Thesis (M Med(Psychiatry))--University of Limpopo (Medunsa Campus) ,2009. / Profiling of mental disorders in tertiary institutions is relatively an understudied subject .The aim of the study was to delineate the types, age and gender distribution of psychiatric disorders in Dr. George Mukhari hospital .This is a tertiary psychiatric unit which caters for mental health care users in Garankuwa , Soshanguve , Mabopane region. The study is retrospective and caters for a period January 2006 to December 2006. Dr George Mukhari being a tertiary institution ,the types of mental disorders seen are the emergency ones i.e. aggressive ,life threatening or complex in nature . Schizophrenia was the most common disorder , affecting more males than females in adults , whereas mental retardation was more common in children affecting more males than females. . This underlay the devastating nature of neuoro-developmental problems in psychiatry. Most of the mental health care users seen were single and un-employed(most on disability grants)

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The overall aim of this project was to investigate the nature and structure of the physiological symptoms of panic attacks and the relationship between these symptoms and use of the health care system by people with a clinical diagnosis of panic disorder. Cioffi's model of somatic interpretation was explored in relation to this issue as it had been previously applied to predominantly physiological conditions and appeared to offer a potentially useful framework for understanding the behaviour of people with panic disorder.The first study consisted of a principal components analysis of 153 panic attack symptom checklists from the Anxiety Disorders Interview Schedule - Third Edition - Revised (ADIS-III-R).Five separate physiological components emerged from the analysis which mirrored common medical conditions. A cluster analysis of the symptoms of 153 individuals indicated that the sample formed five separate groups corresponding to the five physiological components identified. The results of this study supported suggestions put forward in the literature regarding the possible clustering of the physiological symptoms of panic attacks. The study also found evidence to suggest that individuals with panic disorder can be identified in distinct sub-groups according to the most predominant physiological symptoms reported.The second study was made up of two parts. Part one investigated the health utilisation behaviour and associated costs for people with panic disorder and compared them with people with social phobia. Significantly higher costs and rates of utilisation were found for the panic disorder group compared to the group with social phobia. Part two of this study investigated the relationship between a person with panic disorder's most predominant physiological panic symptoms and the type of medical specialists consulted. Fifty three individuals with panic disorder ++ / were included in the study and the proposed relationship was analysed using a bi-partial regression analysis. The respiratory group was significantly related to the type of specialist seen.The third study was aimed at clarifying the interpretation of ambiguous symptoms in panic disorder. Thirty eight people with panic disorder completed a questionnaire requiring them to give explanations as to the cause of a number of ambiguous somatic sensations. It was hypothesised that there would be a relationship between the persons highest component score (as identified in the first study) and the interpretation of threat made in response to the items on the questionnaire. No such relationship was found although significantly more threat-interpretations were made when the individual's cognitive threat schema was activated.Study four investigated the influence of the type of panic recording measure upon the severity and number of panic symptoms reported. A secondary aim was to compare panic symptoms recorded following a panic provocation procedure in the clinic with those recorded following naturally occurring panic attacks. Thirty seven people with panic disorder recorded the symptoms of panic attacks experienced in the natural environment and those induced via hyperventilation in the clinic. It was hypothesised that there would be an effect for recording measure on the dependent variables of symptom severity and number. This hypothesis was supported with the structured recording measure producing significantly more symptoms of a greater severity than the unstructured or descriptive measure. An interaction effect was found for the neurological group of symptoms whereby the severity of symptoms was significantly higher in the clinic setting than in the natural environment with the descriptive measure resulting in significantly greater severity ratings.The final study ++ / investigated the efficacy of information-giving as an intervention for panic disorder. Forty individuals with panic disorder were randomly assigned to either receive two sessions of information-giving as well as self-monitoring of their symptoms or self-monitoring only. As hypothesised the group receiving information as well as self- monitoring had significantly lower levels of general anxiety and depression as well as anticipatory anxiety at the end of the intervention period.Several important implications emerge from these results. The finding that people with panic disorder can be identified according to the predominant set of physiological symptoms they report provides some useful information for identification of the problem in general medical settings. This project demonstrated the need for a screening measure for panic disorder in Australian medical settings as well as the potential effectiveness of the provision of information relating to anxiety and panic. In addition, Cioffi's model of somatic interpretation was found to be a useful framework with which to consider underlying processes relating to the interpretation of panic sensations.

Master of Science / The current study aimed to test the efficacy of individual, synchronous Internet Therapy for panic disorder compared to traditional face-to-face therapy. Thirty participants diagnosed with panic disorder were randomly allocated to either Internet Therapy or face-to-face therapy, and received a manualised cognitive-behavioural treatment program. When analysed separately, results indicated that face-to-face treatment significantly reduced panic symptomatology overall, however significant gains were not shown for the Internet Therapy condition. However, a direct comparison of the two active treatments failed to show significant differences, as measured by a Multivariate Analysis of Variance (MANOVA) on pre- and post-treatment variables. Internet Therapy did, however, significantly reduce certain symptoms of panic disorder, indicating that Internet Therapy may be useful as an adjunctive treatment to face-to-face therapy. Intention-to-treat analyses suggested that face-to-face treatment may be more effective than Internet Therapy for treating panic disorder. Additionally, there were no differences between treatment conditions in levels of working alliance, indicating that among those who stay in treatment, working alliance can be established online at a similar level to that of face-to-face therapy. However a high number of dropouts in the Internet Therapy condition warranted consideration. A thorough explanation of the results is offered in addition to recommendations for the future directions of the research and clinical implementation of Internet Therapy.

Meehl�s (1962, 1989, 1990b) schizotypy and Tsuang et al.�s (1999b, 2000a, 2000b) schizotaxia are fundamentally different notions of the schizophrenia precursor. Both represent a categorical precursor but differ in the nature of their relationships to schizophrenia. Specifically, schizotypy is dimensional, unchanging despite the presence or remission of schizophrenia. In contrast, schizotaxia is a transitional precursor; the presence of schizophrenia signals the end of schizotaxia. There are also differences in the way in which risk is determined. Schizotypy is reflected in a variety of information processing and experiential aberrations, is typically assessed using self-report measures, and is best identified using taxometric analyses. In contrast, schizotaxia is characterised by negative symptoms of schizophrenia and neurocognitive impairment, can be assessed using standardised clinical measures, and is diagnosed at the individual case level. The aim of Phase 1 of this study was to investigate the manifest structure of Meehl�s schizotypy in a sample of psychiatric patients. The aims of Phase 2 were to determine if schizotypy group membership was associated with poorer functioning and to determine the nature of the relationship between Meehl�s (1962, 1989, 1990b) schizotypy and Tsuang et al.�s (1999b, 2000a, 2000b) schizotaxia. Participants in Phase 1 were 109 psychiatric patients and all completed a self-report measure of schizotypy, the Thinking and Perceptual Style Questionnaire (TPSQ; Linscott & Knight, 2004). Multivariate taxometric analyses of TPSQ subscales yielded evidence of a manifest group structure within the sample. The prevalence of the latent group, presumed to reflect schizotypy, was estimated to be 32% (SD = 8%), as yielded by MAXCOV analyses. MAXCOV analyses also yielded a mean indicator validity of 1.02; variance of 7; base rate estimates of .08; and a goodness of fit index of .98. MAMBAC analyses yielded a mean base rate of 56% (SD = 18%). Twenty-nine participants from Phase 1 took part in Phase 2. Fourteen were from the schizotypy group (had a p value of .85 or higher of schizotypy group membership) and 15 from the nonschizotypy group (had a p value of .03 or lower of schizotypy group membership). Participants completed tests of attention, verbal memory, and executive functioning. Negative symptoms of schizophrenia were also rated and diagnosis was determined using a diagnostic interview. The schizotypy group was significantly impaired relative to the nonschizotypy group on neuropsychological test scores spanning domains of attention, verbal memory, and executive functioning. A current DSM-IV diagnosis was made for 71% of the schizotypy group and 43% of the nonschizotypy group. Individuals were classified as having met criteria for schizotaxia if they had a negative symptom impairment and a neuropsychological impairment in two domains. A total of 7 people of 29 met criteria for schizotaxia, 6 of these people were from the schizotypy group. There was statistical evidence that Meehl�s (1962, 1989, 1990b) schizotypy and Tsuang et al.�s (1999b, 2000a, 2000b) schizotaxia are not independent. The proposed precursors for schizophrenia may reflect the same construct, not separate entities. Limitations and implications of these results are considered.

Although the prevalence rate of panic disorder (PD) among adolescents is relatively low, epidemiological research suggests that panic attacks and subclinical panic disorder symptoms occur in a substantial portion of the adolescent population. Retrospective and prospective studies also suggest that adolescence is a critical developmental period for the onset of PD symptoms. Given the negative academic, social, and emotional outcomes associated with undetected and untreated PD, effective prevention and intervention are warranted. Identifying adolescents with current PD or who may be at-risk for future PD is an important step in such treatment efforts. Among professionals working with youth, physicians and medical staff may be at a particularly advantageous position to screen for adolescent panic symptoms, given the high utilization of medical services among those experiencing such PD symptoms. Although limited time and resources within primary care settings frequently hinder effective mental health screening procedures, the use of time-and cost-effective screening instruments may aid professionals in detection efforts. With this in mind, the current study sought to validate a brief screening tool previously studied with adults for use with adolescents seen at pediatrics primary care practices. The screening instrument was evaluated both in terms of its ability to effectively detect adolescents with PD and in terms of the association between positive screen status and cognitive, symptom, and broader impairment variables associated with PD. Participants included 165 adolescents (57% male) ages 12 to 17 (M = 14.40; SD = 1.77) recruited from two general pediatrics clinics in Miami-Dade County, Florida. The sample was 42.3% White, Non-Hispanic, 41.1% Hispanic, 7.9% Black (African-American and Caribbean American), 1.2% Asian American, 7.4% mixed ethnicity or other, and 1.2% unknown. At Time 1, while in the waiting room of a pediatrics clinic, participants completed the Autonomic Nervous System Questionnaire (ANS; Stein et al., 1999), a five-item screening measure of panic symptoms. Of this larger sample, 45 participants (25 screening positive for potential panic disorder and 20 with negative screens, matched by age and gender to the positive screen group) completed telephone-administered follow-up measures at Time 2. Follow-up measures included a more comprehensive diagnostic assessment of PD and agoraphobia, as well as adolescent-report measures of anxiety sensitivity, interpretive biases, overall anxiety and depression, and functional impairment. At Time 1, 65 participants (39.4%) screened positive on the ANS, as indicated by endorsing the first and/or second item on the measure. Of those screening positive, roughly one-third of participants (33.84% of positive screens) endorsed moderate to severe anticipatory anxiety about future panic attacks. The ANS displayed excellent sensitivity (Se = 1.00), with two participants from the positive screen group meeting criteria for PD, and no control participants meeting criteria. However, as expected, specificity of the ANS was lower (Sp = .43), indicating a high degree of false positives (e.g., those screening positive but not meeting criteria for PD). In addition, as hypothesized, the ANS demonstrated good test-retest reliability (r = .74). Independent samples t-tests revealed that positive screen participants had significantly higher self-reported anxiety sensitivity, interpretive biases, anxious and depressive symptoms (including panic), and functional impairment than negative screen participants. This difference remained significant for overall symptom T-scores on the Revised Child Anxiety and Depression Scales (RCADS; Chorpita et al., 2000), even after controlling for group differences in anxiety sensitivity and interpretive biases. Finally, further analyses revealed that participants endorsing both starter items on the ANS (n = 7) had higher elevations on self-reported anxiety sensitivity and panic symptoms, compared to those not endorsing either item or those endorsing the first item (e.g., "In the past six months, did you ever have a spell or an attack when all of a sudden you felt frightened, anxious, or very uneasy?"), but not higher than those endorsing only the second item ("In the past six months, did you ever have a spell or attack when for no reason your heart suddenly began to race, you felt faint, or you couldn't catch your breath?"). These findings offer preliminary validation for the ANS as a screening measure for PD in adolescence, given its high sensitivity and ability to adequately "catch" patients with PD (e.g., low false negative rate). Perhaps even more importantly, those screening positive on the ANS demonstrated higher scores on cognitive correlates of PD and elevated internalizing symptoms and functional impairment, compared to participants screening negative. Based on these analyses, current recommendations for physicians and medical staff are to monitor and follow-up with adolescents screening positive on the ANS for the development of anxiety and panic disorder symptoms, particularly among those who endorse both starter items. However, given the relatively small sample size, replication of these findings in a larger sample is needed to further validate these recommendations. Finally, implications for prevention and intervention within pediatrics settings are discussed.

Dissertation (PhD)--University of Stellenbosch, 2005. / Bibliography. Also available via the Internet.

This study provided information on the long term psychosexual and psychiatric outcomes of 139 boys with gender identity disorder (GID). Standardized assessment data in childhood (mean age, 7.49 years; range, 3–12 years) and at follow-up (mean age, 20.58 years; range, 13–39 years) were used to evaluate gender identity and sexual orientation outcome. At follow-up, 17 participants (12.2%) were judged to have persistent gender dysphoria. Regarding sexual orientation, 82 (63.6%) participants were classified as bisexual/ homosexual in fantasy and 51 (47.2%) participants were classified as bisexual/homosexual in behavior. The remaining participants were classified as either heterosexual or asexual. With gender identity and sexual orientation combined, the most common long-term outcome was desistence of GID with a bisexual/homosexual sexual orientation followed by desistence of GID with a heterosexual sexual orientation. The rates of persistent gender dysphoria and bisexual/homosexual sexual orientation were substantially higher than the base rates in the general male population. Childhood assessment data were used to identify within-group predictors of variation in gender identity and sexual orientation outcome. Social class and severity of cross-gender behavior in childhood were significant predictors of gender identity outcome. Severity of childhood cross-gender behavior was a significant predictor of sexual orientation at follow-up. Regarding psychiatric functioning, the heterosexual desisters reported significantly less behavioral and psychiatric difficulties compared to the bisexual/homosexual persisters and, to a lesser extent, the bisexual/ homosexual desisters. Clinical and theoretical implications of these follow-up data are discussed.

The current study had three main objectives: to examine the relation between trait and state self-objectification and various eating pathology, including restricted eating; to examine the role of general and specific feminist attitudes on body dissatisfaction and trait disordered eating; and to merge two empirically supported models of eating disorders. Using a quasi-experimental research design with an elaborate cover story, one hundred and three women completed a variety of baseline measures and were assigned to one of two state self-objectifying conditions (swimsuit vs. sweater) where body image and body shame were measured at post. Additionally, following the manipulation, participants caloric intake during a snack break was measured. Results indicated that trait self objectification was associated with disordered eating symptomatology and analyses found an effect of condition on body shame, and that this effect was moderated by trait self-objectification. These results were not documented for caloric intake and body dissatisfaction, likely due to time of assessment of these variables. Also, results indicate that objectification theory and the dual pathways model merge well and that in the dual pathway, body shame may be a component of body dissatisfaction. Finally, feminist attitudes were also associated with body dissatisfaction but not with disordered eating symptoms. Implications for clinical work and future research are discussed.

Thesis (Ph. D.)--Lehigh University, 2000. / Includes vita. Includes bibliographical references (leaves 129-141).