This paper presents a review of the theory and empirical evidence that relates to emotionality within psychopathy, in order to assess the capabilities, as well as the deficits that people with psychopathic traits demonstrate. In doing so, many of the major theories that have shaped our understanding of the disorder are presented. Psychopathy is then reviewed in relation to many relevant emotional states, including the emotions of anger and anxiety. In addition, emotions classified as 'moral' or 'self conscious', namely empathy, sympathy, guilt, remorse, shame, embarrassment and pride, are also investigated. From this review it is clear that psychopaths are not the truly unemotional individuals that they are commonly portrayed as being, but instead experience many emotions to varying degrees. This paper concludes by highlighting possible areas for further exploration and research.

Epidemiological studies have associated cannabis use with schizophrenia for decades. In the past decade meta-analyses of this research have helped to establish a causal link between cannabis use and the onset of psychotic symptoms as a result of both acute experimental studies and longitudinal studies of recreational use. Despite this, there is limited understanding of the mechanisms by which cannabis might contribute to the symptoms of schizophrenia. This review presents research on the effects of cannabis in relation to the symptoms of those found in the prodromal phase of schizophrenia, individuals at high risk of developing full psychotic episodes. The importance of investigating the prodrome is outlined before some of the similarities of the phenomenological experiences of the prodrome and those caused by cannabis are illustrated. The paper reviews the cognitive, neurobiological and structural evidence of how cannabis might contribute to the prodrome. The review includes the vulnerability factors that have been shown to mediate these effects. Finally, the paper highlights the evidence that the psychoactive potency of cannabis in the British market has grown and the absence of research into the effects of the recreational use of "skunk," a high potency variety of cannabis which accounts for 81% of the cannabis sold in the UK today.

The present review examines the empirical evidence concerning the impact of therapist self-disclosure on the therapeutic relationship in individual therapy. Twenty studies were reviewed: 11 investigated therapeutic interactions and nine looked at either clients' or therapists' perceptions of the impact of therapist disclosure. Studies of therapeutic interaction suggest that disclosure can play a positive role in developing and maintaining the alliance, although some studies suggest a negative impact. Studies of clients' and therapists' perceptions emphasise the subtle and often mixed impacts of disclosure, highlighting the importance of therapist skill in delivery and the context in which it occurs. Overall, the findings reflect the inherently complex effects of disclosure and the interactional nature of the alliance. Limitations of the research (such as unclear and inconsistent definitions and the challenge of finding appropriate methodology) and clinical implications are discussed.

Existing research indicates that resilience is related to a person's ability to cope with stress. However, there is no empirical evidence to support the existence of such a relationship for undergraduates. The current research examined this association by administering a detailed questionnaire to students at two similar universities at four points during their first fourteen months of university and interviewing a sub-sample at the end of that period. Five hundred and seventy eight undergraduates participated in the study. The results showed that, across the measure period, undergraduates experienced stressors that were predominantly due to daily annoyances and the difficulties of choosing among equally important alternatives in the university environment. They used a mixture of problem-focused coping strategies and self-regulated coping behaviours, but they constantly avoided all emotion-focused coping strategies, except the one of turning to religion for solutions to their problems. There was no association between their coping efforts and their psychological well-being, and between their resilience and their success in courses at the first attempt. First-time achievers, however, sought more information, advice and material assistance from others in order to cope with their stressors. It was concluded that undergraduates repeatedly experience stress due to annoyances and conflicts, that they cope with stress avoiding most emotion-focused coping strategies, signifying that they feel their stressors are amenable to change, that their psychological well-being is not related to how they cope with university stressors, and that their self-esteem and optimism are not related to their coping. However, their lower perceived control is associated with their seeking of advice and support from others, a coping strategy that is consequently associated with their success in courses at the first attempt. Such information will allow universities to be more proactive in the provision of appropriate support information given to the undergraduate.

Background: Many university students experience symptoms of depression, anxiety disorders, substance use disorders or eating disorders. This thesis aimed to develop and evaluate a trait-focused internet-based prevention programme for these disorders in students. The thesis comprises of three studies. Study 1: In a cross-sectional study, 425 students were assessed on personality and mental health. A cluster analysis of indicators of mental health suggested two groups: one "high risk" group (20 per cent), who experienced symptoms of mental disorders; and the remaining students (80 per cent), who did not experience symptoms. Students at high risk showed higher trait anxiety, perfectionism and introversion/hopelessness. Study 2: To investigate challenges of student life, a mixed-methods study combined a web survey and focus groups. In the web survey, students most frequently identified social, practical and academic challenges. The focus groups confirmed these challenges and suggested that stigma and the belief that support mechanisms at university are only for students with severe problems would hinder support seeking. Study 3: Based on the findings from studies 1 and 2, a trait-focused internet-based cognitive-behavioural intervention was developed. This intervention included modules on perfectionism, low self-esteem, difficult emotions and anxiety. An active control intervention and a procedure for personalised feedback were developed. In a randomised controlled trial, the efficacy of the intervention compared to a control intervention was investigated in 1141 students, who were classified as high or low risk according to their personality. The trait-focused intervention reduced depression, anxiety and, to some extent, phobia-related avoidance and eating disorder symptoms in students at high risk. Conclusions: These findings suggest that: (a) students at high risk of developing mental disorders can be identified; (b) high risk students report higher levels of emotional and health difficulties; and (c) the mental health of these students can be improved with an intervention targeting personality risk factors.

The Psychological Flexibility Model describes a process-oriented approach to behaviour change that underpins Acceptance and Commitment Therapy (ACT), a contextual cognitive behavioural intervention. ACT promotes psychological flexibility, which refers to a person’s ability to connect with the present moment fully as a conscious human being (mindfulness and non-judgemental acceptance), and to change or persist with behaviour that is in line with identified values. For people distressed and/or disabled by auditory hallucinations, it is theorised that this experience is responded to in a psychologically inflexible manner: becoming a target for avoidance, control or focus, appraised as more powerful than the person experiencing the voices, and leading to actions that come at the cost of engaging in chosen life directions. Previous research on coping, cognitive models and mindfulness interventions for voice hearing point to the possibility that promoting active acceptance and changing the relationship with voices may be associated with better outcomes. This thesis investigates the role of psychological flexibility with voice hearing using correlational, single-case and experimental research designs. The first study in this thesis investigated the relationship of psychological flexibility and mindfulness with distress, disability, and behavioural responses to voice hearing, using self-report questionnaires in a sample of 50 distressed voice hearers. The findings suggest that psychological flexibility and non-judgemental acceptance, over and above appraisals of voices and thought control strategies, is related to voice hearers’ levels of general depressive and anxiety symptoms, and behavioural resistance to voices, but not to engagement with voices, voice-related distress or life disruption. The second study reports the findings of a 10-session ACT intervention for eight distressed voice hearers using multi-baseline single case design, assessing whether outcome changes following ACT are concomitant with increasing psychological flexibility. Following ACT there were group-level improvements in depressive symptoms, quality of life and social functioning, with changes in psychological flexibility (non-judgemental acceptance, independent action from voices). The third study involved 110 non-clinical participants experiencing simulated auditory hallucinations in an experimental analogue, and investigated differences in response following training in a regulation strategy (acceptance, reappraisal or suppression). This study did not show any significant differences between groups; the potential explanations for this lack of expected difference include the features of simulated voices, sample characteristics, and participants’ degree of adherence to the coping strategy. The findings of these studies are considered within the broader context of emotional wellbeing with voice hearing, functional approaches to understanding responding to voices, and potential implications for clinical and research directions.

Referrer satisfaction is an often-neglected outcome measure in mental health services, and can inform service improvements. We examined referrer satisfaction with a national and specialist OCD and Related Disorders clinic for young people. An online satisfaction questionnaire, comprising 19 closed and one open-ended question, was sent to 155 referrers. Satisfaction was high overall. However, higher levels of satisfaction were noted with respect to treatment plans as compared to treatment outcome. Referrers also made recommendations for service improvements, such as increased communication during treatment, recommendations for after-care, managing co-morbidity, and improving patient engagement. Referrer satisfaction may be improved by addressing these aspects of the service, which are outlined and were fed back to the clinic staff.

Introduction: Psychotic-like experiences are commonly found in the general population; this raises the question as to why some individuals are in ‘need for care’ whilst others are not adversely impacted by such experiences. Cognitive models of psychosis highlight appraisals as key to moving people along the psychosis continuum. Victimisation has also been implicated in both clinical and non-clinical populations. The role of appraisals in providing a cognitive route between victimisation and psychosis is investigated more fully in the current study. Method: Appraisals of two experimentally-induced anomalous experiences (the Cards Task and Telepath Task) and number of victimisation experiences (interpersonal trauma and perceived discrimination) of individuals currently endorsing psychotic-like experiences in ‘need for care’ (N = 25) and ‘not in need for care’ (N = 25) were compared. The relationship between victimisation and appraisal type (maladaptive versus adaptive) was also explored across groups. Results: The ‘need for care’ group endorsed significantly higher ratings on maladaptive appraisals on both experimental tasks. The ‘non-need for care’ group endorsed significantly higher ratings on adaptive appraisals on the Telepath task. There were no significant differences in number of lifetime victimisation experiences between groups; however the ‘need for care’ group reported higher rates of adulthood discrimination. A significant relationship between victimisation and appraisals was not evident. Nevertheless there were some tentative links between adaptive, but not maladaptive, appraisals and impact and powerlessness in relation to victimisation experiences. Conclusions: Results are consistent with cognitive models of psychosis. Similar rates of total victimisation experiences across the lifespan in both groups suggest that victimisation may be implicated in the formation of anomalous experiences, but not in determining ‘need for care’ status. Factors such as social support and on-going impact and powerlessness in relation to the victimisation experiences, may be more relevant to the transition to ‘need for care’.

Substantial evidence from family and twin studies confirms the importance of genes in influencing susceptibility to Bipolar Disorder (BPD) and Depression. Genome- wide association studies have uncovered a few genetic variants of small effect that explain only a fraction of the total heritability of these disorders, and linkage studies have not been able to identify consistent and replicable findings, possibly due to phenotypic complexity and genetic heterogeneity. Large multigenerational families work as powerful samples to mapping loci for complex diseases as they segregate fewer disease causing genes than a collection of independent nuclear families. These fewer genes segregating may also be more highly penetrant and easier to detect in linkage studies. This study performed a whole genome linkage scan of a large multigenerational family from Brazil segregating a severe form of BPD and unipolar depression with the aim of localising and identifying genetic variants that contribute to the development of BPD. The ‘Brazilian Bipolar Family’ (BBF) is one of the largest reported in the literature. Three hundred and eight family members were interviewed using the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID) and the Kiddie-SADS-Present and Lifetime Version (K-SADS-PL) and three- hundred and twenty-four family members were genotyped using the Affymetrix 10K array. Parametric and non-parametric linkage analyses were performed using four hierarchical phenotype models. Four genome-wide significant linkage regions were identified on chromosomes 2p23.1-p22.3, 3p24.3-p24.1, 11p15.4, and 12q24.22- q24.32, and four suggestive linkage regions were identified on chromosomes 1p22.2- p21.3, 1q21.1-q21.3, 12p13.32-p13.31, and 22q11.21-q12.1, which either conferred specific risk to BPD, unipolar depression, or provided evidence for a general mood disorder liability. To determine the role of the identified linkage regions in sporadic bipolar and depression cases, I performed a case control association analysis using bipolar and depression case control cohorts. None of the linkage regions identified in the BBF were found to be associated with BPD or depression. The future aim of this project is to determine the functional variants within the identified linkage regions that may be contributing to the development of mood disorders in the BBF through sequencing analysis, which is already underway.

Background: Acetylcholinesterase inhibitors (AChEIs) are a key component of dementia care. Longitudinal cognitive change in patients before and after AChEI initiation has never been described previously, although individual responses have been described as heterogeneous. Predictors of such responses are not well established. This study describes longitudinal cognitive outcomes for patients who received AChEIs at the South London and Maudsley NHS Foundation Trust, UK during 2003 and 2010 in a routine clinical setting. Aims/ Objectives: The primary objective of the study was to describe trajectories of cognitive function, as measured by the MMSE in routine clinical practice in patients who had received AChEI, drawing on data before and after treatment initiation and comparing these slopes. The second objective was to investigate factors associated with cognitive response to AChEI treatment, defined as the difference in MMSE slopes before and after treatment initiation. Methods: A retrospective longitudinal study was constructed of data on 2,460 patients who received AChEIs with minimum of 1 MMSE score within 1 year before drug initiation and at least 1 MMSE score within 3 years after this. Longitudinal MMSE change was modelled using three-piece linear mixed models with the following segments: 0-12 months prior to AChEI initiation, 0-6 months and 6-36 months after initiation. Results: There was a significant improvement in the MMSE trajectory by 4.16 points per year in patients who received AChEIs during the 6 months after treatment compared with the 12 months before treatment. When stratified by MMSE score at AChEI initiation, lower MMSE was found to be associated with a stronger improvement in post- compared to pre-AChEI trajectory. MMSE score trajectories were similar over the 6-36 months after AChEI initiation compared with the 12 months before initiation. However, when stratified by baseline MMSE, patients with highest baseline MMSE had an exaggerated decline over the later period and those with lowest baseline scores had reduced slopes. Synthesis: This study found a significant improvement in the MMSE in patients who received AChEIs during the 6 months after treatment compared with the 12 months before treatment. When stratified by MMSE score at AChEI initiation, lower MMSE was found to be associated with a stronger improvement in post- compared to pre-AChEI trajectory. Heterogeneous response to AChEIs treatment found during first 6 months of AChEI drug initiation. Non-white ethnic groups who received AChEI treatment responded significantly better than patients from white population. Patients with Alzheimer’s disease recorded at some point responded better to AChEI than those without this diagnosis, and patients with vascular dementia recorded at any point responded less well than those without this diagnosis. Finally, considering pharmacotherapy, patients who received antipsychotics, gastrointestinal drugs and anti-platelet, fibrinolytic and anticoagulant agents at any point in follow-up were found to have a weaker response to AChEIs.