Perceived Self-image, Intellectual Ability, Frontal Lobe Function, and Perceived Ward Atmosphere among Patients with Psychosis

Sammanfattning: These studies were conducted at the Psychiatric Rehabilitation Unit (PRU), characterised by a supportive ego-strenghtening psychodynamic approach. The general aim of the thesis was to study how intellectual ability and perceived self-image were related to perceived ward atmosphere among patients with psychosis. The first study described how patients and staff perceived the ward atmosphere at five different times over a two-year period. The main conclusions were that the ward atmosphere was stable over time and that there were few differences between patients and staff, for example, in perceived staff control and anger and aggression. Patients with a schizophrenia diagnosis perceived a lower level of support and autonomy than patients with other psychosis diagnoses. No differences in perceived ward atmosphere with respect to gender were detected. The ward atmosphere complied with the recommendation for patients with psychosis. The second study illuminated that perceived self-control, paranoid symptoms, social competence, and abstract thinking were related to how the ward atmosphere was perceived by the patients. Self-control, a cluster in the SASB model, was related to how patients perceived support, practical orientation, and order and organisation in the ward atmosphere. Social competence assessed by picture arrangement, a subtest in WAIS-R, was related to perceived order and organisation in the ward atmosphere. The main finding in the third study was that two of the clusters in the SASB model, spontaneity and self-control, were related to frontal lobe function. Patients who perceived a low level of spontaneity and self-control had significantly lower frontal lobe blood flow values than healthy controls and vice versa. From the findings it is obvious that patients with a psychosis diagnosis are not a homogenous group, not only with respect to diagnoses, but differ between themselves on brain functioning, intellectual ability, self-image, social functioning, and in the way in which they perceive the ward atmosphere. The clinical application of the results is discussed with respect to the individualisation of treatment strategies.