Kent-Inge Perseius

Treatment of suicidal and deliberate self-harming patients with borderline personality disorder using dialectical behavioral therapy : the patients' and the therapists' perceptions.

The aim was to investigate patients and therapists perception of receiving and giving dialectical behavioral therapy (DBT). Ten deliberate self-harm patients with borderline personality disorder and four DBT-therapists were interviewed. The interviews were analyzed with qualitative content analysis. The patients unanimously regard the DBT-therapy as life saving and something that has given them a bearable life situation. The patients and the therapists are concordant on the effective components of the therapy: the understanding, respect, and confirmation in combination with the cognitive and behavioral skills. The experienced effectiveness of DBT is contrasted by the patients pronouncedly negative experiences from psychiatric care before entering DBT.

Dialectical behaviour therapy for borderline personality disorder among adolescents and young adults : Pilot study, extending the research findings in new settings and cultures

The aim of this paper was to investigate the feasibility and impact of dialectical behaviour therapy (DBT) for patients with borderline personality disorder (BPD) in a clinical outpatient setting. Eighteen clinicians were trained and supervised in using DBT. Twenty-seven female patients were assessed on a number of variables before the treatment, as well as 5 and 12 months after the start of the DBT. Despite some barriers, DBT could be implemented successfully, and the professionals reported increased competence 1 year after the start of the therapy. Low treatment dropout rates suggested that DBT was well accepted by the patients. One year after the start of treatment, the patients reported significant decrease on most variables measuring psychological distress and number of parasuicidal behaviours. The study provides preliminary support for the feasibility and impact of DBT in the outpatient treatment of BPD in a cultural setting outside the United States.

Evaluating a breakthrough series collaborative in a Swedish health care context.

This study evaluated the use of the Breakthrough Series Collaborative methodology in a Swedish county council improvement program, comparing measurements at the beginning and after 6 months. A questionnaire was used, and improvement processes and outcomes were analyzed. The results showed an overall large engagement in improvements, although the methodology and facilitators were seen as only moderately supportive.

Five Types of Practice-Based Improvement Ideas in Health Care Services : An Empirically Defined Typology

The aim of this study is to empirically identify and present different kinds of practice-based improvement ideas developed in health care services. The focus is on individual placement needs, problems/issues, and the ability to organize work on the development, implementation, and institutionalization of ideas for the health care sector. This study is based on a Swedish county council improvement program. Health care departments and primary health care centers in the Kalmar County Council were invited to apply for money to accomplish improvement projects. A qualitative content analysis was done of 183 proposed applications from various health care departments and primary health care centers. The following 5 types of improvement projects were identified: organizational process, evidence and quality, competence development, process technology, and proactive patient work. This illustrates the range of strategies that encourage letting individual units define their own improvement needs. These projects point to the various problems and experiences health care professionals encounter in their day-to-day work. To generalize beyond this improvement program and to validate the typology, we applied it to all articles found when searching for quality improvement projects in the journal Quality Management in Health Care during the last 2 years and found that all of them could be fitted into at least 1 of those 5 categories. This article provides valuable insights into the current state of improvement work in Swedish health care, and will serve as a foundation for further investigations in this quality improvement program.

Does Dialectical Behavioural Therapy Reduce Treatment Costs for Patients with Borderline Personality Disorder. A Pilot Study

Objective: In order to assess costs — consequences of dialectal behavioural therapy (DBT) in suicidal women with borderline personality disorder (BPD), the present study takes advantage of pilot data collected during a training phase, in relation to a large scale randomised controlled trail (RCT). Method: Under a 18 month period, 22 suicidal women with BPD were treated with outpatient DBT, with focus on reducing parasuicidal behaviour. Outcome data collected retrospectively 12 months before therapy start, were compared to prospective data collected up to 18 months in thrapy. The cost — analysis included direct health care costs only. Results & Conclusions: The results suggest that DBT may have a positive impact on treatment costs, which decreased significantly during the last 12 months in a 18 month therapy period. The reduction of costs is due to decrease in the number of psychiatric inpatient days. The conclusions that can be drawn from the results are, however, limited as the study was not made in RCT conditions and indirect costs to society were not assessed.

Perfectionism and sense of coherence among patients with eating disorders

Abstract Background: There is a substantial body of research on eating disorders and perfectionism. Also there are several studies on eating disorders and sense of coherence (SOC), but studies regarding all three subjects are sparse. Perfectionism and the degree of SOC are considered central and aggravating aspects of psychiatric conditions, not least in relation to eating disorders. Aims: The present study aimed to describe the relationship between perfectionism as operationalized by Garner in the Eating Disorder Inventory-2 and SOC as defined by Antonovsky in the SOC-29 scale. The hypothesis was that SOC should be negatively associated with perfectionism. Methods: Data from the two self-measuring instruments collected from 95 consecutively recruited eating disorder outpatients were analysed with descriptive and inferential statistics. Results: The patients in the present study scored consistently with other Swedish eating disorder samples on the Perfectionism subscale in the Eating Disorder Inventory-2 (EDI-P) and on the SOC-29, indicating a higher degree of perfectionism and weaker SOC than normal population groups. Perfectionism was significantly correlated to SOC. The correlation was negative, confirming the study hypothesis. The hypothesis was further confirmed in a subgroup analysis comparing patients with different degrees of SOC related to their EDI-P scores. Conclusions: Perfectionism is associated with SOC in patients with eating disorders. Clinical implications: The clinical implications derived from the study could be a recommendation to focus on the SOC in patients with an eating disorder with the hope of lowering the patients’ perfectionism as well.

Evaluating a questionnaire to measure improvement initiatives in Swedish healthcare

BackgroundQuality improvement initiatives have expanded recently within the healthcare sector. Studies have shown that less than 40% of these initiatives are successful, indicating the need for an instrument that can measure the progress and results of quality improvement initiatives and answer questions about how quality initiatives are conducted. The aim of the present study was to develop and test an instrument to measure improvement process and outcome in Swedish healthcare.MethodsA questionnaire, founded on the Minnesota Innovation Survey (MIS), was developed in several steps. Items were merged and answer alternatives were revised. Employees participating in a county council improvement program received the web-based questionnaire. Data was analysed by descriptive statistics and correlation analysis. The questionnaire psychometric properties were investigated and an exploratory factor analysis was conducted.ResultsThe Swedish Improvement Measurement Questionnaire consists of 27 items. The Improvement Effectiveness Outcome dimension consists of three items and has a Cronbach’s alpha coefficient of 0.67. The Internal Improvement Processes dimension consists of eight sub-dimensions with a total of 24 items. Cronbach’s alpha coefficient for the complete dimension was 0.72. Three significant item correlations were found. A large involvement in the improvement initiative was shown and the majority of the respondents were satisfied with their work.ConclusionsThe psychometric property tests suggest initial support for the questionnaire to study and evaluate quality improvement initiatives in Swedish healthcare settings. The overall satisfaction with the quality improvement initiative correlates positively to the awareness of individual responsibilities.

Problem-Based Self-care Groups Versus Cognitive Behavioural Therapy for Persons on Sick Leave Due to Common Mental Disorders : A Randomised Controlled Study

Purpose To evaluate the interventional capacity of problem based method groups (PBM) regarding mental health and work ability compared to cognitive behavioural therapy (CBT) for persons on sick leave due to common mental disorders. Methods In a randomised controlled design the experimental group received PBM and the control group received CBT. Outcomes were measured by the Hospital Anxiety and Depression Scale (HADS), the Stress and Crisis Inventory 93 (SCI-93) and the Dialogue about Working Ability instrument (DOA). Results Twenty-two participants in the PBM group and 28 in the CBT group completed intervention. Both groups showed significant lower scores on the two HADS subscales. Regarding stress the PBM group showed significant decrease in one (out of three) subscales of SCI-93. The CBT group showed significant decrease on all subscales of SCI-93. Regarding work ability the PBM group showed significant higher scores on one of five subscales of DOA. The CBT group showed significant higher scores on four of five subscales of DOA. Between groups there were significant differences to the favour of CBT on one of two subscales of HADS, all three subscales of SCI-93 and on two of the five subscales of DOA. Conclusion PBM seem to be able to reduce anxiety- and depression symptoms. CBT showed to be superior to PBM in reducing symptoms in all aspects of mental health, except for anxiety, in which they seem equally effective. Regarding work ability CBT showed to be superior, with significant effect on more aspects compared to PBM.

A Sisyphean task: Experiences of perfectionism in patients with eating disorders

BackgroundDespite the theoretical links between eating disorders and perfectionism, the definition of perfectionism in practice is complicated. The present study explored descriptions and experiences of perfectionism described by a transdiagnostic sample of patients.MethodsIn-depth, semi-structured interviews were carried out with 15 patients. The interviews were analyzed by Thematic Analysis. A comparison between the patients’ scorings on the Eating Disorder Inventory-Perfectionism scale was also performed.ResultsSeven themes were found: The origins of perfectionism, Top performance, Order and self-control, A perfect body, Looking good in the eyes of others, A double-edged coping strategy, and A Sisyphean task. The women in this study did not emphasize weight and body as the main perfectionistic strivings. Core descriptions were instead order, self-control and top performances. All of the participants described the awareness of reaching perfectionism as impossible. Scorings of self-oriented perfectionism was significantly higher compared to socially prescribed perfectionism. No differences in the narratives related to perfectionism scores or eating disorder diagnoses were found.ConclusionsThe results showed that psychometric measures do not always capture the patients’ definitions of perfectionism, but regarding that perfectionism serves as a means to regulate affects and may lead into an exacerbation of the eating disorder, and the development of obsessive-compulsive symptoms, it is important to investigate the personal definitions of perfectionism.

Two Different Strategies to Facilitate Involvement in Healthcare Improvements : A Swedish County Council Initiative

Background: From a management point of view, there are many different approaches from which to choose to engage staff members in initiatives to improve performance. Objective: The present study evaluated how two different types of improvement strategies facilitate and encourage involvement of different professional groups in healthcare organizations. Methods/Design: Empirical data of two different types of strategies were collected within an improvement project in a County Council in Sweden. The data analysis was carried out through classifying the participants’ profession, position, gender, and the organizational administration of which they were a part, in relation to their participation. Setting: An improvement project in a County Council in Sweden. Participants: Designed Improvement Processes consisted of n=105 teams and Intrapreneurship Projects of n=202 projects. Intervention: Two different types of improvement strategies Designed Improvement Processes and Intrapreneurship Projects. Main Outcome Measures: How two different types of improvement strategies facilitate and encourage involvement of different professional groups in healthcare organizations. Results: Nurses were the largest group participating in both improvement initiatives. Physicians were also well represented, although they seemed to prefer the less structured Intrapreneurship Projects approach. Assistant nurses, being the second largest staff group, were poorly represented in both initiatives. This indicates that the benefits and support for one group may push another group aside. Conclusions: Managers need to give prerequisites and incentives for staff who do not participate in improvements to do so. Comparisons of different types of improvement initiatives are an underused research strategy that yields interesting and thoughtful results.