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The purpose of this study is to get a deeper understanding of staff who are exposed to threat and violence in the work with people with mental disabilities. Focus is aimed at the staff´s experience of that in their daily work can be exposed to threat and violence. The first question for the study is what definition the staff gives to threat and violence in the daily work with people with mental disabilities and the second one is what determines the decision in making/or not making a report in threat and violence in the daily work with people with mental disorders. To collect empirical data the study is based on seven individual semistructured interviews with staff working with people with mental disabilities. The theory used to analyse is the normalisationprocess. The analyse is based on the interview-participants views on how they define threat and violence, their view on the client and themselves and also reporting threat and violence. The result is that the staff is affected by different aspects and a conflict is made between context and individual. This conflict contributes to the decision in reporting and definition of threat and violence.

Sexual assault is a wide public health problem given the number of people who are sexually assaulted. Sexual assault affects the psychological well being of people who experience it.The most common reported psychological problems are PTSD and depressive symptoms especially after four to six weeks post sexual assault.These Co morbid disorders affect the normal functioning of an individual such home chores, work and increase mortality rate among sexual assaulted survivors. It was also documented that coping strategies (maladaptive or adaptive) employed by sexual assaulted survivors are the one that determine their recovery.Hence, there was a need to investigate the correlation between coping strategies, the level of PTSD and the level of depression in Ngaka Modiri Molema in the North West Province of South Africa. The study aimed to investigate correlation between coping strategies and the levels of PTSD and depression among sexual assaulted survivors. Correlational cross-sectional design was used in this study.Sample size of 115 of sexually assaulted participants between the age of 18 and 50 was determined through the use of Raosoft calculator. PCL for PTSD, BDI and brief COPE instruments were used to collect data. Information about socio demographic was also obtained.Data analysis was done through frequency distribution to describe the demographic data, levels of PTSD and depression.Data were also analysed through Pearson correlations to determine the possible relationship between coping, PTSD and depressive symptoms. ANOVA, chi-square, cross tabulation were also done to determine the possible relationship between demographic data, level of PTSD and depression. Results showed high level of PTSD and low level of depression among sexual assaulted survivors.They have also showed that there is no relationship between coping strategies and PTSD, and that there was a relationship between coping and depressive symptoms.These findings indicate that coping strategies cannot be regarded as one the factors that can control the non-development and development of PTSD, but could be regarded as one the factors that can account to development and non development of depression. / Thesis (M Cur) North-West University, Mafikeng Campus, 2013

Oppositional defiant disorder (ODD) is often present already at preschool age. Previous research has established the association between temperament and broad categories of behavioral disorders. However, no longitudinal research has studied the potential impact of temperament on changes in ODD symptoms in preschool and early school years. Two birth cohorts of 4-year olds living in the city of Trondheim, Norway, were screened for emotional and behavioral problems and a subsample oversampled for such problems was drawn to take part in the study; 82.1% consented. Parents of 1000 children were interviewed with the Preschool Age Psychiatric Assessment, and ratings of children's temperament were provided using the Child Behavior Questionnaire (CBQ). Children were reassessed after 2 years (N = 797). The temperamental dimensions Surgency (SU) and Negative Affectivity (NA) were positively correlated with initial level of ODD symptoms, and predicted an increase in symptoms from age 4 to 6. High Effortful Control (EC) was associated with little ODD symptoms at age 4, but did not predict change in such symptoms. However, in interaction with NA, EC was associated with lower initial levels of ODD symptoms and predicted a decrease in symptoms from age 4 to 6. More precisely, the protective effect of EC was very strong for children high on NA but lower for children low to moderate on NA. The findings suggest that NA and SU function as risk factors whereas EC protects against ODD in young children. NA serves as a moderator of EC, in that among children high in NA, EC had a large protective effect, whereas among children with lower levels of NA, EC did protect to a lesser degree against ODD symptoms. Results of this study have theoretical implications linking temperament to ODD in preschoolers, and clinical applications utilizing temperament assessment to identify children at risk, prevent development of ODD and match treatment modalities to the child’s specific temperamental strengths and weaknesses.

Thesis (PhD (Psychiatry))--University of Stellenbsoch, 2005. / Background: Obsessive-compulsive disorder (OCD) is a neuropsychiatric condition characterized by significant heterogeneity. It has been suggested that classification of OCD into more homogeneous subtypes, and identification of their associations with etiological factors (e.g. genetic variants, or psychological trauma), and outcome (e.g. disability and treatment response), may be useful. The identified subtypes are not definitive yet and continue to be subject to revision. The overall objective of this dissertation was to assess comprehensively a sample of OCD patients, and to use cluster analytic methods to delineate valid OCD subtypes. Methods: Patients meeting DSM-IV criteria for a primary diagnosis of OCD (N=261) on the Structured Clinical Interview for Axis I Disorders - Patient Version (SCID-I/P), with ages ranging from 16 to 71, took part in the study. The newly developed Structured Clinical Interview for the Diagnosis of putative Obsessive-Compulsive Spectrum Disorders (SCIDOCSD) was administered to assess OCD-related conditions not covered by the SCID-I/P. OCD subtyping, based on OCD symptomatology (assessed with the Yale-Brown Obsessive- Compulsive Symptom Checklist [YBOCS-CL]), and based on comorbidity with the OCD spectrum of disorders (assessed with the SCID-OCSD), proceeded along the following lines: Firstly, latent class cluster analysis (LCA), a categorical analogue to traditional factor analysis (FA), and with many advantages compared to FA, was implemented with the (nine) most frequently endorsed OC symptoms. Secondly, in an attempt to remedy some of the limitations of the LCA (e.g. increased potential for computational instability when additional indicators / symptoms were included), cluster analyses (Ward’s method) were performed on all of the items of the YBOCS-CL and SCID-OCSD, respectively, for all OCD patients. The associations of cluster scores with demographic variables (age, gender), clinical variables (age of onset, obsessive-compulsive symptom severity and dimensions, level of insight, temperament, childhood trauma, treatment response) and genotypes were then examined, using Spearman correlation coefficients, one-way analysis of variance (ANOVA), and Mann- Whitney U-tests, where appropriate. Results: The findings suggested that increased presentation of symptoms characteristic of each of the clusters of cases was associated with specific demographic and clinical characteristics, which substantiated the presence of distinct clinical subtypes of OCD. Cluster analysis of the 45 selected items of the YBOCS-CL in this sample of OCD patients identified 6 separate clusters; these clusters were labelled “Contamination fears / washing”, “Hoarding / collecting”, “Symmetry / ordering / counting / arranging / repeating”, “Sexual”, “Somatic, religious and diverse” and “Harm-related”. Increased presentation of symptoms characteristic of each of the clusters was associated with specific demographic, clinical and, in some cases, genetic characteristics. Of note, the findings indicated the L/L (met/met) genotype of COMT Val158Met polymorphism plays a major role in the increased manifestation of sexual, somatic, religious and diverse, and harm-related symptoms of OCD, as such contributing to the relatively limited data on OC symptom subtypes and genetics. However, the fact that the associated features did not clearly and uniquely differentiate clusters and that clusters were significantly correlated with one another suggested that the delineation of the OCD complex into OC symptom clusters is not the only way to approach the heterogeneity characteristic of OCD. Nevertheless, the significant comorbidity with OCSD’s in the identified clusters (e.g. tics associated with sexual obsessions / compulsions) highlighted the significant relationship of OCD with the OCSD’s. This again raised the question about the way in which the OCSD’s “fit” with the standard OC symptomatology outlined in the YBOCS-CL. A cluster analysis of OCSD’s in OCD patients identified a Tourette’s syndrome / tics subtype of OCD (part of the so-called “reward deficiency” cluster), as well as an impulsivity subtype, and a somatic subtype – each associated with specific clinical and demographic variables. Here, a significant relationship between the identified clusters and the investigated dopaminergic and serotonergic polymorphisms was not found, suggesting that variants in other genes in these systems should also be explored. Conclusion: The main finding was that OCD is indeed a heterogeneous disorder that may be subtyped into different symptom dimensions. The identified OCD subtypes with their associated features were to a large extent consistent with previously published data. However, in contrast to factor analysis, LCA provided a novel, appropriate and advantageous statistical analysis strategy for the data. Furthermore, to our knowledge, the attempt to classifiy OCD according to comorbid OCSD’s was the first cluster analysis based on a prospective comprehensive interview investigating a range of OCSD’s. As such, although the dimensional structure of OCD is still not entirely understood, the categorization of our OCD patients into different groups and the investigation of their respective features have gone beyond the literature and thus add another dimension to the increasing efforts to fully delineate OCD subtypes.

Background: Post Traumatic Stress Disorder (PTSD) is frequently linked with substance use disorder (SUD). However, the nature of this association remains unclear. A clearer understanding of the dynamic associations between PTSD and SUD may shed light on the course of these two disorders thereby, identifying areas for intervention, which may potentially reduce some of the associated costly and harmful outcomes. Methods: Firstly, a systematic review was conducted to investigate the evidence base regarding the relationship between PTSD and SUD. Secondly, an empirical project was undertaken to explore functional associations between PTSD and SUD. This was achieved by comparing, motives for substance use, anxiety and depression symptoms, and SUD symptom severity amongst treatmentseeking adults with and without PTSD. Results: Results from the systematic review suggest that individuals with comorbid PTSD and SUD have more severe clinical profiles compared to individuals with a SUD alone. The results from the empirical study indicate that those with PTSD endorse coping-related motives for substance use significantly more than those without PTSD. Furthermore, those with PTSD had significantly elevated SUD severity ratings and higher anxiety and depression scores. Conclusions: Findings suggest that individuals with comorbid PTSD and SUD are motivated to use substances to cope with negative affect. The clinical implications of this are discussed.

Ways to reduce the impact of worry in generalized anxiety disorder (GAD) have received little experimental research attention. Previous research has found that those with GAD are vulnerable to negative emotionality immediately following periods of worry; emotion regulation strategies could be useful to mitigate reactivity following worry. One promising strategy is mindfulness, defined as sustained attention toward the present moment with an attitude of curiosity and acceptance. Experimental research has found that mindfulness reduces negative affect and improves emotion regulation. This strategy is likely more effective than thought suppression, a common strategy used in GAD. This online study recruited 300 individuals with analogue GAD who completed several self-report measures of worry severity, emotion dysregulation, mindfulness, and experiential avoidance and underwent experimental inductions of worry (versus no-worry control) and regulation strategy (mindfulness versus thought suppression versus no-strategy control) before watching a sad film clip and reporting state affect and emotion dysregulation. Contrary to hypotheses, the mindfulness manipulation did not have a buffering effect on the relation between worry and negative affect or emotion dysregulation. The only predicted significant finding indicated that the mindfulness manipulation had a main effect on negative affect, with visual trends indicating that this effect was driven by those who did not worry. An exploratory analysis indicated that a mindfulness manipulation increased positive affect following worry, however. Clinical implications and future directions are discussed.

Bipolar affective disorder and schizophrenia are highly heritable psychiatric illnesses and the leading causes of worldwide disability. The orbitofrontal cortex (OFC) is a region of the frontal lobe with wide spread connectivity with other brain areas involved in reward, motivation and emotion. Evidence from various neuroimaging, genetic, post-mortem and brain lesion studies suggest that orbitofrontal cortex may play a role in pathophysiology of mental illnesses. This thesis sought to investigate the pathogenesis of major psychiatric illnesses through the investigation of orbitofrontal morphology in schizophrenia and bipolar disorder and through its associations with brain structure and function. Orbitofrontal morphology and its structural and functional associations were examined in healthy controls, patients with schizophrenia or bipolar affective disorder, and those at high genetic risk using functional and structural MRI. In the first study we found that the orbitofrontal type III is more frequent and the orbitofrontal type I is less common in the right hemisphere in patients with schizophrenia while in patients with bipolar disorder type III appears more often in both left and right hemispheres. We then sought to examine the relationship of orbitofrontal morphology to disease risk in a study of 146 people at high risk of developing schizophrenia and 110 people at high risk of developing bipolar disorder. We discovered that in the unaffected high risk groups the orbitofrontal type III predicted the development of later psychiatric illnesses, when combined with anterior cingulate morphology. Finally we showed, in a further study, that OFC morphology was associated with measures of schizotypy, brain structure, brain function and cognition. In conclusion, orbitofrontal morphology is linked to major psychiatric disorder and has significant structural and functional associations. As orbitofrontal sulcogyral patterns are formed in early life a fuller awareness of their relevance to brain function holds out the prospect that we could use such measures as an indicator of vulnerability to the development of illness later in life. This work points to the potential for the foundation of a theory of predictive associations between morphological patterns and the development of psychosis.