| 1. |
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| 2. |
- Englund, Anna-Lena, 1949-, et al.
(författare)
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Värdegrunden reducerad till metod
- 2009
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Ingår i: Pedagogiska magasinet. - Stockholm : Lärarförbundet. - 1401-3320. ; 13:4, s. 18-21
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Tidskriftsartikel (populärvet., debatt m.m.)abstract
- Det behövs en etisk vändning i diskussionen om främjande och förebyggande program. Alltför stort intresse riktas mot frågan om evidens och effektivitet och alltför lite intresse riktas mot värdefrågorna. Vad innebäör det för lärarens professionalism om manualstyrda aktiviteter ersätter samtal och samspel?
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| 3. |
- Engström, Ingemar, 1952-, et al.
(författare)
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Adolescents' Experiences of the Staff's Different Interaction Styles in Coercive Youth Care in Sweden : A Qualitative Study
- 2020
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Ingår i: Issues in Mental Health Nursing. - : Taylor & Francis. - 0161-2840 .- 1096-4673. ; 41:11, s. 1027-1037
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Tidskriftsartikel (refereegranskat)abstract
- We interviewed 20 adolescents who were coercively placed in residential or psychiatric care. The aim was to explore their views on the way staff relate and perform their duties, favorable characteristics in staff, consequences of different treatment from staff and their safety experiences. Thematic analysis identified the following themes: Situational triggers of frustration; Care-based; rule-based; or passive-avoidant interaction styles toward adolescents and their responses; Adolescents' reflections about staff's interaction styles; and the Consequences on the unit atmosphere depending on different interaction styles toward the adolescents. Adolescents preferred staff who showed them respect and a clear wish to make life easier.
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| 4. |
- Engström, Ingemar, 1952-, et al.
(författare)
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Relational continuity may give better clinical outcomes in patients with serious mental illness - a systematic review
- 2023
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Ingår i: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 23:1
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Forskningsöversikt (refereegranskat)abstract
- BackgroundContinuity of care is considered important for results of treatment of serious mental illness (SMI). Yet, evidence of associations between relational continuity and different medical and social outcomes is sparse. Research approaches differ considerably regarding how to best assess continuity as well as which outcome to study. It has hitherto been difficult to evaluate the importance of relational continuity of care. The aim of this systematic review was to investigate treatment outcomes, including effects on resource use and costs associated with receiving higher relational continuity of care for patients with SMI.MethodsEleven databases were searched between January 2000 and February 2021 for studies investigating associations between some measure of relational continuity and health outcomes and costs. All eligible studies were assessed for study relevance and risk of bias by at least two independent reviewers. Only studies with acceptable risk of bias were included. Due to study heterogeneity the synthesis was made narratively, without meta-analysis. The certainty of the summarized result was assessed using GRADE. Study registration number in PROSPERO: CRD42020196518.ResultsWe identified 8 916 unique references and included 17 studies comprising around 300 000 patients in the review. The results were described with regard to seven outcomes. The results indicated that higher relational continuity of care for patients with serious mental illness may prevent premature deaths and suicide, may lower the number of emergency department (ED) visits and may contribute to a better quality of life compared to patients receiving lower levels of relational continuity of care. The certainty of the evidence was assessed as low or very low for all outcomes. The certainty of results for the outcomes hospitalization, costs, symptoms and functioning, and adherence to drug treatment was very low with the result that no reliable conclusions could be drawn in these areas.ConclusionsThe results of this systematic review indicate that having higher relational continuity of care may have beneficial effects for patients with severe mental illness, and no results have indicated the opposite relationship. There is a need for better studies using clear and distinctive measures of exposure for relational continuity of care.
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| 5. |
- Humble, Mats B., 1952-, et al.
(författare)
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Plasma oxytocin changes and anti-obsessive response during serotonin reuptake inhibitor treatment : a placebo controlled study
- 2013
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Ingår i: BMC Psychiatry. - 1471-244X. ; 13, s. 344-
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Tidskriftsartikel (refereegranskat)abstract
- Background: The drug treatments of choice for obsessive-compulsive disorder (OCD) are serotonin reuptake inhibitors (SRIs). However, a correlation between the neuropeptide oxytocin in cerebrospinal fluid and the severity of OCD has previously been shown, and oxytocin and serotonin are interconnected within the brain. Few studies have investigated whether SRIs have any effect on oxytocin; thus, our aim was to explore the possibility that oxytocinergic mechanisms contribute to the anti-obsessive effect of SRIs.Method: In a randomized, double-blind trial, comparing SRIs (clomipramine and paroxetine) with placebo in 36 adults with OCD (characterized for subtypes), plasma oxytocin was measured with radioimmunoassay after plasma extraction, at baseline, after 1 week, and after 4 weeks of treatment, and related to baseline severity and clinical response after 12 weeks, as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).Results: Baseline oxytocin levels correlated positively with baseline Y-BOCS ratings, but only among the future SRI responders. Patients with early onset of OCD had higher baseline oxytocin. During treatment, plasma oxytocin did not differ between SRI and placebo treatment. In SRI responders, plasma oxytocin first decreased and then increased; in non-responders (to SRI as well as to placebo), the reverse was the case. After 4 weeks, treatment responders had attained higher oxytocin levels compared to non-responders. The intra-individual range (i.e. the variability) of plasma oxytocin between measurements was the measure that best differentiated responders from non-responders. This range was higher in responders than non-responders, and lower in patients with autistic traits.Conclusions: SRIs have highly variable effects on plasma oxytocin between individuals. The associations between baseline oxytocin and OCD severity and between oxytocin changes and treatment response support the notions that oxytocin is involved in OCD pathophysiology, and that the anti-obsessive effects of SRIs are partly exerted through oxytocinergic mechanisms.
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| 6. |
- Hylén, Ulrika, 1977-, et al.
(författare)
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Providing Good Care in the Shadow of Violence : An Interview Study with Nursing Staff and Ward Managers in Psychiatric Inpatient Care in Sweden
- 2019
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Ingår i: Issues in Mental Health Nursing. - : Taylor & Francis. - 0161-2840 .- 1096-4673. ; 40:2, s. 148-157
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Tidskriftsartikel (refereegranskat)abstract
- The aim was to describe the nursing staff and ward managers' experiences of safety and violence in everyday meetings with the patients. The qualitative content analyses resulted in four themes: the relationship with the patient is the basis of care; the organizational culture affects the care given; knowledge and competence are important for safe care; and the importance of balancing influence and coercion in care. The staff had a varied ability to meet patients in a respectful way. One way of creating a common approach could be to discuss and reflect upon different options in the meeting with the patient.
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| 7. |
- Nyman-Carlsson, Erika, 1982-, et al.
(författare)
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Eating Disorder Inventory-3, validation in Swedish patients with eating disorders, psychiatric outpatients and a normal control sample
- 2015
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 69:2, s. 142-151
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Eating Disorder Inventory-3 (EDI-3) is designed to assess eating disorder psychopathology and the associated psychological symptoms. The instrument has been revised and has not yet been validated for Swedish conditions in its current form.Aims: The aim of this study was to investigate the validity and reliability of this inventory and present national norms for Swedish females.Methods: Data from patients with eating disorders (n = 292), psychiatric outpatients (n = 140) and normal controls (n = 648), all females, were used to study the internal consistency, the discriminative ability, and the sensitivity and specificity of the inventory using preliminary cut-offs for each subscale and diagnosis separately. Swedish norms were compared with those from Denmark, USA, Canada, Europe and Australian samples.Results: The reliability was acceptable for all subscales except Asceticism among normal controls. Analysis of variance showed that the EDI-3 discriminates significantly between eating disorders and normal controls. Anorexia nervosa was significantly discriminated from bulimia nervosa and eating disorder not otherwise specified on the Eating Disorder Risk Scales. Swedish patients scored significantly lower than patients from other countries on the majority of the subscales. Drive for Thinness is the second best predictor for an eating disorder. The best predictor for anorexia nervosa was Interoceptive Deficits and Bulimia for the other diagnoses.Conclusions/clinical implications: The EDI-3 is valid for use with Swedish patients as a clinical assessment tool for the treatment planning and evaluation of patients with eating-related problems. However, it still exist some uncertainty regarding its use as a screening tool.
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| 8. |
- Pelto-Piri, Veikko, 1959-, et al.
(författare)
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Hantering av hot och våld : Personalens syn på etik, bemötande och säkerhet i mötet med ungdomar på institutioner
- 2017
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- The starting point of this study was that aspects of ethics as well as safety should be taken into account in meetings with patients and clients. The purpose was to increase the understanding of how staff in inpatient and institutional settings relate to the perspectives of good care and safety simultaneously in daily meetings with young clients and patients, especially in aggressive situations. The participants were staff who worked with youngsters on a daily basis at two institutions run by the National Board of Institutional Care (SiS) and a child and adolescent psychiatric clinic. The research questions were: 1) Which values can be found in the staff’s narratives about meetings with youngsters?, 2) How do staff describe the sequence of events in incidents of violence at their workplace?, and 3) How do staff describe their work with prevention and management of violence? Data collection was done through individual interviews, focus group interviews and questionnaires based on the Critical Incident Technique method. Interviews were analyzed with qualitative content analysis. Three themes of staff values emerged in the analysis: 1) From rule to relationship, an experienced movement from a rule-based to a more individualized care, 2) Ways to manage power and responsibility, thoughts about structure and pedagogics, and 3) An institution with a conscious culture, the importance of belonging to a supportive team with common basic views and an open climate. The staff described various kinds of incidents of violence and some of these incidents had serious consequences like seclusion of youngsters and staff injuries causing need for medical care. A need for more education, improved routines and organizational support was expressed. The work to prevent violence included individually detecting risks and, if necessary, communicating with other staff members when assessing these risks. Threats were reported as common but hard to cope with when directed towards a specific staff member and his or her family. The staff stressed the need, after a serious incident, to process what happened with colleagues and youngsters concerned. The colleagues were seen as the most important support, and there were some descriptions of shortcomings in the follow-up routines of violent incidents.
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| 9. |
- Pelto-Piri, Veikko, 1959-, et al.
(författare)
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Paternalism, autonomy and reciprocity : ethical perspectives in encounters with patients in psychiatric in-patient care.
- 2013
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Ingår i: BMC Medical Ethics. - : BioMed Central. - 1472-6939. ; 14:1, s. 49-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Psychiatric staff members have the power to decide the options that frame encounters with patients. Intentional as well as unintentional framing can have a crucial impact on patients' opportunities to be heard and participate in the process. We identified three dominant ethical perspectives in the normative medical ethics literature concerning how doctors and other staff members should frame interactions in relation to patients; paternalism, autonomy and reciprocity. The aim of this study was to describe and analyse statements describing real work situations and ethical reflections made by staff members in relation to three central perspectives in medical ethics; paternalism, autonomy and reciprocity.METHODS: All staff members involved with patients in seven adult psychiatric and six child and adolescent psychiatric clinics were given the opportunity to freely describe ethical considerations in their work by keeping an ethical diary over the course of one week and 173 persons handed in their diaries. Qualitative theory-guided content analysis was used to provide a description of staff encounters with patients and in what way these encounters were consistent with, or contrary to, the three perspectives.RESULTS: The majority of the statements could be attributed to the perspective of paternalism and several to autonomy. Only a few statements could be attributed to reciprocity, most of which concerned staff members acting contrary to the perspective. The result is presented as three perspectives containing eight values.Paternalism; 1) promoting and restoring the health of the patient, 2) providing good care and 3) assuming responsibility.Autonomy; 1) respecting the patient's right to self-determination and information, 2) respecting the patient's integrity and 3) protecting human rights.Reciprocity; 1) involving patients in the planning and implementation of their care and 2) building trust between staff and patients.CONCLUSIONS: Paternalism clearly appeared to be the dominant perspective among the participants, but there was also awareness of patients' right to autonomy. Despite a normative trend towards reciprocity in psychiatry throughout the Western world, identifying it proved difficult in this study. This should be borne in mind by clinics when considering the need for ethical education, training and supervision.
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| 10. |
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| 11. |
- Pelto-Piri, Veikko, 1959-, et al.
(författare)
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Staffs’ perceptions of the ethical landscape in psychiatric inpatient care : A qualitative content analysis of ethical diaries
- 2014
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Ingår i: Clinical Ethics. - London : Sage Publications. - 1477-7509 .- 1758-101X. ; 9:1, s. 45-52
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Tidskriftsartikel (refereegranskat)abstract
- This study presents a qualitative description of situations at work that staff members perceive as giving rise to ethical issues. All staff members working with patients across seven wards were given the opportunity to freely describe ethical considerations in an ethical diary over the course of one week. One hundred and five staff members kept a diary. The diaries were analysed with qualitative content analysis where four dominant themes emerged: good care, order and clarity, loyalty, and inadequacy. These results contain statements in which patients are respected and listened to, as well as statements that express a desire for relatively strict, routine-based care. Relatively few statements were of a reflective or discussing nature which highlights the need for clinical ethical support. There is a need of a visible and supportive leadership which encourages ethical reflection. Reflections on real cases could provide an opportunity to challenge existing practices and thereby promote ethical awareness.
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| 12. |
- Pelto-Piri, Veikko, 1959-, et al.
(författare)
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The ethical landscape of professional care in everyday practice as perceived by staff : a qualitative content analysis of ethical diaries written by staff in child and adolescent psychiatric in-patient care
- 2012
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Ingår i: Child and Adolescent Psychiatry and Mental Health. - London : BioMed Central. - 1753-2000. ; 6:1, s. 18-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Although there has been some empirical research on ethics concerning the attitudes and approaches of staff in relation to adult patients, there is very little to be found on child and adolescent psychiatric care. In most cases researchers have defined which issues are important, for instance, coercive care. The aim of this study was to provide a qualitative description of situations and experiences that gave rise to ethical problems and considerations as reported by staff members on child and adolescent psychiatric wards, although they were not provided with a definition of the concept.METHODS: The study took place in six child and adolescent psychiatric wards in Sweden. All staff members involved with patients on these wards were invited to participate. The staff members were asked to keep an ethical diary over the course of one week, and data collection comprised the diaries handed in by 68 persons. Qualitative content analysis was used in order to analyse the diaries.RESULTS: In the analysis three themes emerged; 1) good care 2) loyalty and 3) powerlessness. The theme 'good care' contains statements about the ideal of commitment but also about problems living up to the ideal. Staff members emphasized the importance of involving patients and parents in the care, but also of the need for professional distance. Participants seldom perceived decisions about coercive measures as problematic, in contrast to those about pressure and restrictions, especially in the case of patients admitted for voluntary care. The theme 'loyalty' contains statements in which staff members perceived contradictory expectations from different interested parties, mainly parents but also their supervisor, doctors, colleagues and the social services. The theme 'powerlessness' contains statements about situations that create frustration, in which freedom of action is perceived as limited and can concern inadequacy in relation to patients and violations in the workplace.CONCLUSIONS: The ethical considerations described by child and adolescent psychiatric care staff are multifaceted and remarkably often concern problems of loyalty and organization. These problems frequently had a considerable influence on the care provided. It seems that staff members lack a language of ethics and require both an ethical education and a forum for discussion of ethical issues.
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| 13. |
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| 14. |
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| 15. |
- Blomqvist, Suzanne, et al.
(författare)
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Interprofessional psychiatric teams : is multidimensionality evident in treatment conferences?
- 2012
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Ingår i: Journal of Interprofessional Care. - New York, USA : Informa Healthcare. - 1356-1820 .- 1469-9567. ; 26:4, s. 289-296
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Tidskriftsartikel (refereegranskat)abstract
- Interprofessional teamwork is practised when the care needs of patients are complex. Little is known about the extent to which team competence really determines patient interventions. The aim of the study was to examine the degree of multidimensionality in patient discussions in psychiatry, and to how different professions contribute. Psychiatric teams were observed during 30 team meetings. A content analysis was used to examine the amount of attention given to medical, psychological and social aspects. The results indicated difficulties in achieving multidimensionality in patient discussions during team meetings. The descriptive element of the discussion was dominated by the social aspect, to which all professions contributed. The analytical element was dominated by the psychological aspect, also to which all the professions contributed. In suggesting interventions, medical interventions were emphasized, principally by the physicians. Decisions on interventions concerned equally medical, social and psychological aspects. An interprofessional composition of teams offers no guarantee that interventions will be of a multidimensional nature. The results are discussed in relation to previous research and practical implications.
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| 16. |
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| 17. |
- Brus, Ole, 1982-, et al.
(författare)
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Long-Term Effect of Maintenance Electroconvulsive Therapy in Patients With Depression-Data From a Small Randomized Controlled Trial
- 2024
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Ingår i: Journal of ECT. - : Lippincott Williams & Wilkins. - 1095-0680 .- 1533-4112.
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: This study aimed to compare the long-term effects of maintenance electroconvulsive therapy (M-ECT) with medication and medication only in patients with depression.METHODS: A randomized controlled trial of 1 year of M-ECT with medication or medication only investigated relapse/recurrence among 56 patients in remission after electroconvulsive therapy (ECT) for depression was conducted. The results of the first year are published already and showed a significant advantage of M-ECT with medication.The current study was a long-term follow-up. When the randomized treatment allocation ended, medication was continued in both groups but M-ECT was terminated. Patients were followed for up to 10 years via Swedish national registers until the study endpoint of a new psychiatric diagnosis as an inpatient, suicide, suspected suicide, or death of another cause. Time to relapse was compared between the M-ECT with medication group and the medication-only group using Kaplan-Meier estimates.RESULTS: The median follow-up time was 6.5 years for the M-ECT and medication group and 3.1 years for the medication-only group. One year after randomization 22 patients remained in the M-ECT and medication group, and 14 patients remained in the medication-only group. Relapse patterns between the treatment groups after the completion of M-ECT seemed to be similar according to visual inspection.CONCLUSIONS: This long-term follow-up study suggests that most of the benefit achieved during the treatment period with M-ECT is maintained over several years, but the small sample size, with accompanying large statistical imprecision, makes the results uncertain. More long-term studies of M-ECT are required.Trial registration: ClinicalTrials.gov identifier: NCT00627887.
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| 18. |
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| 19. |
- Elinder, Göran, et al.
(författare)
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Traumatic shaking : the role of the triad in medical investigations of suspected traumatic shaking
- 2018
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Ingår i: Acta Paediatrica. - Hoboken : John Wiley & Sons. - 0803-5253 .- 1651-2227. ; 107, s. 3-23
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Forskningsöversikt (refereegranskat)abstract
- The Swedish Agency for Health Technology Assessment and Assesment of Social Services (SBU) is an independent national authority, tasked by the government with assessing methods used in health, medical and dental services and social service interventions from a broad perspective, covering medical, economic, ethical and social aspects. The language in SBU's reports are adjusted to a wide audience. SBU's Board of Directors has approved the conclusions in this report. The systematic review showed the following graded results:There is limited scientific evidence that the triad (Three components of a whole. The triad associated with SBS usually comprises subdural haematoma, retinal haemorrhages and encephalopathy.) and therefore, its components can be associated with traumatic shaking (low-quality evidence).There is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low-quality evidence).Limited scientific evidence (low-quality evidence) represents a combined assessment of studies of high or moderate quality which disclose factors that markedly weaken the evidence. It is important to note that limited scientific evidence for the reliability of a method or an effect does not imply complete lack of scientific support. Insufficient scientific evidence (very low-quality evidence) represents either a lack of studies or situations when available studies are of low quality or show contradictory results. Evaluation of the evidence was not based on formal grading of the evidence according to GRADE but on an evaluation of the total scientific basis.
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| 20. |
- Engström, Ingemar, 1952-
(författare)
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Barn- och ungdomspsykiatri
- 2011. - 1
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Ingår i: Pediatrik. - Stockholm : Liber. - 9789147103454 ; , s. 537-555
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 21. |
- Engström, Ingemar, 1952-
(författare)
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Diagnostik och differentialdiagnostik
- 2013. - 1
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Ingår i: Från apati till aktivitet. - Lund : Studentlitteratur AB. - 9789144068152 ; , s. 117-136
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 22. |
- Engström, Ingemar, 1952-
(författare)
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Etik, erfarenhet och evidens
- 2013. - 1
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Ingår i: Palliativ vård. - Lund : Studentlitteratur AB. - 9789144070964 ; , s. 151-162
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 23. |
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| 24. |
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| 25. |
- Engström, Ingemar, 1952-, et al.
(författare)
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Patientens och sjukvårdens värderingar
- 2012. - 1
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Ingår i: Professionell utveckling inom läkaryrket. - Stockholm : Liber. - 9789147099672 ; , s. 27-52
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Bokkapitel (övrigt vetenskapligt/konstnärligt)
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| 26. |
- Engström, Ingemar, 1952-, et al.
(författare)
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Tio myter att avliva om medicinsk etik
- 2010
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Ingår i: Läkartidningen. - Stockholm : Läkartidningen förlag AB. - 0023-7205 .- 1652-7518. ; 107:40, s. 2419-21
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Tidskriftsartikel (refereegranskat)
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| 27. |
- Engström, Ingemar, 1952-, et al.
(författare)
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Vården börjar alltid med mötet
- 2017
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Ingår i: Läkartidningen. - : Sveriges Läkarförbund. - 0023-7205 .- 1652-7518. ; 114:42
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Tidskriftsartikel (refereegranskat)abstract
- Patient care always starts with an encounter Being a doctor is essentially a moral enterprise and all kinds of care begin with the encounter with the patient. This encounter occurs at the intersection of the patient's need for assistance and the doctor's professional knowledge. The meeting can be characterised by paternalism, autonomy or participation. It is important to regard the patient as a person and explore his or her perceptions, apprehensions and expectations early in the meeting. All decisions in medicine rely on both facts and values. It is, therefore, important that both the doctor's and the patient's values and preferences are out in the open. The medical encounter is always asymmetrical, which necessitates that the power perspective be acknowledged.
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| 28. |
- Hedberg, Charlotte, et al.
(författare)
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Can evidence-based medicine become counter-productive?
- 2010
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Ingår i: Scandinavian Journal of Public Health. - London, United Kingdom : Sage Publications. - 1403-4948 .- 1651-1905. ; 38:5, s. 553-4
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Tidskriftsartikel (refereegranskat)
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| 29. |
- Hermansson, Liselotte, 1954-, et al.
(författare)
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Psychosocial adjustment in Swedish children with upper-limb reduction deficiency and a myoelectric prosthetic hand
- 2005
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Ingår i: Acta Paediatrica. - : Wiley. - 0803-5253 .- 1651-2227. ; 94:4, s. 479-88
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Tidskriftsartikel (refereegranskat)abstract
- AIM: To study psychosocial adjustment and mental health in children with upper-limb reduction deficiency and a myoelectric prosthetic hand.METHODS: Sixty-two parents of children aged 8 to 18 y old answered a questionnaire concerning competence and behaviour/emotional problems in their children. Of the 62 children, 37 adolescents aged 11 to 18 y old answered questionnaires concerning competence, problems and mood state. The results were compared with Swedish normative data. The children were divided into five groups based on degree of myoelectric prosthetic use.RESULTS: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand showed social competence and behaviour/emotional problems similar to Swedish standardized norms. However, withdrawn behaviour was significantly higher in all children, social competence was significantly lower in girls, and social activities were significantly lower in older children with upper-limb reduction deficiency. There was a significant difference between prosthetic use groups. Non-users had significantly more delinquent behaviour problems than full-time users. There was an interaction between gender and prosthetic use in their affect on competence and behaviour/emotional problems, yielding two contrasting patterns.CONCLUSION: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand are as well adjusted psychosocially as their able-bodied peers. There are indications, however, of social stigmata related to the deficiency, which have to be considered differently in boys and girls.
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| 30. |
- Holländare, Fredrik, 1972-, et al.
(författare)
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Two-year outcome of internet-based relapse prevention for partially remitted depression
- 2013
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Ingår i: Behaviour Research and Therapy. - : Elsevier BV. - 0005-7967 .- 1873-622X. ; 51:11, s. 719-722
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Tidskriftsartikel (refereegranskat)abstract
- The objective of the study was to investigate the long-term effects of internet-based relapse prevention for sufferers of partially remitted depression. Eighty-four individuals with partially remitted unipolar depression were randomized to either internet-based CBT (iCBT) or to a control group. After the ten week intervention period the participants were followed for 24 months and diagnostic interviews conducted to detect relapse. The intervention and monthly self-ratings of depressive symptoms were administered via an internet-based platform that ensured secure communication with all participants. Significantly fewer participants in the iCBT group had experienced a relapse compared with those in the control group two years after the internet-based intervention. The relapse rate in the iCBT group was 13.7% (CI 95% = 2.5–24.9) and in the control group it was 60.9% (CI 95% = 44.8–77). Furthermore, a significantly larger proportion of the iCBT group experienced remission two years after the intervention compared with the control group. Internet-based CBT seems promising for preventing relapse in sufferers of partially remitted depression.
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| 31. |
- Humble, Mats B., 1952-
(författare)
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Obsessive-compulsive disorder, serotonin and oxytocin : treatment response and side effects
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Obsessive-compulsive disorder (OCD), with a prevalence of 1-2 %, frequently leads a chronic course. Persons with OCD are often reluctant to seek help and, if they do, their OCD is often missed. This is unfortunate, since active treatment may substantially improve social function and quality of life. Serotonin reuptake inhibitors (SRIs) have welldocumented efficacy in OCD, but delayed response may be problematic. Methods to predict response have been lacking. Because SRIs are effective, pathophysiological research on OCD has focussed on serotonin. However, no clear aberrations of serotonin have been found, thus other mechanisms ought to be involved.Our aims were to facilitate clinical detection and assessment of OCD, to search for biochemical correlates of response and side-effects in SRI treatment of OCD and to identify any possible involvement of oxytocin in the pathophysiology of OCD.In study I, we tested in 402 psychiatric out-patients the psychometric properties of a concise rating scale, “Brief Obsessive Compulsive Scale” (BOCS). BOCS was shown to be easy to use and have excellent discriminant validity in relation to other common psychiatric diagnoses.Studies II-V were based on 36 OCD patients from a randomised controlled trial of paroxetine, clomipramine or placebo. In study II, contrary to expectation, we found that the change (decrease) of serotonin in whole blood was most pronounced in non-responders to SRI. This is likely to reflect inflammatory influence on platelet turnover rather than serotonergic processes within the central nervous system.In studies IV-V, we found relations between changes of oxytocin in plasma and the anti-obsessive response, and between oxytocin and the SRI related delay of orgasm, respectively. In both cases, the relation to central oxytocinergic mechanisms is unclear. In males, delayed orgasm predicted anti-obsessive response.
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| 32. |
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| 33. |
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| 34. |
- Lindow, Martin, et al.
(författare)
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Strategies for the Prevention of Violence in Institutional Care : A Qualitative Interview Study With Ward Managers
- 2022
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Ingår i: Frontiers in Psychiatry. - : Frontiers Media S.A.. - 1664-0640. ; 13
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Tidskriftsartikel (refereegranskat)abstract
- Background: The presence of violence within psychiatric and residential settings remains a challenge. Research on this problem has often focused on describing violence prevention strategies from either staffs' or service users' perspectives, and the views of ward managers has been largely overlooked. The aim of the present study was therefore to identify ward managers' strategies to prevent violence in institutional care, focusing on safety and values.Methods: Data were collected using semi-structured interviews with 12 ward managers who headed four different types of psychiatric wards and two special residential homes for adolescents. Qualitative content analysis was applied, first using a deductive approach, in which quotes were selected within a frame of primary, secondary, and tertiary prevention, then by coding using an inductive approach to create themes and subthemes.Results: Ward managers' strategies were divided into the four following themes: (1) Balancing being an active manager with relying on staff's abilities to carry out their work properly while staying mostly in the background; (2) Promoting value awareness and non-coercive practices in encounters with service users by promoting key values and adopting de-escalation techniques, as well as focusing on staff-service user relationships; (3) Acknowledging and strengthening staff's abilities and competence by viewing and treating staff as a critical resource for good care; and (4) Providing information and support to staff by exchanging information and debriefing them after violent incidents.Conclusions: Ward managers described ethical challenges surrounding violence and coercive measures. These were often described as practical problems, so there seems to be a need for a development of higher ethical awareness based on a common understanding regarding central ethical values to be respected in coercive care. The ward managers seem to have a high awareness of de-escalation and the work with secondary prevention, however, there is a need to develop the work with primary and tertiary prevention. The service user group or user organizations were not considered as resources in violence prevention, so there is a need to ensure that all stakeholders are active in the process of creating violence prevention strategies.
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| 35. |
- Lynøe, Niels, et al.
(författare)
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Dödshjälp bakom okunskapens slöja
- 2018
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Ingår i: Läkartidningen. - : Läkartidningen Förlag AB. - 0023-7205 .- 1652-7518. ; 115:24, s. 1020-1020
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Tidskriftsartikel (refereegranskat)
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| 36. |
- Lynøe, Niels, et al.
(författare)
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How to reveal disguised paternalism : version 2.0
- 2021
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Ingår i: BMC Medical Ethics. - : BioMed Central. - 1472-6939. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: We aim to further develop an index for detecting disguised paternalism, which might influence physicians' evaluations of whether or not a patient is decision-competent at the end of life. Disguised paternalism can be actualized when physicians transform hard paternalism into soft paternalism by questioning the patient's decision-making competence.METHODS: A previously presented index, based on a cross-sectional study, was further developed to make it possible to distinguish between high and low degrees of disguised paternalism using the average index of the whole sample. We recalculated the results from a 2007 study for comparison to a new study conducted in 2020. Both studies are about physicians' attitudes towards, and arguments for or against, physician-assisted suicide.RESULTS: The 2020 study showed that geriatricians, palliativists, and middle-aged physicians (46-60 years old) had indices indicating disguised paternalism, in contrast with the results from the 2007 study, which showed that all specialties (apart from GPs and surgeons) had indices indicating high degrees of disguised paternalism.CONCLUSIONS: The proposed index for identifying disguised paternalism reflects the attitude of a group towards physician assisted suicide. The indices make it possible to compare the various medical specialties and age groups from the 2007 study with the 2020 study. Because disguised paternalism might have clinical consequences for the rights of competent patients to participate in decision-making, it is important to reveal disguised hard paternalism, which could masquerade as soft paternalism and thereby manifest in practice. Methods for improving measures of disguised paternalism are worthy of further development.
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| 37. |
- Lynøe, Niels, et al.
(författare)
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Rawlsian reasoning about fairness at the end of life
- 2023
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Ingår i: BMJ Supportive & Palliative Care. - : BMJ. - 2045-435X .- 2045-4368. ; 13:e3, s. e1398-e1404
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVES: The aim of this study was to discuss end-of-life care in the context of Rawls' and Daniels' philosophy of justice. The study is based on an empirical survey of Swedish physicians who were asked whether they would want the option of physician-assisted suicide (PAS) for themselves (hereafter called own preferences), what are their attitudes towards PAS in general and whether they were prepared to prescribe PAS drugs to eligible patients. The question is to what extent the physicians' answers are impartial and consistent in a Rawlsian sense.METHODS: The underlying indicator was the physicians' own preferences. Kappa score inter-rater agreement was measured between that response and that same physician's general attitude towards allowing PAS and preparedness to prescribe PAS drugs. The coherence of provided comments and arguments were analysed using content analysis.RESULTS: Palliative care physicians are the least willing to offer PAS, and surgeons and psychiatrist the most willing. There is a discrepancy between physicians' general attitudes about allowing PAS, their own wishes to be offered PAS at the end of life and the concrete action of prescribing PAS drugs. Arguments given for not prescribing PAS by those in favour of PAS are seemingly but not truly inconsistent.CONCLUSIONS: Those supporting PAS provided impartial and consistent arguments for their stances in a Rawlsian sense, while those against PAS provided partial arguments. Two specialties, psychiatrists and palliative care physicians, were coherent in their reasoning about PAS for themselves and their willingness to prescribe the needed drugs.
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| 38. |
- Lynøe, Niels, et al.
(författare)
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Trends in Swedish physicians’ attitudes towards physician-assisted suicide: a cross-sectional study
- 2021
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Ingår i: BMC Medical Ethics. - : BioMed Central. - 1472-6939. ; 22:1
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Tidskriftsartikel (refereegranskat)abstract
- Aims: To examine attitudes towards physician-assisted suicide (PAS) among physicians in Sweden and compare these with the results from a similar cross-sectional study performed in 2007.Participants: A random selection of 250 physicians from each of six specialties (general practice, geriatrics, internal medicine, oncology, surgery and psychiatry) and all 127 palliative care physicians in Sweden were invited to participate in this study.Setting: A postal questionnaire commissioned by the Swedish Medical Society in collaboration with Karolinska Institute in Stockholm.Results: The total response rate was 59.2%. Slightly fewer than half [47.1% (95% CI 43.7–50.5)] of the respondents from the six specialties accepted PAS, which is significantly more than accepted PAS in the 2007 study [34.9% (95% CI 31.5–38.3)]. Thirty-three percent of respondents were prepared to prescribe the needed drugs. When asked what would happen to the respondent’s own trust in healthcare, a majority [67.1% (95% CI 63.9–70.3)] stated that legalizing PAS would either not influence their own trust in healthcare, or that their trust would increase. This number is an increase compared to the 2007 survey, when just over half [51.9% (95% CI 48.0–55.2)] indicated that their own trust would either not be influenced, or would increase.Conclusions: The study reveals a shift towards a more accepting attitude concerning PAS among physicians in Sweden. Only a minority of the respondents stated that they were against PAS, and a considerable proportion reported being prepared to prescribe the needed drugs for patient self-administration if PAS were legalized.
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| 39. |
- Lynøe, Niels, et al.
(författare)
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Values at stake at the end of life : Analyses of personal preferences among Swedish physicians
- 2022
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Ingår i: Clinical Ethics. - : Sage Publications. - 1477-7509 .- 1758-101X. ; 18:2, s. 239-244
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Tidskriftsartikel (refereegranskat)abstract
- Background Physician-assisted suicide is a controversial issue and has sometimes raised emotion-laden reactions. Against this backdrop, we have analyzed how Swedish physicians are reasoning about physician-assisted suicide if it were to be legalized.Methods and participants We conducted a cross-sectional study and analyzed 819 randomly selected physicians’ responses from general practitioners, geriatricians, internists, oncologists, psychiatrists, surgeons, and all palliativists. Apart from the main questions about their attitude toward physician-assisted suicide, we also asked what would happen with the respondents’ own trust in healthcare if physician-assisted suicide were legalized. Response options were that trust would decrease, not be influenced, or would increase.Results We identified a strong statistical association between on the one hand those whose own trust would increase and who were pro physician-assisted suicide, and on the other hand those who were against physician-assisted suicide and whose own trust would decrease [relative risk: 16.7 (95% confidence interval: 10.2–27.2)]. Among those whose own trust would not be influenced (n = 456), 60% were pro pysician-assisted suicide, 16% were against, and 24% were undecided. Of those whose trust would increase or not be influenced, a large majority supported autonomy-based arguments, whereas those whose trust would decrease supported non-maleficence-based arguments.Conclusion Analyzing the answers after having divided respondents into those whose own trust in healthcare would decrease or increase and not be influenced brings about interesting results such as how the three groups prioritize arguments for and against physician-assisted suicide. This way of analyzing the data seems to be a promising strategy when identifying value-impregnated factual claims.
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| 40. |
- Lytsy, P., et al.
(författare)
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Outcomes associated with higher relational continuity in the treatment of persons with asthma or chronic obstructive pulmonary disease: A systematic review
- 2022
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Ingår i: EClinicalMedicine. - : Elsevier BV. - 2589-5370. ; 49
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Forskningsöversikt (refereegranskat)abstract
- Background Asthma and chronic obstructive pulmonary disease (COPD) are chronic conditions where relational continuity of care, as in regularly meeting the same health care provider, creates opportunities for monitoring and adjustment of treatment based on an individual's changing needs, potentially affecting quality of delivered care. The aim of this systematic review was to investigate the effects of relational continuity in the treatment of persons with asthma or COPD. Methods Eleven databases (CINAHL, Medline, PsycINFO, Scopus, Embase, Cochrane Library, Database of Systematic Review of Effects, DARE, Epistemonikos, NICE Evidence Search, KSR Evidence and AHRQ) were searched between January 1, 2000, and February 1 -4, 2021, for controlled and observational studies about relational continuity and health outcomes for persons with asthma and/or COPD. Inclusion criteria were studies investigating an index or aspect relevant to relational continuity between a health professional/team of health professionals and patients. After screening, and assessment of study relevance and quality by at least two independent reviewers, studies with acceptable risk of bias were included and summary data was extracted from the publications. Main outcomes were mortality, morbidity (including health care utilization) and cost measures. Syntheses without metanalyses were performed due to considerable study heterogeneity. The certainty of the summarized result was assessed using GRADE (the Grading of Recommendations Assessment, Development and Evaluation). PROSPERO study registration number: CRD42020196518. Findings We identified 2824 unique references and included 15 studies (14 observational and 1 randomized controlled trial) in the review, from which results were derived for six outcomes. For persons with asthma or COPD we found that higher compared to lower relational continuity of care prevents premature mortality (low certainty; 2 studies, 111 545 participants), lowers risk of emergency department visits (low certainty, 5 studies, 362 305 participates) and risk of hospitalization (moderate certainty, 9 studies, 525 716 participants), and lowers health care costs (low certainty; 4 studies, 390 682 participants). Results regarding treatment adherence (1 study, 971 participants) and patient perceptions (3 studies, 2026 participants) were assessed as having very low certainty. Interpretation Low to moderate certainty evidence suggests that higher versus lower relational continuity of care for persons with asthma or COPD prevents premature mortality, lowers risks of unplanned health care utilization and reduces health care costs. The results may be of value when planning care for individuals and for policymakers in organizing health care and developing guidelines for treatment and follow-up routines. Copyright (C) 2022 The Author(s). Published by Elsevier Ltd.
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| 41. |
- Nilsson, Karin, et al.
(författare)
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Family Climate And Recovery In Adolescent Onset Eating Disorders : a prospective study
- 2012
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Ingår i: European eating disorders review. - Hoboken, USA : Wiley-Blackwell. - 1072-4133 .- 1099-0968. ; 20:1, s. e96-e102
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Tidskriftsartikel (refereegranskat)abstract
- Objective: This prospective study investigated the self-assessed family climate of adolescent patients and their parents during treatment of and recovery from eating disorders.Method: One hundred two girls aged 13-17 years with eating disorders, answered the self-report Family Climate Scale (FCS) and Eating Disorders Inventory for Children at initial assessment and after 18 and 36 months. The FCS was also answered by their parents at the same time points.Results: Self-assessed family climate and eating disorder symptoms were similar for recovered (R) and nonrecovered (NR) adolescents at initial assessment and at 18 months. At 36 months, FCS Closeness was higher for R, and FCS Distance was lower for R compared with NR. Parents of R adolescents had higher scores on FCS Closeness and lower scores on FCS Chaos compared with parents of NR adolescents at the 36-month follow-up.Conclusion: Self-reported family climate was associated with recovery. Changes in eating disorder symptoms preceded changes in family climate. Copyright (C) 2011 John Wiley & Sons, Ltd and Eating Disorders Association.
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| 42. |
- Nordenskjöld, Axel, 1977-, et al.
(författare)
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Predictors of regained occupational functioning after electroconvulsive therapy (ECT) in patients with major depressive disorder : a population based cohort study
- 2013
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Ingår i: Nordic Journal of Psychiatry. - Oxfordshire, United Kingdom : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 67:5, s. 326-333
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Tidskriftsartikel (refereegranskat)abstract
- Aims: The aim of the present study is to investigate the rate of regained occupational functioning among patients treated with electroconvulsive therapy (ECT) for major depression and to define predictors of time to regained occupational functioning.Methods: A nested cohort study was performed of patients treated by ECT for unipolar major depressive disorder registered in the Quality register for ECT and in the Swedish Social Insurance Agency registry. Predictive values of single clinical variables and their relative importance were tested with Cox regression analysis.Results: 394 patients were identified. Of those, 266 were on non-permanent sick leave and 128 on disability pension during ECT. Within 1 year post-ECT, 71% of the patients with non-permanent sick leave regained occupational functioning. Factors independently associated with a statistically significant increased time to regained occupational functioning were longer duration of sick leave pre-ECT, milder depression pre-ECT, less complete improvement with ECT, benzodiazepine treatment after ECT and co-morbid substance dependence.Conclusions: A large proportion of the patients do not return to work within several months post-ECT. Paradoxically, patients with more severe depression pre-ECT had a reduced time to regained occupational functioning, indicating a larger effect in this patients group of the treatment. Moreover, the period with sick leave compensation might be reduced if ECT is initiated within the first 3 months of sick leave.Clinical implications: Most patients on non-permanent sick leave regain occupational functioning after ECT. However, it usually takes a few months even in symptomatically improved patients.
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| 43. |
- Nordenskjöld, Axel, 1977-, et al.
(författare)
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Predictors of the short-term responder rate of Electroconvulsive therapy in depressive disorders : a population based study
- 2012
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Ingår i: BMC Psychiatry. - London, United Kingdom : BioMed Central. - 1471-244X. ; 12
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Tidskriftsartikel (refereegranskat)abstract
- Background: The aim of the present study is to investigate the responder rate of Electroconvulsive therapy, ECT, in clinical routine work and to define clinical characteristics predictive of response to ECT. The main hypothesis is that the responder rate of ECT might be lower in clinical routine than in controlled trials.Methods: This is a population-based study of all patients (N = 990) treated with ECT for depressive disorders, between 2008-2010 in eight hospitals in Sweden. Patients with Clinical Global Impression-Improvement scores of 1 or 2 (much improved) within one week after ECT were considered responders to ECT. The predictive values of single clinical variables were tested by means of chi-squared tests and the relative importance was tested in a logistic regression analysis.Results: The responder rate was 80.1%. A higher proportion of older patients (>50 years) responded (84.3% vs. 74.2%, p < 0.001). Psychotically depressed patients responded better (88.9% vs. 81.5% for severely depressed and 72.8% for mildly depressed, p < 0.001). There were no significant differences in responder rates between patients suffering from bipolar, first or recurrent major depressive syndromes, or a depressive episode of schizoaffective disorder. Patients with personality disorder had a lower responder rate (66.2% vs. 81.4%, p < 0.001). Also, outpatients had a lower responder rate (66.3%) compared to inpatients (83.4%, p < 0.001). In the logistic regression analysis, inpatient status, psychotic symptoms, absence of schizoaffective disorder and older age were independent factors associated with response to ECT.Conclusions This study focuses exclusively on the short term responder rate with ECT in clinical practice. Similarly to results from controlled trials a high responder rate is reported. Older patients, more severely ill patients, psychotically ill patients and patients without personality disorders had the highest responder rates. Inpatients may have better outcome with ECT than outpatients.
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| 44. |
- Norell-Clarke, Annika, 1979-, et al.
(författare)
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An investigation of cognitive processes as outcomes and mediators of CBT-I for insomnia in a sample with insomnia and depression
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Annan publikation (övrigt vetenskapligt/konstnärligt)abstract
- Aim: CBT for insomnia (CBT-I) seems to affect both insomnia and depression in comorbid samples but there is a gap in the knowledge about how the treatment works. The aim was to gain a greater understanding of the relationship between insomnia-specific cognitive processes, insomnia, depressive symptoms and CBT-I in sample with insomnia comorbid with depressive problems.Methods: 64 participants were recruited through advertisements and randomised to receive either CBT-I or an active control (relaxation training: RT) in groups during four sessions over seven weeks. Insomnia, depressive severity, and cognitive processes were measured pre-, mid- and post-treatment.Results: All cognitive processes: sleep-related worry, dysfunctional beliefs, somatic arousal, selective attention and monitoring, and safety behaviours, lowered over the course of treatment. CBT-I was associated with greater reductions of safety behaviours and dysfunctional beliefs about sleep compared to RT. Mid-treatment dysfunctional beliefs aboutsleep mediated between CBT-I and outcomes on insomnia and depression severity.Conclusion: Dysfunctional beliefs may be a transdiagnostic process of both insomnia and depression. Clinical implications and further directions are discussed.
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| 45. |
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| 46. |
- Norell-Clarke, A., 1979-, et al.
(författare)
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Cognitive behavioural therapy for comorbid insomnia and depression : A randomised, controlled study
- 2013
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Ingår i: Sleep Medicine. - Amsterdam : Elsevier. - 1389-9457 .- 1878-5506. ; 14:Suppl. 1, s. e99-e99
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Introduction: Insomnia and depression is a common comorbidity and several pilot studies have demonstrated promising results on both conditions by targeting insomnia only. The aim was to investigate the effects of CBT for insomnia (CBT-I) on both sleep and depressive symptoms in a sample with insomnia comorbid with major depression, minor depression or depressive symptoms, using a randomized controlled study.Materials and methods: 64 participants were recruited through advertisements and randomised to receive either CBT-I or an active control (relaxation training: RT) in groups during four sessions over seven weeks. Insomnia and depressive severity was measured before, during and after treatment, using Insomnia Severity Index (ISI) and Beck Depression Inventory (BDI- II).Results: We used independent t-tests to investigate if groups were different on symptom severity prior to treatment. There was no difference between CBT-I and RT regarding insomnia severity (t (55) = 1.30, p = 0.20) or depression severity (t (53) = −0.77, p = 0.44). Looking at development over time, mixed between-within subjects ANOVAs demonstrated a significant interaction between treatment type and time for both insomnia and depression (ISI: F (2, 54) = 4.96, p = 0.01; BDI: F (2, 58) = 2.80, p = 0.07) meaning that CBT-I meant a larger decrease of both insomnia and depressive severity compared to control treatment. There was also a significant main effect for time with decreasing scores for both groups over time on ISI (F (2, 52) = 28.86, p = 0.0005) and BDI-II (F (2, 58) = 7.11, p = 0.002) and a main effect for group on ISI (F (1, 53) = 9.25, p = 0.01) but not on BDI-II (F (1, 59) = 0.27, p = 0.60). A six months follow-up assessment is currently conducted and those results will also be presented during the conference.Conclusion: CBT-I was associated with a greater reduction in insomnia and depression severity compared to control treatment. These results show that it is possible to have an effect on both insomnia and depression during a relatively short and cost effective group treatment, targeting insomnia only.
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| 47. |
- Norell-Clarke, Annika, 1979-, et al.
(författare)
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Does Mid-Treatment Insomnia Severity Mediate between Cognitive Behavioural Therapy for Insomnia and Post-Treatment Depression? : An Investigation in a Sample with Comorbid Insomnia and Depressive Symptomatology
- 2018
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Ingår i: Behavioural and Cognitive Psychotherapy. - : Cambridge University Press. - 1352-4658 .- 1469-1833. ; 46:6, s. 726-737
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Recent treatment studies with cognitive behavioural therapy for insomnia (CBT-I) have demonstrated effects on both sleep problems and depression. Two previous studies have indicated that the beneficial effect from CBT-I on depression may come through improved sleep, although insomnia severity during treatment had not previously been investigated as a mediator.AIMS: Our aim was to investigate if insomnia severity during treatment mediated between CBT-I and depression severity after treatment, in a sample with co-morbid insomnia and depressive symptomology. We also examined whether depressive severity during treatment mediated between CBT-I and insomnia after treatment.METHOD: The participants were recruited from advertisements and fulfilled criteria for insomnia diagnosis, and had depressive symptomatology (Beck Depression Inventory-second edition: BDI-II > 13). Two-thirds of the participants were diagnosed with major depressive disorder. The participants received four biweekly group sessions of CBT-I or relaxation training (active control). Insomnia severity (Insomnia Severity Index) and depressive severity (BDI-II) were measured at baseline, mid-treatment, post-treatment and 6-month follow-up. The mid-treatment measures were used as mediators.RESULTS: Mediational analyses demonstrated a significant reciprocal relationship between insomnia severity and depressive severity throughout CBT-I, although mid-treatment insomnia had a stronger effect on depression than mid-treatment depression had on insomnia. The results were similar for both post-treatment and follow-up.DISCUSSION: Some improvement in depressive severity after CBT-I is explained by improved sleep. The findings emphasize the importance of making comorbid insomnia a treatment focus in its own right.
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| 48. |
- Norell-Clarke, Annika, 1979-, et al.
(författare)
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Does Mid-Treatment Insomnia Severity Mediate between Cognitive Behavioural Therapy for Insomnia and Post-Treatment Depression? An Investigation in a Sample with Comorbid Insomnia and Depressive Symptomatology
- 2018
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Ingår i: Behavioural and Cognitive Psychotherapy. - : Cambridge University Press. - 1352-4658 .- 1469-1833. ; 46:6, s. 726-737
-
Tidskriftsartikel (refereegranskat)abstract
- Background: Recent treatment studies with cognitive behavioural therapy for insomnia (CBT-I) have demonstrated effects on both sleep problems and depression. Two previous studies have indicated that the beneficial effect from CBT-I on depression may come through improved sleep, although insomnia severity during treatment had not previously been investigated as a mediator.Aims: Our aim was to investigate if insomnia severity during treatment mediated between CBT-I and depression severity after treatment, in a sample with co-morbid insomnia and depressive symptomology. We also examined whether depressive severity during treatment mediated between CBT-I and insomnia after treatment.Method: The participants were recruited from advertisements and fulfilled criteria for insomnia diagnosis, and had depressive symptomatology (Beck Depression Inventory-second edition: BDI-II > 13). Two-thirds of the participants were diagnosed with major depressive disorder. The participants received four biweekly group sessions of CBT-I or relaxation training (active control). Insomnia severity (Insomnia Severity Index) and depressive severity (BDI-II) were measured at baseline, mid-treatment, post-treatment and 6-month follow-up. The mid-treatment measures were used as mediators.Results: Mediational analyses demonstrated a significant reciprocal relationship between insomnia severity and depressive severity throughout CBT-I, although mid-treatment insomnia had a stronger effect on depression than mid-treatment depression had on insomnia. The results were similar for both post-treatment and follow-up.Discussion: Some improvement in depressive severity after CBT-I is explained by improved sleep. The findings emphasize the importance of making comorbid insomnia a treatment focus in its own right.
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| 49. |
- Norell-Clarke, Annika, 1979-, et al.
(författare)
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Group cognitive behavioural therapy for insomnia : Effects on sleep and depressive symptomatology in a sample with comorbidity
- 2015
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Ingår i: Behaviour Research and Therapy. - : Elsevier. - 0005-7967 .- 1873-622X. ; 74, s. 80-93
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate the effects of group CBT for insomnia (CBT-I) on insomnia and depressive symptomatology in a comorbid sample through a randomised controlled trial with a 6 month follow-up.Methods: 64 participants were recruited through advertisements and randomised to receive CBT-I or an active control (relaxation training: RT) during four group sessions. Insomnia Severity Index and BDI-II were the primary outcome measures, assessed pre-treatment, post-treatment and at 6 month follow-up. Insomnia and depressive diagnoses, and functional impairment were assessed before and after treatment, whereas sleep diary data was gathered continuously from one week before treatment until after treatment.Results: CBT-I was more efficient than RT in reducing insomnia severity and equally effective in reducing depressive symptoms, although CBT-I was associated with a higher proportion of remitted persons than RT, regarding both insomnia and depression diagnoses. Also, CBT-I was associated with less functional impairment, shorter sleep onset latency and wake after sleep onset but both treatments had equal improvements of sleep quality, early morning awakenings and total sleep time.Conclusion: Group CBT-I is an efficient form of insomnia-treatment for people with insomnia comorbid with depressive symptomatology. The mixed results regarding depression outcomes warrants replication and further studies into treatment mechanisms. (C) 2015 Elsevier Ltd. All rights reserved.
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| 50. |
- Norell-Clarke, Annika, 1979-, et al.
(författare)
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How does cognitive behavioral therapy for insomnia work? : An investigation of cognitive processes and time in bed as outcomes and mediators in a sample with insomnia and depressive symptomatology
- 2017
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Ingår i: International Journal of Cognitive Therapy. - : Guilford Publications. - 1937-1209 .- 1937-1217. ; 10:4, s. 304-329
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to gain a greater understanding of the five cognitive processes from the cognitive model of insomnia, negative automatic thoughts, and time in bed as outcomes and potential mediators of cognitive behavioral therapy for insomnia (CBT-I), in a sample with insomnia and depressive symptomatology. Sixty-four participants were randomized to receive either CBT-I or an active control (relaxation training: RT) in groups during four biweekly sessions. Insomnia, depressive severity, and the potential processes of change were measured pre-, mid-, and post-treatment. CBT-I was associated with greater reductions of dysfunctional beliefs about sleep, sleep-related safety behaviors, and time in bed compared to RT. Mid-treatment dysfunctional beliefs about sleep was the only process that mediated between CBT-I and outcomes on insomnia and depressive severity, respectively. The relationships were reciprocal. Dysfunctional beliefs about sleep may be a transdiagnostic process of both insomnia and depression.
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