Bakgrund Trots att personal inom hälso-och sjukvård enligt lag är skyldiga att göra orosanmälan vid misstanke om att ett barn far illa görs relativt få anmälningar inom vuxenpsykiatrin. Essensen inom den psykiatriska vården är vårdrelationen mellan sjuksköterska och patient där kommunikation och patientens delaktighet är av stor betydelse. I sjuksköterskans professionella ansvar ingår att upprätta och behålla en god vårdrelation med sin patient samtidigt som barnperspektivet måste beaktas och skyldigheten att utföra en anmälan vid oro ska följas. Syfte Syftet var att beskriva hur sjuksköterskor,inom vuxenpsykiatrisk öppenvård, erfar och upplever att göra orosanmälan vid misstanke om att ett barn far illa. Metod En kvalitativ studie där åtta sjuksköterskor verksamma på psykiatriska öppenvårdsmottagningar i Stockholms län intervjuades för att besvara studiens syfte. Insamlad data analyserades genom kvalitativ innehållsanalys. Resultat Resultatet presenteras utifrån kategorierna faktorer som påverkar orosanmälan och omvårdnadsperspektivet vid orosanmälan. Sjuksköterskorna i vår studie beskriver att en orosanmälan som leder till stöd för familjen hjälper patienten att fokusera på sin egen behandling. Barnperspektivet måste alltid vara i fokus samtidigt som sjuksköterskan ska sträva efter att med hjälp av kommunikation, tillit och patientens delaktighet behålla och stärka vårdrelationen. Tidigare erfarenhet och stöd från kollegor i teamet skapar trygghet i sjuksköterskans utförande av orosanmälan. Slutsats Resultatet i vår studie tyder på att en orosanmälan i de allra flesta fall bidragit till något positivt i den fortsatta vårdrelationen mellan patient och sjuksköterska. Genom kommunikation och patientens delaktighet kan sjuksköterskan inom den vuxenpsykiatriska öppenvården bidra till att en orosanmälan inte bara leder till att utsatta barn får stöd och skydd, utan också att patienten kan fokusera på sin egen behandling och att den essentiella vårdrelationen bevaras.

Background: Previous research shows that patients with psychotic disorders experience increased vulnerability, powerlessness, and fear as they experience feelings of losing a part of themselves during a psychotic episode. Insufficient knowledge within psychiatric inpatient care is seen by nurses as a hindrance in being able to treat patients with psychotic disorders. Aim: To describe nurses’ experience of meeting patients with psychotic disorders in psychiatric inpatient care. Method: Twelve semi-structured interviews were conducted, the participants consisted of ten nurses specialized in psychiatric care and two general nurses. The interviews were analyzed based on qualitative content analysis with an inductive approach. Results: Nurses experience the importance of understanding the meaning of the relationship and looking after the use of contact personnel which clarified in the category to put the relationship first. Nurses need to create an understanding of the patient and where they are in their situation to minimize the risk of coercive measures being used which is made visible in the category to understand the unique patient. Nurses emphasize that patients remember what happened during care despite ongoing psychosis and how they remember the methods chosen to use for a long time to come which is made visible in the category to have an understanding of the patient’s increased vulnerability. Conclusion: Letting patients be the focus can benefit care in the long run, by creating a safe relationship where the interpersonal relationship can be at the center of the care. This is by creating a safe relationship with an increased understanding of patients where the interpersonal relationship can be at the center of care.

ADHD is one of the most common diagnoses in children and adolescents. For many years, researchers believed that ADHD only affected boys, which led to research being conducted only on boys and men. Recent research has shown, however, that girls are also diagnosed and that it can instead show up in several different ways. Girls showed more often introverted symptoms, while boys more often expressed extroverted symptoms. Previous research shows that girls more often have a comorbidity with depression and anxiety and try to hide their ADHD diagnosis to a greater extent than boys. The purpose of this essay was to increase knowledge about girls' ADHD symptoms and the psychosocial effects that follow. To answer the purpose, a literature study was used where a number of articles were reviewed and compiled. The results of the study indicated insufficient knowledge about girls with ADHD as well as symptoms, treatment and its psychosocial effects. Teachers and other professions had limited knowledge about ADHD and more often recognized stereotypical symptoms that are more prevalent in boys. One can therefore come to the conclusion that girls' symptoms are often overlooked and not always taken as seriously. From a feminist perspective, it can be seen as a phenomenon based on the power structures we live under, which has often become an integral part of our identity.

Bakgrund: Sjuksköterskors ansvarsområde innefattar omvårdnad, och ett av sjuksköterskans kompetensområden är att göra patienten delaktig i sin vård. Dock finns det tillfällen då detta frångås.Tvångsåtgärder kan bli aktuella i samband med vissa psykiatriska sjukdomstillstånd. Fysiska tvångsåtgärder innefattar fasthållning, fastspänning och avskiljning. Syfte: Syftet var att beskriva sjuksköterskors upplevelser av att medverka vid fysiska tvångsåtgärder inom psykiatrisk slutenvård. Metod: En allmän litteraturstudie som baserades på artiklar som var kvalitativa eller hade mixad metod där enbart kvalitativa resultat användes. Tre databaser användes vid sökningen och Högskolan Kristianstads granskningsmall användes för att granska artiklarna. Fribergs (2017) trestegsmodell användes för att analysera artiklarna.  Resultat: Fyra teman framkom under analysen. Dessa var upplevelse av emotionell påverkan vidfysiska situationer, upplevelse av en inre konflikt, upplevelse av makt och maktlöshet samt upplevelse av att behöva stöd. Sjuksköterskor upplevde rädsla och oro över att någon skulle komma till skada i samband med tvångsåtgärder. En inre konflikt uppstod då sjuksköterskorna ogillade att utföra tvång men ansåg att det var nödvändigt för att bevara säkerheten. Bristen på alternativ till tvångsåtgärder ledde till en känsla av maktlöshet. Efter utförda tvångsåtgärder uppstod ett behov av att få stöd från kollegor och chefer. Diskussion: Metoden diskuterades utifrån Shentons (2004) kvalitetsbegrepp tillförlitlighet, verifierbarhet, pålitlighet och överförbarhet. Tre fynd diskuterades i resultatdiskussionen utifrån personcentrerad vård samt sjuksköterskans etiska kod. Dessa var brist på alternativ till tvångsåtgärder, behov av stöttning i samband med tvångsåtgärder och etiska dilemman.

Background: Although it has become more accepted to discuss mental health issues in society negative attitudes persist. This lack of understanding, prejudice, and discriminatory attitudes towards individuals with mental illness result in stereotypes that give rise to stigmatisation. Purpose: The purpose of the paper is to compile previous research to investigate the contexts in which stigmatisation occurs against individuals with mental illness and explore its consequences. Furthermore, it aims to examine measures used to prevent stigmatisation. Method: This paper is a literature review following Arksey & O`Malley`s model for conducting a scoping study. Results: Stigmatisation remains a widespread problem for individuals with mental illness. The most common context where stigmatisation and discrimination occur are out in society by the general public, in workplaces and within healthcare settings. The most severe consequence is self-stigma when individuals internalise the negative attitudes prevalent in society and believe in them. The most successful measure to reducing stigma is contact based interventions. However, there is a lack of evidence on the long-term effectiveness of this method. Conclusion: Stigmatisation against individuals with mental illness continues to be a significant ongoing problem in society despite increased awareness and openness to the subject. The greatest obstacle is the lack of understanding and knowledge about mental illness.

Bakgrund: Hot och våld är vanligt förekommande inom psykiatrisk heldygnsvård och kan anta olika former, inklusive muntliga eller skriftliga hot om fysiskt våld eller skadegörelse. Detta har en betydande påverkan på arbetsmiljön för sjuksköterskorna, vilket resulterar i negativa konsekvenser. Motiv: Det finns ett behov av en djupare förståelse av sjuksköterskans erfarenheter av hot och våld, hur dessa erfarenheter kan bidra till att förbättra vårdkvaliteten, minska risken för trauma både för patienter och sjuksköterskorna samt öka förståelsen i bemötande. Syfte: Syftet med denna studie var att beskriva sjuksköterskors erfarenhet av hot och våld inom psykiatrisk slutenvård. Metod: Studien genomfördes med semistrukturerande intervjuer och analyserad med kvalitativ innehållsanalys. Totalt intervjuades 10 sjuksköterskor inom psykiatrisk slutenvård.  Resultat: Resultat i studien visade att sjuksköterskor inom psykiatrisk slutenvård utsätts för hot och våld i sitt dagliga arbete. Det kan innefatta både verbala och fysiska trakasserier från patienter. Deltagarna beskriver känslor av obehag, rädsla, oro och stress som kan påverka deras förmåga att ge god omvårdnad. De har även upplevt att de blivit kränkta. Betydelsen av bemötande, samarbete och utbildning lyfts fram, tillsammans med förslag på förbättringar för att skapa en tryggare arbetsmiljö. Konklusion: Sjuksköterskor inom psykiatrisk slutenvård står inför hot, verbala trakasserier och fysiskt våld från patienter. Trots dessa påfrestningar försöker sjuksköterskorna hantera situationerna med professionalism och empati. För att skapa en tryggare arbetsmiljö betonas vikten av ett bra bemötande gentemot patienter, samarbete inom personalgruppen och tillgång till adekvat utbildning. Förbättringsförslag inkluderar behovet av bättre anpassade avdelningar och för ökad säkerhet både för personal och patienter.

<p>Det råder brist på forskning som berör psykiatrisk slutenvård utifrån ett patientperspektiv och studier efterfrågas som på djupet kartlägger patienters upplevelser. Syftet med undersökningen var att öppet och förutsättningslöst beskriva upplevelsen av att vara patient i psykiatrisk slutenvård. Tretton patienter inskrivna vid fyra avdelningar intervjuades och materialet analyserades tematiskt. Resultatet visar att deltagarnas upplevelse av den psykiatriska slutenvården är starkt förknippad med de människor de möter på avdelningen.Patientgruppen blir påverkad av stämningen i personalgruppen vilket får konsekvenser för deras upplevelse av vården. Deltagarna uppskattar engagerad personal som är lyhörd för patientens behov och som ger stöd när de behövs som bäst. Patienterna stöttar varandra och delar erfarenheter. Deltagarna upplever att de på olika sätt förlorarkontrollen över sina liv under vistelsen på avdelningen. Avdelningen beskrivs som en plats för välbehövlig vila men upplevs också som långtråkig där tiden går långsamt. Deltagarna tvivlar ibland på vad vården ska ge dem och efterfrågar mer information och delaktighet i behandling samt fler behandlingsmetoder. Resultatet finner stöd i liknande studier på området.</p>

<p>Seasonal variations of mood, behavior and physiology have been of increasing interest. At least two different seasonal rhythms seem to exist: Descriptions of Seasonal Affective Disorder (SAD) with increased weight, increased sleep and fatigue during winter have attracted attention in academic psychiatry and in the general public the last two decades. In addition to such a difference in mood, weight and sleep between summer and winter, many studies describe a spring and fall increase in frequency of suicides and of admissions to hospital for mood disorders. In searching for a possible etiology for these seasonal changes, the main focus has been on variations in length of day. </p><p>The objective of this thesis was to study the existence and pattern of seasonal variation in some forms of behavior and of psychiatric illness among children and adults in Norway. Possible statistical connections between seasonal variations of behavior and changes in length of day and the influences of latitude, sex and age were also studied.</p><p>The monthly numbers of incidents in different groups were studied: All suicides in Norway 1969-96 (N=14.503), admissions to hospital for depression and mania in some hospitals 1992-96 (N=4.341), all violent episodes recorded by the police in Norway 1991-97 (N=82.537), all patient-staff incidents in a psychiatric department 1990-97 (N=502), all telephone calls to the Red Cross help-line for children and adolescents in Norway 1996-98 (N=691.787calls, 220.602 conversations) and in Trondheim, Norway 1991-97 (N=80.983 calls, 22.698 conversations) were included in the thesis. The monthly frequencies of these incidents were compared to an expected equal daily frequency of incidents through the year. Changes with increasing age and increasing latitude were examined. Correlations between the monthly frequencies of incidents and the length of day, with maximum impact at midsummer, and correlations between the monthly frequencies of incidents and the speed of change in length of day, with maximum impact at the equinoxes, were also studied. </p><p>In this thesis, an increased activity in April-June and in October-November is described for all the groups that were studied. In summer and winter there is less activity than in the rest of the year. Among children calling the help-line, a steady diminishing seasonal variation in number of calls with increasing age from 7 to 17 years of age and an increasing seasonal variation in number of calls with increasing latitude were found. Also the seasonal variation of violence increases with increasing latitude in Norway. Among men there is a correlation between the monthly number of suicides and the monthly number of admissions for mania and a correlation between the monthly number of suicides and the monthly number of admissions for depression. Among women there is a diminishing seasonal variation of admissions for depressions with increasing age. The monthly frequency of violence in Norway and the monthly frequency of calls to the Red Cross help-Line for children and adolescents correlated with a delay of 1-2 months with the monthly change in length of day with maximum impact at the equinoxes. </p><p>The results in the thesis correspond with earlier studies describing an increase in the frequency of suicides and an increase in admissions for depressions in spring and fall. A corresponding rhythm for other forms of human behavior is described in the present thesis, indicating that the seasonal rhythm of psychiatric illness reflects a seasonal rhythm of behavior in greater parts of the population. The seasonal variation in behavior seems to increase with increasing latitude, to be more dramatic in the northern than in the southern parts of Norway. In this thesis results supporting a hypothesis of human behavior being influenced by changes in length of day are given. Changes in length of day may induce changes in sleep and other disturbances in the daily rhythm that could change mood and other emotional qualities in vulnerable individuals. The demands on our capability to adapt to changes in length of day are largest at the equinoxes. </p> / <p><b>Årstidsvariasjon av sinnstemning og adferd.</b></p><p>Det er økende interesse for årstidsvariasjon av adferd og av forekomsten av psykiske lidelser. Det synes å foreligge minst to ulike årstidsrytmer i befolkningen; Størst oppmerksomhet har oppdagelsen av vinterdepresjon karakterisert ved tristhet, tretthet, økt vekt og forlenget søvn vakt. I tillegg til en slik forskjell i humør, vekt og søvn mellom sommer og vinter, er det en rekke beskrivelser av overhyppighet av selvmord og av innleggelser i sykehus for depresjoner vår og høst. Årsakene til disse to ulike årstidsrytmene er ikke kjent, men man har antatt at variasjon i dagslengde gjennom året spiller en rolle.</p><p>Hensikten med denne avhandlingen har vært å undersøke om det er årstidsvariasjon i forekomsten av ulike former for adferd og av psykiske lidelser hos barn og voksne i Norge. Videre er eventuelle statistiske sammenhenger mellom adferd og dagslengde gjennom året undersøkt. Til sist er forskjeller i årstidsrytme knyttet til breddegrad, alder og kjønn undersøkt.</p><p>Antallet hendelser pr måned i ulike grupper ble studert; Alle selvmord i Norge 1969-96 (N=14.503), innleggelser for depresjon og mani i en del sykehus 1992-96 (N=4.341), alle registrerte voldsepisoder i Norge 1991-97 (N= 82.537), personalskader i et psykiatrisk sykehus 1991-97 (N=502), alle telefoner til Røde Kors Kontakttelefon for barn og unge i Norge 1996–98 (N=691.787 oppringninger, 220.602 samtaler) og i Trondheim 1991-97 (N=80.983 oppringninger, 22.698 samtaler) ble inkludert i arbeidet. Hyppigheten av alle disse hendelsene i hver måned ble sammenlignet med en forventet lik fordeling av hendelsene året igjennom. Endringer med økende alder og med økende breddegrad ble undersøkt. Videre ble det gjort sammenligninger med dagslengde som er lengst ved sommersolverv og kortest ved vintersolverv, og sammenligninger med endringer av dagslengde som er hurtig ved vår og høstjamndøgn og sakte ved solvervene.</p><p>I alle disse materialene er det en økt aktivitet april – juni og oktober – november, videre er det stille perioder om vinteren og om sommeren. Blant barn som ringer kontakttelefonen er det gradvis avtagende årstidsvariasjon av henvendelser med økende alder fra 7 til 17 år og økende årstidsvariasjon i antallet henvendelser jo lenger nord man kommer i Norge. Også årstidsvariasjonen av vold i Norge endrer seg jo lengre nord man kommer i landet. </p><p>Blant menn er der en korrelasjon mellom det månedlige antallet av selvmord og av innleggelser for mani og mellom antallet selvmord og innleggelser for depresjon. Blant kvinner er det en avtagende årstidsvariasjon av innleggelser for depresjon med økende alder. </p><p>Den månedlige endring av dagslengde som er raskest ved jamndøgnene korrelerer med en viss forsinkelse med forekomsten av vold i Norge og med antallet oppringninger til Barn og Unges kontakttelefon.</p><p>Funnene i avhandlingen er i samsvar med tidligere beskrivelser av en markert økning av suicid og av innleggelser for depresjoner om våren og til dels om høsten. I avhandlingen er en tilsvarende rytme funnet for annen adferd. Dette tyder på at årstidsrytmen av psykiatrisk sykelighet avspeiler en årstidsrytme av adferd i store deler av befolkningen. Videre ser det ut til at forskjellene i adferd gjennom året blir mer markerte jo lengre nord man kommer i landet. I avhandlingen er det funn som støtter en hypotese om at endringer i dagslengde påvirker mennesket, det er mulig at dette skjer gjennom endret søvn og andre forstyrrelser i døgnrytmen. Vår døgnrytme er utsatt for størst krav til å tilpasse seg hurtige endringer i lysforhold rundt jamndøgnene. </p>

<p>It has been suggested that persons with intellectual disabilities (ID) manifest the full range of mental health problems. The main purpose of this thesis is to adapt and evaluate two clinical assessment instruments and to investigate the occurrence of mental health problems as well as psychiatric care utilisation in persons with ID. </p><p>The psychometric properties of a Swedish version of the two instruments [Reiss Screen for Maladaptive Behaviour (RSMB) and the Psychopathology Inventory for Mentally Retarded Adults (PIMRA)] were investigated in a random, institutional and clinical sample of administratively defined (ADDEF) adults with ID (n = 199). The analyses suggest that the RSMB could be used as intended by staff as a primary screening device for the identification of mental health problems in persons with ID, and that the PIMRA had a potential to identify individuals with a specific mental disorder. The psychometric evaluation reveals that the Swedish versions of the RSMB and PIMRA measure a construct related to the diagnostic categories in the DSM-III-R and DSM-IV. This construct could be conceptualised as mental health problems.</p><p>The RSMB and PIMRA results show that the overall occurrence of mental health problems in ADDEF samples of persons with ID (175 men and 148 women) ranged from 34 to 64%.</p><p>The preliminary level of ID was mild (23%), moderate (39%) and severe (38%). The most common mental health problems were aggressive and self-injurious behaviours, depression, anxiety and adjustment disorders. In registered patients receiving out- or in-patient psychiatric care the occurrence of adults with an ICD-10 diagnosis of ID was approximately 1% (70 to 90% had a mild level of ID). </p><p>In contrast to the high frequency of mental health problems reported, psychiatric care was used infrequently. This tendency is particularly evident in persons with moderate and severe ID.</p>

<p>The Scandinavian countries have a long tradition of taking part in peacekeeping missions and also of research in this field. The aim of this thesis is to continue the tradition of research and try to shed some more light on the mental health aspects of peacekeeping operations. Two methods were used to accomplish this. One was to study a Swedish battalion serving for 6 months in NATO´s IFOR mission in Bosnia in 1996, using a longitudinal approach. Questionnaires covering predeployment factors, general mental health, traumatic experiences and effects of support were used. The other method was to perform a register study in which 39 768 individuals who had served in peacekeeping missions were compared to a matched group of the general population with regard to differences in suicide rates. The general level of mental health problems and post-traumatic reactions was low and did not change over time. Traumatic experiences during service only appeared to make a temporary difference in general mental health. There are indications that possible predictors for poor mental health in peacekeepers could be constituted by: lower mean scores on the SOC questionnaire and on the Emotional Stability scale of the FFPI; personality disorders in general; prior family problems or psychiatric problems expressed through suicidal thoughts before deployment and problems experienced post-deployment, such as "relationship problems", death of a close relative", or "financial problems". It was found that the combination of peer support and a defusing session led by platoon commanders had positive effects on the post deployment mental health. The rate of personality disorders appears to be at the same level as or at a slightly lower level than in the general population. Compared to the general population, the suicide rate was showed to be lower in the peacekeeper population.</p>