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  • 851. Wimo, A
    et al.
    Asplund, K
    Mattsson, B
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lundgren, K
    Patients with dementia in group living: experiences 4 years after admission.1995In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 7, no 1, p. 123-7Article in journal (Refereed)
    Abstract [en]

    Sixteen patients with dementia were studied 4 years after admission to group-living (GL) units, an intermediate level of dementia care. Of eight patients who were still alive, four lived in the GL units and four had been institutionalized. The eight patients who had died had spent 89% of their survival time in GL. Aggression was the most frequent cause of institutionalization.

  • 852. Wimo, A
    et al.
    Nelvig, A
    Nelvig, J
    Adolfsson, R
    Umeå University, Faculty of Medicine, Department of Clinical Sciences. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Mattsson, B
    Sandman, P O
    Umeå University, Faculty of Medicine, Department of Nursing.
    Can changes in ward routines affect the severity of dementia? A controlled prospective study.1993In: International psychogeriatrics, ISSN 1041-6102, E-ISSN 1741-203X, Vol. 5, no 2, p. 169-80Article in journal (Refereed)
    Abstract [en]

    An extensive new caring program--including the introduction of Individual Care Plans and changes in ward organization, caring techniques, and caring philosophy--was introduced at two psychogeriatric wards with severely demented patients. The hypotheses were that the patients (n = 31) would improve in psychosocial capacity and orientation and the staff work load would decline in contrast to two other wards with a similar clientele (n = 31). After ten months the milieu was more "homelike," routines were more flexible, and the staff communicated more with the patients. However, the hypotheses were not proven. All patients in both groups deteriorated in ADL capacity, orientation, and behavior. The patients in the program wards became significantly more restless and disoriented and ate less than the patients in the contrast wards. The conclusion is that, despite optimal care, a humanistic approach, and support from staff, the progression of dementia symptoms is inevitable.

  • 853. Winham, S.
    et al.
    Cuellar Barboza, A.
    Batzler, A.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Alda, M.
    Andreassen, O.
    Di Florio, A.
    Forstner, A.
    Kelsoe, J.
    Landen, M.
    Vincent, J.
    McElroy, S.
    Frye, M.
    Biernacka, J.
    Genome-wide interactions with body mass index and bipolar disorder risk: a study from the psychiatric genomics consortium bipolar disorder working group2018In: Bipolar Disorders, ISSN 1398-5647, E-ISSN 1399-5618, Vol. 20, p. 110-111Article in journal (Other academic)
  • 854. Witt, S. H.
    et al.
    Streit, F.
    Jungkunz, M.
    Frank, J.
    Awasthi, S.
    Reinbold, C. S.
    Treutlein, J.
    Degenhardt, F.
    Forstner, A. J.
    Heilmann-Heimbach, S.
    Dietl, L.
    Schwarze, C. E.
    Schendel, D.
    Strohmaier, J.
    Abdellaoui, A.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Air, T. M.
    Akil, H.
    Alda, M.
    Alliey-Rodriguez, N.
    Andreassen, O. A.
    Babadjanova, G.
    Bass, N. J.
    Bauer, M.
    Baune, B. T.
    Bellivier, F.
    Bergen, S.
    Bethell, A.
    Biernacka, J. M.
    Blackwood, D. H. R.
    Boks, M. P.
    Boomsma, D. I.
    Borglum, A. D.
    Borrmann-Hassenbach, M.
    Brennan, P.
    Budde, M.
    Buttenschon, H. N.
    Byrne, E. M.
    Cervantes, P.
    Clarke, T-K
    Craddock, N.
    Cruceanu, C.
    Curtis, D.
    Czerski, P. M.
    Dannlowski, U.
    Davis, T.
    de Geus, E. J. C.
    Di Florio, A.
    Djurovic, S.
    Domenici, E.
    Edenberg, H. J.
    Etain, B.
    Fischer, S. B.
    Forty, L.
    Fraser, C.
    Frye, M. A.
    Fullerton, J. M.
    Gade, K.
    Gershon, E. S.
    Giegling, I.
    Gordon, S. D.
    Gordon-Smith, K.
    Grabe, H. J.
    Green, E. K.
    Greenwood, T. A.
    Grigoroiu-Serbanescu, M.
    Guzman-Parra, J.
    Hall, L. S.
    Hamshere, M.
    Hauser, J.
    Hautzinger, M.
    Heilbronner, U.
    Herms, S.
    Hitturlingappa, S.
    Hoffmann, P.
    Holmans, P.
    Hottenga, J-J
    Jamain, S.
    Jones, I.
    Jones, L. A.
    Jureus, A.
    Kahn, R. S.
    Kammerer-Ciernioch, J.
    Kirov, G.
    Kittel-Schneider, S.
    Kloiber, S.
    Knott, S. V.
    Kogevinas, M.
    Landen, M.
    Leber, M.
    Leboyer, M.
    Li, Q. S.
    Lissowska, J.
    Lucae, S.
    Martin, N. G.
    Mayoral-Cleries, F.
    McElroy, S. L.
    McIntosh, A. M.
    McKay, J. D.
    McQuillin, A.
    Medland, S. E.
    Middeldorp, C. M.
    Milaneschi, Y.
    Mitchell, P. B.
    Montgomery, G. W.
    Morken, G.
    Mors, O.
    Muehleisen, T. W.
    Mueller-Myhsok, B.
    Myers, R. M.
    Nievergelt, C. M.
    Nurnberger, J. I.
    O'Donovan, M. C.
    Loohuis, L. M. O.
    Ophoff, R.
    Oruc, L.
    Owen, M. J.
    Paciga, S. A.
    Penninx, B. W. J. H.
    Perry, A.
    Pfennig, A.
    Potash, J. B.
    Preisig, M.
    Reif, A.
    Rivas, F.
    Rouleau, G. A.
    Schofield, P. R.
    Schulze, T. G.
    Schwarz, M.
    Scott, L.
    Sinnamon, G. C. B.
    Stahl, E. A.
    Strauss, J.
    Turecki, G.
    Van der Auwera, S.
    Vedder, H.
    Vincent, J. B.
    Willemsen, G.
    Witt, C. C.
    Wray, N. R.
    Xi, H. S.
    Tadic, A.
    Dahmen, N.
    Schott, B. H.
    Cichon, S.
    Noethen, M. M.
    Ripke, S.
    Mobascher, A.
    Rujescu, D.
    Lieb, K.
    Roepke, S.
    Schmahl, C.
    Bohus, M.
    Rietschel, M.
    Genome-wide association study of borderline personality disorder reveals genetic overlap with bipolar disorder, major depression and schizophrenia2017In: Translational Psychiatry, ISSN 2158-3188, E-ISSN 2158-3188, Vol. 7, article id e1155Article in journal (Refereed)
    Abstract [en]

    Borderline personality disorder (BOR) is determined by environmental and genetic factors, and characterized by affective instability and impulsivity, diagnostic symptoms also observed in manic phases of bipolar disorder (BIP). Up to 20% of BIP patients show comorbidity with BOR. This report describes the first case–control genome-wide association study (GWAS) of BOR, performed in one of the largest BOR patient samples worldwide. The focus of our analysis was (i) to detect genes and gene sets involved in BOR and (ii) to investigate the genetic overlap with BIP. As there is considerable genetic overlap between BIP, major depression (MDD) and schizophrenia (SCZ) and a high comorbidity of BOR and MDD, we also analyzed the genetic overlap of BOR with SCZ and MDD. GWAS, gene-based tests and gene-set analyses were performed in 998 BOR patients and 1545 controls. Linkage disequilibrium score regression was used to detect the genetic overlap between BOR and these disorders. Single marker analysis revealed no significant association after correction for multiple testing. Gene-based analysis yielded two significant genes: DPYD (P=4.42 × 10−7) and PKP4 (P=8.67 × 10−7); and gene-set analysis yielded a significant finding for exocytosis (GO:0006887, PFDR=0.019; FDR, false discovery rate). Prior studies have implicated DPYD, PKP4 and exocytosis in BIP and SCZ. The most notable finding of the present study was the genetic overlap of BOR with BIP (rg=0.28 [P=2.99 × 10−3]), SCZ (rg=0.34 [P=4.37 × 10−5]) and MDD (rg=0.57 [P=1.04 × 10−3]). We believe our study is the first to demonstrate that BOR overlaps with BIP, MDD and SCZ on the genetic level. Whether this is confined to transdiagnostic clinical symptoms should be examined in future studies.

  • 855.
    Zebialowicz, Jakub
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    ADHD och substansbrukssyndrom – en fallstudie: Hur ser den farmakologiska behandlingen av vuxna med ADHD och samtidigt substansbrukssyndrom ut? En fallstudie2015Independent thesis Basic level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 856.
    Ågren, Sara
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychotherapy.
    Elfving, Helena
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Självmedkänsla och hälsa: Psykoterapeutstudenter och legitimerade psykoterapeuter2016Independent thesis Advanced level (professional degree), 10 credits / 15 HE creditsStudent thesis
    Abstract [sv]

    Självmedkänsla anses vara betydelsefull för vår fysiska och psykiska hälsa och ökar förutsättningarna för vår inre trygghet vid motgångar och svårigheter. Självmedkänsla motverkar nedstämdhet, stress och ökar förmågan till känslomässig självreglering och ger ökad kontakt med adaptiva aktiverande affekter med ökad förmåga till läkande och helande hos människan. Blivande psykoterapeuter och andra inom människovårdande yrken anses speciellt utsatta och självomsorg blir en viktig komponent. Självmedkänsla utvecklas i den trygga anknytningen och kan övas upp som vuxen, via meditation, mindfulness, affektfokuserade psykoterapier och i en trygg terapeutisk relation. Studiens syfte var att undersöka självskattad självmedkänsla och fysisk/psykisk hälsa bland psykoterapeutstudenter och göra en jämförelse med legitimerade psykoterapeuter. En enkät (Self-Compassion Scale, SF-36) som mäter självmedkänsla respektive fysisk/psykisk hälsa, distribuerades till studenterna i en klassrumssituation och till legitimerade psykoterapeuter via post. Totalt kom 33 psykoterapistudenter och 34 legitimerade psykoterapeuter att ingå i studien. Resultatet visar att psykoterapeutstudenterna, enligt självskattning, hade en signifikant bättre självmedkänsla men signifikant sämre fysisk och psykisk hälsa än de legitimerade psykoterapeuterna. Båda grupperna hade en medel nivå avseende självskattad självmedkänsla. Mindfulnessträning och meditation kan vara verktyg att stärka upp självmedkänslan och minska självkritiken.

  • 857.
    Åhman, Marie
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Förenklad ADHD diagnostik Ettårs- uppföljning av patienter samt utvärdering av diagnostisk metodik.2014Independent thesis Advanced level (professional degree), 20 credits / 30 HE creditsStudent thesis
  • 858.
    Åström, Elisabeth
    et al.
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Rönnlund, Michael
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Carelli, Maria Grazia
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Depressive symptoms and time perspective in older adults:: associations beyond personality and negative life events2018In: Aging & Mental Health, ISSN 1360-7863, E-ISSN 1364-6915Article in journal (Refereed)
    Abstract [en]

    Objectives: To examine the extent to which time perspective, an individual’s habitual way of relating to the past, the present, and the future time frames, accounts for variations in self-reported depressive symptoms among older adults.

    Method: Four hundred two participants (60–90 years) completed the Center for Epidemiological Studies Depression scale (CES-D) and the Swedish Zimbardo Time perspective Inventory (S-ZTPI). The influence of personality as reflected by the Temperament and Character Inventory (TCI) and self-reported negative life events (NLEs) were controlled for in hierarchic regression analyses.

    Results: The six S-ZTPI dimensions accounted for 24.5% of the variance in CES-D scores beyond age and gender. Half of the variance remained when the TCI factors and NLEs were controlled for. Past Negative, Future Negative, and Past Positive (inverse association) were the significant unique predictors. Significant age interactions were observed for two S-ZTPI dimensions, with a diminished association to depressive symptoms for Future Negative and a magnified association for Present Fatalistic with higher age.

    Conclusions: The results demonstrate a substantial relation between facets of time perspective and depressive symptoms in old age. They also indicate an age-related shift in the relative importance from concerns about of the future (Future Negative) to the present (Present Fatalistic) with increased age. In young old-age, when the future is more ‘open’, future worries (Future Negative) may be a more frequent source of distress. In late senescence, perceived threats to autonomy (e.g. physical health problems and cognitive deficits), as reflected by higher scores on Present Fatalistic, may instead have more bearing on mood state.

  • 859.
    Åström, Monica
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Depression after stroke1993Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Both stroke and depression are major health problems in the elderly. In this study, the prevalence of major depression after stroke was investigated in a well-defined sample of acute stroke patients (n=80), followed up at 3 months, 1 year, 2 and 3 years after the stroke event. Links to biological and psychosocial factors were examined. Hypercortisolism was studied by the dexamethasone suppression test and compared with healthy elderly. Living conditions (including demographic caracteristics, economic resources, health, functional ability, activity/leisure, social network) and life satisfaction were described before and after stroke in relation to a general elderly population.

    Demographic caracteristics, economic resources, social network and psychiatric morbidity prestroke did not differ from the general elderly population. Already prior to the stroke, patients reported more health problems and lower functional ability in many aspects of daily life, more passive leisure time and a lower global life satisfaction. After stroke, contacts with children were maintained, whilst contacts outside the family declined and remained lower than in the general elderly population. Stroke involved a marked reduction in global life satisfaction. Poor life satisfaction at 1 year remained poor for the entire three years; these stroke victims had a higher frequency of major depression early after stroke.

    The prevalence of major depression was 25% at the acute stage, 31% at 3 months, decreased to 16% at 1 year, was 19% at 2 years and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in self-care ability and loss of social contacts outside the family were the most important predictors at 3 months. From 1 year onwards, loss of social contacts contributed most to depression and at 3 years also cerebral atrophy. Sixty percent of patients with early depression (0-3 months) had recovered at 1 year; those not recovered at 1 year had a high risk of chronicitation.

    Hypercortisolism as measured by the dexamethasone suppression test was associated with major depression late (3 years) but not early (0-3 months) after stroke. At 3 years, the dexamethasone suppression test had a sensitivity of 70%, a specificity of 97%, a positive predictive value of 88%, a negative predicitive value of 91%, and a diagnostic accuracy of 90%. Nonsuppression of dexamethasone at 3 months was a significant predictor of major depression at 3 years.

  • 860.
    Åström, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Major depression in stroke patients: A 3-year longitudinal study1993In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 24, no 7, p. 976-982Article in journal (Refereed)
    Abstract [en]

    BACKGROUND AND PURPOSE: This prospective study was designed to examine the contributions of neurobiological, functional, and psychosocial factors to major depression after stroke. In addition, the prevalence and longitudinal course of major depression were studied. METHODS: Major depression, functional ability, and social network were assessed repeatedly for a period of 3 years in a population-based cohort of 80 patients with acute stroke (mean age, 73 years). Cerebral atrophy and brain lesion parameters were determined from computed tomographic scans performed acutely and after 3 years. RESULTS: The prevalence of major depression was 25% at the acute stage and approximately the same at 3 months (31%). It decreased to 16% at 12 months, was 19% at 2 years, and increased to 29% at 3 years. The most important predictors of immediate major depression were left anterior brain lesion, dysphasia, and living alone. Dependence in activities of daily living was the most important predictor at 3 months. From 12 months on, the patient's having few social contacts outside the immediate family contributed most to depression, and at 3 years cerebral atrophy also contributed. At 1 year, 60% of the patients with early depression (0 to 3 months) had recovered; those not recovered at this follow-up had a high risk of development of chronic depression. CONCLUSIONS: The study has provided evidence of a differentiation of factors likely to be implicated in the development of depression after stroke based or the period of time since the stroke event.

  • 861.
    Åström, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Adolfsson, Rolf
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Åström, T.
    Umeå University, Faculty of Social Sciences, Department of Sociology.
    Life before and after Stroke: Living Conditions and Life Satisfaction in Relation to a General Elderly Population1992In: Cerebrovascular Diseases, ISSN 1015-9770, E-ISSN 1421-9786, Vol. 2, no 1, p. 28-34Article in journal (Refereed)
    Abstract [en]

    Living conditions and life satisfaction before and after stroke were assessed in 80 patients with acute stroke (mean age 73 years). The results were compared with a general elderly population. Already prior to their stroke the patients had more health problems, lower functional ability, more passive leisure time and lower global life satisfaction. Low life satisfaction was associated with dependence in the activities of daily living (ADL). Economic resources, social network and psychiatric morbidity before stroke did not differ from the general elderly population. At 3 months of follow-up, almost half of the patients reported low life satisfaction, compared to only 2% in the national sample. Major depression and ADL dependence were associated with low life satisfaction after stroke. We conclude that much of the disability and handicap seen in stroke patients is present already before the stroke. Stroke-related deterioration of ADL performance, major depression and social disintegration after stroke interact to further reduce life satisfaction for the stroke victims and their families.

  • 862.
    Åström, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Åström, T.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Psychosocial function and life satisfaction after stroke1992In: Stroke, Vol. 23, no 4, p. 527-531Article in journal (Refereed)
    Abstract [en]

    This prospective study was designed to describe different aspects of psychosocial function after stroke and the development of changes over time. A major aim has been to identify mental, functional, and social factors associated with low life satisfaction late after stroke.

    Social network, functional ability, leisure-time activities, experience of ill health, major depression, and life satisfaction were assessed repeatedly over 3 years in a population-based sample of 50 long-term survivors of stroke (mean age 71.4 years).

    Compared with a general elderly population, patients 3 years poststroke had more psychiatric symptoms, lower functional ability, and reduced life satisfaction. Contacts with children were maintained over the 3-year follow-up period, whereas contacts with friends and neighbors declined early after stroke and remained lower than in the general elderly population (p less than 0.05). When time dependency was analyzed, activities of daily living and somatic/neurological symptoms were found to change little after 3 months, while psychiatric symptoms showed changes later. Between 3 and 12 months poststroke, the prevalence of major depression decreased, leisure-time activities and social contacts were partly resumed, and life satisfaction improved (p less than 0.01). Once good life satisfaction was restored it was maintained, and poor life satisfaction at 1 year remained poor for the entire 3 years.

    It is concluded that major depression early after stroke, functional disability, and an impaired social network interact to reduce life satisfaction for the long-term survivors of stroke.

  • 863.
    Åström, Monica
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Olsson, Tommy
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Asplund, Kjell
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Different linkage of depression to hypercortisolism early versus late after stroke: A 3-year longitudinal study1993In: Stroke, ISSN 0039-2499, E-ISSN 1524-4628, Vol. 24, no 1, p. 52-57Article in journal (Refereed)
    Abstract [en]

     Using the dexamethasone suppression test, we studied the suppressibility of the cortisol axis and its clinical determinants at various time points after stroke. A major aim was to examine the dexamethasone test as a diagnostic tool for the diagnosis of major depression in stroke patients.The dexamethasone suppression test, major depression, functional ability, and disorientation were assessed in a cohort of 70 patients with acute stroke and after 3 months (n = 63) and 3 years (n = 43).Early after stroke, 24% of the patients were nonsuppressors, with about the same proportion at 3 months (22%) and 3 years (21%). None of the controls (17 healthy elderly volunteers) were nonsuppressors. High cortisol levels early after stroke were significantly associated with functional impairment (r = 0.35; p = 0.003) and disorientation (r = 0.27; p = 0.03). Three years after stroke, high postdexamethasone cortisol levels were significantly associated with major depression (r = 0.57; p < 0.001). The sensitivity of the dexamethasone test was 70% and the specificity 97%. In a longitudinal analysis of the long-term survivors (n = 42), postdexamethasone cortisol values at 3 months predicted major depression at 3 years.Hypercortisolism is associated with major depression late (3 years) but not early (0-3 months) after stroke. Patients with hypercortisolism 3 months after stroke are at risk of major depression later in the course and warrant careful follow-up from a psychiatric viewpoint.

  • 864.
    Ögren, Kenneth
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Operera psykisk sjukdom2014In: Västerbotten, ISSN 0346-4938, no 3, p. 54-59Article in journal (Other (popular science, discussion, etc.))
  • 865.
    Ögren, Kenneth
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Umeå University, Faculty of Arts, Department of culture and media studies.
    Psychosurgery in Sweden 1944 - 1958: the practice, the professional and media discourse2007Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Background. The pioneering early experiments of prefrontal lobotomy were performed in 1944 by neurosurgeons in Stockholm in collaboration with psychiatrists. There was a rapid implementation of the new surgical approach. In 1946 and 1947 the two state mental hospitals, Umedalen and Sidsjön, introduced prefrontal lobotomy on a large scale. General surgeons now performed operations, a practice which was established all over Sweden. Prefrontal lobotomy was burdened, in certain city hospitals, by an initially high rate of postoperative mortality reaching more than 15 %. Pre-frontal lobotomy was phased out continuously already before 1950 and refined psychosurgical methods were introduced , but prefrontal lobotomy was still continued which lacked specialised neurosurgical units. The aims of the thesis were to contribute to and deepen the knowledge and understanding of the general and specific questions of early psychosurgery in its professional and social context.

    Specific aims: (Explore the practice of prefrontal lobotomy at the Umedalen State Mental hospital and plot the frequency of psychosurgery operations in Sweden.

    • Analyze the patients subjected to prefrontal lobotomy at the Umedalen State Mental Hospital 1947-1958, with respect to symptomatology and diagnosis, indications for the operation, gender distribution postoperative mortality, the practice of consent and other clinical factors.

    • Explore and analyze what was written on psychosurgery, when and how, and to identify differences, similarities and characteristics of the portrayal of psychosurgery in Swedish and American media 1936-1959.

    • Explore and analyze the confluence of the role of the State authority, The Swedish National Board of Health (Medicinalstyrelsen), the professional discourses on lobotomy and the media portrayal, in dealing with problems of implementation and mortality.

    Results. Paper I. At the Umedalen State Mental Hospital, 771 prefrontal lobotomies were performed 1947-1958 with an overall postoperative mortality of 7.4 %. Most of the patients operated on from Umedalen were women (61.2%) and most of the patients were diagnosed with schizophrenia. Of all the lobotomies performed in Sweden (approx. 4,500), 28% had been carried out at the Sidsjön and Umedalen State Mental Hospitals.

    Paper II. A sample of 105 patients, who were studied in detail from psychiatric records. It was found that 79% had been six years in primary school and only 3% had a higher education. In an analysis of the descriptions of behavioural problems stated in the medical records, it was found that the female candidate for prefrontal lobotomy was described as suffering from different problems more often than the male candidate. Disturbing behaviour, fluctuations of mood and violence against others were the most frequently described symptoms most often referred to with respect to the female lobotomy candidate.

    Paper III. In the comparative media study it was found that most of the articles on lobotomy in the Swedish and American media were positive or neutral towards psychosurgery, while very negative articles were least frequent. Neutral articles were more common in Swedish media (43%) while less common in the American media (19%). Articles being very negative towards lobotomy were considerably more often found in the American material (32%) than in the Swedish (14%).

    Paper IV. The implementation of lobotomy was rapid in Sweden and more than 4000 lobotomies were performed between 1944 and 1964. It was considered feasible for prefrontal lobotomies to be performed by general surgeons and, from 1951, it can be verified that most hospitals (12/20) had engaged general surgeons for the lobotomy operation while a minority (8/20) had engaged a neurosurgeon. The Swedish State, through the Swedish National Board of Health was responsible of the allocation and surveillance of mental care. With a system consisting of a Chief Inspector of Mental Care, State mental hospitals were inspected annually. Medical superintendents were given full autonomy to decide on the implementation and practice of lobotomy. No indications were found of any significant interference by the Swedish National Board of Health restricting lobotomy.

    Main conclusion. Medical superintendents were given full autonomy to decide on the clinical practice of lobotomy. Being left in the periphery of neurosurgical facilities, this led to their engaging general surgeons. Patients were operated on in surgical theatres lacking the sophisticated technical equipment of coping securely with haemorrhages, which were common in the early implementation of the operation. The practice of lobotomy in some mental hospitals was extensive and postoperative deaths were numerous but the Swedish National Board of Health took a defensive role and, even with the annual inspections, there was no important interference with the lobotomy question. Swedish media reported mostly positively on lobotomy, underlining the promising prospects of the new method submitted by the early proponents without critical questioning or independent investigations.

  • 866.
    Ögren, Kenneth
    Umeå University, Faculty of Arts, Culture and Media. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    The surgical offensives against mental disorder: psychosurgery in Sweden 1944-19582005Licentiate thesis, comprehensive summary (Other academic)
  • 867.
    Ögren, Kenneth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Implementation of lobotomy in Sweden: the role of the state and the professionsManuscript (Other academic)
  • 868.
    Ögren, Kenneth
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Umeå University, Faculty of Arts, Culture and Media.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lobotomy at a state mental hospital: a survey of patients operated during the period 1947 to 19582007In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 61, no 5, p. 355-362Article in journal (Refereed)
    Abstract [en]

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

  • 869.
    Ögren, Kenneth
    et al.
    Umeå University, Faculty of Arts, Culture and Media. Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Psychosurgery in Sweden 1944-19642005In: Journal of the History of the Neurosciences, ISSN 0964-704X, E-ISSN 1744-5213, Vol. 14, no 4, p. 353-367Article in journal (Refereed)
  • 870.
    Öhlund, Louise
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Research Unit.
    Lieber, Ingrid
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Research Unit.
    Trainee editorial: psychiatry should be taught from day one in medical school2018In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, p. S3-S4Article in journal (Other academic)
  • 871.
    Öhlund, Louise
    et al.
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Ott, Michael
    Umeå University, Faculty of Medicine, Department of Public Health and Clinical Medicine, Medicine.
    Oja, Sofia
    Bergqvist, Malin
    Lundqvist, Robert
    Sandlund, Mikael
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Renberg, Ellinor Salander
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Werneke, Ursula
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry. Sunderby Hospital – Psychiatry, 97180 Luleå, Sweden.
    Reasons for lithium discontinuation in men and women with bipolar disorder: a retrospective cohort study2018In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 18, article id 37Article in journal (Refereed)
    Abstract [en]

    Background: Lithium remains first choice as maintenance treatment for bipolar affective disorder. Yet, about half of all individuals may stop their treatment at some point, despite lithium’s proven benefits concerning the prevention of severe affective episodes and suicide.

    Methods: Retrospective cohort study in the Swedish region of Norrbotten into the causes of lithium discontinuation. The study was set up to (1) test whether patients with bipolar affective disorder or schizoaffective disorder, treated with lithium maintenance therapy, were more likely to discontinue lithium because of adverse effects than lack of therapeutic effectiveness, (2) explore gender differences, (3) understand the role of diagnosis and (4) identify who, patient or doctor, took the initiative to stop lithium. Review of medical records for all episodes of lithium discontinuation that had occurred between 1997 and 2013 with the intent to stop lithium for good.

    Results: Of 873 patients treated with lithium, 54% discontinued lithium, corresponding to 561 episodes of lithium discontinuation. In 62% of episodes, lithium was discontinued due to adverse effects, in 44% due to psychiatric reasons, and in 12% due to physical reasons interfering with lithium treatment. The five single most common adverse effects leading to lithium discontinuation were diarrhoea (13%), tremor (11%), polyuria/polydipsia/diabetes insipidus (9%), creatinine increase (9%) and weight gain (7%). Women were as likely as men to take the initiative to stop lithium, but twice as likely to consult a doctor before taking action (p < 0.01). Patients with type 1 BPAD or SZD were more likely to discontinue lithium than patients with type 2 or unspecified BPAD (p < 0.01). Patients with type 1 BPAD or SZD were more likely to refuse medication (p < 0.01). Conversely, patients with type 2 or unspecified BPAD were three times as likely to discontinue lithium for lack or perceived lack of effectiveness (p < 0.001).

    Conclusions: Stopping lithium treatment is common and occurs mostly due to adverse effects. It is important to discuss potential adverse effects with patients before initiation and continuously during lithium treatment, to reduce the frequency of potentially unnecessary discontinuations.

  • 872.
    Öster, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Magnusson, Eva
    Umeå University, Faculty of Social Sciences, Centre for Women's Studies.
    Egberg Thyme, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Lindh, Jack
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Art therapy for women with breast cancer: the therapeutic concequences of boundary strenghtening2007In: The arts in psychotherapy, ISSN 0197-4556, E-ISSN 1873-5878, Vol. 34, no 3, p. 277-288Article in journal (Refereed)
    Abstract [en]

    Between 2001 and 2004, 42 women with breast cancer (20 women in the study group and 22 women in the control group) participated in an intervention study involving art therapy. This article elaborates on previous quantitative results, taking a discursive approach and drawing on gender theories in analyzing the women's use of interpretative repertoires in interviews and diaries and their answers on single items of the Coping Resources Inventory (CRI). The aim was to inquire into whether and, if so, how and with what consequences women with breast cancer who participated in art therapy improved their access to beneficial cultural interpretative repertoires, compared to a control group. The results showed a connection between participation in art therapy, talking about protecting one's own boundaries, and scoring higher on the CRI compared to the control group. There was also a connection between the control group, repertoire conflicts, and lower scores on the CRI. Our interpretation is that art therapy became a tool the women could use to distinguish cultural understandings about boundaries and, through image making and reflections, to give higher legitimacy to their own interpretations and experience.

  • 873.
    Öster, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Svensk, Ann-Christine
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Magnusson, Eva
    Umeå University, Faculty of Social Sciences, Centre for Women's Studies.
    Thyme Egberg, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Sjõdin, Marie
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Aström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindh, Jack
    Umeå University, Faculty of Medicine, Department of Radiation Sciences.
    Art therapy improves coping resources: a randomized, controlled study among women with breast cancer.2006In: Palliative & Supportive Care, ISSN 1478-9515, E-ISSN 1478-9523, Vol. 4, no 1, p. 57-64Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Women with breast cancer suffer from considerable stress related to the diagnosis, surgery, and medical treatment. It is important to develop strategies to strengthen coping resources among these women. Research in art therapy has shown outcomes such as an increase in self-esteem and cohesion, significant improvement in global health, and a decrease in anxiety and depression. The aim of the present article was to describe the effects of an art therapy intervention program on coping resources in women with primary breast cancer. METHOD: In this article, we report some of the results from a study including 41 women, aged 37-69 years old, with nonmetastatic primary breast cancer, referred to the Department of Oncology at Umeå University Hospital in Sweden for postoperative radiotherapy. The women represented various socioeconomic backgrounds. They were randomized to a study group (n = 20) with individual art therapy for 1 h/week during postoperative radiotherapy or to a control group (n = 21). The article focuses on changes in coping resources, as measured by the Coping Resources Inventory (CRI) before and 2 and 6 months after the start of radiotherapy. The study protocol was approved by the Umeå University Ethical Committee at the Medical Faculty (archive number 99-386). RESULTS: There was an overall increase in coping resources among women with breast cancer after taking part in the art therapy intervention. Significant differences were seen between the study and control groups in the social domain on the second and third occasions. Significant differences were also observed in the total score on the second occasion. SIGNIFICANCE OF RESULTS: This study shows that individual art therapy provided by a trained art therapist in a clinical setting can give beneficial support to women with primary breast cancer undergoing radiotherapy, as it can improve their coping resources.

  • 874.
    Öster, Inger
    et al.
    Umeå University, Faculty of Medicine, Department of Nursing.
    Tavelin, Björn
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Egberg Thyme, Karin
    Umeå University, Faculty of Medicine, Department of Clinical Sciences, Psychiatry.
    Magnusson, Eva
    Umeå University, Faculty of Social Sciences, Department of Psychology.
    Isaksson, Ulf
    Umeå University, Faculty of Medicine, Department of Nursing.
    Lindh, Jack
    Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
    Åström, Sture
    Umeå University, Faculty of Medicine, Department of Nursing.
    Art therapy during radiotherapy: a five-year follow-up study with women diagnosed with breast cancer2014In: The arts in psychotherapy, ISSN 0197-4556, E-ISSN 1873-5878, Vol. 41, no 1, p. 36-40Article in journal (Refereed)
    Abstract [en]

    Follow-up studies on art therapy are lacking. In a randomised art therapy intervention study from 2001-2004 with women with breast cancer, results showed that patients benefitted from participating in art therapy for up to at least four months after the intervention. The aim of this study was to describe the coping resources and quality of life amongst women treated for breast cancer five - seven years after participating in individual art therapy during radiotherapy as compared to a control group. In 2009, thirty-seven women, 18 from the intervention group and 19 from the control group, answered questionnaires about their coping resources and quality of life. The results showed no significant difference between the groups regarding their coping resources or quality of life, except for an unexpected significantly lower score in the domain ‘Social relations’ in the study group as compared to baseline, at the time of the follow up. However, our study from 2001–2004 supports various positive effects of art therapy within six months of participation as compared to a control group. Consequently, attending art therapy during the treatment period for breast cancer can be of great importance to support health, coping and quality of life in a short-term perspective.

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