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  • 301.
    Fischer Grönlund, Catarina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Söderberg, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Dahlqvist, Vera
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Department of Nursing, Ersta Sköndal University College, Stockholm, Sweden.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Zingmark, Karin
    Communicative and organizational aspects of clinical ethics support2019Ingår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 33, nr 16, s. 724-733Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Studies show that healthcare professionals need inter-professional clinical ethics support (CES) in order to communicate and reflect on ethically difficult care situations that they experience in their clinical practice. Internationally, various CES interventions have been performed, but the communication processes and organisation of these interventions are rarely described in detail. The aim of this study was to explore communicative and organisational conditions of a CES intervention with the intention of promoting inter-professional communication about ethically difficult care situations. Eight audio- and video-recorded inter-professional CES sessions, inspired by Habermas' theory of communicative actions, were conducted. The observations were transcribed, sorted, and analysed using concept- and data-driven content analysis methods. The findings show three approaches to promoting communicative agreement, which include the CES facilitators' and participants' approaches to promoting a permissive communication, extended views, and mutual understanding. The CES sessions had organizational aspects for facilitating communicative agreement with both a given structure and openness for variation. The dynamic structure of the organization, promoted both safety and stability as well as a creativity and responsiveness, which in turn opened up for a free and dynamic inter-professional dialogue concerning ethically difficult care situations. The findings constitute a step towards a theory-based CES method inspired by Habermas' theory of communicative action. Further research is needed in order to fully develop the method and obtain increased knowledge about how to promote an inter-professional dialogue about ethically difficulties.

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  • 302.
    Fischer Grönlund, Catarina
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Söderberg, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Zingmark, Karin
    County Council of BD, Sweden.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Dahlqvist, Vera
    Ethically difficult situations in hemodialysis care: nurses' narratives2015Ingår i: Nursing Ethics, ISSN 0969-7330, E-ISSN 1477-0989, Vol. 22, nr 6, s. 711-722Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Providing nursing care for patients with end-stage renal disease entails dealing with existential issues which may sometimes lead not only to ethical problems but also conflicts within the team. A previous study shows that physicians felt irresolute, torn and unconfirmed when ethical dilemmas arose.

    RESEARCH QUESTION: This study, conducted in the same dialysis care unit, aimed to illuminate registered nurses' experiences of being in ethically difficult situations that give rise to a troubled conscience.

    RESEARCH DESIGN: This study has a phenomenological hermeneutic approach.

    PARTICIPANTS: Narrative interviews were carried out with 10 registered nurses working in dialysis care.

    ETHICAL CONSIDERATIONS: The study was approved by the Ethics Committee of the Faculty of Medicine, Umeå University.

    RESULTS: One theme, 'Calling for a deliberative dialogue', and six sub-themes emerged: 'Dealing with patients' ambiguity', 'Responding to patients' reluctance', 'Acting against patients' will', 'Acting against one's moral convictions', 'Lacking involvement with patients and relatives' and 'Being trapped in feelings of guilt'.

    DISCUSSION: In ethically difficult situations, the registered nurses tried, but failed, to open up a dialogue with the physicians about ethical concerns and their uncertainty. They felt alone, uncertain and sometimes had to act against their conscience.

    CONCLUSION: In ethical dilemmas, personal and professional integrity is at stake. Mistrusting their own moral integrity may turn professionals from moral actors into victims of circumstances. To counteract such a risk, professionals and patients need to continuously deliberate on their feelings, views and experiences, in an atmosphere of togetherness and trust.

  • 303.
    Fjellfeldt, Maria
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Eklund, Mona
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Markström, Urban
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Implementation of choice from participants' perspectives: a study of community mental healthcare reform in Sweden2016Ingår i: Journal of Social Work in Disability & Rehabilitation, ISSN 1536-710X, E-ISSN 1536-7118, Vol. 15, nr 2, s. 116-133Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The aim of this study was to explore participants' experiences and opinions about a free-choice system in relation to policy objectives articulated by the national government and local authorities. A case study was conducted. Thirty-five informants participated. Qualitative interviews were undertaken. Results are discussed on how to address different dimensions of choice, not only where, but also what, by whom, how much, and when. They also concern how to design systems that in some ways ensure predictability and continuity to avoid unwanted harm caused by the unpredictability embedded in competitive choice systems. Finally, different aspects of quality need to be addressed.

  • 304.
    Fjällström, Petter
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Hörnsten, Carl
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Lilja, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Hultstrand, Cecilia
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Coe, Anna-Britt
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Hajdarevic, Senada
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Allmänmedicin.
    Reduction in the diagnostic interval after the introduction of cancer patient pathways for colorectal cancer in northern Sweden2023Ingår i: Scandinavian Journal of Primary Health Care, ISSN 0281-3432, E-ISSN 1502-7724, Vol. 41, nr 3, s. 287-296Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: To compare the diagnostic interval for patients with colorectal cancer before and after the introduction of cancer patient pathways in northern Sweden.

    Design: A retrospective study comparing two cohorts (2012 and 2018) of patients diagnosed with colorectal cancer before and after the introduction of cancer patient pathways in 2016.

    Setting: Three counties in northern Sweden with large sparsely populated areas and some cities (637143 residents ∼5.1 residents/km2).

    Subjects: Patients were included from the Swedish Cancer Register. Electronic health records reviews were performed and linked to socioeconomic data from Statistics Sweden.

    Main outcome measures: Differences in the diagnostic intervals, the patient intervals and the characteristics associated with the longest diagnostic intervals and investigations starting at the emergency department.

    Results: The two cohorts included 411 patients in 2012 and 445 patients in 2018. The median diagnostic interval was reduced from 47 days (IQI 18–99) to 29 days (IQI 9–74) (p < 0.001) after the introduction of cancer patient pathways in general. Though for the cases of cancer in the right-side (ascended) colon, the reduction of the diagnostic interval was not observed and it remained associated with investigations starting at the emergency department.

    Conclusion: Our results indicate that cancer patient pathways contributed to an improvement in the diagnostic interval for patients with colorectal cancer in general, yet not for patients with cancer in the right-side colon.

    Implication: In general, cancer patient pathways seem to reduce the diagnostic interval for colorectal cancer but it is not a sufficient solution for all colorectal cancer localisations.

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  • 305.
    Flanagan, John
    et al.
    Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Chatzittofis, Andreas
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Medical School, University of Cyprus, Nicosia, Cyprus.
    Boström, Adrian Desai E.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Neuropaediatric Unit, Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
    Hallberg, Jonas
    Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Öberg, Katarina Görts
    Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Arver, Stefan
    Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
    Jokinen, Jussi
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Department of Clinical Neuroscience/Psychiatry, Karolinska Institutet, Stockholm, Sweden.
    High plasma oxytocin levels in men with hypersexual disorder2022Ingår i: Journal of Clinical Endocrinology and Metabolism, ISSN 0021-972X, E-ISSN 1945-7197, Vol. 107, nr 5, s. e1816-e1822Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Context: Hypersexual disorder (HD) involves excessive, persistent sexual behaviors related to various mood states and the diagnosis compulsive sexual behavior disorder is included as an impulse control disorder in the 11th revision of the International Classification of Diseases. Although the neurobiology behind the disorder is not clear, some studies suggest dysregulated hypothalamic-pituitary-adrenal axis. Oxytocin acts as counterregulatory neuroendocrine hormone to cortisol and is also involved in sexual behavior.

    Objective: We hypothesized that oxytocin may play a role in the pathophysiology of HD with compensatory actions to cortisol.

    Design: Longitudinal.

    Setting: ANOVA clinic (Karolinska University Hospital).

    Patients or other participants: 64 males with HD and 38 age-matched healthy volunteers.

    Main Outcome Measures: Plasma oxytocin levels, measured with radioimmunoassay; Hypersexual Disorder Screening Inventory; and Hypersexual Disorder: Current Assessment Scale for assessing hypersexual symptoms.

    Interventions: A patient subgroup (n=30) completed the manual-based group-administered cognitive-behavioral therapy (CBT) program for HD, and posttreatment oxytocin levels were measured.

    Results: Hypersexual men (n=64) exhibited significantly higher oxytocin plasma levels (mean±SD: 31.0±9.9 pM) compared with healthy volunteers (16.9±3.9 pM; P<0.001). There were significant positive correlations between oxytocin levels and the rating scales measuring hypersexual behavior. Patients who completed CBT treatment (n=30) had a significant reduction of oxytocin plasma levels from pretreatment (30.5±10.1 pM) to posttreatment (20.2±8.0 pM; P<0.001).

    Conclusions: The results suggest that the hyperactive oxytocinergic system in hypersexual men may be a compensatory mechanism to attenuate hyperactive stress.

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  • 306. Forero, Diego A.
    et al.
    Herteleer, Liesbet
    De Zutter, Sonia
    Norrback, Karl-Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Sunderby Hospital, Sweden.
    Nilsson, Lars-Göran
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Sunderby Hospital, Sweden.
    Callaerts, Patrick
    Del-Favero, Jurgen
    A network of synaptic genes associated with schizophrenia and bipolar disorder2016Ingår i: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 17, nr 1-3, s. 68-74Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Identification of novel candidate genes for schizophrenia (SZ) and bipolar disorder (BP), two psychiatric disorders with large epidemiological impacts, is a key research area in neurosciences and psychiatric genetics. Previous evidence from genome-wide studies suggests an important role for genes involved in synaptic plasticity in the risk for SZ and BP. We used a convergent genomics approach, combining different lines of biological evidence, to identify genes involved in the cAMP/PKA/CREB functional pathway that could be novel candidates for BP and SZ: CREB1, CREM, GRIN2C, NPY2R, NF1, PPP3CB and PRKAR1A. These 7 genes were analyzed in a HapMap based association study comprising 48 common SNPs in 486 SZ, 351 BP patients and 514 control individuals recruited from an isolated population in Northern Sweden. Genetic analysis showed significant allelic associations of SNPs in PRKAR1A with SZ and of PPP3CB and PRKAR1A with BP. Our results highlight the feasibility and the importance of convergent genomic data analysis for the identification of candidate genes and our data provide support for the role of common inherited variants in synaptic genes and their involvement in the etiology of BP and SZ.

  • 307.
    Forsberg, Karl A
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Björkman, Tommy
    Sandman, Per-Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Influence of a lifestyle intervention among persons with a psychiatric disability: a cluster randomised controlled trail on symptoms, quality of life and sense of coherence2010Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr 11-12, s. 1519-1528Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Improving physical health with lifestyle programmes in the form of study circles and when involving their cares will in addition to increased physical health end in improved sense of coherence.

  • 308.
    Forsberg, Karl Anton
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. The Vårdal Institute, the Swedish Institute for Health Sciences, Lund.
    Björkman, Tommy
    Sandman, Per Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Influence of a life style intervention among persons with a psychiatric disability: a cluster randomised controlled trial on symptoms, quality of life and sense of coherence2010Ingår i: Journal of Clinical Nursing, ISSN 0962-1067, E-ISSN 1365-2702, Vol. 19, nr 11-12, s. 1519-1528Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims and objectives: The aim of this study was to investigate how a life style intervention programme influences psychiatric and psychosocial factors among persons with psychiatric disabilities.

     Background: Persons with psychiatric disabilities often suffer from a simultaneous physical health problem, where circulatory disorder, hyperlipideamia, digestive disease, diabetes mellitus and obesity are prevalent. Studies have also shown a relationship between physical activity and mental health. But few randomised controlled trails have been aimed specifically at life style interventions and their effect on psychiatric health and quality of life among persons with psychiatric disabilities.

    Design: a cluster randomised controlled trail.

    Methods: Forty one persons with a DSM- ІV diagnosis in eight supported housing facilities and two housing support programmes and their carers were on cluster level randomly assigned to a 12 month health intervention programme in the form of study circles with diet sessions and physical activities or a control programme. The changes in the mean of quality of life, level of functioning, psychiatric symptoms and sense of coherence was investigated and its relationship to physical health and attendance.

    Results: A significant increase in the sense of coherence was seen in both programmes but also significant improvements in the intervention group compared to controls at the follow-up.

    Conclusions: Structured activities in the form of life style intervention programmes with a sufficient level of challenge that encourage persons with psychiatric disabilities to participate in activities in a social context may contribute to a significant increase in the sense of coherence.

    Relevance to clinical practice: Improving physical health with life style programmes in the form of study circles and when involving their cares will in addition to increased physical health end in improved sense of coherence.

  • 309.
    Forsberg, Karl Anton
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Björkman, Tommy
    Sandman, Per Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Physical health: a cluster randomized controlled lifestyle intervention among persons with a psychiatric disability and their staff2008Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, nr 6, s. 486-495Artikel i tidskrift (Refereegranskat)
    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.

  • 310. Forsberg, Karl-Anton
    et al.
    Johansson, M
    Åhman, K
    Borgstedt, M
    Karlsson, EC
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Hälsa och ett liv i balans för personer med psykisk funktionsnedsättning: en arbetsbok för dig som coachar2012 (uppl. 1)Bok (Refereegranskat)
  • 311.
    Forsberg, Karl-Anton
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Lindqvist, Olav
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Björkman, Tommy Nils
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Sandman, Per Olof
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Meanings of participating in a lifestyle programme for persons with psychiatric disabilities.2011Ingår i: Scandinavian Journal of Caring Sciences, ISSN 0283-9318, E-ISSN 1471-6712, Vol. 25, nr 2, s. 357-364Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Lifestyle changes that affect physical and psychological health are described in research literature; however, the meaning of participating in a lifestyle intervention programme together with the staff has not been described. This study illuminates meanings of participating in a lifestyle programme as experienced by persons with psychiatric disabilities. The first author interviewed five women and six men with schizophrenia and depressive syndrome, aged 26-53, participating in a lifestyle programme. The transcribed interviews were analysed using a phenomenological hermeneutic approach inspired by the philosophy of Ricoeur. Meanings of participating in a lifestyle programme include my health can be improved as both the physical effects and the obstacles are considered and the daily life is partially given a changed content in new experiences and by participating in something to take pride in. The meanings of participating together with the staff mean an increased sense of closeness and equality with the staff expressed in changes in relationships and the difference between the two groups being revealed and also in becoming aware of the life situation, an insight into the loss of a healthy life but also hope for the future is expressed. The conclusions that could be drawn from this study are that a lifestyle intervention affects health and other important life areas such as the content of daily life and the relationship with the carers, which appears to affect the sense of hope and the ability to see new possibilities. Carers should find situations and activities where the residents and carers participate under equal conditions giving the residents the opportunity to leave the sick roll, experience equality and develop good relationships.

  • 312. Forsell, Erik
    et al.
    Bendix, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Holländare, Fredrik
    Szymanska von Schultz, Barbara
    Nasiell, Josefine
    Blomdahl-Wetterholm, Margareta
    Eriksson, Caroline
    Kvarned, Sara
    Lindau van der Linden, Johanna
    Söderberg, Elin
    Jokinen, Jussi
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Sweden.
    Wide, Katarina
    Kaldo, Viktor
    Internet delivered cognitive behavior therapy for antenatal depression: A randomised controlled trial2017Ingår i: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 221, s. 56-64Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Major depression occurs in 5-10% of pregnancies and is associated with many negative effects for mother and child, yet treatment options are scarce. To our knowledge, this is the first published randomised controlled trial on Internet delivered Cognitive Behavior Therapy (ICBT) for this group.

    Objective: To test the efficacy of a pregnancy adapted version of an existing 10-week ICBT-program for depression as well as assessing acceptability and adherence.

    Design: Randomised controlled trial.

    Setting: Online and telephone.

    Population or sample: Self-referred pregnant women (gestational week 10-28 at intake) currently suffering from major depressive disorder.

    Methods: 42 pregnant women (gestational week 12-28) with major depression were randomised to either treatment as usual (TAU) provided at their antenatal clinic or to ICBT as an add-on to usual care.

    Main outcome measures: The primary outcome was depressive symptoms measured with the Montgomery-Asberg depression rating scale-self report (MADRS-S). The Edinburgh Postnatal Depression Scale and measures of anxiety and sleep were used. Credibility, satisfaction, adherence and utilization were also assessed.

    Results: The ICBT group had significantly lower levels of depressive symptoms post treatment (p < 0.001, Hedges g = 1.21) and were more likely to be responders (i.e. achieve a statistically reliable improvement) (RR = 0.36; p = 0.004). Measures of treatment credibility, satisfaction, utilization, and adherence were comparable to implemented ICBT for depression.

    Limitations: Small sample size and no long-term evaluation.

    Conclusion: Pregnancy adapted ICBT for antenatal depression is feasible, acceptable and efficacious. These results need to be replicated in larger trials to validate these promising findings.

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  • 313.
    Forsgren, Lars
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap, Klinisk neurovetenskap.
    Ghanean, Helia
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Richter, Jorg
    On the experience of stigma by persons with epilepsy in Sweden and Iran: a comparative study2013Ingår i: Seizure, ISSN 1059-1311, E-ISSN 1532-2688, Vol. 22, nr 9, s. 748-751Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    PURPOSE: The aim of this paper is to compare the experience of stigma by persons with epilepsy in Sweden and Iran.

    METHOD: An adapted version of the Internalized Stigma of Mental Illness Scale was completed by 130 persons with epilepsy in Tehran and 93 patients at a neurology clinic in Sweden.

    RESULTS: The Swedish subjects reported a significantly lower level of experienced stigmatization than the Iranian patients, which we think is an effect of a more individualized medical treatment and a longer experience of health education in the Swedish society.

    CONCLUSION: Improved seizure control, legislative measures and health education are major contributory factors for stigma reduction in a society as regards epilepsy and probably also other medical conditions.

  • 314. Forssén, B.
    et al.
    Ott, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Medicin.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Lithium use among psychiatric patients – a risk factor for hypernatremia?2018Ingår i: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 109, s. 103-103Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [en]

    Aims: Hypernatremia is a serious condition that can potentially become life threatening. It is known, but not well-studied, that lithium can induce nephrogenic diabetes insipidus and thereby increase the risk for hypernatremia. In this study, we tested the hypothesis that lithium was a risk factor for hypernatremia in patients with severe affective disorders. Methods: A retrospective study of hypernatremia episodes in all patients aged 18 years or over in the county of Norrbotten who received treatment with lithium or any other mood stabilizing medication during 1997-2013. We identified all episodes of hypernatremia during this period and compared the patients using lithium with those who did not. Results: We identified a total of 204 hypernatremia episodes in 185 patients. For all the 204 episodes, infection (37%) was the dominating cause. Harmful use of substances including alcohol came second. Lithium was only identified as a cause for hypernatremia in 1 % of all the episodes. In patients aged 65 years or less, harmful use of substances including alcohol was the most common cause. Infection was the dominating cause in patients >65 years. There was no significant difference in hypernatremia episodes between lithium users and non-lithium users. Patients who had suffered episodes of hyponatremia or died of these were significantly older. Conclusion: Lithium does not increase the risk of hypernatremia in patients with severe affective disorder compared to patients who do not use lithium. However, in some patients using lithium, severe episodes of hypernatremia can still occur. Thus, clinicians need to remain vigilant. There is a need for more research concerning other risk factors that may contribute to hypernatremia in patients with severe affective disorder.

  • 315.
    Fransson, Filip
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Harju, Vesa
    Medical Clinic, Kalix Hospital, Kalix, Sweden.
    Öhlund, Louise
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    de Man Lapidoth, Julia
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Jonsson, Andreas P.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Stegmayr, Bernd
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Salander Renberg, Ellinor
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Ott, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Kidney function in patients with bipolar disorder with and without lithium treatment compared with the general population in northern Sweden: results from the LiSIE and MONICA cohorts2022Ingår i: Lancet psychiatry, ISSN 2215-0374, E-ISSN 2215-0366, Vol. 9, nr 10, s. 804-814Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The clinical relevance of lithium nephropathy is subject to debate. Kidney function decreases with age and comorbidities, and this decline might lead to attribution bias when erroneously ascribed to lithium. We aimed to investigate whether patients with bipolar or schizoaffective disorder had faster decline in estimated glomerular filtration rate (eGFR) compared with the general population, whether observed differences in the steepness of the decline were attributable to lithium, and whether such changes depended on the length of lithium exposure.

    Methods: In this cross-sectional cohort study, we used clinical data from the Lithium–Study into Effects and Side-effects (LiSIE) retrospective cohort study, which included patients with bipolar disorder or schizoaffective disorder whose medical records were reviewed up to Dec 31, 2017, and the WHO Monitoring of Trends and Determinants in Cardiovascular Disease (MONICA) study, covering a representative sample of the general population in northern Sweden aged 25–74 years. The primary outcome was the age-associated decline of creatinine-based eGFR, assessed using linear regression. We adjusted for sex and grouped for different lengths of lithium exposure (never or <1 year, 1–5 years, >5–10 years, and >10 years). For patients with moderate-to-severe kidney disease we identified the underlying nephropathy in the case records.

    Findings: From LiSIE, we included 785 patients (498 [63%] female and 287 [37%] male), with a mean age of 49·8 years (SD 13·2; range 25–74). From MONICA, we included 1549 individuals (800 [52%] female and 749 [48%] male), with a mean age of 51·9 years (13·8; 25–74). No ethnicity data were collected. Adjusted for duration of lithium exposure, eGFR declined by 0·57 mL/min/1·73 m2/year (95% CI 0·50–0·63) in patients with bipolar disorder or schizoaffective disorder and by 0·57 mL/min/1·73 m2/year (0·53–0·61) in the reference population. Lithium added 0·54 mL/min/1·73 m2 (0·43–0·64) per year of treatment (p<0·0001). After more than 10 years on lithium, decline was significantly steeper than in all other groups including the reference population (p<0·0001). Lithium nephropathy was judged to be the commonest cause of moderate-to-severe chronic kidney disease, but comorbidities played a role. The effect of lithium on eGFR showed a high degree of inter-individual variation.

    Interpretation: Steeper eGFR decline in patients with bipolar disorder or schizoaffective disorder can be attributed to lithium, but the trajectory of kidney function decline varies widely. Comorbidities affecting kidneys should be treated assertively as one possible means to affect the trajectory. In patients with a fast trajectory, a trade-off is required between continuing lithium to treat mental health problems and discontinuing lithium for the sake of renal health.

    Funding: Norrbotten County Research and Learning Fund Sweden, Visare Norr (Northern County Councils Regional Federation Fund), Swedish Kidney Foundation (Njurfonden), Swedish Kidney Association (Njurförbundet), Norrbotten section.

    Translation: For the Swedish translation of the Summary see Supplementary Materials section.

  • 316.
    Fransson, Filip
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Jonsson, Andreas P.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Ott, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Renal function after discontinuation of chronic lithium treatment: findings from the LiSIE retrospective cohort study2020Ingår i: Nephrology, Dialysis and Transplantation, ISSN 0931-0509, E-ISSN 1460-2385, Vol. 35, s. 592-592Artikel i tidskrift (Övrigt vetenskapligt)
  • 317.
    Fransson, Per
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Sundbom, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Defense Mechanism Test (DMT) and Kernberg’s theory of personality organization related to adolescents in psychiatric care1997Ingår i: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450, Vol. 38, nr 2, s. 95-102Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    75 adolescent psychiatric patients were diagnosed with the perceptual projective test the Defense Mechanism Test (DMT) and also according to Kernberg’s theory of personality organization (PO). The test protocols were scored in respect of 130DMT variables and analyzed by means of partial least squares (PLS) discriminant analysis. The objective was to try to separate the three types of PO, psychotic (PPO), borderline (BPO) and neurotic (NPO) by means of the DMT and also to compare the results with a similar study on adult psychiatric patients. The results showed that it is possible to separate significantly the three groups of PO. The BPO group seemed to be heterogeneous. The results were fairly similar to those obtained with adult psychiatric patients. The overall results supported the concurrent validity of Kernberg’s theory of PO and for the DMT as well. The DMT seems to be a useful diagnostic method in respect of adolescent psychiatric patients.

  • 318.
    Fransson, Per
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Sundbom, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Defense Mechanism Test (DMT) and Kernberg's theory of personality organization related to adolescents in psychiatric care1994Rapport (Övrigt vetenskapligt)
  • 319.
    Fransson, Per
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Sundbom, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Influence of gender and age in the defense mechanism test among adolescents and adults2008Ingår i: Process and personality: actualization of the personal world with process-oriented methods / [ed] Gudmund J. W. Smith and Ingegerd M. Carlsson, Heusenstamm: Ontos , 2008, s. 114-125Kapitel i bok, del av antologi (Övrigt vetenskapligt)
  • 320.
    Fransson, Per
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Sundbom, Elisabet
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    A comparative study of adolescents in psychiatric care assessed by means of the Defense Mechanism Test and the DSM-IV classification system1998Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 52, nr 6, s. 527-536Artikel i tidskrift (Refereegranskat)
    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.

  • 321.
    Fristedt, Joel
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Förutsägande faktorer för återinsättning av litiumbehandling efter utsättning av långtids-litiumunderhållsbehandling hos patienter med bipolär sjukdom- Fynd från den retrospektiva kohortstudien LiSIE2021Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 322.
    Frostad, Stein
    et al.
    Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
    Rozakou-Soumalia, Natalia
    Research Unit Eating Disorders, Psychiatric Center Ballerup, Maglevænget 32, Ballerup, Denmark.
    Dârvariu, Ştefana
    Research Unit Eating Disorders, Psychiatric Center Ballerup, Maglevænget 32, Ballerup, Denmark.
    Foruzesh, Bahareh
    Research Unit Eating Disorders, Psychiatric Center Ballerup, Maglevænget 32, Ballerup, Denmark.
    Azkia, Helia
    Research Unit Eating Disorders, Psychiatric Center Ballerup, Maglevænget 32, Ballerup, Denmark.
    Larsen, Malina Ploug
    Research Unit Eating Disorders, Psychiatric Center Ballerup, Maglevænget 32, Ballerup, Denmark.
    Rowshandel, Ehsan
    Research Unit Eating Disorders, Psychiatric Center Ballerup, Maglevænget 32, Ballerup, Denmark.
    Sjögren, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Research Unit Eating Disorders, Psychiatric Center Ballerup, Maglevænget 32, Ballerup, Denmark.
    BMI at Discharge from Treatment Predicts Relapse in Anorexia Nervosa: A Systematic Scoping Review2022Ingår i: Journal of Personalized Medicine, E-ISSN 2075-4426, Vol. 12, nr 5, artikel-id 836Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Background: Anorexia nervosa (AN) has high rates of enduring disease and mortality. Currently, there is insufficient knowledge on the predictors of relapse after weight normalization and this is why a systematic literature review was performed. Methods: PubMed, EMBASE, PsychInfo, and Cochrane databases were searched for literature published until 13 July 2021. All study designs were eligible for inclusion if they focused on predictors of relapse after weight normalization in AN. Individual study definitions of relapse were used, and in general, this was either a drop in BMI and/or reccurrence of AN symptoms. Results: The database search identified 11,507 publications, leaving 9511 publications after the removal of duplicates and after a review of abstracts and titles; 191 were selected for full-text review. Nineteen publications met the criteria and included 1398 AN patients and 39 healthy controls (HC) from adults and adolescents (ages range 11–73 years). The majority used a prospective observational study design (12 studies), a few used a retrospective observational design (6 studies), and only one was a non-randomized control trial (NRCT). Sample sizes ranged from 16 to 191 participants. BMI or measures of body fat and leptin levels at discharge were the strongest predictors of relapse with an approximate relapse rate of 50% at 12 months. Other predictors included signs of eating disorder psychopathology at discharge. Conclusions: BMI at the end of treatment is a predictor of relapse in AN, which is why treatment should target a BMI well above 20. Together with the time to relapse, these outcomes are important to include in the evaluation of current and novel treatments in AN and for benchmarking.

  • 323.
    Fröjd, Agnes
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Temperaments and course of illness in bipolar disorder2018Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 324.
    Gabrielsson, Sebastian
    et al.
    Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden.
    Engström, Åsa
    Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden.
    Lindgren, Britt-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Molin, Jenny
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Gustafsson, Silje
    Department of Health, Education and Technology, Luleå University of Technology, Luleå, Sweden.
    Self-rated reflective capacity in post-registration specialist nursing education students2022Ingår i: Reflective Practice, ISSN 1462-3943, E-ISSN 1470-1103, Vol. 23, nr 5, s. 539-551Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study aimed to describe self-rated reflective capacity in students enrolled in post-registration specialist nursing education at the advanced level. We applied a non-experimental and cross-sectional design. A survey of 156 specialist nursing students at two universities in Northern Sweden was conducted. Data were collected in 2019 using a web-based questionnaire assessing self-rated reflective capacity through the Reflective Capacity Scale of the Reflective Practice Questionnaire. Data were analyzed descriptively using frequencies and proportions. Correlations were analyzed using Spearman’s rho. Results show that students specializing in psychiatric care and oncological care report a higher reflective capacity than students specializing in other areas. We found no significant correlations between reflective capacity and gender, and reflective capacity in total did not correlate with age or work experience. We conclude that reflective capacity might vary between nursing students in different areas of specialization. Further research is needed to understand causes and impacts of variations in nursing students’ reflective capacities.

    Ladda ner fulltext (pdf)
    fulltext
  • 325.
    Garvis, Susanne
    et al.
    Department of Education, Communication and Learning, University of Gothenburg, Sweden.
    Omma, Lotta
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Wellbeing in Swedish indigenous Sámi children and young people: Looking back and looking forward2019Ingår i: Routledge Handbook of Indigenous Wellbeing / [ed] Christopher Fleming and Matthew Manning, Routledge, 2019, s. 89-96Kapitel i bok, del av antologi (Refereegranskat)
  • 326.
    Geale, Kirk
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Dermatologi och venereologi. Quantify Research, Stockholm, Sweden.
    Henriksson, Martin
    Jokinen, Jussi
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Schmitt-Egenolf, Marcus
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Dermatologi och venereologi.
    Association of Skin Psoriasis and Somatic Comorbidity With the Development of Psychiatric Illness in a Nationwide Swedish Study2020Ingår i: JAMA dermatology, ISSN 2168-6068, E-ISSN 2168-6084, Vol. 156, nr 7, s. 795-804Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Importance: Psoriasis is a complex systemic disease with skin involvement, somatic comorbidity, and psychiatric illness (PI). Although this view of psoriasis is widely accepted, potential synergies within this triad of symptoms have not been adequately investigated.

    Objectives: To investigate the independent association of skin psoriasis and somatic comorbidity with the development of PI and to assess whether skin psoriasis and somatic comorbidity act synergistically to produce a risk of PI that is greater than the additive associations.

    Design, Setting, and Participants: Participants were enrolled between January 2005 and December 2010, in this retrospective matched case-control study using secondary (ie, administrative), population-based registry data from Swedish patients in routine clinical care. The dates of analysis were March 2017 to December 2019. Participants were patients with skin psoriasis and control participants without psoriasis matched on age, sex, and municipality, who were all free of preexisting PI.

    Exposures: Presence of skin psoriasis and somatic comorbidity (captured through the Charlson Comorbidity Index and the Elixhauser Comorbidity Index).

    Main Outcomes and Measures: Risk of PI onset (composite of depression, anxiety, and suicidality) is shown using Kaplan-Meier curves stratified by the presence of skin psoriasis and somatic comorbidity. Adjusted associations of skin psoriasis and somatic comorbidity with the development of PI were analyzed using Cox proportional hazards regression models, including interactions to assess synergistic associations. The 3 components of PI were also assessed individually.a

    Results: A total of 93 239 patients with skin psoriasis (mean [SD] age, 54 [17] years; 47 475 men [51%]) and 1 387 495 control participants (mean [SD] age, 54 [16] years; 702 332 men [51%]) were included in the study. As expected, patients with skin psoriasis were more likely to have somatic comorbidity and PI than control participants. Compared with those without skin psoriasis or somatic comorbidity, patients with psoriasis without somatic comorbidity had a 1.32 times higher risk of PI onset (hazard ratio [HR], 1.32; 95% CI, 1.27-1.36; P < .001), whereas patients with psoriasis with somatic comorbidity had a 2.56 times higher risk of PI onset (HR, 2.56; 95% CI, 2.46-2.66; P < .001). No synergistic associations of skin psoriasis and somatic comorbidity with the development of PI were found (HR, 0.93; 95% CI, 0.81-1.04; P = .21).

    Conclusions and Relevance: This study found that somatic comorbidity appeared to alter PI onset even more than skin psoriasis. The observed association of skin psoriasis and somatic comorbidity with the development of PI reinforces the need for proactive, holistic treatment of patients with psoriasis.

  • 327. Gedeon, Charlotte
    et al.
    Sandell, Mikael
    Birkemose, Inge
    Kakko, Johan
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Runarsdottir, Valgerdur
    Simojoki, Kaarlo
    Clausen, Thomas
    Nyberg, Fred
    Littlewood, Richard
    Alho, Hannu
    Standards for opioid use disorder care: An assessment of Nordic approaches2019Ingår i: Nordic Studies on Alcohol and Drugs, ISSN 1455-0725, E-ISSN 1458-6126, Vol. 36, nr 3, s. 286-298Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims: Outcomes in opioid use disorder (OUD) in Nordic countries have improved with integrated treatment and harm-reduction programmes. Approaches and the standard of care are different across the region. Evidence of treatment needs and current approaches are defined from evidence to inform development of a common standard.

    Method: Evidence of population sizes and treatment approach collected. Common standards for care (harm reduction, pharmacotherapy, psychology/social therapy) defined for each country.

    Results: Evidence defines number in treatment; potential population needing treatment not defined for all countries. Populations sizes, treatment access (ratio in treatment programme compared to total country population) defined: Sweden 4,000 in OUD care (access ratio 40); Finland 3,000 (55); Norway 8,000 (154); Denmark 7,500 (132). Approach to treatment similar: integrated treatment programmes standard. Care provided by specialists in outpatient clinics/primary care; secondary care/inpatient services are available. Harm reduction is limited in Sweden but available and more accessible elsewhere. Treatment entry criteria: access relatively unlimited in Norway and Denmark, more limited in Finland and Sweden. Standards of care defined: easy access to high-quality services, individual planning, care not limited by time, management of relapse, education for patients, continuous engagement, holistic approach including management of comorbidities, needle equipment programmes without limit, treatment in prisons as community.

    Conclusion: There are opportunities to improve OUD care in the Nordics. Policy makers and clinicians can advance OUD care and share common success factors. Collaborative work across the Nordic countries is valuable. Further research in clinical practice development can yield important results for the benefit of patients with OUD.

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  • 328.
    Ghanean, Helia
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Studies on the perception of mental illness and epilepsy in Tehran, Iran: a study in stigma and discrimination2013Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background

    Stigma and discrimination because of medical conditions is a global phenomenon. Epilepsy and mental illness belong to the most stigmatizing disorders world-wide. Culture, religion, education, life-style influences the perception of stigma. There are two aspects of stigma of special interest for this thesis; internalized stigma, which is the perception of a person suffering from a condition and the public perception of this disorder. This study investigates both aspects of stigma because of mental illness and epilepsy. Internalized stigma of mental illness and epilepsy are also studied in Umea, Sweden, with the same instrument as in Iran in order to look at the cultural influence.

    Methods

    Paper 1 and 2 on internalized stigma because of mental disorders and epilepsy in Tehran:

    These studies are cross-sectional with 138 persons with mental illness recruited from three different hospitals in Tehran and 130 persons with epilepsy from one neurologic clinic in Tehran and the Iran epilepsy association. Internalized stigma because of mental illness was measured using ISMI (Internalized Stigma of Mental Illness) questionnaire and because of epilepsy with the same instrument adapted for epilepsy (ISEP). ISMI/ISEP contains 29 items measured by a 4-point Likert scale. An open-ended question about the experiences of discrimination was added.

    Paper 3 and 4 on public attitudes towards mental disorders and epilepsy in Tehran:

    These two studies were performed with 800 individuals randomly chosen from households in four districts of Iran (north, south, east and west). In Paper 3 on attitudes and knowledge of mental illness a modified version of a questionnaire developed for the World Association program to reduce discrimination and stigma because of schizophrenia was used. In Paper 4 on awareness of and attitudes towards epilepsy a questionnaire originally developed by Caveness and Gallup in United States as early as 1949 was used and since used in many studies all over the world.

    Paper 5 and 6 comparing internalized stigma because of mental disorders and epilepsy in Tehran and Umea:

    These two studies included patients suffering from mental disorders (N=163) and epilepsy (N=93) recruited from the university hospital in Umea, Sweden. The same questions as used in Paper 1 and 2 were applied.

    Results

    The experience of stigma because of mental disorders was high in the Iranian sample. The Swedish sample generally reported lower levels of experienced stigma than the Iranian except for items covering self-blame and feelings of alienation. As regards epilepsy the Iranian sample reported quite a high level of experienced stigma compared to the Swedish sample. Generally the patients with epilepsy reported lower levels of experienced stigma compared to patients with mental illness in the two settings. Attitudes towards mentally ill persons in Tehran were at the same levels as in western high income countries. The knowledge about and attitudes towards persons with epilepsy was also generally at the same level as found in other European studies expect for a much lower acceptance as regards accepting a person with epilepsy to marry someone in the family.

    Conclusion

    Stigma because of mental illness and epilepsy is a reality even in Iran, which is an Islamic setting in spite of the teachings of the Koran to show mercy with people who suffer from different ailments and rather well developed health services. The levels of experienced stigma is higher in Iran compared to Sweden, but still there is quite a lot of stigma because of mental illness even in Sweden in spite of several national efforts to reduce stigma. The lower levels of stigma because of epilepsy in both settings and especially in Sweden, is suggested to be the consequence of effective treatments available for epilepsy compared to the less successful treatments available for mental illness. The differences in internalized stigma reported and the public perceptions of stigma because of both mental illness and epilepsy between Iran and Sweden is suggested partly a consequence of the different cultural settings, Sweden being an extremely individualistic society compared to the more collectivistic Iranian society.

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    Ghanean_H
  • 329.
    Ghanean, Helia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Nojomy, Marzieh
    Self-perception of stigma in persons with epilepsy in Tehran, Iran2013Ingår i: Epilepsy & Behavior, ISSN 1525-5050, E-ISSN 1525-5069, Vol. 28, nr 2, s. 163-167Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Epilepsy is one of the most stigmatizing medical conditions worldwide. It could be argued that the problem of stigma and discrimination might be different in an Islamic culture. A cross-sectional study of 130 patients with epilepsy was performed using the Internalized Stigma of Mental Illness (ISMI) questionnaire that was adapted for epilepsy. The questionnaire contained 29 items on a 4-point scale in addition to an open-ended question about experience of discrimination. An average score above the midpoint (2.5) is suggested to indicate a high level of stigma. Approximately 23.7% of the patients reported a score above the midpoint. Unemployment and low education were significantly associated with a high level of internalized stigma. Although epilepsy can be effectively treated, patients in Tehran still experience much stigma. For this reason, strategies for reducing self-perception of stigma should be included in a treatment plan.

    (C) 2013 The Authors. Published by Elsevier Inc. All rights reserved.

  • 330.
    Ghanean, Helia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Nojomi, M
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Community study on attitudes to and knowledge of mental illness in Tehran2015Ingår i: Stigma Research and Action, ISSN 2210-5174, Vol. 5, s. 26-30Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    There are a limited number of studies on attitudes towards mental illness and mentally ill from Islamic countries even though Islam is the second largest of the religious beliefs in the world. An interesting element in Islamic teaching is the idea that mental illness as well as other ailments might be an effect of the will of Allah. This could imply that persons suffering from mental disorders might be less stigmatized. The aim of this study was to determine the knowledge and attitudes towards mental illness in the city of Tehran, Iran. Eight hundred subjects, randomly chosen from 4 districts of Tehran, responded to a modified version of a questionnaire developed by the World Psychiatric Association to reduce stigma because of schizophrenia. The self-completed questionnaire was delivered by 4 trained psychologists. The mean age of the sample was 37.5 years and 53.3% being males. A majority agreed that mental illness could be treated outside the hospital (70%) and 74% thought that mentally ill “can work in regular jobs”. Almost half agreed that “mentally ill are a public nuisance” and that “mentally ill people are dangerous”. One quarter agreed that they “would be ashamed if people knew someone in the family who was diagnosed with mental illness”. Generally males seemed to be more accepting than women. Generally the level of negative attitudes in Tehran population is at the same level as in other countries and cultures studied. Cultural beliefs and Islamic influence on attitudes towards mental illness and mentally ill need further studies. The result indicates a need for further actions to reduce the negative attitudes towards mentally ill in Tehran, Iran.

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  • 331.
    Ghanean, Helia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Nojomi, M
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Internalized stigma of mental illness in Tehran, Iran2011Ingår i: Stigma Research and Action, ISSN 2210-5174, Vol. 1, nr 1, s. 11-17Artikel i tidskrift (Refereegranskat)
    Ladda ner fulltext (pdf)
    fulltext
  • 332.
    Ghanean, Helia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Nojomi, M.
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Public awareness and attitudes towards epilepsy in Tehran, Iran2013Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 6, s. 1-5Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Epilepsy is a prototypical, stigmatised disorder. Numerous studies have been conducted regarding the public perception of epilepsy, but they are primarily from high-income western countries; few studies have taken place in low-to middle-income countries with a traditional culture and a religious orientation. Objective: The public knowledge and attitudes towards epilepsy in Tehran, Iran, is studied. Design: A survey of 800 subjects ranging from 18 to 85 years was randomly chosen from households in Tehran in 2009. The questionnaire used was based on the Caveness and Gallup's studies conducted in the United States in 1949 and it has been used in numerous similar studies all over the world. The mean age of the participants was 37.5 years and 46.7% were female. Pearson's Chi-squared test was used for subgroup analyses. Results: The majority of subjects cited brain disorders as a cause of epilepsy, while 17% indicated the will of God as the cause. Most individuals were willing to work with a person with epilepsy, allow their children to play with a child with epilepsy, and allow people with epilepsy to use public transportation (78-82%). However, only 28% were willing to accept the marriage of a family member to someone with epilepsy. Conclusion: The knowledge and attitudes towards epilepsy are similar to those in Europe, with the exception of a much lower acceptance regarding marriage to a person with epilepsy. However, the low acceptance for marrying someone with epilepsy reveals the remaining misconceptions about the nature of epilepsy in Iran, despite the high educational level in the studied population. Therefore, informational efforts must be employed to change the perception of epilepsy.

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  • 333.
    Ghazinour, Mehdi
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Trauma and resiliency: a study of refugees from Iran resettled in Sweden2003Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Several single factors have been identified as related to coping with trauma and as protective factors. Several studies emphasize the importance of personality, core beliefs, coping strategies and social support. However little attention has been paid to resiliency. The aim of the study was to identify some determinants of an individual’s resiliency after experienced traumatic life events, and to address the issue of its relationship to personality characteristics, psychopathology, coping resources and strategies, social support, sense of coherence and quality of life.

    In the present study, a convenience sample of 100 Iranian refugees, 66 males and 34 females in the age range of 18-65 were investigated. All the subjects have experienced one or several traumatic life events as soldiers, political prisoners or have been victims of torture or have escaped from the country in a stressful way. At the time of the present investigation the mean time living in Sweden was for male subject’s 12.8 years and for female 11.8.

    Nine instruments were administered during individual sessions, Temperament, Character Inventory (TCI), The EMBU (Swedish acronym for own memories concerning upbringing), The Symptom Checklist-90-Revised (SCL-90 – R), Beck Depression Inventory (BDI), Interview Schedule of Social Interaction (ISSI), Coping Resources Inventory (CRI), The Dysfunctional Attitude Scale (DAS), WHOQoL Group, 1995 (WHOQoL-100), The Sense of Coherence Scale (SoC).

    Several significant associations were found between personality temperament and character, parental rearing and psychopathology. When experiences of parental rearing were investigated in relation to psychopathology, male subjects scored high on parental rejection and were also more depressed compared to females. Although the individuals in the sample suffered from depression or anxiety, there were individuals that had adapted them-self well with the new life in Sweden and its demands. Nineteen percent of subjects who had low harm avoidance and high self directedness received more social support, had better coping strategies, higher sense of coherence and finally a better quality of life.

    This dissertation underscores the importance of multiple indicators when trying to understand resiliency. Personality traits, parental rearing, coping resources, social support and sense of coherence were the strongest predictors for resiliency. Having a systemic perspective helps to explain why some individuals are healthy and resilient despite traumatic life events, escaping from home country, applying for asylum, establishing a new home, learning new languages, to study and stablish and develop new bonds.

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  • 334.
    Ghazinour, Mehdi
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Emami, H
    Richter, J
    Abdollahi, M
    Pazhumand, A.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Age and gender differences in the use of various poisoning methods in parasuicide cases admitted to Loghman Hospital in Tehran (2000-2004)2009Ingår i: Journal of Suicide and Life-threatening Behaviour, ISSN 0363-0234, E-ISSN 1943-278X, Vol. 39, nr 2, s. 231-239Artikel i tidskrift (Refereegranskat)
  • 335.
    Ghazinour, Mehdi
    et al.
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Emami, Habib
    Toxicological Research Center, Shaheed Beheshti University of Medical Sciences, Tehran, Iran, and the Tobacco Control and Prevention Research Center.
    Richter, Jörg
    Centre of Child and Adolescent Mental Health, Regions South and East, Oslo, Norway.
    Abdollahi, Mohammad
    Faculty of Pharmacy, and Pharmaceutical Sciences Research Center Tehran University of Medical Sciences, Iran.
    Pazumand, Abdolkarim
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för socialt arbete.
    Age and gender differences in the use of various poisoning methods for deliberate self-harm in individuals admitted to Loghman Hospital in Tehran (2000-2004)2008Ingår i: Journal of Suicide and Life-threatening Behaviour, ISSN 0363-0234, E-ISSN 1943-278X, Vol. 39, nr 2, s. 231-239Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Different methods of poisoning used by individuals with the diagnosis of parasuicide admitted to the Loghman Hospital, Tehran, from 2000 to 2004 were investigated, with particular focus on gender and age differences. Drugs, pesticides, and other agricultural chemicals (women: 12.7%, men: 9%) were the most commonly used methods. In males, the percentage of use of drugs increased with age, but the frequency of pesticides use decreased with age. In females, drugs were most often used in the youngest age group, whereas the use of pesticides was lowest in the youngest age category. Females outnumbered males, especially in the youngest age group of 10 to 19 years olds. Drugs and pesticides were the substances used most often for parasuicide in each age group regardless of gender.

  • 336.
    Ghazinour, Mehdi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Mofidi, Naser
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Richter, Jörg
    Centre of Child and Adolescent Mental Health, Regions South and East, Oslo, Norway.
    Continuity from suicidal ideations to suicide attempts?: An investigation in 18-55 years old adult Iranian Kurds2010Ingår i: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 45, nr 10, s. 973-981Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    A continuum of suicidal behaviour is supported; but, this did not include self-reported suicide attempts. The reported frequency of suicidal thoughts and suicide attempts was highly dependent on applied response categories and the considered timeframe, which has to be considered thoroughly when interpreting related results.

  • 337.
    Ghazinour, Mehdi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    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?2003Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 57, nr 6, s. 419-428Artikel i tidskrift (Refereegranskat)
  • 338.
    Ghazinour, Mehdi
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Richter, Jörg
    Mofidi, Naser
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Continuity from suicidal ideations to suicide attempts in Iranian Kurds?Manuskript (Övrigt vetenskapligt)
    Abstract [en]

    Background. Suicidal ideation is a critical point for the identification of individuals at risk of committing suicide/attempting suicide. Whilst existing studies provide valuable data from Western countries, more research is needed to determine the applicability of these findings outside of the context of Western culture.

    Method. In a cross–sectional study in Sanandaj, capital of Iranian Kurdistan, 1,000 randomly selected individuals were investigated by means of the Attitudes towards Suicide questionnaire which includes items concerning various suicidal thoughts.

    Results. The Iranian Kurds reported very few suicide attempts, whereas the prevalence of reported suicidal thoughts was found to be very high. The assumption of a continuum of suicidal behaviour is supported by our data; but, this did not include self-reported suicide attempts. The various suicidal thoughts showed very low sensitivity and low predictive power in relation to suicide attempts. The reported frequency of suicidal thoughts and the number of suicide attempts during the last year was significantly higher than that from earlier in life. Age was determined to be a substantial moderator variable related to the occurrence of suicidal thoughts and suicide attempts with increasing impact with increasing severity of suicidal behaviour. Gender, cohabitation status and employment situation were largely only weakly associated with the occurrence of suicidal behaviours.

    Conclusions. Culture seems to be of low impact upon the relationship between socio-demographical variables and suicidal behaviour. The reported frequency of suicidal thoughts and suicide attempts seems to be highly dependent on applied response categories and the considered timeframe, which has to be considered thoroughly when interpreting related results, and when comparing with findings from other investigations.

  • 339. Giang, Kim Bao
    et al.
    Allebeck, Peter
    Kullgren, Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Tuan, Nguyen Van
    The Vietnamese version of the Self Reporting Questionnaire 20 (SRQ-20) in detecting mental disorders in rural Vietnam: a validation study.2006Ingår i: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854, Vol. 52, nr 2, s. 175-184Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: There is a need to develop instruments to measure mental disorders in developing countries because mental disorders are increasingly being recognised as a major public health problem. There has been no previous study in Vietnam validating screening instruments for mental health problems. Aim: To adapt and to validate the Self Reporting Questionnaire-20 (SRQ-20) in the Vietnamese community.

    Methods: A Vietnamese version of the SRQ-20 was developed and tested in 52 persons in a district hospital sample and 485 persons in a community sample. The psychiatrists' diagnoses were taken as the validity criterion. Receiver Operating Characteristic (ROC) analysis was performed to identify the optimal cut-off value. The area under the ROC curve (AUC) was calculated to assess the performance of SRQ in different sociodemographic groups.

    Results: In the district hospital sample, the optimal cut-off score was 5/6 with a sensitivity of 85%, a specificity of 46% and an AUC of 0.74 (95% CI: 0.59–0.89). In the community sample, it was 6/7 with a sensitivity of 85%, a specificity of 61% and AUC of 0.86 (95% CI: 0.81–0.93). In terms of AUC, SRQ performed significantly better in the age group 18–24 years as compared with other ages and with single persons as compared with widowed or divorced people.

    Conclusion: The SRQ-20 was found feasible to use and adapt to the Vietnamese setting. We confirmed the value of this instrument for use in developing countries, but the optimal cut-off limit has to be assessed and determined according to local conditions.

  • 340. Giang, Kim Bao
    et al.
    Dzung, Truong Viet
    Kullgren, Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Allebeck, Peter
    Prevalence of mental distress and use of health services in a rural district in Vietnam2010Ingår i: Global Health Action, ISSN 1654-9716, E-ISSN 1654-9880, Vol. 3, s. 2025-Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Although there was a low prevalence of mental distress, the low use of mental health services indicated that there was a treatment gap in mental health care. Since many people used private services, intervention programs should include private providers to strengthen their capacity to provide mental health care for the community.

  • 341.
    Gibbs, Anna
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Maripuu, Martin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Öhlund, Louise
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Widerström, Micael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.
    Nilsson, Niklas Harry
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. Department of Psychiatry, Sunderby Hospital, Luleå, Sweden.
    COVID-19-associated mortality in individuals with serious mental disorders in Sweden during the first two years of the pandemic: a population-based register study2024Ingår i: BMC Psychiatry, E-ISSN 1471-244X, Vol. 24, nr 1, artikel-id 189Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Reports at the beginning of the COVID-19 pandemic suggested differences in COVID-19-associated mortality between individuals with serious mental disorders (SMD) and the population at large.

    Aim: To compare the pattern of COVID-19-associated mortality in individuals with and without SMD in Sweden over the two main pandemic years.

    Methods: We compared the pattern of COVID-19-associated mortality in individuals with and without SMD in Sweden during 2020 and 2021. For SMD, we included psychotic disorder, bipolar disorder, and severe depression. The analysis was based on summary data from the Swedish Board of Health and Welfare covering the entire adult Swedish population.

    Results: The overall relative risk (RR) for experiencing a COVID-19-associated death was 1.66 (CI 1.50–1.83; p < 0.001) for individuals with SMD versus individuals without SMD. The corresponding RRs were 3.25 (CI 2.84–3.71; p < 0.001) for individuals with psychotic disorder, 1.06 (CI 0.88–1.26; p = 0.54) for individuals with bipolar disorder, and 1.03 (CI 0.80–1.32; p = 0.80) for individuals with severe depression. Compared to their respective counterparts in the non-SMD group, in the psychotic disorder and severe depression group, the RR were higher in women than in men. In the bipolar disorder group, the RR was higher in men than in women. The RR of COVID-19-associated death was generally higher in younger individuals with SMD. Individuals with psychosis between 18 and 59 years had the highest RR of COVID-19-associated death with 7.25 (CI 4.54–11.59; p<0.001).

    Conclusions: Individuals with SMD, and particularly those with psychotic disorders, had a higher risk of COVID-19-associated death than the general population. As this is a pattern also seen with other infections, people with SMD may be similarly vulnerable in future pandemics.

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  • 342. Giddaluru, Sudheer
    et al.
    Espeseth, Thomas
    Salami, Alireza
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Aging Research Center, Karolinska Institutet and Stockholm University, 11330 Stockholm, Sweden.
    Westlye, Lars T
    Lundquist, Anders
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Christoforou, Andrea
    Cichon, Sven
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Steen, Vidar M
    Reinvang, Ivar
    Nilsson, Lars Göran
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). ARC, Karolinska Institutet, Stockholm, Sweden.
    Le Hellard, Stéphanie
    Nyberg, Lars
    Umeå universitet, Medicinska fakulteten, Umeå centrum för funktionell hjärnavbildning (UFBI). Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper. Umeå universitet, Medicinska fakulteten, Institutionen för integrativ medicinsk biologi (IMB).
    Genetics of structural connectivity and information processing in the brain2016Ingår i: Brain Structure and Function, ISSN 1863-2653, E-ISSN 1863-2661, Vol. 221, nr 9, s. 4643-4661Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Understanding the genetic factors underlying brain structural connectivity is a major challenge in imaging genetics. Here, we present results from genome-wide association studies (GWASs) of whole-brain white matter (WM) fractional anisotropy (FA), an index of microstructural coherence measured using diffusion tensor imaging. Data from independent GWASs of 355 Swedish and 250 Norwegian healthy adults were integrated by meta-analysis to enhance power. Complementary GWASs on behavioral data reflecting processing speed, which is related to microstructural properties of WM pathways, were performed and integrated with WM FA results via multimodal analysis to identify shared genetic associations. One locus on chromosome 17 (rs145994492) showed genome-wide significant association with WM FA (meta P value = 1.87 × 10(-08)). Suggestive associations (Meta P value <1 × 10(-06)) were observed for 12 loci, including one containing ZFPM2 (lowest meta P value = 7.44 × 10(-08)). This locus was also implicated in multimodal analysis of WM FA and processing speed (lowest Fisher P value = 8.56 × 10(-07)). ZFPM2 is relevant in specification of corticothalamic neurons during brain development. Analysis of SNPs associated with processing speed revealed association with a locus that included SSPO (lowest meta P value = 4.37 × 10(-08)), which has been linked to commissural axon growth. An intergenic SNP (rs183854424) 14 kb downstream of CSMD1, which is implicated in schizophrenia, showed suggestive evidence of association in the WM FA meta-analysis (meta P value = 1.43 × 10(-07)) and the multimodal analysis (Fisher P value = 1 × 10(-07)). These findings provide novel data on the genetics of WM pathways and processing speed, and highlight a role of ZFPM2 and CSMD1 in information processing in the brain.

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  • 343.
    Gonzalez, Henrik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Ottervald, Jan
    Nilsson, Kerstin C
    Sjögren, Niclas
    Miliotis, Tasso
    Von Bahr, Helena
    Khademi, Mohsen
    Eriksson, Bodil
    Kjellström, Sven
    Vegvari, Akos
    Harris, Robert
    Marko-Varga, György
    Borg, Kristian
    Nilsson, Johan
    Laurell, Thomas
    Olsson, Tomas
    Franzén, Bo
    Identification of novel candidate protein biomarkers for the post-polio syndrome - implications for diagnosis, neurodegeneration and neuroinflammation.2009Ingår i: Journal of Proteomics, ISSN 1874-3919, E-ISSN 1876-7737, Vol. 71, nr 6, s. 670-81Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Survivors of poliomyelitis often develop increased or new symptoms decades after the acute infection, a condition known as post-polio syndrome (PPS). The condition affects 20-60% of previous polio patients, making it one of the most common causes of neurological deficits worldwide. The underlying pathogenesis is not fully understood and accurate diagnosis is not feasible. Herein we investigated whether it was possible to identify proteomic profile aberrations in the cerebrospinal fluid (CSF) of PPS patients. CSF from 15 patients with well-defined PPS were analyzed for protein expression profiles. The results were compared to data obtained from nine healthy controls and 34 patients with other non-inflammatory diseases which served as negative controls. In addition, 17 samples from persons with secondary progressive multiple sclerosis (SPMS) were added as relevant age-matched references for the PPS samples. The CSF of persons with PPS displayed a disease-specific and highly predictive (p=0.0017) differential expression of five distinct proteins: gelsolin, hemopexin, peptidylglycine alpha-amidating monooxygenase, glutathione synthetase and kallikrein 6, respectively, in comparison with the control groups. An independent ELISA confirmed the increase of kallikrein 6. We suggest that these five proteins should be further evaluated as candidate biomarkers for the diagnosis and development of new therapies for PPS patients.

  • 344. Goonewardena, P
    et al.
    Gustavson, K H
    Holmgren, G
    Tolun, A
    Chotai, Jayanti
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Johnsen, E
    Pettersson, U
    Analysis of fragile X-mental retardation families using flanking polymorphic DNA probes.1986Ingår i: Clinical Genetics, ISSN 0009-9163, E-ISSN 1399-0004, Vol. 30, nr 4, s. 249-54Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Fragile-X mental retardation (FRAX-MR) is one of the more common X-linked disorders affecting 1 in 1,500 newborn males. This disease is characterized by the expression of fragile site in the region q27.3 of the X-chromosome of affected boys when their lymphocytes are cultured in folate deficient medium. In most patients there is macroorchidism postpubertally. The clinical diagnosis of carrier females based on the expression of fragile site in Xq27.3 is usually difficult and sometimes impossible. About half of the carrier females escape diagnosis by this method. Furthermore, prenatal diagnosis is not always feasible. Using Restriction Fragment Length Polymorphism (RFLP) and cloned DNA segments from the region Xq27-Xqter as probes, we have investigated Swedish families with FRAX-MR in three generations. Interesting observations, previously unreported to our knowledge, have been made in some patients and carrier mothers, using one of the probes which is localized to the distal end of Xq. The significance of these findings and the linkage of the disease locus to the different probes used in this study is presented.

  • 345. Gothefors, Dan
    et al.
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri. 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 disorders2010Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 64, nr 5, s. 294-302Artikel i tidskrift (Refereegranskat)
    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.

  • 346.
    Granholm Valmari, Elin
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för arbetsterapi.
    Melander, Marianne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Hariz, Gun-Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Neurovetenskaper. Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för arbetsterapi.
    Naesström, Matilda
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Lindström, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för arbetsterapi.
    Translation and linguistic validation of the Swedish Recovering Quality of Life (ReQoL): a brief research report2023Ingår i: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 14, artikel-id 1059406Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    In research and among clinicians, the focus has shifted from mainly symptom reduction and increasing functionality to a more recovery-oriented focus. Although there are instruments measuring recovery, there has been a lack of instruments sensitive enough to measure the quality of life for people with severe mental health disorders. Therefore, this study aimed to obtain a Swedish version of the Recovering Quality of Life (ReQoL) questionnaire adhering to best practice guidelines using various steps of translation, linguistic validation, and cognitive debriefing. The cognitive debriefing was conducted with seven participants, and all felt the items in the questionnaire were relevant to their health, apprehensible, and easy to complete. However, some issues were raised regarding wording and the concepts behind certain items. All feedback was considered, and some items were revised in response to criticism after continuous discussions. A Swedish version of ReQoL now exists, and although there is a need for ReQoL in different clinical research settings in Sweden, further research is required to psychometrically test the construct validity as well as reliability of the Swedish version in Sweden.

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  • 347. Grann, Martin
    et al.
    Sturidsson, Knut
    Haggård-Grann, Ulrika
    Hiscoke, Ulrika L
    Alm, Per-Olof
    Dernevik, Mats
    Gumpert, Clara
    Hallqvist, Johan
    Hallquist, Tommy
    Kullgren, Gunnar
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Långström, Niklas
    Lotterberg, Malin
    Nordström, Kristina
    Ståhle, Birgitta
    Woodhouse, Anni
    Methodological development: structured outcome assessment and community risk monitoring (SORM).2005Ingår i: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 28, nr 4, s. 442-456Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper describes an effort to develop a clinical tool for the continuous monitoring of risk for violence in forensic mental health clients who have left their institutions and who are dwelling in the community on a conditional release basis. The model is called Structured Outcome Assessment and Community Risk Monitoring (SORM). The SORM consists of 30 dynamic factors and each factor in SORM is assessed in two ways: The current absence, presence or partial och intermittent presence of the factors, which is an actuarial (systematized and 'objective') assessment. Secondly, the risk effect, i.e. whether the presence/absence of factors currently increases, decreases or is perceived as unrelated to violence risk, is a clinical (or impressionistic) assessment. Thus, the factors considered via the SORM can be coded as risk factors or protective factors (or as factors unimportant to risk of violence) depending on circumstances that apply in the individual case. Further, the SORM has a built-in module for gathering idiographical information about risk-affecting contextual factors. The use of the SORM and its potential as a risk monitoring instrument is illustrated via preliminary data and case vignettes from an ongoing multicenter project. In this research project, patients leaving any of the 9 participating forensic hospitals in Sweden is assessed at release on a variety of static background factors, and the SORM is then administered every 30 days for 2 years.

  • 348. Grunewald, Karl
    et al.
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Markström, Urban
    [The child or the bathing water? - The psychiatry reform again]2004Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, nr 6, s. 496-8Artikel i tidskrift (Refereegranskat)
  • 349. Grunewald, Karl
    et al.
    Jacobsson, Lars
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Sandlund, Mikael
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Markström, Urban
    [The psychiatric reform was necessary! Normalized life conditions for tens of thousands of persons].2004Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, nr 4, s. 307-8Artikel i tidskrift (Refereegranskat)
  • 350.
    Gunnerlind, Oscar
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Lundqvist, Robert
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Ott, Michael
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Avdelningen för medicin.
    Werneke, Ursula
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Alcohol consumption under lockdown measures during the COVID-19 pandemic in three Nordic countries2023Ingår i: International Journal of Social Psychiatry, ISSN 0020-7640, E-ISSN 1741-2854Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: At the beginning of the COVID-19 pandemic, concerns arose about a possible rise in alcohol consumption. Early surveys, however, more commonly pointed towards a decrease of alcohol use. But studies based on self-reports may underestimate alcohol use. They also depend on the population sampled. Because of border closures and gastronomy restrictions, countries with centralised alcohol sales provided a unique opportunity to study total domestic consumption during the pandemic without influence of private import or reliance on self-reports.

    Aims: We examined the correlation between alcohol sales and national COVID-19 restrictions in three such countries, Finland, Norway and Sweden.

    Method: We conducted this study as a mirror image study, comparing alcohol sales during the first 2 years of the COVID-19 pandemic with the two preceding years. We explored hours of daylight/season as potential confounders.

    Results: We found no relevant change in alcohol sales during the pandemic years for Finland or Sweden. For Norway, there was a level-change in sales, which could be explained by decreased imports. Sales followed a seasonal pattern. In all three countries, the initial pandemic increase in alcohol sales coincided with an underlying annually recurring seasonal variation.

    Conclusions: The COVID-19 pandemic had less of an impact on alcohol consumption in the three Nordic countries than could intuitively be expected. The increase of alcohol sales at the beginning of the COVID-19 pandemic coincided with a seasonal rise following a pre-pandemic pattern. Therefore, caution should be exercised with drawing conclusions from data with a short time perspective to avoid attribution bias.

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