Variationen im Gen der Tryptophanhydroxylase 2 (TPH2), das den geschwindigkeitsbestimmenden Schritt der Serotoninsynthese katalysiert, wurden mit psychiatrischen Erkrankungen, die durch emotionale Dysregulation charakterisiert sind, in Verbindung gebracht. Die vorliegende Arbeit evaluierte die Rolle von TPH2 Varianten und Haplotypen bei Persönlichkeitsstörungen der Cluster B und C. Dazu wurden 420 Patienten mit Cluster B oder Cluster C Persönlichkeitsstörung (nach DSM-IV-TR) sowie 336 gesunde Probanden als Kontrollgruppe bezüglich TPH2 SNPs (rs4570625, rs11178997, rs4341581, rs4565946) genotypisiert. Die Persönlichkeitsstörungen wurden mit Hilfe des „Strukturierten Klinischen Interviews für DSM-IV-TR, Achse II“ (SKID-II) diagnostiziert und in die Cluster A, B und C eingeteilt. Die vorliegenden Resultate verknüpfen potentiell funktionelle TPH2 Varianten – insbesondere den rs4570625 SNP – mit Cluster B und Cluster C Persönlichkeitsstörungen. Für beide Patientengruppen zeigte sich eine signifikante globale Assoziation. Das T-Allel von rs4570625 war sowohl mit Cluster B als auch Cluster C Persönlichkeitsstörungen signifikant assoziiert. Diese Ergebnisse bestätigen TPH2 als ein Suszeptibilitäts- und/oder Modifier-Gen von affektiven Spektrumsstörungen. Die Relevanz für die Ätiologie von adulten ADHS und dramatisch-emotionalen Cluster B beziehungsweise ängstlich-furchtsamen Cluster C Persönlichkeitsstörungen muss durch weitere Studien untersucht werden. / Variation in the tryptophan hydroxylase-2 gene (TPH2) coding for the rate-limiting enzyme of serotonin (5-HT) synthesis in the brain has been linked to a spectrum of clinical populations characterized by emotional dysregulation. Here, a set of common single nucleotide polymorphisms (SNPs) in and downstream of the transcriptional control region of TPH2 (rs4570625, rs11178997, rs4341581, rs4565946) was testet for association in two cohorts comprising of 336 healthy individuals and 420 patients with personality disorders. Personality disorders were diagnosed with the Structured Clinical Interview of DSM-IV and were allocated to clusters A, B, and C. Individual SNP and haplotype analyses revealed significant differences in genotype frequencies between controls and cluster B as well as cluster C patients, respectively. In both patient groups, overrepresentation of T allele carriers of a functional polymorphism in the upstream regulatory region of TPH2 (SNP G-703T, rs4570625) was observed. The results link potentially functional TPH2 variants to cluster B and cluster C personality disorders. These findings confirm TPH2 as a susceptibility and/or modifier gene of affective spectrum disorders. The relevance for the etiology of adult ADHD as well as Cluster B and Cluster C personality disorders needs further study.

No description available.

This study examines the stressful responses of faculty/staff and students after experiencing the April 16, 2007 school shootings at Virginia Tech. Understanding people's responses to trauma not only assists in more knowledge about what is stressful after a traumatic event but also may facilitate the finessing of tools and strategies for resilience and recovery in the aftermath of trauma. After investigating stressful responses to the April 16, 2007 shootings at Virginia Tech, and in particular those with probable PTSD (posttraumatic stress disorder), I found it was not always necessary to meet the "stressor" A criterion of PTSD. This is crucial because the "stressor" criterion A of PTSD is required to receive the diagnosis of PTSD. Although I found subtle stress differences for women compared to men, and faculty/staff compared to students, none of the differences were statistically significant. This research additionally contributes to the literature by detailing a profile of stressors for both faculty/staff and students in the aftermath of the worst college campus shooting in U.S. history to date. Findings suggest future research should examine the "stressor" criterion A of PTSD as well as the full spectrum of stressful responses both in the "immediate" and "delayed" aftermath of trauma(s). / Ph. D. / This study looks at responses of stress for faculty/staff and students after being exposed to the April 16, 2007 school shootings at Virginia Tech. Understanding responses to trauma not only provides more knowledge about what is stressful after a traumatic event, it may help us to learn and better fine-tune ways for recovery in the aftermath of trauma. After investigating these stressful responses to the April 16, 2007 shootings at Virginia Tech, and in particular those likely to go on to develop PTSD (posttraumatic stress disorder), I found that it was not always necessary to meet the “stressor” criterion A of PTSD. This is important because the “stressor” criterion A of PTSD is required to receive the PTSD diagnosis. Although I found some interesting differences in stressors for women compared to men, and faculty/staff compared to students, none of the differences were significant statistically. This work also contributes to research by detailing a profile of stressors for both faculty/staff and students in the aftermath of the worst college campus shooting in U.S. history to date. Findings suggest the need to continue to examine criterion A of PTSD as well as the full range of stressful responses both during, and in the aftermath of, trauma(s).

Psykisk hälsa/ohälsa är ett svårdefinierat begrepp som sätter fingret på ett av de största folkhälsoproblemen i vårt land, där depression är en av de vanligaste diagnoserna. Manualerna DSM-IV TR och ICD-10 används inom stora delar av sjukvården, världen över, i syfte att ge kunskap om lämpligast behandling till patienter med psykiska besvär. Denna studie syftar till att, genom en kvalitativ analys, undersöka vilka grunder som finns bakom de vanligast använda diagnosmanualerna och vilka kriterier som krävs för att uppfylla två vanligt förekommande diagnoser, PTSD och svår depression. Vidare syftar studier till att belysa eventuella likheter och olikheter mellan dessa diagnoser och vad det kan föra med sig. Såväl psykologisk forskning som klinisk praktik utgår idag mestadels från psykiatriska diagnoser, vilket kan ha såväl fördelar som nackdelar, men samtidigt diskuteras huruvida man istället ska lägga fokus på en annan mer underliggande nivå, nämligen processerna som sträcker sig över diagnosernas gränser. Fördelarna med ett transdiagnostiskt perspektiv är att det delvis kan ge en förklaring till den höga komorbiditet som finns i kliniska grupper och som skulle kunna iakttas även i de sjukdomsbilder som denna studie fokuserar på. Unified Protocol är en annan behandlingsmodell som tas upp i studien, vilken baseras på en betydande fenotypisk över-lappning mellan olika ångeststörningar hos patienter, där personer med subkliniska nivåer av symtom ändå kan ha en nedsatt funktionsnivå och ett subjektivt lidande, fastän de inte uppfyller alla de diagnostiska kriterierna för en specifik störning. Resultatet visar på möjligheten att se över diagnosgränser, för att öka chanserna för ett tillfrisknande hos patienten. Människans upplevelser av olika situationer den befinner sig i formas av personens egen uppfattning om sin förmåga, eller oförmåga, att påverka resultatet. Att uppleva sig ha mist kontroll över sitt eget liv kan i sig leda till såväl depression som suicidala tankar/-handlingar. Om symtomen för depression jämförs med kriterierna som står att finna under diagnosbilden “Posttraumatiskt stressyndrom” under kapitlet “ångestsyndrom”, kan många likheter konstateras. Slutsatsen blir att likheterna i symtombild skulle ge patienter med PTSD en behandlingsrekommendation som inte alls överensstämmer med de rekommenderade riktlinjer som är utformade för PTSD. Trots diagnosernas likheter rekommenderas olikartad behandling, och även olika förutsättningar för att fungera i kombination med förvärvsarbete påvisas. Vid så lika symtombilder, men ändå så skilda rekommenderade behandlingsplaner utifrån de olika diagnoserna, torde risken för en felaktig rehabiliteringsplan vara över-hängande. / Mental health/illness is complex to define and this highlight of the biggest public health problems in our country, in which depression is one of the most common diagnoses. The manuals DSM-IV TR and ICD-10 is used in much of health care, worldwide, in order to provide knowledge of appropriate treatment for patients with mental disorders. This study aims to, through a qualitative analysis, examine the grounds behind the most commonly used diagnostic manuals and the criteria required to meet two common diagnoses, PTSD and severe depression. Further studies aimed to highlight any similarities and differences between these diagnoses and what it can bring. Both psychological research and clinical practice today is based mostly from psychiatric diagnoses, which can have both advantages and disadvantages, but also discussed whether they should instead focus on another more underlying level, namely the processes that extend across the diagnostic boundaries. The advantages of a trans-diagnostic perspective are that it may partly explain the high co-morbidity found in clinical groups and that could be observed even in those syndromes which this study focuses on. Unified Protocol is a different treatment model that is entered in the study, which is based on a significant phenotypic overlap between anxiety disorders in patients, where individuals with subclinical levels of symptoms still can have a reduced level of functionality and a subjective suffering, although they do not meet all the diagnostic criteria for a specific disorder. The result shows at the opportunity to review the diagnostic boundaries, to increase the chances for a recovery of the patient. The human experiences of different situations it is in the form of personal self-perception of their ability, or inability, to influence the outcome. To experience they have lost control over his own life in itself can lead to both depression that suicidal thoughts / actions. If the symptoms of depression compared with criteria that are to be found during diagnostic image "Post-traumatic stress disorder" in the chapter "disorder" can be found many similarities. The discourse comes to that the similarities in symptoms would provide patients with PTSD, a treatment recommendation, which did not conform to the recommended guidelines that are designed for PTSD. Despite the diagnosis, the similarities are recommended disparate treatment, and also different conditions to work in conjunction with work shown. At this same symptom pictures, yet so different recommended treatment plans based on the different diagnoses, would risk a false rehabilitation plan to be imminent

DSM-IV-TR classifies hypochondriasis as a complex somatoform disorder, characterised by physical complaints for which no organic cause could be identified. DSM-5 replaced it with two new diagnostic terms: somatic symptoms disorder and illness anxiety disorder. The distinction was based on the presence or absence of somatic symptoms, and concerns have been raised with regards to the validity of these new diagnostic concepts. While there has recently been an increase in recognising the role of the underlying anxiety in this condition, the psychological needs of individuals with hypochondriasis remain unclear. It is conceivable that specific emotional and interpersonal dimensions play a mediating role in the onset of hypochondriacal presentations, and have explanatory power with regards to the improvement of tailored therapeutic interventions. The present study used a mixed methodology, with an emphasis on the qualitative component, to investigate emotions and the interpersonal aspects of hypochondriasis. Six young adult females meeting the diagnostic criteria for both DSM-IV-TR hypochondriasis and DSM-5 illness anxiety disorder formed a clinical group for the present study. Semi-structured interviews were administered and analysed in line with the Interpretative Phenomenological Analysis (IPA). Four major themes emerged from the qualitative data: 1) Early life experience; 2) Inward focus; 3) Learned helplessness; and 4) Experience of psychological therapy. Eight subordinate themes were identified: (i) Unmet emotional needs; (ii) Emotional isolation; (iii) There is something wrong with me; (iv) Emotional reasoning; (v) Self-fulfilling prophecy; (vi) External locus of control; (vii) Over-reliance on other people; and (viii) The experience of psychological therapy. Fifty-one female undergraduate psychology students formed a matched comparison group for the study and enabled a supplementary quantitative analysis to be conducted. The quantitative measures included measures of trait (TEIQue-SF) and ability emotional intelligence (MSCEIT) as well as a measure of sociotropy-autonomy (SAS). The quantitative data showed that the clinical group scored significantly lower than the comparison group on the measures of trait emotional intelligence, understanding emotions, and autonomy. Additionally, the clinical group scored significantly higher than the comparison group on the measure of sociotropy. The theoretical and therapeutic recommendations are discussed in light of the limitations of the present study. In conclusion, emotional and interpersonal aspects of DSM-IV-TR Hypochondriasis and DSM-5 illness anxiety disorder in young women provide a useful framework for the conceptualisation and therapeutic management of these conditions. It appears that with its scientific knowledge base, therapeutic flexibility, focus on reflective practice, and the emphasis on an effective working relationship, the discipline of counselling psychology is well-suited to address the needs of participants with hypochondriacal presentations.

This book is an attempt to formulate a sociological theory of the phenomena which is otherwise known as substance abuse and substance dependency in the medical field. The first step toward such a theory is a critique of how DSM-IV presents diagnostic criteria for substance abuse and substance dependency as if these criteria are valid and reliable ways of measuring mental illness and bodily dysfunction. I point to the fact that these criteria neither are valid or reliable variables for measurement nor theoretically grounded defi nitions of the phenomena. My point is that diagnosis is an elaborate way of disguising moral judgments as medical assessments of illness or dysfunction. The second step towards the formulation of my theory goes via my empirical study of nine men and women who call themselves sex and love addicts. By conducting deep interviews with them I conclude that it is impossible to talk about sex and love addiction without constantly referring to stereotypes and widely held assumptions of alcoholics and drug addicts. Moreover it is apparent that these men and women are making moral judgments about themselves rather than pointing to some form of genuine disruption which they cannot control. From my critique and my empirical study I am able to identify a number of areas that a theory of addiction, as opposed to the medical view where this phenomena are being broken down in two sub categories (abuse and dependency), must be able to handle to explain addiction generally and specifically in relation to alcohol, drugs, sex and other forms of social deviance. A number of philosophical hallmarks of medicine is also identifi ed and seen as part of the problem, therefore I mean that a successful theory of addiction must transcend the mind body dualism of Descartes as it is a cornerstone in the medical view upon and understanding of humans. By reconstructing the habitus and field concepts in Pierre Bourdieus theory of practice I mean that it is possible to understand addiction from an action theory point of view. This discussion is also broadened by a pragmatist discussion of the mind and a neo meadian theory of the emotional self. My conclusion is that addiction can be understood and explained within an action theory which focus upon individual as well as collective action and understand this as habitual practice that is partly embodied and therefore not discursive – habits of which we cannot easily speak is seen as one of the compelling components in addiction rather than a mythical loss of control which is nowhere to be found but as a rhetoric grip stemming from the AA view upon addiction as a disease.

No description available.

“The relationship between the criminal and victim is much more complicated than the law would care to acknowledge. The criminal and his victim work on each other unconsciously. We can say that as the criminal shapes the victim, the victim also shapes the criminal. The law differentiates distinctly between the attacker and the victim. But their relationship may be, and often is, quite close, so that their roles are reversed and the victim becomes the determining person, while the [victimiser] in the end becomes his own victim.” (Abrahamsen, 1973:35). This research was directed at establishing whether narcissistic individuals will go to extreme levels of violence, specifically murder, if their self-image is threatened. The aim was to determine the extent of pre-existing narcissistic personality disorder (NPD) in these individuals and how this contributed to the murderous action they committed. Emphasis was placed on the psychological motivation of the perpetrator, as well as the relationship that existed between the perpetrator and the victim prior to the event. As the subject of the research was a relatively unknown phenomenon, a qualitative research approach was used. The research focused on analysing specific cases of murder, more particularly cases where rage-type murders were committed. It endeavoured to identify the underlying personality dynamics to determine whether an association between rage-type murder and NPD exists. Case studies illustrating rage-type murderers who had been admitted to Weskoppies Psychiatric Hospital for a 30-day observation period were identified and analysed. These cases were selected through reviewing the case history of each individual to determine whether the murder fitted the outlined definition of a rage-type murder. The cases that met the outlined requirements were deemed suitable for the purpose of the research, where after the Minnesota Multiphasic Personality Inventory (MMPI-2) results of the selected cases were examined to determine the personality organisation of the individuals. This information was then used to determine the possible association between NPD and rage-type murder. The MMPI-2 was selected as the assessment tool as it is the most widely used personality assessment available. For the purposes of this research a two-point code type was used to indicate the presence of narcissistic personality traits. A two-point code type implies an elevation of two scales, for the purposes of this research specifically the Pd (Psychopathic deviance) scale and the Pa (Paranoia) scale, also referred to as the 4-6/6-4 code type. As interpretation based only on a two-scale elevation was considered to be overly simplistic, all the MMPI-2 clinical scales were interpreted independently, and a clinical interpretation provided in the context of each individual’s background. The 4-6/6-4 code type individual was used to indicate whether the individuals did have narcissistic personality traits, and thus were classified as having NPD. Nine cases were identified of individuals thought to be rage-type murderers, who were admitted for a 30-day period of psychiatric observation to Weskoppies Psychiatric Hospital in Pretoria. Only five cases were acknowledged as rage-type murders. All the cases selected were referred to Weskoppies Psychiatric Hospital by order of the court and involved males over the age of 20 years. The individuals involved were admitted to the Forensic Unit of the hospital and were subjected to standard psychiatric hospital observations, which included psychiatric interviews, psychological interviews, psychological testing, as well as general behavioural observations in the ward. All the information obtained during the standard psychiatric hospital observations is held in the clinical case files in the archives at the hospital. All the standard psychiatric hospital observation evaluations were completed prior to the initiation of the research, and the case records had been closed. Although more research is necessary, this research has established an association between the selected cases of rage-type murder and NPD and there is historic documented evidence suggesting that individuals with NPD will most likely react in a similar manner in similar circumstances, as a result of their underlying personality disorder. This suggests that incarceration in a correctional facility is not the most appropriate place to rehabilitate individuals. It also serves as support to why a person with NPD who commits a rage-type murder should be acquitted because of their personality disorder and subsequently be committed to a psychiatric facility as a patient of the state president. / Dissertation (MA)--University of Pretoria, 2010. / Social Work and Criminology / unrestricted