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Lindström, E
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Publications (10 of 20) Show all publications
Lindström, L., Lindström, E., Nilsson, M. & Hoistad, M. (2017). Maintenance therapy with second generation antipsychotics for bipolar disorder - A systematic review and meta-analysis. Journal of Affective Disorders, 213, 138-150.
Open this publication in new window or tab >>Maintenance therapy with second generation antipsychotics for bipolar disorder - A systematic review and meta-analysis
2017 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 213, 138-150 p.Article, review/survey (Refereed) Published
Abstract [en]

Background: Second generations antipsychotics (SGA) are frequently used for maintenance treatment in bipolar disorder. We systematically reviewed the efficacy and long-term effects of treatment with SGA, regardless of treatment strategy (SGA administered either as monotherapy or as adjunctive therapy), in comparison to placebo, lithium or valproate. Primary outcomes were relapses (mood episode recurrence) and discontinuation. Method: Clinical studies were identified through database searching in PubMed, Embase, PsychInfo and Cochrane Library and critically appraised based on the Cochrane Handbook. Full data extraction of raw data was performed and analyzed with meta-analyses, and level of evidence graded using GRADE. Only randomized controlled studies (RCT) and observational studies were included, with a minimum follow-up of 6 months. Comparators used were restricted to placebo, lithium, valproate or other anti-epileptic drugs. Results: We identified 15 RCTs on SGA in bipolar disorder with follow-up-time of 6 months up to 2 years, and one observational study reporting long-term effects of up to 4 years. A total of 6142 patients were included in the randomized trials. No long-term RCTs beyond 2 years follow-up was identified. All RCTs except for one included patients with bipolar disorder type I only. All RCTs except for two included patients pre-stabilized on the drug under investigation prior to randomization (enrichment design). For SGA as adjunctive therapy to lithium or valproate, meta-analyses showed that treatment with either aripiprazole (RR: 0.65, 95% CI 0.50-0.85), quetiapine (RR: 0.38, 95% CI 0.32-0.46) or ziprasidone (RR: 0.62, 95% CI 0.40-0.96) reduced the overall risk of relapses in patients that had responded during the stabilization phase. Adjunctive therapy with quetiapine was the only drug that reduced both manic and depressive episodes. For SGA as monotherapy, only quetiapine was shown to be better than lithium/ valproate for both manic and depressive relapses, but only for patients stabilized on quetiapine during the acute phase. As monotherapy, olanzapine, quetiapine and risperidone were shown to be superior to placebo in reducing the overall risk of relapses. Limitations: There were considerable limitations to the evidence base of maintenance treatment with SGA in bipolar disorder. Most studies used stabilized patients, i.e. enrichment design (selection bias), had considerable dropout levels (attrition bias), and variable degree of reporting bias. No long-term RCT data on efficacy is available beyond 2 years, and almost all studies are on bipolar disorder type I patients only. Despite these limitations, we elucidate quantitative findings from meta-analyses conducted on the randomized trials published on the topic.

Place, publisher, year, edition, pages
ELSEVIER SCIENCE BV, 2017
Keyword
Manic, Depressive, Adjunct, Adjunctive, Add-on, Combination, Long-term, Aripiprazole, Olanzapine, Quetiapine, Risperidone, Ziprasidone, Mood stabilizers, Lithium, Valproate, Valproic acid
National Category
Neurology Psychiatry
Identifiers
urn:nbn:se:uu:diva-322031 (URN)10.1016/j.jad.2017.02.012 (DOI)000398868300019 ()28222360 (PubMedID)
Available from: 2017-05-16 Created: 2017-05-16 Last updated: 2017-05-16Bibliographically approved
Mitran, B., Guler, R., Lindström, E., Fleetwood, F., Tolmachev, V., Ståhl, S., . . . Löfblom, J. (2016). Feasibility of in vivo imaging of VEGFR2 expression using high affinity antagonistic biparatopic affibody construct Z(VEGFR2)-Bp(2). Paper presented at Annual Congress of the European-Association-of-Nuclear-Medicine (EANM), OCT 15-19, 2016, Barcelona, SPAIN. European Journal of Nuclear Medicine and Molecular Imaging, 43, S97-S98.
Open this publication in new window or tab >>Feasibility of in vivo imaging of VEGFR2 expression using high affinity antagonistic biparatopic affibody construct Z(VEGFR2)-Bp(2)
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2016 (English)In: European Journal of Nuclear Medicine and Molecular Imaging, ISSN 1619-7070, E-ISSN 1619-7089, Vol. 43, S97-S98 p.Article in journal, Meeting abstract (Refereed) Published
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
urn:nbn:se:uu:diva-316220 (URN)000391801600232 ()
Conference
Annual Congress of the European-Association-of-Nuclear-Medicine (EANM), OCT 15-19, 2016, Barcelona, SPAIN
Available from: 2017-02-27 Created: 2017-02-27 Last updated: 2017-11-29Bibliographically approved
Nielsen, R. E., Lindström, E., Telleus, G. K. & Levander, S. (2014). Is the PANSS cognitive scale measuring cognition?. Nordic Journal of Psychiatry, 68(8), 573-578.
Open this publication in new window or tab >>Is the PANSS cognitive scale measuring cognition?
2014 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 68, no 8, 573-578 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate the association between the Positive and Negative Syndrome Scale (PANSS) cognitive factors and cognition assessed by neuropsychological tests. Method: Ninety patients with a psychotic illness, the majority having a schizophrenia diagnosis, were assessed with PANSS ratings and tested by a comprehensive computerized neuropsychological test battery, EuCog. Results: Test performance was in the normal range for some of the cognitive indices, but substantially reduced for others, compared with norms, particularly speed-based indices. PANSS ratings were non-specifically associated with cognitive indices representing performance (speed and accuracy) and problem solving strategies (executive functions). There was no discriminant validity for the cognitive factor. A regression analysis suggested that the PANSS cognitive factors reflected verbal IQ but no other cognitive domain like memory, attention or speed. Conclusion: Cognitive test performance is associated with psychopathology as assessed by PANSS items but in a non-specific way. The PANSS cognitive subscale seems to reflect over-learned verbal skills rather than the cognitive domains, which are known to be specifically affected in schizophrenia and relevant for the prognosis. Consequently, PANSS ratings cannot replace the information inherent in neuropsychological test data. The extensive speed problem of patients with schizophrenia should be studied in more detail using test batteries that focus on that problem.

Keyword
Cognition, Neuropsychology, Schizophrenia
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-238438 (URN)10.3109/08039488.2014.898790 (DOI)000343980600008 ()24724929 (PubMedID)
Available from: 2014-12-12 Created: 2014-12-12 Last updated: 2017-12-05Bibliographically approved
Weitoft, G. R., Berglund, M., Lindström, E. A., Nilsson, M., Salmi, P. & Rosen, M. (2014). Mortality, attempted suicide, re-hospitalisation and prescription refill for clozapine and other antipsychotics in Sweden-a register-based study. Pharmacoepidemiology and Drug Safety, 23(3), 290-298.
Open this publication in new window or tab >>Mortality, attempted suicide, re-hospitalisation and prescription refill for clozapine and other antipsychotics in Sweden-a register-based study
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2014 (English)In: Pharmacoepidemiology and Drug Safety, ISSN 1053-8569, E-ISSN 1099-1557, Vol. 23, no 3, 290-298 p.Article in journal (Refereed) Published
Abstract [en]

Purpose: The aim of this study was to analyse prescription refill, re-hospitalisation, total mortality, mortality because of suicide and attempted suicide among patients who were taking various types of antipsychotics. Methods: A population-based cohort study analysed all patients (n=26046) in Sweden who had been treated for schizophrenia from 2006 to 2009 with regard to re-hospitalisation and prescription refill for various types of antipsychotic treatment. A case-control study nested within the cohort analysed all-cause mortality, mortality because of suicide and attempted suicide in relation to antipsychotic use. The study adjusted for history of hospitalisation for psychiatric and medical care, attempted suicide and use of antidepressants. Results: Aripiprazole users were the only ones who showed significantly lower all-cause risks of death, but so few events occurred among users of this relatively new drug that the results should be interpreted with caution. Clozapine users showed lower odds of death by suicide (odds ratio [OR]=0.45 [95%CI 0.20-0.98]) and of attempted suicide (OR=0.44 [0.28-0.70]) than haloperidol users after adjustment for age, sex and year of discharge. Olanzapine users showed approximately the same favourable pattern. Patients who used clozapine were most likely to refill prescriptions and had lower rates of re-hospitalisation. Only one death and 23 cases of agranulocytosis were reported compared with 223 suicides and 831 suicide attempts. An etiologic fraction calculation suggests that the use of clozapine rather than traditional drugs could have prevented 95 suicide attempts during the period. Conclusion: Clozapine and olanzapine reduce the risk of suicide, attempted suicide and re-hospitalisation.

Keyword
mortality, suicide, suicide attempts, antipsychotics, re-hospitalisation, epidemiology, pharmacoepidemiology
National Category
Pharmacology and Toxicology
Identifiers
urn:nbn:se:uu:diva-227938 (URN)10.1002/pds.3567 (DOI)000332952400009 ()
Available from: 2014-07-07 Created: 2014-07-02 Last updated: 2018-01-11Bibliographically approved
Brain, C., Sameby, B., Allerby, K., Quinlan, P., Joas, E., Lindström, E., . . . Waern, M. (2014). Stigma, discrimination and medication adherence in schizophrenia: Results from the Swedish COAST study. Psychiatry Research, 220(3), 811-817.
Open this publication in new window or tab >>Stigma, discrimination and medication adherence in schizophrenia: Results from the Swedish COAST study
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2014 (English)In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 220, no 3, 811-817 p.Article in journal (Refereed) Published
Abstract [en]

The aims of this naturalistic non-interventional study were to quantify the level of stigma and discrimination in persons with schizophrenia and to test for potential associations between different types of stigma and adherence to antipsychotics. Antipsychotic medication use was electronically monitored with a Medication Event Monitoring System (MEMS (R)) for 12 months in 111 outpatients with schizophrenia and schizophrenia-like psychosis (DSM-IV). Stigma was assessed at endpoint using the Discrimination and Stigma Scale (DISC). Single DISC items that were most frequently reported included social relationships in making/keeping friends (71%) and in the neighborhood (69%). About half of the patients experienced discrimination by their families, in intimate relationships, regarding employment and by mental health staff. Most patients (88%) wanted to conceal their mental health problems from others; 70% stated that anticipated discrimination resulted in avoidance of close personal relationships. Non-adherence (MEMS (R) adherence <= 0.80) was observed in 30 (27.3%). When DISC subscale scores (SD) were entered in separate regression models, neither experienced nor anticipated stigma was associated with adherence. Our data do not support an association between stigma and non-adherence. Further studies in other settings are needed as experiences of stigma and levels of adherence and their potential associations might vary by a healthcare system or cultural and sociodemographic contexts.

Keyword
Discrimination and Stigma Scale (DISC), Experienced discrimination, Anticipated discrimination, Antipsychotics, Medication Event Monitoring System (MEMS (R))
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-243678 (URN)10.1016/j.psychres.2014.10.016 (DOI)000347361300012 ()25457284 (PubMedID)
Funder
Swedish Research Council, K2009-62X-21079-01-3
Available from: 2015-02-19 Created: 2015-02-11 Last updated: 2017-12-04Bibliographically approved
Brain, C., Sameby, B., Allerby, K., Lindström, E., Eberhard, J., Burns, T. & Waern, M. (2014). Twelve months of electronic monitoring (MEMS (R)) in the Swedish COAST-study: A comparison of methods for the measurement of adherence in schizophrenia. European Neuropsychopharmacology, 24(2), 215-222.
Open this publication in new window or tab >>Twelve months of electronic monitoring (MEMS (R)) in the Swedish COAST-study: A comparison of methods for the measurement of adherence in schizophrenia
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2014 (English)In: European Neuropsychopharmacology, ISSN 0924-977X, E-ISSN 1873-7862, Vol. 24, no 2, 215-222 p.Article in journal (Refereed) Published
Abstract [en]

The primary aim was to compare objective and subjective measures of adherence in a naturalistic cohort of schizophrenia outpatients over 12 months between October 2008 and June 2011. Antipsychotic medication adherence was monitored in 117 outpatients diagnosed with schizophrenia or schizophrenia-like psychosis according to DSM-IV criteria in a naturalistic prospective study. Adherence was determined by the Medication Event Monitoring System (MEMS (R)), pill count, plasma levels and patient, staff, psychiatrist and close informant ratings. The plasma level adherence measure reflects adherence to medication and to lab visits. Relationships between MEMS (R) adherence and other measures were expressed as a concordance index and kappa (K). Non-adherence (MEMS (R) <= 0.80) was observed in 27% of the patients. MEMS (R) adherence was highly correlated with pill count (concordance= 89% and K=0.72, p < 0.001). Concordance and K were lower for all other adherence measures and very low for the relationship between MEMS (R) adherence and plasma levels (concordance=56% and K=0.05, p=0.217). Adherence measures were also entered into a principal component analysis that yielded three components. MEMS (R) recordings, pill count and informant ratings had their highest loadings in the first component, plasma levels alone in the second and patient, psychiatrist and staff ratings in the third. The strong agreement between MEMS (R) and pill count suggests that structured pill count might be a useful tool to follow adherence in clinical practice. The large discrepancy between MEMS (R) and the adherence measure based on plasma levels needs further study in clinical settings.

Keyword
Adherence, Schizophrenia, Antipsychotics, Medication Event Monitoring System, Pill count, Plasma levels
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-221980 (URN)10.1016/j.euroneuro.2013.11.013 (DOI)000331680100005 ()
Available from: 2014-04-08 Created: 2014-04-07 Last updated: 2017-12-05Bibliographically approved
Brain, C., Allerby, K., Sameby, B., Quinlan, P., Joas, E., Karilampi, U., . . . Waern, M. (2013). Drug attitude and other predictors of medication adherence in schizophrenia: 12 months of electronic monitoring (MEMS (R)) in the Swedish COAST-study. European Neuropsychopharmacology, 23(12), 1754-1762.
Open this publication in new window or tab >>Drug attitude and other predictors of medication adherence in schizophrenia: 12 months of electronic monitoring (MEMS (R)) in the Swedish COAST-study
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2013 (English)In: European Neuropsychopharmacology, ISSN 0924-977X, E-ISSN 1873-7862, Vol. 23, no 12, 1754-1762 p.Article in journal (Refereed) Published
Abstract [en]

The aim was to investigate clinical predictors of adherence to antipsychotics. Medication use was electronically monitored with a Medication Event Monitoring System (MEMS (R)) for 12 months in 112 outpatients with schizophrenia and schizophrenia-like psychosis according to DSM-IV. Symptom burden, insight, psychosocial function (PSP) and side effects were rated at baseline. A comprehensive neuropsychological test battery was administered and a global composite score was calculated. The Drug Attitude Inventory (DAI-10) was filled in. A slightly modified DAI-10 version for informants was distributed as a postal questionnaire. Nonadherence (MEMS (R) adherence <= 0.80) was observed in 27%. In univariate regression models low scores on DAI-10 and DAI-10 informant, higher positive symptom burden, poor function, psychiatric side effects and lack of insight predicted non-adherence. No association was observed with global cognitive function. In multivariate regression models, low patient-rated DAI-10 and PSP scores emerged as predictors of non-adherence. A ROC analysis showed that DAI-10 had a moderate ability to correctly identify non-adherent patients (AUC=0.73, p<0.001). At the most "optimal" cut-off of 4, one-third of the adherent would falsely be. identified as non-adherent. A somewhat larger AUC (0.78, p<0.001) was observed when the ROC procedure was applied to the final regression model including DAI-10 and PSP. For the subgroup with informant data, the AUC for the DAI-10 informant version was 0.68 (p=0.021). Non-adherence cannot be properly predicted in the clinical setting on the basis of these instruments alone. The DAI-10 informant questionnaire needs further testing.

Keyword
Adherence, Predictors, Schizophrenia, Antipsychotics, Medication Event Monitoring Systein, Drug Attitude Inventory
National Category
Natural Sciences
Identifiers
urn:nbn:se:uu:diva-213908 (URN)10.1016/j.euroneuro.2013.09.001 (DOI)000327921900011 ()
Available from: 2014-01-06 Created: 2014-01-05 Last updated: 2017-12-06Bibliographically approved
Edvinsson, D., Lindström, E., Bingefors, K., Lewander, T. & Ekselius, L. (2013). Gender differences of axis I and II comorbidity in subjects diagnosed with attention-deficit hyperactivity disorder as adults. Acta Neuropsychiatrica, 25(3), 165-174.
Open this publication in new window or tab >>Gender differences of axis I and II comorbidity in subjects diagnosed with attention-deficit hyperactivity disorder as adults
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2013 (English)In: Acta Neuropsychiatrica, ISSN 0924-2708, E-ISSN 1601-5215, Vol. 25, no 3, 165-174 p.Article in journal (Refereed) Published
Abstract [en]

Objective: To investigate gender differences in psychiatric comorbidity patients diagnosed with attention-deficit hyperactivity disorder (ADHD) as adults. Methods: Interviews about current ADHD symptoms and psychiatric comorbidity on axis I and II (Structured Clinical Interview for DSM-IV axis I and axis II) were conducted in a clinical cohort of 168 patients (78 women, 90 men). Independent information on childhood and current symptoms was collected from parents, partners and patient files. Results: The lifetime prevalence of psychiatric comorbidity on axis I reached 92%, and current comorbidity, including autism spectrum disorders and Tourette's syndrome, was 47%. Women had a higher lifetime prevalence of mood and eating disorders compared with men, where substance-use disorders were more frequent. Ten per cent of patients fulfilled diagnostic criteria for a personality disorder. When excluding the general diagnostic criteria, 46% of the patients endorsed the specific criteria for at least one personality disorder. Gender differences were identified with predominance of histrionic personality traits in women and conduct disorder in men. Conclusion: Patients diagnosed with ADHD as adults display an extremely high lifetime axis I comorbidity with a gender-specific pattern similar to the general population. No gender differences were identified with regard to personality disorders; however, an increased prevalence of deviant personality traits was confirmed. This study stresses the importance of evaluating comorbidity among patients diagnosed with ADHD as adults to secure optimal treatment.

Keyword
ADHD, adults, comorbidity, gender
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-204118 (URN)10.1111/j.1601-5215.2012.00682.x (DOI)000320550800006 ()
Available from: 2013-07-22 Created: 2013-07-22 Last updated: 2017-12-06Bibliographically approved
Nielsen, R. E., Lindström, E., Nielsen, J. & Levander, S. (2012). DAI-10 is as good as DAI-30 in schizophrenia. European Neuropsychopharmacology, 22(10), 747-750.
Open this publication in new window or tab >>DAI-10 is as good as DAI-30 in schizophrenia
2012 (English)In: European Neuropsychopharmacology, ISSN 0924-977X, E-ISSN 1873-7862, Vol. 22, no 10, 747-750 p.Article in journal (Refereed) Published
Abstract [en]

Drug attitude inventory (DAI-30) is considered to be the best predictor of poor adherence in first-episode schizophrenia. We compared the short version (DAM 0) with DAI-30 in long-term schizophrenia, documented if DAI was associated with poor insight, PANSS and GAF and constructed DAI-10 percentiles. DAI-30 and DAI-10 were homogenous (r = 0.82 and 0.72, respectively) with good test-retest reliability (0.79). The correlation between the DAI versions was high (0.94). Percentile scores of DAI-10 were computed. DAI is an easy-to-use self-report instrument seemingly assessing a unique clinical dimension relevant to non-adherence. DAI-10 might be preferred for its simplicity and good psychometric properties.

Keyword
Rating scales, Schizophrenia, Cognitive neuroscience, Insight, DAI
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-185197 (URN)10.1016/j.euroneuro.2012.02.008 (DOI)000309781200007 ()
Available from: 2012-11-22 Created: 2012-11-21 Last updated: 2017-12-07Bibliographically approved
Lindström, E., Tuninger, E. & Levander, S. (2012). PECC-Factor structure and findings in three longitudinal cohorts of patients with schizophrenia. Nordic Journal of Psychiatry, 66(1), 33-39.
Open this publication in new window or tab >>PECC-Factor structure and findings in three longitudinal cohorts of patients with schizophrenia
2012 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 66, no 1, 33-39 p.Article in journal (Refereed) Published
Abstract [en]

Background: Symptom control by drug treatment is the most important task in routine clinical care of patients with schizophrenia. Structured assessment methods are needed in this task but not used much. The US-developed Positive and Negative Syndrome Scale (PANSS) is a standard tool for symptom assessment. The Psychosis Evaluation tool for Common use by Caregivers (PECC) was constructed in Europe some years ago, with the intent to overcome some of the PANSS drawbacks. Aims and methods: To validate PECC on three longitudinal cohorts of schizophrenic patients representative of Swedish outpatients (n = 225, six assessments over 5 years), international forensic patients (n = 186) and matched non-forensic controls (n = 116), five assessments over 2 years for both. Results : The factor structure of PECC appears to be highly robust. Norm values (in percentiles) were calculated on the materials. Such data provides for analyses of symptom profiles and improvement over time measured in absolute numbers. Forensic patients appear to have a much lower symptom load (except for cognitive symptoms) than the other groups. Forensic controls had much shorter inpatient times than any other group and never caught up with respect to symptom control, even after 2 years. These differences suggest that the scale is clinically valid. Conclusion: PECC has a more robust factor structure than PANSS and is simpler to use. Percentile norms have been constructed for outpatients with schizophrenia in general and forensic psychiatry. Percentile scores are accessed readily by the net. PECC is available in many languages. Its separate self-harm item may improve assessments of suicide risk among patients with schizophrenia.

Keyword
Assessment of symptoms, Factor structure, Forensic, Longitudinal, Schizophrenia, Suicide ideation
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-316689 (URN)10.3109/08039488.2011.595499 (DOI)000298965100007 ()21958348 (PubMedID)
Available from: 2017-03-06 Created: 2017-03-06 Last updated: 2017-11-29Bibliographically approved
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