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  • 1.
    Akner, Gunnar
    et al.
    Örebro University, School of Health and Medical Sciences.
    Ljunggren, J. G.
    Kjellman, B. F.
    Undén, F.
    Wetterberg, L.
    Adrenocorticotropin and cortisol response to lysine vasopressin in relation to the outcome of the dexamethasone suppression test in major depressive disorder1988In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 77, no 4, p. 404-410Article in journal (Refereed)
    Abstract [en]

    The pathophysiology behind the abnormalities of the hypothalamic pituitary adrenal cortex axis found in patients with major depressive disorder was studied by the use of the vasopressin test. The response of plasma adrenocorticotropin (ACTH) and cortisol to the injection of 10 IU lysine-vasopressin (LVP) was investigated in 18 patients meeting the DSM-III criteria for major depressive episode. The response was correlated to the outcome of the dexamethasone suppression test (DST) with the use of two different cut-off points, 139 nmol/l and 200 nmol/l respectively. The results show that no significant difference was found in ACTH or cortisol response between patients having a normal or abnormal DST. The results do not seem to support the hypothesis that the abnormalities of the hypothalamic pituitary adrenal cortex axis involve a hypersecretion of corticotropin-releasing factor (CRF) and a subsequent desensitization of the corticotrophs to CRF-stimulated ACTH release.

  • 2.
    Andershed, Henrik
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Kerr, Margaret
    Örebro University, School of Law, Psychology and Social Work.
    Stattin, Håkan
    Örebro University, School of Law, Psychology and Social Work.
    Understanding the abnormal by studying the normal2002In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 106, no Suppl. 412, p. 75-80Article in journal (Refereed)
    Abstract [en]

    Objective:  In the present paper we ask whether it is meaningful to study psychopathic traits in non-referred youths and whether this kind of research can be used to understand the development of criminal full-blown psychopathy.

    Method:  We review studies that have investigated the utility of assessing psychopathic traits in non-referred samples of youths.

    Results:  Research shows that psychopathic traits in non-referred youths manifest similarly to how they are manifested among incarcerated offenders, as indicated by similarities in factor structures. Also, psychopathic traits relate similarly to frequent, violent antisocial behavior in non-referred youths as among adult and adolescent institutionalized criminal offenders. Thus, the differences between the non-referred conduct-problem youths exhibiting a psychopathic personality pattern and the incarcerated, criminal youths identified as psychopathic seem to be quantitative rather than qualitative.

    Conclusion:  It is concluded that research on non-referred youth samples can provide important knowledge about the processes that underlie the development of psychopathic traits and how this development can be prevented. Implications for future research and intervention and prevention are discussed.

  • 3. 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)
  • 4.
    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.

  • 5.
    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.

  • 6.
    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.

  • 7.
    Fiorillo, A.
    et al.
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    Giacco, D.
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    De Rosa, C.
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    Kallert, T.
    Department of Psychiatry and Psychotherapy, Dresden University of Technology, Dresden, Germany; Department of Psychiatry Psychosomatic Medicine and Psychotherapy, Park Hospital Leipzig, Leipzig, Germany; Soteria Hospital Leipzig, Leipzig, Germany; Faculty of Medicine, Dresden University of Technology, Dresden, Germany.
    Katsakou, C.
    Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary College, University of London, London, United Kingdom.
    Onchev, G.
    Department of Psychiatry, Medical University of Sofia, Sofia, Bulgaria.
    Raboch, J.
    Department of Psychiatry, 1st Faculty of Medicine, Charles University, Prague, Czech Republic .
    Mastrogianni, A.
    Psychiatric Hospital, Thessaloniki, Greece.
    Del Vecchio, V.
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    Luciano, M.
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    Catapano, F.
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    Dembinskas, A.
    Psychiatric Clinic Vilnius Mental Health Centre, University of Vilnius, Vilnius, Lithuania.
    Nawka, P.
    Psychiatric Hospital, Michalovce, Slovak Republic.
    Kiejna, A.
    Psychiatric Hospital, Michalovce, Slovak Republic; Department of Psychiatry, Medical University, Wroclaw, Poland.
    Torres-Gonzales, F.
    Centro Investigacin Biomedica en Red en Salud Mental (CIBERSAM), University of Granada, Granada, Spain; Hospital Regional Carlos Haya, Malaga, Spain.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Maj, M.
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    Priebe, S.
    Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary College, University of London, London, United Kingdom.
    Patient characteristics and symptoms associated with perceived coercion during hospital treatment2012In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 125, no 6, p. 460-467Article in journal (Refereed)
    Abstract [en]

    Objective: Large numbers of psychiatric patients either are involuntarily admitted to hospital treatment or feel coerced despite a legally voluntary admission. For ethical and clinical reasons, their perceived coercion should be reduced as far as possible. There is however limited evidence on patient characteristics associated with perceived coercion during hospital treatment. This study aimed to identify i) sociodemographic and clinical characteristics associated with perceived coercion at admission and ii) changes in symptoms and global functioning associated with changes in perceived coercion over time.

    Method: Three thousand and ninety three in-patients who were involuntarily admitted or felt coerced to hospital treatment despite a legally voluntary admission were recruited in the European evaluation of coercion in psychiatry and harmonization of best clinical practice EUNOMIA project in 11 European countries. Perceived coercion, global functioning and symptoms were assessed after admission and at a 3-month follow-up.

    Results: Involuntary admission, female gender, poorer global functioning and more positive symptoms were associated with higher levels of perceived coercion at admission. Perceived coercion significantly decreased over time, and the improvements in global functioning and positive symptoms were associated with reduction in perceived coercion.

    Conclusion: Female patients perceive more coercion in psychiatric hospital treatment. Effective treatment for positive symptoms and improving patients global functioning may lead to a reduction in perceived coercion.

  • 8.
    Holländare, Fredrik
    et al.
    Örebro University, School of Health and Medical Sciences.
    Johnsson, Susanne
    Örebro University, School of Law, Psychology and Social Work.
    Randestad, Mia
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Carlbring, Per
    Umeå universitet, Umeå, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Linköping, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Randomized trial of Internet-based relapse prevention for partially remitted depression2011In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 124, no 4, p. 285-294Article in journal (Refereed)
    Abstract [en]

    Objective:

    To investigate whether Internet-based cognitive behaviour therapy (CBT) can prevent relapse in persons with partially remitted major depression after previous treatment.

    Method:

    Seventy-one women and 13 men (N= 84) with partially remitted major depression after treatment were randomly assigned to either 10 weeks of Internet-based CBT or to a control group. Self-help material was used in combination with e-mail contact with a personal therapist. Monthly self-ratings of depressive symptoms were made, and diagnostic interviews were conducted before and after the treatment period, as well as 6 months later.

    Results:

    Significantly fewer participants in the CBT group experienced relapse (4⁄38 or 10.5%) compared with those in the control group (14⁄37 or 37.8%). The difference in relapse rates between groups occurred early in the study period and was still apparent after 6 months. A trend towards a larger reduction in depressive symptoms was observed at post-treatment in the participants who received CBT compared with controls. Reduction in depressive symptoms reduced the risk of relapse. A trend towards a higher remission rate was found in the CBT group at the 6 month follow-up.

    Conclusion:

    Internet-based CBT seems promising in preventing relapse in persons with partially remitted major depression after previous treatment.

  • 9.
    Johansson, Peter
    et al.
    Örebro University, Department of Behavioural, Social and Legal Sciences.
    Andershed, Henrik
    Kerr, Margaret
    Levander, Sten
    On the operationalization of psychopathy: further support for a three-faceted personality oriented model2002In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, ,, Vol. 106, no suppl. s412, p. 81-85Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE:

    This study is an attempt to compare two alternative models of psychopathy (PCL-R); (i) the traditional 17-item two-factor model where the first factor describes a deceitful, manipulative and callous, unemotional dimension and the second factor describes the impulsive, irresponsible and antisocial behavioral lifestyle dimension; and (ii) a recently proposed 13-item three-factor model involving an interpersonal facet, an affective facet and a behavioral facet.

    METHOD:

    Exploratory and confirmatory factor analyses of PCL-R scores on a sample of 293 adult male violent offenders were conducted.

    RESULTS:

    The results of the exploratory factor analysis showed that the 13 items yielded three easily interpretable factors: an interpersonal factor, an affective factor and a behavioral/lifestyle factor. Through confirmatory factor analysis we showed that this model had a significantly closer fit to the data than the classical 17-item, two-factor model of the PCL-R.

    CONCLUSION:

    The study supports the three-faceted model of psychopathy.

  • 10.
    Kellner, Charles H.
    et al.
    New York Community Hospital, Brooklyn, NY, USA; Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, NY, USA.
    Nordenskjöld, Axel
    Örebro University, School of Medical Sciences. University Health Care Research Centre.
    "Treatment Resistance" in Electroconvulsive Therapy (ECT) Patients: Time to Move On2019In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 140, no 5, p. 490-491Article in journal (Refereed)
    Abstract [en]

    The concept of "treatment resistance" has become all the rage in depression research. It is used to define populations in research studies and in treatment algorithms as a rationale for moving on from standard antidepressants to other therapies. In such algorithms, electroconvulsive therapy (ECT) is often bundled improperly with less effective neurostimulation-methods and experimental pharmacotherapies.

  • 11.
    Popiolek, Katarzyna
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Centre.
    Bejerot, Susanne
    Örebro University, School of Medical Sciences. University Health Care Research Centre.
    Brus, Ole
    Örebro University, School of Medical Sciences.
    Hammar, Åsa
    Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway: Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
    Landén, Mikael
    Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lundberg, Johan
    Department of Clinical Neuroscience, Center for Psychiatry Research, Karolinska Institutet, Stockholm, Sweden; Stockholm County Council, Stockholm, Sweden.
    Nordanskog, Pia
    Center for Social and Affective Neuroscience, Department of Clinical and Experimental Medicine, Faculty of Health Sciences, Linköping University, Linköping, Sweden; Department of Psychiatry, Region Östergötland, Linköping, Sweden.
    Nordenskjöld, Axel
    Örebro University, School of Medical Sciences. University Health Care Research Centre.
    Electroconvulsive therapy in bipolar depression: effectiveness and prognostic factors2019In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 140, no 3, p. 196-204Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Electroconvulsive therapy (ECT) is used in patients with severe forms of bipolar depression. ECT is effective but not all patients respond. The aim of this study was to determine prognostic factors for response to ECT in patients hospitalized for bipolar depression.

    METHODS: Data were obtained from several national Swedish registers. All patients with bipolar depression treated with ECT in any hospital in Sweden between 2011 and 2016 for whom information about ECT response was available were included (n = 1251). Response was defined as a score on the Clinical Global Impression - Improvement scale of one or two. Univariate and multivariate logistic regression were conducted to investigate associations between socio-demographic and clinical factors and response.

    RESULTS: Response was achieved in 80.2% patients. Older age was associated with higher response rate to ECT. Patients with comorbid obsessive-compulsive disorder or personality disorder, and patients previously treated with lamotrigine had lower response rate.

    CONCLUSION: ECT for bipolar depression was associated with very high response rates. The strongest prognostic factors were higher age, absence of comorbid obsessive-compulsive disorder or personality disorder, and less prior pharmacologic treatment.

  • 12.
    Rydén, E.
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Thase, M. E.
    University of Pennsylvania School of Medicine and the Veterans Affairs Medical Center, Philadelphia, USA.
    Stråht, D.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Åberg-Wistedt, A.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Bejerot, Susanne
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Landén, M.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    A history of childhood attention-deficit hyperactivity disorder (ADHD) impacts clinical outcome in adult bipolar patients regardless of current ADHD2009In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 120, no 3, p. 239-246Article in journal (Refereed)
    Abstract [en]

    Objective: The occurrence of comorbid attention-deficit hyperactivity disorder (ADHD) might have an impact of the course of the bipolar disorder.

    Method: Patients with bipolar disorder (n = 159) underwent a comprehensive evaluation with respect to affective symptoms. Independent psychiatrists assessed childhood and current ADHD, and an interview with a parent was undertaken.

    Results: The prevalence of adult ADHD was 16%. An additional 12% met the criteria for childhood ADHD without meeting criteria for adult ADHD. Both these groups had significantly earlier onset of their first affective episode, more frequent affective episodes (except manic episodes), and more interpersonal violence than the bipolar patients without a history of ADHD.

    Conclusion: The fact that bipolar patients with a history of childhood ADHD have a different clinical outcome than the pure bipolar group, regardless of whether the ADHD symptoms remained in adulthood or not, suggests that it represent a distinct early-onset phenotype of bipolar disorder.

  • 13. Thalén, B. E.
    et al.
    Kjellman, B. F.
    Ljunggren, J. G.
    Akner, Gunnar
    Örebro University, School of Health and Medical Sciences.
    Kågedal, B.
    Wahlund, B.
    Wetterberg, L.
    Release of corticotropin after administration of corticotropin-releasing hormone in depressed patients in relation to the dexamethasone suppression test1993In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 87, no 2, p. 133-140Article in journal (Refereed)
    Abstract [en]

    The possible hypersecretion involvement of corticotropin-releasing hormone (CRH) in the pathophysiology of hypothalamic-pituitary-adrenocortical axis disturbances in patients with major depressive episode and with an abnormal dexamethasone suppression test (DST) was investigated. The corticotropin (ACTH) and cortisol response to the injection of 45 micrograms of synthetic human CRH at 1630 were analyzed in 24 inpatients with normal (suppressors) or abnormal (nonsuppressors) DST. The outcome of the DST was analyzed using 3 cut-off points for the cortisol levels. The clinical assessments included two rating scales. The results showed that nonsuppressors had a significantly lower ACTH response to CRH stimulation than suppressors at all cut-off points (calculated as net area under the curve and as the difference between the peak and the baseline level) despite no significant differences in the severity of depression.

  • 14.
    Zetterqvist, J.
    et al.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Asherson, P.
    MRC Social, Genetic and Developmental Psychiatry, Institute of Psychiatry, Kings College London, London, UK.
    Halldner, L.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Långström, N.
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Stimulant and non-stimulant attention deficit/hyperactivity disorder drug use: total population study of trends and discontinuation patterns 2006-20092013In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 128, no 1, p. 70-77Article in journal (Refereed)
    Abstract [en]

    Objective: To explore the prevalence and discontinuation of dispensed medications for attention deficit/hyperactivity disorder (ADHD) drugs from 2006 to 2009.

    Method: A total population cohort of all individuals aged 6-45 years, alive and registered as residents in Sweden during any calendar year from 2006 to 2009 (N = 5 149 791) included 41 700 patients dispensed with an ADHD drug (methylphenidate, atomoxetine, amphetamine, or dexamphetamine). The dispensing prevalence was calculated for each year, stratified on sex and age. A longitudinal analysis was also performed to compare the rates of treatment discontinuation across the strata.

    Results: The dispensing prevalence increased from 2.93 per 1000 in 2006 to 6.98 in 2009 (PR = 2.38, 95% CI = 2.34-2.43). The prevalence ratio (PR) was 3.40 for adults, 22-45 years old; 2.41 for adolescents, 15-21 years old; and 1.90 for children aged 6-14. The increase was also greater in women than in men (PR = 2.92 vs. 2.19). Patients aged 15-21 were the most likely to discontinue treatment; after 3 years and 11 months, 27% of those patients were still under treatment.

    Conclusion: From 2006 to 2009, the number of prescriptions dispensed for ADHD drugs increased substantially. The rate of treatment discontinuation in the age interval 15-21 is higher than expected considering the persistence rates of the disorder.

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