| 1. |
- Andersson, Erik, et al.
(author)
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d-Cycloserine vs Placebo as Adjunct to Cognitive Behavioral Therapy for Obsessive-Compulsive Disorder and Interaction With Antidepressants A Randomized Clinical Trial
- 2015
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In: JAMA psychiatry. - : American Medical Association (AMA). - 2168-6238 .- 2168-622X. ; 72:7, s. 659-667
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Journal article (peer-reviewed)abstract
- IMPORTANCE It is unclear whether D-cycloserine (DCS), a partial N-methyl-D-aspartate agonist that enhances fear extinction, can augment the effects of exposure-based cognitive behavioral therapy (CBT) for obsessive-compulsive disorder (OCD). OBJECTIVES To examine whether DCS augments the effects of CBT for OCD and to explore (post hoc) whether concomitant antidepressant medication moderates the effects of DCS. DESIGN, SETTING, AND PARTICIPANTS A 12-week, double-blind randomized clinical trial with 3-month follow-up conducted at an academic medical center between September 4, 2012, and September 26, 2013. Participants included 128 adult outpatients with a primary diagnosis of OCD and a Yale-Brown Obsessive Compulsive Scale (Y-BOCS) score of 16 or higher. Concurrent antidepressant medication was permitted if the dose had been stable for at least 2 months prior to enrollment and remained unchanged during the trial. The main analysis was by intention-to-treat population. INTERVENTIONS All participants received a previously validated Internet-based CBT protocol over 12 weeks and were randomized to receive either 50 mg of DCS or placebo, administered 1 hour before each of 5 exposure and response prevention tasks. MAIN OUTCOMES AND MEASURES Clinician-administered Y-BOCS score at week 12 and at 3-month follow-up. Remission was defined as a score of 12 or lower on the Y-BOCS. RESULTS In the primary intention-to-treat analyses, DCS did not augment the effects of CBT compared with placebo (mean [SD] clinician-rated Y-BOCS score, DCS: 13.86 [6.50] at week 12 and 12.35 [7.75] at 3-month follow-up; placebo: 11.77 [5.95] at week 12 and 12.37 [6.68] at 3-month follow-up) but showed a significant interaction with antidepressants (clinician-rated Y-BOCS, B = -1.08; Z = -2.79; P = .005). Post hoc analyses revealed that antidepressants significantly impaired treatment response in the DCS group but not the placebo group, at both posttreatment and follow-up (clinician-rated Y-BOCS: t(62) = -3.00; P = .004; and t(61) = -3.49; P < .001, respectively). In the DCS group, a significantly greater proportion of antidepressant-free patients achieved remission status at follow-up (60% [95% CI, 45%-74%]) than antidepressant-medicated patients (24% [95% CI, 9%-48%]) (P = .008). Antidepressants had no effect in the placebo group (50% [95% CI, 36%-64%] remission rate in both groups). CONCLUSIONS AND RELEVANCE The findings suggest that antidepressants may interact with DCS to block its facilitating effect on fear extinction. Use of DCS may be a promising CBT augmentation strategy but only in antidepressant-free patients with OCD.
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| 2. |
- Andersson, Evelyn, et al.
(author)
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Genetics of response to cognitive behavior therapy in adults with major depression : a preliminary report
- 2019
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In: Molecular Psychiatry. - : Nature Publishing Group. - 1359-4184 .- 1476-5578. ; 24:4, s. 484-490
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Journal article (peer-reviewed)abstract
- Major depressive disorder is heritable and a leading cause of disability. Cognitive behavior therapy is an effective treatment for major depression. By quantifying genetic risk scores based on common genetic variants, the aim of this report was to explore the utility of psychiatric and cognitive trait genetic risk scores, for predicting the response of 894 adults with major depressive disorder to cognitive behavior therapy. The participants were recruited in a psychiatric setting, and the primary outcome score was measured using the Montgomery Asberg Depression Rating Scale-Self Rated. Single-nucleotide polymorphism genotyping arrays were used to calculate the genomic risk scores based on large genetic studies of six phenotypes: major depressive disorder, bipolar disorder, attention-deficit/hyperactivity disorder, autism spectrum disorder, intelligence, and educational attainment. Linear mixed-effect models were used to test the relationships between the six genetic risk scores and cognitive behavior therapy outcome. Our analyses yielded one significant interaction effect (B = 0.09, p < 0.001): the autism spectrum disorder genetic risk score correlated with Montgomery Asberg Depression Rating Scale-Self Rated changes during treatment, and the higher the autism spectrum disorder genetic load, the less the depressive symptoms decreased over time. The genetic risk scores for the other psychiatric and cognitive traits were not related to depressive symptom severity or change over time. Our preliminary results indicated, as expected, that the genomics of the response of patients with major depression to cognitive behavior therapy were complex and that future efforts should aim to maximize sample size and limit subject heterogeneity in order to gain a better understanding of the use of genetic risk factors to predict treatment outcome.
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| 3. |
- Andersson, Gerhard, et al.
(author)
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Paniksyndrom : ond cirkel av feltolkade kroppsliga signaler
- 2011
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In: Läkartidningen. - : Läkartidningen förlag AB. - 0023-7205 .- 1652-7518. ; 108:14, s. 795-797
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Journal article (peer-reviewed)abstract
- Attacker av intensiv rädsla utan tydlig yttre orsak som leder till rädsla för nya attacker – det kännetecknar paniksyndrom. Evidensbaserade behandlingsalternativ finns, och det finns inget skäl att avvakta med behandling.
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| 4. |
- Andersson, Gerhard, et al.
(author)
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Paniksyndrom - ond cirkel av feltolkade kroppsliga signaler
- 2011
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In: Läkartidningen. - 0023-7205 .- 1652-7518. ; 108:14, s. 795-797
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Journal article (peer-reviewed)abstract
- Paniksyndrom kännetecknas av plötsliga, oväntade panikattacker med rädsla för nya attacker eller konsekvenser av dem. En andel patienter har även agorafobi. Olika förklaringsmodeller har förts fram för att beskriva hur paniksyndrom uppstår och vidmakthålls. Flera behandlingar för paniksyndrom finns, och bland dem är det psykologisk behandling i form av kognitiv beteendeterapi (KBT) eller läkemedelsbehandling (i första hand selektiva serotoninåterupptagshämmare) som rekommenderas och som har stöd i forskningen. I Sverige har Internetbaserad KBT för paniksyndrom utvecklats och prövats med framgång. I valet av behandling bör patientens preferenser vägas in.
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| 5. |
- Beskow, Jan, et al.
(author)
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Omgivning och kultur : 5:e ringen
- 2011. - 1
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In: Psykologisk coaching. - Stockholm : Natur och kultur. - 9789127122048 ; , s. 162-173
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Book chapter (pop. science, debate, etc.)abstract
- Många av de mest framgångsrika coacher som är verksamma i Sverige idag jobbar med kognitiv och beteendeinriktad coaching. Med detta arbetssätt som grund skapas ett coachingsamtal som kan leda till genomgripande förändring. I denna bok varvas teori och praktik. Målgruppen är praktiserande coacher, terapeuter, chefer, psykologer, rådgivare och alla andra som vill jobba med en professionell coachingteori som grund.
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| 6. |
- Blom, Kerstin, et al.
(author)
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Psychological Treatment of Comorbid Insomnia and Depression : A Double-Blind Randomized Placebo-Controlled Trial
- 2024
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In: Psychotherapy and Psychosomatics. - : S. Karger. - 0033-3190 .- 1423-0348. ; 93:2, s. 100-113
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Journal article (peer-reviewed)abstract
- Introduction: Insomnia and depression are highly prevalent disorders and commonly occur together. Cognitive behavioral therapy for insomnia, CBT-I, has been shown to be effective in treating insomnia and also comorbid depression. However, it is unclear whether effects of CBT-I on depression are specific or nonspecific. Also, depressive symptoms often remain too high after CBT-I, indicating a need for improved treatments. The objective was to determine whether combining CBT-I with CBT for depression, without increasing treatment length, reduces both insomnia and depression more than CBT for depression with a placebo insomnia intervention. Methods: A 12-week double-blind randomized controlled trial with a 6-month follow-up in a psychiatric setting using therapist-guided internet-delivered treatments was conducted. Patients (N = 126) were diagnosed with insomnia disorder and major depression by physicians. Primary outcome measures were as follows: self-rating scales Insomnia Severity Index (ISI) and Montgomery-angstrom sberg Depression Rating Scale (MADRS-S). Results: The combined treatment showed specific effects on insomnia severity over the control treatment (p = 0.007) but was not more effective in reducing depression severity. Within-group effects (Cohen's d) at post and at 6 months were as follows: ISI 1.40 and 1.42 (combined treatment), 0.95 and 1.00 (control); MADRS-S 0.97 and 1.12 (combined), 0.88 and 0.89 (control). Conclusions: CBT-I shows large specific effects on insomnia severity and is superior to control in this regard. Both treatments had similar effects on depression severity, i.e., combining CBT-I with CBT for depression did not enhance outcomes on depression compared to control. We suggest CBT-I should always be offered to patients with insomnia and depression comorbidity, possibly as the first-hand choice. Combining it with a psychological treatment for depression could be too burdening and may not be beneficial.
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| 7. |
- Boberg, Julia, et al.
(author)
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Swedish multimodal cohort of patients with anxiety or depression treated with internet-delivered psychotherapy (MULTI-PSYCH)
- 2023
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In: BMJ Open. - : BMJ Publishing Group Ltd. - 2044-6055. ; 13:10
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Journal article (peer-reviewed)abstract
- Purpose Depression and anxiety afflict millions worldwide causing considerable disability. MULTI-PSYCH is a longitudinal cohort of genotyped and phenotyped individuals with depression or anxiety disorders who have undergone highly structured internet-based cognitive-behaviour therapy (ICBT). The overarching purpose of MULTI-PSYCH is to improve risk stratification, outcome prediction and secondary preventive interventions. MULTI-PSYCH is a precision medicine initiative that combines clinical, genetic and nationwide register data.Participants MULTI-PSYCH includes 2668 clinically well-characterised adults with major depressive disorder (MDD) (n=1300), social anxiety disorder (n=640) or panic disorder (n=728) assessed before, during and after 12 weeks of ICBT at the internet psychiatry clinic in Stockholm, Sweden. All patients have been blood sampled and genotyped. Clinical and genetic data have been linked to several Swedish registers containing a wide range of variables from patient birth up to 10 years after the end of ICBT. These variable types include perinatal complications, school grades, psychiatric and somatic comorbidity, dispensed medications, medical interventions and diagnoses, healthcare and social benefits, demographics, income and more. Long-term follow-up data will be collected through 2029.Findings to date Initial uses of MULTI-PSYCH include the discovery of an association between PRS for autism spectrum disorder and response to ICBT, the development of a machine learning model for baseline prediction of remission status after ICBT in MDD and data contributions to genome wide association studies for ICBT outcome. Other projects have been launched or are in the planning phase.Future plans The MULTI-PSYCH cohort provides a unique infrastructure to study not only predictors or short-term treatment outcomes, but also longer term medical and socioeconomic outcomes in patients treated with ICBT for depression or anxiety. MULTI-PSYCH is well positioned for research collaboration.
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| 8. |
- Buchert, Paulina, et al.
(author)
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Translation and linguistic validation of self-administered Swedish version of WHODAS 2.0
- 2015
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Conference paper (peer-reviewed)abstract
- Background: Use of Patient-Reported Outcomes (PROs) is increasingly requested in clinical practice and research. The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic instrument for self-report capturing functioning in the life-domains of understanding and communicating, getting around, self-care, getting along with people, life activities and participation in society. It is based on the same conceptual foundation as the International Classification of Functioning Disability and Health (ICF). Several language versions of WHODAS 2.0 are available and a Swedish version is in progress.Aim: To translate the self-administered 36-item version of WHODAS 2.0 into Swedish and examine the understanding and interpretation of the instruments´ content and response processes.Methods: Translation process was made following WHO guidelines and the WHODAS 2.0 translation package (version 1.0) including: forward-translation, expert panel discussion, back-translation, pre-test of preliminary version, final version, and pilot-testing of the final version.Pre-test was conducted through structured interviews in purposeful samples of Swedish-speaking adults including two patients with bi-polar disorder and a sample from the general population. Pilot-testing of the final version will be performed by structured interviews in a purposeful sample of outpatients.Results: Forward-translation, expert panel discussion, and back-translation resulted in a preliminary Swedish version of WHODAS 2.0. Pre-test revealed some issues related to items in the Participation in society domain, and in the overall lay-out. This resulted in minor changes in selection of words in the final version and suggestions for future revision of the instrument.Pilot-testing of the final version in outpatients are under progress and the result will be ready to present before Conference date in November 2015.Conclusion: The preliminary Swedish self-administered version of WHODAS 2.0 is easy to understand and respond to. Further studies are needed to provide evidence for validity of the final Swedish WHODAS 2.0.
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| 9. |
- El Alaoui, Samir, et al.
(author)
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Predicting Outcome in Internet-Based Cognitive Behaviour Therapy for Major Depression : A Large Cohort Study of Adult Patients in Routine Psychiatric Care
- 2016
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In: PLOS ONE. - : Public Library of Science (PLoS). - 1932-6203. ; 11:9
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Journal article (peer-reviewed)abstract
- Background Although the effectiveness of therapist-guided internet-based cognitive behaviour therapy (ICBT) for treating depression has been well documented, knowledge of outcome predictors and risk factors associated with lower treatment response is limited, especially when the treatment has been conducted within a naturalistic clinical setting. Identification of such factors is important for clinicians when making treatment recommendations. Methods Data from a large cohort (N = 1738) of adult outpatients having been treated with ICBT for depression at an outpatient psychiatric clinic were analysed. A multilevel modelling approach was used to identify patient and treatment variables associated with the speed of recovery during treatment using weekly measurements of the Montgomery Asberg Depression Rating Scale Self-Rated (MADRS-S). Outcomes Adhering to the treatment, perceiving it as credible and working full-time emerged as predictors of a faster pace of recovery and were also associated with a lower level of depression at the end of treatment. Higher pre-treatment depression and sleep problems were associated with a greater improvement rate, but predicted higher depression after treatment. Having a history of psychotropic medication was associated with both slower improvement and higher post-treatment depression. Conclusion Perceived credibility of ICBT is a strong predictor of treatment response. Assessing patient beliefs and expectations may be a useful aid for clinicians when identifying those who are more or less likely to benefit from ICBT. Helping patients improve expectations prior to treatment may be an important goal for clinicians during the initial assessment phase.
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| 10. |
- Forsell, Erik, et al.
(author)
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Development of a very brief scale for detecting and measuring panic disorder using two items from the Panic Disorder Severity Scale-Self Report
- 2019
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In: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 257, s. 615-622
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Journal article (peer-reviewed)abstract
- Objective: To minimize the burden in detecting and monitoring Panic Disorder and Agoraphobia by developing a very brief scale with selected items from the Panic Disorder Severity Scale-Self Report (PDSS-SR), and to investigate the proposed scale's psychometric properties in a comorbid sample. Methods: A sample of 5103 patients from the Internet Psychiatry Clinic in Sweden, diagnosed and treated with Internet-based cognitive behavioral therapy for panic disorder (n = 1390), social anxiety disorder (n = 1313) or depression (n = 2400), responded to the PDSS-SR. Six criteria related to factor structure, sensitivity to change and clinical representativeness were used to select items. Psychometric analyses for the selected very brief scale were performed. Results: Items 2 (distress during panic attacks) and 4 (agoraphobic avoidance), were selected to create the very brief PDSS-SR version. Correlations with the full scale were high at screening, pre and post, and for change (0.87-0.93). Categorical Omega was omega(c) = 0.74. With a cut-off of 3 points, the scale could detect panic disorder in a psychiatric sample with a sensitivity of 85% and a specificity of 66%. Limitations: Limitations include lack of healthy controls and lack of blinding on secondary outcome measures. Conclusion: The proposed 2-item PDSS-SR version is a good candidate for a very brief panic disorder questionnaire, both for detecting cases and for measuring change. This is especially useful in clinical settings when measuring more than one condition at a time.
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| 11. |
- Forsell, Erik, et al.
(author)
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Proof of Concept for an Adaptive Treatment Strategy to Prevent Failures in Internet-Delivered CBT : A Single-Blind Randomized Clinical Trial With Insomnia Patients
- 2019
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In: American Journal of Psychiatry. - : American Psychiatric Association Publishing. - 0002-953X .- 1535-7228. ; 176:4, s. 315-323
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Journal article (peer-reviewed)abstract
- Objective: This study aimed to demonstrate proof of concept for an adaptive treatment strategy in Internet-delivered cognitive-behavioral therapy (ICBT), where risk of treatment failure is assessed early in treatment and treatment for at-risk patients is adapted to prevent treatment failure. Methods: A semiautomated algorithm assessed risk of treatment failure early in treatment in 251 patients undergoing ICBT for insomnia with therapist guidance. At-risk patients were randomly assigned to continue standard ICBT or to receive adapted ICBT. The primary outcome was self-rated insomnia symptoms using the Insomnia Severity Index in a linear mixed-effects model. The main secondary outcome was treatment failure (having neither responded nor remitted at the posttreatment assessment). Results: A total of 102 patients were classified as at risk and randomly assigned to receive adapted ICBT (N=51) or standard ICBT (N=51); 149 patients were classified as not at risk. Patients not at risk had significantly greater score reductions on the Insomnia Severity Index than at-risk patients given standard ICBT. Adapted ICBT for at-risk patients was significantly more successful in reducing symptoms compared with standard ICBT, and it decreased the risk of failing treatment (odds ratio= 0.33). At-risk patients receiving adapted ICBT were not more likely to experience treatment failure than those not at risk (odds ratio= 0.51), though they were less likely to experience remission. Adapted treatment required, on average, 14 more minutes of therapist-patient time per remaining week. Conclusions: An adaptive treatment strategy can increase treatment effects for at-risk patients and reduce the number of failed treatments. Future studies should improve accuracy in classification algorithms and identify key factors that boost the effect of adapted treatments.
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| 12. |
- Gervind, Elisabet, et al.
(author)
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The influence of organizational models on the implementation of internet-based cognitive behavior therapy in primary care: A mixed methods study using the RE-AIM framework
- 2024
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In: Internet Interventions. - : Elsevier. - 2214-7829. ; 35
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Journal article (peer-reviewed)abstract
- Background: Internet-Based Cognitive Behavioral Therapy (iCBT) holds great potential in addressing mental health issues, yet its real-world implementation poses significant challenges. While prior research has predominantly focused on centralized care models, this study explores the implementation of iCBT in the context of decentralized organizational structures within the Swedish primary care setting, where all interventions traditionally are delivered at local Primary Care Centers (PCCs).Aim: This study aims to enhance our understanding of iCBT implementation in primary care and assess the impact of organizational models on the implementation's outcome using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) framework.Method: A mixed-methods research design was employed to identify the factors influencing iCBT implementation across different levels, involving patients, therapists and managers. Data spanning two years was collected and analyzed through thematic analysis and statistical tests. The study encompassed 104 primary care centers, with patient data (n = 1979) sourced from the Swedish National Quality Register for Internet-Based Psychological Treatment (SibeR). Additionally, 53 iCBT therapists and 50 PCC managers completed the Normalization Measure Development Questionnaire, and 15 leaders participated in interviews.Results: Our investigation identified two implementation approaches, one concentrated and one decentralized. Implementation effectiveness was evident through adherence rates suggesting that iCBT is a promising approach for treating mental ill-health in primary care, although challenges were observed concerning patient assessment and therapist drift towards unstructured treatment. Mandatory implementation, along with managerial and organizational support, positively impacted adoption. Results vary in terms of adherence to established protocols, with therapists working in concentrated model showing a significantly higher percentage of registration in the quality register SibeR (X2 (1, N = 2973) = 430.5774, p = 0.001). They also showed significantly higher means in cognitive participation (Z = - 2.179, p = 0.029) and in reflective monitoring (Z = - 2.548, p = 0.011). Discussion: Overall, the study results demonstrate that iCBT, as a complex and qualitatively different intervention from traditional psychological treatment, can be widely implemented in primary care settings. The study's key finding highlights the substantial advantages of the concentrated organizational model. This model has strengths in sustainability, encourages reflective monitoring among therapists, the use of quality registers, and enforces established protocols.Conclusion: In conclusion, this study significantly contributes to the understanding of the practical aspects associated with the implementation of complex internet interventions, particularly in the context of internetbased cognitive-behavioral therapy (iCBT). The study highlights that effective iCBT integration into primary care requires a multifaceted approach, taking into account organizational models, robust support structures, and a commitment to maintaining quality standards. By emphasizing these factors, our research aims to provide actionable insights that can enhance the practicability and real-world applicability of implementing iCBT in primary care settings.
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| 13. |
- Gervind, Elisabet, et al.
(author)
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The transference of research results to practise: Organization and implementation outcomes of iCBT in primary care – a mixed methods study using the RE-AIM framework
- 2022
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In: SWESRII 2022.
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Conference paper (other academic/artistic)abstract
- Background: Healthcare systems all over the world are working in dynamic and resource-constrained contexts. Implementation science plays a critical role in ensuring that costly research results are implemented and improve public health. Implementation of iCBT in regular care has given mixed results and has rarely been documented on the basis of a scientific framework for implementation research. Aim: The overall aim of the present study is to contribute to knowledge about how iCBT can be implemented and organized in primary care. The current study also explores naturalistic variability in two different organizational formats, concentrated and decentralized. Method: A mixed quantitative-qualitative design was used to identify factors that impact the implementation of iCBT across multiple levels, including patient, therapists, leaders and organization. The scientific framework RE-AIM with the dimensions reach (those in the target group participating in the program), effectiveness (effects after completion of the program), adoption (actors who accept the program), implementation (compliance with the program according to protocol), maintenance (sustainability over time) was used to evaluate the implementation. Results: 104 primary care centres participated in the study. Outcomes on patient-data (n=1979) were gathered between 2018 and 2021 from the quality register SibeR. Fifty-four iCBT-therapists, answered the NoMAD-questionnaire and fifteen leaders were interviewed. The materials are currently being analysed.
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| 14. |
- Hagman, Cecilia, 1983, et al.
(author)
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Additive Manufacturing of a Removable Partial Prosthesis in Titanium Using Binder Jetting Technology: A Brief Research Report
- 2022
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In: Frontiers in Manufacturing Technology. - : Frontiers Media SA. - 2813-0359. ; 2
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Journal article (peer-reviewed)abstract
- Objective: The purpose of this study was to measure the surface roughness and compare the fit of a cobalt-chromium selective laser-melted removable partial denture framework and a titanium binder jetting removable partial denture framework. Materials and methods: A design for a removable partial prosthesis framework was made using 3Shape software, and thereafter, one framework was additively manufactured in cobalt-chromium with selective laser melting and one in titanium using binder jetting technology. The weight of the frameworks was measured, and the surface parameters Sa, Sds, and Sdr were measured by white light interferometry. The fit of the frameworks was analyzed using visual inspection and the pressing test. Results: The weight of the frameworks in their post-printed state was 15.66 g and 7.43 g for cobalt-chromium and titanium, respectively. After finishing and polishing, the cobalt-chromium framework’s outer surface showed a high shine and smooth surface, with lower values in the Sa and Sdr parameters. The visual inspection showed gaps in the titanium framework, and the pressing test detected movement greater than 0.5 mm for the same material. Conclusion: The Ti framework showed higher surface roughness and was left with a lackluster finish after polishing. Also, the fit of the Ti framework was not clinically acceptable. The additive manufacturing binder jetting technology for titanium needs improvement or an adjustment of the settings to be used for clinically removable partial dentures. The cobalt-chromium framework manufactured by selective laser melting showed an acceptable clinical fit and surface roughness.
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| 15. |
- Hedman, Erik, et al.
(author)
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Telephone vs. Internet-administration of self-report measures of social anxiety, depressive symptoms, and insomnia : psychometric validation of a method to reduce the impact of missing data
- 2013
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In: Journal of Medical Internet Research. - : JMIR. - 1438-8871. ; 15:10, s. 1-8
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Journal article (peer-reviewed)abstract
- Background: Internet-administered self-report measures of social anxiety, depressive symptoms, and sleep difficulties are widely used in clinical trials and in clinical routine care, but data loss is a common problem that could render skewed estimates of symptom levels and treatment effects. One way of reducing the negative impact of missing data could be to use telephone administration of self-report measures as a means to complete the data missing from the online data collection.Objective: The aim of the study was to compare the convergence of telephone and Internet administration of self-report measures of social anxiety, depressive symptoms, and sleep difficulties.Methods: The Liebowitz Social Anxiety Scale-Self-Report (LSAS-SR), Montgomery-Åsberg Depression Rating Scale-Self-Rated (MADRS-S), and the Insomnia Severity Index (ISI) were administered over the telephone and via the Internet to a clinical sample (N=82) of psychiatric patients at a clinic specializing in Internet-delivered treatment. Shortened versions of the LSAS-SR and the ISI were used when administered via telephone.Results: As predicted, the results showed that the estimates produced by the two administration formats were highly correlated (r=.82-.91; P<.001) and internal consistencies were high in both administration formats (telephone: Cronbach alpha=.76-.86 and Internet: Cronbach alpha=.79-.93). The correlation coefficients were similar across questionnaires and the shorter versions of the questionnaires used in the telephone administration of the LSAS-SR and ISI performed in general equally well compared to when the full scale was used, as was the case with the MADRS-S.Conclusions: Telephone administration of self-report questionnaires is a valid method that can be used to reduce data loss in routine psychiatric practice as well as in clinical trials, thereby contributing to more accurate symptom estimates.
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| 16. |
- Jaillon, Sébastien, et al.
(author)
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The Humoral Pattern Recognition Molecule PTX3 Is a Key Component of Innate Immunity against Urinary Tract Infection.
- 2014
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In: Immunity. - : Elsevier BV. - 1074-7613. ; 40:4, s. 621-632
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Journal article (peer-reviewed)abstract
- Immunity in the urinary tract has distinct and poorly understood pathophysiological characteristics and urinary tract infections (UTIs) are important causes of morbidity and mortality. We investigated the role of the soluble pattern recognition molecule pentraxin 3 (PTX3), a key component of the humoral arm of innate immunity, in UTIs. PTX3-deficient mice showed defective control of UTIs and exacerbated inflammation. Expression of PTX3 was induced in uroepithelial cells by uropathogenic Escherichia coli (UPEC) in a Toll-like receptor 4 (TLR4)- and MyD88-dependent manner. PTX3 enhanced UPEC phagocytosis and phagosome maturation by neutrophils. PTX3 was detected in urine of UTI patients and amounts correlated with disease severity. In cohorts of UTI-prone patients, PTX3 gene polymorphisms correlated with susceptibility to acute pyelonephritis and cystitis. These results suggest that PTX3 is an essential component of innate resistance against UTIs. Thus, the cellular and humoral arms of innate immunity exert complementary functions in mediating resistance against UTIs.
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| 17. |
- Kraepelien, Martin, et al.
(author)
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Individually tailored internet treatment in routine care : A feasibility study
- 2019
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In: Internet Interventions. - : Elsevier. - 2214-7829. ; 18, s. 1-8
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Journal article (peer-reviewed)abstract
- Introduction: Disorder-specific internet treatment, based on cognitive-behavioral therapy, has been a part of routine psychiatric care in Sweden since 2007, provided at the Internet Psychiatry Clinic in Stockholm. Individually tailored treatments, with the opportunity to target more than one condition within the same treatment, has since then been evaluated in randomized trials with promising results. To introduce an individually tailored treatment into a clinical setting originally designed for disorder-specific processes creates challenges, such as how to choose the optimal treatment type for each patient. Methods: The feasibility of a proposed new routine for assessment and initiation of either a disorder-specific or an individually tailored treatment was tested on patients self-referring to the Internet Psychiatry Clinic during three weeks (N = 66), by exploring the match between comorbid problem areas and patients' preferred treatments with available disorder-specific treatment options, as well as presenting these patients' preferred problem areas to work with in individually tailored treatment, and evaluating any problems with the proposed routine. The feasibility (i.e. satisfaction, credibility, treatment activity, adherence, and preliminary symptom reductions) in the individually tailored treatment were also explored on a smaller subgroup of eight patients. Results: A majority (65%) of patients screened had at least 2 comorbid problem areas, although 25% of these comorbid patients that where allocated with the help of the proposed routine still initiated disorder-specific treatment. The proposed assessment routine functioned satisfactorily within the up and running internet clinic. The individually tailored treatment was promising regarding satisfaction, credibility, adherence, and preliminary reductions in symptoms. A notable challenge encountered was that the platform was not set up to assist with assessment process or outcome monitoring for individually tailored treatment. Conclusions: It seems feasible to combine individually tailored internet treatment and disorder-specific internet treatment within the same internet clinic. The addition of tailored treatment may prove to increase the number of patients included in treatment.
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| 18. |
- Midhage, Robin, et al.
(author)
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Psychometric evaluation of the Swedish self-rated 36-item version of WHODAS 2.0 for use in psychiatric populations - using classical test theory.
- 2021
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In: Nordic Journal of Psychiatry. - : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 75:7, s. 494-501
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Journal article (peer-reviewed)abstract
- Aim The aim of this study was to evaluate the reliability and validity of the Swedish version of the self-rated 36-item WHODAS 2.0 in patients from Swedish psychiatric outpatient settings, using classical test theory.Methods The 36-item WHODAS 2.0, together with the Sheehan Disability Scale (SDS), was filled in by a sample of 780 participating psychiatric patients: 512 (65.6%) women, 263 (33.7%) men, and 5 (0.6%) who did not report any sex.Results The internal consistency, measured by Cronbach’s alpha, for the different domains of functioning were between 0.70 and 0.94, and interpreted as good. The confirmatory factor analysis (CFA) revealed two levels: the first level consisted of a general disability factor, while the second level consisted of the six domains of the scale, respectively. The model had borderline fit. There was a significant correlation between WHODAS 2.0 36-item and SDS (n = 395). The WHODAS 2.0 differed significantly between diagnostic groups.Conclusion The present study demonstrates that the Swedish self-rated 36-item version of WHODAS 2.0, within a psychiatric outpatient population, showed good reliability and convergent validity. We conclude that the self-rated 36-item Swedish version of WHODAS 2.0 can be used for valid interpretations of disability in patients with psychiatric health conditions.
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| 19. |
- Månsson, Kristoffer, et al.
(author)
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Can Psychological Treatment Slow Down Cellular Aging in Social Anxiety Disorder? : An Intervention Study Evaluating Changes in Telomere Length and Telomerase Activity
- 2018
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In: Biological Psychiatry. - : Elsevier BV. - 0006-3223 .- 1873-2402. ; 83:9, s. S351-S352
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Journal article (other academic/artistic)abstract
- Background: Mental illness, including anxiety disorders, is linked to accelerated cell aging. This is evidenced by shorter leukocyte telomere length. Cells with critically short telomeres may undergo apoptosis. In dividing cells, telomere shortening is counteracted by the telomeraseenzyme. Telomerase is reportedly low following chronic psychological stress. We hypothesized that a psychological treatment may increase telomerase activity, less telomere attritionand greater symptom improvement.Methods: Forty-six patients (91% SSRI naïve) with social anxiety disorder(SAD; mean age 31, 63% females) underwent a 9-week waiting period, and 9 weeks of Internet-delivered cognitive behavior therapy(CBT). During treatment, symptoms were assessed weekly using the Liebowitz Social Anxiety Scale (LSAS-SR). Fasting blood samples were collected twice before treatment, and at post-treatment. Genomic DNA was extracted using DNeasy® Blood & Tissue Kit (Qiagene) to assess leukocyte telomere length. Telomerase activity was detected by real-time telomeric repeat amplification protocol (RT-TRAP).Results: Patients improved significantly on the LSAS-SR (p<.001; Cohen’s d=1.5). Pre-post changes in telomerase and telomere length correlated positively (Pearson’s r=.31, p=.05). Reduced telomerase activity (<33th percentile) was associated with less improvement and increased activity (>66th percentile) with more improvement on the LSAS-SR (Z=-2.4, p=.02).Conclusions: We demonstrate, to our knowledge for the first time, that altered telomerase activity is associated with clinical response to a psychological treatment in a psychiatric population. The observed CBT effect on telomerase in patients with SAD is consistent with results from animal trials and a small previous study of antidepressants in humans. Thus, telomerase activation may play an important role in clinical recovery.
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| 20. |
- Månsson, Kristoffer N. T., et al.
(author)
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Improvement in indices of cellular protection after psychological treatment for social anxiety disorder
- 2019
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In: Translational Psychiatry. - : Springer Science and Business Media LLC. - 2158-3188. ; 9:1
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Journal article (peer-reviewed)abstract
- Telomere attrition is a hallmark of cellular aging and shorter telomeres have been reported in mood and anxiety disorders. Telomere shortening is counteracted by the enzyme telomerase and cellular protection is also provided by the antioxidant enzyme glutathione peroxidase (GPx). Here, telomerase, GPx, and telomeres were investigated in 46 social anxiety disorder (SAD) patients in a within-subject design with repeated measures before and after cognitive behavioral therapy. Treatment outcome was assessed by the Liebowitz Social Anxiety Scale (self-report), administered three times before treatment to control for time and regression artifacts, and posttreatment. Venipunctures were performed twice before treatment, separated by 9 weeks, and once posttreatment. Telomerase activity and telomere length were measured in peripheral blood mononuclear cells and GPx activity in plasma. All patients contributed with complete data. Results showed that social anxiety symptom severity was significantly reduced from pretreatment to posttreatment (Cohen’s d = 1.46). There were no significant alterations in telomeres or cellular protection markers before treatment onset. Telomere length and telomerase activity did not change significantly after treatment, but an increase in telomerase over treatment was associated with reduced social anxiety. Also, lower pretreatment telomerase activity predicted subsequent symptom improvement. GPx activity increased significantly during treatment, and increases were significantly associated with symptom improvement. The relationships between symptom improvement and putative protective enzymes remained significant also after controlling for body mass index, sex, duration of SAD, smoking, concurrent psychotropic medication, and the proportion of lymphocytes to monocytes. Thus, indices of cellular protection may be involved in the therapeutic mechanisms of psychological treatment for anxiety.
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| 21. |
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| 22. |
- Pankowski, Sara, et al.
(author)
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Group acceptance and commitment therapy (ACT) for bipolar disorder and co-existing anxiety - an open pilot study.
- 2017
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In: Cognitive Behaviour Therapy. - : Taylor & Francis. - 1650-6073 .- 1651-2316. ; 46:2, s. 114-128
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Journal article (peer-reviewed)abstract
- Previous studies have supported acceptance and commitment therapy (ACT) for reducing impairment related to various chronic conditions. ACT may possibly be beneficial for bipolar disorder (BD) with co-existing anxiety, which is associated with a poorer treatment outcome. Efforts are needed to identify suitable psychological interventions for BD and co-existing anxiety. In this open clinical trial, we included 26 patients with BD type 1 or 2 at an outpatient psychiatric unit specializing in affective disorders. The intervention consisted of a 12-session manualized group treatment that included psychoeducation, mindfulness, engaging in values-based behaviour, cognitive defusion, acceptance and relapse prevention modules. Participants completed four self-report questionnaires covering anxiety symptoms (Beck Anxiety Inventory - BAI), depressive symptoms (Beck Depression Inventory - BDI-II), quality of life (Quality of Life Inventory - QOLI) and psychological flexibility (Acceptance and Action Questionnaire - AAQ-2) before, during and after the treatment. At post-treatment, the participants reported significant improvements in all outcome measures, with large effects (Cohen's d between 0.73 and 1.98). The mean reduction in anxiety symptoms was 45%. At post-treatment, 96% of the patients were classified as responders on at least one of the outcome measures. A limitation is that the trial is uncontrolled. The results suggest that ACT has the potential to be an effective treatment for BD patients with co-existing anxiety. Further randomized studies are warranted.
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| 23. |
- Svanborg, Cecilia, et al.
(author)
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Evidence for validity of the Swedish self-rated 36-item version of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) in patients with mental disorders : a multi-centre cross-sectional study using Rasch analysis
- 2022
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In: Journal of Patient-Reported Outcomes. - : Springer Nature. - 2509-8020. ; 6:1
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Journal article (peer-reviewed)abstract
- Background The World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) is a generic instrument for the assessment of functioning in six domains, resulting in a total health-related disability score. The aim of this study was to investigate the psychometric properties of the Swedish-language version of the self-rated 36-item version in psychiatric outpatients with various common psychiatric diagnoses using Rasch analysis. A secondary aim was to explore the correlation between two methods of calculating overall scores to guide clinical practice: the WHODAS simple (summative) model and the WHODAS complex (weighted) model. Methods Cross-sectional data from 780 Swedish patients with various mental disorders were evaluated by Rasch analysis according to the partial credit model. Bivariate Pearson correlations between the two methods of calculating overall scores were explored. Results Of the 36 items, 97% (35 items) were within the recommended range of infit mean square; only item D4.5 (Sexual activities) indicated misfit (infit mean square 1.54 logits). Rating scale analysis showed a short distance between severity levels and disordered thresholds. The two methods of calculating overall scores were highly correlated (0.89-0.99). Conclusions The self-administered WHODAS 2.0 fulfilled several aspects of validity according to Rasch analysis and has the potential to be a useful tool for the assessment of functioning in psychiatric outpatients. The internal structure of the instrument was satisfactorily valid and reliable at the level of the total score but demonstrated problems at the domain level. We suggest rephrasing the item Sexual activities and revising the rating scale categories. The WHODAS simple model is easier to use in clinical practice and our results indicate that it can differentiate function among patients with moderate psychiatric disability, whereas Rasch scaled scores are psychometrically more precise even at low disability levels. Further investigations of different scoring models are warranted.
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| 24. |
- Svanborg, Cecilia
(author)
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Recovery from dysthymia and panic disorder : options and obstacles
- 2008
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Doctoral thesis (other academic/artistic)abstract
- Dysthymia, a depressive disorder with usually an insidious, early onset (before age 21), and panic disorder are psychiatric disorders with a major impact on public health due to their high frequency of recurrence, persistent course and superimposed major depressions. This thesis aimed to improve knowledge of factors that help or hinder recovery from such disorders in ordinary outpatient psychiatric settings. A focus was how various understandings of illness may affect recognition, treatment and outcome. The thesis consists of a study that examined the validity of a self-report instrument for DSM-IV personality disorders, the DIP-Q, in different clinical samples (Paper I), and a prospective 9-year longitudinal study of patients with dysthymia and panic disorder that combined quantitative and qualitative methods (Papers II & III). Paper II presented the long-term outcome, stability of change and impact of comorbid personality disorders. For the investigation of lifetime course and treatments, a modification of the NIMH Life-Charting Methodology was used. Paper III examined the phenomenon of recovery by analysing in-depth interviews with qualitative content analysis. A theory-testing and explorative multiple-case study used developmental cognitive theory as framework to examine barriers to recognition and treatment for patients with early-onset dysthymia (Paper IV). Personality disorders (PD) evaluated by DIP-Q discriminated between different clinical samples and healthy controls, and the self-assessed PD had independent strong associations to depression and belonging to a sample of psychotherapy applicants. In paper II, diagnostic assessments showed low recovery rates; about 50 % had improved, of whom 25 % had recovered. Life-charting and case records indicated that undertreatment contributed to poor outcome. Comorbid PD was a negative prognostic factor and patients with panic disorder had deteriorated compared to the 2-year outcome. Based on the qualitative analysis in Paper III, a general model for recovery from dysthymia and panic disorder is suggested, involving: (1) understanding self and mechanisms of illness, (2) enhanced flexibility of thinking, (3) change from avoidance coping to approach coping, and that a helpful relationship to the health care provider is a vehicle for this change. Patients with dysthymia and panic disorder described specific helpful relationships to therapists ( as a parent vs. as a coach ) and central areas for change (self-acceptance and resolution of relational problems vs. identifying and handling feelings), indicating necessity of distinguishing early onset dysthymia from secondary depressions. The common main obstacle was difficulty in negotiating treatments. Non-remitted with PD had problems expressing needs, which may explain why comorbid PD is a negative prognostic factor. Paper IV showed that barriers to treatment of dysthymia could be explained by misunderstandings as patients mainly expressed illness with a complexity of concrete, perceptually bound language structures and providers focused mainly on a single aspect. Other barriers were patients core pattern of concealing due to fear of rejection and distrust, providers attitudes, access problems and providers lack of follow-up. To achieve higher recovery rates and reduce inequalities in attaining care, comorbid PD need to be assessed and addressed in ordinary psychiatric practice. Early-onset dysthymia needs to be recognised and distinguished from secondary depressions, e.g. by noting cognitive core symptoms and routinely examining age of onset. To enhance collaboration and communication, means of shared understanding and treatment planning are suggested, such as combining diagnostic assessments with attention to patients perceptually bound understanding of illness, goals and treatment preferences, as well as systematic follow-up including re-evaluations. Life-charting may be a tool.
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| 25. |
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