Finn Skårderud

Improving Diabetes Care for Young People With Type 1 Diabetes Through Visual Learning on Mobile Phones: Mixed-Methods Study

Background Only 17% of Norwegian children and adolescents with diabetes achieve international treatment goals measured by glycated hemoglobin (HbA1c). Classic patient–physician consultations seem to be poorly adapted to young children. New strategies that are better attuned to young people to improve support of adolescents’ self-management of diabetes need to be tested and evaluated. Objective (1) To explore how applications for mobile phones can be used in follow-up of adolescents with type 1 diabetes, and (2) to use the findings to guide further development of the applications and as a basis for future studies. Method We pilot tested two mobile phone applications: (1) an application that contained a picture-based diabetes diary to record physical activity and photos taken with the phone camera of food eaten, where the phone also communicated with the glucometer by Bluetooth technology to capture blood glucose values, and (2) a Web-based, password-secured and encrypted short message service (SMS), based on access using login passwords received via SMS to be used by participants to send messages to their providers when they faced obstacles in everyday life, and to send educational messages to the participants. At the end of the 3-month pilot study, 12 participants (7 girls and 5 boys ) aged 13–19 years completed semistructured interviews. The participants had a mean HbA1c value of 8.3 (SD 0.3), mean age of 16.2 (SD 1.7) years, mean body mass index of 23.3 (SD 3.2) kg/m2, and mean diabetes duration of 7.5 (SD 4.6) years. We applied three additional measurements: change in metabolic control as measured by HbA1c, the System Usability Scale, and diabetes knowledge. Results From the interviews, three main categories emerged: visualization, access, and software changes. Participants appreciated the picture-based diary more than the SMS solution. Visualization of cornerstones in diabetes self-care (ie, diet, insulin dosage, physical activity, and pre- and postprandial glucose measurements all transformed into one picture) in the mobile diary was found to be an important educational tool through reflections in action. This led to a change in participants’ applied knowledge about the management of their disease. Additional measurements supplemented and supported the qualitative findings. However, changes in HbA1c and participants’ theoretical knowledge as tested by a 27-item questionnaire, based on a national health informatics’ diabetes quiz, before and after the intervention were not statistically significant (P = .38 and P = .82, respectively, paired-samples t test). Participants suggested additional functionality, and we will implement this in the design of the next software generation. Conclusion Participants reported an increased understanding of applied knowledge, which seem to positively affect diabetes self-care. Visual impressions seem well adapted to the maturation of the adolescent brain, facilitating the link between theoretical knowledge and executive functions. SMS gave the adolescents a feeling of increased access and security. Participants gave valuable input for further development of these applications.

The Link Between Negative Emotions and Eating Disorder Behaviour in Patients with Anorexia Nervosa

BACKGROUND Several theoretical models suggest that deficits in emotional regulation are central in the maintenance of anorexia nervosa (AN). Few studies have examined how patients view the relationship between negative affect and anorectic behaviour. We explored how patients with AN manage the aversive emotions sadness, anger, fear and disgust, and how they link these experiences to their eating disorder behaviours. METHODS Qualitative data were collected through semi-structured interviews with 14 women aged 19-39 years diagnosed with AN (DSM-IV). Interviews were analyzed using Grounded Theory methods. RESULTS The participants tended to inhibit expression of sadness and anger in interpersonal situations and reported high levels of anger towards themselves, self-disgust and fear of becoming fat. Different emotions were managed by means of specific eating disorder behaviours. Sadness was particularly linked to body dissatisfaction and was managed through restrictive eating and purging. Anger was avoided by means of restrictive eating and purging and released through anorectic self-control, self-harm and exercising. Fear was linked to fear of fatness and was managed through restrictive eating, purging and body checking. Participants avoided the feeling of disgust by avoiding food and body focused situations. CONCLUSION Treatment models of eating disorders highlight the significance of working with emotional acceptance and coping in this patient group. Knowledge about how patients understand the relationships between their negative emotions and their anorectic behaviour may be an important addition to treatment programmes for AN.

Use the Body and Forget the Body: Treating Anorexia Nervosa with Adapted Physical Activity

Anorexia nervosa represents an over-concern with body shape and weight. This article describes seven female patients with severe anorexia nervosa who were given a time-limited program of Adapted Physical Activity (APA). The aim was to investigate how social interaction in activities could move negative attention from the objectified anorectic body to a more profound and subjective experience of one’s own body. APA may represent a therapeutic access to anorexia nervosa, as a supplement to psychotherapy.

MINDING THE BABY

The primary aim of this article is to give a theoretical and empirical background for clinical interventions in family-oriented treatment for substance use disorders. The article refers to an ongoing research project, which is based on the concepts of mentalization and parental reflective functioning. Theory of mentalization and attachment theory is explored as explanatory tools of both addictive problem and risk/resilience factors in offspring. Mentalization is defined as the competence to envision mental states in self and others and to understand behaviour in terms of mental states. Substance use is discussed as clinical expressions of impaired mentalizing skills and disorders of state- and affect regulation. Parental reflective function particularly refers to parents’ competences to interpret the mind of their own infant or child. Parental reflective functioning, as ‘minding the baby’, promotes sensitive care, which again serves to protect the infant and the immature brain from potentially dangerous stress and physiological arousal. Substance use often makes the parent ‘absent-minded’ and thus imposes a risk of impaired interactions between caregivers and the extra vulnerable substance exposed child.Without a lifeline to the caregivers’ mind, the development of self regulation and social competences is endangered. High-risk families need substantial support to break the burden of intergenerational transmission of internal representations of caregiving experiences, and to promote good enough care for the infant. The mentalization-based treatment programs (MBT) briefly outlined here, propose a long-term multidisciplinary treatment and follow-up.

‘Bad Boys’’ Bodies: The Embodiment of Troubled Lives. Body Image and Disordered Eating Among Adolescents in Residential Childcare Institutions

Children residing in care (hereafter referred to as childcare residents) are a risk-group for emotional disturbances and behaviour problems. Based on existing knowledge of risk factors one would also expect this population to be a high-risk group for eating disorders and related body-image disorders. The objective of this study was to describe pathological eating behaviour, dysfunctional body focusing and psychological symptoms in a sample of childcare residents compared with a non-clinical sample. Sixty-one childcare residents (aged 14-21 years, mean 16.2) and a non-clinical comparison group ( n = 196) completed the Eating Disorders Inventory - Child version (EDI-C). The childcare residents also completed an extended questionnaire, including questions regarding the use of anabolic-androgenic steroids. Our main findings were high scores on EDI-C symptom scales for boys in the childcare resident group; few differences between girls in the two samples; and a high frequency of having used anabolic-androgenic steroids among boys in care. Body-image problems among boys have hitherto been given little attention. The results call for increased efforts in describing and detecting pathological cognitions, emotions and behaviour concerning the body in males in general and, more specifically, in high-risk male groups, such as childcare residents.

The Process of Help-Seeking in Anorexia Nervosa: Patients’ Perspective of First Contact With Health Services

In this study we explored circumstances, reflections, and reactions to first treatment contact in 34 women (aged 18–51) diagnosed with anorexia nervosa (AN) (DSM-IV). Using methods from grounded theory we identified how the meeting came about, what motivated the patients, and how they reacted to the conversation. The results suggest that (a) health care professionals need to demonstrate effective professional communication skills and proficient knowledge about eating disorders in early contacts; (b) treatment goals other than recovery from AN should be explored; and (c) patients’ view of AN as a strategy for increased control and mastery in life may be a topic for discussion in the early contacts.

Parental Reflective Functioning and Executive Functioning in Mothers with Substance Use Disorder

ABSTRACT Having a substance use disorder (SUD) may adversely affect caregiving capacities. Reflective functioning (RF) and executive functioning (EF) are both important capacities for sensitive parenting, and are often impaired in a SUD. Only a few studies have explored the possible association between the two phenomena. In this study, we used a neuropsychological test battery to assess EF, and the Parent Development Interview to assess RF in a sample of mothers with a SUD (N = 43). Although parental RF (PRF) was associated with EF, when controlled for intelligence (IQ) and mental health, there was no significant association between EF and PRF. Mental health, however, showed a significant negative association with PRF. Splitting the group in two based on PRF level, mothers with a negative to low PRF exhibited more severe difficulties in SUD-related aspects, as well as in several EF components, compared to mothers with an adequate to high PRF, highlighting the association between EF and PRF. The results from this study contribute to enhance our understanding of the dynamics underlying vulnerability in PRF that mothers with small children may experience. We suggest EF to be a prerequisite for adequate PRF, and for interventions to be customized accordingly regarding parents with a SUD.

A Disorder of a Vulnerable Self: Anorexia Nervosa Patients' Understanding of Disorder and Self in the Context of fMRI Brain Scanning

In this article, we aim to explore patient perspectives regarding the etiology of anorexia nervosa (AN) in the context of participating in brain research for AN. This is a qualitative study using semistructured interviews with 12 young AN patients. Data were analyzed according to thematic analysis method. This study shows that patients’ language used to express their understanding of the etiology of AN was characterized by psychological terms such as personality, self-esteem, control, and coping rather than neuroscientific terms. Participants held a complex understanding of the causes of AN, acknowledging a brain–mind relationship. However, participants expressed the hope that brain sciences could contribute to identify an objective, physical proof for AN, that would validate their illness, increase understanding, and reduce blame. The study suggests that prevailing biological explanations promoted by brain research did not encourage simplistic perspectives on causation among patients. Instead, patients viewed biological-based theories and brain science as a means of validating their illness.

The ethics of neuromodulation for anorexia nervosa: a focus on rTMS

ObjectiveRecently there has been emerging clinical and research interest in the application of deep brain stimulation (DBS) and repetitive transcranial magnetic stimulation (rTMS) to the treatment of anorexia nervosa (AN). To our knowledge, few studies have discussed ethical aspects associated with the increased use of neuromodulation in AN, some of which are quite specific to AN, despite the rapid development and dissemination of these new technologies.MethodWe provide a brief overview of three published rTMS studies for AN and discuss ethical issues involved in the use of neuromodulation for AN.ResultsIn contrast to neurosurgery or DBS, rTMS is a less invasive technique, with less associated risk, and thus has greater potential to become a more widespread augmentation or add-on therapy for AN. New therapeutic procedures are promising, yet they raise ethical questions regarding informed consent and patient selection. Illness-specific issues surrounding authenticity and autonomy are important to consider, ensuring an ethical approach to treatment for patients with AN.DiscussionWe argue that ethical investigations for neuromodulation techniques are timely and important, and discussions should go beyond the immediate goals of patient safety, consent, and risk and benefit, to consider broader ethical concepts such as authenticity and autonomy.

Psychotherapy in schizophrenia: a retrospective controlled study

ABSTRACT Introduction: Although pharmacological interventions have been the mainstay of treatment for schizophrenia, there has been a growing recognition of the importance of psychotherapy. Aims: To investigate whether a novel psychotherapeutic approach, dialog therapy (DT), has an effect beyond standard psychiatric treatment (ST) in schizophrenia. Methods: Twenty-four patients diagnosed with schizophrenia and treated with DT and 24 patients matched on age, sex, and diagnosis receiving ST were included in the study. Results: At follow-up after a mean of 4 years and 1 month, the DT group had significantly higher scores on the GAF functions (GAF-F) and GAF symptoms (GAF-S) subscales compared to the ST group. Effect sizes (Cohen’s d) were very large, 238 for GAF-S and 241 for GAF-F. The number and doses of psychoactive drugs were significantly lower in the DT group compared to the ST group at follow-up, despite a shorter time in psychotherapy in the DT group. Conclusions: This study provides preliminary evidence that dialog therapy may lead to improvements in symptoms and functioning compared to standard psychiatric treatment.