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  • 1.
    Alaie, Iman
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Philipson, Anna
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Ssegonja, Richard
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin/CHAP.
    Hagberg, Lars
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Feldman, Inna
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin/CHAP.
    Sampaio, Filipa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Socialmedicin/CHAP.
    Moller, Margareta
    Orebro Univ, Univ Hlth Care Res Ctr, Fac Med & Hlth, Orebro, Sweden.
    Arinell, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Ekselius: Psykiatri.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Ekselius: Psykiatri.
    Päären, Aivar
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    von Knorring, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Ekselius: Psykiatri.
    Olsson, Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    von Knorring, Anne-Liis
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Bohman, Hannes
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Jonsson, Ulf
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri. Karolinska Inst, Karolinska Inst KIND, Dept Womens & Childrens Hlth, Ctr Neurodev Disorders,Pediat Neuropsychiat Unit, Stockholm, Sweden;Stockholm Cty Council, Stockholm Hlth Care Serv, Ctr Psychiat Res, Stockholm, Sweden.
    Uppsala Longitudinal Adolescent Depression Study (ULADS)2019Ingår i: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, nr 3, artikel-id e024939Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Purpose: To present the Uppsala Longitudinal Adolescent Depression Study, initiated in Uppsala, Sweden, in the early 1990s. The initial aim of this epidemiological investigation was to study the prevalence, characteristics and correlates of adolescent depression, and has subsequently expanded to include a broad range of social, economic and health-related long-term outcomes and cost-of-illness analyses.

    Participants: The source population was first-year students (aged 16-17) in upper-secondary schools in Uppsala during 1991-1992, of which 2300 (93%) were screened for depression. Adolescents with positive screening and sex/age-matched peers were invited to a comprehensive assessment. A total of 631 adolescents (78% females) completed this assessment, and 409 subsequently completed a 15year follow-up assessment. At both occasions, extensive information was collected on mental disorders, personality and psychosocial situation. Detailed social, economic and health-related data from 1993 onwards have recently been obtained from the Swedish national registries for 576 of the original participants and an age-matched reference population (N=200 000).

    Findings to date: The adolescent lifetime prevalence of a major depressive episode was estimated to be 11.4%. Recurrence in young adulthood was reported by the majority, with a particularly poor prognosis for those with a persistent depressive disorder or multiple somatic symptoms. Adolescent depression was also associated with an increased risk of other adversities in adulthood, including additional mental health conditions, low educational attainment and problems related to intimate relationships.

    Future plans: Longitudinal studies of adolescent depression are rare and must be responsibly managed and utilised. We therefore intend to follow the cohort continuously by means of registries. Currently, the participants are approaching mid-adulthood. At this stage, we are focusing on the overall long-term burden of adolescent depression. For this purpose, the research group has incorporated expertise in health economics. We would also welcome extended collaboration with researchers managing similar datasets.

  • 2.
    Axfors, Cathrine
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Eckerdal, Patricia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa.
    Volgsten, Helena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Wikström, Anna-Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Klinisk obstetrik.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Sundström Poromaa, Inger
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Reproduktiv hälsa.
    Skalkidou, Alkistis
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Neuroticism is not independently associated with adverse obstetric or neonatal outcomes: An observational studyIngår i: Artikel i tidskrift (Refereegranskat)
  • 3.
    Axfors, Cathrine
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Hellgren, Charlotte
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Reproduktiv hälsa.
    Volgsten, Helena
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Skoog Svanberg, Agneta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Reproduktiv hälsa.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Wikström, Anna-Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Klinisk obstetrik.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Skalkidou, Alkistis
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Sundström-Poromaa, Inger
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Reproduktiv hälsa.
    Neuroticism is associated with higher antenatal care utilization in obstetric low-risk women2019Ingår i: Acta Obstetricia et Gynecologica Scandinavica, ISSN 0001-6349, E-ISSN 1600-0412, Vol. 98, nr 4, s. 470-478Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Introduction

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

    Material and methods

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

    Results

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

    Conclusions

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

  • 4.
    Axfors, Cathrine
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Sylvén, Sara
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Skalkidou, Alkistis
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk forskning.
    Adult attachment's unique contribution in the prediction of postpartum depressive symptoms, beyond personality traits2017Ingår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 222, s. 177-184Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background:

    Personality traits such as neuroticism can help identify pregnant women at risk of postpartum depressive symptoms (PPDS). However, it is unclear whether attachment style could have an additional contribution to this risk elevation. This study aimed to examine the overlap of adult attachment insecurity and neuroticism/trait anxiety as PPDS predictors, taking into account baseline depressive symptoms.

    Methods:

    A Swedish population-based sample of pregnant women reported on adult attachment and either neuroticism (n = 1063) or trait anxiety (n = 555). Depressive symptoms were assessed at baseline, and at six weeks and six months postpartum. Correlations between attachment and neuroticism/trait anxiety were calculated. Generalized linear models of PPDS tested the effect of attachment anxiety and avoidance, adjusting for neuroticism/trait anxiety and baseline depression. Logistic regression models with combined high attachment anxiety and-neuroticism/trait anxiety visualized their value as risk factors beyond antenatal depression.

    Results:

    Attachment and neuroticism/trait anxiety were highly correlated (r = .55.77). Attachment anxiety exerted a partially independent effect on PPDS at six weeks (p < .05) and at six months (p < .05) adjusting for neuroticism. Among antenatally non-depressed, combined high attachment anxiety and high neuroticism or trait anxiety was predictive of PPDS at both assessment points. Limitations: Low acceptance rate, exclusive use of self-reports.

    Conclusions:

    Beyond personality, attachment anxiety had a small independent effect on the risk of PPDS. Combining items of adult attachment and neuroticism/trait anxiety could prove useful in antenatal screening for high risk of PPDS.

  • 5.
    Axfors, Cathrine
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Sylvén, Sara
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Skalkidou, Alkistis
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kvinnors och barns hälsa, Forskargrupper (Inst. för kvinnor och barns hälsa), Obstetrisk och reproduktiv hälsoforskning.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Psychometric properties of the attachment style questionnaire in Swedish pregnant women: short and full versions2017Ingår i: Journal of Reproductive and Infant Psychology, ISSN 0264-6838, E-ISSN 1469-672X, Vol. 35, nr 5, s. 450-461Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objectives: (i) To evaluate the reliability and factor structure of the Attachment Style Questionnaire – Short Form (ASQ-SF) for use in pregnant women and (ii) to compare the reliability and factor structure of the short- and full version-ASQ among pregnant women. Background: Adult attachment insecurity is currently included as a major risk factor in studies of perinatal health. None of the self-report measures with a Swedish translation have been psychometrically evaluated in a pregnant cohort.

    Methods: A population-based cohort of 1631 pregnant women answered the ASQ in late pregnancy. Internal consistency (item- subscale correlations, Cronbach’s α, and α if item deleted) was evaluated for the seven available subscales. Con rmatory factor analysis (CFA) was run to examine the factor structure of the short form compared with the full-version. Test–retest correlations were assessed in a subgroup (n = 48).

    Results: All mean item-subscale correlations for the ASQ-SF were > 0.30. Cronbach’s α’s for ASQ-SF dimensions were as follows: Avoidance (0.87); Anxiety (0.89); Discomfort with Closeness (0.85); Relationships as Secondary (0.54); Con dence (0.83); Need for Approval (0.76); and Preoccupation with Relationships (0.77). No item removal substantively increased subscale α’s. The CFA demonstrated better model t for the ASQ-SF than for the full-version ASQ, while other reliability measures were similar. Test–retest correlations ranged from 0.65 to 0.84.

    Conclusion: The ASQ-SF showed similar psychometric properties in pregnant women as in the general population and had good reliability, but the optimal factor structure needs to be studied further. Results support the usage of the ASQ-SF in pregnant cohorts. 

  • 6.
    Cunningham, Janet L.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Zanzi, Manuel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Willebrand, Mimmie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    No regrets: Young adult patients in psychiatry report positive reactions to biobank participation2017Ingår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, artikel-id 21Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Research in vulnerable individuals must insure voluntariness and minimize negative reactions caused by participation. This study aimed to describe consent and completion rate in young psychiatric patients in relation to study components, degree of disability and to compare response to research participation in patients and controls.

    METHODS: Between 2012 and 2015, 463 patients with psychiatric disorders between the ages of 18-25 from the Dept. of General Psychiatry at Uppsala University Hospital and 105 controls were recruited to donate data and samples to a biobank. Consent and completion in relation to questionnaires, biological sampling of blood, saliva or feces, were monitored. Both groups were also asked about their perceived disability and how research participation affected them.

    RESULTS: Most patients who participated consented to and completed questionnaires and blood sampling. The majority also consented to saliva sampling, while less than half consented to collect feces. Of those who gave consent to saliva and feces only half completed the sampling. Both patients and controls reported high voluntariness and were positive to research participation. Within the patient group, those with greater perceived disability reported greater distress while participating in research, but there was no difference in consent or completion rates or level of regret.

    CONCLUSIONS: With the described information procedures, psychiatric patients, regardless of perceived disability, reported high voluntariness and did not regret participation in biobanking. Compared to questionnaires and blood sampling, given consent was reduced for feces and completion was lower for both saliva and feces sampling.

  • 7.
    Cunningham, Janet
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Zanzi, Manuel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Willebrand, Mimmie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Erratum to: No regrets2017Ingår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, nr 1, artikel-id 74Artikel i tidskrift (Refereegranskat)
  • 8.
    Cunningham, Janet
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Zanzi, Manuel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Willebrand, Mimmie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    No regrets: Young adult patients in psychiatry report positive reactions to biobank participation.2017Ingår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, nr 1, artikel-id 21Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Research in vulnerable individuals must insure voluntariness and minimize negative reactions caused by participation. This study aimed to describe consent and completion rate in young psychiatric patients in relation to study components, degree of disability and to compare response to research participation in patients and controls.

    METHODS: Between 2012 and 2015, 463 patients with psychiatric disorders between the ages of 18-25 from the Dept. of General Psychiatry at Uppsala University Hospital and 105 controls were recruited to donate data and samples to a biobank. Consent and completion in relation to questionnaires, biological sampling of blood, saliva or feces, were monitored. Both groups were also asked about their perceived disability and how research participation affected them.

    RESULTS: Most patients who participated consented to and completed questionnaires and blood sampling. The majority also consented to saliva sampling, while less than half consented to collect feces. Of those who gave consent to saliva and feces only half completed the sampling. Both patients and controls reported high voluntariness and were positive to research participation. Within the patient group, those with greater perceived disability reported greater distress while participating in research, but there was no difference in consent or completion rates or level of regret.

    CONCLUSIONS: With the described information procedures, psychiatric patients, regardless of perceived disability, reported high voluntariness and did not regret participation in biobanking. Compared to questionnaires and blood sampling, given consent was reduced for feces and completion was lower for both saliva and feces sampling.

  • 9.
    Ekselius, Lisa
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Andersson, Eva
    Fagemo, Ingalill
    Herlofson, Jörgen
    Kullgren, Gunnar
    Lindström, Eva
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Svanborg, Pär
    Personlighetsstörningar - Kliniska riktlinjer för utredning och behandling2006Rapport (Övrig (populärvetenskap, debatt, mm))
  • 10.
    Hörberg, Niklas
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Kouros, Ioannis
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    The Swedish version of the Sheehan Disability Scale: a valid and brief measure of functioning2016Ingår i: European Journal of Person Centered Healthcare, ISSN 2052-5656, Vol. 4, nr 1, s. 1-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Rationale, aims and objective: The Sheehan Disability Scale (SDS) is a brief instrument used to measure functional disability, but the Swedish translation has not been psychometrically evaluated. The aim of this paper is to test the psychometric properties of the Swedish translation and to further examine concurrent and external validity.

    Method: In this cross-sectional study, 160 young psychiatric patients from an open care unit in Sweden, were recruited based on a clinical diagnosis of Attention Deficit Hyperactivity Disorder (ADHD), Bipolar Disorder (BD) and/or Borderline Personality Disorder (BPD) and re-diagnosed for confirmation. Participants were interviewed concerning socio-demographic data and a socio-demographic index (SDI) was constructed. Reliability of SDS was measured as internal consistency and an exploratory factor analysis was performed. Level of functioning was measured by SDS scores and Global Assessment of Functioning (GAF). SDS, both self-assessed and expert rated and GAF scores were compared to measure concurrent validity, while SDS and the SDI were compared to measure external validity.

    Results: The Swedish SDS had a Cronbach’s alpha coefficient of 0.77. An exploratory factor analysis showed that the SDS-items loaded on a single factor with an eigenvalue of 2.06. Self-assessed SDS-scores correlated with expert rated GAF-scores (r = -0.606) and, to some extent, with SDI scores (r = 0.280). Patients with an SDI score ≥ 1 had higher SDS-scores (t=2.70, p=0.008).

    Conclusions: The Swedish SDS has similar psychometric properties as the English and Spanish versions. It showed both concurrent and external validity, but external validity was weaker

  • 11.
    Karawajczyk, Malgorzata
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Larsson, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Reduced cystatin C-estimated GFR and increased creatinine-estimated GFR in comparison with iohexol-estimated GFR in a hyperthyroid patient: A case report2008Ingår i: Journal of Medical Case Reports, ISSN 1752-1947, Vol. 2, nr 66Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    ABSTRACT: INTRODUCTION: Estimation of the glomerular filtration rate (GFR) is essential for the evaluation of patients with kidney disease, and for treating patients with drugs that are eliminated from the circulation by the kidneys. Cystatin C has been shown to be superior to creatinine for estimating GFR in several studies. However, studies showing that thyroid function has an impact on cystatin C have not addressed the question of whether the changes in cystatin C levels are due to changes in GFR or in cystatin C synthesis. CASE PRESENTATION: We report an account of a hyperthyroid patient with a discrepancy between the GFR estimates from cystatin C and creatinine. The cystatin C concentration (1.36 mg/L) was higher and gave an estimated GFR which was lower (51 mL/min/1.73 m2), while the creatinine concentration was lower (36 mumol/L) and gave a corresponding creatinine-estimated GFR that was higher (145 mL/min/1.73 m2) than the iohexol-estimated GFR (121 mL/min/1.73 m2) during the hyperthyroid period. After thyroidectomy, the creatinine concentration was 36 mumol/L and creatinine-estimated GFR was calculated as 73 mL/min/1.73 m2, while the cystatin C concentration and cystatin C-calculated GFR was 0.78 mg/L and 114 mL/min/1.73 m2, respectively. CONCLUSION: In contrast to creatinine, cystatin C levels rose in the hyperthyroid state as compared to the euthyroid state. The cystatin C-estimated GFR was reduced compared to the iohexol-estimated GFR. This patient case shows that the hyperthyroid-associated changes in cystatin C levels are not due to changes in GFR. Thyroid function should thus be considered when both cystatin C and creatinine are used as markers of kidney function.

  • 12.
    Kask, Jan
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Kolia, N
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Panagiotakos, D
    Department of Nutrition and Dietetics, Harokopio University, Athens, Greece.
    Ekbom, A
    Unit of Clinical Epidemiology, Department of Medicine, Karolinska Hospital, Karolinska Institute, Stockholm, Sweden.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Papadopoulos, Fotios C.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Anorexia nervosa in males: excess mortality and psychiatric co-morbidity in 609 Swedish in-patients2017Ingår i: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 47, nr 8, s. 1489-1499Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Anorexia nervosa (AN) is a psychiatric disorder with high mortality.

    METHOD: A retrospective register study of 609 males who received hospitalized care for AN in Sweden between 1973 and 2010 was performed. The standardized mortality ratios (SMRs) and Cox regression-derived hazard ratios (HRs) were calculated as measures of mortality. The incidence rate ratios (IRRs) were calculated to compare the mortality rates in patients with AN and controls both with and without psychiatric diagnoses.

    RESULTS: The SMR for all causes of death was 4.1 [95% confidence interval (CI) 3.1-5.3]. For those patients with psychiatric co-morbidities, the SMR for all causes of death was 9.1 (95% CI 6.6-12.2), and for those without psychiatric co-morbidity, the SMR was 1.6 (95% CI 0.9-2.7). For the group of patients with alcohol use disorder, the SMR for natural causes of death was 11.5 (95% CI 5.0-22.7), and that for unnatural causes was 35.5 (95% CI 17.7-63.5). The HRs confirmed the increased mortality for AN patients with psychiatric co-morbidities, even after adjusting for confounders. The IRRs revealed no significant difference in mortality patterns between the AN patients with psychiatric co-morbidity and the controls with psychiatric diagnoses, with the exceptions of alcohol use disorder and neurotic, stress-related and somatoform disorders, which seemed to confer a negative synergistic effect on mortality.

    CONCLUSION: Mortality in male AN patients was significantly elevated compared with the general population among only the patients with psychiatric co-morbidities. Specifically, the presence of alcohol and other substance use disorders was associated with more profound excess mortality.

  • 13.
    Knutsson-Medin, L.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Edlund, Birgitta
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Experiences in a group of grown-up children of mentally ill parents2007Ingår i: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 14, nr 8, s. 744-752Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Children of mentally ill parents have increased rates of psychopathology and reduced adaptive functioning. However, there are very few studies examining the subjective experiences of those children and their opinions concerning their previous contact with psychiatric services. This study followed up a group of children of former psychiatric inpatients by sending them a questionnaire asking about their experiences. Thirty-six individuals responded. Answers were analysed qualitatively by using manifest content analysis. Participants reported negative experiences and lack of information and support from psychiatric care. They had wanted more explanations and more support for themselves. Quantitative data are used to establish the significance of the results.

  • 14.
    Kouros, Ioannis
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Hörberg, Niklas
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Wender Utah Rating Scale-25 (WURS-25): psychometric properties and diagnostic accuracy of the Swedish translation2018Ingår i: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 123, nr 4, s. 230-236Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The aim of this study was to examine the psychometric properties and diagnostic accuracy of the Swedish version of the Wender Utah Rating Scale (WURS) in psychiatric patients with similar symptoms but diagnosed with either attention deficit hyperactivity disorder (ADHD), bipolar disorder (BP), and/or borderline personality disorder (BPD).

    Methods: A total of 121 patients from an outpatient psychiatric clinic for young adults (18–25 years) were diagnosed using the Structured Clinical Interview for DSM Axis I and Axis II (SCID-I and SCID-II), and ADHD was diagnosed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children (K-SADS). WURS were filled in by the participants and compared with a diagnosis of ADHD according to K-SADS.

    Results: Internal consistency of the WURS was 0.94. The principal component analysis resulted in a three-factor solution that accounted for 61.3% of the variance. The ADHD group had significantly higher mean scores compared to all other groups. The diagnostic accuracy of the WURS was examined using AUC and ROC analysis, and the optimal cut-off score was 39, with a sensitivity of 0.88 and specificity of 0.70, with AUC 0.87, 95% CI 0.80–0.94, PPV 0.59, and NPV 0.92.

    Conclusion: The psychometric properties of the Swedish WURS were good. For assessment of adult ADHD, in patients with symptoms of emotional instability, impulsivity, and attention problems but of different origins, a somewhat higher cut-off score than the originally suggested was preferable for identification of ADHD.

  • 15. Ljotsson, B.
    et al.
    Lundin, C.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Mitsell, K.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Carlbring, P.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Ghaderi, Ata
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Remote treatment of bulimia nervosa and binge eating disorder: A randomized trial of Internet-assisted cognitive behavioural therapy2007Ingår i: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 45, nr 4, s. 649-661Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The present study investigated the efficacy of self-help based on cognitive behaviour therapy in combination with Internet support in the treatment of bulimia nervosa and binge eating disorder. After confirming the diagnosis with an in-person interview, 73 patients were randomly allocated to treatment or a waiting list control group. Treated individuals showed marked improvement after 12 weeks of self-help compared to the control group on both primary and secondary outcome measures. Intent-to-treat analyses revealed that 37% (46% among completers) had no binge eating or purging at the end of the treatment and a considerable number of patients achieved clinically significant improvement on most of the other measures as well. The results were maintained at the 6-month follow-up, and provide evidence to support the continued use and development of self-help programmes.

  • 16.
    Meyer, Jenny
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Hallerbäck, Maria Unenge
    Cty Council Varmland, Child & Adolescent Psychiat Unit, Clin Res Ctr, Karlstad, Sweden.
    Lööf, Måns
    Child & Adolescent Psychiat Clin, Gavle, Sweden.
    Isaksson, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri. Karolinska Inst, Dept Womens & Childrens Hlth, Karolinska Inst Ctr Neurodev Disorders KIND Ctr P, Stockholm, Sweden.
    Evaluation of a structured skills training group for adolescents with attention deficit/hyperactivity disorder (ADHD) - study protocol of a randomised controlled trial.2019Ingår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 19, nr 1, artikel-id 171Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Attention deficit/hyperactivity disorder (ADHD) has a negative impact on several domains of life. However, there is a shortage of evidence-based non-pharmacological treatments for adolescents with ADHD. A structured skills training group (SSTG) based on dialectical behaviour therapy (DBT) has been used in adult patients with ADHD with some promising results, although the treatment has not yet been adapted or evaluated for adolescents with ADHD. This study protocol describes how this treatment was adapted for an adolescent population and how the efficacy of the SSTG will be evaluated using a randomised controlled trial (RCT) design.

    METHODS: A sample of 184 adolescents (15-18 years of age) with a diagnosis of ADHD has been recruited from seven child and adolescent psychiatric outpatient units and randomised to either the SSTG or an active control group based on psychoeducation. Measures are conducted weekly during the treatment, as well as 2 weeks before treatment and 2 weeks and 6 months after treatment. The primary outcome measures are ADHD symptoms, functional impairment, quality of life and mindfulness. Secondary outcome measures are symptoms of comorbid psychopathology, perceived stress and sleep problems. This article describes the design, methods and analysis plan for evaluating the efficacy of the SSTG.

    DISCUSSION: The study will be the first RCT to examine the acceptability and efficacy of a SSTG based on DBT adapted for adolescents with ADHD. We believe that the study will extend the current knowledge base about psychological treatment for adolescents with ADHD.

    TRIAL REGISTRATION: ISRCTN registry ( ISRCTN17366720 ). Retrospectively registered May 112,016.

  • 17.
    Odelius, Charlotta Benezeder
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Clinical utility of proposed non-suicidal self-injury diagnosis - A pilot study2014Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 68, nr 1, s. 66-71Artikel i tidskrift (Refereegranskat)
    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.

  • 18.
    Parling, Thomas
    et al.
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Cernvall, Martin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Klinisk psykologi i hälso- och sjukvård.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Holmgren, Sven
    Uppsala University Hospital, Uppsala, Sweden.
    Ghaderi, Ata
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    A randomised trial of Acceptance and Commitment Therapy for Anorexia Nervosa after daycare treatment, including five-year follow-up2016Ingår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 16, artikel-id 272Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: No specific psychotherapy for adult anorexia nervosa (AN) has shown superior effect. Maintenance factors in AN (over-evaluation of control over eating, weight and shape) were addressed via Acceptance and Commitment Therapy (ACT). The study aimed to compare 19 sessions of ACT with treatment as usual (TAU), after 9 to 12weeks of daycare, regarding recovery and risk of relapse up to five years. METHODS: Patients with a full, sub-threshold or partial AN diagnosis from an adult eating disorder unit at a hospital were randomized to ACT (n=24) and TAU (n=19). The staff at the hospital, as well as the participants, were unaware of the allocation until the last week of daycare. Primary outcome measures were body mass index (BMI) and specific eating psychopathology. Analyses included mixed model repeated measures and odds ratios. RESULTS: Groups did not differ regarding recovery and relapse using a metric of BMI and the Eating Disorder Examination Questionnaire (EDE-Q). There were only significant time effects. However, odds ratio indicated that ACT participants were more likely to reach good outcome. The study was underpowered due to unexpected low inflow of patients and high attrition. CONCLUSION: Longer treatment, more focus on established perpetuating factors and weight restoration integrated with ACT might improve outcome. Potential pitfalls regarding future trials on AN are discussed. Trial registration number ISRCTN 12106530. Retrospectively registered 08/06/2016.

  • 19.
    Ramirez, Adriana
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Axis IV - psychosocial and environmental problems - in the DSM-IV2013Ingår i: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 20, nr 9, s. 768-775Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Accessible summary

    • The aim of this study was to extensively explore the properties of the revised axis IV of the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV).
    • Psychosocial and environmental problems, which are believed to exacerbate current mental disorders, were evaluated by using a questionnaire and through clinical interviews. The reliability between self-assessment and professional assessment was also examined.
    • The results showed that the revised axis IV according to DSM-IV seems to have concurrent validity, but is still hampered by limited reliability.
    • These findings could be useful for the upcoming DSM-V revision as well as help clinicians and patients to better identify mental health problems.

    Abstract

    The aim of this study was to further explore the properties of axis IV in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV). In a naturalistic cross-sectional design, a group (n = 163) of young (18–25 years old) Swedish psychiatric outpatients was assessed according to DSM-IV. Psychosocial and environmental problems/axis IV were evaluated through structured interviewing by a social worker and by self-assessment on a questionnaire. Reliability between professional assessment and self-assessment of axis IV was examined. Concurrent validity of axis IV was also examined. Reliability between professional and self-assessed axis IV was fair to almost perfect, 0.31–0.83, according to prevalence and bias-adjusted kappa. Categories of psychosocial stress and environmental problems were related to the presence of axis I disorders, co-morbidity, personality disorders and decreasing Global Assessment of Functioning (GAF) values. The revised axis IV according to DSM-IV seems to have concurrent validity, but is still hampered by limited reliability.

  • 20.
    Ramirez, Adriana
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Axis V - Global Assessment of Functioning Scale (GAF), further evaluation of the self-report version2008Ingår i: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 23, nr 8, s. 575-579Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: The study aimed to examine agreement between patients' and professional staff members' ratings on the Global Assessment of Functioning scale (GAF). METHODS: A total of 191 young adult psychiatric outpatients were included in a naturalistic, longitudinal study. Axis I and axis II disorders were assessed by means of the Structured Clinical Interview for DSM-IV. Before and after treatment, patients and trained staff members did a GAF rating. Agreement between GAF ratings was analyzed using the intra-class correlation coefficient (ICC). RESULTS: The overall intra-class correlation coefficients before and after treatment were 0.65 and 0.86, respectively. Agreement in different axis I diagnostic groups varied, but was generally lower before treatment as compared to after treatment (0.50-0.66 and 0.78-0.90, respectively). Excessive psychiatric co-morbidity was associated with the lowest inter-rater reliability. Agreement, with respect to change in GAF scores during treatment, was good to excellent in all groups. CONCLUSION: Overall, agreement between patients' and professionals' ratings on the GAF scale was good before and excellent after treatment. The results support the usefulness of the self-report GAF instrument for measuring outcome in psychiatric care. However, more research is needed about the difficulties in rating severely disordered patients.

  • 21.
    Ramirez, Adriana
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Depression in young adult psychiatric outpatients: delimiting early onset2015Ingår i: Early Intervention in Psychiatry, ISSN 1751-7885, E-ISSN 1751-7893, Vol. 9, nr 2, s. 108-117Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim

    The aim of this study was to examine differences in childhood, adolescent and adult onset of depression.

    Methods

    Young psychiatric outpatients (n = 156) diagnosed with a lifetime depressive episode were divided into three groups according to age of onset of their first depressive episode: childhood (≤12 years, n = 21), adolescent (13–17 years, n = 58) and early adult onset (18–25 years,n = 77). Participants were assessed by diagnostic interviews and by questionnaires measuring previous life events and childhood developmental delays. Clinical characteristics and various risk factors were compared between groups.

    Results

    This clinical sample was dominated by women, with onset of their first depressive episode occurring during adolescence. Childhood onset was related to an increased number of depressive episodes, higher prevalence of personality disorders, more current social problems and more reported development delays during childhood regarding literacy learning, social skills and memory. They also reported more separation anxiety symptoms and neglect during childhood and more experiences of teenage pregnancies and abortions.

    Conclusions

    Childhood onset of depression is associated with more severe symptoms, more psychosocial risk factors and childhood developmental delays. Because all onset groups shared many features, the results are inconclusive if there are distinct subgroups according to age of onset.

  • 22.
    Ramirez, Adriana
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Mental Disorders Among Young Adults Self-Referred and Referred by Professionals to Specialty Mental Health Care2009Ingår i: Psychiatric Services, ISSN 1075-2730, E-ISSN 1557-9700, Vol. 60, nr 12, s. 1649-1655Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Psychiatric disorders among young adults are prevalent, although a minority seek treatment. The option of direct self-referral to specialty mental health care may lower the help-seeking threshold but may also lead to self-referral by those with symptoms but no diagnosable disorders. This study examined whether differences exist in morbidity and in past use of mental health services between self-referrals to specialty care and those referred by nonpsychiatrist professionals. METHODS: Two hundred consecutive young adult outpatients from a medium-sized city in Sweden who visited a specialty psychiatric clinic were assessed with the Structured Clinical Interview for DSM-IV (axis I and II disorders). Previous mental health contacts were also assessed. RESULTS: A total of 49 patients (25%) were self-referred and 151 (75%) were referred by nonpsychiatrist professionals. Mood disorders and specific phobia were more common among self-referred patients (p<.05 for both), but no other significant between-group differences in axis I or II disorders were found. No differences were found in number of current axis I disorders (2.3 for self-referred and 2.2 for the comparison group), number of lifetime diagnoses (2.9 and 2.9), self-reported age at onset (13.6 and 13.5 years), and GAF ratings (54.5 and 54.7). The proportion of patients with no previous mental health contacts was larger in the self-referred group (35% and 18%, p<.05). CONCLUSIONS: No evidence was found that the option of direct self-referral to specialty mental health care increased help seeking or led to overuse of care, although the generalizability of findings to other settings is unknown.

  • 23.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Influence of Child and Adolescent Psychopathology on Adult Personality Disorder2002Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Individuals afflicted with childhood and adolescent mental disorders have an increased risk for poor outcome in adulthood. The progression of psychopathology from childhood to adult life may be influenced by a multitude of interacting variables, both biological and psychosocial. There is limited information on the relationships between child psychopathology and adult personality and personality disorders. The main aim of this thesis was therefore to gain better knowledge concerning adult personality outcome in patients with early onset of mental disorders.

    Former child psychiatric patients as compared to controls had a significantly higher prevalence of all DSM-IV personality disorders (38.0 vs. 10.9 percent, p<0.001) and also a considerably higher personality disorder co-morbidity. They also had more psychosocial and environmental problems. This was exaggerated in those diagnosed with a personality disorder. Major depression, disruptive disorders and substance use disorders at a young age were strong predictors for adult personality disorder.

    Patients with an early onset major depression had more personality disorders and more deviant personality traits than those with a late onset.

    Forensic psychiatric male patients diagnosed with a previous conduct disorder as compared to those without had more cluster B personality disorders, and more repeated violent criminality and mixed abuse. They also exhibited more deviant personality traits and higher psychopathy scores.

    The instrument "Child and Adolescent Psychiatric Screening Inventory-Retrospect" had acceptable sensitivity and specificity for assessment of child psychiatric disorders. Subscales demonstrated good internal reliability (Crohnbach´s alpha = 0.76-0.93).

    The results suggest that adult personality disturbances are prevalent in individuals affected with mental problems at young ages. A better understanding of the transition of psychopathology from childhood to adulthood and a better identification of those at risk will be of help in attempts to prevent permanent impact on the adult personality.

  • 24.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ungdomar med psykisk ohälsa2013Ingår i: Hälsofrämjande arbete med barn och ungdomar / [ed] Ann-Cathrine Bramhagen & Anna Carlsson, Lund: Studentlitteratur AB, 2013, 1Kapitel i bok, del av antologi (Övrig (populärvetenskap, debatt, mm))
  • 25.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ätstörningar2016Ingår i: Psykiatri / [ed] Jörgen Herlofson, Lisa Ekselius, Anders Lundin, Björn Mårtensson, Marie Åsberg, Lund: Studentlitteratur AB, 2016, 2, s. 443-452Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 26.
    Ramklint, Mia
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Personality disorders and personality traits in early onset versus late onset major depression2003Ingår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 75, nr 1, s. 35-42Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: We aimed to determine the relationship between certain personalitydisorders and/or personality traits and early onset major depression. Methods: A total of 400 depressed primary care patients were assessed for personality disorders using the SCID screen and for personality traits using the Karolinska Scales of Personality (KSP) questionnaire. Early onset was defined as onset of the first episode before the age of 26. Logistic regressions were performed to reveal relationships after adjustment for sex, age and number of previous episodes. Results: Both groups had a similar severity of current illness determined by the Montgomery-Angstromsberg Depression Rating Scale. Those with anearly onset presented with a more debilitating course, seen in the form of more depressive episodes and previous hospitalisations in spite of their younger age. Early onset was also an independent predictor for avoidant, borderline and paranoid personality disorders. It also predicted increased scores on the KSP scales Psychic anxiety, Psychasthenia, Muscular tension, Suspicion and Irritability, and decreased Socialisation. Limitations: The evaluation was performed as a self-assessment, subjects had a superimposed major depressive episode when assessed, and subgroups of individuals were not eligible. Conclusions: Earlyonset major depression is a predictor for personality pathology and deviant personality traits. A better understanding of the interplay between genetics and environment that underlies this phenomenon will help to improve the long-term course in afflicted individuals.

  • 27.
    Ramklint, Mia
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Jeansson, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Holmgren, Sven
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ghaderi, Ata
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Assessing personality disorders in eating disordered patients using the SCID-II: Influence of measures and timing on prevalence rate2010Ingår i: Personality and Individual Differences, ISSN 0191-8869, E-ISSN 1873-3549, Vol. 48, nr 2, s. 218-223Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The SCID-II Personality Questionnaire is available as a screening tool to shorten the time it takes to perform the SCID-II interview. However, very little is known about combining the questionnaire with the interview in eating disordered individuals. The aim of this study was to examine the prevalence of personality disorder (PD) among patients with eating disorders (ED) by combining initial screening self-assessment with a later interview. not performed until axis I symptoms decreased. This was performed on 154 patients with ED. According to the initial self-assessment, the rate of any PD was 90%; however, according to the later SCID-II interview, the rate decreased to 37%. In a sub-sample of 15 patients, the questionnaire was filled out twice: at intake and at the time of the interview. In the subgroup performing the questionnaire twice, there was no decline in PD symptoms over time. However, the PD rate decreased significantly when the patient was assessed by the interview. These findings indicate that the influence of measures might be greater than the influence of timing. The findings support that prevalence rates of PD in eating disordered patients are high, but not as high as it has commonly been reported.

  • 28.
    Ramklint, Mia
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Jeansson, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Holmgren, Sven
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ghaderi, Ata
    Uppsala universitet, Humanistisk-samhällsvetenskapliga vetenskapsområdet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Guided self-help as the first step for bulimic symptoms: Implementation of a stepped-care model within specialized psychiatry2012Ingår i: International Journal of Eating Disorders, ISSN 0276-3478, E-ISSN 1098-108X, Vol. 45, nr 1, s. 70-78Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: This study describes the implementation and effectiveness of the first step, guided self-help (GSH), in a clinical setting, of a stepped-care model of cognitive behavior therapy for patients with bulimic symptoms.

    Method: Eighty-nine patients participated.

    Results: In the intent to-treat analyses, the effect sizes were small to moderate (0.25-0.66). However, the effect sizes were substantially larger (0.44-1.66) for the patients who completed all the GSH sessions (45%). The majority of non-completers stayed within psychiatric services. Supplementary treatments were mostly directed towards comorbid conditions, especially depression. Those discontinuing treatment in advance where characterized by more lifetime diagnoses and higher ratings on the restraint subscale of the EDE-Q.

    Discussion: GSH within specialized psychiatry might be effective for about 30% of the patients. There is no indication of patients losing their confidence in psychiatric services by being offered GSH as the first treatment.

  • 29.
    Ramklint, Mia
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Stålenheim, E. Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    von Knorring, Anne-Liis
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    von Knorring, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Conduct disorder and personality in a forensic psychiatric population2001Ingår i: European Journal of Psychiatry, ISSN 0213-6163, E-ISSN 2340-4469, Vol. 15, nr 4, s. 245-254Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The present study examined 61 men at forensic psychiatric investigation. We compared subjects with or without an assessed previous conduct disorder (CD versus non CD). The CD group showed more DSM-HI-R personality disorders, exhibited more repeated violent criminality and more mixed drug abuse. The CD group differed from the non CD group according to specific personality traits assessed by the Karolinska Scales of Personality (KSP) showing lower scores on the Social desirability and Socialization scale, and higher scores on the Impulsiveness, Monotony avoidance, Verbal aggression, Iritability and Suspicion scales. The CD group had higher psychopathy scores assessed by the Psychopathy Checklist-Revised (PCL-R). The results are in accordance with previous findings in juvenile conduct disordered men. They indicate that personality traits are detectable early in life and stable over time influencing behaviours such as criminality and drug abuse.

  • 30.
    Ramklint, Mia
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Stålenheim, E Gunilla
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    von Knorring, Anne-Liis
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    von Knorring, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Triiodothyronine (T3) related to adolescent conduct disorder in a forensic psychiatric population2000Ingår i: European Journal of Psychiatry, ISSN 0213-6163, E-ISSN 2340-4469, Vol. 14, nr 1, s. 33-41Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    he present study evaluates the relatioships between the thyroid hormones, triiodothyronine (T3) and thyroxine (FT4), in adult life and a history of conduct disorder in 61 men from a forensic psychiatric population. The study population was divided into four groups based on the presence or not of an assessed conduct disorder, as well as a previous child psychiatric contact. The highest T3 values were found in patients with both a previous conduct disorder and a previous child psychiatric contact. There was a positive relationship between conduct disorder and serum levels of FT4. These results may indicate that T3 is a biological marker of aggressive behaviour in children.

  • 31.
    Ramklint, Mia
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    von Knorring, AL
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    von Knorring, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Child and Adolescent Psychiatric Screening Inventory - Retrospect (CAPSI-R): a questionnaire for adults concerning child and adolescent mental disorders.2002Ingår i: European Psychiatry, Vol. 17, s. 61-Artikel i tidskrift (Refereegranskat)
  • 32.
    Ramklint, Mia
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    von Knorring, Anne-Liis
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    von Knorring, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Child and adolescent psychiatric disorders predicting adult personality disorder: A follow-up study2003Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 57, nr 1, s. 23-28Artikel i tidskrift (Refereegranskat)
    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.

  • 33.
    Ramklint, Mia
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    von Knorring, Anne-Liis
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    von Knorring, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Personality disorders in former child psychiatric patients2002Ingår i: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 11, s. 289-295Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The present case-control study was undertaken in order to investigate the long-term outcome with respect to personality disorder (PD) symptomatology in former childpsychiatric in-patients as compared to matched controls from the general population. Altogether 359 former patients and 359 controls were invited to participate in the study. Of these, 164 (46%) former patients and 193 (54%) controls approved participation. From these, 137 age and sex-matched pairs with a mean age of 30.7 (SD = 6.8) years were constructed. Adult PD symptomatology was assessed by means of the DSM-IV and ICD-10 PersonalityQuestionnaire (DIP-Q). There were 52 former patients (38%) and 15 controls (10.9%) who fulfilled criteria for at least one DSM-IV self-reported PD. There was a significantly higher prevalence for all specific self-reported PDs in former patients compared to controls. The mean number of disorders was 1.7 (SD = 2.6) in former patients and 0.3 (SD = 0.8) incontrols. Moreover, former patients fulfilled more PD criteria than controls (23 vs. 11; median numbers). The former patients had significantly lower global functioning and more psychosocial problems than the controls. These problems were related to personalitypathology. The results of this study indicate that child psychiatric morbidity seems to increase the risk for adult PD symptomatology. However, the results may be biased by the low participation rate.

  • 34.
    Silén, Marit
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Centrum för forsknings- och bioetik.
    Haglund, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Hansson, Mats G.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Centrum för forsknings- och bioetik.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap.
    Ethics rounds do not improve the handling of ethical issues by psychiatric staff2015Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, nr 6, s. 1700-1707Artikel i tidskrift (Refereegranskat)
    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.

  • 35.
    Silén, Marit
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Vårdvetenskap.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Hansson, Mats G
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för folkhälso- och vårdvetenskap, Centrum för forsknings- och bioetik.
    Haglund, Kristina
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ethics rounds: An appreciated form of ethics support2016Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 23, nr 2, s. 203-213Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Ethics rounds are one way to support healthcare personnel in handling ethically difficult situations. A previous study in the present project showed that ethics rounds did not result in significant changes in perceptions of how ethical issues were handled, that is, in the ethical climate. However, there was anecdotal evidence that the ethics rounds were viewed as a positive experience and that they stimulated ethical reflection.

    AIM: The aim of this study was to gain a deeper understanding of how the ethics rounds were experienced and why the intervention in the form of ethics rounds did not succeed in improving the ethical climate for the staff.RESEARCH DESIGN:An exploratory and descriptive design with a qualitative approach was adopted, using individual interviews.

    RESEARCH DESIGN: An exploratory and descriptive design with a qualitative approach was adopted, using individual interviews.

    PARTICIPANTS AND RESEARCH CONTEXT: A total of 11 healthcare personnel, working in two different psychiatry outpatient clinics and with experience of participating in ethics rounds, were interviewed.

    ETHICAL CONSIDERATIONS: The study was based on informed consent and was approved by one of the Swedish Regional Ethical Review Boards.

    FINDINGS: The participants were generally positive about the ethics rounds. They had experienced changes by participating in the ethics rounds in the form of being able to see things from different perspectives as well as by gaining insight into ethical issues. However, these changes had not affected daily work.

    DISCUSSION: A crucial question is whether or not increased reflection ability among the participants is a good enough outcome of ethics rounds and whether this result could have been measured in patient-related outcomes. Ethics rounds might foster cooperation among the staff and this, in turn, could influence patient care.

    CONCLUSION: By listening to others during ethics rounds, a person can learn to see things from a new angle. Participation in ethics rounds can also lead to better insight concerning ethical issues.

  • 36.
    Sonnby, Karin
    et al.
    Centrum för klinisk forskning, Västerås.
    Nilsson, Kent W.
    Centrum för klinisk forskning, Västerås.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset. Uppsala Universitet.
    Influence of the parent–adolescent relationship on mental health help-seekingManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Objective: To investigate help-seeking from specialized mental health services, especially in relation to the parent–adolescent relationship, as measured by attachment, and symptoms of attention deficit hyperactivity disorder (ADHD) and/or depression and sex.

    Methods: The study was epidemiological and cross-sectional, and used the Experiences in Close Relationships-Revised-Children (ECR-RC9), the Adult ADHD Self-Report Scale Screener and the Depression Self-Rating Scale-Adolescents. Adolescents, 15 to 18 years old, from the Swedish county of Västmanland participated (N = 4,506, 74% participation rate).

    Results: Help-seeking was predicted by co-occurring symptoms of ADHD and depression (OR = 5.4), symptoms of depression (OR = 4.8) and symptoms of ADHD (OR = 2.6), as well as any experience of sexual abuse (OR = 1.7) and being female (OR = 1.6). Secure attachment to parents, assessed with the ECR-RC9, did not increase help-seeking. Furthermore, in interaction analyses secure attachment to parents in combination with experiences of sexual abuse and/or conduct problems, or to be female and have symptoms of ADHD, decreased the probability of help-seeking.

    Conclusion: Secure attachment, as a measure of the adolescent’s willingness to communicate with their parents about their problems, did not increase help-seeking. Symptoms of ADHD and/or depression predicted help-seeking more than any psychosocial factor.

  • 37.
    Sonnby, Karin
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Centrum för klinisk forskning, Västerås, Uppsala Universitet.
    Skordas, Konstantinos
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset. Uppsala Universitet.
    Olofsdotter, Susanne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Centrum för klinisk forskning, Västerås, Uppsala Universitet.
    Vadlin, Sofia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Centrum för klinisk forskning, Västerås, Uppsala Universitet.
    Nilsson, Kent W.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås. Centrum för klinisk forskning, Västerås.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset. Uppsala Universitet.
    Validation of the World Health Organization Adult ADHD Self-Report Scale for adolescents2015Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, nr 3, s. 216-223Artikel i tidskrift (Refereegranskat)
    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.

  • 38.
    Ståleheim, Gunilla
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    von Knorring, Lars
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Penayo, Ulises
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Bakall, David
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Dyster-Aas, Johan
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Eriksson, Tobias
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Hedlund, Mathilde
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Lindström, Britt
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    de Severin, Aurora
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Szmidt, Malgorzata
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Werner, Jacob
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Odiagnostiserade depressioner finns överallt i vården: Somatisk öppen och sluten vård och primärvård i Uplland screenad2003Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, nr 36, s. 2760-2763Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [sv]

    En större undersökning av depressionsförekomsten inom somatisk öppen och sluten vård samt inom pri- märvården genomfördes under våren 2002 i Uppland under namnet »Depression screening day«.

    52 av 267 patienter hade en depressionsdiagnos känd inom rutinsjukvården. I samband med undersökning- en upptäcktes ytterligare 40 patienter som hade en de- pression.

    En del av de nyupptäckta depressionerna var av lätta- re slag, men knappt 40 procent var av sådan svårig- hetsgrad att de enligt gällande rekommendationer från Läkemedelsverket skulle motivera behandling.

    Inga signifikanta skillnader i svårighetsgrad förelåg mellan patienter diagnostiserade inom rutinsjukvår- den och patienter diagnostiserade i samband med en screeningundersökning. Det tycks således inte främst vara specifika karakteristika hos de depressiva syndro- men som avgör om patienten diagnostiseras inom ru- tinsjukvården eller inte.

  • 39.
    Sundberg, Isak
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Jacobson, Annica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinsk biokemi och mikrobiologi. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ekselius, L
    Cunningham, Janet
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Daytime Melatonin Levels in Saliva are Associated with Inflammatory Markers and Anxiety Disorders in Young Adults with Psychiatric DiseaseManuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    The bidirectional interaction between melatonin and the immune system has largely gone unexplored in a clinical context and especially in a psychiatric population. This study explored the association between melatonin during the day and inflammatory cytokines in young adult patients seeking psychiatric care. Samples and data were collected from 108 young adults (mean age 21, SD=2) at an outpatient clinic for affective disorders. Daytime saliva melatonin levels were analyzed with enzyme-linked immunosorbent assay in relation to normalized serum expression levels of 72 inflammatory markers in a proximity extension assay. In a post hoc analysis, the markers with a significant association with melatonin were tested in a generalized linear model to see whether there is a relationship to anxiety disorder or depression. After Bonferroni correction for multiple testing, melatonin levels at 11:00 were positively correlated with cluster of differentiation 5 (CD5; p=4.2e-4, p adj=0.03). Melatonin levels after lunch were correlated with monocyte chemoattractant protein-1 (MCP-1; p=4.2e-4p adj=0.03), monocyte inflammatory protein-1 alpha (MIP-1α; p=6.5e-4p adj=0.047) and vascular endothelial growth factor A (VEGF-A; p=5.3e-6p adj=0.004). In the generalized linear model, positive associations were found between the presence of any anxiety disorder after lunch and melatonin (p=0.046), VEGF-A (p=0.001) and MIP-1α (p=0.001). Daytime saliva levels of melatonin were related to several inflammatory markers in psychiatric patients. This observation likely reflects the bidirectional relationship between melatonin production and the immune system. These findings may have relevance for the understanding of psychiatric disorders and other disorders associated with the same underlying pathogenesis, including low-grade inflammation.

  • 40.
    Sundberg, Isak
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Lannergård, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Infektionsmedicin.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Cunningham, Janet
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Inflammatory Cytokines in a Repeated Measures Prospective Case Study of Interferon-Induced Depression2017Ingår i: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 81, nr 10, s. S399-S399Artikel i tidskrift (Övrigt vetenskapligt)
  • 41.
    Sundberg, Isak
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Lannergård, Anders
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Infektionsmedicin.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Cunningham, Janet L
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Direct-acting antiviral treatment in real world patients with hepatitis C not associated with psychiatric side effects: a prospective observational study2018Ingår i: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, artikel-id 157Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Treatment of Hepatitis C virus (HCV) infection has evolved from interferon (IFN)-based treatments to direct-acting antivirals (DAAs). Patients with HCV have an elevated psychiatric morbidity (including substance abuse) and patients with such comorbidity have often been excluded from treatment with IFN. To date, little is known about psychiatric adverse effects of DAA-based regimens. We therefore aimed to study the psychiatric side effects of new IFN-free treatment for HCV (including depressive symptoms and sleep) in real world patients also including those with a history of psychiatric diagnosis, substance abuse or drug dependence. Methods: Consecutive patients were monitored during treatment with three of the latest DAA agents (sofosbuvir, simeprevir and daclatasvir). Repeated expert psychiatric assessments from baseline to 12 weeks post-treatment were performed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) clinical version and the self-report versions of the Montgomery Asberg Depression Rating Scale (MADRS-S) and the Pittsburgh Sleep Quality Index (PSQI). Friedman's test was performed to calculate differences in the MADRS-S and PSQI over time. In a post-hoc analysis Wilcoxon's test was used to compare baseline depressive symptoms with those at post-treatment. Spearman's rank correlation test was conducted in another post-hoc analysis to evaluate the correlation between symptoms of depression and HCV viral load at baseline. Results: At baseline, 15/17 patients (88%) had a history of any psychiatric diagnosis; 11 (65%) had a history of substance abuse or dependence; and 11 (65%) had previously been treated with IFN and six of those had experienced psychiatric side effects. There was no correlation between depressive symptoms and HCV viral load at baseline. Symptoms of depression did not increase during DAA treatment and were lower 12 weeks post-treatment compared with baseline: MADRS-S 10.7 vs. 8.3 (p = 0.01). This observation held when excluding patients taking antidepressant medication. Sleep quality did not significantly change during treatment. Adherence to treatment was estimated to 95% and sustained virological response was 88%. Conclusions: Despite high psychiatric morbidity, including previous substance abuse, patients successfully completed DAA treatment without increasing depressive symptoms or sleep disturbance. Symptoms of depression were significantly reduced 12 weeks after DAA treatment.

  • 42.
    Sundberg, Isak
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Stridsberg, Mats
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Biokemisk endokrinologi.
    Papadopoulos, Fotios C
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Cunningham, Janet L
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Salivary Melatonin in Relation to Depressive Symptom Severity in Young Adults.2016Ingår i: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 11, nr 4, artikel-id e0152814Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Reduced levels of melatonin have been associated with severe depression. The aim was to investigate the correlation between salivary melatonin and dimensional measures of depressive symptom severity in young adult psychiatric patients. Levels of melatonin were analyzed in six saliva samples during waking hours from 119 young adult patients under outpatient psychiatric care. Melatonin levels were tested for association with the severity of depressive symptoms using the self-rating version of the Montgomery Åsberg Depression Rating Scale (MADRS-S). Where possible, depressive symptoms were assessed again after 6±2 months of treatment. Response was defined as decrease in MADRS-S by ≥50% between baseline and follow-up. Patients with levels of melatonin in the lowest quartile at bedtime had an increased probability of a high MADRS-S score compared to those with the highest levels of melatonin (odds ratio 1.39, 95% CI 1.15-1.69, p<0.01). A post hoc regression analysis found that bedtime melatonin levels predicted response (odds ratio 4.4, 95% CI 1.06-18.43, p<0.05). A negative relationship between salivary melatonin and dimensional measures of depressive symptom severity was found in young patients under outpatient psychiatric care. Bedtime salivary melatonin levels may have prognostic implications.

  • 43.
    Syk, Mikaela
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ellström, Sofie
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Mwinyi, Jessica
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Funktionell farmakologi.
    Schiöth, Helgi B.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Funktionell farmakologi.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Cunningham, Janet L.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Plasma levels of leptin and adiponectin and depressive symptoms in young adults2019Ingår i: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 272, s. 1-7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

  • 44.
    Syk, Mikaela
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Fredriksson, Robert
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Farmaceutiska fakulteten, Institutionen för farmaceutisk biovetenskap.
    Ekselius, Lisa
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Cunningham, Janet L.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Elevated total plasma-adiponectin is stable over time in young women with bulimia nervosa2017Ingår i: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 41, s. 30-36Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Bulimia nervosa (BN) is characterized by dysregulated eating behaviour and present data suggest adipokines may regulate food intake. We investigated a possible association between BN and adipokine levels and hypothesized that plasma (P)-adiponectin would be elevated and P-leptin and P-leptin-adiponectin-ratio would be reduced in women with BN.

    METHODS: The study was designed as a cross-sectional study with a longitudinal arm for patients with BN. Plasma-adiponectin and leptin was measured in 148 female patients seeking psychiatric ambulatory care and 45 female controls. Fifteen patients were diagnosed with BN and the remaining with other affective and anxiety disorders. P-adiponectin and P-leptin levels were compared between patients with BN, patients without BN and controls. At follow-up 1-2years later, adipokines were reassessed in patients with BN and the Eating Disorder Examination Questionnaire was used to assess symptom severity.

    RESULTS: P-adiponectin was elevated in patients with BN at baseline and at follow-up when compared to patients without BN and controls (P<0.004 and <0.008 respectively). The difference remained significant after controlling for body mass index. P-adiponectin was correlated to symptom severity at follow-up in patients with BN without morbid obesity (ρ=0.72, P<0.04). P-leptin-adiponectin-ratio was significantly lower in patients with BN compared to controls (P<0.04) and P-leptin non-significantly lower.

    CONCLUSIONS: Findings indicate a stable elevation of P-adiponectin in women with BN. P-adiponectin at follow-up correlates to eating disorder symptom severity in patients without morbid obesity, indicating that P-adiponectin should be further investigated as a possible potential prognostic biomarker for BN.

  • 45.
    Söderquist, Fanny
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Sundberg, Isak
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Widerström, Rebecka
    Uppsala Univ, Uppsala, Sweden..
    Hellström, Per M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Gastroenterologi/hepatologi.
    Cunningham, Janet
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Daytime Salivary Melatonin Related to Gastrointestinal Symptoms in Young Adults Seeking Psychiatric Care2018Ingår i: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 83, nr 9, s. S185-S186Artikel i tidskrift (Övrigt vetenskapligt)
  • 46.
    Söderquist, Fanny
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Sundberg, Isak
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Widerström, Rebecka
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Hellström, Per M.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för medicinska vetenskaper, Gastroenterologi/hepatologi.
    Cunningham, Janet
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    The Relationship Between Daytime Salivary Melatonin and Gastrointestinal Symptoms in Young Adults Seeking Psychiatric Care2019Ingår i: Psychosomatic Medicine, ISSN 0033-3174, E-ISSN 1534-7796, Vol. 81, nr 1, s. 51-56Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: The pathophysiology of irritable bowel syndrome (IBS) is not completely understood, although we do know that patients with IBS have a high prevalence of psychiatric comorbidity (mainly depression and anxiety disorders). Melatonin, produced in the gastrointestinal tract, influences gutmotility. Psychiatric conditions are associated with circadian disturbances in peripheral melatonin levels. This study aimed to investigate associations between daytime salivary melatonin and gastrointestinal symptoms in young adult psychiatric patients.

    Methods: Ninety-six patients (86% women), aged 18-25 years (M (SD) = 21 (2)), seeking psychiatric care with primarily anxiety disorders, affective disorders, or both were included in the study. Total scores from the Gastrointestinal Symptoms Rating Scale -IBS were compared with salivary melatonin measured at three time points (30 minutes after waking up, at 11: 00 hours and 30 minutes after lunch) during the waking hours of 1 day.

    Results: After adjustment for potential confounders, melatonin levels in saliva 30 minutes after lunch remained significantly correlated to the total Gastrointestinal Symptoms Rating Scale -IBS score after correction for multiple testing (B = 0.016, SE = 0.006, p =.015, q = 0.045). In a post hoc analysis, symptoms of gastrointestinal pain and bloating contributed most to this association.

    Conclusions: In young adult psychiatric patients, salivary melatonin levels after lunch are associated with gastrointestinal symptoms, which is consistent with the proposed effect of elevated levels of gastrointestinal melatonin on gut motility. This result suggests a link between IBS symptoms and regulation of melatonin in patients with psychiatric disorders.

  • 47.
    Tahib, Nezar
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri. Directorate General of Health in Duhok, Kurdistan region, Iraq.
    Arinell, Hans
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Ahmad, Abdulbaghi
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Validation of the Kurdish version of the Harvard-Uppsala Trauma Questionnaire for Children (HUTQ-C)Manuskript (preprint) (Övrigt vetenskapligt)
    Abstract [en]

    Harvard-Uppsala Trauma Questionnaire for Children (HUTQ-C) is an instrument developed from the adult version of the Harvard Trauma Questionnaire (HTQ) by adding 13 child specific items. The HUTQ-C is used to identify traumatic events among children. However, no psychometric evaluation of the Kurdish translation of the HUTQ-C has been published. The aim of this article was to study the psychometric characteristics of the Kurdish version of the HUTQC. Data on HUTQ-C were collected for 100 street working children and 100 school children in Duhok. The internal consistency of the HUTQ-C was examined with Cronbach's alpha. The convergent validity of the HUTQ-C was examined by comparison with the Child Behavior Checklist (CBCL). The internal consistency for the total 30 items HUTQ-C of the three domains, experienced, witnessed and heard, showed good internal consistency; Cronbach’s alpha was 0.83. The HUTQ-C showed higher internal consistency than both the original 17 items from HTQ and the added 13 child specific items, when these were examined separately. There was significant difference in HUTQ-C scores for those with normal range compared to those with clinical range on the anxious/depressed scale of Child Behavior Check List (CBCL) (KruskalWallis Test=6.22, p<0.05) supporting convergent validity. The Kurdish HUTQ-C shows promising reliability and validity. 

  • 48.
    Tillman, Karin K.
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Hakelius, Malin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Höijer, Jonas
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset. Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Barn- och ungdomspsykiatri.
    Ekselius, L
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Nowinski, Daniel
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för kirurgiska vetenskaper, Plastikkirurgi.
    Papadopoulos, Fotios
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Increased Risk for Neurodevelopmental Disorders in Children With Orofacial Clefts2018Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 57, nr 11, s. 876-883Artikel i tidskrift (Refereegranskat)
    Abstract [en]

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

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

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

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

  • 49.
    Torres Soler, Catalina
    et al.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Olofsdotter, Susanne
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Vadlin, Sofia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Nilsson, Kent W.
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Sonnby, Karin
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, Centrum för klinisk forskning, Västerås.
    Diagnostic accuracy of the Montgomery-Åsberg Depression Rating Scale parent report among adolescent psychiatric outpatients2018Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, nr 3, s. 184-190Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: The diagnostic accuracy of the parent report of the Montgomery-Åsberg Depression Rating Scale (MADRS-P) for the screening of major depressive disorder (MDD) in adolescents has not been evaluated.

    AIM: The aim was to explore the psychometric properties and diagnostic accuracy of the MADRS-P in general child and adolescent psychiatric outpatient services in Sweden.

    METHOD: The study was a validation and a diagnostic accuracy study. Consecutive adolescent psychiatric patients (n = 101, 45 males, mean age 15 years) were assessed with a diagnostic interview, the Kiddie Schedule of Affective Disorders and Schizophrenia for School-Age Children - Present and Lifetime version (K-SADS-PL), as a reference test. Thereafter, their parents reported on the MADRS-P. Both categorical MDD diagnoses and dimensional MDD symptom severity scores were obtained from the K-SADS-PL.

    RESULTS: The internal consistency of the MADRS-P, measured with Cronbach's alpha, was 0.846. The concurrent validity, assessed by Spearman's rho as a correlation between the K-SADS MDD symptom severity score and the MADRS-P score, was 0.580. The area under the curve in a receiver operating characteristic analysis for all participants was 0.786 (95% confidence interval 0.694-0.877, p < .001). At a cut-off of 10, sensitivity was 0.86, specificity 0.54, positive predictive value 0.59 and negative predictive value 0.84.

    CONCLUSIONS: The parent-rated MADRS-P showed similar psychometric properties as previously shown for the self-rated MADRS-S in adults. Although the MADRS-P has acceptable diagnostic accuracy for screening for MDD in adolescents in a general psychiatric setting, it cannot be used alone for diagnosing MDD.

  • 50. Westling, Sofie
    et al.
    Ramklint, Mia
    Uppsala universitet, Medicinska och farmaceutiska vetenskapsområdet, Medicinska fakulteten, Institutionen för neurovetenskap, Psykiatri, Akademiska sjukhuset.
    Självskadebeteende vanligt även utan personlighetssyndrom - Felaktig koppling trolig orsak till överdiagnostik av borderline-personlighetssyndrom2016Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 113, artikel-id DZTLArtikel i tidskrift (Refereegranskat)
    Abstract [sv]

    Self-harm is prevalent in non-psychiatric populations as well as in psychiatric settings, and is common in patients with most psychiatric diagnoses. Persons with self-harm behaviour can be incorrectly diagnosed with borderline personality disorder. There is support for self-harm having an emotion regulating function. Most treatments for self-harm are lengthy and comprehensive and have been developed primarily for persons with borderline personality disorder. Emotion Regulation Group Therapy is an exception, and is given in the form of 14 sessions of group therapy. Persons who self-harm and do not fulfil formal criteria for having a borderline personality disorder are at risk for not receiving effective treatment for self-harm.

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