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Biomedical subjects

S Levander

Publications and source records attributed to S Levander.

At least 19 recordsLinked to original sources
PubMed2004

Schizophrenia, neighbourhood, and crime.

OBJECTIVE: To investigate the relationship between the prevalence of schizophrenia and measures of social deprivation in varying areas in the city of Malmö. METHOD: A case-finding study of schizophrenia was combined with a victimization survey. Data was factor-analysed and visualized using geographical information system software. RESULTS: The schizophrenic patients lived predominantly in socially disorganized areas characterized by high levels of disorder, fear of crime and victimization. The local prevalence of schizophrenia covaried significantly with all indices of social disorganization. In addition, a significant but weak association was obtained between prevalence of schizophrenia and fear of specific persons in the neighbourhood. CONCLUSION: In spite of enormous changes in social conditions, psychiatric knowledge and organization of treatment, and political ambitions, schizophrenic patients still aggregate in socially deprived areas. This segregation may result in worsening of the illness as well as increasing the social disorganization in the local domicile.

Adolescent↗
PubMed2002

On the operationalization of psychopathy: further support for a three-faceted personality oriented model.

OBJECTIVE: This study is an attempt to compare two alternative models of psychopathy (PCL-R); (i) the traditional 17-item two-factor model where the first factor describes a deceitful, manipulative and callous, unemotional dimension and the second factor describes the impulsive, irresponsible and antisocial behavioral lifestyle dimension; and (ii) a recently proposed 13-item three-factor model involving an interpersonal facet, an affective facet and a behavioral facet. METHOD: Exploratory and confirmatory factor analyses of PCL-R scores on a sample of 293 adult male violent offenders were conducted. RESULTS: The results of the exploratory factor analysis showed that the 13 items yielded three easily interpretable factors: an interpersonal factor, an affective factor and a behavioral/lifestyle factor. Through confirmatory factor analysis we showed that this model had a significantly closer fit to the data than the classical 17-item, two-factor model of the PCL-R. CONCLUSION: The study supports the three-faceted model of psychopathy.

Adolescent↗
PubMed2002

One-year outcome in first episode psychosis patients in the Swedish Parachute project.

OBJECTIVE: Implementing a system designed to treat first episode psychotic (FEP) patients. METHOD: Every FEP patient (n=253) from a catchment area of 1.5 million inhabitants were asked to participate in this 5-year project. One historical (n=71) and one prospective (n=64) FEP group were used for comparisons. RESULTS: A total of 175 patients (69%) were followed up through the first year of treatment. Global Assessment of Functioning (GAF) values were significantly higher than in the historical comparison group but similar to the prospective group. Psychiatric in-patient care was lower as was prescription of neuroleptic medication. Satisfaction with care was generally high in the Parachute group. Access to a small overnight crisis home was associated with higher GAF. CONCLUSION: It is possible to successfully treat FEP patients with fewer in-patient days and less neuroleptic medication than is usually recommended, when combined with intensive psychosocial treatment and support.

Antipsychotic Agents↗
PubMed2001

[Using projective tests in forensic psychiatry may lead to wrong conclusions. Only empirically tested tests should be used].

The use of projective and psychometric psychological tests at the Department of Forensic Psychiatry in Stockholm (Huddinge), Sweden, was studied for a population of 60 men, including many patients with neuropsychological disabilities and multiple psychiatric disorders. The results showed that the use of projective tests like Rorschach, Object Relations Test, and House-Tree-Person was more frequent than the use of objective psychometric tests. Neuropsychological test batteries like the Halstead-Reitan Neuropsychological Test Battery or Luria-Nebraska Neuropsychological Battery were not used. The majority of patients were, however, assessed by intelligence scales like the WAIS-R. The questionable reliability and validity of the projective tests, and the risk of subjective interpretations, raise a problem when used in a forensic setting, since the courts' decisions about a sentence to prison or psychiatric care is based on the forensic psychiatric assessment. The use of objective psychometric neuropsychological tests and personality tests is recommended.

Decision Making↗
PubMed2001

Pattern of neuropsychological deficits in patients with treated Wilson's disease.

The study aimed to describe the neuropsychological profiles in patients with treated Wilson's disease (WD). The series included 19 symptomatic and 2 asymptomatic patients with a mean age of 35.3 +/- 9.2 years. They were tested with the Automated Psychological Test system (APT), a comprehensive computerised neuropsychological test battery. APT comprised eleven separate tests and assessed five essential types of neuropsychological functions: motor functions, basic neuropsychological functions, specific cognitive functions, memory, and executive functions. The results were compared to current norms of the test battery. The symptomatic WD patients had significantly lower performance than the norms on all finger tapping tasks, the simple reaction time, the simultaneous capacity background task, the short-term memory test, the index of word decoding speed, the grammatical reasoning test, and the perceptual maze test. They were significantly higher on the index of impulsive errors, and used a significantly more global processing mode in the test of selective attention. The female symptomatic patients displayed more pronounced neuropsychological deficits than the males in the complex tasks. WD patients displayed a specific profile of moderate neuropsychological impairment. The results are theoretically interesting and have practical implications for the management of WD patients, e.g. some patients confronted with the results have had increased compliance.

Adult↗
PubMed2001

Criminality and aggression among psychotic in-patients: frequency and clinical correlates.

OBJECTIVE: Violence is common among patients with psychoses. The aim of the study was to examine relations between diagnoses, crimes, demographic variables and aggressive behaviour during admission to hospital. METHOD: During 14 months 257 patients were consecutively referred to a unit with high staff/patient ratio. They were assessed for clinical symptoms at admittance and discharge. Also legal status, coercive measures, criminality and sentences were examined. RESULTS: Of the 257 patients, 38% were found in the police register and 33% had been prosecuted. Those patients committed 2525 crimes, including 292 acts of violence. Problems during admittance were related more to positive symptoms at admittance than to earlier criminality. CONCLUSION: Criminality rate is high among patients with functional psychoses. Many patients, especially women, had never been evaluated by a forensic psychiatrist. The psychiatric services have to consider the importance of preventing psychotic relapses and thereby also preventing violence and criminality.

Adolescent↗
PubMed2001

Neuropsychological impairment in patients treated with depot neuroleptics: a longitudinal study.

OBJECTIVE: To assess neuropsychological impairments among chronic functional psychotic patients over time, and relations with symptoms, drug dose and side effects. METHOD: Thirty-four patients, representative of the most ill one-third of all patients with chronic functional psychoses known to the psychiatric services in a city catchment area, were assessed for clinical symptoms, drug side effects and by neuropsychological tests at study entry. They were then assessed repeatedly over 2 years. RESULTS: All patients were seriously impaired in the tests. The impairment was stable over time, in spite of substantial changes in the clinical state. The impairment was unrelated to drug and drug dose. Patients with prominent negative symptoms were most impaired and most unable to rate their performance in the tests. CONCLUSION: Patients with chronic functional psychoses do relapse often, also late in the course of the disease. Negative symptoms, marked impairments in simple neuropsychological tests and impaired self-monitoring went together.

Adult↗
PubMed2001

Neuropsychological impairments in patients with schizophrenia: stability and prediction of outcome.

OBJECTIVE: To assess neuropsychological impairments among fairly young schizophrenic patients over time, and relations between impairment and symptoms, drug type and dose. METHOD: Clinical and neuropsychological data for 29 schizophrenic patients have been published earlier. Twenty of these patients were retested after 3 years using the same methods. RESULTS: The patients displayed stable impairments in most neuropsychological tests. Vocabulary and focused attention improved over time, whereas response slowness became more pronounced. Symptoms varied considerably over time. A specific pattern of neuropsychological impairments, but not measures of psychopathology, predicted clinical outcome. Patients were unable to judge their test performance. CONCLUSION: A few years after the first episode, our patients displayed a specific pattern of neuropsychological impairment, which predicted clinical outcome. One aspect of the impairment appears to be failure at self-monitoring.

Adult↗
PubMed2001

Schizophrenia--progressive and massive decline in response readiness by episodes.

OBJECTIVE: To relate the pattern of neuropsychological impairments among schizophrenic patients to case history data and disease characteristics in a cross-sectional study of unselected patients, and to integrate these data with two previous longitudinal studies of neuropsychological impairments among schizophrenic patients. METHOD: One hundred consecutive schizophrenic patients were studied with respect to clinical case history and current symptoms, medication and neuropsychological impairment using a comprehensive computerized test battery. RESULTS: The most salient finding was a marked slowing of response readiness, linearly related to the number of previous acute episodes. The resulting deficit was far beyond what has been obtained in any other group of subjects (average -6 SD for >five episode patients). The impairments in many of the other neuropsychological parameters could to some extent be explained with reference to response slowing, with one exception--verbal short-term memory. Adjustment for important confounding factors (age, duration of illness, medication) did not change the strong negative association between response readiness and number of previous episodes. CONCLUSION: These findings, together with findings of our two previous longitudinal studies and a recent replication, prompted us to suggest that each acute schizophrenic episode inflicts damage to a set of hypothetical structures, cognitive pattern generators. We assume that these structures translate intentions to logistic programs. When damaged, delays are introduced into executive functions and corollary discharge processes will run out of phase with intentions. This model implicates new ways of looking at the generative mechanisms of the illness, and on treatment strategies.

Adult↗
PubMed2001

Interventions in the nurse-patient relationship in forensic psychiatric nursing care: a Swedish survey.

Nurses (Registered nurses, RN, and Licensed Mental Nurses, LMN) working in five Swedish forensic psychiatric units filled in a questionnaire designed for general psychiatric nursing, but modified for forensic use. In this report, data concerning the extent to which treatment interventions included verbal elements, and the focus of these nurse--patient verbal interactions, were analysed. The most commonly used interventions were 'social interaction', 'regular communication' and 'social skills training'. The most common focus in verbal nurse--patient interaction were 'explaining consequences, confronting and encouraging the patient to talk about his/her crime/behaviour', 'interpretative communications with the patient', and 'communication about functions in daily life'. The salient findings were: (1) seven of the fifteen interventions used by the nurses included verbal elements to a great extent; (2) nurses often used confronting interventions, despite the fact that the large EE (expressed emotion) literature suggest that hostility and critical remarks may provoke a worsening of symptoms among psychotic patients; (3) there was only little correspondence between actual practice and theoretical models; and (4) there were unexpectedly small differences between the two professional groups (RN and LMN), suggesting that the roles are not distinct.

Adult↗
PubMed2001

New insights into the second generation antihistamines.

Second generation antihistamines are recognised as being highly effective treatments for allergy-based disease and are among the most frequently prescribed and safest drugs in the world. However, consideration of the therapeutic index or the benefit/risk ratio of the H1 receptor antagonists is of paramount importance when prescribing this class of compounds as they are used to treat non-life threatening conditions. There are many second generation antihistamines available and at first examination these appear to be comparable in terms of safety and efficacy. However, the newer antihistamines in fact represent a heterogeneous group of compounds, having markedly differing chemical structures, adverse effects, half-life, tissue distribution and metabolism, spectrum of antihistaminic properties, and varying degrees of anti-inflammatory effects. With regard to the latter, there is growing awareness that some of these compounds might represent useful adjunct medications in asthma therapy. In terms of safety issues, the current second generation grouping includes compounds with proven cardiotoxic effects and others with the potential for adverse drug interactions. Moreover, some of the second generation H1 antagonists have given cause for concern regarding their potential to cause a degree of somnolence in some individuals. It can be argued, therefore, that the present second generation grouping is too large and indistinct since this was based primarily on the concept of separating the first generation sedating compounds from nonsedating H1 antagonists. Although it is too early to talk about a third generation grouping of antihistamines, future membership of such a classification could be based on a low volume of distribution coupled with a lack of sedating effects, drug interactions and cardiotoxicity.

Anti-Asthmatic Agents↗
PubMed2001

Attention deficit hyperactivity disorder, reading disability, and personality disorders in a prison population.

Attention Deficit Hyperactivity Disorder (ADHD) has long been recognized in children, and for many the disorder persists into adulthood. There is a growing concern that the adults with ADHD who have the least favorable outcome, are among those who end up in prison. The aim of this study was to assess childhood ADHD and its persistence into adulthood among a representative sample of Norwegian prison inmates, as well as personality disorders and reading difficulties, which in previous studies have been linked to ADHD. The results indicate that persistent ADHD is very common among prison inmates. Personality disorders and reading difficulties are also common. Psychiatric comorbidity complicates the diagnosis of ADHD in adults. A greater awareness about ADHD in adults certainly is warranted, especially within the prison system because of the risk of misdiagnosing psychiatric disorders and also the risk of missing a condition possibly amenable to treatment.

Adult↗
PubMed2000

Sex differences in strategy and performance on computerized neuropsychological tests as related to gender identity and age at puberty.

Neuropsychological sex differences have since long been under debate. Support for the relation between behavioral differences and biological variables like hormone influence is, however, emerging. Sixteen men and sixteen women, all university students, were tested with computerized neuropsychological tests (APT), the Bem Sexual Role Inventory, and asked about pubertal age. The results were in line with earlier findings of sex differences in neuropsychological tests, men being faster and women more cautious. The assumption that women tend to use left-hemispheric, verbal/serial strategies also in spatial tasks was also partly supported. In women, late onset of puberty was related to better spatial performance, and there were also more intercorrelations between verbal and spatial tests in the female than in the male group, indicating that women use less specific strategies (more g-factor intelligence) in problem solving, or that aptitudes are less compartmentalized in women than in men.

Adult↗
PubMed2000

Cognitive intervention in unemployed individuals with reading and writing disabilities.

Sixty native-born Swedish unemployed participants with reading and writing disabilities (R&WD) participated in a 20-week educational program aimed at improving reading and writing, verbal memory, self-confidence, and flexibility of perspectives. They were tested with a comprehensive battery (interviews, questionnaires, neuropsychological tests, and tests of academic achievement) before and after the intervention. Sixteen controls, matched for sex, age, education, and nonverbal IQ, participated in the pre- and posttest sessions but received only standard unemployment interventions. The educational program participants' performance in tests assessing spelling, decoding of letters, self-confidence, and flexibility improved significantly in comparison with the controls after the intervention. A significantly larger number of the participants had obtained work or started a regular education than expected. A substantial proportion of unemployed participants have R&WD and it appears that an intensive but fairly short educational program can improve their accessibility to the labor market and their motivation for study.

Aged↗
PubMed1999

Temperament traits in male suicide attempters and violent offenders.

With the purpose of comparing temperament traits in subjects who have been violent towards others and with subjects who have shown self-directed violence, 34 male suicide attempters and 34 male violent offenders were matched for age and psychiatric diagnosis. Violent offenders with a history of suicide attempts were excluded. Temperament traits were assessed by means of the Karolinska Scales of Personality. The temperament profiles of suicide attempters and violent offenders were very similar, with high trait anxiety and very low socialization. Violent offenders displayed significantly higher social desirability (P < 0.001). Suicide attempters tended to have higher indirect aggression and monotony avoidance. Impulsiveness, verbal aggression, and inhibition of aggression were within the normal range in both groups. There were substantial temperamental similarities between suicide attempters and violent offenders. In order to disentangle the differential mechanisms behind aggression towards self and others, we probably need to consider historical as well as current situation factors in a systematic way.

Adult↗