Mental major illness, including psychotic disorders and mood disorders, has been linked to early prenatal/childhood factors and subsequent behavioral health concerns. For example, Watson et al. (1999) found that maternal illness and extreme stress during pregnancy disrupts fetal brain development, increasing the likelihood of depression or schizophrenia in later life. Research has also shown a dose-response effect between the number of adverse childhood experiences (ACEs) and mental health outcomes, with increasing ACEs linked to more severe mental health problems and suicide attempts (Merrick et al., 2017). Persons with major mental illness, like schizophrenia or bipolar disorder, are also at increased risk of suicidal and self-harm behaviors (Happell et al., 2012; Morden et al., 2009). These individuals also demonstrate a higher rate of substance use (Linszen et al., 1995) that often contributes to poor medical health (Dixon et al., 2000; Jeste et al., 1996). The current study sought to differentiate adolescents with and without major mental illness (i.e., psychotic or mood disorders) by investigating a sample of youth who were in a residential treatment facility for sexually abusive behaviors (N = 296). Data related to participants’ prenatal/birth concerns, ACE scores, history of suicide attempts and self-harm, and use of alcohol, tobacco, marijuana, and inhalants were gathered from archival records. Results indicated that there were a number of adolescents diagnosed with a psychotic disorder (n = 33) or mood disorder (n = 189). Two separate logistic regressions assisted with differentiating adolescents with and without psychotic or mood disorders using the specified predictors. A significant model (χ2 = 94.910, Nagelkerke’s R2 = 0.412, p < 0.001) correctly classified 76.4% of participants with a mood disorder. Adolescents with a mood disorder were 4 times as likely to have had prenatal or birth concerns (OR: 4.404, p < 0.001), and were significantly more likely to have higher ACE scores (OR: 1.148, p =.024). Further, those with a mood disorder were 2.5 times as likely to have self-harmed (OR: 2.673, p=.009), and approximately 23 times more likely to have attempted suicide (OR: 22.858, p=.003). Another significant model (χ2 = 29.842, Nagelkerke’s R2 = 0.210, p < 0.001) correctly classified 88.3% of participants with a psychotic disorder. Adolescents with a psychotic disorder diagnosis were significantly more likely to have higher ACE scores (OR: 1.237, p =.020), and were 4 times as likely to have a self-harm history (OR: 4.474, p=.005) compared to those without a psychotic disorder. Results indicate that prenatal/birth concerns appear to be a significant factor for those who are diagnosed with a mood disorder, but not with a psychotic disorder. Also, those with mood disorders, but not psychotic disorders, were more likely to have attempted suicide. Adolescents with either a mood or psychotic disorder both tended to self-harm and have experienced more ACEs. Interestingly, substance use was not higher among adolescents with mood or psychotic disorders, despite predictions and previous research findings.

<div>Objectives: The Attribution Model of mental illness stigma posits that attributions about the causes and controllability of mental illness contribute to prejudicial emotional reactions, which in turn may lead to discriminatory behaviors towards people with mental illnesses. Given that people make different assumptions about different mental illnesses, if this model is correct, it suggests that specific diagnoses would elicit different types of stigma. Another important, but unexamined, predictor is extrinsic religious orientation, which correlates positively with other types of prejudice and may predict higher levels of mental illness stigma. The purpose of this study was to test the Attribution Model of stigma and examine the relationships between diagnosis, religious orientation, and stigma. </div><div>Methods: Participants (n = 334) were recruited via Amazon Mechanical Turk, randomized to read one of three vignettes about a person with a mental illness (i.e., schizophrenia, anorexia nervosa, depression), and completed measures of mental illness stigma, religious orientation and affiliation, familiarity with mental illness, and authoritarianism. Using latent variable path analysis, analysis of covariance, and multiple regression analyses, relationships in the Attribution Model of mental illness stigma were assessed, as well as the impact of diagnosis and extrinsic religiosity on specific aspects of stigma as measured by the Attribution Questionnare-27 subscales (i.e., blame, anger, pity, danger/fear, avoidance, segregation, and coercion). </div><div>Results: Assessment of the Attribution Model indicated moderate overall model fit after respecification. Path coefficients indicated strong relationships between variables that were generally consistent with paths predicted by the model. One notable exception was that feelings of pity were not associated with greater helping behaviors. Analysis of covariance suggested that diagnosis was a key predictor of stigma, and that schizophrenia was the most stigmatized. Multiple regression analyses revealed that extrinsic religiosity was also an important predictor of stigma; extrinsic religiosity appeared to increase certain types of stigma, and moderate the relationship between diagnosis and stigma overall. </div><div>Discussion: Although the respecified Attribution Model fit the data fairly well, the findings suggest that either the scale or the model would benefit from further refinement. Results support prior evidence that severe mental illnesses like schizophrenia are more stigmatized than other diagnoses. Extrinsic religiosity was also predictive of increased stigma, both directly and indirectly. As a moderator, extrinsic religiosity may decrease the impact of diagnosis on stigma, raising stigma for diagnoses perceived as more “controllable” (i.e., anorexia nervosa, depression) such that levels were similar to schizophrenia. Limitations and suggestions for future research are discussed. </div><div><br></div>

Stand-up comedy represents a particularly potent form of rhetorical and performative criticism because of its potential duality. On the surface, a comedy set can look breezy and entertaining while containing a sharper, more critical message underneath. Like a fluffy, besprinkled cupcake hiding a potent antibiotic, stand-up comedy offers potentially healing insight under the cover of whimsy. Comedians have always utilized their performances to skewer those in power, but an increasing number have taken to the stage recently to address a particularly insidious social and cultural malady. The stigma associated with mental illness continues to limit the opportunities of those living with mental disorders, meaning comedians utilizing their performances to push back against this stigma represent a significant form of anti-mental-illness-stigma advocacy. In this dissertation, I argue that stand-up comedy is a uniquely subversive and resistant communicative act that enables performers to combat the stigma associated with mental illness. Grounding my discussion in literature about mental illness and two of the most common disorders, anxiety and depression, I construct an original performance criticism evaluative framework derived from three anti-stigma-advocacy techniques: protest, educate, and contact. While these techniques offer guidance for any kind of anti-stigma advocacy, I draw them into the realm of anti-mental-illness-stigma advocacy by utilizing my framework in a performance criticism of stand-up performances by Aparna Nancherla, Maria Bamford, Bo Burnham, and Chris Gethard—four comics known for discussing their mental health onstage. Moreover, I weave autoethnographic responses to each performance throughout my analysis to showcase the power of these cases of comedic anti-mental-illness-stigma advocacy to alter my perspective on my own anxiety.Ultimately, this dissertation demonstrates the potential of stand-up comedy as anti-mental-illness-stigma advocacy by chronicling my own growth in response to the work of these comedians. It also identifies aspects of stand-up that may be potentially useful to other kinds of anti-stigma advocacy. Additionally, the framework created and used in this dissertation provides both a rubric for future anti-stigma performance criticism and a blueprint for creating anti-stigma performance. Stand-up comedy is a significant performance genre and stand-up comedians can launch biting critiques that cultivate greater cultural citizenship for the marginalized and disenfranchised. A significant number of people will undoubtedly continue to spot the silly facade of stand-up comedy and look past the deeper insight, even though it can educate an audience, protest misinformation, and provide opportunities for contact between otherwise unfamiliar demographics. My effort here is to value stand-up comedy as a powerful communicative act because it has changed my life and will continue to incite change for many others. And that’s no joke.

The purpose of this study was to identify individual characteristics and school experiences of youth with serious emotional disturbance (SED) that may influence their postsecondary employment status.

Thesis (M.A. (Clinical Psychology)) -- University of Limpopo, 2020 / Mental illness is one of the major health challenges that significantly contribute to the global burden of diseases worldwide. Several studies reveal that mental illness often triggers or prompts people to embark on some help-seeking pathways in order to ameliorate their condition. These help-seeking pathways are often not linear routes, but rather recursive and complex. The aim of the study was to explore the pathways followed by caregivers of mentally ill persons seeking mental health care services in Sinthumule Kutama area. The objectives of the study were: a) to examine the experiences of caregivers in caring for persons suffering from mental illness; b) to explore pathways that caregivers often engage in when they are seeking treatment options for mentally ill patients before and/or after they have been diagnosed with their condition; and, c) to find out whether or not caregivers make use of other forms of management in addition to the formal treatment interventions that they may receive from the health care facilities. A qualitative approach was followed; and participants were selected through a snowball sampling method. The sample comprised twelve participants (female=11; Male=1) residing in and around the Sinthumule-Kutama District area, Limpopo Province. The participants’ ages ranged from 24 to 88 years. The data was collected using in-depth, semi-structured individual interviews and analysed using interpretative phenomenological analysis (IPA). The following themes emerged from the study: a) the perceived causes of the mental illness; b) the pathways followed in the management of mental illness; and c) the use of alternative forms of management interventions. The findings of this study revealed that the participants hold different perceptions and beliefs about the probable causes of mental illness. Secondly, the study further revealed that the participants visited a number of alternative management agencies to seek treatment for their mentally ill family members. Thirdly, the pathways that were followed were influenced by several factors such as the perceived cause of the illness, religious or cultural beliefs, severity of symptoms and/or advice from general practitioners and school teachers. This clearly suggests that participants have made use of more than one service provider to seek help for their family members. The path either started with the formal setting, then moved to the informal setting and vice versa. For instance, as soon as individuals with mental illness are discharged from the hospital, the caregivers consulted with other alternative service providers mainly to enhance the treatment they have received for protection from evil forces. The results suggest that help-seeking behaviour and the pathways chosen in the management of mental illness are largely influenced by socio-cultural factors and beliefs about the causes of the disease.

Introduction: Severe mental illness (SMI), Human immunodeficiency virus (HIV) infection and hazardous alcohol use are global epidemics. Each condition is independently associated with significant adverse health outcomes. The presence of two or more of these conditions in one individual may result in worse health outcomes. A key mediator of poor health outcomes are factors such as medication adherence. In resource-limited countries like South Africa, the impact of psycho-social factors may contribute further to worse health outcomes. These factors include poverty and unemployment; as well as gender. In South Africa, proportionately more women are infected with HIV than men; and they are also vulnerable to the problems of trauma and interpersonal violence. The main aim of this study was to investigate the prevalence of a triple co-morbidity of SMI, HIV infection and hazardous alcohol use in a female population at a community psychiatric clinic in Cape Town South Africa; and the impact of this triple comorbidity on medication adherence. Furthermore, we set out to identify demographic and clinical variables that are predictors of poor adherence to both psychotropic medication and ART where applicable. Methods: We conducted a cross-sectional study of female patients presenting to Gugulethu psychiatric clinic over a ten-month period. Demographics and clinical variables were explored using the Alcohol Use Disorders Identification Test (AUDIT); the adapted Morisky Scale to Assess Adherence to Psychotropic Medications; and an adherence to HIV antiretroviral treatment self-assessment instrument. A descriptive analysis of the demographic and predictor variables was undertaken to explore the prevalence of concurrent HIV infection and hazardous alcohol use in out-patients with SMI; as well as to investigate whether co-morbidity is associated with poor levels of adherence to psychotropic medication, as well as antiretroviral treatment (ART) in HIV positive patients. Results: We interviewed 127 patients, of whom 55 were HIV positive (43.3%). The overall prevalence of a triple comorbidity in this population was 7.9%. Only 20% within this triple comorbidity group were adherent to their psychotropic medication. Out of the 10 participants with a triple comorbidity, only five were on ART. Of these 5 participants, only two were adherent. Individuals with hazardous alcohol use were less adherent to psychotropic medication compared to those without. The seven respondents in the dual diagnosis group (SMI and hazardous alcohol use) had the lowest overall psychotropic adherence levels compared to the other subgroups (0%). Furthermore, concurrent hazardous alcohol use predicted poorer levels of compliance to ART for those with HIV infection. Conclusion: The presence of a triple diagnosis was not found to be a predictor of poorer medication adherence, compared to having one or two diagnoses. Nevertheless, there was evidence that concurrent hazardous drinking in SMI patients predicted poor compliance to both psychotropic and ART treatment regimens (for those living with HIV). These patients should be supported in future interventions to improve medication adherence and reduce hazardous drinking.

More than ten million American adults live with a serious mental illness (SMI). Given the deinstitutionalization of psychiatric facilities, caregivers and family members are often needed to care for these individuals. Due to SMI individuals’ extensive needs, caregivers frequently face unique challenges and experiences. Although research has been conducted on caring for individuals with SMI, less information exists about the experiences of rural caregivers of SMI individuals. The purpose of this study was to fill this gap in research by exploring the lived experiences of caregivers of SMI individuals in rural areas with the intention of understanding this population’s unique needs. The research questions focused on the experiences and stressors of caregivers of SMI individuals in a rural community. The frameworks were critical theory and Bowen’s family systems theory. A qualitative phenomenological design study was used employing semi-structured interviews with 4 participants who are caregivers of SMI individuals in a rural New York area. Data from the interviews were coded and analyzed using thematic analysis. Four themes emerged: impact on relationships, thoughts and feelings, impact on caregivers’ well-being, and rural mental health in this area. The potential impact for social change includes the dissemination of information to rural clinicians to assist caregivers with needed support and offer a framework for future curricula.

The hippocampus is a brain structure known for its role in declarative memory- our ability to consciously recall facts and events. The hippocampus is a highly heterogeneous brain structure, and the small subregion CA2 has been shown to be necessary for the formation of social memories, the ability of an animal to recognize previously encountered conspecifics. Changes in excitatory/inhibitory balance have been observed in CA2 in humans with schizophrenia and in mouse models of schizophrenia, suggesting that these alterations may lead to some of the social dysfunction seen in schizophrenia. Although the hippocampal CA2 region has been implicated in social memory and neuropsychiatric disorders, little is known about how CA2 neural activity may encode social interactions and how this coding may be altered in disease. To see if and how CA2 codes for social interactions, I recorded extracellularly from CA2 pyramidal neurons as mice engage in a three-chamber social interaction task where the mice interact with the following task dimensions: space, novel objects, familiar social stimuli, novel social stimuli, and the passage of time. I found that whereas CA2 activity fails to provide a stable representation of space, unlike most other dorsal hippocampal subregions, it does code for contextual changes and for novel social stimuli. In Df(16)A+/- mice, which model the 22q11.2 microdeletion, a major schizophrenia risk factor, CA2 activity fails to encode context or social novelty, consistent with the deficit in social memory seen in these mice. In contrast, CA2 activity shows a surprising increase in spatial coding in Df(16)A+/- mice. These mice were previously shown to have a loss of inhibitory neurons within CA2, and a hyperpolarization of the CA2 pyramidal neuron resting potential. This hyperpolarization is likely due to upregulation of the outward rectifying TREK-1 K+ channel. I found that administration of a TREK-1 K+ channel antagonist rescued social memory and restored the normal CA2 coding properties in the mutants. These results demonstrate a crucial role for CA2 in the encoding of social stimuli and the expression of social memory, and suggest that dysfunction in CA2 may underlie deficits in social function seen in some forms of neuropsychiatric disease.

Magister Curationis / Undiagnosed and untreated medical illnesses are more predominant in patients with mental illnesses, compared to the general population. Concerns have risen about the observed lack of regular screening for Metabolic Syndrome potentially increasing the prevalence rate of the disease especially in young adolescents on anti-psychotics. Recognizing the recurrent co-morbidity between mental and physical health conditions, specific commendations addressing the physical conditions causing the increased morbidity and mortality of people with severe mental illness are needed. In some instances, treatment recommendations for the general population may need to be modified for people with SMI.

Thesis (M. A.(Psychology)) --University of Limpopo, 2019. / The aim of the present study was to investigate knowledge and attitudes of rural community members towards mental illness. A total of 249 participants were selected through simple random sampling from Dikgopeng community, Ga-Dikgale, through the Krejcie and Morgan’s (1970) table. A simple random sampling method was employed in selecting the participants. A quantitative cross-sectional research study was administered using the Mental Attitude Knowledge Scale (MAKS) and Attitude Scale of Mental Illness (ASMI). The MAKS and ASMI are structured 5-point Linkert scale questionnaires translated from English into Sepedi. Demographic data were collected and administered using the demographic questionnaire. The Statistical Package for the Social Science (SPSS) software package for Windows (Version 24) was used to analyse data collected and to draw conclusions from this. Two hypotheses were drawn from the study to help understand the aim of the study. Hypothesis one entailed that there is a significant difference in the level of knowledge towards mental illness by members of GaDikgale community, according to gender and age. According to the present study, there was a mean effect of gender with male participants being more knowledgeable about mental illness as compared to female participants. It was revealed that there was no effect of age on the knowledge scale. Hypothesis two detailed that there is a significant difference in attitudes on mental illness by members of GaDikgale community according to gender and age. From the study, there was a positive attitude towards people with mental illness by the older participants than there was with the younger participants. There was no effect of gender on attitudes towards mental illness. It is shown from the present study that within rural communities, with the majority (57%) of the participants being lay people, mental illness is regarded as a burden for the family, contributing to isolation and poor access to adequate western treatment. Reintegration after treatment and positive recovery is difficult because of lack of knowledge and negative attitudes towards individuals diagnosed with mental illnesses. The burdensome existence of stigmatisation is the consequence of ignorance or misinformation, prejudiced attitudes and or exclusion from normal forms of social participation (Thornicroft, Rose, Kassam & Sartorius, 2007).