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1.
Acta Psychiatr Scand ; 131(3): 185-96, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25597383

ABSTRACT

OBJECTIVE: To investigate the effect of second-generation antipsychotics on cognitive function in patients diagnosed with schizophrenia or schizoaffective disorder. METHOD: Multiple-treatments meta-analysis model. RESULTS: On cognitive composite score, sertindole was superior to clozapine, effect size (ES) 0.87; 95% CI: 0.12-1.63, quetiapine, ES 0.75; 95% CI: 0.00-1.49, and first-generation antipsychotics (FGAs), ES 0.89; 95% CI: 0.14-1.64. Analyses on each cognitive domain showed clozapine, ES 0.37; 95% CI: 0.00-0.74, olanzapine, ES 0.31; 95%CI: 0.02-0.59, quetiapine, ES 0.34; 95% CI: 0.03-0.64, and FGAs, ES 0.51; 95% CI: 0.18-0.83 performing poorer on verbal working memory than ziprasidone, as well as FGAs performing poorer than risperidone, ES 0.31; 95% CI: 0.04-0.58. On executive function, sertindole performed better than clozapine, ES 0.82; 95% CI: 0.06-1.58, olanzapine, ES 0.81; 95% CI: 0.07-1.55, quetiapine, ES 0.76; 95% CI: 0.02-1.51, ziprasidone, ES 0.90; 95% CI: 0.14-1.67, and FGAs, ES 0.83; 95% CI: 0.08-1.58. On processing speed, FGAs performed poorer than sertindole, ES 0.97; 95% CI: 0.02-1.91, and quetiapine, ES 0.36; 95% CI: 0.01-0.72. On long-term verbal working memory, clozapine performed poorer than olanzapine, ES 0.41; 95% CI: 0.06-0.76. On verbal fluency, FGAs performed poorer than olanzapine, ES 0.26; 95% CI: 0.01-0.50, and clozapine, ES 0.44; 95% CI: 0.06-0.81. Lastly, FGAs, ES 0.41; 95% CI: 0.04-0.78, and clozapine, ES 0.44; 95% CI: 0.05-0.83, performed poorer on visuospatial skill compared to olanzapine. CONCLUSION: The meta-analysis was able to detect some trends in the data analyzed, but did not show any drug having a uniform positive cognitive profile.


Subject(s)
Antipsychotic Agents/therapeutic use , Cognition/drug effects , Psychotic Disorders/drug therapy , Schizophrenia/drug therapy , Antipsychotic Agents/adverse effects , Clinical Trials as Topic , Humans , Psychotic Disorders/psychology , Schizophrenic Psychology , Treatment Outcome
2.
Acta Psychiatr Scand ; 126(1): 31-9, 2012 Jul.
Article in English | MEDLINE | ID: mdl-22356584

ABSTRACT

OBJECTIVE: To assess the cognitive effects of sertindole augmentation in clozapine-treated patients diagnosed with schizophrenia. Cognition is secondary outcome of the trial. METHOD: A 12-week, double-blinded, randomized, placebo-controlled, augmentation study of patients treated with clozapine. Participants were randomized 1:1 to receive 16 mg of sertindole or placebo as adjunctive treatment to clozapine. RESULTS: Participants displayed substantial cognitive deficits, ranging from 1.6 standard deviation below norms at baseline to more than three standard deviations on tests of response readiness and focused attention. There were no significant differences between sertindole augmentation and placebo groups at study end. Correlation analysis of Positive and Negative Syndrome (PANSS) subscales, Global Assessment of Functioning subscale (GAF-F) and Clinical Global Impression (CGI) with 20 neurocognitive indices was conducted, but no significant correlations were found. Second, we tested change from baseline to endpoint for the PANSS, GAF-F, and CGI, vs. the concomitant changes in cognitive test performance, and found no significant correlations. CONCLUSION: The clozapine-treated patients displayed marked cognitive deficits at baseline. Adding sertindole did not improve or worsen cognitive functioning, which is in line with previous negative studies of the effect on cognition of augmenting clozapine treatment with another antipsychotic drug.


Subject(s)
Antipsychotic Agents/therapeutic use , Clozapine/therapeutic use , Cognition Disorders/drug therapy , Imidazoles/therapeutic use , Indoles/therapeutic use , Schizophrenia/drug therapy , Adult , Clozapine/administration & dosage , Cognition Disorders/complications , Double-Blind Method , Drug Therapy, Combination , Female , Humans , Imidazoles/administration & dosage , Indoles/administration & dosage , Male , Neuropsychological Tests , Psychiatric Status Rating Scales , Schizophrenia/complications
3.
Acta Psychiatr Scand Suppl ; (435): 5-16, 2007.
Article in English | MEDLINE | ID: mdl-17953521

ABSTRACT

OBJECTIVE: Explore the long-term course of schizophrenia and related disorders. METHOD: Naturalistic study of 225 patients initially treated with risperidone (monotherapy or in combination with other psychotropic drugs) over 5 years. RESULTS: Stable symptomatology and side effects were observed. Clinician GAF scores were 55-61, but patients' self-ratings were higher. Clinician and patient CGI scores were at the same level. Annual in-patient days decreased but days in sheltered accommodations increased still more. Only 12% of the patients studied or worked full-time. One in four had no social contacts except with staff. Eight patients died during the 5 years. CONCLUSION: The findings underline the chronicity and seriousness of psychotic disorders in terms of social outcome and, indirectly, the low quality of life of this group of persons. Patients were generally well aware of their illness and able to sort out symptoms from drug side effects. This opens for more active involvement of patients in monitoring their own treatment.


Subject(s)
Antipsychotic Agents/therapeutic use , Risperidone/therapeutic use , Schizophrenia/drug therapy , Adult , Aged , Akathisia, Drug-Induced/etiology , Antipsychotic Agents/adverse effects , Female , Humans , Longitudinal Studies , Male , Middle Aged , Multicenter Studies as Topic , Patient Compliance , Risperidone/adverse effects
4.
Acta Psychiatr Scand Suppl ; (435): 27-32, 2007.
Article in English | MEDLINE | ID: mdl-17953523

ABSTRACT

OBJECTIVE: To examine nicotine use and its correlates among psychotic patients. METHOD: Longitudinal naturalistic study of 176 patients, diagnosed with schizophrenia or schizophrenia-related psychotic disorders, and treated with risperidone at study entry. Levels of nicotine use (smoking, snuffing) were measured along with other relevant ratings and measurements (symptoms, drug treatment, side effects, weight, cognitive functions and outcome) at baseline and once yearly for 5 years. RESULTS: Nicotine use was twice as common as in the general population. Only few nicotine users had started after onset of psychoses. We could not find any differences among nicotine users and non-users in diagnosis, symptoms, side effects, weight, cognitive functions, personality and outcome, cross-sectionally and longitudinally, ruling against the 'self-medication' hypothesis. CONCLUSION: A parsimonious interpretation of the findings is that patients suffering from psychosis fail to desist from nicotine rather than experience significant positive effects of the usage.


Subject(s)
Schizophrenia/complications , Tobacco Use Disorder/complications , Adolescent , Adult , Aged , Antipsychotic Agents/therapeutic use , Female , Humans , Male , Middle Aged , Schizophrenia/drug therapy , Smoking , Superior Sagittal Sinus , Tobacco, Smokeless
5.
Acta Psychiatr Scand Suppl ; (435): 17-26, 2007.
Article in English | MEDLINE | ID: mdl-17953522

ABSTRACT

OBJECTIVE: Explore how clinicians select drug treatment based on symptoms, side effects and patient factors, including patient participation in the process, and the association between these factors and attitudes towards drugs. METHOD: A cohort of 166 patients initially treated with risperidone was followed with yearly assessments over 5 years. At the end of the study, 101 patients were evaluated of whom 58 were still treated with risperidone. RESULTS: More women than men remained in the study, and on the initial medication. The most common reason for medication switch was lack of efficacy. Clinicians and patients agreed well in their global ratings of medication effects and side effects. Robust associations between switch decisions and patient characteristics including symptoms and side effects could not be identified. The effects of switches were rated as better by the clinicians than by the patients. Negative drug attitudes were associated with pronounced positive symptoms (threshold effect), whereas the corresponding association with 'lack of judgment and insight' was linear over the whole range. CONCLUSION: The decision-making process appears to have many unknown components, and may benefit from more active patient involvement by using structured clinician and patient rating scales for monitoring the treatment. Such shared decision-making may improve compliance.


Subject(s)
Antipsychotic Agents/therapeutic use , Schizophrenia/drug therapy , Adolescent , Adult , Aged , Akathisia, Drug-Induced/etiology , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/adverse effects , Attitude , Female , Humans , Longitudinal Studies , Male , Middle Aged , Multicenter Studies as Topic , Risperidone/administration & dosage , Risperidone/adverse effects , Risperidone/therapeutic use , Sex Factors
6.
Acta Psychiatr Scand Suppl ; (435): 33-40, 2007.
Article in English | MEDLINE | ID: mdl-17953524

ABSTRACT

OBJECTIVE: To explore the direct and indirect costs in a cohort of 225 risperidone-treated patients with schizophrenia followed up annually during 5 years. METHOD: Data on costs for medication, hospitalization, sheltered living and productivity losses, as well as degree of social isolation, were collected. RESULTS: The direct costs were dominated by hospitalization and sheltered living expenses, while drug costs only represented 7% of the direct costs. Indirect costs represented 43% of the total costs during the 5 years. About 12% worked full-time, and 12% worked part-time, implying large productivity losses. As a consequence of the national mental health care reform, a substantial shift of costs from hospital care to sheltered living took place on the national level, but the reduction of hospital days for the study patients over time was much larger suggesting that the switch from first to second generation compounds was therapeutically successful. A high degree of social isolation was seen, with more than 20% being completely without social contacts and 30% seeing friends/relatives less often than once a week. CONCLUSION: The economic costs of schizophrenia are high and driven by the need for assisted living and hospitalizations, together with productivity losses. In addition, the intangible costs, such as social contacts, are also high.


Subject(s)
Antipsychotic Agents/economics , Risperidone/economics , Schizophrenia/economics , Adolescent , Adult , Aged , Antipsychotic Agents/therapeutic use , Costs and Cost Analysis , Female , Humans , Male , Middle Aged , Multicenter Studies as Topic , Risperidone/therapeutic use , Schizophrenia/drug therapy , Sweden
7.
Acta Psychiatr Scand ; 115(4): 277-85, 2007 Apr.
Article in English | MEDLINE | ID: mdl-17355518

ABSTRACT

OBJECTIVE: To examine annual weight-development in a sample of 215 psychotic patients treated with risperidone over 5 years. METHOD: Naturalistic longitudinal study. RESULTS: The sample was more obese than the general population at baseline, but also increased much more in mean body mass index over approximately the same time period, while patients off medication seemed to remain weight stable. Excessive weight gain (>7%) was experienced by 40.2% and was weakly associated with weight at baseline (beta = -0.2%; P = 0.02), while independent of gender, symptoms, years of illness, prolactin levels and nicotine consumption. In patients with complete weight data (n = 87), approximately 72% (3.4 +/- 8.3 kg) of the observed 5 years weight gain (4.7 +/- 11.6 kg) had been accumulated after 2 years. CONCLUSION: Antipsychotic drug treatment resulted in significant weight gain, which levelled off over time. Unfortunately, few significant predictors of adverse weight development could be identified, leaving little guidance for clinical decision making regarding this specific side-effect.


Subject(s)
Body Weight/drug effects , Risperidone/therapeutic use , Schizophrenia/drug therapy , Adult , Aged , Antipsychotic Agents/adverse effects , Antipsychotic Agents/therapeutic use , Female , Follow-Up Studies , Humans , Male , Middle Aged , Obesity/epidemiology , Overweight , Risperidone/adverse effects , Schizophrenia/classification
8.
Acta Psychiatr Scand ; 115(4): 268-76, 2007 Apr.
Article in English | MEDLINE | ID: mdl-17355517

ABSTRACT

OBJECTIVE: To investigate prolactin levels and related side effects in 128 men and 90 women initially treated with risperidone. METHOD: Patients initially treated with risperidone were followed over 5 years, during which 45% were switched to other antipsychotic drugs. RESULTS: Initially, prolactin levels were fivefold the norm in women, and threefold in men. Diagnosis did not affect the prolactin level if adjustment for sex, current age, and age at onset of psychosis was applied. Prolactin levels did not correlate significantly neither with any Positive and Negative Symptom Scale item or subscale, nor with side effects. Drugs other than risperidone were not associated with high prolactin levels. For patients on continuous monotherapy risperidone treatment, there was a marked linear reduction of prolactin level over all 5 years. CONCLUSION: Risperidone induces a higher prolactin elevation than other atypical antipsychotics, but the effect adapts over time. Prolactin was not associated with expected side effects (e.g. sexual, mental, or weight gain).


Subject(s)
Prolactin/blood , Psychotic Disorders/blood , Psychotic Disorders/drug therapy , Risperidone/therapeutic use , Antipsychotic Agents/therapeutic use , Body Mass Index , Body Weight , Chlorpromazine/therapeutic use , Female , Follow-Up Studies , Humans , Longitudinal Studies , Male , Risperidone/blood , Risperidone/pharmacokinetics , Sex Characteristics
9.
Acta Psychiatr Scand ; 114(4): 274-81, 2006 Oct.
Article in English | MEDLINE | ID: mdl-16968365

ABSTRACT

OBJECTIVE: To evaluate "need-specific treatment" of first episode schizophrenia syndrome patients. METHOD: Sixty-one consecutive first episode schizophrenia syndrome patients were followed over 3 years. They were compared with a Historical "treatment as usual" group (n = 41) and a Prospective group from a high quality social and biological psychiatry centre (n = 25). RESULTS: Symptomatic and functional outcome was significantly better compared with the Historical group and equal with the Prospective group. During the first year, the direct costs for in- and out-patient care per patient in the Parachute project were less than half of those in the Prospective group. CONCLUSION: The study confirms the feasibility, clinically and economically, with a large scale application of "need-specific treatments" for first episode psychotic patients.


Subject(s)
Mental Health Services/economics , Schizophrenia/economics , Schizophrenia/therapy , Adult , Ambulatory Care/economics , Cohort Studies , Episode of Care , Feasibility Studies , Female , Follow-Up Studies , Health Care Costs , Hospitalization/economics , Humans , Male , Prospective Studies , Schizophrenia/epidemiology , Sweden/epidemiology , Time Factors
10.
Acta Psychiatr Scand ; 110(2): 92-7, 2004 Aug.
Article in English | MEDLINE | ID: mdl-15233709

ABSTRACT

OBJECTIVE: To investigate the relationship between the prevalence of schizophrenia and measures of social deprivation in varying areas in the city of Malmö. METHOD: A case-finding study of schizophrenia was combined with a victimization survey. Data was factor-analysed and visualized using geographical information system software. RESULTS: The schizophrenic patients lived predominantly in socially disorganized areas characterized by high levels of disorder, fear of crime and victimization. The local prevalence of schizophrenia covaried significantly with all indices of social disorganization. In addition, a significant but weak association was obtained between prevalence of schizophrenia and fear of specific persons in the neighbourhood. CONCLUSION: In spite of enormous changes in social conditions, psychiatric knowledge and organization of treatment, and political ambitions, schizophrenic patients still aggregate in socially deprived areas. This segregation may result in worsening of the illness as well as increasing the social disorganization in the local domicile.


Subject(s)
Crime , Geographic Information Systems , Schizophrenia/complications , Schizophrenia/epidemiology , Social Conditions , Adolescent , Adult , Aged , Crime Victims/psychology , Crime Victims/statistics & numerical data , Epidemiologic Studies , Fear , Female , Health Surveys , Humans , Italy/epidemiology , Male , Middle Aged , Prevalence
11.
Acta Psychiatr Scand ; 106(4): 276-85, 2002 Oct.
Article in English | MEDLINE | ID: mdl-12225494

ABSTRACT

OBJECTIVE: Implementing a system designed to treat first episode psychotic (FEP) patients. METHOD: Every FEP patient (n=253) from a catchment area of 1.5 million inhabitants were asked to participate in this 5-year project. One historical (n=71) and one prospective (n=64) FEP group were used for comparisons. RESULTS: A total of 175 patients (69%) were followed up through the first year of treatment. Global Assessment of Functioning (GAF) values were significantly higher than in the historical comparison group but similar to the prospective group. Psychiatric in-patient care was lower as was prescription of neuroleptic medication. Satisfaction with care was generally high in the Parachute group. Access to a small overnight crisis home was associated with higher GAF. CONCLUSION: It is possible to successfully treat FEP patients with fewer in-patient days and less neuroleptic medication than is usually recommended, when combined with intensive psychosocial treatment and support.


Subject(s)
Mental Health Services/standards , Psychotic Disorders/rehabilitation , Antipsychotic Agents/therapeutic use , Brief Psychiatric Rating Scale , Follow-Up Studies , Hospitalization/statistics & numerical data , Humans , Prospective Studies , Psychotic Disorders/diagnosis , Psychotic Disorders/drug therapy , Severity of Illness Index , Social Support , Sweden , Treatment Outcome
12.
Acta Psychiatr Scand Suppl ; (412): 81-5, 2002.
Article in English | MEDLINE | ID: mdl-12072134

ABSTRACT

OBJECTIVE: This study is an attempt to compare two alternative models of psychopathy (PCL-R); (i) the traditional 17-item two-factor model where the first factor describes a deceitful, manipulative and callous, unemotional dimension and the second factor describes the impulsive, irresponsible and antisocial behavioral lifestyle dimension; and (ii) a recently proposed 13-item three-factor model involving an interpersonal facet, an affective facet and a behavioral facet. METHOD: Exploratory and confirmatory factor analyses of PCL-R scores on a sample of 293 adult male violent offenders were conducted. RESULTS: The results of the exploratory factor analysis showed that the 13 items yielded three easily interpretable factors: an interpersonal factor, an affective factor and a behavioral/lifestyle factor. Through confirmatory factor analysis we showed that this model had a significantly closer fit to the data than the classical 17-item, two-factor model of the PCL-R. CONCLUSION: The study supports the three-faceted model of psychopathy.


Subject(s)
Antisocial Personality Disorder/diagnosis , Adolescent , Adult , Aged , Antisocial Personality Disorder/psychology , Diagnosis, Differential , Factor Analysis, Statistical , Humans , Male , Middle Aged , Severity of Illness Index
13.
Acta Psychiatr Scand Suppl ; (408): 60-4, 2001.
Article in English | MEDLINE | ID: mdl-11730074

ABSTRACT

OBJECTIVE: To assess neuropsychological impairments among fairly young schizophrenic patients over time, and relations between impairment and symptoms, drug type and dose. METHOD: Clinical and neuropsychological data for 29 schizophrenic patients have been published earlier. Twenty of these patients were retested after 3 years using the same methods. RESULTS: The patients displayed stable impairments in most neuropsychological tests. Vocabulary and focused attention improved over time, whereas response slowness became more pronounced. Symptoms varied considerably over time. A specific pattern of neuropsychological impairments, but not measures of psychopathology, predicted clinical outcome. Patients were unable to judge their test performance. CONCLUSION: A few years after the first episode, our patients displayed a specific pattern of neuropsychological impairment, which predicted clinical outcome. One aspect of the impairment appears to be failure at self-monitoring.


Subject(s)
Cognition Disorders/diagnosis , Cognition Disorders/etiology , Schizophrenia/complications , Adult , Antipsychotic Agents/therapeutic use , Female , Follow-Up Studies , Humans , Male , Neuropsychological Tests , Predictive Value of Tests , Reaction Time , Schizophrenia/drug therapy , Self-Assessment , Severity of Illness Index
14.
Acta Psychiatr Scand Suppl ; (408): 75-80, 2001.
Article in English | MEDLINE | ID: mdl-11730076

ABSTRACT

OBJECTIVE: To assess neuropsychological impairments among chronic functional psychotic patients over time, and relations with symptoms, drug dose and side effects. METHOD: Thirty-four patients, representative of the most ill one-third of all patients with chronic functional psychoses known to the psychiatric services in a city catchment area, were assessed for clinical symptoms, drug side effects and by neuropsychological tests at study entry. They were then assessed repeatedly over 2 years. RESULTS: All patients were seriously impaired in the tests. The impairment was stable over time, in spite of substantial changes in the clinical state. The impairment was unrelated to drug and drug dose. Patients with prominent negative symptoms were most impaired and most unable to rate their performance in the tests. CONCLUSION: Patients with chronic functional psychoses do relapse often, also late in the course of the disease. Negative symptoms, marked impairments in simple neuropsychological tests and impaired self-monitoring went together.


Subject(s)
Antipsychotic Agents/therapeutic use , Cognition Disorders/diagnosis , Cognition Disorders/etiology , Schizophrenia/complications , Schizophrenia/drug therapy , Adult , Aged , Aged, 80 and over , Antipsychotic Agents/administration & dosage , Antipsychotic Agents/adverse effects , Delayed-Action Preparations , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neuropsychological Tests , Psychiatric Status Rating Scales , Psychotic Disorders/etiology , Reaction Time , Recurrence , Schizophrenia/diagnosis
15.
Acta Psychiatr Scand Suppl ; (408): 65-74, 2001.
Article in English | MEDLINE | ID: mdl-11730075

ABSTRACT

OBJECTIVE: To relate the pattern of neuropsychological impairments among schizophrenic patients to case history data and disease characteristics in a cross-sectional study of unselected patients, and to integrate these data with two previous longitudinal studies of neuropsychological impairments among schizophrenic patients. METHOD: One hundred consecutive schizophrenic patients were studied with respect to clinical case history and current symptoms, medication and neuropsychological impairment using a comprehensive computerized test battery. RESULTS: The most salient finding was a marked slowing of response readiness, linearly related to the number of previous acute episodes. The resulting deficit was far beyond what has been obtained in any other group of subjects (average -6 SD for >five episode patients). The impairments in many of the other neuropsychological parameters could to some extent be explained with reference to response slowing, with one exception--verbal short-term memory. Adjustment for important confounding factors (age, duration of illness, medication) did not change the strong negative association between response readiness and number of previous episodes. CONCLUSION: These findings, together with findings of our two previous longitudinal studies and a recent replication, prompted us to suggest that each acute schizophrenic episode inflicts damage to a set of hypothetical structures, cognitive pattern generators. We assume that these structures translate intentions to logistic programs. When damaged, delays are introduced into executive functions and corollary discharge processes will run out of phase with intentions. This model implicates new ways of looking at the generative mechanisms of the illness, and on treatment strategies.


Subject(s)
Cognition Disorders/diagnosis , Cognition Disorders/etiology , Schizophrenia/complications , Adult , Antipsychotic Agents/therapeutic use , Brief Psychiatric Rating Scale , Clozapine/therapeutic use , Disease Progression , Female , Humans , Male , Neuropsychological Tests , Psychometrics , Reaction Time , Schizophrenia/diagnosis , Schizophrenia/drug therapy , Severity of Illness Index
16.
Lakartidningen ; 98(26-27): 3118-23, 2001 Jun 27.
Article in Swedish | MEDLINE | ID: mdl-11478205

ABSTRACT

The use of projective and psychometric psychological tests at the Department of Forensic Psychiatry in Stockholm (Huddinge), Sweden, was studied for a population of 60 men, including many patients with neuropsychological disabilities and multiple psychiatric disorders. The results showed that the use of projective tests like Rorschach, Object Relations Test, and House-Tree-Person was more frequent than the use of objective psychometric tests. Neuropsychological test batteries like the Halstead-Reitan Neuropsychological Test Battery or Luria-Nebraska Neuropsychological Battery were not used. The majority of patients were, however, assessed by intelligence scales like the WAIS-R. The questionable reliability and validity of the projective tests, and the risk of subjective interpretations, raise a problem when used in a forensic setting, since the courts' decisions about a sentence to prison or psychiatric care is based on the forensic psychiatric assessment. The use of objective psychometric neuropsychological tests and personality tests is recommended.


Subject(s)
Forensic Psychiatry , Intelligence Tests , Mental Disorders/diagnosis , Neuropsychological Tests , Personality Tests , Projective Techniques , Psychological Tests , Decision Making , Ethics, Medical , Forensic Psychiatry/legislation & jurisprudence , Forensic Psychiatry/standards , Humans , Intelligence Tests/standards , Male , Neuropsychological Tests/standards , Personality Inventory , Personality Tests/standards , Projective Techniques/standards , Psychiatric Status Rating Scales/standards , Psychological Tests/standards , Reproducibility of Results , Risk Factors , Rorschach Test , Sweden
17.
J Am Acad Psychiatry Law ; 29(2): 186-93, 2001.
Article in English | MEDLINE | ID: mdl-11471785

ABSTRACT

Attention Deficit Hyperactivity Disorder (ADHD) has long been recognized in children, and for many the disorder persists into adulthood. There is a growing concern that the adults with ADHD who have the least favorable outcome, are among those who end up in prison. The aim of this study was to assess childhood ADHD and its persistence into adulthood among a representative sample of Norwegian prison inmates, as well as personality disorders and reading difficulties, which in previous studies have been linked to ADHD. The results indicate that persistent ADHD is very common among prison inmates. Personality disorders and reading difficulties are also common. Psychiatric comorbidity complicates the diagnosis of ADHD in adults. A greater awareness about ADHD in adults certainly is warranted, especially within the prison system because of the risk of misdiagnosing psychiatric disorders and also the risk of missing a condition possibly amenable to treatment.


Subject(s)
Attention Deficit Disorder with Hyperactivity/epidemiology , Dyslexia/epidemiology , Personality Disorders/epidemiology , Prisoners/psychology , Adult , Age Factors , Attention Deficit Disorder with Hyperactivity/complications , Attention Deficit Disorder with Hyperactivity/diagnosis , Child , Comorbidity , Diagnosis, Differential , Dyslexia/complications , Dyslexia/diagnosis , Female , Forensic Psychiatry , Humans , Male , Middle Aged , Norway/epidemiology , Personality Disorders/complications , Personality Disorders/diagnosis , Prevalence , Prisoners/statistics & numerical data
18.
Acta Psychiatr Scand ; 103(4): 294-300, 2001 Apr.
Article in English | MEDLINE | ID: mdl-11328244

ABSTRACT

OBJECTIVE: Violence is common among patients with psychoses. The aim of the study was to examine relations between diagnoses, crimes, demographic variables and aggressive behaviour during admission to hospital. METHOD: During 14 months 257 patients were consecutively referred to a unit with high staff/patient ratio. They were assessed for clinical symptoms at admittance and discharge. Also legal status, coercive measures, criminality and sentences were examined. RESULTS: Of the 257 patients, 38% were found in the police register and 33% had been prosecuted. Those patients committed 2525 crimes, including 292 acts of violence. Problems during admittance were related more to positive symptoms at admittance than to earlier criminality. CONCLUSION: Criminality rate is high among patients with functional psychoses. Many patients, especially women, had never been evaluated by a forensic psychiatrist. The psychiatric services have to consider the importance of preventing psychotic relapses and thereby also preventing violence and criminality.


Subject(s)
Aggression/psychology , Crime , Psychotic Disorders/psychology , Psychotic Disorders/rehabilitation , Adolescent , Adult , Aged , Female , Hospitalization , Hospitals, Psychiatric , Humans , Male , Middle Aged , Psychotic Disorders/epidemiology , Sex Distribution
20.
Drugs ; 61(2): 207-36, 2001.
Article in English | MEDLINE | ID: mdl-11270939

ABSTRACT

Second generation antihistamines are recognised as being highly effective treatments for allergy-based disease and are among the most frequently prescribed and safest drugs in the world. However, consideration of the therapeutic index or the benefit/risk ratio of the H1 receptor antagonists is of paramount importance when prescribing this class of compounds as they are used to treat non-life threatening conditions. There are many second generation antihistamines available and at first examination these appear to be comparable in terms of safety and efficacy. However, the newer antihistamines in fact represent a heterogeneous group of compounds, having markedly differing chemical structures, adverse effects, half-life, tissue distribution and metabolism, spectrum of antihistaminic properties, and varying degrees of anti-inflammatory effects. With regard to the latter, there is growing awareness that some of these compounds might represent useful adjunct medications in asthma therapy. In terms of safety issues, the current second generation grouping includes compounds with proven cardiotoxic effects and others with the potential for adverse drug interactions. Moreover, some of the second generation H1 antagonists have given cause for concern regarding their potential to cause a degree of somnolence in some individuals. It can be argued, therefore, that the present second generation grouping is too large and indistinct since this was based primarily on the concept of separating the first generation sedating compounds from nonsedating H1 antagonists. Although it is too early to talk about a third generation grouping of antihistamines, future membership of such a classification could be based on a low volume of distribution coupled with a lack of sedating effects, drug interactions and cardiotoxicity.


Subject(s)
Asthma/drug therapy , Histamine H1 Antagonists/adverse effects , Anti-Asthmatic Agents/adverse effects , Anti-Asthmatic Agents/pharmacokinetics , Anti-Asthmatic Agents/therapeutic use , Central Nervous System/drug effects , Contraindications , Heart/drug effects , Histamine H1 Antagonists/pharmacokinetics , Histamine H1 Antagonists/therapeutic use , Humans , Inflammation/drug therapy , Inflammation Mediators/metabolism , Receptors, Histamine H1/metabolism
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