Can genes predict outcome in CBT?

In a new study by our group, we showed for the first time an association of a polygenetic signal and outcome in CBT. The study was published in Molecular Psychiatry and included 894 individuals with depression who underwent 12 weeks of internet based CBT. Single-nucleotide polymorphism genotyping arrays were used to calculate the genomic risk scores based on large genetic studies of six phenotypes: major depressive disorder, bipolar disorder, attention-deficit/hyperactivity disorder, autism spectrum disorder, intelligence, and educational attainment. The relationships between the six genetic risk scores and cognitive behavior therapy outcome was analyzed. Our analyses yielded one significant interaction effect (B = 0.09, p < 0.001): the autism spectrum disorder genetic risk score correlated with Montgomery Åsberg Depression Rating Scale-Self Rated changes during treatment, and the higher the autism spectrum disorder genetic load, the less the depressive symptoms decreased over time.  Our preliminary results indicated, as expected, that the genomics of the response of patients with major depression to cognitive behavior therapy were complex and that future efforts should aim to maximize sample size and limit subject heterogeneity in order to gain a better understanding of the use of genetic risk factors to predict treatment outcome.

For full text: https://www.nature.com/articles/s41380-018-0289-9

Andersson E, Crowley JJ, Lindefors N, Ljótsson B, Hedman-Lagerlöf E, Boberg J, El Alaoui S, Karlsson R, Lu Y, Mattheisen M, Kähler AK, Svanborg C, Mataix-Cols D, Mattsson S, Forsell E, Kaldo V, Schalling M, Lavebratt C, Sullivan PF, Rück C. Genetics of response to cognitive behavior therapy in adults with major depression: a preliminary report. Molecular Psychiatry. 2018

 

 

 

SweSRII 2018

 

Participants SweSRII 2018 Växjö Linnéuniversitetet
The participants of SweSRII 2018

The yearly conference for research on internet interventions took place in Växjö, att Linnaeus University, on 9th November. The meeting brought together researchers and practitioners from Sweden, Norway and Denmark to present and discuss recent developments and upcoming projects. The Rücklab team was represented by Oskar and Katja.

With a familial atmosphere and representation from both academia and health care, the conference provided a great opportunity to discuss common struggles and potential improvements of our treatment interventions. Some highlights of the programme include individually tailored treatments for patients with multiple psychiatric conditions, the use of emergent technologies like virtual reality to treat mental illness, and disseminating internet-delivered cognitive behavioural therapy in rural settings.

We had a great time and look forward to exchanging ideas and collaborating on project with our colleagues from all over Sweden and elsewhere. Next up is esrii 2019 in Copenhagen!

Funding from the Swedish Research Council

Good news! The Swedish Research Council (Vetenskapsrådet) has awarded us 2.4 million SEK over the next 3 years for our PRiMED-study (Predicting Response to CBT in Mental Disorders using multimodal data and machine learning). Bild1

Anmäl dig till vår genetikstudie

Nu är vår studie av OCD (tvångssyndrom), BDD (dysmorfofobi), samlarsyndrom och tics/Tourettes öppen för att du kan anmäla dig själv oavsett om du har tidigare diagnos eller inte. Du anmäler dig på ocdgenetik.se och svarar på frågor och får sedan ett DNA-salivkit hemskickat. Mer info på sidan.

bilaga 3_poster_annons

New study: Adapted CBT for adults with OCD and ASD

We have just released a pre-print1 where we describe an adapted cognitive behavior therapy for adults with obsessive-compulsive disorder (OCD) and autism spectrum disorder (ASD). You can find the full paper here.

OCD and ASD often co-occur but effective treatment options for this patient group are sorely lacking. We extended an adapted CBT protocol developed in the UK at our specialist clinic for OCD and related disorders (OCD-programmet).

Our results show that OCD-symptoms (both when rated by a clinician and by the participants themselves) decrease over the course of treatment, but that few participants were completely symptom free.

ybocs-compare
Results on the main outcome: Yale-Brown Obsessive-compulsive Scale (YBOCS) rated by clinicians.

We discuss three ways to develop the treatment further: adding more support in between sessions to help participants do exposure exercises on their own, including interventions to help participants find meaningful daily activities, and intensifying the treatment over a shorter time span.

If you are interested in learning more, you can find the pre-print at the pre-print server PsyArXiv.


  1. A pre-print is a manuscript that has been read and approved by all authors but has not gone through peer-review yet. It’s a popular way to quickly disseminate results in fields like genetics, physics and mathematics. It is gaining popularity in other fields as well. Wikipedia article ↩︎

Internet-KBT för tvångssyndrom och dysmorfofobi i reguljär vård

Nu finns internet-KBT för tvångssyndrom (OCD) och dysmorfofobi (BDD) tillgängligt för vuxna personer i hela Sverige!

Vi har utvecklat och utvärderat dessa behandlingar i flera vetenskapliga studier sedan 2011 (OCD) respektive 2014 (BDD) och funnit att de fungerar bra vid båda tillstånden. Det slutgiltiga målet har alltid varit att fler patienter ska få tillgång till effektiv behandling och vi är stolta över att ha nått fram till den här punkten.

Lina Lundström är den person som varit projektledare för implementeringen i reguljär vård och det är tack vare hennes ihärdiga arbete som behandlingarna nu finns tillgängliga.

Instruktioner för egenanmälan till behandlingen

Boende i Stockholms län kan logga in via Vårdguidens e-tjänster för att anmäla sitt intresse för behandling.

Data Science for Mental Health Transfer Learning Roundtable

This week RISE/KTH arranged a roundtable on AI in mental heath research with participants from KI, KTH, Stockholm University and KCL, UCL and Anna Freud Institute in London. We are starting in this exiting field now.

 

20180929_072313.jpg

New study: PRIMED

In collaboration with researchers at Linnéuniversitet, Royal Institute of Technology and University of North Carolina at Chapel Hill we are planning a new study called PRIMED: Predicting Response to CBT in Mental Disorders using multimodal data and machine learning.

Common mental disorders such as depression, social anxiety, panic disorder and OCD have a point prevalence of 15%. CBT is the treatment of choice, yet 30-60% of patients undergoing CBT will not respond to treatment. Identifying non-responders before treatment would allow alternative treatment choices.

Predictor studies have so far not been able to reach an acceptable predictive power to guide clinical decisions so adding fine-grained and multiple types data, including the genetic footprint, may be a way forward.

Hence, the aim of PRIMED is to better predict treatment response to Cognitive behavioral therapy (CBT) in depression, social anxiety disorder, panic disorder, and OCD by using clinical, register-based, and genetic data from 6000 individuals in Sweden.

In PRIMED, potential predictors include clinical information, register based data and genetic variation. Outcomes are short-term clinical data, long-term register based medical data e.g. prescriptions, diagnoses, suicide attempts and social data such as unemployment, sickness absence, and disability pension.

icon primed transparent

In addition to study predictors on these different levels, we also want to add artificial intelligence, or Machine Learning to identify individuals at risk of not responding to treatment. So-called ‘Learning Machines’ can learn from historical cases and then apply what it has learnt to predict outcomes in a single, new case. Rather than considering the effect of one variable on an outcome of interest at a group level, Learning Machines identify patterns of information that can be used to predict the outcome for an individual.

The Learning Machine will learn from a training dataset consisting of 4 000 individuals and then validate its ability to correctly identify patients at risk on 2 000 new patients.

This project pursues a novel research area that can only be developed by a multidisciplinary team involving experts in disparate fields: psychiatry, psychology, epidemiology, AI, and genetics. We have assembled a strong interdisciplinary team from four different universities in two countries and are very excited about this collaboration!

Doctor Evelyn Andersson Hagen!

Congrats Evelyn! She is the 4th PhD student to graduate from our lab and she defended her thesis very well the past Friday. Big thank you to everyone involved!

 

IMG_7693
Evelyn in defense mode.
IMG_7699
From left: Co-supervisor Erik Hedman-Lagerlöf, examination board member Lisa Thorell, main supervisor Christian Rück, Evelyn, co-supervisor Martin Schalling and Cattis Lavebratt, opponent Jönsson, examination board member Lars Westberg and session chair Viktor Kaldo.
IMG_7710
Party!
IMG_7720
Winning shoes!
IMG_7665
Opponent Erik Jönsson, Oslo University.
IMG_7677
ICBT FTW!