De senaste tio åren har det i Sverige visat en ökande trend med psykiatriska sjukdomar. I Sverige insjuknar cirka 15 personer av 100,000 i psykos årligen. Tiden från första symptomdebut till insjuknande kan vara mellan några dagar till flera år och symptomen för psykos kan variera och misstas för depression och ångest. Syftet med studien var att belysa synen på vad omvårdnad är vid psykos och genomfördes som en systematisk litteraturstudie där tio artiklar användes i resultatet. Insjuknande i psykos beskrivs som en oförmåga att kontrollera sig själv och leder ofta till stor rädsla hos patienterna. Teman som framkom var den vårdande psykiatriska miljön, engagemang och delaktighet från personal samt autonomi, stigmatisering och rädsla. Omvårdnad av en patient med psykossjukdom bör karaktäriseras av trygghet, empati, stöd och med utrymme för samtal och reflektioner. Emotionell delaktighet från sjuksköterskan under omvårdnaden är av stor vikt för skapande av en förtrolig relation. Genom att behandla och bemöta patienten som en frisk självständig individ bevaras patientens autonomi och självkänsla i större utsträckning. Vid yrkesverksamhet, vårdutbildningar på olika nivåer och forskning finns en stor okunskap och osäkerhet representerad av psykiatrisk omvårdnad och det är därför stor betydelse av att att utöka och utveckla kunskaperna inom sjukdomarna vid psykos och psykiatrisk omvårdnad. / The last 10 years in Sweden there has been a rising trend of psychiatric diseases. In Sweden approximately 15 people per 100.000 get diagnosed with acute psychosis. The time from the first symptoms to acute psychosis state varies between a few days to multiple years. The psychosis symptoms can also differ and be mistaken for depression and anxiety. The purpose of this study was to enlighten what nursing is with psychosis, and was executed as a systematic literature study, where ten articles was used. Psychosis is described as a disability to control one self and often leads to great fear for the patients. Nursing of a patient with psychosis should be characterized by security, support and empathy with room for talks and reflection. Emotional participation from nurses during the care is of great importance for the creation of steady relationship with the patient. By treating and meeting the patient as a healthy and self-serving individual, the patient maintains autonomous on a bigger scale.  Empirical studies, research and nurse education on different levels today hold a lack of knowledge regarding psychiatric nursing and there is therefore important to develop and increase knowledge of psychosis and psychiatric care.

This study explored the experiences of street-involved youth who have received mental health services for symptoms of methamphetamine-induced psychosis. Specifically, the study investigated what factors were perceived by participants to promote and hinder access to mental health services. The researcher interviewed nine street youth at Covenant House, a Vancouver agency serving street-involved youth. Interview data and the researcher's field notes were coded and analyzed within a grounded theory paradigm. Youth discussed formal and informal sources of help and routes to both. Two distinct perspectives to treatment were identified: an addictions perspective and a concurrent disorders perspective. Respondents outlined the typical pathway into methamphetamine use and described barriers and supports for accessing services while undergoing drug-induced psychosis. Significant factors that encouraged access to services were positive relationships with helpers, strong peer supports, and the use of involuntary services when necessary. Identified barriers included fear of being stigmatized, lack of problem awareness, and systemic barriers. The current research proposed a model of access to mental health services that positions outreach and frontline workers as key figures to mediating street youth's access to appropriate services.

Intervening early in the course of psychotic illness (e.g. schizophrenia) may significantly improve prospects for the recovery, both in medical and psychosocial terms, of the individuals who experience these conditions. Engaging such individuals in care, however, remains a challenge. One barrier to engagement is lack of insight, or the low illness awareness that is considered to be a typical characteristic of people who experience psychotic illnesses, particularly in their early phases. The dominant view of this phenomenon is that it is primarily related to the illness itself and thus is biologically based. There is reason to believe, however, that understanding the psychosis experience is also an interpretive process, and that the meaning of this experience for the individual arises out of dialogue between the person, mental health professionals and significant others. There is also reason to believe that the relationship between insight and recovery may not be as straightforward as presumed. While the dominant view sees insight as a crucial condition for recovery, emerging evidence suggests that insight once gained may lead to depression and demoralization. Insight thus may be understood as an interpretive, dialogical process that is fundamentally narrative in nature, the consequences of which may be divergent. Using qualitative methods (constructivist grounded theory complemented by narrative analysis), the present study sought to understand the process by which insight developed in early psychosis, and sought to explore the relationship between insight and the early stages of illness management and recovery, as reflected by the written and oral accounts of twelve individuals who were within the first three years of illness. Overall, the results suggest that insight development in early psychosis can be conceptualized as the process of coming to an acceptable, adaptive explanation. More specifically, the results first of all suggest that insight development involves finding or negotiating an account of illness that fits or can be accommodated with the individual’s own story of the psychosis experience. The process also involves finding an account of illness and its treatment that can be envisioned as a helpful rather than disruptive aspect of the individual’s future biography.

PURPOSE: To generate a theory of the psychosocial processes influencing weight management among persons newly prescribed atypical antipsychotic medications. RESEARCH QUESTIONS: 1. What influences weight management in persons with first-episode psychosis who are newly prescribed atypical antipsychotic medications? 2. How is weight management facilitated in persons with first-episode psychosis who are newly prescribed atypical antipsychotic medications? 3. What psychosocial processes impede weight management in persons with first-episode psychosis who are newly prescribed atypical antipsychotic medications? METHODS: A qualitative, grounded theory research design was used to guide the study. Semi-structured interviews were the method of data collection and analysis was performed using constant comparison. SAMPLE & SETTING: A sample of 10 participants with first-episode psychosis prescribed atypical antipsychotics for at least eight weeks and six participants with a diagnosis of chronic schizophrenia who have been taking atypical antipsychotic medication for at least three years were obtained from an Outpatient Psychiatric program using theoretical sampling. FINDINGS: Contextual factors influencing weight management were: accessibility to resources, unstructured lifestyle, and others’ perception of their weight. Conditions influencing weight management were: rapid weight gain, insatiable hunger, and a lack of motivation boosters. Participants’ early responses to actions influencing weight gain management included discontinuing medications, choosing lower calorie foods, using walking in daily activities as exercise, accepting weight gain, and trying to manage weight but giving up. The consequences revealed from data analysis were contemplating weight management and not trying, as the barriers to weight management substantially exceeded the facilitators and many procrastinated in taking on any weight management strategies. CONCLUSION: The theoretical framework developed in this study can assist with the understanding and management of weight gain among this unique population. / Thesis (Master, Nursing) -- Queen's University, 2010-09-06 00:12:11.781

Stigma prevents individuals with serious mental illness from seeking assistance (Fung et al., 2007; Vogel et al., 2006). Self-Determination Theory (SDT) seeks to explain how individuals are motivated by environmental factors and how these elements affect their well-being (Deci & Ryan, 1985). Limited information is available about how young adults with mental illness experience stigma, and how this affects their self-determination and ability to recover. This study explores factors that facilitated recovery and thriving behaviors in nine young adults (ages 18-25) with psychosis, by using a combination of interviews and questionnaires. Findings suggest that having a variety of supports and a determination to recover facilitates high self-determination and thriving behavior in these individuals. By identifying factors that assist these individuals ability to thrive, it is anticipated that professionals will intervene with young adults experiencing psychosis more effectively.

Background: The first aim of this thesis was to systematically review the evidence for the impact of interpersonal trauma in childhood on appraisals of auditory hallucinations in adulthood. Informed by this systematic review and cognitive models of psychosis, potential moderators of the relationship between trauma and distress were proposed. Hypotheses: It was hypothesised that the experience of interpersonal trauma in childhood would predict ‘self blaming’ and ‘danger to self’ appraisals made by voice hearers about their auditory hallucinations. It was predicted that these appraisals would interact with the use of avoidant and non avoidant coping strategies and that this would predict wellbeing. Method 1 and results: In order to measure voice appraisals, the Interpretation of Voices Inventory was adapted. It was completed by one hundred and thirteen voice hearing participants and confirmatory factor analysis was used to test the predicted factors. Most items covaried with their respective factors acceptably. A number of items did not load well and it was recommended that they be removed from the measure. The amended factor structure improved the fit of the measure to an acceptable standard. Method 2 and results: Sixty two participants completed additional measures of interpersonal trauma in childhood and wellbeing. Structural equation modeling provided support for a link between severity of childhood trauma and ‘danger to self’ appraisals. ‘Danger to self’ appraisals predicted the use of acceptance based coping and this predicted wellbeing. Independent of this model, interpersonal coping was shown to predict the use of psychological explanations for the experience of auditory hallucinations. Psychological explanations did not predict acceptance or wellbeing. Discussion: It may be clinically helpful to test acceptance based interventions using ‘danger to self’ appraisals as an outcome measure in the future. Possible factors that may have influenced the results were reflected on. The potentially negative impact of insight on wellbeing was discussed. Stigma was highlighted as a potential barrier to non avoidant coping

Bakgrund: Att vara närstående till en person med psykossjukdom kan vara komplicerat, påfrestande och smärtfyllt. Närstående förväntas kunna hantera sin vardag med familj och arbete samtidigt som de fungerar som omsorgsstöd för den sjuke. Den närstående är en av tre parter i vårdandet, patienten, de närstående och vårdpersonalen. För att underlätta för de närstående måste vården sträva efter en relation som bygger på tillit för att underlätta situationen för de närstående. Syfte: Syftet är att beskriva hur vårdpersonal kan vara stöd till närstående som lever nära en person med psykossjukdom. Metod: Metoden är en litteraturstudie med granskning av vetenskapliga artiklar om närståendes upplevelser av att leva nära en person som lider av psykossjukdom samt vårdpersonalens insatser som är till stöd för de närstående. Resultat: Resultatet visar att närstående har varierande upplevelser att av att leva nära en person med psykossjukdom som att det är viktigt för personalen att förstå närståendes upplevelser så att de kan få en bredare kunskap om patientens sjukdom och därmed kunna vara till stöd i vården och som är anpassad utifrån personens individuella behov. Diskussion: Uppsatsen visar att vårdpersonalens bemötande och förhållningssätt gentemot närstående är viktigt samt att deras delaktighet i vården bör förbättras och som i sin tur kan förbättra hälsotillståndet hos patienten med psykossjukdom. Det finns ett stort behov av stöd och kommunikation med vårdpersonal. / Background: Being related to a person who suffers from a psychosis is a complicated, stressful and creates a painful situation. The related are expected to handle their everyday lives including family and work, and at the same time be able to function as support for the patient. Therefore the support shown by the medical staff for the relatives becomes an important issue. Aim: The aim is to describe how nursing staff can provide support to relatives who live close to a person with psychosis. Results: The results are presented in five identified categories where they describe the experience of relatives who live close to a person with psychosis. The descriptions show a variety of experiences of the care of patients with psychosis. This is important knowledge. To sum up, the ability of nursing staff to understand the different experiences of relatives becomes important in order to gain a broader understanding and thereby be able to offer health care adapted to the individual needs of the patient. Discussion: the discussion personal opinions are presented; there is a great need for good alliances, support and communication with the medical staff which implies that the relations between the parties in the nursing relation play a major role in psychosis care.

I Sverige beräknas ca 24 % av befolkningen lida av sömnbesvär och vart tredje besök inom primärvården utgörs av personer som lider av någon form av psykisk ohälsa. Sömnbesvär är vanliga hos personer som har någon form av psykossjukdom och kan leda till att tillståndet förvärras och tillfrisknandet försvåras. Syftet med litteraturstudien var att beskriva vilka omvårdnadsåtgärder som finns att tillgå för att främja nattsömnen hos personer med en psykossjukdom. Studien genomfördes som en litteraturstudie där 9 vetenskapliga artiklar granskades och analyserades. I resultatet skapades två kategorier utifrån hur kunskapsläget såg ut, farmakologiskt perspektiv samt icke-farmakologiska omvårdnadsåtgärder. Resultatet visade att Melatonin och Neuroleptika kunde vara effektiv farmakologisk behandling. Sömnhygieniska principer samt avslappande musik visade sig vara effektiva icke-farmakologiska omvårdnadsåtgärder. Icke- farmakologiska omvårdnadsåtgärder existerar men de är få i förhållande till de farmakologiska åtgärderna som är de mest framträdande varv ytterligare forskning kring icke-farmakologiska åtgärder efterfrågas. Det skulle vara önskvärt att skriva ut icke- farmakologiska omvårdnadsåtgärder ”på recept” i syfte att främja nattsömnen hos personer med psykossjukdom vilket psykiatrisjuksköterskan har en nyckelroll i att utföra. Likaså efterfrågas fortlöpande kompetenshöjande och forskningsbaserad utbildning för psykiatrisjuksköterskor när det gäller sömnbesvär relaterat till psykossjukdom. / In Sweden, approximately 24% suffer from insomnia, and every three visits in primary care are persons who suffer from some form of mental illness. Sleep disorders are common in people who have some form of psychotic illness and can lead to a worsening of the condition and that the recovery becomes harder. The aim of this study was to describe the nursing interventions available to promote sleep in people with a psychotic illness. The study was conducted as a case study where 9 scientific articles were reviewed and analyzed. The result created two categories based on the present knowledge in the area, pharmacological perspective and non- pharmacological nursing interventions. The result showed that melatonin and neuroleptics could be effective pharmacological treatment. Sleep Hygiene principles and relaxant music proved to be effective non- pharmacological nursing interventions. Non- pharmacological nursing interventions exist but they are few in relation to pharmacological actions which are the most prominent. Further researches into non- pharmacological measures are required. It would be desirable to print non- pharmacological nursing interventions "on prescription" in order to promote sleep in people with psychotic illness as the psychiatric nurse has a key role to perform. Similarly, continuous skills enhancement and research-based training for psychiatric nurses regarding sleep disorders related to psychosis are requested.

The discovery that it is possible to identify an individual before the onset of first episode psychosis and that treatment may prevent or delay onset have led to a proliferation of early intervention clinics designed to intervene before symptoms of psychosis have fully appeared. Early intervention has generated considerable debate, given the risks associated with intervening and that the majority of those identified will never develop full-blown psychosis. Despite potential stigmatizing effects, little is known about young people’s views regarding the favourable and/or adverse consequences of early intervention. This research examines the experiences and meaning of illness in young people identified as being at ultra high risk for psychosis and participating in a psychological intervention program. Specifically, the study uses photo elicitation to explore how participants construct and interpret their experiences, and the impact an at risk label has on their sense of self, identity, and social relationships. Five young people were invited to photograph their daily experiences at home, at school, and in the community. The participants and I then analyzed the photographs together in a photo elicitation interview. I further analyzed the visual and textual data from an interactionist perspective, exploring the concept of stigma and its relationship to young people’s experiences. Visual and narrative data revealed that young people reject their at risk status and redefine their experiences to fit with more acceptable and familiar notions of health. Participants are conscious of the stigma associated with psychosis and actively undertake strategies of resistance to avoid stigmatization and uphold a normal self conception and social impression. Photo elicitation provided insight and understanding into the experiences of young people at risk for psychosis that were not available through more traditional methods. The results from this study support the call for a reconsideration of the psychosis risk paradigm. There is a need to increase awareness about the power of diagnostic information and the labeling process. Non-specialized settings such as schools and community health centres may offer more appropriate environments for mental health monitoring and intervention.

The discovery that it is possible to identify an individual before the onset of first episode psychosis and that treatment may prevent or delay onset have led to a proliferation of early intervention clinics designed to intervene before symptoms of psychosis have fully appeared. Early intervention has generated considerable debate, given the risks associated with intervening and that the majority of those identified will never develop full-blown psychosis. Despite potential stigmatizing effects, little is known about young people’s views regarding the favourable and/or adverse consequences of early intervention. This research examines the experiences and meaning of illness in young people identified as being at ultra high risk for psychosis and participating in a psychological intervention program. Specifically, the study uses photo elicitation to explore how participants construct and interpret their experiences, and the impact an at risk label has on their sense of self, identity, and social relationships. Five young people were invited to photograph their daily experiences at home, at school, and in the community. The participants and I then analyzed the photographs together in a photo elicitation interview. I further analyzed the visual and textual data from an interactionist perspective, exploring the concept of stigma and its relationship to young people’s experiences. Visual and narrative data revealed that young people reject their at risk status and redefine their experiences to fit with more acceptable and familiar notions of health. Participants are conscious of the stigma associated with psychosis and actively undertake strategies of resistance to avoid stigmatization and uphold a normal self conception and social impression. Photo elicitation provided insight and understanding into the experiences of young people at risk for psychosis that were not available through more traditional methods. The results from this study support the call for a reconsideration of the psychosis risk paradigm. There is a need to increase awareness about the power of diagnostic information and the labeling process. Non-specialized settings such as schools and community health centres may offer more appropriate environments for mental health monitoring and intervention.