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Werneke, Ursula
Publications (10 of 32) Show all publications
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
Open this publication in new window or tab >>A Mixed Presentation of Serotonin Syndrome Versus Neuroleptic Malignant Syndrome in a 12-Year-Old Boy
2019 (English)In: Pediatric emergency care, ISSN 0749-5161, E-ISSN 1535-1815, Vol. 35, no 5, p. E98-E98Article in journal, Letter (Refereed) Published
Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2019
National Category
Pediatrics
Identifiers
urn:nbn:se:umu:diva-159616 (URN)10.1097/PEC.0000000000001830 (DOI)000467740700007 ()30964850 (PubMedID)
Available from: 2019-06-17 Created: 2019-06-17 Last updated: 2019-06-17Bibliographically approved
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
Open this publication in new window or tab >>Lithium treatment, nephrogenic diabetes insipidus and the risk of hypernatraemia: a retrospective cohort study
2019 (English)In: Therapeutic Advances in Psychopharmacology, ISSN 2045-1253, E-ISSN 2045-1261, Vol. 9Article in journal (Refereed) 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.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
adverse effects, alcoholic intoxication, bipolar disorder, diabetes insipidus, hypernatraemia, lithium
National Category
Endocrinology and Diabetes
Identifiers
urn:nbn:se:umu:diva-158727 (URN)10.1177/2045125319836563 (DOI)000463588000001 ()31007893 (PubMedID)
Available from: 2019-05-21 Created: 2019-05-21 Last updated: 2019-05-21Bibliographically approved
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
Open this publication in new window or tab >>Management of severe arterial hypertension associated with serotonin syndrome: a case report analysis based on systematic review techniques
2019 (English)In: Therapeutic Advances in Psychopharmacology, ISSN 2045-1253, E-ISSN 2045-1261, Vol. 9, p. 1-32Article, review/survey (Refereed) 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.

Place, publisher, year, edition, pages
Sage Publications, 2019
Keywords
antihypertensive agents, arterial hypertension, cyproheptadine, hypertension, propofol, serotonin antagonists, serotonin syndrome
National Category
Pharmacology and Toxicology
Identifiers
urn:nbn:se:umu:diva-157757 (URN)10.1177/2045125318818814 (DOI)000460918500001 ()30886699 (PubMedID)
Available from: 2019-04-08 Created: 2019-04-08 Last updated: 2019-04-08Bibliographically approved
van der Feltz-Cornelis, C. M., Elfeddali, I., Werneke, U., Malt, U. F., Van den Bergh, O., Schaefert, R., . . . Löwe, B. (2018). A European Research Agenda for Somatic Symptom Disorders, Bodily Distress Disorders, and Functional Disorders: Results of an Estimate-Talk-Estimate Delphi Expert Study. Frontiers in Psychiatry, 9, Article ID 151.
Open this publication in new window or tab >>A European Research Agenda for Somatic Symptom Disorders, Bodily Distress Disorders, and Functional Disorders: Results of an Estimate-Talk-Estimate Delphi Expert Study
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2018 (English)In: Frontiers in Psychiatry, ISSN 1664-0640, E-ISSN 1664-0640, Vol. 9, article id 151Article in journal (Refereed) Published
Abstract [en]

Background: Somatic Symptom Disorders (SSD), Bodily Distress Disorders (BDD) and functional disorders (FD) are associated with high medical and societal costs and pose a substantial challenge to the population and health policy of Europe. To meet this challenge, a specific research agenda is needed as one of the cornerstones of sustainable mental health research and health policy for SSD, BDD, and FD in Europe.

Aim: To identify the main challenges and research priorities concerning SSD, BDD, and FD from a European perspective.

Methods: Delphi study conducted from July 2016 until October 2017 in 3 rounds with 3 workshop meetings and 3 online surveys, involving 75 experts and 21 European countries. EURONET-SOMA and the European Association of Psychosomatic Medicine (EAPM) hosted the meetings.

Results: Eight research priorities were identified: (1) Assessment of diagnostic profiles relevant to course and treatment outcome. (2) Development and evaluation of new, effective interventions. (3) Validation studies on questionnaires or semi-structured interviews that assess chronic medical conditions in this context. (4) Research into patients preferences for diagnosis and treatment. (5) Development of new methodologic designs to identify and explore mediators and moderators of clinical course and treatment outcomes (6). Translational research exploring how psychological and somatic symptoms develop from somatic conditions and biological and behavioral pathogenic factors. (7) Development of new, effective interventions to personalize treatment. (8) Implementation studies of treatment interventions in different settings, such as primary care, occupational care, general hospital and specialty mental health settings. The general public and policymakers will benefit from the development of new, effective, personalized interventions for SSD, BDD, and FD, that will be enhanced by translational research, as well as from the outcomes of research into patient involvement, GP-patient communication, consultation-liaison models and implementation.

Conclusion: Funding for this research agenda, targeting these challenges in coordinated research networks such as EURONET-SOMA and EAPM, and systematically allocating resources by policymakers to this critical area in mental and physical well-being is urgently needed to improve efficacy and impact for diagnosis and treatment of SSD, BDD, and FD across Europe.

Place, publisher, year, edition, pages
Frontiers Media S.A., 2018
Keywords
somatic symptom disorder, bodily distress disorder, functional disorders, research agenda, Europe, delphi study, expert survey, EAPM
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-148017 (URN)10.3389/fosyt.2018.00151 (DOI)000431957000001 ()
Available from: 2018-05-30 Created: 2018-05-30 Last updated: 2018-06-09Bibliographically approved
Werneke, U. & Bhugra, D. (2018). Culture makes a person. Nordic Journal of Psychiatry, 72, S1-S2
Open this publication in new window or tab >>Culture makes a person
2018 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, p. S1-S2Article in journal, Editorial material (Other academic) Published
Place, publisher, year, edition, pages
Taylor & Francis, 2018
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-156909 (URN)10.1080/08039488.2018.1525645 (DOI)000458264000001 ()30380984 (PubMedID)
Note

Supplement 1

Available from: 2019-03-09 Created: 2019-03-09 Last updated: 2019-03-09Bibliographically approved
Werneke, U. & Bergdahl, I. A. (2018). Diet, environment and mental health. In: Bhugra D., Bhui K., Wong S., Gilman S. (Ed.), The Oxford Textbook of Public Mental Health: . Oxford: Oxford University Press
Open this publication in new window or tab >>Diet, environment and mental health
2018 (English)In: The Oxford Textbook of Public Mental Health / [ed] Bhugra D., Bhui K., Wong S., Gilman S., Oxford: Oxford University Press, 2018Chapter in book (Refereed)
Abstract [en]

This chapter reviews dietary and environmental factors that may affect mental health. It takes a public health angle but examines the individual patient perspective where relevant. In the first part, the chapter looks at the impact of various nutritional constituents on mental health, including omega-3 fatty acids, vitamins, and minerals. Then, it reviews the evidence for diets and ‘superfoods’, which people might try to improve their mental health. Here, the focus is on neurodevelopmental disorders, depression, and psychosis. Potential interactions between foodstuffs and psychotropic medicines are also explored. The final part concerns environmental toxins that populations may be exposed to that may affect mental health, including lead, methylmercury, and various organic compounds.

Place, publisher, year, edition, pages
Oxford: Oxford University Press, 2018
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-158705 (URN)10.1093/med/9780198792994.003.0047 (DOI)978-0-19-879299-4 (ISBN)
Note

Chapter 47

Available from: 2019-05-07 Created: 2019-05-07 Last updated: 2019-05-28Bibliographically approved
Taylor, D. M. & Werneke, U. (2018). Ethnopharmacology. Paper presented at 4th Conference on Masterclass Psychiatry - Transcultural Psychiatry - Diagnostics and Treatment, FEB 22-23, 2018, Luleå, Sweden. Nordic Journal of Psychiatry, 72, S30-S32
Open this publication in new window or tab >>Ethnopharmacology
2018 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, p. S30-S32Article in journal (Refereed) Published
Abstract [en]

Background: Ethnopharmacology relates to the study of substances used medicinally by different ethnic or cultural groups or handling of, drugs-based ethnicity or pharmacogenetics.

Aims: To review the key aspects of ethnopharmacology.

Method: This lecture gives an overview of the relationship between geography, culture, pharmacogenomics and prescribing.

Results: Although the majority of antipsychotics, antidepressants and mood-stabilisers are widely and cheaply available in generic forms, prescription rates can vary. Clozapine is one such example with prescribing-rates ranging from less than 10 patients per 100,000 people to nearly 180 patients/100,000 people. Pharmacogenetic studies of antipsychotics and antidepressants concern gene polymorphisms that may affect both, pharmacodynamic or pharmacokinetic properties. Considerable genetic and ethnic variability has been seen for the P450 microsomal enzymes CYP 2D6 and 1A2.

Conclusions: With accelerated global mobility and increased understanding of medicinal substances at molecular level, understanding of ethnopharmacology will become increasingly important in routine clinical practice.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Ethnopharmacology, pharmacogenomics, CYP, antipsychotics, antidepressants
National Category
Pharmacology and Toxicology
Identifiers
urn:nbn:se:umu:diva-156906 (URN)10.1080/08039488.2018.1525636 (DOI)000458264000010 ()30688173 (PubMedID)
Conference
4th Conference on Masterclass Psychiatry - Transcultural Psychiatry - Diagnostics and Treatment, FEB 22-23, 2018, Luleå, Sweden
Note

Supplement 1

Available from: 2019-03-09 Created: 2019-03-09 Last updated: 2019-03-19Bibliographically approved
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
Open this publication in new window or tab >>Lithium use among psychiatric patientsor: a risk factor for hypernatremia?
2018 (English)In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 109, p. 103-103Article in journal, Meeting abstract (Other academic) 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.

Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-149113 (URN)10.1016/j.jpsychores.2018.03.058 (DOI)000433271100061 ()
Conference
6th annual scientific conference of the European Association of Psychosomatic Medicine (EAPM), Verona, June 27-30, 2018.
Note

Meeting Abstract: 47

Available from: 2018-06-15 Created: 2018-06-15 Last updated: 2018-06-15Bibliographically approved
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.
Open this publication in new window or tab >>Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study
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2018 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, article id 37Article in journal (Refereed) 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.

Keywords
Lithium, Bipolar disorder, Physical health, Compliance, Side effects
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-145594 (URN)10.1186/s12888-018-1622-1 (DOI)000424707200003 ()29415689 (PubMedID)
Note

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

Available from: 2018-04-04 Created: 2018-04-04 Last updated: 2019-05-06Bibliographically approved
Taylor, D. M., Velaga, S. & Werneke, U. (2018). Reducing the stigma of long acting injectable antipsychotics: current concepts and future developments. Paper presented at 4th Conference on Masterclass Psychiatry - Transcultural Psychiatry - Diagnostics and Treatment, FEB 22-23, 2018, Luleå, Sweden. Nordic Journal of Psychiatry, 72, S36-S39
Open this publication in new window or tab >>Reducing the stigma of long acting injectable antipsychotics: current concepts and future developments
2018 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, p. S36-S39Article in journal (Refereed) Published
Abstract [en]

Background: Long acting injectable antipsychotics (LAI-APs) are considered a major advance in psychiatric treatment concerning treatment adherence and outcomes. Yet, both, doctors and patients remain sceptical.

Aim: To explain the rationale for using LAI-APs, review their effectiveness and explore barriers to use.

Method: Clinical overview of LAI-APs from the patient and doctor's perspective.

Results: LAI-APs were developed to increase adherence to treatment, thereby improving treatment outcomes. LAI-APs may reduce the risk of relapse and hospitalisation. Yet, the evidence from the few meta-analyses available remains weak. Both patients and doctors may associate LAI-APs with stigma and coercion. Current means of improving adherence include more focus on the therapeutic relationship, better information, adverse effects minimisation and half-life extension of LAI-APs. Future means of improving adherence include novel administration techniques that abolish the need for injection.

Conclusions: For both, clinicians and drug developers, drug adherence remains a major target for improving treatment outcomes.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Antipsychotics, long-acting injections, adherence, relapse, blood-brain-barrier
National Category
Psychiatry
Identifiers
urn:nbn:se:umu:diva-156907 (URN)10.1080/08039488.2018.1525638 (DOI)000458264000012 ()30688170 (PubMedID)
Conference
4th Conference on Masterclass Psychiatry - Transcultural Psychiatry - Diagnostics and Treatment, FEB 22-23, 2018, Luleå, Sweden
Note

Supplement 1

Available from: 2019-03-09 Created: 2019-03-09 Last updated: 2019-03-19Bibliographically approved
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