| 1. |
- Bjerkenstedt, Lars, et al.
(författare)
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Support for limited brain availability of tyrosine in patients with schizophrenia
- 2006
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Ingår i: International Journal of Neuropsychopharmacology. - 1461-1457 .- 1469-5111. ; 9, s. 247-255
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Tidskriftsartikel (refereegranskat)abstract
- Several mechanisms have been suggested to account for altered dopaminergic neurotransmission in schizophrenia. The brain is the only organ for which amino-acid transport is limited and competition for transport over the blood-brain barrier (BBB) occurs at physiological plasma concentrations. One line of research suggests that patients with schizophrenia have altered brain levels of the essential amino acid tyrosine, the precursor for the synthesis of dopamine. The most common hypothesis is that less tyrosine is available because of competition with elevated levels of other amino acids. By consequence, the synthesis of dopamine in the brain will decrease. In contrast, another line of evidence suggests a change in the affinity for one of the transport proteins. A limitation of this research has been that the systems for amino-acid transport across the BBB have not been fully characterized at a molecular or functional level. The L system is the major system for transport of tyrosine across cell membranes including the BBB. The A system is also involved in this transport. Earlier in-vitro studies using fibroblasts have demonstrated a normal L system in schizophrenia but nevertheless reduced tyrosine transport. The combination of molecular research, fibroblast techniques, and brain imaging provides a new basis for clinical research on the role of amino-acid membrane transport in schizophrenia.
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| 2. |
- Fernell, Elisabeth, et al.
(författare)
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Aberrant amino acid transport in fibroblasts from children with autism
- 2007
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Ingår i: Neuroscience Letters. - Amsterdam : Elsevier. - 0304-3940 .- 1872-7972. ; 418:1, s. 82-86
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Tidskriftsartikel (refereegranskat)abstract
- Autism is a developmental, cognitive disorder clinically characterized by impaired social interaction, communication and restricted behaviours. The present study was designed to explore whether an abnormality in transport of tyrosine and/or alanine is present in children with autism. Skin biopsies were obtained from 11 children with autism (9 boys and 2 girls) fulfilling the DSM-IV diagnostic criteria for autistic disorder and 11 healthy male control children. Transport of amino acids tyrosine and alanine across the cell membrane of cultured fibroblasts was studied by the cluster tray method. The maximal transport capacity, Vmax and the affinity constant of the amino acid binding sites, Km, were determined. Significantly increased Vmax for alanine (p = 0.014) and increased Km for tyrosine (p = 0.007) were found in children with autism. The increased transport capacity of alanine across the cell membrane and decreased affinity for transport sites of tyrosine indicates the involvement of two major amino acid transport systems (L- and A-system) in children with autism. This may influence the transport of several other amino acids across the blood–brain-barrier. The significance of the findings has to be further explored. © 2007 Elsevier Ireland Ltd. All rights reserved
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| 3. |
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| 4. |
- Jansson, Lennart, et al.
(författare)
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Clients with long-term mental disabilities in a Swedish county : conditions of life, needs of support and unmet needs of service provided by the public health and social service sectors.
- 2003
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Ingår i: European psychiatry. - : Cambridge University Press (CUP). - 0924-9338 .- 1778-3585. ; 18:6, s. 296-305
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Tidskriftsartikel (refereegranskat)abstract
- Objective The purpose of the study was to identify and describe conditions of life and needs of support and public service for clients with a mental disability in a Swedish county population. Methods Public health care and social service providers identified clients and completed a questionnaire concerning the clients' conditions of life and their special needs. A consecutively recruited sample of clients completed a similar questionnaire. Results Totally, 1261 clients were identified. The prevalence of clients with mental disabilities was in the urban and rural areas, 6.4/1000 inhabitants and 4.5/1000 inhabitants, respectively. The most prevalent unmet need (42.9%) was to participate in social and scheduled activities. Almost half of the group was reported to need support in activities of daily living. Clients living in urban settings more often needed support with activities of daily living (P < 0.001), whereas clients living in rural settings more often needed support with job training (P < 0.001) or finding work (P < 0.01). Clients and psychiatric care providers reported the needs of the clients in the same areas; however, clients reported a fewer number of needs than did the care providers. Conclusions By using both psychiatric care and social service providers, effective case findings of clients with a mental disability were possible to achieve. In general, there was high agreement between psychiatric care providers and clients regarding the clients' number of needs of support and their unmet needs of service. However, at the individual level, the agreement between client and psychiatric care providers was lower.
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| 5. |
- Jansson, Lennart, et al.
(författare)
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Needs assessed by psychiatric health care and social services in a defined cohort of clients with mental disabilities
- 2005
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Ingår i: European Archives of Psychiatry and Clinical Neuroscience. - : Springer Science and Business Media LLC. - 0940-1334 .- 1433-8491. ; 255:1, s. 57-64
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Tidskriftsartikel (refereegranskat)abstract
- Background The identification of needs forsupport and service in clients with long-term mentaldisabilities is usually not done by staff personnel fromboth psychiatric care and social services.However, sucha process is probably necessary in order to provide adequatepsychiatric care and social services. Aims To estimatethe prevalence of mentally disabled clients and investigatewhether staff from psychiatric care and socialservices identified the same individuals and the samenumber of needs in the same areas. Methods Clientsfrom a defined catchment area were identified during athree-month period. A questionnaire was developed tocollect socio-demographic information and to assessneeds for support and service. Results The study identified1,290 clients with needs with a prevalence of5.72/1000 inhabitants. More than half of the clientsneeded support in activities of daily living. Only 18.1%of the clients were identified by both organizations. Ingeneral, the staff from psychiatric care and social servicesidentified the same needs at a group level. However,at the individual level, agreement was quite low.Conclusions The staffs from both psychiatric care andsocial services are necessary to evaluate the needs ofsupport and services in clients with mental disabilities.
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| 6. |
- Jansson, Lennart, 1949-
(författare)
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Needs of Support and Service in Mentally Disabled Clients : Population-Based Studies in a Swedish County
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of the present thesis is to investigate needs of support and service in clients with long-term mental disabilities living in the community. A further aim is to study changes in these client needs during a 3.5-year follow-up. A questionnaire, The Need of Support and Service Questionnaire (NSSQ), was developed to provide staffs in psychiatric care and social services with a brief instrument to assess how their clients live in the community and to identify their needs. The results are based on 1,759 clients. The prevalence of clients in urban and rural areas was 6.4/1,000 and 4.5/1,000 inhabitants, respectively. The clients living in the urban setting were more frequently male, older, with a diagnosis of schizophrenia and needed more support in activities of daily living than rural clients. Clients identified by staff in psychiatric care only were more often living with a partner, with children living at home and more often had a rehabilitation allowance than clients identified by social services staff. In clients assessed by both organizations similar needs at a group level were identified. However, agreements were lower at the individual level. Although clients reported fewer needs than staff in psychiatric care, the reported needs were in the same areas.A majority of the clients with unmet needs of service at baseline had their needs met at the 3.5-year follow-up. New unmet needs were also identified at the follow-up, however. The results demonstrate less improvement in clients with schizophrenia as compared with non-schizophrenic clients.In conclusion, needs of support and service present a dynamic process and both psychiatric care and social services should critically evaluate assessments of these needs.
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| 7. |
- Jansson, Lennart, et al.
(författare)
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The Need of Support and Service Questionnaire (NSSQ) : a brief scale to assess needs in clients with long-term mental disabilities
- 2005
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 59:6, s. 465-472
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Tidskriftsartikel (refereegranskat)abstract
- We present the Need of Support and Service Questionnaire (NSSQ), a new instrument developed to provide professionals in psychiatric care and community social services with a tool to assess needs of support and service in mentally disabled clients. The final version of the instrument was designed after comments from professionals in psychiatric care, community social services, and the clients and their relatives. A reliability study (test-retest, n=77), inter-rater (n=69) and a validity study (n=529) were performed. In the validity study, comparisons were done with the Camberwell Assessment of Need (CAN) scale, the Global Assessment of Functioning (GAF) scale and the Social and Occupational Functioning Assessment Scale (SOFAS). The test-retest and inter-rater reliability were 0.86 and 0.76, respectively. The percentage of agreement on the individual items ranged from 83.1% to 100.0% (test-retest) and 76.8% to 100.0% (inter-rater reliability). The corresponding kappa coefficients ranged from 0.63 to 1.00 (test-retest) and 0.33 to 1.00 (inter-rater reliability). The comparison between NSSQ and CAN items demonstrated high sensitivity and specificity as well as satisfactory likelihood ratios (LRs). The correlations between GAF and SOFAS scores and the number of needs of support, number of needs of service and the total number of needs of support and service were -0.49, -0.32 and -0.47, and -0.48, -0.26 and -0.45, respectively. All correlations were statistically significant (P<0.01). The results demonstrated that the psychometric characteristics of the NSSQ were satisfactory. Moreover, professionals without any formal training easily used it.
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| 8. |
- Kajandi, Madis, 1946-
(författare)
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Studies on Quality of Life : A Methodological Perspective on the Definition and Measurement of the Good Life in Patients with Psychiatric Illness
- 2006
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: In social sciences the quality of life (QOL) concept is often connected with efforts to evaluate welfare and well being. In medicine QOL is frequently used as a complement to evaluations of cure. In psychiatry QOL is of special importance because many patients have to endure long periods of illness. Aims: The thesis proposes a definition and operationalization of the QOL concept from a psychiatric perspective, bearing in mind that groups of patients may have a reduced ability to make proper self-observations. Results: The proposed method measures QOL by means of 17 external, interpersonal and internal variables, contrasting the patients own view (the subjective scale) with that of an interviewer’s view based on rating instructions in a manual (the interviewer scale). Reliabilities and feasibility were shown to be good for the interviewer scale and acceptable for the subjective scale, if respondents have an intact self-observing capacity. The results from the empirical studies concerning levels of QOL for five groups of respondents indicate that the interviewer scale differentiates significantly between healthy respondents as well as patients with varying degrees of illness, suggesting that this scale is sensitive to background differences between respondents. The subjective scale did not discriminate between different psychiatric groups. Both scales had acceptable internal consistencies. Variables in the interviewer scale proved to be sensitive to background differences in treatments, diagnosis, varying symptoms and degrees of psychosocial stress. Cluster analyses of variables resulted in re-appearing core clusters in different samples, indicating that respondents ‘Self-image’, ‘Happiness’, ‘Freedom’, and ‘Security’ are central in the proposed QOL concept. These results were consistent between both scales. Conclusions: The interviewer scale based on the existence of general life values proved to be reliable, valid and acceptable. The subjective scale proved to be a complement to the interviewer scale, reliable and feasible for respondents with intact self-observing capacities. The scales appear to differ in focus by giving more emphasis either on general life values (the interviewer scale) or on people’s adjustment to various life situations (the subjective scale).
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| 9. |
- Nilsson, Björn Mikael, et al.
(författare)
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Differences in resting energy expenditure and body composition between patients with schizophrenia and healthy controls
- 2006
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Ingår i: Acta Psychiatrica Scandinavica. - : Wiley. - 0001-690X .- 1600-0447. ; 114, s. 27-35
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Tidskriftsartikel (refereegranskat)abstract
- Objective: A lowered energy metabolism in schizophrenia was reported already in the 1920s. However, these early investigations were case studies without control groups or statistical analysis. In this study the resting energy expenditure (REE) and relevant body composition variables were measured in patients with schizophrenia and healthy controls. Method: REE was determined in 30 patients and 17 controls. The difference between the measured and the expected level for each individual was calculated as ΔREE. Body composition was assessed with bioelectrical impedance and calliper measurements. Results: ΔREE was significantly lower in the patients than in the controls. A decrease was also seen in the non-medicated patients. The patients showed significantly lower percentages of water in fat free-mass and intracellular water. Conclusion: The lowering of REE and body water fractions may suggest a homeostatic aberration in schizophrenia that may be of importance for the understanding of metabolic disturbances observed in the disease.
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| 10. |
- Nilsson, Björn Mikael, et al.
(författare)
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Physical capacity, respiratory quotient and energy expenditure during exercise in male patients with schizophrenia compared with healthy controls
- 2012
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Ingår i: European psychiatry. - : Cambridge University Press (CUP). - 0924-9338 .- 1778-3585. ; 27:3, s. 206-212
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND Despite massive research on weight gain and metabolic complications in schizophrenia there are few studies on energy expenditure and no current data on physical capacity. AIM: To determine oxygen uptake capacity, respiratory quotient (RQ) and energy expenditure during a submaximal exercise test in patients with schizophrenia and healthy controls. METHOD Ten male patients and 10 controls were included. RQ and energy expenditure were investigated with indirect calorimetry during a cycle ergometer test. The submaximal work level was defined by heart rate and perceived exhaustion. Physical capacity was determined from predicted maximal oxygen uptake capacity (VO(2-max)). RESULTS The patients exhibited significantly higher RQ on submaximal workloads and lower physical capacity. A significant lower calculated VO(2-max) remained after correction for body weight and fat free mass (FFM). Energy expenditure did not differ on fixed workloads. CONCLUSION RQ was rapidly increasing in the patients during exercise indicating a faster transition to carbohydrate oxidation and anaerobic metabolism that also implies a performance closer to maximal oxygen uptake even at submaximal loads. This may restrict the capacity for everyday activity and exercise and thus contribute to the risk for weight gain. Physical capacity was consequently significantly lower in the patients.
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| 11. |
- Nilsson, Björn, et al.
(författare)
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Niacin skin-flush response and electrodermal activity in patients with schizophrenia and healthy controls
- 2006
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Ingår i: Prostaglandins, Leukotrienes and Essential Fatty Acids. - : Elsevier BV. - 0952-3278 .- 1532-2823. ; 74, s. 339-346
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Tidskriftsartikel (refereegranskat)abstract
- Patients with schizophrenia have in different studies shown reduced niacin sensitivity and lower electrodermal activity (EDA) after auditory stimulation. Peripheral mediation of prostaglandins may have a physiological role in both responses. This motivates study of both niacin response and electrodermal responding in the same patients with schizophrenia. Thirty patients with schizophrenia and 17 controls were investigated with EDA and thereafter given 200 mg niacin orally with continuous assessment of skin temperature. The patients showed a delayed temperature increase after niacin ingestion (P = 0.002) and a higher frequency of electrodermal non-responding (P < 0.05). Response/non-response for niacin correlated with EDA response/non-response in the patient group (P = 0.009). The niacin test revealed a slower vasodilation reaction in the patients. The association between response patterns for the niacin test and EDA suggests that a common aberration in skin physiology may be of importance for both reactions in schizophrenia.
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| 12. |
- Olsson, Emma, 1977-, et al.
(författare)
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Tyrosine transport in fibroblasts from healthy volunteers and patients with schizophrenia
- 2006
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Ingår i: Neuroscience Letters. - : Elsevier. - 0304-3940 .- 1872-7972. ; 393, s. 211-215
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Tidskriftsartikel (refereegranskat)abstract
- Aberrant tyrosine transport across the fibroblast membrane, as measured by lower Vmax and/or lower Km is a repeated finding in patients with schizophrenia. The aim of this study was to investigate the importance of two major transporters, the L- and A-systems and tyrosine transport in fibroblast cell lines from patients with schizophrenia and healthy volunteers. Fibroblast cell lines, n=6 from healthy volunteers and n=6 from patients with schizophrenia, were included in the study. Uptake of [14-C] L-tyrosine in fibroblasts was measured using the cluster tray method in absence and presence of inhibitors. The uptake of tyrosine by the L-system was evaluated with the inhibitor 2-aminobicyclo heptane-2-carboxylic acid (BCH) and the A-system with the inhibitor nonmetabolized methyl-aminoisobutyric acid (MeAIB). Using [14-C] MeAIB the functionality of system A isoform 2, ATA2, was tested. BCH inhibited the uptake of tyrosine with 90%, showing that tyrosine transport in fibroblasts is mainly transported by the L-system. Not more than 10% could be contributed by the A-system. Excess of MeAIB did not influence tyrosine kinetics. Moreover, MeAIB kinetics did not differ between the patients and the controls. In conclusion, aberrant tyrosine transport observed in patients with schizophrenia is probably linked to the one of the L-systems and does not seem to involve the ATA2 transporter.
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| 13. |
- Umb-Carlsson, Õie, 1953-
(författare)
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Living Conditions of People with Intellectual Disabilities : A Study of Health, Housing, Work, Leisure and Social Relations in a Swedish County Population
- 2005
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The general aim of this thesis is to describe mortality, health and living conditions in an administratively defined county population of people with intellectual disabilities born between 1959 and 1974 (N=213). The living conditions of persons with intellectual disabilities were compared with those of the general population. Moreover, the reports of relatives and staff were compared on the living conditions of people with intellectual disabilities. Information on the living conditions of persons with intellectual disabilities was provided by proxy (relative and staff) questionnaire reports and national welfare statistics conducted by Statistics Sweden (SCB). Medical examination and medical case records were used to obtain data on health and medical services. People with intellectual disabilities lived in the community and took part in numerous common recreational and cultural activities. However, the comparison with the general population indicated clear differences in living conditions, particularly regarding employment and social life. In contrast, surprisingly little variation in living conditions was found in people with intellectual disabilities, despite varying ages and a wide range of level of disabilities. In addition, gender related differences of persons with intellectual disabilities were few when compared with those found in the general population. A wide range of physical and mental health problems were identified in the group with intellectual disabilities. Although a majority of persons with intellectual disabilities had access to a family doctor and attended regular health checks, a number of needs of specialist examinations were identified indicating shortcomings in the quality of health care. Analyses indicated differences in the reports of relatives and staff on living conditions of most domains included in the questionnaire. In general, disagreement was higher on subjective than on objective items. Relative and staff responders contribute dissimilar information that is related to varying viewpoints and different types of information.
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| 14. |
- Vumma, Ravi, et al.
(författare)
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Functional characterization of tyrosine transport in fibroblast cells from healthy controls
- 2008
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Ingår i: Neuroscience Letters. - : Elsevier BV. - 0304-3940 .- 1872-7972. ; 434:1, s. 56-60
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Tidskriftsartikel (refereegranskat)abstract
- Human fibroblast cells are an advantageous model to study the transport of amino acids across cell membranes, since one can control the environmental factors. A major problem in all earlier studies is the lack of precise and detailed knowledge regarding the expression and functionality of tyrosine transporters in human fibroblasts. This motivated us to perform a systematic functional characterization of the tyrosine transport in fibroblast cells with respect to the isoforms of system-L (LAT1, LAT2, LAT3, LAT4), which is the major transporter of tyrosine. Ten (n=10) fibroblast cell lines from healthy volunteers were included in the study. Uptake of L-[U-14C] tyrosine in fibroblasts was measured using the cluster tray method in the presence and absence of excess concentrations of various combinations of inhibitors. This study demonstrated that LAT1 is involved in 90% of total uptake of tyrosine and also around 51% of alanine. Not more than 10% can be accounted for by LAT2, LAT3 and LAT4 isoforms. LAT2 seems to be functionally weak in uptake of tyrosine while LAT3 and LAT4 contributed around 7%. 10% could be contributed by system-A (ATA2 isoform). Alanine consequently inhibited the tyrosine transport by up to 60%. Tyrosine transport through the LAT1 isoform has a higher affinity compared to system-L. In conclusion, the LAT1 isoform is the major transporter of tyrosine in human fibroblast cells. Competition between tyrosine and alanine for transport is shown to exist, probably between LAT1 and LAT2 isoforms. This study established fibroblast cells as a suitable experimental model for studying amino acid transport defects in humans.
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| 15. |
- Wennström, Erik, et al.
(författare)
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Deconstructing the 'black box' of the Camberwell assessment of need score in mental health services evaluation
- 2008
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 43:9, s. 714-719
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The aim of the study was to examine an alternative way of scoring the Camberwell Assessment of Need (CAN) for the purpose of service evaluation, using the by us defined Social Services (SI) and Psychiatric Services (PI) subindices. Methods: CAN assessments in 1997 and 1999 of 262 outpatients (mean age 45 years, 77.1% psychotic disorders) were reanalysed to fit the SI and the PI, which were compared to the full CAN. Results: The mean total needs on the full CAN decreased from 6.65 to 6.22 (P = 0.007), as did the mean unmet needs (1.55-1.81, P = 0.049). The mean total needs on the PI decreased from 2.42 to 2.22 (P = 0.006), as did the mean unmet needs (1.66-0.57, P < 0.001). No changes in mean needs occurred on the SI. Conclusions: All significant changes occurred on the PI, indicating a more beneficial outcome of the psychiatric care than the social care in terms of meeting needs, a result impossible to discern from the total scores of the CAN. Thus, output scores on subindices of the CAN might be useful as outcome measures in service evaluation.
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| 16. |
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| 17. |
- Wennström, Erik, et al.
(författare)
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The Camberwell Assessment of Need as an outcome measure in routine mental health care
- 2006
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 41:9, s. 728-733
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Tidskriftsartikel (refereegranskat)abstract
- Background. Subsidiary findings in several studies indicate that the standard summary scores (total number of needs, met needs and unmet needs) of the Camberwell Assessment of Need (CAN) may conceal important differences among patient populations at the item level of the measure. The aim of this study was to investigate whether changes in need and need status at the item level are adequately reflected by changes in the summary scores. Methods. In a longitudinal design assessments of need in 1997 and 2003 of 192 outpatients (mean age 45.4 years, 78.1% psychotic disorders) in routine mental health care were compared. Results. None of the summary scores changed between 1997 and 2003. This result, however, was contradicted by significant changes in needs at the item level. Conclusions. The summary scores conceal changes in need on the underlying items and thus is recommended not to be used as dependent measures when comparisons among populations or between points in time are of interest.
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| 18. |
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| 19. |
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