Mats Adler | Karolinska Institutet (original) (raw)
Papers by Mats Adler
European Psychiatry, 2012
ABSTRACT Demonstrating the superiority of antidepressants over placebo in randomized clinical tri... more ABSTRACT Demonstrating the superiority of antidepressants over placebo in randomized clinical trials of antidepressants (RCT-ADs) has been difficult. A recent meta-analysis of six RCT-ADs, by Fournier et al., concluded that the efficacy of antidepressants was “nonexistent to negligible” in mild and moderate depression.Objective and aimTo reanalyze the same data in order to investigate if the meta-analysis was biased from insufficient measurement properties of the rating scale used, the 17-item Hamilton Depression Rating Scale (HDRS).Methods We got access to the primary data on item and individual level from 5 of the 6 meta-analyzed RCT-ADs. We reanalyzed these data by means of Item Response Theory (IRT).ResultsIn each of the five studies the reliability of measurement was rapidly decreasing with diminishing depression severity. This resulted in low precision of measurement at endpoint levels and an underestimation of score reductions in patients who initially had milder depressions. As a consequence, 38% of the combined sample was measured at endpoint with IRT estimates of reliability that were less than half of the maximal.Conclusions The HDRS biases randomized clinical trials of antidepressants by providing unreliable primary data. Low or absent effect sizes are to be expected because of the scale's low precision and low sensitivity to change, particularly in mild and moderate depression. The conclusion of the Fournier et al. meta-analysis was therefore unfounded. The clinical value of antidepressants cannot be evaluated from unreliable data. Better measurement techniques for depression severity are urgently needed.
Brain, Behavior, and Immunity, 2013
Recent studies suggest that cytokine-related disturbances of kynurenine metabolism are involved i... more Recent studies suggest that cytokine-related disturbances of kynurenine metabolism are involved in the pathogenesis of schizophrenia and bipolar disorder. Here, we examined the production of kynurenic acid (KYNA) and 3-hydroxykynurenine (3-HK) and the expression of kynurenine pathway enzymes under basal conditions and in the presence of pro-inflammatory cytokines in fibroblast cultures from patients with schizophrenia or bipolar disorder. Higher baseline production of KYNA and 3-HK was demonstrated in fibroblasts obtained from patients as compared with control subjects. Following exposure to interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)1-beta, IL6, or combinations, 3-HK levels, but not KYNA, increased in the fibroblast cultures. After treatments with cytokines the mRNA expression of kynurenine aminotransferase (KAT) enzymes were decreased and kynurenase (KYNU) increased, kynurenine-3-monooxygenase (KMO) levels were not affected. Interaction analyses showed that cells from patients with schizophrenia or bipolar disorder respond differently to pro-inflammatory cytokines in terms of L-kynurenine metabolism as compared to control individuals. Potential associations with two polymorphisms in the KMO allele were also investigated. The single nucleotide polymorphisms (SNPs) rs1053230 and rs2275163 both had effects on KYNA levels but these SNPs did not explain the case-control differences in KYNA or 3-HK levels. In conclusion, our results provide evidence that the kynurenine pathway is abnormally affected by cytokine exposure in fibroblast cultures obtained from patients with schizophrenia or bipolar disorder.
BMC Medical Research Methodology, 2012
Background: This study investigates whether an analysis, based on Item Response Theory (IRT), can... more Background: This study investigates whether an analysis, based on Item Response Theory (IRT), can be used for initial evaluations of depression assessment instruments in a limited patient sample from an affective disorder outpatient clinic, with the aim to finding major advantages and deficiencies of the instruments. Methods: Three depression assessment instruments, the depression module from the Patient Health Questionnaire (PHQ9), the depression subscale of Affective Self Rating Scale (AS-18-D) and the Montgomery-Åsberg Depression Rating Scale (MADRS) were evaluated in a sample of 61 patients with affective disorder diagnoses, mainly bipolar disorder. A '3step IRT strategy' was used.
Nordic Journal of Psychiatry, 2008
Most rating scales for affective disorders measure either depressive or hypomanic/manic symptoms ... more Most rating scales for affective disorders measure either depressive or hypomanic/manic symptoms and there are few scales for hypomania/mania in a self-rating format. We wanted to develop and validate a self-rating scale for comprehensive assessment of depressive, manic/hypomanic and mixed affective states. We developed an 18-item self-rating scale starting with the DSM-IV criteria for depression and mania, with subscales for depression and mania. The scale was evaluated on 61 patients with a diagnosis of affective disorder, predominantly bipolar disorder type I, using Montgomery-Asberg Depression Rating Scale (MADRS), Hypomania Interview Guide-Clinical version (HIGH-C) and Clinical Global Impression scale, modified for bipolar patients (CGI-BP) as reference scales. Internal consistency of the scale measured by Cronbach's alpha was 0.89 for the depression subscale and 0.91 for the mania subscale. Spearman's correlation coefficients (two-tailed) between the depression subscale and MADRS was 0.74 (P<0.01) and between mania subscale and HIGH-C 0.80 (P<0.01). A rotated factor analysis of the scale supported the separation of symptoms in the mania and depression subscale. We established that the self-rating scales sensitivity to identify mixed states, with combined cut-offs on the MADRS and HIGH-C as reference, was 0.90 with a specificity of 0.71. The study shows that the Affective Self Rating Scale is highly correlated with ratings of established interview scales for depression and mania and that it may aid the detection of mixed affective states.
The European Journal of Psychiatry, 2007
Background and Objectives: The aim of the study was to examine the antidepressant effect of a sin... more Background and Objectives: The aim of the study was to examine the antidepressant effect of a single pulse dose of intravenous clomipramine (200 mg i.v.) followed by oral administration as an alternative method to electroconvulsive therapy. Methods: Twenty-one inpatients (8 male, 13 female) with major depression were included. Depression severity was measured by Montgomery Asberg Rating Scale (MADRS) and Clinical Global Impression severity scale (CGI-S) before the pulse dose and 1 week after. The day after the pulse dose, the patient was medicated with 75 mg of oral clomipramine and from day two with 150 mg clomipramine daily. Results: The MADRS score dropped with 39% ± 22% and the CGI score with 28% ± 19% in one week. The improvement of the MADRS score after one week was 13.1 (C.I.9.5-17.0). CGI-ratings dropped from a mean of 5.5 (SD 1.2) to 3.9 (SD 1.1), an improvement of 28% ± 19%.(C.I. 1.0-2.1). Both improvements were significant (p<000.1). Conclusions: Single pulse dose clomipramine administration ameliorates depressive symptoms, and may be an alternative to ECT.
Background: In psychiatry, the assessment of symptom severity is being increasingly assisted by r... more Background: In psychiatry, the assessment of symptom severity is being increasingly assisted by rating scales, in clinical practice as well as in research and quality control. Transforming the subjective symptoms of psychiatric disorders into valid numerical measures is subjected to numerous confounding factors. Careful evaluation of rating scales is therefore essential. This doctoral project arose from a clinical need for a useful self-rating scale for affective symptoms at an outpatient clinic for affective disorders. No existing rating scales fulfilling the clinical need were found in the literature. Aims: The aims of the doctoral project were to develop and evaluate a self rating scale for measurement of severity in depressive, manic and mixed affective states and to explore if Item Response Theory (IRT) is useful for evaluation and improvement of rating scales for mania and depression. A further aim was to investigate if Randomized Controlled Studies of Antidepressants (RCT-ADs...
BMJ Open
ObjectivesThere is concern that the COVID-19 pandemic will be associated with an increase in suic... more ObjectivesThere is concern that the COVID-19 pandemic will be associated with an increase in suicides, but evidence supporting a link between pandemics and suicide is limited. Using data from the three influenza pandemics of the 20th century, we aimed to investigate whether an association exists between influenza deaths and suicide deaths.DesignTime series analysis.SettingSweden.ParticipantsDeaths from influenza and suicides extracted from the Statistical Yearbook of Sweden for 1910–1978, covering three pandemics (the Spanish influenza, the Asian influenza and the Hong Kong influenza).Main outcome measuresAnnual suicide rates in Sweden among the whole population, men and women. Non-linear autoregressive distributed lag models was implemented to explore if there is a short-term and/or long-term relationship of increases and decreases in influenza death rates with suicide rates during 1910–1978.ResultsBetween 1910 and 1978, there was no evidence of either short-term or long-term signi...
Journal of Clinical Sleep Medicine
Nordic Journal of Psychiatry
Background: Subjective memory deficits are common in depression and during series of treatment wi... more Background: Subjective memory deficits are common in depression and during series of treatment with electroconvulsive therapy (ECT). There is a need for feasible assessment of memory deficit. In the Swedish National Quality Register for ECT, patients' subjective memory function is rated by a clinician. Self-ratings would be easier to administer. Objectives: The aim of this study was to analyze the consistency between self-reported and physician estimated subjective memory in depressed patients treated with ECT. Methods: Fifty-two inpatients treated with ECT for major-or bipolar depression were recruited and 41 of them completed the study protocol. Each patient rated their own subjective memory and had it rated in an interview by a physician both before/in the beginning of the ECT series and after the ECT series. The patients' memory was rated and self-rated with the memory item in the Comprehensive Psychopathological Rating Scale (CPRS). We then analyzed correlations, and differences in distributions, between self-reported assessment and physician estimates of patients' subjective memory. Results: The correlations between the self-reported and the physician estimated ratings of subjective memory were 0.699 (p < .01) in baseline ratings and 0.651 (p < .01) in post-treatment ratings. These correlations were relatively high compared to a previous study on self-reported vs. physician estimated CPRS ratings. Conclusions: Based on the results in this study, we propose that patients' self-ratings of subjective memory in association with ECT can be used instead of a physician's rating of patients' subjective memory.
Introduction: Weighted blankets are used for the treatment of insomnia in patients with affective... more Introduction: Weighted blankets are used for the treatment of insomnia in patients with affective disorders and ADHD, despite the lack of scientific support. This study aimed to evaluate the clinical use of weighted blankets for insomnia in patients with affective disorder and ADHD. Methods: 199 psychiatric patients with affective and ADHD diagnoses and co-occurring insomnia were included consecutively and treated with weighted blankets as a part of a clinical routine. They were evaluated before and after four weeks use of the blanket concerning time to sleep onset and ten sleep-related symptoms, using a self-rating scale, and after one year by a telephone interview.Results: The use of weighted blankets reduced the median time to fall asleep from 70 to 30 minutes (p<0.001) and led to a significant improvement of ten other sleep-related symptoms at the follow up after four weeks. After one year the positive effects on sleep were still maintained.Conclusions: The favourable results...
Cognitive behaviour therapy, 2017
Previous studies have supported acceptance and commitment therapy (ACT) for reducing impairment r... more Previous studies have supported acceptance and commitment therapy (ACT) for reducing impairment related to various chronic conditions. ACT may possibly be beneficial for bipolar disorder (BD) with co-existing anxiety, which is associated with a poorer treatment outcome. Efforts are needed to identify suitable psychological interventions for BD and co-existing anxiety. In this open clinical trial, we included 26 patients with BD type 1 or 2 at an outpatient psychiatric unit specializing in affective disorders. The intervention consisted of a 12-session manualized group treatment that included psychoeducation, mindfulness, engaging in values-based behaviour, cognitive defusion, acceptance and relapse prevention modules. Participants completed four self-report questionnaires covering anxiety symptoms (Beck Anxiety Inventory - BAI), depressive symptoms (Beck Depression Inventory - BDI-II), quality of life (Quality of Life Inventory - QOLI) and psychological flexibility (Acceptance and A...
Neuropsychopharmacologia Hungarica : a Magyar Pszichofarmakológiai Egyesület lapja = official journal of the Hungarian Association of Psychopharmacology, 2013
Treatment and management of affective disorders associated with pregnancy is still an underemphas... more Treatment and management of affective disorders associated with pregnancy is still an underemphasized field receiving little attention, furthermore, it is burdened with misinformation as well as incomplete or missing knowledge. Professionals of related fields (psychiatrists, obstetrician-gynecologists) often provide patients with contradicting information or, due to their lack of sufficient knowledge, keep referring the patient for information between different services. However, there is an increasing amount of data and information available, suitable for drawing conclusions and making it possible to provide adequate and credible counselling and information for pregnant women or family planning couples. In the present paper we aim to facilitate this process by reviewing the currently available information.
Quality of Life Research, 2014
Purpose It is important for clinical practice and research that measurement scales of well-being ... more Purpose It is important for clinical practice and research that measurement scales of well-being and quality of life exhibit only minimal differential item functioning (DIF). DIF occurs where different groups of people endorse items in a scale to different extents after being matched by the intended scale attribute. We investigate the equivalence or otherwise of common methods of assessing DIF. Method Three methods of measuring age-and sex-related DIF (ordinal logistic regression, Rasch analysis and Mantel v 2 procedure) were applied to Hospital Anxiety Depression Scale (HADS) data pertaining to a sample of 1,068 patients consulting primary care practitioners. Results Three items were flagged by all three approaches as having either age-or sex-related DIF with a consistent direction of effect; a further three items identified did not meet stricter criteria for important DIF using at least one method. When applying strict criteria for significant DIF, ordinal logistic regression was slightly less sensitive. Conclusions Ordinal logistic regression, Rasch analysis and contingency table methods yielded consistent results when identifying DIF in the HADS depression and HADS anxiety scales. Regardless of methods applied, investigators should use a combination of statistical significance, magnitude of the DIF effect and investigator judgement when interpreting the results.
Nordic Journal of Psychiatry, 2011
The Affective Self Rating Scale (AS-18) is intended for the use in bipolar outpatients. It includ... more The Affective Self Rating Scale (AS-18) is intended for the use in bipolar outpatients. It includes subscales for the rating of depressive and manic-type symptoms. It has previously been validated using methods from Classical Test Theory. The aim of this study was to evaluate the psychometric properties of the AS-18 when used at an outpatient clinic for patients with bipolar disorder at routine visits, and to analyze the potential for improvement of the scale. 231 patients with mainly bipolar I disorder doing ratings on routine visits at an affective disorder outpatient clinic were included. Ratings were analyzed using the Mokken non-parametric and the Rasch parametric model statistical methods. In the Mokken analysis, both subscales of the AS-18 showed a strong ability to rank respondents according to their total score and all items contributed adequately to the measurement. In the Rasch model, there were no indications of disturbing influence from secondary dimensions in the subscales. The depression subscale had the capacity reliably to separate the sample in at most three levels and the mania subscale in two levels. The limited capacity to separate respondents can mainly be explained by a lack of items reflecting lower levels of depressive and manic symptoms. AS-18 has good basic psychometric properties for use of rating of symptoms in bipolar I patients at routine visits, but there is also room for improvement. Item Response Theory (IRT) methods are suitable tools for evaluation and construction of rating scales.
The Journal of Nervous and Mental Disease, 2013
We hypothesized that motor retardation in bipolar depression is mediated by disruption of the pre... more We hypothesized that motor retardation in bipolar depression is mediated by disruption of the pre-executive stages of motor production. We used functional magnetic resonance imaging to investigate neural activity during motor imagery and motor execution to elucidate whether brain regions that mediate planning, preparation, and control of movement are activated differently in subjects with bipolar depression (n = 9) compared with healthy controls (n = 12). We found significant between-group differences. During motor imagery, the patients activated the posterior medial parietal cortex, the posterior cingulate cortex, the premotor cortex, the prefrontal cortex, and the frontal poles more than the controls did. Activation in the brain areas involved in motor selection, planning, and preparation was altered. In addition, limbic and prefrontal regions associated with self-reference and the default mode network were altered during motor imagery in bipolar depression with motor retardation.
Frontiers in Psychiatry, 2014
Psychomotor disturbances are a classic feature of major depressive disorders. These can manifest ... more Psychomotor disturbances are a classic feature of major depressive disorders. These can manifest as lack of facial expressions and decreased speech production, reduced body posture and mobility, and slowed voluntary movement. The neural correlates of psychomotor disturbances in depression are poorly understood but it has been suggested that outputs from the cingulate motor area (CMA) to striatal motor regions, including the putamen, could be involved. We used functional and structural magnetic resonance imaging to conduct a region-of-interest analysis to test the hypotheses that neural activation patterns related to motor production and gray matter volumes in the CMA would be different between depressed subjects displaying psychomotor disturbances (n = 13) and matched healthy controls (n = 13). In addition, we conducted a psychophysiological interaction analysis to assess the functional coupling related to self-paced finger-tapping between the caudal CMA and the posterior putamen in patients compared to controls. We found a cluster of increased neural activation, adjacent to a cluster of decreased gray matter volume in the caudal CMA in patients compared to controls. The functional coupling between the left caudal CMA and the left putamen during finger-tapping task performance was additionally decreased in patients compared to controls. In addition, the strength of the functional coupling between the left caudal CMA and the left putamen was negatively correlated with the severity of psychomotor disturbances in the patient group. In conclusion, we found converging evidence for involvement of the caudal CMA and putamen in the generation of psychomotor disturbances in depression.
European Psychiatry, 2012
ABSTRACT Demonstrating the superiority of antidepressants over placebo in randomized clinical tri... more ABSTRACT Demonstrating the superiority of antidepressants over placebo in randomized clinical trials of antidepressants (RCT-ADs) has been difficult. A recent meta-analysis of six RCT-ADs, by Fournier et al., concluded that the efficacy of antidepressants was “nonexistent to negligible” in mild and moderate depression.Objective and aimTo reanalyze the same data in order to investigate if the meta-analysis was biased from insufficient measurement properties of the rating scale used, the 17-item Hamilton Depression Rating Scale (HDRS).Methods We got access to the primary data on item and individual level from 5 of the 6 meta-analyzed RCT-ADs. We reanalyzed these data by means of Item Response Theory (IRT).ResultsIn each of the five studies the reliability of measurement was rapidly decreasing with diminishing depression severity. This resulted in low precision of measurement at endpoint levels and an underestimation of score reductions in patients who initially had milder depressions. As a consequence, 38% of the combined sample was measured at endpoint with IRT estimates of reliability that were less than half of the maximal.Conclusions The HDRS biases randomized clinical trials of antidepressants by providing unreliable primary data. Low or absent effect sizes are to be expected because of the scale's low precision and low sensitivity to change, particularly in mild and moderate depression. The conclusion of the Fournier et al. meta-analysis was therefore unfounded. The clinical value of antidepressants cannot be evaluated from unreliable data. Better measurement techniques for depression severity are urgently needed.
Brain, Behavior, and Immunity, 2013
Recent studies suggest that cytokine-related disturbances of kynurenine metabolism are involved i... more Recent studies suggest that cytokine-related disturbances of kynurenine metabolism are involved in the pathogenesis of schizophrenia and bipolar disorder. Here, we examined the production of kynurenic acid (KYNA) and 3-hydroxykynurenine (3-HK) and the expression of kynurenine pathway enzymes under basal conditions and in the presence of pro-inflammatory cytokines in fibroblast cultures from patients with schizophrenia or bipolar disorder. Higher baseline production of KYNA and 3-HK was demonstrated in fibroblasts obtained from patients as compared with control subjects. Following exposure to interferon (IFN)-gamma, tumor necrosis factor (TNF)-alpha, interleukin (IL)1-beta, IL6, or combinations, 3-HK levels, but not KYNA, increased in the fibroblast cultures. After treatments with cytokines the mRNA expression of kynurenine aminotransferase (KAT) enzymes were decreased and kynurenase (KYNU) increased, kynurenine-3-monooxygenase (KMO) levels were not affected. Interaction analyses showed that cells from patients with schizophrenia or bipolar disorder respond differently to pro-inflammatory cytokines in terms of L-kynurenine metabolism as compared to control individuals. Potential associations with two polymorphisms in the KMO allele were also investigated. The single nucleotide polymorphisms (SNPs) rs1053230 and rs2275163 both had effects on KYNA levels but these SNPs did not explain the case-control differences in KYNA or 3-HK levels. In conclusion, our results provide evidence that the kynurenine pathway is abnormally affected by cytokine exposure in fibroblast cultures obtained from patients with schizophrenia or bipolar disorder.
BMC Medical Research Methodology, 2012
Background: This study investigates whether an analysis, based on Item Response Theory (IRT), can... more Background: This study investigates whether an analysis, based on Item Response Theory (IRT), can be used for initial evaluations of depression assessment instruments in a limited patient sample from an affective disorder outpatient clinic, with the aim to finding major advantages and deficiencies of the instruments. Methods: Three depression assessment instruments, the depression module from the Patient Health Questionnaire (PHQ9), the depression subscale of Affective Self Rating Scale (AS-18-D) and the Montgomery-Åsberg Depression Rating Scale (MADRS) were evaluated in a sample of 61 patients with affective disorder diagnoses, mainly bipolar disorder. A '3step IRT strategy' was used.
Nordic Journal of Psychiatry, 2008
Most rating scales for affective disorders measure either depressive or hypomanic/manic symptoms ... more Most rating scales for affective disorders measure either depressive or hypomanic/manic symptoms and there are few scales for hypomania/mania in a self-rating format. We wanted to develop and validate a self-rating scale for comprehensive assessment of depressive, manic/hypomanic and mixed affective states. We developed an 18-item self-rating scale starting with the DSM-IV criteria for depression and mania, with subscales for depression and mania. The scale was evaluated on 61 patients with a diagnosis of affective disorder, predominantly bipolar disorder type I, using Montgomery-Asberg Depression Rating Scale (MADRS), Hypomania Interview Guide-Clinical version (HIGH-C) and Clinical Global Impression scale, modified for bipolar patients (CGI-BP) as reference scales. Internal consistency of the scale measured by Cronbach&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s alpha was 0.89 for the depression subscale and 0.91 for the mania subscale. Spearman&amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s correlation coefficients (two-tailed) between the depression subscale and MADRS was 0.74 (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01) and between mania subscale and HIGH-C 0.80 (P&amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). A rotated factor analysis of the scale supported the separation of symptoms in the mania and depression subscale. We established that the self-rating scales sensitivity to identify mixed states, with combined cut-offs on the MADRS and HIGH-C as reference, was 0.90 with a specificity of 0.71. The study shows that the Affective Self Rating Scale is highly correlated with ratings of established interview scales for depression and mania and that it may aid the detection of mixed affective states.
The European Journal of Psychiatry, 2007
Background and Objectives: The aim of the study was to examine the antidepressant effect of a sin... more Background and Objectives: The aim of the study was to examine the antidepressant effect of a single pulse dose of intravenous clomipramine (200 mg i.v.) followed by oral administration as an alternative method to electroconvulsive therapy. Methods: Twenty-one inpatients (8 male, 13 female) with major depression were included. Depression severity was measured by Montgomery Asberg Rating Scale (MADRS) and Clinical Global Impression severity scale (CGI-S) before the pulse dose and 1 week after. The day after the pulse dose, the patient was medicated with 75 mg of oral clomipramine and from day two with 150 mg clomipramine daily. Results: The MADRS score dropped with 39% ± 22% and the CGI score with 28% ± 19% in one week. The improvement of the MADRS score after one week was 13.1 (C.I.9.5-17.0). CGI-ratings dropped from a mean of 5.5 (SD 1.2) to 3.9 (SD 1.1), an improvement of 28% ± 19%.(C.I. 1.0-2.1). Both improvements were significant (p<000.1). Conclusions: Single pulse dose clomipramine administration ameliorates depressive symptoms, and may be an alternative to ECT.
Background: In psychiatry, the assessment of symptom severity is being increasingly assisted by r... more Background: In psychiatry, the assessment of symptom severity is being increasingly assisted by rating scales, in clinical practice as well as in research and quality control. Transforming the subjective symptoms of psychiatric disorders into valid numerical measures is subjected to numerous confounding factors. Careful evaluation of rating scales is therefore essential. This doctoral project arose from a clinical need for a useful self-rating scale for affective symptoms at an outpatient clinic for affective disorders. No existing rating scales fulfilling the clinical need were found in the literature. Aims: The aims of the doctoral project were to develop and evaluate a self rating scale for measurement of severity in depressive, manic and mixed affective states and to explore if Item Response Theory (IRT) is useful for evaluation and improvement of rating scales for mania and depression. A further aim was to investigate if Randomized Controlled Studies of Antidepressants (RCT-ADs...
BMJ Open
ObjectivesThere is concern that the COVID-19 pandemic will be associated with an increase in suic... more ObjectivesThere is concern that the COVID-19 pandemic will be associated with an increase in suicides, but evidence supporting a link between pandemics and suicide is limited. Using data from the three influenza pandemics of the 20th century, we aimed to investigate whether an association exists between influenza deaths and suicide deaths.DesignTime series analysis.SettingSweden.ParticipantsDeaths from influenza and suicides extracted from the Statistical Yearbook of Sweden for 1910–1978, covering three pandemics (the Spanish influenza, the Asian influenza and the Hong Kong influenza).Main outcome measuresAnnual suicide rates in Sweden among the whole population, men and women. Non-linear autoregressive distributed lag models was implemented to explore if there is a short-term and/or long-term relationship of increases and decreases in influenza death rates with suicide rates during 1910–1978.ResultsBetween 1910 and 1978, there was no evidence of either short-term or long-term signi...
Journal of Clinical Sleep Medicine
Nordic Journal of Psychiatry
Background: Subjective memory deficits are common in depression and during series of treatment wi... more Background: Subjective memory deficits are common in depression and during series of treatment with electroconvulsive therapy (ECT). There is a need for feasible assessment of memory deficit. In the Swedish National Quality Register for ECT, patients' subjective memory function is rated by a clinician. Self-ratings would be easier to administer. Objectives: The aim of this study was to analyze the consistency between self-reported and physician estimated subjective memory in depressed patients treated with ECT. Methods: Fifty-two inpatients treated with ECT for major-or bipolar depression were recruited and 41 of them completed the study protocol. Each patient rated their own subjective memory and had it rated in an interview by a physician both before/in the beginning of the ECT series and after the ECT series. The patients' memory was rated and self-rated with the memory item in the Comprehensive Psychopathological Rating Scale (CPRS). We then analyzed correlations, and differences in distributions, between self-reported assessment and physician estimates of patients' subjective memory. Results: The correlations between the self-reported and the physician estimated ratings of subjective memory were 0.699 (p < .01) in baseline ratings and 0.651 (p < .01) in post-treatment ratings. These correlations were relatively high compared to a previous study on self-reported vs. physician estimated CPRS ratings. Conclusions: Based on the results in this study, we propose that patients' self-ratings of subjective memory in association with ECT can be used instead of a physician's rating of patients' subjective memory.
Introduction: Weighted blankets are used for the treatment of insomnia in patients with affective... more Introduction: Weighted blankets are used for the treatment of insomnia in patients with affective disorders and ADHD, despite the lack of scientific support. This study aimed to evaluate the clinical use of weighted blankets for insomnia in patients with affective disorder and ADHD. Methods: 199 psychiatric patients with affective and ADHD diagnoses and co-occurring insomnia were included consecutively and treated with weighted blankets as a part of a clinical routine. They were evaluated before and after four weeks use of the blanket concerning time to sleep onset and ten sleep-related symptoms, using a self-rating scale, and after one year by a telephone interview.Results: The use of weighted blankets reduced the median time to fall asleep from 70 to 30 minutes (p<0.001) and led to a significant improvement of ten other sleep-related symptoms at the follow up after four weeks. After one year the positive effects on sleep were still maintained.Conclusions: The favourable results...
Cognitive behaviour therapy, 2017
Previous studies have supported acceptance and commitment therapy (ACT) for reducing impairment r... more Previous studies have supported acceptance and commitment therapy (ACT) for reducing impairment related to various chronic conditions. ACT may possibly be beneficial for bipolar disorder (BD) with co-existing anxiety, which is associated with a poorer treatment outcome. Efforts are needed to identify suitable psychological interventions for BD and co-existing anxiety. In this open clinical trial, we included 26 patients with BD type 1 or 2 at an outpatient psychiatric unit specializing in affective disorders. The intervention consisted of a 12-session manualized group treatment that included psychoeducation, mindfulness, engaging in values-based behaviour, cognitive defusion, acceptance and relapse prevention modules. Participants completed four self-report questionnaires covering anxiety symptoms (Beck Anxiety Inventory - BAI), depressive symptoms (Beck Depression Inventory - BDI-II), quality of life (Quality of Life Inventory - QOLI) and psychological flexibility (Acceptance and A...
Neuropsychopharmacologia Hungarica : a Magyar Pszichofarmakológiai Egyesület lapja = official journal of the Hungarian Association of Psychopharmacology, 2013
Treatment and management of affective disorders associated with pregnancy is still an underemphas... more Treatment and management of affective disorders associated with pregnancy is still an underemphasized field receiving little attention, furthermore, it is burdened with misinformation as well as incomplete or missing knowledge. Professionals of related fields (psychiatrists, obstetrician-gynecologists) often provide patients with contradicting information or, due to their lack of sufficient knowledge, keep referring the patient for information between different services. However, there is an increasing amount of data and information available, suitable for drawing conclusions and making it possible to provide adequate and credible counselling and information for pregnant women or family planning couples. In the present paper we aim to facilitate this process by reviewing the currently available information.
Quality of Life Research, 2014
Purpose It is important for clinical practice and research that measurement scales of well-being ... more Purpose It is important for clinical practice and research that measurement scales of well-being and quality of life exhibit only minimal differential item functioning (DIF). DIF occurs where different groups of people endorse items in a scale to different extents after being matched by the intended scale attribute. We investigate the equivalence or otherwise of common methods of assessing DIF. Method Three methods of measuring age-and sex-related DIF (ordinal logistic regression, Rasch analysis and Mantel v 2 procedure) were applied to Hospital Anxiety Depression Scale (HADS) data pertaining to a sample of 1,068 patients consulting primary care practitioners. Results Three items were flagged by all three approaches as having either age-or sex-related DIF with a consistent direction of effect; a further three items identified did not meet stricter criteria for important DIF using at least one method. When applying strict criteria for significant DIF, ordinal logistic regression was slightly less sensitive. Conclusions Ordinal logistic regression, Rasch analysis and contingency table methods yielded consistent results when identifying DIF in the HADS depression and HADS anxiety scales. Regardless of methods applied, investigators should use a combination of statistical significance, magnitude of the DIF effect and investigator judgement when interpreting the results.
Nordic Journal of Psychiatry, 2011
The Affective Self Rating Scale (AS-18) is intended for the use in bipolar outpatients. It includ... more The Affective Self Rating Scale (AS-18) is intended for the use in bipolar outpatients. It includes subscales for the rating of depressive and manic-type symptoms. It has previously been validated using methods from Classical Test Theory. The aim of this study was to evaluate the psychometric properties of the AS-18 when used at an outpatient clinic for patients with bipolar disorder at routine visits, and to analyze the potential for improvement of the scale. 231 patients with mainly bipolar I disorder doing ratings on routine visits at an affective disorder outpatient clinic were included. Ratings were analyzed using the Mokken non-parametric and the Rasch parametric model statistical methods. In the Mokken analysis, both subscales of the AS-18 showed a strong ability to rank respondents according to their total score and all items contributed adequately to the measurement. In the Rasch model, there were no indications of disturbing influence from secondary dimensions in the subscales. The depression subscale had the capacity reliably to separate the sample in at most three levels and the mania subscale in two levels. The limited capacity to separate respondents can mainly be explained by a lack of items reflecting lower levels of depressive and manic symptoms. AS-18 has good basic psychometric properties for use of rating of symptoms in bipolar I patients at routine visits, but there is also room for improvement. Item Response Theory (IRT) methods are suitable tools for evaluation and construction of rating scales.
The Journal of Nervous and Mental Disease, 2013
We hypothesized that motor retardation in bipolar depression is mediated by disruption of the pre... more We hypothesized that motor retardation in bipolar depression is mediated by disruption of the pre-executive stages of motor production. We used functional magnetic resonance imaging to investigate neural activity during motor imagery and motor execution to elucidate whether brain regions that mediate planning, preparation, and control of movement are activated differently in subjects with bipolar depression (n = 9) compared with healthy controls (n = 12). We found significant between-group differences. During motor imagery, the patients activated the posterior medial parietal cortex, the posterior cingulate cortex, the premotor cortex, the prefrontal cortex, and the frontal poles more than the controls did. Activation in the brain areas involved in motor selection, planning, and preparation was altered. In addition, limbic and prefrontal regions associated with self-reference and the default mode network were altered during motor imagery in bipolar depression with motor retardation.
Frontiers in Psychiatry, 2014
Psychomotor disturbances are a classic feature of major depressive disorders. These can manifest ... more Psychomotor disturbances are a classic feature of major depressive disorders. These can manifest as lack of facial expressions and decreased speech production, reduced body posture and mobility, and slowed voluntary movement. The neural correlates of psychomotor disturbances in depression are poorly understood but it has been suggested that outputs from the cingulate motor area (CMA) to striatal motor regions, including the putamen, could be involved. We used functional and structural magnetic resonance imaging to conduct a region-of-interest analysis to test the hypotheses that neural activation patterns related to motor production and gray matter volumes in the CMA would be different between depressed subjects displaying psychomotor disturbances (n = 13) and matched healthy controls (n = 13). In addition, we conducted a psychophysiological interaction analysis to assess the functional coupling related to self-paced finger-tapping between the caudal CMA and the posterior putamen in patients compared to controls. We found a cluster of increased neural activation, adjacent to a cluster of decreased gray matter volume in the caudal CMA in patients compared to controls. The functional coupling between the left caudal CMA and the left putamen during finger-tapping task performance was additionally decreased in patients compared to controls. In addition, the strength of the functional coupling between the left caudal CMA and the left putamen was negatively correlated with the severity of psychomotor disturbances in the patient group. In conclusion, we found converging evidence for involvement of the caudal CMA and putamen in the generation of psychomotor disturbances in depression.