<p>Syftet med studien var att undersöka hur samarbetet för individer med samsjuklighet ser ut mellan kommun och landsting samt hur möjligheterna ser ut till samordnad vård och behandling. Frågeställningarna var att ta reda på hur samarbetet ser ut mellan kommun och landsting gällande individer med samsjuklighet samt vilka tillvägagångssätt som finns för att förbättra samordnad vård och behandling mellan kommun och landsting. Studien genomfördes med kvalitativa semistrukturerade intervjuer. Den teoretiska utgångspunkten var Fridolfs (2004) fyra motiv till ett bra samarbete. Utifrån det hermeneutiska synsättet tolkades intervjuerna inför resultatet med hjälp av innehållsanalys. Resultatet visar att det finns ett samarbete mellan kommun och landsting men för förbättring behövs det mer erfarenhet och kunskap om varandras arbetsuppgifter. Slutsatsen av resultatet är att mer forskning fordras om hur och på vilket sätt samarbete mellan kommun och landsting kan förbättras. Kan en gemensam huvudman vara ett alternativ?</p>

<p>Psykisk ohälsa ökar i samhället, 20 % av Sveriges befolkning riskerar att någon gång i livet drabbas av depression. 600 personer varje år drabbas av kronisk njursvikt vilket innebär att dialysbehandling kan bli aktuellt. Att leva med en livslång sjukdom, som det innebär när man behandlas med dialys, och samtidigt drabbas av psykisk ohälsa innebär ett stort lidande för den enskilda individen. Genom att sjuksköterskan bemöter patienterna med empati och medmänsklighet så skapar denne goda förutsättningar för att relationen ska präglas av tillit och ärlighet. Syftet med denna litteraturstudie var att belysa hur sjuksköterskan kan identifiera och förebygga depression hos människor som behandlas med dialys. Resultatet visar att depression är vanligt förekommande bland dialyspatienter. Depression hos dessa människor kan leda till sömnproblem, nutritionsproblem, känsla av förlust och social isolering. Identifiering av depression kan ske genom användning av bedömningsformulär, detta kan även användas som en åtgärd för att förebygga depression. Mer kvalitativ forskning inom ämnet hade varit ett bra sätt för att öka förståelsen för denna patientgrupps situation. Genom att öka kunskapen ökar också förståelsen för depression och vad det innebär att leva med en livslång sjukdom och denna komplexa situation.</p> / <p>Mental illness is increasing in society, 20% of Sweden's population is at risk to suffer some from depression at some point in their lives. 600 people each year suffer from chronic kidney failure, which can lead to the need for dialysis treatment. To live with a lifelong disease and suffer from mental illness at the same time exposes the individual for a great suffering. By responding to the patients with empathy and compassion the nurse creates good conditions for the relationship, to be able to be characterized by trust and honesty. The purpose of this literature study was to elucidate how the nurse can identify and prevent depression for people treated with dialysis. The results show that depression is common among dialysis patients. For these people, depression can lead to sleeping problems, nutritional problems, feelings of loss, and social isolation. Identification of depression can be done through the use of evaluation forms; this can also be used as a measure to prevent depression. More qualitative research on the subject would be a good method to increase the understanding of the situation these patients are in. Raising awareness also increases the understanding of depression and what it means to live with a lifelong disease, and the complex situation it means.</p>

<p>During the last 30 years, studies have shown self-help to be effective in a number of areas, and to produce equal or close to equal results compared to face-to-face therapy. The Internet can reach a large number of people at a low cost and add the possibility of two-way communication to self-help, thereby offering cost-effective psychological treatments.</p><p>This thesis is based on four studies and aiming to investigate if self-help treatment conducted through Internet can reduce problems with insomnia, stress and headache and reach effect sizes comparable to previous minimal contact treatment studies. Other aims were to investigate cost-effectiveness, and to examine if adding regular telephone contact would reduce drop-out rates. Treatments involved psychological techniques previously proved to be effective for each problem.</p><p>The first study showed a significant decrease in headache severity, and 50% of the participants in the treatment condition showed a clinically significant improvement. In Study II an Internet-based stress management program resulted in significant reductions of perceived stress, anxiety and depression. Improvements were found in both groups, with stronger effects in the self-help treatment group. Study III, a sleep management program, resulted in statistically significant improvements in the treatment group on all main variables, including total sleep time, total wake time in bed, and sleep efficiency. Some improvements were also found in the control group. Follow-up data indicated that improvements were sustained. Study IV did not confirm the hypothesis that the drop-out rates during headache treatment should decrease significantly if adding short and regular telephone contacts.</p><p>Results from this thesis suggest that Internet is a medium well suited for therapy, with effect sizes comparable to face-to-face therapy, that using Internet as a medium for treatment can reduce costs while still maintaining similar results, and that adding a small amount of telephone contact does not decrease attrition.</p>

<p>This thesis is based on two independent studies, the first in Stockholm County (index year 1984; n=302), and the second, a replication and validation study, in Uppsala County (index year 1991; n=455).</p><p>The general aim was to study all individuals with Long-term Functional Psychosis (LFP) within the two counties of Sweden from an epidemiological perspective and to perform specific studies on a subgroup of individuals with schizophrenia. In the Stockholm study, the total one-year LFP prevalence was 5.3/1 000; in the the rural, suburban and urban areas it was 3.4, 5.6 and 6.6/1 000, respectively. The total one-year prevalence of LFP in Uppsala was 7.3/1 000; in the rural, peripheral city and central city areas it was 6.0, 7.0, and 8.7/1 000, respectively.</p><p>Within the non-schizophrenic subpopulation, a pronounced difference was demonstrated between the two studies with substantially higher prevalence rates in the Uppsala study. The schizophrenic subgroup in Uppsala was re-diagnosed using parallel diagnostic systems (DSM-III, DSM-III-R, DSM-IV and ICD-10), and reasonably comparable prevalence estimates were obtained.</p><p>In both studies antipsychotic drugs were most frequently prescribed for the patients with schizophrenia, and the doses were considered as low to moderate. In the Uppsala study the doses of antipsychotic drugs decreased with a longer duration of illness, while the opposite was found in the Stockholm study.</p><p>The increased mortality rate among patients with schizophrenia was mainly due to unnatural causes of death and cardiovascular diseases, particularly among males.</p><p>The main methodological differences between the two studies were in the sampling procedures. In the Uppsala study, a larger number of care facilities were screened, and a broader set of diagnostic criteria were used for identifying cases from different registers.</p>

<p>Non-adherence to medication is a major obstacle in the treatment of depression. The objectives of the present study were to explore the effect of two interventions aiming to increase antidepressant treatment adherence, and to examine long-term consequences and costs of depression in adherent and non-adherent primary care patients. </p><p>A randomised controlled design was used to assess the respective effects of a written educational adherence enhancing programme and therapeutic drug monitoring in patients with major depression treated with sertraline for 24 weeks. All patients were prospectively followed during two years. </p><p>Treatment adherence was found in 41% of the 1031 included patients. None of the interventions resulted in a significant increase in adherence rate. However, significantly more patients in the group receiving the written educational material had responded at week 24 as compared to patients in the control group. </p><p>The overall remission rate after two years was 68%. In total, 34% of the responders experienced at least one relapse. Response and remission rates at week 24, year 1 and year 2 were significantly higher in adherent as compared to non-adherent patients. No relationship between adherence and relapse rate was seen. </p><p>The mean total cost per patient during two years was KSEK 363 whereof indirect costs represented 87%. No significant differences in costs between intervention groups or between adherent and non-adherent patients could be demonstrated. However, the mean cost per patient was 39% lower for treatment responders as compared to non-responders. </p><p>Non-adherence was predicted by age below 35 or above 64 years, no concomitant medications, personality disorder, sensation seeking personality traits and substance abuse. </p><p>The results indicate a strong positive relationship between treatment adherence and clinical outcome. In addition, the study shows that depression is a costly disease and that certain patient characteristics predict non-adherence.</p>

<p>The aim of this thesis was to critically examine the current use of the Camberwell Assessment of Need (CAN) in outcome assessment for service evaluation. A further aim was to propose a metric for assessing the adequacy of community mental health services in meeting ongoing needs over longer stretches of time.</p><p>We made four prospective follow-up studies of CAN assessments of patients with severe mental illness in community-based mental health care.</p><p>A factor analysis (n=741) gave support for a three-factor model, comprising only 60% of the CAN items. Need assessments (n= 92) in 1997 and 2003 were compared at both the summed total and the underlying item levels of the CAN. The mean total scores did not change, yet there were significant changes in the underlying items. Changes in mean number of needs between 1997 and 1999 were measured (n=262) with both total scores, summed over all CAN items, and with sub-total scores, summed over two sets of items reflecting the social services and the psychiatric services respectively. As indicated by the sub-total scores, all significant changes occurred within the psychiatric services, a result not possible to discern from the total scores. The Met Needs Index (MNI), defined by us as the aggregate measure of beneficial outcome, indicated that needs in general were met during 71% of the intervals between the annuals assessments from 1997 through 2004. However, the variation among particular items was large.</p><p>In conclusion, the summary scores typically used as outcome measures are likely to conceal meaningful variation at the item level. Nevertheless, sub-total scores, being more transparent, might be more useful in outcome assessment. The MNI is a continuous, normally distributed metric, estimable over any number of consecutive assessments, which seems suitable for assessing the achieved benefit of services for patients with long-term ongoing needs.</p>

During the last 30 years, studies have shown self-help to be effective in a number of areas, and to produce equal or close to equal results compared to face-to-face therapy. The Internet can reach a large number of people at a low cost and add the possibility of two-way communication to self-help, thereby offering cost-effective psychological treatments. This thesis is based on four studies and aiming to investigate if self-help treatment conducted through Internet can reduce problems with insomnia, stress and headache and reach effect sizes comparable to previous minimal contact treatment studies. Other aims were to investigate cost-effectiveness, and to examine if adding regular telephone contact would reduce drop-out rates. Treatments involved psychological techniques previously proved to be effective for each problem. The first study showed a significant decrease in headache severity, and 50% of the participants in the treatment condition showed a clinically significant improvement. In Study II an Internet-based stress management program resulted in significant reductions of perceived stress, anxiety and depression. Improvements were found in both groups, with stronger effects in the self-help treatment group. Study III, a sleep management program, resulted in statistically significant improvements in the treatment group on all main variables, including total sleep time, total wake time in bed, and sleep efficiency. Some improvements were also found in the control group. Follow-up data indicated that improvements were sustained. Study IV did not confirm the hypothesis that the drop-out rates during headache treatment should decrease significantly if adding short and regular telephone contacts. Results from this thesis suggest that Internet is a medium well suited for therapy, with effect sizes comparable to face-to-face therapy, that using Internet as a medium for treatment can reduce costs while still maintaining similar results, and that adding a small amount of telephone contact does not decrease attrition.

This thesis is based on two independent studies, the first in Stockholm County (index year 1984; n=302), and the second, a replication and validation study, in Uppsala County (index year 1991; n=455). The general aim was to study all individuals with Long-term Functional Psychosis (LFP) within the two counties of Sweden from an epidemiological perspective and to perform specific studies on a subgroup of individuals with schizophrenia. In the Stockholm study, the total one-year LFP prevalence was 5.3/1 000; in the the rural, suburban and urban areas it was 3.4, 5.6 and 6.6/1 000, respectively. The total one-year prevalence of LFP in Uppsala was 7.3/1 000; in the rural, peripheral city and central city areas it was 6.0, 7.0, and 8.7/1 000, respectively. Within the non-schizophrenic subpopulation, a pronounced difference was demonstrated between the two studies with substantially higher prevalence rates in the Uppsala study. The schizophrenic subgroup in Uppsala was re-diagnosed using parallel diagnostic systems (DSM-III, DSM-III-R, DSM-IV and ICD-10), and reasonably comparable prevalence estimates were obtained. In both studies antipsychotic drugs were most frequently prescribed for the patients with schizophrenia, and the doses were considered as low to moderate. In the Uppsala study the doses of antipsychotic drugs decreased with a longer duration of illness, while the opposite was found in the Stockholm study. The increased mortality rate among patients with schizophrenia was mainly due to unnatural causes of death and cardiovascular diseases, particularly among males. The main methodological differences between the two studies were in the sampling procedures. In the Uppsala study, a larger number of care facilities were screened, and a broader set of diagnostic criteria were used for identifying cases from different registers.

Non-adherence to medication is a major obstacle in the treatment of depression. The objectives of the present study were to explore the effect of two interventions aiming to increase antidepressant treatment adherence, and to examine long-term consequences and costs of depression in adherent and non-adherent primary care patients. A randomised controlled design was used to assess the respective effects of a written educational adherence enhancing programme and therapeutic drug monitoring in patients with major depression treated with sertraline for 24 weeks. All patients were prospectively followed during two years. Treatment adherence was found in 41% of the 1031 included patients. None of the interventions resulted in a significant increase in adherence rate. However, significantly more patients in the group receiving the written educational material had responded at week 24 as compared to patients in the control group. The overall remission rate after two years was 68%. In total, 34% of the responders experienced at least one relapse. Response and remission rates at week 24, year 1 and year 2 were significantly higher in adherent as compared to non-adherent patients. No relationship between adherence and relapse rate was seen. The mean total cost per patient during two years was KSEK 363 whereof indirect costs represented 87%. No significant differences in costs between intervention groups or between adherent and non-adherent patients could be demonstrated. However, the mean cost per patient was 39% lower for treatment responders as compared to non-responders. Non-adherence was predicted by age below 35 or above 64 years, no concomitant medications, personality disorder, sensation seeking personality traits and substance abuse. The results indicate a strong positive relationship between treatment adherence and clinical outcome. In addition, the study shows that depression is a costly disease and that certain patient characteristics predict non-adherence.

The use of coercion in psychiatry involves clinical, legal, scientific, ethical and emotional considerations. This thesis represents an attempt to further increase our understanding of some empirical aspects of this phenomenon. Interviews with 202 involuntarily admitted psychiatric patients and 201 voluntarily admitted patients and 295 of their next of kins were performed and analysed together with data from records and assessments made by professionals. Data was collected during two different periods of time with a compulsory psychiatric care law reform in between. Experience of at least one coercive measure was more common amongst patients who had been committed during the most recent legislation. Otherwise there were no differences in patient experiences during the different laws. Subjective short-term outcome was associated with having a contact person at the ward and being subjectively treated well. There were no relationships between subjective and assessed outcome or between legal status, perceived coercion at admission and subjective or assessed improvement. The changed legislation had no clear effect on the attitudes of patients and next of kins towards coercion. A majority of patients were able to accurately answer the question whether they had been restrained by belt or not during a specific treatment episode. Nineteen of 115 patients reported they had been restrained by belt. Eleven of these cases were true positive and 8 cases were false positive. In conclusion, the main results were first that when it comes to issues related to psychiatric coercion there are typically considerable differences between how these are perceived and interpreted by the professional and by the patient, and second that efforts made to change the face of psychiatric coercion in the minds of patients as well as the public on part of public policymakers have had limited effects.