| 1. |
- Malm, Ulf, et al.
(författare)
-
Naturalistic studies - Researching the everyday clinical world
- 2009
-
Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 63:2, s. 100-101
-
Tidskriftsartikel (refereegranskat)abstract
- During the last decade, a vast amount of research has been produced concerning the efficacy of different pharmacological and psychological treatments in psychiatry for various diagnoses. This movement towards evidence-based practices has aimed at grounding clinical practice in evidence derived from research, to optimize outcomes. Such developments should translate into the successful management of seriously mentally ill persons, allowing them to remain safely and productively in their communities rather than in more restrictive settings. Treatment regimens grounded in evidence are well behind the deinstitutionalization of mentally ill persons, which has sometimes even lead to their reinstitutionalization in unfavorable settings (jails, nursing homes, etc.) and unsafe living conditions (shelters, streets).
|
|
| 2. |
- Spjut, Christina, et al.
(författare)
-
Current issues in swedish psychiatry
- 2009
-
Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 63:3, s. 270-271
-
Tidskriftsartikel (refereegranskat)
|
|
| 3. |
- Eberhard, Jonas
(författare)
-
SCHIZOPHRENIA IN A LONGITUDINAL PERSPECTIVE clinical and neurocognitive aspects
- 2007
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: To explore the long-term course and to study factors of potential relevance for the treatment and rehabilitation process of patients with schizophrenia and schizophrenia-like disorders. Specific issues concerned cognitive reduction, tardive dyskinesia (TD), prolactin-induced side effects, remission and lack of insight. Method: A naturalistic multicenter study of 225 patients, diagnosed with schizophrenia or schizophrenia-related psychotic disorders and treated with risperidone at study entry, of whom 166 participated in a 5 year longitudinal extension of the original study. Patients were assessed annually with respect to relevant background and clinical factors. Specific to the study is the extended use of parallel patient and clinician ratings. Results: The setting of the main study seem to have resulted in an extremely low attrition rate and high objective drug treatment adherence. Patients were much more apt at self-rating symptoms, global illness and side-effects than expected. Having had many previous acute episodes was associated with more pronounced cognitive reduction. TD was not common, associated with an extra magnitude of cognitive slowing and appeared to be only partly drug related. High levels of prolactin could not be linked to any side effects. Remission was not attained by 40% of the patients. Remission reflected clinicians? but not patients? ratings of symptoms and was linked to social outcome but not to cognition. One third of the patients had a clinically significant lack of insight, which was associated with low premorbid IQ and with executive problems. Conclusions: The extended use of parallel ratings by clinicians and patients, and the focus on optimizing drug treatment appear to have fostered an unusual degree of patient involvement in their own treatment and thereby excellent treatment adherence. These features can be implemented in routine clinical management as a ?small steps in the right direction? strategy. To attain cure we need a grand break-through in our understanding of the disease.
|
|
| 4. |
- Nyrenius, Johan, et al.
(författare)
-
The 'lost generation' in adult psychiatry: psychiatric, neurodevelopmental and sociodemographic characteristics of psychiatric patients with autism unrecognised in childhood
- 2023
-
Ingår i: Bjpsych Open. - 2056-4724. ; 9:3
-
Tidskriftsartikel (refereegranskat)abstract
- BackgroundPatients 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. AimsTo examine psychiatrically relevant characteristics in autistic adult psychiatric out-patients, and to compare the characteristics with non-autistic adult psychiatric out-patients. MethodWe 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. ResultsNo 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. ConclusionsThe 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.
|
|
| 5. |
- Levander, Sten, et al.
(författare)
-
Clinical decision-making during 5 years of antipsychotic treatment
- 2007
-
Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447 .- 0065-1591 .- 1600-5473. ; 116, s. 17-26
-
Tidskriftsartikel (refereegranskat)abstract
- Objective: Explore how clinicians select drug treatment based on symptoms, side effects and patient factors, including patient participation in the process, and the association between these factors and attitudes towards drugs. Method: A cohort of 166 patients initially treated with risperidone was followed with yearly assessments over 5 years. At the end of the study, 101 patients were evaluated of whom 58 were still treated with risperidone. Results: More women than men remained in the study, and on the initial medication. The most common reason for medication switch was lack of efficacy. Clinicians and patients agreed well in their global ratings of medication effects and side effects. Robust associations between switch decisions and patient characteristics including symptoms and side effects could not be identified. The effects of switches were rated as better by the clinicians than by the patients. Negative drug attitudes were associated with pronounced positive symptoms (threshold effect), whereas the corresponding association with 'lack of judgment and insight' was linear over the whole range. Conclusion: The decision-making process appears to have many unknown components, and may benefit from more active patient involvement by using structured clinician and patient rating scales for monitoring the treatment. Such shared decision-making may improve compliance.
|
|
| 6. |
- Stenmark, Richard, et al.
(författare)
-
Resource utilization in mental illness–evaluation of an instrument for measuring direct costs of treatment for patients with severe mental illness (SMI)
- 2023
-
Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 77:2, s. 172-178
-
Tidskriftsartikel (refereegranskat)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.
|
|
| 7. |
- El Mrayyan, Nadia, et al.
(författare)
-
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
- 2022
-
Ingår i: Community Mental Health Journal. - : Springer Science and Business Media LLC. - 0010-3853 .- 1573-2789. ; 58:5, s. 1000-1013
-
Tidskriftsartikel (refereegranskat)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.
|
|
| 8. |
- Westman, Jeanette, et al.
(författare)
-
Outcome of a psychosocial health promotion intervention aimed at improving physical health and reducing alcohol use in patients with schizophrenia and psychotic disorders (MINT)
- 2019
-
Ingår i: Schizophrenia Research. - : Elsevier BV. - 0920-9964 .- 1573-2509. ; 208, s. 138-144
-
Tidskriftsartikel (refereegranskat)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.
|
|
| 9. |
- Nyrenius, Johan, et al.
(författare)
-
Prevalence of Autism Spectrum Disorders in Adult Outpatient Psychiatry
- 2022
-
Ingår i: Journal of Autism and Developmental Disorders. - : Springer Science and Business Media LLC. - 0162-3257 .- 1573-3432. ; 52, s. 3769-3779
-
Tidskriftsartikel (refereegranskat)abstract
- Relatively little has been published about the prevalence of autism in adults with psychiatric disorders. In this study, all new patients referred to an adult psychiatric outpatient clinic in Sweden between November 2019 and October 2020 (n = 562) were screened for autism spectrum disorders using the Ritvo Autism and Asperger Diagnostic Scale Screen (RAADS-14). Out of the 304 (58%) responders, 197 who scored above the cut off (14) were invited to participate in an in-depth assessment. Twenty-six of the 48 that participated in the assessment met criteria for ASD and an additional eight had subthreshold ASD symptoms. We estimated the prevalence of ASD in this population to at least 18.9%, with another 5–10% having subthreshold symptoms.
|
|
| 10. |
- El Mrayyan, Nadia, et al.
(författare)
-
The occurrence of comorbidities with affective and anxiety disorders among older people with intellectual disability compared with the general population : A register study
- 2019
-
Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 19:1
-
Tidskriftsartikel (refereegranskat)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.
|
|
