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Vårdmiljö eller lärandemiljö? : om personer med autism inom vuxenpsykiatrin

Mandre, Eve LU (2002)
Abstract (Swedish)
Popular Abstract in Swedish

Denna avhandling har den tillämpade psykiatrin som sitt forskningsfält och fokuserar på de problem som har samband med vård och behandling av vuxna patienter med autismspektrumstörning.



Avhandlingens syfte är att medverka till att personal inom vuxenpsykiatrin får ökade kunskaper om de svårigheter med kontakt, kommunikation och tänkande som hänger samman med en autismdiagnos. Genom att personalen får en utbildning om patienternas annorlunda psykologiska utveckling kan kunskapen användas för att skapa en individuellt inriktad behandling.



Teorier om barns tidiga sociala inlärning används för att förklara vuxna patienters svårigheter med kontakt, kommunikation... (More)
Popular Abstract in Swedish

Denna avhandling har den tillämpade psykiatrin som sitt forskningsfält och fokuserar på de problem som har samband med vård och behandling av vuxna patienter med autismspektrumstörning.



Avhandlingens syfte är att medverka till att personal inom vuxenpsykiatrin får ökade kunskaper om de svårigheter med kontakt, kommunikation och tänkande som hänger samman med en autismdiagnos. Genom att personalen får en utbildning om patienternas annorlunda psykologiska utveckling kan kunskapen användas för att skapa en individuellt inriktad behandling.



Teorier om barns tidiga sociala inlärning används för att förklara vuxna patienters svårigheter med kontakt, kommunikation och tänkande. Patienter med autism som behandlas inom psykiatrin möta ofta av många förgivet-taganden om vad en vuxen person bör veta och kunna om sociala sammanhang och hur man kommunicerar med sin omgivning och blir ofta missförstådda.



Genom en längre fallbeskrivning visar jag hur en långtidsvårdad rättspsykiatrisk patient blir mer begriplig för sin personal genom att man förstår att han inte haft förmågan att lära sig genom samspel med andra människor och därför varken kunnat tillägna sig accepterade kommunikationssätt eller tankemönster.



Metodiskt använder jag en narrativ kontextuell analys för att sätta in läsaren i de sammanhang där jag genomför en utbildning för psykiatripersonal. I utbildningen, som genomförs på åtta vuxenpsykiatriska avdelningar, använder jag mig av teorier om barns tidiga sociala lärande för att förklara de vuxna patienternas beteenden. Teorier om vuxnas lärande i arbetslivet ligger till grund för utformandet av utbildningarna. Sedan varvas teoretisk kunskap med egen praktisk erfarenhet och reflexion för att beskriva och analysera skeenden på de olika nivåer som leder till att en personalutbildning ger en grupp patienter nya behandlingsmöjligheter.



Den omorientering hos personalen som sker genom utbildningen har i de flesta fallen lett till stora förändringar för patienterna. Flera patienter har fått nya utredningar och diagnoser. Några av dem har kunnat skrivas ut från sluten psykiatrisk vård till kommunala boendeformer - en av dem efter 25 års rättspsykiatrisk vård. (Less)
Abstract
The research field of the thesis is clinical adult psychiatry and it focuses on the treatment of patients with autism spectrum disorders. Before the publication of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) in 1994 intellectually high-functioning patients with autism have not been included in diagnostic manuals and received appropriate treatment in adult psychiatry. In recent years it has become evident that these patients have long existed in psychiatric settings with other diagnoses than autism. This group of patients is poorly understood by their staff and the treatment they receive is seldom related to their specific difficulties.



The aim of the thesis is to contribute with theoretical and... (More)
The research field of the thesis is clinical adult psychiatry and it focuses on the treatment of patients with autism spectrum disorders. Before the publication of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) in 1994 intellectually high-functioning patients with autism have not been included in diagnostic manuals and received appropriate treatment in adult psychiatry. In recent years it has become evident that these patients have long existed in psychiatric settings with other diagnoses than autism. This group of patients is poorly understood by their staff and the treatment they receive is seldom related to their specific difficulties.



The aim of the thesis is to contribute with theoretical and practical knowledge explaining the specific difficulties patients with autism have with contact, communication and cognition. Persons with autism have since early infancy not been able to profit from social learning and social interaction, which results in a psychological development different from normal developmental rules. Individuals with autism do not automatically include the perspectives of others in their communication and cognition. In psychiatric treatment it is normally taken for granted that all patients follow the same psychological rules.



Methods used are qualitative. A contextual analysis is made of eight psychiatric clinics, the staff members´ ideas about treatment, their understanding of their patients and their reorientation related to the patients with autism. Observations and semi-structured interviews are used in order to receive background information about the psychiatric contexts in which the patients with autism are treated. Learning theories about social learning in early infancy are used to explain the different psychology of adults with autism. Learning theories about adult learning are used when designing an education on autism. Documentation received by the staff members, describing their learning process, is analysed and put in relation to the results their learning had for the patients.



The staff of eight psychiatric clinics has received an education on autism, specially designed for their educational needs. The specific difficulties patients with autism have are explained. When alternative explanations are given to those of the autistic patient´s behaviours, which are regarded as problematic or enigmatic by the staff members, a reorientation process begins in the understanding of the patient.



Eight patients with autism are presented as case studies, giving examples of how the reorientation process of the staff members gives new perspectives to the patients´ problems and results in new treatment approaches. The results for most of the patients were spectacular – all patients, who had earlier had diagnoses other than autism, were better understood from the autism perspective. The need for re-diagnosis became apparent. All patients were better understood and received more individualized treatment after the education. One long-term patient was discharged after 25 years in forensic psychiatry. (Less)
Please use this url to cite or link to this publication:
author
opponent
  • Professor Janson, Ulf, Stockholms University
organization
alternative title
From Medication to Education. Persons with Autism in Adult Psychiatry
publishing date
type
Thesis
publication status
published
subject
keywords
clinical psychology, autismspektrumstörningar, Autism, Asperger syndrom, design, pedagogik, psykiatri, psykiatrisk behandling, rehabiliteringsteknik, Psychiatry, rättspsykiatri, psychosomatics, Psykiatri, klinisk psykologi, psykosomatik
pages
185 pages
publisher
Certec, Lund University
defense location
LTH´s Kårhus, Aulan, John Ericssons väg 1, Lund
defense date
2002-05-24 10:00
ISBN
91-628-5219-1
language
Swedish
LU publication?
yes
id
d3ea670e-2b4b-4d87-b386-472d471d9c46 (old id 20740)
alternative location
http://www.certec.lth.se/dok/franvardmiljotill/
http://www.certec.lth.se/doc/frommedicationto/
date added to LUP
2007-05-28 11:17:29
date last changed
2016-09-19 08:45:05
@phdthesis{d3ea670e-2b4b-4d87-b386-472d471d9c46,
  abstract     = {The research field of the thesis is clinical adult psychiatry and it focuses on the treatment of patients with autism spectrum disorders. Before the publication of DSM-IV (Diagnostic and Statistical Manual of Mental Disorders) in 1994 intellectually high-functioning patients with autism have not been included in diagnostic manuals and received appropriate treatment in adult psychiatry. In recent years it has become evident that these patients have long existed in psychiatric settings with other diagnoses than autism. This group of patients is poorly understood by their staff and the treatment they receive is seldom related to their specific difficulties.<br/><br>
<br/><br>
The aim of the thesis is to contribute with theoretical and practical knowledge explaining the specific difficulties patients with autism have with contact, communication and cognition. Persons with autism have since early infancy not been able to profit from social learning and social interaction, which results in a psychological development different from normal developmental rules. Individuals with autism do not automatically include the perspectives of others in their communication and cognition. In psychiatric treatment it is normally taken for granted that all patients follow the same psychological rules.<br/><br>
<br/><br>
Methods used are qualitative. A contextual analysis is made of eight psychiatric clinics, the staff members´ ideas about treatment, their understanding of their patients and their reorientation related to the patients with autism. Observations and semi-structured interviews are used in order to receive background information about the psychiatric contexts in which the patients with autism are treated. Learning theories about social learning in early infancy are used to explain the different psychology of adults with autism. Learning theories about adult learning are used when designing an education on autism. Documentation received by the staff members, describing their learning process, is analysed and put in relation to the results their learning had for the patients.<br/><br>
<br/><br>
The staff of eight psychiatric clinics has received an education on autism, specially designed for their educational needs. The specific difficulties patients with autism have are explained. When alternative explanations are given to those of the autistic patient´s behaviours, which are regarded as problematic or enigmatic by the staff members, a reorientation process begins in the understanding of the patient.<br/><br>
<br/><br>
Eight patients with autism are presented as case studies, giving examples of how the reorientation process of the staff members gives new perspectives to the patients´ problems and results in new treatment approaches. The results for most of the patients were spectacular – all patients, who had earlier had diagnoses other than autism, were better understood from the autism perspective. The need for re-diagnosis became apparent. All patients were better understood and received more individualized treatment after the education. One long-term patient was discharged after 25 years in forensic psychiatry.},
  author       = {Mandre, Eve},
  isbn         = {91-628-5219-1},
  keyword      = {clinical psychology,autismspektrumstörningar,Autism,Asperger syndrom,design,pedagogik,psykiatri,psykiatrisk behandling,rehabiliteringsteknik,Psychiatry,rättspsykiatri,psychosomatics,Psykiatri,klinisk psykologi,psykosomatik},
  language     = {swe},
  pages        = {185},
  publisher    = {Certec, Lund University},
  school       = {Lund University},
  title        = {Vårdmiljö eller lärandemiljö? : om personer med autism inom vuxenpsykiatrin},
  year         = {2002},
}