Hoarding disorder is a mental illness that affects about 2-5 % of the population. The most prominent symptoms of hoarding disorder are the inability to discard things and the excessive acquisition of possessions. The home becomes cluttered, often to the point where one no longer can use the rooms for their intended purposes. For example, one can no longer sleep in the bed or use the kitchen for cooking because of the clutter that takes up space. People with hoarding disorder often experience shame because of their disability and as a consequence they withdraw from social engagements and risk isolation. The purpose of this study was to give a literary review of treatment methods for hoarding disorder and their efficacy in Swedish, but also to show the impact of shame on treatment effect through Thomas Scheff’s theory of shame. The primary treatment method is Cognitive behavioral therapy designed especially for hoarding disorder, and has been tested in different forms such as individual-, group-, and internet based treatment. New treatments using Compassion-focused therapy and Acceptance and commitment therapy have also been developed. Studies on hoarding disorder and shame have shown a correlation between shame, symptom severity and identity. These new treatments address the shame experienced and they can hopefully increase the efficacy rate for hoarding treatment. Important factors for treatment progress were, among others, continued high motivation, frequent contact with clinician and a supportive family. A surprising result was that one study showed almost equal result in treatment led by a non-professional as a professional. More research is needed to further develop effective treatment.

The purpose of this thesis was to investigate the feasibility of a treatment for hypersexual disorder (HD) by calculating and reporting the results with pre-collected data from a research project at ANOVA/Karolinska Universitetssjukhuset. The treatment was a cognitive behavioral group therapy (CBGT) developed for HD administered in a 7-session group setting with a sample of HD-diagnosed women (n = 16). Feasibility was explored through symptom change of hypersexuality, sexual compulsivity, psychological distress, and depression. Symptom change in relationship to treatment attendance was also explored. In this thesis, the results are considered in a broader context, discussing theoretical issues concerning women’s sexuality in relation to hypersexual problems and medicalization of hypersexual behaviors.   The treatment was shown to be feasible. Significant decrease was found on all measures. Attendance rate significantly correlated with a decrease in depressive symptoms, but not on other measures. Women’s sexuality might differ from men’s, but the treatment, which was first evaluated for men, is still feasible for women. Treatment for hypersexual problems in women and hypersexual problems in women in general have been understudied, which makes this study an important contribution to the research field. Further treatment studies could potentially investigate whether specific alterations based on gender and sexual orientation could be needed for further development of the treatment. There are issues concerning medicalization of hypersexual behaviors which should be considered when addressing the phenomenon, such as the influence of moral and cultural factors on the understanding of hypersexuality. Still, there is need for treatment for hypersexual behaviors experienced as problematic, and having these problems addressed within the medical and scientific field has potential for being beneficial and is preferred to having them left to alternative, unregulated health care providers.

Background: MI has been successful in strengthen patient oriented treatment and helpingpatients in need for lifestyle change. However, the method has not been establishedeverywhere and there is still inexperience and unawareness surrounding it. Aim: The aim was to describe nurses' experience of working with Motivational Interviewing( and target what they think are the advantages and obstacles when working with it. Method: A total of seven articles about nurses’ experience of using MI were included in this literature review with thematic content analysis. The articles were analyzed from a care taking perspective. Results: The analysis identified two themes: Advantages with MI and Obstacles with MIWithin these two themes, a total of six under themes or categories have been found. In the first theme: positive results and patient communications. In the second theme: knowledge limitations, time factors, support and disinterest. Conclusion: MI is a simple method to learn and helps the communication between nurse and patient. The main reasons for nurses not using MI are lack of knowledge in the method, them feeling insecure in using it and believing it will take longer time to practice. There are also problems with nurses being uninterested in using MI and management or colleagues not supporting the method, despite the evidence of its success. / Bakgrund: MI har visat sig vara en framgångsrik metod för att stärka den personcentrerade vården och behandla patienter i behov av livsstilsförändringar. Samtidigt har inte metoden etablerat sig överallt och det finns en okunskap om den. Syfte: Syftet med föreliggande studie var att beskriva sjuksköterskors upplevelser av att använda motiverande samtal inom omvårdnad och vad de anser är metodens fördelar och hinder. Metod: Studien är en litteraturstudie med tematisk innehållsanalys. Sammanlagt har sju artiklar analyserats utifrån ett vårdgivarperspektiv. Resultat: Två teman identifierades i analysen fördelar med MI och hinder för att använda MI I dessa teman har totalt sex underteman tagits fram, där positiva resultat och utvecklande patient kommunikation återfinns i det första temat och Brist på kunskap och erfarenhet, tidsfaktorn, uppmuntran och stöttning samt ointresse finns i det andra. Slutsatser: MI är en enkel metod som gynnar vården och patientkommunikationen men som skapar en viss osäkerhet hos utövaren då den skiljer sig mot många sjuksköterskorsutbildning. Huvudanledningarna till att MI inte används genomgående är att sjuksköterskorna inte kan metoden fullt ut, känner sig osäkra på den och tror att den tar längre tid att använda. Det finns också de som väljer bort MI då ledning och kollegor inte uppmuntrar till användning.

Schizophrenia is a severe psychiatric disorder associated with cognitive impairments. Polygenic risk for schizophrenia (SCZ-PGR) has been associated with poor performance in cognitive tasks, both in patients and in healthy individuals. It has also been suggested that schizophrenia is associated with accelerated aging. This study examines the association between SCZ-PGR and accelerated non-pathological cognitive aging by performing longitudinal analyses using linear mixed-effects models. We hypothesize that higher SCZ-PGR is associated with accelerated rate of cognitive decline in healthy elderly. The study sample consist of 1746 Caucasian individuals with genetic data. Their performance in general cognition, episodic memory, semantic memory and visuospatial memory was tested over 25 years. SCZ-PGR was significantly associated with poor cognitive function but was not associated with cognitive decline over time with any of the cognitive domains. Our results indicate that genetics of schizophrenia may not be associated with rate of cognitive aging. / Schizofreni är en svår psykiatrisk sjukdom som är associerad med kognitiv nedsättning. Polygenetisk risk för schizofreni (SCZ-PGR) har associerats med sämre resultat på kognitiva test, både hos schizofrenipatienter och friska individer. Det har även föreslagits att schizofreni är associerad med accelererat åldrande. Denna studie avser undersöka associationen mellan SCZPGR och accelererad icke-patologisk kognitivt åldrande genom att genomföra longitudinella analyser i lineära mixade-effekt-modeller. Vår hypotes är att högre SCZ-PGR är associerad med accelererad kognitivt åldrande hos friska. I denna studie ingår 1746 deltagare, där deltagarnas kognitiva förmåga testades under 25 år. Vi analyserade deras SCZ-PGR i relation till generell kognitiv förmåga, episodminne, semantiskt minne och visuo-spatialt minne, samt associationen mellan SCZ-PGR och förändringen av dessa variabler över tid. SCZ-PGR var signifikant associerad med sämre kognitiv förmåga, men inte med kognitiv försämring över tid. Dessa resultat indikerar att gener relaterade till schizofreni inte är associerade till kognitivt åldrande.

Bakgrund: Vårdsamordningsprocessen ligger till grund för att säkerställa en trygg och säker hemgång från slutenvård för patienter som är i behov av insatser från socialtjänst, kommun eller öppenvård. För att underlätta samarbetet mellan de olika aktörerna används sedan 2017 ärendehanteringssystemet Cosmic LINK som kommunikationsverktyg. Vid implementeringen av systemet inkom det avvikelser och klagomål om handhavandefel, okunskap och oförståelse för varandras verksamheter. Under de workshops som hölls för att få en gemensam förståelse framkom att all personal inte hade nödvändig kunskap och kompetens för att kunna följa vårdsamordningsprocessen på ett patientsäkert sätt. Syfte: Syftet med studien är att kartlägga i vilken utsträckning vårdpersonalen har utbildning och kompetens i ärendehanteringssystemet Cosmic LINK samt undersöka behovet av utbildningsinsatser. Metod: Studien har genomförts med hjälp av både kvantitativ och kvalitativ metod. Den kvantitativa metoden för datainsamling består av en enkät med fasta frågor och kvalitativa inslag skickades ut till berörd vårdpersonal. De två kvalitativa metoderna, fokusgrupp och semistrukturerade intervjuer, användes för att samla in data från vårdpersonal och enhetschefer. Slutsats: Vårt resultat visar att det finns ett omfattande behov av utbildning och kompetensutveckling för vårdpersonalen som handhar Cosmic LINK. För att säkerställa att vårdsamordningen fungerar behövs en förbättring av kommunikation och samarbete mellan de olika nivåerna inom psykiatriska kliniken samt en tydliggjord struktur som gynnar en lärande miljö. / <p>Examen i vårdadministration, YH-utbildning: 20 Yh-poäng</p>

Sammanfattning Bakgrund: Antalet anmälningar om barn som far illa ökar i Sverige. Förklaringarna kan vara många men främst att barnens rättigheter tagit plats i olika verksamheter då barnkonventionen blivit lag. Socialstyrelsen påpekar en bristande följsamhet till anmälningsskyldigheten inom hälso- och sjukvården, särskilt inom vuxenpsykiatrin. Fyra av tio anmälningar handlar om psykisk ohälsa hos vårdnadshavare, vilket visar vuxenpsykiatrins viktiga roll i att upptäcka utsatta barn. Syfte: Beskriva erfarenheter och upplevelser kring anmälan gällande barn som far illa eller riskerar att fara illa utifrån sjuksköterskors perspektiv inom vuxenpsykiatrisk specialistvård. Metod: Kvalitativ intervjustudie med induktiv ansats. Tio sjuksköterskor inom vuxenpsykiatrisk specialistvård deltog genom semistrukturerade intervjuer. Konventionell innehållsanalys användes för att analysera transkriberat material. Resultat: Sjuksköterskorna beskriver patientens psykiska tillstånd som bidragande orsak till oro och om orosanmälan görs. Bristande tydlighet kring rutiner när och hur man ska orosanmäla. Stöd från närmsta kollegor uppfattades positivt och främjande för anmälningsbenägenheten, däremot beskrevs brister i samverkan med socialtjänst och återkoppling vilket upplevdes hämmande. God kommunikation i mötet med patienten ansågs centralt för att upprätthålla en terapeutisk allians eftersom förförståelse och reaktioner visade sig påverka sjuksköterskan och orosanmälan. Konklusion: Sjuksköterskorna behöver stöd i sina bedömningar kring orosanmälan. Tydliga rutiner tillsammans med reflekterande utbildning och implementering av standardiserade instrument skulle kunna göra sjuksköterskan tryggare i sin yrkesroll och därmed skapa bättre förutsättningar för sjuksköterskan att identifiera barn som far illa eller riskerar att fara illa. / Abstract Background: The number of reports of children who are ill is increasing in Sweden. The explanations can be many, but primarily that children's rights have taken place invarious activities when the Convention on the Rights of the Child became law. The National Board of Health and Welfare points out a lack of compliance with the notification obligation within health care, especially within adult psychiatry. Four out of ten reports are about mental illness in guardians, which shows the important role of adult psychiatry in detecting vulnerable children. Purpose: To describe experiences and perceptions regarding reporting of children being mistreated or at risk of mistreatment from the perspective of nurses in adult psychiatric specialist care. Method: A qualitative interview study with an inductive approach. Ten nurses in adult psychiatric specialist care participated through semi-structured interviews. Conventional content analysis was used to analyze transcribed material. Results: Nurses describe the patient's mental state as a contributing factor to their concern and decision to report. There is a lack of clarity regarding procedures for when and how to report concerns. Support from colleagues was seen as positive and promoting reporting, but there were perceived deficiencies in collaboration with social services and feedback, which were perceived as inhibiting. Good communication during the meeting was considered central to maintaining a therapeutic alliance as preconceptions and reactions affect the nurse and the report. Conclusion: Nurses need support in their assessments of reporting concerns. Clear procedures, together with reflective education and implementation of standardized instruments, could make nurses more confident in their professional role, and thus increase the likelihood of identifying more children who are being mistreated or at risk of mistreatment.

The purpose of this essay is to examine the patients who were cared for at Stockholm's psychiatric hospital during three periods in history: 1890–1895, 1905–1910 and 1920–1925. The variables examined in the statistical part of the essay are the number of newly admitted patients per period and the diagnoses these people receive. The second part of the essay takes a closer look at how patients from different payment classes are described in the application documents. The focus has been on compiling positively and negatively value-laden words to see which and how many words are used and whether there are differences between the different classes and genders. Another class aspect that has been investigated is how daily life in the hospital has differed between the classes.           The findings show that the number of patients per year is constantly increasing. There is only a small change between the first and the second survey period, from 1910 until and during the years 1920–1925, an enormous change takes place. Many people in the country are in line to be admitted to a hospital, which means that patients who are not judged as seriously ill or as a danger to themselves and others are discharged at a high rate. The diagnostic system undergoes several changes during the examined period, which makes it difficult to follow individual diagnoses over time.           The discourse analysis of the application documents shows that the men in the first class were the ones who were given by far the best reviews, both by relatives and by the chief physician. The focus was on their intelligence and good mood. First-class women also generally received good marks, but they commented more on her calmness and dignity, completely in line with the bourgeois ideal that prevailed then. Third-class patients did not enjoy the same amount of positive words at all. Their bodies and ability to work arouse the most interest in the doctor and the amount of information about their background is less. Everyday life also separates the classes. Tasks, leisure activities and food are adapted to the classes' previous lives to facilitate care and read justment to society, which means that in the first class you devote a lot of time to reading and writing, while in the third class you work with the physical operation of the hospital. The food would also mimic the one you were used to before, which meant that the food for first class was more than twice as expensive per person per day compared to the food you ate in third class.

Bakgrund: Allt fler människor utsätts och upplever traumatiska händelser i livet. I samband med detta ökar risken att fler drabbas av Posttraumatic stress disorder (PTSD). Att lida av symtom från PTSD kan ge flertalet psykiska och fysiska problem, vilket gör det betydelsefullt för dessa personer att uppsöka vård. Syfte: Belysa de faktorer som påverkat beslutet att söka vård bland personer med PTSD. Metod: En allmän litteraturstudie genomfördes med sökningar i två databaser där tio vetenskapliga artiklar som överensstämde med syftet inkluderades till resultatet. Resultat: I resultatet framkom det att personer med PTSD upplevt en stor mängd faktorer som påverkat beslutet att söka vård. De fyra kategorier som framkom var: tillgänglighet till vården, tidigare vårderfarenheter och möjlighet till delaktighet, stigma samt kunskap och förståelse. Konklusion: Sammanfattningsvis framställdes främst tillgänglighet till vård och stigma som faktorer som påverkat personer med PTSD till att söka vård eller inte. Vikten av ökad kunskap om sjukdomen samt individuellt anpassad vård identifierades som positiva faktorer som påverkat beslutet att söka vård för PTSD. Resultatet ger värdefull information till sjuksköterskor och blivande sjuksköterskor för att öka förståelsen kring vårdbehov hos personer med PTSD. Mer forskning och förbättrat arbete i ämnet behövs för att öka kunskapen och tillgängligheten till vård för PTSD samt minska stigmat kring att söka hjälp. / Background: More people are exposed to and experience traumatic events in their lives. Therefore, the risk of suffering from posttraumatic stress disorder (PTSD) also increases. Suffering from symptoms of PTSD causes several mental and physical problems, which makes it important for these people to seek treatment. Aim: To identify factors influencing the decision to seek treatment among people with PTSD. Method: This study was conducted as a general literature study with searches in two databases where ten articles that were consistent with the purpose were included in the result.Results: The result revealed that people with PTSD experience a significant number of factors that influence their decision to seek treatment. The four categories were: accessibility to care, previous experiences in care and chance to participate, stigma and knowledge and understanding. Conclusion: In summary, accessibility and stigma were mainly produced as factors that affect people with PTSD to seek treatment. The importance of increased knowledge about the disease and personalized care is identified as positive factors as an individual decision to seek care for PTSD. The results provide valuable information to nurses and future nurses to increase understanding of the care needs of people with PTSD. More research and improved work on the subject is needed to increase knowledge about and accessibility to care for PTSD and reduce the stigma around seeking help.

Syfte Manualbaserad bildterapi har bevisad effekt för vuxna med depression och en pilotstudie har undersökt metoden för ungdomar med depression. Denna studie undersökte bildterapeuters uppfattningar av att arbeta med manualbaserad bildterapi med ungdomar med depression. Metod Delfimetoden användes för att digitalt samla in fyra bildterapeuters uppfattningar av att arbeta med manualbaserad bildterapi med ungdomar. Öppna frågor analyserades med innehållsanalys vilket resulterade i kodad data. Koder sammanställdes till frågor och sedan formulerades påståenden utifrån expertpanelens skattningar. Studien pågick i fyra steg.   Resultat Denna studie visade bildterapeuters uppfattningar av att arbeta med manualbaserad bildterapi inom barn- och ungdomspsykiatri. Studiens expertgrupp omfattade alla experter som har använt manualen i denna kontext. Studien utmynnade i expertskattningar av 26 påstående inom kategorierna: tillfredsställelse, utveckling,struktur, ungdomsanpassning, individcentrering, terapeutens kunskap, flexibilitet, psykisk ohälsa och hälsofrämjande. Expertgruppen instämde helt i att bildterapeutens kompetens som bildterapeut, yrkeserfarenhet av målgruppen och bildövningarna var viktiga för behandlingen. Samtliga instämde också helt i att ungdomarnas självkännedom ökade och att manualen kunde vara användbar i delar. Bildterapeutiska processer och terapeutisk potential presenterades utifrån neurovetenskaplig kunskap. Slutsats Behandlingsutbudet för depression hos ungdomar är begränsad i Sverige. Ur denna studie framträder uppfattningar om manualbaserad bildterapi som metod och uppfattningar om dess lämplighet för andra ungdomar inom barn- och ungdomspsykiatrin. Expertgruppen prioriterade bildterapeutens specifika kompetens. Studiens storlek och behandlingens potential är skäl till att fler studier behövs. / Aims Manual-based art therapy [MBAT] has proven effective for adults with depression and a pilot study has examined it as a treatment för adolescents with depression. This study aims to investigate art therapists’ impressions of using MBAT with adolescents with depression.   Methods The Delphi method was used to digitally collect four art therapists’ impressions of using MBAT with adolescents. Content analysis of open questions resulted in coded data. Codes formed the basis for questions and statements were formulated based on the ratings of the expert panel. The study was conducted in four stages.   Results   This study shows art therapists impressions of MBAT within adolescent psychiatry. The expert panel included all art therapists with relevant experience. The study culminated in ratings of 26 statements within the categories: satisfaction, development, structure, adolescent modifications, individual-centred, therapist expertise, flexibility, mental illness and well-being. The panel consistently recognized that the art therapist’s expertise as an art therapist, experience from working with the patient group, and the art interventions themselves as essential to the treatment. The panel found that adolescents’ self-knowledge improved and considered isolated  components of the manual useful. The therapeutic processes and potential of art therapy are presented based on current neurological understanding. Conclusion Recommended treatments for adolescent depression are limited in Sweden. This study highlights impressions of MBAT and belief in its suitability for other adolescents within adolescent psychiatry. The expert group prioritized the specific expertise of the art therapist. The limited size of the panel and the promise of MBAT are reasons for further study.

Gender Dysphoria (GD) is defined as significant distress or impairment caused by the discrepancy between an individual's experienced gender and the sex assigned at birth. This work explores the etiology and outcomes of GD through two studies. The first assesses its prevalence in different twin categories, and the second examines the incidence of idiopathic intracranial hypertension (IIH) in individuals undergoing gonadotropin-releasing hormone analogue (GnRHa) treatment for GD. The first study utilizes a population-based approach to analyze the prevalence of GD in twins, using data from a Swedish population-based cohort collected over a 16-year period. The objective is to assess the influence of genetic and environmental factors on the development of GD by comparing its prevalence in different-sex twins, same-sex twins, and non-twin siblings. The results indicate a higher prevalence of GD in different-sex twins and suggest a potential influence of intrauterine factors in the development of GD, necessitating further examination of current genetic and environmental theories. The second study focuses on evaluating the occurrence of IIH in individuals undergoing treatment with GnRHa for GD in Sweden between 2006 and 2016. The study did not observe any cases of IIH within the studied cohort. While better-powered studies are needed to clarify any potential association between GnRHa and IIH, the study results do not present substantial evidence to support this association.