| 1. |
- Södergård, Susanne, et al.
(författare)
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Intima kroppsberöringar och intimt tal mellan föräldrar och barn
- 1998
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Syftet är att studera förekomst av intima kroppsberöringar och intimt tal mellan föräldrar och barn upp till 12 års ålder. Ett antal föräldrar (50 kvinnor, 46 mmän) besvarade en utdelad enkät. Enligt resultaten förekommer intima beröringar i en mängd varierande situationer, t ex toabesök, sovande, nyfikenhet, tröst, amning, bad, lek, medicinsk anledning. Mer än hälften av alla beröringar från föräldrar gentemot egna barn sker vid hygienskötsel. Barn kommenterar skillnader mellan könen, mellan sig själv och vuxna och kommenterar amning och graviditet, könsorgan och bröst samt ställer frågor inom dessa områden.
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| 2. |
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| 3. |
- Lindquist, Göran, 1923, et al.
(författare)
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Organisk psykiatri. Teoretiska och kliniska aspekter : Organic Psychiatry. Theoretical and clinical aspects.
- 1990
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Bok (övrigt vetenskapligt/konstnärligt)abstract
- In this book a theory about the nature of organic mental disorders (in the narrow sense) and a new diagnostic system for them are presented. The diagnostic concepts used are mainly rooted in the classical Central European psychiatric tradition but have been modified in the light of recently published research and the authors' own clinical experience from different parts of organic psychiatry.
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| 4. |
- Malmgren, Helge, 1945
(författare)
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Asteno-emotionellt syndrom, kognitiv dysfunktion : Astheno-emotional syndrome and cognitive dysfunction after whiplash injuries
- 1999
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Ingår i: Konferens och utbildningsdag om whiplash-skador, Göteborg 19/10 1999.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- Typiska manifestationer av lindriga till måttliga asteno-emotionella syndrom (AE-syndrom, AED): • Koncentrationssvårigheter (ssk. svårighet att upprätthålla koncentration över tid) • Psykisk uttröttbarhet • Sekundära minnestörningar (påverkan såväl på korttidsminnet som på lagring till och framtagning från långtidsminnet) • Emotionell labilitet • Irritabilitet • Överkänslighet för sensoriska stimuli Tänkbara orsaker till AED vid whiplash-trauma: • Vid uppenbar hjärnskada kan ett tydligt AED framträda relativt tidigt. • Ett lindrigt AED baserat på en centralnervös funktionsrubbning kan möjligen uppstå primärt, även om amnesi för episoden inte föreligger. Observera att ett lindrigt AE-syndrom i denna fas kan maskeras av andra, mer påtagliga symtom. • Ett patologiskt signalflöde från den skadade nackregionen (vare sig det når medvetandet eller ej) kan sannolikt innebära en överbelastning av högre centra i CNS, och därför ge ett lindrigt sekundärt AED utan primär dysfunktion i CNS. • Kroniska, upplevda symtom av skadan (smärta, yrsel etc) kan på längre sikt också ge en sådan överbelastning , vilket leder till ett lindrigt AED. Tänkbara följder av AED vid whiplash: AED kan i sig ge psykogena komplikationer, svåra eller omöjliga att skilja från reaktioner av typ PTSD och från sekundära reaktioner på övriga kroniska symtom av skadan. Vanliga psykogena komplikationer: • Ängslan och ångest • Spänning • Huvudvärk • Vegetativa symptom • Depressivitet Av dessa reaktioner är den sekundära depressionen vid utdragna besvär särskilt viktig att beakta, liksom givetvis möjligheten till många onda cirklar med övrig symtomatologi vid whiplashskador (AED --> ökad smärtreaktivitet --> värre AED). Förslag till revision av vårdprogram: • Anamnes beträffande AED bör alltid tas tidigt i förloppet • Neuropsykologisk utredning kan vara indicerad tidigt, även om tydliga kognitiva symtom inte spontant rapporterats • Patientinformationen bör tidigt innefatta en diskussion av symptom, prognos och lämpliga åtgärder vid lindriga astenoemotionella syndrom • Försiktighet med återgång till fullt arbete innan AED har uteslutits.
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| 5. |
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| 6. |
- Malmgren, Helge, 1945
(författare)
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Without a proper definition, you do not see the phenomenon
- 1997
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Ingår i: Consciousness and its pathologies. San Diego, CA, May 17-18, 1997.
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Konferensbidrag (övrigt vetenskapligt/konstnärligt)abstract
- At the beginning of the century, pioneer psychiatrists in the classical German school (Kraepelin, Bonhoeffer) had established beyond reasonable doubt the existence of a certain organic mental syndrome or “reaction form”, variously named “Reizbare Schwäche” (irritable weakness) or “Emotionell-hyperaestetisches Schwächezustand” (emotional-hypersensitive weakness state). This reaction form is typically manifested by concentration difficulties, mental fatiguability, secondary memory disturbances, irritability and emotional lability. The term “astheno-emotional disorder” (AED) has recently been suggested. Patients showing this constellation of symptoms are very common in all parts of organic psychiatry, for example after moderate trauma to the brain, in chronic intoxications, in certain chronic infectious states, in endocrine disorders, as the initial manifestation of a brain tumour, after an intracranial bleeding, and so on. Mild forms of the same disorder are sometimes met with in which no organic cause can be found but where the patient has instead suffered great mental stress. The condition usually affects the patients’ ability to work and is often socially handicapping. In spite of the importance of AED, and in spite of its being well-known to most practitioners in each of the separate areas where it occurs, academic psychiatry has displayed very little interest in the condition during the last 40 years, and the major diagnostic systems of today do not allow for a unitary classification of these cases. For example, in DSM-IV a certain share of the mild cases would receive the diagnosis “mild cognitive disorder”, which would however fit neither mild cases with dominating emotional lability nor any of the (equally common) more severe cases. In this paper, I suggest the following causes of the present situation concerning the diagnosis of AED: (1) The astheno-emotional syndrome is often complicated by secondary, psychogenic reactions such as anxiety, feelings of tension and depressive mood, which can be difficult to disentangle from the primary symptoms. Many earlier classificatory attempts in this area (often in terms of “neurasthenia”) stumbled on a failure to distinguish the primary from the secondary symptoms. (2) The fact that the primary symptoms can themselves be psychogenic in nature, and the fact that the etiology cannot always be known for certain, entail that the disorder has to be delimited without recourse to causes. Many systems instead prefer seperate diagnoses for psychogenic cases. (3) Clinically, cases of AED form a continuum, ranging from very mild disturbances without clinical import to severe disturbances justifying a global diagnosis of dementia. Most diagnostic systems of today do not allow for such large-scale gradations of the severity of a disorder. (4) The conceptual apparatus which is used to describe symptoms is often too coarse to be able to distinguish typical symptoms of AED from similar symptoms which do not belong to this disorder. A clear examples of this is “memory difficulties”, which can refer either to a primary memory disturbance of the kind seen in Korsakov’s amnestic disorder or to secondary effects of concentration difficulties, as in mild AED. Another example is the term “emotional disturbance”, which does not differentiate between the emotional flattening typically seen in severe frontolimbic injuries and the emotional instability which is very common in AED. (5) The operationalistic bias in several recent systems of psychiatric classification prohibits hypothetical diagnoses based on knowledge of the interaction between different psychiatric disorders. From longitudinal studies of patients it is clear that the emotional lability and the manifest fatiguability of a patient with AED can both be completely neutralized if the same patient also suffers an emotional flattening. This means that the diagnosis of AED cannot be completely operationalized in terms of present symptoms. (6) The isolation of different parts of organic psychiatry from each other and from general psychiatry implies that few psychiatrists have a sufficiently broad experience to see the full spectrum of AED.
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| 7. |
- Andræ, Margareta, 1943-
(författare)
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Facing death : physicians' difficulties and coping strategies in cancer care
- 1994
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Even if the treatment of cancer has developed over the last decades 50% of the patients still die of their cancer. The doctor's way of dealing with his and his patient's anxiety must surely be of significance for the treatment the patient receives.In the first part of the thesis earlier studies of physicians' stress and ways of coping are reported. There is a lack of systematic studies which show how doctors working with cancer patients adjust to this work. The aim of this investigation is to study cancer doctors' difficulties and coping strategies. The theoretical frame of the study embraces parts of psychoanalytical theory and coping models, emphasizing that both unconscious and conscious psychological processes play their part in the coping process.The second, empirical part of the study includes 23 physicians strategically selected out of a population of physicians who work with institutional care and who have daily contact with adult cancer patients. The main method of data collection has been a series of recorded interviews. The focus of the interview was the physician's perception of how he reacts, thinks, talks and acts in different phases of the cancer disease. To illustrate the defence strategies of the interviewers, the projective percept-genetic test, the "Defence Mechanism Test" (DMT) is used. The "Structural Analysis of Social Behaviour" (SASB) has been used to study the doctors' self image.The results indicate that the stated difficulties deeply affect the doctor as a human being. The statements reflect conflicting feelings and wishes in relation to authority, conflicting feelings and wishes in relation to frightening and injuring, conflicting feelings and wishes in relation to intimacy/distance. Thirty themes of coping strategies frequently recur and they have been grouped into seven categories. Most of the doctors "seek knowledge" and support from scientific literature. The majority of them state that attempting to "solve a problem" is their main strategy. Most of the doctors "seek support " as a part of their coping strategy. An interesting observation is that the doctors to a higher extent "seek a relation" to their patients rather than to their colleagues. Almost one third use "denial of the severity of a situation" as their main strategy. All the doctors consciously or unconsciously use "diverting strategies", i.e. undertake tasks which are devoid of contact with patients, such as research and administration or other activities which allow them to avoid the patient. One third use "projective manoeuvres" but this is never a main strategy.In the third part of the study the credibility of the results and their pedagogical and practical implications are discussed.
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| 8. |
- Wikman, Marianne, 1941-
(författare)
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To desire and to choose : aspects of women's and men's urge to have children
- 1994
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this study was to increase available knowledge about women's and men’s desire for pregnancy and for a child/children to serve as a basis for further studies of problems and inconsistencies in the reproductive sphere. The motivation to become a parent was hypothesized as being not only of an existential, social, interpersonal and intrapsychic character but also a biologically anchored personality trait.The first part of the study deals with the development of a method for collecting valid information concerning this intimate and personal sphere of life and to categorize this information into measurable dimensions. A questionnaire was constructed and factor analysis was used as a statistical tool. There are two versions of the final instrument, one for women and one for men. Interviews were used as a means of testing the validity of the instrument. Experiences from the methodological development process revealed that it was meaningful to deal with the issue though suitable wording was not easily found.In the main part of the study, two large populations, one reference group of 416 women and 329 men of fertile ages and one group of expecting parents, 369 women and 345 men, were investigated by means of the questionnaire. Attitudes were dominated by two opposing views of children: 'Children mean existential satisfaction' and 'Children mean restriction of freedom'. This confirmed the findings of earlier studies and clinical experience that ambivalence is a natural phenomenon, that may be associated with feelings of guilt. The view of one's own parents as models in parenthood was a third important dimension. The view of the child's sex was a fourth important and complex dimension.The similarities between women and men were striking. There were only subtle differences between reference women and pregnant women. Reference men and child-expecting men had different response patterns, child-expecting men emphasizing more the advantages of having children.In the last part of the study 48 women were followed during pregnancy and after childbirth using the questionnaire and determination of levels of the intestinal peptide gastrin. Gastrin may be a marker of energy-storing characteristics, thus influencing reproductive capacity. There were some attitudinal differences between 0-parous women and parous women, the latter agreeing less with the view of 'children as restriction of freedom'. The view of 'children as existential satisfaction' was agreed with more after childbirth than during pregnancy. The view of one’s own parents as models in parenthood correlated with the levels of gastrin during this period.
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| 9. |
- Bjälke, Christer, et al.
(författare)
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BOF (Barnorienterad familjeterapi) : symtomens arena?
- 1999
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Barnorienterad familjeterapi - BOF, en terapiform där barn och föräldrar leker tillsammans i en sandlåda med ett material av dockor, djur, träd, staket, etc. I studien undersöker vi om man med ledning av det som sker i leken, samhandlingen, kan se och förstå barnets problem, dvs det symtom familjen sökte till BUP för.Vi valde att dela in symtomen i tre huvudgrupper; externaliserande, dvs. utagerande symtom, internaliserande symtom, dvs mer inåtvända symtom som oro, ledsenhet samt somatiserande, där symtomen tar sig kroppsliga uttryck.Nio familjer som inledde en BOF-terapi vid BUP, Vrinnevisjukhuset under 1997-98 kom att ingå i undersökningen.Innan terapin påbörjades fyllde föräldrarna i ett CBCL -formulär om barnets symtom. BOF-terapin utfördes på vanligt sätt med filmning av sessionerna och samtal i familjen om filmerna. Därefter fick vi tillgång till filmerna. Vi fick ej veta något om symtom eller problematik. I ett fall kände vi anmälningsorsaken. Familjesammansättningen var också okänd för oss.Vi har studerat den första terapiomgången med barn, föräldrar och terapeut vid sandlådan. Filmen har transkriberats vilket innebär att varje sammanhållen handling och verbal tur, dvs. yttrande, har dikterats in på band. Ex, Pojke gör: Tar bilen, Mamma säger: "Kom hit" Transkriptionen har skrivits ut och analyserats. Vi har sorterat och räknat antal handlingar och yttranden och för varje aktör. För att få veta intensiteten i leken har vi sedan delat antalet med lekens längd. Vi antog att intensivare lek kan tyda på utagerande problematik.Vi har läst materialet och försökt beskriva terapiomgångarna globalt avseende innehåll och teman i leken, gränser och aktivitet i sandlådan samt terapeutens agerande.I utskrifterna har vi även försökt finna handlingar och yttranden som visar på gränsergränssättning, aggressivitet, omsorg, oro-ängslan, sjukdom-skada, ledsenhet, att bli sedd etc. Vi har även försökt se till samspelet ur olika aspekter.De olika kategorierna har markerats i skriften, förts in i ett protokoll och räknats samman. Vi har jämfört de olika resultaten och ställt en hypotes om barnets symtom.Våra antaganden om varje barns symtom har jämförts med resultatet av CBCL-skattningen. Vi fann, att vi vid åtta av nio barn hamnat inom samma huvudgrupp av symtom som CBCL. Pojken som avvek hade, liksom flertalet av barnen, en dubbel problematik med både internaliserande och externaliserande symtom. I gruppen ingick inget barn med starka somatiserande symtom varför vi ej kan uttala oss om giltigheten för den gruppen.Vår slutsats är att barnets symtom syns i samleken och att BOF-sandlådan verkligen är symtomets arena.
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| 10. |
- Bodlund, Owe, 1949-
(författare)
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Transsexualism and personality : methodological and clinical studies on gender identity disorders
- 1994
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Patients suffering from transsexualism (TS) who apply for sex reassignment surgery (SRS) go through a complex evaluation process before being accepted for treatment. In general, the results from SRS are satisfying. However, further knowledge is needed to clearly delineate transsexualism from other related gender identity disorders (GID) and to improve the selection of candidates for SRS. Personality has for a long time been considered as the key concept for that purpose but systematic studies using reliable instruments are lacking. The present study aims at improving the assessment procedure, validating the concept of transsexualism and studying the outcome of SRS and important prognostic factors.Two methodological studies deal with the development and validation of two self-report instruments based on DSM-III-R: SCID screen covering Axis II personality disorders/traits and Global Assessment of Functioning (GAF-scale, Axis V). SCID screen diagnoses of personality disorders (PD) were compared with diagnoses from independent structured interviews by means of the SCID-II. The overall kappa in identifying a PD was 0.78 varying from 0.34 to 0.81 for the specific PDs when cut-off was adjusted. When applied to a group of GID-patients SCID screen diagnoses agreed well with clinical diagnoses (kappa 0.77). Self-report of the GAF also proved to be a reliable (overall Pearson r=0.62) and useful method and the study lends further support to the validity of Axis V.In three papers a group of 19 transsexuals was studied by means of a) SCID screen to examine their personality in a dimensional and traditional categorical way, b) the GAF-scale to study psychosocial functioning, c) Structural Analysis of Social Behavior (SASB) to examine self-image and d) Defense Mechanism Test (DMT) to analyze psychological defense structures from a psychodynamic perspective. Patients with atypical gender identity disorders (GIDAANT) and patients with borderline personality disorders as well as healthy subjects were used as contrast groups. Among the transsexuals 10 out of 19 had an additional axis I disorder and 37% had at least one PD, predominantly within cluster B. When analyzed dimensionally according to SCID screen, frequent subthreshold personality pathology was found and biological women fulfilled more axis II criteria than men. TS had less axis I and II pathology compared with GIDAANT and psychiatric patients. According to SASB, TS had a positive self-image with both self-control and spontaneous self and predominating self-love. They appeared significantly more healthy on self-image measures than GIDAANT patients. The DMT revealed a different pattern; TS patients were more disturbed in several areas than patients with borderline personality disorder. TS showed no ”emotional investment” and poorer reality orientation in contrast to both healthy controls and the borderline group but shared a similar pregenital pathology with the borderline patients.Finally, five-year outcome was studied among the transsexuals from a multidimensional approach (e.g. work, interpersonal relations, partnership, subjective opinion) and related to index- measurements on DSM-III-R, SCID screen, GAF, SASB and DMT. Based on combined outcome variables, 68% of the subjects were judged to have improved and 16% had an unsatisfactory outcome. One single case regretted the sex change. SCID screen pathology and SASB disturbances emerged as significant predictors for negative outcome, as well as male biological sex and lack of partnership. It was concluded, that although outcome is in general very favorable, the instruments under investigation, in particular SCID screen and SASB, revealed valuable prognostic information and they are suggested to become part of the future routine assessment of candidates for SRS.
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