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  • 1.
    Bejerot, Susanne
    et al.
    Örebro University, School of Medical Sciences.
    Hesselmark, E.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Pediatric autoimmune neuropsychiatric syndrome (PANS), developmental regression and autism2017In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 41, no Suppl., p. S123-S123Article in journal (Other academic)
    Abstract [en]

    Introduction: Pediatric autoimmune neuropsychiatric syndrome (PANS) is a term used to describe a clinical picture which includes sudden onset of psychiatric symptoms and a possible autoimmune genesis. The sudden decline in neuropsychiatric functioning as well as the multiple combinations of symptoms may lead to a clinical phenotype similar to that in infantile autism (IA) with regressive features. We are conducting a study with the aim to evaluate a diagnostic test for PANS currently marketed by Moleculera Labs. All patients in Sweden who had taken the test (n = 154) were invited to the study.

    Objectives: The aim of the study is to characterize a subgroup of patients with IA within the PANS diagnosis study.

    Methods: Participants (n = 53) were examined for psychiatric and somatic symptoms and evaluated for PANS caseness by an experienced psychiatrist. Because the criteria for entering the study was having taken the diagnostic test for PANS, the participants in the study comprise a group with mixed symptoms.

    Results: Twelve participants had IA. Eleven of these reported a developmental regression with loss of abilities. Two of the IA patients also fulfill criteria for PANS. Eight of the IA patients had been treated with antibiotics for psychiatric symptoms and 4 reported a positive effect of this treatment. Nine of the patients had elevated test results suggesting possible PANS according to Moleculera Labs.

    Conclusions: Very early onset on PANS may be phenotypically similar to IA with regressive features. Further analysis of the immunological attributes of patients with autism with regressive features is warranted.

  • 2.
    Bejerot, Susanne
    et al.
    Department of Neuroscience, Psychiatry, University Hospital, Uppsala, Sweden.
    von Knorring, L.
    Department of Neuroscience, Psychiatry, University Hospital, Uppsala, Sweden.
    Ekselius, L.
    Department of Neuroscience, Psychiatry, University Hospital, Uppsala, Sweden.
    Personality traits and smoking in patients with obsessive-compulsive disorder2000In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 15, no 7, p. 395-401Article in journal (Refereed)
    Abstract [en]

    As opposed to other psychiatric populations, subjects with obsessive-compulsive disorder (OCD) smoke less than the general population. The present study aims at further investigating the relationship between smoking in OCD subjects and personality traits. Sixty-four subjects with OCD were interviewed concerning their smoking habits. Personality traits were evaluated using the Karolinska Scales of Personality, and specific obsessive-compulsive personality traits were elicited through self-report questionnaires. Non-smokers were more easily fatigued, more inclined to worry, more remorseful, less self-confident, less impulsive and became uneasy more frequently when urged to speed up, than smokers with OCD. Additionally, non-smokers fulfilled significantly more obsessive-compulsive personality disorder criteria as compared to the smokers (P < 0.001). We propose a clinical subtype of OCD related to non-smoking, psychasthenia, anxiety, and pronounced obsessive-compulsive personality disorder traits.

  • 3.
    Björk, Tabita
    et al.
    Örebro Regional Forensic Psychiatry Service, Örebro, Sweden.
    Lindqvist, Per
    Örebro Regional Forensic Psychiatry Service, Örebro, Sweden.
    A follow-up of mentally disordered offenders: recidivism and mortality2002In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 17, no Sup. 1, p. 141-141Article in journal (Refereed)
  • 4.
    Bornehag, C.-G.
    et al.
    Karlstad University, Karlstad, Sweden.
    Reichenberg, A.
    Icahn School of Medicine at Mount Sinai, NY, USA.
    Unenge Hallerbäck, Maria
    Karlstad University, Karlstad, Sweden.
    Wikström, Sverre
    Karlstad University, Karlstad, Sweden.
    Koch, H. M.
    Institute of the Ruhr-University, Bochum, Germany.
    Jonsson, B. A.
    Lund University, Lund, Sweden.
    Swan, S. H.
    Icahn School of Medicine at Mount Sinai, NY, USA.
    Prenatal exposure to acetaminophen and children's language development at 30 months2018In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 51, p. 98-103Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To examine prenatal APAP exposure in relation to language development in offspring at 30 months of age.

    METHOD: A population-based pregnancy cohort study including 754 women who enrolled in the Swedish Environmental Longitudinal, Mother and child, Asthma and allergy (SELMA) study in pregnancy week 8-13. Two exposure measures were used: (1) maternally reported number of APAP tablets taken between conception and enrollment; (2) APAP urinary concentration at enrollment. Language development at 30 months was assessed by nurse's evaluation and parental questionnaire, including the number of words the child used (<25, 25-50 and >50). Main study outcome; parental report of use of fewer than 50 words, termed language delay (LD).

    RESULTS: 59.2% of women enrolled in weeks 8-13 reported taking APAP between conception and enrollment. APAP was measurable in all urine samples and urinary APAP was correlated with the number of APAP taken during pregnancy (P<0.01). Language delay was more prevalent in boys (12.6%) than girls (4.1%) (8.5% in total). Both the number of APAP tablets and urinary APAP concentration were associated with greater LD in girls but not in boys. The adjusted odds ratio (OR) for LD among girls whose mothers reported >6 vs. 0 APAP tablets was 5.92 (95% confidence interval (CI) 1.10-31.94). The OR for LD in girls whose mothers' urinary APAP was in the highest compared to the lowest quartile was 10.34 (95% CI 1.37-77.86). While it cannot be ruled out, our available data do not support confounding by indication.

    CONCLUSIONS: Given the prevalence of prenatal APAP use and the importance of language development, these findings, if replicated, would suggest that pregnant women should limit their use of this analgesic during pregnancy.

  • 5.
    Brus, Ole
    et al.
    Örebro University, School of Medical Sciences.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Unit of Biostatistics, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, E.
    Department of Psychiatry, Umeå University Hospital, Umeå, Sweden.
    Hultén, Martin
    Psychiatric Neuromodulation Unit (PNU), Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.
    Landén, Mikael
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Lundberg, Johan
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Nordanskog, Pia
    Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Nordenskjöld, Axel
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Self-assessed remission rates after electroconvulsive therapy of depressive disorders2017In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 45, p. 154-160, article id S0924-9338(17)32917-6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Electroconvulsive therapy (ECT) effectively treats severe depression, but not all patients remit. The aim of the study was to identify clinical factors that associate with ECT-induced remission in a community setting.

    METHODS: Depressed patients who underwent ECT in 2011-2014 were identified from the Swedish National Quality Register for ECT. Remission was defined as self-rated Montgomery-Åsberg Depression Rating Scale scores of 0-10 after ECT. Other registers provided data on previous antidepressant use, comorbidities, and demographics.

    RESULTS: Of 1671 patients fulfilling the inclusion criteria, 42.8% achieved remission. Older age, education length over 9 years, psychotic symptoms, shorter duration of preceding antidepressant use, pulse width stimulus≥0.50ms, absence of substance use disorders, anxiety diagnosis, lamotrigine, and benzodiazepines, were associated with remission.

    CONCLUSIONS: This study shows that psychotic subtype of depression and older age are clinically relevant predictors of a beneficial ECT effect. Additionally, ECT outcomes can be further improved by optimizing the treatment technique and concomitant medication.

  • 6.
    Chen, C.
    et al.
    Karolinska Institutet, Stockholm, Sweden.
    Chang, Z.
    Karolinska Institutet, Stockholm, Sweden.
    Kuja-Halkola, R.
    Karolinska Institutet, Stockholm, Sweden.
    D'Onofrio, B. M.
    Indiana University, Bloomington, United States.
    Larsson, Henrik
    Örebro University, School of Medical Sciences.
    Andell, P.
    Karolinska University Hospital, Stockholm, Sweden.
    Lichtenstein, P.
    Karolinska Institutet, Stockholm, Sweden.
    Pettersson, E.
    Karolinska Institutet, Stockholm, Sweden.
    Associations between general and specific mental health conditions in young adulthood and cardiometabolic complications in middle adulthood: A 40-year longitudinal familial coaggregation study of 672 823 Swedish individuals2023In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 66, no Suppl. 1, p. S67-S68, article id O0022Article in journal (Other academic)
    Abstract [en]

    Introduction: Most mental disorders, when examined individually, are associated with an increased risk of cardiometabolic complications. However, these associations might be attributed to a general liability toward psychopathology or confounded by unmeasured familial factors.

    Objectives: To examine whether the associations between psychiatric diagnoses and increased risk of cardiometabolic complications are attributable to a general liability toward psychopathology, or confounded by unmeasured familial factors.

    Methods: We conducted a cohort study in Sweden and identified all individuals and their siblings born in Sweden 1955-1962 with follow-up through 2013. After excluding individuals who died or emigrated before 1987, the final sample consisted 672 823 individuals. We extracted ICD-coded diagnoses (recorded 1973-1987) for ten psychiatric conditions and criminal convictions when participants were aged 18-25 years, and ICD-coded diagnoses (recorded 1987-2013) for five cardiometabolic complications (obesity, hypertensive diseases, hyperlipidemia, type 2 diabetes mellitus, and cardiovascular diseases) when the participants were 51-58 years old. Logistic regression models were used to estimate the bivariate associations between psychiatric conditions or criminal convictions and cardiometabolic complications in individuals. A general factor model was used to identify general, internalizing, externalizing, and psychotic factors based on the psychiatric conditions and criminal convictions. We then regressed the cardiometabolic complications on the latent general factor and three uncorrelated specific factors within a structural equation modeling framework in individuals and across sibling pairs.

    Results: Each psychiatric conditions significantly increased the risk of cardiometabolic complications; however, most of these associations were attributable to the general factor of psychopathology, rather than to specific psychiatric conditions. There were no or only small associations between individuals’ general psychopathology and their siblings’ cardiometabolic complications, suggesting that the associations were not attributable to genetic or environmental confounding factors shared within families. The same pattern was evident for the specific internalizing and psychotic factors.

    Conclusions: Individuals with mental disorders in early life had an increased long term risk of cardiometabolic complications, which appeared attributable to a general liability toward psychopathology. Sibling analyses suggested that the elevated risk could not beattributed to confounds shared within families. This highlights the importance of transdiagnostic and lifestyle based interventions to reduce the risk of cardiometabolic complications, particularly in patients with several mental disorders.

  • 7.
    Dobrosavljevic, Maja
    et al.
    Örebro University, School of Medical Sciences.
    Zhang, Le
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Garcia-Argibay, Miguel
    Örebro University, School of Medical Sciences.
    Du Rietz, Ebba
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Andershed, Henrik
    Örebro University, School of Law, Psychology and Social Work.
    Chang, Zheng
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Faraone, Stephen
    Departments of Psychiatry and of Neuroscience and Physiology, SUNY Upstate Medical University, Syracuse, NY, USA.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Attention-deficit/hyperactivity disorder as a risk factor for dementia and mild cognitive impairment: a population-based register study2021In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 65, no 1, article id e3; PII S0924933821022616Article in journal (Refereed)
    Abstract [en]

    Background: Previous research has indicated that attention-deficit/hyperactivity disorder (ADHD) is associated with an increased risk for dementia, but studies are scarce and inconclusive. We aimed to investigate the association between ADHD, and dementia and mild cognitive impairment (MCI). Additionally, we aimed to investigate the impact of comorbid conditions, educational attainment, head injuries, other developmental disorders, and sex on the association.

    Methods: The study population consisted of 3,591,689 individuals born between 1932 and 1963, identified from Swedish population-based registers. Cases of ADHD, dementia and MCI were defined according to ICD diagnostic codes and ATC codes for medication prescriptions. A Cox proportional hazards model was used to test the associations between ADHD, and dementia and MCI.

    Results: Individuals with ADHD had an increased risk for dementia and MCI. After adjusting for sex and birth year, a hazard ratio (HR) was 2.92 (95% confidence interval 2.40-3.57) for dementia, and 6.21 (5.25-7.35) for MCI. Additional adjustment for psychiatric disorders (depression, anxiety, substance use disorder, and bipolar disorder) substantially attenuated the associations, HR = 1.62 (1.32-1.98) for dementia, and 2.54 (2.14-3.01) for MCI. Common metabolic disorders (hypertension, type 2 diabetes, and obesity), sleep disorders, head injuries, educational attainment, and other developmental disorders, had a limited impact on the association. The association between ADHD and dementia was stronger in men.

    Conclusions: ADHD is a potential risk factor for dementia and MCI, although the risk significantly attenuates after controlling for psychiatric disorders. Further research is needed to confirm these findings and to explore underlying mechanisms of the associations.

  • 8. Fiorillo, A.
    et al.
    De Rosa, C.
    Del Vecchio, V.
    Jurjanz, L.
    Schnall, K.
    Onchev, G.
    Alexiev, S.
    Raboch, J.
    Kalisova, L.
    Mastrogianni, A.
    Georgiadou, E.
    Solomon, Z.
    Dembinskas, A.
    Raskauskas, V.
    Nawka, P.
    Nawka, A.
    Kiejna, A.
    Hadrys, T.
    Torres-Gonzales, F.
    Mayoral, F.
    Björkdahl, A.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Priebe, S.
    Maj, M.
    Kallert, T.
    How to improve clinical practice on involuntary hospital admissions of psychiatric patients: suggestions from the EUNOMIA study2011In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 26, no 4, p. 201-207Article in journal (Refereed)
    Abstract [en]

    Number and procedures of involuntary hospital admissions vary in Europe according to the different socio-cultural contexts. The European Commission has funded the EUNOMIA study in 12 European countries in order to develop European recommendations for good clinical practice in involuntary hospital admissions. The recommendations have been developed with the direct and active involvement of national leaders and key professionals, who worked out national recommendations, subsequently summarized into a European document, through the use of specific categories. The need for standardizing the involuntary hospital admission has been highlighted by all centers. In the final recommendations, it has been stressed the need to: providing information to patients about the reasons for hospitalization and its presumable duration; protecting patients’ rights during hospitalization; encouraging the involvement of family members; improving the communication between community and hospital teams; organizing meetings, seminars and focus-groups with users; developing training courses for involved professionals on the management of aggressive behaviors, clinical aspects of major mental disorders, the legal and administrative aspects of involuntary hospital admissions, on communication skills. The results showed the huge variation of involuntary hospital admissions in Europe and the importance of developing guidelines on this procedure.

  • 9.
    Frank, Elisabeth
    et al.
    Biomax Informatics AB, Planegg, Germany.
    Maier, Dieter
    Biomax Informatics AB, Planegg, Germany.
    Pajula, Juha
    VTT Technical Research Centre of Finland Ltd., Tampere, Finland.
    Suvitaival, Tommi
    Steno Diabetes Center Copenhagen, Gentofte, Denmark.
    Borgan, Faith
    Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK.
    Butz-Ostendorf, Markus
    Biomax Informatics AB, Planegg, Germany.
    Fischer, Alexander
    Philips GmbH Innovative Technologies, Aachen, Germany.
    Hietala, Jarmo
    Department of Psychiatry, University of Turku, Turku, Finland; Turku PET Centre, Turku University Hospital, Turku, Finland.
    Howes, Oliver
    Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; Psychiatric Imaging Group, MRC London Institute of Medical Sciences, Hammersmith Hospital, Imperial College London, London, UK.
    Hyötyläinen, Tuulia
    Örebro University, School of Science and Technology. Department of Chemistry, Faculty of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Janssen, Joost
    Child and Adolescent Psychiatry Department, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Investigación Sanitaria del Hospital Gregorio Marañón (IISGM), Madrid, Spain.
    Laurikainen, Heikki
    Department of Psychiatry, University of Turku, Turku, Finland; Turku PET Centre, Turku University Hospital, Turku, Finland.
    Moreno, Carmen
    Child and Adolescent Psychiatry Department, School of Medicine, Hospital General Universitario Gregorio Marañón, Universidad Complutense, Madrid, Spain; Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Investigación Sanitaria del Hospital Gregorio Marañón (IISGM), Madrid, Spain.
    Suvisaari, Jaana
    National Institute for Health and Welfare (THL), Helsinki, Finland.
    Van Gils, Mark
    VTT Technical Research Centre of Finland Ltd.,Tampere, Finland.
    Oresic, Matej
    Örebro University, School of Medical Sciences. Turku Centre for Biotechnology, University of Turku, Turku, Finland; Åbo Akademi University, Turku, Finland.
    Platform for systems medicine research and diagnostic applications in psychotic disorders - The METSY project2018In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 50, p. 40-46Article in journal (Refereed)
    Abstract [en]

    Psychotic disorders are associated with metabolic abnormalities including alterations in glucose and lipid metabolism. A major challenge in the treatment of psychosis is to identify patients with vulnerable metabolic profiles who may be at risk of developing cardiometabolic co-morbidities. It is established that both central and peripheral metabolic organs use lipids to control energy balance and regulate peripheral insulin sensitivity. The endocannabinoid system, implicated in the regulation of glucose and lipid metabolism, has been shown to be dysregulated in psychosis. It is currently unclear how these endocannabinoid abnormalities relate to metabolic changes in psychosis. Here we review recent research in the field of metabolic co-morbidities in psychotic disorders as well as the methods to study them and potential links to the endocannabinoid system. We also describe the bioinformatics platforms developed in the EU project METSY for the investigations of the biological etiology in patients at risk of psychosis and in first episode psychosis patients. The METSY project was established with the aim to identify and evaluate multi-modal peripheral and neuroimaging markers that may be able to predict the onset and prognosis of psychiatric and metabolic symptoms in patients at risk of developing psychosis and first episode psychosis patients. Given the intrinsic complexity and widespread role of lipid metabolism, a systems biology approach which combines molecular, structural and functional neuroimaging methods with detailed metabolic characterisation and multi-variate network analysis is essential in order to identify how lipid dysregulation may contribute to psychotic disorders. A decision support system, integrating clinical, neuropsychological and neuroimaging data, was also developed in order to aid clinical decision making in psychosis. Knowledge of common and specific mechanisms may aid the etiopathogenic understanding of psychotic and metabolic disorders, facilitate early disease detection, aid treatment selection and elucidate new targets for pharmacological treatments.

  • 10.
    Glans, M.
    et al.
    Faculty of Medicine and Health, University Health Care Research Centre, Örebro, Sweden.
    Bejerot, Susanne
    Örebro University, School of Medical Sciences.
    Elwin, Marie
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Humble, Mats B.
    Örebro University, School of Medical Sciences.
    Symptomatic generalised joint hypermobility and autism spectrum disorder are associated in adults2022In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 65, no Suppl. 1, p. S452-S452, article id EPV0244Article in journal (Other academic)
    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.

  • 11.
    Glans, M.
    et al.
    Faculty of Medicine and Health, University Health Care Research Centre, Örebro, Sweden.
    Bejerot, Susanne
    Örebro University, School of Medical Sciences.
    Nilsson, J. Dossou
    Örebro University, Faculty of Medicine and Health, Örebro, Sweden.
    Tattooing and piercing are associated with symptoms of ADHD: A cross-sectional study of non-clinical adults2022In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 65, no Suppl. 1, p. S84-S85, article id O0057Article in journal (Other academic)
    Abstract [en]

    Introduction: Previous studies suggest that individuals with tattoos and piercings exhibit higher impulsive personality traits compared to peers without body modifications. No studies on body modifications and core-symptoms of ADHD are available.

    Objectives: This study aimed to compare self-reported ADHD symptoms between non-clinical adults with and without body modifications.

    Methods: A non-clinical adult Swedish population (n=815) completed the Adult ADHD self-report scale (ASRS-v1.1) and answered questions concerning body modification. ADHD diagnosis served as exclusion criterion. Three grouping variables were analysed separately; tattoo status, piercing status and a combination of having both tattoo and piercing. Linear regression compared mean ASRS total- and subscale scores between individuals with and without body modification according to each grouping variable, while adjusting for candidate covariates age and sex.

    Results: The prevalence of each body modification variable was; 30% for tattoo, 18% for piercing other than earlobe and 12% for combination of tattoo and piercing. Any combination of body modification was associated with significantly higher ASRS total- and subscale scores compared to no body modification. The most pronounced differences between groups were for the combination of tattoo and piercing, and on the hyperactivity/impulsivity (HI) subscale; revealing adjusted mean differences of 4.3 points (range 0-72) on the ASRS-total score (p <0.001) and 2.6 points (range 0-36) on the ASRS HI subscale (p <0.001).

    Conclusions: Body modification was associated with more pronounced ADHD core symptoms amongst non-clinical adults. Although statistically significant, the clinical significance is uncertain. The prevalence rates of body modifications in our cohort indicate that they are becoming cultural normal.

  • 12.
    Glans, Martin
    et al.
    Örebro University, School of Medical Sciences.
    Bejerot, Susanne
    Örebro University, School of Medical Sciences.
    Humble, Mats B.
    Örebro University, School of Medical Sciences.
    Elwin, Marie
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Thelin, N.
    Division of Psychiatry, Linköping University Hospital, Linköping, Sweden.
    Association between adult adhd and generalised joint hypermobility, with and without systemic manifestations: A case-control study2021In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 64, no Suppl. 1, p. S89-S89Article in journal (Other academic)
    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.

  • 13.
    Humble, Mats B.
    et al.
    Örebro University, School of Medical Sciences.
    Eklund, Daniel
    Örebro University, School of Medical Sciences.
    Fresnais, D.
    School of Medical Sciences, Örebro University, Örebro, Sweden.
    Hylén, Ulrika
    Örebro University, School of Health Sciences.
    Sigra, Sofia
    Örebro University, School of Medical Sciences.
    Thunberg, Per
    Örebro University, School of Medical Sciences.
    Bejerot, Susanne
    Örebro University, School of Medical Sciences.
    Rituximab for treatment-resistant schizophrenia and/or obsessive-compulsive disorder (OCD): functional connectivity and cytokines associated with symptomatic improvements2023In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 66, no Suppl. 1, p. S629-S629, article id EPP1035Article in journal (Other academic)
    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.

  • 14.
    Humble, Mats B.
    et al.
    Örebro University, School of Medical Sciences.
    Reis, M.
    Department of clinical chemistry, Division of laboratory medicine, University health care in Region Skåne, Lund, Sweden.
    Paroxetine concentrations in obsessive-compulsive disorder: Support for a therapeutic interval2017In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 41, no Suppl., p. S322-S322Article in journal (Other academic)
    Abstract [en]

    Introduction: Previous studies of concentrations of serotonin reuptake inhibitors (SRIs) versus therapeutic efficacy have yielded inconsistent results. Even if the relationships between the individual's serotonergic system and the clinical symptoms of obsessive-compulsive disorder (OCD) are poorly understood, the SRIs are consistently effective in OCD. However, studies on SRI concentrations in OCD treatment are rare.

    Objectives/aims: To identify possible links between paroxetine concentrations and anti-obsessive response.

    Methods: In a randomised, double-blind trial, comparing clomipramine, paroxetine and placebo in OCD treatment, serum paroxetine levels were measured after 1 week and after 4 weeks of treatment in 18 patients. Anti-obsessive response was assessed with Yale-Brown obsessive compulsive scale (Y-BOCS) and patients’ global evaluation (PGE), after 12 weeks of treatment.

    Results: Serum paroxetine concentrations after 4 weeks suggested a therapeutic interval between 50 and 240 nmol/L (13–63 ng/mL). The mean Y-BOCS decrease was 54% inside versus 7% outside this interval (t = 3.96; P = 0.0011).

    Conclusions: Paroxetine levels seemingly predicted clinical outcome. Studies with a greater number of patients are necessary in order to confirm this finding and to discern whether it is useful in clinical practice.

  • 15.
    Kooij, J. J. S.
    et al.
    PsyQ Psycho-Medical Programs, Expertise Center Adult ADHD, The Hague, The Netherlands; Amsterdam UMC, LocationVUMc, Dept. of Psychiatry, Amsterdam, the Netherlands.
    Bejerot, Susanne
    Örebro University, School of Medical Sciences.
    Asherson, P.
    University of Bonn, Department of Psychiatry and Psychotherapy, Bonn, Germany.
    Updated European Consensus Statement on diagnosis and treatment of adult ADHD2019In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 56, p. 14-34Article in journal (Refereed)
    Abstract [en]

    Background: Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness.

    Methods: The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated.

    Results: Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated?

    Conclusions: ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.

    Download full text (pdf)
    Updated European Consensus Statement on diagnosis and treatment of adult ADHD
  • 16. Lundqvist, Lars-Olov
    et al.
    Rask, M.
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    David, B.
    School of Health and Caring Sciences, Linnaeus University, Växjö, Sweden.
    Schröder, Agneta
    Örebro University, School of Health Sciences.
    Quality in community-based day center services for people with psychiatric disabilities from the attendees' perspective2017In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 41, no Suppl., p. S790-S790Article in journal (Other academic)
    Abstract [en]

    Community-based day centers in Sweden are well-established arenas for psychiatric rehabilitation. Little is, however, known of the attendees’ perception of the quality of the service provided. Therefore, the aim of the study was to describe and investigate the quality of community-based day center services for people with psychiatric disabilities. A sample of 218 attendees (44% females) between 18 and 71 years old in 14 community-based day center services in Sweden completed the quality in psychiatric care–daily activities (QPC-DA) instrument. The results showed that people with psychiatric disabilities perceived the quality of community-based day center services as high and 87% perceived the overall quality as satisfactory. The highest ratings were found in encounter followed by support, daily activity-specific, secure environment, participation, and the lowest quality was found in secluded environment dimensions of the QPC-DA. Most notably, quality of service was rated higher by those with lower educational level, had waited shorter time to attend the center, and had better mental and physical health. However, particularly aspects of a secluded environment and participation (information) may be areas with potential for improvement. In conclusion, the results adhere to the importance of occupational balance, with periods of rest/privacy during the time at the center.

  • 17.
    Nilsson, Erik
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Evald, Evelina
    Örebro University, School of Medical Sciences, Örebro, Sweden.
    Carrero, Juan Jesus
    Karolinska Institutet, Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    A cohort study of serotonin–norepinephrine re-uptake inhibitors and risk of hyponatremia2020In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 63, no Suppl. 1, p. S486-S486Article in journal (Other academic)
    Abstract [en]

    Introduction: Hyponatremia is a potential side effect of antidepressants and the risk differs across antidepressant subclasses. There is conflicting evidence whether noradrenergic antidepressants are associated with lower risk of hyponatremia than SSRIs.

    Objectives: To compare hyponatremia risk following initiation of SNRIs versus SSRIs.

    Methods: Registry based cohort study including laboratory data on sodium measurements and complete information on drugs dispensed at Swedish pharmacies. New users of an SSRI (citalopram, sertraline,escitalopram, fluoxetine, paroxetine, fluvoxamine) or SNRI (venlafaxine, duloxetine) in Stockholm county 2007-2010 were included. Persons with diabetes mellitus or age <18 years were excluded. Follow up was until death, 2 years, or antidepressant discontinuation. Those lacking a follow-up sodium measurement were excluded from analysis. Hyponatremia was defined as < 136 mmol/L on the firstfollow-up test.

    Results: A total of 37020 persons started treatment with an SSRI (n = 33822) or SNRI (n = 3198). SNRI userswere younger (50 vs 54 years, p <0.001), more often male (40% vs 35%, p <0.001) and had a lower incidence of hyponatremia compared to SSRI users (5.9% vs 7.6%, p <0.001). SNRI users had a lowerrisk of hyponatremia in unadjusted logistic regression analysis (OR 0.77, 95% CI 0.66-0.89, p < 0.001)but differences were attenuated when adjusting for age and sex (OR 0.9, 95% CI 0.78-1.1, p = 0.21).

    Conclusions: Although hyponatremia was more common in SSRI users, our results were compatible with no difference in hyponatremia risk between SSRIs and SNRIs after multivariable adjustment. We speculate that previously observed differences may be due to residual confounding.

  • 18.
    Oresic, Matej
    Örebro University, School of Medical Sciences.
    Molecular lipids in prediction of psychosis and the associated cardiometabolic co-morbidities2021In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 64, no Suppl. 1, p. S16-S16Article in journal (Other academic)
    Abstract [en]

    Lipid metabolism has been an area of increased interest in psychosis research, not only due to its link to metabolic comorbidities, but also due to its putative role in the pathophysiology of psychosis. Lipid disturbances are observed already in the period preceding the onset of psychosis. For example, we performed mass spectrometry based lipidomics in a cohort of individuals at clinical high risk for psychosis (the EU-GEI study) and found that the individuals who transitioned to psychosis within a 2-year follow-up period displayed decreased levels of ether phospholipids. This finding may be of direct (patho) physiological relevance, as ether phospholipids (particularly plasmalogens, a major subgroup of ether phospholipids) are highly enriched in the brain, are supplied to the brain by the liver, have many structural and functional roles, and may act as endogenous antioxidants. Accumulating evidence also suggests that lipid disturbances play a crucial role in the development of metabolic comorbidities associated with psy-chotic disorders. Our lipidomic studies have shown that psychotic patients who rapidly gain weight during follow-up have elevated triglycerides (TGs) with low double bond count and carbon number at baseline. These TGs are known to be associated with non-alcoholic fatty liver disease (NAFLD) and with increased risk of type 2 diabetes. In conclusion, although the mechanisms linking dysregulation of lipid metabolism with the pathophysiology of psychosis are currently poorly understood, findings by us and others suggest that metabolic abnormalities are evident in people who are vulnerable to psychosis, and to the associated metabolic comorbidities.

  • 19.
    Påhlsson, A.
    et al.
    Karolinska Institutet, Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Liu, S.
    Karolinska Institutet, Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Tideman, M.
    Högskolan i Halmstad, Akademin för hälsa och välfärd, Halmstad, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences.
    Lichtenstein, P.
    Karolinska Institutet, Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Butwicka, A.
    Karolinska Institutet, Medical Epidemiology and Biostatistics, Stockholm, Sweden.
    Increased Risk for Substance Use-Related Problems in Mild Intellectual Disability: A Population-Based Cohort Study2022In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 65, no Suppl. 1, p. S79-S80, article id O0042Article in journal (Other academic)
    Abstract [en]

    Introduction: Intellectual disability (ID) has been linked to substance use-related problems (SUP). However, previous research is limited by the small sample sizes, lack of general population comparison and have not accounted for familial confoundings. The role of other psychiatric comorbidities also remains unknown.

    Objectives: To examine the risk of SUP in individuals with mild-ID and assess whether the associations depend on other psychiatric comorbidities, controlling for potential familial confounding.

    Methods: Population-based cohort study of individuals born in Sweden 1973-2003. We identified 19,078 individuals with mild-ID, 953,900 reference individuals from the general population, and 20,722 full-siblings of individuals with mild-ID. Conditional logistic regression models were used to compare individuals with mild-ID to the general population and their full-siblings regarding the risk of SUP, including alcohol and substance use disorders, alcohol and substance-related somatic diseases, substance-related crime, and substance-related death. Analyses were repeated stratified by the presence of psychiatric comorbidities.

    Results: Individuals with mild-ID had increased risks of any SUP (adjusted OR [95%CI]: 1.41 [1.35, 1.47]), compared to the general population, including alcohol-related somatic diseases (3.27 [1.92, 5.59]), alcohol (2.05 [1.91, 2.22]) and drug-use disorder (1.79 [1.69, 1.91]), and alcohol (1.36 [1.19, 1.49]) and drug-related crime (1.27 [1.19, 1.36]). The risk of SUP for individuals with mild ID was particularly elevated with comorbid mood (3.74 [3.47, 4.04]), anxiety (3.30 [3.09, 3.53]) and attention-deficit/hyperactivity disorders (2.61 [2.44, 2.80]). Increased risk of SUP remained significant when controlling for familial confounding.

    Conclusions: Individuals with mild-ID, especially those with other psychiatric comorbidities, are at increased risks of SUP.

  • 20.
    Salzmann-Erikson, Martin
    et al.
    Dalarna Univ, Västerås, Sweden.
    Lützén, Kim
    Dalarna Univ, Falun, Sweden.
    Ivarsson, Ann-Britt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eriksson, Henrik
    Mälardalens University, Eskilstuna, Sweden.
    Intensive psychiatric care2010In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 25, p. 635-635Article in journal (Refereed)
    Abstract [en]

    Introduction: The first psychiatric intensive care unit (PICU) opened in the early 1970's in New York. This ward was designed to manage patient that did not respond to treatment in open psychiatric wards. There are about 15 PICUs in Sweden but the concept has not been specified by any public organs. In many county hospitals, both acute and intensive care units exists parallel.

    Aims: Therefore, the aim of this study was to describe the core characteristics of PICU in Sweden and to describe the care activities provided for patients admitted to PICU.

    Method: Critical incident technique was used. In the study, eighteen caregivers at a PICU participated by completing a semi-structured questionnaire. Additional, in-depth interviews with three nurses and two assistant nurses also constitute the data.

    Results: Four categories were identified that characterise the core of PICU: the dramatic admission, protests and refusal of treatment, escalating behaviours and temporarily coercive measure. Care activities for PICU were also analysed and identified as controlling - establishing boundaries, protecting - warding off, supporting - giving intensive assistance and structuring the environment.

    Conclusions: PICU were interpreted as a level of care as it is composed by limited structures and closeness in care.

  • 21.
    Schröder, Agneta
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Lundqvist, Lars-Olov
    Örebro University, School of Health Sciences. University Health Care Research Center.
    Quality in Psychiatric Care in a global perspective2023In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 66, no Suppl. 1, p. S552-S553, article id EPP0882Article in journal (Other academic)
    Abstract [en]

    Introduction: Worldwide efforts to standardize instruments measuring quality in psychiatric care are rare. The international project “Quality in Psychiatric Care” (QPC) is a large research programme aiming at adapting the versions of the QPC instrument for patients and staff to different international settings.

    Objectives: The aims were to test the psychometric properties and equivalence of dimensionality of the different language versions of QPC and also to describe and compare the quality of psychiatric out-patient, in-patient, forensic in-patient and psychiatric care across different countries.

    Methods: The QPC is a family of instruments based on a definition of quality of psychiatric care from the patients perspective with adapted versions for staff. In this project, we used different language versions in three areas for patient and staff: psychiatric out-patient (QPC-OP/OPS), in-patient (QPC-IP/IPS), and forensic in-patient (QPC-FIP/FIPS).

    Results: Patients in out-patient psychiatric care in Brazil rated the quality of care higher than Swedish patients. Comparisons of forensic in-patient care (QPC-FIP/FIPS) patients were more critical of the care they received while staff were generally more positive on the quality of care provided in both Denmark and Sweden. Quality of in-patient care (QPC-IP/IPS) in Spain show staff rating lower quality of care than patients and lowest in the secure environment, which the Swedish staff rated low as well. In Indonesia the patients rated lower quality than staff and lowest in the discharge dimension, followed by the participation dimension. Generally, staff and patients were similar in their perceptions of the low quality of participation. Several studies in Turkey, Indonesia, Spain, Faroe Islands and Norway is ongoing.

    Conclusions: The psychometric test and validations of the instrument QPC in different language and country versions will assist countries to compare quality of care, quality improvement and permits benchmarking. Since there are few standardized instruments for measuring quality of care in the psychiatric care, the QPC is expected to make an important contribution to the development in the field.

  • 22.
    Schröder, Agneta
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Nursing, Faculty of Health, Care and Nursing, Norwegian University of Science and Technology (NTNU), Gjövik, Norway.
    Lundqvist, Lars-Olov
    Örebro University, School of Health Sciences.
    What patients think about quality of psychiatric care in different countries2019In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 56, p. S373-S373Article in journal (Other academic)
  • 23.
    Sellevåg, Kjersti
    et al.
    NKS Olaviken gerontopsychiatric hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway.
    Bartz-Johannessen, Christoffer Andreas
    Department of Psychiatry, Haukeland University Hospital, Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Norway.
    Oedegaard, Ketil Joachim
    Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Psychiatry, Haukeland University Hospital, Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Norway.
    Nordenskjöld, Axel
    Örebro University, School of Medical Sciences. The University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Mohn, Christine
    Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Norway; National Centre for Suicide Research and Prevention (NSSF), Department of Clinical Medicine, University of Oslo, Norway.
    Bjørke, Jeanette Solheimslid
    Psychiatric Division, Stavanger University Hospital, Stavanger, Norway.
    Kessler, Ute
    Department of Clinical Medicine, University of Bergen, Bergen, Norway; Department of Psychiatry, Haukeland University Hospital, Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Division of Mental Health and Addiction, Oslo University Hospital, Norway.
    Unmasking Patient Diversity: Exploring Cognitive and Antidepressive Effects of Electroconvulsive Therapy2024In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 67, no 1, article id e12Article in journal (Refereed)
    Abstract [en]

    Background: Electroconvulsive therapy (ECT) is an established treatment for depression, but more data on effectiveness and safety in clinical practice is needed. The aim of this register-based study was to investigate short-term effectiveness and cognitive safety after ECT, evaluated by clinicians and patients. Secondary, we investigated predictors for remission and cognitive decline.

    Methods: The study included 392 patients from the Regional Register for Neurostimulation Treatment in Western Norway. Depressive symptoms and cognitive function were assessed with Montgomery-angstrom sberg Depression Rating Scale and Mini-Mental State Examination (clinician-rated) and Beck Depression Inventory and Everyday Memory Questionnaire (patient-rated). Assessments were done prior to ECT-series and a mean of 1.7 days after (range 6 days before and 12 days after) end of ECT-series. Paired samples t-tests were extended by detailed, clinically relevant subgroups. Predictors were examined using logistic regression.

    Results: Clinician- and patient-rated remission rates were 49.5 and 41.0%, respectively. There was a large reduction in depressive symptoms and a small improvement in cognition after ECT, but we also identified subgroups with non-response of ECT in combination with cognitive decline (4.6% clinician-rated, 15.7% patient-rated). Positive predictors for patient- and clinician-rated remission were increasing age, shorter duration of depressive episode, and psychotic features. Antipsychotic medication at the commencement of treatment and previous ECT-treatment gave higher odds of clinician-rated remission, whereas higher pretreatment subjective depression level was associated with lower odds for patient-rated remission. Clinician-rated cognitive decline was predicted by higher pretreatment MMSE scores, whereas psychotic features, increasing age, and greater pretreatment subjective memory concerns were associated with lower odds for patient-rated cognitive decline.

    Conclusions: Our study supports ECT as an effective and safe treatment, although subgroups have a less favorable outcome. ECT should be considered at an early stage for older patients suffering from depression with psychotic features. Providing comprehensive and balanced information from clinicians and patients perspectives on effects and side effects, may assist in a joint consent process.

  • 24.
    Sellin, Tabita
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Holländare, Fredrik
    Örebro University, School of Medical Sciences. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Psychiatric ward consumption before suicide: A case-control study2017In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 41, p. S295-S296, article id EW0559Article in journal (Other academic)
  • 25.
    Strand, M.
    et al.
    Research and Development Unit, Stockholms Centre for Eating Disorders, Stockholm, Sweden.
    Bulik, C. M.
    Department of Medial Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    von Hausswolff-Juhlin, Y.
    Research and Development Unit, Stockholms Centre for Eating Disorders, Stockholm, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences.
    Self-admission to in-patient treatment: Patient experiences of a novel approach in the treatment of severe eating disorders2017In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 41, p. S560-S560, article id EV0480Article in journal (Other academic)
  • 26.
    Wiesel, F.-A.
    et al.
    Department of Neuroscience Psychiatry, Uppsala University Hospital, Uppsala, Sweden.
    Bjerkenstedt, L.
    Department of Clinical Neuroscience, Karolinska Institute, Karolinska Hospital, Stockholm, Sweden.
    Edman, G.
    Department of Psychiatry, R&D Section, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Flyckt, L.
    Department of Psychiatry, R&D Section, Karolinska Institutet, Danderyd Hospital, Stockholm, Sweden.
    Venizelos, Nikolaos
    Örebro University, Department of Clinical Medicine.
    The complexity of using D2-dopamine antagonists in the treatment of patients with schizophrenia2007In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 22, p. S5-S6Article in journal (Refereed)
    Abstract [en]

    Schizophrenia is a complex disorder and the view that schizophrenia is caused by hyperdopaminergic activity is an oversimplification. In fact, there are clinical evidence in accordance with a hypodopaminergic condition. Thus, untreated patients show motor disturbances in line with a decreased dopamine activity in the extrapyramidal system, likewise cognitive deficits and negative symptoms.

     

    In our research we have explored the evidence of schizophrenia as a hyper- or hypodopaminergic condition. With Positron Emission Tomography (PET) we have not seen any evidence of increased D2-dopamine receptors in the brain of never medicated patients. The major dopamine metabolite homovanillic acid (HVA) was lowered in CSF in line with a decreased dopamine turnover in the brain. Tyrosine is precursor to the synthesis of dopamine and for that aim we have made transport studies in an in vitro model with fibroblasts to determine tyrosine kinetics.

     

    The results demonstrated that tyrosine transport is lower in patients with schizophrenia in comparison to healthy controls. Tyrosine kinetics measured with PET demonstrated dysregulation of tyrosine transport into the brain.

    We have found evidence of schizophrenia as a hypodopaminergic condition. This fact is a problem realizing that our antipsychotics are D2-dopamine antagonists, thus decreasing dopamine activity even further.

    The concept of schizophrenia as both a hypo- and hyperdopaminergic condition may explain why clozapine, a week D2-antagonist, works more efficiently than other antipsychotic compounds. It should be recognized that positive symptoms are, at least partly, related to changes in dopamine activity and therefore respond very efficiently to D2-dopamine antagonists.

  • 27.
    Wolf, A.
    et al.
    Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
    Fanshawe, T. R.
    Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK.
    Sariaslan, A.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Cornish, R.
    Oxford Health NHS Foundation Trust, Oxford, UK.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Fazel, S.
    Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, UK.
    Prediction of violent crime on discharge from secure psychiatric hospitals: A clinical prediction rule (FoVOx)2018In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 47, p. 88-93Article in journal (Refereed)
    Abstract [en]

    Background: Current approaches to assess violence risk in secure hospitals are resource intensive, limited by accuracy and authorship bias and may have reached a performance ceiling. This study seeks to develop scalable predictive models for violent offending following discharge from secure psychiatric hospitals.

    Methods: We identified all patients discharged from secure hospitals in Sweden between January 1, 1992 and December 31, 2013. Using multiple Cox regression, pre-specified criminal, sociodemographic, and clinical risk factors were included in a model that was tested for discrimination and calibration in the prediction of violent crime at 12 and 24 months post-discharge. Risk cut-offs were pre-specified at 5% (low vs. medium) and 20% (medium vs. high).

    Results: We identified 2248 patients with 2933 discharges into community settings. We developed a 12-item model with good measures of calibration and discrimination (area under the curve = 0.77 at 12 and 24 months). At 24 months post-discharge, using the 5% cut-off, sensitivity was 96% and specificity was 21%. Positive and negative predictive values were 19% and 97%, respectively. Using the 20% cut-off, sensitivity was 55%, specificity 83% and the positive and negative predictive values were 37% and 91%, respectively. The model was used to develop a free online tool (FoVOx).

    Interpretation: We have developed a prediction score in a Swedish cohort of patients discharged from secure hospitals that can assist in clinical decision-making. Scalable predictive models for violence risk are possible in specific patient groups and can free up clinical time for treatment and management. Further evaluation in other countries is needed.

    Funding: Wellcome Trust (202836/Z/16/Z) and the Swedish Research Council. The funding sources had no involvement in writing of the manuscript or decision to submit or in data collection, analysis or interpretation or any aspect pertinent to the study.

  • 28.
    Zhai, Qiwei
    et al.
    Örebro University, School of Medical Sciences.
    Freund-Levi, Yvonne
    Örebro University, School of Medical Sciences. Department of Neurology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden.
    Horn, A.
    Psychiatry, Örebro University Hospital, Örebro, Sweden.
    Fridenberger, A. -C
    Psychiatry, Örebro University Hospital, Örebro, Sweden.
    Lager, E.
    Psychiatry, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Medical Sciences.
    Persson, Jonas
    Örebro University, School of Law, Psychology and Social Work.
    Physical training for patients with depression and anxiety - a randomized controlled study2021In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 64, no Suppl. 1, p. S690-S690, article id EPV0249Article in journal (Other academic)
    Abstract [en]

    Introduction: Pharmaceutical treatment and psychotherapy constitute the most common treatment methods for depression and anxiety. Physical training has been shown to have comparable effect to cognitive behavioral therapy in treatment of mild to moderate depression and anxiety. Physically active individuals also show lower risks to develop depression and relapse in depression.

    Objectives: The objectives are to evaluate how physical activity can affect depressive and anxiety symptoms, by examining biomarkers in the blood and from the gut and also by measuring cognitive functions. Hopefully, this can lead to new treatment strategies for patients with depression and anxiety.

    Methods: 102 patients are randomized to two groups and undergo 12 weeks intervention as add-on to standard outpatient psychiatric treatment. The first group will participate in physical training three times per week and the other group will receive relaxation therapy on a weekly basis. Daily activity intensity will be measured before and at the last week of intervention with an accelerometer. Blood and faeces sample collection, symptom grading by clinician together with self-rating scales and cognitive screening will be performed at baseline, week 12 and one year of follow-up. The cognitive screenings are performed digitally in cooperation with Mindmore.

    Results: The RCT is currently recruiting patients at the Department of Psychiatry of Örebro University Hospital.

    Conclusions: The project aims to be holistic in its approach, combining the defining clinical psychiatric symptoms in patients who have both depression and anxiety with the finding and evaluation of new biomarkers from blood and gut to improve cognitive functions.

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