Population-based administrative data (2009-2012) from several sources were used to compare the health status and access to health services between a cohort of children in care with developmental disabilities (DD) (n=1,212) and a matched comparison group of children in care without DD (n=2,424). The two study groups were compared on a number of measures, including total respiratory morbidity, prevalence of diabetes, mood and anxiety disorders, continuity of care, injury-related hospitalizations, hospital-based dental care, and total number of ambulatory physician visits. Children in care with DD were significantly more likely to have a history of mood and anxiety disorders, respiratory illnesses, diabetes, hospital-based dental care, and injury-related hospitalizations compared to the matched comparison group. Children in care with DD also had significantly higher number of physician visits than children in the matched comparison group. No significant difference between the two study groups was found for continuity of care. / October 2015

Text in Afrikaans / Skeidingsangs is 'n angsversteuring by kinders weens die onvermoe om van die moeder te skei. Skeidingsangs is by die meeste jong kinders 'n realiteit wanneer hulle van hul moeders geskei word. Die intensiteit van die angservaring van die kind by skeiding word meestal onderskat. Skeidingsangs manifesteer by skooltoetrede. Dit is die kind se eerste formele toetrede tot die leefwereld waar eise aan horn gestel word. Skeidingsangs het 'n negatiewe invloed op die kind se totale leefwereld, sy relasies, skolastiese funksionering en sosiale verhoudinge. Vir die doel van hierdie navorsing word daar gefokus op die junior-primere leerling (Sub A tot Standerd een). Daar is geen differensiasie ten opsigte van geslag nie. 'n Diagnoseringslys, die idiografiese navorsings- en diagnoseringsmodel en pedoterapieprogram (Jacobs: 1980, 1981) is gebruik vir diagnose en terapie van skeidingsangs. Die effektiwiteit en bruikbaarheid van die terapeutiese tegnieke en riglyne vir die ko-terapeute is empiries getoets vanuit 'n sielkundig opvoedkundige perspektief. / Separation anxiety is an anxiety disorder in children as a result of their inability to separate from their mothers. The intensity of the anxiety experience in the child is generally underestimated. Separation anxiety manifests itself when the child enters school. This experience presents in the child's formal entry into the field of experience where personal individual demands are made. Separation anxiety presents a negative influence on the total field of experience, his relations to it, encompassing scholastic functioning and social relationships. The research is focused on the junior primary pupil (Sub A up to Stan de rd 1). There is no differentiation regarding sex. A list of diagnosis, the idiographic research and diagnostic model, and the pedotherapy programme (Jacobs: 1980, · 1981) are all used, to diagnose separation anxiety and for the treatment of this condition. The effectiveness and usefulness of these therapeutic techniques and guidelines for the co-therapists were empirically tested from a psychological educational point of view. / Psychology of Education / M. Ed. (Voorligting)

Made available in DSpace on 2014-12-17T15:37:03Z (GMT). No. of bitstreams: 1 DiegoSS_DISSERT.pdf: 636795 bytes, checksum: 620ad21d2b47550b5781855775d7f30a (MD5) Previous issue date: 2011-05-17 / Coordena??o de Aperfei?oamento de Pessoal de N?vel Superior / Memory and anxiety are related phenomena. Several evidences suggest that anxiety is fundamental for learnining and may facilitate or impair the memory formation process depending of the context. The majority of animal studies of anxiety and fear use only males as experimental subjects, while studies with females are rare in the literature. However, the prevalence in phobic and anxiety disorders is greater in women than in men. Moreover, it is known that gender maybe influence benzodiazepine effects, the classic drugs used for anxiety disorders treatment. In this respect, to further investigate if fear/anxiety aspects related to learning in female subjects would contribute to the study of phobic and anxiety disorders and their relationship with learning/memory processes, the present work investigates (a) the effects of benzodiazepine diazepam on female rats performance in a aversive memory task that assess concomitantly anxiety/emotionality, as the interaction between both; (b) the influence of estrous cycle phases of female rats on diazepam effects at aversive memory and anxiety/emotionality, and the interaction between both and (c) the role of hormonal fluctuations during estrous cycle phases in absence of diazepam effects in proestrus, because female rats in this phase received or not mifepristone, the antagonist of progesterone receptor, previously to the diazepam treatment. For this purpose, the plus maze discriminative avoidance task, previously validated for studies of anxiety concomitantly to learning/memory, was used. The apparatus employed is an adaptation of a conventional plus maze, with two opens arms and two closed arms, one of which presenting aversive stimulation (noise and light). The parameters used were: time in non-aversive arm compared to time in aversive and percentage of time in aversive arm on several temporal divisions, in order to evaluate memory; percentage of time in open arms, risk assessment, head dipping and end exploring to evaluate anxiety ; and distance traveled for locomotion. In experiment I, we found anxiolytic effect of diazepam only for 4 mg/kg dose, however the amnestic effect appear at a dose of 2 mg/kg. In second experiment, rats were divided in groups according estrous cycle phase (metaestrus/diestrus, proestrus e estrus). In this experiment, when we considered estrous cycle phase or diazepam treatment, the results did not demonstrate any differences in anxiety/emotionality parameters. The amnestic effects of diazepam occur in female rats in metestrus/diestrus and estrus and is absent in proestrous rats. Proestrous female rats that received mifepristone exhibited the amnestic effect of diazepam and also anxiolytic effects, that it was not previously observed in this dose. The results have demonstrated dissociation of anxiolytic and amnestic diazepam effects, not previously observed in males; the absence of amnestic effect of diazepam in proestrous phase; and the possible role of progesterone in aversive memory over diazepam effect, because the mifepristone, associated with diazepam, caused amnestic effect in proestrus / A mem?ria e a ansiedade s?o fen?menos relacionados. Diversas evid?ncias sugerem que a ansiedade ? fundamental para o aprendizado, podendo facilitar ou prejudicar a forma??o de mem?rias dependendo da situa??o, o que se constitui num fator relevante tanto para o funcionamento normal dos processos cognitivos quanto para a compreens?o dos transtornos de ansiedade. A maioria dos estudos com modelos animais que se prop?e a estudar medo e ansiedade usa machos como sujeitos experimentais existindo, assim, escassez no estudo de f?meas na literatura. Entretanto, a preval?ncia para transtornos f?bico-ansiosos ? maior em mulheres do que em homens. Al?m disso, sabe-se que o g?nero pode influenciar o efeito de benzodiazep?nicos, f?rmacos classicamente utilizados no tratamento de transtornos de ansiedade. No intuito de contribuir para o estudo de transtornos f?bico-ansiosos e sua rela??o com processos de mem?ria e aprendizado, o presente trabalho investigou (a) os efeitos do benzodiazep?nico diazepam sobre o desempenho de ratas em uma tarefa de mem?ria aversiva com concomitante avalia??o da ansiedade/emocionalidade; (b) a influ?ncia das fases do ciclo estral de ratas no efeito do diazepam na ansiedade/emocionalidade e mem?ria aversiva, assim como a intera??o entre ambas e (c) o papel de flutua??es hormonais ao longo das fases do ciclo sobre aus?ncia do efeito do diazepam no proestro, pois ratas nessa fase receberam ou n?o o antagonista do receptor da progesterona, mifepristona, previamente ao tratamento com diazepam. Para isso, foi utilizado o modelo da esquiva discriminativa em labirinto cruz elevado, previamente validado para estudos envolvendo ansiedade e aprendizagem. O aparato utilizado ? uma adapta??o do labirinto em cruz elevado convencional, constitu?do de dois bra?os abertos e dois bra?os fechados sendo que um dos fechados tem uma estimula??o aversiva com som e luz. Foram utilizados os par?metros: tempo no bra?o n?o-aversivo comparado ao tempo no aversivo e percentual de tempo no bra?o aversivo em diferentes divis?es temporais para avaliar mem?ria; percentual de tempo nos bra?os abertos, avalia??o de risco, mergulhos de cabe?a e explora??o da ponta do bra?o aberto para ansiedade ; e dist?ncia percorrida para locomo??o. A partir da curva dose-resposta, no primeiro experimento, observamos o efeito ansiol?tico (4mg/kg) e amn?stico (2mg/kg) do diazepam. No segundo experimento, as ratas foram separadas de acordo com as fases do ciclo estral (metaestro/diestro, proestro e estro). N?o foram observadas diferen?as significativas na ansiedade/emocionalidade, nem entre fases do ciclo, nem do tratamento com diazepam (2mg/kg). O efeito amn?stico do diazepam ocorreu nas ratas em metaestro/diestro e estro, estando ausente nas ratas em proestro. Na presen?a da mifepristona as ratas em proestro exibiram o efeito amn?stico do diazepam e tamb?m passaram a apresentar efeito ansiol?tico, o qual n?o havia sido observado previamente nesta dose. Os resultados demonstraram dissocia??o de efeitos amn?sticos e ansiol?ticos em f?meas, n?o previamente observada em machos; aus?ncia do efeito amn?stico do diazepam no proestro, que ocorre nas outras fases e o poss?vel papel da progesterona na mem?ria aversiva sob efeito do diazepam, uma vez que a mifepristona possibilitou o efeito amn?stico no proestro, fase na qual os n?veis de progesterona est?o elevados

Anxiety and depression are highly prevalent diseases with common heritable elements, but the particular genetic mechanisms and biological pathways underlying them are poorly understood. Part of the challenge in understanding the genetic basis of these disorders is that they are polygenic and often context-dependent. In my thesis, I apply a series of modern statistical tools to ascertain some of the myriad genetic and environmental factors that underlie fear-related behaviours in nearly two thousand heterogeneous stock mice, which serve as animal models of anxiety and depression. Using a Bayesian method called Sparse Partitioning and a frequentist method called Bagphenotype, I identify gene-by-sex interactions that contribute to variation in fear-related behaviours, such as those displayed in the elevated plus maze and the open field test, although I demonstrate that the contributions are generally small. Also using Bagphenotype, I identify hundreds of gene-by-environment interactions related to these traits. The interacting environmental covariates are diverse, ranging from experimenter to season of the year. With gene expression data from a brain structure associated with anxiety called the hippocampus, I generate modules of co-expressed genes and map them to the genome. Two of these modules were enriched for key nervous system components — one for dendritic spines, another for oligodendrocyte markers — but I was unable to find significant correlations between them and fear-related behaviours. Finally, I employed another Bayesian technique, Sparse Instrumental Variables, which takes advantage of conditional probabilities to identify hippocampus genes whose expression appears not just to be associated with variation in fear-related behaviours, but cause variation in those phenotypes.

These British Association for Psychopharmacology guidelines cover the range and aims of treatment for anxiety disorders. They are based explicitly on the available evidence and are presented as recommendations to aid clinical decision making in primary and secondary medical care. They may also serve as a source of information for patients and their carers. The recommendations are presented together with a more detailed review of the available evidence. A consensus meeting involving experts in anxiety disorders reviewed the main subject areas and considered the strength of evidence and its clinical implications. The guidelines were constructed after extensive feedback from participants and interested parties. The strength of supporting evidence for recommendations was rated. The guidelines cover the diagnosis of anxiety disorders and key steps in clinical management, including acute treatment, relapse prevention and approaches for patients who do not respond to first-line treatments.

Indiana University-Purdue University Indianapolis (IUPUI) / The substantial interpersonal and economic costs of depression make it imperative to better understand the predictors and moderators of depressive symptoms. The ability to use social support protects people from depressive symptoms, but individuals high in attachment avoidance tend not to use others as sources of support. Research has found that attachment avoidance is related to depressive symptoms in some samples but not in others (Mikulincer & Shaver, 2007; Shea, 2011). Thus, there appear to be factors that moderate the relationship between attachment avoidance and depressive symptoms. The present study examined if cognitive abilities that facilitate effective emotion regulation strategies moderate the relationship between attachment avoidance and depressive symptoms. Using a sample of college students, attachment avoidance, cognitive abilities, depressive symptoms, and other indices of psychological distress and well-being were measured and examined for evidence of moderation via hierarchical linear regression. The hypothesis that cognitive abilities moderate the relationship between attachment avoidance and depressive symptoms was not supported (ΔR2 = 0.02, p = .68). Factors contributing to the null findings are discussed and conceptual and methodological suggestions are offered for future research.

Indiana University-Purdue University Indianapolis (IUPUI) / It has traditionally been posited that women show a "telescoped" development of alcohol use disorders (Kuhn, 2011). In particular, a number of clinical studies support striking sex differences in the progression from initial use of alcohol to dependence on the compound; with women showing a faster progression through landmark events associated with the development of alcohol addiction (Randall et al., 1999). However, recent studies have challenged this tenet (Keyes et al., 2010). The work presented herein was designed to determine whether females are indeed more vulnerable to the development of behavioral maladaptations following binge drinking and whether sex differences in GABA(A) receptor regulation might underlie this vulnerability. Using a mouse model of binge drinking this dissertation established that, compared to males, females escalate their binge drinking at a faster rate and maintain altered responsivity to the locomotor effects of alcohol after extended abstinence from binge drinking. Female mice also displayed significant increases in ethanol preference and intake in a continuous, two-bottle choice protocol following a shorter history of binge drinking than males. The final goal was to determine if binge drinking results in unique patterns of anxiety- or depressive-like symptoms in males and females and whether these behaviors would be associated with the dimorphic regulation of GABAA receptor subunits across the prefrontal cortex and hippocampus. Male binge drinkers displayed anxiety-like behavior during early withdrawal that dissipated after 2 weeks of abstinence. There were no significant changes in the expression of delta or gamma2 GABAA receptor subunit mRNA at this time point in the regions analyzed. Females also showed temporary anxiety-like behavior during early withdrawal from binge drinking. Additionally, females displayed significant depressive-like behavior after 2 weeks of abstinence from binge drinking. In particular, diestrus-phase females displayed significantly greater immobility in the forced-swim test after ethanol exposure and no longer maintained the reduced swim-time behavior associated with this phase of the cycle at baseline (when compared to the estrus-phase). qPCR analysis of hippocampal tissues from diestrus females supported a significant reduction in expression of gamma2 GABA(A) subunit mRNA after binge drinking. This effect was not noted for RNA isolated from hippocampal tissues taken during the estrus phase of bingers. These final data suggest possible interaction of estrous-cycle and binge drinking history that may result in the unique expression of deficits following binge drinking for females. Taken together, this work supports sex and estrous dependent effects of binge drinking on behavior and gene regulation.

Le Trouble du Spectre de l’Autisme (TSA) est un trouble neurodéveloppemental défini par deux caractéristiques principales : un comportement social atypique et des intérêts restreints et répétitifs incluant une rigidité comportementale. Le comportement social atypique est typiquement mesuré et quantifié par des déficits de Théorie de l’Esprit (ToM). Les outils classiques pour évaluer la ToM comportent plusieurs limites dont les biais liés à la subjectivité, la pauvre validité écologique et le manque d’échange réciproque. Ainsi, une tâche dyadique et intégrative pourrait pallier ces limites. En population adulte autiste, une telle tâche a été testée. Concrètement, le jeu du Penny-Hiding Game (PHG), où un joueur doit deviner dans laquelle de ses mains un adversaire a caché une pièce de monnaie, a été administré à un groupe de personnes autistes et un groupe de personnes non-autistes. La tâche comportait deux contextes : l’un social, où le participant croyait qu’il jouait contre un être humain en ligne, et l’un non-social, où le participant était informé qu’il jouait contre un ordinateur seulement. Cette étude a montré que les personnes autistes se montraient insensibles au contexte dans leur comportement modélisé par un phénotype computationnel comportant deux indices : la sophistication et la flexibilité. De plus, l’étude a identifié une stratégie de jeu qui semblait propre au groupe autiste. Le phénotype computationnel permettait aussi de classer les participants avec un taux de spécificité équivalent aux outils diagnostiques standards. La présente étude vise donc à étendre cette compréhension de la réciprocité sociale des personnes autistes à une population pédiatrique. L’enjeu des comorbidités en autisme constitue également un frein important aux avancées scientifiques. Ainsi, nous avons décidé d’inclure deux groupes dans notre échantillon qui présentent les comorbidités les plus prévalentes en autisme : le Trouble de l’Attention avec et sans Hyperactivité (TDAH) et les Troubles Anxieux (TA). À la suite d’une analyse de la performance avec ces trois groupes et une inspection visuelle des séquences de choix au cours de la tâche, un paramètre d’alternance/persévération et un groupe d’enfants neurotypiques (NT) ont été ajoutés. Ces deux ajouts font de ce mémoire une étude partiellement exploratoire. Le but était donc de valider la tâche informatique du PHG auprès de populations pédiatriques cliniques, d’identifier et d’explorer des différences de groupes au niveau des stratégies de jeu, de la performance et du phénotype computationnel et d’explorer le rôle potentiel des associations entre le phénotype computationnel, la performance et les symptômes associées aux trois conditions cliniques à l’étude : les symptômes autistiques, attentionnels/exécutifs et anxieux. Les analyses ont permis de révéler que le groupe NT avait une performance significativement supérieure aux groupes TSA, TDAH et TA et que la quantité et la sévérité des symptômes étaient négativement associées au score de performance en contexte social. La stratégie la plus utilisée à travers tous les groupes et indépendamment du contexte était une stratégie d’apprentissage par renforcement et aucune différence au niveau de la sophistication ou de la flexibilité n’a été détectée. Ces deux résultats constituent une non-réplication de ce qui a été observé chez les adultes. La persévérance dans la tâche était plus élevée chez les personnes autistes spécifiquement, ce qui constitue un marqueur potentiel pour dépister, et éventuellement identifier le TSA, bien que d’autres études soient nécessaires pour le confirmer. Cette étude novatrice a permis d’illustrer la complexité de la réalité clinique et de mettre la table pour des études subséquentes en psychiatrie computationnelle auprès des enfants. / Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder defined by two main diagnostic criteria: atypical social communication and restricted, repetitive interests including behavioral rigidity. Atypical social communication is typically measured and quantified by deficits in Theory of Mind (ToM). Conventional tools for assessing ToM have several limitations, including subjectivity bias, poor ecological validity and lack of reciprocal exchange. A dyadic, integrative task could be used to overcome these limitations. Such a task was tested in an adult autistic population. Specifically, the Penny-Hiding Game (PHG), in which a player must guess in which of his or her hands an opponent has hidden a coin, was administered to a group of autistic and a group of non-autistic individuals. The task was comprised of two framings: one social, where the participant believed he or she was playing online against a human being, and one non-social, where the participant was informed that he or she was playing against a computer. This study showed that autistic adults were insensitive to the framing in their behavior, which was modeled by a computational phenotype made up of two indices: sophistication and flexibility. In addition, the study identified an adaptation strategy that appeared to be specific to the autistic group. The computational phenotype also made it possible to classify participants with a specificity equivalent to standard diagnostic tools. The present study therefore aims to extend this understanding of social reciprocity in people with autism to a pediatric population. The issue of comorbidities in autism is also a major obstacle to scientific progress. We therefore decided to include in our sample two groups with the most prevalent comorbidities in autism: Attention-Deficit with or without Hyperactivity Disorder (ADHD) and Anxiety Disorder (AD). Following an analysis of performance with these three groups and visual inspection of choice sequences during the task, an alternation/perseveration parameter and a neurotypical (NT) group were added. These two additions make this master’s thesis partially exploratory. The aims were therefore to validate the PHG computerized task with clinical pediatric populations, to identify and explore group differences in adaptation strategies, performance and computational phenotype, and to explore the potential role of associations between computational phenotype, performance and symptoms associated with the three clinical conditions included in the study: autistic, attentional/executive and anxious symptoms. Analyses revealed that the NT group performed significantly better than the ASD, ADHD and AD groups, and that symptom quantity and severity were negatively associated with task performance score in the social framing. The most frequently used strategy across all groups and regardless of framing was reinforcement learning, and no differences in sophistication or flexibility were detected. These two results represent a lack of replication of previous work with autistic and NT adults. Perseverance in the task was higher in autistic individuals, which could be a potential marker for screening - possibly identifying - ASD, although further studies are needed to confirm this. This novel study helped illustrate the complexity of clinical contexts and set the table for subsequent computational psychiatry studies with children.

[pt] Os distúrbios de ansiedade compreendem uma ampla gama de condições psiquiátricas, incluindo transtorno de ansiedade generalizada (TAG) e fobia específica. Nas últimas décadas, o uso de modelos animais de ansiedade ofereceu importantes insights sobre a interação dessas psicopatologias. Aqui nós investigamos se os ratos Cariocas de alto e baixo congelamento (CAC e CBC, respectivamente), um modelo animal de TAG, mostram fenótipos comportamentais de alto e baixo congelamento similar no condicionamento de medo ao som. Ratos adultos das linhagens CAC (n igual 16), CBC (n igual 16) e ratos Wistar normais (controle, CTL) foram testados em um paradigma de condicionamento clássico de medo ao som durante 3 dias. Respostas de congelamento foram medidas e usadas como evidência de condicionamento de medo. No geral, os ratos CAC e CBC, bem como os animais CTL, apresentaram um condicionamento de medo ao estímulo condicionado auditivo. No entanto, os animais CBC também mostraram uma rápida extinção ao estímulo condicionado auditivo. Discutimos esses resultados de acordo com dados comportamentais e neuronais observados em linhagens de roedores de alta e baixa ansiedade. / [en] Anxiety disorders comprise a broad range of psychiatric conditions, including general anxiety (GAD) and specific phobias. For the last decades the use of animal models of anxiety has offered important insights into the understanding of the association between these psychopathologies. Here we investigate whether Carioca high and low conditioned freezing rats (CHF and CLF, respectively), a GAD animal model of anxiety, show similar high and low freezing behavioral phenotypes for cued auditory fear conditioning. Adult CHF (n equal 16), CLF (n equal 16) and normal age-matched Wistar rats (control, CTL) were tested in a classical auditory cued fear conditioning paradigm over 3 days. Freezing responses were measured and used as evidence of fear conditioning. Overall, both CHF and CLF rats as well as CTL animals displayed fear conditioning to the auditory CS. However, CLF animals showed a rapid extinction to the auditory conditioned stimulus compared to CHF and CTL rats. We discuss these findings in the context of the behavioural and neuronal differences observed in rodent lines of high and low anxiety traits.

This revision of the 2005 British Association for Psychopharmacology guidelines for the evidence-based pharmacological treatment of anxiety disorders provides an update on key steps in diagnosis and clinical management, including recognition, acute treatment, longer-term treatment, combination treatment, and further approaches for patients who have not responded to first-line interventions. A consensus meeting involving international experts in anxiety disorders reviewed the main subject areas and considered the strength of supporting evidence and its clinical implications. The guidelines are based on available evidence, were constructed after extensive feedback from participants, and are presented as recommendations to aid clinical decision-making in primary, secondary and tertiary medical care. They may also serve as a source of information for patients, their carers, and medicines management and formulary committees.