| 1. |
- Holländare, Fredrik, 1972-
(författare)
-
Managing depression via the Internet : self-report measures, treatment & relapse prevention
- 2011
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Cognitive behaviour therapy (CBT) is an effective treatment for depression but access is limited. One way of increasing access is to offer CBT via the Internet. In Study I, guided Internet-based CBT was found to have a large effect on depressive symptoms compared to taking part in an online discussion group. Approximately two hours were spent on guiding each patient and the large effect found differs from previous studies that showed smaller effects, probably due to lack of guidance. The intervention had no effect on the participants’ quality of life but significantly decreased their level of anxiety. Internet-based versions of self-report measures can be more practical and efficient than paper versions. However, before implementation, evidence of psychometrical equivalence to the paper versions should be available. This was tested in Studies II and III for the Montgomery-Åsberg Depression Rating Scale – Self-rated (MADRS-S) and the Beck Depression Inventory – Second Edition (BDI-II). When the full scales were investigated, equivalent psychometric properties were found in the two versions of the MADRS-S and BDI-II. However, in the Internet-version of the BDI-II, a lower score was found for the question about suicidality and the difference was statistically significant. Although the difference was small, this indicates that suicidality might be underestimated when using the Internet-based BDI-II. As the long-term prognosis after treatment for depression is poor, in Study IV we investigated the possibility of delivering CBT-based relapse prevention via the Internet. The results revealed that fewer participants in the intervention group experienced a relapse compared to the control group and that the time spent on guiding each participant was approximately 2.5 hours. A trend towards a higher remission rate was found in the CBT group at the six-month follow-up and a reduction of depressive symptoms was associated with a lowered risk of relapse. CBT-based relapse prevention via the Internet can potentially be made available to large numbers of patients, thus improving their prognosis. The Internet increases the possibilities for health care providers in the management of depression.
|
|
| 2. |
- Humble, Mats B., 1952-
(författare)
-
Obsessive-compulsive disorder, serotonin and oxytocin : treatment response and side effects
- 2016
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Obsessive-compulsive disorder (OCD), with a prevalence of 1-2 %, frequently leads a chronic course. Persons with OCD are often reluctant to seek help and, if they do, their OCD is often missed. This is unfortunate, since active treatment may substantially improve social function and quality of life. Serotonin reuptake inhibitors (SRIs) have welldocumented efficacy in OCD, but delayed response may be problematic. Methods to predict response have been lacking. Because SRIs are effective, pathophysiological research on OCD has focussed on serotonin. However, no clear aberrations of serotonin have been found, thus other mechanisms ought to be involved.Our aims were to facilitate clinical detection and assessment of OCD, to search for biochemical correlates of response and side-effects in SRI treatment of OCD and to identify any possible involvement of oxytocin in the pathophysiology of OCD.In study I, we tested in 402 psychiatric out-patients the psychometric properties of a concise rating scale, “Brief Obsessive Compulsive Scale” (BOCS). BOCS was shown to be easy to use and have excellent discriminant validity in relation to other common psychiatric diagnoses.Studies II-V were based on 36 OCD patients from a randomised controlled trial of paroxetine, clomipramine or placebo. In study II, contrary to expectation, we found that the change (decrease) of serotonin in whole blood was most pronounced in non-responders to SRI. This is likely to reflect inflammatory influence on platelet turnover rather than serotonergic processes within the central nervous system.In studies IV-V, we found relations between changes of oxytocin in plasma and the anti-obsessive response, and between oxytocin and the SRI related delay of orgasm, respectively. In both cases, the relation to central oxytocinergic mechanisms is unclear. In males, delayed orgasm predicted anti-obsessive response.
|
|
| 3. |
- Neander, Kerstin, 1951-
(författare)
-
Indispensable interaction : parents' perspectives on parent-child interaction and beneficial meetings
- 2009
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Parent-child interaction interventions, guided by the aim of promoting child development, have developed in Sweden during the last three decades. The aim of this thesis was to describe families taking part in such interventions and examine short term and long term changes in their problem loads. Praticular interest was directed towards the parents' experiences, both with respect to the treatment they had taken part in at either of four centres for parent-child interaction interventions presented in this thesis and to other persons and/or contexts the parents considered had played an important and beneficial role for the child or the family. The results show that the centres have reached both mothers, fathers and children beset by considerable difficulties in relation to interaction, offering them a treatment which an overwhelming majority of the families have chosen to follow through and which has made a difference to the families. This thesis highlights the significance of beneficial relationships, not only within the intervention but also in other professional contexts, for the enhancing of children's development.
|
|
| 4. |
- Nordenskjöld, Axel, 1977-
(författare)
-
Electroconvulsive therapy for depression
- 2013
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Aim: The overarching aims of the thesis were to identify clinical characteristics that predict the outcomes of depressed patients treated inclinical practice by ECT, and to elucidate the effectiveness of continuation ECT at preventing relapses and recurrences.Methods: The studies included a retrospective chart review, three studies based on a quality register for ECT, and a randomized controlled trial(RCT) examining the effectiveness of continued ECT.Results: The overall response rate to ECT was 80%. Patients with psychotic depression (89%), older patients (84%), and inpatients (83%) had the highest response rates. Patients with personality disorders (66%) and outpatients (66%) had the lowest response rates. With regard to patients on sick leave, 59%, 71% and 88% of patients regained occupational functioning 6, 12 and 24 months after ECT, respectively. The rate of hospitalisation after ECT was high, with rates of 25%, 34%and 44% 6, 12 and 24 months after ECT, respectively. The relapse rate was higher in patients that were taking benzodiazepines and lower in patients that were taking lithium.The relapse rate was significantly lower in patients treated with continued ECT in combination with pharmacotherapy (32%) than in those treated with pharmacotherapy alone (61%). This difference was particularly pronounced in medication-resistant patients (31% vs. 85%)Conclusions: The short-term response rate to ECT is relatively high in all patient subgroups, and is particularly high in older patients, inpatients and patients with severe depression. Patients often regain occupational functioning after ECT; however, this takes a considerably longer time than that required for symptom relief. Nevertheless, the relapse and recurrence rates of patients are high in the years after ECT. Continuation ECT and lithium treatment can be combined with antidepressants to reduce the risk of relapse and recurrence. Further RCTs are required to define the indications for continuation ECT and lithium treatment.
|
|
| 5. |
- Nyman-Carlsson, Erika, 1982-
(författare)
-
Anorexia nervosa - The journey towards recovery : A randomized controlled treatment trial: assessment, prediction, treatment outcome and clinical change
- 2021
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to study young adult women with anorexia nervosa (AN) participating in an randomized controlled trial in relation to assessment, treatment outcome, prediction, and clinical change. The results confirm the Eating Disorder Inventory-3 as a valid instrument for measuring eating disorder symptoms and general psychopathology. AN patients, however, rate themselves significantly lower than patients with other eating disorder diagnoses, and interoceptive deficits are the best predictive subscale for AN diagnosis. Patients significantly improved in terms of weight and eating disorder psychopathology, with no differences between individual CBT and family therapy (FT). Most patients did not fulfill the diagnostic criteria at post-assessment, at 76% and 86% at followup. Patients in FT were considered completers to a higher extent than patients receiving CBT, and 8% were prematurely discharged, in comparison to 30% for CBT. Bulimic symptoms and emotional dysregulation at baseline had a negative effect on diagnostic symptoms, and lower levels of interoceptive deficits predicted weight increase in the FT group. Lower levels of emotional dysregulation and higher levels of interoceptive deficits explained 37% of the variance in BMI changes in the CBT group. The classifications of CS/RCI were shown to be valid when compared to normal controls. Patients classified as clinically significantly improved constituted 35-47% of all patients, and only three patients fulfilled the proposed definition of recovery. The agreement of the diagnostic criteria was fair.The results suggest that individual CBT and FT are effective treatments for young adults. The ability to acknowledge, interpret, and handle emotions is an important aspect of treatment. Self-report measurements are useful for evaluating individual changes; however, diagnostic criteria do not accord with self-reported symptom changes and physical, behavioral, and psychological measurements are important for a complete estimation of recovery.
|
|
| 6. |
- Paulson-Karlsson, Gunilla, 1950-
(författare)
-
Anorexia nervosa : treatment expectations, outcome and satisfaction
- 2012
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Anorexia nervosa is a serious mental disorder with high mortality. It has the lowest prevalence compared with other eating-disorder diagnoses and the onset is related to adolescence, with a majority of female patients. The focus of this thesis is anorexia nervosa and the aim is to study adolescent and adult patients' comprehension and the course of treatment in order to make a contribution to the clinical work relating to these patients. The areas that were studied are expectations of treatment, outcome, predictors of outcome and satisfaction with treatment. Four research papers are included; three originate from work at a specialist eating-disorder unit at Queen Silvia Children's Hospital, Göteborg, Sweden and one from a multicentre study comprising 15 specialised eating-disorder units in Sweden.Paper I has a qualitative design, where participants, 18-25 years of age, were interviewed about their expectations while on the waiting list at a specialist eating-disorder unit. Three main categories of expectations emerged: "Treatment content," "Treatment professionals" and "Treatment focus." The participants expected to receive the appropriate therapy in a collaborative therapeutic relationship and to recover. Paper II evaluated the outcome of a family-based treatment for adolescent patients, 13-18 years old, and their parents. The results indicate that the treatment that is offered appears to be effective, as 78% of the patients were in full remission with less distance and a less chaotic family climate at the 36-month follow-up. Paper III examined the importance of motivation to change eating behaviour, treatment expectationsand experiences, ED symptomatology, self-image and treatment alliance for predicting weight increase in adult patients, 18-46 years of age. Patients' motivation to change eating habits, social relations, self-image, body image and duration of illness were found to predict weight increase both in both the short term (six months) and the long term (36 months). PaperIV studied adolescent patients' and their parents' satisfaction with a family-based treatment a tan 18-month follow-up. The majority of patients (73%) and parents (83%) stated that their expectations had been fulfilled and individual sessions for patients and parents respectively were of great help. Family-based treatment with a combination of individual and family sessions corresponds well to patients' and parents' treatment expectations.Young adult patients' expectations before treatment are multifaceted and should be taken into account in the therapeutic relationship. From the start of treatment, issues relating to patients' motivation, self-image, body image and social relationships should be continuously addressed in order to establish positive collaboration and a weight increase. Anorexia nervosa treatment for adolescents and their parents should be family-based and include family sessions as well as individual sessions for patients and parents. In addition, prevention programmes with the emphasis on early detection should be a prioritised area.
|
|
| 7. |
- Pelto-Piri, Veikko, 1959-
(författare)
-
Ethical considerations in psychiatric inpatient care : The ethical landscape in everyday practice as described by staff
- 2015
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses mainly on the general ethical considerations of staff and not pre-defined specific ethical problems or dilemmas. The aims of this thesis were: first, to map ethical considerations as described by staff members in their everyday work in child and adolescent psychiatry as well as in adult psychiatry; second, from a normative ethical perspective, examine encounters between staff and patients; and third, to describe staff justification for decisions on coercive care in child and adolescent psychiatry. The material in the three first studies comprised ethical diaries written by staff in 13 inpatient clinics. The fourth study included all the medical records of patients who were admitted to coercive care during one year in child and adolescent psychiatry in Sweden.In a final analysis, combining all the four studies, three staff ideals were identified: being a good carer, respecting the patient’s autonomy and integrity and having good relations with patients and relatives. Staff often felt that the only reasonable way in many situations was to act in a paternalistic way and take responsibility, but they considered it to be problematic.Four main themes were identified as ethical considerations. These were the borders of coercion, the emphasis on order and clarity rather than a more reciprocal relationship with patients, a strong expectation of loyalty within the team, and feelings of powerlessness, mostly in relation to patients.I have identified four challenges for inpatient psychiatry. First, formal and informal coercion in inpatient care raise ethical concerns that also can be emotionally difficult for staff. Second, the professional role and care needs to be redeveloped from providing routinised care to providing more individualised care. Third, staff often worry about how patients manage their life after discharge, indicating that patients need better support. Fourth, staff also need support; they often experience feelings of being alone with their thoughts about ethical difficulties at work. Future research could contribute in the mapping of ethical considerations, in helping to develop, implement and evaluate methods for managing these issues in psychiatric settings, and to develop the normative ethical language so that it is more relevant to the clinic reality.
|
|
| 8. |
- Schückher, Fides, 1956-
(författare)
-
Alcohol use disorder in socially stable women receiving outpatient treatment : Individual characteristics of importance for onset age and treatment outcome
- 2020
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Socially stable women with alcohol use disorder (AUD) are seldom studied separately and are often marginalized in treatment of substance abuse. The overall aim of this thesis was to examine variables of importance in relation to age at onset of AUD and treatment outcome.Study I, which included 338 men and women being treated for AUD, showed that women had a significantly later onset and shorter duration in excessive alcohol use as well as less weekly pure alcohol intake than men. Participants with earlier onset of excessive alcohol use reported significantly more psychiatric symptoms and more immature personality traits than those with later onset. Study II-IV included 75 women with AUD receiving outpatient treatment. Of the participants, 68% reported a history of childhood maltreatment. Emotional abuse and their mother’s alcohol and/or substance problems were independent predictors of earlier age at onset of AUD. In Study III treatment outcome was measured as a change in alcohol consumption. A more positive change, especially with regard to abstinence, was found in women who did not report childhood abuse. Study IV showed that, at 12month follow up, most of the participants had reached their end-oftreatment goal either abstinence or low-risk drinking. However, those with a goal of abstinence at the end of treatment showed significantly less risk drinking than those with low-risk drinking as a goal. The most important predictor of abstinence at the 12-month follow up was having abstinence as an end –of –treatment goal. These results indicate the importance of identifying and addressing childhood trauma in treating socially stable women with AUD. Focusing on motivational changes during treatment may also be of importance, especially in patients with relapses, as abstinence still is the most stable treatment option.
|
|
| 9. |
|
|
| 10. |
- Wilhelmsson Göstas, Mona, 1950-
(författare)
-
Psychotherapy patients in mental health care: : attachment styles, interpersonal problems and therapy experiences
- 2014
-
Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mona Wilhelmsson Göstas, School of Health and Medical Sciences, Örebro University, SE-701 82 Örebro, Sweden, mona.vilhelmsson gostas@orebroll.se Attachment styles are relevant to psychotherapy since they highlight the way a person handles interpersonal and emotional stress. This thesis aimed to examine how psychotherapy patients in the public mental health care system report attachment styles related to interpersonal problems and diagnosis before and after psychotherapy and to examine problems and changes and psychotherapy contract and process from patients’ experiences of cognitive behavioural oriented therapy (CBT) and psychodynamic oriented psychotherapy (PDT).The studies are based on data from patients admitted to psychotherapy within the public psychiatric services in Örebro County Council. Studies I and IV were quantitative and used self-reports to examine attachment styles and interpersonal problems before and after psychotherapy. Studies II and III were qualitative interview studies examining patients experiences of problems, changes and psychotherapy process. The patients were diagnosed with mood disorders, anxiety disorders, adjustment disorders and personality disorders and reported insecure avoidant and anxious attachment styles that correlated positively with interpersonal problems when they started therapy. Psychotherapy with CBT or PDT enabled them to turn attachment styles into more secure ones and decrease interpersonal problems Patients aged between 26 and 39, patients who attended 11-25 sessions and patients diagnosed with a personality disorder reported greater changes in secure related attachment than others. Patients described their problems as emotions that could not be regulated, as cognitive disabilities and as problematic behaviours that implied a self-centredness. During the course of psychotherapy, the patients gained abilities to handle their problems. The perceived self-centeredness changed which increased their participation in their life-context.Similarities across the therapy orientations showed that the creation of a new context was essential to pay full attention to the patient’s problems, and that the working method and cooperation with the psychotherapist made up a whole. To make the therapy effective, it is important to build up confidence in cooperation and secure base functions like offering predictability and shaping interventions according to the needs of the patient and their ability to use them.
|
|
