umu.sePublikasjoner
Endre søk
Link to record
Permanent link

Direct link
BETA
Publikasjoner (10 av 14) Visa alla publikasjoner
Ott, M. & Werneke, U. (2019). A Mixed Presentation of Serotonin Syndrome Versus Neuroleptic Malignant Syndrome in a 12-Year-Old Boy [Letter to the editor]. Pediatric emergency care, 35(5), E98-E98
Åpne denne publikasjonen i ny fane eller vindu >>A Mixed Presentation of Serotonin Syndrome Versus Neuroleptic Malignant Syndrome in a 12-Year-Old Boy
2019 (engelsk)Inngår i: Pediatric emergency care, ISSN 0749-5161, E-ISSN 1535-1815, Vol. 35, nr 5, s. E98-E98Artikkel i tidsskrift, Letter (Fagfellevurdert) Published
sted, utgiver, år, opplag, sider
Lippincott Williams & Wilkins, 2019
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-159616 (URN)10.1097/PEC.0000000000001830 (DOI)000467740700007 ()30964850 (PubMedID)
Tilgjengelig fra: 2019-06-17 Laget: 2019-06-17 Sist oppdatert: 2019-06-17bibliografisk kontrollert
Ott, M., Forssén, B. & Werneke, U. (2019). Lithium treatment, nephrogenic diabetes insipidus and the risk of hypernatraemia: a retrospective cohort study. Therapeutic Advances in Psychopharmacology, 9
Åpne denne publikasjonen i ny fane eller vindu >>Lithium treatment, nephrogenic diabetes insipidus and the risk of hypernatraemia: a retrospective cohort study
2019 (engelsk)Inngår i: Therapeutic Advances in Psychopharmacology, ISSN 2045-1253, E-ISSN 2045-1261, Vol. 9Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Hypernatraemia is a serious condition that can potentially become life threatening. It is known that lithium is associated with polyuria and nephrogenic diabetes insipidus, risk factors for hypernatraemia. In this study, we tested the hypothesis that lithium treatment was a risk factor for hypernatraemia.

Methods: We performed a retrospective cohort study in the Swedish region of Norrbotten into the effects and potential adverse effects of lithium treatment and other mood stabilizers (LiSIE). For this particular study, we included all patients who had experienced at least one episode with a sodium concentration > 150 mmol/L between 1997 and 2013. Medical records were reviewed regarding past or current lithium exposure, diabetes insipidus and other potential risk factors for hypernatraemia.

Results: Of 2463 patients included, 185 (7.5%) had experienced 204 episodes of hypernatraemia within the 17-year review period. In patients 65 years or older, infections dominated as the cause with 51%. In patients younger than 65 years, intoxications, particularly with alcohol, dominated as the cause with 35%. In the whole sample, dehydration accounted for 12% of episodes, 25% of which in the context of suspected or confirmed nephrogenic diabetes insipidus. Of all episodes, 25% resulted in death, with infection being the most common cause of death in 62% of cases.

Conclusions: In our sample, infections and harmful use of substances including alcohol were the most common causes of hypernatraemia. Both current and past use of lithium also led to episodes of hypernatraemia, when associated with nephrogenic diabetes insipidus. Clinicians should remain vigilant, have a low threshold for checking sodium concentrations and consider even risk factors for hypernatraemia beyond lithium.

sted, utgiver, år, opplag, sider
Sage Publications, 2019
Emneord
adverse effects, alcoholic intoxication, bipolar disorder, diabetes insipidus, hypernatraemia, lithium
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-158727 (URN)10.1177/2045125319836563 (DOI)000463588000001 ()31007893 (PubMedID)
Tilgjengelig fra: 2019-05-21 Laget: 2019-05-21 Sist oppdatert: 2019-05-21bibliografisk kontrollert
Ott, M., Mannchen, J. K., Jamshidi, F. & Werneke, U. (2019). Management of severe arterial hypertension associated with serotonin syndrome: a case report analysis based on systematic review techniques. Therapeutic Advances in Psychopharmacology, 9, 1-32
Åpne denne publikasjonen i ny fane eller vindu >>Management of severe arterial hypertension associated with serotonin syndrome: a case report analysis based on systematic review techniques
2019 (engelsk)Inngår i: Therapeutic Advances in Psychopharmacology, ISSN 2045-1253, E-ISSN 2045-1261, Vol. 9, s. 1-32Artikkel, forskningsoversikt (Fagfellevurdert) Published
Abstract [en]

Serotonin syndrome is thought to arise from serotonin excess. In many cases, symptoms are mild and self-limiting. But serotonin syndrome can become life threatening, when neuromuscular hyperexcitability spins out of control. Uncontainable neuromuscular hyperexcitability may lead to cardiovascular complications, linked to extreme changes in blood pressure. Currently, there is little guidance on how to control blood pressure in hyperserotonergic states. We report a case with treatment-resistant arterial hypertension, followed by a clinical review (using systematic review principles and techniques) of the available evidence from case reports published between 2004 and 2016 to identify measures to control arterial hypertension associated with serotonin syndrome. We conclude that classic antihypertensives may not be effective for the treatment of severe hypertension associated with serotonin syndrome. Benzodiazepines may lower blood pressure. Patients with severe hypertension not responding to benzodiazepines may benefit from cyproheptadine, propofol or both. In severe cases, higher cyproheptadine doses than currently recommended may be necessary.

sted, utgiver, år, opplag, sider
Sage Publications, 2019
Emneord
antihypertensive agents, arterial hypertension, cyproheptadine, hypertension, propofol, serotonin antagonists, serotonin syndrome
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-157757 (URN)10.1177/2045125318818814 (DOI)000460918500001 ()30886699 (PubMedID)
Tilgjengelig fra: 2019-04-08 Laget: 2019-04-08 Sist oppdatert: 2019-04-08bibliografisk kontrollert
Forssén, B., Ott, M. & Werneke, U. (2018). Lithium use among psychiatric patientsor: a risk factor for hypernatremia?. Paper presented at 6th annual scientific conference of the European Association of Psychosomatic Medicine (EAPM), Verona, June 27-30, 2018.. Journal of Psychosomatic Research, 109, 103-103
Åpne denne publikasjonen i ny fane eller vindu >>Lithium use among psychiatric patientsor: a risk factor for hypernatremia?
2018 (engelsk)Inngår i: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 109, s. 103-103Artikkel i tidsskrift, Meeting abstract (Annet vitenskapelig) Published
Abstract [en]

Aims: Hypernatremia is a serious condition that can potentially become life threatening. It is known, but not well-studied, that lithium can induce nephrogenic diabetes insipidus and thereby increase the risk for hypernatremia. In this study, we tested the hypothesis that lithium was a risk factor for hypernatremia in patients with severe affective disorders. Methods: A retrospective study of hypernatremia episodes in all patients aged 18 years or over in the county of Norrbotten who received treatment with lithium or any other mood stabilizing medication during 1997-2013. We identified all episodes of hypernatremia during this period and compared the patients using lithium with those who did not. Results: We identified a total of 204 hypernatremia episodes in 185 patients. For all the 204 episodes, infection (37%) was the dominating cause. Harmful use of substances including alcohol came second. Lithium was only identified as a cause for hypernatremia in 1 % of all the episodes. In patients aged 65 years or less, harmful use of substances including alcohol was the most common cause. Infection was the dominating cause in patients >65 years. There was no significant difference in hypernatremia episodes between lithium users and non-lithium users. Patients who had suffered episodes of hyponatremia or died of these were significantly older. Conclusion: Lithium does not increase the risk of hypernatremia in patients with severe affective disorder compared to patients who do not use lithium. However, in some patients using lithium, severe episodes of hypernatremia can still occur. Thus, clinicians need to remain vigilant. There is a need for more research concerning other risk factors that may contribute to hypernatremia in patients with severe affective disorder.

sted, utgiver, år, opplag, sider
Elsevier, 2018
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-149113 (URN)10.1016/j.jpsychores.2018.03.058 (DOI)000433271100061 ()
Konferanse
6th annual scientific conference of the European Association of Psychosomatic Medicine (EAPM), Verona, June 27-30, 2018.
Merknad

Meeting Abstract: 47

Tilgjengelig fra: 2018-06-15 Laget: 2018-06-15 Sist oppdatert: 2018-06-15bibliografisk kontrollert
Öhlund, L., Ott, M., Oja, S., Bergqvist, M., Lundqvist, R., Sandlund, M., . . . Werneke, U. (2018). Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study. BMC Psychiatry, 18, Article ID 37.
Åpne denne publikasjonen i ny fane eller vindu >>Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study
Vise andre…
2018 (engelsk)Inngår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, artikkel-id 37Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Lithium remains first choice as maintenance treatment for bipolar affective disorder. Yet, about half of all individuals may stop their treatment at some point, despite lithium’s proven benefits concerning the prevention of severe affective episodes and suicide.

Methods: Retrospective cohort study in the Swedish region of Norrbotten into the causes of lithium discontinuation. The study was set up to (1) test whether patients with bipolar affective disorder or schizoaffective disorder, treated with lithium maintenance therapy, were more likely to discontinue lithium because of adverse effects than lack of therapeutic effectiveness, (2) explore gender differences, (3) understand the role of diagnosis and (4) identify who, patient or doctor, took the initiative to stop lithium. Review of medical records for all episodes of lithium discontinuation that had occurred between 1997 and 2013 with the intent to stop lithium for good.

Results: Of 873 patients treated with lithium, 54% discontinued lithium, corresponding to 561 episodes of lithium discontinuation. In 62% of episodes, lithium was discontinued due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment. The five single most common adverse effects leading to lithium discontinuation were diarrhoea (13%), tremor (11%), polyuria/polydipsia/diabetes insipidus (9%), creatinine increase (9%) and weight gain (7%). Women were as likely as men to take the initiative to stop lithium, but twice as likely to consult a doctor before taking action (p < 0.01). Patients with type 1 BPAD or SZD were more likely to discontinue lithium than patients with type 2 or unspecified BPAD (p < 0.01). Patients with type 1 BPAD or SZD were more likely to refuse medication (p < 0.01). Conversely, patients with type 2 or unspecified BPAD were three times as likely to discontinue lithium for lack or perceived lack of effectiveness (p < 0.001).

Conclusions: Stopping lithium treatment is common and occurs mostly due to adverse effects. It is important to discuss potential adverse effects with patients before initiation and continuously during lithium treatment, to reduce the frequency of potentially unnecessary discontinuations.

Emneord
Lithium, Bipolar disorder, Physical health, Compliance, Side effects
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-145594 (URN)10.1186/s12888-018-1622-1 (DOI)000424707200003 ()29415689 (PubMedID)
Merknad

Correction: Louise Öhlund, Michael Ott, Sofia Oja, Malin Bergqvist, Robert Lundqvist, Mikael Sandlund, Ellinor Salander Renberg and Ursula Werneke. Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study. BMC Psychiatry, 2018;18. DOI: 10.1186/s12888-018-1895-4

Tilgjengelig fra: 2018-04-04 Laget: 2018-04-04 Sist oppdatert: 2019-05-06bibliografisk kontrollert
Ajob, L., Brännström, I., Ott, M. & Werneke, U. (2017). ABC om Wernickes encefalopati. Läkartidningen, 114(ELZT)
Åpne denne publikasjonen i ny fane eller vindu >>ABC om Wernickes encefalopati
2017 (svensk)Inngår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, nr ELZTArtikkel i tidsskrift (Fagfellevurdert) Published
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-144007 (URN)
Tilgjengelig fra: 2018-01-17 Laget: 2018-01-17 Sist oppdatert: 2018-06-09bibliografisk kontrollert
Ott, M., Stegmayr, B., Salander Renberg, E. & Werneke, U. (2017). Prognosis and outcome of severe lithium poisoning: authors' reply [Letter to the editor]. Journal of Psychopharmacology, 31(9), 1275-1277
Åpne denne publikasjonen i ny fane eller vindu >>Prognosis and outcome of severe lithium poisoning: authors' reply
2017 (engelsk)Inngår i: Journal of Psychopharmacology, ISSN 0269-8811, E-ISSN 1461-7285, Vol. 31, nr 9, s. 1275-1277Artikkel i tidsskrift, Letter (Fagfellevurdert) Published
sted, utgiver, år, opplag, sider
Sage Publications, 2017
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-143950 (URN)000419008300016 ()
Tilgjengelig fra: 2018-01-15 Laget: 2018-01-15 Sist oppdatert: 2018-06-09bibliografisk kontrollert
Werneke, U., Jamshidi, F., Taylor, D. M. & Ott, M. (2016). Conundrums in neurology: diagnosing serotonin syndrome - a meta-analysis of cases. BMC Neurology, 16, Article ID 97.
Åpne denne publikasjonen i ny fane eller vindu >>Conundrums in neurology: diagnosing serotonin syndrome - a meta-analysis of cases
2016 (engelsk)Inngår i: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 16, artikkel-id 97Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

Background: Serotonin syndrome is a toxic state, caused by serotonin (5HT) excess in the central nervous system. Serotonin syndrome's main feature is neuro-muscular hyperexcitability, which in many cases is mild but in some cases can become life-threatening. The diagnosis of serotonin syndrome remains challenging since it can only be made on clinical grounds. Three diagnostic criteria systems, Sternbach, Radomski and Hunter classifications, are available. Here we test the validity of four assumptions that have become widely accepted: (1) The Hunter classification performs clinically better than the Sternbach and Radomski criteria; (2) in contrast to neuroleptic malignant syndrome, the onset of serotonin syndrome is usually rapid; (3) hyperthermia is a hallmark of severe serotonin syndrome; and (4) serotonin syndrome can readily be distinguished from neuroleptic malignant syndrome on clinical grounds and on the basis of medication history.

Methods: Systematic review and meta-analysis of all cases of serotonin syndrome and toxicity published between 2004 and 2014, using PubMed and Web of Science.

Results: Two of the four assumptions (1 and 2) are based on only one published study each and have not been independently validated. There is little agreement between current criteria systems for the diagnosis of serotonin syndrome. Although frequently thought to be the gold standard for the diagnosis of the serotonin syndrome, the Hunter criteria did not perform better than the Sternbach and Radomski criteria. Not all cases seem to be of rapid onset and only relatively few cases may present with hyperthermia. The 0 differential diagnosis between serotonin syndrome and neuroleptic malignant syndrome is not always clear-cut.

Conclusions: Our findings challenge four commonly made assumptions about serotonin syndrome. We propose our meta-analysis of cases (MAC) method as a new way to systematically pool and interpret anecdotal but important clinical information concerning uncommon or emergent phenomena that cannot be captured in any other way but through case reports.

Emneord
Serotonin syndrome, Serotonin toxicity, Antidepressive agents, Drug interactions, Diagnosis, fferential, Neuroleptic malignant syndrome, Criteria, Meta-analysis
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-124329 (URN)10.1186/s12883-016-0616-1 (DOI)000379740400001 ()27406219 (PubMedID)
Tilgjengelig fra: 2016-12-14 Laget: 2016-08-04 Sist oppdatert: 2018-06-09bibliografisk kontrollert
Ott, M., Stegmayr, B., Salander Renberg, E. & Werneke, U. (2016). Lithium intoxication: Incidence, clinical course and renal function - a population-based retrospective cohort study. Journal of Psychopharmacology, 30(10), 1008-1019
Åpne denne publikasjonen i ny fane eller vindu >>Lithium intoxication: Incidence, clinical course and renal function - a population-based retrospective cohort study
2016 (engelsk)Inngår i: Journal of Psychopharmacology, ISSN 0269-8811, E-ISSN 1461-7285, Vol. 30, nr 10, s. 1008-1019Artikkel i tidsskrift (Fagfellevurdert) Published
Abstract [en]

When prescribing lithium, the risk of toxicity remains a concern. In this study, we examined a cohort of patients exposed to lithium between 1997 and 2013. The aims of this study were to determine the frequency of lithium intoxication and to evaluate the clinical course and changes in renal function. Of 1340 patients, 96 had experienced at least one episode of lithium levels ⩾1.5 mmol/L, yielding an incidence of 0.01 per patient-year. Seventy-seven patients available for review had experienced 91 episodes, of whom 34% required intensive care and 13% were treated with haemodialysis. There were no fatalities. Acute kidney injury occurred, but renal function at baseline was not different to renal function after the episode. Renal impairment was often associated with co-morbidities and other factors. Both intermittent and continuous-venovenous haemodialysis were used, but the clearance of continuous-venovenous haemodialysis can be too low in cases where large amounts of lithium have been ingested. Saline and forced diuresis have been used and are safe. Lithium intoxication seems rare and can be safely managed in most cases. Physicians should not withhold lithium for fear of intoxication in patients who benefit from it. Yet, physicians should have a low threshold to screen for toxicity.

Emneord
Lithium, bipolar affective disorder, intoxication, renal impairment, haemodialysis
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-123407 (URN)10.1177/0269881116652577 (DOI)000384688900007 ()27307388 (PubMedID)
Tilgjengelig fra: 2016-07-01 Laget: 2016-07-01 Sist oppdatert: 2018-06-07bibliografisk kontrollert
Werneke, U., Ott, M., Stegmayr, B. & Salander Renberg, E. (2015). Does severe affective disorder affect renal function?. Journal of Psychosomatic Research, 78(6), 630-631
Åpne denne publikasjonen i ny fane eller vindu >>Does severe affective disorder affect renal function?
2015 (engelsk)Inngår i: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 78, nr 6, s. 630-631Artikkel i tidsskrift, Meeting abstract (Annet vitenskapelig) Published
Abstract [en]

Background: There is a relationship between affective and somatic morbidity. For instance, patients with bipolar affective disorder (BPAD) and schizophrenia have more diabetes mellitus and a higher cardiovascular mortality. Psychotropic medications seem to only partly account for such associations. The aim of the study was to compare renal function of patients with severe affective disorders with the general population. Method: We examined a representative sample of the population between 25 and 74 years (Northern Sweden Monica Study) and all individuals with comparable age in the Swedish county of Norrbotten with a diagnosis of BPAD, schizoaffective disorder or exposure to lithium between 1997 and 2013 as a proxy for severe affective disorder. All patients were included who consented to the review of their medical case notes and who had a serum creatinine level taken at least within one year of our analysis. We compared the most recent creatinine levels and the eGFR ascertained with the CKD-EPI formula. Results: 955 individuals with severe affective disorder (61% female, 39% male) had a serum creatinine measured in the year of study. 1549 persons (52% female, 48% male) were in the control group. Mean age differed significantly (p < 0.01) between control (mean 51.8 years, SD 13.5) and patients (mean 50.4 years, SD 13.3). 37.8% of the patients had never been exposed to lithium during the last 17 years, 14.3% less than one year, 15.2% 1–5 years and 32.7% more than 5 years. Mean eGFR for the control was 90.19 ml/min/1.73 m2 (SD 15.8) and 90.89 (SD 19.5) in the patient group (p = 0.33). Five people had renal function below 30 ml/min, two in the control group (eGFR 15–30) and three in the long-term lithium group (eGFR < 15). There was no statistically significant difference in renal function between patients and controls as measured. But patients were slightly younger than the controls (1.4 year difference in mean age). Only if the “natural” annual decline in GFR was assumed to be 1.5 ml/min or more, the renal function between both groups would be statistically different. Conclusion: Renal function in patients with severe affective disorders may be lower than in the general population. But, the difference is small and probably without clinical significance in most cases. This would speak against relevant other factors inherently linked to severe affective disorders apart from long-term lithium exposure. We will explore this further in forthcoming analyses.

sted, utgiver, år, opplag, sider
Elsevier, 2015
HSV kategori
Identifikatorer
urn:nbn:se:umu:diva-105245 (URN)10.1016/j.jpsychores.2015.03.138 (DOI)000355060500134 ()
Tilgjengelig fra: 2015-06-24 Laget: 2015-06-22 Sist oppdatert: 2018-06-07bibliografisk kontrollert
Organisasjoner
Identifikatorer
ORCID-id: ORCID iD iconorcid.org/0000-0003-2393-9750