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Helldin, Lars
Publications (10 of 11) Show all publications
Helldin, L., Mohn, C., Olsson, A.-K. & Hjärthag, F. (2020). Neurocognitive variability in schizophrenia spectrum disorders: relationship to real-world functioning. Scandinavian International Conference on Fluid Power (SICFP), 20, Article ID 100172.
Open this publication in new window or tab >>Neurocognitive variability in schizophrenia spectrum disorders: relationship to real-world functioning
2020 (English)In: Scandinavian International Conference on Fluid Power (SICFP), ISSN 1879-9027, E-ISSN 2215-0013, Vol. 20, article id 100172Article in journal (Refereed) Published
Abstract [en]

Neurocognitive variability exists within the schizophrenia spectrum disorder (SSD) population, with subgroups performing at the same level as healthy samples Here we study the relationship between different levels of neurocognitive responding and real-world functioning. The participants were 291 SSD patients and 302 healthy controls that were assessed with a comprehensive neurocognitive battery. In addition, the patients were assessed with the Specific Level of Functioning Scale (SLOF). The results showed that the mean neurocognitive test responses of the SSD group were significantly below that of the control group. However, there was considerable overlap between the cognitive scores of the two groups, with as many as 24% of the patients performing above the mean healthy score for some domains. Moreover, the patients with the highest level of neurocognitive functioning reached the highest levels of practical and work-related functioning outcome skills. There was no significant relationship between neurocognitive and social function skills. The large differences in cognitive performance and their associations with functional outcome within the patient group are rarely addressed in clinical practice, but indicate a clear need for individualized treatment of SSD. Early identification of cognitive risk factors for poor real-life functional outcome is necessary in order to alert the clinical and rehabilitation services about patients in need of extra care.

Keywords
Functional outcome, Neurocognition, Psychosis, Real-world functioning, Schizophrenia, adult, Article, clinical practice, cognition, cognition assessment, cognitive defect, cognitive function test, continuous performance test, controlled study, disease severity, DSM-IV, education, emotionality, executive function, female, Global Assessment of Functioning, human, intelligence quotient, Letter Number Span test, major clinical study, male, mental disease assessment, mental health service, neuropsychological test, physical activity, priority journal, questionnaire, Rey auditory verbal learning test, risk factor, schizophrenia spectrum disorder, scoring system, social status, Specific Level of Functioning Scale, task performance, test retest reliability, trail making test, Wechsler adult intelligence scale, Wisconsin Card Sorting Test, working memory
National Category
Psychiatry
Identifiers
urn:nbn:se:kau:diva-77586 (URN)10.1016/j.scog.2020.100172 (DOI)2-s2.0-85079287095 (Scopus ID)
Available from: 2020-04-24 Created: 2020-04-24 Last updated: 2020-05-11Bibliographically approved
Olsson, A.-K., Hjärthag, F. & Helldin, L. (2019). Overestimated function in patients with schizophrenia: A possible risk factor for inadequate support?. Schizophrenia Research, 206, 194-199
Open this publication in new window or tab >>Overestimated function in patients with schizophrenia: A possible risk factor for inadequate support?
2019 (English)In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 206, p. 194-199Article in journal (Refereed) Published
Abstract [en]

People with schizophrenia often demonstrate an impaired ability to assess and report aspects of their everyday functioning, and the aim of this study is to investigate how patients' self-rating ability regarding functional performance relates to neurocognitive performance and real-world functional performance. A total of 222 outpatients with a schizophrenia spectrum disorder participated in this study. They were divided into groups based on their self-rating ability (determined using self-rating questions) and their observed functional capacity (the UCSD Performance-Based Skills Assessment-Brief, UPSA-B). The results showed that patients with impaired functional capacity perform at a similar cognitive level, regardless of their self-rating ability. When comparing patients with unimpaired function to those with impaired function, we found differences in two cognitive domains; premorbid functioning and executive functioning. The results also reveal that clinicians seem to have greater difficulty assessing patients who over-estimate their functioning. Consequently, when clinicians assessed the patients with the Specific Levels of Functioning Scale (SLOF) no significant differences were found between the group with unimpaired function and the group of overestimators. Patients who overestimate their functioning risk receiving inadequate treatment and support.

Place, publisher, year, edition, pages
Elsevier, 2019
Keywords
Functional capacity, Introspective accuracy, Neurocognition, Real-world functional outcomes, Schizophrenia, Self-awareness
National Category
Psychology Psychiatry
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-70680 (URN)10.1016/j.schres.2018.11.027 (DOI)000467810100028 ()30514644 (PubMedID)
Available from: 2019-01-08 Created: 2019-01-08 Last updated: 2019-09-12Bibliographically approved
Johansson, M., Olsson, A.-K., Iris, v.-H. D. & Helldin, L. (2019). Overestimating Functioning and Long-term Symptomatic Remission Pattern - How Is It Associated?. Paper presented at Congress of the Schizophrenia-International-Research-Society (SRIS), APR 10-14, 2019, Orlando, FL. Schizophrenia Bulletin, 45, S300-S300
Open this publication in new window or tab >>Overestimating Functioning and Long-term Symptomatic Remission Pattern - How Is It Associated?
2019 (English)In: Schizophrenia Bulletin, ISSN 0586-7614, E-ISSN 1745-1701, Vol. 45, p. S300-S300Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2019
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-72117 (URN)10.1093/schbul/sbz018.534 (DOI)000466725400501 ()
Conference
Congress of the Schizophrenia-International-Research-Society (SRIS), APR 10-14, 2019, Orlando, FL
Available from: 2019-05-23 Created: 2019-05-23 Last updated: 2020-01-07Bibliographically approved
Olsson-Tall, M., Hjärthag, F., Marklund, B., Kylén, S., Carlström, E. & Helldin, L. (2019). The Impact of Repeated Assessments by Patients and Professionals: A 4-Year Follow-Up of a Population With Schizophrenia. Journal of the American Psychiatric Nurses Association, 25(3), 189-199
Open this publication in new window or tab >>The Impact of Repeated Assessments by Patients and Professionals: A 4-Year Follow-Up of a Population With Schizophrenia
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2019 (English)In: Journal of the American Psychiatric Nurses Association, ISSN 1078-3903, E-ISSN 1532-5725, Vol. 25, no 3, p. 189-199Article in journal (Refereed) Published
Abstract [en]

The needs of people with schizophrenia are great, and having extensive knowledge of this patient group is crucial for providing the right support. The aim of this study was to investigate, over 4 years, the importance of repeated assessments by patients with schizophrenia and by professionals. Data were collected from evidence-based assessment scales, interviews, and visual self-assessment scales. The data processing used descriptive statistics, correlation and regression analyses. The results showed that the relationships between several of the patients’ self-rating assessments were stronger at the 4-year follow-up than at baseline. In parallel, the concordance rate between patient assessments and case manager assessments increased. The conclusions drawn are that through repeated assessments the patients’ ability to assess their own situation improved over time and that case managers became better at understanding their patients’ situation. This, in turn, provides a safer basis for assessments and further treatment interventions, which may lead to more patients achieving remission, which can lead to less risk for hospitalization and too early death.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
case manager, patient, remission, repeated assessment, schizophrenia
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-68064 (URN)10.1177/1078390318777785 (DOI)000469395200006 ()2-s2.0-85048037656 (Scopus ID)
Available from: 2018-06-26 Created: 2018-06-26 Last updated: 2019-06-13Bibliographically approved
Moradi, H., Harvey, P. D. & Helldin, L. (2018). Correlates of risk factors for reduced life expectancy in schizophrenia: Is it possible to develop a predictor profile?. Schizophrenia Research, 201, 388-392
Open this publication in new window or tab >>Correlates of risk factors for reduced life expectancy in schizophrenia: Is it possible to develop a predictor profile?
2018 (English)In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 201, p. 388-392Article in journal (Refereed) Published
Abstract [en]

Patients with schizophrenia have significantly greater mortality rates than the general population, with an estimated reduced lifespan of 10–20 years. We previously reported on a link between impairment in cognition and premature death in a prospective 20-year study. Patients who had died prematurely showed neurocognitive impairment in nine different cognitive tests compared to those who did not. Based on those findings, in this study the surviving patients in the cohort were divided into three different groups based on neurocognitive impairment and compared on symptom severity including remission status, RAND-36, weight and BMI at onset of illness and baseline of the study, and medical/physical symptomatology (i.e., blood pressure, symptom awareness, vertigo and orthostatic symptoms). Differences were most prominent between the cognitively unimpaired and severely cognitively impaired (SCI) groups, with remission, negative symptoms, general symptoms and PANSS total scores differing. For SF-36 (RAND) Physical functioning and Role limitations due to physical health subscales the SCI were worst. The findings indicate that greater impairments in cognitive ability during the illness are associated with several potential indicators of risk for early mortality. Together these factors may be of guidance for establishing an algorithm to detect patients at risk of premature death early in their illness.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Early detection of risk factors, Premature death, Schizophrenia
National Category
Psychiatry Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-67663 (URN)10.1016/j.schres.2018.05.035 (DOI)000450604800057 ()2-s2.0-85047622004 (Scopus ID)
Available from: 2018-06-14 Created: 2018-06-14 Last updated: 2019-03-20Bibliographically approved
Olsson, A.-K., Olsson-Tall, M., Moradi, H., Hjärthag, F. & Helldin, L. (2018). Less symptoms in schizophrenia a risk factor for impaired insight of functioning?. Paper presented at 6th Biennial Conference of the Schizophrenia-International-Research-Society (SIRS), APR 04-08, 2018, Florence, ITALY. Schizophrenia Bulletin, 44, S263-S264
Open this publication in new window or tab >>Less symptoms in schizophrenia a risk factor for impaired insight of functioning?
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2018 (English)In: Schizophrenia Bulletin, ISSN 0586-7614, E-ISSN 1745-1701, Vol. 44, p. S263-S264Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Oxford: Oxford University Press, 2018
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-67190 (URN)10.1093/schbul/sby017.643 (DOI)000429541800638 ()
Conference
6th Biennial Conference of the Schizophrenia-International-Research-Society (SIRS), APR 04-08, 2018, Florence, ITALY
Note

Background

People with schizophrenia demonstrate deficits in insight and the ability to self-evaluate their functioning. Research about patients’ ability to recognize their psychotic symptoms is well established, but recent findings show that there are still unexplored fields regarding how patients perceive their level of functioning A previous study showed that patients who overestimate their functioning, also consistently get high scores in interview-based assessment regarding real-world functional performance. The possible consequences of patients’ ability to correctly estimate their function need to be further investigated. The aim of the present study was to examine how the perception of one’s own capacity relate to symptoms in patients with schizophrenia spectrum disorders.

Methods

Data collection took place within the ongoing project Clinical Long-term Investigation of Psychosis in Sweden (CLIPS), which examines psychiatric outpatients. In this study, 222 patients with schizophrenia participated. They were divided into four groups based on their results on the UPSA-B and their self-perceived function; two groups with ordinary function (accurate estimators and under -estimators) and two groups with low function (accurate estimators and over-estimators). The groups were compared regarding psychiatric symptoms, examined using the Positive and Negative Syndrome Scale (PANSS). Non-parametric statistics were used to analyze differences in their symptoms.

Results

There were statistically significant differences in the total score of PANSS across the four groups of function. The following analyses showed significant differences in the negative and general domain. Results from the post hoc examination revealed identical patterns in these two symptom domains. The group with Low function accurate estimators have significantly more severe symptoms compared to the other three groups.

Discussion

The result in the present study showed that patients with low function who overestimate their function have less or the same level of symptoms as patients in the two groups with ordinary functioning. In further studies it is important to investigate if this actually is a result of lower symptom level or if it is due to the impaired insight. This is important since the result in the present study mirror previous results where patients who overestimate a low function also, by clinicians, will be perceived as patients with a higher capacity and less difficulties.

Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2019-12-18Bibliographically approved
Mohn, C., Olsson, A.-K. & Helldin, L. (2018). Positive and negative affect in schizophrenia spectrum disorders: A forgotten dimension?. Psychiatry Research, 267, 148-153
Open this publication in new window or tab >>Positive and negative affect in schizophrenia spectrum disorders: A forgotten dimension?
2018 (English)In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 267, p. 148-153Article in journal (Refereed) Published
Abstract [en]

Dysfunctional affectivity is common in schizophrenia spectrum disorders (SSD), and may influence quality of life, illness progression and treatment effects. This study describes Positive (PA) and Negative (NA) affect and their relationship to demographic and clinical variables in 135 individuals with SSD. Affect dimensions were assessed by the Positive and Negative Affect Schedule (PANAS). Stepwise regression analyses with affects as dependent variables and demographic and clinical factors as independent variables were performed. Relative to healthy norms, the participants exhibited lower PA and a similar NA level. The PA score was not influenced by demographic or clinical variables. The NA score was predicted by a combination of male gender, single status, and items of general psychopathology from the Positive and Negative Syndrome Scale (PANSS). There was no relation between affects and classical schizophrenia symptoms. In conclusion, the SSD patients exhibited abnormally low PA. The affect level was not influenced by psychosis symptom severity, indicating that the PANAS is a relatively unbiased rating tool of affective responding in SSD. Finally, male gender, single status and general distress were modestly related to NA.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Affect, PANAS, Psychosis, Schizophrenia, Symptoms
National Category
Psychology
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-68073 (URN)10.1016/j.psychres.2018.05.060 (DOI)000445983700023 ()2-s2.0-85048264040 (Scopus ID)
Available from: 2018-06-26 Created: 2018-06-26 Last updated: 2019-11-11Bibliographically approved
Hawar, M., Olsson, A.-K., Hjärthag, F., Johansson, M., Olsson-Tall, M. & Helldin, L. (2018). Traditional Risk Factors Not Enough To Explain The Short Lifetime Expectancy In Patients With Schizophrenia. Paper presented at 6th Biennial Conference of the Schizophrenia-International-Research-Society (SIRS), APR 04-08, 2018, Florence, ITALY. Schizophrenia Bulletin, 44, S159-S159
Open this publication in new window or tab >>Traditional Risk Factors Not Enough To Explain The Short Lifetime Expectancy In Patients With Schizophrenia
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2018 (English)In: Schizophrenia Bulletin, ISSN 0586-7614, E-ISSN 1745-1701, Vol. 44, p. S159-S159Article in journal (Refereed) Published
Place, publisher, year, edition, pages
Oxford University Press, 2018
National Category
Psychology (excluding Applied Psychology)
Research subject
Psychology with an emphasis on medical psychology
Identifiers
urn:nbn:se:kau:diva-67191 (URN)000429541800385 ()
Conference
6th Biennial Conference of the Schizophrenia-International-Research-Society (SIRS), APR 04-08, 2018, Florence, ITALY
Available from: 2018-04-26 Created: 2018-04-26 Last updated: 2018-06-25Bibliographically approved
Johansson, M., Hjärthag, F. & Helldin, L. (2018). What could be learned from a decade with standardized remission criteria in schizophrenia spectrum disorders: An exploratory follow-up study. Schizophrenia Research, 195(May), 103-109
Open this publication in new window or tab >>What could be learned from a decade with standardized remission criteria in schizophrenia spectrum disorders: An exploratory follow-up study
2018 (English)In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 195, no May, p. 103-109Article in journal (Refereed) Published
Abstract [en]

A decade has passed since the standardized remission criteria of schizophrenia spectrum disorders-the Andreasen Criteria-were defined. Over 2000 studies have been published, but only a few describe symptomatic remission over time. In this prospective study we followed patients for 3 and 5 years, respectively. The aim was to investigate how different symptoms affect the occurrence of remission and how the remission cut-off level affects remission sustainability. The participants were patients diagnosed with schizophrenia spectrum disorders (DSM-IV). First, the importance of each core symptom for remission was examined using the Positive and Negative Syndrome Scale (n = 274). Second, we investigated which items affect patients to either go in and out of remission or never achieve remission (n = 154). Third, we investigated how the sustainability of remission is affected by a cut-off set to 2 (minimal) and 3 (mild) points, respectively (n = 154). All core symptoms affected the occurence of remission, to a higher or lesser extent. Delusions and Hallucinatory behavior contributed the strongest to fluctuation between remission and non-remission, while the contribution of Mannerism and posturing was very marginal. Negative symptoms were enhanced when remission was never achieved. Moreover, the study found that remission duration was significantly longer for the cut-off score 2 rather than 3. The study shows that, over time, remission criteria discriminate between being stable, unstable, or never in remission. Patients with only a minimal occurrence of symptom intensity exhibit a significantly longer remission duration compared to patients with mild symptom intensity, indicating that the treatment goal should be minimal symptom intensity.

Place, publisher, year, edition, pages
Elsevier, 2018
Keywords
Symptomatic remission; Sustainability; Schizophrenia spectrum disorders
National Category
Psychiatry
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-67421 (URN)10.1016/j.schres.2017.09.007 (DOI)000432466700015 ()28899583 (PubMedID)
Available from: 2018-05-31 Created: 2018-05-31 Last updated: 2020-05-26Bibliographically approved
Moradi, H., Olsson, A.-K., Hjärthag, F., Harvey, P. & Helldin, L. (2017). SU42. Physical Fitness in Association With Cognitive Performance—Possible Marker of Short Lifetime Expectancy for Patients With Schizophrenia. Paper presented at 16th International Congress on Schizophrenia Research (ICOSR), MAR 24-28, 2017, San Diego, CA. Schizophrenia Bulletin, 43(Suppl 1), S176-S176
Open this publication in new window or tab >>SU42. Physical Fitness in Association With Cognitive Performance—Possible Marker of Short Lifetime Expectancy for Patients With Schizophrenia
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2017 (English)In: Schizophrenia Bulletin, ISSN 0586-7614, E-ISSN 1745-1701, Vol. 43, no Suppl 1, p. S176-S176Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background: Patients with schizophrenia have about 20 years shorter lifetime expectancy compared to healthy population. Among these patients, cognitive performance is a predictor of early death while illness severity, as expressed in both symptom activity and remission status, has no relation with length of life. Vital signs, such as blood pressure and heart rate, weight including BMI, and spontaneously reported symptoms did neither indicate an increased risk for early death. This work focus on whether self-rated physical condition and activities, in contrast to vital signs and perceived symptoms, could be related to cognitive performance and length of life.Methods: From the Clinical Long-term Investigation of Psychosis in Sweden (CLIPS) study, 310 participants were categorized into 4 groups from their cognitive performance at baseline: good cognitive function (GCF), n = 114, impaired cognitive function (ICF), n = 90, and severely impaired cognitive function (SICF), n = 45. The fourth group was patients who had passed away during the study time, n = 61. Patients’ perceived physical condition was assessed at baseline using the SF-36, which included 10 questions about everyday physical activities. The 4 groups were compared using ANOVAs and post hoc analyzes.Results: Patients who had deceased reported, on average 9.5 years before their death, a significantly (P < .001) more impaired physical condition compared to the GCF group and the ICF group (P = .028) but did not show any difference compared with the SICF group (P = .424). An item analysis showed that especially physical activities, such as walking a distance or climbing the stairs, were impaired. When only alive patients’ physical status vs cognitive performance were analyzed, the GCP were more physical fit than the ICF (P = .018) and SICF (P = .011), but there were no difference between ICF and SICF.Conclusion: In contrast to vital signs and perceived symptoms of illness, patient reported differences in physical fitness corresponded to differences in their cognitive ability. It has earlier been argued that physical performance is an underappreciated variable for improving ADLs. This study indicates that patents’ physical performance may, several years in advance, offer important information about increased risk of an early death.

Place, publisher, year, edition, pages
Oxford University Press, 2017
National Category
Psychiatry
Research subject
Psychology
Identifiers
urn:nbn:se:kau:diva-65296 (URN)10.1093/schbul/sbx024.040 (DOI)000397126200476 ()
Conference
16th International Congress on Schizophrenia Research (ICOSR), MAR 24-28, 2017, San Diego, CA
Available from: 2017-11-30 Created: 2017-11-30 Last updated: 2020-05-25Bibliographically approved
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