Withdrawal and exclusion : a study of the spoken word as means of understanding schizophrenic patients

There are literally thousands of people living among us who suffer from chronic and severe mental illness. There may be as many as one out of 100 that might be described with the diagnosis of schizophrenia. This means that most of us are likely to know, or know of, at least one person who suffers from schizophrenia. Nevertheless, most people perceive it as both distant and elusive. The diagnostic description and characterization of Schizophrenia (DSM-IV, 1994:273ff; ICD-10, 1994:F20), says little about the experience of the illness or of the individuality of persons within the group (of Mishara, 1994). It says little concerning who the patients are as persons, what their lives are like and how they experience themselves and others. It is easy to forget that schizophrenia is an illness that strikes individuals. The experience of schizophrenia thus will be unique for each person (Strauss, 1989; Strauss, 1996; Strauss, 1994). This study was triggered by the question of what is it like to experience a disorder like schizophrenia and the isolation that is associated with it. The intention of this study is to describe some aspects of the condition and the suffering that schizophrenia represents. I was therefore granted access to a rehabilitation unit in a hospital in order to enter into dialogue with patients and staff about schizophrenia and the suffering involved. I also wanted to study how it manifests itself in everyday life

Self-reported health as a predictor of mortality: A cohort study of its relation to other health measurements and observation time.

Self-reported health (SRH) is widely used as an epidemiological instrument given the changes in public health since its introduction in the 1980s. We examined the association between SRH and mortality and how this is affected by time and health measurements in a prospective cohort study using repeated measurements and physical examinations of 11652 men and 12684 women in Tromsø, Norway. We used Cox proportional hazard regression to estimate hazard ratios (HRs) of death for SRH, controlling for pathology, biometrics, smoking, sex and age. SRH predicted mortality independently of other, more objective health measures. Higher SRH was strongly associated with lower mortality risk. Poor SRH had HR 2.51 (CI: 2.19, 2.88). SRH is affected by disease, mental health and other risk factors, but these factors had little impact on HRs (Poor SRH: HR 1.99; CI: 1.72, 2.31). SRH predicted mortality, but with a time-dependent effect. Time strongly affected the hazard ratio for mortality, especially after ten-year follow-up (Poor SRH HR 3.63 at 0-5 years decreased to HR 1.58 at 15-21 years). SRH has both methodological and clinical value. It should not be uncritically utilised as a replacement instrument when measures of physical illness and other objective health measures are lacking

The association of religious factors with mental health-service utilisation and satisfaction in a mixed Sámi and Norwegian adult population: Adopting the SAMINOR 2 Questionnaire Survey

The Indigenous Sámi have poorer mental health than the majority population and fairly equal access to professional mental healthcare. Despite this condition, certain studies indicate that this group is underrepresented among the users of such services. Religion or spirituality (R/S) often influences mental health-service utilisation and satisfaction among other Indigenous peoples and ethnic minorities. Thus, this study examines the situation in Sámi-Norwegian areas. We utilised cross-sectional data from the population-based SAMINOR 2 Questionnaire Survey (2012; subsample n = 2,364; 71% non-Sámi) in mixed Sámi-Norwegian regions of Northern and Central Norway. We analysed the associations between R/S factors and past-year mental health-service utilisation and satisfaction among individuals reporting mental health problems, substance use, or addictive behaviours. Multivariable-adjusted regression models considering sociodemographic factors, including Sámi ethnicity, were applied. Religious attendance was significantly associated with infrequent past-year use of mental health services (OR = 0.77) and fewer mental health problems, indicating that the R/S fellowship may buffer mental distress and represent an alternative psychological support to professional services. R/S was not significantly associated with lifetime mental health-service satisfaction. We found no ethnic differences in service utilisation or satisfaction

The effects of exceeding low-risk drinking thresholds on self-rated health and all-cause mortality in older adults: The Tromsø Study 1994-2020

Background Based on findings of increasing alcohol consumption in older adults, it is important to clarify the health consequences. Using data from the Tromsø study, we aimed to investigate the relationship between different levels of alcohol consumption in old adulthood and self-rated health trajectories and all-cause mortality. Methods This is an epidemiological study utilizing repeated measures from the Tromsø study cohort. It allows followup of participants from 1994 to 2020. A total of 24,590 observations of alcohol consumption were made in older adults aged 60–99 (53% women). Primary outcome measures: Self-rated health (SRH) and all-cause mortality. SRH was reported when attending the Tromsø study. Time of death was retrieved from the Norwegian Cause of Death Registry. The follow-up time extended from the age of study entry to the age of death or end of follow-up on November 25, 2020. Predictor: Average weekly alcohol consumption (non-drinker, Results We found that women who consumed ≥100g/week had better SRH than those who consumed Conclusions There was no clear evidence of an independent negative effect on either self-rated health trajectories or all-cause mortality for exceeding an average of 100g/week compared to lower drinking levels in this study with up to 25 years follow-up. However, some sex-specifc risk factors in combination with the highest level of alcohol consumption led to adverse efects on self-rated health. In men it was the use of sleeping pills or tranquilisers and≥20 years of smoking, in women it was physical illness and older age

Family members’ experiences of “wait and see” as a communication strategy in end-of-life decisions

The aim of this study is to examine family members’ experiences of end-of-life decision-making processes in Norwegian intensive care units (ICUs) to ascertain the degree to which they felt included in the decision-making process and whether they received necessary information. Were they asked about the patient’s preferences, and how did they view their role as family members in the decision-making process? A constructivist interpretive approach to the grounded theory method of qualitative research was employed with interviews of 27 bereaved family members of former ICU patients 3–12 months after the patient’s death. The core finding is that relatives want a more active role in end-of-life decision-making in order to communicate the patient’s wishes. However, many consider their role to be unclear, and few study participants experienced shared decision-making. The clinician’s expression “wait and see” hides and delays the communication of honest and clear information. When physicians finally address their decision, there is no time for family participation. Our results also indicate that nurses should be more involved in family–physician communication. Families are uncertain whether or how they can participate in the decision-making process. They need unambiguous communication and honest information to be able to take part in the decision-making process. We suggest that clinicians in Norwegian ICUs need more training in the knowledge and skills of effective communication with families of dying patients

Withdrawal and exclusion : a study of the spoken word as means of understanding schizophrenic patients

There are literally thousands of people living among us who suffer from chronic and severe mental illness. There may be as many as one out of 100 that might be described with the diagnosis of schizophrenia. This means that most of us are likely to know, or know of, at least one person who suffers from schizophrenia. Nevertheless, most people perceive it as both distant and elusive. The diagnostic description and characterization of Schizophrenia (DSM-IV, 1994:273ff; ICD-10, 1994:F20), says little about the experience of the illness or of the individuality of persons within the group (of Mishara, 1994). It says little concerning who the patients are as persons, what their lives are like and how they experience themselves and others. It is easy to forget that schizophrenia is an illness that strikes individuals. The experience of schizophrenia thus will be unique for each person (Strauss, 1989; Strauss, 1996; Strauss, 1994). This study was triggered by the question of what is it like to experience a disorder like schizophrenia and the isolation that is associated with it. The intention of this study is to describe some aspects of the condition and the suffering that schizophrenia represents. I was therefore granted access to a rehabilitation unit in a hospital in order to enter into dialogue with patients and staff about schizophrenia and the suffering involved. I also wanted to study how it manifests itself in everyday life

Psykisk helse. Forståelse, kommunikasjon og samspill

Boka handler om å forstå mennesker med psykiske lidelser. Boka er skrevet for videreutdanningene inne psykisk helse, men er også nyttig for andre som arbeider med mennesker som enten har en psykisk lidelse eller nedsatt kognitiv evne.Boka drøfter følgende sentrale spørsmål: Hvordan forstå vrangforestillinger? Hva skjer når pasienter opplever at det de sier ansees som meningsløst eller irrelevant? Finnes et eget psykotisk språk? Hvordan etablere forstående relasjoner til en som sliter med psykisk lidelse? Hvordan bruke 'fortellinger' til å forstå pasientens erfaringer og opplevelser