Background: Tobacco use increases the odds of suffering and dying prematurely from a host of chronic disease, including heart disease, stroke, cancer, lung diseases, and mental illness. There is limited published data especially from Canada on the prevalence, etiology, consumption patterns and treatment of tobacco use among persons with mental illness. Objectives: First, understand the social epidemiology and describe the characteristics of a typical smoker with mental illness. Second, understand the likelihood of receiving smoking cessation interventions in mental health institutions of Ontario. Methods: Secondary analysis of the data obtained using the Ontario Mental Health Reporting System (OMHRS). Census level data collected from all the individuals admitted to mental health institutions in Ontario during the period of October 2005 and September 2006. Cross tabs were used to analyze the social epidemiology of smokers. Odds ratios were calculated for the likelihood of the psychiatric diagnosis and receiving smoking cessation intervention. Results: Forty-seven percent of the individuals admitted in mental health beds during the study duration were smokers. The mean age of smokers was lower as compared to non-smokers. Individuals with the diagnosis of substance use disorder were the most likely to be smokers as compared to the reference group. Smokers scoring higher on CAGE score or having a diagnosis of substance use disorder and had more than 5 drinks of alcohol in the last 14 days are more likely to receive the intervention as compared to other smokers. Conclusion: The results of this study suggest that significantly huge populations of individuals in mental health institutions are smokers. The smoking prevalence is higher in males and these males are also more likely to have a diagnosis of substance-related disorder. There is a lack of smoking cessation interventions in mental health facilities.

Background: Tobacco use increases the odds of suffering and dying prematurely from a host of chronic disease, including heart disease, stroke, cancer, lung diseases, and mental illness. There is limited published data especially from Canada on the prevalence, etiology, consumption patterns and treatment of tobacco use among persons with mental illness. Objectives: First, understand the social epidemiology and describe the characteristics of a typical smoker with mental illness. Second, understand the likelihood of receiving smoking cessation interventions in mental health institutions of Ontario. Methods: Secondary analysis of the data obtained using the Ontario Mental Health Reporting System (OMHRS). Census level data collected from all the individuals admitted to mental health institutions in Ontario during the period of October 2005 and September 2006. Cross tabs were used to analyze the social epidemiology of smokers. Odds ratios were calculated for the likelihood of the psychiatric diagnosis and receiving smoking cessation intervention. Results: Forty-seven percent of the individuals admitted in mental health beds during the study duration were smokers. The mean age of smokers was lower as compared to non-smokers. Individuals with the diagnosis of substance use disorder were the most likely to be smokers as compared to the reference group. Smokers scoring higher on CAGE score or having a diagnosis of substance use disorder and had more than 5 drinks of alcohol in the last 14 days are more likely to receive the intervention as compared to other smokers. Conclusion: The results of this study suggest that significantly huge populations of individuals in mental health institutions are smokers. The smoking prevalence is higher in males and these males are also more likely to have a diagnosis of substance-related disorder. There is a lack of smoking cessation interventions in mental health facilities.

Bakgrund: Den mellanmänskliga relationen, baserad på kommunikation och samtal, utgör kärnan i psykiatriskt vårdande. Denna studie utgår från det vårdande samtalets teori där vårdandets grundmotiv är caritas, en naturlig strävan efter att lindra lidande och bevara patientens värdighet i en vårdande relation. Varje sjuksköterska inom psykiatrisk vård kan förväntas möta personer med samsjuklighet i psykisk ohälsa och missbruk eller beroende. Ökad kunskap om dessa personers upplevelser av vårdande samtal förväntas dels öka förståelsen för deras lidande, dels utveckla sjuksköterskans förmåga att i samtalet kombinera etisk hållning, lyhördhet och praktiskt agerande, vilket kan bidra till att fler personer med denna typ av samsjuklighet kan erbjudas samtal som upplevs som vårdande och därmed lindrar lidande. Syfte: Syftet med denna intervjustudie är att belysa upplevelser av vårdande samtal hos personer med samtidig psykisk ohälsa och missbruk eller beroende. Metod: Studien har en fenomenologisk-hermeneutisk ansats för att möjliggöra en djupare förståelse av innebörden i informanternas levda erfarenhet. Fem personer intervjuades om sina upplevelser av vårdande samtal. Resultat: Resultatet presenteras utifrån tre innebördsteman: Där ömsesidigheten skapar trygghet och gemenskap, Ett livsrum där lidandet synliggörs och begripliggörs och Där självaktningen återupprättas. Dessa teman strålar samman i huvudtemat Den trygga fristaden där lidande lindras och värdighet och självaktning återupprättas. Slutsats:Det vårdande samtalet har i denna studie visat sig bidra till att lidande lindras och värdighet och självaktning återupprättas hos personer med samsjuklighet i psykisk ohälsa och missbruk eller beroende. Det vårdande samtalet erbjuder inte bara möjlighet att förmedla och bearbeta lidande utan ger också, med sjuksköterskans stöd, utrymme för lärande och för att hitta de egna resurserna, vilket leder till ökad hälsa, autonomi och självaktning. Genom ytterligare forskning om det vårdande samtalet ur ett patientperspektiv kan evidens samlas som gör att det i daglig klinisk verksamhet än mer kan komma att betraktas som en självklar del i vårdande som lindrar lidande. / Background: The interpersonal relationship, based on communication and conversation, is the core of psychiatric caring. This study uses the theory of the caring conversation as a starting point, where the basis for caring is caritas, an inherent endeavor to alleviate suffering and preserve patient’s dignity in a caring relationship. Every nurse within psychiatric care can expect to meet people with comorbidity in psychiatric illness and substance use disorders or dependency. Increased knowledge about these people’s experiences of the caring conversation is expected to lead to increased understanding of their suffering, as well as develop nurses’ ability to combine ethical awareness, perceptiveness and practical action in each conversation, which in turn can contribute to that more people with this kind of comorbidity can be offered conversations that are caring and thereby alleviate suffering. Aim: The aim of this interview study is to illustrate experiences of caring conversations for people with comorbidity in psychiatric illness and substance use disorders or dependency. Methods: The study has a phenomenological-hermeneutical approach to enable a deaper understanding of the meaning of the lived experience of the informants. Five people were interviewed about their experiences of caring conversations. Findings: The result is presented through three themes of meaning: Where reciprocity creates safety and communion, A lebensraum where suffering is made visible and understandable and Where self-esteem is restituted. These themes come together in the main theme The safe sanctuary where suffering is alleviated and dignity and self-esteem is restituted. Conclusion: It is apparent in this study that the caring conversation contributes to alleviated suffering and restituted dignity and self-esteem for people with comorbidity in psychiatric illness and substance use disorder or dependency. The caring conversation not only provides an opportunity to convey and process suffering, but is also, with the nurse’s support, a forum for learning and for discovering one’s own resources, which leads to increased health, autonomy and self-esteem. With more research about the caring conversation from a patient perspective, evidence can be gathered that will make the caring conversation in daily clinical practice an even more natural part of caring that alleviates suffering.

Behavioral adaptation to a continuously changing environment is critical for the survival of the animals, but also day-to-day interactions in the human world. The main components maintaining flexibility in cognition and behavior are well-established and depend mostly on proper intercommunication within the prefrontal cortex (PFC) and striatum. Some parts of the PFC are densely innervated by the ventral hippocampus (vHPC), which has a great impact on its functioning. Also, hippocampal-prefrontal circuit dysfunction has been shown to disrupt the integrity of flexible cognition in some neuropsychiatric diseases. Therefore, the exact functional role of this pathway is an indispensable part of the research. The aim of this study was to test the role of the vHPC and the medial PFC (mPFC) in an active place avoidance task on a rotating arena in 1) two flexibility task variants - reversal learning and set- shifting - and 2) the spatial memory retrieval. We inactivated these structures by muscimol (GABAA receptor agonist) in a variety of unilateral, bilateral, and combined local injections. Disrupted performance was apparent in reversal learning in vHPC-inactivated rats. No effect was seen in mPFC-inactivated rats. Impairments after the task acquisition were observed in bilateral vHPC and mPFC inactivations...

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(Truncated abstract) The aims of this thesis are: (i) To estimate the prevalence of psychiatric illness among persons with intellectual disability and, conversely, the prevalence of intellectual disability among persons with a psychiatric illness; (ii) To describe the disability and service utilisation profile of persons with conjoint disorder; (iii) To examine, in particular, intellectual disability co-occurring with schizophrenia; and (iv) To explore the role of hereditary and environmental (specifically obstetric) risk factors in the aetiology of (i) intellectual disability and (ii) intellectual disability co-occurring with psychiatric illness. This thesis has a special interest in the relationship between intellectual disability and schizophrenia. Where data and sample sizes permit, it explores that relationship at some depth and has included sections on the putative nature of the link between intellectual disability and schizophrenia in the introductory and discussion chapters. To realise its objectives, the thesis comprises a core study focusing on aims (i) – (iii) and a supplementary study whose focus is aim (iv). It also draws on work from an ancillary study completed prior to the period of candidacy...This thesis found that, overall, 31.7% of persons with an intellectual disability had a psychiatric illness; 1.8% of persons with a psychiatric illness had an intellectual disability. The rate of schizophrenia, but not bipolar disorder or unipolar major depression, was greatly increased among cases of conjoint disorder: depending on birth cohort, 3.7-5.2% of individuals with intellectual disability had co-occurring schizophrenia. Down syndrome was much less prevalent among conjoint disorder cases despite being the most predominant cause of intellectual disability while pervasive developmental disorder was over-represented. Persons with conjoint disorder had a more severe clinical profile including higher mortality rates than those with a single disability. The supplementary study confirmed the findings in the core body of work with respect to the extent of conjoint disorder, its severity, and its relationship with pervasive development disorder and Down syndrome. Moreover, the supplementary study and the ancillary influenza study indicated a role for neurodevelopmental insults including obstetric complications in the adverse neuropsychiatric outcomes, with timing of the insult a potentially critical element in defining the specific outcome. The supplementary study also added new information on familiality in intellectual disability. It found that, in addition to parental intellectual disability status and exposure to labour and delivery complications at birth, parental psychiatric status was an independent predictor of intellectual disability in offspring as well as a predictor of conjoint disorder. In conclusion, the facility to collect and integrate records held by separate State administrative health jurisdictions, and to analyse them within the one database has had a marked impact on the capacity for this thesis to estimate the prevalence of conjoint disorder among intellectually disabled and psychiatric populations, and to understand more about its clinical manifestations and aetiological underpinnings.

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The overall aim of this thesis is to investigate if the somatic comorbidity and increased mortality among persons with psychiatric disability (residents in supported housing facilities) can be influenced. The thesis comprises four papers. Paper I describes the lived experience of health and body. Papers II and III examine the effects of a lifestyle programme on physiological markers (II) and on psychological and quality of life parameters (III). Paper (IV) illustrates the meaning of participating in a life style programme. The data in Papers I and IV comprises narrative interviews with residents (n=11). The studies in Papers II and III are focused on residents and were carried out with a randomized design. The randomization was performed on a group level (supported housing facility). The 12 month intervention consisted of study circles with a theoretical and practical application of dietary information and physical activity for two hours, on a twice weekly basis under the supervision of a study circle leader. The controls were offered an aesthetic study circle and met once a week. The data in Paper II comprises physiological quantitative data from both residents (n=41) and staff (n=41) and in Paper III questionnaires on symptoms and quality of life completed only by residents (n=41). The data was analysed with Qualitative description (I), Phenomenological-hermeneutics (IV), and for papers II and III relevant statistical calculations were used. Health is described in paper I as “having a life as others have” and discloses the losses of important life domains (family, work, security) and the experiences of being deviant and stigmatized. Health is described as “absence of psychological and physical problems” and its hampering effects on quality of life and self-esteem. Health is understood as a phenomenon that could “be influenced by one self”, and there is an insight that health is manageable. Participating in a life style intervention (paper II) meant a significant improvement in risk factors for metabolic syndrome among the residents in comparison with controls. No differences were seen on weight, BMI and improved physical capacity. In paper III a significant positive increase in the Sense of Coherence compared to controls was seen. However no effect was seen on quality of life, psychosocial function or on reduction of symptoms in comparison with controls. Participating in a lifestyle intervention can be understood as the gaining of insights that health can be improved and that the daily life is partly given a changed content (paper II). The participation is also described as meaning an increased sense of closeness and equality in relation to the staff and sometimes a painful insight of their life situation. Participating is also described as entailing a hope that one’s life situation can be affected. In summary this thesis shows that there is some possibility of influencing the physical health (reduced risk of metabolic syndrome) among persons with psychiatric disability by participating in a 12 month intervention programme. The intervention does not show any effects on measures such as quality of life, psychosocial function and presence of symptoms. However, the participants describe that the participation had a meaning in a number of respects. This is a finding that is confirmed by the positive change in sense of coherence. The need to develop preventive care for persons with psychiatric disability and the importance of monitoring the treatment with neuroleptics and its side effects on physical health is an important clinical implication. Furthermore the importance of the responsibility of the care staff is emphasized as well as the importance of supporting a change in lifestyle.

No description available.

No description available.