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  • 251.
    Arnell, Susann
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center, Örebro University, Örebro, Sweden; The Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden.
    Jerlinder, Kajsa
    The Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden; Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.
    Geidne, Susanna
    Örebro University, School of Health Sciences.
    Lundqvist, Lars-Olov
    Örebro University, School of Health Sciences. University Health Care Research Center, Örebro University, Örebro, Sweden; The Swedish Institute for Disability Research (SIDR), Örebro University, Örebro, Sweden.
    Experiences of stakeholder collaboration when promoting participation in physical activity among adolescents with autism spectrum disorder2022In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 44, no 9, p. 1728-1736Article in journal (Refereed)
    Abstract [en]

    PURPOSE: Various stakeholders contribute to the development of healthy physical activity habits in adolescents with autism spectrum disorder (ASD). Parents and stakeholders seek collaborative actions but little is still known about such efforts. The purpose of this study was thus to explore how professionals from different services experience stakeholder collaboration when promoting participation in physical activity for these adolescents.

    METHOD: Five focus group discussions were held with 17 professionals from education, health care, community, and sports organizations, engaged in the promotion of physical activity in adolescents with ASD. The data were analyzed with qualitative content analysis.

    RESULTS: . The professionals though experienced that this collaboration was hampered by the low priority given to physical activity issues within different organizations, by limited resources, lack of knowledge, and unclear roles.

    CONCLUSIONS: Notwithstanding the professionals' different roles, all agreed that physical activity issues need to be prioritized and that each stakeholder needs to acknowledge the shared responsibility of collaboration. However, more clear routines for collaboration that include joined efforts but also highlight the organization-specific responsibilities might enhance the collaborative efforts.

    • In-depth understanding of both the adolescents' needs and the environments in which physical activity is promoted is required if participation in physical activity among adolescents with ASD is to be enhanced.
    • Families and professionals within different organizations need to be supported to collaborate when mapping and meeting the adolescents' physical activity needs.
    • Issues regarding developing physical activity habits need to be prioritized.
    • Professionals, such as education, health, and community professionals who are important for the promotion of healthy physical activity habits need to be included in multi-stakeholder meetings.
  • 252.
    Arnesen, Linn
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sober – Then what? You sober up at “TNE”, but what happens afterwards? Does the healthcare do what it is supposed to do?2017Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 253. Arnfred, Benjamin
    Virtual reality för behandlingav social fobi: Preliminära slutsatser från en stor dansk studie2020In: Tidskriften för Svensk psykiatri, no 3Article in journal (Other academic)
  • 254.
    Arnfred, Benjamin
    et al.
    Copenhagen Univ Hosp, Denmark.
    Bang, Peter
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Neurobiology. Linköping University, Faculty of Medicine and Health Sciences. Copenhagen Univ Hosp, Denmark.
    Hjorthoj, Carsten
    Copenhagen Univ Hosp, Denmark; Univ Copenhagen, Denmark.
    Christensen, Clas Winding
    Copenhagen Univ Hosp, Denmark.
    Moeller, Kirsten Stengaard
    Copenhagen Univ Hosp, Denmark.
    Hvenegaard, Morten
    Copenhagen Univ Hosp, Denmark.
    Agerskov, Lone
    Copenhagen Univ Hosp, Denmark.
    Gausboel, Ulrik Krog
    Copenhagen Univ Hosp, Denmark.
    Soe, Ditte
    Copenhagen Univ Hosp, Denmark.
    Wiborg, Peter
    Copenhagen Univ Hosp, Denmark.
    Smith, Christopher Ian Scholer
    Copenhagen Univ Hosp, Denmark.
    Rosenberg, Nicole
    Copenhagen Univ Hosp, Denmark.
    Nordentoft, Merete
    Copenhagen Univ Hosp, Denmark; Univ Copenhagen, Denmark.
    Group cognitive behavioural therapy with virtual reality exposure versus group cognitive behavioural therapy with in vivo exposure for social anxiety disorder and agoraphobia: a protocol for a randomised clinical trial2022In: BMJ Open, E-ISSN 2044-6055, Vol. 12, no 2, article id e051147Article in journal (Refereed)
    Abstract [en]

    Introduction Anxiety disorders have a high lifetime prevalence, early-onset and long duration or chronicity. Exposure therapy is considered one of the most effective elements in cognitive behavioural therapy (CBT) for anxiety, but in vivo exposure can be challenging to access and control, and is sometimes rejected by patients because they consider it too aversive. Virtual reality allows flexible and controlled exposure to challenging situations in an immersive and protected environment. Aim The SoREAL-trial aims to investigate the effect of group cognitive behavioural therapy (CBT-in vivo) versus group CBT with virtual reality exposure (CBT-in virtuo) for patients diagnosed with social anxiety disorder and/or agoraphobia, in mixed groups. Methods and analysis The design is an investigator-initiated randomised, assessor-blinded, parallel-group and superiority-designed clinical trial. Three hundred two patients diagnosed with social anxiety disorder and/or agoraphobia will be included from the regional mental health centres of Copenhagen and North Sealand and the Northern Region of Denmark. All patients will be offered a manual-based 14-week cognitive behavioural group treatment programme, including eight sessions with exposure therapy. Therapy groups will be centrally randomised with concealed allocation sequence to either CBT-in virtuo or CBT-in vivo. Patients will be assessed at baseline, post-treatment and 1-year follow-up by treatment blinded researchers and research assistants. The primary outcome will be diagnosis-specific symptoms measured with the Liebowitz Social Anxiety Scale for patients with social anxiety disorder and the Mobility Inventory for Agoraphobia for patients with agoraphobia. Secondary outcome measures will include depression symptoms, social functioning and patient satisfaction. Exploratory outcomes will be substance and alcohol use, working alliance and quality of life. Ethics and dissemination The trial has been approved by the research ethics committee in the Capital Region of Denmark. All results, positive, negative as well as inconclusive, will be published as quickly as possible and still in concordance with Danish law on the protection of confidentially and personal information. Results will be presented at national and international scientific conferences. The trial has obtained approval by the Regional Ethics Committee of Zealand (H-6-2013-015) and the Danish Data Protection Agency (RHP-2014-009-02670). The trial is registered at ClinicalTrial.gov as NCT03845101. The patients will receive information on the trial both verbally and in written form. Written informed consent will be obtained from each patient before inclusion in the trial. The consent form will be scanned and stored in the database system and the physical copy will be destroyed. It is emphasised that participation in the trial is voluntary and that the patient can withdraw his or her consent at any time without consequences for further and continued treatment.

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  • 255.
    Arnfred, Benjamin Thorup
    et al.
    Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Institute for Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark.
    Bang, Peter
    Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Institute for Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark.
    Winther Davy, Josefine
    Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark.
    Larsen, Lene Qvist
    Copenhagen Research Center for Mental Health - CORE, Mental Health Center Copenhagen, Copenhagen University Hospital, Denmark; Faculty of Health and Medical Sciences, Department of Public Health, Section of Epidemiology, University of Copenhagen, Denmark.
    Hjorthøj, Carsten
    Christensen, Anne Bryde
    Institute for Clinical Medicine, Faculty of Health and Medical Science, University of Copenhagen, Denmark; Psychiatry West Mental Health Services Region of Zealand, Psychiatric Hospital Slagelse, Denmark.
    Virtual reality exposure in cognitive behavioral group therapy for social anxiety disorder: A qualitative evaluation based on patients’ and therapists’ experiences.2021In: Translational Issues in Psychological Science, ISSN 2332-2136, Vol. 7, no 3, p. 229-247Article in journal (Refereed)
    Abstract [en]

    Social anxiety disorder (SAD) is a highly prevalent and impairing disorder. Current bestpractice is cognitive behavioral therapy (CBT), but there are several challenges associatedwith performing exposure therapy. Virtual reality exposure (VRE) may improvetreatment efficacy of SAD in a group therapy context, because it allows for greatercontrol, flexibility, and individualization of the exposure stimuli. However, to date nostudy has investigated the use of VRE for SAD in a group context. In the present study,nine patients who had undergone group CBT with VRE for SAD and three therapistsresponsible for the treatment were interviewed about their experiences. The objective ofthe study was to investigate the practical and therapeutic challenges of using VRE in agroup therapy context. Thematic analysis was used to analyze the data. The resultsshowed that it was difficult for the patients to engage with the VRE in a group therapycontext and that there were several practical challenges. However, all participants foundthe VRE exercises to be meaningful, because it gave them a medium to practice andunderstand typically avoided social situations. The latter has not previously beendescribed as a treatment mechanism for anxiety through virtual reality. However, theappropriateness of VRE in group therapy remains unclear. Implications are discussed.

  • 256.
    Arnison, Tor
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Epidemiology and Biostatistics.
    Prevention is better than cure: why early interventions for insomnia and chronic pain during adolescence should be a priority2023In: Frontiers in Psychology, E-ISSN 1664-1078, Vol. 14, article id 1206977Article in journal (Refereed)
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  • 257.
    Arnison, Tor
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Epidemiology and Biostatistics.
    Rask, Olof
    Department of Clinical Sciences Lund, Division of Child and Adolescent Psychiatry, Lund University, Lund, Sweden.
    Nordenskjöld, Axel
    Örebro University, School of Medical Sciences. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Movahed Rad, Pouya
    Department of Clinical Sciences, Division of Adult Psychiatry, Faculty of Medicine, Lund University, Lund, Sweden.
    Safety of and response to electroconvulsive therapy during pregnancy: Results from population‐based nationwide registries2023In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447Article in journal (Refereed)
    Abstract [en]

    Introduction: Psychiatric disorders are common during pregnancy, affecting up to 16% of pregnant women. Severe depression and anxiety have significant negative effects on the health of both the mother and the developing fetus. Electroconvulsive therapy (ECT) is considered a treatment option for pregnant women with severe psychiatric disorders when other treatments have been ineffective or pose risks to the fetus. Knowledge of the safety and efficacy of ECT during pregnancy, however, remains limited.

    Methods: Data were obtained from nationwide registries of pregnant women in Sweden who received ECT for a severe psychiatric disorder from January 2008 to December 2021. ECT-related outcomes in pregnant women were compared by propensity score matching with a group of non-pregnant women who also received ECT. Pregnancy-related outcomes were compared with two additional control groups: one consisting of the same group of women who did not receive ECT during another pregnancy and the other composed of pregnant women admitted to inpatient psychiatric care but who did not receive ECT, matched based on propensity score.

    Results: Ninety-five pregnant women received ECT during the study period, accounting for 97 pregnancies. The response rate to ECT in pregnant women (n = 54) was similar to the matched control group of non-pregnant women (74% vs. 65%; OR 1.61; 95% CI 0.79-3.27). Rates of adverse events related to ECT were similar to those in the control group. There were no pre-term births or severe adverse outcomes related to the pregnancy, that were close in time to ECT. Therefore, no adverse outcomes related to pregnancy and childbirth could be directly attributed to ECT. The likelihood of premature birth and a 5-min Apgar score <7 in the newborn were both significantly higher in the ECT group, compared with the matched non-ECT group (OR 2.33, 95% CI 1.15-4.73, p = 0.008, and OR 3.68, 95% CI 1.58-8.55, p < 0.001, respectively). By contrast, no significant differences were observed when women in the pregnant ECT group were compared with the same group lacking ECT during another pregnancy.

    Conclusions: ECT was associated with a positive treatment response in pregnant women with severe psychiatric disorders. The response rate to ECT was similar in pregnant and non-pregnant women. Nevertheless, the risks of premature birth and of a slightly poorer condition in newborns were higher in women who did than did not receive ECT, emphasizing the need for increased attention to severe psychiatric disorders during pregnancy.

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  • 258.
    Arnold, Samuel R. C.
    et al.
    Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia.
    Foley, Kitty-Rose
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Hwang, Ye In (Jane)
    Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia.
    Richdale, Amanda L.
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Uljarevic, Mirko
    Stanford Autism Center, Division of Child and Adolescent Psychiatry, Department of Psychiatry and Behavioral Sciences, School of Medicine, Stanford University.
    Lawson, Lauren P.
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Cai, Ru Ying
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Falkmer, Torbjörn
    Jönköping University, School of Health and Welfare, HHJ. CHILD. Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Falkmer, Marita
    Jönköping University, School of Education and Communication, HLK, CHILD. Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Lennox, Nick
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Urbanowicz, Anna
    Cooperative Research Centre for Living with Autism (Autism CRC), Brisbane, Queensland, Australia.
    Trollor, Julian N.
    Department of Developmental Disability Neuropsychiatry (3DN), UNSW Sydney, New South Wales, Australia.
    Cohort profile: The Australian Longitudinal Study of Adults with Autism2019In: BMJ Open, E-ISSN 2044-6055, Vol. 9, no 12, article id e030798Article in journal (Refereed)
    Abstract [en]

    PURPOSE: There is a significant knowledge gap regarding the lives of adults on the autism spectrum. Some literature suggests significant health and mental health inequalities for autistic adults, yet there is a lack of comprehensive longitudinal studies exploring risk factors. Further, most research does not include the perspective of autistic adults in its conduct or design. Here, we describe the baseline characteristics and inclusive research approach of a nationwide longitudinal study. ​

    PARTICIPANTS: The Autism Cooperative Research Centre for Living with Autism's Australian Longitudinal Study of Adults with Autism (ALSAA) is a questionnaire-based longitudinal study of autistic adults (25+ years old) with follow-up at 2-year intervals. Autistic advisors were involved in each stage of research apart from data analysis. Three questionnaires were developed: self-report, informant report (ie, proxy report) and carers (ie, carer experiences and characteristics). ​

    FINDINGS TO DATE: An inclusive research protocol was developed and agreed with autistic advisors. Baseline data were collected from 295 autistic adults (M=41.8 years, SD=12.0) including 42 informant responses, 146 comparison participants and 102 carers. The majority of autistic participants (90%) had been diagnosed in adulthood (M=35.3 years, SD=15.1). When compared with controls, autistic adults scored higher on self-report measures of current depression and anxiety. Participant comments informed ongoing data gathering. Participants commented on questionnaire length, difficulty with literal interpretation of forced response items and expressed gratitude for research in this area.

    ​FUTURE PLANS: A large comprehensive dataset relating to autistic adults and their carers has been gathered, creating a good platform for longitudinal follow-up repeat surveys and collaborative research. Several outputs are in development, with focus on health service barriers and usage, caregivers, impact of diagnosis in adulthood, further scale validations, longitudinal analyses of loneliness, suicidal ideation, mental illness risk factors and other areas. Baseline data confirm poorer mental health of autistic adults. The ALSAA demonstrates a working approach to inclusive research.

  • 259.
    Arnone, Danilo
    et al.
    Centre for affective Disorders, Psychological Medicine, King's College London, United Kingdom; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada.
    Karmegam, Sendhil Raj
    Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA.
    Östlundh, Linda
    Örebro University, University Library.
    Alkhyeli, Fatima
    United Arab Emirates University, Al Ain, United Arab Emirates.
    Alhammadi, Lamia
    United Arab Emirates University, Al Ain, United Arab Emirates.
    Alhammadi, Shama
    United Arab Emirates University, Al Ain, United Arab Emirates.
    Alkhoori, Amal
    United Arab Emirates University, Al Ain, United Arab Emirates.
    Selvaraj, Sudhakar
    Faillace Department of Psychiatry and Behavioral Sciences, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX, USA; Intra-Cellular Therapies, Inc.
    Risk of suicidal behavior in patients with major depression and bipolar disorder: A systematic review and meta-analysis of registry-based studies2024In: Neuroscience and Biobehavioral Reviews, ISSN 0149-7634, E-ISSN 1873-7528, Vol. 159, article id 105594Article, review/survey (Refereed)
    Abstract [en]

    Suicide is a health priority and one of the most common causes of death in mood disorders. One of the limitations of this type of research is that studies often establish rates of suicide behaviors in mood disorders by using diverse comparison groups or simply monitoring cohort of patients over a time period. In this study registry-based systematic review, national registers were identified through searches in six academic databases, and information about the occurrence of suicide behaviors in mood disorders was systematically extracted. Odds ratios were subsequently calculated comparing rates of death by suicide in mood disorders in comparison with age and period matched rates of death by suicide in the general population obtained from country-wide national registers. The aim was to provide the most recent summary of epidemiological and clinical factors associated to suicide in mood disorders whilst calculating the likelihood of death by suicide in mood disorders in comparison with non-affected individuals according to national databases. The study follows the Preferred Reporting Guidelines for Systematic Reviews and Meta-analyses and was prespecify registered on Prospero (CRD42020186857). RESULTS: suggest that patients with mood disorders are at substantially increased risk of attempting and dying by suicide. Several epidemiological, clinical and social factors are reported to be associated with clinical populations at risk of suicide. Meta-analyses of completed deaths by suicide suggest that the likelihood for dying by suicide in mood disorders is 8.62 times higher in major depression and 8.66 times higher in bipolar disorder with higher number of untoward events in women compared to men in both conditions. The likelihood of dying by suicide in major depressive disorders is higher in the first year following discharge. Clinical guidelines might consider longer periods of monitoring following discharge from hospital. Overall, due to the higher risk of suicide in mood disorders, efforts should be made to increase detection and prevention whilst focusing on reducing risk in the most severe forms of illness with appropriate treatment to promote response and remission at the earliest convenience.

  • 260.
    Arora, Anmol
    et al.
    Univ Cambridge, England.
    Alderman, Joseph E.
    Univ Birmingham, England; Univ Hosp Birmingham NHS Fdn Trust, England; Univ Birmingham, England; Univ Birmingham, England.
    Palmer, Joanne
    Univ Hosp Birmingham NHS Fdn Trust, England; Univ Birmingham, England; Univ Birmingham, England.
    Ganapathi, Shaswath
    Sandwell & West Birmingham Hosp NHS Trust, England.
    Laws, Elinor
    Univ Birmingham, England; Univ Hosp Birmingham NHS Fdn Trust, England; Univ Birmingham, England; Univ Birmingham, England.
    Mccradden, Melissa D.
    Hosp Sick Children, Canada; Peter Gilgan Ctr Res & Learning, Canada; Dalla Lana Sch Publ Hlth, Canada.
    Oakden-Rayner, Lauren
    Univ Adelaide, Australia.
    Pfohl, Stephen R.
    Google Res, CA USA.
    Ghassemi, Marzyeh
    MIT, MA USA; Inst Med Engn & Sci, MA USA; Vector Inst, Canada.
    Mckay, Francis
    Univ Oxford, England.
    Treanor, Darren
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Inflammation and Infection. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Clinical pathology. Linköping University, Center for Medical Image Science and Visualization (CMIV). Leeds Teaching Hosp NHS Trust, England; Univ Leeds, England.
    Rostamzadeh, Negar
    Google Res, Canada.
    Mateen, Bilal
    UCL, England; Wellcome Trust Res Labs, England.
    Gath, Jacqui
    STANDING Together, England.
    Adebajo, Adewole O.
    STANDING Together, England.
    Kuku, Stephanie
    UCL, England.
    Matin, Rubeta
    Oxford Univ Hosp NHS Fdn Trust, England.
    Heller, Katherine
    Google Res, CA USA.
    Sapey, Elizabeth
    Univ Birmingham, England; Univ Hosp Birmingham NHS Fdn Trust, England; Univ Birmingham, England; Univ Birmingham, England; Univ Birmingham, England.
    Sebire, Neil J.
    Great Ormond St Hosp Biomed Res Ctr, England; Univ Hosp London, England.
    Cole-Lewis, Heather
    Google Res, CA USA.
    Calvert, Melanie
    Univ Birmingham, England; Univ Birmingham, England; Univ Birmingham, England; Univ Birmingham, England; Univ Birmingham, England; Univ Birmingham, England; Univ Birmingham, England; Univ Birmingham, England; Univ Birmingham, England.
    Denniston, Alastair
    Univ Birmingham, England; Univ Hosp Birmingham NHS Fdn Trust, England; Univ Birmingham, England; Univ Birmingham, England; Univ Birmingham, England; UCL, England; UCL, England.
    Liu, Xiaoxuan
    Univ Birmingham, England; Univ Hosp Birmingham NHS Fdn Trust, England; Univ Birmingham, England; Univ Birmingham, England.
    The value of standards for health datasets in artificial intelligence-based applications2023In: Nature Medicine, ISSN 1078-8956, E-ISSN 1546-170X, Vol. 29, p. 2929-2938Article in journal (Refereed)
    Abstract [en]

    Artificial intelligence as a medical device is increasingly being applied to healthcare for diagnosis, risk stratification and resource allocation. However, a growing body of evidence has highlighted the risk of algorithmic bias, which may perpetuate existing health inequity. This problem arises in part because of systemic inequalities in dataset curation, unequal opportunity to participate in research and inequalities of access. This study aims to explore existing standards, frameworks and best practices for ensuring adequate data diversity in health datasets. Exploring the body of existing literature and expert views is an important step towards the development of consensus-based guidelines. The study comprises two parts: a systematic review of existing standards, frameworks and best practices for healthcare datasets; and a survey and thematic analysis of stakeholder views of bias, health equity and best practices for artificial intelligence as a medical device. We found that the need for dataset diversity was well described in literature, and experts generally favored the development of a robust set of guidelines, but there were mixed views about how these could be implemented practically. The outputs of this study will be used to inform the development of standards for transparency of data diversity in health datasets (the STANDING Together initiative). A systematic review, combined with a stakeholder survey, presents an overview of current practices and recommendations for dataset curation in health, with specific focuses on data diversity and artificial intelligence-based applications.

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  • 261.
    Arrondo, Gonzalo
    et al.
    Mind-Brain Group, Institute for Culture and Society, University of Navarra, Pamplona, Spain; Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK.
    Solmi, Marco
    Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada; Department of Mental Health, The Ottawa Hospital, Ottawa, ON, Canada; Early Psychosis, Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
    Dragioti, Elena
    Pain and Rehabilitation Centre and Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden; Research Laboratory Psychology of Patients, Families & Health Professionals, Department of Nursing, School of Health Sciences, University of Ioannina, Ioannina, Greece.
    Eudave, Luis
    Faculty of Education and Psychology, University of Navarra, Pamplona, Spain.
    Ruiz-Goikoetxea, Maite
    Servicio Navarro de Salud-Osasunbidea, Navarra, Spain.
    Ciaurriz-Larraz, Amaia M.
    Faculty of Education and Psychology, University of Navarra, Pamplona, Spain.
    Magallon, Sara
    Faculty of Education and Psychology, University of Navarra, Pamplona, Spain.
    Carvalho, Andre F.
    Innovation in Mental and Physical Health and Clinical Treatment (IMPACT) Strategic Research Centre, Deakin University, Geelong, VIC, Australia.
    Cipriani, Andrea
    Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, UK; Oxford Health NHS Foundation Trust, Warneford Hospital, Oxford, UK.
    Fusar-Poli, Paolo
    Early Psychosis, Interventions and Clinical-detection (EPIC) Lab, Department of Psychosis Studies, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK; National Institute for Health Research, Maudsley Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK; OASIS Service, South London and Maudsley NHS Foundation Trust, London, UK; Department of Brain and Behavioral Sciences, University of Pavia, Pavia, Italy.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Correll, Christoph
    The Zucker Hillside Hospital, Division of Psychiatry Research, Northwell Health, Glen Oaks, New York, New York, USA; Department of Psychiatry and Molecular Medicine, The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, New York, USA; Department of Child and Adolescent Psychiatry, Charité Universitäts medizin, Berlin, Germany.
    Cortese, Samuele
    Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; Division of Psychiatry and Applied Psychology, School of Medicine, University of Nottingham, Nottingham, UK; Hassenfeld Children's Hospital at NYU Langone, New York University Child Study Center, New York City, New York, US.
    Associations between mental and physical conditions in children and adolescents: an umbrella review2022In: Neuroscience and Biobehavioral Reviews, ISSN 0149-7634, E-ISSN 1873-7528, Vol. 137, article id 104662Article, review/survey (Refereed)
    Abstract [en]

    We mapped the evidence on the type and strength of associations between a broad range of mental and physical conditions in children and adolescents, by carrying out an umbrella review, i.e., a quantitative synthesis of previous systematic reviews and meta-analyses. We also assessed to which extent the links between mental and physical conditions vary across disorders or, by contrast, are transdiagnostic. Based on a pre-established protocol, we retained 45 studies, encompassing around 12.5 million of participants. In analyses limited to the most rigorous estimates, we found evidence for the following associations: ADHD-asthma, ADHD-obesity, and depression-asthma. A transdiagnostic association was confirmed between asthma and anxiety/ASD/depression/bipolar disorder, between obesity and ADHD/ASD/depression, and between dermatitis and ASD/ADHD. We conclude that obesity and allergic conditions are likely to be associated with mental disorders in children and adolescents. Our results can help clinicians explore potential links between mental and physical conditions in children/adolescent and provide a road map for future studies aimed at shading light on the underlying factors.

  • 262.
    Arrondo, Gonzalo
    et al.
    Univ Navarra, Spain; Univ Southampton, England.
    Solmi, Marco
    Univ Southampton, England; Univ Ottawa, Canada; Ottawa Hosp, Canada; Kings Coll London, England.
    Dragioti, Elena
    Linköping University, Department of Health, Medicine and Caring Sciences, Division of Prevention, Rehabilitation and Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Anaesthetics, Operations and Specialty Surgery Center, Pain and Rehabilitation Center. Univ Ioannina, Greece.
    Eudave, Luis
    Univ Navarra, Spain.
    Ruiz-Goikoetxea, Maite
    Serv Navarro Salud Osasunbidea, Spain.
    Ciaurriz-Larraz, Amaia M.
    Univ Navarra, Spain.
    Magallon, Sara
    Univ Navarra, Spain.
    Carvalho, Andre F.
    Deakin Univ, Australia.
    Cipriani, Andrea
    Univ Oxford, England; Warneford Hosp, England.
    Fusar-Poli, Paolo
    Kings Coll London, England; South London & Maudsley NHS Fdn Trust, England; South London & Maudsley NHS Fdn Trust, England; Univ Pavia, Italy.
    Larsson, Henrik
    Karolinska Inst, Sweden; Orebro Univ, Sweden.
    Correll, Christoph U.
    Northwell Hlth, NY USA; Donald & Barbara Zucker Sch Med Hofstra Northwell, NY USA; Charite, Germany.
    Cortese, Samuele
    Univ Southampton, England; Univ Southampton, England; Solent NHS Trust, England; Univ Nottingham, England; NYU, NY USA.
    Associations between mental and physical conditions in children and adolescents: An umbrella review2022In: Neuroscience and Biobehavioral Reviews, ISSN 0149-7634, E-ISSN 1873-7528, Vol. 137, article id 104662Article, review/survey (Refereed)
    Abstract [en]

    We mapped the evidence on the type and strength of associations between a broad range of mental and physical conditions in children and adolescents, by carrying out an umbrella review, i.e., a quantitative synthesis of previous systematic reviews and meta-analyses. We also assessed to which extent the links between mental and physical conditions vary across disorders or, by contrast, are transdiagnostic. Based on a pre-established protocol, we retained 45 systematic reviews/meta-analyses, encompassing around 12.5 million of participants. In analyses limited to the most rigorous estimates, we found evidence for the following associations: ADHD-asthma, ADHDobesity, and depression-asthma. A transdiagnostic association was confirmed between asthma and anxiety/ASD/depression/bipolar disorder, between obesity and ADHD/ASD/depression, and between dermatitis and ASD/ADHD. We conclude that obesity and allergic conditions are likely to be associated with mental disorders in children and adolescents. Our results can help clinicians explore potential links between mental and physical conditions in children/adolescent and provide a road map for future studies aimed at shading light on the underlying factors.

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  • 263.
    Arvidsson, Barbro
    et al.
    Halmstad University, School of Social and Health Sciences (HOS), Centre of Research on Welfare, Health and Sport (CVHI).
    Skärsäter, IngelaHögskolan Väst, Institutionen för omvårdnad, hälsa och kultur, Avd för sjuksköterskeutbildning.
    Psykiatrisk omvårdnad: att stödja hälsofrämjande processer2006Collection (editor) (Other (popular science, discussion, etc.))
    Abstract [sv]

    oken, den första i sitt slag, har ett hälsofrämjande förhållningssätt både vad gäller att förhindra att psykisk ohälsa uppstår och att förhålla sig till personer som i någon mening drabbats av psykisk ohälsa. Syftet är att locka fram hälsofrämjande processer, att hitta hälsan i det sjuka. Författarna beskriver den vårdande insatsen, mötet och relationen mellan vårdare och patient/vårdtagare. Boken belyser också betydelsen av att övriga sociala relationer fungerar, såväl inom familjen som i övriga samhällslivet.

    (Beskrivning från förlaget)

  • 264.
    Arvidsson, Jenny
    et al.
    Halmstad University, School of Social and Health Sciences (HOS).
    Theodorsson, Linda
    Halmstad University, School of Social and Health Sciences (HOS).
    Den fysiska aktivitetens betydelse för depression2011Independent thesis Basic level (university diploma), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Depression is a disease where scientists are not in agreement on its origin. Research indicates that depression will be the second most common disease in the world year 2020. Physical activity is important for the public health and benefits the individuals both physically and psychologically. The purpose of this literature study was to illustrate the relation between depression and physical activity. The result is based on 14 articles which relate to the purpose. The result showed that persons who are physically active have less risk of suffering from psychological difficulties such as depression. There is also a connection between how much physical activity that is carried out and the degree of depression. The nurse's role is important to prevent and relieve depression. In consultation with the patient, physical activity can be suggested as a complement to medical treatment. It can be enough with a couple of walks per week to prevent beginning of depression as well as ease symptoms for those who already suffer from depression. If more people exercised on a regular basis the frequency of depression would most likely be reduced. Further research in this area should be carried out as well as the implementation of knowledge that already exists. It is important that the beneficial effects, which physical activity has on depression, reach all relevant persons within health and medical care industries and that it is implemented. In conjunction with additional research this can lead to physical activities being partial replacement to medical treatment.

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  • 265.
    Arvidsson Lindvall, Mialinn
    et al.
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre.
    Lidström-Holmqvist, Kajsa
    Örebro University, School of Health Sciences. University Health Care Research Centre, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Neurology and Rehabilitation Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Axelsson Svedell, Lena
    Örebro University, School of Health Sciences. Department of Psychiatry, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Philipson, Anna
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Centre.
    Cao, Yang
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Msghina, Mussie
    Örebro University, School of Medical Sciences. Department of Psychiatry, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    START - physical exercise and person-centred cognitive skills training as treatment for adult ADHD: protocol for a randomized controlled trial2023In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 23, no 1, article id 697Article in journal (Refereed)
    Abstract [en]

    Background: Core symptoms in attention deficit hyperactivity disorder (ADHD) are inattention, impulsivity and hyperactivity. Many individuals with this disorder also have a sedentary lifestyle, co-morbid mental illness such as depressive and anxiety disorders, and reduced quality of life. People with ADHD often have impaired executive function, which among other things may include difficulty in time management and structuring of everyday life. Pharmacological treatment is often the first-line option, but non-pharmacological treatment is also available and is used in clinical settings. In children and adolescents with ADHD, physical exercise is used as a non-pharmacological treatment. However, the evidence for the effectiveness of exercise in adults is sparse.

    Objective: To implement the START intervention (START = Stöd i Aktivitet, Rörelse och Träning [Support in activity, movement and exercise]) consisting of a 12-week, structured mixed exercise programme with or without a cognitive intervention, in adults with ADHD, and study whether it has an effect on core symptoms of ADHD as well as physical, cognitive, mental and everyday functioning compared with usual treatment. A secondary aim is to investigate the participants' experiences of the intervention and its possible benefits, and to evaluate the cost-effectiveness of START compared with usual treatment.

    Methods: This is a randomized controlled trial planned to be conducted in 120 adults with ADHD, aged 18-65. The intervention will be given as an add-on to standard care. Participants will be randomized to three groups. Group 1 will be given a physiotherapist-led mixed exercise programme for 12 weeks. Group 2 will receive the same intervention as group 1 with the addition of occupational therapist-led cognitive skills training. Group 3 will be the control group who will receive standard care only. The primary outcome will be reduction of ADHD symptoms measured using the World Health Organization (WHO) Adult ADHD Self-Report Scale (ASRS-v1.1), Clinical Global Impression-Severity scale (CGI-S) and CGI-Improvement scale (CGI-I). The effect will be measured within 1 week after the end of the intervention and 6 and 12 months later.

    Discussion: Data collection began in March 2021. The final 12-month follow-up is anticipated to be completed by autumn 2024.

    Trial registration: ClinicalTrials.gov (Identifier: NCT05049239). Registered on 20 September 2021 (last verified: May 2021).

  • 266.
    Arvidsson, Ulrica
    et al.
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Östangård, Charlotte
    Linnaeus University, Faculty of Health, Social Work and Behavioural Sciences, School of Health and Caring Sciences.
    Familjemedlemmars upplevelser av att vara anhörig till en person med schizofreni.2011Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [en]

    Background: Schizophrenia is a serious disease with potential to implicate consequences on both the family and the sick. Nurses have a fundamental responsibility to relieve suffering, and also to offer support to both the individual and the family.

    Aim: To illuminate experiences of being a family member to a person with schizophrenia.

    Method: A systematic literature review was chosen. Nine articles were included. After having analyzed the results six categories were found.

    Result: The family members experienced the disease as fluctuating and stressful. Some felt ashamed for their sick family member and withdrew from the rest of the society. It was also common to grieve over the sick family member as they felt they had lost the person he/she ones was. Most studies showed that family members were disappointed with the psychiatric care. They felt excluded from the caring process and lack of information. Hopefully the result of this study leads to that nurses can offer increased support and understanding to the family.

    Conclusions: Disease and illness may affect on the whole life situation. To support a family in a crisis it is necessary to understand the person’s lifeworld and to be able to change their beliefs.

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  • 267.
    Asellus, Peter
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Nordström, Peter
    Nordström, Anna-Lena
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Department of Clinical Neuroscience, Karolinska Institutet, R5, Karolinska University Hospital/Solna, Stockholm, Sweden.
    CSF Apolipoprotein E in attempted suicide2018In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 225, p. 246-249Article in journal (Refereed)
    Abstract [en]

    Background: Cholesterol and cholesterol metabolism, involved in continued neural plasticity, has been associated to suicide and suicidal behavior. Apolipoprotein E (ApoE) plays an important role in the cholesterol metabolism. The purpose of this study was to investigate whether ApoE in cerebrospinal fluid was related to severity of suicidal behavior as measured by number of earlier suicide attempts, reversibility/interruptabilty and violent method of suicide attempt. Methods: CSF ApoE and 5-hydroxyindolacetic acid (5-HIAA) were measured in 42 medication free suicide attempters. Earlier suicide attempts and the reversibility of suicide attempt method were assessed with the Suicide Intent Scale (SIS) and the Freeman Scale. Suicide attempts were classified according to violence of method. Results: CSF ApoE levels significantly negatively correlated to the scores on Freeman Reversibility and there was a trend for lower CSF ApoE levels in suicide attempters using a violent method. Patients with at least one earlier suicide attempt (repeaters) showed a trend for higher CSF ApoE levels compared to suicide attempters debuting with suicidal behavior at inclusion in the study. The correlation between CSF ApoE and 5-HIAA was not significant. Limitations: The main limitations to this study were a relatively small sample size and lack of a healthy control group. Conclusion: Irreversible suicide attempts, representing a high risk for completed suicide, may be associated with lower level of ApoE in CSF.

  • 268. Asellus, Peter
    et al.
    Nordström, Peter
    Nordström, Anna-Lena
    Jokinen, Jussi
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, R5, Karolinska University Hospital/Solna.
    Plasma apolipoprotein E and severity of suicidal behaviour2016In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 190, p. 137-142Article in journal (Refereed)
    Abstract [en]

    There is evidence for association between low cholesterol levels and suicidal behaviour. Since apolipoprotein E (ApoE) is involved in the cholesterol metabolism in both the periphery and in the central nervous system; it may be of particular interest in the neurobiology of suicidal behaviour. Furthermore, hypothalamic-pituitary-adrenal (HPA) axis function, one of the main biological systems implicated in both suicidal behaviour and early-life adversity, affect ApoE levels. Very few studies have assessed plasma ApoE in relation to suicidal behaviour. The purpose of this study was to investigate levels of ApoE in plasma in relation to the severity of suicidal behaviour and life-time adversity in the form of exposure to interpersonal violence in suicide attempters. A total of 100 suicide attempters (67 women and 33 men) were enroled in the study. Information on earlier suicide attempts and age at onset of suicidal behaviour was gathered using the Karolinska Suicide History Interview. The Karolinska Interpersonal Violence Scale was used to assess exposure to interpersonal violence. Plasma ApoE was measured by immunonephelometry according to accredited routines. Patients with at least one earlier suicide attempt had significantly higher ApoE levels compared to suicide attempters debuting with suicidal behaviour at inclusion in the study. A higher number of earlier suicide attempts was significantly correlated with higher plasma ApoE levels. Age at onset was significantly negatively correlated with ApoE after adjusting for age. ApoE showed a significant positive correlation with exposure to interpersonal violence as a child in male suicide attempters. Our findings indicate that ApoE may be related to stress and trauma and the temporal severity of suicidal behaviour.

  • 269. Asherson, P.
    et al.
    Stes, S.
    Nilsson, Maria Markhed
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Berggren, L.
    Svanborg, P.
    Kutzelnigg, A.
    Deberdt, W.
    The effects of atomoxetine on emotional control in adults with ADHD: An integrated analysis of multicenter studies2015In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 30, no 4, p. 511-520Article in journal (Refereed)
    Abstract [en]

    Purpose: To investigate the effects of atomoxetine on emotional control in adults with ADHD. Methods: We performed an integrated analysis using individual patient data pooled from three Eli Lilly-sponsored studies. An integrated analysis can be viewed as a meta-analysis of individual patient-level data, rather than study-level summary data. Results: Two populations were identified: a large sample of patients with pre-treatment baseline data (the "overall population''; n = 2846); and a subset of these patients with placebo-controlled efficacy data from baseline to 10 or 12 weeks after initiating treatment (the "placebo-controlled population''; n = 829). At baseline, in the overall population, similar to 50% of ADHD patients had BRIEF-AS (Behavior Rating Inventory of Executive Function-Adult Version Self-Report) Emotional control subscores between 21 and 30, compared with similar to 10% of normative subjects in the BRIEF-A manual. At endpoint, in the placebo-controlled population, atomoxetine led to a small (effect size 0.19) but significant (P = 0.013) treatment effect for emotional control. The effect size was 0.32 in patients with BRIEF-AS Emotional control scores > 20 at baseline. Improvements in emotional control correlated with improvements in the core ADHD symptoms and quality-of-life. Discussion: As deficient emotional control is associated with impaired social, educational and occupational functioning over and above that explained by core ADHD symptoms alone, improvements in emotional control may be clinically relevant. Conclusion: At baseline, adults with ADHD were more likely to have impaired emotional control than normative subjects. In the adult ADHD patients, atomoxetine treatment was associated with improvements in emotional control, as well as in core ADHD symptoms and quality-of-life.

  • 270.
    Ashworth, Emma
    et al.
    Liverpool John Moores Univ, Fac Hlth, Sch Psychol, Liverpool, Merseyside, England..
    Brooks, Samantha
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Schiöth: Functional Pharmacology. Liverpool John Moores Univ, Fac Hlth, Sch Psychol, Liverpool, Merseyside, England.;Univ Witwatersrand, Sch Human & Community Dev, Dept Psychol, Johannesburg, South Africa..
    Schiöth, Helgi B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Schiöth: Functional Pharmacology. Sechenov First Moscow State Med Univ, Inst Translat Med & Biotechnol, Moscow, Russia..
    Neural activation of anxiety and depression in children and young people: A systematic meta-analysis of fMRI studies2021In: Psychiatry Research: Neuroimaging, ISSN 0925-4927, E-ISSN 1872-7506, Vol. 311, article id 111272Article in journal (Refereed)
    Abstract [en]

    Functional magnetic resonance imaging (fMRI) studies consistently demonstrate altered neural activation in youth experiencing anxiety and depression in a way that is distinct from adult-onset disorders. However, there is a paucity of research systematically reviewing this, and no meta-analyses have been conducted using Activation Likelihood Estimation (ALE). The present study conducted a systematic literature search to identify fMRI studies in youth (age 4?18) with depression or anxiety disorders. 48 studies with over 2000 participants were identified that met the inclusion criteria. Significant foci were extracted. Five ALE meta-analyses were conducted: a) activation for both anxiety disorders and depression; b) activation for anxiety disorders only; c) activation for depression only; d) deactivation for both anxiety disorders and depression; e) deactivation for depression. Results indicated significant clusters of increased activation in the bilateral amygdala for youth with internalising disorders, and specifically for those with anxiety disorders. Significant increased activation extended into the dorsal anterior cingulate, entorhinal cortex, the putamen, and the medial and lateral globus pallidus in youth with anxiety disorders. These findings help to detail the nature of anxiety being an amygdala hyperactivity disorder, whilst also defining the distinction between neural activation patterns in anxiety and depression.

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  • 271.
    Asp, Marie
    et al.
    Lund Univ, Sweden; Psychiat Clin Lund, Sweden.
    Ambrus, Livia
    Lund Univ, Sweden; Psychiat Clin Lund, Sweden.
    Reis, Margareta
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Clinical Chemistry and Pharmacology. Linköping University, Faculty of Medicine and Health Sciences.
    Manninen, Sofie
    Lund Univ, Sweden.
    Fernström, Johan
    Lund Univ, Sweden; Psychiat Clin Lund, Sweden.
    Lindqvist, Daniel
    Lund Univ, Sweden; Psychiat Res Skane, Sweden.
    Westrin, Åsa
    Lund Univ, Sweden; Psychiat Res Skane, Sweden.
    Differences in antipsychotic treatment between depressive patients with and without a suicide attempt2021In: Comprehensive Psychiatry, ISSN 0010-440X, E-ISSN 1532-8384, Vol. 109, article id 152264Article in journal (Refereed)
    Abstract [en]

    Background: Depressed suicide attempters are, according to some earlier studies, treated more often with antipsychotics than depressive non-suicide attempters. Cluster B personality disorders, especially borderline personality disorder, are associated with a high suicide risk, and antipsychotics are commonly used for the reduction of symptoms. However, no previous study has taken comorbid personality disorders into account when assessing the use of antipsychotics in patients with unipolar depression. Therefore, the aim of this study was to investigate the clinical selection of pharmacotherapy in unipolar depression with and without a previous suicide attempt, taking into account potential confounders such as cluster B personality disorders. Methods: The study sample consisted of 247 patients with unipolar depression. The study was approved by the Regional Ethical Review Board in Lund, Sweden. Study participants were recruited from 4 different secondary psychiatric care clinics in Sweden and were diagnosed according to the DSM-IV-TR with the MINI and SCID II. Previous and ongoing psychiatric treatments were investigated in detail and medical records were assessed. Results: Thirty percent of the patients had made previous suicide attempts. Depressed suicide attempters underwent both lifetime treatment with antipsychotics and an ongoing antipsychotic treatment significantly more often than non-attempters. Significances remained after a regression analysis, adjusting for cluster B personality disorders, symptom severity, age at the onset of depression, and lifetime psychotic symptoms. Conclusions: This is the first study to consider the effect of comorbidity with cluster B personality disorders when comparing treatment of depressive suicide and non-suicide attempters. Our findings suggest that suicide attempters are more frequently treated with antipsychotics compared to non-suicide attempters, regardless of cluster B personality disorder comorbidity. These findings are important for clinicians to consider and would also be relevant to future studies evaluating reduction of suicide risk with antipsychotics in patients with psychiatric comorbidity and a history of attempted suicide.

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  • 272.
    Asp, Marie
    et al.
    Lund Univ, Sweden; Psychiat Clin, Sweden.
    Lindqvist, Daniel
    Lund Univ, Sweden; Psychiat Clin, Sweden.
    Fernstrom, Johan
    Lund Univ, Sweden; Psychiat Clin, Sweden.
    Ambrus, Livia
    Lund Univ, Sweden; Psychiat Clin, Sweden.
    Tuninger, Eva
    Lund Univ, Sweden; Psychiat Clin, Sweden.
    Reis, Margareta
    Linköping University, Department of Biomedical and Clinical Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Westrin, Asa
    Lund Univ, Sweden; Psychiat Clin, Sweden.
    Recognition of personality disorder and anxiety disorder comorbidity in patients treated for depression in secondary psychiatric care2020In: PLOS ONE, E-ISSN 1932-6203, Vol. 15, no 1, article id e0227364Article in journal (Refereed)
    Abstract [en]

    Objectives Depression is a common illness with substantial economic consequences for society and a great burden for affected individuals. About 30% of patients with depression do not respond to repeated treatments. Psychiatric comorbidity is known to affect duration, recurrence and treatment outcome of depression. However, there is a lack of knowledge on the extent to which psychiatric comorbidity is identified in the clinical setting for depressed patients in secondary psychiatric care. Therefore, the aim of this study was to compare the agreement between traditional diagnostic assessment (TDA) and a structured and comprehensive diagnostic procedure (SCDP) for identification of personality and anxiety disorder comorbidity in depressed patients in secondary psychiatric care. Methods 274 patients aged 18-77 were referred from four secondary psychiatric care clinics in Sweden during 2012-2017. ICD-10 diagnoses according to TDA (mostly unstructured by psychiatric specialist and residents in psychiatry), were retrieved from medical records and compared to diagnoses resulting from the SCDP in the study. This included the Mini International Neuropsychiatric Interview, the Structured Interview for DSM Axis II Personality Disorders and semi-structured questions on psychosocial circumstances, life-events, psychiatric symptoms, psychiatric treatments, substance use, and suicidal and self-harm behaviour. The assessment was carried out by psychiatric specialists or by residents in psychiatry with at least three years of psychiatric training. Results SCDP identified personality disorder comorbidity in 43% of the patients compared to 11% in TDA (p&lt;0,0001). Anxiety disorder comorbidity was identified in 58% with SCDP compared to 12% with TDA (p&lt;0,0001). Conclusions Important psychiatric comorbidity seems to be unrecognized in depressive patients when using TDA, which is routine in secondary psychiatric care. Comorbidities are better identified using the proposed model involving structured and semi-structured interviews together with clinical evaluations by clinical experts.

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  • 273.
    Aspegren, Erini
    et al.
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Lundin, Anna
    Linnaeus University, Faculty of Health and Life Sciences, Department of Health and Caring Sciences.
    Upplevelser av att ha växt upp med en psykiskt sjuk förälder: En kvalitativ litteraturstudie baserad på självbiografier2019Independent thesis Basic level (degree of Bachelor), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Bakgrund: Psykiska sjukdomar av olika slag är vanligt förekommande i vårt samhälle och i hela världen. Trots detta föreligger ett tabu och ett stigma kring psykisk sjukdom, vilket påverkar såväl den sjuke som de anhöriga negativt. Att växa upp med en psykiskt sjuk förälder kan leda till att barnen inte mår väl och kommer i skymundan.

    Syfte: Syftet var att beskriva vuxna personers upplevelser av att ha växt upp tillsammans med en psykiskt sjuk förälder.

    Metod: Studien är en kvalitativ litteraturstudie med en induktiv ansats, som har utgångspunkt i självbiografier. Data utifrån fem självbiografier har analyserats genom en manifest innehållsanalys.

    Resultat: Barnens upplevelser sammanställdes i tre kategorier och åtta underkategorier. Kategorierna som framkom var Otrygghet, En betungande vardag och Saknad.

    Slutsats: Att som barn ha en förälder som är psykiskt sjuk leder till känslor av ansvarstagande, otrygghet och längtan efter ett vanligt liv. Det är viktigt att sjuksköterskan lyssnar till barnet för att skapa tillit, samt upplyser barnet angående förälderns sjukdom och dess påverkan på familjeförhållandena, för att verka för en bättre hälsa för barnet.

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  • 274.
    Aspeqvist, Erik
    et al.
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Andersson, Hedvig
    Linköping University, Department of Biomedical and Clinical Sciences, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Korhonen, Laura
    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. Linköping University, Department of Biomedical and Clinical Sciences, Barnafrid.
    Dahlström, Örjan
    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.
    Measurement and stratification of nonsuicidal self-injury in adolescents2024In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 24, no 1, article id 107Article in journal (Refereed)
    Abstract [en]

    BackgroundNonsuicidal self-injury (NSSI) is highly prevalent in adolescents. In survey and interview studies assessing NSSI, methods of assessment have been shown to influence prevalence estimates. However, knowledge of which groups of adolescents that are identified with different measurement methods is lacking, and the characteristics of identified groups are yet to be investigated. Further, only a handful of studies have been carried out using exploratory methods to identify subgroups among adolescents with NSSI.MethodsThe performance of two prevalence measures (single-item vs. behavioral checklist) in the same cross-sectional community sample (n = 266, age M = 14.21, 58.3% female) of adolescents was compared regarding prevalence estimates and also characterization of the identified groups with lifetime NSSI prevalence. A cluster analysis was carried out in the same sample. Identified clusters were compared to the two groups defined using the prevalence measures.ResultsA total of 118 (44.4%) participants acknowledged having engaged in NSSI at least once. Of these, a group of 55 (20.7%) adolescents confirmed NSSI on a single item and 63 (23.7%) adolescents confirmed NSSI only on a behavioral checklist, while denying NSSI on the single item. Groups differed significantly, with the single-item group being more severely affected and having higher mean scores on difficulties in emotion regulation, self-criticism, number of methods, higher frequency of NSSI, higher rates of suicidal ideation and suicidal behavior and lower mean score on health-related quality of life. All cases with higher severity were not identified by the single-item question. Cluster analysis identified three clusters, two of which fit well with the groups identified by single-item and behavioral checklist measures.ConclusionsWhen investigating NSSI prevalence in adolescents, findings are influenced by the researchers' choice of measures. The present study provides some directions toward what kind of influence to expect given the type of measure used, both with regards to the size of the identified group and its composition. Implications for future research as well as clinical and preventive work are discussed.

  • 275.
    Aspvall, Kristin
    et al.
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.
    Andersson, Erik
    Karolinska Inst, Dept Clin Neurosci, Div Psychol, Stockholm, Sweden.
    Lenhard, Fabian
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.
    Melin, Karin
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Gothenburg, Sweden;Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Child & Adolescent Psychiat Specialized Unit, Gothenburg, Sweden.
    Norlin, Lisa
    Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Child & Adolescent Psychiat Specialized Unit, Gothenburg, Sweden.
    Wallin, Lena
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Gothenburg, Sweden;Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Child & Adolescent Psychiat Specialized Unit, Gothenburg, Sweden.
    Silverberg-Morse, Maria
    Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.
    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, Stockholm, Sweden.
    Mataix-Cols, David
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.
    Serlachius, Eva
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Stockholm, Sweden;Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.
    Stepped Care Internet-Delivered vs Face-to-Face Cognitive-Behavior Therapy for Pediatric Obsessive-Compulsive Disorder A Trial Protocol for a Randomized Noninferiority Trial2019In: JAMA Network Open, E-ISSN 2574-3805, Vol. 2, no 10, article id e1913810Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE Internet-delivered cognitive behavior therapy is an effective treatment for children and adolescents with obsessive-compulsive disorder and has the potential to markedly increase access to treatment for patients while being cost-effective for health care organizations. OBJECTIVE To investigate whether internet-delivered cognitive behavior therapy implemented within a stepped care model is noninferior to, and cost-effective compared with, the gold standard of face-to-face cognitive behavior therapy for pediatric obsessive-compulsive disorder. DESIGN, SETTING, AND PARTICIPANTS Multicenter, single-blind, randomized clinical noninferiority trial implemented at 2 specialist pediatric obsessive-compulsive disorder clinics in Stockholm and Gothenburg, Sweden. Participants are 152 children and adolescents aged 7 to 17 years with obsessive compulsive disorder, recruited through the 2 clinics and online self-referral. Patients will be randomized 1:1 to the stepped care intervention or face-to-face therapy. Blind evaluations will be conducted after treatment and at 3-month and 6-month follow-ups. At the 6-month follow-up (primary end point), noninferiority will be tested and resource use will be compared between the 2 treatment groups. Data will be analyzed according to intention-to-treat principles. INTERVENTION Patients randomized to stepped care will first receive internet-delivered cognitive behavior therapy for 16 weeks; patients who are classified as nonresponders 3 months after treatment completion will receive additional face-to-face therapy. The control group will receive 16 weeks of face-to-face cognitive behavior therapy immediately following randomization and nonresponders at the 3-month follow-up will, as in the stepped care group, receive additional face-to-face therapy. MAIN OUTCOMES AND MEASURES Noninferiority is defined as a 4-point difference on the primary outcome measure (Children's Yale-Brown Obsessive Compulsive Scale). DISCUSSION Recruitment started October 6, 2017, and was completed May 24, 2019. Results from the primary end point will be available by May 2020. The naturalistic follow-ups (1, 2, and 5 years after the end of treatment) will continue to 2025. There are no interim analyses planned or stopping rules for the trial.

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  • 276.
    Aspvall, Kristina
    et al.
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Solna, Sweden.;Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Andersson, Erik
    Karolinska Inst, Div Psychol, Dept Clin Neurosci, Stockholm, Sweden..
    Melin, Karin
    Univ Gothenburg, Inst Hlth & Care Sci, Sahlgrenska Acad, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Gothenburg, Region Vastra G, Sweden..
    Norlin, Lisa
    Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Gothenburg, Region Vastra G, Sweden..
    Eriksson, Viktor
    Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Vigerland, Sarah
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Solna, Sweden.;Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Jolstedt, Maral
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Solna, Sweden.;Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Silverberg-Mörse, Maria
    Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Wallin, Lena
    Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Gothenburg, Region Vastra G, Sweden.;Univ Gothenburg, Inst Neurosci & Physiol, Sahlgrenska Acad, Gothenburg, Sweden..
    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, Div Biostat, Inst Environm Med, Stockholm, Sweden..
    Lenhard, Fabian
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Solna, Sweden..
    Mataix-Cols, David
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Solna, Sweden.;Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Serlachius, Eva
    Karolinska Inst, Ctr Psychiat Res, Dept Clin Neurosci, Solna, Sweden.;Stockholm Hlth Care Serv, Stockholm, Region Stockhol, Sweden..
    Effect of an Internet-Delivered Stepped-Care Program vs In-Person Cognitive Behavioral Therapy on Obsessive-Compulsive Disorder Symptoms in Children and Adolescents: A Randomized Clinical Trial2021In: Journal of the American Medical Association (JAMA), ISSN 0098-7484, E-ISSN 1538-3598, Vol. 325, no 18, p. 1863-1873Article in journal (Refereed)
    Abstract [en]

    Importance: In most countries, young people with obsessive-compulsive disorder have limited access to specialist cognitive behavioral therapy (CBT), a first-line treatment.

    Objective: To investigate whether internet-delivered CBT implemented in a stepped-care model is noninferior to in-person CBT for pediatric obsessive-compulsive disorder.

    Design, Setting and Participants: A randomized clinical noninferiority trial conducted at 2 specialist child and adolescent mental health clinics in Sweden. Participants included 152 individuals aged 8 to 17 years with obsessive-compulsive disorder. Enrollment began in October 2017 and ended in May 2019. Follow-up ended in April 2020.

    Interventions: Participants randomized to the stepped-care group (n=74) received internet-delivered CBT for 16 weeks. Nonresponders at the 3-month follow-up were then offered a course of traditional face-to-face treatment. Participants randomized to the control group (n=78) immediately received in-person CBT for 16 weeks. Nonresponders at the 3-month follow-up received additional face-to-face treatment.

    Main Outcomes and Measures: The primary outcome was the masked assessor-rated Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) score at the 6-month follow-up. The scale includes 10 items rated from 0(no symptoms) to 4(extreme symptoms), yielding a total score range of 0 to 40, with higher scores indicating greater severity. Assessors were masked to treatment allocation at pretreatment, posttreatment, 3-month follow-up, and 6-month follow-up assessments. The predefined noninferiority margin was 4 points on the CY-BOCS.

    Results: Among the 152 randomized participants (mean age, 13.4 years; 94 [62%] females), 151 (99%) completed the trial. At the 3-month follow-up, 34 participants (46%) in the stepped-care group and 23 (30%) in the in-person CBT group were nonresponders. At the 6-month follow-up, the CY-BOCS score was 11.57 points in the stepped-care group vs 10.57 points in the face-to-face treatment group, corresponding to an estimated mean difference of 0.91 points ([1-sided 97.5% CI, -infinity to 3.28]; P for noninferiority=.02). Increased anxiety (30%-36%) and depressive symptoms (20%-28%) were the most frequently reported adverse events in both groups. There were 2 unrelated serious adverse events (1 in each group).

    Conclusions and Relevance: Among children and adolescents with obsessive-compulsive disorder, treatment with an internet-delivered CBT program followed by in-person CBT if necessary compared with in-person CBT alone resulted in a noninferior difference in symptoms at the 6-month follow-up. Further research is needed to understand the durability and generalizability of these findings.

  • 277.
    Aspvall, Kristina
    et al.
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Nobels Vag 9, S-17165 Stockholm, Sweden.;Stockholm Hlth Care Serv, Stockholm, Sweden..
    Sampaio, Filipa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social medicine/CHAP.
    Lenhard, Fabian
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Nobels Vag 9, S-17165 Stockholm, Sweden..
    Melin, Karin
    Univ Gothenburg, Sahlgrenska Acad, Inst Hlth & Care Sci, Gothenburg, Sweden.;Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Reg Vastra Gotaland, Gothenburg, Sweden..
    Norlin, Lisa
    Sahlgrens Univ Hosp, Dept Child & Adolescent Psychiat, Reg Vastra Gotaland, Gothenburg, Sweden..
    Serlachius, Eva
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Nobels Vag 9, S-17165 Stockholm, Sweden.;Stockholm Hlth Care Serv, Stockholm, Sweden..
    Mataix-Cols, David
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Nobels Vag 9, S-17165 Stockholm, Sweden.;Stockholm Hlth Care Serv, Stockholm, Sweden..
    Andersson, Erik
    Karolinska Inst, Dept Clin Neurosci, Div Psychol, Nobels Vag 9, S-17165 Stockholm, Sweden..
    Cost-effectiveness of Internet-Delivered vs In-Person Cognitive Behavioral Therapy for Children and Adolescents With Obsessive-Compulsive Disorder2021In: JAMA Network Open, E-ISSN 2574-3805, Vol. 4, no 7, article id e2118516Article in journal (Refereed)
    Abstract [en]

    IMPORTANCE: Therapist-guided, internet-delivered cognitive behavioral therapy is an effective treatment option for children and adolescents with obsessive-compulsive disorder, but to our knowledge, its cost-effectiveness compared with traditional in-person treatment has not been established.

    OBJECTIVE: To evaluate the cost-effectiveness of guided internet-delivered cognitive behavioral therapy implemented within a stepped-care model compared with in-person cognitive behavioral therapy for young people with obsessive-compulsive disorder.

    DESIGN, SETTING, AND PARTICIPANTS: This economic evaluation of a randomized noninferiority trial conducted at 2 specialist obsessive-compulsive disorder clinics in Sweden enrolled 152 children and adolescents aged 8 to 17 years with obsessive-compulsive disorder, mainly through clinician referrals (110 [72%]). Recruitment began October 6, 2017, and ended May 24, 2019. Follow-up ended April 14, 2020.

    INTERVENTIONS: Participants were randomly assigned to receive either guided internet-delivered cognitive behavioral therapy or in-person cognitive behavioral therapy during a 16-week period. At the 3-month follow-up, nonresponders in both groups were offered additional in-person cognitive behavior therapy sessions.

    MAIN OUTCOMES AND MEASURES: Health outcomes were treatment response rates (primary outcome), remission rates, and quality-adjusted life-years. Cost data were collected before treatment, after treatment, at 3-month follow-up, and at 6-month follow-up (primary end point) and are presented in 2020 US dollars. The differences in incremental costs and health outcomes were compared between the groups and presented from the health care professional, health care sector, and societal perspectives.

    RESULTS: A total of 152 participants (94 girls [62%]; mean [SD] age, 13.4 [2.5] years) were randomized; 151 (99%) completed the trial. At the 6-month follow-up, 50 of 74 participants (68%) in the stepped-care group and 52 of 77 participants (68%) in the in-person cognitive behavioral therapy groupwere classified as treatment responders (odds ratio, 1.00 [95% CI, 0.51-1.98]; P=.99). Health economic analyses showed that the stepped-care group used fewer therapist resources than the in-person cognitive behavioral therapy group, resulting in a mean cost savings of $2104 (95% CI, $1202-$3006) per participant for the full study period of 10 months, corresponding to a relative savings of 39%. The cost savings remained largely comparable when taking wider health care sector and societal perspectives.

    CONCLUSIONS AND RELEVANCE: This study suggests that, for young people with obsessive-compulsive disorder, a low-cost digital intervention followed by in-person treatment for nonresponders was cost-effective compared with in-person cognitive behavior therapy alone.

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  • 278.
    Asselbergs, Joost
    et al.
    Vrije Univ Amsterdam, Fac Behav & Movement Sci, Sect Clin Psychol, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Vrije Univ, Med Ctr, Amsterdam Publ Hlth Res Inst, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands..
    van Bentum, Jael
    Vrije Univ Amsterdam, Fac Behav & Movement Sci, Sect Clin Psychol, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Vrije Univ, Med Ctr, Amsterdam Publ Hlth Res Inst, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Univ Utrecht, Fac Social & Behav Sci, Dept Clin Psychol, Heidelberglaan 1, NL-3584 CS Utrecht, Netherlands.;Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Heidelberglaan 1, NL-3584 CS Utrecht, Netherlands..
    Riper, Heleen
    Vrije Univ Amsterdam, Fac Behav & Movement Sci, Sect Clin Psychol, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Vrije Univ, Med Ctr, Amsterdam Publ Hlth Res Inst, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Vrije Univ Amsterdam Med Ctr, Amsterdam Med Ctr, Dept Psychiat, Amsterdam, Netherlands.;Univ Southern Denmark, Fac Hlth Sci, Dept Clin Res, Res Unit Telepsychiat & E Mental Hlth, JB Winslows Vej 19, DK-5000 Odense, Denmark..
    Cuijpers, Pim
    Vrije Univ Amsterdam, Fac Behav & Movement Sci, Sect Clin Psychol, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Vrije Univ, Med Ctr, Amsterdam Publ Hlth Res Inst, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Babes Bolyai Univ, Int Inst Psychotherapy, Cluj Napoca, Romania.;WHO, Collaborating Ctr Res & Disseminat Psychol Interve, Amsterdam, Netherlands..
    Holmes, Emily A.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Sijbrandij, Marit
    Vrije Univ Amsterdam, Fac Behav & Movement Sci, Sect Clin Psychol, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;Vrije Univ, Med Ctr, Amsterdam Publ Hlth Res Inst, Boechorststr 7, NL-1081 BT Amsterdam, Netherlands.;WHO, Collaborating Ctr Res & Disseminat Psychol Interve, Amsterdam, Netherlands..
    A systematic review and meta-analysis of the effect of cognitive interventions to prevent intrusive memories using the trauma film paradigm2023In: Journal of Psychiatric Research, ISSN 0022-3956, E-ISSN 1879-1379, Vol. 159, p. 116-129Article, review/survey (Refereed)
    Abstract [en]

    There is an unmet need for effective early interventions that can relieve initial trauma symptoms and reduce symptoms of posttraumatic stress disorder (PTSD). We evaluated the efficacy of cognitive interventions compared to control in reducing intrusion frequency and PTSD symptoms in healthy individuals using the trauma film paradigm, in which participants view a film with aversive content as an experimental analogue of trauma exposure. A systematic literature search identified 41 experiments of different cognitive interventions targeting intrusions. In the meta-analysis, the pooled effect size of 52 comparisons comparing cognitive interventions to no-intervention controls on intrusions was moderate (g =-0.46, 95% CI [-0.61 to-0.32], p < .001). The pooled effect size of 16 comparisons on PTSD symptoms was also moderate (g =-0.31, 95% CI [-0.46 to-0.17], p < .001). Both visuospatial interference and imagery rescripting tasks were associated with significantly fewer in-trusions than controls, whereas verbal interference and meta-cognitive processing tasks showed nonsignificant effect sizes. Interventions administered after viewing the trauma film showed significantly fewer intrusions than controls, whereas interventions administered during film viewing did not. No experiments had low risk of bias (ROB), 37 experiments had some concerns of ROB, while the remaining four experiments had high ROB. To the best of our knowledge, this is the first meta-analysis investigating the efficacy of cognitive interventions targeting intrusions in non-clinical samples. Results seem to be in favour of visuospatial interference tasks rather than verbal tasks. More research is needed to develop an evidence base on the efficacy of various cognitive in-terventions and test their clinical translation to reduce intrusive memories of real trauma.

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  • 279.
    Astenvald, Rebecka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Child and Adolescent Psychiatry.
    Frick, Matilda
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Neufeld, Janina
    Uppsala University, Swedish Collegium for Advanced Study (SCAS). Center of Neurodevelopmental Disorders (KIND), Centre for Psychiatry Research, Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden;Stockholm Health Care Services, Stockholm, Sweden.
    Bölte, Sven
    Isaksson, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Child and Adolescent Psychiatry. Karolinska Inst, Ctr Neurodev Disorders KIND, Ctr Psychiat Res, Dept Womens & Childrens Hlth, Stockholm, Sweden.;Stockholm Hlth Care Serv, Stockholm, Sweden..
    Emotion dysregulation in ADHD and other neurodevelopmental conditions: a co-twin control study2022In: Child and Adolescent Psychiatry and Mental Health, E-ISSN 1753-2000, Vol. 16, article id 92Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Emotion dysregulation (ED) is common in attention-deficit/hyperactivity disorder (ADHD) and often results in adverse outcomes. However, ED has been suggested as a transdiagnostic construct, why the specific association between ADHD and ED when adjusting for other mental health conditions needs further investigation. It is also important to determine the aetiological basis of the association between ADHD and ED to inform the theoretical conceptualization of ADHD.

    METHOD: This study used a co-twin control design, including a sample of dizygotic (DZ) and monozygotic (MZ) twins (N = 389; 45.8% females, age = 8-31 years, MZ twin pairs 57.6%). ED was assessed using the dysregulation profile from the parent-rated Child Behaviour Checklist and its adult version. Regression analyses were used across individuals and within the pairs, while adjusting for diagnoses of autism, intellectual disability, other neurodevelopmental conditions and affective conditions.

    RESULTS: ADHD was significantly associated with ED, even when adjusting for age, sex, attention problems and other mental health conditions, and was the diagnosis most strongly associated with ED. Within-pair analyses revealed that twins with ADHD had higher levels of ED compared to their co-twin without ADHD. This association remained within DZ twins and was non-significant in the MZ subsample, with non-overlapping confidence intervals between the DZ and MZ estimates.

    CONCLUSION: ADHD is strongly and in part independently linked to ED, stressing the importance of early detection and treatment of emotional difficulties within this group. The findings from the within-pair analyses indicate a genetic influence on the association between ADHD and ED.

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  • 280. Athanasiu, Lavinia
    et al.
    Giddaluru, Sudheer
    Fernandes, Carla
    Christoforou, Andrea
    Reinvang, Ivar
    Lundervold, Astri J.
    Nilsson, Lars-Göran
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Aging Research Center, Karolinska Institutet, Stockholm, Sweden.
    Kauppi, Karolina
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB).
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Eriksson, Elias
    Sundet, Kjetil
    Djurovic, Srdjan
    Espeseth, Thomas
    Nyberg, Lars
    Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI). Umeå University, Faculty of Medicine, Department of Integrative Medical Biology (IMB). Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Steen, Vidar M.
    Andreassen, Ole A.
    Le Hellard, Stephanie
    A genetic association study of CSMD1 and CSMD2 with cognitive function2017In: Brain, behavior, and immunity, ISSN 0889-1591, E-ISSN 1090-2139, Vol. 61, p. 209-216Article in journal (Refereed)
    Abstract [en]

    The complement cascade plays a role in synaptic pruning and synaptic plasticity, which seem to be involved in cognitive functions and psychiatric disorders. Genetic variants in the closely related CSMD1 and CSMD2 genes, which are implicated in complement regulation, are associated with schizophrenia. Since patients with schizophrenia often show cognitive impairments, we tested whether variants in CSMD1 and CSMD2 are also associated with cognitive functions per se. We took a discovery-replication approach, using well-characterized Scandinavian cohorts. A total of 1637 SNPs in CSMD1 and 206 SNPs in CSMD2 were tested for association with cognitive functions in the NCNG sample (Norwegian Cognitive NeuroGenetics; n = 670). Replication testing of SNPs with p-value < 0.001 (7 in CSMD1 and 3 in CSMD2) was carried out in the TOP sample (Thematically Organized Psychosis; n =1025) and the BETULA sample (Betula Longitudinal Study on aging, memory and dementia; n = 1742). Finally, we conducted a meta-analysis of these SNPs using all three samples. The previously identified schizophrenia marker in CSMD1 (SNP rs10503253) was also included. The strongest association was observed between the CSMDI SNP rs2740931 and performance in immediate episodic memory (p-value = 5 Chi 10(-6), minor allele A, MAF 0.48-0.49, negative direction of effect). This association reached the study-wide significance level (p <= 1.2 Chi 10(-5)). SNP rs10503253 was not significantly associated with cognitive functions in our samples. In conclusion, we studied n = 3437 individuals and found evidence that a variant in CSMD1 is associated with cognitive function. Additional studies of larger samples with cognitive phenotypes will be needed to further clarify the role of CSMD1 in cognitive phenotypes in health and disease.

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  • 281. Atzendorf, Josefine
    et al.
    Rauschert, Christian
    Seitz, Nicki-Nils
    Lochbühler, Kirsten
    Kraus, Ludwig
    Stockholm University, Faculty of Social Sciences, Department of Public Health Sciences, Centre for Social Research on Alcohol and Drugs (SoRAD). Eötvös Loránd University, Hungary.
    The Use of Alcohol, Tobacco, Illegal Drugs and Medicines: An Estimate of Consumption and Substance-Related Disorders in Germany2019In: Deutsches Ärzteblatt International, E-ISSN 1866-0452, Vol. 116, no 35-36, p. 577-584Article in journal (Refereed)
    Abstract [en]

    Background: Prevalence estimates of the use of tobacco, alcohol, illegal drugs, and psychoactive medications and of substance-related disorders enable an assessment of the effects of substance use on health and society.Methods: The data used for this study were derived from the 2018 Epidemiological Survey of Substance Abuse (Epidemiologischer Suchtsurvey, ESA). The sample of the German adult population comprised 9267 persons aged 18 to 64 (response rate, 42%). Population estimates were obtained by extrapolation to a total resident population of 51 544 494 people.Results: In the 30 days prior to the survey, 71.6% of the respondents (corresponding to 36.9 million persons in the population) had consumed alcohol, and 28.0% (14.4 million) had consumed tobacco. 4.0% reported having used e-cigarettes, and 0.8% reported having used heat-not-burn products. Among illegal drugs, cannabis was the most commonly used, with a 12-month prevalence of 7.1% (3.7 million), followed by amphetamines (1.2%: 619 000). The prevalence of the use of analgesics without a prescription (31.4%) was markedly higher than that of the use of prescribed analgesics (17.5%, 26.0 million); however, analgesics were taken daily less commonly than other types of medication. 13.5% of the sample (7.0 million) had at least one dependence diagnosis (12-month prevalence).Conclusion: Substance use and the consumption of psychoactive medications are widespread in the German population. Substance-related disorders are a major burden to society, with legal substances causing greater burden than illegal substances.

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  • 282.
    Augustine, Lilly
    et al.
    Jonkoping Univ, Sweden.
    Bjereld, Ylva
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Turner, Russell
    Univ Gothenburg, Sweden.
    The Role of Disability in the Relationship Between Mental Health and Bullying: A Focused, Systematic Review of Longitudinal Studies2022In: Child Psychiatry and Human Development, ISSN 0009-398X, E-ISSN 1573-3327Article, review/survey (Refereed)
    Abstract [en]

    Having both a disability and being bullied increases the risk of later mental health issues. Children with disabilities are at greater risk of being bullied and therefore at greater risk of adverse mental health outcomes. We conducted a limited systematic review of longitudinal studies focusing on the role of disability in relation to bullying and mental health problems. Twelve studies with an initial measure of mental health or disorder, measured no later than 10 years of age, were found. Ten of these twelve studies suggested that having a disability before victimisation increased the impact of mental health problems measured after bullying experiences. The conclusion is that children with a disability, such as behavioural problems, have an increased risk of later mental health problems through bullying victimization. Children with two risk factors had significantly worse mental health outcomes. These additional mental health problems may be alleviated through reduced bullying victimisation.

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  • 283. Austin, Christine
    et al.
    Curtin, Paul
    Arora, Manish
    Reichenberg, Abraham
    Curtin, Austen
    Iwai-Shimada, Miyuki
    Wright, Robert O
    Wright, Rosalind J
    Remnelius, Karl Lundin
    Isaksson, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Child and Adolescent Psychiatry.
    Bölte, Sven
    Nakayama, Shoji F
    Elemental Dynamics in Hair Accurately Predict Future Autism Spectrum Disorder Diagnosis: An International Multi-Center Study2022In: Journal of Clinical Medicine, E-ISSN 2077-0383, Vol. 11, no 23, article id 7154Article in journal (Refereed)
    Abstract [en]

    Autism spectrum disorder (ASD) is a neurodevelopmental condition diagnosed in approximately 2% of children. Reliance on the emergence of clinically observable behavioral patterns only delays the mean age of diagnosis to approximately 4 years. However, neural pathways critical to language and social functions develop during infancy, and current diagnostic protocols miss the age when therapy would be most effective. We developed non-invasive ASD biomarkers using mass spectrometry analyses of elemental metabolism in single hair strands, coupled with machine learning. We undertook a national prospective study in Japan, where hair samples were collected at 1 month and clinical diagnosis was undertaken at 4 years. Next, we analyzed a national sample of Swedish twins and, in our third study, participants from a specialist ASD center in the US. In a blinded analysis, a predictive algorithm detected ASD risk as early as 1 month with 96.4% sensitivity, 75.4% specificity, and 81.4% accuracy (n = 486; 175 cases). These findings emphasize that the dynamics in elemental metabolism are systemically dysregulated in autism, and these signatures can be detected and leveraged in hair samples to predict the emergence of ASD as early as 1 month of age.

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  • 284.
    Austin, Christine
    et al.
    Icahn Sch Med Mt Sinai, Dept Environm Med & Publ Hlth, One Gustave L Levy Pl, New York, NY USA.
    Curtin, Paul
    Icahn Sch Med Mt Sinai, Dept Environm Med & Publ Hlth, One Gustave L Levy Pl, New York, NY USA.
    Curtin, Austen
    Icahn Sch Med Mt Sinai, Dept Environm Med & Publ Hlth, One Gustave L Levy Pl, New York, NY USA.
    Gennings, Chris
    Icahn Sch Med Mt Sinai, Dept Environm Med & Publ Hlth, One Gustave L Levy Pl, New York, NY USA.
    Arora, Manish
    Icahn Sch Med Mt Sinai, Dept Environm Med & Publ Hlth, One Gustave L Levy Pl, New York, NY USA.
    Tammimies, Kristiina
    Karolinska Inst, Karolinska Inst Ctr Neurodev Disorders KIND, Ctr Psychiat Res, Dept Womens & Childrens Hlth, Stockholm, Sweden; Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.
    Isaksson, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Inst, Karolinska Inst Ctr Neurodev Disorders KIND, Ctr Psychiat Res, Dept Womens & Childrens Hlth, Stockholm, Sweden; Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden.
    Willfors, Charlotte
    Karolinska Inst, Karolinska Inst Ctr Neurodev Disorders KIND, Ctr Psychiat Res, Dept Womens & Childrens Hlth, Stockholm, Sweden; Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden; Karolinska Inst, Dept Mol Med & Surg, Ctr Mol Med, Stockholm, Sweden.
    Bölte, Sven
    Karolinska Inst, Karolinska Inst Ctr Neurodev Disorders KIND, Ctr Psychiat Res, Dept Womens & Childrens Hlth, Stockholm, Sweden; Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden; Curtin Univ, Sch Occupat Therapy Social Work & Speech Pathol, Curtin Autism Res Grp, Essential Partner Autism CRC, Perth, WA, Australia.
    Dynamical properties of elemental metabolism distinguish attention deficit hyperactivity disorder from autism spectrum disorder2019In: Translational Psychiatry, E-ISSN 2158-3188, Vol. 9, no 1, article id 238Article in journal (Refereed)
    Abstract [en]

    Attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are neurodevelopmental conditions of overlapping etiologies and phenotypes. For ASD, we recently reported altered elemental metabolic patterns in the form of short and irregular zinc and copper cycles. Here, we extend the application of these biomarkers of prenatal and early postnatal elemental metabolism to distinguish between individuals diagnosed with ADHD and/or ASD and neurotypical controls. We recruited twins discordant for ADHD, ASD and other neurodevelopmental diagnoses from national twin studies in Sweden (N = 74) diagnosed according to DSM-5 clinical consensus and standardized psychiatric instruments. Detailed temporal profiles of exposure to 10 metals over the prenatal and early childhood periods were measured using tooth biomarkers. We used recurrence quantification analysis (RQA) to characterize properties of cyclical metabolic patterns of these metals. Regularity (determinism) and complexity (entropy) of elemental cycles was consistently reduced in ADHD for cobalt, lead, and vanadium (determinism: cobalt, β = -0.03, P = 0.017; lead, β = -0.03, P = 0.016; and vanadium, β = -0.03, P = 0.01. Entropy: cobalt, β = -0.13, P = 0.017; lead, β = -0.18, P = 0.016; and vanadium, β = -0.15, P = 0.008). Further, we found elemental pathways and dynamical features specific to ADHD vs ASD, and unique characteristics associated with ADHD/ASD combined presentation. Dysregulation of cyclical processes in elemental metabolism during prenatal and early postnatal development not only encompasses pathways shared by ADHD and ASD, but also comprise features specific to either condition.

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  • 285.
    Awortwe, Victoria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Healthcare Sciences and e-Health.
    Daivadanam, Meena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, International Child Health and Nutrition.
    Adjorlolo, Samuel
    Olsson, Erik M. G.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Coumoundouros, Chelsea
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Healthcare Sciences and e-Health.
    Woodford, Joanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Healthcare Sciences and e-Health.
    Prevalence and social determinants of anxiety and depression among adults in Ghana: a systematic review and meta-analysis protocol2024In: BMJ Open, E-ISSN 2044-6055, Vol. 14, no 4, p. e081927-e081927Article, review/survey (Refereed)
    Abstract [en]

    Introduction Anxiety and depression pose a significant global health challenge, especially affecting adults in low-income and middle-income countries. In many low-income and middle-income countries, including those in sub-Saharan Africa, social determinants such as access to affordable health services, conflict, food insecurity, and poverty may be associated with the prevalence of anxiety and depression, further contributing to health disparities. To mitigate the burden of anxiety and depression in sub-Saharan Africa, it is essential to develop country-level tailored mental health policies and strategies. For example, Ghana is working towards improving mental health via its 12 year Mental Health policy launched in 2021. However, the prevalence of anxiety and depression among adults in Ghana, along with associated social determinants remains largely unknown, posing challenges for mental health planning, resource allocation and developing targeted interventions. This systematic review seeks to (1) examine the prevalence of anxiety and depression among adults in Ghana and (2) explore social determinants potentially associated with anxiety and depression.

    Methods and analysis Electronic databases (eg, African Index Medicus, CINAHL, EMBASE, MEDLINE, and PsycINFO) will be searched with all screening steps conducted by two independent reviewers. Secondary search strategies, including grey literature searches, will be used. Studies reporting on the prevalence of anxiety, depression and/or a combined symptom measure (ie, psychological distress) among adults in Ghana, using validated instruments will be included. If data allows, random-effects-meta-analyses will be performed to estimate pooled prevalence rates of anxiety and depression. Potential clinical and methodological moderators will be examined using subgroup analyses and meta-regression. A narrative synthesis will explore social determinants potentially associated with anxiety and depression among adults in Ghana.

    Ethics and dissemination Ethical approval is not required as no primary data will be collected. Results will be disseminated via a peer-reviewed publication and presentations at academic conferences. Plain language summaries will be provided to relevant non-governmental organisations working in Ghana.

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  • 286.
    Axelsson, Erika
    University College of Arts, Crafts and Design, Institutionen för Bildpedagogik (BI).
    Hur kan vi som blivande lärare arbeta med och förebygga sjukdomarna anorexi och bulimi?2004Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
  • 287.
    Axelsson, Inge
    Mid Sweden University, Faculty of Human Sciences, Department of Nursing Sciences.
    Paracetamol till barn och gravida – försiktighetsprincipen bör råda: Var återhållsam med paracetamol medan riskerna för adhd och astma utreds2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 34-35, p. 1350-Article in journal (Refereed)
  • 288.
    Axelsson, Lena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Åberg, AC
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences. Geriatrik.
    Kroppskännedomsgrupp i psykiatrisk öppenvård: en kvalitativ studie av patienters upplevelser2004Report (Other academic)
    Abstract [en]

    The aim of this study was to explore the experiences that patients in open psychiatric care had of participating in a body awareness group treatment and in which way the body awareness group contributed to the experience and to explore the patients apprehensions about what meaning the body awareness group had for the treatment result. A qualitative ethnographic perspective was used. Data was collected by semi structured qualitative interviews with an interview guide containing themes. Seven patients were interviewed, four in one focus group and three with in-depth interviews. The informants talked about a wide spectrum of experiences. The result indicates that the patients had many benefits from working in a group with body awareness. Five different themes mirrored the informant’s experiences. The themes related to the own self, the own body, the group leader, others and different aspects of the room. Each theme was divided into sub-themes and each theme also had a sub-theme called “a different way of relating”. The result indicates that the physical therapist could, by working on a body-level, affect the patient’s way of relating to all the other themes, which is described in a new model that was created.

  • 289.
    Axelsson Svedell, Lena
    et al.
    Örebro University, School of Health Sciences. Department of Psychiatry, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Lidström-Holmqvist, Kajsa
    Örebro University, School of Health Sciences. Örebro University Hospital. Department of Neurology and Rehabilitation Medicine, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Arvidsson Lindvall, Mialinn
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital. Clinical Epidemiology and Biostatistics, School of Medical Sciences, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Unit of Integrative Epidemiology, Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden.
    Msghina, Mussie
    Örebro University, School of Medical Sciences. Department of Psychiatry, Faculty of Medicine and Health, Örebro University, Örebro, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Feasibility and tolerability of moderate intensity regular physical exercise as treatment for core symptoms of attention deficit hyperactivity disorder: a randomized pilot study2023In: Frontiers in Sports and Active Living, E-ISSN 2624-9367, Vol. 5, article id 1133256Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is associated with sedentary lifestyle, low quality of life and low physical fitness. Studies in children with ADHD have shown that regular physical exercise can help reduce core ADHD symptoms, but evidence for this is lacking in adults. Although guidelines recommend multi-modal treatment, central stimulants (CS) remain the mainstay of treatment. CS are effective in the short-term, but their long-term efficacy remains to be established. There is thus huge unmet need for developing non-pharmacological treatment options, and for well-designed randomized controlled trials (RCTs).

    OBJECTIVE: The study aimed to test the feasibility and tolerability of structured moderate-intensity 12-week physical exercise program for adults with ADHD, as a prelude to an adequately powered RCT which includes long-term follow-up.

    MATERIALS AND METHODS: Fourteen adults with ADHD were recruited, 9 randomized to an intervention group and 5 to a control group. The intervention group received physiotherapist-led 50-minute mixed exercise program, three times a week for 12 weeks, and the control group treatment as usual. Participants were assessed at baseline and after 6 and 12 weeks using clinical and physical evaluations, self-rating questionnaires, and functional magnetic resonance imaging (fMRI) together with paradigms that tested attention, impulsivity and emotion regulation.

    RESULTS: Three participants (21%) dropped out shortly after inclusion before receiving any intervention, while roughly 80% completed the intervention according to protocol. One participant from the intervention group participated in less than 60% of treatment sessions, and one who had done baseline fMRI was unwilling to do post-intervention imaging. Four participants in the intervention group (67%) reported increased stress in prioritizing the intervention due to time-management difficulties. Overall, consistent trends were observed that indicated the feasibility and potential benefits of the intervention on core ADHD symptoms, quality of life, body awareness, sleep and cognitive functioning.

    CONCLUSION: Physiotherapist-led twelve-week regular physical exercise is a feasible and potentially beneficial intervention for adults with ADHD. There was a 20% drop-out initially and 67% of those who completed the intervention reported stress with time management difficulties due to participation. A third arm was thus added to the planned RCT where cognitive intervention administered by an occupational therapist will be given together with physical exercise. Clinical Trial Registration: https://clinicaltrials.gov, identifier NCT05049239.

  • 290.
    Axfors, Cathrine
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Anxious personality traits in pregnant women: Associations with postpartum depression, delivery complications and health care use2018Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Anxious personality traits, including those encompassed by negative emotionality (neuroticism) and the tendency to worry about close relationships (attachment anxiety) during pregnancy were the focus of this thesis. The overall aim was to examine perinatal correlates of these characteris-tics in terms of psychiatric and obstetric health as well as antenatal care (ANC).

    Papers I-II were part of a large population-based project on pregnant women in Uppsala in 2009-2012 (n=2160). Papers III-IV adjoined participants from several projects in 2005-2011, on oral contraceptive use, infertility, induced abortion, premenstrual mood disorder, and perina-tal depression (n=2819). The participants reported on the Swedish universities Scales of Per-sonality for neuroticism (papers II-IV) and the Attachment Style Questionnaire (ASQ) for attachment anxiety (papers I-II). The participants also answered the Edinburgh Postnatal De-pression Scale on depressive symptoms (paper II). In paper III, information on obstetric com-plications for primiparous women with singleton pregnancies (n=1969) was extracted from Swedish national health registers. In paper IV, ANC use was derived from medical records of obstetric low-risk women residing in Uppsala (n=1052).

    The ASQ had similar psychometric properties in pregnant women (n=1631) as in previous reports (paper I). In non-depressed pregnant women (n=1431), the combination of neuroticism and attachment anxiety was the best risk indicator of postpartum depressive symptoms (paper II). Whereas high neuroticism was not related to obstetric complications (paper III), it was associated with higher use of ANC (paper IV).

    Summarized, this thesis illustrates how anxious personality traits may predispose for post-partum depression and higher use of ANC in the absence of obstetric complications. Future development of these findings should be to evaluate individual and societal benefits of a greater emphasis on psychological support in ANC.

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  • 291.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Eckerdal, Patricia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Volgsten, Helena
    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.
    Wikström, Anna-Karin
    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), Clinical Obstetrics.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Sundström Poromaa, Inger
    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), Reproductive Health.
    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.
    Neuroticism is not independently associated with adverse obstetric or neonatal outcomes: An observational studyIn: Article in journal (Refereed)
  • 292.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Iliadis, Stavros I
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Rasmusson, Lovisa L.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Beckman, Ulrika
    Department of Psychiatry, Södra Älvsborgs Hospital, 441 30, Alingsås, Sweden.
    Fazekas, Attila
    Department of Psychiatry, Lund University, 285 21, Lund, Sweden.
    Frisén, Louise
    Department of Clinical Neuroscience, Karolinska Institutet, 171 77, Stockholm, Sweden.
    Sandström, Lotta
    Department of Clinical Sciences, Umeå University, 901 87, Umeå, Sweden.
    Thelin, Nils
    Division of Psychiatry, Linköping University Hospital, 581 85, Linköping, Sweden.
    Wahlberg, Jeanette
    Department of Endocrinology and Department of Health, Medicine and Caring Sciences, Linköping University, 581 83, Linköping, Sweden.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Papadopoulos, Fotios C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Preferences for Gender Affirming Treatment and Associated Factors Among Transgender People in Sweden2023In: Sexuality Research & Social Policy, ISSN 1868-9884, E-ISSN 1553-6610, Vol. 20, no 2, p. 479-490Article in journal (Refereed)
    Abstract [en]

    Introduction

    Gender affirming surgery of primary and/or secondary sex characteristics has been shown to alleviate gender dysphoria. A descriptive snapshot of current treatment preferences is useful to understand the needs of the transgender population seeking health care. This study aimed to describe preferences for gender affirming treatment, and their correlates, among individuals seeking health care for gender dysphoria in Sweden after major national legislative reforms.

    Methods

    Cross-sectional study where transgender patients (n = 232) recruited from all six Gender Dysphoria centers in Sweden 2016–2019, answered a survey on treatment preferences and sociodemographic, health, and gender identity-related information during the same time-period. Factors associated with preferring top surgery (breast augmentation or mastectomy), genital surgery, and other surgery (e.g., facial surgery) were examined in univariable and multivariable regression analyses in the 197 people without prior such treatment. Main study outcomes were preferences for feminizing or masculinizing hormonal and surgical gender affirming treatment.

    Results

    The proportion among birth assigned male and assigned female patients preferring top surgery was 55.6% and 88.7%, genital surgery 88.9% and 65.7%, and other surgery (e.g., facial surgery) 85.6% and 22.5%, respectively. Almost all participants (99.1%) wanted or had already received hormonal treatment and most (96.7%) wished for some kind of surgical treatment; 55.0% wanted both top and genital surgery. Preferring a binary pronoun (he/she) and factors indicating more severe gender incongruence were associated with a greater wish for surgical treatment. Participants with somatic comorbidities were less likely to want genital surgery, while aF with lacking social support were less likely to want internal genital surgery, in the multivariable analyses.

    Conclusions

    In this sample of Swedish young adults seeking health care for gender dysphoria, preferences for treatment options varied according to perceived gender identity.

    Policy Implications

    The study fndings underline the need for individualized care and fexible gender afrming treatmentoptions. The role of somatic comorbidities should be further explored, and support should be ofered to transgender peoplein need. There is an unmet need for facial surgery among aM

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  • 293.
    Axfors, Cathrine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Sylvén, Sara
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    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), Obstetric research.
    Adult attachment's unique contribution in the prediction of postpartum depressive symptoms, beyond personality traits2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 222, p. 177-184Article in journal (Refereed)
    Abstract [en]

    Background:

    Personality traits such as neuroticism can help identify pregnant women at risk of postpartum depressive symptoms (PPDS). However, it is unclear whether attachment style could have an additional contribution to this risk elevation. This study aimed to examine the overlap of adult attachment insecurity and neuroticism/trait anxiety as PPDS predictors, taking into account baseline depressive symptoms.

    Methods:

    A Swedish population-based sample of pregnant women reported on adult attachment and either neuroticism (n = 1063) or trait anxiety (n = 555). Depressive symptoms were assessed at baseline, and at six weeks and six months postpartum. Correlations between attachment and neuroticism/trait anxiety were calculated. Generalized linear models of PPDS tested the effect of attachment anxiety and avoidance, adjusting for neuroticism/trait anxiety and baseline depression. Logistic regression models with combined high attachment anxiety and-neuroticism/trait anxiety visualized their value as risk factors beyond antenatal depression.

    Results:

    Attachment and neuroticism/trait anxiety were highly correlated (r = .55.77). Attachment anxiety exerted a partially independent effect on PPDS at six weeks (p < .05) and at six months (p < .05) adjusting for neuroticism. Among antenatally non-depressed, combined high attachment anxiety and high neuroticism or trait anxiety was predictive of PPDS at both assessment points. Limitations: Low acceptance rate, exclusive use of self-reports.

    Conclusions:

    Beyond personality, attachment anxiety had a small independent effect on the risk of PPDS. Combining items of adult attachment and neuroticism/trait anxiety could prove useful in antenatal screening for high risk of PPDS.

  • 294.
    Ayano, Getinet
    et al.
    Curtin Univ, Sch Populat Hlth, Perth, WA, Australia..
    Tsegay, Light
    Aksum Univ, Aksum, Ethiopia..
    Gizachew, Yitbarek
    Bethel Med Coll, Addis Ababa, Ethiopia..
    Necho, Mogesie
    Wollo Univ, Coll Med & Hlth Sci, Dept Psychiat, Dessie, Ethiopia..
    Yohannes, Kalkidan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, SWEDESD - Sustainability Learning and Research Centre.
    Abraha, Mebratu
    St Paulos Millennium Med Coll, Nursing Educ Dept, Res Directorate Off, Addis Ababa, Ethiopia..
    Demelash, Sileshi
    Ethiopian Publ Hlth Inst, Addis Ababa, Ethiopia.;Maastricht Univ, CAPHRI Sch Publ Hlth & Primary Care, Dept Family Med, Maastricht, Netherlands..
    Anbesaw, Tamrat
    Wollo Univ, Coll Med & Hlth Sci, Dept Psychiat, Dessie, Ethiopia..
    Alati, Rosa
    Curtin Univ, Sch Populat Hlth, Perth, WA, Australia.;Univ Queensland, Inst Social Sci Res, Brisbane, Qld, Australia..
    Prevalence of attention deficit hyperactivity disorder in adults: Umbrella review of evidence generated across the globe2023In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 328, article id 115449Article, review/survey (Refereed)
    Abstract [en]

    Background

    Attention deficit hyperactivity disorder (ADHD) is a class of neurodevelopmental disorders which is commonly diagnosed in school-age children, but it can occur in any age group. To provide a robust synthesis of published evidence on the prevalence of ADHD in adults, we conducted an umbrella review of systematic reviews and meta-analyses.

    Methods

    The review was guided by preferred reporting items for systematic review and meta-analysis (PRISMA). We searched PsychINFO, Web of Science, PubMed, and Scopus to retrieve pertinent studies. The review protocol was registered with PROSPERO (CRD42023389704). A Measurement Tool to Assess Systematic Reviews (AMSTAR) was used to assess the quality of the included studies. A random-effects model was used to perform a meta-analysis.

    Results

    Five systematic reviews and meta-analyses (57 unique primary studies) with data on 21,142,129 adult participants were eligible for inclusion in this umbrella review. Inverse variance weighted random effect meta-analysis of these studies indicated that the pooled prevalence of ADHD in adults was 3.10% (95%CI 2.60–3.60%). ADHD-I (the inattentive type of ADHD) remained the commonest type of ADHD, followed by ADHD-HI (the hyperactive type) and ADHD-C (the combined type).

    Conclusion

    The results indicate that ADHD is relatively high in adults, with ADHD-I remaining the most common subtype. Attention should be given to preventing, reducing, identifying, and managing ADHD in adults.

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  • 295.
    Ayob, Leith
    et al.
    Sunderby sjukhus, Luleå, Sverige.
    Brännström, Ingrid
    Sunderby sjukhus, Luleå, Sverige.
    Ott, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Section of Medicine.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    ABC om Wernickes encefalopati2022In: Psykoser och andra psykosliknande tillstånd, Stockholm: Läkartidningen Förlag AB , 2022, p. 86-93Chapter in book (Other academic)
  • 296.
    Babchishin, K. M.
    et al.
    Univ Ottawa, Royals Inst Mental Hlth Res, Ottawa, ON, Canada.;Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Seto, M. C.
    Univ Ottawa, Royals Inst Mental Hlth Res, Ottawa, ON, Canada..
    Sariaslan, A.
    Univ Oxford, Dept Psychiat, Oxford, England..
    Lichtenstein, P.
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Fazel, S.
    Univ Oxford, Dept Psychiat, Oxford, England..
    Långström, Niklas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden..
    Parental and perinatal risk factors for sexual offending in men: a nationwide case-control study2017In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 47, no 2, p. 305-315Article in journal (Refereed)
    Abstract [en]

    Background. Prior studies suggest parental and perinatal risk factors are associated with later offending. It remains uncertain, however, if such risk factors are similarly related to sexual offending. Method. We linked socio-demographic, family relations, and perinatal (obtained at birth) data from the nationwide Swedish registers from 1973 to 2009 with information on criminal convictions of cases and control subjects. Male sex offenders (n = 13 773) were matched 1: 5 on birth year and county of birth in Sweden to male controls without sexual or non-sexual violent convictions. To examine risk-factor specificity for sexual offending, we also compared male violent, non-sexual offenders (n = 135 953) to controls without sexual or non-sexual violent convictions. Predictors included parental (young maternal or paternal age at son's birth, educational attainment, violent crime, psychiatric disorder, substance misuse, suicide attempt) and perinatal (number of older brothers, low Apgar score, low birth weight, being small for gestational age, congenital malformations, small head size) variables. Results. Conditional logistic regression models found consistent patterns of statistically significant, small to moderate independent associations of parental risk factors with sons' sexual offending and non-sexual violent offending. For perinatal risk factors, patterns varied more; small for gestational age and small head size exhibited similar risk effects for both offence types whereas a higher number of older biological brothers and any congenital malformation were small, independent risk factors only for non-sexual violence. Conclusions. This nationwide study suggests substantial commonalities in parental and perinatal risk factors for the onset of sexual and non-sexual violent offending.

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  • 297.
    Babchishin, Kelly M.
    et al.
    Royals Inst Mental Hlth Res, Forens Res Unit, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada.
    Seto, Michael C.
    Royals Inst Mental Hlth Res, Forens Res Unit, 1145 Carling Ave, Ottawa, ON K1Z 7K4, Canada.
    Fazel, Seena
    Univ Oxford, Dept Psychiat, Oxford, England.
    Långström, Niklas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.
    Are There Early Risk Markers for Pedophilia?: A Nationwide Case-Control Study of Child Sexual Exploitation Material Offenders2019In: Journal of Sex Research, ISSN 0022-4499, E-ISSN 1559-8519, Vol. 56, no 2, p. 203-212Article in journal (Refereed)
    Abstract [en]

    Although prior research suggests associations between parental characteristics and later sexual offending in offspring, possible links between early pregnancy-related factors and sexual offending remain unclear. Early risk markers unique to sexual offending, however, may be more prominent among sexual offenders with atypical sexual interests, such as individuals involved with child sexual exploitation material (CSEM; also referred to as child pornography). We examined the prospective association between parental and pregnancy-related risk markers and a behavioral indicator of pedophilic interest, CSEM offending. All 655 men born in Sweden and convicted of CSEM offending between 1988 to 2009 were matched 1:5 on sex, birth year, and county of birth in Sweden to 3,928 controls without sexual or nonsexual violent convictions. Paternal age (adjusted odds ratio [AOR] = 1.3, 95% confidence interval [CI] [1.1, 1.7]), parental education (AOR = 0.8, 95% CI [0.6, 0.9]), parental violent criminality (AOR = 2.9, 95% CI [2.2, 3.8]), number of older brothers (AOR = 0.8, 95% CI [0.6, 0.9] per brother), and congenital malformations (AOR = 1.7, 95% CI [1.2, 2.4]) all independently predicted CSEM convictions. This large-scale, nationwide study suggests parental risk markers for CSEM offending. We did not, however, find convincing evidence for pregnancy-related risk markers, with the exception of congenital malformations and having fewer older brothers.

  • 298. Back, Christina
    et al.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Interpretativ fenomenologisk analys2015In: Handbok i kvalitativ analys / [ed] Andreas Fejes och Robert Thornberg, Stockholm: Liber, 2015, 2, p. 148-161Chapter in book (Other academic)
  • 299.
    Back, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Parental opinions of their child's experience in the legal process: an interpretative analysis2014In: Journal of Child Sexual Abuse, ISSN 1053-8712, E-ISSN 1547-0679, Vol. 23, no 3, p. 290-303Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to demonstrate how parents of children who are victims of sexual assault experience the legal process from the children’s and parents’ perspective. Nine parents, identified in the records of three public prosecution offices in three cities in Sweden, were interviewed. The parents described feelings of shame and guilt over what their children had experienced. They felt stigmatized and had difficulty fulfilling their parental role, perceived a lack of information and support from the professionals involved, and experienced a sense of withdrawal from their role as parents, though they felt the professionals who worked with their children were helpful and influential.

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  • 300.
    Back, Malin
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences. Futurum Acad Hlth & Care, Sweden.
    Falkenström, Fredrik
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Gustafsson, Sanna Aila
    Orebro Univ, Sweden.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Karolinska Inst, Sweden.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Reduction in depressive symptoms predicts improvement in eating disorder symptoms in interpersonal psychotherapy: results from a naturalistic study2020In: Journal of Eating Disorders, E-ISSN 2050-2974, Vol. 8, no 1, article id 33Article in journal (Refereed)
    Abstract [en]

    Background Interpersonal psychotherapy (IPT) can be effective for both Bulimia Nervosa (BN) and co-occurring depression. While changes in symptoms of Eating disorder (ED) and depression have been found to correlate, it is unclear how they interact during treatment and in which order the symptoms decrease. Methods Thirty-one patients with BN and depressive symptoms received IPT using the manual IPT-BNm in a naturalistic design. The outcome was measured with the Eating Disorder Examination Questionnaire (EDE-Q) and the Montgomery angstrom sberg Depression Rating Scale (MADRS-S). Symptom improvement at each session was measured with Repeated Evaluation of Eating Disorder Symptoms (REDS) and the Patient Health Questionnaire-9 (PHQ-9). Results Significant improvements with large effect sizes were found on both ED symptoms and depression. The rates of change were linear for both BN and depression. A strong correlation between reduction of depressive symptoms and ED symptoms was found. Depressive symptom reduction at one session predicted improvement of ED symptoms at the next session. Conclusions IPT-BNm had an effect on both BN and co-occurring depressive symptoms. The analyses indicated that reduction in depressive symptoms preceded reduction in bulimic symptoms.

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