Oral Health Status and Treatment Needs of the Institutionalized Chronic Psychiatric Patients in two Ontario Psychiatric Care Centres Neyaz Farrahi-Avval Master of Science Graduate Department of Dentistry University of Toronto 2008 Abstract Purpose: To examine the oral health status of psychiatric in-patients at two long-term psychiatric health centres, with one operating a full-time dental care facility. Methods: Data were gathered from clinical examinations, a structured interview and hospital records from 120 participants. Periodontal (CPI) and dental (DMFT) indices, subjectively reported oral health status, and oral health behaviour were subsequently analyzed. Results: Referrals for dental problems were made for 62.9% of participants. Bivariate analyses revealed positive correlations between DMFT scores, age and length of stay. Multiple regression analyses demonstrated correlations between DMFT scores and infrequent dental visits, frequent snacking and age. Patients at the psychiatric hospital without a full-time dental care facility were more likely to have had higher DMFT scores, and infrequent dental visits. Conclusions: Psychiatric patients have poor oral health and significant oral health treatment needs. This study underlines the need for on-site dental care facilities at long-term psychiatric care centres.

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

Thesis (Ph. D.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

Thesis (M.S.) -- Uniformed Services University of the Health Sciences, 2005. / Title from title screen (viewed Aug. 14, 2007). Includes bibliographical references (p. 95-106).

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Die klinische Erfahrung zeigt, dass sich depressive Episoden sehr schnell innerhalb weniger Stunden bis Tage oder sehr langsam innerhalb mehrerer Wochen bis Monate entwickeln können. Hauptziel dieser Arbeit war es, die zeitliche Entwicklung depressiver Episoden bei Patienten mit einer unipolaren oder bipolaren affektiven Störung zu untersuchen. Mithilfe des dafür entwickelten und im Rahmen dieser Studie weiter modifizierten strukturierten Patienteninterview ODI (Onset of Depression Inventory) wurde die Geschwindigkeit des Depressionsbeginns bei 223 konsekutiven Patienten erfasst, von denen 129 in die Auswertung eingeschlossen werden konnten. Es zeigte sich, dass sich depressive Episoden bei Patienten mit bipolarer affektiver Störung signifikant schneller manifestieren als bei Patienten mit unipolarer affektiver Störung. Somit kann die Geschwindigkeit des Depressionsbeginns, gemessen mit dem ODI, als Differenzierungsmerkmal zwischen unipolarer und bipolarer affektiver Störung gewertet werden und im klinischen Alltag helfen, zwischen den beiden Störungsbildern zu unterscheiden.

Genetic factors underlying alcoholism, substance abuse, antisocial and violent behaviour, psychosis, schizophrenia and psychopathy are emerging to implicate dopaminergic and cannabinoid, but also monoaminergic and glutamatergic systems through the maze of promoter genes and polymorphisms. Candidate gene association studies suggest the involvement of a range of genes in different disorders of CNS structure and function. Indices of comorbidity both complicate the array of gene-involvement and provide a substrate of hazardous interactivity. The putative role of the serotonin transporter gene in affective-dissociative spectrum disorders presents both plausible genetic variation and complication of comorbidity. The position of genetic variation is further complicated through ethnic, contextual and social factors that provide geometric progressions in the comordity already underlying diagnostic obstacles. The concept of shared biological susceptibilty to two or more disorder conditions of comorbidity seems a recurring observation, e.g., bipolar disorder with alcoholism or schizophrenia with alcohol/substance abuse or diabetes with schizopsychotic disorder. Several lines of evidence seem to suggest that the factors influencing variation in one set of symptoms and those affecting one or more disorders are observed to a marked extent which ought to facilitate the search for susceptibility genes in comorbid brain disorders. Identification of regional genetic factors is awaited for a more compelling outline that ought eventually to lead to greater efficacy of symptom-disorder arrangements and an augmentation of current pharmacological treatment therapies.

本論文試圖針對目前或曾經有過照顧罹病家人之情感性精神病患進行深度訪談，以了解其家庭生活適應整體歷程中，所遇之壓力負荷議題、照顧議題及生活適應影響議題為何。研究設計採取敘事研究法，針對四位情感性精神病患的照顧故事進行資料蒐集與分析。 　　本研究共有三大部份的發現，在壓力負荷層面中，照顧者主要經驗「情緒困頓」、「責任壓力」、「束縛感受」、「被隔離或排斥的感受」、「對未來的恐懼」、「刻板印象、歧視或烙印」、「家庭功能和關係之變化」等七項主觀或客觀議題；在照顧層面中，照顧者主要面臨了「疾病復發引發負面情緒，影響照顧的能量」、「資源和支持系統之運用」、「生理健康」、「心理健康」、「情感需求支持」等五項議題；在生活適應影響層面中，照顧者面臨「角色轉變」、「相關支持」、「照顧信念」、「照顧需求」等四個面向的議題。 　　在了解情感性精神病患身為疾病照顧者之家庭生活適應歷程中，影響其家庭生活適應之相關因素和議題之後，研究者根據研究結果的整理，提出具體建議與結論，提供助人實務工作和政策方案設計在協助情感性精神病患執行照顧角色之參考。 / This research aims to caregivers who have affective disorder had or having the experience of taking care of his or her sick families. With in-depth interview, author try to understand what issues will face during their process of family-life adjustment, like stress and burden issues, care issues, and live adjustment issues. Research design takes narrative research to collect and analyze from four caregivers who have affective disorder. This research has three parts of finding. First, in "Stress and burden issues", caregivers face seven subjective and objective issues, such as "emotional suffering", "responsibility stress", "feeling of restrain", "feeling of being separated or rejected", "fear of the future", "stereotype, prejudice, and stigma", and "changes of family function and relationship". Second, in "Care issues", caregivers face five issues, such as "symptoms cause negative feelings", "using the resources and supportive system", "mental health", "physical health", and "support of emotional needs". Third, in "Life adjustment issues", caregivers face four issues, such as "role change", "supports", "care belief", "care needs". After discovering those issues and relative factors that influence the process of family-life of caregivers who have affective disorder. Base on above findings, author gives suggestions on policy making and practice work for caregivers who have affective disorder.

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Running title: Seasonal affective disorder and melanopsin. Typescript (photocopy).