Background: A large number of the Swedish population are today living with some kind of mental illness. With an understanding of patient's experiences of continuity, the nurses are able to meet each patient based on their desires. This contributes to an increased opportunity for the patient to achieve health. Aim: The aim of this study was to illuminate patients' experience of continuity of care in psychiatric care. Method: A literature-based study was conducted by analysis of qualitative articles. The articles were found through systematic searches in the databases Cinahl and PsycINFO. A total of eight articles were selected and analysed according to Friberg's five-step model. Results: The result was presented in three main themes which illuminated the patients' perspective. The first theme described the meaning of a care relationship to achieve continuity of care. In the second theme information was presented about how patient participation affects continuity. The third and last theme highlights the organizations effects on continuity. Conclusion: The conclusion is that an increased understanding of patient's own experiences of continuity is needed. It provides an opportunity for patients to achieve health and for health care professionals to meet the patient based on individual conditions in the care relationship. Maintaining continuity in psychiatric care has several positive aspects, both for the individual but also for the health care staff and organization, and should therefore be a priority. / I detta examensarbete var syftet att belysa patienters upplevelser av kontinuitet inom den psykiatriska vården. Psykisk ohälsa är vanligt och förekommer i samhället världen över. Hur patienten upplever den psykiatriska vården påverkas av olika faktorer. Det är av stor betydelse för sjuksköterskan att förstå och lära av dessa faktorer för att möta patienter i olika vårdsammanhang. Patienters upplevelser av kontinuitet var en av dessa faktorer som framkom i detta examensarbete. Efter sökning i två olika databaser kunde åtta kvalitativa vetenskapliga artiklar väljas ut till grund för examensarbetets resultat. Analysen av materialet utgick från Friberg (2017) femstegsmodell som beskrivs i metodavsnittet. Utifrån analysen kunde tre huvudteman och åtta underteman utformas. Det fanns omständigheter i vården som påverkade hälsan negativt. I detta examensarbete framkom det att bristande kontinuitet påverkade patientens utveckling av hälsa. Att upprätthålla kontinuitet visade sig istället leda till att patienten i högre utsträckning fick möjlighet att uppnå hälsa. Resultatet visade att upplevelsen av kontinuitet påverkades av olika faktorer. För att upprätthålla kontinuitet krävdes en fungerande vårdrelation mellan patient och vårdpersonal. Det var även av vikt för patienter att känna sig delaktiga i beslutsfattning. Det gav en motivation till fortsatt vård och behandling. Hur den psykiatriska vårdens organisation var uppbyggd påverkade också patienters upplevelse av kontinuitet. Genom att belysa patienters upplevelser av kontinuitet skapade författarna, i detta examensarbete, förutsättningar för att i framtiden kunna utforma en vård med patienten i fokus.

Magister Curationis - MCur / The re-engineering of the healthcare landscape requires Higher Educational Institutions (HEI) to employ teaching and learning approaches that would produce graduates, who could respond to the transformative initiatives within the healthcare system. Graduates are required to become involved in a service-learning project, as part of their learning experience, within the Masters of Nursing in Advanced Psychiatric Nursing programme. Their learning and teaching activity is intended to prepare them to become competent advanced psychiatric nurse specialists, who are able to address social transformation.

Magister Curationis - MCur / Studies have shown that no great emphasis has been put on hand washing practices in psychiatric health facilities, despite the fact that nosocomial infection outbreaks have been reported for decades. Most studies have focused on hand washing practices among general health personnel; however, little is known about hand washing practices among nurses working at psychiatric hospitals.

Background: Suicidal behaviour is increasingly widespread in South Africa and constitutes a significant burden of disease, often within resource-constrained hospital settings. Little is known about the factors associated with psychiatric admission following an act of deliberate self-harm (DSH) in South Africa. Aim: The aim of this study was to investigate the sociodemographic and clinical factors which differentiated DSH patients who were admitted to an emergency psychiatric unit compared to those who were treated in the emergency department and discharged. Setting: Data were collected for 272 consecutive patients presenting to the emergency department of a tertiary, public, urban hospital in South Africa, as a result of self harm, between 16 June 2014 and 29 March 2015, for an initial epidemiological study of DSH at the hospital. This study had a data subset of 174 of those patients (84 admitted to the emergency psychiatric unit and 90 treated in the emergency department and discharged). Methods: This study was a retrospective cross-sectional analysis, and it analysed existing data from the epidemiological study, using bivariate and multivariate logistic regression analysis. Results: Of the patients admitted to the emergency psychiatric unit, a greater proportion of patients were female (61,9%), were not in a relationship (83,3%), had no dependents (60,7%), were unemployed (73,8%), and had a low socioeconomic status (59,5%). Having dependants was associated with an increased likelihood of admission to the emergency psychiatric unit in bivariate analysis; however, when controlling for other sociodemographic variables, this was no longer significant. None of the clinical variables were significantly associated with admission to the emergency psychiatric unit. Conclusion: The lack of significant findings in the sociodemographic and clinical factors associated with an admission to the emergency psychiatric unit (compared to being treated in the emergency department and discharged) is surprising. At face value, it suggests that there are no obvious differences between the two groups. The use of a validated screening tool or more accurate measure of the clinical correlates (e.g. screening tool for substance-related 6 disorders) could have better highlighted, perhaps subtle, differences between the two groups. It is perhaps more important to question whether the perceived risk factors in DSH patients are associated with suicidal behaviour and whether emergency psychiatric unit admission, based on these factors, is more effective at treating DSH short-term, and reducing suicidal behaviour long-term, than say outpatient-based treatment interventions. Clinician-related factors that influence psychiatric admission decisions following DSH is also an important area for future research.

The Amish are commonly known for horse-and-buggies, simple clothing, and refusal to use electricity. Less commonly known is their rate of mental illness, which is significantly lower than the non-Amish population. The literature that points to lower depression and anxiety among the Amish does not adequately explain what elements of their lifestyle contribute to this phenomenon. Depression and anxiety are a widespread problem in the United States, increasing the importance of understanding a lifestyle that can reduce these issues. The purpose of this study was to explore the Amish way of life through the words of its members. The three research questions that drove this investigation inquired how the Amish conceptualize mental illness, if and how they seek help for mental stress, and what elements of their lifestyle may protect them from higher rates of depression and anxiety. This qualitative study employed social constructionism as the conceptual framework and positive psychology as the theoretical foundation. Data collection employed a purposeful, maximum variation sample and consisted of 14 in depth, semi-structured, face-to-face interviews. Data analysis employed phenomenological techniques as outlined by Moustakas. Elements of the Amish lifestyle contributing to positive mental health include the increasing availability of Amish focused treatment centers, bishops who encourage mental health treatment, family ties, social bonds, work ethic, and the most significant to the Amish: their faith. This study contributes to positive social change by discovering elements of Amish life that may be practical to the non-Amish. If non-Amish find positive meaning from the elements of Amish life, it may lead to lower rates of depression and anxiety.

Counseling students report a lack of competence in spiritual and religious integration (SRI). As such, counselor educators and supervisors (CES) and students want to understand how to develop SRI competence. Although past research highlighted SRI dialogue in training, the problem is that no clear understanding exists about the role of faculty supervisor SRI on perceived student competence. The supervision models used to inform the study included the integrated developmental model, discrimination model, and spirituality in supervision model (SACRED). The purpose of this study was to determine if master’s-level graduate counseling students’ perception of their faculty supervisors’ SRI practices predicted students perceived spiritual competence when considering attendance in faith-based and non-faith-based institutions accredited by the Council for Accreditation of Counseling and Related Education Programs (CACREP). A review of existing literature supported the use of a quantitative, cross-sectional design. An online survey was distributed to students (n=59) in master’s level CACREP counseling programs currently in field experience to measure perceived SRI in supervision and perceived SRI competence. A multiple linear regression revealed there was a statistically significant predictive relationship between supervisor SRI and perceived student competence as measured by the Spiritual and Religious Competence Assessment and the Spiritual Issues in Supervision Scale. These results inform CES about the importance of SRI and students’ ability to work with clients’ spiritual and religious beliefs. On this basis, it is recommended that supervisors focus on SRI in supervision. Future research should focus on additional factors related to SRI competence during counselor training.

More than ten million American adults live with a serious mental illness (SMI). Given the deinstitutionalization of psychiatric facilities, caregivers and family members are often needed to care for these individuals. Due to SMI individuals’ extensive needs, caregivers frequently face unique challenges and experiences. Although research has been conducted on caring for individuals with SMI, less information exists about the experiences of rural caregivers of SMI individuals. The purpose of this study was to fill this gap in research by exploring the lived experiences of caregivers of SMI individuals in rural areas with the intention of understanding this population’s unique needs. The research questions focused on the experiences and stressors of caregivers of SMI individuals in a rural community. The frameworks were critical theory and Bowen’s family systems theory. A qualitative phenomenological design study was used employing semi-structured interviews with 4 participants who are caregivers of SMI individuals in a rural New York area. Data from the interviews were coded and analyzed using thematic analysis. Four themes emerged: impact on relationships, thoughts and feelings, impact on caregivers’ well-being, and rural mental health in this area. The potential impact for social change includes the dissemination of information to rural clinicians to assist caregivers with needed support and offer a framework for future curricula.

Diagnosing post-traumatic stress disorder (PTSD) is challenging and is currently, diagnosis through self-administered checklists. Because a diagnosis of PTSD can open up significant benefits to compensation, education, and medical care, people can tailor their responses to the checklist to help ensure a diagnosis of PTSD. The purpose of the study was to examine the utility of the quantitative electroencephalograph for diagnosing PTSD. Frequency and presence of biomarkers and alpha brain wave symmetry in the frontal and parietal lobes were examined. Research questions involved examining the presence of alpha wave imbalance across the frontal lobe and between the right and left parietal lobes. A secondary data analysis was conducted using data from 108 subjects; these data included records from those with and without a PTSD diagnosis. The results of logistic regression showed that 63% of the clients diagnosed with PTSD were correctly identified and between 7% and 8% of the variance in PTSD was accounted for by frontal lobe asymmetry. The parietal lobe imbalance correctly classified PTSD in 59% of the patients and it identified 3.5–4.9% of the variance, suggesting that asymmetry in the frontal and parietal lobes should not be used as the primary method for diagnosing PTSD. Implications for social change include identifying an objective diagnostic tool that can potentially decrease the possibility of inaccurate diagnoses based on self-reported symptoms. This could lead to eliminating some of the shame and embarrassment veterans and first responders feel toward seeking help for PTSD.

The postmortem human brain as a tool to study central nervous system disease Abnormalities in noradrenergic transmission are likely to play a role in behavioral expressions of a number of psychiatric and neurological disorders. The extent to which these abnormalities are pathognomonic, or even principal pathological features contributing to the illness, remains debatable. Interest in the potential for pathological abnormalities in central norepinephrine in central nervous system (CNS) disorders derives from the three general observations: (1) disruption of behaviors known to be heavily influenced by noradrenergic transmission that are associated with the illness; (2) demonstration that pharmacological manipulation of noradrenergic transmission can precipitate, modify, or alleviate symptoms of these disorders; and (3) certain CNS disorders are characterized pathologically by a loss of noradrenergic neurons in the brain. Research on the pathology of central noradrenergic systems in CNS diseases and their relationship to behavioral alterations utilizes a variety of techniques, most of which are technically indirect, given that we currently are unable to directly measure noradrenergic neuron activity, noradrenergic receptor signaling, or norepinephrine release in vivo in living humans. In vivo imaging methods now permit investigators to measure occupancy of certain receptors, but application of these methods specifically to noradrenergic proteins, such as receptors, enzymes or transporters, has been limited. One method to study the role of norepinephrine in the CNS disorders is to utilize postmortem brain tissue from subjects with a given psychiatric or neurological condition.

In previous studies, we have isolated several marine indole alkaloids and evaluated them in the forced swim test (FST) and locomotor activity test, revealing their potential as antidepressant and sedative drug leads. Amongst the reported metabolites to display such activities was 5-bromo-N,N-dimethyltryptamine. Owing to the importance of the judicious introduction of halogens into drug candidates, we synthesized two series built on a 2-(1H-indol-3-yl)-N,N-dimethylethanamine scaffold with different halogen substitutions. The synthesized compounds were evaluated for their in vitro and in vivo antidepressant and sedative activities using the mouse forced swim and locomotor activity tests. Receptor binding studies of these compounds to serotonin (5-HT) receptors were conducted. Amongst the prepared compounds, 2-(1H-indol-3-yl)-N,N-dimethyl-2-oxoacetamide (1a), 2-(5-bromo-1H-indol-3-yl)-N,N-dimethyl-2-oxoacetamide (1d), 2-(1H-indol-3-yl)-N,N -dimethylethanamine (2a), 2-(5-chloro-1H-indol-3-yl)-N, N-dimethylethanamine (2c), 2-(5-bromo-1H-indol-3-yl)-N,N-dimethylethanamine (2d), and 2-(5-iodo-1H-indol-3-yl)-N,N -dimethylethanamine (2e) have been shown to possess significant antidepressant-like action, while compounds 2c, 2d, and 2e exhibited potent sedative activity. Compounds 2a, 2c, 2d, and 2e showed nanomolar affinities to serotonin receptors 5-HT1A and 5-HT7. The in vitro data indicates that the antidepressant action exerted by these compounds in vivo is mediated, at least in part, via interaction with serotonin receptors. The data presented here shows the valuable role that bromine plays in providing novel chemical space and electrostatic interactions. Bromine is ubiquitous in the marine environment and a common element of marine natural products.