Professional literature in the past five years regarding the care and treatment of deinstitutionalized chronic mentally ill (CMI) persons has presented growing concerns that services for some CMI persons are inadequate or nonexistent. A number of previous authors have suggested that there may be a consistent, as opposed to a random, bias in the traditional mental health service delivery system whose services are contingent upon client characteristics that, in the very least, assume foresight, independence, initiative, and consistency. Lacking these qualities, clients may not seek services to which they are entitled or they may be frustrated in maintaining those services. This study provides a description of a CMI population (n = 142) that received outreach services from a small county psychiatric hospital. These clients were selected because they were evaluated as severely disturbed, potentially impulsive, and had a history of not following through with traditional mental health services, i.e., they did not make or keep prescribed appointments for therapy or education. This group served as a model against which to compare characteristics of the traditionally engaged clients. Previous authors as well as this study found that the dropout populations were younger, less compliant with prescribed anti-psychotic medication, engaged in more alcohol and drug use, were more likely to live independently and to be rehospitalized with greater frequency. Increased hospitalization also correlated with less functional independent living skills. In other reported research several variables were found to discriminate the younger CMI. This study could only confirm an increase in substance abuse although several confounding factors are discussed. Finally, the outreach program itself was examined, some services were quantified, and some were related to specific client characteristics. For instance, 40 percent of this CMI population was primarily reliant on their outreach worker for all transportation beyond walkable distances; and those clients receiving the most number of outpatient visits were those rated most rejecting of services and those with the poorest independent living skills. The treatment population was found to have reduced their total number of admissions and days hospitalized during the two-year period of investigation.

Hyperacusis is a type of decreased sound tolerance where the individual has decreased loudness discomfort levels (LDL), normal hearing thresholds and is sensitive to ordinary environmental sounds. Persons with hyperacusis frequently seek help at audiological departments as they are often affected by other audiological problems. Regrettably, there is neither a consensus-based diagnostic procedure nor an evidence-based treatment for hyperacusis. The principal aim of this thesis was to gain knowledge about the clinical condition hyperacusis. The specific aim of Paper I was to compare hyperacusis measurement tools in order to determine the most valid measures for assessing hyperacusis. Items from a constructed clinical interview were compared with the LDL test, the Hyperacusis Questionnaire (HQ) and the Hospital Anxiety and Depression Scale (HADS). LDLs were significantly correlated with the anxiety subscale of the HADS. A third of the 62 investigated patients scored below the previously recommended cut-off for the HQ. The results suggest that HQ and HADS in combination with a clinical interview are useful as part of the assessment procedure in patients with hyperacusis. The aim of Paper II was to further investigate the patient group with respect to individual characteristics, psychiatric morbidity and personality traits. It was shown that anxiety disorders and anxiety-related personality traits were over-represented, which suggests common or cooperating mechanisms. Avoidance behaviour proved to be very common in the patient group, as was being unable to work due to hyperacusis. In Paper III it was investigated in a randomized controlled trial whether Cognitive Behaviour Therapy (CBT) could be helpful for patients with hyperacusis. The effect of CBT for hyperacusis was assessed with measures of LDLs, symptoms of hyperacusis and of anxiety and depression, fear of (re)injury due to exposure to sounds, and quality of life, compared to a waiting list control group. There were significant group effects for a majority of the measures with moderate and strong effect sizes within- and between groups. After assessment the waiting list group was also given CBT, and was then reassessed with similar effects. The results were maintained for 12 months, concluding CBT to be potentially helpful for these patients.

Research in community management of the severely mentally ill has been scarce. Two primary components of community care in particular need evaluation, residential arrangements and styles of "case management." The purpose of this study was to evaluate the interaction of two types of residential arrangements (single- and double-occupancy) and two types of case management ("assertive" and "limited") in a 2 X 2 design. Participants were individuals with a severe mental illness served by CMHS, Inc. Individuals were matched on DSM-III-R diagnoses and sex: 8 had roommates and received assertive case management, 5 had roommates and limited case management, 5 lived alone and received assertive case management, and 5 lived alone with limited case management. Data were obtained from three independent sources: (1) each client was interviewed using the Denver Community Mental Health Questionnaire (DCMHQ) and the Inventory of Socially Supportive Behaviors (ISSB) on four separate occasions over three consecutive months; (2) frequency of client contact with family members over the same time interval was tracked by case managers; and (3) concurrent attendance in day treatment sessions, diagnosis, number of previous hospitalizations, and approximate number of months of previous hospitalization were obtained from community mental health center records. DCMHQ scores for acute symptoms and interpersonal conflict were combined into an index called problems, while ISSB scores measured social support received. Monthly follow-ups for three consecutive months were used to obtain stable estimates of problems and support. Significant positive correlations were found between family involvement and problems, family involvement and residential arrangements, social support and problems, group attendance percentage and age, problems and social support, and a marginal relationship between residence and social support. Statistically significant negative correlations were found between case management and problems, social support and number of previous hospitalizations, group attendance percentage and problems, and residence and age. In multiple regression involving all predictors, the variables other than roommating and case management, (i.e., average family involvement, number of previous hospitalizations, program attendance, and age, considered together) predicted both problems reported and support received, while as second and third steps in the regression analysis case management and residence did not significantly predict problems or social support. In other words, once chronicity (i.e., number of previous hospitalizations), family contact, age, and group attendance were controlled, case management and residence both vanished as predictors. Future studies should consider these factors, and other aspects of the natural context, when evaluating community interventions for the mentally ill in a more controlled experimental design. With respect to developing new research for community adjustment, recommendations for more controlled studies were made and two new community intervention procedures were described. / Department of Psychological Science

I Sverige lever mellan 20- 40 procent av befolkningen med en psykisk ohälsa. Behandlingen av psykisk ohälsa, utifrån en humanistisk människosyn, inriktar sig på en hälsofrämjande process genom att stödja och stärka individen genom stödjande samtal. Syfte; Syftet med denna studie var att beskriva sjuksköterskors erfarenheter av stödjande samtal inom psykiatrisk öppenvård. Metod; En kvalitativ studie genomfördes där data samlades in med hjälp av semistrukturerade intervjuer av sjuksköterskor inom psykiatrisk öppenvård. Data analyserades med hjälp av en konventionell innehållsanalys. I studien inkluderades totalt 12 sjuksköterskor. Resultat; Stödjande samtal beskrevs av sjuksköterskorna som en viktig och bärande del i relationen mellan sjuksköterska och patient inom psykiatrisk vård. Arbetslivserfarenhet och tillgänglighet beskrevs som betydande faktorer för stödjande samtal. Konklusion; Det fanns en upplevd otydlighet av innehåll och mål med stödjande samtal hos sjuksköterskorna. Otydliga riktlinjer för stödjande samtal kan leda till att sjuksköterskorna blir stressade. Rutiner och struktur är viktiga faktorer och det kan medföra att sjuksköterskorna blir mer stresståliga och finner en ökad trygghet i att utföra stödjande samtal. / In Sweden, 20- 40 percent of people live with a mental illness. The treatment of mental illness is based on a humanistic approach, focusing on health promotion by supporting and strengthening the individual through supportive conversations. Purpose; The purpose of this study was to describe nurses' experiences of supportive conversations in their work with psychiatric outpatients. Method; A qualitative study was conducted, in which data were collected using semi-structured interviews with nurses in outpatient psychiatric care. Data were analyzed by conventional content analysis. The study included a total of 12 nurses. Results; Supporting conversations was described by nurses as an important and fundamental part of the relationship between nurse and patient in psychiatric outpatients. Experience and availability were described as significant factors for supporting conversations. Conclusion; Nurses experienced that content for supporting conversations and aims were indistinct. Indistinct guidelines for supportive conversations may lead to nurses becoming stressed. Routine and structure are important factors that may result in nurses working better under pressure and feeling more confident in supporting conversations.

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M.Cur. / Please refer to full text to view abstract

Bakgrund: I dagsläget finns djur inom vården med ett brett spektrum för att assistera människan med rent praktiska saker. Terapi med djur inom psykiatrin har dock inte etablerat sig på samma sätt med strukturerad evidens som i den somatiska vården. Både barn med psykiatriska handikapp och personer med demens har studerats tillsammans med djurterapi, men studier på patienter med psykisk ohälsa är få. Syfte: Syftet var att beskriva upplevelser av djurterapi hos patienter med psykisk ohälsa samt granska den metodologiska aspekten undersökningsgrupper i valda artiklar. Metod: Artikelsökning skedde vid Högskolan i Gävle under hösten 2016 i databaserna MedLine via PubMed, CINAHL och PsycINFO. Sökord i MeSH-termer var “Animal assisted therapy”. Vid sökning i fritext användes sökorden “Mental disorders”, “Psychiatric disorders” och ”experience”. Dessutom genomfördes en manuell sökning med relevans för inklusionskriterier, syfte och frågeställningar. Artiklar lästes individuellt och gemensamt. Därefter sammanställdes resultat och tabeller. Huvudresultat: Totalt 11 artiklar ingick i litteraturstudien. Artiklarna redovisar övergripande positiva resultat så som en källa till glädje, samhörighet och en känsla av att vara behövd, ökad livskvalitet, självkänsla och ökad social förmåga. I avseende på depression framkom både positiva och negativa resultat. Slutsats: Resultaten i föreliggande litteraturstudie visar att terapi med djur kan ge positiva upplevelser hos patienter med psykisk ohälsa. Detta genom att stärka självkänsla, förmåga att lättare klara av vardagen och underlätta sociala kontakter. För sjuksköterskan kan kunskap och evidensstöd inom djurterapi utgöra ett verktyg i dennes yrkesutövning. Speciellt inom klinisk omvårdnad för att överbrygga interaktion och främja patientens hälsoprocess. Dock är studierna få inom detta ämne och ett bättre kunskapsunderlag är önskvärt för att kunna använda djurterapi på ett evidensbaserat arbetssätt inom vården. / Background: In today’s caring of human beings we find animals to assist in a lot of different ways. Therapy with animals has been studied in younger persons and people with dementia but in persons with psychiatric disorders few studies have been made. Purpose: The aim of this article was to describe experiences of animal assisted therapy (AAT) in patients with psychiatric disorders and survey the methodological aspect investigational groups in the articles. Method: Search of articles was made at Högskolan in Gävle during autumn 2016 using database MedLine and WebCrawler PubMed, CINAHL and PsycINFO using MeSH search word “Animal assisted therapy”. Words used in free text search were “Mental disorders”, “Psychiatric disorders” and ”experience”. Manual search was also made according to relevance, aim and question formulation. Selected articles were read individually and together results and tables were then compiled. Result: This review includes 11 articles. Predominant results were shown regarding experiences as a source of joy, feeling of belonging and to be needed, quality of life, self-esteem and social interaction and lower anxiety. Both positive and negative results were found when it comes to depression. Conclusion: AAT seems to have positive influence in patients with psychiatric disorders regarding better self-esteem, encourage managing daily life and facilitate social interaction. In nursing this knowledge might be a tool to use in clinical care-giving. This could help nurses to support patients to conquer interaction and promote health progress. Howsoever few studies have been made in this topic and better basis of knowledge is desirable to be able to use AAT in nursing based on evidence.

This study was designed to investigate the possibility of relationships among sociometric status, prognosis, and selected personality variables of state hospital patients.

The purpose of this thesis will be to examine one student's personal struggle in life and how those events have helped him to find his purpose and reason for being. This examination will be done by using a Scholarly Personal Narrative (SPN) approach to explain how music has been at the forefront of all moral and ethical decisions ever made in his life in order to find his true calling or vocation. This thesis will be broken down into 3 main chapters with several sub chapters taking the reader though the life of Jared M. Ford. This thesis will then culminate with the authors own understanding of what he feels is his purpose for living. A fourth and chapter will also be included to show the author's own musical works in an attempt to give the reader a better understanding of how music has helped him to understand his true calling.

The present study estimated the genetic and environmental effects on different dimensions of religiosity, explored how genetic and environmental effects covary across different dimensions of religiosity, and decomposed the covariance of genetic and environmental effects between different dimensions of religiosity and internalizing and externalizing psychiatric disorders. Dimensions of religiosity were found to be largely influenced by additive genetic and unique environmental effects, with little influence observed from common enviromental effects. Multidimensional analyses found that the seven religiosity factors observed in the present study were influenced by one common additive genetic factor, three common unique environmental factors, and unique environmental effects specific to each religiosity factor. Bivariate analyses of the seven religiosity factors and four psychiatric disorders found that the negative correlation between alcohol dependence and six of the seven religiosity factors could be accounted for by additive genetic effects. Similar results were obtained for nicotine dependence and one religiosity factor, "Social Religiosity" and for phobia and the religiosity factor "Unvengefulness" with shared genetic factors accounting for the observed correlation. For phobia and the religiosity factor "God as Judge", the correlation due to additive genetic factors was positive while that due to common environmental effects was negative. Analysis of a subset of religiosity items showed that for one religiosity factor, additive genetic effects increased over time while common environmental effects decreased. The results of the present study point to the complexity of the religiosity construct and suggest that various dimensions of religiosity are differentially related to various psychiatric disorders.