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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.
    Bornehag, C.-G.
    et al.
    Karlstad University, Karlstad, Sweden.
    Reichenberg, A.
    Icahn School of Medicine at Mount Sinai, NY, USA.
    Unenge Hallerback, M.
    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.

  • 4.
    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.

  • 5. 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.

  • 6.
    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.

  • 7.
    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.

  • 8.
    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.

  • 9. 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.

  • 10.
    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.

  • 11.
    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)
  • 12.
    Sellin, T.
    et al.
    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)
  • 13.
    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)
  • 14.
    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.

  • 15.
    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.

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