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Biomedical subjects

J Cullberg

Publications and source records attributed to J Cullberg.

At least 19 recordsLinked to original sources
PubMed2006

Neuropsychological functions predict 1- and 3-year outcome in first-episode psychosis.

OBJECTIVE: To examine neuropsychological performance as a possible predictor of course and outcome in first-episode psychotic (FEP) patients. METHOD: A group of consecutive FEP patients (n = 120) tested with Wechsler Adult Intelligence Scales-Revised (WAIS-R) at baseline was compared with a healthy group (n = 30) matched for age, education and gender. Relationship between WAIS-R and both Brief Psychiatric Rating Scale and Global Assessment of Function (GAF) ratings were studied at baseline and at 1- and 3-year follow-ups. RESULTS: The performance of FEP patients was significantly lower (P < 0.001) than that of healthy comparison subjects on all WAIS-R subtests except for Information and Comprehension. The WAIS-R scores of patients with schizophrenia syndromes (DSM-IV) were lower than those of patients with non-schizophrenia syndromes on Block Design. Low WAIS-R Full-Scale IQ scores in FEP patients predicted the presence of negative symptoms at 1-year follow-up and of low GAF ratings at 3-year follow-up. CONCLUSION: Neurocognitive performance at admission appears to predict various aspects of functional outcome in FEP.

Adolescent↗
PubMed2006

Treatment costs and clinical outcome for first episode schizophrenia patients: a 3-year follow-up of the Swedish "Parachute Project" and two comparison groups.

OBJECTIVE: To evaluate "need-specific treatment" of first episode schizophrenia syndrome patients. METHOD: Sixty-one consecutive first episode schizophrenia syndrome patients were followed over 3 years. They were compared with a Historical "treatment as usual" group (n = 41) and a Prospective group from a high quality social and biological psychiatry centre (n = 25). RESULTS: Symptomatic and functional outcome was significantly better compared with the Historical group and equal with the Prospective group. During the first year, the direct costs for in- and out-patient care per patient in the Parachute project were less than half of those in the Prospective group. CONCLUSION: The study confirms the feasibility, clinically and economically, with a large scale application of "need-specific treatments" for first episode psychotic patients.

Adult↗
PubMed2005

Background factors as determinants of satisfaction with care among first-episode psychosis patients.

OBJECTIVE: To evaluate the impact of demographic and psychosocial background factors and psychiatric and functional status before and at admission on the patients' satisfaction with care (PSC) among first-episode psychosis (FEP) patients. METHOD: One year after entering the Parachute Project, 134 FEP patients completed a patient satisfaction questionnaire. The association with demographic and psychosocial background factors, together with psychiatric and functional status before and after admission, was analysed. RESULTS: Twenty-nine per cent of the variance of PSC was explained by factors such as educational level, social network, duration of untreated psychosis (DUP) and Global Assessment of Functioning (GAF) the year prior to onset. Negative symptoms and lack of hope at admission were also predictors of PSC. The strongest predictor was DUP. CONCLUSION: Affecting the public knowledge in psychiatric problems and psychiatric treatment, together with early intervention strategies aiming to decrease the prodromal and DUP period among FEP patients, can positively influence the patients' experience of given care. By increasing the knowledge of available psychiatric treatment, the sense of powerlessness might decrease among the affected persons, and the possibility of early help seeking might increase.

Adult↗
PubMed2002

Young cases of schizophrenia identified in a national inpatient register--are the diagnoses valid?

BACKGROUND: Psychiatric inpatient registers are often used in research in the Nordic countries. We aimed to investigate the validity of recorded diagnoses of schizophrenia in the Swedish National Inpatient Register, in cases of early age at onset. We also wanted to describe the accuracy of the diagnoses in cities/university clinics and country hospitals as well as in child and adolescent psychiatric clinics and clinics for adults. METHOD: One hundred cases with a diagnosis of schizophrenia, born 1973-1977, were randomly selected. The psychiatric records were scrutinised according to the criteria of DSM-IV. RESULTS: Eighty-six per cent (95 % CI 78-93 %) fulfilled the DSM-IV criteria of schizophrenia syndrome and 76 % (95 % CI 66-86 %) fulfilled the "narrow" definition. There were no large differences in the accuracy of the diagnoses between regions or clinics. CONCLUSION: The proportion of "true" cases of schizophrenia is high in the Swedish National Inpatient Register. In addition, the results did not support large differences between clinics or regions although a larger sample size would be needed to test this formally. In comparison with earlier studies from the Nordic countries the validity seems to be quite stable over time, between different ages at onset and between Nordic countries. Thus, the registers are well suited to be used in schizophrenia research.

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

First-episode non-affective psychosis in a total urban population: a 5-year follow-up.

BACKGROUND: The aim of this study is to investigate incidence rates, treatment, and outcome of a total in- and outpatient population of 71 patients (of 18-45 years of age) treated for a first-episode psychosis (DSM-IV) in three catchment areas in Stockholm. METHODS: The study is based on the investigation of records and databases and on information by staff members and patients. RESULTS: The incidence rate was 34.8 per 100,000 inhabitants (aged 18-45 years) and 16.5 per 100,000 inhabitants (total population). Sixty percent were diagnosed with schizophrenia syndromes. At 5-year follow-up, 73 % of the patients in the schizophrenia syndromes group versus 47% of the non-schizophrenia group had a sick pension or were on long-term sick leave. Nine percent of the schizophrenia patients and 39% of the non-schizophrenia psychosis patients were rated as not being in need of treatment. Non-compliance of medication was present in one-third of those patients prescribed neuroleptic medication. Seven percent had never received neuroleptic medication, all of whom were rated as ill at the 5-year follow-up. CONCLUSIONS: Incidence of treated first-episode psychosis is higher than has earlier been found, when exclusively outpatient treated individuals are also included. The social outcome is negative, even in the non-schizophrenia group. Non-compliance with medication and insufficient clinical follow-up may have worsened the results.

Adolescent↗
PubMed1999

Obstetric complications and the risk of schizophrenia: a longitudinal study of a national birth cohort.

BACKGROUND: Numerous epidemiological studies found an increased risk of schizophrenia among persons exposed to various obstetric complications. The underlying mechanisms are unknown. OBJECTIVE: To study specific risk factors, as well as sets of risk factors, representing 3 different etiologic mechanisms: (1) malnutrition during fetal life; (2) extreme prematurity; and (3) hypoxia or ischemia. METHODS: In this longitudinal cohort study, information in the National Birth Register was linked to the National Inpatient Register. We followed up 507516 children born between 1973 and 1977 with regard to a diagnosis of schizophrenia between 1987 and 1995 (238 cases). By record linkage, we also had access to data on psychiatric illness in the mother. Occurrence of schizophrenia was measured by the Mantel-Haenszel test and logistic regression. RESULTS: A number of specific risk factors were associated with an increased risk of schizophrenia. The relative risk (95% confidence interval) for preeclampsia was 2.5 (1.4-4.5); vacuum extraction, 1.7 (1.1-2.6); and malformations, 2.4 (1.2-5.1). In logistic regression models, we found that indicators of all 3 etiologic mechanisms were associated with increased point estimates of schizophrenia, although at lower risk levels. Preeclampsia, an indicator of fetal malnutrition, was the only risk factor with statistically significant increased risk after control for all potentially confounding factors. CONCLUSION: This study supports the theory of an association between obstetric complications and schizophrenia. Although preeclampsia was the strongest individual risk factor, there was evidence of increased risk associated with all 3 etiologic mechanisms.

Adult↗
PubMed1999

Neonatal hyperbilirubinaemia--a vulnerability factor for mental disorder?

OBJECTIVE: Various studies have shown an association between obstetric complications and psychiatric illness. There is a lack of specific aetiological explanations. A possible mechanism contributing to cerebral vulnerability is neonatal hyperbilirubinaemia (NHB). METHOD: A total of 509 children with NHB (bilirubin > 15 mg %) were compared with the same number of controls (matched for gender, place of residence, and date and place of birth) with respect to in-patient psychiatric care during 1971-1993. RESULTS: A significantly greater number of individuals in the NHB group received in-patient psychiatric care than in the control group (OR, 2.5; 95% CI, 1.1-5.5). After exclusion of infants with associated obstetric risk factors, the significantly increased risk for in-patient psychiatric care still remained among the children with NHB (OR, 13.4; 95% CI, 1.6-110.1). CONCLUSION: NHB could be a factor underlying subsequent development of mental ill-health, but larger samples are needed to obtain a more reliable assessment.

Adult↗
PubMed1999

Integrating intensive psychosocial therapy and low dose medical treatment in a total material of first episode psychotic patients compared to "treatment as usual" a 3 year follow-up.

UNLABELLED: Every first episode functional psychosis patient (DSM-IV), age 18-45, with no dominating abuse, and living in an inner city area of 95,000 inhabitants have been treated as far as possible in accordance with the concept of "need adapted treatment" as formulated by Alanen et al 1991. Today about 70 patients have been treated and followed up with different clinical, psychological, and medical methods. The project group to be considered here consists of the first 32 patients, followed up during approximately 3 years. A retrospective comparison group was collected from the same area and from 2 more areas, with the same inclusion criteria. Their first psychotic episode was actualized 1-2 years before the project group was started and 72 cases were collected via records, personal questioning and databases. The outcome regarding in patient care and neuroleptic consumption, work and sickness data could be assessed for this group. RESULTS: In the project group 7/18 patients with schizophrenia diagnoses were free of positive or negative symptoms at follow up. In the non-schizophrenia psychosis group 11/14 had no psychotic symptoms. The mean in patient care consumption was considerably lower than that of the comparison group. 45% of the patients in the project group were on a neuroleptic prescription at the 3-year follow up vs. 71% of the comparison group. For those on a neuroleptic prescription the mean dosage at follow-up was 62 mgm chlorpromazine-eqv/day, vs. 192 mgm for comparison group. All the differences are significant. One conclusion to be made is that, provided a psychosocial support, neuroleptic consumption and in patient care can be considerably lowered with no detrimental effects. This is a pilot study lying behind the so-called "Parachute project", a Swedish multicenter study, which aims at deepening and broadening the clinical and methodological issues for the care of first episode psychosis patients.

Adolescent↗