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R Axelsson

Publications and source records attributed to R Axelsson.

At least 37 records · Page 2Linked to original sources
PubMed1989

Psychopathology during long-term lithium treatment of patients with major affective disorders. A prospective study.

Thirty-seven patients with major affective disorders according to DSM-III and on continuous lithium treatment were followed during a 7-year period. Outcome was assessed by use of the Comprehensive Psychopathological Rating Scale and by the need for additional psychotropic medication and for hospital and outpatient care. Anamnestic variables and patient's attitudes to their lithium medication were also included in the analysis of outcome, as were laboratory data, including lithium parameters. An increase in psychopathology was demonstrated in a significant number of patients and was attributed mainly to an increase in the depressive symptoms, with a significant increase in the rated scores for fatiguability, pessimistic thoughts, reduced sleep, and inner tension. Suicidal thoughts were common, but no suicide attempts were made. A significant number of patients complained of failing memory, but no significant progression was demonstrated during the 7-year study period. The increase in the depressive symptoms was closely correlated with the number of hospital admissions for depressive recurrence and with the number of days in hospital. The following factors showed a significant relationship with the increase in depressive symptoms: serum lithium levels, large increase in the elimination half-life of lithium, low level of social functioning, low TSH values, and need of concomitant administration of antidepressants and benzodiazepines.

Adult↗
PubMed1989

Familial and environmental aetiologic factors in paranoid psychosis quantified by a new statistical method.

A new mathematical model for quantification of familial factors was used in this study of psychiatric morbidity among the first-degree relatives of 25 patients with paranoid psychosis. The method provides a measure, a familial score of psychiatric morbidity of practical value in correlation analysis since it is applicable at different numbers of relatives per proband, excludes the influence of systematical errors, and allows the inclusion of background factors. A total of 159 first-degree relatives above the age of 15 were traced, 44 (28%) of whom were found to have a history of psychiatric disorder. The familial score of psychiatric morbidity, which varied between 2.0 and 23.0 in the 25 patients, was not significantly correlated to neurophysiological findings or clinical picture. A highly significant negative correlation between the familial score and parental age suggested that the relative influence of nonfamilial factors on the development of psychiatric disorder may be increased with increasing parental age.

Adult↗
PubMed1989

Soft-tissue-anchored percutaneous device for long-term intracorporeal access.

A percutaneous device system for long-term intracorporeal access is presented. A technical description of the device is given as well as results from healing in of device dummies and everyday functioning devices both in the short- and long-term perspectives in experimental animals and in human volunteers and patients. Major complications have not been observed by clinical inspection. Histological analyses of the animal experiments indicated that the downgrowth of the epidermal cells was arrested at the most superficial borderline of a preformed cavity region. An increased subepithelial cell density was observed lateral to a moderate sinus tract, but there were no heavy inflammatory cell infiltrations. The clinical success of the implants evaluated appears to be based on the following design factors: (1) selection of titanium as the tissue interfacing surface, (2) surface geometry factors applied, (3) a system of preformed cavities promoting connective-tissue interdigitation, (4) stress relief design of the subcutaneous flange, (5) high-precision surgical instrumentation and method. It is concluded that the results obtained so far are sufficiently promising to justify further controlled clinical trials and extended observation periods.

Animals↗
PubMed1987

Total plasma concentrations, red blood cell concentrations, and radioreceptor assay values compared with unbound plasma concentrations of thioridazine and thioridazine metabolites in psychiatric patients.

Neuroleptic drug concentrations at the receptor sites are likely to be reflected more closely by the unbound than by the total plasma concentrations. The aim of this study was to establish whether or not the unbound plasma concentrations of thioridazine and its main nonconjugated metabolites show a stronger correlation to the red blood cell (RBC) concentration than to the total plasma concentration of the drug. The total and unbound plasma concentrations and the RBC concentrations of thioridazine and its metabolites were therefore determined in thioridazine-treated patients. "Calculated unbound concentration values" were derived from the determined total concentrations of the drug, the concentrations of drug-binding proteins, and previously determined kappa values. Since the RBC concentrations showed the best correlation to the unbound plasma values, they may be a more accurate tool than the total plasma concentrations for monitoring thioridazine treatment. The determined unbound plasma concentrations were better correlated to the calculated unbound concentrations than to the total plasma concentrations. The total plasma concentrations, but neither the unbound plasma nor the RBC concentrations, were significantly correlated to the concentrations of the drug-binding protein alpha 1-acid glycoprotein. Radioreceptor assay values were strongly correlated to the weighted sum of the total and unbound plasma concentrations of thioridazine and its metabolites.

Adolescent↗
PubMed1987

Patterns of response to neuroleptic treatment: factors influencing the amelioration of individual symptoms in psychotic patients.

Fifty-three patients with acute psychotic disorders (diagnosed according to DSM-III) were treated with thioridazine alone and observed during periods of up to 2 months. The amelioration of paranoid ideas and hallucinations (target symptoms) and of concentration difficulties, disorientation, reduced appetite, and reduced sleep (additional symptoms) was studied by repeated psychopathology ratings (CPRS). The patients were classified as "fast, slow or partial responders" according to the therapeutic effect registered on each target symptom. Paranoid ideas disappeared completely after less than 3 weeks of treatment in 28% of the patients (fast responders) and after more than 3 weeks in 32% (slow responders). Hallucinations disappeared significantly faster than paranoid ideas; 47% of the patients were completely free from hallucinations after less than 2 weeks of treatment (fast responders) and 38% after more than 2 weeks (slow responders). The following factors were significantly correlated to positive treatment effects of thioridazine: 1) diagnosis involving a brief history of psychotic symptoms before admission; 2) a low CPRS score for paranoid ideas on admission; 3) presence of disorientation on admission; 4) normal appetite on admission, and 5) rapidly reached optimal serum concentration of the drug.

Acute Disease↗
PubMed1986

Concentrations of thioridazine and thioridazine metabolites in erythrocytes.

The concentrations of thioridazine and its main metabolites in erythrocytes from 61 thioridazine-treated patients were determined by gas-liquid chromatography. The mean and range of the erythrocyte concentrations, expressed as percentage of the corresponding plasma concentrations, were: thioridazine, 5.1% (2.0-10.6); side-chain sulfoxide, 5.6% (1.6-10.4); side-chain sulfone, 3.3% (1.1-6.8); ring sulfoxide 2.7% (0.8-4.9). The erythrocyte and plasma concentrations were significantly correlated. The erythrocyte/plasma concentration ratios, all the erythrocyte concentrations, but none of the plasma concentrations except ring sulfoxide were significantly positively correlated to the dose of thioridazine. The erythrocyte/plasma concentration ratio was not correlated to age. In vitro experiments indicated no clinically relevant erythrocyte-mediated oxidation of thioridazine.

Adult↗
PubMed1984

Mental illness and sex chromosome aberration: renewed interest in light of a current survey.

Chromosome determination in 134 men with psychotic disorder revealed sex chromosome aberrations in three patients; one with karyotype 47, XXY, one with 47, XXY/46, XY, and one with 46, XY/45, XO. The frequency of sex chromosome changes in our population (2%) was significantly increased compared to that in newborns. Since sex chromosome aberrations may play an important role in the etiology of psychiatric disorders, chromosome determination should be included among the routine investigations of patients with psychotic symptoms.

Humans↗
PubMed1984

Hereditary diffuse leucoencephalopathy with spheroids.

The clinical, genetic, and morphological features of a previously unknown progressive neuropsychiatric disease are presented. By genealogical investigation of the background of an uncharacteristic case of presumed organic psychosis, we traced 71 relatives from four generations. The anamnestic data showed various combinations of psychiatric symptoms (depression, anxiety, aggressiveness, and severe dementia), neurological symptoms (impaired balance with retropulsion, hyperkinesia, and epilepsy), and somatic symptoms (gastrointestinal disorders, arthritis, and gynaecological problems) in 17 (11 dead and 6 living) members of the family. Age at onset varied between 8 and 60 years. Some patients rapidly developed severe dementia and died a few months after the onset of symptoms, while in others the course was prolonged with dementia over several decades. The genetic interpretation indicated an autosomal dominant inheritance with possible full penetrance but widely variable expressivity. Morphological studies were performed on the central nervous system of four decreased family members (three siblings and their maternal uncle). The same type of widespread leucoencephalopathy was seen in the four autopsy cases. It was characterised by degeneration and loss of myelin sheaths and axons, occurrence of numerous neuroaxonal spheroids in the affected white matter, accumulation of lipid-laden macrophages, and gliosis. The bilateral, frontal, fronto-parietal, and temporal locations of the most pronounced, diffusely demarcated lesions corresponded fairly well to the symptoms of an organic psychosyndrome with its main substrate in the forebrain. For this new clinico-pathological entity, the name "hereditary diffuse leucoencephalopathy with spheroids" (HDLS) is proposed. As a working hypothesis, it is suggested that not only genetic, but also immunological and possible endocrine factors may contribute to the development of the disease.

Adolescent↗
PubMed1983

Neurofibromatosis in monozygotic twins: a case report.

A case report is given of a pair of monozygotic twin girls with neurofibromatosis caused by a new mutation. The symptomatology was dominated by a neurofibrosarcoma on the leg of one twin and by a large plexiform neurofibroma on the neck of the other twin. Otherwise, the disease showed similar, although not identical or mirror-image distribution of subcutaneous neurofibromas and café-au-lait spots. The twins had identical HLA and blood group antigens and the same chromosome aberration. These case reports indicate that nonhereditary factors may influence the manifestations of neurofibromatosis. A review of the literature on monozygotic twins with neurofibromatosis is given.

Adult↗
PubMed1982

Serum concentration and protein binding of thioridazine and its metabolites in patients with chronic alcoholism.

The blood chemistry and clinical pharmacokinetics of thioridazine and its metabolites, side-chain sulphoxide, side-chain sulphone and ring sulphoxide, were studied in 31 alcoholics and were compared with values in 17 thioridazine-treated controls without alcoholism. Pathological blood chemistry values, including abnormal liver function and protein concentrations, were common among the alcoholics. In relation to dosage, the majority had a low serum concentration of thioridazine and at a given concentration of thioridazine they had high serum concentrations of its metabolites. Positive intercorrelations were found between pathological liver function tests, prolonged serum half-life and increased serum concentration of thioridazine. The free fractions of thioridazine, side-chain sulphoxide and ring sulphoxide were significantly higher and those of the side-chain sulphone lower in the alcoholics than in the controls. The free fractions of side-chain and ring sulphoxide were significantly increased in patients with a low concentration of alpha 1-acid glycoprotein.

Adult↗
PubMed1982

Impairment of the blood-brain barrier as an aetiological factor in paranoid psychosis.

Possible psychiatric implications of impairment of the blood-brain barrier were studied in 25 patients with paranoid psychosis. Determination of the ratio between the albumin concentrations in cerebrospinal fluid and serum showed increased, indicating impairment of the blood-brain barrier, in seven patients and normal values in 18. The two groups were compared for clinical, pharmacokinetic, neurophysiological and anamnestic variables. The highly significant finding that onset of psychosis had occurred, on average, 20 years earlier in the patients with impairment of the blood-brain barrier than in those without suggests that such impairment might influence the development of psychosis in predisposed individuals.

Adolescent↗
PubMed1982

Electrocardiographic changes and serum concentrations in thioridazine-treated patients.

Electrocardiograms and serum concentrations of thioridazine and its metabolites were studied in 43 patients with paranoid psychosis. Two types of T-wave changes were distinguished: Type I with rounded, leveled, or notched T-waves, and Types II with diphasic waves. Significant positive correlations were found between serum drug concentrations and the Type I changes, while the Type II changes showed no concentration dependence. The two types of T-wave changes also differed in respect of prevalence, time of onset, duration, and variation with sex. The ECG response to thioridazine provides useful information about the serum drug concentrations.

Adolescent↗
PubMed1981

Neurofibromatosis. A clinical and genetic study of 96 cases in Gothenburg, Sweden.

Ninety-six persons, living in Gothenburg, Sweden, on the first of January 1978 and known by the health services as cases of neurofibromatosis, were investigated concerning clinical and genetic aspects of the disease. Close relatives were also interviewed and examined. The diagnostic criteria were operationally defined according to number of café-au-lait spots and/or neurofibromas. The prevalence of neurofibromatosis was estimated to be 0.02%. The following findings were made in the patients: axillary freckling (48%), neurological symptoms (30%), epilepsy (3-9%), sarcoma (4%), pheochromocytoma (3%), osseous dysplasias (12%), subnormal intelligence (45%) and psychiatric symptoms (33%). The genetic analysis revealed a dominantly inherited disease with full penetrance and a very high mutation frequency, at least 4.3 X 10(-5). Questions commonly encountered during counselling are discussed.

Adolescent↗