| 1. |
- Levander, Sten, et al.
(författare)
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Clinical decision-making during 5 years of antipsychotic treatment
- 2007
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447 .- 0065-1591 .- 1600-5473. ; 116, s. 17-26
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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.
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| 2. |
- Levander, Sten, et al.
(författare)
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Nicotine use and its correlates in patients with psychosis
- 2007
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447 .- 0065-1591 .- 1600-5473. ; 116, s. 27-32
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine nicotine use and its correlates among psychotic patients. Method: Longitudinal naturalistic study of 176 patients, diagnosed with schizophrenia or schizophrenia-related psychotic disorders, and treated with risperidone at study entry. Levels of nicotine use (smoking, snuffing) were measured along with other relevant ratings and measurements (symptoms, drug treatment, side effects, weight, cognitive functions and outcome) at baseline and once yearly for 5 years. Results: Nicotine use was twice as common as in the general population. Only few nicotine users had started after onset of psychoses. We could not find any differences among nicotine users and non-users in diagnosis, symptoms, side effects, weight, cognitive functions, personality and outcome, cross-sectionally and longitudinally, ruling against the 'self-medication' hypothesis. Conclusion: A parsimonious interpretation of the findings is that patients suffering from psychosis fail to desist from nicotine rather than experience significant positive effects of the usage.
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| 3. |
- Lindström, Eva, et al.
(författare)
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Five-year follow-up during antipsychotic treatment : efficacy, safety, functional and social outcome
- 2007
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447 .- 0065-1591 .- 1600-5473. ; 116, s. 5-16
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Explore the long-term course of schizophrenia and related disorders. Method: Naturalistic study of 225 patients initially treated with risperidone (monotherapy or in combination with other psychotropic drugs) over 5 years. Results: Stable symptomatology and side effects were observed. Clinician GAF scores were 55-61, but patients' self-ratings were higher. Clinician and patient CGI scores were at the same level. Annual in-patient days decreased but days in sheltered accommodations increased still more. Only 12% of the patients studied or worked fulltime. One in four had no social contacts except with staff. Eight patients died during the 5 years. Conclusion: The findings underline the chronicity and seriousness of psychotic disorders in terms of social outcome and, indirectly, the low quality of life of this group of persons. Patients were generally well aware of their illness and able to sort out symptoms from drug side effects. This opens for more active involvement of patients in monitoring their own treatment.
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| 4. |
- Eberhard, Jonas, et al.
(författare)
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Prolactin level during 5 years of risperidone treatment in patients with psychotic disorders
- 2007
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447. ; 115:4, s. 268-276
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate prolactin levels and related side effects in 128 men and 90 women initially treated with risperidone. Method: Patients initially treated with risperidone were followed over 5 years, during which 45% were switched to other antipsychotic drugs. Results: Initially, prolactin levels were fivefold the norm in women, and threefold in men. Diagnosis did not affect the prolactin level if adjustment for sex, current age, and age at onset of psychosis was applied. Prolactin levels did not correlate significantly neither with any Positive and Negative Symptom Scale item or subscale, nor with side effects. Drugs other than risperidone were not associated with high prolactin levels. For patients on continuous monotherapy risperidone treatment, there was a marked linear reduction of prolactin level over all 5 years. Conclusion: Risperidone induces a higher prolactin elevation than other atypical antipsychotics, but the effect adapts over time. Prolactin was not associated with expected side effects (e.g. sexual, mental, or weight gain).
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| 5. |
- Lindstrom, E, et al.
(författare)
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Costs of schizophrenia during five years
- 2007
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 1600-0447 .- 0001-690X. ; 116:S435, s. 33-40
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the direct and Indirect costs in a cohort of 225 risperidone-treated patients with schizophrenia followed up annually during 5 years. Method: Data on costs for medication, hospitalization, sheltered living and productivity losses, as well as degree of social isolation, were collected. Results: The direct costs were dominated by hospitalization and sheltered living expenses, while drug costs only represented 7% of the direct costs. Indirect costs represented 43% of the total costs during the 5 years. About 12% worked full-time, and 12% worked part-time, implying large productivity losses. As a consequence of the national mental health care reform, a substantial shift of costs from hospital care to sheltered living took place on the national level, but the reduction of hospital days for the study patients over time was much larger suggesting that the switch from first to second generation compounds was therapeutically successful. A high degree of social isolation was seen, with more than 20% being completely without social contacts and 30% seeing friends/relatives less often than once a week. Conclusion: The economic costs of schizophrenia are high and driven by the need for assisted living and hospitalizations, together with productivity losses. In addition, the intangible costs, such as social contacts, are also high.
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| 6. |
- Neovius, M., et al.
(författare)
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Weight development in patients treated with risperidone : A 5-year naturalistic study
- 2007
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447. ; 115:4, s. 277-285
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine annual weight-development in a sample of 215 psychotic patients treated with risperidone over 5 years. Method: Naturalistic longitudinal study. Results: The sample was more obese than the general population at baseline, but also increased much more in mean body mass index over approximately the same time period, while patients off medication seemed to remain weight stable. Excessive weight gain (>7%) was experienced by 40.2% and was weakly associated with weight at baseline (β = −0.2%; P = 0.02), while independent of gender, symptoms, years of illness, prolactin levels and nicotine consumption. In patients with complete weight data (n = 87), approximately 72% (3.4 ± 8.3 kg) of the observed 5 years weight gain (4.7 ± 11.6 kg) had been accumulated after 2 years. Conclusion: Antipsychotic drug treatment resulted in significant weight gain, which levelled off over time. Unfortunately, few significant predictors of adverse weight development could be identified, leaving little guidance for clinical decision making regarding this specific side-effect.
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| 7. |
- Nielsen, R. E., et al.
(författare)
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Effects of sertindole on cognition in clozapine-treated schizophrenia patients
- 2012
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley-Blackwell. - 0001-690X .- 1600-0447. ; 126:1, s. 31-39
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To assess the cognitive effects of sertindole augmentation in clozapine-treated patients diagnosed with schizophrenia. Cognition is secondary outcome of the trial. Method: A 12-week, double-blinded, randomized, placebo-controlled, augmentation study of patients treated with clozapine. Participants were randomized 1:1 to receive 16 mg of sertindole or placebo as adjunctive treatment to clozapine. Results: Participants displayed substantial cognitive deficits, ranging from 1.6 standard deviation below norms at baseline to more than three standard deviations on tests of response readiness and focused attention. There were no significant differences between sertindole augmentation and placebo groups at study end. Correlation analysis of Positive and Negative Syndrome (PANSS) subscales, Global Assessment of Functioning subscale (GAF-F) and Clinical Global Impression (CGI) with 20 neurocognitive indices was conducted, but no significant correlations were found. Second, we tested change from baseline to endpoint for the PANSS, GAF-F, and CGI, vs. the concomitant changes in cognitive test performance, and found no significant correlations. Conclusion: The clozapine-treated patients displayed marked cognitive deficits at baseline. Adding sertindole did not improve or worsen cognitive functioning, which is in line with previous negative studies of the effect on cognition of augmenting clozapine treatment with another antipsychotic drug.
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| 8. |
- Lindström, Eva, et al.
(författare)
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Costs of schizophrenia during 5 years
- 2007
-
Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447 .- 0065-1591. ; 116:Suppl.435, s. 33-40
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To explore the direct and Indirect costs in a cohort of 225 risperidone-treated patients with schizophrenia followed up annually during 5 years. Method: Data on costs for medication, hospitalization, sheltered living and productivity losses, as well as degree of social isolation, were collected. Results: The direct costs were dominated by hospitalization and sheltered living expenses, while drug costs only represented 7% of the direct costs. Indirect costs represented 43% of the total costs during the 5 years. About 12% worked full-time, and 12% worked part-time, implying large productivity losses. As a consequence of the national mental health care reform, a substantial shift of costs from hospital care to sheltered living took place on the national level, but the reduction of hospital days for the study patients over time was much larger suggesting that the switch from first to second generation compounds was therapeutically successful. A high degree of social isolation was seen, with more than 20% being completely without social contacts and 30% seeing friends/relatives less often than once a week. Conclusion: The economic costs of schizophrenia are high and driven by the need for assisted living and hospitalizations, together with productivity losses. In addition, the intangible costs, such as social contacts, are also high.
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| 9. |
- Johansson, Peter, et al.
(författare)
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On the operationalization of psychopathy : further support for a three-faceted personality oriented model
- 2002
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447. ; 106:suppl. s412, s. 81-85
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE:This study is an attempt to compare two alternative models of psychopathy (PCL-R); (i) the traditional 17-item two-factor model where the first factor describes a deceitful, manipulative and callous, unemotional dimension and the second factor describes the impulsive, irresponsible and antisocial behavioral lifestyle dimension; and (ii) a recently proposed 13-item three-factor model involving an interpersonal facet, an affective facet and a behavioral facet.METHOD:Exploratory and confirmatory factor analyses of PCL-R scores on a sample of 293 adult male violent offenders were conducted.RESULTS:The results of the exploratory factor analysis showed that the 13 items yielded three easily interpretable factors: an interpersonal factor, an affective factor and a behavioral/lifestyle factor. Through confirmatory factor analysis we showed that this model had a significantly closer fit to the data than the classical 17-item, two-factor model of the PCL-R.CONCLUSION:The study supports the three-faceted model of psychopathy.
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| 10. |
- Levander, Sten, et al.
(författare)
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Schizophrenia - progressive and massive decline in response readiness by episodes
- 2001
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Ingår i: Acta Psychiatrica Scandinavica. - 1600-0447. ; 104:Suppl. 408, s. 65-74
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To relate the pattern of neuropsychological impairments among schizophrenic patients to case history data and disease characteristics in a cross-sectional study of unselected patients, and to integrate these data with two previous longitudinal studies of neuropsychological impairments among schizophrenic patients. Method: One hundred consecutive schizophrenic patients were studied with respect to clinical case history and current symptoms, medication and neuropsychological impairment using a comprehensive computerized test battery. Results: The most salient finding was a marked slowing of response readiness, linearly related to the number of previous acute episodes. The resulting deficit was far beyond what has been obtained in any other group of subjects (average -6 SD for > five episode patients). The impairments in many of the other neuropsychological parameters could to some extent be explained with reference to response slowing, with one exception - verbal short-term memory. Adjustment for important confounding factors (age, duration of illness, medication) did not change the strong negative association between response readiness and number of previous episodes. Conclusion: These findings, together with findings of our two previous longitudinal studies and a recent replication, prompted us to suggest that each acute schizophrenic episode inflicts damage to a set of hypothetical structures, cognitive pattern generators. We assume that these structures translate intentions to logistic programs. When damaged, delays are introduced into executive functions and corollary discharge processes will run out of phase with intentions. This model implicates new ways of looking at the generative mechanisms of the illness, and on treatment strategies.
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