| 1. |
- Bulik, Cynthia M., et al.
(författare)
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SUBJECTIVE EXPERIENCES OF ANOREXIA NERVOSA IN PATIENTS WITH HIGH VS LOW ANOREXIA NERVOSA POLYGENIC RISK
- 2023
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Ingår i: European Neuropsychopharmacology. - : Elsevier. - 0924-977X .- 1873-7862. ; 75:Suppl. 1, s. S14-S14
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Recent genome-wide association studies (GWAS) suggest that genetic factors play a key role in its development and expression and that anorexia nervosa (AN) might have both psychiatric and metabolic underpinnings. One hypothesis is that those with high genetic vulnerability to AN may experience negative energy balance (NEB) (i.e., expending more energy than you consume) in a positive manner, rendering self-starvation and excessive exercise exceptionally reinforcing. This “paradoxical” response to NEB may also complicate recovery. In the Polygenic risk of Anorexia nervosa and its Clinical Expression (PACE) study, we explored differences in clinical and phenomenological/experiential phenotypes (i.e., how patients reported their experience of illness) in 10 individuals with AN who were in the top decile of AN polygenic risk (PRS) and 10 individuals with AN who were in the lowest decile in the Swedish subsample of the Anorexia Nervosa Genetics Initiative (ANGI) study. We interviewed the participants in a double-blind study design using a structured interview guide focusing on the experience of AN, including experiences of NEB (e.g., hunger, satiety, dietary restriction), the development of symptoms, as well as the reactions of others including family members and treatment providers to patients’ experiences of NEB. All interviews have been coded and the blind will be broken in May 2023 at which point group comparisons will be analyzed. This is the first study, to our knowledge, to explore experiential impact of genetic risk. Findings may aid in understanding risk, clinical course, and individual experience of AN and contribute suggestions for tailoring interventions with input from genetic risk profiles.
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| 2. |
- 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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| 3. |
- Lindstedt, Katarina, 1979-, et al.
(författare)
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A life put on hold : adolescents' experiences of having an eating disorder in relation to social contexts outside the family
- 2018
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Ingår i: Journal of Multidisciplinary Healthcare. - : DOVE Medical Press Ltd.. - 1178-2390. ; 11, s. 425-437
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Tidskriftsartikel (refereegranskat)abstract
- Background: As suffering from an eating disorder often entails restrictions on a person's everyday life, one can imagine that it is an important aspect of recovery to help young people learn to balance stressful demands and expectations in areas like the school environment and spare-time activities that include different forms of interpersonal relationships.Purpose: The aim of the present study was to investigate how adolescents with experience from a restrictive eating disorder describe their illness and their time in treatment in relation to social contexts outside the family.Patients and methods: This qualitative study is based on narratives of 15 adolescents with experience from outpatient treatment for eating disorders with a predominately restrictive symptomatology, recruited in collaboration with four specialized eating-disorder units. Data were explored through inductive thematic analysis.Results: The adolescents' descriptions of their illness in relation to their social contexts outside the family follow a clear timeline that includes narratives about when and how the problem arose, time in treatment, and the process that led to recovery. Three main themes were found: 1) the problems emerging in everyday life (outside the family); 2) a life put on hold and 3) creating a new life context.Conclusion: Young people with eating disorders need to learn how to balance demands and stressful situations in life, and to grasp the confusion that often preceded their illness. How recovery progresses, and how the young people experience their life contexts after recovery, depends largely on the magnitude and quality of peer support and on how school and sports activities affect and are affected by the eating disorder.
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| 4. |
- Lindstedt, Katarina, 1979-
(författare)
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A life put on hold : inside and outside perspectives on illness, treatment, and recovery in adolescents with restrictive eating disorders
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to study adolescents with restrictive eating disorders in relation to illness, treatment, and recovery from an inside and outside perspective. Studies I and II are based on data from a national quality register for eating-disorder treatment. Studies III and IV are based on interviews with adolescents previously treated in outpatient care for a restrictive eating disorder. The results showed that 55% of the adolescents were in remission at the end of treatment, and 85% were within a healthy weight range. The average treatment duration was 15 months. Over the years 1999–2014, remission rates and weight recovery increased, whereas treatment duration decreased. Young patients who received mainly family-based treatment had the highest probability of achieving remission at one-year followup, but the patients themselves were most satisfied with individual therapy. The interviews with the adolescents revealed that they often felt a strong ambivalence during the first treatment sessions, both regarding being defined as sick and the involvement of their parents. In retrospect they believed that family involvement was important, but that individual treatment sessions were crucial. The informants highlighted that trust in the therapist was the key to successful treatment. The adolescents’ narratives drew a picture of a life that was “put on hold” during the time of illness, as their involvement in social contexts outside the family was strongly influenced. It was in these contexts that their problems first became visible, and the quality of their interpersonal relationships played a great role in the recovery process. The results suggest that treatment for adolescents with restrictive eating disorders should be better adapted to changed social structures and patients’ individual contexts – a relevant area for future research.
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| 5. |
- Lindstedt, Katarina, 1979-, et al.
(författare)
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Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample : characteristics and treatment outcome
- 2017
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Ingår i: Journal of Eating Disorders. - : BioMed Central. - 2050-2974. ; 5:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Anorexia Nervosa (AN) destroys developmentally important early years of many young people and knowledge is insufficient regarding course, treatment outcome and prognosis. Only a few naturalistic studies have been conducted within the field of eating disorder (ED) research. In this naturalistic study we included adolescents with AN or subthreshold AN treated in outpatient care, and the overall aim was to examine sample characteristics and treatment outcome. Additional aims were to examine potential factors associated with remission as an outcome variable, and possible differences between three time periods for treatment onset.Methods: Participants were identified through the Swedish national quality register for eating disorder treatment (SwEat), in which patients are registered at treatment onset and followed up once a year until end of treatment (EOT). Inclusion criteria were: medical or self-referral to one of the participating treatment units between 1999 and 2014, 13-19 years of age at initial entry into SwEat and diagnosed with AN or subthreshold AN. The total sample consisted of 3997 patient from 83 different treatment units.Results: The results show that 55% of the participants were in remission and approximately 85% were within a healthy weight range at EOT. Of those who ended treatment according to plan, 70% were in remission and 90% within a healthy weight range. The average treatment duration was approximately 15 months. About one third of the patients terminated treatment prematurely, which was associated with a decreased chance of achieving remission. Remission rates and weight recovery increased over time, while treatment duration decreased. Considering treatment outcome, the results did not show any differences between patients with AN or subthreshold AN.Conclusions: The present study shows a relatively good prognosis for adolescent patients with AN or subthreshold AN in routine care and the results indicate that treatment for adolescents with ED in Sweden has become more effective over the past 15 years. The results of the present study contribute to the scope of treatment research and the large-scale naturalistic setting secures the generalizability to a clinical environment. However, more research is needed into different forms of evidence, new research strategies and diversity of treatment approaches.
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| 6. |
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| 7. |
- Lindstedt, Katarina, 1979-, et al.
(författare)
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Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample : Treatment interventions and patient satisfaction
- 2020
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Ingår i: Child and Adolescent Psychiatry and Mental Health. - : BioMed Central. - 1753-2000. ; 14:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Despite major research efforts, current recommendations of treatment interventions for adolescents with anorexia nervosa are scarce, and the importance of patient satisfaction for treatment outcome is yet to be established. The overall aim of the present study was to examine treatment interventions and patient satisfaction in a naturalistic sample of adolescents with anorexia nervosa or subthreshold anorexia nervosa and possible associations to outcome defined as being in remission or not at treatment follow-up.Methods: Participants were identified through the Swedish national quality register for eating disorder treatment (SwEat). The samples consisted of 1899 patients who were follow-up registered 1 year after entering treatment and 474 patients who had completed a 1-year patient satisfaction questionnaire. A two-step cluster analysis was used for identifying subgroups of patients who received certain combinations and various amounts of treatment forms.Results: Patients who received mainly family-based treatment and/or inpatient care were most likely to achieve remission at 1-year follow-up, compared to patients in the other clusters. They were also younger, in general. Individual therapy was the most common treatment form, and was most appreciated among the adolescents. At 1-year follow-up, many patients reported improvements in eating habits, but far fewer reported improvements regarding cognitive symptoms. Overall, the patients rated the therapist relationship in a rather positive way, but they gave quite low ratings to statements associated with their own participation in treatment.Conclusions: The results indicate that young adolescents who receive mainly family-based treatment and/or inpatient care respond more rapidly to treatment compared to older adolescents who receive mainly individual therapy or mixed treatment interventions. At 1-year follow-up, the adolescents reported improvements in behavioral symptoms and seemed quite satisfied with the therapist relationship.
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| 8. |
- Lindstedt, Katarina, 1979-, et al.
(författare)
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Being me and being us : adolescents' experiences of treatment for eating disorders
- 2015
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Ingår i: Journal of Eating Disorders. - : BioMed Central. - 2050-2974. ; 3:9
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: This qualitative study addresses adolescents' perception of treatment for eating disorders. The importance of involving parents in treatment of young people with eating disorders, especially young people with Anorexia Nervosa, is emphasized in a number of studies. Even so, this form of treatment does not work for everybody, not even within a limited diagnostic group. Previous research has revealed that many young people are not entirely satisfied with their treatment. However, there is a lack of knowledge concerning the perspectives of adolescents in outpatient treatment, whose treatment often involves family. The aim of the present study was to investigate how young people with experience from adolescent outpatient treatment for eating disorders, involving family-based and individual based interventions, perceive their time in treatment.METHODS: This study was conducted using a hermeneutic phenomenological approach. Fifteen participants were recruited in collaboration with four specialized eating disorder units and interviewed with the purpose to gather narratives.RESULTS: The analysis revealed that the adolescents sometimes felt more or less forced into treatment, and strong ambivalent feelings about if and how to participate in treatment permeated the adolescents' narratives. The common factors which emerged in the narratives were assembled under the two major themes: Having to involve family in treatment - in one way or another and Making progress in treatment - a matter of trust.CONCLUSIONS: It is of great importance to involve family in treatment in order to understand the problems of the adolescents in their context and be able to take advantage of the resource that parents constitute. However, in certain situations, it is necessary to prioritise individual treatment interventions so that instead of sorting out difficult family situations the therapist focuses on enhancing the young people's resilience, thus enabling them to tackle problematic situations in life.
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