Anne-Liis Von Knorring

Mortality of eating disorders: a follow-up study of treatment in a specialist unit 1974-2000.

OBJECTIVEnTo study excess mortality, causes of death, and co-morbidity in patients with eating disorder (ED), treated in a Swedish specialist facility.nnnMETHODnA retrospective cohort study of 201 patients with ED followed from 1974 to year 2001 in the Swedish Causes of Death Register (SCODR). Standardized mortality ratio (SMR) was calculated with respect to the Swedish population, by gender, age, and calendar time.nnnRESULTSnIn the complete follow-up of 201 patients, 23 had died. At a mean follow-up of 14.3 years the overall SMR was 10. Patients with body mass index (BMI) over 11.5 had an average SMR of about 7 and for those with BMI lower than 11.5 had SMR above 30. Six patients died from AN/starvation, nine due to suicide, and eight from other causes.nnnDISCUSSIONnSMR in anorexia nervosa (AN) is high but not in bulimia nervosa. A risk stratification of AN, based on BMI is suggested.

Suicide and suicide attempts in adolescent-onset psychotic disorders

Eighty-eight subjects with adolescent-onset psychotic disorders (mean age±standard deviation 15.7±1.5u2005years), mainly schizophrenia and affective disorders, were followed up 10.6±3.6u2005years later, rediagnosed (DSM-IV) and assessed with the Positive and Negative Symptom Scale, abuse of drugs including nicotine, the Lancashire Quality of Life Profile and occurrence of suicide or suicide attempts. Four males (4.5% of subjects) had died from suicide while another 25% of the subjects had attempted suicide. Suicide attempts were associated to more depressive symptoms but fewer negative symptoms at first episode, and to number of admissions and to dependence on nicotine at follow-up in a logistic regression. Satisfaction with religion, health, family relations and safety at follow-up were inversely associated to attempting suicide but only satisfaction with religious belief remained after controlling for concurrent symptoms of anxiety and depression.

Adolescent depression and stressful life events: A case-control study within diagnostic subgroups

Life events in depressed adolescents were studied in a case-control design. A total population of 16- to 17-year-old students in the 1st year of high school were screened for depression (n=2300). Every student with indication of depression and one control matched for sex, age, and grade in school was interviewed diagnostically (DICA-R-A). All participating matched pairs in whom the control had no lifetime depressive disorder were used for analysis of life events (177 pairs). They were divided into six subgroups on the basis of depressive and conduct disorders. Depressed and control adolescents were compared with regard to 21 events and conditions of stressful character. Events for total life were studied. Adolescents with depressive disorder had experienced more stressful events and conditions in life than healthy controls. The most characteristic events concerned the important relations to family and friends. The subgroup with comorbid conduct disorder was the most burdened and had much more illness, con...

Central stimulants in the Treatment of attention deficit hyperactivity disorder (ADHD) in children and adolescents: A naturalistic study of the prescription in Sweden 1977-2007

Background: An increased prescription of central stimulants (CS) for treatment of attention-deficit hyperactivity disorder (ADHD) in children and adolescents has been reported in Sweden. Aims: To follow-up the treatment with CS as concerns total as well as regional differences in prescription rate. Efficacy and side-effects reported and gender differences in prescription over time also have been summarized. Methods: Data from the Swedish Medical Products Agency (MPA) of individual licences, annual reports about patients on individual or clinic licences from the MPA and sales statistics from the National Pharmacy (Apoteket AB) have been used. Results: The number of new licences and prescriptions increased dramatically from 1992 to 2007 and a change of preparations was seen. Great differences (fivefold) between the 21 counties of Sweden were noticed. In the follow-up reports to the MPA, a good/moderate treatment effect was reported in 92% and adverse effects were reported in 4% leading to discontinuation of medication in 46% of them. Abuse/misuse of the preparation was suspected in 0.2% of the reports. A tendency of a reduction of the proportion of boys to girls treated through individual licences has been seen. Conclusions: The study, although observational, supports good efficacy, limited adverse effects and a low degree of misuse in clinical use of CS for children and adolescents with ADHD.

Do Kurdistanian and Swedish parents and children differ in their rating of competence and behavioural problems

Objective: This paper investigates child self-rating of behavioural problems and competence as compared with their parents ratings, in comparative samples of Kurdistanian refugee children in Sweden and a group of Swedish children. Method: Kurdistanian and Swedish comparative samples composed of 32 children each matched in age, sex and trauma level, in the same community, and their parents. Among a large battery of instruments, the child behavioural checklist (CBCL) was used in separate interviews with parents and their children. Results: When compared to the childrens self-reported problems scores, the Swedish parents reported significantly lower scores than their children, compared to the Kurdistanian refugee parents. Conclusion: Regardless of cultural backgrounds, there were more similarities than differences in the childrens reporting of their behavioural problems and competence. The discrepancy between the Swedish parents estimation of their childrens behavioural problems and the childrens self-reported behavioural problems could be an effect of the individualistic nature of Swedish society compared with the more collective nature of Kurdistanian culture. However, the results should be considered hypothesis generating rather than conclusive.

Reporting questionnaire for children as a screening instrument for child mental health problems in iraqi kurdistan

To identify child mental health problems in a mid-sized to large city in Iraqi Kurdistan, the Reporting Questionnaire for Children (RQC), followed by the Child Behaviour Checklist (CBCL) and the Post-traumatic Stress Symptom Checklist for Children (PTSS-C), were administered in interview form to the caregivers of 806 school-aged children. To cover different categories of children, four samples were randomly selected from among the general population (n = 201), orphans (n = 241), primary medical care patients (n = 199), and hospital patients (n = 165). The RQC revealed satisfactory validity against a deviant CBCL cut-off. The screening capacity of the RQC was further supported by its similarity to the CBCL in distribution of problem scores among the four samples and its positive correlation with the CBCL, but not with the trauma-related PTSS-C. Although the general population showed lower problem scores than the orphans and the two clinical samples, problem scores in all instruments were considerably higher than those reported from other societies. The RQC seems to be useful as a first-stage screening instrument for child mental health problems in Kurdistan.

Barnpsykiatrisk slutenvård i två lan, en jämförelse

Jaensson C, Brunnander E. Boden P-G, Cederblad M, Hook B, von Knorring A-L. Barnpsykiatrisk slutenvaed i tva lan, en jamforelse.This is part of a study describing + sample of children and adolescents in residential treatment in two counties in Sweden: Ostergotland which has a child psychiatric clinic with four beds, a day treatment and six outpatient departments, and Gavleborg, which has a clinic with fifteen beds and one outpatient department. The present report compares child psychiatry and its effects in these counties. A standardized record. two standardized interviews and DSM III-diagnoses from medical records were included in the study.The patients in the county of Ostergotland have more frequent and severe symptoms, longer treatment periods and often have more than one residential stay. Affective bipolar disorders are more common in Ostergotland due to older patients. Most of the patients in Gavleborg have residential treatment mainly for tests or observation, while in Ostergotland almost half of t...

Barnpsykiatrisk slutenvård i två Iän Reduktion av platsantalet i Östergötland, effekt på klientelsammansättdng och vårdkonsumtion

This report describes part of a larger study comprising 375 children and adolescents hospitalized at the child psychiatric clinic in Linkoping in 1978-1979 and in Linkoping and Gavle between September 1st, 1982 and August 31st. 1984. The article describes the changes caused by a reduction of beds at the clinic in Linkoping from 22 to 4 plus 8 day-care facilities combined with optional » night-foster care homes «. The 192 admissions in 1978-1979 before the reorganization in 1980 were studied retrospectively and the 126 admissions in 1982-1984 were studied prospectively. The case records, standardized interviews with parents and teenagers, and DSM 111 diagnoses were utilized. Admissions decreased one third after the reorganization. The number of children with conduct disorders or alcohol/drug addiction decreased by two-thirds, while the proportion of patients with psychoses increased. Younger patients, especially those with conduct disorders or anxiety syndromes, were admitted to the day care unit, sometime...

Barnpsykiatrisk slutenvård i två län: Beteendestömingar och uppmärksamhetsstörningar

Jaensson C., Brunnander E., Boden P-G, Cederblad M. Hook B, von Knorring A-L. Barnpsykiatrisk slutenvard i tva Ian: Beteendestorningar och uppmarksamhetsstorningar.This section is part of a study describing a sample of 335 children and adolescents in residential treatment during the periods 1978-79 and 1982-84. The report deals with the patients with attention deficit disorders (ADD: 8% of the total group) and conduct disorders (CD: 19%). The two diagnosis groups have many symptoms in common. One difference is that the patients with CD more often have symptoms of asocial behavior. The ADD patients are mostly boys of young age. The CD patients have often been exposed to psycho-social stress. The patients of both groups have a low level of adaptive function the year before residential treatment. The ADD patients often enter residential treatment for observation and are mostly treated indirectly, which means advice to teachers, etc. The patients of the CD group often enter residential treatment for social re...

Pain and depression in children and adolescents

There has been disagreement about at which age children begin to feel pain. Evidence that newborn infants too experience pain has been presented. The understanding of the meaning of pain is dependent on the level of congnitive ability consistent with Piagetian stages and on earlier experiences of pain. Attempts to express pain experiences by numbers have only been made during the last few years, and children can use scales to describe their pain from about five years of age. Chronic pain without an identifiable organic aetiology is mostly located in the abdominal area or the head. There are some associations between recurrent abdominal pain and depression in children. The two conditions have a similar family background and symptoms of pain are common also during a depressive episode in younger children.□ Childhood pain, Childhood depression, Development, Pain experience.