| 1. |
- Anclair, Malin, et al.
(författare)
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Cognitive behavioural therapy and mindfulness for health-related quality of life : Comparing treatments for parents of children with chronic conditions: A pilot feasibility study
- 2017
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Ingår i: Clinical Practice and Epidemiology in Mental Health. - Sharjah, U.A.E : Bentham Open. - 1745-0179. ; 13:1, s. 1-9
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Tidskriftsartikel (refereegranskat)abstract
- Background: Research on parents of children with chronic conditions has shown that this parent group frequently suffers from psychological problems such as deteriorating life quality and stress-related disorders. Objective: The present feasibility study focuses on Health-Related Quality of Life (HRQOL) and life satisfaction of parents of children with chronic conditions. Method: The study was conducted using a repeated measures design and applied either group-based cognitive behavioural therapy (CBT; n = 10) or a group-based mindfulness programme (MF; n = 9). The study participants were wait-listed for six months. Results:The results indicate improvements for participants in both treatment groups regarding certain areas of HRQOL and life satisfaction. After eight group therapy sessions, parents in the two treatment groups significantly improved their Mental Component Summary (MCS) scores as well as their scores on the mental subscales Vitality, Social functioning, Role emotional and Mental health. In addition, some of the physical subscales, Role physical, Bodily pain and General health, showed considerable improvement for the MF group. When testing for clinical significance by comparing the samples with mean values of a norm population, the MCS scores were significantly lower at pre-measurements, but no significant differences were observed post-measurement. For the Physical component summary (PCS) scores, a significantly higher score was observed at post-measurement when compared to the norm population. Moreover, the results indicate improvement in life satisfaction regarding Spare time, Relation to child and Relation to partner. Conclusion: The study concludes that CBT and mindfulness may have a positive effect on areas of HRQOL and life satisfaction.
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| 2. |
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| 3. |
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| 4. |
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| 5. |
- Bäccman, Charlotte, 1973-, et al.
(författare)
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Improved resiliency and well-being among military personnel in a Swedish Naval Force after a counter-piracy operation off the coast of Somalia
- 2016
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Ingår i: Scandinavian Journal of Psychology. - : Wiley. - 0036-5564 .- 1467-9450. ; 57:4, s. 350-358
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Tidskriftsartikel (refereegranskat)abstract
- The aim of this study was to explore: (1) how the psychological health of the members of the first European Union Naval Force (ME01) was affected by international deployment off the coast of Somalia; and (2) if and how organizational and personal factors (e.g., type of personnel category, previous experiences, and resilience) affected their psychological health and well-being post-deployment. The study had an exploratory longitudinal design, where the participants were assessed both before and after deployment (i.e., T1 and T2). The participants (n=129, 120 men, 9 women) were equally distributed between officers (n=68; 64 men, 4 women) and sailors (n=61; 56 men, 5 women). The members' average age was 31years, ranging from 20 to 61. For the majority (78%) ME01 was their first international deployment and officers were, in general, more experienced than sailors. The overall results showed that the members' reported a positive experience with improved resilience and well-being (e.g., sense of coherence). However, the result also showed that type of personnel category (i.e., officer or sailor) affected their psychological health. Why and how these differences among military personnel arise is discussed, but deserves further attention.
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| 6. |
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| 7. |
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| 8. |
- Draxler, Helena, 1977-, et al.
(författare)
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Changes in Psychiatric Symptoms in Swedish Mothers Who Took Part in Project Support : An Intervention for Mothers Exposed to Intimate Partner Violence With Children Who Have Developed Conduct Problems
- 2023
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Ingår i: Violence against Women. - : Sage Publications. - 1077-8012 .- 1552-8448.
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Tidskriftsartikel (refereegranskat)abstract
- Project Support (PS) is an evidence-based individual support and parenting program developed for mothers exposed to intimate partner violence (IPV) whose children have developed conduct disorders. This Swedish feasibility study focuses on changes in the mothers' psychiatric symptoms, in relation to social and emotional support received as part of PS. In a within-subject design in a naturalistic setting (i.e., 10 social service units), mothers (n = 35) reported a significant decrease in symptoms, but from an individual perspective, most mothers still suffered from clinical levels of psychiatric symptoms. The need for additional interventions for mothers exposed to IPV is discussed.
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| 9. |
- Draxler, Helena, 1977-, et al.
(författare)
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From doubt to trust : Swedish mothers' and counsellors' experience testing a parenting programme for mothers exposed to intimate partner violence whose children have developed behavioural problems
- 2020
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Ingår i: Clinical Child Psychology and Psychiatry. - : Sage Publications. - 1359-1045 .- 1461-7021.
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Tidskriftsartikel (refereegranskat)abstract
- Many countries seek evidence-based interventions for children who have been exposed to domestic violence, and they frequently turn to interventions developed in the US and disseminated to Europe as a solution. Societal and cultural differences may, however, pose barriers to successful implementation. Project Support (PS), piloted in this study through social services agencies in Sweden, has shown positive effects in the US for families with children who have been exposed to intimate partner violence (IPV). The aim of this study was to investigate counselors' and caregivers' experiences when giving/receiving PS in Sweden. The study was based on interviews conducted with 11 mothers and 13 counselors with experience in the programme. A thematic analysis showed three themes (Initial doubts, Confidence from positive change, and Flexibility- challenge for the organization) and the study adds information about obstacles for implementation of PS in Sweden. Cultural and organizational differences between Sweden and the US in practice and child-rearing attitudes are highlighted, as well as the importance of making adjustments while maintaining treatment fidelity, and promoting the dissemination of the approach.
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| 10. |
- Draxler, Helena, 1977-
(författare)
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Initial transfer of Project Support from the US to Sweden : Feasibility and clinical aspects as viewed by counsellors and parents
- 2022
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Project Support (PS) is a parenting programme developed and studied in the US for parents and children exposed to intimate partner violence (IPV) and for these children with subsequent behavioural problems. By examining feasibility aspects and using qualitative and quantitative methods, the study aimed to explore the transferability of PS to a new naturalistic context, i.e., Swedish social services. In the qualitative Study I, IPV-exposed mothers and counsellors who received/conducted PS were interviewed about their experiences. Study II explored whether the effects of PS in the US, i.e., reduced children’s psychological symptoms and improved parenting capacity among parents and children exposed to IPV, could be replicated in Sweden. Study III explored group and individual impacts of PS on parents regarding aspects of IPV, global psychiatric symptoms, and post-traumatic stress symptoms. Study IV is a qualitative follow-up study where counsellors were interviewed about how the PS work was or was not continued. The results indicate cultural differences between the US and Sweden in practising parenting skills though role-playing and in how to address and understand child misbehaviour, necessitating adaptation to Swedish values and norms. Results further indicate that PS is a promising intervention for Swedish IPV-exposed parents and their children with behavioural problems, leading to improved parental capacity and decreased child behavioural problems, supporting prior research in an American context. PS generally seems to improve parents’ psychiatric symptoms, but examining each individual revealed that most parents still had dysfunctional levels of symptoms post treatment. Maintenance and use of PS was inconsistent, due to lack of organisational support. The study indicates that PS can be further implemented and evaluated in Sweden, and stresses the importance of conducting feasibility studies when an intervention is to be transferred to a new context.
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| 11. |
- Draxler, Helena
(författare)
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Project Support i svensk socialtjänst : En genomförbarhetsstudie av ett föräldrastödsprogram för våldsutsatta föräldrar och deras barn som utvecklat beteendeproblematik
- 2017
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Licentiatavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Projekt Support (PS) är ett föräldrastödsprogram som har utvecklats i USA för mammor och barn som utsatts för våld i nära relationer där barnen också utvecklat känslomässiga och beteendemässiga problem. Syftet med denna licentiatuppsats är att undersöka hur interventionen mottogs av behandlare och föräldrar inom ramen för svensk socialtjänst med hänsyn till skillnaderna mellan länderna.Två studier genomfördes. I den första studien (studie I) intervjuades behandlare (n 11) och mammor (n 13) från tre kommuner och Sveriges största skyddade boende om sina erfarenheter av att ge och ta emot föräldraintervention. Intervjuerna analyserades separat med hjälp av tematisk analys, vilka sedan sammanslogs i en syntes. Resultaten grupperades i sex teman, vilket indikerade initiala tvivel på interventionene och på deltagarnas egen förmåga. Teman visade också att arbetet med PS ledde till en upplevd positiv förändring av barns beteende, liksom betonades behovet av kompetenta behandlare och anpassning utifrån kulturella skillnader. Den andra studien (studie II) utvärderade interventionens effekt avseende föräldrarnas föräldrakapacitet (n 35) och deras barns psykiska symtom (19 pojkar och 16 flickor, medelålder 6 år). Resultaten visade att effekten som erhållits av PS i Sverige kan i nästan samma omfattning likställas med den effekt som framgår av tidigare studier gjorda i USA. Även barnens känslomässiga symptom, problem och hyperaktivitet minskade, och föräldrarna bemötte sina barn på ett mer positivt sätt. Föräldrarna upplevde också minskad hjälplöshet och rädsla i relationen till sina barn. Det var också en kovarians mellan föräldrarnas känslor (hjälplöshet och rädsla) och barns uppförandeproblem och hyperaktivitet där båda minskade.Slutsatserna i denna licentiatuppsats är för det första att det är möjligt att genomföra PS med föräldrar utsatta för våld i nära relationer och deras barn som har utvecklat känslomässiga och beteendemässiga problem och för det andra att organisatoriska förhållanden behöver anpassas för att interventionen ska kunna implementeras i svensk socialtjänst.
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| 12. |
- Draxler, Helena, 1977-, et al.
(författare)
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Replicability of effect when transferring a supportive programme for parents exposed to intimate partner violence and their children from the US to Sweden
- 2019
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Ingår i: Child Care in Practice. - : Routledge. - 1357-5279 .- 1476-489X. ; 25:4, s. 367-382
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Tidskriftsartikel (refereegranskat)abstract
- Transferring an evidence-based parenting programme for parents exposed to intimate partner violence (IPV) and their children with emotional and behavioural problems reveals the extent to which cultural and social aspects can interfere with the programme’s effectiveness. Feasibility studies are of value in such circumstances, and the aim of the present feasibility study was to explore, on a small scale and in its natural context, whether the effects of the parenting programme, Project Support, were replicable when transferred to another country. In this study, the programme, which was originally designed for parents exposed to IPV and their children who had developed psychological symptoms in the United States, was evaluated in an equivalent population receiving Swedish social services. Parents (n = 35) self-assessed their parenting capacity and their children’s (n = 35) psychological symptoms. The results indicate that the parents improved their parenting capacity, and feelings of helplessness and fear regarding parenting their children decreased. Those feelings were also associated with the children’s psychological symptoms. The promising results are similar to the findings of previous research from the US, and further implementation and evaluation of Project Support in Sweden are indicated.
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| 13. |
- Harvey, P. D., et al.
(författare)
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Functional Capacity and Functional Disability in Schizophrenia : A Cross-National Study in New York and Sweden
- 2008
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Konferensbidrag (refereegranskat)abstract
- Background: Functional disability is a central feature of schizophrenia and has been reported to occur across different countries and systems of care. Recent advances in the assessment of disability have separeted the measuremet of functional capacity: the ability to perform skills required for everyday functioning from the measurement of real-world functional outcomes. This presentation reports on a cross-national study of the correlation between functional capacity measured with the UCSD Performance-based Skills Assessment, Brief version (UPSA-B), casemanager ratings of patient everyday functioning with the Specific Levels Of Functioning (SLOF), and occurrence of real-world functional milestones, including independent living, employment, and marital status. Patients with schizophrenia who lived in an urban American setting and a generally rural region in Sweden were compared on their functional capacity performance and real-world outcomes. Metods:Samples of schizophrenia patients in Sweden (n=146) and New York (n=244) performed the UPSA-B and a neuropsychological assessment and were rated by their case managers. Information from archival records and case managers was used to determine the occurence of the different real world outcomes, including living independently and having ever experienced a stable romantic relationship.Results: Performance on the UPSA-B was essentially identical in the two patient samples, with a total raw score in the New York sample 13.8 and the score in the Swedish sample 13.8. Scores on the case manager ratings of everyday activities were also strikingly similar (New York:49; Sweden:49). Further, the correlation between UPSA-B scores and ratings of everyday activities were quite similar, New York: r=.36 Sweden: r=.27 as were the correlations between NP performance and UPSA-B scores, New York: r=.58; Sweden: r=.55. Also, the proportion of cases who had never been married or had a close relationship was 59% in New York and 64% in Sweden. In notable contrast, 80% of the Swedish patients and 46% of the New York patients were living independently.Implications: Performance-based measures of functional capacity were very similar across samples of people with schizophrenia in very different living environments. These results are consistent with previous studies showing that performance-based measures of cognition are also quite similar across different countries in people with schizophrenia. While measures of functional ability and case manager estimates of patients' real-world outcomes were very similar in level of impairment and correlational structure, real-world residential outcomes were very different. These data suggest that cultural and social support systems can lead to very divergent outcomes in individuals who have evidence of the same levels of ability and potential.
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| 14. |
- Harvey, P.D, et al.
(författare)
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Performance-based measurement of functional disability in schizophrenia: a cross-national study in the United States and Sweden
- 2009
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Ingår i: American Journal of Psychiatry. - : American Psychiatric Association Publishing. - 0002-953X .- 1535-7228. ; :166, s. 821-827
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Recent advances in the assessment of disability in schizophrenia have separated the measurement of functional capacity from real-world functional outcomes. The authors examined the similarity of performance-based assessments of everyday functioning, real-world disability, and achievement of milestones in people with schizophrenia in the United States and Sweden. METHOD: The UCSD Performance-Based Skills Assessment-Brief Version (UPSA-B) and a neuropsychological assessment were administered to schizophrenia patients living in rural areas in Sweden (N=146) and in the New York City area (N=244), and patients' functioning was rated by their case managers. Information from records and case managers was used to determine the frequency of living independently, working, and having ever experienced a stable romantic relationship. RESULTS: Performance on the UPSA-B was essentially identical in the two samples (New York, mean score=13.84; Sweden, mean score=13.30), as were scores on the case manager ratings of everyday activities (New York, mean=49.0; Sweden, mean=48.8). The correlations between UPSA-B score, neuropsychological test performance, and case manager ratings did not differ across the two samples. The proportion of patients who had never had a close relationship and the rate of vocational disability were also nearly identical. However, while 80% of the Swedish patients were living independently, only 46% of the New York patients were. CONCLUSIONS: While scores on performance-based measures of everyday living skills were similar in people with schizophrenia across cultures, real-world residential outcomes were very different. These data suggest that cultural and social support systems can lead to divergent real-world outcomes among individuals who show evidence of the same levels of ability and potential.
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| 15. |
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| 16. |
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| 17. |
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| 18. |
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| 19. |
- Helldin, Lars, et al.
(författare)
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Cognitive performance, symptom severity, and survival among patients with schizophrenia spectrum disorder : A prospective 15-year study
- 2015
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Ingår i: Schizophrenia Research. - : Elsevier BV. - 0920-9964 .- 1573-2509. ; 169:1-3, s. 141-146
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Tidskriftsartikel (refereegranskat)abstract
- Patients with schizophrenia have an average lifespan approximately 20 years shorter than the normal population. This study explored if there were any specific common characteristics among patients with schizophrenia spectrum disorder who died prematurely, compared to those who survived or died at a more normative age. The data were obtained from an ongoing twenty-year longitudinal study wherein 67 patients out of 501 participants had died at an average age of 60.5 years. Differences in baseline assessments of symptoms and cognitive ability were compared across patients who died during the time of the study and survivors. Symptom remission was assessed according to the Andreasen remission criteria as presented in 2005. Cognitive performance was assessed with a battery of instruments measuring vigilance, working memory, learning, short-term memory, and executive function. Two patients committed suicide and together they lowered the average lifespan of the study sample by only 0.27 years. The baseline assessments showed no difference in symptoms or remission status between patients who died and those who survived. This finding was in contrast to the cognitive baseline assessments where it was found that those who had died had performed more poorly in multiple domains, especially executive functioning, cognitive flexibility, learning and short-term memory. Survival analysis with Cox models showed that verbal memory and executive functioning were the most substantial independent predictors. Our study shows that although suicide was not a common cause of death, the average age of death is still young for this patient group and cannot be explained by differences in symptom severity. Our findings indicate that cognitive abilities might be of special interest for affective longevity in patients with schizophrenia, either as a marker of special risk or as a target for direct intervention. (C) 2015 Elsevier B.V. All rights reserved.
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| 20. |
- Helldin, L, et al.
(författare)
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Costs for Schizopsychotic Patients in Sweden
- 2009
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Konferensbidrag (refereegranskat)abstract
- 199 patients in Western Sweden with chronic psychotic illness are studied. The aim is to provide up-to-date costs for a defined patient population with schizopsychotic disorders in Sweden. Patients have the diagnoses of schizophrenia, schizoaffective disorder or delusional disorders. We identify the actual clinical management of illness and explain cost variability. Costs are combined with information on outcomes and severity of the disorder.Total costs per patient-year amount to 62.320 Euro. Direct costs correspond to 41% and indirect costs to 59% of total costs. Inpatient and outpatient care corresponds to 7% each of total costs, while costs for special housing and assistance at home is estimated to 22% of total costs. Medication only corresponds to 3% of total costs.We conclude that costs differ between patients depending on illness severity. Also a reallocation has taken place during the last 15 years between different cost items, from direct costs to indirect costs and from in-patient care at hospitals to out-patient care and assistance at home. The main cost driver is indirect costs due to decreased working ability and premature death. Special housing and home-assistance is the second largest cost item. In-patient care corresponds to 7% of total costs, which 15 years ago amounted to 50% of total costs. This reflects the change in care of schizopsychotic patients. Instead of treating patients at institutions, patients are now to a large extent living in their own housing but often receiving some kind of assistance at home provided by the local municipality.
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| 21. |
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| 22. |
- Helldin, L, et al.
(författare)
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Increase of symptom remission in psychosis : Integrating science and service in the Swedish CLIPS study
- 2009
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Konferensbidrag (refereegranskat)abstract
- The Clinical Long term Investigation of Psychosis in Sweden (CLIPS), is a naturalistic longitudinal study, in which about 300 patients diagnosed with schizophrenia, schizoaffective disorder or delusional disorder are evaluated regularly. Besides being a guideline for treatment, the evaluations are also used for scientific research after informed consent, hence combining regular health service with science in a concrete way. As a likely consequence of the annual structured assessments, the percentage of patients in remission has raised from 35 % to about 50 % in the last three years. Several scientific articles have been published on several psychosis related topics within the frame of the CLIPS study, proving that science can be successfully integrated with clinical practise for better evidence based health care, including a higher percentage of patients in remission
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| 23. |
- Helldin, Lars, et al.
(författare)
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Neurocognitive variability in schizophrenia spectrum disorders : relationship to real-world functioning
- 2020
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Ingår i: Schizophrenia Research. - : Elsevier. - 2215-0013. ; 20, s. 1-6
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Tidskriftsartikel (refereegranskat)abstract
- Neurocognitive variability exists within the schizophrenia spectrum disorder (SSD) population, with subgroups performing at the same level as healthy samples Here we study the relationship between different levels of neurocognitive responding and real-world functioning. The participants were 291 SSD patients and 302 healthy controls that were assessed with a comprehensive neurocognitive battery. In addition, the patients were assessed with the Specific Level of Functioning Scale (SLOF). The results showed that the mean neurocognitive test responses of the SSD group were significantly below that of the control group. However, there was considerable overlap between the cognitive scores of the two groups, with as many as 24% of the patients performing above the mean healthy score for some domains. Moreover, the patients with the highest level of neurocognitive functioning reached the highest levels of practical and work-related functioning outcome skills. There was no significant relationship between neurocognitive and social function skills. The large differences in cognitive performance and their associations with functional outcome within the patient group are rarely addressed in clinical practice, but indicate a clear need for individualized treatment of SSD. Early identification of cognitive risk factors for poor real-life functional outcome is necessary in order to alert the clinical and rehabilitation services about patients in need of extra care.
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| 24. |
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| 25. |
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| 26. |
- Hjortsberg, Catharina, et al.
(författare)
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Costs for patients with psychotic illness : differences depending upon state of remission
- 2011
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Ingår i: The Journal of Mental Health Policy and Economics. - Milano. - 1091-4358. ; 14:2, s. 87-93
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Tidskriftsartikel (refereegranskat)abstract
- Psychotic illnesses have a substantial economic burden on patients, family members, friends, and society in general, still there have been limited attempts to estimate the costs associated with this condition. Moreover, nothing is known about the differences in costs between patients depending on disease severity, i.e. state of remission.AIM:Estimate the direct and indirect costs for a defined patient population with psychotic illness in Sweden, and demonstrate differences in direct costs depending on disease severity (state of remission).MATERIALS AND METHODS:The cost analyses are based on data from the Clinical Long-term Investigation of Psychosis in Sweden (CLIPS), which is an ongoing, single-centre, epidemiological study. Resource use and disease severity were captured for the patients during one year, 2007. Total costs per patients are estimated and cost differences between patients, depending on state of remission, are considered.RESULTS:199 patients with a mean age of 51 (63% men) were followed for 12 months. They had a mean of 6.4 inpatient-days, 1.4 physician visits, 18.6 nurse visits, 1.2 counsellor visits and 6.3 visits to other staff including tests and diagnostic procedures per patient- year. The mean total cost (direct and indirect) amounted to 62,500 per patient and year. Patients in steady state of remission had lower direct costs compared to other patients. Moreover, the size of the various cost items differed between patients' depending on state of remission. Patients in steady remission had almost no inpatient costs.DISCUSSION:For a comprehensive assessment of treatment of psychotic illnesses it is necessary to provide evidence of the costs related to disease severity. We find that patients suffering from psychotic illness have varying costs depending on their disease severity, and this study indicates that if patients can be kept in remission direct costs will decrease. We can also confirm that reallocation has taken place the last 15 years, between different cost items, from in-patient care at hospitals to out-patient care and assistance at home.LIMITATIONS:Information about informal care was collected from patients and not from informal carers themselves.IMPLICATIONS FOR HEALTH CARE PROVISION AND USE:Costs have been reallocated from in-patient care to costs for assistance at home, which is a reflection of the change in care of patients with mental problems that has taken place during the last 15 years. Patients in steady remission have lower costs compared to patients in steady non-remission or patients switching between the two states. A better surveillance of the disorder would lead to lower direct, as well as indirect, costs.
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| 27. |
- Hjortsberg, C, et al.
(författare)
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Direct and indirect costs for psychotic illness in Sweden
- 2010
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Rapport (refereegranskat)abstract
- In this study the direct and indirect costs for a defined patient population with psychotic illness in Sweden was estimated. The cost analyses are based on data from the Clinical Long-term Investigation of Psychosis in Sweden (CLIPS), which was an ongoing, single-centre, epidemiological study at the time of this study. A bottom-up costing approach was used to estimate the total costs for schizophrenia, schizoaffective and delusional disorders in Sweden for 2007. Resource use were captured for the patients during one year. 199 patients with a mean age of 51 (63% men) were followed for 12 months. They had a mean (median) of 6.4 (0) inpatient-days, 1.4 (1.2) physician visits, 18.6 (8.4) nurse visits, 1.2 (0) counsellor visits and 6.3 (1.2) visits to other staff including tests and diagnostic procedures per patient- year. The mean cost in our study amounted to 578,000 per patient year which translates to an estimated cost of illness of 16.8 billion SEK for Sweden. Schizophrenia and related disorders significantly interferes with professional activities and as a result, the total burden on society is great. A reallocation has taken place the last 15 years, between different cost items, from direct costs to indirect costs and from in-patient care at hospitals to out-patient care and assistance at home.
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| 28. |
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| 29. |
- 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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| 30. |
- Hjärthag, Fredrik, 1973-
(författare)
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BUP Värmland : en utvärdering av hur personalen uppfattar effekterna av omorganisation och förstärkning av vårdgarantin
- 2012
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Rapport (övrigt vetenskapligt/konstnärligt)abstract
- Denna rapport redovisar resultatet av en utvärdering som har gjorts om hur personalen vid BUP Värmland uppfattar effekterna av en omorganisation och förstärkningen av vårdgarantin för de olika patientgrupperna. FoU Välfärd Värmland, Karlstads universitet, fick uppdraget av BUP Värmland, Landstinget i Värmland, att under hösten 2011 genomföra utvärderingen vilket gjordes genom en enkätstudie vänd till samtlig personal vid BUP Värmland. Utifrån den höga svarsfrekvensen och utförligheten i svaren, kan det konstateras att personalen vid BUP Värmland är mycket engagerad och mån om att verksamheten skall hålla en hög kvalitet. Organisationens struktur i sig är de flesta svarande nöjda med, men ett stort problem som många beskriver är att mängden patienter upplevs som oproportionerlig i förhållande till befintliga resurser inom BUP Värmland. Detta påverkar också möjligheterna att klara av den förstärkta vårdgarantin som har högprioriterats, enligt de flesta svarande på bekostnad av mer långsiktiga kvalitetsparametrar inom vården. Exempelvis uppges den tydlighet i nya organisationens flöde som var tänkt för patienter med neuropsykiatrisk problematik ha påverkats negativt av en högprioriterad vårdgaranti utifrån de begränsade resurser som finns. Organisationens delar inom BUP Värmland som utgörs av fyra olika enheter, upplevs också av flera i personalen som alltför åtskilda sinsemellan. Personalen är mån om bibehållandet av nuvarande kompetens genom fortbildning och handledning samt rekrytering av ny kompetens för att ännu bättre kunna möta aktuella och framtida vårdbehov.
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| 31. |
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| 32. |
- Hjärthag, Fredrik, 1973-, et al.
(författare)
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Family burden and functional assessment in the Swedish CLIPS-study : Do staff and relatives agree on individuals with psychotic disorders' functional status?
- 2012
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer Science and Business Media LLC. - 0933-7954 .- 1433-9285. ; 47:4, s. 581-587
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Tidskriftsartikel (refereegranskat)abstract
- PURPOSE:In this study, the individuals with psychotic disorders' daily life function was investigated on six dimensions considering their relations to family burden. Functional ratings carried out by relatives and staff were also compared.METHODS:Totally 88 relatives, to as many individuals diagnosed with a psychotic disorder, participated in this study. Relatives were to rate their own perceived burden and their ill relatives' physical functioning, personal care skills, interpersonal relationships, social acceptability, activities, and work skills. The outpatient staff, in all 24 case managers also rated the patients' functional level on the same assessment tool as did the relatives.RESULTS:Most dimensions of patients' everyday functioning were highly correlated to relatives' burden. The two functional dimensions "interpersonal relationships" and "activities" were best at classifying burden when rated by relatives. Also, comparing independent functional ratings by relatives and staff showed that despite great agreements on most dimensions, they differed significantly on "social acceptability" where relatives rated the function to be poorer and "activities" where relatives rated the function to be better.CONCLUSIONS:Relatives, who perceive individuals with a psychotic disorder to be limited in their ability to interpersonal relationships and limited in their ability to activate in everyday life, are more likely to perceive a higher burden. Even though staff and relatives mainly agree on the patients' functional ability, they often differ in ratings regarding patients' social acceptability and ability to activate in everyday life. This should be worth considering in clinical practice as well as in future research.
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| 33. |
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| 34. |
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| 35. |
- Hjärthag, Fredrik, 1973-, et al.
(författare)
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How is family burden correlated to the patients' symptoms, function, quality of life and attitude to medication?
- 2008
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Ingår i: European Neuropsychopharmacology. ; 18:4, s. 468-
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Tidskriftsartikel (refereegranskat)abstract
- Earlier research has concluded that symptom severity is an important factor for explaining family burden related to psychotic illness. Some studies also point out the impaired function of the ill person as a contributing factor to the burden. However, there are few investigations that also considerate the ill persons own view of his/her quality of life and attitude to medication. This study investigates how persons with psychosis symptom severity, functional disability, quality of life and attitude to medication, could be correlated to family burden.
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| 36. |
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| 37. |
- Hjärthag, Fredrik, 1973-, et al.
(författare)
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Illness Related Components for the Family Burden of Relatives to Patients with Psychotic Illness
- 2010
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Ingår i: Social Psychiatry and Psychiatric Epidemiology. - : Springer. - 0933-7954 .- 1433-9285. ; 45:2, s. 275-283
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Tidskriftsartikel (refereegranskat)abstract
- Background: Previous research has shown that symptom severity often implies an increased family burden. Few other illness related variables have, however, been investigated in this context. This study investigates how family burden is affected by symptom, function, and cognition, as well as how the patient perceives his/her illness and quality of life. Method: A total of 99 relatives, to as many patients diagnosed with psychosis and with their illness at a stable level, participated in this study. The relatives estimated their perceived burden, the patients rated the distress caused by their illness as well as the quality of their lives, and the care staff rated the patients’ symptom and function as well as tested their cognitive abilities. Results: Increased family burden can be tied to the patients’ increased symptom severity, to their impaired functioning as well as to the patients’ higher self ratings regarding distress. The family burden is also connected to the patient’s reduced working memory and reduced executive functioning, but this connection is not totally clear and should be further investigated. Of the variables that the patients were rated on, it was the overall functional ability measured with GAF that had the single most impact on perceived family burden. Conclusions: To control illness related variables such as symptoms, impaired functioning, impaired working memory and executive functioning, as well as the patients’ own experiences of distress, is important in order to lessen the burden for the relatives. All aspects of family burden are, however, not explained by these factors, which is why further research within this realm is required.
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| 38. |
- Hjärthag, Fredrik, 1973-, et al.
(författare)
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Professional views of supporting relatives of mental health clients with severe mental illness
- 2017
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Ingår i: International Journal of Social Psychiatry. - : Sage Publications. - 0020-7640 .- 1741-2854. ; 63:1, s. 63-69
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Tidskriftsartikel (refereegranskat)abstract
- Background: Supporting families where one person suffers from long-term severe mental illness (SMI) is essential, but seems hard to reach. The aim of this study was to examine professionals’ views of supporting relatives of persons with SMI. Material: Individual interviews mirroring personal narratives and group interviews reflecting group-processed answers were conducted among 23 professionals and analyzed thematically. Results: Three themes emerged: (a) information and group interaction reduces stigma and increases well-being, (b) professionals need to feel secure and confident about how the support structure works and (c) collaboration is difficult but required on several levels. Conclusion: Trusting relationships with families were considered important, although seldom achieved; professionals wished to feel secure in their role toward relatives of a person with SMI; and professionals wanted to feel confident when working together with other services to support families.
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| 39. |
- Hjärthag, Fredrik, 1973-, et al.
(författare)
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Psychometric Properties of the Burden Inventory for Relatives of Persons with Psychotic Disturbances
- 2008
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Ingår i: Psychological Reports. - : Ammons Scientific. - 0033-2941 .- 1558-691X. - 9789170632273 ; 103, s. 323-335
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Tidskriftsartikel (refereegranskat)abstract
- Earlier studies have shown that close relatives are heavily burdened when a family member has schizophrenia. The current purpose was twofold, (1) to examine the psychometric properties for a test of the burden of family members, one used in Swedish clinical practice (the Care Burden Scale for Relatives) and (2) develop a shortened version with the same or better psychometric properties. Ninety-nine close relatives, 34 men and 65 women, of the same number of patients who had been diagnosed either with schizophrenia or with schizoaffective disorder, were studied. Participants completed the Care Burden Scale for Relatives and a visual analogue scale measuring perceived global burden on which the total burden was assessed. Patients of the close relatives were assessed on clinical tests often used in the psychiatric care, in an attempt to validate the external criteria, such as severity of symptoms and level of functioning. The resulting instrument, Burden Inventory for Relatives of persons with Psychotic disturbances, showed good psychometric properties which simplifies data collection from relatives of patients with psychotic disturbances. In this study, relatives of those patients not in remission evinced a significant greater family burden.
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| 40. |
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| 41. |
- 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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| 42. |
- Ingvarsdotter, Karin, et al.
(författare)
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How Professionals View Multifamily Psychoeducation : A Qualitative Study
- 2016
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Ingår i: Psychiatric quarterly. - New York : Springer Science and Business Media LLC. - 0033-2720 .- 1573-6709. ; 87:2, s. 1-13
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Tidskriftsartikel (refereegranskat)abstract
- Severe mental illness causes suffering for the patient as well as the patient’s immediate family. The Swedish National Board of Health and Welfare has recommended the implementation of multifamily psychoeducation in order to assist patient and family in the recovery process. The aim of this study was to determine how introducing multifamily psychoeducation in Sweden has been viewed by professionals. Semi-structured interviews were conducted with 11 service providers, who were involved in evaluating multifamily psychoeducation. Our main findings fell under the headings of defensive culture and unsuitable model. Resistance to introducing the new intervention was found on multiple levels. The model proposed was considered too rigid for both the target group and the organizations because it could not be adjusted to the needs of patients, families, or facilitators. Despite good evidence for the effectiveness of the intervention, there were difficulties introducing the multifamily psychoeducation model in clinical practice. The feasibility of an intervention needs to be evaluated before adopting it as a national guideline.
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| 43. |
- Johansson, Madeleine, et al.
(författare)
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Cognitive markers related to long-term remission status in Schizophrenia Spectrum Disorders
- 2020
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Ingår i: Psychiatry Research. - : Elsevier. - 0165-1781 .- 1872-7123. ; 289
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Tidskriftsartikel (refereegranskat)abstract
- Cognitive impairment is an established feature of schizophrenia. From a cross-sectional perspective, studies have revealed associations between cognition and remission. Few studies have examined this relationship longitudinally. Here we examine which cognitive domains might be related to long-term remission and symptomatic severity. The present study followed 173 outpatients with schizophrenia for five years, divided into groups based on long-term remission status and symptomatic severity, assessed with the Positive and Negative Syndrome Scale. Cognitive functioning was assessed at baseline, with tests of vigilance, executive functions, processing speed, memory and learning, working memory, and premorbid functioning. Cognitive domains related to long-term remission status were executive functions, working memory, and premorbid functioning. The most prominent cognitive differences were found between the group in stable remission with minimal symptoms, and the non-remission group, the first group demonstrating better cognitive functioning. The study highlights the role of premorbid functioning as a cognitive feature in the prediction of long-term remission. It also indicates the possibility of viewing specific cognitive domains as markers for clinical outcome, highlighting the value of early assessment of cognition. In summary, a certain cognitive profile, in coexistence with long-term non-remission, suggests poorer outcome. Hence, this group is in need of increased support.
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| 44. |
- Johansson, Madeleine, et al.
(författare)
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Exploring cross-sectional and longitudinal symptomatic remission and subjective quality of life in Schizophrenia
- 2023
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Ingår i: Psychiatry Research. - : Elsevier. - 0165-1781 .- 1872-7123. ; 328
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Tidskriftsartikel (refereegranskat)abstract
- Achieving symptomatic remission, as defined by the Remission in Schizophrenia Working Group, is intended tobe a meaningful outcome for individuals with schizophrenia, resulting in enhanced well-being. Cross-sectionalstudies have reported an association between symptomatic remission and subjective quality of life (QoL). Longitudinal studies aimed at examining this association have showed mixed results. The aim of this study was toexplore the relationship between symptomatic remission and subjective QoL, both cross-sectionally andlongitudinally. The study comprised data from what were at most 386 patients with schizophrenia, of whom 122–140 werefollowed over a period of four years. Based on cross-sectional remission status and longitudinal remissionpattern, differences in subjective QoL were explored. Remission status was assessed using the Positive andNegative Syndrome Scale (PANSS), and subjective QoL using the Short Form-36 Health Survey (SF-36). Both the cross-sectional and the longitudinal approach showed that patients in symptomatic remission hadsignificantly higher subjective QoL. Patients who were in non-remission at baseline, but who achieved remissionat follow-up, also had significantly higher subjective QoL at follow-up compared with baseline. The results from the study show a clear association between symptomatic remission and subjective QoL. However, achieving symptomatic remission does not appear to be a guarantee of sustained subjective QoL, andonly continued stable remission appears to result in such an outcome.
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| 45. |
- Johansson, Madeleine
(författare)
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Longitudinellt perspektiv på symtomatisk remission vid schizofreni
- 2023
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Objective: The overall aim of this thesis was to investigate the remission criteria according to the Remisson in Schizophrenia Working Group (RWSG), mainly from a longitudinal perspective.Paper I showed that all remission symptoms in the RSWG criteria, affected the remission status in the cross-sectional setting. In the longitudinal setting, the symptoms Delusions and Hallucinatory behavior contributed mostly to the fluctuation between remission and non-remission, while negative symptoms were more prominent in the group that never reached remission. Finally, the sustainability of remission was significantly longer when only minimal symptom intensity occurred, compared with mild.Paper II showed that the cognitive areas associated with long-term remission pattern were executive functioning, working memory and verbal functioning, where significant better results were shown in the group of stable remission with only minimal symptoms compared to the group never reaching remission. Verbal functioning was the only cognitive area that could predict long-term remission pattern, as a better result increased the probability of being in long-term remission.Paper III focused on the patient’s perspective and examined the relationship between subjective quality of life (SQoL) and remission. The paper showed significant associations between a better SQoL, self-assessed with Short Form Health Survey-36, and both cross-sectional remission and long-term. A significant better SQoL was present regardless of being in stable remission over time or if remission was reached during the study period.Conclusions: The thesis support that the RSWG criteria for remission is a valuable concept, also from a longitudinal perspective. Taken together, the results emphasize the heterogeneity of schizophrenia, where different groups within the disorder show different clinical characteristics. This thesis highlights the importance of regular assessments of broad clinical status, to support a higher frequency and sustainability of remission.
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| 46. |
- Johansson, Madeleine, et al.
(författare)
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What could be learned from a decade with standardized remission criteria in schizophrenia spectrum disorders : An exploratory follow-up study
- 2018
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Ingår i: Schizophrenia Research. - : Elsevier. - 0920-9964 .- 1573-2509. ; 195:May, s. 103-109
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Tidskriftsartikel (refereegranskat)abstract
- A decade has passed since the standardized remission criteria of schizophrenia spectrum disorders-the Andreasen Criteria-were defined. Over 2000 studies have been published, but only a few describe symptomatic remission over time. In this prospective study we followed patients for 3 and 5 years, respectively. The aim was to investigate how different symptoms affect the occurrence of remission and how the remission cut-off level affects remission sustainability. The participants were patients diagnosed with schizophrenia spectrum disorders (DSM-IV). First, the importance of each core symptom for remission was examined using the Positive and Negative Syndrome Scale (n = 274). Second, we investigated which items affect patients to either go in and out of remission or never achieve remission (n = 154). Third, we investigated how the sustainability of remission is affected by a cut-off set to 2 (minimal) and 3 (mild) points, respectively (n = 154). All core symptoms affected the occurence of remission, to a higher or lesser extent. Delusions and Hallucinatory behavior contributed the strongest to fluctuation between remission and non-remission, while the contribution of Mannerism and posturing was very marginal. Negative symptoms were enhanced when remission was never achieved. Moreover, the study found that remission duration was significantly longer for the cut-off score 2 rather than 3. The study shows that, over time, remission criteria discriminate between being stable, unstable, or never in remission. Patients with only a minimal occurrence of symptom intensity exhibit a significantly longer remission duration compared to patients with mild symptom intensity, indicating that the treatment goal should be minimal symptom intensity.
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| 47. |
- Karilampi, Ulla, et al.
(författare)
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Verbal learning in schizopsychotic outpatients and healthy volunteers as a function of cognitive performance levels
- 2007
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Ingår i: Archives of clinical neuropsychology. - : Oxford University Press (OUP). - 0887-6177 .- 1873-5843. ; 22:2, s. 161-174
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE The aim was to analyze and compare neurocognitive test profiles related to different levels of verbal learning performance among schizopsychotic patients and healthy volunteers. METHOD A single-center patient cohort of 196 participants was compared with an equal-sized volunteer group to form three cognitive subgroups based on the shared verbal learning performance. RESULTS 43.9% of the patients had normal learning ability. Despite this, all patients underperformed the volunteers on all subtests with the exception of working memory, and, for those with high learning ability, even verbal facility. All patients also presented equally poor visuomotor processing speed/efficacy. CONCLUSION A global neurocognitive retardation of speed-related processing in schizophrenia is suggested.
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| 48. |
- Lindgren Fändriks, Anna, et al.
(författare)
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Child health care nurses' experience of language screening for 2.5-year-old children : A qualitative study
- 2023
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Ingår i: Nursing Open. - : John Wiley & Sons. - 2054-1058. ; 10:9, s. 6583-6591
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Tidskriftsartikel (refereegranskat)abstract
- Aim: To investigate the experience of Child Health Care Nurses (CHCNs) using language screening for 2.5-year-old children.Design: An exploratory qualitative design with an inductive approach.Method: Data were collected through semi-structured, interviews with Swedish CHCNs who regularly performed language screening for children. The interviews were analysed by thematic analysis.Results: Four themes were identified: 'The difficult visit', 'Explanations for language delay', 'Language screening across cultures' and 'Language screening with children exposed to adverse life events'.Patient or Public Contribution: Our findings suggest that in routine care a modified procedure is used for the language screening of children aged 2.5 to secure the child's cooperation and to preserve an alliance with the parents. Consequently, the validity of the screening is called into question, particularly when it comes to children from families with origins outside the dominant culture and children exposed to adverse life events.
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| 49. |
- Lugnegård, Tove, et al.
(författare)
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Social cognition impairments in Asperger syndrome and schizophrenia.
- 2013
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Ingår i: Schizophrenia research. - Amsterdam : Elsevier BV. - 1573-2509 .- 0920-9964. ; 143:2-3, s. 277-284
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Tidskriftsartikel (refereegranskat)abstract
- Social cognition impairments are well described in both autism spectrum disorders, including Asperger syndrome (AS), and in schizophrenia spectrum disorders. However, little is known about whether there are differences between the two groups of disorders regarding this ability. The aim of this study was to compare social cognition abilities in AS and schizophrenia. Fifty-three individuals (26 men, 27 women) with a clinical diagnosis of AS, 36 (22 men, 14 women) with a clinical diagnosis of schizophrenic psychosis, and 50 non-clinical controls (19 men, 31 women) participated in the study. Clinical diagnoses were confirmed either by Structured Clinical Interview on DSM-IV diagnosis or the Diagnostic Interview for Social and Communication Disorders. Verbal ability was assessed using the Vocabulary subtest of the WAIS-III. Two social cognition instruments were used: Reading the Mind in the Eyes Test (Eyes Test) and the Animations Task. On the Eyes Test, patients with schizophrenia showed poorer results compared to non-clinical controls; however, no other group differences were seen. Both clinical groups scored significantly lower than the comparison group on the Animations Task. The AS group performed somewhat better than the schizophrenia group. Some differences were accounted for by gender effects. Implicit social cognition impairments appear to be at least as severe in schizophrenia as they are in AS. Possible gender differences have to be taken into account in future research on this topic.
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| 50. |
- Moradi, Hawar, et al.
(författare)
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SU42. Physical Fitness in Association With Cognitive Performance—Possible Marker of Short Lifetime Expectancy for Patients With Schizophrenia
- 2017
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Ingår i: Schizophrenia Bulletin. - : Oxford University Press. - 0586-7614 .- 1745-1701. ; 43:Suppl 1, s. S176-S176
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Tidskriftsartikel (övrigt vetenskapligt/konstnärligt)abstract
- Background: Patients with schizophrenia have about 20 years shorter lifetime expectancy compared to healthy population. Among these patients, cognitive performance is a predictor of early death while illness severity, as expressed in both symptom activity and remission status, has no relation with length of life. Vital signs, such as blood pressure and heart rate, weight including BMI, and spontaneously reported symptoms did neither indicate an increased risk for early death. This work focus on whether self-rated physical condition and activities, in contrast to vital signs and perceived symptoms, could be related to cognitive performance and length of life.Methods: From the Clinical Long-term Investigation of Psychosis in Sweden (CLIPS) study, 310 participants were categorized into 4 groups from their cognitive performance at baseline: good cognitive function (GCF), n = 114, impaired cognitive function (ICF), n = 90, and severely impaired cognitive function (SICF), n = 45. The fourth group was patients who had passed away during the study time, n = 61. Patients’ perceived physical condition was assessed at baseline using the SF-36, which included 10 questions about everyday physical activities. The 4 groups were compared using ANOVAs and post hoc analyzes.Results: Patients who had deceased reported, on average 9.5 years before their death, a significantly (P < .001) more impaired physical condition compared to the GCF group and the ICF group (P = .028) but did not show any difference compared with the SICF group (P = .424). An item analysis showed that especially physical activities, such as walking a distance or climbing the stairs, were impaired. When only alive patients’ physical status vs cognitive performance were analyzed, the GCP were more physical fit than the ICF (P = .018) and SICF (P = .011), but there were no difference between ICF and SICF.Conclusion: In contrast to vital signs and perceived symptoms of illness, patient reported differences in physical fitness corresponded to differences in their cognitive ability. It has earlier been argued that physical performance is an underappreciated variable for improving ADLs. This study indicates that patents’ physical performance may, several years in advance, offer important information about increased risk of an early death.
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