This thesis describes an investigation into the effect of maternal psychopathology on infants' mental and psychomotor development. Part one systematically reviews the literature, which considers the effect of maternal psychopathology on infants' mental and psychomotor development in the first two years of life. It concludes that this relationship is likely to be mediated by other variables and future research should explore this relationship further. Part two is an empirical paper that describes an investigation of the relationship between maternal psychopathology and infants' mental and psychomotor development and the potential mediating variables of socioeconomic factors and maternal Emotional Availability. This thesis was linked to Wain's (2010) research and built on the work of Gale (2009). Part three is a critical appraisal that discusses methodological issues and personal reflections on conducting the research.

This thesis investigated processes of change in Multisystemic Therapy (MST) for adolescents with antisocial behaviour problems. Part 1, the literature review, critically evaluates 28 studies investigating how neighbourhood effects on youth antisocial behaviour are mediated and moderated by family, peer and individual variables. The research demonstrated that neighbourhood risk influences young people's behaviour indirectly through more proximal processes such as parenting practices, peer deviancy and individual antisocial beliefs. Family risk was generally found to be amplified in disadvantaged neighbourhoods, such that parenting practices, especially monitoring, had a closer relationship to child behaviour in high-risk contexts, compared to in more advantaged neighbourhoods. Less interaction was found for individual risk factors such as low empathy, which tended to predict delinquency regardless of neighbourhood context Part 2, the empirical paper, is a qualitative study of families' experiences of receiving Multisystemic Therapy, with a particular focus on processes of change. Semi-structured interviews were conducted with 22 parents and 19 young people, and accounts analysed with thematic analysis. Findings highlighted a wide range of positive changes in the young person's behaviour and attitude, as well as family relationships and parenting practices. Increased parenting confidence and competence, reduced conflict in the home, and a return to education for the young person were key to youth behaviour change. Accounts supported an ecosystemic model of intervention for youth antisocial behaviour. Part 3, the critical appraisal, addresses methodological issues of the study. This includes consideration of the influence of researcher perspective, and the impact the research has had on the researcher's future clinical thinking and practice.

User-led services set out to challenge the idea that people with mental health difficulties are non-contributors and to make use of individuals' previously undervalued skills and experience. The first section of this thesis is a review of recent literature on evaluations of user-led services. The review takes an inclusive approach, considering studies that utilise a range of different methodologies, so as to fully capture the wide range of potential benefits of involvement. A prominent example of a user-led service is the Hearing Voices Network, an association of mutual support groups for people who hear voices. An important aspect of the Hearing Voices approach is that the groups are run by people with personal experience of hearing voices. The second section of this thesis is an empirical paper reporting a participatory study into the experiences of peer facilitators of Hearing Voices groups. Working in partnership with the Hearing Voices Network, interviews were conducted with voice hearer facilitators using the methodology of Interpretative Phenomenological Analysis. The third section is a critical appraisal that reviews the study against value-based guidelines for using participatory research methods with mutual support organisations.

The three main aims of this research were: (1) to compare a specific and time-limited form of psychotherapy, namely cognitive therapy, with pharmacotherapy (drug of choice) in the treatment of depression, (2) to test out the effect of combining cognitive therapy and pharmacotherapy (drug of choice) and (3) to investigate the efficacy of these modes of treatment relative to one another in two populations, outpatients from a teaching hospital from the community, i.e. a general practice. Depressed patients were referred from two sources, a hospital outpatient clinic and a general practice clinic, and were screened using a standard psychiatric interview, the Present State Examination, for elicitation of symptoms and signs. On the basis of this interview, Spitzer's research diagnostic criteria were checked. All of the patients admitted to the study satisfied the criteria for primary major depressive disorder. In addition, level of self-reported depression had to be at least mild according to the British norms of the Back Depression Inventory (i.e. > 14). Eighty-eight patients were randomly assigned to pharmacotherapy (drug of choice), individual treatment with cognitive therapy or a combination of pharmacotherapy (drug of choice) and individual cognitive therapy. For the cognitive therapy and combination treatment, the protocol specified a maximum of 20 weeks, with both cognitive therapy groups attending twice a week at the beginning and once a week thereafter. The pharmacotherapy patients were prescribed therapeutic doses appropriate to each drug. If no response occurred (i.e. at least a 50% reduction in level of depression) after a maximum of twelve weeks of treatment, patients wore dropped from the trial whatever type of treatment they received. In the hospital sample all three treatment groups showed statistically significant decreases in depressive symptoms. Combination treatment resulted in greater improvement then did cognitive therapy alone and pharmacotherapy alone on a number of mood and cognitive measures. In the general practice population, combination treatment and cognitive therapy alone resulted in statistically significant decreases in depressive symptoms whereas pharmacotherapy, on the whole, failed to reduce depressive symptoms. Both combination treatment and cognitive therapy alone resulted in significantly greater decreases in depressive symptoms than did pharmacotherapy on several measures of mood and a cognitive measure. When responders only were examined, pharmacotherapy, cognitive therapy and combination treatment produced different patterns of response over the treatment period in terms of self-reported depression and hopelessness. Combination treatment in particular, but cognitive therapy as well, resulted in a quicker and sharper effect then pharmacotherapy, especially on hopelessness, a variable that is reported to correlate highly with suicidal intent. In terms of attrition, no one treatment was better than any other in reducing the number of drop outs from therapy in each population. It was concluded that cognitive therapy is at least as effective as pharmacotherapy in the treatment of hospital outpatients end that it is more effective than pharmacotherapy in depressed general practice patients. Further, the combination of pharmacotherapy and individual cognitive therapy may be particularly useful in the treatment of chronically depressed hospital outpatients.

No description available.

Alzheimer's disease and senile dementia of the Alzheimer type (Alzheimer-type dementia, ATD) are progressive dementing illnesses characterised histopathologically by the presence of neurofibrillary tangles and plaques. Ultrastructurally tangles are composed of paired helical filaments (PHF) (Kidd, 1963) of unknown origin. The purpose of this study was to investigate the biochemical and biophysical properties of tangles, and their constituent PHF. Investigation of tangle solubility by quantitative light microscopy of brain homogenates showed that a proportion of tangles, which varied between brains (ATD and Down's Syndrome with ATD pathology) were soluble in sodium dodecylsulphate (SDS) and NaOH. Tangle solubility in 1&37 SDS was inversely related to duration of dementia suggesting that patients with a long standing illness have more fragile tangles. Ultrastructural studies were carried out on tangle enriched fractions prepared by ultracentrifugation of supernatants from SDS treated brain homogenates and by sucrose density gradient centrifugation of brain homogenates not treated with SDS. PHF in the former preparation were found to be longer with lengthened pitches compared to PHF in the latter preparation. PHF from another SDS treated preparation which was repeatedly freeze thawed (up to 25<SUP>o</SUP>C) were observed to lose their their helical configuration. These electronmicroscopic observations suggest that the helical substructure of PHF can be subject to conformational change, whilst filament structure is retained. Preparation of tangle enriched fractions from ATD brains was investigated using Percoll, sucrose gradient centrifugation and fluorescence activated cell sorting (FACS). Percoll proved unsatisfactory; and sucrose gradient centrifugation was used to prepare fractions enriched in tangles from ATD brains, and control fractions prepared in the same way, from control brains. Tangle preparation using FACS was a new technique, whereby tangles labelled with the fluorescent dye, congo red, could be sorted from ATD brain homogenate. Partially purified tangle preparations were investigated using spectroscopy. The resulting spectra showed features consistent with an increase in β sheet in the tangle enriched versus the control fraction.

No description available.

The study aimed to investigate why sane people with certain symptoms seek treatment and are subsequently given a neurotic diagnosis, whilst others with similar symptoms do not seek treatment and appear to cope with everyday living. The general hypothesis made was that psychological factors are important determinants in seeking or not seeking treatment for those with neurotic symptomatology.

No description available.

No description available.