Functional magnetic resonance imaging has been recently the most common tool for examining the neural activity in human and animals. The goal of a typical data-mining challenge is the localisation of brain areas activated during a cognitive task which is usually performed using a linear model or correlation methods. For this purpose several authors have proposed the use of methods evaluating signal complexity which could possibly overcome some of the shortcomings of the standards methods due to their independence on a priori knowledge of data characteristics. This work explains possibilities of using such methods including aspects of their configuration and it proposes an evaluation of performance of the methods applied on simulated data following expected biological characteristics. The results of the evaluation of performance showed little advantage of these methods over the standard ones in cases when the standard methods were possible to apply. However, some of the methods evaluating signal complexity were found useful for determining the regularity of signals which is a feature that cannot be assessed by the standard methods. Optimal parameters of the methods evaluating signal regularity were determined on simulated data and finally the methods were applied on the data examining emotional processing of...

Bakgrund: Bipolär sjukdom är en kronisk sjukdom som karaktäriseras utav förändringar i patientens aktivitetsnivå och stämningsläge. Dessa episoder benämns som mani-, hypomani- och depressionsepisoder. Behandling och omvårdnad fokuseras på att lindra symtom. Syfte: Syftet med denna litteraturstudie var att belysa patienters erfarenheter av att leva med bipolär sjukdom. Metod: I litteraturstudien användes 8 kvalitativa vetenskapliga artiklar. Dessa har sammanställts och analyserats med inspiration av en kvalitativ innehållsanalys. Vid sökning av artiklar användes databaserna CINAHL, PsycINFO och PubMed. Resultat: Resultatet visar att faktorer som påverkar att leva med bipolär sjukdom var att acceptera eller förneka sjukdomen. Patienterna upplevde identitetsförändringar samt oro inför framtiden. Vardagslivet påverkades i stor utsträckning, främst då regelbunden medicinering samt provtagning behövdes för att kontrollera sjukdomen. Det uppstod varierande känslor vid skiftning i sinnesstämningen. För att kunna kontrollera sjukdomen beskrev patienterna att stöd och stöttning var viktigt, detta för att kunna hantera symtomen samt identifiera varningstecken. Motivation till förändring stärks genom goda relationer samt kunskap och förståelse hos patienter, anhöriga och vårdpersonal. Slutsats: Litteraturstudiens resultat visade att diagnosen kan leda till svåra konsekvenser för de som är drabbade samt deras familj och närstående. Därför krävs det mycket stöd och stöttning, utbildning och information till alla inblandade. / Background: Bipolar disorder is a chronicle disease characterized by changes in the patient ́s activity level and mood. These episodes are referred to as mania-, hypomania- and depressive episodes. Treatment and care are focused on relieving symptoms. Aim: The aim of this study was to illuminate patients’ experiences of living with bipolar disorder. Method: This literature review study used 8 qualitative scientific articles. These were compiled and analyzed with the inspiration of a qualitative content analysis. When searching for articles, databases like Cinahl, PsycInfo and PubMed were used. Results: The result shows that factors affecting living with bipolar disorder was to accept or deny the disease. Patients experienced identity change and concern about the future. Everyday life is affected in a large extent, especially when regular medication and blood sampling was needed in order to control the disease. Varying emotion occurred while oscillation in moods. In order to control the disease patients describes how important it is to have support, this in order to manage the symptoms and being able to identify warning signs. Motivation to change is strengthened by good relationships as well as knowledge and understanding, both in patients, relatives and health professionals. Conclusion: The results of the literature review showed that the diagnosis can produce serious consequences for those involved, their family and those related. Therefore it requires a lot of support, education and information for all involved.

Bakgrund: Bipolär sjukdom är en psykisk sjukdom, sjukdomen utmärks av återkommande depressiva- och maniska perioder som påverkar upplevelser av människors livsvärld och hälsa. Sjuksköterskan har en betydande roll när personer med bipolär sjukdom är i kontakt med hälso-och sjukvården. För att öka förståelse kring upplevelser av att leva med bipolär sjukdom, behövs mer forskning. Syfte: Syfte är att belysa människors upplevelser av att leva med bipolär sjukdom. Metod: En kvalitativ metod användes. Narrativer i form av sex självbiografier analyserades, datamaterialet har analyserats utifrån Dahlborg-Lyckhage beskrivning av att analysera narrativer/berättelser. Resultat: I resultatet framkom det fyra teman; Sjukdomens berg- och dalbana; Den eviga psykiska smärtan och dess konsekvenser; Upplevelser av nära relationer och betydelsen av stöd; När diagnosen blir ett faktum och vården brister. Diskussion: Bipolär sjukdom är en psykisk sjukdom som innefattar både patient och anhöriga. Upplevelsen av att leva med bipolär sjukdom är att leva i både hälsa och ohälsa beroende på i vilken period de befinner sig i förhållande till sjukdomen. Konklusion: Människor som lever med bipolär sjukdom upplever att symtomen påverkar hela personens livsvärld. Sjuksköterskan har en stor inverkan på personens mående och upplevelser. / Background: Bipolar disorder is a mental illness, the disease is characterized by recurrent depressive and manic periods that affect the experiences of human life and health. The nurse has a valuable role when people with bipolar disorder are in contact with healthcare. To increase understanding of experiences of living with bipolar disorder, more research is needed. Aim: The aim is to illustrate people's experiences of living with bipolar disorder. Method: A qualitative method was used. Narratives in the form of six autobiographies were analyzed, the data has been analyzed based on Dahlborg-Lyckhage's description of analyzing narratives / stories. Result: During the analysis, four themes emerged; The roller coaster of the disease; The eternal mental pain and its consequences; Experiences of close relationships and the importance of support; When diagnosis becomes a fact and health is lacking. Discussion: Bipolar disorder is a mental illness involving both patient and relatives. The experience of living with bipolar disorder is to live with both health and illness, depending on which disease period they are in. Support from care and nurses is perceived often as lacking. Conclusion: People living with bipolar disorder experiences that the symptoms affect the entire life as a person. The nurse has a major impact on the person's mood and experiences.

Syftet med studien var att undersöka hur bipolär sjukdom kan påverka en människas identitet. Tidigare forskning har föreslagit  att människor med bipolär sjukdom kan ha svårt att identifiera vem de verkligen är och att de kan ha en mindre utvecklad identitet. I denna kvalitativa studie genomfördes tio djupintervjuer som sedan kodades. En tematisk analys utfördes. Fyra teman identifierades: Uppfattning om identitet, acceptans, föräldraskap och sjukdomens påverkan på livet. En övervägande del av respondenterna uppgav att sjukdomen är en del av deras identitet, detta motsäger tidigare forskning. Acceptans uppges ske i olika steg och förenkla livet när sjukdomen väl är accepterad, forskning stöder detta fynd. Respondenterna beskriver en rädsla att sjukdomen ska påverka föräldraskap eller att sjukdomen redan har påverkat föräldraskapet. Flera respondenter uppger att sjukdomen har lett till ett misslyckat föräldraskap vilket, enligt tidigare forskning, kan leda till mindervärdeskomplex. Sjukdomen anses i övervägande del påverka livet negativt och skapa en funktionsnedsättning. Flera respondenter uppgav att sjukdomen har varit ett hinder i deras arbete och enligt forskning kan även detta påverka respondenternas uppfattning om eget värde negativt. Bipolär sjukdom anses i denna studie påverka identiteten kraftigt och i största mån negativt. Fortsatt forskning bör fokusera på ”mixet-method” studier med kvantitativa korrelationer mellan till exempel typ av bipolär sjukdom och grad av funktionsnedsättning. / The purpose of this study was to investigate how bipolar disorder affects a person’s identity. In this qualitative study ten in-depth interviewes were conducted. The interviews were seperated into pieces that were assigned a specific code and a thematic analysis was performed. Four themes were identified: perception of identity, acceptance, parenting and the impact of the illness on life. The majority of the participants stated that the disease is part of their identity, which contradicts previous research. Acceptance is stated to occur in various stages and simplifies life once the disease is well accepted, reasearch supports this finding. Participants described a fear that the disease will affect parenthood or that the disease has already affected parenthood. Several participants stated that the disease has led to failed parenting which, according to previous research, can lead to inferiority complex. The disease is predominantly affecting life negatively and creating disability. Several participants stated that the disease has been an obstacle in their career and according to research this can also have a negative impact on the participants’ perception of their own value. In this study, bipolar disorder is considered to have a strong negative impact on identity. Continued research should focus on “mixed-methods” studies with quantitative correlations between for example type of bipolar disorder and level of disability.

Os mecanismos bioquímicos envolvidos na maioria das doenças psiquiátricas ainda não estão esclarecidos. Estudos recentes têm sugerido a participação de espécies ativas de oxigênio em diversas patologias. Baseados em informações pre liminares da literatura, propusemo-nos a investigar o possível envolvimento de radicais de oxigênio e enzimas antioxidantes na esquizofrenia e psicose maníaco-depressiva. A análise das atividades eritrocitárias da superóxido dismutase (SOD) e glutationa peroxidase (GSH-Px) nestes pacientes mostrou níveis significativamente elevados de SOD (cerca de 1,5 vezes) em relação aos indivíduos normais. A comparação das atividades enzimáticas, em pacientes esquizofrênicos tratados e não-tratados com neurolépticos, tais como clorpromazina, haloperidol e prometazina, mostrou que o aumento da atividade de SOD não e dependente da farmacoterapia. O efeito da medicação sobre os níveis de atividade da SOD e GSH-Px foi avaliado em estudos-modelo com ratos, constatando-se que o tratamento agudo com clorpromazina e Li2C03 não alterou a atividade destas enzimas em eritrócitos, fígado ou cérebro. O tratamento crônico com clorpromazina resultou em uma diminuição significativa na atividade de SOD eritrocitária e da SOD total dos hemisférios cerebrais e cerebelo Um modelo para a geração de \"stress oxidativo\" cerebral foi proposto administrando-se a neurotoxina 6-hidroxidopamina (6-0HDA) no cérebro de ratos por via intraventricular. Com este modelo estudou-se a indução de SOD pela 6-hidroxidopamina, a nível cerebral e eritrocitário, observando-se aumento significante da atividade de SOD nos dois tecidos. O tratamento prévio com clorpromazina não modificou o efeito da 6-0HDA sobre a atividade da SOD sugerindo que o tratamento com neurolépticos não exclui a ocorrência de um \"stress oxidativo\" no cérebro embora tenha atuado como inibidor de peroxidação lipídica em estudos-modelo. A indução de lipoperoxidação por 6-OHDA em meio aerado tamponado foi demostrada em lipossomos multilamelares de lecitina de ovo, constatando-se inibição do processo pela clorpromazina. Analisando-se o efeito de SOD, catalase e sequestradores de radical hidroxila sobre a velocidade de peroxidase, constatou-se que este radical é o provável agente iniciador do processo. Pela técnica de ressonância paramagnética eletrônica usando captador de spin demonstrou-se a formação de radical hidroxila durante a autoxidação de 6-0HDA em pH fisiológico. Postulou-se que os efeitos lesivos da 6-0HDA possam ser devidos em parte à peroxidação lipídica induzida pelo radical hidroxila, gerado na autoxidação de 6-0HDA no cérebro. A formação de 6-OHDA, \"in vivo\", é um tema controverso na literatura. Tentou-se detectar a formação de cromatografia liquida de alta pressão, em homogenatos do corpo estriado de ratos tratados com inibidores da monoamino oxidase e da catecol-O-metil transferase e com D-anfetamina. Este tratamento foi realizado com o objetivo de simular uma condição onde ocorre uma hiperatividade dopaminérgica, como é proposto na esquizofrenia. Nossos resultados mostraram a formação de uma substância com o mesmo tempo de retenção da 6-OHDA, que, no entanto, não foi identificada como 6-OHDA. Sugere-se que esta substância possa ser outro produto hidroxilado da dopamina, tal como a 5-hidroxidopamina. O modelo experimental sugerido neste trabalho foi adequado para estudar a indução de \"stress oxidativo\" cerebral e deverá ser utilizado em estudos futuros, enfocando a indução de lesões a nível de barreira hemotoencefálica por espécies ativas de oxigênio, geradas por produtos da hidroxilados da dopamina. A formação exacerbada de espécies ativas de oxigênio por substratos endógenos autoxidáveis tais como derivados hidroxilados da dopamina, poderia provocar lesões em estruturas importantes do sistema nervoso central. O aumento da atividade eritrocitária de SOD, em pacientes psiquiátricos, pode ser interpretado como uma resposta da defesa do organismo contra os efeitos deletérios de espécies ativas de oxigênio, geradas no cérebro por estas substâncias endógenas, passiveis de romper a barreira hematoencefálica e atingir eritroblastos, a nível de medula óssea, onde poderiam induzir a síntese de SOD. / The biochemical mechanisms underlying the psychiatric disorders still are to be elucidated. Recent studies have suggested the participation of active oxygen species in a number of normal and pathological processes, including mental diseases. We have then decided to investigate the role of oxyradicals and anti-oxidant enzymes in the cases of schizophrenia and manic-depressive psychosis. The erythrocytic activities of superoxide dismutase (SOD) and of glutathione peroxidase (GSH-Px) in blood obtained from schizophrenic and manic-depressive patients were shown to be 1.5 times higher than in normal individuals. Medication with neuroleptic agents such as chlorpromazine, holoperidol and promethazine did not affect the enzyme activities. In the case of manic-depression carriers, the trends for high anti-oxidant enzyme activities were also shown to be independent of lithium therapy. Model studies carried out with rats revealed that acute treatment with chlorpromazine and Li2C03 does not alter the enzyme activities in either blood, liver or brain. Chronic treatment with chlorpromazine led to significant decrease of erythrocytic SOD and total SOD in cerebral hemispheres and cerebelum. Oxidative stress in the brain of rats triggered by 6-hydroxydopamine (6-0HDA) - a well known neurotoxin is here described as a model aiming to shed some light to the present knowledge of the biochemical basis for those mental disorders. In fact, intraventricular administration of 6-0HDA to the brain of rats resulted in increased SOD levels of blood and brain tissues. Pre-treatment with chlorpromazine did not modify the SOD values, indicating that neuroleptic agents probably do not abolish the cerebral oxydative stress. In vitro studies showed that chlorpromazine does not affect the rate of 6-0HDA aerobic oxidation but inhibits the peroxidation of egg lechitin liposomes. That hydroxyl radicals generated during 6-0HDA autoxidation iniciates the lipoperoxidation is indicated by the observed inhibitory effect of added SOD, catalase and hydroxyl scavengers. Using EPR trapping techniques, hydroxyl radical formation during 6-0HDA autoxidation was confirmed. In vivo occurrence of 6-0HDA still remains a controverse fact in the literature. Using HPLC, we have tried to detect the accummulation of hydroxylated dopamines in homogenates prepared from the brain \"striatum\" of anphetamine-treated rats under concomitant treatment with monoamine oxidase and cathecol-O-methyltransferase inhibitors. Inject a component with approximately the same retention time as that of 6-0HDA was found in the chromatogram, perhaps the 5-0HDA. Based on those events we have tentatively proposed that active oxygen species produced by cerebral endogenous autoxidazable substracts such as 6-0HDA can indeed cause chemical lesions to important structures of the central nervous system, resulting neuro-psychiatria manifestations. In this study, we have interpreted the elevated erythrocytic SOD activities found in mental patients as a response against the deleterious effects of active oxygen species generated in the brain by such autoxidazable substracts which might cross the brain blood barrier, reach the erythroblasts and there induce the SOD biosynthesis.

Os mecanismos bioquímicos envolvidos na maioria das doenças psiquiátricas ainda não estão esclarecidos. Estudos recentes têm sugerido a participação de espécies ativas de oxigênio em diversas patologias. Baseados em informações pre liminares da literatura, propusemo-nos a investigar o possível envolvimento de radicais de oxigênio e enzimas antioxidantes na esquizofrenia e psicose maníaco-depressiva. A análise das atividades eritrocitárias da superóxido dismutase (SOD) e glutationa peroxidase (GSH-Px) nestes pacientes mostrou níveis significativamente elevados de SOD (cerca de 1,5 vezes) em relação aos indivíduos normais. A comparação das atividades enzimáticas, em pacientes esquizofrênicos tratados e não-tratados com neurolépticos, tais como clorpromazina, haloperidol e prometazina, mostrou que o aumento da atividade de SOD não e dependente da farmacoterapia. O efeito da medicação sobre os níveis de atividade da SOD e GSH-Px foi avaliado em estudos-modelo com ratos, constatando-se que o tratamento agudo com clorpromazina e Li2C03 não alterou a atividade destas enzimas em eritrócitos, fígado ou cérebro. O tratamento crônico com clorpromazina resultou em uma diminuição significativa na atividade de SOD eritrocitária e da SOD total dos hemisférios cerebrais e cerebelo Um modelo para a geração de \"stress oxidativo\" cerebral foi proposto administrando-se a neurotoxina 6-hidroxidopamina (6-0HDA) no cérebro de ratos por via intraventricular. Com este modelo estudou-se a indução de SOD pela 6-hidroxidopamina, a nível cerebral e eritrocitário, observando-se aumento significante da atividade de SOD nos dois tecidos. O tratamento prévio com clorpromazina não modificou o efeito da 6-0HDA sobre a atividade da SOD sugerindo que o tratamento com neurolépticos não exclui a ocorrência de um \"stress oxidativo\" no cérebro embora tenha atuado como inibidor de peroxidação lipídica em estudos-modelo. A indução de lipoperoxidação por 6-OHDA em meio aerado tamponado foi demostrada em lipossomos multilamelares de lecitina de ovo, constatando-se inibição do processo pela clorpromazina. Analisando-se o efeito de SOD, catalase e sequestradores de radical hidroxila sobre a velocidade de peroxidase, constatou-se que este radical é o provável agente iniciador do processo. Pela técnica de ressonância paramagnética eletrônica usando captador de spin demonstrou-se a formação de radical hidroxila durante a autoxidação de 6-0HDA em pH fisiológico. Postulou-se que os efeitos lesivos da 6-0HDA possam ser devidos em parte à peroxidação lipídica induzida pelo radical hidroxila, gerado na autoxidação de 6-0HDA no cérebro. A formação de 6-OHDA, \"in vivo\", é um tema controverso na literatura. Tentou-se detectar a formação de cromatografia liquida de alta pressão, em homogenatos do corpo estriado de ratos tratados com inibidores da monoamino oxidase e da catecol-O-metil transferase e com D-anfetamina. Este tratamento foi realizado com o objetivo de simular uma condição onde ocorre uma hiperatividade dopaminérgica, como é proposto na esquizofrenia. Nossos resultados mostraram a formação de uma substância com o mesmo tempo de retenção da 6-OHDA, que, no entanto, não foi identificada como 6-OHDA. Sugere-se que esta substância possa ser outro produto hidroxilado da dopamina, tal como a 5-hidroxidopamina. O modelo experimental sugerido neste trabalho foi adequado para estudar a indução de \"stress oxidativo\" cerebral e deverá ser utilizado em estudos futuros, enfocando a indução de lesões a nível de barreira hemotoencefálica por espécies ativas de oxigênio, geradas por produtos da hidroxilados da dopamina. A formação exacerbada de espécies ativas de oxigênio por substratos endógenos autoxidáveis tais como derivados hidroxilados da dopamina, poderia provocar lesões em estruturas importantes do sistema nervoso central. O aumento da atividade eritrocitária de SOD, em pacientes psiquiátricos, pode ser interpretado como uma resposta da defesa do organismo contra os efeitos deletérios de espécies ativas de oxigênio, geradas no cérebro por estas substâncias endógenas, passiveis de romper a barreira hematoencefálica e atingir eritroblastos, a nível de medula óssea, onde poderiam induzir a síntese de SOD. / The biochemical mechanisms underlying the psychiatric disorders still are to be elucidated. Recent studies have suggested the participation of active oxygen species in a number of normal and pathological processes, including mental diseases. We have then decided to investigate the role of oxyradicals and anti-oxidant enzymes in the cases of schizophrenia and manic-depressive psychosis. The erythrocytic activities of superoxide dismutase (SOD) and of glutathione peroxidase (GSH-Px) in blood obtained from schizophrenic and manic-depressive patients were shown to be 1.5 times higher than in normal individuals. Medication with neuroleptic agents such as chlorpromazine, holoperidol and promethazine did not affect the enzyme activities. In the case of manic-depression carriers, the trends for high anti-oxidant enzyme activities were also shown to be independent of lithium therapy. Model studies carried out with rats revealed that acute treatment with chlorpromazine and Li2C03 does not alter the enzyme activities in either blood, liver or brain. Chronic treatment with chlorpromazine led to significant decrease of erythrocytic SOD and total SOD in cerebral hemispheres and cerebelum. Oxidative stress in the brain of rats triggered by 6-hydroxydopamine (6-0HDA) - a well known neurotoxin is here described as a model aiming to shed some light to the present knowledge of the biochemical basis for those mental disorders. In fact, intraventricular administration of 6-0HDA to the brain of rats resulted in increased SOD levels of blood and brain tissues. Pre-treatment with chlorpromazine did not modify the SOD values, indicating that neuroleptic agents probably do not abolish the cerebral oxydative stress. In vitro studies showed that chlorpromazine does not affect the rate of 6-0HDA aerobic oxidation but inhibits the peroxidation of egg lechitin liposomes. That hydroxyl radicals generated during 6-0HDA autoxidation iniciates the lipoperoxidation is indicated by the observed inhibitory effect of added SOD, catalase and hydroxyl scavengers. Using EPR trapping techniques, hydroxyl radical formation during 6-0HDA autoxidation was confirmed. In vivo occurrence of 6-0HDA still remains a controverse fact in the literature. Using HPLC, we have tried to detect the accummulation of hydroxylated dopamines in homogenates prepared from the brain \"striatum\" of anphetamine-treated rats under concomitant treatment with monoamine oxidase and cathecol-O-methyltransferase inhibitors. Inject a component with approximately the same retention time as that of 6-0HDA was found in the chromatogram, perhaps the 5-0HDA. Based on those events we have tentatively proposed that active oxygen species produced by cerebral endogenous autoxidazable substracts such as 6-0HDA can indeed cause chemical lesions to important structures of the central nervous system, resulting neuro-psychiatria manifestations. In this study, we have interpreted the elevated erythrocytic SOD activities found in mental patients as a response against the deleterious effects of active oxygen species generated in the brain by such autoxidazable substracts which might cross the brain blood barrier, reach the erythroblasts and there induce the SOD biosynthesis.

Bakgrund: Bipolär sjukdom breder ut sig allt mer i Sverige och orsakar stort lidande för den drabbade individen. Sjukdomen pendlar mellan återkommande maniska och depressiva skov, som sliter både fysiskt och psykiskt. Sjukdomen har hög dödlighet och kräver förståelse och kunskap från sjuksköterskor, som med rätt medel kan göra skillnad för människor som lever med bipolär sjukdom. Syfte: Att beskriva patienters upplevelser av hur bipolär sjukdom påverkar det dagliga livet. Metod: Kvalitativ innehållsanalys med induktiv ansats. Datan samlades ur självbiografier författade av personer med bipolär sjukdom. Resultat: Ur analysen av datamaterialet framträdde två teman: Leva mellan ytterligheter och Känna sig utanför med nio subteman. Konklusion: Att leva med bipolär sjukdom innebär ofta stort lidande, med kroppsliga och mentala besvär. Sjuksköterskor har stora möjligheter att lindra detta lidande, men behöver då kunskap och förståelse för livet med bipolär sjukdom. / Background: Bipolar disease keeps spreading across Sweden and causes great suffering. The disease alternates between recurrent manic and depressive relapses, taking its toll both physically and mentally. The disease has a high mortality and nurses need understanding and knowledge to find the right tools with which they are able to make a difference for people with bipolar disease. Aim: To describe patients experiences of the influence of bipolar disease in the daily life. Method: A qualitative content analysis with an inductive approach. The data was gathered from autobiographies written by people diagnosed with bipolar disease. Result: From the analysis of data material two themes emerged: Living between extremes and Feelings of not fitting in and being singled out. The informants experienced great contrasts in the symptoms, from complete darkness to feelings of invincibility with nine subthemes. Conclusion: Life with bipolar disease causes great suffering, both mentally and physically. Nurses have the opportunity to ease this suffering, but this will need knowledge and understanding of bipolar disease.

Research has showed that different light scenarios have a profound effect on hospitalized bipolar patients. Different light situations decrease the hospital stay for patients during both manic and depressive episodes. Nevertheless, a field study carried out during this thesis work of two arbitrary patient rooms in Swedish behavioral health clinics showed no incorporation of this knowledge in the light design of the rooms. Both patient rooms had insufficient light levels both in terms of circadian recommendations and perceived brightness. Hence this thesis suggests an improved light design for patient rooms housing bipolar patients. The basis of the improved design is to incorporate a dynamic, circadian lighting that varies depending on the patient's need and diagnosed episode.

Bakgrund: Bipolär sjukdom är vanlig i världen och det blir vanligare i Sverige att personer med sjukdomen söker vård, både inom öppenvården och slutenvården. Omvårdnaden riktar in sig på att stödja och vägleda i hantering av symptom och sjukdomstecken. Hälsoutbildning har visats kunna fördröja återinsjuknandet och en personcentrerad vårdplan likaså. Många med bipolär sjukdom är odiagnostiserade och sjuksköterskan har en viktig roll i att bidra till att uppmärksamma dessa, för att kunna ge en god omvårdnad. Syfte: Syftet var att belysa personers upplevelser och erfarenheter av att leva med bipolär sjukdom. Metod: En litteraturöversikt har gjorts för att få en överblick över kunskapsläget inom det valda området. Den är baserad på tio kvalitativa vetenskapliga artiklar som hämtades från två databaser. Resultat: Resultatet redovisas i fem övergripande teman med tillhörande subteman. De övergripande teman är: Hur sjukdomen uppfattas, Erfarenheter och upplevelser av sjukdomshantering, Relationer, Upplevelser av stigmatisering och Hur arbetet/studier/ekonomi påverkas av sjukdomen. Diskussion: Resultatet diskuterades tillsammans med livsvärldsbegreppet, bakgrunden och ny forskning. Det som diskuterades var om hur livsvärlden kan hjälpa sjuksköterskan att bidra till identifiering av diagnosen bipolär sjukdom, hur viktig vårdrelationen är och hur viktigt det är för personerna att sjuksköterskan tar del av deras livsvärld. Det diskuterades även om vilken betydelse det har för personerna att få stöd från andra som också har bipolär sjukdom. / Background: Bipolar disorder is common in the world and it is becoming more common in Sweden that people with the illness seek care, both outpatient and inpatient care. Nursing care focus on supporting and guiding the management of symptoms and signs of disease. Health education has been shown to delay the relapse and a person-centered care plan as well. Many people with bipolar disorder are undiagnosed and nurses have an important role in helping to address these in order to provide good care. Aim: The aim was to highlight people's experiences of living with bipolar disorder. Method: A literature review has been made to get an overview of the state of knowledge in the chosen field. It is based on ten qualitative research articles which were collected from two databases. Results: The results are reported in five overarching themes with related subthemes. The overarching themes are: How the disease is perceived, Experiences of disease management, Relationships, Experiences of stigmatization and How the work/study/economy is affected by the disease. Discussion: The results were discussed together with the lifeworld term, background and new research. The discussion was how the lifeworld can help the nurse contribute to identify the diagnose bipolar disorder, how important the care relationship is and how important it is to the persons that the nurse takes part of their lifeworld. It was also discussed about how important it is for the persons to get support from others who also have bipolar disorder.

AbstraktTitel: Upplevelser av att leva med en person med bipolär sjukdom - ett familjeperspektiv – En litteraturstudie. Bakgrund: Psykisk ohälsa och sjukdom är idag så vanligt förekommande att det räknas som ett folkhälsoproblem, men det finns fortfarande fördomar och stigmatisering kvar kring bilden av psykisk ohälsa. Ofta är det närstående som vårdar sina psykiskt sjuka anhöriga och sjukvårdspersonal behöver bli bättre på att möta närstående i vården och ta tillvara på deras kompetens och kunskap. Inom psykiatrin har det visat sig att närstående fortfarande kan känna sig utanför och att de upplever sig inte blir sedda av personalen. Det är viktigt att alla parter blir integrerade i vårdarbetet kring den sjuke och att det krävs samarbete mellan närstående och sjukvårdspersonalen. Syfte: Syftet med denna studie var att beskriva upplevelser av att leva med en person med bipolär sjukdom ur ett familjeperspektiv. Metod: Litteraturstudie genomfördes med åtta artiklar, vilka alla hade kvalitativ ansats. Artiklarna valdes ut utifrån ett helikopterperspektiv, granskades och analyserades för att slutligen sammanställas. Resultat: Resultatet presenteras med tre huvudkategorier och nio subkategorier som i stort speglar närståendes upplevelser av att leva med person med bipolär sjukdom. De tre huvudkategorierna är; isolering och frustration, bemötande och stöd samt anpassning och glädje.  Konklusion: Att som närstående vårda sin närstående med bipolär sjukdom kan innebära en stor börda samtidigt som de uttrycker att de vill vara den som vårdar sin närstående. Många uttrycker djup stolthet och kärlek till sin sjuke närstående och de vill finnas där och ställa upp för denne. Negativa konsekvenser för många närstående är att de ofta upplever isolering och ensamhet. Stöd från andra närstående eller vänner ses som värdefullt för att orka med situationen och stöd från sjukvården är viktigt för att kunna stärka närståendes möjligheter att på bästa sätt hantera livssituationen och att familjen får tillgång till lämplig vård och behandling.   Nyckelord: bipolär sjukdom, upplevelse, närstående, erfarenhet, vårdgivare, syskon, föräldrar, kvalitativ, partner, familj, uppfattning / AbstractTitel: Experiences of living with a person with bipolar disorder from a family perspective - A literature review. Background: Psychiatric illness and psychiatric disease is a major part of the public disease and it´s a common health problem today, but there are still existing prejudice and stigmatization towards psychiatric health problems. Today it´s common that relatives has the role of caregivers to the mentally ill person and the mental health professionals has to become more open minded towards the relatives and see their competence and knowledge about their ill family member. Within the psychiatric care relatives often experience a feeling of exclusion from the staff and they also experience that the health caring staff doesn´t take notice of them. It´s important to integrate all concerned into the care of the mentally ill person and interaction between healthcare staff and relatives are of great importance. Aim: The aim of this literature review was to explain how relatives experience living with a person with bipolar disorder from a familyperspective. Methods: The literature review was conducted from eight articles with qualitative approach. They were chosen from a helicopter perspective, examined, analyzed and finally compiled. Results: The result was presented in three main categories and nine subcategories which represents the experiences relatives to a person with bipolar disorder has. The three main categories was; isolation and frustration, treatment and support, adaptation and happiness.     Conclusion: Taking care of a person with bipolar disorde can be a great burden for relatives, but at the same time many relatives mean that they are the ones who want to take care of them. Many relatives express feelings like love and pride to the ill person and they want to be there for them.  Negative consequences  are that they often experience isolation and loneliness. Support from other family members or friends are importent so that they may be able to cope with the situation. Professional support is also of great important to strengthen the relatives to be able to handle their life and their situation and that the family will receive proper care and treatment.  Keywords: “bipolar disorder”, “bipolar disease”, caregiver, relative*, partner, parent, sibling, family, perspective, experience*, perception, qualitative