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Robert Bodén,1,2 Gunnar Edman,3,4 Johan Reutfors,2 Claes-Göran Östenson,3 Urban Ösby3,4 1Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden; 2Department of Medicine Solna, Centre for Pharmacoepidemiology, Karolinska Institutet, Stockholm, Sweden; 3Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; 4Department of Psychiatry, Tiohundra AB, Norrtälje, Sweden Abstract: It is well known that abdominal obesity, dyslipidemia, and insulin resistance are highly prevalent in patients receiving maintenance treatment with antipsychotics, but there is limited knowledge about the association between cardiovascular risk factors and treatment with antipsychotic drugs. In this naturalistic study we investigated a sample of 809 antipsychotic-treated patients from Swedish psychosis outpatient teams. Cardiovascular risk factors (eg, metabolic syndrome, homeostasis model assessment of insulin resistance, and low-density lipoprotein values) were measured, and their associations to current antipsychotic pharmacotherapy were studied. Ten antipsychotic drugs were compared in a stepwise logistic regression model. For the patients, the presence of the components of metabolic syndrome ranged from 35% for hyperglycemia to 64% for elevated waist circumference. Hypertriglyceridemia was associated with clozapine (odds ratio [OR] = 1.81, 95% confidence interval [CI] 1.08–3.04), reduced high-density lipoprotein with both clozapine and olanzapine (OR = 1.73, 95% CI 1.01–2.97; and OR = 2.03, 95% CI 1.32–3.13), hypertension with perphenazine (OR = 2.00, 95% CI 1.21–3.59), and hyperglycemia inversely with ziprasidone (OR = 0.21, 95% CI 0.05–0.89) and positively with haloperidol (OR = 2.02, 95% CI 1.18–3.48). There were no significant relationships between any of the antipsychotic drugs and increased waist circumference, homeostasis model assessment of insulin resistance, or low-density lipoprotein levels. In conclusion, treatment with antipsychotic drugs is differentially associated with cardiovascular risk factors, even after adjusting for waist circumference, sex, age, and smoking. Keywords: adverse metabolic effects, antipsychotic drugs, cardiovascular risk factors, HOMA-IR, metabolic syndrome

Background and method. Following Achilles tendon rupture (ATR)-surgery, patients using intermittent pneumatic compression (IPC) of the calf, compared to a plaster casted control-group (CTRL), exhibit reduced risk of deep venous thrombosis (DVT). Based on data from a randomized controlled trial (RCT), we investigated which dichotomized subgroups (based on age, sex, BMI and time to surgery (TTS)) within the IPC-(n= 66) and CTRL-group (n= 70) that were most likely to sustain a DVT, and which patients that had most benefit from postoperative IPC. Results. Age ≥39y (OR 6.06, p<0.001) and TTS >66h (OR 2.3, p=0.031) significantly increased the risk of DVT, but not sex or BMI. IPC-treatment significantly reduced the DVT-risk (OR 0.46, p=0.042), with more pronounced effect when considering age and TTS (OR 0.40, p=0.032). Although non-significant, females (OR 1.44, p=0.78) and patients with low BMI (OR 1.16, p=0.84) seemed to exhibit less DVT-preventive effect of IPC. Conclusion. Patients with age >38y and TTS>66h are at increased DVT-risk during post-operative leg immobilization, while adjuvant IPC shows good DVT-preventive effects among most patients, especially in those with high DVT-risk. Further trials are however warranted, to examine the low DVT-preventive effects of IPC discovered among females and patients with low BMI. [ABSTRACT FROM AUTHOR]

Background: Poisoning represents a significant part of admissions to intensive care units. The aim of this nationwide study was to describe recent national quality register data of demographics and mortality for these patients.Method: A retrospective national observational study including all patients over 19 years admitted to an ICU in Sweden, between 1 January 2010 and 31 December 2011, with an ICD-10 code for poisoning. The data were collected from three national registers (The Swedish Intensive Care Register, The National Patient Register, and The Cause of Death Register).Results: The incidence of ICU-treated poisonings was 43/100,000. Twenty-one per cent (n = 8155) of all poisoned patients seeking medical care were admitted to the ICU. Their median age was 38 years (q1-q3: 26-51), as many men as women and 46.5% (n = 3790) had a previous registered poisoning. A mix of different substances was the most common type of suspected poisoning (29.7%, n = 2424). The in-hospital mortality was 1.9% and was correlated to invasive mechanical ventilation (OR 6.91 CI 95% 4.59-10.42), age > 40 (OR 4.54 CI 95% 2.86-7.21) and no previous hospitalisation for poisoning (OR 3.23 CI 95% 2.06-5.07). For 78.3% (n = 119) of the deceased patients, the fatal poisoning was their first diagnosed poisoning. The 30-day mortality was 2.7%, a majority died from poisoning (P < 0.01).Conclusion: In Sweden, patients treated in the ICU due to poisoning represent a fifth of all poisoned patients seeking medical care. Older men with no previous poisoning were considered a high-risk group. [ABSTRACT FROM AUTHOR]

Lipid rescue is used as treatment of various poisonings despite weak scientific evidence. Some experimental studies have indicated a positive effect, but others have not. Clinical studies are lacking, wherefore a systematic review of virtually all published human case reports is presented. The case reports were searched for in PubMed and Web of Science and examined by two experts according to an assessment form grading the probability for a causal connection between lipid rescue and improved symptoms. A total of 160 cases were finally included, of which 30 had no positive effect of lipid rescue. Among the 130 included cases with alleged positive effect, 94 were oral poisonings and 36 were cases with local anesthetic systemic toxicity (LAST). The experts' assessment resulted in a "certain" causal connection in three cases with LAST but not in oral poisoning. Moreover, the mean assessment score among the oral poisonings was significantly worse than the corresponding score in the cases with LAST. The average log p-value of the main toxins among the oral poisonings was significantly lower than the corresponding p-value in the cases with LAST. Among the oral poisonings, 91% had received some other resuscitative treatment more or less simultaneously with lipid rescue. Considering the findings of this study and the increasingly reported adverse effects of lipid rescue, it's reasonable to strictly limit its use in clinical practice. We would not recommend it in oral poisonings. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of the present study was to investigate patterns of personality in patients with subjective cognitive impairment (SCI) and mild cognitive impairment (MCI), compared to healthy controls. Methods: We assessed 24 patients with SCI, 35 patients with MCI and 26 healthy controls with the self-report questionnaire Swedish Universities Scales of Personality measuring aspects of neuroticism/ anxiety proneness, extraversion, and aggression-hostility. Results: Patients with SCI and MCI showed significantly more Somatic Trait Anxiety, Psychic Trait Anxiety and Stress Susceptibility than healthy controls. Moreover, there was a significant increase in Detachment in patients with MCI and a significant decrease in Adventure Seeking in patients with SCI, relative to healthy controls. Conclusions: Patients with SCI and MCI presented specific patterns of personality alterations with higher scores in traits related to anxiety proneness and aggression-hostility and lower in traits of extraversion. In most subscales differences followed a sequential pattern with gradually increasing scores from healthy controls, to patients with SCI and further to MCI. The groups differed in amount and type of symptoms, suggesting that patterns of personality may be related to degree of cognitive impairment. [ABSTRACT FROM AUTHOR]

AIM: This paper is a report of a study conducted to examine changes in personality from late pregnancy to early motherhood in primiparas having vaginal or caesarean deliveries. BACKGROUND: Birth of the first child is a major life event, possibly influencing personality. The physiological and emotional processes that start in pregnant women have a major impact on the evolving mother-child relationship. Knowledge about changes in personality during pregnancy and motherhood is scarce. METHOD: A prospective, group-comparative cohort study including 314 healthy primiparas having either 'caesarean section on maternal request' (n = 74) or 'spontaneous vaginal delivery group' (n = 240). The self-report inventory Karolinska Personality Scales was mailed to participants at 37-39 gestational weeks in pregnancy and 9 months after delivery. Data were collected from January 2003 to June 2006. RESULTS: All mean values of the personality variables were within the normal range. There was a statistically significant increase in Impulsivity (P = 0.046) and decrease in Socialization (P = 0.004). The scores developed differently depending on mode of delivery. Thus, women in the vaginal delivery group increased their scores on the Psychic anxiety and Guilt scales, while those in the caesarean delivery group decreased their scores. Although women in both groups became more impulsive and less socialized, personality remained comparatively stable in the transition from late pregnancy to motherhood. CONCLUSION: As interactive therapeutic midwife/client relationships and maternal/social role preparation have been shown to have a great effect on progress in becoming a mother, knowledge about how personality may affect this process is important so that healthcare professionals can attempt to reduce women's anxiety levels during pregnancy. [ABSTRACT FROM AUTHOR]

Objective: Examine frequency, character and course of symptoms until 3 months after MTBI and the relation between symptoms and disability. Methods: Prospective cohort study of 122 consecutive patients with MTBI. Symptom assessment after 1, 7 and 14 days and 3 months post-injury by use of Rivermead Post-concussional Questionnaire. Disability assessment by use of Rivermead Head Injury Follow-up Questionnaire. Results: Patients reporting one or more symptoms declined from 86% on day 1 to 49% 3 months post-injury, when 25% also reported change in one or more domains of everyday activities. Poor memory, sleep disturbance and fatigue were most commonly reported. Symptom and disability scores were correlated (r = 0.60; p < 0.001). Early symptom load correlated with late symptom load (v=0.38;p< 0.01). Conclusions: Symptoms gradually decline post-injury. Symptoms correlate with disability at 3 months. Patients with early high symptom load are at risk for developing persisting complaints. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to explore the relationship between the proteins S100B and S100A1B and symptoms and signs of cognitive impairment for 3 months after mild traumatic brain injury (MTBI).Methods: Serum concentrations of S100A1B and S100B were examined in a prospective cohort study of patients with MTBI and a Glasgow Coma Scale score of 14 or 15. Cognitive performance was assessed by repeated computerized neuropsychological testing and an extended neuropsychological test. Symptoms were assessed using the Rivermead Post-Concussion Symptoms Questionnaire.Results: Concentrations of S100B and S100A1B were above cut-off in 31% and 48% respectively. Eight percent of the patients had signs of cognitive impairment according to the computerized neuropsychological tests and 30% according to the extended test. Symptoms of cognitive impairment were reported by 44% of the patients on the first day post-injury and by 26% at 3 months. No significant associations between S100B or S100A1B concentrations and symptoms or signs of cognitive impairment were found.Conclusion: Abnormal S100 serum concentrations and symptoms or signs of cognitive impairment were not significantly associated in patients with MTBI and a Glasgow Coma Scale score of 14 or 15. [ABSTRACT FROM AUTHOR]

Establishing post-traumatic stress disorder as a psychiatric diagnosis has only marginally increased awareness of traumatic experiences. Traumas are inconsistently recorded in initial psychiatric histories and, when observed, rarely reflected in the primary diagnosis and treatment. The present study aimed to investigate if there is an association between sufficiently addressing trauma and long-term outcome and what factors affect whether trauma, according to the patient's view, is sufficiently addressed or not. Socio-demographic data, experiences of trauma and treatment, and outcome, were collected retrospectively from Arabic, Iranian, Turkish and Swedish patients, who had visited a psychiatric clinic 3-4 years earlier. Fifty-one patients whose traumatic experiences had been sufficiently addressed were compared with 39 patients who perceived that their traumas had not been addressed. Logistic regression analyses were performed to examine relationships between clinical variables and whether or not traumas had been addressed. Patients with trauma sufficiently addressed reported high confidence in staff (odds ratio, OR=7.2, p <0.001), high self-rated health (OR=8.0, p <0.01) and low scores on the Self-rating Inventory for PTSD (OR=7.7, p <0.05) and Depression Scale (OR=3.0, p <0.15). Reporting less than five different traumas (OR=4.6, p <0.01) and being an ethnic Swede (OR=2.4, p <0.10) were the background variables independently related to having trauma sufficiently addressed. Addressing trauma may improve patients' confidence in staff, self-rated health and trauma-related symptoms. Multiplicity of traumas and belonging to an ethnic minority implied that trauma was less addressed. [ABSTRACT FROM AUTHOR]

This study aims to apply and modify an inventory measuring maternal foetal attachment (MFAS) for use in a Swedish population, and to relate these data to personality traits measured by the Karolinska Scales of Personality (KSP). Previously, we found changes in women's personality traits at childbirth. The attachment and personality profiles were studied in women expecting their first child at the 13th ( n =50, response rate 87%) and 36th week of gestation ( n =50, response rate 76%). The scores on the total MFAS were high, significantly higher for women tested in the later phase of pregnancy ( p <0.01). A factor analysis revealed a four-factor structure ('visualizing motherhood', 'wonder and worry', 'nourishing self and foetus', and 'relation to foetus and own body'), not replicating the five a priori factors of Cranley. Linear regression analyses showed positive correlation between the total attachment score and the tendency to feel 'guilt' and the desire for 'social desirability' as reflected by the KSP. Attachment subscales showed a positive correlation with 'somatic anxiety', 'guilt', 'psychasthenia', 'social desirability', 'inhibited aggression' and phase of pregnancy. Negative correlation with 'psychic anxiety' and 'emotional detachment' was found. These findings are, to our knowledge, a fairly new contribution to the literature on maternal foetal attachment. [ABSTRACT FROM AUTHOR]

The personality pattern of 29 subjects, 10 men and 19 women, with a mean age of 371 years (range 23-68) was studied by means of a personality inventory (KSP) and compared with the personality traits of a `normal population'. The bruxers had significantly higher scores in the somatic anxiety and muscular tension scales and lower scores in the socialization scale; that is, the bruxers were more anxiety-prone, had higher vulnerability for psycho- somatic disorders and were less socialized. The frequent clenchers (once to twice a week) comprised a special subgroup within he material with higher values in the somatic anxiety, psychic anxiety and muscular tension scales. A strong correlation was found between high values in the muscular tension scale and headache; aching neck, back, throat or shoulders; tooth clenching; number of muscles tender at palpation and the clinical dysfunction index (Di). The results of this study indicate a possible aetiological relationship between personality tooth clenching and cranio mandibular dysfunction (CM D), However, the material was small and some precaution must he taken prior to generalization of the results. Studies on larger material are needed and especially more studies in sleep laboratories. [ABSTRACT FROM AUTHOR]

The personality traits of 69 of a sample of 70 adolescents aged 25-26 years were re-examined after 10 years by means of a personality inventory (KSP). A total of 11 subjects had intact dentitions (group I), while 18 subjects had some fillings in their teeth since the first examination (group FI), and 40 subjects had restored dentitions from the starting-point (group F). The subjects with fillings 10 years ago had significantly higher scores in two of the anxiety variables somatic anxiety and muscular tension and in the hostility variable, suspicion, than did those without the fillings. Together with the finding of a significant correlation between high scores for the clinical dysfunction index (Dill and DiIII) and the muscular tension scale, the results of this study support the hypothesis of a possible correlation between dental filling therapy, craniomandibular disorders (CMD) and personality. Frequent tooth clenching (once to twice a week or more) was significantly more common among the subjects with fillings 10 years ago. The clenchers scored highest in the somatic anxiety, muscular tension and suspicion scales and constituted a well-defined subgroup within the subjects of this study. There was a highly significant increase of muscular tension among the clenchers during the 10-year examination period compared to the non-clenchers. However, the results of this study are not cleaT-cut. There was no statistically significant difference in personality between subjects with fillings after 10 years (group F + Fi) and the group of subjects with intact teeth (group I). Hypothetically, this may indicate that the differences found in this study could be due to how long the fillings had been in the mouth and at which age they were inserted. In order to test the hypothesis further and to establish the possible mechanisms behind this finding, more studies are necessary and especially more longitudinal comparative studies between subjects with intact and restored dentitions. [ABSTRACT FROM AUTHOR]

The personality traits of 66 of a sample of 70 adolescents aged 19-21 years were re-examined after 5 years by means of a personality inventory (KSP). A total of 15 subjects had intact dentitions (group I), while 13 subjects had some fillings in their teeth since the first examination (group FI), and 38 subjects had restored dentitions at both examinations (group F). The findings of this study are in agreement with those of the earlier study of Kampe, Edman and Molin (1986). On both occasions the subjects with restored dentitions had higher scores on the Somatic Anxiety and Muscular Tension scales. The differences were more pronounced for the female subjects. With regard to muscular tension, there was a significant interactive effect, with higher values for the female subjects in group F. Individuals with high scores for the Clinical Dysfunction Index (DiII and DiIII) also had the highest scores on the Somatic Anxiety and Muscular Tension scales, thus confirming the validity of the muscle palpation. The hypothesis of a correlation between personality factors and dental-filling therapy was neither accepted nor rejected. The subjects in group F had the highest scores on both occasions on the Somatic Anxiety and Muscular Tension scales, although the subjects in group FI had the lowest scores. Further studies are required, and another 5-year follow-up study of this material could be conclusive. [ABSTRACT FROM AUTHOR]

Compared to healthy controls, unmedicated schizophrenic patients had significantly higher plasma concentrations of taurine, methionine, valine, isoleucine, leucine, phenylalanine, and lysine. Except for taurine, these amino acids share the L-transport system for neutral amino acids. In the patients, homovanillic (HVA) acid levels in CSF were decreased and the plasma levels of the amino acids competing with tyrosine and tryptophan for transport into the brain, were all negatively correlated to the CSF concentrations of HVA and 5-HIAA. These findings could be explained by a change in the affinity of the L-system or by a decrease in its overall capacity in schizophrenia. Raised plasma levels of the competing amino acids may limit the brain uptake of tyrosine, leading to a diminished dopamine turnover, and resulting in a compensatory development of supersensitive dopamine receptors. [ABSTRACT FROM AUTHOR]

This study compared the efficacy and tolerability of sodium cromoglycate (SC) and beclomethasone dipropionate (BDP) in adult patients with bronchial asthma inadequately treated with bronchodilators alone. The study was a double-blind, randomized, double-dummy, parallel-group study. Patients with mild to moderate symptomatic asthma, inadequately treated with bronchodilators only, were, after a 2-week run-in (base-line) period, randomized to 8 weeks of treatment with either SC 10 mg four times daily or BDP 100 μg four times daily. Salbutamol metered-dose inhaler was given as relief medication. A total of 37 patients were randomized for treatment, 19 patients in the SC group and 18 patients in the BD group. Efficacy and safety were determined by daily record card data: morning and evening peak-expiratory-flow rates (PEFR), daytime and nighttime asthma symptom scores, and rescue salbutamol use. At clinic visits, FEV1, and FVC were measured, as were the physicians and the patient's assessment of the medication at the end of the study. The safety and tolerability of the trial medication were assessed by monitoring adverse events throughout the study. A clinically and statistically significant improvement of the asthma in FEV1, symptom scores, rescue meditation, and global opinion of efficacy was observed, and both groups provided equivalent efficacy. The morning PEFR as well as the evening PEFR for both groups improved but was statistically significant only for the BDP group (M-PEFR). Both drugs were tolerated with only a few minor adverse events. This trial shows that SC and BDP are equally effective anti-inflammatory treatments for mild to moderate bronchial asthma in adults. [ABSTRACT FROM AUTHOR]

Signs and symptoms of craniomandibular dysfunction (CMD) and social medical history were reported in 29 subjects, aged 23-68 years, with longstanding (5 years or more) bruxing behaviour. The subjects were selected from answers to an advertisement in the local newspaper. The subjects presented many symptoms of a general character including somatic and psycho-social problems, sleep disorders (72%). and pain (86%). More than half of the subjects (55%) had symptoms every day. Frequent aches in the neck, back, throat or shoulders. were reported by 69% and frequent headache by 48% of the subjects. The most common symptoms of CMD were pain in the face or jaws (48%), stiffness in the jaws in the morning (44%), temporomandibular joint (TMJ) sounds (34%) and fatigue in the jaws during chewing (38%) and the most common clinical signs were more than three muscles tender on palpation (76%), TMJ-sounds (55%) and tenderness of TMJ on lateral palpation (66%). There was a statistically significant correlation between frequent tooth clenching and headache, pain in the neck, back, throat or shoulders, sleep disorders and high scores of the clinical dysfunction index (Di). The frequent clenchers had higher score values than the `non-clenchers' for pain in the face and the jaws; headache; pain in the neck, back, throat or shoulders and the clinical dysfunction index (Di). These findings indicate a causal relationship between frequent tooth clenching and signs and symptoms of CMD, including headache and pain in the neck, back, throat or shoulders and high pathogenicity for frequent clenching. However, the material in this study is small and some precaution must be taken prior to generalized conclusions. More studies are required, especially sleep laboratory investigations, which could perhaps give answers to some of the numerous questions in this unexplored field of odontology. [ABSTRACT FROM AUTHOR]

Skin conductance responses to repeated identical stimuli (11 or 21 tones, 85dBA, 1000 Hz, l-sec duration, sine wave, fast onset) were studied in unmedicated recently admitted RDC diagnosed patients (13 schizophrenic and five paranoid psychotic) and in age- and sex-matched controls. Subjects were classified as nonresponders, fast habituators, habituators, and nonhabituators. The distribution did not differ between patients and controls. There were no nonresponders among the patients and no evidence of bimodality. Schizophrenic patients had more skin conductance responses than controls and a more irregular response course. Analyses of heart rate responses excluded defensive responses, but no conclusions could be drawn as to whether startle or orienting responses had been elicited. The patients had psychophysiological signs of high arousal. They were in an early phase of their illness, with "positive" psychotic symptoms. The absence of nonresponding may be related to the type of patients studied and the characteristics of the stimuli used (high intensity, fast onset tones). [ABSTRACT FROM AUTHOR]

Background. Woman and men practice medicine differently. One recent study showed that patients operated on by female surgeons exhibited better outcome. We hypothesized that the sex of the surgeon would not affect patient outcome, adverse events and the biological processes of healing after surgical repair of Achilles tendon rupture (ATR). Methods. A total of 111 patients with acute ATR were surgically repaired by the surgeon on duty. A specific surgeon could not be decided by the patient. At two-weeks, levels of healing biomarkers collagen I and III were quantified in microdialysates from the operated tendons. At 12-months post-surgery, patient-reported outcome was assessed using the validated Achilles tendon Total Rupture Score (ATRS), and adverse events were measured. Results. Patients treated by female versus male surgeons exhibited higher levels of collagen I (p=0.034) and reported better ATRS (88±8.2 vs. 81±14, p=0.011). Moreover, patients reported less limitations in daily living activity, more strength and less stiffness in the ankle when treated on by female as compared to male surgeons (all p<0.05). No significant difference in the incidence of adverse events was observed between male and female surgeons. Conclusions. The present findings suggest further exploration of the determinating factors including care and communication related to surgeons to improve outcome. [ABSTRACT FROM AUTHOR]

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-naïve 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-naïve. 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-naïve 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-naïve patients. Conclusion These preliminary findings confirm the existence of cognitive impairments at the early stage of schizophrenia in the absence of antipsychotic medication. [ABSTRACT FROM AUTHOR]