The aim of the study was to examine individual staff experience and management of threats and violence in the acute psychiatric department for children and teenagers in Uppsala. Previous research shows that the experience of threats and/or violence is individual, and that it is difficult to distinguish between these concepts. Research shows that it is particularly vulnerable to work in psychiatry when mental illness is a cause when threats and violence occurs. Threats and violence can result in different consequences for the individual. The study is based on qualitative interviews and the material was collected in the autumn of 2012 at Akademiska sjukhuset. The qualitative interviews was transcribed and carefully analyzed. The result had an outcome in four different themes: The diffuse definition between threats and violence that showed how difficult it is to define threats and violence. Causes and staff reaction showed that mental illness, how you treat someone and compulsive cares are contributing factors to threats and violence occurs. This theme also shows ambivalence within the staff, that the behavior is unacceptable meanwhile he or she is mentally ill. Management and reporting showed that the staff has different coping strategies when they deal with threats and violence and that it is different how functional the reporting is. The theme working environment showed that it is a vulnerable environment to work in. Therefore, it is important to get support from colleagues and managers but the staff has different opinions whether they feel supported from managers. There is a need to develop routines for incidents when threats and/or violence have occurred. / Syftet med studien var att undersöka personalens enskilda upplevelse och hantering av hot och våld på Barn- och ungdomspsykiatrins (BUP) akutmottagning i Uppsala. Tidigare forskning visar att det är individuellt hur man upplever hot och våld samt att det är svårt att hålla isär dessa begrepp. Forskning visar även att det innebär en särskilt utsatthet att arbeta inom psykiatrin, då psykiska sjukdomar är en bakomliggande faktor till att hot och våld uppstår. Att bli utsatt för hot och våld kan resultera i olika konsekvenser för den enskilde. Studien baseras på kvalitativa intervjuer och materialet samlades in hösten 2012 på BUP på Akademiska sjukhuset. De kvalitativa intervjuerna transkriberades och analyserades noggrant. Resultatet utmynnade i fyra teman: Den diffusa gränsen mellan hot och våld som visade hur svårdefinierat hot och våld är samt var gränsen mellan dessa går. Orsaker och personalens reaktion tog upp att psykiska sjukdomar, bemötande och tvångsvård är bidragande faktorer till att hot och våld uppstår. I en hot- och/eller våldshändelse uppstår en reaktion hos personal, en ambivalens mellan att personen är psykiskt labil och att beteendet är oacceptabelt.  BUP akutens hantering och rapportering visade att personalen har olika copingstrategier när de ska hantera en hot och/eller våldssituation samt att det är olika hur rapporteringen av dessa situationer fungerar. Det sista temat Arbetsmiljön visade att det är en utsatt miljö att arbeta i och att det är viktigt att få stöd i arbetet, men huruvida personalen upplever att de får stöd ser olika ut. Det finns ett behov för att utveckla rutiner kring samtal efter en hot- och/eller våldshändelse.

Syftet med denna studie var att belysa hur sjuksköterskor kan upptäcka och identifiera signaler hos barn som växer upp i en destruktiv miljö av alkoholmissbruk. Metod som användes för att belysa syftet var beskrivande litteraturstudie. Databaser som användes vid sökningen av valda källor var Medline(PubMed) och Cinahl. Andra sökstrategier var manuellsökning i valda källor. Huvudresultatet visade att barn till föräldrar med tungt alkoholmissbruk framförallt mådde psykiskt dåligt, det tog sig uttryck som depression och utåtagerande beteende. Barns ohälsa i samband med att växa upp i dysfunktionella miljöer relaterat till alkoholmissbruk tog även sig uttryck i återkommande psykosomatiska symtom samt kognitiva brister. Risken för att barn skulle fara illa kopplades även till den känslomässiga miljön som rådde i hemmet. Tecken på ohälsa behövde dock inte vara en följd av en ogynnsam uppväxtmiljö utan kunde härledas till genetiska faktorer. Slutsatsen är, för att kunna identifiera barn som befaras fara illa i sitt hem krävs goda kunskaper om problemets komplexitet. För att utgöra en viktig länk i detta arbete som sjuksköterska krävs förutom kunskap även utarbetade riktlinjer. Virginia Hendersons omvårdnadsteori kan enligt författarna utgöra ett gott stöd i att bedöma varje enskild situation, utifrån dess orsak och verkan baserade tänkande.

Under åren 2008-2010 pågick ett familjeprojekt på barn- och ungdomspsykiatriska kliniken i Stockholm. Tjugofyra familjer skrevs in i projektet och sex behandlare medverkade. Projektets struktur byggde på att familjer, även syskon, till de inskrivna patienterna i högre grad än i vanlig slutenvård skulle närvara och delta i vården. Sessionerna var av en intensitet av tre timmar per dag, tre dagar i veckan, i tre veckor. Genom en kvalitativ studie med intervjuer med ett antal av de som var med, inventeras projektets genomförande och konsekvenser. De som svarat redogör för positiva förändringar, i synnerhet vad gäller relationerna i familjen. Föräldrarna uttrycker att de fått en annan förståelse för sitt barn och barnen att de känner sig mer förstådda. Samarbetet mellan familjerna och de professionella på kliniken verkar ha haft stor betydelse. Självskattningar på Client Satisfaction Questionnaire bekräftar de allmänt goda behandlingsresultaten. / During the years 2008-2010 a family treatment project was run at the child and adolescent psychiatric clinic in Stockholm. Twentyfour families were enrolled in the project and six therapists were involved. The project involved families, including siblings, related to the identified patients to a greater extent than in conventional inpatient care. The sessions had an intensity of three hours a day, three times a week, for three weeks. Through a qualitative study involving interviews with a sample of the participants the experiences and consequences of the project was explored. Respondents described positive changes, especially as regards the relations in the family. Parents expressed that they acquired a different understanding of their children while the children felt more understood than before. The collaboration between the families and the professionals at the clinic seems to have been of great significance to the participants. Ratings on the Client Satisfaction Questionnaire corroborate the positive results of the interviews.

Given the high rates of completed suicide and poor help-seeking among young men, this research explored how young men, who had successfully sought help from a Child and Adolescent Mental Health Service (CAMHS), experienced help-seeking. This study focused on the factors that facilitated initial access and on-going engagement in services. Eight young men between the ages of 16-18, who had entered CAMHS following self-harm or suicidal ideation, and who were engaged in on-going therapy, were recruited. Each young man was interviewed to elicit his personal experiences of help-seeking and help-receiving. Interviews were transcribed and subjected to Interpretative Phenomenological Analysis. Five dominant themes, that overarched participant’s individual experiences, emerged from the data: Role of external adult in recognising, normalising and initiating help seeking; Influence of another;Challenging and renegotiating perception of need for help and meaning behind this need; Change in perspective; Maintaining an independent self; Mechanisms of engagement and Shared experience. Help-seeking was described as a journey of two stages; 1) initial access and 2) on-going engagement, during which the presence and timing of external influences (parents, teachers) and internal influences (personal beliefs and attitudes) were crucial. A model of help-seeking is presented. This study is the first of its kind to consider factors that facilitate the help-seeking journey of young men aged 16-18 following self-harm. It highlights the need for provision of information to parents and teachers about how to identify need and ways to facilitate access to services. Information and guidelines on how to adapt services to meet the complex developmental needs of young men, is highlighted for service developers, commissioners and clinicians.

Thesis (M.S.)--University of Michigan, 1982.

Thesis (M.S.)--University of Michigan, 1982.

Thesis (M.Mus.Ther.)--New Zealand School of Music, Wellington, 2009. / Includes bibliographical references.

Väntelistor till barnpsykiatrisk vård är vanligt förekommande och tiden på väntelista har visats vara påfrestande för familjerna som väntar. Denna studie har undersökt hur föräldrar upplever tiden på väntelista till Barn- och ungdomspsykiatrin (BUP), samt vilka behov av stöd de upplever sig ha under tiden de väntar. Sju föräldrar vars barn väntade på utredning inom BUP intervjuades. Data bearbetades genom tematisk analys. Resultatet visar att föräldrarna upplevde brist på kontroll och hopplöshet, delvis på grund av att de befann sig i ovisshet under väntetiden. Vidare visar resultatet att stödinsatser som innefattar information, konsultation, avlastning och behandling efterfrågades. Resultatet diskuteras med hjälp av teorin om Locus of Control (LOC) och begreppet ovisshetsdiskrepans. Vidare forskning behövs för att öka förståelsen för hur information gällande väntetiden påverkar upplevelsen av väntetiden. Därtill behövs forskning som undersöker om och hur upplevelsen av väntetiden påverkar kommande utredning eller behandling. / Waiting lists in child and adolescent psychiatry are common and waiting for mental health services has been shown to be challenging for the families involved. This study aimed to explore how parents of children on a waiting list for an assessment experienced the wait. The study also explored what kind of support the parents felt that they needed during this period. Interviews were conducted with seven parents of children on waiting lists and data was analyzed using thematic analysis. Results showed that the parents experienced a lack of control and hopelessness during the wait, partly because of the uncertainty that characterized the waiting time. Results concerning parental support showed that information, consultation, social support and treatment were requested. Results were discussed using the theoretical framework Locus of Control (LOC) and uncertainty discrepancy. Future studies exploring how information about the waiting time affects the waiting list experience are needed. In addition, future studies that explore if and how the waiting list experience affects the coming assessment or treatment are needed.

Text in Afrikaans / Die doel van hierdie studie was om die aard van betekenisgewing in die identiteitsvestiging van adolessente met probleme, veral ten opsigte van die realiteit en by die aanleer van sekere lewensvaardighede, te ondersoek. Die ondersoek bestaan uit 'n literatuurstudie sowel as 'n eie empiriese ondersoek. Die betekenisgewingsfenomeen is vanuit 'n empiries-pedagogiese perspektief ondersoek, veral met die implikasies daarvan vir identiteitsvestiging. Die adolessent met probleme is geneig om op 'n onrealistiese wyse betekenisse aan sy verskillende relasies toe te ken. In kort bestaan die probleem daarin dat die adolessent met probleme nie oor die vermoe beskik om die eie 'self' objektief waar te neem nie. Die adolessent se gebrekkige insig en begrip van die realiteit lei dikwels tot irrasionele of onlogiese betekenisgewing. Irrasionele denkwyses veroorsaak by sommige adolessente gevoelens soos angs, vrees, emosionele opwelling, selfverwyt, minderwaardigheid en rigiditeit. Hierdie emosionele probleme manifesteer in 'n identiteitskrisis en word sigbaar in die adolessent se gedrag. Adolessente wat irrasionele betekenisse toeken en nie tot realistiese identiteitsvestiging kom nie, leef dikwels hulle probleme uit deur te steel, seksueel losbandige lewens te lei, dwelmmiddels te gebruik en selfs van die huis weg te loop. In die literatuurstudie is verder ook aandag gegee aan die volgende: • Terapievorme wat van toepassing is in die hulpverlening aan adolessente wat irrasionele betekenisse toeken, • Hulpverlening in groepsverband en • Kommunikasie in groephulpverleningsgebeure. Die empiriese ondersoek is 'n idiografiese ondersoek wat aan die hand van 'n model, volgens Dryden, wat gestruktureer en aangepas is, uitgevoer is. Die model is gebaseer op rasionele-emotiewe-terapie (RET) soos voorgestaan deur Ellis. Vyf adolessente is in die ondersoek betrek. Aan een adolessent is op individuele basis hulp verleen terwyl die ander vier adolessente groepshulpverlening ontvang het. Dit blyk uit die idiografiese ondersoek dat die model en werkswyse wat toegepas is, wel 'n bydrae kan lewer tot die wysiging van onrealistiese betekenisgewing by adolessente met probleme. Deur die hulpverlening verwerf die adolessent 'n lewensvaardigheid waardeur oorgegaan word tot realistiese betekenisgewing en -identiteitsvestiging. Uit die bevindinge van die ondersoek word enkele aanbevelings met betrekking tot verdere navorsing en praktykvoering gemaak. / The aim of the study was to investigate the nature of meaning attribution by which adolescents with problems establish their identity. The following aspects were focussed on: the reality and acquiring certain life-skills. The investigation comprises a literature study as well as an empirical investigation. An empirical-pedagogic perspective was used to examine the phenomenon of significance attribution and the implications thereof in establishing identity. The adolescent with problems tends to attribute unrealistic meaning to his various relationships. Briefly the problems exist because of the lack of ability to perceive the 'self' objectively. This inadequate perception of the adolescent with problems, causes him to attribute irrational or illogical meaning. The tendency of some adolescents, to attribute irrational meaning, causes feelings of anxiety, fear, emotional ebullition, self-blame, inferiority and rigidity. These emotional problems are manifested in an identity crisis and show in the actions of the adolescent. The adolescents, who attribute unrealistic meaning and who do not arrive at realistic self-definition, often act out their problems by stealing, living promiscuous lives, abusing drugs and absconding from home. In the study of literature the following aspects were also focussed on: • Types of therapy applicable in rendering assistance to the adolescent who attributes unrealistic meaning. • Group therapy. • Communication in group therapy events. The empirical research comprises an idiographic investigation, structured on an adapted form of Dryden's model. The model is based on rational-emotive therapy, (RET) as advocated by Ellis. five adolescents were used in this investigation. Individual therapy was given to one adolescent while the other four adolescents received group therapy. From the idiographic investigation it has become evident that the model and the procedure followed, can make a contribution to the adolescent with problems, in changing his tendency to attribute unrealistic meaning to his relationships. He can make successful use of the model as an acquired life-skill to attribute significant meaning in his efforts to arrive at a realistic self-definition. He is thus able to actualise his defined self. Based on the findings of this investigation certain recommendations, concerning further research, as well as counselling in practice, were proposed. / Psychology of Education / D. Ed. (Empiriese Opvoedkunde)

Submitted by Ana Maria Fiscina Sampaio (fiscina@bahia.fiocruz.br) on 2012-12-05T20:20:33Z No. of bitstreams: 1 Solange Tavares Rubim de Pinho Perfil de morbidade... 2006.pdf: 81184537 bytes, checksum: 48f076781a8ab82998dc5db5ee31f2bf (MD5) / Made available in DSpace on 2012-12-05T20:20:33Z (GMT). No. of bitstreams: 1 Solange Tavares Rubim de Pinho Perfil de morbidade... 2006.pdf: 81184537 bytes, checksum: 48f076781a8ab82998dc5db5ee31f2bf (MD5) Previous issue date: 2006 / Escola Bahiana de Medicina e Saúde Pública / Centro de Pesquisas Gonçalo Moniz / A literatura científica internacional tem apontado índices mais altos de transtornos psiquiátricos em adolescentes em conflito com a lei do que entre indivíduos da mesma faixa etária na população geral. A insuficiência de pesquisas sobre o tema, no Brasil, motivou a realização do presente estudo. Objetivo: Descrever o perfil psiquiátrico dos adolescentes em privação de liberdade, numa instituição em Salvador/Bahia. Metodologia: Estudo descritivo, censitário, de corte transversal, que teve por universo uma população de 290 jovens, cumprindo medidas de privação de liberdade na Casa de Acolhimento ao Menor (CAM), entre 2002 e 2003. Foram utilizados um questionário - para identificar dados demográficos, sinais e sintomas psicopatológicos, dados psicossociais - e uma entrevista semi-estruturada para o exame dos adolescentes pesquisados. Resultados: Perfil sociodemográfico: 89,3% eram do sexo masculino; idade média de 16,4 anos; 92,8% tinham o primeiro grau incompleto ou eram analfabetos; 67,6% com renda familiar menor que um salário mínimo e 54% eram procedentes da capital do Estado da Bahia. Dos 290 indivíduos investigados, 24,8% não apresentaram transtornos mentais e 75,2% apresentaram transtornos psiquiátricos, segundo a CID-10. Considerando as patologias isoladamente, a prevalência encontrada foi de 39,3%. Quando analisadas isoladamente e em comorbidade, foram obtidas as seguintes taxas de prevalência: transtornos de conduta 39,3%; transtornos por uso nocivo de substância psicoativa 27,9%; retardo mental 11,7%; transtornos hipercinéticos 11,4%; outros transtornos psicóticos 7,2%; esquizofrenia 2,4%; estados depressivos 5,5%; estados de ansiedade 5,5%; e transtornos mentais orgânicos 3,4%. Relacionando tipo de patologia com modalidade de delito cometido, foram observadas associações estatisticamente significativas de: transtornos de conduta com homicídio e com roubo; transtornos hipercinéticos com roubo; e estados depressivos com roubo. Ao analisar os fatores de risco psicossociais, constatou-se que os transtornos de conduta, os transtornos por uso nocivo de substância psicoativa e os transtornos hipercinéticos apresentaram associação estatisticamente significante com fatores como maus-tratos, abuso sexual, criminalidade e assassinato na família. Conclusão: Existe relação entre o comportamento infrator e o transtorno psiquiátrico no adolescente. Chama a atenção a alta freqüência de jovens com transtorno de conduta, e o fator social tem um peso relevante na ocorrência dessa patologia. O adolescente em conflito com a lei, portador de enfermidade psiquiátrica, necessita de tratamento médico, psicológico e pedagógico, capaz de promover a sua reinserção na esfera social. Os resultados apontaram para a necessidade de se estabelecer estratégias efetivas de prevenção e tratamento na área da saúde mental do menor, bem como garantir a ele todos os direitos fundamentais, possibilitando-lhe um pleno desenvolvimento. / Higher prevalence rates of psychiatric disorders have been reported among adolescents in conflict with the law then among their counterparts on the general population. The paucity of studies on the topic in Brazil has motivated the current study. Aim: To describe the psychiatric profile of adolescents in conflict with the law on a Juvenile Justice institution in Salvador, Bahia, Brazil. Methods: This is a cross-sectional, census study that enrolled a population of 290 adolescents kept on deprivation of liberty regimen at the Casa de Acolhimento ao Menor (CAM), in Salvador/Bahia, in 2002 and 2003. A questionnaire was used to collect demographic and psychosocial data as well as psychopathologic signs and symptoms, and a semistructured interview was carried out on the examination of the adolescents enrolled. Results; Social-demographic profile: 89.3% were male; average age: 16.4 years; 92.8% had not completed the basic school years or could not read; 67.6% had a monthly family income below one minimum salary and 54.0% had come from the capital of the state of Bahia. Among the 290 adolescents enrolled, 24.8% had no mental disturbance, while 75.2% had at least one psychiatric disorder according to ICD-10. Considering the pathologies separately, the prevalence was 39.3%. When analyzed separately and in comorbidity, the following prevalence rates were found: behavioral disorders 39.3%; disorders due to noxious use of psychoactive drugs 27.9%; mental retardation 11.7%; hyperkinetic disorders 11.4%; other psychotic disorders 7.2%; schizophrenia 2.4%; depressive states 5.5%; anxiety states 5.5%; and organic mental conditions 3.4%. Confronting the type of pathology and the type of crime committed, statistically significant associations were found between: behavioral disorders and homicide; behavioral disorders and robbery; hyperkinetic disorders and robbery; depressive states and robbery. Analyzing psychosocial risk factors, it was observed that behavioral disorders, disorders due to noxious use of psychoactive drugs and hyperkinetic disorders are statistically associated with maltreatment, sexual abuse and history of crimes or murder on the family. Conclusion: There is an association between transgressor behaviors and psychiatric disorders in adolescents. The elevated frequency of adolescents with behavioral disorders and the social determinants to the occurrence of that condition must be stressed. Adolescents In conflict with the law and with psychiatric conditions need medical treatment, as well as psychological and pedagogical support In order to promote his/her social reinsertion. The results herein presented highlight the need of establishing effective preventive and therapeutic approaches on the field of adolescents’ mental health and of warranting all their fundamental rights, allowing their full development.