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  • 1.
    Domeij, Helena
    et al.
    Swedish Agcy Hlth Technol Assessment & Assessment, Stockholm, Sweden.
    Fahlstrom, Gunilla
    Swedish Agcy Hlth Technol Assessment & Assessment, Stockholm, Sweden.
    Bertilsson, Goran
    Swedish Agcy Hlth Technol Assessment & Assessment, Stockholm, Sweden.
    Hultcrantz, Monica
    Swedish Agcy Hlth Technol Assessment & Assessment, Stockholm, Sweden; Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden.
    Munthe-Kaas, Heather
    Norwegian Inst Publ Hlth, Ctr Hlth Serv, Oslo, Norway.
    Nehlin Gordh, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Helgesson, Gert
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden.
    Experiences of living with fetal alcohol spectrum disorders: a systematic review and synthesis of qualitative data2018In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 60, no 8, p. 741-+Article, review/survey (Refereed)
    Abstract [en]

    Aim: To identify and assess available evidence from qualitative studies exploring experiences of individuals living with fetal alcohol spectrum disorders (FASD) or those living with a child with FASD, as well as experiences of interventions aimed at supporting individuals with FASD and their families.

    Method: A systematic literature search was conducted in six electronic databases: PubMed, Embase, Cochrane Library, CINAHL, PsycINFO, and Scopus. Included studies were analysed using manifest content analysis. Methodological limitations and confidence in the evidence were assessed using a modified version of the Critical Appraisal Skills Programme and the Grading of Recommendations, Assessment, Development and Evaluation–Confidence in the Evidence from Reviews of Qualitative Research approach respectively.

    Results: Findings from 18 studies show that individuals with FASD experience a variation of disabilities, ranging from somatic problems, high pain tolerance, destructive behaviour, hyperactivity, and aggressiveness, to social problems with friendship, school attendance, and maintenance of steady employment. Most studies reported parents’ experiences with FASD; parenting was viewed as a lifelong engagement and that the whole family is isolated and burdened because of FASD. People with FASD feel that their difficulties affect their daily life in a limiting way and make them feel different from others.

    Interpretation: From the perspective of primarily parents, individuals with FASD and their parents face many different difficulties, for which they need societal support.

  • 2.
    Hammarberg, Anders
    et al.
    Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Riddargatan 1, S-11435 Stockholm, Sweden.; Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Nehlin, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Drinking motives of adult patients seeking treatment for problematic alcohol use2017In: Journal of Addictive Diseases, ISSN 1055-0887, E-ISSN 1545-0848, Vol. 36, no 2, p. 127-135Article in journal (Refereed)
    Abstract [en]

    The Drinking Motives Questionnaire measures motives for alcohol consumption on four subscales. Coping with negative affect and enhancement of positive affect have been shown to be associated with high levels of alcohol consumption and alcohol-related problems. Few studies exist concerning drinking motives among treatment-seeking patients. The aims of the study were to investigate the factor structure of the shortened-form of the revised Drinking Motives Questionnaire, map main drinking motives, explore group differences in motives due to sex, age, level of drinking problems, and symptoms of depression/anxiety and to investigate whether different drinking motives predict alcohol-related problems in this group. There were 274 treatment-seeking patients recruited from four addiction treatment clinics in Sweden. The shortened-form of the revised Drinking Motives Questionnaire was administered in conjunction with a regular visit to the clinics together with measures of degree of alcohol-related problems, psychiatric symptoms, and demographic factors. Main drinking motives were identified. A confirmatory factor analysis was run to confirm the factor structure of the shortened-form of the revised Drinking Motives Questionnaire. A logistic regression using the Enter method was performed to investigate associations between predictors and Alcohol Use Disorder Identification Test scores. The results confirmed the four-factor structure reported in studies on non-treatment-seeking individuals. Coping was the most commonly expressed motive. Not previously found in a clinical sample, the results showed that coping motives, together with being male and having elevated anxiety scores, were associated to Alcohol Use Disorder Identification Test scores indicative of alcohol dependence. The shortened-form of the revised Drinking Motives Questionnaire is a brief and valid instrument that holds potential for clinical use in mapping drinking motives among treatment seekers.

  • 3.
    Helgesson, Gert
    et al.
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm Ctr Healthcare Eth CHE, Stockholm, Sweden..
    Bertilsson, Goran
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden..
    Domeij, Helena
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden..
    Fahlstrom, Gunilla
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden..
    Heintz, Emelie
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden.;Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Hjern, Anders
    Karolinska Inst, Dept Med, Clin Epidemiol, Stockholm, Sweden.;Ctr Hlth Equ Studies, Stockholm, Sweden..
    Nehlin Gordh, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Nordin, Viviann
    Karolinska Inst KIND, Ctr Neurodev Disorders, Stockholm, Sweden..
    Rangmar, Jenny
    Univ Gothenburg, Dept Psychol, Gothenburg, Sweden..
    Rydell, Ann-Margret
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Sundelin Wahlsten, Viveka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Hultcrantz, Monica
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden.;Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Ethical aspects of diagnosis and interventions for children with fetal alcohol Spectrum disorder (FASD) and their families2018In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 19, article id 1Article in journal (Refereed)
    Abstract [en]

    Background:

    Fetal alcohol spectrum disorders (FASD) is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD.

    Methods:

    Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series of discussions with experts in the field, published literature, and medical ethicists.

    Results:

    Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the socia ! services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition.

    Conclusions:

    The value for the concerned individuals of obtaining a FASD-related description of their condition - for instance, in terms of wellbeing - is not established. Nor is it established that allocating resources based, on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs.

  • 4.
    Helgesson, Gert
    et al.
    Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm Ctr Healthcare Eth CHE, Stockholm, Sweden..
    Bertilsson, Göran
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden..
    Domeij, Helena
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden..
    Fahlström, Gunilla
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden..
    Heintz, Emelie
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden.;Karolinska Inst, Med Management Ctr, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Hjern, Anders
    Karolinska Inst, Dept Med, Clin Epidemiol, Stockholm, Sweden.;Ctr Hlth Equ Studies, Stockholm, Sweden..
    Nehlin, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Nordin, Viviann
    Karolinska Inst KIND, Ctr Neurodev Disorders, Stockholm, Sweden..
    Rangmar, Jenny
    Univ Gothenburg, Dept Psychol, Gothenburg, Sweden..
    Rydell, Ann-Margret
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Sundelin Wahlsten, Viveka
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Hultcrantz, Monica
    Swedish Agcy Hlth Technol Assessment Assessment So, Stockholm, Sweden.;Karolinska Inst, Dept Learning Informat Management & Eth, Stockholm, Sweden..
    Ethical aspects of diagnosis and interventions for children with fetal alcohol Spectrum disorder (FASD) and their families2018In: BMC Medical Ethics, ISSN 1472-6939, E-ISSN 1472-6939, Vol. 19, article id 1Article in journal (Refereed)
    Abstract [en]

    Background: Fetal alcohol spectrum disorders (FASD) is an umbrella term covering several conditions for which alcohol consumption during pregnancy is taken to play a causal role. The benefit of individuals being identified with a condition within FASD remains controversial. The objective of the present study was to identify ethical aspects and consequences of diagnostics, interventions, and family support in relation to FASD.

    Methods: Ethical aspects relating to diagnostics, interventions, and family support regarding FASD were compiled and discussed, drawing on a series of discussions with experts in the field, published literature, and medical ethicists.

    Results: Several advantages and disadvantages in regards of obtaining a diagnosis or description of the condition were identified. For instance, it provides an explanation and potential preparedness for not yet encountered difficulties, which may play an essential role in acquiring much needed help and support from health care, school, and the socia ! services. There are no interventions specifically evaluated for FASD conditions, but training programs and family support for conditions with symptoms overlapping with FASD, e.g. ADHD, autism, and intellectual disability, are likely to be relevant. Stigmatization, blame, and guilt are potential downsides. There might also be unfortunate prioritization if individuals with equal needs are treated differently depending on whether or not they meet the criteria for a specific condition. Conclusions: The value for the concerned individuals of obtaining a FASD-related description of their condition - for instance, in terms of wellbeing - is not established. Nor is it established that allocating resources based, on whether individuals fulfil FASD-related criteria is justified, compared to allocations directed to the most prominent specific needs.

  • 5.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Division of Psychiatry, Uppsala University Hospital, Uppsala, Sweden.
    Arinell, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Dyster-Aas, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Division of Psychiatry, Uppsala University Hospital, Uppsala, Sweden.
    Jess, Kari
    School of Education, Health & Social Studies, Dalarna University, Falun, Sweden.
    Alcohol Habits and Health Care Use in Patients with Psychiatric Disorders2017In: Journal of dual diagnosis, ISSN 1530-3209, E-ISSN 1550-4271, Vol. 13, no 4, p. 247-253Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: It is common for persons with psychiatric disorders to also have alcohol problems. Studies in the general population as well as in clinical samples have found hazardous or harmful alcohol habits to be particularly prevalent in the presence of psychiatric disorders. This study sought to explore the relationships between drinking habits and health care utilization (psychiatric as well as general medical) in persons seeking psychiatric treatment and to investigate the associations among age, sex, and type or number of diagnoses and health care use and costs. For the planning of targeted interventions, we also sought to identify subgroups with a high prevalence of hazardous drinking habits.

    METHODS: From a psychiatric clinic for affective disorders at a university hospital in Sweden, patients who had been screened for hazardous drinking (N = 609) were selected. Patients with primary psychosis or substance use disorder receive treatment at other clinics and did not participate. Medical records data were grouped and compared. The International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10) was used for diagnoses and the Alcohol Use Disorders Identification Test for screening. Patients were grouped by drinking habits and sex, age, and diagnosis group, and their psychiatric as well as general medical health care use was compared.

    RESULTS: Abstainers used psychiatric care more than all other drinking groups (p < .001). Psychiatric health care costs were higher in abstainers and low-risk drinkers (1.64 to 1). No differences in general medical care could be identified between drinking groups. Specific subgroups with higher rates of hazardous drinking could not be identified (44% of all males and 34% of all females reported such habits). Inconclusive results from previous research are most likely due to different methods used to classify drinking problems.

    CONCLUSIONS: Abstainers and low-risk drinkers used psychiatric health care to a higher cost than the other drinking groups. Possible explanations are discussed from a clinical and scientific perspective. This study clarifies the need for uniform measures when classifying alcohol use in studies of relationships between alcohol use and health care use. There is also a need to separate former drinkers from abstainers in future studies.

  • 6.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Carlsson, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Patients' Experiences of Using a Cellular Photo Digital Breathalyzer for Treatment Purposes2018In: Journal of addiction medicine, ISSN 1932-0620, E-ISSN 1935-3227, Vol. 12, no 2, p. 107-112Article in journal (Refereed)
    Abstract [en]

    Objectives: The field of eHealth systems is rapidly developing and is now expanding into alcohol treatment settings. Despite a growing public and professional interest, cellular photo digital breathalyzers (CPDBs) have not been investigated in a clinical context so far. In this study, we aimed to investigate the experiences of patients in alcohol treatment who had been using a CPDB—TripleA- for a minimum of three months. What are their personal experiences of using the CPDB? Do the patients think it supports them to change their drinking habits, and if so, in what way?

    Methods: A qualitative interview study with individuals who had been using the CPDB TripleA, for at least 3 months as complement to treatment (12-step program or hospital-based outpatient care). A thematic analysis with an inductive approach was used to identify, analyze, and interpret patterns within data.

    Results: In all, 12 interviews were conducted with 8 men and 4 women. Participants were generally enthusiastic about the CPDB and found it convenient and useful, even though it created a need for privacy when using the device. Although technical problems were substantial, participants were tolerant to those. The system was perceived to support self-control and to restore relations, but did not replace the need for close contact with caregivers. Self-motivation to change drinking habits was essential, and could not be reached by solely using the CPDB.

    Conclusions: Participants perceived the CPDB as a convenient and useful tool that was supportive under the circumstances that it was used in a context that included personal contact with a caregiver; and the user felt more than just a minimum of motivation to reduce drinking. Technical stability needs to be achieved to secure long-term use.

  • 7.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Fredriksson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Grönbladh, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Jansson, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Three hours of training improve psychiatric staff’s self-perceived knowledge and attitudes toward problem-drinking patients2012In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 31, no 4, p. 544-549Article in journal (Refereed)
    Abstract [en]

    Introduction and aims

    Staff attitudes are an important factor in the successful implementation of systematic alcohol strategies and policies.  The forms and extent of training needed to improve therapeutic attitude among psychiatric staff to problem drinking are unclear. The aim of the investigation was to study the knowledge and attitudes of psychiatric staff toward problem drinking patients. A further aim was to investigate whether a short three-hour training is sufficient to improve knowledge and therapeutic attitude toward problem drinking.

    Design and methods

    A tailored training model for psychiatric staff (non-physicians) was carried out at a medium size university clinic. Participants were medical (nurses and psychiatric aides) and non-medical staff (psychologists and social workers). The training consisted of a two-hour workshop and a one-hour follow-up session. Knowledge and attitudes were measured at baseline and follow-up by a questionnaire including vignettes assessment and the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ).

    Results

    In total, 115 persons completed the questionnaire (follow-up rate 83.5 %). The distribution was even (50 % for the medical and 50 % for the non-medical staff). After training, the non-medical staff estimated vignette case severity higher than before. Both staff groups estimated their capacity to help a patient with complex problems higher after training. Role adequacy was higher in both subgroups after training.  Medical staff scored Work satisfaction higher after the training. 

    Discussion and conclusions

    Three hours of tailored training for psychiatric staff improve their knowledge and therapeutic attitude to problem drinking patients.

     

  • 8.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Fredriksson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Jansson, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Brief alcohol screening in a clinical psychiatric population: Special attention needed2012In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 31, no 4, p. 538-543Article in journal (Refereed)
    Abstract [en]

    Introduction and aims: Abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) and single-item screeners show promising results but have not previously been investigated in a clinical psychiatric setting. The aim of the present study was to investigate the capacity of three brief screening methods to detect hazardous drinking in a psychiatric treatment-seeking population.

    Design and methods: Data was collected from consecutive patients (n = 1811) visiting a general psychiatric clinic. The screening capacity of the Heavy Episodic Drinking (HED) screener, AUDIT item # 3 (AUDIT-3) and the three consumption items of AUDIT (AUDIT-C) was compared to the result of the full 10-item AUDIT with cut-off points 6 for females and 8 for males.

    Results: The HED screener and AUDIT-3 with recommended cut-offs captured low rates of hazardous drinkers when compared to the full AUDIT. Lowering the cut-offs created rates far above those of the full AUDIT. AUDIT-C with recommended cut-off limits categorised nearly the same rates of males as the full AUDIT but much higher rates of females. Raising the cut-off for females approached the detection rate of AUDIT-C closely to that of the full AUDIT.

    Discussion and conclusions:The findings of this study suggest that the HED screener is not sensitive enough in the clinical psychiatric setting. When designing alcohol screening measures to be used all over health care organisations, special attention should be paid to psychiatric patients. If a somewhat more extensive screening tool is used, the full AUDIT is recommended.

  • 9.
    Nehlin, Christina Gordh
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Grönbladh, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Fredriksson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Jansson, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Alcohol and Drug Use, Smoking, and Gambling Among Psychiatric Outpatients: A 1-Year Prevalence Study2013In: Substance Abuse, ISSN 0889-7077, E-ISSN 1573-6733, Vol. 34, no 2, p. 162-168Article in journal (Refereed)
    Abstract [en]

    Background and Aims: Studies of alcohol habits in general psychiatric populations are scarce. The objective was to investigate alcohol and drug use, smoking, and gambling in a clinical sample of psychiatric outpatients. A further aim was to study age and gender differences in the rates of these habits. Methods: Data were collected among psychiatric outpatients with mainly mood (47%) and anxiety (35%) disorders. A questionnaire package was distributed, including AUDIT (Alcohol Use Disorders Identification Test), DUDIT (Drug Use Disorders Identification Test), tobacco items, and gambling items. Two major drinking categories were formed: Nonhazardous alcohol use (NH) and Alcohol use above hazardous levels (AH). Results: In total, 2160 patients (65% females) responded to the questionnaire package. The AH rate was high among psychiatric outpatients (28.4%), particularly among young females (46.6%). Young female patients also reported a high prevalence of problematic drug use (13.8%). Problematic drug use, daily smoking, and problematic gambling were frequent. The unhealthy habits were linked to AH. Conclusions: Alcohol and drug use, smoking, and gambling are all highly prevalent among psychiatric outpatients. Young females are in particular need of attention. Interventions should be tailored for co-occurring psychiatric disorders and applied within routine psychiatric care.

  • 10.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Univ Uppsala Hosp, Uppsala, Sweden..
    Nyberg, Fred
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Jess, Kari
    Dalarna Univ, Sch Educ Hlth & Social Studies, Falun, Sweden..
    Brief Intervention Within Primary Care for At-Risk Gambling: A Pilot Study2016In: Journal of Gambling Studies, ISSN 1050-5350, E-ISSN 1573-3602, Vol. 32, no 4, p. 1327-1335Article in journal (Refereed)
    Abstract [en]

    Studies on interventions for at-risk gambling are scarce. This pilot study is the first step in a larger project aimed to develop methods to prevent more serious gambling problems. Drawing on experiences from the alcohol field, the brief intervention (BI) model was tested in a primary care setting. Primary care personnel was trained for 2 days. Patients were screened, and those with signs of problematic gambling were offered a return visit to discuss their gambling habits. Of the 537 screened, 34 (6.3 %) screened positive for problem gambling. Of those, 24 were at-risk gamblers whereof 19 agreed to participate. Six of those 19 took part in a 1-month follow-up. Important information for the planning of upcoming studies was collected from the pilot work. Given that the rate of at-risk gamblers was elevated in this setting we consider primary care a suitable arena for intervention. Staff training and support appeared essential, and questionnaires should be selected that are clear and well-presented so staff feel secure and comfortable with them. The BI model was found to be most suitable for patients already known to the caregiver. The number of participants who were willing to take part in the follow-up was low. To ensure power in future studies, a much larger number of screened patients is evidently necessary.

  • 11.
    Nehlin, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala Univ Hosp, Div Psychiat, Uppsala, Sweden..
    Wennberg, Margareta
    Uppsala Univ Hosp, Div Psychiat, Uppsala, Sweden..
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala Univ Hosp, Div Psychiat, Uppsala, Sweden..
    How do people with mood and anxiety disorders perceive and interpret the Drinking Motives Questionnaire?: A think-aloud study in a clinical setting2018In: Addiction science & clinical practice, ISSN 1940-0632, E-ISSN 1940-0640, Vol. 13, article id 7Article in journal (Refereed)
    Abstract [en]

    Background: Research has identified drinking motives as the final common pathway to alcohol use, and associations between specific drinking motives and drinking patterns have consistently been demonstrated. Data on drinking motives can be used for research, in the planning of prevention strategies and for treatment purposes. The Drinking Motives Questionnaire-Revised (DMQ-R) has become the most used measure of drinking motives. So far, the questionnaire has not been investigated with qualitative methods. The aim of this study was to investigate acceptability, accuracy and usability of the DMQ-R among persons receiving outpatient psychiatric care by studying how responders perceive and interpret the questionnaire.

    Method: A cognitive interviewing technique, the think-aloud method, was used to collect data from 16 non-alcohol dependent patients seeking outpatient psychiatric care (12 women, 4 men). To analyse data, Qualitative Content Analysis was applied in which themes were formed from data only and not from predetermined areas of interest.

    Results: Overall, acceptability of the DMQ-R was high although answers were sometimes given with low accuracy. Responders pointed out that they perceived the questionnaire as non-confrontational and exhaustive. Further, the DMQ-R seemed to launch processes of self-reflection.

    Conclusions: Taken together, the results suggest a support for the use of DMQ-R also in the group of psychiatric outpatients. Still, when interpreting the DMQ-R, a certain insecurity of the exactness of answers should be considered. The graphic design should be particularly clear in this group of patients.

  • 12.
    Nehlin Gordh, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Alcohol Use and Secondary Prevention in Psychiatric Care2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Although alcohol plays an important role in psychiatric morbidity, there is a general lack of strategies within psychiatric care to intervene at alcohol problems in an early stage (secondary prevention). The aim of this thesis was to increase knowledge of adequate forms of secondary alcohol prevention in psychiatric care.  

    The capacity of three brief screening instruments was investigated in a psychiatric outpatient sample (n=1811). The results indicate that the HED (heavy episodic drinking) screener, strongly recommended for health care settings, is not sufficiently sensitive in a psychiatric setting. Instead, the full AUDIT (Alcohol Use Disorders Identification Test) is recommended.

    The knowledge and attitudes of psychiatric staff members to problem-drinking patients were studied and the effects of a three-hour training course were investigated. Confidence in self-perceived capacity to intervene in more severe alcohol problems was raised among all staff after training. Awareness of early signs of problem drinking was raised among psychologists and social workers. The therapeutic attitude of the psychiatric staff was higher when compared with primary care staff.

    Two forms of brief intervention were delivered by clinical psychiatric staff. At 12 months, 29% of all participants had improved their drinking habits, moving from hazardous to non-hazardous level (21%) or from harmful to hazardous level (8%). In the improved group, mean AUDIT score was reduced from 11.0 points at baseline to 5.5 points. Differences in outcome between the two interventions could not be identified.

    Nine high-risk drinking young female psychiatric patients were interviewed, focusing on reasons for excessive drinking and factors facilitating a change in drinking habits. Alcohol played an important role in the lives of the young women. It made them feel social and helped them deal with unbearable emotions. It was also used as a means of self-harm, representing the first stage in an escalating self-harm process. They expressed a need for help from their caregivers in addressing the underlying reasons for drinking.

    Secondary alcohol prevention strategies including appropriate screening methods, staff training and the elaboration of tailored interventions are urgently needed in psychiatric care. The findings of this thesis can be used when forming such strategies.  

    List of papers
    1. Brief alcohol screening in a clinical psychiatric population: Special attention needed
    Open this publication in new window or tab >>Brief alcohol screening in a clinical psychiatric population: Special attention needed
    2012 (English)In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 31, no 4, p. 538-543Article in journal (Refereed) Published
    Abstract [en]

    Introduction and aims: Abbreviated versions of the Alcohol Use Disorders Identification Test (AUDIT) and single-item screeners show promising results but have not previously been investigated in a clinical psychiatric setting. The aim of the present study was to investigate the capacity of three brief screening methods to detect hazardous drinking in a psychiatric treatment-seeking population.

    Design and methods: Data was collected from consecutive patients (n = 1811) visiting a general psychiatric clinic. The screening capacity of the Heavy Episodic Drinking (HED) screener, AUDIT item # 3 (AUDIT-3) and the three consumption items of AUDIT (AUDIT-C) was compared to the result of the full 10-item AUDIT with cut-off points 6 for females and 8 for males.

    Results: The HED screener and AUDIT-3 with recommended cut-offs captured low rates of hazardous drinkers when compared to the full AUDIT. Lowering the cut-offs created rates far above those of the full AUDIT. AUDIT-C with recommended cut-off limits categorised nearly the same rates of males as the full AUDIT but much higher rates of females. Raising the cut-off for females approached the detection rate of AUDIT-C closely to that of the full AUDIT.

    Discussion and conclusions:The findings of this study suggest that the HED screener is not sensitive enough in the clinical psychiatric setting. When designing alcohol screening measures to be used all over health care organisations, special attention should be paid to psychiatric patients. If a somewhat more extensive screening tool is used, the full AUDIT is recommended.

    Keywords
    alcohol screening method, psychiatric patient, hazardous alcohol use, assessment
    National Category
    Medical and Health Sciences
    Research subject
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-168843 (URN)10.1111/j.1465-3362.2011.00333.x (DOI)000304817800024 ()
    Available from: 2012-02-16 Created: 2012-02-16 Last updated: 2017-12-07Bibliographically approved
    2. Three hours of training improve psychiatric staff’s self-perceived knowledge and attitudes toward problem-drinking patients
    Open this publication in new window or tab >>Three hours of training improve psychiatric staff’s self-perceived knowledge and attitudes toward problem-drinking patients
    2012 (English)In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 31, no 4, p. 544-549Article in journal (Refereed) Published
    Abstract [en]

    Introduction and aims

    Staff attitudes are an important factor in the successful implementation of systematic alcohol strategies and policies.  The forms and extent of training needed to improve therapeutic attitude among psychiatric staff to problem drinking are unclear. The aim of the investigation was to study the knowledge and attitudes of psychiatric staff toward problem drinking patients. A further aim was to investigate whether a short three-hour training is sufficient to improve knowledge and therapeutic attitude toward problem drinking.

    Design and methods

    A tailored training model for psychiatric staff (non-physicians) was carried out at a medium size university clinic. Participants were medical (nurses and psychiatric aides) and non-medical staff (psychologists and social workers). The training consisted of a two-hour workshop and a one-hour follow-up session. Knowledge and attitudes were measured at baseline and follow-up by a questionnaire including vignettes assessment and the Short Alcohol and Alcohol Problems Perception Questionnaire (SAAPPQ).

    Results

    In total, 115 persons completed the questionnaire (follow-up rate 83.5 %). The distribution was even (50 % for the medical and 50 % for the non-medical staff). After training, the non-medical staff estimated vignette case severity higher than before. Both staff groups estimated their capacity to help a patient with complex problems higher after training. Role adequacy was higher in both subgroups after training.  Medical staff scored Work satisfaction higher after the training. 

    Discussion and conclusions

    Three hours of tailored training for psychiatric staff improve their knowledge and therapeutic attitude to problem drinking patients.

     

    Keywords
    training effect, staff attitude, psychiatric staff, alcohol training
    National Category
    Medical and Health Sciences
    Research subject
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-168846 (URN)10.1111/j.1465-3362.2011.00373.x (DOI)000304817800025 ()
    Available from: 2012-02-16 Created: 2012-02-16 Last updated: 2017-12-07Bibliographically approved
    3. Brief alcohol intervention in a psychiatric outpatient setting: A randomized controlled study
    Open this publication in new window or tab >>Brief alcohol intervention in a psychiatric outpatient setting: A randomized controlled study
    2012 (English)In: Addiction Science & Clinical Practice, ISSN 1940-0640, Vol. 7, no 23Article in journal (Refereed) Published
    Abstract [en]

    Background:Although brief alcohol intervention (BI) is widely studied, studies from psychiatric outpatient settings are rare. The aim of this study was to investigate the effects of two variants of BI in psychiatric outpatients. By using clinical psychiatric staff to perform the interventions, we sought to collect information of the usefulness of BI in the clinical setting.

    Methods: Psychiatric outpatients with Alcohol Use Disorders Identification Test (AUDIT) scores indicating hazardous or harmful drinking were invited to participate in the study. The outpatients were randomized to minimal (assessment, feedback, and an informational leaflet) or BI (personalized advice added). Measurements were performed at baseline and at six and 12 months after the intervention. The primary outcome was change in AUDIT score at the 12-month follow-up.

    Results: In all, 150 patients were enrolled and received either a minimal intervention (n = 68) or BI (n = 82). At 12 months, there was a small reduction in AUDIT score in both groups, with no significant differences in outcome between groups. At 12-month follow-up, 21% of participants had improved from a hazardous AUDIT score level to a nonhazardous level, and 8% had improved from a harmful level to a hazardous level (8%).

    Conclusions: Brief alcohol interventions may result in a reduction of AUDIT score to a small extent in psychiatric patients with hazardous or harmful alcohol use. Results suggest that BI may be of some value in the psychiatric outpatient setting. Still, more profound forms of alcohol interventions with risky-drinking psychiatric patients need elaboration.

    Keywords
    Brief intervention, alcohol intervention, hazardous alcohol use, harmful alcohol use, psychiatric outpatients
    National Category
    Medical and Health Sciences
    Research subject
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-179328 (URN)10.1186/1940-0640-7-23 (DOI)
    Available from: 2012-08-13 Created: 2012-08-13 Last updated: 2013-03-14Bibliographically approved
    4. Young female psychiatric patients' reasons for excessive alcohol use: a qualitative interview study
    Open this publication in new window or tab >>Young female psychiatric patients' reasons for excessive alcohol use: a qualitative interview study
    2013 (English)In: Mental Health and Substance Use, ISSN 1752-3281, E-ISSN 1752-3273, Vol. 6, no 4, p. 315-324Article in journal (Refereed) Published
    Abstract [en]

    There is a strong and multidirectional link between excessive alcohol use and psychiatric disorders. A large proportion (46.6%) of young female psychiatric outpatients report drinking above hazardous levels. This study explores high risk-drinking young female psychiatric patients' view of the role of alcohol in their lives. A further aim was to identify factors that may facilitate changes in drinking habits. Semi-structured interviews with open-ended questions were performed. The main areas of interest were: positive/negative aspects of alcohol use, risk situations for excessive drinking and factors facilitating change in drinking habits. Data were analysed using qualitative content analysis, a process that includes identifying, coding and categorizing components of the interviews. Nine female high risk-drinking psychiatric patients (mean age 22.2 ± 3.5 years) were interviewed. The reasons for excessive alcohol use were either external, in which case the young females wanted to live up to social expectations, or internal, in which case alcohol was used as an escape from negative feelings or for the purpose of self-harm. The participants requested help from psychiatric care-givers to focus on reasons for drinking and help with addressing underlying needs more functionally. To help avoid the development of complicated comorbidity, psychiatric providers must be aware of the role of alcohol in the patient's life. The categories identified in this study can be used by psychiatric health-care professionals in an interview scheme or checklist when meeting young female patients with excessive drinking.

    Keywords
    Young females, risk drinking, hazardous alcohol use, harmful alcohol use, psychiatric patients, qualitative
    National Category
    Medical and Health Sciences
    Research subject
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-179332 (URN)10.1080/17523281.2012.755559 (DOI)
    Available from: 2012-08-13 Created: 2012-08-13 Last updated: 2017-12-07Bibliographically approved
  • 13.
    Nehlin Gordh, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Fredriksson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Young female psychiatric patients' reasons for excessive alcohol use: a qualitative interview study2013In: Mental Health and Substance Use, ISSN 1752-3281, E-ISSN 1752-3273, Vol. 6, no 4, p. 315-324Article in journal (Refereed)
    Abstract [en]

    There is a strong and multidirectional link between excessive alcohol use and psychiatric disorders. A large proportion (46.6%) of young female psychiatric outpatients report drinking above hazardous levels. This study explores high risk-drinking young female psychiatric patients' view of the role of alcohol in their lives. A further aim was to identify factors that may facilitate changes in drinking habits. Semi-structured interviews with open-ended questions were performed. The main areas of interest were: positive/negative aspects of alcohol use, risk situations for excessive drinking and factors facilitating change in drinking habits. Data were analysed using qualitative content analysis, a process that includes identifying, coding and categorizing components of the interviews. Nine female high risk-drinking psychiatric patients (mean age 22.2 ± 3.5 years) were interviewed. The reasons for excessive alcohol use were either external, in which case the young females wanted to live up to social expectations, or internal, in which case alcohol was used as an escape from negative feelings or for the purpose of self-harm. The participants requested help from psychiatric care-givers to focus on reasons for drinking and help with addressing underlying needs more functionally. To help avoid the development of complicated comorbidity, psychiatric providers must be aware of the role of alcohol in the patient's life. The categories identified in this study can be used by psychiatric health-care professionals in an interview scheme or checklist when meeting young female patients with excessive drinking.

  • 14.
    Nehlin Gordh, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Grönbladh, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Fredriksson, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Jansson, Lennart
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Brief alcohol intervention in a psychiatric outpatient setting: A randomized controlled study2012In: Addiction Science & Clinical Practice, ISSN 1940-0640, Vol. 7, no 23Article in journal (Refereed)
    Abstract [en]

    Background:Although brief alcohol intervention (BI) is widely studied, studies from psychiatric outpatient settings are rare. The aim of this study was to investigate the effects of two variants of BI in psychiatric outpatients. By using clinical psychiatric staff to perform the interventions, we sought to collect information of the usefulness of BI in the clinical setting.

    Methods: Psychiatric outpatients with Alcohol Use Disorders Identification Test (AUDIT) scores indicating hazardous or harmful drinking were invited to participate in the study. The outpatients were randomized to minimal (assessment, feedback, and an informational leaflet) or BI (personalized advice added). Measurements were performed at baseline and at six and 12 months after the intervention. The primary outcome was change in AUDIT score at the 12-month follow-up.

    Results: In all, 150 patients were enrolled and received either a minimal intervention (n = 68) or BI (n = 82). At 12 months, there was a small reduction in AUDIT score in both groups, with no significant differences in outcome between groups. At 12-month follow-up, 21% of participants had improved from a hazardous AUDIT score level to a nonhazardous level, and 8% had improved from a harmful level to a hazardous level (8%).

    Conclusions: Brief alcohol interventions may result in a reduction of AUDIT score to a small extent in psychiatric patients with hazardous or harmful alcohol use. Results suggest that BI may be of some value in the psychiatric outpatient setting. Still, more profound forms of alcohol interventions with risky-drinking psychiatric patients need elaboration.

  • 15.
    Nehlin Gordh, Christina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Nyberg, Fred
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Pharmaceutical Biosciences.
    Öster, Caisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    The patient´s perspective on the link between ADHD and substance use: A qualitative interview study2015In: Journal of Attention Disorders, ISSN 1087-0547, E-ISSN 1557-1246, Vol. 19, no 4, p. 343-350Article in journal (Refereed)
    Abstract [en]

    Object

    The primary aim of this study was to investigate how adult individuals with ADHD perceive the role of alcohol and drugs in their lives. A secondary aim was to identify factors that those individuals consider useful in the treatment and prevention of co-occurring ADHD and substance use disorders.

    Method

    A qualitative interview study with ADHD outpatients (n=14) at a psychiatric clinic. Data were analyzed based on pre-defined areas of interest using a deductive content analysis method.

    Results

    The yearning for belongingness was identified as an important driving force underlying substance use. The participants felt that alcohol/drugs helped them being normal and thus respected and accepted. Early diagnosis of ADHD was perceived essential to avoid SUD.

    Conclusion

    Adults with ADHD may have strong rational and emotional reasons for the use of alcohol and drugs. When planning for the treatment of adult ADHD, investigation of personal reasons for alcohol/drug use deserves a place.

  • 16.
    Öster, Caisa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala Univ Hosp, Uppsala, Sweden.
    Arinell, Hans
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Nehlin, Christina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala Univ Hosp, Uppsala, Sweden.
    The Drinking Motives Questionnaire among Swedish psychiatric patients: An exploration of the four-factor structure2017In: Drug and Alcohol Review, ISSN 0959-5236, E-ISSN 1465-3362, Vol. 36, no 3, p. 400-407Article in journal (Refereed)
    Abstract [en]

    Introduction and Aims: Alcohol use above hazardous limits is common among persons with psychiatric disorders, and there is limited knowledge about motives for drinking. The objective of this study was to explore the adequacy of the four-factor structure of drinking motives in an adult psychiatric outpatient population in Sweden by confirming the factor structure in the Drinking Motives Questionnaire (DMQ-R) and in alternative models.

    Design and Methods: In total, 371 patients responded to the DMQ-R along with the Alcohol Use Disorders Identification Test (AUDIT). AUDIT was used to assess frequency of alcohol consumption, number of drinks consumed on a typical occasion and binge drinking frequency. Confirmatory factor analysis was used to examine the construct validity of the DMQ-R and alternative models, including the short form, DMQ-R SF.

    Results: Fit statistics suggested that the original four-factor model had questionable fit (root mean square error of approximation [RMSEA]=0.10, comparative fit index [CFI]=0.89, standardised root mean square residual [SRMR]=0.08). The model with the best fit indices was the DMQ-R SF (RMSEA=0.07, CFI=0.97, SRMR=0.04). When using DMQ-R SF in further analyses enhancement, the most strongly endorsed motives were related to quantity and AUDIT sum score. Coping motives were most strongly related to AUDIT sum score, frequency and binge drinking. Social motives were only related to binge drinking, whereas conformity motives were not statistically associated with any motives.

    Discussion and Conclusions: The study implies that the 12-item short form, DMQ-R SF, could be more appropriate than the original DMQ-R in this group.

1 - 16 of 16
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