| 1. |
- Hjärthag, Fredrik, 1973-
(författare)
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Screening Family Burden in Clinical Practice : The development of a new instrument and investigation of its correlates to psychotic disorders
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The primary purpose of this thesis is to develop a short and user-friendly instrument for the assessment of family burden caused by psychotic disorders. A secondary purpose is to further investigate variables that might be linked to an increased burden. Of these variables, patients’ reduced functioning will be addressed in more detail. As a final purpose, ratings of disorder-related variables carried out by staff will be compared to similar ratings carried out by relatives. These different purposes are investigated in five studies.In the first study (Paper I) the instrument Burden Inventory for Relatives to persons with Psychotic disturbances (BIRP) is created. This new screening instrument contains ten statements and shows good psychometrical properties for those dimensions that are investigated. In the second study (Paper II) results show that increased family burden can be tied to patients’ impaired functioning as well as to patients’ higher self ratings regarding distress. In the third study (Paper III) different parts of patients’ observable behavioral functioning are investigated and results show that most functional dimensions correlate with family burden. Also staff ratings of function are compared with relatives’ ratings and despite similar patterns in ratings there are differences. In the fourth study (Paper IV) demographic variables are studied and results show that only higher age and fewer contact hours correlate significantly with lower burden. Also, the BIRP instrument shows good stability. In the fifth study (Paper V) correlations with family burden are generally stronger for relatives’ own ratings of illness activity as compared to symptom ratings made by staff. Relatives’ ratings of illness activity do not correlate significantly with staff symptom ratings on all instruments used.The conclusions of this thesis are that the new screening instrument BIRP can be considered a good instrument to use in regular clinical practice in order to measure relatives’ burden in connection to psychotic disorders. Also, the thesis contributes with knowledge about what in the psychotic disorder and which demographic factors might be linked to an increase of family burden. Findings also indicate that it matters who does the rating of a disorder-related variable. Furthermore, in this thesis a theoretical framework for family burden is presented.
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| 2. |
- Hjärthag, Fredrik, 1973-
(författare)
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Assessing Family Burden of Psychotic Illness in Clinical Practice
- 2009
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this thesis was twofold. One purpose was to create a user-friendly instrument to be used in regular clinical practice to collect information regarding family burden of psychotic illness. The second purpose was to study how family burden could be linked to the patients’ level of functioning, the patients’ cognition and the patients’ own experience of their illness. Two studies were conducted. In the first study (Paper I) the instrument Burden Inventory for Relatives to persons with Psychotic disturbances (BIRP) was created. This instrument contained ten statements and showed good psychometrical properties for those dimensions that were investigated. The instrument measures three dimensions of experienced family burden: practical burden, emotional burden, and the relatives’ own health. In the second study (Paper II) the second part of this thesis purpose was investigated. Results showed that increased family burden could be tied to the patients’ impaired functioning as well as to the patients’ higher self ratings regarding distress. The cognitive connection to family burden is not totally clear though, and should be further investigated. A theoretical model which explains the experienced family burden of psychotic illness is also presented within this thesis. The conclusions of this thesis are that BIRP is a useful instrument in regular clinical practise for measuring experienced family burden, and that the patients’ level of functioning and the patients’ own experience of their illness were correlated to the family burden experienced.
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| 3. |
- Ivarsson, Bo, 1947-
(författare)
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Tools for Outcome-informed management of mental illness : Psychometric properties of instruments of the Swedish clinical multicenter Quality Star cohort
- 2011
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The purpose of this thesis was to investigate the psychometric properties of three global user subjective measures of the ”The Quality Star” clinical review model: Consumer Satisfaction Scale, Global Quality of Life scale, and Perceived Global Distress scale. The mental health implementation context of this review model emphasizes the client as an agent of change, taking part in shared decision making in an empowered role as collaborative partner to the professional clinicians. In Paper I study the patient self-rating Consumer Satisfaction Scale gave results comparable to those obtained by independent interviewer assessors. Out of cost-effective perspective professional time is saved and logistics simplified. In Paper II the visual analogue self-rating Global Quality of Life scale was shown to have satisfactory test-retest reliability, and concurrent validity with the “Life as a whole” item of Manchester Short Assessment of Quality of Life (MANSA). The patients’ conceptualizations of the scale based on associative findings with a number of validating instruments were consistent with expected areas of concern for Serious Mentally Ill persons. Similarly, in Paper III the visual analogue scale the Perceived Global Distress scale, showed acceptable clinical test-retest reliability, and concurrent validity with the MANSA item, “How satisfied are you with your mental health”. In associative analyses it was found that depressive, anxiety, interpersonal and existential elements contributed to the patient´s conceptualization of the construct. In Paper IV, a previous finding suggesting that women were more satisfied with the health care and had better social functioning compared to men was further elaborated investigating the discriminative properties of the subjective instruments. In the multi-centre cohort of 2552 patients it was possible to detect differences between genders and functional levels professionally assessed with the split version of Global Assessment of Functioning rating scale. The General discussion underlines that although subjective measures tend to have strong interrelations, supporting earlier findings, one has to use multiple measures for an optimal management of mental illness as the subjective outcome ratings have to be individually interpreted in a feed-back dialogue with the patient and be compared to observational assessments.
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| 4. |
- Johansson, Mattias, 1972-
(författare)
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Qigong : acute affective responses in a group of regular exercisers
- 2009
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Qigong is a Chinese mind-body therapy that aims to, through the use of movements, relaxed breathing and relaxation/meditation, create a healthy flow of life force, qi, in the body, and consequently improve health. A growing number of Qigong studies report beneficial effects on health and well-being. However, little attention has fo-cused on the acute affective responses that accompany single sessions of Qigong ex-ercise. The aim of the present thesis was therefore to study affective reactions to Qigong exercise. In Study I, the effects of Qigong exercise on mood and anxiety were compared to a control group. Results showed partial support for the superiority of Qigong exercise compared to controls. In Study II, different lengths of session time were compared, resulting in similar affective benefits for the 30 and 60-minute ses-sions. In Study III, affective responses were also assessed during the session, using mean scores and individual responses. Results showed an increase toward greater Activated and Deactivated Pleasantness during the session, with the greatest changes at the end of the bout. The majority of individuals reported increased Pleasantness during the Qigong session. Expectations of positive outcomes were significantly as-sociated with only few affective responses. Responses to open-ended questions of af-fective experiences displayed affective reactions mostly toward greater Deactivated Pleasantness. This thesis contributes to a greater understanding of the limited area of Qigong-related affective responses. For the exercisers, Qigong is associated with a greater momentary emotional state. However, due to the highly select group of regu-lar Qigong exercisers, generalizing the results outside the sample population is lim-ited. Theories on active mechanisms in the Qigong-affect relationship, and results from studies of affective responses to similar activities, suggest that other groups of people would also benefit affectively from Qigong exercise. Given the many benefits of positive affect, Qigong exercise may also pose great promises for the enhancement of other areas related to health and well-being. This calls for additional studies.
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| 5. |
- Bood, Sven Åke, 1950-
(författare)
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Bending and Mending the Neurosignature : Frameworks of influence by flotation-REST (Restricted Environmental Stimulation Technique) upon well-being in patients with stress related ailments
- 2007
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The overarching purpose of the current thesis was to assess the long term effects of a treatment program involving flotation-REST for the experience of pain, from the point of view of variables connected with Melzack´s neuromatrix theory, and to examine the extent of a potential attention-placebo effect in connection with flotation-REST.The first study (Paper I) aimed to investigate long-term effects of flotation-REST four months after treatment. Seventy patients participated, diagnosed as having stress-related pain. Participants were randomly assigned to either a control group or a flotation-REST group and participated in a total of twelve flotation REST or control sessions. Results indicated that pain areas, stress, anxiety and depression decreased, while sleep quality, optimism, and prolactin increased. Positive effects generally maintained four months after treatment. The second (Paper II) examined the potential effects of attention-placebo. Thirty-two patients who were diagnosed as having stress-related muscular pain were treated for a period of six weeks. Half of the patients were also given attention for a period of 12 weeks, while the remainder received attention for 6 weeks. Participants in both groups exhibited lowered blood pressure, reduced pain, anxiety, depression, stress, and negative affectivity, as well as increased optimism, energy, and positive affectivity. The third (Paper III) investigated whether or not 33 flotation sessions were more effective for stress related ailments as compared to 12 sessions. Participants were 37 patients with stress related ailments. Analyzes for subjective pain and psychological variables typically indicated that 12 sessions were enough to get considerably improvements and no further improvements were noticed after 33 sessions. Finally, the fourth study (Paper IV) aimed to examine whether and how the combination of therapy and flotation tank could be used to treat patients with severe stress problems. Two women on long-term sick-leave participated in the study, which was carried out over a period of one year. Four overarching themes were generated: the therapeutic work model, transformation of feelings, self-insight and meaning. These together constituted a “therapeutic circle” which after a while transformed in to a “therapeutic spiral” of increased meaning and enhanced wellbeing.It was therefore concluded that flotation tank therapy is an effective method for the treatment of stress-related pain.
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| 6. |
- Niklasson, Mats, 1956-
(författare)
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Sensorimotor Therapy: Assessing Quantitative and Qualitative Expressions of Physiological and Psychological Development in Children
- 2013
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The first purpose of this thesis was to examine whether sensorimotor therapy utilizing the training program ”Retraining for Balance” might be an appropriate technique for sensorimotor proficiency. The second purpose was to gain increased understanding of the effects of sensorimotor therapy on the physical and psychological development of children and youth. A third purpose was to put sensorimotor therapy in a wider perspective through a somewhat novel extension of the theoretical framework. Two naturalistic studies were conducted. Paper I was quantitative and comprised 232 children (181 boys and 51 girls) divided into three groups (1) a younger group (7 years or younger, n=65), (2) a middle group (8 to 10 years old, n=91) and, (3) an older group (11 years old or older, n=76). The participants presented attentional and motor difficulties before starting therapy. The treatment period was in average close to 3 years. Results indicated significant improvements concerning sensorimotor skills in all age groups. Paper II was a qualitative study, which included the records of 8 children (7 boys and 1 girl) randomly selected from the cohort of 232 children. The analysis used the EPP-method and yielded 3 overarching themes, which together formed “the kinesthetic-vestibular developmental model”. The model illustrated how Introductions of sensorimotor exercises pushed the therapy process forward due to periods of Regression and Transformation. The results were generalized to the remaining 224 children in the cohort by comparing each participant’s records with “the kinesthetic-vestibular developmental model”. The tentative conclusion was that sensorimotor therapy according to the method “Retraining for Balance” might constitute a complement to treatment of ADHD, DCD and LD but controlled studies are necessary before more decisive conclusions can be drawn.
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