There has been inadequate attention to the aftercare of psychiatric patients, resulting in an increase in readmission rates plus longer hospital stays. There is a gap in the aftercare for psychiatric patients; The purpose of this qualitative retrospective study is to explore what may have contributed to readmission for psychiatric patients. The biopsychosocial model was used as the theoretical framework to support the direction of the research. The health belief model and transtheoretical model of change were used to further support for biopsychosocial model. The research questions were created to determine the influences on readmission, psychological well-being, explore the adaptation to aftercare and narrative of aftercare from the caregiver. This study used a content analysis to identify patterns and themes with a total of 10 participants. The data used had been previously collected by the behavioral transition team at Houston Methodist Hospital which consists of case notes, mental health diagnoses, hospital history and reasons for readmission. The findings include reports of psychiatric patients not adhering to their prescribed medication due to its side effects or cost, caregivers feeling overwhelmed, and the importance of psychoeducation. Once adjustments were made to the dosage or a prescription for less expensive medication, adherence improved, regular attendance to therapy sessions occurred, and the increase in the level of frustration from the caregiver. Psychiatric patients can benefit in post-discharge care if there is more focus on the reasons for hospital readmission by developing a treatment plan for the prevention of a relapse. This study may improve patient vulnerability to mental health issues and to assist psychiatric patients in establishing balance in their lives.

Bakgrund: Inom psykiatrisk omvårdnad används stödjande samtal som en omvårdnadsåtgärd. Det har framkommit i forskning att patienter upplever god effekt av stödjande samtal. Däremot saknas det forskning kring vad ett stödjande samtal är, utifrån psykiatrisjuksköterskans perspektiv. Syfte: Syftet med studien var att belysa vad ett stödjande samtal är utifrån psykiatrisjuksköterskans perspektiv. Metod: Kvalitativ metod med induktiv ansats har använts. Datamaterialet har analyserats med kvalitativ innehållsanalys. Psykiatrisjuksköterskor inom vuxenpsykiatrisk öppenvård har intervjuats i två regioner i sydvästra Sverige. Tio stycken semistrukturerade intervjuer har genomförts. Resultat: I resultatet framkommer att psykiatrisjuksköterskor anser att det stödjande samtalet ska stärka och identifiera patientens egna resurser. Relationen mellan psykiatrisjuksköterskan och patienten är betydelsefull. Det stödjande samtalet beskrivs som otydligt, saknar struktur och syfte samt tenderar att ha en låg status då det ibland används i väntan på annan behandling. Samtidigt framkommer att det finns en stor frihet med det stödjande samtalet då det inte behöver anpassas till ramar som i en terapi. Konklusion: Det stödjande samtalet är en betydelsefull uppgift där psykiatrisjuksköterskan är bäst lämpad att utföra samtalet. Detta på grund av det omvårdnadsperspektiv psykiatrisjuksköterskan besitter. Det stödjande samtalet är en insats som bör prioriteras inom den vuxenpsykiatriska öppenvården. / Background: In psychiatric nursing, supportive conversations are used as a nursing measure. Research has shown that patients experience a good effect of supportive conversations. On the other hand, there is a lack of research on what a supportive conversation is from the psychiatric nurse's perspective. Aim: The aim of this study was to shed light on what a supportive conversation is from the psychiatric nurse's perspective. Method: Qualitative method with inductive approach has been used. The data material has been analyzed with qualitative content analysis. Psychiatric nurses in adult psychiatric outpatient care have been interviewed in two regions in southwest of Sweden. Ten semi-structured interviews were conducted. Result: The results show that psychiatric nurses believe that the supportive conversation should strengthen and identify the patient's own resources. The relationship between the psychiatric nurse and the patient is of great importance. The supportive conversation is described as unclear, lacks structure and purpose and tends to have a low status as it is sometimes used while the patient is waiting for other treatment. At the same time, it becomes clear that supportive conversation offers a great deal of freedom as it does not need to be adapted to the framework as in a therapy. Conclusion: The supportive conversation is an important task where the psychiatric nurse is best suited to carry out the conversation. This is due to the nursing perspective of the psychiatric nurse. The supportive conversation is an initiative that should be prioritized in adult psychiatric outpatient care.

The study sought to analyse the referrals received by a psychiatric unit in a general hospital in the Western Cape by studying the referral letters and the referral responses. The study sought to determine which departments were referring patients and which patients were being referred. The completeness and appropriateness of the referrals were also studied. The major inferences drawn from this study are that health care workers have a poor concept of what information the psychiatric units needs and about the scope and function of the unit. The poor feedback from the psychiatric unit to the referral source is indicative of the poor communication amongst the health care team members. / Health Studies / M.A. (Advanced Nursing Sciences)

The genetic contribution to the aetiology of psychiatric illness is well-established; however, few variants that alter the encoded protein have been irrefutably identified as causative, leading to the hypothesis that variants affecting gene regulation may play a pathogenic role. This thesis focuses on two genes, Neuregulin 1 (NRG1) and Disrupted in Schizophrenia 1 (DISC1), for which there is strong genetic evidence for involvement in psychiatric illness, as well as evidence for altered expression in patients. Association analysis was carried out to assess the involvement of six intronic NRG1 single nucleotide polymorphisms (SNPs) in schizophrenia and bipolar disorder in two independent samples from the Scottish (Scottish 2; n = 307 control subjects, 303 schizophrenic patients, and 239 bipolar disorder patients and German populations (n = 397 control subjects, 396 schizophrenic patients, and 400 bipolar disorder patients). These SNPs form two haplotypes, one encompassing the 5’ and promoter region of the gene and the other located at the 3’ end of the gene, that were previously associated with schizophrenia and bipolar disorder in a Scottish sample (Scottish 1). The location of these haplotypes, together with the prior evidence for altered NRG1 expression in schizophrenia, suggested the potential involvement of regulatory variants. On combining the Scottish 1 and Scottish 2 samples (combined n = 765 control subjects, 682 schizophrenic patients and 601 bipolar disorder patients), a two- SNP haplotype spanning both coding and non-coding regions in the 3’ region was associated with schizophrenia (p = 0.0037, OR=1.3, 95% CI: 1.1-1.6) and the combined schizophrenia and bipolar disorder case group (p = 0.0080, OR=1.2, 95% CI: 1.1-1.5), with both these associations remaining significant after permutation analysis (p = 0.022 and p = 0.044, respectively). To further understanding of how DISC1, a leading candidate gene for schizophrenia that has also been implicated in other psychiatric disorders, is regulated the previously uncharacterised promoter region was assessed both bioinformatically and in vitro using the dual luciferase reporter assay. The region was found to lack canonical promoter motifs but to contain a CpG island, consistent with DISC1’s ubiquitous pattern of expression. A region located 300bp to -177bp relative to the transcription start site (TSS) was identified as contributing positively to DISC1 promoter activity, whilst a region -982bp to -301bp relative to the TSS was found to confer a repressive effect. FOXP2, a transcription factor which is mutated in a rare speech and language disorder and implicated in autism pathogenesis, was found to repress transcription from the DISC1 promoter. Two pathogenic FOXP2 point mutations reduced this transcriptional repression. Preliminary evidence for a bi-directional regulatory relationship between DISC1 and FOXP2 was observed: a mouse model of schizophrenia that carries a Disc1 L100P amino acid substitution and shows altered developmental Disc1 expression was also found to show altered developmental expression of Foxp2. These results further understanding of two genes whose altered expression might contribute to the pathogenesis of psychiatric illness.

The overall aim was to explore the experiences and knowledge of Personligt Ombud (PO) (a Swedish version of Case Management) and how they relate to the client's recovery as well as their own role of supporting clients in the recovery process. The thesis consists of four original papers (I-IV), and both quantitative and qualitative methods were used. Paper I showed that there were differences in knowledge and attitude toward recovery between three personnel groups: psychiatric outpatient services (POPS), the supported housing team (SHT) and the PO service, where the POs showed greater knowledge about recovery than both POPS and SHT. The results also indicated that university education and training in recovery was positive related to knowledge and attitudes towards recovery. Findings from papers II - IV showed that the clients' choices permeated all of the work that the POs and clients did together. The strategies used by the POs put the client in an active changing process, where he/she became involved in every aspect of the process. The work of the PO included discussions and collaboration with clients. The relationship with the client was the foundation of the work, and it was important to build a working alliance, which also involved a personal dimension. The findings also showed that POs experienced their role as unbounded, where they didn't have to consider any organizational frames, and POs solely represent the client. However, the free role was also connected with responsibilities concerning their work, and POs had to be able to work independently. The role as POs also enables to get a holistic view to both the client as well as to the welfare system. However, the freestanding role demanded legitimacy, and the POs had to work for this. It was important for the PO service to develop good platforms for cooperation with other actors in the society. In conclusion, it is interesting and leads to the question of whether POs and personnel in POPS can relate to two different kinds of recovery: personal vs. clinical. It may be important to consider the need for university education and training in recovery developing recovery-oriented practices. Findings showed that the PO service has developed a method in accordance to the NBHW guidelines, which in many cases, may benefit the clients' recovery process; however, there were aspects the PO service needed to develop. They seemed to use a problem-oriented approach, and they need to change this and look at the clients' strengths, both individual and environmental, and use them in order to support the client to reach goals in life. In Strengths Model Case Management, the Strengths assessment exists, that may be useful. The POs' service also needs to strengthen their organization and possibly develop support among colleagues. / Det övergripande syftet var att undersöka Personligt Ombuds (PO) (en svensk variant av Case Management) erfarenheter och kunskap om återhämtning och hur de använder sig av detta samt deras roll i klientens återhämtningsprocess. Avhandlingen består av fyra originalarbeten (I - IV), där både kvantitativa och kvalitativa metoder användes. Paper I visade att det fanns skillnader i kunskap om återhämtning mellan tre personalgrupper: personal inom psykiatrisk öppenvård, boendestöd och PO verksamheter där det visade sig att POs hade mer kunskap om återhämtning än personal både inom psykiatrisk öppenvård samt boendestödet. Resultatet visade även att universitetsutbildning samt fortbildning i återhämtning hade positiv inverkan på kunskap om återhämtning. Resultaten från paper II - IV visade att klientens val genomsyrade allt arbete som PO och klienten gjorde tillsammans. De strategier som PO använde satte klienten i en aktiv förändringsprocess, där han/hon blev involverad i varje del av processen. Det var viktigt för PO att diskutera och samarbeta med klienterna. I klientarbetet var relationen med klienten en grundbult, där det var viktigt att bygga en allians med varje klient, som även innehöll en personlig dimension. Resultatet visade även att PO upplevde sig obundna i sin roll där de inte behövde anpassa sitt arbete utifrån organisatoriska ramar och tillhörighet, viket bidrog till att PO upplevde att de enbart representerade klienten. Men den fria rollen innebar även att ta ansvar i sitt arbete då PO måste kunna arbeta självständigt. Rollen som PO möjliggör att skapa en helhetssyn på både klienten samt välfärdssystemet. Den fristående rollen krävde legitimitet där PO där det är betydelsefullt att utveckla goda plattformar för samarbete med andra aktörer i samhället. Sammanfattningsvis är det intressant att reflektera om olika yrkesgrupper relaterar till två olika definitioner av återhämtning: personlig vs klinisk återhämtning. I utvecklingen av en återhämtningsinriktad praktik kan det vara betydelsefullt att beakta behovet av personal som är utbildade på universitetsnivå samt fortbildning i återhämtning. Resultaten visade att PO har utvecklat en metod utifrån Socialstyrelsens riktlinjer, vilket i många fall möjligtvis kan gynna klientens återhämtningsprocess, men det finns delar i PO verksamheten som behöver utvecklas. De verkade använda ett problemorienterat förhållningssätt och de bör utveckla verksamheten till att identifiera klienten styrkor, både individuella och miljömässiga och använda dessa för att stödja klienten att nå mål i livet. I Strength Model Case Management finns ett instrument där man tillsammans med klienten inventerar styrkor. Dessa kan bli användbara i processen. PO verksamheten bör även stärka organisationen och eventuellt utveckla stöd bland kollegor.

A literature search was carried out on the role of the Community Psychiatric Nurse (CPN) in counselling within the Primary Health Care Team (PHCT) which highlighted a lack of theoretical knowledge for the psycho-social issues and that CPNs were not trained to provide counselling. The aim of this thesis was centred around the role in counselling the CPNs in Mid-Surrey Health District had in PHCTs, and whether General Practitioners (GPs) perceived CPNs as CPNs or counsellors. Two hypotheses were devised at the beginning of the study and a methodology was pursued in proving or disproving these hypotheses. Results indicated that CPNs were aware of the meaning of the term ‘counselling’ and that all but one felt they had not enough knowledge to carry out more in depth counselling/psychotherapeutic interventions. They all felt that counselling training was inherent to their work as CPNs within the PHCT. This therefore supported the hypothesis that CPN counselling in the PHCT needs to be trained. The GPs result was that they were unaware of qualifications held by CPNs or counsellors. They felt that CPN was invaluable and it would be an advantage if CPNs had counselling training. However, some felt that CPNs needed to retrain the ‘multipurpose’ aspect of their work. From the results it was apparent that there was a misperception of the role of CPN and counsellor as some GPs felt that CPNs were already counsellors. However, the result was inconclusive in proving or disproving the hypothesis. Most GPs introduced the CPN as a CPN and not as a counsellor, although some GPs believed that CPNs were also trained in counselling. It is argued that although these findings indicate that CPNs need counselling training and counselling was perceived as an important part of their work, in depth counselling training was not regarded as necessary to carry out their work as CPN.

The purpose of this study was to test research instruments to measure social and therapeutic rules, role incompetence and violence in hospitalized psychiatric patients. Instruments were tested to measure the specific concepts of: the Discrepant Interpretation of the Therapeutic Rules (GTRS and PTRSI), the Inconsistent Enforcement of the Social Rules (SRSI), the patients' Inability to Adhere to the Therapeutic Rules (PTRSII), the patients' Inability to Adhere to the Social Rules (SRSII) and Violence (VS). The study used a descriptive correlational design. The nursing staff sample consisted of 57 nursing staff working in nine clinical psychiatric units of four local hospitals. The nursing staff sample completed research ratings on 162 patient subjects hospitalized on the units. The data were analyzed for estimations of the psychometric properties of the research instruments. The theory was estimated using correlational and multiple regression techniques. The results indicated that with the exception of the General Therapeutic Rule Scale, the instruments had strong evidence of reliability and validity. The General Therapeutic Rule Scale had limited evidence of reliability and validity. The theoretical model testing indicated that three of the predicted theoretical relationships were supported. The expanded empirical model testing indicated three additional relationships. The amount of variance in violence explained by the expanded empirical model was R² = 18%. The major findings of this study were: (a) the social rules were more important than the therapeutic rules in predicting violence, (b) contrary to the literature, personal patient variables such as, age, sex, and diagnosis did not contribute to violence in the hospital setting, (c) a patient history of violence outside the hospital contributed to the patients' inability to adhere to the rules, (d) a direct relationship existed between the therapeutic and social rules, (e) the subdimensions of violence against self, others and property may be theoretically distinct dimensions of violence, and (f) the relationship of violence and other variables may be curvilinear.

This dissertation is composed of five major chapters. The first is a comprehensiveliterature review, followed by three chapters of research findings, and a final concludingchapter. Major Depressive Disorder (MDD) is a phenotypically complex andheterogeneous syndrome. This challenge and others faced when investigating the geneticbasis for the susceptibility to MDD are discussed, as are tools used to address andovercome these challenges. Included in this review of the literature is a discussion onfindings of genome-wide analyses of MDD, as well as candidate genes that may play arole in the susceptibility to major depression. Following the literature review, threechapters of studies are presented. The first one demonstrates that in humans, the actualnumber of risk genotypes in the serotonin system accounts for over half of the variance inmood response to tryptophan depletion. There was no association between the dopaminesystem and mood response. The main conclusion from that study is that using a pathwayanalysis, rather than a single gene approach, may lead to more informative results whenstudying the genetics of a complex behavior. The next study demonstrates a similarconclusion, however, is not pathway specific. It is shown that in a group of de pressedsubjects not capable of treatment response, the mean number of risk genotypes is greaterthan in a group without depression. This supports the thought that treatment resistancemay be a more severe form of MDD. This study also presents data on single gene resultswhich demonstrate that the genetic basis for susceptibility to major depression may bedifferent and independent from the genetic basis for the capacity to respond to treatment.Several individual polymorphisms are implicated in each case. The final investigation is apublished manuscript refuting the findings of a previously published article onpolymorphisms in the TPH2 gene and association with treatment resistance. Many otherresearch groups have also been able to replicate the results demonstrated here. A finalchapter discusses the overall conclusions about the three research studies, as well as thefield of psychiatric genetics with a focus on the continuing search for the genetic basis ofsusceptibility to major depressive disorder.

No description available.

Class of 2017 Abstract / Objectives: (1) To assess the access to and quality of primary care for patients living with a psychiatric condition(s). (2) To identify demographic factors that may influence the access and quality of primary care services. Methods: Subjects were recruited at HOPE Inc., a behavioral health resource center, in Tucson, Arizona, during pharmacy student-run health fairs. Participants were surveyed using the Primary Care Assessment Tool (PCAT) a questionnaire developed by Johns Hopkins, which assess four domains of primary care. Participants were also surveyed about demographics, mental health diagnosis and their SMI designation. For objective (1): Descriptive statistics for each domain of the PCAT were performed to assess the level of access and quality of care, including comparison to a hypothesized score. For objective (2): Due to the small sample size only descriptive analysis of the demographic data was performed. Results: A total of 11 subjects were surveyed using the PCAT with an average score of 67.64±12.18. This was higher than the hypothesized score of 46. On average, in all four PCAT domains participants scored higher than the hypothesized, value. The lowest scoring domains were, “Care at first contact - Access” and “Coordination of care” (10.45±3.62, Hypothesized score: 8) and (12.36±5.82, Hypothesized score: 10) respectively. The highest scoring domain was “Care at first contact - utilization” (11.09±1.92, Hypothesized score: 12). Conclusions: This study helped to provide a framework for future studies of primary care services using the PCAT survey.