| 1. |
- Söderquist, Fanny
(författare)
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Melatonin in the gastrointestinal tract
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Melatonin is recognised as the pineal hormone regulating sleep and circadian rhythm. It has also been identified in peripheral tissues (mainly in animals) and thought to display a variety of actions, including anti-inflammatory properties, regulation of gastrointestinal (GI) functions, glucose homeostasis and beneficial effects in different tumour types. Patients with irritable bowel disorder commonly exhibit psychiatric co-morbidity and disturbances of the gut-brain axis have been proposed to play a role in these disorders. The focus of this thesis was to study melatonin and melatonin receptors in the normal human GI tract, the pancreas and small intestinal neuroendocrine tumours. The thesis also explores the complex relationship between GI symptoms and underlying psychiatric traits in the context of elevated levels of peripheral melatonin during waking hours.In paper I-II, tissue samples from the normal human GI tract and pancreas and tumour tissue from small intestinal neuroendocrine tumours were analysed for expression of melatonin and melatonin receptors using immunohistochemistry. For tumour patients, melatonin was also analysed in plasma and set in relation to symptoms and outcome. In paper III-IV, a cohort of young adults (18-25 years) seeking psychiatric care was examined for GI symptoms, melatonin levels in saliva, depressive symptoms and anxiety traits. Psychiatric assessments were performed using structured or semi structured interviews. Depressive symptoms were measured using the self-rating version of the Montgomery-Åsberg Depression Rating Scale; GI symptoms were measured using the Gastrointestinal Symptoms Rating Scale for Irritable Bowel Syndrome; and personality traits were evaluated using the Swedish Universities Scales of Personality.Melatonin and melatonin receptors were widely expressed in the normal human gut and pancreas (paper I) but even in small intestinal neuroendocrine tumours known to produce serotonin (paper II). The intensity of the melatonin immunoreactivity in tumour tissue was found to correlate with lower proliferation index. After treatment, plasma levels of melatonin were reduced in tumour patients. Young adult patients seeking psychiatric care reported more GI symptoms than healthy controls, regardless of the currently active psychotropic medication. The level of GI symptoms was associated with severity of depressive symptoms and trait anxiety (paper III). Higher postprandial levels of melatonin were associated with the GI symptoms of bloating and pain (paper IV).In summary, these findings demonstrate the widespread presence of melatonin in the human gut and confirm a link between melatonin, psychiatric health and GI symptoms.
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| 2. |
- Andin, Ulla
(författare)
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Vascular dementia - classification and clinical correlates
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- During the period (1976-1995) a total of 175 consecutive patients (m 88/f 87) with neuropathologically verified vascular dementia (VaD) were examined. 22 patients with pure Alzheimer's Disease (AD) were also studied. All patients were diagnosed and followed at the Department of Psychogeriatrics (Lund University Hospital). The neuropathological examination revealed VaD, sometimes with additional contribution of Alzheimer pathology. The cases were classified as Large Vessel Dementia (LVD), Small Vessel Dementia (SVD) and Hypoperfusive Hypoxic-ischemic Dementia (HHD). The mean age at death was 80 years (range 54-100) and almost identical in the three groups.The results show that VaD is neuropathologically heterogeneous, characterized by one, two or all three types of vascular pathology. The majority of cases (126/175), showed more than one type of brain pathology (vascular or in combination with Alzheimer pathology). There was a large coexistence with Alzheimer pathology (65% of the total 175 cases). 49 cases were pure, with only one type of vascular pathology. SVD was the largest pure group (21% of the total 175 cases). Post mortem verified heart pathology, was twice as common in SVD as in LVD and HHD.Cardio-cerebrovascular features (arrhythmia, congestive heart failure, cardiac infarction, hypertension, orthostatic hypotension and TIA/stroke) were more common in LVD and SVD, than in HHD. The coexistence of Alzheimer pathology did not change these results.Dizziness and unsteadiness or falls were reported in 102 of the 175 VaD patients. Dizziness correlated with hypertension and orthostatic hypotension while unsteadiness correlated only with hypertension. Falls correlated strongly to the use of neuroleptics and hypnotics.Hallucinations/delusions and delirium were reported in many patients and most common in the groups with pure LVD, pure SVD and especially in the SVD with combined Alzheimer pathology.Cardio-cerebrovascular features were more common in patients with AD combined with white matter pathology than those with pure AD. This study illustrates the neuropathological and clinical heterogeneity in VaD. This is of great importance for the understanding, treatment and care of the individual suffering from VaD.
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| 3. |
- Pellas, Johnny
(författare)
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Assessment and psychological treatment of depression in older adults
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Depression is one of the leading causes of disability in older adults worldwide. Many older adults with depression are undetected, and there is a need for brief, scalable psychological treatments for depression that can be delivered remotely.The aims of this thesis were 1) to investigate the diagnostic accuracy of two rating scales (PHQ-9 and GDS-15) for the detection of depression in older adults, and 2) to investigate the feasibility, preliminary efficacy and patients’ experiences of a telephone-based psychological intervention, Behavioral activation with mental imagery (BA-MI), for the treatment of depression in older adults in the context of the covid-19 pandemic. Study I showed that a cutoff of ≥6 on the GDS-15 and ≥5 on the PHQ-9 were optimal to identify major depressive disorder. When identifying both major depressive disorder and subthreshold depression, the optimal cutoff on the GDS-15 was ≥5. Study II was a randomized clinical pilot trial, CoviDep, with a treatment group receiving the BA-MI intervention, and a control group. The drop-out rate was low. Compared to the control group, the treatment group reported a decrease in depressive symptoms throughout the treatment, with a large effect-size at posttreatment. Study III was a long-term follow-up of participants in CoviDep that received the BA-MI intervention. The drop-out rate over time was low, and compared to baseline, decreases in depressive symptoms were observed with a medium effect-size at posttreatment that was maintained 1- and 3 months post-treatment but lower after 6 months. Study IV was a qualitative study. The BA-MI intervention in CoviDep was described as increasing activities and improving mood. Telephone-delivery reduced barriers due to pandemic restrictions but felt less personal and lacking non-verbal communication. Being recognized and talking to a therapist every week was healing, but the manualized mode of treatment seemed to impair the relationship.In sum, this thesis shows that both the GDS-15 and the PHQ-9 are useful tools for the detection of depression in older adults, and adds to the support for telephone-delivered BA for the treatment of depression and indicates that MI-interventions are feasible as an augmentation of BA in older adults.
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| 4. |
- Michelgård Palmquist, Åsa, 1973-
(författare)
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Positron Emission Tomography (PET) Studies in Anxiety Disorders
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Anxiety disorders are very common and the primary feature is abnormal or inappropriate anxiety. Fear and anxiety is often mediated by the amygdala, a brain structure rich in substance P (SP) and neurokinin 1 (NK1) receptors. To learn more about how the human amygdala is modulated by fear and anxiety in event-triggered anxiety disorders and to investigate if the SP/NK1 receptor system is affected, regional cerebral blood flow (rCBF) ([15O]-water; Study I and II) and the SP/NK1 receptor system ([11C]GR205171; Study III and IV) were studied with positron emission tomography (PET). In Study I we investigated the neural correlates of affective startle modulation in persons with specific phobia by measuring rCBF during exposure to fearful and non-fearful pictures, paired and unpaired with acoustic startle stimuli. Fear-potentiated startle was associated with activation of the affective part of the anterior cingulate cortex and the left amygdaloid–hippocampal area. In Study II short-term drug treatment effects on rCBF in patients diagnosed with social phobia was evaluated, comparing the NK1 receptor antagonist GR205171 to the selective serotonin reuptake inhibitor citalopram and placebo. Social anxiety and neural activity in the medial temporal lobe including the amygdala was significantly reduced by both drugs but not placebo. In Study III we investigated if activity in the SP/NK1 receptor system in the amygdala would be affected by fear provocation in individuals with specific snake or spider phobia. Fear provocation was associated with a decreased uptake of the NK1 antagonist [11C]GR205171 in the amygdala, possibly explained by an increase in endogenous SP release occupying the NK1 receptors. Study IV was conducted to explore the resting state NK1 receptor availability in PTSD patients as compared to healthy controls. Increased resting state binding of the tracer [11C]GR205171 in the amygdala of patients with PTSD suggested an increased amount of available receptors. In summary, fear and fear-potentiated startle modulates the human amygdala, possibly through the SP/NK1 receptor system.
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| 5. |
- Bäckström, Josefin, 1977-
(författare)
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Family Members of Patients with Burns : Experiences of a Distressful Episode
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- A severe burn is a trauma associated with long lasting consequences, not only for the survivor but also for the family. Although it is recognized that family members are central in providing social support for the patients, previous research has not focused extensively on this group. The aims of this thesis were to increase knowledge about psychological symptoms and health-related quality of life (HRQoL) in family members of patients with burns, as well as to explore their experiences of burn care and rehabilitation. The research questions were approached using quantitative and qualitative methods.The results showed that most family members demonstrate normal to mild levels of psychological symptoms, while one third demonstrate moderate to severe symptoms during care. The symptoms decreased over time and could be predicted to a certain degree by early symptoms.Further, family members’ report of HRQoL is similar to that of the general population. An improvement is seen over time and HRQoL could be predicted in part by earlier life events and psychological symptoms.Family members’ experiences were explored in an interview study. Qualitative content analysis revealed that the time in hospital is stressful, although there were experiences of a positive character. Family members might benefit from being cared for in a more individualized way. The communication between health care providers and the family members could be improved.Finally, a qualitative content analysis revealed that family members’ experiences and views concerning support is highly individual. There were experiences of sufficient support as well as lack of professional support. Treatment of family members should be modified according to personal circumstances, and it is important to actively include family members in the care process, both before and after discharge.In summary, being a family member of a burn survivor is a distressful experience, not only during care but in many cases also after discharge. The treatment of family members within burn care should be individualized. Some persons are more vulnerable than others and it might be possible to identify those in need of support while care is still ongoing.
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| 6. |
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| 7. |
- Sporrong, Tony
(författare)
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Idag är jag inte riktigt mig själv : en undersökning av psykoanalysens kunskapsobjekt
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Psykoanalysen är ingen vetenskap eftersom den saknar kunskapsobjekt. Med syftet att finna detta objekt och därmed grunda en vetenskap togs avstamp i Freuds begrepp Det Omedvetna. Genom begreppsanalys av Freuds texter och med hjälp av matematisk mängdlära samt nedslag i filosofi och ontologi kunde en första beskrivning av objektet göras. Freuds begrepp visade sig då syfta på ett inlärt men bortträngt Omedvetet som i sin uppbyggnad ligger nära vårt medvetna tänkande. Det sökta objektet däremot, var ett medfött och inte bortträngt psykiskt system med en egen logik, symmetrisk logik, och sannolikt också vårt känslocentrum. Studier av neuropsykoanalys band sedan objektet till Limbiska systemet och det implicita minnet. Här bekräftades att systemet bär våra känslor. Ur författarens praktik hade samtidigt vuxit en idé om att vi föds med en uppsättning bilder av oss själva som är systematiskt ordnade i ett självbildssystem och av grandios natur. Till systemet kunde en livsåskådning knytas som primärt är en idealism. Självbildssystemet skyddades av en homeostatiskt fungerande sjävbildsbevarande drift. Denna drift framstod som vår viktigaste drift. Sexualdrift och självbevarelsedrift intog en sekundär roll. Det fanns sedan fog för att sammanföra det inte bortträngda Omedvetna och självbildssystemet till en enhet och betrakta kombinationen som psykoanalysens kunskapsobjekt. Resultatet hade inflytande på frågor som: den fria viljan, moral, determinism och kunskapssubjektets status.
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| 8. |
- Eckerdal, Patricia, 1972-
(författare)
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Perinatal Complications: Associations with Postpartum depressive symptoms and Neuroticism
- 2018
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Even though most pregnancies and deliveries are uncomplicated, still fifteen percent of all women in developed countries suffer pregnancy-related complications. The aim of this thesis was to explore the associations between perinatal complications and perinatal maternal health, with emphasis on postpartum depressive symptoms (PPDS) and neuroticism taking into account potential confounding or mediating factors such as history of depression, antenatal depressive symptoms and delivery experience.In the first study (n=446), the association between heavy postpartum haemorrhage and PPDS at six weeks postpartum was delineated by using path-analysis in order to provide insight into the complex mediating roles of several consequences of postpartum haemorrhage. There was no direct association between postpartum haemorrhage and PPDS, only an indirect one via anaemia at discharge and negative delivery experience.The second study (n=3888) examined the association of mode of delivery with PPDS at 6 weeks postpartum. The results indicate that the association between elective caesarean section and PPDS is highly confounded by history of depression and fear of delivery, while emergency caesarean section and vacuum extraction increase odds for PPDS by leading to postpartum complications and negative delivery experience.The third study (n=1503) investigated the association between the use of epidural analgesia during delivery and PPDS. A positive association in the crude analysis was no longer present after adjustment for sociodemographic, psychosocial and obstetrical variables, indicating that pain relief through epidural analgesia is not likely to affect risk for PPDS.In the last study (n=1969), the association between neuroticism and perinatal complications was explored. Neuroticism was not associated with adverse perinatal outcomes, except for gestational diabetes mellitus. The association, however, became statistically non-significant after adjusting for psychiatric morbidity.In summary, the current studies do no find evidence for a direct association between perinatal complications and postpartum depressive symptoms or neuroticism. However, several important mediators have been identified, among which postpartum anaemia and negative delivery experience deserve special attention. Also, earlier psychiatric history needs to be addressed as an important confounder.
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| 9. |
- Iliadis, Stavros I, 1983-
(författare)
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Personality and the HPA-axis in Association with Postpartum Depression
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Postpartum depression is a psychiatric disorder affecting a substantial proportion of newly delivered women, and remains a significant cause of childbirth-related morbidity. The aim of the present thesis was to examine psychological, endocrine and genetic aspects of postpartum depression in a large, population-based sample of women in Uppsala, Sweden. All included studies were undertaken as parts of the BASIC-project, a longitudinal study on psychological wellbeing during pregnancy and the postpartum period. Study participants were screened for depressive symptoms in pregnancy week 17 and 32 as well as at six weeks and six months postpartum, mainly by use of the Swedish version of the Edinburgh Postnatal Depression Scale (EPDS). Furthermore, personality was assessed with the Swedish universities Scale of Personality (SSP) in pregnancy week 32. Evening cortisol levels in saliva were measured in pregnancy week 36 and at six weeks postpartum. Blood samples were obtained to measure corticotropin-releasing hormone levels (CRH) and to perform genetic analyses. The results of this thesis demonstrate that neuroticism is a strong and independent predictive factor of depressive symptoms at six weeks and six months postpartum, and has a significant mediatory role in the association between a single nucleotide polymorphism in the hydroxysteroid (11-beta) dehydrogenase 1 gene (HSD11B1) and postpartum depression. Furthermore, women with postpartum depressive symptoms present with a dysregulated hypothalamic-pituitary-adrenal axis activity in terms of elevated cortisol levels postpartum, as well as elevated CRH levels in mid-gestation. In conclusion, this thesis develops current knowledge on several attributes of postpartum depression. Further studies are required to replicate and expand on these results, which would further contribute to early identification of women at risk of postpartum depression and adoption of proper interventions that may moderate the short- and long-term consequences of the disorder.
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| 10. |
- Sylvén, Sara M, 1982-
(författare)
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Biological and Psychosocial Aspects of Postpartum Depression
- 2012
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Postpartum depression (PPD) is one of the most common complications of childbirth around the world. Despite several studies on the underlying mechanisms, the pathophysiology remains elusive. The aims of this thesis were to assess possible associations between the risk for self reported PPD and serum levels of leptin, the season of delivery, the gender of the newborn, and the history of premenstrual symptoms, respectively. A population based cohort of 2318 newly delivered women in Sweden were screened five days, six weeks and six months postpartum, using the Edinburgh Postnatal Depression Scale. This cohort comprised 60% of the total population, and the prevalence of self reported PPD was 11.1% six weeks after the delivery. A negative association between leptin levels at delivery and self reported PPD at six weeks and six months postpartum was evident, even after adjusting for confounding factors. An increased risk for self reported PPD was noted among women delivering during the last three months of the year, compared to those giving birth in April through June. This is of clinical importance, since women delivering at the end of the year could benefit from a closer follow-up after delivery. Despite previous varying findings – depending on study population and consequently different cultural settings – in our study, no association between infant gender and self reported PPD could be detected at six weeks or six months postpartum. However, women giving birth to baby boys had a higher risk for postpartum blues. Lastly, an increased risk for self reported PPD among women with a history of premenstrual symptoms was noted. Interestingly, after stratification for parity, the association between PPD and premenstrual symptoms remained only among multiparas. The association between PPD and premenstrual symptoms might shed light on the many possible routes by which hormonal changes may influence mood in women. In conclusion, this population based study strengthens the notion that PPD is a complex multifactorial disorder, with biological, social and psychological parameters shaping each individual’s risk. Further research is needed in this field, in order to investigate underlying pathophysiological mechanisms, propose more effective diagnostic tests and assess therapeutic interventions.
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