| 1. |
- Choque Olsson, Nora, et al.
(författare)
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Social Skills Training for Children and Adolescents With Autism Spectrum Disorder : A Randomized Controlled Trial
- 2017
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Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry. - : Elsevier BV. - 0890-8567 .- 1527-5418. ; 56:7, s. 585-592
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Social skills group training (SSGT) for children and adolescents with autism spectrum disorder (ASD) is widely applied, but effectiveness in real-world practice has not yet been properly evaluated. This study sought to bridge this gap.METHOD: This 12-week pragmatic randomized controlled trial of SSGT compared to standard care alone was conducted at 13 child and adolescent psychiatry outpatient units in Sweden. Twelve sessions of manualized SSGT ("KONTAKT") were delivered by regular clinical staff. Participants (N = 296; 88 females and 208 males) were children (n = 172) and adolescents (n = 124) aged 8 to 17 years with ASD without intellectual disability. The primary outcome was the Social Responsiveness Scale rating by parents and blinded teachers. Secondary outcomes included parent- and teacher-rated adaptive behaviors, trainer-rated global functioning and clinical severity, and self-reported child and caregiver stress. Assessments were made at baseline, posttreatment, and 3-month follow-up. Moderator analyses were conducted for age and gender.RESULTS: Significant treatment effects on the primary outcome were limited to parent ratings for the adolescent subgroup (posttreatment: -8.3; 95% CI = -14.2 to -1.9; p = .012, effect size [ES] = 0.32; follow-up: -8.6; 95% CI = -15.4 to -1.8; p = .015, ES = 0.33) and females (posttreatment: -8.9; 95% CI = -16.2 to -1.6; p = .019, ES = 0.40). Secondary outcomes indicated moderate effects on adaptive functioning and clinical severity.CONCLUSION: SSGT for children and adolescents with ASD in regular mental health services is feasible and safe. However, the modest and inconsistent effects underscore the importance of continued efforts to improve SSGT beyond current standards.CLINICAL TRIAL REGISTRATION INFORMATION: Social Skills Group Training ("KONTAKT") for Children and Adolescent With High-functioning Autism Spectrum Disorders; https://clinicaltrials.gov/; NCT01854346.
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| 2. |
- Flygare, Oskar, et al.
(författare)
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Adapted cognitive behavior therapy for obsessive-compulsive disorder with co-occurring autism spectrum disorder : A clinical effectiveness study
- 2020
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Ingår i: Autism. - : SAGE Publications. - 1362-3613 .- 1461-7005. ; 24:1, s. 190-199
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Tidskriftsartikel (refereegranskat)abstract
- Obsessive-compulsive disorder and autism spectrum disorder commonly co-occur. Adapted cognitive behavior therapy for obsessive-compulsive disorder in adults with autism spectrum disorder has not previously been evaluated outside the United Kingdom. In this study, 19 adults with obsessive-compulsive disorder and autism spectrum disorder were treated using an adapted cognitive behavior therapy protocol that consisted of 20 sessions focused on exposure with response prevention. The primary outcome was the clinician-rated Yale-Brown Obsessive-Compulsive Scale. Participants were assessed up to 3 months after treatment. There were significant reductions on the Yale-Brown Obsessive-Compulsive Scale at post-treatment (d = 1.5), and improvements were sustained at follow-up (d = 1.2). Self-rated obsessive-compulsive disorder and depressive symptoms showed statistically significant reductions. Improvements in general functioning and quality of life were statistically non-significant. Three participants (16%) were responders at post-treatment and four (21%) were in remission from obsessive-compulsive disorder. At follow-up, three participants (16%) were responders and one (5%) was in full remission. Adapted cognitive behavior therapy for obsessive-compulsive disorder in adults with co-occurring autism spectrum disorder is associated with reductions in obsessive-compulsive symptoms and depressive symptoms. However, outcomes are modest; few patients were completely symptom free, and treatment engagement was low with few completed exposures and low adherence to homework assignments. We identify and discuss the need for further treatment refinement for this vulnerable group.
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| 3. |
- Flygare, Oskar, et al.
(författare)
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Association of anxiety or depression with risk of recurrent cardiovascular events and death after myocardial infarction : A nationwide registry study
- 2023
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Ingår i: International Journal of Cardiology. - 0167-5273 .- 1874-1754. ; 381, s. 120-127
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Tidskriftsartikel (refereegranskat)abstract
- Background: Depression and anxiety are risk factors for patients with myocardial infarction (MI). However, the association of a previous psychiatric diagnosis of anxiety or depression, or only such self-reported symptoms, with cardiovascular outcomes and mortality post-MI has not been previously examined in the same nationwide cohort. Methods: We linked demographic, socioeconomic and clinical data from four nationwide Swedish registries for patients enrolled in cardiac rehabilitation (CR) after first-time MI (2006–2015, N = 45,096). After multiple imputation, we applied Cox regression to estimate the post-MI outcome risk for patients with a previous psychiatric diagnosis of anxiety/depression (Diagnosis), patients with no formal diagnosis but self-reported symptoms of anxiety/depression (Symptoms), versus patients with neither Diagnosis nor Symptoms (Reference). Results: During one-year follow-up, fully adjusted models showed that patients with Diagnosis had a higher risk (hazard ratio [95%CI]) of all-cause mortality (1.86 [1.36, 2.53]), reinfarction (1.14 [1.06, 1.22]), their composite (1.15 [1.07, 1.23]), and an extended cardiovascular composite (1.19 [1.12, 1.26]), versus Reference, even though 77% reported no symptoms at the time of MI. In patients with Symptoms, estimates were also elevated yet somewhat attenuated compared to Reference. Findings were overall robust across multiple sensitivity analyses. Conclusions: Both a previous diagnosis, and present self-reported symptoms of anxiety or depression are associated with an increased risk of death and recurrent cardiovascular events in adults with first-time MI. Only screening for present symptoms is inadequate for assessing this excessive risk. Assessment of both psychiatric history and self-reported symptoms seems warranted for these patients.
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| 4. |
- Flygare, Oskar
(författare)
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Improving access and outcomes in the treatment of obsessive-compulsive disorder
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Effective psychological treatments exist for obsessive-compulsive disorder (OCD) in the form of cognitive behaviour therapy (CBT), but access is limited and adaptations are needed for groups of patients, for example individuals with co-occurring autism spectrum disorder (ASD), that do not respond well to the standard treatment. Moreover, treatment evaluation is not straightforward with multiple definitions and approaches. Standardised criteria for treatment response and remission have been proposed, but empirically validated operationalisations on self-rated questionnaires are lacking. The goal of this thesis was therefore to improve access and outcomes in the treatment of OCD in four empirical studies. In study I, guided and unguided internet-delivered CBT (ICBT) for OCD were compared to face-to-face CBT in a randomised non-inferiority trial. A total of 120 individuals with a primary diagnosis of OCD participated in the trial, and clinical efficacy as well as costeffectiveness was evaluated. Participants in all three groups improved but the noninferiority results for both ICBT treatments were inconclusive as the confidence intervals for treatment difference included the pre-specified 3-point margin on the Yale-Brown Obsessive Compulsive Scale (Y-BOCS) at primary follow-up. Both therapist-guided and unguided ICBT were cost-effective when compared to face-to-face CBT. Study II evaluated an adapted CBT treatment for 19 adults with co-occurring OCD and ASD in an open trial. After treatment, there were significant reductions in OCD symptoms on the Y-BOCS, and the gains were sustained at 3-month follow-up. However, few patients were treatment responders and treatment engagement was low as the patients completed few exposures and homework assignments relative to the number of treatment sessions. Study III analysed the self-rated Obsessive-Compulsive Inventory–Revised (OCI-R) as a tool to evaluate treatment response and remission after CBT for OCD. The OCI-R was compared to expert consensus criteria using the Y-BOCS and Clinical Global Impression Scale using data from 349 participants in three clinical trials. The optimal cut-off for treatment response was a ≥40% reduction on the OCI-R and the optimal cut-off for remission status was an OCI-R total score of ≤8 points. These empirically validated cut-offs are efficient alternatives to clinician-administered assessments which are not always available in regular clinical practice. Study IV was a pilot trial of the therapist-guided ICBT treatment from study I, implemented in the United Kingdom’s Improving Access to Psychological Therapies (IAPT) programme. A total of 474 consecutively referred patients across three IAPT services with a primary diagnosis of OCD were included in the study. After treatment, there were large improvements in self-rated OCD symptoms (d = 1.77), anxiety (d = 1.55), and depression (d = 0.8). The results indicated that therapist-guided ICBT for OCD is an effective treatment when implemented in the IAPT system, but challenges in implementation were identified and discussed. The studies included in this thesis addressed current issues in the treatment of OCD and evaluations of treatment effects. In summary, the studies showed that ICBT for OCD is an effective treatment when delivered in multiple contexts, and is a cost-effective alternative to face-to-face CBT; that an adapted CBT protocol for adults with OCD and co-occurring ASD is promising but that additional innovations are needed to improve outcomes; and that the self-rated OCI-R can be an efficient tool for treatment evaluation when clinician-rated assessments are unavailable. Directions for future research include further implementation of ICBT for OCD and evaluations of its place in a stepped-care health care model, exploring new intensive treatment options for individuals with OCD and ASD, and externally validating the OCI-R cut-offs in diverse clinical samples.
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| 5. |
- Hjalmarsson, Johannes, et al.
(författare)
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Enhancing the value of large-scale energy storage systems in congested distribution grids using service stacking
- 2023
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Ingår i: Journal of Energy Storage. - 2352-152X .- 2352-1538.
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Energy storage systems (ESS) are suitable for many grid applications, where some have large seasonal variations. By combining additional services, i.e., service stacking, companies with energy storage assets may generate additional revenue as well as provide services to the power system. This paper aims to highlight and estimate the technical and economic potential of stacking services using energy storage systems in congested a distribution grid. A scheduling optimization tool was implemented for a large-scale battery ESS providing a selection of deemed relevant services over two years. The results show that there is a great potential to enhance the value of the ESS significantly depending on the service portfolio layout. A capacity life loss model was also implemented to analyse the degradation of the ESS, and the cycle aging was estimated for the chosen portfolios. The results showed that a fully stacked portfolio does not necessarily result in increased cycle aging, but that it depended on the services in the portfolio. The cycle aging was affected the most by stacking flexibility with energy arbitrage, while frequency regulation services only resulted in a few additional cycles during each year of operation.
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| 6. |
- Ivanov, Volen Z., et al.
(författare)
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Enhancing group cognitive-behavioral therapy for hoarding disorder with between-session Internet-based clinician support : A feasibility study
- 2018
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Ingår i: Journal of Clinical Psychology. - : Wiley. - 0021-9762 .- 1097-4679. ; 74:7, s. 1092-1105
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Tidskriftsartikel (refereegranskat)abstract
- Objective Hoarding disorder (HD) is difficult to treat. In an effort to increase efficacy and engagement in cognitive-behavioral therapy (CBT), we developed and evaluated a novel intervention comprising group CBT combined with between-session Internet-based clinician support for people with HD.Method Twenty participants with HD received group CBT combined with an Internet-support system enabling therapist-participant communication between group sessions.Results The treatment was associated with a significant reduction on the Saving InventoryRevised (SI-R) and a large effect size (Cohen's d=1.57) was found at posttreatment. Treatment gains were maintained at the 3-month follow-up. Group attendance was high and no participants dropped out from treatment prematurely. Between-session motivational support from the therapist was most frequently mentioned as the main strength of the system.Conclusion The results of this study support adding Internet-based clinician support to group CBT for HD to increase treatment adherence and, potentially, improve the overall efficacy of CBT.
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| 7. |
- Ivanova, Ekaterina, et al.
(författare)
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Study protocol for a single-blind, parallel-group, randomised, controlled non-inferiority trial of 4-day intensive versus standard cognitive behavioural therapy for adults with obsessive-compulsive disorder
- 2023
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Ingår i: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:12
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Tidskriftsartikel (refereegranskat)abstract
- Introduction Individual cognitive behavioural therapy (CBT) with exposure and response prevention is an effective treatment for obsessive-compulsive disorder (OCD). However, individual CBT is costly and time-consuming, requiring weekly therapy sessions for 3-4 months. A 4-day intensive version of CBT for OCD delivered in group format has been recently developed in Norway (Bergen 4-day treatment, B4DT). B4DT has shown promising results in several uncontrolled and one small, randomised trial, but its non-inferiority to the gold standard treatment has not been established. Methods and analysis This single-blind, randomised controlled trial including 120 patients (60 per arm) will compare B4DT to individual CBT. The primary outcome is the blind assessor-rated Yale-Brown Obsessive Compulsive Scale (Y-BOCS). We hypothesise that B4DT will be non-inferior to gold standard CBT 15 weeks after treatment start. The non-inferiority margin is set at four points on the Y-BOCS. Secondary outcomes include time to treatment response, cost-effectiveness, response and remission rates, drop-out rates and adverse events. Ethics and dissemination This study has been approved by the Swedish Ethical Review Authority. Hypotheses were specified and analysis code published before data collection started. Results from all analyses will be reported in accordance with the Consolidated Standards of Reporting Trials statement for non-pharmacological trials and Consolidated Health Economic Evaluation Reporting Standards irrespective of outcome. Trial registration number NCT05608278.
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| 8. |
- Jonsson, Ulf, 1974-, et al.
(författare)
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Long-term social skills group training for children and adolescents with autism spectrum disorder : a randomized controlled trial.
- 2019
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Ingår i: European Child and Adolescent Psychiatry. - : Springer Science and Business Media LLC. - 1018-8827 .- 1435-165X. ; 28:2, s. 189-201
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Tidskriftsartikel (refereegranskat)abstract
- Social skills group training (SSGT) is widely used for intellectually able children and adolescents with autism spectrum disorder (ASD). Previous studies indicate small to moderate effects on social communication capacities. The duration of most available programs is relatively short, and extended training might lead to further improvement. This randomized controlled trial compared an extended 24-week version of the SSGT program KONTAKT with standard care. The weekly sessions gradually shifted in content from acquisition of new skills to real-world application of the acquired skills. A total of 50 participants with ASD (15 females; 35 males) aged 8-17 years were included. The study was conducted at two child and adolescent psychiatry outpatient units in Sweden. The primary outcome was the Social Responsiveness Scale-Second Edition (SRS-2) rated by parents and blinded teachers. Secondary outcomes included parent- and teacher-rated adaptive behaviors, trainer-rated global functioning and clinical severity, and self-reported child and caregiver stress. Assessments were made at baseline, posttreatment, and at 3-months follow-up. Parent-rated SRS-2 scores indicated large effects posttreatment [- 19.2; 95% CI - 29.9 to - 8.5; p < .001, effect size (ES) = 0.76], which were maintained at follow-up (- 20.7; 95% CI - 31.7 to - 9.7; p < .0001, ES = 0.82). These estimates indicate substantially larger improvement than previously reported for shorter SSGT. However, the effects on teacher-rated SRS-2 and most secondary outcomes did not reach statistical significance. Our results suggest added benefits of extended SSGT training, implying that service providers might reach better results by optimizing the delivery of SSGT.
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| 9. |
- Mataix-Cols, David, et al.
(författare)
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Operational Definitions of Treatment Response and Remission in Obsessive-Compulsive Disorder Capture Meaningful Improvements in Everyday Life
- 2022
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Ingår i: Psychotherapy and Psychosomatics. - : S. Karger AG. - 0033-3190 .- 1423-0348. ; 91:6, s. 424-430
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The operational definitions of treatment response, partial response, and remission in obsessive-compulsive disorder (OCD) are widely used in clinical trials and regular practice. However, the clinimetric sensitivity of these definitions, that is, whether they identify patients that experience meaningful changes in their everyday life, remains unexplored.Objective: The objective was to examine the clinimetric sensitivity of the operational definitions of treatment response, partial response, and remission in children and adults with OCD.Methods: Pre- and post-treatment data from five clinical trials and three cohort studies of children and adults with OCD (n = 1,528; 55.3% children, 61.1% female) were pooled. We compared (1) responders, partial responders, and non-responders and (2) remitters and non-remitters on self-reported OCD symptoms, clinician-rated general functioning, and self-reported quality of life. Remission was also evaluated against post-treatment diagnostic interviews.Results: Responders and remitters experienced large improvements across validators. Responders had greater improvements than partial responders and non-responders on self-reported OCD symptoms (Cohen’s d 0.65–1.13), clinician-rated functioning (Cohen’s d 0.53–1.03), and self-reported quality of life (Cohen’s d 0.63–0.73). Few meaningful differences emerged between partial responders and non-responders. Remitters had better outcomes across most validators than non-remitters. Remission criteria corresponded well with absence of post-treatment diagnosis (sensitivity/specificity: 93%/83%). Using both the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the Clinical Global Impression Scale yielded more conservative results and more robust changes across validators, compared to only using the Y-BOCS.Conclusions: The current definitions of treatment response and remission capture meaningful improvements in the everyday life of individuals with OCD, whereas the concept of partial response has dubious clinimetric sensitivity.
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| 10. |
- Wallert, John, et al.
(författare)
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Predicting remission after internet-delivered psychotherapy in patients with depression using machine learning and multi-modal data
- 2022
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Ingår i: Translational Psychiatry. - : Springer Nature. - 2158-3188. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- This study applied supervised machine learning with multi-modal data to predict remission of major depressive disorder {MDD) after psychotherapy. Genotyped adult patients (n = 894, 65.5% women, age 18-75 years) diagnosed with mild-to-moderate MDD and treated with guided Internet-based Cognitive Behaviour Therapy (ICBT) at the Internet Psychiatry Clinic in Stockholm were included (2008-2016). Predictor types were demographic, clinical, process (e.g., time to complete online questionnaires), and genetic (polygenic risk scores). Outcome was remission status post ICBT (cut-off <= 10 on MADRS-S). Data were split into train (60%) and validation (40%) given ICBT start date. Predictor selection employed human expertise followed by recursive feature elimination. Model derivation was internally validated through cross-validation. The final random forest model was externally validated against a (i) null, (ii) logit, (iii) XGBoost, and {iv) blended meta-ensemble model on the hold-out validation set. Feature selection retained 45 predictors representing all four predictor types. With unseen validation data, the final random forest model proved reasonably accurate at classifying post ICBT remission (Accuracy 0.656 [0.604, 0.705], P vs null model = 0.004; AUC 0.687 [0.631, 0.743]), slightly better vs logit (bootstrap D = 1.730, P = 0.084) but not vs XGBoost (D = 0.463, P = 0.643). Transparency analysis showed model usage of all predictor types at both the group and individual patient level. A new, multi-modal classifier for predicting MDD remission status after ICBT treatment in routine psychiatric care was derived and empirically validated. The multi-modal approach to predicting remission may inform tailored treatment, and deserves further investigation to attain clinical usefulness.
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