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Nilsson, A., Orwelius, L., Sveen, J., Willebrand, M., Ekselius, L., Gerdin, B. & Sjoberg, F. (2019). Anxiety and depression after burn, not as bad as we think-A nationwide study. Burns, 45(6), 1367-1374
Open this publication in new window or tab >>Anxiety and depression after burn, not as bad as we think-A nationwide study
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2019 (English)In: Burns, ISSN 0305-4179, E-ISSN 1879-1409, Vol. 45, no 6, p. 1367-1374Article in journal (Refereed) Published
Abstract [en]

Objective: A history of psychiatric disorders is more common among patients who have had burns than in the general population. To try and find out the scale of the problem we have assessed self-reported symptoms of anxiety and depression after a burn. Methods: Consecutive patients with burns measuring more than 10% total body surface area or duration of stay in hospital of seven days or more were included. Personal and clinical details about the patients were extracted from the database at each center. Data were collected from the Hospital Anxiety and Depression Scale, as well as Health-Related Quality of Life (HRQoL; Short Form-36, SF-36) and questionnaires about socioeconomic factors. All results were obtained 12 and 24 months after the burn, and compared with those from a reference group. Results: A total of 156 patients responded to the questionnaires. Mean (SD) age and TBSA (%) were 46 (16.4) years and 23.6 (19.2) %, respectively. There were no differences in incidence between the burn and reference groups in anxiety or depression either 12 or 24 months after the burn. Those who reported higher anxiety and depression scores also had consistently poorer HRQoL as assessed by the SF-36. Conclusion: Seen as a group, people who have had burns report anxiety and depression the same range as a reference group. Some patients, however, express more anxiety and depression, and concomitantly poorer HRQoL. These patients should be identified, and offered additional support. (C) 2019 Elsevier Ltd and ISBI. All rights reserved.

Place, publisher, year, edition, pages
ELSEVIER SCI LTD, 2019
Keywords
Burns, Quality of life, Anxiety, Depression, Follow-up studies
National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-394054 (URN)10.1016/j.burns.2019.03.014 (DOI)000483339500013 ()31378623 (PubMedID)
Available from: 2019-10-03 Created: 2019-10-03 Last updated: 2019-10-03Bibliographically approved
Axfors, C., Hellgren, C., Volgsten, H., Skoog Svanberg, A., Ekselius, L., Wikström, A.-K., . . . Sundström-Poromaa, I. (2019). Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women. Acta Obstetricia et Gynecologica Scandinavica, 98(4), 470-478
Open this publication in new window or tab >>Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women
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2019 (English)In: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, no 4, p. 470-478Article in journal (Refereed) Published
Abstract [en]

Introduction

Elevated neuroticism is associated with higher health care utilization in the general population. This study aimed to investigate the association between neuroticism and the use of publicly financed antenatal care in obstetric low‐risk women, taking predisposing and need factors for health care utilization into consideration.

Material and methods

Participants comprised 1052 obstetric low‐risk women (no chronic diseases or adverse pregnancy conditions) included in several obstetrics/gynecology studies in Uppsala, Sweden. Neuroticism was self‐rated on the Swedish universities Scales of Personality. Medical records of their first subsequent pregnancy were scanned for antenatal care use. Associations between antenatal care use and neuroticism were analyzed with logistic regression (binary outcomes) or negative binomial regression (count outcomes) comparing the 75th and 25th neuroticism percentiles. Depending on the Akaike information criterion the exposure was modeled as either linear or with restricted cubic splines. Analyses were adjusted for predisposing (sociodemographic and parity) and need factors (body mass index and psychiatric morbidity).

Results

After adjustment, women with higher neuroticism had more fetal ultrasounds (incidence rate ratio = 1.09, 95% confidence interval (CI) 1.02‐1.16), more emergency visits to an obstetrician/gynecologist (incidence rate ratio = 1.22, 95% CI 1.03‐1.45) and were more likely to visit a fear‐of‐childbirth clinic (odds ratio = 2.71, 95% CI 1.71‐4.29). Moreover, they more often consulted midwives in specialized antenatal care facilities (significant J‐shaped association).

Conclusions

Neuroticism was associated with higher utilization of publicly financed antenatal care in obstetric low‐risk women, even after adjusting for predisposing and need factors. Future studies should address the benefits of interventions as a complement to routine antenatal care programs to reduce subclinical anxiety.

Keywords
antenatal care, health care utilization, neuroticism, personality, pregnancy, prenatal care
National Category
Obstetrics, Gynecology and Reproductive Medicine
Research subject
Obstetrics and Gynaecology
Identifiers
urn:nbn:se:uu:diva-364260 (URN)10.1111/aogs.13506 (DOI)000460954800008 ()30457176 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2007-1955Marianne and Marcus Wallenberg Foundation, MMW2011.0115The Swedish Medical Association, SLS-250581Swedish Research Council, 521-2010-3293Swedish Research Council, K2008-54X-20642-01-3Swedish Society of MedicineStiftelsen Söderström - Königska sjukhemmetTore Nilsons Stiftelse för medicinsk forskning
Available from: 2018-10-24 Created: 2018-10-24 Last updated: 2019-04-15Bibliographically approved
Syk, M., Ellström, S., Mwinyi, J., Schiöth, H. B., Ekselius, L., Ramklint, M. & Cunningham, J. L. (2019). Plasma levels of leptin and adiponectin and depressive symptoms in young adults. Psychiatry Research, 272, 1-7
Open this publication in new window or tab >>Plasma levels of leptin and adiponectin and depressive symptoms in young adults
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2019 (English)In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 272, p. 1-7Article in journal (Refereed) Published
Abstract [en]

Circulating levels of adipokines are known to be associated with depression. This study aimed to investigate a possible association between leptin, adiponectin and dimensional measures of depressive symptoms in young adults with and without psychiatric illness. Total plasma adiponectin and leptin levels were measured in 194 young adults seeking psychiatric ambulatory care and 57 healthy controls. Depressive symptoms were assessed using the Montgomery-Åsberg Depression Self-Rating Scale (MADRS-S). Analysis was performed on men and women separately. P-leptin levels were significantly elevated in patients compared with controls and correlated with total MADRS-S scores in the women. Women with P-leptin in the highest quartile reached a significantly higher MADRS-S score than women in the lowest quartile, but this difference disappeared after adjusting for body mass index (BMI) and antidepressant use. MADRS-S score was associated with P-leptin in female patients without antidepressant use, independently of BMI. There was no association between P-leptin levels and current major depression. P-adiponectin levels were not associated with depressive symptoms or current major depression. The findings indicate that P-leptin levels are associated with depressive symptom severity in young women; however, the association is linked to other factors, which challenges its usefulness as a biomarker for depression in clinical psychiatry.

Keywords
Adipokines, Depression, Inflammation, Mood disorders
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-376540 (URN)10.1016/j.psychres.2018.11.075 (DOI)000460994400001 ()30562581 (PubMedID)
Funder
Erik, Karin och Gösta Selanders FoundationFredrik och Ingrid Thurings StiftelseStiftelsen Söderström - Königska sjukhemmetThe Swedish Medical Association
Available from: 2019-02-06 Created: 2019-02-06 Last updated: 2019-04-10Bibliographically approved
Folke, F., Hursti, T., Kanter, J. W., Arinell, H., Tungström, S., Söderberg, P. & Ekselius, L. (2018). Exploring the relationship between activities and emotional experience using a diary in a mental health inpatient setting.. International Journal of Mental Health Nursing, 27(1), 276-286
Open this publication in new window or tab >>Exploring the relationship between activities and emotional experience using a diary in a mental health inpatient setting.
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2018 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, no 1, p. 276-286Article in journal (Refereed) Published
Abstract [en]

Mental health inpatient milieus have repeatedly been found to be associated with passivity, social disengagement, and low levels of interaction with staff. However, little is known about patients' experiences related to different ward activities. In the present study, we aimed to study the reports of activities and associated experiences of patients admitted to acute psychiatric inpatient wards. Disengaged, inactive, and solitary activities were hypothesized to be associated with less reward and more distress than their counterparts. We also aimed to investigate if such activities predicted distress, and if they were associated with clinical severity. Participants (n = 102) recorded their activities along with concurrent ratings of reward and distress in a structured 1-day diary, and nurses provided clinical severity ratings. On average, 3.74 of the 11 hours assessed (34%) were spent doing nothing, only 0.88 hours (8%) were spent with staff, and most of the time was spent in solitude. Doing nothing, being alone, and passivity were associated with the greatest levels of distress and lowest levels of reward, whereas informal socializing demonstrated the opposite pattern. Distress was not predicted by activity or reward when adjusting for baseline distress. Clinical severity was not associated with the amount of time spent alone or the experience of reward during activity. In conclusion, the risk for passivity and social disengagement during admission prevails. This activity pattern could have detrimental emotional consequences and warrants action, but more studies are needed to determine if activity actually precedes emotional experience.

Keywords
activity, diary, hospitalized, mental health inpatient, reward
National Category
Other Medical Sciences not elsewhere specified
Identifiers
urn:nbn:se:uu:diva-330226 (URN)10.1111/inm.12318 (DOI)000419717100027 ()28220616 (PubMedID)
Available from: 2017-09-28 Created: 2017-09-28 Last updated: 2018-02-14Bibliographically approved
Tillman, K. K., Hakelius, M., Höijer, J., Ramklint, M., Ekselius, L., Nowinski, D. & Papadopoulos, F. (2018). Increased Risk for Neurodevelopmental Disorders in Children With Orofacial Clefts. Journal of the American Academy of Child and Adolescent Psychiatry, 57(11), 876-883
Open this publication in new window or tab >>Increased Risk for Neurodevelopmental Disorders in Children With Orofacial Clefts
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2018 (English)In: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 57, no 11, p. 876-883Article in journal (Refereed) Published
Abstract [en]

OBJECTIVE: Children with orofacial clefts (OFC) may have an increased risk of poor mental health. This study aimed to investigate the risk of psychiatric diagnoses in individuals with OFC, stratified by cleft type.

METHOD: A nationwide register-based cohort of all individuals born with nonsyndromic OFC in Sweden between 1973 and 2012 (n = 7,842) was compared to a matched cohort (n = 78,409) as well as to their unaffected siblings (n = 9,637). The risk of psychiatric diagnoses, suicide attempts, and suicides was examined by crude and adjusted Cox regression models. Effect modification by sex was investigated with interaction terms in the models.

RESULTS: Children with cleft lip (CL) had a significantly higher risk of any psychiatric disorder, intellectual disability, and language disorders; children with cleft lip and palate (CLP) had, in addition, an increased risk of autism spectrum disorder (ASD). Children with cleft palate only (CPO) had risk increases for the same diagnoses as children with CL and CLP, but with higher hazard ratios, and also for psychotic disorders, attention-deficit/hyperactivity disorder (ADHD), and other behavioral or emotional disorders in childhood. Sex stratification indicated higher risk increases among females in CL and CLP but not in CPO. Siblings without OFC were less likely to be diagnosed with any psychiatric disorder, intellectual disability, language disorder, ASD, or ADHD compared to their siblings with OFC.

CONCLUSION: Children with nonsyndromic clefts had a significantly higher risk of neurodevelopmental disorders. This risk is unlikely to be explained by familial influences such as inherited genetic or shared environmental factors.

Keywords
epidemiology, neurodevelopmental disorders, nonsyndromic clefts, psychiatric comorbidity
National Category
Psychiatry Neurology
Identifiers
urn:nbn:se:uu:diva-368474 (URN)10.1016/j.jaac.2018.06.024 (DOI)000453802900013 ()30392629 (PubMedID)
Available from: 2018-12-05 Created: 2018-12-05 Last updated: 2019-02-06Bibliographically approved
Edvinsson, D. & Ekselius, L. (2018). Long-Term Tolerability and Safety of Pharmacological Treatment of Adult Attention-Deficit/Hyperactivity Disorder: A 6-Year Prospective Naturalistic Study. Journal of Clinical Psychopharmacology, 38(4), 370-375
Open this publication in new window or tab >>Long-Term Tolerability and Safety of Pharmacological Treatment of Adult Attention-Deficit/Hyperactivity Disorder: A 6-Year Prospective Naturalistic Study
2018 (English)In: Journal of Clinical Psychopharmacology, ISSN 0271-0749, E-ISSN 1533-712X, Vol. 38, no 4, p. 370-375Article in journal (Refereed) Published
Abstract [en]

Background: Attention-deficit/hyperactivity disorder (ADHD) is a behavioral disorder typically treated with stimulants and atomoxetine. Data on long-term tolerability and safety of such pharmacological treatment in subjects diagnosed in adulthood are limited.

Methods: A cohort of adults diagnosed with ADHD according to Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria was followed-up on an average of 6 years after first evaluation. Of 168 adults, 112 (67%) who initiated medication were available for follow-up. Data were obtained from patient record data, self-report forms, and a telephone interview.

Results: Of the 112 participants assessed, 57 (51%) were still on treatment with methylphenidate (MPH) at follow-up and 55 (49%) had discontinued. The 3 leading reasons for discontinuing treatment with MPH were lack of effect (29%), elevated mood or hypomania (11%), and losing contact with the prescribing physician (9%). The most common adverse effects in subjects still on treatment with MPH were decreased appetite (28%), dry mouth (24%), anxiousness/restlessness and increased pulse frequency (19% each), decreased sexual desire (17%), and perspiration (15%). Subjects still on treatment reported increased quality of life, a higher level of functioning, and a greater understanding of their way of functioning from those being close compared with nonmedicated subjects.

Conclusions: The high attrition rate underscores the need for further research to identify possible modes to increase retention to treatment. Those diagnosed with ADHD and on long-term treatment with stimulants experience mild and tolerable adverse effects.

National Category
Psychiatry
Identifiers
urn:nbn:se:uu:diva-327891 (URN)10.1097/JCP.0000000000000917 (DOI)000438053700016 ()29927781 (PubMedID)
Note

Title in dissertation reference list: Long-Term Tolerability and Safety of Pharmacological Treatment of Adult Attention-Deficit/Hyperactivity Disorder

Available from: 2017-08-11 Created: 2017-08-11 Last updated: 2018-09-24Bibliographically approved
Salberg, J., Folke, F., Ekselius, L. & Öster, C. (2018). Nursing staff-led behavioural group intervention in psychiatric in-patient care: Patient and staff experiences. International Journal of Mental Health Nursing, 27(5), 1401-1410
Open this publication in new window or tab >>Nursing staff-led behavioural group intervention in psychiatric in-patient care: Patient and staff experiences
2018 (English)In: International Journal of Mental Health Nursing, ISSN 1445-8330, E-ISSN 1447-0349, Vol. 27, no 5, p. 1401-1410Article in journal (Refereed) Published
Abstract [en]

A promising intervention in mental health in-patient care is behavioural activation (BA). Interventions based on BA can be used by mental health nurses and other staff members. The aim of this study was to evaluate patients' and staff members' experiences of a nursing staff-led behavioural group intervention in mental health in-patient care. The intervention was implemented at three adult acute general mental health in-patient wards in a public hospital setting in Sweden. A self-administrated questionnaire, completed by 84 patients and 34 nurses and nurse assistants, was administered, and nonparametric data analysed using descriptive statistics. Our findings revealed that both patients and nursing staff ranked nursing care and care environment as important aspects in the recovery process. Patients and staff members reported overall positive experiences of the group sessions. Patients with higher frequencies of attendance and patients satisfied with overall care had a more positive attitude towards the intervention. A more positive experience of being a group leader was reported by staff members who had been leading groups more than ten times. The most common impeding factor during implementation, reported by staff members, was a negative attitude to change. Conducive factors were having support from a psychologist and the perception that patients were showing interest. These positive experiences reported by patients and nursing staff, combined with previous research in this field, are taking us one step further in evaluating group sessions based on BA as a meaningful nursing intervention in mental health in-patient care.

Keywords
behavioural activation, evaluation, group intervention, mental health care, nursing
National Category
Nursing Psychiatry
Identifiers
urn:nbn:se:uu:diva-364165 (URN)10.1111/inm.12439 (DOI)000443391700009 ()29446512 (PubMedID)
Available from: 2018-10-29 Created: 2018-10-29 Last updated: 2018-11-16Bibliographically approved
Ekselius, L. (2018). Personality disorder: a disease in disguise. Upsala Journal of Medical Sciences, 123(4), 194-204
Open this publication in new window or tab >>Personality disorder: a disease in disguise
2018 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, no 4, p. 194-204Article, review/survey (Refereed) Published
Abstract [en]

Personality disorders (PDs) can be described as the manifestation of extreme personality traits that interfere with everyday life and contribute to significant suffering, functional limitations, or both. They are common and are frequently encountered in virtually all forms of health care. PDs are associated with an inferior quality of life (QoL), poor health, and premature mortality. The aetiology of PDs is complex and is influenced by genetic and environmental factors. The clinical expression varies between different PD types; the most common and core aspect is related to an inability to build and maintain healthy interpersonal relationships. This aspect has a negative impact on the interaction between health-care professionals and patients with a PD. From being discrete and categorical disease entities in previous classification systems, the current concept of PD, reflected in the newly proposed ICD-11, is a dimensional description based on the severity of the disturbed functioning rather than on the type of clinical presentation. Insight about the characteristics of PDs among medical practitioners is limited, which is partly because persons do not seek health care for their PD, but instead for other medical issues which are obscured by their underlying personality problems. What needs to be emphasized is that PDs affect both the clinical presentation of other medical problems, and the outcome of these, in a negative manner and that the integrated effects of having a PD are a shortened life expectancy. Accordingly, PDs need to be recognized in clinical practice to a greater extent than previously.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2018
Keywords
ICD-11, personality disorders, personality traits, review article
National Category
General Practice
Identifiers
urn:nbn:se:uu:diva-375832 (URN)10.1080/03009734.2018.1526235 (DOI)000455890700001 ()30539674 (PubMedID)
Available from: 2019-02-01 Created: 2019-02-01 Last updated: 2019-02-01Bibliographically approved
Volgsten, H., Schmidt, L., Skoog Svanberg, A., Ekselius, L. & Sundström Poromaa, I. (2018). Psychiatric disorders in women and men up to five years after undergoing assisted reproductive technology treatment: a prospective cohort study. Human Fertility, 1-6
Open this publication in new window or tab >>Psychiatric disorders in women and men up to five years after undergoing assisted reproductive technology treatment: a prospective cohort study
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2018 (English)In: Human Fertility, ISSN 1464-7273, E-ISSN 1742-8149, p. 1-6Article in journal (Refereed) Epub ahead of print
Abstract [en]

This is a prospective cohort study with the objective to describe psychiatric disorders, such as any mood and anxiety disorders, in both women and men five years after assisted reproductive technology (ART). The Primary Care Evaluation of Mental Disorders (PRIME-MD) questionnaire, based on the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), was used as the diagnostic tool to evaluate psychiatric disorders. Logistic regression analysis was used to calculate odds ratios (ORs) and confidence interval (CI) for factors associated with psychiatric disorders at the follow-up. Overall, 278 (63.3%) women and 183 (41.7%) men filled in and returned the questionnaire. Approximately 11.5% of women and 5.5% of men fulfilled the criteria for any psychiatric diagnosis. Of these, any mood disorder was present in 9.4% of women and 4.4% of men. The major risk factor for mood or anxiety disorders at follow-up was mood or anxiety disorders at the time of the index ART. Mood disorders were not more common in women who remained childless after ART. In conclusion, these findings indicate that psychiatric disorders at five years follow-up after ART are less common than at the baseline assessment in conjunction with the ART.

Keywords
Assisted reproductive technology, cohort study, depression, follow-up, infertility, psychiatric disorders
National Category
Psychiatry Obstetrics, Gynecology and Reproductive Medicine
Identifiers
urn:nbn:se:uu:diva-351123 (URN)10.1080/14647273.2018.1474279 (DOI)29768933 (PubMedID)
Available from: 2018-05-19 Created: 2018-05-19 Last updated: 2018-09-12Bibliographically approved
Edvinsson, D. & Ekselius, L. (2018). Six-Year Outcome in Subjects Diagnosed with Attention-Deficit/Hyperactivity Disorder as Adults. European Archives of Psychiatry and Clinical Neuroscience, 268(4), 337-347
Open this publication in new window or tab >>Six-Year Outcome in Subjects Diagnosed with Attention-Deficit/Hyperactivity Disorder as Adults
2018 (English)In: European Archives of Psychiatry and Clinical Neuroscience, ISSN 0940-1334, E-ISSN 1433-8491, Vol. 268, no 4, p. 337-347Article in journal (Refereed) Published
Abstract [en]

There are very few studies on the long-term outcome in subjects diagnosed with ADHD as adults. The objective of the present study was to assess this and relate the outcome to whether there was current medication or not and to other potential predictors of favourable outcome. A prospective clinical cohort of adults diagnosed with ADHD according to DSM-IV criteria was followed-up on an average of 6 years after first evaluation (n = 124; mean age 42 years, 51% males). ADHD symptom trajectories were assessed as well as medication, global functioning, disability, health-related quality of life, and alcohol and drug consumption at follow-up. Ninety percent of those diagnosed were initially treated pharmacologically and half of them discontinued treatment. One-third reported remission, defined as not fulfilling any ADHD subtype and a GAF-value last year ≥ 70, which was not affected by comorbidity at baseline. Current medication was not associated with remission. Subjects evaluated and first diagnosed with ADHD as adults are functionally improved at follow-up 6 years later despite a high percentage of psychiatric comorbidity at baseline. Half dropped out of medication, and there was no difference in ADHD remission between subjects with on-going medication at follow-up or subjects without medication, although current medication was related to a higher degree of self-reported global improvement.

National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:uu:diva-327890 (URN)10.1007/s00406-017-0850-6. (DOI)000432412500003 ()29143159 (PubMedID)
Funder
Swedish Research Council
Available from: 2017-08-11 Created: 2017-08-11 Last updated: 2018-07-30Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-5760-7730

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