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Solberg BS, Kvalvik LG, Instanes JT, Hartman CA, Klungsøyr K, Li L, Larsson H, Magnus P, Njølstad PR, Johansson S, Andreassen OA, Bakken NR, Bekkhus M, Austerberry C, Smajlagic D, Havdahl A, Corfield EC, Haavik J, Gjestad R, Zayats T. Maternal Fiber Intake During Pregnancy and Development of Attention-Deficit/Hyperactivity Disorder Symptoms Across Childhood: The Norwegian Mother, Father, and Child Cohort Study. Biol Psychiatry 2024; 95:839-848. [PMID: 38142720 DOI: 10.1016/j.biopsych.2023.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 12/08/2023] [Accepted: 12/13/2023] [Indexed: 12/26/2023]
Abstract
BACKGROUND Epidemiological studies suggest that maternal diet quality during pregnancy may influence the risk of neurodevelopmental disorders in offspring. Here, we investigated associations between maternal intake of dietary fiber and attention-deficit/hyperactivity disorder (ADHD) symptoms in early childhood. METHODS We used longitudinal data of up to 21,852 mother-father-child trios (49.2% female offspring) from MoBa (the Norwegian Mother, Father, and Child Cohort Study). The relationships between maternal fiber intake during pregnancy and offspring ADHD symptoms at ages 3, 5, and 8 years were examined using 1) multivariate regression (overall levels of ADHD symptoms), 2) latent class analysis (subclasses of ADHD symptoms by sex at each age), and 3) latent growth curves (longitudinal change in offspring ADHD symptoms). Covariates were ADHD polygenic scores in child and parents, total energy intake and energy-adjusted sugar intake, parental ages at birth of the child, and sociodemographic factors. RESULTS Higher maternal prenatal fiber intake was associated with lower offspring ADHD symptom scores at all ages (Bage3 = -0.14 [95% CI, -0.18 to -0.10]; Bage5 = -0.14 [95% CI, -0.19 to -0.09]; Bage8 = -0.14 [95% CI, -0.20 to -0.09]). Of the derived low/middle/high subclasses of ADHD symptoms, fiber was associated with lower risk of belonging to the middle subclass for boys and girls and to the high subclass for girls only (middle: odds ratioboys 0.91 [95% CI, 0.86 to 0.97]/odds ratiogirls 0.86 [95% CI, 0.81 to 0.91]; high: odds ratiogirls 0.82 [95% CI, 0.72 to 0.94]). Maternal fiber intake and rate of change in child ADHD symptoms across ages were not associated. CONCLUSIONS Low prenatal maternal fiber intake may increase symptom levels of ADHD in offspring during childhood, independently of genetic predisposition to ADHD, unhealthy dietary exposures, and sociodemographic factors.
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Affiliation(s)
- Berit Skretting Solberg
- Department of Biomedicine, University of Bergen, Norway; Child and Adolescent Psychiatric Outpatient Unit, Hospital Betanien, Bergen, Norway.
| | | | | | - Catharina A Hartman
- Interdisciplinary Center Psychiatry and Emotion Regulation, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
| | - Kari Klungsøyr
- Department of Global Public Health and Primary Care, University of Bergen, Norway; Division of Mental and Physical Health, Norwegian Institute of Public Health, Bergen, Norway
| | - Lin Li
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Per Magnus
- Centre for Fertility and Health, Norwegian Institute of Public Health, Oslo, Norway
| | - Pål Rasmus Njølstad
- Department of Clinical Science, Mohn Center for Diabetes Precision Medicine, University of Bergen, Bergen, Norway; Children and Youth Clinic, Haukeland University Hospital, Bergen, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Stefan Johansson
- Department of Clinical Science, University of Bergen, Bergen, Norway; Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Division of Mental Health and Addiciton, Oslo University Hospital, Oslo, Norway
| | - Nora Refsum Bakken
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mona Bekkhus
- Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, Norway
| | - Chloe Austerberry
- Centre for Family Research, University of Cambridge, Cambridge, United Kingdom; Research Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom
| | - Dinka Smajlagic
- Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, Norway
| | - Alexandra Havdahl
- Promenta Research Centre, Department of Psychology, University of Oslo, Oslo, Norway; Centre for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway; Nic Waals Institute, Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Elizabeth C Corfield
- Centre for Genetic Epidemiology and Mental Health, Norwegian Institute of Public Health, Oslo, Norway; Nic Waals Institute, Lovisenberg Diakonale Hospital, Oslo, Norway
| | - Jan Haavik
- Department of Biomedicine, University of Bergen, Norway; Bergen Center for Brain Plasticity, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Psychiatry, Research Department, Haukeland University Hospital, Bergen, Norway
| | - Rolf Gjestad
- Department of Psychiatry, Research Department, Haukeland University Hospital, Bergen, Norway; Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tetyana Zayats
- Analytic and Translational Genetics Unit, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts; Stanley Center for Psychiatric Research, Broad Institute of MIT and Harvard, Cambridge, Massachusetts; Program in Medical and Population Genetics, Broad Institute of MIT and Harvard, Cambridge, Massachusetts
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Kahlon S, Gjestad R, Lindner P, Nordgreen T. Perfectionism as a predictor of change in digital self-guided interventions for public speaking anxiety in adolescents: A secondary analysis of a four-armed randomized controlled trial. Cogn Behav Ther 2024; 53:152-170. [PMID: 37991001 DOI: 10.1080/16506073.2023.2281243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 11/05/2023] [Indexed: 11/23/2023]
Abstract
Public Speaking Anxiety (PSA) interventions targeting adolescents exist; however, not all gain improvement. This exploratory study investigated whether PSA interventions resulted in a decrease in perfectionism and whether pre-treatment level and changes in perfectionism moderated the effects on PSA and social anxiety. The sample consisted of 100 adolescents from junior high schools randomized to four groups: 1) VR only (n = 20), 2) VR + online exposure program (n = 20), 3) online psychoeducation and online exposure program (n = 40), 4) waitlist and online psychoeducation program (n = 20). Self-reported symptoms of PSA, social anxiety, and perfectionism were measured at pre, week 3, post, and 3-months follow-up. Level and change in outcome variables were analyzed using latent growth curve modeling. Results revealed that the interventions did not lead to a reduction in perfectionism. Reduction in perfectionism was associated with a larger reduction in all outcome measures from post to follow-up. No interaction was found between pre-treatment perfectionism and PSA symptoms. High pre-treatment levels of perfectionism were associated with poorer outcomes on social anxiety symptoms from post to follow-up for online exposure groups. The results indicate that one should assess and address high pre-treatment levels of perfectionism during PSA interventions.
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Affiliation(s)
- Smiti Kahlon
- Research Centre for Digital Mental Health Services, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Philip Lindner
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Tine Nordgreen
- Research Centre for Digital Mental Health Services, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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Strømme MF, Bartz-Johannessen C, Kjelby E, Mehlum L, Mykletun A, Kroken RA, Johnsen E, Gjestad R. Risk factors for mortality in patients admitted to a psychiatric acute ward: A prospective cohort study. Acta Psychiatr Scand 2024; 149:244-255. [PMID: 38225748 DOI: 10.1111/acps.13657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Revised: 12/18/2023] [Accepted: 01/04/2024] [Indexed: 01/17/2024]
Abstract
INTRODUCTION Associations between psychiatric disorders and mortality have been extensively studied, but limited evidence exists regarding influence of clinical characteristics on mortality risk, at the time of acute psychiatric hospitalization. METHODS A prospective total-cohort study included all patients consecutively admitted to Haukeland University Hospital's psychiatric acute ward in Bergen, Norway between 2005 and 2014 (n = 6125). Clinical interviews were conducted at the first admission within the study period, and patients were subsequently followed for up to 15 years in the Norwegian Cause of Death Registry. Competing risks regression models were used to investigate associations between clinical characteristics at first admission and the risk of natural and unnatural death during follow-up. RESULTS The mean age at first admission and at time of death was 42.5 and 62.8 years, respectively, and the proportion of women in the sample was 47.2%. A total of 1381 deaths were registered during follow-up, of which 65.5% had natural, 30.4% unnatural, and 4.1% unknown causes. Higher age, male sex, unemployment, cognitive deficits, and physical illness were associated with increased risk of natural death. Male sex, having no partner, physical illness, suicide attempts, and excessive use of alcohol and illicit substances were associated with increased risk of unnatural death. CONCLUSION Psychiatric symptoms, except suicide attempts, were unrelated to increased mortality risk. In the endeavor to reduce the increased mortality risk in people with mental disorders, focus should be on addressing modifiable risk factors linked to physical health and excessive use of alcohol and illicit substances.
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Affiliation(s)
- Maria Fagerbakke Strømme
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- NORMENT, Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | - Christoffer Bartz-Johannessen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- NORMENT, Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | - Eirik Kjelby
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- NORMENT, Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Arnstein Mykletun
- Division of Psychiatry, Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
- Centre for Work and Mental Health, Nordland Hospital, Bodø, Norway
- Department for Community Medicine, University of Tromsø, Tromsø, Norway
| | - Rune Andreas Kroken
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- NORMENT, Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- NORMENT, Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, Haukeland University Hospital, University of Bergen, Bergen, Norway
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Division of Psychiatry, Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
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Kjelby E, Gjestad R, Fathian F, Sinkeviciute I, Alisauskiene R, Anda LG, Løberg EM, Reitan SK, Joa I, Larsen TK, Rettenbacher M, Berle JØ, Fasmer OB, Kroken RA, Johnsen E. Reply to a Letter to the Editors From Dr de Souza and colleagues: "Unraveling the Optimal Treatment Approach for Depression in Schizophrenia Spectrum: A Quest for Clarity". J Clin Psychopharmacol 2024; 44:76-78. [PMID: 38100787 DOI: 10.1097/jcp.0000000000001800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
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Johnsen I, Mikkelsen JS, Opheim AA, Gjestad R. To lose a friend: the relationship between professional help and grief among close bereaved friends after the terror attack, 22 July 2011. Eur J Psychotraumatol 2023; 14:2264118. [PMID: 38047875 PMCID: PMC10990438 DOI: 10.1080/20008066.2023.2264118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 07/10/2023] [Indexed: 12/05/2023] Open
Abstract
Background: Close friends are often an overlooked group of bereaved people. This study is based on a sub-project on young adults who experienced the loss of a close friend in the terrorist attack on Utøya, Norway, on 22 July 2011.Objective: The aim of this longitudinal study was to explore the relationship between complicated grief reactions, the need for help, and help received after losing a close friend to a traumatic death.Method: In total, data from 89 people (with a mean age of 21 years, 76.4% female) were collected at one or more of the four time-points: 18, 28, 40, and 102 months after the incident. Latent growth modelling was used to analyse levels of grief reactions and change over time, experienced need for help, and help received.Results: According to the results, the bereaved friends in our study were profoundly impacted by the loss and experienced level of reactions indicating complicated grief (mean scores on the Inventory of Complicated Grief varied from 36.2 to 23.7). A need for help was related to a decrease in grief symptoms, whereas a prolonged need for help was related to no reduction or an increase in grief. Received help was not related to decrease in grief symptoms.Conclusions: These findings underscore the need for continuous professional help, and demonstrate that the present help measures used after traumatic events may not adequately meet the needs of close bereaved friends. This emphasizes the importance of acknowledging friends as bereaved and that follow-up measures should also include this group. Finally, the study highlights the need to learn more about how professional can help bereaved friends.
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Affiliation(s)
- Iren Johnsen
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | | | | | - Rolf Gjestad
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
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Oldervoll LM, Gjestad R, Hilmarsen C C, Ose A, Gullikstad L, Wisløff U, Kulseng B, Grimsmo J. Diastolic function and cardiovascular risk among patients with severe obesity referred to a lifestyle-program - a pilot study. Scand Cardiovasc J Suppl 2023; 57:8-16. [PMID: 36404730 DOI: 10.1080/14017431.2022.2146185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objectives. Severe obesity is associated with a high risk of comorbidities and alterations of cardiac structure and function. The primary aim of the study was to investigate the proportion of diastolic dysfunction (DD) at baseline, and changes in cardiac function from baseline (T1) to 6 months follow-up (T2) among participants with severe obesity attending a lifestyle-intervention. The secondary aim was to explore changes in body mass index (BMI), physical fitness (VO2peak) and cardiovascular risk from T1 to T2 and 12 months follow-up (T3).Design. This was an open single-site prospective observational study. Patients were recruited from an obesity clinic to a lifestyle-intervention consisting of three 3-weeks intermittent stays over 12-months period. Echocardiography was performed at T1 and T2 and BMI, VO2peak and cardiovascular risk measured at T1, T2 and T3.Results. Fifty-six patients were included (mean age 45.1 years; BMI 41.9). Six of 52 patients (12%) had grade 1 DD at T1, while five subjects had DD at T2. E/A ratio (11%, p = .005) and mitral deceleration time (9%, p = .014) were improved at T2. A reduction in BMI (-1.8, p < .001) and improvement in VO2peak (1.6 mL/kg min, p = .026) were assessed at T2 and this improvement persisted at T3. The total cardiovascular risk score was not significantly changed.Conclusion. The patients with severe obesity had low prevalence of DD. For all participants, an improvement in diastolic parameters, and an important initial weight loss was observed.Clinical Trial number: NCT02826122.
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Affiliation(s)
- Line M Oldervoll
- Faculty of Psychology, Centre for Crisis Psychology, University of Bergen, Bergen, Norway.,Faculty of Medicine and Health Sciences, Department of Public Health and Nursing, NTNU, Trondheim, Norway
| | - Rolf Gjestad
- Faculty of Psychology, Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | | | - Anders Ose
- Unicare Røros Rehabilitation, Røros, Norway
| | | | - Ulrik Wisløff
- Faculty of Medicine and Health Sciences, Department of Circulation and Medical Imaging, NTNU, Trondheim, Norway.,School of Human Movement and Nutrition Science, University of Queensland, Queensland, Australia
| | - Baard Kulseng
- Centre for Obesity Research, St. Olavs Hospital, Trondheim, Norway
| | - Jostein Grimsmo
- Department of Cardiac Rehabilitation, LHL (National Organization for Heart and Lung Diseases) Hospital Gardermoen, Jessheim, Norway
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Lygre RB, Gjestad R, Norekvål TM, Mercer SW, Elgen IB. An interdisciplinary intervention for children and adolescents with multiple referrals and complex health complaints: a feasibility study. BMC Health Serv Res 2023; 23:1241. [PMID: 37951903 PMCID: PMC10638682 DOI: 10.1186/s12913-023-10250-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Accepted: 10/30/2023] [Indexed: 11/14/2023] Open
Abstract
BACKGROUND Children and adolescents with complex health complaints are often referred to several different healthcare specialists for assessments and treatment. This may result in fragmented care, higher risks of medical errors, and sub-optimal health outcomes. The aim of this non-controlled open label trial was to evaluate the feasibility of implementing a new interdisciplinary intervention for children and adolescents with multiple referrals and complex health complaints and to gather experiences from participating children, adolescents and parents. METHODS In all, 47 children and adolescents aged 6-16 years with multiple referrals at a tertiary hospital were invited to participate. The intervention was a half-day consultation based on a biopsychosocial model. The aim of the intervention was to clarify the child/adolescent's condition(s) and provide a joint understanding and treatment plan in collaboration with the family. A team consisting of a pediatrician, a physiotherapist and a psychologist delivered the intervention. Acceptance and completion rate was recorded, and child- and parent-experience measures were collected; the children and adolescents completed the Visual Consultation and Relational Empathy Scale (CARE) five questions and parents completed two de novo created measures about their experiences. RESULTS Almost all invited families consented to participate (96%) and ultimately received the interdisciplinary intervention (92%). Mean age of the children and adolescents was 12 years, and under half were boys (40%). Before the intervention, 39 (91%) parents completed a questionnaire about previous experiences with healthcare. After the consultation 39 children and adolescents (91%) and 40 (93%) parents completed the questionnaire regarding their experience with the interdisciplinary intervention. Of the children and adolescents, 18-30 (47-77%) rated relational empathy in the intervention as "Very good" or "Excellent". Of the parents, 35-39 (92-100%) rated their experience with the consultation using the more positive response options. The parents were significantly more content with the intervention compared to previously received healthcare (p < .001). CONCLUSIONS The present intervention was highly acceptable with positively reported experiences from parents of, and children and adolescents with, complex health complaints. A future randomized controlled trial is required to test the effectiveness of this intervention. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov NCT04652154 03.12.2020. Retrospectively registered.
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Affiliation(s)
- Ragnhild B Lygre
- Department of Clinical Medicine, University of Bergen, Postbox 7804, 5020, Bergen, Norway.
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
- Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway.
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tone M Norekvål
- Centre on Patient-Reported Outcomes, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Science, University of Bergen, Bergen, Norway
| | | | - Irene Bircow Elgen
- Department of Clinical Medicine, University of Bergen, Postbox 7804, 5020, Bergen, Norway
- Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway
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Wergeland GJH, Haaland ÅT, Fjermestad KW, Öst LG, Gjestad R, Bjaastad JF, Hoffart A, Husabo E, Raknes S, Haugland BSM. Predictors of school-based cognitive behavior therapy outcome for youth with anxiety. Behav Res Ther 2023; 169:104400. [PMID: 37690362 DOI: 10.1016/j.brat.2023.104400] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 08/08/2023] [Accepted: 08/29/2023] [Indexed: 09/12/2023]
Abstract
Meta-analyses of school-based CBT have shown that prevention for anxiety symptoms typically report small but significant effects. There is limited knowledge regarding which youths may benefit most and least from such programs, and characteristics of youth who respond differentially to interventions of different intensity. The present study examined predictors of school-based CBT outcomes among 302 youths (mean age 14.0 years, SD 0.8, 84% female) who participated in a randomized waitlist-controlled trial comparing a 10-session and a 5-session group intervention. Potential predictors included youth and parental factors, and credibility and expectancy of the interventions. Pre-intervention anxiety and depression levels, and clinician rated severity were examined as moderators of intervention effects. Outcomes were youth-, and parent-reported youth anxiety and depressive symptoms at post-intervention and 1-year follow-up. Higher parent-reported impairment from youth anxiety predicted larger parent-reported anxiety and depressive symptom change, whereas higher caregiver strain was associated with less symptom change. Higher parent rated credibility and expectancy was associated with improved outcomes at post-intervention. At 1-year follow-up, no predictors of outcome were identified. No moderators were identified. Families with high levels of caregiver strain associated with youth anxiety may need extra support regardless of length of intervention program. Parents' credibility and expectancy of interventions should be targeted to optimize school-based CBT.
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Affiliation(s)
- Gro Janne H Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Norway.
| | - Åshild T Haaland
- Department of Child and Adolescence Mental Health, Sørlandet Hospital, Kristiansand, Norway
| | | | | | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Jon F Bjaastad
- Division of Psychiatry, Stavanger University Hospital, Norway
| | - Asle Hoffart
- Research Institute, Modum Bad Psychiatric Centre, Vikersund, Norway
| | - Elisabeth Husabo
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Center, NORCE, Norway
| | | | - Bente S M Haugland
- Regional Centre for Child and Youth Mental Health and Child Welfare, Norwegian Research Center, NORCE, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
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Stabell L, Johnsen E, Kroken RA, Løberg E, Blindheim A, Joa I, Reitan S, Rettenbacher M, Munk-Jørgensen P, Gjestad R. Clinical insight among persons with schizophrenia spectrum disorders treated with amisulpride, aripiprazole or olanzapine: a semi-randomised trial. BMC Psychiatry 2023; 23:482. [PMID: 37386462 PMCID: PMC10311854 DOI: 10.1186/s12888-023-04981-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 06/22/2023] [Indexed: 07/01/2023] Open
Abstract
BACKGROUND Antipsychotic treatment may improve clinical insight. However, previous studies have reported inconclusive findings on whether antipsychotics improve insight over and above the reduction in symptoms of psychosis. These studies assessed homogeneous samples in terms of stage of illness. Randomised studies investigating a mixed population of first- and multiepisode schizophrenia spectrum disorders might clarify this disagreement. METHODS Our data were derived from a pragmatic, rater-blinded, semi-randomised trial that compared the effectiveness of amisulpride, aripiprazole and olanzapine. A sample of 144 patients with first- or multiepisode schizophrenia spectrum disorders underwent eight assessments during a 1-year follow-up. Clinical insight was assessed by item General 12 from the Positive and Negative Syndrome Scale (PANSS). We analysed latent growth curve models to test if the medications had a direct effect on insight that was over and above the reduction in total psychosis symptoms. Furthermore, we investigated whether there were differences between the study drugs in terms of insight. RESULTS Based on allocation analysis, all three drugs were associated with a reduction in total psychosis symptoms in the initial phase (weeks 0-6). Amisulpride and olanzapine were associated with improved insight over and above what was related to the reduction in total psychosis symptoms in the long-term phase (weeks 6-52). However, these differential effects were lost when only including the participants that chose the first drug in the randomisation sequence. We found no differential effect on insight among those who were antipsychotic-naïve and those who were previously medicated with antipsychotics. CONCLUSIONS Our results suggest that antipsychotic treatment improves insight, but whether the effect on insight surpasses the effect of reduced total psychosis symptoms is more uncertain. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT01446328, 05.10.2011.
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Affiliation(s)
- L.A Stabell
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Research Department, Sandviken sykehus, Haukeland University Hospital, P. Box 1400, Bergen, 5021 Norway
| | - E. Johnsen
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - R. A Kroken
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - E.M. Løberg
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - A. Blindheim
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | - I. Joa
- Network for Clinical Research in psychosis, TIPS, Stavanger University Hospital, Stavanger, Norway
- Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - S.K. Reitan
- Department of Mental Health, St. Olav University Hospital, Trondheim, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - M. Rettenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innrain 52, Innsbruck, Austria
| | - P. Munk-Jørgensen
- Department of Psychiatry, University of Southern Denmark, Odense, Denmark
| | - R. Gjestad
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic psychiatry, Haukeland University Hospital, Bergen, Norway
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Alisauskiene R, Johnsen E, Gjestad R, Kroken RA, Kjelby E, Sinkeviciute I, Fathian F, Joa I, Reitan SK, Rettenbacher M, Løberg EM. Does drug use affect the efficacy of amisulpride, aripiprazole and olanzapine in patients with schizophrenia spectrum disorders? Results from a pragmatic, randomised study. Gen Hosp Psychiatry 2023; 83:185-193. [PMID: 37269769 DOI: 10.1016/j.genhosppsych.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 05/01/2023] [Accepted: 05/03/2023] [Indexed: 06/05/2023]
Abstract
OBJECTIVES Drug use is prevalent in patients with schizophrenia spectrum disorders (SSD) but there is limited knowledge about the influence of drug use on the effectiveness of antipsychotic medication. This secondary explorative study compared the effectiveness of three antipsychotics in patients with SSD, with and without drug use. METHODS The BeSt InTro multi-centre, head to head, rater-blinded randomised study compared amisulpride, aripiprazole and olanzapine over a 1-year follow-up period. All patients (n = 144) were aged ≥18 years and met the ICD-10 criteria for SSD (F20-29). Clinical symptoms were assessed using the Positive and Negative Syndrome Scale (PANSS). The primary outcome was reduction of a PANSS positive subscale score. RESULTS At baseline, 38% of all patients reported drug use in the last 6 months before inclusion, with cannabis as the main drug (85%), followed by amphetamine-type stimulants (45%), sedatives (26%), hallucinogens (19%), cocaine (13%), opiates (4%), GHB (4%), solvents (4%), analgesics (4%) and anabolic steroids (2%). The predominant pattern was the use of several drugs. There were no significant overall differences in the PANSS positive subscale score reduction for the three studied antipsychotics among patients either with or without drug use. In the drug use group, older patients treated with amisulpride showed a greater PANSS positive subscale score reduction during the treatment period compared to younger patients. CONCLUSION The current study showed that drug use does not appear to affect the overall effectiveness of amisulpride, aripiprazole and olanzapine in patients with SSD. However, amisulpride may be a particularly suitable choice for older patients with drug use.
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Affiliation(s)
- Renata Alisauskiene
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Postbox 7804, N-5020 Bergen, Norway.
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway.
| | - Rune A Kroken
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Postbox 7804, N-5020 Bergen, Norway.
| | - Eirik Kjelby
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.
| | - Igne Sinkeviciute
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.
| | - Farivar Fathian
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.
| | - Inge Joa
- Network for Clinical Psychosis Research, Division of Psychiatry, Stavanger University Hospital, Stavanger, Norway.
| | - Solveig Klæbo Reitan
- Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway.
| | - Maria Rettenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innrain, 52, Innsbruck, Austria.
| | - Else-Marie Løberg
- Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, N-5035 Bergen, Norway; Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, Bergen, Norway; Department of Clinical Psychology, University of Bergen, Christies gate 12, N-5015 Bergen, Norway; NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.
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11
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Kjelby E, Gjestad R, Fathian F, Sinkeviciute I, Alisauskiene R, Anda L, Løberg EM, Reitan SK, Joa I, Larsen TK, Rettenbacher M, Berle JØ, Fasmer OB, Kroken RA, Johnsen E. Antidepressive Effectiveness of Amisulpride, Aripiprazole, and Olanzapine in Patients With Schizophrenia Spectrum Disorders: A Secondary Outcome Analysis of a Pragmatic, Randomized Trial (BeSt InTro). J Clin Psychopharmacol 2023; 43:246-258. [PMID: 37083542 PMCID: PMC10155702 DOI: 10.1097/jcp.0000000000001679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/22/2023]
Abstract
BACKGROUND Depressive symptoms are frequent in schizophrenia and associated with a poorer outcome. Currently, the optimal treatment for depressive symptoms in schizophrenia remains undetermined. Amisulpride, aripiprazole, and olanzapine all have antidepressive pharmacodynamic properties, ranging from serotonergic affinities to limbic dopaminergic selectivity. Consequently, in a 12-month pragmatic, randomized clinical trial, we aimed to investigate differences in antidepressive effectiveness among amisulpride, aripiprazole, and olanzapine as a secondary outcome, measured by change in the Calgary Depression Scale for Schizophrenia sum score in patients within the schizophrenia spectrum. METHODS Psychotic patients within the schizophrenia spectrum were included, and effectiveness was analyzed with latent growth curve modeling. RESULTS Of the 144 patients, 51 (35%) were women, the mean age was 31.7 (SD 12.7), and 39% were antipsychotic naive. At inclusion, 68 (47%) participants had a Calgary Depression Scale for Schizophrenia sum score >6, indicating severe depressive symptoms. Across the 12-month follow-up, there was a depressive symptom reduction in all medication groups, but no statistically significant differences between the study drugs. Separate analyses of the subcohort with elevated depressive symptoms at inclusion also failed to find differences in depressive symptom reduction between study drugs. The reduction in depressive symptoms mainly occurred within 6 weeks after randomization. CONCLUSIONS There was a reduction in depressive symptoms under treatment with amisulpride, aripiprazole, and olanzapine in acutely psychotic patients with schizophrenia spectrum disorder, but no differences between the drugs.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | - Maria Rettenbacher
- Department of Psychiatry, Psychotherapy, Psychosomatics, and Medical Psychology, University Clinic of Psychiatry I, Medical University of Innsbruck, Innsbruck, Austria
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Kenter RMF, Gjestad R, Lundervold AJ, Nordgreen T. A self-guided internet-delivered intervention for adults with ADHD: Results from a randomized controlled trial. Internet Interv 2023; 32:100614. [PMID: 36969389 PMCID: PMC10033990 DOI: 10.1016/j.invent.2023.100614] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 03/01/2023] [Accepted: 03/14/2023] [Indexed: 03/24/2023] Open
Abstract
Background Attention-deficit/hyperactivity disorder (ADHD) in adulthood, with an estimated prevalence of 2–3 %, is associated with several challenges in daily life functioning. Still, the availability of evidence-based psychological interventions for adults with ADHD is limited. Interventions delivered over the Internet on smartphones or personal computers may help to increase the availability of and access to effective psychological interventions. Objective This study reports on the efficacy of a self-guided psychological Internet-delivered intervention on severity levels of ADHD symptomatology and quality of life in adults with ADHD. Methods Adults with a self-reported ADHD diagnosis (N = 120) were included in a randomized controlled trial with two arms: 1) self-guided Internet-delivered intervention for managing symptoms and impairments related to ADHD (n = 61); 2) online psychoeducation module (control group, n = 59). The primary clinical outcome was severity levels of ADHD as measured with the Adult ADHD Self-Report Scale. Secondary outcomes were quality of life as measured with the Adult ADHD Quality of Life scale and stress as measured with the Perceived Stress Scale. Measures were obtained at three time points: before (baseline), immediately after (8 weeks) and 3 months after the intervention. The secondary objective of the study was to explore user satisfaction with and adherence to the intervention. Results Linear Mixed Model analysis revealed moderate to large between group effect-size improvements on self-report measures of ADHD symptomatology (d = 0.70) and quality of life (d = 0.53). Importantly, effects were maintained at 3-month follow-up (d = 0.76 and d = 0.52). In terms of adherence, 29 % completed all modules, while 59 % completed at least five modules (out of 7). Treatment satisfaction was adequate, with n = 34 (79 %) indicating that they were very satisfied or satisfied with the intervention, and n = 37 (88 %) indicating that they would recommend the intervention to a friend. Discussion The study demonstrated the efficacy of a self-guided Internet-delivered intervention by showing reliable and statistically significant improvements in self-reported ADHD symptomatology and quality of life. The intervention may be suitable for better managing ADHD symptoms in primary care and as a low intensity intervention population wide. Trial registration ClinicalTrials.gov, Identifier NCT04726813, January 27, 2021. The intervention significantly reduced ADHD symptoms and increased quality of life. Between group effect sizes were moderate to large on the primary outcome. Within group effect sizes were large for the intervention group. Fifty-eight percent of intervention group participants demonstrated reliable change. The majority of the participants were satisfied with the intervention.
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Affiliation(s)
- Robin Maria Francisca Kenter
- Division of Psychiatry, Haukeland University Hospital, Haukelandsbakken 15, 5009 Bergen, Norway
- Corresponding author.
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Astri J. Lundervold
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Jonas Lies vei 91, 5009 Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Haukelandsbakken 15, 5009 Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Årstadveien 17, Block D, 5009 Bergen, Norway
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Hoprekstad GE, Kjelby E, Gjestad R, Fathian F, Larsen TK, Reitan SK, Rettenbacher M, Torsvik A, Skrede S, Johnsen E, Kroken RA. Depression trajectories and cytokines in schizophrenia spectrum disorders - A longitudinal observational study. Schizophr Res 2023; 252:77-87. [PMID: 36634451 DOI: 10.1016/j.schres.2022.12.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 12/01/2022] [Accepted: 12/30/2022] [Indexed: 01/11/2023]
Abstract
Depression occurs frequently in all phases of schizophrenia spectrum disorders. Altered activity in the immune system is seen in both depression and schizophrenia. We aimed to uncover depressive trajectories in a sample of 144 adult individuals with schizophrenia spectrum disorders followed for one year, in order to identify possible cytokine profile differences. Patients were assessed longitudinally with the Positive and Negative Syndrome Scale (PANSS) and the Calgary Depression Scale for Schizophrenia (CDSS), where a score above 6 predicts depression. The serum cytokine concentrations for tumor necrosis factor (TNF)-alpha, interferon (IFN)-gamma, interleukin (IL)-1beta, IL-2, IL-4, IL-6, IL-10, IL-12p70 and IL-17A were measured using immunoassays. Latent growth curve models, multilevel models and latent class growth analysis (LCGA) were applied. The LCGA model supported three latent classes (trajectories) with differing CDSS profiles during the one-year follow-up: a high CDSS group (40.8 % of participants), a moderate CDSS group (43.9 %) and a low CDSS group (15.3 %). Five single PANSS items predicted affiliation to depressive trajectory: hallucinations, difficulty in abstract thinking, anxiety, guilt feelings and tension. In the high CDSS group, despite diminishing psychotic symptoms, depressive symptoms persisted throughout one year. The pro-inflammatory cytokines IFN-γ, IL-1β and TNF-α were differentially distributed between the depressive trajectories, although levels remained remarkably stable throughout 12 months. Significant changes were found for the anti-inflammatory cytokine IL-10 at baseline with an accompanying difference in change over time. More research is required to optimize future treatment stratification and investigate the contribution of inflammation in depressed patients with schizophrenia spectrum disorders.
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Affiliation(s)
- Gunnhild E Hoprekstad
- Division of Psychiatry, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Box 1400, 5021 Bergen, Norway.
| | - Eirik Kjelby
- Division of Psychiatry, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Farivar Fathian
- Division of Psychiatry, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
| | - Tor K Larsen
- Department of Clinical Medicine, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; The TIPS-center, Stavanger University Hospital, Stavanger, Norway
| | - Solveig K Reitan
- St. Olav's University Hospital, Department of Mental Health, Trondheim, Norway; Norwegian University of Science and Technology, Department of Mental Health, Trondheim, Norway
| | | | - Anja Torsvik
- Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Silje Skrede
- Department of Clinical Science, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Section of Clinical Pharmacology, Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
| | - Rune A Kroken
- Division of Psychiatry, Haukeland University Hospital, Box 1400, 5021 Bergen, Norway; Department of Clinical Medicine, University of Bergen, P.O. Box 7804, 5020 Bergen, Norway; Norwegian Centre for Mental Disorders Research (NORMENT), Haukeland University Hospital, Box 1400, 5021 Bergen, Norway
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Halstensen K, Gjestad R, Wampold B, Engedal LG, Stålsett G, Granqvist P. Addressing patients’ relationships with god in psychotherapy: Exploring psychodynamic therapy, depressive symptoms, and attachment to God. Spirituality in Clinical Practice 2022. [DOI: 10.1037/scp0000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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15
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Halmøy A, Ring AE, Gjestad R, Møller M, Ubostad B, Lien T, Munkhaugen EK, Fredriksen M. Dialectical behavioral therapy-based group treatment versus treatment as usual for adults with attention-deficit hyperactivity disorder: a multicenter randomized controlled trial. BMC Psychiatry 2022; 22:738. [PMID: 36443712 PMCID: PMC9706966 DOI: 10.1186/s12888-022-04356-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 10/31/2022] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Studies on structured skills training groups have indicated beneficial, although still inconclusive, effects on core symptoms of ADHD in adults. This trial examined effects of Dialectical Behavioral Therapy-based group treatment (DBT-bGT) on the broader and clinically relevant executive functioning and emotional regulation in adults with ADHD. METHODS In a multicenter randomized controlled trial, adult patients with ADHD were randomly assigned to receive either weekly DBT-bGT or treatment as usual (TAU) during 14 weeks. Subsequently, participants receiving TAU were offered DBT-bGT. All were reassessed six months after ended DBT-bGT. Primary outcomes were the Behavior Rating Inventory of Executive Function (BRIEF-A) and the Difficulties in Emotion Regulation Scale (DERS). Secondary outcomes included self-reported ADHD-symptoms, depressive and anxiety symptoms, and quality of life. We used independent samples t- tests to compare the mean difference of change from pre- to post-treatment between the two treatment groups, and univariate linear models adjusting for differences between sites. RESULTS In total, 121 participants (68 females), mean age 37 years, from seven outpatient clinics were included, of whom 104 (86%) completed the 14-week trial. Entering the study, 63% used medication for ADHD. Compared to TAU (n = 54), patients initially completing DBT-bGT (n = 50) had a significantly larger mean reduction on the BRIEF-A (-12.8 versus -0.37, P = 0.005, effect size 0.64), and all secondary outcomes, except for symptoms of anxiety. All significant improvements persisted at 6 months follow-up. Change on DERS did not differ significantly between the groups after 14 weeks, but scores continued to decrease between end of group-treatment and follow-up. CONCLUSIONS This DBT-bGT was superior to TAU in reducing executive dysfunction, core symptoms of ADHD and in improving quality of life in adults with ADHD. Improvements sustained six months after ended treatment. The feasibility and results of this study provide evidence for this group treatment as a suitable non-pharmacological treatment option for adults with ADHD in ordinary clinical settings. TRIAL REGISTRATIONS The study was pre-registered in the ISRCTN registry (identification number ISRCTN30469893, date February 19th 2016) and at the ClinicalTrials.gov (ID: NCT02685254, date February 18th 2016).
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Affiliation(s)
- Anne Halmøy
- Division of Psychiatry, Kronstad District Psychiatric Center, Haukeland University Hospital, 5021, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, 5020, Bergen, Norway.
| | - Anna Edith Ring
- grid.412008.f0000 0000 9753 1393Division of Psychiatry, Research Department, Haukeland University Hospital, 5021 Bergen, Norway
| | - Rolf Gjestad
- grid.412008.f0000 0000 9753 1393Division of Psychiatry, Research Department, Haukeland University Hospital, 5021 Bergen, Norway ,grid.412008.f0000 0000 9753 1393Center for Research and Education in Forensic Psychiatry, Haukeland University Hospital, 5021 Bergen, Norway
| | - Merete Møller
- grid.412938.50000 0004 0627 3923District Psychiatric Center, Østfold Hospital Trust, 1714 Grålum (Sarpsborg), Norway
| | - Bente Ubostad
- grid.412008.f0000 0000 9753 1393Regional Resource Center for Autism, AD/HD, and Tourettes Syndrome, Western Norway Regional Health Authority, Haukeland University Hospital, 5021 Bergen, Norway ,grid.417292.b0000 0004 0627 3659Division of Mental Health & Addiction, Vestfold Hospital Trust, 3101 Tønsberg, Norway
| | - Tage Lien
- grid.55325.340000 0004 0389 8485Regional Resource Center for Autism, AD/HD, and Tourettes Syndrome, South-Eastern Norway Regional Health Authority, Oslo University Hospital, 0424 Oslo, Norway
| | - Ellen Kathrine Munkhaugen
- grid.55325.340000 0004 0389 8485Regional Resource Center for Autism, AD/HD, and Tourettes Syndrome, South-Eastern Norway Regional Health Authority, Oslo University Hospital, 0424 Oslo, Norway ,grid.55325.340000 0004 0389 8485Norwegian National Advisory Unit On Mental Health in Intellectual Disabilities, Oslo University Hospital, 0424 Oslo, Norway
| | - Mats Fredriksen
- grid.417292.b0000 0004 0627 3659Division of Mental Health & Addiction, Vestfold Hospital Trust, 3101 Tønsberg, Norway
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Berge LI, Gjestad R, Franck J, Javaras KN, Greenfield S, Haver B. Gender specific early treatment for women with alcohol addiction (EWA): Impact on work related outcomes. A 25-year registry follow-up of a randomized controlled trial (RCT). Drug Alcohol Depend 2022; 239:109600. [PMID: 36007448 PMCID: PMC9509484 DOI: 10.1016/j.drugalcdep.2022.109600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 06/30/2022] [Accepted: 08/04/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Alcohol contributes to substantial economic burden, at both individual and community levels. We investigated the effect of the Early treatment for Women with Alcohol Addiction (EWA) treatment program on sickness leave, income, unemployment and early retirement pension up to 25 years following intake to treatment. METHODS The EWA RCT included 200 women with alcohol use disorder from 1983 to 1984 at the Karolinska University Hospital, Sweden. Participants were randomized to the EWA program, a two-year specialized woman only treatment including psychiatric, interpersonal and family concerns, or treatment as usual (TAU) in a mixed gender setting. We followed the participants in the RCT from 1985 to 2009 through linkage with a national labor market registry and applied latent growth curve modeling to estimate level and change in sickness leave, income, unemployment and early retirement pension. FINDINGS Relative to TAU, the EWA group had less increase in sickness leave up to 21 years after treatment. Overall, we found no differences in income between treatment groups, yet, a two-year interval analysis showed greater rise in income up to 8 years after treatment for the EWA group. Level and change in unemployment and early retirement pension did not differ between treatment groups. CONCLUSIONS Gender specific treatment emphasizing psychiatric, interpersonal and family issues for women with alcohol addiction had long-term positive effects on sickness leave and income. These findings complement positive clinical outcomes of the EWA treatment program on drinking patterns, mental health and mortality.
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Affiliation(s)
- Line Iden Berge
- NKS Olaviken Gerontopsychiatric Hospital, 5306 Erdal, Norway; Centre for Elderly and Nursing Home Medicine, Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Årstadveien 19, 5009 Bergen, Norway
| | - Rolf Gjestad
- Research department, Division of Psychiatry, Haukeland University Hospital, Sandviksleitet 1, 5036 Bergen, Norway; Center for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Sandviksleitet 1, 5036 Bergen, Norway
| | - Johan Franck
- Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18 A, 17177 Stockholm, Sweden
| | - Kristin Nicole Javaras
- Division of Women's Mental Health, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States
| | - Shelly Greenfield
- Division of Women's Mental Health, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States; Department of Psychiatry, Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States; Division of Alcohol, Drugs and Addiction, McLean Hospital, 115 Mill Street, Belmont, MA 02478, United States
| | - Brit Haver
- Department of Clinical Neuroscience, Karolinska Institutet, Tomtebodavägen 18 A, 17177 Stockholm, Sweden; Department of Clinical Medicine, Faculty of Medicine, University of Bergen, Haukelandsbakken, 5009 Bergen, Norway
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Syrstad VEG, Mjeldheim K, Førland W, Jakobsen P, Gjestad R, Berle JØ, Merikangas KR, Oedegaard KJ, Fasmer OB. Objective assessment of motor activity in a clinical sample of adults with attention-deficit/hyperactivity disorder and/or cyclothymic temperament. BMC Psychiatry 2022; 22:609. [PMID: 36104774 PMCID: PMC9476590 DOI: 10.1186/s12888-022-04242-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 09/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Most research on patterns of motor activity has been conducted on adults with mood disorders, but few studies have investigated comorbid attention-deficit/hyperactivity disorder (ADHD) or temperamental factors that may influence the clinical course and symptoms. Cyclothymic temperament (CT) is particularly associated with functional impairment. Clinical features define both disorders, but objective, biological markers for these disorders could give important insights with regard to pathophysiology and classification. METHODS Seventy-six patients, requiring diagnostic evaluation of ADHD, mood or anxiety disorders were recruited. A comprehensive diagnostic evaluation, including the CT scale of the Temperament Evaluation of Memphis, Pisa, Paris and San Diego - Auto-questionnaire (TEMPS-A), neuropsychological tests and actigraphy, was performed. ADHD was diagnosed according to the DSM-IV criteria. There was a range of different conditions in this clinical sample, but here we report on the presence of CT and ADHD in relation to motor activity. Twenty-nine healthy controls were recruited. We analyzed motor activity time series using linear and nonlinear mathematical methods, with a special focus on active and inactive periods in the actigraphic recordings. RESULTS Forty patients fulfilled the criteria for ADHD, with the remainder receiving other psychiatric diagnoses (clinical controls). Forty-two patients fulfilled the criteria for CT. Twenty-two patients fulfilled the criteria for ADHD and CT, 18 patients met the criteria for ADHD without CT, and 15 patients had neither. The ratio duration of active/inactive periods was significantly lower in patients with CT than in patients without CT, in both the total sample, and in the ADHD subsample. CONCLUSIONS CT is associated with objectively assessed changes in motor activity, implying that the systems regulating motor behavior in these patients are different from both healthy controls and clinical controls without CT. Findings suggest that actigraphy may supplement clinical assessments of CT and ADHD, and may provide an objective marker for CT.
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Affiliation(s)
- Vigdis Elin Giaever Syrstad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, Bergen, Norway. .,Division of Psychiatry, NORMENT, Haukeland University Hospital, Bergen, Norway.
| | | | | | - Petter Jakobsen
- grid.412008.f0000 0000 9753 1393Division of Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Division of Psychiatry, NORMENT, Haukeland University Hospital, Bergen, Norway
| | - Rolf Gjestad
- grid.412008.f0000 0000 9753 1393Division of Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Division of Psychiatry, NORMENT, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443 Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Jan Øystein Berle
- grid.412008.f0000 0000 9753 1393Division of Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Division of Psychiatry, NORMENT, Haukeland University Hospital, Bergen, Norway
| | - Kathleen Ries Merikangas
- grid.416868.50000 0004 0464 0574Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, Maryland USA
| | - Ketil Joachim Oedegaard
- grid.412008.f0000 0000 9753 1393Division of Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Division of Psychiatry, NORMENT, Haukeland University Hospital, Bergen, Norway
| | - Ole Bernt Fasmer
- grid.412008.f0000 0000 9753 1393Division of Psychiatry, Haukeland University Hospital, Bergen, Norway ,grid.7914.b0000 0004 1936 7443Department of Clinical Medicine, University of Bergen, Bergen, Norway ,grid.412008.f0000 0000 9753 1393Division of Psychiatry, NORMENT, Haukeland University Hospital, Bergen, Norway
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Fredriksen KJ, Gjestad R, Walby FA, Anda LG, Oedegaard KJ, Schoeyen HK. High Scores on the Montgomery-Åsberg Depression Rating Scale and Psychotic Symptoms Predict Suicide: A Prospective Cohort Study of Psychiatric Acute Ward Patients. J Clin Psychiatry 2022; 83. [PMID: 35900251 DOI: 10.4088/jcp.21m14018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Objective: To investigate the role of depression severity in suicide risk by studying the predictive value of psychotic symptoms and depression scale scores, controlled for suicidal behavior and gender. Methods: We conducted a prospective cohort study of consecutive psychiatric acute ward admissions between 2005 and 2014 from a Norwegian catchment area. Inclusion criteria were an ICD-10 diagnosis of unipolar or bipolar depression with a current depressive episode (n = 1,846); depression severity was measured by the Montgomery-Åsberg Depression Rating Scale (MADRS). Patients were assessed for suicidal ideation/planning, self-harm, and recent suicide attempts on admission. Mean follow-up time was 5.5 years (minimum/maximum: 0/10.6 years). We used Cox regression analyses and Kaplan-Meier analyses to explore potential predictors and time to suicide. Results: During the follow-up period, 46 patients died by suicide, 30 (65%) of these within the year following admission. Psychotic depression (P = .014), admission MADRS score (P = .006), suicide attempts (P = .021), and male sex (P = .043) significantly predicted suicide. Suicidal ideation and self-harm did not predict suicide. The cumulative suicide risk in psychotic depression was 1.7% after 12 weeks and 3.0% after 52 weeks. Conclusions: Depression severity as measured with the MADRS or a diagnosis of psychotic depression independently predicted suicide. More suicides may be prevented by implementing intensive treatment and post-discharge follow-up for patients who present to psychiatric acute wards with severe depressive episodes and recent suicide attempts, regardless of self-reported suicidal ideation, suicide plans, and self-harm.
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Affiliation(s)
- Kristin J Fredriksen
- Clinic of adult psychiatry, Stavanger University Hospital, Armauer Hansens vei 20, 4011 Stavanger, Norway.,Regional Centre for Clinical Research in Psychosis, Clinic of adult psychiatry, Stavanger University Hospital, Armauer Hansens vei 20, 4011 Stavanger, Norway.,Faculty of Social Sciences, Institute of Health, University of Stavanger, Kjell Arholms gate 41, 4036 Stavanger, Norway.,Corresponding author: Kristin Joerstad Fredriksen, MD, Clinic of Adult Psychiatry, Stavanger University Hospital, Jan Johnsens gate 12, 4011 Stavanger, Norway
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Sandviksleitet 1, 5036 Bergen, Norway
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, 0372 Oslo, Norway
| | - Liss G Anda
- Department of Social Studies, Faculty of Social studies, University of Stavanger, Norway.,Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Ketil J Oedegaard
- Research Department, Division of Psychiatry, Haukeland University Hospital, Norway.,Department of Clinical Medicine, University of Bergen.,NORMENT, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Helle K Schoeyen
- Clinic of adult psychiatry, Stavanger University Hospital, Armauer Hansens vei 20, 4011 Stavanger, Norway
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19
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Nordby ES, Gjestad R, Kenter RMF, Guribye F, Mukhiya SK, Lundervold AJ, Nordgreen T. The Effect of SMS Reminders on Adherence in a Self-Guided Internet-Delivered Intervention for Adults With ADHD. Front Digit Health 2022; 4:821031. [PMID: 35651537 PMCID: PMC9149073 DOI: 10.3389/fdgth.2022.821031] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 04/04/2022] [Indexed: 11/13/2022] Open
Abstract
Background Self-guided Internet-delivered interventions may serve as an accessible and flexible non-pharmacological treatment supplement for adults with ADHD. However, these interventions are challenged by low adherence. Objective To examine whether weekly SMS reminders improve adherence to a self-guided Internet-delivered intervention for adults with ADHD. Method The study used a multiple randomized trial design where the participants who had not completed their weekly module within 2 days were randomized to either receive or not receive an SMS reminder. The primary outcome was adherence, defined as module completion, logins, time spent on intervention, and self-reported practice of coping strategies. Results A total of 109 adults with a self-reported ADHD diagnosis were included in the study. The results showed that SMS reminders were associated with an increased likelihood of login within 48 h during the second module of the intervention, but not for the remaining modules. Moreover, receiving an SMS reminder was associated spending more time on the modules and faster login time in module three and five, specifically. However, the overall results did not show an effect of SMS reminders on module completion, number of logins or practice of coping strategies. Conclusion The results showed that SMS reminders do not improve number of logins, module completion rates or practice of coping strategies, but they may lead to faster login time and more time spent on the modules. To utilize the potential of self-guided Internet-delivered intervention in making non-pharmacological accessible for adults with ADHD, new methods to facilitate meaningful engagement should be developed and tested. Trial Registration ClinicalTrials.gov NCT04511169.
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Affiliation(s)
- Emilie S. Nordby
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Rolf Gjestad
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Research Department, Division of Mental Health, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Robin M. F. Kenter
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Frode Guribye
- Department of Information Science and Media Studies, University of Bergen, Bergen, Norway
| | - Suresh K. Mukhiya
- Department of Computer Science, Electrical Engineering, and Mathematical Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Astri J. Lundervold
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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20
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Fathian F, Gjestad R, Kroken RA, Løberg EM, Reitan SK, Fleichhacker WW, Rettenbacher M, Larsen TK, Joa I, Stabell LA, Kjelby E, Sinkevicute I, Alisauskiene R, Steen VM, Johnsen E. Association between C-reactive protein levels and antipsychotic treatment during 12 months follow-up period after acute psychosis. Schizophr Res 2022; 241:174-183. [PMID: 35131596 DOI: 10.1016/j.schres.2022.01.049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Revised: 01/04/2022] [Accepted: 01/22/2022] [Indexed: 10/19/2022]
Abstract
BACKGROUND A potential role of inflammatory pathways in the pathology of schizophrenia has been suggested for at least a subgroup of patients. Elevated levels of the inflammatory marker C-reactive protein (CRP) have been observed, with associations to pathogenesis and symptoms. The current evidence regarding effects of antipsychotics on CRP levels is ambiguous. OBJECTIVES To examine and compare the influence on CRP levels of three pharmacologically diverse new generation antipsychotics during a one-year follow-up in schizophrenia spectrum disorder. METHODS In a multicenter, pragmatic and rater-blinded randomized trial, the effects of amisulpride, aripiprazole and olanzapine were compared in 128 patients with schizophrenia spectrum disorder. All had positive symptoms of psychosis at study entry. Clinical and laboratory assessments including the measurement of CRP levels were conducted at baseline, and 1, 3, 6, 12, 26, 39, and 52 weeks thereafter. RESULTS For all antipsychotic drugs analysed together, there was an increase in CRP levels during the one-year follow-up. Aripiprazole, as opposed to amisulpride and olanzapine, was associated with a reduced CRP level after one week, after which the CRP level caught up with the other drugs. Compared to those previously exposed to antipsychotic drugs, antipsychotic-naïve patients had lower CRP levels at all follow-up time points, but with the same temporal patterns of change. CONCLUSION Treatment with amisulpride, aripiprazole and olanzapine showed different effects on CRP levels in patients with schizophrenia spectrum disorders, modified by previous antipsychotics exposure status. This finding suggests that antipsychotic drugs may vary with respect to their influence on pro-inflammatory pathways. TRIAL REGISTRATION ClinicalTrials.gov ID: NCT01446328; URL: http://www. CLINICALTRIALS gov/.
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Affiliation(s)
- Farivar Fathian
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.
| | - Rolf Gjestad
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway; Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rune A Kroken
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Else-Marie Løberg
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway; Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Solveig Klæbo Reitan
- Department of Mental Health, St. Olav University Hospital, 7006 Trondheim, Norway; Department of Mental Health, Faculty of Medicine and Health Sciences, NTNU, Trondheim, Norway
| | - W Wolfgang Fleichhacker
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innrain 52, Innsbruck, Austria
| | - Maria Rettenbacher
- Department of Psychiatry, Psychotherapy and Psychosomatics, Medical University of Innsbruck, Innrain 52, Innsbruck, Austria
| | - Tor K Larsen
- Department of Clinical Medicine, University of Bergen, Bergen, Norway; TIPS, Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway
| | - Inge Joa
- TIPS, Network for Clinical Research in Psychosis, Stavanger University Hospital, Stavanger, Norway; Faculty of Health, Network for Medical Sciences, University of Stavanger, Stavanger, Norway
| | - Lena Antonsen Stabell
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Eirik Kjelby
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | - Igne Sinkevicute
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Renata Alisauskiene
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Vidar M Steen
- NORMENT Centre of Excellence, Department of Clinical Science, University of Bergen, Bergen, Norway; Dr. Einar Martens Research Group for Biological Psychiatry, Department of Medical Genetics, Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Division of Psychiatry and NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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21
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Myklebost SB, Gjestad R, Inal Y, Hammar Å, Nordgreen T. Predictors of Treatment Response to an Internet-Delivered Intervention Targeting Residual Cognitive Symptoms After Major Depressive Disorder. Front Psychiatry 2022; 13:795698. [PMID: 35418884 PMCID: PMC8995427 DOI: 10.3389/fpsyt.2022.795698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Residual cognitive symptoms after depression are common and associated with reduced daily life functioning and an increased risk of depression relapse. There is a lack of knowledge on treatments targeting residual cognitive symptoms after major depressive disorder (MDD), including the factors associated with treatment response. The aim of the current study is to explore factors of treatment response to a guided internet-delivered intervention for former depressed adults experiencing residual cognitive symptoms. METHOD Forty-three former depressed adults with residual cognitive symptoms were included. Linear mixed model analyses were used to investigate the impact of pre-treatment demographic-, illness, and symptom variables, and therapy process variables, such as credibility, expectancy, and user behavior, on reduction in residual cognitive symptoms from pre-treatment to 6-month follow-up. RESULTS Having had MDD for a year or less predicted more reductions in residual cognitive symptoms from pre- to 6-month follow-up. Higher levels of perceived treatment credibility and expectancy evaluated in the early course of treatment did also predict a positive treatment response. No demographic-, symptom-variables, previous number of episodes with MDD, and user behavior were associated with change in residual cognitive symptoms. CONCLUSION This study suggests that individuals with shorter duration of previous depressions might have larger reductions in residual cognitive symptoms at 6-month follow-up compared to those with a longer duration of depression. Treatment credibility and expectancy also predicted treatment response and effort should also be made to ensure interventions credibility. Results should be interpreted with caution due to the study having a low sample size. Further investigation of predictors should be conducted in a full scale randomized controlled trial.
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Affiliation(s)
- Sunniva Brurok Myklebost
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Yavuz Inal
- Department of Design, Faculty of Architecture and Design, Norwegian University of Science and Technology, Gjøvik, Norway
| | - Åsa Hammar
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway.,Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tine Nordgreen
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
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22
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Halstensen K, Gjestad R, Luyten P, Wampold B, Granqvist P, Stålsett G, Johnson SU. Depression and mentalizing: A psychodynamic therapy process study. J Couns Psychol 2021; 68:705-718. [PMID: 34351181 DOI: 10.1037/cou0000544] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
The present study aimed to explore the relationship between changes in depressive symptoms and the capacity to mentalize over the course of a 3-month inpatient psychodynamic therapy in a sample of 56 patients with depression. Depressive symptoms and mentalizing were assessed weekly during treatment and at 1-year follow-up with the Beck Depression Inventory and the Reflective Functioning Questionnaire (RFQ). Data were analyzed using Latent Growth Curve (LGC) modeling with structured residuals. In the total sample, depressive symptoms improved on average from baseline to the end of treatment, while mentalizing skills did not. However, individual variations were observed in mentalizing skills, with some patients improving while others did not. Within-patient residual changes in mentalizing skills did not predict residual changes in depressive symptoms. Accordingly, the results did not support mentalizing as a mechanism of change at this level. Nonetheless, between-patient effects were found, showing that patients with higher levels of mentalizing at baseline and patients whose mentalizing skills improved over the course of therapy also had greater reductions in depressive symptoms. We suggest that the presence of relatively higher mentalizing skills might be a factor contributing to moderately depressed individuals' ability to benefit from treatment, while relatively poor or absent mentalizing capacity might be part of the dynamics underlying treatment resistance in individuals with severe depression. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
| | - Rolf Gjestad
- MF Norwegian School of Theology, Religion and Society
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23
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Furnes D, Gjestad R, Mehlum L, Hodgekins J, Kroken RA, Oedegaard K, Mellesdal L. Borderline Personality Disorder: What Predicts Acute Psychiatric Readmissions? J Pers Disord 2021; 35:481-493. [PMID: 31682191 DOI: 10.1521/pedi_2019_33_459] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Individuals diagnosed with borderline personality disorder (BPD) often struggle with chronic suicidal thoughts and behaviors and have frequent acute psychiatric admissions. Prevention of serial admissions and disruptions in long-term treatment strategies is needed. This study explored predictors of how frequently and how quickly patients diagnosed with BPD are readmitted after an index psychiatric admission. The authors identified self-harming behavior as a predictor of readmission frequency, whereas depression and hallucinations and delusions predicted time elapsed between the index admission and the first readmission. The authors recommend that predictors of readmissions should be carefully monitored and treated following index admission.
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Affiliation(s)
- Desiré Furnes
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rolf Gjestad
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lars Mehlum
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Joanne Hodgekins
- Department of Clinical Psychology, Norwich Medical School, University of East Anglia, Norwich, United Kingdom
| | - Rune A Kroken
- Norment, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Norway
| | - Ketil Oedegaard
- Norment, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Norway.,K. G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
| | - Liv Mellesdal
- National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Noway
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24
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Furnes D, Gjestad R, Rypdal K, Mehlum L, Hart S, Oedegaard KJ, Mellesdal L. Suicidal and violent ideation in acute psychiatric inpatients: prevalence, co-occurrence, and associated characteristics. Suicide Life Threat Behav 2021; 51:528-539. [PMID: 33368501 DOI: 10.1111/sltb.12726] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2020] [Revised: 07/07/2020] [Accepted: 09/18/2020] [Indexed: 01/10/2023]
Abstract
OBJECTIVE We studied the point prevalence of suicidal and violent ideation, as well as their co-occurrence and associated characteristics in inpatients with mental health disorders. METHODS Data on suicidal and violent ideation, and sociodemographic and clinical information, were gathered from 1,737 patients when admitted to the acute psychiatric ward. RESULTS The point prevalence was 51.9% for suicidal ideation and 19.8% for violent ideation. The point prevalence of co-occurring suicidal and violent ideation was 12.3%, which was significantly greater than expected by chance. Logistic regression analyses indicated that both suicidal and violent ideation were associated with young age and the absence of diagnoses of psychotic disorders; in addition, suicidal ideation was associated with female gender, violent ideation, and diagnoses of mood- neurotic and personality disorders, whereas violent ideation was associated with male gender, suicidal ideation, and diagnoses of mood and neurotic disorders. CONCLUSIONS Overall, the findings highlight the need for further research on suicidal and violent ideation in people with mental health problems including, but not limited to, their association with adverse behavioral outcomes, as well as the need to routinely assess both suicidal and violent ideation in clinical practice.
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Affiliation(s)
- Desiré Furnes
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rolf Gjestad
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Knut Rypdal
- Centre for Research and Education in Forensic Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, University of Oslo, Oslo, Norway
| | - Stephen Hart
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada.,Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Ketil J Oedegaard
- Norment, Division of Psychiatry, Haukeland University Hospital, Haukeland, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway.,K. G. Jebsen Centre for Research on Neuropsychiatric Disorders, Bergen, Norway
| | - Liv Mellesdal
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
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25
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Vold JH, Gjestad R, Aas CF, Meland E, Johansson KA, Fadnes LT. Validation of a three-item Fatigue Severity Scale for patients with substance use disorder: a cohort study from Norway for the period 2016-2020. Health Qual Life Outcomes 2021; 19:69. [PMID: 33653349 PMCID: PMC7923309 DOI: 10.1186/s12955-021-01708-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 02/17/2021] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Little attention has been paid to customising fatigue questionnaires for patients with Substance Use Disorders (SUDs). The present study aims to validate and shorten the nine-item Fatigue Severity Scale (FSS-9) and Visual Analogue Fatigue Scale (VAFS) for use with this population. METHODS We used data from a nested cohort with annual health assessments with responses on the FSS-9 and VAFS. During the period 2016-2020, 917 health assessments were collected from 655 patients with SUD in Bergen and Stavanger, Norway. A total of 225 patients answered the health assessment at least twice. We defined baseline as the first annual health assessment when the health assessments were sorted chronologically per patient. We checked for internal consistency, and we used longitudinal confirmatory factor analysis (CFA) and linear mixed model (LMM) analysis to validate and shorten the FSS-9 and VAFS. RESULTS The internal consistency of the FSS-9 was excellent with a Cronbach's α of 0.94 at baseline and 0.93 at the second annual health assessment. When shortening the FSS-9 to a three-item FSS (FSS-3, items 5-7), the Cronbach's α was 0.87 at baseline and 0.84 at the second health assessment. The internal consistency was not affected when the VAFS was added to the FSS-3 and the FSS-9. The longitudinal CFA model showed a well-fitting model for the FSS-3 (χ2 = 13.33, degree of freedom = 8, P = 0.101). The LMM analysis showed equal linear changes at the individual level for the FSS-3 (slope: 0.00, P > 0.05) and FSS-9 (slope: 0.01, P > 0.05) between the health assessments. CONCLUSION The FSS-9 could be shortened to the FSS-3 with high validity and reliability for patients with SUDs and the addition of VAFS did not provide much added variability.
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Affiliation(s)
- Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Rolf Gjestad
- Division of Psychiatry, Research Department, Haukeland University Hospital, Bergen, Norway
| | - Christer F Aas
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Eivind Meland
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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26
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Aas CF, Vold JH, Gjestad R, Skurtveit S, Lim AG, Gjerde KV, Løberg EM, Johansson KA, Fadnes LT. Substance use and symptoms of mental health disorders: a prospective cohort of patients with severe substance use disorders in Norway. Subst Abuse Treat Prev Policy 2021; 16:20. [PMID: 33639969 PMCID: PMC7912462 DOI: 10.1186/s13011-021-00354-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2021] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND There is high co-occurrence of substance use disorders (SUD) and mental health disorders. We aimed to assess impact of substance use patterns and sociodemographic factors on mental health distress using the ten-item Hopkins Symptom Checklist (SCL-10) over time. METHODS Nested prospective cohort study of 707 participants with severe SUD across nine opioid-agonist-therapy outpatient clinics and low-threshold municipality clinics in Norway, during 2017-2020. Descriptive statistics were derived at baseline and reported by means and standard deviation (SD). A linear mixed model analysis was used to assess the impact of substance use patterns and sociodemographic factors on SCL-10 sum score with beta coefficients with 95% confidence intervals (CI). RESULTS Mean (SD) SCL-10 score was 2.2 (0.8) at baseline with large variations across patients. We observed more symptoms of mental health disorders among people with frequent use of benzodiazepines (beta 3.6, CI:2.4;4.8), cannabis (1.3, CI:0.2;2.5), opioids (2.7, CI:1.1;4.2), and less symptoms among people using frequent stimulant use (- 2.7, CI:-4.1;-1.4) compared to no or less frequent use. Females (1.8, CI:0.7;3.0) and participants with debt worries (2.2, CI:1.1;3.3) and unstable living conditions (1.7, CI:0.0;3.3) had also higher burden of mental health symptoms. There were large individual variations in SCL-10 score from baseline to follow-up, but no consistent time trends indicating change over time for the whole group. 65% of the cohort had a mean score > 1.85, the standard reference score. CONCLUSIONS People with SUD have a considerable burden of mental health symptoms. We found no association between substance use patterns and change in mental health symptoms over time. This could suggest that the differences observed were indicating flattening of effects or self-medication to a larger degree than medication-related decline in mental health. This call for better individualized mental health assessment and patient care.
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Affiliation(s)
- Christer Frode Aas
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Jørn Henrik Vold
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Svetlana Skurtveit
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway
| | - Aaron Guanliang Lim
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Else-Marie Løberg
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Kjell Arne Johansson
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Bergen Addiction Research group, Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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Ousdal OT, Gjestad R, Oltedal L. Reply to: Clinical Relevance of Brain Changes After Electroconvulsive Therapy: Is There Really No Link at All? Biol Psychiatry 2021; 89:e15-e16. [PMID: 32768147 DOI: 10.1016/j.biopsych.2020.05.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 05/26/2020] [Indexed: 10/23/2022]
Affiliation(s)
- Olga Therese Ousdal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway.
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway; Centre for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Leif Oltedal
- Mohn Medical Imaging and Visualization Centre, Department of Radiology, Haukeland University Hospital, Bergen, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Hagland P, Thorsen AL, Ousdal OT, Gjestad R, de Wit SJ, Hansen B, Hagen K, Kvale G, van den Heuvel OA. Disentangling Within- and Between-Person Effects During Response Inhibition in Obsessive-Compulsive Disorder. Front Psychiatry 2021; 12:519727. [PMID: 33841194 PMCID: PMC8026876 DOI: 10.3389/fpsyt.2021.519727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 02/22/2021] [Indexed: 12/03/2022] Open
Abstract
Background: Obsessive-compulsive disorder (OCD) has been related to worse performance, abnormal brain activity, and functional connectivity during response inhibition. Whether these findings are indications of stable traits that contribute to the development of the disorder, or whether they are a result of the state severity of obsessions and anxiety, remains unclear since previous research mainly has employed cross-sectional designs. The present study aimed to assess longitudinal between- and within-person relationships between symptoms, task performance, right inferior frontal gyrus brain activation, and connectivity between the right amygdala and the right pre-supplementary motor area in 29 OCD patients before and after concentrated exposure and response prevention treatment. Method: Patients received exposure and response prevention delivered during 4 consecutive days, following the Bergen 4-day Treatment format. Patients performed a Stop Signal Task during 3T functional Magnetic Resonance Imaging the day before treatment, as well as 1 week and 3 months after treatment completion. Multilevel models were used to analyze disaggregated within- and between-person effects over time. Independent variables were scores on the symptom severity scales for OCD, anxiety, depression, and state distress during scanning. Dependent variables were reaction time for go trials, stop signal response time, task-related brain activation and connectivity. Results: A positive between-person effect was found for obsessive-compulsive, anxiety, and depressive symptom severity on go trial reaction time, indicating that patients with higher symptom scores on average respond slower during accurate go trials. We also found no significant between- or within-person relations between symptom severity and task-related activation or fronto-limbic connectivity. Conclusions: The between-person findings may point toward a general association between slower processing speed and symptom severity in OCD. Longitudinal studies should disaggregate between- and within-person effects to better understand variation over time.
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Affiliation(s)
- Pernille Hagland
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Anders Lillevik Thorsen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Olga Therese Ousdal
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Radiology, Haukeland University Hospital, Bergen, Norway.,Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Stella J de Wit
- Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
| | - Bjarne Hansen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Kristen Hagen
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Psychiatric Department, Hospital of Molde, Molde, Norway
| | - Gerd Kvale
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Odile A van den Heuvel
- Bergen Center for Brain Plasticity, Haukeland University Hospital, Bergen, Norway.,Department of Anatomy and Neurosciences, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.,Department of Psychiatry, Amsterdam Neuroscience, Amsterdam, Netherlands
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29
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Alisauskiene R, Johnsen E, Gjestad R, Kroken RA, Jørgensen HA, Løberg EM. The Influence of Substance Use on Side Effects of Olanzapine, Quetiapine, Risperidone, and Ziprasidone in Psychosis. Subst Use Misuse 2021; 56:1880-1891. [PMID: 34369263 DOI: 10.1080/10826084.2021.1958858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
BACKGROUND Side effects restrict the optimal use of antipsychotics. Little is known about the influence of substance use on side effects. The aim of this study was to compare antipsychotic side effects in patients with psychosis with and without substance use, while also taking medication history and diagnosis into consideration. METHODS All patients (n = 226, mean age 34, females 33%) diagnosed with schizophrenia spectrum disorders (SSD; F20-F29) or other psychosis (F30-F32; F10-F19), were treated with olanzapine, quetiapine, risperidone or ziprasidone, and were assessed at baseline, 4-weeks, 14-weeks, and 27-weeks. The UKU-Side Effects Self-Rating Scale version was used to evaluate the side effect profiles, and the information on substance use was based on the Clinician Drug Use Scale. RESULTS At baseline, 30% of the patients used substances, 54% were diagnosed with SSD, and 47% were antipsychotic naïve. The occurrence of side effects in total was not different in patients with substance use compared to without after 4-weeks of treatment, nor in the follow-up period. At 4-weeks there were some group differences in relation to substance use, diagnosis, and medication history for single side effects. Patients with substance use showed more increased dream activity, less reduced salivation, and more gynecomastia. Patients with SSD showed less neurological side effects, orgasm dysfunction, and tension/inner unrest. The medication naïve patients showed increased hypokinesia/akinesia. CONCLUSION Substance use alone does not influence the general magnitude of side effects of antipsychotic medication and does not indicate a different prescription practice in patients with psychosis and substance use.
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Affiliation(s)
- Renata Alisauskiene
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway
| | - Erik Johnsen
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Rolf Gjestad
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Rune A Kroken
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Hugo A Jørgensen
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Else-Marie Løberg
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,NORMENT Centre of Excellence, Haukeland University Hospital, Bergen, Norway.,Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
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30
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Vold JH, Gjestad R, Aas CF, Chalabianloo F, Skurtveit S, Løberg EM, Johansson KA, Fadnes LT. Impact of clinical and sociodemographic factors on fatigue among patients with substance use disorder: a cohort study from Norway for the period 2016-2020. Subst Abuse Treat Prev Policy 2020; 15:93. [PMID: 33317568 PMCID: PMC7737389 DOI: 10.1186/s13011-020-00334-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Accepted: 12/04/2020] [Indexed: 11/10/2022]
Abstract
Background The impact of clinical and sociodemographic factors on fatigue remains unknown among patients with substance use disorders (SUD). This study aims to evaluate fatigue among patients with SUD using a nine-item fatigue severity scale (FSS-9) and identify the impact that clinical and sociodemographic factors – such as injecting substance use, chronic infectious diseases, liver fibrosis, opioid agonist therapy (OAT), debt difficulties, and housing situation – have on fatigue. Methods We used data from a cohort of patients with SUD in Norway with annual health assessments surveying FSS-9 and some clinical and sociodemographic factors. A total of 915 FSS-9 measurements were collected from 654 patients during the period 2016–2020. We defined baseline as the first annual health assessment when the health assessments were listed chronologically. Time was defined as years from baseline. We used a linear mixed model to analyse whether the clinical and sociodemographic factors affected the FSS-9 sum score, presented with beta coefficients (β) with 95% confidence intervals (CI). Results The mean sum score of the FSS-9 was 43 (standard deviation: 16) at baseline. Females compared with males (adjusted mean difference of FSS-9 sum score: 4.1, 95% CI: 1.3–7.0), having debt difficulties compared with having no debt difficulties (2.9;0.4–5.3), and frequent use of benzodiazepines (5.7;3.0–8.4) or amphetamines (-5.0;-8.0– -2.0) compared to less frequent or no use of these substances changed the FSS-9 baseline sum score. The other clinical and sociodemographic factors did not predict any clinically relevant change in the FSS-9 sum score from baseline to the following health assessments. Conclusion Patients with SUD suffer from high levels of fatigue. Female patients, patients with debt difficulties, and those with extensive use of benzodiazepines are at particular risk of being fatigued. This should be taken into consideration when planning health services. Supplementary Information The online version contains supplementary material available at 10.1186/s13011-020-00334-x.
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Affiliation(s)
- Jørn Henrik Vold
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway. .,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.
| | - Rolf Gjestad
- Department of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Christer F Aas
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Fatemeh Chalabianloo
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Svetlana Skurtveit
- Department of Mental Disorders, Norwegian Institute of Public Health, Oslo, Norway.,Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
| | - Else-Marie Løberg
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway.,Department of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Kjell Arne Johansson
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Lars Thore Fadnes
- Department of Addiction Medicine, Haukeland University Hospital, Jonas Lies vei 65, N-5021, Bergen, Norway.,Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
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31
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Affiliation(s)
- Atle Dyregrov
- Faculty of Psychology, Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Anita Fjærestad
- Faculty of Psychology, Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Rolf Gjestad
- Faculty of Psychology, Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Jens Thimm
- Faculty of Psychology, Center for Crisis Psychology, University of Bergen, Bergen, Norway
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32
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Austevoll IM, Gjestad R, Solberg T, Storheim K, Brox JI, Hermansen E, Rekeland F, Indrekvam K, Hellum C. Comparative Effectiveness of Microdecompression Alone vs Decompression Plus Instrumented Fusion in Lumbar Degenerative Spondylolisthesis. JAMA Netw Open 2020; 3:e2015015. [PMID: 32910195 PMCID: PMC7489859 DOI: 10.1001/jamanetworkopen.2020.15015] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
IMPORTANCE Conflicting evidence and large practice variation are present in the surgical treatment of degenerative spondylolisthesis. More than 90% of surgical procedures in the United States include instrumented fusion compared with 50% or less in other countries. OBJECTIVE To evaluate whether the effectiveness of microdecompression alone is noninferior to decompression with instrumented fusion in a real-world setting. DESIGN, SETTING, AND PARTICIPANTS This multicenter comparative effectiveness study with a noninferiority design assessed prospective data from the Norwegian Registry for Spine Surgery. From September 19, 2007, to December 21, 2015, 1376 patients at 35 Norwegian orthopedic and neurosurgical departments underwent surgery for lumbar spinal stenosis with degenerative spondylolisthesis without scoliosis. After excluding patients undergoing laminectomy alone, fusion without instrumentation, or surgery in more than 2 levels and those with a former operation at the index level, 794 patients were included in the analyses, regardless of missing or incomplete follow-up data, before propensity score matching. Data were analyzed from March 20 to October 30, 2018. EXPOSURES Microdecompression alone or decompression with instrumented fusion. MAIN OUTCOMES AND MEASURES A reduction from baseline of 30% or greater in the Oswestry Disability Index at 12-month follow-up. RESULTS After propensity score matching, 570 patients (413 female [72%]; mean [SD] age, 64.7 [9.5] years) were included for comparison, with 285 undergoing microdecompression (mean [SD] age, 64.6 [9.8] years; 205 female [72%]) and 285 undergoing decompression with instrumented fusion (mean [SD] age, 64.8 [9.2] years; 208 female [73%]). The proportion of each type of procedure varied between departments. However, changes in outcome scores varied within patients but not between departments. The proportion of patients with improvement in the Oswestry Disability Index of at least 30% was 150 of 219 (68%) in the microdecompression group and 155 of 215 (72%) in the instrumentation group. The 95% CI (-12% to 5%) for the difference of -4% was above the predefined margin of noninferiority (-15%). Microdecompression alone was associated with shorter operation time (mean [SD], 89 [44] vs 180 [65] minutes; P < .001) and shorter hospital stay (mean [SD], 2.5 [2.4] vs 6.4 [3.0] days; P < .001). CONCLUSIONS AND RELEVANCE Among patients with degenerative spondylolisthesis, the clinical effectiveness of microdecompression alone was noninferior to that of decompression with instrumented fusion. Microdecompression alone was also associated with shorter durations of surgery and hospital stay, supporting the suggestion that the less invasive procedure should be considered for most patients.
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Affiliation(s)
- Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- The Norwegian Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tore Solberg
- The Norwegian Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway
- Institute of Clinical Medicine, Arctic University of Norway, Tromsø, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health, Oslo University Hospital, Oslo, Norway
| | - Jens Ivar Brox
- The Norwegian Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway
- Department of Physical Medicine and Rehabilitation, Oslo, University Hospital, Oslo, Norway
| | - Erland Hermansen
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Frode Rekeland
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Christian Hellum
- The Norwegian Registry for Spine Surgery, University Hospital of Northern Norway, Tromsø, Norway
- Division of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
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Lygre RB, Thuen VM, Gjestad R, Norekvål TM, Greve G, Mildestvedt T, Elgen IB. How can we improve specialist health services for children with multi-referrals? Parent reported experience. BMC Health Serv Res 2020; 20:786. [PMID: 32831078 PMCID: PMC7446114 DOI: 10.1186/s12913-020-05666-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 08/18/2020] [Indexed: 12/02/2022] Open
Abstract
Background Children with combined mental and somatic conditions pose a challenge to specialized health services. These cases are often characterized by multi-referrals, frequent use of health services, poor clinical and cost effectiveness, and a lack of coordination and consistency in the care. Reorganizing the health services offered to these children seems warranted. Patient reported experiences give important evidence for evaluating and developing health services. The aim of the present descriptive study was to explore how to improve specialist health services for children with multiple referrals for somatic and mental health conditions. Based on parent reported experiences of health services, we attempted to identify key areas of improvement. Methods As part of a larger, ongoing project; “Transitioning patients’ Trajectories”, we asked parents of children with multiple referrals to both somatic and mental health departments to provide their experiences with the services their children received. Parents/guardians of 250 children aged 6–12 years with multi-referrals to the Departments of Pediatrics and Child and Adolescent Mental Health at Haukeland University Hospital between 2013 and 2015 were invited. Their experience was collected through a 14 items questionnaire based on a generic questionnaire supplied with questions from parents and health personnel. Possible associations between overall experience and possible predictors were analyzed using bivariate regression. Results Of the 250 parents invited, 148 (59%) responded. Mean scores on single items ranged from 3.18 to 4.42 on a 1–5 scale, where five is the best possible experience. In the multiple regression model, perception of wait time (r = .56, CI = .44–.69 / β = 0.16, CI = .05–.28), accommodation of consultations (r = .71, CI = .62–.80 / β = 0.25, CI = .06–.45 / β = 0.27, CI = .09–.44), providing adequate information about the following treatment (r = .66, CI = .55–.77 / β = 0.26, CI = .09–.43), and collaboration between different departments at the hospital (r = .68, CI = .57–.78 / β = 0.20, CI = -.01–.40) were all statistically significantly associated with parents overall experience of care. Conclusions The study support tailored interdisciplinary innovations targeting wait time, accommodation of consultations, communication regarding the following treatment and collaboration within specialist health services for children with multi-referrals to somatic and mental specialist health care services.
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Affiliation(s)
- Ragnhild B Lygre
- Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway.
| | | | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Tone M Norekvål
- Centre on Patient-reported Outcomes Data, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Science, University of Bergen, Bergen, Norway
| | - Gottfried Greve
- Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Heart Disease, Haukeland University Hospital, Bergen, Norway
| | - Thomas Mildestvedt
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Irene Bircow Elgen
- Department of Child and Adolescent Mental Health Services, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Martens C, Goplen FK, Aasen T, Gjestad R, Nordfalk KF, Nordahl SHG. Treatment of horizontal canal BPPV-a randomized sham-controlled trial comparing two therapeutic maneuvers of different speeds. Laryngoscope Investig Otolaryngol 2020; 5:750-757. [PMID: 32864448 PMCID: PMC7444789 DOI: 10.1002/lio2.420] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Revised: 05/15/2020] [Accepted: 06/02/2020] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES To compare the effect of a high-speed barbecue maneuver with the modified Lempert maneuver and sham in patients with benign paroxysmal positional vertigo (BPPV) of the horizontal canal. METHODS Randomized sham-controlled, single blinded multicenter clinical trial in two university hospitals investigating consecutive patients with horizontal canal BPPV.Patients were randomly assigned to high-speed barbecue (HSB), modified Lempert maneuver (ML), or sham maneuver (SM). All treatments were performed in a biaxial rotational chair with weekly follow-up to a maximum of three treatment sessions. The final follow-up was 3 months after the last treatment. RESULTS Primary outcome: 2-week recovery rate per protocol. Secondary outcome: Cumulative recovery rate and Dizziness Handicap Inventory (DHI) scores after 3 months per protocol (HSB and ML) and intention to treat (all groups).Fifty-four patients were analyzed after 2 weeks (HSB = 17; ML = 20; SM = 17). Two-week recovery rate was 14/17 after HSB, 11/20 after ML, and 4/17 after SM, with significantly better recovery in HSB [OR 15.17, 95% CI (1.85, 124.63), P = .001] using sham as base level. Recovery rate after 3 months was 15/17 after HSB and 15/19 after ML. Cumulative recovery rate showed no significant differences between the two treatment groups [95% CI (0.30, 13.14), P = .46] in cure rate DHI [95% CI (-16.56, 15.02), P = .92]. No unexpected adverse events were observed. CONCLUSION Velocity change in horizontal canal BPPV treatment gives a faster initial recovery. Rapid recovery could reduce the disease burden. TRIAL REGISTRATION Clinicaltrials.gov. Identifier: NCT01905800. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Camilla Martens
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology & Head Neck SurgeryHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology & Head Neck SurgeryHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
| | - Torbjørn Aasen
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology & Head Neck SurgeryHaukeland University HospitalBergenNorway
| | - Rolf Gjestad
- Research DepartmentDivision of PsychiatryBergenNorway
| | - Karl Fredrik Nordfalk
- Department of Otorhinolaryngology & Head and Neck SurgeryOslo University HospitalOsloNorway
| | - Stein Helge Glad Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology & Head Neck SurgeryHaukeland University HospitalBergenNorway
- Department of Clinical MedicineUniversity of BergenBergenNorway
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Elgen IB, Stikholmen M, Gjestad R, Danielsen IL, Fevang S. Pre-schoolers Referred to a Child and Adolescent Mental Health Clinic: A Hospital Quality Improvement Report. Clin Med Insights Pediatr 2020; 14:1179556520925479. [PMID: 32655280 PMCID: PMC7333487 DOI: 10.1177/1179556520925479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Accepted: 04/20/2020] [Indexed: 11/17/2022]
Abstract
Objective: Aim of the study was to evaluate the patient pathway from referral to assessment and diagnosis of pre-schoolers referred to a Child and Adolescent Mental Health Clinic (CAMHC) in Norway. Method: Following data were collected retrospectively from medical records over a 2-year study period: data from clinical interviews for diagnostic evaluation, observation findings in kindergartens and the CAMHC, and results from medical examinations. The times taken from referral to first contact with the CAMHC, then to the first evaluation, and finally to diagnosis were assessed. Results: Of 13 402 pre-schoolers, 88 (0.7%) were referred to the CAMHC, of which 15 refused assessment and 69 completed a diagnostic assessment. Of the assessed children, 15 (21%) did not meet any criteria for an International Classification of Diseases, Tenth revision (ICD-10) diagnosis, 26 (38%) were diagnosed with developmental disorders, and 10 (14%) were given a non-specific diagnosis. For those children without a specific diagnosis, the mean time taken from referral to CAMHC assessment and diagnosis was longer, although not statistically significant, compared with those with a specific diagnosis (P = .52). No significant correlation between referral symptoms and final diagnosis was found. Conclusions: Pre-schoolers referred to the CAMHC have an increased risk of having developmental disorders. Furthermore, 1 in 5 of the children had comorbidities. We propose more effective health care service by developing an interdisciplinary approach for the management of these children.
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Affiliation(s)
- Irene B Elgen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | | | - Rolf Gjestad
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Inger Lande Danielsen
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Silje Fevang
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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36
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Lund-Heimark H, Kjelby E, Mehlum L, Gjestad R, Selbæk G, Kroken RA, Johnsen E, Oedegaard KJ, Mellesdal LS. Elderly patients with no previous psychiatric history: suicidality and other factors relating to psychiatric acute admissions. BJPsych Open 2020; 6:e63. [PMID: 32552924 PMCID: PMC7345523 DOI: 10.1192/bjo.2020.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The common recommendation that adults with onset of mental illness after the age of 65 should receive specialised psychogeriatric treatment is based on limited evidence. AIMS To compare factors related to psychiatric acute admission in older adults who have no previous psychiatric history (NPH) with that of those who have a previous psychiatric history (PPH). METHOD Cross-sectional cohort study of 918 patients aged ≥65 years consecutively admitted to a general adult psychiatric acute unit from 2005 to 2014. RESULTS Patients in the NPH group (n = 526) were significantly older than those in the PPH group (n = 391) (77.6 v. 70.9 years P < 0.001), more likely to be men, married or widowed and admitted involuntarily. Diagnostic prevalence in the NPH and PPH groups were 49.0% v. 8.4% (P < 0.001) for organic mental disorders, 14.6% v. 30.4% (P < 0.001) for psychotic disorders, 30.2% v. 55.5% (P < 0.001) for affective disorders and 20.7% v. 13.3% (P = 0.003) for somatic disorders. The NPH group scored significantly higher on the Health of the Nation Outcome Scale (HoNOS) items agitated behaviour; cognitive problems; physical illness or disability and problems with activities of daily living, whereas those in the PPH group scored significantly higher on depressed mood. Although the PPH group were more likely to report suicidal ideation, those in the NPH group were more likely to have made a suicide attempt before the admission. CONCLUSIONS Among psychiatric patients >65 years, the subgroup with NPH were characterised by more physical frailty, somatic comorbidity and functional and cognitive impairment as well as higher rates of preadmission suicide attempts. Admitting facilities should be appropriately suited to manage their needs.
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Affiliation(s)
| | - Eirik Kjelby
- Research Department, Division of Psychiatry, Haukeland University Hospital, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Norway
| | - Rolf Gjestad
- Research Department, Division of Psychiatry; and Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Norway
| | - Geir Selbæk
- Norwegian National Advisory Unit on Ageing and Health, Vestfold Hospital Trust, Norway; Institute for Clinical Medicine, Faculty of Medicine, University of Oslo; and Department of Geriatric Medicine, Oslo University Hospital, Norway
| | - Rune Andreas Kroken
- Norment, Division of Psychiatry, Haukeland University Hospital, Norway; and Department of Clinical Medicine, University of Bergen, Norway
| | - Erik Johnsen
- Norment, Division of Psychiatry, Haukeland University Hospital, Norway; and Department of Clinical Medicine, University of Bergen, Norway
| | - Ketil Joachim Oedegaard
- Norment, Division of Psychiatry, Haukeland University Hospital, Norway; and Department of Clinical Medicine, University of Bergen, Norway
| | - Liv S Mellesdal
- Research Department, Division of Psychiatry, Haukeland University Hospital, Norway
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Mørkved N, Johnsen E, Kroken R, Gjestad R, Winje D, Thimm J, Fathian F, Rettenbacher M, Anda L, Løberg E. Does childhood trauma influence cognitive functioning in schizophrenia? The association of childhood trauma and cognition in schizophrenia spectrum disorders. Schizophr Res Cogn 2020; 21:100179. [PMID: 32461919 PMCID: PMC7240182 DOI: 10.1016/j.scog.2020.100179] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2020] [Revised: 04/29/2020] [Accepted: 05/02/2020] [Indexed: 02/06/2023]
Abstract
Childhood trauma (CT) is a risk factor for schizophrenia spectrum disorders (SSDs), and cognitive impairment is a core feature and a vulnerability marker of SSDs. Studies of the relationship between CT and cognitive impairment in SSDs are inconclusive. In addition, few studies have examined differential effects of CT subtypes, e.g. physical, sexual or emotional abuse/neglect, on cognitive functioning. The present study therefore aimed to examine the effects of CT and CT subtypes on cognitive impairment in SSD. Participants (n = 78) with SSDs completed a comprehensive neuropsychological test battery and the Childhood Trauma Questionnaire Short-Form (CTQ-SF). We compared global cognitive performance as well as scores in seven subdomains (verbal abilities, visuospatial abilities, learning, memory, attention/working memory, executive abilities and processing speed) between participants reporting no CT and those reporting CT experiences using independent samples t-tests as well as linear regression analyses to control for possible confounders. CT subtype physical neglect was associated with attention and working memory after controlling for positive and negative psychosis symptoms, years of education, antipsychotics, gender and age, and adjustment of multiple testing. Our results indicate that the observed heterogeneity in cognitive impairment in SSDs, especially attention/working memory abilities, may in part be associated with childhood physical neglect. Research on childhood trauma and cognitive impairment in SSDs is inconclusive Few studies investigated if CT subtypes (abuse and neglect) could explain the heterogeneity in cognitive impairment in SSDs CT subtype physical neglect was associated with impairment in attention/working memory abilities The observed heterogeneity in cognitive impairment in SSDs may in part be associated with CT subtypes
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Affiliation(s)
- N. Mørkved
- Mosjøen District Psychiatric Centre, Helgeland Hospital, Skjervengan 17, 8657 Mosjøen, Norway
- Department of Psychology, UiT The Arctic University of Norway, Pb 6050 Langnes, 9037 Tromsø, Norway
- Corresponding author at: Skjervengan 17, 8657 Mosjøen, Norway.
| | - E. Johnsen
- NORMENT Centre of Excellence and Division of Psychiatry, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Pb 7800, 5020 Bergen, Norway
| | - R.A. Kroken
- NORMENT Centre of Excellence and Division of Psychiatry, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Pb 7800, 5020 Bergen, Norway
| | - R. Gjestad
- NORMENT Centre of Excellence and Division of Psychiatry, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Sandviksleitet 1, 5036 Bergen, Norway
| | - D. Winje
- Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Christies gate 13, 5015 Bergen, Norway
| | - J. Thimm
- Department of Psychology, UiT The Arctic University of Norway, Pb 6050 Langnes, 9037 Tromsø, Norway
| | - F. Fathian
- NKS Olaviken Gerontopsychiatric Hospital, Ulriksdal 8, 5009 Bergen, Norway
| | - M. Rettenbacher
- Department of Psychiatry and Psychotherapy, Medical University Innsbruck, Innsbruck, Austria
| | - L.G. Anda
- Department of Biological and Medical Psychology, Faculty of Psychology, University of Bergen, Jonas Liesvei 91, BB-building, 5009 Bergen, Norway
- Clinics for Mental Health Care, Stavanger University Hospital, Jan Johnsens gate 12, 4011 Stavanger, Norway
| | - E.M. Løberg
- NORMENT Centre of Excellence and Division of Psychiatry, Haukeland University Hospital, Jonas Lies vei 65, 5021 Bergen, Norway
- Faculty of Psychology, Department of Clinical Psychology, University of Bergen, Christies gate 13, 5015 Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Østre Murallmenningen 7, 5012 Bergen, Norway
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Urheim R, Palmstierna T, Rypdal K, Gjestad R, Senneseth M, Mykletun A. Violence rate dropped during a shift to individualized patient-oriented care in a high security forensic psychiatric ward. BMC Psychiatry 2020; 20:200. [PMID: 32370794 PMCID: PMC7201664 DOI: 10.1186/s12888-020-02524-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2019] [Accepted: 03/03/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Contextual variables such as staff characteristics, treatment programs, assessment routines and administrative structures are found to influence patient violence rates in psychiatric forensic wards. The possible effects of current developments in treatment philosophy emphasizing patients' perspective and treatment involvement upon violence rate have not yet been examined. The aim of this paper is to analyse associations between such developments and the occurrence of violent incidents among patients in a high security forensic psychiatric ward. METHODS During a 17-year period with stable ward conditions, incidents of violence were systematically collected together with diagnostic, risk assessment and demographic patient characteristics. Changes in care- and organizational related variables such as nursing staff characteristics, treatment and management routines were collected. Multilevel modelling was applied to estimate the relationship between these variables and changes in violent incidents. RESULTS A substantial decline in the occurrence of violent incidents paralleled with changes in the ward during the middle phase of the study period. Most of the changes, such as implementation of new treatment and care routines and an increased proportion of female staff and higher education levels, were significantly related to a decrease in the occurrence of violent incidents in the ward. CONCLUSIONS Findings in this study suggest that an increase in individualized, patient-oriented care strategies, delivered by well-educated nursing staff with an equally balanced gender distribution contribute to a low level of violence.
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Affiliation(s)
- Ragnar Urheim
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Department for Mental Health and Suicide, Oslo, Norway
| | - Tom Palmstierna
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Department for Mental Health and Suicide, Oslo, Norway ,grid.4714.60000 0004 1937 0626Social and Forensic Psychiatry Program, Stockholm Centre for Psychiatric Research and Education, Karolinska Institutet, Stockholm, Sweden
| | - Knut Rypdal
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Department for Mental Health and Suicide, Oslo, Norway
| | - Rolf Gjestad
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Department for Mental Health and Suicide, Oslo, Norway
| | - Mette Senneseth
- grid.418193.60000 0001 1541 4204Norwegian Institute of Public Health, Department for Mental Health and Suicide, Oslo, Norway
| | - Arnstein Mykletun
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway. .,Norwegian Institute of Public Health, Department for Mental Health and Suicide, Oslo, Norway.
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Fjermestad KW, Føreland Ø, Oppedal SB, Sørensen JS, Vognild YH, Gjestad R, Öst LG, Bjaastad JF, Shirk SS, Wergeland GJ. Therapist Alliance-Building Behaviors, Alliance, and Outcomes in Cognitive Behavioral Treatment for Youth Anxiety Disorders. J Clin Child Adolesc Psychol 2020; 50:229-242. [PMID: 31910051 DOI: 10.1080/15374416.2019.1683850] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The alliance influences outcomes in CBT for youth anxiety disorders. Thus, knowledge about how therapists can enhance the alliance is needed. METHOD Seventy-three youth with anxiety diagnoses (M age = 11.5 years, SD = 2.2; range 8 to 15 years; 47.9% boys; 90.4% white-European) participated in 10-session cognitive behavioral therapy in community clinics. Therapist alliance-building behaviors in session 2 was reliably coded with the observer-rated Adolescent Alliance-Building Behavior Scale (Revised) (AABS(R)). Alliance was measured as youth- and therapist-rated alliance, and youth-therapist alliance discrepancy in session 3. Outcomes were diagnostic recovery and anxiety symptom reduction at post-treatment and one-year follow-up, and treatment dropout. We examined the direct effects of alliance-building on alliance, alliance on outcomes, and alliance-building on outcomes in multilevel mediation models, and between- versus within-therapist variance across these effects. RESULTS The alliance-building behaviors collaborate, present treatment model, and explore motivation positively predicted alliance, whereas actively structuring the session (i.e., dominating) negatively predicted alliance. The alliance-building behaviors attend to experience, collaborate, explore motivation, praise, and support positively predicted outcomes. The alliance-building behaviors present treatment model, express positive expectations, explore cognitions, and support negatively predicted outcomes. The effect of collaborate on symptom reduction was mediated by youth-therapist alliance discrepancy. There was almost zero between-therapist variance in alliance-building, and considerable within-therapist variance. CONCLUSION Therapist alliance-building behaviors were directly (positively and negatively) associated with alliance and/or outcomes, with only one effect mediated by alliance. Alliance-building behaviors varied far more within therapists (i.e., across clients) than between therapists.
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Affiliation(s)
| | - Øyvind Føreland
- Department of Psychology, University of Oslo.,Department for Addiction Medicine, Sørlandet Regional Hospital Trust
| | - Silje B Oppedal
- Department of Psychology, University of Oslo.,Oslo Educational and Psychological Counselling Service
| | - Julie S Sørensen
- Department of Psychology, University of Oslo.,Oslo Educational and Psychological Counselling Service
| | - Ylva H Vognild
- Department of Psychology, University of Oslo.,Vinderen Adult Mental Health Services, Diakonhjemmet Hospital
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital
| | | | - Jon F Bjaastad
- Division of Psychiatry, Stavanger University Hospital.,Regional Centre for Child and Youth Mental Health and Child Welfare, NORCE Norwegian Research Centre
| | | | - Gro Janne Wergeland
- Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital.,Department of Clinical Medicine, Faculty of Medicine, University of Bergen
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Abstract
Introduction: The loss of a loved one in a terror incident is associated with elevated risk for mental health disorders such as prolonged grief disorder (PGD) and posttraumatic stress disorder (PTSD), but the long- term adaptation after such losses are not well understood. This study aims to explore the trajectories of PGD among parents and siblings (n = 129) after the 2011 terror attack on Utøya Island, Norway. Methods: The 19-item Inventory of Complicated grief (ICG) was used to measure PGD at 18, 28, and 40 months post-loss. Latent class growth analysis (LCGA) was used to identify trajectories of grief and a multinomial regression analysis was conducted to examine predictors of class membership. Results: The analysis identified three grief trajectories; moderate/decreasing class (23%), high/slow decreasing class (64%), and a high/chronic class (13%). Predictors of high/slow recovery or chronic grief was female gender, previous depressive symptoms, and intrusion and avoidance symptoms. Conclusion: The findings highlights the difficult grief process and slow recovery that characterizes the majority of close family members bereaved by a terror-incident. Community mental health programs should strive for both early outreach and long-term follow-up after such incidents.
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Affiliation(s)
- Pål Kristensen
- Center for Crisis Psychology, University of Bergen, Bergen, Norway
| | - Kari Dyregrov
- Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Rolf Gjestad
- Center for Crisis Psychology, University of Bergen, Bergen, Norway.,Research Department, Division of Mental Health, Haukeland University Hospital, Bergen, Norway
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41
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Løberg EM, Gjestad R, Posserud MB, Kompus K, Lundervold AJ. Psychosocial characteristics differentiate non-distressing and distressing voices in 10,346 adolescents. Eur Child Adolesc Psychiatry 2019; 28:1353-1363. [PMID: 30820670 PMCID: PMC6785583 DOI: 10.1007/s00787-019-01292-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Accepted: 02/09/2019] [Indexed: 12/30/2022]
Abstract
Adolescents hearing non-existent voices may be at risk for psychosis, but the prevalence of voice-hearing (VH) in the general population complicates clinical interpretations. Differentiating between VH with and without distress may aid treatment decisions in psychosis services, but understanding the differences between these two phenomena as they present in the normal adolescent population is necessary to validate this differentiation. The present study compared VH with and without distress in 10,346 adolescents in relation to clinical characteristics, known risk factors, predictors and psychosocial moderators of psychosis. A population-based cohort of Norwegian 16-19 years old adolescents completed a comprehensive web-based questionnaire, including two questions from the extended Launay-Slade Hallucinations Scale: (1) I often hear a voice speaking my thoughts aloud and (2) I have been troubled by hearing voices in my head. Adolescents reporting no VH, non-distressing VH or distressing VH were compared on 14 psychosocial and clinical variables. A multinomial regression model showed that non-disturbing voices were predicted by better school grades, social dysfunction, distractibility, affective symptoms and experience of trauma, while the disturbing voices were predicted by the experience of bullying and trauma, perceived negative self-worth and self-efficacy, less family support, dysregulation of activation, distractibility, self-harm and anxiety. Hearing voices without distress versus being distressed by the voices is related to different constellations of psychosocial variables, suggesting that they represent two separate groups of adolescents. The findings validate the emphasis on distress in clinical practice.
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Affiliation(s)
- Else-Marie Løberg
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway.
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Psychology, University of Bergen, Bergen, Norway.
- NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway.
| | - Rolf Gjestad
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Maj-Britt Posserud
- Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
- Gillberg Neuropsychiatry Centre (GNC), University of Gothenburg, Gothenburg, Sweden
| | - Kristiina Kompus
- NORMENT Center of Excellence, Haukeland University Hospital, Bergen, Norway
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- School of Natural Sciences and Health, Tallinn University, Tallinn, Estonia
| | - Astri J Lundervold
- Department of Biological and Medical Psychology, University of Bergen, Bergen, Norway
- Gillberg Neuropsychiatry Centre (GNC), University of Gothenburg, Gothenburg, Sweden
- K. G. Jebsen Center for Neuropsychiatric Disorders, University of Bergen, Bergen, Norway
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42
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Walderhaug EP, Gjestad R, Egeland J, Havik OE, Nordgreen T. Relationships between depressive symptoms and panic disorder symptoms during guided internet-delivered cognitive behavior therapy for panic disorder. Nord J Psychiatry 2019; 73:417-424. [PMID: 31373520 DOI: 10.1080/08039488.2019.1646803] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Aims: The current study explore the relationship between the trajectories of primary panic disorder symptoms and secondary depressive symptoms during guided internet-delivered cognitive behaviour therapy for panic disorder. Materials and methods: The patients (N=143) were recruited from an ongoing effectiveness study in secondary mental health outpatient services in Norway. Weekly self-reported primary panic disorder symptoms and secondary depressive symptoms were analysed. Results: primary panic disorder symptoms and secondary depressive symptoms improved significantly during the course of treatment, and at six months follow-up. Parallel process latent growth curve modelling showed that the trajectory of depressive symptoms and trajectory of panic disorder symptoms were significantly related. A supplementary analysis with cross-lagged panel modelling showed that (1) pre-treatment depressive symptoms predicted a positive effect of panic disorder symptoms early in treatment; (2) high early treatment panic disorder symptoms predicted low depressive symptoms at post-treatment. Conclusions: Guided ICBT for panic disorder is effective for both primary panic disorder symptoms and secondary depressive symptoms. Patients with high pre-treatment secondary depressive symptoms may constitute a vulnerable subgroup. A high level of panic disorder symptoms early in treatment seems beneficiary for depressive symptoms outcome. A time-dependent model may be necessary to describe the relationship between PAD symptoms and depressive symptoms during the course of treatment.
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Affiliation(s)
- Eirik P Walderhaug
- Division of Mental Health and Addiction, Vestfold Hospital , Tønsberg , Norway
| | - Rolf Gjestad
- Research department/Centre for Research and Education in Forensic Psychiatry, Division of Mental Health, Haukeland University Hospital , Bergen , Norway
| | - Jens Egeland
- Division of Mental Health and Addiction, Vestfold Hospital , Tønsberg , Norway.,Department of Psychology, University of Oslo , Oslo , Norway
| | - Odd E Havik
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen , Bergen , Norway
| | - Tine Nordgreen
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen , Bergen , Norway.,eMeistring, Division of Psychiatry, Haukeland University Hospital , Bergen , Norway
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Affiliation(s)
- Atle Dyregrov
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Kari Dyregrov
- Center for Crisis Psychology, Faculty of Psychology, University of Bergen, Bergen, Norway
- Department of Welfare and Participation, Faculty of Social Sciences, Western University of Applied Sciences, Bergen, Norway
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44
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Stabell LA, Gjestad R, Kroken RA, Løberg EM, Jørgensen HA, Johnsen E. Predictors of treatment satisfaction in antipsychotic-naïve and previously medicated patients with acute-phase psychosis. Nord J Psychiatry 2019; 73:349-356. [PMID: 31271338 DOI: 10.1080/08039488.2019.1636134] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Treatment satisfaction predicts treatment adherence and long-term outcome for patients with psychosis. It is therefore important to understand the underpinnings of patient satisfaction in psychosis treatment for optimal treatment delivery. Aims: To examine the associations between satisfaction and level and change in positive symptoms, insight, depression and side effects of antipsychotics in previously medicated and antipsychotic-naïve patients. Method: Data derive from a randomised trial, with 226 respondents at baseline and 104 at follow-up. The measures were the positive subscale and insight item from the Positive and Negative Syndrome Scale, Calgary Depression Scale, the UKU Consumer Satisfaction Rating Scale, and the UKU side effects scale. Structural equation modelling was used to test the model. The full information maximum likelihood estimator used all available data. Results: In the sample of 226 patients, 67.3% were male and 44.2% were antipsychotic-naïve. The mean age was 34.1 years. For previously medicated patients, satisfaction was predicted by level of insight (b = -2.21, β = -0.42) and reduction in positive symptoms (b = -0.56, β = -0.39). For antipsychotic-naïve patients, satisfaction was predicted by level and change of insight (b = -2.21, β = -0.46), change in depression (b = -0.37, β = -0.26) and side effects (b = -0.15, β = -0.30). All predictors were significant at the 0.05 level. Conclusion: Reducing positive symptoms and side effects are important to enhance patient satisfaction. However, improving insight and reducing depression are more important in antipsychotic-naïve patients.
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Affiliation(s)
- Lena Antonsen Stabell
- a Division of Psychiatry and Centre of Excellence NORMENT, Haukeland University Hospital , Bergen , Norway
| | - Rolf Gjestad
- a Division of Psychiatry and Centre of Excellence NORMENT, Haukeland University Hospital , Bergen , Norway.,b Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital , Bergen , Norway
| | - Rune A Kroken
- a Division of Psychiatry and Centre of Excellence NORMENT, Haukeland University Hospital , Bergen , Norway.,c Department of Clinical Medicine, University of Bergen , Bergen , Norway
| | - Else-Marie Løberg
- a Division of Psychiatry and Centre of Excellence NORMENT, Haukeland University Hospital , Bergen , Norway.,d Department of Addiction Medicine, Haukeland University Hospital , Bergen , Norway.,e Department of Clinical Psychology, University of Bergen , Bergen , Norway
| | - Hugo A Jørgensen
- c Department of Clinical Medicine, University of Bergen , Bergen , Norway
| | - Erik Johnsen
- a Division of Psychiatry and Centre of Excellence NORMENT, Haukeland University Hospital , Bergen , Norway.,c Department of Clinical Medicine, University of Bergen , Bergen , Norway
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Abstract
Background: As a result of deinstitutionalization of psychiatric treatment and care, many people with severe mental illness have been offered supported accommodation. However, research on this costly intervention in Norway has been scarce. Aims: The aim of this study was to prospectively investigate the clinical and demographic factors associated with allocation to supported accommodation for people with schizophrenia. Methods: The study was a prospective cohort study of 334 people with schizophrenia acutely admitted to Haukeland University Hospital between 2005 and 2010. Information concerning allocation to supported accommodation in their residential municipalities was collected retrospectively. Univariate and multivariate statistical methods were used to assess the association of clinical and demographical variables with allocation to supported accommodation. Results: Supported accommodation was allocated to 29.6% of the participants during the study period. Age, gender, implementation of compulsory mental health care, substance abuse, symptom burden and suicidality were not associated with allocation to supported accommodation. Functional impairment, especially difficulties with activities of daily living, experiencing exacerbation in the course of chronic disease, being medicated and of Norwegian origin, favoured supported accommodation. Conclusions: Our results supported the hypothesis that people with severe mental illness presenting the greatest need for supported accommodation, based on functional difficulties and exacerbation of chronic disease were allocated supported accommodation. Symptom burden was not associated with allocation. Clinical implications: Further research is needed to examine the impact of supported accommodation on the outcomes for people with schizophrenia.
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Affiliation(s)
| | - Rolf Gjestad
- a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway.,b Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital , Bergen , Norway
| | | | - Erik Johnsen
- a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway.,c Department of Clinical Medicine , University of Bergen , Bergen , Norway.,d NORMENT, Division of Psychiatry , Haukeland University Hospital , Bergen , Norway
| | - Ketil Joachim Oedegaard
- a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway.,c Department of Clinical Medicine , University of Bergen , Bergen , Norway.,d NORMENT, Division of Psychiatry , Haukeland University Hospital , Bergen , Norway
| | - Rune Andreas Kroken
- a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway.,c Department of Clinical Medicine , University of Bergen , Bergen , Norway.,d NORMENT, Division of Psychiatry , Haukeland University Hospital , Bergen , Norway
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Alisauskiene R, Løberg EM, Gjestad R, Kroken RA, Jørgensen HA, Johnsen E. The influence of substance use on the effectiveness of antipsychotic medication: a prospective, pragmatic study. Nord J Psychiatry 2019; 73:281-287. [PMID: 31140342 DOI: 10.1080/08039488.2019.1622152] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background: Psychosis is associated with a high prevalence of substance use, leading to worsened prognosis. Less is known about how comorbid substance abuse may influence the effectiveness of antipsychotic medications. The aim of this study was to compare the effectiveness of second generation antipsychotics in patients with psychosis with and without substance use. Methods: All patients (n = 226) were aged >18 years old had symptom level scores of ≥4 on selected psychosis items on the Positive and Negative Syndrome Scale and met ICD-10 diagnostic criteria for psychosis. Information on substance use was collected based on the Clinician Drug Use Scale. Patients were grouped at baseline according to the presence of substance use, medication history and diagnosis group. Clinical symptoms at baseline and changes at follow-up were assessed with the PANSS. Results: At baseline about 30% of the patients used substances, most frequently cannabis followed by methamphetamine. About half (47%) of the patients had no prior exposure to antipsychotic medication at inclusion. Patients who had consumed substances showed no substantial differences in the PANSS score reduction as a result of antipsychotic medication compared to patients without substance. There were, however, some group differences in relation to pattern of change that were influenced by medication history. Substance use was found to be related to stronger reduction of positive symptoms from week 4 to week 27. Conclusion: Substance use alone did not influence antipsychotic effectiveness in this sample of patients with psychosis.
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Affiliation(s)
| | - Else-Marie Løberg
- a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway.,b Department of Addiction Medicine , Haukeland University Hospital , Bergen , Norway.,c Department of Clinical Psychology , University of Bergen , Bergen , Norway
| | - Rolf Gjestad
- a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway.,d Centre for Research and Education in Forensic Psychiatry , Haukeland University Hospital , Bergen , Norway
| | - Rune A Kroken
- a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway.,e Department of Clinical Medicine , University of Bergen , Bergen , Norway
| | - Hugo A Jørgensen
- a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway
| | - Erik Johnsen
- a Division of Psychiatry , Haukeland University Hospital , Bergen , Norway.,e Department of Clinical Medicine , University of Bergen , Bergen , Norway
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Austevoll IM, Gjestad R, Grotle M, Solberg T, Brox JI, Hermansen E, Rekeland F, Indrekvam K, Storheim K, Hellum C. Follow-up score, change score or percentage change score for determining clinical important outcome following surgery? An observational study from the Norwegian registry for Spine surgery evaluating patient reported outcome measures in lumbar spinal stenosis and lumbar degenerative spondylolisthesis. BMC Musculoskelet Disord 2019; 20:31. [PMID: 30658613 PMCID: PMC6339296 DOI: 10.1186/s12891-018-2386-y] [Citation(s) in RCA: 50] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 12/19/2018] [Indexed: 11/21/2022] Open
Abstract
Background Assessment of outcomes for spinal surgeries is challenging, and an ideal measurement that reflects all aspects of importance for the patients does not exist. Oswestry Disability Index (ODI), EuroQol (EQ-5D) and Numeric Rating Scales (NRS) for leg pain and for back pain are commonly used patients reported outcome measurements (PROMs). Reporting the proportion of individuals with an outcome of clinical importance is recommended. Knowledge of the ability of PROMs to identify clearly improved patients is essential. The purpose of this study was to search cut-off criteria for PROMs that best reflect an improvement considered by the patients to be of clinical importance. Methods The Global Perceived Effect scale was utilized to evaluate a clinically important outcome 12 months after surgery. The cut-offs for the PROMs that most accurately distinguish those who reported ‘completely recovered’ or ‘much improved’ from those who reported ‘slightly improved’, unchanged’, ‘slightly worse’, ‘much worse’, or ‘worse than ever’ were estimated. For each PROM, we evaluated three candidate response parameters: the (raw) follow-up score, the (numerical) change score, and the percentage change score. Results We analysed 3859 patients with Lumbar Spinal Stenosis [(LSS); mean age 66; female gender 50%] and 617 patients with Lumbar Degenerative Spondylolisthesis [(LDS); mean age 67; 72% female gender]. The accuracy of identifying ‘completely recovered’ and ‘much better’ patients was generally high, but lower for EQ-5D than for the other PROMs. For all PROMs the accuracy was lower for the change score than for the follow-up score and the percentage change score, especially among patients with low and high PROM scores at baseline. The optimal threshold for a clinically important outcome was ≤24 for ODI, ≥0.69 for EQ-5D, ≤3 for NRS leg pain, and ≤ 4 for NRS back pain, and, for the percentage change score, ≥30% for ODI, ≥40% for NRS leg pain, and ≥ 33% for NRS back pain. The estimated cut-offs were similar for LSS and for LDS. Conclusion For estimating a ‘success’ rate assessed by a PROM, we recommend using the follow-up score or the percentage change score. These scores reflected a clinically important outcome better than the change score.
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Affiliation(s)
- Ivar Magne Austevoll
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland, University Hospital, Hagaviksbakken 25, 5217 Hagevik, Bergen, Norway. .,Department of Clinical Medicine, University of Bergen, Christies gate 6, 5007 Bergen, Bergen, Norway. .,The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority, Postboks 20, 9038 Tromsø, Bodø, Norway.
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Sanviksleitet 1, 5036 Bergen, Bergen, Norway
| | - Margreth Grotle
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, PB 4950 Nydalen, 0424, Oslo, Oslo, Norway.,Faculty of Health Science, OsloMet - Oslo Metropolitan University, PO box 4 St. Olavs plass, 0130, Oslo, Oslo, Norway
| | - Tore Solberg
- The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority, Postboks 20, 9038 Tromsø, Bodø, Norway.,Department of Neurosurgery, University Hospital of Northern Norway, Sykehusvegen 38, 90919 Tromsø, Tromsø, Norway
| | - Jens Ivar Brox
- The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority, Postboks 20, 9038 Tromsø, Bodø, Norway.,Department of Physical Medicine and Rehabilitation, Oslo University Hospital, PB 4950 Nydalen, 0424, Oslo, Oslo, Norway
| | - Erland Hermansen
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland, University Hospital, Hagaviksbakken 25, 5217 Hagevik, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Christies gate 6, 5007 Bergen, Bergen, Norway.,Department of Orthopedic Surgery, Ålesund Hospital, Møre and Romsdal Hospital Trust, Ålesund, Norway
| | - Frode Rekeland
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland, University Hospital, Hagaviksbakken 25, 5217 Hagevik, Bergen, Norway
| | - Kari Indrekvam
- Kysthospitalet in Hagevik, Orthopedic Clinic, Haukeland, University Hospital, Hagaviksbakken 25, 5217 Hagevik, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Christies gate 6, 5007 Bergen, Bergen, Norway
| | - Kjersti Storheim
- Research and Communication Unit for Musculoskeletal Health (FORMI), Oslo University Hospital, PB 4950 Nydalen, 0424, Oslo, Oslo, Norway
| | - Christian Hellum
- The Norwegian Registry for Spine Surgery (NORspine), Northern Norway Regional Health Authority, Postboks 20, 9038 Tromsø, Bodø, Norway.,Division of Orthopaedic Surgery, Oslo University Hospital, 4950 Nydalen, 0424, Oslo, PB, Norway
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48
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Sinkeviciute I, Gjestad R, Kjelby E, Ratkus L, Hugdahl K, Kroken RA, Loberg EM, Jorgensen HA, Sommer IE, Johnsen E. Trajectories of Treatment Response in Hallucinations. ACTA ACUST UNITED AC 2019. [DOI: 10.4172/neuropsychiatry.1000564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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49
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Kodal A, Fjermestad KW, Bjelland I, Gjestad R, Öst LG, Bjaastad JF, Haugland BSM, Havik OE, Heiervang ER, Wergeland GJH. Predictors of long-term outcome of CBT for youth with anxiety disorders treated in community clinics. J Anxiety Disord 2018; 59:53-63. [PMID: 30273789 DOI: 10.1016/j.janxdis.2018.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Revised: 08/20/2018] [Accepted: 08/31/2018] [Indexed: 01/14/2023]
Abstract
Cognitive behavioral therapy (CBT) has proven long-term effects in youth with anxiety disorders. However, only a few studies have examined predictors of long-term outcomes of CBT treatment. The present study investigated possible predictors of long-term treatment outcomes in youth with mixed anxiety disorders treated in community mental health clinics. A total of 139 youth (mean age at assessment 15.5 years, range 11-21 years) with a principal diagnosis of separation anxiety disorder, social anxiety disorder, and/or generalized anxiety disorder were evaluated a mean of 3.9 years post-treatment (range 2.2-5.9 years). Outcomes were loss of all inclusion anxiety diagnoses, loss of the principal inclusion anxiety diagnosis, and changes in youth- and parent-rated youth anxiety symptoms. Predictors encompassed youth, parent and demographic factors, and post-treatment recovery. The most consistent finding was that low family social class predicted poorer outcomes. Higher treatment motivation was associated with better outcome whereas a diagnosis of social anxiety was associated with poorer outcome. Identified predictors extend on previous findings from efficacy trials, and the results indicate a need for more specific treatment protocols.
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Affiliation(s)
- Arne Kodal
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021 Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, N-5020 Bergen, Norway; Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway.
| | - Krister W Fjermestad
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Psychology, University of Oslo, N-0371 Oslo, Norway
| | - Ingvar Bjelland
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021 Bergen, Norway; Department of Clinical Medicine, Faculty of Medicine and Dentistry, University of Bergen, N-5020 Bergen, Norway
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, N-5036 Bergen, Norway
| | - Lars-Göran Öst
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Psychology, Stockholm University, SE-106 91 Stockholm, Sweden
| | - Jon F Bjaastad
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Division of Psychiatry, Stavanger University Hospital, N-4068 Stavanger, Norway; Uni Research Health, Regional Center for Child and Youth Mental Health and Child Welfare, N-5008 Bergen, Norway
| | - Bente S M Haugland
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Uni Research Health, Regional Center for Child and Youth Mental Health and Child Welfare, N-5008 Bergen, Norway
| | - Odd E Havik
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Clinical Psychology, Faculty of Psychology, University of Bergen, N-5020 Bergen, Norway
| | - Einar R Heiervang
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Institute of Clinical Medicine, University of Oslo, Oslo University Hospital, N-0450 Oslo, Norway
| | - Gro Janne H Wergeland
- Anxiety Research Network, Division of Psychiatry, Research Department, Haukeland University Hospital, N-5036 Bergen, Norway; Department of Child and Adolescent Psychiatry, Division of Psychiatry, Haukeland University Hospital, N-5021 Bergen, Norway; Uni Research Health, Regional Center for Child and Youth Mental Health and Child Welfare, N-5008 Bergen, Norway
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50
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Nordgreen T, Gjestad R, Andersson G, Carlbring P, Havik OE. The effectiveness of guided internet-based cognitive behavioral therapy for social anxiety disorder in a routine care setting. Internet Interv 2018; 13:24-29. [PMID: 30206515 PMCID: PMC6112093 DOI: 10.1016/j.invent.2018.05.003] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2018] [Revised: 05/28/2018] [Accepted: 05/29/2018] [Indexed: 11/30/2022] Open
Abstract
Social anxiety disorder (SAD) is a common mental disorder with high persistence when untreated. As access to effective treatment is limited, guided internet-based cognitive behavioral therapy (ICBT) has been proposed as an effective alternative to face-to-face treatment. In this study, we examined the effectiveness of a 14-week therapist-guided ICBT program for patients with SAD undergoing routine care. From 2014 to 2017, 169 patients were included in the study, of which 145 started the treatment. The sample was all general practitioner-referred and had a lower educational level and higher rate of work absence compared to similar effectiveness studies. Regarding social anxiety symptoms, we identified significant within-group effect sizes (post-treatment: d = 1.00-1.10; six-month follow-up: d = 1.03-1.55). We also found significant effects on secondary depression symptoms (d = 0.67). Clinically significant improvement was reported by 66.2% of the participants, and 16.6% had a significant deterioration. Clinical implications of the current study are that guided ICBT for SAD is an effective treatment for the majority of the patients undergoing routine care. Future studies should explore interventions targeting non-responders and deteriorated patients.
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Affiliation(s)
- Tine Nordgreen
- eMeistring, Bjørgvin DPS, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
| | - Rolf Gjestad
- Research Department, Division of Psychiatry, Haukeland University Hospital, Bergen, Norway
- Centre for Research and Education in Forensic Psychiatry, Haukeland University Hospital, Bergen, Norway
| | - Gerhard Andersson
- Department of Behavioural Sciences and Learning, Linköping University, Sweden
- Department of Clinical Neuroscience, Karolinska Institutet, Sweden
| | - Per Carlbring
- Department of Psychology, Stockholm University, Sweden
- Department of Psychology, University of Southern Denmark, Denmark
| | - Odd E. Havik
- Department of Clinical Psychology, Faculty of Psychology, University of Bergen, Norway
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