Multiple studies investigating the validity of the tripartite model of affect in youth have been supportive of the model; however, few studies have examined the model in narrow age bands or large clinical samples. The current study examined the structure of affect in a sample of psychiatrically hospitalized adolescents. Structural equation modeling was used to examine two-factor (negative affectivity [NA] and positive affectivity [PA]) and three-factor models (NA, PA, and physiological hyperarousal [PH]) with item level data from the Reynolds Adolescent Depression Scale (RADS) and Revised Children's Manifest Anxiety Scale (RCMAS), and from the Millon Adolescent Clinical Inventory (MACI), RADS, and RCMAS. Analyses were completed for the overall sample and for depressive, anxiety, comorbid depression, and anxiety, and other diagnostic groups. With data from the RADS and RCMAS, both the two- and three-factor models provided an equally good fit to the data for the overall sample. However, when tested for invariance across diagnostic groups, the two-factor model was invariant across groups, while the three-factor model yielded inadmissible solutions for the comorbid group, suggesting the two-factor solution provided the best fit to the data. For the data from the MACI, RADS, and RCMAS, one-, two-, and three-factor models were tested, but it was not possible to identify a model of acceptable fit. The t tests were used to examine the patterns of construct scores across diagnostic groups to determine if they were consistent with the tripartite model. Using data from the RCMAS and the RADS, the depressive and anxious diagnostic groups demonstrated similarly high levels of NA, while the anxious group demonstrated significantly higher levels of PA than the depressive group. Similar analyses could not be completed for the data from the MACI, RADS, and RCMAS because of the small sample size for the anxious diagnostic group. While the results of SEM and t-test analyses demonstrate support for the tripartite model and the associated constructs of NA and PA, support was not demonstrated for PH. Results suggest that the tripartite model may be dependent on the instruments used to assess it. Limitations of this study and implications and directions for future research are discussed.

Demographic, historical, psychometric, and clinical data were obtained from the psychiatric files of all patients manifesting schizophrenic symptomatology who were hospitalized in an adolescent psychiatric facility during a five year period (N= 71). Factor analysis of the usable data resulted in three interpretable factors, which included: (1) aggressive behavior; (2) disturbed family functioning; and, (3) thought disorder. Age of first hospitalization correlated positively with factor three. The results provide support for concerns expressed by a number of scientists and clinicians that schizophrenia may not be a discrete, unitary disorder; and that uncritical downward extension of adult diagnoses to adolescents and prepubescent children may be questionable. The results further suggest that current DSM-III and DSMIII- R subtypes of schizophrenia (which are clinically derived and symptom based), are not validated by empirically derived subtypes that include objective indices of behavior along with clinical symptoms. The correlation of "age of first hospitalization" with one of the three factors suggests that developmental level at the onset of illness may represent an important mediating variable in the severity and prognosis of certain subtypes of schizophrenia.

Doctor of Clinical Psychology / Master of Science / Despite a number of different psychotherapeutic approaches having been examined for use with patients with eating disorders, there is still no established psychological treatment associated with acceptable levels of long-term recovery. These poor recovery rates are associated with the observation that eating disorder patients are often ambivalent, or even resistant, to treatment. As such, research has begun to explore the use of Motivational Enhancement Therapy (MET), a treatment approach that aims to engage ambivalent and change resistant patients in the treatment process, with these individuals. Poor motivation to recover is particularly prominent within the inpatient eating disorder setting. However, no previous study has examined the use of MET to foster willingness to engage in treatment with this group of patients. The objectives of the current study were twofold. Firstly, an examination of the effectiveness of an inpatient eating disorders unit affiliated was undertaken in order to further the research base upon which future inpatient interventions can be built and compared. The second objective was to develop and evaluate a brief MET group program for inpatient eating disorder sufferers. The goal of the intervention was to enhance patients’ motivation to more effectively utilise the inpatient program and to hence positively impact upon their psychological, physical and behavioural functioning. Forty-two consecutive inpatients meeting DSM-IV criteria for an eating disorder were recruited into the current study and sequentially allocated to groups. Twenty-three inpatients completed four MET groups in addition to routine hospital care. A control group of 19 participants in the standard hospital treatment program was also employed (TAU group). The inpatient unit was associated with significant improvements on a number of physical, behavioural and emotional outcome measures. Despite no significant differences between the MET and the TAU groups being found on the overall formal outcome measures, there were nevertheless differences between the groups. Specifically, the MET groups appeared to foster longer-term motivation and engagement, and to promote treatment continuation. This study hopes to start a constructive debate on the role of MET in the inpatient eating disorders unit.

The Dangerous and Severe Personality Disorder (DSPD) initiative in England and Wales, underway since 2000, provides specialized care to high risk personality disordered individuals in prison and secure psychiatric facilities. Entry to the service, for a capacity nationwide total of approximately 300 individuals at four sites, is determined in part by risk (whether or not the individual is more likely than not to commit an offence that might be expected to lead to serious physical or psychological harm from which the victim would find it hard to recover). This requires valid procedures for assessing risk to determine individuals’ suitability for entry into and transfer out of the service. Yet little is known about the validity of current risk assessment tools and personality measures with the DSPD population. One of the studies reported, the first of its kind with the DSPD population, described a prospective evaluation of the predictive accuracy of the HCR-20, VRS, Static-99, and Risk Matrix 2000 with 44 admissions to the DSPD unit at a high security forensic psychiatric hospital. Consistent with hypotheses, all tools predicted damage to property. HCR-20 Total and scale scores predicted interpersonal physical aggression with structured final risk judgments also predicting repetitive (2+ incidents of) interpersonal physical aggression. HCR-20 Risk Management scores were significantly associated with imminence of interpersonal physical aggression. The second study described a prospective evaluation of the predictive accuracy of Psychopathy Checklist-Revised Factor and Facet scores as well as scores for Cluster B traits using the International Personality Disorder Examination with the same sample. Partial support for hypotheses was found. Only Borderline PD dimension scores predicted damage to property. Histrionic PD predicted interpersonal physical aggression, and Histrionic, Borderline, and Antisocial PDs all predicted repetitive interpersonal physical aggression. Factor 1 and Facets 1 and 2 were also significant predictors of interpersonal physical aggression. Factor 1 and Histrionic PD scores were also significantly associated with imminence of this type of aggression. Results were discussed in terms of the practical utility of these tools with high risk forensic psychiatric inpatients and the functional link (between personality disorder and violence) criterion for DSPD service entry.

Objective To examine the father’s role when his partner and child are admitted to a perinatal mental health unit. Background Establishing attachment in the first months of life is crucial for infant mental health. Parental mental health and separation can interrupt the formation of attachment. Maternal postnatal mental health is known to affect the father’s well-being and mental health. A systematic review conducted found paternal depression in the first year after birth affects child behavioural and emotional difficulties. One previous study has gathered limited evidence of fathers experiences of a perinatal mental health unit. Method Eight interviews were conducted with fathers whose partner was a current or former inpatient in a perinatal psychiatric unit in Scotland. Grounded Theory was utilised in the collection and analysis of data. No participants reported symptoms of Depression, Anxiety, or Stress at time of interview. Transcripts were coded by the researcher and supervisors and categories were compared. Additionally, results were validated by a participant before completing analysis. Results Maternal postnatal mental illness and hospitalisation was challenging. Long admissions with infrequent visits were most difficult. The overarching category ‘managing the self and other relationships’ captured the father’s experience and how he tried to understand and manage, whilst making and maintaining family bonds. Five subcategories were Bonding with Baby, Keeping the Family Together, Feeling Contained, Feeling Overwhelmed, and Experiencing Uncertainty. Fathers had concerns about bonding and regarded the mother-baby bond as vital. Relationships were strained. Fathers experienced anxiety regarding illness and felt relief on admission. Fathers experienced demands such as work and travel. They tried to retain normality, take each day as it comes, and use family support to cope. Fathers were uncertain about illness and treatment and desired improved communication with professionals. Conclusion Severe maternal postnatal mental illness and inpatient admission affects fathers. Fathers have multiple demands which impact on participation in the unit. Fatherinfant bonding was affected by father availability. Recognition of the father’s experience and increasing father’s knowledge of illness and skills in caregiving is likely to improve the father’s experience and benefit the family.

The Dangerous and Severe Personality Disorder (DSPD) initiative in England and Wales, underway since 2000, provides specialized care to high risk personality disordered individuals in prison and secure psychiatric facilities. Entry to the service, for a capacity nationwide total of approximately 300 individuals at four sites, is determined in part by risk (whether or not the individual is more likely than not to commit an offence that might be expected to lead to serious physical or psychological harm from which the victim would find it hard to recover). This requires valid procedures for assessing risk to determine individuals’ suitability for entry into and transfer out of the service. Yet little is known about the validity of current risk assessment tools and personality measures with the DSPD population. One of the studies reported, the first of its kind with the DSPD population, described a prospective evaluation of the predictive accuracy of the HCR-20, VRS, Static-99, and Risk Matrix 2000 with 44 admissions to the DSPD unit at a high security forensic psychiatric hospital. Consistent with hypotheses, all tools predicted damage to property. HCR-20 Total and scale scores predicted interpersonal physical aggression with structured final risk judgments also predicting repetitive (2+ incidents of) interpersonal physical aggression. HCR-20 Risk Management scores were significantly associated with imminence of interpersonal physical aggression. The second study described a prospective evaluation of the predictive accuracy of Psychopathy Checklist-Revised Factor and Facet scores as well as scores for Cluster B traits using the International Personality Disorder Examination with the same sample. Partial support for hypotheses was found. Only Borderline PD dimension scores predicted damage to property. Histrionic PD predicted interpersonal physical aggression, and Histrionic, Borderline, and Antisocial PDs all predicted repetitive interpersonal physical aggression. Factor 1 and Facets 1 and 2 were also significant predictors of interpersonal physical aggression. Factor 1 and Histrionic PD scores were also significantly associated with imminence of this type of aggression. Results were discussed in terms of the practical utility of these tools with high risk forensic psychiatric inpatients and the functional link (between personality disorder and violence) criterion for DSPD service entry.

Doctor of Clinical Psychology / Master of Science / Despite a number of different psychotherapeutic approaches having been examined for use with patients with eating disorders, there is still no established psychological treatment associated with acceptable levels of long-term recovery. These poor recovery rates are associated with the observation that eating disorder patients are often ambivalent, or even resistant, to treatment. As such, research has begun to explore the use of Motivational Enhancement Therapy (MET), a treatment approach that aims to engage ambivalent and change resistant patients in the treatment process, with these individuals. Poor motivation to recover is particularly prominent within the inpatient eating disorder setting. However, no previous study has examined the use of MET to foster willingness to engage in treatment with this group of patients. The objectives of the current study were twofold. Firstly, an examination of the effectiveness of an inpatient eating disorders unit affiliated was undertaken in order to further the research base upon which future inpatient interventions can be built and compared. The second objective was to develop and evaluate a brief MET group program for inpatient eating disorder sufferers. The goal of the intervention was to enhance patients’ motivation to more effectively utilise the inpatient program and to hence positively impact upon their psychological, physical and behavioural functioning. Forty-two consecutive inpatients meeting DSM-IV criteria for an eating disorder were recruited into the current study and sequentially allocated to groups. Twenty-three inpatients completed four MET groups in addition to routine hospital care. A control group of 19 participants in the standard hospital treatment program was also employed (TAU group). The inpatient unit was associated with significant improvements on a number of physical, behavioural and emotional outcome measures. Despite no significant differences between the MET and the TAU groups being found on the overall formal outcome measures, there were nevertheless differences between the groups. Specifically, the MET groups appeared to foster longer-term motivation and engagement, and to promote treatment continuation. This study hopes to start a constructive debate on the role of MET in the inpatient eating disorders unit.

Class of 2016 Abstract / Objectives: To determine if prescribers took into consideration patients’ metabolic risk factors when prescribing a low, medium or high risk second generation antipsychotic and if non-metabolic risk factors influenced prescribing. Methods: Adults 18 years or older who were admitted to an acute inpatient psychiatry unit and ordered at least one SGA were included in the study. Each patient’s metabolic syndrome risk score was determined using retrospective chart review and they were subsequently divided into low or high-risk groups. Clozapine and olanzapine were categorized as high risk for causing weight gain and diabetes, risperidone and quetiapine were moderate risk, and all others were considered low risk. A chi square test compared the two groups in regard to type of SGA selected, gender, and race, while an independent t-test analyzed the differences in age. Results: 300 patients were analyzed and divided into high (n=57) and low (n=253) risk groups. For the low risk group, 10.7%, 55.1%, and 34.2% were prescribed a low, moderate, or high risk SGA, respectively. For the high-risk group 17.5%, 56.1%, and 26.3% were prescribed a low, moderate, or high risk SGA, respectively. The type of SGA selected was not significantly different between the groups (p=0.262). Equivalence was shown between the two groups in terms of gender and race (p=0.68, p=0.65 respectively). Age was significantly different (p< 0.01). Conclusions: Prescribers may not consider metabolic risk factors when prescribing high risk SGAs such as clozapine and olanzapine.

Class of 2008 Abstract / Objectives: This investigation was to assess the patient, hospital, or payer characteristics of inpatient cases of agranulocytosis from 1997 and 2005 with descriptive statistics. Methods: The retrospective database investigation used the U. S. Department of Health & Human Services, Agency for Healthcare Research and Quality, Healthcare Cost & Utilization Project public use database Nationwide Inpatient Sample (H-CUP NIS) for a principal diagnosis of agranulocytosis. Significance of difference between variables, including standard error (SE), was assessed with a z-test and an alpha level of 0.05. Results: alpha level of 0.05. RESULTS: The mean charges increased from 1997 at $19,670(SE $366) per patient vs. 2005 at $26,866 (SE $813) per patient (p<0.001) while inpatient mortality was not different in 1997 at 718(SE 72) vs. 2005 at 759(SE 69) (p=0.63) and the percentage of patients discharged to home declined from 84.32% [0.85%] in 1997 to 80.12% [1.29%] in 2005 (p=0.007). In 2005, inpatient mortality was lower in teaching hospitals at 1.13%( standard error 0.15%) vs. non teaching hospitals at 2.38%(SE 0.25%) (p<0.001) and for metropolitan areas hospitals at 1.42%(SE 0.14%) vs. non-metropolitan area hospitals at 3.60%(SE 0.68%) (p=0.002). Conclusions: Data from H-CUP NIS indicates higher costs per patient for the primary diagnosis of agranulocytosis in 2005 vs. 1997 while overall inpatient survival is not different and the percentage of patients discharged to home decreased. In 2005 rates of inpatient survival were higher in teaching hospitals than in non-teaching hospitals and hospitals in metropolitan areas than in non-metropolitan areas. These differences were not found in 1997.

Cardiac post-surgery inpatients lack the amount and quality of sleep needed for optimal recovery. I aimed to investigate the non-pharmacological sleep promotion practices used by nurses and the factors that influence their use. Guided by the Theoretical Domains Framework, I developed and administered a survey to registered nurses working in the Cardiac Intensive Care Unit and the cardiac surgery ward in one cardiac centre. Findings revealed that common sleep promotion practices included orientating inpatients to the room (n=88, 96.7%), and providing additional bedding (n=86, 96.6%). The most common enablers were knowledge regarding its benefits (n=72, 100%) and an understanding of its importance (n=77, 98.7%); the most common barriers were an absence of recognition from important healthcare professionals (n=61, 85.9%) and having competing priorities (n=60, 83.3%). These findings can be used in the development of interventions to promote nurses’ use of sleep promotion practices and to improve inpatients’ sleep quality.