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Alhough physical health is significantly improved by weight loss, the effects of losing weight on mental health are less clear, according to a new study by University College London researchers in the UK.
fat woman and thin woman back to back
“People should not expect weight loss to instantly improve all aspects of life,” say the researchers.
The study, which is published in the journal PLOS ONE, looked at 1,979 overweight and obese people in the UK.

It found that people who lost 5% or more of their original weight over 4 years showed significantly improved physical health. However, these people were more likely to report low mood than participants who stayed within their initial weight.

In the study, 14% of the participants lost at least 5% of their body weight – the mean weight loss was 6.8 kg per person.

Adjusting their results to take into account serious health issues and major life events that might cause weight loss and depressed mood, the researchers calculated that the participants who lost weight were 52% more likely to report symptoms of depression.

Lead author Dr. Sarah Jackson, of University College London’s Epidemiology and Public Health department, says:

“We do not want to discourage anyone from trying to lose weight, which has tremendous physical benefits, but people should not expect weight loss to instantly improve all aspects of life.”

She adds that “aspirational advertising by diet brands” may set unrealistic expectations about weight loss by offering what appear to be instant life improvements. Dr. Jackson advises that people should be realistic about weight loss and be prepared for the challenges:

“Resisting the ever-present temptations of unhealthy food in modern society takes a mental toll, as it requires considerable willpower and may involve missing out on some enjoyable activities. Anyone who has ever been on a diet would understand how this could affect well-being.

However, mood may improve once target weight is reached, and the focus is on weight maintenance. Our data only covered a 4-year period so it would be interesting to see how mood changes once people settle into their lower weight.”

She also says that health care professionals should monitor both the physical and mental health of patients when recommending weight loss and offer ongoing support as needed.

What were the study’s limitations?
Although the researchers attempted to factor in major life events that could confound results, such as bereavement, which is known to be associated with both weight loss and depression, they acknowledge that data on this was limited.

The bereavement data only covered parents and spouses during the study, and did not take into account deaths of children, close friends or non-marital partners, or the deaths of parents or spouses shortly before the study commenced.

Another major life event that the study did not have data for that could have caused weight loss and depression was job loss.

The study participants were predominantly white, older adults. It is possible, therefore, that the effects of weight loss might be different among different ethnic groups or younger adults.

Also, the researchers admit problems with the measure of well-being used in the study, explaining:

“The use of an arbitrary, unvalidated threshold to indicate low levels of well-being is also problematic, and we observed some differences in results when well-being data were analyzed continuously, so these results should be interpreted with caution.”

In 2012, Medical News Today reported on a study that found a gene associated with obesity is also linked to an 8% decrease in a person’s chance of developing depression.

Written by David McNamee

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High rates of suicide among military service members and veterans may be related to traumatic experiences they had before enlisting, making them more vulnerable to suicidal behavior when coping with combat and multiple deployments, according to the findings of several recent studies presented at the American Psychological Association’s 122nd Annual Convention.

Experiencing child abuse, being sexually victimized by someone not in the service and exhibiting suicidal behavior before enlisting are significant risk factors for service members and veterans who attempt or commit suicide, according to experts with the National Center for Veterans Studies (NCVS) at the University of Utah. Suicide is the second-leading cause of death among U.S. military personnel. In 2012, there were 319 suicides among active duty service members and 203 among reserve service members, compared to 237 combat-related deaths of active duty service members in Afghanistan, according to the Department of Defense.

Soldiers who reported abuse as children were three to eight times more likely than those who were not abused to report suicidal behavior, which could include thoughts about, planning or attempting suicide, said retired Army Col. James Griffith, PhD. He and other researchers examined Army survey data gathered in 2010 from 12,567 Army National Guard soldiers in 180 company-sized units. Army National Guard and Army Reserve personnel supplement active duty personnel and, at times, comprised 30 to 40 percent of the ground forces in the Iraq and Afghanistan wars. The study found that 16 percent of the respondents reported harsh punishment during childhood and 8 percent reported physical abuse, findings that are similar to those of studies of active duty Army soldiers. Studies of civilians have also shown childhood abuse to be a significant risk factor for suicide, Griffith said.

“Experiencing abuse early in life in the home may lead to a tendency to perceive and experience stressful events as catastrophic and insurmountable,” said Griffith. “A child experiencing abuse has little opportunity to effectively cope when stressed, being in a powerless position with no recourse. This may lead to less ability to handle future stressful circumstances.”

Sexual trauma of any type, whether or not the perpetrator is in the military, increases the risk for suicidal behavior among military personnel, according to other research presented. To determine if there was any difference in suicide risk from military sexual trauma compared to civilian sexual trauma, researchers surveyed 426 service members and veterans from all branches in the armed services enrolled in college classes. More than 25 percent of women and 4 percent of men reported sexual trauma while in the military, which is similar to the prevalence of sexual victimization among the general U.S. and college student populations.

Sexual victimization both within and outside of the military was associated with significantly higher rates of suicidal thoughts and behaviors, but there were no differences between groups that had suffered either civilian or military sexual victimization, according to the presentation. However, there were differences in how men and women coped with sexual victimization.

“Previous research has found that male survivors of military sexual trauma are less likely to seek mental health care than female survivors,” said Craig J. Bryan, PsyD, an Iraq veteran and NCVS executive director. “Men may see it as a threat to their masculinity and be especially prone to shame, which is a strong predictor of suicide attempts in military personnel.”

Service members and veterans who attempted suicide before joining the military were six times more likely to attempt suicide after joining the military than those who had never attempted suicide, said Bobbie N. Ray-Sannerud, PsyD, who previously served as an Air Force psychologist. Among service members and veterans who attempted suicide, approximately 50 percent had thought about committing suicide and 25 percent had attempted suicide before joining the military. For these findings, researchers examined data collected from 371 college student veterans via an anonymous online survey and from 151 military personnel receiving outpatient mental health treatment. The study participants came from all branches of military service.

“No previous studies report when many military personnel and veterans first experience suicidal behavior, despite the fact thon at these vulnerabilities may have a relatively stronger relationship with military and veteran suicide than other commonly investigated risk factors, such as psychiatric symptoms and life stressors,” said Ray-Sannerud. “Information about how suicide risk first emerges in military personnel and which military personnel are most vulnerable after they join the service is important for screening and treatment.”

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Post-traumatic stress disorder and memory is investigated in a new study of a 2001 passenger plane near-disaster, conducted by one of the survivors of that flight. The study identifies a potential risk factor that may help to predict which individuals are most vulnerable to post-traumatic stress disorder.
Air Transat Airbus A330
Flight 236’s pilots successfully glided the plane into a rough landing. Although 18 passengers and crew were injured, the incident resulted in no fatalities.
On August 24th, 2001, Air Transat Flight 236 departed Toronto, Canada, for Lisbon, Portugal, with 306 passengers and crew onboard. Unknown to the pilots, an incorrect hydraulic pump had been installed in the engine, which caused chafing between the fuel line and the hydraulic line during the flight.

Over the Atlantic Ocean, this chafing resulted in the rupture of the right fuel line. After losing 8 tons of fuel, the pilots of Flight 236 were alerted to a problem by the plane’s instruments. They responded by following standard procedure to route fuel from the left wing tank to the right, but this caused the plane’s remaining fuel to leak through the rupture at a rate of about 1 gallon per second.

When the right engine failed, the pilots lowered altitude to 32,000 feet. But when the left engine also flamed out, they had no choice but to maneuver the 200-ton Airbus 330 into a glide and warn passengers and crew to prepare for an ocean ditching. The cabin depressurized, onboard lighting and other systems were lost and a countdown to impact began.

About 25 minutes into the emergency, however, the pilots located a military base on a small island in the Azores and successfully glided Flight 236 into a rough landing. Although 18 passengers and crew were injured, the incident resulted in no fatalities.

Onboard Flight 236 was Dr. Margaret McKinnon, who is now a clinician-scientist at St. Joseph’s Healthcare Hamilton and associate co-chair of research in the Department of Psychiatry and Behavioural Neurosciences at McMaster University in Hamilton, Canada.

“Imagine your worst nightmare – that’s what it was like,” she says of that traumatic experience aboard Flight 236. “This wasn’t just a close call where your life flashes before your eyes in a split second and then everything is okay.”

New study reports ‘two key findings’ relating to PTSD and memory
For her study, which is published in the journal Clinical Psychological Science, Dr. McKinnon recruited 15 other Flight 236 passengers. The quality and accuracy of the participants’ recollection of the Flight 236 emergency was tested by McKinnon and her colleagues and compared against recollections of two other events – 9/11 and a neutral event from the same time period.

stressed man
The researchers found that the Flight 236 passengers displayed “tremendously enhanced vivid memories” of the event.
The researchers found that the Flight 236 passengers displayed “tremendously enhanced vivid memories” of the event. Although the researchers claim they were not surprised by this, it is a key finding that challenges other studies, which tend to find that “memory for traumatic events is impoverished.”

The team also reported a second key finding when they related quality and accuracy of memory recall to which participants had developed PTSD.

The passengers who developed PTSD recalled a high number of “details external to the main event.” These details are defined as recollections that were not specific in time or were repetitions or editorial statements. The participants with PTSD recalled a higher number of these details, compared with both the passengers who did not have PTSD and a control group.

What is more, the PTSD group recalled these details external to the main event across all the events tested, not just the traumatic event. This finding is important as it suggests that it is not simply the memory of the traumatic event itself that is related to PTSD, but also how a person processes memory for events in general.

Dr. Brian Levine, senior author and senior scientist at Baycrest’s Rotman Research Institute and the University of Toronto, Canada, says:

“What our findings show is that it is not what happened but to whom it happened that may determine subsequent onset of PTSD.”

Therefore, being unable to shut out these external or semantic details when recalling a personally experienced event is related to mental control rather than memory recall. The researchers say this finding adds to growing evidence that altered memory processing may be a risk factor for PTSD.

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Reported poor sleep quality, independent of a depressed mood, appears to be associated with an increased risk for suicide in older adults.

Suicide is a preventable public health problem and accounts for almost 1 million deaths annually worldwide. Late life is characterized by an increased prevalence of sleep complaints and disproportionately elevated rates of suicide. The study sample included 420 individuals (400 control patients and 20 patients who died from suicide) who were selected from 14,456 participants.

The authors examined the risk for suicide associated with poor reported sleep in a group of older adults (with an average age of nearly 75 years) during a 10-year observation period.

Those individuals who reported poorer sleep quality at baseline had a 1.4 times increased risk for suicide. When authors controlled for the effects of a depressed mood, people with poorer sleep at baseline still demonstrated a 1.2 times greater risk for suicide during the 10-year observation period. Two sleep factors in particular – difficulty falling asleep and nonrestorative sleep – were associated with increased suicide risk.

“We suggest that poor subjective sleep quality may therefore represent a useful screening tool and a novel therapeutic target for suicide prevention in late life.”

The study is published in JAMA Psychiatry.

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There are currently only two FDA-approved medications for the treatment of posttraumatic stress disorder (PTSD) in the United States. Both of these medications are serotonin uptake inhibitors. Despite the availability of these medications, many people diagnosed with PTSD remain symptomatic, highlighting the need for new medications for PTSD treatment.

The renin-angiotensin system has long been of interest to psychiatry. Some of the first drugs targeting this system were the angiotensin converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), commonly prescribed treatments for high blood pressure.

In the 1990’s, multicenter studies evaluating ACE inhibitors suggested that they improved quality of life as well as other medical outcomes, but these medications did not prove to be sufficiently effective for the treatment of psychiatric disorders to become established treatments.

Recently, however, investigators at Emory University observed that individuals diagnosed with PTSD, and who happened to also be treated with ARBs or ACE inhibitors, exhibited fewer PTSD-like symptoms.

This led the researchers to investigate the underlying mechanisms using an animal model of PTSD in order to expand upon this clinical finding.

Dr. Paul Marvar, first author and Assistant Professor at The George Washington University, explains their findings, “Our current preclinical results show that the ARB losartan, given acutely or chronically to mice, enhances the extinction of fear memory, a process that is disrupted in individuals with PTSD. Overall these data provide further support that this class of medications may have beneficial effects on fear memory in PTSD patients.”

Fear extinction is a process by which a memory associated with fear is gradually ‘overwritten’ in the brain by a new memory with no such association. For example, exposure therapy is a form of fear extinction, whereby repeatedly exposing a patient in a safe manner to a feared object or situation slowly reduces or eliminates their fear. A medication that could potentially enhance the extinction of fear would be welcome to the millions of individuals who continue to suffer with symptoms of PTSD.

“It is exciting to see the renin-angiotensin being explored in new ways in the search for new treatment for PTSD,” commented Dr. John Krystal, Editor of Biological Psychiatry. “There is a tremendous need for more effective treatments for PTSD symptoms.”

Future studies are still necessary before clinical use could be recommended, but there is hope that by targeting this pathway, it may provide a safe and powerful adjunctive novel therapy for the treatment of PTSD.

Depression is almost twice as common, and poor quality of life almost five times as common, in people with bipolar disorder who have elevated or low levels of the stress hormone cortisol in the blood. Researchers at Umeå University, Sweden, report this in a study published in the journal PLOS ONE.

“In bipolar depression the stress system is often activated, which means that the affected individuals have elevated cortisol levels in the blood. We have now been able to show that both over- and underactivity in the stress system, with corresponding elevated or reduced cortisol levels, can impair mental health in terms of depression and poor quality of life in these patients,” says Martin Maripuu, a PhD student at the Department of Clinical Sciences, Psychiatry Unit Umeå University and physician at the psychiatric clinic, Ostersund Hospital.

Bipolar disorder is a lifelong disease that causes recurrent episodes of both mania and depression. Stress is a known trigger for these episodes, and depression and mania also adds to the accumulated stress load.

One of the body’s main stress systems is the HPA axis. This system regulates the production and level of the vital stress hormone cortisol. Cortisol is a hormone that everyone needs in everyday life in order to cope with various stressful situations, such as pain, illness and stress at work.

Stress causes overactivity in the stress system, resulting in elevated levels of cortisol. If the stress continues in the long-term, it is believed to cause an underactivity in the stress system, which results in low cortisol levels.

Previous studies have shown that the stress system is often overactive in patients with bipolar depression. To investigate the relationship between cortisol levels and depression among these patients, the researchers at Umeå University conducted a study with 145 patients who had bipolar disorder, as well as 145 people in a control group. The researchers measured cortisol levels in the participants, both under normal conditions and after the participants had completed a so-called dexamethasone suppression test, which is sensitive to early abnormalities in the stress system.

The results of the study show that more than half of the patients with bipolar disorder who had elevated or low levels of cortisol in the blood, also had depression. Depression was additionally almost twice as common in those who had high cortisol levels and in those who had low cortisol levels, compared with those who had normal levels of the hormone in the blood. Prevalence of low quality of life was six times more common in the group with low cortisol levels and nearly five times more common among those with high cortisol levels, compared with those who exhibited normal activity in the stress system.

The study also shows that people who had low cortisol levels, on average, have had their disease longer than those with high cortisol levels, which could suggest that chronic stress in bipolar disorder can lead to an “exhaustion” of the stress system with reduced cortisol levels as a result. The researchers also believe that the low cortisol levels, once developed, can contribute to a more chronic, manifested state of the disorder.

“These are important results that in the future could contribute to a more personally tailored medical treatment of bipolar disorder. The results may also ultimately lead to the development of new drugs that work by normalizing the stress system and cortisol levels,” says Martin Maripuu.

Scientists at Yerkes National Primate Research Center, Emory University have identified a drug that appears to make memories of fearsome events less durable in mice.

The finding may accelerate the development of treatments for preventing PTSD (post-traumatic stress disorder). The drug, called osanetant, targets a distinct group of brain cells in a region of the brain that controls the formation and consolidation of fear memories.

The results were published in the journal Neuron.

“Potentially, drugs that act on this group of cells could be used to block fear memory consolidation shortly after exposure to a trauma, which would aid in preventing PTSD,” says Kerry Ressler, MD, PhD, professor of psychiatry and behavioral sciences at Emory University School of Medicine and Yerkes National Primate Research Center. “PTSD is unique among psychiatric disorders in that we know when it starts – at the time of the trauma. Finding ways to prevent its development in the first place – in the emergency department or the battlefield – is an important and exciting avenue of research in this area.”

The first author of the paper is postdoctoral fellow Raül Andero Galí, PhD. Ressler and Andero were sifting through a list of many genes that are activated in the brains of mice after they learn to become afraid of a sound, because the sound is paired with a mild electric shock. The researchers were probing for changes in the central amygdala, a region of the brain known to regulate fear learning.

Out of thousands of genes they examined, their “top gene” was Tachykinin 2 or Tac2. The Tac2 gene was turned on more strongly during fear learning in mice that were previously exposed to a model of traumatic stress.

“The Tac2 gene is robustly activated after fear learning and belongs to a pathway that can be specifically blocked with a drug,” Ressler says. “It was interesting that Tac2 is highly expressed in one particular part of the amygdala, but with low or no expression in other brain areas related to the formation of fear memories. Also, we found that the cells that express Tac2 are distinct from those other investigators had previously identified as being involved in fear expression.”

Tac2 is part of a family of messengers in the nervous system known as tachykinins. Drugs that block a product encoded by Tac2’s relative, Tac1, are antiemetics, often prescribed when someone is receiving chemotherapy for cancer.

Osanetant, which blocks the action of Tac2, has been tested in previous clinical studies for schizophrenia and was safe but not effective in addressing that disorder. It has not been tested in humans for PTSD prevention.

“Osanetant is a safe and well-tolerated drug in humans and could be potentially used to prevent PTSD when given shortly after trauma, although more research is needed,” Andero says.

Under the influence of osanetant, mice could still learn to become afraid of a sound paired with a shock, but the mice did not freeze as much in response to the sound a day later, even if the drug was given an hour after training.

“Our goal is to specifically impair emotional memories related to a traumatic event instead of all memories associated with it. Thus, the trauma and its circumstances are remembered but the consolidation of fear memories is impaired, which could decrease the likelihood of developing fear-related disorders,” Andero says.

For children, stress can go a long way. A little bit provides a platform for learning, adapting and coping. But a lot of it – chronic, toxic stress like poverty, neglect and physical abuse – can have lasting negative impacts.

A team of University of Wisconsin-Madison researchers recently showed these kinds of stressors, experienced in early life, might be changing the parts of developing children’s brains responsible for learning, memory and the processing of stress and emotion. These changes may be tied to negative impacts on behavior, health, employment and even the choice of romantic partners later in life.

The study, published in the journal Biological Psychiatry, could be important for public policy leaders, economists and epidemiologists, among others, says study lead author and recent UW Ph.D. graduate Jamie Hanson.

“We haven’t really understood why things that happen when you’re 2, 3, 4 years old stay with you and have a lasting impact,” says Seth Pollak, co-leader of the study and UW-Madison professor of psychology.

Brain Stress
Different forms of early life stress, such as child maltreatment or poverty, impacted the size of two important brain regions: the hippocampus (shown in red) and amygdala (shown in green), according to new University of Wisconsin-Madison research. Children who experienced such stress had small amygdalae and hippocampai, which was related to behavioral problems in these same individuals.
Credit: Image courtesy of Jamie Hanson and Seth Pollak

Yet, early life stress has been tied before to depression, anxiety, heart disease, cancer, and a lack of educational and employment success, says Pollak, who is also director of the UW Waisman Center’s Child Emotion Research Laboratory.

“Given how costly these early stressful experiences are for society … unless we understand what part of the brain is affected, we won’t be able to tailor something to do about it,” he says.

For the study, the team recruited 128 children around age 12 who had experienced either physical abuse, neglect early in life or came from low socioeconomic status households.

Researchers conducted extensive interviews with the children and their caregivers, documenting behavioral problems and their cumulative life stress. They also took images of the children’s brains, focusing on the hippocampus and amygdala, which are involved in emotion and stress processing. They were compared to similar children from middle-class households who had not been maltreated.

Hanson and the team outlined by hand each child’s hippocampus and amygdala and calculated their volumes. Both structures are very small, especially in children (the word amygdala is Greek for almond, reflecting its size and shape in adults), and Hanson and Pollak say the automated software measurements from other studies may be prone to error.

Indeed, their hand measurements found that children who experienced any of the three types of early life stress had smaller amygdalas than children who had not. Children from low socioeconomic status households and children who had been physically abused also had smaller hippocampal volumes. Putting the same images through automated software showed no effects.

Behavioral problems and increased cumulative life stress were also linked to smaller hippocampus and amygdala volumes.

Why early life stress may lead to smaller brain structures is unknown, says Hanson, now a postdoctoral researcher at Duke University’s Laboratory for Neuro Genetics, but a smaller hippocampus is a demonstrated risk factor for negative outcomes. The amygdala is much less understood and future work will focus on the significance of these volume changes.

“For me, it’s an important reminder that as a society we need to attend to the types of experiences children are having,” Pollak says. “We are shaping the people these individuals will become.”

But the findings, Hanson and Pollak say, are just markers for neurobiological change; a display of the robustness of the human brain, the flexibility of human biology. They aren’t a crystal ball to be used to see the future.

“Just because it’s in the brain doesn’t mean it’s destiny,” says Hanson.

In 2011, the United States Military repealed its “don’t ask, don’t tell” policy that prevented gay and lesbian service members from disclosing their sexual orientation. Current estimates indicate that more than 1 million veterans identify as lesbian, gay or bisexual (LGB). Now, a University of Missouri researcher says these service members and veterans often are marginalized and may benefit from mental health professionals, including social workers, who are informed about the needs of individuals who identify as LGB.

“Identifying as LGB and serving in the military can provide a distinct set of experiences and challenges for individuals,” said Michael Pelts, a doctoral student at the School of Social Work in the MU College of Human Environmental Sciences. “Within the U.S., identifying as a service member or veteran can marginalize individuals. This is also true for people who identify as LGB. The impact may be compounding. For example, suicide has a high occurrence rate among veterans and even more so among veterans who identify as LGB.”

Pelts said studies show that the majority of LGB service members and veterans who seek mental health care services do so outside of Veterans Affairs.

“Social workers in the public and private sectors make up the largest group of mental health service providers to veterans and their families,” Pelts said. “It is likely that social workers will continue to see current and new generations of veterans struggling with their sexual identity and with the impact of internal and societal stigmas related to identifying as LGB. Therefore, mental health professionals need to be equipped to care for members of this population.”

Social workers and other mental health providers should challenge their cultural assumptions when treating clients who are veterans or service members, Pelts said.

“It’s not ethically sound practice to assume that all service members and veterans are heterosexual,” Pelts said. “Assuming individuals are heterosexual can compound stress for LGB individuals and make them less likely to share information, which can make it more difficult for health professionals and mental health providers to provide adequate care.”

Pelts said health providers should adopt practices to be more inclusive to veterans who identify as LGB. Part of increasing inclusivity includes simple changes such as modifying medical history forms and in-take documents. By using more inclusive terminology, individuals who identify as LGB may feel less alienated, Pelts said.

“It is essential for mental health professionals to create culturally competent practice approaches,” Pelts said. “Social workers have a tremendous opportunity, if not ethical responsibility, to be leaders in the provision of mental health services for LGB service members, veterans and their families.”

Pelts recently wrote, “Veterans Mental Health: Implication for Services With Gay Men and Lesbians Who Have Served,” which was published in Social Work in Mental Health.

A new register-based study from Karolinska Institutet in Sweden shows that drug therapy for ADHD does not entail an increased risk of suicide attempts or suicide, as was previously feared. The results are published in the British Medical Journal (BMJ).

“Our work in several ways shows that most likely there is no link between treatment with ADHD drugs and an increased risk of suicide attempts or suicide. The results rather indicate that ADHD drugs may have a protective effect,” says Henrik Larsson, researcher at the Department of Medical Epidemiology and Biostatistics, who headed the study.

Earlier research has indicated that ADHD drug treatment would increase the occurrence of suicidal thoughts. However, these studies have been small scale and/or the methods used have been limited, which make the results uncertain. To gain clarity in this matter, researchers at Karolinska Institutet have now used national patient registers to identify all patients in Sweden diagnosed with ADHD between 1960 and 1996; a total of 37,936 individuals. These people were then followed over the period 2006-2009, in terms of drug treatment and events that could be linked to suicide attempts and suicide.

Among other things, the study compared the rate of suicidal behaviors while the patients were receiving ADHD medication, as compared with the rate for the same patients while not receiving medication. Using this design the researchers were able to determine that there was no evidence to support that ADHD drug therapy would increase the risk of suicide attempts/suicide. One strong point of the study now being published is that all the individuals were compared to themselves, as this allowed the researchers to take into account the differences between those taking the drugs and those who do not.

“Many epidemiological studies on the risks related to drugs fail to adjust for the differences between individuals who take the drugs and those who do not. This is a critical limitation given that the individuals on medication are usually more severely ill than the others,” says Henrik Larsson.