The current study aims to clarify how therapist competence/adherence relates to client characteristics, consumer satisfaction, and dropout rates for family interventions for schizophrenia. The study was conducted as part of a larger treatment trial which will test the efficacy of a culturally informed therapy for schizophrenia (CIT-S), against a treatment as usual (TAU) comparison group. Encouragingly, overall, therapists were found to demonstrate very high levels of competence/adherence in both treatment conditions. As hypothesized, less severe psychiatric symptoms and lower ratings of family difficulty were related to greater therapist competence/ adherence in several non-specific (e.g., establishing rapport) and CIT-S specific (fostering family cohesion) domains of treatment. Also as hypothesized, certain aspects of greater competence/ adherence were related to lower dropout rates and higher consumer satisfaction. Contrary to expectations, general emotional distress and family cohesion were not related to competence/adherence. This study suggests that clinicians and clinical researchers may want to take certain client characteristics into account when evaluating therapist performance, choosing clients who are most suitable for therapy, and providing feedback to supervisees. Additionally, clinicians and researchers may want to monitor therapist performance early on in treatment in order to address issues which may impact consumer satisfaction and treatment retention.

Schizoaffective disorder has routinely exhibited poor outcomes related to diagnostic accuracy and reliability. These pitfalls have been linked to the conceptual nature of Schizoaffective Disorder’s combined psychotic and affective symptoms. Clinicians likely perceive the psychotic components of Schizoaffective Disorder as more severe than the affective symptoms, and have demonstrated a bias toward misdiagnosing Schizoaffective Disorder as Schizophrenia. Thus, the present study sought to examine the clinical conceptualizations of Schizoaffective Disorder compared to Schizophrenia, Bipolar Disorder with psychotic features, and Major Depressive Disorder with psychotic features. The participants were clinicians recruited via email and randomly assigned to either select symptoms from a predetermined criteria list (Recognition group) or to freely list features of the disorders based on their own mental representations (Unprompted group). Participants’ conceptualizations of Schizoaffective Disorder were not entirely congruent with DSM-5 criteria; they conceptualized it as less psychotic than Schizophrenia and less affective than the two mood disorder tasks. Schizoaffective Disorder exhibited the lowest proportion of accurate endorsements, and Schizophrenia had the highest proportion. We hypothesized that Schizoaffective Disorder would have the most overextension endorsements because of its fuzzy boundaries, but Schizophrenia had the highest instead. The Recognition Group outperformed the Unprompted Group overall, which can be explained by the availability heuristic. This study’s findings support the notion that Schizoaffective Disorder’s poor diagnostic outcomes are possibly related to clinicians’ conceptualization of the construct, or that its current diagnostic formulation is not congruent with what clinicians observe in clinical settings.

No description available.

People with psychotic disorders die earlier than expected due to physical illnesses such as cardiovascular diseases, diabetes, and cancer. Despite substantial evidence about managing physical health to improve quality of life and reduce morbidity and mortality, there is limited research from the perspectives of people living with psychotic disorders. Since discourses are attached to all areas of knowledge, I situated myself within the critical social paradigm to understand factors that subjugate voices of people with psychotic disorders in research, practices, and policies. I used postcolonial theory as a lens for my research to show power asymmetry that often oppresses and dominates patients based on exclusion. Postcolonial theory in general and Spivak’s theory more specifically helped draw the parallel between systems of power such as colonization and patriarchy that silence the subaltern in the context of colonization and people with mental illness in psychiatry. Committing to Spivak’s theory of subalternity for self-representation, I chose digital storytelling as a methodological approach for generating transformative knowledge that exposes forces that mediate health and illness. Digital storytelling has an epistemological commitment to self-representation and critical reflection through visual, audio, and other forms of expression that facilitate more accurate articulations of experiences. The overarching purpose of this thesis was to explore the process of digital storytelling with people with psychotic disorders as a means of expressing their voices and to understand how nurses and healthcare leaders engage with the digital stories and foresee the use of digital stories in healthcare practices and policies. Six short videos capturing personal stories of people with psychotic disorders about their physical health needs and concerns were produced. Digital stories are audio-visual vignettes of approximately 2-5 minutes in length, presenting first-person stories in conjunction with audiovisual material (photos, images, soundtracks, etc.). The digital stories were presented in 2 focus group sessions to understand their impact on nurses and nursing leaders (n=15). Findings from this research brought forth stories that spoke of deep struggles people with psychotic disorders experience in addressing their physical health concerns within the psychiatric system. Participants talked about their embodied experiences and invisibility in the healthcare system in their digital stories. They expressed that healthcare providers had paternalistic approaches when addressing their physical health problems and revealed how they compensated for their lack of power and loss of identity. Story makers embedded their experiences with notions of powerlessness and despair and the associated negative impact on significant aspects of their lives. By reflecting on the digital stories and placing the content of stories within the larger context of the psychiatric system and current practices, nurses were able to expose power relations and structures such as quantitative approaches to care, stigma, and the biomedical model of care that excluded the experiences of people with psychotic disorders in psychiatry. Meanwhile, reflecting on the stories exposed nurses’ passive stance in challenging and resisting the dynamics that exclude patients’ voices at every level of care. In this research, Spivak’s theory helped highlight the thematic centrality of epistemic violence and the role of the digital stories in overcoming epistemic injustice and opening a line of communication with those in positions of power in psychiatry.

The issue of psychiatric co-morbidity is a serious public health problem occurring more and more frequently in the treatment of addiction and bringing with it various complications and often premature termination of treatment. The scoring system with a fixed set regime is still being used as the main instrument for treatment of addicted clients on the most specialized departments of psychiatric hospitals, although the effectiveness of the scoring system has not yet been clinically verified. The aim of this pilot study is to demonstrate and verify of the individual cases of clients with different categories of dual diagnosis, how they perceive the balance of the sanctions and rewards and fair setting in the context of the scoring system. Other goals are to find out and verify what is the influence of the scoring system on the motivation to change the behavior and success of treatment, what weaknesses clients with dual diagnosis perceive in this system and how they represent the treatment system, which would make them more fit and motivated to change behavior. Further, this study seeks to establish whether difficulties and obstacles on the way to stand up and go through the scoring system are different for individual dual diagnoses. A qualitative approach is used in the research part of the thesis....

For more than half a decade, lithium has been successfully used to treat bipolar disorder. Worldwide, it is considered the first-line mood stabilizer. Apart from its proven antimanic and prophylactic effects, considerable evidence also suggests an antisuicidal effect in affective disorders. Lithium is also effectively used to augment antidepressant drugs in the treatment of refractory major depressive episodes and prevent relapses in recurrent unipolar depression. In contrast to many psychiatric drugs, lithium has outlasted various pharmacotherapeutic ‘fashions’, and remains an indispensable element in contemporary psychopharmacology. Nevertheless, data from pharmacogenetic studies of lithium are comparatively sparse, and these studies are generally characterized by small sample sizes and varying definitions of response. Here, we present an international effort to elucidate the genetic underpinnings of lithium response in bipolar disorder. Following an initiative by the International Group for the Study of Lithium-Treated Patients (www.IGSLI.org) and the Unit on the Genetic Basis of Mood and Anxiety Disorders at the National Institute of Mental Health,lithium researchers from around the world have formed the Consortium on Lithium Genetics (www.ConLiGen.org) to establish the largest sample to date for genome-wide studies of lithium response in bipolar disorder, currently comprising more than 1,200 patients characterized for response to lithium treatment. A stringent phenotype definition of response is one of the hallmarks of this collaboration. ConLiGen invites all lithium researchers to join its efforts. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.

No description available.

Syftet med denna C-uppsats var att belysa hur anhöriga upplever sin roll i kontakten med psykiatrin till en närstående med diagnosen schizofreni eller schizoaffektivt syndrom. Det undersöks vilka erfarenheter anhöriga har angående att delta i processen kring vårdinsatser för en närstående. Vi hoppas att studien kan bidra till ytterligare sociologisk kunskap inom ämnesområdet för att lyfta anhörigas situation och känsla av utanförskap i relation till vården. Uppsatsen bygger på en kvalitativ intervjustudie där åtta personer har intervjuats över telefon och över Zoom. Genom fem artiklar och en historisk tillbakablick över hur psykiatrin i Sverige har utvecklats så får läsaren en djupare förståelse för hur anhörigas roll relaterat till psykiatrin har utvecklats och ser ut idag. Resultatet redovisas genom att presentera tre teman: Anhörigas kontakt med vårdpersonal, Nutid och Framtid samt Förbättringar gällande anhörigas delaktighet. Vid varje tema sammanfattas intervjusvaren där skillnader och likheter framställs och jämförs med varandra. Det teoretiska ramverket grundar sig på Melvin Seemans alienationsteori samt Birgitta Andersheds teori om delaktighet och används i analysen för att besvara frågeställningarna. Resultatet av den sociologiska analysen visar att anhörigas delaktighet i den närståendes vård förebygger anhörigas upplevelser av maktlöshet, meningslöshet och social isolering i sin vardag och i sin relation till vården. Delaktigheten bidrar även till att anhöriga mår bättre psykiskt och att närstående kan få vård i ett tidigare skede. / The purpose of this bachelor’s thesis was to shed light on how relatives experience their role in contact with psychiatry to a relative with a diagnosis of schizophrenia or schizoaffective syndrome. It also examines what experiences relatives have regarding being included in the process around care interventions. We hope that with this study we can contribute to further sociological knowledge in this subject area to raise the situation of relatives. The thesis is based on a qualitative interview study where eight people were interviewed over the phone and over Zoom. Through a number of articles and a historical review of how psychiatric healthcare in Sweden has developed, the reader gets a deeper understanding of how the role of relatives related to psychiatry has developed and how it looks today. The result is presented by three themes: Relatives' contact with care staff, Present and Future and Improvements regarding relatives' participation. For each theme, the interview results are summarized where differences and similarities are presented and compared with each other. The theoretical framework is based on Melvin Seeman's theory of alienation and Birgitta Andershed’s theory on participation and is used in the analysis to answer the questions. The results of the sociological analysis show that the relatives’ participation in the care of the close relative prevents the relatives' experiences of powerlessness, meaninglessness and social isolation in their everyday life and in their relationship to the care. Participation also contributes to relatives feeling better mentally and that relatives can receive care at an earlier stage.

For more than half a decade, lithium has been successfully used to treat bipolar disorder. Worldwide, it is considered the first-line mood stabilizer. Apart from its proven antimanic and prophylactic effects, considerable evidence also suggests an antisuicidal effect in affective disorders. Lithium is also effectively used to augment antidepressant drugs in the treatment of refractory major depressive episodes and prevent relapses in recurrent unipolar depression. In contrast to many psychiatric drugs, lithium has outlasted various pharmacotherapeutic ‘fashions’, and remains an indispensable element in contemporary psychopharmacology. Nevertheless, data from pharmacogenetic studies of lithium are comparatively sparse, and these studies are generally characterized by small sample sizes and varying definitions of response. Here, we present an international effort to elucidate the genetic underpinnings of lithium response in bipolar disorder. Following an initiative by the International Group for the Study of Lithium-Treated Patients (www.IGSLI.org) and the Unit on the Genetic Basis of Mood and Anxiety Disorders at the National Institute of Mental Health,lithium researchers from around the world have formed the Consortium on Lithium Genetics (www.ConLiGen.org) to establish the largest sample to date for genome-wide studies of lithium response in bipolar disorder, currently comprising more than 1,200 patients characterized for response to lithium treatment. A stringent phenotype definition of response is one of the hallmarks of this collaboration. ConLiGen invites all lithium researchers to join its efforts. / Dieser Beitrag ist mit Zustimmung des Rechteinhabers aufgrund einer (DFG-geförderten) Allianz- bzw. Nationallizenz frei zugänglich.