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  • 1.
    Ahlberg, Rickard
    et al.
    Örebro University, School of Medical Sciences.
    Skårberg, Kurt
    Örebro University, School of Medical Sciences. Addiction Center.
    Brus, Ole
    Clinical Epidemiology and Biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Kjellin, Lars
    Örebro University, School of Health Sciences.
    Auricular acupuncture for substance use: a randomized controlled trial of effects on anxiety, sleep, drug use and use of addiction treatment services2016In: Substance Abuse Treatment, Prevention, and Policy, ISSN 1747-597X, E-ISSN 1747-597X, Vol. 11, no 1, article id 24Article in journal (Refereed)
    Abstract [en]

    Background: A common alternative treatment for substance abuse is auricular acupuncture. The aim of the study was to evaluate the short and long-term effect of auricular acupuncture on anxiety, sleep, drug use and addiction treatment utilization in adults with substance abuse.

    Method: Of the patients included, 280 adults with substance abuse and psychiatric comorbidity, 80 were randomly assigned to auricular acupuncture according to the NADA protocol, 80 to auricular acupuncture according to a local protocol (LP), and 120 to relaxation (controls). The primary outcomes anxiety (Beck Anxiety Inventory; BAI) and insomnia (Insomnia Severity Index; ISI) were measured at baseline and at follow-ups 5 weeks and 3 months after the baseline assessment. Secondary outcomes were drug use and addiction service utilization. Complete datasets regarding BAI/ISI were obtained from 37/34 subjects in the NADA group, 28/28 in the LP group and 36/35 controls. Data were analyzed using Chi-square, Analysis of Variance, Kruskal Wallis, Repeated Measures Analysis of Variance, Eta square (η(2)), and Wilcoxon Signed Ranks tests.

    Results: Participants in NADA, LP and control group improved significantly on the ISI and BAI. There was no significant difference in change over time between the three groups in any of the primary (effect size: BAI, η(2) = 0.03, ISI, η(2) = 0.05) or secondary outcomes. Neither of the two acupuncture treatments resulted in differences in sleep, anxiety or drug use from the control group at 5 weeks or 3 months.

    Conclusion: No evidence was found that acupuncture as delivered in this study is more effective than relaxation for problems with anxiety, sleep or substance use or in reducing the need for further addiction treatment in patients with substance use problems and comorbid psychiatric disorders. The substantial attrition at follow-up is a main limitation of the study.

    Trial registration: Clinical Trials NCT02604706 (retrospectively registered).

  • 2.
    Ahonen, Lia
    et al.
    Örebro University, School of Law, Psychology and Social Work. University of Pittsburgh, Pittsburgh PA, USA.
    Loeber, Rolf
    University of Pittsburgh, Pittsburgh PA, USA.
    Dating violence in teenage girls: parental emotion regulation and racial differences2016In: CBMH. Criminal behaviour and mental health, ISSN 0957-9664, E-ISSN 1471-2857, Vol. 26, no 4, p. 240-250Article in journal (Refereed)
    Abstract [en]

    Background: Teen dating violence (TDV) is a common phenomenon of great public concern. TDV may lead to severe long-term consequences for victims and offenders, and even more so for females than for males.

    Aim: The aim of this paper is to investigate possible underlying factors for involvement in TDV either as a perpetrator or a victim. Social learning theory is commonly used to explain internalisation of parents' behaviour on children's behavioural expressions, but less so on parents' emotion regulation as a direct link to later TDV.

    Method: We used longitudinal data from the Pittsburgh Girls Study (N=2450) to investigate if and how parents' positive and negative emotion regulation is related to TDV, controlling for early aggression and race.

    Results: Results show a moderately strong association between parents' negative emotion regulation and their daughters' involvement in serious dating violence. We also found that many more African American girls were involved in TDV compared to Caucasian girls, both as a perpetrator and victim.

    Conclusions and practical implications: We discuss directions for future research focusing on emotion regulation and dating violence. Copyright (c) 2016 John Wiley & Sons, Ltd.

  • 3.
    Alaie, Iman
    et al.
    Dept Psychol, Uppsala Univ, Uppsala, Sweden.
    Frick, Andreas
    Dept Psychol, Uppsala Univ, Uppsala, Sweden.
    Marteinsdottir, Ina
    Dept Clin & Expt Med, Linköping Univ, Linköping, Sweden.
    Hartvig, Per
    Dept Drug Design & Pharmacol, Univ Copenhagen, Copenhagen, Denmark.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Eriksson, Elias
    Dept Pharmacol, Univ Gothenburg, Gothenburg, Sweden.
    Fredrikson, Mats
    Dept Psychol, Uppsala Univ, Uppsala, Sweden.
    Furmark, Tomas
    Dept Psychol, Uppsala Univ, Uppsala, Sweden.
    Serotonin Synthesis Rate and the Tryptophan Hydroxylase-2 G-703T Polymorphism in Social Anxiety Disorder2014In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 75, no 9, p. 357S-357SArticle in journal (Other academic)
  • 4.
    Andersen, Lisa M. J.
    et al.
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Näswall, Katharina
    Department of Psychology, Stockholm University, Stockholm, Sweden; Department of Psychology, University of Canterbury, Christchurch, New Zealand.
    Manouilenko, Irina
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Nylander, Lena
    Department of Clinical Sciences, Psychiatry, Lund University, Lund, Sweden.
    Edgar, Johan
    Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Ritvo, Riva Ariella
    Yale Child Study Center, Yale University School of Medicine, New Haven, USA.
    Ritvo, Edward
    The Neuropsychiatric Institute, UCLA School of Medicine, Los Angeles, USA.
    Bejerot, Susanne
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    The Swedish version of the Ritvo autism and asperger diagnostic scale: revised (RAADS-R). A validation study of a rating scale for adults2011In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 41, no 12, p. 1635-1645Article in journal (Refereed)
    Abstract [en]

    There is a paucity of diagnostic instruments for adults with autism spectrum disorder (ASD). This study evaluates the psychometric properties of the Swedish version of the Ritvo Autism and Asperger Diagnostic Scale-Revised (RAADS-R), an 80-item self-rating scale designed to assist clinicians diagnosing ASD in adults. It was administered to 75 adults with ASD and 197 comparison cases. Also, a subset completed the Autism Spectrum Quotient (AQ). Three out of four subscales had high internal consistency. Sensitivity was 91% and specificity was 93%. The ASD subjects had significantly higher mean scores on all subscales. ASD females had higher scores than ASD males on the sensory motor subscale, a dimension not included in the AQ. RAADS-R showed promising test re-test reliability.

  • 5.
    Andershed, Henrik
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Tuvblad, Catherine
    Utveckling av psykopati från barndom till vuxen ålder2016In: Psykopati / [ed] Mette K. F. Kreis, Helge Andreas Hoff, Henrik Belfrage & Stephen D. Hart, Lund: Studentlitteratur AB, 2016, p. 49-71Chapter in book (Other academic)
  • 6. Andersson, Gerhard
    et al.
    Bergström, Jan
    Buhrman, Monica
    Carlbring, Per
    Holländare, Fredrik
    Örebro University, School of Health and Medical Sciences.
    Kaldo, Viktor
    Nilsson-Ihrfelt, Elisabeth
    Paxling, Björn
    Ström, Lars
    Waara, Johan
    Development of a new approach to guided self-help via the Internet: The Swedish experience2008In: Journal of technology in human services, ISSN 1522-8835, E-ISSN 1522-8991, Vol. 26, no 2-4, p. 161-181Article in journal (Refereed)
    Abstract [en]

    This article describes the development and empirical status of guided Internet-delivered self-help. The treatment approach combines the benefits of bibliotherapy with book-length text materials and the support given online via web pages and e-mail. Interactive features such as online registrations, tests, and online discussion forums are also included. Cognitive behavior therapy (CBT) guided the research and clinical implementations of this approach, as it lends itself more easily to the self-help format compared with other presently available psychotherapy approaches. We include an overview of the research, current issues and research in service delivery, lessons learned through a program of research, and directions for future investigations

  • 7.
    Arnell, Susann
    et al.
    Örebro University, School of Health Sciences. University Health Care Research Center (UFC) Region Örebro County, Örebro, Sweden.
    Jerlinder, K.
    Faculty of Health and Occupational Studies, University of Gävle, Gävle , Sweden.
    Lundqvist, Lars-Olov
    Örebro University, School of Law, Psychology and Social Work. University Health Care Research Center (UFC) Region Örebro County, Örebro, Sweden.
    Participation in physical activities -a multilevel challenge for adolescents with autism spectrum disorders2017Conference paper (Other academic)
    Abstract [en]

    Introduction: Physical inactivity is one of the biggest current public health problems. Few adolescents with autism spectrum disorder (ASD) achieve the recommendation of daily physical activity (PA). The reasons for not being physically active depend on several complex factors, yet not comprehensively described from the adolescents’point of view. The absence of their perspective means that intervention strategies for health enhancing physical activity may not encompass the experiences of the adolescents themselves. Therefore the purpose of this study was to develop an understanding of the perceptions, experiences and reflections of adolescents with ASDs’participation in PA.

    Participants and methods: Twenty-four adolescents, diagnosed with ASD without a co-occurring intellectual disability, aged 12-16 years, participated in the study.Data was collected using qualitative interviews and inductively analyzed using qualitative content analysis.

    Results: Adolescents with ASD were a heterogeneous group in regard to their current PA habits and preferences. Their willingness to participate in PA was conditioned regarding; what, where, when and with whom. They described challenges in the activity and the social context during PA, especially during the mandatory physical education. Perceived demands, freedom of choice, physical ability and sense of control affected their PA participation.

    Conclusion: Findings indicate that the adolescents’willingness to participate was associated with interacting and individual-related conditions, which can be misinterpreted as unwillingness to participate in PA. Thus aspects of autonomy and knowledge about individual conditions and needs have to be recognized when intervention strategies for health enhancing physical activities are planned for this population.

  • 8.
    Baker, J. H.
    et al.
    Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Medical College of Virginia of Virginia Commonwealth University, Richmond, USA; Department of Psychology, Virginia Commonwealth University, Richmond, USA.
    Maes, H. H.
    Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Medical College of Virginia of Virginia Commonwealth University, Richmond, USA; Department of Human Genetics, Virginia Commonwealth University, Richmond, USA; Massey Cancer Center, Virginia Commonwealth University, Richmond, USA.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, P.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Kendler, K. S.
    Virginia Institute for Psychiatric and Behavioral Genetics, Department of Psychiatry, Medical College of Virginia of Virginia Commonwealth University, Richmond, USA; Department of Human Genetics, Virginia Commonwealth University, Richmond, USA; Department of Psychiatry, Virginia Commonwealth University, Richmond, USA.
    Sex differences and developmental stability in genetic and environmental influences on psychoactive substance consumption from early adolescence to young adulthood2011In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 41, no 9, p. 1907-1916Article in journal (Refereed)
    Abstract [en]

    Background: Genetic and environmental factors are important in the etiology of substance use. However, little is known about the stability of these factors across development. We aimed to answer three crucial questions about this etiology that have never been addressed in a single study: (1) Is there a general vulnerability to substance consumption from early adolescence to young adulthood? (2) If so, do the genetic and environmental influences on this vulnerability change across development? (3) Do these developmental processes differ in males and females?

    Method: Subjects included 1480 twin pairs from the Swedish Twin Study of Child and Adolescent Development who have been followed since 1994. Prospective, self-reported regular smoking, alcohol intoxication and illicit drug use were assessed at ages 13-14, 16-17 and 19-20 years. Structural modeling was performed with the program Mx.

    Results: An underlying common factor accounted for the association between smoking, alcohol and illicit drug consumption for the three age groups. Common genetic and shared environmental effects showed substantial continuity. In general, as participants aged, the influence of the shared environment decreased, and genetic effects became more substance specific in their effect.

    Conclusions: The current report answers three important questions in the etiology of substance use. The genetic and environmental risk for substance consumption is partly mediated through a common factor and is partly substance specific. Developmentally, evidence was strongest for stability of common genetic effects, with less evidence for genetic innovation. These processes seem to be the same in males and females.

  • 9.
    Baker, Jessica H.
    et al.
    Department of Psychiatry, University of North Carolina at Chapel Hill, United States.
    Munn-Chernoff, Melissa A.
    Department of Psychiatry, University of North Carolina at Chapel Hill, United States.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, United States.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, United States.
    Maes, Hermine
    Department of Genetics, VA Commonwealth University, United States.
    Kendler, Kenneth S.
    Department of Psychiatry, VA Commonwealth University, United States.
    Shared Familial Risk Between Bulimic Symptoms and Alcohol Involvement During Adolescence2017In: Journal of Abnormal Psychology, ISSN 0021-843X, E-ISSN 1939-1846, Vol. 126, no 5, p. 506-518Article in journal (Refereed)
    Abstract [en]

    Twin studies show the established relation between bulimic symptoms and problematic alcohol involvement in adult females is partly due to shared familial factors, specifically shared genetic effects. However, it is unclear if similar shared etiological factors exist during adolescence or in males. We examined the familial overlap (i.e., genetic and common environmental correlations) between bulimic symptoms and various levels of alcohol involvement in 16- to 17-year-old female and male same-sex twin pairs using sex-specific biometrical twin modeling. Bulimic symptoms were assessed with the Eating Disorder Inventory-2. Alcohol involvement included alcohol use in the last month, having ever been intoxicated, and alcohol intoxication frequency. Results revealed 3 distinct patterns. First, in general, phenotypic correlations indicated statistically similar associations between bulimic symptoms and alcohol involvement in girls and boys. Second, common environmental overlap was significant for the bivariate associations including having ever been intoxicated. Third, moderate genetic correlations were observed between all bulimic symptoms and alcohol involvement in girls and moderate common environmental correlations were observed in boys for the more risky/deviant levels of involvement. Similar to adults, there is familial overlap between bulimic symptoms and alcohol involvement in adolescent girls and boys. These results could inform symptom-and sex-specific, developmentally targeted prevention and intervention programs for the comorbidity between bulimic symptoms and alcohol involvement.

  • 10.
    Beckman, K.
    et al.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm City Council, St Goran, Stockholm, Sweden.
    Mittendorfer-Rutz, E.
    Department of Clinical Neuroscience, Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, P.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Almqvist, C
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Astrid Lindgren Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden.
    Runeson, B.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm City Council, St Goran, Stockholm, Sweden.
    Dahlin, M.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm City Council, St Goran, Stockholm, Sweden.
    Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort2016In: Psychological Medicine, ISSN 0033-2917, E-ISSN 1469-8978, Vol. 46, no 16, p. 3397-3405Article in journal (Refereed)
    Abstract [en]

    Background: Self-harm among young adults is a common and increasing phenomenon in many parts of the world. The long-term prognosis after self-harm at young age is inadequately known. We aimed to estimate the risk of mental illness and suicide in adult life after self-harm in young adulthood and to identify prognostic factors for adverse outcome.

    Method: We conducted a national population-based matched case-cohort study. Patients aged 18-24 years (n = 13 731) hospitalized after self-harm between 1990 and 2003 and unexposed individuals of the same age (n = 137 310 ) were followed until December 2009. Outcomes were suicide, psychiatric hospitalization and psychotropic medication in short-term (1-5 years) and long-term (>5 years) follow-up.

    Results: Self-harm implied an increased relative risk of suicide during follow-up [hazard ratio (HR) 16.4, 95% confidence interval (CI) 12.9-20.9). At long-term follow-up, 20.3% had psychiatric hospitalizations and 51.1% psychotropic medications, most commonly antidepressants and anxiolytics. There was a six-fold risk of psychiatric hospitalization (HR 6.3, 95% CI 5.8-6.8) and almost three-fold risk of psychotropic medication (HR 2.8, 95% CI 2.7-3.0) in long-term follow-up. Mental disorder at baseline, especially a psychotic disorder, and a family history of suicide were associated with adverse outcome among self-harm patients.

    Conclusion: We found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.

  • 11.
    Beckman, Karin
    et al.
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm City Council, St Göran's Hospital, Stockholm, Sweden.
    Mittendorfer-Rutz, Ellenor
    Department of Clinical Neuroscience, Insurance Medicine, Karolinska Institutet, Stockholm, Sweden.
    Waern, Margda
    Institute of Neuroscience and Physiology, Department of Psychiatry and Neurochemistry, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Larsson, Henrik
    Örebro University, School of Medical Sciences. Department of Medical Sciences, Örebro University, Örebro, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Runeson, Bo
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm City Council, St Göran's Hospital, Stockholm, Sweden.
    Dahlin, Marie
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stockholm Health Care Services, Stockholm City Council, St Göran's Hospital, Stockholm, Sweden.
    Method of self-harm in adolescents and young adults and risk of subsequent suicide2018In: Journal of Child Psychology and Psychiatry and Allied Disciplines, ISSN 0021-9630, E-ISSN 1469-7610Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Self-harm is common in youth and an important risk factor for suicide. Certain self-harm methods might indicate a higher risk of suicide. The main aim of this study was to determine whether some methods of self-harm in adolescents (10-17 years) and young adults (18-24 years) are associated with a particularly high risk of suicide. A secondary aim was to ascertain how different self-harm methods might affect the probability of psychiatric follow-up.

    METHOD: Five Swedish registers were linked in a national population-based cohort study. All nonfatal self-harm events recorded in specialist health care, excluding psychiatry and primary care services, among 10-24 year olds between 2000 and 2009 were included. Methods were classified as poisoning, cutting/piercing, violent method (gassing, hanging, strangulation/suffocation, drowning, jumping and firearms), other and multiple methods. Hazard Ratios (HR) for suicide were calculated in Cox regression models for each method with poisoning as the reference. Odds Ratios (OR) for psychiatric inpatient care were determined in logistic regression models. Analyses were adjusted for important covariates and stratified by age group and treatment setting (inpatient/outpatient).

    RESULTS: Among adolescents with initial medical hospitalisation, use of a violent method was associated with a near eightfold increase in HR for suicide compared to self-poisoning in the adjusted analysis [HR 7.8; 95% confidence interval (CI) 3.2-19.0]. Among hospitalised young adult women, adjusted HRs were elevated fourfold for both cutting [4.0 (1.9-8.8)] and violent methods [3.9 (1.5-10.6)]. Method of self-harm did not affect suicide risk in young adult men. Adolescents using violent methods had an increased probability of psychiatric inpatient care following initial treatment for self-harm.

    CONCLUSIONS: Violent self-harm requiring medical hospitalisation may signal particularly high risk of future suicide in adolescents (both sexes) and in young adult women. For the latter group this is the case for cutting requiring hospitalisation as well.

  • 12.
    Bejerot, Susanne
    Karolinska Institute, Stockholm, Sweden.
    An autistic dimension: a proposed subtype of obsessive-compulsive disorder2007In: Autism, ISSN 1362-3613, E-ISSN 1461-7005, Vol. 11, no 2, p. 101-110Article in journal (Refereed)
    Abstract [en]

    This article focuses on the possibility that autism spectrum disorder (ASD: Asperger syndrome, autism and atypical autism) in its milder forms may be clinically important among a substantial proportion of patients with obsessive-compulsive disorder (OCD), and discusses OCD subtypes based on this proposition. The hypothesis derives from extensive clinical experience of OCD and ASD, and literature searches on MEDLINE. Neuropsychological deficits are more common in OCD than in panic disorder and depression. Moreover, obsessive-compulsive and schizotypal personality disorders are over-represented in OCD. These may constitute mis-perceived clinical manifestations of ASD. Furthermore, repetitive behaviours and hoarding are common in Asperger syndrome. It is suggested that the comorbidity results in a more severe and treatment resistant form of OCD. OCD with comorbid ASD should be recognized as a valid OCD subtype, analogous to OCD with comorbid tics. An odd personality, with paranoid, schizotypal, avoidant or obsessive-compulsive traits, may indicate these autistic dimensions in OCD patients.

  • 13.
    Bejerot, Susanne
    Institutionen för klinisk neurovetenskap, Karolins­ka institutet, Stockholm, Sweden.
    Ett överlappande och föränderligt landskap: [An overlapping and changing landscape]2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 39Article in journal (Refereed)
  • 14. Bejerot, Susanne
    Ingen tjänar på att det går inflation i autismspektrumbegreppet: [No one benefits from inflation of the autism spectrum concept]2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 47, p. 2978-2930Article in journal (Refereed)
  • 15.
    Bejerot, Susanne
    institutionen för neurovetenskap, psykiatri, Uppsala universitet, Uppsala, Sweden.
    Kapsulotomi vid tvångssyndrom, en överflödig behandlingsform? Läkemedel och beteendeterapi ger god effekt: [Is capsulotomy in obsessive-compulsive syndromes an unnecessary therapeutic method? Good results with drug therapy and behavior therapy]1998In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 95, no 45, p. 5003-5005Article in journal (Refereed)
  • 16. Bejerot, Susanne
    Kvalitetsregister – hot mot vårdkvalitet, arbetsmiljö och klinisk forskning?: [Quality registry--a threat against quality of health care, occupational environment and clinical research?]2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 14, p. 986-986Article in journal (Refereed)
  • 17. Bejerot, Susanne
    Medicinsk kommentar: Psykokirurgi idag – en kritisk betraktelse. Svåra biverkningar av kapsulotomi visar sig efter 50 års användning: [Psychosurgery today--a critical reflection. Severe adverse effects of capsulotomy seen after 50 years of use]2003In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 100, no 32-33, p. 2502-2504Article in journal (Refereed)
    Abstract [sv]

    Kapsulotomi – »det sista halmstrået« för behandling av terapirefraktärt, invalidiserande tvångssyndrom – har i Sverige under lång tid rapporterats ha försumbara risker.

    Efter export av metoden till USA är resultaten mindre framgångsrika. Biverkningar av frontallobstyp kan möjligen progrediera många år efter ingreppet.

    Kritik har nyligen riktats mot bristen på långtidsuppföljningar och studier med oberoende bedömare.

    Trots att kapsulotomi utförts under lång tid är det vetenskapliga kunskapsläget otillräckligt. Bland annat är frågan om terapiresistens och biverkningar knapphändigt belysta.

    Ett referat av en uppföljning av personer som genomgått kapsulotomi publiceras i detta nummer. Denna vetenskapligt invändningsfria studie visar betydligt mindre gynnsamma resultat än vad tidigare studier gjort.

  • 18. Bejerot, Susanne
    Psychosurgery for obsessive-compulsive disorder: concerns remain2003In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 107, no 4, p. 241-243Article in journal (Refereed)
  • 19. Bejerot, Susanne
    Ska toppstyrd registerforskarindustri ersätta patientnära forskning? : [Is top directed registry research industry to substitute near-patient research?]2009In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 106, no 30-31, p. 1918-1918Article in journal (Refereed)
  • 20.
    Bejerot, Susanne
    Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    The relationship between poor motor skills and neurodevelopmental disorders2011In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 53, no 9, p. 779-779Article in journal (Refereed)
  • 21. Bejerot, Susanne
    Tvångssyndromet. Nya aspekter på psykiatrins kameleont: [The obsessive-compulsive syndrome: new aspects of a psychiatric chameleon]1992In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 89, no 36, p. 2842-2844Article in journal (Refereed)
  • 22. Bejerot, Susanne
    Upprättelse! Diagnos kan bli vändpunkt för vuxna med ADHD/autismspektrumstörning: [Rehabilitation! Diagnosis can be a turning point for adults with ADHD/autism spectrum disorders]2004In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 101, no 42, p. 3222-3223Article in journal (Refereed)
  • 23. Bejerot, Susanne
    Utestängd patientgrupp. Nytänkande krävs för vuxna med ADHD/Tourette/autismspektrumtillstånd: [Excluded patient group. A new approach is necessary for adults with ADHD/Tourette syndrome/autism spectrum disorders]2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, no 19, p. 1508-1508Article in journal (Refereed)
  • 24.
    Bejerot, Susanne
    et al.
    Department of Neuroscience. Psychiatry, University Hospital, Uppsala, Sweden.
    Bodlund, O.
    Department of Psychiatry, University Hospital, Umeå, Sweden.
    Response to high doses of citalopram in treatment-resistant obsessive-compulsive disorder1998In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 98, no 5, p. 423-424Article in journal (Refereed)
    Abstract [en]

    We report a severe case of obsessive-compulsive disorder (OCD) that responded to very high doses of citalopram (160 mg/day) after a poor response to clomipramine 250 mg/day for several years, alone or in combination with buspirone 30 mg/day or flupenthixol 4 mg/day. The patient had previously been submitted for capsulotomy which was declined, probably due to the magical content of her obsessions, which resembled delusions.

  • 25.
    Bejerot, Susanne
    et al.
    Norra Stockholms psykiatri, Stockholm, Sweden.
    Bruno, Kai
    BUP Brommaplan, Stockholm, Sweden.
    Gerland, Gunilla
    Lindquist, Lars
    Infektionskliniken, Karolinska universitetssjukhuset, Huddinge, Sweden.
    Nordin, Viviann
    Sachsska barn- och ungdomssjukhuset, Södersjukhuset, Stockholm, Sweden.
    Pelling, Henrik
    BUP-kliniken, Akademiska sjukhuset, Uppsala, Sweden.
    Humble, Mats B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Misstänk PANDAS hos barn med akuta neuropsykiatriska symptom. Infektion bakom sjukdomen [Suspect PANDAS in children with acute neuropsychiatric symptoms. Infection behind the disease]: långvarig antibiotikabehandling bör övervägas  [long-term antibiotic therapy should be considered]2013In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 110, no 41, p. 1803-1803, article id CDCDArticle in journal (Refereed)
  • 26.
    Bejerot, Susanne
    et al.
    Örebro University Hospital. Dept Clin Neurosci, Karolinska Inst, Stockholm, Sweden.
    Edman, Gunnar
    Dept Psychiat, TioHundra AB, Norrtälje, Sweden.
    Anckarsäter, Henrik
    Inst Neurosci & Physiol, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Berglund, Gunilla
    Dept Psychol, Stockholm Univ, Stockholm, Sweden.
    Gillberg, Christopher
    Inst Neurosci & Physiol, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Hofvander, Björn
    Dept Clin Sci, Lund Univ, Malmö, Sweden.
    Humble, Mats B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Mörtberg, Ewa
    Dept Psychol, Stockholm Univ, Stockholm, Sweden.
    Råstam, Maria
    Dept Clin Sci, Lund Univ, Malmö, Sweden.
    Ståhlberg, Ola
    Inst Neurosci & Physiol, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Frisen, Louise
    Dept Clin Neurosci, Karolinska Inst, Stockholm, Sweden.
    The Brief Obsessive-Compulsive Scale (BOCS): a self-report scale for OCD and obsessive-compulsive related disorders2014In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 68, no 8, p. 549-559Article in journal (Refereed)
    Abstract [en]

    Background: The Brief Obsessive Compulsive Scale (BOCS), derived from the Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) and the children's version (CY-BOCS), is a short self-report tool used to aid in the assessment of obsessive-compulsive symptoms and diagnosis of obsessive-compulsive disorder (OCD). It is widely used throughout child, adolescent and adult psychiatry settings in Sweden but has not been validated up to date.

    Aim: The aim of the current study was to examine the psychometric properties of the BOCS amongst a psychiatric outpatient population.

    Method: The BOCS consists of a 15-item Symptom Checklist including three items (hoarding, dysmorphophobia and self-harm) related to the DSM-5 category "Obsessive-compulsive related disorders", accompanied by a single six-item Severity Scale for obsessions and compulsions combined. It encompasses the revisions made in the Y-BOCS-II severity scale by including obsessive-compulsive free intervals, extent of avoidance and excluding the resistance item. 402 adult psychiatric outpatients with OCD, attention-deficit/hyperactivity disorder, autism spectrum disorder and other psychiatric disorders completed the BOCS.

    Results: Principal component factor analysis produced five subscales titled "Symmetry", "Forbidden thoughts", "Contamination", "Magical thoughts" and "Dysmorphic thoughts". The OCD group scored higher than the other diagnostic groups in all subscales (P < 0.001). Sensitivities, specificities and internal consistency for both the Symptom Checklist and the Severity Scale emerged high (Symptom Checklist: sensitivity = 85%, specificities = 62-70% Cronbach's alpha = 0.81; Severity Scale: sensitivity = 72%, specificities = 75-84%, Cronbach's alpha = 0.94).

    Conclusions: The BOCS has the ability to discriminate OCD from other non-OCD related psychiatric disorders. The current study provides strong support for the utility of the BOCS in the assessment of obsessive-compulsive symptoms in clinical psychiatry.

  • 27.
    Bejerot, Susanne
    et al.
    Department of Psychiatry, University Hospital, Uppsala, Sweden.
    Ekselius, L.
    Department of Psychiatry, University Hospital, Uppsala, Sweden.
    von Knorring, L.
    Department of Psychiatry, University Hospital, Uppsala, Sweden.
    Comorbidity between obsessive-compulsive disorder (OCD) and personality disorders1998In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 97, no 6, p. 398-402Article in journal (Refereed)
    Abstract [en]

    The aims of the present study were to examine the frequency of personality disorders in 36 patients with obsessive-compulsive disorder (OCD), and to investigate whether patients with a coexisting personality disorder could be characterized by certain personality traits assessed by means of the Karolinska Scales of Personality (KSP). In total, 27 (75%) of the OCD patients fulfilled the DSM-III-R criteria for a personality disorder, and 13 patients (36%) had an obsessive-compulsive personality disorder. Subjects with a comorbid personality disorder had significantly higher scores on most of the KSP scales, including all anxiety scales, as well as scales measuring indirect aggression, irritability, guilt and detachment, whereas subjects without personality disorders did not differ significantly from healthy controls with regard to personality traits.

  • 28.
    Bejerot, Susanne
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden .
    Eriksson, Jonna M.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden .
    Sexuality and gender role in autism spectrum disorder: a case control study2014In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 9, no 1, article id e87961Article in journal (Refereed)
    Abstract [en]

    The 'extreme male brain theory of autism' describes an extreme male pattern of cognitive traits defined as strong systemising abilities paired with empathising weaknesses in autism spectrum disorder. However, beyond these cognitive traits, clinical observations have suggested an ambiguous gender-typed pattern regarding several sexually dimorphic traits. The aim of the present study was to investigate if patterns of non-cognitive sexually dimorphic traits differed between the autism spectrum disorder and control groups. Fifty adults with autism spectrum disorder and intelligence within the normal range, and 53 neurotypical controls responded to questions on gender role, self-perceived gender typicality and gender identity, as well as sexuality. Measures used were a Swedish modification of the Bem Sex Role Inventory and questions on sexuality and gender designed for the purpose of this study. Our results showed that one common gender role emerged in the autism spectrum disorder group. Masculinity (e.g. assertiveness, leadership and competitiveness) was weaker in the autism spectrum disorder group than in the controls, across men and women. Self-perceived gender typicality did not differ between the groups but tomboyism and bisexuality were overrepresented amongst women with autism spectrum disorder. Lower libido was reported amongst both male and female participants with autism spectrum disorder compared with controls. We conclude that the extreme male patterns of cognitive functions in the autistic brain do not seem to extend to gender role and sexuality. A gender-atypical pattern for these types of characteristics is suggested in autism spectrum disorder.

  • 29.
    Bejerot, Susanne
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Jonna M.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Bonde, Sabina
    Northern Stockholm Psychiatry, St Göran Hospital, Stockholm, Sweden.
    Carlström, Kjell
    Department of Woman and Child Health, Division of Obstetrics and Gynaecology, Karolinska Institutet, Stockholm, Sweden.
    Humble, Mats B.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Neuroscience, Uppsala University Hospital, Uppsala, Sweden.
    Eriksson, Elias
    Department of Pharmacology, Institute of Neuroscience and Physiology, Göteborg, Sweden.
    The extreme male brain revisited: gender coherence in adults with autism spectrum disorder2012In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 201, p. 116-123Article in journal (Refereed)
    Abstract [en]

    Background: The 'extreme male brain' theory suggests that autism spectrum disorder (ASD) is an extreme variant of male intelligence. However, somewhat paradoxically, many individuals with ASD display androgynous physical features regardless of gender.

    Aims: To assess physical measures, supposedly related to androgen influence, in adults with and without ASD.

    Method: Serum hormone levels, anthropometry, the ratio of 2nd to 4th digit length (2D:4D) and psychiatric symptomatology were measured in 50 adults with high-functioning ASD and age- and gender-matched neurotypical controls. Photographs of face and body, as well as voice recordings, were obtained and assessed with respect to gender coherence, blindly and independently, by eight assessors.

    Results: Women with ASD had higher total and bioactive testosterone levels, less feminine facial features and a larger head circumference than female controls. Men in the ASD group were assessed as having less masculine body characteristics and voice quality, and displayed higher (i.e. less masculine) 2D:4D ratios, but similar testosterone levels to controls. Androgynous facial features correlated strongly and positively with autistic traits measured with the Autism-Spectrum Quotient in the total sample. In males and females with ASD dehydroepiandrosterone sulfate did not decrease with age, in contrast to the control group.

    Conclusions: Women with ASD had elevated testosterone levels and several masculinised characteristics compared with controls, whereas men with ASD displayed several feminised characteristics. Our findings suggest that ASD, rather than being characterised by masculinisation in both genders, may constitute a gender defiant disorder.

  • 30.
    Bejerot, Susanne
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Jonna M.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Mörtberg, Ewa
    Department of Psychology, Stockholm University, Stockholm, Sweden.
    Social anxiety in adult autism spectrum disorder2014In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 220, no 1-2, p. 705-707Article in journal (Refereed)
    Abstract [en]

    A link has been suggested between Autism Spectrum Disorder (ASD) and anxiety disorders. The aim of the study was to examine the severity of social anxiety measured by the Liebowitz Social Anxiety Scale Self-Report and prevalence of Social Anxiety Disorder (SAD) in adults with ASD, with SAD and a non-ASD comparison group. Individuals with ASD showed significantly higher scores of social anxiety and social avoidance relative to the comparison group, but significantly lower scores relative to the SAD sample.

  • 31.
    Bejerot, Susanne
    et al.
    Norra Stockholms psykiatri, Stockholm, Sweden.
    Gardner, Ann
    Järvapsykiatrin, institutionen för klinisk neurovetenskap, Karolinska institutet, Stockholm, Sweden.
    Humble, Mats B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Diagnostik och terapi utmanar än, trots snabb tillväxt av kunskap [Diagnosis and therapy are still challenging, despite the rapid growth of knowledge]2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 39, p. 1638-1641, article id CYRHArticle, review/survey (Refereed)
    Abstract [sv]

    Psychiatric diagnoses are not reflections of the aetiology of the disorder, but rather lists of symptoms with considerable overlaps, which hamper research and may cause confusion. The diagnoses of autism spectrum disorder, attention deficit hyperactivity disorder and tic disorder are often comorbid along with a number of other symptomatic syndromes. Individual immune responsivity is possibly involved in pathophysiological mechanisms. Multiple environmental factors may contribute to the clinical phenotypes. Recent research supports to some extent the involvement of dietary and nutritional factors in ADHD. In spite of impressive progress in the molecular biological understanding of the pathophysiology of these disorders, treatment options are still limited and more research is warranted.

  • 32.
    Bejerot, Susanne
    et al.
    Örebro University, School of Medical Sciences.
    Hesselmark, E.
    Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden.
    Pediatric autoimmune neuropsychiatric syndrome (PANS), developmental regression and autism2017In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 41, no Suppl., p. S123-S123Article in journal (Other academic)
    Abstract [en]

    Introduction: Pediatric autoimmune neuropsychiatric syndrome (PANS) is a term used to describe a clinical picture which includes sudden onset of psychiatric symptoms and a possible autoimmune genesis. The sudden decline in neuropsychiatric functioning as well as the multiple combinations of symptoms may lead to a clinical phenotype similar to that in infantile autism (IA) with regressive features. We are conducting a study with the aim to evaluate a diagnostic test for PANS currently marketed by Moleculera Labs. All patients in Sweden who had taken the test (n = 154) were invited to the study.

    Objectives: The aim of the study is to characterize a subgroup of patients with IA within the PANS diagnosis study.

    Methods: Participants (n = 53) were examined for psychiatric and somatic symptoms and evaluated for PANS caseness by an experienced psychiatrist. Because the criteria for entering the study was having taken the diagnostic test for PANS, the participants in the study comprise a group with mixed symptoms.

    Results: Twelve participants had IA. Eleven of these reported a developmental regression with loss of abilities. Two of the IA patients also fulfill criteria for PANS. Eight of the IA patients had been treated with antibiotics for psychiatric symptoms and 4 reported a positive effect of this treatment. Nine of the patients had elevated test results suggesting possible PANS according to Moleculera Labs.

    Conclusions: Very early onset on PANS may be phenotypically similar to IA with regressive features. Further analysis of the immunological attributes of patients with autism with regressive features is warranted.

  • 33.
    Bejerot, Susanne
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Northern Stockholm Psychiatry, St Göran Hospital, Stockholm, Sweden.
    Humble, Mats B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Childhood clumsiness and peer victimization: a case-control study of psychiatric patients2013In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 13, article id 68Article in journal (Refereed)
    Abstract [en]

    Background: Poor motor and social skills as well as peer victimization are commonly reported in both ADHD and autism spectrum disorder. Positive relationships between poor motor and poor social skills, and between poor social skills and peer victimization, are well documented, but the relationship between poor motor skills and peer victimization has not been studied in psychiatric populations.

    Method: 277 patients (133 males, 144 females), mean age 31 years, investigated for ADHD or autism spectrum disorder in adulthood and with normal intelligence, were interviewed about childhood peer victimization and examined for gross motor skills. The parents completed a comprehensive questionnaire on childhood problems, the Five to Fifteen. The Five to Fifteen is a validated questionnaire with 181 statements that covers various symptoms in childhood across eight different domains, one of them targeting motor skills. Regression models were used to evaluate the relationship between motor skills and the risk and duration of peer victimization, adjusted for sex and diagnosis.

    Results: Victims were described as more clumsy in childhood than their non-victimized counterparts. A significant independent association was found between reportedly poor childhood gross motor skills and peer victimization (adjusted odds ratio: 2.97 [95% confidence interval: 1.46-6.07], n = 235, p = 0.003). In adulthood, the victimized group performed worse on vertical jumps, a gross motor task, and were lonelier. Other factors that were expected to be associated with peer victimization were not found in this highly selected group.

    Conclusion: Poor gross motor skills constitute a strong and independent risk factor for peer victimization in childhood, regardless of sex, childhood psychiatric care and diagnosis.

  • 34. Bejerot, Susanne
    et al.
    Humble, Mats B.
    Hög förekomst av autism hos svensk-somaliska barn [Increased occurrence of autism among Somali children]: Kan D-vitaminbrist spela in? [Does vitamin D deficiency play a role?]2008In: Tidsskrift for Den norske lægeforening, ISSN 0029-2001, E-ISSN 0807-7096, Vol. 128, no 17, p. 1986-1987Article in journal (Refereed)
  • 35.
    Bejerot, Susanne
    et al.
    Department of Neuroscience, Division of Psychiatry, University Hospital, Uppsala, USA; Karolinska Institutet, Department of Clinical Neurosciences and Family Medicine, Division of Psychiatry, Huddinge University Hospital, Huddinge, Sweden.
    Humble, Mats B.
    Department of Neuroscience, Division of Psychiatry, University Hospital, Uppsala, USA; Karolinska Institutet, Department of Clinical Neurosciences and Family Medicine, Division of Psychiatry, Huddinge University Hospital, Huddinge, Sweden.
    Low prevalence of smoking among patients with obsessive-compulsive disorder1999In: Comprehensive Psychiatry, ISSN 0010-440X, E-ISSN 1532-8384, Vol. 40, no 4, p. 268-272Article in journal (Refereed)
    Abstract [en]

    Tobacco smoking is common among psychiatric patients, especially among those with schizophrenia, where the prevalence is extremely high, 74% to 88%, compared with 45% to 70% in patients with other psychiatric diagnoses. Patients with anxiety disorders are less well investigated in this respect, particularly obsessive-compulsive disorder (OCD) patients. Eighty-three psychiatric outpatients with OCD and 110 members of the Swedish OCD Association responded to questions concerning their smoking habits. Among OCD patients, 14% were current smokers (compared with 25% in the general population of Sweden), 72% had never smoked, and 11 previous smokers had stopped, mostly without any difficulties. Since a decreased smoking rate among OCD subjects was confirmed, the smoking prevalences in schizophrenia and OCD, respectively, seem to represent either end of a continuum, and OCD may also differ significantly from other anxiety disorders in this respect. Possible implications of this finding for the purported frontal lobe dysregulation in OCD are discussed.

  • 36.
    Bejerot, Susanne
    et al.
    Department of clinical neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Humble, Mats B.
    Department of clinical neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of clinical neuroscience, Uppsala University hospital, Uppsala, Sweden.
    Gardner, Ann
    Department of clinical neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Endocrine disruptors, the increase of autism spectrum disorder and its comorbidity with gender identity disorder: a hypothetical association2011In: International Journal of Andrology, ISSN 0105-6263, E-ISSN 1365-2605, Vol. 34, no 5 Pt 2, article id e350Article in journal (Refereed)
  • 37.
    Bejerot, Susanne
    et al.
    Department of Clinical Neuroscience, Section Psychiatry St. Göran, Karolinska Institute, Stockholm, Sweden.
    Mörtberg, E.
    Department of Clinical Neuroscience, Section Psychiatry St. Göran, Karolinska Institute, Stockholm, Sweden.
    Do autistic traits play a role in the bullying of obsessive-compulsive disorder and social phobia sufferers?2009In: Psychopathology, ISSN 0254-4962, E-ISSN 1423-033X, Vol. 42, no 3, p. 170-176Article in journal (Refereed)
    Abstract [en]

    Background: Social phobia and obsessive-compulsive disorder (OCD) share several similarities: both are categorized as anxiety disorders, avoidant personality disorder and depression are common in both, they have a similar age of onset and course, and both disorders respond to treatments with serotonin reuptake inhibitors and cognitive behavioural therapy. However, OCD and social phobia differ in respect to their relation to autism spectrum disorders (ASD; i.e. Asperger's syndrome, autism, pervasive disorder not otherwise specified). Findings that suggest a link between OCD and ASD have no parallel in social phobia. Moreover, obsessive-compulsive, paranoid and schizotypal personality disorders are prevalent in OCD and in ASD, but not in social phobia. Individuals with ASD are known to be frequent targets of bullying. We hypothesised that individuals with autistic traits would have been frequent targets for bullies during their childhood, as opposed to people without such traits.

    Methods: Adult patients with social phobia (n = 63) or OCD (n = 65) were assessed regarding autistic traits, and interviewed about being bullied at school. A reference group (n = 551) responded to questions about being bullied.

    Results: There was a significant difference in the prevalence of being bullied between OCD (50%), social phobia patients (20%) and the reference group (27%). Autistic traits were more common in OCD than in social phobia. A history of being bullied was related to autistic traits among patients.

    Conclusions: Falling victim to bullying is not a random event. Autistic traits, i.e. low social skills, may be a predictor of being bullied in school. The high rate of bullying victims in persons who later develop OCD is suggested to be related to the overlap between OCD and ASD.

  • 38.
    Bejerot, Susanne
    et al.
    Örebro University, School of Medical Sciences. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Nilsonne, Gustav
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Stress Research Institute, Stockholm University, Stockholm, Sweden.
    Humble, Mats B.
    Örebro University, School of Medical Sciences. University Health Care Research Centre.
    Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults2017In: Lancet psychiatry, ISSN 2215-0374, E-ISSN 2215-0366, Vol. 4, no 6, p. 437-437Article in journal (Refereed)
  • 39.
    Bejerot, Susanne
    et al.
    Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Nordin, Viviann
    Karolinska Institutet, Stockholm, Sweden.
    Autismspektrumsyndrom ersätter Aspergers syndrome och autism [Autism spectrum syndrome replaces Asperger syndrome and autism].2014In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 111, no 39, p. 1660-1663, article id CUH6Article in journal (Refereed)
    Abstract [sv]

    Autism spectrum disorder describes a behaviourally defined impairment in social interaction and communication, along with the presence of restricted interests and repetitive behaviours. Although the etiology is mostly unknown, it is evident that biological factors affect the brain and result in the autistic clinical presentation. Assessment for diagnosing autism spectrum disorder should be comprehensive in order to cover all sorts of problems related to the disorder. Knowledge and experience from working with neurological and psychiatric disorders are a prerequisite for quality in the examination. Up to now, there is no cure for autism spectrum disorder, but support and adaptations in education are nevertheless important for obtaining sufficient life quality for the patients and the family.

  • 40.
    Bejerot, Susanne
    et al.
    Department of Neuroscience, Psychiatry, University Hospital, Uppsala, Sweden.
    Nylander, L
    Lindström, E
    Autistic traits in obsessive-compulsive disorder2001In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 55, no 3, p. 169-176Article in journal (Refereed)
    Abstract [en]

    In contrast to other non-psychotic psychiatric populations, subjects with obsessive-compulsive disorder (OCD) are more prone to have personality disorder from cluster A (the odd and eccentric cluster). The present study aims at further investigating the relationship between these and other personality traits in OCD subjects and their relation to high functioning autism (HFA) and Asperger disorder. Sixty-four subjects with OCD were included. Personality traits were assessed with the Karolinska Scales of Personality (KSP), and personality disorders with DSM-adapted questionnaires. In addition, autistic traits were assessed in 29 videotaped subjects, by 3 independent raters. Twenty percent of the subjects with OCD were identified as also having autistic traits. These subjects scored higher on KSP scales measuring muscular tension, psychasthenia, and inhibition of aggression and lower on socialization as compared with OCD subjects without autistic traits. Additionally, subjects with autistic traits fulfilled criteria for anxious personality disorders and paranoid personality disorders significantly more often than subjects without autistic traits. We propose that OCD is often related to HFA and Asperger disorder. Self-report questionnaires may be useful in establishing the diagnosis. However, those with the most obvious autistic features seem to be less able to identify these traits in themselves.

  • 41.
    Bejerot, Susanne
    et al.
    Department of Psychiatry, Institute of Clinical Neuroscience, Karolinska Institute, St. Göran’s Hospital, Stockholm, Sweden.
    Nylander, Lena
    Department of Neuroscience, Psychiatry, University Hospital, Lund, Sweden.
    Low prevalence of smoking in patients with autism spectrum disorders2003In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 119, no 1-2, p. 177-182Article in journal (Refereed)
    Abstract [en]

    Psychiatric patients are significantly more often smokers than the general population, the only known exception being obsessive-compulsive disorder (OCD) and catatonic schizophrenia. We have investigated nicotine use in subjects with autism spectrum disorders (ASD). Ninety-five subjects (25 females and 70 males) consecutively diagnosed with any ASD and of normal intelligence were included in the study. Only 12.6% were smokers, compared with 19% in the general population and 47% in a control group of 161 outpatients diagnosed with schizophrenia or a schizophreniform disorder. The results suggest that smoking is rare among subjects with ASD, while the opposite was shown for schizophrenia. If replicated, this finding could suggest biological differences between non-catatonic schizophrenia and ASD, and support the theory of a biological link between ASD and a subtype of OCD, and between ASD and catatonic schizophrenia.

  • 42.
    Bejerot, Susanne
    et al.
    Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institute, Stockholm, Sweden .
    Rydén, Eleonore M.
    Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institute, Stockholm, Sweden .
    Arlinde, Christina M
    Department of Clinical Neuroscience, Section of Psychiatry, Karolinska Institute, Stockholm, Sweden .
    Two-year outcome of treatment with central stimulant medication in adult attention-deficit/hyperactivity disorder: a prospective study2010In: Journal of Clinical Psychiatry, ISSN 0160-6689, E-ISSN 1555-2101, Vol. 71, no 12, p. 1590-1597Article in journal (Refereed)
    Abstract [en]

    Background: Given that adults with ADHD continue to use stimulants for extended periods of time, studies on the long-term effectiveness and adverse events are warranted. The aims of this study were to investigate factors associated with persistence in treatment in an exploratory manner and to document side effects and reasons for discontinuation.

    Method: The current study describes the systematic follow-up of 133 psychiatric patients with DSM-IV-diagnosed ADHD treated with central stimulants at a specialized outpatient unit between January 1, 2001, and August 31, 2006. A standardized questionnaire, derived from the Targeted Attention-deficit Disorder Symptoms Rating Scale, was used in order to measure improvement of the following target symptoms: hyperactivity, impulsivity, irritability, distractibility, structure/organization problems, inattention, and restlessness.

    Results: Eighty percent of the patients were successfully treated with stimulants at the 6- to 9-month follow-up. Fifty percent remained in treatment after 2 years or more. Forty-five percent were treated for comorbid anxiety and/or depression during the study period. Only 15% dropped out because of lack of efficacy. The amount of clinical response over the first 6 to 9 months (but not at 6 weeks) predicted adherence to treatment at 2 years. The patients' heart rate increased from a least squares mean ± SE of 70 ± 2.2 to 80 ± 2.1 bpm (P = .00003) while blood pressure remained unchanged at the ≥ 2-year follow-up. Severe side effects or drug abuse were not detected in this cohort.

    Conclusions: The long-term treatment outcome shows that stimulants are effective in adult ADHD and side effects tend to be mild.

  • 43.
    Bejerot, Susanne
    et al.
    Department of Neuroscience, University Hospital, Uppsala, Sweden.
    Schlette, P.
    Department of Psychiatry, University Hospital, Umeå, Sweden.
    Ekselius, L.
    Department of Neuroscience, University Hospital, Uppsala, Sweden.
    Adolfsson, R.
    Department of Psychiatry, University Hospital, Umeå, Sweden.
    von Knorring, L.
    Department of Neuroscience, University Hospital, Uppsala, Sweden.
    Personality disorders and relationship to personality dimensions measured by the Temperament and Character Inventory in patients with obsessive-compulsive disorder1998In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 98, no 3, p. 243-249Article in journal (Refereed)
    Abstract [en]

    The occurrence of personality disorders was investigated in 36 patients with obsessive-compulsive disorder by means of the SCID Screen questionnaire. In addition, the personality dimensions were explored by means of the Temperament and Character Inventory (TCI). In total, 75% of the patients fulfilled the criteria for a personality disorder according to the SCID Screen questionnaire, mostly (55%) within cluster C. Several significant correlations were found between the separate personality disorders (PD) and subscales of the TCI, the most pronounced being between avoidant and obsessive-compulsive PD and novelty-seeking and self-directedness. Strong correlations were also found between self-directedness and paranoid and borderline PD. In multiple regressions where the presence of PD in clusters A, B and C, respectively, were used as dependent variables and where the separate subscales of the TCI were used as independent variables, the multiple R reached 0.68, 0.76 and 0.80 in clusters A, B and C, respectively. Thus 46-64% of the variance in the personality disorder clusters could be explained by the TCI subscales.

  • 44.
    Bejerot, Susanne
    et al.
    Department of Neuroscience, Psychiatry, University Hospital, Uppsala, Sweden.
    von Knorring, L.
    Department of Neuroscience, Psychiatry, University Hospital, Uppsala, Sweden.
    Ekselius, L.
    Department of Neuroscience, Psychiatry, University Hospital, Uppsala, Sweden.
    Personality traits and smoking in patients with obsessive-compulsive disorder2000In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 15, no 7, p. 395-401Article in journal (Refereed)
    Abstract [en]

    As opposed to other psychiatric populations, subjects with obsessive-compulsive disorder (OCD) smoke less than the general population. The present study aims at further investigating the relationship between smoking in OCD subjects and personality traits. Sixty-four subjects with OCD were interviewed concerning their smoking habits. Personality traits were evaluated using the Karolinska Scales of Personality, and specific obsessive-compulsive personality traits were elicited through self-report questionnaires. Non-smokers were more easily fatigued, more inclined to worry, more remorseful, less self-confident, less impulsive and became uneasy more frequently when urged to speed up, than smokers with OCD. Additionally, non-smokers fulfilled significantly more obsessive-compulsive personality disorder criteria as compared to the smokers (P < 0.001). We propose a clinical subtype of OCD related to non-smoking, psychasthenia, anxiety, and pronounced obsessive-compulsive personality disorder traits.

  • 45.
    Bejerot, Susanne
    et al.
    Karolinska Institute, Department of Clinical Neuroscience Section of Psychiatry, St Göran, Stockholm, Sweden.
    Wetterberg, Lennart
    Karolinska Institute, Department of Clinical Neuroscience Section of Psychiatry, St Göran, Stockholm, Sweden.
    Autism spectrum disorders and psychiatric co-morbidity in adolescents and adults2008In: Clinical Neuropsychiatry, ISSN 1724-4935, Vol. 5, p. 3-8Article in journal (Refereed)
  • 46.
    Belfrage, Henrik
    et al.
    Forensic Psychiatric Centre, Research Unit, Växjö, Sweden; Växjö University, Växjö, Sweden.
    Fransson, Göran
    Sundsvall Forensic Psychiatric Hospital, Sundsvall, Sweden.
    Strand, Susanne
    Forensic Psychiatric Centre, Research Unit, Växjö, Sweden.
    Prediction of violence using the HCR-20: a prospective study in two maximum-security correctional institutions2000In: Journal of forensic psychiatry (Print), ISSN 0958-5184, E-ISSN 1469-9478, Vol. 11, no 1, p. 167-175Article in journal (Refereed)
    Abstract [en]

    The HCR-20 and the PCL:SV were used in a prospective study of 41 long-term sentenced offenders in two correctional, maximum-security institutions. The aim was to test the validity of these instruments in the prediction of institutional violence. All assessments were made by a comprehensive examination of the offenders' files, completed with clinical interviews ranging from 1 to 3 hours. The mean follow-up time was 8 months. Our results show high predictive validity for the HCR-20's clinical and risk management items, but for almost none of its historical items. The results suggest that violence inside correctional institutions can be predicted with a certain degree of validity by using the HCR-20 and the PCL:SV, even within a selective 'high-risk' group of offenders such as that under study here.

  • 47.
    Bergh, Cecilia
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Physiotherapy, Örebro University Hospital, Örebro, Sweden.
    Udumyan, Ruzan
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden.
    Fall, Katja
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden.
    Nilsagård, Ylva
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Centre for Health Care Sciences, Örebro University Hospital, Örebro, Sweden.
    Appelros, Peter
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Neurology, Örebro University Hospital, Örebro, Sweden.
    Montgomery, Scott
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden; Departnment of Epidemiology and Public Health, University College London, London, UK; Cinical Epidemiology Unit, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Stress resilience in male adolescents and subsequent stroke risk: cohort study2014In: Journal of Neurology, Neurosurgery and Psychiatry, ISSN 0022-3050, E-ISSN 1468-330X, Vol. 85, no 12, p. 1331-1336Article in journal (Refereed)
    Abstract [en]

    Objective Exposure to psychosocial stress has been identified as a possible stroke risk, but the role of stress resilience which may be relevant to chronic exposure is uncertain. We investigated the association of stress resilience in adolescence with subsequent stroke risk.

    Methods Register-based cohort study. Some 237 879 males born between 1952 and 1956 were followed from 1987 to 2010 using information from Swedish registers. Cox regression estimated the association of stress resilience with stroke, after adjustment for established stroke risk factors.

    Results Some 3411 diagnoses of first stroke were identified. Lowest stress resilience (21.8%) compared with the highest (23.7%) was associated with increased stroke risk, producing unadjusted HR (with 95% CIs) of 1.54 (1.40 to 1.70). The association attenuated slightly to 1.48 (1.34 to 1.63) after adjustment for markers of socioeconomic circumstances in childhood; and after further adjustment for markers of development and disease in adolescence (blood pressure, cognitive function and pre-existing cardiovascular disease) to 1.30 (1.18 to 1.45). The greatest reduction followed further adjustment for markers of physical fitness (BMI and physical working capacity) in adolescence to 1.16 (1.04 to 1.29). The results were consistent when stroke was subdivided into fatal, ischaemic and haemorrhagic, with higher magnitude associations for fatal rather than non-fatal, and for haemorrhagic rather than ischaemic stroke.

    Conclusions Stress susceptibility and, therefore, psychosocial stress may be implicated in the aetiology of stroke. This association may be explained, in part, by poorer physical fitness. Effective prevention might focus on behaviour/lifestyle and psychosocial stress.

  • 48.
    Bilevicute-Ljunger, Indre
    et al.
    Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden; ME/CFS-rehabilitation, Department of Rehabilitation Medicine, Danderyd University Hospital, Stockholm, Sweden.
    Maroti, Daniel
    Department of Clinical Sciences, Danderyd University Hospital, Karolinska Institutet, Stockholm, Sweden.
    Bejerot, Susanne
    Örebro University, School of Medical Sciences.
    Patients with chronic fatigue syndrome do not score higher on the Autism-apectrum quotient than healthy controls: comparison with autism spectrum disorder2018In: Scandinavian Journal of Psychology, ISSN 0036-5564, E-ISSN 1467-9450Article in journal (Refereed)
    Abstract [en]

    Background: Clinically, there is an overlap of several symptoms of chronic fatigue syndrome (CFS) and autism spectrum disorder (ASD), including fatigue; brain “fog”; cognitive impairments; increased sensitivity to sound, light, and odour; increased pain and tenderness; and impaired emotional contact.

    Methods: Adults with CFS (n = 59) or ASD (n = 50) and healthy controls (HC; n = 53) were assessed with the Autism-Spectrum Quotient (AQ) in a cross-sectional study. Non-parametric analysis was used to compare AQ scores among the groups. Univariate analysis of variance (ANCOVA) was used to identify if age, sex, or diagnostic group influenced the differences in scores.

    Results: Patients with ASD scored significantly higher on the AQ than the CFS group and the HC group. No differences in AQ scores were found between the CFS and HC groups. AQ results were influenced by the diagnostic group but not by age or sex, according to ANCOVA.    

    Conclusions: Despite clinical observations of symptom overlap between ASD and CFS, adult patients with CFS report few autistic traits in the self-report instrument, the AQ. The choice of instrument to assess autistic traits may influence the results.

  • 49. Bjerkenstedt, Lars
    et al.
    Farde, Lars
    Terenius, Lars
    Edman, Gunnar
    Venizelos, Nikolaos
    Örebro University, Department of Clinical Medicine.
    Wiesel, Frits-Axel
    Support for limited brain availability of tyrosine in patients with schizophrenia2006In: International Journal of Neuropsychopharmacology, ISSN 1461-1457, E-ISSN 1469-5111, Vol. 9, no 2, p. 247-255Article in journal (Refereed)
    Abstract [en]

    Several mechanisms have been suggested to account for altered dopaminergic neurotransmission in schizophrenia. The brain is the only organ for which amino-acid transport is limited and competition for transport over the blood-brain barrier (BBB) occurs at physiological plasma concentrations. One line of research suggests that patients with schizophrenia have altered brain levels of the essential amino acid tyrosine, the precursor for the synthesis of dopamine. The most common hypothesis is that less tyrosine is available because of competition with elevated levels of other amino acids. By consequence, the synthesis of dopamine in the brain will decrease. In contrast, another line of evidence suggests a change in the affinity for one of the transport proteins. A limitation of this research has been that the systems for amino-acid transport across the BBB have not been fully characterized at a molecular or functional level. The L system is the major system for transport of tyrosine across cell membranes including the BBB. The A system is also involved in this transport. Earlier in-vitro studies using fibroblasts have demonstrated a normal L system in schizophrenia but nevertheless reduced tyrosine transport. The combination of molecular research, fibroblast techniques, and brain imaging provides a new basis for clinical research on the role of amino-acid membrane transport in schizophrenia.

  • 50.
    Björk, Tabita
    et al.
    Psychiatric Research Centre, Örebro, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    de Santi, Miguel G
    Forensic Psychiatric Service, Örebro County Council, Örebro, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Örebro, Sweden.
    Criminal recidivism and mortality among patients discharged from a forensic medium secure hospital2012In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 66, no 4, p. 283-9Article in journal (Refereed)
    Abstract [en]

    Background: One of the goals in forensic psychiatric care is to reduce the risk of recidivism, but current knowledge about the general outcome of forensic psychiatric treatment is limited.

    Aims: To analyse the rate of criminal recidivism and mortality after discharge in a sample of patients sentenced to forensic psychiatric treatment in a Swedish county.

    Methods: All offenders in Örebro County, Sweden, sentenced to forensic psychiatric treatment and discharged during 1992-2007 were included: 80 males and eight females. Follow-up data was retrieved from the Swedish National Council for Crime Prevention, the National Cause-of-Death register and clinical files. Mean follow-up time was 9.4 years.

    Results: The mean age at discharge was 40 years. Schizophrenia, other psychoses and personality disorders were the most prevalent diagnoses. Thirty-eight percent of those still alive and still living in the country re-offended and were sentenced to a new period of forensic psychiatric treatment or incarceration during follow-up. Four male re-offenders committed serious violent crimes. Substance-related diagnosis was significantly associated with risk of recidivism and after adjustment for diagnoses, age and history of serious violent crime, the Hazard Ratio was 4.04 (95% CI 1.51-10.86, P = 0.006). Of all included patients, 23% had died at the end of follow-up (standardized mortality rate 10.4).

    Conclusions: Since repetition of serious violent crimes was unusual, results indicate a positive development subsequent to treatment for those alive at follow-up.

    Clinical implications: The high mortality rate suggests that more attention should be paid in evaluation of the patients' somatic and psychiatric health during and after care in order to prevent premature death.

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