Acceptance and commitment therapy for autistic adults: A randomized controlled pilot study in a psychiatric outpatient setting / Johan PAHNKE in Autism, 27-5 (July 2023)  

Public ISBD [article]  inAutism > 27-5 (July 2023) . - p.1461-1476 Titre : Acceptance and commitment therapy for autistic adults: A randomized controlled pilot study in a psychiatric outpatient setting Type de document : Texte imprimé et/ou numérique Auteurs : Johan PAHNKE, Auteur ; Markus JANSSON-FRÖJMARK, Auteur ; Gerhard ANDERSSON, Auteur ; Johan BJUREBERG, Auteur ; Jussi JOKINEN, Auteur ; Benjamin BOHMAN, Auteur ; Tobias LUNDGREN, Auteur Article en page(s) : p.1461-1476 Langues : Anglais (eng) Mots-clés : acceptance and commitment therapy;anxiety;autism;cognitive defusion;depression;interventions-psychosocial/behavioral;mindfulness;psychological flexibility;quality of life;stress Index. décimale : PER Périodiques Résumé : Autistic adults are at risk of stress-related psychiatric disorders and reduced life quality due to social, cognitive, and perceptual challenges. Mental health interventions adapted to autistic adults are scarce. Acceptance and commitment therapy has preliminarily indicated health benefits in autistic adults, although it has not been robustly evaluated. Overall, 39 adults (21 males; 21-72?years) with autism spectrum disorder and normal intellectual ability (IQ M?=?108.5; SD?=?13.5) were randomized to 14?weeks of adapted acceptance and commitment therapy group treatment (NeuroACT) or treatment as usual. The intervention was feasible. Perceived stress and quality of life (primary outcomes), alongside psychological inflexibility, cognitive fusion, cognitive and behavioral avoidance, and autistic mannerism were statistically significantly improved in NeuroACT compared with treatment as usual (d?=?0.70-0.90). Clinically significant changes in perceived stress and quality of life were in favor of NeuroACT. Between-group altered depression, anxiety, sleep problems, one quality of life measure, functional impairment, social aspects of autism, and executive difficulties were statistically non-significant. Dropout was slightly higher in NeuroACT. NeuroACT may be a promising treatment for autistic adults with co-existing stress and reduced quality of life. More extensive studies are warranted to evaluate NeuroACT further. Lay abstract Autistic adults are often stressed and feel depressed or anxious. However, mental health programs that are suited for autistic adults are few. Acceptance and commitment therapy is a psychotherapy method that seems to help people feel better, although not thoroughly evaluated in autistic individuals. In this study, 20 autistic adults had 14?weeks of acceptance and commitment therapy group treatment suited for autism (NeuroACT), while 19 autistic adults had ordinary care. The acceptance and commitment therapy group treatment program seemed logical and reasonable to the participants. Also, when comparing the participants in the NeuroACT group with those in the ordinary care group, the NeuroACT participants reported less stress and higher quality of life. Compared to the ordinary care group, they could also manage distressing thoughts better, perceived themselves as more flexible, and did not avoid stressful situations as much as before. However, there was no significant difference between the groups in depression, anxiety, sleep problems, social aspects of autism, everyday functioning, or executive challenges. Slightly more NeuroACT participants did not finish the treatment than ordinary care participants. In conclusion, the NeuroACT program may be a treatment for autistic adults who feel stressed and have reduced quality of life. More studies are needed to see how helpful the NeuroACT program is for autistic adults. En ligne : http://dx.doi.org/10.1177/13623613221140749 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=507 [article] Acceptance and commitment therapy for autistic adults: A randomized controlled pilot study in a psychiatric outpatient setting [Texte imprimé et/ou numérique] / Johan PAHNKE, Auteur ; Markus JANSSON-FRÖJMARK, Auteur ; Gerhard ANDERSSON, Auteur ; Johan BJUREBERG, Auteur ; Jussi JOKINEN, Auteur ; Benjamin BOHMAN, Auteur ; Tobias LUNDGREN, Auteur . - p.1461-1476. Langues : Anglais (eng) in Autism > 27-5 (July 2023) . - p.1461-1476 Mots-clés : acceptance and commitment therapy;anxiety;autism;cognitive defusion;depression;interventions-psychosocial/behavioral;mindfulness;psychological flexibility;quality of life;stress Index. décimale : PER Périodiques Résumé : Autistic adults are at risk of stress-related psychiatric disorders and reduced life quality due to social, cognitive, and perceptual challenges. Mental health interventions adapted to autistic adults are scarce. Acceptance and commitment therapy has preliminarily indicated health benefits in autistic adults, although it has not been robustly evaluated. Overall, 39 adults (21 males; 21-72?years) with autism spectrum disorder and normal intellectual ability (IQ M?=?108.5; SD?=?13.5) were randomized to 14?weeks of adapted acceptance and commitment therapy group treatment (NeuroACT) or treatment as usual. The intervention was feasible. Perceived stress and quality of life (primary outcomes), alongside psychological inflexibility, cognitive fusion, cognitive and behavioral avoidance, and autistic mannerism were statistically significantly improved in NeuroACT compared with treatment as usual (d?=?0.70-0.90). Clinically significant changes in perceived stress and quality of life were in favor of NeuroACT. Between-group altered depression, anxiety, sleep problems, one quality of life measure, functional impairment, social aspects of autism, and executive difficulties were statistically non-significant. Dropout was slightly higher in NeuroACT. NeuroACT may be a promising treatment for autistic adults with co-existing stress and reduced quality of life. More extensive studies are warranted to evaluate NeuroACT further. Lay abstract Autistic adults are often stressed and feel depressed or anxious. However, mental health programs that are suited for autistic adults are few. Acceptance and commitment therapy is a psychotherapy method that seems to help people feel better, although not thoroughly evaluated in autistic individuals. In this study, 20 autistic adults had 14?weeks of acceptance and commitment therapy group treatment suited for autism (NeuroACT), while 19 autistic adults had ordinary care. The acceptance and commitment therapy group treatment program seemed logical and reasonable to the participants. Also, when comparing the participants in the NeuroACT group with those in the ordinary care group, the NeuroACT participants reported less stress and higher quality of life. Compared to the ordinary care group, they could also manage distressing thoughts better, perceived themselves as more flexible, and did not avoid stressful situations as much as before. However, there was no significant difference between the groups in depression, anxiety, sleep problems, social aspects of autism, everyday functioning, or executive challenges. Slightly more NeuroACT participants did not finish the treatment than ordinary care participants. In conclusion, the NeuroACT program may be a treatment for autistic adults who feel stressed and have reduced quality of life. More studies are needed to see how helpful the NeuroACT program is for autistic adults. En ligne : http://dx.doi.org/10.1177/13623613221140749 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=507

Adverse clinical outcomes among youths with nonsuicidal self-injury and suicide attempts: a longitudinal cohort study / Johan BJUREBERG in Journal of Child Psychology and Psychiatry, 63-8 (August 2022)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 63-8 (August 2022) . - p.921-928 Titre : Adverse clinical outcomes among youths with nonsuicidal self-injury and suicide attempts: a longitudinal cohort study Type de document : Texte imprimé et/ou numérique Auteurs : Johan BJUREBERG, Auteur ; Ralf KUJA-HALKOLA, Auteur ; Anna OHLIS, Auteur ; Paul LICHTENSTEIN, Auteur ; Brian M. D'ONOFRIO, Auteur ; Clara HELLNER, Auteur ; Martin CEDERLOF, Auteur Article en page(s) : p.921-928 Langues : Anglais (eng) Mots-clés : Adolescent  Cohort Studies  Humans  Longitudinal Studies  Risk Factors  Self-Injurious Behavior/epidemiology/psychology/therapy  Substance-Related Disorders/epidemiology/therapy  Suicidal Ideation  Suicide, Attempted/psychology  Self-injury  self-harm  suicidal behaviour Index. décimale : PER Périodiques Résumé : BACKGROUND: More knowledge about risks of clinical outcomes associated with nonsuicidal self-injury (NSSI) and suicide attempts (SAs) is needed to inform risk assessment and intervention. METHODS: Longitudinal cohort study based on 1,855 youths was clinically assessed for NSSI and SA, and followed up (from December, 2011 to December 2013) for the outcomes; diagnosed self-injury, alcohol/substance use disorder, and psychiatric inpatient care data derived from Swedish registers. Hazard ratios (HRs) and 95% confidence intervals (CIs) of the outcomes were estimated with Cox regressions, and additionally adjusted for the potential effect of sex and the number of clinical assessments. NSSI and SA were treated as time-varying covariates. RESULTS: Youths with NSSI had elevated risks of all outcomes, compared with youths without NSSI or SA; the HR was 2.3, 95% confidence interval [1.6, 3.4] for self-injury, 1.4 [0.9, 2.1] for alcohol/substance use disorder, and 1.3 [1.0, 1.7] for psychiatric inpatient care. Youths with SA displayed higher risks for the outcomes than the NSSI group; the HR was 5.5 [2.4, 12.6] for self-injury, 2.0 [0.9, 4.4] for alcohol/substance use disorder, and 2.6 [1.5, 4.5] for psychiatric inpatient care. Youths with both NSSI and SA showed similar risks as youths with SA; HR 4.1 [2.0, 8.3] for self-injury, 2.0 [1.1, 4.1] for alcohol/substance use disorder, but a higher risk of psychiatric inpatient care; HR 5.0 [3.1, 7.9]. All results remained virtually unchanged in the adjusted analyses. CONCLUSIONS: Youths with NSSI and/or SA had higher risks for subsequent adverse clinical outcomes. These excess risks were more pronounced among youths with SA and youths with both NSSI and SA, and the risk for psychiatric inpatient care was particularly high in youths with both NSSI and SA. Our findings suggest that early interventions for youths with NSSI or SA should not exclusively focus on suicide prevention, but also consider the risk of subsequent alcohol/substance use disorder. En ligne : http://dx.doi.org/10.1111/jcpp.13544 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=486 [article] Adverse clinical outcomes among youths with nonsuicidal self-injury and suicide attempts: a longitudinal cohort study [Texte imprimé et/ou numérique] / Johan BJUREBERG, Auteur ; Ralf KUJA-HALKOLA, Auteur ; Anna OHLIS, Auteur ; Paul LICHTENSTEIN, Auteur ; Brian M. D'ONOFRIO, Auteur ; Clara HELLNER, Auteur ; Martin CEDERLOF, Auteur . - p.921-928. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 63-8 (August 2022) . - p.921-928 Mots-clés : Adolescent  Cohort Studies  Humans  Longitudinal Studies  Risk Factors  Self-Injurious Behavior/epidemiology/psychology/therapy  Substance-Related Disorders/epidemiology/therapy  Suicidal Ideation  Suicide, Attempted/psychology  Self-injury  self-harm  suicidal behaviour Index. décimale : PER Périodiques Résumé : BACKGROUND: More knowledge about risks of clinical outcomes associated with nonsuicidal self-injury (NSSI) and suicide attempts (SAs) is needed to inform risk assessment and intervention. METHODS: Longitudinal cohort study based on 1,855 youths was clinically assessed for NSSI and SA, and followed up (from December, 2011 to December 2013) for the outcomes; diagnosed self-injury, alcohol/substance use disorder, and psychiatric inpatient care data derived from Swedish registers. Hazard ratios (HRs) and 95% confidence intervals (CIs) of the outcomes were estimated with Cox regressions, and additionally adjusted for the potential effect of sex and the number of clinical assessments. NSSI and SA were treated as time-varying covariates. RESULTS: Youths with NSSI had elevated risks of all outcomes, compared with youths without NSSI or SA; the HR was 2.3, 95% confidence interval [1.6, 3.4] for self-injury, 1.4 [0.9, 2.1] for alcohol/substance use disorder, and 1.3 [1.0, 1.7] for psychiatric inpatient care. Youths with SA displayed higher risks for the outcomes than the NSSI group; the HR was 5.5 [2.4, 12.6] for self-injury, 2.0 [0.9, 4.4] for alcohol/substance use disorder, and 2.6 [1.5, 4.5] for psychiatric inpatient care. Youths with both NSSI and SA showed similar risks as youths with SA; HR 4.1 [2.0, 8.3] for self-injury, 2.0 [1.1, 4.1] for alcohol/substance use disorder, but a higher risk of psychiatric inpatient care; HR 5.0 [3.1, 7.9]. All results remained virtually unchanged in the adjusted analyses. CONCLUSIONS: Youths with NSSI and/or SA had higher risks for subsequent adverse clinical outcomes. These excess risks were more pronounced among youths with SA and youths with both NSSI and SA, and the risk for psychiatric inpatient care was particularly high in youths with both NSSI and SA. Our findings suggest that early interventions for youths with NSSI or SA should not exclusively focus on suicide prevention, but also consider the risk of subsequent alcohol/substance use disorder. En ligne : http://dx.doi.org/10.1111/jcpp.13544 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=486

Melatonin use and the risk of self-harm and unintentional injuries in youths with and without psychiatric disorders / Marica LEONE in Journal of Child Psychology and Psychiatry, 64-7 (July 2023)  

Public ISBD [article]  inJournal of Child Psychology and Psychiatry > 64-7 (July 2023) . - p.1027-1036 Titre : Melatonin use and the risk of self-harm and unintentional injuries in youths with and without psychiatric disorders Type de document : Texte imprimé et/ou numérique Auteurs : Marica LEONE, Auteur ; Ralf KUJA-HALKOLA, Auteur ; Tyra LAGERBERG, Auteur ; Johan BJUREBERG, Auteur ; Agnieszka BUTWICKA, Auteur ; Zheng CHANG, Auteur ; Henrik LARSSON, Auteur ; Brian M. D'ONOFRIO, Auteur ; Amy LEVAL, Auteur ; Sarah E. BERGEN, Auteur Article en page(s) : p.1027-1036 Langues : Anglais (eng) Mots-clés : Melatonin  sleep  injury  self-harm  depression  anxiety Index. décimale : PER Périodiques Résumé : Background Sleep disorders in youth have been associated with increased risks of injury, including suicidal behavior. This study investigated whether melatonin, which is the most common medication for sleep disturbances in youth in Sweden, is associated with a decreased risk of injury. Methods This population-based cohort study included 25,575 youths who initiated melatonin treatment between ages 6 and 18. Poisson regression was used to estimate rate of injuries in the year prior to and following melatonin treatment initiation. A within-individual design was used to estimate relative risks by comparing injury risk in the last unmedicated month with injury risks in the 12months after medication initiation. Analyses were stratified by sex, injury type, psychiatric comorbidities and age at melatonin-treatment initiation. Results While body injuries, falls and transport accident rates were comparable in the year before and after melatonin-treatment initiation, the risk of self-harm was highest in the months immediately prior to medication, and decreased thereafter. This was particularly prominent among adolescents with depression and/or anxiety, with females displaying greater absolute risks than males. Compared to the last unmedicated month, the 12months post medication initiation had decreased relative risks for self-harm, with an IRR [95% CI] in the month following melatonin-treatment initiation of 0.46 [0.270.76] among adolescent females with psychiatric disorders, after excluding antidepressant users. Conclusions Decreased risk of intentional self-harm was observed following melatonin-treatment initiation among females with depression and anxiety, suggesting that sleep interventions could be considered in an effort to reduce risk of self-harm in this population. En ligne : https://doi.org/10.1111/jcpp.13785 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=508 [article] Melatonin use and the risk of self-harm and unintentional injuries in youths with and without psychiatric disorders [Texte imprimé et/ou numérique] / Marica LEONE, Auteur ; Ralf KUJA-HALKOLA, Auteur ; Tyra LAGERBERG, Auteur ; Johan BJUREBERG, Auteur ; Agnieszka BUTWICKA, Auteur ; Zheng CHANG, Auteur ; Henrik LARSSON, Auteur ; Brian M. D'ONOFRIO, Auteur ; Amy LEVAL, Auteur ; Sarah E. BERGEN, Auteur . - p.1027-1036. Langues : Anglais (eng) in Journal of Child Psychology and Psychiatry > 64-7 (July 2023) . - p.1027-1036 Mots-clés : Melatonin  sleep  injury  self-harm  depression  anxiety Index. décimale : PER Périodiques Résumé : Background Sleep disorders in youth have been associated with increased risks of injury, including suicidal behavior. This study investigated whether melatonin, which is the most common medication for sleep disturbances in youth in Sweden, is associated with a decreased risk of injury. Methods This population-based cohort study included 25,575 youths who initiated melatonin treatment between ages 6 and 18. Poisson regression was used to estimate rate of injuries in the year prior to and following melatonin treatment initiation. A within-individual design was used to estimate relative risks by comparing injury risk in the last unmedicated month with injury risks in the 12months after medication initiation. Analyses were stratified by sex, injury type, psychiatric comorbidities and age at melatonin-treatment initiation. Results While body injuries, falls and transport accident rates were comparable in the year before and after melatonin-treatment initiation, the risk of self-harm was highest in the months immediately prior to medication, and decreased thereafter. This was particularly prominent among adolescents with depression and/or anxiety, with females displaying greater absolute risks than males. Compared to the last unmedicated month, the 12months post medication initiation had decreased relative risks for self-harm, with an IRR [95% CI] in the month following melatonin-treatment initiation of 0.46 [0.270.76] among adolescent females with psychiatric disorders, after excluding antidepressant users. Conclusions Decreased risk of intentional self-harm was observed following melatonin-treatment initiation among females with depression and anxiety, suggesting that sleep interventions could be considered in an effort to reduce risk of self-harm in this population. En ligne : https://doi.org/10.1111/jcpp.13785 Permalink : https://www.cra-rhone-alpes.org/cid/opac_css/index.php?lvl=notice_display&id=508

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