Search

Background: On average 110 men under 35 years of age take their own lives in Norway each year. Few receive health assistance in the period prior to the suicide, and little research exists on contact with assistance agencies for persons who take their own lives, beyond studies of the number of doctor visits before the death. This study aimed to obtain knowledge of relatives' need for assistance from the health services, both to identify suicide risk and motivate them to seek help in life crises., Material and Method: Sixty-one in-depth interviews with the bereaved next of kin of young men (18-30 years) were analysed using interpretative phenomenological analysis., Results: The bereaved perceived the generally accepted assumption that suicide is attributable to mental illness as an obstacle to identifying suicide risk. Most of the bereaved saw no signs of mental illness before the suicide. The suicide crisis was associated with relational factors. The bereaved who had harboured the thought that a suicide risk existed found that it was not enough to urge the suicidal person to seek health assistance. Improved knowledge of suicide and seeking health assistance were measures that were proposed., Interpretation: The findings challenge the current prevention model. Healthcare personnel as well as the general population should be better informed that mental illness is neither a sufficient nor a necessary factor to explain suicide, even though a higher risk of suicide is associated with some mental disorders.

With the beautiful and dark film "The white ribbon", from 2009, the Austrian film director Michael Haneke consolidated his status as an international success. A central theme in his films is evilness and its roots. But just as important is his ambition to develop films where evil is not only portrayed, but where spectators are challenged to relate to their own ethical standards and their role as spectators. Haneke is a highly original filmmaker with his consistent search for a film aesthetic that stimulates ethical self-reflection and mentalizing. He partly succeeds in this quest.

Background: The Montebello Centre offers cancer patients and their relatives courses of 5-10 days duration aimed at improving their coping with their disease., Material and Methods: Data on all patients admitted to the Centre 1991-2004 were linked with data from the Norwegian Cancer Registry (n = 10,173). Patients and relatives who took courses in 2004 or 2005 were asked to fill in questionnaires concerning usefulness and satisfaction with the courses., Results: Patients from all parts of Norway have signed up for the courses without substantial regional differences. In relation to the incidence of cancer, most patients came from northern Norway. Women with breast cancer constituted the largest group of patients. One third of the patients were men, and that proportion increased throughout the observation period. Most patients were admitted less than two years after their initial diagnosis. After the year 2000, 67% of the patients have been accompanied by someone. Starting with the first course the five year survival rates were 69% for females and 52% for males. More than 90% of patients and relatives stated that the courses had improved their knowledge of cancer, their coping skills and given new social contacts., Interpretation: The Montebello Centre functions as a national centre. Men and accompanying persons are admitted in an increasing proportion. At the end of the course both patients and their relatives reported the courses to be highly useful, and displayed a high degree of satisfaction . There is a need to know more about the long-term effects of the courses.

Background: Survivors from the Tsunami in South East Asia 2004 and their next of kin were examined during the first year after the event with respect to trauma, symptoms and function, and satisfaction with the help they had been offered., Material and Methods: Patients admitted to a surgical department (n = 20), patients self-selected to a psychiatric outpatient unit (n = 10) and relatives (n = 17) completed the anxiety and depression scale [HADS] (sumscore 0-21) and recorded posttraumatic symptoms in the Impact of Event Scale [IES] (sumscore 0-75) at one, three, eight and 13 months after the Tsunami., Results: Both patients (IES scores fell from 31.7 to 22.7) and relatives (IES scores fell from 38.0 to 23.2) had lower levels of posttraumatic symptoms after 13 months. Patients' anxiety (HAD-scale) was reduced from 8.7 to 7.5 and depression (HAD-scale) from 9.5 to 7.3. For relatives, the corresponding figures were 8.2 to 5.4 for anxiety and 6.5 to 4.1 for depression. After 13 months, 45-65% of the patients had regained at least 80% of their normal function at work, in the family, with friends and during leisure time. 50% had been on sick leave for at least half a year, and 55% were still consulting a psychiatrist/psychologist. The satisfaction with follow-up from Norwegian authorities in the first phase was very low, but medical treatment and psychosocial follow-up in Norway afterwards received high scores., Interpretation: Survivors after the Tsunami experienced substantial psychological distress at 13 months follow-up. Their relatives had similar levels of symptoms, but functioned better in general.

Background: Memorial services in the acute phase after major accidents have been common in Norway since the late 1980ies. We have examined such services from the aspect of liturgy, rite and as help to cope in a crisis. This paper focuses mainly on the last item: What importance does the memorial service have for the participants?, Material and Method: We have interviewed nine bereaved and one rescuer who were involved in four accidents and participated in memorial services thereafter. Transcriptions of the interviews were coded in accordance with inductive code categories and were reorganized in a thematic structure that formed a basis for further analyses., Results: For the bereaved, the situation was characterized by strong emotions and impressions. Some reported a great need to participate in the service; others were ambivalent due to emotional exhaustion and existential distress. Lighting candles and reading names created the strongest memories and were emphasized as important for handling the crisis. The participants experienced the church room as appropriate to enfold their emotions. The rituals helped to confirm reality and release grief, and they helped them to cope with emotional and existential aspects., Interpretation: A memorial service is not therapy as such, but can be understood as a collective ritual response to an extensive crisis experience. Those who participate would also engage in rituals to deal with other emotionally and existentially challenging situations (i.e. funerals). Participation in the service seemed to reduce feelings of helplessness; it connected the individual to the community and contributed to create order in a chaotic situation.

Schizophrenia remains mainly an enigma for clinicians and researchers, and all levels of possible further comprehension should be explored. A fundamental characteristic existential perplexity in schizophrenia has significant bearing on the patient's suffering and functional decline, and deserves the attention of mental health professionals. Early detection, diagnosis and treatment might all profit from an explicit focus on the subjective aspects of this disorder. We developed a phenomenological and existentially oriented patient-centered programme for the diagnostic process and diagnosis mediation in schizophrenia, consistently based on self-reported patient experiences. Conventional diagnostic criteria in combination with a firm focus on additional fundamental experiential alterations constitute a framework that facilitates an open dialogue throughout the evaluation between the patient, his or her family and the therapist. The programme has been developed, adjusted and applied over five years on some 120 patients. It has strengthened diagnostic skills, precision and goal-directedness, increased the interest in precise evaluation, and deepened the theoretical understanding of early diagnosis. It is well accepted by the patients, their families and the professionals. This explicit focus on the patients' inner reality and experiences seems to vitalise the patient-therapist relationship.

Working with families with a child or an adult with an eating disorder is to work with the resources and limitations in the families, how they could cope with this challenge. Family interventions in eating disorders are counselling, working with the family and family-oriented therapy. Studies show documented effects, especially for patients below 18 with anorexia nervosa who have had this disorder for less than three years. Indications for going from working with the family to family therapy are conflicts between parents or between the child and parents, delayed or disturbed psychological development of the child, or when siblings or other family members are believed to have an effect on the healing. Family therapy is to work with the family as a system. The professional responsibilities, the practical tasks and the goals are about interaction in the family, about relations and communication patterns. Interventions in the family are mainly rooted in systemic family therapy. Motivational methods are important, as are cognitive methods and psychoeducational methods, information and learning how to cope with eating disorders.

This article gives an updated review of the history, epidemiology, etiology, and evidence-based treatment of eating disorders (anorexia nervosa, bulimia nervosa, and binge eating disorder), with specific reference to the Norwegian situation. In order to improve clinical skills there is an emphasis on the need for more treatment resources, particularly for the most serious cases, better implementation of evidence-based treatment and on continuous medical education. Given the somatic manifestations of eating disorders, medical doctors are essential in assessment and treatment. Many patients can be successfully treated by general practitioners provided that the general practitioner takes an interest in and is knowledgeable about eating disorders. The need to increase the number of general practitioners participating in ongoing Norwegian educational programmes on eating disorders is stressed.

Background: Psychoeducational family intervention for schizophrenia was developed to reduce stress levels in families in order to improve outcome., Material and Methods: Systematic reviews and search in databases (until February 2002, "Family" and "Schizophrenia") were used to find randomized controlled studies of effect., Results: We found seven studies of short-term family treatment, 15 studies of long-term treatment comparing it to individual therapy, and seven studies comparing family treatment modalities. Long-term family intervention reduces the risk of psychotic relapse to about the half within the first two years. These methods also shorten hospital stays, improve compliance with medication, patients' social functioning and relatives' well-being, and they seem to be cost-effective. Single and group family therapies including patients are equally efficacious. Relatives' groups do not seem to improve outcome. Several factors, such as expressed emotion and duration of illness, modify the effects and should be taken into account., Interpretation: In Norway there is a need for systematic training of mental health workers in these methods. Family intervention should be offered to all persons with schizophrenia who are in frequent contact with relatives.

Background: Schizophrenia is a severe mental illness with a profound negative influence on social functioning. How does a schizophrenic disorder in parents influence their rearing of their children?, Material and Method: An extensive literature search in Medline and PsycInfo., Results and Interpretation: For children with other available carers, an acute psychosis in one parent may lead to a crisis reaction. Here relatively simple interventions can be helpful. In the case of severe and longstanding illness in a parent, the child may get a heavy burden. The illness may seriously interfere with the child's development and attachment behaviour and increase the risk of later psychological problems. Because of feelings of loyalty towards the afflicted parents, children are reluctant to ask for help from outsiders. The parents often want help for the family, but pull back from discussing their problems because they fear loss of custody. Few parts of the treatment system have structured routines for meeting the needs of these families. Comprehensive interventions that support parents' ability to care for their children and give the children opportunity to talk about their situation may relieve the situation.

Background: Dementia is one of the most common conditions in the elderly. In Norway the total prevalence is about 60,000., Material and Methods: The paper is based on the author's clinical experience and a review of the literature., Results: No biological marker exists for Alzheimer's disease and other dementias. The diagnostic work-up thus consists of a comprehensive clinical neuropsychological, physical and psychiatric examination. Imaging of the brain could be useful in the differential diagnostic work-up. In mild cases and cases of suspected dementia, the work-up is carried out in specialist health care. Moderate and severe cases are assessed on primary care. There is currently no cure for dementia disorders, although acetylcholinesterase inhibitors may prove effective for Alzheimer's disease and Lewy body dementia. Behavioural and psychiatric symptoms can be pharmacologically treated., Interpretation: A careful diagnostic work-up must be carried out to diagnose dementia. Symptomatic treatment is available and should be initiated.

Introduction: As part of an international effort, a study of the psychosocial condition of women with cancer in Norway was performed in 1997., Material and Methods: 851 women with breast or gynaecological cancer in 27 Norwegian hospitals were asked to fill in a multi-choice questionnaire., Results: 76% of the breast cancers were detected by the women themselves, 19% by mammography and 11% by clinical examination. Similar numbers for gynaecological cancer were 59% by the women and 41% by the doctors (13% screening smear). 25% of the women were informed about the cancer diagnosis by telephone and 9% by letter. 87% were satisfied with treatment and care, 7% dissatisfied. 62% were satisfied with the availability of doctors, 20% not. In 47% of the breast cases, therapy alternatives were discussed with the patients. In 23% of gynaecological, 50% of breast, and 72% of gynaecological cancer, patients had no wish to participate in the decision. 94 of a total of 850 patients (11%) experienced financial problems after the diagnosis had been established. More than 90% of the women had a better or unchanged relation to their partner, family and friends after treatment. However, 30% of the breast and 14% of the gynaecological cancer patients had problems with their body image, and 16% and 15% felt they were less sexually attractive. 89% felt their partner coped well with the situation, 9% had problems and only 2% lost their partner. 32% of the patients had used alternative medicine, 44% of those with recurrence and 28% under primary treatment., Interpretation: Women operated for breast and gynaecological cancer face a variety of psychosocial and financial problems.

The rights of children in hospitals in Norway are protected by regulations based on Norwegian legislation. These regulations cover matters such as teaching of hospitalized children, housing of parents, economic rights of parents, and information. We did a questionnaire study among hospitalized children and their parents about their views on how hospitals complied with these regulations. 90 of 131 questionnaires (69%) were returned. There was a considerable gap between what the law demands of continuance in health care during treatment, schooling and information, and what children and parents actually experience. The study shows that the present regulations concerning children's rights in hospitals should be changed. The health authorities should demand documentation from the hospitals as to how the rights of children are ensured in hospitals.

Professionals who have worked with survivors of suicide have emphasized the need for systematic support and care, especially for children. The aim of this study was to evaluate the community support for survivors following suicide of young people (< 30 y). The organization and content of the help was evaluated with a view to develop advice regarding improvement of care. 321 out of 481 communities (67%) in Norway answered a questionnaire. A sub-sample of 266 communities which reported having special support programs for survivors of suicide is presented in this article. Data were analysed by quantitative and qualitative methods. The support offered varies across the nation. While the community physician and the parish priest have crucial roles throughout the country, psychological/psychiatric professionals are more often available in the southern parts of Norway and in larger communities. Most communities establish early contact with the survivors. However, the way contact is established seems casual, the length of the follow-up is varying, and the care for children is inadequate. Smaller communities, communities with a coordinator, a crisis team and written routines, seem to offer the best support. Recommendations for crisis and bereavement intervention programs are proposed in this article.

The aim of the study was to gain knowledge of the diagnosis, length of hospital stay, and ethnic background of refugee and immigrant children admitted to the Paediatric Ward at Aker University Hospital in Oslo, and to find out how well the staff and families of the children communicated. 347 children, admitted from ten districts in the immediate vicinity of the hospital, were included in the study. 133 (38%) children had parents who were both born in a non-western country. 44 of the children came from a refugee background and 89 from an immigrant background. The median stay on the Paediatric Ward was three days for the immigrant children and two days for the refugee children and children from Western countries. None of the groups was admitted more frequently than the others. Refugee and immigrant children were most often admitted because of respiratory diseases or obscure symptoms. Communication between the staff and more than 40% of the families with refugee or immigrant backgrounds was not satisfactory. Three out of four mothers and one out of two fathers were unable to communicate well in Norwegian. One third of the mothers had less than six years of school education and one quarter of the immigrant mothers had never attended school.

High technology medicine poses high demands for knowledge and technical competence. In addition, the hospital is expected to represent a model for total care where the "customers" also include family members, eg. parents and children. Both economic and human resources are needed in order to avoid negative after-effects and complications for both patient and family. High technology medicine also raises difficult ethical questions: How much decision-making should be left to parents? These problems are illustrated by clinical examples, and hospital-based ethical committees are suggested as a structure for the further efforts to improve ethical competency at the hospital and to find appropriate solutions for patients and their families in both the long and the short term.

Creutzfeldt-Jacob disease is a rare, neurodegenerative disease caused by a prion protein. The patients are usually between 40 and 60 years old. Most of the patients die within one year after onset of the disease. A typical case is reported. It is pointed out that such a dramatic development can cause anxiety and a feeling of inadequacy for close relatives. To avoid adverse consequences, it is important that the family and the health personnel involved receive necessary and adequate information about the disease.

Factors related to drinking habits among 663 adolescents 14, 15, 17 and 18 years old were investigated in three municipalities by means of a questionnaire. In a multiple regression analysis, variation in alcohol consumption was examined using several independent variables describing access to alcohol, behavioural factors, environmental influences, attitudes and demographic background. The most important factors predicting high alcohol consumption were early drinking debut, being away from home at night without the parents' knowledge, having friends who drink a lot and early high consumption of unhealthy foods such as soft drinks, peanuts and chips. All these factors were again related to upbringing and home environment.

Children with bronchial asthma may have coping problems which involve the whole family. The aim of this study was to find out what strain such families may experience. A questionnaire was sent to all children who, during a five year period, were registered as having a diagnosis of bronchial obstruction in the Department of Paediatrics, Innherred Hospital, Norway. The parents of a sample of the children were interviewed, and the parents of 42 children also answered a questionnaire about coping problems and strain. The results showed that the prevalence of coping problems and strain was low for these families at the time of the interview. Coping problems were greater during the first two years after asthma debut. Mothers felt more strain than the fathers during the two first years.

Military units are designed and trained to operate under stress, crisis and combat. In peacetime conditions the military organization can be subject to unforeseen crisis situations, including fatal accidents during training and exercises. Such critical incidents will affect personnel, leadership, morale and organizational performance. It may also affect the relationship between the military unit and the civilian community. Recent experience has shown that good leadership, personnel support and organizational restructuring are essential elements in the recovery after critical incidents and peacetime disasters. The present study outlines a systematic approach to crisis management in formal organizations. This includes a descriptive analysis of individual and organizational interventions in two military organizations; an army unit of 150 men and a naval unit of 114 men.

Case histories and clinical studies have pointed to the harmful effect on their children when traumatized parents do not communicate their traumatic experiences. The present paper argues that it is not the lack of communication in itself that is harmful. Lack of communication should rather be regarded as a coping mechanism which could indicate intrapersonal and interpersonal problems within the family.