Section A reviews the literature from two areas: it looks first at empirical studies exploring self-stigma in psychosis and secondly at psychological flexibility in psychosis. In doing so, the review aims to consider the question as to whether the psychological flexibility model, as presented by Acceptance and Commitment Therapy, can help us to understand how and why self-stigma can have a detrimental impact on some individuals experiencing symptoms of psychosis. Section B reports on a quantitative study of self-stigma, psychological flexibility, psychological well-being and quality of life in a First Episode Psychosis population. Research suggests that individuals experiencing psychosis may self-stigmatise, whereby negative beliefs and stereotypes about mental health difficulties are internalised. This in turn has been found to impact negatively on a number of areas. The psychological flexibility model presented by Acceptance and Commitment Therapy may help us to understand this. This study aimed to explore self-stigma using both an explicit and implicit measure of self-stigma to see how these were related to psychological flexibility, quality of life and well-being. Twenty-six participants experiencing first episode psychosis were recruited. They completed self-report questionnaires pertaining to quality of life, psychological well-being, psychological flexibility and explicit self-stigma. In addition, they completed a computer based reaction-time task designed to measure implicit self-stigma. Significant relationships were found between explicit self-stigma and well-being, and between psychological flexibility, explicit self-stigma, quality of life and well-being. Explicit self-stigma was found to statistically mediate the relationship between flexibility and well-being. Implicit self-stigma was not related to any investigated variable. The findings suggest psychological inflexibility may lead to greater self-stigma, which in turn decreases psychological well-being. This implied that interventions geared towards increasing flexibility may not only improve well-being, but may also help address issues of self-stigma.

There is limited research concerning the sharing of writing associated with times of personal difficulty. This study aimed to explore the experience and significance of this process with a focus on the interpersonal factors involved and how the potential benefits could be conceptualised. Eight participants were recruited through purposive sampling and interviewed regarding their experiences. Interpretative Phenomenological Analysis was used to analyse the transcripts. Four superordinate themes of ‘Putting the self into the world’; ‘Taking ownership of the process’; ‘Making connections with others’; and ‘Moving beyond surviving to thriving’ were interpreted from the data. Interpersonal factors were of great significance and were discussed in connection with a range of theorists including those from fields of psychoanalysis, phenomenology and humanism. The overall findings were conceptualised through identified links with Ryff’s (1989) multidimensional model of well-being. The findings suggest that the sharing of creative writing associated with times of personal difficulty may be a valuable activity in promoting well-being in both clinical and non-clinical populations. It may be particularly helpful for people who have experienced, or are at risk of social isolation given the experiences that first led the participants to creative writing, and the centrality of ‘connection within others’ within their accounts.

Bakgrund: Det är få verksamheter inom vården som har de rutiner och den kunskap som krävs för att bemöta barn till föräldrar med psykisk sjukdom. Sjuksköterskornas brist på kunskap och beredskap att stödja dessa barn leder till att barnen blir osynliga och inte får den information och det stöd som de behöver. Syfte: Att beskriva barns upplevelser av att leva med förälder med psykisk sjukdom. Metod: Litteraturstudie av tio vetenskapliga artiklar med kvalitativ ansats. Resultat: Resultatet presenteras utifrån fyra huvudkategorier. Stöd och information var en av de viktigaste beståndsdelarna som barnen uttryckte. Att leva med en förälder med psykisk sjukdom påverkar barnen, de lever i oförutsägbarhet, upplever oro, rädsla, skuld och ökat ansvar för föräldern. Brist på information om förälderns sjukdom till barnen samt stöd från vården ledde till att barnens situation försvårades. Samtliga barn uttryckte en önskan om stöd från vården. Slutsats: Denna studie har visat att stöd är viktigt för barn till psykiskt sjuka föräldrar. Sjuksköterskor behöver mer kunskap och beredskap för att kunna synliggöra dessa barn och hjälpa dem till lämpliga stödinsatser. Klinisk betydelse: Genom att belysa barns upplevelser kan stöd, beredskap och utbildning för vårdpersonal utvecklas så att dessa barn får det stöd de behöver. / Background: There are few health care establishments who have the routines and the knowledge required to respond to the children with parents with mental illness. Nurses lack of knowledge and equipment to support these children leads to children becoming invisible and do not receive the information and support they need. Aim: To describe the children's experiences of living with a parent with a mental illness. Method: Literature review of ten scientific articles with an qualitative approach. Results: The results presented from the four main categories. Support and information was one of the key elements that the children expressed. Living with a parent with mental illness affects children, they live in unpredictability, experience anxiety, fear, guilt and responsibility for the parent. Lack of information about the parent's illness to the children and the support of health care led to the children's situation was complicated. All children expressed a desire for support from healthcare. Conclusion: This study has shown that aid is important for children of mentally ill parents. Nurses need more knowledge and equipment to make these invisible children visible and help them to appropriate support. Clinical significance: By illuminate children's experiences can support, equipment and education developed for caregivers so that these children receive the support they need.

Studiens syfte var att undersöka hur ungdomar resonerar kring psykisk hälsa och ohälsa och hur de främjar sin psykiska hälsa. Deras svar analyserades utifrån ett könsteoretiskt perspektiv. Vår studie har genomförts med en kvalitativ ansats och data har samlats in med hjälp av fokusgruppsintervjuer. Bearbetningen av resultatet skedde genom en induktiv innehållsanalys med inspiration av hermeneutiken. Psykisk hälsa är något som ungdomarna beskriver att de gör, känner, främjar och väljer bort. Psykisk hälsa kan också ses som en avsaknad av psykisk ohälsa. Skolan ansågs vara en institution som påverkade deras hälsa i en stor omfattning. Psykisk ohälsa hos kvinnor fokuseras ofta i media och ungdomarnas sätt att resonera kring begreppet speglar detta. Tjejer ansågs av ungdomarna vara de som lider mest av samhällets stereotypa könsroller och skönhetsideal. Tjejers psykiska ohälsa ansågs av ungdomarna ha ett direkt samband med hur de hanterar skönhetsidealen i samhället. Ungdomarnas sätt att resonera speglar de tankar om jämställdhet som råder i samhället, det vill säga att tjejer och killar är relativt jämställda idag, och den komplexitet och de orättvisor som omger genusfrågan. / The purpose of the study was to examine how young adults reason about mental health and mental illness and what they do to promote their own mental health. Their answers were then analyzed from a gender theoretical perspective. The study has been accomplished through a qualitative research method in the form of focus group interviews with young adults. The analysis of the collected data was done through inductive approach with inspiration from the hermeneutic methodology. The young adults in the study thought of mental health as something a person can feel, do and promote, and something that doesn’t have to prioritized if they don’t want to. School as an institution was seen as one of the major things that influenced their mental health. Women’s mental health is often what is highlighted in the media and the young adults way of reasoning about mental health seemed to be influenced by this fact. The young adults thought that young women were the ones suffering the most from society’s stereotypical gender roles. The health of young women was thought of as having a direct connection to how they handled society’s beauty standards. The young adults’ way of reasoning reflected the ideas that exist in society today regarding gender equality in that men and women are relatively equal. The young adults also have knowledge about the complexity of problems that are associated with gender equality.

Psykisk ohälsa hos unga är ett problem som ökar i dagens samhälle. För att främja en bättre psykisk hälsa hos dessa finns kuratorer på skolor, ungdomsmottagningar samt barn- och ungdomspsykiatriska mottagningar. I denna studie har frågorna ställts om kuratorernas bilder gällande de vanligaste orsakerna till psykisk ohälsa hos unga, eventuella könsskillnader samt resurser för att ge stöd. Utifrån sex intervjuer som genomförts med kuratorer på ovan nämnda arbetsplatser visade resultatet att många unga idag lider av problem i hemmet eller skolan, höga krav, depression, ångest, ätstörningar, självskadebeteende, arbetslöshet samt hemmasittande. Av dessa visade sig ätstörningar och självskadebeteende vara vanligast hos flickorna, medan istället hemmasittande och skoltrötthet dominerade hos pojkarna. Övriga orsaker var relativt jämnt fördelade mellan könen. Viktigt är dock att ta hänsyn till mörkertalet av dem som inte söker hjälp. I många avseenden behövde resurserna förbättras, framför allt i form av tid för ungdomarna samt för kompetensutveckling och handledning. / Mental illness among adolescents is a problem which increases in our society. By promoting a better mental health among these, there are social workers working at schools, Youth Clinics and psychiatry receptions for children and adolescents. This study asked the questions about which versions the social workers had about the most usual reasons for mental illness amongst adolescents, if the social workers had noticed any differences of the mental illness between young boys and girls and if the social workers thought that they had sufficient resources to offer the adolescents good help. By six interviews done with social workers on the workplaces above, the results showed that many adolescents today have problems at home or in school, problems with high claims on themselves, depression, anxiety, eating disorders, self-harm, unemployment and sitting at home. Of these reasons for mental illness, eating disorders and self-harm had been found to be most usual amongst the young girls, and sitting at home and school fatigue amongst the young boys. The other reasons for mental illness were pretty much the same amongst boys and girls. Still, it is important to take into account that there are hidden statistics of the young people who do not search for help against their mental illness. The resources needed to be improved in many aspects, mostly by more time by the social workers to help the adolescents and more skills development and tutoring for the social workers.

The overall aim with this thesis is to describe and analyze women’s and men’s recovery processes. More specifically, the aim is to determine what women and men with experience of mental illness describe as contributing to the personal recovery process. The point of departure for the studies was 30 in-depth interviews conducted with 15 men and 15 women. The selection of interview subjects was limited to individuals who had been treated in 24-hour psychiatric care and diagnosed as having schizophrenia, psychosis, a personality disorder, or a bipolar disorder.   Four studies have been carried.  Study 1 was a baseline article that examined what people in recovery from mental illness outline as facilitating factors to their recovery. The results that emerged from that study indicated areas for further analysis to condense the understanding of the recovery process. In study 2 the similarities and the differences in recovery described by women and men were examined. In Study 3 women’s and men’s meaning-making with reference to severe mental illness facilitate the recovery process were studied. The forth study explored how peer-support contribute to women’s and men’s recovery from mental illness.   The results emphasize recovery from mental illness as a social process in which relationships play a key role in creating new identities beside the mental illness. For a majority of the participants meeting peers facilitated the recovery process. The participants described how peer support meant an end to isolation and became an arena for identification, connection, and being important to others. Throughout these recovery processes the impact of gender has been emphasized. The results from this thesis provide new insight into gender as an important factor in understanding the recovery processes. The results from the four studies emphasize the mental patient, the psychiatric interventions and the individual recovery strategies as being influenced by gender constructions.

Bakgrund:I sjuksköterskeutbildningen betonas betydelsen av samarbete med patienters anhöriga. I takt med att synen på psykisk ohälsa förändrades avvecklades den institutionsbaserade vårdformen. 1995 års psykiatrireform syftade till att stärka dessa patienters rättigheter och ställning i samhället Syfte:Beskriva anhörigas upplevelser av att ha en närstående med psykisk ohälsa. Metod:En litteraturöversikt gjord enligt Fribergs (2010) metod för litteraturöversikter. Efter sökningar i databaserna Academic search premiere, Cinahl Plus with Full Text, Medline och PsychInfo valdes tolv kvalitativa artiklar för att analyseras. Den teoretiska referensramen för arbetet är Katie Erikssons lidandebegrepp. Utifrån det har författarna svarat på två frågeställningar: 1)På vilket sätt påverkas anhörigas livvsituation och vad får det för konsekvenser? 2)Vad kan sjuksköterskan göra för att lindra anhörigas lidande? Resultat:Anhöriga bär i det tysta ett tungt ansvar i vården av sina närstående. Ansvaret genererar känslor av förlust, sorg, ensamhet, oro, frustration, skuld och självuppoffring. Många upplever att samarbetet med vården inte fungerar. Information, möjlighet till involvering, samt god vårdtillgänglighet efterfrågas. Anhöriga söker sig bortom vården för att hitta sätt att hantera situationen. Diskussion:Trots att vården skall arbeta för att inkludera anhöriga i vården av sina närstående upplever anhöriga dåligt bemötande. Brister i information, tillänglighet och involvering leder hos de anhöriga till ökat lidande. Orsak till denna upplevda ovilja till samarbete skulle kunna vara att det psykodynamiska synsättet med familjen som sjukdomsorsak lever kvar. / Background:In the nursing education the importance of cooperation with the patients nextof kin is emphasized. Following the changed view on mental illness the institutionalized mental care was phased out. The psychiatric reform of 1995 aimed to reinforce the psychiatric patients rights and positions in the society. Aim:To describe the experiences of the next of kin of mentally ill persons. Method:A literature review was performed according to Fribergs (2010) method for literature review. After searches performed in the databases Cinahl Plus withFull Text, Academic search premiere, Medline and PsychInfo twelvequalitative articles were choosed for analyzis. The theoretical framework of the review is Katie Eriksson’s concept of suffering.Based on her theory the authors have answered following questions: 1) In what way is the next of kins life and situation affected and what are the consequences? 2) How can a nurse ease the suffering of the next of kin? Results:The next of kin carry a big responsibility in the care. The responsibility creates feelings of loss, sorrow, loneliness, worry, frustration, guilt and self affacement. The next of kin experience the cooperation with health care malfunctioning. Information, involvement and availability are desirable features of the health care. The next of kin tend to look beyond the health care to find support. Discussion:Despite guidelines for involving the next of kin in care, they experience bad encounter in contact with formal care. Lack of information, availability and involvement leads to increased suffering for the next of kin. A possible reasonfor the experienced unwillingness of cooperation could be that thepsychodynamic point of view regarding the family as a cause of disease is maintained in the psychiatric care.

This dissertation deals with people with mental illness that currently live in their own accommodation in the community. Common to all mentally ill people is their serious difficulties in carrying out activities and meeting needs in important areas of life. Terms such as "normalisation" and "integration" into the community of this group were important words full of promise at the time the psychiatric reform was carried out. However, there is some strong evidence that the psychiatric reform has not been completely successful. Despite the knowledge that loneliness and social isolation commonly occur among people with mental illness, there is little research that describes how mentally ill people themselves experience their life situation. The overall aim of the dissertation was to gain deeper understanding of the life situation of peop with mental illness via their own narratives on how their day-to-day life appears to them, ar through this gain knowledge of the type of support needed for them to live a satisfactory life. Various data acquisition methods were applied. Study I involved in-depth interview of two men and two women on their daily life. Data acquisition in Study II was via participant observations, an activity unit for people with mental illness. Photographs were used for Studies III and IV Eight informants were issued with disposable cameras and asked to take approximately 10 pictures of objects, situations and/or individuals. These photographs were then used as a basis for follow-up interviews. Results from Study I showed that informants were aware both of their illness and their psychosocial disadvantages, and that they had insight into what was required of them to influence their situation, while simultaneously having insight into their poor ability to tak initiatives. Informants in Study II experienced themselves as unwelcome, vulnerable and marginalised individuals with little hope of a change in existence, resulting in anxiety over the future. They felt trust was lacking in relation to other people and experienced themselves as not accepted in the company of others or by society. Study III provided description of informants occupied with themselves and their existence. The informants tell of a form of spirituality giving them a sense of peace and tranquillity, but which only exists for them at the beginning and end ol life.  Animals are more loyal than people and make no demands, but are however, according to the informants, in a position of dependence on humans. Possessions are of significance to the informants, meaning they see their possessions as part of themselves. In Study IV informants related how they would like their future to appear. They also told what having an identity meant to them, how identity is formed in individuals, what having a mental illness and feeling good means. The informants showed a longing to be seen, but at the same time not wanting to be seen. Finding a meaning with life was important since it could end at any moment. In summary, the findings point to an existential loneliness that consists of a life pattern consisting of an interaction between the impact of the mental illness and the identity as a mentally ill person feelings of marginalisation and abandonment. Experiencing that life has a meaning, possibility o social exchange and a sense of control seem to be important for the persons with mental illness in this study. Consequently, it can be inferred that if the care of people with mental illness pays attention to the dimensions of existential loneliness persons with mental illness may be helped to experience that life has a meaning despite their disability.

Background Patients infected with the human immunodeficiency virus (HIV), the causative agent of the acquired immunodeficiency syndrome (AIDS), have high rates of psychiatric morbidity. The effects of HIV on the Central Nervous System may lead to psychiatric morbidity even before the appearance of the full-blown AIDS syndrome. Sero-prevalence studies of patients with psychoses have found an estimated 5-20% to be HIV positive. However, sero-prevalence estimates vary from study to study due to the differences in sampling by geographic location, socio-economic class, race and ethnicity, and psychiatric-diagnostic composition. The Republic of South Africa has some of the highest prevalence rates in the world and research in this field is escalating rapidly. However research on HIV in patients with mental illness, particularly psychosis is very sparse. Aim of the study To determine the prevalence of HIV sero-positivity amongst patients admitted to Town Hill hospital presenting with first episode psychosis. Method All patients presenting to Town Hill hospital with first episode of psychotic symptoms were recruited to participate in the study. The treating doctor in collaboration with the multi-disciplinary team made the diagnosis of Psychosis. A total number of 63 patients participated in the study. Results. 23.8% of the patients tested positive for the human immunodeficiency virus. Conclusions. The prevalence of HIV sero-positivity is high amongst patients presenting with first episode psychosis. The HIV epidemic could have an important effect on the aetiology and clinical presentation of psychosis. Recommendations State mental health authorities should pursue the promotion of voluntary HIV testing programs, in patients presenting with first episode psychosis as soon as they are capable of giving informed consent. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2007.

<p>Extensive evidence demonstrates how mental illness symptomatology can inhibit perceptions of and actual performance on important tasks. However, receiving treatment from the medical establishment for such symptomatology requires diagnosis, whereby the patient becomes labeled and subject to the stereotypes connected to that label. Mental illness labeling is associated with a variety of negative outcomes including inhibited access to unemployment, housing, health insurance, and marriage and parenthood opportunities and can disrupt interpersonal relationships. However, the repercussions of mental illness labeling for one area of life have remained largely overlooked; that area is task performance. Adults spend a substantial portion of their lives at work engaged in group-based or individual level tasks. This dissertation explores external perceptions of mental illness in task groups and the role of self-internalization of stereotypes about mental illness in individual task performance through two experimental studies. </p><p> Previous research has revealed that, on average, task partners with a mental illness are stigmatized and subject to diminished status when they are identified to participants as having been hospitalized for general psychological problems for an extended period of time. Study 1 of this dissertation explores the stigma- and status-based attributions triggered by engaging with a partner in a mutual task who is identified as having a specific mental illness label: none, Generalized Anxiety Disorder (GAD), Major Depressive Disorder (MDD), Attention-Deficit/Hyperactivity Disorder (ADHD), or schizophrenia. </p><p> Additionally, research has revealed that members of a group about which negative stereotypes exist may face a situational threat in a domain relevant task--stereotype threat. Race, gender, social class, age, and a variety of other sociodemographic attributes can trigger stereotype threat. However, little research has considered the potential for stereotype threat to emerge on the basis of mental illness labeling. Study 2 of this dissertation focusing on individual-level performance, exploring the potential for ADHD to trigger stereotype threat in test-taking situations.</p><p> Results from Study 1 suggest that the specific mental illness labels studied, presented devoid of symptomatology severity, do not trigger stigmatized attributions but may trigger some negative status attributions in the case of a task relevant diagnosis. (ADHD). Study 2 suggests that a task relevant diagnosis may also trigger stereotype threat in a test-taking situation, negatively impacting performance. Taken together, the results indicate that task relevance of one's mental illness label may be a driving factor in negative external and internal perceptions of mental illness.</p> / Dissertation