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Search Results: 1 - 10 of 4788 matches for " Erik Johnsen "
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Priapism in Antipsychotic Drug Use: A Rare but Important Side Effect
Igne Sinkeviciute,Rune A. Kroken,Erik Johnsen
Case Reports in Psychiatry , 2012, DOI: 10.1155/2012/496364
Abstract: Priapism is a rare but important side effect of antipsychotic drugs which may evolve into a urological emergency. Most antipsychotic drugs are alpha-1 adrenergic antagonists, which is thought to be the principal mechanism involved in antipsychotic-induced priapism. Other aetiologies exist, however. A case is presented with multiple episodes of priapism during the use of several different antipsychotic drugs. The case is representative of many patients treated with antipsychotic drugs, as there were hyperprolactinemia, and illicit drug use, which are known causes of priapism. Moreover, the patient used combinations of antipsychotic drugs. The case thus illustrates the etiological complexity which could delay a diagnosis of antipsychotic-induced priapism, and the problem of establishing a link between priapism and one particular ingredient of a drug combination. The case presents how a treatment regimen was finally established balancing antipsychotic efficacy to acceptable side effects and offers guidance to physicians regarding how antipsychotic-induced priapism may be resolved.
Effectiveness of second generation antipsychotics: A systematic review of randomized trials
Erik Johnsen, Hugo A J?rgensen
BMC Psychiatry , 2008, DOI: 10.1186/1471-244x-8-31
Abstract: To review the head-to-head effectiveness of SGAs in the domains of global outcomes, symptoms of disease, and tolerability.Searches were made in Embase, PubMED, and the Cochrane central register of controlled trials for effectiveness studies published from 1980 to 2008, week 1. Different combinations of the keywords antipsychotic*, neuroleptic* AND open, pragmatic, practical, naturalistic, real life, effectiveness, side effect*, unwanted effect*, tolera* AND compar* AND random* were used.Sixteen different reports of randomized head-to-head comparisons of SGA effectiveness were located. There were differences regarding sample sizes, inclusion criteria and follow-up periods, as well as sources of financial sponsorship. In acute-phase and first-episode patients no differences between the SGAs were disclosed regarding alleviating symptoms of disease. Olanzapine was associated with more weight gain and adverse effects on serum lipids. In the chronic phase patients olanzapine groups had longer time to discontinuation of treatment and better treatment adherence compared to other SGAs. The majority of studies found no differences between the SGAs in alleviating symptoms of psychosis in chronically ill patients. Olanzapine was associated with more metabolic adverse effects compared to the others SGAs. There were surprisingly few between-drug differences regarding side effects. First generation antipsychotics were associated with lower total mental health care costs in 2 of 3 studies on chronically ill patients, but were also associated with more extrapyramidal side effects compared to the SGAs in several studies.In chronically ill patients olanzapine may have an advantage over other SGAs regarding longer time to treatment discontinuation and better drug adherence, but the drug is also associated with more metabolic side effects. More effectiveness studies on first-episode psychosis are needed.Results from effectiveness trials on antipsychotics have been awaited with anticipat
Priapism in Antipsychotic Drug Use: A Rare but Important Side Effect
Igne Sinkeviciute,Rune A. Kroken,Erik Johnsen
Case Reports in Psychiatry , 2012, DOI: 10.1155/2012/496364
Abstract: Priapism is a rare but important side effect of antipsychotic drugs which may evolve into a urological emergency. Most antipsychotic drugs are alpha-1 adrenergic antagonists, which is thought to be the principal mechanism involved in antipsychotic-induced priapism. Other aetiologies exist, however. A case is presented with multiple episodes of priapism during the use of several different antipsychotic drugs. The case is representative of many patients treated with antipsychotic drugs, as there were hyperprolactinemia, and illicit drug use, which are known causes of priapism. Moreover, the patient used combinations of antipsychotic drugs. The case thus illustrates the etiological complexity which could delay a diagnosis of antipsychotic-induced priapism, and the problem of establishing a link between priapism and one particular ingredient of a drug combination. The case presents how a treatment regimen was finally established balancing antipsychotic efficacy to acceptable side effects and offers guidance to physicians regarding how antipsychotic-induced priapism may be resolved. 1. Introduction Priapism is defined as prolonged and persistent erection of the penis without sexual stimulation [1] and is divided into a nonischemic type (arterial, high flow) that can be treated conservatively and an ischemic type (venoocclusive, low flow) which may become a urological emergency that requires immediate intervention [1]. A variety of etiological factors are implicated in the condition. Nonischemic priapism is associated with penile or perineal trauma, cocaine, metastatic malignancy, among others, whereas ischemic priapism can be caused by drugs, haematological disorders, metabolic disorders, alcohol, and other factors [2]. Drug-induced priapism is associated with antidepressants, antipsychotics, antihypertensive medications, and accounts for approximately 15% to 41% of all cases, of which antipsychotics-induced priapism is most common [3]. All antipsychotic drugs antagonize dopaminergic transmission at the dopamine type 2 (D2) receptors in the central nervous system (CNS) but are pharmacologically heterogeneous as a drug group. The drugs are usually classified into first (FGA) and second generation antipsychotics (SGAs). The FGAs are characterized by a strong affinity for the D2 receptor, whereas the SGAs are serotonergic antagonists at the 5-HT2A receptors as well as being D2 receptor antagonists [4]. In addition, most antipsychotics have affinities for a wide array of other receptors in the CNS, including histaminergic, noradrenergic, and cholinergic
Rhynchostegium megapolitanum (Web. et Mohr) B.S.G.—A Rare Bryophyte in Dune Ecosystems of Zealand, Denmark  [PDF]
Ib Johnsen
American Journal of Plant Sciences (AJPS) , 2014, DOI: 10.4236/ajps.2014.59152
Abstract:

Rhynchostegium megapolitanum was observed during a study of the effects of the invasive nonnative Rosa rugosa in a sand dune. The vascular as well as the epiphytic and epigeic cryptogam vegetation was recorded., and soil properties were measured. Epihytic lichens were abundant on dead or dying branches of Rosa rugosa scrubs, under which the stable substrate and high light exposure provided growth conditions for an epigeic community dominated by lichens and bryophytes. The occurrence of the rare bryophyte Rhynchostegium megapolitanum is discussed.

Sexual Dysfunction and Hyperprolactinemia in Male Psychotic Inpatients: A Cross-Sectional Study
Erik Johnsen,Rune Kroken,Else-Marie L?berg,Eirik Kjelby,Hugo A. J?rgensen
Advances in Urology , 2011, DOI: 10.1155/2011/686924
Abstract: Introduction. Sexual dysfunction (SD) and hyperprolactinemia are frequently reported in patients with psychotic disorders and have the potential for severe complications but investigations in males are particularly scarce. The primary aims were to determine the prevalence of SD and hyperprolactinemia in male patients and to investigate whether associations exist between SD and prolactin levels. Methods. Cross-sectional data were obtained at discharge from the hospital or 6 weeks after admittance for patients acutely admitted for psychosis and treated with a second-generation antipsychotic drug. Results. Half the patients reported diminished sexual desire and more than a third reported erectile and ejaculatory dysfunctions with no differences among the drugs. More than half the sample was hyperprolactinemic. No association was found between prolactin levels and SD. Conclusion. High rates of SD and hyperprolactinemia were found in male patients and should be a treatment target. SD and hyperprolactinemia were not correlated. 1. Introduction Active psychosis affects most aspects of normal functioning and has been ranked the third most disabling disorder in the general population, and more disabling than paraplegia, blindness, or HIV infection [1]. The life-time prevalence of any psychotic disorder is about 3 in 100 persons [2]. In a substantial proportion of cases, the disorders are chronic and life long. The presence of psychosis will in most instances indicate the use of antipsychotic drugs. Both the nature of the disorders and antipsychotic drug treatment can profoundly affect sexual functioning. Main tolerability issues related to antipsychotic drug use have traditionally been the extrapyramidal syndrome (EPS) associated with the first-generation (typical) antipsychotics, and metabolic adverse effects associated mainly with the second-generation (atypical) agents [3, 4]. Sexual dysfunction (SD) has received far less attention, although these side effects have been reported among the most discomforting ones by patients with schizophrenia [5, 6]. SD is important also as it has negative impact on medication adherence. Antipsychotic-induced hyperprolactinemia is commonly regarded as a frequent cause of SD. As demonstrated in a review by Byerly et al. [7], the findings of different studies are conflicting, however, with regards to associations between hyperprolactinemia and sexual side effects. While differential propensities among second-generation antipsychotics (SGAs) in causing hyperprolactinemia are well documented [8], differences among the SGAs in
Anti-depressive effectiveness of olanzapine, quetiapine, risperidone and ziprasidone: a pragmatic, randomized trial
Eirik Kjelby, Hugo A J?rgensen, Rune A Kroken, Else-Marie L?berg, Erik Johnsen
BMC Psychiatry , 2011, DOI: 10.1186/1471-244x-11-145
Abstract: Adult patients acutely admitted to an emergency ward for psychosis were randomized to olanzapine, quetiapine, risperidone or ziprasidone and followed for up to 2 years. Participants were assessed repeatedly using the Positive and Negative Syndrome Scale - Depression factor (PANSS-D) and the Calgary Depression Scale for Schizophrenia (CDSS).A total of 226 patients were included. A significant time-effect showing a steady decline in depressive symptoms in all medication groups was demonstrated. There were no substantial differences among the SGAs in reducing the PANSS-D score or the CDSS sum score. Separate analyses of groups with CDSS sum scores > 6 or ≤6, respectively, reflecting degree of depressive morbidity, revealed essentially identical results to the primary analyses. There was a high correlation between the PANSS-D and the CDSS sum score (r = 0.77; p < 0.01).There was no substantial difference in anti-depressive effectiveness among olanzapine, quetiapine, risperidone or ziprasidone in this clinically relevant sample of patients acutely admitted to hospital for symptoms of psychosis. Based on our findings we can make no recommendations concerning choice of any particular SGA for targeting symptoms of depression in a patient acutely admitted with psychosis.ClinicalTrials.gov ID; URL: http://www.clinicaltrials.gov/ webcite: NCT00932529Depressive symptoms are common in psychotic disorders, illustrated by point prevalence figures in patients with schizophrenia between 7-75% [1,2]. These figures vary due to different sub-populations and different definitions of depression. The modal rate has been estimated at 25% [2]. The identification of depression in this patient group is challenging for several reasons, including the overlap between depressive symptoms and the negative symptoms of psychosis and depressive features being common in the prodromal phase of schizophrenia [1]. Nevertheless, depression should be diagnosed and properly treated as it is associated with
Effectiveness of second-generation antipsychotics: a naturalistic, randomized comparison of olanzapine, quetiapine, risperidone, and ziprasidone
Erik Johnsen, Rune A Kroken, Tore Wentzel-Larsen, Hugo A J?rgensen
BMC Psychiatry , 2010, DOI: 10.1186/1471-244x-10-26
Abstract: Patients ≥ 18 years of age admitted to the emergency ward for symptoms of psychosis were consecutively randomized to risperidone (n = 53), olanzapine (n = 52), quetiapine (n = 50), or ziprasidone (n = 58), and followed for up to 2 years.A total of 213 patients were included, of which 68% were males. The sample represented a diverse population suffering from psychosis. At admittance the mean Positive and Negative Syndrome Scale (PANSS) total score was 74 points and 44% were antipsychotic drug na?ve. The primary intention-to-treat analyses revealed no substantial differences between the drugs regarding the times until discontinuation of initial drug, until discharge from index admission, or until readmission. Quetiapine was superior to risperidone and olanzapine in reducing the PANSS total score and the positive subscore. Quetiapine was superior to the other drugs in decreasing the PANSS general psychopathology subscore; in decreasing the Clinical Global Impression - Severity of Illness scale score (CGI-S); and in increasing the Global Assessment of Functioning - Split version, Functions scale score (GAF-F). Ziprasidone was superior to risperidone in decreasing the PANSS positive symptoms subscore and the CGI-S score, and in increasing the GAF-F score. The drugs performed equally with regards to most tolerability outcomes except a higher increase of hip-circumference per day for olanzapine compared to risperidone, and more galactorrhoea for risperidone compared to the other groups.Quetiapine appears to be a good starting drug candidate in this sample of patients admitted to hospital for symptoms of psychosis.ClinicalTrials.gov ID; URL: http://www.clinicaltrials.gov/ webcite: NCT00932529For a patient suffering from psychosis, most second-generation antipsychotics (SGAs) have been considered first-line agents based on their more favorable tolerability profiles compared with older first-generation drugs [1-4]. This particularly applies to first episode psychosis [1,3]. M
Treatment of schizophrenia with antipsychotics in Norwegian emergency wards, a cross-sectional national study
Rune A Kroken, Erik Johnsen, Torleif Ruud, Tore Wentzel-Larsen, Hugo A J?rgensen
BMC Psychiatry , 2009, DOI: 10.1186/1471-244x-9-24
Abstract: Data from 486 discharges of patients from emergency inpatient treatment of schizophrenia were collected during a three-month period in 2005; the data were collected in a large national study that covered 75% of Norwegian hospitals receiving inpatients for acute treatment. Antipsychotic treatment, demographic variables, scores from the Global Assessment of Functioning and Health of the Nation Outcome Scales and information about comorbid conditions and prior treatment were analyzed to seek predictors for nonadherence to guidelines.In 7.6% of the discharges no antipsychotic treatment was given; of the remaining discharges, 35.6% were prescribed antipsychotic polypharmacy and 41.9% were prescribed at least one first-generation antipsychotic (FGA). The mean chlorpromazine equivalent dose was 450 (SD 347, range 25–2800). In the multivariate regression analyses, younger age, previous inpatient treatment in the previous 12 months before index hospitalization, and a comorbid diagnosis of personality disorder or mental retardation predicted antipsychotic polypharmacy, while previous inpatient treatment in the previous 12 months also predicted prescription of at least one FGA.Our national survey of antipsychotic treatment at discharge from emergency inpatient treatment revealed antipsychotic drug regimens that are to some degree at odds with current guidelines, with increased risk of side effects. Patients with high relapse rates, comorbid conditions, and previous inpatient treatment are especially prone to be prescribed antipsychotic drug regimens not supported by international guidelines.The clinical differences between antipsychotic drugs are mainly in the areas of safety and tolerability. International guidelines for the treatment of schizophrenia [1-4] offer rational strategies to minimize the burden of side effects related to antipsychotic treatment. These recommendations may be considered according to three dimensions: first-versus second-generation antipsychotics; ant
QTc Prolongation in Patients Acutely Admitted to Hospital for Psychosis and Treated with Second Generation Antipsychotics
Erik Johnsen,Kristina Aanesen,Sanjeevan Sriskandarajah,Rune A. Kroken,Else-Marie L?berg,Hugo A. J?rgensen
Schizophrenia Research and Treatment , 2013, DOI: 10.1155/2013/375020
Abstract: QTc interval prolongation is a side effect of several antipsychotic drugs, with associated risks of torsade de pointes arrhythmias and sudden cardiac death. There is an ongoing debate of whether or not electrocardiogram (ECG) assessments should be mandatory in patients starting antipsychotic drugs. To investigate QTc prolongation in a clinically relevant patient group 171 adult patients acutely admitted to an emergency ward for psychosis were consecutively recruited. ECGs were recorded at baseline and then at discharge or after 6 weeks at the latest (discharge/6 weeks), thus reflecting the acute phase treatment period. The mean QTc interval was 421.1 (30.4)?ms at baseline and there was a positive association between the QTc interval and the agitation score whereas the QTc interval was inversely associated with the serum calcium level. A total of 11.6% had abnormally prolonged QTc intervals and another 14.3% had borderline prolongation. At discharge/6 weeks, the corresponding proportions were reduced to 4.2% and 5.3%, respectively. The reduction of the proportion with prolonged QTc intervals reached statistical significance (chi-square exact test: ). The finding of about one-quarter of the patients with borderline or prolonged QTc intervals could indicate mandatory ECG recordings in this population. This trial is registered with ClinicalTrials.gov ID: NCT00932529. 1. Introduction Prolongation of the heart rate-corrected QT (QTc) interval of the electrocardiogram (ECG) is a major concern because of the associated risk of torsade de pointes (TdP) arrythmias and sudden cardiac death [1]. QTc intervals longer than 500 milliseconds (ms) or increases of more than 60?ms of the QTc interval are established thresholds for clear concern of arrhythmia but increased risk is found also at lower levels of QTc prolongation [2]. The QT interval represents the onset of electrical depolarisation of the ventricles to the end of repolarisation of the heart [1, 2] and is influenced by both physiological and pathological factors including emotional stress, gender, obesity, food consumption, and electrolyte disturbances, as well as diseases of the heart muscle and coronary artery disease [2–4]. Moreover, several drugs including psychotropics can induce prolongation of the QTc interval principally by blocking the rapidly activating potassium current [2, 5, 6]. Antipsychotic drugs are associated with dose related QTc prolongation, and some agents have been intermittently or permanently withdrawn from the market for this reason [2, 5, 7]. Treatment recommendations for
Corrigendum: Patients with schizophrenia fail to up-regulate task-positive and down-regulate task-negative brain networks: an fMRI study using an ICA analysis approach
Merethe Nyg?rd,Tom Eichele,Else-Marie L?berg,Erik Johnsen,Rune A. Kroken,Kenneth Hugdahl
Frontiers in Human Neuroscience , 2013, DOI: 10.3389/fnhum.2013.00231
Abstract:
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