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Langjord T, Pedersen G, Bovim T, Bremer K, Christensen TB, Hove O, Kildahl AN, Mork E, Norheim AB, Ramleth RK, Romm KL, Siqveland J, Schønning T, Stänicke LI, Torgersen T, Pettersen MS, Tveit T, Urnes Ø, Walby FA, Kvarstein EH. Evaluation of health services and treatment alliance among extensively hospitalized patients due to severe self-harm - results from the Extreme Challenges project. Nord J Psychiatry 2024; 78:591-602. [PMID: 39126325 DOI: 10.1080/08039488.2024.2376162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 04/23/2024] [Accepted: 06/30/2024] [Indexed: 08/12/2024]
Abstract
BACKGROUND Extensive psychiatric hospitalization due to repeated severe self-harm (SH), is a poorly researched area, but a challenge within health services (HS). Recent studies have demonstrated high levels of involuntary treatment among patients with severe personality disorder (PD) and complex comorbidity. Keeping focus on extensively hospitalized SH patients, this study aimed to investigate patients' and clinicians' evaluation of HS and treatment alliance. METHOD A cross-sectional study with an inpatient sample (age >18 years) with frequent (>5) or long (>4 weeks) psychiatric hospital admissions last year due to SH or SA recruited from 12 hospitals across health regions (N = 42). Evaluation included patient and clinician report. RESULTS A minority of the patients (14%) were satisfied with HS before the current admission, 45% (patients) and 20% (clinicians) found the current admission helpful, and 46% (patients) and 14% (clinicians) worried about discharge. Treatment complaints were received in 38% of the cases. Outpatient mental HS were available after discharge for 68% and a majority of clinicians indicated satisfactory contact across HS. More intensive or specialized formats were unusual (structured outpatient treatment 35%, day treatment 21%, ambulatory services 32%, planned inpatient services 31%). Mutual problem understanding, aims, and confidence in therapists during the hospital stay were limited (patient-rated satisfactory mutual problem understanding: 39%, aims of stay: 50%, confidence: 50%). Patient and therapist alliance-ratings were in concordance for the majority. CONCLUSION The study highlights poor HS satisfaction, poor patient-therapist coherence, limited treatment alliance and limited follow-up in structured treatments addressing SH or intermediary supportive ambulatory/day/inpatient services.
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Affiliation(s)
- Tuva Langjord
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
| | - Geir Pedersen
- Network for Personality Disorders, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Basic Medical Sciences, University of Oslo, Oslo, Norway
| | - Tone Bovim
- Regional Centre - Violence, Trauma and Suicide Prevention, Oslo, Norway
- Department of Acute Medicine, Division of Medicine, Oslo University Hospital, Oslo, Norway
| | - Kjetil Bremer
- Department for National and Regional Functions, National Advisory Unit Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Oddbjørn Hove
- Department of Research and Innovation, Helse Fonna Health Trust, Haugesund, Norway
| | - Arvid Nikolai Kildahl
- National Advisory Unit Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Nevsom Norwegian Centre of Expertise for Neurodevelopmental Disorders and Hypersomnias, Oslo University Hospital, Oslo, Norway
| | - Erlend Mork
- Early Intervention in Psychosis Advisory Unit for Southeast Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | | | - Ruth-Kari Ramleth
- Department for Child and Adolescent Psychiatry, Oslo University Hospital, Oslo, Norway
| | - Kristin Lie Romm
- Early Intervention in Psychosis Advisory Unit for Southeast Norway, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Johan Siqveland
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
- Department for Research, Division of Mental Health and Addiction, Akershus University Hospital, Oslo, Norway
| | | | - Line Indrevoll Stänicke
- Faculty of Social Sciences, Department of Psychology, University of Oslo, Oslo, Norway
- Child and Adolescent Psychiatry, Nic Waal Institute, Lovisenberg Hospital, Oslo, Norway
| | - Terje Torgersen
- Department of Mental Health Care, St. Olavs Hospital, Trondheim, Norway
- Department of Mental Health, Faculty of Medicine and Health Sciences, Norwegian University of Science and Technology, Trondheim, Norway
| | - Mona S Pettersen
- Department of Health and Care Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Tone Tveit
- Division of Mental Health and Addiction, Bergen University Hospital, Bergen, Norway
| | - Øyvind Urnes
- Department for National and Regional Functions, National Advisory Unit Personality Psychiatry, Section for Personality Psychiatry and Specialized Treatments, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
| | - Fredrik A Walby
- National Centre for Suicide Research and Prevention, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Elfrida Hartveit Kvarstein
- Section for Personality Psychiatry and Specialized Treatments, Department for National and Regional Functions, Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Aujoulat C, Vancappel A, Tapia G. [Effectiveness of psychotherapy on dissociative symptoms in adult populations: A PRISMA systematic review]. L'ENCEPHALE 2024:S0013-7006(24)00044-7. [PMID: 38523025 DOI: 10.1016/j.encep.2024.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Revised: 12/19/2023] [Accepted: 01/12/2024] [Indexed: 03/26/2024]
Abstract
INTRODUCTION Dissociation is a psychological process in reaction to threat which can be found in many psychiatric conditions. Dissociative symptoms can become very disabling, whether in daily life or in care. Nevertheless, few studies seem to have examined the efficacy of psychotherapy on the latter and its relevance as a therapeutic target. METHOD A systematic review of the literature (PRISMA) on the efficacy of psychotherapy on dissociative symptoms in adults with mental disorders was conducted. Effectiveness was considered in terms of reduction in dissociative symptomatology. The search was conducted on Scopus, PubMed and PsycInfo. Overall, 50 full-text articles were evaluated. RESULTS Fourteen studies were included in the review. In all, 711 adult subjects with post-traumatic stress disorder, borderline personality disorder or dissociative disorder were included. Overall, this systematic review reports a reduction in dissociative symptoms associated with a variety of psychotherapeutic interventions, without allowing any conclusions to be drawn on the superiority of one psychotherapy over another. DISCUSSION The conclusions of this work highlight three possible therapeutic orientations for reducing dissociative symptoms: (i) by reintegrating the dynamic subsystems, (ii) by treating the cognitive processes underlying dissociation, and (iii) by acting on the processes identified as common to the effectiveness of psychotherapy.
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Affiliation(s)
| | - Alexis Vancappel
- Laboratoire QualiPsy, EE 1901, université de Tours, Tours, France; Pôle Psychiatrie-addictologie, clinique psychiatrique universitaire - centre régional de psychotraumatologie-CVL, CHRU de Tours, Tours, France
| | - Géraldine Tapia
- Université de Bordeaux, Bordeaux, France; Université de Bordeaux, LabPsy, UR 4139, 33000 Bordeaux, France.
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Heggdal D, Borgejordet S, Fosse R. "Existential Catastrophe Anxiety": Phenomenology of Fearful Emotions in a Subset of Service Users With Severe Mental Health Conditions. Front Psychol 2022; 13:766149. [PMID: 35360621 PMCID: PMC8960201 DOI: 10.3389/fpsyg.2022.766149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 02/21/2022] [Indexed: 12/03/2022] Open
Abstract
A subset of people with severe mental health conditions feels they are on the verge of losing control, even in the absence of external threats or triggers. Some go to extreme ends to avoid affective arousal and associated expectations of a possible, impending catastrophe. We have learned about such phenomenological, emotional challenges in a group of individuals with severe, composite mental health problems and psychosocial disabilities. These individuals have had long treatment histories in the mental health care system. They have been encountered at a specialized inpatient ward offering exposure-based therapy that aims at restoring self-regulation and recovery. We describe the phenomenology of anxiety and fear presented by these service users, a fear we have coined existential catastrophe anxiety (ECa). We also suggest a set of underlying, interacting, psychological mechanisms that may give rise to ECa, before comparing ECa with three other constructs previously described in the literature—annihilation anxiety, ontological insecurity, and affect phobia. These comparisons show several similarities, but also unique qualities with ECa and its suggested underlying mechanisms. The conceptualization of ECa may aid clinicians in addressing extreme experiential turmoil and engage service users in empowering therapeutic projects.
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Affiliation(s)
- Didrik Heggdal
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Synne Borgejordet
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
| | - Roar Fosse
- Division of Mental Health and Addiction, Vestre Viken Hospital Trust, Drammen, Norway
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Holth F, Walby F, Røstbakken T, Lunde I, Ringen PA, Ramleth RK, Romm KL, Tveit T, Torgersen T, Urnes Ø, Kvarstein EH. Extreme challenges: psychiatric inpatients with severe self-harming behavior in Norway: a national screening investigation. Nord J Psychiatry 2018; 72:605-612. [PMID: 30348040 DOI: 10.1080/08039488.2018.1511751] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
BACKGROUND Extreme self-harming behavior is a major challenge for patients and health services. Nevertheless, this patient population is poorly described in research literature. AIMS The aim of this study was to assess the volume of patients with extensive psychiatric hospitalization due to extreme self-harming behaviors, the extent of severe medical sequelae, and collaboration problems within health services. METHODS In a national screening investigation, department managers in 83 adult psychiatric inpatient institutions across all health regions in Norway were invited to participate in a brief, prepared, telephone interview. RESULTS Sixty-one interviews were completed. Extensive hospitalization (prolonged or multiple) due to extreme self-harm was reported for the last year in all health regions and in 427 individual cases. Mean number of cases did not differ by region. Psychiatric hospitalizations were more frequent in hospital units than mental health centers. In 109 of the cases, self-harming behavior had severe medical consequences, including five deaths. In 122 of the cases, substantial collaboration problems within the health services were reported (disagreements on diagnosis, treatment needs and resources). Extensive (long-term) hospitalization was particularly associated with the combination of severe medical sequelae and collaboration problems. CONCLUSION This investigation confirms a noteworthy, nationwide, population of severely self-harming inpatients with extensive health service use, prevalent severe medical complications, and unsatisfactory collaboration within health services. These preliminary results are alarming, and indicate a need for more profound understanding of highly complex and severe cases.
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Affiliation(s)
- Fredrik Holth
- a Section for Personality Psychiatry , Oslo University Hospital , Oslo , Norway
| | - Fredrik Walby
- b Institute for Clinical Medicine, University of Oslo , Oslo , Norway
| | - Thea Røstbakken
- b Institute for Clinical Medicine, University of Oslo , Oslo , Norway
| | - Ingeborg Lunde
- c Trauma and Suicide Prevention , Regional Centre on Violence , East, Oslo , Norway
| | | | | | | | - Tone Tveit
- e Haukeland University Hospital , Oslo , Norway
| | | | - Øyvind Urnes
- a Section for Personality Psychiatry , Oslo University Hospital , Oslo , Norway
| | - Elfrida Hartveit Kvarstein
- a Section for Personality Psychiatry , Oslo University Hospital , Oslo , Norway.,g Institute for Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo , Norway
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