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Biomedical subjects

C Allgulander

Publications and source records attributed to C Allgulander.

At least 19 recordsLinked to original sources
PubMed2001

A prospective study of 86 new patients with social anxiety disorder.

OBJECTIVE: To determine the prognosis in 86 new patients with social anxiety disorder. METHOD: Untreated subjects with social anxiety were recruited by advertising in Stockholm, randomized to 3 months treatment with paroxetine or placebo, and then offered continued specialist care. Metabolizing capacity was determined by genotyping CYP2D6 in the subjects on paroxetine. After a mean 32 months all were contacted for a personal interview. RESULTS: Of the 92 evaluable subjects, 86 (93%) were interviewed. A favourable prognosis was seen in the subjects randomized to paroxetine who chose to continue with serotonergic medication. The least favourable prognosis was in those given placebo who chose not to be treated after the trial. Twenty-four subjects were still symptomatic and dysfunctional and had not sought treatment. Drug-induced adverse effects caused treatment termination in six subjects, one of whom had a poor metabolizing genotype. CONCLUSION: Due to their condition, some subjects with social anxiety refrain from effective treatments. The efficacy of serotonergic medication was maintained and augmented after a mean period of 32 months.

Adult↗
PubMed2001

Venlafaxine extended release (ER) in the treatment of generalised anxiety disorder: twenty-four-week placebo-controlled dose-ranging study.

BACKGROUND: Generalised anxiety disorder (GAD) has received less study than other anxiety disorders, particularly its long-term treatment. AIMS: To assess the efficacy and safety of venlafaxine extended release (ER) in patients with GAD. METHOD: A total of 541 out-patients, 18-86 years old, were recruited to this 24-week, placebo-controlled, double-blind study of three fixed doses (37.5, 75 and 150 mg/day) of venlafaxine ER. RESULTS: All doses of venlafaxine ER showed efficacy superior to placebo, apparent from week 2, that was sustained throughout the 24-week study for the two higher doses. The discontinuation rate did not differ significantly among the treatment groups. CONCLUSIONS: Venlafaxine ER is an effective and safe treatment for GAD for up to 6 months.

Adolescent↗
PubMed2001

Efficacy of usual antidepressant dosing regimens of fluoxetine in panic disorder: randomised, placebo-controlled trial.

BACKGROUND: Although serotonin reuptake inhibitors are effective in panic disorder, questions concerning whether doses associated with antidepressant efficacy are also effective for panic disorder remain. AIMS: To assess the efficacy of the usual antidepressant dose of fluoxetine in treating full panic attacks. METHOD: Patients with panic disorder were randomised to placebo or to fluoxetine initiated at 10 mg daily for 1 week and then increased to 20 mg daily. The trial lasted 12 weeks, but after 6 weeks patients who had failed to achieve a satisfactory response were eligible for dose escalation to a maximum of 60 mg of fluoxetine daily. RESULTS: Fluoxetine was associated with a statistically significantly greater proportion of panic-free patients compared with placebo after 6 weeks and at end-point. CONCLUSIONS: Fluoxetine at a dose of 20 mg daily is safe and efficacious in reducing symptoms of panic disorder. Patients who fail to obtain a satisfactory response at 20 mg daily may benefit from further dose increases.

Adult↗
PubMed2000

Victims of criminal homicide in Sweden: a matched case-control study of health and social risk factors among all 1,739 cases during 1978-1994.

OBJECTIVE: The psychiatric and medical characteristics of victims of homicide have not been systematically studied and are often confounded by race. This study was undertaken to determine health and social factors contributing to the risk of being murdered in the Swedish, predominantly Caucasian population. METHOD: All 1,739 homicides between 1978 and 1994 in Sweden were studied in terms of variables in national case registers regarding health, crimes, immigration, and marital status. The same data were extracted for matched comparison persons in the general population, with controls for time of exposure. The data were analyzed by conditional logistic regression on matched pairs. RESULTS: Traumatic brain injury, physical abuse, alcohol dependence, and criminal recidivism conferred risk of being murdered. CONCLUSIONS: To the authors' knowledge, this is the first report of traumatic brain injury, in both men and women, as a risk factor for being murdered. Brain injury may mark risk-taking behavior in general or may cause provocative behavior.

Adolescent↗
PubMed1999

Paroxetine in social anxiety disorder: a randomized placebo-controlled study.

OBJECTIVE: The aim of this study was to evaluate the utility of paroxetine treatment in social anxiety disorder. METHOD: Previously undiagnosed and untreated subjects with social anxiety disorder (generalized social phobia) were selected from among responders to a newspaper advertisement. They were randomized to double-blind treatment with paroxetine 20-50 mg daily or placebo for 3 months. Outcome measures were self-rated social anxiety and avoidance behaviour, and clinician-rated global assessment of improvement. RESULTS: Significant differences in efficacy between treatments (intent-to-treat analysis: 44 subjects on paroxetine and 48 subjects on placebo) were noted after 4-6 weeks, increasing through the treatment period in the paroxetine group. Nine subjects on paroxetine and 3 subjects on placebo discontinued the treatment due to adverse events. Sexual side-effects were noted by 18 subjects on paroxetine and 4 subjects on placebo. CONCLUSION: Paroxetine was effective in alleviating symptoms and avoidance behaviour in social anxiety disorder.

Adult↗
PubMed1998

[Documented effects of SSRI preparations in anxiety].

The article consists in a review of the clinical evidence for treating anxiety disorders with selective serotonin re-uptake inhibitors (SSRIs). Sufficient documentation now exists to support the use of SSRIs in treating panic and obsessive-compulsive disorders, and in Sweden moclobemide is now approved for use in treating social phobia, and buspirone for use in treating generalised anxiety disorder. Further documentation of the treatment of post-traumatic stress disorder with SSRIs is probably to be expected. Benzodiazepines remain the most commonly used anxiolytics. Although persistent adverse sexual reactions, and withdrawal symptoms upon abrupt termination of medication, are notable side effects of SSRIs, patients become measurably more self-confident and focused, and manage risks more adequately. This underscores the need of further research into the interrelationship of personality traits and anxiety symptoms.

Anti-Anxiety Agents↗
PubMed1998

Changes on the Temperament and Character Inventory after paroxetine treatment in volunteers with generalized anxiety disorder.

Previously untreated symptomatic volunteers with generalized anxiety disorder (GAD) performed the Temperament and Character Inventory at baseline and after 4 to 6 months of paroxetine treatment. Scores from 29 volunteers were analyzed with paired t-tests. A marked reduction was noted in Harm Avoidance and a marked increase was noted in Self-Directedness. Smaller changes were noted in Cooperativeness and Novelty Seeking. Overall, treatment was associated with a reduction in maladaptive personality traits.

Adult↗
PubMed1996

Pilot study of the adjunct utility of a computer-assisted Diagnostic Interview Schedule (C-DIS) in forensic psychiatric patients.

To assess the potential usefulness of a structured and computer-assisted diagnostic interview under field conditions, menu-driven interviews with 18 of 20 probands undergoing forensic psychiatric examination were scored into axis I DSM-III diagnoses, independent of the regularly derived ICD-9 diagnoses. The computer-assisted interview yielded more affective and anxiety disorders than routine clinical procedures, many of which were amenable to treatment. The computer interview was acceptable to the probands. Controlled studies are suggested to assess the benefits of computer-assisted diagnosis in addition to traditional diagnostic procedures in forensic psychiatric patients.

Attitude to Computers↗
PubMed1994

Suicide and mortality patterns in anxiety neurosis and depressive neurosis.

BACKGROUND: The diverging views on suicide risk in patients with morbid anxiety called for a sufficiently large study to estimate the suicide risk in patients with anxiety neurosis and depressive neurosis. METHODS: The identities of all 9912 patients with anxiety neurosis and all 38,529 patients with depressive neurosis in the national Psychiatric Case Register in Sweden between 1973 and 1983, without any other psychiatric diagnoses, were matched with the national Cause-of-Death Register. The observed causes of death among the 9910 patients who died in 1990 or earlier were compared with those expected in the general population. RESULTS: There were 1481 determined and 265 undetermined suicides among the patients; ie, 18% of all deaths. The standardized mortality ratio of suicide before the age of 45 years among men and women with anxiety neurosis was 6.7 and 4.9, respectively; for depressive neurosis, 12.6 and 15.7, respectively. The suicide risk was much higher within 3 months of leaving the hospital. Standardized mortality ratios of death caused by ischemic heart disease and traumatic injury were marginally elevated among men in both diagnostic groups. Women in both categories were at increased risk for death caused by alcohol abuse and cirrhosis of the liver. Obstructive pulmonary disease was another notable cause of death, reflecting the aggravation of anxiety-depressive symptoms by airway obstruction or the effects of tobacco smoking. CONCLUSIONS: The risk of completed suicide among former inpatients with primary anxiety neurosis was higher than in previous, smaller studies and higher yet in patients with depressive neurosis. This hazard may hopefully be reduced by optimizing immediate and long-term treatment for the severely affected.

Adolescent↗
PubMed1992

Risk of suicide by psychiatric diagnosis in Stockholm County. A longitudinal study of 80,970 psychiatric inpatients.

The risk of suicide associated with different psychiatric diagnoses was estimated in 80,970 inpatients in Stockholm County (population 1.6 million). All patients discharged with at least one psychiatric diagnosis between 1973 and 1986 were followed by linkage with the cause-of-death registry through 1987. There were 1,115 definite suicides and 467 undetermined suicides among these during the 15-year follow-up. When 12 diagnostic categories were entered in a proportional hazards model, the highest relative risk (RR) of definite suicide, controlling for sex and age, was noted for affective disorders (RR 2.82), followed by unspecified psychoses (RR 2.69), paranoid psychoses (RR 2.60), addiction to prescription drugs (RR 2.38), neuroses and reactive psychoses (RR 1.96), and schizophrenia (RR 1.64). Alcoholism, personality disorders, organic psychoses, and street drug addiction did not have significantly increased risks of suicide. Male sex increased the risk for definite suicide by 1.56, while the risk was somewhat higher among the young. Having more than one diagnosis increased the relative risk by 1.42. When undetermined suicides were included in the analysis, to alcoholism and street drug abuse were attributed significantly increased risks of suicide, probably owing to the greater difficulty of verifying such cases. We conclude that several psychiatric disorders were conductive to suicide, but that the risk did not vary much with the type of diagnosis. Further studies of confounders are needed, such as the reasons for being admitted to inpatient care, and the impact of somatic and psychiatric comorbidity.

Adolescent↗
PubMed1992

Antecedents of anxiety syndromes in a cohort of 50,465 young men in Sweden. A prospective analysis of self-reported and professionally assessed psychosocial characteristics.

The purpose of this study was to find psychiatric, behavioral and social characteristics that predict subsequent anxiety syndromes in men. Questionnaire data were collected in a cohort of all 50,465 men in Sweden who were conscripted for military training. By record linkage with the national psychiatric inpatient register, we identified 68 probands with pure anxiety neurosis occurring in the cohort during a 13-year follow-up period. Baseline characteristics were categorized into 8 variables that were entered into logistic regression models. We found that reported treatment with psychoactive drugs and perceived mental health problems at baseline increased the odds of being admitted for anxiety neurosis by 1.9 and 1.8. Other predictors were family problems (odds ratio = 2.0) and having a family member being treated with psychoactive drugs (odds ratio = 1.7). Univariate relative risks were higher, and a psychiatric diagnosis at conscription conferred a relative risk of anxiety neurosis of 2.2. A similar profile was obtained for subjects admitted for a depressive neurosis, in support of the continuum hypothesis between anxiety and depression. We conclude that the necessity of admission for anxiety neurosis in young men originates in genuine mental symptoms in the family setting.

Adolescent↗
PubMed1991

Excess mortality among 3302 patients with 'pure' anxiety neurosis.

The survival probability and causes of death before the age of 70 years were analyzed among 3302 inpatients with "pure" anxiety neurosis in Stockholm County, Sweden, who were tracked in case registries by means of automated record linkage during a 14-year period. When all patients with other psychiatric diagnoses and substance abuse were excluded, and marital status controlled for, there was a significant excess of deaths due to verified and undetermined suicides, ie, nearly one third of all deaths. These unnatural deaths preempted any excess in natural causes before the age of 70 years, such as cardiovascular disease. Treatment policy with regard to the use of anxiolytic drugs was not found to influence mortality. We concluded that the risk of suicide in inpatients before the age of 70 years with anxiety disorders may be as high as that in persons with depression or other diagnoses who require inpatient care.

Adult↗
PubMed1991

Psychopathology and treatment of 30,344 twins in Sweden. II. Heritability estimates of psychiatric diagnosis and treatment in 12,884 twin pairs.

We estimated the heritability for inpatient psychiatric treatment, treatment with psychoactive medication, and for psychiatric diagnoses in a randomized sample of 12,884 Swedish twin pairs drawn from the general population for a health survey. We found a genetic contribution to treatment and diagnosis, independent of sex and shared environment. The heritability estimate for inpatient treatment was 0.47, for reported treatment with psychoactive medication 0.49, and for an inpatient diagnosis of neurotic or personality disorder 0.60. No statistically significant heritability was found for the diagnoses of alcohol abuse nor for the heterogeneous group of diagnoses of psychoses. This was probably because of the heterogeneity of cases necessary to form large enough groups for analysis, or ascertainment requiring treatment in a psychiatric unit.

Adolescent↗