The literature review paper is a critique of studies on the topic of compliance/adherence/concordance with medical advice in young people with insulin dependent mellitus (IDDM). It is noted that the body of research under scrutiny does not have a coherent conceptual or methodological framework. Such issues affect the reliability and validity of many results to such an extent that it can be difficult to assess the usefulness of the findings. It is concluded that there is currently a political change that sees a move into more collaborative research with young people and the clinicians who work with them. The empirical paper is a study comparing self care in young people with diabetes or severe food allergy. Some significant within and between group differences were found in the relationships between self care and Multidimensional Health Locus of Control. Implications of the findings for young people are discussed. Recommendations are made for future research particularly for the severe food allergy group where this study is the first to investigate psychosocial aspects of self care.

This thesis was sub~itted in partial fulfilment of the requirement of the degree for Doctor of Clinical Psychology at the University of Binningham. The thesis consists ofa literature review and empirical paper focusing on psychosis in children and adolescents. The literature review investigates the evidence for subgroups of psychosis and schizophrenia, with a particular emphasis on the subgroup of early-onset psychosis (children and adolescents). It is argued that the early-onset subgroup may be overrepresented in samples of people who have been unwell for a while and that a subgroup based approach may have important consequences for future research in psychosis and schizophrenia, such as using subgroup rather than whole group statistical analysis. The empirical paper examines the development of emotional autonomy and personal uniqueness in looked after young people, and compares the presentation of these characteristics to non looked after young people with and without psychosis. It was found that looked after young people demonstrated emotional autonomy from parents but not foster parents and this is discussed as being conducive in emotional autonomy development and as possibly supporting the development of peer relationships in looked after young people.

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This thesis consists of two papers. The first paper is a review of the literature exploring self-harm in Asian females. Research that explored prevalence rates revealed-that during the transition from adolescence to adulthood rates ofself-harm were higher in Asian females compared to their Asian male and White female counterparts. The paper then reviews research that has aimed to identify precipitating factors for Asian female adolescents and Asian women's self-harm. Methodological considerations are discussed and it is argued that further research is needed to inform service provision and delivery. The second paper is a qualitative research project that explored young Pakistani females (aged between 14 and 16 years old) understanding and perception of mental health and mental illness. Focus group transcripts were analysed using Foucauldian Discourse Analysis. Participants drew on psychological and social discourses, and religious and spiritual discourses, to discuss how mental health problems were caused. These discourses were also used to construct mentally ill people as 'different'. Individual interviews were analysed using Interpretative Phenomenological Analysis. Three main themes were identified: complementary and dichotomous understandings of the causes of mental illness, conflicts and contingencies in seeking help and choosing interventions and resolving dilemmas: respect and responsibility.

Three studies are reported which investigate the relevance of the expressed emotion (EE) construct for families/patients from non-western backgrounds (Pakistani Muslims and Sikhs). The first study was concerned with the relationship between ethnicity and EE in patients with a diagnosis of schizophrenia, and also tested four hypotheses which looked at the association of ethnicity and EE with each of the following: the relative's experience of burden; the relative's perception of the amount of social support they received; the use of coping strategies by relatives; and patient's and relative's perceptions of one another. The results indicated a significant difference between ethnic groups in the number of relatives exhibiting high levels of EE: 55% of whites, 80% of Muslims and 30% of Sikhs were rated as high EE. High EE relatives were also more likely to report lower levels of social support, and were more likely to hold negative perceptions about the patient and believe that the patient also holds negative perceptions about them. The second study looked at the effect of EE on the course of schizophrenia. Course of the illness was not significantly different across the three ethnic groups. Using conventional criteria, low EE in whites was predictive of fewer relapses, but was not so for Asians. When the cut-off for emotional over-involvement was changed from 3 to 4 in the case of the Muslims, high EE then did predict relapse. The third study looked at the prevalence of high EE in non-clinical white and Muslim populations: Muslims were significantly more likely than whites to be rated high EE. The results suggest that Muslims are more likely to be classified as being high EE as judged by western cultural norms. Hence, in order to obtain better predictive validity of EE for relapse in schizophrenia in Pakistani culture, the cut-off point for high EE should be adapted to take this into account. Needless to say, further research must be conducted to establish the normative levels for the overt expression of emotion in Pakistani culture.

Three papers report on the role of preoperative expectations and stress in surgical recovery. The first paper critically reviews the role of expectations in surgical recovery. It identifies various types of expectations, their relationship to recovery, and the theoretical and methodological concerns within the literature. The second paper focuses on the role of expectations in recovery before and after surgery, and at seven days follow-up. Preoperative expectations predicted symptom severity, speed of healing, speed of return to work and psychological distress seven days after surgery, after medical and anxiety factors were controlled. The third paper is a brief report comparing the relative contribution of stress and anxiety in recovery from oral surgery. Stress and trait anxiety together predicted postoperative energy ratings, number of symptoms, anxiety and depression at follow-up, after medical and gender effects were controlled. Stress also predicted postoperative complications. The importance of establishing the relationship between factors known to influence recovery, as well as their individual relationships with adverse recovery periods and the development of future preoperative interventions are discussed.

Cognitive deficits are a core disabling feature of schizophrenia, yet remain inadequately treated by current pharmacological or behavioural therapies. The non-competitive NMDAR antagonist ketamine can pharmacologically induce cognitive deficits in both rodents and humans, presenting a novel translational approach for examining mechanisms underlying cognitive deficits associated with schizophrenia (CDS). Nicotine can improve working memory in rodents and in smokers with schizophrenia where heavy tobacco use may reflect self-medication to ameliorate CDS. The roles of the two main subtypes of nAChRs, the α7 and α4β2, in mediating cognitive improvement have yet to be determined. Cohorts of male hooded-Lister rats were trained in the Odour Span Task (OST) until demonstrating asymptotic performance and then exposed to a sub-anaesthetic dose of ketamine or vehicle daily for 5 consecutive days. This sub-chronic regimen produced a replicable, dose-dependent impairment in OST performance that was not restored following anti-psychotic treatment. Nicotine, α7 and α4β2 nAChR-selective agonists improved performance in ketamine-treated animals, with nicotine and one α4β2 agonist also improving the performance of control subjects. These data indicate the α4β2 nAChR as the main receptor subtype mediating the effect of nicotine on the OST in control animals, with a lesser role for the α7 nAChR. The α7 nAChR however was shown to have a role in improving the performance of ketamine-treated animals, as demonstrated by the enhancing effect of allosteric modulator PNU-120596 and Compound T on OST performance; an effect that was blocked by the α7 nAChR antagonist methyllycaconitine. When administered locally into the medial prefrontal cortex (mPFC), nicotine improved, and muscimol impaired OST performance; suggesting the mPFC as the neural site of action in the OST. Complementary data using an in-vitro electrophysiological gamma frequency model of network oscillations indicated an enhancing effect of nicotine on normal gamma frequency oscillations in the rat mPFC and is proposed as a potential mechanism behind the behavioural data. Collectively, these results provide further impetus for targeting nAChRs in the treatment of CDS.

It is certainly noteworthy that, during the last few decades, whatever the contributory forces, more and more emphasis is being placed on the contention that man is a social being and that his individuality as a person is meaningful only in terms of his relations with others. Mead (1947) has shown that man as a social being is subjected throughout his entire individual existence to systematic cultural pressures which reinforce or intensify, elaborate or suppress his psycho-biological potentialities on different lines in different cultures. Cultural anthropologists and those psychiatrists who have been fortunate in working among peoples of different cultural institutions have laid down the hypothesis that cultural factors influence the aetiology and psychopathology of mental disorders.

Delusions are considered to be one of the primary symptoms of psychosis but until recently have received little empirical investigation. One approach has been to examine the extent to which deluded individuals demonstrate cognitive biases which are different from those of normal controls in inductive reasoning tasks. In this study two hypothesis testing tasks were used to investigate cognitive biases in a group of people with persecutory delusions compared to a group whose delusions had remitted and a normal control group. Participants completed two tasks consisting of a series of visual discrimination problems in which they had to choose between pairs of stimuli presented on cards. Condition 1 examined previously reported biases of deluded participants requiring less information before making judgements and being overconfident in their judgements. Positive or negative feedback was given after every card and participants were unconstrained in giving solutions. Condition 2 partially replicated Young and Bentall's (1995) hypothesis testing study and examined participants' ability to process information sequentially and progressively focus down the set of possible correct solutions. Feedback was restricted and participant responding was constrained. No differences were found between groups in condition 1. In condition 2 deluded participants produced fewer hypothesis and sampled from a smaller range of hypotheses than remitted and control participants. Deluded participants also produced fewer correct hypotheses than the other groups. A trend was found for deluded participants to use fewest sensible responses to feedback, followed by remitted and control groups. The reverse trend was found for use of nonsensical responses to feedback. Limitations of the study, implications for clinical practice and suggestions for future research are considered.

The meaning of quality of life as experienced by patients diagnosed with schizophrenia living in the community in Greece has never been a topic of study, either in the Greek or in the international mental health literature. The meaning of 'quality of life' in relation to a person diagnosed with schizophrenia is explored through the relevant literature. Discussions and arguments on the methodological approaches, and the research methods used by researchers are provided in the literature review chapter. The study took place in two phases. Mixed research methods were employed in order to answer the research question of this study. Eight informants were interviewed in the first phase and five life domains were defined as contributing to the informants' quality of life: work and money, family, social functioning, psychological functioning and health. These five domains guided the choice of the quantitative tool in order further explore the research question of the study and to measure the quality of life of patients diagnosed with schizophrenia. The Greek version of the Subjective Quality of Life Profile was used in 100 people diagnosed with schizophrenia living in the community in Greece, and the results showed that the majority of them experienced overall satisfaction and that they were expecting changes for the better to come in the future. This study contributes towards the expansion of knowledge in the mental health area and is expected to be the initiative for further research, since it is the first study to examine the meaning of quality of life of people diagnosed with schizophrenia living in the community in Greece.