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Lindén M, Braude HD, Herlofson J, Nordgaard J, Kelly RE, Eberhard J. Elephants, bushes, hot porridge… and clinical intuition? Nord J Psychiatry 2024; 78:163-164. [PMID: 38015046 DOI: 10.1080/08039488.2023.2283476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Accepted: 11/08/2023] [Indexed: 11/29/2023]
Affiliation(s)
- M Lindén
- Department of Medical History, Faculty of Medicine, Lund University, Lund, Sweden
| | | | | | - J Nordgaard
- Mental Health Center Amager, University Hospital Copenhagen, Copenhagen, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - R E Kelly
- Department of Psychiatry, Weill Cornell Medicine, White Plains, NY, USA
- Department of Clinical Sciences Lund/Helsingborg, Lund University, Lund, Sweden
| | - J Eberhard
- Department of Clinical Sciences Lund/Helsingborg, Lund University, Lund, Sweden
- Adult Psychiatric Clinic of Helsingborg, Region Skåne, Helsingborg, Sweden
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Titulaer J, Gottfridsson R, Nordling D, Fagerström E, Eberhard J, Konradsson-Geuken Å. Sex-specific differences and similarities of olanzapine and risperidone on avoidance suppression in rats in the conditioned avoidance response test. Brain Res 2023; 1818:148527. [PMID: 37567547 DOI: 10.1016/j.brainres.2023.148527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Revised: 07/17/2023] [Accepted: 08/08/2023] [Indexed: 08/13/2023]
Abstract
It is well known that antipsychotic drugs (APDs) are more effective in reducing symptoms in women than in men, and that women are more sensitive to the side effects of APDs. Therefore, it is of great importance that sex differences in drug responses are considered already in the early stages of drug development. In this study, we investigated whether sex-specific differences could be observed in response to the commonly prescribed APDs olanzapine and risperidone using the conditioned avoidance response (CAR) test. To this end we tested the effect of 1.25 and 2.5 mg/kg olanzapine and 0.25 and 0.4 mg/kg risperidone using female and male Wistar rats in the CAR test. Whereas there were no significant differences between the female and male rats in response to either dose of olanzapine administration, an injection of 0.4 mg/kg risperidone significantly suppressed avoidance more in female rats than in male rats. In addition, we found that the estrous cycle of the female rats did not have a significant effect on the avoidance response. In conclusion, we show that there are sex-specific differences as well as similarities between female and male rats in the CAR test and novel APDs should be tested on female and male rats in the future.
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Affiliation(s)
- Joep Titulaer
- Section of Neuropharmacology and Addiction Research, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden; Section of Neuropsychopharmacology, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden
| | - Rebecca Gottfridsson
- Section of Neuropharmacology and Addiction Research, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Daniel Nordling
- Section of Neuropharmacology and Addiction Research, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden; Division of Psychiatry, Clinical Sciences Helsingborg, Lund University, Lund, Sweden
| | - Ella Fagerström
- Section of Neuropharmacology and Addiction Research, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden
| | - Jonas Eberhard
- Division of Psychiatry, Clinical Sciences Helsingborg, Lund University, Lund, Sweden
| | - Åsa Konradsson-Geuken
- Section of Neuropharmacology and Addiction Research, Department of Pharmaceutical Biosciences, Uppsala University, Uppsala, Sweden; Section of Neuropsychopharmacology, Department of Physiology and Pharmacology, Karolinska Institute, Stockholm, Sweden; Division of Psychiatry, Clinical Sciences Helsingborg, Lund University, Lund, Sweden.
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Nyrenius J, Waern M, Eberhard J, Ghaziuddin M, Gillberg C, Billstedt E. Autism in adult psychiatric out-patients: self-reported suicidal ideation, suicide attempts and non-suicidal self-injury. BJPsych Open 2023; 9:e167. [PMID: 37674410 PMCID: PMC10594204 DOI: 10.1192/bjo.2023.553] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Revised: 06/20/2023] [Accepted: 07/24/2023] [Indexed: 09/08/2023] Open
Abstract
BACKGROUND The prevalence of self-reported suicidal ideation, suicide attempts and non-suicidal self-injury (NSSI) remains unclear among adults with autism unrecognised in childhood who attend psychiatric services. AIMS We aimed to estimate the prevalence of suicidal ideation, suicide attempts and NSSI; identify factors associated with suicide attempts and NSSI; and describe NSSI in this group. METHOD Sixty-three new patients at an adult psychiatric out-patient clinic (57% women, mean age 32 years) who met full (n = 52) or subthreshold (two A criteria and minimum of two B criteria; n = 11) DSM-5 criteria for autism spectrum disorder were included in the study. Clinical assessments included overall diagnostic review, Paykel's questions on passive and active suicidality, evaluation of NSSI with the Functional Assessment of Self-Mutilation, and results of cognitive tests. One follow-up of medical records was made. RESULTS In this sample of psychiatric out-patients identified as first having autism in adulthood, almost a third (31%) of patients reported suicidal ideation during the past month, 86% had lifetime suicidal ideation and 25% reported at least one suicide attempt. Factors associated with suicide attempts included hazardous or harmful alcohol use and/or drug-related problems, and severity of depression. A total of 44% reported NSSI. Factors associated with NSSI were female sex, history of suicidal plans and antisocial personality disorder. Substance or alcohol use were often overlooked, especially in women. CONCLUSIONS Suicidal ideation, suicide attempts and NSSI were very common in adults with autism who were recently referred to an out-patient psychiatric service. Suicidal ideation and NSSI were more common than suicide attempts. Clinicians should always consider suicidal ideation and NSSI in adult psychiatric patients with autism.
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Affiliation(s)
- Johan Nyrenius
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Adult Psychiatric Clinic of Helsingborg, Region Skåne, Sweden; and Department of Clinical Sciences Lund/Helsingborg, Lund University, Sweden
| | - Margda Waern
- Sahlgrenska Suicide Studies, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Jonas Eberhard
- Adult Psychiatric Clinic of Helsingborg, Region Skåne, Sweden; and Department of Clinical Sciences Lund/Helsingborg, Lund University, Sweden
| | | | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; and Child Neuropsychiatric Clinic, Sahlgrenska University Hospital, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; and Child Neuropsychiatric Clinic, Sahlgrenska University Hospital, Sweden
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McCrone P, Young AH, Zahn R, Eberhard J, Wasserman D, Brambilla P, Balazs J, Caldas-de-Almeida J, Ulrichsen A, Carli V, Antunes A, Schiena G, Quoidbach V, Boyer P, Strawbridge R. Economic impact of reducing treatment gaps in depression. Eur Psychiatry 2023; 66:e57. [PMID: 37309907 PMCID: PMC10486252 DOI: 10.1192/j.eurpsy.2023.2415] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 04/03/2023] [Accepted: 05/04/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND Major depressive disorder (MDD) is highly prevalent across Europe. While evidence-based treatments exist, many people with MDD have their condition undetected and/or untreated. This study aimed to assess the cost-effectiveness of reducing treatment gaps using a modeling approach. METHODS A decision-tree model covering a 27-month time horizon was used. This followed a care pathway where MDD could be detected or not, and where different forms of treatment could be provided. Expected costs pertaining to Germany, Hungary, Italy, Portugal, Sweden, and the UK were calculated and quality-adjusted life years (QALYs) were estimated. The incremental costs per QALY of reducing detection and treatment gaps were estimated. RESULTS The expected costs with a detection gap of 69% and treatment gap of 50% were €1236 in Germany, €476 in Hungary, €1413 in Italy, €938 in Portugal, €2093 in Sweden, and €1496 in the UK. The incremental costs per QALY of reducing the detection gap to 50% ranged from €2429 in Hungary to €10,686 in Sweden. The figures for reducing the treatment gap to 25% ranged from €3146 in Hungary to €13,843 in Sweden. CONCLUSIONS Reducing detection and treatment gaps, and maintaining current patterns of care, is likely to increase healthcare costs in the short term. However, outcomes are improved, and reducing these gaps to 50 and 25%, respectively, appears to be a cost-effective use of resources.
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Affiliation(s)
- Paul McCrone
- Institute for Lifecourse Development, University of Greenwich, London, UK
| | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, Bethlem Royal Hospital, Beckenham, UK
| | - Roland Zahn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Jonas Eberhard
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Judit Balazs
- Department of Developmental & Clinical Child Psychology, Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Department of Psychology, Oslo New University College, Oslo, Norway
| | - Jose Caldas-de-Almeida
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Andrea Ulrichsen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Vladmir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Ana Antunes
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Giandomenico Schiena
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | | | - Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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Nyrenius J, Eberhard J, Ghaziuddin M, Gillberg C, Billstedt E. The 'lost generation' in adult psychiatry: psychiatric, neurodevelopmental and sociodemographic characteristics of psychiatric patients with autism unrecognised in childhood. BJPsych Open 2023; 9:e89. [PMID: 37222104 DOI: 10.1192/bjo.2023.13] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/25/2023] Open
Abstract
BACKGROUND Patients with 'underlying' autism spectrum disorder (ASD) constitute a significant minority in adult out-patient psychiatry. Diagnoses of previously unrecognised ASD are increasing in adults. Characteristics of patients with autism within adult out-patient psychiatry have not been sufficiently explored, and there have not been any systematic comparisons of characteristics between patients with and those without autism within adult out-patient psychiatric populations. AIMS To examine psychiatrically relevant characteristics in autistic adult psychiatric out-patients, and to compare the characteristics with non-autistic adult psychiatric out-patients. METHOD We assessed 90 patients who were referred to a Swedish psychiatric out-patient clinic and screened for ASD during 2019-2020. Sixty-three patients met the DSM-5 criteria for ASD or 'subthreshold' ASD. The 27 who did not meet the criteria for ASD were used as a comparison group. Assessments were made with structured and well-validated instruments, including parent ratings of developmental history. RESULTS No differences were found between the groups regarding self-reported sociodemographic variables. The ASD group showed a higher number of co-occurring psychiatric disorders than the non-ASD group (t(88) = 5.17, 95% CI 1.29-2.91, d = 1.19). Functional level was lower in the ASD group (t(88) = -2.66, 95% CI -9.46 to -1.27, d = -0.73), and was predicted by the number of co-occurring psychiatric disorders. CONCLUSIONS The results underscore the need for thorough assessment of psychiatric disorders in autistic patients in adult psychiatric services. ASD should be considered as a possible 'underlying' condition in adult psychiatry, and there is no easy way of ruling out ASD in this population.
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Affiliation(s)
- Johan Nyrenius
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden; Adult Psychiatry Clinic Helsingborg, Region Skåne, Sweden; and Department of Clinical Sciences Lund/Clinical Sciences Helsingborg, Lund University, Sweden
| | - Jonas Eberhard
- Adult Psychiatry Clinic Helsingborg, Region Skåne, Sweden; and Department of Clinical Sciences Lund/Clinical Sciences Helsingborg, Lund University, Sweden
| | | | - Christopher Gillberg
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
| | - Eva Billstedt
- Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden
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Keating S, Eberhard J, Friederich J, Wess G. Systolic function in dogs with pulmonic stenosis of different severities and the effect of balloon valvuloplasty. J Vet Cardiol 2023; 46:40-54. [PMID: 37058905 DOI: 10.1016/j.jvc.2023.03.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 03/10/2023] [Accepted: 03/15/2023] [Indexed: 04/07/2023]
Abstract
INTRODUCTION/OBJECTIVES Pulmonic stenosis (PS) is one of the most common congenital heart diseases in dogs leading to right ventricular (RV) pressure overload, myocardial remodeling, and potential RV dysfunction. Our objectives were to investigate the extent of RV systolic dysfunction in canine PS and to examine the immediate influence of balloon valvuloplasty (BV) on systolic function. ANIMALS, MATERIALS AND METHODS This prospective study evaluated 72 dogs with PS and 86 healthy dogs. Echocardiographic parameters of systolic function included normalized tricuspid annular plane systolic excursion (N-TAPSE), normalized systolic myocardial tissue Doppler velocity of the lateral tricuspid annulus (N-RVFW-S'), fractional area change, and speckle-tracking longitudinal endocardial RV strain. Forty-four dogs underwent BV and were re-examined after surgery. RESULTS Systolic function at the basal segment of the RV was significantly lower in the PS group when compared to healthy dogs (mean N-TAPSE 4.29 ± standard deviation 1.18 mm/kg0.285 vs. 5.60 ± 1.29 mm/kg0.285; median N-RVFW-S' 5.28 [lower-upper 25% quantile 4.35-6.43 cm/s/kg0.186] vs. 7.82 [6.73-8.79 cm/s/kg0.186]; all P<0.001). Global longitudinal RV endocardial strain showed no significant difference between the two groups (-28.50 ± 6.23% vs. 28.61 ± 4.64%; P=0.886), but segmental strain analyses revealed basal hypo- and potential compensatory hyperkinesis of the apical RVFW. Furthermore, BV affected most parameters of systolic function, but not the segmental strain values and N-TAPSE. CONCLUSIONS Right ventricular basal longitudinal systolic function is decreased in dogs with PS in comparison to a healthy cohort. Regional and global function does not necessarily coincide.
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Stenmark R, Eberhard J, Edman G, Gaughran F, Jedenius E. Resource utilization in mental illness - evaluation of an instrument for measuring direct costs of treatment for patients with severe mental illness (SMI). Nord J Psychiatry 2023; 77:172-178. [PMID: 35649422 DOI: 10.1080/08039488.2022.2077434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE Serious mental illnesses (SMIs) exert a considerable financial burden on health-care systems. In this study, the resource utilization in mental illness (RUMI) tool was developed and employed to evaluate resource utilization in patients with SMI. MATERIALS AND METHODS Data from 107 patients with SMI treated in four psychiatric outpatient clinics in Sweden were collected. The relationships between costs for physical and psychiatric care, social services, and the justice system, to self-reported health and quality of life, educational level, Global Assessment of Functioning (GAF), the Clinical Global Impressions scale score (CGI), and body mass index (BMI) were studied. RESULTS Sixteen out of 107 patients accounted for 74% of the total costs. The mean and median cost for 6 months included in the survey for social services, family and social welfare and healthcare, psychiatric and physical treatment interventions, mean 8349 EUR, median 2599 EUR per patient (currency value for 2021). Education and psychosocial function (GAF) were both negatively correlated with costs for the social services (education, r=-0.207, p < 0.014; GAF, r=-0.258, p < 0.001). CGI was correlated with costs for physical and psychiatric healthcare (r = 0.161, p < 0.027), social services support (r = 0.245, p = 0.002) and total cost (r = 0.198, p = 0.007). BMI correlated with costs for psychiatric and physical health settings interventions (r = 0.155, p < 0.019) and for somatic and psychiatric medicines (r = 0.154, p < 0.019). CONCLUSION The RUMI scale was acceptable and enabled estimation of resource utilization in a comparable manner across different care settings. Such comparable data have potential to provide a basis for budgeting and resource allocation.
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Affiliation(s)
- Richard Stenmark
- Department of Clinical Sciences Lund, Severe Mental Illness Research Unit, Lund University, Psychiatry Research Center, Region Skåne, Lund, Sweden
| | - Jonas Eberhard
- Department of Clinical Sciences Lund, Severe Mental Illness Research Unit, Lund University, Psychiatry Research Center, Region Skåne, Lund, Sweden.,Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Gunnar Edman
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institute, Stockholm, Sweden.,Research and Development, Norrtälje Hospital, Tiohundra AB, Norrtälje, Sweden
| | - Fiona Gaughran
- Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.,South London and Maudsley NHS Foundation Trust, London, UK
| | - Erik Jedenius
- Department of Clinical Sciences Lund, Severe Mental Illness Research Unit, Lund University, Psychiatry Research Center, Region Skåne, Lund, Sweden
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Wasserman D, Herrman H, Javed A, Ng RM, Falkai P, Samochowiec J, Eberhard J, Sartorius N. WPA's humanitarian actions for Ukrainian psychiatrists and psychiatric patients. World Psychiatry 2023; 22:166-167. [PMID: 36640402 PMCID: PMC9840494 DOI: 10.1002/wps.21050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/08/2022] [Indexed: 01/15/2023] Open
Affiliation(s)
| | - Helen Herrman
- WPA Past President,University of MelbourneMelbourneVICAustralia
| | - Afzal Javed
- WPA President,Pakistan Psychiatry Research Centre, Fountain HouseLahorePakistan
| | - Roger M.K. Ng
- WPA Interim Secretary General,Department of PsychiatryCentral South UniversityHunanChina
| | - Peter Falkai
- EPA President,Max Planck Institute of PsychiatryMunichGermany
| | - Jerzy Samochowiec
- Chair, EPA Council of National Psychiatric Associations,Pomeranian Medical UniversitySzczecinPoland
| | - Jonas Eberhard
- Division of Psychiatry, Department of Clinical SciencesLund UniversityLundSweden
| | - Norman Sartorius
- Association for the Improvement of Mental Health ProgrammesGenevaSwitzerland
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Baruth JM, Lapid MI, Clarke B, Shin AY, Atkinson EJ, Eberhard J, Zavatta G, Åstrand J. Distal radius fractures and risk of incident neurocognitive disorders in older adults: a retrospective cohort study. Osteoporos Int 2022; 33:2307-2314. [PMID: 35835861 DOI: 10.1007/s00198-022-06497-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Accepted: 07/05/2022] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Distal radius fractures (DRF) are associated with increased risk of subsequent fractures and physical decline in older adults. This study aims to evaluate the risk cognitive decline following DRF and potential for timely screening and intervention. METHODS A cohort of 1046 individuals 50-75 years of age with DRF were identified between 1995 and 2015 (81.5% female; mean age 62.5 [± 7.1] years). A control group (N = 1044) without history of DRF was matched by age, sex, and fracture date (i.e., index). The incidence of neurocognitive disorders (NCD) in relation to DRF/index was determined. Group comparisons were adjusted by age and comorbidity measured by the Elixhauser index. RESULTS The DRF group had a greater incidence of NCD compared to the control group (11.3% vs. 8.2%) with a 56% greater relative risk (HR = 1.56, 95% Cl: 1.18, 2.07; p = 0.002) after adjusting for age and comorbidity. For every 10-year age increase, the DRF group was over three times more likely to develop a NCD (HR = 3.23, 95% Cl: 2.57, 4.04; p < 0.001). CONCLUSION DRF in adults ages 50 to 75 are associated with increased risk of developing neurocognitive disorders. DRF may represent a sentinel opportunity for cognitive screening and early intervention. Distal radius fractures (DRF) have been associated with greater risk of future fractures and physical decline. This study reports that DRF are also associated with greater risk of developing neurocognitive disorders in older adults. Timely intervention may improve early recognition and long-term outcomes for older adults at risk of cognitive decline.
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Affiliation(s)
- Joshua M Baruth
- Dept. of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
| | - Maria I Lapid
- Dept. of Psychiatry and Psychology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA
| | - Bart Clarke
- Dept. of Endocrinology, Mayo Clinic, Rochester, MN, USA
| | | | | | - Jonas Eberhard
- Dept. of Clinical Sciences, Lund University, Lund, Sweden
| | - Guido Zavatta
- Dept. of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
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El Mrayyan N, Bökberg C, Eberhard J, Ahlström G. Community-Based Support and Social Services and Their Association with Frailty Factors in Older People with Intellectual Disability and Affective and Anxiety Disorders: A Swedish National Population-Based Register Study. Community Ment Health J 2022; 58:1000-1013. [PMID: 34750683 PMCID: PMC9187569 DOI: 10.1007/s10597-021-00909-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 10/29/2021] [Indexed: 11/28/2022]
Abstract
Affective and anxiety diagnoses are common in older people with intellectual disability (ID). The aim was to describe support and social services for older people with ID and affective and/or anxiety diagnoses, also to investigate in this study group the association between support and social services and frailty factors in terms of specialist healthcare utilisation, multimorbidity, polypharmacy, level of ID and behavioural impairment. Data was selected from four population-based Swedish national registries, on 871 identified persons with affective and/or anxiety diagnoses and ID. Multivariate regression analysis was used to investigate associations between frailty factors during 2002-2012 and social services in 2012. People with multimorbidity who frequently utilised specialist healthcare were less likely to utilise residential arrangements. Those with polypharmacy were more likely utilise residential arrangements, and receive personal contact. People with moderate, severe/profound levels of ID were more likely to utilise residential arrangements and to pursue daily activities.
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Affiliation(s)
- Nadia El Mrayyan
- Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 157, 22100, Lund, Sweden
| | - Christina Bökberg
- Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 157, 22100, Lund, Sweden
| | - Jonas Eberhard
- Division of Psychiatry, Clinical Psychosis Research Unit, Region Skane and Affiliated to Department of Clinical Sciences, Lund University, 25187, Helsingborg, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 157, 22100, Lund, Sweden.
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Strawbridge R, McCrone P, Ulrichsen A, Zahn R, Eberhard J, Wasserman D, Brambilla P, Schiena G, Hegerl U, Balazs J, Caldas de Almeida J, Antunes A, Baltzis S, Carli V, Quoidbach V, Boyer P, Young AH. Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study. Eur Psychiatry 2022; 65:1-21. [PMID: 35703080 PMCID: PMC9280921 DOI: 10.1192/j.eurpsy.2022.28] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 05/19/2022] [Accepted: 05/19/2022] [Indexed: 11/23/2022] Open
Abstract
Background Despite well-established guidelines for managing major depressive disorder, its extensive disability burden persists. This Value of Treatment mission from the European Brain Council aimed to elucidate the nature and extent of “gaps” between best-practice and current-practice care, specifically to:Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model and Recommend policies intending to better meet patient needs (i.e., minimize treatment gaps). Methods After agreement upon a set of relevant treatment gaps, data pertaining to each gap were gathered and synthesized from several sources across six European countries. Subsequently, a modified Delphi approach was undertaken to attain consensus among an expert panel on proposed recommendations for minimizing treatment gaps. Results Four recommendations were made to increase the depression diagnosis rate (from ~50% episodes), aiming to both increase the number of patients seeking help, and the likelihood of a practitioner to correctly detect depression. These should reduce time to treatment (from ~1 to ~8 years after illness onset) and increase rates of treatment; nine further recommendations aimed to increase rates of treatment (from ~25 to ~50% of patients currently treated), mainly focused on targeting the best treatment to each patient. To improve follow-up after treatment initiation (from ~30 to ~65% followed up within 3 months), seven recommendations focused on increasing continuity of care. For those not responding, 10 recommendations focused on ensuring access to more specialist care (currently at rates of ~5–25% of patients). Conclusions The treatment gaps in depression care are substantial and concerning, from the proportion of people not entering care pathways to those stagnating in primary care with impairing and persistent illness. A wide range of recommendations can be made to enhance care throughout the pathway.
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Affiliation(s)
- Rebecca Strawbridge
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Paul McCrone
- Centre for Mental Health, University of Greenwich, London, United Kingdom
| | - Andrea Ulrichsen
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Roland Zahn
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
| | - Jonas Eberhard
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Danuta Wasserman
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | - Paolo Brambilla
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
- Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
| | - Giandomenico Schiena
- Department of Neurosciences and Mental Health, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Ulrich Hegerl
- Department of Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt, Germany
| | - Judit Balazs
- Institute of Psychology, Eötvös Loránd University, Budapest, Hungary
- Department of Psychology, Bjørknes University College, Oslo, Norway
| | - Jose Caldas de Almeida
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Ana Antunes
- Chronic Diseases Research Center, Nova Medical School, Nova University of Lisbon, Lisbon, Portugal
| | - Spyridon Baltzis
- Division of Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Vladmir Carli
- National Centre for Suicide Research and Prevention of Mental Ill-Health, Karolinska Institutet, Stockholm, Sweden
| | | | | | - Allan H. Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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12
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El Mrayyan N, Bökberg C, Eberhard J, Ahlström G. Healthcare utilisation patterns among older people with intellectual disability and with affective and anxiety diagnoses in comparison with the general population. Aging Ment Health 2021; 25:1525-1534. [PMID: 32208744 DOI: 10.1080/13607863.2020.1742657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
OBJECTIVES This study investigates specialist healthcare visits of older people with intellectual disability ID having affective and anxiety diagnoses in comparison with the general population, as well as across different levels of ID, behavioural impairment, and living in special housing in Sweden. METHOD The study is a retrospective national-register-based study from 2002-2012 of people with ID 55 years and older (n = 7936) and a control group the same size matched by birth year and sex from the general population at the end of study. The study groups comprised those with affective (n = 918) and anxiety (n = 825) diagnoses who visited specialist healthcare, including data about living in special housing at the end of study in 2012. RESULTS Older people with ID and with affective and anxiety diagnoses have a higher risk of inpatient and unplanned visits to psychiatric and somatic healthcare than the general population. The average length of stay in inpatient psychiatric healthcare was higher in older people with ID and anxiety diagnoses than in the general population. Within the ID group, more inpatient and unplanned visits were made by those with moderate and severe levels of ID, behavioural impairment, and living in special housing. CONCLUSION Older people with ID and affective and anxiety diagnoses are more likely to have inpatient and unplanned visits for specialist healthcare than the general population. Future research should explore the quality of healthcare services delivered by healthcare providers to older people with ID and with affective and anxiety diagnoses.
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Affiliation(s)
- Nadia El Mrayyan
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Christina Bökberg
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
| | - Jonas Eberhard
- Division of Psychiatry, Clinical Psychosis Research Unit, Region Skane and Affiliated to Department of Clinical Sciences, Lund University, Helsingborg, Sweden
| | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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13
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Wernicke K, Grischke J, Stiesch M, Zeissler S, Krüger K, Bauer P, Hillebrecht A, Eberhard J. Influence of physical activity on periodontal health in patients with type 2 diabetes mellitus. A blinded, randomized, controlled trial. Clin Oral Investig 2021; 25:6101-6107. [PMID: 33796948 PMCID: PMC8531088 DOI: 10.1007/s00784-021-03908-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Accepted: 03/23/2021] [Indexed: 11/30/2022]
Abstract
Objectives The aim was to investigate the effect of physical activity on periodontal health and HbA1c levels in patients with type 2 diabetes mellitus (T2DM) over a period of 6 months. Materials and methods Thirty-seven patients with non-insulin-dependent T2DM were included in the study. The intervention group (n=20) performed physical activity over a period of 6 months. The control group (n=17) did not receive any intervention. Baseline and final examinations included dental parameters and concentrations of glycosylated hemoglobin (HbA1c) and high-sensitivity C-reactive protein (hsCRP). Results Physical activity showed a positive effect on periodontal health. Both the BOP (p= 0.005) and the severity of periodontitis (p= 0.001) were significantly reduced in the intervention group compared to the control group. Furthermore, HbA1c levels were reduced (p= 0.010) significantly in the intervention group while hsCRP levels significantly increased in the control group (p= 0.04). Conclusions Within the limitations of this randomized, controlled trial, physical activity over a period of 6 months is a health-promoting measure for patients with T2DM and improves both periodontal health and HbA1c concentrations.
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Affiliation(s)
- K Wernicke
- Hannover Medical School, Hanover, Germany
| | - J Grischke
- Hannover Medical School, Hanover, Germany. .,Department of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Carl-Neuberg-Str.1, 30625, Hannover, Germany.
| | - M Stiesch
- Hannover Medical School, Hanover, Germany
| | | | - K Krüger
- Justus-Liebig-Universität Gießen, Gießen, Germany
| | - P Bauer
- Justus-Liebig-Universität Gießen, Gießen, Germany
| | | | - J Eberhard
- The University of Sydney School of Dentistry and the Charles Perkins Centre, Faculty of Health and Medicine, The University of Sydney, Sydney, Australia
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14
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Siesing C, Larsson A, Petersson A, Nodin B, Sorbye H, Aasebo K, Qvortrup C, Pfeiffer P, Pontén F, Glimelius B, Eberhard J, Jirström K, Karnevi E. 485P Link between PODXL and the EGFR axis in metastatic colorectal cancer and in vitro: Implications for improved treatment stratification. Ann Oncol 2020. [DOI: 10.1016/j.annonc.2020.08.596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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15
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Iliachenko EK, Ragazan DC, Eberhard J, Berge J. Suicide mortality after discharge from inpatient care for bipolar disorder: A 14-year Swedish national registry study. J Psychiatr Res 2020; 127:20-27. [PMID: 32450359 DOI: 10.1016/j.jpsychires.2020.05.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 05/08/2020] [Accepted: 05/10/2020] [Indexed: 10/24/2022]
Abstract
Bipolar disorder has long been associated with increased risks for suicidality; though factors associated with dying by suicide remain obscure. Here, we retrospectively examine the associations between the different phases of bipolar illness and other common comorbidities with death by suicide in the 120 days following each discharge for Swedes first admitted as inpatients for bipolar disorder during the years 2000-2014. Data on admissions and suicide deaths were extracted from the Swedish National Patient Register and the Cause of Death Register, respectively. ICD-10 diagnostic codes were used to define the phases: depressive, manic, mixed, and other; and the comorbidities: specific substance use disorders, attention deficit hyperactivity disorder, and personality disorders. Extended Cox regressions were employed to model the time to death by suicide as a function of the bipolar phases, comorbidities, and other important control variables. Our analysis included 60,643 admissions by 22,402 patients over an observation time of 15,187 person-years. Overall, 213 (35.7%) of all suicides occurred within 120 days of discharge. Upon adjustment and compared to the depressive phases, manic phases were significantly associated with a far lower hazard of dying by suicide (HR 0.34, 95% CI: 0.21-0.56, p < 0.001), though mixed phases were not (HR 0.92, 95% CI: 0.48-1.73, p = 0.957). With regard to comorbidity, only sedative use disorder remained significantly associated with dying by suicide upon adjustment (HR 2.08, 95% CI: 1.41-3.06, p = 0.001). Vigilant monitoring of patients post discharge and of prescription practices are recommended.
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Affiliation(s)
- Elena K Iliachenko
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden
| | - Dragos C Ragazan
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden
| | - Jonas Eberhard
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden; Region Skåne, Adult Psychiatry Clinic Helsingborg, Helsingborg, Sweden
| | - Jonas Berge
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Division of Psychiatry, Lund, Sweden; Region Skåne, Adult Psychiatry Clinic Malmö, Addiction Centre Malmö, Malmö, Sweden.
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16
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Eberhard J, Wess G. The prevalence of atrial premature complexes in healthy Doberman Pinschers and their role in the diagnosis of occult dilated cardiomyopathy. Vet J 2020; 259-260:105475. [PMID: 32553239 DOI: 10.1016/j.tvjl.2020.105475] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Revised: 05/25/2020] [Accepted: 05/26/2020] [Indexed: 11/28/2022]
Abstract
The importance of atrial premature complexes (APCs) as a possible marker of occult dilated cardiomyopathy (DCM) in Doberman Pinschers (DP) is unknown. The aim of this study was to identify APC in healthy DP and to investigate their role as early markers of occult DCM. Holter-ECG results from 561 examinations of 153 DP at different time points were retrospectively evaluated, with special emphasis on APCs. Holter results from 110 healthy control DPs were compared to the last normal Holter and echocardiographic examinations in 43 DP that subsequently developed DCM within 15 months (DCM group), and to the first examination in the DCM group that contained ventricular premature complexes (VPC). There were no significant differences in the number of APCs or the coupling interval between the control group and the last normal examination in the DCM group (P > 0.05). The number of APCs increased slightly at the first abnormal examination in the DCM group. Healthy male DP had more APCs than females (P = 0.009) and older dogs had APCs more frequently than younger dogs (P < 0.001). About 85% of healthy DP with at least one APC/24 h had <20 APCs/24 h. Extracardiac diseases, especially gastrointestinal diseases influenced the occurrence of APCs (P = 0.037 and P = 0.006, respectively). APCs were present without obvious cardiac disease and were not a marker for the development of DCM, as they were not identified until after VPCs were present.
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Affiliation(s)
- J Eberhard
- Clinic of Small Animal Medicine, LMU University, Veterinärstrasse 13, 80539 Munich, Germany
| | - G Wess
- Clinic of Small Animal Medicine, LMU University, Veterinärstrasse 13, 80539 Munich, Germany.
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17
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Theleritis C, Bonaccorso S, Habib N, Stahl D, Gaughran F, Vitoratou S, Atakan Z, Kolliakou A, Gardner Sood P, Dazzan P, Marques T, McGuire P, Greenwood K, Eberhard J, Breedvelt J, Ferracuti S, Di Forti M, Murray R, Smith S. Sexual dysfunction and central obesity in patients with first episode psychosis. Eur Psychiatry 2020; 42:1-7. [DOI: 10.1016/j.eurpsy.2016.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Revised: 10/14/2016] [Accepted: 11/13/2016] [Indexed: 12/18/2022] Open
Abstract
AbstractBackgroundIn recent years the association between sexual dysfunction (SD) and obesity in the general population has drawn major attention. Although sexual dysfunction is common in psychosis, its relationship with weight gain and obesity remains unclear.AimsTo investigate the association between sexual dysfunction and obesity in a cohort of patients with first episode psychosis.MethodSexual function was assessed in a cohort of patients with first episode psychosis using the Sexual Function Questionnaire (SFQ). Anthropometric measures, including weight, BMI, waist, waist–hip ratio were investigated. Additionally, leptin and testosterone were investigated in male patients.ResultsA total of 116 patients (61 males and 55 females) were included. Of these 59% of males and 67.3% of females showed sexual dysfunction (SD) according to the SFQ. In males, higher SFQ scores were significantly correlated with higher BMI (Std. β = 0.36, P = 0.01), higher leptin levels (Std. β = 0.34, P = 0.02), higher waist–hip ratio (Std. β = 0.32, P = 0.04) and lower testosterone levels (Std. β = −0.44, P = 0.002). In contrast, in females, SFQ scores were not associated with any of these factors.ConclusionsWhile sexual dysfunction is present in both female and male patients with their first episode of psychosis, only in males is sexual dysfunction associated with increased BMI and waist–hip ratio. The association between SD, BMI, low levels of testosterone and high levels of leptin suggest that policies that lead to healthier diets and more active lifestyles can be beneficial at least, to male patients.
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18
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Ragazan DC, Eberhard J, Berge J. Sex-Specific Associations Between Bipolar Disorder Pharmacological Maintenance Therapies and Inpatient Rehospitalizations: A 9-Year Swedish National Registry Study. Front Psychiatry 2020; 11:598946. [PMID: 33262715 PMCID: PMC7688467 DOI: 10.3389/fpsyt.2020.598946] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 10/12/2020] [Indexed: 12/11/2022] Open
Abstract
Background: Long-term pharmacological maintenance therapy is often essential among people with bipolar disorder to reduce the need for inpatient care. Sex-specific responses to maintenance therapies are expected but remain largely unknown. Here, we examined for sex-specific associations between common maintenance therapies for bipolar disorder with inpatient rehospitalizations following patients' index discharges during 2006-2014. Methods: Population-based data on maintenance therapies and rehospitalizations were extracted from Swedish national registries. We adopted the within-individual design to compare the time on- vs. off- maintenance therapy for males and females, respectively. Extended stratified Cox proportional hazards regression models were employed to quantify the rate of rehospitalization as a function of common maintenance drugs and other important time-varying control variables. Results: Our primary analysis included 22,681 bipolar disorder rehospitalizations by 6,400 males and 9,588 (60.0%) females over an observation time of 62,813 person-years. The time spent on- vs. off- maintenance lithium, lamotrigine, quetiapine, or olanzapine was statistically significant upon adjustment among either sex for reducing the rate of bipolar rehospitalizations. Adjusted sex-specific statistically significant associations were also observed. Among females, the time on- (vs. off-) long-acting injectable risperidone reduced the rate of bipolar rehospitalizations by 73% (56-84%), carbamazepine by 44% (18-62%), aripiprazole by 29% (13-42%), and valproate by 23% (11-33%); whereas among males, ziprasidone by 65% (41-79%). Conclusion: The effectiveness of most maintenance therapies is generally comparable and uniform among both males and females. Despite some statistically significant sex-specific associations, estimates for each drug were fairly consistent between sexes.
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Affiliation(s)
- Dragos C Ragazan
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Vancouver Coastal Health Authority, University of British Columbia Hospital Detwiller Pavilion, Vancouver, BC, Canada
| | - Jonas Eberhard
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Region Skåne, Adult Psychiatry Clinic Helsingborg, Helsingborg, Sweden
| | - Jonas Berge
- Division of Psychiatry, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.,Region Skåne, Adult Psychiatry Clinic Malmö, Addiction Centre Malmö, Malmö, Sweden
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19
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Eberhard J, Angin M, Passaes C, Salgado M, Díez Martín J, Nijhuis M, Wensing A, Martinez-Picado J, Schulze Zur Wiesch J, Sáez-Cirión A. The IciStem consortium: T-cell immunology in HIV-1 infected individuals after allogeneic stem cell transplantation. J Virus Erad 2019. [DOI: 10.1016/s2055-6640(20)30156-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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20
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Eriksson SVEN, Eberhard J, Osby U, Westman J, Forslund L, Wallen J. P2547Statin and glucose-lowering treatment in individuals with and without schizophrenia. Eur Heart J 2019. [DOI: 10.1093/eurheartj/ehz748.0875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
We have recently shown that Cardiovascular (CV) mortality is surprisingly high in patients with schizophrenia in Sweden. Diabetes is 2–3 times more common in patients with schizophrenia. Treatment with Metformin have consistently shown effective to lower CV mortality in patients with diabetes. In addition, recent studies have shown that treatment with Metformin reduces weight and improves lipids even in patients with schizophrenia without diabetes. One reason for the high CV mortality in Swedish patients with schizophrenia may be lack of risk factor treatment, such as glucose-lowering treatment and/or lipid lowering treatment with statins.
Objective
To determine the prevalence of treatment with glucose-lowering treatment and statins in patients with and without schizophrenia in Stockholm, Sweden.
Material and methods
Cross-sectional study based on individual-level patient data from the Stockholm regional health-care data warehouse. 6 347 patients with a diagnosis of schizophrenia (International Classification of Diseases, Tenth Revision code F 20.X) were compared with 2 062 112 without schizophrenia from Stockholm County. The prescription of Metformin and insulin were compared in 5-year age groups from 30 to 85 years of age. In addition, the prescription of statins (any statin) were also compared in the same population.
Results
The prescription of metformin in age groups under 60 years were approximately 2 to 8 times more common in patients with schizophrenia, in patients over 60 the corresponding figures were 0.7 to 3 times. The prescription of statin in age groups under 60 were approximately 0.8–3 times more common in patients with schizophrenia. In contrast, in patients over 60 years statins were less often prescribed in patients with schizophrenia compared to controls.
Figure 1
Conclusions
Our results indicate that lack of treatment with metformin may not be a reason for the increase cardiovascular mortality in patients with schizophrenia. However, the surprisingly low prescription of statins in older (>60 years) patients with schizophrenia might explain the high CV mortality in this patient group.
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Affiliation(s)
- S V E N Eriksson
- Karolinska Institute, Center for Molecular Karolinska Institutet, Stockholm, Sweden, Stockholm, Sweden
| | - J Eberhard
- Lunds University, Division of Psychiatry, Lund, Sweden
| | - U Osby
- Karolinska Institute, Center for Molecular Karolinska Institutet, Stockholm, Sweden, Stockholm, Sweden
| | - J Westman
- Karolinska Institute, Center for Molecular Karolinska Institutet, Stockholm, Sweden, Stockholm, Sweden
| | - L Forslund
- Karolinska Institute, Clinical Pharmacology, Stockholm, Sweden
| | - J Wallen
- Karolinska Institute, Center for Molecular Karolinska Institutet, Stockholm, Sweden, Stockholm, Sweden
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21
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Borg D, Sundberg J, Brun E, Kjellén E, Petersson K, Hermansson M, Johansson J, Eberhard J, Johnsson A. PALAESTRA: A phase II trial with short-course radiotherapy followed by chemotherapy as palliative treatment in esophageal adenocarcinoma. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz247.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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22
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Falk P, Severin M, Guren MG, Österlund P, Hofsli E, Giwercman A, Eberhard J, Sorbye H. Sex hormones and sperm parameters after adjuvant oxaliplatin-based treatment for colorectal cancer. Ann Oncol 2019. [DOI: 10.1093/annonc/mdz246.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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23
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Ragazan DC, Eberhard J, Ösby U, Berge J. Gender influence on the bipolar disorder inpatient length of stay in Sweden, 2005-2014: A register-based study. J Affect Disord 2019; 256:183-191. [PMID: 31177046 DOI: 10.1016/j.jad.2019.05.052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/03/2019] [Accepted: 05/27/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND The influence of gender on bipolar disorder is controversial and it is unclear if inpatient care differs between men and women. Here, we investigate for gender differences in the inpatient length of stay for Swedes admitted for bipolar disorder and explore other factors that could explain any observed association. METHODS Admission data were extracted from the Swedish National Patient Register and included all patients first admitted to a psychiatric inpatient unit with a bipolar disorder diagnosis, circa 2005-2014. Patients were then retrospectively followed for subsequent hospitalizations. Diagnostic subtypes were categorized by ICD-10 clusters: depressive, depressive with psychotic features, manic, manic with psychotic features, mixed, and other. Psychotropic therapies preceding the corresponding admissions were attained from the Prescribed Drug Register. Mixed-effects zero-truncated negative binomial regressions were employed to model the length of stay per admission. RESULTS Analysis included 39,653 admissions by 16,271 inpatients (60.0% women). Overall, when compared to men, women spent 7.5% (95% CI: 4.2-11.0%, p < 0.001) extra days hospitalized per admission. However, upon adjusting for candidate confounders, including the bipolar subtype, and selected comorbidities and psychotropics, the association weakened wherein women then spent 3.7% (95% CI: 0.1-6.9%, p = 0.028) extra days hospitalized per admission. LIMITATIONS The integrity of register data can be variable and the adherence to outpatient dispensed psychotropics could not be validated. CONCLUSION Although the influence of gender on the bipolar disorder inpatient length of stay is evident, other factors attenuate and better explain this crude observation.
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Affiliation(s)
- Dragos C Ragazan
- Lund University, Dept. of Clinical Sciences Lund, Division of Psychiatry, Baravägen 1, Psykiatriska kliniken, Lund, Sweden.
| | - Jonas Eberhard
- Lund University, Dept. of Clinical Sciences Lund, Division of Psychiatry, Baravägen 1, Psykiatriska kliniken, Lund, Sweden
| | - Urban Ösby
- Karolinska Institutet, Dept. of Clinical Neuroscience, Stockholm, Sweden
| | - Jonas Berge
- Lund University, Dept. of Clinical Sciences Lund, Division of Psychiatry, Baravägen 1, Psykiatriska kliniken, Lund, Sweden
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Axmon A, El Mrayyan N, Eberhard J, Ahlström G. Pharmacotherapy for mood and anxiety disorders in older people with intellectual disability in comparison with the general population. BMC Psychiatry 2019; 19:238. [PMID: 31370823 PMCID: PMC6676521 DOI: 10.1186/s12888-019-2191-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2018] [Accepted: 06/23/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND People with intellectual disability (ID) have high prevalence of psychiatric disorders, but even higher rates of prescription of psychotropic drugs. METHODS Using Swedish national registers, we identified a group of older people with ID and diagnosis of mood disorders (ICD-10 codes F32-F39) and/or anxiety (ICD-10 code F4) during 2006-2012 (n = 587) and a referent group of people from the general population with the same diagnoses during the same time period (n = 434). For both groups, we collected information on prescription of anxiolytics, hypnotics and sedatives, antidepressants, and GABA-agonists. RESULTS Among those with a diagnosis of anxiety, people with ID were more likely than those in the general population to be prescribed anxiolytics (Relative Risk 1.32 [95% Confidence Interval 1.19-1.46]) and GABA-agonists (1.10 [1.08-1.31]). Moreover, among those with anxiety but without mood disorders, ID was associated with increased prescription of antidepressants (1.20 [1.03-1.39]). Within the ID cohort, behaviour impairment and MSP (i.e. moderate, severe, or profound) ID was associated with increased prescription of anxiolytics, both among those with anxiety (1.15 [1.03-1.30] for behaviour impairment and 1.23 [1.10-1.38] for MSP ID) and among those with mood disorders (1.14 [0.97-1.35] for behaviour impairment and 1.26 [1.04-1.52] for MSP ID). Moreover, MSP ID was associated with increased prescription of GABA-agonists among those with anxiety (1.23 [1.10-1.38]). CONCLUSIONS The excess prescription of anxiolytics but not antidepressants may suggest shortages in the psychiatric health care of older people with intellectual disability and mood and anxiety disorders.
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Affiliation(s)
- Anna Axmon
- EPI@LUND, Division of Occupational and Environmental Medicine, Department of Laboratory Medicine, Lund University, SE-221 00, Lund, Sweden.
| | - Nadia El Mrayyan
- 0000 0001 0930 2361grid.4514.4Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 00 Lund, Sweden
| | - Jonas Eberhard
- 0000 0001 0930 2361grid.4514.4Division of Psychiatry, Department of Clinical Sciences Lund, Lund University, SE-25187 Helsingborg, Sweden
| | - Gerd Ahlström
- 0000 0001 0930 2361grid.4514.4Department of Health Sciences, Faculty of Medicine, Lund University, SE-221 00 Lund, Sweden
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25
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Maron E, Baldwin DS, Balõtšev R, Fabbri C, Gaur V, Hidalgo-Mazzei D, Hood S, Juhola M, Kampman O, Kasper S, Kärkkäinen H, Látalová K, Lähteenvuo M, Mastellos N, McTigue J, Metsallik J, Metspalu A, Nutt D, Nykänen P, Olisa N, Pogarell O, Popovic D, Antoni Ramos-Quiroga J, Ross P, Serretti A, Spies M, Thibaut F, Tiainen K, Tiihonen J, Vieta E, Võhma Ü, Van Westrhenen R, Zubanovic B, Eberhard J. Manifesto for an international digital mental health network. ACTA ACUST UNITED AC 2019. [DOI: 10.1080/2575517x.2019.1617575] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Eduard Maron
- Department of Psychiatry, University of Tartu, Tartu, Estonia
- Faculty of Medicine, Department of Medicine, Centre for Neuropsychopharmacology, Division of Brain Sciences, Imperial College London, London, UK
- Department of Psychiatry, North Estonia Medical Centre, Tallinn, Estonia
- Documental Ltd, Tallinn, Estonia
| | - David S. Baldwin
- Department of Clinical and Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
- Southern Health NHS Foundation Trust, College Keep, Southampton, UK
| | - Roman Balõtšev
- Department of Psychiatry, University of Tartu, Tartu, Estonia
| | - Chiara Fabbri
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | - Vikas Gaur
- Health Informatics & Telemedicine Department, Mahatma Gandhi University of Medical Sciences Technology, Jaipur, India
| | - Diego Hidalgo-Mazzei
- Centre for Affective Disorders, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- Bipolar Disorders Programme, Department of Psychiatry and Psychology, Institute of Neurosciences, Hospital Clinic de Barcelona, CIBERSAM, IDIBAPS, Barcelona, Spain
| | - Sean Hood
- Division of Psychiatry, Faculty of Health & Medical Sciences, The University of Western Australia, Perth, Australia
| | - Martti Juhola
- Faculty of Information Technology and Communication Sciences, Tampere University, Tampere, Finland
| | - Olli Kampman
- School of Medicine, Tampere University, Tampere, Finland
- Department of Psychiatry, Seinäjoki Hospital District, Seinäjoki, Finland
| | - Siegfried Kasper
- Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria
| | | | - Klára Látalová
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc, The Czech Republic
| | - Markku Lähteenvuo
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
| | - Nikolas Mastellos
- Centre for Population Health Sciences, Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
| | - Joseph McTigue
- Medical School, The University of Western Australia, Perth, Australia
| | - Janek Metsallik
- School of Information Technologies, Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Andres Metspalu
- Estonian Genome Center, Institute of Genomics, University of Tartu, Tartu, Estonia
| | - David Nutt
- Department of Psychiatry, North Estonia Medical Centre, Tallinn, Estonia
| | - Pirkko Nykänen
- School of Medicine, Tampere University, Tampere, Finland
| | - Nigel Olisa
- Department of Psychiatry, Faculty of Medicine and Dentistry, Palacky University in Olomouc, University Hospital Olomouc, Olomouc, The Czech Republic
| | - Oliver Pogarell
- Department of Psychiatry and Psychotherapy, University Hospital, LMU Munich, Germany
| | - Dina Popovic
- Department of Psychiatry, Sheba Medical Center, Tel Aviv, Israel
| | - Josep Antoni Ramos-Quiroga
- Department of Psychiatry, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Biomedical Network Research Centre on Mental Health (CIBERSAM), Instituto de Salud Carlos III, Barcelona, Spain
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Peeter Ross
- School of Information Technologies, Department of Health Technologies, Tallinn University of Technology, Tallinn, Estonia
| | - Alessandro Serretti
- Department of Biomedical and NeuroMotor Sciences, University of Bologna, Bologna, Italy
| | | | - Florence Thibaut
- University Hospital Cochin, Faculty of Medicine Paris Descartes, Centre Psychiatry and Neurosciences, Paris, France
| | - Kimmo Tiainen
- Department of Psychiatry, Seinäjoki Hospital District, Seinäjoki, Finland
| | - Jari Tiihonen
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Eduard Vieta
- Division of Psychiatry, Faculty of Health & Medical Sciences, The University of Western Australia, Perth, Australia
| | - Ülle Võhma
- Department of Psychiatry, North Estonia Medical Centre, Tallinn, Estonia
| | - Roos Van Westrhenen
- Outpatient Clinic Pharmacogenetics, Parnassia Psychiatric Institute, Amsterdam, The Netherlands
- Dept. Of Psychiatry & Neuropsychology, Faculty of Health Sciences, Maastricht University, Maastricht, The Netherlands
| | - Belmin Zubanovic
- Department of Clinical Sciences, Division of Psychiatry, Lund University, Helsingborg, Sweden
| | - Jonas Eberhard
- Department of Clinical Sciences, Division of Psychiatry, Lund University, Helsingborg, Sweden
- Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
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El Mrayyan N, Eberhard J, Ahlström G. The occurrence of comorbidities with affective and anxiety disorders among older people with intellectual disability compared with the general population: a register study. BMC Psychiatry 2019; 19:166. [PMID: 31159756 PMCID: PMC6547488 DOI: 10.1186/s12888-019-2151-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 05/20/2019] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Little is known regarding the burden of comorbidities among older people with intellectual disability (ID) who have affective and anxiety disorders. Therefore, we aimed to investigate the occurrence and risk of psychiatric and somatic comorbidities with affective and/or anxiety disorders in older people with ID compared to the general population. METHODS This population study was based on three Swedish national registers over 11 years (2002-2012). The ID group was identified in the LSS register, which comprises of data on measures in accordance with the Act Concerning Support and Service for Persons with Certain Functional Impairments (n = 7936), and a same-sized reference cohort from the Total Population Register was matched by sex and year of birth. The study groups consisted of those with affective (n = 918) and anxiety (n = 825) disorder diagnoses. The information about diagnoses were collected from the National Patient Register based on ICD-10 codes. RESULTS The rate of psychiatric comorbidities with affective and anxiety disorders was approximately 11 times higher for people with ID compared to the general reference group. The two most common psychiatric comorbidities occurred with affective and anxiety disorders were Unspecified non-organic psychosis and Other mental disorders due to brain damage and dysfunction and to physical disease (8% for each with affective disorders and 7 and 6% with anxiety disorders, respectively). In contrast, somatic comorbidity comparisons showed that the general reference group was 20% less likely than the ID cohort to have comorbid somatic diagnoses. The most commonly occurring somatic comorbidities were Injury, poisoning and certain other consequences of external causes (49 and 47% with affective and anxiety disorders, respectively) and Signs and symptoms and abnormal clinical and laboratory findings not elsewhere classified (44 and 50% with affective and anxiety disorders, respectively). CONCLUSION Older people with ID and with affective and anxiety diagnoses are more likely to be diagnosed with psychiatric comorbidities that are unspecified, which reflects the difficulty of diagnosis, and there is a need for further research to understand this vulnerable group. The low occurrence rate of somatic diagnoses may be a result of those conditions being overshadowed by the high degree of psychiatric comorbidities.
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Affiliation(s)
- Nadia El Mrayyan
- Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 157, SE-22100, Lund, Sweden.
| | - Jonas Eberhard
- 0000 0001 0930 2361grid.4514.4Division of Psychiatry, Clinical Psychosis Research Unit, Region Skane and Affiliated to Department of Clinical Sciences, Lund University, SE-25187 Helsingborg, Sweden
| | - Gerd Ahlström
- 0000 0001 0930 2361grid.4514.4Department of Health Sciences, Faculty of Medicine, Lund University, PO Box 157, SE-22100 Lund, Sweden
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Westman J, Eberhard J, Gaughran FP, Lundin L, Stenmark R, Edman G, Eriksson SV, Jedenius E, Rydell P, Overgaard K, Abrams D, Greenwood KE, Smith S, Ismail K, Murray R, Ösby U. Outcome of a psychosocial health promotion intervention aimed at improving physical health and reducing alcohol use in patients with schizophrenia and psychotic disorders (MINT). Schizophr Res 2019; 208:138-144. [PMID: 30979666 DOI: 10.1016/j.schres.2019.03.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 02/23/2019] [Accepted: 03/26/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Life expectancy is reduced by 19 years in men and 17 in women with psychosis in Sweden, largely due to cardiovascular disease. AIM Assess whether a psychosocial health promotion intervention improves cardiometabolic risk factors, quality of life, and severity of illness in patients with psychotic disorders more than treatment as usual. METHODS A pragmatic intervention trial testing a manual-based multi-component health promotion intervention targeting patients with psychosis. The Swedish intervention was adapted from IMPaCT therapy, a health-promotion program based on motivational interviewing and cognitive behavioral therapy, designed to be incorporated into routine care. The intervention group consisted of 119 patients and the control group of 570 patients from specialized psychosis departments. Outcome variables were assessed 6 months before intervention during the run-in period, again at the start of intervention, and 12 months after the intervention began. The control group received treatment as usual. RESULTS The intervention had no significant effect on any of the outcome variables. However, BMI, waist circumference, systolic BP, heart rate, HbA1c, general health, and Clinical Global Impressions Scale score improved significantly during the run-in period before the start of the active intervention (observer effect). The multi-component design meant that treatment effects could only be calculated for the intervention as a whole. CONCLUSION The results of the intervention are similar to those of the U.K. IMPaCT study, in which the modular health-promotion intervention had little effect on cardiovascular risk indicators. However, in the current study, the run-in period had a positive effect on cardiometabolic risk factors.
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Affiliation(s)
- Jeanette Westman
- Dept of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Academic Primary Health Care Centre, Region Stockholm, Sweden.
| | - Jonas Eberhard
- Division of Psychiatry, Dept of Clinical Sciences, Lund University, Lund, Sweden; Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Fiona P Gaughran
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Lennart Lundin
- Sahlgrenska University Hospital, Gothenburg, Sweden; Swedish Schizophrenia Fellowship, Stockholm, Sweden
| | - Richard Stenmark
- Division of Psychiatry, Dept of Clinical Sciences, Lund University, Lund, Sweden
| | - Gunnar Edman
- Norrtälje Hospital, Tiohundra AB, Norrtälje, Sweden; Dept of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden
| | - Sven V Eriksson
- Department of Internal Medicine, Enköping Hospital, Enköping, Sweden; Aleris Specialist Care, Gothenburg, Sweden
| | - Erik Jedenius
- Dept of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden; Division of Psychiatry, Dept of Clinical Sciences, Lund University, Lund, Sweden
| | - Pia Rydell
- Sahlgrenska University Hospital, Gothenburg, Sweden
| | | | | | - Kathryn E Greenwood
- School of Psychology, University of Sussex, Brighton, UK; Sussex Partnership NHS Foundation Trust, UK
| | - Shubulade Smith
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Khalida Ismail
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK
| | - Robin Murray
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, UK; South London and Maudsley NHS Foundation Trust, London, UK
| | - Urban Ösby
- Dept of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Center for Molecular Medicine, Karolinska University Hospital, Stockholm, Sweden
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Weibring K, Nord C, Ståhl O, Eberhard J, Sandberg K, Johansson H, Arver S, Giwercman A, Cohn-Cedermark G. Sperm count in Swedish clinical stage I testicular cancer patients following adjuvant treatment. Ann Oncol 2019; 30:604-611. [PMID: 30798330 DOI: 10.1093/annonc/mdz017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/08/2023] Open
Abstract
BACKGROUND Little is known regarding sperm production following adjuvant treatment in testicular cancer (TC) clinical stage I (CS I) patients. PATIENTS AND METHODS A total of 182 TC patients aged 18-50 years were prospectively included during 2001-2006 at any given time within 5 years of orchiectomy. Semen samples were delivered postorchiectomy but before further treatment, 6, 12, 24, 36 and 60 months (T0-T60) after completed therapy. Total sperm number (TSN) and sperm concentration (SC) were used as measurements of testicular function. Four groups according to treatment modality were identified; Radiotherapy; To a total dose of 25.2 Gy to the infradiaphragmal paraaortic and ipsilateral iliac lymph nodes (RT, N = 70), one cycle of adjuvant BEP (bleomycin, etoposide, cisplatin, 5 day regimen) (BEP, N = 62), one cycle of adjuvant carboplatin AUC 7 (Carbo, N = 22), and patients managed by surveillance (SURV, N = 28). RESULTS In the cross-sectional analysis, a significant but transient drop in mean TSN and mean SC (T0-T60) was seen at T6 after radiotherapy. Apart from a significant increase in mean SC at T12 compared with baseline, no significant differences were observed in the other treatment groups. In 119 patients delivering 3 or more samples, values in TSN and SC were rather stable over time. Azoospermic patients (N = 11) were observed in most treatment groups except for in the BEP group. During follow-up, one azoospermic patient belonging to the Carbo group became normospermic. CONCLUSIONS No clinically significant long-term effect on TSN or SC associated with adjuvant treatment in TC CSI patients was found. However, as patients may have low sperm counts before orchiectomy as well as after adjuvant treatment, we offer sperm banking before orchiectomy as assisted reproductive measures may be necessary regardless of treatment given.
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Affiliation(s)
- K Weibring
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm.
| | - C Nord
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Lund
| | - J Eberhard
- Department of Oncology, Skane University Hospital, Lund
| | - K Sandberg
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
| | - H Johansson
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
| | - S Arver
- Department of Medicine/Huddinge, Karolinska Institute, Stockholm; Centre for Andrology and Sexual Medicine, Karolinska University Hospital, Stockholm
| | - A Giwercman
- Department of Translational Medicine, Lund University, Malmo, Sweden
| | - G Cohn-Cedermark
- Department of Oncology-Pathology, Karolinska Institute, Stockholm; Department of Oncology, Karolinska University Hospital, Stockholm
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Berntsson J, Eberhard J, Nodin B, Larsson A, Jirstrom K. Pre-diagnostic anthropometry, sex, and risk of colorectal cancer according to tumor-infiltrating immune cell composition. Ann Oncol 2018. [DOI: 10.1093/annonc/mdy281.085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Dreyer H, Grischke J, Tiede C, Eberhard J, Schweitzer A, Toikkanen SE, Glöckner S, Krause G, Stiesch M. Epidemiology and risk factors of peri-implantitis: A systematic review. J Periodontal Res 2018; 53:657-681. [PMID: 29882313 DOI: 10.1111/jre.12562] [Citation(s) in RCA: 220] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2018] [Indexed: 12/13/2022]
Abstract
The purpose of this systematic review and meta-analysis was to assess the prevalence, incidence and risk factors of peri-implantitis in the current literature. An electronic search was performed to identify publications from January 1980 until March 2016 on 9 databases. The prevalence and incidence of peri-implantitis were assessed in different subgroups of patients and the prevalences were adjusted for sample size (SSA) of studies. For 12 of 111 identified putative risk factors and risk indicators, forest plots were created. Heterogeneity analysis and random effect meta-analysis were performed for selected potential risk factors of peri-implantitis. The search retrieved 8357 potentially relevant studies. Fifty-seven studies were included in the systematic review. Overall, the prevalence of peri-implantitis on implant level ranged from 1.1% to 85.0% and the incidence from 0.4% within 3 years, to 43.9% within 5 years, respectively. The median prevalence of peri-implantitis was 9.0% (SSA 10.9%) for regular participants of a prophylaxis program, 18.8% (SSA 8.8%) for patients without regular preventive maintenance, 11.0% (SSA 7.4%) for non-smokers, 7.0% (SSA 7.0%) among patients representing the general population, 9.6% (SSA 9.6%) for patients provided with fixed partial dentures, 14.3% (SSA 9.8%) for subjects with a history of periodontitis, 26.0% (SSA 28.8%) for patients with implant function time ≥5 years and 21.2% (SSA 38.4%) for ≥10 years. On a medium and medium-high level of evidence, smoking (effect summary OR 1.7, 95% CI 1.25-2.3), diabetes mellitus (effect summary OR 2.5; 95% CI 1.4-4.5), lack of prophylaxis and history or presence of periodontitis were identified as risk factors of peri-implantitis. There is medium-high evidence that patient's age (effect summary OR 1.0, 95% CI 0.87-1.16), gender and maxillary implants are not related to peri-implantitis. Currently, there is no convincing or low evidence available that identifies osteoporosis, absence of keratinized mucosa, implant surface characteristics or edentulism as risk factors for peri-implantitis. Based on the data analyzed in this systematic review, insufficient high-quality evidence is available to the research question. Future studies of prospective, randomized and controlled type including sufficient sample sizes are needed. The application of consistent diagnostic criteria (eg, according to the latest definition by the European Workshop on Periodontology) is particularly important. Very few studies evaluated the incidence of peri-implantitis; however, this study design may contribute to examine further the potential risk factors.
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Affiliation(s)
- H Dreyer
- Clinic of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hanover, Germany
| | - J Grischke
- Clinic of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hanover, Germany
| | - C Tiede
- Clinic of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hanover, Germany
| | - J Eberhard
- Faculty of Dentistry and the Charles Perkins Centre, University of Sydney, Sydney, NSW,, Australia
| | - A Schweitzer
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - S E Toikkanen
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany
| | - S Glöckner
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Translational Infrastructure Epidemiology, German Centre for Infection Research, Braunschweig, Germany
| | - G Krause
- Department of Epidemiology, Helmholtz Centre for Infection Research, Braunschweig, Germany.,Twincore, Centre for Experimental and Clinical Infections Research, Hanover, Germany.,Hannover Medical School, Hanover, Germany
| | - M Stiesch
- Clinic of Prosthetic Dentistry and Biomedical Materials Science, Hannover Medical School, Hanover, Germany
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Isaksson S, Bogefors K, Ståhl O, Eberhard J, Giwercman YL, Leijonhufvud I, Link K, Øra I, Romerius P, Bobjer J, Giwercman A. High risk of hypogonadism in young male cancer survivors. Clin Endocrinol (Oxf) 2018; 88:432-441. [PMID: 29245176 DOI: 10.1111/cen.13534] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2017] [Revised: 11/08/2017] [Accepted: 12/10/2017] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Cancer and its treatment in childhood and young adulthood can cause hypogonadism, leading to increased risk of long-term morbidity and mortality. The aim of this study was to evaluate the risk of presenting with biochemical signs of hypogonadism in testicular cancer survivors (TCS) and male childhood cancer survivors (CCS) in relation to the type of treatment given. DESIGN Case-control study. PATIENTS Ninety-two TCS, 125 CCS (mean age 40 and median age 34 years, respectively; mean follow-up time 9.2 and 24 years, respectively) and a corresponding number of age-matched controls. MEASUREMENTS Fasting morning blood samples were analysed for total testosterone (TT), follicle-stimulating hormone (FSH) and luteinizing hormone (LH). The odds ratios (OR) for hypogonadism, defined as primary, secondary, compensated or ongoing androgen replacement, were calculated for TCS and CCS and for subgroups defined by diagnosis and treatment. RESULTS Hypogonadism was found in 26% of CCS and 36% of TCS, respectively (OR: 2.1, P = .025 and OR = 2.3, P = .021). Among CCS, the OR was further increased in those given testicular irradiation (OR = 28, P = .004). Radiotherapy other than cranial or testicular irradiation plus chemotherapy, or cranial irradiation without chemotherapy, associated also with increased ORs (OR = 3.7, P = .013, and OR = 4.4, P = .038, respectively). Among TCS, those receiving >4 cycles of cisplatin-based chemotherapy had OR = 17, P = .015. CONCLUSIONS Biochemical signs of testosterone deficiency are recognized as markers of decreased life expectancy. Thus, the risk of hypogonadism in TCS and CCS should be recognized and emphasizes the need of long-term follow-up for these men.
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Affiliation(s)
- S Isaksson
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Oncology, Skane University Hospital, Malmö and Lund, Sweden
| | - K Bogefors
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Oncology, Skane University Hospital, Malmö and Lund, Sweden
| | - O Ståhl
- Department of Oncology, Skane University Hospital, Malmö and Lund, Sweden
| | - J Eberhard
- Department of Oncology, Skane University Hospital, Malmö and Lund, Sweden
| | - Y L Giwercman
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - I Leijonhufvud
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Reproductive Medicine Centre, Skane University Hospital, Malmö, Sweden
| | - K Link
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
| | - I Øra
- Department of Pediatrics, Pediatric Oncology, Clinical Sciences, Lund University, Lund, Sweden
| | - P Romerius
- Department of Pediatrics, Pediatric Oncology, Clinical Sciences, Lund University, Lund, Sweden
| | - J Bobjer
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Department of Urology, Skane University Hospital, Malmö, Sweden
| | - A Giwercman
- Molecular Reproductive Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Sweden
- Reproductive Medicine Centre, Skane University Hospital, Malmö, Sweden
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Gaughran F, Stahl D, Ismail K, Greenwood K, Atakan Z, Gardner-Sood P, Stubbs B, Hopkins D, Patel A, Lally J, Lowe P, Arbuthnot M, Orr D, Corlett S, Eberhard J, David AS, Murray R, Smith S. Randomised control trial of the effectiveness of an integrated psychosocial health promotion intervention aimed at improving health and reducing substance use in established psychosis (IMPaCT). BMC Psychiatry 2017; 17:413. [PMID: 29284438 PMCID: PMC5745644 DOI: 10.1186/s12888-017-1571-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Accepted: 12/05/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND People with psychosis have a reduced life expectancy of 10-20 years, largely due to cardiovascular disease. This trial aimed to determine the effectiveness of a modular health promotion intervention (IMPaCT Therapy) in improving health and reducing cardiovascular risk in psychosis. METHODS A multicentre, two arm, parallel cluster RCT was conducted across five UK mental health NHS trusts. Community care coordinators (CC) were randomly assigned to training and supervision in delivering IMPaCT Therapy or treatment as usual (TAU) to current patients with psychosis (cluster). The primary outcome was the physical and mental health subscales of the Short form-36 (SF-36) questionnaire. RESULTS Of 104 care coordinators recruited, 52 (with 213 patients) were randomised to deliver IMPaCT therapy and 52 (with 193 patients) randomised to TAU. Of 406 patients, 318 (78%) and 301 (74%) attended 12- and 15-month follow-up respectively. IMPaCT therapy showed no significant effect on the physical or mental health component SF-36 scores versus TAU at 12 or 15 months. No effect was observed for cardiovascular risk indicators, except for HDL cholesterol, which improved more with IMPACT therapy than TAU (Treatment effect (95% CI); 0.085 (0.007 to 0.16); p = 0.034). The 22% of patients who received >180 min of IMPACT Therapy in addition to usual care achieved a greater reduction in waist circumference than did controls, which was clinically significant. CONCLUSION Training and supervising community care coordinators to use IMPaCT therapy in patients with psychosis is insufficient to significantly improve physical or mental health quality of life. The search for effective, pragmatic interventions deliverable in health care services continues. TRIAL REGISTRATION The trial was retrospectively registered with ISRCTN registry on 23/4/2010 at ISRCTN58667926 ; recruitment started on 01/03/2010 with first randomization on 09.08.2010 ISRCTN58667926 .
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Affiliation(s)
- Fiona Gaughran
- National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK. .,Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK.
| | - Daniel Stahl
- 0000 0001 2322 6764grid.13097.3cBiostatistics Department, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill, London, UK
| | - Khalida Ismail
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill, London, UK
| | - Kathryn Greenwood
- 0000 0004 1936 7590grid.12082.39Sussex Partnership NHS Foundation Trust and School of Psychology, University of Sussex, Brighton, UK
| | - Zerrin Atakan
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Poonam Gardner-Sood
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Brendon Stubbs
- 0000 0001 2322 6764grid.13097.3cHealth Service and Population Research Department, Institute of Psychiatry, Kings College London, London, UK ,0000 0000 9439 0839grid.37640.36Physiotherapy Department, South London and Maudsley NHS Foundation Trust, London, UK
| | - David Hopkins
- Department of Diabetic Medicine, King’s College Hospital NHS Foundation Trust, King’s Health Partners, London, UK
| | - Anita Patel
- 0000 0001 2171 1133grid.4868.2Health Economics, Centre for Primary Care & Public Health, Blizard Institute, Queen Mary University of London, London, UK
| | - John Lally
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK ,0000 0000 9439 0839grid.37640.36National Psychosis Service, South London and Maudsley NHS Foundation Trust, London, UK
| | - Philippa Lowe
- Carer Expert and Chair of Trustees, Rethink Mental Illness, London, UK
| | | | | | - Sarah Corlett
- Interim Director of Public Health, London Borough Of Lambeth, London, UK
| | - Jonas Eberhard
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK ,0000 0001 0930 2361grid.4514.4Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Anthony S. David
- 0000 0001 2322 6764grid.13097.3cInstitute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill, London, UK
| | - Robin Murray
- 0000 0001 2322 6764grid.13097.3cDepartment of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, London, UK
| | - Shubulade Smith
- 0000 0001 2322 6764grid.13097.3cDepartment of Forensic and Neurodevelopmental Science, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, Denmark Hill, London, UK ,0000 0000 9439 0839grid.37640.36Forensic Intensive Care Service, South London and Maudsley NHS Foundation Trust, London, UK
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Suppes T, Eberhard J, Lemming O, Young AH, McIntyre RS. Anxiety, irritability, and agitation as indicators of bipolar mania with depressive symptoms: a post hoc analysis of two clinical trials. Int J Bipolar Disord 2017; 5:36. [PMID: 29105003 PMCID: PMC5673059 DOI: 10.1186/s40345-017-0103-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 09/11/2017] [Indexed: 01/14/2023] Open
Abstract
Background Symptoms of anxiety, irritability, and agitation (AIA) are prevalent among patients with bipolar I disorder (BD-I) mania with depressive symptoms, and could potentially be used to aid physicians in the identification of this more severe form of BD-I. Using data from two clinical trials, the aims of this post hoc analysis were to describe the phenomenology of bipolar mania in terms of AIA and depressive symptoms, and to evaluate the influence of these symptoms on the likelihood of remission during treatment. Methods Patients with a BD-I manic or mixed episode (Diagnostic and Statistical Manual of Mental Disorders IV criteria) were randomised to 3 weeks of double-blind treatment with asenapine, placebo, or olanzapine (active comparator). Anxiety was defined as a score of ≥3 on the Positive and Negative Syndrome Scale ‘anxiety’ item, irritability as a score of ≥4 on the Young Mania Rating Scale (YMRS) ‘irritability’ item, and agitation as a score of ≥3 on the YMRS ‘increased motor activity–energy’ item. Depressive symptoms were defined as a score of ≥1 on three or more individual Montgomery–Åsberg Depression Rating Scale (MADRS) items, or a MADRS Total score of ≥20. Results A total of 960 patients with BD-I were analysed, 665 with a manic episode and 295 with a mixed episode. At baseline, 61.4% had anxiety, 62.4% had irritability, 76.4% had agitation, and 34.0% had all three AIA symptoms (‘severe AIA’); 47.3% had three or more depressive symptoms, and 13.5% had a MADRS total score of ≥20. Anxiety, irritability, and severe AIA (but not agitation) were statistically significantly more common in patients with depressive symptoms. Patients with anxiety or severe AIA at baseline were statistically significantly less likely to achieve remission (YMRS total <12). In general, remission rates were higher with asenapine and olanzapine than with placebo, irrespective of baseline AIA or depressive symptoms. Conclusions Assessment of AIA symptoms in bipolar mania could enable physicians to identify patients with more severe depressive symptoms, allowing for appropriate intervention. Assessment and monitoring of AIA may help physicians to predict which patients may be harder to treat and at risk for self-harm. Trial registration ClinicalTrials.gov NCT00159744, NCT00159796. Registered 8 September 2005 (retrospectively registered)
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Affiliation(s)
- Trisha Suppes
- VA Palo Alto Health Care System and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, CA, USA.
| | - Jonas Eberhard
- H. Lundbeck A/S, Valby, Copenhagen, Denmark.,Department of Clinical Sciences, Lund University, Lund, Sweden.,Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | | | - Allan H Young
- Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience (IoPPN), King's College London, London, UK
| | - Roger S McIntyre
- Mood Disorders Psychopharmacology Unit, University Health Network, University of Toronto, Toronto, ON, Canada
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Svensson M, Borg D, Hedner C, Eberhard J, Nodin B, Leandersson K, Jirström K. PD-L1 expression in primary tumours and paired lymph node metastases in chemoradiotherapy-naïve esophageal and gastric adenocarcinoma: Relationship with MSI status and prognosis. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Lundgren S, Karnevi E, Elebro J, Nodin B, Eberhard J, Leandersson K, Jönsson G, Jirström K. The mutational landscape of periampullary adenocarcinomas in relation to morphological subtype and patient survival. Ann Oncol 2017. [DOI: 10.1093/annonc/mdx369.097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Eberhard J, Stumpp N, Winkel A, Schrimpf C, Bisdas T, Orzak P, Teebken OE, Haverich A, Stiesch M. Streptococcus mitis and Gemella haemolysans were simultaneously found in atherosclerotic and oral plaques of elderly without periodontitis-a pilot study. Clin Oral Investig 2016; 21:447-452. [PMID: 27037569 DOI: 10.1007/s00784-016-1811-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2015] [Accepted: 03/23/2016] [Indexed: 01/19/2023]
Abstract
OBJECTIVES Local infections may contribute to the initiation and progression of several clinical diseases in humans. Atherosclerotic plaques of subjects suffering from periodontitis are colonized by periopathogens; however, the presence of bacteria in atherosclerotic plaques in patients without severe forms of periodontitis is of high relevance for the general population. MATERIALS AND METHODS Patients who were electively treated for atherosclerotic lesions of the carotid artery and without clinical signs of periodontitis were eligible for the study. Oral and atherosclerotic plaques were sampled, processed, and analyzed for their microbial composition by 454-sequencing. RESULTS Seventeen patients were included in the analyses, and 76 % of all atherosclerotic plaque specimens were positive for bacterial DNA. In the oral plaques, 76,532 sequences were identified representing 1 phylum, 17 classes, 112 families, and 263 genera. In atherosclerotic plaques, 6112 sequences representing 1 phylum, 4 classes, 8 families, and 36 genera were found. The bacterial DNAs of the species Gemella haemolysans and Streptococcus mitis were simultaneously found in atherosclerotic as well as oral plaque samples of 3 patients. CONCLUSIONS These results indicated that in subjects without periodontitis, the transmission of oral bacteria to atherosclerotic plaques of the carotid artery is a feasible event. CLINICAL RELEVANCE The prevention of transient bacteremia from the oral cavity requires high levels of oral health.
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Affiliation(s)
- J Eberhard
- Department of Prosthetic Dentistry and Biomaterial Sciences, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,Faculty of Dentistry, The University of Sydney, Sydney, New South Wales, Australia.
| | - N Stumpp
- Department of Prosthetic Dentistry and Biomaterial Sciences, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - A Winkel
- Department of Prosthetic Dentistry and Biomaterial Sciences, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - C Schrimpf
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - T Bisdas
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - P Orzak
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - O E Teebken
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - A Haverich
- Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - M Stiesch
- Department of Prosthetic Dentistry and Biomaterial Sciences, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Mortensen GL, De J, Holme M, Neve T, Torell PG, Eberhard J. Social Aspects of the Quality of Life of Persons Suffering from Schizophrenia. ACTA ACUST UNITED AC 2016. [DOI: 10.4236/ojpsych.2016.61005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Eberhard J, Weiller E. Suicidality and symptoms of anxiety, irritability, and agitation in patients experiencing manic episodes with depressive symptoms: a naturalistic study. Neuropsychiatr Dis Treat 2016; 12:2265-71. [PMID: 27621637 PMCID: PMC5012613 DOI: 10.2147/ndt.s111094] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Patients with a bipolar I disorder (BD-I) manic episode meeting the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), criteria for "with mixed features" have a high incidence of suicide attempts and of anxiety, irritability, and agitation (AIA) symptoms. The aim of this analysis was to explore the relationship between suicidality and AIA symptoms in patients with BD-I experiencing mania with depressive symptoms, using data from a previous naturalistic study. PATIENTS AND METHODS Psychiatrists completed an online questionnaire about their adult patients who had a current BD-I manic episode. Questions covered the DSM-5 "with mixed features" specifier, the severity of AIA symptoms, the frequency and controllability of suicidal ideation, and the number of suicide attempts. RESULTS Of 1,035 patients with BD-I mania who were included in the analyses, 348 (33.6%) met the criteria for the DSM-5 "with mixed features" specifier (three or more depressive symptoms). These patients were further stratified according to the severity of their AIA symptoms: "mild AIA" (zero or one AIA symptom above a severity threshold; 105 patients) or "severe AIA" (all three AIA symptoms above a severity threshold; 167 patients). A greater incidence of suicidal ideation was observed in the severe AIA group (71.9%) than in the mild AIA group (47.6%). Twice as many patients had easily controlled suicidal ideation than difficult-to-control suicidal ideation in both subgroups. The mean number of suicide attempts was higher in the severe AIA group than in the mild AIA group, during the current episode (0.84 vs 0.34 attempts, respectively; P<0.05) and over the patient's lifetime (1.56 vs 1.04 attempts, respectively). CONCLUSION The high risk of suicide among BD-I mania patients with depressive symptoms is further increased when they experience severe AIA symptoms. Recognizing AIA symptoms in BD-I mania could provide a means of identifying patients with depressive symptoms, as well as those who may be suicidal, thereby allowing for appropriate, tailored treatment.
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Affiliation(s)
- Jonas Eberhard
- Department of Clinical Sciences, Lund University, Lund, Sweden
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Regauer S, Gamper M, Welter J, Eberhard J, Viereck V. Are Mast Cells still good Biomarkers for Bladder Pain Syndrome/Interstitial Cystitis? Geburtshilfe Frauenheilkd 2015. [DOI: 10.1055/s-0035-1555027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Hillebrecht A, Frech T, Linnenweber S, Bauer P, Hellmann S, Wyss D, Eberhard J, Krüger K, Walscheid R, Mooren FC, Zeißler S. Untersuchung der optimalen Bewegungsintervention für Pat. mit Typ2 Diabetes mellitus anhand von drei Bewegungsinterventionsstudien. DIABETOL STOFFWECHS 2015. [DOI: 10.1055/s-0035-1549662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Dommisch H, Staufenbiel I, Schulze K, Stiesch M, Winkel A, Fimmers R, Dommisch J, Jepsen S, Miosge N, Adam K, Eberhard J. Expression of antimicrobial peptides and interleukin-8 during early stages of inflammation: An experimental gingivitis study. J Periodontal Res 2015; 50:836-45. [DOI: 10.1111/jre.12271] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2015] [Indexed: 11/28/2022]
Affiliation(s)
- H. Dommisch
- Department of Periodontology and Synoptic Dentistry; Charité - University Medicine Berlin; Berlin Germany
- Department of Oral Health Sciences; Health Science Center; University of Washington; Seattle WA USA
- Department of Periodontology, Operative and Preventive Dentistry; University Hospital Bonn; Bonn Germany
| | - I. Staufenbiel
- Department of Conservative Dentistry, Periodontology and Preventive Dentistry; Hannover Medical School; Hannover Germany
| | - K. Schulze
- Clinic for Dental Prosthetics and Biomedical Materials Science; Hannover Medical School; Hannover Germany
| | - M. Stiesch
- Clinic for Dental Prosthetics and Biomedical Materials Science; Hannover Medical School; Hannover Germany
| | - A. Winkel
- Clinic for Dental Prosthetics and Biomedical Materials Science; Hannover Medical School; Hannover Germany
| | - R. Fimmers
- Institute of Medical Biometry; Informatics and Epidemiology; University of Bonn; Bonn Germany
| | - J. Dommisch
- Department of Periodontology, Operative and Preventive Dentistry; University Hospital Bonn; Bonn Germany
| | - S. Jepsen
- Department of Periodontology, Operative and Preventive Dentistry; University Hospital Bonn; Bonn Germany
| | - N. Miosge
- Research Group for Oral Biology and Tissue Regeneration; Department of Prosthetic Dentistry; University Hospital Göttingen; Göttingen Germany
| | - K. Adam
- Clinic for Dental Prosthetics and Biomedical Materials Science; Hannover Medical School; Hannover Germany
| | - J. Eberhard
- Clinic for Dental Prosthetics and Biomedical Materials Science; Hannover Medical School; Hannover Germany
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Fagiolini A, Eberhard J. National Differences in the Prevalence of Depressive Symptoms in Mania: a Naturalistic Study Using the Dsm-5 ‘with Mixed Features’ Specifier M.I.N.I. Module. Eur Psychiatry 2015. [DOI: 10.1016/s0924-9338(15)31892-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Abstract
OBJECTIVE This study aimed to evaluate patients with bipolar I disorder (BD-I) who have mania with depressive symptoms and who meet the new "with mixed features" specifier of the Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5). METHOD This prospective, multinational, naturalistic study surveyed psychiatrists and their patients with BD-I from October 2013 to March 2014. Eligible patients had BD-I, had a (current) manic episode, and had experienced onset of a manic episode within the previous 3 months. Psychiatrists provided patient information on depressive symptoms (DSM-5 criteria); symptoms of anxiety, irritability, and agitation; suicide attempts; and physician satisfaction with treatment response. Data were stratified according to whether patients met the criteria for the BD-I "with mixed features" specifier of DSM-5 (≥3 depressive symptoms) or not, and characteristics were compared between the two subgroups. Patients also self-reported on depressive symptoms using the Mini-International Neuropsychiatric Interview module questionnaire. RESULTS Overall, 34% of 1,035 patients met the criteria for BD-I "with mixed features," exhibiting ≥3 depressive symptoms during their current manic episode. This correlated with the matched patient self-reports of depressive symptoms. During their current manic episode, BD-I patients "with mixed features" had more severe symptoms of anxiety, irritability, and agitation (average composite severity score of 4.1 vs 3.4), a higher incidence of suicide attempts (38% vs 9%), and more physician dissatisfaction with treatment response (22% vs 14%), compared to patients with 0-2 depressive symptoms (all P<0.05). CONCLUSION This study found that patients with BD-I "with mixed features" (ie, ≥3 depressive symptoms during a manic episode), suffered, on average, from a greater burden of disease than patients with pure mania. Improved identification of these patients may help to optimize treatment outcomes.
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Affiliation(s)
- Allan H Young
- Institute of Psychiatry, King's College London, London, UK
| | - Jonas Eberhard
- Institute of Psychiatry, King's College London, London, UK ; Corporate Medical Affairs, H. Lundbeck A/S, Copenhagen, Denmark
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Lee Mortensen G, Vinberg M, Lee Mortensen S, Balslev Jørgensen M, Eberhard J. Bipolar patients' quality of life in mixed states: a preliminary qualitative study. Psychopathology 2015; 48:192-201. [PMID: 25895658 DOI: 10.1159/000381479] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 03/09/2015] [Indexed: 11/19/2022]
Abstract
BACKGROUND Approximately 20% of patients with bipolar disorder experience mixed states. Mixed states are associated with more comorbidity, poorer treatment response and prognosis, increased relapse rate, and decreased functioning. This study aimed to produce in-depth knowledge about bipolar patients' quality of life (QoL) and functioning related to mixed states. SAMPLING AND METHODS This study used qualitative research methods. A semi-structured interview guide based on a literature study was applied in interviews with 6 remitted bipolar I patients having experienced mixed states. A medical anthropological approach was applied to analyse the data. RESULTS Participants described mixed states as worse than other bipolar disorder states and their residual symptoms were prolonged. Mixed states affected the functioning of patients in key life domains such as self-esteem, family, love and social life, physical well-being, and working capability. CONCLUSIONS Mixed states may severely affect the QoL and functioning of bipolar patients. Our results indicate that improving these should be a main goal of patient treatment. With an aim of adequately identifying and treating mixed states, our findings highlight the need for knowledge about this particularly severe expression of bipolar disorder. These results should be confirmed in a larger sample of patients with varying socioeconomic status.
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Larsson A, Wangefjord S, Emberger G, Sundström M, Nodin B, Eberhard J, Jirström K. Association and Prognostic Interaction of Podocalyxin Like-Protein with Epidermal Growth Factor Receptor Alterations in Colorectal Cancer: a Cohort Study. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu333.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Olofsson S, Nodin B, Gaber A, Eberhard J, Uhlén M, Cavallin-Ståhl E, Jirström K. Low Rbm3 Protein Expression Correlates with Clinical Stage, Prognostic Index and Increased Risk of Treatment Failure in Testicular Non-Seminomatous Germ Cell Cancer. Ann Oncol 2014. [DOI: 10.1093/annonc/mdu358.18] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Dommisch H, Winter J, Götz W, Miesen J, Klein A, Hierse L, Deschner J, Jäger A, Eberhard J, Jepsen S. Effect of growth factors on antimicrobial peptides and pro-inflammatory mediators during wound healing. Clin Oral Investig 2014; 19:209-20. [DOI: 10.1007/s00784-014-1239-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2013] [Accepted: 03/25/2014] [Indexed: 12/26/2022]
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Lu I, Eberhard J, Ahmad F, Bhatnagar N, Behrens G, Jacobs R, Schmidt R, Meyer-Olson D. Elevated CD57 and CD95 expressions are associated with lower numbers of CD4+ recent thymic emigrants in HIV-1 infected immune responders following antiretroviral treatment. Immunol Lett 2014; 158:1-6. [DOI: 10.1016/j.imlet.2013.11.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2013] [Revised: 11/13/2013] [Accepted: 11/20/2013] [Indexed: 10/26/2022]
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Isaksson S, Eberhard J, Ståhl O, Cavallin-Ståhl E, Cohn-Cedermark G, Arver S, Lundberg Giwercman Y, Giwercman A. Inhibin B concentration is predictive for long-term azoospermia in men treated for testicular cancer. Andrology 2014; 2:252-8. [DOI: 10.1111/j.2047-2927.2014.00182.x] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Revised: 12/20/2013] [Accepted: 12/28/2013] [Indexed: 01/15/2023]
Affiliation(s)
- S. Isaksson
- Reproductive Medicine Centre; Skåne University Hospital; Malmö Sweden
- Department of Oncology; Skåne University Hospital; Lund Sweden
| | - J. Eberhard
- Department of Oncology; Skåne University Hospital; Lund Sweden
| | - O. Ståhl
- Department of Oncology; Skåne University Hospital; Lund Sweden
| | | | - G. Cohn-Cedermark
- Department of Oncology; Karolinska Institutet and University Hospital; Stockholm Sweden
| | - S. Arver
- Centre for Andrology and Sexual Medicine; Karolinska University Hospital; Stockholm Sweden
- Department of Medicine; Karolinska Institutet; Stockholm Sweden
| | | | - A. Giwercman
- Reproductive Medicine Centre; Skåne University Hospital; Malmö Sweden
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Brain C, Sameby B, Allerby K, Lindström E, Eberhard J, Burns T, Waern M. Twelve months of electronic monitoring (MEMS®) in the Swedish COAST-study: a comparison of methods for the measurement of adherence in schizophrenia. Eur Neuropsychopharmacol 2014; 24:215-22. [PMID: 24359935 DOI: 10.1016/j.euroneuro.2013.11.013] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2013] [Revised: 11/24/2013] [Accepted: 11/27/2013] [Indexed: 10/25/2022]
Abstract
The primary aim was to compare objective and subjective measures of adherence in a naturalistic cohort of schizophrenia outpatients over 12 months between October 2008 and June 2011. Antipsychotic medication adherence was monitored in 117 outpatients diagnosed with schizophrenia or schizophrenia-like psychosis according to DSM-IV criteria in a naturalistic prospective study. Adherence was determined by the Medication Event Monitoring System (MEMS®), pill count, plasma levels and patient, staff, psychiatrist and close informant ratings. The plasma level adherence measure reflects adherence to medication and to lab visits. Relationships between MEMS® adherence and other measures were expressed as a concordance index and kappa (K). Non-adherence (MEMS® ≤0.80) was observed in 27% of the patients. MEMS® adherence was highly correlated with pill count (concordance= 89% and K=0.72, p<0.001). Concordance and K were lower for all other adherence measures and very low for the relationship between MEMS® adherence and plasma levels (concordance=56% and K=0.05, p=0.217). Adherence measures were also entered into a principal component analysis that yielded three components. MEMS® recordings, pill count and informant ratings had their highest loadings in the first component, plasma levels alone in the second and patient, psychiatrist and staff ratings in the third. The strong agreement between MEMS® and pill count suggests that structured pill count might be a useful tool to follow adherence in clinical practice. The large discrepancy between MEMS® and the adherence measure based on plasma levels needs further study in clinical settings.
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Affiliation(s)
- Cecilia Brain
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden; Nå Ut-teamet, Psychosis Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Birgitta Sameby
- Nå Ut-teamet, Psychosis Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Katarina Allerby
- Nå Ut-teamet, Psychosis Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Eva Lindström
- Department of Neuroscience, Uppsala University Hospital, Uppsala, Sweden
| | - Jonas Eberhard
- Department of Psychosis Studies, Institute of Psychiatry at the Maudsley, King's College London, United Kingdom
| | - Tom Burns
- Department of Psychiatry, University of Oxford, Warneford Hospital, Oxford, United Kingdom
| | - Margda Waern
- Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Sweden
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