Individer med ett psykiskt funktionshinder har varit en del av en het debatt som pågått i Sverige en längre tid. Att ha både ett psykiskt funktionshinder och ett missbruk kallas för att ha en Dubbeldiagnos, (DD). Denna studie vill undersöka hur vårdpersonal upplever sitt arbete med att motivera brukare med DD till att förändra sin dagliga livsföring. Studien baseras på kvalitativa intervjuer med vårdpersonal, sammanlagt 12 intervjuer. Vårdpersonalen upplever sitt arbete som mycket positivt men att en känsla av frustration uppkommer då framsteg sker i en mycket långsam process. Detta upplever personalen beror på att missbruk tillåts på boendet. Inre och yttre motivation i samspel ansågs påverka en brukare med betoning på den inre.

<b>Background:</b> Individuals with intellectual disabilities (ID) have a higher prevalence of comorbid psychiatric disorders and challenging behaviours compared to the general population. Though less common, one area of concern among those with ID is pica (the ingestion of inedible substances). To date, there is little knowledge of pica, particularly with respect to its risk factors and social consequences. The closure of Ontario's three remaining facilities by 2009 underscores the importance of having knowledge of complex behaviours such as pica for improving supports and services in the community for these individuals. The aim of this study is to better understand the characteristics and support needs of adults with ID and pica. This study is comprised of a quantitative and qualitative component. <b>QUANTITATIVE STUDY</b> <b>Objectives:</b> To investigate the prevalence, risk factors, social and medical characteristics of pica. To determine how pica is managed in terms of hours of supervision, receipt of interventions, and psychotropic medication. <b>Methods:</b> Secondary data analysis was performed on two samples as part of cross-sectional study: 1008 persons with ID from Ontario's facilities and 420 community-dwelling adults with ID from southwestern Ontario. All persons had been assessed using the interRAI Intellectual Disability (interRAI ID)?a comprehensive and standardized instrument that measures a variety of domains for support planning. Bivariate and multivariate analyses were restricted to the facility sample due to the small size of persons with pica in the community. <b>Results:</b>The overall prevalence of pica was 22. 0% and 3. 3% in the facilities and the community, respectively. Logistic regression analysis showed that being male, cognitive functioning, autism, and being non-verbal were associated with a higher odds of having pica, whereas activities of daily living (ADL) was a protective factor. A quadratic relationship was observed between cognitive function and pica: the risk of pica increased with severity of cognitive impairment up to moderate to severe levels of impairment and then diminished among those with very severe cognitive impairment. Behaviour management, self-care skills, and 8 hours or more of one-to-one supervision were more likely to be provided to persons with pica. Compared to persons without pica, persons with pica had higher rates of being prescribed antipsychotic medication. Surprisingly, pica was not associated with higher rates of gastrointestinal health problems, with the exception of acid reflux. The negative social outcomes of pica, however, were many: pica was associated with higher odds of not having a strong and supportive relationship with family, lack of contact with family or other close relations, and absence of participation in social and recreational activities. <b>QUALITATIVE STUDY</b> <b>Objective:</b> To determine the support needs of adults with ID and pica from the perspective of direct-care staff of facility and community settings. <b>Methods</b>: Through two focus groups, the perspectives of four staff from Huronia Regional Centre (HRC), and six staff from community agencies from southwestern Ontario were examined. Transcripts were analyzed thematically for factors that facilitated or hindered the management of pica. <b>Results:</b> Qualitative data revealed three categories that underpinned reduction in pica: preventative measures (environmental controls, close supervision, and the provision of alternative activities), formal supports, and familiarity with the individual. On the other hand, inadequate staff support, lower functioning level of the individual, and lack of knowledge acted as barriers to managing and reducing pica. These barriers were associated with persons participating in fewer recreational activities and community outings, and in some cases the use of mechanical restraints. Barriers specific to each setting in the management of pica were also illuminated. Staff in both settings tended to be self-sufficient and isolated in managing this complex behaviour. <b>Conclusions:</b> Results suggest that attention should be equally paid to the potential social consequences of pica rather than solely to its health risks. Higher staff to client ratios, and training and education for staff to provide more active support to promote individuals' engagement in recreational activity and community integration is needed. Key recommendations also focus on educating and training staff on the risk factors and appropriate management of pica. Improving the collaboration and knowledge exchange among developmental service agencies is also recommended to enhance the management of pica among caregivers. Lastly, the community at large needs education on pica to foster more inclusive community living for those with ID.

No description available.

Thesis (Ph. D.)--University of Washington, 2001. / Vita. Includes bibliographical references (leaves 53-64).

Title from title page of PDF (University of Missouri--St. Louis, viewed March 2, 2010). Includes bibliographical references (p. 42-53).

Legislative changes in line with changing societal perspectives have resulted in increased service pressure on primary health practitioners to take further responsibility for the assessment and treatment of co-morbid psychiatric disorders in individuals with intellectual disability (ID) and for secondary and tertiary level services to reduce waitlists. The unique attributes of the ID population and a core lack of training for health professionals in the ID field has resulted in a large number of practitioners feeling under-trained and under-resourced to carry out this role effectively, to the potential detriment of the ID population. The challenges health practitioners experience when diagnosing co-morbid mental health disorders in individuals with ID and how they overcome these challenges was explored in this study. Participants were health practitioners of varying professions, including Psychiatrists, Clinical Psychologists and General Practitioners. Health practitioners completed an online survey and/or partook in a focus group or individual interview. The method used in this research was thematic analysis. The study found that health practitioners use holistic and contextual approaches to carry out assessments of individuals with ID, utilise ID specific tools, and liaise with experienced, specialised health practitioners as ways of dealing with the complexity of diagnosing co-morbid mental health difficulties in individuals with ID. In addition, it is recommended that more training in the ID area is provided for health practitioners, particularly for GPs in light of recent policy changes with emphasis of assessment and treatment occurring at the primary health level and for best practice guidelines to be developed. A further research project is suggested, exploring specific challenges facing GPs in this area of practice.

Thesis (M.A.)--University of Hawaii at Manoa, 2005. / Includes bibliographical references (leaves 69-78). / viii, 78 leaves, bound 29 cm

Thesis (Ph.D.)--Kent State University, 2008. / Title from PDF t.p. (viewed May 21, 2009). Advisor: Jason McGlothlin. Keywords: integrated dual disorder treatment, co-occurring disorders. Includes bibliographical references (p. 255-280).

Previous research has demonstrated that individuals with a dual diagnosis often engage in challenging behavior as a means to fulfil their needs and wants. Functional behavioral assessments (FBA) are a way of evaluating these behaviors and creating effective interventions to reduce them and increase socially appropriate alternative behaviors. The present study assessed the convergent validity for three types of FBAs, including the Questions About Behavioral Function (QABF) questionnaire, trial-based functional analysis, and traditional functional analysis, for three adults with a dual diagnosis within a day program setting. Results found correspondence between two forms of assessments, the trial-based functional analysis and traditional functional analysis, for one out of the three subjects. Due to a lack of engagement in the targeted behavior for the other two subjects, results were inconclusive. Results of the QABF did not match those of the functional analyses for any of the subjects, suggesting that the assessment should be used with caution. The trial-based functional analysis may be a viable tool for assessing function for the challenging behavior of adults with a dual diagnosis, although it should not be used as a replacement for the traditional functional analysis.

Este estudo teve como objetivo avaliar a associação entre dependência de maconha, transtornos psiquiátricos comórbidos e estágios de mudança em uma amostra de usuários de maconha que procuraram por tratamento. Um total de oitenta pacientes que procuraram por tratamento para dependência de maconha em um ambulatório especializado foram avaliados. Os dados em relação a dependência de maconha e transtornos psiquiátricos comórbidos foram obtidos através de um questionário sociodemográfico e o SCAN (Schedules for Assessment in Neuropsychiatry). A motivação dos pacientes para o tratamento foi avaliada através da URICA (University of Rhode Island Change Assessment). A gravidade da dependência da maconha foi avaliada através da ASI (Addiction Severity Index). Houve alta proporção de comorbidades psiquiátricas na amostra de participantes. O diagnóstico de esquizofrenia foi associado à predominância do estágio de mudança de precontemplação e os diagnósticos de transtornos do humor e ansiedade foram associados aos estágios de contemplação e ação. Conclui-se que pacientes dependentes da maconha que procuram por tratamento têm alta prevalência de transtornos psiquiátricos associados e que este fator pode influenciar a motivação para o tratamento. / This study aimed to explore the association among cannabis dependence, concurrent psychiatric disorders, and stages of change in a sample of treatment-seeking patients. A total of eighty patients who sought treatment for cannabis dependence at a specialized outpatient clinic were assessed. Data on cannabis dependence and concurrent disorders were obtained by means of the Schedules for Assessment in Neuropsychiatry (SCAN). Motivation was assessed through the University of Rhode Island Change Assessment (URICA). Cannabis dependence severity was assessed through ASI (Addiction Severity Index). There was a high prevalence of concurrent psychiatric disorders in this sample. Diagnosis of schizophrenia was associated with lower motivation scores and the precontemplation stage of change. Diagnoses of mood and anxiety disorders were associated with higher motivation scores and contemplation and action stages of change. We concluded that cannabis dependent patients who seek treatment have a high prevalence of concurrent disorders and the diagnosis of a concurrent disorder may influence motivation for treatment.