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1.
  • Andrén, Per, et al. (författare)
  • Evaluating care pathways for pediatric anxiety disorders: Study protocol for a pilot randomized controlled trial of stepped care vs stratified care.
  • 2023
  • 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.
  • Armstrong, Gabrielle, et al. (författare)
  • Factors associated with internalizing and externalizing symptoms in a clinical sample of youth with misophonia
  • 2023
  • Ingår i: Journal of Obsessive-Compulsive and Related Disorders. - 2211-3649. ; 39
  • Tidskriftsartikel (refereegranskat)abstract
    • Misophonia is an often chronic condition characterized by strong, unpleasant emotional reactions when exposed to specific auditory or visual triggers. While not currently defined within existing classification systems, and not clearly fitting within the framework of extant psychiatric conditions, misophonia has historically been studied most frequently within the context of obsessive-compulsive and related disorders. Internalizing and externalizing psychiatric symptoms are common in misophonia, but specific factors that confer risk for these symptoms remain unknown. The present cross-sectional study examined whether sensory sensitivity and cognitive emotion regulation facets are associated with co-occurring internalizing and externalizing symptoms in 102 youth with misophonia aged 8–17 years (Nfemales = 69). Participants completed self-report assessments of misophonia severity, sensory sensitivity, cognitive emotion regulation, and emotional-behavioral functioning. In the final model, controlling for all variables, multiple linear regression analyses revealed that sensory sensitivity and age were significant predictors of internalizing symptoms, while sensory sensitivity and the other-blame cognitive emotion regulation facet were significant predictors of externalizing symptoms. Further, findings demonstrated that the positive reappraisal cognitive emotion regulation facet moderated the effect of misophonia severity on internalizing symptoms. Results highlight a strong, consistent relation between sensory sensitivities (beyond sound sensitivity) and psychiatric symptoms in misophonic youth. Further research is necessary to determine mechanisms and clinical variables impacting internalizing and externalizing symptoms within youth with misophonia.
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3.
  • Aspvall, Kristina, et al. (författare)
  • Validity and clinical utility of the obsessive compulsive inventory - Child version : Further evaluation in clinical samples
  • 2020
  • Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 20:1
  • 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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4.
  • Barcaccia, Barbara, et al. (författare)
  • Mindfulness, Self-Compassion and Attachment: A Network Analysis of Psychopathology Symptoms in Adolescents
  • 2020
  • Ingår i: Mindfulness. - : Springer Science and Business Media LLC. - 1868-8535 .- 1868-8527. ; 11, s. 2531-2541
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesMindfulness, positive self-related attitudes and secure attachment have been shown to protect against psychopathology during adolescence, but it is unknown how these factors are related to each other and which are most strongly linked to psychopathology symptoms.MethodsA cross-sectional research design was used with a large sample of adolescents (aged 14 to 18 years; n = 1660) that completed validated measures of mindfulness, self-related attitudes, attachment, depression, anxiety and anger. We employed network analytic methods in order to better understand associations among these variables.ResultsMindfulness was linked to lower levels of depression and anxiety while self-reassurance was linked to lower levels of anxiety and higher levels of anger. Self-hate was linked to depression. In turn, self-reassurance and self-hate were differentially linked to facets of attachment, particularly trust in parents.ConclusionsInterventions combining mindfulness practice and clinical techniques based on attachment theory, which operate on different psychological levels, may improve self-related attitudes, which in turn can help ameliorate depression and anxiety in adolescents. Alternatively, interventions directly targeting self-related attitudes, particularly self-reassurance and self-inadequacy, hold promise to achieve positive effects on mental health among adolescents.
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5.
  • Barcaccia, Barbara, et al. (författare)
  • Purpose in life as an asset for well-being and a protective factor against depression in adolescents
  • 2023
  • Ingår i: Frontiers in Psychology. - 1664-1078. ; 14
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose in life, which is a central component of the eudaimonic paradigm of well-being, has been sparsely examined in adolescence. This is unfortunate as adolescence is characterised by identity development and is a key period for the onset of mental disorders. To inform future research on well-being and purpose in life in adolescents, we drew factors from several fields of research, including mental health and psychological factors, and explored which factors were most strongly associated with purpose in life. Data were collected in a sample of 444 Italian adolescents (Mage = 16.30 [SD = 1.50], range: 14 to 20 years; 58% girls) and associations with mental health (stress, anxiety, depression, anger), psychological traits (mindfulness, self-hate, self-inadequacy, self-reassurance, isolation), and sociodemographic variables (age, sex, place of birth) were examined. Regression, dominance, and network analyses indicated that a stronger sense of purpose in life was associated with lower depressive symptoms, higher levels of self-reassurance, and being born in Italy. Our findings suggest that purpose in life is an important asset for well-being in adolescents and may protect against depression. Future longitudinal and/or experimental research should examine the potential protective role of purpose in life in relation to adolescent depression and how self-reassurance and sociodemographic factors (e.g., immigrant background) are involved.
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6.
  • Barcaccia, Barbara, et al. (författare)
  • Whom are you mad at? : Anger and revenge in obsessive-compulsive symptoms during adolescence
  • 2022
  • Ingår i: Journal of Obsessive-Compulsive and Related Disorders. - : Elsevier BV. - 2211-3649. ; 35
  • Tidskriftsartikel (refereegranskat)abstract
    • Previous research has extensively explored the role of anxiety, disgust, guilt, and shame in obsessive-compulsive (OC) symptoms, but few studies have investigated anger and associated vengeful motivations, especially during adolescence, when OC symptoms typically onset. This is unfortunate as anger is a key human emotion linked to various aspects of behaviour. Our aim was to explore how anger and revenge motivations were associated with the most common OC subtypes in adolescents. Participants were 1035 high school students who completed a battery of questionnaires including the Obsessive-Compulsive Inventory-Child Version, the Children's Depression Inventory, the Transgression-Related Interpersonal Motivations Inventory-18 and the State-Trait Anger Expression Inventory for children and adolescents. Even when accounting for different aspects of anger, TRIMs and depression, trait anger (i.e., a stable tendency to experience anger) was uniquely associated with all types of OC symptoms (doubting/checking, obsessing, and ordering). Unique associations were also found between revenge motivation and doubting/checking and obsessing. Our findings show that adolescents with high OC symptoms may experience not only intense anger, but also vengeful feelings and motivations. Future research should examine how anger, vengeful motivations and OC symptoms co-develop over time. Clinicians should be aware that anger and vengeful motivations can be part of the clinical presentation of OCD, which can inform assessment and treatment.
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7.
  • Billot, Moana, et al. (författare)
  • Network Analysis Reveals Unique Associations of Mindfulness and Distress with Immunity in Māori and Non-Māori New Zealanders
  • 2023
  • Ingår i: Mindfulness. - 1868-8535. ; 14, s. 2211-2223
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivesA healthy immune system is required to protect against viral infection and ensure the efficacy of vaccines. Psychological distress can threaten immune resilience, while mindfulness practices can be protective. In New Zealand, Māori experience significantly higher levels of distress compared to non-Māori. The aim of this study was to explore the role of ethnicity in the relations among immunity, depression, anxiety, stress, and mindfulness relate to each other.MethodNetwork analysis was used to explore unique relations among distress (depression, anxiety, stress), mindfulness facets, and immune status in matched (age, ranging from 19 to 88 years, sex, and self-classified socio-economic status) samples of Māori (n = 195) and non-Māori (n = 195) participants from New Zealand.ResultsThe networks of distress, mindfulness, and immune status were significantly different between Māori and non-Māori participants. The mindfulness facets Describe and Act with Awareness were more strongly positively linked in Māori, and Non-judge and Depression more strongly negatively linked in Māori, while Describe and Non-judge were more strongly positively linked in non-Māori. For both Māori and non-Māori, similarities included a negative link between anxiety and immune status, strong positive links between the distress variables, and positive links between the mindfulness facets of Non-judge and Act with Awareness, Observe and Non-React, and Observe and Describe.ConclusionsThese findings suggest that anxiety is strongly linked to poor immunity across both Māori and non-Māori in New Zealand while networks of mindfulness and distress also demonstrated differences unique for each of these groups. Both similarities and differences between Māori and non-Māori should be considered when developing targeted interventions to improve physical and mental health in New Zealand.
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8.
  • Breeze, Catherine, et al. (författare)
  • Unique contributions of anxiety, stress and depression to immunity: A cross-cultural investigation
  • 2024
  • Ingår i: Journal of Affective Disorders Reports. - 2666-9153. ; 15
  • Tidskriftsartikel (refereegranskat)abstract
    • While immunity and psychological distress are strongly associated, studies seldom consider how different types of distress relate to immune functioning. The literature tends to emphasis the impact of stress on immunity. The present cross-sectional study estimated the unique contributions of depression, anxiety, and stress on immune function in culturally diverse samples of adults from Italy, New Zealand and India. Participants were Italian (n = 1061), New Zealand (n = 1037), and Indian (n = 384) volunteers. Stepwise multiple linear regression and dominance analysis were used to analyse differences in immunity uniquely explained by anxiety, depression, and stress. While samples from the three countries differed significantly, anxiety consistently explained the greatest proportion of differences in immunity. After accounting for the effect of anxiety, stress and depression explained only negligible variation in immune functioning. This association of anxiety with immune functioning was consistent across three different countries and this unique impact was further confirmed by the results of dominance analysis. These findings suggest a clear link between anxiety and immunity, which advances the prevailing stress-disease model and foster further experimental and longitudinal research into the impact of anxiety on immunity.
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9.
  • Bångstad, Amanda, et al. (författare)
  • Perceived causal symptom network of adolescent mental health issues
  • 2022
  • Ingår i: Journal of Child and Adolescent Mental Health. - 1728-0583. ; 34:1-3, s. 101-114
  • Tidskriftsartikel (refereegranskat)abstract
    • Adolescent mental health is difficult to capture in categories such as depression or specific anxiety disorders. An alternative is to approach psychiatric symptoms as causal networks, potentially revealing feedback loops that maintain a pathological state. One approach to creating such networks, implemented in the PECAN methodology, is to ask adolescents about their perceptions of the causes to their symptoms. For this purpose, a transdiagnostic item list was created, and adolescents who screened positive for depression (N = 55) completed twice in two weeks a survey quantifying perceptions of causality between their mental health problems. A network that was averaged across all participants was reliable and revealed three strong feedback loops: a first loop running through stress, insomnia, fatigue, procrastination, and back to stress; a second loop between stress and overthinking; and a third loop between stress and procrastination. Although all adolescents in the study screened positive for depression, symptoms of depression were not particularly central to the network. Instead, the most central symptoms were procrastination and overthinking. The average test-retest reliability for individual networks was low, limiting clinical application. In conclusion, PECAN was found to be reliable and useful when creating a group-level network of adolescent mental health problems. While informative at a group level, the method should be improved before it can be used to inform treatment at the individual level.
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10.
  • Cardeña, Etzel, et al. (författare)
  • A Network Analysis to Identify Associations between PTSD and Dissociation among Teenagers
  • 2022
  • Ingår i: Journal of Trauma & Dissociation. - : Informa UK Limited. - 1529-9732 .- 1529-9740. ; 23:4, s. 432-450
  • Tidskriftsartikel (refereegranskat)abstract
    • We conducted a network analysis of measures of dissociation and posttraumatic symptoms (PTS) with a varied sample of adolescents (N = 312), some of them previously exposed to war scenarios. The global measure of dissociation (A-DES) was uniquely linked to the arousal PTS symptom cluster (CRIES-13), in particular sleep problems, but not to the reexperiencing and avoidance clusters. Three of four (i.e., depersonalization/derealization, amnesia, mental partition/compartmentalization) dissociation clusters were uniquely linked to PTS severity, but not absorption. The results with the pooled groups were generally representative of both groups. The DP/DR relation to PTS was based on data from both samples, whereas the link between amnesia and partition/parts might have been driven by the normative group, although the refugee sample had significantly higher scores in those variables. The results replicate some previous findings with adult samples and suggest new paths for research and theory.
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11.
  • Cardeña, Etzel, et al. (författare)
  • The Relation Between Peritraumatic Dissociation and Coping Strategies: A Network Analysis
  • 2024
  • Ingår i: Psychological Trauma: Theory, Research, Practice, and Policy. - : American Psychological Association (APA). - 1942-9681 .- 1942-969X. ; 16:5, s. 749-758
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: Peritraumatic dissociation (PD) and coping strategies (CS) around the time of trauma are significantpredictors of acute and long-term posttraumatic symptomatology (PTS), but it is unclear howthey relate to each other. The aim of this study was to examine their association using a nationwide, representativesample following the September 11 attacks in the United States (N = 3,134). Method: Weused exploratory and confirmatory network analyses to estimate reliable associations between PD andCS, as well as looking at those variables as predictors of PTS at 2, 6, and 12 months after the attack.Results: Analyses showed that: (a) PD formed 3 factors (alterations of consciousness, depersonalization,and compartmentalization) distinct from coping strategies; (b) PD related only to some CS; (c) copingthrough denial had a particularly strong link to alterations of consciousness among adults. Both alteredconsciousness and denial predicted PTS significantly 2, 6, and 12 months after the attack, with alteredconsciousness being the stronger predictor (and a better predictor of PTS than other types of PD). Forteens, the only significant link between PD and CS was for compartmentalization and substance abuse.Conclusion: PD and CS were related in adults and contributed independently to later PTS.
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12.
  • Cervin, Matti, et al. (författare)
  • A multi-group confirmatory factor analysis of the revised children's anxiety and depression scale (RCADS) in Spain, Chile and Sweden
  • 2022
  • Ingår i: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327. ; 310, s. 228-234
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundThere is a need for a measure that can be used across countries and cultures to advance cross-cultural research about internalizing mental health symptoms in children and adolescents. The Revised Children's Anxiety and Depression Scale (RCADS) is a potential candidate, but no study has examined whether its scales are measured similarly in youth populations from different countries.MethodsIn this study, we use confirmatory factor analysis (CFA) and multi-group CFA to examine the cross-cultural properties of a short and free to use 30-item version of RCADS that assesses social, generalized, panic, and separation anxiety alongside depression and obsessive-compulsive symptoms. We tested the factor structure of RCADS in children and adolescents from Chile, Spain, and Sweden, recruited using different research designs (i.e., school-based studies and an anonymous web survey), and whether the factor structure showed measurement invariance across the three countries.ResultsThe proposed factor structure of RCADS showed good model/data fit in all three countries and was superior to a unidimensional model in which correlations among scale items were explained by a single broad internalizing factor. Each RCADS subscale showed adequate to excellent internal consistency in all three countries and multi-group CFA supported scalar invariance across the three countries.LimitationsNo clinical sample was included.ConclusionsThis study provides an important first step in supporting the use of RCADS in cross-cultural research on depression, anxiety and obsessive-compulsive symptoms in children and adolescents, but more work on validity aspects of the scale across cultures is needed.
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13.
  • Cervin, Matti, et al. (författare)
  • A Psychometric Evaluation of the Expanded Version of the Inventory of Depression and Anxiety Symptoms (IDAS-II) in Children and Adolescents
  • 2024
  • Ingår i: Assessment. - : Sage Publications. - 1552-3489 .- 1073-1911. ; 31:3, s. 588-601
  • Tidskriftsartikel (refereegranskat)abstract
    • The expanded version of the Inventory of Depression and Anxiety Symptoms (IDAS-II) is a self-report measure of 18 empirically derived internalizing symptom dimensions. The measure has shown good psychometric properties in adults but has never been evaluated in children and adolescents. A Swedish version of the IDAS-II was administered to 633 children and adolescents (Mage =16.6 [SD = 2.0]) and 203 adults (Mage = 35.4 [SD = 12.1]). The model/data fit of the 18-factor structure was excellent in both samples and measurement invariance across age groups was supported. All scales showed good to excellent internal consistency and psychometric properties replicated in the younger youth sample (< 16 years). Among youth, good convergent validity was established for all scales and divergent validity for most scales. The IDAS-II was better at identifying youth with current mental health problems than an internationally recommended scale of internalizing symptoms. In conclusion, the IDAS-II shows promise as a measure of internalizing symptoms in youth.
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14.
  • Cervin, Matti (författare)
  • Beyond fear: Incompleteness and disgust in pediatric obsessive-compulsive disorder
  • 2019
  • Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
    • A comprehensive understanding of the emotional mechanisms that motivate the symptoms of pediatric obsessive-compulsive disorder (OCD) is important for models of the etiology and treatment of the disorder. Existing models have emphasized the central role of fear, but recent research has highlighted that OCD may also be underpinned by incompleteness and disgust. However, whether incompleteness is relevant for the understanding of pediatric OCD has not been examined and no studies have conjointly examined fear, incompleteness, and disgust in clinical samples. The present thesis concerned itself with the degree to which fear, incompleteness, and disgust (a) could be validly assessed in youth with OCD and anxiety disorders; (b) discriminated pediatric OCD from pediatric anxiety disorders; (c) underpinned the main symptom dimensions of pediatric OCD; and (d) predicted treatment outcome for youth with OCD. Youth seeking treatment for pediatric OCD and anxiety disorders (assessed via structured diagnostic interviews) completed self-report and interview-based measures of trait (everyday experiences) and state (direct emotion involvement in symptoms) levels of fear, incompleteness, and disgust. Non-clinical youth were recruited from local schools and completed the same trait-level measures. Results showed that both children and adolescents were able to comprehend the concept of incompleteness and to report on whether this emotion, as well as fear and disgust, was part of their general emotional responses and in their symptoms of OCD and anxiety disorders. Trait-level fear and disgust were elevated in youth with OCD and anxiety disorders when compared to non-clinical youth, while incompleteness was only elevated in youth with OCD. When examining dimensional associations between self-reported trait-level emotion and self-reported symptom severity, fear was positively associated with OCD, anxiety, and depression, while incompleteness was uniquely associated with OCD, and disgust uniquely associated with anxiety. Regarding the direct involvement of these emotions in the symptoms of OCD and social anxiety disorder and generalized anxiety disorder, fear was again shown to be related to both OCD and anxiety disorders, incompleteness specifically related to OCD (particularly symmetry-related OCD), and disgust specifically related to contamination-based OCD. Youth with OCD symptoms characterized by high levels of incompleteness and disgust evidenced a poorer response to OCD treatment. Overall, the present thesis suggests that additional studies are warranted that examine the relationship between incompleteness and disgust in relation to the heterogeneity and treatment of pediatric OCD. Further, to better outline factors specifically related to the development and maintenance of pediatric OCD, theoretical models should more clearly account for emotion-related motivators other than fear.
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15.
  • Cervin, Matti, et al. (författare)
  • Cognitive Beliefs Across the Symptom Dimensions of Pediatric Obsessive-Compulsive Disorder: Type of Symptom Matters
  • 2022
  • Ingår i: Behavior Therapy. - : Elsevier BV. - 0005-7894. ; 53:2, s. 240-254
  • Tidskriftsartikel (refereegranskat)abstract
    • The cognitive model of obsessive-compulsive disorder (OCD) posits that dysfunctional cognitive beliefs are crucial to the onset and maintenance of OCD; however, the relationship between these cognitive beliefs and the heterogeneity of OCD symptoms in children and adolescents remains unknown. We examined how the major belief domains of the cognitive model (inflated responsibility/threat estimation, perfectionism/intolerance of uncertainty, importance/control of thoughts) and dysfunctional metacognitions were related to OCD symptoms across the following dimensions: doubting/checking, obsessing, hoarding, washing, ordering, and neutralization. Self-report ratings from 137 treatment-seeking youth with OCD were analyzed. When cognitive beliefs and symptom dimensions were analyzed in tandem, inflated responsibility/threat estimation and dysfunctional metacognitions were uniquely related to doubting/checking, obsessing, and hoarding and perfectionism/intolerance of uncertainty to ordering. Cognitive beliefs explained a large proportion of variation in doubting/checking (61%) and obsessing (46%), but much less so in ordering (15%), hoarding (14%), neutralization (8%), and washing (3%). Similar relations between cognitive beliefs and symptom dimensions were present in children and adolescents. Cognitive beliefs appear to be relevant for pediatric OCD related to harm, responsibility, and checking, but they do not map clearly onto contamination and symmetry-related symptoms. Implications for OCD etiology and treatment are discussed.
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16.
  • Cervin, Matti (författare)
  • Developmental signs of ADHD and autism: a prospective investigation in 3623 children
  • 2023
  • Ingår i: European Child & Adolescent Psychiatry. - : Springer Science and Business Media LLC. - 1435-165X .- 1018-8827. ; 32:10, s. 1969-1978
  • Tidskriftsartikel (refereegranskat)abstract
    • Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are neurodevelopmental disorders with an early onset. Guidelines recommend a careful evaluation of developmental history when assessing the disorders, but it is unclear how children with ADHD and ASD differ from their peers growing up. In this study, physical, family, psychological, social, and educational information were examined in 3623 ethnically diverse children that were prospectively followed from birth to age 15 as part of the Fragile Families and Child Wellbeing Study. Fifteen-thousand variables were screened, and 506 variables included in the final analyses. Accuracy of the most indicative information to predict ADHD and ASD diagnoses in adolescence was evaluated. Adolescents with ADHD (n = 627) and ASD (n = 91) differed from their peers on a plethora of developmental signs, with signs closely related to the core symptoms of the disorders after age 5 being most indicative of the disorders. Predictive models correctly identified 66% of individuals with ADHD and 81% of those with ASD, but 62–88% of identified cases were false positives. The mean proportion of developmental deviations was 18.7% in the ADHD group, 20.0% in the ASD group, and 15.6% in peers; youth with both ADHD and ASD (n = 50) deviated on 21.8% of all developmental signs and had more pronounced deviations than those with ADHD or ASD alone. ADHD and ASD are characterized by broad and non-specific developmental deviations. Developmental information alone cannot be used to accurately predict diagnostic status in adolescence and false positives are likely if the diagnostic process relies heavily on such information. Developmental deviations are part of normal development and common in children without ADHD and ASD. Etiological heterogeneity and considerable temporal fluctuation in the core characteristics of ADHD and ASD may explain the lack of distinct developmental patterns.
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17.
  • Cervin, Matti, et al. (författare)
  • Effects of cognitive-behavioral therapy on core aspects of anxiety in anxious youth with autism
  • 2023
  • Ingår i: Research in Autism Spectrum Disorders. - 1750-9467. ; 107, s. 1-10
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundAnxiety disorders (ADs) are common in youth with autism and cognitive-behavioral therapy (CBT) may be less efficacious than among anxious youth without autism. Yet, little is known about which aspects of anxiety are targeted less effectively by CBT in youth with autism.MethodWe pooled youth with autism and ADs randomized to CBT or a control condition from five randomized controlled trials (RCTs; CBT, n = 197, Mage = 10.30 [2.05], age range: 7–16; control conditions, n = 83; Mage = 10.57 [2.30], age range: 7–16) and examined whether CBT outperformed control conditions across core aspects of anxiety and whether more pronounced autism traits predicted outcomes. CBT response in youth with autism was also compared to CBT response among anxious youth without autism (n = 129; Mage = 11.16 [2.80], age range: 7–17).ResultsCBT for youth with autism yielded significantly better effects than control conditions for frequency of symptoms, intensity of anxiety, avoidance, family interference, and social interference but not for physical symptoms of anxiety. Youth with more pronounced autism traits had poorer outcomes for frequency of symptoms, family interference, and social interference. Compared to anxious youth without autism, youth with autism had poorer outcomes for physical symptoms and family interference.ConclusionsCBT is efficacious across core aspects of anxiety for youth with autism, but outcomes for anxiety-related interference, particularly for those with more pronounced autism traits, may be poorer than among youth without autism. More work is needed to better understand how anxiety impacts the everyday lives of anxious youth with autism and which interventions and support are needed.
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18.
  • Cervin, Matti, et al. (författare)
  • Efficacy and acceptability of cognitive-behavioral therapy and serotonin reuptake inhibitors for pediatric obsessive-compulsive disorder: a network meta-analysis
  • 2024
  • Ingår i: Journal of Child Psychology and Psychiatry. - 0021-9630. ; 65:5, s. 594-609
  • Forskningsöversikt (refereegranskat)abstract
    • BackgroundCognitive-behavioral therapy (CBT) and serotonin reuptake inhibitors (SRIs) are recommended treatments for pediatric obsessive-compulsive disorder (OCD), but their relative efficacy and acceptability have not been comprehensively examined. Further, it remains unclear whether the efficacy of in-person CBT is conserved when delivered in other formats, such as over telephone/webcam or as Internet-delivered CBT (ICBT).MethodsPubMed, PsycINFO, trial registries, and previous systematic reviews were searched for randomized controlled trials (RCTs) comparing CBT (in-person, webcam/telephone-delivered, or ICBT) or SRIs with control conditions or each other. Network meta-analyses were conducted to examine efficacy (post-treatment Children's Yale-Brown Obsessive Compulsive Scale) and acceptability (treatment discontinuation). Confidence in effect estimates was evaluated with CINeMA (Confidence in Network Meta-Analysis).ResultsThirty eligible RCTs and 35 contrasts comprising 2,057 youth with OCD were identified. In-person CBT was significantly more efficacious than ICBT, waitlist, relaxation training, and pill placebo (MD range: 3.95–11.10; CINeMA estimate of confidence: moderate) but did not differ significantly from CBT delivered via webcam/telephone (MD: 0.85 [−2.51, 4.21]; moderate), SRIs (MD: 3.07 [−0.07, 6.20]; low), or the combination of in-person CBT and SRIs (MD: −1.20 [−5.29, 2.91]; low). SRIs were significantly more efficacious than pill placebo (MD: 4.59 [2.70, 6.48]; low) and waitlist (MD: 8.03 [4.24, 11.82]; moderate). No significant differences for acceptability emerged, but confidence in estimates was low.ConclusionsIn-person CBT and SRIs produce clear benefits compared to waitlist and pill placebo and should be integral parts of the clinical management of pediatric OCD, with in-person CBT overall having a stronger evidence base. The combination of in-person CBT and SRIs may be most efficacious, but few studies hinder firm conclusions. The efficacy of CBT appears conserved when delivered via webcam/telephone, while more trials evaluating ICBT are needed.
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19.
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20.
  • Cervin, Matti, et al. (författare)
  • Incompleteness and disgust predict treatment outcome in pediatric obsessive compulsive disorder
  • 2021
  • Ingår i: Behavior Therapy. - : Elsevier BV. - 0005-7894. ; 52:1, s. 53-63
  • 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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21.
  • Cervin, Matti, et al. (författare)
  • Incompleteness, harm avoidance, and disgust: A comparison of youth with OCD, anxiety disorders, and no psychiatric disorder
  • 2020
  • Ingår i: Journal of Anxiety Disorders. - : Elsevier BV. - 1873-7897 .- 0887-6185. ; 69
  • 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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22.
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23.
  • Cervin, Matti, et al. (författare)
  • Involvement of fear, incompleteness, and disgust during symptoms of pediatric obsessive-compulsive disorder
  • 2021
  • Ingår i: European Child & Adolescent Psychiatry. - : Springer Science and Business Media LLC. - 1435-165X .- 1018-8827. ; 30, s. 271-281
  • 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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24.
  • Cervin, Matti, et al. (författare)
  • Measuring harm avoidance, incompleteness, and disgust in youth with obsessive-compulsive disorder and anxiety disorders
  • 2019
  • Ingår i: Journal of Obsessive-Compulsive and Related Disorders. - : Elsevier BV. - 2211-3649. ; 22
  • 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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25.
  • Cervin, Matti, et al. (författare)
  • Measuring misophonia in youth: A psychometric evaluation of child and parent measures
  • 2023
  • Ingår i: Journal of Affective Disorders. - 0165-0327. ; 338, s. 180-186
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundMisophonia is characterized by intense emotional reactions to specific sounds or visual stimuli and typically onsets during childhood. An obstacle for research and clinical practice is that no comprehensively evaluated measures for pediatric misophonia exist.MethodsIn a sample of 102 youth meeting the proposed diagnostic criteria of misophonia, we evaluated the child and parent-proxy versions of the self-reported Misophonia Assessment Questionnaire (MAQ; assessing broad aspects of misophonia) and the child version of the Amsterdam Misophonia Scale (A-MISO-S; assessing misophonia severity). Confirmatory and exploratory factor analysis were used to examine factor structures of the measures. Further, child-parent agreement on the MAQ and associations between MAQ/A-MISO-S and impairment, quality of life, and misophonia-related school interference were examined to evaluate aspects of convergent validity.ResultsFor both youth- and parent-ratings, four MAQ factors emerged: pessimism, distress, interference, and non-recognition. A-MISO-S showed a unidimensional structure, but the item ‘effort to resist’ did not load significantly onto the unidimensional factor. Good child-parent agreement on the MAQ scales were found and both MAQ and A-MISO-S were moderately to strongly associated with misophonia-related impairment and school interference, and inversely associated with quality of life.LimitationsMAQ and A-MISO-S assess sensitivity to auditory but not visual stimuli, the sample size was modest, and repeated assessments were not conducted.ConclusionsThe combination of MAQ and A-MISO-S shows promise as a multidimensional assessment approach for pediatric misophonia. Future evaluations should include known-groups validity, screening performance, and sensitivity to change in symptom severity.
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26.
  • Cervin, Matti (författare)
  • Obsessive-Compulsive Disorder : Diagnosis, Clinical Features, Nosology, and Epidemiology
  • 2023
  • Ingår i: Psychiatric Clinics of North America. - : Elsevier BV. - 1558-3147 .- 0193-953X. ; 46:1, s. 1-16
  • Tidskriftsartikel (refereegranskat)abstract
    • Key points• Obsessive-compulsive disorder is a disabling mental disorder with a lifetime prevalence of around 2% with similar rates across age groups and countries.• Diagnosis is made based on a pattern of time-consuming, clinically distressing, or impairing obsessions and compulsions and most cases emerge during puberty or early adulthood.• Obsessions are recurrent, persistent, and intrusive thoughts, urges, or images, and compulsions are repetitive behaviors or mental acts performed to manage
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27.
  • Cervin, Matti, et al. (författare)
  • Obsessive-compulsive symptoms and their links to depression and anxiety in clinic- and community-based pediatric samples: A network analysis
  • 2020
  • Ingår i: Journal of Affective Disorders. - : Elsevier BV. - 1573-2517 .- 0165-0327. ; 271, s. 9-18
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Symptoms of depression and anxiety are common in children with obsessive-compulsive disorder (OCD) and associated with more severe OCD, greater impairment, and worse treatment outcome. Beyond twin studies showing that genetic factors contribute to the high co-occurrence, few studies have examined how OCD, depression, and anxiety are linked in youth, and current studies often fail to account for OCD and anxiety heterogeneity. Methods: Network analysis was used to investigate how OCD were linked to depression and anxiety in multinational youth diagnosed with OCD (total n = 419) and in school-recruited, community-based samples of youth (total n = 2 991). Results: Initial results aligned with earlier work showing that severity of obsession-related symptoms are important in linking OCD to depression in youth with OCD. However, when symptom content of OCD (e.g., washing, ordering) was fully taken into account and when measures of anxiety were included, specific OCD symptom dimensions (primarily obsessing and doubting/checking) were linked to specific anxiety dimensions (primarily panic and generalized anxiety) which in turn were linked to depression. These results were replicated in three separate community-based samples from Chile, Italy, and Spain using different measures of anxiety and depression. Limitations: Cross-sectional data were analyzed which precludes causal inference. Self-report measures were used. Conclusions: Youth with OCD with symptoms related to doubting/checking and obsessing should be carefully assessed for symptoms of panic and generalized anxiety. Non-responders to standard OCD treatment may benefit from interventions targeting panic and generalized anxiety, but more research is needed to test this hypothesis.
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28.
  • Cervin, Matti, et al. (författare)
  • Posttraumatic Symptoms in 3–7 Year Old Trauma‑Exposed Children: Links to Impairment, Other Mental Health Symptoms, Caregiver PTSD, and Caregiver Stress
  • 2020
  • Ingår i: Child Psychiatry and Human Development. - : Springer Science and Business Media LLC. - 0009-398X .- 1573-3327.
  • Tidskriftsartikel (refereegranskat)abstract
    • Few studies have examined how PTSD symptoms in young children are associated with other mental health symptoms and mood and functioning in caregivers. This is an important gap in the literature as such knowledge may be important for assessment and treatment. This study used network analysis to identify how the major symptom domains of PTSD in young trauma-exposed children were related to impairment, internalizing and externalizing symptoms, caregiver PTSD, and caregiver stress. Caregivers of 75 trauma-exposed 3–7 year old children reported on their child’s symptoms and impairment and their own PTSD symptoms and caregiver stress. A strong association between the child PTSD domains of intrusions and avoidance emerged, which is in line with theoretical notions of how PTSD onsets and is maintained in adolescents and adults. Externalizing child symptoms were strongly linked to PTSD-related impairment and caregiver stress, highlighting the need to carefully assess and address such symptoms when working with young trauma-exposed children. Internalizing symptoms were uniquely associated with all three of the major childhood PTSD symptom domains with further implications for assessment and treatment.
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29.
  • Cervin, Matti (författare)
  • Sensory Processing Difficulties in Children and Adolescents with Obsessive-Compulsive and Anxiety Disorders
  • 2023
  • Ingår i: Research on Child and Adolescent Psychopathology. - : Springer Science and Business Media LLC. - 2730-7166 .- 2730-7174. ; 51:2, s. 223-232
  • Tidskriftsartikel (refereegranskat)abstract
    • Altered sensory processing has been linked to symptoms of obsessive-compulsive disorder (OCD) and anxiety disorders (ADs) in youth, but few studies have examined sensory processing in clinical samples and no study has analyzed self-report data from youth meeting diagnostic criteria for OCD or ADs. This study included 86 youth with OCD, 82 youth with ADs, and 46 youth without psychiatric disorders. Participants completed the adolescent version of the Sensory Profile and scales measuring three symptom dimensions of OCD, four symptom dimensions of anxiety, and symptoms of major depression. Results showed that different forms of sensory processing difficulties (sensitivity, avoidance, low registration) were adequately captured by one broad sensory processing factor. Youth with OCD and ADs reported statistically significantly more sensory difficulties than youth without psychiatric disorders, but the two clinical groups did not differ from each other. Altered sensory processing in the clinical groups was not explained by the presence of neurodevelopmental disorders. Sensory difficulties were moderately to strongly related to all self-reported symptom dimensions, and uniquely related to the OCD dimension of symmetry/ordering and the anxiety dimensions of panic and social anxiety. Most youth in the clinical groups were classified as having difficulties with sensory processing. The present study shows that sensory processing difficulties are common in youth with OCD and ADs, not explained by co-occurring neurodevelopmental disorders, and linked to a host of internalizing symptoms. More research is needed to identify whether sensory processing difficulties precede, follow, or mutually reinforce the development of OCD and ADs in youth.
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30.
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31.
  • Cervin, Matti, et al. (författare)
  • Symptom Dimension Breakpoints for the Obsessive-Compulsive Inventory-Child Version (OCI-CV)
  • 2022
  • Ingår i: Child Psychiatry and Human Development. - : Springer Science and Business Media LLC. - 0009-398X .- 1573-3327.
  • Tidskriftsartikel (refereegranskat)abstract
    • Pediatric obsessive-compulsive disorder (OCD) clusters around three major symptom dimensions: contamination/cleaning, symmetry/ordering, and disturbing thoughts/checking. The Obsessive-Compulsive Inventory-Child Version (OCI-CV) is a self-report questionnaire that provides scores along six theory-based OCD dimensions, but no study has evaluated how well OCI-CV identifies clinically significant symptoms within each of the three major symptom dimensions of OCD. We examined this question using data from 197 Swedish and Spanish youth with OCD. All youth completed the OCI-CV and clinically significant symptom severity within each major OCD dimension was established with a validated interview-based measure. Results showed that a score ≥ 3 on the OCI-CV washing scale excellently captured those with clinically significant contamination/cleaning symptoms (AUC = 0.85 [0.80–0.90], 79% accuracy). A score ≥ 4 on the obsessing scale adequately captured those with disturbing thoughts/checking symptoms (AUC = 0.71 [0.64–0.78], 67% accuracy) and a score ≥ 3 on the ordering scale adequately captured those with symmetry/ordering symptoms (AUC = 0.72 [0.65–0.79], 70% accuracy). Similar accuracy of the breakpoints was found in the Swedish and Spanish samples. OCI-CV works well to identify youth with pediatric OCD that have clinically significant contamination/cleaning symptoms. The measure can also with adequate precision identify those with clinically significant disturbing thoughts/checking and symmetry/ordering symptoms. The breakpoints provided in this study can be used to examine differences in clinical presentation and treatment outcome for youth with different types of OCD.
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32.
  • Cervin, Matti, et al. (författare)
  • Symptom-specific effects of cognitive-behavioral therapy, sertraline, and their combination in a large randomized controlled trial of pediatric anxiety disorders
  • 2020
  • Ingår i: Journal of Child Psychology and Psychiatry. - : Wiley. - 0021-9630 .- 1469-7610. ; 61:4, s. 492-502
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Pediatric anxiety disorders are highly prevalent and associated with significant functional disabilities and lifelong morbidity. Cognitive-behavioral therapy (CBT), sertraline, and their combination are effective treatments, but little is known about how these treatments exert their effects.Methods: Using network intervention analysis (NIA), we analyzed data from the largest randomized controlled treatment trial of pediatric anxiety disorders (Child/Adolescent Anxiety Multimodal Study, NCT00052078, clinicaltrials.gov/ct2/show/NCT00052078) and outlined the causal symptom domain-specific effects of CBT, sertraline, and their combination over the course of the 12-week treatment while taking into account both specificity and overlap between symptom dimensions. Results: All active treatments produced positive effects with the most pronounced and consistent effects emerging in relation to psychological distress, family interference, and avoidance. Psychological distress was consistently the most and physical symptoms the least influential symptom domain in the disorder network.Conclusions: All active treatments showed beneficial effects when compared to placebo and NIA identified that these effects were exerted similarly across treatments and primarily through a reduction of psychological distress, family interference, and avoidance. CBT and sertraline may have differential mechanisms of action in relation to psychological distress. Given the lack of causal effects on interference outside family and physical symptoms, interventions tailored to target these domains may aid in the building of more effective treatments. Psychological distress and avoidance should remain key treatment focuses because of their central roles in the disorder network. The findings inform and promote developing more effective interventions. Keywords: CBT/cognitive behavior therapy; anxiety/anxiety disorders; pharmacotherapy; clinical trials; child/adolescent.
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33.
  • Cervin, Matti, et al. (författare)
  • Taboo obsessions and their association with suicidality in obsessive-compulsive disorder
  • 2022
  • Ingår i: Journal of Psychiatric Research. - : Elsevier BV. - 1879-1379 .- 0022-3956. ; 154, s. 117-122
  • Tidskriftsartikel (refereegranskat)abstract
    • Individuals with obsessive-compulsive disorder (OCD) more often think about, attempt, and die by suicide than individuals from the general population. Sexual and religious obsessions (i.e., taboo obsessions) have been linked to increased risk of suicidality, but it is unclear if they explain additional risk over and above other risk factors. We refined the recently proposed multidimensional hierarchical model of OCD and explored how each symptom dimension in the model was associated with suicidality in a random half (n = 500) of a well-characterized cohort of patients with OCD. Symptom dimensions and other risk factors significantly associated with suicidality were included in a confirmatory multivariable model conducted with the other half of the sample (n = 501). The predictive confirmatory model accounted for 19% of the variance in suicidality. Taboo obsessions, the general OCD factor (i.e., having many different OCD symptoms at the same time), lifetime major depression, and lifetime substance use disorders significantly predicted suicidality in this model. Lifetime major depression explained most unique variance in suicidality (5.6%) followed by taboo obsessions and the general OCD factor (1.9% each). Taboo obsessions explain a small but significant proportion of variance in suicidality and should be considered an independent risk factor for suicidality in patients with OCD.
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34.
  • Cervin, Matti, et al. (författare)
  • Technology‐delivered cognitive‐behavioral therapy for pediatric anxiety disorders: a meta‐analysis of remission, posttreatment anxiety, and functioning
  • 2021
  • Ingår i: Journal of Child Psychology and Psychiatry. - : Wiley. - 0021-9630 .- 1469-7610.
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundThe efficacy of technology-delivered cognitive-behavioral therapy (tCBT) for pediatric anxiety disorders (ADs) is uncertain as no meta-analysis has examined outcomes in trials that used structured diagnostic assessments at pre- and posttreatment.MethodsWe carried out a systematic review and meta-analysis of randomized controlled trials (RCTs) of tCBT for pediatric ADs that included participants <18 years of age with a confirmed primary AD according to a structured diagnostic interview. Nine studies with 711 participants were included.ResultstCBT outperformed control conditions for remission for primary AD (37.9% vs. 10.2%; k = 9; OR = 4.73; p < .0001; I2 = 0%; moderate certainty), remission for all ADs (19.5% vs. 5.3%; k = 8; OR = 3.32; p < .0001; I2 = 0%; moderate certainty), clinician-rated functioning (k = 7; MD = −4.38; p < .001; I2 = 56.9%; low certainty), and caregiver-reported anxiety (k = 7; SMD = 0.27; p = .02; I2 = 41.4%; low certainty), but not for youth-reported anxiety (k = 9; SMD = 0.13; p = .12; I2 = 0%; low certainty). More severe pretreatment anxiety, a lower proportion of completed sessions, no face-to-face sessions, media recruitment, and a larger proportion of females were associated with lower remission rates for primary AD.ConclusionstCBT has a moderate effect on remission for pediatric ADs and clinician-rated functioning, a small effect on caregiver-reported anxiety, and no statistically significant effect on youth-reported anxiety. The certainty of these estimates is low to moderate. Remission rates vary substantially across trials and several factors that may influence remission were identified. Future research should examine for whom tCBT is most appropriate and what care to offer the large proportion that does not remit. Future RCTs should consider contrasting tCBT with partial tCBT (e.g., including therapist-led exposure) and/or face-to-face CBT.
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35.
  • Cervin, Matti, et al. (författare)
  • The centrality of doubting and checking in the network structure of obsessive-compulsive symptom dimensions in youth
  • 2020
  • Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry. - : Elsevier BV. - 0890-8567 .- 1527-5418. ; 59:7, s. 880-889
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective. Obsessive-compulsive disorder (OCD) is a heterogeneous condition with well-established symptom dimensions across the lifespan. The objective of the present study was to use network analysis to investigate the internal structure and central features of these dimensions in unselected schoolchildren and in youth with OCD.Method. We estimated the network structure of OCD symptom dimensions in 6,991 schoolchildren and 704 youth diagnosed with OCD from 18 sites across six countries. All participants completed the Obsessive Compulsive Inventory - Child Version.Results. In both the school-based and clinic-based samples, the OCD dimensions formed an interconnected network with doubting/checking emerging as a highly central node, i.e. exerting strong influence over other symptom dimensions in the network. The centrality of the doubting/checking dimension was consistent across countries, genders, age groups, clinical status, and tic disorder comorbidity. Network differences were observed for age and gender in the school-based but not the clinic-based samples.Conclusion. The centrality of doubting/checking in the network structure of childhood OCD adds to classic and recent conceptualizations of the disorder in which the important role of doubt in disorder severity and maintenance is highlighted. The present results suggest that doubting/checking is a potentially important target for further research into the etiology and treatment of childhood OCD.
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36.
  • Cervin, Matti, et al. (författare)
  • The p Factor Consistently Predicts Long-Term Psychiatric and Functional Outcomes in Anxiety-Disordered Youth
  • 2021
  • Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry. - : Elsevier BV. - 0890-8567. ; 60:7, s. 902-912
  • Tidskriftsartikel (refereegranskat)abstract
    • ObjectivePediatric anxiety disorders can have a chronic course and are considered gateway disorders to adult psychopathology, but no consistent predictors of long-term outcome have been identified. A single latent symptom dimension that reflects features shared by all mental health disorders, the p factor, is thought to reflect mechanisms that cut across mental disorders. Whether p predicts outcome in youth with psychiatric disorders has not been examined. We tested whether the p factor predicted long-term psychiatric and functional outcomes in a large naturalistically followed-up cohort of anxiety-disordered youth.MethodYouth enrolled in a randomized controlled treatment trial of pediatric anxiety during childhood/adolescence were followed-up on average six years posttreatment and then annually for four years. Structural equation modeling was used to estimate p at baseline. p and previously established predictors were modeled as predictors of long-term outcome.ResultsHigher levels of p at baseline were related to more mental health disorders, poorer functioning, and greater impairment across all measures at all follow-up time points. p predicted outcome above and beyond previously identified predictors, including diagnostic comorbidity at baseline. Post hoc analyses showed that p predicted long-term anxiety outcomes, but not acute treatment outcome, suggesting that p may be uniquely associated with long-term outcome.ConclusionYouth with anxiety disorders who present with a liability towards broad mental health problems may be at a higher risk for poor long-term outcome across mental health and functional domains. Efforts to assess and address this broad liability may enhance long-term outcome.
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37.
  • Cervin, Matti, et al. (författare)
  • Towards a definitive symptom structure of obsessive-compulsive disorder: A factor and network analysis of 87 distinct symptoms in 1366 individuals
  • 2022
  • Ingår i: Psychological Medicine. - 1469-8978. ; 52:14, s. 3267-3279
  • Tidskriftsartikel (refereegranskat)abstract
    • Background. The symptoms of obsessive-compulsive disorder (OCD) are highly heterogeneous and it is unclear what is the optimal way to conceptualize this heterogeneity. This study aimed to establish a comprehensive symptom structure model of OCD across the lifespan using factor and network analytic techniques.Methods. A large multinational cohort of well-characterized children, adolescents, and adults diagnosed with OCD (N = 1366) participated in the study. All completed the Dimensional Yale-Brown Obsessive-Compulsive Scale, which contains an expanded checklist of 87 distinct OCD symptoms. Exploratory and confirmatory factor analysis were used to outline empirically supported symptom dimensions, and interconnections among the resulting dimensions were established using network analysis. Associations between dimensions and sociodemographic and clinical variables were explored using structural equation modeling (SEM).Results. Thirteen first-order symptom dimensions emerged that could be parsimoniously reduced to eight broad dimensions, which were valid across the lifespan: Disturbing Thoughts, Incompleteness, Contamination, Hoarding, Transformation, Body Focus, Superstition, and Loss/Separation. A general OCD factor could be included in the final factor model without a significant decline in model fit according to most fit indices. Network analysis showed that Incompleteness and Disturbing Thoughts were most central (i.e., had most unique interconnections with other dimensions). SEM showed that the eight broad dimensions were differentially related to sociodemographic and clinical variables.Conclusions. Future research will need to establish if this expanded hierarchical and multidimensional model can help improve our understanding of the etiology, neurobiology
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38.
  • Cervin, Matti, et al. (författare)
  • Validation of an interview-only version of the Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) in treatment-seeking youth with obsessive-compulsive disorder
  • 2019
  • Ingår i: Psychiatry Research. - : Elsevier BV. - 0165-1781. ; 271, s. 171-177
  • Tidskriftsartikel (refereegranskat)abstract
    • There is a growing body of evidence suggesting that individuals with obsessive-compulsive disorder (OCD) may be sub-typed along different symptom dimensions. These dimensions may help explain responsiveness to current treatments. The Dimensional Yale-Brown Obsessive-Compulsive Scale (DY-BOCS) is a validated instrument involving a self-report screening tool followed by a structured interview in which the presence/absence and severity of OCD symptom dimensions are assessed and rated. The present study investigated the validity of a briefer, interview-only version of the DY-BOCS modified for use in routine care. Clinically-referred children and adolescents (N=119) with OCD were administered the DY-BOCS along with other measures of OCD, anxiety, depression, and overall functioning and a subset (N=100) were reassessed on average 14 months after initial assessment. This briefer, interview-only version of the DY-BOCS demonstrated high levels of internal consistency and correlated in the moderate to strong range with alternative measures of OCD severity and OCD symptom dimensions. Change scores on the DY-BOCS from baseline to follow-up were significantly correlated with change scores on the alternative measures of OCD and clinician-rated improvement, suggesting that this brief version of the DY-BOCS is valid and sensitive to the effects of treatment for OCD delivered in routine clinical care.
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39.
  • Chalmers, Rebecca, et al. (författare)
  • Networks of inflammation, depression, and cognition in aging males and females
  • 2022
  • Ingår i: Aging clinical and experimental research. - : Springer Science and Business Media LLC. - 1720-8319.
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundPrioritizing the maintenance of healthy cognitive aging and personalizing preventive interventions to enhance their effectiveness is crucial as the global population ages. Systemic inflammation and depression in older people have been associated with decreased levels of cognition but results have been inconsistent.AimsTo explore the interactive network of inflammation, depression and cognition by sex in older people.MethodsWe used novel network analysis to explore the unique associations between inflammatory biomarkers, depression, cognition, and somatic, genetic, and lifestyle risk factors in an older (aged 70–90 years), non-demented, community-dwelling sample from the longitudinal Sydney Memory and Aging Study (N = 916) at baseline and at a two-year follow-up.ResultsThe networks of biomarkers, depression, cognition, and relevant covariates were significantly different between males and females. A stable negative link between depression and cognition was found in females only; a stable positive association between biomarker interleukin-6 and depression was found in females only; and a stable positive association between biomarker interleukin-8 and alcohol was found in females only. For both males and females, a stable, positive relationship was found between the presence of APOE-ε4 gene and biomarker C-reactive protein; between education and cognition; and between biomarker interleukin-6 and all other biomarkers.ConclusionsThese findings suggest different psychophysiological mechanisms underlie the interactive network of biomarkers, depression and cognition in males and females that should be considered when designing personalized preventive interventions to maintain cognitively healthy aging.
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40.
  • Claesdotter, Emma, et al. (författare)
  • The effects of ADHD on cognitive performance
  • 2018
  • Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 72:3, s. 158-163
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Attention-deficit hyperactivity disorder (ADHD) is a common and impairing neurodevelopmental disorder. The Cambridge Neuropsychological Test Automated Battery (CANTAB) is a computerized test battery with standardized procedures and solid psychometric properties targeting multiple neuropsychological functions.Aims: The aim of this study was to look at the effects of ADHD on cognitive performance using CANTAB expressed as a statistical interaction term in regression modeling.Methods: We assessed 112 drug-naive subjects (age: 7-18 years) with ADHD based on DSM IV criteria and compared them to 95 control subjects (age: 7-18 years). All participants were administered five CANTAB tasks designed to capture different aspects of executive functioning: Stockings of Cambridge (SOC), Intra/Extra dimensional shift (IED), Spatial Working Memory (SWM), Simple Reaction Time (SRT) and Stop Signal Task (SST).Results: T-tests showed a difference between ADHD and control subjects in all cognitive measures except SOC. The majority of measures showed a non-linear effect of age. SWM strategy and SST direction errors showed a linear effect of age. ADHD diagnosis had a statistically significant effect on performance. For all tests except SOC, ADHD produced the main effect without interaction with age.Discussion: For all CANTAB measures, ADHD diagnosis had a significant effect on performance and produced this effect without interaction with age in all tests except SOC, indicating that the developmental trajectories were parallel in both groups. The results indicate that cognitive performance is impaired in youth with ADHD and that CANTAB can be a valuable tool in the diagnostic assessment of ADHD.
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41.
  • CLAESDOTTER HYBBINETTE, EMMA, et al. (författare)
  • Gender specific differences in auditory brain stem response in young patients with ADHD
  • 2016
  • Ingår i: Neuropsychiatry. - 1758-2008. ; 6:1, s. 28-35
  • Tidskriftsartikel (refereegranskat)abstract
    • Objective: The auditory brainstem response (ABR) is often affected in neurodevelopmental disorders. The aim of this study was to investigate gender differences in ABR between young females and young males with ADHD, compared to control subjects. Method: We studied 63 females with ADHD (mean 13.8 years), 26 female controls (mean 13.8years), 48 males with ADHD (mean 13.1 years), and 20 male controls (mean 12.8years). All patients were diagnosed according to the DSM-IV. An ABR consists of seven positive peaks (wave I–VII) 10 ms following a stimulus, recorded by electrodes on the mastoid processes of each ear and on the forehead. Results: When analysing the ABRs of the female ADHD patients 3 traits were identified; TR6, TR14 and TR15. The higher value in TR6 (p=0.000064) is explained as an aberrant thalamus profile. In TR14 (p=0.00059) presence of 3500 Hzfrequencies in the region from superior olivary complex to thalamus. TR15 (p=0.00035) represents more aberrant curve profiles in the region of the lateral leminiscus. In the ABR of the male patients we found we 3 traits; TR4, TR5 and TR14. TR 4 (p=0.00105) is a lower correlation to a norm curve in inferior colliculus and thalamic area. TR5 (p=0.00027) identifies irregular curve profiles representing the nucleus cochlea. TR14 (p=0.00013) presence of 3500 Hz-frequencies in the region from superior olivary complex to thalamus. Conclusion: Young females with ADHD exhibited a significantly different ABR in a region between cochlear nucleus and superior olivary complex and in the thalamic region. In the male ADHD group ABR aberrancies were found in the midbrain region and in the more peripheral part; nucleus cocleus. The only trait that was significantly different between the ADHD group and the control subjects, for both male and females, was TR14. These data indicate both gender specific aberrations in the ABR in ADHD subjects as well as specific differences between ADHD subjects and normal controls.
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42.
  • Claesdotter-Knutsson, Emma, et al. (författare)
  • Abnormal auditory brainstem response in the pons region in youth with autism
  • 2019
  • Ingår i: Neurology Psychiatry and Brain Research. - : Elsevier BV. - 0941-9500. ; 32, s. 122-125
  • Tidskriftsartikel (refereegranskat)abstract
    • Purpose of the article: Autism spectrum disorder (ASD)is an impairing neurodevelopmental disorder with an unknown etiology. The present study aims to investigate if the auditory brainstem response (ABR)to complex stimuli in children and adolescents diagnosed with ASD can be a possible objective biomarker in autism. Materials and methods: The ABR of 39 youth with ASD (7–18 years)were compared to the ABR of 34 typically developed youth (TD). The ABR consists of seven positive peaks (waves I–VII)that occur during 10 Ms following a sound stimulus. Results: The amplitude of wave III (region 2.5–4.0 Ms)was higher in the ASD group compared to the TD group. The TD males showed a significant lower degree of correlation, between left and right ear compared to the ASD groups and the TD females. Conclusions: Altered auditory processing was evident in the pons region of the brainstem for the ASD group when compared to the TD group. Implications of the findings are discussed in relation to the neurobiology and assessment of autism spectrum disorder in youth.
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43.
  • Fausto Borrelli, Davide, et al. (författare)
  • Psychotic Vulnerability and its Associations with Clinical Characteristics in Adolescents with Obsessive-Compulsive Disorder
  • 2023
  • Ingår i: Research on Child and Adolescent Psychopathology. - 2730-7166. ; 51:10, s. 1535-1548
  • Tidskriftsartikel (refereegranskat)abstract
    • Compared to peers, children and adolescents with obsessive-compulsive disorder (OCD) are at increased risk of developing psychotic disorders. Yet very few studies have examined early indicators of psychosis in pediatric OCD. In the present study, 52 youth with a primary diagnosis of OCD (Mage = 15.66 [SD = 2.33], 59.6% girls) were interviewed using the Schizophrenia Proneness Instrument Child and Adolescent version (SPI-CY), which is a comprehensive clinical interview assessing both Cognitive–Perceptual basic symptoms (COPER) and high-risk criterion Cognitive Disturbances (COGDIS). Associations between COPER/COGDIS symptoms and demographic and clinical characteristics were examined. Findings showed that COPER or COGDIS symptoms were present in 44% of participants, with no significant difference between girls and boys. Psychotic vulnerability was associated with an earlier age of OCD onset, greater OCD severity, poorer insight, and more contamination/cleaning symptoms. Psychotic vulnerability was also strongly associated with worse psychosocial functioning. Findings suggest that early indicators of psychosis are frequent in pediatric OCD and associated with more severe OCD and poorer functioning. Research examining how psychotic vulnerability is associated with short- and long-term outcomes for youth with OCD is needed.
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44.
  • Ferrández-Mas, Jesús, et al. (författare)
  • Relationship between Cognitive Strategies of Emotion Regulation and Dimensions of Obsessive–Compulsive Symptomatology in Adolescents
  • 2023
  • Ingår i: Children (Basel, Switzerland). - 2227-9067. ; 10:5, s. 1-14
  • Tidskriftsartikel (refereegranskat)abstract
    • Cognitive emotion regulation refers to the management of one’s emotions through cognitive strategies. Studies have found that individuals with obsessive–compulsive symptoms utilize emotion regulation strategies differently compared to those without these symptoms. This study aims to investigate the relationship between cognitive strategies for emotion regulation and specific dimensions of obsessive–compulsive symptoms in adolescents. A cross-sectional descriptive study was conducted with 307 adolescents between 12 and 18 years old. Associations between sociodemographic variables, obsessive–compulsive symptoms, and emotion regulation strategies were examined using regression and network analyses. Regression results indicated that emotion regulation strategies and gender accounted for 28.2% of the variation in overall obsessive–compulsive symptoms (p < 0.001) and that emotion regulation explained most variance in the symptom dimension of obsessing. Network analysis showed that self-blame and catastrophizing were uniquely linked to overall obsessive–compulsive symptoms, while several strategies were uniquely linked to specific symptom dimensions. The adaptive strategy that demonstrated the strongest association with obsessive–compulsive symptoms was refocus on planning, while maladaptive strategies included catastrophizing, self-blame, and rumination. In conclusion, the results support the relationship between cognitive strategies for emotion regulation and dimensions of obsessive–compulsive symptoms in adolescents, though these relations appear complex and require further investigation. Addressing emotion regulation in the prevention of obsessive–compulsive symptoms may be warranted, but prospective studies are needed.
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45.
  • Gerdle, Björn, et al. (författare)
  • Outcomes of Interdisciplinary Pain Rehabilitation Across Subgroups of the Multidimensional Pain Inventory : A Study From the Swedish Quality Registry for Pain Rehabilitation
  • 2021
  • Ingår i: Pain Practice. - : Wiley. - 1530-7085 .- 1533-2500. ; 21:6, s. 662-679
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction The Multidimensional Pain Inventory (MPI) is frequently used in the assessment of chronic pain. Three subgroups have been derived from MPI: adaptive coper (AC), dysfunctional (DYS), and interpersonally distressed (ID). The primary aim of this study was to examine whether outcome of Interdisciplinary Multimodal Pain Rehabilitation Programs (IMMRPs) differed across the MPI subgroups. Methods Patients with chronic pain (N = 34,513), included in the Swedish Quality Registry for Pain Rehabilitation, were classified into MPI subgroups and a subset that participated in IMMRPs (N = 13,419) was used to examine overall treatment outcomes using a previously established Multivariate Improvement Score (MIS) and 2 retrospective patient-evaluated benefits from treatment. Results The subgroups differed on sociodemographic characteristics, pain duration, and spatial spreading of pain. DYS and ID had the best overall outcomes to MIS. AC had the best outcomes according to the 2 retrospective items. Transition into other subgroups following IMMRP was common and most prominent in DYS and least prominent in AC. Conclusion The validity of the MPI subgroups was partially confirmed. DYS and ID had the most severe clinical presentations at baseline and showed most improvement following IMMRP, but overall severity in DYS and ID at post-treatment was still higher than in the AC group. Future studies should examine how processes captured by MPI interact with neurobiological, medical, sociodemographic, and adaptation/coping factors and how these interactions impact severity of chronic pain and treatment outcome.
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46.
  • Gerdle, Björn, et al. (författare)
  • Spreading of Pain in Patients with Chronic Pain is Related to Pain Duration and Clinical Presentation and Weakly Associated with Outcomes of Interdisciplinary Pain Rehabilitation : A Cohort Study from the Swedish Quality Registry for Pain Rehabilitation (SQRP)
  • 2021
  • Ingår i: Journal of Pain Research. - : Dove Medical Press LTD. - 1178-7090. ; 14, s. 173-187
  • Tidskriftsartikel (refereegranskat)abstract
    • Introduction: The extent to which pain is distributed across the body (spreading of pain) differs largely among patients with chronic pain conditions and widespread pain has been linked to poor quality of life and work disability. A longer duration of pain is expected to be associated with more widespread pain, but studies are surprisingly scarce. Whether spreading of pain is associated with clinical presentation and treatment outcome in patients seen in interdisciplinary multimodal pain rehabilitation programs (IMMRPs) is unclear. The association between spreading of pain and (1) pain duration (2) clinical presentation (eg, pain intensity, pain-related cognitions, psychological distress, activity/participation aspects and quality of life) and (3) treatment outcome were examined. Methods: Data from patients included in the Swedish Quality Registry for Pain Rehabilitation were used (n=39,916). A subset of patients that participated in IMMRPs (n=14,666) was used to examine whether spreading of pain at baseline predicted treatment outcome. Spreading of pain was registered using 36 predefined anatomical areas which were summarized and divided into four categories: 1-6 regions with pain (20.6% of patients), 7-12 regions (26.8%), 13-18 regions (22.0%) and 19-36 regions (30.6%). Results: More widespread pain was associated with a longer pain duration and a more severe clinical picture at baseline with the strongest associations emerging in relation to health and pain aspects (pain intensity, pain interference and pain duration). Widespread pain was associated with a poorer overall treatment outcome following IMMRPs at both post-treatment and at a 12-month follow-up, but effect sizes were small. Discussion: Spreading of pain is an indicator of the duration and severity of chronic pain and to a limited extent to outcomes of IMMRP. Longer pain duration in those with more widespread pain supports the concept of early intervention as clinically important and implies a need to develop and improve rehabilitation for patients with chronic widespread pain.
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47.
  • Guzick, Andrew, et al. (författare)
  • Clinical characteristics, impairment, and psychiatric morbidity in 102 youth with misophonia
  • 2022
  • Ingår i: Journal of Affective Disorders. - : Elsevier BV. - 0165-0327. ; 324, s. 395-402
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundThere is little information on the clinical presentation, functional impact, and psychiatric characteristics of misophonia in youth, an increasingly recognized syndrome characterized by high emotional reactivity to certain sounds and associated visual stimuli.MethodOne-hundred-two youth (8–17 years-old) with misophonia and their parents were recruited and compared with 94 youth with anxiety disorders. Participants completed validated assessments of misophonia severity, quality of life, as well as psychiatric symptoms and diagnoses.ResultsThe most common misophonia triggers included eating (96 %), breathing (84 %), throat sounds (66 %), and tapping (54 %). Annoyance/irritation, verbal aggression, avoidance behavior, and family impact were nearly universal. Misophonia severity was associated with internalizing symptoms, child-reported externalizing behaviors, and poorer quality of life. High rates of comorbidity with internalizing and neurodevelopmental disorders were found. Quality of life and externalizing behaviors were not significantly different between misophonia and anxiety samples; internalizing symptoms and autism characteristics were significantly higher among youth with anxiety disorders.LimitationsThis self-selected sample was characterized by limited multicultural diversity.ConclusionsThis study presents misophonia as a highly impairing psychiatric syndrome. Future interdisciplinary work should clarify the mechanisms of misophonia, establish evidence-based treatments, and extend these findings to randomly sampled and more culturally diverse populations.
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48.
  • Hopkins, Ella G., et al. (författare)
  • Network of mental activities, cognitive function and depression in older men and women
  • 2023
  • Ingår i: Journal of Psychiatric Research. - 1879-1379. ; 162, s. 113-122
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundEvidence suggests that lifestyle activities impact cognitive and mental health in older populations. However, how lifestyle factors are associated with one another, and which factors are most important for cognitive function and mental health has received comparatively little attention.DesignBayesian-Gaussian network analysis was used to investigate unique associations between mental activities (MA; i.e., activities involving cognitive engagement), global cognition, and depression at three time-points in a large sample of older adults (baseline, 2 years, and 4 years follow-up).SettingThis study used longitudinal data from participants living in Australia and participating in the Sydney Memory and Ageing Study.ParticipantsThe sample included 998 participants (55% female) aged between 70 and 90, without a diagnosis of dementia at baseline.MeasurementsNeuropsychological assessment of global cognition, self-reported depressive symptoms, and self-reported information about daily MA.ResultsCognitive functioning was positively associated with playing tabletop games and using the internet in both sexes at all time-points. MA were differentially linked in men and women. Depression was not consistently associated with MA in men across the three time-points; women who visited artistic events consistently had lower depression scores.ConclusionsEngaging with tabletop games and using the internet was associated with better cognition in both sexes, however sex acted as a modifier for other associations. These findings are useful for future investigations that consider interactive associations between MA, cognition, and mental health in older adults, and their possible roles in promoting healthy aging.
  •  
49.
  • Hunsche, Michelle, et al. (författare)
  • Social functioning and the presentation of anxiety in children on the autism spectrum: A multimethod, multiinformant analysis
  • 2022
  • Ingår i: Journal of Abnormal Psychology. - : American Psychological Association (APA). - 0021-843X. ; 131:2, s. 198-208
  • Tidskriftsartikel (refereegranskat)abstract
    • Co-occurring anxiety in children on the autism spectrum is associated with greater social challenges, including poorer social skills and relationships, which may influence the severity and presentation of anxiety symptoms, particularly social anxiety. The current study used Bayesian network analytics (Williams & Mulder, 2020) and a multimethod approach to examine (a) how different facets of social functioning relate to one another and to anxiety severity and comorbidity, (b) which facet(s) are most influential and thus may represent optimal targets for intervention, and (c) how social functioning relates to the presentation of social fears in a large treatment-seeking sample of autistic children with anxiety disorders (n = 191, 7–13 years). Results indicated strong associations among measures of social ability (i.e., theory of mind [ToM], social motivation, friendship attainment) and among measures of social integration (i.e., bullying, interpersonal and peer difficulties), with only bullying demonstrating a significant association with anxiety. ToM was the most interconnected variable in the network, and social motivation demonstrated the strongest individual connections with other variables, particularly with other facets of social ability. Socially anxious children with impaired ToM were less likely to express fears of negative evaluation, resulting in a distinct diagnostic presentation of social fears. Findings suggest that social motivation and ToM may represent important targets for intervention for autistic children with co-occurring anxiety. Further, social–cognitive difficulties associated with autism, like ToM, may play a role in distinct manifestations of anxiety in these youth.
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50.
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