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  • 1.
    Carlsson, Björn
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk farmakologi.
    Olsson, Gunilla
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Onkologi. Linköpings universitet, Hälsouniversitetet.
    Reis, Margareta
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Psykiatri. Linköpings universitet, Hälsouniversitetet.
    Wålinder, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Psykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Psykiatriska kliniken.
    Nordin, Conny
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Psykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Psykiatriska kliniken.
    Lundmark, Jöns
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Geriatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Scordo, M. G.
    Dahl, M-L.
    Bengtsson, Finn
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk farmakologi.
    Ahlner, Johan
    Linköpings universitet, Institutionen för medicin och hälsa, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Enantioselective Analysis of Citalopram and Metabolites in Adolescents2001Ingår i: Therapeutic drug monitoring, ISSN 0163-4356, Vol. 23, nr 6, s. 658-664Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Studies of the antidepressant effect and pharmacokinetics of citalopram have been performed in adults, but the effects on children and adolescents have only been studied to a minor extent despite its increasing use in these age groups. The aim of this study was to investigate a group of adolescents treated for depression, with respect to the steady-state plasma concentrations of the enantiomers of citalopram and its demethylated metabolites desmethylcitalopram and didesmethylcitalopram. Moreover, the authors studied the genotypes for the polymorphic cytochrome P450 enzymes CYP2D6 and CYP2C19 in relation to the different enantiomers. The S/R ratios of citalopram and desmethylcitalopram found in this study of 19 adolescents were similar to studies involving older patients. The concentrations of the R-(-)- and S-(+)-enantiomers of citalopram and desmethylcitalopram were also in agreement with values from earlier studies, the R-(-)-enantiomer (distomer) being the major enantiomer. The results indicate that the use of oral contraceptives may have some influence on the metabolism of citalopram. This might be because of an interaction of the contraceptive hormones with the CYP2C19 enzyme.

  • 2.
    Fall, Per-Arne
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Geriatrik. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Geriatriska kliniken.
    Ekman, R.
    Granérus, Ann-Kathrine
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Geriatrik. Linköpings universitet, Hälsouniversitetet.
    Thorell, Lars-Håkan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Psykiatri. Linköpings universitet, Hälsouniversitetet.
    Wålinder, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Psykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Psykiatriska kliniken.
    ECT in Parkinson's disease: Changes in motor symptoms, monoamine metabolites and neuropeptides1995Ingår i: Journal of Neural Transmission. Parkinson's disease and dementia section., ISSN 0936-3076, Vol. 10, nr 2-3, s. 129-140Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Electroconvulsive therapy (ECT) was given to 16 non-depressed, non-demented patients with advanced Parkinson's disease (PD). In all the patients an antiparkinsonian effect was seen, lasting for 18 months in one patient, 3-5 months in seven patients, and a few days to four weeks in eight patients. After ECT the levels of homovanillic acid and neuropeptide Y in cerebrospinal fluid (CSF) were significantly increased. The eight patients with long lasting motor improvement after ECT had significantly lower CSF-3-methoxy-4-hydroxyphenylglycol compared to the group with short lasting improvement. Five patients developed transitory mental confusion after ECT. In these patients, and in no others, a high albumin-ratio was found already before ECT was given - an indication of blood CSF barrier damage. Our results suggest that ECT is valuable in patients with drug refractory PD or PD with intolerance to antiparkinsonian drugs.

  • 3.
    Jonsson, Dick
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Wålinder, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Psykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Psykiatriska kliniken.
    Cost-effectiveness of clozapine treatment in therapy-refractory schizophrenia1995Ingår i: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 92, nr 3, s. 199-201Artikel i tidskrift (Refereegranskat)
    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.

  • 4.
    Jonsson, Dick
    et al.
    Linköpings universitet, Institutionen för hälsa och samhälle, Centrum för utvärdering av medicinsk teknologi. Linköpings universitet, Hälsouniversitetet.
    Wålinder, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Psykiatri. Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Psykiatriska kliniken.
    The socioeconomic cost of treatment of therapy-refractory schizophrenic patients in Sweden1994Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 48, nr 5, s. 311-313Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of the study is to examine the socioeconomic costs of treatment of therapy-refractory schizophrenic patients. The patients usually have a great need for health care and remain in institutions for long periods of time. The method is retrospective, and the data refer to patients who received treatment at the Department of Psychiatry, University Hospital in Linköping, Sweden in 1990. The total annual health care cost for treatment of therapy-refractory schizophrenia is estimated to be SEK 4.8 million (USD 1 = SEK 7.7). Inpatient care amounts to 93% of the total cost, and the cost of outpatient care to 6%. The cost of drugs and laboratory services corresponds to 1 % of the total cost. The high cost of inpatient care and the low cost of outpatient care may indicate that a redistribution of resources from inpatient to outpatient care is necessary. A generalization of the results indicates that the total annual cost of treating all therapy-refractory schizophrenic patients in Sweden is approximately SEK 1.9 billion. The result highlights the need for discussions concerning alternative treatment methods but also focuses on the importance of using health economic evaluations within psychiatry.

  • 5.
    Lundmark, Jöns
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Psykiatri. Linköpings universitet, Hälsouniversitetet.
    Bengtsson, Finn
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Psykiatri. Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Nordin, Conny
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Psykiatri. Linköpings universitet, Hälsouniversitetet.
    Reis, Margareta
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Wålinder, Jan
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Psykiatri. Linköpings universitet, Hälsouniversitetet.
    Therapeutic drug monitoring of selective serotonin reuptake inhibitors influences clinical dosing strategies and reduces drug costs in depressed elderly patients2000Ingår i: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 101, nr 5, s. 354-359Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Lundmark, Jöns
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Psykiatri. Linköpings universitet, Hälsouniversitetet.
    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.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Psykiatri. Linköpings universitet, Hälsouniversitetet.
    Wålinder, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Psykiatri. Linköpings universitet, Hälsouniversitetet.
    Paroxetine: pharmacokinetic and antidepressant effect in the elderly1989Ingår i: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 80, nr S350, s. 76-80Artikel i tidskrift (Refereegranskat)
    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.

  • 7.
    Lundmark, Jöns
    et al.
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Psykiatri. Linköpings universitet, Hälsouniversitetet.
    Wålinder, Jan
    Linköpings universitet, Institutionen för klinisk och experimentell medicin, Psykiatri. Linköpings universitet, Hälsouniversitetet.
    Alling, C.
    University Hospital, Lund, Sweden.
    Manniche, P. M.
    Novo Nordisk A/S, Copenhagen, Denmark.
    Dalgaard, L.
    Novo Nordisk A/S, Copenhagen, Denmark.
    The effect of paroxetine on cerebrospinal fluid concentrations of neurotransmitter metabolites in depressed patients1994Ingår i: European Neuropsychopharmacology, ISSN 0924-977X, E-ISSN 1873-7862, Vol. 4, nr 1, s. 1-6Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper describes the effect of the selective serotonin reuptake inhibiting drug (SSRI), paroxetine, on cerebrospinal fluid concentrations of neurotransmitter metabolites in depressed patients. 5-Hydroxyindoleacetic acid (5-HIAA), 3-methoxy-4-hydroxyphenylglycol (MHPG) and homovanillic acid (HVA) were measured at baseline and after 3 weeks of treatment with 30 mg paroxetine daily. In line with similar studies on other SSRIs, influence on both the serotonin and noradrenaline metabolite was found. The mechanism behind the action of paroxetine on both 5-HIAA and MHPG is assumed to be an expression of the linkage between the serotonergic and noradrenergic systems in the brain. A frequently reported correlation between 5-HIAA and HVA was also found. The analysis of paroxetine in CSF proves the transportation of the drug into the central nervous system.

  • 8.
    Reis, Margareta
    et al.
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Psykiatri. Linköpings universitet, Hälsouniversitetet.
    Olsson, Gunilla
    Division of Child and Adolescence Psychiatry, Department of Neuroscience, Uppsala University, Uppsala.
    Carlsson, Björn
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Lundmark, Jöns
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Psykiatri. Linköpings universitet, Hälsouniversitetet.
    Dahl, Marja-Liisa
    Clinical Pharmacology, Department of Medical Sciences, Uppsala University, Uppsala.
    Wålinder, Jan
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Psykiatri. Linköpings universitet, Hälsouniversitetet.
    Ahlner, Johan
    Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Bengtsson, Finn
    Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Psykiatri. Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Linköpings universitet, Hälsouniversitetet.
    Serum levels of citalopram and its main metabolites in adolescent patients treated in a naturalistic clinical setting2002Ingår i: Journal of Clinical Psychopharmacology, ISSN 0271-0749, E-ISSN 1533-712X, Vol. 22, nr 4, s. 406-413Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The prescribing of selective serotonin reuptake inhibitors for adolescents is extensive despite the fact that there are few pharmacokinetic (PK), effi]cacy, safety, or tolerability studies on this group. This study reports the PK findings from two trials in adolescents treated with citalopram (CIT) in naturalistic clinical settings: one retrospective and one prospective. The aim of our study was to describe serum concentrations of CIT, desmethylcitalopram (DCIT), and didesmethylcitalopram (DDCIT) (trough values in steady state) in adolescents in relation to daily dose and clinical information obtained from therapeutic drug monitoring request forms. Altogether, 44 patients younger than 21 years were scrutinized using this combined open-label approach. The main findings were that (1) there was a pronounced interindividual variability of serum CIT, DCIT, and DDCIT concentrations in all doses prescribed, in agreement with previous studies on adults; on correcting for dose, the coefficient of variance was about 50% for CIT, DCIT, and DDCIT; (2) the transformation of CIT to DCIT and of DCIT to DDCIT was similar within the dose range 20 to 60 mg/day; (3) there was a difference between the sexes on comparing the dose-corrected concentrations of CIT and DCIT, with girls presenting significantly higher values than boys; and (4) there was a strong dose-serum concentration relationship in three identified subgroups of adolescents: (a) nonsmokers (CIT, r 2 = 0.71; DCIT, r 2 = 0.81), (b) girls not taking oral contraceptives (CIT, r 2 = 0.75; DCIT, r 2 = 0.71,), and (c) girls in the last 14 days of the menstrual cycle (CIT, r 2 = 0.68; DCIT, r 2 = 0.64). In summary, the present study tentatively supports influences of sex, oral contraceptives, and smoking habits on the disposition of CIT in younger patients. Hence, future studies on CIT should assess these parameters.

  • 9.
    Wålinder, Jan
    et al.
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Psykiatri. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Psykiatriska kliniken.
    Prochazka, J
    Odén, A
    Sjödin, Ingemar
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för nervsystem och rörelseorgan, Psykiatri. Östergötlands Läns Landsting, Närsjukvården i centrala Östergötland, Psykiatriska kliniken.
    Dahl, ML
    Ahlner, Johan
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi.
    Bengtsson, Finn
    Linköpings universitet, Hälsouniversitetet. Linköpings universitet, Institutionen för medicin och vård, Klinisk farmakologi. Östergötlands Läns Landsting, Laboratoriemedicinskt centrum, Klinisk farmakologi.
    Mirtazapine naturalistic depression study (in Sweden) - MINDS(S): Clinical efficacy and safety2006Ingår i: Human Psychopharmacology: Clinical and Experimental, ISSN 0885-6222, E-ISSN 1099-1077, Vol. 21, nr 3, s. 151-158Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To study how implementation of a naturalistic trial design for mirtazapine treatment in major depressive disorder for six (up to 12) months could be used and evaluated by means of clinical efficacy and safety. Method: An open-labelled, prospective, multicenter, non-comparative trial was conducted during a 2-year period in patients with major depression according to DSM-IV treated in psychiatric departments and primary care in Sweden. Minimal inclusion and exclusion criteria were used in order to diminish the potential patient selection bias. Maximum flexibility of the dosage of mirtazapine was allowed, and clinical assessments included MADRS, CGI, vital signs and spontaneous reporting of adverse events. Results: 192 patients were found eligible and enrolled in the study. A significant improvement in depressive symptoms according to MADRS and CGI was observed including particularly marked sleep improvement early in the treatment. Slight increases in body weight and BMI were observed. The investigational drug was well tolerated overall. Conclusion: The clinical efficacy and safety of mirtazapine found in this naturalistic setting is in line with previously reported data on mirtazapine in traditional controlled clinical trials. The results confirm that the naturalistic study design facilitated conduct of the trial. The authors suggest that this type of study design should also be applied to other antidepressant drugs that are frequently prescribed in the general population. Copyright © 2006 John Wiley & Sons, Ltd.

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