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1
Topor, Alain. "Managing the contradictions : Recovery from severe mental disorders." Doctoral thesis, Stockholms universitet, Institutionen för socialt arbete - Socialhögskolan, 2001. http://urn.kb.se/resolve?urn=urn:nbn:se:su:diva-37506.
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One of the assumptions made when mental problems are defined as a medical problem is that certain problems, certain diagnoses, are chronic. Nevertheless, a substantial number of follow-up studies have shown that the course of development in patients with these diagnoses is neither uniform nor chronic. The aim of this dissertation is to summarise the state of the art in the knowledge about recovery from severe mental disorders and to examine in depth which factors people who have recovered regard as having helped them in their recovery, and in which ways. These two aims have resulted in two separate but complementary presentations of results. The review of the state of the art, which focuses on the diagnosis schizophrenia, shows that some two-thirds of the patients who received this diagnosis have recovered, either totally or socially. The variation in the percentage of persons who have recovered is explained in the study by such factors as fluctuations in national and local unemployment rates, in definitions of the diagnoses and in access to psychiatric care. On the other hand, the introduction of various treatment interventions seems to have had no noticeable effect on the recovery rate, although it has affected the relapse frequency. There is still a long way to go towards understanding the recovery process and how it can be facilitated. The interview study with persons who have been treated for severe mental disorders and recovered show the patients themselves to be a crucial factor in their own recovery. Throughout the whole course of the disorder, they struggle to find ways to manage both their symptoms and the factors that cause them. What appears to others as symptoms might instead be theperson’s unsuccessful attempts to manage existential problems. Entering into and maintaining relationships with other people is another crucial factor in recovery work. Professionals from a variety of backgrounds as well as family members and other laypersons can contribute to recovery, first and foremost in that they represent continuity between diverse facets of the person’s life; they engage with the person in his/her full complexity, not as someone reduced to a diagnosis and a given patient role, nor by denying the fact of the person’s suffering. Still another factor in recovery work is material conditions which impact on the person’s possibility to regain an identity as a full member of the community. Lastly, the descriptions that the respondents give of their recovery practice have certain constructed meanings in common. These meanings can be categorised as medical, therapeutic, spiritual and interactional. In many of the life stories collected in this study, several of these categories of meaning appear in unison, co-existing in one and the same life story. There is a recurrent theme running through these practice stories of recovery: that people in their everyday lives are not reducible to their problems, but at the same time these problems must not be denied. That people have both weaknesses and strengths, sometimes existing within the same spheres of life and occurring simultaneously; but that in relationships with other people they are given scope to manage and live with these contradictions is of central importance for recovery practice.
2
Drake, Rachel Mari’. "Effects of severe and persistent mental illness on maximal aerobic capacity." Thesis, Wichita State University, 2011. http://hdl.handle.net/10057/3950.
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Maximal aerobic capacity (VO2max) is a good indicator of overall health and is commonly
measured in the general population, but often goes overlooked in individuals with SMI.
Previous studies involving exercise and SMI focus mainly on self-perception and mood.
Only one study has measured the VO2max in this select population while promoting exercise
and dietary changes. Purpose: To assess the maximum aerobic capacity, weight, and body
fat percentage (BF%) in individuals with SMI. Methods: Weight, BF%, and VO2max were
measured prior to wellness intervention (pre) and following wellness intervention (post).
Forty-nine individuals (27=male, 22=female) with a mean age of 43±13.20 years of age and
a diagnosis meeting the criteria for severe and persistent mental illness (SMI) were
assessed. SMI classification among the subjects as follows: schizophrenia (n=11), bipolar
disorder (n=17), schizoaffective disorder (n=14), major depressive disorder (n=7).
Results: No significant difference was observed between baseline and endpoint
measurements of BF% in all diagnoses except MDD. Males with MDD benefited from a
wellness intervention with a significantly lower BF% (p(.036);p<0.05). A wellness
intervention did not increase in the VO2max in individuals with SMI (p(.0358);p<0.05).
Individuals with SMI continually rated in the very poor to poor section for VO2max.
Conclusion: Individuals with SMI tend to have low aerobic capacity and high body fat
percentage. Individuals in the current study did not benefit from a wellness intervention in
terms of BF% and VO2max except males with MDD. Males with MDD significantly lowered
their BF% following a wellness intervention.Thesis (M.Ed.)--Wichita State University, College of Education, Dept. of Human Performance Studies.
3
Vaughan, Hillary A. Faulk. "Effects of an intermediate care program for inmates with severe persistent mental illnesses." View electronic thesis, 2008. http://dl.uncw.edu/etd/2008-2/vaughanh/hillaryvaughan.pdf.
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4
Pasmeny, Gloria A., and University of Lethbridge Faculty of Education. "Social support and quality of life in adults with severe and persistent mental illness." Thesis, Lethbridge, Alta. : University of Lethbridge, Faculty of Education, 2008, 2008. http://hdl.handle.net/10133/780.
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The current study investigated the relationship between social support and quality of life
(QoL) as well as social support and community functioning among persons with severe
and persistent mental illness (SPMI). Empirical data from Phase II of the Continuity of
Mental Health Services (COMHS) Study of Alberta (Adair, Wild, Joyce, McDougall,
Gordon, et al., 2003) were used to comprehensively examine these variables among a
broad-based sample of 301 people with SPMI receiving a mix of inpatient, outpatient,
and community services. Multiple measures administered in Phase II of the COMHS
research program provided comprehensive data on QoL (i.e., disease-specific and generic
QoL), functioning (i.e., community ability), and objective (OSS) and subjective (SSS)
measures of social support. Higher ratings of both OSS and SSS were associated with
better QoL and functioning at outcome. Participant ratings of objective dimensions of
their own social support were shown to be most important in determining life quality and
functioning at outcome. Of the two SSS variables, the one most predictive of life quality
was the participants’ sense of the provision and receipt of social support. Clinician-rated
OSS was a significant predictor of QoL only for participants who rated social support
availability as poor. The results of this study may inform policy development, planning,
and resource allocation for community treatment programs in Alberta and elsewhere, as
there is widespread support both provincially and nationally for increasing community
support services and decreasing the number and length of inpatient admissions (Kirby &
Keon, 2006). A better understanding of the relative impact of social support variables is
essential for further development of effective psychosocial rehabilitation programming.xvii, 217 leaves ; 29 cm.
5
Hsiao, Chiu-Yueh Van Riper Marcia L. "Individual and family adaptation to severe and persistent mental illness SPMI in Taiwanese families." Chapel Hill, N.C. : University of North Carolina at Chapel Hill, 2008. http://dc.lib.unc.edu/u?/etd,1705.
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Thesis (Ph. D.)--University of North Carolina at Chapel Hill, 2008.Title from electronic title page (viewed Sep. 16, 2008). "... in partial fulfillment of the requirements for the degree of Doctor of Philosophy in the School of Nursing." Discipline: Nursing; Department/School: Nursing.
6
Thompson, Jennifer Nicole. "INVESTIGATING THE ATTITUDES OF GRADUATE SOCIAL WORK STUDENTS TOWARD SEVERE AND PERSISTENT MENTAL ILLNESS." CSUSB ScholarWorks, 2017. https://scholarworks.lib.csusb.edu/etd/535.
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Stigma is one of the foremost barriers to effective mental health treatment of consumers. Social workers currently provide the majority of mental health treatment in the United States. Examining levels of stigma present in social work students would be valuable in providing future interventions. A quantitative study was conducted utilizing an online questionnaire. The survey was distributed by the CSUSB Department of Social Work to graduate social work students. Statistical analysis utilizing SPSS software was conducted following data collection. Data analysis indicated that there was no significant difference in the attitudes regardless of exposure to severe mental illness. The findings of this study indicate that exposure to severe mental illness may not be the only factor in determining one’s attitude. Implications of these findings for social work research include outlining the need for further examination of stigma to identify more specific factors in the formation of stigmatic attitudes.
7
Ivarsson, Ann-Britt. "Occupational Performance in Individuals with Severe Mental Disorders : Assessment and Family Burden." Doctoral thesis, Uppsala : Acta Universitatis Upsaliensis, 2002. http://publications.uu.se/uu/fulltext/nbn_se_uu_diva-2690.pdf.
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8
Harrison, Kimberly S. "Validation of clinical screens for suicidality and severe mental disorders for jail inmates." Thesis, University of North Texas, 2005. https://digital.library.unt.edu/ark:/67531/metadc4774/.
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Psychologists and other mental health professionals working in correctional institutions bear the considerable responsibility for identifying, diagnosing, and treating mentally disordered inmates. The importance of these responsibilities has been recognized in recent years because of the burgeoning population of inmates in general and the higher numbers of inmates with mental illness in particular. Research has demonstrated that the screens currently used in correctional settings to identify mentally disordered and suicidal inmates are either unvalidated or generally ineffective. This study investigates the validity of different mental health screens in a jail population. Inmates from the Grayson County Jail were administered three screens: the Referral Decision Scale (RDS), Personality Assessment Screener (PAS), and the Mental Disability/Suicide Intake Screen (MDSIS). Criterion measures were the Schedule for Affective Disorders and Schizophrenia (SADS) for Axis I disorders and the Suicide Probability Scale (SPS) for suicidal ideation. Results indicate that each screen most effectively assessed one clinical domain: the RDS for psychosis, the MDSIS for suicidality, and the PAS for depression. Gender differences were observed in screen items most effective for classifying inmates by suicide risk level.
9
Galon, Patricia Ann. "COMPARISON OF HEALTH CARE CONTEXT, COERCION, AND COMPLIANCE IN PERSONS WITH SEVERE AND PERSISTENT MENTAL ILLNESS." University of Akron / OhioLINK, 2006. http://rave.ohiolink.edu/etdc/view?acc_num=akron1144851107.
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10
Gatfield, Pamela Jo'. "Day treatment programs for adults with severe and persistent mental illness: Effectiveness measured in rates of recidivism." CSUSB ScholarWorks, 2003. https://scholarworks.lib.csusb.edu/etd-project/2299.
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This study measured the effectiveness of rehabilitative day treatment (RDT) programs for persons with severe and persistant mental illness in San Bernardino County. The effectiveness of RDT services was determined by rates of recidivism.
11
Duchaine, Fanny. "Conséquences de la pandémie de COVID-19 sur la mortalité, les parcours de soins et d’accompagnement de personnes en situation de handicap : l’exemple de trois pathologies invalidantes." Electronic Thesis or Diss., Strasbourg, 2025. http://www.theses.fr/2025STRAG002.
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La pandémie de COVID-19 a entraîné des conséquences sanitaires inédites. Le système de soins s’est rapidement retrouvé submergé par les patients et des réorganisations ont été nécessaires pour les prendre en charge. Le recours aux soins pour d’autres causes que l’infection a alors été interrompu ou reporté. Les mesures de restriction mises en place ont participé à accroître ces difficultés et ont également eu un effet délétère sur l’accompagnement par des professionnels ou des proches. En s’appuyant sur des méthodes qualitatives et quantitatives ainsi que deux sources de données complémentaires, cette thèse s’attache à décrire les trajectoires de soins et d’accompagnement ainsi que la mortalité, pour trois populations spécifiques. Cela permet d’identifier les changements qui ont eu lieu pendant la pandémie et leurs conséquences à court ou moyen terme. Au-delà des résultats, l’objectif est de présenter une méthodologie reproductible pour d’autres populationsThe COVID-19 pandemic had unprecedented health consequences. The health care system was quickly overwhelmed by patients and had to be reorganized. Treatment for other causes was then interrupted or postponed. The restrictions imposed have increased to these difficulties and had a detrimental effect on the support provided by professionals or relatives. Using qualitative and quantitative methods and two complementary data sources, this thesis aims to describe care and support trajectories, as well as mortality, for three specific populations. This will allow us to identify the changes that may have occurred during the pandemic and their short- and medium-term consequences. Beyond the results, the aim is to present a reproducible methodology for other populations
12
Houghton, Margaret Amy. "The effect of the PROMPT system of therapy on a group of children with severe persistent sound system disorders /." [St. Lucia, Qld.], 2004. http://www.library.uq.edu.au/pdfserve.php?image=thesisabs/absthe18060.pdf.
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13
Baronet, Anne-Marie. "Variables associated with feelings of subjective burden in caregivers of persons with a severe and persistent mental illness." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2001. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp05/NQ66120.pdf.
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14
Eggers, Sarah H. "Using Photography and Poetry in Group Therapy for People with Severe and Persistent Mental Illness: An Outcome Study." Digital Commons at Loyola Marymount University and Loyola Law School, 2014. https://digitalcommons.lmu.edu/etd/58.
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This research explores the experience of participation in a pilot program that integrated poetry and photography for a group of seven adults living with severe and persistent mental illness. Data was gathered in the form of written, visual and verbal responses generated through a semistructured, qualitative focus group that took the week after the end of the pilot program. The data was categorized and coded using a analytical procedure based on Photovoice, a participatory action research model that seeks to empower research participants by providing them with cameras to document and share issues of importance to their lives. Analysis of the data resulted in the emergence of six overarching themes: 1) The group experience 2) Self vs. other 3) Accomplishment and challenge 4) Confinement vs. freedom 5) Observing vs. Being observed/new perspectives and 6) Memories recalled. These themes were examined against existing literature about the use of photography and poetry in therapy, arts-based and group therapy treatments of severe and persistent mental illness, and the use of participatory and artsbased research in mental health. The findings of this research emphasize the rich possibilities for incorporating linked language/written and visual interventions in the treatment of severe and persistent mental illness, as the two offer complementary but distinct opportunities for healing, growth and self-expression. Moreover, this study demonstrates the importance of including mental health clients as participants in qualitative research regarding their perceptions of treatment, and the fundamentally empowering experience of being viewed and treated as experts on their own lives.
15
Holt, Clare L. "The rehabilitation of offenders diagnosed with severe mental illness." Thesis, Canterbury Christ Church University, 2011. http://create.canterbury.ac.uk/10333/.
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Section A: This paper reviews the existing theoretical and empirical literature of relevance to offenders with severe mental illness (SMI) in the UK. Due to the lack of theory accounting for progress through forensic mental health services (FMHS) as currently constituted, the adjacent areas of mental health recovery and forensic rehabilitation are the major focus. Relevant empirical literature is synthesised and critically evaluated and this paper concludes by (a) summarising research challenges that remain pertinent to this area of enquiry and (b) outlining recommendations as to how research can usefully proceed. Section B: The UK’s increasing recognition of offenders with SMI and the lack of a theoretical account specific to this group provided the rationale for this study. The aim was to develop a preliminary model of the ways offenders with SMI progress through FMHS towards reintegration with the community. Semi-structured interviews were conducted with seven FMHS-users and three FMHS staff members. Grounded theory was used to build a preliminary model, which contained six main categories: learning about and managing mental health, establishing facilitative relationships with staff, moving on from prison and early experiences of FMHS, developing self-direction, doing work in therapy, and managing wider support networks. Findings extend existing literature by providing a preliminary theoretical account of the multiple domains that influence progression of offenders with SMI towards reintegration with the community. Results are discussed with regard to the existing literature and clinical implications are outlined. Recommendations for future research are made. Section C: In order to reflect upon the process of conducting this project, the author considers four questions: (1) what research skills have been developed and what skills continue to require development?, (2) what would be done differently were this project to be repeated?, (3) what changes in clinical practice will occur as a consequence of this research?, and (4) what areas would future research focus on and how would this be approached?
16
Kemppainen, L. (Liisa). "Family predictors of severe mental disorders and criminality in the Northern Finland 1966 Birth Cohort." Doctoral thesis, University of Oulu, 2001. http://urn.fi/urn:isbn:9514265114.
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Abstract
Early family characteristics may influence the later development of severe
mental
disorders and criminality of a child. The association between an adverse family
environment during childhood and its later consequences in adulthood, however,
are still widely open. The aim of the present study was to analyse in a
longitudinal perspective, family risks of severe hospital-treated mental
disorders and criminal behaviour in the Northern Finland 1966 Birth Cohort and to
develop a descriptive life span model of schizophrenia.
A large, general population birth cohort (N =11 017), the Northern Finland
1966
Birth Cohort was used as a study population. This database provides the
information of prospectively collected data on both biological and social aspects
of pregnancy, the characteristics of family, the mother, the father, and the
child. The information of psychiatric outcomes was gathered from the Finnish
Hospital Discharge Register (FHDR) and the data on registered criminal behaviour
of the cohort members come from computerized files maintained by the Ministry of
Justice.
Children born to multiparous mothers (GMP) i.e. those that had undergone at
least
six deliveries were more commonly treated in mental hospitals later in life (4.5%
vs. 3.4%; p=0.028) than children born to mothers that have fewer children. Of the
diagnostic groups, the risk of psychoses other than schizophrenia (OR 2.3; 95% CI
1.2-4.7), and depressive disorders (OR 2.2; 1.0-4.5) was elevated among adult
children of those mothers.
Birth order was associated with adult schizophrenia. The risk was elevated
among
male firstborns (ratio 1.5; 95% CI 1.0-2.2), but it was lower than expected among
male lastborns (ratio 0.7; 95% CI 0.5-0.9). The elevated risk was not
significantly associated with female schizophrenia patients. On the contrary, the
risk was lower than expected among females who were not first, not last or not
only children in the family (ratio 0.6; 95% CI 0.3-0.9).
Among males the risk for violent crimes later in life was elevated among
the
only children (OR 1.8; 95% CI 1.1-3.0). If perinatal risk was additional
exposure, the risk increased up to 4-fold (OR 4.4; 95% CI 1.9-10.8). Combining
with maternal risks increased the risk up to 6-fold (OR 5.9; 95% CI 3.1-11.3) and
with paternal risk up to 8-fold (OR 8.4; 95% CI 3.9-18.1), respectively.
Among females the absence of the father during childhood until the age of 14 was
the strongest risk factor in predicting later criminality (OR 2.5; 95% CI
1.4-4.3). Further, in the families, where the father was present, maternal
smoking during pregnancy together with being born unwanted increased the
prevalence for criminal offending significantly up to 7.2%.
In conclusion, some characteristics of the early childhood family
environment were associated with mental disorders and criminality in adulthood and form part
of the developmental trajectory of these disorders. Early detection of such
children at risk is important in preventing mental disorders and criminality in
adulthood.
17
Abbo, Catherine. "Profiles and outcome of traditional healing practices for severe mental illnesses in two districts of Eastern Uganda." Stockholm : Kampala : Karolinska institutet ; Makerere University, 2009. http://diss.kib.ki.se/2009/978-91-7409-590-6/.
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18
Smith, Laura. "African Caribbean men with conduct disorder and severe mental illness : reducing violence and improving therapeutic engagement." Thesis, Canterbury Christ Church University, 2011. http://create.canterbury.ac.uk/10338/.
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Section A: A review of literature focused on African Caribbean men with diagnoses of both conduct disorder (as an indicator of antisocial behaviour) and severe mental illness. The review concludes that disorganised infant attachments appear to be predictive of conduct disorder, psychosis and poor engagement with services in a reciprocal 'vicious circle'. Section B: Empirical Paper: This study examined the relationships of African Caribbean men with severe mental illness and a history of conduct disorder, linking this to engagement with services. This was explored qualitatively using attachment theory and Lacanian discourse analysis within a psychosocial methodology. Four interviews were conducted and the texts were analysed. The findings echo the evidence base in showing that, according to this interpretation, all participants showed signs of disorganised attachment. All had had adverse encounters within mental health services although all could also cite discrete experiences which had been helpful and supportive. Each participant held different views about the interaction of ethnicity with care. Section C: A critical reflection on the research process, including: thoughts on learning experiences; retrospective changes to the study; clinical implications; and ideas for future research.
19
Grant, Lyle George. "A descriptive qualitative study of what informs and influences smoking behaviours in community dwelling persons with severe and persistent mental illness." Thesis, University of British Columbia, 2007. http://hdl.handle.net/2429/32611.
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Smoking establishes poor health trajectories and is the leading preventable cause of death
in Canada. Individuals with severe and persistent mental illness (SPMI) have a prevalence of
smoking 2 to 3 times that of the general population. While many are motivated to stop smoking,
the quit rate in this group is low and their unique reasons for smoking not fully understood.
Current understanding of tobacco use among those with SPMI largely comes from quantitative
studies that have used pre-determined frameworks for understanding factors that affect and
influence smoking behaviours. Little is known about the perspectives of those with SPMI. In
this descriptive qualitative study semi-structured interviews were conducted with thirteen
community dwelling persons with SPMI to explore what informs and influences their smoking
behaviours. The findings provide an understanding of the importance of smoking to the lives of
those with SPMI. For most of the participants, smoking began as an anticipated positive
enhancement of their self-esteem and/or identity, but evolved into a stigma with associated
negative consequences. Participants perceived smoking as affecting their image, influencing
social relations, and helping them adjust to mood changes. Participants revealed the complex
ways in which they experienced smoking both as a group and as individuals, and in so doing
illustrated the various agents that shape individual health choices around smoking. This study
presents unique perspectives from participants' about their motivations for smoking, how they
view themselves in relation to smoking, and what factors are important in influencing their
personal behaviours around smoking. This study offers important opportunity for increased
understanding and contains various recommendations for further inquiry and study.Applied Science, Faculty of
Nursing, School of
Graduate
20
Briney, Glenna Denise. "Long term effects of day treatment programs for adults with severe and persistent mental illness: Effectiveness measured in rates of recidivism." CSUSB ScholarWorks, 2005. https://scholarworks.lib.csusb.edu/etd-project/2731.
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The purpose of this study was to compare and measure the long term effectiveness of the rehabilitative day treatment program at San Bernardino County's Department of Mental Health. This current study was completed in 2005 and is a follow up study tracking the long term effectiveness of the program.
21
Greaves, Adele. "An initial investigation into the effectiveness of group therapeutic puppetry with adults with severe mental illness." Thesis, Canterbury Christ Church University, 2011. http://create.canterbury.ac.uk/10189/.
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Section A explores the role of creative arts therapies (CATs) in assisting recovery from severe mental illness (SMI). It examines the congruence of CATs with recovery models, and critically reviews evidence for the effectiveness of art and drama therapy with adults with mental health problems. It then examines one form of CAT which combines art and drama therapy – therapeutic puppetry. Underlying theoretical models and the existing evidence base with adults with SMI are outlined and critiqued. The review concludes with a summary of proposed arguments and research recommendations. Section B reports on a pilot investigation of group therapeutic puppetry with people with SMI. Background: Therapeutic puppetry is the use of puppets to aid emotional healing. There is no published research investigating the effectiveness of therapeutic puppetry with people with SMI. Aims: A pilot investigation of group therapeutic puppetry with people with SMI tested the hypotheses that this intervention results in improvements in mental wellbeing, self-esteem, and body connection. It also investigated mechanisms of change, and service user acceptability and experience. Method: This mixed methodology study utilised five single AB design case studies with time series data analysed using simulation modelling analysis. Qualitative data was collected via participant observation and participant interviews and analysed using thematic analysis. Results: Three participants experienced statistically and clinically significant changes in either positive or negative directions during the intervention, with all participants describing therapeutic puppetry as powerful and beneficial. Conclusions: Therapeutic puppetry is a potentially powerful medium which could be utilised by various mental health professionals. Service users find therapeutic puppetry acceptable and beneficial despite it being an occasionally difficult and intense experience. Section C is a critical appraisal of the conducted research, examining lessons learnt, identified training needs, changes to clinical practice and future research directions.
22
Chang, Kam Hock. "A Heideggerian hermeneutic study : the lived experiences of the Chinese family caregivers of relatives with severe and persistent mental illness in Malaysia." Thesis, University of Salford, 2004. http://usir.salford.ac.uk/26611/.
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An increasing number of families are being invariably forced to take on the role of a caregiver to their relative with severe and persistent mental illness following the development of community psychiatry and a movement to deinstitutionalize mental health care, both in the developed and developing countries. The lived experiences of these family caregivers have attracted the attentions of a remarkable number of researchers in nursing, and other health and social care disciplines. However, a review of the literature has uncovered that the findings of their research studies generally are far from conclusive due to a variety of serious epistemological and methodological flaws. Furthermore, a large number of these studies are situated in the quantitative paradigm, and therefore are heavily influenced by scientism, which strongly advocates quantification, and the use of mathematics for the exploration of the phenomenon under study. The quantitative paradigm is antithesis to the study of the lived experiences of the family caregivers. The contention is that human experiences cannot be studied holistically and meaningfully with the detached observer approach that could only yield answers that are expressed in numbers and percentages rather than capturing the thick and rich human experiences in a vivid and poignant manner. Lastly, a large majority of these research studies are conducted in the western cultures, and therefore may not be applicable to the family caregivers in oriental cultures. Therefore, this Heideggerian hermeneutic study is undertaken with the aim of describing and constructing a possible interpretation of the day-to-day lived experiences of the Chinese family caregivers of relatives with severe and persistent mental illness in Malaysia. The seminal work of Martin Heidegger (1889-1976), Being and Time, Division I, underpin the philosophical framework of this study. Shared conversations, which center on the day-to-day lived experiences of the 19 Chinese family caregivers of relatives with severe and persistent mental illness in Malaysia that meet the study criteria were conducted. Eight major themes that reflect the meaning of the day-to-day lived experiences of the Chinese family caregivers emerged from the collected study data, which were thematically analyzed. The major themes include: Being thrown into the trajectories of family caregiving; Answering to the call of conscience; Managing the day-to-day care; Enduring the caregiving process; Surviving the caregiving process; Chronic sorrow and grief; Constant worries and fears; and Making sense of the caregiving experiences. The emergent themes were individually described and discussed in great depth from the Heideggerian perspective. The study highlights a number of critical issues and the thesis discusses these in depth.
23
Strutton, David R. "The impact of treatment and treatment interactions on employment outcomes for individuals with schizophrenia and other severe mental disorders." Available to US Hopkins community, 2003. http://wwwlib.umi.com/dissertations/dlnow/308077.
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Boles, Shawna Elizabeth Walker. "A Training Curriculum for Assessing and Treating Sex Offenders with Mental Illnesses." Antioch University / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=antioch1310570423.
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Taka-Eilola, T. (Tiina). "Mental health problems in the adult offspring of antenatally depressed mothers in the Northern Finland 1966 Birth Cohort:relationship with parental severe mental disorder." Doctoral thesis, Oulun yliopisto, 2019. http://urn.fi/urn:isbn:9789526222455.
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Abstract Maternal depressed mood during pregnancy is common, but studies on the offspring of antenatally depressed mothers, with a long follow-up, are scarce. The aim was to study whether the adult offspring of antenatally depressed mothers are at an elevated risk of psychoses, depression, bipolar disorder, antisocial and borderline personality disorder, and schizotypal and affective traits. Parental severe mental disorder was considered as both a genetic and environmental risk factor for mental disorders. The data are based on the unselected, prospective, population-based Northern Finland 1966 Birth Cohort of 12,058 live-born children. The data were collected beginning from pregnancy and ending mid-adulthood. The mothers were asked about their mood during pregnancy at the antenatal clinic at 24–28 gestational weeks. Of the mothers, 13.9% rated themselves as depressed (11.8%) or very depressed (2.1%) during pregnancy. Parents’ severe, hospital-treated mental disorders, and the cohort members’ mental disorders were identified mainly by using the Finnish Care Register for Health Care. In this study, the adult offspring of antenatally depressed mothers had an increased risk of depression, and the male offspring for antisocial personality disorder, compared to cohort members without antenatally depressed mothers. The offspring with both maternal antenatal depressed mood and parental severe mental disorder had a markedly elevated risk of schizophrenia and depression, compared to cohort members without one or both of the risk factors. This is the first study where the offspring of antenatally depressed mothers were followed till mid-adulthood, also taking into account parental severe mental disorders. Based on the findings, the prevention of and early intervention in antenatal depression, especially in families with severe mental illness, might present an opportunity to reduce the risk of mental disorders in the offspringTiivistelmä Äitien raskausajan masennus on yleistä, mutta pitkiä seurantatutkimuksia raskausaikana masentuneiden äitien lapsista on vähän. Tutkimuksen tavoitteena oli selvittää, onko raskausaikana masentuneiden äitien aikuisilla jälkeläisillä kohonnut riski sairastua skitsofreniaan, masennukseen, kaksisuuntaiseen mielialahäiriöön, epäsosiaaliseen tai epävakaaseen persoonallisuushäiriöön, ja ilmeneekö heillä enemmän skitsotyyppisiä tai affektiivisia piirteitä. Vanhempien vakavien mielenterveydenhäiriöiden katsottiin olevan sekä mahdollisia geneettisiä että ympäristöön liittyviä riskitekijöitä jälkeläisten mielenterveyshäiriöille. Tutkimus perustuu yleisväestöön pohjautuvaan, prospektiiviseen Pohjois-Suomen vuoden 1966 syntymäkohorttiin, johon kuuluu 12 058 elävänä syntynyttä lasta. Kohortin jäseniä on seurattu sikiöajalta keski-ikään, aina 49 ikävuoteen saakka. Äitien raskaudenaikaista mielialaa tiedusteltiin raskausviikoilla 24–28 neuvolassa. 13,9 % äideistä raportoi mielialansa masentuneeksi (11,8 %) tai hyvin masentuneeksi (2.1%) raskausaikana. Vanhempien vakavat mielenterveydenhäiriöt ja kohortin jäsenten mielenterveyshäiriöt selvitettiin pääosin hoitoilmoitusrekisteritiedoista. Tutkimuksessa raskaudenaikana masentuneiden äitien lapsilla havaittiin kohonnut depressioriski sekä kohonnut epäsosiaalisen persoonallisuushäiriön riski miehillä, verrattuna kohortin jäseniin, joiden äitien mieliala ei ollut masentunut raskausaikana. Kohortin jäsenillä, joiden äideillä oli raskausajan masennusta ja toisella vanhemmista vakava mielenterveyshäiriö, oli kohonnut riski sairastua skitsofreniaan ja depressioon, verrattuna heihin, joilla oli vain yksi tai ei kumpaakaan näistä riskitekijöistä. Tämä on ensimmäinen tutkimus, jossa raskausaikana masentuneiden äitien lapsia on seurattu keski-ikään saakka, huomioiden myös vanhempien vakavat mielenterveydenhäiriöt. Tutkimuksen tulosten perusteella äidin raskausajan masennusoireiden varhaisen tunnistamisen ja hoidon voitaisiin ajatella vähentävien jälkeläisten mielenterveysongelmien riskiä, etenkin perheissä, joissa on vakavia mielenterveysongelmia
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Boen, Randall. "The Evaluation of Attitudes towards Individuals with Mental Illness among Counselors in Training." OpenSIUC, 2018. https://opensiuc.lib.siu.edu/dissertations/1643.
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Negative attitudes and stigma associated with mental illness have a profound impact on individuals who experience them. Researchers have defined stigma as the attribution of a deviant characteristic to members of a particular group. Persons with severe and persistent mental illness (SPMI) face many difficulties that impact their full participation in social life. Although attitudinal reactions to individuals with SPMI have improved considerably over the last few decades, there are still areas for improvement. Limited research has been conducted to evaluate attitudes and stigma associated with individuals with SPMI among human service professionals-in-training (HSPs). For this study HSPs were defined as individuals entering into social service, mental health, and substance abuse professions. Further, there have only been a few published studies in attitude research that utilized randomized vignettes portraying individuals with two different mental health diagnoses. Data collection occurred in counselor education and similar programs at many universities. A total of 79 participants (20 males and 58 females) took part in this study. Recruitment efforts reached HSPs at 27 universities throughout the contiguous United States. For this study, participants were asked to respond to self-report surveys and to one of two written vignettes to quantify their attitudes toward the individuals depicted in them. The two vignettes described an individual with a mental illness and differed in the diagnosis attributed to the individual: schizophrenia spectrum disorder in one vignette and generalized anxiety disorder in the other vignette. Results indicated that although there were slight mean differences between the two groups of participants, the differences were not statically significant, t (77) = 0.63, p =53. The Attribution Questionnaire-27 (AQ-27; Corrigan, 2012) gathered overall attitudes towards mental illness. The Mental Health Provider Stigma Inventory (MHPSI; Kennedy, Abell, & Mennicke, 2014) was used to collect data on attitudes, behaviors, and social pressure impacting stigma towards individuals who have SPMI. Data collected with these two scales yielded evidence to indicate that participants held stigmatizing attitudes towards individuals with SPMI. Data gathered suggested that graduate students in rehabilitation counselor education programs expressed fewer stigmatizing attitudes than students from other programs. This result was seen across both measures. Data were collected on frequency of contact with persons with mental illness to evaluate the association between contact frequency and knowledge of mental illness and negative attitudes. Demographic data gathered included gender, age, professional training, and number of years of work experience in a counseling-related role. Further, a hierarchical multiple regression was used to determine which order of predictors were statistically significant to the outcome measure. Prior literature suggest that prior contact and familiarity scores playing a more important role in predicting the outcome variable (AQ-27) then the demographic information. The first model was statistically significant F(6,72) =3.64, p= .003 and explained 23% of the variance in the dependent variable (AQ-27 total scores). After the input of these demographic factors the second step included LOF and SADP- PCF-R scores. After entry of the second step the overall variance was 28%. The second model was statically significant F(8,70) = 3.39 p = 002 and explained an additional 4% variance in the model. In the final adjusted model, four out of the seven predictor variables were statistically significant. A small pilot study consisting of rehabilitation counseling professionals was used to develop the methodologies for this study. The primary limitation of the primary study was the sample size. Further details of the methodology used and limitations of this particular study will be described in subsequent chapters. Implications of this study and suggested future research are proposed.
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Wennström, Erik. "The Camberwell Assessment of Need as an Outcome Measure in Community Mental Health Care." Doctoral thesis, Uppsala University, Department of Neuroscience, 2008. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-8439.
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The aim of this thesis was to critically examine the current use of the Camberwell Assessment of Need (CAN) in outcome assessment for service evaluation. A further aim was to propose a metric for assessing the adequacy of community mental health services in meeting ongoing needs over longer stretches of time.
We made four prospective follow-up studies of CAN assessments of patients with severe mental illness in community-based mental health care.
A factor analysis (n=741) gave support for a three-factor model, comprising only 60% of the CAN items. Need assessments (n= 92) in 1997 and 2003 were compared at both the summed total and the underlying item levels of the CAN. The mean total scores did not change, yet there were significant changes in the underlying items. Changes in mean number of needs between 1997 and 1999 were measured (n=262) with both total scores, summed over all CAN items, and with sub-total scores, summed over two sets of items reflecting the social services and the psychiatric services respectively. As indicated by the sub-total scores, all significant changes occurred within the psychiatric services, a result not possible to discern from the total scores. The Met Needs Index (MNI), defined by us as the aggregate measure of beneficial outcome, indicated that needs in general were met during 71% of the intervals between the annuals assessments from 1997 through 2004. However, the variation among particular items was large.
In conclusion, the summary scores typically used as outcome measures are likely to conceal meaningful variation at the item level. Nevertheless, sub-total scores, being more transparent, might be more useful in outcome assessment. The MNI is a continuous, normally distributed metric, estimable over any number of consecutive assessments, which seems suitable for assessing the achieved benefit of services for patients with long-term ongoing needs.
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Teferra, Abebe Solomon. "Studies on psychotic disorders in rural Ethiopia." Doctoral thesis, Umeå universitet, Psykiatri, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-43826.
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Background Studies on course and outcome of schizophrenia coming from low income countries are increasingly becoming important to challenge the existing dogma claiming good outcome in these countries. Besides clinical course and outcome, mortality is considered a very important outcome measure for schizophrenia. Culture and tradition play a significant role in the manifestations of severe mental illnesses (SMI). Khat is a culturally accepted plant endemic to Eastern Africa, which is chewed by people for its stimulating effect. It is believed that Khat influences the course and outcome of schizophrenia although systematic studies are scarce. Patients with SMI continue to chew khat despite advice from their doctors to desist. Reasons for this behavior were not fully investigated before. Objectives - To describe the 5-year clinical course and outcome and mortality of schizophrenia in Butajira. - To explore traditional views on psychosis in the semi-nomadic Borana population. - To describe the perceived causes and preferred treatment for SMI in the semi-nomadic Borana population - To explore reasons for khat chewing behavior in people with SMI in Butajira. Methods The studies were done in two sites: Butajira and Borana. The Butajira study involved screening, using CIDI and Key Informants (KIs), of more than 68,000 adults aged 15-49. Of these, 321 people were diagnosed with schizophrenia and were followed-up for five years to look into their clinical course and outcome, including mortality. A qualitative study involving 37 men with SMI and 30 female caregivers was conducted in Butajira to study reasons why patients continue to chew khat despite their physicians’ advice against it. The Borana study of a remote semi-nomadic population in southern Ethiopia, used qualitative methods involving 56 KIs to identify descriptions of psychosis, perceived causes and preferred treatment in the community. Cases identified by the KIs also underwent SCAN interview for confirmatory diagnosis. Results The five year follow-up of schizophrenia patients showed that 45% of participants were continuously symptomatic with 30.3% having had continuous psychotic episode. About 20% had experienced continuous remission. Being single (OR = 3.41, 95% CI = 1.08-10.82, P = 0.037), on antipsychotic treatment for at least 50% of follow up time (OR = 2.28, 95% CI = 1.12-4.62, P = 0.023), and having a diagnosis of paranoid subtype of schizophrenia (OR = 3.68, 95% CI = 1.30-10.44, P = 0.014) were associated with longer period of remission. A total of 38 (12.4%) patients, thirty four men (11.1%) and four women (1.3%) died during the 5-year follow-up period. The mean age (SD) of the deceased for both sexes was 35 (7.35): 35.3 (7.4) for men and 32.3 (6.8) for women. The most common cause of death was infection, 18/38 (47.4%) followed by severe malnutrition, 5/38 (13.2%) and suicide 4/38 (10.5%). The overall SMR was 5.98 (95% CI = 4.09 to 7.87): 6.27 (95% C I = 4.16 to 8.38) for men and 4.30 (95% CI = 1.02 to 8.52) for women. Patients residing in rural areas had lower mortality with adjusted HR of 0.30 (95% CI = 0.12-0.69) but those with insidious onset had higher mortality with adjusted HR 2.37 (95% CI = 1.04-5.41). Treatment with antipsychotics for less than 50% of the follow-up time was also associated with higher mortality, adjusted HR 2.66 (1.054-6.72). In the Borana study, the incongruity between local and psychiatric concepts in the CIDI lay mainly in the fact that KIs described characteristics of marata (madness) in terms of overt behavioral symptoms instead of thought disturbances. Following the focus group discussions, participants identified 8 individuals with schizophrenia and 13 with a psychotic mood disorder, confirmed by SCAN interview. Supernatural causes such as possession by evil spirits, curse, bewitchment, ‘exposure to wind’ and subsequent attack by evil spirits in postnatal women; bio-psycho-social causes such as infections (malaria), loss, ‘thinking too much’, and alcohol and khat abuse were mentioned as causes of SMI. The preferred treatments for severe mental illness included mainly traditional approaches, such as consulting Borana wise men or traditional healers, prayer, holy water treatment and, finally, seeking modern health care. Regarding khat and SMI in Butajira, reasons given by patients as well as caregivers were more or less congruent: social pressure, a means for survival by improving function, combating medication side effects, to experience pleasure and curbing appetite. Conclusion Schizophrenia runs a chronic and non-remitting course and was associated with very high premature mortality in Butajira. Continued treatment with antipsychotics has been a consistent predictor of favorable outcome and reduced mortality. Case identification in studies of psychotic disorders in traditional communities are likely to benefit from combining structured interviews with the key informant method. Planning mental health care in traditional communities needs to involve influential people and traditional healers to increase acceptability of modern mental health care. Patients with SMI chewed khat for some important reasons that clinicians need to consider in their management.
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MONZIO, COMPAGNONI MATTEO. "The quality of clinical pathways delivered to patients with severe mental disorders. A multi-regional italian investigation based on healthcare utilization databases. The QUADIM project." Doctoral thesis, Università degli Studi di Milano-Bicocca, 2020. http://hdl.handle.net/10281/262317.
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Improving the quality of care is a leading priority for national health systems, consistent with the aim of improving population health, while maintaining the sustainability of the whole health system, especially for the mental health system, since it is composed by a complex network of community mental health teams of professionals and a wide range of community-based treatment, rehabilitation, day-care and residential care facilities.
The quality of routine mental healthcare is still far from optimal, worldwide and in Italy, because it is not always delivered in accordance with evidence-based mental health standards and it can vary greatly among providers. Indeed, the construct of process indicators in the field of mental health is often not completely consistent with recommendations in evidence-based guidelines, where existing. To date, only few studies have analyzed this issue in Italy, despite the quality of mental health care has become a frequent subject of international evaluations.
Given these premises, the QUADIM Project (“Clinical pathways in patients with severe mental disorders in Italy”), an Italian multi-regional project funded in 2016 by the Italian Health Ministry, was conducted with the aim to assess the quality of healthcare pathways provided to patients with serious mental illnesses (SMI) assisted by regional Departments of Mental Health (DMHs) in a real-world setting, using a set of process indicators developed by a panel of experts starting from a document approved by the italian Unified State-Regions Conference (2014).
The main aim of this thesis was the conduction and the management of this project, which constituted my thesis project during the PhD.
For each of the four SMI investigated (i.e., schizophrenic, depressive, bipolar and personality disorders), from the regional Healthcare Utilization (HCU) databases were identified the cohorts of adult patients affected by this specific mental disorder and taken in care by regional DMHs during the years 2015-2016. The adherence of these patients to the defined process indicators was evaluated during the first 12 months of follow-up, assessing strengths and weaknesses of the four regional mental health systems.
As far as the process indicators were designed and developed taking inspiration from clinical recommendations that should be followed for improving the quality of mental healthcare, and by considering that a better process profile, as measured by these indicators, not necessarily lead to better outcomes, a secondary aim of the QUADIM project was the conduction of a validation study for evaluating their relationship with measurable clinical outcomes. Thus, among patients affected by an incident schizophrenic spectrum disorder, case-crossover study was conducted in order to validate some process indicators, relating them, as a proxy of the quality of delivered care, with some clinical outcomes, such as admission to hospital psychiatric wards (GHPWs).
The layout of the thesis has been divided into different sections. I will proceed in the first instance by giving an overview of the QUADIM project and the methods used to identify the cohorts of patients affected by SMI, to design and develop the process indicators and to conduct the validation study among patients with incident schizophrenic spectrum disorder; proceeding with a detailed description of the results and reporting the main findings of the validation study. Finally, the implications of monitoring the process of care of patients with incident schizophrenic disorder and, more in general, of the proposed approach, were discussed.Improving the quality of care is a leading priority for national health systems, consistent with the aim of improving population health, while maintaining the sustainability of the whole health system, especially for the mental health system, since it is composed by a complex network of community mental health teams of professionals and a wide range of community-based treatment, rehabilitation, day-care and residential care facilities. The quality of routine mental healthcare is still far from optimal, worldwide and in Italy, because it is not always delivered in accordance with evidence-based mental health standards and it can vary greatly among providers. Indeed, the construct of process indicators in the field of mental health is often not completely consistent with recommendations in evidence-based guidelines, where existing. To date, only few studies have analyzed this issue in Italy, despite the quality of mental health care has become a frequent subject of international evaluations. Given these premises, the QUADIM Project (“Clinical pathways in patients with severe mental disorders in Italy”), an Italian multi-regional project funded in 2016 by the Italian Health Ministry, was conducted with the aim to assess the quality of healthcare pathways provided to patients with serious mental illnesses (SMI) assisted by regional Departments of Mental Health (DMHs) in a real-world setting, using a set of process indicators developed by a panel of experts starting from a document approved by the italian Unified State-Regions Conference (2014). The main aim of this thesis was the conduction and the management of this project, which constituted my thesis project during the PhD. For each of the four SMI investigated (i.e., schizophrenic, depressive, bipolar and personality disorders), from the regional Healthcare Utilization (HCU) databases were identified the cohorts of adult patients affected by this specific mental disorder and taken in care by regional DMHs during the years 2015-2016. The adherence of these patients to the defined process indicators was evaluated during the first 12 months of follow-up, assessing strengths and weaknesses of the four regional mental health systems. As far as the process indicators were designed and developed taking inspiration from clinical recommendations that should be followed for improving the quality of mental healthcare, and by considering that a better process profile, as measured by these indicators, not necessarily lead to better outcomes, a secondary aim of the QUADIM project was the conduction of a validation study for evaluating their relationship with measurable clinical outcomes. Thus, among patients affected by an incident schizophrenic spectrum disorder, case-crossover study was conducted in order to validate some process indicators, relating them, as a proxy of the quality of delivered care, with some clinical outcomes, such as admission to hospital psychiatric wards (GHPWs). The layout of the thesis has been divided into different sections. I will proceed in the first instance by giving an overview of the QUADIM project and the methods used to identify the cohorts of patients affected by SMI, to design and develop the process indicators and to conduct the validation study among patients with incident schizophrenic spectrum disorder; proceeding with a detailed description of the results and reporting the main findings of the validation study. Finally, the implications of monitoring the process of care of patients with incident schizophrenic disorder and, more in general, of the proposed approach, were discussed.
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Tenbarge, Brittany A. "The Relationship between the Wellness Management and Recovery Program and Physical Health." University of Toledo / OhioLINK, 2011. http://rave.ohiolink.edu/etdc/view?acc_num=toledo1321586339.
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VORST, DEBORAH ANN. "The Impact Of An Integrated Dual Disorder Treatment Model In Detecting Substance Use Disorders And Referral To Community Services In A Population With Severe Mental Illness." University of Cincinnati / OhioLINK, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1212029473.
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Bazhuni, Natasha Frias Nahim. "Dispositivos de atendimento na clínica psicanalítica para crianças com distúrbios graves: uma experiência em uma clínica escola." Universidade de São Paulo, 2016. http://www.teses.usp.br/teses/disponiveis/47/47133/tde-16092016-140108/.
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As experiências de tratamento no campo da saúde mental infantil com crianças com distúrbios graves, atualmente existentes no país, carecem de avaliações mais precisas de seus modelos clínicos e institucionais para examinar sua efetividade e propiciar a indicação de parâmetros mais detalhados para as exigências desse campo. Esta pesquisa se desenvolveu a partir do trabalho de supervisão dos atendimentos de crianças com distúrbios graves, orientados pela psicanálise Freud-lacaniana, desenvolvido em uma clínica-escola de uma Universidade particular de Psicologia da Bahia. Adotou-se como estratégia clínica a inclusão da escuta a pais e crianças, em sessões separadas, pelo mesmo estagiário de psicologia. A questão central desta pesquisa é apontar que esse dispositivo pode ser implementado e desenvolvido na clínica-escola com esses estagiários. Foram apresentados e discutidos fragmentos de um atendimento clínico, selecionados em função de terem sido os desencadeadores das principais observações e questões clínico-teóricas abordadas. Analisa-se que uma intervenção na loucura a dois que se instala na relação mãe e criança deve ser feita e tem a eficácia de permitir que o traço nomeador da criança se escreva ou acabe de ser escrito. Dessa forma, a separação é o processo visado nessa proposição de trabalho que busca desalojar a criança do lugar de objeto incluído no Outro, e do qual ela condensa o gozo, fazendo surgir um sujeito. Acentua-se que é o trabalho com o significante que permite a quebra da repetição, possibilitando ao sujeito, em uma nova temporalidade, se posicionar ante os significantes que o marcaram. A pesquisa revela sua relevância científica e social, na medida em que indica ser possível a implementação do dispositivo psicanalítico proposto numa clínica-escola de Psicologia, o que aumenta os espaços de atendimento de crianças com distúrbios graves no campo da saúde mentalCurrent treatment experiences in the field of children\'s mental health for children with severe disorders, in our country, lack of more accurate evaluations of clinical and institutional models to be able to examine their effectiveness and to provide an indication for more detailed parameters for the requirements in this field. This research was developed from clinical supervision of the work with children with severe disorders based on Freud-lacanians psychoanalyses implemented in a psychology school-clinic of a private university at Bahia. We adopted as a clinical strategy the inclusion of psychoanalytic listening to parents and their children, in separate sessions by the same psychology intern. The central contention of this research is that this therapeutic device can be implemented and developed in school-clinic with this interns. Fragments of sessions from a clinic consultation were presented and discussed. These fragments were selected because they trigged the main observations of the clinical and theoretical issues addressed. Our analysis found that an intervention in the shared psychotic disorder in the relationship of mother and child should be made and this is effective in allowing the nominator trace of the child to be written or the writing to be finished. These separation is the main objective of this proposed process, that seeks to change the child from being an object included in another person, in whom she condenses all her jouissance, to a subject in and of itself. We stress that working with the signifier allows them to break the repetition circle, enabling the subjects, in a new temporality, to position themselves before the signifier who has marked them. This research reveals its scientific and social relevance as it indicates that is possible to implement psychoanalytic treatment device in a psychology clinical-school which increases the attendance spaces for children with severe disorders
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Lindström, Maria. "Promoting agency among people with severe psychiatric disability : occupation-oriented interventions in home and community settings." Doctoral thesis, Umeå universitet, Arbetsterapi, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-50038.
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In general, people with severe psychiatric disability living in sheltered or supported housing lead passive, solitary lives. Current rehabilitative approaches often neglect considering an agentic perspective of the residents in sheltered or supported housing. Furthermore, the outreach and societal contexts are often not considered. Thus, practitioners tend to overlook the potential in providing support and rehabilitation that is adapted to their individual, collective and changing needs. My approach was to develop a model for Everyday Life Rehabilitation (ELR), which has a potential to promote agency while targeting recovery, meaningful daily occupations, social participation, and person-driven goals. We employed two occupational therapists (OT) and offered an intervention with ELR in a medium-sized municipality in northernSwedenand evaluated this intervention from the perspectives of residents and community care workers (CCW), using a combination of quantitative and qualitative methods. This thesis comprises four studies that focus on a home and community context, late rehabilitation efforts, daily occupations, and client-centredness. The overall aim is to understand and evaluate the impact of recovery- and occupation-oriented interventions in a home context for people with severe psychiatric disability. The study settings are sheltered and supported housing facilities. The first study (n=6) explores the significance of home for occupational transformations. The analysis reveals how residential conditions facilitate rehabilitative interactions, generating occupational transformations such as increasing social competence and taking charge of daily occupations. The second study evaluates occupation- and health-related outcomes of the ELR-intervention for residents (n=17). Pre-, post-, and follow-up differences in tests scores on goal attainment, occupation, and health-related factors indicate that important progress is made. The third study explores residents’ (n=16) narratives about occupational transformations in the context of everyday life and life history. Narrative analysis discloses stories of ‘rediscovering agency’, referring to occupational and identity transformations. The fourth study illuminates community care workers’ (n=21) experiences of collaborating with residents and OTs, using ELR. The CCW’ view on residents, rehabilitation, and the own role, along with organisational conditions in the housing facility, seem to characterise different outlooks influencing the CCWs responsiveness or resistance to the intervention. In conclusion, rehabilitation in a supported housing context appears paradoxical due to tensions between opposing values such as authentic versus artificial, and independence versus dependence. However, if residents are engaged in challenging these tensions, they can function as ‘progressive tensions’ generating change. Considering the personal and social meaning of home also appears to be valuable. The intervention studies on ELR, demonstrate its value for participants and indicates that a recovery approach applying ELR would promote shared perspectives among residents, CCWs, and OTs, while facilitating ‘agent-supported rehabilitation’ and ‘out-of-housing strategies’. The thesis provides initial support for the use of ELR-interventions and proposes continued research.Vardagslivets Rehabilitering (Everyday Life Rehabilitation)
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Walby, Gary W. "Associations between individual, social, and service factors, recovery expectations and recovery strategies for individuals with mental illness." [Tampa, Fla.] : University of South Florida, 2006. http://purl.fcla.edu/usf/dc/et/SFE0002203.
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Dellazizzo, Laura. "La violence chez les personnes ayant des troubles mentaux : éclaircir les liens entre les troubles mentaux graves, les troubles de personnalité et les abus de substances." Thèse, 2017. http://hdl.handle.net/1866/20487.
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Bello, Iruma. "Cognitive motivational systems and life satisfaction in severe and persistent mental illness." Thesis, 2008. http://hdl.handle.net/10125/20867.
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Ahrens, Christine S. "Factors influencing vocational capacity in persons with severe and persistent mental illness." 1997. http://catalog.hathitrust.org/api/volumes/oclc/40248486.html.
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Thesis (Ph. D.)--University of Wisconsin--Madison, 1997.Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 109-123).
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Portnoff, Larissa. "The Structure of Mental Health in Haiti: A Latent Class Analysis of Common Mental Disorders, Severe Mental Disorders, Neurological Conditions, Clinical Symptoms, and Functional Impairment." Thesis, 2021. https://doi.org/10.7916/d8-4kkf-nn80.
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The experience of mental disorders while part of humanity, reveal inequities that are inhumane due to a lack of quality clinical service provisions globally. In Haiti, a formalized mental healthcare infrastructure developed after the 2010 earthquake where emerging dissemination and implementation studies demonstrated the potential for treatment utilization within recently established primary care. Partners in Health (PIH) and Zanmi Lasante (ZL) the frontline healthcare team have coordinated with the Haitian Ministry of Health to lead this initiative. A community-based mental healthcare system has proven to be sustainable through a task-sharing model, which delivers mental healthcare for common mental disorders (CMDs), severe mental disorders (SMDs), and neurological conditions (NCs)–with specific care pathways for major depression, psychotic disorders, and epilepsy. The extent to which patient mental healthcare are evaluated in lower-middle income countries (LMICs) like Haiti, however, have been limited. The primary aim of this study was to therefore evaluate patterns of mental disorders and to assess current patient care priorities in Haiti.
The present study, builds upon previous literature by examining the continuum of mental disorders. A latent class analysis provides a data-driven approach to examine features of mental disorders to inform clinical treatment and best practices. EHR data from PIH and ZL were obtained from patients (N=914) who met criterion for a primary diagnosis and had completed mental health evaluations that were assessed at 13 sites in Haiti from 2016-2018. Known characteristics of mental disorders include the patient’s primary diagnosis, mood symptoms such as depression and suicidality, and the level of functional impairment. Accordingly, each were included as an LCA model indicator. Post-hoc multinomial logistic regression (MLR) models predicted mental health class selection and correlates based on the descriptive and clinical symptom variables. Results suggested there are six distinct mental health subgroups, that were distinguished by functional impairment: class 1a “common mental disorders– none to low functional impairment” (11.5%), class 2a “severe mental disorders–none to low functional impairment” (4.9%), class 3a “neurological conditions–none to low functional impairment” (11.1%), class 4b “common mental disorders–high functional impairment” (38.62%), class 5b “severe mental disorders–high functional impairment” (13.02%), and class 6b “neurological conditions–high functional impairment” (20.9%).
MLR model 1 revealed CMDs were 2–3 times more likely female and received psychosocial interventions more often, and by comparison SMDs and NCs typically received psychiatric medication. MLR model 2 included patient’s clinical symptoms, that suggested severe CMDs with high functional impairment were somewhat more likely depressed when compared to other LCA subgroups. Although, in all likelihood this finding was probably attributed to CMDs including mild to severe forms of major depression, whereas SMDs were mostly psychotic disorder and bipolar disorder. Taken together, the most frequent primary diagnosis included: 1) major depressive disorder (60.3%) and generalized anxiety disorder (27.2%) for CMDs, 2) psychotic spectrum disorders (47.6%) and bipolar disorder (23.7%) for SMDs, and 3) epilepsy (88.8%) for NCs. Patients were infrequently diagnosed with co-occurring psychological disorders. The varied mental health disorder subgroups that participated in psychotherapy and psychiatric medication management, demonstrate such mental health treatments for Haitian’s are feasible and acceptable. While the present analysis was exploratory, LCA provides potential tools for treatment specification and best practices.
The WHODAS, a measure of functional impairment, may be useful as a screening tool for triage, and primary outcome to determine patient improvement. Mental healthcare pathways based on results should expand to include women’s mental health and bipolar disorder. These findings are generalizable due to the data being from a community sample and directly from EHRs with inclusion criterion that was not limited by diagnostic specification, symptom severity, or co–occurring disorders. Overall, there is a vast need for mental health services that are broadly accessible for CMDs, SMDs, and NCs. This study highlights, specific clinical training and supervision needs, and the necessity for increased nursing, psychiatry, and neurology collaboration in Haiti. There is hope that healthcare expansion will strengthen and continue to empower communities in Haiti.
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Comstock, Margaret. "Health practices of people with persistent mental illness a research report submitted in partial fulfillment ... Master of Science (Psychiatric-Mental Health Nursing) /." 1990. http://catalog.hathitrust.org/api/volumes/oclc/68795158.html.
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Scott, Roger L. "Community treatment outcomes for persons with severe and persistent mental illiness a theory-driven evaluation of assertive community treatment /." 2004. http://purl.galileo.usg.edu/uga%5Fetd/scott%5Froger%5Fl%5F200408%5Fphd.
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Lee, Shu-Chun, and 李淑君. "Health-Related Quality of Life in Patients with Severe and Persistent Mental Illness in Community Rehabilitation Centers and Outpatient Programs." Thesis, 2013. http://ndltd.ncl.edu.tw/handle/40836789945149862044.
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碩士國防醫學院
公共衛生學研究所
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Background: Department of Health, Executive Yuan, Taiwan had a program about community psychiatric rehabilitation for patients with severe and persistent mental illness (SPMI) in 1988. Further, Taiwan’s Mental Health Act included the service of the community psychiatric rehabilitation and the service became an important part for patients with SPMI. Objective: Health-related quality of life (HRQOL) is one of the most valuable goals of treatment in patients with SPMI. The purpose of this study was to invesigtate the factors that influrence HRQOL. Methods: Four psychiatric rehabilitation centers and the outpatients of one Taipei city psychiatric center were selected in this study, which included 138 clients. Inclusion criteria were a DSM-IV diagnosis of schizophrenia, and mood disorder. HRQOL was measured using the Quality of Life for Mental Disorder (QOLMD). Structural equation modeling (SEM) was chosen to investigate the correlations between demographic characteristics and HRQOL. Result: This model showed that the eight domains of QOLMD can be separated into three hierarchies. For the outpatients without psychiatric rehabilitation center services, the autonomy of HRQOL were influenced by diagnosis (β=0.35, p<0.001), the health maintenance, economical ability and social activities were influenced by Personal and Social Performance (PSP) (β=0.29, p=0.003; β=0.31, p=0.002; β=0.23, p=0.006) and the social activities were influcened by education (β=-0.18, p=0.015). For the patients in the psychiatric rehabilitation centers, the life satisfaction of HRQOL were influenced by PSP function (β=-0.10, p=0.075), the autonomy was influenced by employment and education (β=0.32, p<0.001; β=-0.14, p=0.064) and the physical health was influenced by diagnosis and education (β=-0.14, p=0.045; β=0.18, p=0.011). Conclusion: The model helped us understand the interrelation and pathway among various domains in three hierarchies of HRQOL in patients with SPMI. The factors that influenced HRQOL for SPMI in medical services are quite different. The services for patients with SPMI have to be modified by different medical characteristics to improve HRQOL.
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Isaacs, Patti Mieko. "Aloha `aina : A Hawaiian garden intervention designed to plant the seeds of recovery in persons with severe and persistent mental illness." Thesis, 2008. http://hdl.handle.net/10125/20847.
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Thesis (Ph.D.)--University of Hawaii at Manoa, 2008.This study was the first of its kind to evaluate the adaptation of a traditional, empirically supported, Western treatment of family education and social skills training to fit the needs of individuals of Pacific Islander and Asian culture with severe and persistent mental illness. The main purpose of the present study was to evaluate the efficacy of the Aloha Garden, a Hawaiian garden intervention program designed to promote recovery in individuals with severe and persistent mental illness at the Hawaii State Hospital. The heart of the Aloha Garden is aloha `aina (love of the land) which is assumed to be central in the healing of Native Hawaiian individuals. It is also assumed that the teaching of Hawaiian values in a "real life setting" is applicable to other minority clients who share similar beliefs and expectations as Native Hawaiians. The effects of the Aloha Garden were examined prospectively using measures of recovery, hope, spirituality, aggression, and treatment compliance. Multilevel modeling was used to analyze the quantitative data. One qualitative question on the effects of the Aloha Garden on recovery was asked of the participants in the Aloha Garden. Over the eleven-month period of study, both Aloha Garden participants and non-participants demonstrated improved environmental recovery, hope, and spirituality. In addition, the Aloha Garden participants had statistically higher personal recovery and treatment compliance and lower incidence of aggression than the study participants not involved in the Aloha Garden. The effects of Aloha `Aina were not limited to individuals who identified with Hawaiian and Asian cultures but were also found to improve recovery in individuals of Western cultures.
Includes bibliographical references (leaves xxx-xxx).
Also available by subscription via World Wide Web
163 leaves, bound 29 cm
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Tomassi, Simona, and Sarah Tosato. "CHILDHOOD TRAUMATIC EXPERIENCES AND MENTAL HEALTH: INVESTIGATING BIOLOGICAL, PSYCHOLOGICAL AND SOCIAL CORRELATES." Doctoral thesis, 2019. http://hdl.handle.net/11562/990894.
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BACKGROUND: Childhood traumatic experiences, including physical and sexual abuse, antipathy, and neglect, are significantly associated with higher risk of developing both mental disorders and medical conditions. AIM: To elucidate the effects of childhood trauma on health, especially mental health, taking into account some literature-selected biological, psychological, and social correlates. METHODS: Investigations were conducted in three different sample groups: (1) a group of First Episode Psychosis (FEP) patients belonging to the “Genetics, Endophenotypes and Treatment: Understanding early Psychosis” (GET UP) Research Project; (2) a group of hepatitis C patients included in the "Chronic Inflammation and Depression” Research Project; and (3) a sample of healthy subjects. In these three samples, childhood traumatic experiences were evaluated by the Childhood Experience of Care and Abuse Questionnaire (CECA) questionnaire (Bifulco et al., 2005): physical punishments, sexual unwanted experiences, loss, separation, antipathy, and neglect were investigated. HPA axis functioning, cannabis use, and glucose metabolism were investigated as potentially involved biological correlates. HPA axis functioning was estimated by measuring salivary cortisol levels, as both diurnal cortisol levels and Cortisol Awakening Response (CAR). The Cannabis Experiences Questionnaire (CEQ) (Barkus et al., 2006) evaluated cannabis use. The concentrations of C-peptide, Ghrelin, GIP, GLP-1, Glucagon, Insulin, Leptin, PAI-1, Resistin and Visfatin were determined using Bio-PlexPro™ Human Diabetes Assays (Bio-Rad, CA, USA). Coping strategies, age, gender, education, socio-economic status, and recent severe stressful life events were taken into account as potentially involved psychosocial correlates. RESULTS: (1) Significant associations between severe sexual abuse and a diagnosis of affective psychosis and between childhood trauma, severe sexual abuse in particular, and lifetime cannabis use were found in FEP subjects. No gender difference was detected. Moreover, C-peptide and insulin levels were found increased in traumatized FEP subjects. Indeed, we found that C-peptide was higher in patients who experienced childhood trauma (with or without severe life events), while Insulin was higher in patients who reported childhood trauma (with no mention of severe recent stressful life events), in comparison to FEP subjects without traumatic events. (2) In subjects affected by Hepatitis C, childhood trauma, parental antipathy, and neglect were found significantly associated with higher levels of depressive and anxious symptomatology and with greater emotional distress. Exploring different types of trauma, we found that subjects with a history of physical punishments demonstrated significantly increased levels of depression, emotional distress, and fatigue in comparison with subjects not recalling this history. An even stronger association was found between sexual unwanted experiences and levels of depression, anxiety, and emotional distress. Healthy subjects (3) with a history of childhood trauma showed higher lifetime frequency of positive psychotic-like symptomatology, while maternal antipathy was significantly associated with lower lifetime frequency of negative symptoms and lower levels of distress in response to depressive symptoms. Lifetime cannabis use and salivary cortisol levels were explored as potentially mediating factors, but no mediational effect was found. Finally, higher insulin levels were significantly associated in healthy subjects with physical abuse and childhood trauma plus severe life events (SLEs); Body Mass Index (BMI), which was also significantly associated with higher insulin levels, completely mediated the association with physical abuse, while childhood trauma plus SLEs and BMI gave independent contributions to higher insulin levels. Higher PAI-1 levels were found in subjects reporting childhood trauma and SLEs. Finally, physical abuse, severe sexual abuse and childhood trauma plus SLEs were found significantly associated with higher C-peptide levels. BMI completely mediated the association between physical abuse and C-Peptide, while severe sexual abuse or childhood trauma plus SLEs and BMI independently contributed to C-Peptide levels. CONCLUSION: Our findings confirmed the detrimental consequences of childhood trauma, even at non-clinical level. On the other side, some of our results evoked a potential increased resilience in subjects with a history of childhood traumatic experiences.
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Campbell, Linda E. "What characteristics are associated with good versus poor parenting outcomes amongst parents living with psychotic disorders: a confirmatory factor analysis." Thesis, 2015. http://hdl.handle.net/1959.13/1308159.
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Masters Research - Master of Clinical Psychology (MClinPsych)Scope: Parenthood is central to most adult people’s personal and social identity. For many people with psychotic disorders, parenthood is associated with formidable challenges that, for some, are difficult to overcome. Some of these challenges are present prior to the onset of the psychotic disorder, yet others occur as a consequence of the disorder. Many of these challenges are associated with social disadvantage that would make it difficult to parent with or without a psychotic disorder. Others are more directly associated with disorder itself such as problematic symptoms and decreased level of functioning. Whilst some parents with psychotic disorder manage well in their parenting, others have problems that can result in poor parent-child relationships and/or loss of custody. Purpose: The current study aimed to identify latent variables predictive of good enough parenting outcome amongst a representative sample of parents with psychotic disorders. Methodology: The second Australian national survey used a two-phase design to include a catchment population of 1.5 million people aged 18-64 (Morgan et al., 2012). In the first phase people who attended services that support people with mental illness, such as public mental health services and non-government organisations, were screened for psychosis during the census month (March, 2010). Of those participants who screened positive (N= 7955), a randomised sample stratified by age group was chosen and asked to consider participation in the study. Thereafter, in the second phase a total of 1825 people were interviewed and assessed. Out of these participants, data pertaining to 234 parents living with dependent children were included in the current analysis. Parenting outcome was operationalized as quality of care of children (last 12 months). Five latent variables were constructed, using a hypothesis-driven approach from contemporary literature, and labelled psychosocial support, illness severity, substance abuse/dependence, adaptive functioning and parenting role. The data were analysed using a confirmatory factor analysis. Results: Importantly, seventy-five per cent of participants were not identified as having any parenting dysfunction in the last 12 months (outcome variable). Out of five hypothesised latent variables, severity of illness and adaptive functioning were found to be reliably associated with the outcome variable. Meanwhile, neither the latent variables psychosocial functioning, substance abuse/dependence nor parenting role was found to be related to the outcome variable although the variables did have an indirect relationship via their association with either severity of illness and/or adaptive functioning. General conclusions: Whilst the majority of the participants were functioning adequately well in their parenting role, for those parents who were not doing well, increased symptom severity and decreased adaptive functioning presented significant difficulties. Implications: Many parents with psychosis are in need of assistance to manage their parenting obligations. However, it is important to consider that symptoms and functioning can change episodically and therefore it is vital to have targeted and flexible support that can temporarily assist in times of need to improve not only parenting outcomes but also maximise child outcomes.
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Parletta, Vanessa Anne. "Evaluating evidence-based supported employment implemented within an Australian disability employment service for adults with mental illness." Thesis, 2015. http://hdl.handle.net/1959.13/1308201.
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Professional Doctorate - Doctor of Business Administration (DBA)According to the Australian Department of Social Services, people within Australian Disability Employment Services (DES) with mental illnesses are achieving below-average job commencements and the lowest percentage of 26-week employment milestones out of all disability types. This study evaluated an Individual Placement and Support (IPS) enhancement intervention implemented within an existing DES on the Central Coast of New South Wales involving 68 adults with mental illness. Thirty-seven participants had compulsory DES participation obligations as a condition of receiving welfare benefits. Thirty-one participants were volunteers. All were tracked for 18 months following commencement to assess progress in terms of job commencements and 13- and 26-week employment milestones. DES services enhanced by IPS achieved significantly more job commencements (67.6%) than pre-IPS DES services (56.1%) and the national average for DES providers (39.9%). Contrary to expectations, participants with compulsory participation obligations benefited from both programs as much as volunteers. IPS-enhanced services generated the most net revenue (gross revenue less direct costs of service delivery) in the current funding system when targeted to Employment Support Services (ESS) Funding Level Two participants. IPS enhanced services were more cost effective per person, and per 26 week employment milestone, when targeted to those with the most intensive assistance needs. Further financial advantages of utilising IPS enhanced interventions are expected as the Australian Government increases the emphasis on results-based funding.
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Lévesque, Isabelle Sarah. "L’itinérance chez une cohorte de jeunes adultes avec premier épisode psychotique : étude comparative à 2 ans de l’impact de l’itinérance sur l’évolution fonctionnelle et symptomatique." Thèse, 2018. http://hdl.handle.net/1866/22314.
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Beaudoin, Mélissa. "Étude de la relation entre la consommation de cannabis et la violence chez les individus atteints de troubles mentaux graves." Thèse, 2019. http://hdl.handle.net/1866/23658.
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La violence est responsable de 2,5 % des décès à travers le monde, en plus d’avoir un impact important sur la santé physique et mentale des victimes. Par conséquent, il s’agit d’un problème de santé publique prioritaire. Des études récentes réalisées auprès d’individus atteints de troubles mentaux graves (TMG) ont démontré qu’il existe une association entre l’usage du cannabis et les comportements violents. Considérant que ces individus sont plus à risque de consommer des drogues et de commettre des crimes que la population générale, cette découverte est particulièrement importante dans le contexte actuel de la légalisation. L’objectif de mon projet de recherche était donc de valider et de préciser la relation entre le cannabis et la violence chez les individus TMG. Pour se faire, trois études ont été réalisées. La première visait à faire état de la littérature au moyen d’une méta-analyse. En regroupant les études ayant calculé une telle association chez les TMG, nous avons mis en lumière l’existence d’une association modérée entre l’usage du cannabis et la violence. Pour ce qui est de la deuxième étude, nous avons identifié les principaux facteurs de risque dynamiques et statiques de la violence et de la criminalité chez les TMG ; dans les deux cas, l’usage du cannabis était un facteur d’une importance majeure. La dernière étude a permis de confirmer la relation unidirectionnelle entre l’usage persistant du cannabis et la violence dans une population atteinte de schizophrénie. Finalement, ces résultats seront particulièrement importants afin de formuler des recommandations cliniques pertinentes. De futures études devront toutefois être réalisées afin d’élucider les mécanismes sous-jacents de cette association.Worldwide, violence is responsible for 2.5% of deaths, besides having an important impact on victims’ physical and mental health. Therefore, it is a priority public health problem. Recent studies of individuals with severe mental illnesses (SMI) have shown that an association exists between cannabis use and violent behaviours. Considering that these individuals are at higher risk of drug consumption and crime than the general population, this discovery is particularly important in the current context of the legalization. My research project therefore aimed to validate and to specify the relationship between cannabis use and violence in SMI individuals. To do so, three studies were conducted. The first one was to report current literature through a meta-analysis. By grouping the studies that calculated such an association among SMI, a moderate association was found between cannabis use and violence. As for the second study, we identified the main dynamic and static risk factors for violence and criminality in SMI; in both cases, cannabis use was one of these factors. The last study confirmed the unidirectional relationship between persistent cannabis use and violence in a population with schizophrenia. Finally, these results will be particularly important in order to formulate relevant clinical recommendations. However, future studies will need to be conducted to elucidate the underlying mechanisms of this association.