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Schückher, F., Sellin Jönsson, T., Engström, I. & Berglund, K. (2019). History of childhood abuse is associated with less positive treatment outcomes in socially stable women with alcohol use disorder. BMC Women's Health, 19(1), Article ID 159.
Open this publication in new window or tab >>History of childhood abuse is associated with less positive treatment outcomes in socially stable women with alcohol use disorder
2019 (English)In: BMC Women's Health, ISSN 1472-6874, E-ISSN 1472-6874, Vol. 19, no 1, article id 159Article in journal (Refereed) Published
Abstract [en]

Background: To examine the relationship between treatment outcome, as measured according to change in alcohol consumption, and a history of childhood abuse (emotional, physical, sexual) in socially stable women undergoing treatment for alcohol use disorder (AUD).

Methods: Participants were assessed using the Addiction Severity Index and the Mini International Neuropsychiatric Interview at the beginning of treatment (n = 75), end of treatment (n = 59) and 12 month follow-up after treatment (n = 57). Self-report data on alcohol consumption were obtained at all three time-points using the Alcohol Habits Inventory-Revised 2. Self-report data on childhood maltreatment were obtained at the beginning of treatment using the Childhood Trauma Questionnaire-short form. Study outcomes were changes in alcohol consumption (grams of pure alcohol per week), risk-drinking and reported abstinence.

Results: Of the 75 women enrolled, 38 (50.7%) reported a history of childhood abuse and the rest did not. Both groups showed a significant improvement in all three outcomes at the end of treatment and at 12-month follow-up. At the end of treatment, a significant inter-group difference was found for reported abstinence (non-abused group, 39.3% vs abused, 12.9%; p < 0.05). At 12-month follow-up, significant inter-group differences were observed for all treatment outcomes, with superior outcomes being found for the non-abused group, including a higher proportion of women with reported abstinence (55.6% vs 13.3%; p < 0.01).

Conclusion: The present findings suggest that an evaluation of a possible history of childhood abuse is warranted in all women seeking treatment for AUD, irrespective of social stability. In terms of clinical practice, the results suggest that additional interventions may be warranted in this population.

Place, publisher, year, edition, pages
BMC, 2019
Keywords
Adult women, Alcohol use disorder, Childhood abuse, Treatment outcome
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:oru:diva-79099 (URN)10.1186/s12905-019-0857-4 (DOI)000502718200002 ()31830964 (PubMedID)2-s2.0-85076488310 (Scopus ID)
Note

Funding Agency:

University Health Care Research Center, Region Örebro County, Sweden

Available from: 2020-01-15 Created: 2020-01-15 Last updated: 2020-01-15Bibliographically approved
Nyman-Carlsson, E., Norring, C., Engström, I., Gustafsson, S. A., Lindberg, K., Paulson-Karlsson, G. & Nevonen, L. (2019). Individual cognitive behavioral therapy and combined family/individual therapy for young adults with Anorexia nervosa: A randomized controlled trial. Psychotherapy Research
Open this publication in new window or tab >>Individual cognitive behavioral therapy and combined family/individual therapy for young adults with Anorexia nervosa: A randomized controlled trial
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2019 (English)In: Psychotherapy Research, ISSN 1050-3307, E-ISSN 1468-4381Article in journal (Refereed) Epub ahead of print
Abstract [en]

OBJECTIVE: In this study, we evaluate the efficacy of outpatient individual cognitive behavioral therapy for young adults (CBT-YA) and combined family/individual therapy for young adults (FT-YA) for anorexia nervosa (AN).

METHOD: Participants (aged 17-24 years) with AN in Sweden were recruited and assigned to 18 months of CBT-YA or FT-YA. Treatment efficacy was assessed primarily using BMI, presence of diagnosis, and degree of eating-related psychopathology at post-treatment and follow-up. Secondary outcomes included depression and general psychological psychopathology. The trial was registered at http://www.isrctn.com/, ISRCTN (25181390).

RESULTS: Seventy-eight participants were randomized, and seventy-four of them received allocated treatment and provided complete data. Clinical outcomes from within groups resulted in significant improvements for both groups. BMI increased from baseline (CBT-YA 16.49; FT-YA 16.54) to post-treatment (CBT-YA 19.61; FT-YA 19.33) with high effect sizes. The rate of weight restoration was 64.9% in the CBT-YA group and 83.8% in the FT-YA group. The rate of recovery was 76% in both groups at post-treatment, and at follow-up, 89% and 81% had recovered in the CBT-YA and FT-YA groups respectively.

CONCLUSIONS: Outpatient CBT-YA and FT-YA appear to be of benefit to young adults with AN in terms of weight restoration and reduced eating disorder and general psychopathology.

Place, publisher, year, edition, pages
Routledge, 2019
Keywords
Anorexia nervosa, cognitive behavioral therapy, family therapy, outpatient treatment, randomized controlled trial
National Category
Applied Psychology
Identifiers
urn:nbn:se:oru:diva-77871 (URN)10.1080/10503307.2019.1686190 (DOI)000495523000001 ()31709920 (PubMedID)
Note

Funding Agencies:

Vardal Foundation, Sweden  

Krica Foundation, Sweden  

Örebro University, Sweden 

Available from: 2019-11-14 Created: 2019-11-14 Last updated: 2019-11-27Bibliographically approved
Nyman-Carlsson, E., Birgegård, A., Engström, I., Gustafsson, S. A. & Nevonen, L. (2019). Predictors of outcome among young adult patients with anorexia nervosa in a randomised controlled trial. European eating disorders review, 27(1), 76-85
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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2019 (English)In: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968, Vol. 27, no 1, p. 76-85Article in journal (Refereed) Published
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
John Wiley & Sons, 2019
Keywords
BMI, anorexia nervosa, outcome, prediction, young adults
National Category
Psychiatry Psychology
Identifiers
urn:nbn:se:oru:diva-68439 (URN)10.1002/erv.2630 (DOI)000453012700008 ()30094893 (PubMedID)2-s2.0-85052807835 (Scopus ID)
Funder
Vårdal Foundation
Available from: 2018-08-13 Created: 2018-08-13 Last updated: 2019-01-08Bibliographically approved
Hylén, U., Engström, I., Engström, K., Pelto-Piri, V. & Anderzen-Carlsson, A. (2019). 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, 40(2), 148-157
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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2019 (English)In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 40, no 2, p. 148-157Article in journal (Refereed) Published
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, 2019
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)000463571900009 ()30376382 (PubMedID)2-s2.0-85055739883 (Scopus ID)
Funder
Forte, Swedish Research Council for Health, Working Life and Welfare, 2013-0389
Available from: 2018-11-07 Created: 2018-11-07 Last updated: 2019-06-19Bibliographically approved
Svensson, A. F., Khaldi, M., Engström, I., Matusevich, K. & Nordenskjöld, A. (2019). Remission rate of transcranial magnetic stimulation compared with electroconvulsive therapy: a case-control study. Nordic Journal of Psychiatry, 72(7), 471-476
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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2019 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 72, no 7, p. 471-476Article in journal (Refereed) Published
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, 2019
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)000456435500003 ()30359165 (PubMedID)2-s2.0-85055553308 (Scopus ID)
Note

Funding Agency:

Region Örebro county

Available from: 2018-11-06 Created: 2018-11-06 Last updated: 2019-02-07Bibliographically approved
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
Lynøe, N., Engström, I. & Juth, N. (2018). Dödshjälp bakom okunskapens slöja. Läkartidningen, 115(24), 1020-1020, Article ID EZ4T.
Open this publication in new window or tab >>Dödshjälp bakom okunskapens slöja
2018 (Swedish)In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 115, no 24, p. 1020-1020, article id EZ4TArticle in journal, Editorial material (Refereed) Published
Place, publisher, year, edition, pages
Läkartidngen Förlag AB, 2018
National Category
Medical Ethics
Research subject
Ethics
Identifiers
urn:nbn:se:oru:diva-72005 (URN)29893983 (PubMedID)2-s2.0-85048720759 (Scopus ID)
Available from: 2019-02-01 Created: 2019-02-01 Last updated: 2019-02-04Bibliographically approved
Schückher, F., Sellin, T., Fahlke, C. & Engström, I. (2018). The Impact of Childhood Maltreatment on Age of Onset of Alcohol Use Disorder in Women. European Addiction Research, 24(6), 278-285
Open this publication in new window or tab >>The Impact of Childhood Maltreatment on Age of Onset of Alcohol Use Disorder in Women
2018 (English)In: European Addiction Research, ISSN 1022-6877, E-ISSN 1421-9891, Vol. 24, no 6, p. 278-285Article in journal (Refereed) Published
Abstract [en]

It is unclear whether exposure to childhood maltreatment is associated with the age of onset of alcohol use disorder (AUD). A group of socially stable women with AUD seeking treatment (n = 75) were interviewed using the Addiction Severity Index and the Mini International Neuropsychiatric Interview. They also filled out the Childhood Trauma Questionnaire-short form. Emotional abuse, sexual abuse and multiple childhood traumas were found to be associated with earlier onset of AUD. Multivariable linear regression analysis showed that independent predictors for an earlier onset of AUD were exposure to emotional abuse (beta = -7.44, SE = 2.83, adjusted p = 0.010) and mother's alcohol/substance problems (beta = -7.87, SE = 3.45, adjusted p = 0.026). These variables explained 18.9% of the variance of age of onset of AUD. These findings highlight a need for increased clinical attention to AUD subgroups who have experienced childhood maltreatment, especially emotional abuse, as well as a need for including support in the patient's own parental role in the treatment.

Place, publisher, year, edition, pages
S. Karger, 2018
Keywords
Age of onset, Alcohol use disorder, Childhood maltreatment, Mother’s alcohol/substance problems
National Category
Psychiatry
Research subject
Psychiatry
Identifiers
urn:nbn:se:oru:diva-72004 (URN)10.1159/000494766 (DOI)000456650200002 ()30448841 (PubMedID)2-s2.0-85057010272 (Scopus ID)
Note

Funding Agency:

University Health Care Research Center, Region Örebro County, Sweden

Available from: 2019-02-01 Created: 2019-02-01 Last updated: 2019-02-13Bibliographically approved
Schückher, F., Sellin, T., Fahlke, C. & Engström, I. (2018). The Impact of Childhood Maltreatment on Onset Age of Alcohol Use Disorder in Women Seeking Treatment. In: : . Paper presented at 2018 Annual Meeting, American Psychiatric Association, New York, NY, USA, 5-9 May, 2018.
Open this publication in new window or tab >>The Impact of Childhood Maltreatment on Onset Age of Alcohol Use Disorder in Women Seeking Treatment
2018 (English)Conference paper, Oral presentation with published abstract (Refereed)
National Category
Substance Abuse
Identifiers
urn:nbn:se:oru:diva-73847 (URN)
Conference
2018 Annual Meeting, American Psychiatric Association, New York, NY, USA, 5-9 May, 2018
Available from: 2019-04-17 Created: 2019-04-17 Last updated: 2019-04-17Bibliographically 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
Organisations
Identifiers
ORCID iD: ORCID iD iconorcid.org/0000-0002-3227-2487

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