Bakgrund: När en person drabbas av Alzheimers sjukdom sker en drastisk förändring i både personens och anhörigas livssituation. Anhöriga tar på sig rollen som anhörigvårdare och träder in i en främmande livsvärld som präglas av lidande. För att lindra detta lidande krävs det att sjuksköterskan har stor kunskap och bättre förståelse för hur de anhöriga upplever den förändrade livssituationen. Syfte: Syftet med denna studie är att belysa hur anhörigas upplevelser av att vårda en närstående med AS porträtteras i spelfilm. Metod: En empirisk kvalitativ ansats med direkta och ostrukturerade observationer av tre filmer har gjorts. Fältanteckningar har förts och analyserats med hjälp av en kvalitativ innehållsanalys. Resultat: Anhörigas upplevelser av att vårda en närstående med AS framförs i fyra teman: när livsvärldsmönstret brister; sorg; förlust av frihet; att släppa taget. Slutsats: Anhöriga känner att det är deras ansvar att vårda sin partner. Att bli anhörigvårdare innebär en förlust av frihet, social isolering och en känsla av ensamhet. De känslomässiga upplevelserna är främsta orsaken till lidandet. Filmerna som har använts i studien är ett kraftfullt medium som kan användas i utbildningssyfte. / Background: When a person is diagnosed with AS, a drastic change takes place in both the patient's and the relatives' lives. The relatives become an informal caregiver, they enter into a foreign world of suffering. In order to alleviate this suffering, the nurse must have greater knowledge and a better understanding of how the relatives experience their changed lifeworld. Aim: The aim of this study is to explore how relatives experience taking care of a partner with AS portrayed in films. Methods: An empirical qualitative approach with direct and unstructured observations of three films has been used. The material consisted of field notes which were analyzed with the help of a qualitative content analysis. Results: Relatives' experiences of caring for a partner with AS are presented in four themes: when the lifeworld texture ruptures; sorrow; loss of freedom; letting go. Conclusion: Relatives feel a responsibility to care for their partner. Becoming an informal caregiver means a loss of freedom, social isolation and a feeling of loneliness. The emotional experiences are the main cause of the suffering. The films used in this study are a powerful medium that can be used for educational purposes.

People with a diagnosis of schizophrenia have been found to perform poorly on tasks assessing semantic memory, and these impairments have been proposed to be related to certain symptoms, in particular Formal Thought Disorder (FTD). A systematic literature review and meta-analysis identified the need a) to determine whether semantic memory is a primary impairment in schizophrenia and not secondary to other cognitive impairments and b) what cognitive models could provide the best explanation for the impairment. With these aims, Studies One and Two compared the performance of a group of people with schizophrenia across a battery of semantic memory tests (Hodges, Salmon and Butters, 1992). In order to eliminate confounding variables, two clinical control groups were recruited for comparison, one with a probable degraded semantic memory arising from Alzheimer‘s Dementia (AD) and the other with a primary dysexecutive syndrome caused by acquired brain injury (ABI). From these comparisons, it was possible to profile the semantic memory impairment in schizophrenia with the conclusion that any deficits are task-specific. Unlike the AD group, the impairment did not seem to arise from a loss of stored knowledge but nor did a retrieval problem, in its simplest terms, offer the best explanation. Since the ABI group performed normally on the battery it is clear that a dysexecutive syndrome does not necessarily explain poor semantic memory performance. Qualitatively, the associations and categories formed by people with schizophrenia on tasks of semantic categorisation e.g. the Category Generation Test (CGT) (Green, Done, Anthony, McKenna and Ochocki, 2004) often resemble loosening of associations and psychotic speech. In order to understand more about the processes involved in the formation of these bizarre categories, I compared performance on the CGT of groups of people with schizophrenia, AD and ABI. I found that the people with AD performed fairly similarly to the people with schizophrenia in that they sorted cards in an idiosyncratic way but the ABI group performed normally, adhering to taxonomic categories. Although this result might suggest that the bizarre associations on the CGT in people with schizophrenia are caused by a deficit in semantic memory (and not a dysexecutive syndrome), further analysis found important differences between the AD and the schizophrenia group in the way the card sorts were formed. In addition, both these groups showed intact semantic memory knowledge of the items they mis-sorted, indicating that categorisation problems do not necessarily arise from a degraded memory store. The difficulties people with schizophrenia appear to have on tests of associations and categorisation (e.g. CGT) could arise from a disorganised semantic memory i.e. differences in the way in which concepts are interconnected. On the CGT, patients with schizophrenia were far more likely to sort items on the basis of thematic (situational) information suggesting a preference for thematic over taxonomic associations. To test this, participants were tested using a triadic comparison task which requires choosing whether an item is best associated with a taxonomic, thematic or perceptually related item. On this test patients performed comparably to controls suggesting that their semantic memory is organised normally and that the abnormalities in the way in which items are associated on some semantic memory tests, including the CGT, are task-specific. It has been proposed that one of the core problems in schizophrenia is that there is ―an aberrant assignment of salience‖ (Kapur 2003) to contextually inappropriate concepts due to a dysregulated dopamine system (Kapur 2003; Kapur et al 2005). It is possible that this could also explain the semantic memory impairments in schizophrenia i.e. certain less relevant concepts/ associations are chosen because they are experienced as more salient. To test this, a group of patients with schizophrenia were assessed using a test of semantic salience. Compared to controls, the patients made significantly more errors of salience including significantly more errors where large aberrant attributions of importance were given to items. The tendency to make errors on the salience test was highly correlated with errors on the CGT and also the semantic association tests, indicating a common underlying mechanism. Therefore, it can be concluded that the semantic memory impairments in schizophrenia are task-specific, not caused by a loss of semantic knowledge or a dysexecutive syndrome, but due to an aberrant assignment of salience to less relevant semantic concepts. More work is needed to understand the cognitive processes underlying this aberrant attribution process, and also the biological substrates involved.

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