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No description available.

Prison self-injury rate accelerates at four times the rise in population” (The Howard League for Penal Reform; 2008a) The rise in self-harm figures in forensic settings in 2003 may largely be due to the improvement in the reporting of self-harm levels in prisons in December 2002. However it does not account for the continued rise in self-harm figures during the years that followed. Despite the increase, there have been few interventions to support prisoners who self-harm, particularly in remand settings. For this purpose the Carousel programme was designed by a counselling psychologist specifically to meet the demands of the female remand population. The aim of this study was to evaluate the effectiveness of Carousel. Forty women who had a history of deliberate self-harm entered and completed the programme through means of self-referral. The study employed both a quantitative and qualitative methodology to evaluate the programme. Participants were interviewed and assessed both at the start and completion of Carousel. This included monitoring levels of self-harm incidents, levels of anxiety and depression using the 14-item Hospital Anxiety and Depression Scale (HADS) (Zigmond & Snaith, 1983), and coping levels using the 60-item Coping Styles Questionnaire (CSQ) (Roger, Jarvis & Najarian, 1993). Results showed a significant decrease in depression and anxiety, a reduction in self-harm levels and a change of coping styles in the desired direction. Qualitative methodology using content analysis was employed to ascertain the components of the programme which were deemed most helpful or unhelpful to the participants. Findings suggest that the most useful components within the programme are coping strategies, management of self-harm behaviours, antecedent, behaviour and consequence (ABC) sessions and the understanding of the brain and associated emotions with self-harm behaviours. Implications for counselling psychology and clinical practice are highlighted and limitations of the current study and directions for future research suggested within the report.

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O mundo vive uma epidemia de obesidade, isto significa que o número de pessoas que tem o peso excessivo aumentou e atingiu proporções preocupantes e de risco à saúde. Alterações emocionais podem estar associadas à obesidade. É importante que os tratamentos para obesidade não estejam voltados apenas para melhora da qualidade de vida relacionada à saúde física, mas também à saúde mental. Sendo assim, esta pesquisa teve como objetivo geral, verificar o estado emocional (ansiedade e depressão) dos pacientes com sobrepeso e obesidade que participaram de grupos de reeducação alimentar nas Unidades de Saúde da Família (USF) em Pindamonhangaba e como objetivos específicos, caracterizar a amostra estudada (aspectos sócio demográficos e clínicos) e verificar as relações entre o estado emocional (ansiedade de depressão) da amostra estudada e as variáveis pesquisadas. Para a coleta de dados foi utilizado um instrumento para caracterização sócio demográfica/clínica da amostra e o questionário Self Reporting Questionnaire (SRQ-20) desenvolvido para rastreamento da ansiedade e depressão (Transtorno Mental Comum - TMC). Foram sujeitos deste estudo 56 pacientes. Quanto à caracterização sócio demográfica, houve predomínio do sexo feminino (98,2%), com média de faixa etária de 51,08 anos, com companheiro (80%) e com 2º grau completo (44,6%). Com relação à ocupação, a maioria relatou ser do lar. A média da renda familiar foi de R$ 780,88. Referente ao tempo de participação nos grupos de reeducação alimentar, a maioria apresentou frequência de 1 mês a 11 meses (33,9%). Quanto à caracterização clínica, os sujeitos apresentaram médias de: peso (82,77 kg), altura (1,57m); Índice de Massa Corpórea (IMC = 33,33 Kg/m2) e Circunferência Abdominal (CA) 101,79 cm. Com relação às comorbidades, 53,6% relatou Hipertensão Arterial Sistêmica (HAS), 17,9% Diabetes Mellitus (DM), 7,1% problemas de tireoide e 14,3% outras doenças. No que se refere ao número de refeições diárias, 37,5% relatou que realiza quatro refeições/dia. Vinte e quatro (44,4%) pacientes apresentaram o hábito de beliscar e 18 (33,3%) apresentaram compulsão alimentar. Quanto ao consumo de alimentos, 94,6% dos pacientes relatou o consumo de verduras e legumes, 92,9% frutas, 51,8% doces e 51,8% refrigerantes. Quanto à atividade física, 69,6% praticavam alguma atividade, com 25% realizando-a duas vezes na semana e 42,1% relataram caminhada. Trinta e cinco (62,5%) pacientes não apresentaram TMC e 21 (37,5%) apresentaram TMC. Comparando os pacientes com e sem TMC e as variáveis, não houve diferença significativa estatisticamente nas variáveis: idade, sexo, estado civil, tempo de participação no grupo de reeducação alimentar, peso, altura, IMC, CA, classificação do IMC, HAS, DM, ato de beliscar e consumo de verduras, legumes, frutas, doces e refrigerantes. Houve diferença estatisticamente significativa nas variáveis: renda familiar (p=0,027); escolaridade (p=0,044); atividade física (p= 0,030); número de refeições realizadas diariamente p (=0,027) e compulsão alimentar (p=0,027) e a ausência de transtorno mental comum. Conclui-se que, respeitando as individualidades de cada paciente, o grupo de reeducação alimentar é um recurso importante para a melhora da qualidade de vida dos pacientes com sobrepeso e obesidade, proporcionando a possibilidade de diminuição dos TMC e práticas de promoção e prevenção à saúde. / The world is experiencing an obesity epidemic, this means that the number of people who have excessive weight increased and reached worrying proportions and health risk. Emotional changes may be associated with obesity. It is important that treatments for obesity be not only aimed to improve quality of life related to physical health but also mental health. Thus, this research aimed to check the emotional state (anxiety and depression) of patients with overweightness and obesity in nutritional education groups at the Family Health Units (USF) in Pindamonhangaba and, as specific objectives, to characterize the studied sample (socio-demographic and clinical) and to examine relationships between emotional state (depression anxiety) of the studied sample and the researched variables. To collect data, was used a tool for socio-demographic / clinical characterization of the sample and the Self Reporting Questionnaire (SRQ-20) developed for the tracking of anxiety and depression (mental health problems - TMC). Fifty-six patients participated in this study. As regards the socio-demographic, there was a female predominance (98.2%), with an average age of 51.08 years, with a partner (80%) and high-school degree (44.6%). Regarding occupation, the majority reported being housewives. The average family income was R$ 780,88. Regarding length of participation in the nutritional education group, most of them presented frequency from 1 month to 11 months (33.9%). As for the clinical characterization, the subjects showed averages of: weight (82.77 kg), height (1.57 m), Body Mass Index (BMI = 33.33 kg/m2) and waist circumference (WC) 101.79 cm. With regard to comorbidities, 53.6% reported high blood pressure (hypertension), 17.9% diabetes mellitus (DM), 7.1% thyroid problems and 14.3% other diseases. With regard to the number of meals per day, 37.5% reported having four meals per day. Twenty-four (44.4%) patients had the habit of nibbling and 18 (33.3%) had binge eating disorder. As for food consumption, 94.6% of the patients reported consumption of vegetables, 92.9% fruits, 51.8% sweets and 51.8% soft drinks. As for physical activity, 69.6% practiced some activity, with 25% doing it twice a week and 42.1% reported to walk. Thirty-five (62.5%) patients did not have TMC and 21 (37.5%) had TMC. Comparing patients with and without TMC and the variables, there was no statistically significant difference in the variables: age, sex, marital status, length of participation in group nutritional education, weight, height, BMI, WC, BMI classification, hypertension, DM, act of nibbling and consumption of vegetables, fruit, sweets and soft drinks. There was a statistically significant difference in the variables: family income (p = 0.027), education (p = 0.044), physical activity (p = 0.030), number of meals per day (p = 0.027) and binge eating (p = 0.027) and absence of common mental disorder. We conclude that, while respecting the individuality of each patient, the nutritional education group is an important resource for improving the quality of life of overweight and obese patients, providing the possibility of reducing the TMC and practicing health promotion and prevention.

Les pathologies dépressives se définissent par des symptômes hétérogènes qui incluent les troubles du sommeil comme facteur de comorbidité. La comorbidité des troubles du sommeil dans la dépression est habituellement marquée d’une diminution de sommeil lent, d’une augmentation de sommeil paradoxal et d’une fragmentation du sommeil, tant chez l’Homme qu’au sein des modèles animaux de la pathologie.Le premier objectif de ce travail expérimental a été de caractériser les troubles du sommeil suspectés dans un modèle animal de souris adultes rendues anxio/dépressives par l’administration chronique de corticostérone. Les résultats obtenus ont montré qu’une administration chronique de corticostérone induit une hypersomnie avec augmentation de sommeil lent, une diminution du sommeil paradoxal et une fragmentation des états de veille et de sommeil. La description du sommeil du modèle de souris CORT enrichit la classification actuelle en modélisant des troubles du sommeil atypiques présents chez près de 20% des sujets dépressifs. Le second objectif a été de corriger ces troubles du sommeil par l’administration chronique d’antidépresseurs classique (fluoxétine) et innovant (agomélatine). Si chacune des molécules antidépressives testées a révélé un effet bénéfique vis-à-vis de la somnolence des souris CORT, l’agomélatine a montré sa supériorité pour prévenir l’inhibition du sommeil paradoxal induite par la corticostérone et accentuée par la fluoxétine. / Depressive disorders are definded by heterogeneous symptoms that include sleep disorders such as comorbid condition. Comorbidity of sleep disorders in depression is usually marked by a decrease in NREM sleep, increased REM sleep and sleep fragmentation, both in humans and within animal models of the disease. The first aim of this experimental work was to characterize sleep problems suspected in an animal model of adult mice rendered anxio/depressive by chronic administration of corticosterone. The results showed that chronic administration of corticosterone induced hypersomnia with increased NREM sleep, decreased REM sleep and led to fragmented sleep/wake states. The description of the sleep cycle of the CORT mouse model of anxiety/depression enriches the current classification by modeling atypical sleep disorders present in nearly 20% of the depressed subjects. The second aim was to correct these sleep disorders by chronic administration of classical (fluoxetine) and innovative (agomelatine) antidepressants. If each antidepressant molecules tested showed a beneficial effect towards drowsiness of CORT-treated mice, agomelatine has shown its superiority to prevent the inhibition of REM sleep induced by chronic corticosterone which was enhanced by chronic fluoxetine treatment.

A computer interview has been found to be valuable in eliciting information. This thesis describes the use of a CIS in two different clinical settings (GP surgery and chiropractic clinic), with the aims of aiding recognition of patients with anxiety or depression and enhancing communication between patient and clinician. The Hospital Anxiety and Depression Scale (HADS) was included in the computer interview. 60 patients used the CIS in both settings, 6 GPs and 3 chiropractors were involved in the study. A high level of acceptance of the CIS was found in patients and clinicians in both settings. 99% of patients rated the system as “easy” or “extremely easy to use”. In the GP surgery, 80% of patients felt that they were “possibly” (68.33%) or “definitely” (11.67%) more focussed for the consultation. In the chiropractic clinic, 41.7% of patients said they disclosed new information and 33.3% felt better prepared for the consultation. The CIS aided the recognition of some individuals with anxiety or depression, more so within the chiropractic clinic than in the GP surgery. The information in the interview transcript was considered more useful by the chiropractors than the GPs (85% v 21.67%); this could be partially attributable to the fact that the chiropractors added 15 reassessment questions to the question set, whilst the GPs only added 4, more general, questions. The CIS also helped to highlight communication issues and show trends within the patient populations. Although the CIS was found to be of benefit in both settings, the GPs felt that it was more appropriate for use with specific patient groups. In the chiropractic clinic, the CIS was an effective addition to the periodic patient reassessment process. It would be possible to deliver other, individualised screening interviews using the CIS, delivery of which could be enhanced using handheld devices.

Background: In 1992, the ICD-10 introduced the concept of mixed anxiety–depression disorder (MAD). However, a study examining the stability of this ICD-10-diagnosis is lacking. Our objective was to examine the 12 month outcome of MAD in comparison to the outcome of depression, anxiety, and comorbid depression and anxiety. Methods: 85 MAD patients, 496 patients with major depression, 296 patients with anxiety disorders, and 306 comorbid patients were reassessed after 12 months. Rates of depression, anxiety, and MAD were compared using χ2-tests. Results: While depressive disorders and anxiety disorders showed relatively high stability, MAD Patients had no higher rates of MAD at follow-up than patients with depression, anxiety or both. Limitations: Detailed information regarding treatment and disorders during the follow-up interval was lacking. Prevalence rates of MAD in single centres were too small for contrasting centres. Conclusions: MAD cannot be seen as a stable diagnosis: Most of MAD patients remit; many of them shift to other diagnoses than depression or anxiety. The ICD-10 criteria have to be specified more exactly.

The aim of this thesis was to examine the validity of the main concepts of metacognitive theory in a Turkish sample and set the stage for metacognitive research in Turkey from the clinical psychology perspective. In addition to this, research attention was focused on two important topics remained to be empirically validated in the metacognition literature: (1) the unique contributions of &ldquo / cognitive content&rdquo / versus &ldquo / metacognition&rdquo / to the prediction of anxiety and depression symptoms, and (2) the vulnerability function of metacognitions in the development of anxiety and depression symptoms. To achieve these generic aims of the study, a two-step research plan each of which has its own specific objectives was followed. Data for cross-sectional and prospective parts of the study were collected from Turkish and British non-clinical samples. In the cross-sectional part, mainly the independent contribution of metacognitions to pathological worry, obsessive-compulsive symptomatology, and anxiety and depressive symptoms above and beyond the contribution of cognitive content was evaluated. By doing so, also the relationship patterns between metacognitions and psychological symptomatology were revealed in the Turkish sample. Consistent with the recent burgeoning of research, the association between increased levels of metacognitions and increased levels of anxiety and depression was shown in the Turkish sample, as well. Moreover, metacognitive factors were found to be associated with the symptoms of anxiety and depression independently of the relevant cognitive content. In most analyses, metacognitions emerged as slightly stronger predictors of a given symptom dimension compared to the relevant cognitive content. In the prospective part, the causal role of metacognitions following stress in the development of anxiety and depression symptoms was examined. In the Turkish sample, higher levels of negative beliefs about worry predicted augmentation in anxiety and depression symptoms from Time 1 to Time 2. Besides, higher levels of lack of cognitive confidence interacted with higher levels of daily hassles to predict intensification of the anxiety scores. However, the British data did not support the causal role of metacognitions in the development of anxiety and depression symptoms. The statistical comparisons between Turkish and British samples indicated that the Turkish sample has a tendency to score significantly higher than the British sample on the metacognitive variables. Moreover, for all but one metacognitive factor, the interactions with cultural group (Turkish vs. British) were not significant in predicting psychopathology, indicating generalization of metacognitive theory to both the Turkish and British samples. Findings of this study were well in line with the metacognitive theory and discussed in the light of the relevant literature.

Looming Maladaptive Style (LMS) was proposed to be an anxiety specific cognitive vulnerability factor. Perfectionism also acts as a vulnerability to both anxiety disorders and depression. Parenting is another factor associated with both anxiety and depression, with a majority of studies focusing on care and overprotection dimensions of parenting. These parenting dimensions have been reported to be associated with vulnerabilities to psychological disorders. The present study, aims to investigate the parental characteristics associated with LMS and perfectionism as well as testing the mediator roles of these constructs in the relationship of parental bonding to social anxiety and depression. To fulfill this aim, data was gathered from 389 university students all of whom were administered a questionnaire package composed of Looming Maladaptive Style Questionnaire- Revised (LMSQ-R), Parental Bonding Inventory (PBI), Liebowitz Social Anxiety Scale (LSAS), Brief Fear of Negative Evaluation (BFNE) and Beck Depression Inventory (BDI). In order to obtain psychometric characteristics of LMSQ-R, the scale was administered to a group of 176 university students prior to the main study. Results revealed that both social looming and maladaptive perfectionism were associated with dimensions of parenting. Although perfectionism was associated with both social anxiety and depression, LMS was much more closely associated with social anxiety. Maladaptive perfectionism had a significant mediator role between all dimensions of PBI and depression. Perfectionism also mediated the relationship between maternal care and social anxiety. LMS was not found to have any mediator role. These results were discussed under the light of relevant literature.