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Background Methamphetamine induced psychosis (MAP) and schizophrenia present with similar positive symptoms of psychosis, are characterized by evidence of attentional impairment, and show symptomatic response to treatment with dopamine antagonists. At the same time, MAP is considered a transient condition, while schizophrenia can be conceptualized as a neurodevelopmental disorder. Despite advances in the neurobiology of these two conditions, the extent to which their underlying attentional neurocircuitry show overlaps or differences has not often been directly compared. This thesis compared MAP, schizophrenia and healthy controls, in order to examine overlap and differences in 1) subcortical regulation of cortical inhibition and excitability, 2) resting state cortical and subcortical connectivity, and the dynamics of rhythmic neural activity between states, and 3) cortical-cortical connectivity using event related potential (ERP) responses to stimuli with a continuous performance task (CPT). Methods Outpatients treated for MAP and schizophrenia were recruited through hospitals and psychiatric institutions in the Western Cape. A final cohort of 24 MAP and 28 schizophrenia and 32 healthy control participants were included in the analyses for this thesis. For the cortical silent period (CSP) paradigm, the participant was asked to maintain isometric contraction between the thumb and index finger while TMS pulses at 120% and 140% resting motor threshold (RMT) were delivered to the primary motor cortical area corresponding to the abductor pollicis brevis (APB). Parameters extracted from CSP data included the latency to motor evoked potential (MEP), MEP amplitude and CSP duration. Electroencephalographs (EEGs) were performed with bilateral prefrontal, frontal, frontal temporal, central and parietal electrode locations. Relative EEG frequency power data were extracted from 3 stages during the EEG session, including states of eyes open, eyes closed, and during performance of the CPT. The CPT consisted of a series of random consonant letters. Participants were asked to respond to the letter "S" with a finger press only if it was the 3rd consecutive occurrence. ERP data were extracted and averaged from consecutive cues (S1 and S2), target (S3) and distractor (individual "S") stimuli in the CPT task. ERP data were analysed for group differences in N100, P200, N200 and P300 amplitudes and latencies at each electrode location with sufficient signal quality. Results In the CSP protocol, MAP and schizophrenia groups showed smaller MEP amplitudes at both 120% and 140% RMT stimulation levels in comparison to controls. Both MAP and schizophrenia groups had lower alpha and higher delta relative frequency band power, with schizophrenia showing significant differences from controls at more electrode positions than MAP. While controls demonstrated a decrease in alpha power between the eyes closed and eyes open resting states, this did not occur in MAP or schizophrenia. During the CPT, both MAP and schizophrenia achieved fewer correct targets and showed slower reaction times than healthy controls. In addition, MAP responded more often than the other two groups to the S2 stimulus (which required response inhixii Abstract bition). ERP analysis found smaller N100, larger P200, larger N200 and larger P300 amplitudes in MAP in response to stimuli requiring inhibition than in schizophrenia and controls, whereas schizophrenia showed longer P300 latencies in response to the target and distractor stimuli than in MAP and controls. Conclusions MEP results suggest that MAP and schizophrenia may have similar subcortical dysregulation, suggestive of altered dopaminergic regulation in the basal ganglia-thalamus-cortex loop. EEG frequency power results suggest that MAP and schizophrenia both display an inflexibility of subcortical systems involved in adaptation to environmental changes, suggesting deficiencies in the CT-TRN-TC loop in both MAP and schizophrenia. CPT performance and the pattern of ERP alterations in MAP suggests greater cholinergic impairment during attentional performance in MAP than in schizophrenia. Taken together, while there is considerable overlap in cortical-subcortical inhibition and connectivity in MAP and schizophrenia, there are also important differences; findings that emphasize both the similarities and dissimilarities that are seen clinically.

Schizophrenia and other severe mental illnesses (SMI) often have adverse effects on work functioning. However, most research on employment in people with SMI has been conducted in developed countries and much less is known about work patterns and interest in work in people with SMI living in developing countries, including India. Moreover, treatment for SMI in developing countries is largely limited to pharmacotherapy; psychosocial interventions including vocational rehabilitation are rarely available. A comprehensive understanding of employment in people with SMI living in developing countries would inform the development of vocational services for this population. Therefore, a series of three studies were conducted as part of this dissertation with the goal of evaluating rates of employment, interest in employment, perceived benefits of work and problems related to work among employed participants, perceived barriers and desired job supports among unemployed participants, and to examine stability and change in work status and interest in work over a one-year period. In Study 1, interviews were conducted with 550 people with SMI receiving psychiatric outpatient services at two private hospitals in two different districts in the state of Maharashtra in western India. The results were that 60.9% of participants were working, with employment rates being significantly higher in men than in women (79.4% vs. 35.9%). In addition, the rates of work were higher in people who were living in rural areas compared to those living in urban areas (77.8% vs. 48.9%). The majority of employed participants living in rural areas were working in family operated businesses such as farming, while work for independent employers was more common in urban areas. Among the participants who were working for independent employers, more than 45% obtained jobs through their family or friends. Interest in work was high (77.4%) among unemployed participants and the majority indicated wanting help with their job search and with managing their mental illness. Social norms related to gender specific roles in Indian society, in which men are expected to be primary wage earners, and the involvement of families in employment may have contributed to high work rates in this study. The strong interest in work among unemployed participants suggests that the deployment of vocational services for people with SMI in India could improve employment rates. Study 2 was a one-year follow-up of participants in Study 1 to evaluate stability and change in employment status and interest in work. A total of 459 (83.5%) participants completed follow-up interviews, of whom 62.9% were employed at follow-up, compared to 60.9% at the baseline assessment. Employment status was highly stable over the one-year period, with 56.4% working at both assessments and 32.4% not working at either assessment. Among the participants who were working at both assessments, more than 80% of were employed in the same job, for an average period of 10 years. Among the participants who were unemployed at baseline, 16.9% began working at follow-up. Although interest in work among those who were unemployed was lower at follow-up than baseline (62.8% vs. 73%, respectively), 58.1% expressed a consistent interest in work across both assessments. The most commonly desired job supports for unemployed participants were assistance with finding a job and help with mental illness management. The findings suggest that the work status of people with SMI in India is stable over a period of one year. The majority of participants who wanted to work at baseline remained unemployed at follow-up but still wanted to work, suggesting that vocational rehabilitation programs for people with SMI in India could improve their employment functioning. Study 3 employed the same methods used in Study 1 to collect data from 150 participants with SMI who were receiving psychiatric outpatient services from a public hospital located in the same predominantly urban district in the state of Maharashtra as the private hospital in Study 1. This study was aimed at evaluating employment functioning in people with SMI receiving public outpatient psychiatric services as compared to those receiving private outpatient treatment in Study 1 based on the assumption that people with lower economic means would be more likely to receive treatment at a public hospital. The results of this study were that 40% of participants were working, which was slightly lower than the 48.9% employment rate in urban areas in Study 1, and much lower than rates of employment in the general population. The majority of participants were working for independent employers, similar to the employed participants urban areas in Study 1, who found their jobs with the help of family and/or friends. Over 90% of the unemployed participants expressed interest in work (compared to 79% in urban areas in Study 1), and most of them wanted help finding a job and coping with their mental illness. The slightly lower rates of work in this study compared to Study 1 may be related to the smaller proportion of participants who were working in family businesses than in Study 1 (5% vs. 13%, respectively), and greater severity of illness, as suggested by the higher proportion of participants with schizophrenia-spectrum disorders than Study 1 (90% vs. 66.2%, respectively), and a greater proportion of participants with a history of psychiatric hospitalization than Study 1 (89.3% vs. 49.5%). The findings indicate that there are significant levels of unemployment among people with SMI living in urban areas in India who are receiving publicly funded treatment, and a very high interest in work. The findings provide further support for the need for interventions designed to improve employment functioning in people with SMI living in India. Taken together these three studies indicated that while rates of work in people with SMI in India are higher than rates reported in developed countries, significant unemployment is still present, especially in urban areas. Furthermore, most unemployed persons want to work. Work status was relatively stable over time, as was the strong interest in work among unemployed participants. A high proportion of participants endorsed the need for work supports related to the job search and illness management across the three studies, suggesting the need for vocational rehabilitation services that are culturally tailored for Indian society. / 2021-09-25T00:00:00Z

Graduate school is a high stress situation due to the need of fulfilling expectations while balancing various personal, professional, and educational obligations. As a result, graduate students are especially susceptible to mental health conditions during their educational journey. Take a Stability Equilibrium Course (Take a SEC) was developed as an adaptable 11-week prevention program focused on providing support and mental health education during a graduate student’s first semester. Take a SEC can be purchased by university graduate programs. This cost includes materials and guided demonstration instructions, one-on-one problem solving with the program developer, and a team to determine short-term and long-term outcomes. This program is ideal for universities due to its affordable costs and ability to customize the program to fit the cohort’s needs with virtual or in-person methods. Although Take a SEC has several goals, ultimately this program aims to decrease negative stigmas towards mental illness and encourage peers to seek care earlier or help others struggling with their mental health to decrease the rates of dropouts, hospitalizations, and suicides in this population. This program has the opportunity and theoretical basis to reverse the growing trend of mental health conditions in graduate students. With university support, proper funding, and accessibility, Take a SEC will have the power to help individuals achieve their academic endeavors and overcome challenges during their university journey and beyond.

Emerging evidence indicates that the prevalence of child and adolescent psychiatric symptoms and disorders increased in the twenty-first century. However, few studies have focused on recent time trends in the prevalence of anxiety disorders among United States (US) children and adolescents specifically. Relatedly, an open question in the field is what factors are driving increases in reported mental health symptoms and disorders, including anxiety, among US youth. To this end, this study uses data from the National Survey on Children’s Health, a nationally representative cross-sectional survey of US parents and caregivers, to assess recent temporal trends in anxiety disorders among US children and adolescents. This study also tests associations between multiple social ecological factors (i.e., socioeconomic status, physical health, family composition, parental mental health, and neighborhood disadvantage) and youth anxiety at each survey year. Overall, results indicated that among US 6 to 17-year-olds the prevalence of parent-reported lifetime anxiety or depression increased from 5.4% to 8.3% between 2003 to 2011/12. The estimated prevalence of parent-reported lifetime anxiety rose from 10.0% to 11.5% between 2016 and 2018 among US children and adolescents aged 6 to 17. The estimated prevalence of parent-reported current anxiety increased from 8.5% to 9.5% between 2016 and 2018. Additionally, several socioecological factors at the individual- and family-level were associated with youth anxiety at each survey year. Results suggest that ongoing collaboration amongst parents/caregivers, physicians, mental health providers, and school staff might help identify at-risk youth, as well as inform the need for effective prevention and intervention strategies and guide best practices for these strategies.

BACKGROUND: Adolescents exposed to substance-related content online appear to have higher rates of substance use; youth with a history of Problematic Internet Use (PIU) also may be more likely to struggle with substance use. There is limited data examining what types of digital media may be more significantly associated with use of substances, or whether youth with active PIU symptoms are more likely to use substances. This study used smartphone-based ecological momentary assessment to gather pilot data on potentially relevant relationships between PIU, digital media exposures, and substance use. METHODS: Youth aged 13-23 were recruited from outpatient mental health clinics at Cambridge Health Alliance. Participants used the app MindLamp for 6 weeks to record daily substance use, online exposures to drug-related content, PIU (via the PIU-SF-6 screen), and most frequently used apps or websites that day. Digital media content was extracted from daily iPhone screen time reports. Multilevel mixed effects regression models were used to analyze data, controlling for random effects at the level of the participant. RESULTS: The pilot study recruited 26 participants (61.5% female, mean age 15.96). There was a significant positive correlation between PIU score and the active urge to use substances; however, controlling for urge to use substances and online substance-related exposures, PIU scores were significantly lower on days with reported substance use. Days with frequent use of direct messaging social media platforms were associated with greater risk for both exposure to substance-related content online and substance use. Substance use was specifically linked to viewing social media posts where peers had disclosed their own substance use. CONCLUSION: Use of social media platforms that allow for direct messaging appear to be associated with a greater risk of both exposure to substance-related content and substance use. Our data also suggest that excessive Internet use may actually represent a coping skill to avoid engagement in substance use. More highly powered longitudinal studies are needed to confirm and expand upon our findings. / 2025-02-26T00:00:00Z

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