While many studies of risk factors for psychosis focus on positive symptoms, such as subthreshold levels of hallucinations and delusions, fewer studies have examined negative symptoms in the early course of the schizophrenia or other psychotic disorders. This relative lack of focus on the role of negative symptoms is problematic, given findings that negative symptoms, such as a loss of motivation and pleasure (MAP), are associated with a more persistent and impairing course of psychosis, and tend to appear earlier in the development of psychotic symptoms. Psychotic disorders, which afflict approximately 3-5% of the population, tend to emerge in late adolescence/early adulthood and are among the most debilitating and costly of mental disorders. The current project explored three areas of negative symptoms in young adults who demonstrated a range of psychotic-like experiences (PLEs). First, a review of the literature pertaining to negative symptoms across the span of psychosis was conducted. Second, we tested whether experiential negative symptoms – specifically MAP deficits – were associated with increases in PLEs, including those that are experienced as distressing (PLEDs). Third, we examined the potential influence of episodic memory performance factors on the relationship between MAP symptoms and PLEs/PLEDs. Collectively, this project highlights the importance of including negative symptoms (i.e., MAP deficits) and/or cognitive performance (i.e., associative/relational learning/memory) outcomes when evaluating people with PLEs/PLEDs to identify those who may be at greater risk for developing a psychotic disorder. / Psychology

Borderline Personality Disorder (BPD) is an enduring personality disorder marked by severe self-damaging behaviors such as self-harm, substance use, and disordered eating behaviors. This study examined the emotional antecedents and consequences of self-damaging behavior (self-harm, binge drinking, substance use, and disordered eating behavior) among individualls who report features of BPD to assess the function of these behaviors. Additionally, this study examined whether self-reported difficulties in emotion regulation mediated the relationship between features of BPD and the presence of self-damaging behavior. Results from this study found support for the use of self-harm, drugs use, and disordered eating behavior to regulate emotional experiences and all forms of self-damaging behavior were found to significantly increase the presence of pleasant emotional experiences. The function of self-damaging behavior remains stable, regardless of whether the behavior occurs in isolation or co-occurs with other self-damaging behaviors. In addition, higher rates of polysubstance use were found for individuals with features of BPD compared to those without. Higher rates of difficulties in emotion regulation were found to be associated with features of BPD and the presence of self-damaging behavior was found to partially mediate the relationship between the two constructs. Findings from this study have substantial implications for the conceptualization and treatment of self-damaging behavior in individuals with BPD. / Psychology

Childhood trauma greatly impacts the lives of patients and their future health outcomes. Since the discovery of the utility of the Adverse Childhood Experiences (ACEs) screening tool in the 1990s, many providers have attempted to screen and intervene on these past experiences of trauma with mixed results. ACEs have an outsized impact on adult health. There is considerable literature documenting the changing state of screening for ACEs in adult populations, and the compelling rationales for doing so. There are also a number of interventions available currently, but providers face challenges to use them. Ethical considerations and issues with the current state of screening for ACEs exist, due to some of these challenges and differential availability of interventions between populations. Here, I use the principles of urban bioethics to explain the ethical obligation of screening for ACEs despite these challenges and to dispute previous discussions on this topic. This article will show that there are general strategies that providers can take to implement ACEs screening in an ethical manner and specifically discusses trauma-informed care’s utility to help achieve these strategies. Through this discussion, I hope to encourage providers to reconsider ACEs screening and give them strategies to do so. / Urban Bioethics

Maternal adverse childhood experiences (ACEs) are associated with difficulties in parent- child relationships, however, research to date has focused on cross-sectional associations. Parent and child behavior may be differently affected by ACEs as a child develops and caregiving demands change. Furthermore, poorer executive function (EF) is associated with both ACEs and problematic parenting processes, and may be one potential mechanism involved in the intergenerational transmission of ACEs. This study examined longitudinal associations between maternal ACEs, maternal EF, and patterns of change in maternal and child emotional availability (EA) using longitudinal multilevel modelling (MLM). Mother-child dyads (N = 114) were followed at five separate assessments over a 5-year period. Maternal ACEs were measured retrospectively at 3-months postpartum, maternal EF was assessed at 8-months, and mother-child interactions were videotaped at 18-, 36- and 60-months postpartum. Results revealed that maternal EA was stable, while child EA increased from 18- to 60-months postpartum. Maternal ACEs were negatively associated with maternal and child EA at 18-months postpartum and this effect decreased overtime. In contrast, there was a persistent, positive effect of maternal EF on EA trajectories. Maternal EF did not mediate the association between ACEs and EA. Findings also demonstrated significant within-dyad associations between maternal and child EA. These findings lead to a deeper understanding of the effects of maternal influences on parent-child relationships. We provide important evidence regarding the intergenerational transmission of ACEs, demonstrating that effects of maternal ACEs on parenting are not necessarily persistent. Findings also support sustained relations between maternal EF and maternal and child behavior across development, suggesting the utility of EF as an intervention target. / Thesis / Master of Science (MSc) / Adverse childhood experiences (ACEs), which are experiences of abuse, neglect, and household dysfunction, are risk factors for difficulties in parent-child relationships when individuals become parents themselves. In addition, ACEs are associated with deficits in higher-order cognitive abilities called executive functions (EF) in adulthood, which may also, in turn, compromise an individual’s ability to provide sensitive and nurturing care to their children. The following thesis explores the collective relationships between maternal ACEs, maternal EF, and emotional availability during parent-child interactions in a community sample of mothers and their children, followed from toddlerhood (18-months postpartum) to preschool (60-months postpartum). Findings from this study demonstrate unique trajectories of maternal and child emotional availability during this period in development. Higher maternal ACEs were associated with decreased emotional availability during parent-child interactions at 18-months postpartum and this effect decreased overtime. Mothers with higher EF, and their children, demonstrated increased emotional availability across development. Maternal ACEs was not associated with maternal EF. Findings are relevant in informing the development and adaptation of timely and preventative parenting interventions.

Background: Palliative care aims to improve the quality of life for patients with limited time remaining. In the transition to end-of-life care, the complete focus is on relieving symptoms and easing the patient's pain. It has emerged that patients experience inadequate communication from nurses during their hospital stay, while nurses perceive insufficient knowledge regarding conversations with relatives. Engaging with relatives' experiences at the end of life contributes to a greater understanding of their preferred approach. Aim: To create an overview of relatives' experiences in palliative care. Method: Involves a general literature review that included eight qualitative and four quantitative articles. Results: The articles results pointed to three main themes: the importance of communication for relatives, the impact of the care environment on their palliative care experience, and how the illness affected life outside of caregiving. Conclusion: Insufficient support and communication were crucial factors in relatives the end-of-life experiences. Positive health outcomes were observed in relatives receiving support, information, and discussions in the end-of-life stage. Relatives experienced that the attitude of nurses, influenced their well-being, leading to difficulties in balancing everyday life while maintaining strength in front of the patient.

Background: The emergency department is available all hours of the day for patients who have suffered an acute injury or illness. The nurses' experience work in the emergency department as hectic and stressful. Heavy workloads and overcrowding make the nurses feel anxious and frustrated that they cannot provide optimal care to the patients. According to chosen nursing scientific theory, care can be experienced as caring or uncaring. Laws and governing documents that the health and medical care must comply with and the nurses' area of responsibility appear. Aim: To describe patients’ experiences of care in the emergency department. Method: General literature review based on eleven articles with a qualitative approach and four articles with a quantitative approach. Results: Six categories were identified in the analysis; The importance of communication, The importance of information, The importance of the encounter, The importance of security, the importance of time spent waiting and the importance of surroundings. It emerged that the patients' experiences of being cared for in the emergency department varied. The patients experienced a lack of communication and information. The patients experienced different encounters, long waiting times and a hectic environment. These experiences resulted in anxiety and discomfort. When the nurses were well versed in their work, the patients felt more secure and trusted the nurses. Conclusion: Positive and negative experiences are identified by patients in the emergency department. The healthcare staff needs continuous training, improvement of the environment is required to improve the patients' experience of care.

Current political rhetoric and some media commentaries suggest there is a yawning gap of understanding between policymakers and the reality of families living in poverty in 21st century Britain. A key reason identified for the disconnect between policymakers and families is the absence of the voices of the families in public discourse. In this paper accounts of the lived experiences of parents in poverty are examined in four UK qualitative studies published in the period 1998-2016. Their accounts highlight how problems of disadvantage can be cumulative, compounding and enduring. The struggle to provide the basics of family life and the role of supportive communities and relationships are explored. The impact on parents of financial stress, the sense of shame and stigma often experienced and the consequences for their physical and mental health are highlighted. Under the government’s austerity policy, there is an increase in poverty even in working families, an increase in homelessness and considerable evidence emerging on the damaging consequences of food and fuel poverty on the health of children and parents. Listening to the lived realities of individual families provides a much greater understanding of family poverty and its causes and consequences, provides a corrective to the critical pejorative rhetoric and lays the foundation for the provision of appropriate government support.

Background: Depression is one of the most common illnesses in the world, which today affects 280 million people globally. Depression occurs at all ages and is the largest group of mental illnesses linked to suicide. Women and the elderly are the most prone to depression. Depression is considered a public disease and is a complex disease with many aspects that influence its course and onset. The research indicates that the care of depressive patients can be deficient and lead to patient suffering and mistrust of the healthcare system. Furthermore, previous research shows that there is a lack of patients' perceived experiences of depression. In order to improve patients' treatment results, it is important to gain more understanding of depressive patients by allowing their point of view to take a greater place. Aim: The aim was to describe adult patients' experiences of living with depression. Method: A structured literature study with a focus on qualitative research containing seventeen scientific articles that were analyzed thematically in accordance with Braun and Clarke's content analysis. Results: Two main themes and five subthemes were identified. The first main theme was Malaise with the subtheme Emotional experience and the subtheme Experiences of physical discomfort. The second main theme were Social aspects with the subtheme The social self-image, the subtheme Experiences of coping strategies and the subtheme Experiences of healthcare. Conclusion: Depression has a significant impact on the life of the sufferer. The disease entails a wide range of emotional and physical ailments that cause the depressive patient to feel unwell. The disease entails a changed self-image that causes suffering and affects social aspects in the patient's life. Coping strategies affect everyday life and have an effect on the patient in social contexts. Experiences with healthcare affected patients' depression. Specialist nurses have a central role in care and, with the help of nurturing communication, they can instill vitality and hope in the depressive patient. By gainingan increased understanding of the patient's malaise and social aspects surrounding the depressed patient, specialist nurses can identify symptoms of depression in good time and provide more empathetic care.

Background: In intensive care, mechanical ventilation is a common treatment for critically ill patients. Patients are often treated with both sedative and pain-relieving drugs, which together with invasive mechanical ventilation puts the patient in a particularly vulnerable situation as the ability to verbally communicate is limited. This makes it difficult for both the intensive care nurse and relatives to know what the patient remembers and how they have experienced their time with mechanical ventilation. Aim: To review and synthesize qualitative studies that have explored adult patients' memories of their time with invasive mechanical ventilation in an intensive care unit. Method: A structured literature review with qualitative design. Structured searches were conducted in the databases PubMed, CINAHL and Psychinfo, which resulted in 18 articles of qualitative design and mixed method and published between the years 2009-2024. Included articles are quality reviewed according to Caldwell's review template and the results of the articles are analyzed using an inductive thematic analysis. Results: The results present two main themes with associated subthemes. The main theme In the shadow of suffering had associated subthemes Pain and discomfort and An unreal existence. The main theme Abandoned in a strange environment had associated subthemes Voiceless in a world of sound and Seeing yourself fragile through the eyes of others. Conclusion: Patients' memories of the time in the intensive care unit with invasive mechanical ventilation vary, but overall the period is described as heavy and psychologically stressful. Communication and information from relatives and healthcare professionals is crucial for patients' well-being, and intensivecare nurses have an important role in supporting and including relatives in care. A professional approach to nursing care, regardless of whether the patient is sedated or awake, is essential for as pleasant an experience as possible.

Bakgrund: Hjärtsvikt är en sjukdom som påverkar cirka 64 miljoner människor i världen. Hjärtsvikt kan visa sig med eller utan symtom och är en stor anledning till inläggning på sjukhus. För att personer ska kunna leva med sin hjärtsvikt används både medicinsk och icke-medicinsk behandling, det vill säga egenvårdsåtgärder för symtomlindring. Syfte: att beskriva personers erfarenheter av egenvård vid hjärtsvikt. Metod: litteraturöversikt med kvalitativ metod med en induktiv ansats genomfördes baserad på tolv vetenskapliga artiklar tagna från CINAHL och Medline. Artiklarna analyserades med hjälp av Fribergs (2022) innehållsanalys. Resultat: Det framkom tre huvudteman med subteman. Behov av socialt stöd (stöd från vårdpersonal och stöd från relationer), fysiska svårigheter (att hantera det dagliga livet och den fysiska påverkan) och psykiska svårigheter (att vara självständighet och att lära känna sin sjukdom). Slutsats: Personernas erfarenheter skiljer sig gentemot varandra. Den gemensamma nämnaren är den sociala interaktionen, hur stödet av omgivningen påverkar personens motivation. Det är viktigt med den personcentrerade vården för att hjälpa personerna med hjärtsvikt med deras besvär och utmaningar i vardagen gällande egenvårdsåtgärder. / Background: Heart failure is a disease that affects approximately 64 million people worldwide. Heart failure can manifest with or without symptoms and is a major cause of hospital admissions. Both medical and non-medical treatments, such as self-care measures for symptom relief, are used to help individuals live with their heart failure. Purpose: To describe individuals' experiences of self-care in heart failure. Method: A literature review using a qualitative method with an inductive approach was conducted, based on twelve scholarly articles retrieved from CINAHL and Medline. The articles were analyzed using Friberg's (2022) content analysis. Results: Three main categories with subcategories emerged. These were the need for social support (support from healthcare professionals and support from relationships), physical difficulties (managing daily life and physical impact), and psychological difficulties (maintaining independence and understanding one's illness). Conclusion: Individuals' experiences vary, but a common theme is the importance of social interaction and how support from their environment influences their motivation. Person-centered care is crucial in assisting individuals with heart failure in managing their symptoms and daily challenges related to self-care measures.