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PTSD patients show increasing cytokine levels during treatment despite reduced psychological distress
Get PDFBackground: A reciprocal relationship between activated innate immune system and changes in mood and behavior has been established. There is still a paucity of knowledge on how the immune system responds during psychiatric treatment. We aimed to explore circulating cytokines and assess psychiatric symptom severity scores during 12 weeks of inpatient psychiatric treatment. Methods: The study was a longitudinal assessment of 124 patients (88 women and 36 men) in treatment at Modum Psychiatric Center, Norway. The patient sample comprised a mixed psychiatric population of whom 39 were diagnosed with posttraumatic stress disorder (PTSD). Serum blood samples for cytokine analysis and measures of mental distress using Global Severity Index were collected at admission (T0), halfway (T1), and before discharge (T2). Other factors assessed were age, gender, and the use of antidepressants and anti-inflammatory drugs. Multilevel modeling was used for longitudinal analyses to assess the repeated cytokine samples within each patient. Results: Overall level of IL-1RA was higher in PTSD patients when compared to those without PTSD (P=0.021). The level of IL-1β, MCP-1, and TNF-α increased over time in PTSD compared to non-PTSD patients (P=0.025, P=0.011 and P=0.008, respectively). All patients experienced reduced mental distress as measured by self-reported Global Severity Index scores. Stratified analysis showed that PTSD patients who used anti-inflammatory drugs had higher levels of IL-1β (P=0.007) and TNF-α (P=0.049) than PTSD patients who did not use such drugs. Conclusion: The study indicates that traumatized patients may have a distinct neuroimmune development during recovery. Their activated immune system shows even further activation during their rehabilitation despite symptom reduction.PTSD patients show increasing cytokine levels during treatment despite reduced psychological distress.Innlandet Hospital Trust, Health Region South-East, NorwaypublishedVersio
Rescue the child or treat the adult? Understandings among professionals in dual treatment of substance-use disorders and parenting
Get PDFAims: Dual treatment of parents with substance-use disorders (SUD) is an approach which aims
to meet the needs of both SUD patients and their children. Whereas the parents need to learn to
live without substances, the children need a predictable and structured environment with parents
who are sensitive and psychologically available. In this study we explore the possibilities and
challenges of this joint approach from the perspectives of professionals employed in an in-patient
facility for families with parental SUD. Methods: A qualitative design was used comprising three focus-group interviews with 15 professionals: two groups with ward staff and one with therapists,
all working at a family ward for parents with SUD and their children. Data were analysed using
thematic analysis. Results: Professionals faced difficulties combining the needs of parents and
children and seemed to choose to prioritise either the adult with SUD or the wellbeing of the child.
However, some professionals described what might be a third and alternative solution by supporting
the mothers in everyday life, routines, and care, through exploring present moment
situations. This approach seemed to help parents become more conscious of the child, their
interaction with the child, and their own feelings. Professionals described working at the family
ward as emotionally challenging. Conclusion: Combining treatment of parental SUD, interventions
to improve parenting roles and practice, and at the same time focusing on the developmental
needs of children, is experienced as a complex and demanding task. Different priorities and
treatment aims may enhance tensions between professionals. Even though professionals experience
in-patient dual treatment as challenging, they believe this approach facilitates positive
development in substance dependent parents and their children.publishedVersio
Association between vascular comorbidity and progression of Alzheimer's disease: a two-year observational study in Norwegian memory clinics
Get PDFAbstract
BACKGROUND:
Vascular risk factors increase the risk of Alzheimer's disease (AD), but there is limited evidence on whether comorbid vascular conditions and risk factors have an impact on disease progression. The aim of this study was to examine the association between vascular disease and vascular risk factors and progression of AD.
METHODS:
In a longitudinal observational study in three Norwegian memory clinics, 282 AD patients (mean age 73.3 years, 54% female) were followed for mean 24 (16-37) months. Vascular risk factors and vascular diseases were registered at baseline, and the vascular burden was estimated by the Framingham Stroke Risk Profile (FSRP). Cerebral medical resonance images (MRIs) were assessed for white matter hyperintensities (WMH), lacunar and cortical infarcts. The associations between vascular comorbidity and progression of dementia as measured by annual change in Clinical Dementia Rating Sum of Boxes (CDR-SB) scores were analysed by multiple regression analyses, adjusted for age and sex.
RESULTS:
Hypertension occurred in 83%, hypercholesterolemia in 53%, diabetes in 9%, 41% were overweight, and 10% were smokers. One third had a history of vascular disease; 16% had heart disease and 15% had experienced a cerebrovascular event. MRI showed lacunar infarcts in 16%, WMH with Fazekas score 2 in 26%, and Fazekas score 3 in 33%. Neither the vascular risk factors and diseases, the FSRP score, nor cerebrovascular disease was associated with disease progression in AD.
CONCLUSIONS:
Although vascular risk factors and vascular diseases were prevalent, no impact on the progression of AD after 2 years was shown.The work by Rannveig S. Eldholm and Maria L. Barca was funded from the
Norwegian ExtraFoundation for Health and Rehabilitation through the
Norwegian Health Association. Rannveig S. Eldholm also received funding
from the Liaison Committee between the Central Norway Regional Health
Authority and the Norwegian University of Science and Technology (NTNU).
Karin Persson’s work was funded by the Southern and Eastern Norway
Regional Health Authority.publishedVersio
Still reduced cardiovascular mortality 12 years after supplementation with selenium and coenzyme Q10 for four years: A validation of previous 10-year follow-up results of a prospective randomized double-blind placebo-controlled trial in elderly
Get PDFSelenium and coenzyme Q10 are both necessary for optimal cell function in the body. The intake of selenium is low in Europe, and the endogenous production of coenzyme Q10 decreases as age increases. Therefore, an intervention trial using selenium and coenzyme Q10 for four years as a dietary supplement was performed. The main publication reported reduced cardiovascular mortality as a result of the intervention. In the present sub-study the objective was to determine whether reduced cardiovascular (CV) mortality persisted after 12 years, in the supplemented population or in subgroups with diabetes, hypertension, ischemic heart disease or reduced functional capacity due to impaired cardiac function. Methods From a rural municipality in Sweden, four hundred forty-three healthy elderly individuals were included. All cardiovascular mortality was registered, and no participant was lost to the follow-up. Based on death certificates and autopsy results, mortality was registered. Findings After 12 years a significantly reduced CV mortality could be seen in those supplemented with selenium and coenzyme Q10, with a CV mortality of 28.1% in the active treatment group, and 38.7% in the placebo group. A multivariate Cox regression analysis demonstrated a reduced CV mortality risk in the active treatment group (HR: 0.59; 95%CI 0.42–0.81; P = 0.001). In those with ischemic heart disease, diabetes, hypertension and impaired functional capacity we demonstrated a significantly reduced CV mortality risk. Conclusions This is a 12-year follow-up of a group of healthy elderly participants that were supplemented with selenium and coenzyme Q10 for four years. Even after twelve years we observed a significantly reduced risk for CV mortality in this group, as well as in subgroups of patients with diabetes, hypertension, ischemic heart disease or impaired functional capacity. The results thus validate the results obtained in the 10-year evaluation. The protective action was not confined to the intervention period, but persisted during the follow-up period. The mechanisms behind this effect remain to be fully elucidated, although various effects on cardiac function, oxidative stress, fibrosis and inflammation have previously been identified. Since this was a small study, the observations should be regarded as hypothesis-generating.Still reduced cardiovascular mortality 12 years after supplementation with selenium and coenzyme Q10 for four years: A validation of previous 10-year follow-up results of a prospective randomized double-blind placebo-controlled trial in elderlyPart of the analysis costs was supported by grants from Pharma Nord Aps, Denmark, the County Council of O¨stergo¨tland, Linko¨ping University. The funding organizations had no role in the design, management, analysis, or interpretation of the data, nor in the preparation, review or approval of the manuscript. No economic compensation was distributed.publishedVersio
Bruk av medikamenter for alkoholbrukslidelser i Norge 2004–16
Get PDFBAKGRUNN
Alkoholbrukslidelser forårsaker alvorlig sykelighet og tidlig død. Livstidsprevalens
estimeres til 7–10 % i den norske befolkningen. Mange pasienter kommer ikke inn i
behandlingsapparatet, og det antas at få av dem som kommer i behandling får
medikamentell behandling. På markedet er det flere medikamenter som kan hjelpe til med
å redusere mengde inntatt alkohol og å opprettholde avhold fra alkohol. Vi ønsket å få
innsikt i disse medikamentenes forskrivningsforekomst og -praksis.
MATERIALE OG METODE
Vi hentet krypterte data fra Nasjonalt reseptbasert legemiddelregister om alle som fikk
medikamenter for alkoholbrukslidelse i perioden 2004–16. De inkluderte legemidlene var
disulfiram, akamprosat, naltrekson 50 mg og nalmefen.
RESULTATER
Årsprevalensen for forskrivning økte fra 0,85 til 1,13 per 1 000 innbyggere i
observasjonstiden. Halvparten av alle pasientene hadde kun én ekspedert resept.
Disulfiram var det hyppigst forskrevne medikamentet. Det var en svak økning i prevalens i
aldersgrupper til og med 55 år og en betydelig økning for de over 55 år.
KONKLUSJON
Det har vært en svak økning i prevalens i forskrivning i observasjonstiden. Disulfiram var
det mest forskrevne medikamentet. Økningen i forskrivning var størst blant kvinner og i
gruppen over 55 år.publishedVersio
Cortisol levels among older people with and without depression and dementia
Get PDFABSTRACTCortisol dysregulation has been reported in dementia and depression. Cortisol levels and its associates were investigated among older people living at home and in nursing homes, in a cross-sectional study. A sample of 650 older people, from the community (home and nursing homes) and specialized care (memory clinics and old age psychiatry wards), mean age 76.8 (SD = 10.3) (dementia n = 319, depression, n = 154, dementia plus depression n = 53, and reference group n = 124), was included. Assessment included the Mini Mental State Examination (MMSE), Cornell scale for depression in dementia, activities of daily living scales, and salivary cortisol. Number of drugs was registered. The results showed that the cortisol ratio was highest among patients with dementia and co-morbid depression in comparison to those with either depression or dementia and the reference group. Characteristics significantly associated with cortisol levels were higher MMSE score (in patients with dementia and co-morbid depression), male gender (in people with dementia), and number of medications (in the reference group). We conclude that the cortisol ratio was highest among patients with dementia and co-morbid depression in comparison to those with either depression or dementia and the reference group. The association of cortisol level with MMSE score among patients with dementia and depression could further indicate that increased stress is related to cognitive function.acceptedVersio
Stability in basic self-disturbances and diagnosis in a first treated psychosis: A seven year follow-up study
Get PDFBackground: Basic self-disturbances (BSDs) are considered core features of schizophrenia spectrum disorders, and are present in the prodromal, early psychotic and chronic phases. Considerable levels of BSDs are also present at first treatment in some patients with psychotic disorders outside the schizophrenia spectrum. There is limited knowledge about the stability of self-disturbances over time.
Aim: To explore the stability of BSDs in a seven-year follow-up of first treatment patients, and the association between baseline levels and changes in BSDs and diagnostic changes at follow-up.
Method: Longitudinal study of 56 patients (35 schizophrenia and 21 non-schizophrenia) recruited at their first treatment for a psychotic disorder. BSDs were assessed using the Examination of Anomalous Self-Experience (EASE), while diagnostic categories, clinical symptom severity, and functioning were assessed with standard clinical instruments.
Results: The schizophrenia group had significantly lower levels of BSDs at follow-up compared to baseline. The EASE domain "Cognition and stream of consciousness" was the most stable. There were no diagnostic changes into or out of schizophrenia spectrum. Patients with schizophrenia had significantly higher levels of BSDs both at baseline and at follow up than patients with psychotic disorders outside the schizophrenia spectrum, who showed stable low levels.
Conclusion: We found a decrease and thus less stability in BSDs in schizophrenia than expected. This might indicate that BSDs tent to weaken over time, and that unknown individual characteristics may influence the development of BSDs. Diagnostic stability from baseline to follow-up may be due to long DUP before service entry.acceptedVersio
Is perceived intolerance to milk and wheat associated with the corresponding IgG and IgA food antibodies? A cross sectional study in subjects with morbid obesity and gastrointestinal symptoms
Get PDFBackground: Serum IgG and IgA food antibodies have been used for dietary advice to subjects with gastrointestinal symptoms and perceived food intolerance, but the role of these antibodies in mediating intolerance is controversial. The present study investigated associations between perceived gastrointestinal intolerance to milk-or wheat and the corresponding s-IgG and s-IgA food antibodies in subjects with morbid obesity.
Methods: Subjects with morbid obesity (BMI ≥ 40 kg/m2 or ≥35 kg/m2 with obesity-related complications) were included. Irritable Bowel Syndrome (IBS) was diagnosed based on the Rome III criteria. Severity of specific gastrointestinal symptoms were measured with the Gastrointestinal Symptom Rating Scale (GSRS)-IBS. S-IgG against cow's milk, cheese, wheat and gluten, and s-IgA against casein and gliadin were measured.
Results: Ninety-seven subjects (80 females) with mean age 45 (SD 8.4) years were included, 70 had gastrointestinal complaints, 25 had IBS, and 22 and 20 reported milk- and wheat- intolerance respectively. There were no significant differences in serum concentrations or proportions of subjects above defined cut-off values for the antibodies between subjects with and without gastrointestinal complaints. In the group with gastrointestinal complaints, no significant differences were found between subjects with and without perceived food intolerance. Except for a significant correlation between IgG against cheese and GSRS-diarrhea (Rho: -0.25, P = 0.04), no significant correlations were found between the antibodies and type or degree of gastrointestinal symptoms, including IBS.
Conclusions: The study showed no associations between perceived milk or wheat intolerance and the corresponding s-IgG and s-IgA food antibodies in subjects with morbid obesity.The study has received funding from Innlandet Hospital Trust, Brumunddal,
Norway, and Lab1 AS, Sandvika, NorwaypublishedVersio
The role of therapy in impairing quality of life in dermatological patients: A multinational study
No full textSkin disease and its therapy affect health-related quality of life (HRQoL). The aim of this study was to measure the burden caused by dermatological therapy in 3,846 patients from 13 European countries. Adult outpatients completed questionnaires, including the Dermatology Life Quality Index (DLQI), which has a therapy impact question. Therapy issues were reported by a majority of patients with atopic dermatitis (63.4%), psoriasis (60.7%), prurigo (54.4%), hidradenitis suppurativa (54.3%) and blistering conditions (53%). The largest reduction in HRQoL attributable to therapy, as a percentage of total DLQI, adjusted for confounders, was seen in blistering conditions (10.7%), allergic/drug reactions (10.2%), psoriasis (9.9%), vasculitis/immunological ulcers (8.8%), atopic dermatitis (8.7%), and venous leg ulcers (8.5%). In skin cancer, although it had less impact on HRQoL, the reduction due to therapy was 6.8%. Treatment for skin disease contributes considerably to reducing HRQoL: the burden of dermatological treatment should be considered when planning therapy and designing new dermatological therapies.The role of therapy in impairing quality of life in dermatological patients: A multinational studypublishedVersio
Nutrient intake and environmental enteric dysfunction among Nepalese children 9-24 months old-the MAL-ED birth cohort study.
Get PDFBACKGROUND:
Nutrient deficiencies limit the growth and turnover of intestinal mucosa, but studies assessing whether specific nutrients protect against or improve environmental enteric dysfunction (EED) are scarce. We aimed to investigate associations between nutrient intake and EED assessed by lactulose:mannitol (L:M) ratio, anti-1-antitrypsin, myeloperoxidase (MPO), and neopterin (NEO) among children 9-24 months in Bhaktapur, Nepal.
METHODS:
Among 231 included children, nutrient intake was assessed monthly by 24 h recalls, and 3-month usual intake was estimated using Multiple Source Method. Associations between nutrient intake and L:M ratio (measured at 15 months) were assessed using multiple linear regression, while associations between nutrient intake and fecal markers (measured quarterly) were assessed using Generalized Estimating Equations (GEE) models.
RESULTS:
We found that associations between nutrient intake from complementary food and L:M ratio, alpha-1-antitrypsin (AAT), MPO and NEO were generally negative but weak. The only significant associations between nutrient intake (potassium, magnesium, phosphorous, folate, and vitamin C) and markers for intestinal inflammation were found for MPO.
CONCLUSION:
Negative but weak associations between nutrient intake and markers of intestinal inflammation were found. Significant associations between several nutrients and MPO might merit further investigation.We thank the staff, children, and caregivers of the MAL-ED Bhaktapur site for their contributions. This work was supported by the Bill & Melinda Gates Foundation (grant number OPP47075); the Foundation for the NIH and the National Institutes of Health, Fogarty International Center.submittedVersio