Objectives: To explore whether a semi–structured post-traumatic amnesia (PTA) assessment interview (PTA-I) provides a practicable but equivalent estimation of PTA in patients attending the Emergency Department (ED) with head injury (HI) compared to the established Westmead PTA Scale Revised (R-WPTAS). Procedure: PTA was assessed using the R-WPTAS (includes a visual memory component) and the PTA-I (includes retrospective and verbal memory components), in patients attending an ED with (n=30) or without (n= 30) HI. Outcome measures were the Post-concussion Syndrome Checklist (PCSC) and the Glasgow Coma Scale (GCS). McNemar’s Tests and Chi-square analyses were used to determine the results. Results: The verbal memory component overestimated PTA in the control group by 24 %. Overall, the PTA-I did not discriminate between HI and control participants. However the retrospective PTA assessment embedded within the PTA-I did, with 100 % accuracy. Conclusions: The use of a verbal memory component to assess PTA in the ED is not supported by the results of this study. A retrospective PTA assessment appears to allow more accurate decision making regarding the admission criteria used in the ED and has advantages over the R-WPTAS: fewer test materials and no repeat assessments required to achieve an estimate of PTA duration.

To date, there is little research into either stress reactivity or the specificity of psychological characteristics in particular forms of sleep disorder. NREM parasomnias are a relatively un-studied group of sleep disorders. The purpose of this study was to gain greater insight into how people with NREM parasomnias respond to ‘threat’ and to life situations. In particular, the aim was to investigate how their responses to a psychological stressor compared to individuals with insomnia and to good sleepers by measuring autonomic arousal, as well as subjective appraisals of stress. Baseline levels of autonomic arousal were intended to provide insight into daytime arousal levels at the trait level. Participants (N = 38) were recruited from the general population and attended the University of Glasgow Sleep Centre to take part. Autonomic arousal was measured via continuous electrocardiogram (ECG) recordings of heart rate (HR) and cardiac vagal tone (CVT) whilst participants took part in baseline, stressor (a difficult mathematical task) and recovery phases. In general, group differences were not found, however this may be partly due to the small sample size and corresponding lack of power to detect differences. The results indicated that the NREM group reacted to stress in a similar way to good sleepers. In general, it was the insomnia group but not the NREM group whose data differed from good sleepers. However, both the NREM parasomnia and Insomnia groups exhibited a relatively higher (though not statistically significant) resting baseline HR compared to the good sleeper group, suggesting a higher level of underlying sympathetic arousal. The findings of this type of study have potentially important implications for the development of treatment programmes for NREM parasomnias. However, further work needs to be done before any conclusions can be drawn. The study was intended as an exploratory study and the preliminary findings indicate that further exploration is warranted.

Background: Classification systems for use in the diagnosis of mental disorders have been developed based on a categorical model of psychopathology. Although current categorical diagnostic classification systems have been found to have good utility and reliability, studies have questioned whether these systems have adequate validity. Dimensional models of psychopathology have been examined as an alternative to categorical diagnostic classification systems and found to be more strongly related to clinical parameters, such as the severity and outcome of mental disorders. A literature review found a small evidence base on dimensional models of psychopathology experienced by adults with intellectual disabilities. However, the findings were limited by small sample sizes, biased samples and inclusion of only a limited range of items of psychopathology. Furthermore, the methods of exploratory factor analysis used do not meet established best practice guidelines. Informed by the existing literature, this thesis aimed to; 1. identify a dimensional model of psychopathology experienced by adults with intellectual disabilities 2. examine the associations of a dimensional model of psychopathology with measures of the severity and outcome of mental disorders 3. compare the predictive validity of dimensional and categorical models of psychopathology. Methods: The Psychiatric Present State- Learning Disabilities (PPS-LD) was used as a structured instrument to collect psychopathology data. Exploratory factor analysis (EFA) following best practice guidelines was used to identify dimensions of psychopathology. Continuous measures representing the dimensions of psychopathology were calculated. Meeting criteria for the diagnosis of a mental disorder from the Diagnostic Criteria for Psychiatric Disorders for use with Adults with Learning Disabilities (DC-LD) was used as the variable representing the categorical model of psychopathology. Baseline data was collected on four measures of severity; the Health of the Nation Outcome Scales- Learning Disabilities (HoNOS-LD), Global Assessment of Functioning (GAF), Clinical Global Impression (CGI), and the Camberwell Assessment of Needs for Adults with Developmental and Intellectual Disabilities- Research version (CANDID-R) unmet needs. These measures were completed again at follow up 4-5 years later and change over time used as a measure of longitudinal outcome. Bivariate statistics and multivariate linear regression were used to examine the associations of the dimensions of psychopathology, and DC-LD diagnosis, with the measures of the severity of and longitudinal outcome of mental disorders. Relevant socio-clinical variables, associated with psychopathology in previous populationbased intellectual disabilities studies were included in the analyses: gender, age, living circumstances, level of intellectual disabilities, autism, Down syndrome, epilepsy, sensory impairments, mobility problems and incontinence. Key results: A model of psychopathology with four dimensions was extracted from the EFA. This model was stable in two additional EFA using random samples. There were no significant correlations between the four dimensions which were labeled depressive,organic, behaviour-affective and anxiety. Only the anxiety dimension of psychopathology was not associated with any of the measures of severity of mental disorders. The depression dimension was independently associated with severity on the HoNOS-LD (β=.413, p<.001), GAF (β=-.402, p<.001) and the CGI (β=.457, p<.001). The organic dimension was independently associated with severity on the HoNOS-LD (β=.205, p=.004), GAF(β=-.326 p<.001) and CGI (β=.266, p<.001). The behaviour-affective dimension was independently associated with severity on the HoNOS-LD (β=.332, p<.001), GAF (β=-.286, p<.001), CGI (β=.253, p<.001) and CANDID-R unmet needs (β=.178, p=.018). Level of intellectual disabilities was independently associated with severity on the HoNOS-LD and CANDID-R unmet needs. Finally, younger age (β=-.208, p=.010), living independently (β=-.599, p<.001) and not having a visual impairment (β=-.191, p=.009) were associated with greater CANDID-R unmet needs. None of the baseline measures of psychopathology were associated with longitudinal outcome on the CANDID-R unmet needs. Baseline scores on the depressive dimension were significantly associated with longitudinal outcome on the HoNOS-LD(β=.297, p=.034), GAF (β=.342, p=.002) and CGI (β=.373, p=.001). Similarly, the behaviour-affective dimension was significantly associated with longitudinal outcome on the HoNOS-LD (β=.292, p=.033), GAF (β=.244, p=.036) and CGI(β=.298, p=.009). The organic dimension was only associated with longitudinal outcome on the HoNOS-LD (β=-.382, p=.006). Individuals with mild intellectual disabilities had poorer outcomes on all four measures of longitudinal outcome. Hearing impairment was associated with poorer outcome on the GAF (β=-.483, p=.000) and CGI (β=-.331, p=.004), and poorly controlled seizures with poorer outcome on the CGI (β=-1.638, p=.004).The variable representing the categorical model of psychopathology was only independently associated with severity on the HoNOS-LD (β=.178, p=.026), and longitudinal outcome on the GAF (β=.259, p=.045) and CGI (β=.257, p=.044). However, when categorical and dimensional models were both included in the regression analyses only the dimensional model of psychopathology was retained as independently associated with these measures of severity and outcome. Conclusions: The description of a stable dimensional model demonstrates the value of using multivariate statistical methods to examine psychopathology experienced by adults with intellectual disabilities. Since the findings suggest that dimensional models have better validity than categorical models of psychopathology, the use of EFA, and other multivariate methods, could contribute to the development of valid diagnostic classification systems. The presence of affective items of psychopathology across the depressive, behaviour-affective and anxiety dimensions highlights the possible relevance of a global affective model of psychopathology. Findings reported in this thesis support the potential relevance of models of affect regulation and affective arousal to developing an understanding of psychopathology experienced by persons with intellectual disabilities. There are similarities between the dimensional model in this thesis and the tripartite model of depression and anxiety psychopathology, described in the literature- which has depressive, anxiety and general distress dimensions. Overlaps between the behaviour-affective dimension, and general distress dimension within the tripartite model, suggest that there may be an association between affective psychopathology and problem behaviours. However, it could be that this association is with affective psychopathology in the general distress dimension, rather than with depressive psychopathology, as examined in previous studies. Confirmatory factor analyses should be considered to examine the four dimension model of psychopathology. Future studies involving individuals with intellectual disabilities should examine the relevance of global affective models of psychopathology.

<p> This paper explores trauma as a continuum and how various forms of trauma can be treated with mindfulness and somatic psychotherapy modalities. Ten modalities are discussed through hermeneutic, heuristic, and intuitive inquiry research methods: mindful breathing; mindfulness-based stress reduction (MBSR); emotional freedom techniques (EFT) and energy psychology; eye movement desensitization and reprocessing (EMDR) and attachment focused EMDR; Hakomi mindfulness-centered psychotherapy; sensorimotor psychotherapy; somatic experiencing; acupuncture, Soma Neuromuscular Integration&reg; bodywork, and authentic movement. Unique to this thesis is the approach to somatically releasing trauma using an acronym framework created by the author, conceptualized as Safety, Trust, Acceptance, Belonging, Love, Earth, and Ecopsychology (STABLE&copy;). Adding a depth psychotherapy perspective, the myth of Inanna is offered as an allegory to enrich the practice of co-regulating patients as they work through their trauma narratives. Recognizing nature as an essential component to healing the wounds of the soul adds an ecopsychological and wilderness therapy perspective.</p>

Species relationships of the endemic Elaphoglossum, and the extent and distribution of population genetic diversity were investigated using allozyme analysis in chapter five. As well as supporting the relationships of the taxa in the molecular phylogeny, the allozyme data suggest a hybrid origin of E. dimorphum between E. nervosum and E. bfurcatum. In addition the allozyme data revealed significant genetic differentiation in populations of E. nervosum and E. bfurcatum which should be taken into consideration in any future conservation programme. To conclude, Chapter 5 is a general discussion on the evolution and conservation of island plants, highlighting my research findings from St Helena and comparing it to other studies.

Typescript / Includes bibliographical references (leaves 150-154) / 154 leaves : / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Thesis (M.D)--University of Adelaide, 1935

This study aimed to investigate any difference between the attributions parents made about their child’s sleep problem, in parents of children with an Autism Spectrum Disorder and parents of children with Down Syndrome. Seventy-six parents of children with an Autism Spectrum Disorder and fifty-two parents of children with Down Syndrome completed a series of questionnaires on-line, regarding their child’s sleep problem, their beliefs about their child’s sleep problem and the parent’s level of anxiety and depression. A significant difference was found between the groups on four of the causal items; other health problem, child’s emotional state, child’s personality and diet. Parents of children with Down Syndrome showed a higher level of agreement that their child’s sleep problem could be attributed to another health problem compared to parents of children with an Autism Spectrum Disorder. Parents of children with an Autism Spectrum Disorder showed a higher level of agreement that their child’s sleep problem could be attributed to their child’s personality, their child’s emotional state and their child’s diet compared to parents of children with DS. There was a high level of agreement across all parents that their child’s disability was a causal factor to their sleep problem and differences in attributions may reflect characteristics of the child’s diagnosis. The results are consistent with previous findings that parents view disability as an important causal factor to their child’s sleep problem and suggest a possible overlap in parent’s views of their child’s sleep problem and views of their disability.

Background: Post-traumatic stress disorder (PTSD) can occur following a traumatic event that has led to moderate to severe traumatic brain injury (TBI) even when there is little or no memory for the event. The incidence of PTSD is higher when diagnosed by self-report questionnaires compared to structured clinical interview. Previous studies suggest PTSD can be misdiagnosed in a significant proportion of cases and the incidence is in fact low. To explore this issue further there is a need to not only understand whether there are differences between cases that do and do not fulfill symptom criteria for PTSD, but also whether some cases have ‘partial PTSD’; that is to say they have PTSD symptoms but do not fulfill the DSM-IV symptom criteria exactly. Aims: The study aims to establish whether an attentional bias to trauma related words exists in people with TBI who report PTSD symptoms and to investigate the relationship between physiological arousal and attentional bias in people with a TBI reporting PTSD symptoms. Method: Forty-one participants with severe-extremely severe TBI were recruited from the community and completed measures of cognitive functioning. Attentional bias was measured using a Stroop task in which trauma, negative, neutral and positive words were administered randomly. Physiological reactivity (heart rate) was recorded and PTSD ‘caseness’ was established using a self-report questionnaire and a clinician-administered structured interview. Results: No significant relationship between PTSD symptom severities and attentional bias to trauma stimuli was apparent. Those with ‘PTSD’ demonstrated significantly slower reaction times to negative words however; this bias was associated with self-report of depression rather than PTSD symptomatology. Heart rate decreased throughout the interview and was not associated with PTSD symptom severities. Conclusions: Greater PTSD symptom reporting was not associated with an attentional bias to trauma words. Heart rate decreased over the course of the interview, independent of PTSD severity and diagnosis. This suggests that ‘partial’ PTSD was not present, and instead those who reported PTSD symptoms were curious about the gap in memory caused by amnesia without the associated fear response.

The present study applied a combined behavioural and attitudinal approach in occupational safety in a Hong Kong-based metal house in Shenzhen, China in an attempt to modify the safety behaviours and attitudes of the workers by means of posted feedback plus goal-setting. To the best of the researcher's knowledge, this is the first study of this type to be attempted in a Chinese industrial setting. A total of 142 respondents from the four departments, namely Heavy Duty, Small Press, Hand Press and Drilling were involved in the survey with a multiple-based line design for an environment where random sampling was impossible. Meanwhile, the study also intended to explore the underlying factors that affected the safety attitudes of the respondents. These factors included influences from traditional culture and religions. A self-constructed observation checklist and a questionnaire adopted from the Health and Safety Executive Report No. 81 (HSE, 1996) on attitude investigation were the major research instruments. Percentaged analysis, ANOVA, T-Test and Fisher Exact Test set at 0.05 level were applied to determine the significance of differences in the workers' behaviours and attitudes before and after the intervention. From the results of the research, it was found that i) there were relationships between the workers' behaviours in occupational safety and posted-feedback plus goal-setting in the Heavy-duty Press, Small Press and Hand Press Departments; ii) there were relationships between the intervention and the workers' attitudes in terms of -'Supervisor Satisfaction' in the Heavy Duty and the Small Press Departments; -'Shop-floor Training' with the Heavy Duty Press and the Small Press Departments; -'Safety Meeting' with the Small Press Department; -' Safety Working Procedures' with the Heavy Duty Press and the Small Press Departments; iii) the results demonstrated that there were relationships between attitudes of the formally trained workers and those of their peer workers without formal training towards occupational safety in terms of -'Supervisor Satisfaction' with the Heavy Duty Press Department; -'Safety Meeting' with the Heavy Duty Press Department; -' Safety Working Procedures' with the Small Press department; iv) there were relationships between workers with self-reported accident rates and those without in terms of their safety attitudes towards -'Supervisor Knowledge' with the Heavy Duty Press Department; -'Shop-floor Satisfaction' with the Heavy Duty Press Department; -'Shop-floor Environment: Hardware' with the Small Press Department. Intervention was related to both the workers' attitudes and their behaviours in work safety in the Heavy-duty Press, the Small Press and the Hand Press departments. Throughout the investigation, no significant change was found with both the respondents' safety behaviours or attitudes in the Drilling Department during the periods when interventions were introduced to other departments. Concerning the controlling factors for the workers' attitudes towards work safety, cultural and religious factors could explain the workers' under-reporting of accidents and injuries. These findings implied that researchers needed to be aware of the tremendous local cultural and religious concerns when applying western rationales to constructing a safety culture in developing countries.

This thesis is concerned with staff carers of individuals with a learning disability and a diagnosis of schizophrenia. To date this group of carers have received no attention from researchers. This is in contrast to a vast body of literature, which has established the psychological impact of care giving on the relatives of patients with a diagnosis of schizophrenia, without a learning disability. The term ‘schizophrenia’ has been used throughout this thesis. This reflects the use of psychiatric diagnoses in the body research and clinical literature, which has guided the development of the current study. The first paper critically reviews the application of attribution theory to the study of relatives’ coping responses to schizophrenia and the associated symptomatology. The literature review has been prepared for submission to Schizophrenia Bulletin (see Appendix B for Instructions to Authors). The brief research paper reports on the development of the Attributions for Schizophrenia Questionnaire (ASchizQ) and a preliminary investigation with staff carers of individuals with a mild learning disability and a diagnosis of schizophrenia. This paper has been prepared for submission to the Journal of Applied Research in Intellectual Disabilities (see Appendix C for Instructions to Authors). The main research paper focuses on the application of attribution theory to staff caring for individuals with a mild learning disability and diagnosis of schizophrenia. It examines the relationship between staff carers’ causal attributions about schizophrenia and the associated symptomatology and their current coping styles. This paper has been prepared for submission to the British Journal of Clinical Psychology (see Appendix D for Instructions to Authors). Finally, the research review describes some of my experiences and observations of conducting research with carers of individuals with a mild learning disability and a diagnosis schizophrenia.