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  • 1.
    Ahmad, Abdulbaghi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Larsson, Bo
    Sundelin Wahlsten, Viveka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    EMDR treatment for children with PTSD: Results of a randomized controlled trial2007In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 61, no 5, p. 349-354Article in journal (Refereed)
    Abstract [en]

    The objective of the study was to examine the efficacy of EMDR treatment for children with post-traumatic stress disorder ( PTSD) compared with untreated children in a waiting list control group (WLC) participating in a randomized controlled superiority trial (RCT). Thirty-three 6-16-year-old children with a DSM-IV diagnosis of PTSD were randomly assigned to eight weekly EMDR sessions or the WLC group. The Posttraumatic Stress Symptom Scale for Children (PTSS-C scale) was used in interviews with children to evaluate their symptoms and outcome. Post-treatment scores of the EMDR group were significantly lower than the WLC indicating improvement in total PTSS-C scores, PTSD-related symptom scale, and the subscales re-experiencing and avoidance among subjects in the EMDR group, while untreated children improved in PTSD-non-related symptom scale. The improvement in re-experiencing symptoms proved to be the most significant between-group difference over time. The results of the present exploratory study including a limited number of children with PTSD are encouraging and warrant further controlled studies of larger samples of children suffering from PTSD.

  • 2.
    Ahmad, Abdulbaghi
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Sundelin Wahlsten, Viveka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Traumatic experiences and post-traumatic stress disorder in Kurdistanian children and their parents in homeland and exile: An epidemiological approach2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 6, p. 457-463Article in journal (Refereed)
    Abstract [en]

    The prevalence and correlates of post-traumatic stress disorder (PTSD) were assessed in random samples of school-aged Kurdistanian children and their parents in homeland and exile. Of the 376 eligible children at the two sites, 312 children and their parents (293 mothers and 248 fathers) completed the Harvard-Uppsala Trauma Questionnaire and Posttraumatic Stress Symptom interviews for children, and Harvard Trauma Questionnaire for parents. Unlike their children, fathers showed significantly higher PTSD frequencies in exile than in the homeland. The fathers' PTSD negatively correlated with the living standard and fathers' education, while child PTSD mostly correlated with maternal education and living in exile. Living in exile seems to have a negative impact on fathers' post-traumatic reactions, despite its positive influence on children. High drop-outs in exile limit the conclusions.

  • 3.
    Bodén, Robert
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Abrahamsson, Tore
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Holm, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Borg, Jacqueline
    Psychomotor and cognitive deficits as predictors of 5-year outcome in first-episode schizophrenia2014In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 68, no 4, p. 282-288Article in journal (Refereed)
    Abstract [en]

    Background: Cognitive deficits are common in schizophrenia but the predictive value of these deficits for long-term outcome in first-episode patients is unclear. Aims: We aimed to investigate associations of performance in psychomotor and cognitive tests with a 5-year functional and symptomatic outcome. Methods: After clinical stabilization, patients with a first schizophrenia spectrum diagnosis (n = 46) were assessed for global cognitive function [Synonyms, Reasoning, and Block Design (SRB)], psychomotor speed [Trail Making Test (TMT) and finger tapping] and verbal learning (Claeson-Dahl Verbal Learning Test). The subsequent 5-year outcome regarding independent living, occupational and social function, and symptomatic remission status was assessed. Results: Low psychomotor speed was associated with poor social function 5 years later, with an odds ratio (OR) of 3.37 and a 95% confidence interval (CI) of 1.08-10.51, adjusted for antipsychotic drug use. Better performance on finger tapping with the non-dominant hand was associated with an increased risk of a 5-year symptomatic non-remission (adjusted OR = 0.42, CI 0.19-0.96). Occupational function and independent living were not significantly associated with any of the investigated tests. Conclusions: Psychomotor speed is associated with a long-term outcome regarding social function and symptom remission in patients with first-episode schizophrenia.

  • 4. Dahl, A.
    et al.
    Kruger, Bjartveit
    Dahl, Havard
    Karlsson, Hasse
    Von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Stordal, Eystein
    SPIFA-A presentation of the Structured Psychiatric Interview for General Practice2009In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 63, no 6, p. 443-453Article in journal (Refereed)
    Abstract [en]

    Background: The diagnostic ability of general practitioners (GPs) concerning mental disorders is not optimal, and could be improved by structured diagnostic interviews. Various aspects of the Structured Psychiatric Interview for General Practice (SPIFA) are examined. Aims: The inter-rater reliability of the SPIFA, the time used by GPs and specialists and the GPs satisfaction are examined. The properties of the SPIFA are compared with those of the Prime-MD and the MINI schedules. Methods: Inter-rater reliability of the SPIFA was tested in 336 patients in general practice. The patients were randomized to two interview strategies. Either both GPs and psychiatrists used the SPIFA, or GPs used the SPIFA and psychiatrists a modified version of the SCID for Axis I disorders. The satisfaction was investigated by a questionnaire sent to 1000 GPs who had SPIFA training. Results: The SPIFA showed adequate inter-rater reliability for depression, anxiety disorders and increased suicidal risk for both interview strategies. In patients with more than two co-morbid disorders, the inter-rater reliability was poor. The mean duration of SPIFA was 21 min for SPIFA screening and 22 min for SPIFA manual. The 192 GPs responding to the questionnaire were mostly satisfied with the SPIFA. Conclusions: The SPIFA seems to be a reliable, valid and helpful instrument for GPs making diagnoses of mental disorders in their patients. Compared with the Prime MD and the MINI, the SPIFA seemed to have comparable psychometric properties but better feasibility in primary care.

  • 5.
    Dyster-Aas, Johan
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Arnberg, Filip K.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Lindam, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Bergh Johannesson, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Lundin, Tom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Michel, Per-Olof
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Impact of physical injury on mental health after the 2004 Southeast Asia tsunami2012In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 66, no 3, p. 203-208Article in journal (Refereed)
    Abstract [en]

    Background : The risk of developing enduring post-traumatic stress reactions and mental health problems in the aftermath of disasters is substantial. However, there are inconsistencies regarding the contribution of physical injury as an independent risk factor for developing psychiatric morbidity after disasters.

    Aims : The aim was to assess whether physical injury was associated with post-traumatic stress reactions and general mental health after adjusting for perceived life-threat in the aftermath of the 2004 tsunami.

    Methods : A sample of 1501 highly exposed survivors from the 2004 Southeast Asia tsunami was selected from a cohort of Swedish survivors surveyed 14 and 36 months after the event. The impact of physical injury on post-traumatic stress and general mental health was assessed by regression models accounting for subjective life-threat.

    Results : Physical injury was associated with higher levels of post-traumatic stress reactions and poorer general mental health. These associations were observed at both 14 and 36 months after the disaster.

    Conclusions : Physical injury has a specific contribution to the association between traumatic experience and both post-traumatic stress reactions and general mental health in victims of the 2004 tsunami. The effect is stable over several years.

  • 6. Eklund, Mona
    et al.
    Bengtsson-Tops, Anita
    Lindstedt, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Construct and discriminant validity and dimensionality of the Interview Schedule for Social Interaction (ISSI) in three psychiatric samples2007In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 61, no 3, p. 182-188Article in journal (Refereed)
    Abstract [en]

    This study was aimed at investigating the psychometric properties of the Interview Schedule for Social Interaction (ISSI), in terms of construct and discriminant validity and unidimensionality, in three psychiatric samples with varying prerequisites for social interaction: 1) an outpatient sample of working age with mixed diagnoses, 2) an outpatient sample with schizophrenia, and 3) an inpatient sample composed of mentally ill, male offenders. The target constructs were psychosocial functioning and satisfaction in different life domains. It was hypothesized that the ISSI would mainly be related to psychosocial functioning and life domains characterized by social interaction, such as friends and family. A second hypothesis was that the ISSI ratings would discriminate between the three samples. The first hypothesis was confirmed, but the pattern of relationships was somewhat different between the groups. Whereas family contacts were of great importance for social integration in Samples 1 and 2, friends seemed more important for the mentally ill offenders. The second hypothesis was partly confirmed: three ISSI sub-scales out of four discriminated between the samples. Moreover, the ISSI proved to be a unidimensional construct. The support for the four proposed sub-scales was not unanimous, however, and the sub-scales targeting attachment constituted less stable factors. This study demonstrated the construct and discriminant validity of the ISSI when applied to samples with various mental disorders. The fact that similar results were obtained in all three samples, despite varying prerequisites for social interaction, strongly supports the validity of the ISSI. Providing the sub-scales are used with caution, the ISSI seems to be a reliable tool for use with patients with severe mental disorders.

  • 7.
    Fors, Björn Milesson
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Isacson, Dag
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Bingefors, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmacy.
    Widerlöv, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Mortality among persons with schizophrenia in Sweden: An epidemiological study2007In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 61, no 4, p. 252-259Article in journal (Refereed)
    Abstract [en]

    The objective of the study was to analyse 10-year mortality among persons with schizophrenia from an epidemiological perspective. This cohort study included all persons with schizophrenia (n=255) living in the northern catchment area in Uppsala in 1991, and 1275 subjects from the national population register matched for sex, age and living area. The prevalence of schizophrenia was 0.37% and the mortality rate for individuals with schizophrenia was higher than for referents: 23.0% vs. 11.2%. The higher mortality among those with schizophrenia was mainly the result of unnatural causes and cardiovascular disease, especially in men. Excess mortality from cardiovascular disease was more pronounced in middle age, irrespective of gender. Multivariate analysis revealed higher mortality among individuals with schizophrenia living in the city than among those living in less urbanized areas. People with schizophrenia die more often than those without schizophrenia from unnatural causes or circulatory diseases. Individuals with schizophrenia die sooner from circulatory diseases than those without schizophrenia. Having schizophrenia and living in the city also results in higher mortality than having schizophrenia and living in other areas. The risk of early death from circulatory disease needs to be studied in more detail to reveal the potential respective contributions of intrinsic patient vulnerability, lifestyle factors and side-effects from psychotropic drugs.

  • 8.
    Färdig, Rickard
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Fredriksson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital. Uppsala University, Disciplinary Domain of Science and Technology, Biology, Department of Organismal Biology, Environmental toxicology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Lewander, Tommy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Melin, Lennart
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Mueser, Kim
    Center for Psychiatric Rehabilitation, Boston University, MA, USA.
    Neurocognitive functioning and outcome of the Illness Management and Recovery Program for clients with schizophrenia and schizoaffective disorder2016In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 70, no 6, p. 430-435Article in journal (Refereed)
    Abstract [en]

    The relationship between psychosocial programming and neurocognition has been established in previous research, but has not been explored in the context of the Illness Management and Recovery Program (IMR). This study examined associations between neurocognition and illness self-management skills acquisition, based on two previous trials of IMR. Neurocognitive functioning was assessed at baseline and post-treatment in 53 participants with schizophrenia or schizoaffective disorder who completed the IMR. Illness self-management was measured by the client and clinician versions of the Illness Management and Recovery Scale. Statistical analyses investigated improvements in neurocognitive functioning and possible association between illness self-management skills acquisition and neurocognitive functioning. Speed of processing as measured by the Trail Making Test A, was related to client-reported acquisition of illness self-management skills, before and after controlling for psychiatric symptoms and medication, but did not predict improvement in clinician ratings of client illness self-management skills. However, when controlling for client session attendance rates, the association between speed of processing and client-reported illness self-management skills acquisition ceased to be statistically significant, which suggests that compromised neurocognitive functioning does not reduce response to training in illness self-management in itself. The association between the frequency of attended IMR sessions and outcome of the IMR seems to decrease the negative impact of compromised neurocognition on illness self-management skills acquisition. Also, clients with slower speed of processing may experience less benefit from the IMR and may attend fewer sessions.

  • 9.
    Goldin, Stephen
    et al.
    Division of Child and Adolescent Psychiatry, Department of Clinical Sciences, Umeå University, Sweden.
    Hägglöf, Bruno
    Division of Child and Adolescent Psychiatry, Department of Clinical Sciences, Umeå University, Sweden.
    Levin, Lilian
    Division of Child and Adolescent Psychiatry, Department of Clinical Sciences, Umeå University, Sweden.
    Persson, Lars Åke
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Mental health of Bosnian refugee children: A comparison of clinician appraisal with parent, child and teacher reports2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 3, p. 204-216Article in journal (Refereed)
    Abstract [en]

    This study compares clinician appraisal of Bosnian refugee children with independent parent, child and teacher reports. From whom and by what means can children “at risk” be reasonably identified? Forty-eight Bosnian refugee children (aged 7-20), resettled in Sweden 1994-95, were assessed clinically by means of a semi-structured interview. Thereafter, standardized mental health questionnaires were administered to parents (Achenbach's Child Behavior Checklist), children (Achenbach's Youth Self-Report and Macksoud's Posttraumatic Stress Reaction Checklist) and teachers (clinician designed School Competence Scale and Achenbach's Teacher's Report Form). On clinician interview, nearly half of the children (48%) were identified with one or more mental health problem “demanding further attention”. Depressiveness was the single most prevalent symptom (31%); followed by post-traumatic stress (23%), and anxiety-regressiveness (15%). At the same time, 75% of the children were rated by teachers as “quite competent” in school. Parent, child and clinician appraisals of primary school children showed broad similarities. Teachers reported a similar prevalence of child distress, but identified different symptoms and different children demanding attention. Evaluation of teenage youths showed greater disparity: teenagers labeled their own symptoms more often as post-traumatic stress reactions and teachers identified few youths in need of attention. Inter-relatedness among parent, child and clinician appraisals supports the robustness of our semi-structured interview. At the same time, apartness of teacher report underscores the need to incorporate an outside-world vantage point in the process of risk assessment. Also, a more concrete presentation of post-traumatic stress reactions and a higher “further attention” threshold for inward emotional problems seem called for.

  • 10.
    Haglund, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    von Essen, Louise
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Locked entrance doors at psychiatric wards: advantages and disadvantages according to voluntarily admitted patients2005In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 59, no 6, p. 511-515Article in journal (Refereed)
    Abstract [en]

    Entrance doors at wards where psychiatric care is provided are sometimes locked, which is notthe case at wards where somatic care is provided. How locked entrance doors at psychiatricwards are experienced by patients has been investigated to a very limited extent. The aim was todescribe voluntarily admitted patients’ perceptions of advantages and disadvantages about beingcared for on a psychiatric ward with a locked entrance door. Audio-taped, semi-structuredinterviews were conducted with 20 patients voluntarily admitted at psychiatric wards. Contentanalysis revealed six categories of advantages and 11 categories of disadvantages. Mostadvantages were categorized as ‘‘protects patients and staff against ‘the outside’ ’’, ‘‘providespatients with a secure and efficient care’’ and ‘‘provides staff with a sense of control over thepatients’’. Most disadvantages were categorized as ‘‘makes patients feel confined’’, ‘‘makespatients feel dependent on the staff ’’ and ‘‘makes patients feel worse emotionally’’. Patientsperceive a variety of advantages and disadvantages, for themselves, their visitors and staff,connected to locked entrance doors at psychiatric wards. A locked door may make the wardappear as both a prison and a sanctuary. It is important that staff try to minimize patients’concerns connected to the locked door.

  • 11. Hanna, Vian Nissan
    et al.
    Ahmad, Abdulbaghi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Suicide in the Kurdistan Region of Iraq, state of the art2009In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 63, no 4, p. 280-284Article in journal (Refereed)
    Abstract [en]

    In recent years the, incidence of suicide in Kurdistan has been increasing, especially among females, to a degree it cannot be neglected. Consequently, attention was given to this phenomena and the aggressive method of suicide used by young peoples, especially females, in Kurdistan. In attempt to obtain an objective picture of the frequently media-reported suicide among youths and women in the Kurdistan Region of Iraq. The responsible authorities and medical service units in the region were visited to collect information, and the available data were explored to produce a state-of-the-art overview on the subject. Because of insufficient documentation and lack of systematic registration, the data on suicide were scattered and difficult to evaluate. However, the findings did confirm that suicide exists as a serious problem in the society in Kurdistan, particularly among females. Urgent attention is demanded from the responsible authorities and organizations concerned in the region. Further research is needed to investigate the exact extent of suicide and its correlates in the society in Kurdistan, in order to plan for effective preventive measures.

  • 12. Heir, Trond
    et al.
    Rosendal, Susanne
    Bergh-Johannesson, Kerstin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
    Michel, Per-Olof
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Mortensen, Erik L.
    Weisaeth, Lars
    Andersen, Henrik S.
    Hultman, Christina M.
    Tsunami-affected Scandinavian tourists: Disaster exposure and post-traumatic stress symptoms2011In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 65, no 1, p. 9-15Article in journal (Refereed)
    Abstract [en]

    Background: Studies of short- and long-term mental effects of natural disasters have reported a high prevalence of post-traumatic stress. Less is known about disaster-exposed tourists repatriated to stable societies. Aims: To examine the association between exposure to the 2004 Southeast Asian tsunami and symptoms of post-traumatic stress in three Scandinavian tourist populations. Methods: Postal survey of Norwegian, Danish and Swedish Southeast Asia tourists registered by the police when arriving at national airports. Follow-up time was 6 (Norway), 10 (Denmark) and 14 months (Sweden) post-disaster; 6772 individuals were included and categorized according to disaster exposure: danger exposed (caught or chased by the waves), non-danger exposed (other disaster-related stressors) and non-exposed. Outcome measures were the Impact of Event Scale-Revised (IES-R) and Post Traumatic Stress Disorder Check List (PCL). Results: Danger exposed reported more post-traumatic stress than non-danger exposed, and the latter reported more symptoms than non-exposed (each P<0.001). Comparison of the Norwegian and Swedish data suggested that symptoms were attenuated at 14 months follow-up (P<0.001). Female gender and low education, but not age, predicted higher levels of symptoms. Conclusions: Disaster-exposed tourists repatriated to unaffected home environments show long-term post-traumatic stress disorder symptoms related to the severity of exposure.

  • 13.
    Holm, Jonas
    et al.
    Orebro Univ, Sch Med Sci, Orebro, Sweden..
    Brus, Ole
    Orebro Univ, Sch Med Sci, Clin Epidemiol & Biostat, Orebro, Sweden..
    Båve, Ullvi
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden..
    Landen, Mikael
    Karolinska Inst, Dept Med Epidemiol & Biostat, Stockholm, Sweden.;Gothenburg Univ, Sahlgrenska Acad, Inst Neurosci & Physiol, Gothenburg, Sweden..
    Lundberg, Johan
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Stockholm, Sweden..
    Nordanskog, Pia
    Linkoping Univ, Dept Clin & Expt Med, Ctr Social & Affect Neurosci, Fac Hlth Sci, Linkoping, Sweden.;Reg Ostergotland, Dept Psychiat, Linkoping, Sweden..
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Nordenskjöld, Axel
    Orebro Univ, Sch Med Sci, Orebro, Sweden..
    Improvement of cycloid psychosis following electroconvulsive therapy2017In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 71, no 6, p. 405-410Article in journal (Refereed)
    Abstract [en]

    Background: The treatment of choice for cycloid psychosis has traditionally been electroconvulsive therapy (ECT), but there is a lack of studies on its effectiveness.

    Aims: The primary aim of this register study was to determine the rates of remission and response after ECT for cycloid psychosis. The secondary aim was to examine possible predictors of outcome.

    Methods: Data were obtained from the National Quality Register for ECT in Sweden. The study population was patients (n=42) who received ECT for acute polymorphic psychotic disorder without symptoms of schizophrenia or for cycloid psychosis between 2011-2015 in 13 hospitals. Remission and response rates were calculated using Clinical Global Impression-Severity (CGI-S) and -Improvement scores, respectively. Variables with possible predictive value were tested using Chi-square and Fisher's exact test.

    Results: The response rate was 90.5%. The remission rate was 45.2%. Of 42 patients, 40 improved their CGI-S score after ECT (p<0.001). The mean number of ECT treatments was 2.5 for non-responders and 7.0 for responders (p=0.010). The mean number of ECT treatments did not differ significantly between remitters and non-remitters (7.2 vs 6.1, p=0.31). None of the other investigated potential predictors was statistically significantly associated with outcome.

    Conclusions: ECT is an effective treatment for cycloid psychosis. Future studies need to compare the outcome of ECT to that of other treatment strategies. Clinical implications: The high response rate with ECT indicates that cycloid psychosis is a clinically useful diagnosis.

  • 14.
    Janols, Lars-Olof
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Liliemark, Jan
    Klintberg, Karin
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Central stimulants in the Treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents: A naturalistic study of the prescription in Sweden 1977-20072009In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 63, no 6, p. 508-516Article in journal (Refereed)
    Abstract [en]

    Central   stimulants in the treatment of attention-deficit hyperactivity disorder   (ADHD) in children and adolescents. A naturalistic study of the   prescription in Sweden, 1977-2007. Nord J Psychiatry 2009; 63: 508-516.   Background: An increased prescription of central stimulants (CS) for   treatment of attention-deficit hyperactivity disorder (ADHD) in   children and adolescents has been reported in Sweden. Aims: To   follow-up the treatment with CS as concerns total as well as regional   differences in prescription rate. Efficacy and side-effects reported   and gender differences in prescription over time also have been   summarized. Methods: Data from the Swedish Medical Products Agency   (MPA) of individual licences, annual reports about patients on   individual or clinic licences from the MPA and sales statistics from   the National Pharmacy (Apoteket AB) have been used. Results: The number   of new licences and prescriptions increased dramatically from 1992 to   2007 and a change of preparations was seen. Great differences   (fivefold) between the 21 counties of Sweden were noticed. In the   follow-up reports to the MPA, a good/moderate treatment effect was   reported in 92% and adverse effects were reported in 4% leading to   discontinuation of medication in 46% of them. Abuse/misuse of the   preparation was suspected in 0.2% of the reports. A tendency of a   reduction of the proportion of boys to girls treated through individual   licences has been seen. Conclusions: The study, although observational,   supports good efficacy, limited adverse effects and a low degree of   misuse in clinical use of CS for children and adolescents with ADHD.

  • 15.
    Jansson, Lennart
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
    Wennström, Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
    Wiesel, Frits-Axel
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
    The Need of Support and Service Questionnaire (NSSQ): a brief scale to assess needs in clients with long-term mental disabilities2005In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 59, no 6, p. 465-472Article in journal (Refereed)
    Abstract [en]

    We present the Need of Support and Service Questionnaire (NSSQ), a new instrument developed to provide professionals in psychiatric care and community social services with a tool to assess needs of support and service in mentally disabled clients. The final version of the instrument was designed after comments from professionals in psychiatric care, community social services, and the clients and their relatives. A reliability study (test-retest, n=77), inter-rater (n=69) and a validity study (n=529) were performed. In the validity study, comparisons were done with the Camberwell Assessment of Need (CAN) scale, the Global Assessment of Functioning (GAF) scale and the Social and Occupational Functioning Assessment Scale (SOFAS). The test-retest and inter-rater reliability were 0.86 and 0.76, respectively. The percentage of agreement on the individual items ranged from 83.1% to 100.0% (test-retest) and 76.8% to 100.0% (inter-rater reliability). The corresponding kappa coefficients ranged from 0.63 to 1.00 (test-retest) and 0.33 to 1.00 (inter-rater reliability). The comparison between NSSQ and CAN items demonstrated high sensitivity and specificity as well as satisfactory likelihood ratios (LRs). The correlations between GAF and SOFAS scores and the number of needs of support, number of needs of service and the total number of needs of support and service were -0.49, -0.32 and -0.47, and -0.48, -0.26 and -0.45, respectively. All correlations were statistically significant (P<0.01). The results demonstrated that the psychometric characteristics of the NSSQ were satisfactory. Moreover, professionals without any formal training easily used it.

  • 16. Josefsson, Ann
    et al.
    Sydsjö, Gunilla
    Berg, Göran
    Dahl, Marja-Liisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Wadelius, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Clinical pharmacogenomics and osteoporosis.
    Nordin, Conny
    CYP2D6 genotypes and depressive symptoms during late pregnancy and postpartum2004In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 58, no 1, p. 61-4Article in journal (Refereed)
    Abstract [en]

    The aim of this exploratory was to investigate the theory of a relation between cytochrome P450 2D6 (CYP2D6) genotype and depressive symptoms in late pregnancy and/or postpartum. We studied 145 women with depressive symptoms. CYP2D6 genotype was analysed in leukocyte DNA by polymerase chain reaction (PCR). There were no significant differences in CYP2D6 genotypes between the groups of women being depressed during and/or after pregnancy. The frequencies of CYP2D6 genotypes did not differ from other European studies. This study cannot confirm that depressive symptoms in late pregnancy and postpartum are connected with CYP2D6 genotype. It is, however, noteworthy that the frequency of ultrarapid metabolizers was higher than in a general Caucasian population. This warrants further exploration in a greater study sample, but should also be investigated in a general population with major depression.

  • 17.
    Khalifa, Najah
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Dalan, Marie
    Rydell, Ann-Margret
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Tourette Syndrome in the General Child Population: Cognitive functioning and self-perception2010In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 64, no 1, p. 11-18Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to examine the cognitive function and self-perception in a school-population-based sample of children with Tourette syndrome (TS). Many studies have examined cognitive and emotional functioning in clinical samples but to our knowledge, there is no population-based study of TS in schoolchildren. In a population-based sample identified in a rigid diagnostic procedure (n = 25), cognitive functioning and self-perception were examined. There was a large variation in the cognitive functioning of children with TS, at least one third obtaining subnormal results. The profile of index scores on the Wechsler Intelligence Scale for Children (WISC) factors was somewhat uneven, with the freedom from distractibility and processing speed factors presenting the lowest median scores. The TS group had more negative self-perceptions than a comparison group. Tic severity or age at onset was not associated with cognitive performance or self-perception. Children who were taking medication had lower full IQ scores than children who were not. Low cognitive abilities and negative self-perception may be common in community-based samples of children with Tourette syndrome.

  • 18.
    Källmén, Håkan
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Wennberg, Peter
    Berman, Anne H.
    Bergman, Hans
    Alcohol habits in Sweden during 1997-2005 measured with the AUDIT2007In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 61, no 6, p. 466-470Article in journal (Refereed)
    Abstract [en]

    This study aimed to describe changes in Swedish alcohol habits during a period of "harmonization" with European Union alcohol policy. Three random samples collected during the years 1997 (n = 997), 2001 (n = 893) and 2005 (n = 914) were compared. Alcohol habits and hazardous consumption was measured with the AUDIT (Alcohol Use Disorders Identification Test) distributed to the respondents by post. Results were somewhat diverse, but significant changes in alcohol habits occurred among two subgroups of the population: for women and the age group between 28 and 60 years, AUDIT scores peaked in 2001. The results are discussed in relation to the changes made in Swedish alcohol policy during the investigation period.

  • 19.
    Lindstedt, Helena
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Söderlund, Anne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Stålenheim, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Sjödén, Per-Olow
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences.
    Personality traits as predictors of occupational performance and life satisfaction among mentally disordered offenders2005In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 59, no 5, p. 357-364Article in journal (Refereed)
    Abstract [en]

    The study investigated to what extent personality traits, e.g. socialization, proneness for anxiety, aggression and hostility were associated with and predictive of self-reported and observed occupational performance and perceived life satisfaction among male mentally disordered offenders (MDOs). Also, subjects with psychopathic-related personality traits were compared with subjects without such traits regarding demographic data and dependent variables. The MDOs were included from the Swedish National Board of Forensic Medicine. A total of 55 subjects were visited at their hospital ward for data collection with the Karolinska Scales of Personality (KSP), Capability to Perform Daily Occupation (CPDO), Allen Cognitive Level Screen (ACLS) and the Manchester Quality of Life Scale (MANSA). Seven KSP scales and two KSP factors correlated significantly with the dependent variables. Regression analyses revealed that the KSP Socialization scale, the KSP Anxiety-proneness and Psychopathy factors were the most important predictors. Subjects with psychopathy differed from remaining groups by having more conduct disorders before 15 years, being more often brought up in outcasted families and less subjected to measures of pupil welfare activities. The life history was concluded to be important influencing occupational performance and life satisfaction. Subjects with high anxiety proneness should be given attention in treatment planning.

  • 20. Lindström, E
    et al.
    Eberhard, J
    Fors, BM
    Hansen, K
    Sapin, C
    A pharmacoeconomic analysis of sertindole in the treatment of schizophrenia in Sweden.2011In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725Article in journal (Refereed)
  • 21. Lindström, Eva
    et al.
    Eriksson, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Forensic Medicine.
    Levander, Sten
    Suicides during 7 years among a catchment area cohort of patients with psychoses2012In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 66, no 1, p. 8-13Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate a series of consecutive suicides at a psychosis clinic by using a psychological autopsy technique. Method: The clinic serves an adult population of 225,000 individuals, of whom 0.5% have regular contact with the clinic. During a 7 1/2-year period, 23 men and nine women committed suicide, which corresponds to an odds ratio of 14. Results: Most patients were schizophrenic, and 24 were outpatients. Suicide methods were violent in all but two cases. Nineteen had a history of at least one suicide attempt, and 24 were known to have had suicidal ideation. More than half had no social contacts over the last year except with psychiatric staff. The median time between the last contact with the psychiatric services and the suicide was 4 days. No warning signs were noted. At the time of death, 3 of the 24 who were prescribed antipsychotics, and none of the 10 who were prescribed antidepressants had plasma levels of the corresponding drug. Conclusion: Findings of special interest are the lack of forewarnings and the poor drug compliance. Patients appear to have played "business as usual" with the care-givers, and did it well. Is it a sign of health and despair, or illness?

  • 22.
    Lindström, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Jedenius, Erik
    Levander, Sten
    A symptom Self-rating Scale for Schizophrenia (4S): Psychometric properties, reliability and validity2009In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 63, no 5, p. 368-374Article in journal (Refereed)
    Abstract [en]

    The objective of the study was to validate a self-administrated symptom rating scale for use in patients with schizophrenia spectrum disorders by item analysis, exploration of factor structure, and analyses of reliability and validity. Data on 151 patients, initially treated by risperidone, obtained within the framework of a naturalistic Phase IV longitudinal study, were analysed by comparing patient and clinician ratings of symptoms, side-effects and global indices of illness. The Symptom Self-rating Scale for Schizophrenia (4S) is psychometrically adequate (item analysis, internal consistency, factor structure). Side-effect ratings were reliable. Symptom ratings displayed consistent associations with clinicians' ratings of corresponding symptom dimensions, suggesting construct validity. Patients had most difficulties assessing negative symptom items. Patients were well able to assess their own symptoms and drug side-effects. The factor structure of symptom ratings differs between patients and clinicians as well as how they construe global indices of illness. Clinicians focus on psychotic, patients on affective symptoms. Use of symptom self-ratings is one way to improve communication and thereby strengthen the therapeutic alliance and increase treatment adherence.

  • 23.
    Lindström, Eva
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Tuninger, Eva
    Lund Univ, Dept Clin Sci, Lund, Sweden..
    Levander, Sten
    Malmo Univ, Fac Hlth & Soc, SE-20506 Malmo, Sweden..
    PECC-Factor structure and findings in three longitudinal cohorts of patients with schizophrenia2012In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 66, no 1, p. 33-39Article in journal (Refereed)
    Abstract [en]

    Background: Symptom control by drug treatment is the most important task in routine clinical care of patients with schizophrenia. Structured assessment methods are needed in this task but not used much. The US-developed Positive and Negative Syndrome Scale (PANSS) is a standard tool for symptom assessment. The Psychosis Evaluation tool for Common use by Caregivers (PECC) was constructed in Europe some years ago, with the intent to overcome some of the PANSS drawbacks. Aims and methods: To validate PECC on three longitudinal cohorts of schizophrenic patients representative of Swedish outpatients (n = 225, six assessments over 5 years), international forensic patients (n = 186) and matched non-forensic controls (n = 116), five assessments over 2 years for both. Results : The factor structure of PECC appears to be highly robust. Norm values (in percentiles) were calculated on the materials. Such data provides for analyses of symptom profiles and improvement over time measured in absolute numbers. Forensic patients appear to have a much lower symptom load (except for cognitive symptoms) than the other groups. Forensic controls had much shorter inpatient times than any other group and never caught up with respect to symptom control, even after 2 years. These differences suggest that the scale is clinically valid. Conclusion: PECC has a more robust factor structure than PANSS and is simpler to use. Percentile norms have been constructed for outpatients with schizophrenia in general and forensic psychiatry. Percentile scores are accessed readily by the net. PECC is available in many languages. Its separate self-harm item may improve assessments of suicide risk among patients with schizophrenia.

  • 24.
    Lundin, Tom
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
    Jansson, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
    Traumatic impact of a fire disaster on survivors: A 25-year follow-up of the 1978 hotel fire in Borås, Sweden2007In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 61, no 6, p. 479-485Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to investigate the long-term psychological and mental health outcomes among survivors of a disastrous hotel fire. A 25-year follow-up investigation among adolescent and young adult survivors of a fire disaster was conducted in Boras, Sweden. A self-evaluation questionnaire and four self-rating scales - the IES-22, PTSS-10, GHQ-28 and SoC - were sent by mail to the participants. The results from the self-reported data showed low levels of psychiatric illness. Moreover, the respondents reported a low level of traumatic stress symptoms. More than 50% of the participants stated that the fire had a determining effect on their lives. Sixteen (21.3%) respondents indicated that the fire still had an impact on their daily lives. Differences between men and women were reported in most of the self-rating scales. The results indicate that a traumatizing experience (such as a fire disaster) still had a small effect on psychological health in a long-term perspective.

  • 25. Malmberg, Mikael
    et al.
    Rydell, Ann-Margret
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Smedje, Hans
    Validity of the Swedish version of the Strengths and Difficulties Questionnaire (SDQ-Swe)2003In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 57, no 5, p. 357-63Article in journal (Refereed)
    Abstract [en]

    The Strengths and Difficulties Questionnaire (SDQ) is an internationally widely used, brief screening instrument for mental health problems in children and teenagers. The SDQ probes behaviours and psychological attributes reflecting the child's difficulties as well as strengths, and targets hyperactivity/inattention, emotional symptoms, conduct problems, peer problems and prosocial behaviour. Also, the instrument taps the impact aspect, i.e. whether the child is judged to suffer from emotional or behavioural problems severe enough to cause distress or social impairment. Studies of the original English SDQ, as well as of translations into several other languages, attest to a compelling usefulness and validity of the instrument. In this investigation, the adequacy of the Swedish adaptation of the SDQ (SDQ-Swe) was tested in comparisons between parent reports on 5-15-year-old children drawn from a community sample (n=263) and from a child psychiatric sample (n=230). Results showed that the instrument differentiated well between the community and the psychiatric samples, the latter displaying more symptoms, fewer strengths and more social impairment. Moreover, ROC analyses showed satisfactory sensitivity and specificity of the principal scales of the SDQ-Swe at proposed cut-offs. Hence, results showed adequate validity of the SDQ-Swe, suggesting that this new instrument, an instrument in tune with the ideas of contemporary child psychiatry and psychology, is a useful tool for mental health screening in children and adolescents.

  • 26.
    Malmström, Emma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Hörberg, Niklas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Kouros, Ioannis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Haglund, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Young patients' views about provided psychiatric care2016In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 70, no 7, p. 521-527Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Psychiatric illness is common among young adults, but there are only a few studies examining their views about the care they receive. There is a paradigm shift towards person-centred care and, therefore, a need for patients' perspectives in the development of clinical guidelines.

    AIM: The aim of this study was to examine the views about provided psychiatric care in a group of young adult psychiatric patients.

    METHOD: This study was part of a larger study. Patients between the ages of 19-29 years old (n = 127) diagnosed with bipolar disorder, borderline personality disorder, and/or attention deficit hyperactivity disorder were interviewed. Participants answered open-ended questions concerning their views about provided psychiatric care in six different areas.

    RESULT: The results were categorized into six themes: (1) Wish for better diagnostic assessments, (2) Dissatisfaction with treatment, (3) Inadequate information, (4) Lack of professional attitude, (5) Feeling abandoned, and (6) Satisfaction with care.

    CONCLUSION: Young psychiatric patients expressed a need for improvement of services that, if implemented, could make psychiatric care more person-centred.

  • 27.
    Marteinsdottir, I
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Furmark, Tomas
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Tillfors, Maria
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Ågren, H
    Hartvig, P
    Fredrikson, Mats
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Långström, B
    Fischer, H
    Antoni, Gunnar
    Hagberg, G
    Presynaptic serotonin imaging in social phobia using [3-11C]-5-hydroxy-L-tryptophan and PET: Meeting Abstract2001In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 55, p. 98-Article in journal (Refereed)
  • 28.
    Marteinsdottir, Ina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Svensson, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Svedberg, Marcus
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Anderberg, Ulla Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Social Medicine.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    The role of life events in social phobia2007In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 61, no 3, p. 207-212Article in journal (Refereed)
    Abstract [en]

    The aim was to investigate the relationship between life events and social phobia. An inventory assessing life events during childhood, adulthood as well as life events experienced in relation to the onset of the disorder was administrated to 30 subjects with a DSM-IV diagnosis of social phobia. They were recruited by announcement and diagnosed by the Structured Clinical Interview for DSM-IV for axes I and II disorders. Seventy-five controls were selected by matching age and gender from the local population register. Individuals with social phobia reported significantly more life events during childhood and more life events with negative impact during the social phobia debuting year. Conversely, they described fewer events in the adult life than the controls. Close relatives with disabling conditions in the childhood, conflicts with wife/husband/cohabitant and divorces or similar were significantly more common in the debuting year in social phobic group. In adult life, the healthy individuals described significantly more often increased authority at work. A gender-specific analysis revealed significantly more experiences of a death of a relative/close friend during the year before the social phobia debut and significantly more negative life events in the women's adult life. In summary, the present results support that life events have a role in social phobia that may be gender influenced.

  • 29.
    Michel, Per-Olof
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
    Lundin, Tom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
    Larsson, Gerry
    Personality disorders in a Swedish peacekeeping unit2005In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 59, no 2, p. 134-138Article in journal (Refereed)
    Abstract [en]

    There is a lack of knowledge about the incidence of personality disorders and their consequences among peacekeepers. Moreover, most studies are follow-up studies in which, if at all, personality traits are screened for after the soldiers have left their service abroad. The aim of this paper was to study personality disorders in a longitudinal perspective. The method used was to screen the personnel in a Swedish mechanized battalion serving in Bosnia from March until October 1996 on four occasions: before deployment, immediately after deployment, 6 months after deployment and 1 year after deployment. Serving in the battalion were 724 individuals of whom 516 took part in the survey. The screening instrument used was the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q). The result shows that the rate of personality disorders were on the same level, or a little bit lower, than in the general population. Moreover, personality disorders were related to impaired general mental health and to reported traumatic experiences. Personality disorders also seemed to contribute to poor mental health 1 year after returning home from a mission abroad. The implications of these results for the future selection of peacekeepers are discussed.

  • 30. Nielsen, Rene Ernst
    et al.
    Lindström, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Telleus, Gry Kjaersdam
    Levander, Sten
    Is the PANSS cognitive scale measuring cognition?2014In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 68, no 8, p. 573-578Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate the association between the Positive and Negative Syndrome Scale (PANSS) cognitive factors and cognition assessed by neuropsychological tests. Method: Ninety patients with a psychotic illness, the majority having a schizophrenia diagnosis, were assessed with PANSS ratings and tested by a comprehensive computerized neuropsychological test battery, EuCog. Results: Test performance was in the normal range for some of the cognitive indices, but substantially reduced for others, compared with norms, particularly speed-based indices. PANSS ratings were non-specifically associated with cognitive indices representing performance (speed and accuracy) and problem solving strategies (executive functions). There was no discriminant validity for the cognitive factor. A regression analysis suggested that the PANSS cognitive factors reflected verbal IQ but no other cognitive domain like memory, attention or speed. Conclusion: Cognitive test performance is associated with psychopathology as assessed by PANSS items but in a non-specific way. The PANSS cognitive subscale seems to reflect over-learned verbal skills rather than the cognitive domains, which are known to be specifically affected in schizophrenia and relevant for the prognosis. Consequently, PANSS ratings cannot replace the information inherent in neuropsychological test data. The extensive speed problem of patients with schizophrenia should be studied in more detail using test batteries that focus on that problem.

  • 31.
    Nilsson, Björn Mikael
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Holm, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Karolinska Scales of Personality, cognition and psychotic symptoms in patients with schizophrenia and healthy controls2016In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 70, no 1, p. 53-61Article in journal (Refereed)
    Abstract [en]

    Background: Studies on both personality dimensions and cognition in schizophrenia are scarce. The objective of the present study was to examine personality traits and the relation to cognitive function and psychotic symptoms in a sample of patients with schizophrenia and healthy controls. Method: In total 23 patients with schizophrenia and 14 controls were assessed with the Karolinska Scales of Personality (KSP). A broad cognitive test programme was used, including the Wechsler Adult Intelligence Scales, the Finger-Tapping Test, the Trail Making Test, the Verbal Fluency Test, the Benton Visual Retention Test, the Wisconsin Card Sorting Test and Rey Auditory Verbal Learning Test . Results: Compared with controls, the patients exhibited prominent elevations on KSP scales measuring anxiety proneness and neuroticism (P = 0.000005-0.0001), on the Detachment scale (P < 0.00009) and lower value on the Socialization scale (P < 0.0002). The patients also scored higher on the Inhibition of Aggression, Suspicion, Guilt and Irritability scales (P = 0.002-0.03) while the remaining five scales did not differ between patients and controls. KSP anxiety-related scales correlated with the Positive and Negative Symptoms Scale (PANSS) general psychopathology subscale. Cognitive test results were uniformly lower in the patient group and correlated with PANSS negative symptoms subscale. There was no association between KSP scale scores and PANSS positive or negative symptoms. Conclusion: The patients revealed a highly discriminative KSP test profile with elevated scores in neuroticism- and psychoticism-related scales as compared to controls. Results support previous findings utilizing other personality inventories in patients with schizophrenia. Cognitive test performance correlated inversely with negative symptoms.

  • 32.
    Nilsson, Doris
    et al.
    Linkoping Univ, Dept Behav Sci & Learning, Psychol Sect, SE-58183 Linkoping, Sweden..
    Nordenstam, Carin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Green, Sara
    Linkoping Univ, Dept Behav Sci & Learning, Psychol Sect, SE-58183 Linkoping, Sweden..
    Wetterhall, Annika
    Linkoping Univ, Dept Behav Sci & Learning, Psychol Sect, SE-58183 Linkoping, Sweden..
    Lundin, Tom
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Svedin, Carl Goran
    Linkoping Univ, Child & Adolescent Psychiat, Dept Clin & Expt Med, Fac Hlth Sci, SE-58185 Linkoping, Sweden..
    Acute stress among adolescents and female rape victims measured by ASC-Kids: A pilot study2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 7, p. 539-545Article in journal (Refereed)
    Abstract [en]

    Background: Rape is considered a stressful trauma and often with durable consequences. How the aftermath of rape is for young adolescents' girls considering acute stress is an overlooked field and remains to be studied. Aims: In this study, we wanted to investigate acute stress among adolescent victims of rape and the psychometric properties of the Acute Stress Checklist for Children (ASC-Kids). Methods: A clinical sample (n = 79) of raped girls, 13 - 17 years old who had turned to a special rape victim unit for treatment, answered the ASC-Kids. ASC-Kids was also given to a group of minor stressed, non-raped adolescents in the same age range (n = 154) together with the University of California at Los Angeles Post-traumatic Stress Disorder Reaction Index (UCLA PTSD RI), and the Sense of Coherence Scale 13 (SOC-13). Results : The scores from the groups were compared and showed significant differences in mean values on all the diagnostic criteria of acute stress disorder. In the clinical group, 36.7% obtained full ASD criteria. ASC-Kids could discriminate well between groups. Cronbach's alpha was found to be excellent, and the correlation between the UCLA PTSD RI and ASC-Kids found to be good; both ASC-Kids and UCLA PTSD RI had a good and moderate negative correlation with SOC-13. Conclusion: Adolescent female rape victims were shown to have a very high level of acute stress, and the ASC-Kids was found to have sound psychometrics and can be a valuable screening instrument to support clinicians in their assessments of an indication of adolescents after potentially stressful events such as rape.

  • 33. Nordenskjöld, A
    et al.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Brus, O
    Engström, I
    Predictors of regained occupational functioning after electroconvulsive therapy (ECT) in patients with major depressive disorder: A population based cohort study2013In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 67, no 5, p. 326-333Article in journal (Refereed)
    Abstract [en]

    Aims:

    The aim of the present study is to investigate the rate of regained occupational functioning among patients treated with electroconvulsive therapy (ECT) for major depression and to define predictors of time to regained occupational functioning.

    Methods:

    A nested cohort study was performed of patients treated by ECT for unipolar major depressive disorder registered in the Quality register for ECT and in the Swedish Social Insurance Agency registry. Predictive values of single clinical variables and their relative importance were tested with Cox regression analysis.

    Results:

    394 patients were identified. Of those, 266 were on non-permanent sick leave and 128 on disability pension during ECT. Within 1 year post-ECT, 71% of the patients with non-permanent sick leave regained occupational functioning. Factors independently associated with a statistically significant increased time to regained occupational functioning were longer duration of sick leave pre-ECT, milder depression pre-ECT, less complete improvement with ECT, benzodiazepine treatment after ECT and co-morbid substance dependence.

    Conclusions:

    A large proportion of the patients do not return to work within several months post-ECT. Paradoxically, patients with more severe depression pre-ECT had a reduced time to regained occupational functioning, indicating a larger effect in this patients group of the treatment. Moreover, the period with sick leave compensation might be reduced if ECT is initiated within the first 3 months of sick leave.

    Clinical implications:

    Most patients on non-permanent sick leave regain occupational functioning after ECT. However, it usually takes a few months even in symptomatically improved patients.

  • 34. Nordenskjöld, Axel
    et al.
    Von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Engström, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Rehospitalization rate after continued electroconvulsive therapy-A retrospective chart review of patients with severe depression2011In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 65, no 1, p. 26-31Article in journal (Refereed)
    Abstract [en]

    Background: Electroconvulsive therapy, ECT, is an effective acute treatment for severe depression. Today ECT is usually discontinued when the patient's depressive symptoms abate, although relapse is common. Some studies suggest that continuation ECT (cECT) may prevent relapse of depression, but there are few studies available. Aims: The aim of this study was to describe the need for inpatient care before, during and after cECT. Methods: A retrospective chart. review was conducted of all patients (n=27) treated with cECT between 2005 and 2007 at Orebro University Hospital, Sweden. All patients were severely depressed at the initiation of index ECT. The DSM-IV diagnoses were major depression (n=19), bipolar depression (n=5) or schizoaffective depression (n=3). Results: The hospital day quotient was lower (HDQ=15) during cECT (mean duration+/-standard deviation=104+/-74 days) than during the 3 years prior to cECT (HDQ=26). The rehospitalization rate was 43% within 6 months and 58% within 2 years after the initiation of cECT. Seven patients were rehospitalized while on cECT. Conclusion: The need for inpatient care was reduced during cECT. However, rehospitalization was common. At the initiation of the cECT, the patients were improved by the index ECT. Also cECT was often terminated after rehospitalization, which contributed to the lowered hospital day quotient during cECT. Randomized clinical trials are needed to establish the efficacy of cECT. Clinical implications: Relapses and recurrences in depressed patients are common after ECT treatment. The results indicate that continuation ECT combined with pharmacotherapy might be an alternative treatment strategy.

  • 35. Nordstrom, Tanja
    et al.
    Ebeling, Hanna
    Hurtig, Tuula
    Rodriguez, Alina
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Savolainen, Jukka
    Moilanen, Irma
    Taanila, Anja
    Comorbidity of disruptive behavioral disorders and attention-deficit hyperactivity disorder-Indicator of severity in problematic behavior?2013In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 67, no 4, p. 240-248Article in journal (Refereed)
    Abstract [en]

    Background: Disruptive behavioral disorders (DBD) and attention-deficit hyperactivity disorder (ADHD) are both characterized by certain patterns of misbehavior among adolescents. Aims: The aim of this study was to examine how the comorbidity of DBD and ADHD affects in misbehavior among adolescents. Methods: A total of 158 adolescents aged 16-18 years, from a subsample of the Northern Finland Birth Cohort 1986 (NFBC 1986), were interviewed with the Finnish translation of the semi-structured Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime (K-SADS-PL) in order to obtain DBD, including conduct disorder (CD) and oppositional defiant disorder (ODD), and ADHD diagnoses. The structure of the CD symptoms, obtained from the K-SADS-PL, was compared with the previously formed model about the development of the problematic behavior. The severity of the CD symptoms was compared with adolescents diagnosed with only DBD, only ADHD and with both DBD and ADHD. Also, the associations with other psychiatric disorders diagnosed at age 16 were evaluated. Results: The boys in the study sample were diagnosed with ADHD or with comorbid DBD and ADHD more often than girls. The severity of CD symptoms was statistically significantly associated with the comorbid DBD and ADHD group. The adolescents diagnosed with comorbid DBD and ADHD had an increased risk for anxiety disorders, depressive disorders and substance abuse disorders. Conclusions: The comorbidity of DBD and ADHD seems to indicate the severity of CD symptoms. Clinical implications: The comorbidity between DBD and ADHD should be considered in clinical practice because it could indicate more serious problematic behavior than pure disorders alone.

  • 36.
    Odelius, Charlotta Benezeder
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Clinical utility of proposed non-suicidal self-injury diagnosis - A pilot study2014In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 68, no 1, p. 66-71Article in journal (Refereed)
    Abstract [en]

    In the forthcoming fifth revision of the Diagnostic and Statistical Manual of Mental Disorders (DSM), a new diagnosis is proposed: non-suicidal self-injury (NSSI). To test its clinical utility in a pilot study, NSSI criteria were assessed in 39 young psychiatric outpatients with self-harm behavior. There were no differences between the NSSI (n = 18) and the non-NSSI (n = 21) groups concerning other diagnoses, including borderline personality disorder (BPD) (22% vs. 24%). However, NSSI patients had more suicidal behavior than non-NSSI patients. This pilot study indicates that the NSSI diagnosis is different from BPD, but it does not delimit suicidal behavior.

  • 37.
    Olsson, Gunilla Maria
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Mårild, Staffan
    Alm, Jan
    Brodin, Ulf
    Rydelius, Per-Anders
    Marcus, Claude
    The Adolescent Adjustment Profile (AAP) in comparisons of patients with obesity, phenylketonuria or neurobehavioural disorders2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 1, p. 66-76Article in journal (Refereed)
    Abstract [en]

    Psychosocial development in children with chronic disease is a key issue in paediatrics. This study investigated whether psychosocial adjustment could be reliably assessed with the 42-item Adolescent Adjustment Profile (AAP) instrument. The study mainly focused on adjustment-to-obesity measurement, although it compared three patient groups with chronic conditions. All phenylketonuria (PKU) patients in Sweden between ages 9 and 18 and their parents and teachers were invited to participate. Patients with neurobehavioural syndromes and obesity were age- and gender-matched with PKU patients. Healthy children constituted a reference group. Psychosocial adjustment was measured using the AAP, which is a multi-informant questionnaire that contains four domains. Information concerning parents' socio-economic and civil status was requested separately. Respondents to the three questionnaires judged the PKU patients to be normal in all four domains. Patients with neurobehavioural syndromes demonstrated less competence and the most problems compared with the other three groups. According to the self-rating, the parent rating and the teacher rating questionnaires, obese patients had internalizing problems. The parent rating and the teacher rating questionnaire scored obese patients as having a lower work capacity than the reference group. Compared with the reference group, not only families with obese children but also families with children with neurobehavioural syndromes had significantly higher divorce rates. Obese patients were also investigated with the Strength and Difficulties Questionnaire (SDQ), another instrument that enables comparison between two measures of adjustment. The AAP had good psychometric properties; it was judged a useful instrument in research on adolescents with chronic diseases.

  • 38. Pettersson, Agneta
    et al.
    Boström, Kristina Bengtsson
    Gustavsson, Petter
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Which instruments to support diagnosis of depression have sufficient accuracy? A systematic review2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 7, p. 497-508Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Instruments are frequently used in case finding, diagnosis and severity grading of major depression, but the evidence supporting their utility is weak.

    AIM: To systematically review the specificity and sensitivity of instruments used to diagnose and grade the severity of depression.

    METHODS: MEDLINE, PsycInfo, Embase and the Cochrane Library databases were searched until April 2014. Fifty studies fulfilled the inclusion criteria. Risk of bias was assessed with QUADAS. The average sensitivity and specificity of each instrument was estimated with hierarchical summary receiver operating characteristics analyses and the confidence in the estimates was evaluated using GRADE. Minimum acceptable sensitivity/specificity, with structured interview as the reference, was 80%/80% for structured interviews and 80%/70% for case-finding instruments. The minimum acceptable standard for severity measures was a correlation of 0.7 with DSM-IV classification.

    RESULTS: Twenty instruments were investigated. The average sensitivity/specificity was 85%/92% for the Structured Clinical Interview for DSM-IV-Axis-I Disorders (SCID-I), 95%/84% for the Mini International Neuropsychiatric Interview (MINI), < 70%/85% for the Primary Care Evaluation of Mental Disorders (PRIME-MD), 88%/78% for the Patient Health Questionnaire-9 (PHQ-9) with a cut-off score of 10, 69%/95% for PHQ-9 as a diagnostic algorithm and 70%/83% for the Hospital Anxiety and Depression Scale (HADS) with a cut-off score of 7. The confidence in the estimates for the other instruments was very low.

    CONCLUSIONS: Only the SCID-I, MINI and PHQ-9 with a cut-off score of 10 fulfilled the minimum criteria for sensitivity and specificity. The use of the PRIME-MD and HADS is not supported by current evidence.

  • 39.
    Ramklint, Mia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Child and adolescent psychiatric disorders predicting adult personality disorder: A follow-up study2003In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 57, no 1, p. 23-28Article in journal (Refereed)
    Abstract [en]

    The objective of this study was to examine associations between childhood and adolescent psychiatric disorders and adult personality disorders in a group of former child psychiatric inpatients. One hundred and fifty-eight former inpatients with a mean age of 30.5 +/- 7.1 years at investigation had their childhood and adolescentAxis I disorders, obtained from their medical records, coded into DSM-IV diagnoses.Personality disorders in adulthood were assessed by means of the DSM-IV and ICD-10 Personality Questionnaire (DIP-Q). The predictive effects of child and adolescentAxis I disorders on adult personality disorders were examined with logistic regression analyses. The odds of adult schizoid, avoidant, dependent, borderline and schizotypalpersonality disorders increased by almost 10, five, four, three and three times, respectively, given a prior major depressive disorder. Those effects were independent of age, sex and other Axis I disorders. In addition, the odds of adult narcissistic and antisocial personality disorders increased by more than six and five times, respectively, given a prior disruptive disorder, and the odds of adult borderline, schizotypal, avoidant and paranoid personality disorders increased between two and three times given a prior substance-related disorder. The results illustrate an association between mental disorders in childhood and adolescence and adultpersonality disorders. Identification and successful treatment of childhood psychiatricdisorders may help to reduce the risk for subsequent development of an adultpersonality disorder.

  • 40.
    Rubertsson, Christine
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Obstetrics and Gynaecology.
    Börjesson, Karin
    Berglund, Anna
    Josefsson, Ann
    Sydsjö, Gunilla
    The Swedish validation of Edinburgh Postnatal Depression Scale (EPDS) during pregnancy2011In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 65, no 6, p. 414-418Article in journal (Refereed)
    Abstract [en]

    Background:

    Around 10-15% of women suffer from depressive illness during pregnancy or the first year postpartum. Depression during pregnancy constitutes a risk for prenatal stress and preterm birth. No validated screening instrument for detecting depression during pregnancy was available in Swedish.

    Aims:

    We aimed to validate the Edinburgh Postnatal Depression Scale (EPDS) against DSM-IV criteria for depression during pregnancy, establish a reliable cut-off and estimate the correlation between the EPDS and HAD-S (Hospital Anxiety and Depression Scale).

    Methods:

    In a population-based community sample of 1175 pregnant women, 918 women (78%) answered questionnaires with the EPDS and HAD-S. In all, 121 were interviewed using the PRIME-MD (Primary Care Evaluation of Mental disorders) for diagnosing depression. Women were interviewed in mean gestational week 13 (range 8-21). For the EPDS, a receiver operating characteristic (ROC) curve was calculated for prediction of depression. Pearson's correlation coefficient was used to investigate the association between EPDS and HAD-S scores.

    Results:

    The optimal cut-off score on the EPDS scale for detecting depression was >= 13 (standard error coefficient of 1.09 and c-statistics of 0.84) giving a sensitivity of 77% and specificity of 94%. The EPDS scores correlated strongly with the HAD-S, Pearson's correlation was 0.83 (P < 0.0001).

    Conclusions:

    This study confirms that the EPDS is a valid screening instrument for detection of depressive symptoms during pregnancy. The EPDS shows persuasive measuring outcomes with an optimal cut-off at >= 13. Clinical implications: Healthcare for pregnant women should consider screening procedures and follow-up routines for depressive symptoms.

  • 41.
    Rydell, Ann-Margret
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    An efficacy study of a combined parent and teacher management training programme for children with ADHD2012In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, no 66, p. 123-130Article in journal (Refereed)
  • 42. Sarin, Freddy
    et al.
    Wallin, Lennart
    Widerlöv, Birgitta
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Cognitive behavior therapy for schizophrenia: A meta-analytical review of randomized controlled trials2011In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 65, no 3, p. 162-174Article, review/survey (Refereed)
    Abstract [en]

    Background: In the UK and in Sweden, cognitive behavior therapy (CBT) has been recommended for schizophrenia. The two recent meta-analyses examined results soon after treatment and not at follow-up. Aim: To determine the effectiveness of CBT in people with schizophrenia, both after treatment and at follow-up, and to compare it with treatment as usual (TAU) and other psychological treatments. Methods: The search was carried in the databases CENTRAL (Cochrane Central Register of Controlled Trials), PsycINFO and PubMed (Medline). Inclusion criteria were randomized controlled trials (RCTs) with low risk of bias. Two reviewers, working independently, extracted data. The results were analyzed using risk ratio (RR), risk difference (RD), mean difference (MD), or standardized mean difference (SMD). Outcome measures were symptoms, use of medication, relapse and clinically important improvement. Results: When CBT was compared with other psychological treatments at follow-up, there was strong evidence (with small treatment effect) that intervention has an effect with positive symptoms (P == 0.02), negative symptoms (P == 0.03) and general symptoms (P == 0.003). After treatment, there was a trend in favor of CBT, but not statistically significantly so. Conclusion: It appears that the effect of CBT is delayed; it could be seen a few months after the treatment had terminated. Therapies for patients with schizophrenia that were 20 sessions long or more had better outcomes than those that were shorter.

  • 43.
    Silén, Marit
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Haglund, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Hansson, Mats G.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Centre for Research Ethics and Bioethics.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Ethics rounds do not improve the handling of ethical issues by psychiatric staff2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 6, p. 1700-1707Article in journal (Refereed)
    Abstract [en]

    Background. One way to support healthcare staff in handling ethically difficult situations is through ethics rounds that consist of discussions based on clinical cases and are moderated by an ethicist. Previous research indicates that the handling of ethically difficult situations in the workplace might have changed after ethics rounds. This, in turn, would mean that the “ethical climate”, i.e. perceptions of how ethical issues are handled, would have changed. Aim. To investigate whether ethics rounds could improve the ethical climate perceived by staff working in psychiatry outpatient clinics. Methods. In this quasi-experimental study, six inter-professional ethics rounds led by a philosopher/ethicist were conducted at two psychiatry outpatient clinics. Changes in ethical climate were measured at these clinics as well as at two control clinics at baseline and after the intervention period using the instrument Hospital Ethical Climate Survey. Results. Within-groups comparisons of median sum scores of ethical climate showed that no statistically significant differences were found in the intervention group before or after the intervention period. The median sum scores for ethical climate were significantly higher, both at baseline and after the intervention period (P ≤ 0.001; P = 0.046), in the intervention group. Conclusions. Ethics rounds in psychiatric outpatient clinics did not result in significant changes in ethical climate. Outcomes of ethics rounds might, to a higher degree, be directed towards patient-related outcomes rather than towards the staff's working environment, as the questions brought up for discussion during the ethics rounds concerned patient-related issues.

  • 44.
    Sjöberg, Rickard L.
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm , Centre for Clinical Research, County of Västmanland.
    Lindholm, Torun
    Children's autobiographical reports about sexual abuse: a narrative review of the research literature2009In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 63, no 6, p. 435-442Article, review/survey (Refereed)
    Abstract [en]

    Background: The empirical and theoretical literature on children's autobiographical statements about child sexual abuse and other forms of maltreatment should be of potential importance to all professionals who regularly interview children as part of their professional duties. Aims: To present an introduction to this field. Methods: Narrative review. Results: Preschool children appear to be capable of providing reliable testimony on highly salient personal experiences such as sexual abuse, though a substantial proportion of children may choose not to. However, suggestive interviewing practises, particularly when used with younger children, may elicit false allegations. There is little evidence to suggest that experiences from the preverbal period of life can later be meaningfully reconstructed by means of statements or clinical signs. Conclusions: Use of children as witnesses and informants requires special considerations, knowledge and skills.

  • 45.
    Sjölander, Linda
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Vadlin, Sofia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Olofsdotter, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Sonnby, Karin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Validation of the parent version of the World Health Organization Adult ADHD Self-Report Scale for adolescents.2016In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 70, no 4, p. 255-261Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: To investigate the validity of a parent version of the World Health Organization Adult Attention-Deficit/Hyperactivity Disorder (ADHD) Self-Report Scale for adolescents (ASRS-AP) and the 6-question screening version (ASRS-AP-S).

    METHODS: Adolescent psychiatric outpatients (N = 112, mean age 15 years, 40% boys) and their parents were interviewed with the Kiddie Schedule of Affective Disorders and Schizophrenia (K-SADS), and the parents reported on the ASRS-AP/ASRS-AP-S.

    RESULTS: Internal consistency (Cronbach's alpha) was 0.93 for ASRS-AP and 0.85 for ASRS-AP-S, 0.91 and 0.87 for the inattention subscale, and 0.91 and 0.72 for the hyperactivity subscale, respectively. The concurrent validity (Spearman's correlation coefficient) between the total K-SADS ADHD symptom severity score and the sum of the score on the ASRS-AP/ASRS-AP-S was 0.75 and 0.66, respectively. Diagnostic accuracy measures for the ASRS-AP and ASRS-AP-S were 78% and 80% sensitivity, 75% and 74% specificity, 73% and 71% positive predictive value (PPV), and 81% and 82% negative predictive value (NPV), respectively.

    CONCLUSIONS: The ASRS-AP and ASRS-AP-S showed high internal consistency and concurrent validity in relation to total K-SADS ADHD symptom severity score. Both scales showed favourable diagnostic accuracy measures.

  • 46. Soderstrom, Staffan
    et al.
    Pettersson, Richard
    Nilsson, Kent W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Quantitative and subjective behavioural aspects in the assessment of attention-deficit hyperactivity disorder (ADHD) in adults2014In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 68, no 1, p. 30-37Article in journal (Refereed)
    Abstract [en]

    Background: Self-rating scales and cognitive tests are instruments used in the assessment of attention-deficit hyperactivity disorder (ADHD). However, few studies have examined the differential validity of these kinds of instruments in psychiatric samples. Aims: To examine the discriminative validity of two self-report scales (ADHD Self-Report Scale [ASRS v. 1.1], Current Symptom Scale [CSS]) and a continuous performance test with measures of motor activity (QBTest Plus). Methods: The interrelation between the instruments, and their abilities to differentiate between patients with an ADHD diagnosis and non-ADHD patients referred for psychiatric assessment were examined in a naturalistic sample of 61 adult patients. Results: The area under the receiver operating characteristic curve (AUC) for the dichotomized versions of the test variables in all tests ranged from 0.61 to 0.71. The ASRS and CSS exhibited sensitivity of 90.2% and 85.4%, and specificity of 35.0% and 40.0%, respectively. Variables from the QBTest Plus showed the opposite result for the variables QBImpulsivity and QBInattention, with sensitivity of 58.5% and 36.3% and specifi city of 80.0% and 100.0%. Sensitivity and specifi city of QBActivity were 68.3% and 65.0%, respectively. A stepwise discriminant function analysis showed that two variables from the QBTest Plus-QBInattention and QBActivity-accounted for 22.8% of the between-group variability, with the strongest predictor being QBInattention. The function yielded an overall correct classification of 72.1%. The classification correctly identified 87.8% of patients diagnosed with ADHD and 40.0% of non-ADHD patients. Conclusion: The discriminant validity of self-rating scales and the more objective measure of ADHD symptoms are poor and should be integrated generally with other sources of data.

  • 47.
    Solstrand Dahlberg, Linda
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Wiemerslage, Lyle
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Swenne, Ingemar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Larsen, Anna
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Stark, Julia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Rask-Andersen, Mathias
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Salonen-Ros, Helena
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Larsson, Elna-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Schiöth, Helgi B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Brooks, Samantha J.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology. Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa.
    Adolescents newly diagnosed with eating disorders have structural differences in brain regions linked with eating disorder symptoms2017In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 71, no 3, p. 188-196Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Adults with eating disorders (ED) show brain volume reductions in the frontal, insular, cingulate, and parietal cortices, as well as differences in subcortical regions associated with reward processing. However, little is known about the structural differences in adolescents with behavioural indications of early stage ED.

    AIM: This is the first study to investigate structural brain changes in adolescents newly diagnosed with ED compared to healthy controls (HC), and to study whether ED cognitions correlate with structural changes in adolescents with ED of short duration.

    METHODS: Fifteen adolescent females recently diagnosed with ED, and 28 age-matched HC individuals, were scanned with structural magnetic resonance imaging (MRI). Whole-brain and region-of-interest analyses were conducted using voxel-based morphometry (VBM). ED cognitions were measured with self-report questionnaires and working memory performance was measured with a neuropsychological computerized test.

    RESULTS AND CONCLUSIONS: The left superior temporal gyrus had a smaller volume in adolescents with ED than in HC, which correlated with ED cognitions (concerns about eating, weight, and shape). Working memory reaction time correlated positively with insula volumes in ED participants, but not HC. In ED, measurements of restraint and obsession was negatively correlated with temporal gyrus volumes, and positively correlated with cerebellar and striatal volumes. Thus, adolescents with a recent diagnosis of ED had volumetric variations in brain areas linked to ED cognitions, obsessions, and working memory. The findings emphasize the importance of early identification of illness, before potential long-term effects on structure and behaviour occur.

  • 48.
    Sonnby, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Centrum för klinisk forskning, Västerås, Uppsala Universitet.
    Skordas, Konstantinos
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala Universitet.
    Olofsdotter, Susanne
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Centrum för klinisk forskning, Västerås, Uppsala Universitet.
    Vadlin, Sofia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Centrum för klinisk forskning, Västerås, Uppsala Universitet.
    Nilsson, Kent W.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland. Centrum för klinisk forskning, Västerås.
    Ramklint, Mia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala Universitet.
    Validation of the World Health Organization Adult ADHD Self-Report Scale for adolescents2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 3, p. 216-223Article in journal (Refereed)
    Abstract [en]

    Background: The World Health Organization Adult ADHD Self Report Scale (ASRS) is a widely used diagnostic tool for assessment of attention-deficit hyperactivity disorder (ADHD) symptoms in clinical psychiatry in Sweden. The ASRS consists of 18 questions, the first six of which can be used as a short screening version (ASRS-S). There is a version for adolescents—ASRS-Adolescent (ASRS-A)—and the corresponding screening version (ASRS-A-S), which has not been validated to date.

    Aim: The aim was to validate the ASRS-A and the ASRS-A-S for use in adolescent clinical populations.

    Methods: Adolescent psychiatric outpatients (n = 134, mean age 15 years, 40% boys) reported on the ASRS-A, and were interviewed with the Kiddie Schedule of Affective Disorders and Schizophrenia (K-SADS), a semi-structured interview, together with a parent.

    Results: Internal consistency was 0.79 for the ASRS-A-S and 0.92 for the ASRS-A (Cronbach's alpha). Internal consistency values were 0.79 and 0.87 for the inattention subscale, and 0.68 and 0.89 for the hyperactivity subscale, respectively. Concurrent validity values, measured with Spearman's correlation coefficient, between the total K-SADS ADHD symptom severity score and the sum of ASRS-A-S and ASRS-A total scores were 0.51 and 0.60, respectively. Psychometric properties of the ASRS-A-S and the ASRS-A were: sensitivity 74% and 79%; negative predictive value 81% and 84%; specificity 59% and 60%; and positive predictive value 49% and 51%, respectively. Both versions showed better properties for girls than for boys.

    Conclusion: Both the ASRS-A-S and the ASRS-A showed promising psychometric properties for use in adolescent clinical populations.

  • 49.
    Sonnby, Karin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Åslund, Cecilia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Leppert, Jerzy
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Nilsson, Kent W
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centre for Clinical Research, County of Västmanland.
    Symptoms of ADHD and depression in a large adolescent population: Co-occurring symptoms and associations to experiences of sexual abuse2011In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 65, no 5, p. 315-322Article in journal (Refereed)
    Abstract [en]

    Background: Symptoms of either attention-deficit hyperactivity disorder (ADHD) or depression constitute the most common reasons for contact with child and adolescent psychiatry. The development of psychiatric symptoms can be explained by a combination of environmental stress events and genetic vulnerability. One common form of environmental stress with high impact on health is sexual abuse.

    Aims: To investigate the prevalence and co-occurrence of symptoms of ADHD and depression in relation to experiences of sexual abuse in a large adolescent general population.

    Method: All 15- and 18-year-old students (n = 4910) in the Swedish county of Vestmanland answered a school-based screening instrument including the six-question ADHD self-rating scale (ASRS), the Depression Self-Rating Scale (DSRS) and questions relating to experiences of sexual abuse.

    Results: The prevalence of co-occurring symptoms of ADHD and depression was 2.4% (boys 1.0%, girls 3.9%). The prevalence of experience of any sexual abuse was 20.9% (boys 13.3%, girls 28.7%). Of those with co-occurring symptoms, 48% of the boys and 47% of the girls reported a history of sexual abuse.

    Conclusions: School-based screening for co-occurring symptoms of ADHD and depression might be a method that identifies students at psychiatric and psychosocial risk.

  • 50.
    Sundelin Wahlsten, Viveka
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Ahmad, Abdulbaghi
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Do Kurdistanian and Swedish parents and children differ in their rating of competence and behavioural problems?2002In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 56, no 4, p. 279-283Article in journal (Refereed)
    Abstract [en]

    Objective

    This paper investigates child self-rating of behavioural problems and competence as compared with their parents' ratings, in comparative samples of Kurdistanian refugee children in Sweden and a group of Swedish children.

    Method

    Kurdistanian and Swedish comparative samples composed of 32 children each matched in age, sex and trauma level, in the same community, and their parents. Among a large battery of instruments, the child behavioural checklist (CBCL) was used in separate interviews with parents and their children.

    Results

    When compared to the children's self-reported problems scores, the Swedish parents reported significantly lower scores than their children, compared to the Kurdistanian refugee parents.

    Conclusion

    Regardless of cultural backgrounds, there were more similarities than differences in the children's reporting of their behavioural problems and competence. The discrepancy between the Swedish parents' estimation of their children's behavioural problems and the children's self-reported behavioural problems could be an effect of the individualistic nature of Swedish society compared with the more collective nature of Kurdistanian culture. However, the results should be considered hypothesis generating rather than conclusive.

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