Review and debate on exhaustion disorder

Recently, a number of members of the research group together with colleagues from the Stress Research Institute at Stockholm University, published a scoping review on exhaustion disorder where they gathered all empirical studies of exhaustion disorder. The review showed that the existing state of knowledge is scarce and the authors concluded that more research is needed to build a solid knowledge base for exhaustion disorder.

Today, May 13th, the authors also debated the subject in Dagens Nyheter “The exhausted must have access to the right care” (in Swedish), highlighting the fact that new criteria are being developed without first being scientifically evaluated, arguing that there is a great risk for unsafe care and unneccesary suffering for the patients.

The authors are Elin Lindsäter, Frank Svärdman, John Wallert, Ekaterina Ivanova, Anna Söderholm, Robin Fondberg, Gustav Nilsonne, Simon Cervenka, Mats Lekander and Christian Rück. They are affiliated to Karolinska Institutet, Stress Research Institute at Stockholm University and the new in-formal research network Stockholm Stress Collaborative.

Click here for the review Exhaustion Disorder: A Scoping Review of Research on a Recently Introduced Stress.

Click here for the debate article.

Elin Lindsäter i podden Medicinvetarna

Elin Lindsäter medverkar i senaste avsnittet av Karolinska Institutets podcast Medicinvetarna på tema Utmattningssyndrom: Vad vet vi idag?

Podcasten handlar om utmattningssyndrom, en diagnos som har fortsatt att öka. Elin talar om dess utmaningar, dels när det kommer till den diagnostiska gränssättningen mellan utmattning och depression, och dels att det saknas vetenskapligt underlag för att rekommendera olika behandlingar.

– De här patienterna lider och behöver hjälp. Men idag saknas underlaget för att veta hur vi bäst kan hjälpa dem, säger Elin Lindsäter.

Avsnittet hittar du i din podd-app eller genom att klicka här.

Photo: Micke Sandström

English translation: Elin Lindsäter talks about the Swedish diagnosis utmattningssyndrom (exhaustion disorder) and its challenges in diagnostics and treatment, in the latest episode of Karolinska Institutets podcast Medicinvetarna (in Swedish).

Genetics in patients with severe treatment refractory OCD – Grant to Long Chen

Research group member Long Chen recently received a grant from the Bror Gadelius memorial fund for his project about genetics in patients with severe treatment refractory obsessive-compulsive disorder (OCD).

The purpose of the study is to accurately map unusual genetic variations in patients with severe treatment refractory OCD. This will be executed by using whole exome sequencing, a method where the protein-coding parts of the gene (the exome) is sequenced. The aim is also to study wether unusual genetic variations have any predictive value for treatment outcomes after deep brain stimulation (DBS), a method that has been shown to benefit patients that are not helped by the current evidence-based medical and psychotherapeutic treatment methods.


New grant to Mia Asplund

For the second year in a row, Mia Asplund has received a grant from the Mental Health Fund (Fonden för Psykisk Hälsa).

The grant is for the last part of Mia’s PhD research project, a randomized controlled study (RCT) testing the effect of internet based behavior therapy for dermatillomania.

100 000 kr for interesting and important research.


Photo: Micke Sandström

Welcoming Olly Kravchenko

We are happy to announce that Olly Kravchenko just joined the Rück research lab as our new PhD student!

Photo: Micke Sandström

Olly has a background in project management, product testing, and user experience research in tech start-ups. She also has a MSc in German and English Language & Literature (Kyiv National Linguistic University) and a MSc in Public Health Sciences (Stockholm University). She recently finished an internship at the Department of Medical Epidemiology and Biostatistics at Karolinska Institutet, working on a genetically informed research project using data from the Swedish Twin Registry.

Here at the Rück Research Lab, Olly will mainly be working with the PRiSMED project, with John Wallert as main supervisor and Christian Rück as co-supervisor.

About the project
PRiSMED: Predicting health and socioeconomic outcomes in patients with common psychiatric disorders

Depression, social anxiety disorder, panic disorder, and obsessive-compulsive disorder are common mental disorders with a combined point prevalence of 15%. Almost 50% of diagnoses leading to sick-leave in Sweden are psychiatric and their share is increasing. Cognitive behavior therapy (CBT) is first-line treatment for these conditions. Yet, 30-60% of patients will not respond to CBT. Several predictors of CBT outcome have been proposed. Results are mixed and lack predictive acuity to guide clinical decisions. Prediction studies using larger samples and multimodal data (clinical, register, genetic) are urgently needed. Coupled with advanced modelling, we could augment precision psychiatry allowing for tailored intervention and cost-effective resource use.

The project main purpose is improved outcome prediction for common mental disorders in routine clinical care. We will build prediction models for both clinical CBT outcomes (e.g., remission) and long-term outcomes (e.g., poverty) using multimodal data on 5,000 genotyped and register-linked patients treated with CBT – the hitherto largest data collection of its kind.

The project has three aims. Aim 1 uses traditional statistical methods to identify group-level predictors for these outcomes. Aim 2 applies Machine Learning (ML) to identify which individual will experience these outcomes. Aim 3 will plan and initiate a trial comparing a developed ML algorithm versus clinicians at predicting remission in prospective CBT patients.

New publication: Implementation of ICBT for OCD in UK’s IAPT system

Another new publication by Oskar Flygare et al!

Implementing therapist-guided internet-delivered cognitive behaviour therapy for obsessive–compulsive disorder in the UK’s IAPT programme: A pilot trial

Digital therapies such as internet-delivered cognitive behaviour therapy (ICBT) can improve treatment access for patients with common mental disorders, but are rarely used in the Improving Access to Psychological Therapies (IAPT) programme in the United Kingdom. The objective of this study was to evaluate an evidence-based ICBT intervention for obsessive-compulsive disorder (OCD-NET) in three IAPT services in an open trial.

Consecutively referred patients with a primary diagnosis of OCD (= 474) were offered OCD-NET. Symptoms of OCD, depression, anxiety, and level of functioning were measured weekly throughout treatment.

In the full intention to treat sample (= 474), the intervention was associated with large reductions in self-reported OCD symptoms (d = 1.77), anxiety (d = 1.55) and depression (d = 0.8), as well as improvements in functional impairment (d = 0.51 to 0.72). Further, 35% of participants were in recovery at their last assessment, 25% achieved reliable improvement and 15% met criteria for both recovery and improvement. Among participants completing at least 4 modules (= 261), corresponding to an adequate ‘dose’ of treatment, the rates of recovery (44%), reliable improvement (34%) and reliable recovery (21%) were higher. A majority of participants were satisfied with the online treatment and found the online materials helpful.

OCD-NET is an effective treatment when delivered in regular care within the IAPT system. Challenges associated with implementing ICBT in regular health care are discussed.

Rates of recovery, reliable change, and reliable recovery using the first and last assessments on the OCI-R and PHQ-9

Maria Bragesjö receives award for clinical contributions

Maria Bragesjö has received the Swedish Behavioral Therapy Association’s (Beteendeterapeutiska föreningen BTF) award for clinical contributions.

The nomination mentioned Maria’s clinical efforts as a therapist learning and teaching Prolonged Exposure therapy (PE), a specific type of cognitive behavioral therapy that teaches individuals to gradually approach trauma-related memories. It also acknowledged her research focusing on developing early interventions for trauma and PTSD, including the CIPE (Condensed Internet-delivered Prolonged Exposure) method.

Maria Bragesjö is a lic. psychologist, PhD, lic. psychotherapist, a specialist in clinical psychology and psychological manager at the Trauma Program at Psykiatri Sydväst. She joined the research group in September 2021 and registered as a postdoc in January 2022. Her research focuses on trauma and PTSD, specifically on early interventions for potentially traumatic events and different ways to effectively treat PTSD and complex PTSD.


PTP-psykolog sökes

Till hösten söker vi en forskningsintresserad PTP-psykolog till vår grupp!

I forskargruppen pågår ett flertal projekt kring psykologisk behandling, bland annat studier av så kallad Bergen 4 dagars behandling men också flera andra studier kring flera olika diagnoser. Ett annat forskningsfokus är prediktiv modellering av behandlingsutfall samt suicid. Utmattningssyndrom är ett annat fokusområde. Vilket forskningsprojekt som är aktuellt i denna tjänst avgörs i samråd med den sökande.

De kliniska delarna utgör hälften av arbetstiden och genomförs i våra FoU-projekt och på klinikens vårdenheter. Du ska under handledning bedriva psykiatriskt bedömnings- och behandlingsarbete. Det psykiatriska behandlingsarbetet vilar på KBT, varför dokumenterat goda kunskaper i KBT är meriterande, liksom erfarenhet av projektarbete och projektledning.

Tjänsten utlyses av Psykiatri Sydväst och där utlyses även två PTP-platser till Viktor Kaldos forskargrupp.

Läs mer och ansök här.

English translation: We are hiring a psychology intern (PTP-psykolog) for a 50/50 research/clinical employment at the Rück research lab and at Psykiatri Sydväst.

Elin Lindsäter receives grant for primary care research

Elin Lindsäter recently received a two-year grant, “clinical postdoc in primary care”!  🎊

The grant is a part of a larger fund announcement within primary care. The SLSO Research, Development and Education commettee (SLSO’s FoUU-kommitté) describes the investment as an effort to strengthen and renew the clinically oriented medical research that improves and develops healthcare, with a focus on the role of primary care in the healthcare system.

Elin Lindsäter is a lic. Psychologist and PhD at Karolinska Institutet. She works at Gustavsberg primary care center where she, along with her clinical research, works with education and implementation of evidence-based treatments for conditions such as depression, anxiety disorders and stress-related disorders.