Dissertations / Theses on the topic 'Dissertations – Psychiatry'

Obesity remains a public health concern among persons with mental illness resulting from the interaction of a combination of factors such as genetic, medication, effects of their symptoms, social, and environmental factors. Obesity complications account for increased mortality and morbidity, reduced life expectancy, and quality of life in persons with mental illness. The management of obesity is challenging and predicting the ability of mental health professionals to advise patients on weight management behavior is important to improve patients' overall well-being. The social cognitive theory constructs knowledge, expectations, situational perception, self-efficacy, and goal setting were utilized in predicting Weight Management Advice Behavior (WMAB) among psychiatry professionals. WMAB described the ability of professionals to effectively offer advice on managing weight. A cross-sectional study design was used, in which data were collected using a validated instrument. A sample size of 134 was used and the collected data were analyzed using simple and multiple linear regression, logistic regression and MANOVA. Self-efficacy, goal setting, knowledge, and situational perception were found to have a significant association with WMAB individually. Only self-efficacy (p < .001), goal setting (p < .001), knowledge (p < .001), and situational perception (p < .05) were independent predictors of WMAB among psychiatry healthcare professionals. There were significant differences among the professional groups with regards to knowledge, self-efficacy, goal setting, situational perception, and expectations. The study findings will bring about positive social change by informing the advice of professionals, reducing obesity and alleviating its burden among people with mental illness.

Stressors affecting healthcare providers have accelerated in recent years, causing increasing rates of burnout and emotional exhaustion. Evidence suggests that improving general mental well-being of nurses could enhance their resilience and ability to cope in stressful situations. Psychiatric nurses are at risk by caring for involuntary and manipulative patients who can be violent and abusive. The purpose of this project was to improve psychiatric nurses' mental well-being through the implementation of a gratitude practice and examined the effect of this brief gratitude intervention on their mental well-being. Models informing this project were human caring theory, resilience theory, and positive psychology models of gratitude benefits. Thirty psychiatric nurses participated; they were told to privately note 3 things they were grateful for in a gratitude journal each day. The Warwick-Edinburgh Mental Well-Being Scale was administered pre- and postintervention, and chi-square analysis was performed, converting sum scores into categories (low-moderate-high); statistical significance was not demonstrated (Pearson chi-square = .1.176, Crarmer's V of .183). Nonparametric Wilcoxin Signed Rank Test and Mann-Whitney U also compared scores of pr-e and posttests. The Wilcoxin Signed Rank revealed significant differences (Z = -1.402, p = .027) but only had 6 matched pairs. Mann-Whitney U showed no significant differences between the pre- and posttest scores (U = 108, p = .161). Limitations were the inability to match identification numbers except for 6. Recommendations are gratitude education and repeat the study. This could begin to affect positive social change by promoting self-care of the nurses via incorporating principles of positive psychology into daily practice.

Thesis (PhD (Psychiatry))-- Stellenbosch University, 2006.
ENGLISH ABSTRACT: Obsessive-compulsive disorder (OCD), a debilitating psychiatric disorder, affects 2-3% of the general population, and represents a global health problem. Evidence from family studies suggests that genetic factors play a role in mediating disease development. However, the pattern of inheritance is not consistent with monogenic disorders, but is “genetically complex”. Case-control association analysis, which facilitates dissection of the genetic aetiology of complex disorders, has yielded many inconsistent results in OCD studies, making identification of predisposing alleles difficult. These discrepant findings can largely be attributed to inappropriate statistical methodology and the lack of OCD phenotypic resolution. Although classified as a single clinical entity according to structured algorithms, OCD probably represents a final common outcome of multiple underlying aetiologies. Thus, numerous clinical subtypes of the disorder have been proposed; these “intermediate” phenotypes may be more closely related to a particular genetic substrate than the higher order construct of OCD. Furthermore, although genes encoding serotonergic (5-HT) and dopaminergic components are most commonly investigated, it is likely that the behavioural manifestations of OCD are mediated by a broader network of interconnected neurotransmitter and signalling pathways. Consequently, the aim of the present study was two-fold: to address the factors that may have confounded previous genetic case-control association studies and to investigate the genetic aetiology of OCD phenotypes while accounting for these factors. Case and control individuals were drawn from the reportedly genetically homogeneous Afrikaner population. However, as no empirical evidence existed to support the absence of genetic substructure, which would confound genetic association studies, a Bayesian modelbased clustering algorithm (Structure), that groups individuals on the basis of observed genotype data, was employed to assess population stratification in both case and control Afrikaner subjects. OCD patients were clinically stratified by gender, symptom severity, age at onset, the presence of selected co-morbid disorders and the presence of selected symptom dimensions, to facilitate the identification of susceptibility genes more closely related with these subtypes. Candidate genes included those coding for components of the 5-HT (5-HT receptors 1Dβ, 2A, 2C and 6), dopaminergic (dopamine receptors 1, 2, 3 and 4, dopamine transporter and catechol-O-methyltransferase [COMT]), glutamatergic (glutamate receptor subunit 2B [GRIN2B]) and neurodevelopmental pathways (brain-derived neurotrophic factor [BDNF] and homeobox 8 [HoxB8]), as well as previously uninvestigated genes (angiotensinconverting enzyme I, inositol-trisphosphate, phospholipase-C-gamma 1 and estrogen receptor alpha). The relationship between variants in these genes and OCD (or OCD subtypes) was investigated in a single locus and a haplotype context, while meta-analyses using published population-based case-control association data were also conducted. Significant associations noted between distinct COMT variants and OCD implicated COMT in the development of a genetically discrete, gender-dependant, early-onset, tic-related phenotype in males. Furthermore, investigations of variations in BDNF and GRIN2B point towards a genetically distinct, neurodevelopmental subtype of the disorder, mediated, in males at least, primarily by dysfunctions in BDNF. The striking gender dimorphism noted in these associations indicates the possibility of an epigenetic hormonal influence. Moreover, the significant association of polymorphisms within GRIN2B, in both a single locus and haplotype context, suggests the involvement of this gene in mediating a phenotypic subtype characterised by an early-onset, more severe form of the disorder. The present investigation forms part of ongoing research to elucidate genetic components involved in the aetiopathology of OCD and OCD-related subtypes. Such studies may pave the way towards more efficacious pharmacotherapeutic strategies, which will ease the suffering of individuals who are afflicted with this incapacitating condition.
AFRIKAANSE OPSOMMING: Obsessiewe-kompulsiewe steuring (OKS) is 'n aftakelende psigiatriese siektetoestand wat 2- 3% van die algemene bevolking affekteer en 'n globale gesondheidsprobleem verteenwoordig. Familiestudies dui daarop dat genetiese faktore 'n rol in die ontwikkeling van hierdie siekte speel. Die patroon van oorerwing is egter nie verenigbaar met dié van monogeniese siektes nie, maar is geneties "kompleks". Geval-kontrole assosiasie-ontleding, wat die disseksie van die genetiese etiologie van komplekse siektes fasiliteer, het teenstrydige resultate in OKS gelewer en dit bemoeilik die identifikasie van predisponerende allele. Die teenstrydige bevindings kan grootliks aan ontoepaslike statistiese metodiek en die gebrek aan fenotipiese differensiasie in OKS toegeskryf word. Alhoewel dit volgens gestruktureer algoritmes as 'n enkele kliniese entiteit geklassifiseer word, verteenwoordig OKS waarskynlik die eindresultaat van veelvoudige onderliggende oorsake. Baie kliniese subtipes van die toestand is al voorgestel en dié "intermediêre' fenotipes mag nader verwant aan 'n spesifieke genetiese substraat as die hoër orde konsep van OKS wees. Verder, alhoewel die gene wat die serotonergiese (5-HT) en dopaminergiese komponente kodeer meestalondersoek word, is dit waarskynlik dat die gedragsmanifestasies van OKS deur 'n breër netwerk van intergekonnekteerde neuro-oordragstof- en seinoordragpaaie meegebring word Gevolglik was die doel van die huidige studie tweevoudig: om faktore wat vorige genetiese geval-kontrole assossiasie-studies verwar het aan te spreek en om die genetiese etiologie van OKS-fenotipes te ondersoek met in ag neming van hierdie faktore. Geval- en kontrole-individue is gekies uit die Afrikaner-bevolking wat as geneties homogeen beskryf kan word. Daar was geen empiriese bewyse vir die afwesigheid van 'n genetiese substruktuur (wat genetiese assossiasie-studies sou verwar),nie. Daarom is 'n Bayesiese model-gebaseerde groeperings-algoritme (Structure), wat individue op grond van waargenome genotipiese data groepeer, gebruik om die populasie-stratifikasie is beide gevalen kontrole- Afrikaner-individue te bepaal. OKS-pasiënte is klinies gestratifiseer volgens geslag, ernstigheid van simptome, ouderdom by aanvang van simptome, die teenwoordigheid van geselekteerde komorbiede siektetoestande en die teenwoordigheid van geselekteerde simptoomdimensies of -groepe, om die identifikasie van moontlike vatbaarheidsgene wat nader verwant is aan die verskillende subtipes te fasiliteer/vergemaklik. Kandidaatgene het ingesluit: dié wat kodeer vir komponente van die 5-HT-(5-HT reseptore IDB, 2A, 2C and 6), dopaminergiese (dopamienreseptore 1, 2, 3 and 4, dopamien-transporter and katesjol-O-metieltransferase [COMTJ), glutamatergiese (glutamaat-reseptor subeenheid 2B [GRIN2B]) and neuro-ontwikkelingspaaie (brein-gederiveerde neurotrofiese faktor [BDNF] en homeobox 8 [HoxB8]), sowel as die gene wat nie voorheen ondersoek is nie (angiotensien-omsettingsensiem I, inositol-trisfosfaat, fosfolipase-C-gamma 1 en estrogeen-reseptor alpha). Die verhouding tussen variante in hierdie gene en OKS (of OKS-subtipes) is ondersoek in 'n enkel-lokus en haplotipe konteks, en meta-analises, wat gepubliseerde bevolkings-gebaseerde geval-kontrole ontledingsdata gebruik het, is ook gedoen. Beduidende assosiasies gevind tussen spesifieke COMT-variante en OKS in mans, het daarop gedui dat COMT in die ontwikkeling van geneties-diskrete, vroeë-aanvang, senutrekking ("tics") -verwante fenotipe in mans betrokke is. Verder het ondersoeke van variasies in BDNF en GRIN2B daarop gedui dat 'n geneties-afsonderlike, neuro-ontwikkelings-subtipe van.OKS wat, ten minste in mans, primêr deur wanfunksie van BDNF meegebring word. Die opvallende geslags verskil wat in hierdie assosiasies gesien word, dui op die moontlikheid van 'n epigenetiese hormonale invloed. Bowendien, die beduidende assosiasie van polimorfismes in GRIN2B in beide die enkel-lokus en haplotipe konteks, dui op die betrokkenheid van hierdie geen in die meebring van 'n fenotipiese subtipe wat deur 'n vroeë aanvang, en meer ernstige vorm van die siekte gekenmerk word. Die huidige ondersoek vorm deel van voortgesette navorsmg om die genetiese komponente wat betrokke is by die etiopatologie van OKS en OKS-subtipes, bloot te lê. Sodanige studies kan die weg baan na meer doeltreffende farmakoterapeutiese strategieë wat die lyding van indi vidue wat deur hierdie aftakelende toestand geraak word, kan verlig.

Thesis(DMed (Psychiatry))-- University of Stellenbosch, 2007.
Alcohol-induced psychotic disorder (also known as alcohol hallucinosis) is a complication of alcohol abuse that requires clinical differentiation from alcohol withdrawal delirium and schizophrenia. Although extensively described, few studies utilized standardized research instruments and brain-imaging has thus far been limited to case reports. The aim of this study was to prospectively compare four population groups (ie. patients with alcohol-induced psychotic disorder, schizophrenia, uncomplicated alcohol dependence and a healthy volunteer group) according to demographic, psychopathological and brainimaging variables utilizing (i) rating scales and (ii) single photon emission computed tomography (SPECT). The third component of the study was designed to investigate the (iii) effect of anti-psychotic treatment on the psychopathology and regional cerebral blood flow (rCBF) before and after six weeks of treatment with haloperidol. Effort was made to ensure exclusion of comorbid medical disorders, including substance abuse. The study provides further supportive evidence that alcohol-induced psychotic disorder can be distinguished from schizophrenia. Statistically significant differences in rCBF were demonstrated between the alcohol-induced psychotic disorder and other groups. Changes in frontal, temporal, parietal, occipital, thalamic and cerebellar rCBF showed statistically significant negative correlations with post-treatment improvement on psychopathological variables and imply dysfunction of these areas in alcohol-induced psychotic disorder. The study was unable to distinguish between pharmacological effects and improvement acccomplished by abstinence from alcohol.
Stellenbosch: Stellenbosch University

Thesis (MMed)--University of Stellenbosch, 2004.
ENGLISH ABSTRACT: Numerous tests exist for the assessment of general cognitive functioning. Most of these tests were developed within the discipline of psychology. Neuropsychological tests are very useful, but have some limitations. Administration of the tests is limited to a psychologist, is very timeconsuming in that it can take 3-8 hours to administer and often need specialized equipment. At the other end of the continuum are very brief screening tests. General practitioners, psychiatrists and occupational therapists, in addition to psychologists, also use these tests. Although useful, the short tests only provide limited information. An intermediate level test streamlining the assessment process between the very short and longer neuropsychological tests is therefore introduced by this study. The Bedside Cognitive Assessment Battery (BCAB) was developed in 1995 and are since used, at Tygerberg Hospital's Memory Clinic, to assess patients and teach students. The test comprehensively assesses the six main classes of cognitive functioning, namely attention and concentration, speech, memory, motor functioning, perceptual functioning and executive functioning. Approximately 35-45 minutes is required for administration and training is needed to administer the BCAB. No specialized equipment is needed for administration. The battery can therefore be used at the bedside, in the office or at old age homes. The aims of this study were to validate the BCAB for use with people aged eighteen years and older, and provide normative values for use in clinical settings. The test was revised in 1997 and 2001, and extensively so in 2002, but was never formally evaluated for validity. Well-known single tests were used to compile the BCAB. Most of these tests have proven validity and reliability, but only for foreign populations. In addition, some items were reformulated and others created by the researchers. The introduction of normative values would also be useful to assist in the delineation of cognitively intact and impaired individuals. This study succeeded in providing a table of normative values. One-hundred-and-sixty Afrikaans and English participants, and fourteen Xhosa participants were assessed in their mother tongue language. This project thus also introduced a Xhosa version of the BCAB. The purpose of the Xhosa version was to address the lack of culturally relevant cognitive assessment instruments. Results were evaluated for the effects of the variables' language, gender, age and education. The effect of language was most noticeable in the Xhosa group. Gender did not affect results as dramatically as age and especially, education. These significant effects on the aforementioned variables have been described in previous reports. The BCAB is thus relevant and useful as a detector of mild to moderate impairment. It can also be used to identify specific impairment. This can narrow down the investigation of psychologists, thus saving time and money. In addition, medical and nonmedical staff can use the BCAB. Some limitations were also identified. The sample used may limit the generalization of results. Some test items also need revision, along with further validation studies. Clinicians are therefore advised to use the BCAB only in addition to complete clinical examinations when making decisions regarding a patient's cognitive status. The BCAB appears to be a valid tool for bedside assessment. However, this study could only set the stage for further research, especially studies concerned with establishing normative values.
AFRIKAANSE OPSOMMING: Verskeie toetse bestaan vir die evaluering van algemene kognitiewe funksionering, waarvan die meeste ontwikkel is binne die sielkunde. Neuro-sielkundige toetse is baie bruikbaar, maar het sekere beperkings. Administrasie van die toetse is beperk tot sielkundiges, maar tydrowend weens 'n tydsduur van drie tot agt uur, en verg dikwels gespesialiseerde toerusting. Aan die ander kant is heelwat kart siftings-toetse beskikbaar. Aigemene praktisyns, sielkundiges en arbeidsterapeute, asook sielkundiges, gebruik dit. Hoewel bruikbaar, bied die kart toetse beperkte inligting. 'n lntermediere vlak toets om die evaluerings-proses tussen kart en langer neuro-sielkundige toetse te integreer word met hierdie studie beoog. Die Bedkant Kognitiewe Evaluasie Battery (BKEB) is in 1995 ontwikkel en gebruik in die Geheue-kliniek van die Tygerberg Hospitaal om pasiente te evalueer en studente op te lei. Die toets is gerig op die omvattende evaluering van die ses hoof-klasse van kognitiewe funksionering. Hierdie klasse omvat aandag en konsentrasie, spraak, geheue, motoriese funksionering, perseptuele funksionering en uitvoerende funksionering. Sowat 35 tot 45 minute word benodig vir administrasie terwyl opleiding vereis word vir die neem van die toets. Geen gespesialiseerde toerusting is nodig nie. Die battery kan dus by die bedkant, in die kantoor of in ouetehuise gebruik word. Die doelwitte van hierdie studie is om die BKEB te evalueer in gebruik by 18-jariges en ouer, en normatiewe waardes te bepaal vir gebruik in kliniese omgewings. Die toets is in 1997 en 2001 hersien. In 2002 is dit uitvoerig hersien, maar nooit ge-evalueer vir geldigheid nie. Bekende enkel-toetse is gebruik am die BKEB saam te stel. Dit is as geldig en betroubaar bewys, hoewel slegs onder buitelandse bevolkingsgroepe. Hierbenewens is sekere items herformuleer en ander bygewerk deur die navorsers. Normatiewe waardes sal oak handig wees in die afbakening van kognitief normaal-funksionerende en kognitief-ingekorte individue. Hierdie studie het daarin geslaag am 'n tabel van normatiewe waardes daar te stel. Een-honderd-en-sestig Afrikaans- en Engels-sprekendes, en 14 Xhosa-sprekendes is tydens hierdie studie in hulle moedertaal ge-evalueer. Hierdie projek het dus oak 'n Xhosaweergawe van die BKEB geskep. Die doel van die Xhosa-weergawe was am die gebrek aan 'n kultureel toepaslike kognitiewe instrument te beklemtoon. Resultate is ge-evalueer gedagtig aan veranderlikes soos taal, geslag, ouderdom en opleidingsvlak. Taal het die grootste invloed gehad op uitslae van Xhosa-deelnemers. Geslag het nie die uitslae so dramaties bernvloed soos ouderdom, en veral opleidingsvlak nie. Literatuur het meestal die groot uitwerking van hierdie veranderlikes bevestig. Die BKEB is dus relevant en handig in die naspeuring van ligte tot matige kognitiewe ingekortheid. Dit kan ook gebruik word om spesifieke kognitiewe ingekortheid te identifiseer. Die kan die omvang van ondersoek deur sielkundiges vernou, wat kan lei tot In groot besparing in tyd en geld. Hierbenewens kan mediese en nie-mediese personeel aangewend word in die gebruik van die BKEB. Sekere tekortkominge is ge·,dentifiseer. Die steekproef mag egter die veralgemening van die uitslae beperk. Sekere toets-items mag ook hersiening vereis, tesame met verdere geldigheid-studies. Kliniese praktisyns word daarom aangeraai om die BKEB slegs in aanvulling tot omvattende kliniese ondersoeke te gebruik vir besluite m.b.t. In pasient se kognitiewe status. Die BKEB kom voor as In geldige instrument vir bedkant evaluering. Hierdie studie kon egter slegs die tafel dek vir verdere ondersoek, veral t.o.v. studies wat poog om normatiewe waardes daar te stel.

Thesis (PhD)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: Background The changes in cognition, brain structure, and neurological soft signs which are characteristic of schizophrenia appear to have been present before the onset of the phenotype. They therefore find relevance as potential vulnerability markers of the disease. Neurological soft signs are of particular interest because they can be elicited quickly, reliably and cheaply. They have also been touted as markers of certain characteristics of schizophrenia. The most convincing evidence for these assertions come from prospective longitudinal studies of first episode, medication naive patients with schizophrenia. Most of these studies have been based on wholly Caucasian or mixed samples of Caucasians and other races. The present study provides important reference data on the nature of neurological soft signs in indigenous African subjects and clarifies the trait or state marking signs in this population. Method A total of 84 patients with first episode, schizophrenia, schizo-affective disorder, or schizophreniform disorder meeting criteria in the fourth edition of the Diagnostic and Statistical Manual for Mental Disorders were consecutively recruited. Information on demographic characteristics, personal medical and psychiatric history, as well as family history was obtained at baseline. Neurological assessment was based on the 26 item Neurological Evaluation Scale. An exploratory factor analysis of the items in the scale was conducted using the baseline measurements. The derived sub-sets of neurological soft signs were then followed up longitudinally and in parallel with the ‘functional categories’ of the signs. The study describes the profile of neurological soft signs across the one year course of schizophrenia, as well as their relationship with a wide range of clinical and outcome variables. The severity of the baseline psychopathology was evaluated by administering the Positive and Negative Syndrome Scale. The overall clinical status was assessed using Clinical Global Impression. Additional assessments included the Calvary Depression Scale for Schizophrenia, Birchwood Insight Scale, Social and Occupational Functioning Assessment Scale, and the World Health Organisation Quality of Life Scale (WHO QoL-BREF). Pre-morbid adjustment was assessed using the Pre morbid Adjustment Scale, while extra-pyramidal effect of antipsychotics was assessed using the Extra-pyramidal Symptoms Rating Scale. Assessments were repeated at three monthly intervals for the full 12 months. Results Neurological soft signs were present in 96.4% of the sample at baseline. The signs loaded into a four factor structure: perceptual and motor sequencing (audio-visual integration, fist-edge palm, rhythm tapping, extinction, and right-left confusion), eye movements (synkinesis, convergence, and gaze impersistence), motor co-ordination and graphaesthesia (tandem walk, adventitious flow, and graphaesthesia), as well as stegreognosis. The scores for the perceptual and motor sequencing factor, as well as those for the sequencing of complex motor acts ‘functional category’ were stable across three measurements over 12 months (F=1.26, p=0.287, and F=1.87, p=0.158 respectively). The sequencing of complex motor act signs was not significantly correlated with the clinical and outcome characteristics of schizophrenia. However, other signs, as well as the NES total score were significantly correlated with more severe negative and disorganized psychopathology, as well as poorer outcome in terms of functioning and quality of life. Conclusion Neurological soft signs were present at a high frequency at baseline. A preponderance of the signs was associated with a more severe negative and disorganization psychopathology, as well as a poorer functional outcome and quality of life. Abnormal sequencing of complex motor act signs, and signs of abnormal cognitive processing of perceptual stimuli where resistant to changes in psychopathology, and thus may represent viable trait markers for schizophrenia in this cohort.

Thesis (PhD)--Stellenbosch University, 2011.
ENGLISH ABSTRACT: The practice of psychometric testing of cognitive functioning in South Africa is hampered by the paucity of normative data that adequately characterize our ethnically, linguistically, socioeconomically, and educationally diverse population. The general aim of this study was to ascertain whether cognitive tests developed in settings outside of the Western Cape urbanized area have valid application for clinical and research purposes in that area. Strategies used to achieve that aim included: 1) translation, adaptation, and subsequent administration of a compendium of tests in a sample of typically developing, coloured and white, 12- to 15-yearold, Afrikaans- and English-speaking adolescents; 2) evaluation of the relative impact of sociodemographic factors (age, sex, language, quality of education, and race) on test performance and the consequent derivation of appropriately stratified normative data; and 3) evaluation of the cross-cultural utility of the normative data by comparing data collected from the study sample to norms derived from other populations. Results indicated that sex and language of testing impacted minimally on cognitive functioning. In contrast, the pervasive and deleterious impact of disadvantaged quality of education on cognitive performance within typically developing adolescents was clearly demonstrated. For participants with advantaged quality of education, coloured race was associated with lower performance on measures of intelligence, semantic fluency, and one measure of attention. Furthermore, the results provided evidence of age-related increments in cognitive performance, particularly after the age of 12. For cognitive measures that were significantly affected by language, race, and quality of education, trends of a downward continuum of performance were demonstrated, from highest to lowest, as follows: 1) English-white-advantaged; 2) Afrikaans-white-advantaged; 3) Englishcoloured- advantaged; 4) English-coloured-disadvantaged; 5) Afrikaans-coloured-advantaged; and 6) Afrikaans-coloured-disadvantaged. Cross-cultural comparisons of norms showed that for some tests, norms derived from other populations were suitable for use in the study sample. For other tests, however, results showed that for certain subgroups, it was essential to use the stratified norms derived from the study in order to prevent misdiagnoses.
AFRIKAANSE OPSOMMING: Die psigometriese toetsing van kognitiewe funksionering word in Suid-Afrika gekniehalter deur 'n gebrek aan normatiewe data wat ons etnies, taalkundig, sosio-ekonomies en opvoedkundig diverse bevolking genoegsaam tipeer. Die algemene doel van hierdie studie was om vas te stel of kognitiewe toetse wat in omgewings buite die Wes-Kaapse stedelike gebied ontwikkel is, ook vir kliniese en navorsingsdoeleindes binne hierdie stedelike gebied aangewend kan word. Hiervoor is onder meer die volgende strategieë gevolg: 1) 'n kompendium toetse is vertaal, aangepas en vervolgens afgeneem onder ’n toetsgroep tipies ontwikkelende, bruin en wit, 12- tot 15-jarige, Afrikaans- en Engelssprekende adolessente; 2) die relatiewe impak van sosiodemografiese faktore (ouderdom, geslag, taal, opvoedingsgehalte en ras) op toetsprestasie, en die gevolglike verkryging van toepaslik gestratifiseerde normatiewe data, is beoordeel en 3) die kruiskulturele nut van die normatiewe data is beoordeel deur die data wat van die toetsgroep in hierdie studie verkry is, te vergelyk met norme wat van ander populasies bekom is. Die resultate toon dat geslag en die taal waarin die toets afgeneem word 'n minimale uitwerking op kognitiewe funksionering het. Daarenteen is duidelik bewys dat swakker gehalte opvoeding ’n verreikende en skadelike uitwerking op die kognitiewe funksionering van tipies ontwikkelende adolessente het. By deelnemers met beter gehalte opvoeding blyk daar 'n verband te wees tussen die bruin rassegroep en laer prestasie wat betref maatstawwe van intelligensie en semantiese vaardigheid, asook een maatstaf van konsentrasie. Voorts lewer die resultate bewys van ouderdomsverwante toenames in kognitiewe prestasie, veral ná die ouderdom van 12. Wat betref kognitiewe maatstawwe wat beduidend deur taal, ras en opvoedingsgehalte beïnvloed is, is 'n afwaartse prestasiekontinuum opgemerk wat van hoog na laag soos volg daar uitsien: 1) Engels-wit-bevoordeel, 2) Afrikaans-wit-bevoordeel, 3) Engels-bruin-bevoordeel, 4) Engelsbruin- benadeel, 5) Afrikaans-bruin-bevoordeel en 6) Afrikaans-bruin-benadeel. Kruiskulturele normvergelykings toon dat, wat sommige toetse betref, die norme wat van ander populasies bekom is ook geskik was vir gebruik onder die toetsgroep in hierdie studie. Wat ander toetse betref, het die resultate egter getoon dat dit by bepaalde subgroepe noodsaaklik is om die gestratifiseerde norme wat uit die betrokke studie afgelei is te gebruik ten einde verkeerde diagnoses te voorkom.

Thesis (PhD (Psychiatry))--University of Stellenbosch, 2011.
ENGLISH ABSTRACT: Contemporary research has confirmed the presence of cognitive deficits as a core feature of schizophrenia that has a definite and adverse impact on functional outcome. Cognitive functioning can be improved by psychopharmacological intervention, with evidence supporting the superiority of second generation antipsychotics over their first generation predecessors. Despite evidence that cognitive impairment contributes to medication non-adherence and that depot antipsychotics are able to enhance treatment compliance whilst decreasing relapse rates, depot preparations remain less frequently prescribed than their oral counterparts, especially in patients with first episode psychosis (FEP). The aims of this study were primarily to investigate cognitive deficits in patients with FEP, and to then describe the response of these impairments to treatment with a very low dose flupenthixol decanoate. This was a prospective, non-randomized, single arm, open-label, longitudinal study of 58 participants with FEP treated according to a fixed protocol over a period of 12 months. There was a wash-out phase of up to seven days during which all psychotropic medications were discontinued. There was an initial treatment period of one week with oral flupenthixol 1mg/day, after which flupenthixol decanoate was initiated at 10mg intramuscular depot injection every fortnight. Dose increases, in cases of poor or inadequate response, were allowed at 6-weekly intervals and in increments of 10mg per injection, up to a maximum of 30mg per fortnight. The principal findings of the study were as follows: The majority of participants were markedly ill, with significant cognitive impairment at baseline. There was a discrepancy between subjectively reported, and objectively measured, cognitive impairment. The majority of the participants responded to, and achieved remission, on a very low dose of flupenthixol decanoate (22.48 ± 0.47mg/month). The majority of symptomatic and cognitive improvement occurred between baseline and three months, with response leveling out at six months. Social cognition did not improve significantly over time, whereas functional outcome and quality of life did improve with treatment. Flupenthixol decanoate was well tolerated and side-effects were of a mild and transient nature. This study reconfirms that the majority of individuals with FEP experience significant cognitive impairment at baseline. It also suggests that these impairments can be successfully treated with a very low dose of flupenthixol decanoate. The use of depot flupenthixol decanoate ensures sustained treatment delivery, thereby decreasing the risk for relapse. This holds the promise of improved long-term functional outcome for those suffering with psychotic illness.
AFRIKAANSE OPSOMMING: Onlangse navorsing het kognitiewe inkorting identifiseer as een van die kern simptoomkomplekse van skisofrenie, met toenemende bewyse vir die duidelike en ongunstige impak hiervan op funksionele uitkoms. Kognitiewe funksionering kan deur psigofarmakologiese ingrepe verbeter word. Onlangse literatuur toon dat die tweede generasie antipsigotika relatief meer effektief is as hulle eerste generasie voorgangers. Ondanks bewyse vir die negatiewe impak van kognitiewe inkorting op behandelingsinskiklikheid, én data wat daarop wys dat die gebruik van langwerkende intramuskulere (depot) antipsigotika inskiklikheid verbeter en periodes van simptoom-terugval voorkom, word dié preparate steeds minder gereeld as hulle orale eweknieë voorgeskryf, veral by pasiënte met 'n eerste episode psigose (FEP). Die doel van hierdie studie was om kognitiewe probleme by pasiënte met FEP te beskryf, en ook om die respons hiervan op behandeling met 'n baie lae dosis flupentiksol dekanoaat, te ondersoek. Die studie was 'n prospektiewe, nie-ewekansige, enkel middel, oop studie van 58 deelnemers met FEP, wat oor „n tydperk van 12 maande volgens 'n spesifieke protokol behandel is. Daar was 'n uitwas periode van 7 dae, waartydens alle psigotrope medikasie gestaak is. Hierna is behandeling met orale flupentiksol 1mg/dag begin vir een week, waarna flupentiksol dekanoaat geinisieer is teen 10mg intramuskulêr elke 2de week. Dosisverhogings, in geval van onvoldoende respons, was toelaatbaar met 6-weeklikse tussenposes, in inkremente van 10mg per inspuiting, tot 'n maksimum van 30mg elke 2de week. Die vernaamste bevindinge van die studie was soos volg: Die meerderheid van die deelnemers was ernstig siek, met beduidende kognitiewe inkorting tydens basislyn evaluasie. Daar was 'n verskil tussen subjektief-gerapporteerde en objektief-meetbare kognitiewe inkorting. Die meerderheid van die deelnemers het goed reageer op behandeling en het ook remissie op 'n baie lae dosis flupentiksol dekanoaat (22.48 ± 0.47mg/maand), bereik. Die meerderheid van simptomatiese en kognitiewe verbetering het plaasgevind binne die eerste 3 maande, met afplatting in die tempo en hoeveelheid van verbetering vanaf 6 maande. Sosiale kognisie het nie beduidend gedurende die studieperiode verbeter nie. Funksionele uitkoms en lewenskwailiteit van deelnemers het ook met behandeling verbeter. Flupentiksol dekanoaat is goed verdra en die newe-effekte, indien dit teenwoordig was, was van ligte graad en verbygaande aard. Hierdie studie herbevestig dat individue met FEP beduidende kognitiewe inkorting by basislyn ervaar, maar dat hierdie inkortings effektief met 'n baie lae dosis van flupentiksol dekanoaat behandel kan word. Die gebruik van depot flupentiksol is 'n suksesvolle manier om volgehoue behandeling te verseker en sodoende die risiko vir terugvalle te verminder. Dit verstewig dus die hoop op beter langtermyn funksionering vir persone met psigotiese siektes.

Dissertation (PhD)--Stellenbosch University, 2003.
ENGLISH ABSTRACT: Although schizophrenia is traditionally viewed as an illness with a very poor prognosis, research over the last few years indicates that early intervention may substantially improve the long-term outcome of this disorder. Several studies suggest that patients with first-episode psychosis (FEP) are more sensitive to, and require lower doses of antipsychotic medications than patients with more chronic forms of illness. However, the optimal dose of first-generation anti psychotics in patients with FEP has not been explored extensively and continues to be a controversial subject. This study evaluated the efficacy and safety of low-dose haloperidol in a South African cohort with FEP. The study was conducted in two phases: Phase 1 was an open-label, naturalistic study of 57 subjects with FEP who were commenced on 1mg of haloperidol for 4 weeks, after which gradual escalation of doses were allowed, if required. Subjects who failed to respond at haloperidol 10mg per day were switched to thioridazine. Failure to respond to thioridazine 600mg per day was interpreted to indicate treatment resistance. These subjects were then commenced on clozapine. The principal finding of this phase of the study was that the majority of subjects could be stabilized and maintained on very low doses of haloperidol (1.7 ± 1.0 mg/day at 12 months and 1.3 ±0.8 mg/day at 24 months). Ratings for extra-pyramidal side-effects did not increase significantly from baseline over the duration of the study, except in the case of tardive dyskinesia (TD), where a substantial number of subjects (12.3%) developed TD within 12 months of starting treatment. Phase 2 of the study was a double-blind, randomized controlled trial of low-dose (2mg/day) versus "standard dose" (8mg Iday) haloperidol. Forty subjects were included in this phase of the study; 20 in each treatment arm. The main finding was that there were no significant differences in treatment reponse between the two treatment groups. There were, however, significant differences between the two treatment groups in extrapyramidal side effects (EPSE), with the 8mg per day group exhibiting significantly higher levels of EPSE than the 2mg per day group. This was manifested by significant differences in scores on the Extrapyramidal Symptom Rating Scale (ESRS) and the Simpson-Angus Rating Scale. Furthermore, subjects in the 8mg haloperidol per day group required significantly higher doses of anticholinergic medication and had significantly higher mean levels of prolactin at the end of the study period. This study indicates that a majority of subjects with first-episode psychosis can be treated and maintained successfully with very low doses of haloperidol. It also shows that low-dose treatment is as effective as, and better tolerated than, "standard" doses. Despite the success with the low-dose treatment, however, there was still a much higher than expected incidence of tardive dyskinesia, a serious and potentially irreversible side-effect of neuroleptic treatment.
AFRIKAANSE OPSOMMING: Hoewel skisofrenie tradisioneel gesien is as 'n siekte met 'n uiters swak prognose, dui navorsing oor die afgelope jare daarop dat vroeë ingryping die langtermynuitkoms van hierdie toestand drasties mag verbeter. Resultate van verskeie studies dui daarop dat pasiënte met eerste-episode psigose (EEP) nie net meer sensitief is vir antipsigotiese middels nie, maar ook laer dosisse daarvan benodig tydens behandeling as pasiënte met meer kroniese vorms van psigotiese siekte. Desondanks is die kwessie van die korrekte dosis van eerste generasie antipsigotika in hierdie groep nog onvolledig nagevors en bly dit 'n omstrede onderwerp. Hierdie studie het ten doel gehad om die effektiwiteit en veiligheid van lae dosis haloperidol in 'n Suid-Afrikaanse populasie van pasiënte met EEP te evalueer. Die studie is uitgevoer in twee fases: Fase 1 was 'n oop, naturalistiese studie van 57 pasiënte met EEP wat aanvanklik behandel is met 1mg haloperidol per dag vir 4 weke, waarna geleidelike verhoging van dosisse toegelaat is, soos nodig. Diegene wat nie bevredigende respons getoon het op haloperidol 10mg per dag nie, is oorgeskakel na tioridasien. Ontoereikende respons teen 600mg/dag tioridasien is geïnterpreteer as 'n aanduiding van behandelingsweerstandigheid en behandeling met klosapien is begin. Die belangrikste bevinding van hierdie fase van die studie was dat die meerderheid pasiënte gestabiliseer en in stand gehou kom word op baie lae dosisse haloperidol (1.7 ± 1.0 mg/dag op 12 maande en 1.3 ±0.8 mg/dag op 24 maande). Metings van ekstra-piramidale newe-effekte (EPNE) het nie beduidend toegeneem oor die duur van die studie nie, behalwe in die geval van tardiewe diskinese (TO), waar 'n beduidende aantal pasiënte (12.3%) TO ontwikkel het binne 12 maande na aanvang van behandeling. Fase 2 van die studie was 'n dubbelblinde, ewekansig gerandomiseerde studie waarin behandeling met lae dosis haloperidol (2mg/dag) vergelyk is met "standaard" dosis haloperidol (8mg/dag). Veertig pasiënte is ingesluit in hierdie fase van die studie, 20 in elke behandelingsarm. Die hoofbevinding was dat daar geen beduidende verskille in respons op behandeling was tussen die twee groepe nie. Daar was egter beduidende verskille in EPNE, waar die 8mg/dag groep beduidend hoër vlakke van EPNE gehad het as die 2mg/dag groep. Hierdie verskil in EPNE is aangedui deur 'n statisties beduidende verskil in tellings op die Extrapyramidal Symptom Rating Scale (ESRS) en die Simpson- Angus Rating Scale. Verder het pasiënte in die 8mg/dag groep beduidend hoër dosisse antikolinerge medikasie benodig en ook hoër gemiddelde prolaktienvlakke gehad teen die einde van studie. Hierdie studie dui dus daarop dat die meerderheid van pasiënte met EEP suksesvol behandel en in stand gehou kan word met baie lae dosisse haloperidol. Die studie wys ook daarop dat behandeling met lae dosisse net so effektief is en beter verdra word as behandeling met "standaard" dosisse. Ten spyte van die suksesvolle gebruik van lae dosisse medikasie het die studie egter ook getoon dat daar "n baie hoër as verwagte insidensie was van TO, "n emstige en potensieelonomkeerbare newe-effek van neuroleptiese behandeling.

Thesis (PhD)-- Stellenbosch University, 2014.
ENGLISH ABSTRACT: Schizophrenia is a phenotypically heterogeneous disorder believed to have a strong genetic component. Limiting its clinical heterogeneity by means of subtyping may help to shed light on some of the genetic underpinnings of the disease. This study describes the application of factor analysis (FA), latent class analysis (LCA) and factor mixture modeling in a sample of 734 Xhosa-speaking schizophrenic subjects using factor analytically derived variables previously identified in an independent sample of this population. LCA was performed on the following 8 SANS and SAPS items identified by preliminary exploration of the data: eye contact, auditory hallucinations, global hallucinations score, global delusions score, grooming, affective non-responsiveness, spontaneous movement, and commenting voices. A four class model provided the best fit. Classes 1 and 2 were characterized by predominantly positive and predominantly negative symptoms, respectively, class 3 by both positive and negative symptoms and class 4 by few or absent symptoms. A history of cannabis use or abuse increased the probability of a subject being allocated to class 1, while being male made a person more likely to be included in class 2. Factor mixture modelling was performed by first using latent class analysis, then factor analysis and then the factor mixture analysis were done. The fit among these three types were then investigated. The results show that factor mixture modelling uncovered a heterogeneous latent variable structure that fits the data well with the latent classes capturing distinct positive symptom/behaviours and factors capturing severity variations. This study, the first to report on the latent class structure of schizophrenia in a sample of patients from a sub-Saharan African population, supports the universality of specific latent classes across ethnic boundaries. The results further support reports that gender, sibpair status and cannabis use may influence the phenomenology of schizophrenia. The identification of subgroups may represent an intermediate step in the search for endophenotypes of schizophrenia.
AFRIKAANSE OPSOMMING: Skisofrenie is „n psigiatriese steuring met „n heterogene fenotipe en „n vermoedelik sterk genetiese vatbaarheid. Ten einde die lig te werp op die genetiese onderbou van skisofrenie word gepoog om die kliniese heterogenisiteit te beperk deur middel van subgroepering. Hierdie studie beskryf die gebruik van latente klas analise (LKA) in „n groep van 734 Xhosa-sprekendes met skisofrenie. Die LKA word baseer op die gebruik van veranderlikes wat deur middel van faktor analise op simptome in „n onafhanklike studiegroep van Xhosa-sprekendes met skisofrenie verkry is. Die LKA is gedoen op die volgende 8 “SAPS” en “SANS” veranderlikes wat deur voorlopige ondersoek van die data ge-indentifiseer is: oogkontak, gehoorshallusinasies, globale hallusinasie telling, globale waantelling, selfversorging, affektiewe nie-responsiwiteit, spontane beweging en stemme wat kommentaar lewer. „n Vierklas oplossing het die beste passing getoon. Klas 1 en 2 is gekenmerk deur oorwegend positiewe en negatiewe simptome onderskeidelik, klas 3 het beide positiewe en negatiewe simptome gehad en klas 4 het baie min of geen simptome getoon nie. „n Geskiedenis van kannabis gebruik of misbruik het die kans verhoog dat die individue in klas 1 gevind sou word, terwyl manlike geslag as veranderlike die kanse verhoog het vir allokasie in klas 2. Faktor mengsel modelering is gedoen deur eers „n latent klas analise te voltooi, gevolg deur „n faktor analise, en laastens „n factor mengsel analise. Die passing tussen die drie analises is daarna evalueer. Faktor mengsel modelering toon „n heterogene latente klas struktuur wat voldoen aan die passingsvereistes. Die latente klasse blyk spesifieke positiewe simptome/gedrag te verteenwoordig, terwyl die factor grad van erns variasie aandui. Hierdie studie is die eerste om die latente klas struktuur van skisofrenie in „n subsahara-Afrika populasie, die Xhosa, te beskryf. Die resultate onderstreep die universialiteit van die latente struktuur van skisofrenie se simptome oor etniese grense heen. Verder ondersteun die resultate die moontlike rol van geslag, aangetaste sibstatus en kannabis gebruik in skisofrenie se fenomenologie. Die identifisering van die subgroepe mag „n intermediêre stap in die soektog vir endofenotipes van skisofrenie verteenwoordig.

Thesis (PhD (Psychiatry))--University of Stellenbosch, 2011.
ENGLISH ABSTRACT: Pregnancy is often accompanied by distressing psychological symptoms such as anxiety. These symptoms may result from changes in cognitive-affective processing, which in turn reflect hormonal changes during this time. However, findings on associations between psychological distress, cognitive-affective changes and hormones have been inconsistent. Furthermore, few studies have investigated the neural circuitry underlying distress and cognitive-affective processing in pregnancy. The prefrontal cortex (PFC) plays a specific role in regulating emotion. Determining the relationship between these changes in cognitive-affective processing and in prefrontal circuitry is important, given the high prevalence of depressive and anxiety disorders in pregnancy. The overall objective of this study was to investigate distressing psychological symptoms and their association with cognitive-affective processes and neurobiological changes over the course of pregnancy. Pregnant women with low risk singleton pregnancies were recruited from Midwife Obstetric Units in the Western Cape. Non-pregnant healthy controls were also recruited from the same demographic area. Distress levels were assessed using the K-10, Spielberger State -Trait Inventory, and Perceived Stress Scale. Subjectively experienced cognitive ability was asked about. Objective cognitive ability was assessed using standardized neuropsychological tests. Selective attention to threat such as fear and anger was assessed using a Facial Stroop Task. Neural circuitry was assessed using Near-Infrared Spectroscopy while viewing dynamic emotional facial expressions of threat (Emotion Recognition Task). Glucocorticoid (cortisol) and gonadal hormonal levels (estrogen, progesterone, and testosterone) were also determined at each trimester of pregnancy. Associations between distressing psychological symptoms, cognitive-affective processes and neurobiology were assessed using standard statistical methods. The main findings to emerge from this research were that, 1. pregnant women had significantly higher trait anxiety at trimester 2, compared to trimester 1 of pregnancy; 2. compared to non-pregnant women, pregnant women paid significantly more attention to fearful faces across trimesters, suggesting altered cognitive-affective processing in pregnancy compared to non-pregnancy; 3. pregnant women demonstrated significantly increased PFC activation in response to fearful and angry faces (all trimesters) that was particularly evident at trimester 2; 4. the PFC activation was, across trimesters, significantly correlated with distress and selective attention to threat; and 5. the PFC activation was, across trimesters, also significantly associated with increased glucocorticoid and gonadal hormone levels. The main findings of this study are consistent with previous literature insofar as distress has previously been associated with altered cognitive-affective processing and prefrontal cortex activation, but extend it by showing that emotional regulation is altered in pregnancy compared to the non-pregnant state. These data provide an important insight into distressing psychological symptoms and their associations with cognitive-affective processes, and changes in neural circuitry and in hormone levels in pregnancy. These findings are also the first to show that structures involved in emotional processing (e.g. the PFC) also play a role in the regulation of affect in pregnancy. Future research should explore the causal mechanisms underlying altered emotional regulation in pregnancy, and include pregnant women that are clinically depressed or anxious as comparison subjects.
AFRIKAANSE OPSOMMING: Swangerskap word dikwels geassosieër met stres-veroorsakende sielkundige simptome soos angstigheid. Hierdie simptome mag die gevolg wees van veranderinge in kognitief-affektiewe prosessering, wat op sy beurt mag dui op hormonale veranderinge. Bevindinge oor assosiasies tussen sielkundige stres, kognitief-affektiewe prosessering en hormone is tot dusver onbeslis. Voorts was min studies gerig op die neurologiese meganika onderliggend aan stres en kognitief-affektiewe prosessering tydens swangerskap. Die prefrontale korteks (PFK) het 'n spesifieke rol in die regulering van emosie. Die bepaling van spesifieke assosiasies tussen veranderinge in kognitief-affektiewe prosessering en in prefrontale regulering is belangrik, gegewe die hoë voorkoms van toestande soos depressie en angssteurings tydens swangerskap. Die doel met hierdie studie was 'n ondersoek na assosiasies tussen stres-veroorsakende sielkundige simptome, kognitief-affektiewe prosesse en neurobiologie tydens swangerskap. Swanger vroue met lae risiko enkel-swangerskappe is gewerf by klinieke in Wes-Kaapland. Gesonde nie-swanger vroue is uit dieselfde omgewing gewerf as kontroles. Angs-vlakke is geevalueer met behulp van die K-10; die Spielberger State-Trait Inventory en die Perceived Stress Scale. Vrae is tydens ondersoeke gevra oor subjektief-ervaarde kognitiewe vermoë. Voorts is kognitiewe vermoë geëvalueer met behulp van gestandardiseerde neurosielkundige toetse. Hierbenewens is selektiewe aandag aan bedreigende gesigte wat vrees en woede toon, geëvalueer met behulp van 'n Facial Stroop Task. Neurologiese funksie is geëvalueer met gebruik van Na-Infrarooi Spektroskopie terwyl dinamiese bedreigende emosionele gesigsuitdrukkings vertoon is (Emotion Recognition Task). Gluko-kortikoïed (kortisol) en geslagshormoonvlakke (estrogeen, progesteroon, en testosteroon) is gemeet tydens elke trimester. Verwantskappe tussen stresvolle simptome, kognitief-affektiewe prosessering en neurobiologie is geëvalueer met standaard statistiese metodes. Die hoofbevindinge het op die volgende gedui: 1. swanger vroue het betekenisvolle hoër trait angs-vlakke getoon in trimester 2, vergeleke met trimester 1; 2. vergeleke met nie-swanger vroue, het swanger vroue beduidend meer aandag geskenk aan angstige gesigsuitdrukkings tydens elke trimester wat mag dui op veranderde kognitief-affektiewe prosessering tydens swangerskap vergeleke met nie-swangerskap; 3. swanger vroue het beduidend hoër PFK aktivering getoon teenoor angstige en kwaai gesigte in alle trimesters, maar veral in trimester 2; 4. swanger vroue se PFK aktivering het, in alle trimesters, beduidend gekorreleer het met stres-vlakke en selektiewe aandag teenoor bedreigende stimuli; en 5. swanger vroue se PFK aktivering het, in alle trimesters, ook 'n beduidende verwantskap getoon met verhoogde gluko-kortikoïed en geslagshormoonvlakke. Die hoofbevindinge in hierdie studie stem ooreen met vorige literatuur wat aangedui het dat daar 'n verband is tussen stres en veranderinge in kognitief-affektiewe prosessering en in prefrontale korteks aktivering, maar dui verder op veranderinge in emosionele regulering tydens swangerskap vergeleke met nie-swangerskap. Die data bied 'n belangrike insig in stres-veroorsakende sielkundige simptome; hul verwantskap met kognitief-affektiewe prosesse; veranderinge in neurologiese netwerke; en veranderinge in hormoonvlakke tydens swangerskap. Sover bekend is dit ook die eerste keer bevind dat strukture wat betrokke is by emosionele prosessering (bv. die PFK), ook betrokke is in die regulering van emosie tydens swangerskap. Dit is belangrik dat toekomstige navorsing die onderliggende meganismes wat veranderinge in emosionele regulering teweeg bring, ondersoek. Verdere ondersoek om hierdie veranderinge in swanger depressie-lyers of diegene met angssteurings te vergelyk is ook van belang.

According to recent research, more than 75% of newly employed nurses leave employment within 6 months. Changes in organizational training programs are needed in order to improve psychiatric nurse retention, nationally and globally. A healthy work environment (HWE) has been described as an environment that includes mentoring for good communication skills; it is also one that explores collaborative strategies for safe practice; professional advancement; and empowerment through research, education, and skill development. Examination of the impact of this HWE psychiatric nurse orientation training program on nurse retention was done using Rogers' theory of diffusion. Study variables included the length of training and retention rates pre- and post-training to help identify the impact of the HWE training program on retention using different methods of policy review. The project included 88 nurses and outcomes were measured through review of hire and termination rates for the targeted facility 3 months pre- and post-intervention. An independent samples t test revealed that the average retention rate for nurses trained in the current versus HWE program differed significantly by program (p > .05). Training also was shown to improve clinical practice and increase awareness of existing evidence about strategies to improve psychiatric nurse retention. Social change implications include potentially decreasing the costs associated with hiring and training nurses, improving clinical practice, adding to the nursing knowledge base and skill set, and enhancing workflow processes for quality outcomes.

Thesis (PhD)--Stellenbosch University, 2008.
ENGLISH ABSTRACT: Investigations into the neurobiology of obsessive-compulsive disorder (OCD) have provided useful insights into this prevalent and disabling disorder in recent decades. Encouraging advances have also been made in the pharmacological treatment of OCD. This has improved the quality of life for many who typically endure chronic unremitting symptoms. Despite the widespread use of first-line agents selective for the serotonergic system in OCD, relatively little is known about the neurobiology of treatment response, the specific components of the serotonin system involved in symptom modulation, and the overlapping and distinct brain regions impacted by alternative treatment options. Despite the advance that selective serotonin re-uptake inhibitors have been, a significant proportion of patients still fail to respond adequately to these agents, and alternative pharmacological interventions are required. The use of dopamine antagonists, a strategy which until recently has had only limited supporting data, presents one such alternative. Little however, is known about which subsets of patients are most likely to respond to these agents. In this thesis, I will present a series of six studies that use pharmacological treatments and single photon emission computed tomography (SPECT) to make contributions to three primary areas in OCD namely; neurobiology, treatment and the intersection of the two. First, I address OCD neurobiology by examining the impact of OCD on resting brain function. I then examine the effects of pharmacological challenge of the serotonin 1B receptor using sumatriptan on regional cerebral blood flow (rCBF) and clinical symptomatology. Second, I examine the intersection of neurobiology and treatment as I explore the changes in rCBF in response to treatment with inositol, a precursor of the phosphoinositol second messenger system. I then examine the distinct and overlapping effects on rCBF of treatment for 12 weeks with the selective serotonin re-uptake inhibitor (SSRI) citalopram across anxiety disorders. Third, I address treatment of OCD by examining the efficacy of controlled augmentation of serotonin re-uptake inhibitors with quetiapine, a dopamine antagonist, in treatment refractory OCD. I then combine this data with a second similar dataset to derive a predictive model for treatment outcome with quetiapine augmentation of SRIs. I demonstrate that rCBF in OCD differs significantly from normal controls, is correlated with severity in frontal brain regions, and remains an important line of investigation for OCD pathophysiology that has yet to fully delineated. Pharmacological challenge of the 5HT1B autoreceptor with the selective agonist sumatriptan results in heterogeneous behavioural and regional brain perfusion changes in OCD. Attenuation of pre-frontal perfusion following 5HT1B agonist administration is in line with the effects of SRIs. This work suggests that direct or indirect effects of SRIs on the 5HT1B receptor may be involved in mediating a clinical response in OCD. In the section exploring the intersection of neurobiology and treatment, I show that changes in rCBF partially parallel treatment response to SSRIs across a range of anxiety disorders. These data suggest that a degree of overlap exists in the neurobiology of treatment response or indeed core neurobiology across different anxiety disorders. I then show that effective treatment with inositol in OCD results in rCBF changes that are partially in line with the effects of SRIs on brain perfusion. These data support suggestions that second messengers may form part of the common pathway of action for effective anti-obsessional compounds. In the study in which we augmented SRIs with quetiapine, no advantage over placebo was found. This data has, however, recently been combined with similar data in meta-analyses and demonstrated a benefit over placebo. Finally, we found that patients who have failed fewer SRI trials, have more severe illness, and clinical dimensions with a putative dopaminergic underpinning, may derive preferential benefit from serotonin/dopamine antagonist augmentation of SRIs. Through this series of clinical treatment and functional brain imaging studies in OCD, I have contributed to the neurobiological understanding of OCD, and its treatment in refractory populations. In addition I have explored the intersection of these two domains using novel as well as conventional treatment across other anxiety disorders. Treatment and pharmacological challenges used, either directly or indirectly impacted the monoamine systems serotonin and dopamine and advanced our understanding of their involvement in symptom generation. Future work should focus on the functional intersection of brain function, treatment response, and functional genetic polymorphisms within the monoamine systems of the brain.
AFRIKAANSE OPSOMMING: Ondersoek na die neurobiologie van obsessief-kompulsiewe steuring (OKS) het in die afgelope dekades sinvolle bydraes gelewer tot die begrip van hierdie algemene en verminkende steuring. Bemoedigende vordering is ook in die farmakologiese behandeling van OKS gemaak. Dit het tot ’n verbetering in kwalitiet van lewe van meeste pasiënte gelei wat normaalweg kronies en onophoudelike simptome moet verduur. Ten spyte van die uiteenlopende gebruik van eerste-linie behandeling wat spesifiek inwerk op die serotonien sisteem in OKS, is relatief min bekend oor die neurobiologie van respons op behandeling. So ook is min bekend oor; eerstens die spesifieke komponente van die serotonien sisteem wat betrokke is by simptoom modulasie, en tweedens die gedeeltelik samevallende en afsonderlike brein streke wat deur alternatiewe farmakologiese behandelings beïnvloed word. Ten spyte van die vooruitgang wat die selektiewe serotonien heropname inhibeerders tot gevolg gehad het, is daar nog altyd ‘n betekenisvolle proporsie van pasiënte wat nie voldoende respondeer op hierdie behandelings opsie nie. Dus word alternatiewe opsies benodig. Een so ‘n opsie is die klas dopamien reseptor blokkeerders wat tot onlangs min ondersteunende data gehad het. So ook, is min bekend oor die subgroepe van pasiënte wat die meeste voordeel uit hierdie alternatief sal trek. In hierdie proefskrif sal ek ‘n reeks van ses studies wat farmakologiese middels en enkel foton emissie rekenaar tomografie (EFERT) gebruik om ‘n bydra tot kennis in drie primêre areas van OKS te maak. By name; neurobiologie, behandeling, en die kruispunt van die twee. Eerstens spreek ek neurobiologie aan deur middel van ’n studie wat rustende brein bloed vloei (rBBV) in OKS ondersoek. Hierna ondersoek ek veranderings op rBBV en simptome na eenmalige toediening van ‘n serotonien 1B reseptor agonis, sumatriptan. Tweedens ondersoek ek die kruispunt van neurobiologie en behandeling deur die effek van behandeling met inositol, ‘n voorloper van die fosfoinositol tweedeboodskapper sisteem, op rBBV. Ek ondersoek dan die rBBV patroon van veranderinge in brein streke wat deur twaalf weke van behandeling met die selektiewe serotonien heropname inhibeerder citalopram in verskeie angversteurings bewerkstellig word. Laastens, spreek ek behandeling van OKS aan deur middel van ‘n gekontroleerde studie wat ondersoek instel na die effektiwiteit van die byvoeging van quetiapien, ‘n dopamien reseptor antagonis, tot serotonien heropname inhibeerders in behandelingsweerstandige OKS. Ek kombineer dan hierdie data met ’n soortgelyke datastel om ‘n model af te lei wat kliniese uitkoms vir hierdie behandelings opsie voorspel. Ek het gedemonstreer dat rBBV in OKS betekenisvol verskil van gesonde vergelykbare kontroles. Hierdie verskille het gekorreleer met ernstigheid van OKS in frontale brein streke. Dus bly hierdie tipe studies ’n belangrike rigting van ondersoek in OKS patofisiologie wat tot op hede nie tenvolle uitgewerk is nie. Eenmalige toediening van sumatriptan, het heterogene gedrags en rBBV veranderings in OKS tot gevolg gehad. Pre-frontale verhogings in rBBV voor behandeling is met 5HT1B sumatriptan toediening verminder, ’n effek wat in lyn staan met die effek van selektiewe serotonien heropname inhibeerders. Hierdie werk stel voor dat direkte of indirekte effekte van selektiewe serotonien heropname inhibeerders op die 5HT1B reseptore betrokke mag wees by die meganisme van behandelingsrespons in OKS. In die afdeling waarin ek die kruispunt van neurobiologie en behandeling ondersoek, demonstreer ek dat rBBV veranderings gedeeltelik oorvleuel met dié wat deur selektiewe serotonien heropname inhibeerders veroorsaak word in verskeie angsversteurings. Hierdie data stel voor dat oorvleueling in die neurbiologie van beide behandelingsrespons en kern neurobiologie van hierdie angversteurings ’n waarskynlikheid is. Ek wys ook dat effektiewe behandeling met inositol in OKS ook veranderings in rBBV bewerkstellig wat gedeeltelik in lyn staan met dié van die selektiewe serotonien heropname inhibeerders. Hierdie data ondersteun dus hipoteses van ‘n gemeenskaplike meganisme, wat tweede boodskapper sisteme insluit, wat in die behandelings respons van effektiewe anti-obsessionale middels betrokke is. Die finale deel van hierdie proefskrif handel oor behandeling van OKS. Ten spyte van die onvermoë om ‘n verskil tussen quetiapien en plasebo te demonstreer, het ons onlangs met hierdie data in ‘n reeks meta-analises wel ‘n voordeel vir hierdie intervensie getoon. Ten slote, het ons gevind dat (1) pasiënte wat minder kursusse selektiewe serotonien heropname inhibeerders gefaal het; (2) voor behandeling ‘n erger vorm van OKS gehad het, en (3) ook voordoen met simptoom dimensies wat oënskynlik ‘n dopaminerge basis het, die grootste waarskynlikheid toon om met quetiapien byvoeging tot selektiewe serotonien heropname inhibeerders te respondeer. Met hierdie reeks behandelings en funksionele breinbeeldings ondersoeke, lewer ek ‘n bydra tot die begrip van OKS. Spesifiek dra ek by tot die begrip van die neurobiologie, hantering van behandelingsweerstandige OKS asook die kruispunt van die twee. Farmakologiese middels wat ons óf eenmalig óf vir ‘n volle behandelingskursus toegedien het, het direkte of indirekte uitwerkings op die serotonien and dopamien sisteme gehad, en dus dra hierdie werk ook by tot kennis oor dié se betrokkenheid al dan nie in simptoom modulasie in OKS. Toekomstige werk in die area sal in die breë fokus op die kruispunt van breinfunksie, behandelingsrespons en funksionele genetiese polimorfismes van die monoamien sisteem.

Childhood trauma is the primary reason children and adolescents display behavioral issues that require hospitalization. Implementation of a trauma-€informed care (TIC) program was the intervention chosen at a child and adolescent behavioral health hospital to decrease physical holds and seclusion rates for patients aged 3 to 17 and to reduce the risk of retraumatization of children needing psychiatric care. Six core strategies from the National Association of Mental Health Program Directors was the framework for this project. The number of crisis interventions before and after implementation were 440 and 259, respectively. The number of seclusions before implementation was 215, and total number of restraints was 225. The number of seclusions after implementation was 125, and total number of restraints was 134. Data showed that implementing a TIC program decreased the use of physical holds and seclusions by 26% within 6 months of program implementation. The implications of this project for positive social change include changing the approach to children with high-€risk behaviors by decreasing the risk for retraumatization.

Engaging in physical activity can help older adults to take part in community activities, maintain relationships, and initiate new friendships, thus preventing loneliness and depression. The purpose of this quality improvement (QI) project was to evaluate whether participation in physical activity improved depressive symptoms in 15 older adults at a local senior center. Pender’s health promotion model was used to determine nursing and behavioral science views on components that affect health behavior. The Exercise Benefit/Barrier Scale (EBBS) survey was evaluated before implementation of the walking program to measure the benefits of and barriers to exercise. The EBBS results showed that participants perceived physical activity as beneficial with high percentages in the dimensions of physical performance (90%) and psychosocial aspects (76%). The leading barrier to exercise was fatigue (50%). The 15 elderly participants tracked physical activity by counting the number of steps a day over a 2-month period with a mean number of steps of 3,788/day. The Patient Health Questionnaire-2 (PHQ-2) was administered before and after implementation of physical activity tracking to measure changes in mood and sadness over the past 2 weeks. Forty-seven percent of the participants had depressive symptoms before the program, compared to 13% after the program. Using descriptive statistics via percent difference, results revealed a 34% decrease in depressive symptoms in the program participants. Therefore, this QI project was successful in improving depressive symptoms among older adults. This project paves the way for positive social change through improved quality of life and improved physical/mental health outcomes for older adults who participate in a physical walking activity by decreasing depressive symptoms.

Thesis (DMed (Psychiatry))--University of Stellenbosch, 2005.
BACKGROUND Schizophrenia is a heterogeneous disorder, which has been shown to have both environmental and genetic risk factors. Since family history (genetic loading) of psychosis appears to be one of the strongest risk factors for the development of schizophrenia, the investigation of affected sib pairs can be used to explore shared familial factors. The Xhosa-speaking inhabitants in the Western, Eastern and Southern Cape provinces, an African population of relatively homogeneous ethnicity, provided a sample of the first large clinical phenotype of schizophrenia. AIM The main aim of this study was to identify shared symptoms or symptom clusters in a sample of Xhosa-speaking sib pairs, with the aid of structured assessment tools.

Background: Major depression is one of the most prevalent, disabling, and costly illnesses worldwide. Despite a 400% increase in antidepressant medication use since 1988, fewer than half of treated depression patients experience a clinically meaningful reduction in symptoms and uncertainty exists regarding how to successfully obtain symptom remission. Identifying homogenous subgroups based on clinically observable characteristics could improve the ability to efficiently predict who will benefit from which treatments. Methods: Latent class analysis and latent transition analysis (LTA) were applied to data from the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study to explore how to efficiently identify subgroups comprised of the multiple dimensions of depression and examine changes in subgroup membership during treatment. The specific aims of this dissertation were to: 1) evaluate latent depression subgroups for men and women prior to antidepressant treatment; 2) examine transitions in these subgroups over 12 weeks of citalopram treatment; and 3) examine differences in functional impairment between women’s depression subgroups throughout treatment. Results: Four subgroups of depression were identified for men and women throughout this work. Men’s subgroups were distinguished by depression severity and psychomotor agitation and retardation. Severity, appetite changes, insomnia, and psychomotor disturbances characterized women’s subgroups. Psychiatric comorbidities, especially anxiety disorders, were related to increased odds of membership in baseline moderate and severe depression subgroups for men and women. After 12 weeks of citalopram treatment, depression severity and psychomotor agitation were related to men’s chances of improving. Severity and appetite changes were related to women’s likelihood of improving during treatment. When functional impairment was incorporated in LTA models for women, baseline functional impairment levels were related to both depression subgroups at baseline and chances of moving to a different depression subgroup after treatment. Conclusion: Depression severity, psychomotor disturbances, appetite changes, and insomnia distinguished depression subgroups in STAR*D. Gender, functional impairment, comorbid psychiatric disorders, and likelihood of transitioning to subgroups characterized by symptom improvement differed between these subgroups. The results of this work highlight how relying solely on summary symptom rating scale scores during treatment obscures changes in depression that might be informative for improving treatment response.

Research on rates of HIV testing among individuals diagnosed with Bipolar Disorder (BPD) is limited, while HIV infection continues to rise among BPD individuals. The problem is that BPD individuals are at high risk for HIV infection due to non-adherence to treatment for bipolar disorder and manic episodes that can lead to high-risk behaviors. The goal of the study was to examine the association between selected demographic variables, having a bipolar diagnosis, engaging in high-risk behaviors, inability to afford treatment for bipolar disorder, non-adherence to treatment for bipolar disorder, and substance abuse, and their relationship to obtaining an HIV test (the dependent variable) for individuals with BPD. The epidemiologic triangle model served as the theoretical model to assist with interpreting findings. Data collected from 383 BPD diagnosed individuals from the 2007 National Health Interview Study were analyzed using binary logistic regression, chi-square, and multiple logistic regression methods. The results indicated that all 5 behavioral independent variables were significantly associated (p=.000) with obtaining an HIV test. Significant associations were also found for demographic variables (race, gender, and homelessness) as confounding factors that influenced HIV testing among BPD individuals. Implications for positive social change are increased education on the risks of HIV infection and the need for appropriate HIV testing among BPD diagnosed individuals in an effort to protect the health and welfare of this vulnerable population.

Dissertation (PhD)--Stellenbosch University, 2001.
ENGLISH ABSTRACT: Obsessive-compulsive disorder (OCD) is characterized by intrusive thoughts (obsessions) and repetiti ve mental acts or behaviours (compulsions) . For many years, it was considered a rather uncommon condition, caused by unconscious conflict, and somewhat resistant to treatment. In recent decades, however, it has emerged that OCD is a highly prevalent disorder, mediated by particular neuroanatomical circuits (e.g. striatal pathways) and neurochemical systems (e.g. the serotonin system), and responsive to treatment with serotonin reuptake inhibitors (SRIs) . Nevertheless, many questions remain; about the specificity of neuroanatomical findings to OCD, about the role of the multiple serotonin (5-HT) receptor subtypes (e.g. 5-HT10)' and about the appropriate pharmacotherapy for patients resistent to SRI treatment? In a series of studies, 1) the neuroanatomy of OCD was assessed by means of magnetic resonance imaging and neuropsychological testing, 2) the neurochemistry of OCD was assessed by means of functional brain imaging after administration of a 5-HT10 agonist, and 3) the pharmacotherapy of OCD was explored in a series of treatment-refractory OCD and OCD spectrum disorder patients using SRI augmentation with a dopamine blocker. Although no significant difference was found in the volume of the caudate in women with OCD and controls, there was a significant correlation between caudate volume and neuropsychological dysfunction in patients, consistent with evidence of striatal involvement in OCD. Functional imaging demonstrated behavioural heterogeneity, but brain-behaviour correlations were positive, consistent with preclinical evidence of a role for the 5-HTlD receptor in the mediation of OCD. Finally, preliminary treatment findings with dopamine blocker augmentation of a SRI were promising, consistent with preclinical understandings of the interactions between the dopamine and serotonin systems. Although oeD is a complex disorder, a number of future research avenues hold promise for providing a thorough delineation of its pathogenesis.
AFRIKAANSE OPSOMMING: Obsessief-kompulsiewe steuring (OKS) word gekenmerk deur indringende gedagtes (obsessies) en herhalende gedagtes of gedrag (kompulsies). Vir baie jare is dit beskou as 'n redelik seldsame toestand wat veroorsaak word deur onbewustelike konflik, en wat in 'n mate teen behandeling weerstandig is. Meer onlangs het dit egter na vore getree as 'n toestand wat baie dikwels voorkom, wat deur spesifieke neuroanatomiese siklusse (bv. striatale bane) en neurochemiese sisteme (bv. die serotonien-sisteem) teweeg gebring word, en wat op behandeling met serotonien heropname inhibeerders (SHIs) reageer. Nogtans is daar steeds baie vrae; oor die spesifisiteit van neuroanatomiese bevindinge vir OKS, oor die rol van die veelvuldige serotonien (5-HT) reseptor subtipes (bv. 5- HT1D), en oor die toepaslike farmakoterapie vir pasiënte wat weerstandig is vir SHI behandeling. In' n reeks van navorsingstudies, is 1.) die neuroanatomie van OKS deur middel van magnetiese resonans beelding en neurosielkundige toetse ondersoek, 2. ) die neurochemie van OKS deur middel van funksionele breinbeelding na toediening van 'n 5-HT1D agonis bepaal, en 3.) die farmakoterapie van OKS in 'n reeks van behandelingsweerstandige OKS en OKS-spektrum steuring pasiënte - waar gebruik gemaak is van SHI aanvulling met 'n dopamien-blokker - ondersoek. Alhoewel daar geen beduidende verskil in die volume van die caudata in vroue met OKS en kontroles gevind is nie, was daar 'n beduidende korrelasie tussen die caudata volume en neurosielkundige wanfunksionering in pasiënte, in ooreenstemming met striatale betrokkenheid in OKS. Funksionele beelding het positief, in demonstreer, maar ooreenstemming met brein-gedrag pre-kliniese heterogeneïteit korrelasies was in gedrag bewyse vir 'n rol vir die 5-HT1D reseptor in die bemiddeling van OKS. Ten laaste, voorlopige behandelingsbevindinge oor dopamienblokker aanvulling van 'n SHI is belowend, in ooreenstemming met v

Thesis (PhD)--Stellenbosch University, 2014.
ENGLISH ABSTRACT: The etiology of anxiety disorders remains incompletely understood. Clear evidence for a genetic component has been proposed; however, there is also an increasing focus on environmental factors and the interaction between these and the genetic components that may mediate (anxiety) disorder pathogenesis. No single gene or genetic component has been explicitly identified as being involved in the development of anxiety disorders. This is most likely due to a number of reasons, which include, for example, the heterogeneity of anxiety disorders, the contribution of environmental factors and methodological limitations (e.g. small sample size) of research studies. Until now, genetic association studies usually focused on one particular psychiatric disorder at a time. However, with the difficulty in identifying susceptibility genes and/or loci in heterogeneous disorders like obsessive-compulsive disorder and other conditions in the anxiety spectrum, it is perhaps timely to consider multivariate genetics and epidemiological studies in a number of disorders sharing a core characteristic – such as anxiety. In addition to genetic underpinnings, a number of environmental variables have also been identified as risk factors for pathological anxiety, including adverse life events like childhood physical and sexual abuse. The hypothesis for this project is that a pre-existing genetic vulnerability (or genetic risk) interacts with the impact of adverse life events to result in the development of one or more anxiety disorder(s). Considering phenotypic overlap amongst the anxiety disorders, it is likely that diverse networks of genes and/ or interacting pathways are responsible for the phenotypic manifestations observed. Sprague Dawley rats exhibiting behaviours indicative of anxiety in the context of environmental stressors (maternal separation and restraint stress) were used as model for the identification of novel susceptibility genes for anxiety disorders in humans. The striatum has previously been implicated as a candidate in the brain architecture of anxiety pathogenicity, and is also a site exhibiting a high degree of synaptic plasticity. The synaptic plasticity pathway was investigated using the dorsal striatum of the rat brain and several genes were identified to be aberrantly expressed in “anxious” rats relative to controls (Mmp9, Bdnf, Ntf4, Egr2, Egr4, Grm2 and Arc). In humans, it was found that the severity of early adversity was significantly and positively associated with the presence of an anxiety disorder in adulthood. When the human homologues of the susceptibility candidate genes that were identified using the animal model were screened in a human cohort of patients with obsessive-compulsive disorder (OCD), panic disorder (PD) or social anxiety disorder (SAD) (relative to controls), five single nucleotide polymorphisms (SNPs) were found to be significantly associated with these conditions. Four of these SNPs were also found to significantly interact with the severity of childhood trauma. Haplotype analysis of variants within the identified susceptibility candidates revealed novel haplotype associations, four of which are located in the MMP9 gene. Notably, this the first study to link these particular mutations in the MMP9 gene with anxiety disorders and this finding is consistent with previous work suggesting that MMP9 is involved in conditions like cardiovascular disease and cancer which have been associated with increased prevalence of anxiety disorders. In conclusion, this project yielded important findings pertaining to the etiology of anxiety disorders. The use of a combined anxiety disorders cohort (OCD, PD and SAD) may suggest that the associations found here may hold true for anxiety disorders in general and not only for a particular clinically delineated condition. Childhood trauma was confirmed as an increased susceptibility risk for anxiety disorders. Also, this research contributed several novel susceptibility genes (MMP9, EGR2, EGR4, NTF4, and ARC), five significant SNP associations, four significant SNP-environment interactions and five haplotype associations (within MMP9 and BDNF) as candidates for anxiety pathogenicity. The identified polymorphisms and haplotypes were demonstrated to be associated with susceptibility to anxiety disorders in a gene-environment correlation and gene-environment interaction.
AFRIKAANSE OPSOMMING: Die oorsake van angssteurings word steeds nie volledig verstaan nie. Daar is duidelike bewyse vir 'n genetiese komponent, maar daar is ook toenemende fokus op omgewingsfaktore en die interaksie tussen hierdie omgewingsfaktore en genetiese komponente by angssteurings. Geen enkele geen of genetiese komponent is al geïdentifiseer as diè wat betrokke is by die ontwikkeling van angssteurings nie. Dit is waarskynlik weens 'n aantal redes, wat byvoorbeeld, die heterogeneïteit van angssteurings, die bydrae van omgewingsfaktore en metodologiese beperkings (bv. klein steekproef) van die navorsingstudies, insluit. Verder het genetiese assosiasiestudies tot nou toe gewoonlik net op een spesifieke psigiatriese versteuring op 'n slag gefokus. Maar, gegewe die uitdaging om vatbaarheidsgene en / of loci in heterogene steurings soos obsessief – kompulsiewe steuring (OKV) en ander toestande op die angsspektrum te identifiseer, is dit tyd om genetiese en kliniese studies in ‘n aantal steurings - met ‘n oorvleuende kern-element soos angs -, gesamentlik te oorweeg. Bykomend tot die genetiese boustene, is ‘n aantal omgewingsveranderlikes soos traumatiese lewenservarings tydens die kinderjare as risikofaktore vir patologiese angs geidentifiseer. Die hipotese vir hierdie projek is dat daar 'n interaksie tussen genetiese kwesbaarheid (of genetiese risiko) en traumatiese lewensevarings is en dat dit tot die ontwikkeling van 'n / veelvoudige angssteuring(s) kan lei. Inaggenome die fenotipiese oorvleueling tussen die angssteurings, is dit waarskynlik dat diverse netwerke van gene en / of interaktiewe geen-paaie vir die manifestasie van hierdie toestande verantwoordelik is. Sprague Dawley-rotte met gedragswyses aanduidend van angs, in die konteks van omgewingstressore (d.i. skeiding van die ma-rot en bedwang-stres [restraint stress]), is as model gebruik vir die identifisering van nuwe vatbaarheidsgene vir angssteurings in mense. Die striatum is voorheen as ‘n kandidaat in die brein-argitektuur van patologiese angs voorgehou, en is ook ‘n plek met ‘n hoë mate van sinaptiese plastisiteit. Die sinaptiese plastisiteit is ondersoek deur te fokus op die dorsale striatum van die rotbrein en daar is verskeie gene gevind wat anders is in “angstige” rotte in vergelyking met kontroles (Mmp9, Bdnf, Ntf4, Egr2, Egr4, Grm2 en Arc). In mense is daar gevind dat die ernstigheidsgraad van vroeë trauma beduidend en positief met die teenwoordigheid van ‘n angssteuring tydens volwassenheid verband hou. Toe die menslike ekwivalente van die vatbaarheidsgene wat met die dieremodel geïdentifiseer is in ‘n mens-kohort met obsessief-kompulsiewe steuring (OKS), panieksteuring (PS) en sosiale angssteuring (SAS) ondersoek is, is gevind dat daar 5 enkele nukleotied polimorfismes (ENPs) is wat met die toestande verband hou. Daar is ook gevind dat vier van hierdie ENPs beduidend verband hou met die ernstigheidsgraad van trauma tydens die kinderjare. Haplotipe analise van variante binne die geïdentifiseerde vatbaarheidsgene het op nuwe haplotipe assosiasies – waarvan 4 op die MMP9-geen geleë is – gedui. Hierdie is dus die eerste studie wat gevind het dat dié spesifieke mutasies van die MMP9-geen met angssteurings verband hou. Hierdie bevinding strook met vorige werk wat daarop dui dat die MMP9-geen by toestande soos kardiovaskulêre siekte en kanker wat ook met verhoogde voorkoms van angssteurings verband hou, betrokke is. Ter afsluiting kan ons sê dat hierdie projek belangrike bevindinge oor die oorsake van angssteurings gemaak het. Die gebruik van ‘n gekombineerde angssteurings-kohort (OKS. PS en SAS) kan moontlik suggereer dat die assosiasies wat ons hier gevind het, waar is vir alle angssteurings en nie net vir ‘n spesifieke afgebakende toestand nie. Traumatiese ervarings tydens die kinderjare is ook bevestig as ‘n risiko vir die ontwikkeling van angssteurings. Hierdie navorsing het ook verskeie nuwe vatbaarheidsgene (MMP9, EGR2, EGR4, NTF4, en ARC), 5 beduidende ENP assosiasies, 4 beduidende ENP-omgewings-interaksies en 5 haplotipe assosiasies (by MMP9 en BDNF) geïdentifiseer as moontlike kandidate wat ‘n rol speel by die ontstaan van patologiese angs. Daar is ook gevind dat die geïdentifiseerde polimorfismes en haplotipes met vatbaarheid vir angssteurings in ‘n geen-omgewing- korrelasie en geen-omgewing- interaksie verband hou. Stellenbosch University http://scholar.sun.ac.za

Background: The mood stabilizer lithium has long been reported to be associated with reduced suicide risks, but many studies reporting associations between lithium and reduced suicide risks also have been nonrandomized and lacked adjustment for many potential confounders, active controls, uniform follow-up, or intent-to-treat samples. Concerns also have been raised that medications being considered as potential suicide preventative might increase risks of nonsuicide mortality while reducing risks of suicide. Methods: Three studies of Veterans Health Administration (VHA) patients were conducted combining high-dimensional propensity score matching with intent-to-treat analyses to examine the associations between lithium and valproate and one-year suicide and nonsuicide mortality outcomes. Results: In intention-to-treat analyses, initiation of lithium, compared to valproate, was associated with increased suicide mortality over 0-365 days among patients with bipolar disorder (Hazard Ratio (HR) 1.50 [95% Confidence Interval 1.05, 2.15]) Nonsuicide mortality among VHA patients with or without bipolar disorder was not significantly associated with the initiation of lithium compared to valproate ( HR 0.92 [0.82-1.04]). Rates of treatment discontinuation, however, were very high (≈ 92%). Longitudinal analyses revealed that the increased suicide risks associated with initiating lithium among patients with bipolar disorder occurred exclusively after discontinuation of lithium vii treatment. In secondary analyses restricted to patients still receiving their initial treatment, there was no difference in suicide risk between the initiation of lithium or valproate. Conclusions: Significantly increased risks of suicide were observed at one year among VHA patients with bipolar disorder initiating lithium compared to valproate, related to risks observed after the discontinuation of lithium treatment Since these studies are nonrandomized, confounding may account for some or all of our findings, including the risks observed after lithium discontinuation. Nevertheless, these results suggest that health systems and providers consider steps to minimize any potential lithium discontinuation-associated risk. Approaches might include educating patients about possible risks associated with discontinuation and closely monitoring patients after discontinuation if feasible. Given the obvious importance of any substantive difference between lithium and valproate in suicide or nonsuicide mortality risk, our studies also suggest that further research is needed, especially research that can further minimize the potential for confounding.

Thesis (PhD)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: It is more than 18 years since South Africa became a democratic country. However, many South Africans are still discriminated against when accessing state services, such as healthcare services (Drennan, 1999). The problem is that healthcare practitioners, in the higher positions of the healthcare system, are commonly made up of professionals who speak only one or at most two of South Africa’s official languages (Swartz, 1998). Due to the lack of funding ad hoc arrangements are made for interpreter-services (Drennan, 1999). Anyone available that can speak even a fragment of the patient’s language, such as nurses, household aides and security guards are called to act as interpreters (Drennan, 1999; Smith, 2011). In many clinical settings, although not ideal, it is possible to treat patients even if there are minimal shared communicative resources (Anthonissen & Meyer, 2008). However, in psychiatric care, language is the primary diagnostic tool, and is one of the central instruments through which patients voice their symptoms (Westermeyer & Janca, 1997). In the Western Cape (one of the nine provinces in South Africa), clinicians working in psychiatric care are mainly fluent in English and Afrikaans. Many Black isiXhosa-speaking patients are not proficient in these languages. The aim of this dissertation is to gain a better understanding of the language barriers facing isiXhosa-speaking patients by focusing on natural conversations, which take place during psychiatric interviews within a particular psychiatric institution in the Western Cape. I made video-recordings of interpreter-mediated psychiatric interviews (n=13) as well as psychiatric interviews (n=12) conducted without the use of an interpreter. In addition, I had discussions (i.e. through semi-structured interviews) with registrars, interpreters and patients to understand their views about issues related to language barriers and interpreting practices. I used an ethnographic approach and the method of Conversation Analysis to understand the study findings. The findings, derived from the psychiatric interviews that were not interpreter-mediated, suggest that the Limited English Proficient (LEP) patients had great difficulty communicating with the registrars. The findings (emerging from the interpreter-mediated encounters and semi-structured interviews), strongly suggest that the haphazard use of hospital employees, who are not trained and employed to act as interpreters, have a significant impact on the goals of the psychiatric interview. In some instances, the use of ad hoc interpreters positively contributed to the successful achievement of the goals of the psychiatric interview. In most instances, the use of ad hoc interpreters inhibited the successful achievement of the goals of the psychiatric interview. One of the most significant findings was that interpreters’ interpretations of patients’ words at times suggest that patients appear to be more psychiatrically ill (increasing the risk for over-diagnosis) than it appears when looking at patients’ original responses. In essence, the lack of language services is unjust towards patients, clinicians, hospital staff acting as ad hoc interpreters, and LEP patients caught in a system, which construct them as voiceless, dependent, powerless, healthcare users.
AFRIKAANSE OPSOMMING: Suid-Afrika is vir die afgelope 18 jaar `n demokratiese land, maar ongeag die afskaffing van apartheid word daar steeds teen baie Suid-Afrikaners gediskrimineer. Dit is veral die geval wanneer Suid-Afrikaners gebruik maak van gesondheidsdienste (Drennan, 1999). Baie gesondheidspraktisyne of dokters is alleenlik vaardig in een of op die meeste twee offisiële Suid-Afrikaanse tale (Swartz, 1998). Ongelukkig weens `n gebrek aan fondse, is die meeste hospitale nie instaat om amptelike tolke in diens te neem nie. Gevolglik word ad hoc reëlings getref wanneer pasiënte tolkdienste benodig. Gewoonlik word enige iemand, insluitende verpleegsters, skoonmakers en sekuriteitswagte, wat selfs net tot `n sekere mate die pasiënt se taal kan praat, gebruik as tolke (Drennan, 1999; Smith, 2011). Die gebrek aan tolkdienste is veral problematies wanneer dit kom by psigiatriese dienste. Dit is omdat in psigiatrie word taal en kommunikasie as primêre diagnostiese instrument gebruik, en pasiënte gebruik hoofsaaklik taal om hul simptome en ervaringe met die dokter mee te deel (Westermeyer & Janca, 1997). In die Wes-Kaap (een van Suid-Afrika se nege provinsies) is die meeste dokters wat in psigiatriese instansies werk hoofsaaklik Engels en / of Afrikaans-sprekend. Baie Swart isiXhosa-sprekende pasiënte, wat gebruik maak van psigiatriese staatsdienste, is egter nie vlot in Afrikaans en Engels nie. Die doel van my proefskrif is om hierdie probleem, wat baie siXhosa-sprekende pasiënte in die gesig staar, beter te verstaan. Ek het besluit om dit te doen deur te fokus op `n spesifieke aspek – natuurlike gesprekke tussen dokters en isiXhosa-sprekende pasiënte. Dokters en pasiënte kommunikeer onder andere gedurende psigiatriese onderhoude, en ek het besluit om video opnames van psigiatriese onderhoude te maak. Ek het die video opnames in `n spesifieke hospitaal in die Wes-Kaap gemaak. Die video opnames het ingesluit psigiatriese onderhoude (n=12) waarin die dokter en pasiënt in Engels kommunikeer, sowel as onderhoude (n=13) waarin die dokter en pasiënt deur middel van (d.m.v) `n ad hoc tolk kommunikeer. Ek het ook gesprekke gevoer (deur middel van semi-gestruktureerde onderhoude) met pasiënte, dokters, en ad hoc tolke om hulle insigte en opinies rakende die bogenoemde taalkwessies beter te verstaan. Verder het ek `n ethnografiese benadering en gespreksanaliese gebruik om die data te benader en verstaan. Die bevindinge wat voortgevloei het uit die psigiatriese onderhoude (beide waarin daar nie `n tolk gebruik was nie, sowel as die waarin daar `n tolk gebruik was) suggereer dat die gebrek aan tolkdienste dikwels die doel van psigiatriese onderhoud ondermyn. Dit komvoor dat in die psigiatriese onderhoude, waarin daar nie tolk gebruik was nie, die pasiënte dit baie moeilik gevind het om met die dokters in Engels te kommunkeer. Dit is waarskynlik omdat hulle nie oor die nodige taalvaardighede beskik om hulleself ten volle in Engels uit te druk nie. Dit kom wel voor dat in sommige gevalle gedurende die psigiatriese onderhoude, waarin die dokters en pasiënte d.m.v.`n tolk gekommunikeer het, het die gebruik van `n tolk `n positiewe impak gehad. Die probleem is egter dat in baie gevalle het dit geblyk het die gebruik van tolke `n ongewenste impak gehad. Een van die belangrikste voorbeelde hiervan is dat die tolke se weergawes van die pasiënte se woorde, dit dikwels laat voorkom asof pasiënte nie juis veel insig in hulle psigiatriese versteurings gehad het nie. Wanneer daar egter gekyk word na die pasiënte se oorspronklike weergawes is dit duidelik dat sommige pasiënte wel insig gehad het. Die bevindinge suggereer hoofsaaklik dat die gebrek aan offisieel en opgeleide tolkdienste onregverdig is teenoor die pasiënte, ad hoc tolke, en die dokters. Dit dra ook by tot `n gesondsheids-sisteem waarin isiXhosa-sprekende pasiënt uitgebeeld word as afhanklik, tot `n groot mate magteloos en sonder `n sê.

Thesis (DMed (Psychiatry))--University of Stellenbosch, 2007.
This study reports on the effect of seminar education by studying changes in knowledge, attitude and behaviour to haloperidol prescribing patterns of psychiatrists who In summary, this study demonstrated a direct relationship between seminar attendance and changes to selected minimum effective haloperidol dose and duration of treatment. However, seminar attendance did not appear to be a significant factor in changes to antipsychotic class used for treatment and changes in optimal effective haloperidol dose: rather a change in the level of “background” knowledge of participants was most likely responsible. This study also found individual participant characteristic differences in those who did change treatment duration and minimum effective dose. In conclusion, this study showed that the successful integration of international treatment recommendations into daily psychiatric practise could be facilitated by the use of appropriate educational seminars. Not all attendees benefit i.e. “learn”, but those needing to “learn” most do - i.e. those who need to change their prescribing habits most to meet internationally accepted guidelines. The peer exposure provided allows a format for informed discussion and the practise of evidence-based medicine. The judicious use of such seminars should result in better treatment options and outcomes for patients.attended evidence-based schizophrenia seminars presented by the Lundbeck Institute in Denmark. The objectives of the study were two-fold. Firstly, it set out to determine whether changes actually occurred in the post-seminar haloperidol prescribing behaviour of participants. This was done by analysing changes in choice of optimal haloperidol dose (both in acute treatment i.e. most effective dose and maintenance treatment i.e. minimum effective dose), selected duration of treatment (for first- and multi-episode schizophrenia patients) and drug-class used (conventional versus new generation antipsychotic). The study then investigated whether these changes (if they occurred) could be ascribed wholly or in part to the effect of schizophrenia seminar attendance, or whether other factors e.g. scientific progress over time in understanding schizophrenia and its treatment (“background” knowledge) and differences between participant datasets studied (only paired pre- and post-seminar data were used in this study) also played a role. Secondly, it attempted to identify factors predictive of seminar participants changing their haloperidol prescribing behaviour post-seminar i.e. what were the factors that predisposed some attendees to change their prescribing behaviour? This was done by analysing the effect that pre-seminar prescribing behaviour, participant nationality, patient caseload, work experience and workplace environment had on post-seminar behaviour. Results show that changes did occur in post-seminar haloperidol prescribing behaviour, but that they were not always due to an effect of seminar attendance. Only the changes in the minimum effective haloperidol dose and duration of treatment for first- and multi-episode schizophrenia patients could validly be ascribed to the effects of schizophrenia seminar attendance. Furthermore, multivariate analysis of the factors relating to these changes found that a participant was most likely to change their selected minimum effective haloperidol dose to be more in line with internationally accepted standards if they i) selected above the target dose pre-seminar, ii) had a relatively low caseload comprised mainly of schizophrenia patients and iii) came from either Greece, Germany, Britain, Spain, Italy or some other Eastern European country. The single most important factor related to changes in duration of treatment was found to be pre-seminar behaviour: respondents below the recommended duration of treatment increased their duration of treatment significantly.

The history of the care of the mentally ill in Britain, which has been broadly reflected in Western Australia since 1826, can be conveniently, if simplistically divided into a number of epochs. Each epoch is characterised by a particular focus or paradigm of clinical management, which prevails over a period of time but is then followed by a comparatively short period of rapid change to a new paradigm. Such changes are shaped by a number of forces, but three categories can be readily identified. These are: concepts of mental illness; reactions of administrative systems and the attitudes of medical practitioners. As the concept of the nature of mental illness has changed, succeeding epochs have evolved to a more humane and enlightened approach to the mentally ill. Nevertheless, each management paradigm has failed to deliver the expected 'cures' and the consequent reduction in the burden of illness. Each has been replaced by a new and radically different paradigm, often at enormous cost, but there has been no progressive evolution towards a system that incorporates measures that have proven value. In recent years 'Community Care', has failed in such a manner that there have been strong arguments that it should be abandoned. At the same time there is evidence that a new paradigm 'Primary Care Psychiatry' is emerging as government policy. The challenge is to preserve the best elements of community care and integrate Primary Care Psychiatry into the broader framework. The best chance of achieving this is to develop a gradual, evolutionary process, built on consensus between psychiatrists, general practitioners and administrators.
The purposes of the present research are threefold: to develop a conceptual model for an optimal community based mental health service. Then by examining the views of general practitioners, psychiatrists and administrators, determine the degree of congruence of these views. This is achieved by a qualitative study comprising extended interviews with 24 GPs, 15 psychiatrists and 11 administrators. This approach is chosen over a more broadly based, structured questionnaire approach for two reasons. Firstly, the views expressed in informal face to face interviews are more likely to be true expressions of opinion, especially when these are critical. Secondly, by using a comparatively unstructured approach, the stakeholders are able to express views on issues that they consider important. Finally, the areas of consensus and disagreement are analysed and recommendations made on strategies to develop a plan for a practical, viable service in a local area.

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Thesis (M.A.)--University of South Florida, 2003.
Includes bibliographical references.
Text (Electronic thesis) in PDF format.
ABSTRACT: The development of ideas on deinstitutionalization of mental patients has a much longer history in the United States than is commonly acknowledged. Evidence of intense discussion on the rights of the mentally disturbed, curative as opposed to control measures in their treatment, and the drawbacks of congregating the afflicted in large institutions can be found as early as the middle of the 19th century. This discussion was provoked by dissemination of knowledge about the oldest community care program of all: the colony of mental patients in Gheel, Belgium. Based on document analysis of publications in the American Journal of Insanity from 1844 to 1921, this study attempts to trace how this discussion resulted in the first wave of deinstitutionalization in the American mental health care system, and the successful implementation of the alternative of hospital treatment.
ABSTRACT: My study further documents how the development of this program was inhibited by the need of psychiatry to attain professional legitimation. In its struggle to acquire public respect and occupational authority, the profession focused on somatic explanations of disease that could justify categorization of psychiatry as a branch of medical science. While this claim was not decisively supported by laboratory findings, or the ability to cure patients, psychiatry put forward genetic explanations of mental disorder. This took the profession to the extreme of the eugenics movement, and eventually positioned it as an institution of social control instead of medical authority. Having thus failed to achieve the ultimate professional legitimation in the medical field, psychiatry was exposed to a new wave of criticism in the 1960s, which led to the second wave of deinstitutionalization. History repeated itself with the same outcome.
ABSTRACT: In the absence of overall support within psychiatric circles, and a lack of appreciation of family care as a viable alternative to hospital treatment among social scientists, deinstitutionalization could not but fail again. The contribution of the study lies in the areas of deinstitutionalization, professionalization of expert labor, and the social construction of mental illness and deviance.
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Thesis (PhD)--Stellenbosch Univesity, 2011.
ENGLISH ABSTRACT: It is well established that South African women are disproportionately affected by HIV/AIDS and gender based violence. Research to date has provided evidence for neurocognitive decline in individuals infected with HIV/AIDS and in individuals who have experienced early life trauma. However, many gaps remain in our knowledge about the neurocognitive profile of HIV and childhood trauma in South African women. The present study focused on the neurocognitive effects of HIV infection and childhood trauma, both separately and in combination in South African women. The primary aim of the study was to assess neurocognitive functioning in HIV-positive and matched HIVnegative controls, with and without a history of childhood trauma. Moreover, the study sought to assess the synergistic relationship between HIV and childhood trauma in influencing neurocognitive outcomes, a relationship which has not yet been investigated. A neuropsychological battery sensitive to HIV-related impairments was administered to 83 HIV-positive and 47 matched HIV-negative women with histories of childhood trauma. A history of childhood trauma was assessed using the Childhood Trauma Questionnaire short form (CTQ-SF). Forty eight of the 83 HIV-positive women were exposed to childhood trauma. Among the control subjects, a total of twenty women were exposed to childhood trauma. Findings of the present study revealed neurocognitive deficits in memory and executive functions. Results demonstrated significant HIV effects in memory (HVLT-R learning and delay trials), and executive functions (Halstead Category test). Similarly, a trauma effect was evident in delayed recall (HVLT-R delay). Moreover, results revealed a significant interaction effect between HIV status and trauma status on the WAIS-III Symbol Search Task, a task of psychomotor speed. However, HIV-negative controls with a history of childhood trauma scored the highest on this task. Although this finding was unexpected, it may suggest that psychomotor speed may not be a sensitive or discriminating test of childhood trauma in healthy adults. The present study demonstrated evidence for HIV and trauma effects in the ability domains of learning and delayed recall and executive functions. Although the present study did not find evidence for a synergistic relationship between HIV and trauma, it did provide evidence for both HIV and trauma effects on neurocognition, a finding in keeping with previous studies. Future research should be prospective in nature and should better delineate the nature, severity, and temporal relationship of childhood trauma to neurocognitive outcomes, as well as the mediators and moderators of these outcomes.
AFRIKAANSE OPSOMMING: Dit is alombekend dat Suid-Afrikaanse vroue buite verhouding swaar deur MIV/vigs en geslagsgebaseerde geweld getref word. Navorsing tot dusver lewer bewyse van neurokognitiewe verswakking by individue met MIV/vigs sowel as individue wat vroeg in hulle lewe reeds trauma ervaar het. Tog is daar steeds vele gapings in ons kennis oor die neurokognitiewe profiel met betrekking tot MIV en kindertrauma onder Suid- Afrikaanse vroue. Hierdie studie konsentreer op die neurokognitiewe uitwerking van MIV-infeksie en kindertrauma, afsonderlik sowel as gesamentlik, op Suid-Afrikaanse vroue. Die hoofdoel van die studie was om neurokognitiewe funksionering by MIV-positiewe vroue te bepaal en dit met gepaste MIV-negatiewe kontrolepersone te vergelyk, met én sonder 'n geskiedenis van kindertrauma. Daarbenewens wou die studie die sinergistiese verwantskap tussen MIV en kindertrauma in hul impak op neurokognitiewe uitkomste bepaal – 'n verwantskap wat tot dusver nog nie ondersoek is nie. 'n Neurosielkundige toetsbattery wat gevoelig is vir MIV-verwante swakhede is onder 83 MIV-positiewe vroue en 47 gepaste MIV-negatiewe kontrolepersone met 'n geskiedenis van kindertrauma afgeneem. 'n Geskiedenis van kindertrauma is met behulp van die kort weergawe van die kindertraumavraelys (CTQ-SF) vasgestel. Agt-en-veertig van die 83 MIV-positiewe vroue is as kinders aan trauma blootgestel. Van die kontrolegroep het 20 vroue in hul kindertyd trauma beleef. Die studie het neurokognitiewe tekorte in korttermyngeheue én uitvoerende funksies aan die lig gebring. Die resultate het 'n beduidende MIV-verwante uitwerking op korttermyngeheue (hersiene Hopkins- verbale leer-en-vertragingstoets, oftewel HVLT-R) sowel as uitvoerende funksies (Halstead-kategorietoets) getoon. Eweneens het die studie op 'n duidelike traumaverwante uitwerking op herinneringsvermoë (HVLT-R-vertraging) gedui. Daarbenewens het die WAIS-II- (Wechsler-volwassene-intelligensieskaal) simboolsoekopdrag – 'n psigomotoriese spoedtoets – 'n beduidende wisselwerkingseffek tussen MIV-status en traumastatus getoon. Tog het MIV-negatiewe kontrolepersone met 'n geskiedenis van kindertrauma die beste in hierdie opdrag gevaar. Hoewel hierdie bevinding verrassend was, kan dit daarop dui dat psigomotoriese spoed dalk nie 'n gevoelige of diskriminerende toets van kindertrauma by gesonde volwassenes is nie. Die studie het bewys gelewer van MIV- en traumaverwante uitwerkings op korttermyngeheue en uitvoerende funksies. Hoewel die ondersoek nie bewyse van 'n sinergistiese verwantskap tussen MIV en trauma kon vind nie, het dit wél bevestig dat MIV en trauma neurokognitiewe werking beïnvloed – 'n bevinding wat in pas is met vorige studies. Toekomstige navorsing behoort ondersoekend te wees en die aard, felheid en tydgebondenheid van die verwantskap tussen kindertrauma en neurokognitiewe uitkomste, sowel as die mediator- en moderatorveranderlikes van hierdie uitkomste, beter te omskryf.

Thesis (PhD (Psychiatry))--Stellenbosch University, 2008.
BACKGROUND: Schizophrenia is a heterogeneous illness resulting from complex gene-environment interplay. The majority of molecular genetic work done has involved Caucasian populations, with studies in these and Asian populations showing 2-32% of sufferers to have chromosomal aberrations. So far the discovery of a specific susceptibility mechanism or gene still eludes us, but the use of endophenotypes is advocated as a useful tool in this search. No cytogenetic studies of this nature have been reported in any African schizophrenia population. AIM: The aim of the study was to combine genotypic and phenotypic data, collected in a homogenous population in a structured manner, with the hope of characterising an endophenotype that could be used for more accurate identification of individuals with possible chromosomal abnormalities. METHODOLOGY: A structured clinical interview was conducted on 112 Xhosa schizophrenia patients. (Diagnostic Interview for Genetic Studies, including Schedules for the Assessment of Negative and Positive Symptoms.) Blood samples (karyotyping and/or FISH analysis) as well as urine samples (drug screening) were obtained and nine head and facial measurements were performed. Descriptive statistics were compiled with reference to demographic, clinical and morphological variables. Comparisons between mean differences for these variables were made.

Thesis (PhD)--Stellenbosch University, 2013.
ENGLISH ABSTRACT: HIV infection, substance abuse, and psychiatric disorders are major public health issues in South Africa. Psychiatric disorders and substance-use disorders together have a negative impact on the health outcomes of people living with HIV and AIDS (PLWHA), such as poor adherence to anti-retrovirals (ARVs), HIV disease progression, lower CD4 counts, vulnerability to opportunistic infections, high viral loads, possible drug resistance, and an earlier onset of death. The overall aim of this study was to investigate the relationship between substance abuse practices and the health status and health behaviour of patients attending HIV clinics in the Cape Metropole. The study used a cross-sectional study design for collecting data on hazardous or harmful use of alcohol and problematic drug use, demographic information and health status among patients attending eight HIV clinics in the Cape Metropole. A sub-sample of patients were assessed on the following domains: depression, psychological distress, psychopathology, post-traumatic stress disorder (PTSD), risky sexual behaviour, adherence to ARVs, levels of resilience, levels of social support and patient’s work, family and social functioning. Of the 608, 10% of consecutively selected patients completed an additional psychiatric diagnostic interview (Mini International Neuropsychiatric Interview). The main findings to emerge from this study are: 1. Patients reporting hazardous or harmful use of alcohol and/or drug use are significantly more likely to be non-adherent to ARVs and have lower CD4 counts than their non-substance abusing counterparts 2. Hazardous or harmful use of alcohol has a direct influence on CD4 count resulting in lower CD4 counts and participants being less likely to be on ARVs. 3. Hazardous or harmful use of alcohol has a direct relationship in predicting tuberculosis (TB). 4. Hazardous or harmful users of alcohol and/or problematic drug users are more likely to report psychological distress (anxiety and depression), depression and low levels of family support than their non-using counterparts. 5. Participants who met the criteria for major depression are significantly more likely to be non-adherent to ARVs. 6. Gender, depression, psychological distress, and PTSD were found to be significant determinants of hazardous or harmful use of alcohol. 7. Psychological distress (anxiety and depression) is significant in directly predicting ARV non-adherence. 8. Male participants and those who stopped taking their ARVs were more likely to have lower CD4 counts than female participants and those who did not stop. 9. PTSD was found to predict psychological distress indicating that participants who experienced trauma were more likely to suffer from psychological distress (anxiety and depression) compared to those who did not experience any PTSD. Participants with lower levels of family support were more likely to suffer from psychological distress than those with high levels of family support.
AFRIKAANSE OPSOMMING: MIV infeksie, dwelmmisbruik en geestesversteurings is groot gesondheidskwessies in Suid-Afrika. Geestesversteurings en dwelmmisbruik het gesamentlik 'n negatiewe uitwerking op die gesondheid van mense wat met MIV en VIGS saamleef (PLWHA), soos byvoorbeeld nie-nakoming in die gebruik van antiretrovirale (ARV’s), MIVsiekteverloop, laer CD4-tellings, vatbaarheid vir opportunistiese infeksies, hoë virale ladings, moontlike weerstand teen medikasie en 'n verkorte leeftyd. Die oorkoepelende doel van hierdie studie was om die verhouding tussen dwelmmisbruik en die gesondheidstatus en -gedrag van pasiënte wat MIV klinieke in die Kaapse Metropool besoek, te bestudeer. Die studie het 'n deursnee-ontwerp gebruik om data in te samel oor die nadelige en gevaarlike gebruik van alkohol en problematiese dwelmgebruik, demografiese inligting, en die gesondheidstatus onder pasiënte wat agt MIV klinieke in die Kaapse Metropool besoek het. 'n Subgroep pasiënte geassesseer op die volgende gebiede: depressie, psigologiese angsversteuring, psigopatologie, posttraumatiese stresversteuring (PTSV), riskante seksuele gedrag, nakoming in die gebruik van ARV’s, weerstandigheidsvlakke , vlakke van sosiale ondersteuning, asook pasiënte se werk, familie en sosiale funksionering. Van die 608 deelnemers is 10% van die pasiënte opeenvolgend geselekteer om 'n addisionele diagnostiese psigiatriese onderhoud te ondergaan (Mini International Neuropsychiatric Interview). Die vernaamste bevindinge wat uit die studie gekom het, is: 1. Pasiënte wat nadelige en gevaarlike gebruik van alkohol en/of dwelms rapporteer is beduidend meer geneig om nie die gebruik van ARV’s na te kom nie, en het laer CD4-tellings as hulle eweknieë wat nie dwelms misbruik nie. 2. Die nadelige en gevaarlike gebruik van alkohol het 'n direkte invloed op CD4- tellings wat lei tot laer CD4-tellings en dat pasiënte minder geneig is om op ARV’s te wees. 3. Die nadelige en gevaarlike gebruik van alkohol hou direk verband met die voorspelbaarheid van tuberkulose (TB). 4. Nadelige en gevaarlike gebruikers van alkohol en/of problematiese dwelmgebruikers, is meer geneig om psigologiese angsversteurings (angs en depressie), depressie, en laer vlakke van familieondersteuning te rapporteer as hul niegebruiker-eweknieë. 5. Deelnemers wat aan die kriteria vir ernstige depressie voldoen, is aansienlik meer geneig tot nie-nakoming in die gebruik van ARV’s. 6. Daar is gevind dat geslag, depressie, psigologiese angs en PTSV beduidende bydraende faktore is tot die nadelige en gevaarlike gebruik van alkohol. 7. Psigologiese angsversteurings (angs en depressie) is beduidend om direk die nie-nakoming van ARV’s te voorspel. 8. Manlike deelnemers en diegene wat hul ARV’s gestaak het, was meer geneig om laer CD4-tellings te hê as vroulike deelnemers en diegene wat nie die gebruik van medikasie gestaak het nie. 9. Daar is gevind dat PTSV psigologiese angs voorspel het wat aandui dat deelnemers wat trauma ondervind het, meer geneig was om aan psigologiese angsversteurings (angs en depressie) te ly in vergelyking met diegene wat geen PTSV ervaar het nie. Deelnemers met laer vlakke van familieondersteuning was meer geneig om aan psigologiese angsversteurings te ly as diegene met hoë vlakke van familiebystand.

Depression is a common comorbidity in rheumatoid arthritis (RA), yet it may not be adequately recognized during routine clinical care. RA symptoms may confer a risk for depression, and vice versa; depression may affect RA disease activity and response to treatment. The study aims were to compare patient- and physician-reported depression measures, evaluate the temporal bi-directional association between RA disease activity and depressive symptomology, and assess depression as a moderator of RA treatment. Patients were identified using a national RA registry sample (Consortium of Rheumatology Researchers of North America; CORRONA). Depression prevalence and incidence rates were estimated, and concordance and disagreement using measures reported separately by patients and physicians, as well as baseline cross-sectional associations between RA disease and a history of depression. A survival analysis was conducted to temporally predict the incident onset of self-reported depressive symptoms using the different metrics of RA disease activity. Also, mixed effects models were used to assess prospective changes in RA disease activity by prevalent and incident depressive symptom status. Lastly, logistic regression models compared the likelihood of clinical response to RA treatment during follow-up in those with and without depression when starting biologic disease modifying anti-rheumatic drug (DMARD) therapy. Patient-reported depression rates were much higher and significantly different from physician based comorbidity estimates. Patient and physician RA disease activity measures were associated with an increased risk for depression onset, but not laboratory-reported serum biomarkers. Similarly, depression was temporally associated with significantly slower rates of decline regarding every patient-reported disease activity measure, some physician-reported metrics, but not acute phase reactants. Moreover, there was a significantly lower probability of achieving clinical remission among those with depression on a biologic DMARD after 6 months and an analogous effect at 12-months that was slightly lower in magnitude, which did not reach statistical significance. Rheumatologists under-reported the occurrence of prevalent and incident depressive symptoms, and thus are likely unaware of its presence in their RA patients. Further, the results suggest the bi-directional effects between these conditions are related to the cognitive and behavioral aspects of depression and their interactions with disease activity, rather than shared immunological mechanisms in the context of cell-mediated immunity. When also considering the impact on clinical response to biologic DMARDS, the findings collectively imply that rheumatologists must address any challenges due to depression to provide the best care to their patients.

Communication Skills of Novice Psychiatric Nurses with Aggressive Psychiatric Patients by Rose L. Moss MS, University of Hartford, 1996 Project Submitted in Partial Fulfillment of the Requirements for the Degree of Doctor of Nursing Practice Walden University March 2015 The transition from novice nurse to a competent psychiatric staff nurse is often associated with major communication challenges, primarily when caring for aggressive patients. Guided by Peplau's theory, this quantitative study assessed the communication skills of novice psychiatric nurses (N = 25) who worked 24 months or less in the state psychiatric hospital with aggressive psychiatric patients. Additionally, certain demographic data such as gender, age range, level of education, and length of time working were analyzed to determine their impact on communication skills. The survey consisted of 20 questions which assessed demographic data, communications skills, and hospital-based orientation. Based on ANOVA, novice nurses did not differ on hospital-based orientation based on gender, age, level of education, or length of time working. Novice nurses' communication skills did not differ by gender, age or level of education; however, novice psychiatric nurses who had worked 19-24 months had stronger communication skills than those working less time with aggressive patients (F = 6.9, p < 0.005). A communication skills class during hospital orientation to prepare novice nurses to communicate effectively with aggressive patient was recommended to nursing leadership and staff. A communication skills class held during hospital orientation could enhance the nurse-patient relationship, cultivate a safer and secure milieu, and improve patient outcomes. The findings have implications for positive social change for staff development to improve the hospital orientation for novice psychiatric nurses to become better equipped as effective communicators with aggressive psychiatric patients.

Nicotine dependence is hypothesized to be due to neuroadaptations that ultimately drive compulsive nicotine use. The studies in this thesis aim to understand how the “upregulation” of nicotinic acetylcholine receptors (nAChRs) caused by chronic exposure to nicotine contributes to nicotine reward and nicotine withdrawal. Previous studies have shown that chronic nicotine induces upregulation of nAChRs containing the α4 subunit (α4* nAChR) within the Ventral Tegmental Area (VTA), a brain region critical for the rewarding properties of all illicit drugs. Curiously, α4* nAChR upregulation occurs specifically in the inhibitory GABAergic neuronal subpopulation of the VTA. To determine if increased expression and activation of α4* nAChRs in VTA GABAergic neurons contributes to nicotine dependence behaviors, I devised a viral-mediated, Creregulated gene expression system that selectively expressed α4 nAChR subunits containing a “gain-of-function” point mutation (a leucine mutated to a serine residue at the TM2 9´ position: Leu9´Ser) in VTA GABAergic neurons of adult mice. Sub-reward doses of nicotine were sufficient to activate VTA GABAergic neurons in mice expressing Leu9´Ser α4 nAChR subunits in VTA GABAergic neurons (Gad2VTA: Leu9´Ser mice) and exhibited acute hypolocomotion upon initial injection of low doses of nicotine that developed tolerance with subsequent nicotine exposures compared to control animals. In the conditioned place preference procedure, nicotine was sufficient to condition a significant place preference in Gad2VTA: Leu9´Ser mice at low nicotine doses that failed to condition control animals. I conclude from these data that upregulating α4* nAChRs on VTA GABAergic neurons increases sensitivity to nicotine reward. In a separate study testing the hypothesis that overexpression of Leu9´Ser α4* nAChRs in VTA GABAergic neurons disrupts baseline behavior and promotes anxiety-like behaviors, I found that overexpressing Leu9´Ser α4* nAChRs in VTA GABAergic neurons had a minimal effect on unconditioned anxiety-like behaviors. Drug naïve Gad2VTA: Leu9´Ser and control mice failed to exhibit any behavioral differences in the open-field, marble burying test and elevated plus maze compared to control. Together, these data indicate that overexpression of the “gain-of-function” α4* nAChRs in VTA GABAergic neurons contributes to reward sensitivity without increasing susceptibility to nicotine withdrawal symptoms. My data indicates that nAChRs expressed in VTA GABAergic neurons may be a suitable target for the development of better smoking cessation aids.

Prior research has indicated that public stigma towards individuals diagnosed with mental illness may be reduced by exposing individuals to the truths about mental illness and by exposing individuals to a mentally ill person who by society's standards is a productive functioning adult. This study detemined whether the conditions shown to be effective for the public may, in turn, decrease the extent to which individuals diagnosed with mental illness stigmatizes themselves. Four conditions (education alone, contact alone, education-contact, control) were used to determine which method was more effective in reducing the effects of stigma. Stigma was measured using the Internalized Stigma of Mental Illness total and subscale scores and Devaluation-Discrimination Scale which were administered before the treatment session (pre), at the end of the treatment session (post), and at a 2-week follow-up. Conducting 4 (condition) X 3 (time) ANOVAs showed no significant results for any measure. Due to low power from poor participation-in-the-2--week-follow-up, 4 x 2 mixed_factorial ANOVA's were conducted without the follow-up data. The ISMI and Devaluation-Discrimination scores for each condition differed significantly for pre/post scores but not for conditions, with no significant interactions.

Suicide is a major health concern worldwide. Nurse practitioners must possess suicide assessment skills and treatment knowledge to ensure appropriate identification of persons with suicidal ideation. The purpose of this project was to assess psychiatric nurse practitioners' knowledge of suicide prevention in rural Kentucky. The conceptual framework was Orlando's nursing process theory, which emphasizes the importance of nurse-patient interaction. A 13-item survey of suicide-related knowledge and skills was administered to 10 psychiatric nurse practitioners in rural Kentucky. Only 3 participants responded correctly to a question related to suicidality in persons with borderline personality disorder. Regarding competency and support for assessing suicide, 100% of participants reported that they were comfortable asking direct and open-ended questions regarding suicide. Nine of the 10 respondents assessed their knowledge and skills as sufficient to engage effectively with patients contemplating suicide, which indicates that psychiatric nurse practitioners may overestimate their ability to identify and treat persons with suicidal ideation. Healthcare providers in all specialties can benefit from this project by improving competencies and guiding continuing education to bridge any gaps in knowledge for adequately assessing suicide. Further education is needed for psychiatric nurse practitioners to promote positive social change for suicidal persons, their families, and their communities.

Adolescence and young adulthood are the periods of development associated with the highest amount of risk-taking. One theory, the Dual-Systems model, suggests that this could be due to an imbalance in the maturation of two brain systems: reward appraisal, which matures first, and cognitive control, which matures later. This imbalance may be the cause of adolescents’ tendency to favor immediate rewards, disregarding consequences. Depressed adolescents, however, behave differently. While it is not exactly clear whether they take more risks or fewer risks, depressed adolescents display different interactions and decision making with their peers than non-depressed adolescents. This study attempted to use these patterns of behavior already identified in previous research to predict where an adolescent would fall on a depression continuum based on their Self-Focused and Other-Focused risk behaviors. Results did not find a link between depression and either type of risk. Results may be inconclusive due to issues within the data and data collection process.

Statistics show a high prevalence of metabolic syndrome (MetS) in patients with mental illness receiving second-generation antipsychotic medications. MetS is associated with elevation of obesity, truncal obesity, blood pressure, cholesterol, and fasting glucose. The purpose of this project was to educate psychiatric providers about the importance of MetS screening, early detection, management, and referral for better treatment and management. The project was guided by Lewin's theory of change model. The project inquired if educational intervention on MetS improved providers' knowledge and intent to adopt MetS guidelines. A literature review and established guidelines of the American Psychiatric Association and American Diabetic Association about MetS in psychiatric patients directed the educational content. Five expert panelists with over 10 years of experience in psychiatric mental health reviewed the educational content using a Likert-type questionnaire. Findings resulted in the acceptance of the educational content without further recommendation. Twelve staff attended the educational session presented on MetS. Comparison of the pretest and posttest questionnaires that has 5 multiple choice questions indicated some positive effects. The good knowledge of MetS, how to screen for MetS, health promotion activities with consumers, metabolic profile of different neuroleptic medications, providers' roles in MetS. The participants' overall knowledge about MetS screening improved from 8.3% pretest to 83.3% after receiving the educational program. The educational project for MetS screening might foster positive social change by improving continuity and quality of care, which will lead to better patient outcomes, reduce healthcare cost, and impact positive patient outcomes.

Psychiatric recovery-oriented care is aimed at improving patients' quality of care while increasing the efficiency of health care providers. Despite the benefits of recovery-oriented care, this approach is often lacking in health care settings. The purpose of this project was to implement a recovery-oriented training on psychoeducational groups on a 26-bed psychiatric unit. The Iowa model of evidence-based practice and adult learning theory provided the framework for the project. The objectives were to (a) assess training needs, (b) evaluate barriers for recovery-oriented psychiatric nursing, (c) develop strategies to address barriers, (d) train staff in psychoeducational approaches, and (e) evaluate the training effectiveness. Information on knowledge, confidence, training needs and barriers in conducting psychoeducational groups was collected from 24 nursing staff. Open-ended interviews were conducted to ascertain staff perceptions on training needs and barriers. Interview responses were analyzed for common themes. Staff expressed a need for training and perceived a lack of knowledge and time as barriers in conducting psychoeducational groups. A questionnaire was used to collect data on knowledge (8 items) and confidence (5 items) pre and post training. Pre/post responses were analyzed using descriptive statistics and paired sample t test. Results showed a significant increase in staff knowledge, but not confidence in conducting psychoeducational groups from pre to posttest. Results may be used by psychiatric nursing staff to improve the quality of recovery-oriented care, patient satisfaction, and efficiency of the care delivery system. Recovery-oriented psychiatric care implicitly changes social norms by helping individuals with mental health problems integrate back into their communities.

The overall objective of this study was to compare the attitudes of psychiatric social workers and psychiatric nurses, and its impact of service delivery to the dual diagnosed population. To attain this objective the following areas were addressed by the researcher; Professionals' attitudes, values, and beliefs about the dual diagnosed population and their families; and how the professionals' view of self effects the attitudes, values, and beliefs. A comparative research design was used in this study. A self-administered questionnaire was given to thirteen psychiatric social workers and thirteen psychiatric nurses from the professional population located in the Atlanta area. In this study, there was no statistical significant difference found between psychiatric social workers and psychiatric nurses' values, attitudes, and beliefs toward working with the dual diagnosed patient.

A psiquiatria classifica os aspectos da psicopatologia por meio do manual diagnóstico e Estatístico de Transtornos Mentais. Este manual ao longo de sua história, passou por muitas modificações e variadas versões. O objetivo da presente pesquisa é fazer uma análise crítica do diagnóstico de TDA/H, conforme descrito pelo manual tomando como referência a psicanálise. A escolha da psicanálise como elemento norteador dessa leitura crítica deve-se à importância dada pela mesma à história individual e a singularidade como inerentes ao sujeito, ao buscar ouvir e ofertar a palavra a cada um. Este trabalho tem como objetivos específicos: discutir como as evidências dos sinais e sintomas ajudaram na reflexão sobre o diagnóstico do TDA/H; demonstrar a compreensão psicanalítica da dimensão subjetiva e do aparelho psíquico; apresentar o paralelismo entre as modificações no social e a produção de novos sintomas subjetivos. Para realizar essa proposta optamos por utilizar o DSM-V, em sua edição mais recente, assim como o Manual para Diagnóstico e Tratamento do Transtorno de Déficit de Atenção/Hiperatividade TDA/H, terceira edição. Considerar o social e sua ideologia consumista, atravessado por mudanças na lei simbólica é fundamental para a pesquisa, uma vez que, os postulados da pós-modernidade desconsideram a subjetividade, exaltam todos os tipos de excesso e contribuem para o apagamento do limite. O questionamento sobre o modo diagnóstico do TDA/H justifica-se em virtude de se servir de uma metodologia meramente estatística e da falta de uma etiologia para o referido transtorno. Assim como, a desconsideração da singularidade do sujeito e sua submissão a processos inconscientes que buscam satisfação, uma vez que a organização mental e a economia pulsional são particulares e únicas. Sabe-se do potencial organizador de certa renúncia pulsional, da restrição de gozo que impõe sacrifícios e gera algum mal-estar, mas que é fundamental e estruturante para sujeito. Esta é uma pesquisa de caráter teórico, que utiliza a análise crítica para pensar o diagnóstico de TDA/H, conforme descrito pelo DSM-V sob a ótica da psicanálise. Busca-se oferecer outra leitura possível para pensar o TDA/H.
The psychiatry classifies the aspects of psychopathology by the Diagnostic and Statistical Manual of Mental Disorders. This Manual, throughout its history, passes through many changes and variety versions. The object of this research is making a critical analysis about the ADHD diagnosis, as described by the psychiatry taking as reference the psychoanalysis. The choice of psychoanalysis as guiding element of this critical reading is due to the importance of consider the unique history and the singularity as inherent to the subject, while seek to listen and offer the word for each one. This paper have these specific purposes: discuss how the signs and symptoms evidence helped on the reflection about the ADHD diagnosis; demonstrate the psychoanalytical understanding of the subjective dimension and the psychic apparatus; present the parallelism among the modifications on social and production of new subjective symptoms. To achieve this proposal we have opted to use the DSM-V, in the most recent edition, as well as Manual para Diagnóstico e Tratamento do Transtorno de Deficit de Atenção/Hiperatividade TDA/H, third edition. However, consider the social in its consumer ideology, crossed by modifications at the symbolic law is fundamental for the research, after all, the postulates of post-modernity ignore the subjectivity, exalt all kinds of excess, contributing to erase the limits. The questioning about ADHD diagnosis mode is justified because it is served by merely statistical methodology and the lack of an etiology for referred disorder. As well as, the disregard of the subject singularity and his submission to unconscious processes that seeks satisfaction, because the mental organization and pulsional economy are individual and unique. It is know that the organizer potential of certain pulsional resignation, of joy restriction that impose sacrifice and creates unease, however it is fundamental and structuring for the subject. This is a research with theoretical character, that use as method the critical analysis of ADHD, according to presented in DSM-V, under viewpoint of psychoanalysis. It seeks to offer other achievable reading to think the ADHD.

Adequate medication management is a focus of effective care that is often overlooked in caring for adults with comorbid psychiatric and physical conditions, especially in patients who are treated by multiple care providers and have a variety of health issues at the same time. The purpose of this project was to develop evidence-based policies and practice guidelines to reduce polypharmacy in elderly patients in a rural outpatient psychiatric clinic. Bandura's self-efficacy theory was used to inform the project for its value in assessing motivation, capacity for self-regulation, and perceptions of individual ability. An interdisciplinary team of stakeholders explored best practices for electronic health records (EHR) in a rural mental health facility, created policy and practice guidelines, and developed implementation and evaluation plans to guide the initiative as it moves forward. The team included physicians, psychiatrists, psychologists, nurse practitioners, nursing support staff, social workers, and substance abuse counselors. The team explored approaches for implementing EHR-based medication management based on research in the current literature and goals/objectives of each department. Team members identified major issues and proposed guideline changes based on evidence in their own fields. The team then collaborated to develop policies and practice guidelines in a series of meetings designed to build consensus for supporting a unified set of products to be accepted by all departments. The resulting policies and practice guidelines are accompanied by plans for implementation and evaluation that provide the institution with a comprehensive solution to polypharmacy in elderly patients. This project may improve overall quality of care by reducing medication and preventing health complications related to polypharmacy.

Millions of individuals suffer disability or death from immune-based inflammatory diseases. If psychiatric disorders could be empirically linked to the prediction of immune-based inflammatory diseases, there would be a basis for promoting disease prevention measures for individuals diagnosed with one of four psychiatric disorders. Psychoneuroimmunology provided the theoretical base for understanding emotionally induced medical disease development. In this quantitative study, a parallel archival research design was used to investigate the degree to which generalized anxiety disorder, posttraumatic stress disorder, major depression recurrent, and dysthymic disorder predicted the presence of atherosclerosis, cardiovascular heart disease, rheumatoid arthritis, cancer, and type II diabetes. There were 1,209 electronic medical records of adult patients obtained through purposive stratified sampling. A secondary data analysis was employed using descriptive cross tabulation, chi-square test of independence, and multinomial logistic regression. The findings revealed major depression recurrent was a statistically significant predictor for atherosclerosis, rheumatoid arthritis, type II diabetes and cancer. Generalized anxiety disorder was a statistically significant predictor for cancer. The results can promote positive social change by providing information that could be used to develop assessment plans that identity individuals who are at risk of developing the comorbid diseases. The prevention programs could effectively be used to minimize the subsequent development of inflammatory diseases, which in turn could decrease the onset of the medical diseases among individuals with psychiatric disorders.

Hypertension is a serious health problem in the United States. Clinical nurses may serve as facilitators in the screening, diagnosis, and treatment of hypertension. The purpose of this project was to evaluate the effectiveness of an education program on hypertension screening guidelines for nurses working in an outpatient psychiatric clinic. The project was supported by the health promotion model. The project used a pre- and post survey designed by the DNP student to collect data on nurses' knowledge, attitudes, and willingness to screen psychiatric patients for hypertension. Surveys consisted of 10 questions using a 5-point Likert-type scale. The results of the project indicated that the educational program was effective in changing the practice of nurses regarding the screening of patients for hypertension. Before administering the educational program, 9 nurses were not screening patients on a consistent basis. After the educational program, survey results indicated that 11 nurses would use a policy to screen each clinic patient for hypertension. It is recommended, based on the findings of this study, that the clinic develops a regular training and education program on hypertension screening for the staff. The implications for social change move beyond the study setting. Results may be used to improve screening for hypertension in the future. This could create social change in the way screenings are performed, which could affect the overall health of patient.

Psychosocial rehabilitation (PSR) is a community-based service that addresses the challenges faced by people diagnosed as having psychiatric disabilities. While working with co workers and clients, PSR workers may harbor perceptions that could lower the effectiveness of their work and hinder recovery by their clients. Although cognitive-behavioral theory has suggested an association, research has not yet connected PSR worker attitudes about psychiatric situations to their feelings and behavior. In this nonexperimental factorial design, 196 PSR workers were surveyed about the frustrations presented by stressful interpersonal job situations using the Psychiatric Situations Scale to identify whether occupation (case workers, residential workers, day program workers, and vocational workers), years of experience (low: less than 5 years, medium: between 5 and 10 years, high: more than 10 years), and gender were associated with significant attitude differences. The most interesting research question was whether there were differences in the levels of frustration experienced by persons in different PSR occupations. The data were analyzed using ANOVA. No significant main effects or simple effects were revealed. This likely occurred because PSR socializes workers into their mission and values leaving similar attitudes across groups, and also because the sample was homogeneous. Social change implications include the addition of new data to the research, thus enabling researchers to more efficiently identify significant differences among PSR workers. Such results should improve PSR through training targeted toward groups at-risk for the development of burnout and client secondary gain. PSR might be improved by future research that uses an increased sample size to obtain a heterogenous sample, uses other variables, or uses the qualitative method to categorize data.

The purpose of this project was to implement an educational program that provided psychiatric nurses with the knowledge and skills to engage patients with a diagnosis of schizophrenia in self-care management regarding medication and treatment adherence. The theory employed in the project was the educational theory. Evidence of effectiveness came from a pre- and postintervention assessment of nurses' knowledge and confidence in teaching about medication, along with a pre- and postassessment of knowledge gained as a result of the educational intervention. Pre- and posteducational rates of patient rehospitalization for medication nonadherence were compared. The results indicated a 15% rate of readmission of schizophrenia patients prior to the educational sessions. The 30-day readmission rate decreased to approximately 5% after the educational sessions. Based on these results, it was concluded that the educational project intervention had a positive impact on improving knowledge and insight of the nurses about nonadherence to medication among patients with schizophrenia. The positive social impact of improving nurses' knowledge of educating schizophrenic patients are increased patient well-being and reduced social costs associated with relapse and readmission. Recommendations from this project include that nurses should educate patients with schizophrenia on how to adhere to medication directives and the importance of doing so.

Due to the deinstitutionalization movement, many mentally ill individuals have left asylum treatment centers and have had no safe housing. The purpose of this grounded theory study was to explore the attitudes and opinions of homeless, mentally ill people regarding the community resources they consume and how they perceive and navigate those resources. The research questions focused on homeless, mentally ill individuals' shared experiences accessing health care, psychiatric care, and housing services as well as, barriers that impacted homeless, mentally ill individuals' use of these services, and their needs to address these barriers. Data were collected using face to face, semi structured interviews with 12 homeless individuals. The thematic analysis consisted of open and axial coding. Axial coding was used to assign and like categories and subcategories of codes according to their properties and dimensions. Emergent patterns were identified from the data to explain the lived experiences of mentally ill homeless people and their opinion and attitudes towards navigating of mentally ill homeless programs. The responses expressed the needs that were unmet: lack of mental health assistance, food needs, hygiene needs, safety concerns and survival needs. In order to make positive social change outreach predicated on increasing clear communication between outreach workers and the homeless mentally ill allows for developing a trusting relationship necessary in establishing contact and credibility in providing on going impactful treatment for the homeless mentally ill population.