Burn injuries are associated with significant mortality and morbidity. Intentional burn injuries are not well understood, and warrant study to improve adjustment and outcomes. The present study examined group differences between intentional and unintentional burn injuries, comparing individuals with self-inflicted (SIB; n=109) and other-inflicted (OIB; n=109) burns to an unintentional burn (UB) group. Compared to UB, those with intentional (SIB, OIB) burn injuries were more likely to be young, female, unmarried, unemployed, abuse substances, and have positive alcohol/drug screens at hospital admission. Individuals with intentional burns report more psychological distress, lower quality of life in some areas, and lower life satisfaction. When SIB and OIB were examined individually, OIB were more likely to be African American compared to SIB and UB. OIB also had more anxiety and paranoia than UB. SIB was more likely than OIB and UB to have had medical problems or psychiatric disorders and treatment prior to the burn injury. Those with SIB were 3 times more likely than UB to die in the hospital even after controlling for age, severity of burn, and inhalation injuries. Moreover, the SIB group had high rates of suicidal ideation at discharge and follow-up. Treatment implications for burn treatment providers were discussed.

The primary interest of this investigation concerned the self-injurious thoughts and behaviors (SITBs) of inpatient adolescents. Previous researchers have provided descriptive information regarding either automatic (or intrinsic) and social components using the Self-Injurious Thoughts and Behaviors Interview (SITBI). However, the presence and trends of these components have not firmly been established, suggesting the need to explore this area further. Eighty-two adolescent inpatients were selected and interviewed using the SITBI to evaluate the predictive ability of self-reported self-injurious behavior with regard to social and automatic, negative and positive functions. Results showed that depending on the type of thought or behavior displayed one could discern the motivation behind their actions. Automatic-Negative was seen to have the strongest relationship across all SITB behaviors while Automatic-Negative was not found to be relatively low compared to other SITB behaviors. Both Social-Positive and Social-Negative were found to be present in moderate relationships compared to Automatic in general.

Self-injurious behavior (SIB) is a complex phenotype that occurs with an increasing prevalence of about 7-34% in humans and 10-12% in non-human primates (NHPs). This study evaluated the efficacy of probiotic Lactobacillus reuteri as a treatment for self-injurious behavior (SIB) and sleep disruption in rhesus macaques. The treatment was proposed to alleviate mild self-biting, sleep disruption, and reduce chronically elevated hypothalamic-pituitary-adrenocortical (HPA) axis activity, all hallmark features of monkeys with this condition. The probiotic preparation included two strains of L. reuteri (L. reuteri ATCC PTA 6475 & L. reuteri DSM 17938) containing on average 200 million colony forming units per chewable tablet. The study was conducted on 14 rhesus macaque monkeys (9 males) housed at the University of Massachusetts Amherst. To our knowledge this is the first time that a Lactobacillus strain has been used as a treatment for SIB in rhesus macaques. This study utilizes motion-activated infrared camera technology, modified enzyme-immunosorbent-assays (EIAs) techniques to measure hair cortisol concentrations, and daily behavioral observations to provide an overall assessment of the behavioral, physiological, and sleep associated implications of probiotic treatment on SIB and control non-human primates (NHPs). Administration of L reuteri modestly decreased biting behavior in monkeys with SIB (F(2,12) = 5.64, p= 0.02) and showed overall decrease in nighttime activity across all subjects but did not normalize SIB to nonSIB values. Hair cortisol values are pending. These findings and the findings of previous work further strengthen the argument for probiotics as an efficacious treatment for SIB behavior.

Bakgrund: Tidigare forskning beskriver att sjuksköterskor i stor utsträckning erfar vården av personer med självskadebeteende utmanande samtidigt som forskning kring personernas erfarenheter visar att de ofta upplever vården negativt. Vården har ofta ett fokus på olika säkerhetsaspekter och negativa attityder bland vårdpersonal kan leda till ett sämre bemötande. Sjuksköterskornas erfarenheter visar på ett behov av ökad kunskap kring självskadebeteende. Syfte: Sjuksköterskors erfarenheter av att vårda personer med självskadebeteende inom psykiatrisk slutenvård. Metod: Studien har en kvalitativ design med induktiv ansats. Data samlades in via semistrukturerade intervjuer och sex sjuksköterskor verksamma i psykiatrisk slutenvård deltog. Resultatet analyserades via en kvalitativ innehållansalys. Resultat: Resultatet visar att sjuksköterskornas erfarenheter handlar om att vårda i det känslomässigt komplexa, viktiga aspekter kring att vårda tillsammans med andra samt betydelsen av att mötas i det svåra. Slutsats: Vårdandet innebär att sjuksköterskor påverkas känslomässigt och de upplever ofta att de inte vet hur de ska hjälpa personerna. Den vårdande relationen ses som viktigast för främjandet av en god vård. Reflektion och stöd av teamet är betydelsefullt, dels genom att arbetssituationen upplevs lättare, dels genom ett genererande av gemensamma kunskaper kring vårdandet. / Background: Previous research describes that nurses to a large extent find the care of people with self-harming behavior challenging and difficult, while research on the persons experiences shows that they often experience the care in a negative manner. Negative attitudes exist among healthcare staff, which can lead to poorer treatment. The nurses’ experiences show a need for increased knowledge about self-harming behaviour. Aim: Nurses experiences of caring for people with self-harming behaviour in psychiatric inpatient care. Method: The study has a qualitative design with an inductive approach. Data were collected via semi-structured interviews and six nurses working in psychiatric inpatient care participated. The result was analyzed by a qualitative content analysis. Result: The results show that the nurses experiences are about caring in an emotional complexity, important aspects of caring among others and the importance to be able to meet the person in emotionally demanding situations. Conclusion: Caring leads to evoking of complex emotions and the nurses often feel that they do not know how to help the person. The caring relationship is seen as the most important aspect of good care. Reflection and support by the team is experienced important because it leads to a better work situation as well as it generates knowledge of self-harming behaviour.

Bakgrund: Självskadebeteende är ett omtvistat begrepp som inte är en egen diagnos. De självskadande handlingarna börjar ofta under puberteten och brukar avta i ung vuxenålder. Självskadebeteende är ett uttryck för stort lidande. Det är viktigt att skilja mellan suicidalt beteende och självskadebeteende. Självskadebeteende kan mätas på olika sätt och det saknas i nuläget nationella riktlinjer gällande vård och behandling.  Syfte: Syftet var att undersöka vilken behandling som bör rekommenderas för patienter med självskadebeteende.  Metod: Studien är en systematisk litteraturöversikt med kvantitativ ansats innefattande 14 RCT-studier. Sammanställningen har gjorts enligt de steg som beskrivs av Bettany-Saltikov och McSherry (2016).  Resultat: Resultatet omfattar 14 studier utförda i sju antal länder. Deltagarantal i studierna varierade mellan n=33 till n=832 och utgjordes av både tonåringar och vuxna. Samtliga studier var utförda inom psykiatrisk öppenvård. Olika former av behandlingar undersöktes. Av de 14 inkluderade studierna visade 9 studier att interventionen hade bättre effekt än den som kontrollgruppen gavs, vilket oftast var standardvård. Bäst effekt hade DBT vilket gavs som intervention i tre studier. Slutsats: Denna litteraturöversikts resultat indikerar att DBT är den behandling som ger bäst effekt vid behandling av patienter med SB.  Då populationerna var små och innehållet i behandlingsinterventionerna varierade är det svårt att dra säkra slutsatser. Det behövs fler väldesignade studier som utvärderar behandling för patienter med SB där insatser initieras av sjuksköterskor. Mer forskning behövs kring nya tekniska hjälpmedel som del av behandling vid SB. / Background: Self-Injurious Behaviour (SIB) is a discussed subject and is not classified as a diagnosis. The acts of Self Harm usually start during puberty and clings off in young adulthood. SIB is an expression of great suffering. It is important to differ between suicidal behaviour and SIB. SIB can be measured in various ways. Sweden is currently lacking national guidelines for care and treatment of SIB. Aim: The purpose was to investigate what treatment that should be recommended for patients with SIB Method: The study is a quantitative literature review based on 14 RCT-studies. The joint compilation has been made step by step based on the method described by Bettany-Saltikov och McSherry (2016).  Results: The result includes 14 studies performed in seven countries. The participants varied between n=33 and n=832 and was adolescents and adults. All studies were performed in psychiatric outpatients departments. Of the 14 included studies, 9 showed that the intervention has a better effect than the one given til the control group, often care as normal. Best effect was seen when DBT was given. Conclusion: This literature review indicates that DBT is the treatment that has best effect in SIB. The populations examined were small and the interventions of big variation wherefore it is hard to draw definite conclusion. More well-designed evaluation treatment where care is initiated by nurses are needed. Further research on new technology as a part of treatment in SIB is also required.

Bakgrund: Självskadebeteende är ett paraplybegrepp som benämner individer som skadar sig själva. I Sverige hamnar ungefär 4000 män och 7000 kvinnor på akuten på grund av självskador. Forskning visade att flertal av den här patientgruppen har negativa erfarenheter av hälso- och sjukvården på grund av negativa attityder hos vårdpersonal. Flera sjuksköterskor beskrev att de behöver mer kunskap och förståelse för självskadebeteende. Syfte: Syftet med det här arbetet var att sammanställa forskning om sjuksköterskors erfarenheter av att vårda patienter med självskadebeteende. Metod: En litteraturstudie genomfördes med hjälp av 11 kvalitativa artiklar som analyserades med integrerad analys. Resultat: Litteraturstudien resulterade i två huvudkategorier; Syn på omvårdnad och interna processer relaterade till omvårdnaden av patienter med självskadebeteende och förutsättningar för att uppnå god omvårdnad av patienter med självskadebeteende. Slutsats: I den här litteraturstudien framkom att flera sjuksköterskor upplever att de möter på flera utmaningar inom deras arbetsmiljö. Merparten av sjuksköterskorna har även uttryckt att har fått psykisk ohälsa på grund av bristande arbetsförhållanden och bristande stöd från ledningen. Sammanfattningsvis visar den här studien att det finns ett ökat behov av kompetens, handledning samt bättre förutsättningar och resurser inom arbetsplatsen för att sjuksköterskorna ska kunna erbjuda personcentrerad vård till patienter med självskadebeteende. / Background: Self-injurious behavior is an umbrella term that refers to individuals who harm themselves. In Sweden, approximately 4,000 men and 7,000 women end up in the emergency room due to self-harm. Research showed that the majority of this patient group have negative experiences with nurses due to prejudices and negative attitudes about self-harming behavior. Several nurses described that they need more knowledge and understanding of self-harming behavior. Purpose: The purpose of this work was to compile research on nurses' experiences of caring for patients with self-harming behaviour. Method: A literature study was conducted using 11 qualitative articles that were analyzed using integrated analysis. Results: The literature study is included in two main categories; Views on nursing and internal processes related to the nursing of patients with self-harming behavior and conditions for achieving good nursing of patients with self-harming behavior. Conclusion: In this literature study, it emerged that several nurses feel that they face several challenges within their work environment. Most of the nurses have also expressed that they have suffered from mental illness due to poor working conditions and lack of support from management. In summary, this study shows that there is an increased need for supervision as well as better conditions and resources within the workplace for nurses to be able to offer person-centered care to patients with self-harming behavior

This dissertation has multiple goals. First to analyze self-destructive behavior and its relations to ethics. Secondly to evaluate four different ethical perspectives regarding self-destructiveness from a certain position of human nature. The third goal is to construct a position that deals with self-destructive behavior in a way that is improved and well-managed compared to the four ethical perspectives analyzed earlier. The first goal is met by comparing and evaluating different theories concerning self-destructive behavior and discussing the ethical implications surrounding them. Self-destructive behavior is seen as a way of communicating, which puts a moral pressure on both the self-destructive person and the society around her. The four ethical perspectives represented by Robert Nozick and Thomas Szasz, two neoliberals, James B Nelson, a body theologian inspired by Paul Tillich, Gail Weiss, a body feminist and Mary Timothy Prokes, a catholic body theologian, are hence met by the problem of self-destruct, analyzed and critically evaluated. In the final chapter the author constructs an improved ethical perspective concerned with self-destructiveness, based on altruism, responsibility and broad-mindedness.

Made available in DSpace on 2016-07-27T14:20:35Z (GMT). No. of bitstreams: 1 Ellen Portilho de Souza.pdf: 1371955 bytes, checksum: 3ec9f0f9cb974638e8fca9566dbc2586 (MD5) Previous issue date: 2014-12-10 / This study aimed to functionally analyze and assess a series of treatments for the reduction of self-injurious behavior on a person with development disability. The assignment was carried out in a special education institute in central Goiás, and the subject was a 26-years-old female. Two experimental designs, multiple elements and alternate treatments, were applied. In order to assess the antecedents and consequents of self-injuring behavior, a functional assessment process was used, which included (1) indirect assessment through interview, (2) direct observation, and (3) functional analysis, through the design of multiple conditions using the following: attention, demand, control, and alone. The attention condition was subdivided into three sub conditions: shared attention, attention-reprimand, and noncontingent attention. The demand condition was subdivided into two kinds of academic demand: shape fitting and reading activities. The alone condition was subdivided into: alone with activity and alone without activities. The use of an intervention program through the design of ABCAD alternate treatments was chosen to intervene in self injurious behavior. The results suggest selfinjurious behavior has the role of self-stimulation, i.e., automatic reinforcement. The demand condition as an establishing operation for the emission of these behaviors and negative reinforcement was also discussed. Conditions of 30-seconds fixed-time (B) and differential reinforcement of alternative behaviors (D) resulted in reduction on the frequency of these behaviors. Density reduction of the noncontingent design as the responsible for the increase of self-injurious behavior frequency on condition (C) was also discussed. / O presente estudo teve como objetivo avaliar uma série de tratamentos para diminuição do comportamento autolesivo de uma pessoa com desenvolvimento atípico após avaliação funcional. O trabalho foi realizado em uma instituição de ensino especial do interior de Goiás e teve como participante uma pessoa adulta, sexo feminino e 26 anos. Foram empregados dois delineamentos experimentais: o de múltiplos elementos e o de tratamentos alternados. Para avaliar os antecedentes e consequentes do comportamento autolesivo, foi usado processo de avaliação funcional que incluiu (1) avaliação indireta por meio de entrevista, (2) observação direta e, (3) análise funcional, por meio do delineamento de múltiplas condições utilizando as condições: atenção, demanda, e controle e sozinha. A condição de atenção foi subdivida em três subcondições: atenção-dividida, atenção-reprimenda e atenção não contingente. A condição demanda foi subdivida em: demanda encaixe e demanda leitura. A condição sozinha foi subdivida em: sozinha c atividade e sozinha sem atividades. Para intervir no comportamento autolesivo, optou-se pelo uso de um programa de intervenção por meio do delineamento de tratamentos alternados do tipo ABCAD. Os resultados sugerem que o comportamento autolesivo tem função de autoestimulação, ou seja, reforçamento automático. Também foi discutida a condição de demanda como operação estabelecedora para emissão desses comportamentos e reforçamento negativo. As condições de tempo-fixo 30 segundos (B) e reforçamento diferencial de comportamentos alternativos (D) ocasionaram redução na frequência desses comportamentos. Discute-se ainda a diminuição da densidade do esquema não-contingente como sendo responsável pelo aumento da frequência do comportamento autolesivo na condição (C).

Contexto: Pouco se sabe a respeito da prevalência e correlatos de autolesão deliberada em jovens de países em desenvolvimento. Além disso, existe uma escassez de estudos avaliando associações clínicas e com psicopatologia familiar ajustando-se para outras comorbidades, especialmente numa faixa etária mais jovem da população (dos 6 aos 14 anos). Objetivos: Nós investigamos a prevalência e as associações de autolesão deliberada em jo- vens desta faixa etária com fatores de risco demográficos (idade, gênero, status socioeconô- mico e etnicidade), clínico (diagnóstico psiquiátrico das crianças) e familiar (diagnóstico psiquiátrico materno) em um grande estudo comunitário no Brasil. Métodos: Participantes (n=2.508) e suas mães (n=2,295) da Coorte de Alto-Risco para Transtornos Psiquiátricos foram avaliados através da Development and Well Being Assess- ment (DAWBA) e Mini International Neuropsychiatric Interview (MINI) respectivamente. Autolesão atual (no último mês) e ao longo da vida foram estimadas, incluindo análises estratificadas por faixa etária. Regressões logísticas foram realizadas investigando o papel do diagnóstico clínico de crianças e adolescentes e da psicopatologia materna sobre as estimativas de autolesão, ajustando-se para potenciais fatores confundidores. Resultados: A prevalência de autolesão deliberada atual foi de 0,8% (0,6% para crianças e 1% para adolescentes) e ao longo da vida foi de 1,6% (1,8% e 1,5% respectivamente). Estas estimativas não variaram de acordo com a idade, sexo e etnicidade. No entanto, pertencer à classe média esteve associado a uma diminuição de 70% na probabilidade de se relatar um episódio de autolesão ao longo da vida comparando-se com a classe mais favorecida. Autolesão atual e ao longo da vida foram mais frequentes em jovens com Depressão Maior, Transtorno de Déficit de Atenção e Hiperatividade (TDAH) e Transtorno Opositor Desafiante (TOD), mesmo em modelos múltiplos ajustado para variáveis demográficas e co- ocorrência de transtornos psiquiátricos. Além disso, a presença de transtorno de ansiedade nas mães esteve fortemente associada com autolesão deliberada recente e ao longo da vida em seus descendentes. Ao estratificar-se a análise por faixa etária, esta associação tornou- se não significativa para crianças com autolesão recente e adolescentes com autolesão ao longo da vida; ao passo que, especificamente em crianças, autolesão recente foi associada com transtorno de humor materno. Conclusão: A autolesão deliberada é um problema importante em crianças e adolescen- tes. Os diagnósticos de Depressão Maior, TDAH e TOD estão consistentemente associados com este comportamento, bem como ter uma mãe com um transtorno de ansiedade. Nos- sos resultados salientam a importância de se perguntar a respeito de comportamentos suicidas em jovens com comportamentos disruptivos, independentemente da comorbidade com depressão, e também realçam a necessidade de estratégias preventivas com um en- volvimento familiar. / Background: Little is known about the prevalence and correlates of deliberate self-harm (DSH) in youngsters from low and middle-income countries. In addition, there is a shortage of studies evaluating clinical associations and family psychopathology adjusting for other comorbidities, especially in a younger age-group (from 6 to 14 years). Objectives: We investigated prevalence and associations of DSH in youngsters of that age range with demographic (age, gender, socioeconomic status and ethnicity), clinical (children psychiatric diagnosis) and familial risk factors (maternal psychiatric diagnosis) from a community-based study from Brazil. Methods: Participants (n=2,508) and their mothers (n=2,295) from the High Risk Co- hort for Psychiatric Disorders (HRC) were assessed through the Development andWell Be- ing Assessment (DAWBA) and the Mini International Neuropsychiatric Interview (MINI) respectively. Current (last month) and lifetime DSH were estimated, including analysis stratified by age-groups. Logistic regressions were performed investigating the role of youths’ clinical diagnoses and maternal psychopathology on prevalence estimates of DSH adjusting for potential confounding factors. Results: Prevalence of current DSH was 0.8% (0.6% for children and 1% for adolescents) and life-time DSH was 1.6% (1.8% and 1.5% respectively). These estimatives did not vary with age, gender and ethnicity. However, being from middle class was associated with a 70% decrease in the odds of reporting a lifetime episode of DSH comparing to the wealthiest class. Current and life-time DSH was more frequent in youth with Major Depression, Attention-Deficit/Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD), even in multiple models accounting for demographic variables and co- occurring psychiatric disorders. Anxiety in mothers was strongly associated with current and life-time DSH in the offspring but when stratifying by age-group this association becomes non-significant for children with current DSH and for adolescents with lifetime DSH, whereas current DSH was associated with maternal mood disorder specifically in young children. Conclusion: Diagnoses of Major Depression, ADHD and ODD are consistently associated with DSH as well as having a mother with anxiety disorder. Our results emphasize the necessity to ask about suicidal behavior in young people with disruptive behaviors, regard- less of comorbidity with depression, and also highlight the need for preventive strategies with a family component.

Archived data was utilized for the present study which examined self-injurious behaviors in a college population. College students, who engage in non-suicidal self-injury, or NSSI, were expected to evidence a higher knowledge base for the behavior than those who do not. The demographic variables of gender and sexual orientation were predicted to be over represented in the NSSI group. Further, this study examines the perceived riskiness of the behavior in individuals who self-injure, as well as their perceptions of others who engage in NSSI. The survey consisted of four sections: demographics, knowledge ofNSSI, experience with NSSI, and perceptions ofNSSI. Individuals who engage in or have a history of NSSI evidence a higher mean score or better knowledge of the behavior than those who do not. The NSSI population evidences disproportionate numbers of females and individuals with gay, lesbian, and questioning sexual orientations. Further, when examining the perceived riskiness of self-injury, the NSSI group views the behavior as less risky than the non self-injury group. Results are discussed in relation to the need for accurate knowledge about NSSI and additional research directions.