Diss. (sammanfattning) Stockholm : Karolinska institutet, 2009. / Härtill 4 uppsatser.

Several studies show that the clinical reality in psychiatric care does not correspond to the demand of consumer participation from a variety of policy documents that has been produced recently. Studies also show that there is a lot to do in improving, patients with sever mental illness, becoming more involved in their own care. The nurse has a central role in this work. The Norwegian nursing theorist Jan-Kåre Hummelvolls holistic, existentialistic model for psychiatric nursing were used as theoretical ground. The aim of this study was to examine how nurses in psychiatric outpatient units, caring for patients with psychotic disorders, experiences consumer participation. Qualitative phenomenological method was used. Semi-structured interviews with six nurses caring for patients suffering from psychotic disorders in outpatient units were conducted. The interviews were recorded and transcript by the author and then analyzed using qualitative content analyze. Two themes were identified: To follow the road chosen by the patient and When consumer participation risks failing. The result of this study shows that there are several factors that influences nurses job to involve patients in their care. The interviews also showed that there were areas where consumer participation was more problematic. To share a decision with the patient is a way to improve consumer participation. Shared decision making is a complicated process where the nurse needs support to succeed. In pharmacological issues nurses must continue working with consumer participation.

Bakgrund  Många studier visar att personer med psykiska besvär oftare drabbas av fysisk ohälsa och unga personer med psykossjukdom utgör en speciellt utsatt grupp. Syfte Syftet var att undersöka hur unga vuxna med psykossjukdomar upplever sin kroppsliga hälsa. Arbetet syftade även till att kartlägga patienternas uppfattning om hjälp- och stödbehov när det gäller upprätthållande/förbättring av hälsotillståndet. Metod En kvalitativ studie med intervjuer med tio patienter. Intervjuerna analyserades med kvalitativ innehållsanalys. Resultat Analysen ledde fram till ett tema: Synen på den kroppsliga hälsan är en strävan efter att med stöd och hjälp leva ett liv som alla andra. Temat uppstod utifrån fyra kategorier. 1. Hur man lever livet – livsstilsaspekter som studiedeltagarna förknippade med kroppslig hälsa, dvs. motion, kost, rökning, rutiner i vardagen. 2. Att känna sig frisk – kroppslig hälsa som motsats till sjukdom. Kategorin inkluderar även balans och energi. 3. Hälsa som en process – beskrivning av hälsa i följande dimensioner: gemenskap och självständighet, vändpunkt och förändring samt sorg och hopp. 4. Stöd och hjälp från hälso- och sjukvården – studiedeltagarnas erfarenhet av tillit samt önskemål om större tillgänglighet, mer individanpassade insatser och utökat finansiellt stöd. Slutsats Unga vuxna med psykossjukdom uppfattade kroppslig hälsa som ett mångdimensionellt fenomen som gick långt utanför den biomedicinska traditionen där hälsa ses som frånvaro av sjukdom. Det är patientens egen förståelse av hens hälsa som borde styra psykiatrisjuksköterskans omvårdnadsarbete i stort och hälsofrämjande insatser i synnerhet.

Background: There is currently very little research on recovery from the perspective ofindividuals with recent-onset of psychotic disorders. Forming a better understanding ofthesubjective meaning ofrecovery and recovery experiences during this early phase ofrecovery caninform effective and meaningful service design and practices.Method: Thirty individuals recovering from psychosis and receiving specialized earlyinterventiontreatment were interviewed regarding the meaning and experience of recovery frompsychosis during the early phase (2-5 years) ofthe illness course.Results: Recovery was described as a multidimensional experience that included aspects of"illness recovery," "psychological recovery," and "social recovery." Seven common earlyrecovery experiences were identified. Individual variations in the magnitude ofdescribeddisruption of self and social functioning, duration ofthe illness-acceptance process and theprocess treatment negotiation greatly influenced the experience ofrecovery.Conclusion: Differences in illness acceptance and social recovery trajectories have importantimplications for understanding individual responses to the experience ofpsychosis, its diagnosisand treatment. These differences emphasize the importance of assisting individuals with theconstruction of meaning and the reengagement in social roles following the initial illnessexperience. / Contexte: Il y a actuellement peu de recherche sur la rétablissement du point de vue d'individusaprès un premier épisode de psychose. La formation d'une meilleure compréhension de senssubjectif des expériences de rétablissement pendant cette première phase de rétablissement peutinformer le design efficace et expressif des services et des pratiques.Méthode: Trente individus se rétablissement de la psychose et recevant un traitement depremière intervention spécialisé ont été interviewés à propos du sens et de l'expérience derétablissement de la psychose pendant la première phase (2-5 ans) du cours de maladie.Résultats: La rétablissement a été décrite comme une expérience multidimensionnelle qui ainclus des aspects de "la rétablissement de maladie," "la rétablissement psychologique," et "larétablissement sociale." Identifiées ont été sept premières expériences de rétablissementcommunes. Les variations individuelles dans l'étendue de perturbation décrite de soi et defonctionnement social, la durée du processus d'acceptation de maladie et de la négociation duprocessus de traitement ont beaucoup influencé l'expérience de rétablissement.Conclusions : Les différences dans les trajectoires d'acceptation de maladie et de rétablissementsociale ont des implications importantes pour comprendre les réponses individuelles àl'expérience de psychose, sa diagnose et traitement. Ces différences accentuent l'importanced'assister les individus avec la construction de sens et avec le réengagement dans les rôlessociaux après l'expérience de maladie initiale.

Background: Apart from individuals with clinical psychosis, community surveys have shown that many otherwise-well individuals endorse items designed to identify psychosis. The clinical relevance of psychotic-like experiences (PLE) in individuals who are not psychotic is not clear. This thesis aimed to examine the prevalence, demographic and psychosocial correlates and antecedents of PLE in the Australian community. Method: Data from three population-based studies was examined. The Australian National Survey of Mental Health and Wellbeing interviewed 10,641 individuals living in private dwellings in Australia. We examined the impact of selected demographic variables on endorsement of psychosis screen and probe items from the Composite International Diagnostic Interview (CIDI). We also examined the effect of exposure to traumatic events (with and without Post Traumatic Stress Disorder (PTSD)) on the endorsement of CIDI psychosis items. The youth component of the Australian National Survey of Mental Health and Wellbeing collected demographic and clinical data on a nationally representative sample of 1261 adolescents aged 13-17 years. The prevalence of hallucination endorsement on the Youth Self Report (YSR) in Australian adolescents was examined. The association between hallucination endorsement, demographic variables (sex, age, urbanicity and family composition) and clinical variables (self-reported depression, marijuana and alcohol use, DSM IV diagnoses, emotional/ behavioral problems as reported by the parent on the Child Behaviour Check List (CBCL)) were examined. The Mater- University of Queensland Study of Pregnancy (MUSP) is a prospective longitudinal birth cohort study of 7223 mothers and their offspring who received antenatal care between 1981 and 1984. Psychotic-like experiences were assessed in the offspring at the 21 year follow-up using the Peters Delusional Inventory (PDI) and the CIDI. We examined the prevalence of PLEs, and examined the effect of age (the age range at the 21 year follow-up was 18 to 23 years) and sex on PLE. A second study examined the emotional and behavioural antecedents of PLE at 21 years as measured by the CBCL at five and 14 years and the YSR at 14 years. Results: An estimated 11.7% of Australian adults endorsed at least one psychosisscreening item. Higher endorsement was associated with younger age, migrants from non- English speaking backgrounds, not being married, unemployment, living in an urban region and lowest socioeconomic levels. Exposure to any traumatic event was associated with increased endorsement of PLE (Rate Ratio =2.68; 95% CI 2.18, 3.30). A diagnosis of PTSD further increased endorsement of PLE (Rate Ratio =9.24; 95% CI 6.95, 12.27). Hallucinations were reported by 8.4% of Australian adolescents. Those living in blended or sole parent families were more likely to report hallucinations than those living with both biological parents (OR 3.27; 95% CI 1.93, 5.54; OR 2.60; 95% CI 1.63, 4.13 respectively). Hallucinations were more prevalent in adolescents who had high CBCL scores or elevated depression symptoms (OR 3.30; 95% CI 2.10, 5.20; OR 5.02; 95% CI 3.38, 7.45 respectively). Hallucinations were more prevalent in those adolescents who had smoked cannabis more than twice in the month prior to the survey (OR 3.27; 95% CI 1.76, 6.08). In the 21 year follow-up of the MUSP study, older age (18-20 compared to 21-23 years) was significantly associated with a reduction of CIDI delusions (OR 0.66, 95% CI 0.48, 0.92) and PDI total scores (OR=0.68, 95% CI 0.55, 0.83). Women were significantly more likely to endorse items related to hallucinations (OR=1.49, 95% CI 1.14, 1.95) but not delusions. High CBCL scores at 5 and 14 years predicted high total PDI scores; Those in the highest quartile of YSR scores at 14 years were nearly four times more likely to have high levels of psychotic-like experiences at age 21 (OR=3.71, 95% CI 2.92, 4.71). Adolescent onset psychopathology and continuous psychopathology through both childhood and adolescence strongly predict PLE at age 21. Conclusions: Psychotic-like experiences are relatively common in population surveys of Australian adults and adolescents. In adults, the demographic correlates of PLE are similar to those of schizophrenia. There is a strong association between PLE and exposure to trauma. The correlates of PLE in adolescents are different to those of adults. The reduction in prevalence of delusions between late adolescence and young adulthood is coincident with normal neurophysiological changes in the frontal lobes, suggesting hypotheses suitable for future research. The association between marijuana use and hallucinations in adolescents is further evidence of the potential harm caused by use of cannabis. The onset or persistence of emotional distress during adolescence is associated with an increased risk of PLE in adulthood. These findings are relevant to both clinical practice and future research. Psychotic symptoms create diagnostic uncertainty. There is potential for patients with anxiety (PTSD) or mood disorders to be incorrectly diagnosed with a psychotic illness and receive inappropriate management. Equally, there is a risk that subjects who have an emerging psychotic disorder and comorbid anxiety or depression or have had exposure to traumatic events may have treatment of their psychosis delayed as psychotic symptoms are incorrectly ascribed to a syndrome other than psychosis. Clinicians need to be aware of this diagnostic tension so that accurate assessments and appropriate treatments can be initiated at the earliest possible opportunity. The resolution of childhood emotional distress prior to adolescence appears to reduce the risk of PLE and possibly psychosis in adults. Strategies targeting emotionally distressed children may offer opportunities for psychosis prevention. Further research is required to explore the relationship between PLE and vulnerability to psychosis and other mental health problems. It remains unclear if PLE are reliable endophenotypes for schizophrenia. If this is the case, examining genetic and environmental risk factors for onset and persistence of PLE, and the neuroimaging changes that occur as individuals with PLE convert to psychosis will provide important new clues to our understanding of the aetiopathogenesis of psychosis.

Diss. Stockholm : Karolinska institutet, 2007.

Diss. (sammanfattning) Stockholm : Karol. inst., 2002. / Härtill 5 uppsatser.

Diss. Linköping : Univ., 1999.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2005. / Härtill 6 uppsatser.

Psychotic-like experiences (PLEs) are prevalent occurrences deemed comparable with the symptoms of psychosis, but not sufficiently severe to warrant a diagnosis upon clinical presentation. Their presence is associated with several adverse clinical outcomes: the onset of various common mental health disorders (e.g. anxiety, mood, substance abuse), poorer functioning, non-remission and relapse. Sleep and circadian rhythm disruption (SCRD) is observed in 30-80% of patients with psychosis. The omnipotence of SCRD across all phases of the disorder (including the prodromal, acute, chronic and residual phases) raises the question as to whether SCRD may directly contribute to the development of psychosis. Assuming that PLEs are along the same continuum to developing psychosis, a logical next step to further disentangle the sleep-psychosis relationship is to examine whether SCRD relates to the experience of PLEs and whether this relationship is bi-directional. This thesis begins by examining the core predictions made by a continuum model of understanding psychosis and how specific parameters of sleep may influence PLEs. A smaller high-definition cross-sectional study follows, examining biological underpinnings (electroencephalography (EEG), electrocardiography (ECG), endogenous melatonin rhythms and actigraphy) of a complaint of poor sleep and their relation to the occurrence of PLEs. We then refocus on which parameters of sleep are most integral to the sleep-PLE relationship and close with an investigation of how Hypothalamic Pituitary Adrenal (HPA) axis activity may further our knowledge of this relationship. The findings of this thesis demonstrate specificity in the parameters of sleep shown to impact certain PLEs. The importance of objective sleep and biologically driven measures in this line of research are underscored, with group differences in EEG, ECG and melatonin. This thesis also highlights dissociative symptomatology as a candidate mediator for the sleep-psychosis relationship, and emphasises the ties between paranoia and negative affect. Finally, this thesis also illuminates the challenges of examining the relationship between sleep and PLEs in isolation, and suggests that they must be considered within the broader framework of co-existing mental health problems.