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  • 1.
    Bergh, Andreas
    et al.
    Örebro University, School of Humanities, Education and Social Sciences.
    Englund, Anna-Lena
    Örebro University, School of Humanities, Education and Social Sciences.
    Englund, Tomas
    Örebro University, School of Humanities, Education and Social Sciences.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Engström, Karin
    Stockholms universitet, Stockholm, Sweden.
    Prevention and promotion programs in Swedish schools as an answer to what?: An analysis of national policy texts2013Conference paper (Refereed)
  • 2.
    Bergh, Andreas
    et al.
    Örebro University, School of Humanities, Education and Social Sciences.
    Englund, Anna-Lena
    Örebro University, School of Humanities, Education and Social Sciences.
    Englund, Tomas
    Örebro University, School of Humanities, Education and Social Sciences.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Engström, Karin
    Stockholms universitet, Stockholm, Sweden.
    Värdepremisser i främjande och förebyggande program i skolan: rapport från forskningsprojektet En värdefull skola2013Report (Refereed)
    Download (pdf)
    Bergh, Englund, Englund, Engström & Engström
  • 3.
    Björk, Tabita
    et al.
    Dept Clin Neurosci, Karolinska Inst, Stockholm, Sweden.
    Skårberg, Kurt
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital.
    Eating disorders and anabolic androgenic steroids in males: similarities and differences in self-image and psychiatric symptoms2013In: Substance Abuse Treatment, Prevention, and Policy, E-ISSN 1747-597X, Vol. 8, no 30, p. 1-7Article in journal (Refereed)
    Abstract [en]

    Background: Body dissatisfaction is common among both females and males. Dissatisfaction with the body is a risk factor both for onset of eating disorders and for abuse of anabolic androgenic steroids (AAS). Few studies have however investigated if there are other similarities in respect to self-image or psychiatric symptoms between clinical samples of eating disordered males and males in treatment for negative effects of AAS use.

    Aim: The aim of this study was to compare two clinical samples, one of males with ED and one of males who used AAS, regarding self-image and psychiatric symptoms.

    Methods: This study compared males with eating disorders (n = 13) and males who recently stopped AAS use (n = 29) on self-image and psychiatric symptoms, using The Structural Analysis of Social Behavior self-questionnaire and a shortened version of The Symptom Check List.

    Results: The eating disorder group reported significantly lower scores for Self-emancipation and Active self-love and higher scores for Self-blame and Self-hate. Both groups reported serious psychiatric symptoms. The common denominator between groups was serious psychiatric symptomatology rather than negative self-image.

    Conclusions: The negative self-image profile, especially self-hate, found among males with Eating Disorders may indicate that the studied groups differ in aetiology of the underlying problems. The serious psychiatric symptoms in both groups call staff to pay attention to any thoughts of suicide due to severe depressive symptoms where by specialized psychiatric treatment may be needed.

  • 4. Björk, Tabita
    et al.
    Skårberg, Kurt
    Engström, Ingemar
    Eating disorders or the use of anabolic androgenic steriodes in males: Different manifestation of negative self-image?2011Conference paper (Refereed)
  • 5. Björk, Tabita
    et al.
    Skårberg, Kurt
    Engström, Ingemar
    Negative self-image: A common denominator between males with Eating Disorders and males using Anabolic Androgenic Steroids?2011Conference paper (Other academic)
  • 6.
    Blomqvist, Suzanne
    et al.
    Psychiatric Research Centre, Örebro County Council, Örebro, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Interprofessional psychiatric teams: is multidimensionality evident in treatment conferences?2012In: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 26, no 4, p. 289-296Article in journal (Refereed)
    Abstract [en]

    Interprofessional teamwork is practised when the care needs of patients are complex. Little is known about the extent to which team competence really determines patient interventions. The aim of the study was to examine the degree of multidimensionality in patient discussions in psychiatry, and to how different professions contribute. Psychiatric teams were observed during 30 team meetings. A content analysis was used to examine the amount of attention given to medical, psychological and social aspects. The results indicated difficulties in achieving multidimensionality in patient discussions during team meetings. The descriptive element of the discussion was dominated by the social aspect, to which all professions contributed. The analytical element was dominated by the psychological aspect, also to which all the professions contributed. In suggesting interventions, medical interventions were emphasized, principally by the physicians. Decisions on interventions concerned equally medical, social and psychological aspects. An interprofessional composition of teams offers no guarantee that interventions will be of a multidimensional nature. The results are discussed in relation to previous research and practical implications.

  • 7.
    Brus, Ole
    et al.
    Örebro University, School of Medical Sciences.
    Cao, Yang
    Örebro University, School of Medical Sciences. Örebro University Hospital.
    Carlborg, Andreas
    Karolinska Institutet, Department of Clinical Neuroscience, Stockholm, Sweden.
    Engström, Ingemar
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    von Knorring, Lars
    Uppsala University, Department of Neuroscience, Psychiatry.
    Ljung, Tomas
    Clinic of Psychiatry, Falun, Sweden.
    Nordenskjöld, Axel
    Örebro University, School of Medical Sciences. University Health Care Research Centre.
    Long term effect of continuation electroconvulsive therapy for depressive patients: a randomized controlled trialManuscript (preprint) (Other academic)
  • 8.
    Brus, Ole
    et al.
    Örebro University, School of Medical Sciences. Clinical epidemiology and biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Cao, Yang
    Örebro University, School of Medical Sciences. Clinical epidemiology and biostatistics, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Carlborg, Andreas
    Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Engström, Ingemar
    Örebro University, School of Medical Sciences. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    von Knorring, Lars
    Department of Neuroscience, Psychiatry, Uppsala University, Uppsala, Sweden.
    Nordenskjöld, Axel
    Örebro University, School of Medical Sciences. University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
    Long-Term Effect of Maintenance Electroconvulsive Therapy in Patients With Depression-Data From a Small Randomized Controlled Trial2024In: Journal of ECT, ISSN 1095-0680, E-ISSN 1533-4112Article in journal (Refereed)
    Abstract [en]

    OBJECTIVES: This study aimed to compare the long-term effects of maintenance electroconvulsive therapy (M-ECT) with medication and medication only in patients with depression.

    METHODS: A randomized controlled trial of 1 year of M-ECT with medication or medication only investigated relapse/recurrence among 56 patients in remission after electroconvulsive therapy (ECT) for depression was conducted. The results of the first year are published already and showed a significant advantage of M-ECT with medication.The current study was a long-term follow-up. When the randomized treatment allocation ended, medication was continued in both groups but M-ECT was terminated. Patients were followed for up to 10 years via Swedish national registers until the study endpoint of a new psychiatric diagnosis as an inpatient, suicide, suspected suicide, or death of another cause. Time to relapse was compared between the M-ECT with medication group and the medication-only group using Kaplan-Meier estimates.

    RESULTS: The median follow-up time was 6.5 years for the M-ECT and medication group and 3.1 years for the medication-only group. One year after randomization 22 patients remained in the M-ECT and medication group, and 14 patients remained in the medication-only group. Relapse patterns between the treatment groups after the completion of M-ECT seemed to be similar according to visual inspection.

    CONCLUSIONS: This long-term follow-up study suggests that most of the benefit achieved during the treatment period with M-ECT is maintained over several years, but the small sample size, with accompanying large statistical imprecision, makes the results uncertain. More long-term studies of M-ECT are required.Trial registration: ClinicalTrials.gov identifier: NCT00627887.

  • 9. Båtelson, Karin
    et al.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Petersson, Göran
    Replik till Hans Wingstrand et al angående vårdens IT-system [Reply to Hans Wingstrand et al regarding healthcare IT systems]: "Viktigt med avvägning mellan patientsäkerhet och integritet" ["Important to balance patient safety and privacy"]2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, article id DD9CArticle in journal (Refereed)
  • 10. Eckerdal, Gunnar
    et al.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Kristoffersson, Ulf
    Löfmark, Rurik
    Sallin, Karl
    Thulesius, Hans
    Bengtsson, Håkan
    Johnsson, Lars-Åke
    Etisk argumentation och klinisk verklighet kan med fördel förenas2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 28-29, p. 2097-2098Article in journal (Other (popular science, discussion, etc.))
  • 11. Eckerdal, Gunnar
    et al.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Lynöe, Niels
    Löfmark, Rurik
    Sallin, Karl
    Respektera patientens rätt avstå från livsuppehållande behandling: nya riktlinjer från Svenska Läkaresällskapets delegation för medicinsk etik2007In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 104, no 41, p. 2969-2971Article in journal (Refereed)
    Abstract [sv]

    Delegationen för medicinsk etik framhåller patientens rätt

    • att avstå från potentiellt livsförlängande behandling

    • att i osäkra fall få livsuppehållande behandling tills

    det är uppenbart att den inte kan gagna patienten

    • att i alla situationer få adekvat symtomlindring.

    Det är speciellt angeläget att i dessa situationer dokumentera beslut och beslutsunderlag i patientens journal

  • 12.
    Elinder, Göran
    et al.
    Department of Pediatrics, Karolinska Institutet, Stockholm, Sweden.
    Eriksson, Anders
    Department of Community Medicine and Rehabilitation, Forensic Medicine, Umeå University, Umeå, Sweden; The National Board of Forensic Medicine, Linköping, Sweden.
    Hallberg, Boubou
    Karolinska Institutet, Stockholm, Sweden; Department of Pediatrics and Neonatology, Karolinska University Hospital, Stockholm, Sweden.
    Lynøe, Niels
    Medical Ethics, Karolinska Institutet, Stockholm, Sweden.
    Sundgren, Pia Maly
    Diagnostic Radiology, Lund University, Lund, Sweden; Department of Neuroradiology, Skåne University Hospital, Lund, Sweden.
    Rosén, Måns
    Health Technology Assessment, Karolinska Institutet, Stockholm, Sweden.
    Engström, Ingemar
    Örebro University, School of Medical Sciences. Child and Adolecent Psychiatry, University Health Care Research Center.
    Erlandsson, Björn-Erik
    Medical Technology, Royal Institute of Technology, Stockholm, Sweden.
    Traumatic shaking: The role of the triad in medical investigations of suspected traumatic shaking2018In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 107, no S472, p. 3-23Article, review/survey (Refereed)
    Abstract [en]

    The Swedish Agency for Health Technology Assessment and Assesment of Social Services (SBU) is an independent national authority, tasked by the government with assessing methods used in health, medical and dental services and social service interventions from a broad perspective, covering medical, economic, ethical and social aspects. The language in SBU's reports are adjusted to a wide audience. SBU's Board of Directors has approved the conclusions in this report. The systematic review showed the following graded results:

    • There is limited scientific evidence that the triad (Three components of a whole. The triad associated with SBS usually comprises subdural haematoma, retinal haemorrhages and encephalopathy.) and therefore, its components can be associated with traumatic shaking (low-quality evidence).
    • There is insufficient scientific evidence on which to assess the diagnostic accuracy of the triad in identifying traumatic shaking (very low-quality evidence).

    Limited scientific evidence (low-quality evidence) represents a combined assessment of studies of high or moderate quality which disclose factors that markedly weaken the evidence. It is important to note that limited scientific evidence for the reliability of a method or an effect does not imply complete lack of scientific support. Insufficient scientific evidence (very low-quality evidence) represents either a lack of studies or situations when available studies are of low quality or show contradictory results. Evaluation of the evidence was not based on formal grading of the evidence according to GRADE but on an evaluation of the total scientific basis.

  • 13.
    Englund, Anna-Lena
    et al.
    Örebro University, School of Humanities, Education and Social Sciences.
    Englund, Tomas
    Örebro University, School of Humanities, Education and Social Sciences.
    Engström, Karin
    Örebro University, School of Humanities, Education and Social Sciences.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Värdegrunden reducerad till metod2009In: Pedagogiska magasinet, ISSN 1401-3320, Vol. 13, no 4, p. 18-21Article in journal (Other (popular science, discussion, etc.))
    Abstract [sv]

    Det behövs en etisk vändning i diskussionen om främjande och förebyggande program. Alltför stort intresse riktas mot frågan om evidens och effektivitet och alltför lite intresse riktas mot värdefrågorna. Vad innebäör det för lärarens professionalism om manualstyrda aktiviteter ersätter samtal och samspel?

  • 14.
    Englund, Tomas
    et al.
    Örebro University, School of Humanities, Education and Social Sciences.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Behaviorismens återkomst i svensk skola: exemplet Skol-Komet2011In: Pedagogiska Magasinet, ISSN 1401-3320, Vol. 15, no 2, p. 14-17Article in journal (Other academic)
  • 15.
    Englund, Tomas
    et al.
    Örebro University, School of Humanities, Education and Social Sciences.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Skol-Komet står för en instrumentell syn på relationer2011In: Pedagogiska Magasinet, ISSN 1401-3320, Vol. 15, no 4, p. 72-73Article in journal (Other academic)
  • 16.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Adolescents' perception of coercive treatment: conclusions and clinical implications2007In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 7, no Suppl 1, p. S108-Article in journal (Refereed)
    Abstract [en]

    BackgroundThe aim of the study was to describe how involuntarily and voluntarily admitted adolescents talk about their experiences from child and adolescent psychiatric care with special focus on coercion, participation and dialogue.

    MethodsTwenty-one adolescents, ten involuntarily and eleven voluntarily admitted, were interviewed in-depth. The transcriptions were analyzed based on theories on participation and human dialogue.

    ResultsThe adolescents' experiences of coercion show a wide variation that didn't correspond very well with the formal situation. Coercion was experienced in many ways and was also valued quite differently with respect to the impact of the treatment in their lives. The adolescents' experience of participation in the planning of the treatment was very sparse. The requirements for participation of patients in Swedish law were seldom met, according to the adolescents. The adolescents' experiences of dialogue with the staff also varied considerably. Examples will be given from different experiences during the presentation.

    Conclusion Coercion is, from a subjective perspective, a concept with many meanings. The correspondence between formal coercion and experienced coercion is quite weak. Adolescents seldom feel genuinely engaged in the planning of their own treatment, despite legal requirements. Trustful and reciprocal relations were sometimes to be found in their stories. This seems difficult, but not impossible, to reach even under coercive circumstances.

  • 17.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Apathetic children: a phenomenological interpretation of a psychiatric epidemic in Sweden2008Conference paper (Refereed)
    Abstract [en]

    Purpose: Since 2001, over four hundred children and adolescents in Sweden, who all have been asylum seekers, have developed a psychiatric syndrome with more or less complete loss of mental and physical functions. These children have been called “apathetic”. This epidemic has led to considerable interest, both in Sweden and abroad. The media debate about this epidemic has mostly centred on the possibilities of simulation or parental forcing of their children. The psychiatric debate has centred mostly on different diagnostic possibilities. There has also been an extensive ethical debate both among professionals and on the public arena. Not much interest has been paid to the syndrome from a phenomenological perspective.

    Method: I will in this paper present the key case that I was summoned by the Swedish government to examine. This is the case of Makram, 11 years of age, who had been in an almost persistent apathetic state since one and a half year. The case will be interpreted using thoughts from Karl Jaspers and Martin Heidegger.

    Results: The life experience of Makram will be discussed in terms of a total withdrawal from the world, which is interpreted as a solution to lift off an all too heavy burden within the family. The process into apathy will be discussed in relation to psychiatric and philosophical concepts like withdrawal and stupor. My discussion will centre on possible interpretations from a phenomenological perspective based on interviews with patients.

    Conclusion: The key interpretation will be that this is a syndrome characterized by a withdrawal from being in the communal world and stay in a private world until circumstances have changed enough to elicit a longing for coming back to the real world.

  • 18.
    Engström, Ingemar
    Örebro University, Department of Health Sciences.
    Apathetic children from a phenomenological perspective2007Conference paper (Refereed)
  • 19.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psykiatriskt forskningscentrum, Örebro universitet, Örebro, Sverige.
    Barn- och ungdomspsykiatri2011In: Pediatrik / [ed] Christian Moëll & Jan Gustavsson, Stockholm: Liber, 2011, 1, p. 537-555Chapter in book (Other academic)
  • 20.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psykiatriskt forskningscentrum, Örebro.
    Diagnostik och differentialdiagnostik2013In: Från apati till aktivitet: Teori och behandling av flyktingbarn med svår psykisk ohälsa / [ed] Henry Ascher & Anders Hjern, Lund: Studentlitteratur AB, 2013, 1, p. 117-136Chapter in book (Other academic)
  • 21.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Ethical reflections on organ donation from children2011In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 100, no 9, p. 1172-1174Article in journal (Refereed)
  • 22.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Etik, erfarenhet och evidens2013In: Palliativ vård: Begrepp och perspektiv i teori och praktik / [ed] Birgitta Andershed, Britt-Marie Ternestedt, Cecilia Håkanson, Lund: Studentlitteratur AB, 2013, 1, p. 151-162Chapter in book (Other academic)
  • 23.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Etik, erfarenhet och evidens: hur ska man se på psykiatrin?2008In: Tidskriften för svensk psykiatri, ISSN 1653-8579, no 2, p. 32-35Article in journal (Other academic)
  • 24.
    Engström, Ingemar
    Örebro University, Department of Health Sciences.
    Hur kan psykiatrisk tvångsvård motiveras ur ett etiskt perspektiv?2007Conference paper (Refereed)
  • 25.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ingemar Engström, Svenska Läkaresällskapet [Ingemar Engström, Swedish Society of Medicine]: [Plånboken bör inte få avgöra tillgång till nya effektiva läkemedel The wallet should not determine access to new and effective drugs]2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, article id DEU6Article in journal (Refereed)
  • 26.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Justifications of coercion: are decisions of coercive care psychiatric or ethical?2008Conference paper (Refereed)
    Abstract [en]

    Questions on coercion in psychiatric care have long been controversial themes for psychiatry. Health care is usually based on the patient’s wish for help whereas psychiatric care to a large extent is based on the decisions of others, first and foremost by psychiatrists. Due to the reduction of beds in psychiatric care, an increasing proportion of beds are used for committed patients. This makes the questions even more relevant, despite a decrease in absolute numbers.

    The legal prerequisites for coercive care are based only on psychiatric criteria, which points to a notion of fact-based rationality, whereas ethical reasons for coercion at best may be implicit. This paper is based on an ongoing study of coercive care in child and adolescent psychiatry, where the files and the certificates for all committed patients during one year in Sweden are analyzed with respect to given reasons for decisions of coercive care. The core question is whether ethical reasons are present and if so, what ethical values are judged to be at risk in different clinical situations.

    This paper advocates a stronger emphasis on ethical questions in discussions of the use of coercion in psychiatry. We advocate an open discussion of which fundamental values may be at stake in such instances and the ethical reasons involved in making these judgments. The need for a transparent deliberative process involving all parties to the coercion is emphasized.

  • 27.
    Engström, Ingemar
    Örebro University, Department of Health Sciences.
    Medical decision making with adolescents: cultural differences and communicative prerequisites2007Conference paper (Refereed)
  • 28.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Människa och läkare2008In: Svensk psykiatri, ISSN 1653-8579, no 4, p. 37-37Article in journal (Other (popular science, discussion, etc.))
  • 29.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Normalitet i psykiatrin2008Conference paper (Refereed)
  • 30.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Om normalitet i psykiatriska sammanhang2008Conference paper (Refereed)
    Abstract [sv]

    Inom psykiatrin ställs ofta medicinsk-filosofiska frågor på sin spets. Även om inte psykiatrin är artskild från andra medicinska specialiteter, så blir frågor om ontologiska och epistemologiska grundantaganden tydligare och mer avgörande i det kliniska handlandet.

    En grundfråga är hur psykiatrins kompetensområde och kunskapsanspråk kan avgränsas. I praktiska termer kan det uttryckas som; vilka patienter kan räkna med att få hjälp i den psykiatriska vården? Vad är psykiatrins område? Det brukar uttryckas i termer av psykisk sjukdom eller allvarlig psykisk störning eller liknande begrepp, som kan förefalla tydliga, men som vid varje försök till definition visar sig vara tämligen undanglidande.

    DSM-systemet har konstruerats så att diagnoser definieras med explicita operationaliserade kriterier, där målet är att alla som använder systemet ska vara överens om en diagnos oavsett teoretisk tillhörighet, kulturell kontext eller liknande.

    Det finns emellertid ett grundkriterium i hela DSM-systemet, som lyfter fram frågan om symtomens påverkan på funktioner i livet. Detta grundkriterium benämns ”kliniskt signifikant lidande”. Själva begreppet visar sig dock innehålla ett grundantagande om att det är läkaren som definierar om ett sådant lidande föreligger; därav termen ”kliniskt signifikant”. Frågan om vad som är ett ”lidande” kvarstår emellertid odefinierat.

    Låt mig ge några historiska och aktuella exempel på försök till avgränsningar av psykisk sjukdom. Dessa kan förhoppningsvis fungera som ”fallbeskrivningar” att diskutera under symposiet.

    1. Homosexualitet

    Homosexualitet var klassificerat som en psykisk sjukdom/störning fram till 1973, då det försvann i det amerikanska DSM-systemet. Tillvägagångssättet med vilket detta skedde ger oss emellertid intressant information om hur diagnoser ges legitimitet eller ej.

    Det finns ett antal diagnoser i DSM-IV som kallas ”sexuella funktionsstörningar” eller ”sexuella avvikelser”. I den förstnämnda gruppen återfinns exempelvis impotens och vaginism. I den senare gruppen återfinns exempelvis exhibitionism, pedofili eller sadism/masochism. Det var i denna grupp som tidigare också homosexualitet förekom.

    På grund av samhälleliga diskussioner under slutet av 1960- och början av 1970-talet så kom rimligheten av att betrakta homosexualitet som en diagnos att ifrågasättas. Till slut kom denna diskussion att leda fram till att man inom American Psychiatric Association (som konstruerar DSM-systemet) röstade om homosexualitet skulle vara kvar i DSM-systemet eller ej. Med knapp majoritet röstades för att stryka denna diagnos.

    Detta leder till frågor om vem som definierar vad som är sjukt och inte sjukt. Det leder också till frågor om vilka kriterier som kan användas som grund för en sådan definition. Medicinska kriterier är väl rimligt, men här finns det också andra kriterier som kan anföras i en sådan diskussion.

    Man kan också jämföra med när någon astronomi-sammanslutning häromåret röstade för att Pluto inte längre ansågs vara en planet eller Kyrkomötets i Nicea beslut medelst omröstning om kvinnan har en själ eller ej.

    2. Social fobi

    Social fobi kan fungera som ett exempel på den viktiga distinktionen mellan grad och art. Denna diagnos har, ivrigt understött av läkemedelsindustrin, på senare år ökat i användning, ofta med läkemedel som första behandlingsalternativ. Det är ställt utom allt tvivel att det finns personer som har svår ångest i specifika sociala situationer som blir till ett betydande funktionshinder i det dagliga livet.

    Frågan gäller då närmast om detta är en sjukdom i den meningen att det går att distinkt avgränsa den från ”normal” blyghet, eller om det snarare är en gradfråga, det vill säga att alla människor kan uppleva obehag i speciella situationer men vissa mer än andra.

    Om det snarare är en ”graddiagnos” än en ”artdiagnos” uppstår frågan om vem som har tolkningsföreträdet. Hur kan läkaren med bibehållen medicinsk förankring beakta personens egen beskrivning av sitt lidande. Med andra ord; hur fastställer läkaren om det föreligger ett ”kliniskt signifikant lidande”?

    En annan frågeställning är vilka konsekvenser det har i ett prioriteringsperspektiv om patienten ges hela tolkningsföreträdet.

    3. ADHD

    Debatten om ADHD/DAMP har varit mer intensiv i Sverige än någon annanstans i världen. Även här är det tämligen okontroversiellt att påstå att det finns barn med svårigheter när det gäller uppmärksamhet, koncentration och motorik. Att de barn med betydande svårigheter inom dessa områden kan behöver stöd och hjälp på olika sätt är därmed också uppenbart.

    Det uppstår emellertid problem när sjukvården anmodas att ställa diagnos på barn i syfte att detta krävs för att skolan ska kunna sätta in erforderliga insatser. Här uppstår en situation där läkaren utsätts för påtryckningar från andra myndigheter och/eller föräldrar att ställa en diagnos som kanske inte anses medicinskt motiverad men där omsorgen om barnet och dess rätt till insatser leder till ett problematiskt handlande.

    Hur ska vi finna ett språk och ett tolkningssystem som innebär att diagnosen inte får den stora betydelse som den har i dag?

  • 31.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Psykiatri - en specialitet om hjärnan eller om människan?2008In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 105, no 43, p. 3057-3057Article in journal (Other (popular science, discussion, etc.))
  • 32.
    Engström, Ingemar
    Örebro University, Department of Health Sciences.
    Psykiatriska aspekter på avbrytande av livsuppehållande behandling2007Conference paper (Refereed)
  • 33.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    The "Forced to help" study: study design, methods and epidemiological data2007In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 7, no Suppl 1, p. S 104-Article in journal (Refereed)
    Abstract [en]

    Background The aim of the study was to examine coercive treatment in Swedish child and adolescent psychiatry from different scientific perspectives. The study was done in a multidisciplinary group comprised of researchers and PhD-students from child and adolescent psychiatry, law, philosophy, education and sociology. In this presentation, the design of the study will be presented and also some preliminary epidemiological data.

    Methods Epidemiological data from the period 2000 – 2004 was collected from all clinics in Sweden. Hospital records concerning all involuntarily admitted persons less than 18 years of age during one year were also collected from all clinics in Sweden.

    Results We found a tendency towards more coercive care during recent years. At least 150 children and adolescents were involuntarily admitted annually. The variation between counties was considerable. In some counties, adolescents on coercive treatment were treated together with adults. Girls were involuntarily admitted twice as often as boys. The most frequent diagnoses were psychosis, anorexia nervosa, self-destructive behavior and drug abuse.

    Conclusion Coercive treatment seems to be more frequent in recent years, but the variation is large between different counties. Contrary to adults, girls are more frequently treated involuntarily than boys. Further analysis of data is necessary to get a more comprehensive picture of the reasons for coercion of under aged persons.

  • 34.
    Engström, Ingemar
    Örebro University, Department of Health Sciences.
    Tvingad till hjälp: ett forskningsprojekt om tvång i svensk barn- och ungdomspsykiatri2007Conference paper (Refereed)
  • 35.
    Engström, Ingemar
    Örebro University, Department of Health Sciences.
    Vad har vi lärt oss av de apatiska flyktingbarnen?2007Conference paper (Refereed)
  • 36.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    VBM - ett nödvändigt komplement till EBM2008In: SLS aktuellt, ISSN 1650-8203, Vol. 8, no 2, p. 4-4Article in journal (Other academic)
  • 37.
    Engström, Ingemar
    et al.
    Örebro University, School of Medical Sciences. Universitetssjukvårdens forskningscent­rum (UFC), Region Örebro County, Örebro, Sweden.
    Bengtsson, Saskia
    Mobila geriatriska teamet, Länssjukhuset Ryhov, Jönköping, Sweden.
    Vården börjar alltid med mötet2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, no 42, article id ERRMArticle in journal (Refereed)
    Abstract [sv]

    Patient care always starts with an encounter Being a doctor is essentially a moral enterprise and all kinds of care begin with the encounter with the patient. This encounter occurs at the intersection of the patient's need for assistance and the doctor's professional knowledge. The meeting can be characterised by paternalism, autonomy or participation. It is important to regard the patient as a person and explore his or her perceptions, apprehensions and expectations early in the meeting. All decisions in medicine rely on both facts and values. It is, therefore, important that both the doctor's and the patient's values and preferences are out in the open. The medical encounter is always asymmetrical, which necessitates that the power perspective be acknowledged.

  • 38.
    Engström, Ingemar
    et al.
    Örebro University, School of Medical Sciences. University Health Care Research Center.
    Engström, Karin
    School of Culture and Education, Södertörn University, Stockholm, Sweden.
    Sellin, Tabita
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Research Center.
    Adolescents' Experiences of the Staff's Different Interaction Styles in Coercive Youth Care in Sweden: A Qualitative Study2020In: Issues in Mental Health Nursing, ISSN 0161-2840, E-ISSN 1096-4673, Vol. 41, no 11, p. 1027-1037Article in journal (Refereed)
    Abstract [en]

    We interviewed 20 adolescents who were coercively placed in residential or psychiatric care. The aim was to explore their views on the way staff relate and perform their duties, favorable characteristics in staff, consequences of different treatment from staff and their safety experiences. Thematic analysis identified the following themes: Situational triggers of frustration; Care-based; rule-based; or passive-avoidant interaction styles toward adolescents and their responses; Adolescents' reflections about staff's interaction styles; and the Consequences on the unit atmosphere depending on different interaction styles toward the adolescents. Adolescents preferred staff who showed them respect and a clear wish to make life easier.

  • 39.
    Engström, Ingemar
    et al.
    Örebro University, School of Medical Sciences. Örebro University Hospital. University Health Care Center.
    Hansson, Lars
    Department of Health Sciences, Lund University, Lund, Sweden.
    Ali, Lilas
    Institute of Health and Care Sciences, University of Gothenburg, Gothenburg, Sweden.
    Berg, Jenny
    SBU - Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden.
    Ekstedt, Mirjam
    Department of Health and Caring Sciences, Linnaeus University, Kalmar, Sweden.
    Engström, Sven
    Futurum, Region Jönköping County, Jönköping, Sweden.
    Fredriksson, Maja Kärrman
    SBU - Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden.
    Liliemark, Jan
    SBU - Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden.
    Lytsy, Per
    SBU - Swedish Agency for Health Technology Assessment and Assessment of Social Services, Stockholm, Sweden.
    Relational continuity may give better clinical outcomes in patients with serious mental illness: a systematic review2023In: BMC Psychiatry, E-ISSN 1471-244X, Vol. 23, no 1, article id 952Article, review/survey (Refereed)
    Abstract [en]

    BACKGROUND: Continuity of care is considered important for results of treatment of serious mental illness (SMI). Yet, evidence of associations between relational continuity and different medical and social outcomes is sparse. Research approaches differ considerably regarding how to best assess continuity as well as which outcome to study. It has hitherto been difficult to evaluate the importance of relational continuity of care. The aim of this systematic review was to investigate treatment outcomes, including effects on resource use and costs associated with receiving higher relational continuity of care for patients with SMI.

    METHODS: Eleven databases were searched between January 2000 and February 2021 for studies investigating associations between some measure of relational continuity and health outcomes and costs. All eligible studies were assessed for study relevance and risk of bias by at least two independent reviewers. Only studies with acceptable risk of bias were included. Due to study heterogeneity the synthesis was made narratively, without meta-analysis. The certainty of the summarized result was assessed using GRADE. Study registration number in PROSPERO: CRD42020196518.

    RESULTS: We identified 8 916 unique references and included 17 studies comprising around 300 000 patients in the review. The results were described with regard to seven outcomes. The results indicated that higher relational continuity of care for patients with serious mental illness may prevent premature deaths and suicide, may lower the number of emergency department (ED) visits and may contribute to a better quality of life compared to patients receiving lower levels of relational continuity of care. The certainty of the evidence was assessed as low or very low for all outcomes. The certainty of results for the outcomes hospitalization, costs, symptoms and functioning, and adherence to drug treatment was very low with the result that no reliable conclusions could be drawn in these areas.

    CONCLUSIONS: The results of this systematic review indicate that having higher relational continuity of care may have beneficial effects for patients with severe mental illness, and no results have indicated the opposite relationship. There is a need for better studies using clear and distinctive measures of exposure for relational continuity of care.

  • 40.
    Engström, Ingemar
    et al.
    Örebro University, School of Health and Medical Sciences.
    Lynöe, Niels
    Karolinska Institutet, Stockholm, Sweden.
    Patientens och sjukvårdens värderingar2012In: Professionell utveckling inom läkaryrket / [ed] Sven Olov Andersson et al, Stockholm: Liber, 2012, 1, p. 27-52Chapter in book (Other academic)
  • 41.
    Engström, Ingemar
    et al.
    Psykiatriskt forskningscentrum, Örebro, Sweden.
    Lynøe, Niels
    Centrum för hälso-och sjukvårdsetik, Karolinska institutet, Stockholm, Sweden.
    Tio myter att avliva om medicinsk etik2010In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 107, no 40, p. 2419-21Article in journal (Refereed)
  • 42.
    Engström, Ingemar
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Ågård, Anders
    Etiken och juridiken tydlig kring livsuppehållande behandling [Ethics and jurisprudence concerning life-sustaining treatment is clear]2015In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 112, article id DSCWArticle in journal (Refereed)
  • 43.
    Engström, Ingemar
    et al.
    Universitetssjukvårdens forskningscentrum, Region Örebro Län, Örebro, Sverige.
    Ågård, Anders
    Sahlgrenska universitetssjukhuset, Göteborg, Sverige.
    Läkarens viktiga möte med patienten2017In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 114, article id ESC3Article in journal (Refereed)
  • 44.
    Hedberg, Charlotte
    et al.
    Kvartersakuten Surbrunnsgatan, Centre for Family Medicine, Karolinska Institute, Stockholm, Sweden.
    Engström, Ingemar
    Centre for Psychiatric Research, Örebro, Sweden.
    Vickhoff, Renee
    Kärråkra vårdcentral, Eslöv, Sweden.
    Lynöe, Niels
    Centre for Healthcare Ethics, Karolinska Institute, Stockholm, Sweden.
    Can evidence-based medicine become counter-productive?2010In: Scandinavian Journal of Public Health, ISSN 1403-4948, E-ISSN 1651-1905, Vol. 38, no 5, p. 553-4Article in journal (Refereed)
  • 45.
    Hermansson, Liselotte
    et al.
    Örebro University Hospital, Örebro, Sweden; Karolinska Institute, Stockholm, Sweden.
    Eliasson, A. C.
    Karolinska Institute, Stockholm, Sweden.
    Engström, Ingemar
    Örebro University, Department of Clinical Medicine.
    Psychosocial adjustment in Swedish children with upper-limb reduction deficiency and a myoelectric prosthetic hand2005In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, no 4, p. 479-88Article in journal (Refereed)
    Abstract [en]

    AIM: To study psychosocial adjustment and mental health in children with upper-limb reduction deficiency and a myoelectric prosthetic hand.

    METHODS: Sixty-two parents of children aged 8 to 18 y old answered a questionnaire concerning competence and behaviour/emotional problems in their children. Of the 62 children, 37 adolescents aged 11 to 18 y old answered questionnaires concerning competence, problems and mood state. The results were compared with Swedish normative data. The children were divided into five groups based on degree of myoelectric prosthetic use.

    RESULTS: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand showed social competence and behaviour/emotional problems similar to Swedish standardized norms. However, withdrawn behaviour was significantly higher in all children, social competence was significantly lower in girls, and social activities were significantly lower in older children with upper-limb reduction deficiency. There was a significant difference between prosthetic use groups. Non-users had significantly more delinquent behaviour problems than full-time users. There was an interaction between gender and prosthetic use in their affect on competence and behaviour/emotional problems, yielding two contrasting patterns.

    CONCLUSION: Children with upper-limb reduction deficiency and a myoelectric prosthetic hand are as well adjusted psychosocially as their able-bodied peers. There are indications, however, of social stigmata related to the deficiency, which have to be considered differently in boys and girls.

  • 46.
    Holländare, Fredrik
    et al.
    Örebro University, School of Health and Medical Sciences.
    Andersson, Gerhard
    Dept Clin Neurosci, Sect Internet Psychiat, Karolinska Inst, Stockholm, Sweden; Linköping Univ, Linköping, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    A comparison of psychometric properties between internet and paper versions of two depression instruments (BDI-II and MADRS-S) administered to clinic patients2010In: Journal of Medical Internet Research, E-ISSN 1438-8871, Vol. 12, no 5, article id e49Article in journal (Refereed)
    Abstract [en]

    Background: Self-report measures can guide clinical decisions and are useful when evaluating treatment outcomes. However, many clinicians do not use self-report measures systematically in their clinical practice. Internet-based questionnaires could facilitate administration, but the psychometric properties of the online version of an instrument should be explored before implementation. The recommendation from the International Test Commission is to test the psychometric properties of each questionnaire separately.

    Objective: Our objective was to compare the psychometric properties of paper-and-pencil versions and Internet versions of two questionnaires measuring depressive symptoms.

    Methods: The 87 participating patients were recruited from primary care and psychiatric care within the public health care system in Sweden. Participants completed the Beck Depression Inventory (BDI-II) and the Montgomery- Åsberg Depression Rating Scale—Self-rated (MADRS-S), both on paper and on the Internet. The order was randomized to control for order effects. Symptom severity in the sample ranged from mild to severe depressive symptoms.

    Results: Psychometric properties of the two administration formats were mostly equivalent. The internal consistency was similar for the Internet and paper versions, and significant correlations were found between the formats for both MADRS-S (r= .84) and the BDI-II (r= .89). Differences between paper and Internet total scores were not statistically significant for either questionnaire nor for the MADRS-S question dealing with suicidality (item 9) when analyzed separately. The score on the BDI-II question about suicidality (item 9) was significantly lower when administered via the Internet compared with the paper score, but the difference was small (effect size, Cohen’s [d] = 0.14). There were significant main effects for order of administration on both questionnaires and significant interaction effects between format and order. This should not, however, pose a problem in clinical use as long as the administration format is not changed when repeated measurements are made.

    Conclusions: The MADRS-S can be transferred to online use without affecting the psychometric properties in a clinically meaningful way. The full BDI-II also seems to retain its properties when transferred; however, the item measuring suicidality in the Internet version needs further investigation since it was associated with a lower score in this study. The use of online questionnaires offers clinicians a more practical way of measuring depressive symptoms and has the potential to save resources.

  • 47.
    Holländare, Fredrik
    et al.
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Psychiatric Research Center, Örebro University Hospital, Region Örebro County, Örebro, Sweden.
    Anthony, Susanne A.
    School of Law, Psychology & Social Work, Örebro University, Örebro, Sweden.
    Randestad, Mia
    School of Law, Psychology & Social Work, Örebro University, Örebro, Sweden.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Carlbring, Per
    Stockholm Univ, Dept Psychology, Stockholm, Sweden.
    Andersson, Gerhard
    Department of Behavioural Sciences and Learning, Linköping University, Linköping, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
    Two-year outcome of internet-based relapse prevention for partially remitted depression2013In: Behaviour Research and Therapy, ISSN 0005-7967, E-ISSN 1873-622X, Vol. 51, no 11, p. 719-722Article in journal (Refereed)
    Abstract [en]

    The objective of the study was to investigate the long-term effects of internet-based relapse prevention for sufferers of partially remitted depression. Eighty-four individuals with partially remitted unipolar depression were randomized to either internet-based CBT (iCBT) or to a control group. After the ten week intervention period the participants were followed for 24 months and diagnostic interviews conducted to detect relapse. The intervention and monthly self-ratings of depressive symptoms were administered via an internet-based platform that ensured secure communication with all participants. Significantly fewer participants in the iCBT group had experienced a relapse compared with those in the control group two years after the internet-based intervention. The relapse rate in the iCBT group was 13.7% (CI 95% = 2.5-24.9) and in the control group it was 60.9% (CI 95% = 44.8-77). Furthermore, a significantly larger proportion of the iCBT group experienced remission two years after the intervention compared with the control group. Internet-based CBT seems promising for preventing relapse in sufferers of partially remitted depression. (C) 2013 Elsevier Ltd. All rights reserved.

  • 48.
    Holländare, Fredrik
    et al.
    Örebro University, School of Health and Medical Sciences.
    Askerlund, Anna-Maria
    Örebro University, School of Law, Psychology and Social Work.
    Nieminen, Anna
    Örebro University, School of Law, Psychology and Social Work.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Can the BDI-II and MADRS-S be transferred to online use without affecting their psychometric properties?2008In: Electronic Journal of Applied Psychology, Vol. 4, no 2, p. 63-65Article in journal (Refereed)
    Abstract [en]

    The Internet has brought new possibilities to psychological assessment. Although there are several advantages to online assessment, there are also challenges. The aim of this study is to test the psychometric equivalence of the traditional paper versions and Internet adapted versions of the BDI-II and the MADRS-S. The 71 participants were recruited at a university campus, and filled out the BDI-II and MADRS-S on both Internet and paper. They were randomized to complete either the Internet versions or the paper versions first, and then complete the other version on the next day. For both the BDI-II and the MADRS-S the Chronbach’s alpha levels were similar in the two mediums of administration. No significant differences were found between the paper versions and the Internet versions and the scores from the two differing mediums correlated highly for both questionnaires. Therefore, it was concluded that the psychometric properties of the BDI-II and the MADRS-S remained unchanged after transformation to online use.

  • 49.
    Holländare, Fredrik
    et al.
    Örebro University, School of Health and Medical Sciences.
    Johnsson, Susanne
    Örebro University, School of Law, Psychology and Social Work.
    Randestad, Mia
    Örebro University, School of Law, Psychology and Social Work.
    Tillfors, Maria
    Örebro University, School of Law, Psychology and Social Work.
    Carlbring, Per
    Umeå universitet, Umeå, Sweden.
    Andersson, Gerhard
    Linköpings universitet, Linköping, Sweden.
    Engström, Ingemar
    Örebro University, School of Health and Medical Sciences.
    Randomized trial of Internet-based relapse prevention for partially remitted depression2011In: Acta Psychiatrica Scandinavica, ISSN 0001-690X, E-ISSN 1600-0447, Vol. 124, no 4, p. 285-294Article in journal (Refereed)
    Abstract [en]

    Objective:

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

    Method:

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

    Results:

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

    Conclusion:

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

  • 50.
    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, 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.

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