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Lorentzen S. Focused group analytic psychotherapy: An integration of clinical experience and research. J Clin Psychol 2022; 78:1613-1623. [PMID: 35689824 PMCID: PMC9543503 DOI: 10.1002/jclp.23397] [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] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 05/14/2022] [Accepted: 05/18/2022] [Indexed: 11/27/2022]
Abstract
Objective Group‐analytic psychotherapy is probably the most commonly used psychodynamic group therapy in Europe. This paper describes focused group analytic psychotherapy (FGAP), a new time–limited version of this therapy, based on clinical experience and research. The therapy/suitability of patients It is relatively structured and individually oriented, and designed for patients with a certain ability to tolerate internal and external stress, without decompensating or developing serious behavioral disturbances (they should have a limited degree of personality pathology). Patients entering FGAP should establish a circumscribed therapy focus ahead of therapy, based on some dysfunctional patterns of interpersonal problems, conflicts, and/or symptoms related to a psychodynamic hypothesis/case formulation. Selection/preparation The paper describes patient selection and preparation, the evolvement of the group process, and how therapist and other group members interact/intervene. Clinical material/vignettes Central elements in the evaluation and aspects of the therapy are described and illustrated with an extensive case description and clinical material and vignettes from the group process.
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Affiliation(s)
- Steinar Lorentzen
- Division of Mental Health and Addiction, Medical Faculty, Institute for Clinical Medicine, University of Oslo, Oslo, Norway
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Pedersen G, Kvarstein EH, Wilberg T, Folmo EJ, Burlingame GM, Lorentzen S. The Group Questionnaire (GQ)—Psychometric properties among outpatients with personality disorders. Group Dynamics: Theory, Research, and Practice 2021. [DOI: 10.1037/gdn0000176] [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: 11/08/2022]
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Lorentzen S. God bok om gruppeterapi. Tidsskriftet 2019. [DOI: 10.4045/tidsskr.19.0023] [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: 11/02/2022] Open
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Lorentzen S, Strauss B, Altmann U. Process-outcome relationships in short- and long-term psychodynamic group psychotherapy: Results from a randomized clinical trial. Group Dynamics: Theory, Research, and Practice 2018. [DOI: 10.1037/gdn0000084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Church C, Andreassen OA, Lorentzen S, Melle I, Aas M. Childhood Trauma and Minimization/Denial in People with and without a Severe Mental Disorder. Front Psychol 2017; 8:1276. [PMID: 28883800 PMCID: PMC5573805 DOI: 10.3389/fpsyg.2017.01276] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Accepted: 07/12/2017] [Indexed: 11/30/2022] Open
Abstract
Background: Childhood trauma has garnered extensive research concerning its role in the psychopathology of mental disorders, including psychosis. The Childhood Trauma Questionnaire (CTQ) utilizes a minimization/denial (MD) scale to denote potential under-reporters of trauma, yet MD scores are infrequently reported and validations of the scale are lacking in the literature. Study aim: Elucidate differences in MD between patients with severe mental disorders to healthy individuals, and secondly, investigate if MD influences reports of childhood trauma between the groups. Methods: We included 621 patients with a DSM-schizophrenia spectrum, bipolar spectrum diagnosis, or major depression disorder with psychotic features and 299 healthy controls as part of the NORMENT study in Oslo, Norway. History of childhood trauma was obtained using the CTQ. Clinical diagnoses were assessed using the Structured Clinical Interview for DSM Disorders. Results: A significantly greater proportion of healthy controls (42.8%) had a positive MD score compared to patients (26.7%). When controlling for MD, the patient group still exhibited elevated reports of childhood trauma compared to controls (Cohen’s d = 1.27), concordant with reports of childhood trauma being more frequently reported in a population of severe mental disorders. Conclusion: Elevated MD in the healthy control group could suggest an enhanced self-serving bias, potentially attenuated in the psychiatric group. Clinicians and researchers would benefit from including the MD component of CTQ when assessing retrospective information on childhood trauma to rule out potential effect of MD.
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Affiliation(s)
- Chelsea Church
- School of Psychology, University of GlasgowGlasgow, United Kingdom
| | - Ole A Andreassen
- Division of Mental Health and Addiction, NORMENT K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of OsloOslo, Norway
| | | | - Ingrid Melle
- Division of Mental Health and Addiction, NORMENT K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of OsloOslo, Norway
| | - Monica Aas
- Division of Mental Health and Addiction, NORMENT K.G. Jebsen Centre for Psychosis Research, Oslo University Hospital and Institute of Clinical Medicine, University of OsloOslo, Norway
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Lorentzen S. Assessment of Change after Long-Term Psychoanalytic Group Treatment: Presentation of a Field Study of Outpatients from Private Psychiatric Practice. ACTA ACUST UNITED AC 2016. [DOI: 10.1177/05333160022077407] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The main purpose of this article is to underline the importance of doing clinical research on long-term, dynamic group psychotherapy as it is carried out in practice (effectiveness study). After a review of the outcome literature, which mainly consists of experimental studies (efficacy studies), an effectiveness study from a private practice will be described with some preliminary results. Experiences from implementation of a research project in clinical practice are presented and the strengths and limitations of the two research methods are discussed.
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Abstract
In this paper, I underline the challenges for group-analytic research by demonstrating the immense difference in the amount of research done in group psychotherapy in general as compared to group analysis. After presenting an overview of findings from empirical, quantitative outcome studies in group psychotherapy at large, I will discuss some trends in contemporary group psychotherapy research, and finally, I will give a rough sketch of group-analytic research. I will focus on quantitative research and I will see group analysis as a clinical enterprise - a theory, model, art and craft that has been developed and can be used to treat psychiatric disorders, and toameliorate psychological problems.
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Lorentzen S, Fjeldstad A, Ruud T, Høglend PA. Comparing Short- and Long-Term Group Therapy: Seven-Year Follow-Up of a Randomized Clinical Trial. Psychother Psychosom 2016; 84:320-1. [PMID: 26279294 DOI: 10.1159/000381751] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/11/2014] [Accepted: 03/17/2015] [Indexed: 11/19/2022]
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Fjeldstad A, Høglend P, Lorentzen S. Presence of personality disorder moderates the long-term effects of short-term and long-term psychodynamic group therapy: A 7-year follow-up of a randomized clinical trial. Group Dynamics: Theory, Research, and Practice 2016. [DOI: 10.1037/gdn0000055] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Fjeldstad A, Høglend P, Lorentzen S. Patterns of Change in Interpersonal Problems During and After Short-term and Long-term Psychodynamic Group Therapy: A Randomized Clinical Trial. Psychother Res 2015; 27:350-361. [PMID: 26514065 DOI: 10.1080/10503307.2015.1102357] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [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: 10/22/2022] Open
Abstract
OBJECTIVE In this study, we compared the patterns of change in interpersonal problems between short-term and long-term psychodynamic group therapy. METHOD A total of 167 outpatients with mixed diagnoses were randomized to 20 or 80 weekly sessions of group therapy. Interpersonal problems were assessed with the Inventory of Interpersonal Problems at six time points during the 3-year study period. Using linear mixed models, change was linearly modelled in two steps. Earlier (within the first 6 months) and later (during the last 2.5 years) changes in five subscales were estimated. RESULTS AND CONCLUSION Contrary to what we expected, short-term therapy induced a significantly larger early change than long-term therapy on the cold subscale and there was a trend on the socially avoidant subscale, using a Bonferroni-adjusted alpha. There was no significant difference between short-term and long-term group therapy for improving problems in the areas cold, socially avoidant, nonassertive, exploitable, and overly nurturant over the 3 years.
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Affiliation(s)
- Anette Fjeldstad
- a Department for Research and Development , Clinic for Mental Health and Addiction Oslo University Hospital , Oslo , Norway
| | - Per Høglend
- b Institute for Clinical Medicine, University of Oslo , Oslo , Norway
| | - Steinar Lorentzen
- a Department for Research and Development , Clinic for Mental Health and Addiction Oslo University Hospital , Oslo , Norway.,b Institute for Clinical Medicine, University of Oslo , Oslo , Norway
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Abstract
This paper gives an overview of group psychotherapy in Norway: the history, approaches in use, programs for systematic training, how group services are financed, and finally how practice and research are integrated in the public mental health system.
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Affiliation(s)
- Steinar Lorentzen
- Professor emeritus and a psychiatrist at the Institute of Clinical Medicine, University of Oslo
| | - Theresa Wilberg
- Senior researcher at the Department of Research and Development, Clinic for Mental Health and Addiction, at Oslo University Hospital
| | - Egil W Martinsen
- Head of the Department of Research and Development, Clinic for Mental Health and Addiction, at Oslo University Hospital and professor at the Institute of Clinical Medicine, University of Oslo
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Lorentzen S. Cohesion, Alliance, and Outcome in Group Psychotherapy: Comments on Joyce et al. (2007) and Johnson (2007). Int J Group Psychother 2015; 58:403-9. [DOI: 10.1521/ijgp.2008.58.3.403] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Lorentzen S, Høglend P, Martinsen EW, Ringdal E. Practice-Based Evidence: Patients Who Did Not Respond to Group Analysis. Int J Group Psychother 2015; 61:366-95. [DOI: 10.1521/ijgp.2011.61.3.366] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bakali JV, Wilberg T, Klungsøyr O, Lorentzen S. Development of Group Climate in Short- and Long-Term Psychodynamic Group Psychotherapy. Int J Group Psychother 2015; 63:366-93. [DOI: 10.1521/ijgp.2013.63.3.366] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Suszek H, Holas P, Wyrzykowski T, Lorentzen S, Kokoszka A. Short-term intensive psychodynamic group therapy versus cognitive-behavioral group therapy in day treatment of anxiety disorders and comorbid depressive or personality disorders: study protocol for a randomized controlled trial. Trials 2015; 16:319. [PMID: 26220089 PMCID: PMC4517633 DOI: 10.1186/s13063-015-0827-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 06/29/2015] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Psychodynamic and cognitive-behavioral group therapies are frequently applied in day hospitals for the treatment of anxiety disorders and comorbid depressive or personality disorders in Poland and other Eastern European countries. Yet there is not enough evidence as to their effectiveness in this environment; this study addresses this gap. The aim of the study is to determine the effectiveness of these two kinds of day treatment care consisting of intensive, short-term group psychodynamic and cognitive-behavioral therapy, for patients with anxiety disorders and/or comorbid depressive or personality disorders. Our objectives are to: 1) show the effectiveness of each treatment in a day-care setting relative to the wait-list control group; 2) demonstrate the relative short- and long-term effectiveness of the two active treatments; 3) carry out a preliminary examination of the predictors and moderators of treatment response; 4) carry out a preliminary examination of the mediators of therapeutic change; and 5) compare the impact of both methods of treatment on the outcome of the measures used in this study. METHODS/DESIGN In this randomized controlled trial, a total of 199 patients with anxiety disorders and comorbid depressive and/or personality disorders will be assigned to one of three conditions: 1) psychodynamic group therapy; 2) cognitive-behavioral group therapy; or 3) wait-list control group. The therapy will last 12 weeks. Both treatments will be manualized (the manuals will address comorbidity). Primary outcome measures will include self-reported symptoms of anxiety, observer-rated symptoms of anxiety, global improvement, and recovery rate. Secondary outcome measures will include the number of pathological personality traits, depression, self-esteem, defense mechanisms, beliefs about self and others, interpersonal problems, object relations, parental bonding, meta-cognition, and quality of life. Measures will be taken at baseline, post-treatment, and at six months following the end of therapy. DISCUSSION The rationale is to investigate how effectively anxiety disorders and/or comorbid depressive or personality disorders can be treated in a day hospital setting, typical of the Polish health care system, during a three-month treatment period. TRIAL REGISTRATION Clinicaltrials.gov identifier NCT02126787 , registered on 28 April 2014.
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Affiliation(s)
- Hubert Suszek
- Faculty of Psychology, University of Warsaw, Ul. Stawki 5/7, 00-183, Warsaw, Poland.
| | - Paweł Holas
- Faculty of Psychology, University of Warsaw, Ul. Stawki 5/7, 00-183, Warsaw, Poland.
| | | | - Steinar Lorentzen
- Institute of Clinical Medicine, University of Oslo, PO Box 1039, , Blindern, Oslo, 0315, Norway.
| | - Andrzej Kokoszka
- II Department of Psychiatry, Medical University of Warsaw, ul. Kondratowicza 8, 03-242, Warsaw, Poland.
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Lorentzen S, Fjeldstad A, Ruud T, Marble A, Klungsøyr O, Ulberg R, Høglend PA. The Effectiveness of Short- and Long-Term Psychodynamic Group Psychotherapy on Self-Concept: Three Years Follow-Up of a Randomized Clinical Trial. Int J Group Psychother 2015; 65:362-85. [PMID: 26076204 DOI: 10.1521/ijgp.2015.65.3.362] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
We compared differences in self-concept change across three years after short-(STG) and long-term (LTG) psychodynamic group psychotherapy, in a mixed sample of outpatients. Self-concept was assessed at baseline and three years later, using the Structural Analysis of Social Behavior Questionnaire. Vector scores Affiliation and Autonomy were primary, and the eight cluster scores-self-free, self-affirm, self-love, self-protect, self-control, self-blame, self-attack, and self-neglect-were secondary outcome measures. Within group univariate analyses showed change in LTG across three years on the vector scores Affiliation and Autonomy, while STG only changed on Autonomy. Comparisons between STG and LTG demonstrated a significantly larger improvement in Affiliation in LTG than in STG. This difference was explained by a higher improvement in the cluster scores of self-blame, self-attack, and self-neglect in LTG, dimensions that weight negatively on the Affiliation score. Patients with more serious self-neglect and harsh, punitive self-attack/self-blame may profit more in long-term than in short-term groups.
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Affiliation(s)
- Steinar Lorentzen
- Institute of Clinical Medicine at the University of Oslo and the Department for Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Anette Fjeldstad
- Department for Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Torleif Ruud
- Department for Research and Development, Division of Mental Health Services, Akershus University Hospital, L∅renskog, Norway, and the Institute of Clinical Medicine at the University of Oslo
| | - Alice Marble
- Institute of Clinical Medicine at the University of Oslo
| | - Ole Klungsøyr
- Department for Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Randi Ulberg
- Division of Mental Health and Addiction, Vestfold Hospital Trust, T∅nsberg, Norway
| | - Per A Høglend
- Institute of Clinical Medicine at the University of Oslo
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Lorentzen S, Ruud T, Fjeldstad A, Høglend PA. Personality disorder moderates outcome in short- and long-term group analytic psychotherapy: A randomized clinical trial. Br J Clin Psychol 2014; 54:129-46. [PMID: 25178520 DOI: 10.1111/bjc.12065] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2013] [Revised: 04/01/2014] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In a randomized clinical trial, short- and long-term psychodynamic group psychotherapy (STG and LTG, respectively) schedules were equally effective for the 'typical' patient during a 3-year study period. Although several studies have reported good effects for patients with personality disorders (PD) in diverse forms of psychotherapy, the significance of treatment duration is unclear. Therefore, we tested the hypothesis that PD patients would improve more during and after LTG than STG. DESIGN A randomized, longitudinal, prospective study contrasting the outcomes during and after short- and long-term dynamic group psychotherapies. METHODS One hundred and sixty-seven outpatients with mood disorders, anxiety disorders, or PD were randomized to STG or LTG (respectively, 20 or 80 weekly sessions of 90 min each). Outcome measures are as follows: symptoms (SCL-90-R), interpersonal problems (IIP-C), and psychosocial functioning (GAF split version: GAF-Symptom and GAF-Function). PD pathology (number of PD criteria items) was selected a priori as a putative moderator of treatment effects. Change during the 3-year study period was assessed using linear mixed models. The study was registered at ClinicalTrials.gov as NCT 00021417. RESULTS Our hypothesis was supported, as patients with PD improved significantly more regarding all outcome variables in LTG than STG. For patients without PD, the rate of change was similar across 3 years; however, the rate of change in symptoms and interpersonal problems was higher in STG during the first 6 months. CONCLUSIONS The effectiveness of LTG is higher for patients with co-morbid PD. Patients without PD do not appear to experience additional gain from LTG. PRACTITIONER POINTS Clinical implications: LTG demonstrates better effectiveness than STG for patients with personality disorder co-morbidity (PD). Patients without PD do not appear to experience additional gain from attending LTG. Correct initial allocation to treatment duration may prevent disruptive breaks in relationships and lead to both human and economic cost savings. Limitations: Trials on mixed diagnostic samples may limit the ability to fully assess change for specific diagnostic groups. Therapists were unable to select patients and compose their own groups. Although this condition might increase the generalizability of the results, it may also have restricted the therapists and the clinical situation inadvertently.
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Affiliation(s)
- Steinar Lorentzen
- Institute of Clinical Medicine, Clinic of Mental Health and Addiction, University of Oslo, Norway; Department of Research and Development, Clinic of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Steen NE, Methlie P, Lorentzen S, Dieset I, Aas M, Nerhus M, Haram M, Agartz I, Melle I, Berg JP, Andreassen OA. Altered systemic cortisol metabolism in bipolar disorder and schizophrenia spectrum disorders. J Psychiatr Res 2014; 52:57-62. [PMID: 24534618 DOI: 10.1016/j.jpsychires.2014.01.017] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [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: 06/10/2013] [Revised: 01/23/2014] [Accepted: 01/27/2014] [Indexed: 11/18/2022]
Abstract
Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is suggested as a pathophysiological factor in bipolar disorder and schizophrenia. Increased clearance of cortisol was recently indicated as a component in the HPA axis hyperdrive. The aim of the present study was to test the model of increased cortisol metabolism in a new replication sample separately and combined with a previously published sample of bipolar disorder and schizophrenia. Spot urine was sampled from 212 healthy controls (HC) and 221 patients with a schizophrenia spectrum disorder (SCZ, n = 115) and bipolar disorder (BD, n = 106). Of these, a subsample of 169 HC and 155 patients was included in a previous report. Urinary free cortisol, cortisone and their metabolites were measured, and the activities of 5α-reductase, 5β-reductase and 11β-HSD were estimated and analyzed for differences between groups. In the new sample, there was increased enzyme activity in SCZ for 5β-reductase (p = 0.024 vs HC; p = 0.027 vs BD) and 11β-HSD2 (p = 0.014 vs HC; p = 0.004 vs BD). In the combined sample, there was increased activity in SCZ for 5α-reductase (p < 0.001 vs HC; p = 0.020 vs BD), 5β-reductase (p < 0.001 vs HC; p = 0.045 vs BD) and 11β-HSD2 (p < 0.001 vs HC; p = 0.043 vs BD), and in BD for 5β-reductase (p = 0.002), 11β-HSD2 (p = 0.039) and 5α-reductase (trend, p = 0.084) (all vs HC). The findings confirm increased systemic cortisol metabolism in BD and SCZ. This is most consistent in SCZ, with BD taking an intermediate position. The design makes it impossible to determine the direction of the effect. However, the findings merit further study of cortisol metabolism as a possible component in the HPA axis dysfunction and pathophysiology of BD and SCZ.
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Affiliation(s)
- Nils Eiel Steen
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Drammen District Psychiatric Center, Clinic of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway.
| | - Paal Methlie
- Institute of Medicine, University of Bergen, Bergen, Norway; Hormone Laboratory, Haukeland University Hospital, Bergen, Norway
| | - Steinar Lorentzen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Research and Development, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Dieset
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Monica Aas
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mari Nerhus
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Marit Haram
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ingrid Agartz
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Ingrid Melle
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Jens P Berg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway; Department of Medical Biochemistry, Oslo University Hospital, Oslo, Norway; Hormone Laboratory, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- KG Jebsen Centre for Psychosis Research, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway; Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Abstract
Group therapy is used extensively within public mental health services, but more detailed knowledge is needed. All 25 health authorities in Norway were invited to describe their groups: theory, primary tasks, interventions, structure, patients and therapists. Four hundred twenty-six groups, 296 in community mental health centres and 130 in hospitals, were categorized into nine types, based on theoretical background. Psychodynamic groups were most frequent, followed by cognitive-behavioural, psycho-educative, social skills/coping and art/expressive groups. Weekly sessions of 90 min and treatment duration <6 or >12 months was most frequent. Main diagnosis for 2391 patients: depression (517), personality disorder (396), schizophrenia/psychosis (313) and social phobia (249). Patients with depression or personality disorder were mostly in psychodynamic groups, psychosis/bipolar disorder in psycho-educative groups. Cognitive-behavioural groups were used across several diagnoses. Most therapists were nurses, only 50% had a formal training in group therapy. There is a plethora of groups, some based on one theoretical school, while others integrate theory from several 'camps'. Patients with similar diagnosis were offered different group approaches, although some trends existed. More research evidence from regular clinical groups is needed, and clinician-researcher networks should be developed. More group therapists with formal training are needed.
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Affiliation(s)
- S Lorentzen
- Inst Clinical Medicine, University of Oslo; Oslo University Hospital, Clinic of Mental Health and Addiction, Oslo
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Lorentzen S. Eklektisk psykoterapi. Tidsskriftet 2014. [DOI: 10.4045/tidsskr.14.0161] [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: 11/02/2022] Open
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Mork E, Walby FA, Harkavy-Friedman JM, Barrett EA, Steen NE, Lorentzen S, Andreassen OA, Melle I, Mehlum L. Clinical characteristics in schizophrenia patients with or without suicide attempts and non-suicidal self-harm--a cross-sectional study. BMC Psychiatry 2013; 13:255. [PMID: 24106884 PMCID: PMC3852098 DOI: 10.1186/1471-244x-13-255] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [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: 03/22/2013] [Accepted: 10/03/2013] [Indexed: 12/04/2022] Open
Abstract
BACKGROUND To investigate whether schizophrenia patients with both suicide attempts and non-suicidal self-harm have earlier age of onset of psychotic and depressive symptoms and higher levels of clinical symptoms compared to patients with only suicide attempts or without suicide attempt. METHODS Using a cross-sectional design, 251 patients (18-61 years old, 58% men) with schizophrenia treated at hospitals in Oslo and Innlandet Hospital Trust, Norway, were assessed with a comprehensive clinical research protocol and divided into three groups based on their history of suicide attempts and non-suicidal self-harm. RESULTS Suicide attempts were present in 88 patients (35%); 52 had suicide attempts only (29%) and 36 had both suicide attempts and non-suicidal self-harm (14%). When compared with nonattempters and those with suicide attempts without non-suicidal self-harm, patients with both suicide attempts and non-suicidal self-harm were more frequently women, younger at the onset of psychotic symptoms, had longer duration of untreated psychosis, and had higher levels of current impulsivity/aggression and depression. Patients with both suicide attempts and non-suicidal self-harm were more likely to repeat suicide attempts than patients with suicide attempts only. CONCLUSIONS Patients with both suicide attempts and non-suicidal self-harm had different illness history and clinical characteristics compared to patients with only suicide attempts or patients without suicidal behavior. Our study suggests that patients with both suicide attempts and non-suicidal self-harm represent a distinct subgroup among patients with schizophrenia and suicidal behavior with their early onset of psychotic symptoms, high rate of repeated suicidal behavior and significant treatment delay.
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Affiliation(s)
- Erlend Mork
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, 0372 Oslo, Norway.
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, 0372 Oslo, Norway,Department of Psychiatry, Diakonhjemmet Hospital, 0319 Oslo, Norway
| | | | - Elizabeth A Barrett
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway
| | - Nils E Steen
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway,Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Steinar Lorentzen
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway,Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Ole A Andreassen
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway,Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Ingrid Melle
- Division of Mental Health and Addiction, Oslo University Hospital, 0424 Oslo, Norway,Institute of Clinical Medicine, University of Oslo, 0318 Oslo, Norway
| | - Lars Mehlum
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Sognsvannsveien 21, 0372 Oslo, Norway
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Aas M, Haukvik UK, Djurovic S, Bergmann Ø, Athanasiu L, Tesli MS, Hellvin T, Steen NE, Agartz I, Lorentzen S, Sundet K, Andreassen OA, Melle I. BDNF val66met modulates the association between childhood trauma, cognitive and brain abnormalities in psychoses. Prog Neuropsychopharmacol Biol Psychiatry 2013; 46:181-8. [PMID: 23876786 DOI: 10.1016/j.pnpbp.2013.07.008] [Citation(s) in RCA: 71] [Impact Index Per Article: 6.5] [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: 03/14/2013] [Revised: 07/03/2013] [Accepted: 07/10/2013] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Brain derived neurotrophic factor (BDNF) is important for brain development and plasticity, and here we tested if the functional BDNF val66met variant modulates the association between high levels of childhood abuse, cognitive function, and brain abnormalities in psychoses. METHOD 249 patients with a broad DSM-IV schizophrenia spectrum disorder or bipolar disorder were consecutively recruited to the TOP research study (mean±age: 30.7±10.9; gender: 49% males). History of childhood trauma was obtained using the Childhood Trauma Questionnaire. Cognitive function was assessed through a standardized neuropsychological test battery. BDNF val66met was genotyped using standardized procedures. A sub-sample of n=106 Caucasians with a broad DSM-IV schizophrenia spectrum disorder or bipolar disorder (mean±age: 32.67±10.85; 49% males) had data on sMRI. RESULTS Carriers of the Methionine (met) allele exposed to high level of childhood abuse demonstrated significantly poorer cognitive functioning compared to homozygotic Valine (val/val) carriers. Taking in consideration multiple testing, using a more conservative p value, this was still shown for physical abuse and emotional abuse, as well as a trend level for sexual abuse. Further, met carriers exposed to high level of childhood sexual abuse showed reduced right hippocampal volume (r(2)=0.43; p=0.008), and larger right and left lateral ventricles (r(2)=0.37; p=0.002, and r(2)=0.27; p=0.009, respectively). Our findings were independent of age, gender, diagnosis and intracranial volume. CONCLUSION Our data demonstrate that in patients with psychoses, met carriers of the BDNF val66met with high level of childhood abuse have more cognitive and brain abnormalities than all other groups.
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Affiliation(s)
- Monica Aas
- Institute of Clinical Medicine, University of Oslo, Norway; Psychosis Research Unit, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
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Etain B, Aas M, Andreassen OA, Lorentzen S, Dieset I, Gard S, Kahn JP, Bellivier F, Leboyer M, Melle I, Henry C. Childhood trauma is associated with severe clinical characteristics of bipolar disorders. J Clin Psychiatry 2013; 74:991-8. [PMID: 24229750 DOI: 10.4088/jcp.13m08353] [Citation(s) in RCA: 142] [Impact Index Per Article: 12.9] [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: 01/04/2013] [Accepted: 03/02/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE Beyond genetic risk variants, the pathophysiology of bipolar disorders is likely to be partly determined by environmental susceptibility factors. Our study is one of the first to investigate, in a large sample of well-characterized bipolar patients, associations between clinical presentations and childhood trauma subtypes, including neglect and abuse items. METHOD 587 patients with DSM-IV-defined bipolar disorder were recruited from France and Norway between 1996-2008 and 2007-2012, respectively. History of childhood trauma was obtained using the Childhood Trauma Questionnaire. Clinical variables were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders (Norwegian sample) or the Diagnostic Interview for Genetic Studies (French sample). RESULTS Earlier age at onset of bipolar illness, suicide attempts, rapid cycling, and an increased number of depressive episodes each had significant associations (P ≤ .001) with at least 1 subtype of childhood trauma (emotional abuse, sexual abuse, and emotional neglect). Multivariate analyses investigating trauma variables together showed that both emotional and sexual abuse were independent predictors of lower age at onset (P = .002 for each) and history of suicide attempts (OR = 1.60 [95% CI, 1.07 to 2.39], P = .023; OR = 1.80 [95% CI, 1.14 to 2.86], P = .012, respectively), while sexual abuse was the strongest predictor of rapid cycling (OR = 2.04 [95% CI, 1.21 to 3.42], P = .007). Females reported overall higher childhood trauma frequency and greater associations to clinical expressions than males (P values < .05). CONCLUSIONS Our results demonstrate consistent associations between childhood trauma and more severe clinical characteristics in bipolar disorder. Further, they show the importance of including emotional abuse as well as the more frequently investigated sexual abuse when targeting clinical characteristics of bipolar disorder.
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Affiliation(s)
- Bruno Etain
- Pôle de Psychiatrie, Hôpital Henri Mondor-Albert Chenevier, Assistance Publique Hôpitaux de Paris (APHP); and Institut National de la Santé et de la Recherche Médicale (INSERM) U955
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Abstract
BACKGROUND There are no randomised clinical trials comparing the outcomes of short- with long-term psychodynamic group psychotherapy. AIMS To compare differences in outcome during and after short- and long-term group psychotherapy. METHOD In total, 167 out-patients with mood, anxiety and personality disorders were randomised to short- or long-term group therapy (20 or 80 weekly, 90 min sessions). Outcome measures were: symptoms (Symptom Checklist 90 - Revised), interpersonal problems (Inventory of Interpersonal Problems - Circumplex) and psychosocial functioning (Global Assessment of Functioning (GAF) split version: GAF-Symptom and GAF-Function). Change over the 3-year study period was assessed using linear mixed models. The study was registered in clinicalTrials.gov as NCT00521417. RESULTS Patients in both groups made significant gains. A significantly larger symptomatic change over time was found for long-term compared with short-term therapy, but no significant differences were detected for the three remaining outcome variables. There was a higher number of premature terminations in the long-term (33.3%) compared with the short-term group (8.6%). CONCLUSIONS Short- and long-term therapy seem equally effective for typical out-patients seeking group psychotherapy, except for symptomatic distress.
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Affiliation(s)
- Steinar Lorentzen
- Steinar Lorentzen, MD, PhD, Department for Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital, and Institute of Clinical Medicine, University of Oslo; Torleif Ruud, MD, PhD, Department for Research and Development, Division of Mental Health Services, Akershus University Hospital, Lørenskog, and Institute of Clinical Medicine, University of Oslo; Anette Fjeldstad, MD, Department of Research and Development, Clinic for Mental Health and Addiction, Oslo University Hospital; Per Høglend, MD, PhD, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Knutzen M, Bjørkly S, Eidhammer G, Lorentzen S, Helen Mjøsund N, Opjordsmoen S, Sandvik L, Friis S. Mechanical and pharmacological restraints in acute psychiatric wards--why and how are they used? Psychiatry Res 2013; 209:91-7. [PMID: 23219102 DOI: 10.1016/j.psychres.2012.11.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [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] [Received: 05/14/2012] [Revised: 10/11/2012] [Accepted: 11/10/2012] [Indexed: 12/11/2022]
Abstract
Restraint use has been reported to be common in acute psychiatry, but empirical research is scarce concerning why and how restraints are used. This study analysed data from patients' first episodes of restraint in three acute psychiatric wards during a 2-year study period. Logistic regression analyses were used to identify predictors for type and duration of restraint. The distribution of restraint categories for the 371 restrained patients was as follows: mechanical restraint, 47.2%; mechanical and pharmacological restraint together, 35.3%; and pharmacological restraint, 17.5%. The most commonly reported reason for restraint was assault (occurred or imminent). It increased the likelihood of resulting in concomitant pharmacological restraint. Female patients had shorter duration of mechanical restraint than men. Age above 49 and female gender increased the likelihood of pharmacological versus mechanical restraint, whereas being restrained due to assault weakened this association. Episodes with mechanical restraint and coinciding pharmacological restraint lasted longer than mechanical restraint used separately, and were less common among patients with a personality disorder. Diagnoses, age and reason for restraint independently increased the likelihood for being subjected to specific types of restraint. Female gender predicted type of restraint and duration of episodes.
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Affiliation(s)
- Maria Knutzen
- Centre for Research and Education in Forensic Psychiatry, Oslo University Hospital, P.O. Box 4956, Nydalen, N-0424 Oslo, Norway.
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Peleikis DE, Varga M, Sundet K, Lorentzen S, Agartz I, Andreassen OA. Schizophrenia patients with and without post-traumatic stress disorder (PTSD) have different mood symptom levels but same cognitive functioning. Acta Psychiatr Scand 2013; 127:455-63. [PMID: 23176609 DOI: 10.1111/acps.12041] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [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] [Accepted: 10/09/2012] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate differences in cognitive function and level of psychopathology in patients with schizophrenia (SZ) with or without psychological traumatization/post-traumatic stress disorder (PTSD). We hypothesized that traumatized patients with or without PTSD would have more severe cognitive impairments because of the neuropathological changes associated with PTSD, and more severe psychopathology compared with non-traumatized SZ patients. METHOD Seventy-five SZ patients with traumatization and 217 SZ patients without traumatization were evaluated regarding the symptoms and cognitive functioning, using standard symptom scales (PANSS; CDSS) and a neuropsychological test battery (IQ, verbal memory, attention, working memory, psychomotor speed, and executive functioning). RESULTS No significant differences were observed between the groups in cognitive test performance. The patients in the traumatized group with PTSD showed significantly more current depression than the non-traumatized group (P = 0.012). CONCLUSION The findings did not support the hypothesis that the presence of comorbid PTSD/traumatization in SZ is associated with increased cognitive impairment. The increase in current depression in SZ with comorbid traumatization suggests that more severe psychopathology is associated with traumatization.
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Affiliation(s)
- D E Peleikis
- Department of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
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Larsson S, Aas M, Klungsøyr O, Agartz I, Mork E, Steen NE, Barrett EA, Lagerberg TV, Røssberg JI, Melle I, Andreassen OA, Lorentzen S. Patterns of childhood adverse events are associated with clinical characteristics of bipolar disorder. BMC Psychiatry 2013; 13:97. [PMID: 23522391 PMCID: PMC3637635 DOI: 10.1186/1471-244x-13-97] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [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: 02/14/2012] [Accepted: 03/04/2013] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies in bipolar disorder investigating childhood trauma and clinical presentations of the illness have mainly focused on physical and sexual abuse. Our aim was to explore further the relationship between childhood trauma and disease characteristics in bipolar disorder to determine which clinical characteristics were most strongly associated with childhood trauma total score, as well as subtypes of adverse childhood events, including physical, sexual, emotional abuse and neglect. METHODS 141 Patients with bipolar disorder were consecutively recruited, and disease history and clinical characteristics were assessed. History of childhood abuse was obtained using the Childhood Trauma Questionnaire (CTQ). Statistical methods used were factor analysis, Poisson and linear regression, and generalized additive modeling (GAM). RESULTS The factor analysis of CTQ identified three factors: emotional abuse/neglect, sexual abuse and physical abuse. There were significant associations between CTQ total score and earlier onset of illness, reduced level of psychosocial functioning (GAF; Global Assessment of Functioning) and decreased number of hospitalization, which mainly were due to the factor emotional abuse/neglect. Physical abuse was significantly associated with lower GAF scores, and increased number of mood episodes, as well as self-harm. Sexual abuse was significantly associated with increased number of mood episodes. For mood episodes and self-harm the associations were characterized by great variance and fluctuations. CONCLUSIONS Our results suggest that childhood trauma is associated with a more severe course of bipolar illness. Further, childhood abuse (physical and sexual), as well as emotional abuse and neglect were significantly associated with accelerating staging process of bipolar disorder. By using specific trauma factors (physical abuse, sexual abuse and emotional abuse/neglect) the associations become both more precise, and diverse.
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Affiliation(s)
- Sara Larsson
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Monica Aas
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Ole Klungsøyr
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Agartz
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Erlend Mork
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Nils Eiel Steen
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Elizabeth A Barrett
- Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Jan Ivar Røssberg
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ole A Andreassen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Steinar Lorentzen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway,Institute of Clinical Medicine, Clinic of Health and Addiction, University of Oslo, 1039, Blindern, Oslo, N-0315, Norway
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Larsson S, Andreassen OA, Aas M, Røssberg JI, Mork E, Steen NE, Barrett EA, Lagerberg TV, Peleikis D, Agartz I, Melle I, Lorentzen S. High prevalence of childhood trauma in patients with schizophrenia spectrum and affective disorder. Compr Psychiatry 2013; 54:123-7. [PMID: 22901835 DOI: 10.1016/j.comppsych.2012.06.009] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [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: 09/17/2011] [Revised: 05/30/2012] [Accepted: 06/11/2012] [Indexed: 10/28/2022] Open
Abstract
OBJECTIVE Childhood trauma (CT) is a major risk factor for various psychiatric disorders. We wanted to determine the prevalence of CT in a catchment area-based sample of schizophrenia spectrum and affective disorder (including bipolar disorder and depressive episodes with psychotic features) and to explore potential differences in types of CT between the diagnostic groups. METHOD Three hundred five patients were recruited consecutively from psychiatric units at 3 major hospitals in Oslo, Norway, diagnosed with Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Traumatic childhood events were assessed with Childhood Trauma Questionnaire. RESULTS Eighty-two percent of the patients had experienced one or more CT events, the most frequent subtype of trauma being emotional neglect. The schizophrenia spectrum group reported significantly more physical abuse and physical neglect than the affective group. CONCLUSION A high prevalence of CT in patients with severe mental disorder was detected. This reminds us of the importance of exploring this issue when we treat such patients. The mechanisms behind these differences are unclear. Further research is needed to study potential associations between CT and the clinical picture of the disorder.
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Affiliation(s)
- Sara Larsson
- Department of Research and Development, Clinic of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Aas M, Steen NE, Agartz I, Aminoff SR, Lorentzen S, Sundet K, Andreassen OA, Melle I. Is cognitive impairment following early life stress in severe mental disorders based on specific or general cognitive functioning? Psychiatry Res 2012; 198:495-500. [PMID: 22472845 DOI: 10.1016/j.psychres.2011.12.045] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [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: 09/21/2011] [Revised: 12/29/2011] [Accepted: 12/30/2011] [Indexed: 01/03/2023]
Abstract
Schizophrenia spectrum and bipolar disorder are characterized by high levels of childhood trauma as well as of cognitive dysfunction. Our aim is to investigate the association between these two factors in the largest study in the literature so far. A total of 406 patients with schizophrenia spectrum- or bipolar disorders were recruited from a catchment area based organization in Oslo, Norway. Information about early life stress was obtained using the Childhood Trauma Questionnaire (CTQ). Cognitive function was assessed through a comprehensive and standardized neuropsychological test battery. Physical abuse, sexual abuse and physical neglect were significantly associated with reduced scores on working memory and executive function scales (p=0.04 to p<0.001), and verbal and performance tasks from the Wechsler Abbreviated Scale of Intelligence (WASI) (p=0.059 to p<0.001). When verbal and performance tasks from the WASI were added into a multivariate regression model, the association between CTQ and the specific cognitive domains decreased, and only WASI scores remained statistically significant. Our results indicate that childhood trauma is associated with a reduction in cognitive function across cognitive domains in patients with schizophrenia spectrum- and bipolar disorders, in particular working memory and executive function as well as general cognition. Moreover, these dysfunctions seem to be driven by underlying deficits in general cognitive tasks as measured by the WASI.
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Affiliation(s)
- Monica Aas
- Institute of Clinical Medicine, University of Oslo, Norway.
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Abstract
Treatment manuals may have different purposes. In clinical work it may be to demonstrate the main feabtures and principles of a treatment method to trainees. In psychotherapy research it may be an attempt to ensure that all patients are influenced in a similar way, thus trying to increase the internal validity of the study. Measures taken to ensure internal validity (randomization, inclusion of patients with similar diagnosis, check of treatment fidelity etc.) often reduce the possibility of generalizing the results from such studies to a regular clinical context (external validity). This article describes how treatment manuals for short- and long-term analytic group psychotherapies (20 and 80 weekly sessions, respectively) were developed. We wanted to study the significance of the treatment length, and potential moderators and mediators of differential change in the treatment of regular patients with mixed disorders (anxiety, affective, and mild to moderate personality disorders) who had been referred to outpatient services. The article presents reflections, choices, and dilemmas encountered in developing these manuals. Brief examples from the manuals are presented, highlighting differences between the two formats.
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Horneland M, Børnes DS, Høbye K, Knutsen H, Lorentzen S. Can the Clinician–Researcher Gap be Bridged? Experiences from a Randomized Clinical Trial in Analytic/Dynamic Group Psychotherapy. ACTA ACUST UNITED AC 2012. [DOI: 10.1177/0533316411424370] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This article describes how four seasoned clinicians and group analysts working in public mental health services, experience their participation in a randomized trial of short-term versus long-term analytic group psychotherapy (20 or 80 sessions). The design makes it possible to integrate the research with regular clinical practice, and participation gives the institutions the opportunity to fulfil obligations of doing research, that are imposed on the Community Mental Health Centres. The experiences are mainly described from the clinicians’ position, but some comments from the research director are included. The collaboration across approximately five years is found to be interesting and rewarding. Based on the assumption that further steps are made to strengthen and develop the qualitative aspects of such projects, the clinicians recommend such collaboration as a feasible and useful way to build and maintain a bridge across the gap that too often seems to separate researchers and clinicians. This is assumed to be profitable for everyone involved, not least the patients.
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Hersoug AG, Høglend P, Gabbard GO, Lorentzen S. The combined predictive effect of patient characteristics and alliance on long-term dynamic and interpersonal functioning after dynamic psychotherapy. Clin Psychol Psychother 2012; 20:297-307. [DOI: 10.1002/cpp.1770] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 11/02/2011] [Accepted: 01/04/2012] [Indexed: 11/09/2022]
Affiliation(s)
| | - Per Høglend
- Institute of Clinical Medicine Vinderen; University of Oslo; Norway
| | - Glen O. Gabbard
- Department of Psychiatry; Baylor College of Medicine; Texas; USA
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Aas M, Djurovic S, Athanasiu L, Steen NE, Agartz I, Lorentzen S, Sundet K, Andreassen OA, Melle I. Serotonin transporter gene polymorphism, childhood trauma, and cognition in patients with psychotic disorders. Schizophr Bull 2012; 38:15-22. [PMID: 21908796 PMCID: PMC3245595 DOI: 10.1093/schbul/sbr113] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [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: 11/14/2022]
Abstract
OBJECTIVE The functional polymorphism in the promoter region of the SLC6A4/5-HTT serotonin transporter gene (5-HTTLPR) has been linked to altered stress response. Carriers of the short (s-) allele have increased negative psychological reactions and stress hormone release compared with carriers of the long (l-) allele, interacting with severe life events including childhood trauma. High stress levels are associated with cognitive impairments in a variety of clinical and experimental studies. Patients with psychotic disorders are characterized both by more childhood traumatic events and abnormal stress responses and by significant but highly variable cognitive dysfunction. We hypothesize that 5-HTTLPR variations and long-term effects of childhood trauma interact and contribute to some of the variation in cognitive dysfunction seen in patients with psychotic disorders. METHODS Patients with psychotic disorders (schizophrenia and affective spectrums) were recruited from a catchment area-based treatment organization. History of childhood abuse was obtained by the Childhood Trauma Questionnaire. Cognitive function was assessed through a comprehensive, standardized neuropsychological test battery. 5-HTTLPR genotypes were analyzed using standard polymerase chain reaction. RESULTS We observed a significant interaction between 5-HTTLPR variants and childhood trauma across cognitive domains; here, homozygotic s-carriers exposed to high levels of childhood trauma (physical neglect and abuse) had significantly poorer cognitive functioning than all other groups. CONCLUSIONS Our results need replication but underline the importance of investigating childhood trauma and its interaction with genetic markers when studying cognitive dysfunction in patients with psychotic disorders.
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Affiliation(s)
- Monica Aas
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Srdjan Djurovic
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
| | - Lavinia Athanasiu
- Psychosis Research Unit, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Nils Eiel Steen
- Psychosis Research Unit, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Agartz
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Steinar Lorentzen
- Department of Psychiatric Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Kjetil Sundet
- Department of Psychology, University of Oslo, Oslo, Norway
| | - Ole A. Andreassen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Psychosis Research Unit, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Ingrid Melle
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway,Psychosis Research Unit, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
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Mork E, Mehlum L, Barrett EA, Agartz I, Harkavy-Friedman JM, Lorentzen S, Melle I, Andreassen OA, Walby FA. Self-harm in patients with schizophrenia spectrum disorders. Arch Suicide Res 2012; 16:111-23. [PMID: 22551042 DOI: 10.1080/13811118.2012.667328] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.8] [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: 10/28/2022]
Abstract
This study describes the prevalence, clinical characteristics, and gender profile of self-harm in a cross-sectional sample of 388 patients with schizophrenia spectrum disorders. All patients were interviewed and assessed with respect to lifetime self-harm and relevant clinical variables. An overall of 49% of the patients reported self-harm which was associated with female gender, having had a depressive episode, younger age at psychosis onset, alcohol abuse or dependence, current suicidality, awareness of illness, and low adherence to prescribed medication. Higher awareness of having a mental disorder was associated with self-harm in men only, while emotional dysregulation was associated with self-harm in women only. We conclude that while self-harm in patients with schizophrenia spectrum disorders is highly prevalent in both genders, risk factors in men and women differ in several important ways.
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Affiliation(s)
- Erlend Mork
- National Centre for SuicideResearch and Prevention, Institute ofClinical Medicine, University of Oslo, Oslo, Norway.
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Steen NE, Methlie P, Lorentzen S, Hope S, Barrett EA, Larsson S, Mork E, Almås B, Løvås K, Agartz I, Melle I, Berg JP, Andreassen OA. Increased systemic cortisol metabolism in patients with schizophrenia and bipolar disorder: a mechanism for increased stress vulnerability? J Clin Psychiatry 2011; 72:1515-21. [PMID: 21367348 DOI: 10.4088/jcp.10m06068yel] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.0] [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: 02/19/2010] [Accepted: 03/29/2010] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The hypothalamic-pituitary-adrenal (HPA) axis seems dysregulated and part of the pathophysiology in bipolar disorder and schizophrenia, but the underlying mechanisms are unknown. Recent evidence indicates that systemic cortisol metabolism influences blood cortisol levels and HPA axis functioning. Our objective was to estimate systemic cortisol metabolism by means of the activity of 5α-reductase, 5β-reductase, and 11β-hydroxysteroid dehydrogenase (11β-HSD) in patients with bipolar disorder and schizophrenia spectrum disorders compared to healthy controls. METHOD Inpatients and outpatients aged 18 to 65 years with DSM-IV bipolar disorder (n = 69) or schizophrenia (n = 87) were consecutively recruited to the catchment area-based Thematically Organized Psychosis Research (TOP) study. Healthy controls (n = 169) were randomly selected from statistical records from the same catchment area and were contacted by letter inviting them to participate. Spot urine samples were collected in a cross-sectional manner from November 2006 to November 2008. Urinary free cortisol and cortisone and their metabolites were analyzed with liquid chromatography tandem mass spectrometry and used as indicators of 5α-reductase, 5β-reductase, and 11β-HSD activity. RESULTS The combined patient group had increased activity of 5α-reductase, 5β-reductase, and 11β-HSD2 (all P < .001) compared to controls. Elevated systemic cortisol metabolism was present in both schizophrenia (5α-reductase, 5β-reductase, and 11β-HSD2; all P < .001) and bipolar disorder (5α-reductase [P = .016], 5β-reductase [P = .001], and 11β-HSD2 [P = .007]). CONCLUSIONS The results indicate increased activity of cortisol metabolism in patients with bipolar disorder and schizophrenia compared to healthy controls and suggest that increased systemic cortisol metabolism is involved in the pathophysiology and stress vulnerability in these severe mental disorders. The findings should be explored further in terms of potential new drug targets, and they add to the physiologic rationale for stress coping strategies in these patient groups.
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Affiliation(s)
- Nils Eiel Steen
- Section for Psychosis Research, Clinic of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.
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Lorentzen S, Rønnestad MH, Orlinsky D. Sources of influence on the professional development of psychologists and psychiatrists in Norway and Germany. European Journal of Psychotherapy & Counselling 2011. [DOI: 10.1080/13642537.2011.570016] [Citation(s) in RCA: 3] [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: 10/17/2022]
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Knutzen M, Mjosund NH, Eidhammer G, Lorentzen S, Opjordsmoen S, Sandvik L, Friis S. Characteristics of psychiatric inpatients who experienced restraint and those who did not: a case-control study. Psychiatr Serv 2011; 62:492-7. [PMID: 21532074 DOI: 10.1176/ps.62.5.pss6205_0492] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [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: 12/15/2022]
Abstract
OBJECTIVE Use of restraint in acute psychiatric wards is highly controversial. Knowledge is limited about the characteristics of patients who are restrained and the predictors of use of restraint. This study examined whether restrained patients differed from nonrestrained patients in demographic, clinical, and medicolegal variables and to what extent the variables predicted use of restraint. METHODS A two-year retrospective case-control design was used. The sample comprised all restrained patients (N=375) and a randomly selected control group of nonrestrained patients (N=374) from three catchment-area-based acute psychiatric wards in Norway. Data sources were restraint protocols and electronic patient files. RESULTS The restrained patients were significantly younger and more likely to be men, to reside outside the wards' catchment areas, and to have an immigrant background. Restrained patients also had more admissions and longer inpatient stays than nonrestrained patients and were more likely to be involuntarily referred and to have one or more of the following ICD-10 diagnoses: a substance use disorder, schizophrenia or a related psychotic disorder, and bipolar disorder. Binary logistic regression analyses, adjusting for age, gender, immigrant background, and catchment area, indicated that the number of admissions, length of stay, legal basis for referral, and diagnosis each independently predicted the use of restraint. No interactions were found. CONCLUSIONS Use of restraint was predicted by multiple admissions, long inpatient stays, involuntary admission, and serious mental illness. Identifying patients at risk may inform the development of alternatives to restraint for these patients.
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Affiliation(s)
- Maria Knutzen
- Department of Research and Education, Oslo University Hospital,Oslo, Norway.
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Bakali JV, Wilberg T, Hagtvet KA, Lorentzen S. Sources accounting for alliance and cohesion at three stages in group psychotherapy: Variance component analyses. Group Dynamics: Theory, Research, and Practice 2010. [DOI: 10.1037/a0019170] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Steen NE, Tesli M, Kähler AK, Methlie P, Hope S, Barrett EA, Larsson S, Mork E, Løvås K, Røssberg JI, Agartz I, Melle I, Djurovic S, Lorentzen S, Berg JP, Andreassen OA. SRD5A2 is associated with increased cortisol metabolism in schizophrenia spectrum disorders. Prog Neuropsychopharmacol Biol Psychiatry 2010; 34:1500-6. [PMID: 20800085 DOI: 10.1016/j.pnpbp.2010.08.013] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [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: 07/01/2010] [Revised: 08/17/2010] [Accepted: 08/18/2010] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Dysfunction of the hypothalamic-pituitary-adrenal (HPA) axis is documented in bipolar disorder and schizophrenia, but the mechanism is unclear; recently, increased activity of cortisol metabolizing enzymes was indicated in these disorders. We investigated whether five genes involved in cortisol metabolism were associated with altered activity of cortisol metabolizing enzymes in bipolar disorder (BD) and schizophrenia spectrum disorders (SCZ). METHODS A case-control sample of subjects with BD (N=213), SCZ (N=274) and healthy controls (N=370) from Oslo, Norway, were included and genotyped from 2003 to 2008. A sub-sample (healthy controls: N=151; SCZ: N=40; BD: N=39) had estimated enzyme activities based on measurements of urinary free cortisol, urinary free cortisone and metabolites. A total of 102 single nucleotide polymorphisms (SNPs) in the SRD5A1, SRD5A2, AKR1D1, HSD11B1 and HSD11B2 genes were genotyped, and significant SNPs analyzed in the sub-sample. RESULTS There was a significant association of rs6732223 in SRD5A2 (5α-reductase) with SCZ (p=0.0043, Bonferroni corrected p=0.030, T risk allele). There was a significantly increased 5α-reductase activity associated with rs6732223 (T allele) within the SCZ group (p=0.011). CONCLUSIONS The present data suggest an interaction between SCZ and SRD5A2 variants coding for the enzyme 5α-reductase, giving rise to increased 5α-reductase activity in SCZ. The findings may have implications for cortisol metabolizing enzymes as possible drug targets.
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Affiliation(s)
- Nils Eiel Steen
- Section for Psychosis Research, Clinic of Mental Health and Addiction, Oslo University Hospital, Ullevål Hospital, P.O. Box 4956 Nydalen, 0424 Oslo, Norway.
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Djurovic S, Gustafsson O, Mattingsdal M, Athanasiu L, Bjella T, Tesli M, Agartz I, Lorentzen S, Melle I, Morken G, Andreassen OA. A genome-wide association study of bipolar disorder in Norwegian individuals, followed by replication in Icelandic sample. J Affect Disord 2010; 126:312-6. [PMID: 20451256 DOI: 10.1016/j.jad.2010.04.007] [Citation(s) in RCA: 96] [Impact Index Per Article: 6.9] [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: 11/19/2009] [Revised: 04/12/2010] [Accepted: 04/12/2010] [Indexed: 11/25/2022]
Abstract
BACKGROUND In the present study we investigated genetic variants associated with bipolar disorder in a homogenous Norwegian sample, and potential genetic overlap with schizophrenia, using the Affymetrix 6.0 array. METHODS We carried out a genome-wide association study (GWAS) by genotyping 620 390 single-nucleotide polymorphisms (SNPs) in a case-control sample of Norwegian origin (the TOP study) including bipolar disorder (n=194), healthy controls (n=336) and schizophrenia (n=230), followed by replication and combined analysis in a genetically concordant Icelandic sample of bipolar disorder (n=435), and healthy controls (n=10,258). RESULTS We selected 1000 markers with the lowest P values in the TOP discovery GWAS and tested these (or their surrogates) for association in the Icelandic replication sample. Polymorphisms on 35 loci were confirmed associated with bipolar disorder (nominal P value<0.05; not corrected for multiple testing) in the replication sample. The most significant markers were located in DLEU2, GUCY1B2, PKIA, CCL2, CNTNAP5, DPP10, and FBN1. The combined group of schizophrenia and bipolar disorder compared to controls did not provide additional significant findings. LIMITATIONS Relatively small number of samples. CONCLUSIONS We detected weak but reproducible association with markers in several genes, in proximity to susceptibility loci found in previous GWAS studies of bipolar disorder. Further work is required to study their localization, expression, and regulation and international meta-analytic efforts will help to further elucidate their role.
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Hope S, Melle I, Aukrust P, Agartz I, Lorentzen S, Steen NE, Djurovic S, Ueland T, Andreassen OA. Osteoprotegerin levels in patients with severe mental disorders. J Psychiatry Neurosci 2010; 35:304-10. [PMID: 20569643 PMCID: PMC2928283 DOI: 10.1503/jpn.090088] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [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: 12/12/2022] Open
Abstract
BACKGROUND Severe mental disorders are associated with elevated levels of inflammatory markers. In the present study, we investigated whether osteoprotegerin (OPG), a member of the tumour necrosis factor receptor family involved in calcification and inflammation, is elevated in patients with severe mental disorders. METHODS We measured the plasma levels of OPG in patients with severe mental disorders (n = 312; 125 with bipolar disorder and 187 with schizophrenia) and healthy volunteers (n = 239). RESULTS The mean plasma levels of OPG were significantly higher in patients than in controls (t531 = 2.6, p = 0.01), with the same pattern in bipolar disorder and schizophrenia. The increase was significant after adjustment for possible confounding variables, including age, sex, ethnic background, alcohol consumption, liver and kidney function, diabetes, cardiovascular disease, autoimmune diseases and levels of cholesterol, glucose and C-reactive protein. LIMITATIONS Owing to the cross-sectional design, it is difficult to determine causality. CONCLUSION Our results indicate that elevated OPG levels are associated with severe mental disorders and suggest that mechanisms related to calcification and inflammation may play a role in disease development.
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Affiliation(s)
- Sigrun Hope
- Department of Psychiatry, Østfold Hospital, Fredrikstad, Norway.
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Larsson S, Lorentzen S, Mork E, Barrett EA, Steen NE, Lagerberg TV, Berg AO, Aminoff SR, Agartz I, Melle I, Andreassen OA. Age at onset of bipolar disorder in a Norwegian catchment area sample. J Affect Disord 2010; 124:174-7. [PMID: 19931918 DOI: 10.1016/j.jad.2009.10.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2009] [Revised: 10/30/2009] [Accepted: 10/31/2009] [Indexed: 11/19/2022]
Abstract
BACKGROUND Early onset of bipolar disorder (BD) is an important clinical predictor of a more severe course and poorer outcome. A higher proportion of childhood onset BD has been reported in studies from USA compared to Europe. We investigated age at onset of first affective episode in a Norwegian sample and compared it to previous European and US findings. In addition, we examined whether age at onset influenced on time to first treatment, and if patient characteristics related to illness severity influenced age at onset. METHODS Two hundred and twenty five BD patients were recruited consecutively mainly from psychiatric out-patient units at three major hospitals in Oslo, Norway, diagnosed using SCID-I and divided into four groups based on age at onset. RESULTS Six percent of the patients had onset in childhood, 32% in adolescence, 43% in young adulthood, and 19% as adults. Average age at onset was 22.8 years (SD 9.4). There was a significantly higher age at onset and a significantly shorter time from onset to first treatment in patients with lifetime hospitalization. LIMITATION Retrospective information which could be confounded by collection bias. CONCLUSION Age at onset in our sample resembled previous European studies, but not US- or Norwegian studies. The difference in age at onset seems more related to different definitions of onset, than to hospitalization history. This highlights the importance of improving the research criteria and of using similar criteria to ascertain age at onset.
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Affiliation(s)
- Sara Larsson
- Institute of Psychiatry, University of Oslo, Oslo, Norway.
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Abstract
This study examined the relationships among group therapy processes measured by the Working Alliance Inventory-Short Form, the Therapeutic Factors Inventory Cohesiveness subscale, and the Group Climate Questionnaire-Short Form in a sample of 145 patients attending 18 psychodynamic groups. Five hypothesized models were tested early in therapy (Sessions 3 and 4) using multilevel confirmatory factor analysis. Two three-factor models approached conventional standards of model fit. By merging these two models, a three-factor model consisting of member-leader alliance, positive bonding relationship, and negative relationship fit the data well. Later in therapy, member-leader bonding was no longer important to member-group cohesion, indicating that cohesion and alliance and the member-leader versus member-group bonding represent different processes.
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Affiliation(s)
- Jan V Bakali
- Clinic for Mental Health, Olso University Hospital, Aker, Norway.
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Hope S, Melle I, Aukrust P, Steen NE, Birkenaes AB, Lorentzen S, Agartz I, Ueland T, Andreassen OA. Similar immune profile in bipolar disorder and schizophrenia: selective increase in soluble tumor necrosis factor receptor I and von Willebrand factor. Bipolar Disord 2009; 11:726-34. [PMID: 19839997 DOI: 10.1111/j.1399-5618.2009.00757.x] [Citation(s) in RCA: 115] [Impact Index Per Article: 7.7] [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: 12/13/2022]
Abstract
BACKGROUND Alterations in the inflammatory system have been associated with schizophrenia and major depression, while bipolar disorder has been less studied. Most previous studies examined small samples, and the literature is inconsistent with regard to specific underlying immune mechanisms. In the present study, we examined markers representing different inflammatory pathways, and the aim was to investigate whether the levels of inflammatory parameters in a representative sample of bipolar disorder and schizophrenia are elevated compared to healthy controls, and to investigate whether the inflammatory profile is different between the groups. METHODS Plasma levels of soluble tumor necrosis factor receptor 1 (sTNF-R1), interleukin-1 receptor antagonist (IL-1Ra), interleukin-6 (IL-6), high-sensitivity CRP (hs-CRP), soluble CD40L ligand (sCD40L), and von Willebrand factor (vWf) were measured with ELISA techniques in a catchment area based sample of consecutively referred patients with severe mental disorders [N = 311, comprising bipolar disorder (n = 125) and schizophrenia (n = 186)] and in healthy volunteers (n = 244). RESULTS Plasma levels of sTNF-R1 and vWf were statistically significantly increased in both bipolar disorder and schizophrenia compared to controls (p < 0.00001), and were also increased in unmedicated patients, but there were no major differences between the two diagnostic groups. Controlling for age, gender, ethnicity, cardiovascular disorders, kidney and liver function, and other confounders did not affect the results. There were no differences in other inflammation factors between the groups. CONCLUSION The present results indicate specific alterations of endothelium-related inflammation processes in both bipolar disorder and schizophrenia.
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Affiliation(s)
- Sigrun Hope
- Department of Psychiatry, Østfold Hospital, Eidsberg, Norway.
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Lorentzen S, Høglend PA. Moderators of the effects of treatment length in long-term psychodynamic group psychotherapy. Psychother Psychosom 2008; 77:321-2. [PMID: 18663333 DOI: 10.1159/000147946] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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