The present study examined the subjective experiences of individuals living in the community with a severe or persistent mental illness receiving services from the Sunnybrook Program of Assertive Community Treatment (SunPACT). The researcher employed McCracken’s (1998) Long Interview Method to interview a sample of 8 clients from SunPACT. The aim of this research was to explore client perspectives on their experiences of SunPACT and their perception of its impact on their quality of life. The findings from this study overlapped with the literature, as well providing new and vital information in the implementation and monitoring of quality of care of an ACT model. This research demonstrated that clients experience the effects of their treatment differently, and therefore, understanding client feedback is imperative to understanding how to maximize treatment benefits and provide effective services. Specific details about their experiences are outlined. Implications for social work practice are discussed.

Background: Traumatic musculoskeletal injury (TMsI) often leads to chronic pain and post-traumatic stress disorder (PTSD). This study examined factors of a modified diathesis-stress model in the development of PTSD symptoms following TMsI. Methods: 205 patients were recruited in this prospective, observational study. Within 14 days of injury, participants completed an in-hospital questionnaire investigating acute symptoms of anxiety, depression, pain, and PTSD. Results: Logistic regression identified multiple factors associated with symptoms of PSTD (p<.0001). Neuropathic pain (odds ratio[OR]=1.091, 95% confidence interval[CI] 1.020-1.168), general anxiety (OR=1.176, 95%CI 1.046-1.318), pain anxiety (OR=1.056, 95%CI 1.018-1.094), and pain catastrophizing (OR=1.168, 95%CI 1.016-1.348) were associated with acute symptoms of PTSD. Conclusions: The results support the modified diathesis-stress model indicating that neuropathic pain, general anxiety, pain anxiety, and pain catastrophizing are associated with symptoms of PTSD. Future studies should examine the influence of these acute factors on the development of chronic pain and PTSD following TMsI.

The purpose of this study was to explore the relationship between the formalization of inter-organizational partnerships and collaboration among staff members working together across primary care, mental health and addition organizations to provide services to adults with complex mental health and addiction needs. Phase I of the study provided an environmental scan of existing partnerships among Family Health Teams (FHTs) and Community Health Centres (CHCs), and the Mental Health and/or Addiction (MHA) organizations they partner with, in the province of Ontario (Canada). Phase II explored the relationship between formalization and a) administrative collaboration and b) and service delivery collaboration. The hypotheses proposed that staff members who are part of formalized partnerships would report higher levels of collaboration. Phase III explored how formal and informal partnerships and collaboration are experienced by the administrative and service provider staff members who work across FHTs, CHCs and MHAs organizations. Using a mixed methods approach, data were collected using electronic surveys and telephone interviews. The results of Phase I indicated that FHTs and CHCs in Ontario have between 1-3 partnerships with MHA organizations. Most are informal partnerships, have existed for less than 5 years, and most staff members (partners) interact on a monthly basis. The quantitative results of Phase II showed no significant relationship between formalization and either form of collaboration. The qualitative findings from Phase III provide two key contributions. First, the results of the interviews may help explain why collaboration was not higher in formalized partnerships, as demonstrated by the range of advantages and disadvantages experienced by administrators and service providers in both formal and informal partnerships. Second, the findings illuminate factors related to the process of creating and/or formalizing partnerships, suggesting that there may be other factors that mediate or have a direct impact on the relationship between formalization and collaboration. By bringing together the study findings, the study addresses a gap in the literature by proposing a pathway through which formalization may be associated with collaboration. The results of the study provide opportunities for future research to help improve the quality and accessibility of services to adults with complex mental health and addiction needs.

A single-item measure of self-rated mental health (SRMH) asks respondents to rate their mental health on a 5-point scale from ‘excellent’ to ‘poor’. SRMH is being used increasingly in research and on population health surveys. However, little is known about this item, as there are no literature reviews and few formal validation studies. The aim of this study is to understand what SRMH measures by conducting the first known systematic review of SRMH literature, followed by analysis of the Canadian Community Health Survey (CCHS 1.2). Results of the systematic review reveal SRMH has relationships with mental health scales, mental disorders, self-rated health, health problems, service utilization, and service satisfaction. Analysis of CCHS 1.2 data finds SRMH is associated with psychiatric diagnoses, distress, physical health, and sociodemographic characteristics. Both studies conclude SRMH is measuring mental health and more; however, there needs to be more research to understand the specifics of these relationships.

While neuropsychological deficits have been reported in healthy individuals who use cannabis, data in patients with multiple sclerosis (MS) are lacking. Given that MS is associated with cognitive deterioration, the aim of this study was to determine the cognitive effects of inhaled or ingested cannabis in this population. Fifty MS patients (25 cannabis users and 25 non-users) completed the Minimal Assessment of Cognitive Function in MS battery of neuropsychological tests. Cannabis users had significantly poorer performance on measures of information processing speed, executive functions, and visuospatial perception, and were twice as likely to be classified as globally cognitively impaired. Similar results were found after controlling for potential confounding variables. This study provides evidence that prolonged cannabis use in MS patients is associated with poorer performance on cognitive domains commonly affected in this population. The therapeutic benefits patients may derive from using cannabis should be weighed against the associated cognitive side-effects.

A single-item measure of self-rated mental health (SRMH) asks respondents to rate their mental health on a 5-point scale from ‘excellent’ to ‘poor’. SRMH is being used increasingly in research and on population health surveys. However, little is known about this item, as there are no literature reviews and few formal validation studies. The aim of this study is to understand what SRMH measures by conducting the first known systematic review of SRMH literature, followed by analysis of the Canadian Community Health Survey (CCHS 1.2). Results of the systematic review reveal SRMH has relationships with mental health scales, mental disorders, self-rated health, health problems, service utilization, and service satisfaction. Analysis of CCHS 1.2 data finds SRMH is associated with psychiatric diagnoses, distress, physical health, and sociodemographic characteristics. Both studies conclude SRMH is measuring mental health and more; however, there needs to be more research to understand the specifics of these relationships.

While neuropsychological deficits have been reported in healthy individuals who use cannabis, data in patients with multiple sclerosis (MS) are lacking. Given that MS is associated with cognitive deterioration, the aim of this study was to determine the cognitive effects of inhaled or ingested cannabis in this population. Fifty MS patients (25 cannabis users and 25 non-users) completed the Minimal Assessment of Cognitive Function in MS battery of neuropsychological tests. Cannabis users had significantly poorer performance on measures of information processing speed, executive functions, and visuospatial perception, and were twice as likely to be classified as globally cognitively impaired. Similar results were found after controlling for potential confounding variables. This study provides evidence that prolonged cannabis use in MS patients is associated with poorer performance on cognitive domains commonly affected in this population. The therapeutic benefits patients may derive from using cannabis should be weighed against the associated cognitive side-effects.

Many pathological processes are associated with excessive neurotransmitter release that leads to the over-stimulation of post-synaptic neurotransmitter receptors. Examples include excessive activation of glutamate receptors in ischemic stroke and hyper-dopaminergic state in schizophrenia and drug addiction. Thus, it would seem that simply antagonizing the involved receptors should be able to correct the pathological condition. In some instances, this strategy has been somewhat effective, such as with the use of dopamine D2 receptor antagonists as antipsychotics in the treatment of positive symptoms of schizophrenia despite severe side effect. However, clinical application of drugs antagonizing glutamate receptor in the treatment of stoke, although attracting intensive research effort, has been restricted by serious side effects caused by suppressing postsynaptic responses that are needed for normal brain function. As a consequence, it is important to develop novel therapeutics aiming at specific targets with minimized side effects. Numerous studies have suggested that the pathophysiology of neuropsychiatric disorders, drug addictions and stroke involves multiple neurotransmitter receptor systems such as the dopamine and glutamate systems. The activation or inhibition of one receptor can have cross-functional effect that will be better understood by investigating the functional and structural relationship between receptor systems. Thus, the present study has focused on characterizing receptor-receptor interactions associated with dopamine receptors and glutamate receptors, and to elucidate the physiological and pathological consequence of altered receptor interactions in schizophrenia, depression and ischemic stroke.

Parents raising children with Attention-deficit/hyperactivity disorder (ADHD) experience high levels of parenting stress, especially when ADHD is accompanied by comorbid Oppositional Defiant Disorder (ADHD/ODD). Children with ADHD experience difficulties with their executive functions in such areas as inhibition control, working memory, and emotional regulation. Despite evidence linking ADHD with parenting stress, and ADHD with executive function difficulties (EFDs), there is little research exploring whether EFDs within an ADHD population are associated with parenting stress. This dissertation’s main objective is to determine whether parent-reported and teacher-reported childhood EFDs are associated with elevated levels of parenting stress. A secondary data analysis was completed on a cross-section of parent and teacher completed psychiatric assessment measures for children (n=243) diagnosed with ADHD. Measures included the Behavior Rating Inventory of Executive Function, the Conners’ Parent Rating Scale and the Parenting Stress Index, Long Form. A number of important findings were produced; key of which was the finding that a strong association exists between parent-reported EFDs and Child Domain parenting stress. Consistent with prior ADHD research, difficulties with emotional control and inhibition were found to be potent predictors of Child Domain parenting stress. To a lesser degree, children’s difficulties with initiation and self-monitoring were associated with Child Domain parenting stress, suggesting that daily hassles pose challenges for parents, especially when the child attends a new school. Also important was the finding that parent-reported oppositionality partially mediated the relationship between EFDs with emotional control, inhibition and shift, and Child Domain parenting stress. Despite teachers’ reports that children displayed more severe behaviours than were reported by parents, teacher-reported EFDs were not significantly associated with Child Domain parenting stress, with a few exceptions. Although not a well-explored concept within the literature on ADHD and parenting stress, parental acceptance of the child emerged as source of Child Domain parenting stress and a potential focus for assessment and treatment. Findings from the current study suggest that early identification and intervention with emotional control difficulties and ODD are vital due to their strong association with clinically significant levels of Child Domain parenting stress.

Many pathological processes are associated with excessive neurotransmitter release that leads to the over-stimulation of post-synaptic neurotransmitter receptors. Examples include excessive activation of glutamate receptors in ischemic stroke and hyper-dopaminergic state in schizophrenia and drug addiction. Thus, it would seem that simply antagonizing the involved receptors should be able to correct the pathological condition. In some instances, this strategy has been somewhat effective, such as with the use of dopamine D2 receptor antagonists as antipsychotics in the treatment of positive symptoms of schizophrenia despite severe side effect. However, clinical application of drugs antagonizing glutamate receptor in the treatment of stoke, although attracting intensive research effort, has been restricted by serious side effects caused by suppressing postsynaptic responses that are needed for normal brain function. As a consequence, it is important to develop novel therapeutics aiming at specific targets with minimized side effects. Numerous studies have suggested that the pathophysiology of neuropsychiatric disorders, drug addictions and stroke involves multiple neurotransmitter receptor systems such as the dopamine and glutamate systems. The activation or inhibition of one receptor can have cross-functional effect that will be better understood by investigating the functional and structural relationship between receptor systems. Thus, the present study has focused on characterizing receptor-receptor interactions associated with dopamine receptors and glutamate receptors, and to elucidate the physiological and pathological consequence of altered receptor interactions in schizophrenia, depression and ischemic stroke.