1
|
Brown P, Waite F, Lambe S, Jones J, Jenner L, Diamond R, Freeman D. Automated Virtual Reality Cognitive Therapy (gameChange) in Inpatient Psychiatric Wards: Qualitative Study of Staff and Patient Views Using an Implementation Framework. JMIR Form Res 2022; 6:e34225. [PMID: 35412462 PMCID: PMC9044147 DOI: 10.2196/34225] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 01/30/2022] [Accepted: 01/30/2022] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Automated virtual reality (VR) therapy could allow a greater number of patients to receive evidence-based psychological therapy. The aim of the gameChange VR therapy is to help patients overcome anxious avoidance of everyday social situations. gameChange has been evaluated with outpatients, but it may also help inpatients prepare for discharge from psychiatric hospital. OBJECTIVE The aim of this study is to explore the views of patients and staff on the provision of VR therapy on psychiatric wards. METHODS Focus groups or individual interviews were conducted with patients (n=19) and National Health Service staff (n=22) in acute psychiatric wards. Questions were derived from the nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability framework. Expectations of VR therapy were discussed, and participants were then given the opportunity to try out the gameChange VR therapy before they were asked questions that focused on opinions about the therapy and feasibility of adoption. RESULTS There was great enthusiasm for the use of gameChange VR therapy on psychiatric wards. It was considered that gameChange could help build confidence, reduce anxiety, and "bridge that gap" between the differences of being in hospital and being discharged to the community. However, it was reflected that the VR therapy may not suit everyone, especially if they are acutely unwell. VR on hospital wards for entertainment and relaxation was also viewed positively. Participants were particularly impressed by the immersive quality of gameChange and the virtual coach. It was considered that a range of staff groups could support VR therapy delivery. The staff thought that implementation would be facilitated by having a lead staff member, having ongoing training accessible, and involving the multidisciplinary team in decision-making for VR therapy use. The most significant barrier to implementation identified by patients and staff was a practical one: access to sufficient, private space to provide the therapy. CONCLUSIONS Patients and staff were keen for VR to be used on psychiatric wards. In general, patients and staff viewed automated VR therapy as possible to implement within current care provision, with few significant barriers other than constraints of space. Patients and staff thought of many further uses of VR on psychiatric wards. The value of VR therapy on psychiatric wards now requires systematic evaluation. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.2196/20300.
Collapse
Affiliation(s)
- Poppy Brown
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Felicity Waite
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Sinead Lambe
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Julia Jones
- Nottinghamshire Healthcare NHS Foundation Trust, Nottingham, United Kingdom
| | - Lucy Jenner
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Rowan Diamond
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| | - Daniel Freeman
- Oxford Health NHS Foundation Trust, Oxford, United Kingdom
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
| |
Collapse
|
2
|
Greenwell K, Sereda M, Bradbury K, Geraghty AWA, Coulson NS, Hoare DJ. Intervention Planning for the Tinnitus E-Programme 2.0, an Internet-Based Cognitive Behavioral Intervention for Tinnitus. Am J Audiol 2021; 30:241-254. [PMID: 34038162 DOI: 10.1044/2021_aja-20-00131] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
Purpose The purpose of this study is to comprehensively describe the intervention planning process for the Tinnitus E-Programme 2.0, an Internet-based cognitive behavioral intervention for tinnitus. Method Theory-, evidence-, and person-based approaches to intervention development were used. In Phase 1, quantitative systematic reviews were used to identify potentially effective intervention techniques and design features. Primary mixed-methods research involving adults with tinnitus explored the acceptability of the first version of the intervention. In Phase 2, person-based guiding principles highlighted key intervention design objectives and features to address needs of the intervention's target group (identified in Phase 1) to maximize its acceptability, feasibility of delivery, and effectiveness. Theory-based "behavioral analysis" and "logic modeling" comprehensively described intervention content and potential mechanisms of action. From this planning work, a prototype intervention was developed. Results The intervention design objectives outlined in the guiding principles were to (a) normalize tinnitus, (b) support users to maintain a regular relaxation practice, (c) minimize the worsening of users' tinnitus sensation, and (d) ensure the intervention is accessible to those with hearing loss. Behavioral analysis and logic modeling identified intervention processes (e.g., illness perceptions, beliefs about consequences, skills, goals) and purported mediators (acceptance of tinnitus, negative thinking, use of the cognitive skills tools for managing negative thoughts, and practicing regular relaxation) hypothesized to facilitate reductions in tinnitus symptom severity. Conclusions The guiding principles highlight key design objectives and features to consider when developing interventions for tinnitus. The logic model offers hypothesized mechanisms of action that can be tested in future process analyses.
Collapse
Affiliation(s)
- Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, United Kingdom
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Hearing Sciences group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
| | - Magdalena Sereda
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Hearing Sciences group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
| | - Katherine Bradbury
- Centre for Clinical and Community Applications of Health Psychology, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, United Kingdom
| | - Adam W. A. Geraghty
- School of Primary Care, Population Sciences and Medical Education, Faculty of Medicine, University of Southampton, United Kingdom
| | - Neil S. Coulson
- Division of Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, United Kingdom
| | - Derek J. Hoare
- National Institute for Health Research (NIHR) Nottingham Biomedical Research Centre, Hearing Sciences group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
| |
Collapse
|
3
|
Abstract
Tinnitus is a common symptom. Standard therapies aim at improving the quality of life and reducing the psychological stress associated with tinnitus. Most interventions have little or no effect on the main symptom. Those affected subjects, however, want such a change and prefer a specific solution, such as pharmacologic therapy to other modalities. Scientific efforts have not yet led to significant improvement in the range of therapies. This article outlines existing efforts and develops ideas on how research for improved tinnitus therapy might look in the future.
Collapse
Affiliation(s)
- Tobias Kleinjung
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 24, Zurich CH 8091, Switzerland.
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy, Interdisciplinary Tinnitus Center, University of Regensburg, Universitätsstrasse 84, Regensburg D 93053, Germany
| |
Collapse
|
4
|
Allan S, Mcleod H, Bradstreet S, Beedie S, Moir B, Gleeson J, Farhall J, Morton E, Gumley A. Understanding Implementation of a Digital Self-Monitoring Intervention for Relapse Prevention in Psychosis: Protocol for a Mixed Method Process Evaluation. JMIR Res Protoc 2019; 8:e15634. [PMID: 31821154 PMCID: PMC6930509 DOI: 10.2196/15634] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Revised: 09/22/2019] [Accepted: 09/23/2019] [Indexed: 12/12/2022] Open
Abstract
Background Relapse is common in people who experience psychosis and is associated with many negative consequences, both societal and personal. People who relapse often exhibit changes (early warning signs [EWS]) in the period before relapse. Successful identification of EWS offers an opportunity for relapse prevention. However, several known barriers impede the use of EWS monitoring approaches. Early signs Monitoring to Prevent relapse in psychosis and prOmote Well-being, Engagement, and Recovery (EMPOWER) is a complex digital intervention that uses a mobile app to enhance the detection and management of self-reported changes in well-being. This is currently being tested in a pilot cluster randomized controlled trial. As digital interventions have not been widely used in relapse prevention, little is known about their implementation. Process evaluation studies run in parallel to clinical trials can provide valuable data on intervention feasibility. Objective This study aims to transparently describe the protocol for the process evaluation element of the EMPOWER trial. We will focus on the development of a process evaluation framework sensitive to the worldview of service users, mental health staff, and carers; the aims of the process evaluation itself; the proposed studies to address these aims; and a plan for integration of results from separate process evaluation studies into one overall report. Methods The overall process evaluation will utilize mixed methods across 6 substudies. Among them, 4 will use qualitative methodologies, 1 will use a mixed methods approach, and 1 will use quantitative methodologies. Results The results of all studies will be triangulated into an overall analysis and interpretation of key implementation lessons. EMPOWER was funded in 2016, recruitment finished in January 2018. Data analysis is currently under way and the first results are expected to be submitted for publication in December 2019. Conclusions The findings from this study will help identify implementation facilitators and barriers to EMPOWER. These insights will inform both upscaling decisions and optimization of a definitive trial. Trial Registration ISRCTN Registry ISRCTN99559262; http://www.isrctn.com/ISRCTN99559262 International Registered Report Identifier (IRRID) DERR1-10.2196/15634
Collapse
Affiliation(s)
- Stephanie Allan
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Hamish Mcleod
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Simon Bradstreet
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Sara Beedie
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - Bethany Moir
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| | - John Gleeson
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - John Farhall
- Department of Psychology and Counselling, La Trobe University, Melbourne, Australia
| | - Emma Morton
- School of Behavioural and Health Sciences, Australian Catholic University, Melbourne, Australia
| | - Andrew Gumley
- Mental Health & Wellbeing, University of Glasgow, Glasgow, United Kingdom
| |
Collapse
|
5
|
Greenwell K, Sereda M, Coulson NS, Hoare DJ. Understanding User Reactions and Interactions With an Internet-Based Intervention for Tinnitus Self-Management: Mixed-Methods Evaluation. Am J Audiol 2019; 28:697-713. [PMID: 31487477 DOI: 10.1044/2019_aja-18-0171] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Purpose Internet-based interventions have the potential to reduce the disparity in access to psychological therapy that people with tinnitus currently experience. One example is the Tinnitus E-Programme, which, although freely available online, has not yet been formally evaluated. The purpose of this study was to evaluate past, current, and new users' reactions and interactions with the Tinnitus E-Programme. Method Study 1 used an online survey to gather past and current users' reactions to, and interactions with, the intervention (n = 27). Study 2 used interviews and a relaxation log to assess how new users implemented the skills they learned into their everyday lives (n = 13). Results Generally, users expressed positive views on the intervention content and design features. Users particularly valued the education about tinnitus and its management and the relaxation skills training, and use of these components was high. In contrast, user reactions to self-monitoring tools, an online support forum, and therapist support were mixed, and use was lower. Implementation was limited by instances of poor usability and accessibility, user engagement, and adherence to relaxation goals. Users' perceptions of the intervention's credibility and relevance and beliefs regarding a negative impact on their tinnitus influenced engagement. Users in both studies identified several benefits gained, including functional and emotional management, self-efficacy for managing and coping with tinnitus, understanding tinnitus and its management, social support, and acceptance of tinnitus. Conclusion Findings suggest that the intervention was acceptable to its target group but also highlighted some areas for improvement. These findings will be used to inform further optimization work.
Collapse
Affiliation(s)
- Kate Greenwell
- Centre for Clinical and Community Applications of Health Psychology, University of Southampton, United Kingdom
- National Institute for Health Research Nottingham Biomedical Research Centre, Hearing Sciences Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
| | - Magdalena Sereda
- National Institute for Health Research Nottingham Biomedical Research Centre, Hearing Sciences Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
| | - Neil S. Coulson
- Division of Rehabilitation and Aging, School of Medicine, University of Nottingham, United Kingdom
| | - Derek J. Hoare
- National Institute for Health Research Nottingham Biomedical Research Centre, Hearing Sciences Group, Division of Clinical Neuroscience, School of Medicine, University of Nottingham, United Kingdom
| |
Collapse
|
6
|
Abstract
In recent years, applications (apps) for medical purposes have been developed and introduced, including apps that perform diagnostics and documentation for hearing loss and tinnitus in combination with smartphones. Even therapeutic apps, particularly for chronic tinnitus, have been launched. This review discusses the existing scientific literature for these smartphone applications. For tinnitus, Internet-based cognitive behavioral therapy has been developed and evaluated. For tinnitus therapy, introduced apps combine acoustic stimulation and music, or serve acoustic stimulation of cortical regions around the tinnitus frequency. Although these apps appear very innovative, their effectiveness has not yet been scientifically proven. A general problem associated with using smartphone apps lies in their safety in terms of possible side effects and personal data protection. However, Internet programs and apps can be a useful supplement to multimodal tinnitus therapies.
Collapse
Affiliation(s)
- G Hesse
- Tinnitus-Klinik am Krankenhaus Bad Arolsen, Große Allee 50, 34454, Bad Arolsen, Deutschland. .,Universität Witten/Herdecke, Witten, Deutschland.
| |
Collapse
|
7
|
Kalle S, Schlee W, Pryss RC, Probst T, Reichert M, Langguth B, Spiliopoulou M. Review of Smart Services for Tinnitus Self-Help, Diagnostics and Treatments. Front Neurosci 2018; 12:541. [PMID: 30177869 PMCID: PMC6109754 DOI: 10.3389/fnins.2018.00541] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 07/17/2018] [Indexed: 11/27/2022] Open
Abstract
In the recent years, there has been an increasing interest in the potential of internet- and smartphone-based technologies for the support of tinnitus patients. A broad spectrum of relevant approaches, some in the form of studies, others in the form of market products, have been mentioned in literature. They include auditory treatments, internet-based Cognitive Behavioral Therapy (iCBT), serious games, and questionnaires for tinnitus monitoring. The goal of this study is to highlight the role of existing internet-based and smart technologies for the advancement of tinnitus clinical practice: we consider contributions that refer to treatments and diagnostics, and we include contributions refering to self-help measures. We elaborate on the potential and challenges of such solutions and identify constraints associated to their deployment, such as the demand for familiarity with internet-based services and the need to re-design interactive services so that they fit on the small surface of a smartwatch.
Collapse
Affiliation(s)
- Sven Kalle
- Faculty of Computer Science, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany.,Department of Psychiatry and Psychotherapy of Regensburg University, Regensburg, Germany
| | - Winfried Schlee
- Department of Psychiatry and Psychotherapy of Regensburg University, Regensburg, Germany
| | - Rüdiger C Pryss
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems an der Donau, Austria
| | - Manfred Reichert
- Institute of Databases and Information Systems, Ulm University, Ulm, Germany
| | - Berthold Langguth
- Department of Psychiatry and Psychotherapy of Regensburg University, Regensburg, Germany
| | - Myra Spiliopoulou
- Faculty of Computer Science, Otto-von-Guericke-University Magdeburg, Magdeburg, Germany
| |
Collapse
|
8
|
McFerran D, Hoare DJ, Carr S, Ray J, Stockdale D. Tinnitus services in the United Kingdom: a survey of patient experiences. BMC Health Serv Res 2018; 18:110. [PMID: 29433479 PMCID: PMC5809968 DOI: 10.1186/s12913-018-2914-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 02/06/2018] [Indexed: 11/19/2022] Open
Abstract
Background Tinnitus service provision in the United Kingdom has been investigated from the healthcare provider’s perspective demonstrating considerable regional variation particularly regarding availability of psychological treatments. An audiological-based tinnitus service, however, was reportedly available for all tinnitus patients in the UK. The aim of the current study was to define and evaluate nationwide tinnitus healthcare services from the patients’ viewpoint. Methods Secondary analyses were performed on data from a 33-item questionnaire provided by the British Tinnitus Association. The questionnaire had been distributed via email and social media. Results Responses from 937 participants who had or had previously experienced tinnitus were analysed. All but one person had at some time consulted their GP. About one in five received medication in primary care. The majority were referred to secondary care, generally an ENT surgeon or audiovestibular physician; some were referred directly to audiological services. In secondary care the majority underwent audiometric testing and over half underwent MRI scanning. Drugs were prescribed less frequently in secondary care. About one third of patients were referred onwards from diagnostic services in secondary care to receive therapeutic interventions for tinnitus. Therapy was generally delivered by an audiologist or hearing therapist. Just under two fifths of people discharged from secondary care returned to their GP, with most returning within one year. Over a third of this group were re-referred to secondary care. Few patients saw a psychologist (2.6%) though some psychological treatments were delivered by appropriately trained audiologists. Negative counselling from healthcare professionals in both primary and secondary care settings was reported. Conclusions Although the UK has developed a national service for patients with tinnitus many people find it difficult to access, being blocked at the primary care level or after secondary care diagnostic services. Many of those discharged from secondary care return to their GP within a short space of time and are re-referred to secondary care creating an unsatisfactory and expensive revolving-door pattern of healthcare. Despite psychological treatment modalities having the best evidence base for successful tinnitus management, only a minority of tinnitus patients ever get to meet a psychologist. Electronic supplementary material The online version of this article (10.1186/s12913-018-2914-3) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Don McFerran
- Colchester Hospital University NHS Foundation Trust, Department of Otolaryngology, Essex County Hospital, Lexden Rd, Colchester, Essex, CO3 3NB, UK.
| | - Derek J Hoare
- NIHR Nottingham Hearing Biomedical Research Centre, Otology and Hearing Group, Division of Clinical Neuroscience, University of Nottingham, Nottingham, NH1 5DU, UK
| | - Simon Carr
- Regional Department of Neurotology, Department of Otolaryngology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - Jaydip Ray
- Regional Department of Neurotology, Department of Otolaryngology, Royal Hallamshire Hospital, Sheffield, S10 2JF, UK
| | - David Stockdale
- British Tinnitus Association, Ground Floor, Unit 5, Acorn Business Park, Woodseats Close, Sheffield, S8 0TB, UK
| |
Collapse
|
9
|
Beukes EW, Vlaescu G, Manchaiah V, Baguley DM, Allen PM, Kaldo V, Andersson G. Development and technical functionality of an Internet-based intervention for tinnitus in the UK. Internet Interv 2016; 6:6-15. [PMID: 30135809 PMCID: PMC6096206 DOI: 10.1016/j.invent.2016.08.002] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2016] [Revised: 08/08/2016] [Accepted: 08/11/2016] [Indexed: 12/20/2022] Open
Abstract
PURPOSE Creative approaches to improve access to evidence-based tinnitus treatments are required. The purpose of this study was to develop an Internet-based cognitive behavioural therapy (iCBT) intervention, for those experiencing tinnitus in the United Kingdom (UK). Furthermore, it aimed, through technical functionality testing, to identify specific aspects of the iCBT that require improving. METHOD An innovative iCBT intervention for treating tinnitus in the UK has been developed using a cognitive-behavioural theoretical framework. This iCBT was evaluated by two user groups during this developmental phase. Initially, five expert reviews evaluated the intervention, prior to evaluation by a group of 29 adults experiencing significant levels of tinnitus distress. Both groups evaluated iCBT in an independent measures design, using a specifically designed satisfaction outcome measure. RESULTS Overall, similar ratings were given by the expert reviewers and adults with tinnitus, showing a high level of satisfaction regarding the content, suitability, presentation, usability and exercises provided in the intervention. The iCBT intervention has been refined following technical functionality testing. CONCLUSIONS Rigorous testing of the developed iCBT intervention has been undertaken. These evaluations provide confidence that further clinical trials can commence in the UK, to assess the feasibility and effectiveness of this iCBT intervention for tinnitus.
Collapse
Affiliation(s)
- Eldré W. Beukes
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom,Corresponding author at: Department of Vision and Hearing Sciences, Faculty of Science and Technology, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom.
| | - George Vlaescu
- Department of Behavioral Sciences and Learning, Linköping University, Linköping SE-581 83, Sweden
| | - Vinaya Manchaiah
- Department of Behavioral Sciences and Learning, Linköping University, Linköping SE-581 83, Sweden,Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX 77710, USA,Audiology India, Mysore, Karnataka 570023, India
| | - David M. Baguley
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom,Audiology Department, Cambridge University Hospital NHS Foundation Trust, Cambridge CB2 0QQ, United Kingdom
| | - Peter M. Allen
- Department of Vision and Hearing Sciences, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom,Vision and Eye Research Unit, Anglia Ruskin University, Cambridge CB1 1PT, United Kingdom
| | - Viktor Kaldo
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, M46, Huddinge hospital, SE-141 86 Stockholm, Sweden
| | - Gerhard Andersson
- Department of Behavioral Sciences and Learning, Linköping University, Linköping SE-581 83, Sweden,Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Stockholm County Council, M46, Huddinge hospital, SE-141 86 Stockholm, Sweden
| |
Collapse
|