<p>Methadone Maintenance treatment of compulsive opioid addiction was started by the study of Dole and Nyswander (1965) and has subsequently been replicated in programs throughout the world. Methadone treatment has become the most effective modality for the treatment of chronic heroin addiction. </p><p>In 1966 a Swedish National methadone maintenance program was opened at the Psychiatric Research Center, Ulleråker hospital at Uppsala.</p><p>The aim of this thesis was to study the outcome of methadone treatment along various lines:</p><p>• An open randomised controlled study comparing the efficacy of methadone treatment and drug free treatment in 34 heroin addicts, 20-24 years of age. </p><p>• Before/after comparisons of rehabilitation among 345 heroin addicts admitted during the 23 years when this was a centralised National program.</p><p>• Retention in treatment.</p><p><b>Study subjects, methods and treatment goals: </b>Subjects underwent an admission procedure when background data was collected through hospital records, and personal interviews. Therapeutic efforts focused on vocational rehabilitation, i.e. a return to full-time work or studies, hoping to make patients abandon their drug addict’s life-style and make them socially accepted and self-supporting. </p><p><b>Results: </b>Thirty-four heroin addicts with a history of 4-8 years of heroin use were randomly assigned either to methadone treatment (17) or an untreated control group (17). The controls could not apply for methadone treatment until two years later. Outcome after six years observation showed that 81% became free of drug abuse, while the corresponding figure for the controls was only 1/17 (6%). The mean yearly death rate for the controls was 7.2%. Likewise, among the total material of 345 heroin addicts, 70-80% of the patients became engaged in work or studies, a significant increase compared with the situation before treatment (1.7%). The program was an effective reducer of illicit heroin use and criminality among its patients and prevented the occurrence of HIV infection among patients in long-term methadone treatment. The average one-year retention during 1967-1989 was 90% and cumulative retention showed that 29% were still in treatment 10 years after admission.</p><p><b>Conclusion: </b>The present results emphasise the importance of vocational rehabilitation and support in a treatment strategy based on long-term maintenance therapy.</p>

<p>The present longitudinal study, which comprised 125 children from Grade 2 (typal age: 8) to Grade 6 (typal age: 13), examines and interprets the results of several decoding and reading comprehension tests. A point of departure is the proposition that there may be a lack of concepts about central questions that help interpret the results of an expanding test practice in the educational system. To construct the central questions the typologies and hypothetical causes of reading problems ought to be constrained in relation to explanatory constructs combining reading acquisition and reading difficulties. </p><p>First, the field of research on reading acquisition and reading difficulties was surveyed as a background to the presentation of the model, which is heavily indebted to and basically molded on the balance model but which also takes advantage of the proposition of combining the double-route and connectionist approaches. </p><p>Second, the following themes were investigated empirically:</p><p>– The predictive power of the tests: Generally, there seem to be almost as accurate predictions from Grade 2 as from Grade 3. A combined decoding-comprehension prediction was not shown to be more powerful as a product than as a linear combination.</p><p>– The possibility of an image/symbol transition in early reading acquisition: A weak image/letter decoding correlation distinguished boys weak in reading comprehension from all others in Grade 3; a weak letter/word decoding correlation distinguished those weak from those strong in reading comprehension regardless of gender in Grades 2 and 3; and a weak image/word decoding correlation distinguished boys from girls in Grade 2. </p><p>– Indications of stages in the development of reading: The conclusion is that orthographic decoding is more strongly related to reading comprehension than is phonologic decoding but there appears to be a parallel development of phonologic and orthographic decoding between Grades 3 and 6. This pattern seems to be the same for boys and girls and for those with low and high reading comprehension. </p><p>– Comparing subtypes: The surface/phonologic dyslexia distinctions were tentatively related to the linguistic/perceptual dyslexia distinctions and the letter/word-decoding screening instrument. The compensatory concept is questioned.</p><p>– Dimensions in reading acquisition and reading difficulties: A conclusive proposition of the study is that the hypothetical twofold metaphor/metonym character of language may be instrumental in analysing the complex interaction between the characteristic traits of the learning brain and the construction of meaning through script.</p>

Being severely burned is a traumatic life event that affects the victim both physically and psychologically. Recovery can be a long process that is dependent in part upon psychological factors, but research in this area is still quite limited. The main aim of the thesis was to explore coping, personality and cognitive processes in long-term and short-term adaptation. The participants were recruited from three separate samples of former and consecutive adult burn patients. A questionnaire, the Coping with Burns Questionnaire (CBQ), was developed to retrospectively assess coping. It consisted of six coping factors related in different ways to self-reported health status. Regarding personality, the former patients displayed slightly more Neuroticism than people in general, suggesting an overrepresentation of premorbid neurotic personality traits. Avoidant coping was related to poorer perceived health status, more maladaptive personality traits, and was a strong predictor of psychological symptoms at three months post-burn. Regarding cognitive processes, a moderate attentional bias towards burn-related information was found in the former patients when using the emotional Stroop task. This indicates that the burn may still be an important issue years after the event. Finally, former patients’ reactions to participating in a trauma-related postal survey were investigated. A majority felt that participation was positive or even beneficial, while a small subgroup felt that participation was cumbersome or negative. To summarise, although many burn patients adapt well in the long run, the burn may still be a significant theme and the subgroup of Avoidant copers are especially vulnerable. The CBQ seems to be an adequate tool for discerning individuals at risk for poor adjustment. Trauma-related postal questionnaires are well accepted by a majority of former burn patients. Although long-term prospective follow-ups are needed to further validate the results, it is suggested that early screening of psychological factors could be of value in burn care.

Methadone Maintenance treatment of compulsive opioid addiction was started by the study of Dole and Nyswander (1965) and has subsequently been replicated in programs throughout the world. Methadone treatment has become the most effective modality for the treatment of chronic heroin addiction. In 1966 a Swedish National methadone maintenance program was opened at the Psychiatric Research Center, Ulleråker hospital at Uppsala. The aim of this thesis was to study the outcome of methadone treatment along various lines: • An open randomised controlled study comparing the efficacy of methadone treatment and drug free treatment in 34 heroin addicts, 20-24 years of age. • Before/after comparisons of rehabilitation among 345 heroin addicts admitted during the 23 years when this was a centralised National program. • Retention in treatment. <b>Study subjects, methods and treatment goals: </b>Subjects underwent an admission procedure when background data was collected through hospital records, and personal interviews. Therapeutic efforts focused on vocational rehabilitation, i.e. a return to full-time work or studies, hoping to make patients abandon their drug addict’s life-style and make them socially accepted and self-supporting. <b>Results: </b>Thirty-four heroin addicts with a history of 4-8 years of heroin use were randomly assigned either to methadone treatment (17) or an untreated control group (17). The controls could not apply for methadone treatment until two years later. Outcome after six years observation showed that 81% became free of drug abuse, while the corresponding figure for the controls was only 1/17 (6%). The mean yearly death rate for the controls was 7.2%. Likewise, among the total material of 345 heroin addicts, 70-80% of the patients became engaged in work or studies, a significant increase compared with the situation before treatment (1.7%). The program was an effective reducer of illicit heroin use and criminality among its patients and prevented the occurrence of HIV infection among patients in long-term methadone treatment. The average one-year retention during 1967-1989 was 90% and cumulative retention showed that 29% were still in treatment 10 years after admission. <b>Conclusion: </b>The present results emphasise the importance of vocational rehabilitation and support in a treatment strategy based on long-term maintenance therapy.

The present longitudinal study, which comprised 125 children from Grade 2 (typal age: 8) to Grade 6 (typal age: 13), examines and interprets the results of several decoding and reading comprehension tests. A point of departure is the proposition that there may be a lack of concepts about central questions that help interpret the results of an expanding test practice in the educational system. To construct the central questions the typologies and hypothetical causes of reading problems ought to be constrained in relation to explanatory constructs combining reading acquisition and reading difficulties. First, the field of research on reading acquisition and reading difficulties was surveyed as a background to the presentation of the model, which is heavily indebted to and basically molded on the balance model but which also takes advantage of the proposition of combining the double-route and connectionist approaches. Second, the following themes were investigated empirically: – The predictive power of the tests: Generally, there seem to be almost as accurate predictions from Grade 2 as from Grade 3. A combined decoding-comprehension prediction was not shown to be more powerful as a product than as a linear combination. – The possibility of an image/symbol transition in early reading acquisition: A weak image/letter decoding correlation distinguished boys weak in reading comprehension from all others in Grade 3; a weak letter/word decoding correlation distinguished those weak from those strong in reading comprehension regardless of gender in Grades 2 and 3; and a weak image/word decoding correlation distinguished boys from girls in Grade 2. – Indications of stages in the development of reading: The conclusion is that orthographic decoding is more strongly related to reading comprehension than is phonologic decoding but there appears to be a parallel development of phonologic and orthographic decoding between Grades 3 and 6. This pattern seems to be the same for boys and girls and for those with low and high reading comprehension. – Comparing subtypes: The surface/phonologic dyslexia distinctions were tentatively related to the linguistic/perceptual dyslexia distinctions and the letter/word-decoding screening instrument. The compensatory concept is questioned. – Dimensions in reading acquisition and reading difficulties: A conclusive proposition of the study is that the hypothetical twofold metaphor/metonym character of language may be instrumental in analysing the complex interaction between the characteristic traits of the learning brain and the construction of meaning through script.

Bakgrund: Alla, som vårdas inom rättspsykiatrisk vård, har någon form av psykiskt funktionshinder och har också begått ett eller flera brott. Vården regleras av ett antal lagar. I rehabiliteringen ingår utslussning av patienten till öppna vårdformer genom så kallad permission. Ett antal av de patienter som har permission återintas emellanåt till slutenvården av olika orsaker. De benämns ibland som svängdörrspatienter. Syfte: Syftet var att belysa olika berörda personalgruppers syn på och erfarenheter av vad som har betydelse för om en patient som vårdas enligt lagen om rättspsykiatrisk vård, lyckas eller misslyckas med sin permission. Metod: En kvalitativ ansats valdes och två fokusgruppsintervjuer med sex deltagare i varje grupp genomfördes. Texten analyserades med hjälp av en kvalitativ innehållsanalys. Resultat: Tre huvudteman som hade betydelse för om en permission lyckades framkom: samsjuklighet, hur grundläggande behov mötts och samverkan runt patienten. Under dessa framkom 14 subteman: rätt psykiatrisk diagnos, samtidigt missbruk, följsamhet i medicinering, socialt nätverk, sysselsättning, tryggt boende, patientens ekonomi, se patientens behov, tydlig planering, kunskap och motivation, otydlig ansvarsfördelning, samverkan inför permission, kontaktmannaskap och uppföljning i öppenvård. Konklusion: Mycket fungerar bra i vården runt patienten inom rättspsykiatrisk vård. Brister finns dock som behöver förbättras och utvecklas. Det är viktigt att patienterna är delaktiga i vården och att olika instanser skapar individuella förutsättningar och flexibla lösningar för att permissionen ska lyckas. Ordnad ekonomi är av stor betydelse för att permissionen ska lyckas, då det påverkar många delar i patientens vardag. När patienten misslyckas med permissionen kan orsaken vara att man inte har tagit reda på dennes verkliga behov eller inte tagit tillräcklig hänsyn till dessa i permissionsplaneringen. Bristande resurser i samhället bidrar ibland till att patienter inom rättspsykiatrisk vård inte får rätt eller tillräckliga insatser, vilket är ett problem. / Background: Everyone in forensic care has some type of psychiatric disability and has carried out one or more criminal acts. The care is regulated in a number of laws. One part of the patient’s rehabilitation is the transition from closed to open care by so-called leave. A number of the patients that are on leave are sometimes readmitted to closed care for different reasons. These patients are sometimes referred to as “revolving door patients”. Aim: The aim was to determine different concerned personnel groups’ opinions and experiences of what is important, if a patient that is cared for according to the law of forensic care, is to be successful or unsuccessful with his/her leave. Method: A qualitative approach was chosen and two focus group interviews, with six participants in each group, were performed. The text was analyzed with the help of a qualitative content analysis. Results: Three main themes came to light that have significance as to how successful a leave is: comorbidity, how fundamental needs are taken care of and collaboration concerning the patient. 14 subthemes were found under the three main themes: correct psychiatric diagnosis, concurrent misuses, compliance in medication, social networks, employment, safe accommodation, the patient’s economy, seeing the patients needs, clear planning, knowledge and motivation, indistinct line of responsibility, collaboration prior to leave, contacts and follow-up in open care. Conclusion: Many functions are adequate in the care of patients within forensic care. Though there are deficiencies that need to be improved and developed. It is important that the patients participate in the care and that different authorities create individual conditions and flexible solutions if a leave is to be successful. Arranged economy is important if a leave is to be successful, as much of the patient’s everyday existence is affected. When the patient is unsuccessful with a leave, the reason could be that the patient’s real needs are not known, or not enough consideration has been taken to the patients needs when planning the leave. Inadequate public recourses sometimes contribute to patients, in forensic care, not receiving correct or sufficient measures (help), which is a problem.

Bakgrund: Det finns i litteraturen inga självklara definitioner på vad en informell tvångsåtgärd är. En definition som nämns är en tvångsåtgärd som patienter får underkasta sig som inte är reglerad i lagstiftningen. Tidigare forskning menar även att det kan innebära hot om repressalier om patienterna inte medverkar till förutbestämda åtgärder, vilket en del deltagare menar är ett bra sätt för att få patienter att medverka till sin vård. Den litteraturgenomgång som genomförts visar att det finns få genomförda studier i ämnet informellt tvång. Syfte: Syftet med studien är att undersöka sjuksköterskornas erfarenheter av informellt tvång. Metod: Studien genomfördes som en intervjustudie med kvalitativ ansats. Materialet analyserades sedan med Graneheim och Lundmans kvalitativa innehållsanalys. Resultat: Resultatet redovisas utifrån fem kategorier med tillhörande underkategorier. Informellt tvång som maktutövning, Informellt tvång utifrån en vilja att hjälpa, Sjuksköterskornas erfarenheter av informellt tvång, En korrekt dokumentation av informellt tvång är centralt samt Erfarenhet av informellt tvång ger medvetenhet. Slutsats: Det finns inga riktigt tydliga skillnader mellan informellt och formellt tvång i praktiken. Patienter inom den akutpsykiatriska slutenvården utsätts för hot om tvång och de ställs inför ultimatum beträffande sin vård. Det finns inte heller några tydliga definitioner på vad informellt tvång är vilket behöver tydliggöras för att kunna ge en bättre förståelse för betydelsen av begreppet. / Background: In literature, there is not a singular definition of what an informal coercive action is. One of the definitions mentioned however is as follows: “ A informal coercive action is an coercive measure that patients may receive, one that is not regulated by law.” Earlier research also suggests that it can mean under the threat of reprisals should the patients not commit to the predetermined measures, which according to some participants is a good way to make the patients mediate to their care. The literary review done, shows that there are only a handful of studies concluded on the subject of informal coercion. Purpose: The purpose of this study is to examine nurses experience of informal coercion. Method: The study was accomplished through interviews with qualitative effort. The gathered material was then analysed with Graneheim´s and Lundman´s content analysis. Results: The outcome was then presented based on five categories with associated subcategories. Informal coercion as exercised power, Informal coercion based on a will to help, Nurses experiences of informal coercion, Documentation of informal coercion events and its importance and Experiencing informal coercion raises awareness. Conclusion: In practice, there are no evident differences between informal coercion. Patients in emergency psychiatric care are exposed to threats of coercion and put to ultimatums regarding their care. Neither are there any clear definitions of what informal coercion is, this needs to be clarified to achive a better understanding of what informal coercion is.

Mental illness is a major problem in today's society and many individuals have experienced a mental health problem. Severe mental illness, such as schizophrenia, bipolar disorder, and major depression, is also relatively common, and mental illness can even lead to a person taking their own life. For individuals who have such destructive thoughts, quick access to care and proper evaluation and treatment is crucial. Therefore, the value of acquiring a special ambulance with a focus on psychiatric care has been identified. However, to utilize these special ambulances to their full potential, it is important that they are placed at optimal locations.         We propose an optimization model that aims to identify optimal locations for psychiatric emergency units in a specific geographical region. A collaboration with Region Skåne allowed us to use real data, and thus perform a scenario study to evaluate the optimization model. In our scenario study, we used our model to identify the optimal placements of one, two, and three psychiatric ambulances based on population and risk probability, respectively. The results from the scenario study show that the optimal location for a certain area can vary depending on which perspective is chosen. It is therefore important to have clear and well-thought-out goals for the placement of special ambulances.

This study analyses the fact that young adults under the age of 21 were sent to mental institutions in the early 20th century. To further examine this statement, three main questions provide insights about life inside of the mental hospital in Växjö, Sweden. What factors did overall result in psychiatric care for young adults in the early 20thcentury? By using microhistory as a historical method, what aspects can indicate patient's subordinate role at the hospital? How can the psychiatric institutions be viewed from a disciplinary standpoint while focusing on the power they possess over underage individuals? The chosen institution is called Sankt Sigfrid's hospital (alsoWexio hospital) and provides valuable records and journals between the years of 1907and 1921, on which the study is based on. The results show that a total of 38 patients were admitted to the hospital under this period. Generally, there were 5 different illnesses that resulted in psychiatric care and dementia primaria was the most common one. The ages ranged between 11 and 20, with 20 as the most common age when arriving at the hospital. According to the results, most patients came from a background of farming and landowning. Poor relief was the most common factor for young adults being admitted to the hospital, whereas the second most common factor was the father overseeing the decision. Furthermore, 4 patients were part of a microhistorical study which primarily concluded that they were being subjected to constraint by the hospital. Since the material is examined from a disciplinary standpoint where the hospital is viewed in a position of power, the result is an example of psychiatric expansion through the country. This maintains the belief that psychiatric care developed through different phases of the 19th and 20th century and thus were in constant reform, whereas this study is merely an example of this process of developing.

Bakgrund: Samtidigt som andligt utövande hos personer med psykossjukdom påverkar faktorer såsom välbefinnande, återhämtning och läkemedelsföljsamhet upplever dessa patienter att den andliga dimensionen inte tas i beaktning av sjuksköterskan i omvårdnaden. För att förbättra den holistiska omvårdnaden är det således av vikt att få en ökad förståelse för sjuksköterskans erfarenhet av andlig omvårdnad till patienter med psykossjukdom. Syfte: Att beskriva psykiatrisjuksköterskans erfarenhet av andlig omvårdnad till patienter med psykossjukdom. Metod: Kvalitativ litteraturöversikt med systematiskt tillvägagångssätt. Betydelse: Genom att undersöka psykiatrisjuksköterskans erfarenheter av andlig omvårdnad hos patienter med psykossjukdom kan vi öka vår kunskap kring hur den andliga dimensionen kan integreras i omvårdnaden. Resultat: Tre huvudteman formulerades: Sjuksköterskans förutsättningar; Definitionen av andlighet, Sjuksköterskans egna trossystem, Sjuksköterskans personliga egenskaper. Hindrande faktorer; Kunskapsbrist, Strukturella faktorer, Stigma. Främjande faktorer; Vårdrelationen, Livsberättelsen som verktyg, Andligt empatiskt förhållningssätt, och Betydelsen av klinisk erfarenhet. Slutsats: Andlighet i vårdkontexten behöver definieras och andlig omvårdnad behöver utformas och implementeras i omvårdnaden. Sjuksköterskor behöver kunna prata om den andliga dimensionen och ha självkännedom om den egna andligheten. Sjuksköterskor behöver ha kunskap i kulturell och religiös normativitet samt hur andliga uttryck kan skiljas från psykotiska symtom, vilket behöver integreras i läroplanen. / Background: Whilst practicing spirituality among people with psychotic illness affects factors such as well-being, recovery and compliance, the experiences of these patients is that the nurse does not take this dimension into consideration in the nursing care. To improve holistic care, it is therefore of importance to increase knowledge revolving the nurse’s experiences of spiritual care to patients with psychotic illnesses. Aim: The aim of this study was to describe psychiatric nurses’ experiences of spiritual care to patients with psychotic illnesses. Method: A qualitative literary study with a systematic approach. Meaning: By examining the psychiatric nurses’ experiences of spiritual care amongst patients with psychotic illness, we hope to increase the knowledge in how the spiritual dimension can be integrated into nursing care. Result: Three main themes were formulated: The nurses' prerequisite qualification; The definition of spirituality, The nurses' own belief system, The nurses' personal presumptions. Impeding factors: Lack of knowledge, Structural factors, Stigma. Promoting factors; The nurse-patient relationship, The life story used as a tool for continued care, The spiritual empathic approach, and The importance of clinical experience. Conclusion: Spirituality in the context of care needs to be defined, and spiritual care needs to be adequately shaped and applied in nursing. Nurses need to be able to discuss the spiritual dimensionand possess a self-awareness regarding their own spirituality. Nurses require knowledge concerning cultural and religious normativity, and how displays of spirituality can be distinguished from psychotic symptoms, which needs to be included in the nursing curriculum.