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  • 1. Andre, Kadri
    et al.
    Kampman, Olli
    Illi, Ari
    Viikki, Merja
    Setala-Soikkeli, Eija
    Mononen, Nina
    Lehtimaki, Terho
    Haraldsson, Susann
    Umeå University, Faculty of Medicine, Department of Medical Biosciences.
    Koivisto, Pasi A.
    Leinonen, Esa
    SERT and NET polymorphisms, temperament and antidepressant response2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 7, p. 531-538Article in journal (Refereed)
    Abstract [en]

    Background: The genetic variations in norepinephrine transporter (NET) and serotonin transporter (SERT) genes have been associated with personality traits, several psychiatric disorders and the efficacy of antidepressant treatment. Aims: We investigated the separate effects and possible interactions between NET T-182C (rs2242446) and SERT 5-HTTLPR (rs4795541) polymorphisms on selective serotonin reuptake inhibitors (SSRI) treatment response and temperamental traits assessed by the Temperament and Character Inventory (TCI) in a clinical sample of subjects with major depressive disorder (MDD). Methods: Our sample of 97 patients with major depression completed the 107-item TCI temperament questionnaire (version IX) at the initial assessment of the study and after 6 weeks of follow-up. All subjects received selective SSRI medications. Temperament dimension scores at baseline (1) and endpoint (2) during antidepressant treatment were analyzed between NET and SERT genotypes. Results: SS-genotype of 5-HTTLPR was associated with higher baseline Persistence scores than SL- or LL-genotype. A corresponding but weaker association was found at endpoint. No differences were found between 5-HTTLPR genotypes and other temperament dimensions and 5-HTTLPR genotypes had no effect on treatment response. Conclusions: Our results suggest that the SS-genotype of 5-HTTLPR is associated with Persistence scores in patients with MDD. Higher Persistence could be viewed as a negative trait when recovering from stress and its association with short and "weaker" S-allele may be related to less efficient serotonin neurotransmission, possibly resulting in less effective coping strategies on a behavioral level.

  • 2. Bejerholm, Ulrika
    et al.
    Areberg, Cecilia
    Hofgren, Caisa
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Rinaldi, Miles
    Individual placement and support in Sweden: a randomized controlled trial2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 1, p. 57-66Article in journal (Refereed)
    Abstract [en]

    Background: Currently there is no evidence on the effectiveness of Individual Placement and Support (IPS) in Sweden. Aims: To determine the effectiveness of IPS on vocational outcomes among people with severe mental illness (SMI) in a Swedish context. A secondary aim was to evaluate a community integration effect. Methods: A randomized controlled trial with a parallel design was used. Mental health outpatients with SMI were randomized to IPS or traditional vocational rehabilitation (TVR) services. The allocation status was assessor-blinded. The primary outcome was competitive employment. All vocational outcomes were collected continuously, and socio-demographic and clinical variables at baseline, 6 and 18 months. The trial is registered with ClinicalTrials.gov: NCT00960024. Results: One hundred and twenty participants were randomized. Eighty seven per cent were assessed after 6 months, and 73% after 18 months. IPS was more effective than TVR in terms of gaining employment at 18-month follow-up (46% vs. 11%; difference 36%, 95% CI 18-54), along with the amount of working hours and weeks, longer job tenure periods and income. Cox regression analysis showed that IPS participants gained employment five times quicker than those in TVR. Ninety per cent of the IPS participants became involved in work, internships or education, i.e. activities integrated in mainstream community settings, while 24% in the TVR group achieved this. Conclusions: IPS is effective in a Swedish context in terms of gaining employment and becoming integrated within the local community. The welfare system presented obstacles for gaining competitive employment directly and it was indicated that internships delayed time to first competitive employment.

  • 3.
    Börjesson, Josefine
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Armelius, Bengt-Åke
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Östgård-Ybrandt, Helene
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    The psychometric propeerties of the Swedish version of the Adolescent Drug Abuse Diagnosis (ADAD)2007In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 61, no 3, p. 225-232Article in journal (Refereed)
    Abstract [en]

    The psychometric properties of the Swedish version of the Adolescent Drug Abuse Diagnosis (ADAD) instrument were evaluated in two adolescent groups. The participants in the Normal group comprised 121 adolescents aged 15-17 years and the participants in the group of adolescents with antisocial problems comprised 1168 youths aged 10-21 years detained under the Swedish Care of Young Persons Act in special youth homes. The ADAD instrument produced good interrater reliability; the subscales showed moderate internal consistency and concept validity was satisfactory and comparable with American and Swiss versions. Finally, the ADAD subscales produced meaningful correlations. The interviewer rating, the adolescent’s rating and the composite scores are compared and discussed. The Swedish version of ADAD appears to be a psychometrically good instrument for assessing the severity of adolescent problems and their need for treatment. However, the composite scores need to be reconstructed to be useful in future research.

  • 4.
    Carlborg, Andreas
    et al.
    Karolinska Inst, Dept Clin Neurosci, Karolinska Univ Hosp, Solna, Sweden.
    Jokinen, Jussi
    Karolinska Inst, Dept Clin Neurosci, Karolinska Univ Hosp, Solna, Sweden.
    Nordström, Anna-Lena
    Karolinska Inst, Dept Clin Neurosci, Karolinska Univ Hosp, Solna, Sweden.
    Jönsson, Erik G
    Karolinska Inst, Dept Clin Neurosci, Karolinska Univ Hosp, Solna, Sweden.
    Nordström, Peter
    Karolinska Inst, Dept Clin Neurosci, Karolinska Univ Hosp, Solna, Sweden.
    Attempted suicide predicts suicide risk in schizophrenia spectrum psychosis2010In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 64, no 1, p. 68-72Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: People with schizophrenia have an increased risk of suicide and attempted suicide is suggested to be an important risk factor.

    AIM: Our objective was to assess the cumulative survival, predictive values and odds ratios of attempted suicide for suicide in a long-term cohort of patients with schizophrenia spectrum psychosis with and without previous attempted suicide.

    METHOD: Inpatients (n=224) hospitalized with schizophrenia spectrum psychosis were followed for a mean of 25 years. All patients were followed up for causes of death. Information on suicide attempt before the end of the observation period was retrieved from medical records.

    RESULTS: Eight percent died by suicide during the follow-up. Eighteen percent of suicide attempters died by suicide. Two percent of non-attempters died by suicide. There was a strong association between previous suicide attempt and suicide in men and women. Odds ratio for attempters vs. non-attempters was 10. Suicide risk was almost three times higher in male than female suicide attempters.

    CONCLUSION: Previous attempted suicide is an important risk factor for suicide in both men and women with schizophrenia spectrum psychosis, particularly in male suicide attempters. The suicide risk remains high over a long period. Continuous assessment of risk factors and appropriate treatment are crucial for this patient group to prevent suicide.

  • 5.
    Carlborg, Andreas
    et al.
    Karolinska Inst, Dept Clin Neurosci, Karolinska Univ Hosp, Solna, Sweden.
    Jokinen, Jussi
    Karolinska Inst, Dept Clin Neurosci, Karolinska Univ Hosp, Solna, Sweden.
    Nordström, Anna-Lena
    Karolinska Inst, Dept Clin Neurosci, Karolinska Univ Hosp, Solna, Sweden.
    Jönsson, Erik G
    Karolinska Inst, Dept Clin Neurosci, Karolinska Univ Hosp, Solna, Sweden.
    Nordström, Peter
    Karolinska Inst, Dept Clin Neurosci, Karolinska Univ Hosp, Solna, Sweden.
    Early death and CSF monoamine metabolites in schizophrenia spectrum psychosis2011In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 65, no 2, p. 101-5Article in journal (Refereed)
    Abstract [en]

    INTRODUCTION: Patients with schizophrenia have higher rates of mortality than the general population. Lower concentrations of the cerebrospinal fluid (CSF) monoamine metabolites homovanillic acid (HVA) and 5-hydroxyindoleacetic acid (5-HIAA) have been associated with suicidal, aggressive and impulsive behavior. Mortality has been suggested as a measure of impulsivity and a relationship between early death and lower concentrations of CSF monoamine metabolites has been reported but the studies are few with short periods of follow-up and small numbers.

    AIM: The objective of this study was to investigate a relationship between early death and concentrations of CSF 5-HIAA and HVA.

    METHODS: Three hundred and eighty-five inpatients with schizophrenia spectrum psychosis were lumbar punctured in a standardized manner and followed for a median of 26 years. Patients were searched to identify those who had died. Causes of death were obtained from the Causes of Death Register.

    RESULTS: During the time of follow-up, 97 patients died. Schizophrenia spectrum psychosis patients died at an earlier age from both natural and unnatural causes of death. No significant associations were found between CSF 5-HIAA and HVA concentrations and non-suicidal death. Attempted suicide was not a risk factor for non-suicidal death at younger age.

    CONCLUSION: Patients with schizophrenia spectrum psychosis die at an earlier age from both natural and unnatural causes of death. Attempted suicide is not a risk factor for non-suicidal death at younger age. Low concentrations of CSF HVA and 5-HIAA were not a risk factor for non-suicidal death at younger age in schizophrenia spectrum psychosis.

  • 6.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Suicide aggregation in relation to socio-demographic variables and the suicide method in a general population: assortative susceptibility.2005In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 59, no 5, p. 325-30Article in journal (Refereed)
    Abstract [en]

    One area of research in suicidology aims at understanding the processes underlying aggregation or clustering of suicide cases within a limited period of time or space (suicide epidemics). Susceptibility to, or propagation of, suicidal behavior due to given risk factors may be operating through media other than space, and its susceptibility for the receiver may be different within different types of strata that are determined by socio-demographic, personality-related or biological-susceptibility differences. We use the term "assortative susceptibility" for this phenomenon. Aggregated cases, comprising calendar months with an unusually large number of suicides after adjusting for seasonal and yearly variations, were defined in the register of all 1093 completed suicides during 1969-93 in the county of Västerbotten in northern Sweden. Binary multiple logistic regressions were performed to compare the aggregated cases with the remaining cases. Compared with the remaining cases, the aggregated cases included significantly more of males and of those living in the rural forested regions. Also, suicide by firearms was significantly more aggregated than the other methods. Our results suggest that middle-aged or older men from the rural areas, who have access to firearms, are likely to belong to the socio-demographic stratum that is susceptible to the processes that give rise to aggregations or clusters of suicides in this county (assortative susceptibility).

  • 7.
    Chotai, Jayanti
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Smedh, Kristina
    Johansson, Carolina
    Nilsson, Lars-Göran
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    An epidemiological study on gender differences in self-reported seasonal changes in mood and behaviour in a general population of northern Sweden.2004In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 58, no 6, p. 429-37Article in journal (Refereed)
    Abstract [en]

    Gender differences have been reported regarding symptoms, prevalence and heritability of seasonal affective disorders (SAD). We focus on gender aspects in this study of self-reported seasonal changes in mood and behaviour in a general population. The Seasonal Pattern Assessment Questionnaire (SPAQ) was completed by 2620 adults (55.6% women) aged 35-85 years, enrolled in the Betula prospective random cohort study of Umeå, Sweden. October to February turned out to be suitable winter months. SAD was found in 2.2% and sub-syndromal SAD (S-SAD) in 5.7%. Women had about 1.5 times higher prevalences than men, and seasonality problems decreased with age in both genders. Preference for eating least was distributed with a peak in summer, whereas preference for eating most had a major peak in winter (winter eaters) and a minor peak in summer (summer eaters). Significantly more of winter eaters in women, and significantly more of summer eaters in men, felt worst in winter. Seasonal change in weight was considered significantly as a problem by women but not by men. Winter behaviour of sleeping most was considered significantly as a problem by men but not by women. Women reacted significantly to temperature-related changes (negatively to cold/short days and positively to hot/long days), whereas men reacted significantly to sunshine-related changes (negatively to cloudy days and positively to sunny days). Subtle gender differences may thus underlie the pathophysiology of seasonal problems. Studies of an eventual efficacy of treating SAD women with raised ambient temperature, and gender-specific comparisons with other therapies, would be of interest.

  • 8.
    Ekholm, Birgit
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ekholm, Andreas
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Vares, Maria
    Osby, Urban
    Sedvall, Göran C
    Jönsson, Erik G
    Evaluation of diagnostic procedures in Swedish patients with schizophrenia and related psychoses.2005In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 59, no 6, p. 457-464Article in journal (Refereed)
    Abstract [en]

    We aimed to estimate the value of structured interviews, medical records and Swedish register diagnoses for assessing lifetime diagnosis of patients with schizophrenia. Psychiatric records and diagnostic interviews of 143 Swedish patients diagnosed by their treating physician with schizophrenia and related disorders were scrutinized. Based on record analysis only, or a combined record and interview analysis, DSM-IV diagnoses were obtained by the OPCRIT algorithm. Independent of the OPCRIT algorithm, a standard research DSM-IV diagnosis, based on both record and interview analysis, was given by the research psychiatrist. Concordance rates for the different psychosis diagnoses were calculated. DSM-IV diagnoses based on records only, showed a good to excellent agreement with diagnoses based on records and interviews. Swedish register diagnoses displayed generally poor agreement with the research diagnoses. Nevertheless, 94% of subjects sometimes registered with a diagnosis of schizophrenic psychoses (i.e. schizophrenia, schizoaffective psychosis or schizophreniform disorder) displayed a standard research DSM-IV diagnosis of these disorders. For patients in long-term treatment for schizophrenia in Sweden, psychiatric record reviews should be optimal, cost effective and sufficient for assessment of lifetime research diagnoses of schizophrenia. For these patients a research interview adds little new information. The results further indicate that a Swedish register diagnosis of schizophrenic psychoses has a high positive predictive power to a standard research DSM-IV diagnosis of the disorders. It is concluded that for future Swedish large-scale genetic studies focusing on a broad definition of schizophrenia, it would be sufficient to rely on the Swedish register diagnoses of schizophrenic psychosis.

  • 9.
    Forsberg, Karl Anton
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Björkman, Tommy
    Sandman, Per Olof
    Umeå University, Faculty of Medicine, Department of Nursing.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Physical health: a cluster randomized controlled lifestyle intervention among persons with a psychiatric disability and their staff2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 6, p. 486-495Article in journal (Refereed)
    Abstract [en]

    The objective was to explore the impact on physical health of a lifestyle programme among persons with psychiatric disabilities, and their caregivers. Their satisfaction with the intervention was also assessed. Somatic comorbidity and an increased mortality related to the lifestyle among persons with psychiatric disabilities are well known. Few randomized controlled trials have been aimed specifically at lifestyle issues among persons with a psychiatric disability. This trial includes clients with psychiatric disabilities living in supported housing and their staff. Forty-one persons with a DSM-?V diagnosis of severe mental illness from psychiatric disability from 10 supported housing facilities and 41 of their caregivers participated in this 12-month study during 2005-2006 in Sweden. The supported housing facilities with residents and staff were randomly assigned to either a health intervention programme or a control programme with an aesthetic content. The presence of metabolic syndrome and changes in the mean of physiological parameters such as Hba1c, P-glucose, P-insulin, lipids, blood pressure, physical working capacity, body mass index, Heart Score were investigated and participants' satisfaction assessed. There was a significant reduction in the mean of metabolic syndrome criteria in the intervention group compared with the control group at the follow-up. The participants expressed satisfaction with the programme. The results indicate that health interventions on lifestyle issues when involving carers are appreciated, feasible and could be successful in reducing some health-related risk factors among persons with psychiatric disabilities.

  • 10.
    Fransson, Per
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Sundbom, Elisabet
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    A comparative study of adolescents in psychiatric care assessed by means of the Defense Mechanism Test and the DSM-IV classification system1998In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 52, no 6, p. 527-536Article in journal (Refereed)
    Abstract [en]

    Twenty-seven adolescents in psychiatric care, assessed by means of DSM-IV, and 33 healthy controls were tested using the projective percept-genetic Defense Mechanism Test (DMT). Three diagnostic subgroups were created: psychotic (Axis 1), borderline personality disorder (Axis 2), and a non-patient group. The test protocols were scored with regard to 130 DMT variables and analyzed by means of partial least squares (PLS) discriminant analysis and by means of a pattern analysis of the DMT variables. The results showed that it was possible to distinguish significantly among the three groups. Specific perceptual distortions were identified among the three groups. It was concluded that DMT is a promising instrument in the assessment of adolescents in psychiatric care.

  • 11.
    Ghazinour, Mehdi
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Richter, Jörg
    University of Rostock-Germany.
    Eisemann, Martin
    Department of Psychology-Tromsö Unversity.
    Do Parental Rearing and Personality Characteristics have a Buffering Effect against Psychopathological manifestations among Iranian Refugees in Sweden?2003In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 57, no 6, p. 419-428Article in journal (Refereed)
  • 12.
    Goldin, Stephen
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Hägglöf, Bruno
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Levin, Lilian
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Child and Adolescent Psychiatry.
    Persson, Lars Åke
    International Maternal and Child Health, Department of Women's and Children's Health, Uppsala University, Sweden.
    Mental health of Bosnian refugee children: a comparison of clinician appraisal with parent, child and teacher reports2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 3, p. 204-216Article in journal (Refereed)
    Abstract [en]

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

  • 13. Gothefors, Dan
    et al.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Swedish Psychiatric Association. .
    Attvall, Stig
    Erlinge, David
    Jarbin, Håkan
    Lindström, Kjell
    von Hausswolff-Juhlin, Yvonne Linné
    Morgell, Roland
    Toft, Eva
    Osby, Urban
    Swedish clinical guidelines: prevention and management of metabolic risk in patients with severe psychiatric disorders2010In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 64, no 5, p. 294-302Article in journal (Refereed)
    Abstract [en]

    Individuals with severe psychiatric disorders are more likely than the population at large to develop metabolic derangements such as overweight and diabetes. Cardiovascular disease is also more frequently seen in this group. Contributing factors may include inappropriate diet or lack of physical activity, but antipsychotic medication may also play a role. Seven Swedish specialist medical societies have collaborated in formulating a set of concise clinically applicable guidelines-reproduced here in modified form-for the prevention and management of metabolic risk in this patient group. The importance of implementation is emphasized.

  • 14.
    Gustafsson, Per E
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Nelson, Nina
    Gustafsson, Per A
    Diurnal cortisol levels, psychiatric symptoms and sense of coherence in abused adolescents.2010In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 64, no 1, p. 27-31Article in journal (Refereed)
    Abstract [en]

    Background. The role of the hypothalamic-pituitary-adrenal (HPA) axis in psychiatric disorders following trauma is poorly studied and most studies have been done on adults. Aims. To investigate the association of mental well-being and diurnal cortisol in abused adolescents. Methods. The present cross-sectional study examined diurnal salivary cortisol (measured three times a day during three days) in relation to psychiatric symptoms (Trauma Symptoms Checklist for Children) and the salutogenic construct “sense of coherence”, in 15 adolescents exposed to childhood abuse. Results. Significant correlations were found between symptoms and sense of coherence versus early and late morning cortisol concentrations. The correlations were most consistent for internalizing and externalizing symptoms, and somewhat less for post-traumatic symptoms and sense of coherence. In contrast, evening cortisol did not correlate with any of the psychological measures. Conclusion. These results extend previous research findings by pointing towards a relation between symptoms and higher morning cortisol and accentuated diurnal cortisol variation in abused adolescent as opposed to lower basal cortisol and a flattening of the cortisol rhythm repeatedly observed in traumatized adults. Clinical implications. The pathophysiology of the impact of trauma on youth, including the impact on biological stress systems, are important for an understanding of the consequences of trauma and may serve as a basis for the development of new treatment options.

  • 15. Hansson, Lars
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Bengtsson-Tops, Anita
    Bjarnason, Olafur
    Karlsson, Hasse
    Mackeprang, Torben
    Merinder, Lars
    Nilsson, Liselotte
    Sørgaard, Knut
    Vinding, Hanne
    Middelboe, Thomas
    The relationship of needs and quality of life in persons with schizophrenia living in the community. A Nordic multi-center study.2003In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 57, no 1, p. 5-11Article in journal (Refereed)
    Abstract [en]

    The relationship between needs for care and support and subjective quality of life was investigated in a cross-sectional multi-center study including 418 individuals with schizophrenia from 10 centers in Nordic countries. Needs in 22 domains were investigated by interviews with key workers and their patients using the Camberwell Assessment of Need scale, and quality of life by the Lancashire Quality of Life Profile. The results showed that key workers rated slightly more needs than patients. To have more unmet needs, as rated by both key workers and patients, were correlated to a worse overall subjective quality of life, while met needs showed no such association. A regression analysis, controlling for clinical and social characteristics of the patients, showed more unmet needs to be associated with a worse quality of life, accounting for 6% out of a total of 41% explained variance in subjective quality of life. Regression analyses of the relationship of unmet needs in specific life domains and overall quality of life showed that unmet needs in five domains as perceived by patients accounted for 17% of the explained variance in overall quality of life. More than half of this variance was related to an unmet need in the domain of social relationships. It is concluded that unmet needs are of specific importance in needs assessment and that attention must be paid to separate met needs for care and services from unmet needs, since the latter seem more important to consider in order to improve outcome of interventions with regard to quality of life. Specific attention should in this context also be paid to unmet needs concerning social relationships and problems with accommodation.

  • 16.
    Hansson, Maja
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Chotai, Jayanti
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    What made me feel better?: patients' own explanations for the improvement of their depression2012In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 66, no 4, p. 290-296Article in journal (Refereed)
    Abstract [en]

    Background: Depression is common among primary care patients and the usual treatment often consists of antidepressant medication and supportive counselling/follow-ups. Previous studies have shown that patients and professionals have different beliefs about treatment, which in turn can decrease acceptance of the diagnosis, compliance and treatment outcome. Aims: The purpose of this study was to investigate previously depressed patients' beliefs about the cause of their improvement. Methods: Depressed primary care patients (n = 184) who considered themselves improved at follow-up answered an open-ended question about what they believed had made them better. Among these 117 patients had, in addition to treatment as usual, participated in an intervention with patient education and group counselling (the Contactus programme), whereas 67 were controls. The groups were comparable at baseline and 82% were on antidepressants. Results: In total, the patients mentioned 14 separate improving factors, which could be organized to the larger themes external factors, self-management, passing spontaneously and professional help. The most frequently mentioned factors for improvement were the Contactus programme (53.0%), antidepressants (40.2%) and personal development (27.2%). Few gender and age differences were seen. The controls who mentioned professional help were more likely to have a better outcome. Conclusions: The patients were generally positive to professional help such as antidepressants and the Contactus programme. Patient education and group counselling seems to be a valuable supplement to treatment of depressed patients in primary care.

  • 17. Ineland, Lisa
    et al.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Salander Renberg, Ellinor
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sjölander, Per
    Attitudes towards mental disorders and psychiatric treatment--changes over time in a Swedish population.2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 3, p. 192-7Article in journal (Refereed)
    Abstract [en]

    Over the years a lot of research of attitudes towards mental disorders, towards people with mental illness and towards psychiatric services and treatment have shown a persistent negative attitude. There are, however, few studies on changes over time. The aim of this study was to compare responses to a questionnaire on attitudes towards mental disorders and psychiatric patients and the perception of psychiatric treatment in a community in northern Sweden in 1976 and 2003. In 1976 a random sample of 391 persons 18-70 years of age were asked and in 2003 a new sample of 500 persons from the same community were approached with the same questions. There are considerable changes over time. In 2003, almost 90% agree to the statement that mental illness harms the reputation more than physical illness, compared with 50% in 1976. In 2003, 51% agreed to the statement "Most people with mental disorders commit violent acts more than others" compared with 24% in 1976. There is an apparent ambivalence towards psychiatric treatment. Whilst 88% would advice a person with mental problems to contact a psychiatrist, still 26% would not like themselves to be referred to a psychiatrist. We argue that improving treatment methods is as important as changing attitudes through accurate information.

  • 18. Kjellin, Lars
    et al.
    Andersson, Kristina
    Bartholdson, Erik
    Candefjord, Inga-Lill
    Holmstrom, Helge
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Wallsten, Tuula
    Östman, Margareta
    Coercion in psychiatric care: patients' and relatives' experiences from four Swedish psychiatric services2004In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 58, no 2, p. 153-159Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to explore possible regional differences in the use of coercion in psychiatric care as experienced by patients and relatives. At four psychiatric care settings in different parts of Sweden, 138 committed and 144 voluntarily admitted patients were interviewed at admission using the Nordic Admission Interview. At discharge or, if the care episode was still ongoing, after 3 weeks of care, a follow-up patient interview and an interview with 162 relatives of these patients took place. In one of the centers, where involuntarily admitted patients were treated without locking the doors of the wards, the patients reported less coercion at admission than in the other three centers. Regarding the patients' reports of the use of coercive measures, personal treatment and outcome of care, and concerning the relatives' experiences, few differences were found between centers among committed and voluntarily admitted patients, respectively. Coercion in psychiatric care, as reported by patients and relatives, was not always legally based, and many of the patients reported they felt violated during the admission process. Only a minority of patients and relatives reported participation in treatment and care planning, as regulated by law. Still, a majority of both committed and voluntarily admitted patients reported they had been well treated by the personnel at admission as well as during the stay at the ward, and that they had been improved in their mental health after the psychiatric care episode.

  • 19.
    Mirnezami, Helia Faghir
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Edin-Liljegren, Anette
    Changes in attitudes towards mental disorders and psychiatric treatment 1976-2014 in a Swedish population2016In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 70, no 1, p. 38-44Article in journal (Refereed)
    Abstract [en]

    Background: Mental illness has always been subject to stigma and discrimination. There are a number of studies on public attitudes towards people with mental illness. Long-term studies, however, examining changes over time are scarce. Aims: The aim of this study was to examine potential changes concerning attitudes between 1976 and 2014 in Vilhelmina, a community in northern Sweden. Methods: A postal questionnaire was sent out to a random sample of 500 adults aged 18-70 years. The same questionnaire has previously been used in 1976 and 2003. Results: The attitudes towards people with mental illness have not generally become more positive over the years. In 2014 almost a quarter of the population still think that people with mental illness commit violentX acts more than others. Even more people in 2014 than in 1976 agree to the statement that mental illness harms the reputation more than a physical disease (77.2% versus 52.8%). People with low educational level have more negative views than people with higher education. Younger respondents, < 20 years, had a more positive view than the older age groups. Almost 70% of the respondents would advise someone with psychological problems to seek a psychiatrist but only 23% of the respondents would follow their own advice. Psychotherapy has been and is still highly appreciated. As regards medication the perception is more critical, but there has been a significant change, however, to a more positive attitude towards medication since 1976. Conclusion: Attitudes towards mental illness and mentally ill people have not changed substantially over time.

  • 20.
    Naesström, Matilda
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Blomstedt, Patric
    Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience, Clinical Neuroscience.
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    A systematic review of psychiatric indications for deep brain stimulation, with focus on major depressive and obsessive-compulsive disorder2016In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 70, no 7, p. 483-491Article, review/survey (Refereed)
    Abstract [en]

    Background: Deep brain stimulation is a treatment under investigation for a range of psychiatric disorders. It has shown promising results for therapy-refractory obsessive-compulsive disorder (OCD) and major depressive disorder (MDD). Other indications under investigation include Tourette's syndrome, anorexia nervosa and substance use disorders.Aims: To review current studies on psychiatric indications for deep brain stimulation (DBS), with focus on OCD and MDD.Method: A systematic search was carried out in MEDLINE, and the literature was searched to identify studies with DBS for psychiatric disorders. The identified studies were analysed based on patient characteristics, treatment results and adverse effects of DBS.Results: A total of 52 papers met the inclusion criteria and described a total of 286 unique patients treated with DBS for psychiatric indications; 18 studies described 112 patients treated with DBS for OCD in six different anatomical targets, while nine studies presented 100 patients with DBS for MDD in five different targets.Conclusion: DBS may show promise for treatment-resistant OCD and MDD but the results are limited by small sample size and insufficient randomized controlled data. Deep brain stimulation for OCD has received United States Food and Drug Administration approval. Other psychiatric indications are currently of a purely experimental nature.

  • 21.
    Nilsson, Doris
    et al.
    BUP-Elefanten, Department of Child and Adolescent Psychiatry, IMK, Linköping University, Linköping, Sweden.
    Gustafsson, Per E
    Department of Child and Adolescent Psychiatry, IKE, Faculty of Health Sciences, Linköping University, Sweden.
    Svedin, Carl Göran
    Department of Child and Adolescent Psychiatry, IKE, Faculty of Health Sciences, Linköping University, Sweden.
    Self-reported potentially traumatic life events and symptoms of post-traumatic stress and dissociation2010In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 64, no 1, p. 19-26Article in journal (Refereed)
    Abstract [en]

    Objective: To investigate single potentially traumatic events and cumulative effects of these events based on the reported symptoms of post-traumatic stress and dissociation. An additional goal was to evaluate the psychometric properties of Life Incidence of Traumatic Events—Student scale (LITE-S). Methods: 400 adolescents from the normative population answered the questionnaire Life Incidence of Traumatic Experiences (LITE-S) together with Trauma Symptom Checklist for Children (TSCC), Dissociation-Questionnaire-Sweden (Dis-Q-Sweden) and Adolescent-Dissociative Experience Scale (A-DES). The single self-reported traumas, and the cumulative self-reported traumas and their effects on post-traumatic stress disorder and dissociative symptoms scales were examined. The psychometric properties of LITE-S were first investigated through calculating, test–retest reliability by Pearson correlation for the total scale and by Cohen's kappa item per item. Results: Self-reported symptoms were related to both the cumulative traumas and exposure to some single traumas, such as seeing somebody get hurt, having parents destroy things or hurting each other, being whipped or hit, or even being made to carry out some kind of sexual act. Interpersonal events were consistently more strongly related to symptoms across the TSCC clinical scales. Finally, test–retest reliability as found to be for the total scale r=0.76 and kappa item per item ranging between k=0.33 and 0.86. Conclusion: The cumulative effects of potentially traumatic events on adolescents are significant, and interpersonal traumas results in more self-reported symptoms of post-traumatic stress and dissociation than non-interpersonal. LITE has satisfactory psychometric properties concerning reliability. Clinical implications: The results underline the importance in clinical practice of taking into consideration how many potentially traumatic events an adolescent has experienced before, seeking help on specific occasion. This knowledge can help the clinician to understand better the breadth of feelings their client is experiencing and thus can help the clinician better to be able to suggest appropriate treatment.

  • 22.
    Nilsson, Mats
    et al.
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine.
    Lökk, Johan
    Norberg, Bo
    Hultdin, Johan
    Umeå University, Faculty of Medicine, Department of Medical Biosciences, Clinical chemistry.
    Sandström, Herbert
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Westman, Göran
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Sex differences in cobalamin (vitamin B12) opinions of Swedish physicians.2002In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 56, no 4, p. 299-303Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to elucidate possible sex differences in knowledge, competence and attitudes behind decision-making on cobalamin-associated problems (vitamin B(12)). The study was conducted by postal questionnaires to Swedish physicians in 1996-98. The participants were recruited by random sampling of general practitioners (1996, 1998), and a total sampling of geriatricians (1998). The overall response rate was 71%. The study group comprised 480 female physicians and 526 male physicians. The responses to 24 statements in the questionnaire were measured by means of visual analogue scales. Group differences were evaluated by medians and shapes of distributions. The female doctors appeared to value patient-related symptoms and signs more than male doctors. Conversely, male doctors relied on laboratory tests more than female doctors. As reflected by questionnaire answers, female doctors appeared to be more informed than male doctors on cobalamin-associated clinical problems. Group differences between the sexes were marginal from a numerical point of view. It is suggested that the statistical differences observed should be regarded as negligible until confirmed by further studies.

  • 23.
    Nordström, Annika
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Bodlund, Owe
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Every third patient in primary care suffers from depression, anxiety or alcohol problems2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 3, p. 250-255Article in journal (Refereed)
    Abstract [en]

    The aims of the study were to explore the prevalence of patients with depression and anxiety in primary care, its co-occurrence with hazardous/harmful alcohol use, and its relation to gender, age and reason for visit. A questionnaire, including the self-rating Hospital Anxiety and Depression scale and the Alcohol Use Disorder Identification Test, was consecutively distributed to 1800 patients at 11 primary healthcare centres in the county of Västerbotten, Sweden. The response rate was 77.3% (1392 patients), 38% men and 62% women. A total of 31.9% showed symptoms of depression and/or anxiety, with no gender differences. Harmful/hazardous alcohol use was found in 11.9% of the patients, 17.3% in men and 8.8% in women, although the region in Sweden has relatively low alcohol consumption among the population. Age was an important factor. Incidences of the conditions often occurred simultaneously. About half (51%) of those with harmful/hazardous alcohol use also showed symptoms of depression and/or anxiety. The most common causes for patients with symptoms of depression, anxiety or risk consumption of alcohol to seek care were the same as for the general population, namely complaints of pain or infection. Only 7.8% visited the primary care for psychiatric reasons, according to their own given reasons. In all, 38% of the patients showed signs of psychiatric symptoms and/or alcohol problems or a combination of these. The fact that every third patient showed symptoms of depression, anxiety and/or alcohol problems underlines the strategic position for early identification, intervention and treatment within primary healthcare.

  • 24.
    Omma, Lotta
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Alcohol use in young indigenous Sami in Sweden2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 8, p. 621-628Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Evidence suggests socially disadvantaged people or those who live in socially disadvantaged areas experience more harm per gram of alcohol consumed than people with greater social advantages. In the Sami group, probable associations between alcohol use and several areas of health have been explored, but there are no studies regarding the drinking habits of young Sami in Sweden.

    AIMS: To investigate alcohol use in young Sami in Sweden, and in a reference group from the general young Swedish population in the same area; to evaluate likely associations between gender, education, family situation and alcohol use.

    METHODS: The Alcohol Use Disorder Identification Test was used in a cross-sectional study comprising 516 Sami (18-28 years), and a reference group (18-29 years, n = 218).

    RESULTS: No significant differences in hazardous/harmful alcohol drinking in young Sami and Swedes were found. Nearly half the men and ~35% of the women reported risky alcohol use. Gender differences were reported only in the Sami. Sami men had 1.6 times higher odds of hazardous/harmful drinking compared to Sami women. Only in the Sami were lower education levels associated with higher odds of hazardous/harmful drinking. Experiences of "often forgetting important things", seldom "looking forward with joy", and self-perceived ethnicity-related negative treatment were associated with hazardous/harmful drinking.

    CONCLUSIONS: Although alcohol use in young Sami appears to be similar to alcohol use in young non-Sami Swedes, important risk factors for hazardous/harmful drinking are identified, e.g. ethnicity-related negative treatment. These should be taken into account when planning for preventive interventions.

  • 25. Pihkala, Helja
    et al.
    Dimova-Branstrom, Neda
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Talking about parental substance abuse with children: eight families' experiences of Beardslee's family intervention2017In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 71, no 5, p. 395-401Article in journal (Refereed)
    Abstract [en]

    Background: Many children are affected by parental substance use disorder. Beardslee's family intervention (BFI) is a family-based psycho-educative method for children of mentally ill parents, used in psychiatric practise in several Nordic countries. The method has also been used to some extent when a parent suffers from substance use disorder. Aims: The aim of the study was to explore the family members' experiences of the BFI when a parent has a diagnosis of substance use disorder, to gain new knowledge about the process of the BFI in this area. Methods: Ten children and 14 parents were interviewed about their experiences 6 months after a BFI. The interviews were analyzed by qualitative content analysis. The children's psychological symptoms were measured by the Strengths and Difficulties Questionnaire at baseline and after 6 months. Results: Increased openness about the substance use disorder in the families was a recurrent theme throughout the material and a central issue reported in the children's experiences. The children had a high level of psychological symptoms according to the SDQ at baseline, but the majority of them felt that the BFI made a positive difference in their families and for themselves. The parents reported improved wellbeing of their children. Conclusions and clinical implications: Positive experienced effects for children and parents are reported in families with parental substance use disorder, with possible connection to use of BFI. The present study suggests that Beardslee's family intervention is applicable as a preventive method for children in families with a parent suffering from substance use disorder.

  • 26.
    Pihkala, Heljä
    et al.
    Psychiatric clinic, Skellefteå Hospital, Skellefteå.
    Johansson, Eva
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Family Medicine.
    Longing and fearing for dialogue with children: depressed parents' way into Beardslee's preventive family intervention2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 5, p. 399-404Article in journal (Refereed)
    Abstract [en]

    Background: There is a growing interest in prevention of mental disorders in children of mentally ill parents. Beardslee's preventive family intervention is a method recently introduced into Sweden. When asking parents to participate in this intervention it has become evident how sensitive the issue of parenthood is to our patients.

    Aim: The study aims at exploring what depressed parents considered as obstacles and facilitating factors for accepting Beardslee's family intervention.

    Methods: Ten parents from two psychiatric clinics and one primary health care centre in northern Sweden were interviewed by semi-structured technique. Nine of these parents had accepted and participated in Beardslee's family intervention, one parent had been offered but refused participation. Data were analysed according to grounded theory.

    Results: The main reason for taking part was the lack of dialogue these parents perceived with their children. There were difficulties in talking about and finding words to explain the depression. The parents were worried about their children, wishing to know how the children were actually feeling, and wanting the professionals to take a look at them. To open up was both frightening and tempting. It implied the consideration of many aspects: the right timing, shame and guilt, the partner's interest, the children's willingness and the involvement of professionals.

    Conclusion: The findings show the delicacy of the issue of children's well-being when a parent is depressed and they highlight some important topics to discuss with the parents when preventive interventions are offered.

  • 27.
    Renberg, Fredrik Edin
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Microdecisions instead of coercion: patient participation and self-perceived discrimination in a psychiatric ward2019In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 73, no 8, p. 532-538Article in journal (Refereed)
    Abstract [en]

    Aims: Patients may experience unfair reception when in contact with psychiatric services. The aims are to illuminate these perceptions, and the extent of inpatients' involvement in their care, and if degree of involvement depends on compulsory or voluntary care. Furthermore, we sought to determine if an educational intervention for staff members, including systematic listening and offering the inpatients involvement using microdecisions, affects the inpatients' experiences and the use of coercion.

    Materials and methods: We used a naturalistic setting case control design in two psychiatric wards for one year, including all inpatients (n = 685) of which 458 took part of the microdecision intervention. Structured direct interviews were carried out with inpatients based on the Discrimination and Stigma Scale (DISC), Dyadic OPTION, and CollaboRATE instruments before (n = 19) and after (n = 46) the intervention. Frequencies of coercive measures before and after the intervention were compared (n = 685).

    Results: Respondents subjected to the intervention experienced less discrimination related to psychiatric care compared to responders not subjected. Tendencies of improvements post intervention were found for some aspects of involvement, as attention to concerns and possibilities to ask questions. A decrease in the use of coercive measures at three and six months after the start of the intervention was observed.

    Conclusion: Results suggest that the intervention could decrease the inpatients' experiences of discrimination during psychiatric care as well as the use of coercion in the service. The Dyadic OPTION instrument showed a mixed picture with results implying improvements in some areas and impairments in others.

  • 28.
    Schön, Ulla-Karin
    et al.
    Högskolan Dalarna.
    Svedberg, Petra
    Halmstad Universitet.
    Rosenberg, David
    Umeå University, Faculty of Social Sciences, Department of Social Work.
    Evaluating the INSPIRE measure of staff support for personal recovery in a Swedish psychiatric context2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 4, p. 275-281Article in journal (Refereed)
    Abstract [en]

    Background: Recovery is understood to be an individual process that cannot be controlled, but can be supported and facilitated at the individual, organizational and system levels. Standardized measures of recovery may play a critical role in contributing to the development of a recovery-oriented system. The INSPIRE measure is a 28-item service user-rated measure of recovery support. INSPIRE assesses both the individual preferences of the user in the recovery process and their experience of support from staff. Aim: The aim of this study was to evaluate the psychometric properties of the Swedish version of the INSPIRE measure, for potential use in Swedish mental health services and in order to promote recovery in mental illness. Method: The sample consisted of 85 participants from six community mental health services targeting people with a diagnosis of psychosis in a municipality in Sweden. For the test-retest evaluation, 78 participants completed the questionnaire 2 weeks later. Results: The results in the present study indicate that the Swedish version of the INSPIRE measure had good face and content validity, satisfactory internal consistency and some level of instability in test-retest reliability. Conclusions: While further studies that test the instrument in a larger and more diverse clinical context are needed, INSPIRE can be considered a relevant and feasible instrument to utilize in supporting the development of a recovery-oriented system in Sweden.

  • 29. Shibre, Teshome
    et al.
    Kebede, D
    Alem, Atalay
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kebreab, S
    Melaku, Z
    Deyassa, Negussie
    Negash, Alemayehu
    Fekadu, A
    Fekadu, Daniel
    Medhin, G
    Negeri, C
    Jacobsson, Lars
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Kullgren, Gunnar
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Neurological soft signs (NSS) in 200 treatment-naïve cases with schizophrenia: a community-based study in a rural setting.2002In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 56, no 6, p. 425-31Article in journal (Refereed)
    Abstract [en]

    Several studies have reported neurological soft signs (NSS) to be common in individuals with schizophrenia. The majority of these studies are based on clinical samples exposed to neuroleptic treatment. The present study reports on 200 treatment-naïve and community-identified cases of schizophrenia and 78 healthy individuals from the same area, evaluated using the Neurological Evaluation Scale (NES). The median NES score was 5.0 for cases of schizophrenia and 1.5 for healthy subjects. The impairment rate of NSS in cases with schizophrenia was 65.0% against 50.0% in healthy subjects, and the difference was statistically significant (chi2 = 5.30; df = 1; P < 0.021). NSS abnormality is as common in treatment-naïve cases as reported in many studies in those on neuroleptic medication. There was no significant relation between the NSS impairment and duration of illness, remission status, positive symptoms, negative symptoms and disorganized symptoms.

  • 30. Sjöberg, Rickard L
    False claims of victimization: a historical illustration of a contemporary problem.2002In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 56, no 2Article in journal (Refereed)
    Abstract [en]

    In this article, a false claim of victimization made by a man in his late 20s during a 17th-century outbreak of mass allegations of Satanic abuse is described and discussed in relation to contemporary issues with relevance to psychiatry and applied mental health.

  • 31. Sjöberg, Rickard L
    et al.
    Lindholm, Torun
    Children's autobiographical reports about sexual abuse: A narrative review of the research literature.2009In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 63, no 6Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The empirical and theoretical literature on children's autobiographical statements about child sexual abuse and other forms of maltreatment should be of potential importance to all professionals who regularly interview children as part of their professional duties.

    AIMS: To present an introduction to this field.

    METHODS: Narrative review.

    RESULTS: Preschool children appear to be capable of providing reliable testimony on highly salient personal experiences such as sexual abuse, though a substantial proportion of children may choose not to. However, suggestive interviewing practises, particularly when used with younger children, may elicit false allegations. There is little evidence to suggest that experiences from the preverbal period of life can later be meaningfully reconstructed by means of statements or clinical signs.

    CONCLUSIONS: Use of children as witnesses and informants requires special considerations, knowledge and skills.

  • 32. Sjöberg, Rickard L
    et al.
    Lindholm, Torun
    Gender biases in decisions on euthanasia among Swedish jurors.2003In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 57, no 6Article in journal (Refereed)
    Abstract [en]

    The present study set out to investigate whether group-based biases may influence decisions regarding euthanasia in Swedish jurors (nämndemän). Thirty-eight Swedish jurors were presented with a case description of euthanasia in a severely brain-damaged patient. Age and gender of the patient were systematically varied. The jurors were asked to what extent they believed that euthanasia was ethical in the case presented to them and whether they thought that it should be legal. Jurors tended to be supportive of euthanasia and were more so when it was used on patients who belonged to the opposite gender. These results suggest that group-based biases may influence decisions regarding euthanasia in Swedish jurors. The finding has implication for the Swedish debate regarding a possible legalization of such procedures.

  • 33.
    Strömberg, Gunvor
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Dahl, A
    Malker, H
    Westman, G
    Detecting early signs of psychosis.: Vignettes presented to professionals in primary health care and psychiatry.2005In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 59, no 5, p. 343-349Article in journal (Refereed)
  • 34.
    Söderberg, Stig
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Personality disorders in parasuicide2001In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 55, no 3, p. 163-167Article in journal (Refereed)
  • 35. Sørgaard, Knut W
    et al.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Heikkilä, Jyrki
    Hansson, Lars
    Vinding, Hanne R
    Bjarnason, Olafur
    Bengtsson-Tops, Anita
    Merinder, Lars
    Nilsson, Lise-Lotte
    Middelboe, Thomas
    Schizophrenia and contact with health and social services: A Nordic multi-centre study2003In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 57, no 4, p. 253-261Article in journal (Refereed)
    Abstract [en]

    Background: In a Nordic multi-centre study investigating the life and care situation of persons with schizophrenia living in the community, factors explaining use of health and social services were examined. Method: Four hundred and eighteen individuals with schizophrenia from 10 sites were interviewed about their contact with different services (support functions within and outside the mental health services, general practitioners (GPs), physicians in the mental health, psychotherapy, day-care and inpatient treatment), psychopathology, social network and needs for care. Results: Physicians and support contacts within the mental health system were most used and GPs and psychotherapy least. Three groups of variables were stabile predictors of contact: rural-urban differences, diagnoses (hebephrenic schizophrenia associated with less contact with physicians in the mental services and more with GPs) and health needs as experienced by the patients. No differences between the centres with regard to total service use were found, but the patterns of contact reflected urban-rural variance. A low number of health needs predicted contact with physicians within the mental health services, whereas a high number of such needs was related to contact with GPs and support functions within the mental health services. Social relations exhibited the highest number of unmet needs. Conclusions: Contact with physicians working in the mental health services was much more common than contact with GPs. Based on a broad spectre of demographic, clinical and network variables, it was not possible to find models that explained substantial parts of the variance of service use. Patterns of contact were different in rural, town and city-surroundings, and with the exception of psychotherapy, the rural pattern was characterized by use of less specialized services. The importance of health needs and diagnosis as predictors of contact illustrate the profound and lasting effects on health of having a diagnosis of schizophrenia.

  • 36. Taylor, David M.
    et al.
    Velaga, Sitaram
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Reducing the stigma of long acting injectable antipsychotics: current concepts and future developments2018In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, p. S36-S39Article in journal (Refereed)
    Abstract [en]

    Background: Long acting injectable antipsychotics (LAI-APs) are considered a major advance in psychiatric treatment concerning treatment adherence and outcomes. Yet, both, doctors and patients remain sceptical.

    Aim: To explain the rationale for using LAI-APs, review their effectiveness and explore barriers to use.

    Method: Clinical overview of LAI-APs from the patient and doctor's perspective.

    Results: LAI-APs were developed to increase adherence to treatment, thereby improving treatment outcomes. LAI-APs may reduce the risk of relapse and hospitalisation. Yet, the evidence from the few meta-analyses available remains weak. Both patients and doctors may associate LAI-APs with stigma and coercion. Current means of improving adherence include more focus on the therapeutic relationship, better information, adverse effects minimisation and half-life extension of LAI-APs. Future means of improving adherence include novel administration techniques that abolish the need for injection.

    Conclusions: For both, clinicians and drug developers, drug adherence remains a major target for improving treatment outcomes.

  • 37. Taylor, David M.
    et al.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ethnopharmacology2018In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, p. S30-S32Article in journal (Refereed)
    Abstract [en]

    Background: Ethnopharmacology relates to the study of substances used medicinally by different ethnic or cultural groups or handling of, drugs-based ethnicity or pharmacogenetics.

    Aims: To review the key aspects of ethnopharmacology.

    Method: This lecture gives an overview of the relationship between geography, culture, pharmacogenomics and prescribing.

    Results: Although the majority of antipsychotics, antidepressants and mood-stabilisers are widely and cheaply available in generic forms, prescription rates can vary. Clozapine is one such example with prescribing-rates ranging from less than 10 patients per 100,000 people to nearly 180 patients/100,000 people. Pharmacogenetic studies of antipsychotics and antidepressants concern gene polymorphisms that may affect both, pharmacodynamic or pharmacokinetic properties. Considerable genetic and ethnic variability has been seen for the P450 microsomal enzymes CYP 2D6 and 1A2.

    Conclusions: With accelerated global mobility and increased understanding of medicinal substances at molecular level, understanding of ethnopharmacology will become increasingly important in routine clinical practice.

  • 38. Wallsten, Tuula
    et al.
    Ostman, Margareta
    Sjöberg, Rickard L
    Kjellin, Lars
    Patients' and next-of-kins' attitudes towards compulsory psychiatric care.2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 6Article in journal (Refereed)
    Abstract [en]

    The introduction of a new Civil Commitment Act in Sweden in 1992 involved a shift of emphasis from medical to judicial authority. Little is known about general patient attitudes to compulsory care. The aim of the study was to study possible differences in attitudes, before and after the mental health law reform, among involuntarily and voluntarily admitted patients and their next-of-kins towards involuntary psychiatric admission. Samples of 84 committed and 84 voluntarily admitted patients in 1991 and 118 committed and 117 voluntarily admitted patients in 1997-99 were interviewed within 5 days from admission and at discharge, or after 3 weeks of care. Samples of 64 next-of-kins to the committed patients and 69 next-of-kins to the voluntarily admitted patients in 1991, and 73 and 89 next-of-kins, respectively, in 1997-99 were interviewed approximately 1 month after the admission. Few changes in attitudes were found between the two study occasions. A majority of all patients stated that it should be possible to compulsorily admit patients, and a great majority of the patients and the next-of kins stated that decisions regarding compulsory admission should be taken by doctors. Most patients and next-of-kins regarded decisions about involuntary psychiatric care mainly as a medical matter. Strong support for coercion in order to protect the patient and others was found among next-of-kins. The law reform was not reflected in attitudinal differences.

  • 39.
    Werneke, Ursula
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Research Unit.
    Bhugra, Dinesh
    Culture makes a person2018In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, p. S1-S2Article in journal (Other academic)
  • 40.
    Ögren, Kenneth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Umeå University, Faculty of Arts, Culture and Media.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lobotomy at a state mental hospital: a survey of patients operated during the period 1947 to 19582007In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 61, no 5, p. 355-362Article in journal (Refereed)
    Abstract [en]

    This retrospective survey aims at describing patients subjected to prefrontal lobotomies and the general treatment conditions at Umedalen State Mental Hospital during the period 1947–1958. Data collected from psychiatric and surgical medical records was analysed using quantitative and qualitative content analysis. A total of 771 patients subjected to lobotomy during the years 1947–1958 were identified. From these, a sample of 105 patients was selected for the purpose of obtaining detailed data on socio-economic status, diagnosis, symptomatology, other psychiatric treatments applied before the pre-frontal lobotomy operation, time spent in hospital before operation, praxis of consent and mortality. The diagnosis of schizophrenia was found in 84% of the 771 lobotomized patients. The post-operative mortality was 7.4% (57 deaths), with the highest rate in 1949 (17%). The mean age of the patient at the time of operation was 44.8 years for females and 39.5 years for male patients. The average length of pre-operative time in hospital for females was 10.7 years and for males 3.5 years. It remains unclear why this mental hospital conducted the lobotomy operation to such a comparatively great extent. Factors such as overcrowding of wards and its status as a modern mental hospital may have contributed.

  • 41.
    Öhlund, Louise
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Research Unit.
    Lieber, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Research Unit.
    Trainee editorial: psychiatry should be taught from day one in medical school2018In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, p. S3-S4Article in journal (Other academic)
1 - 41 of 41
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