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"After all the traumas my body has been through, I feel good that it is still working."--Basic Body Awareness Therapy for traumatised refugees.

https://arctichealth.org/en/permalink/ahliterature270470
Source
Torture. 2015;25(1):33-50
Publication Type
Article
Date
2015
Author
Kajsa Stade
Signe Skammeritz
Charlotte Hjortkjær
Jessica Carlsson
Source
Torture. 2015;25(1):33-50
Date
2015
Language
English
Publication Type
Article
Keywords
Awareness
Denmark - epidemiology
Emotions
Ethnic Groups
Female
Follow-Up Studies
Humans
Male
Middle Aged
Physical Therapy Modalities
Psychotherapy, Group - methods
Quality of Life - psychology
Refugees - psychology
Retrospective Studies
Stress, Psychological - ethnology - psychology - therapy
Surveys and Questionnaires
Abstract
Basic Body Awareness Therapy (BBAT) is a form of physiotherapy that is often used for psychiatric patients in Scandinavian countries. To our knowledge there has not been any studies investigating BBAT as a treatment for traumatised refugees until now.
To explore the compliance, acceptability and treatment satisfaction using group BBAT in traumatised refugees. To study changes in psychiatric and somatic symptoms as well as quality of life, level of functioning and quality of movement during treatment with BBAT.
All Arabic speaking patients that previously had received treatment at the Competence Centre for Transcultural Psychiatry in Copenhagen from April 2008 to June 2009 were invited to participate (N=29). Nine persons were included in a male (N=4) and female (N=5) group. All participants were traumatised refugees. The BBAT treatment consisted of 14 sessions over a period of 14 weeks. Before and after treatment the participants were interviewed using a semi-structured interview guide. The interviews were transcribed and analysed with a thematic approach. The participants also filled out self-administrated questionnaires and two physiotherapists tested the participants' movement harmony using the Body Awareness Rating Scale-Movement Harmony (BARS-MH) test. At the end of the study, the participants filled out anonymous questionnaires about treatment satisfaction.
The results showed that the participants had a high compliance, acceptability and treatment satisfaction with BBAT. The majority of participants showed improvements in symptoms from baseline to post-intervention on the self-administrated questionnaires and in the BARS-MH test.
Further research is needed to expand the scientific knowledge regarding the use of BBAT in traumatised refugees. If future research can confirm our positive findings it will have a considerable impact on future treatment designs and for the individual patient.
PubMed ID
26021346 View in PubMed
Less detail

Assessment of dissociation in Bosnian treatment-seeking refugees in Denmark.

https://arctichealth.org/en/permalink/ahliterature268448
Source
Nord J Psychiatry. 2015 May;69(4):307-14
Publication Type
Article
Date
May-2015
Author
Sabina Palic
Jessica Carlsson
Cherie Armour
Ask Elklit
Source
Nord J Psychiatry. 2015 May;69(4):307-14
Date
May-2015
Language
English
Publication Type
Article
Keywords
Adult
Aged
Bosnia and Herzegovina - ethnology
Denmark - ethnology
Dissociative Disorders - diagnosis - ethnology - psychology
Female
Humans
Male
Middle Aged
Patient Acceptance of Health Care - ethnology - psychology
Refugees - psychology
Treatment Outcome
Abstract
Dissociative experiences are common in traumatized individuals, and can sometimes be mistaken for psychosis. It is difficult to identify pathological dissociation in the treatment of traumatized refugees, because there is a lack of systematic clinical descriptions of dissociative phenomena in refugees. Furthermore, we are currently unaware of how dissociation measures perform in this clinical group.
To describe the phenomenology of dissociative symptoms in Bosnian treatment-seeking refugees in Denmark.
As a part of a larger study, dissociation was assessed systematically in 86 Bosnian treatment-seeking refugees using a semi-structured clinical interview (Structured Interview for Disorders of Extreme Stress-dissociation subscale; SIDES-D) and a self-report scale (Dissociative Experiences Scale; DES).
The SIDES-D indicated twice as high prevalence of pathological dissociation as the DES. According to the DES, 30% of the refugees had pathological dissociation 15 years after their resettlement. On the SIDES-D, depersonalization and derealization experiences were the most common. Also, questions about depersonalization and derealization at times elicited reporting of visual and perceptual hallucinations, which were unrelated to traumatic re-experiencing. Questions about personality alteration elicited spontaneous reports of a phenomenon of "split" pre- and post-war identity in the refugee group. Whether this in fact is a dissociative phenomenon, characteristic of severe traumatization in adulthood, needs further examination.
Knowledge of dissociative symptoms in traumatized refugees is important in clinical settings to prevent misclassification and to better target psychotherapeutic interventions. Much development in the measurement of dissociation in refugees is needed.
PubMed ID
25415764 View in PubMed
Less detail

Clinical outcome and time trends of surgically treated renal cell carcinoma between 1986 and 2010: results from a single centre in Sweden.

https://arctichealth.org/en/permalink/ahliterature297894
Source
Scand J Urol. 2018 Jun; 52(3):206-212
Publication Type
Journal Article
Date
Jun-2018
Author
Beata Grabowska
Emma Ulvskog
Jessica Carlsson
Michelangelo Fiorentino
Francesca Giunchi
Per Lindblad
Pernilla Sundqvist
Author Affiliation
a Department of Urology, Faculty of Medicine and Health , Örebro University , Örebro , Sweden.
Source
Scand J Urol. 2018 Jun; 52(3):206-212
Date
Jun-2018
Language
English
Publication Type
Journal Article
Keywords
Adult
Aged
Aged, 80 and over
Calcium - blood
Carcinoma, Renal Cell - blood - mortality - pathology - surgery
Female
Humans
Kidney Neoplasms - blood - mortality - pathology - surgery
Male
Middle Aged
Neoplasm Staging - trends
Retrospective Studies
Survival Rate - trends
Sweden
Treatment Outcome
Tumor Burden
Abstract
The aims of this study were to create a cohort of retrospectively collected renal cell carcinoma (RCC) specimens to be used a basis for prognostic molecular studies, and to investigate the outcome and time trends in patients surgically treated for RCC in a single-centre cohort.
Patients undergoing surgery for RCC between 1986 and 2010 were included in the study. Medical records were reviewed, and the diagnostic tissue was re-evaluated according to a modern classification. The change in patient and tumour characteristics over time was analysed.
The study included 345 patients. Smaller tumours, as indicated by primary tumour diameter, tumour (T) stage and American Joint Committee on Cancer (AJCC) stage, were found more frequently in later years compared to the early 1990s. No changes in the clinical outcome for the patients were seen among the time periods investigated. Increasing T stage, AJCC stage, primary tumour diameter and decreasing haemoglobin levels were associated with cancer-specific mortality in univariate analysis. A high calcium level was significantly associated with increased cancer-specific mortality (hazard ratio?=?4.25, 95% confidence interval 1.36-13.28) in multivariate analysis.
This study on patients who underwent surgery for RCC from 1986 to 2010 at a single institution in Sweden indicates that there has been a change in tumour characteristics of patients diagnosed with RCC over time. It was also shown that calcium levels were an independent prognostic factor for cancer-specific mortality in this cohort. This cohort could provide a valuable basis for further molecular studies.
PubMed ID
29972347 View in PubMed
Less detail

Comparison of psychiatric disability on the health of nation outcome scales (HoNOS) in resettled traumatized refugee outpatients and Danish inpatients.

https://arctichealth.org/en/permalink/ahliterature267219
Source
BMC Psychiatry. 2014;14:330
Publication Type
Article
Date
2014
Author
Sabina Palic
Michelle Lind Kappel
Monica Stougaard Nielsen
Jessica Carlsson
Per Bech
Source
BMC Psychiatry. 2014;14:330
Date
2014
Language
English
Publication Type
Article
Keywords
Adult
Aged
Denmark - epidemiology
Disabled Persons - psychology
Emigration and Immigration - trends
Female
Health Services Needs and Demand - trends
Humans
Inpatients - psychology
Male
Middle Aged
Outpatients - psychology
Refugees - psychology
Stress Disorders, Post-Traumatic - diagnosis - epidemiology - psychology
Treatment Outcome
Abstract
Currently, the mental health issues of traumatized refugees are mainly documented in terms of posttraumatic stress disorder, depression, and anxiety. Importantly, there are no reports of the level of psychiatric disability in treatment seeking traumatized refugees resettled in the West. Insufficient acknowledgment of the collective load of bio-psycho-social problems in this patient group hinders effective psychiatric and social service utilization outside the specialized clinics for traumatized refugees.
The level of psychiatric disability in traumatized refugees from Danish specialized clinics (N = 448) is documented using routine monitoring data from pre- and post-treatment on the Health of Nation Outcome Scales (HoNOS). Furthermore, the HoNOS ratings are compared with routine monitoring data from Danish inpatients with different diagnoses (N = 10.911).
The routinely collected data indicated that despite their outpatient status, traumatized refugees had higher levels of psychiatric disability at pre-treatment compared to most inpatients. Moreover, the traumatized refugees had a HoNOS profile characterized by an overall high problem level in various psychiatric and social domains. The rate of pre- to post-treatment improvement on the HoNOS was smaller for the traumatized refugees than it was for the psychiatric inpatients.
The level, and the versatile profile, of psychiatric disability on the HoNOS point to complex bio-psycho-social problems in resettled treatment seeking traumatized refugees. Thus, a broader assessment of symptoms and better cooperation between psychiatric, health care, and social systems is necessary in order to meet the treatment needs of this group.
Notes
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PubMed ID
25519423 View in PubMed
Less detail

The effect of flexible cognitive-behavioural therapy and medical treatment, including antidepressants on post-traumatic stress disorder and depression in traumatised refugees: pragmatic randomised controlled clinical trial.

https://arctichealth.org/en/permalink/ahliterature277334
Source
Br J Psychiatry. 2016 Mar;208(3):252-9
Publication Type
Article
Date
Mar-2016
Author
Caecilie Böck Buhmann
Merete Nordentoft
Morten Ekstroem
Jessica Carlsson
Erik Lykke Mortensen
Source
Br J Psychiatry. 2016 Mar;208(3):252-9
Date
Mar-2016
Language
English
Publication Type
Article
Keywords
Adult
Antidepressive Agents - administration & dosage
Cognitive Therapy
Combined Modality Therapy
Denmark
Depressive Disorder - drug therapy
Female
Humans
Male
Mianserin - administration & dosage - adverse effects
Middle Aged
Patient Education as Topic
Psychiatric Status Rating Scales
Quality of Life
Refugees - psychology
Sertraline - administration & dosage
Stress Disorders, Post-Traumatic - drug therapy - therapy
Treatment Outcome
Abstract
Little evidence exists on the treatment of traumatised refugees.
To estimate treatment effects of flexible cognitive-behavioural therapy (CBT) and antidepressants (sertraline and mianserin) in traumatised refugees.
Randomised controlled clinical trial with 2 × 2 factorial design (registered with Clinicaltrials.gov, NCT00917397, EUDRACT no. 2008-006714-15). Participants were refugees with war-related traumatic experiences, post-traumatic stress disorder (PTSD) and without psychotic disorder. Treatment was weekly sessions with a physician and/or psychologist over 6 months.
A total of 217 of 280 patients completed treatment (78%). There was no effect on PTSD symptoms, no effect of psychotherapy and no interaction between psychotherapy and medicine. A small but significant effect of treatment with antidepressants was found on depression.
In a pragmatic clinical setting, there was no effect of flexible CBT and antidepressants on PTSD, and there was a small-to-moderate effect of antidepressants and psychoeducation on depression in traumatised refugees.
PubMed ID
26541687 View in PubMed
Less detail

Secondary psychotic features in refugees diagnosed with post-traumatic stress disorder: a retrospective cohort study.

https://arctichealth.org/en/permalink/ahliterature284130
Source
BMC Psychiatry. 2017 Jan 05;17(1):5
Publication Type
Article
Date
Jan-05-2017
Author
Mette Nygaard
Charlotte Sonne
Jessica Carlsson
Source
BMC Psychiatry. 2017 Jan 05;17(1):5
Date
Jan-05-2017
Language
English
Publication Type
Article
Keywords
Adult
Delusions - diagnosis
Denmark
Female
Hallucinations - diagnosis - psychology
Humans
Male
Mental Health - statistics & numerical data
Middle Aged
Personality Disorders - diagnosis
Psychotic Disorders - diagnosis - psychology
Refugees - psychology - statistics & numerical data
Retrospective Studies
Stress Disorders, Post-Traumatic - diagnosis - psychology
Stress, Psychological - diagnosis
Young Adult
Abstract
A substantial amount of refugees (10-30%) suffer from Post-Traumatic Stress Disorder (PTSD). In Denmark there are different facilities specialised in psychiatric treatment of trauma-affected refugees. A previously published case report from such a facility in Denmark shows that some patients suffer from secondary psychotic symptoms alongside their PTSD. The aim of this study was to illustrate the characteristics and estimate the prevalence of psychotic features in a clinical population of trauma-affected refugees with PTSD.
Psychiatric records from 220 consecutive patients at Competence Centre for Transcultural Psychiatry (CTP) were examined, and all the PTSD patients were divided into two groups; one group with secondary psychotic features (PTSD-SP group) and one without (PTSD group). A categorisation and description of the secondary psychotic features was undertaken.
One hundred eighty-one patients were diagnosed with PTSD among which psychotic symptoms were identified in 74 (40.9, 95% CI 33.7-48.1%). The majority of symptoms identified were auditory hallucinations (66.2%) and persecutory delusions (50.0%). There were significantly more patients diagnosed with enduring personality change after catastrophic experience in the PTSD-SP group than in the PTSD group (P?=?0.009). Furthermore the PTSD-SP group included significantly more patients exposed to torture (P?=?0.001) and imprisonment (P?=?0.005).
This study provides an estimation of PTSD-SP prevalence in a clinical refugee population with PTSD. The study points to the difficulties distinguishing psychotic features from flashbacks and the authors call for attention to psychotic features in PTSD patients in order to improve documentation and understanding of the disorder.
Notes
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PubMed ID
28056884 View in PubMed
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Somatic comorbidity among migrants with posttraumatic stress disorder and depression - a prospective cohort study.

https://arctichealth.org/en/permalink/ahliterature283200
Source
BMC Psychiatry. 2016 Dec 13;16(1):447
Publication Type
Article
Date
Dec-13-2016
Author
Mette Lolk
Stine Byberg
Jessica Carlsson
Marie Norredam
Source
BMC Psychiatry. 2016 Dec 13;16(1):447
Date
Dec-13-2016
Language
English
Publication Type
Article
Keywords
Adult
Cohort Studies
Comorbidity
Denmark - epidemiology
Depression - epidemiology
Female
Humans
Male
Middle Aged
Prospective Studies
Stress Disorders, Post-Traumatic - epidemiology
Transients and Migrants - psychology - statistics & numerical data
Young Adult
Abstract
In a cohort of migrants in Denmark, we compared somatic disease incidence among migrants diagnosed with posttraumatic stress disorder (PTSD) and depression with migrants without a diagnosed psychiatric disorder.
The study builds on a unique cohort of migrants who obtained residence permit in Denmark from 1993 to 2010 (N?=?92,104). The association with somatic disease was explored via register linkage. We used Poisson regression to model incidence rate ratios (IRR) adjusted for age, sex, income and region of origin. The Danish Data Protection Agency granted authorisation for the implementation of the project (No 2012-41-0065).
Our results showed that migrants diagnosed with PTSD and depression had significantly higher rates of somatic diseases compared with migrants without diagnosed psychiatric disorders - especially, infectious disease (IRR, 1.89; 95% CI, 1.45-2.48; p?
Notes
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PubMed ID
27964720 View in PubMed
Less detail

Treatment of trauma-affected refugees with venlafaxine versus sertraline combined with psychotherapy - a randomised study.

https://arctichealth.org/en/permalink/ahliterature282978
Source
BMC Psychiatry. 2016 Nov 08;16(1):383
Publication Type
Article
Date
Nov-08-2016
Author
Charlotte Sonne
Jessica Carlsson
Per Bech
Ask Elklit
Erik Lykke Mortensen
Source
BMC Psychiatry. 2016 Nov 08;16(1):383
Date
Nov-08-2016
Language
English
Publication Type
Article
Keywords
Adult
Antidepressive Agents, Second-Generation - therapeutic use
Anxiety - drug therapy
Denmark
Depression - drug therapy
Female
Humans
Male
Middle Aged
Psychiatric Status Rating Scales
Quality of Life - psychology
Refugees - psychology
Research Design
Sertraline - therapeutic use
Stress Disorders, Post-Traumatic - drug therapy - psychology
Surveys and Questionnaires
Treatment Outcome
Venlafaxine Hydrochloride - therapeutic use
Abstract
The prevalence of trauma-related psychiatric disorders is high among refugees. Despite this, little is known about the effect of pharmacological treatment for this patient group. The objective of the present study was therefore to examine differences in the effects of venlafaxine and sertraline on Post-Traumatic Stress Disorder (PTSD), depression and functional impairment in trauma-affected refugees.
The study was a randomised pragmatic trial comparing venlafaxine and sertraline in combination with psychotherapy and social counselling. PTSD symptoms were measured on the Harvard Trauma Questionnaire - part IV, which was the primary outcome measure. Other outcome measures included: Hopkins Symptom Check List-25 (depression and anxiety), Social Adjustment Scale - short version (social functioning), WHO-5 Well-being Index (quality of life), Crisis Support Scale (support from social network), Sheehan Disability Scale (disability in three areas of functioning), Hamilton Depression and Anxiety scale, the somatisation items of the Symptoms Checklist-90, Global Assessment of Functioning scales and the summarised score of pain in four body areas rated on visual analogue scales.
Two hundred seven adult refugee patients were included in the trial (98 in the venlafaxine and 109 in the sertraline group). Of these, 195 patients were eligible for intention-to-treat analyses. Small but significant pre-treatment to post-treatment differences were found on the Harvard Trauma Questionnaire and a number of other ratings in both groups. On the primary outcome measure, no difference was found in treatment effect between the sertraline and venlafaxine group. A significant group difference was found in favour of sertraline on the Sheehan Disability Scale.
Sertraline had a slightly better outcome than venlafaxine on some of the secondary outcome measures, but not on the primary outcome measure. Furthermore, a higher percentage of dropouts was found in the venlafaxine group compared to the sertraline group. Although this could indicate that sertraline was better tolerated, which is supported by other studies, a final conclusion on tolerability cannot be drawn from the current study due to lack of systematic reporting of side effects.
ClinicalTrials.gov NCT01569685 . Registration date: 28/2/12.
Notes
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PubMed ID
27825327 View in PubMed
Less detail

Treatment of traumatised refugees with basic body awareness therapy versus mixed physical activity as add-on treatment: Study protocol of a randomised controlled trial.

https://arctichealth.org/en/permalink/ahliterature274827
Source
Trials. 2015;16:477
Publication Type
Article
Date
2015
Author
Maja Sticker Nordbrandt
Jessica Carlsson
Laura Glahder Lindberg
Hinuga Sandahl
Erik Lykke Mortensen
Source
Trials. 2015;16:477
Date
2015
Language
English
Publication Type
Article
Keywords
Adaptation, Psychological
Awareness
Chronic Pain - diagnosis - physiopathology - psychology - therapy
Cognitive Therapy - methods
Denmark
Exercise Therapy - adverse effects - methods
Health status
Humans
Mental health
Motor Activity
Pain Measurement
Pain Perception
Psychiatric Status Rating Scales
Psychological Trauma - diagnosis - physiopathology - psychology - therapy
Quality of Life
Refugees - psychology
Research Design
Self Concept
Stress Disorders, Post-Traumatic - diagnosis - physiopathology - psychology - therapy
Time Factors
Treatment Outcome
Abstract
Treatment of traumatised refugees is one of the fields within psychiatry, which has received little scientific attention. Evidence based treatment and knowledge on the efficiency of the treatment for this complex patient group is therefore scarce. This leads to uncertainty as to which treatment should be offered and potentially lowers the quality of life for the patients. Chronic pain is very common among traumatised refugees and it is believed to maintain the mental symptoms of trauma. Hence, treating chronic pain is believed to be of high clinical value for this patient group. In clinical studies, physical activity has shown a positive effect on psychiatric illnesses such as depression and anxiety and for patients with chronic pain. However, scientific knowledge about physical activity as part of the treatment for traumatised refugees is very limited and no guidelines exist on this topic.
This study will include approximately 310 patients, randomised into three groups. All three groups receive psychiatric treatment as usual for the duration of 6-7 months, consisting of consultations with a medical doctor including pharmacological treatment and manual-based Cognitive Behavioural Therapy. The first group only receives treatment as usual while the second and the third groups receive either Basic-Body Awareness Therapy or mixed physical activity as add-on treatments. Each physical activity is provided for an individual 1-hour consultation per week, for the duration of 20 weeks. The study is being conducted at the Competence Centre for Transcultural Psychiatry, Mental Health Centre Ballerup in the Capital Region of Denmark. The primary endpoint of the study is symptoms of Post Traumatic Stress Disorder; the secondary endpoints are depression and anxiety as well as quality of life, functional capacity, coping with pain, body awareness and physical fitness.
This study will examine the effect of physical activity for traumatised refugees. This has not yet been done in a randomised controlled setting on such a large scale before. Hereby the study will contribute to important knowledge that is expected to be used in future clinical guidelines and reference programs.
ClinicalTrials.gov NCT01955538 . Date of registration: 18 September 2013.
Notes
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PubMed ID
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