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Biomedical subjects

L von Knorring

Publications and source records attributed to L von Knorring.

At least 19 recordsLinked to original sources
PubMed1995

Principal components and further possibilities with the PANSS.

At the end of the last century, Hughlings-Jackson suggested that positive and negative syndromes should be kept apart in psychotic disorders. When the concepts of dementia praecox and schizophrenia were introduced by Kraepelin and Bleuler, emphasis was laid on the negative symptoms, regarded as fundamental. After the introduction of the "first rank symptoms" by Schneider emphasis switched to the positive symptoms in schizophrenia and these symptoms were included in most diagnostic criteria. In the 1980s Andreasen and Crow suggested a dichotomy into positive and negative syndromes in schizophrenia. Kay and co-workers introduced a Positive And Negative Syndrome Scale (PANSS) for schizophrenia. In the original studies satisfactory construct validity and inter-rater reliability were demonstrated. However, in studies outside the USA a high construct validity was found for the negative scales but not for the positive and general psychopathology scales. Furthermore, the inter-rater reliability of the negative scale was a problem. After introduction of the Structured Clinical Interview for the PANSS (SCI-PANSS) the inter-rater reliability increased for all three scales. In an early study Kay and Sevy found seven factors in a principal component analysis of the PANSS and suggested a four factor pyramidical model. Later principal component analyses by Lepine, Peralta et al. and Kawasaki et al. suggested that the four factor model was an oversimplification and Lindström and von Knorring suggested a five factor pyramidical model. A similar model was later suggested by Bell et al. after a reanalysis of the original series of Kay and Sevy.(ABSTRACT TRUNCATED AT 250 WORDS)

Affective Symptoms↗
PubMed1995

Prescription drug and healthcare use among Swedish patients treated with antidepressants.

OBJECTIVE: To analyze healthcare and prescription drug use among patients taking and those not taking antidepressant drugs in a Swedish community. DESIGN: Cross-sectional study. SETTING: General population of the rural Swedish municipality Tierp of approximately 20,000 inhabitants. PARTICIPANTS: All residents of Tierp aged 25 years or older during 1988. MAIN OUTCOME MEASURES: Mean number of ambulatory care visits, hospital bed days, and prescriptions per person; proportion of those taking prescription drugs in different pharmacologic classes. RESULTS: Patients treated with antidepressant drugs had a significantly (p < 0.05) greater use of ambulatory care, hospital care, and prescription drugs than those who did not take antidepressants in the study population. They also had an increased frequency of use of prescription drugs from virtually all pharmacologic classes. Furthermore, the risk for polypharmacy was high in patients treated with antidepressant medications. CONCLUSIONS: Those who took antidepressant drugs consumed more health services and prescription drugs than did those not taking an antidepressant. Patients receiving antidepressant treatment may be at serious risk for iatrogenic disease and should be evaluated carefully with respect to concomitant drug use.

Adult↗
PubMed1994

Idiopathic pain and depression.

This report summarizes research on the hypothesis that idiopathic chronic pain syndromes and depressive disorders share certain common pathogenetic mechanisms. There is increasing evidence that this may be partly true. Not only do chronic pain syndromes respond to treatment with antidepressants, but there are also striking clinical similarities between these syndromes and depressive syndromes. However, important differences do exist (e.g., the courses of these disorders are usually dissimilar). Family studies show that affective disorders are common in first-degree relatives of patients with idiopathic pain syndromes, but it is impossible to conclude from this that clear-cut genetic factors are of importance. Factors common to both syndromes include common personality traits, shortened rapid eye movements in sleep EEG, hypercortisolaemia and pathological dexamethasone suppression tests, low levels of melatonin in serum and urine and high levels of endorphins and Fraction I in cerebro-spinal fluid. One important common pathogenetic mechanism seems to be disturbances in the serotoninergic system.

Chronic Disease↗
PubMed1994

Changes in single symptoms and separate factors of the schizophrenic syndrome after treatment with risperidone or haloperidol.

Risperidone, a rather selective blocker of D-2 and 5-HT-2 receptors, was, in the doses 1 mg, 4 mg, 8 mg, 12 mg and 16 mg a day, compared to the rather selective D-2 blocker haloperidol in the dose of 10 mg a day, in 88 chronic schizophrenic patients. After one week placebo wash-out, the patients were randomly assigned to one of the six treatment groups and the study was performed as a double blind parallel-group study for 8 weeks. In the present analysis, a special emphasis has been laid on the effects on single symptoms and separate factors in the schizophrenic syndrome. Overall, risperidone in a dose of 4 mg a day was comparable to haloperidol in a dose of 10 mg a day. Risperidone was found to have a curvilinear dose-response curve with an optimum effect of 4 mg day on the negative, anxious/depressive and cognitive factors and with an optimum effect of 8 mg day on the positive and excited factors. While haloperidol had significant effects on the negative and anxious/depressive factors, risperidone had significant effects on all five factors - the positive, the negative, the excited, the anxious/depressive and the cognitive. The fact that the novel drug had significant effects on the cognitive factor might be of great importance as concerns the possibilities for rehabilitation of chronic schizophrenic patients.

Double-Blind Method↗
PubMed1994

Symptoms in schizophrenic syndromes in relation to age, sex, duration of illness and number of previous hospitalizations.

In studies by means of the Swedish version of the Positive and Negative Syndrome Scale, we have demonstrated a 5-factor model of schizophrenia, including positive, negative, excited, anxious/depressive and cognitive factors. In this study, the 5 factors were correlated with background factors in a series comprising 140 patients with schizophrenic syndromes. None of the 5 factors revealed any significant age or sex differences. The positive factor correlated positively with the number of previous hospitalizations and the negative factor correlated negatively. The excited factor correlated negatively with age at onset, age at first hospitalization and positively with the duration of the illness and the number of previous hospitalizations. The cognitive factor correlated negatively with age at onset and age at first hospitalization and positively with the duration of the illness. Age at onset was positively correlated with delusions, excitement, unusual thought content and poor impulse control and negatively with lack of spontaneity. The duration of illness correlated positively with excitement, difficulty in abstract thinking and mannerisms. The number of previous hospitalizations correlated positively with delusions, excitement, unusual thought content and poor impulse control and significant negative correlations were demonstrated as concerns blunted affect and lack of spontaneity.

Adult↗
PubMed1994

SCID II interviews and the SCID Screen questionnaire as diagnostic tools for personality disorders in DSM-III-R.

A modified version of the SCID Screen questionnaire covering 103 criteria by means of 124 questions was compared with SCID II interviews in 69 psychiatric patients. The correlation between the number of criteria fulfilled in the SCID II interviews or the questionnaires was 0.84. In the SCID interviews, 54% of the patients had a personality disorder. When the SCID Screen questionnaire was used, 73% had a personality disorder. When the cut-off level for diagnosis was adjusted, the frequency found by means of the SCID screen questionnaire or the interviews was roughly the same, 58% and 54%, respectively. The overall kappa for agreement between the SCID II interviews and questionnaire with adjusted cut-off was 0.78.

Adult↗
PubMed1994

Axis V--Global Assessment of Functioning Scale. Evaluation of a self-report version.

The present study examines a self-report version of the Global Assessment of Functioning Scale according to Axis V (GAF self-report). The sample (n = 73) was a psychiatric outpatient population from a catchment area clinic. Patients with psychotic and organic mental disorders were not included. The diagnostic distribution on Axis I was similar to the findings from previous studies. Axis II disorders were identified among 47%, of whom a majority also had a concomitant Axis I disorder. The mean GAF expert score was 66.5 (range: 48-86). High complexity and severity of disorders and a high number of fulfilled Axis II criteria were significantly associated with low GAF scores. Independent expert ratings on GAF were correlated with the GAF self-report overall at r = 0.62, varying from 0.45 to 0.91 between different diagnostic groups. In general, the patients scored themselves lower (mean: -4.4 units) than expert ratings. Patients with depressive symptoms from an adjustment disorder or mood disorder were most prone to underestimation. Women also tended to score themselves lower than experts did. Conclusively, the GAF self-report turned out to be a valid and reliable unidimensional instrument measuring psychological, social and occupational functioning. The GAF is easy to handle, and with a self-report version as a complement, Axis V could be more frequently used in future clinical practice and research.

Activities of Daily Living↗
PubMed1994

Interrater reliability of the Structured Clinical Interview for the Positive and Negative Syndrome Scale for schizophrenia.

The Swedish version of the Positive and Negative Syndrome Scale for schizophrenia (PANSS) has been tested and construct validity, internal reliability and interrater reliability have been demonstrated to be quite satisfactory. However, the interrater reliability of the negative symptoms was unsatisfactory low. In this study, the Swedish version of the Structured Clinical Interview for the PANSS has been tested. The interrater reliability is increased as compared with the inter-rater reliability achieved by means of the PANSS. As concerns the positive scale, the intraclass coefficients increased to 0.98-0.99 with the SCID-PANSS. For the negative scale, the intraclass coefficients increased to 0.83-0.90 with the SCID-PANSS, and for the general scale the increase was to 0.95-0.98 with the SCID-PANSS. It was also demonstrated that the interrater reliability is higher for the positive and the negative factors derived from the PANSS than for the positive and the negative scales.

Anxiety Disorders↗
PubMed1993

Personality disorders in DSM-III-R as categorical or dimensional.

Despite the atheoretical approach of the DSM-III-R, the personality disorders have their roots in specific theoretical schools. Due to clinical tradition, analogies with Axis I and the tradition in psychiatry and medicine, the personality disorders are presented as categories although there is more empirical support for a dimensional approach. This study attempted to determine whether the separate personality disorders meet Kendell's criteria for distinct entities, i.e., bimodality with distinct points of rarity. None of the personality disorders met the criteria for a distinct disease entity. Instead, all of the personality disorders presented as continuous, dimensional personality traits present among healthy subjects and more pronounced in patients with mental disorders.

Adult↗
PubMed1992

Long-term effects of an educational program for general practitioners given by the Swedish Committee for the Prevention and Treatment of Depression.

In 1983-1984 the Swedish Committee for the Prevention and Treatment of Depression offered an educational program on diagnosis and treatment of depressive disorders to all general practitioners on the island of Gotland. The program has been carefully evaluated; 1982 was used as the baseline and the main evaluation was carried out in 1985. After the educational programs, the frequency of sick leave for depressive disorders decreased, the frequency of inpatient care for depressive disorders decreased to 30% of that at the baseline; the prescription of antidepressants increased, but prescription of major tranquilizers, sedatives and hypnotics decreased. The frequency of suicide on the island decreased significantly. This study describes the long-term effects. In 1988, 3 years after the project ended, the inpatient care for depressive disorders increased, the suicidal rate returned almost to baseline values and the prescription of antidepressants stabilized. Thus, the effects were strictly related in time to the educational programs, indicating that the effects were real and not only a coincidence with local trends on Gotland. Furthermore, the results indicate that educational programs that can have pronounced effects on the health care system have to be repeated approximately every 2 years if long-term effects are to be expected.

Cross-Sectional Studies↗
PubMed1992

Cost-benefit analysis of an educational program for general practitioners by the Swedish Committee for the Prevention and Treatment of Depression.

In 1983-1984 the Swedish Committee for the Prevention and Treatment of Depression launched an educational program on the diagnosis and treatment of depressive disorders for all general practitioners on the island of Gotland. The baseline year chosen was 1982 and the immediate effects were evaluated in 1985. In 1988 the long-term effects were evaluated. These two evaluations indicated strictly time-related beneficial effects on the frequency of sick leave and inpatient care for depressive disorders, the pattern of prescription of psychopharmacologic drugs and the frequency of suicide. This article describes a cost-benefit analysis of the program. The cost of the educational program, changes in drug prescription and inpatient care were calculated as well as indirect costs concerning changes in morbidity and mortality. The calculation of the savings to society was subject to a sensitivity analysis. This shows that the educational program resulted in savings to society on the order of about SEK 155 million (USD 26 million). It is concluded that educational programs of this kind should be repeated every second to third year.

Absenteeism↗
PubMed1992

The Nordic concept of reactive psychosis--a multicenter reliability study.

Reactive psychosis is a common diagnosis in the Nordic countries (Norway, Sweden, Denmark, Finland and Iceland) and in several other parts of the world. In ICD-9 and DSM-III-R, the concept is defined more narrowly than in the Nordic tradition. In this study we examined the interrater reliability of the Nordic concept by the case-summary method between clinicians from 9 university departments in the Nordic countries. The results show that Nordic psychiatrists have a reasonably reliable concept of reactive psychosis, and that this psychosis can be diagnosed as reliably as schizophrenia and affective psychosis.

Affective Disorders, Psychotic↗
PubMed1992

The Swedish version of the Positive and Negative Syndrome Scale (PANSS) for schizophrenia. Construct validity and interrater reliability.

The Positive and Negative Syndrome Scale (PANSS) has been translated into Swedish and tested in 88 chronic schizophrenic patients. All 4 subscales exhibited a roughly normal distribution. The overall alpha for the positive, negative and general psychopathology subscales were 0.81, 0.58 and 0.63, respectively. The correlation between the positive and negative subscales was -0.17 (NS). The interrater reliability was 0.73-0.75 for the positive, 0.65-0.74 for the negative and 0.75-0.77 for the general psychopathology subscales. The intraclass coefficients were 0.75-0.77 for the positive, 0.27-0.46 for the negative, 0.56-0.72 for the general psychopathology subscales and 0.66-0.71 for the total scale. Thus, the validity and reliability of the PANSS (Swedish version) are quite satisfactory.

Antipsychotic Agents↗