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SAMMANFATTNING Bakgrund: Antipsykotika utgör grunden i behandling av psykossjukdomar. Bristande följsamhet till läkemedelsbehandlingen är dock vanligt förekommande och en stor anledning till att patienter återinsjuknar i psykos och behöver vårdas inom slutenvård. Syfte: Dels att beskriva hur patienter som vårdas inom sluten psykiatrisk psykosvård uppfattar läkemedelsadministrering och dels att beskriva om patienterna uppfattar att sjuksköterskors bemötande i samband med läkemedelsadministrering har betydelse för deras inställning till att medicinera. Metod: Kvalitativ ansats. Intervjustudie med fenomenografi som metod i datainsamling och analys. Resultat: Tio beskrivningskategorier identifierades: Läkemedel befogat och bra, tar läkemedel trots ambivalens/motstånd, läkemedelsadministrationen – ett odramatiskt moment, tvångsmedicinering, behov av information om läkemedel, att vilja ha kontroll eller överlåta ansvar, en stressig situation, belöning för medverkan i medicinering, bemötandet spelar ingen roll och bemötandet spelar stor/viss roll.  Slutsats: Patienter som vårdas inom sluten psykiatrisk psykosvård uppfattar medicinering med antipsykotika och momentet läkemedelsadministration olika. Dessa individuella uppfattningar skulle troligtvis kunna identifieras om rutiner för samtal med patienter kring dessa frågor utarbetas på avdelningar där sådan vård bedrivs. Sannolikheten för att frivilliga lösningar och en bättre individuellt anpassad vård lättare skulle kunna bedrivas borde då öka. Strävan måste vara att så långt det är möjligt undvika tvångsmedicinering och situationer och bemötande som i denna studie identifierats som mindre positiva då de kan utgöra en risk att patienter blir negativt inställda till att medicinera. Ambitionen måste vara att hitta arbetssätt som syftar till långvarig följsamhet. / ABSTRACT Background: Antipsychotics are the basis of the treatment of psychotic illnesses. Lack of adherence to medication is common and a major reason why patients recurrence of psychosis and need to be cared for in hospital. Purpose: To describe how patients with psychosis, cared for in inpatient psychiatric wards, understand medication administration and also to describe if the patients perceive that nurses treatment in the moment of medication administration has an impact on their attitudes to medicate. Method: Qualitative approach. An interview study with phenomenography as a method of data collection and analysis.  Results: Ten categories were identified: medicines justified and well, take medicine despite ambivalence/resistance, administration of medicine – an undramatic moment, coerced medication, need for information about medicines, want to have control or assign responsibility, a stressful situation, reward for participation in the medication, treatment don´t  matter and treatment play a major/some role. Conclusion: Patients with psychosis, who are cared for in inpatient psychiatric wards, understand medication with antipsychotics and the moment of drug administration different. These individual understandings would likely be identified if routines for dialogue with patients about these issues were developed at wards where such care is conducted. The probability of voluntary solutions and better individualized care should then be increased. The ambition must as far as possible be to avoid forced medication and situations identified as less positive in this study as they may pose a risk to cause negative attitudes to medication among patients.  The ambition must be to find ways of working aimed at long-term adherence.

Magister Curationis - MCur / There is a growing burden of disease associated with mental disorders especially in low and middle-income countries. This growing burden is accompanied by an increase in psychotic disorders and has increased the demand for antipsychotic medication. The increase in the use of antipsychotic medication has resulted in the increase in side-effects that have a detrimental effect on the health of the mental health care user. Antipsychotic medication side-effects have been classified as the primary indicator for medication non-adherence. There is a relationship between psychiatric nurses’ knowledge and attitudes towards the use and the non-adherence of antipsychotic medication.

Thesis (M.Cur) --University of Limpopo, 2013 / Adherence to antipsychotic medication is very important to patients with schizophrenia. Therefore, if patients with schizophrenia are non-adherent to treatment, they are at risk of relapse and being re-admitted at a mental health care institution in the Limpopo Province. Despite the proven benefits of antipsychotic medications, half of the patients with schizophrenia do not take their prescribed drugs. The researcher has observed the following occurrences during practice: • Lack of adherence to antipsychotic medications of schizophrenic patients results in symptoms not being relieved, poor drug effectiveness and patients developed other serious or costly consequences, such as being violent and damaging property; • High rate of relapse; and • High rate of re-admissions. This research questions has guided the study: • What are the factors affecting adherence of mentally stable schizophrenic patients to antipsychotic medications at a mental health institution in the Limpopo Province? • Do mentally stable schizophrenic patients adhere to prescribed treatment? • Are there any guidelines used to promote adherence to antipsychotic treatment? The aim of the study has been to determine the level of adherence of mentally stable schizophrenic patients to antipsychotic medication at a mental healthcare institution in the Limpopo Province. The objectives of the study have been to describe adherence of mentally stable schizophrenic patients to antipsychotic medication at a mental health institution in the Limpopo Province. It implies that participants have been given the opportunity to describe their experience while on medication. vi Their responses have led to the development of guidelines to promote adherence of mentally stable schizophrenic patients to antipsychotic medication. The study site has been the Thabamoopo Mental Healthcare Institution in the Capricorn District of the Limpopo Province. A descriptive, exploratory and contextual qualitative research design has been used in this study. The population has consisted of all mentally stable schizophrenic patients and all the carers of such patients. Non-probability purposive sampling has been used to select participants in this study. The researcher has used a semi- structured interview with two schedule guides for the patient and carers/relatives, which have specified the issues and questions covered. It has assisted the researcher with gathering information about the problem studied (De Vos et al. 2005).A total of twenty (n = 20) participants, consisting of fourteen (n = 14) mentally stable schizophrenic patients and six (n = 6) carers/relatives has been included voluntarily in the semi-structured interview sessions. The steps of data analysis as described by Tesch (1990) in Cresswell (1994) have been followed in this study. The findings of this study reveal a central storyline which indicates that participants share the same point of view in connection with aspects of adherence to antipsychotic treatment and also knowledge about the causes of mental illness and its prognosis. The following four themes and their sub-themes have emerged during data analysis: Theme 1: Participants share the same point of view related to aspects of adherence to antipsychotic treatment; Theme 2: Knowledge related to mental illness; Theme 3: Health seeking behaviours of mentally ill patients; and Theme 4: Experiences of relatives caring for mentally stable patients on treatment. Guidelines and recommendations based on the findings of this study are described in Chapter 4. The criteria for establishing the trustworthiness of qualitative data maintained in this study have been: Credibility, dependability, confirmability and transferability. The following ethical principles have been adhered to: The principle of beneficence, justice, the principle of human respect and dignity, permission to conduct the study, informed consent and confidentiality, privacy and anonymity.

Schizophrenia is a complex and pervasive brain disorder that effects millions of people in the United States. There are three tiers of symptoms associated with the disorder, they include: positive symptoms, negative symptoms and thought disorders. The most common method of treatment for this disorder involves the use of antipsychotic medications, and while these medications have been shown to be effective in treating certain positive symptoms of the disorder, they have a tendency to be less effective in treating the negative cluster of symptoms and the thought disorders that can be highly debilitating for patients. The aim of this review was to determine the level of effectiveness of psychosocial treatments for the disorder, and in particular to look in to Cognitive- Behavioral Therapy (CBT) as an adjunctive method of treatment to be used in conjunction with medication. By performing searches using the PsycInfo, ERIC, EBSCO and Medline databases, the researcher was able to draw the conclusion that while there are some complications and areas of improvement in study construction, CBT can indeed be a helpful method of treatment for many patients. Importantly, CBT tends to be a very flexible treatment that can accommodate many different combinations of symptoms at varying levels or severity and stages of the illness. A discussion of a possible model of treatment that uses CBT was also undertaken to provide readers with a practical example of how this form of treatment can be used. / text

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This thesis sought to explore the phenomenon of discontinuing neuroleptic medication for psychosis. It comprises three standalone papers. Papers one and two have been prepared for submission to journals and in accordance with the journal guidelines. Paper one is a systematic literature review synthesising studies investigating the association between neuroleptic discontinuation and functional outcomes. Databases were systematically searched and thirteen studies were included in the review. Evidence regarding the association between discontinuation from neuroleptic medication and functional outcomes was mixed. Findings are limited by the scarcity of evidence, diversity in the study methods and designs used, and methodological and design quality issues. Paper two is a qualitative study exploring personal accounts of making choices about neuroleptic medication, specifically considering decisions to discontinue. Twelve participants were interviewed and a constructivist grounded theory approach was used to analyse transcripts. The findings suggest that making sense of choices relates to a continuation-discontinuation spectrum and involves three interrelated tasks. The tasks are: forming a personal theory of the need for, and acceptability of, neuroleptic medication; negotiating the challenges of forming alliances with others; and weaving a safety net to safeguard wellbeing. A theoretical model explaining the processes involved in the tasks and the mediating factors is presented and discussed. The clinical implications of the findings are discussed with reference to existing literature. Paper three is not intended for publication and is a critical review of the research process, in which the strengths and weaknesses of the systematic review and empirical study are evaluated. Personal and professional reflections on the experience of conducting a systematic review and an empirical qualitative study are discussed and the implications of the research for future clinical practice and research are considered.

The term splitting is defined as a process of formation of mental aggregates linked incompatible experiences producing numerous divisions in mental apparatus. Current findings indicate that psychological splitting in schizophrenia is likely specifically presented on a neural level as disrupted organization in neural communication. This disrupted neural communication likely underlies deficits in mental processing described by various neuroscientific concepts such as theories of disturbed connectivity, corollary discharges and dynamic complexity. In this context, a purpose of the theoretical part of the dissertation is to describe basic neuroscience theories that complementarily reflect interrelated processes between mind and brain underlying disturbances of mental integration that likely present a neural representation of the splitting. A purpose of the first part of the empirical research was to examine relationships between psychological process of splitting and disturbed cognitive and affective functions in schizophrenia. A sample of patients with borderline personality disorder (BPD) was used as a control group in this study. Methods: In the clinical study, we have assessed 30 patients with schizophrenia and 35 patients with BPD. The symptoms of splitting were measured using self- reported...

Syfte: Syftet med arbetet är att fördjupa och undersöka relevanta kunskaper om patienters erfarenheter av omvårdnadsåtgärder som underlättar deras följsamhet vid antipsykotisk läkemedelsbehandling. Bakgrund: Sverige drabbas 1500–2000 människor av psykos varje år och forskning inom ämnet är viktigt då psykossjukdom utgör ett stort lidande för individen, dess anhöriga samt orsakar stora kostnader för samhället. Följsamheten vid antipsykotisk läkemedelsbehandling är ofta bristfällig vilket många gånger leder till återinsjuknande och inläggningar inom slutenvården. Metod: Systematisk litteraturstudie med kvalitativ ansats. Studiens resultat baserades på tio kvalitativa artiklar. Dataanalys: Latent innehållsanalys. Resultat: Analysen resulterade i fyra kärnteman. Dessa var; personcentrerad vård, coping-strategier, terapeutisk allians och självinsikt. Slutsats: Problematik framträder när vårdtagaren inte är delaktig i sin vård och när samsyn brister eller saknas vilket leder till negativ inverkan på följsamhet. Nyckeln till god följsamhet bygger på en kombination av de fyra kärnteman och det är viktigt att sjuksköterskan inger hopp och stöttar patienten genom behandlingen för ett positivt vårdförlopp. / Aim: The aim of the study was to explore patients’ experiences of nursing care measures that facilitate their adherence during antipsychotic treatment. Background: On a yearly basis about 1500-2000 people develop psychosis in Sweden. This leads to great suffering for the affected individual, their relatives and is also causing high economic burden on the society. The adherence during antipsychotic treatment is often poor which frequently leads relapse and rehospitalization. Method: Qualitative literature review. Data analysis: Latent content. Result: The result was based on ten qualitative articles whereof four main themes were found. These were; person-centered care, coping strategies, therapeutic alliance and self awareness. Conclusion: Poor patient involvement and lack of consensus between care providers and patients leads to negative impact on the treatment adherence. The key for successful medication adherence is based on the understanding and implementation of the four themes. It is also important for the nurse to provide hope, trust and security during the treatment.

The term splitting is defined as a process of formation of mental aggregates linked incompatible experiences producing numerous divisions in mental apparatus. Current findings indicate that psychological splitting in schizophrenia is likely specifically presented on a neural level as disrupted organization in neural communication. This disrupted neural communication likely underlies deficits in mental processing described by various neuroscientific concepts such as theories of disturbed connectivity, corollary discharges and dynamic complexity. In this context, a purpose of the theoretical part of the dissertation is to describe basic neuroscience theories that complementarily reflect interrelated processes between mind and brain underlying disturbances of mental integration that likely present a neural representation of the splitting. A purpose of the first part of the empirical research was to examine relationships between psychological process of splitting and disturbed cognitive and affective functions in schizophrenia. A sample of patients with borderline personality disorder (BPD) was used as a control group in this study. Methods: In the clinical study, we have assessed 30 patients with schizophrenia and 35 patients with BPD. The symptoms of splitting were measured using self- reported...