Doctor of Clinical Psychology / Master of Science / Despite a number of different psychotherapeutic approaches having been examined for use with patients with eating disorders, there is still no established psychological treatment associated with acceptable levels of long-term recovery. These poor recovery rates are associated with the observation that eating disorder patients are often ambivalent, or even resistant, to treatment. As such, research has begun to explore the use of Motivational Enhancement Therapy (MET), a treatment approach that aims to engage ambivalent and change resistant patients in the treatment process, with these individuals. Poor motivation to recover is particularly prominent within the inpatient eating disorder setting. However, no previous study has examined the use of MET to foster willingness to engage in treatment with this group of patients. The objectives of the current study were twofold. Firstly, an examination of the effectiveness of an inpatient eating disorders unit affiliated was undertaken in order to further the research base upon which future inpatient interventions can be built and compared. The second objective was to develop and evaluate a brief MET group program for inpatient eating disorder sufferers. The goal of the intervention was to enhance patients’ motivation to more effectively utilise the inpatient program and to hence positively impact upon their psychological, physical and behavioural functioning. Forty-two consecutive inpatients meeting DSM-IV criteria for an eating disorder were recruited into the current study and sequentially allocated to groups. Twenty-three inpatients completed four MET groups in addition to routine hospital care. A control group of 19 participants in the standard hospital treatment program was also employed (TAU group). The inpatient unit was associated with significant improvements on a number of physical, behavioural and emotional outcome measures. Despite no significant differences between the MET and the TAU groups being found on the overall formal outcome measures, there were nevertheless differences between the groups. Specifically, the MET groups appeared to foster longer-term motivation and engagement, and to promote treatment continuation. This study hopes to start a constructive debate on the role of MET in the inpatient eating disorders unit.

Doctor of Clinical Psychology / Master of Science / Despite a number of different psychotherapeutic approaches having been examined for use with patients with eating disorders, there is still no established psychological treatment associated with acceptable levels of long-term recovery. These poor recovery rates are associated with the observation that eating disorder patients are often ambivalent, or even resistant, to treatment. As such, research has begun to explore the use of Motivational Enhancement Therapy (MET), a treatment approach that aims to engage ambivalent and change resistant patients in the treatment process, with these individuals. Poor motivation to recover is particularly prominent within the inpatient eating disorder setting. However, no previous study has examined the use of MET to foster willingness to engage in treatment with this group of patients. The objectives of the current study were twofold. Firstly, an examination of the effectiveness of an inpatient eating disorders unit affiliated was undertaken in order to further the research base upon which future inpatient interventions can be built and compared. The second objective was to develop and evaluate a brief MET group program for inpatient eating disorder sufferers. The goal of the intervention was to enhance patients’ motivation to more effectively utilise the inpatient program and to hence positively impact upon their psychological, physical and behavioural functioning. Forty-two consecutive inpatients meeting DSM-IV criteria for an eating disorder were recruited into the current study and sequentially allocated to groups. Twenty-three inpatients completed four MET groups in addition to routine hospital care. A control group of 19 participants in the standard hospital treatment program was also employed (TAU group). The inpatient unit was associated with significant improvements on a number of physical, behavioural and emotional outcome measures. Despite no significant differences between the MET and the TAU groups being found on the overall formal outcome measures, there were nevertheless differences between the groups. Specifically, the MET groups appeared to foster longer-term motivation and engagement, and to promote treatment continuation. This study hopes to start a constructive debate on the role of MET in the inpatient eating disorders unit.

Magister Psychologiae - MPsych / Substance abuse is a public health concern in South Africa, and Western Cape Province in particular has been identified as having alarming rates of substance abuse. Substance abuse is the cause of some of the most pervasive and costly problems in society. Substance abuse is associated with various social problems such as crime, violence, unemployment, poverty, risky sexual behaviours, the escalation of chronic diseases such as AIDS and TB, and dysfunctional family life – and these problems are often interlinked. Furthermore, substance disorders place a huge strain on the health and welfare system of South Africa. In- and outpatient treatment facilities exist in communities to assist with alleviating the problem of substance abuse. Aftercare facilities are a form of outpatient service for substance abusers who have completed inpatient treatment. The primary aim of aftercare is to assist recovered substance abusers to maintain treatment gains by abstaining from substance use and to facilitate their reintegration with their families and communities. The purpose of the present study was to explore and obtain an in-depth understanding of the experiences of rehabilitated substance abusers in aftercare, following their completion of inpatient treatment. The sampling method for the study was purposive, and the sample consisted of two female and six male participants. Participants' attendance at the aftercare programme was verified with the aftercare coordinator. Semi-structured interviews were conducted and data were analysed using interpretative phenomenological analysis. Results of the study found that, overall, participants had a positive experience of aftercare. Furthermore, results indicated that aftercare played a vital role in assisting participants to maintain treatment gains.

Substance abuse has been identified internationally and in South Africa as an escalating problem that has harmful effects on the substance user and on society. The cost of treating substance-related disorders places a strain on the allocation of financial resources to treat the problem. When relapse occurs in substance users who have already undergone rehabilitation, it increases the costs of treatment. Waiting lists at treatment centres are also negatively affected for first-time admissions when relapsed substance users are re-admitted. The study aimed to identify relapse indicators by post-discharge follow-up of adult substance users in a registered, non-profit, state-subsidised treatment facility in Cape Town. Marlatt’s Dynamic model of relapse was used to explore the individual and socio-cultural factors which were potentially associated with relapse. A quantitative research design using archival data and purposive sampling was used to identify possible relapse indicators. The participants were ex-patients who had undergone an inpatient treatment programme and who had been followed up post discharge. Ethical clearance was obtained from the University of the Western Cape Higher Degrees Committee. Written permission was granted by the treatment centre who is the original data owner.The majority of participants were male. More than half of the sample reported polysubstance use and, for more than half of them, the age of onset of substance use was between 11 and 15 years. Severe depression was present for more than a third of the participants, whilst the majority of the sample was assessed as being substance dependent. A large proportion of patients had family members who also used substances. The majority of the sample was unemployed and more than half had received previous substance abuse treatment. Significant associations were not established between the identified variables within the groups of factors. Additional studies are required to explore the factors contributing to relapse in this patient population. / Magister Artium (Psychology) - MA(Psych)

Thesis advisor: Barbara E. Wolfe / Despite the chronicity and less than optimal outcomes of inpatient treatment (IPT) for anorexia nervosa (AN), treatment guidelines continue to reflect the common notion of one-size-fits-all and the process of weight restoration continues to be poorly understood. Weight restoration, a primary goal of IPT for AN, does not occur in isolation but rather reflects an adaptation process within internal and external environments. It is unknown whether or not there are unique patterns of change in body weight that are associated with factors identified in the existing literature as being predictors of weight gain. The purpose of this study was to explore the extent to which patterns of change in body weight existed among individuals during IPT for AN, and the relationship with factors identified in the existing literature as being predictors of weight gain (i.e., age at time of admission, admission caloric intake, percent of ideal body weight [IBW] at time of admission, body weight at time of discharge, body mass index [BMI] at time of discharge). Individuals who were diagnosed with AN and admitted to the inpatient unit of an eating disorder treatment facility in the Northeast between January 1, 2012 to December 31, 2015 were included in this retrospective, exploratory study (N = 500). Group-based trajectory modeling (GBTM) was used to identify distinct trajectories of change in body weight, and to determine the risk of being in a particular trajectory. Four distinct trajectories were identified: weight gain (n = 197), weight loss (n = 177), weight plateau (n = 82), and weight fluctuate (n = 44) groups. Significant predictors of trajectories were age, history of prior IPT for AN, admission caloric intake, body weight at time of admission and discharge, and length of stay. Results from this study suggest that a further understanding of patterns of change in body weight among individuals with AN, will help guide assessment and treatment interventions and consequently influence outcomes. Additionally, there is an opportunity to update treatment guidelines and recommendations for AN. / Thesis (PhD) — Boston College, 2016. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

Os transtornos alimentares (TA) são doenças graves de etiologia multifatorial, que cursam com alterações importantes no comportamento alimentar e complicações clínicas como desnutrição e distúrbios hidroeletrolíticos, além de comorbidades psiquiátricas. A hospitalização integral é uma modalidade terapêutica indicada quando o seguimento ambulatorial não atinge resultados satisfatórios associados à piora dos sintomas. O objetivo deste estudo foi descrever as características e resultados da hospitalização dos pacientes com TA atendidos pelo Grupo de Assistência em Transtornos Alimentares do Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto-USP. Dados antropométricos, bioquímicos e clínicos foram coletados a partir da revisão de prontuários dos pacientes internados durante o período de 1982 a 2011. Como resultado, observou-se que das 186 pessoas que receberam atendimento pelo serviço, 44,6% deles (n=83) necessitaram de no mínimo, uma internação durante o tratamento. A predominância foi do sexo feminino (95,2%), da raça branca (94%), solteira (76%) e sem filhos (78,3%). Cursavam o ensino médio (50,6%) com idade de 23,3±10,8 anos. O diagnóstico era de anorexia do tipo restritivo (AN-R) para 54,2% (n=45) deles, 31,3% (n=.26) apresentavam anorexia do subtipo compulsão periódica/purgativo (AN-CP) e 14,5% (n=12) tinham bulimia nervosa (BN). A média de internações foi de 1,9±3,9 vezes sendo que 73,5% (n=61) dos pacientes foram internados apenas uma vez, por 41,2±37,6 dias. Para aqueles que precisaram dessa modalidade de tratamento por mais de uma vez, a duração da hospitalização, considerando todas as internações, foi de 70,6±115,9 dias com extensa variação (3 a 804 dias). Não foi observada associação entre o número de internações com o Índice de Massa Corporal (IMC) e com o tempo de sintomas antes do diagnóstico. O IMC dos pacientes mudou significativamente (p<0,05) durante a internação (para o grupo com AN-R: de 13,5kg/m2 para 14,8kg/m2 ; para os com AN-CP: de 15,7kg/m2 para 16,9kg/m2 ; naqueles com BN: de 22,0kg/m2 para 21,0kg/m2 ). A amenorréia esteve presente em 69% (n=45) das mulheres, sendo mais frequente naquelas com AN-R (65,1%). Dos 23 pacientes (27,7%) que realizaram o exame de densitometria óssea, 44,4% (n=10) apresentam osteopenia e 29,7% (n=7) osteoporose. Os valores médios da maioria dos parâmetros bioquímicos avaliados estavam dentro da normalidade, com exceção do beta-caroteno, que encontrava-se elevado, tanto no início quanto no final da internação. A Nutrologia foi a enfermaria na qual a maioria das internações ocorreu (79,5%) e a necessidade de terapia nutricional foi a indicação mais frequente (62,3%). A via de administração de nutrientes preferencialmente utilizada foi a via oral (67,5%), apesar de ter sido observado aumento de 2,3 vezes na escolha da terapia nutricional enteral exclusiva nos pacientes que foram internados mais de uma vez. O acompanhamento multidisciplinar foi evidenciado, pois além do médico, houve a participação maciça de nutricionistas (87,9%) e psiquiatras (72,3%). Como conclusão, a hospitalização integral é uma modalidade bastante indicada no tratamento de pacientes com TA, mas sua duração é prolongada e requer a assistência de diversos profissionais. No entanto, quando indicada a partir de critérios bem estabelecidos proporciona melhora no estado nutricional. Futuros estudos são necessários para ampliar e aprofundar os resultados encontrados possibilitando o aprimoramento de condutas terapêuticas. / Eating disorders (ED) are serious diseases with multiple etiologies that course with major changes in eating behavior and clinical complications such as malnutrition and electrolyte disturbances, and also psychiatric comorbidities. Inpatient treatment is a modality of treatment used when the outpatient follow-up did not reach satisfactory results associated with worsening of clinical status. The aim of this study was to describe the characteristics and outcomes of the hospitalization in patients with ED who were treated by Assistance Group on Eating Disorders from the Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto - USP. Anthropometric, biochemical and clinical data were collected from the medical records of patients admitted between 1982 and 2011. It was observed that among 186 patients attended by the service, 44.6% (n = 83) required at least one inpatient treatment. Most patients were female (95.2%) and white (94%). The majority was single (76%), with no children 78.3%) and were high school students (50.6%). The mean age was 23.3± 10.8 years old. According to the diagnosis, 54.2% of patients had anorexia nervosa, restricting subtype (AN-R), 31.3% had anorexia nervosa binge-eating/purging subtype (AN-CP) and 14.5% had bulimia nervosa (BN). The mean age at admission was 23.3 ± 10.8 years (range 8-58 years), 73.5% of patients were hospitalized only once. The mean number of admissions was 1.9 ± 3.9 times and 73.5% (n=61) were hospitalized only once, during 41.2 ± 37.6 days. For those who needed this type of treatment more than once, the length of stay, considering all admissions, was 70.6 ± 115.9 days with extensive variation (3-804 days). No associations were observed between the number of hospitalizations and Body Mass Index (BMI) and duration of symptoms before diagnosis. The BMI of the patients changed significantly (p <0.05) during hospitalization (for the group with AN-R, from 13.5 kg/m2 to 14.8 kg/m2 ; for AN-CP: 15.7 kg/m2 to 16.9 kg/m2 , those with BN: from 22.0 kg/m2 to 21.0 kg/m2 ). Amenorrhea was present in 69% (n = 45) women, most frequently in those with AN-R (65.1%). According to exam of bone densitometry of 23 patients (27.7%), 44.4% (n=10) had osteopenia and 29.7% (n=7) had osteoporosis. The mean values of most biochemical parameters were within normal limits, except for beta- carotene, which was above the normal range, both in admission and discharge. The Nutrology was the infirmary where the majority of hospitalizations occurred (79.5%), nutritional support was the most frequent indication for hospitalization (62.3%). The route of administration of nutrients preferably used was oral (67.5%), although it has been observed an increase at 2.3 times on exclusively enteral feeding in patients admitted more than once. The multidisciplinary team reveals, besides the doctor, the massive presence of dietitians (87.9%) and extensive involvement of psychiatrists (72.3%). It is concluded that inpatient treatment is needed in patients with ED, often shows prolonged duration and requires the assistance of various professionals. However, when indicated based on criteria well established can provide improvement in nutritional status. Future studies are needed to broaden the results enabling the improvement of therapeutic approaches.

Aggressive or explosive behaviors in children typically occur within the context of a variety of psychiatric diagnoses and pose additional challenges when children present with histories of abuse. These behaviors are often interpreted as deliberate or noncompliant and management of these extreme behaviors often results in locked seclusion in most inpatient psychiatric settings. Locked seclusion remains controversial at best and raises legal and ethical issues regarding its safe and therapeutic use. &lt;br&gt;This retrospective quantitative study evaluated the effectiveness of the Collaborative Problem-Solving (CPS) approach as a less restrictive behavioral intervention on an inpatient child psychiatric unit with children ages 5-12 years that introduced the CPS approach during a nine month performance improvement project from July 1, 2006 - March 31, 2007. This study sought to determine what variables, if any, impacted the use of locked seclusion before, during, and after CPS implementation and whether children with histories of abuse were placed in locked seclusion at a significantly different rate relative to admissions of children who did not have histories of abuse. Erik Erikson's Theory of Psychosocial Development served as the theoretical framework.&lt;br&gt;The closed medical record review involved 197 admissions and 167 children. All data were analyzed in two parts: the entire nine month period of 197 admissions and by time period, based on when the CPS intervention was introduced and implemented on the unit. &lt;br&gt;Length of stay was the only variable statistically significant during the nine month period (n=197) and third time period of January -March 2007 (n=65) when CPS was fully implemented and assessed. This finding suggests that a child's longer length of stay may have had a relationship with being placed in locked seclusion. When length of stay was controlled as an influence with history of abuse, the variable of interest for this study, children with histories of abuse for the nine month period were not significantly more likely of being placed in locked seclusion than children without histories of abuse; for the third time period, they were found to be almost eight times less likely of being placed in locked seclusion with an odds ratio of 7.81.&lt;br&gt;Although these findings suggest a favorable response to the CPS approach and that behaviors associated with traumatized children were normalized to that of their peer group, the results must be considered with caution. There were many limitations to the initial project and any inferred success with abused children and the CPS approach is based on statistical outcomes only. Other variables not measured or controlled must be considered as potential influences that may have impacted these outcomes. As such, future research evaluating CPS effectiveness with traumatized children is recommended. / School of Nursing; / Nursing / PhD; / Dissertation;

Disertaciniame darbe nagrinėjama depresija sergančių asmenų savijauta ir subjektyvus gyvenimo vertinimas stacionarinio gydymo laikotarpiu, šių reiškinių sąsaja bei pokyčiai gydymo metu. Siekiama atskleisti subjektyvaus asmens savo ligos ir sveikatos vertinimo svarbą prognozuojant sveikimo nuo depresijos rezultatus. Darbe siekiama detaliai išanalizuoti depresija sergančių asmenų savijautos struktūrą, taip pat patikrinti prielaidą, kad subjektyvus gyvenimo vertinimas gali būti laikomas psichikos sveikatos išteklių rodikliu. Teorinėms darbo prielaidoms patikrinti gydymo pradžioje ir pabaigoje buvo ištirti 195 depresija sergantys asmenys besigydantys psichiatrijos stacionare, naudojant klausimyną depresijos pokyčiams vertinti (Pranckevičienė, Goštautas, 2007), Pasaulinės sveikatos organizacijos gyvenimo kokybės klausimyną (PSOGK – Trumpas) ir kitas papildomas metodikas. Statistinė rezultatų analizė atskleidė, kad depresija sergančių asmenų savijauta yra daugiakomponentė ir psichologinių bei somatinių savijautos komponentų išskyrimas yra naudingas analizuojant depresija sergančių asmenų sveikimą stacionarinio gydymo laikotarpiu. Subjektyvus gyvenimo vertinimas neprognozuoja gydymo rezultatų, tačiau yra tinkamas subjektyvus visuminės sveikatos matas, nes gerai parodo funkcines ir kognityvines depresijos pasekmes, t.y. pasikeitusį suvokimą. Tyrimas iliustruoja psichologinės pagalbos svarbą stacionarinio depresijos gydymo laikotarpiu. / The study analyses patients’ subjective complaints and subjective evaluation of life, and seeks to evaluate changes and relationships of these phenomena during inpatient treatment of depression, stressing the importance of subjective experience in understanding the burden of the illness, resources for recovery and treatment outcomes. The study seeks to analyze the structure of depressed patients’ subjective complaints, as well as to evaluate the utility of the subjective evaluation of life for treatment outcome evaluation. 195 depressed inpatients were assessed at the beginning of the treatment and at the time of discharge, using measures of subjective depressive complaints (Pranckevičienė, Goštautas, 2007), subjective quality of life (WHOQOL-Bref) and other clinical and social-demographic data. The results of the study show that additional attention to psychological and somatic components of patients’ subjective complaints is useful and compliments the analysis of depressed inpatients’ recovery process. The subjective evaluation of life should be interpreted as a more generic measure of consequences of depression, but not as a measure of depressed inpatient’s recovery resources. The results validate the need of psychological interventions during inpatient treatment.

The study analyses patients’ subjective complaints and subjective evaluation of life, and seeks to evaluate changes and relationships of these phenomena during inpatient treatment of depression, stressing the importance of subjective experience in understanding the burden of the illness, resources for recovery and treatment outcomes. The study seeks to analyze the structure of depressed patients’ subjective complaints, as well as to evaluate the utility of the subjective evaluation of life for treatment outcome evaluation. 195 depressed inpatients were assessed at the beginning of the treatment and at the time of discharge, using measures of subjective depressive complaints (Pranckevičienė, Goštautas, 2007), subjective quality of life (WHOQOL-Bref) and other clinical and social-demographic data. The results of the study show that additional attention to psychological and somatic components of patients’ subjective complaints is useful and compliments the analysis of depressed inpatients’ recovery process. The subjective evaluation of life should be interpreted as a more generic measure of consequences of depression, but not as a measure of depressed inpatient’s recovery resources. The results validate the need of psychological interventions during inpatient treatment. / Disertaciniame darbe nagrinėjama depresija sergančių asmenų savijauta ir subjektyvus gyvenimo vertinimas stacionarinio gydymo laikotarpiu, šių reiškinių sąsaja bei pokyčiai gydymo metu. Siekiama atskleisti subjektyvaus asmens savo ligos ir sveikatos vertinimo svarbą prognozuojant sveikimo nuo depresijos rezultatus. Darbe siekiama detaliai išanalizuoti depresija sergančių asmenų savijautos struktūrą, taip pat patikrinti prielaidą, kad subjektyvus gyvenimo vertinimas gali būti laikomas psichikos sveikatos išteklių rodikliu. Teorinėms darbo prielaidoms patikrinti gydymo pradžioje ir pabaigoje buvo ištirti 195 depresija sergantys asmenys besigydantys psichiatrijos stacionare, naudojant klausimyną depresijos pokyčiams vertinti (Pranckevičienė, Goštautas, 2007), Pasaulinės sveikatos organizacijos gyvenimo kokybės klausimyną (PSOGK – Trumpas) ir kitas papildomas metodikas. Statistinė rezultatų analizė atskleidė, kad depresija sergančių asmenų savijauta yra daugiakomponentė ir psichologinių bei somatinių savijautos komponentų išskyrimas yra naudingas analizuojant depresija sergančių asmenų sveikimą stacionarinio gydymo laikotarpiu. Subjektyvus gyvenimo vertinimas neprognozuoja gydymo rezultatų, tačiau yra tinkamas subjektyvus visuminės sveikatos matas, nes gerai parodo funkcines ir kognityvines depresijos pasekmes, t.y. pasikeitusį suvokimą. Tyrimas iliustruoja psichologinės pagalbos svarbą stacionarinio depresijos gydymo laikotarpiu.

Abstract Ensuring of Respite Care Services in the Česká Lípa Region after Releasing of Patients from Hospital The goal of this thesis is to map the scope, the quality and further relationships of respite care in the Česká Lípa region in case of patients released from hospitals for whom a respite care is indicated, to find shortcomings of the systém and to propose optimal solutions of problems. There were two hypotheses set: H1: Sufficient respite care services are not provided to clients at weekends, H2: Consecutive respite care is not duly indicated by physicians to all clients released from hospitals who need it. The theoretical part of the thesis describes characteristics of respite care, its meaning and the process of ins development. The research was carried out trough the questioning method, using questionnaires and anasysis of documents. The other part of the thesis presents the results of performed quantitative research. These results were acquired by means of evaluation of questionnaires. The anasysis of acquired data confirmed both the supposed hypotheses. The discussion elucidates some problems related to the given theme and the conclusion of the thesis recommends some measures to improve the quality and continuity of providing the respite care services in the Česká Lípa region. The results of the thesis may inspire the existing as well as newly established respite care agencies to increase the quality of respite care.