Evidence-based medicine, randomized controlled trials, publication bias, patient population, follow-up and access.
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Antidepressive Agents↗
Biomedical subjects
Lars von Knorring
Publications and source records attributed to Lars von Knorring.
Child and adolescent psychiatric disorders predicting adult personality disorder: a follow-up study.
The objective of this study was to examine associations between childhood and adolescent psychiatric disorders and adult personality disorders in a group of former child psychiatric inpatients. One hundred and fifty-eight former inpatients with a mean age of 30.5 +/- 7.1 years at investigation had their childhood and adolescent Axis I disorders, obtained from their medical records, coded into DSM-IV diagnoses. Personality disorders in adulthood were assessed by means of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q). The predictive effects of child and adolescent Axis I disorders on adult personality disorders were examined with logistic regression analyses. The odds of adult schizoid, avoidant, dependent,borderline and schizotypal personality disorders increased by almost 10, five, four, three and three times, respectively, given a prior major depressive disorder. Those effects were independent of age, sex and other Axis I disorders. In addition, the odds of adult narcissistic and antisocial personality disorders increased by more than six and five times, respectively, given a prior disruptive disorder, and the odds of adult borderline, schizotypal, avoidant and paranoid personality disorders increased between two and three times given a prior sub-stance-related disorder. The results illustrate an association between mental disorders in childhood and adolescence and adult personality disorders. Identification and successful treatment of childhood psychiatric disorders may help to reduce the risk for subsequent development of an adult personality disorder.
Adolescent↗
Neurofunctional correlates of posttraumatic stress disorder: a PET symptom provocation study.
SUMMARY: Patients with combat-related posttraumatic stress disorder (PTSD) show altered cognitive and affective processing and symptomatic responding following exposure to trauma reminders. Previous symptom provocation studies using brain imaging have involved Vietnam veterans. In this study neural correlates were investigated in patients with PTSD resulting from trauma in more recent war zones. (15)Oxygen water and positron emission tomography were used to measure regional cerebral blood flow (rCBF) in patients with war- and combat-related chronic PTSD during exposure to combat and neutral sounds. Self-reports and heart rate confirmed symptomatic responding during traumatic stimulation. The war-related condition, as compared to the neutral, increased rCBF in the right sensorimotor areas (Brodmann areas 4/6), extending into the primary sensory cortex (areas 1/2/3), and the cerebellar vermis. RCBF also increased in the right amygdala and in the periaqueductal gray matter adjacent to the pons. During provocation rCBF was lowered in the right retrosplenial cortex (areas 26/29/30 extending into area 23). Symptom provocation in PTSD promote sensorimotor, amygdaloid and midbrain activation. We conclude that perceptually induced symptom activation in PTSD is associated with an emotionally determined motor preparation and propose that subcortically initiated rather than cortically controlled memory mechanisms determine this pattern.
Adult↗
Personality disorders in former child psychiatric patients.
The present case-control study was undertaken in order to investigate the long-term outcome with respect to personality disorder (PD) symptomatology in former child psychiatric in-patients as compared to matched controls from the general population. Altogether 359 former patients and 359 controls were invited to participate in the study. Of these, 164 (46 %) former patients and 193 (54 %) controls approved participation. From these, 137 age and sex-matched pairs with a mean age of 30.7 (SD = 6.8) years were constructed. Adult PD symptomatology was assessed by means of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q). There were 52 former patients (38 %) and 15 controls (10.9 %) who fulfilled criteria for at least one DSM-IV self-reported PD. There was a significantly higher prevalence for all specific self-reported PDs in former patients compared to controls. The mean number of disorders was 1.7 (SD = 2.6) in former patients and 0.3 (SD = 0.8) in controls. Moreover, former patients fulfilled more PD criteria than controls (23 vs. 11; median numbers). The former patients had significantly lower global functioning and more psychosocial problems than the controls. These problems were related to personality pathology. The results of this study indicate that child psychiatric morbidity seems to increase the risk for adult PD symptomatology. However, the results may be biased by the low participation rate.
Adolescent↗
Mental and personality disorders as well as personality traits in a Swedish male criminal population.
The study describes personality traits and the presence of personality disorders and mental disorders in a consecutive series of 130 male prisoners in Swedish jails sentenced for serious criminality. The investigation included a psychiatric examination by means of the Structured Clinical Interview (SCID) as well as information taken from criminal records. Personality assessments were made by means of self-report questionnaires, the Karolinska Scales of Personality (KSP) and the DSM-IV and ICD-10 Personality Disorder Questionnaire (DIP-Q). The most common mental disorders were alcohol and drug abuse/dependence, which were present in 55% of the subjects. Personality disorders, too, were common, being present in 56% of the subjects. In the KSP, high scores were found in scales related to impulsiveness, sensation-seeking, nervous tension and distress, cognitive-social anxiety, hostility and aggression. Very low scores were found in the Socialization scale, reflecting a high degree of psychopathy-related personality traits. Despite the high morbidity, the global level of functioning was unexpectedly high, 66 according to GAF. The male prisoners sentenced for heavy criminality had a high degree of both mental disorders and personality disorders. Furthermore, psychopathy-related personality traits were common.
Adult↗
Psychiatry within Nordic countries.
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Finland↗
Pain perception and endorphin levels in cerebrospinal fluid.
In 45 consecutive patients with chronic pain syndromes endorphins, fraction I of the cerebrospinal fluid and pain measures by means of electric stimulation via saline electrodes were investigated. In patients with high levels of fraction I (above median) pain threshold, PT and tolerance level, TL, in condition C (continuous stimulation increase) were found to be significantly higher than in patients with low levels of fraction I (below median). The results indicate that the endorphins are one of the physiological factors that contribute to the pain threshold and the tolerance level.
Adult↗