Grete Dyb

Analgesic use: A predictor of chronic pain and medication overuse headache The Head–HUNT Study

1. Miller JW, Selhub J, Nadeau MR, Thomas CA, Feldman RG, Wolf PA. Effect of Ldopa on plasma homocysteine in PD patients: relationship to B-vitamin status. Neurology 2003;60:1125–1129. 2. Clarke S. Protein methylation. Curr Opin Cell Biol 1993;5:977–983. 3. Bottiglieri T, Hyland K. S-adenosyl-methionine levels in psychiatric and neurologic disorders. Acta Neurol Scand 1994;suppl 154:19–26. 4. Werner P, Di Rocco A, Prikhojan A, et al. COMT-dependent protection of dopaminergic neurons by methionine, dimethionine, and S-adenosylmethionine (SAM-e) against L-Dopa toxicity in vitro: implications for Parkinson’s disease treatment. Brain Res 2001;893:278–281. 5. Cai H, Wang X, Colagiuri S, Wilcken DE. Methionine synthase D919G mutation in type 2 diabetes and its relation to vascular events. Diabetes Care 1998;10:1774–1775. 6. Widner B, Leblhuber F, Frick B, Laich A, Artner-Dworzak E, Fuchs D. Moderate hyperhomocysteinaemia and immune activation in Parkinson’s disease. J Neural Transm 2002;109:1445–1452. 7. Widner B, Leblhuber F, Fuchs D. Increased neopterin production and tryptophan degradation in advanced Parkinson’s disease. J Neural Transm 2002;109:181–189. 8. Schroecksnadel K, Frick B, Winkler C, Leblhuber F, Wirleitner B, Fuchs D. Hyperhomocysteinemia and immune activation. Clin Exp Immunol (in press). 9. Fuchs D, Jaeger M, Widner B, Wirleitner B, Artner-Dworzak E, Leblhuber F. Is hyperhomocysteinemia due to oxidative depletion of folate rather than insufficient dietary intake? Clin Chem Lab Med 2001;39:691–694. 10. Chalmers JP, Baldessarini RJ, Wurtman RJ. Effects of L-dopa on norepinephrine metabolism in the brain. Proc Natl Acad Sci 1971;68:662– 666. 11. Ordonez LA, Wurtman RJ. Methylation of exogenous 3,4-dihydroxyphenylalanine (L-Dopa)—effects on methyl group metabolism. Biochem Pharmacol 1973;22:134–137. 12. Miller JW, Shukitt-Hale B, Villalobos-Molina R, Nadeau MR, Selhub J, Joseph JA. Effect of L-dopa and the catechol-O-methyltransferase inhibitor Ro 41-0960 on sulfur amino acid metabolites in rats. Clin Neuropharmacol 1997;20:55–66. 13. Daly D, Miller JW, Nadeau MR, Selhub J. The effect of L-dopa administration and folate deficiency on plasma homocysteine concentrations in rats. J Nutr Biochem 1997;8:634–640.

Analgesic overuse among adolescents with headache The Head-HUNT-Youth Study

Objectives: To examine the association between the use of analgesics and primary headache disorders (i.e., migraine and tension-type headache) among adolescents in relation to age, gender, and headache frequency. Methods: This cross-sectional, population-based study was conducted in Norway from 1995 to 1997. The total study population consisted of 5,471 adolescents, 13 to 18 years of age, who were interviewed about their headache complaints and completed a comprehensive questionnaire including use of analgesics. Results: The prevalence of daily headache associated with analgesic use was 0.5%, with a higher rate for girls (0.8%) than for boys (0.2%). There was a significant association for both genders between analgesic use and headache, although most pronounced for migraine. There was a significant linear relationship between analgesic use and headache frequency. Analgesic use was more common among girls than boys and increased with age both for those with and those without headache. Conclusions: The use of analgesics is common among adolescents with headache, especially among girls. Although this study did not directly evaluate for medication-overuse headache, the trend of frequent analgesic use suggests this possibility. Parents and physicians should increase their awareness of potential analgesic overuse, especially among adolescents with frequent headache.

An unfavorable lifestyle and recurrent headaches among adolescents The HUNT Study

Objectives: To examine the relationship between recurrent headache disorders (i.e., migraine and tension-type headache) and lifestyle factors (overweight, low physical activity, and smoking) in an unselected population study among adolescents. Methods: In this cross-sectional study from Norway, a total of 5,847 students were interviewed about headache complaints and completed a comprehensive questionnaire including items concerning physical activity and smoking. In addition, they underwent a clinical examination with height and weight measurements. Adolescents with high physical activity who were not current smokers and not overweight were classified as having a good lifestyle status. These students were compared to those with 1 or more of the negative lifestyle factors present in regard to headache diagnosis and headache frequency. Results: In adjusted multivariate analyses, recurrent headache was associated with overweight (odds ratio [OR] = 1.4, 95% confidence interval [CI] 1.2–1.6, p < 0.0001), low physical activity (OR = 1.2, 95% CI 1.1–1.4, p = 0.002), and smoking (OR = 1.5, 95% CI 1.3–1.7, p < 0.0001). The prevalence of OR increased with more than 1 negative lifestyle factor present, evident for headache diagnoses and frequency. Conclusion: The results from the present study show that overweight, smoking, or low physical activity are independently and in combination associated with recurrent headache among adolescents. The associations observed and the additive effect of these negative lifestyle factors on the prevalence of recurrent headache indicates possible targets for preventive measures.

Post-traumatic stress reactions in survivors of the 2011 massacre on Utøya Island, Norway

BACKGROUND Although youths in many countries have been exposed to terrorism, few studies have examined early risk and protective factors for the subsequent development of mental health problems. AIMS To investigate the levels of post-traumatic stress in survivors of the 2011 massacre on Utøya Island compared with the general population in Norway, and to identify predictive factors. METHOD Four hundred and ninety survivors were invited to participate. Structured face-to-face interviews were performed 4-5 months after the attack. RESULTS There were 325 study participants (response rate 66%). Survivors had been highly exposed to danger and loss. Post-traumatic stress levels were more than six times higher in survivors than in the general population. Predictors were female gender, minority ethnic status, high level of trauma exposure, pain, the loss of someone close and social support. CONCLUSIONS Survivor characteristics that can be assessed in the early aftermath of a terrorist attack strongly predict the subsequent mental health problems of exposed youths. The highly elevated symptoms observed were largely attributable to the traumatic experience and reflect the mental health costs of the terrorist attack.

A longitudinal study of posttraumatic stress reactions in Norwegian children and adolescents exposed to the 2004 tsunami

OBJECTIVE To investigate the prevalence of symptoms of posttraumatic stress disorder (PTSD) and factors related to level of these in children who experienced a catastrophe as tourists and were therefore able to return to the safety of their homeland. DESIGN Face-to-face semistructured interviews and assessments. SETTING Children and adults were interviewed in their homes 10 months and 2(1/2) years after the tsunami. PARTICIPANTS A volunteer sample of adults and children aged 6 to 17 years who were exposed to the 2004 tsunami (at 10 months, 133 children and 84 parents; at 2(1/2) years, 104 children and 68 parents). Main Exposure The tsunami in Southeast Asia on December 26, 2004. OUTCOME MEASURES University of California, Los Angeles (UCLA) PTSD Reaction Index. RESULTS Two children had scores indicative of PTSD at 10 months. There was a significant decrease in symptoms after 2(1/2) years, and no children had scores exceeding the clinical cutoff at this time. Only the death of a family member and subjective distress were independently and significantly associated with PTSD scores at 10 months, whereas sex, need for professional mental health services prior to the tsunami, and parental sick leave owing to the tsunami were independent predictors of PTSD symptoms at follow-up. CONCLUSIONS The children reported fewer symptoms of PTSD compared with children in other disaster studies. Predictor variables changed from disaster-related subjective distress to factors related to general mental health at follow-up. The findings indicate the importance of secondary adversities and pretrauma functioning in the maintenance of posttraumatic stress reactions.

The day Norway cried: Proximity and distress in Norwegian citizens following the 22nd July 2011 terrorist attacks in Oslo and on Utøya Island

Background : Terrorism may create fear and stress reactions not only in the direct victims, but also in the general population. Objective : This study investigated emotional responses in the Norwegian population following the 22nd July 2011 terrorist attacks. We hypothesized that Oslo residents would report a higher level of fear responses compared with people living outside Oslo and that proximity would be associated with early distress and later post-traumatic stress reactions. Method : Representative samples were drawn from the Norwegian Population Registry. Telephone interviews were conducted 4–5 months after the attacks. The response rate for the Oslo sample (N=465) was 24% of the total sample, and 43% of those who were actually reached by phone and asked to participate. Corresponding figures for the sample living outside Oslo (N=716) were 19% and 30%. Results : Our results show strong immediate emotional responses, particularly sadness and a feeling of unreality, in both samples. Jumpiness and other fear responses were significantly higher among Oslo residents. Current level of risk perception was low 4–5 months after the attacks; however, a significant minority reported to feel less safe than before. Geographical and psychological proximity were associated with early emotional responses. Psychological proximity was significantly associated with post-traumatic stress reactions, while measures of geographical proximity were not. Immediate emotional responses, first-week reactions, and first-week jumpiness were uniquely and significantly associated with post-traumatic stress reactions. Post-traumatic stress reactions were elevated in ethnic minorities. Conclusions : The terrorist attacks seem to have had a significant effect on the Norwegian population, creating sadness and insecurity, at least in the short term. Proximity to the terrorist attacks was strongly associated with distress in the population, and early distress was strongly related to later post-traumatic stress reactions. Our results indicate that psychological proximity is more strongly associated with post-traumatic stress reactions than geographical proximity, and underline the importance of differentiated measurements of various aspects of early distress. For the abstract or full text in other languages, please see Supplementary files under Article Tools online

Children’s and parents’ posttraumatic stress reactions after the 2004 tsunami

This study examined the association between parents’ and children’s posttraumatic stress reactions after the tsunami disaster in Southeast Asia in 2004. Parents of 319 Norwegian children and adolescents aged 6–18 years reported on children’s exposure to the tsunami and children’s immediate subjective responses. The Child Stress Disorder Checklist was used to measure children’s posttraumatic stress reactions 6–8 months after the tsunami, and the Impact of Event Scale Revised measured parental PTSD. Results indicated that parents’ posttraumatic stress reactions significantly predicted PTSD reactions in their children. The strongest association was found for parental intrusive reactions and hyperarousal. Highly exposed children seemed to be more vulnerable to parental distress compared to children with lower levels of exposure. The study demonstrates that parental distress can endure and worsen the impact of a disaster in children. In assessments of trauma-related consequences and in therapeutic work with children clinicians need to expand the focus to include their parents and family.

PTSD prevalence and symptom structure of DSM-5 criteria in adolescents and young adults surviving the 2011 shooting in Norway

BACKGROUND Diagnostic criteria for Posttraumatic Stress Disorder (PTSD) have been revised for DSM-5. Two key changes include alteration of the clustering of PTSD symptoms and new PTSD symptom criteria related to negative alterations in cognition and mood. In this study, we empirically investigated these changes. METHODS We interviewed 325 adolescents and young adults who survived the 2011 youth camp shooting at Utøya Island, Norway. The UCLA PTSD Reaction Index for DSM-IV was used to assess symptoms of PTSD. In addition, 11 questions were added to assess the four new symptom criteria within the new DSM-5 symptom categories. RESULTS PTSD prevalence did not differ significantly whether DSM-IV (11.1%) or DSM-5 (11.7%) criteria were used and the Cohen׳s Kappa for consistency between the diagnoses was 0.061. Confirmatory factor analyses showed that the four-factor structure of the DSM-5 fit the data adequately according to the conceptual model outlined. LIMITATIONS The homogeneity of this sample of highly exposed subjects may preclude generalization to less severely exposed groups. Also, we did not assess criterion G in regard to symptoms causing clinically significant distress and functional impairment. CONCLUSION The prevalence of PTSD was quite similar regardless of diagnostic system. The relatively low concordance between the diagnoses has implications for eligibility for a diagnosis of PTSD.

Lessons learned about psychosocial responses to disaster and mass trauma: an international perspective

At the 13th meeting of the European Society for Traumatic Stress Studies in 2013, a symposium was held that brought together international researchers and clinicians who were involved in psychosocial responses to disaster. A total of six disasters that occurred in five countries were presented and discussed. Lessons learned from these disasters included the need to: (1) tailor the psychosocial response to the specific disaster, (2) provide multi-dimensional psychosocial care, (3) target at-risk population groups, (4) proactively address barriers in access to care, (5) recognise the social dimensions and sources of resilience, (6) extend the roles for mental health professionals, (7) efficiently coordinate and integrate disaster response services, and (8) integrate research and evaluation into disaster response planning.

The relationship of anxiety, depression and behavioral problems with recurrent headache in late adolescence – a Young-HUNT follow-up study

BackgroundThe comorbidity of headache and psychiatric symptoms is a well-recognized clinical phenomenon, but there are only limited data regarding the temporal relationship between headache and symptoms of anxiety and depression as well as behavioral problems in adolescents. This study investigates the relationship of anxiety and depressive symptoms and behavioral problems at baseline with recurrent headache at follow-up four years later.MethodsWithin the Nord-Trøndelag Health Study (HUNT), including repeated population-based studies conducted in Norway, 2399 adolescents in junior high schools aged 12–16 years (77% of the invited) participated in Young-HUNT1 (1995–1997) and again at follow-up four years later, in Young-HUNT2 (2000–2001). The same comprehensive questionnaire that included assessment of symptoms of anxiety and depression and behavioral problems, i.e. conduct and attention difficulties was completed in both studies. In addition 1665 of the participants were interviewed about their headache complaints in Young-HUNT2.ResultsIn adjusted multivariate analyses we found that higher scores of anxiety and depressive symptoms at baseline were associated with recurrent headache at follow-up four years later (OR: 1.6, 95% CI: 1.2-2.1, p = 0.001), evident for migraine (OR: 1.8, 95% CI: 1.2-2.7, p = 0.008) and non-classifiable headache (OR: 1.7, 95% CI: 1.0-2.8, p = 0.034), but not statistically significant for tension-type headache (OR: 1.4, 95% CI: 1.0-1.9, p = 0.053). Higher scores of anxiety and depressive symptoms at baseline were significantly associated with more frequent headache at follow-up (monthly vs. no recurrent headache OR: 1.8, 95% CI: 1.3-2.5, p = 0.001, weekly or daily vs. no recurrent headache OR: 1.9, 95% CI: 1.2-2.9, p = 0.005). Among adolescents without recurrent headache at baseline, higher scores for symptoms of anxiety and depression were associated with new onset migraine four years later (OR: 2.6, 95% CI: 1.1-4.8, p = 0.036). Higher scores of attention problems at baseline were associated with non-classifiable headache at follow-up (OR: 2.0, 95% CI: 1.3-3.4, p = 0.017).ConclusionsResults from the present study showed that symptoms of anxiety and depression in early adolescence were associated with recurrent headache four years later. Recognizing anxiety and depressive symptoms should be considered part of the clinical assessment in young headache patients, as early identification of these associated factors may lead to improved headache management.