Background Perinatal markers of prenatal development are associated with offspring psychiatric symptoms. However, there is little research investigating the specificity of perinatal markers for the development of specific disorders. This study aimed to explore if perinatal markers are specifically associated with adolescent substance use disorder (SUDs). Methods Adolescent participants from two study centers, one for SUD patients (n = 196) and one for general psychopathology (n = 307), were recruited for participation. Since the SUD participants presented with a number of comorbid disorders, we performed a 1-on-1 matching procedure, based on age, gender, and specific pattern of comorbid disorders. This procedure resulted in n = 51 participants from each group. From all participants and their mothers we recorded perinatal markers (mode of birth, weeks of completed pregnancy, birth weight, Apgar score after 5 min) as well as intelligence quotient (IQ). The SUD sample additionally filled out the Youth Safe Report (YSR) as well as the PQ-16 and the DUDIT. We aimed to distinguish the two groups (SUD sample vs. general psychiatric sample) based on the perinatal variables via a logistic regression analysis. Additionally, linear regressions were performed for the total group and the subgroups to assess the relationship between perinatal variables and IQ, YSR, DUDIT and PQ-16. Results The perinatal variables were not able to predict group membership (X2 [4] = 4.77, p = .312, Cox & Snell R² = 0.053). Odds ratios indicated a small increase in probability to belonging to the general psychiatric sample instead of the SUD sample if birth was completed via C-section. After Bonferroni-correction, the linear regression models showed no relation between perinatal markers and IQ (p = .60, R² = 0.068), YSR (p = .09, R² = 0.121), DUDIT (p = .65, R² = 0.020), and PQ-16 (p = .73, R² =0.021).

Schizophrenia is a severe neuropsychiatric disorder of largely unknown etiology that is often accompanied by high rates of cigarette smoking, reduced quit success, and high relapse rates. Dysregulated dopamine signaling and aberrant synaptic plasticity in the mesocorticolimbic pathway are implicated in the pathophysiology of schizophrenia and conferred substance abuse disorder and relapse vulnerability. Genetic factors are presumed to play a significant role in the development of schizophrenia, with a 40-50% concordance rate for monozygotic twins, although genetic markers are inconsistent. As such, epigenetic factors have instead been implicated. Specifically, there is strong evidence to suggest DNA methylation at several candidate genes contributes significantly to the pathophysiology of schizophrenia. To investigate this heritable component, our laboratory has developed a novel heritable model of drug abuse vulnerability in psychosis. This model is the first to show heritable increases in dopamine D2 receptor sensitivity via several behavioral and neurobiological markers, including enhanced behavioral responding to nicotine and changes in D2 signaling cascades in brain regions associated with psychosis and comorbid drug abuse. Increased D2 receptor sensitivity is the most consistent biomarker of psychosis found in preclinical animal models and postmortem brain tissue of individuals diagnosed with schizophrenia, lending considerable strength to the validity of the model. This study aimed to further validate the model as a useful and valuable tool for better understanding the pathophysiology of comorbid nicotine use and relapse in psychosis, and to explore more effective therapeutic targets than current antipsychotic medications. Results reveal DNA methylation as an epigenetic mechanism conferring heritability of the psychosis-like phenotype in the model. We additionally demonstrate altered relapse-like behavior, clinically consistent with reduced quit success and elevated relapse vulnerability. Interestingly, changes in relapse-like behavior were correlated to elevated protein levels of brain derived neurotrophic factor (BDNF), a marker of activity-dependent plasticity, in brain areas associated with drug reward. Further, modulation of the metabotropic glutamate type 5 (mGlu5) receptor alleviates the enhanced nicotine conditioned place preference observed in the model. Mechanistically, mGlu5 modulation restores normal dopamine D2 signaling and mitigates aberrant plasticity responses that are thought to drive the behavior in a region-specific manner.

Over the past 150 years of neuroscientific research, the field has undergone a tremendous evolution. Starting out with lesion-based inference of brain function, functional neuroimaging, introduced in the late 1980s, and increasingly fine-grained and sophisticated methods and analyses now allow us to study the live neural correlates of complex behaviors in individuals and multiple agents simultaneously. Classically, brain-behavior coupling has been studied as an association of a specific area in the brain and a certain behavioral outcome. This has been a crucial first step in understanding brain organization. Social cognitive processes, as well as their neural correlates, have typically been regarded and studied as isolated functions and blobs of neural activation. However, as our understanding of the social brain as an inherently dynamic organ grows, research in the field of social neuroscience is slowly undergoing the necessary evolution from studying individual elements to how these elements interact and their embedding within the overall brain architecture. In this article, we review recent studies that investigate the neural representation of social cognition as interacting, complex, and flexible networks. We discuss studies that identify individual brain networks associated with social affect and cognition, interaction of these networks, and their relevance for disorders of social affect and cognition. This perspective on social cognitive neuroscience can highlight how a more fine-grained understanding of complex network (re-)configurations could improve our understanding of social cognitive deficits in mental disorders such as autism spectrum disorder and schizophrenia, thereby providing new impulses for methods of interventions.

Introdução: Os transtornos mentais que ocorrem na comunidade e em culturas diversas são temas de grande interesse frente às constantes transformações sociais no mundo. A mudança do foco de pesquisa para os transtornos freqüentes na comunidade possibilitou aperfeiçoamentos metodológicos e desenvolvimento de instrumentos sensíveis para a sua detecção. A inclusão da variável cultural no estudo da psiquiatria, por sua vez, questiona o universalismo psicopatológico, a taxonomia ocidental e o diagnóstico de síndromes culturalmente específicas. Uma amostra desta visão psiquiátrica, ancorada na questão cultural e de transtornos da comunidade, são as pesquisas envolvendo neurastenia, um transtorno neurótico comum entre os chineses. O presente trabalho é um estudo observacional e transversal dos transtornos mentais comuns entre os indivíduos chineses da comunidade. Objetivo: Avaliar a psicopatologia não-psicótica dos chineses residentes na cidade de São Paulo, através de instrumentos padronizados. Material e Método: Os sujeitos da comunidade (n = 211), chineses e seus descendentes, preencheram um questionário de auto-avaliação e foram entrevistados por pesquisadores treinados. Os instrumentos utilizados foram: Chinese Health Questionnaire (CHQ-12), Escala de Sintomas Físicos, Escala de Eventos Vitais, Inventário de Depressão de Beck (BDI), Inventário de Ansiedade Traço-Estado (IDATE) e Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Os dados foram analisados através de estatística descritiva, análise univariada (testes de qui-quadrado, Fisher e t de Student), análise multivariada (regressão logística), análise da curva ROC, análise fatorial exploratória (CHQ-12) e análise de correlação. Resultados: A probabilidade dos indivíduos pontuar alto no CHQ-12 ou ser casos prováveis de transtornos mentais comuns associou ao fato de ser do sexo feminino (OR = 2,31; IC95%: 1,12–4,75) e fluentes em chinês mandarim (OR = 3,37; IC95%: 1,68–6,78). Além disso, aqueles sujeitos com queixas físicas (OR = 4,20; IC95%: 1,70–10,40), relato de eventos-vitais no último ano (OR = 4,91; IC95%: 1,51–16,00) e pontuação alta no BDI (OR = 1,29; IC95%: 1,20–1,41) também tiveram maior chance de apresentar transtornos. O coeficiente de consistência interna &#61537; de Cronbach do CHQ-12 foi de 0,71 e a correlação item-total variou de 0,25 a 0,55, mostrando boa fidedignidade e homogeneidade deste instrumento. Adotando SCAN como critério-padrão, o melhor ponto de corte de CHQ-12 foi 2/3. Os seguintes indicadores de validade foram calculados a partir deste critério: sensibilidade 75%, especificidade 71%, valor preditivo positivo 55%, valor preditivo negativo 86% e taxa de classificação incorreta 28%. A curva ROC foi utilizada para avaliar a capacidade discriminante do instrumento, tendo uma área sob a curva de 0,728. O questionário CHQ-12 também se correlacionou significativamente com Escala de Sintomas Físicos (p < 0,005), Escala de Eventos Vitais (p < 0,005), BDI (p < 0,0005) e IDATE (p < 0,05). Na análise fatorial exploratória, três dimensões psicopatológicas explicaram 47,8% da variância total do CHQ-12. O conteúdo sintomatológico avaliado por este instrumento pode ser descrito como tridimensional, contendo fator somático, depressivo e de preocupação. As entrevistas do SCAN (n = 25) geraram diagnósticos de distimia, depressão e insônia não orgânica (CID-10). Os item-grupos “mau funcionamento subjetivo" (p < 0,005) e “características especiais de depressão" (p < 0,005) predominaram no perfil sintomatológico dos casos positivos de SCAN. Conclusão: Os transtornos mentais comuns predominantes na comunidade chinesa de São Paulo são os transtornos neuróticos, muito sugestivos de neurastenia. Os sujeitos chineses da comunidade apresentam uma psicopatologia própria, semelhante àquela dos indivíduos do seu país de origem. O CHQ-12 é um instrumento de rastreamento culturalmente sensível, que apresenta evidências de confiabilidade e validade para ser aplicado em outras populações de chineses. / Introduction: Community and culturally specific mental disorders have attracted much interest lately as a consequence of the constant social changes in the world. The shift of research focus to community-specific disorders has permitted methodological improvements and the development of tools for their detection. The inclusion of the cultural variable in the study of psychiatry questions psychopathological universality, Western taxonomy, and the diagnosis of culturally specific syndromes. The research of neurasthenia, a common neurotic disorder among the Chinese, is an example of the psychiatric approach based on cultural issues and on community disorders. This is an observational and transversal study of the common mental disorders among Chinese individuals in the community. Objective: to assess the non-psychotic psychopathology of the Chinese who live in the city of São Paulo, using standardized instruments. Materials and Methods: Individuals of the community (n = 211), Chinese and their descendants, filled out a self-evaluation questionnaire and were interviewed by trained researchers. The instruments used were: Chinese Health Questionnaire (CHQ-12), Physical Symptom Scale, Life Event Scale, Beck Depression Inventory (BDI), Trait-State Anxiety Inventory (STAI), and Schedule for Clinical Assessment in Neuropsychiatry (SCAN). The data were analyzed with descriptive statistics, univariate analysis (chi-square, Fisher and Student’s t tests), multivariate analysis (logistic regression), ROC curve analysis, exploratory factor analysis (CHQ-12), and correlation analysis. Results: The likelihood of an individual scoring high in CHQ-12 or having a probable common mental disorder is associated to the fact of being female (OR = 2.31; 95% CI: 1.12–4.75) and fluent in Mandarin Chinese (OR = 3.37; 95% CI: 1.68–6.78). Moreover, those with physical complaints (OR = 4.20; 95% CI: 1.70–10.40), reporting life events in the previous year (OR = 4.91; 95% CI: 1.51–16.00) and scoring high in BDI (OR = 1.29; 95% CI: 1.20–1.41) also had a greater likelihood of presenting disorders. CHQ-12’s Cronbach’s &#61537; coefficient of internal consistency was 0.71 and the item-total correlation ranged from 0.25 to 0.55, showing that this instrument is reliable and homogeneous. Using SCAN as a standard criterion, the best cut-off point for CHQ-12 was 2/3. The other validity indicators were calculated based on that criterion: sensitivity 75%, specificity 71%, positive predictive value 55%, negative predictive value 86%, and misclassification rate 28%. ROC curve was used to evaluate the discriminating capacity of the instrument, having an area under the curve of 0.728. CHQ-12 questionnaire also correlated significantly with the Physical Symptom Scale (p < 0.005), Life Event Scale (p < 0.005), BDI (p < 0.0005), and STAI (p < 0.05). In the exploratory factor analysis, three psychopathologic dimensions explained 47.8% of the total variance of CHQ-12. The symptomatological content evaluated by this instrument may be described as three-dimensional, including somatic, depressive and preoccupation factors. SCAN interviews (n = 25) led to diagnoses of dysthymia, depression and non-organic insomnia (ICD-10). The item-groups “poor subjective functioning" (p < 0.005) and “special features of depression" (p < 0.005) prevailed on the symptomatological profile of SCAN-positive cases. Conclusion: the most common mental disorders in São Paulo’s Chinese community are the neurasthenia-like neurotic disorders. The individuals of the Chinese community presented a unique psychopathology, resembling that of their country of origin. CHQ-12 is a culturally sensitive screening instrument, which seems to be reliable and valid enough to be used in other Chinese populations.

PDSE are common (19.6%) in the local stroke population. Both premorbid factors as well as stroke-related factors contribute to the development of PRSD and PSDE. The application of different diagnostic criteria for PSDE will affect the frequency and the associated radiological characteristics. As regards the screening methods of PSDE, a more specific instrument should supplement the IQCODE or MDRS-IP in a two-stage screening procedure. / PSD is also common (16--17%) among local stroke survivors. Both psychosocial factors and the location of cerebrovascular lesions play an important role in the development of PSD. PSD in local Chinese seems to have a favorable short-term outcome in comparison with their Caucasian counterparts. With regard to the screening of PSD in Chinese, we found that both the GDS and HADS depression subscale have a satisfactory response rate and accuracy in detecting PSD. However, due to the relative low frequency of PSD in the local stroke population, a more specific instrument should supplement the GDS in a two-stage screening procedure. Finally, the familiarity of the rater with the subjects based on a preexisting therapeutic relationship did not influence the accuracy of screening for PSD in Chinese patients. / There has been a paucity of data on the frequency, clinical correlates and methods of screening of poststroke dementia (PSDE) and depression (PSD) in Chinese populations. The objective of this thesis is to examine the prevalence, diagnostic criteria and clinical correlates of PSDE and PSD in Chinese stroke patients in Hong Kong. A series of studies were all carried out; the author of the thesis had interviewed all the subjects 1--3 months after their index stroke and made the diagnosis of dementia and depression according to the DSM-IV criteria. / Tang Wai Kwong. / "July 2005." / Adviser: Gabor S. Ungvari. / Source: Dissertation Abstracts International, Volume: 67-01, Section: B, page: 0177. / Thesis (M.D.)--Chinese University of Hong Kong, 2005. / Includes bibliographical references (p. 136-191). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Electronic reproduction. [Ann Arbor, MI] : ProQuest Information and Learning, [200-] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / School code: 1307.

Luk Leung Andrew. / "April 2004." / Thesis (Ph.D.)--Chinese University of Hong Kong, 2004. / Includes bibliographical references (p. 504-551). / Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web. / Mode of access: World Wide Web. / Abstracts in English and Chinese; questionnaire in Chinese.

Introdução: Os transtornos mentais que ocorrem na comunidade e em culturas diversas são temas de grande interesse frente às constantes transformações sociais no mundo. A mudança do foco de pesquisa para os transtornos freqüentes na comunidade possibilitou aperfeiçoamentos metodológicos e desenvolvimento de instrumentos sensíveis para a sua detecção. A inclusão da variável cultural no estudo da psiquiatria, por sua vez, questiona o universalismo psicopatológico, a taxonomia ocidental e o diagnóstico de síndromes culturalmente específicas. Uma amostra desta visão psiquiátrica, ancorada na questão cultural e de transtornos da comunidade, são as pesquisas envolvendo neurastenia, um transtorno neurótico comum entre os chineses. O presente trabalho é um estudo observacional e transversal dos transtornos mentais comuns entre os indivíduos chineses da comunidade. Objetivo: Avaliar a psicopatologia não-psicótica dos chineses residentes na cidade de São Paulo, através de instrumentos padronizados. Material e Método: Os sujeitos da comunidade (n = 211), chineses e seus descendentes, preencheram um questionário de auto-avaliação e foram entrevistados por pesquisadores treinados. Os instrumentos utilizados foram: Chinese Health Questionnaire (CHQ-12), Escala de Sintomas Físicos, Escala de Eventos Vitais, Inventário de Depressão de Beck (BDI), Inventário de Ansiedade Traço-Estado (IDATE) e Schedule for Clinical Assessment in Neuropsychiatry (SCAN). Os dados foram analisados através de estatística descritiva, análise univariada (testes de qui-quadrado, Fisher e t de Student), análise multivariada (regressão logística), análise da curva ROC, análise fatorial exploratória (CHQ-12) e análise de correlação. Resultados: A probabilidade dos indivíduos pontuar alto no CHQ-12 ou ser casos prováveis de transtornos mentais comuns associou ao fato de ser do sexo feminino (OR = 2,31; IC95%: 1,12–4,75) e fluentes em chinês mandarim (OR = 3,37; IC95%: 1,68–6,78). Além disso, aqueles sujeitos com queixas físicas (OR = 4,20; IC95%: 1,70–10,40), relato de eventos-vitais no último ano (OR = 4,91; IC95%: 1,51–16,00) e pontuação alta no BDI (OR = 1,29; IC95%: 1,20–1,41) também tiveram maior chance de apresentar transtornos. O coeficiente de consistência interna &#61537; de Cronbach do CHQ-12 foi de 0,71 e a correlação item-total variou de 0,25 a 0,55, mostrando boa fidedignidade e homogeneidade deste instrumento. Adotando SCAN como critério-padrão, o melhor ponto de corte de CHQ-12 foi 2/3. Os seguintes indicadores de validade foram calculados a partir deste critério: sensibilidade 75%, especificidade 71%, valor preditivo positivo 55%, valor preditivo negativo 86% e taxa de classificação incorreta 28%. A curva ROC foi utilizada para avaliar a capacidade discriminante do instrumento, tendo uma área sob a curva de 0,728. O questionário CHQ-12 também se correlacionou significativamente com Escala de Sintomas Físicos (p < 0,005), Escala de Eventos Vitais (p < 0,005), BDI (p < 0,0005) e IDATE (p < 0,05). Na análise fatorial exploratória, três dimensões psicopatológicas explicaram 47,8% da variância total do CHQ-12. O conteúdo sintomatológico avaliado por este instrumento pode ser descrito como tridimensional, contendo fator somático, depressivo e de preocupação. As entrevistas do SCAN (n = 25) geraram diagnósticos de distimia, depressão e insônia não orgânica (CID-10). Os item-grupos “mau funcionamento subjetivo” (p < 0,005) e “características especiais de depressão” (p < 0,005) predominaram no perfil sintomatológico dos casos positivos de SCAN. Conclusão: Os transtornos mentais comuns predominantes na comunidade chinesa de São Paulo são os transtornos neuróticos, muito sugestivos de neurastenia. Os sujeitos chineses da comunidade apresentam uma psicopatologia própria, semelhante àquela dos indivíduos do seu país de origem. O CHQ-12 é um instrumento de rastreamento culturalmente sensível, que apresenta evidências de confiabilidade e validade para ser aplicado em outras populações de chineses. / Introduction: Community and culturally specific mental disorders have attracted much interest lately as a consequence of the constant social changes in the world. The shift of research focus to community-specific disorders has permitted methodological improvements and the development of tools for their detection. The inclusion of the cultural variable in the study of psychiatry questions psychopathological universality, Western taxonomy, and the diagnosis of culturally specific syndromes. The research of neurasthenia, a common neurotic disorder among the Chinese, is an example of the psychiatric approach based on cultural issues and on community disorders. This is an observational and transversal study of the common mental disorders among Chinese individuals in the community. Objective: to assess the non-psychotic psychopathology of the Chinese who live in the city of São Paulo, using standardized instruments. Materials and Methods: Individuals of the community (n = 211), Chinese and their descendants, filled out a self-evaluation questionnaire and were interviewed by trained researchers. The instruments used were: Chinese Health Questionnaire (CHQ-12), Physical Symptom Scale, Life Event Scale, Beck Depression Inventory (BDI), Trait-State Anxiety Inventory (STAI), and Schedule for Clinical Assessment in Neuropsychiatry (SCAN). The data were analyzed with descriptive statistics, univariate analysis (chi-square, Fisher and Student’s t tests), multivariate analysis (logistic regression), ROC curve analysis, exploratory factor analysis (CHQ-12), and correlation analysis. Results: The likelihood of an individual scoring high in CHQ-12 or having a probable common mental disorder is associated to the fact of being female (OR = 2.31; 95% CI: 1.12–4.75) and fluent in Mandarin Chinese (OR = 3.37; 95% CI: 1.68–6.78). Moreover, those with physical complaints (OR = 4.20; 95% CI: 1.70–10.40), reporting life events in the previous year (OR = 4.91; 95% CI: 1.51–16.00) and scoring high in BDI (OR = 1.29; 95% CI: 1.20–1.41) also had a greater likelihood of presenting disorders. CHQ-12’s Cronbach’s &#61537; coefficient of internal consistency was 0.71 and the item-total correlation ranged from 0.25 to 0.55, showing that this instrument is reliable and homogeneous. Using SCAN as a standard criterion, the best cut-off point for CHQ-12 was 2/3. The other validity indicators were calculated based on that criterion: sensitivity 75%, specificity 71%, positive predictive value 55%, negative predictive value 86%, and misclassification rate 28%. ROC curve was used to evaluate the discriminating capacity of the instrument, having an area under the curve of 0.728. CHQ-12 questionnaire also correlated significantly with the Physical Symptom Scale (p < 0.005), Life Event Scale (p < 0.005), BDI (p < 0.0005), and STAI (p < 0.05). In the exploratory factor analysis, three psychopathologic dimensions explained 47.8% of the total variance of CHQ-12. The symptomatological content evaluated by this instrument may be described as three-dimensional, including somatic, depressive and preoccupation factors. SCAN interviews (n = 25) led to diagnoses of dysthymia, depression and non-organic insomnia (ICD-10). The item-groups “poor subjective functioning” (p < 0.005) and “special features of depression” (p < 0.005) prevailed on the symptomatological profile of SCAN-positive cases. Conclusion: the most common mental disorders in São Paulo’s Chinese community are the neurasthenia-like neurotic disorders. The individuals of the Chinese community presented a unique psychopathology, resembling that of their country of origin. CHQ-12 is a culturally sensitive screening instrument, which seems to be reliable and valid enough to be used in other Chinese populations.

Bakgrund: Samsjuklighet är vanligt förekommande bland personer med psykisk ohälsa. Samtidigt finns indikationer på att patienter med vanligt förekommande psykiatriska diagnoser riskerar att inte få fullgod behandling av sina somatiska sjukdomstillstånd. Bristande vårdkvalité och tillgänglighet är två orsaker som anses vara bidragande till förlust av levnadsår hos denna patientgrupp. Patienter med psykisk ohälsa har rätt till en vård utan diskriminering, men forskningen visar att det kan förekomma negativa attityder och stigmatisering mot dessa patienter från vårdpersonal. Syfte: Syftet med litteraturöversikten var att belysa upplevelser och erfarenheter hos patienter med psykisk ohälsa av bemötande från vårdpersonal i den somatiska vården. Metod: Litteraturöversikt med 13 vetenskapliga artiklar från sex olika länder hämtades från Cinahl och PsycINFO. Artiklarna analyserades enligt Friberg. Resultat: Fyra huvudteman identifierades: Erfarenheter av att bli marginaliserad, Erfarenheter av bra bemötande, Erfarenheter av att vården inte räcker till och Konsekvenser av negativt bemötande. Diskussion: Med Orlandos teori om det dynamiska förhållandet mellan sjuksköterska och patient som teoretisk utgångspunkt diskuteras resultatet i relation till Orlandos nyckelbegrepp: evidensbaserad vård, dialog och reflektion. Behov av ytterligare kompetens hos vårdpersonal i att vårda patienter med psykisk ohälsa var en sak som lyftes. / Background: Somatic and psychiatric comorbidity are frequent in patients with mental illness. There is a risk that patients with common mental disorders don’t get adequate treatment for their somatic health problems. Lack of care quality and availability to somatic health care are issues considered contributory to years of life lost to these patients. Patients with mental disorders have the right to receive care without discrimination, though research indicates that negative attitudes and discrimination by health-care personnel towards these patients may occur. Aim: The aim of this literature review was to reveal how patients with mental illness experience the encounter with health care personnel in somatic care. Method: A literature review with 13 original research articles from six different countries was retrieved from the databases Cinahl and PsycINFO. The studies were analyzed based on Fribergs method. Results: Four main themes were crystallized: Experiences of being marginalized, Positive experiences of health care, Experiences of health care not being good enough and Consequences of negative attitudes. Discussion: The article result was discussed related to Orlando’s nursing process The dynamic nurse-patient relationship and her key concepts: evidence-based nursing, communication, dialogue and reflection. The need for additional   expertise in caring for patients with mental illness was one of the points raised.

Treningsterapi som en del av tverrfaglig spesialisert rusbehandling. Formålet med studiet er å undersøke hvordan en gruppe pasienter med rusmiddelavhengighet og psykiske lidelser opplever og beskriver sine erfaringer med treningsterapi som en del av behandlingen ved Stiftelsen Bergensklinikkene. Dette sett i lys av Self-Determination Theory (SDT) - selvbestemmelsesteorien.    Studiet har en kvalitativ tilnærming hvor det empiriske materialet er basert på forskningsintervju. Det er blitt gjennomført intervjuer av syv pasienter med rusmiddelavhengighet alle med erfaring med bruk av treningsterapi ved Bergensklinikkene. Treningsterapi vil si planlagte og strukturerte fysiske aktiviteter. Empirien i dette studiet er analysert ved bruk av tradisjonell kvalitativ tilnærming og meningskonsentrering. Hovedfunnene viser at et autonomistøttende miljø er en forutsetning for å bli motivert for behandling. Brukermedvirkning og selvbestemmelse er faktorer som styrker motivasjonen for endring.   Økt kompetanse blant pasientene gjennom nye erfaringer og økt innsikt i treningsterapi, ga grunnlag for en autonomistyrt behandling.  Relasjon til treningsterapeutene var viktig for at pasientene opplevde terapeutens informasjon og veiledning som nyttig. Opplevelsen av et inkluderende felleskap med behandlere og medpasienter var av stor betydning for informantene. I studien kom det frem at behovet for tettere oppfølging i overgangen fra institusjon til hjem var nødvendig.     Opplevelse av bedre rusmestring, bedre søvn, mindre angst og depresjon og mindre ADHD-symptomer var viktige motivasjonsfaktorer. Dessuten ga fysiske effekter både indre og ytre motivasjon til bruk av treningsterapi. Gjennom studien kan en ut fra resultatene konkludere med at informantene blant annet vektlegger en autonomistøttende struktur, økt kompetanse, opplevelse av fellesskap og motivasjon som viktig og nødvendig i treningsterapi. / Excercise as therapy  Exercise as therapy as part of multidisciplinary specialized treatment. The purpose of the study is to understand how a group of patients with substance use disorders and mental illness experience and describe their experiences with exercise therapy as part of treatment at the Bergen Clinics Foundation. The thesis uses a framework of self-determination theory (SDT).   The study has a qualitative approach where the empirical material is based on research interviews. Seven patients were strategically selected to undertake semi-structured interviews regarding their experience with exercise as therapy as part of multidisciplinary specialized treatment in The Bergen Clinics Foundation. Exercise as therapy is physical activity that is planned and structured. The empirical data in this study is analyzed using the traditional qualitative approach.    The results show that an autonomy supportive environment is a prerequisite for being motivated for treatment. User involvement and self-determination are factors that strengthen the motivation for change.   Increased competence among patients through new experiences and greater insight into exercise as therapy, provided the basis for an autonomy-guided therapy. The patients´ relationship with the therapists was important: in case this relationship was deficient, they wouldn´t experience the information and guidance as helpful.   The experience of an inclusive community of practitioners and fellow patients was of great significance for patients. The study revealed that the need for closer monitoring of the transition from institutional to home was necessary.    Experience of better control of drug dependence, better sleep, less anxiety and depression and less ADHD symptoms were important motivators. Besides giving physical effects both intrinsic and extrinsic motivation for use of exercise as therapy.   One can conclude from the study that in the patients´ view an autonomy supportive structure, increased expertise, experience of community and motivation represented the most important and indispensable factors in exercise therapy.

Depuis la désinstitutionalisation dans les milieux psychiatriques, il a été souvent mentionné qu’une augmentation des admissions dans les milieux carcéraux et de psychiatrie légale était en cours afin de prendre soin des personnes atteintes de troubles mentaux graves (TMG). Parallèlement, plusieurs auteurs ont rapporté que les individus ayant des troubles mentaux sévères sont plus à risque de perpétrer des gestes antisociaux ou de violence. À l’égard de cette problématique, nous soutenons le modèle de la spécificité clinique. Celui-ci précise que des profils psychopathologiques particuliers augmentent le risque de violence, conduisent à différents types de fonctionnement social et articulent la demande de soins. L’environnement a, de plus, un effet modulateur au niveau du fonctionnement distinctif de l’individu. Une relation bidirectionnelle se construit entre la spécificité psychopathologique et l’environnement, plus particulièrement en ce qui a trait aux relations interpersonnelles, au milieu socioéconomique, au patron d’utilisation des services de psychiatrie et à l’interaction avec le système de justice qui déterminent subséquemment le type de prise en charge ou le statut légal du patient. Afin d’appuyer ce modèle, les profils des patients atteints de TMG en fonction des statuts légaux, du milieu de soins (psychiatrie générale et psychiatrie légale) et de l’utilisation des mesures d’isolement et de contentions ont été examinés. Les patients ont été évalués par des mesures sociodémographiques (indicateurs du fonctionnement social, des relations interpersonnelles et du milieu socioéconomique), psychodiagnostiques (SCID-I et II) et de la psychopathie. De même, le dossier criminel, les dossiers médicaux hospitaliers et administratifs (MED-ECHO et RAMQ) ont été observés. Les devis étaient rétrospectifs. Par ailleurs, au niveau de l’interaction entre les services de psychiatrie et l’individu atteint d’un TMG, nous avons exploré la perception subjective des intervenants en santé mentale quant à l’agressivité et la violence. Nous avons considéré l’impact de cette perception sur la manière d’offrir des soins, plus particulièrement en ce qui a trait aux mesures coercitives (mesures d’isolement avec ou sans contentions), lors des hospitalisations. Les cinq études ont appuyé l’idée d’une spécificité clinique tant sur le plan des profils cliniques des individus que sur la manière d’offrir les services, spécialement au niveau des mesures de contrôles. Les caractéristiques de la personne et de l’environnement semblent de ce fait jouer un rôle important dans le type de services que recevra un individu souffrant de TMG. Ces travaux ouvrent sur la possibilité de mieux déterminer l’étiologie et la gestion de la violence de même que la manière dont le système s’occupe des patients à risque de violence. / Since deinstitutionalization in psychiatry, it has often been mentioned that individuals who in the past would have been cared for in psychiatric hospitals are today ending up in forensic hospitals or, worse, in prison. Meanwhile, several authors have reported that individuals with severe mental illness are more likely to commit antisocial acts or violence. In respect of this issue, we support the clinical specificity model. It specifies that psychopathological profiles increase the risk of violence and lead to different types of social functioning. The environment has also a modulating effect on the functioning of the individual distinctiveness. A bidirectional relationship is built between the specific psychopathology and the environment, particularly with regard to interpersonal relationships, socioeconomic background, the pattern of psychiatric services use and the interaction with the justice system that subsequently determine the type of care or patient's legal status. To support this hypothesis, we examined the profiles of patients with severe mental illness based on legal status and care setting (general psychiatry and forensic psychiatry) and the use of seclusion and restraint. Patients were evaluated by sociodemographic measures (indicators of social functioning, interpersonal relationships and socioeconomic background) and measures of psychodiagnostic (SCID-I and II) and psychopathy. In addition, criminal records, official provincial government physician-billing and hospitalization files (MED-ECHO and Medicare) were observed. The designs were retrospectives. Moreover, in order to explore the subjective perception of aggression and violence of mental health workers, the level of interaction that occurs between psychiatric services and the individual suffering from severe mental illness, were evaluated. We considered the impact of this perception on how to provide care, particularly with respect to coercive measures (measures of seclusion with or without restraints) during hospitalization. The five studies have supported the clinical specificity of both the clinical profiles of individuals and the way to deliver services, especially coercion. The characteristics of the individual and the environment seem to play an important role in the type of service received by an individual with severe mental illness. This work opens the possibility in subsequent studies to better determine the etiology of aggression, how to manage violence and to identify the care offered on the issue.