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- Stålnacke, Mattias, 1981-
(författare)
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Cognitive function, quality of life and functional brain networks : before and after glioma surgery
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The aim of this thesis was to investigate how cognitive function and quality of life are affected by glioma surgery in the supplementary motor area (SMA) and the lower primary motor cortex (M1), as well as to explore possible changes in functional network connectivity after surgery in the SMA.Sixteen patients subject to resective neurosurgical procedures due to gliomas in either the SMA or the M1 were studied. Neuropsychological tests, Quality of Life (QoL) questionnaires and resting state functional magnetic imaging sequences were administered before surgery and at follow-up. Neuropsychological testing was also performed 1-2 days after SMA resection.SMA resections were associated with significant but transient impairments of cognitive control. However, subjective sense of volition and long-term perception of QoL remained intact. Changes in interhemispheric connectivity in the sensorimotor network after SMA resections were variable between patients and non-significant at the group level. Resections of the lower M1 were associated with a slight impairment of maximal speech speed but not with clinically significant declines in QoL or cognitive function. Glioma resections in the SMA and lower M1 may affect aspects of cognitive and motor function. However, thanks to the brain’s capacity for functional reorganization and compensation this will typically not cause permanent and significant negative effects on cognitive function or QoL.
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| 2. |
- Wallsten, Tuula, 1953-
(författare)
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Compulsory Psychiatric Care: Perspectives from the Swedish Coercion Study : Patient Experiences, Documented Measures, Next of Kins’ Attitudes and Outcome
- 2008
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- The use of coercion in psychiatry involves clinical, legal, scientific, ethical and emotional considerations. This thesis represents an attempt to further increase our understanding of some empirical aspects of this phenomenon. Interviews with 202 involuntarily admitted psychiatric patients and 201 voluntarily admitted patients and 295 of their next of kins were performed and analysed together with data from records and assessments made by professionals. Data was collected during two different periods of time with a compulsory psychiatric care law reform in between.Experience of at least one coercive measure was more common amongst patients who had been committed during the most recent legislation. Otherwise there were no differences in patient experiences during the different laws.Subjective short-term outcome was associated with having a contact person at the ward and being subjectively treated well. There were no relationships between subjective and assessed outcome or between legal status, perceived coercion at admission and subjective or assessed improvement.The changed legislation had no clear effect on the attitudes of patients and next of kins towards coercion.A majority of patients were able to accurately answer the question whether they had been restrained by belt or not during a specific treatment episode. Nineteen of 115 patients reported they had been restrained by belt. Eleven of these cases were true positive and 8 cases were false positive. In conclusion, the main results were first that when it comes to issues related to psychiatric coercion there are typically considerable differences between how these are perceived and interpreted by the professional and by the patient, and second that efforts made to change the face of psychiatric coercion in the minds of patients as well as the public on part of public policymakers have had limited effects.
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