| 1. |
|
|
| 2. |
- Faria, Vanda, et al.
(författare)
-
Do You Believe It? Verbal Suggestions Influence the Clinical and Neural Effects of Escitalopram in Social Anxiety Disorder : A Randomized Trial
- 2017
-
Ingår i: EBioMedicine. - : Elsevier BV. - 2352-3964. ; 24, s. 179-188
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for depression and anxiety, but their efficacy relative to placebo has been questioned. We aimed to test how manipulation of verbally induced expectancies, central for placebo, influences SSRI treatment outcome and brain activity in patients with social anxiety disorder (SAD).Methods: We did a randomized clinical trial, within an academic medical center (Uppsala, Sweden), of individuals fulfilling the DSM-IV criteria for SAD, recruited through media advertising. Participants were 18 years or older and randomized in blocks, through a computer-generated sequence by an independent party, to nine weeks of overt or covert treatment with escitalopram(20 mg daily). The overt group received correct treatment information whereas the covert group was treated deceptively with the SSRI described, by the psychiatrist, as active placebo. The treating psychiatrist was necessarily unmasked while the research staff was masked from intervention assignment. Treatment efficacy was assessed primarily with the self-rated Liebowitz Social Anxiety Scale (LSAS-SR), administered at week 0, 1, 3, 6 and 9, also yielding a dichotomous estimate of responder status (clinically significant improvement). Before and at the last week of treatment, brain activity during an emotional face-matching task was assessed with functional magnetic resonance imaging (fMRI) and during fMRI sessions, anticipatory speech anxiety was also assessed with the Spielberger State-Trait Anxiety Inventory - State version (STAI-S). Analyses included all randomized patients with outcome data at posttreatment. This study is registered at ISRCTN, number 98890605.Findings: Between March 17th 2014 and May 22nd 2015, 47 patients were recruited. One patient in the covert group dropped out after a few days of treatment and did not provide fMRI data, leaving 46 patients with complete outcome data. After nine weeks of treatment, overt (n = 24) as compared to covert (n = 22) SSRI administration yielded significantly better outcome on the LSAS-SR (adjusted difference 21.17, 95% CI 10.69–31.65, p < 0.0001) with more than three times higher response rate (50% vs. 14%; χ2(1) = 6.91, p = 0.009) and twice the effect size (d = 2.24 vs. d = 1.13) from pre-to posttreatment. There was no significant between-group difference on anticipatory speech anxiety (STAI-S), both groups improving with treatment. No serious adverse reactions were recorded. On fMRI outcomes, there was suggestive evidence for a differential neural response to treatment between groups in the posterior cingulate, superior temporal and inferior frontal gyri (all z thresholds exceeding 3.68, p ≤ 0.001). Reduced social anxiety with treatment correlated significantly with enhanced posterior cingulate (z threshold 3.24, p = 0.0006) and attenuated amygdala (z threshold 2.70, p = 0.003) activity.Interpretation: The clinical and neural effects of escitalopram were markedly influenced by verbal suggestions. This points to a pronounced placebo component in SSRI-treatment of SAD and favors a biopsychosocial over a biomedical explanatory model for SSRI efficacy.
|
|
| 3. |
- Hjorth, Olof, et al.
(författare)
-
Expectancy effects on serotonin and dopamine transporters during SSRI treatment of social anxiety disorder : a randomized clinical trial
- 2021
-
Ingår i: Translational Psychiatry. - : Springer Nature. - 2158-3188. ; 11:1
-
Tidskriftsartikel (refereegranskat)abstract
- It has been extensively debated whether selective serotonin reuptake inhibitors (SSRIs) are more efficacious than placebo in affective disorders, and it is not fully understood how SSRIs exert their beneficial effects. Along with serotonin transporter blockade, altered dopamine signaling and psychological factors may contribute. In this randomized clinical trial of participants with social anxiety disorder (SAD) we investigated how manipulation of verbally-induced expectancies, vital for placebo response, affect brain monoamine transporters and symptom improvement during SSRI treatment. Twenty-seven participants with SAD (17 men, 10 women), were randomized, to 9 weeks of overt or covert treatment with escitalopram 20 mg. The overt group received correct treatment information whereas the covert group was treated deceptively with escitalopram, described as an active placebo in a cover story. Before and after treatment, patients underwent positron emission tomography (PET) assessments with the [C-11]DASB and [C-11]PE2I radiotracers, probing brain serotonin (SERT) and dopamine (DAT) transporters. SAD symptoms were measured by the Liebowitz Social Anxiety Scale. Overt was superior to covert SSRI treatment, resulting in almost a fourfold higher rate of responders. PET results showed that SERT occupancy after treatment was unrelated to anxiety reduction and equally high in both groups. In contrast, DAT binding decreased in the right putamen, pallidum, and the left thalamus with overt SSRI treatment, and increased with covert treatment, resulting in significant group differences. DAT binding potential changes in these regions correlated negatively with symptom improvement. Findings support that the anxiolytic effects of SSRIs involve psychological factors contingent on dopaminergic neurotransmission while serotonin transporter blockade alone is insufficient for clinical response.
|
|
| 4. |
- Hjorth, Olof, et al.
(författare)
-
Expression and co-expression of serotonin and dopamine transporters in social anxiety disorder : a multitracer positron emission tomography study
- 2021
-
Ingår i: Molecular Psychiatry. - : Springer Nature. - 1359-4184 .- 1476-5578. ; 26:8, s. 3970-3979
-
Tidskriftsartikel (refereegranskat)abstract
- Serotonin and dopamine are putatively involved in the etiology and treatment of anxiety disorders, but positron emission tomography (PET) studies probing the two neurotransmitters in the same individuals are lacking. The aim of this multitracer PET study was to evaluate the regional expression and co-expression of the transporter proteins for serotonin (SERT) and dopamine (DAT) in patients with social anxiety disorder (SAD). Voxel-wise binding potentials (BPND) for SERT and DAT were determined in 27 patients with SAD and 43 age- and sex-matched healthy controls, using the radioligands [11C]DASB (3-amino-4-(2-dimethylaminomethylphenylsulfanyl)-benzonitrile) and [11C]PE2I (N-(3-iodopro-2E-enyl)-2beta-carbomethoxy-3beta-(4'-methylphenyl)nortropane). Results showed that, within transmitter systems, SAD patients exhibited higher SERT binding in the nucleus accumbens while DAT availability in the amygdala, hippocampus, and putamen correlated positively with symptom severity. At a more lenient statistical threshold, SERT and DAT BPND were also higher in other striatal and limbic regions in patients, and correlated with symptom severity, whereas no brain region showed higher binding in healthy controls. Moreover, SERT/DAT co-expression was significantly higher in SAD patients in the amygdala, nucleus accumbens, caudate, putamen, and posterior ventral thalamus, while lower co-expression was noted in the dorsomedial thalamus. Follow-up logistic regression analysis confirmed that SAD diagnosis was significantly predicted by the statistical interaction between SERT and DAT availability, in the amygdala, putamen, and dorsomedial thalamus. Thus, SAD was associated with mainly increased expression and co-expression of the transporters for serotonin and dopamine in fear and reward-related brain regions. Resultant monoamine dysregulation may underlie SAD symptomatology and constitute a target for treatment.
|
|
| 5. |
|
|
| 6. |
- Jutterström, Sara, et al.
(författare)
-
Kvicksilver i Skinnmuddselets regleringsdamm - 30 års övervakning
- 2023
-
Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Kontrollprogrammet för Skinnmuddselets reglering har följt utvecklingen av koncentrationen av kvicksilver i vatten och fisk i Skinnmuddselet i nära 30 år, sedan kort efter dämningen och skapandet av regleringsmagasinet 1989.I kontrollprogrammets mätserier kan man tydligt se att kvicksilverhalten i fisk ökade efter dämningen för att sedan, tillsammans med kvicksilverhalten i vattnet, klinga av och lägga sig på relativt stabila nivåer. De första kvicksilvermätningarna i vattnet i Skinnmuddselet gjordes 1992, dvs. ca 3 år efter dämningen. Efter de initialt höga värdena uppmätta under 1992 och 1993 sjönk halten metylkvicksilver under en 10-års-period för att sedan plana ut.Efter denna period sågs enskilda höga kvicksilverhalter som har kunnat härledas till exempelvis hantering av flyttorv och avrinning efter torrperioder. Andra höga värden kan troligtvis ha orsakats av störningar i marken i avrinningsområdet, exempelvis avverkning eller framförande av tunga maskiner. Kvicksilverhalten i fisk undersöktes för 10-cm abborre, 25-cm abborre samt 1-kg gädda. Efter dämningen kunde man se en snabb ökning av kvicksilverhalten för 10-cm abborre i Skinnmuddselet som nådde sitt maximum 1991 (från 0.15 mg/kg till 0.65 mg/kg) följt av en avklingning och stabilisering efter ca 5-7 år.Även för 1-kg gädda ökade koncentrationerna snabbt, dock inte lika snabbt som för 10-cm abborren utan med sitt maximum 1992 (1.4 mg/kg) och också en längre avklingning av kvicksilverhalten. Efter ca 15-20 år kom kvicksilverhalterna i gädda ner till de halter som uppmättes innan dämning (0.5 mg/kg i Skinnmuddselet).I Viskasjön, som använts som referens, har kvicksilverhalterna legat stabilt för både abborre och gädda under hela kontrollprogramsperioden. Ett sidoprojekt genomfördes, där låga doser av selen tillsattes i vatten i området för att undersöka dess effekt på kvicksilver i biota, och detta har sedan följts upp inom kontrollprogrammet.Selenförsöket i Lavsjön visade tydligt en positiv påverkan av låg-lågdos selenbehandling på kvicksilverhalten i biota med en flerårig minskning av halten metylkvicksilver i abborre och gädda.1994 började flyttorv uppträda i selet. Förutom att större sjok utgör en risk för riksväg 92 och för nedre delen av Skinnmuddselet, sker ofta också en större urlakning av kvicksilver genom den ökade genomsköljningen av torven.I rapporten sammanfattas de åtgärder som utförts över åren för att hantera flyttorven i syfte att ge så lite påverkan på kvicksilverhalterna som möjligt.
|
|
| 7. |
- Spendrup, Sara, et al.
(författare)
-
Consumer attitudes towards hydroponic cultivation of vegetables - Specifically exploring the impact of the fertilisation strategy (using mineral origin or food waste as fertiliser)
- 2024
-
Ingår i: Food Quality and Preference. - 0950-3293 .- 1873-6343. ; 113
-
Tidskriftsartikel (refereegranskat)abstract
- This study explores consumer attitudes and beliefs towards hydroponics (growing without soil), as well as the willingness to eat vegetables grown using two different fertilisation strategies (mineral and food waste). The impact of food neophobia, connectedness to nature and awareness of ongoing climate change is also explored. Data were collected through a survey (October 2021) with 1,000 Swedish respondents. Less than half of the respondents were aware of hydroponics, with no differences due to gender or age. Nonetheless, education turned out to be a predictor. No differences were seen in attitude due to gender or level of education, yet a slightly more positive attitude was found among older respondents and a more positive attitude among those who had not heard about hydroponic systems before. Food neophobia and higher age only (negatively) predicted the willingness to eat food with input from food waste, whereas connectedness to nature did not predict willingness to eat vegetables from any of the two fertilising systems. A belief in climate change had a positive impact on the willingness to eat vegetables from both systems. The results revealed significant differences between the two systems, with the circular perceived as significantly more natural, environmentally friendly, more exciting, representing the future, more energy efficient, more innovative as well as more positive overall, compared to the mineral. These qualities could be used by stakeholders when communicating these new systems. The results support the understanding that hydroponics is a food technology to which consumers express positive attitudes and beliefs.
|
|
| 8. |
- Wlad, Magdalena, et al.
(författare)
-
Dorsal anterior cingulate cortex activity during cognitive challenge in social anxiety disorder
- 2023
-
Ingår i: Behavioural Brain Research. - : Elsevier. - 0166-4328 .- 1872-7549. ; 442
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Social anxiety disorder (SAD) is associated with aberrant emotional information processing while little is known about non-emotional cognitive processing biases. The dorsal anterior cingulate cortex (dACC) has been implicated in SAD neuropathology and is activated both by emotional and non-affective cognitive challenges like the Multisource Interference Task (MSIT).Methods: Here, we used fMRI to compare dACC activity and test performance during MSIT in 69 SAD patients and 38 healthy controls. In addition to patient-control comparisons, we examined whether neural activity in the dACC correlated with social anxiety, trait anxiety or depression levels.Results: The MSIT activated the dACC as expected but with no differences in task performance or neural reactivity between SAD patients and controls. There were no significant correlations between dACC activity and social or trait anxiety symptom severity. In patients, there was a significant negative correlation between dACC activity and depressive symptoms.Conclusions: In absence of affective challenge, we found no disorder-related cognitive profile in SAD patients since neither MSIT task performance nor dACC neural activity deviated in patients relative to controls.
|
|
