Some systemic markers of inflammation in older adults with psychiatric disorders

Research has demonstrated that inflammation is a central part of several psychiatric disorders, of which depression in the most researched condition. Most studies have, however, been conducted on younger adults, and studies on elderly are scarce. This thesis explores the possible association between systemic markers of inflammation and characteristics of older psychiatric patients. In study I, we investigated possible correlations between the levels of 27 cytokines in plasma, and clinical and demographical variables, in diagnostically unselected in-patients that were 60 years and older (N = 98). We found no significant associations between cytokine levels and diagnoses, nor any other variables. However, we did find higher levels of 10 cytokines in the non-depressed patients, possibly as a result of the higher prevalence of cardiovascular disease and dementia. In study II, we explored whether changes in the level of 27 cytokines plasma during the treatment of diagnostically unselected psychiatric in-patients aged 60 years or more (N = 49) could be related to clinical and demographical variables, as well as self-reported clinical improvement. We found a positive correlation between clinical improvement and falling cytokine levels (p < 0.033), irrespective of psychiatric diagnoses or other variables. In study III, we investigated possible correlations between two levels of depression - moderate and moderate-severe depression - and CRP in serum, in younger (40 - 59 years) versus older adults (≥ 60 years) (N = 19,947). We found a multi-adjusted association between depression and elevated CRP in younger adults, but not in older adults. The studies of this thesis could not confirm an association between markers of systemic inflammation, and diagnoses and other characteristics of older adults with psychiatric disorders. In particular, this research could not, unlike most studies on younger adults, confirm a link between markers of systemic inflammation and depression in older adults.Depresjon – en betent sak? Betennelse er kroppens generelle respons på sykdom og skade. For eksempel svarer kroppen med betennelse når vi angripes av et virus eller får et spark på leggen. Ved en betennelse frigjøres betennelsesstoffer fra stedet hvor infeksjonen eller skaden er. Disse stoffene fungerer som kallesignaler for de hvite blodlegemene og gjør at blodgjennom-strømmingen øker, slik at kroppens forvar kommer i gang. For å finne ut om man har en betennelse i kroppen kan man undersøke mengden av betennelsesstoffer i blodet, som for eksempel CRP eller såkalte cytokiner. CRP produseres i leveren og cytokinene produseres av immuncellene. Forskning har vist at det kan oppstå betennelse i kroppen også når vi rammes av en psykisk lidelse. Det man har forsket mest på er depresjon. Her viser forskningen at deprimerte personer har økte nivåer av betennelsesstoffer i blodet. Man har også funnet at mengden av betennelsesstoffer samsvarer med hvor deprimert man er, og hvilken prognose man har. Det aller meste av forskningen på dette feltet er utført på yngre voksne. Eldre voksne, dvs. personer som er 60-65 år eller eldre, er sjelden inkludert i forskningen. Forskningen vår fokusert spesielt på eldre. Vi har sett på om det er sammenheng mellom betennelsesstoffer og ulike psykiske lidelser, spesielt depresjon, hos personer som er 60 år og eldre. I denne forskningen inngår to studier av eldre pasienter innlagt ved en alderspsykiatrisk avdeling, og én befolkningsstudie (den syvende Tromsøundersøkelsen). Resultantene viser at det ikke er noen sikker sammenheng mellom psykisk lidelser og betennelse hos eldre. Det er særlig interessant at man ikke finner noen sammenheng mellom depresjon og betennelse hos eldre, noe som skiller seg fra tilsvarende forskning på yngre personer. En mulig grunn til dette er at immunsystemet til eldre oppfører seg annerledes enn hos yngre

Probable clozapine-induced parenchymal lung disease and perimyocarditis: A case report

Background: Clozapine is the archetypical atypical antipsychotic, its primary indication being treatment resistant schizophrenia. Severe side effects caused by clozapine, including leukopenia, agranulocytosis, and myocarditis, are well known. A rarely described side effect is concurrent perimyocarditis and parenchymal lung disease. Case presentation: A previously physically healthy 23-year-old male Caucasian that suffered from schizophrenia presented with flu-like symptoms 1 week after starting clozapine treatment. Treatment with clozapine was discontinued. He developed respiratory distress. Investigations showed significant parenchymal infiltration in both of the lungs, pericardial fluid, and heart failure. He initially received treatment for suspected malignant neuroleptic syndrome and later for suspected infection, but these tentative diagnoses were not confirmed. The patient’s condition gradually improved. In retrospect, clozapine-induced parenchymal lung disease and perimyocarditis were deemed the most probable causes. Conclusions: Concurrent perimyocarditis and parenchymal lung disease are rare side effects of clozapine. Clozapine-induced disease in general is considered an exclusion diagnosis. Lacking a verifiable diagnosis when suspecting a side effect of clozapine, clinicians might treat the most likely and serious condition presenting and consider discontinuing clozapine until the diagnostic uncertainty is reasonably resolved

C-reactive protein levels and depression in older and younger adults - A study of 19,947 individuals. The Tromsø study

In recent years, a connection between depression and inflammation has been established, with a range of immunological changes, both cellular and humoral, presenting during depressive states (Beydoun et al., 2016; Haapakoski et al., 2015; Wium-Andersen et al., 2013). Furthermore, there seems to be a dose-response relationship between depression and inflammation, in the sense that the more severe the depression, the higher the level of systemic inflammation markers, most notably expressed as elevated levels of C-reactive protein (CRP) in peripheral blood (Kohler-Forsberg et al., 2017). Accordingly, CRP has been suggested as a marker of depression severity and depression subtypes, as well as an indicator of specific symptom profiles (Jokela et al., 2016). Furthermore, inflammation has been suggested as a target for treatment with immunomodulatory drugs (Alexopoulos and Morimoto, 2011; Kohler et al., 2014). However, the research populations are predominantly younger adults, mainly in clinical settings, and there are few community-based studies providing comparative analyses of age-groups, or focusing specifically on the older population. For those that do, the results are inconsistent, as some demonstrate an association between CRP and depression (Bondy et al., 2021; Sonsin-Diaz et al., 2020; White et al., 2017), while others do not (Baune et al., 2012; Bremmer et al., 2008; Eurelings et al., 2015; Penninx et al., 2003). Thus, it is still unclear whether the inflammation in depression unfolds to the same extent in depressed older adults as in younger adults, and how the severity of the depression relates to inflammation in different age groups

Sport, fotball og folkehøgskole - Sosialisering, gruppeprosesser og elevkulturendringer i den norske folkehøgskolen

Denne oppgaven beskriver endringen i elevkulturen blant idrettselever i folkehøgskolen, i lys av ulike sosialiserings- og gruppeteoretiske forståelser. Det er gjort en del forskning på sosialisering og grupper innenfor mange forskjellige kontekster og aldersgrupper, men folkehøgskolen er et relativt lite berørt forskningsfelt. Sosialisering er noe alle mennesker går gjennom omtrent hele livet, og vennskap og medlemskap i ulike grupper er et viktig aspekt når vi snakker om sosialiseringsprosesser. Ulike sosialiseringsprosesser vil også være viktig når kulturer dannes og endres, også i skolen, og derfor har hovedfokuset i denne oppgaven vært å beskrive hvordan elevene ved en folkehøgskole sosialiseres til en gitt skolekultur, og hvordan de samtidig sosialiseres inn i sin egen elevkultur på skolen. Studien har tatt utgangspunkt i én norsk folkehøgskole som case, og har bestått av to ulike feltbesøk på én ukes varighet, med 11 ukers mellomrom. Oppgaven er en kvalitativ studie, hvor det har blitt gjennomført deltakende observasjon og semistrukturerte intervjuer, både i individuelt og i fokusgruppeformat. Under det første besøket gjennomførte jeg individuelle intervjuer med rektor ved folkehøgskolen og med lærerne på sport- og fotballinja ved skolen. I tillegg var jeg med som deltagende observatør i linjetimene til sport- og fotballinja. Også under det andre besøket var jeg med som deltagende observatør i sport- og fotballtimene, i tillegg til individuelle intervjuer med lærerne på de to linjene og rektor. Under det andre besøket gjennomførte jeg også to fokusgruppeintervju med et utvalg elever fra de to klassene. Dataene er blitt transkribert og analysert ved hjelp av en temasentrert analyse. Analysen viser at elevkulturen i løpet av de 11 ukene har endret seg i form av at den er blitt en elevkultur som i stedet for å stå i et opposisjonsforhold til skolekulturen, støtter opp om denne ved hjelp av en form for sosial kontroll elevene imellom. Videre har elevene blitt sosialisert til en dominerende skolekultur samtidig som de har skapt sin egen elevkultur. Disse prosessene har funnet sted ved ulike sosialiserings- og gruppedannelsesprosesser, som følge av den rollen elevene, rektor og særlig lærerne har som sosialiseringsagenter, og ved bruk av ulike aktiviteter, og spesielt aktiviteter som foregår utendørs. Oppgaven har stor utviklingsdimensjonen, og danner et utgangspunkt for videre forskning i form av at den bidrar til et forskningsfelt som er relativt lite, samtidig som det argumenteres for at videre forskning bør fokusere på longitudinelle og komparative studier, da det vil styrke folkehøgskolen som forskningsfelt. This assignment describes the change in the student culture among sports students in the folk high school, in light of different socialization understandings and group theoretical understandings. A lot of research has been done on socialization and groups in many different contexts and age groups, but folk high school is a relatively small research area. Socialization is something all humans go through throughout their lives, and friendship and membership in different groups is an important aspect when talking about socialization processes. Different socialization processes will also be important when cultures are formed and changed, also in school, and therefore the main focus of this assignment has been to describe how students at a folk high school socialize to a given school culture and how they at the same time are socialized in their own student culture at school. The base of this study is a Norwegian folk high school, which has been used as a case, and has consisted of two different field studies with one week's duration each, with an interval of 11 weeks. The assignment is a qualitative study, where participatory observation and semistructural interviews have been conducted, both individually and in focus groups. During the first visit, I conducted individual interviews with the principal at the folk high school and with the teachers in the sport and football classes at. In addition, I participated as a participating observer in these classes. During the second visit, I also participated as a participating observer in the sport and football classes, as well as conducting individual interviews with the teachers in the two classes and with the principal. During the second visit, I also conducted two focus group interviews with a selection of students from the two classes. The analysis shows that the student culture has changed in the course of the 11 weeks in the form of a student culture that, instead of being in opposition with the school culture, supports this culture by means of a social control among the students. Furthermore, the students have become socialized into a dominant school culture while at the same time creating their own student culture. These processes have taken place in form of different socialization and group formation processes, due to the role the pupils, the principal and especially the teachers have as socializing agents, and through the use of various activities, in particular outdoor activities. The assignment has a large development dimension and forms a starting point for further research in the form of contributing to a relatively small research field, while arguing that further research should focus on longitudinal and comparative studies as it will strengthen the folk high school as a research field

Using SIGMA for Retrieving Japanese Data

Background There is a paucity of studies on inflammatory markers in elderly psychiatric patients. Hence, our study was undertaken to investigate cytokines as biomarkers in diagnostically unselected elderly patients admitted to a psychiatric hospital. Methods Demographic data, clinical data and blood samples, including 27 cytokines, were collected from 98 patients above 60 years, consecutively admitted to a psychiatric hospital in Tromsø, Norway (69°N). Results The most common diagnosis was Recurrent depressive disorder (26.5%), the second most common was dementia in Alzheimer’s disease (20.4%). The most frequent somatic disease was cardiovascular disease (28%). No statistical association (p < 0.01) was found between cytokines and gender, age, BMI, anti-inflammatory drugs, psychotropic drugs, reason for admittance, smoking, vitamin supplements, alcohol consumption, length of stay, somatic disease (present/not-present) or psychiatric diagnoses. However, when allocating patients to two groups, depression and no depression, we found higher levels of 10 cytokines in the no depression group (FDR-p < 0.0044). Possibly, this could in part be explained by the higher prevalence of cardiovascular disease (CVD) and dementia in the no depression group, as these factors were significant predictors of patients being categorized as not depressed in a logistic regression. In addition, other unknown factors might have contributed to the association between no depression and elevated cytokines. On the other hand, the high level of psychiatric and somatic comorbidity in the study population may have led to increased levels of cytokines in general, possibly diluting the potential effect of other factors, depression included, on the cytokine levels. The size of the study, and particularly the size of the subgroups, represents a limitation of the study, as do the general heterogeneity and the lack of a control group. Conclusions There was no significant difference in cytokine levels between various psychiatric diagnoses in hospitalized elderly psychiatric patients. This indicates that previous findings of correlations between cytokines and various psychiatric disorders in highly selected adult cases might not be applicable to elderly psychiatric inpatients. Further immunological studies are needed on gerontopsychiatric patients in general and gerontopsychiatric patients with specific disorders, preferably with patients that are physically healthy

Changes in cytokines during treatment of elderly, hospitalized psychiatric patients - a naturalistic study

Immunological abnormalities have been demonstrated in several psychiatric disorders. Predominantly, studies have focused on younger adults, and research on elderly psychiatric in-patients is scant. In this naturalistic study, we investigated changes in cytokine levels during the treatment of diagnostically unselected elderly psychiatric in-patients, and whether these changes could be related to clinical outcomes. Clinical variables, demographic data, lifestyle data, and blood samples, including 27 plasma cytokines representing a broad spectrum of inflammatory mediators, were collected from 81 patients, 60 years and older, at admission and discharge. A subgroup of 49 patients also completed a self-reported clinical, psychiatric status form, indicating their level of recovery during hospitalisation. Statistical analyses demonstrated that a broad range of cytokines fell during treatment, and the fall was associated with clinical improvement, irrespective of psychiatric and somatic diagnoses. Exploiting cytokines as biomarkers of clinical traits might to be of limited use in a general population of elderly psychiatric in-patients as the field stands now

Changes in cytokines during treatment of elderly, hospitalized psychiatric patients - a naturalistic study

Immunological abnormalities have been demonstrated in several psychiatric disorders. Predominantly, studies have focused on younger adults, and research on elderly psychiatric in-patients is scant. In this naturalistic study, we investigated changes in cytokine levels during the treatment of diagnostically unselected elderly psychiatric in-patients, and whether these changes could be related to clinical outcomes. Clinical variables, demographic data, lifestyle data, and blood samples, including 27 plasma cytokines representing a broad spectrum of inflammatory mediators, were collected from 81 patients, 60 years and older, at admission and discharge. A subgroup of 49 patients also completed a self-reported clinical, psychiatric status form, indicating their level of recovery during hospitalisation. Statistical analyses demonstrated that a broad range of cytokines fell during treatment, and the fall was associated with clinical improvement, irrespective of psychiatric and somatic diagnoses. Exploiting cytokines as biomarkers of clinical traits might to be of limited use in a general population of elderly psychiatric in-patients as the field stands now