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Lindström, L
Alternative names
Publications (10 of 18) 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
Nilsson, B., Lindström, L. & Bodén, R. (2017). Persistent Clozapine Associated Tachycardia Investigated with 24 Hour Ambulatory Electrocardiogram. Paper presented at 72nd Annual Scientific Convention and Meeting of the Society-of-Biological-Psychiatry (SOBP), MAY 18-20, 2017, San Diego, CA. Biological Psychiatry, 81(10), S408-S408.
Open this publication in new window or tab >>Persistent Clozapine Associated Tachycardia Investigated with 24 Hour Ambulatory Electrocardiogram
2017 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 81, no 10, S408-S408 p.Article in journal, Meeting abstract (Other academic) Published
Keyword
Schizophrenia, Clozapine, Tachycardia, ECG, Adverse effect
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-331807 (URN)10.1016/j.biopsych.2017.02.737 (DOI)000400348701103 ()
Conference
72nd Annual Scientific Convention and Meeting of the Society-of-Biological-Psychiatry (SOBP), MAY 18-20, 2017, San Diego, CA
Available from: 2017-10-18 Created: 2017-10-18 Last updated: 2017-10-18Bibliographically approved
Nilsson, B., Edström, O., Lindström, L., Wernegren, P. & Bodén, R. (2017). Tachycardia in Patients Treated with Clozapine versus Antipsychotic Long-Acting Injections. Paper presented at 72nd Annual Scientific Convention and Meeting of the Society-of-Biological-Psychiatry (SOBP), MAY 18-20, 2017, San Diego, CA. Biological Psychiatry, 81(10 S), S408-S409.
Open this publication in new window or tab >>Tachycardia in Patients Treated with Clozapine versus Antipsychotic Long-Acting Injections
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2017 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 81, no 10 S, S408-S409 p.Article in journal, Meeting abstract (Other academic) Published
Keyword
Schizophrenia, Clozapine, Tachycardia, Long acting injectable, Adverse Effects
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-331808 (URN)10.1016/j.biopsych.2017.02.738 (DOI)000400348701104 ()
Conference
72nd Annual Scientific Convention and Meeting of the Society-of-Biological-Psychiatry (SOBP), MAY 18-20, 2017, San Diego, CA
Available from: 2017-10-18 Created: 2017-10-18 Last updated: 2017-10-18Bibliographically approved
Nilsson, B. M., Edström, O., Lindström, L., Wernegren, P. & Bodén, R. (2017). Tachycardia in patients treated with clozapine versus antipsychotic long-acting injections. International Clinical Psychopharmacology, 32(4), 219-224.
Open this publication in new window or tab >>Tachycardia in patients treated with clozapine versus antipsychotic long-acting injections
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2017 (English)In: International Clinical Psychopharmacology, ISSN 0268-1315, E-ISSN 1473-5857, Vol. 32, no 4, 219-224 p.Article in journal (Refereed) Published
Abstract [en]

Tachycardia is a known adverse effect during clozapine treatment. However, prevalence reported differs widely between studies and hitherto there are no studies comparing clozapine-treated patients with a similar control group. The present study was carried out to assess the prevalence of tachycardia in patients treated with clozapine and antipsychotic long-acting injections (LAI). Data on heart rate (HR), concomitant medication, and relevant anthropometric and laboratory measurements were collected for all clozapine-treated patients (n=174) in a defined catchment area and compared with data on patients treated with LAI (n=87). In total, 33% of patients on long-term clozapine treatment had tachycardia (HR>100) compared with 16% in the LAI group (P<0.001). The mean HR was 91 in the clozapine group and 82 in the LAI group (P<0.001). Clozapine dose correlated with HR. The majority of patients with HR more than 100 received no specific treatment for tachycardia. In conclusion, the prevalence of tachycardia was twice as high in patients treated with clozapine as in a similar patient group with severe schizophrenia spectrum disorder. The tachycardia was in many cases clinically unnoticed. Tachycardia during antipsychotic treatment is a common phenomenon that must be monitored for actively and, when noticed, further investigated and treated.

Keyword
adverse effects, cardiovascular health, clozapine, long-acting injectable antipsychotics, schizophrenia, tachycardia
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-319081 (URN)10.1097/YIC.0000000000000169 (DOI)000402552700006 ()28225439 (PubMedID)
Available from: 2017-03-31 Created: 2017-03-31 Last updated: 2017-09-19Bibliographically approved
Neider, D., Lindström, L. H. & Boden, R. (2016). Risk factors for suicide among patients with schizophrenia: a cohort study focused on cerebrospinal fluid levels of homovanillic acid and 5-hydroxyindoleacetic acid. Neuropsychiatric Disease and Treatment, 12, 1711-1714.
Open this publication in new window or tab >>Risk factors for suicide among patients with schizophrenia: a cohort study focused on cerebrospinal fluid levels of homovanillic acid and 5-hydroxyindoleacetic acid
2016 (English)In: Neuropsychiatric Disease and Treatment, ISSN 1176-6328, E-ISSN 1178-2021, Vol. 12, 1711-1714 p.Article in journal (Refereed) Published
Abstract [en]

Background: The objective of this study was to investigate the association between 5-hydroxyindoleacetic acid (5-HIAA) and homovanillic acid (HVA) in cerebrospinal fluid (CSF), bullying, and later suicide among patients with schizophrenia. Methods: Ninety-nine patients with schizophrenia were included. Correlations of clinical factors, 5-HIAA and HVA, and later suicide were investigated. Results: Twelve patients committed suicide (12%) during a 28-year follow-up period. Later suicide was correlated to bullying in childhood (P=0.02) and a lower quotient of HVA/5-HIAA in CSF (P<0.05). Conclusion: Suicide in schizophrenia is related to childhood exposedness and CSF neurotransmitter levels.

Keyword
psychosis, risk factors, bullying, HVA, 5-HIAA, CSF
National Category
Neurology Psychiatry
Identifiers
urn:nbn:se:uu:diva-300101 (URN)10.2147/NDT.S107178 (DOI)000379339400001 ()
Available from: 2016-08-02 Created: 2016-08-02 Last updated: 2017-11-28Bibliographically approved
Severance, E. G., Tveiten, D., Lindström, L. H., Yolken, R. H. & Reichelt, K. L. (2016). The Gut Microbiota and the Emergence of Autoimmunity: Relevance to Major Psychiatric Disorders. Current pharmaceutical design, 22(40), 6076-6086.
Open this publication in new window or tab >>The Gut Microbiota and the Emergence of Autoimmunity: Relevance to Major Psychiatric Disorders
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2016 (English)In: Current pharmaceutical design, ISSN 1381-6128, E-ISSN 1873-4286, Vol. 22, no 40, 6076-6086 p.Article, review/survey (Refereed) Published
Abstract [en]

Background: Autoimmune phenotypes are prevalent in major psychiatric disorders. Disequilibria of cellular processes occurring in the gastrointestinal (GI) tract likely contribute to immune dysfunction in psychiatric disorders. As the venue of a complex community of resident microbes, the gut in a homeostatic state equates with a functional digestive system, cellular barrier stability and properly regulated recognition of self and non-self antigens. When gut processes become disrupted as a result of environmental or genetic factors, autoimmunity may ensue. Methods: Here, we review the issues pertinent to autoimmunity and the microbiome in psychiatric disorders and show that many of the reported immune risk factors for the development of these brain disorders are in fact related and consistent with dysfunctions occurring in the gut. We review the few human microbiome studies that have been done in people with psychiatric disorders and supplement this information with mechanistic data gleaned from experimental rodent studies. Results: These investigations demonstrate changes in behavior and brain biochemistry directly attributable to alterations in the gut microbiome. We present a model by which autoantigens are produced by extrinsically-derived food and microbial factors bound to intrinsic components of the gut including receptors present in the enteric nervous system. Conclusion: This new focus on examining activities outside of the CNS for relevance to the etiology and pathophysiology of psychiatric disorders may require new modalities or a re-evaluation of pharmaceutical targets found in peripheral systems.

Keyword
Microbiota, schizophrenia, autism, psychosis, NMDA receptor, bacteria, virus, gluten, celiac disease, gut-brain axis
National Category
Pharmaceutical Sciences
Identifiers
urn:nbn:se:uu:diva-315024 (URN)10.2174/1381612822666160914183804 (DOI)000390650900003 ()
Available from: 2017-02-08 Created: 2017-02-08 Last updated: 2017-11-29Bibliographically approved
Stålberg, G., Ekselius, L., Lindström, L. H., Larhammar, D. & Bodén, R. (2014). Neuropeptide Y, social function and long-term outcome in schizophrenia. Schizophrenia Research, 156(2-3), 223-227.
Open this publication in new window or tab >>Neuropeptide Y, social function and long-term outcome in schizophrenia
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2014 (English)In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 156, no 2-3, 223-227 p.Article in journal (Refereed) Published
Abstract [en]

There is a lack of biomarkers in schizophrenia and the mechanisms underlying the observed deficits in social functioning are poorly understood. This cohort study aimed to explore whether neurotransmitter neuropeptide Y (NPY) in cerebrospinal fluid (CSF) from patients with schizophrenia is correlated to social function and clinical variables. A further aim was to determine whether baseline levels of NPY were associated with subsequent 3-year outcome. Fifty-six consecutively admitted patients with schizophrenia were included and underwent lumbar puncture and symptom ratings before antipsychotic treatment. NPY levels in CSF were determined by radioimmunoassay. Social function (Social Competence and Social Interest) was assessed by Nurses' Observation Scale for Inpatient Evaluation while psychiatric symptoms were rated using the Comprehensive Psychopathological Rating Scale. Three-year outcome was assessed with the Strauss–Carpenter Outcome Scale. Cross-sectional analysis showed a correlation between level of NPY and Social Competence at index admission (rs = 0.37, p < 0.05). The longitudinal analysis (i.e. at the 3-year follow-up) indicated that, for each standard deviation increase in baseline NPY, there was an increased risk of being unemployed (odds ratio [OR] 2.02, 95% confidence interval [CI] 1.07–3.82), having moderate or severe symptoms (OR 3.09, CI 1.30–7.32) or being hospitalized at least 6 months the previous year (OR 3.24, CI 1.09–9.64). However, NPY was not correlated to Social Interest or clinical variables at index admission. In conclusion, NPY levels in CSF are correlated to Social Competence and seem to predict some aspects of longitudinal outcome in schizophrenia.

Keyword
Neuropeptides, Biological predictor, Social skills, Psychosis
National Category
Psychiatry
Research subject
Psychiatry; Neuroscience; Psychology
Identifiers
urn:nbn:se:uu:diva-209625 (URN)10.1016/j.schres.2014.04.006 (DOI)000341313200014 ()
Available from: 2013-10-22 Created: 2013-10-22 Last updated: 2017-12-06Bibliographically approved
Bodén, R., Lindström, L., Rautaharju, P. & Sundström, J. (2012). Electrocardiographic signs of autonomic imbalance in medicated patients with first-episode schizophrenia spectrum disorders: relations to first treatment discontinuation and five-year remission status. European psychiatry, 27(3), 213-218.
Open this publication in new window or tab >>Electrocardiographic signs of autonomic imbalance in medicated patients with first-episode schizophrenia spectrum disorders: relations to first treatment discontinuation and five-year remission status
2012 (English)In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 27, no 3, 213-218 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE:

To explore measures in electrocardiograms (ECG) influenced by autonomic balance in early schizophrenia spectrum disorders and to examine their relation to subsequent first antipsychotic pharmacotherapy discontinuation and five-year remission status.

SUBJECTS AND METHODS:

Twelve-lead ECGs were recorded at baseline in 58 patients with first-episode schizophrenia spectrum disorders and in 47 healthy controls of similar age. Selected ECG variables included heart rate and measures of repolarization. Pharmacotherapy data were extracted from medical records. At a five-year follow-up the patients were interviewed and assessed with the Positive and Negative Syndrome Scale.

RESULTS:

Patients had higher heart rate and a different ST-T pattern than the controls. High T-wave amplitudes in the leads aVF and V5 and ST-elevations in V5 were associated both with higher risk of an earlier discontinuation of first antipsychotic pharmacotherapy and with non-remission five years later.

DISCUSSION AND CONCLUSION:

In this longitudinal cohort study, simple ECG measures influenced by autonomic balance in the early phase of schizophrenia spectrum disorders contained prognostic information. As this is the first report of this association and is based on a relatively small sample, the results should be interpreted with caution.

National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-168676 (URN)10.1016/j.eurpsy.2010.12.002 (DOI)000302516500009 ()21316200 (PubMedID)
Available from: 2012-02-14 Created: 2012-02-14 Last updated: 2017-12-07Bibliographically approved
Sjöberg, R. L., Nilsson, K. W., Wargelius, H.-L., Leppert, J., Lindström, L. & Oreland, L. (2007). Adolescent girls and criminal activity: Role of MAOA-LPR genotype and psychosocial factors. American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, 144(2), 159-164.
Open this publication in new window or tab >>Adolescent girls and criminal activity: Role of MAOA-LPR genotype and psychosocial factors
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2007 (English)In: American Journal of Medical Genetics Part B: Neuropsychiatric Genetics, ISSN 1552-4841, E-ISSN 1552-485X, Vol. 144, no 2, 159-164 p.Article in journal (Refereed) Published
Abstract [en]

Recent findings among boys show that interactions between a polymorphism in the monoamine oxidase A gene promoter region (MAOA-LPR) and psychosocial factors predict criminal activity. The objective of this study was to investigate whether this finding could be extended to adolescent girls. One hundred nineteen female adolescents were recruited among respondents to a cross-sectional study of the total population of 16- and 19-year old girls. These girls constituted a randomly selected sub-sample from groups representing different degrees of risk behavior. The subjects filled in a questionnaire and were interviewed and genotyped with regard to MAOA-LPR. The results indicate that the long, (4-repeat) allele confer an increased risk for criminal behavior in the presence of psychosocial risk. Among girls without social risk, MAOA-LPR genotype was of no importance for criminal behavior. The present results suggest that previous observations on adolescent males, which demonstrate that the short MAOA-LPR genotype and psychosocial adversity interact to predict criminal activity, may not be applicable to females.

Keyword
Adolescents, Criminology, Environment, Genes, Monoamine oxidase, Sex characteristics, Social support
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-94074 (URN)10.1002/ajmg.b.30360 (DOI)000244729000002 ()17034017 (PubMedID)
Available from: 2006-03-17 Created: 2006-03-17 Last updated: 2017-12-14Bibliographically approved
Nilsson, K. W., Sjöberg, R. L., Wargelius, H.-L., Leppert, J., Lindström, L. & Oreland, L. (2007). The monoamine oxidase A (MAO-A) gene, family function and maltreatment as predictors of destructive behaviour during male adolescent alcohol consumption. Addiction, 102(3), 389-398.
Open this publication in new window or tab >>The monoamine oxidase A (MAO-A) gene, family function and maltreatment as predictors of destructive behaviour during male adolescent alcohol consumption
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2007 (English)In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 102, no 3, 389-398 p.Article in journal (Refereed) Published
Abstract [en]

AIM: To investigate possible interactions between a polymorphism in the monoamine oxidase A (MAO-A) gene promoter, family relations and maltreatment/sexual abuse on adolescent alcohol-related problem behaviour among male adolescents. DESIGN, SETTING AND PARTICIPANTS: A cross-sectional study of a randomized sample of 66 male individuals from a total population of 16- and 19-year adolescents from a Swedish county. Boys, who volunteered to participate answering an alcohol-related problem/behaviour questionnaire, were investigated with regard to interactions between such problems, family function, maltreatment and MAO-A genotype. MEASUREMENTS: MAO-A genotype, family relations history, history of being maltreated or abused and alcohol-related problem behaviour. FINDINGS: Boys with the short (three-repeat) variant of the MAO-A gene, who had been maltreated/abused or came from families with poor relations, showed significantly higher scores of alcohol-related problems. We also found that maltreatment/abuse independently showed the strongest relation to alcohol-related problems among boys in our model. CONCLUSIONS: The results suggest that both maltreatment and MAO-A genotype may be useful for the understanding of male adolescent alcohol-related problem behaviour.

Keyword
Adolescent, Alcohol drinking, Behaviour, Environment, Genes, Juvenile delinquency, Risk-taking
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-11381 (URN)10.1111/j.1360-0443.2006.01702.x (DOI)000244098000010 ()17298646 (PubMedID)
Available from: 2008-04-01 Created: 2008-04-01 Last updated: 2017-12-11Bibliographically approved
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