PubMed Health⌕ Search

Biomedical subjects

K Gunnar Götestam

Publications and source records attributed to K Gunnar Götestam.

At least 19 recordsLinked to original sources
PubMed2006

An open clinical trial of cognitive-behaviour therapy in children and adolescents with obsessive-compulsive disorder administered in regular outpatient clinics.

UNLABELLED: The aim of the present study was to examine the effectiveness of manual-guided cognitive-behaviour therapy (CBT) for childhood obsessive-compulsive disorder (OCD) administered within three regular, i.e., non-academic, Norwegian outpatient child psychiatric clinics. METHODS: A total of 28 youngsters, aged 8-17 with primary OCD entered the study. Assessment at intake included Norwegian versions of the K-SADS-PL, Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS), and a measure of OCD-specific functional impairment (Child OCD Impact Scale (COIS)). Therapy consisted of 12 manual-guided sessions with combined individual and family CBT-based interventions and was conducted by psychologists and physicians under training and supervision. Outcome was assessed after treatment and at 3- and 6-month follow-ups by means of the CY-BOCS, the Clinical Global Impression (CGI) and the CGI-Improvement scales, and the COIS. RESULTS: Twenty-four youngsters (86%) completed treatment and were available for the follow-up assessments. Significant improvements were found on all outcome measures after treatment, including a mean symptom reduction on the CY-BOCS of 60.6%, increasing to 68.8% at the 6-month follow-up. Estimates of within-group effect sizes showed strong effects of treatment. CONCLUSION: The results of the present study suggest that manual-guided CBT for childhood OCD can be successfully implemented in non-academic community child psychiatric settings with outcomes in accordance with previous findings from highly specialised university clinics.

Adolescent↗
PubMed2006

Treatment motivation, treatment expectancy, and helping alliance as predictors of outcome in cognitive behavioral treatment of OCD.

Predictors of improvement in obsessive-compulsive symptoms (Y-BOCS) in a randomized clinical trial with adult obsessive-compulsive disorder outpatients were examined. Results of multiple regression analyses revealed that a positive helping alliance was significantly predictive of posttreatment Y-BOCS. Treatment expectancy and high motivation to change were not significantly related to posttreatment outcome. None of the predictors were significantly related to Y-BOCS levels at 12-month follow-up, but positive alliance showed a trend to significance.

Adult↗
PubMed2005

Characteristics of anorexia nervosa-related deaths in Norway (1992-2000): data from the National Patient Register and the Causes of Death Register.

OBJECTIVE: This study investigated demographic and diagnostic characteristics of individuals whose medical record or death certificate indicated the presence of anorexia nervosa at the time of death. METHOD: Two national registers, the National Patient Register (NPR) and the Causes of Death Register (CODR), were examined in Norway for anorexia nervosa-related deaths occurring across a 9-year period (1992-2000). RESULTS: The medical record or death certificate listed anorexia nervosa as a diagnosis or cause of death for 66 individuals. Rates of death were 6.46 and 9.93 per 100,000 deaths for the NPR and the CODR, respectively. A substantial percentage of deaths (43.9%) in both registers occurred at or above the age of 65 years. For the NPR, the mean age at the time of death was 61 years and 31% of deaths occurred among men. For the CODR, the mean age at the time of death was 49 years and 18% of deaths occurred among men. DISCUSSION: Potential merits and shortcomings of assessing mortality rates using register-based data without linkage to a previously identified clinical sample are discussed.

Adolescent↗
PubMed2004

[Eating disorders in a historical perspective].

Disordered eating has been known since antiquity and is mentioned in medical journals as well as in popular literature. The holy anorectics in the Middle Ages wanted to achieve spiritual perfection, while the anorectics of today are seeking bodily perfection. Hilde Bruch and Mara Selvini Palazzoli were the first to focus on anorectic symptoms like leanness and body image disturbance. The breakthrough in clinical and scientific work on bulimia nervosa came around 1980, primarily due to Russell's achievements. In 1874, Sir William Gull was the first to use anorexia nervosa as a diagnosis, while bulimia nervosa was first used in 1979. In the history of Norwegian psychiatry, several psychiatric disorders were described at an early stage, yet eating disorders have only been discussed in the scientific literature from the 1980s and onwards. Eating disorders have now become a cause of concern on the part of health authorities; their policy is to improve clinical skills at all levels rather than to build up specialised clinics.

Anorexia Nervosa↗
PubMed2004

[Pathological overeating--an overview].

An eating disorder apart from anorexia nervosa and bulimia nervosa is "binge eating disorder" (BED): eating in a short period of time a large quantity of food and a feeling of lack of control over food intake. There is also an atypical rest category, "eating disorders not otherwise specified" (EDNOS). Diagnostic criteria for BED and EDNOS are incomplete, particularly with respect to the definition of "bingeing" relative to bulimia nervosa. More restrictive criteria for anorexia nervosa and bulimia nervosa skew the diagnostic distribution towards BED and EDNOS, though the total prevalence of eating disorders remains unchanged. For BED and EDNOS taken together the lifetime prevalence in women is about 6%. The relationship between BED, EDNOS and overweight has mainly been overlooked; further investigations are needed. Lasting treatment effects have been found for overweight people with BED. Other eating disorders apart from anorexia nervosa and bulimia are prevalent and clinically important, and research has opened up a potential for effective treatment.

Bulimia↗
PubMed2004

[Eating disorders--an overview].

This article gives an updated review of the history, epidemiology, etiology, and evidence-based treatment of eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder), with specific reference to the Norwegian situation. In order to improve clinical skills there is an emphasis on the need for more treatment resources, particularly for the most serious cases, better implementation of evidence-based treatment and on continuous medical education. Given the somatic manifestations of eating disorders, medical doctors are essential in assessment and treatment. Many patients can be successfully treated by general practitioners provided that the general practitioner takes an interest in and is knowledgeable about eating disorders. The need to increase the number of general practitioners participating in ongoing Norwegian educational programmes on eating disorders is stressed.

Adult↗
PubMed2004

Changes of glial-neuronal interaction and metabolism after a subconvulsive dose of pentylenetetrazole.

Pentylenetetrazole (PTZ) injection causes seizures in rodents and this is used in several models of epilepsy. In the present study a low dose (20 mg/kg) was injected into rats in order to analyze metabolic disturbances caused by subconvulsive amounts of PTZ. Intraperitoneal injection of PTZ was followed, 30 min later, by injection of [1-(13C)]glucose plus [1,2-(13C)]acetate and 15 min thereafter decapitation. Analyses of extracts from cerebrum, subcortex and cerebellum were performed using 13C NMRS and HPLC. Whereas convulsive doses of PTZ lead to most pronounced changes in cerebellum [J. Neurochem. 85 (2003) 1200], it could be shown that subconvulsive doses affected mainly amino acid metabolism in cerebrum. In glutamatergic neurons in the cerebrum PTZ affected both the metabolic and releasable pools of glutamate, whereas, in the subcortex and cerebellum only the metabolic pool was affected. This could be deducted from the findings that less [4-(13C)]glutamine, [3,4-(13C)]glutamate and [2-(13C)]aspartate, which are labeled from [1-(13C)]glucose, were detected in this area. Glial metabolism was also changed as evidenced by the decreased pyruvate carboxylation versus pyruvate dehydrogenation ratio both in cerebrum and subcortex. Comparison between convulsive and nonconvulsive doses of PTZ lead to the hypothesis that changes observed in the cerebellum are mainly due to seizures, whereas those in cerebrum and subcortex are coupled to the action of the chemical stimulant.

Acetates↗
PubMed2004

Prevalence of eating disorders in female and male adolescents (14-15 years).

OBJECTIVE: The main aim of the present study is to establish the prevalence of eating disorders (ED) in adolescents of both genders. To our knowledge, such data have not previously been published using both DSM-IV and DSM-III-R criteria. METHOD: The study sample consisted of 1960 adolescents (1026 girls and 934 boys), 14-15 years of age. The participants completed the Survey for Eating Disorders (SEDs), including DSM-III-R and DSM-IV diagnoses for all subcategories of ED. RESULTS: Lifetime prevalence of any ED among girls was 17.9% anorexia nervosa (AN) 0.7%, bulimia nervosa (BN) 1.2%, binge eating disorder (BED) 1.5%, and EDs not otherwise specified (EDNOS) 14.6%. Corresponding numbers for boys for any ED is 6.5%, AN 0.2%, BN 0.4%, BED 0.9%, and EDNOS 5.0%. DISCUSSION: Our prevalence rates on AN, BN, and BED largely support previous school/community-based studies, while our figures on EDNOS were rather high. Generally, we found high numbers for boys with ED.

Adolescent↗
PubMed2004

Clinicians' views on management of obsessive-compulsive disorders in children and adolescents.

Research on obsessive-compulsive disorder (OCD) in children and adolescents has led to important developments with clinical implications as regards assessment and treatment. These developments have resulted in new guidelines and recommendations as to what is regarded to be an adequate treatment of the disorder. The objective of the present study was to examine if these developments have led to changes in the views on clinical management of childhood OCD among child psychiatry personnel in Norway. A national survey was conducted by means of a questionnaire addressing preferences and practices among clinicians in their assessment and management of OCD, the clinicians self-reported experienced treatment success, and need to develop clinical skills on assessing and treating childhood OCD. Seventy-nine clinicians (58.5%) responded. The results showed that cognitive/behavioural, family and medication approaches were preferred over psychodynamic and humanistic approaches in the management of OCD. The preferred cognitive/behavioural approach seems to be more cognitive than behavioural, and only one-third of clinicians reported frequent use of anxiety-provoking methods in treatment of childhood OCD. Clinicians that self-rated the Clinical Global Improvement Scale on their last treated OCD case indicated moderate treatment success. Because of low numbers of OCD cases in the clinics, the majority of clinicians are rated as inexperienced in the management of the disorder and results show a need for adequate training opportunities. It is concluded that clinicians have accommodated to recommended standards in the management of childhood OCD, but some results are contradictory and do not justify conclusive statements. The study needs to be supplemented by research focusing on more specific elements of the preferred treatments, thus narrowing the scope of the present study.

Adolescent↗
PubMed2004

Internet addiction: characteristics of a questionnaire and prevalence in Norwegian youth (12-18 years).

The use of the Internet has increased considerably during the last few years, and there are also some clinical observations that some people 'get hooked', and develop an Internet addiction. An epidemiological study was performed in a representative sample of the Norwegian youth population (N= 3,237; response rate 45.2%). The proportion not using Internet was only 4.9%, while 35.8% were non-frequent users, and 49.6% (1,591) were frequent (weekly) users. They used the Internet on the mean 4.3 hours a week. A mean of 1.98% (boys 2.42%, girls 1.51%) could be described as having an 'Internet addiction' according to the criteria in the Diagnostic Questionnaire of Young (1998), and an additional 8.68% (in sum 10.66) were considered to have an at-risk Internet use (boys 9.21%, girls 8.13%). If these proportions were calculated on individuals who used the Internet frequently, 4.02% fulfilled 5 criteria, and an additional 17.66% 3-4 criteria, giving quite high figures of problematic Internet use (in sum 21.68). The different diagnostic criteria gave a broad range of affirmative answers (from 0.4% to 27.9%). The results have important implications for further studies of prevalence, implementation of preventive measures, and the development of treatment approaches for Internet addiction.

Adolescent↗
PubMed2004

Problems with computer games without monetary reward: similarity to pathological gambling.

An epidemiological study was performed on a representative sample of the Norwegian youth population (12 to 18 years old, N=3,237; response rate 45.2%). The percentage who were frequent players (weekly) of different computer games was 63.3%, and the percentage of infrequent users was 36.7%. A mean of 2.7% (4.2% of the boys, 1.1% of the girls) could be described as exhibiting "pathological playing" according to the criteria in the 1998 Diagnostic Questionnaire for Internet Addiction of Young, and an additional 9.82% (14.5% of the boys, 5.0% of the girls) were considered to be engaging in "at-risk playing." Of the weekly gamblers, 4.2% fulfilled 5 criteria for pathological playing, and an additional 15.5% 3 to 4 criteria, i.e., at-risk playing. This indicated that frequent gaming on computer games without money rewards may be related to problematic playing even though no monetary reward is involved.

Adolescent↗
PubMed2004

Validation of the lie/bet screen for pathological gambling on two normal population data sets.

The validity of the Lie/Bet Screen was tested on two community population samples, one adult (n=2,014) and one adolescent sample (n=3,237), in Norway. With positive responses on at least one of the questions on Lie/Bet Screen used as the cutoff point the screen showed high both sensitivity and specificity. The negative predictive value was also high, but the positive predictive value was comparatively lower. A prediction of probable pathological gambling or "At-risk gambling" based on both Lie/Bet questions identified a valid screening in the two samples (0.54% in adults, 5.6% in adolescents). Compared to the use of the full DSM-IV this is pretty close, with the figures 0.45% and 5.22%. It is concluded that the Lie/Bet Screen may function as a good screening device for pathological gambling plus At-risk gambling in normal community samples.

Adolescent↗
PubMed2004

Depressed mood impedes pain treatment response in patients with fibromyalgia.

OBJECTIVE: To investigate prognostic factors in the course of the fibromyalgia syndrome (FM) from baseline to post-treatment. METHODS: Fifty-seven patients with FM were examined in a randomized intervention study. Pre-treatment variables were entered into linear regression analyses: gender, age, duration of disease, allocation to treatment, pain distribution (based on a patient-made drawing), fatigue, sleep disturbance, and depressed mood (based on visual analog scores), with pain distribution at treatment completion as the dependent variable. RESULTS: Depressed mood at baseline was a significant predictor of sustained widespread pain at treatment completion. CONCLUSION: The findings indicate a role for depressed mood as a predictive factor for treatment response.

Adult↗
PubMed2003

Social network as a moderator in the relation between trauma exposure and trauma reaction: a survey among UN soldiers and relief workers.

Social network as a moderator between trauma exposure and post-trauma symptomatology was studied. Two samples--relief workers and UN soldiers--were assessed on trauma exposure, social network and three dependent measures related to post-trauma reactions. Regression analysis and interaction plots were used to determine the presence of interaction effects between trauma exposure and social network. All four network variables moderated the relationship between trauma exposure and post-trauma reactions among relief workers, while among UN soldiers only two such buffer effects were found. Furthermore, among UN soldiers one of these interaction effects was reversed, indicating social support to be important for those low on trauma exposure, while among relief workers support was important in the high-exposure condition. The results indicate a difference with respect to the importance of social network as a moderator between groups exposed to different kinds of war trauma. Differences in motivational systems may also exist. However, further research will have to establish this.

Adult↗
PubMed2003

Pentylenetetrazole decreases metabolic glutamate turnover in rat brain.

Seizures were induced in rats by intraperitoneal injection of pentylenetetrazole (PTZ, 70 mg/kg), followed, 30 min later, by injection of [1-13C]glucose and [1,2-13C]acetate. Analyses of extracts from cortex, subcortex and cerebellum were performed using 13C magnetic resonance spectroscopy and HPLC. It could be shown that PTZ affected different brain regions differently. The total amounts of glutamate, glutamine, GABA, aspartate and taurine were decreased in the cerebellum and unchanged in the other brain regions. GABAergic neurones in the cortex and subcortex were not affected, whereas those in the cerebellum showed a pronounced decrease of GABA synthesis. However, glutamatergic neurones in all brain regions showed a decrease in glutamate labelling and in addition a decreased turnover in cerebellum. It could be shown that this decrease was in the metabolic pool of glutamate whereas release of glutamate was unaffected since glutamine labelling from glutamate was unchanged. Aspartate turnover was also decreased in all brain regions. Changes in astrocyte metabolism were not detected, indicating that PTZ had no effect on astrocyte metabolism in the early postictal stage.

Animals↗
PubMed2003

Gambling and problematic gambling with money among Norwegian youth (12-18 years).

An epidemiological study was performed on a representative sample of the Norwegian youth population (12-18 years; n=3237; response rate 45.2%). The proportion that never gambled was 17.6% and a majority (57.5%) gambled seldom, whereas 24.9% gambled weekly (36.2% of the males and 13.1% of the females). In relation to problematic gambling, the results showed that 1.76% had pathological gambling (2.79% in men and 0.69% in females) and 3.46% "at-risk" gambling. Problematic gambling (pathological gambling plus "at-risk" gambling) was 5.22% (7.82% of the males and 2.52% of the females). The group gambling frequently (at least weekly) was used to calculate pathological gambling and "at-risk" gambling. This resulted in high values, with 7.08% with pathological gambling (7.69% of males and 5.31% of females) and an additional 13.91% with "at-risk" gambling. The DSM-IV, with only 10 questions, gives a conservative estimate of pathological gambling. Slot machines proved the most popular game with 81.8%, followed by football tip (70.8%), Lotto (68.7%) and lotteries (39.4%). When it comes to problematic and pathological gambling, Lotto ranked high compared to other plays that were used more frequently.

Adolescent↗
PubMed2002

[Eating disorders--how should treatment be organized?].

BACKGROUND: Well controlled normal population studies show no sharp increase in the incidence and prevalence of eating disorders. However, more individuals seem to seek treatment, and there is a need for more precise estimates of the expected patient load at various levels of care. MATERIALS AND METHODS: The total number of potential patients was estimated on the basis of data on the number of women aged 15-44 years, the number of hospitals and outpatient clinics per county in Norway, working hours per year for general practitioners, and the prevalence of eating disorders. RESULTS: In total, about 50,000 Norwegian women may suffer from eating disorders; about 600 may need highly specialized services. At the most, each outpatient clinic may expect about 80 annual referrals for bulimia nervosa and binge eating disorder, and each hospital may expect 10-20 patients with bulimia nervosa. On average, each outpatient clinic and hospital may expect 8-9 referrals of patients with anorexia nervosa. INTERPRETATION: There is a need for increased treatment capacity, better clinical skills and better organization of treatment services for patients with eating disorders.

Adolescent↗