| 1. |
- Ayob, Leith, et al.
(författare)
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ABC om Wernickes encefalopati
- 2022
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Ingår i: Psykoser och andra psykosliknande tillstånd. - Stockholm : Läkartidningen Förlag AB. - 9789198509830 ; , s. 86-93
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 2. |
- Bhugra, Dinesh, et al.
(författare)
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World Psychiatric Association-Asian journal of psychiatry commission on psychiatric education in the 21st century
- 2023
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Ingår i: Asian Journal of Psychiatry. - : Elsevier. - 1876-2018 .- 1876-2026. ; 88
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Tidskriftsartikel (refereegranskat)abstract
- Psychiatric practice faces many challenges in the first quarter of 21st century. Society has transformed, as have training requirements and patient expectations, underlining an urgent need to look at educational programmes. Meanwhile, awareness has grown around psychiatric disorders and there are evolving workforce trends, with more women going to medical school and specialising in psychiatry. Trainee psychiatrists carry different expectations for work-life balance and are increasingly becoming conscious of their own mental health. A tendency to see health as a commodity and the litigious nature of society has elicited additional pressures for healthcare professionals. Cartesian mind-body dualism has created further complexity and this can often be frustrating for patients and care-partners alike. In many cultures across Asia and beyond, patients can present with physical symptoms to express underlying psychological distress with increasing physical investigations. Simultaneously, in various countries, a shift from asylums to community-based interventions and then home treatments have changed psychiatric care in remarkable ways. These changes have added to pressures faced by mental healthcare professionals. However, trainees and other mental healthcare professionals continue to receive similar training as they did a generation ago. The tensions and differences in ideology/orientation between different branches of psychiatry have made responses to patient needs challenging. Recognising that it is difficult to predict the future, this World Psychiatric Association-Asian Journal of Psychiatry Commission makes recommendations that could help institutions and individuals enhance psychiatric education. This Commission draws from existing resources and recent developments to propose a training framework for future psychiatrists.
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| 3. |
- Clapham, Eric
(författare)
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Suicide in schizophrenia and adverse events during antipsychotic medication
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis considers side effects and other adverse events during treatment with antipsychotic medication. All included studies use an epidemiological methodology with data from Swedish population-based health registers. The first two studies utilise a nested case-control design, whereas the third and fourth studies rely on cohort designs.The first study considers the impact of extrapyramidal symptoms on suicidality in a schizophrenia spectrum patient group in Stockholm County in Sweden. In this sample, extrapyramidal symptoms are found to be associated with a decreased risk of suicide.The second study involves suicidal communication, blindly extracted from patient records, as risk factors for suicide among patients with schizophrenia spectrum disorders. More severe forms of suicidal ideation and behaviour, such as suicide attempt, are associated with a higher risk of death by suicide, which is consistent with current clinical practice regarding suicide risk assessments.The third study considers the risk of bone fracture during treatment with antipsychotic medications. The study finds that risperidone is not associated with an increased risk of fracture compared with first-generation antipsychotics.The fourth study considers the risk of perimyocarditis and heart failure during treatment with clozapine and the chemically similar medications olanzapine and quetiapine. It finds that clozapine is associated with a substantially elevated risk of perimyocarditis in the short term and a more modest risk of heart failure in the long term, compared with no antipsychotic treatment. Treatment with at least one of olanzapine or quetiapine is not found to be associated with an increased risk of these adverse cardiac events, compared with no antipsychotic medication.
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| 4. |
- Fransson, Filip, et al.
(författare)
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Kidney function in patients with bipolar disorder with and without lithium treatment compared with the general population in northern Sweden : results from the LiSIE and MONICA cohorts
- 2022
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Ingår i: Lancet psychiatry. - : Elsevier. - 2215-0374 .- 2215-0366. ; 9:10, s. 804-814
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Tidskriftsartikel (refereegranskat)abstract
- Background: The clinical relevance of lithium nephropathy is subject to debate. Kidney function decreases with age and comorbidities, and this decline might lead to attribution bias when erroneously ascribed to lithium. We aimed to investigate whether patients with bipolar or schizoaffective disorder had faster decline in estimated glomerular filtration rate (eGFR) compared with the general population, whether observed differences in the steepness of the decline were attributable to lithium, and whether such changes depended on the length of lithium exposure.Methods: In this cross-sectional cohort study, we used clinical data from the Lithium–Study into Effects and Side-effects (LiSIE) retrospective cohort study, which included patients with bipolar disorder or schizoaffective disorder whose medical records were reviewed up to Dec 31, 2017, and the WHO Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, covering a representative sample of the general population in northern Sweden aged 25–74 years. The primary outcome was the age-associated decline of creatinine-based eGFR, assessed using linear regression. We adjusted for sex and grouped for different lengths of lithium exposure (never or <1 year, 1–5 years, >5–10 years, and >10 years). For patients with moderate-to-severe kidney disease we identified the underlying nephropathy in the case records.Findings: From LiSIE, we included 785 patients (498 [63%] female and 287 [37%] male), with a mean age of 49·8 years (SD 13·2; range 25–74). From MONICA, we included 1549 individuals (800 [52%] female and 749 [48%] male), with a mean age of 51·9 years (13·8; 25–74). No ethnicity data were collected. Adjusted for duration of lithium exposure, eGFR declined by 0·57 mL/min/1·73 m2/year (95% CI 0·50–0·63) in patients with bipolar disorder or schizoaffective disorder and by 0·57 mL/min/1·73 m2/year (0·53–0·61) in the reference population. Lithium added 0·54 mL/min/1·73 m2 (0·43–0·64) per year of treatment (p<0·0001). After more than 10 years on lithium, decline was significantly steeper than in all other groups including the reference population (p<0·0001). Lithium nephropathy was judged to be the commonest cause of moderate-to-severe chronic kidney disease, but comorbidities played a role. The effect of lithium on eGFR showed a high degree of inter-individual variation.Interpretation: Steeper eGFR decline in patients with bipolar disorder or schizoaffective disorder can be attributed to lithium, but the trajectory of kidney function decline varies widely. Comorbidities affecting kidneys should be treated assertively as one possible means to affect the trajectory. In patients with a fast trajectory, a trade-off is required between continuing lithium to treat mental health problems and discontinuing lithium for the sake of renal health.Funding: Norrbotten County Research and Learning Fund Sweden, Visare Norr (Northern County Councils Regional Federation Fund), Swedish Kidney Foundation (Njurfonden), Swedish Kidney Association (Njurförbundet), Norrbotten section.Translation: For the Swedish translation of the Summary see Supplementary Materials section.
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| 5. |
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| 6. |
- Gibbs, Anna, et al.
(författare)
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COVID-19-associated mortality in individuals with serious mental disorders in Sweden during the first two years of the pandemic : a population-based register study
- 2024
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Ingår i: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Reports at the beginning of the COVID-19 pandemic suggested differences in COVID-19-associated mortality between individuals with serious mental disorders (SMD) and the population at large.Aim: To compare the pattern of COVID-19-associated mortality in individuals with and without SMD in Sweden over the two main pandemic years.Methods: We compared the pattern of COVID-19-associated mortality in individuals with and without SMD in Sweden during 2020 and 2021. For SMD, we included psychotic disorder, bipolar disorder, and severe depression. The analysis was based on summary data from the Swedish Board of Health and Welfare covering the entire adult Swedish population.Results: The overall relative risk (RR) for experiencing a COVID-19-associated death was 1.66 (CI 1.50–1.83; p < 0.001) for individuals with SMD versus individuals without SMD. The corresponding RRs were 3.25 (CI 2.84–3.71; p < 0.001) for individuals with psychotic disorder, 1.06 (CI 0.88–1.26; p = 0.54) for individuals with bipolar disorder, and 1.03 (CI 0.80–1.32; p = 0.80) for individuals with severe depression. Compared to their respective counterparts in the non-SMD group, in the psychotic disorder and severe depression group, the RR were higher in women than in men. In the bipolar disorder group, the RR was higher in men than in women. The RR of COVID-19-associated death was generally higher in younger individuals with SMD. Individuals with psychosis between 18 and 59 years had the highest RR of COVID-19-associated death with 7.25 (CI 4.54–11.59; p<0.001).Conclusions: Individuals with SMD, and particularly those with psychotic disorders, had a higher risk of COVID-19-associated death than the general population. As this is a pattern also seen with other infections, people with SMD may be similarly vulnerable in future pandemics.
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| 7. |
- Gunnerlind, Oscar, et al.
(författare)
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Alcohol consumption under lockdown measures during the COVID-19 pandemic in three Nordic countries
- 2024
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Ingår i: International Journal of Social Psychiatry. - : Sage Publications. - 0020-7640 .- 1741-2854. ; 70:1, s. 48-58
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Tidskriftsartikel (refereegranskat)abstract
- Background: At the beginning of the COVID-19 pandemic, concerns arose about a possible rise in alcohol consumption. Early surveys, however, more commonly pointed towards a decrease of alcohol use. But studies based on self-reports may underestimate alcohol use. They also depend on the population sampled. Because of border closures and gastronomy restrictions, countries with centralised alcohol sales provided a unique opportunity to study total domestic consumption during the pandemic without influence of private import or reliance on self-reports.Aims: We examined the correlation between alcohol sales and national COVID-19 restrictions in three such countries, Finland, Norway and Sweden.Method: We conducted this study as a mirror image study, comparing alcohol sales during the first 2 years of the COVID-19 pandemic with the two preceding years. We explored hours of daylight/season as potential confounders.Results: We found no relevant change in alcohol sales during the pandemic years for Finland or Sweden. For Norway, there was a level-change in sales, which could be explained by decreased imports. Sales followed a seasonal pattern. In all three countries, the initial pandemic increase in alcohol sales coincided with an underlying annually recurring seasonal variation.Conclusions: The COVID-19 pandemic had less of an impact on alcohol consumption in the three Nordic countries than could intuitively be expected. The increase of alcohol sales at the beginning of the COVID-19 pandemic coincided with a seasonal rise following a pre-pandemic pattern. Therefore, caution should be exercised with drawing conclusions from data with a short time perspective to avoid attribution bias.
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| 8. |
- Lieber, Ingrid, 1990-
(författare)
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Affective disorders and their treatments : implications for thyroid function
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- BackgroundThe relationship between affective disorders, mood-stabilisers and thyroid dysfunction is complex and poorly understood. Symptoms of thyroid dysfunction can overlap with symptoms of affective disorder, destabilise mood, and impact physical health. Subjective symptoms and biochemical abnormalities may not always match, especially when changes in thyroid function are only mild. Therefore, diagnosis and treatment of both hypothyroidism and hyperthyroidism in individuals with affective disorders remain complex. For lithium, a first-line treatment for bipolar disorder, an impact on thyroid function was first described in 1968. Since that time, it has become evident that lithium is much more frequently associated with hypothyroidism than hyperthyroidism. But even for lithium, many aspects of how associated thyroid dysfunction should be handled remain unclear. Aims The overall aim of this thesis was, in five studies, to examine aspects of the diagnosis and treatment of thyroid dysfunction in individuals with affective disorders, with a particular focus on lithium. The individual aims of the five studies were todetermine if lithium-associated hypothyroidism was reversible in individuals who had discontinued lithium.identify patterns and trends in thyroid hormone replacement therapy prescribed for individuals with bipolar or schizoaffective disorder.assess whether elevated thyroxine concentrations (hyperthyroxinaemia) were a risk factor for lithium intoxication caused by a change in tubular renal function.examine the incidence rate and aetiology of lithium-associated hyperthyroidism in individuals with bipolar or schizoaffective disorder.explore the attitudes of practising clinicians towards the diagnosis and treatment of subclinical hypothyroidism in individuals with or without affective disorder or anxiety.MethodsStudies 1–4 were part of the LiSIE (Lithium - Study into Effects and Side Effects) retrospective cohort study. LiSIE compares the effects and adverse effects of lithium treatment and other mood stabilisers in the Norrbotten Region and the Region of Västerbotten over a time period of up to 21 years between 1997–2017. For our studies, we used data from the Norrbotten Region only. Study 5 used a three-round modified Delphi consensus-building process. Study 5 was conducted with clinicians from three specialties, general practice, endocrinology and psychiatry, from two countries with similar health care systems, Sweden and the UK. ResultsStudy 1: Of 1340 potentially eligible individuals with lithium treatment, 90 individuals (who had developed hypothyroidism while treated with lithium and later discontinued lithium), were included. Of these, 27% had overt hypothyroidism at the start of thyroid hormone replacement therapy. Of the 85 individuals available for follow-up, 41% stopped thyroid hormone replacement therapy after lithium discontinuation. Only six individuals reinstated thyroid hormone replacement therapy subsequently. Only one had overt hypothyroidism.Study 2: Of 1564 potentially eligible individuals with bipolar or schizoaffective disorder, 291 (27%) had received thyroid hormone replacement therapy at some point during the 21-year review period. In 41% of cases, thyroid hormone replacement therapy was started for subclinical hypothyroidism. At the start of thyroid hormone replacement therapy, the median thyroid stimulating hormone (TSH) concentration was 6.0 (IQR 4.0) mIU/L. The median free serum thyroxine (fT4) was 11.8 (IQR 3.9) pmol/L. The median TSH concentration at the start of thyroid hormone replacement therapy decreased annually by 0.10 mIU/L, being significantly higher in individuals treated with lithium than in individuals treated with other mood stabilisers.Study 3: Of 1562 potentially eligible individuals with bipolar or schizoaffective disorder, 53 individuals had experienced a total of 65 episodes of unintentional lithium intoxication during the review period. In nine episodes, there was elevated fT4 at the time of lithium intoxication, corresponding to an incidence of 1.3 episodes/1000 person-years. For all nine episodes of unintentional lithium intoxication, we could identify alternative explanations that were more plausible than hyperthyroxinaemia. Study 4: In 1562 individuals with bipolar disorder or schizoaffective disorder, we identified 16 episodes of hyperthyroidism, corresponding to an incidence rate of 0.9 episodes/1000 person-years. Individuals who had concurrently been exposed to lithium, had an incidence rate of 1.3 episodes/1000 person-years. Individuals who had been previously exposed to lithium had an incidence rate of 0.8/1000 person-years. Individuals who had never been exposed to lithium (lithium naïve) had a 0.5/1000 person-years incidence rate. There were no significant differences in the risk ratios for individuals with concurrent or previous exposure compared to lithium-naïve individuals, neither for hyperthyroidism overall, nor for thyrotoxicosis or thyroiditis. Study 5: For the expert panel, 60 clinicians; 20 general practitioners, 20 endocrinologists and 20 psychiatrists were recruited. Fifty-three (88%) participants completed all three rounds. The participants reached a consensus on five of the 26 practice statements. The participants agreed that (a) repeated testing was required for the diagnosis of subclinical hypothyroidism, (b) antibody screening should usually occur, and (c and d) antibody screening would strengthen the indication for thyroid hormone replacement therapy in both individuals with and without affective disorder or anxiety. The participants disagreed with (e) requiring a TSH threshold of ≥ 20 mIU/L before starting thyroid hormone replacement therapy.ConclusionsStudy 1: In most cases, lithium-associated hypothyroidism appears reversible. Therefore, thyroid hormone replacement therapy could be discontinued more often once lithium is stopped. Study 2: In most cases, thyroid hormone replacement therapy was started with mild or absent thyroid function changes. The TSH level at which thyroid hormone replacement therapy was initiated decreased over time. When starting thyroid hormone replacement therapy for subclinical hypothyroidism in people with bipolar or schizoaffective disorder, clinicians must carefully weigh the benefits and risks.Study 3: Lithium intoxication with simultaneously elevated fT4 is uncommon. A direct causal link between elevated fT4 and altered tubular renal function remains elusive. An increased frequency of routine thyroid function tests is unlikely to decrease the risk of lithium intoxication. Study 4: Lithium-associated hyperthyroidism is uncommon. The risk of hyperthyroidism does not differ significantly between lithium-exposed and lithium-naïve individuals.Study 5: Attitudes toward diagnosing and treating subclinical hypothyroidism remain diverse. A threshold of an TSH of at least 20 mIU/L for thyroid hormone replacement therapy start, suggested in a previously published guideline, was deemed too high. As the evidence regarding diagnosis and treatment of subclinical hypothyroidism remains limited, future guidelines should consider the views of a broad range of practising clinicians to increase their clinical acceptability and usefulness.
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| 9. |
- Lieber, Ingrid, et al.
(författare)
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Elevated Thyroxine Concentration and Lithium Intoxication - An Analysis Based on the LiSIE Retrospective Cohort Study
- 2022
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Ingår i: Journal of Clinical Medicine. - : MDPI. - 2077-0383. ; 11:11
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Tidskriftsartikel (refereegranskat)abstract
- (1) Background: It has been suggested that hyperthyroxinaemia is a risk factor for lithium intoxication by altering tubular renal function. (2) Methods: We determined the relevance of hyperthyroxinaemia as a risk factor for lithium intoxication in patients with bipolar or schizoaffective disorder in the framework of the LiSIE (Lithium-Study into Effects and Side Effects) retrospective cohort study. Of 1562 patients included in the study, 897 patients had been exposed to lithium at any time between 1997 and 2017 with 6684 person-years of observation. (3) Results: There were 65 episodes of unintentional lithium intoxication in 53 patients. There were nine episodes with hyperthyroxinaemia at the time of lithium intoxication, yielding an incidence of 1.3 episodes/1000 person-years. For all nine episodes, we could identify alternative, more plausible, explanations for the observed lithium intoxications. (4) Conclusions: We conclude that hyperthyroxinaemia-associated unintentional lithium intoxication is an uncommon event. A direct causal link between hyperthyroxinaemia and altered tubular renal function remains elusive. Increasing the frequency of routine thyroid function tests seems unlikely to decrease the risk of lithium intoxication.
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| 10. |
- Lieber, Ingrid, et al.
(författare)
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Incidence of hyperthyroidism in patients with bipolar or schizoaffective disorder with or without lithium : 21-year follow-up from the LiSIE retrospective cohort study
- 2023
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Ingår i: Therapeutic Advances in Psychopharmacology. - : Sage Publications. - 2045-1253 .- 2045-1261. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: Lithium-associated hyperthyroidism is much rarer than lithium-associated hypothyroidism. Yet, it may be of substantial clinical significance for affected individuals. For instance, lithium-associated hyperthyroidism could destabilise mood, mimic manic episodes and impact physical health. Only few studies have explored incidence rates of lithium-associated hyperthyroidism. Even fewer studies have compared incidence rates according to lithium exposure history.Objectives: To determine the impact of lithium treatment on the incidence rate of hyperthyroidism in patients with bipolar or schizoaffective disorder and assess its aetiology.Design: This study is part of the LiSIE (Lithium - Study into Effects and Side Effects) retrospective cohort study.Methods: Between 1997 and 2017, patients in the Swedish region of Norrbotten with a diagnosis of bipolar or schizoaffective disorder were screened for all episodes of overt hyperthyroidism in form of thyrotoxicosis or thyroiditis. Incidence rates of episodes of hyperthyroidism per 1000 person-years (PY) were compared in relation to lithium exposure; concurrent, previous, or no exposure ever (lithium-naïve patients).Results: In 1562 patients, we identified 16 episodes of hyperthyroidism corresponding to an incidence rate of 0.88 episodes per 1000 PY. Ninety-four percent of episodes had occurred in women. Patients who had concurrently been exposed to lithium, had an incidence rate of 1.35 episodes per 1000 PY. Patients who had previously been exposed to lithium had an incidence rate of 0.79 per 1000 PY. Patients who had never been exposed to lithium had an incidence rate of 0.47 per 1000 PY. There were no significant differences in the risk ratios for patients with concurrent or previous exposure compared with lithium-naïve patients, neither for hyperthyroidism overall, thyrotoxicosis, or thyroiditis.Conclusion: Lithium-associated hyperthyroidism seems uncommon. The risk of hyperthyroidism does not seem significantly higher in patients with current or previous lithium exposure than in lithium-naïve patients.
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