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  • 1. Ajob, Leith
    et al.
    Brännström, Ingrid
    Ott, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Fellow of the Royal College of Psychiatrists (FRCPsych).
    ABC om Wernickes encefalopati2017Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, nr ELZTArtikel i tidskrift (Refereegranskat)
  • 2. Forssén, B.
    et al.
    Ott, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Lithium use among psychiatric patientsor: a risk factor for hypernatremia?2018Ingår i: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 109, s. 103-103Artikel i tidskrift (Övrigt vetenskapligt)
    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.

  • 3. Ladenheim, D
    et al.
    Horn, O
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Phillpot, M
    Murungi, A
    Theobald, N
    Orkin, C
    Potential health risks of complementary alternative medicines in HIV patients.2008Ingår i: HIV Medicine, ISSN 1464-2662, E-ISSN 1468-1293, Vol. 9, nr 8, s. 653-9Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There are potentially significant health risks posed by the concomitant use of CAMs in patients taking ARV therapy. Medical practitioners need to be able to identify CAM use in HIV-positive patients and recognize potential health risks. Patients should be encouraged to disclose CAM use to their clinicians and other healthcare professionals.

  • 4.
    Lakhanpaul, Monica
    et al.
    Academic Division of Child Health, Department of Medical Education and Social Care, Leicester Royal Infirmary, Leicester, UK.
    MacFaul, R
    Pinderfields General Hospital, Wakefield, UK.
    Werneke, Ursula
    Homerton University Hospital and Institute of Psychiatry, East London and City Mental Health Trust, London, UK.
    Armon, K
    Norfolk and Norwich University Hospital NHS Trust, Norwich, UK.
    Hemingway, P
    School of Health and Related Research, University of Sheffield, Sheffield, UK.
    Stephenson, T
    Academic Division of Child Health, School of Human Development, University of Nottingham, Nottingham, UK.
    An evidence-based guideline for children presenting with acute breathing difficulty2009Ingår i: Emergency Medicine Journal, ISSN 1472-0205, E-ISSN 1472-0213, Vol. 26, nr 12, s. 850-853Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We have developed an evidence-based guideline that has subsequently been successfully implemented in the paediatric emergency departments and disseminated nationally. Results showing the effect of the guideline upon practice will be published separately.

  • 5.
    Ott, Michael
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Forssén, Björn
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Sunderby Research Unit, Umeå University, Umeå, Sweden.
    Lithium treatment, nephrogenic diabetes insipidus and the risk of hypernatraemia: a retrospective cohort study2019Ingår i: Therapeutic Advances in Psychopharmacology, ISSN 2045-1253, E-ISSN 2045-1261, Vol. 9Artikel i tidskrift (Refereegranskat)
    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.

  • 6.
    Ott, Michael
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Mannchen, Julie K.
    Jamshidi, Fariba
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Sunderby Research Unit.
    Management of severe arterial hypertension associated with serotonin syndrome: a case report analysis based on systematic review techniques2019Ingår i: Therapeutic Advances in Psychopharmacology, ISSN 2045-1253, E-ISSN 2045-1261, Vol. 9, s. 1-32Artikel, forskningsöversikt (Refereegranskat)
    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.

  • 7. Ott, Michael
    et al.
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Salander Renberg, Ellinor
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Lithium intoxication: Incidence, clinical course and renal function - a population-based retrospective cohort study2016Ingår i: Journal of Psychopharmacology, ISSN 0269-8811, E-ISSN 1461-7285, Vol. 30, nr 10, s. 1008-1019Artikel i tidskrift (Refereegranskat)
    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.

  • 8.
    Ott, Michael
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Salander Renberg, Ellinor
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Sunderby Research Unit – Psychiatry.
    Prognosis and outcome of severe lithium poisoning: authors' reply2017Ingår i: Journal of Psychopharmacology, ISSN 0269-8811, E-ISSN 1461-7285, Vol. 31, nr 9, s. 1275-1277Artikel i tidskrift (Refereegranskat)
  • 9.
    Ott, Michael
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Sunderby Research Unit.
    A Mixed Presentation of Serotonin Syndrome Versus Neuroleptic Malignant Syndrome in a 12-Year-Old Boy2019Ingår i: Pediatric emergency care, ISSN 0749-5161, E-ISSN 1535-1815, Vol. 35, nr 5, s. E98-E98Artikel i tidskrift (Refereegranskat)
  • 10. Taylor, David M.
    et al.
    Velaga, Sitaram
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Reducing the stigma of long acting injectable antipsychotics: current concepts and future developments2018Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, s. S36-S39Artikel i tidskrift (Refereegranskat)
    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.

  • 11. Taylor, David M.
    et al.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Ethnopharmacology2018Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, s. S30-S32Artikel i tidskrift (Refereegranskat)
    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.

  • 12. van der Feltz-Cornelis, Christina M.
    et al.
    Elfeddali, Iman
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Sunderby Research Unit.
    Malt, Ulrik F.
    Van den Bergh, Omer
    Schaefert, Rainer
    Kop, Willem J.
    Lobo, Antonio
    Sharpe, Michael
    Söllner, Wolfgang
    Löwe, Bernd
    A European Research Agenda for Somatic Symptom Disorders, Bodily Distress Disorders, and Functional Disorders: Results of an Estimate-Talk-Estimate Delphi Expert Study2018Ingår i: Frontiers in Psychiatry, ISSN 1664-0640, E-ISSN 1664-0640, Vol. 9, artikel-id 151Artikel i tidskrift (Refereegranskat)
    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.

  • 13.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    A lively mind in a frozen body: the history of Rickety Kate—an australian poet who suffered from rheumatoid arthritis2011Ingår i: Journal of Evidence-Based Complementary & Alternative Medicine, ISSN 2156-5872, Vol. 16, nr 3, s. 233-238Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    "Rickety Kate” was the descriptive name of Minnie Agnes Filson, a popular Australian poet featured widely in the Australian media from the 1930s through to the 1960s. The assumed name was a reflection of her severe rheumatoid arthritis, which left her completely immobilized. During her lifetime, Kate received a variety of conventional medical treatments, which proved largely ineffective. She finally turned to an Indian healer, who managed to improve her quality of life although her physical disabilities persisted. This article explores the history of rheumatoid arthritis from a patient’s perspective in the light of the scientific knowledge at the time and critically reflects on the relationship between conventional and complementary/alternative medicine then and today.

  • 14.
    Werneke, Ursula
    Sunderby Hospital, Department of Psychiatry, Luleå, Sweden.
    Book reviews: How to use herbs, nutrients, and yoga in mental health care. By Richard P. Brown, Patricia L. Garbarg & Philip R. Muskin ; Norton & Company. 2009. 352pp. ISBN: 97803937052562009Ingår i: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 195, nr 6, s. 559-Artikel i tidskrift (Refereegranskat)
  • 15.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Complementary and alternative therapies2017Ingår i: The female mind: a user's guide / [ed] Kathryn Abel, RCPsych Publications , 2017, s. 231-237Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    Complementary and alternative therapies are popular all over the world. Some complementary therapies, such as certain herbal remedies and acupuncture, are thousands of years old. But we still know comparatively little about most of them, because systematic research has only become available in the past few decades.

  • 16.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Complementary and alternative treatments in mental health care2008Ingår i: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 192, nr 1, s. 75-76Artikel i tidskrift (Refereegranskat)
  • 17.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Complementary medicines2009Ingår i: The New Oxford Textbook of Psychiatry, 2nd edition / [ed] Gelder M, Lopez-Ibor, Andreasen NC, Geddes J, Oxford University Press , 2009Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 18.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Complementary medicines in mental health2009Ingår i: Evidence-Based Mental Health, ISSN 1362-0347, E-ISSN 1468-960X, Vol. 12, nr 1, s. 1-4Artikel i tidskrift (Refereegranskat)
  • 19.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Psychiatry and reality: perception of matter or matter of perception?2011Ingår i: NeuroQuantology, ISSN 1303-5150, Vol. 9, nr 1, s. 190-201Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Current concepts of delusion rely on the assumption that one single objective external reality exists as a benchmark for our internal experiences. With the advent of quantum theory this assumption has become untenable. Accepting the Copenhagen interpretation that there is no reality beyond what is revealed by the act of measurement or observation implies that there is no objective reality. One alternative interpretation of quantum theory is the "many worlds" interpretation which finds its philosophical correlate in the "plurality of worlds" theory. However, the idea of all possible worlds being not just possible but real is even more counter-intuitive. Virtual reality is a way to systematically alter the usual relationship between external reality and the user's experience of it. Although virtual reality is not the same as parallel reality and both are separate strands in the "fabric of reality" they are related. With the advance of virtual reality there is already developing an increasing sense that the real and digital worlds seem to converge. But even if we believed in only one single objective external reality we could still never experience this reality directly. Our experience of reality is essentially one of virtual reality as generated by our brain. The "many worlds" interpretation implies that other copies of our brain rendering other experiences exist. Thus, in view of the uncertain nature of reality it is necessary to rethink our accepted concept of psychosis. Currently, meticulous history taking and accurate clinical observation remains our best option trying to understand psychotic symptoms.

  • 20.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Review: adding Chinese herbal medicine to antipsychotics may improve some outcomes in schizophrenia, but more high quality trials are needed.2008Ingår i: Evidence-Based Mental Health, ISSN 1362-0347, E-ISSN 1468-960X, Vol. 11, nr 1, s. 19-Artikel i tidskrift (Refereegranskat)
  • 21. Werneke, Ursula
    Transforming health with evidence and empathy: : A report from the fourth annual scientific conference of the EAPM 2016 in Luleå, Sweden2016Ingår i: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 88, artikel-id 14Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    With the European Association of Psychosomatic Medicine (EAPM) now in its fourth year after the amalgamation of two major European psychosomatic societies, the conference traveled far north to Luleå, right beneath the Arctic Circle in Sweden. Over 400 delegates from 40 countries in Scandinavia, Europe and across the world made their way to Luleå to share their clinical and research expertise with us. We were humbled by the extraordinary efforts some delegates took to reach us. What would usually have been an easy to reach destination with about twenty flights on weekdays from Stockholm turned out to be a real challenge. Air traffic had been hit by industrial action of Swedish pilots. The walk-out just resolved 36 h before the conference commenced. While we were determined to keep calm and carry on, people, in true fighting spirit, made it to Luleå irrespective of all obstacles. We had chosen the conference theme “Transforming Health with Evidence and Empathy” to reflect the enormous challenges today's practitioners of psychosomatic medicine encounter. What Sir William Osler knew already 200 years ago still holds today: “It is much more important to know what sort of patient has a disease than what sort of disease a patient has.” Modern science adds a biological dimension to this fundamental insight and the keynotes followed this line of thinking. In the first plenary, we explored the link between evidence and empathy with Gary Rodin (Toronto), Carmine Pariante (London) and Manfred Beutel (Mainz). The second plenary tackled insomnia and obesity with Colin Shapiro (Toronto) and Gladys Witt-Strain (New York). The third plenary, Neuroscience between Body and Mind” was brought to us by Tjörborn Elvsåshagen (Oslo), Rikard Wicksell (Stockholm) and Robert Maunder (Toronto). In his Frits Huyse award lecture, James Strain (New York), argued that depression was a systematic disease and not simply a mental health problem. Then, Michael Sharpe (Oxford), winner of this year's Alison Creed award, tied it all together, stressing the need of integrating physical and mental health care. An absolute highlight was the opening keynote by Sir Simon Wessely, President of the Royal College of Psychiatrists. In his uniquely entertaining style, he reminded us that current undergraduate medical training with its focus on clear-cut tangible diseases left new doctors poorly equipped to deal with the plethora of chronic symptoms, syndromes and soft signs, still awaiting neurobiological explanation. That is why the EAPM annual conference is so important. This meeting provides an opportunity to share expertise concerning conditions commonly encountered but rarely taught. The EAPM 2016 followed the APM example and opened itself to clinicians. Both research and clinical masterclasses and workshops were woven into the main conference to increase cohesion of the program and ensure that researchers and clinicians remained equally engaged throughout the conference. Particularly popular proved our in-house Masterclass Psychopharmacology in collaboration with the Maudsley Hospital in London, the masterclass Functional Disorders from Aarhus University and a workshop on cognitive assessment in young and old delivered by psychologists from Maastricht and Aarhus University. In the spirit of building bridges between clinicians and researchers, Luleå South Rotary Club had generously donated a Young Health Professionals Travel Award for a practitioner from a middle or low income country. Dr. Deirdre Pieterse, a psychiatrist from Cape Town, South Africa, proved a worthy winner and we wish her luck with her continued training in liaison psychiatry. The conference was rounded off by a powerful concert with Sami singer, Sofia Jannok and Norrbotten Big Band, followed by a midsummer themed dinner, complete with typical Swedish midsummer weather of rain and grey skies. We were delighted to welcome to this year's EAPM some of world's most eminent experts of psychosomatic medicine and liaison psychiatry. The conference theme “Transforming Health with Evidence and Empathy” has provoked many thoughts, some of which we have encapsulated in our EAPM 2016 conference video. And if the EAPM 2016 has demonstrated that evidence and empathy do not exclude but complement each other, we feel accomplished in our mission. Still, there is a lot to be done. Let's continue the dialogue at the EAPM 2017 in Barcelona next year

  • 22.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Sunderby Hospital Luleå.
    Weight or shape: finding your way to diet and exercise2017Bok (Refereegranskat)
  • 23.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Withania somnifera: From Ayurveda towards Western medical practice: a systematic review2009Ingår i: Recent Progress in Medicinal Plants: Search for Natural Drugs / [ed] V.K. Singh, J.N. Govil, Houston: Studium Press LLC , 2009, s. 237-256Kapitel i bok, del av antologi (Övrigt vetenskapligt)
    Abstract [en]

    Withania somnifera (WS) has been used in ayurvedic medicine for more than 3000 years and has been implicated as of potential benefit for various somatic conditions. This study was conducted to define the potential of WS for further development and integration into the disease and symptom oriented Western medical system through systematic review of the Medline and Cochrane databases. The current evidence base on WS is currently limited to in vitro and animal experiments. The underlying mechanisms of action of WS identified seem to rely predominantly on antioxidant properties and stimulation of the cellular immune system. Thus, WS may potentially be of use as an adjunctive treatment of cancer, infections and inflammatory processes so far as stimulation of the immune system is desirable. WS may also be beneficial in the prevention or amelioration of neurodegenerative processes associated with oxidative stress as well as osteoarthritis. Although further proof of principle work is required, the development of WS as a disease oriented medicinal substance now requires well-designed clinical studies in humans.

  • 24.
    Werneke, Ursula
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Department of Psychiatry, Sunderby Hospital, Luleå, Sweden.
    Bergdahl, Ingvar A.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Yrkes- och miljömedicin.
    Diet, environment and mental health2018Ingår i: The Oxford Textbook of Public Mental Health / [ed] Bhugra D., Bhui K., Wong S., Gilman S., Oxford: Oxford University Press, 2018Kapitel i bok, del av antologi (Refereegranskat)
    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.

  • 25.
    Werneke, Ursula
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Sunderby Research Unit.
    Bhugra, Dinesh
    Culture makes a person2018Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, s. S1-S2Artikel i tidskrift (Övrigt vetenskapligt)
  • 26.
    Werneke, Ursula
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Sunderby Hospital, 97180 Luleå, Sweden.
    Jamshidi, Fariba
    Taylor, David M.
    Ott, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Conundrums in neurology: diagnosing serotonin syndrome - a meta-analysis of cases2016Ingår i: BMC Neurology, ISSN 1471-2377, E-ISSN 1471-2377, Vol. 16, artikel-id 97Artikel i tidskrift (Refereegranskat)
    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.

  • 27.
    Werneke, Ursula
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Department of Clinical Sciences, Sunderby Research Unit.
    Ott, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Response to "The impact of modern treatment principles may have eliminated lithium-induced renal failure" Aiff et al. 20142014Ingår i: Journal of Psychopharmacology, ISSN 0269-8811, E-ISSN 1461-7285, Vol. 28, nr 12, s. 1189-1190Artikel i tidskrift (Refereegranskat)
  • 28.
    Werneke, Ursula
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Department of Psychiatry, Sunderby Hospital, Lulea, Sweden.
    Ott, Michael
    Department of Nephrology Division of Internal Medicine Sunderby Hospital Luleå, Sweden.
    Salander Renberg, Ellinor
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Stegmayr, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Taylor, D.
    Pharmacy Department South London and Maudsley NHS Foundation Trust and the Institute of Pharmaceutical Sciences, King's College, London London, UK.
    Long-term lithium treatment and the risk of renal failure vs. risk of suicide: a decision analysis2012Ingår i: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 72, nr 6, s. 508-508Artikel i tidskrift (Övrigt vetenskapligt)
  • 29.
    Werneke, Ursula
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Ott, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin. Division of Internal Medicine, Department of Nephrology, Sunderby Hospital, Luleå, Sweden.
    Salander Renberg, Ellinor
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Taylor, D
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    A decision analysis of long-term lithium treatment and the risk of renal failure2012Ingår i: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 126, nr 3, s. 186-197Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To establish whether lithium or anticonvulsant should be used for maintenance treatment for bipolar affective disorder (BPAD) if the risks of suicide and relapse were traded off against the risk of end-stage renal disease (ESRD).

    Method: Decision analysis based on a systematic literature review with two main decisions: (1) use of lithium or at treatment initiation and (2) the potential discontinuation of lithium in patients with chronic kidney disease (CKD) after 20 years of lithium treatment. The final endpoint was 30 years of treatment with five outcomes to consider: death from suicide, alive with stable or unstable BPAD, alive with or without ESRD.

    Results: At the start of treatment, the model identified lithium as the treatment of choice. The risks of developing CKD or ESRD were not relevant at the starting point. Twenty years into treatment, lithium still remained treatment of choice. If CKD had occurred at this point, stopping lithium would only be an option if the likelihood of progression to ESRD exceeded 41.3% or if anticonvulsants always outperformed lithium regarding relapse prevention.

    Conclusion: At the current state of knowledge, lithium initiation and continuation even in the presence of long-term adverse renal effects should be recommended in most cases.

  • 30.
    Werneke, Ursula
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Ott, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Salander Renberg, Ellinor
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Does severe affective disorder affect renal function?2015Ingår i: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 78, nr 6, s. 630-631Artikel i tidskrift (Övrigt vetenskapligt)
    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.

  • 31.
    Werneke, Ursula
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Taylor, David
    Sanders, Thomas A. B.
    Behavioral Interventions for Antipsychotic Induced Appetite Changes2013Ingår i: Current Psychiatry Reports, ISSN 1523-3812, E-ISSN 1535-1645, Vol. 15, nr 3, s. 347-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Weight gain remains a well recognized yet difficult to treat adverse effect of many anti-psychotic drugs including agents of the first and second generation. The weight gain liabilities of antipsychotic drugs are partly associated with their ability to increase appetite. Most behavioral interventions for weight control remain of limited efficacy, possibly because they do not specifically target the neuroendocrine factors regulating appetite. Identifying new weight management interventions directly acting on the biochemical and neuroendocrine mechanisms of anti-psychotic induced weight gain may help to improve the efficacy of behavioral weight management programs. Such potentially specific strategies include (1) using diets which do not increase appetite despite calorie restriction; (2) countering thirst as an anticholinergic side-effect; (3) discouraging cannabis use and (4) adding metformin to a behavioral intervention. In view of our currently rather limited treatment repertoire it seems timely systematically to explore such novel options.

  • 32.
    Öhlund, Louise
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Ott, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Oja, Sofia
    Bergqvist, Malin
    Lundqvist, Robert
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Renberg, Ellinor Salander
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Sunderby Hospital – Psychiatry, 97180 Luleå, Sweden.
    Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study2018Ingår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, artikel-id 37Artikel i tidskrift (Refereegranskat)
    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.

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