Background/aims: There is considerable evidence that euthymic individuals with bipolar disorder experience both significant impairment in cognitive function – especially verbal memory and executive function – and significant impairment in psychosocial function. There is also some evidence that bipolar disorder is associated with altered emotional processing, although the findings are somewhat mixed. The aims of the present study were to address some of the outstanding questions about these three areas in euthymic bipolar patients: 1) is there a relationship between verbal memory impairment and executive dysfunction? 2) Can cognitive function be improved? 3) Do patients show differences in the explicit and/or implicit processing of emotional information? 4) Is there a relationship between cognitive dysfunction, emotion‐processing impairment, and psychosocial functioning? Method: A large sample of euthymic patients with bipolar disorder and healthy controls underwent a battery of neuropsychological tests, tests of emotion processing, and had their social function measured via a selection of clinician‐ and self‐rated measures. Results: 1) Deficits in executive function were insufficient to explain the entire extent of the verbal memory impairment in this group, suggesting they are two distinct areas of impairment. 2) A subgroup of patients who underwent a simple self‐monitoring intervention significantly outperformed a control group of patients on several indices of one cognitive functioning measure. 3) Patients showed little evidence of impairment in emotion processing on either explicit or implicit measures. 4) Functioning was most strongly predicted by psychological factors, such as self‐esteem, anxiety and dysfunctional attitudes. Cognitive function was also a significant, although weaker, predictor. Overall models accounted for more than 60% of the variance in functioning. Conclusion: Cognitive dysfunction in bipolar disorder appears to be multi‐faceted and involve more than one area of impairment. Efforts to improve functional outcomes would be best served focusing on improving self‐esteem and psychological coping resources.

Shape and weight over-concern and self-evaluation almost exclusively in these terms is a core feature of eating disorder psychopathology and it is this which is thought to drive weight control behaviours. The literature indicates concerns about weight and shape can be present in children at least as young as eight rears of age. Currently, there is no tool available which measures a child's over-concern with their body shape and weight per se. This study developed an assessment of children's body shape and weight over-concern, using scales measuring shape and weight concern and perceived importance of shape and weight. The properties of the new shape and weight over-concern assessment were examined in relation to children's self-perception and implicit attitudes towards overweight. Participants were 333 Year 5 children (181 boys and 152 girls) from North Yorkshire primary schools, with a mean age of 9 years 7 months. They completed measures of body shape perception, dietary restraint, height and weight accuracy, self-esteem and body shape and weight over-concern. In addition they completed a timed implicit association task which assessed implicit attitudes towards overweight. The new assessment was concluded to have good psychometric properties and to be a reasonable assessment of shape and weight over-concern in children. Children with high shape and weight concern tended to be heavier, less satisfied with their weight and body shape, have lower self-esteem and report increased levels of dietary restraint. High levels of perceived importance of shape and weight also impacted on this latter variable. A general anti-fat bias was indicated from this group of children. Dietary restraint score was a significant predictor of shape and weight over-concern, as was global self-worth (for the boys) and physical appearance (for the girls). No gender differences were found in the assessment of shape and weight over-concern. This study is the first to measure shape and weight over-concern in children and highlights a need of continued research of over-concern in children and adults. This will continue to inform intervention and prevention programmes of eating disorders. Further research into the implicit anti-fat attitudes in children as young as 9 years is also indicated, especially in respect of shape and weight over-concern.

This qualitative study is an investigation of subjective accounts of Psychosis, with a particular focus on positive aspects of the experience from people who have continuing treatment needs and from those in recovery. The findings offer insight which is applicable to mental health services, psychological understanding and interventions. 15 semi-structured interviews were conducted with 10 participants, four of whom were in recovery and six of whom had continuing needs. Participants welcomed the opportunity to share their stories, and their descriptions were eloquent and valuable. Interpretative Phenomenologica Alnalysis was used to analyset he data. Subordinate themes were clustered around seven master themes in order to explore how positive experiences fit into the experience of psychosis as a whole and to determine the frameworks people used to find meaning in their experiences. Similarities and differences between the two groups were explored. Participants were interested in exploring positive aspects of their experience. They identified 14 positive sub-themes( e.g . enhanced sensory experiences, support and comfort from the voices, accessing an alternative experience), and their implications (e. g. absolution from responsibility, educational and professional opportunities, empowerment through recovery). Only one participant was unable to identify positive aspects of his experience of psychosis.

One in four people in Britain experience mental health difficulties at some point in their lives and psychiatric diagnosis is an integral part of the treatment for many of those referred for help with their difficulties. The research literature indicates the impact that diagnosis has on an individual's life and offers conflicting views as to whether or not diagnosis is useful for individuals who receive a diagnosis. However the impact that diagnosis can have on the therapeutic relationship has yet to be considered. The purpose of this research was twofold; to explore how working with clients who have a psychiatric diagnosis is experienced by psychologists and secondly to formulate an explanatory theory of this process. This grounded theory study used purposive sampling to recruit fourteen Chartered COWlSelling Psychologists and theoretical sampling to recruit one Chartered Clinical Psychologist. Participants were interviewed using a semi structured interview format. The basic social process that emerged from the data indicated that many participants experienced feelings of uncertainty when working with diagnosis and that they adopted one of three positions on diagnosis; 'uncritically adopting diagnosis' whereby they worked with diagnosis seemingly without any critical appraisal; 'challenging diagnosis' whereby they adopted a critical position towards diagnosis; and 'pragmatic positioning' which involved both compromise and avoidance of diagnosis as a way of attempting to reduce their feelings of uncertainty and cognitive dissonance. In seeking certainty many participants engaged with , I ~ diagnosis and thereby tended to disengage with their counselling psychology identity as they struggled to hold both the medical model and the counselling psychology philosophy at once. This created cognitive dissonance which motivated participants to adopt a pragmatic position to reduce the conflict. The pragmatic position adopted is untenable, leading to further dissonance and uncertainty. Some chose to opt out of working with diagnosis at a later point in the process when maintaining a pragmatic position was no longer desirable or possible for them. What has been identified is a lack of confidence in working with diagnosis and a struggle to adapt to a medical model context. This has implications for practice, supervision and training and more generally for counselling psychology as a profession. TIlls will be discussed in addition to the limitations of the study and avenues for further research. , ..

This thesis presents empirical evidence regarding the labour market experiences of people with mental health disabilities. It analyses data from the third wave of the Labour Force Swvey (LFS) (2007) in conjunction with qualitative,data collected between 2006 and 2009. Sixty-four people reporting mental health disabilities with a range of employment statuses, both active and inactive were interviewed regarding their labour market experiences. This research addresses a significant gap in the academic literature. While there has been noteworthy research establishing that people with mental health disabilities experience disadvantage in the labour market, influential medical concepts of disability continue to effect subsequent explanations for such patterns. From such a perspective, the exclusion of people with mental health disabilities is essentially rational; they are impaired and are inherently less employable. The evidence from this thesis challenges such conceptualisations of mental health. It adopts a social model of disability whilst recognising and addressing it has limitations in the case of mental health. The thesis presents clear quantitative and qua1itative evidence of economic exclusion. Evidence from the LFS demonstra tes that, of all disabled groups, those self-reporting mental health disabilities were the most likely to express a desire for employment, yet amongst the least likely to be employed. In addition, there was clear evidence of underemployment, with panicipants reporting a reliance on part-time or temporary work despite a desire for full-time, permanent work. Qualitative data challenges the dominant stereotype of people with mental health disabilities as less employable as a direct result of the impairments associated with the ir illnesses. Instead these patterns were largely perceived as being the result of society's reaction to mental ' illnesses' and subsequent creation of a variety of individual. organisational, structural and institutional barriers to employment. This provides the basis of a relevant social model that does not deny the presence or importance of the very real symptoms of mental health disabilities, but argues that these do not necessarily have to result in labour market disadvantage.

No description available.

Evidence from studies exploring relapse rates in people with a diagnosis of schizophrenia has shown that the quality of the relationship between people with psychosis and their relatives is an important predictor in determining outcome (Butzlaff & Hooley 1998). The importance of the discrepancy between illness representations within family members was highlighted in the development of the Self Regulation Model (Leventhal et aI., 1985). A study by Lobban et aI., (2006) acknowledged the importance of patient beliefs about their mental health problem and how any discrepancies between these beliefs and their relatives' beliefs may cause such incongruence that this damages the quality of their relationship. Lobban et aI., (2006) explored the discrepancies in appraisals in patients with a diagnosis of schizophrenia and their relatives in relation to Expressed Emotion (EE) and found greater discrepancies between illness models of schizophrenia in patient-relative dyads with a high-EE relative than in those involving a low-EE relative. There is also evidence' to suggest that family difficulties occur early on in the psychosis (Gleeson et aI., 1999). As over 60% of those with a first episode of a major mental illness return to live with relatives, it is important to explore the impact of this within patient-relative dyads. Therefore, this study aims to further explore the relationship between discrepancies of mental health problem beliefs in patient-relative dyads in first episode psychosis using an in depth measure of EE. In this study, 63 patient-relative dyads were recruited. All patients were administered the Illness Perception Questionnaire for Schizophrenia (lPQS - Patient version) and they also took part in the PANSS interview to assess symptomatology of psychosis. All relatives were administered the IPQS (Relative version) and they also took part in the Camberwell Family Interview to assess their EE status. Following these assessments, the patient-relative dyads were categorised into high EE (n=32) and low EE (n=31). Contrary to Lobban et aI's study, there were no differences found in discrepancy scores in patient-relative dyads between the high and low EE groups. However, when the dimensions of high EE (criticism, emotional overinvolvement and hostility) were dichotomised into high and low groups, there were greater discrepancies in perceptions of illness identity in dyads low in criticism. High EOI dyads had greater discrepancies in perceptions of illness consequences and they attributed significantly more symptoms to medication as opposed to those dyads low in EOI. However, these results should be interpreted with caution, as the high EE groupings were not evenly distributed. These findings provide tentative evidence that illness representations held by patients and their relatives who are experiencing recent onset psychosis may be transient in nature and less entrenched than those who have experienced a more prolonged exposure to the impact of the mental health problems. As these beliefs may not be as crystallised as those in a more chronic population, this gives further weight to the argument of the importance of providing suitable early intervention support packages to not only the patient, but also their relatives.

Chronic fatigue syndrome is a symptomatically defined condition primarily characterised by a minimum of 6 months severe and debilitating fatigue of new onset which cannot be explained by any other medical causes. CFS is considered a controversial condition as aetiology is unclear, prognosis poor and symptom patterns commonly fluctuate. Families may be particularly important in CFS as the loss of wider social networks may make CFS patients more reliant on close family members. What little work there is suggests that significant others and CFS patients hold largely similar beliefs about the illness and that significant others' responses may be associated with functional outcome in CFS (Heijmans, de Ridder, & Bensing, 1999; Schmaling, Smith, & Buchwald, 2000). The primary purpose of this study was to explore the illness cognitions, including spontaneously made causal explanations for CFS onset and symptoms (causal attributions), of significant others of patients with CFS in relation to a number of outcomes including significant others' burden, distress and their behavioural responses to the CFS patient. A secondary feature of this study is the use of a variety of different quantitative and qualitative research methods, combined to obtain a detailed understanding of significant others' beliefs. Participants were 30 CFS patients and their nominated 'significant other'. Participants were interviewed at home using a semistructured interview examining illness cognitions. They also completed a battery of questionnaires measuring distress and the illness perceptions of both patient and significant other. Patient functioning was assessed from the viewpoints of both patient and significant other. Significant others also completed a measure of behavioural responses to the patient, and a measure of burden. Additionally, eighty five undergraduate students completed questionnaire measures to assess their knowledge of and beliefs about CFS. CFS patients and students reported less coherent models of the condition than did significant others. Significant others' illness cognitions were found to be predictive of burden and distress experienced, and their behavioural responses were associated with a number of aspects of patient functioning. Significant other distress was associated with personal and global attributions. Rejecting-hostile responses towards the patient were associated with attributing CFS to causes personal to the patient. Where significant others made more controllability attributions, they were less likely to make responses encouraging the patient to rest. Additionally, there were significant associations between causal attributions and a number of illness cognition dimensions which are discussed. The use of qualitative analysis techniques (thematic analysis and interpretative phenomenological analysis) identified issues of identity as important in terms of illness beliefs and behavioural response. The present study demonstrates that illness cognitions, whether measured using standard questionnaires, from spontaneous attributions, or qualitatively, are related to important outcomes for both the significant other and the CFS patient. However, the use of different methods demonstrates that what appear to be similar or the same constructs derived from different methodologies may actually be subtly different. In terms of formulating models of illness, the present study highlights the importance of clarity when utilising terminology in terms of research in this area. Further research in this area might usefully focus on an examination of the way in which two partners thinking about and experiencing the impact of chronic illness together formulate a joint story with a particular focus on how such a joint story might develop.

No description available.

No description available.