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Sökning: L773:1471 244X > (2020-2021)

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1.
  • Ahlström, G, et al. (författare)
  • Specialist psychiatric health care utilization among older people with intellectual disability - predictors and comparisons with the general population : a national register study
  • 2020
  • Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 20
  • Tidskriftsartikel (refereegranskat)abstract
    • BACKGROUND: People with intellectual disability (ID) face considerable barriers to accessing psychiatric health care, thus there is a risk for health disparity. The aims of the present study were 1) to compare specialist psychiatric health care utilization among older people with ID to that with their age peers in the general population, taking into account demographic factors and co-morbidities associated with specialist psychiatric health care utilization and 2) to determine a model for prediction of specialist psychiatric health care utilization among older people with ID.MATERIAL AND METHODS: We identified a national cohort of people with ID (ID cohort), aged 55+ years and alive at the end of 2012 (n = 7936), and a referent cohort from the general population (gPop cohort) one-to-one matched by year of birth and sex. Data on utilization of inpatient and outpatient specialist psychiatric health care, as well as on co-morbidities identified in either psychiatric or somatic specialist health care, were collected from the National Patient Register for the time period 2002-2012.RESULTS: After adjusting for sex, age, specialist psychiatric health care utilization the previous year, and co-morbidities, people in the ID cohort still had an increased risk of visits to unplanned inpatient (relative risk [RR] 1.95), unplanned outpatient (RR 1.59), planned inpatient (RR 2.02), and planned outpatient (RR 1.93) specialist psychiatric health care compared with the general population. Within the ID cohort, increasing age was a predictor for less health care, whereas psychiatric health care the previous year predicted increased risk of health care utilization the current year. As expected, mental and behavioral disorders predicted increased risk for psychiatric health care. Furthermore, episodic and paroxysmal disorders increased the risk of planned psychiatric health care.CONCLUSIONS: Older people with ID have a high need for psychiatric specialist health care due to a complex pattern of diagnoses. Further research needs to investigate the conditions that can explain the lesser psychiatric care in higher age groups. There is also a need of research on health care utilization among people with ID in the primary health care context. This knowledge is critical for policymakers' plans of resources to meet the needs of these people.
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2.
  • Allerby, Katarina, 1980, et al. (författare)
  • Striving for a more person-centered psychosis care: results of a hospital-based multi-professional educational intervention
  • 2020
  • Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 20
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Reluctance on the part of mental health professionals constitutes an important barrier to patient participation in care. In order to stimulate person-centeredness in the inpatient care of persons with psychotic illness, we developed and tested an educational intervention for hospital staff (including psychiatrists) at all four wards at the Psychosis Clinic, Sahlgrenska University Hospital in Gothenburg, Sweden. The intervention was co-created by professionals, patients, and researchers using a participatory approach. In addition to lectures and workshops, staff created and implemented small projects to increase person-centeredness on their own wards. A primary focus was to establish a partnership between patient and staff by capturing and utilizing the patient's narrative to support active engagement in the care process. This included the development of a person-centered care plan. We hypothesized that the intervention would be associated with increased patient empowerment (primary outcome) and satisfaction with care (secondary outcome). Methods: A before and after design was used to test group differences in patient empowerment (Empowerment Scale) and consumer satisfaction (UKU-ConSat Rating Scale). All patients receiving inpatient psychosis care during measuring periods were eligible if meeting inclusion criteria of schizophrenia spectrum disorder, age > 18, and ability to comprehend study information. Severe cognitive deficit and inadequate Swedish language skills were exclusion criteria. Data on possible confounding variables including overall health (EQ-5D), symptom burden (PANSS), and functional ability (GAF) were collected alongside outcome measures. Results: ANCOVAs with overall health as a confounding variable showed no group differences regarding empowerment before (n = 50) versus after (n = 49) intervention, sample mean = 2.87/2.99, p = .142, eta(2) = .02, CI = -.27-.04. Consumer satisfaction (n = 50/50) was higher in the post-implementation group (4.46 versus 11.71, p = .041 eta(2) = .04, CI = -14.17- -.31). Conclusion: The hypothesis regarding the primary outcome, empowerment, was not supported. An increase in the secondary outcome, satisfaction, was observed, although the effect size was small, and results should be interpreted with caution. Findings from this staff educational intervention can inform the development of future studies aimed at improvement of inpatient care for persons with severe mental illness.
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3.
  • Argentzell, Elisabeth, et al. (författare)
  • Exploring mediators of the recovery process over time among mental health service users, using a mixed model regression analysis based on cluster RCT data
  • 2020
  • Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 20:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Personal recovery is associated with many significant health-related factors, but studies exploring associations between activity factors and personal recovery among service users are scarce. The aims of this study were hence to; 1) investigate if various aspects of activity may mediate change in recovery while also acknowledging clinical, sociodemographic and well-being factors; 2) explore the effects of two activity-based interventions, Balancing Everyday Life (BEL) or standard occupational therapy (SOT), on personal recovery among service users. Methods: Two-hundred-and-twenty-six service users were included in a cluster RCT, 133 from BEL units and 93 from SOT units. Participants commonly had a diagnosis of mood disorder and the mean age was 40. Instruments used targeted activity, mastery and functioning. A mixed-model regression analysis was employed. Results: The model tested was whether selected variables could be used to mediate the change in recovery from the start to a six-month follow-up after intervention. Participants’ personal recovery increased after treatment and increased further at the follow-up. The general level of recovery was negatively related to a diagnosis of depression/anxiety, both before and after treatment, but depressed/anxious service users still increased their recovery. There were no significant relations between recovery and sex or age. The interactions between change in recovery and changes in depression/anxiety, satisfaction with activities, sex, and age were all non-significant. All possible treatment mediators included were related to change in recovery, the strongest being occupational engagement and mastery, followed by activity satisfaction and symptoms. Mediation was shown by the decrease in the effect of the time factor (from intervention start to completion) when the covariates were introduced. In all cases the time variable was still significant. When testing a model with all variables simultaneously as covariates, occupational engagement and mastery were strongly significant. There was no difference between interventions regarding recovery improvement. Conclusion: The treatments were equally beneficial and were effective regardless of gender, age and diagnosis. Those who gained most from the treatment also gained in feelings of mastery and activity engagement. Activity engagement also moderated the level of recovery. To enhance recovery, interventions should facilitate meaningful activities and gaining control in life. Trial registration: The study was registered with ClinicalTrials.gov. Reg. No. NCT02619318. Retrospectively registered: December 2, 2015.
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4.
  • Aspvall, Kristina, et al. (författare)
  • Validity and clinical utility of the obsessive compulsive inventory - Child version : Further evaluation in clinical samples
  • 2020
  • Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 20:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background: Obsessive-compulsive disorder (OCD) is a clinically heterogeneous disorder. Currently, the Obsessive Compulsive Inventory-Child Version (OCI-CV) is the only self-report measure that fully captures this symptom heterogeneity in children and adolescents. The psychometric properties of the OCI-CV are promising but evaluations in large clinical samples are few. Further, no studies have examined whether the measure is valid in both younger and older children with OCD and whether scores on the measure are elevated in youths with OCD compared to youths with other mental disorders. Methods: To address these gaps in the literature, we investigated the psychometric properties and validity of a Swedish version of the OCI-CV in a large clinical sample of youth aged 6-18 years with OCD (n = 434), anxiety disorders (n = 84), and chronic tic disorders (n = 45). Results: Internal consistency coefficients at the total scale and subscale level were consistent with the English original and in the acceptable range. Confirmatory factor analyses revealed an adequate fit for the original six-factor structure in both younger and older children with OCD. Correlations between total scores on the OCI-CV and the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) were small at pre-treatment (r = 0.19) but large at post-treatment (r = 0.62). Youth with OCD scored higher than those with anxiety and chronic tic disorders, and the OCI-CV was sensitive to symptom change for youth undergoing treatment for OCD. Conclusions: This Swedish version of the OCI-CV appears to be a valid and reliable measure of the OCD symptom dimensions across age groups and has good clinical utility.
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5.
  • Bartfai, Aniko, et al. (författare)
  • Impaired cognitive functioning in stress-induced exhaustion disorder : a new tablet-based assessment
  • 2021
  • Ingår i: BMC Psychiatry. - : BioMed Central. - 1471-244X. ; 21:1
  • Tidskriftsartikel (refereegranskat)abstract
    • Background The adverse health effects of stress induced exhaustion disorder (SED) cause increasing concern in Western societies. This disorder is characterized by severe fatigue, decreased tolerance to further stress, and attention and memory lapses. Despite subjective complaints, individual cognitive deficits are not always detected in a clinical setting, which calls for the validation of more sensitive instruments. Aim The objective of this study was to investigate if a short, tablet-based serial naming task, MapCog Spectra (MCS) could be used as a marker for cognitive problems in SED. Participants The study comprised of 39 subjects (35 females, four males) with SED. Their mean age was 46,8 years (SD 10.1; range 30-60 yrs.). All participants were healthcare professionals, with a college or university degree, doctors, registered nurses, and psychologists. Methods The MCS was used to assess the number of aberrant pauses during serial naming of coloured geometrical shapes. The Coding, Matrix Reasoning, Digit Span, Symbol Search of the WAIS-IV, and RUFF 2&7 tests, were administered together with a short interview. Results Mean values were within normal reference limits for all tests, except for the MCS, which showed a significantly higher number of aberrant pauses (p < 0,001) in the SED group, compared to normal reference values. Although subjects performed within normal limits on the RUFF 2&7, a significant difference between individuals was found in the performance strategy of the participants. Conclusion Here we report that subjects with SED have performance deficits on the MCS, in terms of aberrant pause times, despite average performance on WAIS-IV tests measuring inductive reasoning, processing speed, working memory, and attention. We also demonstrate that subjects use different strategies to overcome their problems. These findings add to the growing evidence of cognitive deficits in SED and that the MCS might aid neuropsychologists in disentangling cognitive markers, important to substantiate the subjective complaints of affected individuals.
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6.
  • Berg, Matilda, et al. (författare)
  • Knowledge gain and usage of knowledge learned during internet-based CBT treatment for adolescent depression : a qualitative study
  • 2020
  • Ingår i: BMC Psychiatry. - : BioMed Central. - 1471-244X. ; 20:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundThe role of explicit learning of treatment content in internet-based cognitive-behavioural treatment (ICBT) is an emerging field of research. The objective of this study was to explore clients experiences of their ICBT treatment for depression with a focus on knowledge gain and usage of knowledge learned during treatment.MethodsA strategic sample of ten adolescents, aged between 15 and 19 years, who had received ICBT for major depression within a clinical controlled trial were recruited for the study. Semi-structured interviews were conducted 6 months following trial completion. Data were transcribed and analysed using thematic analysis. The participants had a general adherence rate of 6–8 opened modules out of 8 possible.ResultsTwo main themes were identified; “Active agents of CBT” and “Passive agents of CBT”, with each theme consisting of three and two sub-themes. Active agents of CBT reflect a tendency to specifically remember and actively apply specific CBT principles in present life situations. Passive agents of CBT reflect a tendency to remember CBT treatment principles vaguely and express a passive or reactive usage of learned therapy content.ConclusionThe findings suggest that young clients can remember and apply CBT principles 6 months after their treatment. However, while experiencing benefits of treatment, clients recall and application of treatment strategies vary. The study emphasizes the importance of exploring client recall of CBT components and how valuable it is to explicitly remember contents of a treatment in order to improve and maintain improvement. Further studies on the role of knowledge and memory of ICBT for adolescent populations are warranted.
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7.
  • Brahim, Lydia Ould, et al. (författare)
  • The effects of self-management interventions on depressive symptoms in adults with chronic physical disease(s) experiencing depressive symptomatology : a systematic review and meta-analysis
  • 2021
  • Ingår i: BMC Psychiatry. - : BioMed Central (BMC). - 1471-244X. ; 21:1
  • Forskningsöversikt (refereegranskat)abstract
    • Background Chronic diseases are the leading cause of death worldwide. It is estimated that 20% of adults with chronic physical diseases experience concomitant depression, increasing their risk of morbidity and mortality. Low intensity psychosocial interventions, such as self-management, are part of recommended treatment; however, no systematic review has evaluated the effects of depression self-management interventions for this population. The primary objective was to examine the effect of self-management interventions on reducing depressive symptomatology in adults with chronic disease(s) and co-occurring depressive symptoms. Secondary objectives were to evaluate the effect of these interventions on improving other psychosocial and physiological outcomes (e.g., anxiety, glycemic control) and to assess potential differential effect based on key participant and intervention characteristics (e.g., chronic disease, provider). Methods Studies comparing depression self-management interventions to a control group were identified through a) systematic searches of databases to June 2018 [MEDLINE (1946 -), EMBASE (1996 -), PsycINFO (1967 -), CINAHL (1984 -)] and b) secondary 'snowball' search strategies. The methodological quality of included studies was critically reviewed. Screening of all titles, abstracts, and full texts for eligibility was assessed independently by two authors. Data were extracted by one author and verified by a second. Results Fifteen studies were retained: 12 for meta-analysis and three for descriptive review. In total, these trials included 2064 participants and most commonly evaluated interventions for people with cancer (n = 7) or diabetes (n = 4). From baseline to < 6-months (T1), the pooled mean effect size was - 0.47 [95% CI -0.73, - 0.21] as compared to control groups for the primary outcome of depression and - 0.53 [95% CI -0.91, - 0.15] at >= 6-months (T2). Results were also significant for anxiety (T1) and glycemic control (T2). Self-management skills of decision-making and taking action were significant moderators of depression at T1. Conclusion Self-management interventions show promise in improving depression and anxiety in those with concomitant chronic physical disease. The findings may contribute to the development of future Self-management interventions and delivering evidence-based care to this population. Further high-quality RCTs are needed to identify sources of heterogeneity and investigate key intervention components.
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8.
  • Bulik, CM, et al. (författare)
  • The Binge Eating Genetics Initiative (BEGIN): study protocol
  • 2020
  • Ingår i: BMC psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 20:1, s. 307-
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundThe Binge Eating Genetics Initiative (BEGIN) is a multipronged investigation examining the interplay of genomic, gut microbiota, and behavioral factors in bulimia nervosa and binge-eating disorder.Methods1000 individuals who meet current diagnostic criteria for bulimia nervosa or binge-eating disorder are being recruited to collect saliva samples for genotyping, fecal sampling for microbiota characterization, and recording of 30 days of passive data and behavioral phenotyping related to eating disorders using the appRecovery Recordadapted for the Apple Watch.DiscussionBEGIN examines the interplay of genomic, gut microbiota, and behavioral factors to explore etiology and develop predictors of risk, course of illness, and response to treatment in bulimia nervosa and binge-eating disorder. We will optimize the richness and longitudinal structure of deep passive and active phenotypic data to lay the foundation for a personalized precision medicine approach enabling just-in-time interventions that will allow individuals to disrupt eating disorder behaviors in real time before they occur.Trial registrationThe ClinicalTrials.gov identifier isNCT04162574. November 14, 2019, Retrospectively Registered.
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9.
  • Bulik, CM, et al. (författare)
  • The Eating Disorders Genetics Initiative (EDGI): study protocol
  • 2021
  • Ingår i: BMC psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 21:1, s. 234-
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundThe Eating Disorders Genetics Initiative (EDGI) is an international investigation exploring the role of genes and environment in anorexia nervosa, bulimia nervosa, and binge-eating disorder.MethodsA total of 14,500 individuals with eating disorders and 1500 controls will be included from the United States (US), Australia (AU), New Zealand (NZ), and Denmark (DK). In the US, AU, and NZ, participants will complete comprehensive online phenotyping and will submit a saliva sample for genotyping. In DK, individuals with eating disorders will be identified by the National Patient Register, and genotyping will occur using bloodspots archived from birth. A genome-wide association study will be conducted within EDGI and via meta-analysis with other data from the Eating Disorders Working Group of the Psychiatric Genomics Consortium (PGC-ED).DiscussionEDGI represents the largest genetic study of eating disorders ever to be conducted and is designed to rapidly advance the study of the genetics of the three major eating disorders (anorexia nervosa, bulimia nervosa, and binge-eating disorder). We will explicate the genetic architecture of eating disorders relative to each other and to other psychiatric and metabolic disorders and traits. Our goal is for EDGI to deliver “actionable” findings that can be transformed into clinically meaningful insights.Trial registrationEDGI is a registered clinical trial: clinicaltrials.govNCT04378101.
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10.
  • Clason van de Leur, Jakob, et al. (författare)
  • Standardized multimodal intervention for stress-induced exhaustion disorder : an open trial in a clinical setting
  • 2020
  • Ingår i: BMC Psychiatry. - : Springer Science and Business Media LLC. - 1471-244X. ; 20:1
  • Tidskriftsartikel (refereegranskat)abstract
    • BackgroundLong-term sick-leave due to stress-related ill-health is increasing in several economically developed countries. Even though different forms of interventions are administered in regular care for stress-related disorders, such as Stress-induced Exhaustion disorder (SED), the scientific evidence for the effectiveness of such treatments is sparse. The objective of this study was to explore changes in SED-symptoms and return-to-work-rates in a large group of SED-patients participating in a standardized Multimodal intervention (MMI) in a clinical setting.MethodThis open clinical trial tracked 390 patients who fulfilled the criteria for SED undergoing a 24-week MMI, including return-to-work-strategies. Before inclusion, all patients underwent a multi-professional assessment by a team of licensed physicians, licensed psychologists, and licensed physiotherapists. Self-rated questionnaires were administered before treatment, at treatment-start, mid-treatment, post-treatment, and at 12-month follow-up. Within-group change was evaluated over time with mixed-effects models. Beyond different symptoms, working time, sick-leave compensation, and adverse effects were also measured.ResultsThere were significant improvements in symptoms of SED, burnout, anxiety, depression, and insomnia, with large within-group effect sizes (d = 0.91–1.76), improvements that were maintained at 12-month follow-up. Furthermore, there was a significant increase in quality of life and large improvements in average working time and sick-leave compensation. Some adverse effects were reported, mainly concerning an increase in stress, anxiety, and worry.ConclusionSED-patients participating in this standardized MMI reported large symptom alleviation, increased working time and reduced sick-leave compensation, indicating a beneficial treatment. There were some adverse effects, but no more so than other psychological treatments. This study confirms previous findings that high levels of depression and anxiety decrease to sub-clinical levels during treatment, while symptoms of SED also decline, yet still persists above sub-clinical levels at 12-month follow-up. On the whole, this open clinical trial suggests that a standardized MMI, administered in a clinical setting, improves symptoms and return-to-work rates in a clinically representative SED-population.
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