Valentina Cabral Iversen

Acute admissions among immigrants and asylum seekers to a psychiatric hospital in Norway.

Abstract.Objective:The purpose of the present study was to compare admission rates, including admission by coercion, length of hospital stay and diagnosis among immigrants, asylum seekers and Norwegian-born patients.Material:All admissions (n=3053) to Østmarka Hospital during the period 1995–2000 were examined. A sample including all immigrants (94) and asylum seekers (39) as well as a control group of 133 Norwegians was analysed.Results:Immigrants and Norwegians had the same relative risk of admission (1.07). The relative risk of admission was higher for asylum seekers compared to Norwegians (8.84). There were differences in the diagnoses given at discharge in the three groups of patients, both among men (χ2=22.33, df=6, p<0.001) and women (χ2=15.31, df=6, p<0.001). Schizophrenia was frequent among female immigrants. The number of admissions by coercion was highest among immigrants, and lowest among asylum seekers (χ2=12.03, df=2, p<0.005).Conclusion:Compared to Norwegians and immigrants, asylum seekers had high admission rates and low frequency of admissions by coercion. Schizophrenia was frequent among female immigrants admitted to hospital.

Differences in acute psychiatric admissions between asylum seekers and refugees

The objective of the study was to examine differences between asylum seekers, living in asylum seekers’ centres, and refugees, who officially have been granted asylum, when they were acutely admitted to a psychiatric hospital. All 53 asylum seekers and 45 refugees, acutely admitted to a Norwegian psychiatric hospital from 1995 to 2001 were included. The number of admissions by coercion, diagnosis, length of hospital stay and years residing in Norway at the time of the admissions were compared between the two groups. Post-traumatic stress disorder (PTSD) was more frequent among asylum seekers (43.4%) than among refugees (11%), while schizophrenia was more frequent among refugees (62.2%) than among asylum seekers (15%). The refugees (24.4%) were more often admitted by coercion than asylum seekers (11%). The high proportion of PTSD among asylum seekers compared to refugees may be explained by experiences in Norway after arrival into the country. The stresses of life in reception centres and the risk of being expelled from the country may contribute more to these admittances than experiences in the asylum seekers countries of origin.

Acute unstable depressive syndrome (AUDS) is associated more frequently with epilepsy than major depression

BackgroundDepressive disorders are frequent in epilepsy and associated with reduced seizure control. Almost 50% of interictal depressive disorders have to be classified as atypical depressions according to DSM-4 criteria. Research has mainly focused on depressive symptoms in defined populations with epilepsy (e.g., patients admitted to tertiary epilepsy centers). We have chosen the opposite approach. We hypothesized that it is possible to define by clinical means a subgroup of psychiatric patients with higher than expected prevalence of epilepsy and seizures. We hypothesized further that these patients present with an Acute Unstable Depressive Syndrome (AUDS) that does not meet DSM-IV criteria of a Major Depressive Episode (MDE). In a previous publication we have documented that AUDS patients indeed have more often a history of epileptic seizures and abnormal EEG recordings than MDE patients (Vaaler et al. 2009). This study aimed to further classify the differences of depressive symptoms at admittance and follow-up of patients with AUDS and MDE.Methods16 AUDS patients and 16 age- and sex-matched MDE patients were assessed using the Symptomatic Organic Mental Disorder Assessment Scale (SOMAS), the Montgomery and Åsberg Depression Rating Scale (MADRS), and the Mini-Mental State Test (MMST), at day 2, day 4-6, day 14-16 and 3 months after admittance to a psychiatric emergency unit. Life events were assessed with The Social Readjustment Rating Scale (SRRS) and The Life Experience Survey (LES). We also screened for medication serum levels and illicit drug metabolites in urine.ResultsAUDS patients had significantly higher SOMAS scores (average score at admission 6.6 ± 0.8), reflecting increased symptom fluctuation and motor agitation, and decreased insight and concern compared to MDE patients (2.9 ± 0.7; p < 0.001). Degree of mood depression, cognition, life events, drug abuse and medication did not differ between the two groups.ConclusionsAUDS patients present with rapidly fluctuating mood symptoms, motor agitation and relative lack of insight and concern. Seizures, epilepsy and EEG abnormalities are overrepresented in AUDS patients compared to MDE patients. We suggest that the study of AUDS patients may offer a new approach to better understanding epilepsy and its association with depressive disorders.Trial registrationNCT00201474

Effects of a psychiatric intensive care unit in an acute psychiatric department

Psychiatric acute units use different levels of segregation to satisfy needs for containment and decrease in sensory input for behaviourally disturbed patients. Controlled studies evaluating the effects of the procedure are lacking. The aim of the present study was to compare effects in acutely admitted patients with the use of a psychiatric intensive care unit (PICU) and not in a psychiatric acute department. In a naturalistic study, one group of consecutively referred patients had access only to the PICU, the other group to the whole acute unit. Data were obtained for 56 and 62 patients using several scales. There were significant differences in reduction of behaviour associated with imminent, threatening incidents (Broset Violence Checklist), and actual number of such incidents (Staff Observation Aggression Scale-Revised) in favour of the group that was treated in a PICU. The principles of patient segregation in PICUs have favourable effects on behaviours associated with and the actual numbers of violent and threatening incidents.

Calibrating and adjusting expectations in life: A grounded theory on how elderly persons with somatic health problems maintain control and balance in life and optimize well-being

Aim: This study aims at exploring the main concern for elderly individuals with somatic health problems and what they do to manage this. Method: In total, 14 individuals (mean = 74.2 years; range = 68–86 years) of both gender including hospitalized and outpatient persons participated in the study. Open interviews were conducted and analyzed according to grounded theory, an inductive theory-generating method. Results: The main concern for the elderly individuals with somatic health problems was identified as their striving to maintain control and balance in life. The analysis ended up in a substantive theory explaining how elderly individuals with somatic disease were calibrating and adjusting their expectations in life in order to adapt to their reduced energy level, health problems, and aging. By adjusting the expectations to their actual abilities, the elderly can maintain a sense of that they still have the control over their lives and create stability. The ongoing adjustment process is facilitated by different strategies and result despite lower expectations in subjective well-being. The facilitating strategies are utilizing the network of important others, enjoying cultural heritage, being occupied with interests, having a mission to fulfill, improving the situation by limiting boundaries and, finally, creating meaning in everyday life. Conclusion: The main concern of the elderly with somatic health problems was to maintain control and balance in life. The emerging theory explains how elderly people with somatic health problems calibrate their expectations of life in order to adjust to reduced energy, health problems, and aging. This process is facilitated by different strategies and result despite lower expectation in subjective well-being.

Therapeutic alliance in early schizophrenia spectrum disorders: a cross-sectional study

BackgroundThe therapeutic alliance is related to better course and outcome of treatment in schizophrenia. This study explores predictors and characteristics of the therapeutic alliance in recent-onset schizophrenia spectrum disorders including the agreement between patient and therapist alliance ratings.MethodsForty-two patients were assessed with demographic, neurocognitive, and clinical measures including the Positive and Negative Syndrome Scale (PANSS). The therapeutic alliance was measured with the Working Alliance Inventory - Short Form (WAI-S).ResultsPatient WAI-S total scores were predicted by age and PANSS excitative symptoms. Therapist WAI-S total scores were predicted by PANSS insight. Patient and therapist WAI-S total scores were moderately associated. Neurocognition was not associated with working alliance.ConclusionWorking alliance is associated with specific demographic and symptom characteristics in patients with recent-onset schizophrenia spectrum disorders. There is moderate agreement between patients and therapists on the total quality of their working alliance. Findings highlight aspects that may increase therapists’ specificity in the use of alliance-enhancing strategies.

Clinical differences between immigrants voluntarily and involuntarily admitted to acute psychiatric units: a 3‐year prospective study

Involuntary psychiatric admissions are widespread among patients with an immigrant background. According to a study in Norway, involuntary admissions are about 75% of admissions among immigrants compared to roughly 50% among ethnic Norwegians. The aim of the present study was to compare clinical and demographic characteristics of immigrant patients with involuntary or voluntary admissions to two acute psychiatric units. A 3-year prospective study of 94 immigrant patients involuntarily and voluntarily admitted to acute psychiatric units was carried out. Sixty-two patients (66.0%) were voluntarily and 30 (31.9%) involuntarily admitted. Involuntary admissions were significantly higher among men (22, 73.3%) compared to women (8, 26.7%; χ(2) = 4.507, d.f. = 1, P= 0.03). The mean length of stay for voluntary and involuntary patients were 7.8 (SD = 6.6) and 21.6 (SD = 27.3; t=-2.7, d.f. = 88, P= 0.01). Patients diagnosed with schizophrenia and psychotic disorder were more often admitted involuntarily (63.0%; χ(2) = 17.83, P= 0.001). This study confirms that immigrant patients diagnosed with psychotic disorders are more often involuntarily than voluntarily admitted. Comparing the clinical and demographic characteristics of immigrants helps identify the reasons behind involuntary admissions and might improve efforts towards reducing such admissions in the future.

Peak-experiences among norwegian youth

This study marks the first empirical investigation of youthful peak-experiences among Nordic persons. The sample comprised 309 native Norwegian college students who generated 318 retrospective reports (occurring below the age of 14). Early peaks involving interpersonal joy--especially the 3 sub-categories of family togetherness, the birth of a baby sibling or cousin, and romantic bliss--were most frequently reported. In frequency, these were followed by peaks involving nature and developmental landmarks. The relevance of these findings for fostering Nordic youth development from a positive, strength-based perspective is discussed. Avenues for future research are highlighted.

Patients' perceptions of their stay in a psychiatric seclusion area

Background : The psychological, social, and physical aspects of the ward milieu affect treatment outcomes and patient satisfaction. The primary aim of the present study was to describe and explore patients’ perceptions of their stay at a Norwegian seclusion area. The patients’ experience of having received help and support from the staff, sense of respectful treatment, information received regarding effects and side effects from medication, and feelings of security in the seclusion areas were of interest. Method : In a given period, all patients acutely admitted to a seclusion area were evaluated on a number of rating scales. Immediately after discharge they were invited to evaluate their treatment satisfaction on an eight-item VAS-scale. Results : The main finding is that the patients generally experienced the stay as positive. The three single items of support from the staff, a sense of respectful treatment, and feelings of security were assessed as positive, while the patients’ experience of having received help and information regarding medication was evaluated as neither positive nor negative. Conclusion : In general, patients experienced their stay as positive. The patients that were admitted voluntarily reported significantly better experiences with regard to the help received, support from the staff, and respectful treatment.

Differences and similarities between mothers and fathers of premature children: a qualitative study of parents’ coping experiences in a neonatal intensive care unit

BackgroundThe aim of this study was to explore and describe the coping experiences of parents to children admitted to a neonatal unit.MethodsA qualitative research approach was chosen, using in-depth interviews with eight fathers and eight mothers.ResultsThe main findings were that parents with previous complicated births had more difficulties in coping compared to those parents with no experience with complications. Coping seemed easier where parents’ opinions were heard regarding their baby’s care and when both parents were present in the neonatal intensive care unit (NICU). The main similarities between mothers and fathers were the reluctance to speak their opinions on childcare, and both experienced a sense of alienation and problems in bonding with the baby. They also needed a limitation on the number of visitors in the NICU. Differences between mothers and fathers were that fathers tried hard to be the strong partner in the relationship, and were more concerned with the mother if she was seriously ill postpartum, while mothers were more concerned for their baby. Mothers’ postpartum period was felt as more stressful if the father was not present, but mothers were also better at welcoming support from the health personnel.ConclusionThis study highlights the parent’s coping experiences in NICUs. Coping seemed easier where parents’ opinions were heard. Nurses in the NICU should take the former experiences of the parents into consideration when nursing in the NICU and planning for discharge.