Search

SummaryIn a previous cisternographic study of the cerebrospinal fluid (CSF) circulation in schizophrenic patients, indications for disturbed flow dynamics were found in 10 of 30 subjects. In order to replicate and investigate the clinical and pathophysiological significance of this finding, 39 schizophrenic patients and 42 healthy subjects were examined with an improved method for measurement of CSF circulation. 99mTc-DTPA was injected intrathecally and the gamma cisternograms were evaluated blindly. Correlations between cisternography findings and age, duration of disease, previous hospitalizations, positive or negative symptomatology, exposure to neuroleptics, psychiatric family history, CT findings and CSF levels of protein, tryptophan and monoamine metabolites, were calculated. Seven of the patients showed abnormalities in the cisternograms with a slow or obstructed flow of CSF over the convexities (P < 0.01) whereas none of the healthy volunteers showed abnormalities. There were no correlations between disturbed CSF circulation in the patients and the clinical and biochemical parameters, thus the significance of the deviations, similar to other biological aberrations found in schizophrenic patients, is not known. Recent developments in magnetic resonance imaging offer new possibilities to further examine CSF circulation abnormalities in schizophrenia.

Introduction A majority of the studies on cognition in schizophrenia have been conducted in drug-treated patients. In healthy subjects, administration of antipsychotic medication has been found to have a negative impact on cognitive performance in domains such as speed of processing and attention. Antipsychotic drugs occupy the D2-dopamine receptor, a receptor subtype that has been related to cognitive function. Studies employing Positron Emission Tomography have shown that poor performance in several cognitive domains is associated to low D2-receptor binding. It is therefore crucial to examine cognition in drug-naive patients with schizophrenia. Objectives In FES patients: To examine the profile of cognitive impairments in the absence of antipsychotic medication and compare with the cognitive profile of patients who are on antipsychotic medication. Aims To study cognition in FES. Methods The Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery was administered to 60 patients with early schizophrenia and 30 healthy controls, 50% of the patients were drug-naive. This research is ongoing and a part of the Karolinska Schizophrenia Project (KaSP), a multidisciplinary research consortium that examines the pathophysiology of schizophrenia. Results Preliminary findings show that patients perform worse than healthy controls in all cognitive domains, with no significant differences between drug-naive and medicated patients. Attention and Visual memory were the domains with the greatest impairments. The results are compared with our previous meta-analytic findings in drug-naive patients. Conclusion These preliminary findings confirm the existence of cognitive impairments at the early stage of schizophrenia in the absence of antipsychotic medication.

Background:Several studies from different countries demonstrate that cardiovascular mortality is the main cause of death for schizophrenia patients as well as for the population although patients with schizophrenia have a doubled cardiovascular mortality risk. The general population of Sweden has during recent years experienced remarkable declines in mortality from cardiovascular disease resulting in increased overall life expectancy. It is unclear whether patients with schizophrenia have experienced these benefits.Methods:Standardized mortality ratios (SMR) for schizophrenia patients in Sweden during 1970 through 2003 were analyzed, using data from national registers on diagnosis and causes of death. Secular trends for SMR were calculated in Poisson regression models.Results:SMR was for schizophrenia patients for all causes of death 2.33 for men and 2.35 for women, cardiovascular death 2.08 for men and 2.15 for women, coronary heart disease 1.91 for men and 2.06 for women, and for myocardial infarction 1.75 for men and 1.86 for women. Age-standardized mortality ratios for schizophrenia patients increased significantly (p

Background and Aims:In bipolar disorder, hospital treatment is generally required in acute manic episodes, due to lack of compliance and adherence to treatment, and in episodes with marked depressive symptoms, especially suicidal ideation. Analyzing patterns of hospital admission rates is important in order to estimate treatment outcomes in both the acute and remitting phases of the disease. The aim of this study was to analyze secular trends in admissions and re-admissions for bipolar disorder in Sweden.Methods:For bipolar disorder and its subdiagnoses, the number of admissions, length of stay and days in hospital during 1997-2005 was calculated. Readmission rates over five years were calculated for patients discharged for the first and the second time during 2000.Results:The number of admissions for patients with bipolar disorder in Sweden increased from around 3,500 to more than 4,000, partly explained by increasing rates of first admissions. Three fourths were readmissions. Hospital days increased, since the length of stay was not reduced. Manic episodes represented half the hospitalizations, depressive a quarter, and mixed ten percent. Patients with their second admission had 1.9 readmissions during five years, compared to 1.2 for patients with their first admission in 2000.Conclusions:Physicians should consider early and effective treatment with long term outcomes in mind. The progressive course is clearly shown by the increasing rates of readmissions after the second admission compared to the first. The increasing number of first admissions is an indication that more patients have received a bipolar disorder diagnosis.

Schizophrenia is a complex disorder and the view that schizophrenia is caused by hyperdopaminergic activity is an oversimplification. In fact, there are clinical evidence in accordance with a hypod ...

Introduction Rapid cycling (RC) is a severe form of bipolar disorder (BD) with an increased rate of episodes. Circadian disturbances are common in BD, and those with RC might be even more vulnerable. Aims To investigate if the P2RX7 gene would be involved in the circadian rhythm and in part thereby be implicated in RC. Methods Gene expression was analyzed in peripheral mononuclear cells (PBMCs) from healthy volunteers (n=8) at the sleep research center, University of California, Irvine Medical Center, USA. Swedish outpatients recruited from psychiatric clinics for BD, diagnosed with BD type 1(n=569; RC: n=121) and anonymous blood donor controls (n=1,044) was investigated in case-case and case-control SNP/haplotype association analyses. Results P2RX7 RNA levels were dramatically increased during sleep deprivation in PBMCs from the healthy volunteers (p=2.3 * 10 -9 ). The P2RX7 rs 2230912 _A allele was more common (OR=2.2, p=0.002) and the ACGTTT haplotype in P2RX7 containing the protective rs2230912_G allele was less common, among RC cases compared to nonRC bipolar patients and blood donor controls. Conclusions Sleep deprivation activates P2RX7 expression in healthy persons which suggests that P2RX7 is involved in, or downstream, circadian rhythm regulation. The putatively low-activity P2RX7 rs2230912 allele A variant was associated with RC in BD which supports earlier findings of P2RX7 associations to affective disorder.

A biological marker may serve as a link between the clinical manifestation of schizophrenia and the underlying susceptibility gene (s) and it may also serve the purpose to delineate subgroups or “endophenotypes”. Aberrant tyrosine transport across the cell membrane in patients with schizophrenia is such a biological marker. Previous studies have showed a reduced tyrosine transport across the fibroblast cell membrane in patients with schizophrenia. the experiments were performed in fibrobasts that had grown for several generations in vitro. Thus, the aberrant tyrosine transportation is likely to reflect a genetic trait that is transmitted through several cell generations. an association between aberrant tyrosine transport across fibroblast membrane and neurocognitive dysfunction was found for patients with schizophrenia in a previous study indicating a connection between deficient tyrosine transport and cognitive dysfunction. the aim of the present study was to investigate the occurrence of aberrant tyrosine transport across the fibroblast membrane in first-degree relatives to patients with schizophrenia to find indications of inheritance. Significant correlations between patients and their mothers were found regarding aberrant tyrosine transport and, furthermore, the mothers with aberrant tyrosine transport showd signs of reduced cognitive functioning. Maternal inheritance is a possible mode for genetic transmissionssion of susceptibility to schizophrenia for a subgroup of patients with low cognitive functioning.

Background and Aims:Longstanding symptoms after mild traumatic brain injury (MTBI) may be attributable to factors other than the MTBI, pretraumatic as well as posttraumatic factors. A recognised problem when assessing pretraumatic factors is underestimation due to recall bias. The aim of the study was to explore prognostic factors for the development of postconcussional disorder (PCD) after MTBI.Methods:In a prospective cohort of MTBI patients, pretraumatic (previous psychiatric disorder, personality traits, coping ability, GAF, psychosocial stressors, medical condition), peritraumatic (duration of loss of consciousness and amnesia, GCS score at presentation, intracranial hemmorhage) and posttraumatic (posttraumatic stress, anxiety, depression) factors were thoroughly assessed within one week after the trauma, when recall bias was estimated to be negliable. Outcome (persisting symptoms and disability) was assessed at three months post injury. Logistic regression analysis was performed to calculate the independent contribution to the outcome from different factors.Results:Three months post injury, 17 % had postconcussional disorder (PCD). Posttraumatic hyperarousal (OR 9.08), concurrent medical conditions (OR 6.19), female gender (OR 5.54) and psychosocial stressors (OR 11.93) independently predicted PCD, but injury related factors had no significant relation to the outcome.Conclusions:Pre- and posttraumatic factors significantly contribute to the long term outcome after MTBI and should be taken into account in the clinical assessment of patients with PCD. The findings support an etiological model that recognises predisposing and perpetuating factors as well as the precipitating head injury as determinants for the development of PCD.