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  • 1.
    Agnafors, Sara
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Children's and Women's Health. Linköping University, Faculty of Medicine and Health Sciences. Sodra Alvsborgs Hosp, Sweden.
    Kjellstrom, Anna Norman
    Reg Vastra Gotaland, Sweden.
    Bjork, Marcus Praetorius
    Reg Vastra Gotaland, Sweden; Univ Gothenburg, Sweden.
    Rusner, Marie
    Sodra Alvsborgs Hosp, Sweden; Univ Gothenburg, Sweden.
    Torgerson, Jarl
    Sahlgrens Univ Hosp, Sweden.
    Health care utilization in children and adolescents with psychiatric disorders2023In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 148, no 4, p. 327-337Article in journal (Refereed)
    Abstract [en]

    Objective: Mental illness is increasing among young people and likewise the request for health care services. At the same time, somatic comorbidity is common in children and adolescents with psychiatric disorders. There is a lack of studies on health care use in children and adolescents, and the hypothesis was that children and adolescents with psychiatric disorders use more primary-, and specialized somatic health care compared to children without psychiatric disorders. Methods: In this retrospective population-based register study, all individuals aged 3-17 years living in Vastra Gotaland region in Sweden in 2017 were included (n = 298,877). Linear and Poisson regression were used to compare health care use during 2016-2018 between children with and without psychiatric diagnoses, controlling for age and gender. The results were reported as unstandardised beta coefficient (beta) and adjusted prevalence ratio (aPR) respectively. Results: Having a psychiatric diagnosis was associated with more primary care visits (beta 2.35, 95% CI 2.30-2.40). This applied to most diagnoses investigated. Girls had more primary care visits than boys. Likewise, individuals with psychiatric diagnoses had more specialized somatic outpatient care (beta 1.70, 95% CI 1.67-1.73), both planned and unplanned (beta 1.23, 95% CI 1.21-1.25; beta 0.18, 95% CI 0.17-0.19). Somatic inpatient care was more common in those having a psychiatric diagnosis (aPR 1.65, 95% CI 1.58-1.72), with the diagnoses of psychosis and substance use exerting the greatest risk. Conclusions: Psychiatric diagnoses were associated with increased primary-, somatic outpatient- as well as somatic inpatient care. Increased awareness of comorbidity and easy access to relevant health care could be beneficial for patients and caregivers. The results call for a review of current health care systems with distinct division between medical disciplines and levels of health care.

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  • 2.
    Andersson, Gerhard
    Linköping University. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences and Learning.
    The contribution of active medication to combined treatments of psychotherapy and pharmacotherapy for adult depression: a meta-analysis.2010In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 121, no 6, p. 415-23Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Although there is sufficient evidence that combined treatments of psychotherapy and pharmacotherapy are more effective for depression in adults than each of the treatments alone, it remains unclear what the exact contribution of active medication is to the overall effects of combined treatments. This paper examines the contribution of active medication to combined psychotherapy and pharmacotherapy treatments. METHOD: Meta-analysis of randomised controlled trials comparing the combination of psychotherapy and pharmacotherapy with the combination of psychotherapy and placebo. RESULTS: Sixteen identified studies involving 852 patients met our inclusion criteria. The standardised mean difference indicating the differences between the combination of psychotherapy and pharmacotherapy and the combination of psychotherapy and placebo was 0.25 (95% CI: 0.03-0.46), which corresponds to a numbers-needed-to-be-treated of 7.14. No significant differences between subgroups of studies were found. CONCLUSION: Active medication has a small but significant contribution to the overall efficacy of combined treatments.

  • 3.
    Bogren, Lennart
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Bogren, Inga-Britt
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Early visual information processing and the defence mechanism test in schizophrenia.1999In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 6, p. 460-465Article in journal (Refereed)
  • 4.
    Dragioti, Elena
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. University of Ioannina, Greece.
    Karathanos, V.
    University of Ioannina, Greece.
    Gerdle, Björn
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Evangelou, E.
    University of Ioannina, Greece; Imperial Coll London, England.
    Does psychotherapy work? An umbrella review of meta-analyses of randomized controlled trials2017In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 136, no 3, p. 236-246Article, review/survey (Refereed)
    Abstract [en]

    Objective: To map and evaluate the evidence across meta-analyses of randomized controlled trials (RCTs) of psychotherapies for various outcomes. Methods: We identified 173 eligible studies, including 247 meta-analyses that synthesized data from 5157 RCTs via a systematic search from inception to December 2016 in the PubMed, PsycINFO and Cochrane Database of Systematic Reviews. We calculated summary effects using random-effects models, and we assessed between-study heterogeneity. We estimated whether large studies had significantly more conservative results compared to smaller studies (small-study effects) and whether the observed positive studies were more than expected by chance. Finally, we assessed the credibility of the evidence using several criteria. Results: One hundred and ninety-nine meta-analyses were significant at P-value amp;lt;= 0.05, and almost all (n = 196) favoured psychotherapy. Large and very large heterogeneity was observed in 130 meta-analyses. Evidence for small-study effects was found in 72 meta-analyses, while 95 had evidence of excess of significant findings. Only 16 (7%) provided convincing evidence that psychotherapy is effective. These pertained to cognitive behavioural therapy (n = 6), meditation therapy (n = 1), cognitive remediation (n = 1), counselling (n = 1) and mixed types of psychotherapies (n = 7). Conclusions: Although almost 80% meta-analyses reported a nominally statistically significant finding favouring psychotherapy, only a few meta-analyses provided convincing evidence without biases.

  • 5.
    Hedman, E.
    et al.
    Karolinska University Hospital Huddinge, Sweden Karolinska Institute, Sweden .
    Andersson, E.
    Karolinska University Hospital Huddinge, Sweden .
    Ljotsson, B.
    Karolinska University Hospital Huddinge, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Andersson, E.
    Karolinska University Hospital Huddinge, Sweden .
    Schalling, M.
    Karolinska Institute, Sweden Karolinska Institute, Sweden .
    Lindefors, N.
    Karolinska University Hospital Huddinge, Sweden .
    Ruck, C.
    Karolinska University Hospital Huddinge, Sweden .
    Clinical and genetic outcome determinants of Internet- and group-based cognitive behavior therapy for social anxiety disorder2012In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 126, no 2, p. 126-136Article in journal (Refereed)
    Abstract [en]

    Hedman E, Andersson E, Ljotsson B, Andersson G, Andersson E, Schalling M, Lindefors N, Ruck C. Clinical and genetic outcome determinants of Internet- and group-based cognitive behavior therapy for social anxiety disorder (SAD). Objective: No study has investigated clinical or genetic predictors and moderators of Internet-based cognitive behavior therapy (ICBT) compared with cognitive behavioral group therapy for (CBGT) for SAD. Identification of predictors and moderators is essential to the clinician in deciding which treatment to recommend for whom. We aimed to identify clinical and genetic (5-HTTLPR, COMTval158met, and BDNFval66met) predictors and moderators of ICBT and CBGT. Method: We performed three types of analyses on data from a sample comprising participants (N = 126) who had undergone ICBT or CBGT in a randomized controlled trial. Outcomes were i) end state symptom severity, ii) SAD diagnosis, and iii) clinically significant improvement. Results: The most stable predictors of better treatment response were working full time, having children, less depressive symptoms, higher expectancy of treatment effectiveness, and adhering to treatment. None of the tested gene polymorphisms were associated with treatment outcome. Comorbid general anxiety and depression were moderators meaning that lower levels were associated with a better treatment response in ICBT but not in CBGT. Conclusion: We conclude that demographic factors, symptom burden, adherence, and expectations may play an important role as predictors of treatment outcome. The investigated gene polymorphisms do not appear to make a difference.

  • 6.
    Hedman, E.
    et al.
    Karolinska Institute, Sweden Karolinska Institute, Sweden Karolinska Institute, Sweden .
    Ljotsson, B.
    Karolinska Institute, Sweden Karolinska Institute, Sweden .
    Ruck, C.
    Karolinska Institute, Sweden .
    Bergstrom, J.
    Stockholm University, Sweden .
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Kaldo, V.
    Karolinska Institute, Sweden .
    Jansson, L.
    Karolinska Institute, Sweden .
    Andersson, E.
    Karolinska Institute, Sweden .
    Andersson, E.
    Karolinska Institute, Sweden .
    Blom, K.
    Karolinska Institute, Sweden .
    El Alaoui, S.
    Karolinska Institute, Sweden .
    Falk, L.
    Karolinska Institute, Sweden .
    Ivarsson, J.
    Karolinska Institute, Sweden .
    Nasri, B.
    Karolinska Institute, Sweden .
    Rydh, S.
    Karolinska Institute, Sweden .
    Lindefors, N.
    Karolinska Institute, Sweden .
    Effectiveness of Internet-based cognitive behaviour therapy for panic disorder in routine psychiatric care2013In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 128, no 6, p. 457-467Article in journal (Refereed)
    Abstract [en]

    ObjectiveGuided Internet-based cognitive behaviour therapy (ICBT) for panic disorder has been shown to be efficacious in several randomized controlled trials. However, the effectiveness of the treatment when delivered within routine psychiatric care has not been studied. The aim of this study was to investigate the effectiveness of ICBT for panic disorder within the context of routine psychiatric care. MethodWe conducted a cohort study investigating all patients (n=570) who had received guided ICBT for panic disorder between 2007 and 2012 in a routine care setting at an out-patient psychiatric clinic providing Internet-based treatment. The primary outcome measure was the Panic Disorder Severity Scale-Self-report (PDSS-SR). ResultsParticipants made large improvements from screening and pretreatment assessments to posttreatment (Cohens d range on the PDSS-SR=1.07-1.55). Improvements were sustained at 6-month follow-up. ConclusionThis study suggests that ICBT for panic disorder is as effective when delivered in a routine care context as in the previously published randomized controlled trials.

  • 7.
    Hollandare, F
    et al.
    University Orebro.
    Johnsson, S
    University Orebro.
    Randestad, M
    University Orebro.
    Tillfors, M
    University Orebro.
    Carlbring, P
    Umea University.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Clinical and Social Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Behavioural Sciences and Learning, Psychology.
    Engstrom, I
    University Orebro.
    Randomized trial of Internet-based relapse prevention for partially remitted depression2011In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 124, no 4, p. 285-294Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate whether Internet-based cognitive behaviour therapy (CBT) can prevent relapse in persons with partially remitted major depression after previous treatment. less thanbrgreater than less thanbrgreater thanMethod: Seventy-one women and 13 men (N = 84) with partially remitted major depression after treatment were randomly assigned to either 10 weeks of Internet-based CBT or to a control group. Self-help material was used in combination with e-mail contact with a personal therapist. Monthly self-ratings of depressive symptoms were made, and diagnostic interviews were conducted before and after the treatment period, as well as 6 months later. less thanbrgreater than less thanbrgreater thanResults: Significantly fewer participants in the CBT group experienced relapse (4/38 or 10.5%) compared with those in the control group (14/37 or 37.8%). The difference in relapse rates between groups occurred early in the study period and was still apparent after 6 months. A trend towards a larger reduction in depressive symptoms was observed at post-treatment in the participants who received CBT compared with controls. Reduction in depressive symptoms reduced the risk of relapse. A trend towards a higher remission rate was found in the CBT group at the 6 month follow-up. less thanbrgreater than less thanbrgreater thanConclusion: Internet-based CBT seems promising in preventing relapse in persons with partially remitted major depression after previous treatment.

  • 8.
    Holmqvist, Rolf
    et al.
    Linköping University, Department of Behavioural Sciences.
    Armelius, B-Å.
    Emotional reactions to psychiatric patients1994In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 90, p. 204-209Article in journal (Refereed)
  • 9.
    Holmqvist, Rolf
    et al.
    Linköping University, Department of Behavioural Sciences.
    Fogelstam, H.
    Psychological climate and countertransference in psychiatric treatment homes1996In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 93, p. 288-295Article in journal (Refereed)
  • 10.
    Hydén, Lars-Christer
    Linköping University, Faculty of Arts and Sciences. Linköping University, The Tema Institute.
    Care utilization and the incidence of suicide. Suicide victims' contacts with primary health care and psychiatry in six psychiatric districts in the County of Stockholm from 1979 to 1990hy1997In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 93, p. 442-446Article in journal (Refereed)
  • 11.
    Isacsson, G.
    et al.
    Karolinska Institute.
    Holmgren, Anita
    National Board for Forensic Medicine.
    Osby, U.
    Karolinska Institute.
    Ahlner, Johan
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
    Decrease in suicide among the individuals treated with antidepressants: a controlled study of antidepressants in suicide, Sweden 1995-20052009In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 120, no 1, p. 37-44Article in journal (Refereed)
    Abstract [en]

    Objective: Ecological studies have demonstrated a substantial decrease in suicide in parallel with an increase in the use of antidepressants. Causality cannot, however, be inferred from such studies. The aim of this study was to test on the individual level the hypothesis that treatment with antidepressant medication has been a substantially contributing cause of the decrease in suicide. Method: Time trends in the detection of antidepressants and five control medications in the forensic toxicological screening of 16 937 suicides and 33 426 controls in Sweden 1995-2005. Results: The expected number of antidepressant-positive suicides in 2005 was 409 if the hypothesis was true and 603 if it was false. The observed number in 2005 was 420. The control medications were detected to the extent that was expected if not preventing suicide. Conclusion: The observed trend in the number of suicides with antidepressants was well predicted by the hypothesis that the increased use of antidepressants has been a substantially contributing cause of the decrease in suicide.

  • 12.
    Isacsson, G
    et al.
    Karolinska Institute.
    Holmgren, Per
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
    Ahlner, Johan
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology . Linköping University, Faculty of Health Sciences.
    Selective serotonin reuptake inhibitor antidepressants and the risk of suicide: a controlled forensic database study of 14,857 suicides2005In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 111, no 4, p. 286-290Article in journal (Refereed)
    Abstract [en]

    To test the hypothesis that selective serotonin reuptake inhibitor (SSRI) antidepressants may have a suicide emergent effect, particularly in children and adolescents. Detections of different antidepressants in the forensic toxicological screening of 14 857 suicides were compared with those in 26 422 cases of deaths by accident or natural causes in Sweden 1992-2000. There were 3411 detections of antidepressants in the suicides and 1538 in the controls. SSRIs had lower odds ratios than the other antidepressants. In the 52 suicides under 15 years, no SSRIs were detected. In 15-19-year age group, SSRIs had lower relative risk in suicides compared with non-SSRIs. The hypothesis that treatment of depressed individuals with SSRIs leads to an increased risk of suicide was not supported by this analysis of the total suicidal outcome of the nationwide use of SSRIs in Sweden over a period of 9 years, either in adults or in children or adolescents.

  • 13.
    Isacsson, G.
    et al.
    Karolinska University Hospital, Sweden.
    Reutfors, J.
    Karolinska Institute, Sweden.
    Papadopoulos, F.C.
    University Uppsala Hospital, Sweden.
    Ösby, U.
    Karolinska University Hospital, Sweden.
    Ahlner, Johan
    Linköping University, Department of Medical and Health Sciences, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
    Retracted articel: Antidepressant medication prevents suicide in depression2010In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 122, no 6, p. 454-460Article in journal (Refereed)
    Abstract [en]

    Objective: Ecological studies have demonstrated a substantial decrease in suicide in parallel with an increasing use of antidepressants. To investigate on the individual level the hypothesis that antidepressant medication was a causal factor. Method: Data on the toxicological detection of antidepressants in 18 922 suicides in Sweden 1992-2003 were linked to registers of psychiatric hospitalization as well as registers with sociodemographic data. Results: The probability for the toxicological detection of an antidepressant was lowest in the non-suicide controls, higher in suicides, and even higher in suicides that had been psychiatric inpatients but excluding those who had been in-patients for the treatment of depression. Conclusion: The finding that in-patient care for depression did not increase the probability of the detection of antidepressants in suicides is difficult to explain other than by the assumption that a substantial number of depressed individuals were saved from suicide by postdischarge treatment with antidepressant medication.

  • 14.
    Janelidze, S.
    et al.
    Lund University, Sweden; Lund University, Sweden.
    Suchankova, P.
    University of Gothenburg, Sweden.
    Ekman, A.
    University of Gothenburg, Sweden.
    Erhardt, S.
    Karolinska Institute, Sweden.
    Sellgren, C.
    Karolinska Institute, Sweden.
    Samuelsson, Martin
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Westrin, A.
    Lund University, Sweden.
    Minthon, L.
    Lund University, Sweden.
    Hansson, O.
    Lund University, Sweden.
    Traskman-Bendz, L.
    Lund University, Sweden.
    Brundin, L.
    Michigan State University, MI USA; Van Andel Research Institute, MI USA.
    Low IL-8 is associated with anxiety in suicidal patients: genetic variation and decreased protein levels2015In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 131, no 4, p. 269-278Article in journal (Refereed)
    Abstract [en]

    ObjectiveRecent studies indicate that inflammation may play a role in the pathophysiology of suicidality. Interleukin-8 (IL-8) is a chemokine that in addition to its function in the immune system also exert neuroprotective properties. The involvement of this chemokine in neuropsychiatric conditions is incompletely known. MethodWe measured plasma and cerebrospinal fluid (CSF) IL-8, as well as the genotype frequency of a single nucleotide polymorphism (-251A/T, rs4073) in the promoter region of the IL8 gene, in suicide attempters (n=206) and healthy controls (n=578). ResultsPlasma and CSF levels of IL-8 were significantly lower in suicide attempters with anxiety than in healthy controls. IL-8 in both plasma and CSF correlated negatively with symptoms of anxiety. Compared with the population-based cohort, the IL-8-251T allele was more prevalent among female suicide attempters. Furthermore, suicide attempters carrying this allele showed more severe anxiety. This correlative study warrants further mechanistic studies on the effects of IL-8 in the central nervous system. ConclusionWe suggest that IL-8 might be involved in the biological mechanisms mediating resilience to anxiety. Thus, our findings highlight the chemokine IL-8 as a potential target for future development of anti-anxiety treatments and suicide prevention.

  • 15.
    Jonsson, Dick
    et al.
    Linköping University, Department of Department of Health and Society, Center for Medical Technology Assessment. Linköping University, Faculty of Health Sciences.
    Wålinder, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Cost-effectiveness of clozapine treatment in therapy-refractory schizophrenia1995In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 92, no 3, p. 199-201Article in journal (Refereed)
    Abstract [en]

    The costs and effects of clozapine treatment of refractory schizophrenic patients have been discussed recently. This study shows that 18 months of clozapine treatment results in an improvement of symptoms and social functioning in approximately 70% of treatment-refractory schizophrenic patients, compared with treatment with conventional neuroleptics during a similar period of time. Treatment with clozapine reduces the cost of inpatient care but places increased demands on active rehabilitation resources in outpatient care. This leads to increased total costs in a short-term perspective, but clozapine treatment is cost-saving for annual maintenance therapy. These costs must be weighed against the positive effects on psychotic symptoms and social functioning.

  • 16.
    Lundmark, Jöns
    et al.
    Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Linköping University, Faculty of Health Sciences.
    Bengtsson, Finn
    Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Linköping University, Department of Medicine and Care, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
    Nordin, Conny
    Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Linköping University, Faculty of Health Sciences.
    Reis, Margareta
    Linköping University, Department of Medicine and Care, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
    Wålinder, Jan
    Linköping University, Department of Neuroscience and Locomotion, Psychiatry. Linköping University, Faculty of Health Sciences.
    Therapeutic drug monitoring of selective serotonin reuptake inhibitors influences clinical dosing strategies and reduces drug costs in depressed elderly patients2000In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 101, no 5, p. 354-359Article in journal (Refereed)
    Abstract [en]

    Objective: This study was initiated in order to describe and evaluate the effects of a therapeutic drug monitoring (TDM) routine of selective serotonin reuptake inhibitors (SSRIs) on treatment strategies and drug costs in depressed elderly patients.

    Method: Blood samples were drawn from elderly depressed patients and analysed for steady-state trough serum concentrations of citalopram (n=48), paroxetine (n=48) or sertraline (n=39). A global efficacy evaluation was made at baseline and after 6–9 months. Antidepressant drug costs before and after TDM were estimated.

    Results: Eight samples were excluded due to technical problems or non-compliance. In 65 of the 127 (51.2%) remaining cases, the treatment strategy was changed according to the TDM outcome, in most a reduction of the prescribed dose. Bioanalytical TDM costs included the antidepressant drug costs after TDM were reduced by 10.2%.

    Conclusion: The results support the utility of TDM in the search for the individual minimum effective SSRI dose in the elderly.

  • 17.
    Lundmark, Jöns
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Psychiatry. Linköping University, Faculty of Health Sciences.
    Scheel Thomsen, I.
    Department R, Aalborg Psychiatric Hospital, Aalborg, Denmark.
    Fjord-Larsen, T.
    Department R, Aalborg Psychiatric Hospital, Aalborg, Denmark.
    Manniche, P. M.
    Ferrosan, Søborg, Denmark.
    Mengel, H.
    Ferrosan, Søborg, Denmark.
    Møller-Nielsen, E. M.
    Department R, Aalborg Psychiatric Hospital, Aalborg, Denmark.
    Pauser, H.
    Linköping University, Department of Clinical and Experimental Medicine, Psychiatry. Linköping University, Faculty of Health Sciences.
    Wålinder, Jan
    Linköping University, Department of Clinical and Experimental Medicine, Psychiatry. Linköping University, Faculty of Health Sciences.
    Paroxetine: pharmacokinetic and antidepressant effect in the elderly1989In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 80, no S350, p. 76-80Article in journal (Refereed)
    Abstract [en]

    To evaluate the pharmacokinetic properties, efficacy, and tolerability of paroxetine in elderly depressed patients, a clinical study was set up - initially at Aalborg Psychiatric Hospital in Denmark, and subsequently at the University Hospital in Linköping, Sweden. A total of 21 patients with a median age of 72 years were included in the study. After a single dose of 20 or 30mg of paroxetine followed by two drug-free days, treatment continued with 20 or 30mg daily for seven weeks. The majority of patients showed a continuous reduction in their HAMD scores, starting in the second week of treatment. Paroxetine was well tolerated at the doses given, and side-effects were mostly mild and transient. Steady-state, pre-dose plasma levels of paroxetine showed considerable variability, and the median steady-state concentration was higher in elderly patients compared with data from a previous study in young volunteers. Elimination half-lives also showed variability between these elderly patients, but tended to be longer after cessation of multiple dosing than after a single dose. They also tended to be longer than in the young volunteers. The results of this study do not advocate reduced doses of paroxetine in the elderly, but further studies are warranted.

  • 18.
    Monfils Gustafsson, Wiktor
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Josefsson, Ann
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Ekholm, Katarina
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Preterm birth or foetal growth impairment and psychiatric hospitalization in adolescence and early adulthood in a Swedish population-based birth cohort2009In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 119, no 1, p. 54-61Article in journal (Refereed)
    Abstract [en]

    Objective: Preterm birth and restricted foetal growth are related to symptoms of psychiatric disorder. Our aim was therefore to investigate possible relations between being born preterm and/or small for gestational age (SGA) and later psychiatric hospitalization.

    Method: A population-based registry study of psychiatric hospitalization of in total 155 994 boys and 148 281 girls born in Sweden in 1973-1975.

    Results: The risk of hospitalization for all mental disorders was increased for preterm SGA boys (OR 2.19, 95% CI 1.49-3.21); at-term SGA boys (OR 1.55, 95% CI 1.34-1.79); at-term SGA girls (OR 1.31, 95% CI 1.15-1.50). At-term SGA boys and girls suffered increased risk of anxiety and adjustment disorders (OR 1.70, 95% CI 1.18-2.45 and OR 1.49, 95% CI 1.14-1.94). Preterm SGA boys were at risk of personality disorders (OR 3.30, 95% CI 1.16-9.41) and psychotic disorders (OR 4.36, 95% CI 1.85-10.30).

    Conclusion: The results show a relationship between being born SGA and later psychiatric hospitalization, where preterm birth and male gender seem to increase the risk.

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  • 19.
    Nettelbladt, Per
    et al.
    Lund University Hospital.
    Bogren, M
    Lund University Hospital.
    Mattisson, C
    Lund University Hospital.
    Ojesjo, L
    Karolinska Institute.
    Hagnell, O
    Lund University Hospital.
    Hofvendahl, E
    Lund University Hospital.
    Toraker, P
    Lund University Hospital.
    Bhugra, D
    De Crespigny Park.
    Does it make sense to do repeated surveys? - The Lundby Study, 1947-1997.2005In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 111, no 6, p. 444-452Article in journal (Refereed)
    Abstract [en]

    Objective:  To describe the Lundby Study and the difficulties in doing repeated surveys.

    Method:  Best-estimate consensus diagnoses have been used since 1957 together with DSM-IV and ICD-10 in 1997.

    Results:  The Lundby population consisting of 3563 probands was investigated in 1947, 1957 and 1972. Sufficient information was available for 98–99%. In 1997–2000 a fourth field investigation was carried out. Attrition rate for the interviews was 13% (238/1797). About 36% (1030/2827) had died between 1972 and 1997, but data from registers, case notes and key-informants for the period 1972 and 1997 completed the information for 94% (2659/2827). The population has followed the same pattern of development as many rural populations in Sweden since the 1940s. Multiple sources of information are preferable in longitudinal studies in order to tackle the problem of changing diagnostic systems.

    Conclusion:  Low attrition rates over 50 years and reasonable diagnostic uniformity make comparisons over time justifiable.

  • 20.
    Nordanskog, Pia
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Radiological Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Larsson, M. R.
    Lund University, Sweden.
    Larsson, E.-M.
    Uppsala University, Sweden.
    Johansson, A.
    Lund University, Sweden.
    Hippocampal volume in relation to clinical and cognitive outcome after electroconvulsive therapy in depression2014In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 129, no 4, p. 303-311Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    In a previous magnetic resonance imaging (MRI) study, we found a significant increase in hippocampal volume immediately after electroconvulsive therapy (ECT) in patients with depression. The aim of this study was to evaluate hippocampal volume up to 1 year after ECT and investigate its possible relation to clinical and cognitive outcome.

    METHOD:

    Clinical and cognitive outcome in 12 in-patients with depression receiving antidepressive pharmacological treatment referred for ECT were investigated with the Montgomery-Asberg Depression Rating Scale (MADRS) and a broad neuropsychological test battery within 1 week before and after ECT. The assessments were repeated 6 and 12 months after baseline in 10 and seven of these patients, respectively. Hippocampal volumes were measured on all four occasions with 3 Tesla MRI.

    RESULTS:

    Hippocampal volume returned to baseline during the follow-up period of 6 months. Neither the significant antidepressant effect nor the significant transient decrease in executive and verbal episodic memory tests after ECT could be related to changes in hippocampal volume. No persistent cognitive side effects were observed 1 year after ECT.

    CONCLUSION:

    The immediate increase in hippocampal volume after ECT is reversible and is not related to clinical or cognitive outcome.

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  • 21.
    Papola, D.
    et al.
    Univ Verona, Italy.
    Ostuzzi, G.
    Univ Verona, Italy.
    Gastaldon, C.
    Univ Verona, Italy.
    Morgano, G. P.
    McMaster Univ, Canada.
    Dragioti, Elena
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center.
    Carvalho, A. F.
    Univ Toronto, Canada; CAMH, Canada.
    Fusar-Poli, P.
    Kings Coll London, England; South London and Maudsley NHS Fdn Trust, England; Univ Pavia, Italy; South London and Maudsley NHS Fdn Trust, England.
    Correll, C. U.
    Zucker Hillside Hosp, NY USA; Hofstra Northwell, NY USA; Feinstein Inst Med Res, NY USA; Charite Univ Med Berlin, Germany.
    Solmi, M.
    Kings Coll London, England; Univ Padua, Italy; Univ Padua, Italy.
    Barhui, C.
    Univ Verona, Italy.
    Antipsychotic use and risk of life-threatening medical events: umbrella review of observational studies2019In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 140, no 3, p. 227-243Article, review/survey (Refereed)
    Abstract [en]

    Objective To quantify the risk of hip fracture, thromboembolism, stroke, myocardial infarction, pneumonia and sudden cardiac death associated with exposure to antipsychotics. Methods Systematic searches were conducted in Medline, Embase and PsycINFO from inception until 30/07/2018 for systematic reviews of observational studies. AMSTAR-2 was used for the quality assessment of systematic reviews, while the strength of associations was measured using GRADE and quantitative umbrella review criteria (URC). Results Sixty-eight observational studies from six systematic reviews were included. The association between antipsychotic exposure and pneumonia was the strongest [URC = class I; GRADE = low quality; odds ratio (OR) = 1.84, 95% confidence interval (CI) = 1.62-2.09; participants = 28 726; age = 76.2 +/- 12.3 years], followed by the association with hip fracture (URC = class II; GRADE = low quality; OR = 1.57, 95% CI = 1.42-1.74; participants = 5 288 118; age = 55.4 +/- 12.5 years), and thromboembolism (URC = class II; GRADE = very low quality; OR = 1.55, 95% CI = 1.31-1.83; participants = 31 417 175; age = 55.5 +/- 3.2 years). The association was weak for stroke (URC = class III; GRADE = very low quality; OR = 1.45, 95% CI = 1.24-1.70; participants = 65 700; age = 68.7 +/- 13.8 years), sudden cardiac death (URC = class III; GRADE = very low quality; OR = 2.24, 95% CI = 1.45-3.46; participants = 77 488; age = 52.2 +/- 6.2 years) and myocardial infarction (URC = class III; GRADE = very low quality; OR = 2.21, 95% CI = 1.41-3.46; participants = 399 868; age = 74.1 +/- 9.3 years). Conclusion The most robust results were found for the risk of pneumonia, followed by the risk of hip fracture and thromboembolism. For stroke, sudden cardiac death and myocardial infarction, the strength of association was weak. The observational nature of the primary studies may represent a source of bias.

  • 22.
    Popiolek, K.
    et al.
    Orebro Univ, Sweden.
    Beierot, S.
    Orebro Univ, Sweden.
    Brus, O.
    Orebro Univ, Sweden.
    Hammer, A.
    Univ Bergen, Norway; Haukeland Hosp, Norway.
    Leaden, M.
    Gothenburg Univ, Sweden; Karolinska Inst, Sweden.
    Lundberg, J.
    Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Nordanskog, Pia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Psykiatriska kliniken inkl beroendekliniken.
    Nordenskjold, A.
    Orebro Univ, Sweden.
    Electroconvulsive therapy in bipolar depression - effectiveness and prognostic factors2019In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 140, no 3, p. 196-204Article in journal (Refereed)
    Abstract [en]

    Objective Electroconvulsive therapy (ECT) is used in patients with severe forms of bipolar depression. ECT is effective but not all patients respond. The aim of this study was to determine prognostic factors for response to ECT in patients hospitalized for bipolar depression. Methods Data were obtained from several national Swedish registers. All patients with bipolar depression treated with ECT in any hospital in Sweden between 2011 and 2016 for whom information about ECT response was available were included (n = 1251). Response was defined as a score on the Clinical Global Impression - Improvement scale of one or two. Univariate and multivariate logistic regression were conducted to investigate associations between socio-demographic and clinical factors and response. Results Response was achieved in 80.2% patients. Older age was associated with higher response rate to ECT. Patients with comorbid obsessive-compulsive disorder or personality disorder, and patients previously treated with lamotrigine had lower response rate. Conclusion Electroconvulsive therapy for bipolar depression was associated with very high response rates. The strongest prognostic factors were higher age, absence of comorbid obsessive-compulsive disorder or personality disorder, and less prior pharmacologic treatment.

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  • 23.
    Sienaert, Pascal
    et al.
    Katholieke Univ Leuven, Belgium; Univ Leuven, Belgium.
    Brus, Ole
    Örebro Univ, Sweden.
    Lambrichts, Simon
    Katholieke Univ Leuven, Belgium; Univ Leuven, Belgium.
    Lundberg, Johan
    Karolinska Inst, Sweden; Stockholm Cty Council, Sweden.
    Nordanskog, Pia
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Psykiatriska kliniken i Linköping. Dept Psychiat, Sweden.
    Obbels, Jasmien
    Katholieke Univ Leuven, Belgium; Univ Leuven, Belgium.
    Verspecht, Shauni
    Katholieke Univ Leuven, Belgium; Univ Leuven, Belgium.
    Vansteelandt, Kristof
    Katholieke Univ Leuven, Belgium; Univ Leuven, Belgium.
    Nordenskjöld, Axel
    Örebro Univ, Sweden.
    Suicidal ideation and ECT, ECT and suicidal ideation: A register study2022In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 146, no 1, p. 74-84Article in journal (Refereed)
    Abstract [en]

    Objective Although electroconvulsive therapy (ECT) is anti-suicidal, it is not known whether the presence of suicidal ideation (SI) at baseline predicts response and remission after ECT. The aim of the study was to analyze the impact of baseline SI on response and remission following ECT treatment in a large sample of patients with depression and to assess SI before and after ECT. Methods This population-based register study used data from the Swedish National Quality Register for ECT and the Swedish Patient Register. Patients aged 18 years or older who had received ECT for a unipolar or bipolar depressive episode between 2011 and 2018 were included in the study. SI was defined as a score of >= 4 on the last item of the Montgomery-angstrom sberg Depression Rating Scale - Self Assessment (MADRS-S). Using a logistic regression model, SI at baseline was used to predict response and remission following ECT, while controlling for depression severity, psychotic symptoms, presence of a comorbid personality disorder, age, sex, electrode position, unipolar or bipolar disorder, and number of previous suicide attempts at baseline. Results In patients who exhibited SI at baseline, 53.7% (N = 632) of cases showed a response to ECT, whereas 68.4% (N = 690) of patients without SI showed a response. In addition, 27.2% (N = 320) of cases with SI achieved remission, whereas 48.5% (N = 489) of cases without SI achieved remission. The odds of achieving response and remission for patients with SI were 0.75 and 0.58 times, respectively, those for patients without SI. Of the 1178 patients with pre-treatment SI, 75.64% (N = 891) exhibited no SI at the end of treatment. Moreover, in this subgroup, the presence of a personality disorder, higher MADRS-S-score, and younger age were associated with persistent SI. Conclusion The presence of SI was associated with lower ECT response and remission rates. Nevertheless, depressive symptoms and SI were reduced in a large proportion of patients across both patient groups. Clinicians should be aware of the lower likelihood of achieving a successful outcome following ECT in younger patients who present with a non-psychotic depressive episode, SI, and (suspected) personality disorders. More research is warranted regarding if these patients can achieve similar or better results with other treatments.

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  • 24.
    Ólafsdóttir, María
    et al.
    Linköping University, Department of Department of Health and Society, General Practice. Linköping University, Faculty of Health Sciences.
    Marcusson, Jan
    Linköping University, Department of Neuroscience and Locomotion, Geriatrics. Linköping University, Faculty of Health Sciences.
    Skoog, Ingemar
    Institute of Clinical Neuroscience, Department of Psychiatry, Sahlgrenska University Hospital, Göteborg University, Sweden.
    Mental Disorders Among Elderly People in Primary Care: The Linköping Study2001In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 104, no 1, p. 12-18Article in journal (Refereed)
    Abstract [en]

    Objective: The aims of this study were to describe the prevalence of mental disorders among elderly patients in primary care and to compare diagnoses from psychiatric interview with diagnoses in medical records.

    Method: Patients aged 70 years and above attending a primary care centre (N=350) were studied using a psychiatric and medical record examination.

    Results: The prevalence of mental disorder according to the psychiatric interview was 33% (16% dementia, 17% other mental disorders). Only 49% of these had any psychiatric diagnosis in case records and 17–38% received specific treatments. The frequency of psychiatric symptoms among those with no mental disorder was between 1% and 66%. Patients with mental disorders were more often females, had more visits to a doctor, more diagnoses in medical records, and were prescribed more drugs.

    Conclusion: Mental disorders and symptoms are common among the elderly in primary care. More effort should be made to increase the recognition rate.

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