder, development coordination disorder, attention-deficit/hyperactivity disorder, hypomania, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, conversion disorder, psychosis, and schizotypal personality syndrome. At age 24, she was found to have elevated titers of aquaporin-4 antibodies in serum, suggestive of probable neuromyelitis optica. She subsequently developed visual impairment, and swollen optic nerves were verified by magnetic resonance imaging. She was thus treated with a chimeric monoclonal antibody targeted against the pan-B-cell marker CD20 (rituximab), and almost all symptoms, including the psychiatric symptoms, rapidly decreased. We found a significant increase of extracellular microparticles of aquaporin-4 in cerebrospinal fluid sampled from our patient when she was 22 years old, 2 years before the full clinical development of neuromyelitis optica.

CONCLUSIONS: Microparticles of aquaporin-4 represent subcellular arrangements that may influence the pathogenesis of neuromyelitis optica spectrum disorders and may serve as biomarkers for the underlying cellular disturbances. The increase of aquaporin-4 microparticles in cerebrospinal fluid may be used for early diagnostic purposes; for prevention; and for evaluation of effective treatment, long-term follow-up studies, and elucidating the pathophysiology in neuromyelitis optica spectrum disorders. Further studies of aquaporin-4 microparticles in cerebrospinal fluid of patients with neuromyelitis optica and similar neuropsychiatric disorders are thus called for.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Antibodies, Aquaporin-4, Case report, Conversion disorder, La belle indifférence, Microparticles, Neuromyelitis optica spectrum disorder, Obsessive-compulsive disorder, Pediatric autoimmune neuropsychiatric disorders
National Category
Rheumatology and Autoimmunity
Identifiers
urn:nbn:se:oru:diva-72040 (URN)10.1186/s13256-018-1929-z (DOI)30696485 (PubMedID)2-s2.0-85060700660 (Scopus ID)
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2020-01-23Bibliographically approved
Hesselmark, E. & Bejerot, S. (2019). Patient Satisfaction and Treatments Offered to Swedish Patients with Suspected Pediatric Acute-Onset Neuropsychiatric Syndrome and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections. Journal of child and adolescent psychopharmacology, 29(8), 634-641
Open this publication in new window or tab >>Patient Satisfaction and Treatments Offered to Swedish Patients with Suspected Pediatric Acute-Onset Neuropsychiatric Syndrome and Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal Infections
2019 (English)In: Journal of child and adolescent psychopharmacology, ISSN 1044-5463, E-ISSN 1557-8992, Vol. 29, no 8, p. 634-641Article in journal (Refereed) Published
Abstract [en]

Objectives: Pediatric acute-onset neuropsychiatric syndrome (PANS) and pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (PANDAS) are subtypes of Obsessive-Compulsive Disorder (OCD) with suggested autoimmune etiology. Immunomodulatory treatments have been introduced as treatment options. A recent systematic review concluded that the evidence for all treatment options for PANS and PANDAS is inconclusive. However, case reports and clinical experience suggest that antibiotics and immunomodulatory treatment may be helpful. Treatment may also affect the patients' satisfaction with health care services offered. This study aims to describe the treatments given to a cohort of Swedish patients with suspected PANS and PANDAS, the patient rated treatment effects, and to establish if any specific treatment predicts higher patient satisfaction.

Methods: Fifty-three patients (m = 33, f = 20, median age = 14, age range = 4-36) with suspected PANS or PANDAS were enrolled and assessed for PANS and PANDAS caseness, treatments given, treatment effects, global improvement, and patient satisfaction. Cases with confirmed and suspected PANS or PANDAS were compared regarding the frequency of treatments given and treatment effect. A linear regression model was used to see if treatments given or global improvement predicted patient satisfaction.

Results: Twenty-four participants fulfilled criteria for PANS or PANDAS and 29 did not. The most common treatments given were antibiotics (88%), nonsteroidal anti-inflammatory drugs (67%), cognitive behavioral therapy (53%), and selective serotonin reuptake inhibitors (42%). There were no major differences between confirmed and suspected cases regarding what treatments they had received or their effect. Patient satisfaction was predicted by overall clinical improvement at the time of assessment. Antibiotics and intravenous immunoglobulin (IVIG) were rated as the most successful treatments by participants and were associated with higher patient satisfaction.

Conclusions: It was more common that patients had received antibiotics than common psychiatric treatments for their psychiatric symptoms. Antibiotics and IVIG were experienced as effective treatments by the patients. Patient satisfaction was on average moderately low, and higher patient satisfaction was associated with global clinical improvement.

Place, publisher, year, edition, pages
Mary Ann Liebert, 2019
Keywords
Obsessive-compulsive disorder, patient satisfaction, pediatric acute-onset neuropsychiatric syndrome, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections, treatment outcome
National Category
Rheumatology and Autoimmunity Pediatrics Psychiatry
Identifiers
urn:nbn:se:oru:diva-73898 (URN)10.1089/cap.2018.0141 (DOI)000465469300001 ()31009235 (PubMedID)
Funder
Swedish Research Council, 523-2011-3646The Swedish Brain Foundation, FO2015-0191
Note

Funding Agencies:

Bror Gadelius Minnesfond  

Psykiatrifonden  

Stockholm County Council (PPG projects)  20130671  20150150 

Available from: 2019-04-24 Created: 2019-04-24 Last updated: 2019-11-21Bibliographically approved
Lugnegård, T. & Bejerot, S. (2019). Retrospective parental assessment of childhood neurodevelopmental problems: the use of the Five to Fifteen questionnaire in adults. BJPsych Open, 5(3), Article ID e42.
Open this publication in new window or tab >>Retrospective parental assessment of childhood neurodevelopmental problems: the use of the Five to Fifteen questionnaire in adults
2019 (English)In: BJPsych Open, E-ISSN 2056-4724, Vol. 5, no 3, article id e42Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Attention-deficit hyperactivity disorder and autism are increasingly recognised in adults. For a diagnostic evaluation, parental information on childhood development is needed. However, no instruments that retrospectively describe neurodevelopmental problems in childhood are validated for evaluating adults. The 181-item parent-report questionnaire Five to Fifteen (FTF) is nevertheless frequently used for assessments in adulthood.

AIMS: To examine if FTF is reliable for obtaining retrospective neurodevelopmental history among young adults.

METHOD: Details of parents who had assessed their children with the FTF for neuropsychiatric evaluation were retrieved and they were asked to complete the FTF again 10-19 years later. Agreements between original and retrospective scorings were analysed.

RESULTS: Long-term reliability for FTF varies considerably between individual items. Several difficulties are reported as more severe at the retrospective scoring than at the original scoring. A selection of 24 items (FTF-Brief) with good agreement over time, is presented for use in adult psychiatry settings.

CONCLUSION: Neuropsychiatric symptoms may fluctuate over time and become more prominent when demands increase. Informants' recollections of their child's neurodevelopmental symptoms may be a selection of symptoms that are longstanding rather than present at a specific age in childhood.

DECLARATION OF INTEREST: None.

Place, publisher, year, edition, pages
Royal College of Psychiatrists, 2019
Keywords
Autistic spectrum disorders, attention deficit hyperactivity disorders, developmental disorders, rating scales, tic disorders
National Category
Medical and Health Sciences Psychiatry
Identifiers
urn:nbn:se:oru:diva-79289 (URN)10.1192/bjo.2019.30 (DOI)31530308 (PubMedID)
Available from: 2020-01-21 Created: 2020-01-21 Last updated: 2020-01-24Bibliographically approved
Bejerot, S., Lindgren, A., Rosén, J., Bejerot, E. & Elwin, M. (2019). Teaching psychiatry to large groups in society. BMC Medical Education, 19(1), Article ID 148.
Open this publication in new window or tab >>Teaching psychiatry to large groups in society
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2019 (English)In: BMC Medical Education, ISSN 1472-6920, E-ISSN 1472-6920, Vol. 19, no 1, article id 148Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: There is a need to educate a range of professionals in caring for individuals with long-term mental disability who reside within our communities. Empathy alone is insufficient. The Kognus 4-Step Education Program was developed to achieve this goal.

METHOD: The program consisted of independent courses, including an 18-session basic course on psychiatric disability (on-site or online), advanced courses, and highly specialized training programs (Nidotherapy/Peer Consultation). Experts lectured together with clients with psychiatric disabilities. We first report Swedish reforms in which institutionalized patients were relocated to semi-independent individual households. We then describe the design and implementation of the education program. Approximately 50% of participants who were younger than 36 years old lacked any healthcare education. The participants' backgrounds, perceptions, participation in the education program, and costs are presented.

RESULTS: Between 2009 and 2014, 8959 participants attended the Kognus psychiatry courses online or on-site in Stockholm (basic on-site course, n = 2111; online course, n = 4480; advanced courses, n = 2322; highly specialized programs, n = 46). A total of 73% of the participants satisfactorily attended the basic sessions on-site compared with 11% of the online participants. The developers conducted the education program for the first 3 years. Thereafter, another course provider continued the program with other types of participants. The program was perceived to be equally interesting and meaningful to participants with low and high levels of education, demonstrating the generalizability of the program. The quality of the basic and advanced courses was rated as 4.4 and 4.3, respectively, on a 5-point Likert scale.

CONCLUSIONS: Personnel without appropriate education who work with people with psychiatric/intellectual disabilities can be educated in large numbers. The Kognus program represents a novel and successful way of training people who have no formal education about some essentials of good mental healthcare. Moreover, the model can be easily implemented elsewhere.

Place, publisher, year, edition, pages
BioMed Central, 2019
Keywords
Health education, Intellectual disability, Mental disorder, Mental health services, Nidotherapy, Patient-centered care, Social support, Staff development
National Category
Pedagogy
Identifiers
urn:nbn:se:oru:diva-74315 (URN)10.1186/s12909-019-1596-9 (DOI)000468411700002 ()31096962 (PubMedID)2-s2.0-85065869602 (Scopus ID)
Funder
Swedish National Board of Health and WelfareSwedish Research Council, 523-2011-3646
Available from: 2019-05-20 Created: 2019-05-20 Last updated: 2020-01-23Bibliographically approved
Bejerot, S., Klang, A. & Hesselmark, E. (2019). The Cunningham Panel: concerns remain [Letter to the editor]. Translational Psychiatry, 9(1), Article ID 224.
Open this publication in new window or tab >>The Cunningham Panel: concerns remain
2019 (English)In: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 9, no 1, article id 224Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Nature Publishing Group, 2019
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-76427 (URN)10.1038/s41398-019-0562-y (DOI)000486266500001 ()31506420 (PubMedID)2-s2.0-85072029916 (Scopus ID)
Funder
Stockholm County Council, 20150150 20130671The Royal Swedish Academy of Sciences, 523-2011-3646The Swedish Brain Foundation, FO2015-0191
Available from: 2019-09-16 Created: 2019-09-16 Last updated: 2020-01-23Bibliographically approved
Bejerot, S. & Hesselmark, E. (2019). The Cunningham Panel is an unreliable biological measure [Letter to the editor]. Translational Psychiatry, 9(1), Article ID 49.
Open this publication in new window or tab >>The Cunningham Panel is an unreliable biological measure
2019 (English)In: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 9, no 1, article id 49Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Nature Publishing Group, 2019
National Category
Otorhinolaryngology Pediatrics Psychiatry
Identifiers
urn:nbn:se:oru:diva-72037 (URN)10.1038/s41398-019-0413-x (DOI)000459833200003 ()30705260 (PubMedID)2-s2.0-85060934571 (Scopus ID)
Available from: 2019-02-12 Created: 2019-02-12 Last updated: 2019-06-18Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3587-6075

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