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Biomedical subjects

Sten Levander

Publications and source records attributed to Sten Levander.

16 recordsLinked to original sources
PubMed2006

Tardive dyskinesia and antipsychotics: a 5-year longitudinal study of frequency, correlates and course.

The present study comprised a naturalistic, multicentre, 5-year study of course and correlates of tardive dyskinesia (TD). One hundred and sixty-six patients treated with risperidone were included during 1995/96 and followed once a year for 5 years. Mean age at inclusion was 38 years, and mean illness duration was 12 years. Tardive dyskinesia was assessed by the Abnormal Involuntary Movement Scale, and each patient's cognitive function was tested with a comprehensive computerised test battery. At study entry, 14% had TD according to a criterion index. Fifty percent were aware of it, but few reported distress. Age and sex did not correlate with TD, but schizophrenia and bipolar diagnoses did. The presence and intensity of TD correlated with all Positive and Negative Syndrome Scale for Schizophrenia symptom dimensions except the affective factor, but not with type of medication or chlorpromazine-equivalent levels. Tardive dyskinesia patients were cognitively impaired in tests reflecting mental speed, but not in other cognitive modalities. Over the 453 patient years of exposure, five patients developed TD and 14 became free of it. Our findings support the view that TD: (i) is a dynamic phenomenon; (ii) is only partly drug-induced; (iii) has a mild course during treatment with modern neuroleptics; and (iv) appears to have some correlation with mental slowness.

Adolescent↗
PubMed2005

Current therapy issues and unmet clinical needs in the treatment of schizophrenia: a review of the new generation antipsychotics.

This review discusses the atypical antipsychotics, focusing on the possibility of symptom reduction with a minimum of side-effects. A selective review of clinically relevant reports, studies and meta-analyses is presented. The results from clinical trials suggest that atypical agents improve negative and affective symptoms, and cognitive functioning more than typical antipsychotics, but that the pattern of effects on these domains, as well as on suicidality, appears to differ. In clinical trials, the newer drugs generally have less extrapyramidal side-effects (EPS) than typical antipsychotics. However, amisulpride, risperidone, olanzapine and ziprasidone still show evidence of a dose-related increase in EPS, whereas clozapine, quetiapine, sertindole and aripiprazole do not. Weight gain, increased blood lipids/cholesterol, and insulin resistance/type 2 diabetes are emerging as significant treatment-associated concerns, particularly for clozapine and olanzapine. Sedation has been reported for all the newer compounds except sertindole. The considerable variation in benefit/risk profiles of the atypical compounds can help the clinician to select the most appropriate treatment for individual patients.

Antipsychotic Agents↗
PubMed2005

Reliability and Validity Evaluation of the Psychopathy Checklist: Screening Version (PCL:SV) in Swedish correctional and forensic psychiatric samples.

This study evaluated the structural reliability, construct-related validity, and cultural validity generalization of the Hare Psychopathy Checklist: Screening Version (PCL:SV) in a sample of more than 560 male and female Swedish forensic psychiatric treatment patients, forensic evaluation patients, and criminal offenders. Structural reliability was excellent for most indices. PCL:SV scores were higher for males than females for total and Part 1 scores (interpersonal/affective features) but not for Part 2 (behavioral features). With some exceptions, PCL:SV scores were meaningfully related to aggression to others, a measure of risk for violence, substance use problems, personality disorder (positive), and psychosis (negative). Correlations between PCL:SV and aggression were larger for females than males, although the difference was smaller when personality disorder was held constant. The structural reliability and pattern of validity coefficients were comparable in these Swedish samples to other non-North American samples. Implications for the cross-cultural manifestation and correlates of psychopathy are discussed.

Adolescent↗
PubMed2004

Neurocognitive and psychopathological correlates of self-monitoring ability in schizophrenia.

In a previous study reported by our group one salient finding was that many patients with schizophrenia appeared to be unable to judge their own quality of life (QoL) and that this inability was associated with negative symptoms. The association between negative symptoms, poor self-monitoring capacity and lack of insight might be explained by a common underlying factor, i.e. neurocognitive impairment. Fifty schizophrenic patients were examined by symptom ratings and a comprehensive neuropsychological test battery. The cognitive performance of the patients was very poor. The major findings of the present study were the association between clinically rated Lack of judgement (PANSS G12) and 1) a set of standard performance and executive indices of the computerised tests, and 2) difference scores between objective performance/strategies and self-ratings of the same attributes. There appears to be a substantial contribution of cognitive and executive problems to the poor judgement and lack of insight of schizophrenic patients, and these problems can to some extent be assessed objectively.

Adult↗
PubMed2003

Premorbid IQ and schizophrenia. Increasing cognitive reduction by episodes.

In order to test the hypothesis that acute schizophrenia episodes have a negative impact on cognitive function, 35 consecutive non-abuse schizophrenia outpatients (age < 60) were enrolled in this study. All subjects for whom grades from the 9(th) year of the Swedish school system were available, had to complete a comprehensive computerized neuropsychological test session. Symptoms were rated by PANSS and GAF, previous episodes were tallied, and medication was logged. A premorbid cognitive score was calculated on the basis of school grades and validated by comparison with academic career and current cognitive performance (r = 0.56). Half had college level studies or higher, and the overall school grades for the group were above average. PANSS (sum = 59) and GAF [59] ratings as well as medication (M = 230 CPZ units) suggested a moderate symptom level. Two patients had no neuroleptic drugs, 16 had atypical and 17 had conventional neuroleptics. Vocabulary was intact. On average, patients had lost 1 standard deviation (SD) in most cognitive tests but response time slowing amounted to 3.5 SD. There were no differences in cognition between drug types and no correlation with CPZ dose. The number of previous episodes was positively correlated with reaction time prolongation and negatively correlated with short-term verbal memory, consistent with a previous study suggesting that acute episodes cause specific cognitive reduction.

Adult↗
PubMed2002

[Schizophrenia and violence].

BACKGROUND: Increased attention is given to aggression and violence in people with mental disorders, though little is known of what aspects of mental disorders are associated with violence or about the strength of these associations. MATERIAL AND METHODS: A review of the topic is given based on international research. RESULTS AND INTERPRETATION: Many studies have reported an increased risk of homicide among people suffering from schizophrenia. There are many ways of classifying symptoms in schizophrenia and there has been a clinical impression that violence is related to positive symptoms and disorganization. However, the predictive value of symptoms is small compared to such characteristics as early onset of antisocial behaviour, antisocial and psychopathic traits, earlier violence and abuse problems. Alcohol and substance abuse is associated with an increased risk of violent behaviour in people with and without mental disorders. Recent research suggests that this increased risk is larger still in people with schizophrenia than in people with no mental disorders.

Cohort Studies↗