[Truncated abstract] Auditory hallucinations (AHs) are one of the most common symptoms of schizophrenia, and are associated with high levels of distress, functional impairment, and need for care. However, current understanding of the exact causes and thus treatment of AHs is still in its infancy. Recently, Badcock and colleagues proposed a cognitive dual-deficit model of AHs, which stipulates that intentional inhibition deficits underlie the intrusive and unintentional nature of AHs, while context memory binding deficits explain the source misattribution (Waters, Badcock, Michie, & Maybery, 2006). While this model seems to best explain the different features of AHs, the precise components of inhibitory control involved, and the evident role of negative affect in the production of AHs, have not been empirically examined. Thus, the first two aims of this thesis were to clarify the critical component(s) of inhibitory control specifically related to AHs, and to examine the relationships between negative affect (chiefly anxiety), AHs and inhibitory control. Finally, AHs are also commonly reported by individuals in the general population, consistent with a continuum approach to AHs. Accordingly, the third aim of this thesis was to investigate whether similar relationships exist between hallucinatory-type experiences, inhibitory processes and negative affect in both hallucination predisposition and schizophrenia. The first study presents the findings from two related investigations of hallucination predisposition. ... However, the study revealed a significant relationship between intentional inhibition and trait anxiety (which was independent of hallucination predisposition) allowing the possibility that more severe or longer lasting changes in anxiety may indeed exacerbate difficulties with intentional inhibition. The final study sought to determine whether the pattern of relationships between AHs, inhibitory impairments and anxiety in schizophrenia are similar to those found in hallucination predisposition. The same three cognitive tasks previously employed (ICIM, B-P, and DI) were administered to schizophrenia (N = 61) and healthy control (N = 34) participants. Schizophrenia participants overall exhibited difficulties intentionally resisting interference from distracting stimuli, however did not have difficulties [intentionally or unintentionally] inhibiting task-irrelevant memory traces. Consistent with the continuum approach, AHs were related only to difficulties with intentional inhibition, and these difficulties existed independently from anxiety (although anxiety was related to intentional inhibition) and were unrelated to other schizophrenia symptoms. Together, the studies support the first component of Badcock et al.'s dual-deficit model of AHs, with hallucinatory experiences in both hallucination predisposition and schizophrenia associated with specific intentional inhibition impairments. The findings also suggest that while anxiety may contribute to the production of AHs by exacerbating v existing intentional inhibition impairments, it is likely that anxiety has additional routes of influence. These findings provide strong support for the continuum approach to AHs. The implications of these findings and possible avenues for future research are discussed.

<p>Bakgrund: Schizofreni är en sjukdom som drabbar cirka 1 % av befolkningen, men en evidensbaserad, effektiv behandling med få biverkningar saknas. Denna litteraturstudie syftar till att kartlägga kvalitetsindikatorer som utgör grunden för en god omvårdnad av patienter med schizofreni. Syfte: Att sammanställa och belysa kvalitetsindikatorer som förväntas säkerställa en god kvalitet i omvårdnad och bemötande av patienter med schizofreni. Design: Litteraturstudie Metod: Litteraturstudie av 17 vetenskapliga artiklar, en review-artikel samt fyra debattartiklar om behandling av schizofreni, som analyserats och kvalitetsgranskats för att kunna belysa vilka faktorer som utgör kvalitetsindikatorer vid omvårdnad av patienter med schizofreni. Resultat: Kvalitetsindikatorer vid omvårdnad av patienter med schizofreni är ett holistiskt synsätt där patienten står i centrum och vården ges av välutbildade vårdgivare. Patienten ska erbjudas möjlighet att vara aktiv i sin behandling. Behandlingsmetod ska väljas och/eller kombineras efter patientens individuella behov och önskemål samt syfta till att involvera anhöriga i vårdprocessen. Slutsats: Det finns många omvårdnadsmetoder för schizofreni, vilken som ger bäst effekt varierar då diagnosen är mycket individuell. Det är viktigt att vårdgivare i samråd med patienten anstränger sig för att finna den metod som passar individen bäst.</p> / <p>Background: Schizophrenia is a psychiatric diagnosis which affects about 1 % of the population. However, there is no evidence based effective treatment with limited side-effects available. This literature review seeks to clarify quality indicators which constitute the basis for a good treatment and care for patients with schizophrenia. Aim: To compile and illuminate quality indicators expected to guarantee good quality of the care and treatment received by patients with schizophrenia. Design: Literature study. Methods: For this review 17 scientific articles, one review and four papers on the subject of treatment of schizophrenia were analyzed and quality examined in order to illuminate the factors which constitute the basis of quality indicators for good treatment and care for patients with schizophrenia. Results: Quality indicators in caring for patients with schizophrenia constitute a holistic, patient centered approach. The caregivers are well educated and the patient is encouraged to take an active part in the treatment. The method of treatment should be chosen and/or combined in accordance with the patient’s individual needs and wishes. It also aims to include close relations in the caring process. Conclusion: There are many methods of treatment available for schizophrenia. It is however a very individual diagnosis, and which treatment gives the best effect varies from case to case. It is important that caregivers, while including the patient in the process, strive to find the method most suited to the individual.</p>

Bakgrund: Schizofreni är en sjukdom som drabbar cirka 1 % av befolkningen, men en evidensbaserad, effektiv behandling med få biverkningar saknas. Denna litteraturstudie syftar till att kartlägga kvalitetsindikatorer som utgör grunden för en god omvårdnad av patienter med schizofreni. Syfte: Att sammanställa och belysa kvalitetsindikatorer som förväntas säkerställa en god kvalitet i omvårdnad och bemötande av patienter med schizofreni. Design: Litteraturstudie Metod: Litteraturstudie av 17 vetenskapliga artiklar, en review-artikel samt fyra debattartiklar om behandling av schizofreni, som analyserats och kvalitetsgranskats för att kunna belysa vilka faktorer som utgör kvalitetsindikatorer vid omvårdnad av patienter med schizofreni. Resultat: Kvalitetsindikatorer vid omvårdnad av patienter med schizofreni är ett holistiskt synsätt där patienten står i centrum och vården ges av välutbildade vårdgivare. Patienten ska erbjudas möjlighet att vara aktiv i sin behandling. Behandlingsmetod ska väljas och/eller kombineras efter patientens individuella behov och önskemål samt syfta till att involvera anhöriga i vårdprocessen. Slutsats: Det finns många omvårdnadsmetoder för schizofreni, vilken som ger bäst effekt varierar då diagnosen är mycket individuell. Det är viktigt att vårdgivare i samråd med patienten anstränger sig för att finna den metod som passar individen bäst. / Background: Schizophrenia is a psychiatric diagnosis which affects about 1 % of the population. However, there is no evidence based effective treatment with limited side-effects available. This literature review seeks to clarify quality indicators which constitute the basis for a good treatment and care for patients with schizophrenia. Aim: To compile and illuminate quality indicators expected to guarantee good quality of the care and treatment received by patients with schizophrenia. Design: Literature study. Methods: For this review 17 scientific articles, one review and four papers on the subject of treatment of schizophrenia were analyzed and quality examined in order to illuminate the factors which constitute the basis of quality indicators for good treatment and care for patients with schizophrenia. Results: Quality indicators in caring for patients with schizophrenia constitute a holistic, patient centered approach. The caregivers are well educated and the patient is encouraged to take an active part in the treatment. The method of treatment should be chosen and/or combined in accordance with the patient’s individual needs and wishes. It also aims to include close relations in the caring process. Conclusion: There are many methods of treatment available for schizophrenia. It is however a very individual diagnosis, and which treatment gives the best effect varies from case to case. It is important that caregivers, while including the patient in the process, strive to find the method most suited to the individual.

Efter psykiatrireformen i mitten av 1990-talet övergick Sverige från den tidigare institutionsbaserade vården till den idag kommunbaserade vården. Vi som vårdare kan nu träffa på människan med schizofren sjukdom var vi än jobbar, då människan med schizofren sjukdom även får kroppsliga sjukdomar. Schizofreni är en sjukdom som ofta innefattar en värld som kan upplevas främmande, svår att förstå och långt ifrån den livsvärld vi som vårdare vanligtvis möter. Om förståelsen hos oss som vårdare brister i hur människan med schizofren sjukdom upplever sin livsvärld kan det påverka bemötandet och vården negativt. För att kunna ge ett värdigt och respektfullt bemötande behövs kunskap och förståelse om hur människan med schizofren sjukdom upplever sin livsvärld och mötet i vården.Syftet med litteraturstudien är att belysa hur människan med schizofren sjukdom upplever sin livsvärld och mötet i vården. Tre biografier skrivna av människor som själva har upplevt schizofreni har använts som grund för analys, enligt Fribergs (2006) modell för att analysera berättelser (narrativer). I diskussionen av studiens resultat har även fem stycken artiklar använts som grund för diskussion.Resultatet har delats in i åtta olika kategorier, upplevelsen av: den andra världen, mellan världar, rädsla för förändrad identitet, negativ identitet, negativa röster, positiva röster, dålig vård, bra vård.I diskussionen diskuteras den för studien valda metoden och fynden från analysen tillsammans med de fem artiklar som ligger till grunden för diskussionen. / <p>Program: Sjuksköterskeutbildning</p><p>Uppsatsnivå: C</p>

La tesi si è focalizzata sullo studio del comportamento violento in pazienti con una diagnosi di Disturbo dello Spettro Schizofrenico (DSS) e una storia di violenza, appaiati a dei controlli. Il protocollo ha incluso anche un periodo di osservazione di un anno. Il progetto di ricerca è stato condotto in alcune strutture residenziali (studio 1) e presso alcuni Centri di Salute Mentale (studio 2) del nord Italia, con gli obiettivi di: (i) analizzare le caratteristiche socio-demografiche, cliniche e neuropsicologiche di pazienti con DSS e una storia di violenza comparati a pazienti con DSS, senza tale storia, appaiati per genere ed età; (ii) quantificare i comportamenti violenti esibiti dai pazienti con DSS durante un anno di osservazione, e identificarne i possibili fattori protettivi e di rischio; (iii) caratterizzare i pazienti con DSS che hanno esibito condotte particolarmente violente durante l’anno di osservazione. I risultati mostrano specifiche condizioni cliniche e di funzionamento cognitivo caratterizzanti i pazienti con storia di violenza, ed evidenziano diversi fattori associati all’esibizione di comportamenti violenti nei due servizi. / This thesis addresses the phenomenon of violence by patients with Schizophrenia Spectrum Disorders (SSDs) who had a history of violence, compared to matched controls. The research protocol also included a 1-year observation period. The research project has been carried out in ordinary psychiatric residential facilities (study 1) and in Community Mental Health Centres (study 2) in northern Italy. The aims were: (i) to investigate the demographic, clinical, and neurocognitive features of patients with SSDs who had a history of violence, matched by age, gender and diagnosis to controls; (ii) to quantify violence exhibited by patients with SSDs during 1 year, and to identify protective and risk factors for such violence; (iii) to characterize patients exhibiting considerable violence during the study period. The results of the project show different clinical and cognitive characteristics for patients with a history of violence and for controls, and different factors associated with violence exhibited in the two care settings.