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

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

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

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

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

    Trial registration: Clinical Trials NCT02604706 (retrospectively registered).

  • 2.
    Björk, Tabita
    et al.
    Psychiatric Research Centre, Örebro, Sweden; Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
    de Santi, Miguel G
    Forensic Psychiatric Service, Örebro County Council, Örebro, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Örebro, Sweden.
    Criminal recidivism and mortality among patients discharged from a forensic medium secure hospital2012In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 66, no 4, p. 283-9Article in journal (Refereed)
    Abstract [en]

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

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

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

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

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

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

  • 3.
    Callenmark, Björn
    et al.
    Stockholm County Council, Sweden; Örebro County Council, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Örebro County Council, Sweden.
    Rönnqvist, Louise
    Umeå University, Sweden.
    Bolte, Sven
    Karolinska Institutet, Stockholm, Sweden.
    Explicit versus implicit social cognition testing in autism spectrum disorder2014In: Autism, ISSN 1362-3613, E-ISSN 1461-7005, Vol. 18, no 6, p. 684-693Article in journal (Refereed)
    Abstract [en]

    Although autism spectrum disorder is defined by reciprocal social-communication impairments, several studies have found no evidence for altered social cognition test performance. This study examined explicit (i.e. prompted) and implicit (i.e. spontaneous) variants of social cognition testing in autism spectrum disorder. A sample of 19 adolescents with autism spectrum disorder and 19 carefully matched typically developing controls completed the Dewey Story Test. 'Explicit' (multiple-choice answering format) and 'implicit' (free interview) measures of social cognition were obtained. Autism spectrum disorder participants did not differ from controls regarding explicit social cognition performance. However, the autism spectrum disorder group performed more poorly than controls on implicit social cognition performance in terms of spontaneous perspective taking and social awareness. Findings suggest that social cognition alterations in autism spectrum disorder are primarily implicit in nature and that an apparent absence of social cognition difficulties on certain tests using rather explicit testing formats does not necessarily mean social cognition typicality in autism spectrum disorder.

  • 4.
    Choque Olsson, Nora
    et al.
    Center of Neurodevelopmental Disorders (KIND), Neuropsychiatry Unit, Karolinska Institutet, Stockholm; Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm.
    Flygare, Oskar
    Center of Neurodevelopmental Disorders (KIND), Neuropsychiatry Unit, Karolinska Institutet, Stockholm; Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm.
    Coco, Christina
    Center of Neurodevelopmental Disorders (KIND), Neuropsychiatry Unit, Karolinska Institutet, Stockholm; Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm.
    Görling, Anders
    Center of Neurodevelopmental Disorders (KIND), Neuropsychiatry Unit, Karolinska Institutet, Stockholm; Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm.
    Råde, Anna
    Center of Neurodevelopmental Disorders (KIND), Neuropsychiatry Unit, Karolinska Institutet, Stockholm; Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm.
    Chen, Qi
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lindstedt, Katarina
    Örebro University, School of Medical Sciences. University Health Care Research Center, Region Örebro County, Örebro, sweden.
    Berggren, Steve
    Center of Neurodevelopmental Disorders (KIND), Neuropsychiatry Unit, Karolinska Institutet, Stockholm; Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm.
    Serlachius, Eva
    Child- and adolescent Psychiatry, Stockholm County Council, Stockholm, Sweden.
    Jonsson, Ulf
    Center of Neurodevelopmental Disorders (KIND), Neuropsychiatry Unit, Karolinska Institutet, Stockholm; Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm.
    Tammimies, Kristiina
    Center of Neurodevelopmental Disorders (KIND), Neuropsychiatry Unit, Karolinska Institutet, Stockholm; Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm.
    Kjellin, Lars
    University Health Care Research Center, Region Örebro County, Örebro, sweden.
    Bölte, Sven
    Center of Neurodevelopmental Disorders (KIND), Neuropsychiatry Unit, Karolinska Institutet, Stockholm; Child and Adolescent Psychiatry, Center for Psychiatry Research, Stockholm County Council, Stockholm.
    Social Skills Training for Children and Adolescents With Autism Spectrum Disorder: A Randomized Controlled Trial2017In: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 56, no 7, p. 585-592, article id S0890-8567(17)30202-2Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: Social skills group training (SSGT) for children and adolescents with autism spectrum disorder (ASD) is widely applied, but effectiveness in real-world practice has not yet been properly evaluated. This study sought to bridge this gap.

    METHOD: This 12-week pragmatic randomized controlled trial of SSGT compared to standard care alone was conducted at 13 child and adolescent psychiatry outpatient units in Sweden. Twelve sessions of manualized SSGT ("KONTAKT") were delivered by regular clinical staff. Participants (N = 296; 88 females and 208 males) were children (n = 172) and adolescents (n = 124) aged 8 to 17 years with ASD without intellectual disability. The primary outcome was the Social Responsiveness Scale rating by parents and blinded teachers. Secondary outcomes included parent- and teacher-rated adaptive behaviors, trainer-rated global functioning and clinical severity, and self-reported child and caregiver stress. Assessments were made at baseline, posttreatment, and 3-month follow-up. Moderator analyses were conducted for age and gender.

    RESULTS: Significant treatment effects on the primary outcome were limited to parent ratings for the adolescent subgroup (posttreatment: -8.3; 95% CI = -14.2 to -1.9; p = .012, effect size [ES] = 0.32; follow-up: -8.6; 95% CI = -15.4 to -1.8; p = .015, ES = 0.33) and females (posttreatment: -8.9; 95% CI = -16.2 to -1.6; p = .019, ES = 0.40). Secondary outcomes indicated moderate effects on adaptive functioning and clinical severity.

    CONCLUSION: SSGT for children and adolescents with ASD in regular mental health services is feasible and safe. However, the modest and inconsistent effects underscore the importance of continued efforts to improve SSGT beyond current standards.

    CLINICAL TRIAL REGISTRATION INFORMATION: Social Skills Group Training ("KONTAKT") for Children and Adolescent With High-functioning Autism Spectrum Disorders; https://clinicaltrials.gov/; NCT01854346.

  • 5. Eklund, Mona
    et al.
    Örnsberg, Lena
    Ekström, Christina
    Jansson, Birgitta
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Outcomes of activity-based assessment (BIA) compared with standard assessment in occupational therapy2008In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 15, no 4, p. 196-203Article in journal (Refereed)
    Abstract [en]

    This study was aimed at investigating the outcomes of an activity-based assessment (BIA) compared with standard assessment (SA) for evaluating clients undergoing psychiatric occupational therapy. Patients admitted to a psychiatric occupational therapy unit were randomized into the BIA or the SA assessment. The outcome indicators were (a) clients' satisfaction with the occupational therapy during the assessment period, (b) clients' awareness of capacities and occupational problems, (c) satisfaction with the assessment among the referring physicians, and (d) outcomes of the intervention following the assessment, in terms of changes in occupational performance and satisfaction. The groups did not differ in awareness of occupational problems, but the BIA group was more satisfied than the SA group with the support of their contact person and with the group leader during the period of assessment. Furthermore, physicians receiving feedback on patients in the BIA group were more satisfied than those receiving feedback on patients in the SA group. However, the groups did not differ concerning change during the treatment period in occupational performance or satisfaction. Thus, there was no difference between the assessment methods regarding the outcomes of the treatment following assessment. Minor advantages from the patients' perspective were found, in terms of better satisfaction in the BIA group, and from the referring physicians' perspective the BIA clearly seemed more satisfying than the SA. Thus, the findings showed that the BIA possessed better qualities than the SA regarding the indicators pertaining to satisfaction, but not concerning awareness of capacities and problems or the outcome of the subsequent treatment. 

  • 6.
    Elwin, Marie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Region Örebro County, Örebro University Hospital, Örebro, Sweden.
    Ek, Lena
    Department of Psychogeriatrics, Blekinge Hospital, Karlskrona, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Region Örebro County, Örebro University Hospital, Örebro, Sweden.
    Schröder, Agneta
    Psychiatric Research Centre, Region Örebro County, Örebro University Hospital, Örebro, Sweden.
    Too much or too little: hyper- and hypo-reactivity in high-functioning autism spectrum conditions2013In: Journal of Intellectual & Developmental Disability, ISSN 1366-8250, E-ISSN 1469-9532, Vol. 38, no 3, p. 232-241Article in journal (Refereed)
    Abstract [en]

    Background: Sensory reactivity in people with autism spectrum conditions (ASC) has been found to differ in comparison to reactivity in people without ASC. In this study sensory experiences of high-functioning individuals with ASC were explored and described.

    Method: Interview data from 15 participants with a diagnosis of ASC were analysed by content analysis.

    Results: Seven aspects of sensory experiences were identified: Being hyper- and hypo-reactive, reacting to general overload, having strong stimuli preferences, managing attentiveness to stimuli, managing sensory/motor stimuli, and dealing with consequences of sensory reactions in daily life.

    Conclusions: The categorisation of sensory reactivity in this study can guide clinicians on how to pose questions about sensory issues to individuals with ASC. The assessment of spectrum-specific sensory experiences in high-functioning ASC and their association with other social and nonsocial features of ASC are goals for further research.

  • 7.
    Elwin, Marie
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research centre, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Ek, Lena
    Department of Psychology, Stockholm University, Sweden.
    Schröder, Agneta
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research centre, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research centre, School of Health and Medical Sciences, Örebro University, Örebro, Sweden.
    Autobiographical Accounts of Sensing in Asperger Syndrome and High-Functioning Autism2012In: Archives of Psychiatric Nursing, ISSN 0883-9417, E-ISSN 1532-8228, Vol. 26, no 5, p. 420-429Article in journal (Refereed)
    Abstract [en]

    Sensory experiences in Asperger syndrome (AS) or high-functioning autism (HFA) were explored by qualitative content analysis of autobiographical texts by persons with AS/HFA. Predetermined categories of hyper- and hyposensitivity were applied to texts. Hypersensitivity consists of strong reactions and heightened apprehension in reaction to external stimuli, sometimes together with overfocused or unselective attention. It was common in vision, hearing, and touch. In contrast, hyposensitivity was frequent in reaction to internal and body stimuli such as interoception, proprioception, and pain. It consists of less registration, discrimination, and recognition of stimuli as well as cravings for specific stimuli. Awareness of the strong impact of sensitivity is essential for creating good environments and encounters in the context of psychiatric and other health care.

  • 8.
    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, p. 103-110Article 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.

  • 9.
    Elwin, Marie
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Schröder, Agneta
    Örebro University, School of Health Sciences. Örebro University Hospital. Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Ek, Lena
    Department of Psychology, Lund University, Lund, Sweden.
    Wallsten, Tuula
    Centre for Clinical Research, Uppsala University, Uppsala, Sweden.
    Kjellin, Lars
    Örebro University Hospital. Faculty of Medicine and Health, University Health Care Research Center, Örebro University, Örebro, Sweden.
    Sensory Clusters of Adults With and Without Autism Spectrum Conditions2017In: Journal of autism and developmental disorders, ISSN 0162-3257, E-ISSN 1573-3432, Vol. 47, no 3, p. 579-589Article in journal (Refereed)
    Abstract [en]

    We identified clusters of atypical sensory functioning adults with ASC by hierarchical cluster analysis. A new scale for commonly self-reported sensory reactivity was used as a measure. In a low frequency group (n = 37), all subscale scores were relatively low, in particular atypical sensory/motor reactivity. In the intermediate group (n = 17) hyperreactivity, sensory interests and sensory/motor issues were significantly elevated in relation to the first group, but not hyporeactivity. In a high frequency subgroup (n = 17) all subscale scores were significantly elevated and co-occurrence of hyper- and hyporeactivity was evident. In a population sample, a cluster of low scorers (n = 136) and high scorers relative to the other cluster (n = 26) was found. Identification of atypical sensory reactivity is important for targeting support.

  • 10.
    Elwin, Marie
    et al.
    Örebro University, School of Health Sciences.
    Schröder, Agneta
    Örebro University, School of Health Sciences.
    Ek, Lena
    Department of Psychology, Lund University, Lund, Sweden.
    Wallsten, Tuula
    Centre for Clinical Research, Uppsala University, the County Hospital, Västerås, Sweden.
    Kjellin, Lars
    Örebro University, School of Health Sciences.
    Sensory clusters of adults with and without autism spectrum conditionsManuscript (preprint) (Other academic)
  • 11. Fiorillo, A.
    et al.
    De Rosa, C.
    Del Vecchio, V.
    Jurjanz, L.
    Schnall, K.
    Onchev, G.
    Alexiev, S.
    Raboch, J.
    Kalisova, L.
    Mastrogianni, A.
    Georgiadou, E.
    Solomon, Z.
    Dembinskas, A.
    Raskauskas, V.
    Nawka, P.
    Nawka, A.
    Kiejna, A.
    Hadrys, T.
    Torres-Gonzales, F.
    Mayoral, F.
    Björkdahl, A.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Priebe, S.
    Maj, M.
    Kallert, T.
    How to improve clinical practice on involuntary hospital admissions of psychiatric patients: suggestions from the EUNOMIA study2011In: European psychiatry, ISSN 0924-9338, E-ISSN 1778-3585, Vol. 26, no 4, p. 201-207Article in journal (Refereed)
    Abstract [en]

    Number and procedures of involuntary hospital admissions vary in Europe according to the different socio-cultural contexts. The European Commission has funded the EUNOMIA study in 12 European countries in order to develop European recommendations for good clinical practice in involuntary hospital admissions. The recommendations have been developed with the direct and active involvement of national leaders and key professionals, who worked out national recommendations, subsequently summarized into a European document, through the use of specific categories. The need for standardizing the involuntary hospital admission has been highlighted by all centers. In the final recommendations, it has been stressed the need to: providing information to patients about the reasons for hospitalization and its presumable duration; protecting patients’ rights during hospitalization; encouraging the involvement of family members; improving the communication between community and hospital teams; organizing meetings, seminars and focus-groups with users; developing training courses for involved professionals on the management of aggressive behaviors, clinical aspects of major mental disorders, the legal and administrative aspects of involuntary hospital admissions, on communication skills. The results showed the huge variation of involuntary hospital admissions in Europe and the importance of developing guidelines on this procedure.

  • 12.
    Fiorillo, A.
    et al.
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    Giacco, D.
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    De Rosa, C.
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    Kallert, T.
    Department of Psychiatry and Psychotherapy, Dresden University of Technology, Dresden, Germany; Park Hospital Leipzig, Department of Psychiatry, Psychosomatic Medicine, and Psychotherapy, Leipzig & Soteria Hospital, Leipzig, Germany; Faculty of Medicine, Dresden University of Technology, Dresden, Germany.
    Katsakou, C.
    Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary College, University of London, United Kingdom.
    Onchev, G.
    Department of Psychiatry, Medical University of Sofia, Sofia, Bulgaria.
    Raboch, J.
    Department of Psychiatry, 1st Faculty of Medicine, Charles University, Prague, Czech Republic .
    Mastrogianni, A.
    Psychiatric Hospital, Thessaloniki, Greece.
    Del Vecchio, V.
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    Luciano, M.
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    Catapano, F.
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    Dembinskas, A.
    Psychiatric Clinic Vilnius Mental Health Centre, University of Vilnius, Vilnius, Lithuania.
    Nawka, P.
    Psychiatric Hospital, Michalovce, Slovak Republic.
    Kiejna, A.
    Psychiatric Hospital, Michalovce Slovak Republic; Department of Psychiatry, Medical University, Wroclaw, Poland.
    Torres-Gonzales, F.
    Centro Investigacin Biomedica en Red en Salud Mental (CIBERSAM), University of Granada, Spain; Hospital Regional Carlos Haya, Malaga, Spain.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Maj, M.
    Department of Psychiatry, University of Naples SUN, Naples, Italy.
    Priebe, S.
    Unit for Social and Community Psychiatry, Barts and the London School of Medicine and Dentistry, Queen Mary College, University of London, United Kingdom.
    Patient characteristics and symptoms associated with perceived coercion during hospital treatment2012In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 125, no 6, p. 460-467Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 13. Fortugno, Federico
    et al.
    Katsakou, Christina
    Bremner, Stephen
    Kiejna, Andrzej
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Nawka, Petr
    Raboch, Jiri
    Kallert, Thomas
    Priebe, Stefan
    Symptoms associated with victimization in patients with schizophrenia and related disorders2013In: PLoS ONE, ISSN 1932-6203, E-ISSN 1932-6203, Vol. 8, no 3, p. e58142-Article in journal (Refereed)
    Abstract [en]

    Background: Patients with psychoses have an increased risk of becoming victims of violence. Previous studies have suggested that higher symptom levels are associated with a raised risk of becoming a victim of physical violence. There has been, however, no evidence on the type of symptoms that are linked with an increased risk of recent victimization.

    Methods: Data was taken from two studies on involuntarily admitted patients, one national study in England and an international one in six other European countries. In the week following admission, trained interviewers asked patients whether they had been victims of physical violence in the year prior to admission, and assessed symptoms on the Brief Psychiatric Rating Scale (BPRS). Only patients with a diagnosis of schizophrenia or related disorders (ICD-10 F20-29) were included in the analysis which was conducted separately for the two samples. Symptom levels assessed on the BPRS subscales were tested as predictors of victimization. Univariable and multivariable logistic regression models were fitted to estimate adjusted odds ratios.

    Results: Data from 383 patients in the English sample and 543 patients in the European sample was analysed. Rates of victimization were 37.8% and 28.0% respectively. In multivariable models, the BPRS manic subscale was significantly associated with victimization in both samples.

    Conclusions: Higher levels of manic symptoms indicate a raised risk of being a victim of violence in involuntary patients with schizophrenia and related disorders. This might be explained by higher activity levels, impaired judgement or poorer self-control in patients with manic symptoms. Such symptoms should be specifically considered in risk assessments.

  • 14.
    Gustafsson, Sanna Aila
    et al.
    Örebro University, School of Health and Medical Sciences.
    Edlund, Birgitta
    Institutionen för folkhälso- och vårdvetenskap, Uppsala Universitet.
    Davén, Josefine
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Norring, Claes
    Centrum för psykiatriforskning, KI.
    How to deal with perceived expectations in daily life: reflections of adolescent girls suffering from eating disordersManuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study was to investigate how adolescent girls with eating disorders reflect upon various ways of dealing with societal expectations in daily life. Eighteen interviews with girls in the age span 15-19 were analysed using the phenomenographic approach.

    The results could be summarized into three qualitatively different conceptions: A) being oneself, B) adapting to different situations and C) presenting oneself in a positive light. These conceptions were expressed in five courses of action.

  • 15.
    Gustafsson, Sanna Aila
    et al.
    Örebro University, School of Health and Medical Sciences.
    Edlund, Birgitta
    Institutionen för folkhälso- och vårdvetenskap, Uppsala universitet, Uppsala, Sweden.
    Davén, Josefine
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Norring, Claes
    Centrum för psykiatriforskning, Karolinska Institute, Stockholm Sweden.
    How to deal with sociocultural pressures in daily life: reflections of adolescent girls suffering from eating disorders2011In: Journal of Multidisciplinary Healthcare, ISSN 1178-2390, E-ISSN 1178-2390, Vol. 18, no 4, p. 103-110Article in journal (Refereed)
    Abstract [en]

    Adolescent girls with eating disorders experience unattainable and contradictory expectations in daily life, which create stress and negatively affect their self-evaluation. Disordered eating may function as a way of seeking control and consistency. In order to make progress in the understanding of eating disorders, the aim of this study was to describe how adolescent girls with eating disorders reflect upon ways of dealing with sociocultural pressures in daily life. Eighteen interviews with girls aged 15-19 years were analyzed using a phenomenographic approach. The results were summarized into three conceptions: "Striving to be oneself " (conception A) was described as the most desirable, but also the hardest. "Adapting to various situations" (conception B) was used without much reflection, as long as it worked, but when this way of dealing with everyday expectations was unsuccessful it was evaluated negatively. "Presenting oneself in a positive light" (conception C) was described negatively even when it was successful. Within these conceptions, the participants described various strategies that could be used more or less effectively depending on the circumstances. A common theme was their difficulties in finding a balance between trying harder to live up to perceived expectations from others on one hand, and trying to accept the situation as it was, without trying to change themselves or the situation, on the other hand. The participants believed that their eating disorder was partly a result of being unable to deal with sociocultural pressures in an effective way, and they experienced a conflict between societal values of being assertive and values of being interpersonally oriented. Implications for treatment are discussed.

  • 16.
    Gustafsson, Sanna Aila
    et al.
    Örebro University, School of Health and Medical Sciences.
    Edlund, Birgitta
    Instituationen för folkhälso- och vårdvetensakp, Uppsala Universitet, Uppsala, Sweden.
    Davén, Josefine
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Norring, Claes
    Centrum för Psykiatriforskning, Karolinska Institute, Stockholm, Sweden .
    Perceived expectations in daily life among adolescent girls suffering from an eating disorder: A Phenomenographic Study2010In: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 18, no 1, p. 25-42Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe the variation of perceived expectations in daily life of adolescent girls suffering from eating disorders. Eighteen interviews with girls between the age of 15 and 19 years were analyzed according to the phenomenographic approach. The results could be summarized into three categories: expectations from others, self-imposed expectations, and conflicting expectations. Each of these could be further subdivided into two conceptions. Conflicting and unattainable expectations were severe stressors in the informants’ lives. Many informants had problems identifying expectations that were not explicit. The informants internalized these expectations and interpreted them to be self-imposed. Clinical implications are suggested.

  • 17.
    Gustafsson, Sanna Aila
    et al.
    Örebro University, School of Health and Medical Sciences.
    Edlund, Birgitta
    Institutionen för folkhälso- och vårdvetenskap.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Norring, Claes
    Personal standards, self-evaluation and perceived benefits of thinness in girls and young women with disturbed eating2008In: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968, Vol. 16, no 6, p. 463-471Article in journal (Other academic)
    Abstract [en]

    The aim of this study was to examine personal standards, self-evaluation and perceived benefits of thinness in Swedish females 14-21 years with disturbed eating (DE) and to compare these to a group with other psychosocial problems and to a symptom free group. Seventy subjects with DE-group, 65 subjects with psychosocial problems and 70 symptom free subjects were compared regarding items selected from four questionnaires. High personal standards expressed in a competitive way were specific for the DE-group. In comparison with the other groups the DE-group also reported significantly more perceived benefits of thinness and they more frequently believed that thinness would make them more popular. The DE-group also reported a more negative self-evaluation, although this was a trait shared with the subjects with other psychosocial problems and consequently not specific for the DE-group. Identifying specific factors that perpetuate DE habits is important in order to improve our understanding and enhance the treatment of eating disorders.

  • 18.
    Gustafsson, Sanna Aila
    et al.
    Örebro University, School of Health and Medical Sciences.
    Edlund, Birgitta
    Institutionen för folkhälso- och vårdvetenskap, Uppsala Universitet.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Norring, Claes
    Center för psykiatriforskning, Karolinska institutet.
    Risk and protective factors for disturbed eating in adolescent girls: aspects of perfectionism and attitudes to eating and weight2009In: European eating disorders review, ISSN 1072-4133, E-ISSN 1099-0968, Vol. 17, no 5, p. 380-389Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to longitudinally examine the role of personal standards, self-evaluation, perceived benefits of thinness and attitudes to eating and weight in the development of healthy versus disturbed eating in adolescent girls.

    In a longitudinal study, girls who participated in two assessments, four to five years apart, were divided into three groups according to the attitudes to eating that they manifested at the second evaluation: those with disturbed eating patterns (DE-group n=49), those with intermediate concerns about eating (IE-group, n= 260) and those with healthy eating attitudes (HE-group n=120).

    Variables concerning attitudes to eating and weight and physical self-evaluation emerged as risk factors, whereas personal standards or self-evaluation in general did not. Protective factors were a low BMI, healthy eating attitudes, an accepting attitude towards body size and a positive self-evaluation, particularly with regard to physical and psychological characteristics.

    The results of this study contribute to the understanding of early risk and protective factors for eating disturbances in girls.

  • 19.
    Kjellin, Lars
    et al.
    Örebro University, School of Health and Medical Sciences.
    Cizinsky Sjödahl, Rosmarie
    Eklund, Mona
    Activity-based assessment (BIA)-inter-rater reliability and staff experiences2008In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, Vol. 15, no 2, p. 75-81Article in journal (Refereed)
    Abstract [en]

    The BIA method, based on assessment of patients in activities, was developed to enable reliable assessment of clients' occupational functioning. The method evaluates the patient's ego functions and capacity for activity and participation. The aims of this study were to examine inter-rater reliability for the BIA method and to compare the experiences of staff working with the BIA with those of staff using standard assessment (SA). In SA, the patient's activity problems and capacities were assessed without using any structured protocol. Four staff members worked according to the BIA method and eight according to SA. The estimation of reliability was based on data from 14 patients who went trough the BIA and were assessed by five staff members. These assessments resulted in all in about 400 statements, which were classified and compared for agreement between raters. In order to address the aim concerning staff experiences, a questionnaire was filled out anonymously by the staff. The inter-rater reliability of the nine ego functions varied from 0.76 to 1.00. The scale was deemed appropriate by the BIA staff and they had significantly higher median ratings on work satisfaction and appropriateness than the SA staff. In conclusion, the inter-rater reliability of the BIA was found to be good. The BIA method also seems to have a high degree of appropriateness, constituting a promising assessment tool when occupational functioning is addressed.

  • 20.
    Kjellin, Lars
    et al.
    Örebro University, Department of Clinical Medicine.
    Engström, Ingemar
    Örebro University, Department of Clinical Medicine.
    Tvångsvård av barn och ungdomar saknar enhetlig, nationell praxis: enkätstudie visar på stora regionala variationer2006In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 103, no 42, p. 3162-3164Article in journal (Refereed)
  • 21.
    Kjellin, Lars
    et al.
    Örebro University, Department of Clinical Medicine.
    Høyer, Georg
    Engberg, Marianne
    Kaltiala-Heino, Rittakerttu
    Sigurjónsdóttir, Maria
    Differences in perceived coercion at admission to psychiatric hospitals in the Nordic countries2006In: Social Psychiatry and Psychiatric Epidemiology, ISSN 0933-7954, E-ISSN 1433-9285, Vol. 41, no 3, p. 241-247Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: International variation in compulsory admissions to psychiatric care has mainly been studied in terms of civil commitment rates. The objectives of this study were to compare and analyse the levels of perceived coercion at admission to psychiatric in-patient care among the Nordic countries and between centres within these countries, in relation to legal prerequisites and clinical practice. METHOD: From one to four centres each in Denmark, Iceland, Norway, Finland and Sweden, a total of 426 legally committed and 494 formally voluntarily admitted patients were interviewed within 5 days from admission. RESULTS: The proportion of committed patients reporting high levels of perceived coercion varied among countries (from 49% in Norway to 100% in Iceland), and in Sweden, only, among centres (from 29 to 90%). No clear variations in this respect were found among voluntary patients. A wide concept of coercion in the Civil Commitment Act and no legal possibility of detention of voluntary patients were associated to low levels of perceived coercion at admission among committed patients. CONCLUSION: For committed patients, differences in national legal prerequisites among countries were reflected in differences in perceived coercion. The results from Sweden also indicate that local care traditions may account for variation among centres within countries.

  • 22.
    Kjellin, Lars
    et al.
    Örebro University, School of Health and Medical Sciences.
    Mårtensson, Anders
    Trycket på psykiatrijouren ökar: fler besök, men andelen nya sökande minskar ; originalstudie2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 10, p. 726-729Article in journal (Other academic)
  • 23.
    Kjellin, Lars
    et al.
    Örebro University, School of Health and Medical Sciences.
    Wallsten, Tuula
    Clin Res Ctr, Cent Hosp, Uppsala Univ, Västerås, Sweden.
    Accumulated coercion and short-term outcome of inpatient psychiatric care2010In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 10, p. 53-Article in journal (Refereed)
    Abstract [en]

    Background: The knowledge of the impact of coercion on psychiatric treatment outcome is limited. Multiple measures of coercion have been recommended. The aim of the study was to examine the impact of accumulated coercive incidents on short-term outcome of inpatient psychiatric care Methods: 233 involuntarily and voluntarily admitted patients were interviewed within five days of admission and at discharge or after maximum three weeks of care. Coercion was measured as number of coercive incidents, i.e. subjectively reported and in the medical files recorded coercive incidents, including legal status and perceived coercion at admission, and recorded and reported coercive measures during treatment. Outcome was measured both as subjective improvement of mental health and as improvement in professionally assessed functioning according to GAF. Logistic regression analyses were performed with patient characteristics and coercive incidents as independent and the two outcome measures as dependent variables Results: Number of coercive incidents did not predict subjective or assessed improvement. Patients having other diagnoses than psychoses or mood disorders were less likely to be subjectively improved, while a low GAF at admission predicted an improvement in GAF scores Conclusion: The results indicate that subjectively and professionally assessed mental health short-term outcome of acute psychiatric hospitalisation are not predicted by the amount of subjectively and recorded coercive incidents. Further studies are needed to examine the short- and long-term effects of coercive interventions in psychiatric care.

  • 24.
    Kjellin, Lars
    et al.
    Örebro University, School of Health and Medical Sciences.
    Östman, Olle
    Östman, Margareta
    Compulsory psychiatric care in Sweden: development 1979-2002 and area variation2008In: International Journal of Law and Psychiatry, ISSN 0160-2527, E-ISSN 1873-6386, Vol. 31, no 1, p. 51-59Article in journal (Refereed)
    Abstract [en]

    As in many other countries, the Swedish legislation on compulsory psychiatric care has been revised several times during the last four decades. Great regional differences within the country in the use of compulsory psychiatric care have been reported. The aims of this study were to describe the development of compulsory psychiatric care in Sweden 1979–2002, and to analyse differences between two groups of counties, one group with high and one with low civil commitment rates, in terms of psychiatric care structure, resources and processes. Data on civil commitments and forensic psychiatric care in Sweden 1979–2002 were collected from public statistics. At least one responsible person in leading position (administrative manager or chief psychiatrist) in each of the included counties was interviewed. The total number of involuntarily hospitalised patients decreased about 80% between censuses in 1979 and 2002, but the rates of forensic patients were unchanged. No clear-cut differences were found in the analyses of structure, resources and processes of psychiatric services between counties with high and counties with low levels of compulsory care. The equality before the law may be questioned. The importance of leadership is emphasised for future analyses.

  • 25.
    Lindstedt, Katarina
    et al.
    Örebro University, School of Medical Sciences. Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Kjellin, Lars
    Örebro University, School of Health Sciences. Örebro University Hospital. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Adolescents with full or subthreshold anorexia nervosa in a naturalistic sample - characteristics and treatment outcome2017In: Journal of Eating Disorders, E-ISSN 2050-2974, Vol. 5, no 1, article id 4Article in journal (Refereed)
    Abstract [en]

    Background: Anorexia Nervosa (AN) destroys developmentally important early years of many young people and knowledge is insufficient regarding course, treatment outcome and prognosis. Only a few naturalistic studies have been conducted within the field of eating disorder (ED) research. In this naturalistic study we included adolescents with AN or subthreshold AN treated in outpatient care, and the overall aim was to examine sample characteristics and treatment outcome. Additional aims were to examine potential factors associated with remission as an outcome variable, and possible differences between three time periods for treatment onset.

    Methods: Participants were identified through the Swedish national quality register for eating disorder treatment (SwEat), in which patients are registered at treatment onset and followed up once a year until end of treatment (EOT). Inclusion criteria were: medical or self-referral to one of the participating treatment units between 1999 and 2014, 13-19 years of age at initial entry into SwEat and diagnosed with AN or subthreshold AN. The total sample consisted of 3997 patient from 83 different treatment units.

    Results: The results show that 55% of the participants were in remission and approximately 85% were within a healthy weight range at EOT. Of those who ended treatment according to plan, 70% were in remission and 90% within a healthy weight range. The average treatment duration was approximately 15 months. About one third of the patients terminated treatment prematurely, which was associated with a decreased chance of achieving remission. Remission rates and weight recovery increased over time, while treatment duration decreased. Considering treatment outcome, the results did not show any differences between patients with AN or subthreshold AN.

    Conclusions: The present study shows a relatively good prognosis for adolescent patients with AN or subthreshold AN in routine care and the results indicate that treatment for adolescents with ED in Sweden has become more effective over the past 15 years. The results of the present study contribute to the scope of treatment research and the large-scale naturalistic setting secures the generalizability to a clinical environment. However, more research is needed into different forms of evidence, new research strategies and diversity of treatment approaches.

  • 26.
    Lindstedt, Katarina
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Neander, Kerstin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Gustafsson, Sanna Aila
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Being me and being us: adolescents' experiences of treatment for eating disorders2015In: Journal of eating disorders, ISSN 2050-2974, Vol. 3, no 9Article in journal (Refereed)
    Abstract [en]

    BACKGROUND: This qualitative study addresses adolescents' perception of treatment for eating disorders. The importance of involving parents in treatment of young people with eating disorders, especially young people with Anorexia Nervosa, is emphasized in a number of studies. Even so, this form of treatment does not work for everybody, not even within a limited diagnostic group. Previous research has revealed that many young people are not entirely satisfied with their treatment. However, there is a lack of knowledge concerning the perspectives of adolescents in outpatient treatment, whose treatment often involves family. The aim of the present study was to investigate how young people with experience from adolescent outpatient treatment for eating disorders, involving family-based and individual based interventions, perceive their time in treatment.

    METHODS: This study was conducted using a hermeneutic phenomenological approach. Fifteen participants were recruited in collaboration with four specialized eating disorder units and interviewed with the purpose to gather narratives.

    RESULTS: The analysis revealed that the adolescents sometimes felt more or less forced into treatment, and strong ambivalent feelings about if and how to participate in treatment permeated the adolescents' narratives. The common factors which emerged in the narratives were assembled under the two major themes: Having to involve family in treatment - in one way or another and Making progress in treatment - a matter of trust.

    CONCLUSIONS: It is of great importance to involve family in treatment in order to understand the problems of the adolescents in their context and be able to take advantage of the resource that parents constitute. However, in certain situations, it is necessary to prioritise individual treatment interventions so that instead of sorting out difficult family situations the therapist focuses on enhancing the young people's resilience, thus enabling them to tackle problematic situations in life.

  • 27.
    Nawka, Alexander
    et al.
    Charles University, Prague, Czech Republic.
    Kalisova, Lucie
    Charles University, Prague, Czech Republic.
    Raboch, Jiri
    Charles University, Prague, Czech Republic.
    Giacco, Domenico
    Queen Mary, University of London, London, UK; University of Naples, Naples, Italy.
    Cihal, Libor
    Central land office, Ministry of Agriculture, Prague, Czech Republic.
    Onchev, Georgi
    Medical University of Sofia, Sofia, Bulgaria.
    Karastergiou, Anastasia
    Psychiatric Hospital, Thessaloniki, Greece.
    Solomon, Zahava
    University of Tel Aviv, Tel Aviv, Israel .
    Fiorillo, Andrea
    University of Naples, Naples, Italy.
    Del Vecchio, Valeria
    University of Naples, Naples, Italy.
    Dembinskas, Algirdas
    University of Vilnius, Vilnius, Lithuania.
    Kiejna, Andrzej
    Medical University, Wroclaw, Poland.
    Nawka, Petr
    Psychiatric private practice, Dresden, Germany.
    Torres-Gonzales, Francisco
    University of Granada, Granada, Spain .
    Priebe, Stefan
    Queen Mary, University of London, London, UK.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Kallert, Thomas W.
    Park Hospital Leipzig, Leipzig, Germany; Soteria Hospital Leipzig, Leipzig, Germany; Dresden University of Technology, Dresden, Germany.
    Gender differences in coerced patients with schizophrenia2013In: BMC Psychiatry, ISSN 1471-244X, E-ISSN 1471-244X, Vol. 13, p. 257-Article in journal (Refereed)
    Abstract [en]

    Background: Despite the recent increase of research interest in involuntary treatment and the use of coercive measures, gender differences among coerced schizophrenia patients still remain understudied. It is well recognized that there are gender differences both in biological correlates and clinical presentations in schizophrenia, which is one of the most common diagnoses among patients who are treated against their will. The extent to which these differences may result in a difference in the use of coercive measures for men and women during the acute phase of the disease has not been studied.

    Methods: 291 male and 231 female coerced patients with schizophrenia were included in this study, which utilized data gathered by the EUNOMIA project (European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice) and was carried out as a multi-centre prospective cohort study at 13 centers in 12 European countries. Sociodemographic and clinical characteristics, social functioning and aggressive behavior in patients who received any form of coercive measure (seclusion and/or forced medication and/or physical restraint) during their hospital stay were assessed.

    Results: When compared to the non-coerced inpatient population, there was no difference in sociodemographic or clinical characteristics across either gender. However coerced female patients did show a worse social functioning than their coerced male counterparts, a finding which contrasts with the non-coerced inpatient population. Moreover, patterns of aggressive behavior were different between men and women, such that women exhibited aggressive behavior more frequently, but men committed severe aggressive acts more frequently. Staff used forced medication in women more frequently and physical restraint and seclusion more frequently with men.

    Conclusions: Results of this study point towards a higher threshold of aggressive behavior the treatment of women with coercive measures. This may be because less serious aggressive actions trigger the application of coercive measures in men. Moreover coerced women showed diminished social functioning, and more importantly more severe symptoms from the " excitement/hostile" cluster in contrast to coerced men. National and international recommendation on coercive treatment practices should include appropriate consideration of the evidence of gender differences in clinical presentation and aggressive behaviors found in inpatient populations.

  • 28.
    Pelto-Piri, Veikko
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lindvall, Christina
    Örebro Municipality, Social Services, Örebro, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Justifications for coercive care in child and adolescent psychiatry: A content analysis of medical documentationManuscript (preprint) (Other academic)
  • 29.
    Pelto-Piri, Veikko
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Lindvall, Christina
    FPS, Örebro, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Justifications for coercive care in child and adolescent psychiatry, a content analysis of medical documentation in Sweden2016In: BMC Health Services Research, ISSN 1472-6963, E-ISSN 1472-6963, Vol. 16, article id 66Article in journal (Refereed)
    Abstract [en]

    Background: There has been considerable interest in normative ethics regarding how and when coercive care can be justified. However, only a few empirical studies consider how professionals reason about ethical aspects when assessing the need for coercive care for adults, and even less concerning children and adolescents. The aim of this study was to examine and describe how professionals document their value arguments when considering the need for coercive psychiatric care of young people.

    Methods: All 16 clinics that admitted children or adolescents to coercive care during one year in Sweden were included in the study. These clinics had a total of 155 admissions of 142 patients over one year. Qualitative content analysis with a deductive approach was used to find different forms of justification for coercive care that was documented in the medical records, including Care Certificates.

    Results: The analysis of medical records revealed two main arguments used to justify coercive care in child and adolescent psychiatry: 1) the protection argument - the patients needed protection, mainly from themselves, and 2) the treatment requirement argument - coercive care was a necessary measure for administering treatment to the patient. Other arguments, namely the caregiver support argument, the clarification argument and the solidarity argument, were used primarily to support the two main arguments. These supportive arguments were mostly used when describing the current situation, not in the explicit argumentation for coercive care. The need for treatment was often only implicitly clarified and the type of care the patient needed was not specified. Few value arguments were used in the decision for coercive care; instead physicians often used their authority to convince others that treatment was necessary.

    Conclusions: One clinical implication of the study is that decisions about the use of coercive care should have a much stronger emphasis on ethical aspects. There is a need for an ethical legitimacy founded upon explicit ethical reasoning and after communication with the patient and family, which should be documented together with the decision to use coercive care.

  • 30. Petkari, Eleni
    et al.
    Salazar-Montes, Ana M.
    Kallert, Thomas W.
    Priebe, Stefan
    Fiorillo, Andrea
    Raboch, Jiri
    Onchev, Georgi
    Karastergiou, Anastasia
    Nawka, Alexander
    Dembinskas, Algirdas
    Kiejna, Andrzej
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Torres-Gonzalez, Francisco
    Cervilla, Jorge A.
    Acute psychopathology as a predictor of global functioning in patients with ICD-10 non-affective psychosis: a prospective study in 11 European countries2011In: Schizophrenia Research, ISSN 0920-9964, E-ISSN 1573-2509, Vol. 131, no 1-3, p. 105-111Article in journal (Refereed)
    Abstract [en]

    This prospective analysis aimed to study the influence of psychopathological dimensions on the global functioning of persons suffering from psychotic disorders, taking into account the role of a broad range of potential confounders. A large international cohort (n = 1888) with ICD-10 non-affective psychosis was evaluated both at baseline during a hospital admission and three months after discharge. Trained interviewers administered a global functioning scale (GAF) and a psychopathological scale (BPRS) at baseline and follow-up). Baseline BPRS psychopathological dimensions were extracted using Principal Component Analysis. Results of multiple linear regression analyses demonstrated that affective symptoms (depressive or manic) prospectively predict a better global functioning, whilst agitation/cognitive symptoms determined poorer global functioning. Other predictors showing an independent effect on better global functioning were medication compliance, country of residence, female gender, married or coupled status, younger age and having a diagnosis of schizoaffective disorder rather than schizophrenia or other ICD-10 psychosis. A predicting model for global functioning in patients with psychosis is provided, showing that assessment of affective and agitation/cognitive symptoms should be emphasised during admission as they can be more informative than positive/negative symptoms in prospectively planning follow-up care that is geared towards a better functional recovery. (C) 2011 Elsevier B.V. All rights reserved.

  • 31.
    Priebe, Stefan
    et al.
    Berts & London Sch Med & Dent, Unit Social & Community Psychiat, Queen Mary Univ London, London, England.
    Katsakou, Christina
    Berts & London Sch Med & Dent, Unit Social & Community Psychiat, Queen Mary Univ London, London, England.
    Gloeckner, Matthias
    Dept Psychiat & Psychotheapy, Univ Hosp Carl Gustav Carus, Tech Univ Dresden, Dresden, Germany.
    Dembinskas, Algirdas
    Psychiat Clin, Vilnius Univ, Vilnius, Lithuania.
    Fiorillo, Andrea
    , Dept Psychiat, Univ Naples Federico 2, Naples, Italy.
    Karastergiou, Anastasia
    Acute Ward, Psychiat Hosp Thessaloniki, Thessaloniki, Greece.
    Kiejna, Andrzej
    Dept Psychiat, Wroclaw Med Univ, Wroclaw, Poland.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Nawka, Pitr
    Psychiat Oupatient Clin, Dresden, Germany.
    Onchev, George
    Dept Psychiat, Med Univ Sofia, Sofia, Bulgaria.
    Raboch, Jiri
    Dept Psychiat, Sch Med 1, Charles Univ Prague, Prague, Czech Republic.
    Schuetzwohl, Matthias
    Dept Psychiat & Psychotheapy, Univ Hosp Carl Gustav Carus, Tech Univ Dresden, Dresden, Germany.
    Solomon, Zahava
    Tel Aviv, Tel Aviv Univ, Israel.
    Torres-Gonzalez, Francisco
    CIBERSAM, Univ Granada, Granada, Spain.
    Wang, Duolao
    Dept Epidemiol & Populat Hlth, London Sch Hyg & Trop Med, London WC1, England.
    Kallert, Thomas
    Fac Med, Dept Psychiat & Psychotherapy, Tech Univ Dresden, Dresden, Germany; Dept Psychiat Psychosomat Med & Psychotherapy, Pk Hosp Leipzig, Leipzig, Germany; Soteria Hosp Leipzig, Leipzig, Germany.
    Patients' views of involuntary hospital admission after 1 and 3 months: prospective study in 11 European countries2010In: British Journal of Psychiatry, ISSN 0007-1250, E-ISSN 1472-1465, Vol. 196, no 3, p. 179-185Article in journal (Refereed)
    Abstract [en]

    Background Legislation and practice of involuntary hospital admission vary substantially among European countries, but differences in outcomes have not been studied. Aims To explore patients' views following involuntary hospitalisation in different European countries. Method in a prospective study in 11 countries, 2326 consecutive involuntary patients admitted to psychiatric hospital departments were interviewed within 1 week of admission; 1809 were followed up 1 month and 1613 3 months later. Patients' views as to whether the admission was right were the outcome criterion. Results In the different countries, between 39 and 71% felt the admission was right after 1 month, and between 46 and 86% after 3 months. Females, those living alone and those with a diagnosis of schizophrenia had more negative views. Adjusting for confounding factors, differences between countries were significant. Conclusions International differences in legislation and practice may be relevant to outcomes and inform improvements in policies, particularly in countries with poorer outcomes. Declaration of interest None.

  • 32.
    Raboch, Jiri
    et al.
    Dept Psychiat, Fac Med 1, Charles Univ Prague, Prague, Czech Republic.
    Kalisova, Lucie
    Dept Psychiat, Fac Med 1, Charles Univ Prague, Prague, Czech Republic.
    Nawka, Alexander
    Dept Psychiat, Fac Med 1, Charles Univ Prague, Prague, Czech Republic.
    Kitzlerova, Eva
    Dept Psychiat, Fac Med 1, Charles Univ Prague, Prague, Czech Republic.
    Onchev, Georgi
    Dept Psychiat, Med Univ Sofia, Sofia, Bulgaria.
    Karastergiou, Anastasia
    Thessaloniki Psychiat Hosp, Thessaloniki, Greece.
    Magliano, Lorenza
    Dept Psychiat, Second University of Naples, Naples, Italy.
    Dembinskas, Algirdas
    Psychiat Clin, Vilnius Mental Hlth Ctr, Vilnius State Univ, Vilnius, Lithuania.
    Kiejna, Andrzej
    Dept Psychiat, Med Univ, Wroclaw, Poland.
    Torres-Gonzales, Francisco
    Dept Legal Med & Psychiat, Ctr Invest Biomed Red Salud Mental, Univ Granada, Granada, Spain.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Priebe, Stefan
    Unit Social & Community Psychiat, Barts & London Sch Med & Dent, Queen Mary Univ London, London, England.
    Kallert, Thomas W.
    Dept Psychiat & Psychotherapy, Tech Univ Dresden, Dresden, Germany.
    Use of coercive measures during involuntary hospitalization: findings from ten European countries2010In: Psychiatric Services, ISSN 1075-2730, E-ISSN 1557-9700, Vol. 61, no 10, p. 1012-1017Article in journal (Refereed)
    Abstract [en]

    Objective: Involuntary treatment in mental health care is a sensitive but rarely studied issue. This study was part of the European Evaluation of Coercion in Psychiatry and Harmonization of Best Clinical Practice (EUNOMIA) project. It assessed and compared the use of coercive measures in psychiatric inpatient facilities in ten European countries. Methods: The sample included 2,030 involuntarily admitted patients. Data were obtained on coercive measures (physical restraint, seclusion, and forced medication). Results: In total, 1,462 coercive measures were used with 770 patients (38%). The percentage of patients receiving coercive measures in each country varied between 21% and 59%. The most frequent reason for prescribing coercive measures was patient aggression against others. In eight of the countries, the most frequent measure used was forced medication, and in two of the countries mechanical restraint was the most frequent measure used. Seclusion was rarely administered and was reported in only six countries. A diagnosis of schizophrenia and more severe symptoms were associated with a higher probability of receiving coercive measures. Conclusions: Coercive measures were used in a substantial group of involuntarily admitted patients across Europe. Their use appeared to depend on diagnosis and the severity of illness, but use was also heavily influenced by the individual country. Variation across countries may reflect differences in societal attitudes and clinical traditions. (Psychiatric Services 61: 1012-1017, 2010)

  • 33.
    Selvin, Mikael
    et al.
    Örebro University, School of Health Sciences. University Health Care Center.
    Almqvist, Kjerstin
    Department for Social and Psychological studies, Karlstad.
    Kjellin, Lars
    Örebro University, School of Health Sciences. University Health Care Center.
    Schröder, Agneta
    Örebro University, School of Health Sciences. University Health Care Center.
    The Concept of Patient Participation in Forensic Psychiatric Care: The Patient Perspective2016In: Journal of Forensic Nursing, ISSN 1939-3938, E-ISSN 1556-3693, Vol. 12, no 2, p. 57-63Article in journal (Refereed)
    Abstract [en]

    The importance of patient participation is advocated in medical treatment and nursing care and has been linked to increased quality of care, increased patient satisfaction, and treatment adherence. Still, patients in forensic psychiatric care often report being unhappy with their experienced level of participation. The concept of patient participation is complex and has several definitions, thus it is important to investigate it from different perspectives in different contexts. The aim of this study was to describe patients' perceptions of the concept of patient participation in forensic psychiatric care. A qualitative design with a phenomenographic approach was used, and interviews with 19 participants in a Swedish setting were completed. The participants described the concept of patient participation in forensic psychiatric care as follows: influence, to have good communication and to be involved; confidence, to trust the treatment and to have mutual trust; and own responsibility, to participate in activities and to take the initiative. On the basis of the results of this study, improved patient participation in forensic psychiatric care may be achieved with active communication, by building up and maintaining trust for the professional competence and by encouraging patients' own responsibility. It is important that knowledge about patients' views of the concept of patient participation is included in the planning and improvement of forensic care.

  • 34. Wallsten, Tuula
    et al.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences.
    Sjöberg, Rickard L.
    The diagnostic accuracy of questions about past experiences of being mechanically restrained in a population of psychiatric patients2008In: Memory, ISSN 0965-8211, E-ISSN 1464-0686, Vol. 16, no 5, p. 548-555Article in journal (Refereed)
    Abstract [en]

    Information about stressful life experiences obtained from patients during diagnostic interviews is an important foundation for clinical decision making. In this study self-reports from 115 committed psychiatric patients of experiences of mechanical restraint were compared with medical records. The sensitivity of patient self-reports was 73% (11/15) and the specificity was 92% (92/100). No clear relationship between psychiatric symptoms and reliability of self-reports was identified. The results highlight the subjective qualities of narratives about past experiences.

  • 35. 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, p. 444-449Article 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.

  • 36.
    Wilhelmsson Göstas, Mona
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Wiberg, Britt
    Department of Psychology, Umeå university, SE-901 87 UMEÅ.
    Brus, Ole
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Changes in attachment styles and interpersonal problems after different forms of psychotherapyManuscript (preprint) (Other academic)
    Abstract [en]

    Attachment theorists and researchers have argued that psychotherapy may be an opportunity to revise insecure attachment styles, enabling more flexibility in interpersonal relationships. Attachment theory was developed to understand human reactions to life stressors, such as loss and separation. The term attachment style reflects a person’s most typical internal working models to seek proximity in relationships. This study examines whether self-reported attachment styles measured by the Attachment Style Questionnaire (ASQ) changed after a course of either cognitive behavioural (CBT) or psychodynamic oriented psychotherapy (PDT) in a clinical sample of psychotherapy patients (n= 111). One aim was to examine changes related to differences in gender, age, diagnoses, therapy method and number of sessions. Another aim was to examine whether changes correlated with changes in interpersonal problems measured by the Inventory of Interpersonal Problems (IIP). Results showed an increase in security in attachment styles that correlated with a decrease in interpersonal problems. No differences between therapy methods were found. The age group 26 to 39 reported greater security and less avoidance compared to patients over 40. Patients who attended between 11 and 25 sessions scored higher as regards security compared to those with 1-10 sessions but there was no difference for those with more than 25 sessions. The study supports results from a few other studies that psychotherapy increases the attachment-related security of patients. As an increase in security is associated with a decrease in interpersonal problems, attachment styles can be perceived as mediating factors in psychotherapy outcome irrespective of psychotherapy orientation.

  • 37.
    Wilhelmsson Göstas, Mona
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Örebro, sweden.
    Wiberg, Britt
    Department of Psychology, Umeå University, Umeå, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Örebro, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Örebro, Sweden.
    Self-reported anxious- and avoidant-related attachment correlated to interpersonal problems by patients starting psychotherapy2012In: E-Journal of Applied Psychology, ISSN 1832-7931, E-ISSN 1832-7931, Vol. 8, no 1, p. 9-17Article in journal (Refereed)
    Abstract [en]

    Attachment theory is an encompassing theory for understanding human reactions to life stressors, such as loss and separation and interpersonal problems are common reasons for seeking psychotherapy. Psychotherapy may be an opportunity to revise insecure attachment and handle interpersonal problems. This study examined attachment styles and interpersonal problems in a clinical sample of psychotherapy patients (n =168) at the start of psychotherapy. The main aim was to study how self-reported attachment styles, measured by the Attachment Style Questionnaire (ASQ), correlated with interpersonal problems measured using the Inventory of Interpersonal Problems (IIP). Avoidant-related  and anxious-related  attachment scales correlated positively to the total IIP scores. Inconsistent with findings in nonclinical samples, specific interpersonal problems in the dominant and affiliative parts of the IIP correlated positively to both the anxious-related and the avoidant-related attachment scales. The findings imply that a challenge for the therapist, at the start of psychotherapy, is to balance providing security with encouraging exploration of feelings, thoughts, and behaviour in the patient’s interpersonal problems in current relationships. Exploring individual profiles of attachment styles helps to clarify motives in expressed interpersonal problems.

     

     

  • 38.
    Wilhelmsson Göstas, Mona
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Örebro County Council, Örebro.
    Wiberg, Britt
    Department of Psychology, Umeå University, Umeå, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Centre, Örebro County Council, Örebro.
    Increased participation in the life context: a qualitative study of clients' experiences of problems and changes after psychotherapy2012In: European Journal of Psychotherapy, ISSN 1364-2537, E-ISSN 1469-5901, Vol. 14, no 4, p. 365-380Article in journal (Refereed)
    Abstract [en]

    People use psychotherapy in different ways depending on how they perceive their problems and themselves. Exploring a person’s experiences of problems and changes after psychotherapy is important for evaluating outcomes of therapies. Based on descriptions from people with recent experiences of psychotherapy, the aim of this study was to gain a deeper understanding of the participants’ problems before psychotherapy and of changes after psychotherapy. Fourteen participants  selected based on variations in age, gender, marital status, occupation, number of sessions and psychotherapy orientation (CBT and PDT), were interviewed after completing psychotherapy. A qualitative content analysis of the transcribed interviews was performed. Problems before psychotherapy showed a relationship between the categories overwhelming emotions, cognitive problems and problematic behaviours. The theme self-centredness captured the latent content of being so absorbed by problems that these prevent participation in the life context.  Descriptions of changes were summarized in the categories emotions became balanced, cognitive functioning became evident and possibility to influence one’s behaviour, overlapping the two therapy orientations. The themes awareness of self-agency and tools to handle problems expressed the understanding of the descriptions of changes which made an optimal participation in the person’s life context possible. No differences between therapy groups were found.

     

  • 39.
    Wilhelmsson Göstas, Mona
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Wiberg, Britt
    Inst. för psykologi, Umeå University, Umeå, Sweden.
    Neander, Kerstin
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Kjellin, Lars
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    ’Hard work’ in a new context: clients’ experiences of psychotherapy2013In: Qualitative Social Work, ISSN 1473-3250, E-ISSN 1741-3117, Vol. 12, no 3, p. 340-357Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to describe and gain an understanding of clients’ experiences of psychotherapy contracts and processes in cognitive behavioural therapy (CBT) and psychodynamic psychotherapy (PDT). Fourteen participants were interviewed after ending their psychotherapy. To get information richness they were selected with as great a variation as possible in relation to their life context. Qualitative content analysis was used to analyze the descriptions and the significance of the descriptions. Similarities between the two therapy orientations emerged throughout the informants’ experiences. These similarities were expressed in the two themes The creation of a new context and The working method and the cooperation with the psychotherapist made up a whole. The psychotherapy process was described as “hard work” in a new context, markedly different from the ordinary social context. From the informants’ perspective, the creation of a new context offered a possibility to give full attention, together with the psychotherapist, to oneself and to the problems one was grappling with. A salient feature was the informant’s responsibility for agreements in the psychotherapy contract, especially in relation to the number of sessions and the creation of cooperation with the therapist. Irrespective of therapy orientation the therapeutic techniques were described as inextricably linked to the cooperation with the psychotherapist. An implication for practice and research from these findings is to give more weight to the influence of cooperation in psychotherapy techniques, irrespective of therapy orientation. Another implication is an awareness that the client’s knowledge of her/his difficulties, needs and desire for change, capacity to make an effort and to assume responsibility always have to be highlighted and have an impact on the psychotherapy contract and process.

     

     

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