| 1. |
- Lindstrom, Eva, et al.
(författare)
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Development and validation of the Fast Assessment in Acute Treatment of Psychosis-Observation Rating Scale (FAST-O)
- 2011
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Ingår i: International Journal of Psychiatry in Clinical Practice. - : Informa UK Limited. - 1471-1788 .- 1365-1501. ; 15:3, s. 180-195
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Tidskriftsartikel (refereegranskat)abstract
- Objectives. There is a need for an observation scale for assessment and monitoring of acutely psychotic patients. Milestones based on such ratings should be defined, similar to the PANSS-based Remission criteria. FAST-O is such an instrument (11 items and a CGI rating). Methods. Reliability, validity and factor structure were analyzed in four separate studies-most importantly in one study of 33 chronic forensic in-patients rated concurrently by three independent raters, and another study of 91 Psychiatric Intensive Care Units patients and 20 newly admitted forensic patients, rated twice, each time by two independent raters. Results. The factor structure was simple, two factors and an orphan item (Depression). Reliability was adequate on item (>0.75) as well as scale (>0.85) level. There was no bias related to the rater's professional background. The instrument was sensitive to change. Percentile-based algorithms allow characterization of patients and groups. Tentative treatment milestones are defined; a clinical state "half-way" between the acute state and remission. Conclusions. FAST-O is a reliable, valid and easy to implement observation scale for patients with a psychotic illness, which can be used without bias by all staff.
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| 2. |
- Lindström, Eva, et al.
(författare)
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PECC-Factor structure and findings in three longitudinal cohorts of patients with schizophrenia
- 2012
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Ingår i: Nordic Journal of Psychiatry. - : Informa Healthcare. - 0803-9488 .- 1502-4725. ; 66:1, s. 33-39
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Tidskriftsartikel (refereegranskat)abstract
- Background: Symptom control by drug treatment is the most important task in routine clinical care of patients with schizophrenia. Structured assessment methods are needed in this task but not used much. The US-developed Positive and Negative Syndrome Scale (PANSS) is a standard tool for symptom assessment. The Psychosis Evaluation tool for Common use by Caregivers (PECC) was constructed in Europe some years ago, with the intent to overcome some of the PANSS drawbacks. Aims and methods: To validate PECC on three longitudinal cohorts of schizophrenic patients representative of Swedish outpatients (n = 225, six assessments over 5 years), international forensic patients (n = 186) and matched non-forensic controls (n = 116), five assessments over 2 years for both. Results: The factor structure of PECC appears to be highly robust. Norm values (in percentiles) were calculated on the materials. Such data provides for analyses of symptom profiles and improvement over time measured in absolute numbers. Forensic patients appear to have a much lower symptom load (except for cognitive symptoms) than the other groups. Forensic controls had much shorter inpatient times than any other group and never caught up with respect to symptom control, even after 2 years. These differences suggest that the scale is clinically valid. Conclusion: PECC has a more robust factor structure than PANSS and is simpler to use. Percentile norms have been constructed for outpatients with schizophrenia in general and forensic psychiatry. Percentile scores are accessed readily by the net. PECC is available in many languages. Its separate self-harm item may improve assessments of suicide risk among patients with schizophrenia
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| 3. |
- Asp, Marie, et al.
(författare)
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Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care
- 2020
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Ingår i: PLOS ONE. - : PUBLIC LIBRARY SCIENCE. - 1932-6203. ; 15:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Depression is a common illness with substantial economic consequences for society and a great burden for affected individuals. About 30% of patients with depression do not respond to repeated treatments. Psychiatric comorbidity is known to affect duration, recurrence and treatment outcome of depression. However, there is a lack of knowledge on the extent to which psychiatric comorbidity is identified in the clinical setting for depressed patients in secondary psychiatric care. Therefore, the aim of this study was to compare the agreement between traditional diagnostic assessment (TDA) and a structured and comprehensive diagnostic procedure (SCDP) for identification of personality and anxiety disorder comorbidity in depressed patients in secondary psychiatric care. Methods 274 patients aged 18-77 were referred from four secondary psychiatric care clinics in Sweden during 2012-2017. ICD-10 diagnoses according to TDA (mostly unstructured by psychiatric specialist and residents in psychiatry), were retrieved from medical records and compared to diagnoses resulting from the SCDP in the study. This included the Mini International Neuropsychiatric Interview, the Structured Interview for DSM Axis II Personality Disorders and semi-structured questions on psychosocial circumstances, life-events, psychiatric symptoms, psychiatric treatments, substance use, and suicidal and self-harm behaviour. The assessment was carried out by psychiatric specialists or by residents in psychiatry with at least three years of psychiatric training. Results SCDP identified personality disorder comorbidity in 43% of the patients compared to 11% in TDA (p<0,0001). Anxiety disorder comorbidity was identified in 58% with SCDP compared to 12% with TDA (p<0,0001). Conclusions Important psychiatric comorbidity seems to be unrecognized in depressive patients when using TDA, which is routine in secondary psychiatric care. Comorbidities are better identified using the proposed model involving structured and semi-structured interviews together with clinical evaluations by clinical experts.
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| 4. |
- Dalteg, Arne, et al.
(författare)
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Psychosis in adulthood is associated with high rates of ADHD and CD problems during childhood
- 2014
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 68:8, s. 560-566
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients diagnosed with schizophrenia display poor premorbid adjustment (PPA) in half of the cases. Attention deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) are common child psychiatric disorders. These two facts have not previously been linked in the literature. Aims: To determine the prevalence of ADHD/CD problems retrospectively among patients with psychoses, and whether and to what extent the high frequency of substance abuse problems among such patients may be linked to ADHD/CD problems. Method: ADHD and CD problems/diagnoses were retrospectively recorded in one forensic (n = 149) and two non-forensic samples (n = 98 and n = 231) of patients with a psychotic illness: schizophrenia, bipolar or other, excluding drug-induced psychoses. Results: ADHD and CD were much more common among the patients than in the general population-the odds ratio was estimated to be greater than 5. There was no significant difference in this respect between forensic and non-forensic patients. Substance abuse was common, but substantially more common among patients with premorbid ADHD/CD problems. Conclusions: Previous views regarding PPA among patients with a psychotic illness may reflect an association between childhood ADHD/CD and later psychosis. The nature of this association remains uncertain: two disorders sharing some generative mechanisms or one disorder with two main clinical manifestations. Childhood ADHD and particularly CD problems contribute to the high frequency of substance abuse in such groups.
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| 5. |
- Hodgins, Sheelagh, et al.
(författare)
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A multisite study of community treatment programs for mentally ill offenders with major mental disorders : Design, measures, and the forensic sample
- 2007
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Ingår i: Criminal justice and behavior. - : SAGE Publications. - 0093-8548 .- 1552-3594. ; 34:2, s. 211-228
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Tidskriftsartikel (refereegranskat)abstract
- This article presents reasons for undertaking ""The Comparative Study of the Prevention of Crime and Violence by Mentally Ill Persons"" and reasons for decisions regarding the study design and choice of measures. A brief portrait of the forensic patients that have been recruited is also presented. Community treatment programs could offer long-term cost-effective care for offenders with major mental disorders (MMDs). The study aims to identify the necessary ingredients of an effective program. Sites are selected in four countries where identification of most, if not all, persons with MMD who commit crimes within the catchment area was possible. Within each site, two samples of patients with MMD are recruited, one from a forensic hospital and one from a general psychiatric hospital. Assessments are completed prior to discharge. Participants are followed during a 5-year period. Comparisons of the forensic patients recruited in the four sites indicate many more similarities than differences.
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| 6. |
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| 7. |
- 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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| 8. |
- Michel, Steven F., et al.
(författare)
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Using the HCR-20 to Predict Aggressive Behavior among Men with Schizophrenia Living in the Community: Accuracy of Prediction, General and Forensic Settings, and Dynamic Risk Factors
- 2013
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Ingår i: International Journal of Forensic Mental Health. - : Informa UK Limited. - 1932-9903 .- 1499-9013. ; 12:1, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- The HCR-20 is widely used to assess risk of violence among patients with schizophrenia. Further understanding of the accuracy and changes over time in C and R scores is needed. Using prospectively collected data on 248 men with schizophrenia, the present study found that the HCR-20 significantly predicted aggressive behavior over 24 months. The H, C, R, HCR-20 total, and final risk judgment scores were unable to predict aggressive behavior better than chance among the general psychiatric patients in the first six months after discharge. Changes in three C items, the total R score, and in three R items significantly predicted changes in aggressive behavior.
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| 9. |
- Stjernswärd, Sigrid, et al.
(författare)
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A modified Drug Attitude Inventory used in long-term patients in sheltered housing
- 2013
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Ingår i: European Neuropsychopharmacology. - : Elsevier. - 0924-977X .- 1873-7862. ; 23:10, s. 1296-1299
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Tidskriftsartikel (refereegranskat)abstract
- The self-report Drug Attitude Inventory (DAI), in 30- and 10-item versions, provides unique information of clinical relevance for monitoring treatment adherence among people diagnosed with schizophrenia. The primary purpose of this paper was to evaluate the 10-item version among patients living in sheltered housing. Data were collected among 68 persons living in sheltered housing, most of them (82%) diagnosed with schizophrenia, 6% with non-organic psychoses, and 12% with other diagnoses. The dichotomic response format of the original DAI-10 was replaced by a 4-point Likert scale, in order to improve the resolution of the scale. Over 90% of the participants produced meaningful scores. A factor analysis suggested a 2-factor orthogonal structure: one highly homogenous factor (5 items) reflected wanted effects of the drug and displayed a bimodal distribution; one factor (3 items) reflected side effects. One item concerned the perceived control over one's drug treatment, which is a key clinical issue. One item was conceptually ambiguous and displayed no correlations with the other items. On the basis of the results we suggest cut-off scores which indicate the need for three kinds of adherence-improving interventions. Summing up, by dropping one item and using a Likert scale response format, the resulting instrument, DAI-9, appears to be an easy-to-use self-report instrument for monitoring drug attitudes and to identify needs for treatment adherence interventions among seriously ill patients.
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| 10. |
- Tuninger, Eva
(författare)
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Depot neuroleptic maintenance treatment: clinical, pharmacological and neuropsychological aspects
- 1997
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Neuroleptic maintenance treatment is effective to reduce the risk of further episodes of schizophrenia and other chronic psychoses, except affective. Lack of insight often lead to poor compliance to the prescripted medication. Then, neuroleptics might be given as depot injections. A group of chronic psychotic outpatients were assessed of clinical symptoms and side effects regularely during the three years. Rating scores were analysed in relation to drug doses (in chlorpromazine equivalents), drug plasma level and to performance in a small neuropsychological test battery (Tapping and Alternating tests, Digit Span test, Auditive and Visual Reaction Time tests and two self-rating scales). Of the 89 depot-treated patients 38 were not eligibble to enter the study. Outcome of the participating 51 patients and of the 38 non-eligible patients was examined in their hospital case records after 3 and 5 years. Only 18% of the 89 patients were stable after 5 years. Eight patients died at a median age of 47 years. Three of them committed suicide. Outcome was significantly worse for the non-eligible patient group (p<.01). The relapse risk was considerable even after 20 years duration of the illness. Relapse rate was high also in old patients. To reduce the relapse risk, depot neuroleptic doses should be tapered very slowly, maximum once a year and only in steps of 10-20% of the actual dose. The inter-individual variation of optimal doses and drug plasma levels are too large among the patients to define a "therapeutic window" of neuroleptic doses or plasma levels in maintenance treatment. The intraindividual variations of drug plasma levels were considerable and were not associated with side effect ratings. In a pilot study with a new dopamine D2 ligand, NCQ298, six neuroleptic-treated patients and six controls were examined using SPECT. The aim was to study if the ligand can be used to quantify D2-receptor occupancy. A significant difference in dopamine D2 receptor occupancy was obtained between neuroleptic-treated subjects and controls measured by SPECT, but the method must be more developed before it can be used as a standard method in finding the optimal neuroleptic dose. Simple motor tests can to some extent be used as an indicator of the rehabilitation potential of chronic psychotic patients. Subjects with prominent negative symptoms had more neuropsychological impairments than others. Patients with core schizophrenia had a markedly slower tapping rate in the right hand compared to the left, suggesting a more marked left-hemisphere disturbance. In patients with auditory hallucinationes tapping rates of especially the right hand correlated negatively to the intensity of hallucinations. Side effects, EPS, may slow performance of some motor tests (Finger Alternation) and also affect the reaction time.
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