| 1. |
- Andersson, Peter, et al.
(författare)
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Changes in Body Mass Index During Mandatory Forensic Psychiatric Care : Findings from a Long-Term (2009-2020) Cohort Study Based on Swedish Registry Data
- 2024
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Ingår i: International Journal of Forensic Mental Health. - : Routledge. - 1499-9013 .- 1932-9903. ; 23:2, s. 106-116
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Tidskriftsartikel (refereegranskat)abstract
- Lifespan is reduced by approximately 15 years in individuals suffering from severe mental illnesses such as schizophrenia spectrum disorders. Contributing to this is an increased prevalence of metabolic syndrome, an assortment of factors that confer risk of diabetes type 2 and cardiovascular disease. Body Mass Index (BMI) is predictive of metabolic syndrome. Previous research indicates that the BMI of incarcerated individuals not suffering from a major mental disorder increase during incarceration, especially amongst females. However, information on the development of BMI during forensic psychiatric care is scarcer, and follow-up periods have been short. Thus, the authors extracted data from the Swedish National Forensic Psychiatric Register regarding the longitudinal development of BMI in 3389 individuals who received court mandated forensic psychiatric care in Sweden during 2009-2020. A significant increase in BMI by 1.1% per year was observed during the first four years of care. After this, changes were no longer significant. Factors associated with a larger increase in BMI were female gender, being prescribed antipsychotics, young age at admission, receiving outpatient care, and access to an external support person. There was an inverse association between BMI and symptom severity. Substantial heterogeneity was observed in longitudinal changes in individual BMI and in comparisons between individuals receiving care at different clinics.
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| 2. |
- Andersson, Peter, et al.
(författare)
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Implementation and evaluation of Illness Management and Recovery (IMR) in mandated forensic psychiatric care-Study protocol for a multicenter cluster randomized trial
- 2022
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Ingår i: Contemporary Clinical Trials Communications. - : Elsevier. - 2451-8654. ; 27
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: Forensic mental health care is hampered by lack of evidence-based treatments. The Swedish forensic mental health population consists of patients suffering from severe illnesses such as schizophrenia and bipolar disorders, similar to populations in international studies. Illness Management and Recovery (IMR) is an intervention for patients with serious mental illness, based on psychoeducational, cognitive-behavioral and motivational components. The purpose is to strengthen participants' illness management skills and recovery.Objective: To test effectiveness of IMR within forensic mental health by comparing it to treatment as usual.Method: This is a cluster-randomized controlled trial. Patients in forensic mental health inpatient units are randomized to an active (IMR) or a control condition (treatment as usual). Clustering of patients is based on ward-units where inpatients are admitted. Patients in the active condition receive two group and one individual IMR sessions per week. The treatment phase is estimated to last nine months. Outcomes include illness related disability, illness management skills, sense of recovery, hope, mental health and security related problems. Outcomes are measured at baseline, four months into treatment, at treatment completion and at three months follow-up. Staff experiences of implementing IMR will be explored by a self-report measure and semi-structured interview based on Normalization Process Theory.Ethics and dissemination: The study is approved by the Swedish Ethical Review Authority (Registration No. 2020-02046). Participation will be voluntary based on written informed consent. Results will be disseminated through peer-reviewed articles and conferences. The study is registered in the US registry of clinical trials (NCT04695132).
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| 3. |
- Grann, Martin, et al.
(författare)
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Methodological development : structured outcome assessment and community risk monitoring (SORM)
- 2005
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Ingår i: International Journal of Law and Psychiatry. - : Elsevier BV. - 0160-2527 .- 1873-6386. ; 28:4, s. 442-456
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Tidskriftsartikel (refereegranskat)abstract
- This paper describes an effort to develop a clinical tool for the continuous monitoring of risk for violence in forensic mental health clients who have left their institutions and who are dwelling in the community on a conditional release basis. The model is called Structured Outcome Assessment and Community Risk Monitoring (SORM). The SORM consists of 30 dynamic factors and each factor in SORM is assessed in two ways: The current absence, presence or partial och intermittent presence of the factors, which is an actuarial (systematized and 'objective') assessment. Secondly, the risk effect, i.e. whether the presence/absence of factors currently increases, decreases or is perceived as unrelated to violence risk, is a clinical (or impressionistic) assessment. Thus, the factors considered via the SORM can be coded as risk factors or protective factors (or as factors unimportant to risk of violence) depending on circumstances that apply in the individual case. Further, the SORM has a built-in module for gathering idiographical information about risk-affecting contextual factors. The use of the SORM and its potential as a risk monitoring instrument is illustrated via preliminary data and case vignettes from an ongoing multicenter project. In this research project, patients leaving any of the 9 participating forensic hospitals in Sweden is assessed at release on a variety of static background factors, and the SORM is then administered every 30 days for 2 years.
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| 4. |
- Larsen, Anna, et al.
(författare)
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Bulimia symptoms in Czech youth : prevalence and association with internalizing problems
- 2020
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Ingår i: Eating and Weight Disorders. - : Springer. - 1124-4909 .- 1590-1262. ; 25, s. 1543-1552
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Tidskriftsartikel (refereegranskat)abstract
- Objective Although clinical studies suggest that bulimia symptoms are common in youth, research on the prevalence of such symptoms and of their association with comorbid internalizing problems in the general population has been limited. This study aimed to evaluate the gender-specific prevalence of bulimia symptoms in Czech youth and explored the association between a clinical level of self-reported bulimia symptoms (CLBS) and internalizing problems by gender, controlling for age, socio-economic status and puberty status. Method The study was conducted on a representative national sample of Czech youth (N = 4430, 57.0% female) using self-report scales. Multivariate analysis of covariance (MANCOVA) was used to examine the associations. Results The 3-month CLBS prevalence was higher in girls (11.4%) than in boys (3.8%) and in both genders a CLBS was associated with higher levels of comorbid internalizing problems. Discussion Timely recognition of bulimia symptoms and associated risk factors is important for early prevention and intervention strategies.
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| 5. |
- Saunderson, Jonathan Marshall, et al.
(författare)
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Posttraumatic Stress and Perceived Interpersonal Provocation in Adolescents
- 2023
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Ingår i: Journal of Interpersonal Violence. - : Sage Publications. - 0886-2605 .- 1552-6518. ; 38:3-4, s. 3191-3214
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To examine the impact of posttraumatic stress on the choice of responses to and attribution of intentionality in peer provocation in adolescent boys and girls. Methods: A sample of 2678 adolescents from Northern Russia, aged 13-17 years (59.3% female; 95.7% ethnic Russian) completed self-reports on posttraumatic stress and rated hypothetical peer provocation scenarios that teenagers can encounter in their daily lives. Results: Adolescents with clinically significant levels of posttraumatic stress symptoms (n=184 (6.8%)) reported a different pattern of reactions to peer provocation as compared to all other adolescents. Boys and girls with high levels of posttraumatic symptoms reported that they would be less likely to discuss conflict situations and more likely to react with physical aggression. Compared to their male counterparts, girls with high levels of posttraumatic stress symptoms were more likely to endorse hostile intentions, avoid provocations, and were less likely to endorse verbally aggressive responses. In provocation scenarios that involved physical aggression, girls with high levels of posttraumatic stress symptoms were less likely to endorse verbal aggressive responses and more likely to endorse physically aggressive responses than girls without clinically significant levels of posttraumatic symptoms. Girls with high levels of posttraumatic stress symptoms were also more likely to avoid socially aggressive situations than non-traumatized girls, whereas boys had an opposite pattern. Conclusions: High levels of posttraumatic stress symptoms may play a significant role in the endorsement of aggressive reactions in conflicts with peers and patterns of reactions may be gender-specific. A history of posttraumatic stress should be carefully evaluated in children and adolescents seeking treatment for aggressive behavior.
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| 6. |
- Sturidsson, Knut
(författare)
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Measures in forensic psychiatry : risk monitoring and structured outcome assessment
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Background: Violent offenders suffering from a major mental disorder (MMD) are sometimes publicly portrayed as particularly dangerous. In reality however, only a small fraction of those inflicted with a MMD do commit any violent offence. The present thesis focuses on means to monitor risk of violence and to some extent measure the content and outcome of forensic psychiatric care. The overall aim of this thesis was to investigate forensic psychiatric risk assessments from a broad perspective, covering outcomes not only as violent recidivism or not. Method: Part of the work presented in this thesis (papers I and II) deals with an instrument for structured outcome measurement and community risk monitoring (SORM) used for a prospective follow-up of patients discharged from forensic psychiatric care into the community. It describes the development and testing of the SORM (paper I). By using the SORM, clinicians perceptions of which factors increase or decrease the risk of violence among out-patients is explored (paper II). Paper III explores how available patient time is used in forensic psychiatry. Paper IV describes the development of a local quality register at a forensic clinic. Results: The inter-rater reliability of the factors in SORM as measured by calculating Cohen s kappa was on average = 0.88. The SORM was also used to study clinicians perception on which factors increased or decreased the risk of violence among former forensic psychiatric patients. Most emphasis was put on: lack of insight, lack of treatment motivation, psychiatric institutional treatment, professional support contacts, and substance misuse. Least weight was given to physical healthcare, children, occupational training and employment services, partner, and impaired daily functioning. In paper III results showed that 122 different activities occurred in a forensic psychiatric clinic. The activities were grouped into 5 categories, sleep and rest, unstructured activities, daily routines, structured activities, and treatment. Average time use in the different categories was 9.07 hours of sleep and rest, 8.60 hours of unstructured activities, 4.42 hours of daily routines, 1.60 hours of structured activities, and 0.31 hours (18.6 minutes) of treatment. No significant differences in time use on treatment between subgroups of individuals characterised by diagnoses of substance use, psychotic disorders, personality disorder, or assessed as high or low violence risk were found. Paper IV reports on the development of and findings from a local quality register in forensic psychiatry. Findings from the quality register are that about 70 percent of the patients rate their quality of life as high. Also, close to 90 percent of the patients rate their health as 50 or higher on VAS-scale ranging from zero to one hundred. A further finding is that the administration of atypical anti-psychotic medication is associated with a higher BMI. Conclusions: The use of structured models for risk assessment, risk monitoring and also for measuring outcome is called for. An increase in transparency regarding measures used in forensic psychiatry with regards to both risk assessment and risk monitoring and the actual contents of the care provided is much needed to provide a basis for the furthering of research on risk factors as well as research on forensic psychiatric treatment. To widen and deepening our understanding of the process of violent recidivism, and ultimately treating major mental disorder, more data has to be gathered and analysed. Quality registers, which are called for on other grounds, could easily form a base for gathering more data and knowledge to inform risk assessment research.
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