Nordic Journal of Psychiatry最新文献

{"title":"CYP2D6 UM phenotype is not related to suicide attempts in depressive patients in secondary psychiatric care.","authors":"Marie Asp, Amanda Holck, Henrik Green, Åsa Westrin, Margareta Reis","doi":"10.1080/08039488.2025.2553573","DOIUrl":"10.1080/08039488.2025.2553573","url":null,"abstract":"<p><strong>Introduction: </strong>The hepatic cytochrome P450 system includes the polymorphic <i>CYP2D6</i> gene. CYP2D6 ultra rapid metabolizers (UMs) were 10-fold more common in suicide victims than in the general population in a previous study. The aim of this study was to investigate if the occurrence of the CYP2D6 UM genotype differs between subjects with and without previous suicide attempt in patients treated for depression in secondary psychiatric care.</p><p><strong>Material and methods: </strong>The study \"Genes, Depression and Suicidality\" (GEN-DS) included 407 subjects treated for depression in secondary psychiatric care between 2012 and 2021. Subjects were genotyped for CYP2D6, interviewed according to a semi-structured protocol and diagnosed according to the Diagnostic and Statistical Manual of Mental Disorders 4th ed (DSM-IV-TR).</p><p><strong>Results: </strong>Of the 407 subjects, 128 subjects (31.4%) had a history of one or more suicide attempt. Two (1.6%) in the suicide attempt group were categorized as UMs, as compared to 9 (3.2%) in the non-suicide attempt group. There was no statistical significance between the groups (<i>p</i> = 0.27, Fisher's exact test). Bipolar disorder, personality disorders, substance use disorders and lifetime presence of psychotic symptoms were more common in suicide attempters.</p><p><strong>Conclusion: </strong>Based on our results, CYP2D6 UMs are not over-represented among suicide attempters in depressed patients treated in secondary psychiatric care. Analysis of CYP2D6 genotype can be useful for optimizing pharmacological treatment in depression but genotyping does not seem relevant for the clinical assessment of suicidality in difficult-to-treat depression.</p>","PeriodicalId":19201,"journal":{"name":"Nordic Journal of Psychiatry","volume":" ","pages":"556-563"},"PeriodicalIF":1.5,"publicationDate":"2025-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144963078","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Psychometric properties of the Adult Anxiety Scale in a Swedish community sample.","authors":"Maria Hedqvist, Sofia Vadlin, Cecilia Åslund, Susan H Spence, Cecilia A Essau, Susanne Olofsdotter","doi":"10.1080/08039488.2025.2520219","DOIUrl":"10.1080/08039488.2025.2520219","url":null,"abstract":"<p><p><b>Purpose:</b> Although anxiety disorders are common worldwide and often associated with significant impairment, many cases remain undetected and thus untreated. A lack of adequate screening partly explains this treatment gap, and easy-to-use screening instruments are needed to capture more than one type of anxiety disorder. The aim was to evaluate the psychometric properties of one such promising instrument: the Adult Anxiety Scale, AAS-15, intended to measure social anxiety disorder (social phobia), generalized anxiety disorder, and panic disorder. <b>Materials and methods:</b> The Swedish version of the AAS-15 was evaluated in a community sample (<i>N</i> = 1066, mean age 22.93 years, 64.4% women). <b>Results:</b> The psychometric properties were found to be good. Internal consistency ranged from very good to excellent, and a confirmatory factor analysis supported a three-factor model consistent with the three anxiety disorder dimensions that it purported to assess. <b>Conclusion:</b> This evaluation of the AAS-15 supports the view of the scale as a useful tool for assessing social anxiety disorder, generalized anxiety disorder, and panic disorder. With strong psychometric properties, quick and easy administration, and coverage of the most common types of anxiety disorders in adults, the AAS-15 is a valuable addition to standardized assessment and anxiety screening in a variety of healthcare settings.</p>","PeriodicalId":19201,"journal":{"name":"Nordic Journal of Psychiatry","volume":" ","pages":"435-440"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144326340","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Prevalence of misophonia in patients with bipolar disorder: its relationship with autism spectrum symptoms and emotion regulation skills in comparison to a control group.","authors":"Gizem İletmiş, Gozde Bacik Yaman","doi":"10.1080/08039488.2025.2511068","DOIUrl":"10.1080/08039488.2025.2511068","url":null,"abstract":"<p><strong>Introduction: </strong>The aim of this study is to determine the prevalence of misophonia in patients diagnosed with bipolar disorder (BD), examine its relationship with autism spectrum symptoms and emotion regulation skills, and compare it with a healthy control group.</p><p><strong>Methods: </strong>The study included 105 patients diagnosed with BD in remission for at least three months and 105 age-, gender-, and education-matched healthy controls. All participants completed the sociodemographic data form, Hamilton Depression Rating Scale, Young Mania Rating Scale, Revised Amsterdam Misophonia Scale, Emotion Regulation Skills Questionnaire, and Autism Spectrum Quotient.</p><p><strong>Results: </strong>Misophonia symptoms were statistically significantly more prevalent in the healthy control group (63.8%) than in the BD group (48.6%) (<i>p</i> = 0.026). Among BD patients with misophonia symptoms, a history of suicide attempts and higher autistic traits were statistically significantly more common (<i>p</i> = 0.026, <i>p</i> = 0.003, respectively). No statistically significant relationship was found between the severity of misophonia and autism traits (<i>r</i> = 0.200; <i>p</i> = 0.159) or emotion regulation skills (<i>r</i> = -0.178; <i>p</i> = 0.210). Multivariate regression analyses identified suicide attempt history and autistic traits as significant predictors of misophonia severity.</p><p><strong>Conclusion: </strong>Misophonia symptoms were more prevalent in control group, contrary to our hypothesis. BD patients exhibited pronounced emotion regulation deficits, which worsened with increased autistic traits. Misophonia symptoms were statistically significantly associated with adverse psychiatric outcomes in BD patients. These findings highlight the importance of assessing misophonia, emotion regulation, and autistic traits collectively in clinical settings, and suggest that addressing misophonia symptoms in treatment planning may enhance patient functioning.</p>","PeriodicalId":19201,"journal":{"name":"Nordic Journal of Psychiatry","volume":" ","pages":"417-426"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208995","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Electroconvulsive therapy in erotomanic delusion: a path to belief updating.","authors":"Isabelle Montet, Alessia Longo, Hugo Bottemanne","doi":"10.1080/08039488.2025.2528094","DOIUrl":"10.1080/08039488.2025.2528094","url":null,"abstract":"<p><strong>Objective: </strong>Erotomania is a rare delusional disorder marked by the persistent, unfounded belief that another person is in love with the affected individual. While antipsychotic medications may alleviate the intensity of delusions, the core belief often persists, leading to significant emotional distress and potential behavioral risks. The aim of this study was to illustrate the potential therapeutic role of electroconvulsive therapy (ECT) in the treatment of chronic, treatment-resistant erotomania.</p><p><strong>Materials and methods: </strong>We present a case report of a patient with a lifelong erotomanic delusion, centered on the same individual, which persisted unchanged despite multiple pharmacological treatments. The patient underwent a course of ECT, and clinical observations were documented throughout the treatment process. In addition to symptom monitoring, we explored the cognitive mechanisms potentially involved in the therapeutic response, with particular attention to belief updating and cognitive flexibility.</p><p><strong>Results: </strong>ECT led to a marked reduction in the patient's conviction regarding the erotomanic delusion, alongside improvements in emotional regulation and daily functioning. These changes appeared to be sustained over time. The treatment was well tolerated, with no significant adverse effects reported.</p><p><strong>Conclusions: </strong>This case suggests that ECT may be a viable option for patients with severe, treatment resistant erotomania. Beyond symptomatic relief, ECT may facilitate the recalibration of maladaptive beliefs by enhancing cognitive flexibility, supporting the view that belief updating mechanisms play a key role in the resolution of persistent delusions. Further studies are needed to systematically evaluate ECT's efficacy in delusional disorders.</p>","PeriodicalId":19201,"journal":{"name":"Nordic Journal of Psychiatry","volume":" ","pages":"472-474"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144541595","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Internet-delivered acceptance and commitment therapy for COVID-19 related health anxiety: a pragmatic study.","authors":"Ditte Hoffmann Frydendal, Katrine Ingeman, Per Klausen Fink, Kaare Bro Wellnitz, Lisbeth Frostholm","doi":"10.1080/08039488.2025.2506560","DOIUrl":"10.1080/08039488.2025.2506560","url":null,"abstract":"<p><strong>Background: </strong>Health anxiety (HA) is characterized by excessive worries about having a serious illness, persisting even after medical reassurance. The COVID-19 pandemic, with widespread media coverage and lockdowns, may induce or exacerbate HA. During a pandemic, treatment options can be limited by lockdowns and social distancing, making remote, internet-delivered therapies particularly useful for individuals isolating due to health worries. This study aimed to assess the effectiveness of an internet-delivered Acceptance and Commitment Therapy (iACT) for COVID-19-related HA.</p><p><strong>Methods: </strong>In a Danish university hospital, an uncontrolled national implementation project was conducted. Patients self-referred were assessed <i>via</i> video, and those eligible (≥18 years) received 12 weeks of iACT. The primary outcome was HA symptoms measured by the Whiteley-6-R Index. Secondary outcomes included somatic symptoms, depression, anxiety, quality of life, and life satisfaction. Changes from baseline to post-treatment were analyzed using paired t-tests and Cohen's d for effect size.</p><p><strong>Results: </strong>Out of 223 screened patients, 105 were eligible for enrollment, and 67 responded to post-treatment questionnaires. Significant improvements were observed across all outcomes, particularly for HA (<i>d</i> = 1.40) and anxiety (<i>d</i> = 0.80), along with better quality of life (<i>d</i> = 0.65) and life satisfaction (<i>d</i> = 0.64).</p><p><strong>Conclusions: </strong>Implementation of self-referral and internet-delivered treatment into routine care was feasible and seemed to be effective in treating COVID-19-related HA. However, for self-referred participants, the poor eligibility and motivation may be a limitation when implementing this online treatment during a pandemic. In addition, collecting data in routine care may be a challenge.</p><p><strong>Trial registry numbers: </strong>Approved by the Danish Data Protection Agency (ID no. 790861).</p>","PeriodicalId":19201,"journal":{"name":"Nordic Journal of Psychiatry","volume":" ","pages":"401-407"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144258545","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Evaluation of a modified version of the attitudes about mental illness and its treatment instrument: psychometric assessment and attitudes among adolescents in Sweden.","authors":"Veronica Hermann, Anton Dahlberg, Anna Sarkadi, Lars Hansson, Ann-Christin Karlsson, Natalie Durbeej","doi":"10.1080/08039488.2025.2526555","DOIUrl":"10.1080/08039488.2025.2526555","url":null,"abstract":"<p><strong>Introduction: </strong>Globally, many adolescents suffer from mental health problems and related stigma. Assessing mental health stigma among youth is crucial to addressing this problem. The aim of this study was to examine the psychometric properties of a modified version of the Attitudes About Mental Illness and its Treatment (AAMIT) instrument and to describe attitudes according to the instrument, among Swedish adolescents.</p><p><strong>Methods: </strong>A total of 2,079 adolescents in lower and upper secondary high schools on Gotland, Sweden, responded to the instrument. Exploratory and confirmatory factor analyses and assessment of internal consistency were conducted. The adolescents' views on the instrument were analysed through qualitative content analysis of open-ended comments.</p><p><strong>Results: </strong>Exploratory factor analysis suggested a three-factor model, with seven items in total. The internal consistency of the subscales was found to be acceptable, with alpha values at 0.72-0.80. Mean scores on the subscales indicated a low prevalence of negative attitudes overall. However, 34.7% of the participants agreed with the stereotype that people with mental health problems are unpredictable, and 25.5% agreed that it is difficult to talk to people with such conditions. Negative attitudes were more prevalent among boys and adolescents with a foreign background. Many participants, nonetheless, found it difficult to evaluate the item statements, and a substantial proportion selected the 'don't know' response option.</p><p><strong>Conclusion: </strong>Findings indicate a need for inclusive mental health education throughout the general population, youth involvement in attitude assessment design, and further validation of the AAMIT instrument before its application in future research.</p>","PeriodicalId":19201,"journal":{"name":"Nordic Journal of Psychiatry","volume":" ","pages":"450-461"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144575939","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A mixed method study on suicidal behavior among people with bipolar disorder in Rwanda.","authors":"Maja Bendtsen, Nelly Umulisa Rurangwa, Caroline Juhl Arnbjerg, Emmanuel Musoni-Rwililiza, Laura Glahder Lindberg, Kate Andreasson Aamund, Per Kallestrup, Jessica Carlsson","doi":"10.1080/08039488.2025.2511073","DOIUrl":"10.1080/08039488.2025.2511073","url":null,"abstract":"<p><strong>Background: </strong>Three out of four individuals who complete suicide reside in low- and middle-income countries. More than half of them have an underlying mental health disorder. Of all mental health disorders, bipolar disorder has one of the highest occurrences of suicide. This study aims to assess the prevalence and experiences of suicidal behavior among outpatients with bipolar disorder in Rwanda and identify protective factors and potential interventions.</p><p><strong>Methods: </strong>This study uses a mixed methods design with quantitative data on the prevalence of suicidal behavior among people with bipolar disorder and qualitative in-depth interviews employing a phenomenological approach.</p><p><strong>Results: </strong>Among 131 outpatients with bipolar disorder, the prevalence of attempted suicide was 18.3%. Thirteen outpatients participated in qualitative interviews. We found that the mental pain of bipolar disorder triggered suicidal behavior, but that universal themes such as hardship and loneliness were also drivers for suicidal behavior. The stigmatization of both mental health disorders and suicide was found to influence suicidal behavior. Social support, religion, and mental health care services were described as protective factors against suicidal behavior.</p><p><strong>Conclusion: </strong>The prevalence of suicidal behavior was found to be remarkably lower than global estimates for people with bipolar disorder. This may be due to the strong communal support from religion and family, contrasting with more individualistic societies. The study highlights the need for the de-stigmatization of suicide and mental health disorders and the necessity of improved access to quality mental health care in Rwanda.</p>","PeriodicalId":19201,"journal":{"name":"Nordic Journal of Psychiatry","volume":" ","pages":"427-434"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144208994","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The psychosocial problem areas, needs and resources in people with coexisting schizophrenia and type 2 diabetes. Design and results of a survey study.","authors":"Sabrina Trappaud Rønne, Mette Juel Rothmann, Rikke Jørgensen, Lene Eide Joensen, Bryan Cleal, Peter Haulund Gæde, Richard Ig Holt, Sidse Marie Arnfred","doi":"10.1080/08039488.2025.2524371","DOIUrl":"10.1080/08039488.2025.2524371","url":null,"abstract":"<p><strong>Aim: </strong>To explore the illness and treatment burden, mental well-being, and received support for illness management among people with schizophrenia and type 2 diabetes.</p><p><strong>Materials and methods: </strong>62 Danish adults recruited from psychiatric outpatient clinics participated in this cross-sectional study using a questionnaire compiled for this specific purpose. The questionnaire included measures of burden of illness and treatment (daily impact of diabetes and schizophrenia, treatment burden, diabetes empowerment), mental well-being (general well-being and diabetes distress), and social relations and support (general and illness-specific support). Descriptive analyses of survey data were conducted.</p><p><strong>Results: </strong>Participants reported daily negative impact from living with schizophrenia and diabetes on their physical health, emotional well-being, sleep, and feelings about their future. However, this negative impact was higher from schizophrenia than type 2 diabetes. 55% of all participants reported high treatment burden, and 74% reported low to moderate diabetes empowerment. Approximately 30% reported high levels of diabetes distress, and 49% reported low general well-being. The support for schizophrenia mainly came from mental health professionals, care coordinators, and family and friends, while diabetes support mainly came from general practitioners and family and friends.</p><p><strong>Conclusions: </strong>Living with coexisting schizophrenia and type 2 diabetes often involves a high burden of illness and treatment, low diabetes empowerment, high diabetes distress and low general well-being. This study highlights a need for engaging mental health professionals, care coordinators, family and friends in the daily management of coexisting schizophrenia and diabetes in future interventional studies and clinical practice.</p>","PeriodicalId":19201,"journal":{"name":"Nordic Journal of Psychiatry","volume":" ","pages":"441-449"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144560612","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The role of treatment expectations in predicting treatment outcomes: examining clinical and demographic influences.","authors":"Nor Christian Torp, Davið Rma Højgaard, Marianne Aalberg, Katja Anna Hybel, Guðmundur Ágúst Skarphéðinsson, Per Hove Thomsen, Tord Ivarsson, Bernhard Weidle, Judith Nissen, Karin Melin, Sanne Jensen","doi":"10.1080/08039488.2025.2528075","DOIUrl":"10.1080/08039488.2025.2528075","url":null,"abstract":"<p><strong>Objective: </strong>The primary aim of this study was to investigate the potential relationship between treatment expectancy and treatment compliance with patient demographic and treatment outcome of exposure-based CBT (EB-CBT), as reported by youth with OCD, their parents, and therapists. The secondary aim is to investigate the correlation of these factors with obsessive-compulsive symptoms before and after treatment.</p><p><strong>Method: </strong>This study is a part of the NordLOTS, in which 269 children and adolescents, aged 7-17 years, with a DSM-IV diagnosis of OCD, were treated with a 14-week EB-CBT program. Patients, parents, and therapists rated their expectancy of the treatment, and therapists rated patients' and parents' compliance with treatment. A Children's Yale-Brown Obsessive Compulsive Scale (CY-BOCS) score ≤15 was defined as treatment response. Linear mixed effects models were used to assess associations.</p><p><strong>Results: </strong>Higher patient-rated treatment expectancy was significantly associated with lower pre-treatment CY-BOCS total score, as well as lower levels of parent-rated externalizing symptoms. Higher therapist-rated treatment expectancy was significantly associated with lower levels of parent-rated externalizing symptoms.</p><p><strong>Conclusions: </strong>Children and adolescents displaying higher treatment expectancies exhibit milder symptoms of OCD and externalizing symptoms, alongside experiencing more favorable outcomes from EB-CBT.</p><p><strong>Clinical trials registration information: </strong>This study was registered in Current Controlled Trials; Nordic Long-term Obsessive-compulsive disorder (OCD) Treatment Study (www.controlled-trials.com ISRCTN66385119).</p>","PeriodicalId":19201,"journal":{"name":"Nordic Journal of Psychiatry","volume":" ","pages":"462-471"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144591848","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Association between complexity and adherence to psychotherapy in outpatients awaiting psychotherapy for mood and personality disorders.","authors":"Oliver Rumle Hovmand, Nina Reinholt, Anne Bryde, Kraka Bjørnholm, Dorrit Dilling-Hansen, Sidse Arnfred","doi":"10.1080/08039488.2025.2507737","DOIUrl":"10.1080/08039488.2025.2507737","url":null,"abstract":"<p><strong>Background: </strong>The Measure of Common Characteristics that Complicate Care (C4) is a clinician-administered checklist designed to quantify characteristics that could complicate care in outpatient psychiatry. This study investigated the C4 checklist against disturbance of personality function and early adherence to psychotherapy.</p><p><strong>Methods: </strong>The recruits for the trial were patients awaiting group psychotherapy in psychotherapy outpatient clinics, who were scored with the C4 and responded to the Level of Personality Functioning Scale-Brief Form (LPFS-BF) questionnaire. We compared differences in case complexity across diagnostic groups and the correlation with the LPFS-BF. Finally, we evaluated the usefulness of the C4 in identifying those who attended ≥ 3 of their first four sessions of psychotherapy by conducting receiver operating characteristic (ROC) curves and linear regression analysis with percentage adherence as a dependent variable.</p><p><strong>Results: </strong>One hundred and fifty-nine patients with emotional disorders, personality disorders, and PTSD were included. Of these, 86 started their psychotherapy courses during the study and were included in the prediction analysis. C4 scores did not differ between diagnostic groups and were not correlated with the LPFS-BF. ROC analysis indicated poor accuracy (AUC=.46) in screening for early adherence to psychotherapy, as did analyses with the LPFS-BF as a cofactor.</p><p><strong>Conclusions: </strong>The C4 was not able to predict early adherence to psychotherapy in psychiatric outpatients, and as it also had no correlation with personality functioning, it was not possible to establish external validity. Future studies should investigate case complexity using a more controlled design and examine the outcomes of psychotherapy and adherence.</p>","PeriodicalId":19201,"journal":{"name":"Nordic Journal of Psychiatry","volume":" ","pages":"408-416"},"PeriodicalIF":1.5,"publicationDate":"2025-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144266847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}