Mid Sweden University

Despite its high prevalence, individuals suffering from skin-picking disorder (SPD) face limited access to treatment due to several factors, including geographical and economic barriers, as well as a shortage of properly trained therapists. Offering Internet-delivered therapy could be a solution to these barriers. This study aimed to evaluate the efficacy of therapist-guided Internet-delivered acceptance-enhanced behavior therapy (iBT) for SPD compared to a wait-list control condition. Participants randomized to the intervention group received 10 weeks of iBT (n = 35), while those in the control group were placed on a wait-list (n = 35). The primary outcome was the Skin Picking Scale—Revised (SPS-R). Mixed-model regression analyses demonstrated a significantly greater improvement in SPD symptoms in the iBT group compared to the control group at posttreatment (between-group difference −5.1 points, F = 9.69, p <.001). The between-group effect size was in the large range, with a bootstrapped d of 1.3 (95% CI [0.92, 1.69]). At posttreatment, 43% of the participants in the iBT group were classified as responders, and 31% were in remission, compared to 0% responders and 3% in remission in the control group. At the 6-month follow-up, the SPD symptoms had increased compared to posttreatment. However, the improvement from pretreatment remained significant. Participants reported a high level of satisfaction and credibility of the treatment, and a perceived good level of working alliance. Compared to wait-list control, iBT is an efficacious treatment for SPD at posttreatment and follow-up, with the potential to substantially increase the availability and access to evidence-based treatment for this disorder. Replication studies, particularly those comparing iBT to an active control, are warranted. 

Despite the well-documented link between child maltreatment (CM) and mental health, evidence suggests substantial variability in the post-traumatic sequelae of CM across cultures. The perceived acceptability of CM in one’s community might moderate the association between CM and mental health, but little research has been conducted on it so far. This study examined how the perceived acceptability of CM may influence the relationship between CM experiences and post-traumatic symptoms in individuals from four different continents and if the pattern of associations is the same across countries. We recruited a sample of 478 adults from Cameroon (n = 111), Canada (n = 137), Japan (n = 108), and Germany (n = 122). We administered online questionnaires and performed multiple group moderation analyses for total CM, neglect, physical abuse, emotional maltreatment, sexual abuse, and exposure to domestic violence (DV). A significant positive main effect of CM on post-traumatic symptoms was found in the overall sample and in Cameroon; in Germany, only neglect and emotional maltreatment were positively associated to post-traumatic symptoms. Moderation effects were identified; the perceived acceptability of neglect in Cameroon and Germany and of exposure to DV in Cameroon had a dampening effect on the relationship between CM experiences and post-traumatic symptoms. Our findings confirm that CM experiences entail long-term post-traumatic sequelae that can vary across cultures and CM subtypes and further our understanding of this issue by showing that the perceived acceptability of CM may be an understudied moderator. 

The clinical impact of structured risk assessment instruments has been limited by a lack of information regarding a) their short-term accuracy and b) the relationship between change as measured by the instrument and a change in the risk for harm. Data were collected every 4 weeks on a) variables designed to resemble the items of a structured risk assessment instrument, b) substance use, c) social circumstances and mental state, and d) violent behavior. Scores on the variables designed to resemble the items of a risk assessment instrument were associated with violence during the ensuing 4 weeks. However, an increase in a subject's score on these variables was not associated with violence. Instead, increasing cocaine use and increasing social conflict as described by the subject at interview were associated with violence during those weeks. Copyright © 2013 Lippincott Williams & Wilkins.

Research about online sexual violence (OSV) is needed to be able to better meet the needs of girls in psychiatric care. The objectives of this study are to explore experiences of online sexual violence among young female psychiatric service users. Interviews with nine girls with psychiatric care needs were analyzed with thematic analysis. The findings are summarized in four themes which contribute to the notion that online sexual violence is only one, albeit important, part of a more complex picture of violence among young girls in psychiatric care. The girls’ narratives are shaped by, as well as reproducing gender norms. 

Diminished emotional capacity is a core characteristic of psychopathic personality. We examined behavioral and electrophysiological differences in attentional bias to emotional material in 34 healthy individuals rated high or low in psychopathic traits using the short form of the Psychopathic Personality Inventory-Revised (18 high-trait, 16 low-trait). While performing an emotional Stroop task, high-trait participants displayed reduced emotional modulation of the late positive potential (LPP, 400-600ms), and early anterior positivity (EAP, 200-300ms) amplitudes. Results suggest blunted bias to affective content in psychopathic personality, characterized by diminished early capture to emotional salience (EAP) and dampened cognitive emotional processing (LPP).

Social anxiety disorder (SAD) can come in different forms, presenting problems for diagnostic classification. Here, we examined personality traits in a large sample of patients (N = 265) diagnosed with SAD in comparison to healthy controls (N = 164) by use of the Revised NEO Personality Inventory (NEO-PI-R) and Karolinska Scales of Personality (KSP). In addition, we identified subtypes of SAD based on cluster analysis of the NEO-PI-R Big Five personality dimensions. Significant group differences in personality traits between patients and controls were noted on all Big Five dimensions except agreeableness. Group differences were further noted on most lower-order facets of NEO-PI-R, and nearly all KSP variables. A logistic regression analysis showed, however, that only neuroticism and extraversion remained significant independent predictors of patient/control group when controlling for the effects of the other Big Five dimensions. Also, only neuroticism and extraversion yielded large effect sizes when SAD patients were compared to Swedish normative data for the NEO-PI-R. A two-step cluster analysis resulted in three separate clusters labelled Prototypical (33%), Introvert-Conscientious (29%), and Instable-Open (38%) SAD. Individuals in the Prototypical cluster deviated most on the Big Five dimensions and they were at the most severe end in profile analyses of social anxiety, self-rated fear during public speaking, trait anxiety, and anxiety-related KSP variables. While additional studies are needed to determine if personality subtypes in SAD differ in etiological and treatment-related factors, the present results demonstrate considerable personality heterogeneity in socially anxious individuals, further underscoring that SAD is a multidimensional disorder.

Purpose: Poythress, Edens, et al. (2010) recently used cluster analysis to identify subtypes of antisocial and psychopathic offenders using a diverse collection of theoretically important clustering variables. Two predicted subtypes, primary and secondary psychopathy, were identified, in addition to non-psychopathic and (unexpectedly) "fearful" psychopathic offenders. The purpose of the present research was to determine whether these clusters could be replicated using a single self-report measure, the Psychopathic Personality Inventory (PPI; Lilienfeld & Andrews, 1996). Method: Study 1: We used discriminant function analysis (DFA) to predict cluster membership for the Poythress et al. subtypes based solely on the eight subscales of the PPI. Results: Study 1: Though overall classification accuracy with the original clusters was poor, PPI-derived subtypes differed from each other in theoretically consistent ways on several criterion measures. Method: Study 2: We used the PPI-based DFA to classify a separate sample of prison inmates from a prior PPI study (Edens et al., 2008). Results: Study 2: As predicted, inmates classified into the secondary psychopathy subgroup demonstrated the highest rates of aggressive misconduct whereas non-psychopathic were the least prone to engage in misconduct. Conclusion: The PPI may serve as a relatively simple method of identifying theoretically meaningful subtypes of psychopathic offenders.

We evaluated the interrater reliability and concurrent validity of the HCR-20 Version 3 (HCR-20V3). Three sets of ratings were completed by experienced clinicians for 35 forensic psychiatric patients, for both HCR-20 Versions 2 and 3. Reliability analyses focused on ratings of the presence of Version 3 risk factors, presence of Version 3 risk factor sub-items, relevance ratings for Version 3 risk factors, and Version 3 summary risk ratings for future violence. Concurrent validity analyses focused on the correlational association between Versions 2 and 3 in terms of the number of risk factors present. Findings indicated that Versions 2 and 3 were strongly correlated (.69 -.90). Interrater reliability was consistently excellent for the presence of risk factors and for summary risk ratings. The majority of relevance and sub-item ratings were in the good to excellent range, although there was a minority of such ratings in the fair or poor categories. Findings support the concurrent validity and interrater reliability of HCR-20V3. Implications for use of HCR-20V3 by professionals and agencies are discussed. © 2014 International Association of Forensic Mental Health Services.

The HCR-20 Version 3 (HCR-20V3) was published in 2013, after several years of development and revision work. It replaces Version 2, published in 1997, on which there have been more than 200 disseminations based on more than 33,000 cases across 25 countries. This article explains (1) why a revision was necessary, (2) the steps we took in the revision process, (3) key changes between Version 2 and Version 3, and (4) an overview of HCR-20V3's risk factors and administration steps. Recommendations for evaluating Version 3 are provided. © 2014 International Association of Forensic Mental Health Services.

Övergripande kunskaper kring gränsområdet och samarbetet mellan barn- och ungdomspsykiatrin och allmänpsykiatrin saknas nästan helt trots att de två disciplinerna har funnits parallellt under nästan hela 1900-talet. Brister i samarbetet har uppmärksammats i de statliga utredningar som under 1990-talet presenterades om den psykiatriska och den barn- och ungdomspsykiatriska vården. Undersökningen är en beskrivning av kunskaper/värderingar om varandra vid jämförelse av personalgrupper inom barn- och ungdomspsykiatri och vuxenpsykiatri. Målet är att beskriva vad som krävs för att utveckla samarbetet för äldre tonåringar/unga vuxna i åldrarna 16-25 år. Jämförelsen av personalgruppernas kunskaper/värderingar om varandra gjordes genom en enkätundersökning. Då liknande undersökningar ej har återfunnits vid litteratursökning kan denna enkätstudie ses som en �första förberedande� studie eller av pilotkaraktär. Till denna valdes sex personalgrupper med gemensam utbildning ut. . Resultaten tyder på att det inom vuxenpsykiatrisk verksamhet finns brister när det gäller barn- och ungdoms kunskap i allmänhet och att det finns skillnader i syn- och arbetssätt mellan disciplinerna. Grundutbildningen inom vårdyrkena borde förbättras både vad gäller barn- och ungdomspsykiatri och i vidareutbildningen bör kunskaper om varandras områden ingå. Organisationen inom sjukhuset ansågs utgöra ett hinder för samarbete. Övergången för patienter från barn- och ungdomspsykiatrin till vuxenpsykiatrin sågs som ett problem av båda personalgrupperna. Det fanns intresse för samarbete kring ungdomsgruppen med en vilja att närma sig varandra utifrån denna grupps behov.

Beskrivning av organisationsförändring från traditionell barnpsykiatrisk skutenvård med miljöterapeutisk inriktning till öppenvård med systemisk inriktning. Intevjuer med personal 3 år efter förändringen Personalen är nöjdare med detta sätt att arbeta och vården kunde bedrivas på ett effektivare sätt

Denna artikel bygger på Ulf Engqvists avhandling, som kan ses som ett steg i processen att bättre leva upp till bland annat psykiatrireformens intentioner kring barns och vuxnas psykiska hälsa. Det krävs ett bättre samarbete mellan de psykiatriska kunskapsområdena, psykiatriska verksamheter och andra myndigheter som påverkar den psykiska hälsan i det svenska samhället. Dessa förbättringar i hälso- och sjukvården som organisation och att alltid hålla patinternas bästa för ögonen kan förbättra prognosen för barn i riskzonen

Avhandlingen behandlar gränsområdet mellan barn- och ungdomspsykiatri och vuxenpsykiatri. Syfte: att beskriva hur det går för barn- och ungdomspsykiatrins patienter, vilken den patientgrupp är som blir gemensam för de båda disciplinerna och vad som krävs för att utveckla samarbetet för äldre tonåringar/unga vuxna i åldrarna 16-25 år. Metod: Journal och registerstudie. Enkätundersökning riktad till personalgrupperna inom de två psykiatriska disciplinerna. Resultat: 25 patienter, 1,8 procent avled, majoriteten på grund av självmord. Drygt var 4:e tidigare BUP-patient och nästan dubbelt så många kvinnor som män (1,7:1), har sökt vuxenpsykiatrisk kontakt efter den barn- och ungdomspsykiatriska vården. En tredjedel av de tidigare BUP-patienterna var kända i kriminalregistret. Elva personer, 0,8 procent hade utvecklat så allvarligt missbruk att LVM-vård hade skett. Resultaten av enkätundersökningen tyder på att det inom vuxenpsykiatrisk verksamhet finns brister när det gäller barn- och ungdoms kunskap i allmänhet och att det finns skillnader i syn- och arbetssätt mellan disciplinerna. Övergången för patienter från barn- och ungdomspsykiatrin till vuxenpsykiatrin sågs som ett problem av båda personalgrupperna.

The overall aim was to provide information about child and adolescent psychiatric (CAP) patients and their outcome as adults: Were their difficulties in childhood due to mental illness, disablement and/or behaviour disorders? What happened to them as adults? Who were the patients in need of psychiatric care (GenP) in adulthood that had not had previous contact with CAP? Did this group differ from the former CAP group? Methods: Paper I-III: 1,400 CAP patients admitted 1975-1990 to inpatient or outpatient CAP care in Jämtland County, Sweden were followed until 2003. Paper IV: A sample of 167 GenP patients not treated in CAP was compared to GenP patients with a history of CAP care. Hospital records at CAP were reassessed according to a study specific protocol. Outcome was measured in relation to register data on mortality, suicides, psychiatric/somatic care, and criminal convictions. CAP records were examined for those treated for psychosis either at CAP and or in GenP. Results: Every third CAP patient has later received GenP care. They constituted a small part of the GenP patients in the same age-groups. The CAP patients showed an elevated rate of early death. Two of the 19 who later committed suicide had been initially admitted because of attempted suicide. Every third CAP patient had a criminal record. Over the past 50 years, the percentage of Swedish boys admitted to CAP care and later registered as criminals seems to have doubled while the corresponding percentage for girls has increased almost seven times. Behavioural disorders as a reason for CAP care were the most substantial risk factor for later criminality. Sixty-two former CAP patients (4.4%) received a psychosis diagnosis during the observation time 48 of them within the Schizophrenia categories and 14 with Psychotic Mood Disorder. Mean age at first onset was 21.4 years. Changes in behaviour, including social isolation, refusal to go to school, loneliness and odd behaviour in general were the initial signs and symptoms most frequently observed prior or upon admission to CAP-care. The GenP patients with and without a previous history in CAP care had similar problems as adults. Both groups had a larger need of somatic hospital inpatient-care before the age of 18 years when compared to the general population. More than a third of the treatment occasions occurred in paediatric care. Conclusions: Psychosocial risk factors and social maladjustment in childhood seem to be the most important predictors of early death, including suicide. The increased risk of later criminality is hypothetically the result of rising alcohol consumption in Sweden, the comorbid use of illegal drugs, and changes in the organization of child social welfare work, the school system, and CAP methods that has occurred since 1970. Patients with onset of schizophrenia before 13-17 years of age showed typical symptoms upon admission to CAP care; while late-onset psychosis among former CAP could not be predicted from information gathered during CAP care. There is a group of patients treated in paediatrics and in CAP during childhood and adolescence before becoming later patients in GenP. These patients can most likely be identified during childhood if a closer collaboration is developed between paediatrics and CAP services. Hypothetically, the need of GenP care as adults in the larger group of GenP patients without a previous CAP history may develop from accumulated stressful life-events.

BACKGROUND: Increased mortality rates among previous child and adolescent psychiatry (CAP) patients have been found in Scandinavian studies up to the 1980s. The suicide risk in this group has been estimated to be almost five times higher than expected. This article addresses two questions: Do Swedish CAP patients continue to risk premature death and what kind of information related to psychiatric symptoms and/or behavior problems can predict later suicide? METHODS: Hospital files, Sweden's census databases (including immigration and emigration) and administrative databases (including the Swedish Hospital Discharge register and the Persons Convicted of Offences register), and the Cause of Death register were examined to determine the mortality rate in a group of 1,400 former CAP inpatients and outpatients over a period of 12-33 years. Observed and expected numbers of deceased were calculated with the prospective method and the standardized mortality ratio (SMR) method. The relative risk or the risk ratio (RR) is presented with 95% confidence intervals (CIs). Significance level tests were made using two-by-two tables and chi-square tests. The Cox proportional-hazards regression model was used for survival analysis. RESULTS: Twenty-four males and 14 females died. Compared with the general population, the standardized mortality ratio in this group of CAP patients was significantly higher in both sexes. Behavioral problems, school problems, and co-morbid alcohol or drug abuse and criminality (including alcohol-related crimes) were found to be important predictors. Thirty-two deaths were attributed to suicide, intoxication, drug overdose, or accident; one patient died of an alcohol abuse-related disorder, and five patients died of natural causes. Suicide was the most common cause of death, but only 2 of these 19 cases were initially admitted for attempted suicide. CONCLUSION: We suggest that suicide and death prevention among CAP patients may not be a psychiatric issue per se but a future function of society's juvenile social-welfare investments and juvenile-delinquency prevention programs.

Background Sweden has an extensive child and adolescent psychiatric (CAP) research tradition in which longitudinal methods are used to study juvenile delinquency. Up to the 1980s, results from descriptions and follow-ups of cohorts of CAP patients showed that children´s behavioural disturbances or disorders and school problems, together with dysfunctional family situations, were the main reasons for families, children, and youth to seek help from CAP units. Such factors were also related to registered criminality and registered alcohol and drug abuse in former CAP patients as adults. This study investigated the risk for patients treated 1975-1990 to be registered as criminals until the end of 2003. Methods A regional sample of 1,400 former CAP patients, whose treatment occurred between 1975 and 1990, was followed to 2003, using database-record links to the Register of Persons Convicted of Offences at the National Council for Crime Prevention (NCCP). Results Every third CAP patient treated between 1975 and 1990 (every second man and every fifth woman) had entered the Register of Persons Convicted of Offences during the observation period, which is a significantly higher rate than the general population. Conclusions Results were compared to published results for CAP patients who were treated between 1953 and 1955 and followed over 20 years. Compared to the group of CAP patients from the 1950s, the results indicate that the risk for boys to enter the register for criminality has doubled and for girls, the risk seems to have increased sevenfold. The reasons for this change are discussed. Although hypothetical and perhaps speculative this higher risk of later criminality may be the result of lack of social control due to (1) rising consumption of alcohol, (2) changes in organisation of child social welfare work, (3) the school system, and (4) CAP methods that were implemented since 1970.

Background

This investigation was designed to characterize psychotic disorders among patients originally treated as in- and outpatients by child and adolescent psychiatric services and subsequently followed-up into mid-adulthood. The age at the first onset on symptoms, possible changes in diagnoses, early signs noted prior to or upon admission to child and adolescent psychiatric care and possible differences between patients with early- and later- onset disorder were of particular interest.

Methods

The study population consisted of patients (285 in- and 1115 outpatients) born between 1957 and 1976 and admitted to and treated by child and adolescent psychiatric care units in Jämtland County, Sweden, between 1975 and 1990. The status of their mental health was monitored until 2003 using official registries and hospital records. Diagnoses based on the ICD-8 and -9 systems, which were used in Sweden from 1968-1997, converted to diagnoses according to ICD-10, which has been in use since 1997. The Comprehensive Assessment of at Risk Mental States was employed to assess the information concerning psychopathology provided by the hospital records.

Results

By the end of the follow-up period 62 former child and adolescent psychiatric patients (36 females and 26 males), 4.4% of the entire study group, had received an ICD-10 diagnosis of "F20-29: Schizophrenia, schizotypal and delusional disorders" (48) and/or "F30-39: Psychotic mood disorders" (14). One-third (21) of these individuals were given their initial diagnosis of psychosis in connection with child and adolescent psychiatric care. Two of these 21 were not treated later for this disorder in general (adult) psychiatric care whereas the remaining 19 individuals were diagnosed for the same type of disorder as adults. The other 41 patients were diagnosed as psychotic only in connection with general (adult) psychiatric care. The mean age at the time of first onset of symptoms was 21.4 years (SD 6.4) and corresponding median age was 18. Behavioural changes and positive symptoms were the most frequent signs associated with a diagnosis of "F20-F29: Schizophrenia, schizotypal and delusional disorders" made during child and adolescent psychiatric care. In cases where a specific psychopathology developed later on the initial admission to child and adolescent psychiatry involved unspecified psychopathology.

Conclusions

In summary, it appears that psychotic disorders are relatively uncommon among patients admitted to child and adolescent psychiatric care in Sweden. However, individuals experiencing early onset of disorders categorized as "F20-29: Schizophrenia, schizotypal and delusional disorders" may already exhibit typical symptoms upon admission to child and adolescent psychiatric care of the age of 13-17; whereas late-onset disorders it appear not be associated with any obvious signs or symptoms years before the disorder has developed fully. Finally, certain cases of psychotic disorder during adolescence seem to have been episodic.

It is well established that burnout in medical students is associated with depression and anxiety at a syndromal level. Moreover, there is an ongoing debate about the extent to which burnout overlaps with depression and anxiety. The emerging network approach to psychopathology offers a new perspective on the interrelations between mental disorders focusing on symptom-level association. In this cross-sectional study, we exploratively investigated the associations among burnout, depression, and anxiety in 574 swiss medical students using a network analytic approach for the first time. Symptoms of depression and anxiety were assessed with the Patient Health Questionnaire and Generalized Anxiety Disorder respectively. Burnout was assessed with two single-item questions, one referring to emotional exhaustion and the other to depersonalization. We found a dense network in which at least one dimension of burnout was related to eleven of the sixteen included symptoms. This suggests that burnout is closely related to depression and anxiety but also has its own characteristics. Notably, suicidal ideation was not associated with either emotional exhaustion or depersonalization after adjusting for the influence of the remaining symptoms of anxiety and depression. Hence, the well-documented relationship between burnout and suicidal ideation in medical students may be entirely mediated by the experience of anxiety and depression. Hence, the well-documented relationship between burnout and suicidal ideation in medical students might be fully mediated by the experience of anxiety and depression. The collection of the sample after the first wave of infections during the SARS-CoV2 pandemic and the non-representativeness of the investigated sample limit the study's generalizability.

Background: Perceived social support is an established predictor of post-traumatic stress disorder (PTSD) after exposure to a traumatic event. Gender is an important factor that could differentiate responses to social support, yet this has been little explored. Symptoms of complex PTSD are also common following trauma but have been under-researched in this context. Large scale studies with culturally diverse samples are particularly lacking.Objectives: In a multi-country sample, we examined: (a) gender differences in perceived social support and both posttraumatic stress symptom severity (PTSS) and complex posttraumatic stress symptom severity (CPTSS); (b) associations between social support and PTSS/CPTSS; and (c) the potential moderating role of gender in the relationship between perceived social support and trauma-related distress.Method: A total of 2483 adults (Mage = 30yrs, 69.9% females) from 39 countries, who had been exposed to mixed trauma types, completed the Multidimensional Scale of Perceived Social Support and the International Trauma Questionnaire (which captures PTSS/CPTSS). Regression analyses examined associations between gender, perceived social support, and PTSS/CPTSS; and tested for gender by social support interactions in predicting PTSS/CPTSS scores. Models were adjusted for age and socioeconomic status.Results: In our cross-country sample, females had greater PTSS/CPTSS than males (B = .23 [95% CI 0.16, 0.30], p < .001; B = .20 [0.12, 0.27], p < .001; respectively), but there was no evidence of gender differences in perceived social support (B = .05 [-0.05, 0.16], p = .33). For both genders, low perceived social support was associated with higher PTSS/CPTSS (females: B = -.16 [-0.20, -0.12], p < .001; B = -.27 [-0.30, -0.24], p < .001; respectively; males: B = -.22 [-0.29, -0.15], p < .001; B = -.31 [-0.36, -0.26], p < .001; respectively), and for PTSS only we found weak evidence that this association was stronger for males vs. females (B = .07 [0.04, 0.14, p = .04).Conclusion: Individuals who feel more socially supported have lower trauma-related distress, and this association is similar in males and females. PTSD/CPTSD interventions may benefit from augmenting perceived social support, regardless of gender.; In our multi-country sample, females show higher levels of (complex) posttraumatic stress symptom severity than males.There is no evidence of gender differences in perceived social support.Greater perceived social support is associated with lower (complex) posttraumatic stress symptom severity across both genders.

The amygdala is a key structure in the pathophysiology of anxiety disorders, and a putative target for anxiolytic treatments. Selective serotonin reuptake inhibitors (SSRIs) and placebo seem to induce anxiolytic effects by attenuating amygdala responsiveness. However, conflicting amygdala findings have also been reported. Moreover, the neural profile of responders and nonresponders is insufficiently characterized and it remains unknown whether SSRIs and placebo engage common or distinct amygdala subregions or different modulatory cortical areas. We examined similarities and differences in the neural response to SSRIs and placebo in patients with social anxiety disorder (SAD). Positron emission tomography (PET) with oxygen-15-labeled water was used to assess regional cerebral blood flow (rCBF) in 72 patients with SAD during an anxiogenic public speaking task, before and after 6-8 weeks of treatment under double-blind conditions. Response rate was determined by the Clinical Global Impression-Improvement scale. Conjunction analysis revealed a common rCBF-attenuation from pre- to post-treatment in responders to SSRIs and placebo in the left basomedial/basolateral and right ventrolateral amygdala. This rCBF pattern correlated with behavioral measures of reduced anxiety and differentiated responders from nonresponders. However, nonanxiolytic treatment effects were also observed in the amygdala. All subgroups, including nonresponders, showed deactivation of the left lateral part of the amygdala. No rCBF differences were found between SSRI responders and placebo responders. This study provides new insights into the brain dynamics underlying anxiety relief by demonstrating common amygdala targets for pharmacologically and psychologically induced anxiety reduction, and by showing that the amygdala is functionally heterogeneous in anxiolysis.

Impulsivity is an important component If many forms of psychopathology. Though widely used as an index of this construct, the 30-item Barratt Impulsiveness Scale-11 (HIS-11) has demonstrated questionable psychometric properties in several research reports. An 8-item shortened Version has recently been proposed, the Barran Impulsiveness Scale Brief (BIS-Brief) form, which was designed to overcome some of the limitations of the longer scale. In this report, we examine the internal structure and theoretically relevant external correlates of this new short form in large archival samples of individuals involved in the criminal justice system (prison inmates, substance abusers in mandatory treatment, and forensic inpatients). Confirmatory factor analysis of the BIS-Brief indicates adequate fit following a relatively minor modification. Correlations between the HIS-Brief and an array' of criterion measures other self-report scales, interview-based measures, and behavioral outcomes are consistent with predictions and show relatively little or no decrement in predictive validity when compared with the 30-item HIS-11. Our results suggest that the HIS-Brief is a promising brief measure of impulsivity that evinces good psychometric properties across a range of offender samples.

The neurokinin-1 (NK1) receptor is abundantly expressed in the fear circuitry of the brain, including the amygdala, where it modulates stress and anxiety. Despite its proposed involvement in psychopathology, only a few studies of NK1 receptor availability in human subjects with anxiety disorders exist. Here, we compared NK1 receptor availability in patients with social anxiety disorder (SAD; n = 17) and healthy controls (n = 17) using positron emission tomography and the radiotracer [11C]GR205171. The Patlak Graphical plot using a cerebellar reference region was used to model the influx parameter, Ki measuring NK1 receptor availability. Voxel-wise statistical parametric mapping analyses revealed increased NK1 receptor availability specifically in the right amygdala in SAD patients relative to controls. Thus, we demonstrate that exaggerated social anxiety is related to enhanced NK1 receptor availability in the amygdala. This finding supports the contribution of NK1 receptors not only in animal models of stress and anxiety but also in humans with anxiety disorders.

Depression and mental illness is now a major health problem. Although the physical health benefits are well known, there are few in health care that uses physical activity as complementary treatment of depression state. The purpose of this qualitative study was to identity and describe staff's experience and views on physical activity as part of psychiatric care for depression condition. The study was a qualitative study of structuring focus group interviews who were analyzed using content analysis in which a major theme; To have knowledge and ideas but not getting to it, two themes and seven subthemes, was the result. The results of the study showed that nursing staff felt that it was better before when it was a more structured life with exercise and planned activities of each department that the patients would participate in. The results showed both obstacles and opportunities in terms of physical activity as health care measure. The conclusion is that the staff has knowledge of care measures for depression but it is a great need for improved physical activity on depression for patients in psychiatric clinic.

Placebo may yield beneficial effects that are indistinguishable from those of active medication, but the factors underlying proneness to respond to placebo are widely unknown. Here, we used functional neuroimaging to examine neural correlates of anxiety reduction resulting from sustained placebo treatment under randomized double-blind conditions, in patients with social anxiety disorder. Brain activity was assessed during a stressful public speaking task by means of positron emission tomography before and after an 8 week treatment period. Patients were genotyped with respect to the serotonin transporter-linked polymorphic region (5-HTTLPR) and the G-703T polymorphism in the tryptophan hydroxylase-2 (TPH2) gene promoter. Results showed that placebo response was accompanied by reduced stress-related activity in the amygdala, a brain region crucial for emotional processing. However, attenuated amygdala activity was demonstrable only in subjects who were homozygous for the long allele of the 5-HTTLPR or the G variant of the TPH2 G-703T polymorphism, and not in carriers of short or T alleles. Moreover, the TPH2 polymorphism was a significant predictor of clinical placebo response, homozygosity for the G allele being associated with greater improvement in anxiety symptoms. Path analysis supported that the genetic effect on symptomatic improvement with placebo is mediated by its effect on amygdala activity. Hence, our study shows, for the first time, evidence of a link between genetically controlled serotonergic modulation of amygdala activity and placebo-induced anxiety relief.

BACKGROUND: Evidence is accumulating that pharmacological blockade of the substance P preferring neurokinin-1 (NK1) receptor reduces anxiety. This study compared the effects of an NK1 receptor antagonist, citalopram, and placebo on brain activity and anxiety symptoms in social phobia.

METHODS: Thirty-six patients diagnosed with social phobia were treated for 6 weeks with the NK1 antagonist GR205171 (5 mg), citalopram (40 mg), or matching placebo under randomized double-blind conditions. GR205171 was administered for 4 weeks preceded by 2 weeks of placebo. Before and after treatment, regional cerebral blood flow (rCBF) during a stressful public speaking task was assessed using oxygen-15 positron emission tomography. Response rate was determined by the Clinical Global Impression Improvement Scale.

RESULTS: Patients improved to a larger extent with the NK1 antagonist (41.7% responders) and citalopram (50% responders), compared with placebo (8.3% responders). Within- and between-group comparisons showed that symptom improvement was paralleled by a significantly reduced rCBF response to public speaking in the rhinal cortex, amygdala, and parahippocampal-hippocampal regions. The rCBF pattern was corroborated in follow-up analyses of responders and subjects showing large state anxiety reduction.

CONCLUSIONS: Short-term administration of GR205171 and citalopram alleviated social anxiety. Neurokinin-1 antagonists may act like serotonin reuptake inhibitors by attenuating neural activity in a medial temporal lobe network.

BACKGROUND: Although the amygdala is thought to be a crucial brain region for negative affect, neuroimaging studies do not always show enhanced amygdala response to aversive stimuli in patients with anxiety disorders. Serotonin (5-HT)-related genotypes may contribute to interindividual variability in amygdala responsiveness. The short (s) allele of the 5-HT transporter linked polymorphic region (5-HTTLPR) and the T variant of the G-703T polymorphism in the tryptophan hydroxylase-2 (TPH2) gene have previously been associated with amygdala hyperresponsivity to negative faces in healthy controls. We investigated the influence of these polymorphisms on amygdala responsiveness to angry faces in patients with social anxiety disorder (SAD) compared with healthy controls.

METHODS: We used positron emission tomography with oxygen 15-labelled water to assess regional cerebral blood flow in 34 patients with SAD and 18 controls who viewed photographs of angry and neutral faces presented in counterbalanced order. We genotyped all participants with respect to the 5-HTTLPR and TPH2 polymorphisms.

RESULTS: Patients with SAD and controls had increased left amygdala activation in response to angry compared with neutral faces. Genotype but not diagnosis explained a significant portion of the variance in amygdala responsiveness, the response being more pronounced in carriers of s and/or T alleles.

LIMITATIONS: Our analyses were limited owing to the small sample and the fact that we were unable to match participants on genotype before enrollment. In addition, other imaging techniques not used in our study may have revealed additional effects of emotional stimuli.

CONCLUSION: Amygdala responsiveness to angry faces was more strongly related to serotonergic polymorphisms than to diagnosis of SAD. Emotion activation studies comparing amygdala excitability in patient and control groups could benefit from taking variation in 5-HT-related genes into account.

Childhood Emotional Maltreatment (CEM) is a significant but under-studied risk factor for impaired mental health, with adolescents being particularly susceptible. This systematic review and meta-analysis, prospectively registered in PROSPERO as CRD42022383005, aims to synthesize the findings of studies investigating the association between CEM and adolescent psychopathology, making it the first attempt to the best of our knowledge. Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, a comprehensive search (PubMed, Scopus, PsycINFO, Science Direct, Embase, and ProQuest) yielded 12,224 studies, from which 72 were included in the qualitative synthesis. The meta-analysis was conducted on 76 effect sizes (ranging from 0.01 to 0.57) extracted from 56 studies. The assessment of publication bias utilized funnel plots, Egger’s regression test, and the trim and fill method, if required. Additionally, a predictor analysis investigated the influence of study-level variables on the CEM-psychopathology association. Results revealed a significant positive correlation between CEM and adolescent psychopathology (Pooled association: 0.24–0.41) Furthermore, assessment of publication bias indicated no significant bias. The predictor analysis suggested minimal influence of study-level variables. The study underscores the urgent need to address CEM as a crucial risk factor for adolescent psychopathology. The significant positive correlation between CEM and psychopathological outcomes highlights the detrimental effects of CEM on adolescents. Awareness, prevention efforts, and targeted interventions are essential to mitigate these effects. Further studies with culturally diverse and larger sample sizes are required, with emphasis on methodological rigor, given that most of the identified studies showed a high risk of bias. 

Childhood Sexual Abuse (CSA) poses a significant risk to mental health, especially among adolescents. This systematic review and meta-analysis investigates the association between CSA and adolescent psychopathology. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines, we conducted an extensive search across multiple databases, including PubMed, Scopus, PsycINFO, Science Direct, Embase, and ProQuest, resulting in 27,207 observational studies. From this pool, 87 studies (n: 189,393) were included in the qualitative synthesis and 78 studies were included in meta-analysis, discussing CSA and adolescent’s psychopathology Random effect model with Cohen’s d values were used to analyze data. To assess publication bias, funnel plots, Egger’s regression test, and the fill and trim method were employed, with no significant bias found. The results indicated a positive correlation between CSA and adolescent psychopathology, for example, depression, anxiety, PTSD, suicidal ideation, nonsuicidal self-injury, anger, substance use, and sexrelated behaviors (Pooled association: 0.13–0.25, 95% CI [0.04, 0.28]). Subgroup analysis showed the strongest association in clinical samples. Furthermore, the moderator analysis suggested minimal influence of study-level variables, as well as men showing higher levels of anger and suicidal ideation. The positive correlation between CSA and psychopathological outcomes highlights the detrimental effects of CSA on adolescents’ mental health. To mitigate these effects, increased awareness, prevention efforts, and targeted interventions are essential. 

Previous studies report a preference for larger comfortable interpersonal distance (CIPD) in individuals with child maltreatment (CM) when being approached by others. Yet, research on approaching others, as opposed to being approached, as well as on potential effects of social anxiety and depression is lacking. We investigated if CM and depressive symptoms influence CIPD and if social anxiety mediates the possible association of CM and CIPD when approaching a female stranger. One hundred ten participants with CM (CM) and 58 participants without CM (non-CM) experiences performed the stop-distance paradigm and stopped first when feeling uncomfortable (D1) and again when feeling very uncomfortable (D2). CM experiences were associated with a preference for larger CIPD, independent of depressive symptoms. All CM subtypes were associated with a larger D2. The relationship between CM and CIPD was partially mediated by social anxiety. These novel findings can help to develop interventions strengthening socially relevant skills and processes in those affected by CM, targeting alterations in social anxiety and depression. 

Objective: Specific phobia is a common anxiety disorder, but the literature on associated brain structure alterations exhibits substantial gaps. The ENIGMA Anxiety Working Group examined brain structure differences between individuals with specific phobias and healthy control subjects as well as between the animal and blood-injection-injury (BII) subtypes of specific phobia. Additionally, the authors investigated associations of brain structure with symptom severity and age (youths vs. adults). Methods: Data sets from 31 original studies were combined to create a final sample with 1,452 participants with phobia and 2,991 healthy participants (62.7% female; ages 5-90). Imaging processing and quality control were performed using established ENIGMA protocols. Subcortical volumes as well as cortical surface area and thickness were examined in a preregistered analysis. Results: Compared with the healthy control group, the phobia group showed mostly smaller subcortical volumes, mixed surface differences, and larger cortical thickness across a substantial number of regions. The phobia subgroups also showed differences, including, as hypothesized, larger medial orbitofrontal cortex thickness in BII phobia (N=182) compared with animal phobia (N=739). All findings were driven by adult participants; no significant results were observed in children and adolescents. Conclusions: Brain alterations associated with specific phobia exceeded those of other anxiety disorders in comparable analyses in extent and effect size and were not limited to reductions in brain structure. Moreover, phenomenological differences between phobia subgroups were reflected in diverging neural underpinnings, including brain areas related to fear processing and higher cognitive processes. The findings implicate brain structure alterations in specific phobia, although subcortical alterations in particular may also relate to broader internalizing psychopathology.

Background: The most used questionnaires for PTSD screening in adults were developed in English. Although many of these questionnaires were translated into other languages, the procedures used to translate them and to evaluate their reliability and validity have not been consistently documented. This comprehensive scoping review aimed to compile the currently available translated and evaluated questionnaires used for PTSD screening, and highlight important gaps in the literature.

Objective: This review aimed to map the availability of translated and evaluated screening questionnaires for posttraumatic stress disorder (PTSD) for adults.

Methods: All peer-reviewed studies in which a PTSD screening questionnaire for adults was translated, and which reported at least one result of a qualitative and /or quantitative evaluation procedure were included. The literature was searched using Embase, MEDLINE, and APA PsycInfo, citation searches and contributions from study team members. There were no restrictions regarding the target languages of the translations. Data on the translation procedure, the qualitative evaluation, the quantitative evaluation (dimensionality of the questionnaire, reliability, and performance), and open access were extracted.

Results: A total of 866 studies were screened, of which 126 were included. Collectively, 128 translations of 12 different questionnaires were found. Out of these, 105 (83.3%) studies used a forward and backward translation procedure, 120 (95.2%) assessed the reliability of the translated questionnaire, 60 (47.6%) the dimensionality, 49 (38.9%) the performance, and 42 (33.3%) used qualitative evaluation procedures. Thirty-four questionnaires (27.0%) were either freely available or accessible on request.

Conclusions: The analyses conducted and the description of the methods and results varied substantially, making a quality assessment impractical. Translations into languages spoken in middle- or low-income countries were underrepresented. In addition, only a small proportion of all translated questionnaires were available. Given the need for freely accessible translations, an online repository was developed.

Intrusive memories are a hallmark symptom of posttraumatic stress disorder (PTSD). They reflect excessive and uncontrolled retrieval of the traumatic memory. Acute elevations of cortisol are known to impair the retrieval of already stored memory information. Thus, continuous cortisol administration might help in reducing intrusive memories in PTSD. Strong perceptual priming for neutral stimuli associated with a "traumatic" context has been shown to be one important learning mechanism that leads to intrusive memories. However, the memory modulating effects of cortisol have only been shown for explicit declarative memory processes. Thus, in our double blind, placebo controlled study we aimed to investigate whether cortisol influences perceptual priming of neutral stimuli that appeared in a "traumatic" context. Two groups of healthy volunteers (N = 160) watched either neutral or "traumatic" picture stories on a computer screen. Neutral objects were presented in between the pictures. Memory for these neutral objects was tested after 24 hours with a perceptual priming task and an explicit memory task. Prior to memory testing half of the participants in each group received 25 mg of cortisol, the other half received placebo. In the placebo group participants in the "traumatic" stories condition showed more perceptual priming for the neutral objects than participants in the neutral stories condition, indicating a strong perceptual priming effect for neutral stimuli presented in a "traumatic" context. In the cortisol group this effect was not present: Participants in the neutral stories and participants in the "traumatic" stories condition in the cortisol group showed comparable priming effects for the neutral objects. Our findings show that cortisol inhibits perceptual priming for neutral stimuli that appeared in a "traumatic" context. These findings indicate that cortisol influences PTSD-relevant memory processes and thus further support the idea that administration of cortisol might be an effective treatment strategy in reducing intrusive reexperiencing. © 2014 Holz et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Purpose:The study explores international trends in law on compulsory commitment to care of substance misusers (CCC), and two subtypes – civil CCC and CCC within criminal justice legislation – as well as maximum length and amount of applications of such care. Method: The time period covers more than 25 years, and a total of 104 countries and territories. The study is based on available data in three times of observation (1986, 1999 and 2009). Applications of CCC in number of cases are studied on European level for the years 2002–2006. Trends are analyzed using nonparametric tests and general linear models for repeated measures. Findings are discussed from contextual analysis. Result:  There is a trend towards decrease in the number of countries worldwide having civil CCC legislation after the millennium, while CCC under criminal law has increased since the mid-1980s, resulting in some total net decrease. The shift results in longer mean duration of CCC and an increase in the number of cases sentenced. Conclusion:  There is a risk that the shift from civil CCC to penal CCC implies more focus on young outacting males in compulsory treatment and that the societal responsibility for more vulnerable persons might be neglected.

This study's aim was to elucidate health-care staff experience of working on a locked acute psychiatric ward. In many countries changes in health care has contributed to fewer beds available in inpatient care, and a concentration of patients with severe psychiatric conditions. This implies a changing work environment in acute psychiatric care. Qualitative interviews with health-care staff (n= 10) were carried out on a ward for patients with affective disorder and eating disorder in a Swedish hospital. Qualitative content analysis was used. Four themes were identified from the data: 'undergoing changes in care delivery', 'feeling a need for security and control', 'managing the demands at work' and 'feeling a sense of responsibility'. This study adds to earlier research into how a sense of responsibility can place a significant burden on health-care staff working on a locked psychiatric ward and also contribute to increased control of patients. This study also shows that relationships and power structures among health-care staff need to be addressed when organizational changes are made in care delivery. Further research is needed to reach a comprehensive understanding of care on locked acute psychiatric wards, including a development of nursing and medicine as knowledge domains in one common context. © 2012 Blackwell Publishing.

This review summarises research studies on the impact and beneficial effects of different types of exercise on childhood attention-deficit/hyperactivity disorder (ADHD) and provides recommendations for the scientific and therapeutic communities. Conclusion Although the design and the exercise interventions featured in these studies varied considerably, all showed that exercise reduced the symptoms of ADHD and led to improvements in social behaviour, motor skills, strength and neuropsychological parameters.

Background: The role of the placenta in fetal programming has been recognized as a highly significant, yet often neglected area of study. We investigated placental size in relation to psychopathology, in particular attention deficit hyperactivity disorder (ADHD) symptoms, in children at 8 years of age, and later as adolescents at 16 years. Methodology/Principal Findings: Prospective data were obtained from The Northern Finland Birth Cohort (NFBC) 1986. Placental weight, surface area and birth weight were measured according to standard procedures, within 30 minutes after birth. ADHD symptoms, probable psychiatric disturbance, antisocial disorder and neurotic disorder were assessed at 8 years (n = 8101), and ADHD symptoms were assessed again at 16 years (n = 6607), by teachers and parents respectively. We used logistic regression analyses to investigate the association between placental size and mental health outcomes, and controlled for gestational age, birth weight, socio-demographic factors and medical factors, during gestation. There were significant positive associations between placental size (weight, surface area and placental-to-birth-weight ratio) and mental health problems in boys at 8 and 16 years of age. Increased placental weight was linked with overall probable psychiatric disturbance (at 8y, OR = 1.14 [95% CI = 1.04-1.25]), antisocial behavior (at 8 y, OR = 1.14 [95% CI = 1.03-1.27]) and ADHD symptoms (inattention-hyperactivity at 16y, OR = 1.19 [95% CI = 1.02-1.38]). No significant associations were detected among girls. Conclusions/Significance: Compensatory placental growth may occur in response to prenatal insults. Such overgrowth may affect fetal development, including brain development, and ultimately contribute to psychopathology.