| 1. |
- Andrén, Per, et al.
(författare)
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Evaluating care pathways for pediatric anxiety disorders: Study protocol for a pilot randomized controlled trial of stepped care vs stratified care.
- 2023
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Konferensbidrag (refereegranskat)abstract
- Introduction: Anxiety disorders are common and debilitating in children and adolescents. Cognitive behavioral therapy (CBT), delivered both in-person and by the internet (ICBT), is efficacious, but access for young individuals is limited and it remains unclear how to structure the care pathway to maximize benefit.Methods: To inform a fully powered randomized controlled trial (RCT), a pilot RCT will be conducted where 50 youth with anxiety disorders are randomized to one out of two care pathways: stepped care or stratified care. Both pathways consist of up to two courses (A and B) of evidence-based treatment (12 weeks of either ICBT or in-person CBT). The two treatments share the same basic components (e.g., psychoeducation, exposure) but differ in their format of delivery, with in-person CBT enabling higher personalization and therapist-involvement, but to a higher cost. In stepped care, all participants are offered ICBT in course A and treatment non-responders are offered in-person CBT in course B. In stratified care, those with the highest risk of treatment non-response are offered in-person CBT in course A (~50%), while the other half are offered ICBT. As in stepped care, non-responders in stratified care are offered in-person CBT in course B. The primary endpoint is the outcome assessment after course B. The objectives of the pilot are to examine the feasibility, acceptability, and safety of the study procedures.Time plan: Recruitment for the study will begin in August 2023 and the final participant is expected to reach the primary endpoint in August 2024.
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| 2. |
- Aspvall, Kristina, et al.
(författare)
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Validity and clinical utility of the obsessive compulsive inventory - Child version : Further evaluation in clinical samples
- 2020
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Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 20:1
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Tidskriftsartikel (refereegranskat)abstract
- Background: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous disorder. Currently, the Obsessive Compulsive Inventory-Child Version (OCI-CV) is the only self-report measure that fully captures this symptom heterogeneity in children and adolescents. The psychometric properties of the OCI-CV are promising but evaluations in large clinical samples are few. Further, no studies have examined whether the measure is valid in both younger and older children with OCD and whether scores on the measure are elevated in youths with OCD compared to youths with other mental disorders. Methods: To address these gaps in the literature, we investigated the psychometric properties and validity of a Swedish version of the OCI-CV in a large clinical sample of youth aged 6-18 years with OCD (n = 434), anxiety disorders (n = 84), and chronic tic disorders (n = 45). Results: Internal consistency coefficients at the total scale and subscale level were consistent with the English original and in the acceptable range. Confirmatory factor analyses revealed an adequate fit for the original six-factor structure in both younger and older children with OCD. Correlations between total scores on the OCI-CV and the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) were small at pre-treatment (r = 0.19) but large at post-treatment (r = 0.62). Youth with OCD scored higher than those with anxiety and chronic tic disorders, and the OCI-CV was sensitive to symptom change for youth undergoing treatment for OCD. Conclusions: This Swedish version of the OCI-CV appears to be a valid and reliable measure of the OCD symptom dimensions across age groups and has good clinical utility.
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| 3. |
- Axfors, Cathrine, et al.
(författare)
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Mortality outcomes with hydroxychloroquine and chloroquine in COVID-19 from an international collaborative meta-analysis of randomized trials
- 2021
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Ingår i: Nature Communications. - : Springer Nature. - 2041-1723. ; 12:1
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Tidskriftsartikel (refereegranskat)abstract
- Substantial COVID-19 research investment has been allocated to randomized clinical trials (RCTs) on hydroxychloroquine/chloroquine, which currently face recruitment challenges or early discontinuation. We aim to estimate the effects of hydroxychloroquine and chloroquine on survival in COVID-19 from all currently available RCT evidence, published and unpublished. We present a rapid meta-analysis of ongoing, completed, or discontinued RCTs on hydroxychloroquine or chloroquine treatment for any COVID-19 patients (protocol: https://osf.io/QESV4/). We systematically identified unpublished RCTs (ClinicalTrials.gov, WHO International Clinical Trials Registry Platform, Cochrane COVID-registry up to June 11, 2020), and published RCTs (PubMed, medRxiv and bioRxiv up to October 16, 2020). All-cause mortality has been extracted (publications/preprints) or requested from investigators and combined in random-effects meta-analyses, calculating odds ratios (ORs) with 95% confidence intervals (CIs), separately for hydroxychloroquine and chloroquine. Prespecified subgroup analyses include patient setting, diagnostic confirmation, control type, and publication status. Sixty-three trials were potentially eligible. We included 14 unpublished trials (1308 patients) and 14 publications/preprints (9011 patients). Results for hydroxychloroquine are dominated by RECOVERY and WHO SOLIDARITY, two highly pragmatic trials, which employed relatively high doses and included 4716 and 1853 patients, respectively (67% of the total sample size). The combined OR on all-cause mortality for hydroxychloroquine is 1.11 (95% CI: 1.02, 1.20; I-2=0%; 26 trials; 10,012 patients) and for chloroquine 1.77 (95%CI: 0.15, 21.13, I-2=0%; 4 trials; 307 patients). We identified no subgroup effects. We found that treatment with hydroxychloroquine is associated with increased mortality in COVID-19 patients, and there is no benefit of chloroquine. Findings have unclear generalizability to outpatients, children, pregnant women, and people with comorbidities. Hydroxychloroquine and chloroquine have been investigated as a potential treatment for Covid-19 in several clinical trials. Here the authors report a meta-analysis of published and unpublished trials, and show that treatment with hydroxychloroquine for patients with Covid-19 was associated with increased mortality, and there was no benefit from chloroquine.
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| 4. |
- Björkstrand, Frida, et al.
(författare)
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Access to psychological treatment for chronic cancer-related Pain in Sweden
- 2024
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Ingår i: Scandinavian Journal of Pain. - 1877-8860. ; 24:1, s. 1-5
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Tidskriftsartikel (refereegranskat)abstract
- ObjectivesCancer related pain (CRP) is among the most frequent collateral effects of cancer, with chronic CRP, lasting at least three months, affecting >40% of cancer survivors.Evidence based treatments, including pain-focused Cognitive Behavioral Therapy(CBT) are available, but it appears that cancer patients/survivors are often poorlyinformed about CRP or the potential benefits of CBT for such pain. The present studyexamines current experience of Swedish cancer patients/survivors in relation to CRP.MethodsParticipants (N= 276; 83% female; mean age = 55.5 years, SD=11.9) were recruited to an online survey via cancer websites in Sweden, and provided information about their history of chronic CRP, and whether they received information about or treatment for CRP from a healthcare professional.ResultsParticipants had a history of breast (36%), gynecological (12%), lung (10%), colon(8%) and other forms of cancer (36%). A majority (74%) reported a history of chronicCRP and being prescribed analgesic medications (70%). Less than half (47%)received information from their healthcare provider about the risk of CRP and only 13% with chronic CRP received psychological treatment, and of these only 33% received CBT. Among those receiving psychological treatment for chronic CRP, satisfaction rates were moderate, reported as an average of 6 on a 0-10 scale (SD 2.6).ConclusionsGreater efforts are needed to raise awareness among cancer patients/survivors, andhealthcare providers about the risk of CRP and evidence-based interventions,including CBT, the first-line intervention for chronic pain. These efforts will need to be matched with increases in treatment capacity, particularly pain-focused CBT.
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| 5. |
- Björkstrand, Frida Köhler, et al.
(författare)
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Access to psychological treatment for chronic cancer-related pain in Sweden
- 2024
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Ingår i: Scandinavian Journal of Pain. - : Walter de Gruyter. - 1877-8860 .- 1877-8879. ; 24:1
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Tidskriftsartikel (refereegranskat)abstract
- Objectives Cancer-related pain (CRP) is among the most frequent collateral effects of cancer, with chronic CRP, lasting at least 3 months, affecting >40% of cancer survivors. Evidence-based treatments, including pain-focused cognitive behavioral therapy (CBT), are available, but it appears that cancer patients/survivors are often poorly informed about CRP or the potential benefits of CBT for such pain. This study examined current experience of Swedish cancer patients/survivors in relation to CRP. Methods Participants (N = 276; 83% female; mean age = 55.5 years, SD = 11.9) were recruited to an online survey via cancer websites in Sweden, and they provided information about their history of chronic CRP and whether they received information about or treatment for CRP from a healthcare professional. Results Participants had a history of breast (36%), gynecological (12%), lung (10%), colon (8%), and other forms of cancer (36%). A majority (74%) reported a history of chronic CRP and being prescribed analgesic medications (70%). Less than half (47%) received information from their healthcare provider about the risk of CRP and only 13% with chronic CRP received psychological treatment, and of these, only 33% received CBT. Among those receiving psychological treatment for chronic CRP, satisfaction rates were moderate, reported as an average of 6 on a 0-10 scale (standard deviation 2.6). Conclusions Greater efforts are needed to raise awareness among cancer patients/survivors and healthcare providers about the risk of CRP and evidence-based interventions, including CBT, the first-line intervention for chronic pain. These efforts will need to be matched with increases in treatment capacity, particularly pain-focused CBT.
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| 6. |
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| 7. |
- Cervin, Matti, et al.
(författare)
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Incompleteness and disgust predict treatment outcome in pediatric obsessive compulsive disorder
- 2021
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Ingår i: Behavior Therapy. - : Elsevier BV. - 0005-7894. ; 52:1, s. 53-63
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Tidskriftsartikel (refereegranskat)abstract
- Increasing evidence suggests that pediatric obsessive-compulsive disorder (OCD) is underpinned not only by fear but by feelings of incompleteness and disgust, but it is currently unclear whether emotion-involvement in OCD symptoms is associated with treatment response in youth with OCD. The present study investigates whether treatment outcome for youth with OCD was predicted by the degree to which fear, disgust, and incompleteness underpinned baseline OCD symptoms. Children and adolescents with OCD entering treatment for this condition (n = 111) were administered standardized OCD symptom measures and an interview designed to assess the degree of fear, incompleteness, and disgust experienced during current OCD symptoms. Follow-up assessments occurred on average 13 months after baseline with each participant coded for outcome according to internationally acknowledged change criteria for pediatric OCD. Participants who reported higher levels of incompleteness and disgust as part of their baseline OCD symptoms had poorer outcomes. Fear did not predict outcome. If replicated under controlled conditions, these results suggest that incompleteness and disgust may act as barriers to improvement in pediatric OCD and that treatment modifications that target these emotions may improve outcome for a subset of youth.
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| 8. |
- Cervin, Matti, et al.
(författare)
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Incompleteness, harm avoidance, and disgust: A comparison of youth with OCD, anxiety disorders, and no psychiatric disorder
- 2020
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Ingår i: Journal of Anxiety Disorders. - : Elsevier BV. - 1873-7897 .- 0887-6185. ; 69
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Tidskriftsartikel (refereegranskat)abstract
- Psychological models of pediatric obsessive-compulsive disorder (OCD) place a heavy emphasis on harm avoidance as a maintaining factor and target for treatment. Incompleteness and disgust may also play a role in pediatric OCD but remain under studied. Youth with OCD (n=100), anxiety disorders (n=96), and no psychiatric disorder (n=25) completed self-report measures of trait-level incompleteness, harm avoidance, and disgust and current symptoms of OCD, anxiety, and depression. Group differences and associations between emotions, symptoms, and pre- to post-treatment change in overall OCD severity were examined. Youth with OCD and anxiety disorders scored higher on harm avoidance and disgust than youth with no psychiatric disorder. Youth with OCD scored higher on incompleteness than youth with anxiety disorders and youth with no psychiatric disorder. Harm avoidance showed unique associations to self-reported symptoms of OCD, anxiety, and depression while incompleteness was uniquely related to OCD and disgust to anxiety. Within the OCD sample, incompleteness and harm avoidance were differentially related to the major OCD symptom dimensions, and change in incompleteness was uniquely related to pre- to post-treatment change in OCD severity. Trait-level incompleteness appears to play a central role in pediatric OCD and studies investigating its direct involvement in symptoms and associations with treatment outcome are needed. The role of disgust in relation to pediatric OCD remains unclear.
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| 9. |
- Cervin, Matti, et al.
(författare)
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Involvement of fear, incompleteness, and disgust during symptoms of pediatric obsessive-compulsive disorder
- 2021
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Ingår i: European Child & Adolescent Psychiatry. - : Springer Science and Business Media LLC. - 1435-165X .- 1018-8827. ; 30, s. 271-281
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Tidskriftsartikel (refereegranskat)abstract
- Fear has been assigned a central role in models of obsessive–compulsive disorder (OCD), but empirical investigations into the emotions that underpin OCD symptoms are few, especially in pediatric samples. Using validated, clinician-led structured interviews, 124 youth with OCD reported on the presence and severity of symptoms across the main symptom dimensions of OCD (aggressive, symmetry, contamination) and the degree to which fear, incompleteness, and disgust accompanied these symptoms. For comparison purposes, the degree of fear, incompleteness, and disgust during symptoms was obtained also from youth with social anxiety disorder (SAD; n = 27) and generalized anxiety disorder (GAD; n = 28). Participants with OCD reported that all three emotions were involved in their symptoms; however, fear was most strongly linked to aggressive symptoms, incompleteness to symmetry symptoms, and disgust to contamination symptoms. Incompleteness differentiated youth with OCD from those with SAD and GAD. No differences for these emotions were found for youth with OCD with versus without the tic-disorder subtype or comorbid autism. A positive association between incompleteness and self-reported hoarding emerged among youth with OCD. Further studies of the emotional architecture of pediatric OCD, and its relationship to etiology and treatment, are warranted.
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| 10. |
- Cervin, Matti, et al.
(författare)
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Measuring harm avoidance, incompleteness, and disgust in youth with obsessive-compulsive disorder and anxiety disorders
- 2019
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Ingår i: Journal of Obsessive-Compulsive and Related Disorders. - : Elsevier BV. - 2211-3649. ; 22
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Tidskriftsartikel (refereegranskat)abstract
- Alongside harm avoidance, incompleteness and disgust have been proposed as important emotion-related motivators underlying the symptoms of obsessive-compulsive disorder (OCD). The aim of the present study was to investigate the validity of self-report and interview-based measures of these constructs in youth with OCD (N=100) and anxiety disorders (N=96). All participants completed self-report measures of trait-level harm avoidance and incompleteness (Obsessive-Compulsive Trait Core Dimensions Questionnaire; OCTCDQ) and a measure of trait-level disgust propensity (Disgust Emotion Scale for Children; DES-C). Participants with OCD were also interviewed about the role that harm avoidance, incompleteness, and disgust played in their moment-to-moment experience of symptoms using a modified version of the Obsessive-Compulsive Core Dimensions Interview (OC-CDI). All measures exhibited theoretically sound factor structures and good internal consistency. Self-report scores for harm avoidance and incompleteness were significantly correlated with scores on the interview-based measure of these emotions in current OCD symptoms. A weaker relationship was observed for disgust. The OCTCDQ, DES-C, and OC-CDI appear to be valid for use with clinically-referred youth, and may be useful when studying the etiology, phenomenology, and course of pediatric OCD. More work is needed to better understand how trait-level aspects of disgust relate to moment-to-moment experiences of disgust in OCD.
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