Thesis (MA)--University of Stellenbosch, 2004. / ENGLISH ABSTRACT: Two recent local studies of relapse among individuals who had attended inpatient alcohol rehabilitation programmes in the Western Cape found relapse rates of up to 60%. A high incidence of comorbid anxiety, low self-efficacy and avoidant coping style were principal reasons cited for relapse. The following literary review was undertaken in an effort at better understanding current findings on the comorbid relationship between alcohol abuse/dependency and anxiety, and on dysfunctional coping styles and relapse. It also reviews current literature and theory concerning the treatment of alcoholics using the Relapse Prevention (RP) model of therapy. Based on these findings, recommendations are made for the application of RP to the clinical psychology groups run for alcohol abusing/dependent inpatients at Neuro Clinic D, Stikland Hospital, Western Cape. Relapse Prevention Therapy was selected because of its integrated approach to addressing both substance abuse and the inadequate coping styles that often render people vulnerable to anxiety, depression and relapse. It was also chosen because of the more constructive, less punitive approach it takes to substance dependence/abuse and the issue of lapses and relapse. The recommendations made in this review should not, in any way, be seen as criticism of the existing programme at Neuro Clinic D. They are, essentially, the individual reflections of the author based on the four months he spent conducting clinical psychology groups in the unit and the findings of two local studies that looked at some of the reasons for relapse following treatment in this and other local facilities. The specific focus on the groups run by clinical psychologists should also not be seen as ignoring the important and valuable work done by other professionals in the unit; notably those in psychiatry, nursing, social work, occupational therapy and pastoral care. On the contrary, information gathered by these professionals is vital to the team effort of rehabilitation, and the identification of psychosocial stressors and cognitive patterns that place people at risk of relapse. / AFRIKAANSE OPSOMMING: Twee onlangse plaaslike studies van terugvalonder pasiënte wat binnepasiëntalkoholrehabilitasieprogramme in die Weskaap bygewoon het, het terugvalkoerse van tot 60% gerapporteer. 'n Hoë voorkoms van komorbiede angs, lae sin van self-vermoë en 'n vermydende streshanteringstyl was die hoofredes aangevoer vir die terugval. Die volgende literatuur-oorsig is onderneem in 'n poging tot 'n beter begrip van huidige bevindinge oor die komorbiede verhouding tussen alkoholmisbruik/afhanklikheid en angs, en oor wanfunksionele streshanteringstyle en terugval. Die oorsig beskou ook huidige literatuur en teorie aangaande die behandeling van alkoholiste deur middel van die Relapse Prevention (RP) model (Terugvalvoorkomingsmodel) van terapie. Op grond van hierdie bevindinge word aanbevelings gemaak VIr die toepassing van RP op die kliniese-sielkundegroepe aangebied VIr alkoholmisbruikende/afhanklike binnepasiënte by Neurokliniek D, Stiklandhospitaal, Weskaap. RP is gekies op grond van sy geïntegreerde benadering tot beide substansmisbruik en die onvoldoende streshanteringstyle wat dikwels mense kwesbaar maak vir angs, depressie en terugval. Die model is ook gekies as gevolg van die meer konstruktiewe, minder strafgerigte benadering tot substansafhanklikheid/misbruik en tot val en terugval. Die aanbevelings in hierdie oorsig moet in geen opsig beskou word as kritiek op die bestaande programme in Neurokliniek D nie. Hulle is, in wese, die individuele gevolgtrekkings van die skrywer gebaseer op sy vier maande ondervinding met sielkundegroepe in die eenheid en op die bevindinge van twee plaaslike studies wat ondersoek ingestel het na sommige van die redes vir terugval na behandeling in hierdie en ander plaaslike fasiliteite. Die spesifieke fokus op die groepe wat deur kliniese sielkundiges bestuur word moet ook nie gesien word as 'n geringskatting van die belangrike werk van ander professionele mense in die eenheid nie, in die besonder dié in psigiatrie, verpleging, maatskaplike werk, arbeidsterapie and pastorale sorg. In teendeel, inligting ingesamel deur hierdie mense is lewensbelangrik vir die spanpoging van rehabilitasie, en vir die identifisering van psigo-sosiale stressors en kognitiewe patrone wat pasiënte vatbaar maak vir terugval.

This study investigated the association between the severity of Tourette Syndrome (TS) and comorbid tendencies (Attention Deficit Hyperactivity Disorder (ADHD), Obsessive-Compulsive Disorder (OCD), and rage), maternal differential treatment, fairness evaluation of maternal differential treatment, and communication with both sibling and family relationships. Fifty-five mothers and healthy siblings of individuals with Tourette Syndrome participated in the study. The parents provided information regarding family demographics and the severity of Tourette Syndrome and comorbid tendencies, and the healthy siblings completed the sibling and family relationship questionnaires. The questionnaires were posted on a secure website, where the parents and healthy siblings could complete the online measures via internet connections. <br /><br /> The study revealed several important findings. The results showed significant associations between the severity of Tourette Syndrome and comorbid OCD, ADHD and rage tendencies thus suggesting that studying Tourette Syndrome without considering comorbidity would be unrealistic. Additionally, communication regarding Tourette Syndrome between the healthy siblings and their parents played an important role with respect to sibling and family relationships. Communication between the healthy siblings and their parents predicted more warmth between the healthy siblings and their sibling with Tourette Syndrome as well as more family cohesion and adaptability as reported by the healthy siblings. Communication had a significant moderating effect on both severity of Tourette Syndrome and healthy siblings' fairness evaluation of maternal differential treatment in predicting family relationships. When the sibling had less severe Tourette Syndrome, the healthy siblings reported more family adaptability when they had more communication with their parents, and reported less family adaptability when they had less communication with their parents. The results also indicated that when healthy siblings perceived their maternal differential treatment to be unfair, they reported more family cohesion when they had more communication with their parents, and reported less family cohesion when they had less communication with their parents. The study did not support the negative impact of maternal differential treatment on sibling relationships; however, the results confirmed the previous findings regarding the moderating effect of fairness evaluation on maternal differential treatment in predicting sibling relationships. When the sibling with Tourette Syndrome was favored, the healthy siblings reported more sibling warmth when they perceived the favouritism (maternal differential treatment) to be fair. Furthermore, the results showed that healthy siblings' perceptions of maternal differential treatment could predict cohesion and adaptability in the family. The more the healthy siblings reported being treated differently by their mothers, the less cohesion and adaptability they reported in their families. <br /><br /> The present study supported previous studies in finding that sibling conflict decreased with age. The results also highlighted the role of age in moderating the effects of communication and maternal differential treatment in predicting sibling conflict. When healthy siblings had more communication with their parents they reported more conflict with their sibling with Tourette Syndrome when they were younger, and reported less sibling conflict with their sibling with Tourette Syndrome when they were older. Furthermore, when healthy siblings were favored by their mothers, they reported more conflict with their sibling with Tourette Syndrome when they were younger than when they were older, thereby emphasizing the importance of developmental differences in dynamics between the siblings. The significant contributions of the study include underlining the importance of communication, the relationship between Tourette Syndrome and comorbid conditions, and healthy siblings' perceptions of sibling and family relationships.

Bakgrund: Att leva som diagnostiserad med ett psykiatriskt tillstånd kan innebära flertalet utmaningar. Personer med psykiatriska tillstånd kan dagligen uppleva sig utsatta för fördomar, bevisligen inte enbart i sin vardag i samhället utan även inom vårdkontexten. Somatisk samsjuklighet är ett reellt problem som drabbar en stor del av de personer som diagnostiserats med psykiatriska tillstånd. Vårdpersonal beskrev upplevelser av rädsla och osäkerhet i möten med personer med psykiatriska tillstånd och de belyste bristande kunskaper kring hur de bör bemöta personer med psykiatriska tillstånd. Syfte: Syftet med studien var att belysa de erfarenheter personer med psykiatriska tillstånd beskrivit i kontakt med somatisk vård. Metod: Studien som utförts var en litteraturöversikt enligt Friberg. Genom sökningar med hjälp av databaser såsom Cinahl Complete och PubMed har författarna funnit studier som i litteraturöversikten analyserats och tematiserats. Resultat: Litteraturöversiktens resultat identifierade ett huvudtema: Psykiatriska patienters erfarenheter av somatisk vård och två underteman: Vårdpersonalens bemötande och Bemötandets betydelse för patienters upplevelser av delaktighet. Diskussion: Litteraturöversiktens resultat diskuterades i förhållande till utvalda budord från tidvattenmodellen. Resonemang fördes kring vikten av bemötande och delaktighet. / Background: Living with a psychiatric diagnosis may entail numerous challenges for the individual. People diagnosed with mental illness can daily experience a vulnerability to prejudice, not only in their everyday life in society but also within the healthcare context. Comorbidity is a substantial problem among a considerable part of the population with psychiatric diagnosis. Healthcare staff has described experiences of fear and uncertainty when dealing with people with psychiatric diagnosis, they enlightened a lack of knowledge when it comes to properly responding to the needs of people with a psychiatric diagnosis. Aim: The aim of this study was to investigate the experiences people with mental illness describe in contact with somatic healthcare. Method: The authors carried out a literature review. Through searches in databases such as Cinahl Complete and PubMed they have found articles that were analyzed and divided into themes. Result: The result of the literature review identified one main theme: Psychiatric patients’ experiences of somatic care and two subthemes: Healthcare staffs’ treatment and the treatments effect on patient participation. Discussion: The results found in the literature review were discussed in relation to chosen commitments from the tidal model. Reasoning arguments concerning treatment and ways to promote patient participation were held and discussed.

Major Depression (MD) and Generalized Anxiety Disorder (GAD) are psychiatric disorders that arise from dysfunction of the core human capacities for emotion. Sapience is inextricably bound up with the potential for feelings of regret, worry and concern. When these emotions lead to clinically significant impairment or distress, they may result in one or both of the disorders of MD and GAD. The occurrence of MD and GAD in the same person, known as comorbidity, is remarkably high; substantially higher than would be expected by chance. MD and GAD have been studied since the mid-20th century, resulting in a substantial body of literature. The personality trait of neuroticism is also known to correlate highly with these disorders. This project was designed to compare the etiological structure of MD and GAD using a range of psychosocial and genetic methods in three datasets, while also assessing the correlated trait of neuroticism. Results are used to inform theoretical formulation of an approximate model of comorbidity for the two disorders. Psychosocial findings suggest that MD and GAD have similar relationships with most risk factors, and that neuroticism displays results consistent with it composing a portion of the liability to MD and GAD. Efforts to detect specific genetic loci involved in the etiology of MD and GAD are modestly successful. Two genome-wide significant variants were found for MD (one already identified in the literature); two for GAD, and one for neuroticism. There were also a number of significant genomic regions for each outcome. The use of aggregate genetic methods to estimate heritability based on genotypes was less successful. Estimation was only successful in one sample of the three, and produced modest estimates of heritability (0.2-0.25) for MD and comorbid MD+GAD. Genetic correlation was estimated to be very high between neuroticism and MD. Models of comorbidity are evaluated in light of these results, and a model comprising multiple liability distributions, one shared entirely by MD and GAD, and two additional correlated ones for the two disorders, with reciprocal phenotypic causation, is deemed most consistent with observed evidence.

This article is about the application of the two coercive legislations, Care of Abusers (Special Provisions) Act (LVM) and  the Compulsory Psychiatric Care Act (LPT) when individuals suffer from comorbidity. The authority who files the application for coercive interventions differs between the legislations. In LVM the social welfare board files the application and in LPT the chief psychiatrist.  Earlier research has shown that the individuals of the comorbidity group do not get their needs met in either of the legislations. It has also occurred that concrete arguments which relate to statutory criteria are missing. Our aim was to gain knowledge about how the court argued for these criteria, especially in cases where comorbidity exist. Another aim was to see which legislation that gave legal impact. Finally, we wanted to examine the roles of the chief psychiatrist and the social welfare board in court negotiations. We decided to study twenty court cases from Administrative court, ten cases from LVM and ten from LPT where the same individual had been committed to coercive care according to both legislations, this to capture the comorbidity. We interpreted the documents using discourse analysis and selected two concepts, inspired by Foucault and Fairclough, that we thought could be fruitful for our analysis. The result shows that there is more often argumentation about if the legal criteria in LVM are fulfilled compared to LPT where the argumentation is less informative. This result may have been influenced by the secrecy of Law. We also found out that the legislation that was given legal impact depended on the authorities assess of which need that was most urgent. The last finding was that the chief psychiatrist`s opinion was never questioned by the court, but the statements made by the social welfare board was.

Bakgrund: Det finns många faktorer som påverkar egenvårdsprocessen och personer som lever med hjärtsvikt upplever hinder och svårigheter i att utföra egenvård. Egenvård består främst av medicinering och livsstilsförändringar och om god egenvård upprätthålls kan personer med hjärtsvikt leva ett bra liv trots sjukdom. Egenvårdsförmåga mäts med två mätinstrument, European Heart Failure Self-Care Behaviour Scale (EHFScBS) och Self-Care Heart Failure Index (SCHFI). Syfte: Att identifiera och beskriva faktorer samt deras effekt på egenvårdsförmågan hos personer med hjärtsvikt. Metod: Litteraturöversikten gjordes utifrån 15 kvantitativa studier. Artiklar söktes fram i databaserna CINAHL och Medline. I samtliga artiklar är egenvårdsförmågan mätt med olika versioner av EHFScBS och SCHFI. Artiklar analyserades med hjälp av Fribergs trestegsmodell. Resultat: 44 identifierade faktorer framkom varav 38 faktorer var signifikanta för egenvårdsförmåga. Mest förekommande signifikanta faktorer var ålder, multisjuklighet, sjukdomsduration, NYHA-klassificering, ejektionsfraktion, sjukhusinläggningar, vårdgivare, depressiva symtom och kön. Slutsats: Faktorer med betydelse för egenvård var kognition, multisjuklighet och socialt stöd. Dessa har en relation till varandra och visar på en komplex situation. Identifierade faktorer kan ge ökad förståelse för vad som påverkar egenvårdförmågan och på så sätt vara ett underlag för vårdpersonal så att omvårdnaden personcentreras. / Background: There are many factors affecting the self-care process and people living with heart failure experience obstacles and difficulties to perform self-care. Self-care mainly consists of medication and lifestyle changes and people who maintain good self-care can live a good life despite the disease. Self-care ability can be measured using two instruments, European Heart Failure Self-care Behavior Scale (EHFScBS) and Self-Care Heart Failure Index (SCHFI). Aim: To identify and describe factors and their effects on self-care ability in people with heart failure. Method: This literature review is based on quantitative studies. 15 articles were found in the databases CINAHL and Medline. In all articles self-care ability was measured with different versions of EHFScBS and SCHFI. Articles were analyzed using Fribergs three-step model. Results: 44 factors were identified and 38 factors were significant in self-care ability. Most common significant factors were age, comorbidity, disease duration, NYHA-classification, ejection fraction, hospitalization, caregiver, depressive symptoms and gender. Conclusion: Factors affecting self-care was cognition, comorbidity and social support. They have a relationship to each other that shows complexity. Identified factors may increase understanding of what affects self-care and can be used to support health professionals in person centered care.

No description available.

Denna tvärsnittsstudie syftade till att undersöka samförekomst av smärtrelaterad rädsla och social ångest i ett kliniskt sample med kronisk smärtproblematik. Syftet var också att beskriva och kontrastera samvariation av transdiagnostiska faktorer i eventuella subgrupper. Datan bestod av enkätsvar från 196 deltagare i Social ångest smärta-projektet som leds av Örebro universitet och Akademiska sjukhuset i Uppsala. En klusteranalys fick fram fyra subgrupper bland deltagarna. En subgrupp utmärkte sig för hög komorbiditet. Denna grupp visade höga nivåer av tänkbara transdiagnostiska faktorer som ångestkänslighet och negativ affekt, samt hög smärtkatastrofiering. Det diskuterades kring dessa faktorers roll som sårbarhets- och vidmakthållandeprocesser, utifrån aktuella teoretiska modeller. Studiens kliniska implikationer belyser behovet av hänsyn till dessa faktorers roll vid behandling och framtida forskning. / This cross-sectional study aimed to explore co-occurrence of pain-related fear and social anxiety in a clinical sample with chronic pain. The purpose was also to describe and contrast co-variation of transdiagnostic factors in potential subgroups. The data consisted of 196 answered questionnaires from the Social anxiety pain-project led by Örebro University and the Uppsala University Hospital. A cluster analysis produced four subgroups among the participants. One subgroup was salient for its high comorbidity. This group showed high levels of potential transdiagnostic factors such as anxiety sensitivity and negative affect, as well as high pain catastrophizing. These factors are discussed in terms of their role as vulnerability and maintaining factors, in the light of current theoretical models. The clinical implications of this study suggest taking the role of these factors into account in aspects of treatment and future research.

Background: Patients with mental illness is commonly present in physical healthcare for either mental illness or both mental illness and physical illness. Earlier research shows that patients feel aggrieved and discriminated against by healthcare professionals in physical healthcare due to mental illness. Patient experience that they do not receive good care, increasing the suffering. Aim: The aim was to describe nurses' experiences of caring for patients with mental illness in physical healthcare. Method: Systematic literature review with a descriptive synthesis according to Evans (2002), where 14 qualitative research articles where analyzed with an inductive approach. Result: The nurses experienced patients with mental illness as a danger and as not being their responsibility. They could not meet the patients' needs and experienced a lack of knowledge to care for them. They were sceptical about these patients and described negative attitudes and prejudices against them, and that the physical healthcare environment was not suitable for those patients. Conclusion: Nurses need skills in psychiatric nursing and a broader introduction into the basic psychiatric care. These skills are necessary to provide quality care that protects patients’ privacy and dignity and reduces the stigma of patients with mental illness.

La psychopathie est un désordre de la personnalité caractérisé par des traits de comportement, tels qu’un manque d’empathie, du narcissisme, une estime de soi élevée, etc. Souvent, ces traits sont considérés comme indésirables. Ces caractéristiques se manifestent chez l’homme et la femme, autant dans la population criminelle que non-criminelle. L’étude de la psychopathie et la relation entre celle-ci et d’autres désordres mentaux représente un domaine relativement novateur de la psychologie. Des études démontrent une forte corrélation négative entre la psychopathie et l'anxiété, et entre la psychopathie et la dépression. Au total, 92 étudiants actuels ou ayant récemment graduées, au niveau du baccalauréat, de la maîtrise, et du doctorat ont été recrutés pour participer à cette étude. Ces participants ont complété quatre questionnaires standardisées qui évaluent leur niveau de psychopathie, d’anxiété et de dépression. Les évaluations utilisées sont le « Levenson’s Self-Report Psychopathy scale », le « Childhood and Adolescent Taxon Self-Report », le « Beck Depression Inventory », et le « Beck Anxiety Inventory ». Les résultats suggèrent l'existence d'une forte corrélation positive entre la dépression et la psychopathie, entre l'anxiété et la psychopathie, et entre l'anxiété et la dépression. Des variables additionnelles, tels que le sexe et l’éducation antérieure, contribuent aussi de façon significatives à ce modèle. Les résultats sont analysés tout en considérant des études antérieures et l’importance de la comorbidité psychopathique dans la recherche à venir. / Psychopathy is a personality disorder characterized by behavioral traits that are often considered undesirable. These traits include callousness, lack of empathy, narcissism, and increased sense of self-worth. These characteristics of psychopathy manifest themselves in men and women alike, and within both criminal and noncriminal populations. The study of the relationship between psychopathy and other mental disorders is a relatively new area of research within the field of psychology. The present study attempted to expand this area of research, namely by examining the relationship between psychopathy, anxiety, and depression. Studies conducted on this relationship have thus far shown that both anxiety and depression disorder are significantly and negatively correlated with psychopathy. For the present study, a total of 92 currently enrolled or recently graduated undergraduate and graduate students were recruited for participation. The participants completed four standardized scales that assessed their level of psychopathy, anxiety, and depression disorder. Participants were assessed using the Levenson’s Self-Report Psychopathy scale, the Childhood and Adolescent Taxon Self-Report, the Beck Depression Inventory, and the Beck Anxiety Inventory. The results suggested that both anxiety and depression are positively and significantly correlated with psychopathy as well as with each other. Additional variables, such as gender and educational origins, were found to contribute significantly to the model. The discussion of the results of the present study includes the findings of previous, related research as well as the importance of psychopathic comorbidity analyses in future research.