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  • 1.
    Alföldi, Peter
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Dragioti, Elena
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Wiklund, Tobias
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Gerdle, Björn
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    SPREADING OF PAIN AND INSOMNIA IN PATIENTS WITH CHRONIC PAIN: RESULTS FROM A NATIONAL QUALITY REGISTRY (SQRP)2017Inngår i: Journal of Rehabilitation Medicine, ISSN 1650-1977, E-ISSN 1651-2081, Vol. 49, nr 1, s. 63-70Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Objective: To explore how demographics, pain, psychosocial factors and insomnia relate to the spread of chronic pain. Methods: The study included 708 patients (68% women; median age 46 years; interquartile range 3557 years) with chronic pain who were referred to a multidisciplinary pain centre. Spreading of pain was assessed using a questionnaire covering 36 anatomically predefined pain regions. Data were collected on demographics, pain symptoms, psychological distress, and insomnia (Insomnia Severity Index). Four sub-categories of chronic pain were established: chronic local pain, chronic regional pain medium, chronic regional pain heavy, and chronic widespread pain. Results: The median number of pain regions was 10 (interquartile range 6-18). Prevalence of chronic pain was as follows: chronic local pain 9%, chronic regional pain medium 21%, chronic regional pain heavy 39%, and chronic widespread pain 31%. In the regression models, being a woman and persistent pain duration had the strongest associations with spreading of pain, but anxiety, pain interference, and insomnia were also important factors. Conclusion: Spreading of chronic pain can only partly be explained by the simultaneous levels of insomnia. Female sex, pain duration, pain interference and anxiety appear to have more significant relationships with the spread of pain. Targeting these factors may lead to improvements in treatment and prevention strategies.

  • 2.
    Alföldi, Peter
    et al.
    Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Smärt och rehabiliteringscentrum. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin.
    Gerdle, Björn
    Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Smärt och rehabiliteringscentrum. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin.
    Wiklund, Tobias
    Linköpings universitet, Hälsouniversitetet. Östergötlands Läns Landsting, Sinnescentrum, Smärt och rehabiliteringscentrum. Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin.
    Comorbid insomnia in patients with chronic pain: a study based on the Swedish quality registry for pain rehabilitation (SQRP)2014Inngår i: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 36, nr 20, s. 1661-1669Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Purpose: This study investigates the prevalence of insomnia and its relationship to other symptoms and health aspects in patients with chronic pain. Methods: Patients with chronic pain conditions (n = 845) referred to a multidisciplinary pain centre completed surveys provided by the Swedish quality registry for pain rehabilitation (SQRP). The SQRP collects data on socio-demographics, health status, symptoms of pain, mood and insomnia and life satisfaction. Results: The majority of patients (65.3%) had clinical insomnia according to the insomnia severity index (ISI). Insomnia correlated significantly but weakly with pain, depression, anxiety and coping; the strongest multivariate correlations were found with depression and anxiety followed by pain interference and pain severity. Pain intensity, depression and anxiety correlated stronger than ISI with respect to the two investigated aspects of health. Conclusions: The prevalence of insomnia is high in patients with chronic pain conditions, but the level of importance in relation to other symptoms for health aspects is low, and the associations with other important symptoms are relatively weak. One way to increase the effects of multimodal rehabilitation programs may be to provide interventions directed specifically at insomnia rather than focusing only on interventions that address pain, depression and anxiety. Implications for Rehabilitation The prevalence of insomnia is high in patients with complex chronic pain conditions. Relatively low correlations existed between insomnia and pain intensity, depression, anxiety and other psychological aspects. Pain intensity, anxiety and depression were more important for perceived health aspects than insomnia. One way to increase the effects of multimodal rehabilitation programs may be to also include interventions directed directly to insomnia.

  • 3.
    Blom, Kerstin
    et al.
    Karolinska Institute, Sweden.
    Tarkian Tillgren, Hanna
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Wiklund, Tobias
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Hälsouniversitetet. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Danlycke, Ewa
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Forssen, Mattias
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Söderström, Alexandra
    Linköpings universitet, Institutionen för beteendevetenskap och lärande. Linköpings universitet, Filosofiska fakulteten.
    Johansson, Robert
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Hesser, Hugo
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten.
    Jernelov, Susanna
    Karolinska Institute, Sweden.
    Lindefors, Nils
    Karolinska Institute, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Institutionen för beteendevetenskap och lärande, Psykologi. Linköpings universitet, Filosofiska fakulteten. Karolinska Institute, Sweden.
    Kaldo, Viktor
    Karolinska Institute, Sweden.
    Internet-vs. group-delivered cognitive behavior therapy for insomnia: A randomized controlled non-inferiority trial2015Inngår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 70, s. 47-55Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    The aim of this study was to compare guided Internet-delivered to group-delivered cognitive behavioral therapy (CBT) for insomnia. We conducted an 8-week randomized controlled non-inferiority trial with 6-months follow-up. Participants were forty-eight adults with insomnia, recruited via media. Interventions were guided Internet-delivered CBT (ICBT) and group-delivered CBT (GCBT) for insomnia. Primary outcome measure was the Insomnia Severity Index (ISI), secondary outcome measures were sleep diary data, depressive symptoms, response- and remission rates. Both treatment groups showed significant improvements and large effect sizes for ISI (Within Cohens d: ICBT post = 1.8, 6-months follow-up = 2.1; GCBT post = 2.1, 6-months follow-up = 2.2). Confidence interval of the difference between groups posttreatment and at FU6 indicated non-inferiority of ICBT compared to GCBT. At post-treatment, two thirds of patients in both groups were considered responders (ISI-reduction greater than 7p). Using diagnostic criteria, 63% (ICBT) and 75% (GCBT) were in remission. Sleep diary data showed moderate to large effect sizes. We conclude that both guided Internet-CBT and group-CBT in this study were efficacious with regard to insomnia severity, sleep parameters and depressive symptoms. The results are in line with previous research, and strengthen the evidence for guided Internet-CBT for insomnia. Trial registration: The study protocol was approved by, and registered with, the regional ethics review board in Linkoping, Sweden, registration number 2010/385-31.

    Fulltekst (pdf)
    fulltext
  • 4.
    Dragioti, Elena
    et al.
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Wiklund, Tobias
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Siamouli, Melina
    Aristotle University of Thessaloniki, Greece.
    Moutou, Katerina
    Aristotle University of Thessaloniki, Greece.
    Fountoulakis, Konstantinos N.
    Aristotle University of Thessaloniki, Greece.
    Could PANSS be a useful tool in the determining of the stages of schizophrenia? A clinically operational approach2017Inngår i: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 86, s. 66-72Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Staging in schizophrenia might be an important approach for the better treatment and rehabilitation of patients. The purpose of this study was to empirically devise a staging approach in a sample of stabilized patients with schizophrenia. One hundred and seventy patients aged amp;gt;= 18 years (mean = 40.7, SD = 11.6) diagnosed by DSM-5 criteria were evaluated with the Positive and Negative Syndrome Scale (PANSS). Principal components analysis (PCA) with varimax rotation was used. The model was examined in the total sample and separately across a hypothesized stage of illness based on three age groups and between the two sexes. The PCA revealed a six factor structure for the total sample: 1) Negative, 2) Positive, 3) Depression and anxiety, 4) Excitement and Hostility, 5) Neurocognition and 6) Disorganization. The separate PCAs by stage of illness and sex revealed different patterns and quality of symptomatology. The Negative and Positive factors were stable across all examined groups. The models corresponding to different stages differed mainly in terms of neurocognition and disorganization and their interplay. Catatonic features appear more prominent in males while in females neurocognition takes two forms; one with disorganization and one with stereotype thinking with delusions. This study suggests that the three arbitrary defined stages of illness (on the basis of age) seem to reflect a progress from a preserved insight and more coherent mental functioning to disorganization and eventually neurocognitive impairment. Sexes differ in terms of the relationship of psychotic features with neurocognition. These results might have significant research and clinical implications. (C) 2016 Elsevier Ltd. All rights reserved.

  • 5.
    Fountoulakis, K.N.
    et al.
    Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
    Dragioti, Elena
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Stockholm Psychiatric Southwest Clinic, Karolinska Huddinge University Hospital, Sweden.
    Theofilidis, A.T.
    3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
    Wiklund, Tobias
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Stockholm Psychiatric Southwest Clinic, Karolinska Huddinge University Hospital, Huddinge, Sweden.
    Atmatzidis, Xenofon
    Linköpings universitet, Institutionen för hälsa, medicin och vård. Linköpings universitet, Medicinska fakulteten. Stockholm Psychiatric Southwest Clinic, Karolinska Huddinge University Hospital, Huddinge, Sweden.
    Nimatoudis, I.
    3rd Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
    Thys, E.
    University Psychiatric Center, Katholieke Universiteit Leuven, Kortenberg, Belgium.
    Wampers, M.
    University Psychiatric Center, Katholieke Universiteit Leuven, Kortenberg, Belgium; Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium.
    Hranov, L.
    University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry sveti Naum, Sofia, Bulgaria.
    Hristova, T.
    University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry sveti Naum, Sofia, Bulgaria.
    Aptalidis, D.
    University Multiprofile Hospital for Active Treatment in Neurology and Psychiatry sveti Naum, Sofia, Bulgaria.
    Milev, R.
    Department of Psychiatry, Queens University, Providence Care Hospital, Kingston, ON, Canada.
    Iftene, F.
    Department of Psychiatry, Queens University, Providence Care Hospital, Kingston, ON, Canada.
    Spaniel, F.
    National Institute of Mental Health, Klecany, Czech Republic.
    Knytl, P.
    National Institute of Mental Health, Klecany, Czech Republic.
    Furstova, P.
    National Institute of Mental Health, Klecany, Czech Republic.
    From, T.
    Department of Psychiatry, University of Turku, Turku, Finland.
    Karlsson, H.
    Department of Psychiatry, University of Turku, Turku, Finland.
    Walta, M.
    Department of Psychiatry, University of Turku, Turku, Finland.
    Salokangas, R.K.R.
    Department of Psychiatry, University of Turku, Turku, Finland.
    Azorin, J.-M.
    Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France; Timone Institute of Neuroscience, Marseille, France.
    Bouniard, J.
    Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France; Timone Institute of Neuroscience, Marseille, France.
    Montant, J.
    Department of Psychiatry, Sainte Marguerite University Hospital, Marseille, France; Timone Institute of Neuroscience, Marseille, France.
    Juckel, G.
    Department of Psychiatry, Ruhr University Bochum, Bochum, Germany.
    Haussleiter, I.S.
    Department of Psychiatry, Ruhr University Bochum, Bochum, Germany.
    Douzenis, A.
    2nd Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece.
    Michopoulos, I.
    2nd Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece.
    Ferentinos, P.
    2nd Department of Psychiatry, National and Kapodistrian University of Athens, Athens, Greece.
    Smyrnis, N.
    Department of Psychiatry, National and Kapodistrian University of Athens School of Medicine, Eginition Hospital, Athens, Greece.
    Mantonakis, L.
    Department of Psychiatry, National and Kapodistrian University of Athens School of Medicine, Eginition Hospital, Athens, Greece.
    Nemes, Z.
    Nyír Gyula Hospital, Budapest, Hungary.
    Gonda, X.
    Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
    Vajda, D.
    Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
    Juhasz, A.
    Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary.
    Shrivastava, A.
    Western University, London, ON, Canada.
    Waddington, J.
    Department of Molecular and Cellular Therapeutics, Royal College of Surgeons in Ireland, Dublin, Ireland.
    Pompili, M.
    Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, SantAndrea Hospital, Sapienza University of Rome, Rome, Italy.
    Comparelli, A.
    Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, SantAndrea Hospital, Sapienza University of Rome, Rome, Italy.
    Corigliano, V.
    Department of Neurosciences, Mental Health and Sensory Organs, Suicide Prevention Center, SantAndrea Hospital, Sapienza University of Rome, Rome, Italy.
    Rancans, E.
    Department of Psychiatry and Narcology, Riga Stradins University, Riga, Latvia.
    Navickas, A.
    Department of Clinic of Psychiatric, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Department of Psychosocial Rehabilitation, Vilnius Mental Health Center, Vilnius, Lithuania; Department for Psychosis Treatment, Vilnius Mental Health Center, Vilnius, Lithuania.
    Hilbig, J.
    Department of Clinic of Psychiatric, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Department of Psychosocial Rehabilitation, Vilnius Mental Health Center, Vilnius, Lithuania; Department for Psychosis Treatment, Vilnius Mental Health Center, Vilnius, Lithuania.
    Bukelskis, L.
    Department of Clinic of Psychiatric, Faculty of Medicine, Vilnius University, Vilnius, Lithuania; Department of Psychosocial Rehabilitation, Vilnius Mental Health Center, Vilnius, Lithuania; Department for Psychosis Treatment, Vilnius Mental Health Center, Vilnius, Lithuania.
    Stevovic, L.I.
    Clinical Department of Psychiatry, Clinical Centre of Montenegro, Podgorica, Montenegro; Department of Psychiatry, School of Medicine, University of Montenegro, Podgorica, Montenegro; Clinical Department of Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro.
    Vodopic, S.
    Clinical Department of Psychiatry, Clinical Centre of Montenegro, Podgorica, Montenegro; Department of Psychiatry, School of Medicine, University of Montenegro, Podgorica, Montenegro; Clinical Department of Neurology, Clinical Centre of Montenegro, Podgorica, Montenegro.
    Esan, O.
    Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
    Oladele, O.
    Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
    Osunbote, C.
    Department of Psychiatry, College of Medicine, University of Ibadan, Ibadan, Nigeria.
    Rybakowski, J.K.
    Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.
    Wojciak, P.
    Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.
    Domowicz, K.
    Department of Adult Psychiatry, Poznan University of Medical Sciences, Poznan, Poland.
    Figueira, M.L.
    Department of Psychiatry and Mental Health, Santa Maria University Hospital, Lisbon, Portugal.
    Linhares, L.
    Department of Psychiatry and Mental Health, Santa Maria University Hospital, Lisbon, Portugal.
    Crawford, J.
    Department of Psychiatry and Mental Health, Santa Maria University Hospital, Lisbon, Portugal.
    Panfil, A.-L.
    University of Medicine and Pharmacy of Târgu Mures, Târgu Mures, Romania.
    Smirnova, D.
    Department of Psychiatry, Samara Psychiatric Hospital, Inpatient Unit, Samara State Medical University, Samara, Russian Federation.
    Izmailova, O.
    Department of Psychiatry, Samara Psychiatric Hospital, Inpatient Unit, Samara State Medical University, Samara, Russian Federation.
    Lecic-Tosevski, D.
    Institute of Mental Health, Belgrade, Serbia; Serbian Academy of Sciences and Arts, Belgrade, Serbia.
    Temmingh, H.
    Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
    Howells, F.
    Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
    Bobes, J.
    Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.
    Garcia-Portilla, M.P.
    Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.
    Garciá-Alvarez, L.
    Department of Psychiatry, University of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Oviedo, Spain.
    Erzin, G.
    Psychiatry Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
    Karada, H.
    Psychiatry Department, Diskapi Yildirim Beyazit Training and Research Hospital, Ankara, Turkey.
    De, Sousa A.
    Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India.
    Bendre, A.
    Department of Psychiatry, Lokmanya Tilak Municipal Medical College, Mumbai, India.
    Hoschl, C.
    National Institute of Mental Health, Klecany, Czech Republic.
    Bredicean, C.
    University of Medicine, Pharmacy of Timisoara, Timisoara, Romania.
    Papava, I.
    University of Medicine, Pharmacy of Timisoara, Timisoara, Romania.
    Vukovic, O.
    Institute of Mental Health, School of Medicine, University of Belgrade, Belgrade, Serbia.
    Pejuskovic, B.
    Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
    Russell, V.
    Department of Psychiatry, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
    Athanasiadis, L.
    1st Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
    Konsta, A.
    1st Department of Psychiatry, Faculty of Medicine, School of Health Sciences, Aristotle University of Thessaloniki, Thessaloniki, Greece.
    Stein, D.
    Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa; MRC Unit on Risk and Resilience in Mental Disorders, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
    Berk, M.
    IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia; Orygen, National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia.
    Dean, O.
    IMPACT Strategic Research Centre, School of Medicine, Barwon Health, Deakin University, Geelong, Australia; Orygen, National Centre of Excellence in Youth Mental Health, Parkville, VIC, Australia; Centre for Youth Mental Health, Florey Institute for Neuroscience and Mental Health, Parkville, VIC, Australia; Department of Psychiatry, University of Melbourne, Parkville, VIC, Australia.
    Tandon, R.
    Department of Psychiatry, University of Florida, Gainesville, FL, United States.
    Kasper, S.
    Department of Psychiatry and Psychotherapy, Medical University of Vienna, Vienna, Austria.
    De, Hert M.
    University Psychiatric Center, Katholieke Universiteit Leuven, Kortenberg, Belgium; Department of Neurosciences, Katholieke Universiteit Leuven, Leuven, Belgium; Antwerp Health Law and Ethics Chair, AHLEC University, Antwerpen, Belgium.
    Modeling psychological function in patients with schizophrenia with the PANSS: An international multi-center study2021Inngår i: CNS Spectrums, ISSN 1092-8529, E-ISSN 2165-6509, Vol. 26, nr 3, s. 290-298Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Background.

    The aim of the current study was to explore the changing interrelationships among clinical variables through the stages of schizophrenia in order to assemble a comprehensive and meaningful disease model.

    Methods.

    Twenty-nine centers from 25 countries participated and included 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Multiple linear regression analysis and visual inspection of plots were performed.

    Results.

    The results suggest that with progression stages, there are changing correlations among Positive and Negative Syndrome Scale factors at each stage and each factor correlates with all the others in that particular stage, in which this factor is dominant. This internal structure further supports the validity of an already proposed four stages model, with positive symptoms dominating the first stage, excitement/hostility the second, depression the third, and neurocognitive decline the last stage.

    Conclusions.

    The current study investigated the mental organization and functioning in patients with schizophrenia in relation to different stages of illness progression. It revealed two distinct “cores” of schizophrenia, the “Positive” and the “Negative,” while neurocognitive decline escalates during the later stages. Future research should focus on the therapeutic implications of such a model. Stopping the progress of the illness could demand to stop the succession of stages. This could be achieved not only by both halting the triggering effect of positive and negative symptoms, but also by stopping the sensitization effect on the neural pathways responsible for the development of hostility, excitement, anxiety, and depression as well as the deleterious effect on neural networks responsible for neurocognition.

  • 6.
    Fountoulakis, Konstantinos N.
    et al.
    Aristotle Univ Thessaloniki, Greece.
    Dragioti, Elena
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum. Karolinska Huddinge Univ Hosp, Sweden.
    Theofilidis, Antonis T.
    Aristotle Univ Thessaloniki, Greece.
    Wiklund, Tobias
    Linköpings universitet, Institutionen för medicin och hälsa, Avdelningen för samhällsmedicin. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum. Karolinska Huddinge Univ Hosp, Sweden.
    Atmatzidis, Xenofon
    Linköpings universitet, Institutionen för medicin och hälsa. Linköpings universitet, Medicinska fakulteten. Karolinska Huddinge Univ Hosp, Sweden.
    Nimatoudis, Ioannis
    Aristotle Univ Thessaloniki, Greece.
    Thys, Erik
    Katholieke Univ Leuven, Belgium; KU, Belgium.
    Wampers, Martien
    Katholieke Univ Leuven, Belgium; KU, Belgium.
    Hranov, Luchezar
    Univ Multiprofile Hosp Act Treatment Neurol and Psy, Bulgaria.
    Hristova, Trayana
    Univ Multiprofile Hosp Act Treatment Neurol and Psy, Bulgaria.
    Aptalidis, Daniil
    Univ Multiprofile Hosp Act Treatment Neurol and Psy, Bulgaria.
    Milev, Roumen
    Queens Univ, Canada.
    Iftene, Felicia
    Queens Univ, Canada.
    Spaniel, Filip
    Natl Inst Mental Hlth, Czech Republic.
    Knytl, Pavel
    Natl Inst Mental Hlth, Czech Republic.
    Furstova, Petra
    Natl Inst Mental Hlth, Czech Republic.
    From, Tiina
    Univ Turku, Finland.
    Karlsson, Henry
    Univ Turku, Finland.
    Walta, Maija
    Univ Turku, Finland.
    Salokangas, Raimo K. R.
    Univ Turku, Finland.
    Azorin, Jean-Michel
    St Marguerite Univ Hosp, France; CNRS, France; Aix Marseille Univ, France.
    Bouniard, Justine
    St Marguerite Univ Hosp, France; CNRS, France; Aix Marseille Univ, France.
    Montant, Julie
    St Marguerite Univ Hosp, France; CNRS, France; Aix Marseille Univ, France.
    Juckel, Georg
    Ruhr Univ Bochum, Germany.
    Haussleiter, Ida S.
    Ruhr Univ Bochum, Germany.
    Douzenis, Athanasios
    Univ Athens, Greece.
    Michopoulos, Ioannis
    Univ Athens, Greece.
    Ferentinos, Panagiotis
    Univ Athens, Greece.
    Smyrnis, Nikolaos
    Univ Athens, Greece.
    Mantonakis, Leonidas
    Univ Athens, Greece.
    Nemes, Zsofia
    Nyiro Gyula Hosp, Hungary.
    Gonda, Xenia
    Semmelweis Univ, Hungary.
    Vajda, Dora
    Semmelweis Univ, Hungary.
    Juhasz, Anita
    Semmelweis Univ, Hungary.
    Shrivastava, Amresh
    Western Univ, Canada.
    Waddington, John
    Royal Coll Surgeons Ireland, Ireland.
    Pompili, Maurizio
    Sapienza Univ Rome, Italy.
    Comparelli, Anna
    Sapienza Univ Rome, Italy.
    Corigliano, Valentina
    Sapienza Univ Rome, Italy.
    Rancans, Elmars
    Riga Stradins Univ, Latvia.
    Navickas, Alvydas
    Vilnius Univ, Lithuania; Vilnius Mental Hlth Ctr, Lithuania.
    Hilbig, Jan
    Vilnius Univ, Lithuania; Vilnius Mental Hlth Ctr, Lithuania.
    Bukelskis, Laurynas
    Vilnius Univ, Lithuania; Vilnius Mental Hlth Ctr, Lithuania.
    Stevovic, Lidija Injac
    Clin Ctr Montenegro, Montenegro; Univ Montenegro, Montenegro; Clin Ctr Montenegro, Montenegro.
    Vodopic, Sanja
    Clin Ctr Montenegro, Montenegro; Univ Montenegro, Montenegro; Clin Ctr Montenegro, Montenegro.
    Esan, Oluyomi
    Univ Ibadan, Nigeria.
    Oladele, Oluremi
    Univ Ibadan, Nigeria.
    Osunbote, Christopher
    Univ Ibadan, Nigeria.
    Rybakowski, Janusz K.
    Poznan Univ Med Sci, Poland.
    Wojciak, Pawel
    Poznan Univ Med Sci, Poland.
    Domowicz, Klaudia
    Poznan Univ Med Sci, Poland.
    Figueira, Maria Luisa
    Santa Maria Univ Hosp, Portugal.
    Linhares, Ludgero
    Santa Maria Univ Hosp, Portugal.
    Crawford, Joana
    Santa Maria Univ Hosp, Portugal.
    Panfil, Anca-Livia
    Univ Med and Pharm Targu Mures, Romania.
    Smirnova, Daria
    Samara State Med Univ, Russia.
    Izmailova, Olga
    Samara State Med Univ, Russia.
    Lecic-Tosevski, Dusica
    Inst Mental Hlth, Serbia; Serbian Acad Arts and Sci, Serbia.
    Temmingh, Henk
    Univ Cape Town, South Africa.
    Howells, Fleur
    Univ Cape Town, South Africa.
    Bobes, Julio
    Univ Oviedo, Spain; Ctr Invest Biomed Red Salud Mental CIBERSAM, Spain.
    Garcia-Portilla, Maria Paz
    Univ Oviedo, Spain; Ctr Invest Biomed Red Salud Mental CIBERSAM, Spain.
    Garcia-Alvarez, Leticia
    Univ Oviedo, Spain; Ctr Invest Biomed Red Salud Mental CIBERSAM, Spain.
    Erzin, Gamze
    Diskapi Yildirim Beyazit Training and Res Hosp, Turkey.
    Karadag, Hasan
    Diskapi Yildirim Beyazit Training and Res Hosp, Turkey.
    De Sousa, Avinash
    Lokmanya Tilak Municipal Gen Hosp and Med Coll, India.
    Bendre, Anuja
    Lokmanya Tilak Municipal Gen Hosp and Med Coll, India.
    Hoschl, Cyril
    Natl Inst Mental Hlth, Czech Republic.
    Bredicean, Cristina
    Univ Med and Farm Timisoara, Romania.
    Papava, Ion
    Univ Med and Farm Timisoara, Romania.
    Vukovic, Olivera
    Univ Belgrade, Serbia.
    Pejuskovic, Bojana
    Royal Coll Surgeons Ireland, Ireland.
    Russell, Vincent
    Royal Coll Surgeons Ireland, Ireland.
    Athanasiadis, Loukas
    Aristotle Univ Thessaloniki, Greece.
    Konsta, Anastasia
    Aristotle Univ Thessaloniki, Greece.
    Stein, Dan
    Univ Cape Town, South Africa.
    Berk, Michael
    Deakin Univ, Australia; Orygen, Australia; Univ Melbourne, Australia; Univ Melbourne, Australia; Univ Melbourne, Australia.
    Dean, Olivia
    Deakin Univ, Australia.
    Tandon, Rajiv
    Univ Florida, FL 32611 USA.
    Kasper, Siegfried
    Med Univ Vienna, Austria.
    De Hert, Marc
    Katholieke Univ Leuven, Belgium; KU, Belgium.
    Staging of Schizophrenia With the Use of PANSS: An International Multi-Center Study2019Inngår i: International Journal of Neuropsychopharmacology, ISSN 1461-1457, E-ISSN 1469-5111, Vol. 22, nr 11, s. 681-697Artikkel i tidsskrift (Fagfellevurdert)
    Abstract [en]

    Introduction

    A specific clinically relevant staging model for schizophrenia has not yet been developed. The aim of the current study was to evaluate the factor structure of the PANSS and develop such a staging method.

    Methods

    Twenty-nine centers from 25 countries contributed 2358 patients aged 37.21 ± 11.87 years with schizophrenia. Analysis of covariance, Exploratory Factor Analysis, Discriminant Function Analysis, and inspection of resultant plots were performed.

    Results

    Exploratory Factor Analysis returned 5 factors explaining 59% of the variance (positive, negative, excitement/hostility, depression/anxiety, and neurocognition). The staging model included 4 main stages with substages that were predominantly characterized by a single domain of symptoms (stage 1: positive; stages 2a and 2b: excitement/hostility; stage 3a and 3b: depression/anxiety; stage 4a and 4b: neurocognition). There were no differences between sexes. The Discriminant Function Analysis developed an algorithm that correctly classified >85% of patients.

    Discussion

    This study elaborates a 5-factor solution and a clinical staging method for patients with schizophrenia. It is the largest study to address these issues among patients who are more likely to remain affiliated with mental health services for prolonged periods of time.

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  • 7.
    Wiklund, Tobias
    Linköpings universitet, Institutionen för hälsa, medicin och vård, Avdelningen för prevention, rehabilitering och nära vård. Linköpings universitet, Medicinska fakulteten. Region Östergötland, Sinnescentrum, Smärt och rehabiliteringscentrum.
    Insomnia Symptoms in Chronic Pain: Clinical presentation, risk and treatment2021Doktoravhandling, med artikler (Annet vitenskapelig)
    Abstract [en]

    In recent years, chronic and recurrent pain have gained interest as distinct conditions interacting both with peripheral and central parts of the nervous system as well as with the immune system. The risk of getting affected by abnormal pain modulation i.e., chronic pain is not equally distributed in the population and the search for risk factors is therefore of interest. One potential risk factor for chronic pain is insomnia symptoms i.e., difficulties falling asleep or maintaining sleep. In turn, insomnia symptoms are overrepresented in persons with chronic pain. Common current pain treatments lead to limited improvement of insomnia symptoms calling for treatments specifically directed to improve sleep. The overall aim of this thesis is therefore to investigate the distribution of insomnia severity in patients seeking specialized care for chronic pain, to investigate the role of insomnia severity as a risk factor for spreading of pre-existing pain, and to evaluate potential treatments for insomnia symptoms comorbid to chronic pain.

    Study I highlighted the high prevalence rates of insomnia symptoms in patients with chronic pain conditions. Roughly, insomnia was six times more common in our sample compared to the general population. We also showed that there were weak connections between insomnia symptoms and other variables (primarily psychological symptoms and pain intensity). In Study II physical exercise was more efficacious than Acceptance and Commitment Therapy-based stress management and the active control group in reducing insomnia symptoms and pain intensity short term. Improvements in physical exercise were largely maintained after twelve months but pain intensity had then also declined in the control group. No improvements in the Acceptance and Commitment Therapy-based stress management remain significant when an intention to treat principles were applied. In Study III, a dose-dependent increase in risk for spreading of pain was confirmed in subjects reporting moderate and severe insomnia symptoms. Though, there was no increase in the risk of pain spreading in subjects reporting sub-threshold insomnia symptoms (according to Insomnia Severity Index). In Study IV patients in the Internet-delivered Cognitive Behavioural Therapy for insomnia group, showed a more rapid improvement in insomnia symptoms than patients in the internet-delivered applied relaxation. The effect of Cognitive Behavioural Therapy for insomnia had declined slightly after six months and the Applied Relaxation group had continued to improve, leading to a comparable outcome on the Insomnia Severity Index at six-month follow-up.

    In conclusion, insomnia symptoms are common in patients seeking specialized pain care. High levels of insomnia symptoms increase the risk of spreading of pre-existing pain and this in a dose-dependent manner. Physical exercise has significant, but not clinically meaningful effects on pain intensity and insomnia symptoms. Internet-delivered Cognitive Behavioral Therapy for insomnia leads to a more rapid reduction of insomnia symptoms compared to applied relaxation, although long-term effects are uncertain 

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