The Preadmission Nursing Home Assessment (PNHA) in Iceland in 1992-2001 - Relationship to survival and admission to a long term care facility

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenObjective: PNHA is a standardized evaluation of the elderly which everyone who applies for an admission to long term care (LTC) in Iceland must undergo. The objective of this study is to describe the elderly who asked for an admission to LTC in The Reykjavík metropolitan area and in Akureyri over a 10 year period. A special attention is paid to factors that could possibly predict survival after PNHA. Material and methods: Every PNHA evaluation is stored in a database by SKYRR Inc. Information from that database regarding all who lived in the greater Reykjavík area and Akureyri and had undergone their first PNHA during the period from January 1st 1992 to 31st of December 2001, was collected. Information about survival was collected from the the Icelandic national registry. There were 4272 individuals in the study group. SPSS was used for statistical analysis. Results: The average enrolment age of men in nursing homes(NH) in Reykjavík was 82.7 -/+ 0.5 years and for women 84.4 -/+ 0.4 (p<0.01). Men were about one third of residents in NH's. The average waiting time for men from the first PNHA to NH placement was 219 -/+ 20 days and for women 290 -/+ 22 days (p<0.01). Of those who were waiting for NH's, 22% of men and 14% of women died without being admitted (p<0,01). The mean survival of men in NH's in Reykjavík was 2.5 -/+ 0.2 years and for women 3.1 -/+ 0.2 years (p<0.01). Factors predicting longer survival for men in Reykjavík were lower age, good mobility and being able to eat but for women the factors were lower age and good mobility. Conclusions: It's in all stakeholders' interest that elderly people are enabled to live at home for as long as possible. Factors that predict survival should be taken into account when the elderly are prioritized for admission to NH's so that elderly who are predicted to have the lowest survival rate of assessed are those admitted first.Tilgangur: Vistunarmat aldraðra er staðlað mat sem allir þeir sem óska varanlegrar vistunar á stofnun fyrir aldraða á Íslandi þurfa að undirgangast. Markmið rannsóknarinnar er að lýsa þeim öldruðu sem óskuðu eftir varanlegri vistun á höfuðborgarsvæðinu og á Akureyri á 10 ára tímabili. Þá eru skoðaðir sérstaklega þeir þættir vistunarmatsins sem kynnu að hafa forspárgildi fyrir lifun. Efniviður og aðferðir: Allar umsóknir um vistunarmat aldraðra eru færðar inn í gagnabanka sem er varðveittur hjá SKÝRR hf. Fengnar voru upplýsingar úr þeim gagnabanka um alla sem bjuggu á tilgreindu svæði og gengust undir fyrsta vistunarmat á tímabilinu 1. janúar 1992 til 31. desember 2001 en upplýsingar um lifun voru fengnar úr þjóðskrá. Samtals voru þetta 4272 einstaklingar. Notast var við tölfræðiforritið SPSS® við tölfræðilega úrvinnslu. Niðurstöður: Meðalaldur karla sem voru vistaðir á hjúkrunarheimili í Reykjavík var 82,7 ár ± 0,5 en hjá konum var meðalaldur 84,4 ár ± 0,4 sem er marktækur munur, p<0,01. Karlar voru um þriðjungur vistaðra. Meðalbiðtími vistaðra frá fyrsta mati í hjúkrunarþörf í Reykjavík var 219 ± 20 dagar hjá körlum og 290 ± 22 dagar hjá konum og er munurinn marktækur, p<0,01. Af þeim sem biðu vistunar í Reykjavík létust 22% karla og 14% kvenna á fyrsta árinu án þess að til vistunar kæmi og er munurinn marktækur, p<0,01. Karlar lifðu að meðaltali í 2,5 ± 0,2 ár á hjúkrunarheimilum í Reykjavík en konur 3,1 ± 0,2 ár sem er marktækur munur, p<0,01. Þeir þættir sem spáðu marktækt fyrir um lifun hjá körlum í Reykjavík voru aldur, hreyfigeta og hæfni til að matast en hjá konum voru spáþættirnir aldur og hreyfigeta. Ályktun: Það er hagur allra að aldraðir geti dvalið sem lengst heima en þegar þörf hefur myndast fyrir varanlega vistun væri réttmætt að forgangsraða þannig að þeir sem skemmst eiga ólifað samkvæmt spáþáttum lifunar fengju úthlutað vistrými fyrst

Geðrof í kjölfar ADHD-lyfjameðferðar : Sjúkratilfelli

Publisher Copyright: © 2023 Laeknafelag Islands. All rights reserved.In view of the ongoing rise of ADHD prescriptions among adults in Iceland, it is important that doctors are aware that psychosis is a rare but at times a serious adverse reaction to such treatment. In 2022 5% of adults were prescribed medication to treat ADHD in Iceland. In this case report we present a case of methylphenidate-induced psychosis in a young man with no previous history of psychotic episodes who required admission to the psychiatric intensive care unit.Peer reviewe

Neutropenia and agranulocytosis during treatment of schizophrenia with clozapine versus other antipsychotics: an observational study in Iceland

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files.Data on the haematological outcomes of patients who continue clozapine treatment following neutropenia are very rare as even mild neutropenia results in mandatory discontinuation of clozapine in most countries. However, in Iceland where clozapine monitoring is less stringent allows an observational study to be done on the risk of agranulocytosis and neutropenia during treatment with clozapine compared with other antipsychotics among patients with schizophrenia.The present study is a part of a wider ongoing longitudinal study of schizophrenia in Iceland. We identified 201 patients with schizophrenia treated with clozapine and 410 patients with schizophrenia who had never been on clozapine by searching the electronic health records of Landspitali, the National University Hospital. Neutrophil counts were searched in electronic databases to identify patients who developed neutropenia/agranulocytosis and the frequency of neutrophil measurements was examined as well.The median number of days between neutrophil measurements during the first 18 weeks of clozapine treatment was 25 days but after the first 18 weeks on the drug the median became 124 days. Thirty four cases of neutropenia were identified during clozapine treatment with an average follow up time of 9.2 years. The majority, 24 individuals developed mild neutropenia (1500-1900 neutrophils/mm(3)). None of these progressed to agranulocytosis. The remaining 10 patients developed neutropenia in the range 500-1400 /mm(3) of whom one developed agranulocytosis, three stopped clozapine use and 6 patients continued on clozapine for at least a year without developing agranulocytosis. Unexpectedly, schizophrenia patients on other antipsychotics had an equal risk of developing neutropenia as those on clozapine.Neutropenia is common both in patients with schizophrenia on clozapine treatment and in those never on clozapine. Therefore a large part of neutropenia during clozapine treatment is probably not caused by clozapine. These findings have implications in assessing the balance between the risk of progression from neutropenia to agranulocytosis against the morbidity resulting from the premature discontinuation of clozapine under the current monitoring regulations in the US and in most of Europe.info:eu-repo/grantAgreement/EC/FP7/279227 National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London, Maudsley NHS Foundation Trust and King’s College London

Clozapine treatment and discontinuation in Iceland: A national longitudinal study using electronic patient records.

To access publisher's full text version of this article, please click on the hyperlink in Additional Links field or click on the hyperlink at the top of the page marked Files. This article is open access.Clozapine is the only drug approved for treatment-resistant schizophrenia. There is evidence that clozapine is underutilized.To evaluate the initiation and discontinuation of clozapine at Landspitali University Hospital in Iceland and the prevalence of antipsychotic polypharmacy in clozapine-treated patients.The study is a part of an ongoing longitudinal study of schizophrenia in Iceland. We identified 201 patients on clozapine or who have been on clozapine by using a keyword search in the electronic health records and by reviewing their medical records.Mean age at first treatment with clozapine was 37.8 years. Mean follow-up period on clozapine was 11 years. After 20 years of treatment 71.2% of patients were still on clozapine. After one year of treatment 84.4% of patients were still receiving clozapine treatment. We estimate that 11.4% of patients with schizophrenia in Iceland are taking clozapine and that 16% have been treated with clozapine at some point. Polypharmacy is common, since nearly 2/3, 65.6%, of patients taking clozapine use at least one other antipsychotic and 16.9% are also receiving depot injections.We need to increase the awareness of psychiatrists in Iceland with regard to treatment with clozapine, since only about half of the estimated population of patients with treatment-resistant schizophrenia in Iceland have ever been treated with clozapine. Nearly two thirds of patients who are prescribed clozapine in Iceland remain on it long-term.info:eu-repo/grantAgreement/EC/FP7/279227 National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London and Maudsley NHS Foundation Trust and King's College Londo

Aukaverkanir geðrofslyfja - Gögn og gildi til að varða bestu leiðir til notkunar clozapine í geðklofa sem svarar illa meðferð

Background: Schizophrenia is a chronic serious mental disorder with prevalence close to 0.7%. Early symptoms of schizophrenia generally appear in late adolescence or the early twenties. The prognosis is usually worse in cases of early onset. The symptomatology of schizophrenia is complex and can vary a lot between individuals. The two main symptom dimensions are referred to as positive symptoms and negative symptoms. The most common positive symptoms are: hallucinations, particularly auditory hallucinations, delusions, disturbances of thought and persecutory ideation. The most common negative symptoms are: lack of social interest, loss of personal hygiene, reduced motivation, loss of insight and blunting of affect. Over 100 variants are now known in the genome that increase the risk of schizophrenia and the genetic pathogenesis is therefore very complex. Environmental risk factors are believed to play a role in the pathogenesis of schizophrenia, especially cannabis use in adolescence. The socioeconomic cost of schizophrenia is very high because the disease often causes disability among young sufferers. Patients with schizophrenia have a reduced life expectancy of 22.5-25 years. The main reasons are unhealthy lifestyle (most patients smoke, take little exercise, use alcohol or illicit substances and are on a poor diet), cardiovascular disease and suicide. About 20-30% of patients do not respond to conventional antipsychotic treatment and are said to have treatment-resistant schizophrenia (TRS). The only approved treatment that has proven to be efficacious in TRS and been shown to improve overall mortality as well as reduce suicide attempts and probably the odds of suicide is the antipsychotic clozapine. Despite this clozapine is often used rather late in the disease course, most probably due to many side effects and some rare adverse drug reactions (ADR) which can be life-threatening for a very small proportion of TRS patients. A much greater number of patients with TRS lose years of life because they commit suicide or die prematurely due to an unhealthy lifestyle than those who pass away as a result of these rare ADRs. Despite this the proportion of TRS patients with schizophrenia that have ever had clozapine prescribed is much less than the expected 20-30% in most countries. Fewer still remain on the treatment long term for various reasons. Clozapine is not available in a depot injectable preparation and that limits its effectiveness in the treatment of patients with lack of insight or who have difficulty in taking tablets daily. Objective: To study the use of clozapine in the treatment of schizophrenia in Iceland and to assess serious side effects of antipsychotics, focusing on clozapine. Assess neutropenia and the progression to agranulocytosis and compare the prevalence for patients on clozapine versus those that have never been on clozapine. Examine the proportion of patients who had developed diabetes or dyslipidemia and compare it to a standard Icelandic population. Finally, to contribute to Evidence-Based as well as Value-Based Practice and shared decision-making in the often challenging treatment and long term care of patients with TRS. Method: The study population consisted of patients who had participated in an ongoing joint research project of Landspitali University Hospital and deCODE genetics on psychotic disorders. Patients were recruited to the study between 1986-2014. A total of 611 patients with schizophrenia took part in the study. Patients’ health records were searched electronically to identify patients who had used clozapine. The health records were then reviewed to confirm use of clozapine. Patients´ health records were searched electronically to seek information on side effects and ADRs as well as the blood test database at Landspitali. Statistical analyses were performed using STATA. Results: The use of clozapine in Iceland is described in paper I. Two hundred and one patients took clozapine at some point during the study. The mean age at the start of clozapine use was 37.8 years. Some 71.2% of patients who began treatment with clozapine remained on clozapine treatment 20 years later. It was estimated that 11.4% of patients with schizophrenia in Iceland were using clozapine and that 16% had ever tried clozapine treatment. Antipsychotic polypharmacy was common since two out of every three patients, 65.6%, also used other antipsychotics alongside treatment with clozapine. Paper II focuses on neutropenia and agranulocytosis in the course of treatment of TRS with clozapine versus other antipsychotics. After the first 18 weeks of clozapine treatment the median number of days between neutrophil measurements was 124 days. Neutropenia was observed in 34 patients out of 188 on clozapine and of those 24 developed mild neutropenia (granulocytes between 1500-1900/mm3). One year after the neutropenia 28 patients out of 34 were still on clozapine. No difference was observed in the proportion of patients who developed moderate to severe neutropenia (granulocytes in the range 0-1400/mm3) between patients on clozapine versus TRS patients who had never been on clozapine. In paper III it was presented that women on clozapine were 4.4 times more likely to have been diagnosed with type 2 diabetes (T2D) than women in the general population. Males on clozapine were 2.3 times more likely to have been diagnosed with T2D than males in the general population. Triglycerides were higher both among those with schizophrenia who had been on clozapine as well as among patients with schizophrenia who had never received clozapine compared to the general population. One case of ketoacidosis was identified in a patient with type 1 diabetes. Conclusions: More patients with TRS in Iceland and other countries should get the opportunity to be offered treatment with clozapine. A large proportion of neutropenia developing during clozapine treatment is probably not caused by clozapine. If clozapine treatment proves to be effective a decision to stop clozapine should only be taken following careful consideration of all possible options in cases of moderate neutropenia, because there are usually no other alternative treatment options available that offer comparable effectiveness available. Doctors must be well aware of the risk of metabolic syndrome during clozapine treatment, especially the high risk of T2D developing in women.Bakgrunnur: Geðklofi er langvinnur alvarlegur geðsjúkdómur með algengi nálægt 0,7%. Fyrstu einkenni geðklofa koma oftast fram seint á unglingsárum eða á þrítugsaldri, en þeim mun fyrr sem sjúkdómurinn kemur fram eru horfurnar að jafnaði verri. Einkennaróf geðklofa er margþætt og birtingarform veikindanna getur því verið talsvert mismunandi milli einstaklinga. Tvær helstu víddir sjúkdómsins eru svokölluð jákvæð einkenni og neikvæð einkenni (brottfallseinkenni). Algengustu jákvæðu einkennin eru: ofskynjanir og þá einkum ofheyrnir, ranghugmyndir, truflun á hugsun og aðsóknarkennd. Algengustu neikvæðu einkennin eru: félagsleg einangrun, skert persónuhirða, minni áhugahvöt, innsæisleysi og skert tilfinningaleg viðbrögð. Nú eru þekktir yfir 100 breytileikar í erfðamenginu sem auka líkur á geðklofa og samband erfða og svipgerðar því afar flókið. Talið er að umhverfisþættir komi auk þess við sögu í tilurð geðklofa, ekki síst regluleg notkun unglinga á kannabisefnum. Samfélagslegur kostnaður vegna geðklofa er hár þar sem sjúkdómurinn veldur mjög oft örorku ungs fólks. Sjúklingar með geðklofa lifa að meðaltali 22,5-25 árum skemur en aðrir. Helstu ástæður þess eru óheilbrigður lífstíll (flestir reykja, lítil hreyfing, óheilbrigt mataræði og notkun vímugjafa), hjarta og æðasjúkdómar og loks sjálfsvíg. Um 20-30% sjúklinga svara ekki hefðbundinni meðferð með geðrofslyfjum og eru þeir sagðir vera með meðferðarþráan geðklofa. Eina meðferðin sem hefur sannað sig sem gagnreynd meðferð hjá þeim hópi er geðrofslyfið clozapín, en oft er það notað frekar seint í sjúkdómsferlinu vegna margvíslega aukaverkana, sem sumar hverjar geta verið lífshættulegar. Mun fleiri sjúklingar með meðferðarþráan geðklofa falla þó fyrir eigin hendi en látast vegna þessara sjaldgæfu aukaverkana, en clozapín er það lyf sem helst minnkar líkur á sjálfsvígum og dregur úr dánartíðni í þessum hópi. Þrátt fyrir það eru margir læknar ragir við að bjóða sjúklingum meðferðina og hlutfall sjúklinga sem fær að reyna clozapín meðferð vegna meðferðarþrás geðklofa er hvarvetna mun lægra en 20-30%. Clozapín er ekki til sem forðalyf í sprautuformi. Það takmarkar notagildi þess í tilfellum þar sem sjúklingar hafa mjög skert innsæi eða ráða illa við að taka töflur daglega. Markmið: Að rannsaka notkun clozapíns hér á landi í meðferð geðklofa og alvarlegar aukaverkanir geðrofslyfja með áherslu á clozapín. Skoða kyrningafæð (neutropenia) og tengingu hennar við algjöra kyrningafæð (agranulocytosis) og bera saman tíðnina hjá sjúklingum á clozapín og þeim sem hafa aldrei farið á clozapín. Einnig á að kanna tíðni sykursýki og blóðfituröskunar og bera saman við almennt íslenskt þýði. Síðast en ekki síst að þróa frekar gagnreynda og gildismiðaða meðferð og sameiginlega ákvarðanatöku í langtíma meðferð meðferðarþrás geðklofa. Aðferð: Þýðið í rannsókninni samanstóð af sjúklingum sem hafa tekið þátt í geðrofsrannsókn LSH og Íslenskrar erfðagreiningar. Sjúklingum var safnað í rannsóknina á árunum 1986-2014. Samtals voru upplýsingar um 611 sjúklinga notaðar í rannsókninni. Til að finna sjúklinga sem höfðu notað geðrofslyfið clozapín var leitað að rafrænum skjölum í sjúkraskrá Landspítala sem bentu til clozapín notkunar. Þau skjöl voru lesin til að meta hvort hægt væri að staðfesta clozapín notkun. Til að finna upplýsingar um aukaverkanir var framkvæmd rafræn leit í sjúkraskrám auk þess sem aðgangur fékkst að blóðprufugagnagrunni Landspítala. Tölfræðiúrvinnsla var gerð í STATA. Niðurstöður: Í grein I er fjallað um notkun clozapíns á Íslandi. Tvöhundruð og einn sjúklingur hafði fengið meðferð með clozapíni. Meðalaldur við upphaf clozapíns notkunar reyndist 37,8 ár á tímabilinu. Um 71,2% sjúklinga sem hófu meðferð með clozapíni voru enn á clozapín meðferð 20 árum síðar. Við áætluðum að 11,4% sjúklinga með geðklofa á Íslandi væru að taka clozapín og 16% þeirra hefðu einhvern tíma reynt meðferð með lyfinu. Fjöllyfjanotkun geðrofslyfja var algeng samhliða clozapín meðferð þar sem tveir af hverjum þremur sjúklingum eða 65,6% notuðu önnur geðrofslyf samhliða meðferð með clozapíni. Grein II fjallar um kyrningafæð og algjöra kyrningafæð. Eftir fyrstu 18 vikurnar á clozapín meðferð þá var miðgildi milli mælinga á kyrningum 124 dagar. Kyrningafæð greindist hjá 34 sjúklingum af 188 á clozapín meðferð en oftast var um að ræða væga kyrningafæð (kyrningar milli 1500-1900/mm3 ) eða hjá 24 sjúklingum. Einu ári eftir kyrningarfæð voru 28 af 34 sjúklingum ennþá á clozapíni. Enginn munur kom fram á tíðni alvarlegrar kyrningafæðar (kyrningar á bilinu 0-1400/mm3 ) hjá sjúklingum á clozapíni og sjúklingum með geðklofa sem höfðu aldrei farið á clozapín meðferð. Í grein III kemur fram að konur sem hafa tekið clozapín voru 4,4 sinnum líklegri en konur í almennu þýði til að hafa greinst með sykursýki týpu 2. Karlar á clozapín meðferð voru 2,3 sinnum líklegri til að hafa greinst með sykursýki týpu 2 en karlar í almennu þýði. Þríglýseríð voru einnig hærri bæði hjá þeim sem höfðu tekið clozapín og hjá sjúklingum með geðklofa sem höfðu aldrei tekið clozapín samanborið við almennt þýði. Eitt tilfelli af ketónblóðsýringu greindist hjá sjúklingi með sykursýki af týpu 1. Ályktanir: Hærra hlutfall sjúklinga með meðferðarþráan geðklofa á Íslandi og í öðrum löndum ætti að eiga þess kost að reyna meðferð með clozapíni. Stór hluti af kyrningafæð sem kemur fram hjá sjúklingum á clozapín meðferð stafar líklega ekki af lyfinu. Því þarf að ígrunda vel ákvarðanir um að hætta clozapín meðferð einstaklinga með meðferðarþráan geðklofa á grundvelli miðlungs alvarlegrar kyrningafæðar hafi meðferð skilað góðum árangri og þar sem þá er almennt ekki önnur meðferð með sambærilega virkni í boði. Læknar þurfa að vera vel vakandi fyrir efnaskiptavillu af völdum clozapíns og þá sérstaklega sykursýki týpu 2 hjá konum.Landspitali, The National University Hospital European Union’s Seventh Framework Programme for research, technological development and demonstration under grant agreement no. 279227 (CRESTAR)

Constipation, ileus and medication use during clozapine treatment in patients with schizophrenia in Iceland

To access publisher's full text version of this article click on the hyperlink belowPurpose of the article: Clozapine is the only evidence based treatment for treatment-resistant schizophrenia. Constipation is a well known side effect of clozapine treatment. The aims of this study are to describe the prevalence of constipation and ileus during clozapine treatment of patients with schizophrenia in Iceland and to assess the concomitant use of medication that can cause constipation, and laxatives used to treat constipation. We identified 188 patients treated with clozapine by searching the electronic health records of Landspitali, the National University Hospital, during the study period 1.1.1998 - 21.11.2014. Cases of constipation and ileus were identified using an electronic search with keywords related to ileus in the patients' electronic health records. Detailed medication use was available for 154 patients that used clozapine for at least one year. Four out of 188 patients were diagnosed with ileus that resulted in admission to hospital. Two of these required a permanent stoma as a consequence of their ileus. Laxatives were prescribed for 24 out of 154 patients (15.4%) while on clozapine. In total 40.9% of the patients either had laxatives prescribed or had constipation documented in the medical records. Apart from clozapine, other medications known to cause constipation were prescribed to 28 out of 154 patients (18.2%). Constipation is a common problem during clozapine treatment which can progress to full-blown ileus which can be fatal. Clinicians need to monitor signs of constipation during treatment with clozapine and respond to it with lifestyle advice and laxative treatment.European Unio

Functional recovery after first episode psychosis rehabilitation in an early intervention psychosis center in Iceland

Publisher Copyright: © 2022 Laeknafelag Islands. All rights reserved.INNGANGUR Einstaklingar greinast almennt ungir með geðrofssjúkdóma og þrátt fyrir meðferð hefur stór hluti viðvarandi einkenni sem leiða gjarnan til skertrar samfélagslegrar virkni og örorku. Markmið rannsóknarinnar var að kanna hversu hátt hlutfall ungra einstaklinga sem fengu snemmíhlutun í geðrof hér á landi árin 2010-2020 tók þátt í námi eða vinnu að endurhæfingu lokinni, ásamt því að kanna hvaða þættir hefðu forspárgildi um það. EFNIVIÐUR OG AÐFERÐIR Rannsóknin er afturskyggn ferilrannsókn sem byggði á upplýsingum úr sjúkraskrám allra sem útskrifuðust af Laugarásnum meðferðargeðdeild á árunum 2010-2020 eftir lengri en 6 mánaða endurhæfingu (n=144). Einþátta og fjölþátta tvíkosta aðhvarfsgreining var framkvæmd til að kanna hvaða breytur höfðu forspárgildi um náms- og atvinnuþátttöku að endurhæfingu lokinni. NIÐURSTÖÐUR 75% þjónustuþega voru atvinnulausir við innritun sem bendir til hrakandi samfélagslegrar virkni fyrir inngrip í fyrsta geðrof. Við útskrift var rúmur helmingur þjónustuþega í vinnu eða námi. Starfsendurhæfing á Laugarásnum reyndist vera sá þáttur sem hafði mest jákvætt forspárgildi um náms- og atvinnuþátttöku við útskrift. Aðrir helstu forspárþættir voru þeir sem endurspegluðu alvarlegan geðrofssjúkdóm og samfélagslega virkni fyrir innskrift. Meirihluti þjónustuþega (66%) hafði sögu um kannabisneyslu sem reyndist einnig hafa neikvætt forspárgildi um náms- og atvinnuþátttöku við útskrift. ÁLYKTANIR Ljóst er að betur má ef duga skal ef auka á samfélagslega virkni ungs fólks á Íslandi eftir fyrsta geðrof. Mikilvægt er að tryggja skilvirka starfsendurhæfingu á Laugarásnum þar sem starfsendurhæfing var einn fárra þátta sem hafði forspárgildi um náms- og atvinnuþátttöku við útskrift sem hægt er að hafa áhrif á í endurhæfingunni. BACKGROUND: Because of the early onset and disabling symptoms of schizophrenia spectrum disorders many individuals with these disorders are unemployed from an early age and disability pension rates are high. The aim of this study was to assess functional recovery and identify vocational predictors among young first episode psychosis patients registered in an early intervention psychosis center in Iceland in 2010-2020. METHODS: The study is a retrospective cohort study based on the medical records of those who were discharged from Laugaras, the only early intervention psychosis program in Iceland after six months or longer rehabilitation in 2010-2020 (n=144). Univariate and multivariate logistic regression was used to identify vocational predictors. RESULTS: 75% of patients were unemployed at admission to the early intervention center but over half of the patients were employed or in school at discharge. Vocational rehabilitation was the strongest vocational predictor (OR 13.93, 95% CI 3.85-63.89). Other vocational predictors were those that reflect a disabling psychiatric disorder and social functioning before the onset of early intervention. 66% of patients had a history of cannabis use which had a negative impact on employment and education at discharge. CONCLUSIONS: In spite of intensive rehabilitation at an early intervention center, almost half of the patients were neither employed nor in school at discharge. The strongest vocational predictor was vocational rehabilitation which was also one of few vocational predictors that can be influenced by admission to an early intervention psychosis center. It therefore seems important to ensure that effective vocational rehabilitation is readily available at early intervention psychosis centers.Peer reviewe

Risk of diabetes and dyslipidemia during clozapine and other antipsychotic drug treatment of schizophrenia in Iceland.

To access publisher's full text version of this article click on the hyperlink belowType 2 diabetes (T2D) and raised blood lipids are associated with the use of antipsychotics, not least clozapine.To describe the prevalence of high blood glucose levels, T2D, and dyslipidemia, in association with the use of clozapine or other antipsychotics in patients with schizophrenia in Iceland.This study identified 188 patients treated with clozapine and 395 patients never treated with clozapine by searching the electronic health records of Landspitali, the National University Hospital. The comparison group consisted of Icelandic population controls. Data were obtained on blood glucose, HbA1c, and blood lipid levels from these health records.The prevalence of T2D was 14.3% in the clozapine group, where the mean age was 51.2 years, and 13.7% in the never-on-clozapine group, where the mean age was 58.6 years. Males on clozapine were 2.3-times more likely and females 4.4-times more likely to have developed T2D than controls from an age-adjusted Icelandic cohort, while males on other antipsychotics were 1.5-times more likely and females 2.3-times as likely to have T2D than controls. Only one case of ketoacidosis was identified. Triglyceride levels were significantly higher in both treatment groups compared to controls in the age-adjusted Icelandic cohort.Clinicians must take active steps to reduce the risk of T2D and raised triglycerides in patients with schizophrenia. Antipsychotics were associated with a greater risk of T2D developing in females compared to males.European Union National Institute for Health Research (NIHR) Mental Health Biomedical Research Centre at South London Maudsley NHS Foundation Trust King's College Londo