| 1. |
- Abé, Christoph, et al.
(författare)
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Brain structure and clinical profile point to neurodevelopmental factors involved in pedophilic disorder
- 2021
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Ingår i: Acta Psychiatrica Scandinavica. - : John Wiley & Sons. - 0001-690X .- 1600-0447. ; 143:4, s. 363-374
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Pedophilic disorder (PD) is characterized bypersistent, intense sexual attraction to prepubertal children that the individual has acted on, or causes marked distress or interpersonal difficulty. Although prior research suggests that PD has neurodevelopmental underpinnings, the evidence remains sparse. To aid the understanding of etiology and treatment development, we quantified neurobiological and clinical correlates of PD.Method: We compared 55 self-referred, help-seeking, non-forensic male patients with DSM-5 PD with 57 age-matched, healthy male controls (HC) on clinical, neuropsychological, and structural brain imaging measures (cortical thickness and surface area, subcortical and white matter volumes). Structural brain measures were related to markers for aberrant neurodevelopment including IQ, and the 2nd to 4th digit ratio (2D:4D).Results: PD was associated with psychiatric disorder comorbidity and ADHD and autism spectrum disorder symptoms. PD patients had lower total IQ than HC. PD individuals exhibited cortical surface area abnormalities in regions belonging to the brain's default mode network and showed abnormal volume of white matter underlying those regions. PD subjects had smaller hippocampi and nuclei accumbens than HC. Findings were not related to history of child-related sexual offending. IQ correlated negatively with global expression of PD-related brain features and 2D:4D correlated with surface area in PD.Conclusions: In the largest single-center study to date, we delineate psychiatric comorbidity, neurobiological and cognitive correlates of PD. Our morphometric findings, their associations with markers of aberrant neurodevelopment, and psychiatric comorbidities suggest that neurodevelopmental mechanisms are involved in PD. The findings may need consideration in future development of clinical management of PD patients.
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| 2. |
- Andersson, Linnea, et al.
(författare)
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Independent component analysis of rsfMRI data in pedophilic disorder: A Swedish case control study
- 2022
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Ingår i: Annual Meeting ISMRM (International Society of Magnetic Resonance in Medicine).
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Konferensbidrag (refereegranskat)abstract
- Fifty percent of all child sexual abuse (CSA) perpetrators are individuals with pedophilic disorder. The neural underpinnings of pedophilic disorder are unknown. We conducted a case-control study aiming to investigate functional connectivity alterations using independent component analysis on resting state fMRI data in search of biomarkers that can be used for preventing CSA. The results suggest there are functional connectivity alterations in several resting state networks in individuals with pedophilic disorder.
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| 3. |
- Bayram, Gökçe, et al.
(författare)
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Health care professionals’ view on pedophilic disorder : a qualitative study
- 2021
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Ingår i: Sexual and Relationship Therapy. - : Taylor & Francis Group. - 1468-1994 .- 1468-1749. ; 38:4, s. 684-695
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Tidskriftsartikel (refereegranskat)abstract
- In the last few years there has been a shift in the view on pedophilia and its treatment in international diagnostic manuals and expert consensus documents. This study seeks to investigate the approach of health care professionals’ on some of the topics that are mostly debated: whether pedophilia without distress or acting out should be considered a mental disorder, whether there can be a changeability of pedophilic sexual interest over life and what the main aim of treatment should be. Qualitative content analysis was used to analyze the responses in semi-structured interviews of eight Swedish health care professionals with significant clinical experience from this patient category. These results suggest that there is a lack of consensus regarding all three topics, and that the opinions of the experienced health care professionals did not fully comply with the international experts agreements. This might lead to differences in clinical practice depending on who meets the patient, it can make the patients unsure about how they will be treated if they seek help, and it demonstrates a gap between published international research and clinical practice.
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| 4. |
- Latth, Johanna, et al.
(författare)
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Effects of internet-delivered cognitive behavioral therapy on use of child sexual abuse material : A randomized placebo-controlled trial on the Darknet
- 2022
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Ingår i: Internet Interventions. - : Elsevier. - 2214-7829. ; 30
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The use of child sexual abuse material (CSAM) is an international public health and child protection challenge.Objective: To investigate whether Prevent It, a therapist-supported, internet-delivered, eight-week, cognitive behavioral therapy, reduces CSAM viewing among users.Methods: We conducted a global online single-blind (participants), parallel-group, superiority, randomized, psychological placebo-controlled trial with a one-month follow-up, 2019-2021 (ISRCTN76841676). We recruited anonymous participants, mainly from Darknet forums. Inclusion criteria: age 18+ years, past week CSAM use, and sufficient English language skills; exclusion criteria: severe psychiatric illness or non-serious intent to participate. The main outcome was change in self-reported, weekly viewing time from pre-to post-treatment, according to the Sexual Child Molestation Risk Assessment+.Results: A total of 160 participants (157 male, 2 non-binary, and 1 not reporting gender) from all world regions (age intervals [%]: 18-29 [49]; 30-39 [30]; 40-49 [15]; 50-59 [6]) were randomized (1:1) to Prevent It (N = 80) or Placebo (N = 80). Between-group, intention-to-treat analyses suggested a significantly larger decrease in viewing time in Prevent It participants vs. controls pre-to post-treatment (Prevent It: N = 76, Placebo: N = 78, estimate-0.25, 95 % CI,-0.46 to-0.04, p = .017, Cohen's d 0.18). Negative side effects from treatment were fewer in Prevent It compared to control participants and neither group reported severe adverse events.Conclusion: We provide initial support for the feasibility, efficacy, and safety of Prevent It to reduce CSAM viewing among motivated users. Further research is needed to validate these findings.
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| 5. |
- Liberg, Benny, et al.
(författare)
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Motor imagery in bipolar depression with slowed movement.
- 2013
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Ingår i: The Journal of nervous and mental disease. - 1539-736X. ; 201:10, s. 885-93
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Tidskriftsartikel (refereegranskat)abstract
- We hypothesized that motor retardation in bipolar depression is mediated by disruption of the pre-executive stages of motor production. We used functional magnetic resonance imaging to investigate neural activity during motor imagery and motor execution to elucidate whether brain regions that mediate planning, preparation, and control of movement are activated differently in subjects with bipolar depression (n = 9) compared with healthy controls (n = 12). We found significant between-group differences. During motor imagery, the patients activated the posterior medial parietal cortex, the posterior cingulate cortex, the premotor cortex, the prefrontal cortex, and the frontal poles more than the controls did. Activation in the brain areas involved in motor selection, planning, and preparation was altered. In addition, limbic and prefrontal regions associated with self-reference and the default mode network were altered during motor imagery in bipolar depression with motor retardation.
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| 6. |
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| 7. |
- Rahm, Christoffer
(författare)
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Cognitive and negative symptoms in schizophrenia : studies of patients and healthy controls using magnetic resonance imaging
- 2013
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Schizophrenia is a severe psychiatric illness. It affects young people and often results in lifelong complications such as a distorted perception of reality, decreased cognitive ability and impairment in the realms of motivation and emotions. There is no effective treatment available for two of the symptom domains: cognitive symptoms and the so-called negative symptoms. In recent years, attention has been drawn to the fact that these are the symptom domains resulting in the greatest functional impairment and which best predict a negative prognosis. The need for increased knowledge of the underlying neurobiological correlate is therefore great. Another aspect of the disease-diagnosis in the new onset phase, is an area also requiring more attention, as it is of the utmost importance that a reliable diagnosis be made quickly in order that the correct treatment may be initiated. This thesis describes four studies carried out by myself and my colleagues. Each study addresses different aspects of these schizophrenia-related problems. Diagnostic stability (DS) in the new onset phase of schizophrenia and other psychotic disorders was investigated in the first study. The diagnostic development was analyzed in material documenting 146 first episode psychosis patients that were followed prospectively and longitudinally over 3 years. A large variation in DS was found between the various diagnoses and diagnostic groups. Generally, schizophrenia and the schizophrenia spectrum had high DS, while the DS of diagnoses such as delusional disorder and schizoaffective disorder was low. On the basis of this it is suggested to be restrictive in the use of specific diagnoses in the early phase of a psychotic disorder. The second study examined whether the network of brain regions which processes cognitive control activates different circuits depending on whether the distraction to be processed in parallel with solving a task is of a cognitive or affective nature. A group of 11 healthy subjects were asked to perform counting Stroop (cStroop) and affective counting Stroop (aStroop) during one session while being scanned by a magnetic resonance imaging (MRI) camera. The blood oxygen level dependent (BOLD) functional MRI (fMRI) data shows that this division is present not only in the anterior cingulum cortex (ACC) as expected from previous studies, but also in the dorsolateral prefrontal cortex (DLPFC). This implies separate circuits within the cognitive control network for affective and cognitive distractions. The third studywas devoted to the neurochemical regulation of the cognitive control network. Pharmaco fMRI technique was used to investigate whether brain regions, as activated by aStroop and cStroop respectively, react differently to the selective serotonin reuptake inhibitor (SSRI) agent escitalopram when it is used as a pharmacological probe. A group of 11 healthy subjects performed aStroop and cStroop while being scanned by an MRI camera. Escitalopram was administered after the first session, and the subjects repeated the same examination after a period of four hours. It was found that activation in the rostral ACC by aStroop was significantly decreased following intake of escitalopram. The implication is that the ability to pursue goal-oriented behavior while being disturbed by affective stimuli, an ability which is often impaired in states such as schizophrenia, may be improved on administration of an SSRI. The amygdala’s involvement in the negative symptoms of schizophrenia was examined in the fourth study. The amygdala is a region in the medial temporal lobe of the brain which is critical to faculties such as assigning value to affective stimuli. It was found that the volume of the amygdala as measured by MRI and the activity of the amygdala during an affect inducing paradigm called the Face Matching Task paradigm as measured by BOLD fMRI had a negative correlation to the level of negative symptoms in a group of 28 schizophrenia patients. No significant difference was however found in the volume or activity of theamygdala between this group of patients and a group of 28 matched healthy control subjects. We believe this indicates that the amygdala is involved in the neurobiology of negative symptoms.
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| 8. |
- Savard, Josephine, et al.
(författare)
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Impulsivity in Compulsive Sexual Behavior Disorder and Pedophilic Disorder
- 2021
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Ingår i: Journal of Behavioral Addictions. - : Akademiai Kiado. - 2062-5871 .- 2063-5303. ; 10:3, s. 839-847
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Tidskriftsartikel (refereegranskat)abstract
- Background and aims: Impulsivity is regarded as a risk factor for sexual crime reoffending, and a suggested core feature in Compulsive Sexual Behavior Disorder. The aim of this study was to explore clinical (e.g. neurodevelopmental disorders), behavioral and neurocognitive dimensions of impulsivity in disorders of problematic sexuality, and the possible correlation between sexual compulsivity and impulsivity.Methods: Men with Compulsive Sexual Behavior Disorder (n = 20), and Pedophilic Disorder (n = 55), enrolled in two separate drug trials in a specialized Swedish sexual medicine outpatient clinic, as well as healthy male controls (n = 57) were assessed with the Hypersexual Behavior Inventory (HBI) for sexual compulsivity, and with the Barratt Impulsiveness Scale (BIS) and Connors' Continuous Performance Test-II (CPT-II) for impulsivity. Psychiatric comorbidity information was extracted from interviews and patient case files.Results: Approximately a quarter of the clinical groups had Attention-Deficit/Hyperactivity Disorder (ADHD) or Autism Spectrum Disorder. Both clinical groups reported more compulsive sexuality (r = 0.73-0.75) and attentional impulsivity (r = 0.36-0.38) than controls (P < 0.05). Based on results on univariate correlation analysis, BIS attentional score, ADHD, and Commissions T-score from CPT-II were entered in a multiple linear regression model, which accounted for 15% of the variance in HBI score (P < 0.0001). BIS attentional score was the only independent positive predictor of HBI (P = 0.001).Discussion: Self-rated attentional impulsivity is an important associated factor of compulsive sexuality, even after controlling for ADHD. Psychiatric comorbidity and compulsive sexuality are common in Pedophilic Disorder.Conclusion: Neurodevelopmental disorders and attentional impulsivity - including suitable interventions - should be further investigated in both disorders.
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