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Search Results: 1 - 10 of 218 matches for " Torleif Ruud "
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Forskning om bruk av psykisk helsevern i Norge
Torleif Ruud m.fl.
Norsk Epidemiologi , 2009,
Abstract: -
Horizontal equity and mental health care: a study of priority ratings by clinicians and teams at outpatient clinics
Per Arne Holman, Torleif Ruud, Sverre Grepperud
BMC Health Services Research , 2012, DOI: 10.1186/1472-6963-12-162
Abstract: Twenty anonymous case vignettes based on representative referrals were classified by 42 admission team members at 16 CMHCs in the South-East Health Region of Norway. All clinicians were experienced, and were responsible for priority setting at their centres. The classifications were first performed independently by the 42 clinicians (i.e., individual rating), and then evaluated utilizing team consensus within each CMHC (i.e., team rating). Interrater reliability was estimated using intraclass correlation coefficients (ICCs) while the reliability of rating across raters and units (generalizability) were estimated using generalizability analysis.The ICCs (2.1 single measure, absolute agreement) varied between 0.40 and 0.51 using individual ratings and between 0.39 and 0.58 using team ratings. Our findings suggest a fair (low) degree of interrater reliability, and no improvement of team ratings was observed when compared to individual ratings. The generalizability analysis, for one rater within each unit, yields a generalizability coefficient of 0.50 and a dependability coefficient of 0.53 (D study). These findings confirm that the reliability of ratings across raters and across units is low. Finally, the degree of inconsistency, for an average measurement, appears to be higher within units than between units (G study).The low interrater reliability and generalizability found in our study suggests that horizontal equity to mental health services is not ensured with respect to priority. Priority -setting in teams provides no significant improvement compared to individual rating, and the additional use of these resources may be questionable. Improved guidelines, tutorials, training and calibration of clinicians may be utilized to improve the reliability of priority-setting.
Treatment and outcomes of crisis resolution teams: a prospective multicentre study
Nina Hasselberg, Rolf W Gr?we, Sonia Johnson, Torleif Ruud
BMC Psychiatry , 2011, DOI: 10.1186/1471-244x-11-183
Abstract: The study had a multicentre prospective design, examining routine data for 680 patients and 62 staff members of eight CRTs. The clinical staff collected data on the demographic, clinical, and content of treatment variables. The service practices of the staff were assessed on the Community Program Practice Scale. Information on each CRT was recorded by the team leaders. The outcomes of crises were measured by the changes in Global Assessment of Functioning scale scores and the total scores on the Health of the Nation Outcome Scales between admission and discharge. Regression analysis was used to predict favourable outcomes.The mean length of treatment was 19 days for the total sample (N = 680) and 29 days for the 455 patients with more than one consultation; 7.4% of the patients had had more than twice-weekly consultations with any member of the clinical staff of the CRTs. A doctor or psychologist participated in 55.5% of the treatment episodes. The CRTs collaborated with other mental health services in 71.5% of cases and with families/networks in 51.5% of cases. The overall outcomes of the crises were positive, with a small to medium effect size. Patients with depression received the longest treatments and showed most improvement of crisis. Patients with psychotic symptoms and substance abuse problems received the shortest treatments, showed least improvement, and were most often referred to other parts of the mental health services. Length of treatment, being male and single, and a team focus on out-of-office contact were predictors of favourable outcomes of crises in the adjusted model.Our study indicates that, compared with the UK, the Norwegian CRTs provided less intensive and less out-of-office care. The Norwegian CRTs worked more with depression and suicidal crises than with psychoses. To be an alternative to hospital admission, the Norwegian CRTs need to intensify their treatment and meet more patients outside the office.The crisis resolution team (CRT) model
A cross-sectional prospective study of seclusion, restraint and involuntary medication in acute psychiatric wards: patient, staff and ward characteristics
Tonje Husum, Johan Bj?rngaard, Arnstein Finset, Torleif Ruud
BMC Health Services Research , 2010, DOI: 10.1186/1472-6963-10-89
Abstract: Multilevel logistic regression using Stata was applied with data from 1016 involuntary admitted patients that were linked to data about wards. The sample comprised two hierarchical levels (patients and wards) and the dependent variables had two values (0 = no use and 1 = use). Coercive measures were defined as use of seclusion, restraint and involuntary depot medication during hospitalization.The total number of involuntary admitted patients was 1214 (35% of total sample). The percentage of patients who were exposed to coercive measures ranged from 0-88% across wards. Of the involuntary admitted patients, 424 (35%) had been secluded, 117 (10%) had been restrained and 113 (9%) had received involuntary depot medication at discharge. Data from 1016 patients could be linked in the multilevel analysis. There was a substantial between-ward variance in the use of coercive measures; however, this was influenced to some extent by compositional differences across wards, especially for the use of restraint.The substantial between-ward variance, even when adjusting for patients' individual psychopathology, indicates that ward factors influence the use of seclusion, restraint and involuntary medication and that some wards have the potential for quality improvement. Hence, interventions to reduce the use of seclusion, restraint and involuntary medication should take into account organizational and environmental factors.Use of coercion in treatment is controversial [1-5], and reducing use of coercion in psychiatric services is a priority health political issue in Western countries [6-8]. Too much use of coercion in mental health care may be a threat to the quality of care, as well as to patients' human rights. It is of crucial importance to develop a better understanding of the processes and factors involved to reduce the use of coercion. There is evidence of considerable variation in the extent to which coercive measures are used. This is shown in international comparative studie
An implementation study of the crisis resolution team model in Norway: Are the crisis resolution teams fulfilling their role?
Nina Hasselberg, Rolf W Gr?we, Sonia Johnson, Torleif Ruud
BMC Health Services Research , 2011, DOI: 10.1186/1472-6963-11-96
Abstract: The study was a naturalistic study of eight CRTs and 680 patients referred to these teams in Norway. Mental health problems were assessed using the Health of the Nation Outcome Scales (HoNOS), Global Assessment of Functioning Scales (GAF) and the International Statistical Classification of Diseases and Related Health Problems, 10th Revision (ICD-10).None of the CRTs operated 24 hours a day, seven days a week (24/7 availability) or had gate-keeping functions for acute wards. The CRTs also treated patients who were not considered for hospital admission. Forty per cent of patients waited more than 24 hours for treatment. Fourteen per cent had psychotic symptoms, and 69% had affective symptoms. There were significant variations between teams in patients' total severity of symptoms and social problems, but no variations between teams with respect to patients' aggressive behaviour, non-accidental self-injury, substance abuse or psychotic symptoms. There was a tendency for teams operating extended hours to treat patients with more severe mental illnesses.The CRT model has been implemented in Norway without a rapid response, gate-keeping function and 24/7 availability. These findings indicate that the CRTs do not completely fulfil their intended role in the mental health system.The key characteristics of CRT model are separate multidisciplinary mobile teams offering rapid short term emergency services in the community, as an alternative to inpatient admission [1]. CRTs are intended to operate 24 hours, 7 days per week with a gate keeping function to acute wards. The target group is patients with psychosis or other mental health problems so severe and acute that without the involvement of a CRT, acute admission would usually be necessary [1-5]. Establishing CRTs is a part of the national mental health policy in several countries. In the UK, CRTs have been rapidly implemented across the country with 343 teams in place in 2006/07 [6], and in Norway 35 of the 75 community menta
Substance abuse in patients admitted voluntarily and involuntarily to acute psychiatric wards: a national cross-sectional study
Anne Opsal,?istein Kristensen,Torleif Ruud,Tor K. Larsen
Norsk Epidemiologi , 2011,
Abstract: Background: Substance abuse and mental disorder comorbidity is high among patients admitted to acute psychiatric wards. The aim of the study was to identify this co-occurrence as a reason for involuntary admission and if specific substance use-related diagnoses were associated with such admissions. Methods: The study was a part of a multicentre, cross-sectional national study carried out during 2005-2006 within a research network of acute mental health services. Seventy-five percent of Norwegian hospitals providing acute in-patient treatment participated. Substance use was measured using the Clinician Rating Scale and the ICD-10 diagnoses F10-19. Diagnostic assessments were performed by the clinicians during hospital stay. Results: Overall, 33.2% (n=1,187) of the total patient population (3,506) were abusing alcohol or drugs prior to admission according to the Clinician Rating Scale. No difference in the overall prevalence of substance abuserelated diagnoses between the two groups was found. Overall, 310 (26%) of the admissions, 216 voluntarily and 94 involuntarily admitted patients received a double diagnosis. Frequent comorbid combinations among voluntarily admitted patients were; a combination of alcohol and either mood disorder (40%) or multiple mental disorders (29%). Among involuntarily admitted patients, a combination of poly drug use and schizophrenia was most frequent (47%). Substance abusing patients diagnosed with mental and behavioral disorders due to the use of psychoactive stimulant substances had a significantly higher risk of involuntary hospitalization (OR 2.3). Conclusion: Nearly one third of substance abusing patients are involuntarily admitted to mental hospitals, in particular stimulant drug use was associated with involuntarily admissions.
A cross-sectional study of patients with and without substance use disorders in Community Mental Health Centres
Linda E Wüsthoff, Helge Waal, Torleif Ruud, Rolf W Gr?we
BMC Psychiatry , 2011, DOI: 10.1186/1471-244x-11-93
Abstract: As part of the evaluation of the National Plan for Mental Health, all patients seen in eight CMHCs during a 4-week period in 2007 were studied (n = 2154). The CMHCs were located in rural and urban areas of Norway. The patients were diagnosed according to the ICD-10 diagnoses and assessed with the Health of the Nation Outcome Scales, the Alcohol Use Scale and the Drug Use Scale.Patients with SUD in CMHCs are more frequently male, single and living alone, have more severe morbidity, less anxiety and mood disorders, less outpatient treatment and less improvement in regard to recovery from psychological symptoms compared to patients with no SUD.CMHCs need to implement systematic screening and diagnostic procedures in order to detect the special needs of these patients and improve their treatment.Epidemiological studies have consistently established high comorbidity between psychiatric disorders and substance use disorders (SUD) [1-5]. By SUD we refer to abuse, dependence and addiction from both alcohol and other substances. This comorbidity is even more pronounced in clinical populations, particularly among homeless groups [6] and in acute psychiatric wards [7,8] where patients with schizophrenia are particularly frequent. The prevalence of SUD varies considerably between studies, i.e. 24-50% [7-9]. This is explainable by differences in substance use levels in the catchment areas and by intake policies. Another explanation could be insufficient diagnostic practice [10]. Several studies have found under-diagnosis of SUD in psychiatric hospitals [11,12]. There is also evidence that this group of patients do not receive health services according to their needs. Harris and Edlund found that mental health programs provided substance use services to only 31% of the clients evidencing severe mental illness with SUD [13].These investigations have laid a sound basis for the knowledge on comorbidity among inpatient populations. Little, however, is known about the prevalence of SU
Treatment of schizophrenia with antipsychotics in Norwegian emergency wards, a cross-sectional national study
Rune A Kroken, Erik Johnsen, Torleif Ruud, Tore Wentzel-Larsen, Hugo A J?rgensen
BMC Psychiatry , 2009, DOI: 10.1186/1471-244x-9-24
Abstract: Data from 486 discharges of patients from emergency inpatient treatment of schizophrenia were collected during a three-month period in 2005; the data were collected in a large national study that covered 75% of Norwegian hospitals receiving inpatients for acute treatment. Antipsychotic treatment, demographic variables, scores from the Global Assessment of Functioning and Health of the Nation Outcome Scales and information about comorbid conditions and prior treatment were analyzed to seek predictors for nonadherence to guidelines.In 7.6% of the discharges no antipsychotic treatment was given; of the remaining discharges, 35.6% were prescribed antipsychotic polypharmacy and 41.9% were prescribed at least one first-generation antipsychotic (FGA). The mean chlorpromazine equivalent dose was 450 (SD 347, range 25–2800). In the multivariate regression analyses, younger age, previous inpatient treatment in the previous 12 months before index hospitalization, and a comorbid diagnosis of personality disorder or mental retardation predicted antipsychotic polypharmacy, while previous inpatient treatment in the previous 12 months also predicted prescription of at least one FGA.Our national survey of antipsychotic treatment at discharge from emergency inpatient treatment revealed antipsychotic drug regimens that are to some degree at odds with current guidelines, with increased risk of side effects. Patients with high relapse rates, comorbid conditions, and previous inpatient treatment are especially prone to be prescribed antipsychotic drug regimens not supported by international guidelines.The clinical differences between antipsychotic drugs are mainly in the areas of safety and tolerability. International guidelines for the treatment of schizophrenia [1-4] offer rational strategies to minimize the burden of side effects related to antipsychotic treatment. These recommendations may be considered according to three dimensions: first-versus second-generation antipsychotics; ant
Differences between patients' and clinicians' report of sleep disturbance: a field study in mental health care in Norway
H?vard Kallestad, Bjarne Hansen, Knut Langsrud, Torleif Ruud, Gunnar Morken, Tore C Stiles, Rolf W Gr?we
BMC Psychiatry , 2011, DOI: 10.1186/1471-244x-11-186
Abstract: We used three cross-sectional, multicenter data-sets from 2002, 2005, and 2008. Data-set 1 included diagnostic codes from 93% of all patients receiving treatment in mental health care in Norway (N = 40261). Data-sets 2 (N = 1065) and 3 (N = 1181) included diagnostic codes, patient- and clinician-reported sleep disturbance, and use of prescribed hypnotic medication from patients in 8 mental health care centers covering 10% of the Norwegian population.34 patients in data-set 1 and none in data-sets 2 and 3 had a diagnosis of insomnia as a primary or comorbid diagnosis. In data-sets 2 and 3, 42% and 40% of the patients reported sleep disturbance, whereas 24% and 13% had clinician-reported sleep disturbance, and 7% and 9% used hypnotics. Patients and clinicians agreed in 29% and 15% of the cases where the patient or the clinician or both had reported sleep disturbance. Positive predictive value (PPV) of clinicians' evaluations of patient sleep disturbance was 62% and 53%. When the patient reported sleep disturbance as one of their most prominent problems PPV was 36% and 37%. Of the patients who received hypnotic medication, 23% and 29% had neither patient nor clinician-rated sleep disturbance.When patients meet the criteria for a mental disorder, insomnia is almost never diagnosed, and sleep disturbance is imprecisely recognized relative to the patients' experience of sleep disturbance.Sleep disturbance is likely to be a core feature across several mental disorders [1,2]. In patients with depression, sleep disturbance predicts poorer treatment outcome and is associated with more suicide attempts [3,4]. Moreover, 40%-70% of patients successfully treated for depression still experience sleep disturbance after treatment [3,5], and these patients may be at a higher risk of relapses into new episodes [6]. This challenges the assumption that the sleep disturbance will also be improved once the primary mental disorder is treated. It may be more adequate to assume that there is
Impact of sleep disturbance on patients in treatment for mental disorders
H?vard Kallestad, Bjarne Hansen, Knut Langsrud, Torleif Ruud, Gunnar Morken, Tore C Stiles, Rolf W Gr?we
BMC Psychiatry , 2012, DOI: 10.1186/1471-244x-12-179
Abstract: 2246 patients receiving treatment for mental disorders in eight public mental health care centers in Norway were evaluated in a cross-sectional study using patient and clinician reported measures. Patients reported quality of life, symptom severity, and benefit from treatment. Clinicians reported disorder severity, level of functioning, symptom severity and benefit from treatment. The hypothesis was tested using multiple hierarchical regression analyses.Sleep disturbance was, adjusted for age, gender, time in treatment, type of care, and the presence of any primary mental disorder, associated with lower quality of life, higher symptom severity, higher disorder severity, lower levels of functioning, and less benefit from treatment.Sleep disturbance ought to be considered a stand-alone therapeutic entity rather than an epiphenomenon of existing diagnoses for patients receiving treatment in mental health care.Sleep disturbance affects 50% to 80% of all patients with mental disorders and it is currently a symptom of 19 axis I disorders [1-3]. At the same time, it is considered to be a disorder in itself if the sleep disturbance impairs daily functioning [4,5]. With this diagnostic multitude, there is a possibility that clinicians regard the sleep disturbance as an epiphenomenon that will be dissolved once the primary mental disorder is treated and not as a valid stand-alone clinical entity [1]. This distinction can have consequences for choice of treatment for these patients [1] and sleep disturbance is poorly recognized when patients have a mental disorder [6,7].The relationship between sleep and mental disorders is complex and not fully understood. Sleep disturbance may precede depression [8-10], and 40% to 70% of patients who are successfully treated for depression experience sleep disturbance as a residual symptom [11-13]. On the other hand, the remission rate following anti-depressive treatment can be doubled if adjunct treatment for sleep disturbance is provided [
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