| 1. |
- Alem, Atalay, et al.
(författare)
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Clinical course and outcome of schizophrenia in a predominantly treatment-naive cohort in rural Ethiopia
- 2009
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Ingår i: Schizophrenia Bulletin. - : Oxford University Press (OUP). - 0586-7614 .- 1745-1701. ; 35:3, s. 646-654
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Tidskriftsartikel (refereegranskat)abstract
- The established view that schizophrenia may have a favorable outcome in developing countries has been recently challenged; however, systematic studies are scarce. In this report, we describe the clinical outcome of schizophrenia among a predominantly treatment-naive cohort in a rural community setting in Ethiopia. The cohort was identified in a 2-stage sampling design using key informants and measurement-based assessment. Follow-up assessments were conducted monthly for a mean duration of 3.4 years (range 1-6 years). After screening 68 378 adults, ages 15-49 years, 321 cases with schizophrenia (82.7% men and 89.6% treatment naive) were identified. During follow-up, about a third (30.8%) of cases were continuously ill while most of the remaining cohort experienced an episodic course. Only 5.7% of the cases enjoyed a near-continuous complete remission. In the final year of follow-up, over half of the cases (54%) were in psychotic episode, while 17.6% were in partial remission and 27.4% were in complete remission for at least the month preceding the follow-up assessment. Living in a household with 3 or more adults, later age of onset, and taking antipsychotic medication for at least 50% of the follow-up period predicted complete remission. Although outcome in this setting appears better than in developed countries, the very low proportion of participants in complete remission supports the recent observation that the outcome of schizophrenia in developing countries may be heterogeneous rather than uniformly favorable. Improving access to treatment may be the logical next step to improve outcome of schizophrenia in this setting.
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| 2. |
- Armelius, Bengt-Åke, 1944-, et al.
(författare)
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Borderline diagnosis from hospital records : reliability and validity of Gunderson's diagnostic interview for Borderlines (DIB)
- 1985
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Ingår i: Journal of Nervous and Mental Disease. - 0022-3018 .- 1539-736X. ; 173:1, s. 32-4
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Tidskriftsartikel (refereegranskat)abstract
- Two trained and experienced clinical psychologists and two nontrained students rated the sections in Gunderson's Diagnostic Interview for Borderlines (DIB) on the basis of hospital records for 16 patients (DIB-R). The results showed that both reliability and validity, i.e., correlations with an actual interview, were unexpectedly high, around .80 for the trained judges and around .55 for the nontrained judges. The conclusion is that the DIB may be used for retrospective diagnosis of borderline patients from hospital records.
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| 3. |
- Armelius, Bengt-Åke, 1944-, et al.
(författare)
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Personality organization defined by DMT and the structural interview
- 1990
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Ingår i: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 31:2, s. 81-8
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Tidskriftsartikel (refereegranskat)abstract
- The psychoanalytic concept of Personality Organization (PO) may be operationalized by means of a Structural Interview as well as by means of psychological tests. The present study utilized the Structural Interview and a projective test called the Defence Mechanism Test (DMT) to operationalize the PO concept on a sample of 50 psychiatric inpatients. The reliability of the PO judgements were found to be acceptable for both the Structural Interview and the DMT. The validity, which was estimated as the correlation between the two methods, was also found to be substantial. The conclusion is that the concept of PO may be reliably operationalized for psychiatric patients and seems to have concurrent validity. Both the DMT and the Structural Interview may be used for differential diagnosis of PO.
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| 4. |
- Grann, Martin, et al.
(författare)
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Psychopathy (PCL-R) predicts violent recidivism among criminal offenders with personality disorders in Sweden
- 1999
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Ingår i: Law and human behavior. - : American Psychological Association (APA). - 0147-7307 .- 1573-661X. ; 23:2, s. 205-217
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Tidskriftsartikel (refereegranskat)abstract
- Psychopathy as conceptualized with Hare's Psychopathy Checklist Revised, PCL-R, has attracted much research during the 1990s. In the Scandinavian countries, few studies that empirically support the validity of North American risk assessment techniques in our regional context have been published. The purpose of this paper is to explore the predictive power of the PCL-R in a population of personality-disordered violent offenders subjected to forensic psychiatric evaluation in Sweden. Following release from prison (n = 172), discharge from forensic psychiatric treatment (n = 129), or probation (n = 51), a total of 352 individuals were followed for up to 8 years (mean = 3.7 years) with reconviction for violent crime as endpoint variable (base rate 34%). As the estimate of predictive power, the area under the curve of a receiver operating characteristic (AUC of ROC) analysis was calculated. For PCL-R scores to predict 2-year violent recidivism, AUC of ROC was .72 (95% CI: .66-.78). In addition, the personality dimension of psychopathy (Factor 1) and the behavioral component (Factor 2) both predicted 2-year recidivism significantly better than random: AUC of ROC .64 (95% CI: .57-.70) and .71 (95% CI: .65-.77), respectively. We conclude that psychopathy is probably as valid a predictor of violent recidivism in Swedish forensic settings as seen in previous North American studies.
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| 5. |
- Herrera Rodríguez, Andrés, et al.
(författare)
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Pathways to suicidal behaviour among adolescent girls in Nicaragua
- 2006
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Ingår i: Social Science and Medicine. - : Elsevier BV. - 0277-9536 .- 1873-5347. ; 62:4, s. 805-814
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Tidskriftsartikel (refereegranskat)abstract
- Adolescent girls are the most frequent suicide attempters worldwide. However, there is little knowledge about pathways leading to suicidal behaviour among young people, in particular in low-income countries. This study explores the motives and processes related to suicidal behaviour among young girls in Nicaragua. Individual in-depth interviews were conducted with eight girls aged between 12 and 19 admitted to hospital after attempting suicide. The audio-taped interviews lasted 2–4 h and were transcribed, translated into English and coded for content. Grounded theory and content analysis were used to construct a theory of the mechanisms behind their suicidal behaviour. A tentative model exploring pathways to suicidal behaviour is described with four main categories: structuring conditions, triggering events, emotions and actions taken. The model illustrates the dialectic interplay between structure and actions taken. Actions taken were categorized as problem solving or various forms of escape where failure with either of these strategies resulted in a suicide attempt. Dysfunctional families, absent fathers and lack of integration into society were some of the structuring conditions that lead to emotional distress. Abuse, deaths in the family, break-up with boyfriends or suicide among friends acted as triggering events. A striking finding was the obvious narrative competence of the girls. Our findings indicate that suicide prevention programmes for young people must offer support from professionals, independent of their family and social networks. Institutions in the community in contact with young people with suicidal behaviour must develop communicative skills to offer a trusting environment mobilising the resources that young people have.
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| 6. |
- Idenfors, Hans, et al.
(författare)
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Professional Care as an Option Prior to Self-Harm A Qualitative Study Exploring Young People's Experiences
- 2015
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Ingår i: Crisis. - : Hogrefe Publishing. - 0227-5910 .- 2151-2396. ; 36:3, s. 179-186
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Tidskriftsartikel (refereegranskat)abstract
- Background: Deliberate self-harm (DSH) is a growing problem among young people and is a major risk factor for suicide. Young adults experiencing mental distress and suicidal ideation are reluctant to seek help, requiring new strategies to reach this group. Aims: The present study explored young people's views of professional care before first contact for DSH, and factors that influenced the establishing of contact. Method: Interviews with 10 young individuals, shortly after they had harmed themselves, were analyzed using qualitative content analysis. Results: The participants emphasized the importance of receiving more knowledge on where to turn, having different help-seeking options, and receiving immediate help. Family and friends were vital for support and making health care contact. The quality of the professional contact was stressed. Several reasons for not communicating distress were mentioned. Two themes were identified: "A need for a more flexible, available and varied health care" and "A struggle to be independent and yet being in need of reliable support." Conclusion: These findings suggest that easy and direct access to professional help is a decisive factor for young people experiencing psychological problems and that health services must find new ways of communicating information on seeking mental health help.
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| 7. |
- Jegannathan, Bhoomikumar, et al.
(författare)
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High exposure to suicide, a risk factor among university students in Cambodia
- 2010
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Ingår i: Journal of Indian Association for Child and Adolescent Mental Health. - : Sage Publications. - 0973-1342 .- 2754-6349. ; 6:4, s. 84-100
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Tidskriftsartikel (refereegranskat)abstract
- Suicide rates are on the increase among young people in several countries. Exposure to suicide among significant others, a well-known risk factor for suicidal behavior, is less studied in low-income, post-conflict countries. This study focuses on university students, a group known to be at risk for suicidal expressions, such as death-wishes, suicidal ideation, plans and attempts.Aim: To investigate suicidal expressions among university students in Cambodia and their relationship to exposure to suicidal behavior among significant others.Methods: 109 university students in the age group 18 to 24 from the Royal University of Phnom Penh (RUPP) responded to Attitude Towards Suicide (ATTS) questionnaire, that reveals the exposure to suicidal behavior among significant others and self-reported suicidal expressions.Results: 44.9% reported any of the suicidal expressions during the previous year. Young men reported significantly more exposure to suicide among relatives than women (34.5%, 13.7%, p=0.015). Exposure to completed/attempted suicide among siblings and other relatives was s own suicidal ideation (OR=5.09, 3.16, respectively) and self-reported probability for suicide (OR=4.35, 3.36, respectively). Young men exposed to suicide among siblings and friends were more at risk for suicidal ideation (OR= 7.17, 4.56, respectively) and those exposed to suicide among relatives reported suicide as a probability (OR= 4.58), whereas exposure was not associated to suicidal expression in young women.Conclusions: Suicide prevention strategies in the universities in Cambodia should focus on the students exposed to suicide, as they are vulnerable for increased suicidal expressions.
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| 8. |
- Kullgren, Gunnar, 1948-
(författare)
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Clinical studies on the borderline concept with special reference to suicidal behavior
- 1987
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The diagnostic concept of borderline personality has had various meanings throughout the last decades. From current clinical practice and research two principally different concepts have emerged: The syndrome concept of borderline personality disorder ( BPD ) as identified by the DSM-III or the Diagnostic Interview for Borderline (DIB) and the psychodynamic concept of borderline personality organization (BPO) as defined from the structural Interview (SI) by Otto Kernberg.In the first part of the present study, the DIB, the SI and a percept-genetic test called Defense Mechanism test (DMT) have been utilized in a clinical study on psychiatric inpatients. In the second part completed suicides are studied among patients with borderline personality disorder.Inter-rater reliability was satisfactory for the DIB both when utilized as a clinical interview and as a chart scoring instrument. Previous research findings concerning descriptive validity of the BPD concept were further supported. Fairly reliable scorings of personality organization could be made from the SI. BPO turned out to be a very inclusive concept and a subgroup (46%) also met criteria for BPD. By means of the DMT specific psychodynamic features were identified among patients with BPD which discriminated them from patients with other personality disorders or schizophrenic disorder. It is concluded, that there is empirical support to consider BPD a valid diagnostic entity. BPO should be conceptualized as a level of personality functioning rather than a diagnostic category and its validity remains to be proven.Patients with BPD were not seriously overrepresented in a material of 145 psychiatric patients, suicided during inpatient care or shortly after discharge 1961 to 1980. The number and proportion of borderline patients, however, increased for every five- years-period. In an analysis of cases suicided during inpatient treatment, repressive/rejective behavior from staff was frequently observed. Risk factors were identified in comparative studies. Male sex, extensive earlier hospitalization, repressive/rejective staff behavior and frequent previous suicide attempts were associated with completed suicides. A specific pattern of psychological variables was identified among suicided borderline patients including antisocial traits, drug abuse and a less intense interpersonal attachment.
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| 9. |
- Obando Medina, Claudia, et al.
(författare)
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A qualitative study on primary health care professionals' perceptions of mental health, suicidal problems and help-seeking among young people in Nicaragua
- 2014
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Ingår i: BMC Family Practice. - : BioMed Central. - 1471-2296. ; 15, s. 129-
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Tidskriftsartikel (refereegranskat)abstract
- BACKGROUND: Mental health problems among young peoples are a growing public health issue around the world. In low- income countries health systems are characterized by lack of facilities, human resources and primary health care is rarely an integrated part of overall health care services. This study aims at exploring how primary health care professionals in Nicaragua perceive young people's mental health problems, suicidal problems and help-seeking behaviour.METHODS: Twelve in-depth interviews were conducted with nurses and doctors working in primary health care services in León, Nicaragua. A qualitative research design was applied. Data was analysed using thematic analysis approach.RESULTS: This study revealed that doctors and nurses were reluctant to deal with young people presenting with suicidal problems at the primary health care. This was more likely to stem from feelings of incompetence rather than from negative attitudes. Other barriers in providing appropriate care to young people with mental health problems were identified such as lack of time, lack of privacy, lack of human resources, lack of trained professionals and difficulties in communicating with young people. The primary health care (PHC) professionals suggested different solutions to improve care for young people with suicidal problems.CONCLUSION: PHC doctors and nurses in Nicaragua felt that providing skilled mental health services to young people was a priority for them but they also identified a number of barriers to be able to do so. They discussed ways to improve young people's willingness to share sensitive issues with them and suggested ways to make PHC more appreciated by young people.
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| 10. |
- Shibre, Teshome, et al.
(författare)
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Suicide and suicide attempts in people with severe mental disorders in Butajira, Ethiopia : 10 year follow-up of a population-based cohort
- 2014
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Ingår i: BMC Psychiatry. - : BioMed Central. - 1471-244X. ; 14, s. 150-
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Tidskriftsartikel (refereegranskat)abstract
- Background: People with severe mental disorders (SMD) are at higher risk of suicide. However, research into suicide attempts and completed suicide in people with SMD in low-and middle-income countries is mostly limited to patients attending psychiatric facilities where selection bias is likely to be high. Methods: A population-based cohort of 919 people with SMD from rural Ethiopia (who received standardized clinician diagnoses of schizophrenia (n = 358) major depressive disorder (n = 216) and bipolar I disorder (n = 345)) were followed up annually for an average of 10 years. The Longitudinal Interval Follow-up Evaluation chart was administered by psychiatrists and used to evaluate systematically suicidal behavior and risk factors, which may be amenable to intervention. Results: Over the follow-up period, the cumulative risk of suicide attempt was 26.3% for major depression, 23.8% for bipolar I disorder and 13.1% for schizophrenia, (p < 0.001). The overall incidence of completed suicide was 200.2/100,000 person-years (CI = 120.6, 312.5). Hanging was the most frequent method used (71.5%) for both attempters and completers. Most people who completed suicide were successful on the first attempt (84.2%), but the case-fatality rate for suicide attempt was 9.7%. In the adjusted logistic regression model, being currently married (Adjusted OR) =2.17, 95% CI = 1.21, 3.91), and having a diagnosis of bipolar I disorder (Adjusted OR = 2.59, 95% CI = 1.57, 4.26) or major depression (Adjusted OR = 2.71, 95% CI = 1.60, 4.58) were associated significantly with increased risk of suicide attempts. Conclusion: In this sample of people with SMD from a rural setting, the rate of suicide was high. Initiatives to integrate mental health service into primary care need to focus on limiting access to suicide methods in people with SMD in addition to expanding access to mental health care.
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