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Norell-Clarke, A., Tillfors, M., Jansson-Fröjmark, M., Holländare, F. & Engström, I. (2018). Does Mid-Treatment Insomnia Severity Mediate between Cognitive Behavioural Therapy for Insomnia and Post-Treatment Depression?: An Investigation in a Sample with Comorbid Insomnia and Depressive Symptomatology. Behavioural and Cognitive Psychotherapy, 46(6), 726-737
Open this publication in new window or tab >>Does Mid-Treatment Insomnia Severity Mediate between Cognitive Behavioural Therapy for Insomnia and Post-Treatment Depression?: An Investigation in a Sample with Comorbid Insomnia and Depressive Symptomatology
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2018 (English)In: Behavioural and Cognitive Psychotherapy, ISSN 1352-4658, E-ISSN 1469-1833, Vol. 46, no 6, p. 726-737Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Recent treatment studies with cognitive behavioural therapy for insomnia (CBT-I) have demonstrated effects on both sleep problems and depression. Two previous studies have indicated that the beneficial effect from CBT-I on depression may come through improved sleep, although insomnia severity during treatment had not previously been investigated as a mediator.

AIMS: Our aim was to investigate if insomnia severity during treatment mediated between CBT-I and depression severity after treatment, in a sample with co-morbid insomnia and depressive symptomology. We also examined whether depressive severity during treatment mediated between CBT-I and insomnia after treatment.

METHOD: The participants were recruited from advertisements and fulfilled criteria for insomnia diagnosis, and had depressive symptomatology (Beck Depression Inventory-second edition: BDI-II > 13). Two-thirds of the participants were diagnosed with major depressive disorder. The participants received four biweekly group sessions of CBT-I or relaxation training (active control). Insomnia severity (Insomnia Severity Index) and depressive severity (BDI-II) were measured at baseline, mid-treatment, post-treatment and 6-month follow-up. The mid-treatment measures were used as mediators.

RESULTS: Mediational analyses demonstrated a significant reciprocal relationship between insomnia severity and depressive severity throughout CBT-I, although mid-treatment insomnia had a stronger effect on depression than mid-treatment depression had on insomnia. The results were similar for both post-treatment and follow-up.

DISCUSSION: Some improvement in depressive severity after CBT-I is explained by improved sleep. The findings emphasize the importance of making comorbid insomnia a treatment focus in its own right.

Place, publisher, year, edition, pages
Cambridge University Press, 2018
Keywords
Cognitive behavioural therapy, depression, group psychotherapy, insomnia, randomized controlled trial, statistical mediation
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-67316 (URN)10.1017/S1352465818000395 (DOI)000444683800006 ()29898793 (PubMedID)2-s2.0-85048765370 (Scopus ID)
Note

Funding Agencies:

Stiftelsen Professor Bror Gadelius Minnesfond  

Psykiatrifonden  

Research Committee of Region Örebro County, Sweden

Available from: 2018-06-19 Created: 2018-06-19 Last updated: 2018-10-01Bibliographically approved
Nyman-Carlsson, E., Birgegård, A., Engström, I., Gustafsson, S. A. & Nevonen, L. (2018). Predictors of outcome among young adult patients with anorexia nervosa in a randomised controlled trial. European eating disorders review
Open this publication in new window or tab >>Predictors of outcome among young adult patients with anorexia nervosa in a randomised controlled trial
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2018 (English)In: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: The prognosis in cases of anorexia nervosa (AN) is unsatisfactory, and it is therefore important to examine pretreatment predictors of outcome.

METHODS: Female AN patients (N = 74) included in a randomised controlled trial receiving individual cognitive behavioural therapy (CBT) or family-based treatment (FBT) were included. Predictors of the outcome were explored using pretreatment eating disorder psychopathology.

RESULTS: In the CBT group, lower levels of emotional dysregulation and greater deficits in identifying and coping with inner states were predictors of weight increase, explaining 37.7% of the variance. In the FBT group, lower interoceptive deficits predicted an increase in weight (explaining 17.7% of the variance), whereas bulimic behaviour (32.4%) and problems with emotional regulation (23.3%) were predictors of increased diagnostic symptoms.

CONCLUSIONS: Bulimic symptoms and the ability to identify and cope with emotional states appear to be important aspects that should be addressed in the treatment of young adult patients with AN.

Place, publisher, year, edition, pages
Wiley-Blackwell, 2018
Keywords
BMI, anorexia nervosa, outcome, prediction, young adults
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-68439 (URN)10.1002/erv.2630 (DOI)30094893 (PubMedID)
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2018-09-04Bibliographically approved
Hylén, U., Engström, I., Engström, K., Pelto-Piri, V. & Anderzen-Carlsson, A. (2018). Providing Good Care in the Shadow of Violence: An Interview Study with Nursing Staff and Ward Managers in Psychiatric Inpatient Care in Sweden. Issues in Mental Health Nursing, 1-10
Open this publication in new window or tab >>Providing Good Care in the Shadow of Violence: An Interview Study with Nursing Staff and Ward Managers in Psychiatric Inpatient Care in Sweden
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2018 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, p. 1-10Article in journal (Refereed) Epub ahead of print
Abstract [en]

The aim was to describe the nursing staff and ward managers' experiences of safety and violence in everyday meetings with the patients. The qualitative content analyses resulted in four themes: the relationship with the patient is the basis of care; the organizational culture affects the care given; knowledge and competence are important for safe care; and the importance of balancing influence and coercion in care. The staff had a varied ability to meet patients in a respectful way. One way of creating a common approach could be to discuss and reflect upon different options in the meeting with the patient.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
National Category
Nursing Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:oru:diva-69999 (URN)10.1080/01612840.2018.1496207 (DOI)30376382 (PubMedID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-0389
Available from: 2018-11-07 Created: 2018-11-07 Last updated: 2018-11-08Bibliographically approved
Svensson, A. F., Khaldi, M., Engström, I., Matusevich, K. & Nordenskjöld, A. (2018). Remission rate of transcranial magnetic stimulation compared with electroconvulsive therapy: a case-control study. Nordic Journal of Psychiatry, 1-6
Open this publication in new window or tab >>Remission rate of transcranial magnetic stimulation compared with electroconvulsive therapy: a case-control study
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2018 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, p. 1-6Article in journal (Refereed) Epub ahead of print
Abstract [en]

PURPOSE: To compare the rate of remission, rate of response, change in depressive symptoms, and adverse effects between repetitive transcranial magnetic stimulation (rTMS) and electroconvulsive therapy (ECT).

MATERIALS AND METHODS: In this retrospective case-control study, 35 patients treated for depression with rTMS (left dorsolateral prefrontal cortex, 90% observed motor threshold, 10 Hz, 2000 pulses/session, 15 sessions) at Örebro University Hospital, Sweden (cases), were compared with a matched group of 35 patients treated for depression with ECT (controls). Data on controls were obtained from the Swedish National Quality Register for ECT (Q-ECT). Severity of depression was evaluated using the Montgomery-Åsberg Depression rating scale (MADRS).

RESULTS: Remission rate was 26% for cases and 43% for controls (p = .3). Response rate was 40% for cases and 51% for controls (p = .63). The median decrease in MADRS was 11 (IQR 3-19) vs. 17 (IQR 6-27; p = .10) for rTMS and ECT, respectively. There was no statistically significant difference in any measure of treatment effect between rTMS and ECT. More than half of the patients of the rTMS group experienced scalp discomfort and 11% of the ECT group had memory disturbances.

CONCLUSIONS: All measures of therapeutic efficacy were numerically inferior in the rTMS group compared to the ECT group. The differences were not statistically significant, probably because the sample size was small. More studies are required to find the optimal place for rTMS within the Swedish health care system. Such studies could be facilitated by inclusion of rTMS in the Q-ECT.

Place, publisher, year, edition, pages
Taylor & Francis, 2018
Keywords
Major depressive disorder, electroconvulsive therapy, repetitive transcranial magnetic stimulation, treatment outcome
National Category
Psychiatry
Identifiers
urn:nbn:se:oru:diva-69891 (URN)10.1080/08039488.2018.1481998 (DOI)30359165 (PubMedID)
Note

Funding agency: Region Örebro county

Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2018-11-07Bibliographically approved
Elinder, G., Eriksson, A., Hallberg, B., Lynøe, N., Sundgren, P. M., Rosén, M., . . . Erlandsson, B.-E. (2018). Traumatic shaking: The role of the triad in medical investigations of suspected traumatic shaking. Acta Paediatrica, 107(S472), 3-23
Open this publication in new window or tab >>Traumatic shaking: The role of the triad in medical investigations of suspected traumatic shaking
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2018 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no S472, p. 3-23Article, review/survey (Refereed) Published
Abstract [en]

The Swedish Agency for Health Technology Assessment and Assesment of Social Services (SBU) is an independent national authority, tasked by the government with assessing methods used in health, medical and dental services and social service interventions from a broad perspective, covering medical, economic, ethical and social aspects. The language in SBU's reports are adjusted to a wide audience. SBU's Board of Directors has approved the conclusions in this report. The systematic review showed the following graded results:

  • There is limited scientific evidence that the triad (Three components of a whole. The triad associated with SBS usually comprises subdural haematoma, retinal haemorrhages and encephalopathy.) and therefore, its components can be associated with traumatic shaking (low-quality evidence).
  • There is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low-quality evidence).

Limited scientific evidence (low-quality evidence) represents a combined assessment of studies of high or moderate quality which disclose factors that markedly weaken the evidence. It is important to note that limited scientific evidence for the reliability of a method or an effect does not imply complete lack of scientific support. Insufficient scientific evidence (very low-quality evidence) represents either a lack of studies or situations when available studies are of low quality or show contradictory results. Evaluation of the evidence was not based on formal grading of the evidence according to GRADE but on an evaluation of the total scientific basis.

Place, publisher, year, edition, pages
Wiley-Blackwell Publishing Ltd., 2018
Keywords
Brain oedema, Child abuse, Infant, Retinal haemorrhage, Shaken Baby Syndrome, Subdural haematoma
National Category
Health Care Service and Management, Health Policy and Services and Health Economy Pediatrics
Identifiers
urn:nbn:se:oru:diva-68680 (URN)10.1111/apa.14473 (DOI)000442730400001 ()30146789 (PubMedID)2-s2.0-85052239909 (Scopus ID)
Available from: 2018-09-03 Created: 2018-09-03 Last updated: 2018-09-11Bibliographically approved
Pelto-Piri, V., Engström, K. & Engström, I. (2017). Hantering av hot och våld: Personalens syn på etik, bemötande och säkerhet i mötet med ungdomar på institutioner. Stockholm, Sweden: Statens institutionsstyrelse, SiS
Open this publication in new window or tab >>Hantering av hot och våld: Personalens syn på etik, bemötande och säkerhet i mötet med ungdomar på institutioner
2017 (Swedish)Report (Other academic)
Abstract [en]

The starting point of this study was that aspects of ethics as well as safety should be taken into account in meetings with patients and clients. The purpose was to increase the understanding of how staff in inpatient and institutional settings relate to the perspectives of good care and safety simultaneously in daily meetings with young clients and patients, especially in aggressive situations. The participants were staff who worked with youngsters on a daily basis at two institutions run by the National Board of Institutional Care (SiS) and a child and adolescent psychiatric clinic. The research questions were: 1) Which values can be found in the staff’s narratives about meetings with youngsters?, 2) How do staff describe the sequence of events in incidents of violence at their workplace?, and 3) How do staff describe their work with prevention and management of violence? Data collection was done through individual interviews, focus group interviews and questionnaires based on the Critical Incident Technique method. Interviews were analyzed with qualitative content analysis. Three themes of staff values emerged in the analysis: 1) From rule to relationship, an experienced movement from a rule-based to a more individualized care, 2) Ways to manage power and responsibility, thoughts about structure and pedagogics, and 3) An institution with a conscious culture, the importance of belonging to a supportive team with common basic views and an open climate. The staff described various kinds of incidents of violence and some of these incidents had serious consequences like seclusion of youngsters and staff injuries causing need for medical care. A need for more education, improved routines and organizational support was expressed. The work to prevent violence included individually detecting risks and, if necessary, communicating with other staff members when assessing these risks. Threats were reported as common but hard to cope with when directed towards a specific staff member and his or her family. The staff stressed the need, after a serious incident, to process what happened with colleagues and youngsters concerned. The colleagues were seen as the most important support, and there were some descriptions of shortcomings in the follow-up routines of violent incidents.

Place, publisher, year, edition, pages
Stockholm, Sweden: Statens institutionsstyrelse, SiS, 2017. p. 84
Series
Institutionsvård i Fokus ; 12
Keywords
Ethics, violence, prevention, institution, staff
National Category
Social Work
Identifiers
urn:nbn:se:oru:diva-67182 (URN)978-91-87053-54-2 (ISBN)
Available from: 2018-06-05 Created: 2018-06-05 Last updated: 2018-06-05Bibliographically approved
Norell-Clarke, A., Tillfors, M., Jansson-Fröjmark, M., Holländare, F. & Engström, I. (2017). How does cognitive behavioral therapy for insomnia work?: An investigation of cognitive processes and time in bed as outcomes and mediators in a sample with insomnia and depressive symptomatology. International Journal of Cognitive Therapy, 10(4), 304-329
Open this publication in new window or tab >>How does cognitive behavioral therapy for insomnia work?: An investigation of cognitive processes and time in bed as outcomes and mediators in a sample with insomnia and depressive symptomatology
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2017 (English)In: International Journal of Cognitive Therapy, ISSN 1937-1209, E-ISSN 1937-1217, Vol. 10, no 4, p. 304-329Article in journal (Refereed) Published
Abstract [en]

The aim of this study was to gain a greater understanding of the five cognitive processes from the cognitive model of insomnia, negative automatic thoughts, and time in bed as outcomes and potential mediators of cognitive behavioral therapy for insomnia (CBT-I), in a sample with insomnia and depressive symptomatology. Sixty-four participants were randomized to receive either CBT-I or an active control (relaxation training: RT) in groups during four biweekly sessions. Insomnia, depressive severity, and the potential processes of change were measured pre-, mid-, and post-treatment. CBT-I was associated with greater reductions of dysfunctional beliefs about sleep, sleep-related safety behaviors, and time in bed compared to RT. Mid-treatment dysfunctional beliefs about sleep was the only process that mediated between CBT-I and outcomes on insomnia and depressive severity, respectively. The relationships were reciprocal. Dysfunctional beliefs about sleep may be a transdiagnostic process of both insomnia and depression.

Place, publisher, year, edition, pages
Guilford Publications, 2017
Keywords
Cognitive behavioral therapy, depression, dysfunctional beliefs, insomnia, mediation
National Category
Psychiatry Psychology (excluding Applied Psychology)
Research subject
Psychiatry
Identifiers
urn:nbn:se:oru:diva-64742 (URN)10.1521/ijct.2017.10.4.304 (DOI)000423606400003 ()2-s2.0-85039558365 (Scopus ID)
Note

Funding Agencies:

Psykiatrifonden  

Research Committee of Region Örebro County, Sweden

Available from: 2018-01-31 Created: 2018-01-31 Last updated: 2018-02-23Bibliographically approved
Sandlund, M., Bremer, A., Ågård, A., Engström, I. & Sallin, K. (2017). Kontinuitet främjar personligt och professionellt ansvarstagande. Läkartidningen, 114, Article ID ETHI.
Open this publication in new window or tab >>Kontinuitet främjar personligt och professionellt ansvarstagande
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2017 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, article id ETHIArticle in journal (Refereed) Published
Place, publisher, year, edition, pages
Läkartidningen Förlag AB, 2017
National Category
Medical Ethics
Identifiers
urn:nbn:se:oru:diva-62406 (URN)29064529 (PubMedID)
Available from: 2018-01-02 Created: 2018-01-02 Last updated: 2018-09-03Bibliographically approved
Schückher, F., Sellin, T., Berglund, K., Berggren, U., Balldin, J., Engström, I. & Fahlke, C. (2017). The Importance of Age at Onset of Excessive Alcohol Use with Regard to Psychiatric Symptoms and Personality Characteristics. Alcoholism Treatment Quarterly, 35(4), 328-343
Open this publication in new window or tab >>The Importance of Age at Onset of Excessive Alcohol Use with Regard to Psychiatric Symptoms and Personality Characteristics
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2017 (English)In: Alcoholism Treatment Quarterly, ISSN 0734-7324, E-ISSN 1544-4538, Vol. 35, no 4, p. 328-343Article in journal (Refereed) Published
Abstract [en]

Psychiatric symptoms and personality characteristics were studied in men (n=252) and women (n=86) as they commenced treatment for excessive alcohol use. The Addiction Severity Index, Symptom Check List, and Temperament and Character Inventory were used. ANOVA with early/late onset and gender as covariates showed significantly lower scores for psychiatric symptoms and more mature personality characteristics in the late-onset group compared to early onset. Men described more depression and anxiety, and women higher persistence. Results indicate the importance of considering age at onset of excessive alcohol use when patients enter treatment because different treatment approaches may be required.

Place, publisher, year, edition, pages
Taylor & Francis Group, 2017
Keywords
alcohol onset, gender, personality, psychiatric symptoms
National Category
Substance Abuse
Identifiers
urn:nbn:se:oru:diva-61355 (URN)10.1080/07347324.2017.1350540 (DOI)000411473600003 ()2-s2.0-85026532744 (Scopus ID)
Note

Funding Agency:

University Health Care Research Center, Region Örebro County, Sweden 

Available from: 2017-10-09 Created: 2017-10-09 Last updated: 2018-08-06Bibliographically approved
Engström, I. & Bengtsson, S. (2017). Vården börjar alltid med mötet. Läkartidningen, 114(42), Article ID ERRM.
Open this publication in new window or tab >>Vården börjar alltid med mötet
2017 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 42, article id ERRMArticle in journal (Refereed) Published
Abstract [sv]

Patient care always starts with an encounter Being a doctor is essentially a moral enterprise and all kinds of care begin with the encounter with the patient. This encounter occurs at the intersection of the patient's need for assistance and the doctor's professional knowledge. The meeting can be characterised by paternalism, autonomy or participation. It is important to regard the patient as a person and explore his or her perceptions, apprehensions and expectations early in the meeting. All decisions in medicine rely on both facts and values. It is, therefore, important that both the doctor's and the patient's values and preferences are out in the open. The medical encounter is always asymmetrical, which necessitates that the power perspective be acknowledged.

Place, publisher, year, edition, pages
Sveriges Läkarförbund, 2017
National Category
Medical Ethics
Identifiers
urn:nbn:se:oru:diva-62409 (URN)29064515 (PubMedID)
Available from: 2017-12-11 Created: 2017-12-11 Last updated: 2018-08-13Bibliographically approved
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3227-2487

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