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. 2021 Dec 23;3(4):e4581.
doi: 10.32872/cpe.4581. eCollection 2021 Dec.

A Self-Report Measure of Perfectionism: A Confirmatory Factor Analysis of the Swedish Version of the Clinical Perfectionism Questionnaire

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Free PMC article

A Self-Report Measure of Perfectionism: A Confirmatory Factor Analysis of the Swedish Version of the Clinical Perfectionism Questionnaire

Allison Parks et al. Clin Psychol Eur. .
Free PMC article

Abstract

Background: Perfectionism is often defined as the strive for achievement and high standards, but can also lead to negative consequences. In addition to affecting performance and interpersonal relationships, perfectionism can result in mental distress. A number of different self-report measures have been put forward to assess perfectionism. Specifically intended for clinical practice and research, the Clinical Perfectionism Questionnaire (CPQ) was developed and is presently available in English and Persian. To promote its use in additional contexts, the current study has translated and investigated the psychometric properties of the Swedish version of the CPQ.

Method: A Confirmatory Factor Analysis was performed to examine the best fit with data, using a priori-models and a sample of treatment-seeking participants screened for eligibility to receive Internet-based cognitive behavior therapy (n = 223).

Results: The results indicated a lack of fit with data. A two-factor structure without the two reversed items (2 and 8) exhibited the best fit, perfectionistic strivings and perfectionistic concerns, but still had poor structural validity. Correlations with self-report measures of perfectionism, depression, anxiety, dysfunctional beliefs, self-criticism, quality of life, and self-compassion were all in the expected directions. Eight-week test-retest correlation was Pearson r = .62, 95% Confidence Interval [.45, .74], using data from 72 participants in the wait-list control, and the internal consistency for the CPQ, once removing the reversely scored items, was Cronbach's α = .72.

Conclusion: The CPQ can be used as a self-report measure in Swedish, but further research on its structural validity is needed.

Keywords: Clinical Perfectionism Questionnaire; Swedish; confirmatory factor analysis; perfectionism; psychometrics.

Conflict of interest statement

The authors have no conflict of interest to report.

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. 2022 Sep 28;156:36-43.
doi: 10.1016/j.jpsychires.2022.09.042. Online ahead of print.

Lower plasma concentrations of short-chain fatty acids (SCFAs) in patients with ADHD

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Free article

Lower plasma concentrations of short-chain fatty acids (SCFAs) in patients with ADHD

Liu L Yang et al. J Psychiatr Res. .
Free article

Abstract

Short-chain fatty acids (SCFAs), produced during bacterial fermentation, have been shown to be mediators in the microbiota-gut-brain axis. This axis has been proposed to influence psychiatric symptoms seen in attention deficit hyperactivity disorder (ADHD). However, there is no report of plasma SCFA concentrations in ADHD. The aim of this study was to explore the plasma concentrations of SCFAs in children and adults with ADHD and the possible factors that could influence those levels. We collected data on age group, sex, serum vitamin D levels, delivery mode, body mass index, diet, medication and blood samples from 233 ADHD patients and 36 family-related healthy controls. The concentrations of SCFAs and the intermediary metabolite succinic acid, were measured using liquid chromatography-mass spectrometry. Adults with ADHD had lower plasma concentrations of formic, acetic, propionic and succinic acid than their healthy family members. When adjusting for SCFA-influential factors among those with ADHD, children had lower concentrations of formic, propionic and isovaleric acid than adults, and those who had more antibiotic medications during the last 2 years had lower concentrations of formic, propionic and succinic acid. When adjusting for antibiotic medication, we found that among children, those currently on stimulant medication had lower acetic and propionic acid levels, and adults with ADHD had lower formic and propionic acid concentrations than adult healthy family members. In all, our findings show lower-than-normal plasma concentrations of SCFAs in ADHD explained in-part by antibiotic medication, age and stimulant medication. Whether or not this is of clinical significance is yet to be explored.

Keywords: Acetate; Antibiotic medication; Butyrate; Propionate; Psychostimulant medication; Succinate.

Conflict of interest statement

Declaration of competing interest The authors have no competing interests in relation to the work described.

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. 2022 Jul 12;12(7):e060159.
doi: 10.1136/bmjopen-2021-060159.

Moderate-to-vigorous group aerobic exercise versus group leisure activities for mild-to-moderate depression in adolescents: study protocol for a multicentre randomised controlled trial

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Moderate-to-vigorous group aerobic exercise versus group leisure activities for mild-to-moderate depression in adolescents: study protocol for a multicentre randomised controlled trial

Rebecca Mortazavi et al. BMJ Open. .
Free PMC article

Abstract

Introduction: Depression is common, increasing among adolescents and carries risk of disability, lower educational achievements, cardiovascular disease, substance abuse, self-harm and suicide. The effects of evidence-based treatments with medication or psychotherapy are modest. Aerobic exercise is a promising intervention for adolescents with depression, but available studies are hampered by methodological shortcomings. This study aims to evaluate aerobic group exercise versus an active comparator of leisure group activities in adolescents from clinical services with mild-to-moderate depression.

Methods and analysis: This study is a multicentre randomised controlled trial at four psychiatric clinics in Sweden. Participants (n=122) will be randomised 1:1 to group exercise delivered by exercise professionals and supported by mental health (MH) workers or leisure activities lead by the same MH workers for 1 hour three times a week for 12 weeks. Participants will be assessed at baseline, single blind after 13 weeks and 26 weeks and openly after 1 year. Participants randomised to the leisure group will be offered exercise in the open phase. The primary outcome is clinician-rated Children's Depression Rating Scale-Revised. Secondary outcomes are self-rated Quick Inventory of Depressive Symptomatology, self-rated functioning; clinician-rated improvement and functioning; objectively measured aerobic capacity, muscular strength, muscular endurance, body composition and presence or activity of selected biological markers of neuroprotection and neuroinflammation in blood samples. Further outcomes are cost-effectiveness and adolescents', parents' and coaches' experiences of the interventions and an exploration of how the adolescents' health and lifestyle are influenced by the interventions through qualitative interviews.

Ethics and dissemination: The study is approved by the Swedish Ethical Review Authority (Ref. 2021-05307-01). Informed consent in writing will be provided from patients and parents of participants below 15 years of age. The results of this study will be communicated to the included participants and healthcare providers and also submitted for publication in peer-reviewed journals.

Trial registration number: NCT05076214.

Keywords: Child & adolescent psychiatry; Clinical trials; Depression & mood disorders; HEALTH ECONOMICS; QUALITATIVE RESEARCH.

Conflict of interest statement

Competing interests: None declared.

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. 2022 May 30;23(1):516.
doi: 10.1186/s12891-022-05470-y.

Evaluation of implementation and effectiveness of neck-specific exercise for persistent disability and pain after whiplash injury: study protocol for a randomized controlled study using a hybrid 2 design

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Evaluation of implementation and effectiveness of neck-specific exercise for persistent disability and pain after whiplash injury: study protocol for a randomized controlled study using a hybrid 2 design

Gunnel Peterson et al. BMC Musculoskelet Disord. .
Free PMC article

Abstract

Background: Persistent pain and disability in whiplash-associated disorders (WAD) grades II and III are common. In two randomized controlled trials (RCTs) of neck-specific exercises (NSE), we have seen promising results in chronic WAD, with a sustained clinically important reduction in pain and disability. NSE can also be delivered through internet support (NSEIT) and a few visits to a physiotherapist, saving time and cost for both patients and providers. NSE have been shown to have positive effects in other neck pain disorders and we will evaluate the diffusion of the exercises to other patients. The aims of the proposed study are to evaluate an implementation strategy for NSEIT and NSE in primary health care and to evaluate the effectiveness of NSEIT and NSE in clinical practice.

Methods: The proposed study is a prospective cluster-randomized mixed-design study with hybrid 2 trial design. Reg. physiotherapists working in twenty physiotherapy clinics will be included. The primary implementation outcome is proportion of patients with neck pain receiving neck-specific exercise. Secondary outcomes are; physiotherapists attitudes to implementation of evidence-based practice, their self-efficacy and confidence in performing NSEIT/NSE, number of patients visits, and use of additional or other exercises or treatment. To further evaluate the implementation strategy, two qualitative studies will be performed with a sample of the physiotherapists. The primary outcome in the patient effectiveness evaluation is self-reported neck disability according to the Neck Disability Index (NDI). Secondary outcomes are pain intensity in the neck, arm, and head; dizziness; work- and health-related issues; and patient's improvement or deterioration over time. All measurements will be conducted at baseline and at 3 and 12 months. Physiotherapists´ self-efficacy and confidence in diagnosing and treating patients with neck pain will also be evaluated directly after their instruction in NSEIT/NSE.

Discussion: This trial will evaluate the implementation strategy in terms of adoption of and adherence to NSEIT and NSE in clinical primary health care, and measure diffusion of the method to other patients. In parallel, the effectiveness of the method will be evaluated. The results may guide physiotherapists and health care providers to sustainable and effective implementation of effective exercise programs.

Trial registration: The randomized trial is registered on ClinicalTrials.gov , NCT05198258 , initial release date January 20, 2022.

Keywords: Exercise; Implementation science; Neck pain; Rehabilitation; Whiplash injuries.

Conflict of interest statement

The authors declare that they have no competing interests. The authors declare no conflict of interest associated with any financial organization regarding the material discussed in this study.

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. 2022 Jul;313:114638.
doi: 10.1016/j.psychres.2022.114638. Epub 2022 May 15.

Neurodevelopmental disorders and comorbidity in young adults attending a psychiatric outpatient clinic

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Free article

Neurodevelopmental disorders and comorbidity in young adults attending a psychiatric outpatient clinic

Eberhard David et al. Psychiatry Res. 2022 Jul.
Free article

Abstract

"Missed" cases with neurodevelopmental disorders (NDDs) within adult psychiatry services have attracted increasing attention in the last decade. Key questions have been what the prevalence of NDDs (particularly attention-deficit/hyperactivity disorder/ADHD and autism spectrum disorder/ASD) is, and what the clinical and gender characteristics of those with NDD in adult psychiatry are. All first-time attenders at an adult psychiatry clinic serving 18-25 years old were invited to take part in the study regardless of cause of concern. Participation in the study included diagnostic in-depth evaluation performed by experienced adult psychiatrists. Clinical diagnoses (DSM-IV-TR and DSM-5 criteria) were based on all available information (clinical psychiatric interview, clinical observation, and self-rating questionnaires). Almost two thirds (63%) of the study group met criteria for ADHD or ASD. Most of the patients with NDD (particularly the "NDD females") had not been diagnosed in childhood. Twelve percent of the females included had been given an ADHD diagnosis in childhood. In the current study we found that 48% of the females had ADHD. The high male:female NDD ratio reported among children, was not obvious in our NDD group. The results underscore the importance of screening for NDD in adult psychiatric services regardless of referral reason.

Keywords: ADHD; Adult psychiatry; Autism spectrum disorders; Prevalence.

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. 2022 Feb 22;12(1):73.
doi: 10.1038/s41398-022-01833-0.

Association of cumulative early medical factors with autism and autistic symptoms in a population-based twin sample

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Association of cumulative early medical factors with autism and autistic symptoms in a population-based twin sample

Torkel Carlsson et al. Transl Psychiatry. .
Free PMC article

Abstract

Although highly heritable, environment also contributes to the etiology of autism spectrum disorder (ASD), with several specific environmental factors previously suggested. A registry-linked population-based twin cohort of 15,701 pairs (586 individuals with an ASD diagnosis), was established within the Child and Adolescent Twin Study in Sweden. Participants were evaluated for autistic symptoms at age 9 using the Autism-Tics, ADHD and other Comorbidities parental interview. A series of binary cut-offs indicated whether participants scored over various ASD symptom percentiles. Three early medical factors previously associated with ASD, beyond familial confounding (low birth weight, congenital malformations and perinatal hypoxia), were summed up creating an individual cumulative exposure load. A series of unconditional logistic regressions between all individuals and conditional regressions within twin pairs were performed for each outcome and exposure level. Between all individuals increasing cumulative early exposure loads were associated with increasing risk of ASD diagnosis (OR 3.33 (95%CI 1.79-6.20) for three exposures) and autistic symptoms (ranging from OR 2.12 (1.57-2.86) for three exposures at the 55th symptom percentile cut-off to OR 3.39 (2.2-5.24) at the 95th). Within twin pairs, the association between three exposures and an ASD diagnosis remained similar, but not statistically significant (OR 2.39 (0.62-9.24)). Having a higher load of early cumulative exposure was consistently associated with autistic symptoms after adjusting for familial confounding and sex (OR 3.45 (1.66-7.15) to OR 7.36 (1.99-27.18)). This study gives support to the cumulative stress hypothesis of ASD, and the dimensional model regarding environmental exposures, after adjustment for familial confounding.

Conflict of interest statement

The authors declare no direct competing interests related to this article. SB discloses that he has in the last 3 years acted as an author, consultant or lecturer for Medice and Roche. He receives royalties for textbooks and diagnostic tools from Hogrefe.

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Published Erratum
. 2022 Apr;92:108.
doi: 10.1016/j.sleep.2021.12.012. Epub 2022 Jan 5.

'Corrigendum to "Association of bedtime with mortality and major cardiovascular events: an analysis of 112,198 individuals from 21 countries in the PURE study" [Sleep Medicine 80 (2021) 265-272]'

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Published Erratum

'Corrigendum to "Association of bedtime with mortality and major cardiovascular events: an analysis of 112,198 individuals from 21 countries in the PURE study" [Sleep Medicine 80 (2021) 265-272]'

Chuangshi Wang et al. Sleep Med. 2022 Apr.
No abstract available

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. 2021 Sep;41(9):2024-2031.
doi: 10.1111/liv.14978. Epub 2021 Jun 30.

Hepatitis C elimination in Sweden: Progress, challenges and opportunities for growth in the time of COVID-19

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Free PMC article

Hepatitis C elimination in Sweden: Progress, challenges and opportunities for growth in the time of COVID-19

Sarah Blach et al. Liver Int. 2021 Sep.
Free PMC article

Abstract

Background & aims: In 2014, the burden of hepatitis C virus (HCV) in Sweden was evaluated, to establish a baseline and inform public health interventions. Considering the changing landscape of HCV treatment, prevention, and care, and in light of the COVID-19 pandemic, this analysis seeks to evaluate Sweden's progress towards the World Health Organization (WHO) elimination targets and identify remaining barriers.

Methods: The data used for modelling HCV transmission and disease burden in Sweden were obtained through literature review, unpublished sources and expert input. A dynamic Markov model was employed to forecast population sizes and incidence of HCV through 2030. Two scenarios ('2019 Base' and 'WHO Targets') were developed to evaluate Sweden's progress towards HCV elimination.

Results: At the beginning of 2019, there were 29 700 (95% uncertainty interval: 19 300-33 700) viremic infections in Sweden. Under the base scenario, Sweden would achieve and exceed the WHO targets for diagnosis, treatment and liver-related death. However, new infections would decrease by less than 10%, relative to 2015. Achieving all WHO targets by 2030 would require (i) expanding harm reduction programmes to reach more than 90% of people who inject drugs (PWID) and (ii) treating 90% of HCV + PWID engaged in harm reduction programmes and ≥7% of PWID not involved in harm reduction programmes, annually by 2025.

Conclusions: It is of utmost importance that Sweden, and all countries, find sustainability in HCV programmes by broadening the setting and base of providers to provide stability and continuity of care during turbulent times.

Keywords: COVID-19; Sweden; elimination; hepatitis C virus.

Conflict of interest statement

S.B. and D.R.‐S. are employees of the Center for Disease Analysis Foundation (CDAF). Over the past 3 years, CDAF has received research funding from Gilead, AbbVie and Vaccine Impact Modeling Consortium. CDAF has also received grants from CDC Foundation, John Martin Foundation, ASTHO, Zeshan Foundation and private donors. A.‐S.D. has received honoraria for lectures/consultancy from AbbVie, Gilead and MSD. A.J. has received research support from AbbVie and honoraria from MSD. M.K. has received honoraria for lectures from AbbVie, Gilead, MSD, Mundipharma, DnE Pharma and Nordic Drugs and has received research grants from Gilead and Nordic Drugs. P.‐E.K. has received honoraria for lectures from Gilead. H.R. has been a member of advisory boards for Gilead, AbbVie, Merck and VBI Vaccines. All proceeds are donated to CDAF. He is the managing director of Center for Disease Analysis (CDA) and CDAF. S.A. has received honoraria for lectures/consultancy from AbbVie, BMS, Gilead, MSD, and has received research grants from AbbVie and Gilead.

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. 2021 Apr;80:265-272.
doi: 10.1016/j.sleep.2021.01.057. Epub 2021 Feb 5.

Association of bedtime with mortality and major cardiovascular events: an analysis of 112,198 individuals from 21 countries in the PURE study

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Association of bedtime with mortality and major cardiovascular events: an analysis of 112,198 individuals from 21 countries in the PURE study

Chuangshi Wang et al. Sleep Med. 2021 Apr.

Erratum in

Abstract

Objectives: This study aimed to examine the association of bedtime with mortality and major cardiovascular events.

Methods: Bedtime was recorded based on self-reported habitual time of going to bed in 112,198 participants from 21 countries in the Prospective Urban Rural Epidemiology (PURE) study. Participants were prospectively followed for 9.2 years. We examined the association between bedtime and the composite outcome of all-cause mortality, non-fatal myocardial infarction, stroke and heart failure. Participants with a usual bedtime earlier than 10PM were categorized as 'earlier' sleepers and those who reported a bedtime after midnight as 'later' sleepers. Cox frailty models were applied with random intercepts to account for the clustering within centers.

Results: A total of 5633 deaths and 5346 major cardiovascular events were reported. A U-shaped association was observed between bedtime and the composite outcome. Using those going to bed between 10PM and midnight as the reference group, after adjustment for age and sex, both earlier and later sleepers had a higher risk of the composite outcome (HR of 1.29 [1.22, 1.35] and 1.11 [1.03, 1.20], respectively). In the fully adjusted model where demographic factors, lifestyle behaviors (including total sleep duration) and history of diseases were included, results were greatly attenuated, but the estimates indicated modestly higher risks in both earlier (HR of 1.09 [1.03-1.16]) and later sleepers (HR of 1.10 [1.02-1.20]).

Conclusion: Early (10 PM or earlier) or late (Midnight or later) bedtimes may be an indicator or risk factor of adverse health outcomes.

Keywords: Bedtime; Cardiovascular events; Mortality.

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Clinical Trial
. 2020 Dec 29;10(1):22417.
doi: 10.1038/s41598-020-79959-8.

Actionable and incidental neuroradiological findings in twins with neurodevelopmental disorders

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Free PMC article
Clinical Trial

Actionable and incidental neuroradiological findings in twins with neurodevelopmental disorders

Lynnea Myers et al. Sci Rep. .
Free PMC article

Abstract

While previous research has investigated neuroradiological findings in autism spectrum disorder (ASD) and attention-deficit hyperactivity disorder (ADHD), the entire range of neurodevelopmental disorders (NDDs) has not yet been well-studied using magnetic resonance imaging (MRI). Considering the overlap among NDDs and simultaneous development of the brain and face, guided by molecular signaling, we examined the relationship of actionable and incidental (non-actionable) MRI findings and NDD diagnoses together with facial morphological variants and genetic copy number variants (CNVs). A cross-sectional study was conducted with a twin cohort 8-36 years of age (57% monozygotic, 40% dizygotic), including 372 subjects (46% with NDDs; 47% female) imaged by MRI, 280 with data for facial morphological variants, and 183 for CNVs. Fifty-one percent of participants had MRI findings. Males had a statistically significantly higher percentage of MRI findings (57.7%) compared with females (43.8%, p = 0.03). Twin zygosity was not statistically significantly correlated with incidence or severity of specific MRI findings. No statistically significant association was found between MRI findings and any NDD diagnosis or facial morphological variants; however, MRI findings were statistically significantly associated with the number of CNVs (OR 1.20, 95% CI 1.00-1.44, p = 0.05, adjusted OR for sex 1.24, 95% CI 1.03-1.50, p = 0.02). When combining the presence of MRI findings, facial morphological variants, and CNVs, statistically significant relationships were found with ASD and ADHD diagnoses (p = 0.0006 and p = 0.002, respectively). The results of this study demonstrate that the ability to identify NDDs from combined radiology, morphology, and CNV assessments may be possible. Additionally, twins do not appear to be at increased risk for neuroradiological variants.

Conflict of interest statement

M-L.H. is on the CLN2 Advisory Board for BioMarin Pharmaceuticals and receives book authorship royalties from McGraw-Hill. T.C. works as a child psychiatrist at PRIMA Psychiatry. S.B. discloses that he has in the last 5 years acted as an author, consultant or lecturer for Shire/Takeda, Medice, Roche, Eli Lilly, and Prima Psychiatry. S.B. receives royalties for textbooks and diagnostic tools from Huber/Hogrefe, Kohlhammer and UTB. L.M., E.C., K.L., R. K-H., and K.T. declare no potential conflicts of interest.

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. 2020 Dec;41:118-131.
doi: 10.1016/j.euroneuro.2020.10.005. Epub 2020 Nov 5.

Proinflammatory mediators and their associations with medication and comorbid traits in children and adults with ADHD

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Free article

Proinflammatory mediators and their associations with medication and comorbid traits in children and adults with ADHD

Liu L Yang et al. Eur Neuropsychopharmacol. 2020 Dec.
Free article

Abstract

Peripheral immune activation can influence neurodevelopment and is increased in autism, but is less explored in attention deficit hyperactivity disorder (ADHD). Patients with ADHD often display comorbid autism traits and gastrointestinal (GI) symptoms. Plasma protein levels of two acute phase reactants, C-reactive protein (CRP) and serum amyloid A (SAA), and two endothelial adhesion molecules, soluble intercellular adhesion molecule 1 (sICAM-1) and soluble vascular cell adhesion molecule 1 (sVCAM-1), which share important roles in inflammation, were analyzed in 154 patients with ADHD and 61 healthy controls. Their associations with ADHD diagnosis, severity, medication and comorbid autistic symptoms, emotion dysregulation and GI symptoms were explored. The ADHD patients had increased levels of sICAM-1 and sVCAM-1 compared to healthy controls (p = 8.6e-05, p = 6.9e-07, respectively). In children with ADHD, the sICAM-1 and sVCAM-1 levels were higher among those with ADHD medication than among children (p = 0.0037, p = 0.0053, respectively) and adults (p = 3.5e-09, p = 1.9e-09, respectively) without ADHD medication. Among the adult ADHD patients, higher sICAM-1 levels were associated with increased comorbid autistic symptoms in the domains attention to detail and imagination (p = 0.0081, p = 0.00028, respectively), and higher CRP levels were associated with more GI symptoms (p = 0.014). sICAM-1 and sVCAM-1 levels were highly correlated with each other, and so were CRP and SAA levels. To conclude, vascular inflammatory activity may be overrepresented in ADHD, with elevated sICAM-1 and sVCAM-1 levels and this may in children be a consequence of current ADHD medication, and in adults relate to increased comorbid autistic symptoms. Replication is warranted.

Keywords: ADHD; Adhesion molecules; Autism; Inflammation; Stimulants.

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. 2021 Oct;33(4):1448-1495.
doi: 10.1017/S0954579420000620.

Early environmental risk factors for neurodevelopmental disorders - a systematic review of twin and sibling studies

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Early environmental risk factors for neurodevelopmental disorders - a systematic review of twin and sibling studies

Torkel Carlsson et al. Dev Psychopathol. 2021 Oct.
Free PMC article

Abstract

While neurodevelopmental disorders (NDDs) are highly heritable, several environmental risk factors have also been suggested. However, the role of familial confounding is unclear. To shed more light on this, we reviewed the evidence from twin and sibling studies. A systematic review was performed on case control and cohort studies including a twin or sibling within-pair comparison of neurodevelopmental outcomes, with environmental exposures until the sixth birthday. From 7,315 screened abstracts, 140 eligible articles were identified. After adjustment for familial confounding advanced paternal age, low birth weight, birth defects, and perinatal hypoxia and respiratory stress were associated with autism spectrum disorder (ASD), and low birth weight, gestational age and family income were associated with attention-deficit/hyperactivity disorder (ADHD), categorically and dimensionally. Several previously suspected factors, including pregnancy-related factors, were deemed due to familial confounding. Most studies were conducted in North America and Scandinavia, pointing to a global research bias. Moreover, most studies focused on ASD and ADHD. This genetically informed review showed evidence for a range of environmental factors of potential casual significance in NDDs, but also points to a critical need of more genetically informed studies of good quality in the quest of the environmental causes of NDDs.

Keywords: confounding factors; environmental exposure; neurodevelopmental disorders; systematic review; twin and sibling studies.

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None

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Randomized Controlled Trial
. 2020 Oct;89:9-19.
doi: 10.1016/j.bbi.2020.05.056. Epub 2020 Jun 1.

Effects of a synbiotic on symptoms, and daily functioning in attention deficit hyperactivity disorder - A double-blind randomized controlled trial

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Randomized Controlled Trial

Effects of a synbiotic on symptoms, and daily functioning in attention deficit hyperactivity disorder - A double-blind randomized controlled trial

Elin Skott et al. Brain Behav Immun. 2020 Oct.
Free article

Abstract

Some prebiotics and probiotics have been proposed to improve psychiatric symptoms in children with autism. However, few studies were placebo-controlled, and there is no study on persons with an attention deficit hyperactivity disorder (ADHD) diagnosis. Our aim was to study effects of Synbiotic 2000 on psychiatric symptoms and functioning in children and adults with ADHD without an autism diagnosis. Children and adults (n = 182) with an ADHD diagnosis completed the nine weeks randomized double-blind parallel placebo-controlled trial examining effects of Synbiotic 2000 on the primary endpoints ADHD symptoms, autism symptoms and daily functioning, and the secondary endpoint emotion regulation, measured using the questionnaires SNAP-IV, ASRS, WFIRS, SCQ, AQ and DERS-16. Levels at baseline of plasma C-reactive protein and soluble vascular cell adhesion molecule-1 (sVCAM-1), central to leukocyte-endothelial cell adhesion facilitating inflammatory responses in tissues, were measured using Meso Scale Discovery. Synbiotic 2000 and placebo improved ADHD symptoms equally well, and neither active treatment nor placebo had any statistically significant effect on functioning or sub-diagnostic autism symptoms. However, Synbiotic 2000, specifically, reduced sub-diagnostic autism symptoms in the domain restricted, repetitive and stereotyped behaviors in children, and improved emotion regulation in the domain of goal-directed behavior in adults. In children with elevated sVCAM-1 levels at baseline as well as in children without ADHD medication, Synbiotic 2000 reduced both the total score of autism symptoms, and the restricted, repetitive and stereotyped behaviors. In adults with elevated sVCAM-1 at baseline, Synbiotic 2000 significantly improved emotion regulation, both the total score and four of the five subdomains. To conclude, while no definite Synbiotic 2000-specific effect was detected, the analysis of those with elevated plasma sVCAM-1 levels proposed a reduction of autism symptoms in children and an improvement of emotion regulation in adults with ADHD. Trial registration number: ISRCTN57795429.

Keywords: Autism; Emotion reactivity; Inflammation; Lactic acid bacteria; Lactobacillus; Prebiotics; Probiotics; Repetitive behavior; Vascular cell adhesion molecule-1.

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. 2020 Dec;44(6):265-268.
doi: 10.1192/bjb.2020.28.

Psychoeducation and motivational interviewing to reduce relapses and increase patients' involvement in antipsychotic treatment: interventional study

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Psychoeducation and motivational interviewing to reduce relapses and increase patients' involvement in antipsychotic treatment: interventional study

Gabriella Bröms et al. BJPsych Bull. 2020 Dec.
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Abstract

Aims and method: To assess whether the combination of motivational interviewing and psychoeducation affects relapse rate and stimulates involvement of people with psychosis in their treatment. We conducted an interventional study including patients with schizophrenia or schizoaffective disorder treated with oral antipsychotics, without previous experience of long-acting injectable antipsychotics (LAIs). They were randomised to either psychoeducation with motivational interviewing or a control group. Hospital admissions 18 months before and after the intervention, and switches to LAIs 18 months after the intervention, were recorded.

Results: The two groups each comprised 101 participants. Fourteen from the intervention group and seven from the control group switched to LAIs. Five in the intervention group instigated the switch themselves, compared with zero controls (P = 0.06). Fourteen in the intervention group were readmitted to hospital during follow-up, compared with 23 in the control group (P = 0.14).

Clinical implications: Psychoeducation with motivational interviewing may increase patients' involvement in their treatment and reduce the relapse frequency.

Keywords: Motivational interviewing; adherence; antipsychotics; psychoeducation; schizophrenia.

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. 2019 Nov 26;9(1):317.
doi: 10.1038/s41398-019-0653-9.

Early exposure to antibiotic drugs and risk for psychiatric disorders: a population-based study

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Early exposure to antibiotic drugs and risk for psychiatric disorders: a population-based study

Catharina Lavebratt et al. Transl Psychiatry. .
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Abstract

Early life exposure to infection, anti-infectives and altered immune activity have been associated with elevated risk of some psychiatric disorders. However, the risk from exposure in fetal life has been proposed to be confounded by familial factors. The hypothesis of this study is that antibiotic drug exposure during the fetal period and the first two postnatal years is associated with risk for later development of psychiatric disorders in children. All births in Finland between 1996 and 2012, 1 million births, were studied for antibiotic drug exposure: mothers during pregnancy and the children the first two postnatal years. The children were followed up for a wide spectrum of psychiatric diagnoses and psychotropic drug treatment until 2014. Cox proportional hazards modeling was used to estimate effects of antibiotic drug exposure on offspring psychiatric disorders. Modestly (10-50%) increased risks were found on later childhood development of sleep disorders, ADHD, conduct disorder, mood and anxiety disorders, and other behavioral and emotional disorders with childhood onset (ICD-10 F98), supported by increased risks also for childhood psychotropic medication. The prenatal exposure effects detected were not explained by explored familial confounding, nor by registered maternal infections. To conclude, this longitudinal nation-wide study shows that early life antibiotic drug exposure is associated with an increased risk for childhood development of psychopathology. Given the high occurrence of early-life antibiotic exposure, these findings are of public health relevance. Whether the associations reflect effects of the antibiotic drug use or of the targeted infections remains to be explored further.

Conflict of interest statement

The authors declare that they have no conflict of interest.

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