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Biomedical subjects

M Asberg

Publications and source records attributed to M Asberg.

At least 55 records · Page 3Linked to original sources
PubMed1995

Survival analysis of suicide risk after attempted suicide.

Survival analysis of suicide risk by sex and age after attempted suicide was studied in a cohort of 1573 suicide attempters referred to the psychiatric emergency room at the Karolinska Hospital from 1981 to 1988. The time course of suicide risk and the overall prognosis after attempted suicide and, in particular, the possible usefulness of sex and age as risk factors for the prediction of suicide risk after attempted suicide was analyzed. Nearly two thirds of the sample were women and most of the suicide attempters were young (in their twenties and thirties), and the median age was 35 years. The overall mortality after a 5-year mean observation period after attempted suicide was 11%, and the suicide mortality was 6%. The suicide risk after attempted suicide among men (8.3%) was nearly twice the female suicide risk (4.3%). Age as a possible suicide risk factor was analyzed for each sex separately by median split subgrouping. It was concluded that both older and younger male suicide attempters are at high risk of suicide (7% and 10% respectively), and older women are at higher risk than younger (6% vs 2%). The suicide risk is particularly high during the first year after the suicide attempt. The high suicide risk group of young adult male suicide attempters is one of the main feasible targets of psychiatric intervention research programs on suicidal behavior. Suicide among young men is a major cause of years of life lost.

Adolescent↗
PubMed1994

A new self-rating scale for depression and anxiety states based on the Comprehensive Psychopathological Rating Scale.

Self-assessment scales have long been used in psychiatric research even if their validity has often been questioned, one reason being poor the concordance of expert ratings. In clinical practice the use of rating scales is restricted, since they are considered to be time-consuming and perhaps even to disrupt the clinician's rapport with the patient. In the present study, a self-assessment scale, the CPRS Self-rating Scale for Affective Syndromes (CPRS-S-A), was constructed by re-phrasing in a self-rating format 19 items from the original Comprehensive Psychopathological Rating Scale (CPRS) and covering depression, anxiety and obsessional symptoms. In a group of 30 patients with depression syndromes and anxiety syndromes, the CPRS-S-A and the original CPRS were both used on 2 occasions. The patient's Global Assessment of Functioning scores ranged from 30 to 76 (mean 58), which suggests a moderate severity of illness, as does the fact that the majority were outpatients. There was a high degree of concordance between the instruments for most items and for the scores on the subscales for both diagnostic groups (i.e., the Montgomery-Asberg Depression Rating Scale and the Brief Anxiety Scale, which are both subscales drawn from the CPRS). The time taken to complete the CPRS-S-A varied from 5 to 30 min (mean 19 min for depressive and 16 min for anxiety patients on the first occasion, 13 min for both groups on the second), and the self-rating procedure was readily accepted by both groups of patients. The CPRS-S-A would thus seem to be a promising instrument for quantitative rating of symptoms in ambulatory patients, both in clinical practice and in research.

Adult↗
PubMed1994

Relationship between components of alexithymia as measured with psychodynamic ratings and subjective lack of well-being.

Two alexithymia-related characterological patterns, identified by means of psychodynamic assessments in a study of patients with ulcerative colitis, were further investigated regarding subjective lack of well-being. The multidisturbed group (with disturbances in interpersonal relations) was symptomatically characterized by more sadness and by less initiative, but manifested less anxiety, enjoyed sex and slept well at night. The inhibited group was characterized by the opposite. The groups could not be discriminated on the basis of their general adaptive level of functioning. Our results suggest that alexithymia may have several dimensions, associated with different characterological disturbances and symptoms.

Adolescent↗
PubMed1994

CSF 5-HIAA predicts suicide risk after attempted suicide.

Suicide risk after attempted suicide, as predicted by cerebrospinal fluid (CSF) monoamine metabolite concentrations, was studied in a sample of 92 psychiatric mood disorder inpatients admitted shortly after attempting suicide. The potential of the serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA) in the CSF to predict suicide risk within the first year after attempted suicide was studied by means of survival analysis after after median split subgrouping. Eleven patients (12%) committed suicide within 1 year after attempted suicide. Eight of these belonged to the below-the-median (< 87 nM) CSF 5-HIAA subgroup, that is, the suicide risk was 17% as compared with 7% among those with above-the-median CSF 5-HIAA. The cumulative number of survived patient-months during the first year after attempted suicide was significantly lower in the low CSF 5-HIAA subgroup. It was concluded that low CSF 5-HIAA predicts short-range suicide risk after attempted suicide in mood disorder psychiatric inpatients. These findings lend further support to the serotonin hypothesis of suicide risk.

Adult↗
PubMed1993

Serotonin selective antidepressant drugs: past, present, future.

Classic antidepressant drugs, amine uptake inhibitors of the imipramine type and the monoamine oxidase inhibitors, alter the functioning of serotonin (5-hydroxytryptamine, 5-HT) neurons in the brain. This discovery, made more than two decades ago, has had a profound impact on the study of depressive illness as well as on the development of new models of antidepressant treatment. Apart from their obvious clinical value, antidepressant drugs have come to be used as research tools to study the pathophysiology of depressive illness. A main goal in the development of antidepressant drugs has been to design drugs with more selective effects on the nerve cells that are thought to be important in depressive illness, thereby avoiding unnecessary side effects and possibly enhancing therapeutic effects. Drugs that selectively affect 5-HT neurons have proved to be uptake inhibitors--including fluoxetine, fluvoxamine, paroxetine, sertraline, and citalopram--and are now available. All of them appear to have an antidepressant effect equivalent to standard reference compounds, with a different spectrum of side effects. One of the most interesting aspects of the serotonergic drugs is their broad spectrum of action, in particular, their effects in patients with obsessive-compulsive disorder, panic disorder, and possibly some disorders of impulse control. There is still relatively little knowledge of which aspects of 5-HT function are important for the antidepressant, antiobsessive, and antipanic effects. The availability of drugs that selectively affect the different 5-HT receptors, such as the partial 5-HT1A agonist gepirone, will presumably be helpful for modern studies of the "anatomy of melancholy."

Antidepressive Agents↗
PubMed1992

Blood levels of melatonin, serotonin, cortisol, and prolactin in relation to the circadian rhythm of platelet serotonin uptake.

Blood levels of melatonin, serotonin, cortisol, prolactin, and serotonin uptake by platelets were measured at 08:00, 14:00, 20:00, 02:00, and 08:00 hours in 10 healthy men who ranged in age from 27 to 35 years. The Km values of serotonin active transport by platelets were significantly correlated with melatonin blood levels. There were no other significant correlations. The secretion of steroid hormones and prolactin showed an increase at 02:00 hours; levels of prolactin decreased at 08:00 hours, but steroid levels continued to rise. This finding suggests either a direct effect of melatonin on serotonin active transport or the influence of the suprachiasmatic nucleus on serotonin uptake by platelets. It is also possible that there is a simultaneous decrease in serotonin uptake and decline from peak levels of melatonin due to the rise in steroid secretion.

Adult↗
PubMed1992

Suicide risk and serotonin.

The accumulating research evidence for the psychobiological reconceptualization of suicidal behaviour is briefly reviewed, particularly regarding the serotonin hypothesis of suicide risk. The first suggestion of a link between suicide and serotonin came with the biochemical results from postmortem brain studies of suicide victims. Currently available research data suggest decreased brain stem levels of serotonin and 5-HIAA, altered distribution of presynaptic binding of the ligand 3H-imipramine to serotonin neurons and a region-specific increase in the number of postsynaptic 5HT2 receptors in the prefrontal cortex in suicide victims. Early CSF studies have indicated decreased CSF 5-HIAA in patients recently attempting suicide and follow-up studies of large samples of mood-disorder patients confirm the original hypothesis that low CSF 5-HIAA predicts suicide risk after attempted suicide. However, the clinical utility of these compelling biological correlates of suicide in the management of suicide risk in psychiatric patients will depend on the results of psychopharmacological treatment research targeting suicidal behaviour.

Behavior↗
PubMed1992

The concept of alexithymia: an empirical study using psychodynamic ratings and self-reports.

In patients with ulcerative colitis, alexithymia and related traits were studied using the Karolinska Psychodynamic Profile (KAPP), a recently constructed psychodynamic assessment instrument, and other measures of alexithymia (the Schalling-Sifneos Personality Scale (SSPS) and the Beth Israel Questionnaire (BIQ)), and other personality traits using the Karolinska Scales of Personality (KSP). The results of these measures were analyzed for correlation. The prevalence of mental disorder as defined by DSM-III was not above normal, and the KSP T-scores were within normal limits. As rated with the KAPP, alexithymia was uncorrelated with age or level of education, but was inversely correlated with proximity to a major life event (abdominal surgery), suggesting that alexithymia may have a defensive function. Cluster analysis, with Regression in the service of the ego (R), Alexithymia (A) and Normopathy (N) as clustering variables, yielded 3 groups: normal, multidisturbed (problems with R, A and N) and inhibited (problems with R and N). SSPS failed to distinguish between the multidisturbed and the inhibited groups, and BIQ between any groups. In the multidisturbed group, correlations were found with detachment and with disturbances in interpersonal relations. The results suggest that disturbances in object relations are of major importance in alexithymia.

Adolescent↗
PubMed1992

Stability over time of character assessment using a psychodynamic instrument and personality inventories.

In a group of patients with a preoperative diagnosis of ulcerative colitis, the stability of character traits and modes of mental functioning were studied after a major life event, major abdominal surgery, using the Karolinska Psychodynamic Profile (KAPP), an interview-based assessment instrument founded upon psychoanalytic theory. In addition, different personality and temperamental variables were assessed with 2 self-report instruments. The patients were assessed before surgery, and follow-up was made at least 1 year after their final scheduled surgery. Although the patients had undergone major abdominal surgery and convalescence between the assessments, the correlations between the scores before and after surgery were very high, and the levels of the scores were very similar. This was true for all the instruments, indicating that they assessed stable characteristics in the patients. The changes that did occur were mainly in the predicted direction. The results of this study suggest that the KAPP can assess modes of mental functioning and character traits that are relatively stable and only slowly variable.

Adaptation, Psychological↗
PubMed1991

Memory effects of clomipramine treatment: relationship to CSF monoamine metabolites and drug concentrations in plasma.

Performance on tasks tapping automatic and voluntary aspects of memory, attention, and motor speed was examined in 14 patients with major depressive disorder, before and after 3 weeks of treatment with clomipramine (150 mg/day), a potent serotonin and noradrenaline uptake blocker with anticholinergic side effects. Performance on tasks requiring frontal functions improved or did not change, whereas verbal learning and retention, where hippocampal functioning is critical, were impaired. The latter tasks were negatively related to cerebrospinal fluid (CSF) 5-HIAA levels and plasma concentration of clomipramine. The results provide further support for the regulatory role of monoaminergic systems in cognition. Furthermore, we found the automatic-voluntary capacity distinction less heuristically useful. Physiological mechanisms regulating different aspects of cognition and memory appeared to be more closely related to the type of task used than to its capacity-demanding properties.

Adult↗
PubMed1991

The Karolinska Psychodynamic Profile. I. Validity and dimensionality.

The Karolinska Psychodynamic Profile (KAPP) is a new rating instrument based on psychoanalytical theory that is intended to assess relatively stable modes of mental functioning, as they appear in self-perception and in interpersonal relations. The 18 subscales of the KAPP and their scale steps are described in detail. The information needed for assessment is obtained through a structural interview procedure. The KAPP can discriminate between patients with and without a DSM-III diagnosis. It does not appear to be sensitive to the strain of a major life event. Comparison between interview-based ratings and projective test-based ratings shows satisfactory agreement and similarities in factor structure. The KAPP appears to possess both discriminative and construct validity.

Adjustment Disorders↗
PubMed1991

The Karolinska Psychodynamic Profile. II. Interdisciplinary and cross-cultural reliability.

The Karolinska Psychodynamic Profile (KAPP) is a rating instrument based on psychoanalytical theory, that is intended to assess relatively stable modes of mental functioning, as they appear in self-perception and in interpersonal relations. The 18 subscales of the KAPP and their scale steps are described in detail and kept close to clinically observable phenomena. The information needed for assessment is obtained through a structural interview procedure. The interrater reliability was tested with different Swedish raters with varying psychodynamic training and experience. It was also tested with a non-Swedish rater with psychoanalytic training. The interrater correlations were generally high, suggesting that the KAPP has interdisciplinary and cross-cultural reliability.

Adjustment Disorders↗
PubMed1991

Effects of clomipramine treatment on cerebrospinal fluid monoamine metabolites and platelet 3H-imipramine binding and serotonin uptake and concentration in major depressive disorder.

In an open study of 12 inpatients who met the DSM-III criteria for a major depressive episode, the effects of clomipramine (CI) on the monoamine metabolites 5-hydroxyindoleacetic acid (5-HIAA), homovanillic acid (HVA), 4-hydroxy-3-methoxyphenyl glycol (HMPG) in cerebrospinal fluid (CSF) were measured simultaneously with the effects on 3H-imipramine binding, serotonin (5-HT) uptake and 5-HT concentration in platelets after 3 and 6 weeks of treatment. Drug (CI and desmethylclomipramine) plasma concentrations were determined. The concentrations of 5-HIAA and HMPG decreased substantially, and the concentration of HVA remained unchanged. There was also a large and significant reduction of the number of imipramine binding sites (Bmax) and of the platelet 5-HT concentration. The 5-HT uptake was not measurable after 3 weeks of treatment. None of the parameters changed significantly between weeks 3 and 6. There were no significant correlations between antidepressant effect (measured by the Montgomery-Asberg Depression Rating Scale) and plasma drug concentrations, although a tendency to a significant correlation between antidepressant effect and CI was observed at 3 weeks. There were no significant intercorrelations between the different 5-HT parameters and no other significant correlations between the biochemical measures and clinical outcome.

Adult↗