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  • 1.
    Helldin, Lars
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies. NU Hlth Care, Dept Psychiat, Trollhattan, Sweden..
    Hjärthag, Fredrik
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies.
    Olsson, Anna-Karin
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies. NU Hlth Care, Dept Psychiat, Trollhattan, Sweden..
    Harvey, Philip D.
    Univ Miami, Miller Sch Med, Dept Psychiat, Coral Gables, FL 33124 USA.;Bruce W Carter VA Med Ctr, Res Serv, Miami, FL USA..
    Cognitive performance, symptom severity, and survival among patients with schizophrenia spectrum disorder: A prospective 15-year study2015In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 169, no 1-3, p. 141-146Article in journal (Refereed)
    Abstract [en]

    Patients with schizophrenia have an average lifespan approximately 20 years shorter than the normal population. This study explored if there were any specific common characteristics among patients with schizophrenia spectrum disorder who died prematurely, compared to those who survived or died at a more normative age. The data were obtained from an ongoing twenty-year longitudinal study wherein 67 patients out of 501 participants had died at an average age of 60.5 years. Differences in baseline assessments of symptoms and cognitive ability were compared across patients who died during the time of the study and survivors. Symptom remission was assessed according to the Andreasen remission criteria as presented in 2005. Cognitive performance was assessed with a battery of instruments measuring vigilance, working memory, learning, short-term memory, and executive function. Two patients committed suicide and together they lowered the average lifespan of the study sample by only 0.27 years. The baseline assessments showed no difference in symptoms or remission status between patients who died and those who survived. This finding was in contrast to the cognitive baseline assessments where it was found that those who had died had performed more poorly in multiple domains, especially executive functioning, cognitive flexibility, learning and short-term memory. Survival analysis with Cox models showed that verbal memory and executive functioning were the most substantial independent predictors. Our study shows that although suicide was not a common cause of death, the average age of death is still young for this patient group and cannot be explained by differences in symptom severity. Our findings indicate that cognitive abilities might be of special interest for affective longevity in patients with schizophrenia, either as a marker of special risk or as a target for direct intervention. (C) 2015 Elsevier B.V. All rights reserved.

  • 2.
    Helldin, Lars
    et al.
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology.
    Kane, John M.
    The Zucker Hillside Hospital and the Albert Einstein College of Medicine.
    Hjärthag, Fredrik
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology.
    Norlander, Torsten
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology.
    The importance of cross-sectional remission in schizophrenia for long-term outcome: A clinical prospective study2009In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 115, no 1, p. 67-73Article in journal (Refereed)
  • 3.
    Helldin, Lars
    et al.
    The NU Health Care, Department of Psychiatry.
    Kane, John M.
    The Zucker Hillside Hospital and the Albert Einstein College of Medicine.
    Karilampi, Ulla
    Department of Psychology, Göteborg University.
    Norlander, Torsten
    Department of Psychology, Karlstad University.
    Archer, Trevor
    Department of Health and Behavioural Science, Kalmar University.
    Remission in prognosis of functional outcome: A new dimension in the treatment of patients with psychotic disorders2007In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 93, p. 160-168Article in journal (Refereed)
  • 4. Johansson, Madeleine
    et al.
    Hjärthag, Fredrik
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology. Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013).
    Helldin, Lars
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013).
    What could be learned from a decade with standardized remission criteria in schizophrenia spectrum disorders: An exploratory follow-up study2018In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 195, no May, p. 103-109Article in journal (Refereed)
    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.

  • 5.
    Lugnegård, Tove
    et al.
    Sahlgrenska akademin Göteborg.
    Unenge Hallerbäck, Maria
    Sahlgrenska akademin Göteborg.
    Hjärthag, Fredrik
    Karlstad University, Faculty of Economic Sciences, Communication and IT, Department of Psychology.
    Gillberg, C
    Sahlgrenska akademin Göteborg.
    Social Cognition Impairments in Asperger Syndrome and Schizophrenia2013In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 143, p. 277-284Article in journal (Refereed)
    Abstract [en]

    Social cognition impairments are well described in both autism spectrum disorders, including Asperger syndrome (AS), and in schizophrenia spectrum disorders. However, little is known about whether there are differences between the two groups of disorders regarding this ability. The aim of this study was to compare social cognition abilities in AS and schizophrenia. Fifty-three individuals (26 men, 27 women) with a clinical diagnosis of AS, 36 (22 men, 14 women) with a clinical diagnosis of schizophrenic psychosis, and 50 non-clinical controls (19 men, 31 women) participated in the study. Clinical diagnoses were confirmed either by Structured Clinical Interview on DSM-IV diagnosis or the Diagnostic Interview for Social and Communication Disorders. Verbal ability was assessed using the Vocabulary subtest of the WAIS-III. Two social cognition instruments were used: Reading the Mind in the Eyes Test (Eyes Test) and the Animations Task. On the Eyes Test, patients with schizophrenia showed poorer results compared to non-clinical controls; however, no other group differences were seen. Both clinical groups scored significantly lower than the comparison group on the Animations Task. The AS group performed somewhat better than the schizophrenia group. Some differences were accounted for by gender effects. Implicit social cognition impairments appear to be at least as severe in schizophrenia as they are in AS. Possible gender differences have to be taken into account in future research on this topic.

  • 6.
    Moradi, Hawar
    et al.
    Department of Psychiatry, NU Health Care Hospital, Trollhättan, Sweden & Institute of Medicine, The Sahlgrenska Academy, University of Gothenburg, Sweden.
    Harvey, Philip D.
    Department of Psychiatry, University of Miami Miller School of Medicine, United States & Research Service, Bruce W. Carter VA Medical Center, Miami, FL, United States.
    Helldin, Lars
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013). Department of Psychiatry, NU Health Care Hospital, Trollhättan, Sweden.
    Correlates of risk factors for reduced life expectancy in schizophrenia: Is it possible to develop a predictor profile?2018In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 201, p. 388-392Article in journal (Refereed)
    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.

  • 7.
    Olsson, Anna-Karin
    et al.
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013). Department of Psychiatry, NU-Hospital Group, Trollhättan, Sweden.
    Hjärthag, Fredrik
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013).
    Helldin, Lars
    Karlstad University, Faculty of Arts and Social Sciences (starting 2013), Department of Social and Psychological Studies (from 2013). Department of Psychiatry, NU-Hospital Group, Trollhättan, Sweden.
    Overestimated function in patients with schizophrenia: A possible risk factor for inadequate support?2019In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 206, p. 194-199Article in journal (Refereed)
    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.

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