Bakgrund: Patienter med psykisk ohälsa har länge varit en stigmatiserad grupp inom vården och samhället och med psykiatriska diagnoser följer ofta förutfattade meningar hos omgivningen vilket påverkar patientgruppen negativt. Patienter med psykisk ohälsa löper också större risk att dö i förtid, bland annat på grund av att deras somatiska besvär underdiagnostiseras och misstolkas för att vara psykiska åkommor.   Syfte: Att beskriva sjuksköterskors erfarenheter av att möta och vårda patienter med psykisk ohälsa inom den somatiska vården.   Metod: Detta är en litteraturstudie baserat på åtta kvalitativa studier.   Resultat: Litteraturstudien resulterade i tre huvudkategorier: organisatoriska faktorer, sjuksköterskans kompetens och mötet med patienten. Dessa delades in i ytterligare sju subkategorier.  Konklusion: Sjuksköterskorna inom den somatiska vården upplevde patienter med psykiska ohälsa som svåra och oförutsägbara och de efterfrågade mer kunskap inom ämnet. Det organisatoriska och kollegiala stödet var också bristfälligt och skapade hinder för sjuksköterskorna att ge den goda vård de önskade. Vidare forskning på ämnet är önskvärt. / Background: For a long time, patients with mental disorders have been stigmatized in both society and in care settings. It has shown that psychiatric diagnoses often come with prejudice. This affects this group of patients negatively, as it creates a barrier towards seeking somatic health care. They also have a higher mortality rate, because of misinterpreted somatic symptoms and limited care access.   Aim: To describe nurses' experiences of meeting and caring for patients with mental disorders in somatic care.   Methods: A literature review based on eight qualitative studies.   Results: This literature study resulted in three main categories: organizational factors, the nurse’s competence and the meeting with the patients. These were further divided into seven subcategories.   Conclusion: The somatic nurses’ experienced patients with mental disorder as difficult and unpredictable and they requested more knowledge in the subject. They were also affected by the lack of organizational and collegial support which created obstacles in providing adequate care for these patients. Further research on the topic is suggested.

No description available.

Bakgrund: Psykisk ohälsa och substansbruk utgör båda separat globala hälsoproblem. Samsjuklighet i form av psykisk ohälsa och substansbruk är vanligt förekommande och komplexiteten av denna sjukdomsbild utgör utmaningar för hälso- och sjukvården.  Syfte: Studiens syfte var att beskriva upplevelser av möten med omvårdnadspersonal bland personer med samsjuklighet i form av psykisk ohälsa och substansbruk.  Metod: En allmän litteraturstudie genomfördes, i enlighet med Nio-Stegsmodellen av Polit och Beck. Denna översikt inkluderade och metodiskt analyserade nio originalartiklar, med användning av innehållsanalysmetodiken som beskrivits av Graneheim och Lundman.  Resultat: Tre huvudkategorier framträdde: Personen bakom substansbruket, Vårdrelations betydelse och Utmaningar kopplade till samsjuklighet, tillsammans med sex underliggande subkategorier.  Slutsats: Personer med samsjuklighet i form av psykisk ohälsa och substansbruk utgör en komplex patientgrupp. Studiens resultat tyder på att vårdsystemets utformning och upplevd bristande kunskap hos omvårdnadspersonalen utgör hinder för dessa patienter att erhålla adekvat vård. Det krävs en ökad kunskap och förståelse hos omvårdnadspersonal för de unika utmaningar som dessa personer står inför för att bättre kunna möta deras behov. Ytterligare forskning på detta område behövs därmed för att förbättra vården av denna patientgrupp. / Background: Mental health and substance use both separately constitute global health challenges. Comorbidity of mental health issues and substance use is common, and the complexity of this clinical picture poses challenges for healthcare.  Aim: The study's aim was to describe experiences of encounters with nursing staff among individuals with comorbidity of mental illness and substance use.  Method: A general literature review was conducted, adhering to the Nine-Step model by Polit and Beck. This review included and methodically analyzed nine original articles, employing the content analysis methodology outlined by Graneheim and Lundman.  Results: Three main categories were identified: The person behind the substance use, The significance of the care relationship, and Challenges related to comorbidity, along with six associated subcategories.  Conclusions: People with comorbidity in the form of mental disorder and substance use constitute a complex patient group. This study’s results imply that the design of the healthcare system and the perceived lack of knowledge among nursing staff pose barriers for these patients to receive adequate care. There is a need for increased knowledge and understanding among nursing staff regarding the unique challenges faced by these people to better meet their needs. Further research in this area is therefore needed to improve the care of this patient group.

Epidemiological trends in mental disorders are shown against a background governed by medical aid health policy. The study quantitatively analyzed a dataset of mental disorders for South Africa’s leading medical aid scheme. South Africa’s leading medical aid scheme has been in operation for almost three decades. This degree of longevity allows for a reliable longitudinal analysis of diagnostic trends. Through consent of the Scheme, a database was provided, which lists mental disorder diagnoses over seven years from 2008 to mid-way through 2015. Data from this source were analyzed and interpreted. Data fields provided and made use of from the raw medical scheme database are: Date of admission (Year, Month); Patient gender; Database population per year; Patient diagnosis (DEG Description); Total per DEG Description. Each diagnosis (mental disorder) is presented in the following ways: 1. Bar charts showing the volume of specific mental illnesses each year. 2. Bar charts showing fluctuations of occurrence of a specific mental illness over time. 3. Frequency of specific mental illnesses over time, relative to the entire database population. 4. Male:Female ratio per mental disorder. 5. Female Outpatient vs. Inpatient volumes across each mental disorder and across all years (2008 – 2015).v 6. Male Outpatient vs. Inpatient volumes across each mental disorder and across all years (2008 – 2015). 7. Total number of patients per mental disorder across time (2008 – 2015). 8. Frequency polygons showing the fluctuation of a selected mental disorder over time as compared to other selected mental disorders. It is found that there are changes in prevalence rates of mental disorders over time and that these fluctuations are attributed to an economic factor within medical aid scheme cost-driven policy. The effect of cost-driven policy is that members diagnosed with a mental disorder may not be granted provision of adequate treatment because diagnosis is in part, determined by economic structures. Costs for mental illness treatment programmes are curtailed by keeping patient numbers significantly low, by radically over-diagnosing certain mental illnesses treated with comparably cheaper pharmaceuticals or by drastically curbing time spent in a mental health facility. Some members of the medical aid scheme have been deliberately misdiagnosed. Alternatively, those, correctly diagnosed, do not receive the treatment required of such an illness. The scenario then is of thousands of mentally ill people, who are not treated effectively. Members continue to pay fees, paying under the illusion that medical cover ensures effective treatment / Psychology / M.A. Psychology

Les facteurs associés aux recommandations d’experts psychiatres-légistes et aux verdicts à la cour de non-responsabilité criminelle pour cause de troubles mentaux ont peu été étudiés au Canada. Une collecte de données sociodémographiques, criminologiques et psychologiques a été réalisée à l’Institut national de psychiatrie légale Philippe-Pinel et au Palais de justice de Montréal sur 100 dossiers médicaux et plumitifs. Des analyses de régressions logistiques ont été exécutées afin d’identifier les facteurs sociodémographiques, criminologiques et psychologiques associés aux recommandations et aux verdicts de non-responsabilité criminelle pour cause de troubles mentaux. Les psychiatres ont recommandé la non-responsabilité criminelle pour cause de troubles mentaux pour 49% des sujets alors que les tribunaux ont reconnu 45% de l’échantillon comme étant non criminellement responsable. Les résultats suggèrent qu’une désorganisation cognitive et une perte de contrôle causée par un état psychotique au moment du crime, ainsi qu’un historique de verdicts de non-responsabilité criminelle pour cause de troubles mentaux sont associés aux recommandations psychiatriques de non-responsabilité criminelle. De plus, les résultats indiquent que de ne pas avoir d’information concernant la présence ou l’absence d’idées délirantes au moment du crime est associé aux verdicts de non-responsabilité criminelle pour cause de troubles mentaux. Cette étude permet de mettre en lumière les biais possibles dans le processus d’évaluation de non-responsabilité criminelle pour cause de troubles mentaux ainsi que les définitions et éléments du processus décisionnel qui mériteraient d’être précisés. / To our knowledge, factors associated with experts’ recommendations and courts’ verdicts of not criminally responsible on account of mental disorder (NCRMD) have received little attention in Canada. Sociodemographic, criminological, and psychological variables were coded from 100 medical files at the Institut national de psychiatrie légale Philippe-Pinel and court dockets of Montréal's provincial court. Logistic regression analyses were carried out to identify factors associated with experts’ recommendations and courts’ verdicts of non-criminal responsibility on account of mental disorder. Psychiatrists recommended non-criminal responsibility on account of mental disorder for 49% of subjects while the court found 45% of the sample to be NCRMD. Results show that disorganized cognition and psychosis-associated loss of control at the time of the offence, as well as having prior NCRMD verdicts, are predictive of a psychiatric recommendation of non-criminal responsibility on account of mental disorder. Results also suggest that not having information regarding the presence or absence of delusional ideation is associated with receiving a verdict of non-criminal responsibility on account of mental disorder. This study paves the way for the forensic mental health and legal fields to better understand the current clinical operationalization - and its shortcomings - of section 16 of the Criminal Code - not criminally responsible on account of mental disorder.

Bakgrund: Fysisk aktivitet är något i princip alla människor behöver för att må bra fysiskt och mentalt. Några som är i extra stort behov av fysisk aktivitet är personer med psykisk ohälsa då de ofta också drabbas fysisk ohälsa. Bland annat beroende på att passivitet kan vara ett symtom och att en del psykofarmaka ger metabola störningar.   Syfte: Syftet var att belysa upplevelser av motion hos personer med psykisk ohälsa samt faktorer som kan vara motiverande.   Metod: En litteratursökning har genomförts för att skapa en översikt över vetenskapliga artiklar om   motiverande faktorer och upplevelser av fysisk aktivitet hos personer med psykisk ohälsa. Studien baseras på åtta kvalitativa artiklar som granskats och analyserats med influens av Willman & Stoltz (2012) samt Friberg (2012). Det vetenskapliga underlaget  är hämtat från Cinahl, psycinfo samt Pubmed och artiklarna är publicerade mellan 2000-2013.   Resultat: Dataanalysen gav tre huvudteman. Det första beskriver motion som inre tillfredsställelse med ett antal subteman som främst handlar om upplevelsen av fysisk aktivitet. Det andra huvudtemat är Gemenskap som stöd och trygghet som främst handlar om gruppen och hur brukaren kan bli delaktig . Det tredje temat är konsten att komma i form och beskriver självhjälpsstrategier, hinder och vikten av stöd för tillfrisknandet som process.   Diskusssion: Resultatet diskuterade möjligheterna att skapa ”empowerment” hos brukarna i form av delaktighet och självbestämmande. Dels genom brukarnas egna önskemål men också genom de Motiverande faktorer som upptäcktes. Här finns en möjlighet för vården att påskynda ett tillfrisknande.

Bakgrund: Psykisk ohälsa är ett växande samhällsproblem. Attityder av negativt slag presenteras som en grund för stigmatisering som preciserades redan av de gamla grekerna. Integrationen av stigma är ett problem för samhället då det påverkar och influerar våra tankar och handlingar. Vidare kan det bidra till hur vårdrelationen kommer att se ut vilket i sin tur kan bli positivt eller negativt. Hur sjuksköterskan uttrycker sina attityder mot patienter spelar således en viktig roll. Detta för att kunna ge alla patienter den personcentrerade och goda vård de har laglig rätt till få. Syfte: Att beskriva hur hälso- och sjukvårdspersonal uttrycker deras attityder gentemot patienter med psykisk störning. Metod: En litteraturöversikt med datainsamling från databaserna CINAHL Complete, Medline och PsycINFO. Resultat: Både positiva och negativa attityder återfanns i resultatet. Även stigmatisering av personer med psykisk ohälsa förekom. Patienter med psykiska störningar blev även misstrodda för sina fysiska symtom då de sökte somatisk vård. Attityder visade sig skilja sig beroende på erfarenhet, utbildning och var de arbetar. Det framkom en kunskapsbrist och ett kunskapsbehov. Vidare efterfrågas utbildning och mer träning i möten med personer med psykisk störning av hälso-och sjukvårdspersonal. Diskussion: Resultatet diskuteras utifrån bakgrunden samt Joyce Travelbees teori om den mellanmänskliga relationen. I resultatet framkom att både positiva och negativa attityder uttrycks gentemot patienter med psykisk störning. Även stigmatisering förekom i form av uttryckta attityder och som strukturellt problem. Hälso-och sjukvårdspersonal lyfter deras kunskap om psykisk ohälsa som bristfällig och en önskan om att öka kunskapen. / Background: Mental illness is a growing problem in the society. Attitudes of negative character are presented as the ground for stigmatizing and since the old Greeks we have been forming the meaning of the word stigma. Stigma has become wider and more integrated in the society. The integration of stigma is a growing problem due to its impact and influence in the way we humans think and act. In addition this can be a contribution to how the healthcare relationship turns out, it may be positive or negative. However the expressed attitudes against patients play an important role in the hope of providing good care. Aim: The aim of this study is to describe how healthcare professionals express their attitudes towards patients with mental disorder. Method: The method used by the authors is a structured review of the literature using databases such as CINAHL Complete, Medline and PsycINFO. Results: The result showed that healthcare workers express both positive and negative attitudes, even stigmatization occurs. Patients with mental disorder were also misbelieved for their physical symptoms. Healthcare professionals mixed attitudes varied depending on work experience, education and place of work. The need for more education was expressed by a big number   of participants. Discussion: The result has been discussed based on the background and Joyce Travelbee’s theory, Human-to-Human Relationship. The result revealed both positive and negative attitudes towards people with mental illness. Also stigmatization was highlighted in the form of expressed attitudes and structural problem. Healthcare professionals also underline their knowledge of mental illness as being inadequate and a wish for increased knowledge was expressed.

Psychologists and other mental health professionals working in correctional institutions bear the considerable responsibility for identifying, diagnosing, and treating mentally disordered inmates. The importance of these responsibilities has been recognized in recent years because of the burgeoning population of inmates in general and the higher numbers of inmates with mental illness in particular. Research has demonstrated that the screens currently used in correctional settings to identify mentally disordered and suicidal inmates are either unvalidated or generally ineffective. This study investigates the validity of different mental health screens in a jail population. Inmates from the Grayson County Jail were administered three screens: the Referral Decision Scale (RDS), Personality Assessment Screener (PAS), and the Mental Disability/Suicide Intake Screen (MDSIS). Criterion measures were the Schedule for Affective Disorders and Schizophrenia (SADS) for Axis I disorders and the Suicide Probability Scale (SPS) for suicidal ideation. Results indicate that each screen most effectively assessed one clinical domain: the RDS for psychosis, the MDSIS for suicidality, and the PAS for depression. Gender differences were observed in screen items most effective for classifying inmates by suicide risk level.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

[pt] A proposta deste estudo é verificar os avanços das políticas públicas no que diz respeito a promoção do direito à convivência familiar e comunitária às crianças e aos adolescentes portadores de transtorno mental. Elegeu-se as políticas de Assistência Social e de Saúde Mental, focando-se, mais especificamente, nas diretrizes para o CAPSi - Centro de Atenção Psicossocial Infantil e Juvenil - e para o CRAS - Centro de Referência de Assistência Social. A Política Nacional de Assistência Social e o Sistema Único de Assistência Social são recentes. A atual prioridade da Assistência Social recai sob a família e seus membros. Entende-se que as famílias das crianças e adolescentes portadores de transtorno mental são mais vulneráveis social e economicamente devido a toda sobrecarga causada pelos sintomas do transtorno mental, por isso considera-se que a atuação da Assistência Social seja de extrema relevância. No entanto, no que diz respeito à criança e ao adolescente portadores de transtorno mental, muito ainda pode ser feito. A Política de Saúde Mental Infantil e Juvenil também enfatiza muito a família. Acredita-se que a criança e o adolescente têm mais probabilidade de sucesso no tratamento quando mantidos em seu ambiente familiar. As famílias devem fazer parte integrante do tratamento. Este estudo verificou que os profissionais do CAPSi estão bastante atentos e envolvidos com a Política de Saúde Mental e suas diretrizes. Acima de tudo verifica-se a riqueza do trabalho com as famílias das crianças e adolescentes portadores de transtorno mental, demonstrando a preocupação com a promoção do direito à convivência familiar e comunitária. / [en] The purpose of this study is to check the progress of public policies regarding promotion of the right of children and adolescents with mental disorder to family and community living. We select the policies of Social Welfare and Mental Health, focusing, more specifically, the guidelines for the CAPSi - Psychosocial Care Centre for Children and Youth - and the CRAS - Reference Centre for Social Welfare. The National Policy on Social Welfare are recent. The current priority of the Social Welfare falls under the family and its members. It is understood that the families of children and adolescents with mental disorders are more vulnerable socially and economically because the entire burden caused by symptoms of mental disorder, so it is considered that the performance of Social Welfare is of extreme importance. However, regard to children and adolescents with mental disorder, much can still be done. The Mental Health Policy to Children and Youth also emphasizes the family too. It is believed that children and adolescents are most likely to have success in treatment when kept in their home environment. Families should be included in treatment. This study found that professionals in the CAPSi are very attentive and involved with the Mental Health Policy and its guidelines. Above all there is a wealth of work with families of children and adolescents with mental disorders, demonstrating the concern with the promotion of the right to family and community living.