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  • 101.
    Bodén, Robert
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Lindström, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Rautaharju, Pentti
    Wake Forest Univ, Dept Epidemiol & Prevent, Div Publ Hlth Sci, Winston Salem, NC 27109 USA.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Electrocardiographic signs of autonomic imbalance in medicated patients with first-episode schizophrenia spectrum disorders: relations to first treatment discontinuation and five-year remission status2012In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 27, no 3, p. 213-218Article in journal (Refereed)
    Abstract [en]

    PURPOSE:

    To explore measures in electrocardiograms (ECG) influenced by autonomic balance in early schizophrenia spectrum disorders and to examine their relation to subsequent first antipsychotic pharmacotherapy discontinuation and five-year remission status.

    SUBJECTS AND METHODS:

    Twelve-lead ECGs were recorded at baseline in 58 patients with first-episode schizophrenia spectrum disorders and in 47 healthy controls of similar age. Selected ECG variables included heart rate and measures of repolarization. Pharmacotherapy data were extracted from medical records. At a five-year follow-up the patients were interviewed and assessed with the Positive and Negative Syndrome Scale.

    RESULTS:

    Patients had higher heart rate and a different ST-T pattern than the controls. High T-wave amplitudes in the leads aVF and V5 and ST-elevations in V5 were associated both with higher risk of an earlier discontinuation of first antipsychotic pharmacotherapy and with non-remission five years later.

    DISCUSSION AND CONCLUSION:

    In this longitudinal cohort study, simple ECG measures influenced by autonomic balance in the early phase of schizophrenia spectrum disorders contained prognostic information. As this is the first report of this association and is based on a relatively small sample, the results should be interpreted with caution.

  • 102.
    Bodén, Robert
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
    Lindström, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
    Rautaharju, Pentti
    Department of Epidemiology and Prevention, Division of Public Health Sciences, Wake Forest university, North Carolina.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences.
    Relations of electrocardiographic signs of autonomic balance to 5-year outcome in first-episode schizophreniaManuscript (preprint) (Other academic)
  • 103.
    Bodén, Robert
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Persson, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Wall, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Lubberink, Mark
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Uppsala Univ, Uppsala, Sweden..
    Larsson, Elna-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Antoni, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Medicinal Chemistry, Division of Molecular Imaging.
    Striatal Phosphodiesterase 10A and Medial Prefrontal Cortical Thickness in Patients with Schizophrenia: A PET and MRI Study2017In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 81, no 10, p. S386-S387Article in journal (Other academic)
  • 104.
    Bodén, Robert
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Persson, Jonas
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Wall, Anders
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Lubberink, Mark
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Larsson, Elna-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Radiology.
    Antoni, Gunnar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Pharmacy, Department of Medicinal Chemistry.
    Striatal phosphodiesterase 10A and medial prefrontal cortical thickness in patients with schizophrenia: a PET and MRI study2017In: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 7, no 3, article id e1050Article in journal (Refereed)
    Abstract [en]

    The enzyme phosphodiesterase 10A (PDE10A) is abundant in striatal medium spiny neurons and has been implicated in the pathophysiology of schizophrenia in animal models and is investigated as a possible new pharmacological treatment target. A reduction of prefrontal cortical thickness is common in schizophrenia, but how this relates to PDE10A expression is unknown. Our study aim was to compare, we believe for the first time, the striatal non-displaceable binding potential (BPND) of the new validated PDE10A ligand [(11)C]Lu AE92686 between patients with schizophrenia and healthy controls. Furthermore, we aimed to assess the correlation of PDE10A BPND to cortical thickness. Sixteen healthy male controls and 10 male patients with schizophrenia treated with clozapine, olanzapine or quetiapine were investigated with positron emission tomography (PET) and magnetic resonance imaging (MRI). Striatal binding potential (BPND) of [(11)C]Lu AE92686 was acquired through dynamic PET scans and cortical thickness by structural MRI. Clinical assessments of symptoms and cognitive function were performed and the antipsychotic dosage was recorded. Patients with schizophrenia had a significantly lower BPND of [(11)C]Lu AE92686 in striatum (P=0.003) than healthy controls. The striatal BPND significantly correlated to cortical thickness in the medial prefrontal cortex and superior frontal gyrus across patients with schizophrenia and healthy controls. No significant correlation was observed between the BPND for [(11)C]Lu AE92686 in striatum and age, schizophrenia symptoms, antipsychotic dosage, coffee consumption, smoking, duration of illness or cognitive function in the patients. In conclusion, PDE10A may be important for functioning in the striato-cortical interaction and in the pathophysiology of schizophrenia.

    Download full text (pdf)
    fulltext
  • 105.
    Bodén, Robert
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
    Sundström, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences, Internal Medicine.
    Lindström, Eva
    Wieselgren, Ing-Marie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
    Lindström, Leif
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, Ulleråker, University Hospital.
    Five-year outcome of first-episode psychosis before and after the implementation of a modified assertive community treatment programme2010In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 45, no 6, p. 665-674Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Assertive community treatment programmes are increasingly common worldwide but without much knowledge of their long-term effect. We investigated whether the implementation of such a programme would improve symptomatic and functional outcome 5 years later. METHODS: Naturalistic cohort study between 1995 and 2000 of all first-episode psychosis patients (n = 144) in Uppsala County, Sweden. We compared a 3-year period before (non-mACT) and after the introduction of a modified assertive community treatment (mACT) programme in 1998. Five-year outcome was assessed for symptoms and functioning and the two co-primary outcome measures were positive and negative symptoms. Regression models were adjusted for a propensity score based on multiple baseline variables and use of antipsychotics at 5-year follow-up. RESULTS: Contrary to our hypothesis, patients in the mACT group, compared to those in the non-mACT group, had a borderline significant increased risk of having a poor 5-year outcome regarding positive psychotic symptoms [adjusted odds ratio (OR) 3.21, 95% confidence interval (CI) 0.97-10.63]. There was no difference at the 5-year follow-up between the mACT and non-mACT group regarding negative symptoms (adjusted OR 1.65, 95% CI 0.48-5.66), or any of the secondary outcome measures: global assessment of functioning, hazardous alcohol use, use of illicit drugs, working or being in education, independent living, subjective satisfaction with life or suicide. Results were similar in subgroup analyses. CONCLUSIONS: The implementation of a modified assertive community treatment was not followed by subsequent improvements of 5-year outcome on a group level for patients with first-episode psychosis.

  • 106.
    Boettcher, Johanna
    et al.
    Free Univ Berlin, Berlin, Germany.
    Magnusson, Kristoffer
    Karolinska Inst, Stockholm, Sweden.
    Marklund, Arvid
    Stockholm Univ, Stockholm, Sweden.
    Berglund, Ellinor
    Stockholm Univ, Stockholm, Sweden.
    Blomdahl, Rikard
    Stockholm Univ, Stockholm, Sweden.
    Braun, Ulrike
    Stockholm Univ, Stockholm, Sweden.
    Delin, Lovisa
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Lunden, Charlotte
    Stockholm Univ, Stockholm, Sweden.
    Sjöblom, Katja
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Sommer, Daniel
    Free Univ Berlin, Berlin, Germany.
    von Weber, Kaspar
    Stockholm Univ, Stockholm, Sweden.
    Andersson, Gerhard
    Linkoping Univ, Linkoping, Sweden;Karolinska Inst, Stockholm, Sweden.
    Carlbring, Per
    Stockholm Univ, Stockholm, Sweden;Univ Southern Denmark, Odense, Denmark.
    Adding a smartphone app to internet-based self-help for social anxiety: A randomized controlled trial2018In: Computers in human behavior, ISSN 0747-5632, E-ISSN 1873-7692, Vol. 87, p. 98-108Article in journal (Refereed)
    Abstract [en]

    Background: Increasing access to treatment via smartphone apps is an important topic in Social Anxiety Disorder (SAD). 'Challenger' is an app promoting exposure exercises in daily life. The present study evaluated the additional benefit of using the app as adjunct to Internet-based unguided self-help for SAD. In a second step, we also tested how the app and the self-help programme (SH) should best be combined. Method: 209 patients diagnosed with SAD were randomly allocated to three groups. Group 1 received the app and the self-help programme for six weeks (parallel treatment), group 2 first received SH for six weeks and then the app for six weeks (sequential treatment). Group 3 was a wait-list group. Comparisons were made at week 7 evaluating the potential add-on effect of the app (SH plus app versus SH only) and at week 14 comparing the parallel to the sequential treatment. Participants filled in questionnaires prior, during, and post treatment, and at 4- and 12- months follow-up. Results: Intention-to-treat analyses showed no significant effect of adding the app to Internet-based self-help. However, among participants actively using the app, adding Challenger to self-help resulted in significantly less social anxiety (d = 0.30). At week 14, decreases in social anxiety were large for both the parallel and the sequential group with no differences between the active groups (d(within) = 1.12-1.19). Changes were maintained throughout the follow-up period. Conclusion: Results of the current study cautiously support the notion of adding a smartphone app to unguided self-help for SAD. Future studies should investigate how patients can be motivated to use the app more frequently.

  • 107.
    Bohman, Hannes
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Adolescents with Depression Followed up: Prognostic Significance of Somatic Symptoms and Their Need of In-Patient Care2012Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    A dualist approach that distinguishes between mind and body is still the norm in Western medicine. Although we now know that physical and mental health are related in adults, little is known about if, or with what mechanisms, mental illnesses or depression early in life, will affect future physical and psychological health. In-between mental and somatic disorders there are somatic symptoms without medical explanation. These are symptoms that cause much suffering and impairment which are costly for society. Still little is known what they are, how they should be treated and what consequences they have for adolescents when they grow up. This study aims to investigate the long-term relationship between mental and somatic disease and the outcome of adolescents with functional somatic symptoms.

    The thesis is based on a 15-year follow-up study of a population-based investigation of adolescent depression. In 1991–1993 first year students in upper secondary school (age 16–17) in Uppsala, Sweden, were screened for depression (n=2300). Adolescents with positive screening and selected peers with negative screening (n=631) were assessed regarding mental health and somatic symptoms. At around age 31, the participants were followed-up in personal interviews (n=369) and national registers (n=609). Outcomes regarding mental DSM-IV diagnosis, in-patient ICD-10 disease diagnosis from the patient register, and blood vessel wall thickness were assessed.

    The most important finding is the unexpected poor short and long-term outcome in adolescents with somatic symptoms. The result proves the need for better treatment. The strong prediction of functional somatic symptoms for mental disorder, independent of adolescent depression, suggests that somatic symptoms and depression symptoms are different expressions of a common disorder. Female adolescents with depression need more psychiatric and somatic in-patient care but the males do not. Instead, they have considerably more in-patient stays due to alcohol and drug abuse. The males might be taken care of outside the health care system and seem to need special attention. In women with adolescent and recurrent adult depression there is an association with premature aging of the carotid wall. These women are at risk of developing early cardio-vascular disease and need early interventions.

     

    List of papers
    1. Somatic symptoms as a marker for severity in adolescent depression
    Open this publication in new window or tab >>Somatic symptoms as a marker for severity in adolescent depression
    Show others...
    2010 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 11, p. 1724-1730Article in journal (Refereed) Published
    Abstract [en]

    Aim: This study aims to investigate the prevalence of somatic symptoms in depressed adolescents and in their healthy peers. A second aim is to investigate the correlation, in the depressed adolescents, between the number of somatic symptoms and severe concurrent symptoms, signs and life events. Methods: The total population of 16-17 year olds - in the city of Uppsala - was screened for depression and then interviewed using a structured interview questionnaire. Depressed subjects and matched controls were identified. A total of 177 pairs were used for pair-wise analyses of somatic symptoms. Severe symptoms, signs and life events were selected for analysing their relation to depression with somatic symptoms. Results: The adolescents with depressive disorders experienced considerably more somatic symptoms than their healthy controls. The duration and depth of the depression correlated with the number of somatic symptoms. There was a strong correlation between depression with many somatic symptoms and suicidal plans/thoughts, suicidal attempts, disruptive behaviour, as well as multiple stressful relationships. Conclusion: This study demonstrates that somatic symptoms are common in adolescent depression. Multiple somatic symptoms within depression imply a higher severity in terms of duration, depth and psychiatric comorbidity. The strong correlation with suicidal plans, suicidal attempts and disruptive behaviour is concerning.

    Keywords
    Adolescent depression, Somatic symptoms, Severity of depression
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-134185 (URN)10.1111/j.1651-2227.2010.01906.x (DOI)000282641600024 ()
    Available from: 2010-11-22 Created: 2010-11-22 Last updated: 2017-12-12Bibliographically approved
    2. Prognostic significance of functional somatic symptoms in adolescence: a 15-year community-based follow-up study of adolescents with depression compared with healthy peers
    Open this publication in new window or tab >>Prognostic significance of functional somatic symptoms in adolescence: a 15-year community-based follow-up study of adolescents with depression compared with healthy peers
    Show others...
    2012 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 12, p. 90-Article in journal (Refereed) Published
    Abstract [en]

    Background

    There is a lack of population-based long-term longitudinal research on mental health status and functional physical/somatic symptoms. Little is known about the long-term mental health outcomes associated with somatic symptoms or the temporal relationship between depression and such symptoms. This 15-year study followed up adolescents with depression and matched controls, screened from a population-based sample, who reported different numbers of somatic symptoms.

    Methods

    The total population of 16–17-year-olds in Uppsala, Sweden, was screened for depression in 1991–1993. Adolescents who screened positive and an equal number of healthy controls took part in a semi-structured diagnostic interview. In addition, 21 different self-rated somatic symptoms were assessed. Sixty-four percent of those adolescents participated in a follow-up structured interview 15 years later.

    Results

    Somatic symptoms in adolescence predicted depression and other adult mental disorders regardless of the presence of adolescent depression. In adolescents with depression, the number of functional somatic symptoms predicted, in a dose response relationship, suicidal behavior, bipolar episodes, and psychotic episodes as well as chronic and recurrent depression. Contrary to expectations, the somatic symptoms of abdominal pain and perspiration without exertion better predicted depression than all DSM-IV depressive symptoms. Abdominal pain persisted as an independent strong predictor of depression and anxiety, even after controlling for other important confounders.

    Conclusions

    Somatic symptoms in adolescence can predict severe adult mental health disorders. The number of somatic symptoms concurrent with adolescent depression is, in a stepwise manner, linked to suicidal attempts, bipolar disorders, psychotic disorders, and recurrent and chronic depression. These findings can be useful in developing treatment guidelines for patients with somatic symptoms.

    Keywords
    Adolescent depression, Long-term follow-up, Functional somatic symptoms, Anxiety and suicidal behavior
    National Category
    Psychiatry
    Research subject
    Child and Youth Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-180071 (URN)10.1186/1471-244x-12-90 (DOI)000308698500001 ()22839681 (PubMedID)
    Projects
    Långtidsuppföljning av deprimerade tonåringar
    Available from: 2012-08-29 Created: 2012-08-29 Last updated: 2017-12-07Bibliographically approved
    3. Long term follow up of adolescent depression: a population based study
    Open this publication in new window or tab >>Long term follow up of adolescent depression: a population based study
    Show others...
    2010 (English)In: Upsala Journal of Medical Sciences, ISSN 0300-9734, E-ISSN 2000-1967, Vol. 115, no 1, p. 21-29Article in journal (Refereed) Published
    Abstract [en]

    Adolescent depression is common. Earlier studies indicate that relapses and recurrences are common. But many questions are still unanswered. The aim of the present study has been to follow subjects with adolescent depressions, identified in a population-based study, over a 15-year period. Subjects with adolescent depression (n = 362) and a comparison group (n = 250) were followed in the National Swedish registers.

    The formerly depressed females had significantly more out-patient visits, and a significantly higher proportion (78.4% versus 69.6%) had at least one out-patient visit. Among the males, no significant differences were found as concerns out-patient visits. The formerly depressed females had significantly more in-patient stays (3.6 versus 2.4) and a significantly higher total number of in-patient days (27.4 versus 10.1). A significantly higher proportion had in-patient days due to mental disorders (9.5% versus 4.6%), in particular anxiety disorders (4.9% versus 1.0%). As concerns the males, a significantly higher proportion had in-patient days due to mental disorders (16.5% versus 1.8%), in particular alcohol and drug abuse (7.6% versus 0%).

    Among the formerly depressed females there were no significant differences against the comparison group as concerns the proportion of being a mother, number of children per woman, or age at first child. However, a significantly higher proportion of the formerly depressed females had had different, usually mild, disorders related to pregnancy (8.6% versus 0.6%). The children of the women with adolescent depressions were not affected.

    Keywords
    adolescent depression, child-birth, health care, long-term follow-up, population-based sample, pregnancy
    National Category
    Basic Medicine Clinical Medicine
    Research subject
    Child and Youth Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-171046 (URN)10.3109/03009730903572057 (DOI)000275061700004 ()20095923 (PubMedID)
    Available from: 2012-03-15 Created: 2012-03-15 Last updated: 2018-01-12Bibliographically approved
    4. Thicker carotid intima layer, thinner media layer and higher intima/media ratio in women with recurrent depressive disorders: a pilot study using non-invasive high frequency ultrasound
    Open this publication in new window or tab >>Thicker carotid intima layer, thinner media layer and higher intima/media ratio in women with recurrent depressive disorders: a pilot study using non-invasive high frequency ultrasound
    Show others...
    2010 (English)In: World Journal of Biological Psychiatry, ISSN 1562-2975, E-ISSN 1814-1412, Vol. 11, no 1, p. 71-75Article in journal (Refereed) Published
    Abstract [en]

    Background. Growing evidence indicates that depression is an important risk factor for coronary heart disease. Thus, the aim of the present study has been to investigate if young women with adolescent onset and recurrent depressive disorders have signs of carotid intima and media changes already at the age of 30. Methods. Fifteen subjects with adolescent onset recurrent depressive disorders, mean age 31.5 years, were compared to 20 healthy women with a mean age of 39.6 years. The thickness of carotid artery intima and media was assessed, using non-invasive high-frequency ultrasound (25MHz). Results. The subjects with recurrent depressive disorders had significantly thicker carotid intima, significantly thinner carotid media and significantly higher intima/media ratio despite the fact that they were about 10 years younger than the healthy women. Hypertension, obesity or smoking could not explain the results. Conclusion. Already at the age of 30, subjects with recurrent depressive disorders with adolescent onset do have early signs of carotid intima and media changes, indicating a less healthy artery wall, despite otherwise no clinical signs of cardiovascular disease.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2010
    Keywords
    Recurrent depression, adolescent onset, cardiovascular disease, carotid intima, carotid media
    National Category
    Psychiatry Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-125134 (URN)10.3109/15622970902789122 (DOI)000274882600008 ()19333836 (PubMedID)
    Available from: 2010-05-07 Created: 2010-05-07 Last updated: 2017-12-12Bibliographically approved
    Download full text (pdf)
    fulltext
  • 108.
    Bohman, Hannes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Päären, Aivar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Olsson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Prognostic significance of functional somatic symptoms in adolescence: a 15-year community-based follow-up study of adolescents with depression compared with healthy peers2012In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 12, p. 90-Article in journal (Refereed)
    Abstract [en]

    Background

    There is a lack of population-based long-term longitudinal research on mental health status and functional physical/somatic symptoms. Little is known about the long-term mental health outcomes associated with somatic symptoms or the temporal relationship between depression and such symptoms. This 15-year study followed up adolescents with depression and matched controls, screened from a population-based sample, who reported different numbers of somatic symptoms.

    Methods

    The total population of 16–17-year-olds in Uppsala, Sweden, was screened for depression in 1991–1993. Adolescents who screened positive and an equal number of healthy controls took part in a semi-structured diagnostic interview. In addition, 21 different self-rated somatic symptoms were assessed. Sixty-four percent of those adolescents participated in a follow-up structured interview 15 years later.

    Results

    Somatic symptoms in adolescence predicted depression and other adult mental disorders regardless of the presence of adolescent depression. In adolescents with depression, the number of functional somatic symptoms predicted, in a dose response relationship, suicidal behavior, bipolar episodes, and psychotic episodes as well as chronic and recurrent depression. Contrary to expectations, the somatic symptoms of abdominal pain and perspiration without exertion better predicted depression than all DSM-IV depressive symptoms. Abdominal pain persisted as an independent strong predictor of depression and anxiety, even after controlling for other important confounders.

    Conclusions

    Somatic symptoms in adolescence can predict severe adult mental health disorders. The number of somatic symptoms concurrent with adolescent depression is, in a stepwise manner, linked to suicidal attempts, bipolar disorders, psychotic disorders, and recurrent and chronic depression. These findings can be useful in developing treatment guidelines for patients with somatic symptoms.

    Download full text (pdf)
    fulltext
  • 109.
    Bohman, Hannes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    von Knorring, Anne-Liis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    von Knorring, Lars
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Olsson, Gunilla
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Päären, Aivar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Larsson, Marita
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Naessén, Tord
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health.
    Thicker carotid intima layer, thinner media layer and higher intima/media ratio in women with recurrent depressive disorders: a pilot study using non-invasive high frequency ultrasound2010In: World Journal of Biological Psychiatry, ISSN 1562-2975, E-ISSN 1814-1412, Vol. 11, no 1, p. 71-75Article in journal (Refereed)
    Abstract [en]

    Background. Growing evidence indicates that depression is an important risk factor for coronary heart disease. Thus, the aim of the present study has been to investigate if young women with adolescent onset and recurrent depressive disorders have signs of carotid intima and media changes already at the age of 30. Methods. Fifteen subjects with adolescent onset recurrent depressive disorders, mean age 31.5 years, were compared to 20 healthy women with a mean age of 39.6 years. The thickness of carotid artery intima and media was assessed, using non-invasive high-frequency ultrasound (25MHz). Results. The subjects with recurrent depressive disorders had significantly thicker carotid intima, significantly thinner carotid media and significantly higher intima/media ratio despite the fact that they were about 10 years younger than the healthy women. Hypertension, obesity or smoking could not explain the results. Conclusion. Already at the age of 30, subjects with recurrent depressive disorders with adolescent onset do have early signs of carotid intima and media changes, indicating a less healthy artery wall, despite otherwise no clinical signs of cardiovascular disease.

  • 110.
    Bohman, Hannes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Låftman, Sara B
    Cleland, Neil
    Lundberg, Mathias
    Päären, Aivar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Somatic symptoms in adolescence as a predictor of severe mental illness in adulthood: a long-term community-based follow-up study.2018In: Child and Adolescent Psychiatry and Mental Health, ISSN 1753-2000, E-ISSN 1753-2000, Vol. 12, article id 42Article in journal (Refereed)
    Abstract [en]

    Background: Somatic symptoms are common and costly for society and correlate with suffering and low functioning. Nevertheless, little is known about the long-term implications of somatic symptoms. The objective of this study was to assess if somatic symptoms in adolescents with depression and in their matched controls predict severe mental illness in adulthood by investigating the use of hospital-based care consequent to different mental disorders.

    Methods: The entire school population of 16-17-year-olds in the city of Uppsala, Sweden, was screened for depression in 1991-1993 (n = 2300). Adolescents with positive screenings (n = 307) and matched non-depressed controls (n = 302) participated in a semi-structured diagnostic interview for mental disorders. In addition, 21 different self-rated somatic symptoms were assessed. The adolescents with depression and the matched non-depressed controls were engaged in follow-up through the National Patient Register 17-19 years after the baseline study (n = 375). The outcome measures covered hospital-based mental health care for different mental disorders according to ICD-10 criteria between the participants' ages of 18 and 35 years.

    Results: Somatic symptoms were associated with an increased risk of later hospital-based mental health care in general in a dose-response relationship when adjusting for sex, adolescent depression, and adolescent anxiety (1 symptom: OR = 1.63, CI 0.55-4.85; 2-4 symptoms: OR = 2.77, 95% CI 1.04-7.39; ≥ 5 symptoms: OR = 5.75, 95% CI 1.98-16.72). With regards to specific diagnoses, somatic symptoms predicted hospital-based care for mood disorders when adjusting for sex, adolescent depression, and adolescent anxiety (p < 0.05). In adolescents with depression, somatic symptoms predicted later hospital-based mental health care in a dose-response relationship (p < 0.01). In adolescents without depression, reporting at least one somatic symptom predicted later hospital-based mental health care (p < 0.05).

    Conclusions: Somatic symptoms in adolescence predicted severe adult mental illness as measured by hospital-based care also when controlled for important confounders. The results suggest that adolescents with somatic symptoms need early treatment and extended follow-up to treat these specific symptoms, regardless of co-occurring depression and anxiety.

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  • 111.
    Bohman, Hannes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, SE-17177 Stockholm, Sweden.; Stockholm Cty Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Låftman, Sara B.
    Stockholm Univ, Karolinska Inst, Ctr Hlth Equ Studies CHESS, SE-10691 Stockholm, Sweden..
    Päären, Aivar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, SE-17177 Stockholm, Sweden..
    Parental separation in childhood as a risk factor for depression in adulthood: a community-based study of adolescents screened for depression and followed up after 15 years2017In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 17, article id 117Article in journal (Refereed)
    Abstract [en]

    Background

    Earlier research has investigated the association between parental separation and long-term health outcomes among offspring, but few studies have assessed the potentially moderating role of mental health status in adolescence. The aim of this study was to analyze whether parental separation in childhood predicts depression in adulthood and whether the pattern differs between individuals with and without earlier depression.

    Methods

    A community-based sample of individuals with adolescent depression in 1991–93 and matched non-depressed peers were followed up using a structured diagnostic interview after 15 years. The participation rate was 65% (depressed n = 227; non-depressed controls n = 155). Information on parental separation and conditions in childhood and adolescence was collected at baseline. The outcome was depression between the ages 19–31 years; information on depression was collected at the follow-up diagnostic interview. The statistical method used was binary logistic regression.

    Results

    Our analyses showed that depressed adolescents with separated parents had an excess risk of recurrence of depression in adulthood, compared with depressed adolescents with non-separated parents. In addition, among adolescents with depression, parental separation was associated with an increased risk of a switch to bipolar disorder in adulthood. Among the matched non-depressed peers, no associations between parental separation and adult depression or bipolar disorder were found.

    Conclusions

    Parental separation may have long-lasting health consequences for vulnerable individuals who suffer from mental illness already in adolescence.

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  • 112.
    Bohman, Hannes
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health. Karolinska Inst, Dept Clin Neurosci, Ctr Psychiat Res, Stockholm, Sweden.; Stockholm Country Council, Stockholm Hlth Care Serv, Stockholm, Sweden..
    Låftman, Sara B.
    Stockholm Univ, Karolinska Inst, Ctr Hlth Equ Studies, Stockholm, Sweden..
    Päären, Aivar
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Jonsson, Ulf
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry.
    Somatic symptoms in adolescence as a predictor of in-patient care for mental disorders in adulthood2016Conference paper (Refereed)
  • 113.
    Bolte, Sven
    et al.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden;Stockholm Cty Council, Ctr Psychiat Res, KIND, Stockholm, Sweden.
    Tomalski, Przemyslaw
    Univ Warsaw, Fac Psychol, Neurocognit Dev Lab, Warsaw, Poland.
    Marschik, Peter B.
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden;Med Univ Graz, Inst Physiol, Ctr Physiol Med, Graz, Austria.
    Berggren, Steve
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden;Stockholm Cty Council, Ctr Psychiat Res, KIND, Stockholm, Sweden.
    Norberg, Joakim
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Falck-Ytter, Terje
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Pokorska, Olga
    Univ Warsaw, Fac Psychol, Neurocognit Dev Lab, Warsaw, Poland.
    Jones, Emily J. H.
    Univ London, Birkbeck Coll, Ctr Brain & Cognit Dev, London, England.
    Charman, Tony
    Kings Coll London, Inst Psychiat Psychol & Neurosci, London, England.
    Roeyers, Herbert
    Univ Ghent, Dept Expt Clin & Hlth Psychol, Ghent, Belgium.
    Kostrzewa, Elzbieta
    Karolinska Inst, Dept Womens & Childrens Hlth, Stockholm, Sweden.
    Challenges and Inequalities of Opportunities in European Psychiatry Research The Example of Psychodiagnostic Tool Availability in Research on Early Autism Identification2018In: European Journal of Psychological Assessment, ISSN 1015-5759, E-ISSN 2151-2426, Vol. 34, no 4, p. 270-277Article in journal (Refereed)
    Abstract [en]

    Europe is diverse in terms of economy, cultures, socio-demography, and languages. A crucial aspect of psychiatric research is the availability of standardized screening, diagnostic, and characterization instruments. We fine-mapped the accessibility of 14 clinical scales and cognitive tests for the assessment of early childhood Autism Spectrum Disorder (ASD; e.g., ADOS, ADI-R, SCQ, SRS, CHAT, MESL) within 21 European countries. These tools are essential for internationally competitive early ASD detection research. We identified a considerable variation not only in the availability, but also psychometric standardization, and formal distribution of the instruments between the countries, privileging English speaking, high-income, and highly populated European countries. Absence of country-specific standardization was a problem across many countries, independent of income and size. Findings demonstrate, on a concrete level, the challenges in creating equal early ASD identification research opportunities in Europe, and the need for increased funding for instrument development and validation. We discuss the reasons, implications, and consequences of this inequity and ways of reducing it.

  • 114.
    Bondjers, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Post-traumatic Stress Disorder – Assessment of current diagnostic definitions2020Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Post-traumatic stress disorder (PTSD) is a debilitating condition that may arise after exposure to shocking, frightening, or dangerous events. Hallmark symptoms are re-experiencing, avoidance, and hyperarousal. Other common symptoms are more ancillary and overlap with other psychiatric disorders (e.g., anhedonia, interpersonal problems, and affective dysregulation). The variety of symptoms associated with PTSD allows for large differences in symptom presentation between individuals. Studies of the latent structure of PTSD (e.g., latent class analysis, confirmatory factor analysis) have been highly influential in the conceptualisation of the disorder. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the eleventh edition of the International Classification of Diseases (ICD-11) have taken vastly different approaches to handling the symptom variety, with DSM-5 encompassing a broad definition, and the ICD-11 instead proposing a narrow PTSD construct and introducing the new diagnosis complex PTSD (CPTSD), comprising PTSD in conjunction with ancillary symptoms.

    The principal aims of the present thesis were to examine how different symptom presentations of PTSD were associated with well-known predictors of PTSD and prospective outcome, to evaluate the dimensional structure of PTSD as it is proposed in current diagnostic nomenclature, to provide methods for assessing PTSD in the Swedish language, and to evaluate the diagnostic agreement between DSM-5 and ICD-11.

    Using latent class analysis, subgroups with differences in PTSD symptom presentation were examined and assessed regarding their predictive validity. In a sample of natural disaster survivors, subgroups differed mainly in symptom severity. In a mixed trauma sample, subgroups differed in their likelihood of fulfilling hallmark versus ancillary symptoms, and in self-reported concurrent and prospective psychological distress.

    As for the dimensional structure of DSM-5 symptomology, support was not found for the four-factor DSM-5 model, but rather for a six-factor and a seven-factor model. For ICD-11 symptomatology, the ICD-11 model was supported, both with and without a higher-order separation of PTSD and CPTSD. Two instruments for assessing PTSD were evaluated: the PTSD checklist for DSM-5 (PCL-5) and the International Trauma Interview for ICD-11 (ITI). Results indicated support for both instruments as valid and reliable tools. The diagnostic agreement between DSM-5 and ICD-11 was moderate.

    Summarised, the studies suggest that variables such as secondary stressors and event-specific exposure influence symptom expression, and that the combination of hallmark and ancillary symptoms of PTSD is associated with the long-term maintenance of psychological distress. Results support the use of the PCL-5 and the ITI as assessment tools for DSM-5 and ICD-11 PTSD. The insufficient agreement between DSM-5 and ICD-11 PTSD and CPTSD poses a challenge for future researchers and clinicians.

    List of papers
    1. Similarity in symptom patterns of posttraumatic stress among disaster-survivors: a three-step latent profile analysis
    Open this publication in new window or tab >>Similarity in symptom patterns of posttraumatic stress among disaster-survivors: a three-step latent profile analysis
    2018 (English)In: European Journal of Psychotraumatology, ISSN 2000-8066, E-ISSN 2000-8066, Vol. 9, no 1, article id 1546083Article in journal (Refereed) Published
    Abstract [en]

    Background: Individuals express symptoms of posttraumatic stress in various ways, noted for example in the many symptom combinations in the diagnostic manuals. Studies aiming to examine differences of symptom presentations by extracting latent classes or profiles indicate both the presence of subtypes with differing symptomatology and subtypes distinguished by severity levels. Few studies have examined subtype associations with long-term outcomes. Objective: The current study aimed to apply latent profile analysis on posttraumatic stress (PTS) in a highly homogenous sample of Swedish tourists exposed to the 2004 Southeast Asia tsunami and to examine if classes differed in their long-term outcome. Methods: An latent profile analysis was conducted using self-report data collected one year after the disaster from 1638 highly exposed survivors that endorsed 1 symptom of PTS. Associations were examined between the classes and predictors of PTS (loss of a relative or friend, subjective life threat) and levels of PTS at a three-year follow up. Results: The latent profile analysis indicated four classes: minimal, low, moderate, and severe symptoms. The classes were distinguished mainly by their levels of PTS. Loss of a relative or friend and subjective life threat were associated with a higher likelihood of belonging to any other class than the minimal class. The severity level of the classes at one year were predictive of PTS severity at the three-year follow-up. Conclusions: Homogeneous profiles of posttraumatic stress differing mainly in symptom severity were found in this sample of disaster survivors. Profile diversity may be related to sample variation and unmeasured confounders rather than reflect qualitatively different disorders.

    Keywords
    PTSD, posttraumatic stress, trauma, latent profile analysis, natural disaster, longitudinal study
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-369456 (URN)10.1080/20008198.2018.1546083 (DOI)000450666500001 ()30479702 (PubMedID)
    Funder
    Swedish National Board of Health and Welfare
    Available from: 2018-12-13 Created: 2018-12-13 Last updated: 2020-01-23Bibliographically approved
    2. Validation of a clinician-administered diagnostic measure of ICD-11 PTSD and Complex PTSD: the International Trauma Interview in a Swedish sample
    Open this publication in new window or tab >>Validation of a clinician-administered diagnostic measure of ICD-11 PTSD and Complex PTSD: the International Trauma Interview in a Swedish sample
    Show others...
    2019 (English)In: European Journal of Psychotraumatology, ISSN 2000-8066, E-ISSN 2000-8066, Vol. 10, no 1, article id 1665617Article in journal (Refereed) Published
    Abstract [en]

    Background: The recently published ICD-11 includes substantial changes to the diagnosis of posttraumatic stress disorder (PTSD) and introduces the diagnosis of Complex PTSD (CPTSD). The International Trauma Interview (ITI) has been developed for clinicians to assess these new diagnoses but has not yet been evaluated.

    Objectives: To evaluate the psychometric properties of the Swedish translation of the ITI by examining the interrater agreement, latent structure, internal consistency, and convergent and discriminant validity.

    Methods: In a prospective study, 186 adults who had experienced a potentially traumatic event were assessed with the ITI and answered questionnaires for symptoms of posttraumatic stress, other psychiatric disorders, functional disability, and quality of life (QoL).

    Results: The diagnostic rate was 16% for PTSD and 6% for CPTSD. Interrater agreement was satisfactory (α = .76), and confirmatory factor analysis indicated that a two-factor second-20 order model consistent with the ICD-11 model of CPTSD provided acceptable fit to the data. Composite reliability analysis demonstrated that the ITI possessed acceptable internal reliability, and associations with measures of other psychiatric disorders, insomnia, functional disability, and QoL supported the concurrent validity of the ITI.

    Conclusion: Swedish ITI shows promise as a clinician-administered instrument to assess and diagnose ICD-11 PTSD and CPTSD.

    National Category
    Psychiatry
    Research subject
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-395492 (URN)10.1080/20008198.2019.1665617 (DOI)000488883400001 ()31632616 (PubMedID)
    Funder
    Swedish National Board of Health and Welfare
    Available from: 2019-10-20 Created: 2019-10-20 Last updated: 2020-01-23Bibliographically approved
    3. Psychometric Properties of the Swedish Version of the PTSD Checklist for DSM-5 (PCL-5): Sensitivity, Specificity, Diagnostic Accuracy and Structural Validity in a Mixed Trauma Sample
    Open this publication in new window or tab >>Psychometric Properties of the Swedish Version of the PTSD Checklist for DSM-5 (PCL-5): Sensitivity, Specificity, Diagnostic Accuracy and Structural Validity in a Mixed Trauma Sample
    2020 (English)In: Article in journal (Refereed) Submitted
    National Category
    Medical and Health Sciences
    Identifiers
    urn:nbn:se:uu:diva-403113 (URN)
    Available from: 2020-01-23 Created: 2020-01-23 Last updated: 2020-01-31Bibliographically approved
    4. Symptom patterns of DSM-5 PTSD and ICD-11 DSO criteria, and their associations with functional disability, quality of life and long-term outcome.
    Open this publication in new window or tab >>Symptom patterns of DSM-5 PTSD and ICD-11 DSO criteria, and their associations with functional disability, quality of life and long-term outcome.
    (English)Manuscript (preprint) (Other academic)
    National Category
    Psychiatry
    Identifiers
    urn:nbn:se:uu:diva-403111 (URN)
    Available from: 2020-01-23 Created: 2020-01-23 Last updated: 2020-01-23
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  • 115.
    Bondjers, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    DSM-5 and ICD-11 symptom profiles in a diverse sample of trauma victims2017Conference paper (Refereed)
    Abstract [en]

    Introduction: Research suggest different trajectories of posttraumatic stress symptoms over time (e.g., resilient, recovering, and chronic) among survivors from natural disasters. It is not known, however, if disaster survivors present with distinct symptom profiles and, if so, whether these profiles are related to severity, recovery and exposure characteristics.Methods and Results: This study aims to investigate symptom profiles among Swedish survivors of the 2004 Indian Ocean tsunami using latent profile analysis. Participants include adult survivors who were pulled into the waves and responded to postal surveys 1 and 3 years after the disaster (n=2009). Posttraumatic stress symptoms were assessed with the Impact of Event Scale-Revised (IES-R). The symptom profiles generated from the first year survey will be compared with regard to established predictors of posttraumatic stress, such as disaster exposure, bereavement, perceived social support as well as posttraumatic stress and general distress at three years.Discussion: The presentation will shed light on whether there are distinct symptom profiles among disaster survivors. We will discuss the implications for psychosocial care after natural disasters. The results are relevant for victims of natural disasters in general, and increases knowledge about the characteristics of posttraumatic stress and may improve psychosocial services after traumatic events.

  • 116.
    Bondjers, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Screening for chronic PTSD after disasters: The gap between self-reported posttraumatic stress and PTSD cases in psychiatric services2017Conference paper (Refereed)
    Abstract [en]

    Introduction: Screening disaster survivors for mental health problems after initial recovery may detect unrecognized cases of chronic PTSD. This presentation compares published findings of PTSD prevalence after the 2004 tsunami among exposed Swedish adult survivors.

    Method: Register data were collected for psychiatric diagnoses made in specialized healthcare for 8762 Swedish adults with various levels of disaster exposure. Posttraumatic stress (PTS) was assessed and exposure established for 2268 individuals who filled out the Impact of Event Scale–Revised (IES-R) in surveys at 1, 3, and 6 years post-disaster. A subset of directly exposed participants (n=142) were assessed for current and post-disaster PTSD with SCID interviews.

    Results: In the survey sample, 5% of participants reported very high and 11% reported high levels of PTS across all surveys. The post-disaster prevalence of PTSD was 11.3% in the interview sample. In healthcare services, the 5-year incidence was 0.5% for PTSD and 2.1% for any stress-related disorder. Findings suggested that the IES-R possessed good screening properties, e.g., sensitivity ≥ 0.92.

    Discussion: These studies indicate large differences between the PTS load among survivors and the number of PTSD cases in healthcare services, making a case for individual symptom screening. Yet, screening for chronic PTSD with current methods will yield a substantial numbers of incorrectly classified survivors (640 false positives in this sample), providing challenges to psychosocial follow-up services.

    Part of symposium: Screening for mental health after trauma in children and adults: importance, instruments, & innovations

  • 117.
    Bondjers, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Symptom profiles of posttraumatic stress among Swedish survivors of a natural disaster and their prospective value to long-term distress2017Conference paper (Refereed)
    Abstract [en]

    Introduction: Research suggest different trajectories of posttraumatic stress symptoms over time (e.g., resilient, recovering, and chronic) among survivors from natural disasters. It is not known, however, if disaster survivors present with distinct symptom profiles and, if so, whether these profiles are related to severity, recovery and exposure characteristics.Methods and Results: This study aims to investigate symptom profiles among Swedish survivors of the 2004 Indian Ocean tsunami using latent profile analysis. Participants include adult survivors who were pulled into the waves and responded to postal surveys 1 and 3 years after the disaster (n=2009). Posttraumatic stress symptoms were assessed with the Impact of Event Scale-Revised (IES-R). The symptom profiles generated from the first year survey will be compared with regard to established predictors of posttraumatic stress, such as disaster exposure, bereavement, perceived social support as well as posttraumatic stress and general distress at three years.Discussion: The presentation will shed light on whether there are distinct symptom profiles among disaster survivors. We will discuss the implications for psychosocial care after natural disasters. The results are relevant for victims of natural disasters in general, and increases knowledge about the characteristics of posttraumatic stress and may improve psychosocial services after traumatic events.

  • 118.
    Bondjers, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Hyland, Philip
    Department of Psychology, Maynooth University, Kildare, Ireland.
    Roberts, Neil P.
    Cardiff & Vale University Health Board, Cardiff, United Kingdom; UK School of Medicine, Cardiff University, Cardiff, United Kingdom.
    Bisson, Jonathan I.
    UK School of Medicine, Cardiff University, Cardiff, United Kingdom.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Validation of a clinician-administered diagnostic measure of ICD-11 PTSD and Complex PTSD: the International Trauma Interview in a Swedish sample2019In: European Journal of Psychotraumatology, ISSN 2000-8066, E-ISSN 2000-8066, Vol. 10, no 1, article id 1665617Article in journal (Refereed)
    Abstract [en]

    Background: The recently published ICD-11 includes substantial changes to the diagnosis of posttraumatic stress disorder (PTSD) and introduces the diagnosis of Complex PTSD (CPTSD). The International Trauma Interview (ITI) has been developed for clinicians to assess these new diagnoses but has not yet been evaluated.

    Objectives: To evaluate the psychometric properties of the Swedish translation of the ITI by examining the interrater agreement, latent structure, internal consistency, and convergent and discriminant validity.

    Methods: In a prospective study, 186 adults who had experienced a potentially traumatic event were assessed with the ITI and answered questionnaires for symptoms of posttraumatic stress, other psychiatric disorders, functional disability, and quality of life (QoL).

    Results: The diagnostic rate was 16% for PTSD and 6% for CPTSD. Interrater agreement was satisfactory (α = .76), and confirmatory factor analysis indicated that a two-factor second-20 order model consistent with the ICD-11 model of CPTSD provided acceptable fit to the data. Composite reliability analysis demonstrated that the ITI possessed acceptable internal reliability, and associations with measures of other psychiatric disorders, insomnia, functional disability, and QoL supported the concurrent validity of the ITI.

    Conclusion: Swedish ITI shows promise as a clinician-administered instrument to assess and diagnose ICD-11 PTSD and CPTSD.

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  • 119.
    Bondjers, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Roberts, Neil
    Cardiff and Vale University Health Board, Cardiff, Wales, UK.
    Bisson, Jonathan
    Cardiff University School of Medicine, Cardiff, Wales, UK.
    Hyland, Philip
    Department of Psychology, Maynooth University, Ireland.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Reliability and validity of the Swedish international trauma interview for posttraumatic stress disorders in the ICD-112019In: European Journal of Psychotraumatology: Trauma in Transition: Building Bridges, 2019, Vol. 10, article id 1613836Conference paper (Refereed)
  • 120.
    Bondjers, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Sveen, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Psychometric Properties of the PTSD Checklist for DSM-5 (PCL-5) in parents to children with burns.2015Conference paper (Refereed)
    Abstract [en]

    Introduction Symptoms of post-traumatic stress disorder (PTSD) is a common problem among parents of children with burns. However, there is a paucity of evaluated screening tools for this population. The aim was to evaluate the psychometric properties of the PTSD Checklist (PCL), which is recently revised in accordance to the Diagnostic and statistical manual of mental disorders, 5th ed.  

    Methods The participating parents (N= 62, mean age= 38) completed self-report questionnaires 0.8-5.6 years after their child’s burn. Measures were the PCL-5 (consisting of four subscales; Intrusion, Avoidance, Negative alterations in cognitions and mood, and Arousal and reactivity), the Impact of Event Scale-Revised (with three subscales; Intrusion, Avoidance and Hyperarousal) and the Perceived Stress Scale. The children had a TBSA burned ranging from 1 to 31 % and were 0.1-15.0 years of age at injury.

    Results The average PCL-5 scores were low to moderate and indicated that no parent was above the recommended preliminary cut off of 38 for PTSD. Cronbach’s alpha values were acceptable and varied between 0.56 and 0.77 for the four PCL-5 subscales and mean inter-item correlations ranged from 0.22 to 0.73. The PCL-5 subscales were positively correlated with the corresponding IES-R subscales as well as the total PSS score (p<.05). There were no associations between the PCL-5 and  burn severity (TBSA, TBSA-FT, and LOS), time since injury, child age or gender, or parent gender. 

    Conclusion In conclusion, the PCL-5 had high internal consistency and evaluation of concurrent validity suggested moderate associations with other measures of traumatic stress and perceived stress as expected. The moderate associations with other measures of stress is to be expected, taking into account the slightly different constructs targeted by the three measures in this study. This first study suggests that the PCL-5 is a psychometrically sound instrument that deserves further evaluation as a screening tool for parents of children with burns.

  • 121.
    Bondjers, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    A Prospective Study of ICD-11 and DSM-5 PTSD, Functional Disability and Quality of Life2018Conference paper (Refereed)
    Abstract [en]

    Introduction: It is unclear if there are differences between the ICD-11 and DSM-5 diagnoses for PTSD related to type of potential traumatic event (PTE) and patient-reported outcomes.Method: In an ongoing prospective study, 250 participants were assessed with structured clinical interviews for ICD-11 and DSM-5 PTSD, functional disability (FD) and quality of life (QoL) at the first assessment point (T1). Participants were followed up after six months (T2) with self-rated symptom levels, functional disability (FD), and quality of life (QoL).

    Results: Interim results (N=184) from T1 indicate that 68% did not fulfil criteria for any PTSD diagnosis. Of those with PTSD, 58% fulfilled criteria for both systems, 13% for ICD-11 only and 31% for DSM-5 only. Fulfilling criteria for both disorders was associated with higher FD and lower QoL at T1. Loss was more common among those fulfilling criteria for DSM-5 only.Conclusions: The concordance between the systems were low, and there were differences regarding event type and outcome. This presentation will discuss these results and present outcomes assessed at T2.Relevance: Knowledge about the differences between the ICD-11 and DSM-5 PTSD specifications are necessary to better understand how these differences influence prevalence rates, diagnostic status, as well as to understand the advantages and disadvantages of each system.

  • 122.
    Bondjers, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    An Evaluation of the ICD-11 Trauma Interview Schedule Compared to the Clinician Administered PTSD Scale and WHODAS 2.02016Conference paper (Refereed)
    Abstract [en]

    The 11th revision of the International Classification of Diseases (ICD) proposes two related diagnoses for posttraumatic symptomatology: posttraumatic stress disorder (PTSD) and complex PTSD (C-PTSD). The ICD- 11 task force has developed a structured clinical interview, the ICD-11 Trauma Interview Schedule, to assess the presence of the disorders.

    The ICD-11 proposal differ from the DSM-5 PTSD diagnosis and the divergence between the two may have important consequences for diagnostic assessments. In an ongoing study, 100 participants who have experienced a potentially traumatic event during the past 5 years are recruited via adverts in local media, primary care facilities and outpatient psychiatric care facilities. Participants are interviewed using the ICD-11 Trauma Interview Schedule, the Clinician-Administered PTSD scale (CAPS-5) and the WHODAS 2.0. The aim of this presentation is to evaluate the user experience of the ICD-11 trauma interview schedule. Furthermore, the DSM-5 and ICD-11 criteria will be compared regarding rates of PTSD, symptom profiles, functional disability, demographics, and type of trauma. Relevance: Increasing the knowledge about the differences between the DSM-5 and ICD-11 diagnosis of PTSD regarding disease rate and predictive ability will facilitate the transition from ICD-10 to ICD-11 for clinicians and researchers.

  • 123.
    Bondjers, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Psychometric properties of the Swedish PTSD Checklist for DSM-5 (PCL-5).2016Conference paper (Refereed)
    Abstract [en]

    Recent changes in the criteria of posttraumatic stress disorder call for new evaluations of tools to assess posttraumatic symptomatology. The aim of this study is to evaluate the psychometric properties of the Swedish PTSD Checklist (PCL-5)1, which was recently revised in accordance to the Diagnostic and statistical manual of mental disorders, 5th ed2. This poster will present data from an ongoing study with approximately 150 participants who were assessed with rating scales of posttraumatic stress and clinical interviews (CAPS-55 and MINI 6.04). The focus will be on the psychometric properties of the PCL-5 and its relationship to the CAPS-5, the Impact of Event Scale-Revised3, and the MINI. Preliminary results will detail screening and psychometric properties of the PCL-5, including internal consistency, test-retest reliability, convergent and discriminant validity as well as sensitivity and specificity for PTSD according to CAPS-5. Relevance: Information about the psychometric properties of the PCL-5 is timely and relevant for clinicians. Performance assessments in different countries also provide a basis for future evaluations of cultural invariance of a measure. PTSD poses an on-going and increasing burden on society and documented methods of detection is key to identify individuals in need of further services.

  • 124.
    Bondjers, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Similarity in symptom patterns of posttraumatic stress among disaster-survivors: a three-step latent profile analysis2018In: European Journal of Psychotraumatology, ISSN 2000-8066, E-ISSN 2000-8066, Vol. 9, no 1, article id 1546083Article in journal (Refereed)
    Abstract [en]

    Background: Individuals express symptoms of posttraumatic stress in various ways, noted for example in the many symptom combinations in the diagnostic manuals. Studies aiming to examine differences of symptom presentations by extracting latent classes or profiles indicate both the presence of subtypes with differing symptomatology and subtypes distinguished by severity levels. Few studies have examined subtype associations with long-term outcomes. Objective: The current study aimed to apply latent profile analysis on posttraumatic stress (PTS) in a highly homogenous sample of Swedish tourists exposed to the 2004 Southeast Asia tsunami and to examine if classes differed in their long-term outcome. Methods: An latent profile analysis was conducted using self-report data collected one year after the disaster from 1638 highly exposed survivors that endorsed 1 symptom of PTS. Associations were examined between the classes and predictors of PTS (loss of a relative or friend, subjective life threat) and levels of PTS at a three-year follow up. Results: The latent profile analysis indicated four classes: minimal, low, moderate, and severe symptoms. The classes were distinguished mainly by their levels of PTS. Loss of a relative or friend and subjective life threat were associated with a higher likelihood of belonging to any other class than the minimal class. The severity level of the classes at one year were predictive of PTS severity at the three-year follow-up. Conclusions: Homogeneous profiles of posttraumatic stress differing mainly in symptom severity were found in this sample of disaster survivors. Profile diversity may be related to sample variation and unmeasured confounders rather than reflect qualitatively different disorders.

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  • 125.
    Bondjers, Kristina
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Arnberg, Filip
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Medicinska och farmaceutiska vetenskapsområdet, centrumbildningar mm, National Center for Disaster Psychiatry.
    Symptom patterns of DSM-5 PTSD and ICD-11 DSO criteria, and their associations with functional disability, quality of life and long-term outcome.Manuscript (preprint) (Other academic)
  • 126.
    Bonnevier, Johan
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine.
    A study of diadochokinesia in schoolchildren1968In: Acta paedopsychiatrica, ISSN 0001-6586, Vol. 35, no 2-3, p. 70-78Article in journal (Refereed)
  • 127.
    Bonsall, M. B.
    et al.
    Univ Oxford, Dept Zool, Math Ecol Res Grp, Oxford OX1 3PS, England;St Peters Coll, Oxford OX1 2DL, England.
    Wallace-Hadrill, S. M. A.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Geddes, J. R.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Goodwin, G. M.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Holmes, Emily A.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Nonlinear time-series approaches in characterizing mood stability and mood instability in bipolar disorder2012In: Proceedings of the Royal Society of London. Biological Sciences, ISSN 0962-8452, E-ISSN 1471-2954, Vol. 279, no 1730, p. 916-924Article in journal (Refereed)
    Abstract [en]

    Bipolar disorder is a psychiatric condition characterized by episodes of elevated mood interspersed with episodes of depression. While treatment developments and understanding the disruptive nature of this illness have focused on these episodes, it is also evident that some patients may have chronic week-to-week mood instability. This is also a major morbidity. The longitudinal pattern of this mood instability is poorly understood as it has, until recently, been difficult to quantify. We propose that understanding this mood variability is critical for the development of cognitive neuroscience-based treatments. In this study, we develop a time-series approach to capture mood variability in two groups of patients with bipolar disorder who appear on the basis of clinical judgement to show relatively stable or unstable illness courses. Using weekly mood scores based on a self-rated scale (quick inventory of depressive symptomatology-self-rated; QIDS-SR) from 23 patients over a 220-week period, we show that the observed mood variability is nonlinear and that the stable and unstable patient groups are described by different nonlinear time-series processes. We emphasize the necessity in combining both appropriate measures of the underlying deterministic processes (the QIDS-SR score) and noise (uncharacterized temporal variation) in understanding dynamical patterns of mood variability associated with bipolar disorder.

  • 128.
    Bonsall, Michael B.
    et al.
    Univ Oxford, Dept Zool, Oxford OX1 3PS, England;St Peters Coll, Oxford OX1 2DL, England.
    Geddes, John R.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX1 7JX, England.
    Goodwin, Guy M.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX1 7JX, England.
    Holmes, Emily A.
    MRC, Cognit & Brain Sci Unit, Cambridge CB2 7EF, England;Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Bipolar disorder dynamics: affective instabilities, relaxation oscillations and noise2015In: Journal of the Royal Society Interface, ISSN 1742-5689, E-ISSN 1742-5662, Vol. 12, no 112, article id 20150670Article in journal (Refereed)
    Abstract [en]

    Bipolar disorder is a chronic, recurrent mental illness characterized by extreme episodes of depressed and manic mood, interspersed with less severe but highly variable mood fluctuations. Here, we develop a novel mathematical approach for exploring the dynamics of bipolar disorder. We investigate how the dynamics of subjective experience of mood in bipolar disorder can be understood using a relaxation oscillator (RO) framework and test the model against mood time-series fluctuations from a set of individuals with bipolar disorder. We show that variable mood fluctuations in individuals diagnosed with bipolar disorder can be driven by the coupled effects of deterministic dynamics (captured by ROs) and noise. Using a statistical likelihood-based approach, we show that, in general, mood dynamics are described by two independent ROs with differing levels of endogenous variability among individuals. We suggest that this sort of nonlinear approach to bipolar disorder has neurobiological, cognitive and clinical implications for understanding this mental illness through a mechacognitive framework.

  • 129.
    Borsook, D.
    et al.
    Boston Childrens Hosp, Ctr Pain & Brain, Boston, MA 02115 USA.;Massachusetts Gen Hosp, Boston, MA 02114 USA.;Boston Childrens Hosp, Dept Anesthesia Crit Care & Pain Med, Boston, MA USA.;Mclean & Massachusetts Gen Hosp, Dept Psychiat, Boston, MA USA.;Harvard Med Sch, Boston, MA USA..
    Linnman, C.
    Boston Childrens Hosp, Ctr Pain & Brain, Boston, MA 02115 USA.;Massachusetts Gen Hosp, Boston, MA 02114 USA.;Boston Childrens Hosp, Dept Anesthesia Crit Care & Pain Med, Boston, MA USA.;Harvard Med Sch, Boston, MA USA..
    Faria, Vanda
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology. Boston Childrens Hosp, Ctr Pain & Brain, Boston, MA 02115 USA.;Massachusetts Gen Hosp, Boston, MA 02114 USA.;Boston Childrens Hosp, Dept Anesthesia Crit Care & Pain Med, Boston, MA USA.;Harvard Med Sch, Boston, MA USA..
    Strassman, A. M.
    Beth Israel Deaconess Med Ctr, Dept Anesthesia Crit Care & Pain Med, Boston, MA USA.;Harvard Med Sch, Boston, MA USA..
    Becerra, L.
    Boston Childrens Hosp, Ctr Pain & Brain, Boston, MA 02115 USA.;Massachusetts Gen Hosp, Boston, MA 02114 USA.;Boston Childrens Hosp, Dept Anesthesia Crit Care & Pain Med, Boston, MA USA.;Mclean & Massachusetts Gen Hosp, Dept Psychiat, Boston, MA USA.;Harvard Med Sch, Boston, MA USA..
    Elman, I.
    Wright State Univ, Boonshoft Sch Med, Dept Psychiat, Dayton, OH 45435 USA.;Dayton VA Med Ctr, Dayton, OH USA..
    Reward deficiency and anti-reward in pain chronification2016In: Neuroscience and Biobehavioral Reviews, ISSN 0149-7634, E-ISSN 1873-7528, Vol. 68, p. 282-297Article, review/survey (Refereed)
    Abstract [en]

    Converging lines of evidence suggest that the pathophysiology of pain is mediated to a substantial degree via allostatic neuroadaptations in reward- and stress-related brain circuits. Thus, reward deficiency (RD) represents a within-system neuroadaptation to pain-induced protracted activation of the reward circuits that leads to depletion-like hypodopaminergia, clinically manifested anhedonia, and diminished motivation for natural reinforcers. Anti-reward (AR) conversely pertains to a between-systems neuroadaptation involving over-recruitment of key limbic structures (e.g., the central and basolateral amygdala nuclei, the bed nucleus of the stria terminalis, the lateral tegmental noradrenergic nuclei of the brain stem, the hippocampus and the habenula) responsible for massive outpouring of stressogenic neurochemicals (e.g., norepinephrine, corticotropin releasing factor, vasopressin, hypocretin, and substance P) giving rise to such negative affective states as anxiety, fear and depression. We propose here the Combined Reward deficiency and Anti-reward Model (CReAM), in which biopsychosocial variables modulating brain reward, motivation and stress functions can interact in a 'downward spiral' fashion to exacerbate the intensity, chronicity and comorbidities of chronic pain syndromes (i.e., pain chronification).

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  • 130.
    Boström, Adrian
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Ciuculete, Diana-Maria
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Attwood, Misty M.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Krattinger, Regina
    Univ Zurich, Univ Zurich Hosp, Dept Clin Pharmacol & Toxicol, Zurich, Switzerland..
    Nikontovic, Lamia
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Titova, Olga E
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Kullak-Ublick, Gerd A.
    Univ Zurich, Univ Zurich Hosp, Dept Clin Pharmacol & Toxicol, Zurich, Switzerland..
    Mwinyi, Jessica
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    Schiöth, Helgi B.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Functional Pharmacology.
    A MIR4646 associated methylation locus is hypomethylated in adolescent depression2017In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 220, p. 117-128Article in journal (Refereed)
    Abstract [en]

    Background: Studies of epigenetics and transcriptional activity in adolescents may provide knowledge about possible preventive strategies of depression. Methods: We present a methylome-wide association study (MWAS) and cohort validation analysis of depression in adolescents, in two separate cohorts: discovery (n = 93) and validation data set 1 (n = 78). The genome-wide methylation pattern was measured from whole blood using the Illumina 450K array. A second validation cohort, validation data set 2, consists of post-mortem brain biopsies from depressed adults (n = 58). We performed a MWAS by robust multiple linear regressions of methylation to a modified risk-score assessment of depression. Methylation levels of candidate CpG sites were correlated with expression levels of the associated gene in an independent cohort of 11 healthy volunteers. Results: The methylation state of two CpG sites reliably predicted ratings of depression in adolescents (cg13227623 and cg04102384) (p < 10E-06). Cohort validation analysis confirmed cg04102384 - located in the promoter region of microRNA 4646 (MIR4646) - to be hypomethylated in both validation data set 1 and validation data set 2 (p < 0.05). Cg04102384 was inversely correlated to expression levels of MIR4646-3p in healthy controls (p < 0.05). Limitations: MIR4646 was not differentially expressed in a subset of samples with adolescent depression measured by qRT-PCR measurements. Conclusion: We identify a specific MIR4646 associated epigenetic risk site to be associated with depression in adolescents. Cg04102384 putatively regulates gene expression of MIR4646-3p. Target gene prediction and gene set overrepresentation analysis revealed involvement of this miRNA in fatty acid elongation, a process related to omega-3 fatty acids, previously associated with depression.

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  • 131.
    Bothelius, Kristoffer
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Kyhle, Kicki
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Broman, Jan-Erik
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Gordh, Torsten
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Anaesthesiology and Intensive Care.
    Fredrikson, Mats
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Initial Sleep Time Predicts Success in Manual-Guided Cognitive Behavioral Therapy for Insomnia2016In: Behavioural Sleep Medicine, ISSN 1540-2002, E-ISSN 1540-2010, Vol. 14, no 4, p. 378-388Article in journal (Refereed)
    Abstract [en]

    Cognitive behavioral therapy produces significant and long-lasting improvement for individuals with insomnia, but treatment resources are scarce. A "stepped care" approach has therefore been proposed, but knowledge is limited on how to best allocate patients to different treatment steps. In this study, 66 primary-care patients with insomnia attended a low-end treatment step: manual-guided cognitive behavioral therapy (CBT) for insomnia delivered by ordinary primary-care personnel. Based on clinically significant treatment effects, subjects were grouped into treatment responders or nonresponders. Baseline data were analyzed to identify predictors for treatment success. Long total sleep time at baseline assessment was the only statistically significant predictor for becoming a responder, and sleep time may thus be important to consider before enrolling patients in low-end treatments.

  • 132.
    Bourne, Corin
    et al.
    Univ Oxford, Dept Psychiat, Warneford Hosp, Oxford OX3 7JX, England.
    Frasquilho, Francisco
    UCL, Res Dept Clin Educ & Hlth Psychol, London WC1E 6BT, England.
    Roth, Anthony D.
    UCL, Res Dept Clin Educ & Hlth Psychol, London WC1E 6BT, England.
    Holmes, Emily A.
    Univ Oxford, Dept Psychiat, Warneford Hosp, Oxford OX3 7JX, England.
    Is it mere distraction?: Peri-traumatic verbal tasks can increase analogue flashbacks but reduce voluntary memory performance2010In: Journal of Behavior Therapy and Experimental Psychiatry, ISSN 0005-7916, E-ISSN 1873-7943, Vol. 41, no 3, p. 316-324Article in journal (Refereed)
    Abstract [en]

    Several experiments have shown that we can reduce the frequency of analogue flashbacks with competing tasks presented during a trauma film (i.e. peri-traumatically). A "distraction" hypothesis suggests that any competing task may reduce flashbacks due to distraction and/or a load on executive control. Alternatively, a "modality" hypothesis based on clinical models of PTSD suggests that certain tasks will not protect against intrusions (Experiment 1) and could actually increase them (Experiment 2). Experiment 1 contrasted two concurrent tasks, Verbal Interference (counting backwards in threes) and Visuospatial tapping, against a no-task Control condition during trauma film viewing. The Visuospatial group had significantly fewer intrusions of the film over 1-week than the Control group. Contrary to a distraction account, the Verbal Interference group did not show this effect. Using a larger sample. Experiment 2 showed that the Verbal Interference group (counting backwards in sevens) had more intrusions (and inferior voluntary memory) than no-task Controls. We propose that this is in line with a modality hypothesis concerning trauma flashbacks. Disrupting verbal/conceptual processing during trauma could be harmful for later flashbacks. (C) 2010 Elsevier Ltd. All rights reserved.

  • 133. Bowers, L.
    et al.
    Haglund, Kristina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience.
    Muir-Cochrane, E.
    Nijman, H.
    Simpson, A.
    Van Der Merwe, M.
    Locked doors: a survey of patients, staff and visitors2010In: Journal of Psychiatric and Mental Health Nursing, ISSN 1351-0126, E-ISSN 1365-2850, Vol. 17, no 10, p. 873-880Article in journal (Refereed)
    Abstract [en]

    Locking the door of adult acute psychiatric wards has become increasingly common in the UK. There has been little investigation of its efficacy or acceptability in comparison to other containment methods. We surveyed the beliefs and attitudes of patients, staff and visitors to the practice of door locking in acute psychiatry. Wards that previously participated in a previous study were contacted and sent a questionnaire. A total of 1227 responses were obtained, with the highest number coming from staff, and the smallest from visitors. Analysis identified five factors (adverse effects, staff benefits, patient safety benefits, patient comforts and cold milieu). Patients were more negative about door locking than the staff, and more likely to express such negative judgments if they were residing in a locked ward. For staff, being on a locked ward was associated with more positive judgments about the practice. There were significant age, gender and ethnicity effects for staff only. Each group saw the issue of locked doors from their own perspective. Patients registered more anger, irritation and depression as a consequence of locked doors than staff or visitors thought they experienced. These differences were accentuated by the actual experience of the ward being locked.

  • 134. Brain, Cecilia
    et al.
    Sameby, Birgitta
    Allerby, Katarina
    Quinlan, Patrick
    Joas, Erik
    Lindström, Eva
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Burns, Tom
    Waern, Margda
    Stigma, discrimination and medication adherence in schizophrenia: Results from the Swedish COAST study2014In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 220, no 3, p. 811-817Article in journal (Refereed)
    Abstract [en]

    The aims of this naturalistic non-interventional study were to quantify the level of stigma and discrimination in persons with schizophrenia and to test for potential associations between different types of stigma and adherence to antipsychotics. Antipsychotic medication use was electronically monitored with a Medication Event Monitoring System (MEMS (R)) for 12 months in 111 outpatients with schizophrenia and schizophrenia-like psychosis (DSM-IV). Stigma was assessed at endpoint using the Discrimination and Stigma Scale (DISC). Single DISC items that were most frequently reported included social relationships in making/keeping friends (71%) and in the neighborhood (69%). About half of the patients experienced discrimination by their families, in intimate relationships, regarding employment and by mental health staff. Most patients (88%) wanted to conceal their mental health problems from others; 70% stated that anticipated discrimination resulted in avoidance of close personal relationships. Non-adherence (MEMS (R) adherence <= 0.80) was observed in 30 (27.3%). When DISC subscale scores (SD) were entered in separate regression models, neither experienced nor anticipated stigma was associated with adherence. Our data do not support an association between stigma and non-adherence. Further studies in other settings are needed as experiences of stigma and levels of adherence and their potential associations might vary by a healthcare system or cultural and sociodemographic contexts.

  • 135.
    Breedh, Julia
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Comasco: Neuropsychopharmacology. Uppsala University, Science for Life Laboratory, SciLifeLab.
    Comasco, Erika
    Uppsala University, Science for Life Laboratory, SciLifeLab. Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Comasco: Neuropsychopharmacology.
    Hellgren, Charlotte
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Papadopoulos, Fotios C.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Hypothalamic-pituitary-adrenal axis responsiveness, startle response, and sensorimotor gating in late pregnancy2019In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 106, p. 1-8Article in journal (Refereed)
    Abstract [en]

    During pregnancy, the hypothalamic-pituitary-adrenal (HPA) axis, the main regulator of the stress response, undergoes dramatic changes. The acoustic startle response (ASR) and the prepulse inhibition (PPI) of the startle response are neurophysiological research tools and objective measures of an individual's response to an emotional context or stressor. The ASR and PPI are influenced by psychiatric diseases characterized by anxiety symptoms and are sensitive to cortisol. Hence, the ASR and the PPI can be used to investigate the effects of pregnancy-induced endocrine changes and their contribution to affective disorders. The present study sought to investigate the association between measures of HPA-axis responsiveness, startle reactivity and sensorimotor gating during pregnancy that to date remains unknown. The eye-blink component of the ASR, and its prepulse inhibition, were measured in 107 late third trimester pregnant women. Saliva samples were collected to assess the cortisol awakening response (CAR), a measure of HPA-axis activity. Blood was sampled to measure serum levels of cortisol, cortisone and the cortisone to cortisol ratio. Ongoing anxiety disorders, sleep duration, smoking, and age were considered as potential confounders in the statistical analyses. CAR reactivity, measured as area under the curve (AUC) increase and above baseline, was positively associated with baseline startle magnitude [Cohen's d = 0.27; F (1, 105) = 4.99; p = 0.028, and Cohen's d = 0.30; F (1, 105) = 6.25; p = 0.014, respectively] as well as PPI at 86 dB [Cohen's d = 0.29; F (1, 105) = 5.93; p = 0.017; and Cohen's d = 0.34; F (1, 105) = 8.38; p = 0.005, respectively]. The observed positive correlation between startle magnitude in pregnant women and greater increase in cortisol during the awakening response may be interpreted as heightened neurophysiological reactivity, likely associated with dysregulation of the stress system.

  • 136.
    Brenner, Philip
    et al.
    Karolinska Inst, Ctr Pharmacoepidemiol, Dept Med Solna, Stockholm, Sweden.
    Brandt, Lena
    Karolinska Inst, Ctr Pharmacoepidemiol, Dept Med Solna, Stockholm, Sweden.
    Li, Gang
    Janssen Res & Dev LLC, Titusville, NJ USA.
    DiBernardo, Allitia
    Janssen Res & Dev LLC, Titusville, NJ USA.
    Bodén, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Karolinska Inst, Ctr Pharmacoepidemiol, Dept Med Solna, Stockholm, Sweden.
    Reutfors, Johan
    Karolinska Inst, Ctr Pharmacoepidemiol, Dept Med Solna, Stockholm, Sweden.
    Substance use disorders and risk for treatment resistant depression: a population-based, nested case-control study2020In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 115, no 4, p. 768-777Article in journal (Refereed)
    Abstract [en]

    Background and aims: Treatment-resistant depression (TRD), defined as inadequate treatment response after at least two adequate treatment trials, is common among patients initiating antidepressant treatment. Current or previous substance use disorders (SUD) are common among patients with depression and often lead to worse treatment outcomes. However, in clinical studies, SUD have not been found to increase the risk for TRD. The aim of this study was to investigate the association between SUD and TRD.

    Design: Nested case-control study.

    Setting: Nation-wide governmental health-care registers in Sweden.

    Cases and controls: Data on prescribed drugs and diagnoses from specialized health care were used to establish a prospectively followed cohort of antidepressant initiators with depression (n = 121 669) from 2006 to 2014. Of these, 15 631 patients (13%) were defined as TRD cases, with at least three treatment trials within a single depressive episode. Each case with TRD was matched on socio-demographic data with five controls with depression.

    Measurements: Crude and adjusted odds ratios (aOR) with 95% confidence intervals (CI) estimated the association between TRD and SUD diagnosis and/or treatment in five different time intervals until the time for fulfillment of TRD definition for the case. The analysis was adjusted for clinical and socio-demographic covariates.

    Findings: Having any SUD during, or <= 180 days before start of, antidepressant treatment was associated with almost double the risk for TRD [<= 180 days before: adjusted OR (aOR) = 1.86, CI = 1.70-2.05]. Increased risks for TRD were found <= 180 days before treatment start for the subcategories of sedative use (aOR = 2.37; 1.88-2.99), opioids (aOR = 2.02; 1.48-2.75), alcohol (aOR = 1.77; CI = 1.59-1.98) and combined substance use (aOR = 2.31; 1.87-2.99).

    Conclusions: Recent or current substance use disorders is positively associated with treatment resistance among patients initiating treatment for depression.

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  • 137.
    Brenner, Philip
    et al.
    Karolinska Inst, Dept Med Solna, Ctr Pharmacoepidemiol, Stockholm, Sweden.
    Brandt, Lena
    Karolinska Inst, Dept Med Solna, Ctr Pharmacoepidemiol, Stockholm, Sweden.
    Li, Gang
    Janssen Res & Dev LLC, Titusville, NJ USA.
    DiBernardo, Allitia
    Janssen Res & Dev LLC, Titusville, NJ USA.
    Bodén, Robert
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Ekselius: Psychiatry. Karolinska Inst, Dept Med Solna, Ctr Pharmacoepidemiol, Stockholm, Sweden.
    Reutfors, Johan
    Karolinska Inst, Dept Med Solna, Ctr Pharmacoepidemiol, Stockholm, Sweden.
    Treatment-resistant depression as risk factor for substance use disorders: a nation-wide register-based cohort study2019In: Addiction, ISSN 0965-2140, E-ISSN 1360-0443, Vol. 114, no 7, p. 1274-1282Article in journal (Refereed)
    Abstract [en]

    Background and aims Treatment-resistant depression (TRD) is common among patients with major depressive disorder (MDD). MDD may increase the risk for developing substance use disorders (SUD). The aim of this study was to investigate the risk for developing SUD among patients with TRD compared with other depressed patients.

    Design Observational cohort study.

    Setting Nation-wide governmental health registers in Sweden.

    Participants All patients aged 18-69 years with an MDD diagnosis in specialized health care who had received at least one antidepressant prescription during 2006-14 were identified. Patients with at least three treatment trials within a single depressive episode were classified with TRD.

    Measurements Patients with TRD were compared with the whole MDD cohort regarding risk for obtaining a SUD diagnosis or medication using survival analyses adjusted for socio-demographics and comorbidities.

    Findings Of 121 669 MDD patients, 13% were classified with TRD. Among the patients without any history of SUD, patients with TRD had a risk increase for any SUD both ≤ 1 and > 1 year after antidepressant initiation [> 1 year hazard ratio (HR) = 1.4; 95% confidence interval (CI) = 1.3-1.5]. Risks were elevated for the subcategories of opioid (HR = 1.9, 95% CI = 1.4-2.5) and sedative SUD (HR = 2.7, 95% CI = 2.2-3.2). Patients with a history of SUD had a risk increase for any SUD ≤ 1 year after start of treatment (HR = 1.2, 95% CI = 1.1-1.4), and both ≤ 1 year and > 1 year for sedative (> 1 year HR = 2.0, 95% CI = 1.3-3.0) and multiple substance SUD (HR = 1.9, 95% CI = 1.4-2.5).

    Conclusions Patients with treatment-resistant depression may be at greater risk for substance use disorders compared with other patients with major depressive disorder. Patterns may differ for patients with and without a history of substance use disorders, and for different categories of substance use disorder.

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  • 138. Brewin, CR
    et al.
    Holmes, Emily A.
    Psychology and cognitive processing in PTSD2003In: Psychiatry, Vol. 6, p. 28-31Article in journal (Refereed)
  • 139.
    Bridel, Claire
    et al.
    Vrije Univ Amsterdam Med Ctr, Neurochem Lab, Dept Clin Chem, Neurosci Campus Amsterdam, NL-1081 HV Amsterdam, Netherlands.
    van Wieringen, Wessel N.
    Vrije Univ Amsterdam Med Ctr, Dept Epidemiol & Biostat, Amsterdam, Netherlands;Vrije Univ Amsterdam, Dept Math, Amsterdam, Netherlands.
    Zetterberg, Henrik
    Sahlgrens Univ Hosp, Clin Neurochem Lab, Molndal, Sweden;Univ Gothenburg, Inst Neurosci & Physiol, Dept Psychiat & Neurochem, Sahlgrenska Acad, Gothenburg, Sweden;UCL Inst Neurol, Dept Mol Neurosci, Queen Sq, London, England;UCL, Dementia Res Inst, London, England.
    Tijms, Betty M.
    Vrije Univ Amsterdam Med Ctr, Dept Neurol, Neurosci Campus Amsterdam, Amsterdam, Netherlands;Vrije Univ Amsterdam Med Ctr, Alzheimer Ctr, Neurosci Campus Amsterdam, Amsterdam, Netherlands.
    Teunissen, Charlotte E.
    Vrije Univ Amsterdam Med Ctr, Neurochem Lab, Dept Clin Chem, Neurosci Campus Amsterdam, NL-1081 HV Amsterdam, Netherlands.
    Alvarez-Cermeno, Jose C.
    Ramon y Cajal Univ Hosp, Multiple Sclerosis Unit, Madrid, Spain.
    Andreasson, Ulf
    Sahlgrens Univ Hosp, Clin Neurochem Lab, Molndal, Sweden.
    Axelsson, Markus
    Univ Gothenburg, Inst Neurosci & Physiol, Dept Psychiat & Neurochem, Sahlgrenska Acad, Gothenburg, Sweden.
    Backstrom, David C.
    Umea Univ, Dept Pharmacol & Clin Neurosci, Umea, Sweden.
    Bartos, Ales
    Charles Univ Prague, Dept Neurol, Fac Med 3, Prague, Czech Republic;Gen Univ Hosp, Prague, Czech Republic;Natl Inst Mental Hlth, Klecany, Czech Republic.
    Bjerke, Maria
    Univ Antwerp, Dept Biomed Sci, Reference Ctr Biol Markers Dementia BIODEM, Inst Born Bunge, Antwerp, Belgium.
    Blennow, Kaj
    Sahlgrens Univ Hosp, Clin Neurochem Lab, Molndal, Sweden;Univ Gothenburg, Inst Neurosci & Physiol, Dept Psychiat & Neurochem, Sahlgrenska Acad, Gothenburg, Sweden.
    Boxer, Adam
    Univ Calif San Francisco, Dept Neurol, Memory & Aging Ctr, San Francisco, CA USA.
    Brundin, Lou
    Karolinska Inst, Neuroimmunol Unit, Dept Clin Neurosci, Stockholm, Sweden;Karolinska Univ Hosp, Dept Neurol, Stockholm, Sweden.
    Burman, Joachim
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Landtblom: Neurology.
    Christensen, Tove
    Aarhus Univ, Dept Biomed, Aarhus, Denmark;Rigshosp, Dept Neurol, Copenhagen Univ Hosp, Copenhagen, Denmark.
    Fialova, Lenka
    Gen Univ Hosp, Prague, Czech Republic;First Fac Med, Inst Med Biochem, Prague, Czech Republic;Charles Univ Prague, Diagnost Lab, Prague, Czech Republic.
    Forsgren, Lars
    Umea Univ, Dept Pharmacol & Clin Neurosci, Umea, Sweden.
    Frederiksen, Jette L.
    Rigshosp, Dept Neurol, Copenhagen Univ Hosp, Copenhagen, Denmark.
    Gisslen, Magnus
    Univ Gothenburg, Sahlgrenska Acad, Dept Infect Dis, Gothenburg, Sweden.
    Gray, Elizabeth
    Univ Oxford, Nuffield Dept Clin Neurosci, Oxford, England.
    Gunnarsson, Martin
    Orebro Univ Hosp, Dept Neurol, Fac Med & Hlth, Orebro, Sweden.
    Hall, Sara
    Lund Univ, Clin Memory Res Unit, Dept Clin Sci, Fac Med, Lund, Sweden;Lund Univ, Wallenberg Ctr Mol Med, Lund, Sweden.
    Hansson, Oskar
    Lund Univ, Clin Memory Res Unit, Dept Clin Sci, Fac Med, Lund, Sweden;Lund Univ, Wallenberg Ctr Mol Med, Lund, Sweden.
    Herbert, Megan K.
    Univ Gothenburg, Sahlgrenska Acad, Dept Internal Med & Clin Nutr, Inst Med, Gothenburg, Sweden;Sahlgrens Univ Hosp, Dept Endocrinol, Gothenburg, Sweden.
    Jakobsson, Joel
    Univ Gothenburg, Inst Neurosci & Physiol, Dept Psychiat & Neurochem, Sahlgrenska Acad, Gothenburg, Sweden.
    Jessen-Krut, Jan
    Univ Gothenburg, Sahlgrenska Acad, Dept Infect Dis, Gothenburg, Sweden.
    Janelidze, Shorena
    Lund Univ, Clin Memory Res Unit, Dept Clin Sci, Fac Med, Lund, Sweden;Lund Univ, Wallenberg Ctr Mol Med, Lund, Sweden.
    Johannsson, Gudmundur
    Univ Gothenburg, Sahlgrenska Acad, Dept Internal Med & Clin Nutr, Inst Med, Gothenburg, Sweden;Sahlgrens Univ Hosp, Dept Endocrinol, Gothenburg, Sweden.
    Jonsson, Michael
    Univ Gothenburg, Inst Neurosci & Physiol, Dept Psychiat & Neurochem, Sahlgrenska Acad, Gothenburg, Sweden.
    Kappos, Ludwig
    Univ Hosp, Dept Med, Basel, Switzerland;Univ Basel, Basel, Switzerland.
    Khademi, Mohsen
    Karolinska Inst, Neuroimmunol Unit, Dept Clin Neurosci, Stockholm, Sweden;Karolinska Univ Hosp, Dept Neurol, Stockholm, Sweden.
    Khalil, Michael
    Med Univ Graz, Dept Neurol, Graz, Austria.
    Kuhle, Jens
    Univ Hosp, Dept Med, Basel, Switzerland;Univ Basel, Basel, Switzerland.
    Landen, Mikael
    Univ Gothenburg, Inst Neurosci & Physiol, Dept Psychiat & Neurochem, Sahlgrenska Acad, Gothenburg, Sweden.
    Leinonen, Ville
    Univ Eastern Finland, Inst Clin Med, Neurosurg, Kuopio, Finland;Kuopio Univ Hosp, Dept Neurosurg, Kuopio, Finland.
    Logroscino, Giancarlo
    Univ Bari, Unit Neurodegenerat Dis, Dept Clin Res Neurol, Bari, Italy.
    Lu, Ching-Hua
    Blizard, North East London & Essex MND Care Ctr, Neurosci & Trauma Ctr, London, England;China Med Univ Hosp, Dept Neurol, Taichung, Taiwan.
    Lycke, Jan
    Univ Gothenburg, Inst Neurosci & Physiol, Dept Psychiat & Neurochem, Sahlgrenska Acad, Gothenburg, Sweden.
    Magdalinou, Nadia K.
    UCL Inst Neurol, Reta Lila Weston Inst Neurol Studies, Queen Sq, London, England.
    Malaspina, Andrea
    Blizard, North East London & Essex MND Care Ctr, Neurosci & Trauma Ctr, London, England;Barts, Inst Cell & Mol Med, London, England;Barts, London Sch Med & Dent, London, England;Barts, Barts Hlth NHS Trust, London, England.
    Mattsson, Niklas
    Lund Univ, Clin Memory Res Unit, Dept Clin Sci, Fac Med, Lund, Sweden;Lund Univ, Wallenberg Ctr Mol Med, Lund, Sweden.
    Meeter, Lieke H.
    Erasmus MC, Alzheimer Ctr, Rotterdam, Netherlands;Erasmus MC, Dept Neurol, Rotterdam, Netherlands;Vrije Univ Amsterdam Med Ctr, Dept Clin Genet, Amsterdam, Netherlands.
    Mehta, Sanjay R.
    Univ Calif San Diego, Div Infect Dis, La Jolla, CA 92093 USA.
    Modvig, Signe
    Rigshosp, Dept Clin Immunol, Copenhagen Univ Hosp, Copenhagen, Denmark.
    Olsson, Tomas
    Karolinska Inst, Neuroimmunol Unit, Dept Clin Neurosci, Stockholm, Sweden;Karolinska Univ Hosp, Dept Neurol, Stockholm, Sweden.
    Paterson, Ross W.
    UCL Inst Neurol, Dementia Res Ctr, Queen Sq, London, England.
    Perez-Santiago, Josue
    Univ Puerto Rico, Puerto Rico OMICS Ctr, Ctr Comprehens Canc, San Juan, PR 00936 USA.
    Piehl, Fredrik
    Karolinska Inst, Neuroimmunol Unit, Dept Clin Neurosci, Stockholm, Sweden;Karolinska Univ Hosp, Dept Neurol, Stockholm, Sweden.
    Pijnenburg, Yolande A. L.
    Vrije Univ Amsterdam Med Ctr, Dept Neurol, Neurosci Campus Amsterdam, Amsterdam, Netherlands;Vrije Univ Amsterdam Med Ctr, Alzheimer Ctr, Neurosci Campus Amsterdam, Amsterdam, Netherlands.
    Pyykko, Okko T.
    Univ Eastern Finland, Inst Clin Med, Neurosurg, Kuopio, Finland;Kuopio Univ Hosp, Dept Neurosurg, Kuopio, Finland.
    Ragnarsson, Oskar
    Orebro Univ Hosp, Dept Neurol, Fac Med & Hlth, Orebro, Sweden.
    Rojas, Julio C.
    Univ Calif San Francisco, Dept Neurol, Memory & Aging Ctr, San Francisco, CA USA.
    Christensen, Jeppe Romme
    Aarhus Univ, Dept Biomed, Aarhus, Denmark;Rigshosp, Dept Neurol, Copenhagen Univ Hosp, Copenhagen, Denmark.
    Sandberg, Linda
    Umea Univ, Dept Pharmacol & Clin Neurosci, Umea, Sweden.
    Scherling, Carole S.
    Belmont Univ, Dept Psychol Sci, Nashville, TN USA;Belmont Univ, Neurosci Program, Nashville, TN USA.
    Schott, Jonathan M.
    UCL Inst Neurol, Dementia Res Ctr, Queen Sq, London, England.
    Sellebjerg, Finn T.
    Rigshosp, Dept Neurol, Copenhagen Univ Hosp, Copenhagen, Denmark.
    Simone, Isabella L.
    Univ Bari, Dept Basic Med Sci Neurosci & Sense Organs, Bari, Italy;San Camillo Forlanini Hosp, Rome, Italy.
    Skillback, Tobias
    Univ Gothenburg, Inst Neurosci & Physiol, Dept Psychiat & Neurochem, Sahlgrenska Acad, Gothenburg, Sweden.
    Stilund, Morten
    Aarhus Univ, Dept Biomed, Aarhus, Denmark.
    Sundstrom, Peter
    Umea Univ, Dept Pharmacol & Clin Neurosci, Umea, Sweden.
    Svenningsson, Anders
    Karolinska Inst, Danderyd Hosp, Dept Clin Sci, Stockholm, Sweden.
    Tortelli, Rosanna
    Univ Bari, Unit Neurodegenerat Dis, Dept Clin Res Neurol, Bari, Italy;Pia Fdn Cardinale G Panico, Lecce, Italy.
    Tortorella, Carla
    Univ Bari, Dept Basic Med Sci Neurosci & Sense Organs, Bari, Italy.
    Trentini, Alessandro
    Univ Ferrara, Dept Biomed & Specialist Surg Sci, Ferrara, Italy.
    Troiano, Maria
    Univ Bari, Dept Basic Med Sci Neurosci & Sense Organs, Bari, Italy.
    Turner, Martin R.
    Univ Oxford, Nuffield Dept Clin Neurosci, Oxford, England.
    van Swieten, John C.
    Erasmus MC, Alzheimer Ctr, Rotterdam, Netherlands;Erasmus MC, Dept Neurol, Rotterdam, Netherlands.
    Vagberg, Mattias
    Umea Univ, Dept Pharmacol & Clin Neurosci, Umea, Sweden.
    Verbeek, Marcel M.
    Radboud Univ Nijmegen, Med Ctr, Donders Inst Brain Cognit & Behav, Dept Neurol, Nijmegen, Netherlands;Radboud Alzheimer Ctr, Dept Lab Med, Nijmegen, Netherlands.
    Villar, Luisa M.
    Ramon y Cajal Univ Hosp, Dept Immunol, Madrid, Spain.
    Visser, Pieter Jelle
    Vrije Univ Amsterdam Med Ctr, Dept Neurol, Neurosci Campus Amsterdam, Amsterdam, Netherlands;Vrije Univ Amsterdam Med Ctr, Alzheimer Ctr, Neurosci Campus Amsterdam, Amsterdam, Netherlands;Maastricht Univ, Dept Psychiat & Neuropsychol, Sch Mental Hlth & Neurosci, Alzheimer Ctr Limburg, Maastricht, Netherlands.
    Wallin, Anders
    Univ Gothenburg, Inst Neurosci & Physiol, Dept Psychiat & Neurochem, Sahlgrenska Acad, Gothenburg, Sweden.
    Weiss, Andreas
    Evotec AG, Manfred Eigen Campus, Hamburg, Germany.
    Wikkelso, Carsten
    Univ Gothenburg, Inst Neurosci & Physiol, Dept Psychiat & Neurochem, Sahlgrenska Acad, Gothenburg, Sweden.
    Wild, Edward J.
    UCL Inst Neurol, Queen Sq, London, England.
    Diagnostic Value of Cerebrospinal Fluid Neurofilament Light Protein in Neurology: A Systematic Review and Meta-analysis2019In: JAMA Neurology, ISSN 2168-6149, E-ISSN 2168-6157, Vol. 76, no 9, p. 1035-1048Article, review/survey (Refereed)
    Abstract [en]

    Importance  Neurofilament light protein (NfL) is elevated in cerebrospinal fluid (CSF) of a number of neurological conditions compared with healthy controls (HC) and is a candidate biomarker for neuroaxonal damage. The influence of age and sex is largely unknown, and levels across neurological disorders have not been compared systematically to date.

    Objectives  To assess the associations of age, sex, and diagnosis with NfL in CSF (cNfL) and to evaluate its potential in discriminating clinically similar conditions.

    Data Sources  PubMed was searched for studies published between January 1, 2006, and January 1, 2016, reporting cNfL levels (using the search terms neurofilament light and cerebrospinal fluid) in neurological or psychiatric conditions and/or in HC.

    Study Selection  Studies reporting NfL levels measured in lumbar CSF using a commercially available immunoassay, as well as age and sex.

    Data Extraction and Synthesis  Individual-level data were requested from study authors. Generalized linear mixed-effects models were used to estimate the fixed effects of age, sex, and diagnosis on log-transformed NfL levels, with cohort of origin modeled as a random intercept.

    Main Outcome and Measure  The cNfL levels adjusted for age and sex across diagnoses.

    Results  Data were collected for 10 059 individuals (mean [SD] age, 59.7 [18.8] years; 54.1% female). Thirty-five diagnoses were identified, including inflammatory diseases of the central nervous system (n = 2795), dementias and predementia stages (n = 4284), parkinsonian disorders (n = 984), and HC (n = 1332). The cNfL was elevated compared with HC in a majority of neurological conditions studied. Highest levels were observed in cognitively impaired HIV-positive individuals (iHIV), amyotrophic lateral sclerosis, frontotemporal dementia (FTD), and Huntington disease. In 33.3% of diagnoses, including HC, multiple sclerosis, Alzheimer disease (AD), and Parkinson disease (PD), cNfL was higher in men than women. The cNfL increased with age in HC and a majority of neurological conditions, although the association was strongest in HC. The cNfL overlapped in most clinically similar diagnoses except for FTD and iHIV, which segregated from other dementias, and PD, which segregated from atypical parkinsonian syndromes.

    Conclusions and Relevance  These data support the use of cNfL as a biomarker of neuroaxonal damage and indicate that age-specific and sex-specific (and in some cases disease-specific) reference values may be needed. The cNfL has potential to assist the differentiation of FTD from AD and PD from atypical parkinsonian syndromes.

  • 140.
    Bridge, Holly
    et al.
    Univ Oxford, John Radcliffe Hosp, FMRIB Ctr, Oxford OX3 9DU, England.
    Harrold, Stephen
    Univ Oxford, John Radcliffe Hosp, FMRIB Ctr, Oxford OX3 9DU, England.
    Holmes, Emily A.
    Univ Oxford, Dept Psychiat, Oxford, England.
    Stokes, Mark
    Univ Oxford, Dept Expt Psychol, Oxford OX1 3UD, England.
    Kennard, Christopher
    Univ Oxford, Nuffield Dept Clin Neurosci, Oxford, England.
    Vivid visual mental imagery in the absence of the primary visual cortex2012In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 259, no 6, p. 1062-1070Article in journal (Refereed)
    Abstract [en]

    The role of the primary visual cortex in visual mental imagery has provided significant debate in the imagery literature. Functional neuroimaging studies show considerable variation depending on task and technique. Patient studies can be difficult to interpret due to the diverse nature of cortical damage. The type of cortical damage in patient SBR is exceedingly rare as it is restricted to the gray matter of the calcarine sulcus. In this study, we show that in spite of his near-complete cortical blindness, SBR exhibits vivid visual mental imagery both behaviorally and when measured with functional magnetic resonance imaging. The pattern of cortical activation to visual mental imagery in SBR is indistinguishable from individual sighted subjects, in contrast to the visual perceptual responses, which are greatly attenuated.

  • 141.
    Brocki, Karin
    et al.
    Uppsala University, Disciplinary Domain of Humanities and Social Sciences, Faculty of Social Sciences, Department of Psychology.
    Clerkin, S. M.
    Guise, K. G.
    Fan, Jin
    Fossella, J. A.
    Assessing the molecular genetics of the development of executive attention in children: focus on genetic pathways related to the anterior cingulate cortex and dopamine2009In: Neuroscience, ISSN 0306-4522, E-ISSN 1873-7544, Vol. 164, no 1, p. 241-246Article, review/survey (Refereed)
    Abstract [en]

    It is well known that children show gradual and protracted improvement in an array of behaviors involved in the conscious control of thought and emotion. Non-invasive neuroimaging in developing populations has revealed many neural correlates of behavior, particularly in the developing cingulate cortex and frontostriatal circuits. These brain regions, themselves, undergo protracted molecular and cellular change in the first two decades of human development and, as such, are ideal regions of interest for cognitive- and imaging-genetic studies that seek to link processes at the biochemical and synaptic levels to brain activity and behavior. We review our research to date that employs both adult and child-friendly versions of the attention network task (ANT) in an effort to begin to describe the role of specific genes in the assembly of a functional attention system. Presently, we constrain our predictions for genetic association studies by focusing on the role of the anterior cingulate cortex (ACC) and of dopamine in the development of executive attention.

  • 142.
    Brown, Richard J.
    et al.
    Univ Manchester, Sch Psychol Sci, Manchester, Lancs, England.
    Danquah, Adam N.
    Univ Manchester, Sch Psychol Sci, Manchester, Lancs, England.
    Miles, Eleanor
    Univ Manchester, Sch Psychol Sci, Manchester, Lancs, England.
    Holmes, Emily A.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford, England.
    Poliakoff, Ellen
    Univ Manchester, Sch Psychol Sci, Manchester, Lancs, England.
    Attention to the body in nonclinical somatoform dissociation depends on emotional state2010In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 69, no 3, p. 249-257Article in journal (Refereed)
    Abstract [en]

    Objective: Unexplained neurological symptoms ("somatoform dissociation") are common in health care settings and associated with disproportionately high levels of distress, disability, and resource utilization. Theory suggests that somatoform dissociation is associated with disturbed attentional processing, but there is a paucity of research in this area and the available evidence is contradictory. Methods: We compared undergraduate participants (n=124) with high and low scores on the Somatoform Dissociation Questionnaire (SDQ-20) on a tactile cueing paradigm measuring the time course of attention to touch, following either a neutral film or a film designed to simulate the emotional effects of trauma exposure. Results: Following the neutral film, high SDQ-20 participants exhibited delayed disengagement from tactile cue stimuli compared to the low SDQ-20 group. Following the "trauma" film, however, the high SDQ-20 group showed attentional effects suggesting avoidance of the tactile stimuli in this condition. Early attention to tactile cues following the trauma film predicted film-related intrusive thoughts after the experiment. Conclusion: These findings suggest that both body vigilance and body avoidance may be involved in the expression of somatoform dissociation. (C) 2010 Elsevier Inc. All rights reserved.

  • 143.
    Browning, Michael
    et al.
    Department of Psychiatry, University of Oxford, UK..
    Blackwell, Simon E
    Department of Psychiatry, University of Oxford, UK..
    Holmes, Emily A.
    Department of Psychiatry, University of Oxford, UK..
    The use of cognitive bias modification and imagery in the understanding and treatment of depression.2013In: Current topics in behavioral neurosciences, ISSN 1866-3370, Vol. 14, p. 243-60Article in journal (Refereed)
    Abstract [en]

    Cognitive models of depression form the natural link between neurobiological and social accounts of the illness. Interest in the role of cognition in depression has recently been stimulated by the advent of simple, computer-based "cognitive bias modification" (CBM) techniques which are able to experimentally alter cognitive habits in clinical and non-clinical populations. In this chapter, we review recent work which has used CBM techniques to address questions of aetiology and treatment in depression with a particular focus on the interface with neurobiological and social processes relevant to the illness. We find that there are early signs that CBM may be a useful tool in exploring the aetiology of depression, particularly in regard to the neural and genetic factors which influence susceptibility to the illness and response to treatment. There is also early evidence suggesting that CBM has promise in the treatment and prevention of depression. This work suggests that the beneficial effects of CBM are mediated by the interaction between cognitive functioning and environmental and social information. In summary, by providing a method for altering habitual cognitive function in experimental and clinical settings CBM techniques have begun to further the understanding of and the treatment for depression.

  • 144.
    Browning, Michael
    et al.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Holmes, Emily A.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Charles, Matthew
    UCL, Res Dept Clin Educ & Hlth Psychol, London WC1E 6BT, England.
    Cowen, Philip J.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Harmer, Catherine J.
    Univ Oxford, Dept Psychiat, Oxford OX1 2JD, England.
    Using Attentional Bias Modification as a Cognitive Vaccine Against Depression2012In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 72, no 7, p. 572-579Article in journal (Refereed)
    Abstract [en]

    Background: Negative attentional biases are thought to increase the risk of recurrence in depression, suggesting that reduction of such biases may be a plausible strategy in the secondary prevention of the illness. However, no previous study has tested whether reducing negative attentional bias causally affects risk factors for depressive recurrence. The current experimental medicine study reports the effects of a computerized attentional bias modification (ABM) procedure on intermediate measures of the risk of depressive recurrence (residual depressive symptoms and the cortisol awakening response) in patients with recurrent depression. Methods: Sixty-one patients with at least two previous episodes of depression who were currently in remission were randomized to receive either an active (positive) or placebo computer-based ABM regime. The ABM regime presented either pictures of faces or words. Residual depressive symptoms, measured using the Beck Depression Inventory and the cortisol awakening response were measured immediately before and after completion of the bias modification and then again after 4 weeks' follow-up. Results: Positive, face-based ABM reduced both measures of recurrence risk (Beck Depression Inventory and cortisol awakening response). This effect occurred during the month following completion of bias modification. Word-based modification did not influence the outcome measures. Conclusions: Positive face-based ABM was able to reduce intermediate measures of recurrence risk in previously depressed patients. These results suggest that ABM may provide a "cognitive vaccine" against depression and offer a useful strategy in the secondary prevention of the illness.

  • 145.
    Browning, Michael
    et al.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Holmes, Emily A.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Murphy, Susannah E.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Goodwin, Guy M.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Harmer, Catherine J.
    Univ Oxford, Warneford Hosp, Dept Psychiat, Oxford OX3 7JX, England.
    Lateral Prefrontal Cortex Mediates the Cognitive Modification of Attentional Bias2010In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 67, no 10, p. 919-925Article in journal (Refereed)
    Abstract [en]

    Background: A tendency to orient attention toward threatening stimuli may be involved in the etiology of anxiety disorders. In keeping with this, both psychological and pharmacological treatments of anxiety reduce this negative attentional bias. It has been hypothesized, but not proved, that psychological interventions may alter the function of prefrontal regions supervising the allocation of attentional resources. Methods: The current study examined the effects of a cognitive training regime on attention. Participants were randomly assigned to one of two training conditions: "attend-threat" training, which increases negative attentional bias, or "avoid-threat" training, which reduces it. The behavioral effects of training were assessed using a sample of 24 healthy participants. Functional magnetic resonance imaging data were collected in a further 29 healthy volunteers using a protocol that allowed the influence of both stimuli valence and attention to be discriminated. Results: Cognitive training induced the expected attentional biases in healthy volunteers. Further, the training altered lateral frontal activation to emotional stimuli, with these areas responding specifically to violations of the behavioral rules learned during training. Connectivity analysis confirmed that the identified lateral frontal regions were influencing attention as indexed by activity in visual association cortex. Conclusions: Our results indicate that frontal control over the processing of emotional stimuli may be tuned by psychological interventions in a manner predicted to regulate levels of anxiety. This directly supports the proposal that psychological interventions may influence attention via an effect on the prefrontal cortex.

  • 146.
    Bränn, Emma
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Fransson, Emma
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research. Karolinska Institutet, Stockholm, Sweden..
    White, Richard A
    Norwegian Institute of Public Health, Oslo, Norway.
    Papadopoulos, Fotios C
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Edvinsson, Åsa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Kamali-Moghaddam, Masood
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Immunology, Genetics and Pathology.
    Cunningham, Janet L
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Sundström Poromaa, Inger
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Reproductive Health.
    Skalkidou, Alkistis
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Women's and Children's Health, Research group (Dept. of women´s and children´s health), Obstetrics and Reproductive Health Research.
    Inflammatory markers in women with postpartum depressive symptoms2018In: Journal of Neuroscience Research, ISSN 0360-4012, E-ISSN 1097-4547Article in journal (Refereed)
    Abstract [en]

    Postpartum depression (PPD) is a devastating disorder affecting not only more than 10% of all women giving birth, but also the baby, the family, and the society. Compiling evidence suggests the involvement of the immune system in the pathophysiology of major depression; yet, the immune response in perinatal depression is not as well studied. The aim of this study was to investigate the alterations in peripheral levels of inflammatory biomarkers in 169 Swedish women with and without depressive symptoms according to the Edinburgh postnatal depression scale or the M.I.N.I neuropsychiatric interview at eight weeks postpartum. Among the 70 markers analyzed with multiplex proximity extension assay, five were significantly elevated in women with postpartum depressive symptoms in the adjusted LASSO logistic regression analysis: Tumor necrosis factor ligand superfamily member (TRANCE) (OR-per 1 SD increase = 1.20), Hepatocyte growth factor (HGF) (OR = 1.17) Interleukin (IL)-18 (OR = 1.06), Fibroblast growth factor 23 (FGF-23) (OR = 1.25), and C-X-C motif chemokine 1 (CXCL1) (OR 1.11). These results indicate that women with PPD have elevated levels of some inflammatory biomarkers. It is, therefore, plausible that PPD is associated with a compromised adaptability of the immune system.

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  • 147.
    Bråthén Wijana, Moa
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Child and Adolescent Psychiatry. Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Enebrink, Pia
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Liljedahl, Sophie I.
    Lund Univ, Dept Psychol, Lund, Sweden.
    Ghaderi, Ata
    Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Preliminary evaluation of an intensive integrated individual and family therapy model for self-harming adolescents2018In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, article id 371Article in journal (Refereed)
    Abstract [en]

    BackgroundTo investigate the outcome of an integrated individual and family therapy (Intensive Contextual Treatment: ICT) in terms of reducing suffering and increasing functional adjustment among self-harming and/or suicidal adolescents with high symptom loads and their families.MethodsForty-nine self-harming and/or suicidal adolescents, M-age=14.6, of predominantly Swedish origin and female gender (85.7%) participated with their parents. The study had a within group design with repeated measures at pre- and post-treatment, as well as six- and twelve-months follow-ups. Self-reports were used for the main outcomes; self-harm rates, suicide attempts, parent-reported days of inpatient/institutional care, internalized and externalized symptoms, perceived stress, emotion regulation, school hours and adjustment. Secondary outcomes were levels of reported expressed emotions within family dyads, as well as parental anxiety, depression and stress.ResultsFrom pre- to post-assessment, the adolescents reported significant reductions of self-harm (p=.001, d=0.54) and suicide attempts (p<.0001, d=1.38). Parent-reported days of inpatient/institutional care were reduced, as well as parent- and adolescent-reported internalizing and externalizing symptoms. Furthermore, school attendance and adjustment were improved, and the adolescents reported experiencing less criticism while parents reported less emotional over-involvement. The results were maintained at follow-ups.ConclusionsThe adolescents and the parents reported improvements for the main outcomes. This treatment appears promising in keeping the families in treatment and out of hospital, suggesting that an integrative approach may be beneficial and feasible for this group.Trial registrationThis study has been approved 19/12 2011, by the regional review board in Stockholm (Dnr 2011/1593-31/5).

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  • 148.
    Brück, Carolin
    et al.
    Eberhard Karls Univ Tubingen, Dept Psychiat & Psychotherapy, Med Ctr, Calwerstr 14, D-72076 Tubingen, Germany..
    Derstroff, Stephanie
    Eberhard Karls Univ Tubingen, Dept Psychiat & Psychotherapy, Med Ctr, Calwerstr 14, D-72076 Tubingen, Germany..
    Jacob, Heike
    Eberhard Karls Univ Tubingen, Dept Psychiat & Psychotherapy, Med Ctr, Calwerstr 14, D-72076 Tubingen, Germany..
    Wolf-Arehult, Martina
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital. Eberhard Karls Univ Tubingen, Dept Psychiat & Psychotherapy, Med Ctr, Calwerstr 14, D-72076 Tubingen, Germany.
    Wekenmann, Stefanie
    Eberhard Karls Univ Tubingen, Dept Psychiat & Psychotherapy, Med Ctr, Calwerstr 14, D-72076 Tubingen, Germany..
    Wildgruber, Dirk
    Eberhard Karls Univ Tubingen, Dept Psychiat & Psychotherapy, Med Ctr, Calwerstr 14, D-72076 Tubingen, Germany..
    Perception of Verbal and Nonverbal Emotional Signals in Women With Borderline Personality Disorder: Evidence of a Negative Bias and an Increased Reliance on Nonverbal Cues2017In: Journal of Personality Disorders, ISSN 0885-579X, E-ISSN 1943-2763, Vol. 31, no 2, p. 221-231Article in journal (Refereed)
    Abstract [en]

    Studies conducted in patients diagnosed with borderline personality disorder (BPD) have documented a variety of anomalies concerning patients' abilities to interpret emotional signals. Attempting to clarify the bases of these anomalies, the current literature draws attention to a possible role of dysfunctional expectations, such as the expectation of social rejection. Dysfunctional expectations, however, may not only bias social interpretations, but may also focus attention on social cues most important in conveying emotional messages, such as nonverbal signals. To explore these assumptions, 30 female BPD patients were tasked to judge the valence of emotional states conveyed by combinations of verbal and nonverbal emotional cues. Compared to controls, BPD patients exhibited a negative bias in their interpretations and relied more on available nonverbal cues. Shifts in the relative importance of nonverbal cues appeared to be rooted mainly in a reduced reliance on positive verbal cues presumably deemed less credible by BPD patients.

  • 149.
    Bäckström, Josefin
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Family Members of Patients with Burns: Experiences of a Distressful Episode2013Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    A severe burn is a trauma associated with long lasting consequences, not only for the survivor but also for the family. Although it is recognized that family members are central in providing social support for the patients, previous research has not focused extensively on this group. The aims of this thesis were to increase knowledge about psychological symptoms and health-related quality of life (HRQoL) in family members of patients with burns, as well as to explore their experiences of burn care and rehabilitation. The research questions were approached using quantitative and qualitative methods.

    The results showed that most family members demonstrate normal to mild levels of psychological symptoms, while one third demonstrate moderate to severe symptoms during care. The symptoms decreased over time and could be predicted to a certain degree by early symptoms.

    Further, family members’ report of HRQoL is similar to that of the general population. An improvement is seen over time and HRQoL could be predicted in part by earlier life events and psychological symptoms.

    Family members’ experiences were explored in an interview study. Qualitative content analysis revealed that the time in hospital is stressful, although there were experiences of a positive character.  Family members might benefit from being cared for in a more individualized way. The communication between health care providers and the family members could be improved.

    Finally, a qualitative content analysis revealed that family members’ experiences and views concerning support is highly individual. There were experiences of sufficient support as well as lack of professional support. Treatment of family members should be modified according to personal circumstances, and it is important to actively include family members in the care process, both before and after discharge.

    In summary, being a family member of a burn survivor is a distressful experience, not only during care but in many cases also after discharge. The treatment of family members within burn care should be individualized. Some persons are more vulnerable than others and it might be possible to identify those in need of support while care is still ongoing.

    List of papers
    1. Prediction of psychological symptoms in family members of patients with burns 1 year after injury
    Open this publication in new window or tab >>Prediction of psychological symptoms in family members of patients with burns 1 year after injury
    2013 (English)In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 2, p. 384-393Article in journal (Refereed) Published
    Abstract [en]

    Aim

    To report a study of predictors of psychological symptoms in family members of patients with burns.

    Background

    Family members are important as a source of social support for patients undergoing prolonged rehabilitation. Little is known about psychological symptoms of family members of patients with burns, especially in the long term.

    Design

    The design of the study was prospective and longitudinal.

    Methods

    Forty-four family members of adult patients treated in a burn centre between 2000-2007 completed questionnaires during care and at 3, 6, and 12 months after injury. Psychological symptoms were assessed with the Hospital Anxiety and Depression Scale. Predictors for anxiety and depression were explored in regression analyses.

    Results

    The mean scores indicated normal to mild symptoms in general. Moderate and severe symptom levels during care and at 12 months were demonstrated on the anxiety subscale by 15/44 and 5/39, respectively, and on the depression subscale by 5/44 and 0/39 of the family members, respectively. In the final regression models, the primary predictor was psychological symptoms at the previous assessment. Other predictors were previous life events, age, and the coping strategy avoidance.

    Conclusion

    Family members of patients with burns demonstrate normal to mild levels of psychological symptoms that decrease over time. One-third show moderate to severe anxiety symptoms during care and may benefit from counselling. Previous symptoms predict later symptoms, indicating that screening with a validated instrument is useful. The results provide guidance for nurses in assessing and planning adequate interventions for family members.

    Keywords
    burns, family members, injury, nursing, psychological symptoms, rehabilitation
    National Category
    Psychiatry Nursing Surgery
    Research subject
    Psychiatry; Caring Sciences in Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-190020 (URN)10.1111/j.1365-2648.2012.06017.x (DOI)000313722600014 ()22509932 (PubMedID)
    Available from: 2013-01-07 Created: 2013-01-07 Last updated: 2017-12-06Bibliographically approved
    2. Health-related quality of life in family members of patients with burns
    Open this publication in new window or tab >>Health-related quality of life in family members of patients with burns
    Show others...
    2014 (English)In: Journal of Burn Care & Research, ISSN 1559-047X, E-ISSN 1559-0488, Vol. 35, no 3, p. 243-250Article in journal (Refereed) Published
    Abstract [en]

    A severe burn not only affects the patients, but may also have a great impact on the lives of family members. It is known that family members of patients with burns experience psychological distress, but health-related quality of life (HRQoL) has not been studied in this group. The aim was to study predictors of HRQoL in family members of patients with burns. Forty-four family members of adult patients treated in a burn center, between 2000 and 2007, completed questionnaires during care, and at 3, 6, and 12 months after injury. HRQoL was assessed with the EuroQol 5D (EQ-5D), which consists of the dimensions: mobility, self-care, usual activities, pain, and anxiety/depression. The questionnaire generates an EQ-5D index and a visual analog scale (VAS) score. Overall, the EQ-5D index was similar to that of the general population. A slight improvement in HRQoL was found in the VAS scores and in the anxiety/depression dimension over time. In regression models, HRQoL was primarily predicted by earlier life events, symptoms of post-traumatic stress disorder, and HRQoL, assessed during the patients’ hospitalization. In summary, HRQoL assessed with VAS scores increased slightly during the first year postburn, and early screening for life events and psychological symptoms, and HRQoL might be useful in identifying family members in need of support.

    Keywords
    burns, family members, injury, health related quality of life, rehabilitation
    National Category
    Psychiatry Surgery Nursing
    Research subject
    Psychiatry; Caring Sciences in Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-208623 (URN)10.1097/BCR.0b013e318295744e (DOI)000335394600015 ()
    Available from: 2013-10-06 Created: 2013-10-06 Last updated: 2017-12-06Bibliographically approved
    3. Family members of patients with severe burns: Experiences during care and rehabilitation
    Open this publication in new window or tab >>Family members of patients with severe burns: Experiences during care and rehabilitation
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    The aim was to explore experiences of care and rehabilitation in family members of patients with burns. Ten semi-structured interviews analyzed using qualitative content analysis resulted in seven categories related to the care: Feeling distress, Receiving excellent care, Being treated in an insensitive way, Reluctance towards giving care, Being the hub of the family network, Feeling hope, and Being thankful. Six categories were related to rehabilitation: Ambiguous feelings, Difficulties after discharge, Being forced to take responsibility, Handling the situation, Gaining support and Being thankful. Although there are positive experiences during care, family members experience the time in hospital and after discharge as distressful and could benefit from being cared for in a more individualized way. Improved communication between caregivers and the family member may be important. Family members need to be included in the planning of care and support offered at discharge could ease the burden on these individuals.

    Keywords
    burns, experience, family members, nursing, recovery
    National Category
    Nursing Psychiatry Surgery
    Research subject
    Psychiatry; Caring Sciences in Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-208624 (URN)
    Available from: 2013-10-07 Created: 2013-10-06 Last updated: 2014-01-23
    4. Family members’ experiences of support during care and rehabilitation of patients with severe burns
    Open this publication in new window or tab >>Family members’ experiences of support during care and rehabilitation of patients with severe burns
    (English)Manuscript (preprint) (Other academic)
    Abstract [en]

    Aim: The aim of this study was to explore family members’ experiences of support during burn care and during the rehabilitation phase after hospital discharge.

    Background: Family members are important in the recovery process of patients with severe burns; however, few previous studies have focused on how this group experiences and values support during care and rehabilitation.

    Methods: Ten semi-structured interviews with family members of patients treated at the national burn centres were recorded digitally, transcribed verbatim, and analysed using content analysis. The informants were included nationwide, most were females, and different socioeconomic groups were represented.

    Results: Categories related to experiences during care were: Nonsupport, Professional support, Support from family and friends, A wish for support, and That little something extra. Categories related to experiences during rehabilitation were: Nonsupport, Professional support, Support from family and friends, Support from the injured person and Religion. Support from other family members and friends was generally considered the most important source of support, and there was a wish for more proactive support from care professionals.

    Conclusion: The experience of support is individual, which makes supporting family members a complex task. Individualized treatment of family members and their inclusion in the care process are of central importance, as is identifying specific needs for support both during the time in hospital and during rehabilitation. It is important to be proactive and offer support.

    Keywords
    burns, experience, family members, nursing, recovery, support
    National Category
    Nursing Surgery Psychiatry
    Research subject
    Psychiatry; Caring Sciences in Medical Sciences
    Identifiers
    urn:nbn:se:uu:diva-208625 (URN)
    Available from: 2013-10-07 Created: 2013-10-06 Last updated: 2014-01-23
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  • 150.
    Bäckström, Josefin
    et al.
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Ekselius, Lisa
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Gerdin, Bengt
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Plastic Surgery.
    Willebrand, Mimmie
    Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Neuroscience, Psychiatry, University Hospital.
    Prediction of psychological symptoms in family members of patients with burns 1 year after injury2013In: Journal of Advanced Nursing, ISSN 0309-2402, E-ISSN 1365-2648, Vol. 69, no 2, p. 384-393Article in journal (Refereed)
    Abstract [en]

    Aim

    To report a study of predictors of psychological symptoms in family members of patients with burns.

    Background

    Family members are important as a source of social support for patients undergoing prolonged rehabilitation. Little is known about psychological symptoms of family members of patients with burns, especially in the long term.

    Design

    The design of the study was prospective and longitudinal.

    Methods

    Forty-four family members of adult patients treated in a burn centre between 2000-2007 completed questionnaires during care and at 3, 6, and 12 months after injury. Psychological symptoms were assessed with the Hospital Anxiety and Depression Scale. Predictors for anxiety and depression were explored in regression analyses.

    Results

    The mean scores indicated normal to mild symptoms in general. Moderate and severe symptom levels during care and at 12 months were demonstrated on the anxiety subscale by 15/44 and 5/39, respectively, and on the depression subscale by 5/44 and 0/39 of the family members, respectively. In the final regression models, the primary predictor was psychological symptoms at the previous assessment. Other predictors were previous life events, age, and the coping strategy avoidance.

    Conclusion

    Family members of patients with burns demonstrate normal to mild levels of psychological symptoms that decrease over time. One-third show moderate to severe anxiety symptoms during care and may benefit from counselling. Previous symptoms predict later symptoms, indicating that screening with a validated instrument is useful. The results provide guidance for nurses in assessing and planning adequate interventions for family members.

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