| 1. |
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| 2. |
- Bejerot, Susanne, 1955-, et al.
(författare)
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The Brief Obsessive-Compulsive Scale (BOCS) : a self-report scale for OCD and obsessive-compulsive related disorders
- 2014
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Ingår i: Nordic Journal of Psychiatry. - : Informa Healthcare. - 0803-9488 .- 1502-4725. ; 68:8, s. 549-559
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Tidskriftsartikel (refereegranskat)abstract
- Background: The Brief Obsessive Compulsive Scale (BOCS), derived from the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the children's version (CY-BOCS), is a short self-report tool used to aid in the assessment of obsessive-compulsive symptoms and diagnosis of obsessive-compulsive disorder (OCD). It is widely used throughout child, adolescent and adult psychiatry settings in Sweden but has not been validated up to date.Aim: The aim of the current study was to examine the psychometric properties of the BOCS amongst a psychiatric outpatient population.Method: The BOCS consists of a 15-item Symptom Checklist including three items (hoarding, dysmorphophobia and self-harm) related to the DSM-5 category "Obsessive-compulsive related disorders", accompanied by a single six-item Severity Scale for obsessions and compulsions combined. It encompasses the revisions made in the Y-BOCS-II severity scale by including obsessive-compulsive free intervals, extent of avoidance and excluding the resistance item. 402 adult psychiatric outpatients with OCD, attention-deficit/hyperactivity disorder, autism spectrum disorder and other psychiatric disorders completed the BOCS.Results: Principal component factor analysis produced five subscales titled "Symmetry", "Forbidden thoughts", "Contamination", "Magical thoughts" and "Dysmorphic thoughts". The OCD group scored higher than the other diagnostic groups in all subscales (P < 0.001). Sensitivities, specificities and internal consistency for both the Symptom Checklist and the Severity Scale emerged high (Symptom Checklist: sensitivity = 85%, specificities = 62-70% Cronbach's alpha = 0.81; Severity Scale: sensitivity = 72%, specificities = 75-84%, Cronbach's alpha = 0.94).Conclusions: The BOCS has the ability to discriminate OCD from other non-OCD related psychiatric disorders. The current study provides strong support for the utility of the BOCS in the assessment of obsessive-compulsive symptoms in clinical psychiatry.
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| 3. |
- Björk, Tabita, 1966-, et al.
(författare)
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Criminal recidivism and mortality among patients discharged from a forensic medium secure hospital
- 2012
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Ingår i: Nordic Journal of Psychiatry. - London, United Kingdom : Informa Healthcare. - 0803-9488 .- 1502-4725. ; 66:4, s. 283-9
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Tidskriftsartikel (refereegranskat)abstract
- Background: One of the goals in forensic psychiatric care is to reduce the risk of recidivism, but current knowledge about the general outcome of forensic psychiatric treatment is limited.Aims: To analyse the rate of criminal recidivism and mortality after discharge in a sample of patients sentenced to forensic psychiatric treatment in a Swedish county.Methods: All offenders in Örebro County, Sweden, sentenced to forensic psychiatric treatment and discharged during 1992-2007 were included: 80 males and eight females. Follow-up data was retrieved from the Swedish National Council for Crime Prevention, the National Cause-of-Death register and clinical files. Mean follow-up time was 9.4 years.Results: The mean age at discharge was 40 years. Schizophrenia, other psychoses and personality disorders were the most prevalent diagnoses. Thirty-eight percent of those still alive and still living in the country re-offended and were sentenced to a new period of forensic psychiatric treatment or incarceration during follow-up. Four male re-offenders committed serious violent crimes. Substance-related diagnosis was significantly associated with risk of recidivism and after adjustment for diagnoses, age and history of serious violent crime, the Hazard Ratio was 4.04 (95% CI 1.51-10.86, P = 0.006). Of all included patients, 23% had died at the end of follow-up (standardized mortality rate 10.4).Conclusions: Since repetition of serious violent crimes was unusual, results indicate a positive development subsequent to treatment for those alive at follow-up.Clinical implications: The high mortality rate suggests that more attention should be paid in evaluation of the patients' somatic and psychiatric health during and after care in order to prevent premature death.
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| 4. |
- Bodén, Robert, 1973-, et al.
(författare)
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Psychomotor and cognitive deficits as predictors of 5-year outcome in first-episode schizophrenia
- 2014
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 68:4, s. 282-288
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Tidskriftsartikel (refereegranskat)abstract
- Background: Cognitive deficits are common in schizophrenia but the predictive value of these deficits for long-term outcome in first-episode patients is unclear. Aims: We aimed to investigate associations of performance in psychomotor and cognitive tests with a 5-year functional and symptomatic outcome. Methods: After clinical stabilization, patients with a first schizophrenia spectrum diagnosis (n = 46) were assessed for global cognitive function [Synonyms, Reasoning, and Block Design (SRB)], psychomotor speed [Trail Making Test (TMT) and finger tapping] and verbal learning (Claeson-Dahl Verbal Learning Test). The subsequent 5-year outcome regarding independent living, occupational and social function, and symptomatic remission status was assessed. Results: Low psychomotor speed was associated with poor social function 5 years later, with an odds ratio (OR) of 3.37 and a 95% confidence interval (CI) of 1.08-10.51, adjusted for antipsychotic drug use. Better performance on finger tapping with the non-dominant hand was associated with an increased risk of a 5-year symptomatic non-remission (adjusted OR = 0.42, CI 0.19-0.96). Occupational function and independent living were not significantly associated with any of the investigated tests. Conclusions: Psychomotor speed is associated with a long-term outcome regarding social function and symptom remission in patients with first-episode schizophrenia.
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| 5. |
- Borelius, M, et al.
(författare)
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Help break the stigma against mental illness!
- 2014
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Ingår i: Nordic journal of psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 68:4, s. 225-226
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)
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| 6. |
- Carlborg, Andreas, et al.
(författare)
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Attempted suicide predicts suicide risk in schizophrenia spectrum psychosis
- 2010
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 64:1, s. 68-72
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: People with schizophrenia have an increased risk of suicide and attempted suicide is suggested to be an important risk factor.AIM: Our objective was to assess the cumulative survival, predictive values and odds ratios of attempted suicide for suicide in a long-term cohort of patients with schizophrenia spectrum psychosis with and without previous attempted suicide.METHOD: Inpatients (n=224) hospitalized with schizophrenia spectrum psychosis were followed for a mean of 25 years. All patients were followed up for causes of death. Information on suicide attempt before the end of the observation period was retrieved from medical records.RESULTS: Eight percent died by suicide during the follow-up. Eighteen percent of suicide attempters died by suicide. Two percent of non-attempters died by suicide. There was a strong association between previous suicide attempt and suicide in men and women. Odds ratio for attempters vs. non-attempters was 10. Suicide risk was almost three times higher in male than female suicide attempters.CONCLUSION: Previous attempted suicide is an important risk factor for suicide in both men and women with schizophrenia spectrum psychosis, particularly in male suicide attempters. The suicide risk remains high over a long period. Continuous assessment of risk factors and appropriate treatment are crucial for this patient group to prevent suicide.
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| 7. |
- Carlborg, Andreas, et al.
(författare)
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Early death and CSF monoamine metabolites in schizophrenia spectrum psychosis
- 2011
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 65:2, s. 101-5
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Tidskriftsartikel (refereegranskat)abstract
- INTRODUCTION: Patients with schizophrenia have higher rates of mortality than the general population. Lower concentrations of the cerebrospinal fluid (CSF) monoamine metabolites homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) have been associated with suicidal, aggressive and impulsive behavior. Mortality has been suggested as a measure of impulsivity and a relationship between early death and lower concentrations of CSF monoamine metabolites has been reported but the studies are few with short periods of follow-up and small numbers.AIM: The objective of this study was to investigate a relationship between early death and concentrations of CSF 5-HIAA and HVA.METHODS: Three hundred and eighty-five inpatients with schizophrenia spectrum psychosis were lumbar punctured in a standardized manner and followed for a median of 26 years. Patients were searched to identify those who had died. Causes of death were obtained from the Causes of Death Register.RESULTS: During the time of follow-up, 97 patients died. Schizophrenia spectrum psychosis patients died at an earlier age from both natural and unnatural causes of death. No significant associations were found between CSF 5-HIAA and HVA concentrations and non-suicidal death. Attempted suicide was not a risk factor for non-suicidal death at younger age.CONCLUSION: Patients with schizophrenia spectrum psychosis die at an earlier age from both natural and unnatural causes of death. Attempted suicide is not a risk factor for non-suicidal death at younger age. Low concentrations of CSF HVA and 5-HIAA were not a risk factor for non-suicidal death at younger age in schizophrenia spectrum psychosis.
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| 8. |
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| 9. |
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| 10. |
- Cuijpers, Pim, et al.
(författare)
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Psychological treatment of depression: Results of a series of meta-analyses
- 2011
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Ingår i: Nordic Journal of Psychiatry. - : Informa Healthcare. - 0803-9488 .- 1502-4725. ; 65:6, s. 354-364
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Tidskriftsartikel (refereegranskat)abstract
- Cuijpers P, Andersson G, Donker T, van Straten A. Psychological treatment of depression: Results of a series of meta-analyses. Nord J Psychiatry 2011;65:354-364. less thanbrgreater than less thanbrgreater thanBackground: In the past few decades, a considerable number of studies have examined the effects of psychotherapies for adult depression. Aim: We described the results of a series of meta-analyses examining what this large body of research has contributed to our knowledge of these treatments of depression. Results: We found that different types of psychotherapy are efficacious in the treatment of adult depression, including cognitive behavior therapy, interpersonal psychotherapy, problem-solving therapy, non-directive supportive therapy and behavioral activation therapy. Differences between types of psychotherapy are small. The efficacy of psychotherapy for mild to moderate depression is about the same as the efficacy of pharmacotherapy, and that combined treatment is more effective than psychotherapy alone and pharmacotherapy alone. Psychotherapy is not only effective in depressed adults in general, but also in older adults, women with postpartum depression, patients with general medical disorders, in inpatients, in primary care patients, patients with chronic depression and in subthreshold depression. Conclusions: We found no evidence showing that psychotherapy is less efficacious in severe depression ( with mean baseline Hamilton Depression Rating Scale scores up to 31, mean Beck Depression Inventory scores up to 35.85 and mean Beck Depression Inventory-II scores up to 36.50), but effects are smaller in chronic depression. We also found that the effects of psychotherapy are probably overestimated because of publication bias and the relatively low quality of many studies in the field.
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| 11. |
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| 12. |
- Dalteg, Arne, et al.
(författare)
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Psychosis in adulthood is associated with high rates of ADHD and CD problems during childhood
- 2014
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 68:8, s. 560-566
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Tidskriftsartikel (refereegranskat)abstract
- Background: Patients diagnosed with schizophrenia display poor premorbid adjustment (PPA) in half of the cases. Attention deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) are common child psychiatric disorders. These two facts have not previously been linked in the literature. Aims: To determine the prevalence of ADHD/CD problems retrospectively among patients with psychoses, and whether and to what extent the high frequency of substance abuse problems among such patients may be linked to ADHD/CD problems. Method: ADHD and CD problems/diagnoses were retrospectively recorded in one forensic (n = 149) and two non-forensic samples (n = 98 and n = 231) of patients with a psychotic illness: schizophrenia, bipolar or other, excluding drug-induced psychoses. Results: ADHD and CD were much more common among the patients than in the general population-the odds ratio was estimated to be greater than 5. There was no significant difference in this respect between forensic and non-forensic patients. Substance abuse was common, but substantially more common among patients with premorbid ADHD/CD problems. Conclusions: Previous views regarding PPA among patients with a psychotic illness may reflect an association between childhood ADHD/CD and later psychosis. The nature of this association remains uncertain: two disorders sharing some generative mechanisms or one disorder with two main clinical manifestations. Childhood ADHD and particularly CD problems contribute to the high frequency of substance abuse in such groups.
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| 13. |
- Dekeyser, Linda, et al.
(författare)
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Self-reported mental health in 12-year-old second-generation immigrant children in Sweden
- 2011
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Ingår i: Nordic Journal of Psychiatry. - : Informa Healthcare. - 0803-9488 .- 1502-4725. ; 65:6, s. 389-395
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Tidskriftsartikel (refereegranskat)abstract
- Today 29.3% of all newborns in Sweden are second-generation immigrants. Studies on mental health among these children are few, inconclusive and vary widely with regard to the informant used and the age of the immigrant. The majority of previous studies focus on study groups that cover a wide age span but since mental health varies considerably during the pre-adolescent and adolescent years, more age-specific studies are needed. Additional focus on the health and well-being of these children is necessary if a well-functioning society is to develop. Aim: To investigate whether and how second-generation immigrant children in Sweden differ from non-immigrant children in their presentation of self-reported mental health at the age of 12. Methods: Second-generation immigrant children (n = 142) from a birth cohort in southern Sweden, subjects of the SESBiC-study (the South East Sweden Birth Cohort-study) were compared with non-immigrant children (n = 1036) from the same cohort in their presentation of self-reported mental health at the age of 12 using the Strengths and Difficulties Questionnaire. Gender, family structure and parents educational level were controlled for. Results: Second-generation immigrant children did not differ from the non-immigrant children in their own presentation of mental health at the age of 12 in any of the categories of immigrant groups. Conclusion: It is a promising sign for future integration that second-generation immigrant childrens self-reported mental health at the age of 12 was quite similar to that of non-immigrant children.
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| 14. |
- Dyster-Aas, Johan, et al.
(författare)
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Impact of physical injury on mental health after the 2004 Southeast Asia tsunami
- 2012
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 66:3, s. 203-208
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Tidskriftsartikel (refereegranskat)abstract
- Background : The risk of developing enduring post-traumatic stress reactions and mental health problems in the aftermath of disasters is substantial. However, there are inconsistencies regarding the contribution of physical injury as an independent risk factor for developing psychiatric morbidity after disasters. Aims : The aim was to assess whether physical injury was associated with post-traumatic stress reactions and general mental health after adjusting for perceived life-threat in the aftermath of the 2004 tsunami. Methods : A sample of 1501 highly exposed survivors from the 2004 Southeast Asia tsunami was selected from a cohort of Swedish survivors surveyed 14 and 36 months after the event. The impact of physical injury on post-traumatic stress and general mental health was assessed by regression models accounting for subjective life-threat. Results : Physical injury was associated with higher levels of post-traumatic stress reactions and poorer general mental health. These associations were observed at both 14 and 36 months after the disaster. Conclusions : Physical injury has a specific contribution to the association between traumatic experience and both post-traumatic stress reactions and general mental health in victims of the 2004 tsunami. The effect is stable over several years.
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| 15. |
- Dåderman, Anna Maria, 1953-, et al.
(författare)
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Flunitrazepam intake in male offenders
- 2012
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Ingår i: Nordic Journal of Psychiatry. - : Informa Healthcare. - 0803-9488 .- 1502-4725. ; 66:2, s. 131-140
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Tidskriftsartikel (refereegranskat)abstract
- The abuse of flunitrazepam (FZ) compounds is worldwide, and several studies have reflected on the consequences with regard to violence, aggression and criminal lifestyle of FZ users. Criminals take high doses of FZ or some other benzodiazepines to "calm down" before the planned crime. There is support from earlier studies that most likely, all benzodiazepines may increase aggression in vulnerable males. Chronic intake of high doses of FZ increases aggression in male rats. Because psychopathy involves aggression, we have examined whether psychopathy as well as any of the four facets of the Psychopathy Checklist-Revised (PCL-R) (Interpersonal, Affective, Lifestyle and Antisocial) are related to different substance use disorders, with the focus on FZ. We have also examined the relationship between each PCL-R item and FZ use. Participants were 114 male offenders aged 14-35 years, all of whom were convicted for severe, predominantly violent, offences. Substance use, including FZ, was not more common in those who scored high in psychopathy. Use of FZ was more common in offenders who scored high in Facet 4 (Antisocial) of the PCL-R (odds ratio = 4.30, 95% CI 1.86-9.94). Only one of the PCL-R items, "Criminal versatility", was significantly associated with FZ use (odds ratio = 3.7). It may be concluded that intake of FZ has a specific relationship to only one of the facets and not to psychopathy per se. ; The findings have also important theoretical implications because Facet 4 is not a key factor of the construct of psychopathy. Clinical implications of the article: We have used the new two-factor and four-facet theoretical model of psychopathy in the young offender population, many of them with one or more substance use disorders. The present results suggest that antisocial behavior defined by Facet 4 (poor behavioral control, early behavior problems, juvenile delinquency, revocation of conditional release and criminal versatility) in the studied subjects is more typical for FZ users than it is for non-FZ users. This may have implications for assessment and treatment. Clinicians should be aware that criminals with high scores on Facet 4 have a more than fourfold odds of being a FZ user. This conclusion has an important clinical implication because FZ abuse is very common and is not always the focus of a forensic psychiatric assessment. ;
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| 16. |
- Eklund, Mona, et al.
(författare)
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Psychometric properties and factor structure of the Swedish version of the Perceived Stress Scale.
- 2014
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Ingår i: Nordic Journal of Psychiatry. - : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 68:7, s. 494-499
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Tidskriftsartikel (refereegranskat)abstract
- The Perceived Stress Scale (PSS) measures general stress and the Swedish version, although used in several studies, has not been extensively evaluated for psychometric properties. Aims: This study aimed to investigate psychometric properties and the factor solution of the Swedish 14-item version when used with two samples, namely a mixed Internet sample of women and men (n = 171) and another of women with stress-related disorders (n = 84). Classical test theory, including confirmatory factor analysis, was employed. Results: The factor structure supported a two-factor model for the PSS and confirmed other language versions of the PSS, although one items showed a low item-total correlation. The PSS showed to be feasible with the investigated samples and the results indicated no ceiling or floor effects and good internal consistency of the PSS. Several aspects of construct validity were shown. An association of − 0.66 between the PSS and a measure of coping indicated good concurrent validity. Criterion validity was demonstrated through a statistically significant difference (P < 0.001) between the women with stress-related disorders and the Internet sample. Predictive validity of the PSS could be demonstrated in a short-term perspective. Based on the sample with stress-related disorders, sensitivity to change was shown through a statistically significant stress reduction (P < 0.001) from entering work rehabilitation to discharge. Conclusions: The Swedish version of the PSS showed satisfactory psychometric properties and may be recommended for use with people with and without known stress-related disorders.
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| 17. |
- Eklund, Mona, et al.
(författare)
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Psychometric properties of a Swedish version of the Pearlin Mastery Scale in people with mental illness and healthy people
- 2012
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Ingår i: Nordic Journal of Psychiatry. - Abingdon : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 66:6, s. 380-388
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Tidskriftsartikel (refereegranskat)abstract
- Background: Mastery refers to the degree to which people perceive that they can control factors that influence their life situation, and has been found important for people's quality of life and well-being. It is thus essential to be able to measure mastery in a valid and reliable way. Aim: This study aimed at using the Rasch measurement model to investigate the psychometric properties of a Swedish version of the Pearlin Mastery Scale (Mastery-S). Methods: A sample of 300 healthy individuals and 278 persons with mental illness responded to the Mastery-S. Item responses were Rasch analysed regarding model fit, response category functioning, differential item functioning (DIF) and targeting, using the partial credit model. Results: The Mastery-S items represented a logical continuum of the measured construct but one item displayed misfit. Reliability (Person Separation Index) was 0.7. The response categories did not work as expected in three items, which could be corrected for by collapsing categories. Three items displayed DIF between the two subsamples, which caused a bias when comparing mastery levels between subsamples, suggesting the Mastery-S is not truly generic. Conclusions: The Mastery-S may be used to obtain valid and reliable data, but some precautions should be made. If used to compare groups, new analyses of DIF should first be made. Users of the scale should also consider exempting item 6 from the scale and analyse it as a separate item. Finally, rewording of response categories should be considered in order to make them more distinct and thereby improve score reliability.
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| 18. |
- Ewalds-Kvist, Béatrice, et al.
(författare)
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Impact of gender and age on attitudes towards mental illness in Sweden
- 2013
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 67:5, s. 360-368
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Tidskriftsartikel (refereegranskat)abstract
- Background: Factors such as respondent's sex, age, experience of mental illness and marital status have been found to impact public prejudices toward persons with mental illness. Aims: The impact of respondents' sex, age, real-life experience and marital status on their attitudes towards mental illness was the focus of this study. Methods: Altogether, 2391 respondents completed the Swedish version of Community Attitudes toward the Mentally Ill, CAMI-S. Their answers were reduced by principal component analysis into four factors: Open-minded and Pro-integration, Fear and Avoidance, Community Mental Health Ideology and Intention to Interact with Persons with Mental Illness. By Structural Equation Modeling (SEM), the relations between public's sex and age on their attitudes toward mental illness on these four factors were assessed. Impact of experience and marital status on attitudes towards mental illness was assessed by analysis of variance (ANOVA). Results: Females were found to hold a greater open-mindedness and were positive to pro-integration, but they were also fearful and avoidant, more so than males, relative to persons with mental illness. With regard to getting older, as age increased, so did open-mindedness and a pro-integration attitude relative to persons with mental illness; on the other hand as age increased, community mental health ideology decreased. As attitudes of open-mindedness and pro-integration improved, so did attitudes representing community mental health ideology. Furthermore, as fear and avoidance increased, attitudes of open-mindedness and pro-integration increased but also the intention to interact with persons subject to mental illness was improved.
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| 19. |
- Ewalds-Kvist, Béatrice, et al.
(författare)
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Student nurses and the general population in Sweden : Trends in attitudes towards mental illness
- 2013
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 67:3, s. 164-170
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate attitudes towards mental illness displayed by student nurses' with previous contact with mentally disordered persons prior to education in psychiatric nursing and to evaluate trends in attitudes towards mental illness exhibited by student nurses and the public in Sweden. Methods: Altogether 246 student nurses enrolled in three universities in Sweden (mean age = 27.9 +/- 7.5 years) out of which 210 were females and 36 males, completed prior to their obligatory course in psychiatric nursing a shortened version of 11 internally reliable (Cronbach's alpha 0.84) items from the Swedish version of the Community Attitudes towards Mental Illness questionnarie. The selected items were named the Student Nurse Attitude Index (SNAI) and formed the basis for an evaluation of trends exhibited by student nurses and the attitudes of the general population towards mental illness by means of Jonkheere's trend test. By linear regression analysis, the impact of previous contact with mental illness on student nurses' attitudes towards mental illness prior to education in psychiatric nursing was assessed. Results: Student nurses did not demonstrate, in contrast to the public in Sweden, a trend of positive attitudes toward persons with mental illness. Even so, it was revealed that student nurses who had experienced some type of contact with mental illness prior to education in psychiatric nursing exhibited a positive attitude, more so than those lacking contact, toward mental illness. Conclusions: The findings corroborated the contact hypothesis, implying that direct contact with persons with mental illness will encourage acceptance and enhance a positive attitude towards mental illness in general.
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| 20. |
- Gothefors, Dan, et al.
(författare)
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Swedish clinical guidelines-Prevention and management of metabolic risk in patients with severe psychiatric disorders
- 2010
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 64:5, s. 294-302
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Tidskriftsartikel (refereegranskat)abstract
- Individuals with severe psychiatric disorders are more likely than the population at large to develop metabolic derangements such as overweight and diabetes. Cardiovascular disease is also more frequently seen in this group. Contributing factors may include inappropriate diet or lack of physical activity, but antipsychotic medication may also play a role. Seven Swedish specialist medical societies have collaborated in formulating a set of concise clinically applicable guidelines-reproduced here in modified form-for the prevention and management of metabolic risk in this patient group. The importance of implementation is emphasized.
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| 21. |
- Grip, Karin, 1973, et al.
(författare)
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Maternal report on child outcome after a community-based program following intimate partner violence
- 2012
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 66:4, s. 239-247
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Tidskriftsartikel (refereegranskat)abstract
- Background: This study examined the perceived effectiveness of a 15-week community-based program for 46 children exposed to intimate partner violence (IPV) and their mothers. Aims: The primary aims were to describe the children who entered one of the existing community-based programs in terms of behavioral problems and to evaluate the impact of the program on children's general behavioral functioning as assessed by their mothers. Results: Children's rated behavioral problems (SDQ) dropped following treatment; the effect size was in the medium range. The social impairment caused by the problems decreased as well. The effect regarding behavioral problems was not related to the degree of exposure to IPV or the mothers own changes in trauma symptoms following treatment. Results were analyzed as well at the individual level with the Reliable Change Index (RCI), which showed that the majority of children were unchanged following treatment. Conclusions: One implication from the study is the need for baseline screening and assessment. About half of the current sample had a clinical symptom picture indicating the need for specialized psychiatric/psychotherapeutic treatment. Furthermore, the reduction in behavioral problems was significant but many children still had high levels of behavioral problems after treatment, indicating a need of a more intense or a different type of intervention.
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| 22. |
- Gustafsson, Per E, et al.
(författare)
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Diurnal cortisol levels, psychiatric symptoms and sense of coherence in abused adolescents.
- 2010
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 64:1, s. 27-31
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Tidskriftsartikel (refereegranskat)abstract
- Background. The role of the hypothalamic-pituitary-adrenal (HPA) axis in psychiatric disorders following trauma is poorly studied and most studies have been done on adults. Aims. To investigate the association of mental well-being and diurnal cortisol in abused adolescents. Methods. The present cross-sectional study examined diurnal salivary cortisol (measured three times a day during three days) in relation to psychiatric symptoms (Trauma Symptoms Checklist for Children) and the salutogenic construct “sense of coherence”, in 15 adolescents exposed to childhood abuse. Results. Significant correlations were found between symptoms and sense of coherence versus early and late morning cortisol concentrations. The correlations were most consistent for internalizing and externalizing symptoms, and somewhat less for post-traumatic symptoms and sense of coherence. In contrast, evening cortisol did not correlate with any of the psychological measures. Conclusion. These results extend previous research findings by pointing towards a relation between symptoms and higher morning cortisol and accentuated diurnal cortisol variation in abused adolescent as opposed to lower basal cortisol and a flattening of the cortisol rhythm repeatedly observed in traumatized adults. Clinical implications. The pathophysiology of the impact of trauma on youth, including the impact on biological stress systems, are important for an understanding of the consequences of trauma and may serve as a basis for the development of new treatment options.
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| 23. |
- Hansson, Helena, et al.
(författare)
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Intervention with feedback using Outcome Questionnaire 45 (OQ-45) in a Swedish psychiatric outpatient population. A randomized controlled trial.
- 2013
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 67:4, s. 274-281
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Tidskriftsartikel (refereegranskat)abstract
- Aim: The objective of the study was to evaluate the efficacy of the Outcome Questionnaire 45 (OQ-45) with feedback in a Swedish psychiatric outpatient population using a randomized controlled design. Method: In all 1720 patients made at least one regular visit to the clinics in the period 12 February 2007 to 10 February 2008 and received information about the study. Of these, 374 patients (22%) agreed to participate. After written consent, 188 patients were randomized to the feedback group and 186 patients to the control group. Those constituted the intention-to-treat (ITT) group. Two hundred and sixty-two patients (70%) completed the OQ-45 questionnaire at least twice, and they were included in the per-protocol analysis. Those who improved less than expected and were at risk for treatment failure were called alerted patients. Results: There was a tendency that patients who received feedback improved more than the controls in OQ-45 total score. In the ITT analysis, the P-value was 0.061 and the effect size g = 0.21. In the per-protocol analysis the P-value was 0.076 and the effect size g = 0.24. In the intervention group, 27% of the patients were alerted because of risk of treatment failure vs. 28% in the control group (reaching level of alertness). The OQ-45 differences between the intervention and control groups did not significantly differ for patients who were alerted/reaching level of alertness and for non-alerted patients (g = 0.17 and g = 0.28, respectively). Conclusions: The feedback group had a tendency to improve more than the control group, possibly indicating that the method is effective, and the result (basically) supports previous findings.
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| 24. |
- Hansson, Lars, et al.
(författare)
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Perceived and anticipated discrimination in people with mental illness-An interview study.
- 2013
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488.
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Tidskriftsartikel (refereegranskat)abstract
- Background. Studies on perceived discrimination of people with mental illness are largely lacking. The purpose of the study was to investigate perceived discrimination in a sample of users in contact with mental health services in Sweden. Methods. Interviews were conducted with 156 users, asking for perceived and anticipated discrimination during the last 2 years. Background characteristics were also collected. Results. Perceived discrimination was common. Highest frequencies were reported regarding family (54%), avoidance by people who knew about the mental illness (53%) and in making or keeping friends (50%). A majority of those anticipating discrimination regarding job or education seeking, or starting a close relationship did not report having been discriminated in these areas. Previous hospitalizations were associated with discrimination, and age with anticipated discrimination. Conclusions. Public stigma and self-stigma have been reported to have a number of negative consequences for people with mental illness. Discrimination is part of this complex situation and this study showed that this largely affects a number of individual life areas posing an obstacle for social integration. Anticipated discrimination or self-stigma was also prevalent and it is pointed out that this to a great extent is an obstacle on its own without being promoted by actual experiences of discrimination.
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| 25. |
- Hansson, Maja, 1980-, et al.
(författare)
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What made me feel better? : patients' own explanations for the improvement of their depression
- 2012
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Ingår i: Nordic Journal of Psychiatry. - : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 66:4, s. 290-296
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Tidskriftsartikel (refereegranskat)abstract
- Background: Depression is common among primary care patients and the usual treatment often consists of antidepressant medication and supportive counselling/follow-ups. Previous studies have shown that patients and professionals have different beliefs about treatment, which in turn can decrease acceptance of the diagnosis, compliance and treatment outcome.Aims: The purpose of this study was to investigate previously depressed patients’ beliefs about the cause of their improvement. Methods: Depressed primary care patients (n = 184) who considered themselves improved at follow-up answered an open-ended question about what they believed had made them better. Among these 117 patients had, in addition to treatment as usual, participated in an intervention with patient education and group counselling (the Contactus programme), whereas 67 were controls. The groups were comparable at baseline and 82% were on antidepressants. Results: In total, the patients mentioned 14 separate improving factors, which could be organized to the larger themes external factors, self-management, passing spontaneously and professional help. The most frequently mentioned factors for improvement were the Contactus programme (53.0%), antidepressants (40.2%) and personal development (27.2%). Few gender and age differences were seen. The controls who mentioned professional help were more likely to have a better outcome. Conclusions: The patients were generally positive to professional help such as antidepressants and the Contactus programme. Patient education and group counselling seems to be a valuable supplement to treatment of depressed patients in primary care.
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| 26. |
- Hansson, Sara Lina, et al.
(författare)
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The Autism--Tics, AD/HD and other Comorbidities (A-TAC) telephone interview: convergence with the Child Behavior Checklist (CBCL).
- 2010
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 64:3, s. 218-224
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To compare telephone interview screening for child psychiatric/neuropsychiatric disorders using the inventory of Autism-Tics, Attention deficit/hyperactivity disorder (AD/HD) and other Comorbidities (A-TAC) with results from the Child Behavior Checklist (CBCL). Background: The A-TAC is a parent telephone interview focusing on autism spectrum disorders (ASDs) and co-existing problems, developed for lay interviewers. Subjects and methods: A-TAC telephone interviews and CBCL questionnaires were obtained from parents of 106 Swedish twin pairs aged 9 and 12 years. Results: Correlations between A-TAC modules and CBCL scales aimed at measuring similar concepts were generally significant albeit modest, with correlation coefficients ranging from 0.30 through 0.55. Conclusion: The A-TAC has convergent validity with the CBCL in several problem areas, but the A-TAC also provides more detailed and specific assessments of ASD symptoms and related neuropsychiatric problems.
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| 27. |
- Heir, Trond, et al.
(författare)
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Tsunami-affected Scandinavian tourists : Disaster exposure and post-traumatic stress symptoms
- 2011
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 65:1, s. 9-15
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Tidskriftsartikel (refereegranskat)abstract
- Background: Studies of short- and long-term mental effects of natural disasters have reported a high prevalence of post-traumatic stress. Less is known about disaster-exposed tourists repatriated to stable societies. Aims: To examine the association between exposure to the 2004 Southeast Asian tsunami and symptoms of post-traumatic stress in three Scandinavian tourist populations. Methods: Postal survey of Norwegian, Danish and Swedish Southeast Asia tourists registered by the police when arriving at national airports. Follow-up time was 6 (Norway), 10 (Denmark) and 14 months (Sweden) post-disaster; 6772 individuals were included and categorized according to disaster exposure: danger exposed (caught or chased by the waves), non-danger exposed (other disaster-related stressors) and non-exposed. Outcome measures were the Impact of Event Scale-Revised (IES-R) and Post Traumatic Stress Disorder Check List (PCL). Results: Danger exposed reported more post-traumatic stress than non-danger exposed, and the latter reported more symptoms than non-exposed (each P<0.001). Comparison of the Norwegian and Swedish data suggested that symptoms were attenuated at 14 months follow-up (P<0.001). Female gender and low education, but not age, predicted higher levels of symptoms. Conclusions: Disaster-exposed tourists repatriated to unaffected home environments show long-term post-traumatic stress disorder symptoms related to the severity of exposure.
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| 28. |
- Hiltunen, Arto J., et al.
(författare)
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The first 38 methadone maintenance treatment patients in Stockholm : 15-year follow-up with a main focus on detoxification from methadone
- 2011
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 65:2, s. 106-111
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Tidskriftsartikel (refereegranskat)abstract
- Background/aims: The present study investigated the first 38 methadone maintenance treatment (MMT) patients in Stockholm. The aim was: (i) to investigate the possible predictive factors for successful treatment termination, and (ii) the long-term outcome effects and life situation of MMT patients and those who terminated the treatment. Methods: The patients were interviewed at the start and approximately 15 years later, and divided into four groups: (1) no withdrawal attempts, (2) forced to stop the treatment, (3) successful tapering and (4) non-successful tapering. Results: The predictive factor found that Group 1 showed a lower life quality compared with Groups 3 and 4. Fifteen years later, the life situations of Groups 3 and 4 were significantly more stable. Also the subjective well-being in Group 3 was significantly higher. Over all, Group 2 showed significantly more illicit drug use compared with Group 3. The social life situation was significantly improved for all patients during the 15 years. Conclusion: This study confirms our earlier findings that the ultimate goal of MMT for the motivated patients with good progress should be an opiate-free life. The life situation and subjective well-being seems to be higher after successful termination of MMT.
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| 29. |
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| 30. |
- Holmqvist, Rolf, 1948-, et al.
(författare)
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The effects of psychological treatment in primary care in Sweden—A practice-based study
- 2014
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Ingår i: Nordic Journal of Psychiatry. - : Informa Healthcare. - 0803-9488 .- 1502-4725. ; 68:3, s. 204-212
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Tidskriftsartikel (refereegranskat)abstract
- Background: Practice-based studies have found substantial effects of psychological treatment in routine care, often equivalent between treatment methods. Factors that moderate treatment outcome may be important to assess.Aim: The purpose of this study was to evaluate treatment outcome in psychological treatment in primary care, and to compare outcome between the most frequently used methods. An additional aim was to study factors that might moderate outcome differences.Method: The Clinical Outcome in Routine Evaluation (CORE) system was used to evaluate psychological treatment at Swedish primary care centers. Treatment methods were coded by the therapists after treatment. Three major treatment orientations-directive (cognitive, behavioral and CBT), reflective (psychodynamic and relational) and supportive therapy were compared. Patient and therapist variables were studied as treatment moderating factors.Results: Analyses of 733 therapies, delivered by 70 therapists, showed good results in short psychological treatments (median session number = 6). Forty-three percent of the patients were remitted, 34% recovered. For patients receiving at least five sessions, the figures were 50% and 40%. Directive therapy and reflective therapy had comparable outcome, and better than supportive treatment. Patients in supportive therapy had higher age and received fewer therapy sessions. The patients' motivation, alliance capacity and reflective ability, as rated by the therapist after treatment, were lower for patients in supportive treatment.Conclusions: Psychological treatment in primary care obtains god results. Supportive therapy should be studied more systematically, particularly with regard to variables that may moderate treatment outcome.
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| 31. |
- Högberg, Torbjörn, et al.
(författare)
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Swedish attitudes towards persons with mental illness
- 2012
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 66:2, s. 86-96
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Tidskriftsartikel (refereegranskat)abstract
- Background: Negative and stigmatizing attitudes towards persons with mental illness must be dealt with to facilitate the sufferers' social acceptance. Aim: The present study aimed at survey Swedish attitudes towards persons with mental illness related to factors impacting these attitudes. Material and Methods: New CAMI-S based on the questionnaire Community Attitudes to Mental Illness in Sweden ([CAMI] Taylor & Dear, 1981) was developed with nine behavioral-intention items and thus comprised a total of 29 items. Of 5000 Swedish people, 2391 agreed to complete the questionnaire. Principal component analysis rendered four factors reflecting attitudes towards the mentally ill: Intention to Interact, Fearful and Avoidant, Open-minded and Pro-Integration, as well as Community Mental Health Ideology. The factors were analyzed for trends in attitudes. By MANOVA, the experience of mental illness effects on mind-set towards the sufferers was assessed. By means of logistic regression, demographic factors contributing to positive attitudes towards persons with mental illness residing in the neighborhood were assessed. Results: By New CAMI-S, the Swedish attitudes towards the mentally ill were surveyed and trends in agreement with living next to a person with mental illness were revealed in three out of four factors derived by principal component analysis. Aspects impacting the Swedish attitudes towards persons with mental illness and willingness to have him/her residing in the neighborhood comprised experience of mental illness, female gender, age (31-50 years), born in Scandinavia or outside Europe, only 9 years of compulsory school and accommodation in flat. Conclusion: The New CAMI-S came out as a useful tool to screen Swedish attitudes towards persons with mental illness. Most Swedes were prepared to live next to the mentally ill.
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| 32. |
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| 33. |
- Khalifa, Najah, et al.
(författare)
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Tourette Syndrome in the General Child Population : Cognitive functioning and self-perception
- 2010
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 64:1, s. 11-18
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Tidskriftsartikel (refereegranskat)abstract
- The aim of the study was to examine the cognitive function and self-perception in a school-population-based sample of children with Tourette syndrome (TS). Many studies have examined cognitive and emotional functioning in clinical samples but to our knowledge, there is no population-based study of TS in schoolchildren. In a population-based sample identified in a rigid diagnostic procedure (n = 25), cognitive functioning and self-perception were examined. There was a large variation in the cognitive functioning of children with TS, at least one third obtaining subnormal results. The profile of index scores on the Wechsler Intelligence Scale for Children (WISC) factors was somewhat uneven, with the freedom from distractibility and processing speed factors presenting the lowest median scores. The TS group had more negative self-perceptions than a comparison group. Tic severity or age at onset was not associated with cognitive performance or self-perception. Children who were taking medication had lower full IQ scores than children who were not. Low cognitive abilities and negative self-perception may be common in community-based samples of children with Tourette syndrome.
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| 34. |
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| 35. |
- Källmen, Håkan, et al.
(författare)
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Psychometric properties and norm data of the Swedish version of the NEO-PI-R
- 2011
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 65:5, s. 311-314
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Tidskriftsartikel (refereegranskat)abstract
- Background: Internationally, the NEO Personality Inventory-Revised (NEO-PI-R) is a well established questionnaire for assessment of personality in accordance with the Five Factor Model. The instrument has been translated into many languages including Swedish. Aim: The aim of this study was to make a psychometric evaluation of the Swedish version of NEO-PI-R based on a sample from the general population. Methods: Postal questionnaires were sent to a random sample of 1250 persons (n = 766 responders). Results and conclusions: The test showed satisfactory internal consistency in the broad factors as well as the facets. A factor analysis indicated that the factors were similar but not identical to those obtained in American studies. In sum, The Swedish version of the NEO-PI-R shows satisfactory psychometric properties and the instrument will continue to be a valuable tool in psychological research and in clinical practice.
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| 36. |
- Larsen, John Teilmann, et al.
(författare)
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Metabolic syndrome and psychiatrists' choice of follow-up interventions in patients treated with atypical antipsychotics in Denmark and Sweden
- 2011
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 65:1, s. 40-46
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Tidskriftsartikel (refereegranskat)abstract
- Introduction: The aim of the present study was to obtain point prevalence estimates of the metabolic syndrome according to the NCEP III criteria in a sample of patients with schizophrenia spectrum disorders treated with atypical antipsychotic drugs in Denmark and Sweden, and to assess the psychiatrists' choice of recommendations for follow-up interventions based on the patients' laboratory results. Method: This was a cross-sectional, observational multi-center study in Denmark and Sweden, in consecutively screened in- and outpatients with schizophrenia spectrum disorders and continuously treated for at least 3 months with atypical antipsychotic drugs. Results: The metabolic syndrome as per medical history was present in 1% of 582 evaluable patients at baseline. After performing laboratory measurements and applying the NCEP III criteria, metabolic syndrome was confirmed in 43% of subjects. The high rate of metabolic syndrome did not elicit much decisive action on the part of the treating psychiatrists; the most frequent action taken was dietary and exercise advice (in 75% of subjects), while in 54% and 19% of subjects a laboratory follow-up and blood pressure follow-up were advised respectively. Change of antipsychotic medication was recommended in only 10% of patients, and in further 11% of patients, no action was taken. Conclusion: Observed metabolic syndrome prevalence rates were at least twice the rates observed in a normal, non-diabetic population. It appears that in this vulnerable population of patients with schizophrenia spectrum disorders, metabolic syndrome remains underdiagnosed and undertreated.
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| 37. |
- Larsson Lindahl, Marianne, et al.
(författare)
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Case management in aftercare of involuntarily committed patients with substance abuse. A randomized trial.
- 2013
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 67:3, s. 197-203
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Case management has since the 1970s been widely used to co-ordinate services for mental health patients. The methodology has expanded to support patients in many different types of conditions. This study is one of very few randomized trials on case management in a European setting. It examined the impact of case management on substance abuse and use of service after discharge from court-ordered institutional care. Methods: Court-ordered patients with substance abuse (n = 36) were randomly assigned to either strengths based case management or treatment-as-usual during 6 months in aftercare. Data was collected at intake, at conclusion of intervention and at 6 month's follow-up with a follow-up rate of 94%. Results: Case management interventions were well received by the patients with no drop-out during intervention. Patients with the support of a case manager seemed to sustain abstinence in a higher degree compared with treatment-as-usual but no differences were detected in regard to use of care. A subgroup analysis showed that patients with a continuous drug abuse did have access to care from both social welfare and hospital care systems. Conclusions: Case management may be useful in order to retain abstinence in aftercare following court-ordered treatment. The social welfare and hospital care systems seem to provide care irrespective of case manager intervention. The study design, interventions and assessments instruments were well received by patients but needs to be replicated with a larger population. Clinical implications: The 100% retention in the case management support group indicates that patients were satisfied with this type of intervention and the methodology seems to be useful in order to retain abstinence.
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| 38. |
- Larsson Lindahl, Marianne, et al.
(författare)
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Commitment to coercive care in relation to substance abuse reports to the social services. A 2-year follow-up.
- 2010
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 64, s. 372-376
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Tidskriftsartikel (refereegranskat)abstract
- Background: In Sweden, a person with substance abuse can be reported to the social services for an investigation about commitment to coercive care. After a change in legislation, municipalities varied greatly in the ratio of commitments/reports compared with the period before the legislation was amended. Aims: The primary aims of this study were first, to investigate whether subjects from municipalities with a high ratio of commitments/reports have a better outcome compared with subjects from municipalities with a low ratio and second, if a high ratio has an impact on mortality. Methods: The study involved two municipalities with high ratio of commitments/reports with 56 cases reported for substance abuse including 31 committed cases (55%). It also included two municipalities with a low ratio, 50 reported cases including six committed cases (12%). Two social service inspectors at the country administrative board assessed the cases in terms of severity of addiction according to legal criteria (kappa(s)=0.66), indicating good inter-rater agreement. A global index based on information about substance abuse, employment and housing was used as outcome measure at the 2-year follow-up. Results: Global outcome did not differ between cases from high- and low-ratio municipalities. Seven subjects had deceased because of causes related to substance abuse. None of the deceased had been committed to coercive care. Conclusions and clinical implications: In conclusion, the different ratios of commitments/reports did not influence global outcome. Commitment may reduce substance-related deaths.
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| 39. |
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| 40. |
- Lindström, Eva, et al.
(författare)
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PECC-Factor structure and findings in three longitudinal cohorts of patients with schizophrenia
- 2012
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Ingår i: Nordic Journal of Psychiatry. - : Informa Healthcare. - 0803-9488 .- 1502-4725. ; 66:1, s. 33-39
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Tidskriftsartikel (refereegranskat)abstract
- Background: Symptom control by drug treatment is the most important task in routine clinical care of patients with schizophrenia. Structured assessment methods are needed in this task but not used much. The US-developed Positive and Negative Syndrome Scale (PANSS) is a standard tool for symptom assessment. The Psychosis Evaluation tool for Common use by Caregivers (PECC) was constructed in Europe some years ago, with the intent to overcome some of the PANSS drawbacks. Aims and methods: To validate PECC on three longitudinal cohorts of schizophrenic patients representative of Swedish outpatients (n = 225, six assessments over 5 years), international forensic patients (n = 186) and matched non-forensic controls (n = 116), five assessments over 2 years for both. Results: The factor structure of PECC appears to be highly robust. Norm values (in percentiles) were calculated on the materials. Such data provides for analyses of symptom profiles and improvement over time measured in absolute numbers. Forensic patients appear to have a much lower symptom load (except for cognitive symptoms) than the other groups. Forensic controls had much shorter inpatient times than any other group and never caught up with respect to symptom control, even after 2 years. These differences suggest that the scale is clinically valid. Conclusion: PECC has a more robust factor structure than PANSS and is simpler to use. Percentile norms have been constructed for outpatients with schizophrenia in general and forensic psychiatry. Percentile scores are accessed readily by the net. PECC is available in many languages. Its separate self-harm item may improve assessments of suicide risk among patients with schizophrenia
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| 41. |
- Lindström, Eva, et al.
(författare)
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Suicides during 7 years among a catchment area cohort of patients with psychoses
- 2012
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Ingår i: Nordic Journal of Psychiatry. - : Informa Healthcare. - 0803-9488 .- 1502-4725. ; 66:1, s. 8-13
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate a series of consecutive suicides at a psychosis clinic by using a psychological autopsy technique. Method: The clinic serves an adult population of 225,000 individuals, of whom 0.5% have regular contact with the clinic. During a 7½-year period, 23 men and nine women committed suicide, which corresponds to an odds ratio of 14. Results: Most patients were schizophrenic, and 24 were outpatients. Suicide methods were violent in all but two cases. Nineteen had a history of at least one suicide attempt, and 24 were known to have had suicidal ideation. More than half had no social contacts over the last year except with psychiatric staff. The median time between the last contact with the psychiatric services and the suicide was 4 days. No warning signs were noted. At the time of death, 3 of the 24 who were prescribed antipsychotics, and none of the 10 who were prescribed antidepressants had plasma levels of the corresponding drug. Conclusion: Findings of special interest are the lack of forewarnings and the poor drug compliance. Patients appear to have played "business as usual" with the care-givers, and did it well. Is it a sign of health and despair, or illness?
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| 42. |
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| 43. |
- Maddux, Rachel, et al.
(författare)
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The Swedish Depressive Personality Disorder Inventory: Psychometrics and clinical correlates from a DSM-IV and proposed DSM-5 perspective.
- 2012
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 66:Online September 22, 2011, s. 167-177
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Tidskriftsartikel (refereegranskat)abstract
- Background: Depressive personality is commonly seen in clinical practice, and today only one exclusive self-report instrument-the Depressive Personality Disorder Inventory (DPDI)-is available for its assessment based on the DSM-IV description of the construct. Aims: The purpose of this research was to evaluate a Swedish version of this measure (DPDI-Swe) in terms of its reliability, internal structure, and convergent validity using related variables from the DSM-IV criteria for depressive personality disorder (DPD) and the proposed DPD trait set for DSM-5. Methods: A non-clinical sample of 255 adults in southern Sweden completed a self-report package, which, in addition to DPD, included the assessment of self-esteem, optimism, hope, rumination, worry, depression, and anxiety. Quality of life was also measured. Results: Results indicated that the DPDI-Swe was internally consistent (α = 0.96). Exploratory factor analysis with oblique rotation yielded three components, together accounting for 48.21% of the variance in DPDI-Swe scores. There were strong positive associations between the DPDI-Swe and measures of depression, anxiety, rumination, and worry, and strong negative associations between the DPDI-Swe and measures of self-esteem, optimism, hope, and quality of life. These significant relationships remained, albeit slightly diminished, after statistically controlling for current depressed mood. Conclusions and clinical implications: The DPDI-Swe appears to be a reliable and valid measure of DPD, and it is available for clinical and research use.
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| 44. |
- Mattisson, Cecilia, et al.
(författare)
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Correspondence between clinical diagnoses of depressive and anxiety disorders and diagnostic screening via the Hopkins Symptom Check List-25 in the Lundby Study.
- 2013
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 67:3, s. 204-213
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To compare clinical assessments of mental disorders with the Hopkins Symptom Check List-25 (HSCL-25) in a population-based sample consisting of middle-aged and elderly subjects. Background: The Lundby Study is a prospective cohort study that evaluated mental disorders and personality traits in an unselected Swedish population. The study commenced in 1947, with follow-ups in 1957, 1972 and 1997 (n = 3563). Method: Psychiatrists evaluated participants for mental disorders at several field investigations. In 1997, participants were also asked to complete the HSCL-25. Subjects with diagnoses of schizophrenia, dementia and certain other conditions were excluded leaving 1189 subjects aged 40-96 years. Diagnostic assessments by psychiatrists were compared with the results of the HSCL-25. Sensitivity and specificity were calculated at two cut-off levels of the HSCL-25 (1.55 and 1.75), and receiver operating characteristic (ROC) curves were plotted. The performance of the HSCL-25 was analysed with regard to anxiety and depression subscales. Results: The concordance of HSCL-25 with clinical best-estimate diagnoses was low. The anxiety subscale discriminated better than the depressive subscale. Conclusions: The correspondence between the clinical diagnoses made by psychiatrists and the HSCL-25 was not acceptable at a cut-off level 1.55. The HSCL-25 is limited in its ability to identify clinical syndromes. The HSCL-25 should be applied only as a preliminary screen for emotional distress and anxiety syndromes.
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| 45. |
- Mothander, Pia Risholm, et al.
(författare)
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Self-reported depressive symptoms and parental stress in mothers and fathers who bring their infants to an infant mental health clinic
- 2010
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 64:5, s. 310-316
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Tidskriftsartikel (refereegranskat)abstract
- Background: The parental functioning and its influence upon infant mental health development have been extensively studied but there are few clinical studies investigating less severe psychiatric problems among mothers and fathers in the same family. Aim: This study focuses on the emotional well-being of mothers' and fathers' who bring their infants to an Infant Mental Health Clinic. Methods: The studied sample is comprised of 63 families with 0-47-month-old infants where the mothers completed the Center for Epidemiological Study-Depression Scale (CES-D), including 43 families in which the CES-D was completed by both parents. In 44 families, the mothers also filled in the Swedish Parental Stress Questionnaire (SPSQ), including 32 where the SPSQ was completed by both parents. The children were independently classified with the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC 0-3). Results: Altogether, 54% of the mothers and 11% of the fathers reported depressive symptoms above the CES-D clinical cut-off. Self-rated depressive symptoms and parental stress were strongly related. The mothers' self-rated depressive symptoms were associated with the severity of their infant's problems, but the association was not specific to the DC 0-3 Axis I classification. The mothers' stress level was marginally related to DC 0-3 Axis II relationship classification. Conclusion: The results indicate that the inclusion of systematic parental self-ratings in infant mental health assessments could add clinical information facilitating the planning of family oriented interventions.
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| 46. |
- Nager, Anna, et al.
(författare)
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High lifelong relapse rate of psychiatric disorders among women with postpartum psychosis
- 2013
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 1502-4725 .- 0803-9488. ; 67:1, s. 53-58
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Tidskriftsartikel (refereegranskat)abstract
- Nager A, Szulkin R, Johansson S-E, Johansson L-M, Sundquist K. High lifelong relapse rate of psychiatric disorders among women with postpartum psychosis. Nord J Psychiatry 2013;67:53-58. Background: The relapse rate for psychiatric disorders after postpartum psychosis is high. Apart from subsequent puerperal periods, previous studies have not examined when relapses in psychiatric disorders occur. In addition, little is known about the impact of certain individual factors on the risk of non-puerperal readmission among women with previous postpartum psychosis. Aims: The first aim was to examine the association between non-puerperal readmission due to psychiatric disorders and years of follow-up (in total, 30 years) in women with postpartum psychosis. The second aim was to examine the impact of age, type of psychosis, previous hospitalization for psychiatric disorders and level of education on the risk of non-puerperal readmission due to psychiatric disorders. Methods: All Swedish women aged 20-44 with postpartum psychosis (n = 3140) were followed between 1975 and 2004 for non-puerperal readmission due to psychiatric disorders. A Cox frailty regression model was used to estimate hazard ratios for non-puerperal readmission. Results: The risk of non-puerperal readmission, although gradually decreasing with time, remained high many years after the postpartum psychosis. The risk of non-puerperal readmission was significantly higher among women with schizophrenia, lower levels of education and previous psychiatric hospitalization. Conclusions: Postpartum psychosis is often part of a lifelong recurrent psychiatric disorder. Women with schizophrenia, lower levels of education and hospitalization due to a psychiatric disorder prior to postpartum psychosis have a higher risk of non-puerperal readmission. Clinical implications: The findings constitute important knowledge for all healthcare workers encountering women with a previous postpartum psychosis.
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| 47. |
- Nielsen, Rene Ernst, et al.
(författare)
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Is the PANSS cognitive scale measuring cognition?
- 2014
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Ingår i: Nordic Journal of Psychiatry. - : Informa Healthcare. - 0803-9488 .- 1502-4725. ; 68:8, s. 573-578
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate the association between the Positive and Negative Syndrome Scale (PANSS) cognitive factors and cognition assessed by neuropsychological tests. Method: Ninety patients with a psychotic illness, the majority having a schizophrenia diagnosis, were assessed with PANSS ratings and tested by a comprehensive computerized neuropsychological test battery, EuCog. Results: Test performance was in the normal range for some of the cognitive indices, but substantially reduced for others, compared with norms, particularly speed-based indices. PANSS ratings were non-specifically associated with cognitive indices representing performance (speed and accuracy) and problem solving strategies (executive functions). There was no discriminant validity for the cognitive factor. A regression analysis suggested that the PANSS cognitive factors reflected verbal IQ but no other cognitive domain like memory, attention or speed. Conclusion: Cognitive test performance is associated with psychopathology as assessed by PANSS items but in a non-specific way. The PANSS cognitive subscale seems to reflect over-learned verbal skills rather than the cognitive domains, which are known to be specifically affected in schizophrenia and relevant for the prognosis. Consequently, PANSS ratings cannot replace the information inherent in neuropsychological test data. The extensive speed problem of patients with schizophrenia should be studied in more detail using test batteries that focus on that problem.
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| 48. |
- Nilsson, Doris, et al.
(författare)
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Self-reported potentially traumatic life events and symptoms of post-traumatic stress and dissociation
- 2010
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 64:1, s. 19-26
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To investigate single potentially traumatic events and cumulative effects of these events based on the reported symptoms of post-traumatic stress and dissociation. An additional goal was to evaluate the psychometric properties of Life Incidence of Traumatic Events—Student scale (LITE-S). Methods: 400 adolescents from the normative population answered the questionnaire Life Incidence of Traumatic Experiences (LITE-S) together with Trauma Symptom Checklist for Children (TSCC), Dissociation-Questionnaire-Sweden (Dis-Q-Sweden) and Adolescent-Dissociative Experience Scale (A-DES). The single self-reported traumas, and the cumulative self-reported traumas and their effects on post-traumatic stress disorder and dissociative symptoms scales were examined. The psychometric properties of LITE-S were first investigated through calculating, test–retest reliability by Pearson correlation for the total scale and by Cohen's kappa item per item. Results: Self-reported symptoms were related to both the cumulative traumas and exposure to some single traumas, such as seeing somebody get hurt, having parents destroy things or hurting each other, being whipped or hit, or even being made to carry out some kind of sexual act. Interpersonal events were consistently more strongly related to symptoms across the TSCC clinical scales. Finally, test–retest reliability as found to be for the total scale r=0.76 and kappa item per item ranging between k=0.33 and 0.86. Conclusion: The cumulative effects of potentially traumatic events on adolescents are significant, and interpersonal traumas results in more self-reported symptoms of post-traumatic stress and dissociation than non-interpersonal. LITE has satisfactory psychometric properties concerning reliability. Clinical implications: The results underline the importance in clinical practice of taking into consideration how many potentially traumatic events an adolescent has experienced before, seeking help on specific occasion. This knowledge can help the clinician to understand better the breadth of feelings their client is experiencing and thus can help the clinician better to be able to suggest appropriate treatment.
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| 49. |
- 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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| 50. |
- Nordenskjöld, Axel, et al.
(författare)
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Rehospitalization rate after continued electroconvulsive therapy : a retrospective chart review of patients with severe depression
- 2011
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Ingår i: Nordic Journal of Psychiatry. - : Informa Healthcare. - 0803-9488 .- 1502-4725. ; 65:1, s. 26-31
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Tidskriftsartikel (refereegranskat)abstract
- Background: Electroconvulsive therapy, ECT, is an effective acute treatment for severe depression. Today ECT is usually discontinued when the patient’s depressive symptoms abate, although relapse is common. Some studies suggest that continuation ECT (cECT) may prevent relapse of depression, but there are few studies available.Aims: The aim of this study was to describe the need for inpatient care before, during and after cECT. Methods: A retrospective chart. review was conducted of all patients (n=27) treated with cECT between 2005 and 2007 at Orebro University Hospital, Sweden. All patients were severely depressed at the initiation of index ECT. The DSM-IV diagnoses were major depression (n=19), bipolar depression (n=5) or schizoaffective depression (n=3).Results: The hospital day quotient was lower (HDQ=15) during cECT (mean duration+/-standard deviation=104+/-74 days) than during the 3 years prior to cECT (HDQ=26). The rehospitalization rate was 43% within 6 months and 58% within 2 years after the initiation of cECT. Seven patients were rehospitalized while on cECT.Conclusion: The need for inpatient care was reduced during cECT. However, rehospitalization was common. At the initiation of the cECT, the patients were improved by the index ECT. Also cECT was often terminated after rehospitalization, which contributed to the lowered hospital day quotient during cECT. Randomized clinical trials are needed to establish the efficacy of cECT. Clinical implications: Relapses and recurrences in depressed patients are common after ECT treatment. The results indicate that continuation ECT combined with pharmacotherapy might be an alternative treatment strategy.
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