Les études sur le fardeau des aidants de personnes atteintes de troubles mentaux ont à ce jour été réalisées principalement dans des contextes d'hospitalisation ou de services externes. On connaît très peu la situation des aidants dans le contexte de l'hôpital de jour, une modalité de services ambulatoires utilisée davantage aujourd'hui comme alternative à l'hospitalisation. Cette étude avait pour but de décrire le fardeau des aidants primaires (N 25) de personnes admises à un hôpital de jour psychiatrique, dans une perspective d'examen de l'évolution du fardeau entre le moment de l'admission (T 1 ) et cinq semaines après le congé (T 2 ). Les hypothèses étaient: (1) que le fardeau des aidants serait plus important à l'admission qu'à la période post-traitement, (2) qu'à l'admission, les variables liées à l'état actuel du malade auraient une contribution plus importante sur le fardeau que les variables liées aux caractéristiques sociodémographiques, du malade, à l'histoire et à l'évolution de la maladie, (3) qu'à l'admission, les comportements symptomatiques auraient un contribution plus importante sur le fardeau que les dysfonctions sociales et les effets indésirables sur l'entourage et (4) qu'au T 2 , les variables liées aux effets indésirables sur l'entourage auraient une contribution plus importante sur le fardeau que les variables liées aux symptômes et aux dysfonctions sociales du malade. (Abstract shortened by UMI.)

Children with chronic illness are confronted with a variety of acute and chronic stressors. As a result, they require coping strategies that can be used successfully during extremely stressful situations. Mental skills training programs teach children stress management and relaxation techniques that may be used during stressful encounters. The primary purpose of this multiple case study was to evaluate the effectiveness of Orlick's Feeling Great Program in teaching children with chronic illness to deal successfully with stress and find highlights. Qualitative research methods were used to explore factors related to the process of learning mental skills, including types of skills used most often, the influence of context, and factors that effect skill development. Four children receiving treatment for cancer between the ages of 7--9 learned techniques such as muscle relaxation, diaphragm breathing and imagery. Data collection included participant observation, field notes, interview data and highlight journals. Program participants perceived the program to be effective in fostering the development of improved coping skills for use within a variety of situations. During acute stressors, such as painful medical procedures, children and parents reported fewer incidents of reactive coping behaviors, such as crying, and described an increased number of proactive coping responses, such as deep breathing. Furthermore, children learned to cope effectively with chronic stressors, such as feelings of anxiety, nausea and treatment side effects.

Cette étude descriptive-corrélative vérifie la relation entre le déni de la maladie et l'observance thérapeutique auprès de 44 hommes et femmes atteints de trouble bipolaire vivant dans la communauté et tous membres du groupe de soutien Les Bipos Inc. Les instruments de mesure comprennent: Perception de l'Impact de la Maladie Mentale (PIMM), des échelles analogues pour l'observance et un questionnaire sur l'histoire de la maladie (hospitalisation et rechute). Les résultats démontrent des corrélations fortes entre la dimension espoir du PIMM et la cessation partielle des médicaments; entre la cessation partielle des médicaments et le nombre de rechutes; entre l'observance des rendez-vous thérapeutiques et la cessation totale du traitement pharmacothérapeutique. Plusieurs coefficients de corrélation d'ordre moyen sont démontrés entre les autres dimensions du PIMM et l'observance. L'influence significative (p < 0.05) du groupe de soutien sur quelques dimensions du PIMM est aussi démontrée.

The purpose of this study was to introduce positive life skills to a family with special needs. A qualitative single case study was used to discover whether positive life skills would be advantageous as tools or resources for one family with special needs. Mental skills activities, such as Orlick's Feeling Great program for children, were adapted and presented through audio tape and activities to the family, at their home on a weekly basis. Information was gained through observations, conversations, interviews and interactions. Weekly notes were gathered and reported. Two interviews were taped mid-way through the program and at the end of the program. The interviews were transcribed; the objective was to see if the positive life skills were useful as tools or resources for the family. A detailed description of the responses of the child, the parents and the researcher are given. Through the span of this study the family was equipped with a common language and action for dealing effectively with stressful situations. Of immeasurable value was the family's discovery that despite their many demands, there was time to spend together which could re-energize each of them. The coping of this family was improved and they viewed themselves as functioning at a much greater level than before this program began. This project presents one family's journey of interacting with each other while discovering that mental skills can help them all to face the special demands and stress of their unique family. Future research could examine the collaborative efforts of education or health professions in supporting children with disability and their families, with respect to the usefulness of mental skills as a means of coping with unique demands.

Cette étude examine l'effet de la désinstitutionnalisation sur les perceptions de parents d'enfants-adultes vivant avec une déficience intellectuelle. L'échantillon est constitué de' 66 participants divisés en deux groupes. Le groupe expérimental comptait 33 personnes responsables d'un enfant-adulte qui allait vivre la transition d'un milieu institutionnel à un milieu communautaire. Le groupe témoin comptait aussi 33 personnes responsables d'un enfant-adulte qui vivait dans la communauté depuis au moins deux ans. Les membres du groupe expérimental ont été évalués avant la désinstitutionnalisation de l'enfant-adulte et de nouveau de quatre à six mois après la transition en milieu communautaire. Les sujets du groupe témoin ont été évalués deux fois en respectant un intervalle similaire à celui du groupe expérimental. Les instruments de mesure utilisés sont l'Inventaire des rôles liés à l'intégration sociale (version revisée), l'Échelle des comportements négatifs, l'Échelle québécoise de comportements adaptatifs (ÉQCA), l'Échelle de stress familial et l'Échelle de fréquence des contacts. Les résultats indiquent, pour les deux groupes, qu'il n'existe aucune différence entre les perceptions parentales aux deux temps d'évaluation, sauf pour la fréquence de contacts des parents du groupe expérimental avec l'enfant-adulte. Le nombre de visites des parents à l'enfant-adulte dans sa nouvelle résidence a augmenté significativement. Il ressort aussi des analyses effectuées que l'augmentation de la fréquence des contacts est associée à une réduction de la distance entre le domicile familial et le milieu de vie de l'enfant-adulte vivant avec une déficience intellectuelle. Enfin, les analyses révèlent une réduction du nombre de comportements négatifs, tels qu'évalués par les intervenants, approchant du niveau de signification.

Background. Despite its prevalence and clinical relevance, cognitive impairment typically remains undetected in 50% of cases. Objective. To develop clinically sensible (quick, simple, acceptable), accurate and readily recalled screens for cognitive impairment based on easily reproducible analytic strategies. Methods. The Canadian Study of Health and Aging (CSHA-1) served as the derivation data set. 3MS cognitive screening questions which were judged as most likely to be employed by busy clinicians and which were significantly associated (via chi2 analysis) with cognitive impairment were selected as independent variables for multivariate analysis. The screening tests derived from logistic regression and recursive partitioning analyses which most closely approximated the sensitivity and specificity of the entire 3MS were externally validated. Results. Two logistic regression based scales and two recursive partitioning algorithms demonstrated sensitivities and specificities approaching those of the complete 3MS (approximately 80% and 60% respectively). The sensitivity was superior to that of the MMSE. Conclusion. Readily reproducible multivariate analysis based strategies can be developed which generate practical screening tests with psychometric properties approaching those of the 3MS. Given the existence of verification bias, these screens as well as screens with higher sensitivity and lower specificity must be validated prospectively before they can be clinically employed.

Longitudinal information indicates children who present with 'hard-to-manage' or problematic behaviours at a very young age are at risk for on-going difficulties with parents, peers and in school. However, there are few interventions that have demonstrated effectiveness in ameliorating the symptoms that appear to be precursors of Attention Deficit Hyperactivity Disorder (ADHD). Despite the use of methylphenidate (MPH) to treat Attention Deficit Hyperactivity Disorder in very young children, there is little information related to its efficacy within this age group. This study examined the effectiveness of medication on the cognitive, behavioural and interpersonal domains of young children who were diagnosed with ADHD. The children were assessed using cognitive measures, behavioural ratings scales and interactive measures assessing child compliance and attention. Furthermore, the effect of the children's medication status on parental style, skills and stress also were assessed using behavioural observations of parent and child engaged in interactive tasks. Changes in parental style, skills and stress were evaluated. Twenty-four children, aged 4 to 6 years, diagnosed with ADHD, participated in a double-blind, placebo-controlled study evaluating the efficacy of 0.3 mg/kg and 0.5 mg/kg methylphenidate BID. All treatments were randomized and administered for a minimum of 7 days. Results indicated improvements related to medication were obtained on measures of cognitive tests of attention and as assessed by parent rating scales. Cognitive tests of impulsivity presented an equivocal picture of sensitivity to medication treatment. Attentional abilities in an interactive setting indicated a medication response from Baseline measures only and the degree to which this effect was augmented by Placebo treatment was unclear. That is, there was some evidence that parental expectancies played a role in these measures. No changes were obtained with respect to the children's tendency to comply with parental requests. Side effects were not significantly increased with medication treatment. Parental skills appeared unaffected by the child's medication status. However, parental style appeared to become more positive especially following treatment with the higher dose. Although the stress reported to be experienced by the parent decreased following treatment, the response was non-specific, that is, not related to the medication status of the child. Not surprisingly, clinical change analyses showed parent ratings were more effective than the cognitive task in picking up the number of children who had responded favourably to medication. Parents rated many children as having improved or normalized following treatment with both doses. Similar rates of positive change were obtained with respect to negative behaviours. This investigation into the efficacy of MPH in the treatment of very young children diagnosed with ADHD indicated that it was effective in allievating symptoms of inattention as assessed by laboratory tests and by parent rating scales. Although parents rated negative behaviours as having decreased as a function of medication, these behavioural changes were not detected during the interactive tasks In general, parent-child tasks did not demonstrate the effectiveness of medication in changing the parents' behaviours or the parent-child dynamic.

Description of research. This thesis explores how police intervene with clientele signalled as mentally ill, or acting in such a way that the presence of a mental health problem is perceived. Officers were interviewed in rural and urban detachments and forces in neighbouring jurisdictions in Eastern Ontario. All of the officers interviewed were bound by the same legislation and guidelines with respect to mental health and to policing, described in the theoretical framework of this thesis. Rural and urban perceptions are compared to determine differences in the areas explored: available information, general knowledge, descriptions of incidents, causes of disturbed behaviour, police actions, and interactions with community or health authorities to whom clients may be referred for further mental health interventions. Research method. The thesis compares non-directive interview material for differences in and within themes addressed. Seven interviews, all with male officers, are analyzed. Three interviews were conducted in urban stations; four in rural detachments. In both of the compared groups, one officer is a senior officer and all others are constables. The choices of topic, research subject, and other features of the methodology are defended based on feminist and other critical analyses of traditional sociological research. (Abstract shortened by UMI.)

Abstract not available.

Major depressive disorder (MDD) constitutes the most commonly diagnosed mental illness affecting 16% of the population. Reduction in serotonergic tone is the most widely accepted etiological hypothesis for MDD and antidepressant treatments enhance serotonin (5-hydroxytryptamine, 5-HT) neurotransmission. Negative regulation of serotonergic raphe neurons is mediated by somatodendritic 5-HT1A autoreceptors, which are increased in depressed suicides and become down-regulated before antidepressants take effect. I hypothesized that genetic variations in regulatory regions of this receptor that dictate its expression, could contribute to predisposition to depression and treatment responsiveness. I initially addressed the basal mechanisms of human 5-HT1A receptor gene regulation using transient transfections with luciferase reporter constructs of 5' flanking sequences. A region between -1624 and -1550 by displayed strong repressor activity and contained at least three repressor elements: a consensus RE-1 and two copies of a novel dual repressor element (DRE). By yeast one-hybrid screening we identified a novel calcium-regulated repressor (Freud-1) that binds to DRE to reduce basal 5-HT1A receptor expression in neurons. Using an inhibitor of histone deacetylase (HDAC), we have demonstrated that Freud-1 mediates HDAC-independent repression in neuronal 5-HT1A positive cells, while REST or other DRE binding proteins recruit HDAC-dependant mechanisms to silence the receptor in non-neuronal 5-HT1A-negative cells. I also searched for sequence variations in 5-HT1A regulatory regions that may associate with depression. Further downstream from this region, we have identified a functional C(-1019)G polymorphism in the human 5-HT1A promoter that associates with major depression and completed suicide. The occurrence of the G allele at -1019 by prevents binding and repression by specific transcription factors NUDR and Hes5, identified by yeast one hybrid approach, and results in de-repression of the 5-HT1A receptor gene and hence, may contribute to the predisposition to depression. In conclusion, I have identified important transcriptional regulatory elements and proteins of the 5-HT1A gene implicated in serotonin neurotransmission, and characterized the mechanism of a new functional 5-HT1A promoter polymorphism involved in both suicide and MDD. This study may provide an improved marker for diagnosis and treatment of depression and provide a model for correlation between polymorphisms, gene expression and mental illnesses.