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1.
Health Serv Res Manag Epidemiol ; 10: 23333928231159808, 2023.
Article in English | MEDLINE | ID: mdl-36923210

ABSTRACT

Background/aims: An effective workflow at the endoscopy unit is important for optimal production. We conducted a time-and-motion study to identify the amount of time that patients spend during the different steps of a regular endoscopy procedure and compared propofol with midazolam sedation. Methods: Data from 376 patients were prospectively collected. Durations of the different procedure steps were measured. Correlations between recovery times, age, and dose of sedative were calculated. Multiple regression analysis was performed to evaluate how various factors affect recovery time. Results: The use of midazolam resulted in significantly shorter procedure duration for gastroscopy (5.1 vs 8.3 min), shorter endoscopist delay duration for either types of endoscopy (5.9 vs 8.3 min for gastroscopy and 6.7 vs 11.4 min for colonoscopy), shorter endoscopy room duration for gastroscopy (22.2 vs 30.0 min), shorter recovery time for colonoscopy (23.4 vs 27.4 min) and shorter Endoscopy Unit Duration for either type of endoscopy (77.1 vs 101.4 min for gastroscopy and 99.6 vs 123.2 min for colonoscopy). There was a weak correlation between dose of midazolam and recovery time. Conclusions: In contrast to other studies, propofol administration leads to more time spent at different steps in the workflow at our unit. Implementing propofol sedation will not improve efficacy if other steps in the workflow are not taken into account.

2.
Hum Brain Mapp ; 43(1): 414-430, 2022 01.
Article in English | MEDLINE | ID: mdl-33027543

ABSTRACT

First-degree relatives of patients diagnosed with schizophrenia (SZ-FDRs) show similar patterns of brain abnormalities and cognitive alterations to patients, albeit with smaller effect sizes. First-degree relatives of patients diagnosed with bipolar disorder (BD-FDRs) show divergent patterns; on average, intracranial volume is larger compared to controls, and findings on cognitive alterations in BD-FDRs are inconsistent. Here, we performed a meta-analysis of global and regional brain measures (cortical and subcortical), current IQ, and educational attainment in 5,795 individuals (1,103 SZ-FDRs, 867 BD-FDRs, 2,190 controls, 942 schizophrenia patients, 693 bipolar patients) from 36 schizophrenia and/or bipolar disorder family cohorts, with standardized methods. Compared to controls, SZ-FDRs showed a pattern of widespread thinner cortex, while BD-FDRs had widespread larger cortical surface area. IQ was lower in SZ-FDRs (d = -0.42, p = 3 × 10-5 ), with weak evidence of IQ reductions among BD-FDRs (d = -0.23, p = .045). Both relative groups had similar educational attainment compared to controls. When adjusting for IQ or educational attainment, the group-effects on brain measures changed, albeit modestly. Changes were in the expected direction, with less pronounced brain abnormalities in SZ-FDRs and more pronounced effects in BD-FDRs. To conclude, SZ-FDRs and BD-FDRs show a differential pattern of structural brain abnormalities. In contrast, both had lower IQ scores and similar school achievements compared to controls. Given that brain differences between SZ-FDRs and BD-FDRs remain after adjusting for IQ or educational attainment, we suggest that differential brain developmental processes underlying predisposition for schizophrenia or bipolar disorder are likely independent of general cognitive impairment.


Subject(s)
Bipolar Disorder/pathology , Cognitive Dysfunction/pathology , Educational Status , Genetic Predisposition to Disease , Intelligence/physiology , Neuroimaging , Schizophrenia/pathology , Bipolar Disorder/complications , Bipolar Disorder/diagnostic imaging , Cognitive Dysfunction/diagnostic imaging , Family , Humans , Magnetic Resonance Imaging , Schizophrenia/complications , Schizophrenia/diagnostic imaging , Schizophrenia/etiology
3.
Elife ; 102021 02 26.
Article in English | MEDLINE | ID: mdl-33646943

ABSTRACT

We performed a systematic analysis of blood DNA methylation profiles from 4483 participants from seven independent cohorts identifying differentially methylated positions (DMPs) associated with psychosis, schizophrenia, and treatment-resistant schizophrenia. Psychosis cases were characterized by significant differences in measures of blood cell proportions and elevated smoking exposure derived from the DNA methylation data, with the largest differences seen in treatment-resistant schizophrenia patients. We implemented a stringent pipeline to meta-analyze epigenome-wide association study (EWAS) results across datasets, identifying 95 DMPs associated with psychosis and 1048 DMPs associated with schizophrenia, with evidence of colocalization to regions nominated by genetic association studies of disease. Many schizophrenia-associated DNA methylation differences were only present in patients with treatment-resistant schizophrenia, potentially reflecting exposure to the atypical antipsychotic clozapine. Our results highlight how DNA methylation data can be leveraged to identify physiological (e.g., differential cell counts) and environmental (e.g., smoking) factors associated with psychosis and molecular biomarkers of treatment-resistant schizophrenia.


Subject(s)
DNA Methylation , Epigenome , Psychotic Disorders/physiopathology , Schizophrenia, Treatment-Resistant/physiopathology , Adult , Aged , England , Female , Humans , Ireland , Male , Middle Aged , Psychotic Disorders/genetics , Schizophrenia, Treatment-Resistant/genetics , Scotland , Sweden , Young Adult
4.
Schizophr Res ; 228: 360-366, 2021 02.
Article in English | MEDLINE | ID: mdl-33548836

ABSTRACT

Insights into determination of study participation are useful for researchers, clinicians and for ethical considerations. Few large-scale genomic studies have involved motives for enrollment, in schizophrenia patients and unaffected controls. In a case-control study with participants recruited nation-wide in Sweden between 2005 and 2010, semi-structured interviews on motives and attitudes towards future studies were explored in 2767 schizophrenia cases and 4466 controls. In qualitative and quantitative analyses, we identified altruism as a major determinant in 84% of the cases and in 97% of the controls. Among pre-defined subcategories of altruism, cases with schizophrenia were more often referring to science for example, 'I want to help science move forward' or 'I want better medications for future generations' in relation to unaffected controls that were more often referring to common humanity such as 'It is my duty and responsibility to help'. In schizophrenia, motives related to personal benefit and social influence were reported by 9% and 5%. We conclude that individuals with schizophrenia frequently report altruistic motives for study participation, almost to the same extent as unaffected controls. In contrast to unfortunate stereotypes, people with schizophrenia wish others to benefit from their experiences with severe mental illness and should not be refrained from participating in genomic research.


Subject(s)
Schizophrenia , Case-Control Studies , Humans , Motivation , Surveys and Questionnaires , Sweden
5.
J Atten Disord ; 25(3): 312-321, 2021 02.
Article in English | MEDLINE | ID: mdl-30024318

ABSTRACT

Objective: The Quantified Behavioral Test (QbTest) is a computerized diagnostic test for ADHD, used in clinical psychiatric care, but its validity may be questioned. We analyzed the QbTest's diagnostic validity and its relation to cognitive ability and psychosocial factors in an adolescent population with a high occurrence of neurodevelopmental disorders. Method: In total, 340 participants aged 15 years, completed the QbTest, along with questionnaires, clinical and intelligence quotient (IQ) assessments. Results: The clinical assessment resulted in 89 (26%) participants with ADHD. Area under curve (AUC) scores indicated a random to poor validity of the QbTest (AUC range = 0.48-0.64). QbTest scores of inattention and impulsivity correlated with IQ. Conclusion: The QbTest was insufficient as a diagnostic test for ADHD, and was not able to differentiate ADHD from other neurodevelopmental conditions. Clinicians should be aware of the dubious discriminating power of the QbTest.


Subject(s)
Attention Deficit Disorder with Hyperactivity , Behavior Rating Scale , Adolescent , Attention , Attention Deficit Disorder with Hyperactivity/diagnosis , Humans , Impulsive Behavior , Surveys and Questionnaires
6.
J Neurodev Disord ; 12(1): 44, 2020 12 23.
Article in English | MEDLINE | ID: mdl-33357227

ABSTRACT

BACKGROUND: Clinical studies found that medication for attention-deficit/hyperactivity disorder (ADHD) is effective in coexisting autism spectrum disorder (ASD), but current research is based on small clinical studies mainly performed on children or adolescents. We here use register data to examine if individuals with ADHD and coexisting ASD present differences in the prescribing patterns of ADHD medication when compared to individuals with pure ADHD. METHODS: Data with information on filled prescriptions and diagnoses was retrieved from the Swedish Prescribed Drug Register and the National Patient Register. We identified 34,374 individuals with pure ADHD and 5012 individuals with ADHD and coexisting ASD, aged between 3 and 80 years. The first treatment episode with ADHD medications (≥ 2 filled prescriptions within 90 days) and daily doses of methylphenidate during a 3-year period was measured. Odds ratios (ORs) were calculated for the likelihood of being prescribed ADHD medication in individuals with and without ASD and Wilcoxon rank-sum test was used to compare group differences in dose per day. RESULTS: Individuals with ADHD and coexisting ASD were less likely to start continuous treatment with ADHD medication (ADHD 80.5%; ADHD with ASD 76.2%; OR, 0.80; 95% confidence interval, 0.75-0.86), were less likely to be prescribed methylphenidate, and were more commonly prescribed second line treatments such as dexamphetamine, amphetamine, or modafinil. No group difference was observed for atomoxetine. In adults with ADHD and coexisting ASD, methylphenidate was prescribed in lower daily doses over three years as compared to individuals with pure ADHD. CONCLUSIONS: The findings indicate that there are differences in the medical treatment of individuals with or without ASD. If these differences are due to different medication responses in ASD or due to other factors such as clinicians' perceptions of medication effects in patients with ASD, needs to be further studied.


Subject(s)
Attention Deficit Disorder with Hyperactivity , Autism Spectrum Disorder , Methylphenidate , Pharmaceutical Preparations , Adolescent , Adult , Aged , Aged, 80 and over , Attention Deficit Disorder with Hyperactivity/complications , Attention Deficit Disorder with Hyperactivity/drug therapy , Attention Deficit Disorder with Hyperactivity/epidemiology , Autism Spectrum Disorder/complications , Autism Spectrum Disorder/drug therapy , Autism Spectrum Disorder/epidemiology , Child , Child, Preschool , Humans , Methylphenidate/therapeutic use , Middle Aged , Sweden/epidemiology , Young Adult
7.
Eur Arch Psychiatry Clin Neurosci ; 270(7): 933-938, 2020 Oct.
Article in English | MEDLINE | ID: mdl-31302732

ABSTRACT

Preclinical studies indicate a link between the kynurenine pathway and monocyte chemoattractant protein-1 (MCP-1), but there is a lack of clinical studies examining this further. We here perform a secondary analysis of kynurenine metabolites and MCP-1 in cerebrospinal fluid of 23 twins affected from schizophrenia, bipolar disorder or unaffected. We show an association between MCP-1 and kynurenic acid (KYNA), driven by unique environmental influences and a less pronounced association between MCP-1 and tryptophan. No association was detected between MCP-1 and quinolinic acid. Further studies on the mechanism behind the putative relationship between KYNA and MCP-1 are needed.


Subject(s)
Bipolar Disorder/cerebrospinal fluid , Chemokine CCL2/cerebrospinal fluid , Kynurenic Acid/cerebrospinal fluid , Schizophrenia/cerebrospinal fluid , Adult , Aged , Cohort Studies , Female , Humans , Male , Middle Aged , Quinolinic Acid/cerebrospinal fluid , Sweden , Tryptophan/cerebrospinal fluid
8.
Biol Psychiatry ; 86(7): 545-556, 2019 10 01.
Article in English | MEDLINE | ID: mdl-31443932

ABSTRACT

BACKGROUND: Schizophrenia and bipolar disorder share genetic liability, and some structural brain abnormalities are common to both conditions. First-degree relatives of patients with schizophrenia (FDRs-SZ) show similar brain abnormalities to patients, albeit with smaller effect sizes. Imaging findings in first-degree relatives of patients with bipolar disorder (FDRs-BD) have been inconsistent in the past, but recent studies report regionally greater volumes compared with control subjects. METHODS: We performed a meta-analysis of global and subcortical brain measures of 6008 individuals (1228 FDRs-SZ, 852 FDRs-BD, 2246 control subjects, 1016 patients with schizophrenia, 666 patients with bipolar disorder) from 34 schizophrenia and/or bipolar disorder family cohorts with standardized methods. Analyses were repeated with a correction for intracranial volume (ICV) and for the presence of any psychopathology in the relatives and control subjects. RESULTS: FDRs-BD had significantly larger ICV (d = +0.16, q < .05 corrected), whereas FDRs-SZ showed smaller thalamic volumes than control subjects (d = -0.12, q < .05 corrected). ICV explained the enlargements in the brain measures in FDRs-BD. In FDRs-SZ, after correction for ICV, total brain, cortical gray matter, cerebral white matter, cerebellar gray and white matter, and thalamus volumes were significantly smaller; the cortex was thinner (d < -0.09, q < .05 corrected); and third ventricle was larger (d = +0.15, q < .05 corrected). The findings were not explained by psychopathology in the relatives or control subjects. CONCLUSIONS: Despite shared genetic liability, FDRs-SZ and FDRs-BD show a differential pattern of structural brain abnormalities, specifically a divergent effect in ICV. This may imply that the neurodevelopmental trajectories leading to brain anomalies in schizophrenia or bipolar disorder are distinct.


Subject(s)
Bipolar Disorder , Brain/pathology , Genetic Predisposition to Disease , Schizophrenia , Adult , Bipolar Disorder/genetics , Bipolar Disorder/pathology , Cohort Studies , Female , Humans , Male , Middle Aged , Schizophrenia/genetics , Schizophrenia/pathology , Young Adult
9.
Psychiatry Res ; 278: 180-187, 2019 08.
Article in English | MEDLINE | ID: mdl-31207455

ABSTRACT

Twin- and family studies have shown variations in the heritability estimates of bipolar disorder (BPD). The current study uses an updated statistical methodology for heritability estimation in BPD by taking available time of follow-up into account while controlling for co-variates. We identified monozygotic and dizygotic same and different sex twins with BPD (n = 804) or unaffected from BPD (n = 91,604) from the Swedish Twin Register and the National Patient Register. We applied structural equational modeling with inversed probability weighting to estimate the heritability, taking into account censoring and truncation of data. Sex-limitation models were constructed to analyze qualitative or quantitative sex-differences in BPD. Heritability for BPD was 60.4% (95% Confidence Interval: 50.3-70.5) after age, sex, left-hand truncation and censoring of the data was taken into account. A larger proportion of females were affected from BPD (females 62.2%; males 37.8%, p < 0.001), but no sex-difference in BPD heritability was found, nor any sex-specific genetic effects. We demonstrated a robust 60% heritability for BPD with no evidence of sex-specific genetic effects on disease liability.


Subject(s)
Bipolar Disorder/epidemiology , Bipolar Disorder/genetics , Genetic Predisposition to Disease/epidemiology , Genetic Predisposition to Disease/genetics , Registries , Sex Characteristics , Adult , Diseases in Twins/genetics , Female , Humans , Male , Sweden
10.
Schizophr Res ; 204: 183-192, 2019 02.
Article in English | MEDLINE | ID: mdl-30121189

ABSTRACT

The schizophrenia and bipolar twin study in Sweden (STAR) is a large nation-wide cohort of monozygotic (MZ) and dizygotic (DZ) same-sex twins with schizophrenia or bipolar disorder and healthy control pairs, extensively characterized with brain imaging, neuropsychological tests, biomarkers, genetic testing, psychiatric symptoms and personality traits. The purpose is to investigate genetic and environmental mechanisms that give rise to schizophrenia and bipolar disorder as well as the intermediate phenotypes. This article describes the design, recruitment, data collection, measures, collected twins' characteristics, diagnostic procedures as well as ongoing and planned analyses. Identification of biomarkers, genetic and epigenetic variation and the development of specific and common endophenotypes for schizophrenia and bipolar disorder are potential gains from this cohort.


Subject(s)
Bipolar Disorder , Endophenotypes , Gene-Environment Interaction , Registries , Schizophrenia , Adult , Aged , Biomarkers , Bipolar Disorder/diagnostic imaging , Bipolar Disorder/etiology , Bipolar Disorder/genetics , Bipolar Disorder/physiopathology , Cohort Studies , Female , Humans , Male , Middle Aged , Research Design , Schizophrenia/diagnostic imaging , Schizophrenia/etiology , Schizophrenia/genetics , Schizophrenia/physiopathology , Sweden , Young Adult
11.
Psychiatry Res ; 258: 9-14, 2017 12.
Article in English | MEDLINE | ID: mdl-28968513

ABSTRACT

Previous studies on the relationship between autoimmune diseases, schizophrenia, and bipolar disorder are mainly based on hospital discharge registers with insufficient coverage of outpatient data. Furthermore, data is scant on the prevalence of autoimmune diseases in bipolar subgroups. Here we estimate the self-reported prevalences of autoimmune diseases in schizophrenia, bipolar disorder type I and II, and controls. Lifetime prevalence of autoimmune diseases was assessed through a structured interview in a sample of 9076 patients (schizophrenia N = 5278, bipolar disorder type I N = 1952, type II N = 1846) and 6485 controls. Comparative analyses were performed using logistic regressions. The prevalence of diabetes type 1 did not differ between groups. Hyperthyroidism, hypothyroidism regardless of lithium effects, rheumatoid arthritis, and polymyalgia rheumatica were most common in bipolar disorder. Systemic lupus erythematosus was less common in bipolar disorder than in the other groups. The rate of autoimmune diseases did not differ significantly between bipolar subgroups. We conclude that prevalences of autoimmune diseases show clear differences between schizophrenia and bipolar disorder, but not between the bipolar subgroups.


Subject(s)
Autoimmune Diseases/epidemiology , Bipolar Disorder/epidemiology , Schizophrenia/epidemiology , Case-Control Studies , Female , Humans , Male , Middle Aged , Prevalence
12.
Eur Arch Psychiatry Clin Neurosci ; 267(5): 391-402, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28039552

ABSTRACT

Schizophrenia and bipolar disorder are debilitating psychiatric disorders with partially shared symptomatology including psychotic symptoms and cognitive impairment. Aberrant levels of microglia and neurodegenerative cerebrospinal fluid (CSF) markers have previously been found in schizophrenia and bipolar disorder. We aimed to analyze familial and environmental influences on these CSF markers and their relation to psychiatric symptoms and cognitive ability. CSF was collected from 17 complete twin pairs, nine monozygotic and eight dizygotic, and from one twin sibling. Two pairs were concordant for schizophrenia, and 11 pairs discordant for schizophrenia, schizoaffective disorder or bipolar disorder, and four pairs were not affected by psychotic disorders. Markers of microglia activation [monocyte chemoattractant protein-1 (MCP-1), chitinase 3-like protein 1 (YKL-40), and soluble cluster of differentiation 14 (sCD14)], markers of ß-amyloid metabolism (AßX-38, AßX-40, AßX-42 and Aß1-42), soluble amyloid precursor proteins (sAPP-α and sAPP-ß), total tau (T-tau), phosphorylated tau (P-tau), and CSF/serum albumin ratio were measured in CSF using immunoassays. Heritability of the CSF markers was estimated, and associations to psychiatric and cognitive measurements were analyzed. Heritability estimates of the microglia markers were moderate, whereas several neurodegenerative markers showed high heritability. In contrast, AßX-42, Aß1-42, P-tau and CSF/serum albumin ratio were influenced by dominant genetic variation. Higher sCD14 levels were found in twins with schizophrenia or bipolar disorder compared to their not affected co-twins, and higher sCD14-levels were associated with psychotic symptoms. The study provides support for a significant role of sCD14 in psychotic disorders and a possible role of microglia activation in psychosis.


Subject(s)
Amyloid beta-Peptides/cerebrospinal fluid , Biomarkers/cerebrospinal fluid , Diseases in Twins , Lipopolysaccharide Receptors/metabolism , Psychotic Disorders/cerebrospinal fluid , Adult , Amyloid beta-Peptides/blood , Biomarkers/blood , Chemokine CCL2/blood , Chemokine CCL2/cerebrospinal fluid , Chitinase-3-Like Protein 1/blood , Chitinase-3-Like Protein 1/cerebrospinal fluid , Female , Genetic Predisposition to Disease , Humans , Male , Middle Aged , Psychometrics , Psychotic Disorders/blood , Psychotic Disorders/genetics , Psychotic Disorders/psychology , Statistics as Topic , Twins, Dizygotic , Twins, Monozygotic
13.
Psychiatry Res ; 247: 105-112, 2017 Jan.
Article in English | MEDLINE | ID: mdl-27886578

ABSTRACT

Increased cytokines and kynurenic acid (KYNA) levels in cerebrospinal fluid (CSF) have been reported in patients with schizophrenia and bipolar disorder. The aim of the present study was to investigate cytokines and kynurenines in the CSF of twin pairs discordant for schizophrenia or bipolar disorder and to study these CSF markers in relation to psychotic symptoms and personality traits. CSF levels of tryptophan (TRP), KYNA, quinolinic acid (QUIN), interleukin (IL)-6, IL-8 and tumor necrosis factor-alpha (TNF-α) were analyzed in 23 twins with schizophrenia or bipolar disorder, and in their not affected co-twins. Ratings of psychotic symptoms and personality traits were made using the Scales for Assessment of Negative and Positive symptoms, the Structured Clinical Interview for DSM-IV - Axis II Disorders, and the Schizotypal Personality Questionnaire - Brief. A total score for psychotic symptoms and personality traits was constructed for analysis. CSF KYNA was associated with the score for psychotic symptom and personality traits. TNF-α and IL-8 were associated, and the intra-pair differences scores of TNF-α and IL-8 were highly correlated. Intraclass correlations indicated genetic influences on CSF KYNA, TRP, IL-8 and TNF-α. The association between KYNA and psychotic symptoms further supports a role of KYNA in psychotic disorders.


Subject(s)
Bipolar Disorder/cerebrospinal fluid , Kynurenic Acid/cerebrospinal fluid , Personality , Schizophrenia/cerebrospinal fluid , Schizophrenic Psychology , Twins/psychology , Bipolar Disorder/psychology , Female , Humans , Interleukin-6/cerebrospinal fluid , Interleukin-8/cerebrospinal fluid , Male , Middle Aged , Psychotic Disorders/complications , Quinolinic Acid/cerebrospinal fluid , Tryptophan/cerebrospinal fluid , Tumor Necrosis Factor-alpha/cerebrospinal fluid
14.
Fertil Steril ; 105(6): 1594-1602.e3, 2016 06.
Article in English | MEDLINE | ID: mdl-26920258

ABSTRACT

OBJECTIVE: To investigate associations between depression, anxiety, and antidepressants before in vitro fertilization (IVF) and IVF cycle outcomes, including pregnancy, live birth, and miscarriage. DESIGN: Nationwide register-based cohort study. SETTING: Not applicable. PATIENT(S): Nulliparous women undergoing their first IVF cycle recorded in the Swedish Quality Register of Assisted Reproduction, January 2007 to December 2012 (n = 23,557). INTERVENTION(S): Not applicable. MAIN OUTCOME MEASURE(S): Associations between diagnoses of depression/anxiety, antidepressants, and IVF cycle outcome evaluated using logistic regression to produce adjusted odds ratios (AOR) and 95% confidence intervals (CI). RESULT(S): In total, 4.4% of women had been diagnosed with depression/anxiety and/or dispensed antidepressants before their IVF first cycle. The odds for pregnancy and live birth were decreased (n = 1,044; AOR = 0.86; 95% CI, 0.75-0.98; and AOR = 0.83; 95% CI, 0.72-0.96, respectively). For women with a prescription for a selective serotonin reuptake inhibitor (SSRI) only (n = 829), no statistically significant associations were found. Women with non-SSRI antidepressants (n = 52) were at reduced odds of pregnancy (AOR = 0.41; 95% CI, 0.21-0.80) and live birth (AOR = 0.27; 95% CI, 0.11-0.68). Women with a depression/anxiety diagnosis with no antidepressant (n = 164) also had reduced odds of pregnancy (AOR = 0.58; 95% CI, 0.41-0.82) and live birth (AOR = 0.60; 95% CI, 0.41-0.89). Among the women who became pregnant (39.7%), there were no statistically significant associations between exposure and miscarriage except for the women taking non-SSRI antidepressants (AOR = 3.56; 95% CI, 1.06-11.9). CONCLUSION(S): A diagnosis of depression/anxiety and/or treatment with antidepressants before IVF was associated with slightly reduced odds of pregnancy and live birth. Women with the presence of depression/anxiety without antidepressants had a more pronounced reduction in odds, implying that the underlying disorder is important for the observed association.


Subject(s)
Antidepressive Agents/therapeutic use , Anxiety/drug therapy , Depression/drug therapy , Fertilization in Vitro/methods , Pregnancy Rate , Adolescent , Adult , Anxiety/diagnosis , Anxiety/epidemiology , Cohort Studies , Depression/diagnosis , Depression/epidemiology , Female , Fertilization in Vitro/trends , Humans , Longitudinal Studies , Middle Aged , Pregnancy , Pregnancy Rate/trends , Registries , Sweden/epidemiology , Treatment Outcome , Young Adult
15.
Mult Scler ; 20(14): 1881-91, 2014 Dec.
Article in English | MEDLINE | ID: mdl-25013151

ABSTRACT

BACKGROUND: Psychiatric disorders are known to be prevalent in multiple sclerosis (MS). OBJECTIVE: The objective of this paper is to study comorbidity between MS and bipolar disorder, schizophrenia and depression in a nationwide cohort and to determine whether shared genetic liability underlies the putative association. METHODS: We identified ICD-diagnosed patients with MS (n = 16,467), bipolar disorder (n = 30,761), schizophrenia (n = 22,781) and depression (n = 172,479) in the Swedish National Patient Register and identified their siblings in the Multi-Generation Register. The risk of MS was compared in psychiatric patients and in matched unexposed individuals. Shared familial risk between MS and psychiatric disorders was estimated by sibling comparison. RESULTS: The risk of MS was increased in patients with bipolar disorder (hazard ratio (HR) 1.8, 95% confidence interval (CI) 1.6-2.2, p < 0.0001) and depression (HR 1.9, 95% CI 1.7-2.0, p < 0.0001). MS risk in schizophrenia was decreased (HR 0.6, 95% CI 0.4-0.9, p = 0.005). The association between having a sibling with a psychiatric disorder and developing MS was not significant. CONCLUSION: We found a strong positive association between MS and bipolar disorder and depression that could not be explained by genetic liability. The unexpected negative association between MS and schizophrenia might be spurious or indicate possible protective mechanisms that warrant further exploration.


Subject(s)
Bipolar Disorder/epidemiology , Depressive Disorder, Major/epidemiology , Multiple Sclerosis/epidemiology , Schizophrenia/epidemiology , Siblings , Adult , Aged , Case-Control Studies , Cohort Studies , Comorbidity , Depressive Disorder/epidemiology , Female , Humans , Male , Middle Aged , Prevalence , Sweden/epidemiology
16.
Schizophr Res ; 143(1): 192-7, 2013 Jan.
Article in English | MEDLINE | ID: mdl-23182441

ABSTRACT

Schizophrenia is a diagnosis with a set of symptoms of aberrant psychological phenomena. Here, we discuss that there may be an imbalance of proteostasis of neurons in the brain leading to increase in membrane shedding and buildup of microparticles (MPs) appearing in the cerebrospinal fluid. The number of MPs can be determined and their phenotypes verified by size and membrane expression with flow cytometry. This is the first report of specified MPs in cerebrospinal fluid (CSF) in schizophrenia. Two 56-year-old Swedish-born female monozygotic twins of Caucasian ethnicity with onset of schizophrenia more than 30years ago were studied. Three fractions of fresh CSF were examined for microparticles by flow cytometry analysis, which measure the specific binding of antibodies to CD42a (platelet-MP; 33 GPIX), CD144 (endothelial-MP; Ve-cadherin), CD45 (leukocyte-MP; pan-leukocyte antigen) and of phosphatidylserine to lactadherin. The patients with schizophrenia displayed more phosphatidylserine-positive MPs in CSF compared with healthy control subjects. The scanning electron microscopic (SEM) structures in CSF studied over a 3-year period in twins with schizophrenia were of similar appearance at both time points. The increased number of MPs in fresh CSF may be a sign of enhanced membrane shedding in the central nervous system. Such MPs can be investigated for both human and non-human DNA, RNA and microRNA that may activate different immune signaling systems in patients with schizophrenia.


Subject(s)
Cell-Derived Microparticles/physiology , Schizophrenia/cerebrospinal fluid , Antigens, CD/cerebrospinal fluid , Blood Platelets/metabolism , Blood Platelets/ultrastructure , Cell-Derived Microparticles/ultrastructure , Female , Flow Cytometry , Humans , Microscopy, Electron, Scanning , Middle Aged , Phagocytes/pathology , Phagocytes/ultrastructure , Schizophrenia/blood , Twins, Monozygotic
17.
PLoS One ; 7(9): e45994, 2012.
Article in English | MEDLINE | ID: mdl-23049916

ABSTRACT

BACKGROUND: Using scanning electron microscopy, microscopic structures have been identified in fresh cerebrospinal fluid (CSF) in patients with schizophrenia and bipolar disorder, but only rarely in control subjects. However, it has not been determined whether these microscopic particles represent state or trait markers, i.e. if their presence is related to clinical manifestations of the disease or if they also can be found in as yet asymptomatic individuals with a genetic liability. This question can be addressed by studying twins discordant or concordant for schizophrenia or bipolar disorder. METHODOLOGY/PRINCIPAL FINDINGS: We investigated microscopic structures in CSF in 102 individuals: 21 monozygotic and 16 dizygotic twins affected or not affected with schizophrenia, schizoaffective disorder or bipolar disorder and in 65 healthy singleton controls. A first and a second fraction of CSF was freshly applied on filters and examined by scanning electron microscopy technique. Spherical particles with lipid appearance averaging between 0.1 to 8.0 µm in diameter were detected in the center of the filter as well as located in the margins of larger aggregates binding in a viscous state. Structures were found in 12 of 17 probands, 5 of 12 healthy co-twins and 3 of 73 healthy controls. Thus, a positive microscopic finding significantly increased the likelihood of belonging to the proband group (OR=48, 95% CL: 8.2-550, p<0.0001) and the co-twin-group (OR=16, 95% CL: 2.0-218, p=0.006). Age, sex, history of alcohol abuse or anxiety syndrome, somatic disorder and markers of acute inflammatory activity did not account for group differences; nor did exposure to psychotropic medication. CONCLUSION: Presence of microscopic particles in CSF may possibly reflect trait dependent genetic or environmental vulnerability in patients with schizophrenia, schizoaffective disorder or bipolar disorder.


Subject(s)
Bipolar Disorder/cerebrospinal fluid , Schizophrenia/cerebrospinal fluid , Adult , Body Mass Index , Case-Control Studies , Diseases in Twins , Female , Humans , Male , Microscopy, Electron, Scanning/methods , Middle Aged , Models, Neurological , Odds Ratio , Polycarboxylate Cement/chemistry , Regression Analysis , Sweden , Twins, Dizygotic , Twins, Monozygotic
18.
J Exp Biol ; 214(Pt 6): 907-14, 2011 Mar 15.
Article in English | MEDLINE | ID: mdl-21346117

ABSTRACT

Corticotropin-releasing factor (CRF) is central in the stress response but also modulates several behaviors including anxiety-related behaviors and aggression. In this study, juvenile rainbow trout (Oncorhynchus mykiss) were tested for competitive ability, determined during dyadic fights for dominance, after intracerebroventricular (i.c.v.) administration of CRF, urotensin I (UI), the non-specific CRF antagonist α-helical RF(9-41) (ahCRF) or the CRF receptor subtype 1-specific antagonist antalarmin, when paired with a mass-matched con-specific injected with saline. In addition, isolated fish received the same substances. Plasma cortisol and brain monoamines were monitored in all fish. Most fish receiving CRF showed a conspicuous behavior consisting of flaring the opercula, opening the mouth and violent shaking of the head from side to side. When this occurred, the fish immediately forfeited the fight. Similar behavior was observed in most fish receiving UI but no effect on outcome of dyadic fights was noted. This behavior seems similar to non-ambulatory motor activity seen in rats and could be anxiety related. Furthermore, fish receiving CRF at a dose of 1000 ng became subordinate, whereas all other treatments had no effects on the outcome of dyadic fights. In addition, isolated fish receiving ahCRF had lower brain stem concentrations of 5-hydroxyindoleacetic acid, serotonin, 3,4-dihydroxyphenylacetic acid and dopamine. In conclusion, CRF seems to attenuate competitive ability, and both CRF and UI seem to induce anxiety-like behavior.


Subject(s)
Aggression/physiology , Anxiety/metabolism , Behavior, Animal , Corticotropin-Releasing Hormone/metabolism , Oncorhynchus mykiss/physiology , Urotensins/metabolism , 3,4-Dihydroxyphenylacetic Acid/metabolism , Aggression/drug effects , Animals , Anxiety/blood , Behavior, Animal/drug effects , Corticotropin-Releasing Hormone/antagonists & inhibitors , Corticotropin-Releasing Hormone/pharmacology , Dopamine/metabolism , Hydrocortisone/blood , Hydroxyindoleacetic Acid/metabolism , Oncorhynchus mykiss/blood , Peptide Fragments/pharmacology , Pyrimidines/pharmacology , Pyrroles/pharmacology , Rats , Serotonin/metabolism , Social Dominance
19.
Adv Exp Med Biol ; 617: 573-9, 2008.
Article in English | MEDLINE | ID: mdl-18497084

ABSTRACT

Prostate cancer (PC) is one of the most common cancers among men, and vitamin D and its metabolites are candidates for prevention and therapy of this disease. The vitamin D metabolites, 1, 25-dihydroxyvitamin D3 (1,25D) and 25-hydroxyvitamin D3, decreases cellular proliferation and invasiveness, and stimulates differentiation of PC cells. However, the underlying mechanisms are not fully clarified, and there is evidence that some of these effects of the vitamin D system are mediated by specific membrane-associated receptors/binding proteins in addition to its nuclear receptor, suggesting multiple regulatory pathways. The aim of the present study was to examine the role of membrane initiated pathways mediating effects of 1,25D on cell invasiveness in LNCaP cells. Treatment with 1,25D evoked a dose-dependent activation of the JNK/SAPK MAPK signaling pathways within 10 min, demonstrating membrane initiated signaling of 1,25D in LNCaP cells. Furthermore, treatment with 1,25D decreased LNCaP cell invasiveness by approximately 20% after 48 h. Using an inhibitor (SP600125) for the JNK/SAPK MAPK signaling pathway in combination with 1,25D on LNCaP cells, the inhibitory action of 1,25D on invasiveness was eliminated. In conclusion, 1,25D decrease invasiveness of LNCaP cells by interaction with a putative membrane associated receptor, which activate membrane, initiated signaling via the JNK/SAPK MAPK signaling pathway.


Subject(s)
JNK Mitogen-Activated Protein Kinases/metabolism , Mitogen-Activated Protein Kinases/metabolism , Prostatic Neoplasms/drug therapy , Prostatic Neoplasms/metabolism , Signal Transduction/drug effects , Vitamin D/analogs & derivatives , Anthracenes/pharmacology , Cell Proliferation/drug effects , Drug Therapy, Combination , Humans , JNK Mitogen-Activated Protein Kinases/antagonists & inhibitors , Male , Mitogen-Activated Protein Kinases/antagonists & inhibitors , Neoplasm Invasiveness , Neoplasms, Hormone-Dependent/drug therapy , Neoplasms, Hormone-Dependent/metabolism , Neoplasms, Hormone-Dependent/pathology , Prostatic Neoplasms/pathology , Tumor Cells, Cultured , Vitamin D/pharmacology
20.
Gen Comp Endocrinol ; 141(1): 58-65, 2005 Mar.
Article in English | MEDLINE | ID: mdl-15707603

ABSTRACT

The effects of GH on various types of behaviour in fish are well documented although the underlying mechanisms are not fully understood. In rainbow trout, an involvement of the brain dopaminergic system in mediating the behavioural effects of GH has been indicated, as GH can alter the brain dopaminergic activity. To further examine the role of the dopaminergic system in the mediation of GH effects on locomotion and foraging, GH- and sham-implanted juvenile rainbow trout were injected with the selective D1 dopamine antagonist SCH23390 or vehicle. Swimming and feeding activity was then studied by direct observation. Brains were thereafter sampled and analysed for the content of serotonin, dopamine and their metabolites in the hypothalamus, optic tectum, cerebellum, telencephalon, and brain stem. GH increased swimming activity as well as feed intake, effects which were abolished by SCH23390. By itself, the antagonist did not affect behaviour, nor did it affect the brain monoamines. In contrast, treatment with GH, with or without SCH23390, decreased the content of the dopamine metabolite homovanillic acid (HVA) in the optic tectum and the cerebellum, as well as the serotonin content (5-HT) in the optic tectum. It is concluded that the D1 dopamine receptor of the dopaminergic system appears to be of importance in the mediation of the effects of GH on behaviour.


Subject(s)
Benzazepines/pharmacology , Feeding Behavior/physiology , Growth Hormone/pharmacology , Oncorhynchus mykiss/physiology , Swimming/physiology , Animals , Brain/physiology , Receptors, Dopamine D1/antagonists & inhibitors
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