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  • 1.
    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)
  • 2.
    Bejerot, Susanne
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Edgar, Johan
    Faculty of Health Sciences, Linköping University, Linköping, Sweden.
    Humble, Mats B.
    Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
    Poor performance in physical education: a risk factor for bully victimization. A case-control study2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 3, p. 413-419Article in journal (Refereed)
    Abstract [en]

    Aim: Poor social skills are a risk factor for becoming bullied, which could explain why this frequently occurs to children with autism spectrum disorders (ASD) and attention-deficit hyperactivity disorder (ADHD). Poor social skills tend to coexist with clumsiness. According to a pilot study, poor performance in physical education (PE) was correlated with bully victimization.

    Methods: Sixty-nine healthy university students reported performance in PE and bully victimization in childhood. In addition, the participants responded to questionnaires for ADHD and ASDs to assess personality traits related to increased risk for bully victimization.

    Results: Below average performance in PE was a risk factor of being bullied in school with an odds ratio of 3.6 [95% confidence interval: 1.23-10.5; p = 0.017]. Strong correlations between poor performance in PE and long duration of victimization (p = 0.007) and poor performance in PE and high frequency of victimization (p = 0.008) were found. Autistic traits were related to performance below average in PE.

    Conclusion: Poor motor skills are a strong risk factor for becoming bullied. Prevention programmes that identify, protect and empower the clumsy children could be an important step to avoid bullying of the most vulnerable children.

  • 3.
    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.

  • 4.
    Bejerot, Susanne
    et al.
    Örebro University, School of Medical Sciences.
    Edman, Gunnar
    Department of Clinical Sciences, Danderyds Sjukhus, Karolinska Institutet, Solna, Sweden..
    Frisén, Louise
    Department of Clinical Neuroscience, Karolinska Institutet, Solna, Sweden.
    Humble, Mats B.
    Örebro University, School of Medical Sciences.
    Evidence-Based Brief Obsessive-Compulsive Scale2017In: Journal of Central Nervous System Disease, ISSN 1179-5735, E-ISSN 1179-5735, Vol. 9, article id UNSP 1179573517702867Article in journal (Other academic)
  • 5.
    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.

  • 6.
    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.

  • 7.
    Bejerot, Susanne
    et al.
    Karolinska Institutet, Stockholm, Sweden .
    Gardner, Ann
    Järvapsykiatrin, Stockholm, Sweden.
    Humble, Mats B.
    Äldrepsykiatrin, Akademiska sjukhuset, Uppsala, Sweden.
    D-vitaminbrist [Vitamin D deficiency]: vems ansvar? [who's responsibility?]2011In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 108, no 14, p. 812-812Article in journal (Refereed)
  • 8.
    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.

  • 9. Bejerot, Susanne
    et al.
    Humble, Mats B.
    D-vitamin och graviditet [Vitamin D and pregnancy]: Etnisk-kulturella riktlinjer efterlyses [Ethnocultural guidelines wanted]2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 35, p. 2343-2344Article in journal (Refereed)
  • 10. 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)
  • 11.
    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.

  • 12.
    Bejerot, Susanne
    et al.
    Department of Clinical Neuroscience, Section Psychiatry St. Göran, Karolinska Institute, Stockholm, Sweden .
    Humble, Mats B.
    Department of Clinical Sciences, Lund University, Malmö, Sweden.
    Relevance of motor skill problems in victims of bullying2007In: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 120, no 5, p. 1227-1228Article in journal (Refereed)
  • 13.
    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)
  • 14.
    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, Region Örebro County, Örebro, Sweden.
    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)
  • 15.
    Bejerot, Susanne
    et al.
    Karolinska institutet, Stockholm, Sweden.
    Plenty, Stephanie
    Karolinska institutet, Stockholm, Sweden.
    Humble, Alice
    Malmö University, Malmö, Sweden.
    Humble, Mats B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Poor Motor Skills: A Risk Marker for Bully Victimization2013In: Aggressive Behavior, ISSN 0096-140X, E-ISSN 1098-2337, Vol. 39, no 6, p. 453-461Article in journal (Refereed)
    Abstract [en]

    Children who are clumsy are often bullied. Nevertheless, motor skills have been overlooked in research on bullying victimization. A total of 2,730 Swedish adults (83% females) responded to retrospective questions on bullying, their talents in physical education (i.e., coordination and balls skills) and school academics. Poor talents were used as indicators of poor gross motor skills and poor academic skills. A subset of participants also provided information on educational level in adulthood, childhood obesity, belonging to an ethic minority in school and socioeconomic status relative to schoolmates. A total of 29.4% of adults reported being bullied in school, and 18.4% reported having below average gross motor skills. Of those with below average motor skills, 48.6% were bullied in school. Below average motor skills in childhood were associated with an increased risk (OR 3.01 [95% CI: 1.97-4.60]) of being bullied, even after adjusting for the influence of lower socioeconomic status, poor academic performance, being overweight, and being a bully. Higher odds for bully victimization were also associated with lower socioeconomic status (OR 2.29 [95% CI: 1.45-3.63]), being overweight (OR 1.71 [95% CI: 1.18-2.47]) and being a bully (OR 2.18 [95% CI: 1.53-3.11]). The findings indicate that poor gross motor skills constitute a robust risk-marker for vulnerability for bully victimization. Aggr. Behav. 39:453-461, 2013. (c) 2013 The Authors. Aggressive Behavior Published by Wiley-Blackwell

  • 16.
    Fernell, Elisabeth
    et al.
    Gillberg Neuropsychiat Ctr, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden; Res & Dev Ctr, Skaraborgs Hosp, Skövde, Sweden.
    Bejerot, Susanne
    Dept Clin Neurosci, Karolinska Inst, Stockholm, Sweden.
    Westerlund, Joakim
    Dept Psychol, Univ Stockholm, Stockholm, Sweden.
    Miniscalco, Carmela
    Gillberg Neuropsychiat Ctr, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Simila, Henry
    Inst Brain, Univ Queensland, Brisbane Qld, Australia.
    Eyles, Darryl
    Inst Brain, Univ Queensland, Brisbane Qld, Australia; Queensland Ctr Mental Hlth Res, Univ Queensland, Brisbane Qld, Australia.
    Gillberg, Christopher
    Gillberg Neuropsychiat Ctr, Sahlgrenska Acad, Univ Gothenburg, Gothenburg, Sweden.
    Humble, Mats B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Autism spectrum disorder and low vitamin D at birth: a sibling control study2015In: Molecular Autism, ISSN 2040-2392, ISSN 2040-2392, Vol. 6, article id 3Article in journal (Refereed)
    Abstract [en]

    Background: Insufficient vitamin D activity has attracted increasing interest as a possible underlying risk factor in disorders of the central nervous system, including autism.

    Methods: In this study, 25-hydroxyvitamin D (25(OH) D) was analysed in 58 Sweden-born sibling pairs, in which one child had autism spectrum disorder (ASD) and the other did not. The study group consisted of two representative samples; 47 Gothenburg sibling pairs with mixed ethnicities and 11 Stockholm sibling pairs with Somali background. 25(OH) D levels were analysed in the stored dried blood spots taken in the neonatal period for metabolic screening.

    Results: The collapsed group of children with ASD had significantly lower vitamin D levels (M = 24.0 nM, SD = 19.6) as compared with their siblings (M = 31.9 nM, SD = 27.7), according to a paired samples t-test (P = 0.013). The difference was-most likely-not only accounted for by a difference in season of birth between ASD and non-ASD siblings since the mean 25(OH)D levels differed with similar effect size between the sibling pairs born during winter and summer, respectively. All children with African/Middle East background, both the children with ASD and their non-ASD siblings, had vitamin D deficiency.

    Conclusions: The findings suggest that low prenatal vitamin D may act as a risk factor for ASD, however, there is a need for replication with larger samples. Future research should study whether or not adequate supplementation of vitamin D to pregnant women might lower the risk for ASD in the offspring.

  • 17.
    Glans, Martin
    et al.
    Örebro University, School of Medical Sciences. Stockholm County Council, Stockholm, Sweden.
    Bejerot, Susanne
    Örebro University, School of Medical Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Humble, Mats B.
    Örebro University, School of Medical Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Generalised joint hypermobility and neurodevelopmental traits in a non-clinical adult population2017In: BJPsych Open, E-ISSN 2056-4724, Vol. 3, no 5, p. 236-242Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: Generalised joint hypermobility (GJH) is reportedly overrepresented among clinical cases of attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and developmental coordination disorder (DCD). It is unknown if these associations are dimensional and, therefore, also relevant among non-clinical populations.

    AIMS: To investigate if GJH correlates with sub-syndromal neurodevelopmental symptoms in a normal population.

    METHOD: Hakim-Grahame's 5-part questionnaire (5PQ) on GJH, neuropsychiatric screening scales measuring ADHD and ASD traits, and a DCD-related question concerning clumsiness were distributed to a non-clinical, adult, Swedish population (n=1039).

    RESULTS: In total, 887 individuals met our entry criteria. We found no associations between GJH and sub-syndromal symptoms of ADHD, ASD or DCD.

    CONCLUSIONS: Although GJH is overrepresented in clinical cases with neurodevelopmental disorders, such an association seems absent in a normal population. Thus, if GJH serves as a biomarker cutting across diagnostic boundaries, this association is presumably limited to clinical populations.

  • 18.
    Holländare, Fredrik
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Eriksson, Annsofi
    Örebro University, Örebro, Sweden.
    Lövgren, Lisa
    Örebro University, Örebro, Sweden.
    Humble, Mats B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Internet-Based Cognitive Behavioral Therapy for Residual Symptoms in Bipolar Disorder Type II: A Single-Subject Design Pilot Study2015In: JMIR Research Protocols, ISSN 1929-0748, E-ISSN 1929-0748, Vol. 4, no 2, article id e44Article in journal (Refereed)
    Abstract [en]

    Background: Bipolar disorder is a chronic condition with recurring episodes that often lead to suffering, decreased functioning, and sick leave. Pharmacotherapy in the form of mood stabilizers is widely available, but does not eliminate the risk of a new depressive or (hypo) manic episode. One way to reduce the risk of future episodes is to combine pharmacological treatment with individual or group psychological interventions. However, access to such interventions is often limited due to a shortage of trained therapists. In unipolar depression there is now robust evidence of the effectiveness of Internet-based psychological interventions, usually comprising psychoeducation and cognitive behavioral therapy (CBT). Internet-based interventions for persons suffering from bipolar disorder could increase access to psychological treatment.

    Objective: The aim of this study was to investigate the feasibility of an Internet-based intervention, as well as its effect on residual depressive symptoms in persons diagnosed with bipolar disorder type II (BP-II). The most important outcomes were depressive symptoms, treatment adherence, and whether the patient perceived the intervention as helpful.

    Methods: A total of 7 patients diagnosed with bipolar disorder type II at a Swedish psychiatric outpatient clinic were offered the opportunity to participate. Of the 7 patients, 3 (43%) dropped out before treatment began, and 4 (57%) were treated by means of an online, Internet-based intervention based on CBT (iCBT). The intervention was primarily aimed at psychoeducation, treatment of residual depressive symptoms, emotion regulation, and improved sleep. All patients had ongoing pharmacological treatment at recruitment and established contact with a psychiatrist. The duration of BP-II among the treated patients was between 6 and 31 years. A single-subject design was used and the results of the 4 participating patients were presented individually.

    Results: Initiating treatment was perceived as too demanding under current life circumstances for 3 patients who consequently dropped out during baseline assessment. Self-ratings using the Montgomery-sberg Depression Rating Scale-Self-rated (MADRS-S) showed symptom reduction in 3 (75%) of the 4 treated cases during iCBT. In the evaluation of the treatment, 2 patients reported that they perceived that the treatment had reduced symptoms a little, 1 that it had reduced symptoms very much, and 1 not at all. Treatment adherence (ie, module completion) was fairly high in 3 cases. In general, the modules were perceived as fairly helpful or very helpful by the patients. In one case, there was a reliable change-according to the Reliable Change Index-in self-rated symptoms of depression and perseverative thinking.

    Conclusions: The treatment seemed to have acceptable feasibility. The iCBT intervention could be an effective way to treat residual symptoms in some patients with bipolar disorder type II. This should be investigated in a larger study.

  • 19.
    Holländare, Fredrik
    et al.
    Örebro University, School of Science and Technology.
    Eriksson, Ann-sofi
    Lövgren, Lisa
    Humble, Mats
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Boersma, Katja
    Örebro University, School of Law, Psychology and Social Work.
    Internet-Based Cognitive Behavior Therapy for Residual Symptoms in Bipolar II: A Single Subject Design PilotIn: Journal of Medical Internet Research, ISSN 1438-8871, E-ISSN 1438-8871Article in journal (Refereed)
  • 20.
    Humble, Mats B.
    Örebro University, School of Medical Sciences.
    Obsessive-compulsive disorder, serotonin and oxytocin: treatment response and side effects2016Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    Obsessive-compulsive disorder (OCD), with a prevalence of 1-2 %, frequently leads a chronic course. Persons with OCD are often reluctant to seek help and, if they do, their OCD is often missed. This is unfortunate, since active treatment may substantially improve social function and quality of life. Serotonin reuptake inhibitors (SRIs) have welldocumented efficacy in OCD, but delayed response may be problematic. Methods to predict response have been lacking. Because SRIs are effective, pathophysiological research on OCD has focussed on serotonin. However, no clear aberrations of serotonin have been found, thus other mechanisms ought to be involved.

    Our aims were to facilitate clinical detection and assessment of OCD, to search for biochemical correlates of response and side-effects in SRI treatment of OCD and to identify any possible involvement of oxytocin in the pathophysiology of OCD.

    In study I, we tested in 402 psychiatric out-patients the psychometric properties of a concise rating scale, “Brief Obsessive Compulsive Scale” (BOCS). BOCS was shown to be easy to use and have excellent discriminant validity in relation to other common psychiatric diagnoses.

    Studies II-V were based on 36 OCD patients from a randomised controlled trial of paroxetine, clomipramine or placebo. In study II, contrary to expectation, we found that the change (decrease) of serotonin in whole blood was most pronounced in non-responders to SRI. This is likely to reflect inflammatory influence on platelet turnover rather than serotonergic processes within the central nervous system.

    In studies IV-V, we found relations between changes of oxytocin in plasma and the anti-obsessive response, and between oxytocin and the SRI related delay of orgasm, respectively. In both cases, the relation to central oxytocinergic mechanisms is unclear. In males, delayed orgasm predicted anti-obsessive response.

    List of papers
    1. The Brief Obsessive-Compulsive Scale (BOCS): a self-report scale for OCD and obsessive-compulsive related disorders
    Open this publication in new window or tab >>The Brief Obsessive-Compulsive Scale (BOCS): a self-report scale for OCD and obsessive-compulsive related disorders
    Show others...
    2014 (English)In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 68, no 8, p. 549-559Article in journal (Refereed) Published
    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.

    Place, publisher, year, edition, pages
    Informa Healthcare, 2014
    Keywords
    Attention deficit hyperactivity disorder, Autism, Assessment, Compulsive behaviour, Obsessions
    National Category
    Psychiatry
    Research subject
    Psychiatry
    Identifiers
    urn:nbn:se:oru:diva-39459 (URN)10.3109/08039488.2014.884631 (DOI)000343980600005 ()24568661 (PubMedID)
    Available from: 2014-12-10 Created: 2014-12-10 Last updated: 2018-06-14Bibliographically approved
    2. Reactivity of serotonin in whole blood: relationship with drug response in obsessive-compulsive disorder
    Open this publication in new window or tab >>Reactivity of serotonin in whole blood: relationship with drug response in obsessive-compulsive disorder
    2001 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 49, no 4, p. 360-368Article in journal (Refereed) Published
    Abstract [en]

    Background: Obsessive-compulsive disorder responds almost only to potent serotonin reuptake inhibitors. Previous studies have suggested a relation between serotonergic function and clinical outcome in serotonin reuptake inhibitor treatment of obsessive-compulsive disorder.

    Methods: In a randomized, double-blind trial, comparing clomipramine, paroxetine, and a placebo in obsessive-compulsive disorder, serotonin levels in whole blood (WB-5-HT) were measured at baseline, after 1 week, and after 4 weeks of treatment and related to clinical outcome in 36 patients.

    Results: In patients treated with serotonin reuptake inhibitors there was a pronounced decrease of WB-5-HT, variable after 1 week and uniformly maximal after 4 weeks. The decrease of WB-5-HT after 1 week of serotonin reuptake inhibitor treatment correlated negatively with clinical outcome after 12 weeks (r = -.61, p =.0006); hence, patients with slower WB-5-HT reactivity eventually responded better to treatment. Baseline WB-5-HT, but not WB-5-HT reactivity, was related to season. Depression, autistic traits, and previous serotonin reuptake inhibitor treatment predicted nonresponse.

    Conclusions: A fast decrease of WB-5-HT was associated with poor clinical outcome. This may be related to faster serotonin efflux from platelets, which has previously been linked to autism. Further studies are necessary to identify the underlying mechanism and discern whether serotonin reuptake inhibitor-induced WB-5-HT decrease is clinically useful.

    Place, publisher, year, edition, pages
    New York, USA: Elsevier, 2001
    Keywords
    Obsessive-compulsive disorder, serotonin, kinetics, serotonin reuptake inhibitors, autism, prediction of response, randomized controlled trial
    National Category
    Medical and Health Sciences Psychiatry Neurology
    Identifiers
    urn:nbn:se:oru:diva-50184 (URN)10.1016/S0006-3223(00)00956-2 (DOI)000167183100007 ()11239907 (PubMedID)2-s2.0-0035865647 (Scopus ID)
    Available from: 2016-05-03 Created: 2016-05-03 Last updated: 2017-11-30Bibliographically approved
    3. Reactivity of serotonin in whole blood: response to Mulder et al.
    Open this publication in new window or tab >>Reactivity of serotonin in whole blood: response to Mulder et al.
    2002 (English)In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 51, no 3, p. 267-268Article in journal, Letter (Other academic) Published
    Place, publisher, year, edition, pages
    Elsevier, 2002
    National Category
    Psychiatry Neurosciences
    Identifiers
    urn:nbn:se:oru:diva-51955 (URN)10.1016/S0006-3223(01)01316-6 (DOI)000173811000011 ()
    Available from: 2016-09-05 Created: 2016-09-05 Last updated: 2018-01-10Bibliographically approved
    4. Plasma oxytocin changes and anti-obsessive response during serotonin reuptake inhibitor treatment: a placebo controlled study
    Open this publication in new window or tab >>Plasma oxytocin changes and anti-obsessive response during serotonin reuptake inhibitor treatment: a placebo controlled study
    2013 (English)In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 13, p. 344-Article in journal (Refereed) Published
    Abstract [en]

    Background: The drug treatments of choice for obsessive-compulsive disorder (OCD) are serotonin reuptake inhibitors (SRIs). However, a correlation between the neuropeptide oxytocin in cerebrospinal fluid and the severity of OCD has previously been shown, and oxytocin and serotonin are interconnected within the brain. Few studies have investigated whether SRIs have any effect on oxytocin; thus, our aim was to explore the possibility that oxytocinergic mechanisms contribute to the anti-obsessive effect of SRIs.

    Method: In a randomized, double-blind trial, comparing SRIs (clomipramine and paroxetine) with placebo in 36 adults with OCD (characterized for subtypes), plasma oxytocin was measured with radioimmunoassay after plasma extraction, at baseline, after 1 week, and after 4 weeks of treatment, and related to baseline severity and clinical response after 12 weeks, as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).

    Results: Baseline oxytocin levels correlated positively with baseline Y-BOCS ratings, but only among the future SRI responders. Patients with early onset of OCD had higher baseline oxytocin. During treatment, plasma oxytocin did not differ between SRI and placebo treatment. In SRI responders, plasma oxytocin first decreased and then increased; in non-responders (to SRI as well as to placebo), the reverse was the case. After 4 weeks, treatment responders had attained higher oxytocin levels compared to non-responders. The intra-individual range (i.e. the variability) of plasma oxytocin between measurements was the measure that best differentiated responders from non-responders. This range was higher in responders than non-responders, and lower in patients with autistic traits.

    Conclusions: SRIs have highly variable effects on plasma oxytocin between individuals. The associations between baseline oxytocin and OCD severity and between oxytocin changes and treatment response support the notions that oxytocin is involved in OCD pathophysiology, and that the anti-obsessive effects of SRIs are partly exerted through oxytocinergic mechanisms.

    Keywords
    Obsessive-compulsive disorder, Oxytocin/plasma, Serotonin, Serotonin uptake inhibitors, Treatment response, Randomized controlled trial, Autism spectrum disorder, Placebo response
    National Category
    Medical and Health Sciences Psychiatry
    Identifiers
    urn:nbn:se:oru:diva-33285 (URN)10.1186/1471-244X-13-344 (DOI)000329160000001 ()24359174 (PubMedID)2-s2.0-84890670310 (Scopus ID)
    Funder
    Swedish Research Council, 2011-3646
    Note

    Funding Agency: Örebro County Council; Örebro University (se även Forskningsfinansiär)

    Available from: 2014-01-24 Created: 2014-01-24 Last updated: 2017-12-06Bibliographically approved
    5. Orgasm, Serotonin Reuptake Inhibition, and Plasma Oxytocin in Obsessive-Compulsive Disorder. Gleaning From a Distant Randomized Clinical Trial
    Open this publication in new window or tab >>Orgasm, Serotonin Reuptake Inhibition, and Plasma Oxytocin in Obsessive-Compulsive Disorder. Gleaning From a Distant Randomized Clinical Trial
    2016 (English)In: Sexual medicine, ISSN 2050-1161, Vol. 4, no 3, p. e145-e155Article in journal (Refereed) Published
    Abstract [en]

    Introduction: Serotonin reuptake inhibitors (SRIs) are widely used for the treatment of psychiatric disorders, including obsessive-compulsive disorder (OCD). SRIs commonly cause delayed orgasm, the mechanism of which is poorly understood. Oxytocin is involved in sexual function and is interconnected with serotonin within the brain. SRIs are reported to affect the oxytocin system, but possible relations between SRI-induced changes of sexual function and oxytocin are unexplored in humans. In a randomized, double-blinded, placebo-controlled trial of OCD, the anti-obsessive efficacy and adverse events of SRIs and oxytocin measurements were studied.

    Aims: To identify possible correlates between oxytocin levels and sexual function; find out whether sexual side effects correlate with levels of oxytocin and/or paroxetine and clomipramine; and test whether changes in sexual functioning are related to an anti-obsessive response.

    Methods Reported sexual function and oxytocin plasma levels at rest were studied in 31 adults (15 men and 16 women) with OCD who participated in a randomized, double-blinded trial comparing the SRIs clomipramine and paroxetine with placebo. Sexual adverse effects were quantified by a clinician-administered semistructured interview. Anti-obsessive response was based on the Yale-Brown Obsessive-Compulsive Scale.

    Main outcome measures: Ratings on the Sexual Symptom Checklist, plasma oxytocin, serum paroxetine and clomipramine levels, and Yale-Brown Obsessive-Compulsive Scale scores.

    RESULTS: Baseline oxytocin levels were positively correlated with baseline OCD severity, but not with sexual functioning. Impaired orgasm at week 6 was reported by 73% of SRI-treated and 20% of placebo-treated patients (P = .03). Impaired orgasm was related to higher oxytocin levels after 4 weeks of SRI treatment (P < .01) but not to SRI concentrations. In men, an association between impaired orgasm and anti-obsessive treatment response was found (P = .028).

    CONCLUSION: This pilot study suggests that some collateral effects of SRIs, particularly delayed orgasm, might be influenced by changes within the oxytocinergic system and are related to anti-obsessive mechanisms. Early-onset delayed orgasm in SRI-treated patients could serve as a predictor for OCD treatment response.

    Place, publisher, year, edition, pages
    Oxford, United Kingdom: Elsevier, 2016
    Keywords
    Obsessive-Compulsive Disorder; Oxytocin/Plasma; Serotonin; Clomipramine; Paroxetine; Serotonin Uptake Inhibitors; Response Prediction; Adverse Effects; Randomized Controlled Trial; Sexual Physiology
    National Category
    Psychiatry General Practice
    Identifiers
    urn:nbn:se:oru:diva-50976 (URN)10.1016/j.esxm.2016.04.002 (DOI)000389259700003 ()27320409 (PubMedID)2-s2.0-85006216627 (Scopus ID)
    Available from: 2016-06-21 Created: 2016-06-21 Last updated: 2018-07-14Bibliographically approved
  • 21.
    Humble, Mats B.
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Bejerot, Susanne
    Örebro University, School of Medical Sciences. University Health Care Research Center, Region Örebro County, Örebro, Sweden.
    Orgasm, Serotonin Reuptake Inhibition, and Plasma Oxytocin in Obsessive-Compulsive Disorder. Gleaning From a Distant Randomized Clinical Trial2016In: Sexual medicine, ISSN 2050-1161, Vol. 4, no 3, p. e145-e155Article in journal (Refereed)
    Abstract [en]

    Introduction: Serotonin reuptake inhibitors (SRIs) are widely used for the treatment of psychiatric disorders, including obsessive-compulsive disorder (OCD). SRIs commonly cause delayed orgasm, the mechanism of which is poorly understood. Oxytocin is involved in sexual function and is interconnected with serotonin within the brain. SRIs are reported to affect the oxytocin system, but possible relations between SRI-induced changes of sexual function and oxytocin are unexplored in humans. In a randomized, double-blinded, placebo-controlled trial of OCD, the anti-obsessive efficacy and adverse events of SRIs and oxytocin measurements were studied.

    Aims: To identify possible correlates between oxytocin levels and sexual function; find out whether sexual side effects correlate with levels of oxytocin and/or paroxetine and clomipramine; and test whether changes in sexual functioning are related to an anti-obsessive response.

    Methods Reported sexual function and oxytocin plasma levels at rest were studied in 31 adults (15 men and 16 women) with OCD who participated in a randomized, double-blinded trial comparing the SRIs clomipramine and paroxetine with placebo. Sexual adverse effects were quantified by a clinician-administered semistructured interview. Anti-obsessive response was based on the Yale-Brown Obsessive-Compulsive Scale.

    Main outcome measures: Ratings on the Sexual Symptom Checklist, plasma oxytocin, serum paroxetine and clomipramine levels, and Yale-Brown Obsessive-Compulsive Scale scores.

    RESULTS: Baseline oxytocin levels were positively correlated with baseline OCD severity, but not with sexual functioning. Impaired orgasm at week 6 was reported by 73% of SRI-treated and 20% of placebo-treated patients (P = .03). Impaired orgasm was related to higher oxytocin levels after 4 weeks of SRI treatment (P < .01) but not to SRI concentrations. In men, an association between impaired orgasm and anti-obsessive treatment response was found (P = .028).

    CONCLUSION: This pilot study suggests that some collateral effects of SRIs, particularly delayed orgasm, might be influenced by changes within the oxytocinergic system and are related to anti-obsessive mechanisms. Early-onset delayed orgasm in SRI-treated patients could serve as a predictor for OCD treatment response.

  • 22.
    Humble, Mats B.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Uppsala university.
    Bejerot, Susanne
    Uppsala university.
    Bergqvist, Peter B. F.
    AstraZeneca, Lund, Sweden.
    Reactivity of serotonin in whole blood: response to Mulder et al.2002In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 51, no 3, p. 267-268Article in journal (Other academic)
  • 23.
    Humble, Mats B.
    et al.
    Department of Clinical Neuroscience, Division of Psychiatry, St. Göran, Karolinska Institutet, Stockholm, Sweden.
    Gustafsson, Sven
    Department of Laboratory Medicine, Section for Clinical Chemistry, Karolinska Institutet, Stockholm, Sweden.
    Bejerot, Susanne
    Department of Clinical Neuroscience, Division of Psychiatry, St. Göran, Karolinska Institutet, Stockholm, Sweden.
    Low serum levels of 25-hydroxyvitamin D (25-OHD) among psychiatric out-patients in Sweden: relations with season, age, ethnic origin and psychiatric diagnosis2010In: Journal of Steroid Biochemistry and Molecular Biology, ISSN 0960-0760, E-ISSN 1879-1220, Vol. 121, no 1-2, p. 467-470Article in journal (Refereed)
    Abstract [en]

    In a chart review at a psychiatric out-patient department, latitude 59.3 degrees N, a sample of patients with tests of serum 25-hydroxy-vitamin D (25-OHD) and plasma intact parathyroid hormone (iPTH) was collected, together with demographic data and psychiatric diagnoses. During 19 months, 117 patients were included. Their median 25-OHD was 45 nmol/l; considerably lower than published reports on Swedish healthy populations. Only 14.5% had recommended levels (over 75). In 56.4%, 25-OHD was under 50 nmol/l, which is related to several unfavourable health outcomes. Seasonal variation of 25-OHD was blunted. Patients with ADHD had unexpectedly low iPTH levels. Middle East, South-East Asian or African ethnic origin, being a young male and having a diagnosis of autism spectrum disorder or schizophrenia predicted low 25-OHD levels. Hence, the diagnoses that have been hypothetically linked to developmental (prenatal) vitamin D deficiency, schizophrenia and autism, had the lowest 25-OHD levels in this adult sample, supporting the notion that vitamin D deficiency may not only be a predisposing developmental factor but also relate to the adult patients' psychiatric state. This is further supported by the considerable psychiatric improvement that coincided with vitamin D treatment in some of the patients whose deficiency was treated.

  • 24.
    Humble, Mats B.
    et al.
    Örebro University, School of Medical Sciences.
    Reis, M.
    Department of clinical chemistry, Division of laboratory medicine, University health care in Region Skåne, Lund, Sweden.
    Paroxetine concentrations in obsessive-compulsive disorder: Support for a therapeutic interval2017In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 41, no Suppl., p. S322-S322Article in journal (Other academic)
    Abstract [en]

    Introduction: Previous studies of concentrations of serotonin reuptake inhibitors (SRIs) versus therapeutic efficacy have yielded inconsistent results. Even if the relationships between the individual's serotonergic system and the clinical symptoms of obsessive-compulsive disorder (OCD) are poorly understood, the SRIs are consistently effective in OCD. However, studies on SRI concentrations in OCD treatment are rare.

    Objectives/aims: To identify possible links between paroxetine concentrations and anti-obsessive response.

    Methods: In a randomised, double-blind trial, comparing clomipramine, paroxetine and placebo in OCD treatment, serum paroxetine levels were measured after 1 week and after 4 weeks of treatment in 18 patients. Anti-obsessive response was assessed with Yale-Brown obsessive compulsive scale (Y-BOCS) and patients’ global evaluation (PGE), after 12 weeks of treatment.

    Results: Serum paroxetine concentrations after 4 weeks suggested a therapeutic interval between 50 and 240 nmol/L (13–63 ng/mL). The mean Y-BOCS decrease was 54% inside versus 7% outside this interval (t = 3.96; P = 0.0011).

    Conclusions: Paroxetine levels seemingly predicted clinical outcome. Studies with a greater number of patients are necessary in order to confirm this finding and to discern whether it is useful in clinical practice.

  • 25.
    Humble, Mats B.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Psychiatric Research Centre, Örebro, Sweden.
    Uvnäs-Moberg, Kerstin
    Swedish University of Agricultural Sciences, Skara, Sweden .
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Örebro County Council, Örebro, Sweden.
    Bejerot, Susanne
    Karolinska Institutet, Stockholm, Sweden.
    Plasma oxytocin changes and anti-obsessive response during serotonin reuptake inhibitor treatment: a placebo controlled study2013In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 13, p. 344-Article in journal (Refereed)
    Abstract [en]

    Background: The drug treatments of choice for obsessive-compulsive disorder (OCD) are serotonin reuptake inhibitors (SRIs). However, a correlation between the neuropeptide oxytocin in cerebrospinal fluid and the severity of OCD has previously been shown, and oxytocin and serotonin are interconnected within the brain. Few studies have investigated whether SRIs have any effect on oxytocin; thus, our aim was to explore the possibility that oxytocinergic mechanisms contribute to the anti-obsessive effect of SRIs.

    Method: In a randomized, double-blind trial, comparing SRIs (clomipramine and paroxetine) with placebo in 36 adults with OCD (characterized for subtypes), plasma oxytocin was measured with radioimmunoassay after plasma extraction, at baseline, after 1 week, and after 4 weeks of treatment, and related to baseline severity and clinical response after 12 weeks, as measured by the Yale-Brown Obsessive Compulsive Scale (Y-BOCS).

    Results: Baseline oxytocin levels correlated positively with baseline Y-BOCS ratings, but only among the future SRI responders. Patients with early onset of OCD had higher baseline oxytocin. During treatment, plasma oxytocin did not differ between SRI and placebo treatment. In SRI responders, plasma oxytocin first decreased and then increased; in non-responders (to SRI as well as to placebo), the reverse was the case. After 4 weeks, treatment responders had attained higher oxytocin levels compared to non-responders. The intra-individual range (i.e. the variability) of plasma oxytocin between measurements was the measure that best differentiated responders from non-responders. This range was higher in responders than non-responders, and lower in patients with autistic traits.

    Conclusions: SRIs have highly variable effects on plasma oxytocin between individuals. The associations between baseline oxytocin and OCD severity and between oxytocin changes and treatment response support the notions that oxytocin is involved in OCD pathophysiology, and that the anti-obsessive effects of SRIs are partly exerted through oxytocinergic mechanisms.

  • 26.
    Humble, Mats
    et al.
    Psychiatry of Northern Dalecarlia, Mora Hospital, Mora, Sweden; Karolinska Institutet, Division of Psychiatry, Danderyd Hospital, Danderyd, Sweden.
    Bejerot, Susanne
    Department of Neuroscience, Division of Psychiatry, Uppsala University, Uppsala, Sweden.
    Bergqvist, P. B.
    Department of Clinical Pharmacology, Lund University, Lund, Sweden.
    Bengtsson, F.
    Department of Clinical Pharmacology, Lund University, Lund Sweden; Department of Neuroscience and Locomotion, Division of Psychiatry, Linköping University Hospital, Linköping, Sweden.
    Reactivity of serotonin in whole blood: relationship with drug response in obsessive-compulsive disorder2001In: Biological Psychiatry, ISSN 0006-3223, E-ISSN 1873-2402, Vol. 49, no 4, p. 360-368Article in journal (Refereed)
    Abstract [en]

    Background: Obsessive-compulsive disorder responds almost only to potent serotonin reuptake inhibitors. Previous studies have suggested a relation between serotonergic function and clinical outcome in serotonin reuptake inhibitor treatment of obsessive-compulsive disorder.

    Methods: In a randomized, double-blind trial, comparing clomipramine, paroxetine, and a placebo in obsessive-compulsive disorder, serotonin levels in whole blood (WB-5-HT) were measured at baseline, after 1 week, and after 4 weeks of treatment and related to clinical outcome in 36 patients.

    Results: In patients treated with serotonin reuptake inhibitors there was a pronounced decrease of WB-5-HT, variable after 1 week and uniformly maximal after 4 weeks. The decrease of WB-5-HT after 1 week of serotonin reuptake inhibitor treatment correlated negatively with clinical outcome after 12 weeks (r = -.61, p =.0006); hence, patients with slower WB-5-HT reactivity eventually responded better to treatment. Baseline WB-5-HT, but not WB-5-HT reactivity, was related to season. Depression, autistic traits, and previous serotonin reuptake inhibitor treatment predicted nonresponse.

    Conclusions: A fast decrease of WB-5-HT was associated with poor clinical outcome. This may be related to faster serotonin efflux from platelets, which has previously been linked to autism. Further studies are necessary to identify the underlying mechanism and discern whether serotonin reuptake inhibitor-induced WB-5-HT decrease is clinically useful.

  • 27.
    Manouilenko, Irina
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Järva Psychiatric Outpatient Clinic, Spånga, Sweden.
    Eriksson, Jonna M.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Humble, Mats B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Bejerot, Susanne
    Örebro University Hospital. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Minor physical anomalies in adults with autism spectrum disorder and healthy controls2014In: Autism Research and Treatment, ISSN 2090-1925, E-ISSN 2090-1933, article id 743482Article in journal (Refereed)
    Abstract [en]

    Minor Physical Anomalies (MPAs) are subtle abnormalities of the head, face, and limbs, without significant cosmetic or functional impact to the individual. They are assumed to represent external markers of developmental deviations during foetal life. MPAs have been suggested to indicate severity in mental illness and constitute external markers for atypical brain development. Higher frequencies of MPAs can be found in children with autism. The aims of the present study were to examine the prevalence and patterns of MPAs in adults with autism spectrum disorder (ASD) and to investigate whether MPAs are associated with symptom severity and overall functioning. Fifty adults with ASD and intelligence within the normal range and 53 healthy controls were examined with the Waldrop scale, an instrument for assessing MPAs. Face and feet were photographed enabling blinded assessment. Significant differences between the ASD and the control group were found on the MPA total scores, and also in the craniofacial region scores. Moreover, the shape of the ears was associated with autistic traits, in the ASD group. High MPA total scores were associated with poorer functioning. The findings suggest a link between MPAs, autistic traits, and level of functioning. Assessment of MPAs may assist in the diagnostic procedure of psychiatric disorders.

  • 28.
    Manouilenko, Irina
    et al.
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Järva psychiatric out-patient clinic, Praktikertjänst AB, Stockholm, Sweden.
    Humble, Mats B.
    Örebro University, School of Medical Sciences. University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Georgieva, Jeanette
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Bejerot, Susanne
    Örebro University, School of Medical Sciences. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; University Health Care Research Centre, Region Örebro County, Örebro, Sweden.
    Brainstem Auditory Evoked Potentials for diagnosing Autism Spectrum Disorder, ADHD and Schizophrenia Spectrum Disorders in adults: A blinded study2017In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 257, p. 21-26Article in journal (Refereed)
    Abstract [en]

    The aim of the present study was to examine the clinical utility of complex auditory brainstem response (c-ABR) and investigate if c-ABR is helpful in the diagnostic procedure. Thirty-one adult psychiatric patients, thoroughly diagnosed with autism spectrum disorder (ASD) (n=16), ADHD (n=8), or schizophrenia spectrum disorder (SSD) (n=7) and 15 healthy controls (HC), were blindly assessed with SensoDetect BERA. This c-ABR correctly identified psychiatric diagnoses in 4 patients (13%) and provided partially correct diagnoses in 11 more patients. Of the 15 HC, 6 were misclassified as psychiatric patients. The Cohen´s kappa coefficient (κ) was substantial for HC (κ=0.67), fair for SSD (κ=0.37), slight for ADHD (κ=0.09) and without agreement in ASD (κ=-0.03). In conclusion, we found the c-ABR method unhelpful and unreliable as a tool in clinical diagnostics.

  • 29.
    Meehan, Adrian D.
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Geriatrics, Örebro University Hospital, Örebro, Sweden.
    Humble, Mats B.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Psychiatry, Örebro University Hospital, Örebro, Sweden.
    Yazarloo, Payam
    Department of Psychiatry, Ryhov Hospital, Jönköping, Sweden .
    Järhult, Johannes
    Department of Surgery, Ryhov Hospital, Jönköping, Sweden .
    Wallin, Göran
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Surgery, Örebro University Hospital, Örebro, Sweden.
    The prevalence of lithium-associated hyperparathyroidism in a large Swedish population attending psychiatric outpatient units2015In: Journal of Clinical Psychopharmacology, ISSN 0271-0749, E-ISSN 1533-712X, Vol. 35, no 3, p. 279-285Article in journal (Refereed)
    Abstract [en]

    Objective: This retrospective study determined the prevalence of lithium-associated hyperparathyroidism (LHPT) in 2 geographically defined, equivalent populations in Sweden, with no other selection bias.

    Methods: The medical journals of all patients receiving lithium treatment were examined specifically regarding their biochemistry: calcium, parathyroid hormone (PTH), creatinine, and vitamin D. The condition LHPT was defined biochemically. All patient data were noted, and the prevalence of the condition could thereby be calculated.

    Results: A total of 423 patients were included (251 women and 172 men; 3: 2), treated over a mean of 13.5 years (range, 1-46 years), aged 19 to 92. 77 patients (18%) were identified with LHTP whose median serum calcium-was 2.55 mmol/L and PTH was 99 ng/L. A further 21% showed tendencies toward hypercalcemia. Forty-three percent had vitamin D insufficiency. Five patients (approximately 1%) had undergone parathyroidectomy.

    Conclusion: The prevalence of LHPT is high and often goes undetected. Vitamin D insufficiency is common as is polypharmacy. Surgery, for unclear reasons, has not been performed extensively, possibly because of limited knowledge of the underlying pathophysiology or surgery's significance. We present standard recommendations on patient management and suggest continual, specific follow-up including the monitoring of calcium, PTH, and vitamin D at least annually. Surgery should be considered with intention to improve psychiatric well-being and provide multiorgan protection.

  • 30.
    Meehan, Adrian David
    et al.
    Örebro University, School of Medical Sciences. Department of Geriatrics, Örebro University Hospital, Örebro, Sweden.
    Humble, Mats B.
    Örebro University, School of Medical Sciences. Psychiatric Research Centre, Örebro University Hospital, Örebro, Sweden.
    Yazarloo, Payam
    Department of Psychiatry, Ryhov Hospital, Jönköping, Sweden .
    Järhult, Johannes
    Department of Surgery, Ryhov Hospital, Jönköping, Sweden .
    Wallin, Göran
    Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Reply to comments From Dr Lozano, et al - Concerning the prevalence of lithium-associated hyperparathyroidism2016In: Journal of Clinical Psychopharmacology, ISSN 0271-0749, E-ISSN 1533-712X, Vol. 36, no 2, p. 191-192Article in journal (Refereed)
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