Thesis (M.A. (Psychology)) - Rhodes University, 2007.

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Thesis (doctoral)--Lund University, 1997. / Added t.p. with thesis statement inserted.

Schizophrenia is among the most debilitating mental disorders, yet the pathophysiology remains unclear. The basal ganglia, a region of the brain involved in motor, cognitive, and sensory processes, may be involved in the pathophysiology of schizophrenia. Some, but not all, neuroimaging studies suggest abnormalities of the basal ganglia in schizophrenia. However, previous studies have examined whole basal ganglia nuclei as opposed to using a unified basal ganglia complex that incorporates anterior-posterior divisions, dorsal-ventral divisions, and gray-white matter segmentation. The hypothesis for the present study was that basal ganglia sub-regions forming functionally relevant subdivisions might be different in schizophrenia. Magnetic resonance imaging scans were acquired from 25 first-episode schizophrenia subjects and 24 healthy subjects. Using manual and automated neuroimaging techniques, total and segmented (gray-white matter) volumes were obtained for the caudate, putamen, and globus pallidus. For the striatum (caudate and putamen), total and segmented volumes were obtained for their respective sub-regions. These sub-regions were restructured into associative, limbic, and sensorimotor subdivisions. Schizophrenia subjects had 6% smaller gray matter volumes for the caudate and 8% smaller gray matter volumes for the associative striatum relative to healthy subjects. Basal ganglia function was studied by examining performance on a neuropsychological test that assesses frontostriatal functioning. For male subjects there was a significant negative correlation between volume of the associative striatum and performance on the neuropsychological test (r=-0.57, p=0.03). Smaller volumes of the associative striatum were associated with more errors on the neuropsychological test. This test was specific to the associative striatum, as another neuropsychological test did not reveal any correlation. In schizophrenia subjects, the relationship between basal ganglia volumes and motor symptoms severity was examined. For antipsychotic-naive subjects there was a significant negative correlation between volume of the motor striatum and severity of Parkinsonism (r=-0.65, p=0.03). The present study suggests that total basal ganglia nuclei volumes are not different in schizophrenia, but gray matter volumes of total basal ganglia nuclei and subdivisions forming functional units may be different in schizophrenia. Structural abnormalities involving the basal ganglia may lead to disrupted functional circuits in schizophrenia. / Medicine, Faculty of / Graduate

This Thesis describes the epidemiology of schizophrenia and related disorders in the defined catchment area of Camberwell, SE London, UK, over the period 1965 to 1984. Cases were ascertained through the comprehensive Camberwell Cumulative Psychiatric Case Register. All first-contact patients with a Register diagnosis of any non-affective non-organic psychotic illness were included in the study. Diagnostic uniformity was ensured by rediagnosis of all cases (n=531) using the computerised OCCPI system, which facilitates rediagnosis according to a wide range of diagnostic criteria. Trends in the incidence of non-affective functional psychoses over the two decades during which the Camberwell Register was operational, are explored. The findings, of a rising rate of illness in Camberwell, are discussed in terms of changes in the demography of the general population over the years, and suggestions offered for discrepancies with other studies of time trends in schizophrenia, particular emphasis being placed on changes in the ethnic composition of Camberwell over this period. A case-control study design is used to explore whether the rising incidence of the illness in the area is due solely or largely to drift into the area of ill individuals, or whether some of the variance can be explained in terms of a pernicious inner-city effect operating during early development (in utero or in early childhood). The findings of an excess of schizophrenia patients actually having been born in the inner city suggests that something about poor households in the inner city might predispose to the illness in later life. This is discussed in the general framework of the neurodevelopmental hypothesis of schizophrenia, which proposes that at least some individuals have a form of illness consequent upon subtle damage to the developing brain. A major focus of the analyses is gender differences in schizophrenia, and late onset schizophrenia. Early-onset males were particularly likely to fulfil stringent diagnostic criteria for the illness, and to show premorbid dysfunction. The results are interpreted in the neurodevelopmental framework, and reference made to differences in male and female brains in their vulnerability to neurodevelopmental illnesses in general. Taking this theme forward, a form of factor analysis called latent class analysis is used to further explore the notion of different subtypes of schizophrenia, one of which is an early-onset severe male-predominant form (theoretically consequent upon neurodevelopmental deviance). The analyses resulted in a "best fit" model of three subtypes, one an early-onset male-predominant type associated with premorbid dysfunction ("neurodevelopmental" type); a later-onset "paranoid" type; and an affect-laden type exclusive to females ("schizoaffective" type). There were associations with a number of variables of potential importance in terms of aetiology, namely an association of the "neurodevelopmental" type with a family history of schizophrenia and obstetric complications; an association of the "paranoid" type with winter birth; and of the "affective" type with a family history of psychiatric disorder other than schizophrenia (predominantly affective disorder). This typology does not adequately account for those patients with a late (over 45 years), or very-late onset of illness (over 60). Phenomenological, premorbid, and other differences between early- and late-onset patients are analysed, and the results discussed in the broader framework of the literature on late-onset non-affective psychoses.

No description available.

Assignment (MA) -- University of Stellenbosch, 2004. / ENGLISH ABSTRACT: This literature review explores the research on the clinical presentation of childhood onset schizophrenia (COS) that has been conducted over the past ten years. A literature search was done using internet search engines and psychological databases to collect English language journals from 1994 onwards. Research indicates that COS is a stable diagnosis. Generally, there is a clear history of premorbid abnormalities, an insidious onset and a deteriorating course. For the majority of cases there seems to be a poor outcome. In conclusion, despite the limitations in the research conducted thus far, findings provide important insights regarding COS and several possibilities for future research. / AFRIKAANSE OPSOMMING: Hierdie literere oorsig fokus op navorsing wat die afgelope tien jaar gedoen is oor die kliniese aanbieding van skisofrenie wat in die kinderjare begin (COS). Daar is gebruik gemaak van Internet "soek enjins" en sielkundige databasisse ten einde Engelstalige joernale op te spoor wat vanaf 1994 tot nou oor die onderwerp verskyn het. Navorsing dui daarop dat COS 'n stabiele diagnose is. Oor die algemeen toon dit 'n duidelike geskiedenis van premorbiede abnormaliteite, 'n ongemerkte aanvang en verloop en agteruitgang oor tyd. In die meeste gevalle blyk daar 'n swak uitkoms te wees. Laastens bied die bevindinge belangrike insigte ten opsigte van COS en heelwat moontlikhede vir toekomstige navorsing, ten spyte van die beperkinge in die navorsing wat tot dusver gedoen is.

No description available.

Aim: This thesis describes a study undertaken to investigate the effect, feasibility and acceptability of health education groups for adults with a diagnosis of schizophrenia. Background: Common medical problems are more prevalent in this client group. Life expectancy is significantly reduced with the majority of deaths resulting from natural and preventable causes. Unhealthy lifestyles have been implicated in this excess mortality. However, few studies have evaluated the outcomes of health education. Methods: Guided by the UK Medical Research Councils framework for the evaluation of complex health care interventions, health education literature was used to model a group intervention programme. A preliminary investigation was conducted using a single group pre-test post-test design. Data regarding the effect of the intervention on participants’ lifestyles were collected at interview pre, post and six months after the health education groups. Feasibility was assessed through monitoring patterns of referral and attendance. Data regarding acceptability were collected by conducting focus groups with participants who attended the health education groups and mental health practitioners who co-facilitated them. Results: 45 participants were offered the intervention. 87% (n=39) attended the health education groups. Post-intervention results showed a significant increase in levels of exercise (Z = -2.77, p = 0.006) and the number of portions of fruit and vegetables consumed (t = -5.38, p =<0.001). Changes remained significant for both exercise (Z = -2.31, p = 0.021) and fruit and vegetable intake (t = -3.77, p = 0.002) at follow up and effect sizes were large. Small but non significant changes were shown in the amount of fried food eaten (F = 4.70, df = 2, p = 0.09) and the number of cigarettes smoked per day (F = 0.83, df = 2, p =0.66). The feasibility of the intervention was good and results of focus groups indicated that health education delivered in a group format was acceptable to the participants of the study. Conclusions: Health education delivered according to the protocol developed in this study may help adults with schizophrenia to develop healthier lifestyles. However, due to methodological limitations only speculative conclusions can be made regarding the causality of effect. Further more rigorous investigation of the efficacy of the intervention in a larger scale randomised controlled trial is indicated.

published_or_final_version / abstract / Psychiatry / Master / Master of Philosophy