| 1. |
- Elwin, Marie, 1953-
(författare)
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Description and measurement of sensory symptoms in autism spectrum
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Unusual responses to sensory stimuli have been reported in nearly all children with autism spectrum conditions (ASC). A few studies on adults indicate that the sensory and perceptual problems persist into adulthood. Sensory symptoms have not been included in the diagnostic criteria for ASC but in the new diagnostic manual (DSM-5, 2013) hyper- or hyporeactivity or unusual sensory interests were included in the diagnostic criteria for ASC. Sensory phenomena are mostly investigated in studies involving children and the scales used to measure sensory reactivity have been constructed on the basis of the scientific literature and parents’ reports. The experiences of adults with ASC are not well understood and have not been systematically used to develop measures.The overall aim of the thesis was to capture the first-hand experiences of and perspectives on sensory reactivity and translate them into a self-rating scale. To fulfil this overarching aim the personal sensory experiences of adults with ASC were investigated and the variations and range of atypical sensory phenomena explored and described in two qualitative studies (study I and II). The analyses of the firstperson descriptions enabled the development of items for a scale. These were reduced in steps and the final scale which was named the Sensory Reactivity in Autism Spectrum scale (SR-AS) comprised 32 items in four subscales: high awareness/ hyperreactivity, low awareness/hyporeactivity, strong sensory interests and sensory/motor. The SR-AS was validated using content and factor analyses. Its discriminative validity was then investigated as well as its reliability in the form of internal consistency (study III). In the final step the scale was used to identify clusters of atypical sensory functioning in adults with ASC by hierarchical cluster analysis (study IV). Three different sensory clusters were found.The main contribution of this thesis is its presentation of individual experience and perspectives and the creation of an clinical tool to measure atypical sensory reactivity frequently experienced by people with ASC. The ways in which the SR-AS can be used comprise assessment of individual sensory patterns for self-knowledge and awareness, to enable the development of coping strategies and to provide information on environmental adjustments required. In diagnostic processes where other criteria for ASC are fulfilled the SR-AS can be used for assessing sensory symptoms according to the DSM-5.
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| 2. |
- Fogelkvist, Maria, 1983-
(författare)
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Body image in patients with residual eating disorder symptoms : treatment effects of acceptance and commitment therapy and participants' reflections
- 2021
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to evaluate an acceptance and commitment (ACT) group intervention targeting body image in patients with residual eating disorder (ED) symptoms, including treatment effects and participants’ reflections on body image and the intervention. Studies I, II and III are based on a randomized controlled trial including 99 patients that were randomized to the ACT intervention or to continue treatment as usual (TAU). Different self-assessment questionnaires were administered before and after the intervention and at follow up by one and two years. Study IV is based on interviews with patients that had completed the intervention, and did not participate in the trial. From written evaluations in study I body image was shown to mean different things for different individuals. This was also shown by different expectations on treatment. Study II showed that the ACT intervention was superior to TAU in reducing ED symptoms and body dissatisfaction, while care consumption was lower. In addition, ratings of dropout was low. In study III, it was shown that symptom improvement from the ACT intervention rather than TAU was more pronounced in participants with restrictive ED psychopathology. Participants who displayed binge eating and/or purging ED psychopathology, showed improvement on ED symptoms regardless of intervention. Participants younger than 25, and with lower ratings at baseline, showed no improvement on ED symptoms if continuing with TAU. From interviews with participants in study IV, the intervention was described as demanding, and participants described the importance of their own efforts. Specific processes of the intervention were helpful and the context of the group and context outside of treatment could facilitate or hinder progress. Perceived changes in body image differed between participants in study I, showing the potential breadth of the intervention.Conclusions from this thesis was that an intervention based on ACT targeting body image was suitable and helpful for patients with residual EDsymptoms. Though the intervention was demanding, dropout was low, and specific processes were described as helpful.
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| 3. |
- Gustafsson, Sanna Aila, 1972-
(författare)
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The importance of being thin : perceived expectations from self and others and the effect on self-evaluation in girls with disordered eating
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aims of this thesis were to examine personal standards, self-evaluation and attitudes to eating and weight in the development of disturbed eating in adolescent girls, and to examine how adolescent girls with a clinical eating disorder reflect upon and deal with perceived expectations in daily life.Studies I and II were quantitative studies, conducted in a population-based longitudinal study. Studies III and IV were qualitative interview studies of girls who were suffering from eating disorders and the data were analysed using a phenomenographic approach.Study I showed that high personal standards expressed in a competitive way were specific for the girls with disturbed eating. These girls also reported a negative physical self-evaluation and often believed that thinness would make them more popular. In study II variables concerning attitudes to eating and weight and physical self-evaluation emerged as risk factors for disturbed eating, whereas personal standards or self-evaluation in general did not. Protective factors were a low BMI, healthy eating attitudes, an accepting attitude towards body size and a positive self-evaluation. Three categories of perceived expectations were described in study III: expectations from others, self-imposed expectations and conflicting expectations. Many informants had problems identifying expectations that were not explicit and they interpreted them as self-imposed. In study IV the various ways in which the informants reflected on dealing with these expectations were summarized into three qualitatively different conceptions: being oneself, adapting to different situations and presenting oneself in a positive light. These conceptions were expressed in five patterns of action, which could have various functions for different individuals and in different situations.The results suggest that in order to prevent and treat eating disorders and related problems it is essential to integrate both intrapersonal and contextual factors that contribute to the development and maintenance of these conditions.
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| 4. |
- Humble, Mats B., 1952-
(författare)
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Obsessive-compulsive disorder, serotonin and oxytocin : treatment response and side effects
- 2016
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Obsessive-compulsive disorder (OCD), with a prevalence of 1-2 %, frequently leads a chronic course. Persons with OCD are often reluctant to seek help and, if they do, their OCD is often missed. This is unfortunate, since active treatment may substantially improve social function and quality of life. Serotonin reuptake inhibitors (SRIs) have welldocumented efficacy in OCD, but delayed response may be problematic. Methods to predict response have been lacking. Because SRIs are effective, pathophysiological research on OCD has focussed on serotonin. However, no clear aberrations of serotonin have been found, thus other mechanisms ought to be involved.Our aims were to facilitate clinical detection and assessment of OCD, to search for biochemical correlates of response and side-effects in SRI treatment of OCD and to identify any possible involvement of oxytocin in the pathophysiology of OCD.In study I, we tested in 402 psychiatric out-patients the psychometric properties of a concise rating scale, “Brief Obsessive Compulsive Scale” (BOCS). BOCS was shown to be easy to use and have excellent discriminant validity in relation to other common psychiatric diagnoses.Studies II-V were based on 36 OCD patients from a randomised controlled trial of paroxetine, clomipramine or placebo. In study II, contrary to expectation, we found that the change (decrease) of serotonin in whole blood was most pronounced in non-responders to SRI. This is likely to reflect inflammatory influence on platelet turnover rather than serotonergic processes within the central nervous system.In studies IV-V, we found relations between changes of oxytocin in plasma and the anti-obsessive response, and between oxytocin and the SRI related delay of orgasm, respectively. In both cases, the relation to central oxytocinergic mechanisms is unclear. In males, delayed orgasm predicted anti-obsessive response.
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| 5. |
- Lindstedt, Katarina, 1979-
(författare)
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A life put on hold : inside and outside perspectives on illness, treatment, and recovery in adolescents with restrictive eating disorders
- 2019
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overall aim of this thesis was to study adolescents with restrictive eating disorders in relation to illness, treatment, and recovery from an inside and outside perspective. Studies I and II are based on data from a national quality register for eating-disorder treatment. Studies III and IV are based on interviews with adolescents previously treated in outpatient care for a restrictive eating disorder. The results showed that 55% of the adolescents were in remission at the end of treatment, and 85% were within a healthy weight range. The average treatment duration was 15 months. Over the years 1999–2014, remission rates and weight recovery increased, whereas treatment duration decreased. Young patients who received mainly family-based treatment had the highest probability of achieving remission at one-year followup, but the patients themselves were most satisfied with individual therapy. The interviews with the adolescents revealed that they often felt a strong ambivalence during the first treatment sessions, both regarding being defined as sick and the involvement of their parents. In retrospect they believed that family involvement was important, but that individual treatment sessions were crucial. The informants highlighted that trust in the therapist was the key to successful treatment. The adolescents’ narratives drew a picture of a life that was “put on hold” during the time of illness, as their involvement in social contexts outside the family was strongly influenced. It was in these contexts that their problems first became visible, and the quality of their interpersonal relationships played a great role in the recovery process. The results suggest that treatment for adolescents with restrictive eating disorders should be better adapted to changed social structures and patients’ individual contexts – a relevant area for future research.
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| 6. |
- Pelto-Piri, Veikko, 1959-
(författare)
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Ethical considerations in psychiatric inpatient care : The ethical landscape in everyday practice as described by staff
- 2015
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- This thesis focuses mainly on the general ethical considerations of staff and not pre-defined specific ethical problems or dilemmas. The aims of this thesis were: first, to map ethical considerations as described by staff members in their everyday work in child and adolescent psychiatry as well as in adult psychiatry; second, from a normative ethical perspective, examine encounters between staff and patients; and third, to describe staff justification for decisions on coercive care in child and adolescent psychiatry. The material in the three first studies comprised ethical diaries written by staff in 13 inpatient clinics. The fourth study included all the medical records of patients who were admitted to coercive care during one year in child and adolescent psychiatry in Sweden.In a final analysis, combining all the four studies, three staff ideals were identified: being a good carer, respecting the patient’s autonomy and integrity and having good relations with patients and relatives. Staff often felt that the only reasonable way in many situations was to act in a paternalistic way and take responsibility, but they considered it to be problematic.Four main themes were identified as ethical considerations. These were the borders of coercion, the emphasis on order and clarity rather than a more reciprocal relationship with patients, a strong expectation of loyalty within the team, and feelings of powerlessness, mostly in relation to patients.I have identified four challenges for inpatient psychiatry. First, formal and informal coercion in inpatient care raise ethical concerns that also can be emotionally difficult for staff. Second, the professional role and care needs to be redeveloped from providing routinised care to providing more individualised care. Third, staff often worry about how patients manage their life after discharge, indicating that patients need better support. Fourth, staff also need support; they often experience feelings of being alone with their thoughts about ethical difficulties at work. Future research could contribute in the mapping of ethical considerations, in helping to develop, implement and evaluate methods for managing these issues in psychiatric settings, and to develop the normative ethical language so that it is more relevant to the clinic reality.
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| 7. |
- Selvin, Mikael, 1978-
(författare)
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Patient participation and quality of forensic psychiatric care
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aims of this thesis were to investigate the quality of forensic psychiatric care, to describe the concept of patient participation from a patient and health care professional perspective, and to initiate the development of an instrument for measuring participation from a patient perspective.Forensic psychiatric care is a specialized form of care where patients who have committed a crime that would normally have led to prison, instead are treated for a serious mental disorder. In study I patients’ and professionals’ experiences of quality of forensic psychiatric care were measured, and one of the findings was that questions regarding participation was rated as low by both patients and staff. In Study II the patients perceived the concept of patient participation as: Influence by having good communication and being involved; Confidence by mutual trust and trusting the care; Own responsibility by taking part in activities and to take own initiative. The findings in Study III highlights the importance as a professional to create prerequisites for patient participation by using good communication and inviting the patient to be involved, whilst at the same time adjusting for the forensic psychiatric conditions by taking professional responsibility and assessing the patients’ current capacity. If used correctly, patient participation encourages the patient to become more independent. In study IV, the initial development of an instrument for measuring participation in forensic care from a patient perspective was described. The findings contribute with important knowledge that can encourage reflection and accordingly help mental health professionals and decision makers to create an environment that promotes patient participation in forensic psychiatric care. Further research should investigate the longterm effects of increasing the participation, such as cost effectiveness, treatment times and risk of committing new crimes.
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| 8. |
- Wilhelmsson Göstas, Mona, 1950-
(författare)
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Psychotherapy patients in mental health care: : attachment styles, interpersonal problems and therapy experiences
- 2014
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Mona Wilhelmsson Göstas, School of Health and Medical Sciences, Örebro University, SE-701 82 Örebro, Sweden, mona.vilhelmsson gostas@orebroll.se Attachment styles are relevant to psychotherapy since they highlight the way a person handles interpersonal and emotional stress. This thesis aimed to examine how psychotherapy patients in the public mental health care system report attachment styles related to interpersonal problems and diagnosis before and after psychotherapy and to examine problems and changes and psychotherapy contract and process from patients’ experiences of cognitive behavioural oriented therapy (CBT) and psychodynamic oriented psychotherapy (PDT).The studies are based on data from patients admitted to psychotherapy within the public psychiatric services in Örebro County Council. Studies I and IV were quantitative and used self-reports to examine attachment styles and interpersonal problems before and after psychotherapy. Studies II and III were qualitative interview studies examining patients experiences of problems, changes and psychotherapy process. The patients were diagnosed with mood disorders, anxiety disorders, adjustment disorders and personality disorders and reported insecure avoidant and anxious attachment styles that correlated positively with interpersonal problems when they started therapy. Psychotherapy with CBT or PDT enabled them to turn attachment styles into more secure ones and decrease interpersonal problems Patients aged between 26 and 39, patients who attended 11-25 sessions and patients diagnosed with a personality disorder reported greater changes in secure related attachment than others. Patients described their problems as emotions that could not be regulated, as cognitive disabilities and as problematic behaviours that implied a self-centredness. During the course of psychotherapy, the patients gained abilities to handle their problems. The perceived self-centeredness changed which increased their participation in their life-context.Similarities across the therapy orientations showed that the creation of a new context was essential to pay full attention to the patient’s problems, and that the working method and cooperation with the psychotherapist made up a whole. To make the therapy effective, it is important to build up confidence in cooperation and secure base functions like offering predictability and shaping interventions according to the needs of the patient and their ability to use them.
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