Search

IntroductionThe legal criteria for involuntary admission in Norway are that the patient has a serious psychiatric disorder (i.e. psychosis) and is in need of admission to secure needed treatment or that there is a risk of danger. While there have been some studies focusing on coercion in hospitals, less is known about the processes leading up to involuntary admission and the reasoning of referring doctors. In Norway, it is primarily general practitioners (GPs) that refer patients.AimsTo study which factors that GPs who had recently referred patients to involuntary admission thought might have made their latest referral unnecessary.MethodsSeventy-four GPs were interviewed by phone. They had all recently referred patients involuntarily to a major Norwegian university psychiatric hospital. One central question concerned how their latest involuntary referral might have been avoided.ResultsThese are the main factors that the GPs thought could have been of importance in avoiding involuntary referral of their patients:– that the patient took the prescribed medication (28%);– that they personally had the opportunity to closely follow up the patient in the following days (22%);– that other health care staff could follow up the patient closely in the patient's own home (i.e. home care nursing, etc.) (19%);– that a family member of the patient could help the patient (8%).ConclusionsThe GPs suggested that an increased availability of resources and more assistance from other parts of the health service were some of the factors that could be of importance in reducing involuntary admissions.

BackgroundA total of, 14 Norwegian assertive community treatment (ACT) teams have been established. During the teams’ first year of operation, approximately 35% of the enrolled patients were subjected to community treatment orders (CTOs) at intake. CTOs are a legal mechanism to secure treatment adherence, and may be used in Norway when severely mentally ill patients refuse necessary treatment (‘treatment criterion’) or when they are considered a danger to themselves or others (‘danger criterion’). Even if the use of CTOs seems to increase in Norway, few have examined in detail how and why these decisions are made. The purpose of the present study was to explore assessments of need for treatment and danger in decisions about CTOs.MethodSemi-structured interviews with eight responsible clinicians and four focus-group interviews with 20 ACT providers were recorded and transcribed. We also read case files and observed selected treatment planning meetings. The data were analyzed with a modified grounded theory approach.ResultsThe ACT teams provided high-intensive services over longer periods of time, which gave the teams important knowledge about the patients, reduced clinical uncertainty, and allowed for well-informed decisions about the need for coercive interventions. The treatment criterion was typically used to justify the need for CTOs. However, the danger criterion was in some cases used when patients had to be readmitted to hospital.ConclusionsAccording to the clinicians that were interviewed, patients’ need for treatment was most often used to justify the CTOs in the Norwegian ACT teams.

IntroductionMental illness are among the most prevalent causes of death [1]. Larger population based studies are needed in order to control the high mortality rates for psychiatric patients [2].ObjectiveTo examine the relationship between psychiatric disease and somatic illness.MethodData from health-related databases and registries are cross-matched by social security number for all psychiatric patients in North-Norway for 2008–2016/2017. n = 4000–6000.(Table 1)Mortality is considered multifactorial, and risk factors may appear as both direct and indirect causes. A high number of demographic, somatic, psychiatric and service related variables allow the study to control for interactions and confounding associations by multivariate analyses.Results/planned papersA case-register study of the comorbidity of mental and somatic disorders in North Norway: Research protocol.Increased mortality in psychiatric patients: A case-registry study.Comorbidity of cancer and psychiatric illness: Findings from North Norway.Cardiovascular disease is prevalent among people suffering from depression and anxiety.The importance of the use of antipsychotic medication for physical health.Coercion and general health among psychiatric patients. The importance in continuity of care.Substance-use among psychiatric patients. Implications for general health and care pathways.Psychiatric patients use of general practitioner medical treatment.Table 1An overview of the information that will be retreived from the registries.Disclosure of interestThe authors have not supplied their declaration of competing interest.

BackgroundSome prior studies of brainstem audiometry have found illness-specific aberrations, suggesting that this procedure can be of use to clinicians in diagnosing certain psychiatric illnesses.AimsThe study aimed to examine the diagnostic properties of a brain stem audiometry procedure (SD-BERA®) for patients suffering from schizophrenia and bipolar disorder.MethodsA blinded study including 12 patients with schizophrenia, 12 patients with bipolar disorder, and 12 healthy controls was performed in 2014/2015. The patients were recruited from psychiatric specialist services and a primary care office in the County of Troms, Norway. The patients and controls were examined with brainstem audiometry. The clinical diagnoses were not known to the researchers who analysed the brain stem audiometry data at the Swedish company SensoDetect. Sensitivity and specificity for each group (compared to healthy controls) was calculated.ResultsThe brain stem audiometry procedure had a high degree of sensitivity (1.00), but a lower degree of specificity (0.45) when patients suffering from bipolar disorder were compared to healthy controls. For the diagnosis of schizophrenia, the brain stem audiometry procedure had a high degree of specificity (0.91), but a lower degree of sensitivity (0.33) when patients were compared to healthy controls.ConclusionsThis method may help clinicians by lending support to a clinically suspected diagnosis of schizophrenia. The relatively low specificity for bipolar disorder could suggest that the method needs further development before it can be useful clinically when the diagnosis of bipolar disorder is suspected. Further scientific testing is needed to verify these findings.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introduction Since 2007 14 ACT-teams have been established in Norway. Despite the lack of clear evidence for efficacy, CTOs are used as a tool for supporting patients with severe mental illness that are difficult to engage to promote medication adherence and early identification of relapse. There is not much literature about the use of CTOs in ACT-teams. Objectives This study explores the perceptions and experiences of users in Norwegian ACT-teams with recent experience of CTOs. According to the ACT-model establishing trust and a treatment alliance is of significant importance Beside exploring how CTOs influence upon the users‘life-situation and the relationship to the team-members, the study will also focus on the service users‘experience of whether their opinions and whishes are of importance to the treatment planning process. Methodology In-depth interviews with 18 selected users from three ACT-teams will be analyzed by using a modified grounded theory approach, based upon initial, focused and theoretical coding and constant comparison. Results The users perceive the uncertainty of the length of the CTO and the threat of being recalled to hospital if they don‘t comply with treatment difficult to accept. To receive support and respect from the ACT team has been important to increase their sense of safety and stability. Conclusions The results from this study can give useful information about how users‘perceive community treatment orders, which is important for how health personnel encounter ethical dilemmas and ambivalences that may accompany the use of committed community treatment.

Introduction In Norway, it is mainly GPs that admit refer involuntarily to psychiatric hospitals. The process is regulated by legislation that requires that the patient suffers from a serious psychiatric disorder and is a danger to him/herself or that necessary treatment cannot be given otherwise. About 1/3 of patients are referred involuntarily in Norway. While legislators have tried to reduce the number of patients being referred involuntarily by changing the legislative requirements, the proportion of involuntarily referred patients has remained high. More knowledge is needed about why patients are referred involuntarily, and especially about GP's expectations. Aims To examine which expectations GPs have when referring patients involuntarily to a psychiatric hospital. Methods Semi-structured phone interviews were performed with 74 GPs that had referred patients involuntarily to a major Norwegian University Psychiatric Hospital. One topic that was discussed was GPs expectations. Each GP could give several expectations. Results 81% expected to solve an acute situation and make sure that the patient was cared for. 58% expected that appropriate medical treatment would be given. 38% expected a major change/improvement in the treatment or care of the patient. 22% expected that the patient's diagnosis would become clearer during the stay. Conclusions GPs may have different expectations when admitting patients involuntarily to psychiatric hospital. Solving an acute situation and making sure that the patient was cared for was the most important expectation given by the GPs.

Introduction The clinical case report has a long-standing tradition in the medical literature. While its scientific significance has become smaller as more advanced research methods have gained ground, case reports are still presented in many medical journals. Some scholars point to its limited value for medical progress, while others assert that the genre is undervalued. Objectives To assess the medical scientific community's viewpoints on the merits and limitations of the case report. Method We searched PubMed and Google Scholar and select textbooks on epidemiology and medical research for articles discussing the merits and limitations of clinical case reports and performed a non-systematic review. Results The major merits of case reporting were these: Detecting novelties, generating hypotheses, pharmacovigilance, high applicability when other research designs are not possible to carry out, allowing emphasis on the narrative aspect (in-depth understanding), and educational value. The major limitations were: Lack of ability to generalize, no possibility to establish cause-effect relationship, danger of over-interpretation, publication bias, retrospective design, distraction of reader when focusing on the unusual. Conclusions Despite having lost its central role in medical literature in the 20th century, the genre still appears popular. It is a valuable part of the various research methods, especially since it complements other approaches. Furthermore, it also contributes in areas of medicine that are not specifically research-related, e.g. as an educational tool.

Introduction School dropout and subsequent youth unemployment are important risk factors for mental problems. It is important to understand which factors that may lead to youth dropping out of high school. Aims The aims were to explore the subjective experiences of people who had not completed high school and who had problems getting work. To examine how the parents’ involvement in the children's lives influenced their schooling experiences. Methods Five Norwegian men and five women (aged 18–28) who had not completed high school and who had not been able to find work were interviewed qualitatively. The interviews were transcribed in full and analyzed drawing on Grounded Theory. Results The informants had struggled with an accumulation of risk factors constantly challenging their resilience, eventually resulting in dropout. In these individual educational trajectories, one experience was shared by most: the lack of stable parental involvement. Moving between parents or losing contact with parental figures all together made the direct involvement from parents in the child's learning activities over time more complicated. Several had experienced intense levels of marital conflict often ending in divorce with periods of little or no contact with one parent, thus threatening the child's emotional security and resulting in withdrawal or aggressive behavior. The low-achieving boys gave the non-practical focus of the high school curricula as an explanation for dropout. The high-achieving boys reported shyness. The girls focused on social and family issues. Conclusions This qualitative study suggests that parental involvement may be of importance to drop-out from school.

IntroductionParticipation in social, cultural, and physical activities positively influences perceptions of health and quality of life. Few have studied how substance abuse influences patients’ participation in social, cultural and physical activities.Objectives/aimsWe examined patterns of past, recent and future (desired) activities of patients being admitted to substance abuse treatment at a Norwegian university hospital.MethodsA questionnaire was developed specifically for the self-reporting of social, cultural, and physical activities. Psychiatric diagnoses including substance use diagnoses and other clinical and demographic data were also obtained. Data were analysed with descriptive and comparative analyses, including ANOVA.Results78 patients responded (71%), 23 women, 55 men. Mean age was 38. 71% had a diagnosis of mental and behavioural disorders due to psychoactive substance use, while some had personality disorders (8.9%) or schizophrenia (3.6%). The total amount of activities had dropped significantly compared to before the respondents started abusing substances, and the drop was particularly pronounced for physical activities (Figure).Changes in activitiesMost expressed an interest in increasing their social, cultural, and physical activities.ConclusionThe total amount of social, cultural, and physical activities falls markedly after starting substance abuse. Helping patients regain positive activities may improve subjective health and quality of life.

IntroductionIndividuals’ self-image and how they view their personal qualities can be of great importance for how and where they seek help for their health problems. Few have studied in-depth the connection between self-image and the use of text-based Internet communication.Objectives/aimsWe examined how members of two Internet-based Alcoholic Anonymous groups explained their preferences for using Internet-based AA groups, either alone or in combination with face-to-face AA groups.MethodsData were obtained over the course of one year by means of participant observation and in-depth e-mail interviews with 11 members from different countries. The first author participated in two online AA groups by posting and responding to the topics in the e-mail meeting, bulletin board and discussion forum. The 11 e-mail interviews were semi-structured and asynchronous, that is, they were not conducted in real-time but over a period ranging from five weeks to three months.ResultsOnline AA members explain their preferences for using Internet-based self-help groups by referring to their self-image and personal qualities as well as their self-diagnoses (e.g. social anxiety, aspergers syndrom, compulsiveness and impulsiveness). Some use a combination of online and face-to-face groups which helps them to overcome their social phobia.ConclusionInternet self-help groups seem to represent an important alternative for people who experience difficulties with face-to-face communication. Participation in online AA groups is easier to combine with everyday life. The Internet groups provide a more anonymous context for people who want to be heard, but not necessarily seen.

In the treatment of eating disorders, little is know about the role and impact of psychoeducative programmes and whether patients experience such programmes as helpful in their healing processes. Examining these questions is the purpose of this study, using an explorative and descriptive design based on content analysis. Thirteen female patients participated in qualitative interviews. The analysis of healing processes experienced during the programme participation resulted in six main categories i.e. “Self-awareness”, “Setting boundaries”, “Feelings and self-mobilisation”, “Self-regulation”, “Self-reflexivity” and “Motivation and Self-improvement”. The present study clearly indicates that according to the patients’ experiences, a psychoeducative programme may facilitate healing processes. The study also supports an impression of an indirect impact on healing processes in terms of more readiness to seek treatment. There is a need for more knowledge about how treatment and psychoeducative programmes may be coordinated.

ObjectivesThere is a need for more research on women with coronary disease and potential gender differences. This paper report a study of gender differences in psychological distress, health behavior, and coronary health in patients having coronary artery bypass graft surgery (CABG).Methods229 patients (41 women) having CABG treatment at a hospital in Northern Norway completed a questionnaire 3-15 months after discharge (mean = 8.8, SD = 3.2), and medical data were gathered from their hospital records. Age ranged from 35 to 65 years (Mean = 60.5, SD= 7.4).ResultsNo gender differences were found on age, education, work status, or living alone, on coronary health measured by LVEF, NYHA, blood pressure, diabetes, on health related life style measured by smoking, BMI, and physical activity, or the number of days treated at the hospital, or time since hospital discharge.In univariate analysis, women (compared with men) reported higher levels of mental distress (SCL10; mean = 1.85 versus 1.57, t = 2.73, p< .006). Furthermore, women experienced the time at home following hospital discharge as more difficult than what men did. In a logistic regression analysis of gender, SCL10 together with LVEF were significant predictors, controlling for time since hospital discharge and days treated at the hospitalDiscussionThe higher rate of depression among female CABG patients in this study from Northern Norway is comparable to studies elsewhere. Results are discussed in light of theories of coping and self-regulation, other studies on gender differences in CAD, and implications for treatment.

Little is known about how different groups of health-care workers compare to each other and to the general public in their opinions about involuntary admission and treatment. In the present study, 1,094 people in Norway responded to a questionnaire containing three cases with patients suffering from schizophrenia. They were asked in which cases they would admit involuntarily and treat involuntarily with neuroleptics. An overwhelming majority would coerce when the patients were violent. Between a third and a half would coerce when the patients had problems coping with activities of daily life, or when the patients were in an early schizophrenic development with few symptoms. In all the cases, significantly more would accept involuntary admission than involuntary treatment with neuroleptics. The results suggest that health-care workers' attitudes to coercion in psychiatric care are in line with the attitudes of the general public. Prior experience with coercion, female sex, not having a college/university education, having a profession other than social worker, and not currently being employed in the psychiatric services, were positive predictors of willingness to coerce.