No description available.

Current treatment practice guidelines in a number of countries mandate the assessment of violence risk in all patients diagnosed with schizophrenia. Although more than 100 different instruments have been developed to facilitate the assessment of violence risk, few have been specifically validated for use in those with schizophrenia. Recent work instead suggests that these instruments are typically associated with lower predictive validity in samples with schizophrenia when compared to that achieved in diagnostically heterogeneous samples, leading to concerns that these instruments omit risk factors that may be specific to the prediction of violence risk in this population. The present thesis therefore aimed to investigate the predictive validity of a number of risk factors for violence in those with schizophrenia. Firstly, to identify key risk factors for violence, a meta-analysis was undertaken, finding that although a number of criminal history risk factors are strongly associated with violence risk, nonetheless a number of risk factors rarely assessed by existing violence risk assessment instruments were significantly associated with violence in those with schizophrenia; most notably a history of attempted suicide. Results of this review also suggested that although the criminal history domain is most strongly associated with violence risk, nonetheless, there is considerable variability in the magnitude of association for the individual risk factors. Study two therefore aimed to investigate this variability and found that a history of violence was most strongly associated with subsequent violence. Study three aimed to identify whether suicidal behaviour, which has rarely been considered risk factors for violence in previous work, incrementally contributes to the prediction of violence. A simple risk model composed of young age, comorbid substance use disorder, previous violence, and a history of suicidal threats, explained as much predictive validity, as measured by the area under the receiver operating characteristic curve, as established risk assessment instruments such as the HCR–20, LSI–R, PCL–R, and VRAG. Current risk assessment approaches may therefore need revision in light of these findings.

Neuregulin 1 (NRG1) is a growth factor implicated in neurodevelopment and postnatal maintenance of synaptic circuits. Its gene has been associated with schizophrenia, and the expression of the type I isoform (NRG1tyI) is increased in patients’ brains. Earlier behavioural phenotyping of mice over-expressing NRG1tyI revealed impairment in hippocampus-dependent spatial working memory. This present work investigates the effects of increased NRG1tyI expression on hippocampal network functioning in these mice. Fast network oscillations, specifically at gamma frequencies, were studied in CA3 hippocampal slices in a carbachol model using cellular and extracellular microelectrode recording techniques. The peak frequency of field potential oscillations was significantly reduced in slices from NRG1tyI mice compared to wild-type littermates. In addition, NRG1tyI mouse slices were more prone to develop epileptiform activity. During rhythmic activity, the balance of phasic excitation and inhibition was significantly altered in principal cells of NRG1tyI mice. Inhibitory synaptic input was more sustained, while excitatory synaptic currents were kinetically unchanged but larger and more variable in amplitude. Together, these data suggest altered functioning of the GABAergic inhibitory circuits that generate and maintain gamma oscillations. Because parvalbumin-expressing (PV+) interneurons are a major target of NRG1 signalling, the inhibition from PV+ interneurons to pyramidal cells was examined next. Channelrhodopsin-2-mediated photostimulation of PV+ cell axons failed to show changes in GABAergic inhibition of CA3 pyramidal cells in NRG1tyI mice. However, synaptic miniature glutamatergic neurotransmission was reduced in identified PV+ basket cells (BCs) and axo-axonic cells (AACs) but not in pyramidal cells. The change was expressed postsynaptically, affecting NMDA receptor- but not AMPA receptor-mediated currents. The data suggest that NRG1tyI over-expression results in alterations in PV+ interneuron types, particularly at the glutamatergic synapses that excite these cells. These changes and the altered gamma oscillations are already evident in late adolescence — before the age at which cognitive deficits are detectable.

Syrén, Susanne (2010). Det outsagda och ohörsammade lidandet. Tillvaron för personer med långvarig psykossjukdom och deras närstående (Being in the world with long term psychotic illness – the unspoken and unheard suffering), Linnaeus University Dissertations No 6/2010. ISBN: 978-91-86491-07-9. Written in Swedish with a summary in English. Aim: The overall aim of the thesis was to describe the lived experience of being in the world with long term psychotic illness. This is described from three perspectives; the perspective of persons diagnosed with long term psychotic disorder; the perspective of their relatives; and a family perspective. Method: Three studies were conducted guided by a reflective lifeworld approach grounded in phenomenology. The data were generated through individual, group, and family interviews. Data were analyzed for essential meanings of being in the world. Results: Persons with long term psychotic illness live in a borderland of paradoxes between the usual and unusual. For the ill persons the existence is incomprehensible and defenceless with feelings of not being at home in the body and in the world. They search for themselves in a care context that is contradictory, simultaneously good and hostile. These experiences are mostly unspoken, a struggle with doubts about having health or illness, what is good or evil, and about being usual or unusual. The relatives exist in a dilemma of the possible and impossible, a continual infinite struggle. Co-existing with their ill family member is a communion and a longing for togetherness is prominent. Relatives struggle with responsibilities for themselves and for their ill family member. In these unheard struggles the relatives yearn for participation in the formal care context. Family interviews with persons with long term psychotic illness and their relatives revealed a co-existence hovering between chaos and boredom while striving for a peaceful and quiet life. Thefamilies search for constancy and predictability in the presence of incomprehensible and threatening dangers. The experience of being a We balances the unshared meanings of being in the world and the loss of being able to experience and do things together. The experience of being a We keeps their individual existence and co- existence from falling apart.Conclusion: Persons with long term psychotic illness and their relatives have to withstand extensive existential suffering, which is unspoken and unheard. Formal caring should be existential caring, supporting the ill person’s comprehensibility and understanding of life, and feelings and experiences of being at home. Further, relatives should be acknowledged both as persons and carers and invited to participate in formal care. These results also point to the importance of strengthening feelings of togetherness and of being a We through systemic oriented existential conversations, where the ill person, their relative and a formal carer converse together.

The purpose of this study was to describe experiences in daily social life of parents of children with psychotic illness. Five parents with long-term experience of psychotic illness have been interviewed. The frame of reference in emotion theories of Thomas Scheff and Randall Collins have been used to analyze the results. The study is qualitative and has a phenomenological approach to shed lights of meanings in daily social life. The following meanings was found: Openness with certain reservation shows that honesty is important for the feeling of solidarity, Social expectations in daily life describes the parents´own expectations as well as expectations from others. In The important confirmation the findings show that the parents´need understanding for the family situation, and the findings also show the importance of support for the family and the acceptance of the psychotic illness.

En psykossjukdom medför att perceptionen av världen och andra människor förändras. Patienter med en psykossjukdom upplever sig ha sämre livskvalitet och hälsa än andra individer i samhället och de upplever ofta lidande på grund av sin sjukdom. Sjuksköterskor upplever blandade känslor i samband med vård av patienter med en psykossjukdom, men deras grundläggande uppgift är trots detta att främja hälsa, förebygga sjukdom, återställa hälsa och att lindra lidande. Syftet med denna studie är att belysa hur patienter med en psykossjukdom upplever vården på en psykiatrisk slutenvårdsavdelning, ur ett patientperspektiv. Studien är en systematisk litteraturstudie och data analyserades med en induktiv latent innehållsanalys. Resultatet visade att patienternas upplevelser kan beskrivas i fyra områden: rädsla och osäkerhet påverkar interaktionen med andra; tvångsåtgärder: skrämmande men nödvändiga; självbestämmande, delaktighet och välbefinnande; samt vårdpersonalen är avgörande för patienternas upplevelser. I studien diskuteras rädsla och osäkerhet; att vårdpersonalen och upplevelserna påverkar attityden till behandlingen; vårdpersonalens betydelsefulla roll när patienten har svåra symtom; individualiserad vård och god kommunikation bidrar till ökat välbefinnande samt att mer kompetens hos vårdpersonal kan minska bruket av tvångsåtgärder. Studiens slutsats är att sjuksköterskor har en central roll i patienternas upplevelse av vården. De har ansvar för att interaktionen med patienten och relationsbyggande fortlöper samt att användandet av tvångsinsatser motiveras och enbart sker när det är absolut nödvändigt, annars finns risk att behandlingsresultat och följsamhet av behandling efter utskrivning påverkas negativt. / A psychosis means that the perception of the world and other people change. Patients with a psychotic disorder perceive themselves as having poorer quality of life and health than other individuals in the community and they often experience suffering because of their illness. Nurses experience mixed feelings while caring for patients with a psychotic disorder, but in spite of this a nurse’s fundamental duty is to promote health, prevent disease, restore health and to alleviate suffering. The purpose of this study is to highlight how patients with a psychotic disorder experience health care in a psychiatric inpatient ward, from a patient perspective. The study is a systematic literature review and data were analyzed using an inductive latent content analysis. The results showed that patients 'experiences involved four areas: fear and insecurity affects the interaction with others; coercive measures: scary but necessary; autonomy, participation and welfare, and nursing staff is crucial for patients' experiences. In the study, several areas were discussed about the patient's experiences: fear and insecurity; that care staff and experiences affect the attitude to treatment; healthcare personnel's important role when the patient experience severe symptoms; individualized care and good communication contribute to increased well-being, and that more skills in healthcare professionals can reduce the use of coercive measures. The study's conclusion is that nurses have a central role in the patients' experience of the health care. They are responsible for the interaction with the patient and for keeping the building of the nurse-patient relationship in progress. They are also responsible so that the use of coercive action is justified and only occurs when it is absolutely necessary, otherwise there is a risk that the treatment results and adherence to treatment after discharge are adversely affected.

Background: In Sweden 1500-2000 people fall ill with psychosis every year and approximately 30,000-40,000 people live with schizophrenia, which is the most common psychotic illness. Symptoms of psychosis such as lack of perception of reality and thought disorders cause difficulties in communication for healthcare professionals. When caring for people with psychotic illnesses healthcare professionals require knowledge about treatment and caregiving for this patient group. Aim: The aim of the study was to describe people with psychotic illnesses experience with healthcare professionals. Method: Nine articles are included in this literature study and the results were analyzed using a thematic analysis. Result: Two main themes with associated sub-themes have been identified to answer the aim of this study. The first main theme is Obstacles in the meeting that resulted in three sub-themes, Lack of conversational support, Lack of individually tailored patient information and Participation. The second main theme is Affirmative meetings with two sub-themes of Confidence, trust and security in the meeting and To see the person behind the illness. Conclusion: The results indicate that a relationship built on respect and empathy enables person-centered nursing. Inadequate communication and information are described as negative experiences that created difficulties in the meeting / Bakgrund: I Sverige insjuknar 1500-2000 personer i psykos varje år och cirka 30 000-40 000 personer lever med schizofreni, den vanligaste psykossjukdomen. Symtom på psykos såsom bristande verklighetsuppfattning och tankestörningar medför svårigheter i kommunikationen för vårdpersonalen. Vid vårdandet av personer med psykossjukdomar behövs det kunskap kring behandling och omvårdnadsbehov samt bemötande. Syfte: Syftet med studien var att beskriva hur personer med psykossjukdomar upplever mötet med vårdpersonal. Metod: En litteraturstudie med nio vetenskapliga artiklar inkluderades och analyserades utifrån en tematisk analys. Resultat: Två huvudteman med tillhörande subteman har identifierats för att besvara syftet. Första huvudtemat var hinder i mötet som resulterade i tre subteman: Brist på samtalsstöd, Brist på individanpassad patientinformation och Delaktighet. Det andra huvudtemat var Bekräftande möten med två subteman Förtroende, tillit och trygghet i mötet samt Att se människan bakom sjukdomen.    Slutsats: Resultaten tyder på att en relation som är byggd på respekt och empati möjliggör för personcentrerad omvårdnad. Bristfällig kommunikation och information beskrivs som negativa upplevelser som skapade svårigheter i mötet.

The diploma thesis deals with the topic of quality of life in people with mental, respectively psychotic, diseases. It is a serious illness that affects all the personality and has a great impact on the quality of life. In the theoretical part is defined the concept of quality of life, its history, different angles of view and methods of measurement. Then you can find a detailed description of psychotic disease and life with it, and it is also more closely devoted to the quality of life of people with mental illness and its measurement. In the empirical part quantitative research is presented, whose aim is to determine which areas of life perceive people with psychotic illness as inferior to those without mental illness. Another aim is to find out whether social workers who work with people with psychotic illness at social housing shelter perceive the quality of life of these patientsin a different way than the patients themselves. The results obtained with the SQUALA subjective quality questionnaire show that these patients feel a lower quality of life in the area of health and close relationships than the general population. Furthermore, the results show that social workers are well aware of the quality of life of their clients with a psychotic illness, where they differ only in the area of...

The diploma thesis is dealing with the issues of people with psychotic illness on the labour market, recognition of problems, which they deal with in their work life, and identification of current possibilities, which are offered to people with psychotic illness on the labour market. The purpose of the diploma thesis is finding the limits and precautions, which could help them enter the labour market. It provides basic view of two psychotic illnesses, schizophrenia and affective disorder of personality. Both illnesses are discussed with regard to their symptoms, cause of origin and progression of the disease, focusing on their employability. The diploma thesis sums up the employment situation of people with psychotic illness and the attitude of society towards them. Empirical survey verifies the established hypothesis and analyzes the results of the questionnaire survey among the patients of Psychiatric hospital Bohnice. Key Words psychotic illness, mental illness, shizophrenia, affective disorder of personality, labour market, unemployment, employability at labour market, stigmatization

The development of predictive biomarkers in neuroscience is increasingly enabling bioprediction of adverse behavioural events, from psychosis to impulsive violent reaction. Because many brain-based disorders can be thought of as end-states of a long development, bioprediction carries immense therapeutic potential. In this thesis, I analyse issues raised by the development of bioprediction of brain-based disorder. I argue that ethical analysis of probabilities and risk information bioprediction provides is confounded by philosophical and social structures that have, until recently, functioned nominally well by assuming categorical (binary) concepts of disorder, especially regarding brain-disorder. Through an analysis of the philosophical concept of disorder, I argue that we can and ought to reorient disorder around probability of future harm and stratify disorder based on the magnitude of risk. Rejection of binary concepts in favour of this non-binary (probability-based) one enables synergy with bioprediction and circumnavigation of ethical concerns raised about proposed disorders of risk in psychiatry and neurology; I specifically consider psychosis and dementia risk. I then show how probabilistic thinking enables consideration of the implications of bioprediction for two areas salient in mental health: moral responsibility and justice. Using the example of epilepsy and driving as a model of obligations to protect others against risk of harm, I discuss how the development of bioprediction is poised to enhance moral responsibility. I then engage with legal cases and science surrounding a predictive biomarker of impulsive violent reaction to propose that bioprediction can sometimes rightly diminish responsibility. Finally, I show the relevance of bioprediction to theories of distributive justice that assign priority to the worse off. Because bioprediction enables the identification of those who are worse off in a way of which we have previously been ignorant, a commitment to assign priority to the worse off requires development of and equal access to biopredictive technologies.