Adult psychiatric patients with neuropsychiatric symptoms, in particular Autism Spectrum Disorders (ASD)
Johan Nyrenius, psychologist and doctoral student tells us all about his research at the Gillberg Neuropsychiatry Centre
What is your professional background and where are you currently working Johan?
- I am a psychologist and specialist in neuropsychology. I actually did my internship during the psychologist training at BNK in 2007, it is very fun to be back. During the internship period, I also worked in Personal Assistance Care with young adults and I remember that it was educational to see the people both from a clinic perspective and in everyday life. I started working as a psychologist in child habilitation and then child psychiatry, but since 2014 I have been active in adult psychiatry in Helsingborg and northwestern Skåne. I have primarily worked with assessments of neuropsychiatric conditions and also with psychological treatment of psychiatric comorbidity in patients with primarily autism and/or ADHD. I have also worked for a few years with eating disorders.
- Since the turn of the year 2020/2021, I have been working as a specialist psychologist within adult psychiatry in northwestern Skåne. In that role, I work, among other things, with the implementation of new care processes, care programs and other organisational development. We are also building up a local research network in Helsingborg with a lot of encouragement and support from our management. I work clinically one day a week, right now with addiction and LARO patients (Medical-assisted rehabilitation for opioid dependence), and also work on my doctoral project.
You are a PhD student at the GNC, what is your project about?
- My project is about the group of people with autism spectrum disorders who go undetected during childhood or adolescence but have time to grow up before they have access to an assessment and can get a diagnosis. In adult psychiatric outpatient care, we do not know how many there are, who thus seek contact with adult psychiatry with an autistic way of functioning but without having received a diagnosis. There is a lot of speculation but not so much systematic research on the whole group, besides those that focused on subgroups in psychiatry such as eating disorder patients (e.g. Maria Råstam's research) or depressed patients (e.g. Takara & Kondo's study from 2014). In addition to the prevalence issue in adult psychiatry, we also examine the group to be able to see what needs there are. We then look primarily at factors such as psychiatric comorbidity, functional level, suicidality and self-harm, but we look a little broader than just psychiatric factors and also examine, for example, social and economic factors.
What made you decide to enter the world of research and why this particular research topic?
- I received support and help from Eva Billstedt to write my specialist thesis, also about the same group of patients. There are large knowledge gaps around the patient group (adults with autism and psychiatric comorbidity), which creates a great deal of frustration in the clinical work, both for patients and staff. Eva and I thought it was fun to work together so we simply continued and could then broaden the approach around this group. It is a lot of work and toil, but it concerns a group of patients who suffer severely and do not have access to adequate help at present and we must begin to get a grip on how many it concerns, how they feel, what their lives look like and get more clues about how we can help them.
You have recently published your first article in the Nordic Journal of Psychiatry. What was that article about and what were the main findings?
- The article was about the impact of cognitive functions on adaptive functioning (everyday functioning) in adult psychiatric patients who were first investigated in adulthood and diagnosed with autism. We looked at a small group of 30, and in that group we could see that "broader", or more complex, cognitive functions - working memory and process speed - have an impact on adaptive functioning, while more "pointed" cognitive functions such as cognitive flexibility or automation does not seem to have any direct impact. We also saw that this group of patients had a severely impaired adaptive functional ability, i.e., everyday functioning, regardless of level of ability
What are you working on at this very moment?
- Right now I am working together with my supervisors on my first article based on the data I have collected during the doctoral project. In this article, we examine the prevalence of autism and sub-clinical autism (clear autistic traits, but not sufficient for a diagnosis) in the group seeking psychiatric contact for the first time in at least six months. So right now it's an endless revision and re-analysis work, but we'll send out the manuscript at least before the summer, I think.
What has been the highlight of your PhD studies so far?
- I think the absolute best thing is the contacts it entails with other researchers, both locally, regionally, nationally and internationally. Many have both offered and provided support in various ways. Soon we will return to a situation where you can also meet in other ways than via video meetings as well.
Have you come across many obstacles so far?
- It happens all the time, not least difficulties in obtaining funding or that data collection problems arise. You get used to it and gradually learn not to panic, at least not as often. I have been very lucky with supervisors, both at GNC and locally here in Helsingborg, and I also have strong support from the organisation management in psychiatry in Helsingborg. Without the support of Eva, Jonas Eberhard, Christopher Gillberg and my managers here in Helsingborg, I would never have been able to run the project.
Is doing a PhD as you imagined?
- Everyone I had contact with before I started with this told me that it's an incredible amount of work, stress and insecurity - so I thought I was mentally prepared for it all, but it dawned on me pretty quickly that I had a really too nice picture of it all before. But you get used to it gradually. Fortunately, I have an understanding wife and children who can cope with the fact that I am not always completely reachable.
I spend most of my time with my family (my children are still quite young), especially now during the pandemic. Otherwise, I have a great interest in food and drink. Swimming has sailed up as an interest over the past year and I have that in common with my son, it's fun to be able to do something together. I hope that the swimming pools can open again soon.