Suchergebnisse

Abstract Background Community treatment orders (CTOs) were legally implemented in psychiatry in Sweden in 2008, both in general psychiatry and in forensic psychiatric care. A main aim with the reform was to replace long leaves from compulsory psychiatric inpatient care with CTOs. The aims of the present study were to examine the use of compulsory psychiatric care before and after the reform and if this intention of the law reform was fulfilled. Methods The study was based on register data from the computerized patient administrative system of Örebro County Council. Two periods of time, two years before (I) and two years after (II) the legal change, were compared. The Swedish civic registration number was used to connect unique individuals to continuous treatment episodes comprising different forms of legal status and to identify individuals treated during both time periods. Results The number of involuntarily admitted patients was 524 in period I and 514 in period II. CTOs were in period II used on relatively more patients in forensic psychiatric care than in general psychiatry. In all, there was a 9% decrease from period I to period II in hospital days of compulsory psychiatric care, while days on leave decreased with 60%. The number of days on leave plus days under CTOs was 26% higher in period II than the number of days on leave in period I. Among patients treated in both periods, this increase was 43%. The total number of days under any form of compulsory care (in hospital, on leave, and under CTOs) increased with five percent. Patients with the longest leaves before the reform had more days on CTOs after the reform than other patients. Conclusions The results indicate that the main intention of the legislator with introducing CTOs was fulfilled in the first two years after the reform in the studied county. At the same time the use of coercive psychiatric care outside hospital, and to some extent the total use of coercive in- and outpatient psychiatric care, increased. Adding an additional legal coercive instrument in psychiatry may increase the total use of coercion.

Background: Studies that differentiate among diagnoses have detected divergent results in the experience of family burden. Aim: This study aimed to investigate differences in family burden and participation in care between relatives from subgroups of psychoses, affective disorders and 'other diagnoses', and between different subgroups of relatives. Method: In a Swedish longitudinal study performed in 1986, 1991 and 1997, 455 close relatives of both committed and voluntarily admitted patients were interviewed concerning different aspects of their burden, need for support and participation in the actual care situation. Results: Relatives showed burdens in several of the aspects measured. In only one aspect of the investigated burden items was a difference found between different diagnostic subgroups. The relatives of patients with affective disorder more often had to give up leisure time. However, spouses showed more burdens and more often experienced sufficient participation in the patient's treatment than other subgroups while siblings more seldom experienced burdens and more seldom felt that their own needs for support had been met by the psychiatric services. Within each diagnostic subgroup there were differences between subgroups of relatives. Conclusion: Being a close relative, and living together with a severely mentally ill person in an acute situation, is one factor of importance for experiencing burden and participation in care, contradicting the conventional wisdom which differentiates between diagnoses.

The aim of this study was to describe and gain an understanding of clients' experiences of psychotherapy contracts and processes in cognitive behavioural therapy (CBT) and psychodynamic psychotherapy (PDT). Fourteen participants were interviewed after ending their psychotherapy. To get information richness they were selected with as great a variation as possible in relation to their life context. Qualitative content analysis was used to analyse the descriptions and the significance of the descriptions. Similarities between the two therapy orientations emerged throughout the informants' experiences. These similarities were expressed in the two themes: The creation of a new context and The working method and the cooperation with the psychotherapist made up a whole. The psychotherapy process was described as 'hard work' in a new context, markedly different from the ordinary social context. From the informants' perspective, the creation of a new context offered a possibility to give full attention, together with the psychotherapist, to oneself and to the problems one was grappling with. A salient feature was the informant's responsibility for agreements in the psychotherapy contract, especially in relation to the number of sessions and the creation of cooperation with the psychotherapist. Irrespective of therapy orientation the therapeutic techniques were described as inextricably linked to the cooperation with the psychotherapist. An implication for practice and research from these findings is to give more weight to the influence of cooperation in psychotherapy techniques, irrespective of therapy orientation. Another implication is an awareness that the client's knowledge of her/his difficulties, needs and desire for change, capacity to make an effort and to assume responsibility always have to be highlighted and have an impact on the psychotherapy contract and process.

[Introduction] Coerced admission to psychiatric hospitals, defined by legal status or patient's subjective experience, is common. Evidence on clinical outcomes however is limited. This study aimed to assess symptom change over a three month period following coerced admission and identify patient characteristics associated with outcomes. [Method] At study sites in 11 European countries consecutive legally involuntary patients and patients with a legally voluntary admission who however felt coerced, were recruited and assessed by independent researchers within the first week after admission. Symptoms were assessed on the Brief Psychiatric Rating Scale. Patients were re-assessed after one and three months. [Results] The total sample consisted of 2326 legally coerced patients and 764 patients with a legally voluntary admission who felt coerced. Symptom levels significantly improved over time. In a multivariable analysis, higher baseline symptoms, being unemployed, living alone, repeated hospitalisation, being legally a voluntary patient but feeling coerced, and being initially less satisfied with treatment were all associated with less symptom improvement after one month and, other than initial treatment satisfaction, also after three months. The diagnostic group was not linked with outcomes. [Discussion] On average patients show significant but limited symptom improvements after coerced hospital admission, possibly reflecting the severity of the underlying illnesses. Social factors, but not the psychiatric diagnosis, appear important predictors of outcomes. Legally voluntary patients who feel coerced may have a poorer prognosis than legally involuntary patients and deserve attention in research and clinical practice. ; he multi-site research project (Acronym: EUNOMIA) "European Evaluation of Coercion in Psychiatry and Harmonisation of Best Clinical Practise" was funded by the European Commission (Quality of Life and Management of Living Resources Programme, contract no. QLG4-CT-2002-01036).