John Bowlby på besök i 1950-talets Sverige: En udda fågel i svensk barnpsykiatri

The mismatch between John Bowlby and post-war Swedish child psychiatry: Account of a research visitIn the first half of 1950, the British psychiatrist and psychoanalyst John Bowlby visited France, Sweden, the Netherlands, and the USA to gain information about the state of the art in the care of homeless children. The World Health Organization published Bowlby’s conclusions asMaternal Care and Mental Health (1952). The article aims to present an account and discussion of Bowlby’s weeklong visit to Sweden, based on previously unpublished notebooks and letters. The analysis shows a clear mismatch between Bowlby’s ideas and those of his Swedish hosts working in child psychiatry and social care. At first sight, Bowlby seemed to align with the Swedish psychoanalytically oriented child psychiatrists, while rejecting those Swedish experts who represented a biological approach with ideas about heredity, but it was more complicated than that. Bowlby also appreciated the methodological rigor and statistical methods of the latter current. What he did not appreciate, however, was that both Swedish currents, despite their mutual disagreements, shared a similar view of the importance of the environment for child development that was much broader than his own. For Bowlby’s hosts, environmental factors such as housing, schooling, parental care, number of siblings, social contacts, etc. were all important for the understanding of poor mental health and social maladjustment in childhood. As also becomes clear from the title of his book, Bowlby rejected such a broad approach and focused exclusively on mother-child bonding as determining children’s mental development and health. This mismatch between Bowlby and the Swedish experts explains why Bowlby paid only scarce attention to Swedish views in his WHO report, why this report and his later ideas about the importance of mother-child attachment initially met with little enthusiasm, and why he remained a "queer fish" in Sweden.Development Psychopathology in context: famil

A tale of four countries: How Bowlby used his trip through Europe to write the WHO report and spread his ideas

Attachment theory, developed by child psychiatrist John Bowlby, is considered a major theory in developmental psychology. Attachment theory can be seen as resulting from Bowlby's personal experiences, his psychoanalytic education, his subsequent study of ethology, and societal developments during the 1930s and 1940s. One of those developments was the outbreak of World War II and its effects on children's psychological wellbeing. In 1950, Bowlby was appointed WHO consultant to study the needs of children who were orphaned or separated from their families for other reasons and needed care in foster homes or institutions. The resulting report is generally considered a landmark publication in psychology, although it subsequently met with methodological criticism. In this paper, by reconstructing Bowlby's visit to several European countries, on the basis of notebook

A tale of four countries: How Bowlby used his trip through Europe to write the WHO report and spread his ideas

Attachment theory, developed by child psychiatrist John Bowlby, is considered a major theory in developmental psychology. Attachment theory can be seen as resulting from Bowlby's personal experiences, his psychoanalytic education, his subsequent study of ethology, and societal developments during the 1930s and 1940s. One of those developments was the outbreak of World War II and its effects on children's psychological wellbeing. In 1950, Bowlby was appointed WHO consultant to study the needs of children who were orphaned or separated from their families for other reasons and needed care in foster homes or institutions. The resulting report is generally considered a landmark publication in psychology, although it subsequently met with methodological criticism. In this paper, by reconstructing Bowlby's visit to several European countries, on the basis of notebooks and letters, the authors shed light on the background of this report and the way Bowlby used or neglected the findings he gathered

Prognostic imaging biomarkers for diabetic kidney disease (iBEAt): Study protocol

Background: Diabetic kidney disease (DKD) remains one of the leading causes of premature death in diabetes. DKD is classified on albuminuria and reduced kidney function (estimated glomerular filtration rate (eGFR)) but these have modest value for predicting future renal status. There is an unmet need for biomarkers that can be used in clinical settings which also improve prediction of renal decline on top of routinely available data, particularly in the early stages. The iBEAt study of the BEAt-DKD project aims to determine whether renal imaging biomarkers (magnetic resonance imaging (MRI) and ultrasound (US)) provide insight into the pathogenesis and heterogeneity of DKD (primary aim) and whether they have potential as prognostic biomarkers in DKD (secondary aim). Methods: iBEAt is a prospective multi-centre observational cohort study recruiting 500 patients with type 2 diabetes (T2D) and eGFR ≥30 ml/min/1.73m2. At baseline, blood and urine will be collected, clinical examinations will be performed, and medical history will be obtained. These assessments will be repeated annually for 3 years. At baseline each participant will also undergo quantitative renal MRI and US with central processing of MRI images. Biological samples will be stored in a central laboratory for biomarker and validation studies, and data in a central data depository. Data analysis will explore the potential associations between imaging biomarkers and renal function, and whether the imaging biomarkers improve the prediction of DKD progression. Ancillary substudies will: (1) validate imaging biomarkers against renal histopathology; (2) validate MRI based renal blood flow measurements against H2O15 positron-emission tomography (PET); (3) validate methods for (semi-)automated processing of renal MRI; (4) examine longitudinal changes in imaging biomarkers; (5) examine whether glycocalyx and microvascular measures are associated with imaging biomarkers and eGFR decline; (6) explore whether the findings in T2D can be extrapolated to type 1 diabetes. Discussion: iBEAt is the largest DKD imaging study to date and will provide valuable insights into the progression and heterogeneity of DKD. The results may contribute to a more personalised approach to DKD management in patients with T2D. Trial registration: Clinicaltrials.gov (NCT03716401)

Recommendations for the transition of patients with ADHD from child to adult healthcare services:a consensus statement from the UK adult ADHD network

The aim of this consensus statement was to discuss transition of patients with ADHD from child to adult healthcare services, and formulate recommendations to facilitate successful transition. An expert workshop was convened in June 2012 by the UK Adult ADHD Network (UKAAN), attended by a multidisciplinary team of mental health professionals, allied professionals and patients. It was concluded that transitions must be planned through joint meetings involving referring/receiving services, patients and their families. Negotiation may be required to balance parental desire for continued involvement in their child’s care, and the child’s growing autonomy. Clear transition protocols can maintain standards of care, detailing relevant timeframes, responsibilities of agencies and preparing contingencies. Transition should be viewed as a process not an event, and should normally occur by the age of 18, however flexibility is required to accommodate individual needs. Transition is often poorly experienced, and adherence to clear recommendations is necessary to ensure effective transition and prevent drop-out from services

Self-Guided Psychological Treatment for Depressive Symptoms: A Meta-Analysis

Background: A number of trials have examined the effects of self-guided psychological intervention, without any contact between the participants and a therapist or coach. The results and sizes of these trials have been mixed. This is the first quantitative meta-analysis, aimed at organizing and evaluating the literature, and estimating effect size. Method: We conducted systematic literature searches in PubMed, PsycINFO and Embase up to January 2010, and identified additional studies through earlier meta-analyses, and the references of included studies. We identified seven randomized controlled trials that met our inclusion criteria, with a total of 1,362 respondents. The overall quality of the studies was high. A post-hoc power calculation showed that the studies had sufficient statistical power to detect an effect size of d = 0.19. Results: The overall mean effect size indicating the difference between self-guided psychological treatment and control groups at post-test was d = 0.28 (pless than0.001), which corresponds to a NNT of 6.41. At 4 to 12 months follow-up the effect size was d = 0.23. There was no indication for significant publication bias. Conclusions: We found evidence that self-guided psychological treatment has a small but significant effect on participants with increased levels of depressive symptomatology.Original Publication:Pim Cuijpers, Tara Donker, Robert Johansson, David C. Mohr, Annemieke van Straten and Gerhard Andersson, Self-Guided Psychological Treatment for Depressive Symptoms: A Meta-Analysis, 2011, PLoS ONE, (6), 6.http://dx.doi.org/10.1371/journal.pone.0021274Copyright: Public Library of Science (PLoS)http://www.plos.org

Suicidality among adolescents engaging in nonsuicidal self-injury (NSSI) and firesetting: The role of psychosocial characteristics and reasons for living

Background: Co-occurrence of problem behaviors, particularly across internalizing and externalizing spectra, increases the risk of suicidality (i.e., suicidal ideation and attempt) among youth. Methods: We examined differences in psychosocial risk factors across levels of suicidality in a sample of 77 school-based adolescents engaging in both nonsuicidal self-injury (NSSI) and repeated firesetting. Participants completed questionnaires assessing engagement in problem behaviors, mental health difficulties, negative life events, poor coping, impulsivity, and suicidality. Results: Adolescents endorsing suicidal ideation reported greater psychological distress, physical and sexual abuse, and less problem solving/goal pursuit than those with no history of suicidality; adolescents who had attempted suicide reported more severe NSSI, higher rates of victimization and exposure to suicide, relative to those with suicidal ideation but no history of attempt. Additional analyses suggested the importance of coping beliefs in protecting against suicidality. Conclusions: Clinical implications and suggestions for future research relating to suicide prevention are discussed

Protocol for a randomised controlled trial investigating the effectiveness of an online e-health application compared to attention placebo or sertraline in the treatment of generalised anxiety disorder

Background: Generalised anxiety disorder (GAD) is a high prevalence, chronic psychiatric disorder which commonly presents early in the lifespan. Internet e-health applications have been found to be successful in reducing symptoms of anxiety and stress for post traumatic stress disorder (PTSD), panic disorder, social phobia and depression. However, to date, there is little evidence for the effectiveness of e-health applications in adult GAD. There are no studies which have directly compared e-health applications with recognised evidence-based medication. This study aims to determine the effectiveness of a web-based program for treating GAD relative to sertraline and attention placebo.Methods/Design: 120 community-dwelling participants, aged 18-30 years with a clinical diagnosis of GAD will be recruited from the Australian Electoral Roll. They will be randomly allocated to one of three conditions: (i) an online treatment program for GAD, E-couch (ii) pharmacological treatment with a selective serotonin re-uptake inhibitor (SSRI), sertraline (a fixed-flexible dose of 25-100 mg/day) or (iii) an attention control placebo, HealthWatch. The treatment program will be completed over a 10 week period with a 12 month follow-up.Discussion: As of February 2010, there were no registered trials evaluating the effectiveness of an e-health application for GAD for young adults. Similarly to date, this will be the first trial to compare an e-health intervention with a pharmacological treatment.Trial Registration: Current Controlled Trials ISRCTN76298775