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  • 151. Andersson, Gerhard
    et al.
    Bergström, Jan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Lindefors, Nils
    The use of the Internet in the treatment of anxiety disorders2005In: Current Opinion in Psychiatry, ISSN 0951-7367, E-ISSN 1473-6578, Vol. 18, no 1, p. 73-73Article in journal (Refereed)
  • 152. Andersson, Gerhard
    et al.
    Bergström, Jan
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Holländare, Fredrik
    Carlbring, Per
    Kaldo, Viktor
    Ekselius, Lisa
    Internet-based self-help for depression: randomised controlled trial2005In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 187, no 5, p. 456-461Article in journal (Refereed)
  • 153.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Rozental, Alexander
    Karolinska Inst, Sweden; UCL, England.
    Response and Remission Rates in Internet-Based Cognitive Behavior Therapy: An Individual Patient Data Meta-Analysis2019In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 10, article id 749Article, review/survey (Refereed)
    Abstract [en]

    Background: Internet-delivered cognitive behavior therapy (ICBT) was developed over 20 years ago and has since undergone a number of controlled trials, as well as several systematic reviews and meta-analyses. However, the crucial question of response rates remains to be systematically investigated. The aim of this individual patient meta-analysis (IPDMA) was to use a large dataset of trials conducted in Sweden to determine reliable change and recovery rates across trials for a range of conditions.

    Methods: We used previously collected and aggregated data from 2,866 patients in 29 Swedish clinical trials of ICBT for three categories of conditions: anxiety disorders, depression, and others. Raw scores at pre-treatment and post-treatment were used in an IPDMA to determine the rate of reliable change and recovery. Jacobson and Truax’s, (1991) reliable change index (RCI) was calculated for each primary outcome measure in the trials as well as the recovery rates for each patient, with the additional requirement of having improved substantially. We subsequently explored potential predictors using binomial logistic regression.

    Results: In applying an RCI of z = 1.96, 1,162 (65.6%) of the patients receiving treatment were classified as achieving recovery, and 620 (35.0%) were classified as reaching remission. In terms of predictors, patients with higher symptom severity on the primary outcome measure at baseline [odds ratio (OR) = 1.36] and being female (OR = 2.22) increased the odds of responding to treatment. Having an anxiety disorder was found to decrease the response to treatment (OR = 0.51). Remission was predicted by diagnosis in the same direction (OR = 0.28), whereas symptom severity was inversely predictive of worse outcome (OR = 0.81). Conclusions: Response seems to occur among approximately half of all clients administered ICBT, whereas about a third reach remission. This indicates that the efficacy of ICBT is in line with that of CBT based in prior trials, with a possible caveat being the lower remission rates. Having more symptoms and being female might increase the chances of improvement, and a small negative effect of having anxiety disorder versus depression and other conditions may also exist. A limitation of the IPDMA was that only studies conducted in Sweden were included.

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  • 154.
    Andersson, Gerhard
    et al.
    Institutionen för beteendevetenskap och lärande, Linköpings universitet, Linköping, Sverige.
    Carlbring, Per
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Svanborg, Cecilia
    Institutionen för klinisk vetenskap, Karolinska institutet, Stockholm, Sverige.
    Bergström, Jan
    Psykologiska institutionen, Stockholms universitet, Stockholm, Sverige.
    Öst, Lars-Göran
    Psykologiska institutionen, Stockholms universitet, Stockholm, Sverige.
    Lindefors, Nils
    Institutionen för klinisk vetenskap, avdelning psykiatri, Karolinska institutet, Stockholm, Sverige.
    Paniksyndrom: ond cirkel av feltolkade kroppsliga signaler2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 14, p. 795-797Article in journal (Refereed)
    Abstract [sv]

    Attacker av intensiv rädsla utan tydlig yttre orsak som leder till rädsla för nya attacker – det kännetecknar paniksyndrom. Evidensbaserade behandlingsalternativ finns, och det finns inget skäl att avvakta med behandling.

  • 155.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Titov, Nickolai
    Macquarie Univ, Australia.
    Lindefors, Nils
    Karolinska Inst, Sweden.
    Internet Interventions for Adults with Anxiety and Mood Disorders: A Narrative Umbrella Review of Recent Meta-Analyses2019In: Canadian journal of psychiatry, ISSN 0706-7437, Vol. 64, no 7, p. 465-470Article, review/survey (Refereed)
    Abstract [en]

    Internet-delivered cognitive behaviour therapy (ICBT) has existed for 20 years and there are now several controlled trials for a range of problems. In this paper, we focused on recent meta-analytic reviews of the literature and found moderate to large effects reported for panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, and major depression. In total, we reviewed 9 recent meta-analytic reviews out of a total of 618 meta-analytic reviews identified using our search terms. In these selected reviews, 166 studies were included, including overlap in reviews on similar conditions. We also covered a recent review on transdiagnostic treatments and 2 reviews on face-to-face v. internet treatment. The growing number of meta-analytic reviews of studies now suggests that ICBT works and can be as effective as face-to-face therapy.

  • 156. Andersson, Gerhard
    et al.
    Carlbring, Per
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Clinical psychology. University of Southern Denmark, Denmark.
    Titov, Nickolai
    Lindefors, Nils
    Internet Interventions for Adults with Anxiety and Mood Disorders: A Narrative Umbrella Review of Recent Meta-Analyses2019In: Canadian journal of psychiatry, ISSN 0706-7437, Vol. 64, no 7, p. 465-470Article, review/survey (Refereed)
    Abstract [en]

    Internet-delivered cognitive behaviour therapy (ICBT) has existed for 20 years and there are now several controlled trials for a range of problems. In this paper, we focused on recent meta-analytic reviews of the literature and found moderate to large effects reported for panic disorder, social anxiety disorder, generalized anxiety disorder, posttraumatic stress disorder, and major depression. In total, we reviewed 9 recent meta-analytic reviews out of a total of 618 meta-analytic reviews identified using our search terms. In these selected reviews, 166 studies were included, including overlap in reviews on similar conditions. We also covered a recent review on transdiagnostic treatments and 2 reviews on face-to-face v. internet treatment. The growing number of meta-analytic reviews of studies now suggests that ICBT works and can be as effective as face-to-face therapy.

  • 157.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Karolinska Inst, Sweden; Reg Stockholm, Sweden.
    Olsson, Elin
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Ringsgard, Emma
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Sandgren, Therese
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Viklund, Ida
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Andersson, Catja
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Hesselman, Ylva
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Johansson, Robert
    Stockholm Univ, Sweden.
    Nordgren, Lise Bergman
    Orebro Univ, Sweden.
    Bohman, Benjamin
    Karolinska Inst, Sweden; Reg Stockholm, Sweden.
    Individually tailored Internet-delivered cognitive-behavioral therapy for survivors of intimate partner violence: A randomized controlled pilot trial2021In: Internet Interventions, ISSN 2214-7829, Vol. 26, article id 100453Article in journal (Refereed)
    Abstract [en]

    Intimate partner violence (IPV) is a serious public health concern worldwide and defined as behavior performed by spouses or other intimate partners that causes physical, sexual, or psychological harm. Internet-delivered cognitive-behavioral therapy (ICBT) may be particularly useful for survivors of IPV for several reasons, including barriers pertaining to limited community recourses and treatment availability, safety concerns, and issues of stigma, guilt and shame, which may prevent members of this population from seeking help via face-to face interactions. However, Internet interventions are lacking. The primary aim of the present randomized controlled pilot trial was to explore the feasibility of ICBT as guided self-help individually tailored to the pre dominant symptomatology of PTSD or depression in survivors of IPV. A second aim was to conduct a preliminary evaluation exploring the short-and long-term effects of the treatment in comparison to a waitlist control con-dition. Results showed that the treatment was feasible. Attrition rate was low (9.4%), and participants were satisfied with treatment. However, treatment adherence was moderate in terms of completed modules (62.5%). Results of the preliminary evaluation of treatment effects showed large and statistically significant between-group effect sizes (Cohens d = 0.86-1.08) on some measures of PTSD and depression at post assessment, fa-voring the treatment condition. However, there were no effects on other measures. At follow-up assessment, when the control condition had received delayed treatment, there were large and statistically significant within-group effect sizes (d = 0.96-1.48) on measures of PTSD, depression and anxiety, and small effects (d = 0.48) on a measure of quality of life. The results of the present pilot study are promising and warrant further research on ICBT for this population.

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  • 158. Andersson, Gerhard
    et al.
    Paxling, Bjorn
    Roch-Norlund, Pie
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Östman, Gunnar
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Norgren, Anna
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Almlöv, Jonas
    Georen, Lisa
    Breitholtz, Elisabeth
    Stockholm University, Faculty of Social Sciences, Department of Psychology.
    Dahlin, Mats
    Cuijpers, Pim
    Carlbring, Per
    Silverberg, Farrell
    Internet-Based Psychodynamic versus Cognitive Behavioral Guided Self-Help for Generalized Anxiety Disorder: A Randomized Controlled Trial2012In: Psychotherapy and Psychosomatics, ISSN 0033-3190, E-ISSN 1423-0348, Vol. 81, no 6, p. 344-355Article in journal (Refereed)
    Abstract [en]

    Background: Guided Internet-based cognitive behavior therapy (ICBT) has been tested in many trials and found to be effective in the treatment of anxiety and mood disorders. Generalized anxiety disorder (GAD) has also been treated with ICBT, but there are no controlled trials on guided Internet-based psychodynamic treatment (IPDT). Since there is preliminary support for psychodynamic treatment for GAD, we decided to test if a psychodynamically informed self-help treatment could be delivered via the Internet. The aim of the study was to investigate the efficacy of IPDT for GAD and to compare against ICBT and a waiting list control group. Method: A randomized controlled superiority trial with individuals diagnosed with GAD comparing guided ICBT (n = 27) and IPDT (n = 27) against a no treatment waiting list control group (n = 27). The primary outcome measure was the Penn State Worry Questionnaire. Results: While there were no significant between-group differences immediately after treatment on the main outcome measure, both IPDT and ICBT resulted in improvements with moderate to large within-group effect sizes at 3 and 18 months follow-up on the primary measure in the completer analyses. The differences against the control group, although smaller, were still significant for both PDT and CBT when conforming to the criteria of clinically significant improvement. The active treatments did not differ significantly. There was a significant group by time interaction regarding GAD symptoms, but not immediately after treatment. Conclusions: IPDT and ICBT both led to modest symptom reduction in GAD, and more research is needed.

  • 159.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Paxling, Björn
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Roch-Norlund, Pie
    Department of Psychology, Stockholm University.
    Östman, Gunnar
    Department of Psychology, Stockholm University.
    Norgren, Anna
    Department of Psychology, Stockholm University.
    Almlöv, Jonas
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Georén, Lisa
    Department of Psychology, Uppsala University.
    Breitholtz, Elisabeth
    Department of Psychology, Stockholm University.
    Dahlin, Mats
    Psykologpartners, Linköping.
    Cuijpers, Pim
    Vrije University, Amsterdam, The Netherlands .
    Carlbring, Per
    Umeå University.
    Silverberg, Farrell
    Philadelphia School of Psychoanalysis and Private Practice, Philadelphia, USA.
    Internet-Based Psychodynamic versus Cognitive Behavioral Guided Self-Help for Generalized Anxiety Disorder: A Randomized Controlled Trial2012In: Psychotherapy and Psychosomatics, ISSN 0033-3190, E-ISSN 1423-0348, Vol. 81, no 6, p. 344-355Article in journal (Refereed)
    Abstract [en]

    Background: Guided Internet-based cognitive behavior therapy (ICBT) has been tested in many trials and found to be effective in the treatment of anxiety and mood disorders. Generalized anxiety disorder (GAD) has also been treated with ICBT, but there are no controlled trials on guided Internet-based psychodynamic treatment (IPDT). Since there is preliminary support for psychodynamic treatment for GAD, we decided to test if a psychodynamically informed self-help treatment could be delivered via the Internet. The aim of the study was to investigate the efficacy of IPDT for GAD and to compare against ICBT and a waiting list control group. Method: A randomized controlled superiority trial with individuals diagnosed with GAD comparing guided ICBT (n = 27) and IPDT (n = 27) against a no treatment waiting list control group (n = 27). The primary outcome measure was the Penn State Worry Questionnaire. Results: While there were no significant between-group differences immediately after treatment on the main outcome measure, both IPDT and ICBT resulted in improvements with moderate to large within-group effect sizes at 3 and 18 months follow-up on the primary measure in the completer analyses. The differences against the control group, although smaller, were still significant for both PDT and CBT when conforming to the criteria of clinically significant improvement. The active treatments did not differ significantly. There was a significant group by time interaction regarding GAD symptoms, but not immediately after treatment. Conclusions: IPDT and ICBT both led to modest symptom reduction in GAD, and more research is needed.

  • 160.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Institutionen för klinisk neurovetenskap, Karolinska Instituttet, Stockholm.
    Sarkohi, Ali
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Avslutande ord2019In: Somatisk sjukdom: ett biopsykosocialt perspektiv, Lund: Studentlitteratur , 2019, 1, , p. 495p. 261-263Chapter in book (Other academic)
  • 161.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Department of Otorhinolaryngology. Linköping University, Department of Biomedical and Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Institutionen för klinisk neurovetenskap, Karolinska Instituttet, Stockholm.
    Sarkohi, Ali
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Introduktion till ett biopsykosocialt perspektiv2021In: Psykisk ohälsa: ett biopsykosocialt perspektiv, Lund: Studentlitteratur , 2021, 1, , p. 495p. 15-21Chapter in book (Other academic)
  • 162.
    Andersson, Gerhard
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Titov, Nickolai
    Macquarie Univ, Australia.
    Dear, Blake F.
    Macquarie Univ, Australia.
    Rozental, Alexander
    Karolinska Inst, Sweden; UCL, England.
    Carlbring, Per
    Stockholm Univ, Sweden; Univ Southern Denmark, Denmark.
    Internet-delivered psychological treatments: from innovation to implementation2019In: World Psychiatry, ISSN 1723-8617, E-ISSN 2051-5545, Vol. 18, no 1, p. 20-28Article in journal (Refereed)
    Abstract [en]

    Internet interventions, and in particular Internet-delivered cognitive behaviour therapy (ICBT), have existed for at least 20 years. Here we review the treatment approach and the evidence base, arguing that ICBT can be viewed as a vehicle for innovation. ICBT has been developed and tested for several psychiatric and somatic conditions, and direct comparative studies suggest that therapist-guided ICBT is more effective than a waiting list for anxiety disorders and depression, and tends to be as effective as face-to-face CBT. Studies on the possible harmful effects of ICBT are also reviewed: a significant minority of people do experience negative effects, although rates of deterioration appear similar to those reported for face-to-face treatments and lower than for control conditions. We further review studies on change mechanisms and conclude that few, if any, consistent moderators and mediators of change have been identified. A recent trend to focus on knowledge acquisition is considered, and a discussion on the possibilities and hurdles of implementing ICBT is presented. The latter includes findings suggesting that attitudes toward ICBT may not be as positive as when using modern information technology as an adjunct to face-to-face therapy (i.e., blended treatment). Finally, we discuss future directions, including the role played by technology and machine learning, blended treatment, adaptation of treatment for minorities and non-Western settings, other therapeutic approaches than ICBT (including Internet-delivered psychodynamic and interpersonal psychotherapy as well as acceptance and commitment therapy), emerging regulations, and the importance of reporting failed trials.

  • 163.
    Andersson, Gunnel
    et al.
    Södertörns högskola.
    Bülow, PerJönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Psykiatriska kliniken, Länssjukhuset Ryhov, Jönköping.Denhov, AnneInstitutionen för socialt arbete, Stockholms universitet.Topor, AlainInstitutionen för socialt arbete, Stockholms universitet.
    Från patient till person: Om allvarliga psykiska problem - vardag, vård och stöd2016Collection (editor) (Other academic)
  • 164.
    Andersson, Gunnel
    et al.
    FoU-Södertörn, R&D, Stockholm, Sweden.
    Denhov, Anne
    Department of Social Work, Stockholm University, Stockholm, Sweden.
    Bülow, Per
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Behavioural Science and Social Work. Jönköping University, School of Health and Welfare, HHJ. SALVE (Social challenges, Actors, Living conditions, reseach VEnue). Department of Psychiatry, Ryhov County Hospital, Jönköping, Sweden.
    Topor, Alain
    Department of Social Work, Stockholm University, Stockholm, Sweden.
    Aloneness and loneliness – persons with severe mental illness and experiences of being alone2015In: Scandinavian Journal of Disability Research, ISSN 1501-7419, E-ISSN 1745-3011, Vol. 17, no 4, p. 353-365Article in journal (Refereed)
    Abstract [en]

    People with severe mental illness (SMI) are often described as lonely and socially incapable – an inability resulting from the mental illness. The aim of this article is to explore experiences of being alone among persons with SMI. The article is based on interviews with 19 persons diagnosed with psychosis who were interviewed between four and nine times over a period of three years. The findings show that experiences of being alone can be identified by two concepts: aloneness and loneliness. The persons in the study appeared as socially able and active in relation to their social lives. However, a social agent does not operate in a void but in interaction with specific living conditions; the experiences of aloneness and loneliness may be viewed as the result of the interplay between the individual and the social and material environment.

  • 165.
    Andersson, Gunnel
    et al.
    Research and Development Center, FoU Södertörn, Haninge, Sweden.
    Ellegård, Kajsa
    Division Technology and Social Change, Department of Thematic Studies, Linköping University, Linköping, Sweden.
    Bülow, Per
    Jönköping University, School of Health and Welfare, HHJ, Dept. of Social Work.
    Denhov, Anne
    Department of Social Work, Stockholm University, Stockholm, Sweden.
    Vrotsou, Katerina
    Department of Science and Technology, Linköping University, Norrköping, Sweden.
    Stefansson, Claes-Göran
    Department of Social Work, Stockholm University, Stockholm, Sweden.
    Topor, Alain
    Department of Social Work, Stockholm University, Stockholm, Sweden.
    A longitudinal study of men and women diagnosed with psychosis: trajectories revealing interventions in a time-geographic framework2022In: GeoJournal, ISSN 0343-2521, E-ISSN 1572-9893, Vol. 87, no 4, p. 2423-2440Article in journal (Refereed)
    Abstract [en]

    The living conditions for persons with severe mental illness have undergone substantial change in Sweden as well as in the rest of the Western world due to the downsizing of inpatient care and the development of community-based interventions. However, there is a lack of knowledge concerning the “trajectories of interventions” in this new, fragmented, institutional landscape. The aim of the study was to explore types of interventions and when they occur in a 10-year follow-up of 437 women and men diagnosed with psychosis for the first time. Based on registers and using a timegeographic visualization method, the results showed a great diversity of trajectories and differences between sexes. The aggregate picture revealed that over the 10-year period there were considerable periods with no interventions for both men and women. Furthermore, institutional interventions more commonly occurred among women but appeared for longer periods among men. Community-based interventions declined among women and increased among men during the period.

  • 166.
    Andersson, Gunnel
    et al.
    FoU Sodertorn, Res & Dev Ctr, Handen, Sweden..
    Vrotsou, Katerina
    Linkoping Univ, Dept Sci & Technol, Norrkoping, Sweden..
    Denhov, Anne
    Stockholm Univ, Dept Social Work, Stockholm, Sweden..
    Topor, Alain
    Stockholm Univ, Dept Social Work, Stockholm, Sweden.;Univ Agder, Dept Psychosocial Work, Kristiansand, Norway..
    Bulow, Per
    Jönköping University, School of Health and Welfare, HHJ, Dep. of Social Work.
    Ellegard, Kajsa
    Linkoping Univ, Dept Themat Studies TEMA, Technol & Social Change TEMAT, Linkoping, Sweden..
    A diversity of patterns: 10-year trajectories of men and women diagnosed with psychosis for the first time. A time-geographic approach2020In: Moravian Geographical Reports, ISSN 1210-8812, E-ISSN 2199-6202, Vol. 28, no 4, p. 283-298Article in journal (Refereed)
    Abstract [en]

    People with severe mental illness face a different 'interventional' landscape compared to some decades ago, when mental hospitals were dominant, in Sweden as well as in the rest of the Western world. The aim of the research reported in this article was to follow men and women diagnosed with psychosis for the first time over a 10-year period, and to explore what interventions they experienced. The interventions, here defined as "spheres", were either community-based or institutional. A third sphere represents no interventions. Based on data from registers and using a time-geographic approach, the individuals were visualised as 10-year trajectories where their transitions between the different spheres were highlighted. The results show a great diversity of trajectories. Two main categories were detected: two-spheres (community-based and no interventions) and three-spheres (adding institutional interventions). One third of the population experienced only community-based interventions, with a higher proportion of men than women. Consequently, more women had institutional experience. Two sub-categories reveal trajectories not being in the interventional sphere in a stepwise manner before the 10th year, and long-term trajectories with interventions in the 10th year. The most common pattern was long-term trajectories, embracing about half of the population, while one-fifth left the institutional sphere before the 5th year.

  • 167.
    Andersson, Hedvig
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Aspeqvist, Erik
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Svedin, Carl Göran
    Marie Cederschiold Univ, Sweden.
    Jonsson, Linda S.
    Marie Cederschiold Univ, Sweden.
    Landberg, Åsa
    Marie Cederschiold Univ, Sweden.
    Zetterqvist, Maria
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Department of Child and Adolescent Psychiatry in Linköping.
    Emotional Dysregulation and Trauma Symptoms Mediate the Relationship Between Childhood Abuse and Nonsuicidal Self-Injury in Adolescents2022In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 13, article id 897081Article in journal (Refereed)
    Abstract [en]

    BackgroundNonsuicidal self-injury (NSSI) is common in adolescents. Emotion dysregulation has been identified as a core mechanism in the development and maintenance of NSSI and it is therefore an important target when addressing NSSI. The pathogenic connection between different kinds of childhood abuse, difficulties in emotion regulation and NSSI needs further investigation. The objective of this study was to examine whether difficulties with emotion regulation and trauma symptoms, separately and together, mediate the relationships between sexual, physical and emotional abuse and NSSI. MethodCross-sectional data was collected from 3,169 adolescent high-school students aged 16-19 years (M = 18.12, SD = 0.45). Data from self-reported experiences of childhood abuse, current difficulties with emotion regulation (measured with the Difficulties with Emotion Regulation Scale, DERS-16) and trauma symptoms (measured with the Trauma Symptom Checklist for Children, TSCC), and NSSI were collected. Structural Equation Modeling (SEM) was used to test the proposed relationships between variables. ResultsThe prevalence of life-time NSSI was 27.4%. Prevalence of reported childhood abuse was 9.2, 17.5, and 18.0% for sexual, physical, and emotional abuse, respectively. Childhood abuse, difficulties with emotion regulation and trauma symptoms exhibited significant positive associations with NSSI in adolescents. Emotional dysregulation and trauma symptoms were both found to mediate the relationship between childhood abuse and NSSI. Latent variable models were found to fit data well. ConclusionResults indicate that increased levels of emotional dysregulation and trauma symptoms in relation to childhood abuse contribute to the increased risk of NSSI. Further, results point to some aspects of emotional dysregulation and trauma symptoms being more important in this regard. Clinical implications are discussed.

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  • 168.
    Andersson, Hedvig
    et al.
    Linköpings universitet.
    Aspeqvist, Erik
    Linköpings universitet.
    Dahlström, Örjan
    Linköpings universitet.
    Svedin, Carl Göran
    Marie Cederschiöld University, Department of Social Sciences.
    Jonsson, Linda S.
    Marie Cederschiöld University, Department of Social Sciences.
    Landberg, Åsa
    Marie Cederschiöld University, Department of Social Sciences.
    Zetterqvist, Maria
    Universitetssjukhuset i Linköping.
    Emotional Dysregulation and Trauma Symptoms Mediate the Relationship Between Childhood Abuse and Nonsuicidal Self-Injury in Adolescents2022In: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 13, article id 897081Article in journal (Refereed)
    Abstract [en]

    Background: Nonsuicidal self-injury (NSSI) is common in adolescents. Emotion dysregulation has been identified as a core mechanism in the development and maintenance of NSSI and it is therefore an important target when addressing NSSI. The pathogenic connection between different kinds of childhood abuse, difficulties in emotion regulation and NSSI needs further investigation. The objective of this study was to examine whether difficulties with emotion regulation and trauma symptoms, separately and together, mediate the relationships between sexual, physical and emotional abuse and NSSI.

    Method: Cross-sectional data was collected from 3,169 adolescent high-school students aged 16–19 years (M = 18.12, SD = 0.45). Data from self-reported experiences of childhood abuse, current difficulties with emotion regulation (measured with the Difficulties with Emotion Regulation Scale, DERS-16) and trauma symptoms (measured with the Trauma Symptom Checklist for Children, TSCC), and NSSI were collected. Structural Equation Modeling (SEM) was used to test the proposed relationships between variables.

    Results: The prevalence of life-time NSSI was 27.4%. Prevalence of reported childhood abuse was 9.2, 17.5, and 18.0% for sexual, physical, and emotional abuse, respectively. Childhood abuse, difficulties with emotion regulation and trauma symptoms exhibited significant positive associations with NSSI in adolescents. Emotional dysregulation and trauma symptoms were both found to mediate the relationship between childhood abuse and NSSI. Latent variable models were found to fit data well.

    Conclusion: Results indicate that increased levels of emotional dysregulation and trauma symptoms in relation to childhood abuse contribute to the increased risk of NSSI. Further, results point to some aspects of emotional dysregulation and trauma symptoms being more important in this regard. Clinical implications are discussed.

  • 169.
    Andersson, Hedvig
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Svensson, E.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Magnusson, A.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Zetterqvist, Maria
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Psykiatricentrum, Department of Child and Adolescent Psychiatry in Linköping.
    Young adults looking back at their experiences of treatment and care for nonsuicidal self-injury during adolescence: a qualitative study2024In: Child and Adolescent Psychiatry and Mental Health, E-ISSN 1753-2000, Vol. 18, no 1, article id 16Article in journal (Refereed)
    Abstract [en]

    BackgroundNonsuicidal self-injury (NSSI) is associated with stigma, and negative attitudes among healthcare professionals toward NSSI have been reported. A person-centered approach that focuses on how individuals with lived experience of NSSI perceive the treatment and care they receive is invaluable in reducing barriers to help-seeking and improving treatment and mental healthcare services. The aim of the current qualitative study was to explore the perceptions of young adults when they look back upon their experiences of psychiatric treatment for NSSI during adolescence.MethodsTwenty-six individuals with lived experience of NSSI who were in contact with child and adolescent psychiatry during adolescence were interviewed. The interviews were analyzed using thematic analysis.ResultsThree main themes were developed: Changed perceptions in retrospect, The importance of a collaborative conceptualization and Lasting impression of the relationship. Participants' perception of themselves as well as the treatment changed over time. The importance of a joint understanding of NSSI and an agreed-upon treatment focus was emphasized. The relationship to the mental health professionals, and experiences of how NSSI was communicated, were salient several years later.ConclusionsHealthcare professionals need to communicate about NSSI in a respectful manner and include the perspective of the adolescent with lived experience of NSSI in a joint conceptualization of NSSI and treatment focus.

  • 170.
    Andersson, Josefin
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Lindhult, Helena
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    SJUK PÅ RIKTIGT?: En litteraturstudie om hur personer med diagnosen depression upplever mötet med sjukvården2012Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
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  • 171.
    Andersson Konke, Linn
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Falck-Ytter, Terje
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Shragge, Ingrid
    Brocki, Karin
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Deferred Gratification as a Protective factor for Autistic Symptom-Adaptive Behavior Associations in 3-Year-OldsManuscript (preprint) (Other academic)
    Abstract [en]

    Background: Children with ASD and/or ADHD often struggle with tasks that demand executive functioning (EF) and deferred gratification. However, whether children with a family history of ASD and/or ADHD differ on these types of tasks in comparison to peers with a family history of typical likelihood is not known. In addition, little is known about the specificity of these domains in relation to autistic traits, ADHD traits and adaptive behaviors early in life and whether deferred gratification and strong EF skills may function as protective factors in the trait-adaptive behaviour association.

    Methods:  A total of 77 infant siblings at 3 years of age participated in the study and we examined the effect of type of family history -FH-ASD, FH-ASD/ADHD and family history of typical likelihood FH-TL- on EF performance, deferred gratification skills and adaptive behaviors, as well as specific and shared associations, including moderation effects. Measures included behavioral lab-tasks (common EF and deferred gratification), parent-rated adaptive behavior using VABS, and clinician ratings using ADOS-2 (autistic symptoms) and ADHD DSM-5 Rating Scale (ADHD RS). 

    Results: Lower levels of deferred gratification was specifically related to adaptive behavior, while lower level performance on common EF was specific for ADHD traits and adaptive behavior. Finally, deferred gratification moderated the association between autistic symptoms and adaptive behavior, in that stronger ability to defer gratification attenuated the association between autistic traits and adaptive functions. 

    Conclusions: In terms of specificity, we found unique associations between deferred gratification and autistic traits, and between common EF and ADHD traits. Finally, the results are in line with the idea that strong EF may act as a protective factor for children with an elevated likelihood of ASD and/or ADHD. However, our findings point at more affective than cognitive aspects of EF as particularly important for attenuating the association between autistic traits and adaptive behaviors. 

  • 172. Andersson, Lena M. C.
    et al.
    Hjern, Anders
    Stockholm University, Faculty of Social Sciences, Centre for Health Equity Studies (CHESS). Karolinska Institute, Sweden.
    Ascher, Henry
    Suicidal thoughts among undocumented migrants in Sweden2021In: International Journal of Migration, Health and Social Care, ISSN 1747-9894, E-ISSN 2042-8650, Vol. 17, no 2, p. 105-118Article in journal (Refereed)
    Abstract [en]

    Purpose - Early identification of persons at risk is essential in suicide prevention. Undocumented migrants (UM) live under limited conditions and are to a high degree invisible, both in research and in suicide prevention programmes. The aim of this study was to investigate prevalence rates of suicidal thoughts among UM in Sweden.

    Design/methodology/approach - This cross-sectional study was part of the Swedish Health Research on Undocumented Migrants project (SHERUM). The study population consisted of 104 UM over 18 years of age recruited through informal networks. Data on 112 multiple choice questions was collected via trained interviewers in Gothenburg, Stockholm and Malmo during 2014-2016. To assess suicidal thoughts (the last two weeks) one item asking about suicidal thought in the Beck Depression Inventory scale (BDI-II) was used. Logistic regression and chi-square analyses were made to identify risk and protective factors.

    Findings - Suicidal thoughts were found in 43.2% of the 88 UM that answered the question on suicidal thoughts. Being a parent had some protective influence on the prevalence of suicidal thoughts while the housing situation, having been exposed to crime and having mental illness were all statistically significant risk factors for suicidal thoughts. However, due to low sample size, few variables presented statistically significant differences.

    Originality/value - This study presents an alarmingly high prevalence of suicidal thoughts among undocumented migrants in Sweden, a difficult-to reach, vulnerable and rarely studied group. Targeted strategies are imperative to include undocumented migrants in suicidal prevention programmes.

  • 173.
    Andersson, Linus
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Claesson, Anna-Sara
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB), Physiology. Umeå University, Faculty of Medicine, Department of Radiation Sciences, Diagnostic Radiology.
    Stenberg, Berndt
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Dermatology and Venerology.
    Nordin, Steven
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Brain responses to olfactory and trigeminal exposure in idiopathic environmental illness (IEI) attributed to smells: An fMRI study2014In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 77, no 5, p. 401-408Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Idiopathic environmental intolerance (IEI) to smells is a prevalent medically unexplained illness. Sufferers attribute severe symptoms to low doses of non-toxic chemicals. Despite the label, IEI is not characterized by acute chemical senses. Theoretical models suggest that sensitized responses in the limbic system of the brain constitute an important mechanism behind the symptoms. The aim was to investigate whether and how brain reactions to low-levels of olfactory and trigeminal stimuli differ in individuals with and without IEI. METHODS: Brain responses to intranasally delivered isoamyl acetate and carbon dioxide were assessed in 25 women with IEI and 26 non-ill controls using functional magnetic resonance imaging. RESULTS: The IEI group had higher blood-oxygenated-level-dependent (BOLD) signal than controls in the thalamus and a number of, mainly, parietal areas, and lower BOLD signal in the superior frontal gyrus. The IEI group did not rate the exposures as more intense than the control group did, and there were no BOLD signal differences between groups in the piriform cortex or olfactory regions of the orbitofrontal cortex. CONCLUSIONS: The IEI reactions were not characterized by hyper-responsiveness in sensory areas. The results can be interpreted as a limbic hyperreactivity and speculatively as an inability to inhibit salient extemal stimuli.

  • 174.
    Andersson, Liselotte
    et al.
    University West, Department of Nursing, Health and Culture.
    Jakum, Päivi
    University West, Department of Nursing, Health and Culture.
    Inte som i Gökboet: sjuksköterskors beskrivningar av omvårdnadsprocessen inom den rättspsykiatriska vården : en kvalitativ studie2009Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Forensic psyhiatric care protects the society by giving patients care to diminish risks of serious crimes. In their work the nurses use different care methods to help and support the patient in managing his or her life situation. To clarify how a group of nurses describe the nursing process in forensic psychiatric care. A qualitative study based on interviews. Six nurses were interviewed about their work in four different forensic psychiatric care units. The nursing process in is divided into four categories: evaluation, planning, implementation and assessment. The results are based on the way the interviewed nurses described the essential roles of nurse-patient relationship and structured routines in nursing process. The study also shows some specific difficulties in nursing work, for example the mental dysfunctions of patients, the level of competence among staff and the patients need for social interaction and existence beyond their specific needs.

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  • 175.
    Andersson, M. J.
    et al.
    Lund Univ, Dept Clin Sci, Lund, Sweden..
    Kenttä, Göran
    Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics.
    Moesch, K.
    Malmö Univ, Dept Sports Sci, Malmö, Sweden..
    Borg, E.
    Stockholm Univ, Dept Psychol Percept & Psychophys, Stockholm, Sweden..
    Claesdotter-Knutsson, E.
    Lund Univ, Dept Clin Sci, Lund, Sweden..
    Håkansson, A.
    Lund Univ, Dept Clin Sci, Lund, Sweden..
    Symptoms of Depression and Anxiety Among Elite High School Student-Athletes in Sweden During the COVID-19 Pandemic: A Longitudinal Study2023In: European Psychiatry 66(2023):Suppl. 1, Cambridge University Press, 2023, Vol. 66, p. S593-S594, article id EPP0961Conference paper (Other academic)
  • 176.
    Andersson, Mitchell J
    et al.
    Malmö Addiction Center, Region Skåne, Clinical Sports and Mental Health Unit, Malmö, Sweden.; Faculty of Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden..
    Kenttä, Göran
    Swedish School of Sport and Health Sciences, GIH, Department of Physiology, Nutrition and Biomechanics. Swedish Sports Confederation, Stockholm, Sweden; School of Human Kinetics, University of Ottawa, Ottawa, Canada.
    Moesch, Karin
    Swedish Sports Confederation, Stockholm, Sweden.; Department of Sports Science, Malmö University, Malmö, Sweden.
    Borg, Elisabet
    Faculty of Social Sciences, Department of Psychology - Perception and Psychophysics, Stockholm University, Stockholm, Sweden..
    Claesdotter-Knutsson, Emma
    Faculty of Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden..
    Håkansson, Anders
    Malmö Addiction Center, Region Skåne, Clinical Sports and Mental Health Unit, Malmö, Sweden.; Faculty of Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden..
    Symptoms of depression and anxiety among elite high school student-athletes in Sweden during the COVID-19 pandemic: A repeated cross-sectional study.2023In: Journal of Sports Sciences, ISSN 0264-0414, E-ISSN 1466-447X, Vol. 41, no 9, p. 874-883Article in journal (Refereed)
    Abstract [en]

    The COVID-19 pandemic precipitated numerous changes in daily life, including the cancellation and restriction of sports globally. Because sports participation contributes positively to the development of student-athletes, restricting these activities may have led to long-term mental health changes in this population. Using a repeated cross-sectional study design, we measured rates of depression using the Patient Health Questionnaire-2 and anxiety using the Generalized Anxiety Disorder-2 scale in student-athletes attending elite sport high schools in Sweden during the second wave of the pandemic (February 2021; n = 7021) and after all restrictions were lifted (February 2022; n = 6228). Depression among student-athletes decreased from 19.8% in 2021 to 17.8% in 2022 (p = .008, V = .026), while anxiety screening did not change significantly (17.4% to 18.4%, p > .05). Comparisons between classes across years revealed older students exhibited decreases in depressive symptoms, while younger cohorts experienced increases in symptoms of anxiety from 2021 to 2022. Logistic regressions revealed that being female, reporting poorer mental health due to COVID-19, and excessive worry over one's career in sports were significant predictors of both depression and anxiety screenings in 2022. Compared to times when sports participation was limited, the lifting of restrictions was associated with overall reduced levels of depression, but not anxiety.

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  • 177. Andersson, Mitchell J.
    et al.
    Kenttä, Göran
    Moesch, Karin
    Borg, Elisabet
    Stockholm University, Faculty of Social Sciences, Department of Psychology, Perception and psychophysics.
    Claesdotter-Knutsson, Emma
    Håkansson, Anders
    Symptoms of depression and anxiety among elite high school student-athletes in Sweden during the COVID-19 pandemic: A repeated cross-sectional study2023In: Journal of Sports Sciences, ISSN 0264-0414, E-ISSN 1466-447X, Vol. 41, no 9, p. 874-883Article in journal (Refereed)
    Abstract [en]

    The COVID-19 pandemic precipitated numerous changes in daily life, including the cancellation and restriction of sports globally. Because sports participation contributes positively to the development of student-athletes, restricting these activities may have led to long-term mental health changes in this population. Using a repeated cross-sectional study design, we measured rates of depression using the Patient Health Questionnaire-2 and anxiety using the Generalized Anxiety Disorder-2 scale in student-athletes attending elite sport high schools in Sweden during the second wave of the pandemic (February 2021; n = 7021) and after all restrictions were lifted (February 2022; n = 6228). Depression among student-athletes decreased from 19.8% in 2021 to 17.8% in 2022 (p = .008, V = .026), while anxiety screening did not change significantly (17.4% to 18.4%, p > .05). Comparisons between classes across years revealed older students exhibited decreases in depressive symptoms, while younger cohorts experienced increases in symptoms of anxiety from 2021 to 2022. Logistic regressions revealed that being female, reporting poorer mental health due to COVID-19, and excessive worry over one’s career in sports were significant predictors of both depression and anxiety screenings in 2022. Compared to times when sports participation was limited, the lifting of restrictions was associated with overall reduced levels of depression, but not anxiety.

  • 178.
    Andersson, Peter
    et al.
    Department of Clinical Neuroscience/Psychology, Karolinska Institute, Stockholm, Sweden; Center for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Jamshidi, Esmail
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
    Ekman, Carl-Johan
    Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Karolinska University Hospital, Region Stockholm, Stockholm, Sweden; Stockholm Health Care Services, Karolinska University Hospital, Region Stockholm, Sweden.
    Tedroff, Kristina
    Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital.
    Björkander, Jonnie
    Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
    Sjögren, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lundberg, Johan
    Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Karolinska University Hospital, Region Stockholm, Stockholm, Sweden; Stockholm Health Care Services, Karolinska University Hospital, Region Stockholm, Sweden.
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Karolinska University Hospital, Region Stockholm, Stockholm, Sweden; Stockholm Health Care Services, Karolinska University Hospital, Region Stockholm, Sweden.
    Boström, Adrian Desai E.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Karolinska University Hospital, Region Stockholm, Stockholm, Sweden; Stockholm Health Care Services, Karolinska University Hospital, Region Stockholm, Sweden; Department of Women's and Children's Health/Neuropediatrics, Karolinska Institute, Stockholm, Sweden.
    Anorexia nervosa with comorbid severe depression: a systematic scoping review of brain stimulation treatments2023In: Journal of ECT, ISSN 1095-0680, E-ISSN 1533-4112, Vol. 39, no 4, p. 227-234Article in journal (Refereed)
    Abstract [en]

    Major depressive disorder (MDD) is highly prevalent in individuals with anorexia nervosa (AN) and is a predictor of greater clinical severity. However, there is a limited amount of evidence supporting the use of psychotropic medications for its management. A systematic scoping review was conducted to assess the current literature on brain stimulation treatments for AN with comorbid MDD, with a specific focus on MDD treatment response and weight restoration. This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the PubMed, PsycInfo, and MEDLINE databases were searched until July 2022 using specific key words related to AN and brain stimulation treatments. A total of 373 citations were identified, and 49 treatment studies that met the inclusion criteria were included in the review. The initial evidence suggests that electroconvulsive therapy, repetitive transcranial magnetic stimulation, and deep-brain stimulation may be effective in managing comorbid MDD in AN. Emerging evidence suggests that transcranial direct current stimulation may have a positive effect on body mass index in individuals with severe to extreme AN. However, there is a need for the development of better measurement techniques for assessing the severity of depression in the context of AN. Controlled trials that are adequately designed to account for these limitations are highly warranted for deep-brain stimulation, electroconvulsive therapy, and repetitive transcranial magnetic stimulation and hold promise for providing clinically meaningful results.

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  • 179.
    Andersson, Peter
    et al.
    Department of Clinical Neuroscience/Psychology, Karolinska Institute, Stockholm, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Falun, Sweden.
    Jamshidi, Esmail
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
    Ekman, Carl-Johan
    Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden.
    Tedroff, Kristina
    Department of Women's and Children's Health/Neuropediatrics, Karolinska Institutet, Stockholm, Sweden.
    Björkander, Jonnie
    Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
    Sjögren, Magnus
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lundberg, Johan
    Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden.
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden.
    Boström, Adrian Desai E.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden; Department of Women's and Children's Health/Neuropediatrics, Karolinska Institutet, Stockholm, Sweden.
    Mapping length of inpatient treatment duration and year-wise relapse rates in eating disordered populations in a well-defined Western-European healthcare region across 1998–20202023In: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, Vol. 32, no 4, article id e1960Article in journal (Refereed)
    Abstract [en]

    Objectives: Updated international guideline recommendations for AN inpatient care rely on expert opinions/observational evidence and promote extended inpatient stays, warranting investigation using higher-level ecological evidence.

    Methods: The study was conducted according to Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Data encompassing 13,885 ED inpatients (5336 adolescents and 8549 adults) was retrieved from Swedish public health registries. Variables analyzed included (1) ED inpatient care opportunities, (2) unique number of ED inpatients and (3) mean length of ED-related inpatient stays in age groups 15–19 and 20–88+, across 1998–2020.

    Results: Mean length of inpatient stays was inversely correlated to relapse to ED-related inpatient care within the same year (p < 0.001, R-squaredadj = 0.5216 and p < 0.00001, R-squaredadj = 0.5090, in the 15–19 and 20–88+ age groups, respectively), independent of number of ED inpatients treated within a year in both age groups. Extending mean adolescent inpatient duration from 35 to 45 days was associated with a ∼30% reduction in the year-wise relapse rate.

    Conclusions: Mean length of ED-related inpatient treatment stays was associated with reduced relapses to inpatient care within the same year, which could be interpreted as support for recommendations to include a stabilization phase in inpatient ED treatment.

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  • 180.
    Andersson, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Karolinska Inst, Dept Clin Neurosci Psychol, Stockholm, Sweden..
    Jamshidi, Esmail
    Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden.;Umeå Univ, Dept Clin Sci Psychiat, Umeå, Sweden..
    Ekman, Carl-Johan
    Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden.;Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Tedroff, Kristina
    Karolinska Inst, Dept Womens & Childrens Hlth Neuropediat, Stockholm, Sweden..
    Björkander, Jonnie
    Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Sjögren, Magnus
    Umeå Univ, Dept Clin Sci Psychiat, Umeå, Sweden..
    Lundberg, Johan
    Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden.;Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Jokinen, Jussi
    Umeå Univ, Dept Clin Sci Psychiat, Umeå, Sweden.;Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Boström, Adrian Desai E.
    Umeå Univ, Dept Clin Sci Psychiat, Umeå, Sweden.;Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth Neuropediat, Stockholm, Sweden..
    Mapping length of inpatient treatment duration and year-wise relapse rates in eating disordered populations in a well-defined Western-European healthcare region across 1998-20202023In: International Journal of Methods in Psychiatric Research, ISSN 1049-8931, E-ISSN 1557-0657, Vol. 32, no 4, article id e1960Article in journal (Refereed)
    Abstract [en]

    Objectives: Updated international guideline recommendations for AN inpatient care rely on expert opinions/observational evidence and promote extended inpatient stays, warranting investigation using higher-level ecological evidence.

    Methods: The study was conducted according to Guidelines for Accurate and Transparent Health Estimates Reporting (GATHER). Data encompassing 13,885 ED inpatients (5336 adolescents and 8549 adults) was retrieved from Swedish public health registries. Variables analyzed included (1) ED inpatient care opportunities, (2) unique number of ED inpatients and (3) mean length of ED-related inpatient stays in age groups 15-19 and 20-88+, across 1998-2020.

    Results: Mean length of inpatient stays was inversely correlated to relapse to ED-related inpatient care within the same year (p < 0.001, R-squared(adj) = 0.5216 and p < 0.00001, R-squared(adj) = 0.5090, in the 15-19 and 20-88+ age groups, respectively), independent of number of ED inpatients treated within a year in both age groups. Extending mean adolescent inpatient duration from 35 to 45 days was associated with a similar to 30% reduction in the year-wise relapse rate.

    Conclusions: Mean length of ED-related inpatient treatment stays was associated with reduced relapses to inpatient care within the same year, which could be interpreted as support for recommendations to include a stabilization phase in inpatient ED treatment.

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  • 181.
    Andersson, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Karolinska Inst, Dept Clin Neurosci Psychol, Stockholm, Sweden..
    Jamshidi, Esmail
    Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden.;Umeå Univ, Dept Clin Sci Psychiat, Umeå, Sweden..
    Ekman, Carl-Johan
    Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden.;Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, SE-17176 Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm Hlth Care Serv, Reg Stockholm, SE-17176 Stockholm, Sweden..
    Tedroff, Kristina
    Karolinska Univ Hosp, Stockholm Hlth Care Serv, Reg Stockholm, SE-17176 Stockholm, Sweden..
    Björkander, Jonnie
    Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Sjögren, Magnus
    Umeå Univ, Dept Clin Sci Psychiat, Umeå, Sweden..
    Lundberg, Johan
    Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden.;Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, SE-17176 Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm Hlth Care Serv, Reg Stockholm, SE-17176 Stockholm, Sweden..
    Jokinen, Jussi
    Umeå Univ, Dept Clin Sci Psychiat, Umeå, Sweden.;Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, SE-17176 Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm Hlth Care Serv, Reg Stockholm, SE-17176 Stockholm, Sweden..
    Desai Boström, Adrian E.
    Umeå Univ, Dept Clin Sci Psychiat, Umeå, Sweden.;Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, SE-17176 Stockholm, Sweden.;Karolinska Univ Hosp, Stockholm Hlth Care Serv, Reg Stockholm, SE-17176 Stockholm, Sweden.;Karolinska Inst, Dept Womens & Childrens Hlth Neuropediat, Stockholm, Sweden..
    Anorexia Nervosa With Comorbid Severe Depression: A Systematic Scoping Review of Brain Stimulation Treatments2023In: Journal of ECT, ISSN 1095-0680, E-ISSN 1533-4112, Vol. 39, no 4, p. 227-234Article in journal (Refereed)
    Abstract [en]

    Major depressive disorder (MDD) is highly prevalent in individuals with anorexia nervosa (AN) and is a predictor of greater clinical severity. However, there is a limited amount of evidence supporting the use of psychotropic medications for its management. A systematic scoping review was conducted to assess the current literature on brain stimulation treatments for AN with comorbid MDD, with a specific focus on MDD treatment response and weight restoration. This review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the PubMed, PsycInfo, and MEDLINE databases were searched until July 2022 using specific key words related to AN and brain stimulation treatments. A total of 373 citations were identified, and 49 treatment studies that met the inclusion criteria were included in the review. The initial evidence suggests that electroconvulsive therapy, repetitive transcranial magnetic stimulation, and deep-brain stimulation may be effective in managing comorbid MDD in AN. Emerging evidence suggests that transcranial direct current stimulation may have a positive effect on body mass index in individuals with severe to extreme AN. However, there is a need for the development of better measurement techniques for assessing the severity of depression in the context of AN. Controlled trials that are adequately designed to account for these limitations are highly warranted for deep-brain stimulation, electroconvulsive therapy, and repetitive transcranial magnetic stimulation and hold promise for providing clinically meaningful results.

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  • 182.
    Andersson, Peter
    et al.
    Department of Clinical Neuroscience/Psychology, Karolinska Institutet, Stockholm, Sweden; Centre for Clinical Research Dalarna, Uppsala University, Uppsala, Sweden.
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden.
    Jarbin, Håkan
    Section of Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Lund, Sweden; Child and Adolescent Psychiatry, Region Halland, Halmstad, Sweden.
    Lundberg, Johan
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
    Desai Boström, Adrian E.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm Health Care Services, Region Stockholm, Karolinska University Hospital, Stockholm, Sweden; Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden.
    Association of Bipolar Disorder Diagnosis With Suicide Mortality Rates in Adolescents in Sweden2023In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 80, no 8, p. 796-802Article in journal (Refereed)
    Abstract [en]

    Importance: The association of early diagnosis and management of bipolar disorder with adolescent suicide mortality (ASM) is unknown.

    Objective: To assess regional associations between ASM and bipolar disorder diagnosis frequencies.

    Design, Setting, and Participants: This cross-sectional study investigated the association between annual regional ASM and bipolar disorder diagnosis rates in Swedish adolescents aged 15 to 19 years in January 1, 2008, through December 31, 2021. Aggregated data without exclusions reported at the regional level encompassed 585 suicide deaths, constituting 588 unique observations (ie, 21 regions, 14 years, 2 sexes).

    Exposures: Bipolar disorder diagnosis frequencies and lithium dispensation rates were designated as fixed-effects variables (interaction term in the case of males). An interaction term between psychiatric care affiliation rates and the proportion of psychiatric visits to inpatient and outpatient clinics constituted independent fixed-effects variables. Region and year comprised random intercept effect modifiers. Variables were population adjusted and corrected for heterogeneity in reporting standards.

    Main Outcomes and Measures: The main outcomes were sex-stratified, regional, and annual ASM rates in adolescents aged 15 to 19 years per 100 000 inhabitants as analyzed using generalized linear mixed-effects models.

    Results: Female adolescents were diagnosed with bipolar disorder almost 3 times more often than male adolescents (mean [SD], 149.0 [19.6] vs 55.3 [6.1] per 100 000 inhabitants, respectively). Median regional prevalence rates of bipolar disorder varied over the national median by a factor of 0.46 to 2.61 and 0.00 to 1.82 in females and males, respectively. Bipolar disorder diagnosis rates were inversely associated with male ASM (β = -0.00429; SE, 0.002; 95% CI, -0.0081 to -0.0004; P = .03) independent of lithium treatment and psychiatric care affiliation rates. This association was replicated by β-binomial models of a dichotomized quartile 4 ASM variable (odds ratio, 0.630; 95% CI, 0.457-0.869; P = .005), and both models were robust after adjusting for annual regional diagnosis rates of major depressive disorder and schizophrenia. No such association was observed in females.

    Conclusions and Relevance: In this cross-sectional study, lower suicide death rates in adolescent males was robustly associated with regional diagnosis rates of bipolar disorder at an estimated magnitude of approximately 4.7% of the mean national suicide death rate. The associations could be due to treatment efficacy, early diagnosis and management, or other factors not accounted for.

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  • 183.
    Andersson, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Karolinska Inst, Dept Clin Neurosci Psychol, Stockholm, Sweden..
    Jokinen, Jussi
    Karolinska Inst, Karolinska Univ Hosp, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Region Stockhol, Sweden.;Karolinska Univ Hosp, Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden.;Umeå Univ, Dept Clin Sci Psychiat, Umeå, Sweden..
    Jarbin, Håkan
    Lund Univ, Dept Clin Sci, Sect Child & Adolescent Psychiat, Lund, Sweden.;Child & Adolescent Psychiat, Halmstad, Region Halland, Sweden..
    Lundberg, Johan
    Karolinska Inst, Karolinska Univ Hosp, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Region Stockhol, Sweden.;Karolinska Univ Hosp, Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden.;Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Desai Boström, Adrian E.
    Karolinska Inst, Dept Womens & Childrens Hlth, Nobels Vag 6, S-17165 Solna, Stockholm, Sweden.;Karolinska Inst, Karolinska Univ Hosp, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Region Stockhol, Sweden.;Umeå Univ, Dept Clin Sci Psychiat, Umeå, Sweden.;Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Association of Bipolar Disorder Diagnosis With Suicide Mortality Rates in Adolescents in Sweden2023In: JAMA psychiatry, ISSN 2168-6238, E-ISSN 2168-622X, Vol. 80, no 8, p. 796-802Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To assess regional associations between ASM and bipolar disorder diagnosis frequencies.

    DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study investigated the association between annual regional ASM and bipolar disorder diagnosis rates in Swedish adolescents aged 15 to 19 years in January 1, 2008, through December 31, 2021. Aggregated data without exclusions reported at the regional level encompassed 585 suicide deaths, constituting 588 unique observations (ie, 21 regions, 14 years, 2 sexes).

    EXPOSURES: Bipolar disorder diagnosis frequencies and lithium dispensation rates were designated as fixed-effects variables (interaction term in the case of males). An interaction term between psychiatric care affiliation rates and the proportion of psychiatric visits to inpatient and outpatient clinics constituted independent fixed-effects variables. Region and year comprised random intercept effect modifiers. Variables were population adjusted and corrected for heterogeneity in reporting standards.

    MAIN OUTCOMES AND MEASURES: The main outcomeswere sex-stratified, regional, and annual ASM rates in adolescents aged 15 to 19 years per 100 000 inhabitants as analyzed using generalized linear mixed-effects models.

    RESULTS: Female adolescents were diagnosed with bipolar disorder almost 3 times more often than male adolescents (mean [SD], 149.0 [19.6] vs 55.3 [6.1] per 100 000 inhabitants, respectively). Median regional prevalence rates of bipolar disorder varied over the national median by a factor of 0.46 to 2.61 and 0.00 to 1.82 in females and males, respectively. Bipolar disorder diagnosis rates were inversely associated with male ASM (beta= -0.00429; SE, 0.002; 95% CI, -0.0081 to -0.0004; P =.03) independent of lithium treatment and psychiatric care affiliation rates. This association was replicated by beta-binomial models of a dichotomized quartile 4 ASM variable (odds ratio, 0.630; 95% CI, 0.457-0.869; P =.005), and both models were robust after adjusting for annual regional diagnosis rates of major depressive disorder and schizophrenia. No such association was observed in females.

    CONCLUSIONS AND RELEVANCE: In this cross-sectional study, lower suicide death rates in adolescent males was robustly associated with regional diagnosis rates of bipolar disorder at an estimated magnitude of approximately 4.7% of the mean national suicide death rate. The associations could be due to treatment efficacy, early diagnosis and management, or other factors not accounted for.

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  • 184.
    Andersson, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Karolinska Inst, Dept Clin Neurosci, Div Psychol, S-17177 Stockholm, Sweden..
    Tistad, Malin
    Dalarna Univ, Sch Hlth & Welf, S-79188 Falun, Sweden.;Karolinska Inst, Dept Neurobiol Care Sci & Soc, Div Family Med & Primary Care, S-14183 Huddinge, Sweden..
    Eriksson, Åsa
    Karolinska Inst, Dept Clin Neurosci, Div Psychol, S-17177 Stockholm, Sweden..
    Enebrink, Pia
    Karolinska Inst, Dept Clin Neurosci, Div Psychol, S-17177 Stockholm, Sweden..
    Sturidsson, Knut
    Karolinska Inst, Dept Clin Neurosci, Div Psychol, S-17177 Stockholm, Sweden..
    Implementation and evaluation of Illness Management and Recovery (IMR) in mandated forensic psychiatric care-Study protocol for a multicenter cluster randomized trial2022In: Contemporary Clinical Trials Communications, E-ISSN 2451-8654, Vol. 27, article id 100907Article in journal (Refereed)
    Abstract [en]

    Introduction: Forensic mental health care is hampered by lack of evidence-based treatments. The Swedish forensic mental health population consists of patients suffering from severe illnesses such as schizophrenia and bipolar disorders, similar to populations in international studies. Illness Management and Recovery (IMR) is an intervention for patients with serious mental illness, based on psychoeducational, cognitive-behavioral and motivational components. The purpose is to strengthen participants' illness management skills and recovery.

    Objective: To test effectiveness of IMR within forensic mental health by comparing it to treatment as usual.

    Method: This is a cluster-randomized controlled trial. Patients in forensic mental health inpatient units are randomized to an active (IMR) or a control condition (treatment as usual). Clustering of patients is based on ward-units where inpatients are admitted. Patients in the active condition receive two group and one individual IMR sessions per week. The treatment phase is estimated to last nine months. Outcomes include illness related disability, illness management skills, sense of recovery, hope, mental health and security related problems. Outcomes are measured at baseline, four months into treatment, at treatment completion and at three months follow-up. Staff experiences of implementing IMR will be explored by a self-report measure and semi-structured interview based on Normalization Process Theory.

    Ethics and dissemination: The study is approved by the Swedish Ethical Review Authority (Registration No. 2020-02046). Participation will be voluntary based on written informed consent. Results will be disseminated through peer-reviewed articles and conferences. The study is registered in the US registry of clinical trials (NCT04695132).

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  • 185.
    Andersson, Peter
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Center for Clinical Research Dalarna. Karolinska Inst, Dept Clin Neurosci, Div Psychol, S-17165 Stockholm, Sweden..
    von Schreeb, Agnes
    Karolinska Inst, Dept Clin Neurosci, Div Psychol, S-17165 Stockholm, Sweden..
    Johansson, Linnea
    Karolinska Inst, Dept Clin Neurosci, Div Psychol, S-17165 Stockholm, Sweden..
    Sturidsson, Knut
    Karolinska Inst, Dept Clin Neurosci, Div Psychol, S-17165 Stockholm, Sweden..
    Wetterborg, Dan
    Karolinska Inst, Dept Clin Neurosci, Div Psychol, S-17165 Stockholm, Sweden..
    Sorjonen, Kimmo
    Karolinska Inst, Dept Clin Neurosci, Div Psychol, S-17165 Stockholm, Sweden..
    Changes in Body Mass Index During Mandatory Forensic Psychiatric Care: Findings from a Long-Term (2009-2020) Cohort Study Based on Swedish Registry Data2024In: International Journal of Forensic Mental Health, ISSN 1499-9013, E-ISSN 1932-9903, Vol. 23, no 2, p. 106-116Article in journal (Refereed)
    Abstract [en]

    Lifespan is reduced by approximately 15 years in individuals suffering from severe mental illnesses such as schizophrenia spectrum disorders. Contributing to this is an increased prevalence of metabolic syndrome, an assortment of factors that confer risk of diabetes type 2 and cardiovascular disease. Body Mass Index (BMI) is predictive of metabolic syndrome. Previous research indicates that the BMI of incarcerated individuals not suffering from a major mental disorder increase during incarceration, especially amongst females. However, information on the development of BMI during forensic psychiatric care is scarcer, and follow-up periods have been short. Thus, the authors extracted data from the Swedish National Forensic Psychiatric Register regarding the longitudinal development of BMI in 3389 individuals who received court mandated forensic psychiatric care in Sweden during 2009-2020. A significant increase in BMI by 1.1% per year was observed during the first four years of care. After this, changes were no longer significant. Factors associated with a larger increase in BMI were female gender, being prescribed antipsychotics, young age at admission, receiving outpatient care, and access to an external support person. There was an inverse association between BMI and symptom severity. Substantial heterogeneity was observed in longitudinal changes in individual BMI and in comparisons between individuals receiving care at different clinics.

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  • 186.
    Andersson, S.
    et al.
    Länssjukhuset, Halmstad.
    Fridlund, Bengt
    Halmstad University, School of Social and Health Sciences (HOS).
    The aphasic person's views of the encounter with other people: a grounded theory analysis2002In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 9, no 3, p. 285-292Article in journal (Refereed)
    Abstract [en]

    Notes that being affected by aphasia influences the total life experience. The aim of this study was to generate a theoretical model, from a nursing perspective, of what 12 aphasic persons (aged 28-92 yrs old) experience in encounters with other people. Data were collected through interviews which adopted a biophysical, socio-cultural and psychological approach and then analyzed using grounded theory method. Two main categories emerged, namely: interaction and support. Encountered experiences led to (1) a feeling of having ability, (2) a feeling of being an outsider, and (3) a feeling of dejection or uncertainty. The feeling state was dependent on whether the interaction was obstructed or secure and on whether the support resulted in strengthened or impaired self-esteem. Therefore, nurses need to give support that enhances patients self-esteem and which results in them gaining a positive and realistic view of their aphasia, as well as involving those around them in this perspective. This then will give the possibility for the patient to turn the interaction process from an obstructed into a secure one.

  • 187.
    Andersson, Sam
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Bathula, Deepti. R.
    Department of Computer Science and Engineering, Indian Institute of Technology Ropar, Rupnagar, Punjab, 140001, India.
    Iliadis, Stavros I.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Walter, Martin
    Department of Psychiatry and Psychotherapy, University Hospital Jena, Jena, Germany; Department of Psychiatry and Psychotherapy, Eberhardt Karls University, Tübingen, Germany; Department of Behavioral Neurology, Leibniz Institute for Neurobiology, Magdeburg, Germany.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Predicting women with depressive symptoms postpartum with machine learning methods2021In: Scientific Reports, E-ISSN 2045-2322, Vol. 11, no 1, article id 7877Article in journal (Refereed)
    Abstract [en]

    Postpartum depression (PPD) is a detrimental health condition that affects 12% of new mothers. Despite negative effects on mothers' and children's health, many women do not receive adequate care. Preventive interventions are cost-efficient among high-risk women, but our ability to identify these is poor. We leveraged the power of clinical, demographic, and psychometric data to assess if machine learning methods can make accurate predictions of postpartum depression. Data were obtained from a population-based prospective cohort study in Uppsala, Sweden, collected between 2009 and 2018 (BASIC study, n = 4313). Sub-analyses among women without previous depression were performed. The extremely randomized trees method provided robust performance with highest accuracy and well-balanced sensitivity and specificity (accuracy 73%, sensitivity 72%, specificity 75%, positive predictive value 33%, negative predictive value 94%, area under the curve 81%). Among women without earlier mental health issues, the accuracy was 64%. The variables setting women at most risk for PPD were depression and anxiety during pregnancy, as well as variables related to resilience and personality. Future clinical models that could be implemented directly after delivery might consider including these variables in order to identify women at high risk for postpartum depression to facilitate individualized follow-up and cost-effectiveness.

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  • 188.
    Andersson Sundell, K.
    et al.
    University of Gothenburg, Sweden.
    Jönsson, Anna K.
    Region Östergötland, Center for Diagnostics, Department of Clinical Pharmacology. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Department of Medical and Health Sciences, Division of Drug Research.
    Beliefs about medicines are strongly associated with medicine-use patterns among the general population2016In: International journal of clinical practice (Esher), ISSN 1368-5031, E-ISSN 1742-1241, Vol. 70, no 3, p. 277-285Article in journal (Refereed)
    Abstract [en]

    AimsTo investigate self-reported beliefs and perceived sensitivity to medicines and their effects in relation to self-reported use of medicines and herbal remedies. MethodsA survey sent to 13,931 randomly selected Swedish adults included the Beliefs about Medicines Questionnaire-General (BMQ-General) Questionnaire and the Perceived Sensitivity to Medicines Scale (PSM). The survey also asked about individuals use of prescribed and over-the-counter (OTC) medicines and herbal remedies in the past month. We examined all associations between scores on the BMQ-General subscales and PSM in relation to the use of medicines and herbal remedies, using analysis of covariance adjusted for potential confounders. ResultsAmong 7099 respondents, those using herbal remedies exclusively believed strongly that prescription and OTC medicines are harmful and overprescribed. Respondents using prescription and OTC medicines reported more positive beliefs [coefficient 0.67 (95% CI 0.47-0.87) and 0.70 (95% CI 0.51-0.90)] on the benefits of medicines compared with those using herbal remedies [-0.18 (95% CI -0.57-0.20)]. Perceived sensitivity to medicines was higher among those using herbal remedies only [1.25 (95% CI 0.46-2.03)] compared with those using no medicines (reference 0) or prescription [-0.44 (95% CI -0.84 to -0.05)] or OTC [-0.27 (95% CI -0.66-0.12)] medicines alone. ConclusionRespondents using prescription and/or OTC medicines reported stronger positive beliefs about the benefits of medicines in general, supporting the hypothesis that beliefs influence medicine use. Therefore, addressing beliefs and concerns about medicines during patient counselling may influence medicine use, particularly regarding unintentional non-adherence.

  • 189.
    Anderssson, Jenny
    et al.
    Linköping University, Department of Behavioural Sciences and Learning.
    Karlsson, Ellen
    Linköping University, Department of Behavioural Sciences and Learning.
    The Reading the Mind in the Eyes Test - Revised Version á la Andersson & Karlsson2010Independent thesis Advanced level (degree of Master (Two Years)), 20 credits / 30 HE creditsStudent thesis
    Abstract [en]

    Introduction: The Reading the Mind in the Eyes Test is a widely used test for measuring aspects of social cognition. The aim of the present study was to provide results from a group of typically developing Swedish children (age 9-12) and to compare these results with children and adults in other Swedish and English studies, as well as results from a group of children with Asperger syndrome. Method: A Swedish version of the child version of the test was completed by 83 controls and by six children with Asperger syndrome. Results were compared between the two groups and with data from other studies. Results: The children in the current study did not differ on scores compared to children in the same age group in other studies. The children in the current study scored significantly lower than adults in an earlier study. The results from the children with Asperger syndrome did not differ significantly to the results from the controls.

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  • 190.
    Andersén, Mikael
    et al.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden;Stockholm Health Care Services, Stockholm County Council, Stockholm, Sweden.
    Birgegård, Andreas
    Centre for Psychiatry Research, Department of Clinical Neuroscience Karolinska Institutet, &amp; Stockholm Health Care Services, Stockholm County Council Stockholm Sweden.
    Diagnosis‐specific self‐image predicts longitudinal suicidal ideation in adult eating disorders2017In: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 50, no 8, p. 970-978Article in journal (Refereed)
    Abstract [en]

    Objective: Eating disorders (ED) are prevalent, serious illnesses with elevated mortality, mainly attributable to suicide. Predictors of suicidality include binge/purge symptomatology, impulsivity, and psychiatric comorbidity, as well as personality factors. Recent research has also shown self‐image (the Structural Analysis of Social Behavior, SASB, model) to predict manifest suicide attempts in ED, and the study explored suicide risk prediction to increase knowledge of warning signs and intervention targets.

    Method: Participants were adult ED patients registered in the Stepwise clinical database (N = 1537) with anorexia nervosa (AN), bulimia nervosa (BN), binge‐eating disorder (BED), or other specified feeding and eating disorder (OSFED). The SASB self‐image questionnaire was used in stepwise regressions to predict 12‐month suicidal ideation, both self‐ and clinician‐rated, in models both excluding and including baseline clinical variables.

    Results: Validation analyses showed fair correspondence between outcome variables as well as with suicide attempts. Different variables predicted suicidality in different diagnoses, over and above baseline clinical variables in all but one regression model. Low Self‐protection was important in AN and BN, high Self‐control in AN, and high Letting go of the self in BN. For BED, self‐blame explained variance, and in OSFED, lack of self‐love.

    Discussion: Findings are in line with research showing differential self‐image‐based prediction of important outcomes in ED, with noteworthy consistencies across diagnoses and suicidality variables. Strengths included the large sample, and limitations pertained to measures, attrition and Type II error risk. Replication is needed, but findings are consistent with some previous work and offers clinical and research implications.

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  • 191.
    Andersén, Åsa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Berglund, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Carpentsier, Beatrice
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Anderzén, Ingrid
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Utvärdering av rehabiliteringskoordinator inom psykiatrisk specialistsjukvård: Slutrapport2023Report (Other academic)
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  • 192.
    Andreasson, Anna N.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Jones, M. P.
    Walker, M. M.
    Talley, N. J.
    Nyhlin, H.
    Agréus, L.
    Prediction pathways for innate immune pathology, IBS, anxiety and depression in a general population (The POPCOL Study)2013In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 32, p. e46-e46Article in journal (Other academic)
    Abstract [en]

    The aim of this study was to ascertain whether low grade innate inflammation contributes to a pathway of depression and anxiety via irritable bowel syndrome (IBS). We evaluated innate immune cell counts in colonic mucosa in normal subjects and those with IBS (Rome III) from a population based study in which 745 randomly selected subjects had a colonoscopy (mean age 51 years;57% women). Intraepithelial lymphocytes (IELs) per 100 enterocytes and eosinophils (eos) per five non-overlapping high power fields (HPF) were counted in 90 controls and 100 cases; immunocytochemistry (CD117) was performed for mast cells per 5HPF in 80 controls and 81 cases. IELs, mast cells and eos were individually summed over 5 sites (terminal ileum, caecum, transverse colon, sigmoid colon and rectum). Anxiety and depression scores were calculated from HADS. A causal model path model which hypothesises immune cells being associated with IBS which, in turn, is associated with elevated anxiety and depression was tested using path analysis implemented in the MPlus software. All hypothesised paths reached statistical significance (p < .05) supporting the individual hypothesized pathways. The overall model fit was reasonable although imperfect. In conclusion, a significant contribution of innate immune inflammatory load leading to anxiety and depression via IBS was found. Whether therapy directed to decreasing this inflammatory load also lifts depression and anxiety should be further explored.

  • 193.
    Andreasson, Anna N.
    et al.
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Schiller, Helena
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Kecklund, Göran
    Stockholm University, Faculty of Social Sciences, Stress Research Institute.
    Lekander, Mats
    Stockholm University, Faculty of Social Sciences, Stress Research Institute. Karolinska Institutet, Sweden.
    Contemplate your symptoms and re-evaluate your health2015In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 49, p. e38-e39Article in journal (Refereed)
    Abstract [en]

    Bodily signals and how these are interpreted affect self-ratings of health. It is thus reasonable that appraisals of health are affected by imminent exposures and disease primes. We aimed to investigate whether self-ratings of health are affected by a symptom rating and if changes are substantiated in persons who report more symptoms. We used data from 813 persons who completed a questionnaire daily for 21 consecutive days. The questionnaire included a one-item self-rating of health (“pre-SRH”; 1 = excellent, 7 = very poor), a subsequent 26-item rating of physical and mental symptoms and thereafter a second (identical) self-rating of health (“post-SRH”). Paired t-tests were used to test for differences between pre-SRH and post-SRH. Mixed effect regression models were used to calculate the interaction effect of pre-SRH and symptom score on post-SRH adjusted for gender, age and if the person had been working that day (13545 observations). SRH worsened significantly (p  <<.0001) after the symptom rating, from 2.72 pre-SRH (95%CI:−2.70–2.74) to 2.77 post-SRH (95%CI:2.75–2.79). There was a significant interaction between pre-SRH and symptoms on post-SRH so that persons who reported more symptoms changed their post-SRH rating to a higher degree than those who reported fewer symptoms, irrespective of their subjective health status. The results support the notion that subjective health perception is affected by focus of attention, and that the effect depends on level of symptoms.

  • 194.
    Andreasson, Kasper
    et al.
    University West, Department of Health Sciences, Section for nursing - undergraduate level.
    Ekman, Eric
    University West, Department of Health Sciences, Section for nursing - undergraduate level.
    De svåra samtalen: En studie om sjuksköterskors upplevelser av att vårda suicidala patienter2022Independent thesis Basic level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Suicide is a worldwide problem that generates both great suffering for the individual and its family as well as a large economic impact for the society. 800 000 people commit suicide each year globally, of whom many have already been in contact with the care system without getting the help they need. The aim of this study was to describe nurses’ experiences of caring for suicidal patients. We conducted a literature study based on analysis of qualitative studies according to Friberg’s five step model. Ten studies, published 2011-2021, were included. When asked about their experiences, nurses empathize the need of patient safety and the importance of forming a close partnership with the patient. They also empathize the emotional impact the caring of these patients put on them. Patient safety for these patients is a matter of both a safe hospital environment and nurses being well educated and aware of suicidal cues. The formation of a partnership is crucial for the nurse’s ability to make a good assessment and is usually facilitated by nurses being open and personal as well as empathic and present in the moment. However, becoming too close to the patient may be emotionally tough if the patient commits suicide. Nurses therefore need support and tools for handling their emotions. Further on, to make a good assessment the nurses also need to be able to tune into the patients verbally unexpressed needs. 

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  • 195.
    Andren, Per
    et al.
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    de la Cruz, Lorena Fernandez
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Isomura, Kayoko
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Lenhard, Fabian
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Hall, Charlotte L.
    Univ Nottingham, Inst Mental Hlth Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Inst Mental Hlth, Sch Med Mental Hlth & Clin Neurosci, NIHR MindTech MedTech Cooperat, Innovat Park,Triumph Rd, Nottingham, England..
    Davies, E. Bethan
    Univ Nottingham, Inst Mental Hlth Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Inst Mental Hlth, Sch Med Mental Hlth & Clin Neurosci, NIHR MindTech MedTech Cooperat, Innovat Park,Triumph Rd, Nottingham, England..
    Murphy, Tara
    UCL Great Ormond St Inst Child Hlth ICH, 30 Guilford St, London WC1N 1EH, England.;Great Ormond St Hosp Children NHS Fdn Trust, Psychol & Mental Hlth Serv, Great Ormond St, London, England..
    Hollis, Chris
    Univ Nottingham, Inst Mental Hlth Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Inst Mental Hlth, Sch Med Mental Hlth & Clin Neurosci, NIHR MindTech MedTech Cooperat, Innovat Park,Triumph Rd, Nottingham, England.;Univ Nottingham, Div Psychiat & Appl Psychol, Inst Mental Hlth, NIHR Nottingham Biomed Res Ctr, Nottingham, England..
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Bottai, Matteo
    Karolinska Inst, Inst Environm Med, Unit Biostat, Stockholm, Sweden..
    Serlachius, Eva
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Andersson, Erik
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Mataix-Cols, David
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Reg Stockholm, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Efficacy and cost-effectiveness of therapist-guided internet-delivered behaviour therapy for children and adolescents with Tourette syndrome: study protocol for a single-blind randomised controlled trial2021In: Trials, E-ISSN 1745-6215, Vol. 22, article id 669Article in journal (Refereed)
    Abstract [en]

    Background: Treatment guidelines recommend behaviour therapy (BT) for patients with Tourette syndrome (TS) and chronic tic disorder (CTD). However, BT is rarely accessible due to limited availability of trained therapists and long travel distances to specialist clinics. Internet-delivered BT has the potential of overcoming these barriers through remote delivery of treatment with minimal therapist support. In the current protocol, we outline the design and methods of a randomised controlled trial (RCT) evaluating an internet-delivered BT programme referred to as BIP TIC. The trial's primary objective is to determine the clinical efficacy of BIP TIC for reducing tic severity in young people with TS/CTD, compared with an active control intervention. Secondary objectives are to investigate the 12-month durability of the treatment effects and to perform a health economic evaluation of the intervention.

    Methods: In this single-blind superiority RCT, 220 participants (9-17 years) with TS/CTD throughout Sweden will be randomised to 10-12 weeks of either therapist-supported internet-delivered BT based on exposure with response prevention (BIP TIC) or therapist-supported internet-delivered education. Data will be collected at baseline, 3 and 5 weeks into the treatment, at post-treatment, and 3, 6, and 12 months post-treatment. The primary endpoint is the 3-month follow-up. The primary outcome is tic severity as measured by the Yale Global Tic Severity Scale - Total Tic Severity Score. Treatment response is operationalised as scores of "Very much improved" or "Much improved" on the Clinical Global Impression - Improvement scale, administered at the primary endpoint. Outcome assessors will be blind to treatment condition at all assessment points. A health economic evaluation of BIP TIC will be performed, both in the short term (primary endpoint) and the long term (12-month follow-up). There are no planned interim analyses.

    Discussion: Participant recruitment started on 26 April 2019 and finished on 9 April 2021. The total number of included participants was 221. The final participant is expected to reach the primary endpoint in September 2021 and the 12-month follow-up in June 2022. Data analysis for the primary objective will commence after the last participant reaches the primary endpoint.

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  • 196.
    Andren, Per
    et al.
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden.;Lund Univ, Dept Clin Sci, Lund, Sweden..
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Ringberg, Helene
    Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Wachtmeister, Vera
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Warnström, Moa
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Isomura, Kayoko
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Aspvall, Kristina
    Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Lenhard, Fabian
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden..
    Hall, Charlotte L.
    Univ Nottingham, Natl Inst Hlth & Care Res MindTech MedTech Coopera, Sch Med, Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Natl Inst Hlth & Care Res Nottingham Biomed Res Ct, Inst Mental Hlth, Mental Hlth & Clin Neurosci, Nottingham, England..
    Davies, E. Bethan
    Univ Nottingham, Natl Inst Hlth & Care Res MindTech MedTech Coopera, Sch Med, Mental Hlth & Clin Neurosci, Nottingham, England..
    Murphy, Tara
    UCL, Great Ormond St Inst Child Hlth, London, England.;Great Ormond St Hosp Sick Children, Psychol & Mental Hlth Serv, Great Ormond St, London, England..
    Hollis, Chris
    Univ Nottingham, Natl Inst Hlth & Care Res MindTech MedTech Coopera, Sch Med, Mental Hlth & Clin Neurosci, Nottingham, England.;Univ Nottingham, Natl Inst Hlth & Care Res Nottingham Biomed Res Ct, Inst Mental Hlth, Mental Hlth & Clin Neurosci, Nottingham, England..
    Feldman, Inna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Bottai, Matteo
    Karolinska Inst, Inst Environm Med, Unit Biostat, Stockholm, Sweden..
    Serlachius, Eva
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Lund Univ, Dept Clin Sci, Lund, Sweden..
    Andersson, Erik
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    de la Cruz, Lorena Fernandez
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden..
    Mataix-Cols, David
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Gävlegatan 22, S-11330 Stockholm, Sweden.;Stockholm Hlth Care Serv, Reg Stockholm, Stockholm, Sweden.;Lund Univ, Dept Clin Sci, Lund, Sweden..
    Internet-Delivered Exposure and Response Prevention for Pediatric Tourette Syndrome: 12-Month Follow-Up of a Randomized Clinical Trial2024In: JAMA Network Open, E-ISSN 2574-3805, Vol. 7, no 5, article id e248468Article in journal (Refereed)
    Abstract [en]

    Importance: Behavior therapy is a recommended intervention for Tourette syndrome (TS) and chronic tic disorder (CTD), but availability is limited and long-term effects are uncertain.

    Objective: To investigate the long-term efficacy and cost-effectiveness of therapist-supported, internet-delivered exposure and response prevention (ERP) vs psychoeducation for youths with TS or CTD.

    Design, Setting, And Participants: This 12-month controlled follow-up of a parallel group, superiority randomized clinical trial was conducted at a research clinic in Stockholm, Sweden, with nationwide recruitment. In total, 221 participants aged 9 to 17 years with TS or CTD were enrolled between April 26, 2019, and April 9, 2021, of whom 208 (94%) provided 12-month follow-up data. Final follow-up data were collected on June 29, 2022. Outcome assessors were masked to treatment allocation throughout the study.

    Interventions: A total of 111 participants were originally randomly allocated to 10 weeks of therapist-supported, internet-delivered ERP and 110 participants to therapist-supported, internet-delivered psychoeducation.

    Main Outcomes And Measures: The primary outcome was within-group change in tic severity, measured by the Total Tic Severity Score of the Yale Global Tic Severity Scale (YGTSS-TTSS), from the 3-month follow-up to the 12-month follow-up. Treatment response was defined as 1 (very much improved) or 2 (much improved) on the Clinical Global Impression-Improvement scale. Analyses were intention-to-treat and followed the plan prespecified in the published study protocol. A health economic evaluation was performed from 3 perspectives: health care organization (including direct costs for treatment provided in the study), health care sector (additionally including health care resource use outside of the study), and societal (additionally including costs beyond health care [eg, parent's absenteeism from work]).

    Results: In total, 221 participants were recruited (mean [SD] age, 12.1 [2.3] years; 152 [69%] male). According to the YGTSS-TTSS, there were no statistically significant changes in tic severity from the 3-month to the 12-month follow-up in either group (ERP coefficient, -0.52 [95% CI, -1.26 to 0.21]; P = .16; psychoeducation coefficient, 0.00 [95% CI, -0.78 to 0.78]; P > .99). A secondary analysis including all assessment points (baseline to 12-month follow-up) showed no statistically significant between-group difference in tic severity from baseline to the 12-month follow-up (coefficient, -0.38 [95% CI, -1.11 to 0.35]; P = .30). Treatment response rates were similar in both groups (55% in ERP and 50% in psychoeducation; odds ratio, 1.25 [95% CI, 0.73-2.16]; P = .42) at the 12-month follow-up. The health economic evaluation showed that, from a health care sector perspective, ERP produced more quality-adjusted life years (0.01 [95% CI, -0.01 to 0.03]) and lower costs (adjusted mean difference -$84.48 [95% CI, -$440.20 to $977.60]) than psychoeducation at the 12-month follow-up. From the health care organization and societal perspectives, ERP produced more quality-adjusted life years at higher costs, with 65% to 78% probability of ERP being cost-effective compared with psychoeducation when using a willingness-to-pay threshold of US $79 000.

    Conclusions And Relevance: There were no statistically significant changes in tic severity from the 3-month through to the 12-month follow-up in either group. The ERP intervention was not superior to psychoeducation at any time point. While ERP was not superior to psychoeducation alone in reducing tic severity at the end of the follow-up period, ERP is recommended for clinical implementation due to its likely cost-effectiveness and support from previous literature.

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  • 197.
    Andren, Victoria
    et al.
    Stockholm Univ, Dept Psychol, Stockholm, Sweden.;Ctr Innovat Res & Educ, Västerås, Sweden..
    Ojemyr, Torun Lindholm
    Ctr Innovat Res & Educ, Västerås, Sweden..
    Yourstone, Jenny
    Södertörn Univ, Dept Social Sci, Stockholm, Sweden..
    Damberg, Mattias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Disciplinary Domain of Medicine and Pharmacy, research centers etc., Centre for Clinical Research, County of Västmanland. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Gender and arson: psychosocial, psychological, and somatic offender characteristics at the time of the crime2023In: Journal of Forensic Psychiatry & Psychology, ISSN 1478-9949, E-ISSN 1478-9957, Vol. 34, no 1, p. 113-130Article in journal (Refereed)
    Abstract [en]

    Deliberate fire-setting, such as the crime of arson, can have devastating, even lethal, consequences. This study compared factors at the time of arson by female and male offenders in Sweden between 2000-2010. The women (n = 100), and men (n = 100) included in this study were randomly chosen from among all individuals who had been convicted for arson during this period and who underwent forensic psychiatric investigations. Information regarding psychiatric and somatic characteristics, their psychosocial situation, and whether they were in contact with health or social services before the arsons were examined. The results showed that both women and men have complex psychiatric and somatic characteristics, as well as psychosocial situations. Women showed more self-destructive behaviour, lower Global Assessment of Functioning scores, and had been in contact with psychiatric health services to a greater extent than men. More women than men had children. These findings suggest that specific actions may be needed for preventing and treating women compared with men at risk for committing arson.

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  • 198. Andreou, Dimitrios
    et al.
    Saetre, Peter
    Milesson Fors, Björn
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Nilsson, Björn Mikael
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Kullberg, Joel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Jönsson, Erik Gunnar
    Ebeling Barbier, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Agartz, Ingrid
    Cardiac left ventricular ejection fraction in men and women with schizophrenia on long-term antipsychotic treatment2020In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 218, p. 226-232Article in journal (Refereed)
    Abstract [en]

    Patients with schizophrenia exhibit a higher cardiovascular mortality compared to the general population which has been attributed to life-style factors, genetic susceptibility and antipsychotic medication. Recent echocardiographic studies have pointed to an association between clozapine treatment and reduced left ventricular ejection fraction (LVEF), a measure that has been inversely associated with adverse outcomes including all-cause mortality. Cardiovascular magnetic resonance (CMR) is considered the reference method for LVEF measurement. The aim of the present study was to investigate the LVEF in patients with schizophrenia on long-term treatment with antipsychotics and healthy controls. Twenty-nine adult patients with schizophrenia on long-term medication with antipsychotics and 27 age-, sex- and body mass index-matched healthy controls (mean ages 44 and 45 years, respectively) were recruited from outpatient psychiatric clinics in Uppsala, Sweden. The participants were interviewed and underwent physical examination, biochemical analyses, electrocardiogram and CMR. Men with schizophrenia on long-term antipsychotic treatment showed significantly lower LVEF than controls (p = 0.0076), whereas no such difference was evident among women (p = 0.44). Specifically, clozapine-treated male patients had 10.6% lower LVEF than male controls (p = 0.0064), whereas the LVEF was 5.5% below that of controls among male patients treated with non-clozapine antipsychotics (p = 0.047). Among medicated men with schizophrenia, we found significantly lower LVEF compared to healthy individuals, suggesting the need of routine cardiac monitoring in this patient group. This is the first study showing a significant negative association between treatment with non-clozapine antipsychotics and LVEF.

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  • 199. Andreou, Dimitrios
    et al.
    Saetre, Peter
    Werge, Thomas
    Andreassen, Ole A.
    Agartz, Ingrid
    Sedvall, Göran C.
    Hall, Håkan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
    Terenius, Lars
    Jönsson, Erik G.
    Tryptophan hydroxylase gene 1 (TPH1) variants associated with cerebrospinal fluid 5-hydroxyindole acetic acid and homovanillic acid concentrations in healthy volunteers2010In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 180, no 2-3, p. 63-67Article in journal (Refereed)
    Abstract [en]

    Tryptophan hydroxylase (TPH) is the rate-limiting enzyme in serotonin synthesis. We investigated possible relationships between five TPH1 gene polymorphisms and cerebrospinal fluid (CSF) concentrations of the major serotonin metabolite 5-hydroxyindoleacetic acid (5-HIAA), the major dopamine metabolite homovanillic acid (HVA), and the major norepinephrine metabolite 3-methoxy-4-hydroxyphenylglycol (MHPG) in healthy volunteers (n = 132). The G-allele of the TPH1 rs4537731 (A-6526G) polymorphism was associated with 5-HIM and HVA, but not MHPG concentrations. None of the other four TPH1 polymorphisms (rs211105, rs1800532, rs1799913 and rs7933505) were significantly associated with any of the monoamine metabolite concentrations. Two (rs4537731G/rs211105T/rs1800532C/rs1799913C/rs7933505G and rs4537731A/rs211105T/rs1800532C/rs1799913C/rs7933505G) of five common TPH1 five-allele haplotypes were associated with 5-HIAA and HVA concentrations in opposite directions. None of the common haplotypes was associated with MHPG concentrations in the CSF. The results suggest that TPH1 gene variation participates in the regulation of serotonin and dopamine turnover rates in the central nervous system of healthy human subjects.

  • 200.
    Andreou, Dimitrios
    et al.
    Karolinska Hosp & Inst, Dept Clin Neurosci, Psychiat Sect, HUBIN Project, Stockholm, Sweden..
    Soderman, Erik
    Karolinska Hosp & Inst, Dept Clin Neurosci, Psychiat Sect, HUBIN Project, Stockholm, Sweden..
    Axelsson, Tomas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Molecular Medicine.
    Sedvall, Goran C.
    Karolinska Hosp & Inst, Dept Clin Neurosci, Psychiat Sect, HUBIN Project, Stockholm, Sweden..
    Terenius, Lars
    Karolinska Hosp & Inst, Dept Clin Neurosci, Psychiat Sect, HUBIN Project, Stockholm, Sweden..
    Agartz, Ingrid
    Karolinska Hosp & Inst, Dept Clin Neurosci, Psychiat Sect, HUBIN Project, Stockholm, Sweden.;Univ Oslo, NORMENT, Inst Clin Med, Oslo, Norway.;Diakonhjemmet Hosp, Dept Psychiat Res, Oslo, Norway..
    Jonsson, Erik G.
    Karolinska Hosp & Inst, Dept Clin Neurosci, Psychiat Sect, HUBIN Project, Stockholm, Sweden.;Univ Oslo, NORMENT, Inst Clin Med, Oslo, Norway..
    Cerebrospinal fluid monoamine metabolite concentrations as intermediate phenotypes between glutamate-related genes and psychosis2015In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 229, no 1-2, p. 497-504Article in journal (Refereed)
    Abstract [en]

    Glutamate-related genes have been associated with schizophrenia, but the results have been ambiguous and difficult to replicate. Homovanillic acid (HVA), 5-hydroxyindoleacetic acid (5-HIAA) and 3-methoxy-4-hydroxyphenylglycol (MHPG) are the major degradation products of the monoamines dopamine, serotonin and noradrenaline, respectively, and their concentrations in the cerebrospinal fluid (CSF), mainly HVA, have been associated with schizophrenia. In the present study, we hypothesized that CSF HVA, 5-HIAA and MHPG concentrations represent intermediate phenotypes in the association between glutamate-related genes and psychosis. To test this hypothesis, we searched for association between 238 single nucleotide polymorphisms (SNPs) in ten genes shown to be directly or indirectly implicated in glutamate transmission and CSF HVA, 5-HIAA and MHPG concentrations in 74 patients with psychotic disease. Thirty-eight nominally significant associations were found. Further analyses in 111 healthy controls showed that 87% of the nominal associations were restricted to the patients with psychosis. Some of the psychosis-only-associated SNPs found in the D-amino acid oxidase activator (DADA) and the kynurenine 3-monooxygenase (KMO) genes have previously been reported to be associated with schizophrenia. The present results suggest that CSF monoamine metabolite concentrations may represent intermediate phenotypes in the association between glutamate-related genes and psychosis.

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