Antalet människor som har diagnostiserats med ADHD respektive med ätstörning har ökat i jämförelse med tidigare år. Det har påvisats en koppling mellan dessa, en samsjuklighet mellan ADHD och ätstörning. Syftet med denna studie var att undersöka ätstörningsbehandlares erfarenhet och reflektioner kring samsjukligheten mellan ADHD och ätstörning. Det genomfördes åtta semistrukturerade intervjuer med verksamma ätstörningsbehandlare. Utifrån tematiseringen av intervjuerna framkom fyra teman. De identifierade temana var: likartade symtom vid ADHD som vid ätstörning, ADHD som en (bort)förklaring, ADHD påverkar behandlingen och Behandlarnas utbildningsbehov. Resultatet visade bland annat att behandlarna upplevde svårigheter att identifiera samsjukligheten mellan ätstörning och ADHD. I linje med tidigare forskning kan denna svårighet resultera i utmaningar vid bedömning av omvårdnadsdiagnostik vilket är ett hinder för att upprätta en korrekt individuell vårdplan. Ätstörningsbehandlarna uppmärksammade även ett behov av utbildning av samsjukligheten mellan ADHD och ätstörning i syfte att underlätta arbetet med den typen av patientgrupp.

No description available.

No description available.

No description available.

No description available.

No description available.

Prognostic scores, and more specifically comorbidity scores, are important and widely used measures in the health care field and in health services research. A comorbidity is an existing disease an individual has in addition to a primary condition of interest, such as cancer. A comorbidity score is a summary score that can be created from these individual comorbidities for prognostic purposes, as well as for confounding adjustment. Despite their widespread use, the properties of and conditions under which comorbidity scores are valid dimension reduction tools in statistical models is largely unknown. This dissertation explores the use of summary comorbidity measures in statistical models. Three particular aspects are examined. First, it is shown that, under standard conditions, the predictive ability of these summary comorbidity measures remains as accurate as the individual comorbidities in regression models, which can include factors such as treatment variables and additional covariates. However, these results are only true when no interaction exists between the individual comorbidities and any additional covariate. The use of summary comorbidity measures in the presence of such interactions leads to biased results. Second, it is shown that these measures are also valid in the causal inference framework through confounding adjustment in estimating treatment effects. Lastly, we introduce a time dependent extension of summary comorbidity scores. This time dependent score can account for changes in patients' health over time and is shown to be a more accurate predictor of patient outcomes. A data example using breast cancer data from the SEER Medicare Database is used throughout this dissertation to illustrate the application of these results to the health care field. / Statistics

The well-documented relationship between alcohol use and affective distress can be destructive, in many cases leading to negative physiological, social, and legal consequences. Binge drinking, defined as a pattern of drinking that brings blood alcohol concentration levels to 0.08 g/dL, typically reached after drinking more than 4 (for women) or 5 (for men) standard drinks in under two hours, is an increasingly popular activity, particularly among young people, and rates of binge drinking spike around the same time lifelong patterns of alcohol abuse are being established. Given the prominence of negative affect and associated constructs (i.e., repetitive negative thought, intolerance of uncertainty, anxiety sensitivity, self-efficacy) in models of alcohol use, anxiety, and mood disorders, the present study examines the predictors and consequences of negative affect and associated constructs the day after binge drinking. Our primary aims were: (a) to determine the prevalence of negative affect the day after binge drinking in a large, undergraduate sample, and (b) to examine differences in negative affect, post-event processing, and negative perceived self-efficacy between individuals on days following binge drinking as compared to days following abstinence and to assess whether neuroticism moderated these differences. Secondary aims included examining predictors of situational avoidance, changes in alcohol use and negative affect, and psychological factors associated with neuroticism and increases in negative affect (i.e., alcohol-induced memory losses and intolerance of uncertainty, physical hangover symptoms and anxiety sensitivity). We hypothesized that types of negative affect (e.g., anxiety, depression, guilt) would be reported by 5% to 25% of the sample and that individuals in the binge group would report higher levels of state negative affect, post- event processing, and negative perceived self-efficacy in academic, social, and coping domains than individuals in the abstinence group. Further, we predicted that higher levels of neuroticism would be associated with higher levels of the outcome variables. Neuroticism was expected to moderate the main effect of group such that neuroticism would have a greater effect in the binge group than in the abstinence group. To these ends, the study was conducted in two parts: first, prevalence of negative affect the day after binge drinking was assessed in a large, undergraduate sample (N = 808). Then, a subsample (n = 139) was recruited to participate in a longitudinal, quasi- experimental examination in which participants were assessed at three time points: baseline, the day following either a night of binge drinking or a night of abstinence, and two weeks following their second assessment. In line with hypotheses, types of negative affect ranged in prevlance from 22.8% of the sample (Apathy) to 1.0% of the sample (Suicidal thoughts). In addition, negative affect, post-event processing, and negative perceived self-efficacy in academic, social, and coping domains were higher on days following binge drinking compared to days following abstinence. Of note, neuroticism did not moderate any of these relationships. Additional results and implications are discussed. / Psychology

Objective: The present study examined the potential roles of externalizing and depressive co-occurring psychopathology on the time-course to anxiety treatment response among youth receiving different treatment conditions. Method: Participants were 488 youth (aged 7-17 years) who received either Cognitive-Behavioral Therapy (CBT) (N = 139), sertraline (SRT) (N = 133), CBT+sertraline (COMB; N = 140), or pill placebo (PLB; N = 76) in the Child/Adolescent Anxiety Multimodal Study (CAMS; Walkup et al., 2008). Results: Findings did not demonstrate a significant relation of comorbid psychopathology with treatment response time-course. Participants in CBT and SRT had significantly different overall treatment response trajectories, though comorbid psychopathology did not significantly relate to the observed treatment response trajectories. Exploratory analyses revealed that parental treatment assignment reaction to CBT was positively associated with more favorable treatment response time course, whereas parental treatment assignment reaction to SRT did not significantly relate to treatment response time course. Conclusions: Our results are consistent with the notion that current interventions (CBT, SRT) produce improvements that generalize across co-occurring depressive and externalizing psychopathology. Clinical implications for the treatment of anxious youth with regard to comorbidity and contextual factors are discussed and suggestions for future research are offered. / Psychology

Among those seeking treatment for a substance use disorder (SUD), the prevalence of a concurrent anxiety disorder or posttraumatic stress disorder (PTSD) is surprisingly high, with some estimates placing the comorbidity rate at 33% to 43%. There is evidence that this comorbidity is associated with greater symptom severity, impairment, and substance use relapse than when the disorders present independently. One of the greatest challenges that clinicians face when presented with a patient with an anxiety disorder/PTSD and SUD is deciding how to approach treatment. Though the prevailing approach has been to treat the disorders sequentially, with the SUD receiving initial attention, there is a movement towards developing integrated or concurrent treatment models. The current meta-analytic study examined integrated or concurrent psychotherapies or pharmacotherapies for SUDs and anxiety disorders or PTSD. A meta-analysis on this topic is particularly important given the generally mixed findings of existing randomized controlled trials in this area of research. Our main question of interest was how integrated/concurrent treatments compared to single-target treatments. In addition, we explored whether there were outcome differences between psychotherapy and pharmacotherapy, between anxiety disorders and PTSD, and differences based on treatment setting (e.g., substance use treatment center versus other settings). Our findings suggested that integrated or concurrent treatments were superior in reducing anxiety or PTSD symptoms, compared to treatments that only targeted substance use or anxiety/PTSD. The effect, however, was small. There was no evidence that integrated or concurrent treatments improved substance use outcomes in comparison to stand alone substance use treatment. We also found evidence that treatment studies conducted at substance use inpatient or outpatient programs produced smaller anxiety/PTSD effects. A trend was found suggesting combined psychotherapy-pharmacotherapy interventions may be more effective than psychotherapy alone. No difference was found between treatments targeting PTSD versus anxiety disorders. Implications of our findings are discussed. / Psychology