OBJECTIVE: The current study investigated the accuracy of reported current and historical weights and of menstrual status in teenage girls with eating disorders. METHOD: Reported current weight in one interview was compared with measured weight at another occasion. Reported historical weights were compared with documented weights from growth charts of the school health services. Reports of menstrual status from two different interviews were compared. RESULTS: The overall correlation between reported and measured/documented weight was high. Current weight was reported with high accuracy in all diagnostic groups and without tendencies to underreport. Patients with bulimia nervosa, but not those with anorexia nervosa, underreported their historical top weight. The most common reason for large discrepancies between reported and documented historical weights was that the two weights compared referred to different time points. The reports on menstrual status were divergent for 13% of the patients, most notably 4 of 15 patients on oral contraceptives had been categorized as having menstruations in one of the interviews. CONCLUSION: Reported weight history and menstrual status are of high accuracy in teenage girls with eating disorders.
Self-report measures can guide clinical decisions and are useful when evaluating treatment outcomes. However, many clinicians do not use self-report measures systematically in their clinical practice. Internet-based questionnaires could facilitate administration, but the psychometric properties of the online version of an instrument should be explored before implementation. The recommendation from the International Test Commission is to test the psychometric properties of each questionnaire separately.
Our objective was to compare the psychometric properties of paper-and-pencil versions and Internet versions of two questionnaires measuring depressive symptoms.
The 87 participating patients were recruited from primary care and psychiatric care within the public health care system in Sweden. Participants completed the Beck Depression Inventory (BDI-II) and the Montgomery-Åsberg Depression Rating Scale-Self-rated (MADRS-S), both on paper and on the Internet. The order was randomized to control for order effects. Symptom severity in the sample ranged from mild to severe depressive symptoms.
Psychometric properties of the two administration formats were mostly equivalent. The internal consistency was similar for the Internet and paper versions, and significant correlations were found between the formats for both MADRS-S (r = .84) and the BDI-II (r = .89). Differences between paper and Internet total scores were not statistically significant for either questionnaire nor for the MADRS-S question dealing with suicidality (item 9) when analyzed separately. The score on the BDI-II question about suicidality (item 9) was significantly lower when administered via the Internet compared with the paper score, but the difference was small (effect size, Cohen's [d] = 0.14). There were significant main effects for order of administration on both questionnaires and significant interaction effects between format and order. This should not, however, pose a problem in clinical use as long as the administration format is not changed when repeated measurements are made.
The MADRS-S can be transferred to online use without affecting the psychometric properties in a clinically meaningful way. The full BDI-II also seems to retain its properties when transferred; however, the item measuring suicidality in the Internet version needs further investigation since it was associated with a lower score in this study. The use of online questionnaires offers clinicians a more practical way of measuring depressive symptoms and has the potential to save resources.
The Eating Disorder Inventory-3 (EDI-3) is designed to assess eating disorder psychopathology and the associated psychological symptoms. The instrument has been revised and has not yet been validated for Swedish conditions in its current form.
The aim of this study was to investigate the validity and reliability of this inventory and present national norms for Swedish females.
Data from patients with eating disorders (n = 292), psychiatric outpatients (n = 140) and normal controls (n = 648), all females, were used to study the internal consistency, the discriminative ability, and the sensitivity and specificity of the inventory using preliminary cut-offs for each subscale and diagnosis separately. Swedish norms were compared with those from Denmark, USA, Canada, Europe and Australian samples.
The reliability was acceptable for all subscales except Asceticism among normal controls. Analysis of variance showed that the EDI-3 discriminates significantly between eating disorders and normal controls. Anorexia nervosa was significantly discriminated from bulimia nervosa and eating disorder not otherwise specified on the Eating Disorder Risk Scales. Swedish patients scored significantly lower than patients from other countries on the majority of the subscales. Drive for Thinness is the second best predictor for an eating disorder. The best predictor for anorexia nervosa was Interoceptive Deficits and Bulimia for the other diagnoses. Conclusions/clinical implications: The EDI-3 is valid for use with Swedish patients as a clinical assessment tool for the treatment planning and evaluation of patients with eating-related problems. However, it still exist some uncertainty regarding its use as a screening tool.
It is unclear whether exposure to childhood maltreatment is associated with the age of onset of alcohol use disorder (AUD). A group of socially stable women with AUD seeking treatment (n = 75) were interviewed using the Addiction Severity Index and the Mini International Neuropsychiatric Interview. They also filled out the Childhood Trauma Questionnaire-short form. Emotional abuse, sexual abuse and multiple childhood traumas were found to be associated with earlier onset of AUD. Multivariable linear regression analysis showed that independent predictors for an earlier onset of AUD were exposure to emotional abuse (beta = -7.44, SE = 2.83, adjusted p = 0.010) and mother's alcohol/substance problems (beta = -7.87, SE = 3.45, adjusted p = 0.026). These variables explained 18.9% of the variance of age of onset of AUD. These findings highlight a need for increased clinical attention to AUD subgroups who have experienced childhood maltreatment, especially emotional abuse, as well as a need for including support in the patient's own parental role in the treatment.
Interprofessional teamwork is practised when the care needs of patients are complex. Little is known about the extent to which team competence really determines patient interventions. The aim of the study was to examine the degree of multidimensionality in patient discussions in psychiatry, and to how different professions contribute. Psychiatric teams were observed during 30 team meetings. A content analysis was used to examine the amount of attention given to medical, psychological and social aspects. The results indicated difficulties in achieving multidimensionality in patient discussions during team meetings. The descriptive element of the discussion was dominated by the social aspect, to which all professions contributed. The analytical element was dominated by the psychological aspect, also to which all the professions contributed. In suggesting interventions, medical interventions were emphasized, principally by the physicians. Decisions on interventions concerned equally medical, social and psychological aspects. An interprofessional composition of teams offers no guarantee that interventions will be of a multidimensional nature. The results are discussed in relation to previous research and practical implications.
The aim of this study was to improve our understanding of the proposed association between anabolic-androgenic steroids (AAS) and criminality.
The study was based on interviews and criminality data involving 32 users of AAS who had sought treatment for AAS-related problems at a psychiatric addiction clinic in Sweden. A score derived from the number of crimes, their level of severity and the relevant time periods was computed to allow comparisons between subgroups sorted according to type and timing of drug use.
The criminal activity level increased for 69% of the individuals after having started to use drugs. This was particularly obvious in the group who had started its involvement with drugs by using AAS. Crimes of violence and weapon offences showed a great increase in incidence after drug use had been initiated. The study also showed a significant decrease in criminality after treatment, particularly among individuals who had started their drug use with AAS.
The results suggest that there is an association between the use of AAS and criminality, especially with regard to crimes of violence and weapon offences, and that this criminality may be enhanced when AAS are combined with other drugs of abuse.
There has been considerable interest in normative ethics regarding how and when coercive care can be justified. However, only a few empirical studies consider how professionals reason about ethical aspects when assessing the need for coercive care for adults, and even less concerning children and adolescents. The aim of this study was to examine and describe how professionals document their value arguments when considering the need for coercive psychiatric care of young people.
All 16 clinics that admitted children or adolescents to coercive care during one year in Sweden were included in the study. These clinics had a total of 155 admissions of 142 patients over one year. Qualitative content analysis with a deductive approach was used to find different forms of justification for coercive care that was documented in the medical records, including Care Certificates.
The analysis of medical records revealed two main arguments used to justify coercive care in child and adolescent psychiatry: 1) the protection argument - the patients needed protection, mainly from themselves, and 2) the treatment requirement argument - coercive care was a necessary measure for administering treatment to the patient. Other arguments, namely the caregiver support argument, the clarification argument and the solidarity argument, were used primarily to support the two main arguments. These supportive arguments were mostly used when describing the current situation, not in the explicit argumentation for coercive care. The need for treatment was often only implicitly clarified and the type of care the patient needed was not specified. Few value arguments were used in the decision for coercive care; instead physicians often used their authority to convince others that treatment was necessary.
One clinical implication of the study is that decisions about the use of coercive care should have a much stronger emphasis on ethical aspects. There is a need for an ethical legitimacy founded upon explicit ethical reasoning and after communication with the patient and family, which should be documented together with the decision to use coercive care.
AIM: To investigate the prevalence of symptoms and signs related to starvation at the initial examination of adolescent girls with eating disorders (ED). METHODS: Two hundred and eleven girls with eating disorders recruited for a multicentre research and evaluation programme of six specialist eating disorder services in Sweden have been studied. The presence or absence of 12 symptoms, reported by the patients, and 16 signs, observed by the examiners, were registered and related to body weight. RESULTS: Eleven observed signs--loss of subcutaneous fat, loss of muscle mass, loss of muscular force, dry and scaly skin, brittle nails, dry and brittle hair, lanugo hair, resting pulse