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  • Buchhave, Peder, et al. (författare)
  • Longitudinal study of CSF biomarkers in patients with Alzheimer's disease.
  • 2009
  • Ingår i: PLoS ONE. - Public Library of Science. - 1932-6203. ; 4:7
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: The CSF biomarkers tau and Abeta42 can identify patients with AD, even during the preclinical stages. However, previous studies on longitudinal changes of tau and Abeta42 in individual patients with AD and elderly controls report somewhat inconsistent results. METHODOLOGY/PRINCIPAL FINDINGS: We investigated the levels of tau and Abeta42 at baseline and after 1 year in 100 patients with AD. In a second cohort of 45 AD patients we measured the CSF biomarkers at baseline and after 2 years. Moreover, in 34 healthy elderly controls the CSF biomarkers were followed for 4 years. The baseline levels of tau were increased with >60% in AD patients compared to controls (p<0.001), while baseline Abeta42 levels were decreased with >50% (p<0.001). In the AD group followed for 2 years, tau increased with 16% compared to the baseline levels (p<0.05). However, the levels of tau were stable over 4 years in the controls. The levels of Abeta42 did not change significantly over time in any of the groups. In the patients with AD, tau was moderately associated with worse cognitive performance already at baseline (p<0.05). CONCLUSIONS/SIGNIFICANCE: Tau and Abeta42 in CSF seem to reflect the underlying disease state in both early and late stages of AD. The slight increase in tau over time observed in the patients with AD is modest when compared to the relatively large difference in absolute tau levels between AD patients and controls. Therefore, these markers maintain their usefulness as state markers over time and might serve as surrogate markers for treatment efficacy in clinical trials.
  • Flink, Roland, et al. (författare)
  • Complications to invasive epilepsy surgery workup with subdural and depth electrodes: a prospective population-based observational study
  • 2014
  • Ingår i: Journal of Neurology Neurosurgery and Psychiatry. - 0022-3050. ; 85:7, s. 716-720
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective In some patients who undergo presurgical workup for drug-resistant epilepsy invasive seizure monitoring is needed to define the seizure onset zone and delineate eloquent cortex. Such procedures carry risks for complications causing permanent morbidity and even mortality. In this study, prospective data on complications in a national population-based sample were analysed. Design Complication data from the prospective Swedish National Epilepsy Surgery Register were analysed for 271 patients in whom therapeutic surgery was preceded by invasive monitoring 1996-2010. Results Complications occurred in 13/271 patients (4.8%). Subdural grids carried the highest risk of complications (7.4%). There was no surgical mortality or permanent morbidity. Subdural haematomas were most common (n=7) followed by epidural haematomas (n= 3). Valproate treatment and having a haematoma was associated with an OR of 1.53 (CI 0.38 to 6.12) compared to having a haematoma without valproate treatment. Having a complication during invasive monitoring was associated with a significant OR of 6.27 (CI 1.32 to 29.9) of also having a complication at therapeutic surgery compared to the risk of having a complication only at surgery. Conclusions In this prospective population-based epilepsy surgery series, the most common complications were haematomas, and subdural grids carried the highest risk. Close supervision and rapid interventions led to avoidance of permanent morbidity. The clinical implications of the slightly increased risk of haematomas with valproate treatment needs further investigation as does the finding of an increased risk for complications at epilepsy surgery for patients who had a complication during invasive monitoring.
  • Furmark, Tomas, et al. (författare)
  • Serotonin synthesis rate and the tryptophan hydroxylase-2 : G-703T polymorphism in social anxiety disorder
  • 2016
  • Ingår i: Journal of Psychopharmacology. - London, United Kingdom : Sage Publications. - 0269-8811. ; 30:10, s. 1028-1035
  • Tidskriftsartikel (refereegranskat)abstract
    • It is disputed whether anxiety disorders, like social anxiety disorder, are characterized by serotonin over- or underactivity. Here, we evaluated whether our recent finding of elevated neural serotonin synthesis rate in patients with social anxiety disorder could be reproduced in a separate cohort, and whether allelic variation in the tryptophan hydroxylase-2 (TPH2) G-703T polymorphism relates to differences in serotonin synthesis assessed with positron emission tomography. Eighteen social anxiety disorder patients and six healthy controls were scanned during 60 minutes in a resting state using positron emission tomography and 5-hydroxy-L-[β -(11)C]tryptophan, [(11)C]5-HTP, a substrate of the second enzymatic step in serotonin synthesis. Parametric images were generated, using the reference Patlak method, and analysed using Statistical Parametric Mapping (SPM8). Blood samples for genotyping of the TPH2 G-703T polymorphism were obtained from 16 social anxiety disorder patients (T carriers: n=5, GG carriers: n=11). A significantly elevated [(11)C]5-HTP accumulation rate, indicative of enhanced decarboxylase activity and thereby serotonin synthesis capacity, was detected in social anxiety disorder patients compared with controls in the hippocampus and basal ganglia nuclei and, at a more lenient (uncorrected) statistical threshold, in the amygdala and anterior cingulate cortex. In patients, the serotonin synthesis rate in the amygdala and anterior cingulate cortex was significantly elevated in TPH2 T carriers in comparison with GG homozygotes. Our results support that social anxiety disorder entails an overactive presynaptic serotonergic system that, in turn, seems functionally influenced by the TPH2 G-703T polymorphism in emotionally relevant brain regions.
  • Hansson, Oskar, et al. (författare)
  • Combined rCBF and CSF biomarkers predict progression from mild cognitive impairment to Alzheimer's disease.
  • 2009
  • Ingår i: Neurobiology of Aging. - Elsevier. - 1558-1497. ; 30:2, s. 165-173
  • Tidskriftsartikel (refereegranskat)abstract
    • This study aimed to identify preclinical Alzheimer's disease (AD) in patients with mild cognitive impairment (MCI) using measurements of both regional cerebral blood flow (rCBF) and cerebrospinal fluid (CSF) biomarkers. Baseline rCBF assessments (133Xe method) were performed in 70 patients with MCI who were cognitively stable for 4–6 years, 69 patients with MCI who subsequently developed AD, and 33 healthy individuals. CSF was collected at baseline and analyzed for β-amyloid1–42, total tau and phophorylated tau. In contrast to patients with stable MCI, those who subsequently developed AD had decreased rCBF in the temporo-parietal cortex already at baseline. The relative risk of future progression to AD was particularly increased in MCI patients with decreased rCBF in parietal cortex (hazard ratio 3.1, P < 0.0001). Subjects with pathological levels of both CSF tau and β-amyloid1–42 were also at high risk of developing AD (hazard ratio 13.4, P < 0.0001). The MCI patients with a combination of decreased parietal rCBF and pathological CSF biomarkers at baseline had a substantially increased risk of future development of AD, with a hazard ratio of 24.3 (P < 0.0001), when compared to those with normal CSF biomarkers. Moreover, decreased parietal rCBF (but not CSF biomarkers) was associated with a more rapid progression to AD. In conclusion, the combination of rCBF and CSF biomarkers improves the risk assessment of progression to AD in patients with MCI.
  • Henje Blom, Eva, et al. (författare)
  • Pro-inflammatory cytokines are elevated in adolescent females with emotional disorders not treated with SSRIs
  • 2012
  • Ingår i: Journal of Affective Disorders. - 0165-0327. ; 136:3, s. 716-23
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: Adults with major depressive disorder (MDD) show elevated levels of IL-6 and TNF-alpha. Studies of adolescents with MDD or anxiety disorders (AD) are few and present conflicting results.METHODS: We studied plasma cytokines in a clinical sample of adolescent females with MDD and/or clinical AD (n=60, mean age 16.8 years), compared to healthy controls (n=44; mean age 16.5 years).RESULTS: The clinical sample showed significantly higher values of IL-2 (Z=-4.09, p&gt;0.0001), IL1-beta (Z=-2.40, p&lt;0.05) and IL-10 (Z=-2.38, p&lt;0.05) as compared to controls. The subgroup of the clinical sample not treated with SSRIs had a significant difference of IL-6 (Z=-2.26, p&lt;0.05) in addition to the difference of IL-2 and IL1-beta, but showed no difference of IL-10 as compared to the controls. SSRI treatment was related to IL-6, explaining 26% of the variance in the clinical sample after controlling for BMI and symptom severity. In the clinical sample, levels of IL-6 and IFN-gamma were positively correlated with self-assessed symptoms of anxiety and/or depression (corr.coeff 0.35 resp 0.40 at p&lt;0.05).LIMITATIONS: The cross-sectional design does not allow for conclusions on causality. The sample sizes were relatively small and a large drop-out in the clinical sample may have influenced the representativity.DISCUSSION: The study suggests that pro-inflammatory cytokines are part of the pathophysiology of emotional disorders in adolescent females and that SSRIs have anti-inflammatory properties. The findings prompt further studies on the specific mechanisms involved and may contribute to the development of more effective treatment and prevention.
  • Lundh, Anna, et al. (författare)
  • Outcomes of child psychiatric treatment.
  • 2013
  • Ingår i: Acta psychiatrica Scandinavica. - 1600-0447. ; 128:1, s. 34-44
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective The aim of this study was to investigate outcomes of child psychiatric outpatient treatment as usual and to identify outcome predictors, with special regard to attention-deficit/hyperactivity disorder (ADHD), mood disorder, obsessive-compulsive disorder and conduct disorder. Method Routinely collected data from 12613 outpatients between July 2006 and January 2010 in Stockholm, Sweden were analysed. The outcome measure was change in Children's Global Assessment Scale (CGAS) ratings between first visit and case closure (CGAS). Results CGAS improved during the course of treatment across all diagnostic groups, ranging from a mean change of 4 (mental retardation) to 16 (suicide attempts). CGAS was two times higher in the mood disorder group compared with the ADHD group. In the mood disorder group, several psychotherapies were associated with better outcome but not medication. In the ADHD group, psychotherapeutic interventions were also associated with better outcome, but those who received treatment with central stimulants received less non-medical interventions. Conclusion Whereas the functional impairment and the level of improvement in mood disorder corresponded to previous efficacy studies, the ADHD patients were more impaired and improved less after treatment. This should prompt a critical discussion as to whether ADHD patients receive the best available treatment in CAMHS in Stockholm and elsewhere.
  • Passant, Ulla, et al. (författare)
  • Psychiatric Symptoms and Their Psychosocial Consequences in Frontotemporal Dementia.
  • 2005
  • Ingår i: Alzheimer Disease and Associated Disorders. - Lippincott Williams & Wilkins. - 0893-0341. ; 19 Suppl 1, s. 15-18
  • Tidskriftsartikel (refereegranskat)abstract
    • Based on a retrospective study of 19 neuropathologically verified cases with frontotemporal dementia (FTD), neuropsychiatric symptoms related to behavioral disturbances and their psychosocial consequences were studied. The results indicate that frontotemporal dementia is often misdiagnosed early in the clinical course. Behavioural features with impaired social interactions, impaired personal regulation, and loss of insight were seen in all patients. The psychosocial consequences reported in this paper challenge future research in frontotemporal dementia.
  • Pettersson, Cecilia, et al. (författare)
  • Description of an intensive nutrition therapy in hospitalized adolescents with anorexia nervosa.
  • 2016
  • Ingår i: Eating behaviors. - 1873-7358. ; 21, s. 172-178
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: To describe an intensive nutrition therapy for hospitalized adolescents and young adults with anorexia nervosa (AN) in terms of body weight, body composition, energy balance and food related anxiety. Method: Twenty-six young females, 16-24 years of age, with AN were invited to participate at admission to a specialized eating disorder unit in Goteborg, Sweden. Intensive nutrition therapy comprised 12 weeks on a structured meal plan. Six meals were served daily, in combination with high-energy liquid nutritional supplements from start. Energy and nutrient intakes, energy expenditure, body composition and food related anxiety were measured during the study. A 3-month follow-up of body weight and food related anxiety was conducted. Results: Twenty-one patients participated. The total daily energy intake was, during the first week of treatment, (mean +/- SD) 3264 +/- 196 kcal (74 kcal/kg), and decreased gradually during treatment to 2622 +/- 331 kcal (49 kcal/kg). Total daily energy expenditure was initially 1568 +/- 149 kcal and increased gradually to 2034 +/- 194 kcal. Patients gained on average 9.8 +/- 2.1 kg and body mass index increased from 15.5 +/- 0.9 to 19.0 +/- 0.9 kg/m(2). Body fat increased from 13 +/- 6% to 26 +/- 6%. Fat free mass remained unchanged, but skeletal muscle mass increased from 16.7 +/- 2.0 to 17.6 +/- 2.4 kg, p = 0.009. Patients food related anxiety decreased significantly during treatment and was still unchanged 3 months later. Conclusion: The presented intensive nutrition therapy with initially high energy and nutrient intakes produced substantial weight gain, increased fat and muscle mass and decreased food related anxiety in AN patients, without any clinical side effects. (C) 2016 Elsevier Ltd. All rights reserved.
  • Plenty, Stephanie, et al. (författare)
  • Applying an ESSENCE framework to understanding adult autism spectrum disorder and ADHD retrospective parent reports of childhood problems
  • 2013
  • Ingår i: Scientific World Journal. - New York, USA : Hindawi Publishing Corporation. - 1537-744X. ; 2013
  • Tidskriftsartikel (refereegranskat)abstract
    • Diagnoses of autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) are increasingly being made in adulthood. However, assessments can fail to address the diverse range of problems that patients have experienced. The current study applied an early symptomatic syndromes eliciting neurodevelopmental clinical examinations (ESSENCE) framework to explore retrospectively reported childhood developmental and behavioral problems. It examined if adult ASD and ADHD patients would show problems outside those reflected in the respective diagnostic criteria, and also if these patient groups would show more extensive childhood problems than other psychiatric patients. Parents of adults with ADHD (n = 130), ASD (n = 57), coexisting ADHD and ASD (n = 38), and other psychiatric disorders (n = 56) reported on a range of childhood problems. Descriptions of the ADHD, ASD, and ADHD+ASD groups reflected greater impairment than descriptions for patients with other psychiatric disorders in most problem areas. Although differences were observed between ADHD and ASD patients in the core diagnostic areas, these syndromes also shared a number of childhood difficulties. The ESSENCE approach can assist in understanding the symptom history of adult ADHD and ASD patients and can be helpful to distinguish their childhood experiences from other psychiatric patients' experiences.
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