| 61. |
- Pettersson, Agneta, et al.
(författare)
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Which instruments to support diagnosis of depression have sufficient accuracy? A systematic review
- 2015
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 69:7, s. 497-508
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Instruments are frequently used in case finding, diagnosis and severity grading of major depression, but the evidence supporting their utility is weak.AIM: To systematically review the specificity and sensitivity of instruments used to diagnose and grade the severity of depression.METHODS: MEDLINE, PsycInfo, Embase and the Cochrane Library databases were searched until April 2014. Fifty studies fulfilled the inclusion criteria. Risk of bias was assessed with QUADAS. The average sensitivity and specificity of each instrument was estimated with hierarchical summary receiver operating characteristics analyses and the confidence in the estimates was evaluated using GRADE. Minimum acceptable sensitivity/specificity, with structured interview as the reference, was 80%/80% for structured interviews and 80%/70% for case-finding instruments. The minimum acceptable standard for severity measures was a correlation of 0.7 with DSM-IV classification.RESULTS: Twenty instruments were investigated. The average sensitivity/specificity was 85%/92% for the Structured Clinical Interview for DSM-IV-Axis-I Disorders (SCID-I), 95%/84% for the Mini International Neuropsychiatric Interview (MINI), < 70%/85% for the Primary Care Evaluation of Mental Disorders (PRIME-MD), 88%/78% for the Patient Health Questionnaire-9 (PHQ-9) with a cut-off score of 10, 69%/95% for PHQ-9 as a diagnostic algorithm and 70%/83% for the Hospital Anxiety and Depression Scale (HADS) with a cut-off score of 7. The confidence in the estimates for the other instruments was very low.CONCLUSIONS: Only the SCID-I, MINI and PHQ-9 with a cut-off score of 10 fulfilled the minimum criteria for sensitivity and specificity. The use of the PRIME-MD and HADS is not supported by current evidence.
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| 62. |
- Pihkala, Helja, et al.
(författare)
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Talking about parental substance abuse with children : eight families' experiences of Beardslee's family intervention
- 2017
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Ingår i: Nordic Journal of Psychiatry. - : TAYLOR & FRANCIS LTD. - 0803-9488 .- 1502-4725. ; 71:5, s. 395-401
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Tidskriftsartikel (refereegranskat)abstract
- Background: Many children are affected by parental substance use disorder. Beardslee's family intervention (BFI) is a family-based psycho-educative method for children of mentally ill parents, used in psychiatric practise in several Nordic countries. The method has also been used to some extent when a parent suffers from substance use disorder. Aims: The aim of the study was to explore the family members' experiences of the BFI when a parent has a diagnosis of substance use disorder, to gain new knowledge about the process of the BFI in this area. Methods: Ten children and 14 parents were interviewed about their experiences 6 months after a BFI. The interviews were analyzed by qualitative content analysis. The children's psychological symptoms were measured by the Strengths and Difficulties Questionnaire at baseline and after 6 months. Results: Increased openness about the substance use disorder in the families was a recurrent theme throughout the material and a central issue reported in the children's experiences. The children had a high level of psychological symptoms according to the SDQ at baseline, but the majority of them felt that the BFI made a positive difference in their families and for themselves. The parents reported improved wellbeing of their children. Conclusions and clinical implications: Positive experienced effects for children and parents are reported in families with parental substance use disorder, with possible connection to use of BFI. The present study suggests that Beardslee's family intervention is applicable as a preventive method for children in families with a parent suffering from substance use disorder.
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| 63. |
- Porter, Susann, et al.
(författare)
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The effect of individual enabling and support on empowerment and depression severity in persons with affective disorders : outcome of a randomized control trial
- 2018
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 72:4, s. 259-267
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the effect of Individual Enabling and Support (IES) on empowerment and depression severity as compared to Traditional Vocational Rehabilitation (TVR) in people with affective disorders at 12 months follow-up. Additionally, longitudinal changes within the intervention groups and the correlation over time between empowerment and depression severity were evaluated. Method: A single-blind randomized controlled trial of two intervention groups, IES (n = 33) and TVR (n = 28), was performed with measurement points at baseline, 6, and 12 months. Individuals with affective disorders, including depression and bipolar disorder diagnoses were included. The Empowerment Scale and Montgomery–Åsberg Depression Self-Rating Scale were administered, and Intention-To-Treat analysis was applied. The study was registered with the trial number ISRCTN93470551. Result: There was a statistically significant difference between the intervention groups on empowerment and depression severity at 12 months. Within-group analysis showed that IES-participants increased their perceived empowerment and decreased their depression severity between measurement points, this was not seen among TVR-participants. A moderate, inverse relationship was detected between empowerment and depression. Conclusion: IES is more effective in increasing empowerment and decreasing depression severity after a 12-month intervention than is TVR. This study was limited by a small sample size and larger trials in different contexts are needed.
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| 64. |
- Rangmar, Jenny, et al.
(författare)
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Cognitive and executive functions, social cognition and sense of coherence in adults with fetal alcohol syndrome.
- 2015
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 69:6, s. 472-478
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Tidskriftsartikel (refereegranskat)abstract
- Background: Primary disabilities in children with fetal alcohol syndrome (FAS) are the results of alcohol’s teratogen effect on the fetal brain. Reduced cognitive and executive functions and social cognition are examples of such disabilities. Little is known about primary disabilities in adults with FAS as well as their sense of coherence (SoC). There is thus a need for knowledge about FAS in adulthood. Aims: To investigate cognitive and executive functions, social cognition and SoC in adults with FAS. Methods: Twenty adults with FAS (mean age: 30 years) were compared with 20 individuals matched on gender and age. Berg’s Card-sorting Test-64, the Tower of Hanoi, Raven’s Coloured Progressive Matrices, Digit Span, Faux Pas and the Swedish version of Antonovsky’s Sense of Coherence Scale (SoC-29) were used. Results: The FAS group had a weak SoC and displayed deficits in the neuropsychological tests sensitive to cognitive and executive functions and social cognition. The FAS group’s median SoC score was 112, lower than the comparison group’s median of 133 (P0.001). The FAS group had median scores of 29.0 on Raven’s Matrices. The median for Digit Span was 5 forwards and 3 backwards, lower than in the comparison group (P0.001). Conclusions: Reduced cognitive and executive functions and impaired social cognition are assumed to have a major impact on life for adults with FAS. We suggest that the findings showing that adults with FAS had a weak SoC, with particularly low scores on the manageability scale, reflect their experiences of living with those primary disabilities. Clinical implications: This study may enhance healthcare for individuals prenatally exposed to alcohol. In general, it contributes with knowledge about this group of individuals who need to be more visible in healthcare, and particularly, it demonstrates some of the neuropsychological disabilities they might have.
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| 65. |
- Renberg, Fredrik Edin, et al.
(författare)
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Microdecisions instead of coercion : patient participation and self-perceived discrimination in a psychiatric ward
- 2019
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Ingår i: Nordic Journal of Psychiatry. - : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 73:8, s. 532-538
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Tidskriftsartikel (refereegranskat)abstract
- Aims: Patients may experience unfair reception when in contact with psychiatric services. The aims are to illuminate these perceptions, and the extent of inpatients' involvement in their care, and if degree of involvement depends on compulsory or voluntary care. Furthermore, we sought to determine if an educational intervention for staff members, including systematic listening and offering the inpatients involvement using microdecisions, affects the inpatients' experiences and the use of coercion.Materials and methods: We used a naturalistic setting case control design in two psychiatric wards for one year, including all inpatients (n = 685) of which 458 took part of the microdecision intervention. Structured direct interviews were carried out with inpatients based on the Discrimination and Stigma Scale (DISC), Dyadic OPTION, and CollaboRATE instruments before (n = 19) and after (n = 46) the intervention. Frequencies of coercive measures before and after the intervention were compared (n = 685).Results: Respondents subjected to the intervention experienced less discrimination related to psychiatric care compared to responders not subjected. Tendencies of improvements post intervention were found for some aspects of involvement, as attention to concerns and possibilities to ask questions. A decrease in the use of coercive measures at three and six months after the start of the intervention was observed.Conclusion: Results suggest that the intervention could decrease the inpatients' experiences of discrimination during psychiatric care as well as the use of coercion in the service. The Dyadic OPTION instrument showed a mixed picture with results implying improvements in some areas and impairments in others.
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| 66. |
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| 67. |
- Saha, Sanjib, et al.
(författare)
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Cost-effectiveness of supported employment adapted for people with affective disorders
- 2018
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Ingår i: Nordic Journal of Psychiatry. - : Informa UK Limited. - 0803-9488 .- 1502-4725. ; 72:3, s. 236-239
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Tidskriftsartikel (refereegranskat)abstract
- Objective: The individual enabling and support (IES) model was effective in gaining competitive employment for people with affective disorders compared with traditional vocational rehabilitation (TVR) services in a randomized controlled trial in a Swedish setting. The object of this study is to perform a cost-effectiveness analysis of IES comparing to TVR. Methods: We considered the costs of intervention and productivity gain due to increased competitive employment. We estimated quality of life using EuroQol 5 Dimension (EQ-5D) and Manchester Short Assessment of Quality of Life (MANSA) scale. EQ-5D was translated into quality-adjusted life-years (QALY), using the UK, Danish, and Swedish tariffs. We performed the analysis from a societal perspective with a one-year timeframe. Results: The cost of IES was €7247 lower per person per year (2014 prices) compared to TVR. There were no significant differences in QALY improvement within or between groups. However, quality of life measured by the MANSA scale significantly improved over the study period in IES. Limitations: Besides the small sample size, details on the intervention costs for both IES and TVR group were unavailable and had to be obtained from external sources. Conclusions: Implementation of IES for people with affective disorders is most likely cost-saving and is potentially even dominating TVR, although a larger trial is required to establish this.
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| 68. |
- Schmidt, Manuela, et al.
(författare)
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Clinical profiles and temporal patterns of psychiatric emergency room visitors in Sweden
- 2018
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Ingår i: Nordic Journal of Psychiatry. - : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 72:3, s. 197-204
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Tidskriftsartikel (refereegranskat)abstract
- AIMS: To describe persons visiting the psychiatric emergency room (PER) in Sweden and to compare persons who frequently (PFV) and infrequently (PIFV) visit PERs in terms of group size, age, gender, PER location inside versus outside the home municipality, diagnosis (ICD 10), temporal patterns of visits and hospital admissions.METHODS: This register study included all visits to PERs in one Swedish county over 3 years, 2013-2015 (N = 67,031 visits). The study employed descriptive statistics as well as Chi-square tests combined with Bonferroni correction to compare PFV with PIFV.RESULTS: Of the total of 27,282 visitors, 2201 (8.1%) were identified as PFV (five or more visits within 12 months) and they accounted for 38.1% of the total visits. The study found differences between PFV and PIFV in gender, diagnostic profile, hospital admissions and temporal patterns. Differences were also detected with regard to distance between PERs and home municipalities. However, no age-related differences were found between the two groups.CONCLUSIONS: PFV and PIFV have different clinical profiles and temporal patterns. These results may be important when planning, developing and evaluating interventions targeting the needs of each group, which is in accordance with a person-centred approach. Such an approach might eventually result in fewer visits to PERs.
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| 69. |
- Schön, Ulla-Karin, 1970-, et al.
(författare)
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Evaluating the INSPIRE measure of staff support for personal recovery in a Swedish psychiatric context
- 2015
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Ingår i: Nordic Journal of Psychiatry. - London : Informa Healthcare. - 0803-9488 .- 1502-4725. ; 69:4, s. 275-281
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Tidskriftsartikel (refereegranskat)abstract
- Background: Recovery is understood to be an individual process that cannot be controlled, but can be supported and facilitated at the individual, organizational and system levels. Standardized measures of recovery may play a critical role in contributing to the development of a recovery-oriented system. The INSPIRE measure is a 28-item service user-rated measure of recovery support. INSPIRE assesses both the individual preferences of the user in the recovery process and their experience of support from staff. Aim: The aim of this study was to evaluate the psychometric properties of the Swedish version of the INSPIRE measure, for potential use in Swedish mental health services and in order to promote recovery in mental illness. Method: The sample consisted of 85 participants from six community mental health services targeting people with a diagnosis of psychosis in a municipality in Sweden. For the test-retest evaluation, 78 participants completed the questionnaire 2 weeks later. Results: The results in the present study indicate that the Swedish version of the INSPIRE measure had good face and content validity, satisfactory internal consistency and some level of instability in test-retest reliability. Conclusions: While further studies that test the instrument in a larger and more diverse clinical context are needed, INSPIRE can be considered a relevant and feasible instrument to utilize in supporting the development of a recovery-oriented system in Sweden. © 2014 Informa Healthcare.
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| 70. |
- Selenius, Heidi, 1976-, et al.
(författare)
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Experiences of self-injury and aggression among women admitted to forensic psychiatric care
- 2017
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Ingår i: Nordic Journal of Psychiatry. - Abingdon : Taylor & Francis. - 0803-9488 .- 1502-4725. ; 71:4, s. 304-311
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Tidskriftsartikel (refereegranskat)abstract
- Background: Self-injury and institutional violence are well-known characteristics of female forensic psychiatric patients, but research on patients' experiences of these behaviours is limited.Aim: The aim of the study was to investigate how female forensic psychiatric patients describe their self-injury and aggression.Methods: The authors performed qualitative in-depth interviews with 13 female forensic psychiatric inpatients. The interviews were analysed using thematic analysis.Results: The analysis resulted in three themes describing the process of handling negative thoughts and emotions by using self-injury or aggression towards others and thereby experiencing satisfaction. Both self-injury and aggression were experienced as strategies for emotional regulation. The forensic psychiatric care was perceived as important for the women in developing less harmful strategies for coping with negative thoughts and emotions instead of injuring themselves or others.Conclusions: Self-injury and aggression are often risk-assessed separately, but results from the present study suggest that these behaviours need a more holistic approach.
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