Author: Christian Rück

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Har du tvångssyndrom och vill delta i en behandlingsstudie?

Den behandling som visat sig effektivast mot tvångssyndrom är kognitiv beteendeterapi (KBT).  Kognitiv beteendeterapi går ut på att förändra tankar och beteenden för att kunna må bättre och nå mål man värderar som viktiga.

Att behandlingen sker inom ramen för en studie innebär för dig som behandlingsdeltagare att den är helt gratis.

I studien kommer det att bli aktuellt med ett bedömningsbesök på Karolinska universitetssjukhuset Huddinge. Kommer du med i studien kommer du att lottas till antingen internetbehandling eller behandling där du träffar  en psykolog. Det går inte att påverka vilken typ av behandling som du kommer att lottas till.

För att kunna bli aktuell för studien behöver du bland annat:

  • vara folkbokförd i Stockholms län, Södermanlands län eller Upplands län
  • vara minst 18 år
  • lida av tvångstankar och tvångshandlingar
  • ha tid att engagera dig i ditt behandlingsarbete under cirka 14 veckor
  • ha tillgång till dator och internet
  • ha möjlighet att göra praktiska övningar i din egen vardag
  • ha möjlighet att ta dig till Karolinska universitetssjukhuset Huddinge

Intresseanmälan gör du här.

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New teammember: Ingrid Pettersson

Our newest addition is Ingrid Pettersson, medical student from Umeå University, who for her master thesis will study the neurocognition of OCD. This is an extention of our previous work in this area done in collaboration with Valerie Voon, Trevor Robbins and others at Cambridge University that has resulted in the following papers:

Voon V, Morris L, Irvine M, Rück C, Worbe Y, Derbyshire K, Rankov V, Schreiber L, Odlaug B, Harrison N, Wood J, Robbins T, Bullmore E, Grant J. Risk taking in disorders of natural and drug rewards: neural correlates and effects of probability, valence and magnitude. Neuropsychopharmacology advance online publication 15 October 2014; doi: 10.1038/npp.2014.242

Voon V, Derbyshire K, Rück C, Irvine MA, Worbe Y, Enander J, Schreiber LR, Gillan C, Fineberg NA, Sahakian BJ, Robbins TW, Harrison NA, Wood J, Daw ND, Dayan P, Grant JE, Bullmore ET. Disorders of compulsivity: a common bias towards learning habits. Mol Psychiatry. 2014 May 20. doi: 10.1038/mp.2014.44

Ingrid testing the CANTAB system on Chris.
Ingrid testing the CANTAB system on Chris.
News

New teammember: Christopher LaLima

Christopher LaLima, student at Hofstra in New York, who has worked in our pilot study of iCBT for OCD at Columbia University is now joining us here in Sweden for a year. He will work in our BDD project. Today was his first day at work and it started with some drama: he lost his passport on his way to work and our search and rescue efforts yielded nothing. But there is a happy ending: a very nice person replied to our SOS on Instagram and had heard that the passport had been found in the bus and now Chris has his passport back. Anyway, Chris you are very welcome in our group! (And hold on to you passport).

Chris wondering where he left his passport. But still trying not to look too freaked out about it.
Chris wondering where he left his passport. But still trying not to look too freaked out about it.
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New pilot study on acceptance-based exposure therapy for Body Dysmorhic Disorder (BDD)

In a collaboration between Karolinska Institutet and Stockholm University led by Johanna Linde, a pilot study on an acceptance-based approach to BDD has just been published in Behavior Therapy. Highlights included:

  • Pilot study examined the treatment outcomes and feasibility of acceptance-based exposure therapy for BDD in 21 patients
  • At post-treatment, symptoms of BDD, depression, psychological flexibility, quality of life and general functioning were significantly improved
  • Dropout was low, and treatment gains were maintained at 6 months follow-up

These findings need to be confirmed by a controlled study before clinically inplemented.

Linde, J., Rück, C., Bjureberg, J., Ivanov, V. Z., Radu Djurfeldt, D., & Ramnerö.  Acceptance-based exposure therapy for body dysmorphic disorder: A pilot study. Behav Ther. 2015 Jul;46(4):423-31. doi: 10.1016/j.beth.2015.05.002.

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New study: Validity of tic and OCD diagnoses in Swedish registers

The usefulness of cases diagnosed in registers for research purposes is dependent on diagnostic validity. This new study aimed to investigate the validity  of recorded diagnoses of tic disorders and obsessive-compulsive disorder (OCD) in the Swedish National Patient Register (NPR). 100 tic disorder cases and 100 OCD cases were randomly selected from the NPR based on codes from the International Classification of Diseases (ICD) 8th, 9th and 10th editions, together with 50 epilepsy and 50 depression control cases. The obtained psychiatric records were blindly assessed by 2 senior psychiatrists according to the criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) and ICD-10.

Results Between 1969 and 2009, the NPR included 7286 tic disorder and 24 757 OCD cases. The vast majority (91.3% of tic cases and 80.1% of OCD cases) are coded with the most recent ICD version (ICD-10). For tic disorders, the PPV was high across all ICD versions (PPV=89% in ICD-8, 86% in ICD-9 and 97% in ICD-10). For OCD, only ICD-10 codes had high validity (PPV=91–96%). None of the epilepsy or depression control cases were wrongly diagnosed as having tic disorders or OCD, respectively. Inter-rater reliability was outstanding for both tic disorders (κ=1) and OCD (κ=0.98).

Conclusions The validity and reliability of ICD codes for tic disorders and OCD in the Swedish NPR is generally high. We propose simple algorithms to further increase the confidence in the validity of these codes for epidemiological research.

Read the full text here

Rück C., Larsson K.J., Lind K., Perez-Virgil A., Isomura K., Sariaslan A., Lichtenstein P., Mataix-Cols D. Validity and reliability of chronic tic disorder and obsessive-compulsive disorder diagnoses in the Swedish National Patient Register. BMJ Open. 2015 Jun 22;5(6):e007520. doi: 10.1136/bmjopen-2014-007520

News

New study: Chronic tic disorders highly heritable

The risk for tic disorders, including Tourette syndrome and chronic tic disorders, increased with the degree of genetic relatedness in a study of families in Sweden, according to an article published online today by JAMA Psychiatry.

While tic disorders are thought to be strongly familial and heritable, precise estimates of familial risk and heritability are lacking.

David Mataix-Cols, lead author, of the Karolinska Institutet, Stockholm, and coauthors including Johan Larsson and Christian Rück from our group tried to overcome some of those limitations by estimating family clustering and heritability of tic disorders using data from two Swedish population-based registers. We identified 4,826 individuals diagnosed as having Tourette syndrome or chronic tic disorders from 1969 through 2009.

The authors found first-degree relatives of individuals with tic disorders had higher risk of having Tourette syndrome or chronic tic disorders than second- and third-degree relatives. In turn, the odds were higher for second-degree relatives than third-degree relatives.

Full siblings, parents and children of individuals with Tourette syndrome or chronic tic disorder (all with 50 percent genetic similarity but with siblings assumed to have more shared environment because they grew up together) had comparable risks. The results also indicate that risks for full siblings (50 percent genetic similarity) were higher than those for maternal half siblings (25 percent genetic similarity) despite similar shared environmental exposures. First cousins (12.5 percent) genetic similarity had a three-fold higher risk of having Tourette syndrome or chronic tic disorders compared with control patients.

“The heritability of tic disorders was estimated to be approximately 77 percent, with the remaining variance being attributable to nonshared environmental influences and measurement error. … Our heritability estimates place tic disorders among the most heritable neuropsychiatric conditions,” the study concludes.

Mataix-Cols D, Isomura K, Pérez-Vigil A, Chang Z, Rück C,  Larsson KJ, ; Leckman JF, Serlachius E, Larsson H, Lichtenstein P. Familial Risks of Tourette Syndrome and Chronic Tic Disorders: A Population-Based Cohort Study. JAMA Psychiatry. Published online June 17, 2015. doi:10.1001/jamapsychiatry.2015.0627

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Conferment ceremony for Erik Andersson

Karolinska Institutet held its traditional Conferment ceremony for doctoral students. The ceremony took place in the Blue Hall of Stockholm City Hall was followed by a banquet in the Golden Hall and dance. Erik Andersson was promoted to PhD, as symbolized by putting on a funny hat.

Anyway, we congratulate Erik to this achivement! You are the best!

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Erik getting his hat
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“Yeah, I did it. Can you believe it?”
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Erik Andersson and his superproud ex-supervisor Christian Rück
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Party like it is promovering, man.
News

New publication in JAMA Psychiatry: d-Cycloserine as Adjunct to CBT in OCD

Our study of d-cycloserine in OCD is out now in JAMA Psychiatry (click for link). This randomized clinical trial examines whether d-cycloserine augments cognitive behavioral therapy in the treatment of obsessive-compulsive disorder (OCD) and whether concomitant use of antidepressants moderates the effects of d-cycloserine.

Sammanfattning på svenska: http://ki.se/nyheter/tuberkulosmedicin-kan-forbattra-effekt-av-kbt

Andersson E, Hedman E, Enander J,  Radu Djurfeldt D, Ljótsson B, Cervenka S, Isung J, Svanborg C, Mataix-Cols D, Kaldo V, Andersson G, Lindefors N, Rück C. D-cycloserine vs Placebo as Adjunct to Cogntive Behavioral Therapy for Obsessive-Compulsive Disorder and Interaction With Antidepressants: A randomized clinical trial. JAMA Psychiatry. Published online May 13, 2015. doi:10.1001/jamapsychiatry.2015.0546.