| 1. |
- Humble, Mats B., 1952-
(författare)
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Obsessive-compulsive disorder, serotonin and oxytocin : treatment response and side effects
- 2016
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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.
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| 2. |
- Paulson-Karlsson, Gunilla, 1950-
(författare)
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Anorexia nervosa : treatment expectations, outcome and satisfaction
- 2012
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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.
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| 3. |
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| 4. |
- Wilhelmsson Göstas, Mona, 1950-
(författare)
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Psychotherapy patients in mental health care: : attachment styles, interpersonal problems and therapy experiences
- 2014
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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.
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| 5. |
- Blomqvist, Suzanne, 1957-
(författare)
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Kompetensutnyttjande i mångprofessionella psykiatriska team
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- I vårdverksamhet för patienter med komplexa vårdbehov är teamarbete en vanlig arbetsform. I forskning om mångprofessionellt teamarbete i vården beskrivs fördelar med organisationsformen, samtidigt som svårigheter påtalas somden mångprofessionella sammansättningen kan medföra. Inom forskningen har man dock i liten utsträckning undersökthuruvida de patientinsatser som görs av mångprofessionella vårdteam verkligen präglas av teamens breda kompetens. Manredovisar heller någon övergripande teoretisk modell som beskriver faktorer betydelsefulla för utfallet av vårdteams arbete ibemärkelsen mångdimensionalitet.Syftet med detta arbete har varit att undersöka i vilken utsträckning patientarbetet i mångprofessionella psykiatriska teampräglas av teamets samlade kompetens, samt på vilket sätt de olika professionerna bidrar till grad av mångdimensionalitet ipatientarbetet. Ett syfte har också varit att undersökta vad som kan vara viktiga påverkansfaktorer för utnyttjandet av densamlade kompetensen i psykiatriska team.Två empiriska studier har genomförts. Den första studien syftade till att ge en bild av grad av mångdimensionalitet ipatientarbetet, samt av på vilket sätt de olika professionerna bidrar med sin kompetens. I denna studie observeradesvuxenpsykiatriska teams arbete under behandlingskonferens. Resultatet av observationsstudien visade att de studeradeteamen hade svårigheter att under hela diskussionen belysa patienterna på ett mångsidigt sätt – diskussionen dominerades avdet sociala perspektivet. Till denna dominans av det sociala perspektivet bidrog alla professionerna. Resultatet pekade ävenpå ett underutnyttjande främst av omvårdnadspersonalen men även av kuratorerna under behandlingskonferens. Vidarevisade resultatet att en mycket stor del av diskussionsutrymmet ägnades åt att beskriva patienten och en mycket liten del åtanalys- och beslutsprocessen. Till dominansen av det beskrivande momentet bidrog alla professionerna.Den andra studien syftade till att belysa vad som kan vara viktiga påverkansfaktorer för huruvida patientarbetet ipsykiatriska team får en mångdimensionell prägel. I denna studie intervjuades personal från psykiatrin, och utgångspunkt förintervjuerna var resultatet från observationsstudien. De förklaringar intervjugrupperna lämnade till det sociala perspektivetsdominans och till dominansen av det beskrivande momentet handlade om behov hos medlemmar i psykiatriska team av attkänna sig delaktiga och jämlika, samt av att relationerna i teamet skall vara konfliktfria. Ett underutnyttjande avomvårdnadspersonal samt kuratorer förklarade man med ett hierarkiskt förhållande mellan medlemmar i psykiatriska team.Sammanfattningsvis kan sägas att resultatet av de två studierna pekar mot att relationella aspekter av teamarbetet samt etthierarkiskt förhållande mellan professionerna kan begränsa psykiatriska teams möjlighet till att under behandlingskonferensbelysa patientärenden på ett mångsidigt sätt, samt till fullo utnyttja teamets samlade kompetens.
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| 6. |
- Engström, Ingemar, 1952-, et al.
(författare)
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Relational continuity may give better clinical outcomes in patients with serious mental illness - a systematic review
- 2023
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Ingår i: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 23:1
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Forskningsöversikt (refereegranskat)abstract
- BackgroundContinuity of care is considered important for results of treatment of serious mental illness (SMI). Yet, evidence of associations between relational continuity and different medical and social outcomes is sparse. Research approaches differ considerably regarding how to best assess continuity as well as which outcome to study. It has hitherto been difficult to evaluate the importance of relational continuity of care. The aim of this systematic review was to investigate treatment outcomes, including effects on resource use and costs associated with receiving higher relational continuity of care for patients with SMI.MethodsEleven databases were searched between January 2000 and February 2021 for studies investigating associations between some measure of relational continuity and health outcomes and costs. All eligible studies were assessed for study relevance and risk of bias by at least two independent reviewers. Only studies with acceptable risk of bias were included. Due to study heterogeneity the synthesis was made narratively, without meta-analysis. The certainty of the summarized result was assessed using GRADE. Study registration number in PROSPERO: CRD42020196518.ResultsWe identified 8 916 unique references and included 17 studies comprising around 300 000 patients in the review. The results were described with regard to seven outcomes. The results indicated that higher relational continuity of care for patients with serious mental illness may prevent premature deaths and suicide, may lower the number of emergency department (ED) visits and may contribute to a better quality of life compared to patients receiving lower levels of relational continuity of care. The certainty of the evidence was assessed as low or very low for all outcomes. The certainty of results for the outcomes hospitalization, costs, symptoms and functioning, and adherence to drug treatment was very low with the result that no reliable conclusions could be drawn in these areas.ConclusionsThe results of this systematic review indicate that having higher relational continuity of care may have beneficial effects for patients with severe mental illness, and no results have indicated the opposite relationship. There is a need for better studies using clear and distinctive measures of exposure for relational continuity of care.
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| 7. |
- Gustafsson, Per E, 1981-
(författare)
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Psychosocial Stress, Mental Health and Salivary Cortisol in Children and Adolescents
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Stressful experiences and conditions in childhood influence the health and well-being of the growing individual, and can also confer a long-lasting impact into adult life. Delineating the social, mental and biological aspects of stress in children and adolescents is therefore of great concern for human beings. Despite these notions, much knowledge is lacking regarding stress in childhood.This thesis aimed at examining diverse aspects of stress in children and adolescents: associations between social conditions, traumatic life events, mental health, and salivary cortisol as a measure of the activity of a major physiological stress system. Cross-sectional samples included two non-clinical samples of school-aged children (N=240-336) and adolescents (N =400), and two clinical samples of children with obsessive-compulsive disorder (OCD) (N =23) and adolescents who had experienced childhood abuse (N =15). Main measures were salivary cortisol sampled three times a day, and questionnaires to teachers, parents and children with questions about each child’s mental health, traumatic life events and about the socioeconomic situation of the parents.The main findings include observation of 1) higher cortisol levels in children with a moderate level of psychosocial burden (low socioeconomic status, immigrant family, social impairment of mental health problems), 2) higher cortisol levels in children with OCD who also displayed a tendency to decreasing cortisol in the face of an acute stressor, and 3) cortisol was positively related to mental health problems in abused adolescents. Furthermore, the deleterious effect of 4) traumatic events involving a social dimension, interpersonal traumas, and 5) cumulative traumatic events, polytraumatization, on the mental health of children and adolescents was indicated.The findings are discussed with respect to the complex interactions between social, mental and biological aspects of children and adolescents. The consequences of adverse experiences in childhood may represent pathways to future health problems. Consideration of the social circumstances in childhood might in the future guide public health policies and the identification of target groups for preventive interventions as well as leading to improvements in treatment for children exposed to severe stress.
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| 8. |
- Holländare, Fredrik, 1972-
(författare)
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Managing depression via the Internet : self-report measures, treatment & relapse prevention
- 2011
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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.
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| 9. |
- Neander, Kerstin, 1951-
(författare)
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Indispensable interaction : parents' perspectives on parent-child interaction and beneficial meetings
- 2009
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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.
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| 10. |
- Nordenskjöld, Axel, 1977-
(författare)
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Electroconvulsive therapy for depression
- 2013
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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.
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