This thesis is a descriptive analysis of a milieu programme, giving specific attention to its groupwork methods and contributions which is in operation at Warrendale, a residential treatment home for emotionally disturbed girls situated in Newmarket, Ontario. Against a brief history of the institution, it gives the theoretical basis of the work done with children, using the milieu concept as pioneered by Fritz Redl and Bruno Bettleheim. The institution uses caseworkers and groupworkers as residential staff, dealing directly with the children, but only the group work aspects of the programme are considered here. Three aspects of the total milieu are considered; (a) routines and rules; (b) leisure-time activities and the community; (c) discipline and problem-handling. Parts of the life of the institution are illustrated and analyzed in relation to the various therapeutic goals of the institution; (a) tension reduction; (b) individuality; (c) gaining relationships; (d) expression and release of feelings. The value of these three aspects are also considered for their diagnostic value. The contribution and use of group skills in the milieu setting are considered in the light of the therapeutic goals mentioned above. The group session is the principal technique considered, and the interpretive and goal setting values of group sessions are brought out. The significance of celebrating social festivities and the special uses of group sessions as expressive media are also exemplified as a part of group skills. The overall contributions, and possibilities of improvement, are summarized in a concluding chapter. / Arts, Faculty of / Social Work, School of / Graduate

The objective of this thesis is to create a spatial representation of a bipolar episode. The role of this concept is to investigate the nature of spaces and their relations with dissimilar spaces, resembling a first-hand account of spasmodic incidents experienced by a person with this manic depressive illness. The site is located in an abandoned mine as to represent a feeling of isolation, such as experience by a bipolar individual during an episode of depression. The existing infrastructure incorporated with the new formal experience is to be used in understanding the two poles of bipolar disorder and exploiting those values to create a unified space. The design will be used to spatially organize a chaotic experience to bring awareness of mental illnesses. "Bipolar disorder, also known as manic depressive illness, is a brain disorder that is a roller-coaster in mood, energy levels, and the ability to carry out day-to-day tasks. People with bipolar disorder experience periods of unusually intense emotion, cha es in sleep patterns and unusual behaviors. These distinct periods are called 'mood episodes,' either associated with mania or depression. Mood episodes are drastically different from the moods and behaviors that are typical for the average person."1 During mania, euphoria or irritability are manifested through symptoms such as: destructibility, insomnia, grandiosity, flight of irrational and high speed thought. Depression is characterized by feelings of exhaustion, self hatred, and suicidal thoughts. Mood episodes can include both manic and depressive symptoms, which is referred to as a mixed state can cycle rapidly between mania and depression phases, from three to four times a year to several times during a single day. Sometimes, a person with severe episodes of mania or depression also have psychotic symptoms, such as hallucinations or delusions. The psychotic symptoms tend to match the person's extreme mood. "Abnormalities in the prefrontal cortex result in a cognitive disconnect in planning, working memory, problem solving and temporal sequencing of information. Disrupted organization and execution of plans occur when there is damage to this region of the brain."2 The physical movement experienced by a bipolar individual across space can generate temporal illusions of reality. The distance between spaces and experience becomes a subjective experience. Space can be experienced as a relative location of objects of places, as the distance and expanse that separate or link place. The organization of space is dependent upon not only sight but psychological responses to reality. By shifting from one place to another, a person acquires a sense of direction. Forward, backward, and sideways are experientially differentiated, that is known subconsciously in perspicacity. / 0 / SPK / specialcollections@tulane.edu

This collection of memoir essays chronicles the author's 19 year struggle with chronic depression. "The Invisible Dragon" explores the onset of the disease and its cure. "The Silent Typewriter" looks at how it affected the author as a writer. "Roses for Trish" discusses how it affected his wife. "My Mother's Son" explores the possibility that he inherited depression from his mother. The final essay, "The Dragon Returns" probes the author's life in 2012 with the probability that he has a personality disorder. The preface examines several depression memoirs and explores the strategies used by William Styron, Elizabeth Wurtzel and Kay Redfield Jamison to prevent sliding into the pitfalls inherent in a linear structure. Among these are the use of alternative structures, language, characterization, focus and imagery.

This study explored stigma associated with mental illness among Indonesian adults living in Indonesia. It investigated how mentally ill adults (both mentally ill patients and mental health nurses) perceive mental illness and how they respond to stigmatization on a daily basis. Given the current state of knowledge with regards to the meaning and process of stigma and mental illness among adults in Indonesia, a constructivist grounded theory was considered to be the method of choice for this study. We recruited 15 nurses and 15 patients to participate in the study; all from a psychiatric hospital in Indonesia. Data collection methods involved semi-structured interviews with the 30 participants as well as mute evidence, field notes and memos. Data analysis occurred over a period of six months. In keeping with the basic principles of a grounded theory method (Charmaz, 2006) as well as Paillé’s (1994) structure for data analysis which are congruent with Charmaz’s principles and include stages of codification, categorization, linking categories, integration, conceptualization, and theorization, 5 discrete but interrelated categories were produced: 1) treatment of mental illness; 2) violence; 3) fear; 4) constructing cursed citizens; and 5) stigmatization. Research results show that the experience of stigma for mentally ill patients in Indonesia is pervasive and impedes mental health services utilization. The stigmatization of mental illness is manifested by family members, members of the community, mental health professionals and staff, and also by governmental institutions and the media. Stigmatization is characterized by violence, fear, exclusion, isolation, rejection, blame, discrimination, and devaluation. Moreover, because of their (mis)understanding of mental illness, patients and families turn to alternative treatments provided by non-professionals (shamans, Islamic leaders, paranormals and traditional Chinese medicine); these individuals play a central role in supporting and offering solutions for someone suffering from a mental illness. In Indonesia, stigma affects mentally ill individuals at many levels. Until stigma associated with mental illness is addressed nationwide, those suffering from mental illness will continue to suffer and be prevented from accessing mental health services. As the results of this study have shown, patients seeking treatment experience violence and fear. Families and their mentally ill relatives have been expelled by their community, or have simply disappeared. Both physical and psychological abuse and humiliation have led to patients being avoided, rejected, and neglected, and thus isolated, hidden, or abandoned to the streets. There is a pressing need to combat mental illness stereotypes in Indonesia and health professionals, namely nurses, government agencies as well as the media must play a pivotal role in this process.

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A research report submitted to the faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine. Johannesburg, 2017. / In South Africa, very little is known regarding the spectrum of clinical illnesses for which older patients are admitted to hospital. Within this group who are admitted, even less is known of the burden of HIV disease. This study investigated the clinical indications for acute medical admission in adults over the age of 50 years at Chris Hani Baragwanath Academic Hospital. The study also determined the prevalence of HIV infection of those with HIV, their access and adherence to treatment. Methods: This was a prospective, observational study of patients over 50 years of age who were acutely admitted to the medical wards of Chris Hani Baragwanath Academic Hospital (CHBAH) between August 2014 to March 2015. Results: A total of 200 participants 50 years and older were enrolled, 34% HIV-positive, 37% HIV-negative and 29% whose HIV status was unknown. The HIV-positive group was younger (p <0.0001), had poorer access to pension funds (p<0.0001) and higher burdens of acute infectious illness when compared to their HIV-negative counterparts (p<0.0068). HIV-negative patients had higher rates of acute cardiovascular and haematological conditions (p<0.0001) and higher rates of chronic non-communicable disease (p<0.0004), predominantly diabetes mellitus (p<0.0095) and hypertension (p<0.0024). Conclusion: In older patients hospitalised for acute illness, both infectious and non-communicable disease play a significant role however, in those with HIV, the infectious burden of disease is more prominent while non-communicable chronic disease predominated in those without HIV. / LG2018

Several studies have made use of EEG features to detect specific mental health illnesses such as epilepsy or schizophrenia, as supplementary diagnosis to the usual symptom-based diagnoses. At the same time general mental health diagnostic tools (biomarker or symptom-based) to identify individuals who are manifesting early signs of mental health disorders are not commonly available. This thesis seeks to explore the potential use of EEG features as a biomarker-based tool for general mental health diagnosis. Specifically, the predictive ability using machine learning of a general biomarker derived from EEG readings elicited from an oddball auditory experiment to predict someone’s mental health status (mentally ill or healthy) is investigated in this study. Given that mindfulness exercises are regularly provided as treatment for a wide range of mental illnesses, the features of interest seek to quantify it as a measure of mental health. The 2 feature sets developed and tested in this study were collected from a traumatic brain injury (TBI) and healthy controls dataset. Further testing of these feature sets was done on the Bipolar and Schizophrenia Network on Intermediate Phenotypes (BSNIP) dataset containing multiple mental illnesses and healthy controls to test the features for generalizability. Feature Set 1 consisted of the average and variance of P300 and N200 ERP component peak amplitudes and latencies across the centroparietal and fronto-central EEG channels respectively. Feature Set 2 contains the average and variance of P300 and N200 ERP component mean amplitudes across the centro-parietal andfronto-central EEG channels respectively. The predictive ability of these 2 feature sets was tested. Logistic regression, support vector machines, decision trees, random forests, KNN classification algorithms were used, and random forest and KNN were used in combination with oversampling to predict the mental health status of the subjects (whether they were cases or healthy controls). The model performance was tested using accuracy, precision, sensitivity, specificity, f1 score, confusion matrices, and AUC of the ROC. The results of this thesis show promise on the use of EEG features as biomarkers to diagnose mental illnesses or to get a better understanding of mental wellness. The use of this technology opens doors for more accurate, biomarker-based diagnosis of mental health conditions, lowering the cost of mental health care, and making mental health care accessible for more people.

The tick-borne Lyme disease, caused by the bacterium Borrelia burgdorferi, as well as some other Borrelia species, is the subject of a dispute as to whether its conditions persist following recommended antibiotic treatment lasting no more than three weeks. Advocates for the existence of chronic Lyme disease point to numerous animal models that show some traces of the bacteria remaining after treatment and call for both the long term use of antibiotics and for the disease to be recognized as chronic and to be diagnosed more expediently. Opponents of the existence of chronic Lyme disease argue that the scientific evidence for these arguments is insufficient, citing that long term symptoms are actually signs of other diseases erroneously grouped with Lyme, that current antibiotic regimens suffice for Lyme disease treatment, and that additional antibiotics beyond current treatments provide no increase in beneficial outcomes. The evidence currently is insufficient to support many of the claims by supporters of chronic Lyme disease and further studies must be done before evidence from the animal models can be applied to human patients. The fact that Borrelia burgdorferi in particular, and perhaps other members of the Borrelia genus, has evolved many singularly peculiar traits such as a lack of reliance on iron and a large extrachromosomal genome suggest that it is not outside the realm of possibility that there is some other facet of Lyme disease not currently recognized or understood. Future exploration is needed to fully understand mechanisms of pathogenesis of this bacterium in order to either confirm or deny the ability of Lyme disease to persist in humans following treatment.

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / Two attitude dimensions which become highly relevant for the person who is admitted to the psychiatric ward of a hospital are acceptance of mental illness and acceptance of mental patients. It is assumed that under the impact of hospitalization acceptance of both mental illness and mental patients and rejection of both mental illness and mental patients tend to become consonant attitude combinations, and it is also assumed that rejection of mental patients and acceptance of mental illness becomes a dissonant attitude combination. Three hypotheses were derived from balance theory and subjected to test. They were first, that people realign attitudes to reduce dissonance, second that people realign attitudes to increase consonance, and third, that people maintain consonant attitude combinations more frequently than dissonant combinations. These hypotheses were tested in the following manner. Ninety-four new admissions to the open psychiatric ward of the Boston Veterans Administration Hospital were administered a questionnaire and interview at time of admission and again after a significant period of hospitalization (approximately ninety days). The questionnaire contained sixteen items measuring acceptance-rejection of mental patients, divided into four subsets each sampling from somewhat different response modes (statement agreement, statement disagreement, adjective ratings, and sentence completion). On the basis of "social distance" score summed across all sixteen items, subjects were divided into accept, neutral, and reject groups of equal frequency. The interview inquired into the patient's perception, belief, and interpretations concerning symptoms, probable cause, and preferred treatment of his own illness. Verbatim interview responses were rated for expression of acceptance and rejection of a psychiatric viewpoint. On the basis of summed ratings, subjects were divided into three groups of equal frequency representing acceptance, neutrality, and rejection at the dimension of mental illness. On the basis of the groupings on the dimension of mental patient and mental illness, subjects were assigned to nine attitude combinations representing varying degrees of consonance, dissonance, and non-consonance. Initial attitude combinations were treated as the independent variable and changes from one combination to another were treated as the dependent variable. Results: There was no special tendency for subjects with dissonant attitude combinations to shift away fran dissonance either in the direction of consonance or merely to non-dissonance. The first hypothesis was thus not confirmed. However, there did appear to be a significant tendency for subjects to shift from non-consonant to consonant attitude combinations, confirming the second hypothesis. Finally, there was no significant indication of greater stability in initially consonant attitude combinations than in non-consonant combinations. The third hypothesis, like the first, was therefore not confirmed. Theoretical Implications: There appears to be some utility in subdividing the omnibus balance hypothesis into three sub-hypotheses: namely, dissonance reduction, consonance increment, and consonance maintenance. Practical Implications: Social integration and acceptance of other mental patients may be a necessary precursor of acceptance of a psychological orientation toward illness in one's self. If psychological insight is the goal, a patient may be more receptive after he has come to perceive mental patients as potential friends and companions and people who are not too much different from himself. If social integration is the principal goal, however, there is no guarantee that acceptance of mental illness in the self will induce greater acceptance of other mental patients. Balance theory, per se, does not appear to be an effective predictor of attitude change in this setting, and it is premature to suggest direct application of the theory to ward management problems. Nevertheless, theoretical analyses are useful in clarifying and sharpening many of the issues confronting the practitioner. / 2031-01-01

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