The diploma is about the topic of multidisciplinarity in community care of people with mentally illness. I chose this topic because I meet clients who have lived for various periods of time knowing that they suffer of mental illness. Over time, I began deeply perceive how mental illnesses affect all areas of client's lives. In the modern sense of community-based psychiatric services, multidisciplinary cooperation should become a provider of more comprehensive, better quality and more effective services for people with mental illness who require health care, but also social care that facilitates inclusion in the society of people who suffer of mental illness. Multidisciplinary collaboration is an interdisciplinary collaboration in social and health services, illustrates different theories that use various terminologies. The collaboration of experts from different disciplines, in addition to the term multidisciplinary, can be referred also as interdisciplinary or intersectoral. Another reason for choosing the topic of the thesis is the increas of discussions and even practical steps within the Strategy of Psychiatric Reform in the Czech Republic. An integral part of the thesis is an introduction to mental health issues, it's history and current planned transformation, which is a priority within the...

Since the earliest published American narratives, writers and subsequent Western clinicians alike have often mislabeled Indigenous behaviors, especially the behaviors of Indigenous women, as insanity. And yet, as Pemina Yellow Bird (Three Affiliated Tribes) explains, "Native peoples generally do not have a notion of "insane" or "mentally ill." (4). Instead, Indigenous peoples often discuss mental health in their communities through storytelling. As but one example of the ways that cultural narratives work to reclaim Indigenous understandings of mental health, this paper analyzes how the writings of Chickasaw author Linda Hogan challenge non-Indigenous understandings of mental health as a gendered phenomenon within tribal communities. Hogan does this in ways that destigmatize behaviors including hallucinations or prophetic dreams that Western medicine considers abnormal, and reintroduces community-specific understandings of these behaviors as either a supernatural phenomenon or a gift of foreknowledge. Hogan's novel Solar Storms (1995), in particular, reframes stereotypical images of tribal women as insane with images of Indigenous women as cultural, political, and spiritual leaders in their communities. While she addresses community-specific understandings of actual mental illness, Hogan also characterizes what many might mistake for mental illness as the essential foresight of Indigenous women and thereby offers a healing corrective to the prevailing narrative of Indigenous women's presumed insanity. A central discussion in this paper is how Hogan defines knowledge-making and Indigenous women's rights and responsibilities in Solar Storms. The term "rights and responsibilities" refers to a sense of stewardship Indigenous women in the novel experience to protect land and community: this charge may include giving life through childbirth, communicating with animals and the dead, dreaming of medicinal plants, intuitively remembering traditional song and dance, "seeing" creatures without one's eyesight, and healing abilities, among others. Female knowledge-making, then, refers to insights about oneself, community, and the material and immaterial world in enacting these behaviors. By expressing the possibilities of Indigenous women's relationship with the natural and supernatural world instead of either exoticizing or dismissing them, Solar Storms works to legitimize Indigenous modes of female knowledge-making in the face of ongoing colonial assumptions about Indigenous insanity.

Mental illness affects one in five Canadians and this number is higher among post-secondary students (Canadian Mental Health Association, 2012). Over the last three decades, studies have sought to determine how many students have mental health concerns in hope of substantiating the need for more support and funding for mental health services on campus. Knowledge gained from these studies is often seeped in a bio-medical perspective of mental health and illness, where the students’ mental health concerns are problematized and the target of psy interventions. What is lacking is an understanding of the university students’ lived experience, a person-centered understanding that sheds light on what supports or threatens students’ mental well-being while illuminating the socio, political and economic realities that may be at play in the lived experience of students with mental health concerns. This research project has addressed this gap by using interpretative phenomenological analysis to explore the lived experience of baccalaureate nursing students in the university and critically appraise their understanding of their lived experience. This research concludes that the rising rates of mental health concerns are the distillate of the psy complex and the by-product of student stress within the university and not merely a problem inherent to a student as the psy complex purports. This new knowledge may serve as a foundation for, meaningful mental health services on campus and, the development of nursing curricula that is sensitive to the lived experience of nursing students with mental health concerns, one that fosters mental well-being and recovery.

Art, process, and materials offer me an escape from the sometimes-crushing realities of my personal struggle with chronic mental illness. Escape is often my primary motivator for making art. However, personal meaning and understanding sometimes come while I'm working in the studio. Sometimes the meanings of the work only become clear years later. Personal experience and experimenting with materials and processes have led me to an appreciation and awareness of entropy--the second law of thermodynamics. My sculptures use spontaneity, abstraction, and process to dialogue with entropy.

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Mental illness has been a perplexing mystery for centuries, inciting both fear and stigmatization. Yet, the knowledge that the brain gives rise to the mind transformed the field of psychiatry; biological studies of aberrant human behavior has revealed that mental disorders are rooted in physical abnormalities that may be targeted to alleviate symptoms. Even with recent progress, there remains many open questions, one of which is: how exactly are some individuals more susceptible to developing these disorders than others? Excess, or traumatic, stress can lead to the onset of maladaptive disorders such as major depressive disorder (MDD) and post-traumatic stress disorder (PTSD). But what if it were possible to prevent these diseases from occurring in the first place? What if there was a prophylactic or vaccine-like approach to increase resilience against environmental stressors? Would we be able to target susceptible populations and administer this prophylactic? In this thesis, I present our work demonstrating the potential for prophylactic pharmaceuticals to enhance stress resilience and protect against stress-induced psychopathology. (R,S)-ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, has been demonstrated to be a viable candidate drug to administer as a prophylactic against stress-induced psychopathology. It was serendipitously discovered to rapidly (in as little as a half hour) and persistently (up to 2 weeks) alleviate depressive symptoms in patients with MDD. Since its discovery as an effective antidepressant, research has been focused on its mechanism of action with the goal of ultimately developing more efficacious, rapid-acting, long-lasting antidepressant drugs. However, in our lab, we made a truly unexpected discovery in 2016, described in Chapter 2: (R,S)-ketamine prevents the development of psychiatric symptoms when administered before a stressor. We found that prophylactic (R,S)-ketamine is effective against behavioral despair and buffers against learned fear in a time- and dose-specific manner, described in Chapter 3. This was the first indication that a drug can be administered before stress to prevent stress-induced psychopathology, opening a novel field of preventative psychopharmaceuticals. Follow-up studies in our and other labs have consistently replicated this effect using different stressors and mouse strains, in rats, and in both males and females. These data demonstrate that (R,S)-ketamine can effectively enhance resilience pre-clinically. To address how (R,S)-ketamine is inducing long-lasting protection, in Chapter 4, I describe a study that used a metabolomics platform to uncover the long-term effects of (R,S)-ketamine in buffering against learned fear. We found that (R,S)-ketamine alters purine and pyrimidine metabolism in brain and, most notably, the periphery. These data suggest the potential to conduct a simple blood test to screen for biomarkers of prophylactic efficacy in the clinic. However, while these data revealed the end-products of therapeutic efficacy, it was unknown what brain mechanisms may mediate such long-lasting protection against a psychological stressor. In a separate study, the ventral CA3 (vCA3) region of the hippocampus was uncovered to be necessary for (R,S)-ketamine’s prophylactic fear buffering effects, and that targeting this region both mimics and occludes its effects. It was then discovered that 1 week after a single administration of (R,S)-ketamine or FENM, AMPA bursts were attenuated in vCA3. These data reveal vCA3 a central node for prophylactic (R,S)-ketamine efficacy. The biggest limitation of these preliminary studies is that they each only assessed changes at single timepoints rather than mapped out what occurs throughout treatment, during stress, and during recall of a stressor. It remained unknown whether (R,S)-ketamine alters the experience or recollection of a stressor to induce long-lasting protection. The next goal was to use in vivo technologies such as 1-photon Ca2+ imaging in freely-moving mice to develop a more thorough understanding of how exactly (R,S)-ketamine is acting on vCA3 to confer its prophylactic fear buffering effects, which is outlined in Chapter 5. Mice were imaged in the ventral hippocampus throughout a prophylactic (R,S)-ketamine administration paradigm. We found that prophylactic (R,S)-ketamine administration buffered against the experience of the stressor specifically in vCA3 and reduced ventral hippocampal correlated network activity to ultimately buffer against learned fear. These data indicate that (R,S)-ketamine actively buffers against learned fear in the ventral hippocampal at the time of stress. The promise of (R,S)-ketamine is that it is also beneficial as a prophylactic in other settings beyond MDD and PTSD, such as in patients with traumatic brain injury (TBI). In Chapter 6, I describe a study that sought to determine whether (R,S)-ketamine can be useful as a prophylactic for TBI-induced neuropsychiatric effects. Here, TBI mice developed fear generalization, or the inability to distinguish between fear-inducing and neutral stimuli. To understand how TBI alters fear memory traces to promote fear generalization, we used the ArcCreERT2 x enhanced yellow fluorescent protein (eYFP) activity-dependent memory tagging strategy developed by Dr. Christine Ann Denny and found that TBI-induced fear generalization is partially mediated by dentate gyrus (DG) memory trace dysregulation. To reverse this fear generalization phenotype, a single administration of (R,S)-ketamine 1 hour after a TBI prevented the fear generalization phenotype. These data reveal the possibility of administering (R,S)-ketamine or other prophylactics in the clinic as part of post-operative care for TBI patients to prevent long-term fear generalization deficits. Altogether, this thesis demonstrates the potential for pharmacotherapies for stress resilience enhancement and reveals potential targets for prophylactic drug development. We have uncovered the long-term metabolomic changes that occur after a single dose of (R,S)-ketamine, revealed a central node for prophylactic efficacy, mapped the dynamic changes that occur throughout treatment, and applied the prophylactic paradigm to a model of TBI to demonstrate the broad range of applications of this approach. This work paves the way for the novel field of preventative psychiatry and opens new avenues to explore ways to reduce the devastating impact of mental illness on individuals and society.

A multimedia novel of speculative fiction exploring the mental health crisis in America.

The common mental disorders (CMDs) which include non-psychotic depression and anxiety-related disorders aggregate mental illnesses commonly seen together without assuming clear diagnostic boundaries. Thus, it provides an excellent platform for a symptom-level investigation of common suffering in regions where the current Western-based diagnostic categories may not apply. This current study investigates the symptom networks of CMDs among adult primary care patients in India, using data from a clinical trial testing the effectiveness of a collaborative stepped-care intervention led by lay health counselors. Network modeling was used to investigate a) symptom centralities, b) boundaries between depression and anxiety-related disorders, and c) baseline differences in network configurations across gender, public versus private health care settings, and treatment response over one-year of follow-up. Intense anxiety/panic and fatigue were the most central symptoms overall. While panic and depressed mood were the most central in public health care settings, fatigue and depressed mood were most central in private settings. Overall, findings indicate central symptoms might differ across cultures and socioeconomic groups. To the knowledge of this current author, this is the first study investigating the symptom networks of CMDs among primary care patients in India.

Background: People suffering from mental illness are stigmatised in almost all societies and nurses are in key position to break this stigma. Ghana is a country greatly influenced by religion and traditional beliefs, which, by and large, affects the perception of mental illness. Nursing students have the opportunity to learn how to understand mental illness and have, due to this, an important role fighting old traditions and breaking the stigma. Aim: to examine Ghanaian nursing student’s attitudes towards mental illness. Method: This is a descriptive empirical study carried out by collecting qualitative data with semi-structured interviews. Result: The students recognize that lack of education and information within the Ghanaian society contributes to stigmatization and isolation of people suffering from mental disorders. Lack of resources, hospitals and educated health care-staff are major problems that need to be solved. The students highlight that society believes mental illness to be caused by evil spirits as result of bad behavior. The students state that mental illness is caused by chemical imbalance in the body due to heredity, nutritional factor and/or drugs. The students stress the importance of treating mentally ill patients as any other patient; good nursing is believed to be fundamental to the recovery process. Conclusion: The students’ attitudes towards mental illness differs a lot form their perception of what society in general considers. Clinical significance: The findings show a need for broadening the knowledge about mental illness in the Ghanaian community; nurses could help eradicating the stigmatization of mentally ill persons.

The purpose of this study was to determine how to best motivate smokers with schizophrenia or schizoaffective disorder to seek treatment for tobacco dependence. Smokers with schizophrenia or schizoaffective disorder (N=78) were randomly assigned to receive a Motivational Interviewing, Psychoeducational, or Minimal Control intervention. A greater proportion of participants receiving the Motivational Interviewing intervention followed through on a referral for tobacco dependence treatment within one-week and one-month post-intervention. Mixed model Analyses of Variance found no differences between groups at one-week or at one-month with respect to tobacco use or motivation to quit. Within group analyses indicated that participants in the Motivational Interviewing and Psychoeducational groups reported significant decreases in cigarettes smoked per day. Only participants in the Motivational Interviewing group showed significant increases in confidence in their ability to quit smoking.