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  • 1.
    Bejerot, Susanne
    et al.
    Örebro University Hospital. Karolinska Inst, Dept Clin Neurosci, Stockholm, Sweden.
    Edman, Gunnar
    TioHundra AB, Dept Psychiat, Norrtälje, Sweden.
    Anckarsäter, Henrik
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Gothenburg, Sweden.
    Berglund, Gunilla
    Stockholm Univ, Dept Psychol, Stockholm, Sweden.
    Gillberg, Christopher
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Gothenburg, Sweden.
    Hofvander, Björn
    Lund Univ, Dept Clin Sci, Malmö, Sweden.
    Humble, Mats B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Mörtberg, Ewa
    Stockholm Univ, Dept Psychol, Stockholm, Sweden.
    Råstam, Maria
    Lund Univ, Dept Clin Sci, Malmö, Sweden.
    Ståhlberg, Ola
    Univ Gothenburg, Sahlgrenska Acad, Inst Neurosci & Physiol, Gothenburg, Sweden.
    Frisen, Louise
    Karolinska Inst, Dept Clin Neurosci, 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, 549-559 p.Article 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.

  • 2.
    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, 169-176 p.Article 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.

  • 3.
    Björk, Tabita
    et al.
    Psychiatric Research Centre, Örebro; Department of Clinical Neuroscience, Karolinska Institute, Stockholm.
    de Santi, Miguel G
    Forensic Psychiatric Service, Örebro County Council, Örebro.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Örebro.
    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, 283-9 p.Article 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.

  • 4.
    Elwin, Marie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre.
    Schröder, Agneta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre.
    Ek, Lena
    Habilitation and Rehabilitation For Adults, Växjö, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre.
    Development and pilot validation of a sensory reactivity scale for adults with high functioning autism spectrum conditions: Sensory Reactivity in Autism Spectrum (SR-AS)2016In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 70, no 2, 103-110 p.Article in journal (Refereed)
    Abstract [en]

    Background: Unusual reactions to sensory stimuli are experienced by 90-95% of people with an autism spectrum condition (ASC). Self-reported sensory reactivity in ASC has mainly been measured with generic questionnaires developed and validated on data from the general population. Interest in sensory reactivity in ASC increased after the inclusion of hyper- and hypo-reactivity together with unusual sensory interest as diagnostic markers of ASC in the DSM-5.

    Aims: To develop and pilot validate a self-report questionnaire designed from first-hand descriptions of the target group of adults diagnosed with high functioning ASC. Psychometric properties of the questionnaire were evaluated on a sample of participants with ASC diagnoses (N = 71) and a random sample from the general population (N = 162).

    Results: The Sensory Reactivity in Autism Spectrum (SR-AS is intended to be used as a screening tool in diagnostic processes with adults and for support in adapting compensating strategies and environmental adjustments. The internal consistency was high for both the SR-AS and its subscales. The total scale Cronbach's alpha was 0.96 and the subscales alphas were 0.80. Confirmatory factor analysis (CFA) showed best fit for a four-factor model of inter-correlated factors: hyper and hypo-reactivity, strong sensory interest and a sensory/motor factor. The questionnaire discriminated well between ASC-diagnosed participants and participants from the general population.

    Conclusions: The SR-AS displayed good internal consistency and discriminatory power and promising factorial validity.

  • 5.
    Holm, Jonas
    et al.
    School of Medical Sciences, Örebro University, Örebro, Sweden .
    Brus, Ole
    Örebro University, School of Medical Sciences. Clinical Epidemiology and Biostatistics, Örebro University Hospital, Örebro, Sweden.
    Båve, Ullvi
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Landen, Mikael
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Institute of Neuroscience and Physiology, The Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden.
    Lundberg, Johan
    Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, 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.
    von Knorring, Lars
    Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden .
    Nordenskjöld, Axel
    Örebro University, School of Medical Sciences.
    Improvement of cycloid psychosis following electroconvulsive therapy2017In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 71, no 6, 405-410 p.Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: The treatment of choice for cycloid psychosis has traditionally been electroconvulsive therapy (ECT), but there is a lack of studies on its effectiveness.

    AIMS: The primary aim of this register study was to determine the rates of remission and response after ECT for cycloid psychosis. The secondary aim was to examine possible predictors of outcome.

    METHODS: Data were obtained from the National Quality Register for ECT in Sweden. The study population was patients (n = 42) who received ECT for acute polymorphic psychotic disorder without symptoms of schizophrenia or for cycloid psychosis between 2011-2015 in 13 hospitals. Remission and response rates were calculated using Clinical Global Impression-Severity (CGI-S) and -Improvement scores, respectively. Variables with possible predictive value were tested using Chi-square and Fisher's exact test.

    RESULTS: The response rate was 90.5%. The remission rate was 45.2%. Of 42 patients, 40 improved their CGI-S score after ECT (p < 0.001). The mean number of ECT treatments was 2.5 for non-responders and 7.0 for responders (p = 0.010). The mean number of ECT treatments did not differ significantly between remitters and non-remitters (7.2 vs 6.1, p = 0.31). None of the other investigated potential predictors was statistically significantly associated with outcome.

    CONCLUSIONS: ECT is an effective treatment for cycloid psychosis. Future studies need to compare the outcome of ECT to that of other treatment strategies.

    CLINICAL IMPLICATIONS: The high response rate with ECT indicates that cycloid psychosis is a clinically useful diagnosis.

  • 6.
    Manouilenko, Irina
    et al.
    Järva Psychiatric Services, Praktikertjänst AB, Stockholm, Sweden; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Bejerot, Susanne
    Örebro University, School of Medicine, Örebro University, Sweden. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Sukhareva-Prior to Asperger and Kanner2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 6, 1761-1764 p.Article in journal (Refereed)
    Abstract [en]

    As early as 1926, the Kiev-based child psychiatrist Grunya Efimovna Sukhareva (1891-1981) published a detailed description of autistic traits in a number of children in a scientific German psychiatry and neurology journal. She initially used the term schizoid (eccentric) psychopathy but later replaced it with autistic (pathological avoidant) psychopathy to describe the clinical picture of autism. Her original article was available almost two decades before the case reports of Asperger and Kanner; nevertheless, Sukhareva's pioneer work has been greatly overlooked. Here we present her description of autistic psychopathy in relation to the DSM-5 criteria of today.

  • 7.
    Nevonen, Lauri
    et al.
    Örebro University, Department of Clinical Medicine.
    Clinton, David
    Norring, Claes
    Validating the EDI-2 in three Swedish female samples: eating disorders patients, psychiatric outpatients and normal controls2006In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 60, no 1, 44-50 p.Article in journal (Refereed)
    Abstract [en]

    The aim of the current study was to validate the Eating Disorders Inventory 2 (EDI-2) in a Swedish population by investigating how it discriminates between three female samples aged 18 to 50 years: patients with eating disorders (n = 978), psychiatric outpatients (n = 106) and normal controls (n = 602), as well as between different eating disorder diagnoses. The internal consistency of the EDI-2 was above 0.70 for most subscales. The EDI-2 discriminated well between patients with eating disorders and normal controls on all subscales. On the symptom-related subscales, eating disorder patients scored highest followed by psychiatric controls and normals. All subscales except Perfectionism, Interoceptive awareness and Asceticism discriminated eating disorder patients and psychiatric controls. Bulimia patients scored higher than anorexics on the symptom subscales. It is concluded that the EDI-2 discriminates well between eating disorder patients and both psychiatric and normal controls.

  • 8.
    Nevonen, Lauri
    et al.
    Örebro University, School of Health and Medical Sciences.
    Mark, Mia
    Levin, Birgitta
    Lindström, Marianne
    Paulson-Karlsson, Gunilla
    Örebro University, School of Health and Medical Sciences.
    Evaluation of a new Internet-based self-help guide for patients with bulimic symptoms in Sweden2006In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 60, no 6, 463-468 p.Article in journal (Refereed)
    Abstract [en]

    The current study evaluated a new Internet-based self-help guide based on cognitive-behavioural therapy for patients with bulimic symptoms. Thirty-eight participants from a waiting list at an eating-disorder outpatient unit were assessed pre-treatment, post-treatment and at a 2-month follow-up using the Rating of Anorexia and Bulimia interview-revised version, an anamnesis questionnaire, the Eating Disorder Inventory-2 (EDI-2) and Symptom Check List-90-Revised (SCL-90R). The SCL-90R Global Severity Index and most EDI-2 subscales showed significant differences from pre-to post-treatment and the 2-month follow-up, apart from ineffectiveness, impulse regulation and social insecurity. Expert ratings revealed a significant reduction in vomiting, dietary restraints and weight phobia, with the exception of binge eating from pre-treatment to the 2-month follow-up. Exercise increased significantly, indicating that participants changed their method of compensation. An Internet-based self-help guide for bulimic symptoms is a promising new tool and can be used effectively as the first step in a stepped-care model. Further evaluations with randomized controlled trials are necessary.

  • 9. Nordenskjöld, Axel
    et al.
    Knorring, Lars von
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Rehospitalization rate after continued electroconvulsive therapy: a retrospective chart review of patients with severe depression2011In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 65, no 1, 26-31 p.Article in journal (Refereed)
    Abstract [en]

    Background: Electroconvulsive therapy, ECT, is an effective acute treatment for severe depression. Today ECT is usually discontinued when the patient’s depressive symptoms abate, although relapse is common. Some studies suggest that continuation ECT (cECT) may prevent relapse of depression, but there are few studies available.

    Aims: The aim of this study was to describe the need for inpatient care before, during and after cECT. Methods: A retrospective chart. review was conducted of all patients (n=27) treated with cECT between 2005 and 2007 at Orebro University Hospital, Sweden. All patients were severely depressed at the initiation of index ECT. The DSM-IV diagnoses were major depression (n=19), bipolar depression (n=5) or schizoaffective depression (n=3).

    Results: The hospital day quotient was lower (HDQ=15) during cECT (mean duration+/-standard deviation=104+/-74 days) than during the 3 years prior to cECT (HDQ=26). The rehospitalization rate was 43% within 6 months and 58% within 2 years after the initiation of cECT. Seven patients were rehospitalized while on cECT.

    Conclusion: The need for inpatient care was reduced during cECT. However, rehospitalization was common. At the initiation of the cECT, the patients were improved by the index ECT. Also cECT was often terminated after rehospitalization, which contributed to the lowered hospital day quotient during cECT. Randomized clinical trials are needed to establish the efficacy of cECT. Clinical implications: Relapses and recurrences in depressed patients are common after ECT treatment. The results indicate that continuation ECT combined with pharmacotherapy might be an alternative treatment strategy.

  • 10.
    Nordenskjöld, Axel
    et al.
    Örebro University, School of Medical Sciences. Department of Psychiatry.
    Mårtensson, Björn
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Pettersson, Agneta
    Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    Heintz, Emelie
    Health Economist, Swedish Agency for Health Technology Assessment and Assessment of Social Services (SBU), Stockholm, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden.
    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.
    Effects of Hesel-coil deep transcranial magnetic stimulation for depression: a systematic review2016In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 70, no 7, 492-497 p.Article, review/survey (Refereed)
    Abstract [en]

    Background: One third of the depressed patients are not improved by antidepressant drugs and psychological treatments, and there is a need for additional treatments. Repetitive transcranial magnetic stimulation (rTMS) is being developed towards an alternative in treatment-resistant depression. Deep transcranial stimulation (dTMS) with the Hesel-coil (H-coil) is a further development of rTMS aiming to enhance the effect by getting the magnetic pulses to penetrate deeper into the brain.

    Aims: This report aims to assess the evidence-base for dTMS for depression. The report also includes an assessment of the ethical and economic aspects involved.

    Methods: A systematic review of the effects of H-coil dTMS on depression was conducted and the scientific support was evaluated using GRADE (Grading of Recommendations Assessment, Development and Evaluation).

    Results: Only one controlled study was identified. In the sham-controlled randomized study, 212 participants with major depression that had not responded to antidepressant medication were enrolled. A two-point superiority in Hamilton Depression Rating Scale was observed in the dTMS arm vs the sham-arm at 4 weeks, but the difference was not statistically significant. No serious adverse events were reported apart from rare cases of epileptic seizures.

    Conclusions: The existing scientific support for H-coil dTMS therapy for depression is insufficient. The clinical implication is that the use of dTMS in depression should be restricted to the framework of clinical trials pending further studies. Fortunately, additional studies are underway and the evidence base should presumably improve over the next several years.

  • 11.
    Nordenskjöld, Axel
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Psychiatric Research Centre.
    von Knorring, Lars
    Psychiatric Research Centre, Örebro County Council, Örebro, Sweden; Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
    Brus, Ole
    Örebro University Hospital, Örebro County Council, Örebro, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Predictors of regained occupational functioning after electroconvulsive therapy (ECT) in patients with major depressive disorder: a population based cohort study2013In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 67, no 5, 326-333 p.Article in journal (Refereed)
    Abstract [en]

    Aims: The aim of the present study is to investigate the rate of regained occupational functioning among patients treated with electroconvulsive therapy (ECT) for major depression and to define predictors of time to regained occupational functioning.

    Methods: A nested cohort study was performed of patients treated by ECT for unipolar major depressive disorder registered in the Quality register for ECT and in the Swedish Social Insurance Agency registry. Predictive values of single clinical variables and their relative importance were tested with Cox regression analysis.

    Results: 394 patients were identified. Of those, 266 were on non-permanent sick leave and 128 on disability pension during ECT. Within 1 year post-ECT, 71% of the patients with non-permanent sick leave regained occupational functioning. Factors independently associated with a statistically significant increased time to regained occupational functioning were longer duration of sick leave pre-ECT, milder depression pre-ECT, less complete improvement with ECT, benzodiazepine treatment after ECT and co-morbid substance dependence.

    Conclusions: A large proportion of the patients do not return to work within several months post-ECT. Paradoxically, patients with more severe depression pre-ECT had a reduced time to regained occupational functioning, indicating a larger effect in this patients group of the treatment. Moreover, the period with sick leave compensation might be reduced if ECT is initiated within the first 3 months of sick leave.

    Clinical implications: Most patients on non-permanent sick leave regain occupational functioning after ECT. However, it usually takes a few months even in symptomatically improved patients.

  • 12.
    Nyman-Carlsson, Erika
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Capio Eating Disorder Centre, Stockholm, Sweden .
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre.
    Norring, Claes
    Stockholm Center for Eating Disorders, R & D Unit, Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden .
    Nevonen, Lauri
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Praktikertjänst Psychiatry AB, Stockholm, Sweden .
    Eating Disorder Inventory-3, validation in Swedish patients with eating disorders, psychiatric outpatients and a normal control sample2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 2, 142-151 p.Article in journal (Refereed)
    Abstract [en]

    Background: The Eating Disorder Inventory-3 (EDI-3) is designed to assess eating disorder psychopathology and the associated psychological symptoms. The instrument has been revised and has not yet been validated for Swedish conditions in its current form.

    Aims: The aim of this study was to investigate the validity and reliability of this inventory and present national norms for Swedish females.

    Methods: Data from patients with eating disorders (n = 292), psychiatric outpatients (n = 140) and normal controls (n = 648), all females, were used to study the internal consistency, the discriminative ability, and the sensitivity and specificity of the inventory using preliminary cut-offs for each subscale and diagnosis separately. Swedish norms were compared with those from Denmark, USA, Canada, Europe and Australian samples.

    Results: The reliability was acceptable for all subscales except Asceticism among normal controls. Analysis of variance showed that the EDI-3 discriminates significantly between eating disorders and normal controls. Anorexia nervosa was significantly discriminated from bulimia nervosa and eating disorder not otherwise specified on the Eating Disorder Risk Scales. Swedish patients scored significantly lower than patients from other countries on the majority of the subscales. Drive for Thinness is the second best predictor for an eating disorder. The best predictor for anorexia nervosa was Interoceptive Deficits and Bulimia for the other diagnoses.

    Conclusions/clinical implications: The EDI-3 is valid for use with Swedish patients as a clinical assessment tool for the treatment planning and evaluation of patients with eating-related problems. However, it still exist some uncertainty regarding its use as a screening tool.

  • 13.
    Olofsson, Malin Elisabeth
    et al.
    Örebro University, School of Law, Psychology and Social Work. Modum Bad, Vikersund, Norway.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Engh, Johannes
    Örebro University, School of Law, Psychology and Social Work.
    Wurm, Matilda
    Örebro University, School of Law, Psychology and Social Work.
    A psychometric evaluation of the Swedish version of the Responses to Positive Affect questionnaire2014In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 68, no 8, 588-593 p.Article in journal (Refereed)
    Abstract [en]

    Background: Previous research mainly focused on responses to negative affect in relation to depression, and less on responses to positive affect. Cognitive responses to positive affect are interesting in the context of emotion regulation and emotion disorders: positive rumination is associated to hypomania risk and bipolar disorder. There is to date no questionnaire in Swedish that captures the phenomena of cognitive response styles.

    Aims: The aim of this study was to investigate the replicability of the Responses to Positive Affect questionnaire (RPA) in a newly translated Swedish versionand to test its psychometric properties.

    Methods: Swedish undergraduates (n 111) completed a set of self-report questionnaires in a fixed order.

    Results: The hypothesized three-factor model was largely replicated in the subscales Self-focused positive rumination, Emotion-focused positive rumination and Dampening. The two positive rumination subscales were strongly associated with each other and current positive affect. The subscales showed acceptable convergent and incremental validity with concurrent measures of depression, hypomania, anxiety, repetitive negative thinking, and positive and negative affect. The model explained 25% of the variance in hypomania, but fell short in the explanation of depression.

    Conclusions: The Swedish version of the RPA shows satisfactory reliability and initial fi ndings from a student sample indicate that it is a valid measure comparable with the original RPA questionnaire. Results give emphasis to the importance of further exploration of cognitive response styles in relation to psychopathology.

  • 14.
    Paulson Karlsson, Gunilla
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Queen Silvia Children´s Hospital, Göteborg, Sweden.
    Clinton, David
    Karolinska Institute, Stockholm, Sweden; Resource Ctr Eating Disorders, Stockholm, Sweden.
    Nevonen, Lauri
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Prediction of weight increase in anorexia nervosa2013In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 67, no 6, 424-432 p.Article in journal (Refereed)
    Abstract [en]

    Background: Anorexia nervosa (AN) is a serious psychiatric disorder with high mortality rates a poor outcome and no empirically supported treatment of choice for adults. Weight increase is essential for recovery from AN why research exploring important contributors is crucial.

    Aims: The current study examined the importance of motivation to change eating behaviour, treatment expectations and experiences, eating disorder symptomatology, self-image and treatment alliance for predicting weight increase. Methods: Female patients (n = 89) between 18 and 46 years of age with Lambda N were assessed pre-treatment and at 6- and 36-month follow-ups with interviews and self-report questionnaires. At the 6-month follow-up the response rates differed from n = 58 (65%) to 66 (74%), and at the 36-month follow-up the response rates differed from n = 71 (80%) to 82 (92%).

    Results: At treatment start, expressed motivation to change eating habits, social insecurity and self-neglect were predictors of weight increase from 0 to 6 months, while duration, the time from onset to entering treatment, body dissatisfaction and interoceptive awareness were predictors of weight increase from 0 to 36 months.

    Conclusions: In designing treatment for adult patients with AN, it is essential to include multifaceted interventions addressed to patients' motivation to change, social relations, negative self-image and body dissatisfaction in order to achieve weight increase. Early detection and thereby short duration is an additional important factor that contributes to weight increase.

  • 15.
    Selenius, Heidi
    et al.
    Örebro University, School of Law, Psychology and Social Work.
    Leppänen Östman, Sari
    Department of Social Sciences, Mid Sweden University, Sweden.
    Strand, Susanne
    Örebro University, School of Law, Psychology and Social Work. Centre for Forensic Behavioural Science at Swinburne University of Technology, Melbourne, Australia.
    Self-harm as a risk factor for inpatient aggression among women admitted to forensic psychiatric care2016In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 70, no 7, 554-560 p.Article in journal (Refereed)
    Abstract [en]

    Background: Inpatient aggression among female forensic psychiatric patients has been shown to be associated with self-harm, that is considered to be a historical risk factor for violence. Research on associations between previous or current self-harm and different types of inpatient aggression is missing.

    Aim: The aim of this register study was to investigate the prevalence of self-harm and the type of inpatient aggression among female forensic psychiatric inpatients, and to study whether the patients’ self-harm before and/or during forensic psychiatric care is a risk factor for inpatient aggression.

    Methods: Female forensic psychiatric patients (N=130) from a high security hospital were included.

    Results: The results showed that 88% of the female patients had self-harmed at least once during their life and 57% had been physically and/or verbally aggressive towards staff or other patients while in care at the hospital. Self-harm before admission to the current forensic psychiatric care or repeated selfharm were not significantly associated with inpatient aggression, whereas self-harm during care was significantly associated with physical and verbal aggression directed at staff.

    Conclusions: These results pointed towards self-harm being a dynamic risk factor rather than a historical risk factor for inpatient aggression among female forensic psychiatric patients. Whether self-harm is an individual risk factor or a part of the clinical risk factor ‘Symptom of major mental illness’ within the HCR-20V3 must be further explored among women. Thus, addressing self-harm committed by female patients during forensic psychiatric care seems to be important in risk assessments and the management of violence, especially in reducing violence against staff in high-security forensic psychiatric services.

  • 16.
    Selenius, Heidi
    et al.
    Örebro University, School of Law, Psychology and Social Work. Department of Special Education, Stockholm University, Stokholm, Sweden.
    Strand, Susanne
    Örebro University, School of Law, Psychology and Social Work. Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia.
    Experiences of self-injury and aggression among women admitted to forensic psychiatric care2017In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 71, no 4, 304-311 p.Article in journal (Refereed)
    Abstract [en]

    Background: Self-injury and institutional violence are well-known characteristics of female forensic psychiatric patients, but research on patients' experiences of these behaviours is limited.

    Aim: The aim of the study was to investigate how female forensic psychiatric patients describe their self-injury and aggression.

    Methods: The authors performed qualitative in-depth interviews with 13 female forensic psychiatric inpatients. The interviews were analysed using thematic analysis.

    Results: The analysis resulted in three themes describing the process of handling negative thoughts and emotions by using self-injury or aggression towards others and thereby experiencing satisfaction. Both self-injury and aggression were experienced as strategies for emotional regulation. The forensic psychiatric care was perceived as important for the women in developing less harmful strategies for coping with negative thoughts and emotions instead of injuring themselves or others.

    Conclusions: Self-injury and aggression are often risk-assessed separately, but results from the present study suggest that these behaviours need a more holistic approach.

  • 17.
    Selenius, Heidi
    et al.
    Department of Social Sciences, Mid Sweden University, Sundsvall, Sweden.
    Strand, Susanne
    Department of Social Sciences, Mid Sweden University, Sundsvall, Sweden; Centre for Forensic Behavioural Science, Swinburne University of Technology, Melbourne, Australia.
    Superficiality in forensic psychiatric patients is related to superior phonological, semantic and syntactic skills2015In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 69, no 5, 392-396 p.Article in journal (Refereed)
    Abstract [en]

    Background: Psychopaths are reported to have unusual language processing, and they have beensuggested to have better phonological awareness than do non-psychopaths. Phonologicalprocessing skills have not been studied among psychopathic persons, and it is unclear how thedegree of psychopathy is related to such skills.

    Aims: One aim of the present study was toinvestigate this relationship. An additional aim was to investigate how affective-interpersonaltraits and antisocial lifestyle of psychopaths are related to verbal skills such as reading andspelling, as well as to phonological processing skills.

    Material and methods: Forty (80% male)forensic psychiatric patients participated. They were all Swedish speaking and their mean agewas 36 years. The patients performed reading and spelling tests as well as a battery of tasksassessing phonological processing. The patients were also assessed using the Psychopathy Checklist: Screening Version (PCL:SV).

    Results: The patients’ scores on Factor 1 (affective andinterpersonal traits) of the PCL:SV were significantly positively correlated with results on decoding of sentences and reading speed tests as well as with phonological processing skills. However, the only item that was significantly related to phonological processing skills as wellas semantic and syntactic skills was Superficial.

    Conclusions: In general, psychopaths easilyshift conversational topics, and it may be due to a certain cognitive skill such as rapidautomatized naming. We suggest that further studies focus on rapid automatized naming inpsychopaths to clarify whether their superficial character might be related to rapid naming.

  • 18.
    Selenius, Heidi
    et al.
    Örebro University, School of Law, Psychology and Social Work. Specialpedagogiska institutionen, Stockholms universitet, Stockholm, Sweden.
    Strand, Susanne
    Örebro University, School of Law, Psychology and Social Work. Centre for Forensic Behavioural Science at Swinburne University of Technology, Melbourne, Australia.
    The experiences of self-harm and aggression among women admitted to forensic psychiatric care2017In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725Article in journal (Refereed)
  • 19. Wallsten, Tuula
    et al.
    Östman, Margareta
    Sjöberg, Rickard L.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Patients' and next-of-kins' attitudes towards compulsory psychiatric care2008In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 62, no 6, 444-449 p.Article in journal (Refereed)
    Abstract [en]

    The introduction of a new Civil Commitment Act in Sweden in 1992 involved a shift of emphasis from medical to judicial authority. Little is known about general patient attitudes to compulsory care. The aim of the study was to study possible differences in attitudes, before and after the mental health law reform, among involuntarily and voluntarily admitted patients and their next-of-kins towards involuntary psychiatric admission. Samples of 84 committed and 84 voluntarily admitted patients in 1991 and 118 committed and 117 voluntarily admitted patients in 1997-99 were interviewed within 5 days from admission and at discharge, or after 3 weeks of care. Samples of 64 next-of-kins to the committed patients and 69 next-of-kins to the voluntarily admitted patients in 1991, and 73 and 89 next-of-kins, respectively, in 1997-99 were interviewed approximately 1 month after the admission. Few changes in attitudes were found between the two study occasions. A majority of all patients stated that it should be possible to compulsorily admit patients, and a great majority of the patients and the next-of kins stated that decisions regarding compulsory admission should be taken by doctors. Most patients and next-of-kins regarded decisions about involuntary psychiatric care mainly as a medical matter. Strong support for coercion in order to protect the patient and others was found among next-of-kins. The law reform was not reflected in attitudinal differences.

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