Multisensory environments facilitate behavioral functioning in humans. The redundant signal effect (RSE) refers to the observation that individuals respond more quickly to stimuli when information is presented as multisensory, redundant stimuli rather than as a single stimulus presented to either modality alone. Our studies show that the disinhibiting effects of alcohol are attenuated when stop signals are multisensory versus unisensory. The present study expanded on this research to test the degree to which multisensory stop signals could also attenuate the disinhibiting effects of alcohol in those with attention-deficit hyperactivity disorder (ADHD), a clinical population characterized by poor impulse control. The study compared young adults with ADHD with healthy controls and examined the acute impairing effect of alcohol on response inhibition to stop signals that were presented as a unisensory stimulus or a multisensory stimulus. For controls, results showed alcohol impaired response inhibition to unisensory stop signals but not to multisensory stop signals. Response inhibition of those with ADHD was impaired by alcohol regardless of whether stop signals were unisensory or multisensory. The failure of multisensory stimuli to attenuate alcohol impairment in those with ADHD highlights a specific vulnerability that could account for heightened sensitivity to the disruptive effects of alcohol.

The purpose of this study was to evaluate a token economy program at Oregon State Hospital in terms of patients’ behavioral improvement during the first seventy days of the program. As the study progressed, it became apparent that a study of the problems involved in initiating this program would be significant. Thus an attempt has been made to evaluate both the patients’ behavioral improvement and the problems involved in setting up an effective token economy program. Prior to the June 1, 1972 reorganization of the hospital, the county geographical unit system had been in effect for approximately eleven years. On June 1st, three admission wards, two social remotivation wards, a behavior modification ward, two self-care wards and a token economy ward were established. Although token economy programs have been widely used in state mental hospitals and in Veterans Administration Psychiatric hospitals across the country, this was the first attempt to use this type of operant conditioning therapy at Oregon State Hospital.

Anxiety disorders (ADs) and stress-related disorders are some of the most common psychiatric disorders in the United States. Like other c0mplex psychiatric illness, genetics and neuroimaging research has focused on understanding their underlying neurobiology. Areas within the fear-network play important roles in threat perception, fear conditioning/learning, cognitive processing, and modulation of fear responses including contextual modulation and extinction and have been implicated in ADs as well as stress disorders such as posttraumatic stress disorder (PTSD). The primary gap in the current search for underlying biological mechanisms is in whether biomarkers associated with disorders share genetic influences with the disorders they index. Therefore, the aims of this dissertation are: 1) to examine the shared etiology of PTSD and threat-related brain regions while accounting for trauma using a large sample of male twins who served in the military during the Vietnam War; 2) to elucidate the shared and specific risk factors (genetic, familial environment and unique environment) and their roles amongst fear and anxiety domains in children; and 3) to examine whether brain regions previously implicated in fear processing and anxiety are significantly associated with a genetic factor score indexing fear and anxiety measures in a child sample. Using biometrical twin modeling this dissertation produced several novel findings regarding etiology of PTSD, threat-related domains and associated brain morphometry. Analyses investigating brain morphometric differences as potential endophenotypes for PTSD provided preliminary evidence that their phenotypic association is largely accounted for by environmental influences, specifically trauma exposure. However, sample size-induced model instability limits the ability to make definitive conclusions. Examining domains of fear and anxiety in children suggested a substantial genetic overlap between the two. Finally, the incorporation of a genetic factor score derived from the results of the biometrical modeling of fear and anxiety provided preliminary evidence for a genetic relationship between fear/anxiety and brain regions of interest. Although these results should be interpreted within the context of important limitations, they provide clear evidence that additional research into the genetic relationship between brain regions and disorders with larger sample sizes is justified.

One in five Australians has a mental disorder and it is estimated that one in four families have a member who has a mental disorder. Since the 1960s there has been an 80 percent decrease in Australian institution-based mental health care. The majority of people who have a mental disorder are now treated in their local community and many of them live with their families. The change in the delivery of mental health care has seen the family emerge as one of the most important supports to their ill family member. While the changes in the delivery of mental health care have been based on human rights concerns, changes in mental health legislature, and economic factors, the multi-dimensional experience of being a primary carer of a person with a mental disorder remains relatively unexplored. The need for empirical evidence on the primary carer's experience is noted in both the scientific literature and from carers themselves and the principal aim of conducting this research was to address the identified need. This qualitative study, using grounded theory methodology, presents the findings of interviews with 27 primary carers and memos documented throughout the study. In addition, existing literature of relevance to the findings of this study is presented. A substantive theory of seeking balance to overcome being consumed is presented in this thesis. Using the grounded theory method the constant comparative analysis of data revealed that the basic social psychological problem shared by all participants was the experience of "being consumed". The problem of being consumed consisted of two stages: "disruption of established lifestyle" and a "sustained threat to self-equilibrium". Six conditions were identified as influencing participants' experience of being consumed. / In order to address the problem of being consumed, participants engaged in a basic social psychological process of "seeking balance". When participants were engaged in this process they moved from a state of being consumed to one whereby they established and consolidated a balanced life perspective that incorporated their caregiving role. The process of seeking balance consisted of three phases: "utilising personal strategies to reduce the problem of being consumed', "restoring self- identity", and "reaching out to make a difference". In addition, data analysis identified the presence of a three phase sub-process entitled "trying to make sense of what was happening". Phases one of the core and sub- processes occurred primarily in the period prior to the time when a psychiatric diagnosis was made on the affected family member. Participants became engaged in the remaining two phases of the core and sub-processes when they became aware that their affected family member had a mental disorder. At the time of being interviewed for this study some participants were not yet engaged in the final phase of the process of seeking balance. Participants' experience of seeking balance was not related to the length of their caregiving experience but rather to their experience of seeking balance and the conditions influencing that process. Four conditions were identified as influencing participants' experience of seeking balance. / This thesis presents the substantive theory of seeking balance to overcome being consumed. While the findings support existing scientific literature, the substantive theory also presents a new insight on caring from the primary carer's perspective. In particular, the findings challenge health professionals to actively pursue strategies to reduce carers' experience of being consumed. The findings of this study have implications for service provision and clinical practice, policy and planning, research, education, the general population, mental health consumers, and carers.

A day treatment program is an important component on the continuum of care for young people with moderate to severe mental health issues. The aim of this research was to investigate whether adolescents who participate in a structured day treatment program demonstrate greater mental health gains than adolescents receiving less intensive outpatient treatment. In addition, the research investigated whether mental health gains were related to intake diagnosis and whether parents reported higher levels of mental health gain than the client in their self-report ratings. The setting for the research was The Cottage, an adolescent day treatment program, run by the Child and Adolescent Mental Health Service (CAMHS) in the Australian Capital Territory. The program provides intense multi-faceted treatment within a therapeutic milieu environment for clients aged 12-18 years with moderate to severe mental health issues. The study involved a Day Program group of 22 clients from The Cottage and included a comparison group of 20 outpatient clients from CAMHS. Results indicated that individuals in both treatment approaches had statistically significant reductions in anxiety and depression symptomology and improvements in outcome measures, but there were no significant differences between the two treatment groups. The data indicated a statistically significant difference in return to school rates, whereby approximately 82% of individuals in the day treatment program had returned to school/employment, whilst only 30% of individuals in outpatient treatment had returned to school/employment within three months post treatment. The results did not demonstrate that the degree of mental health gain was dependent upon intake diagnosis and although not statistically significant, parents rated their children as more severe in terms of psychopathology than the client.

<p><b>VLBW adolescents</b></p><p>We found that the VLBW adolescents had specific emotional and cognitive traits. Some of them fit with psychiatric concepts and others do not. They had an increased risk of developing psychiatric symptoms and disorders compared with controls, especially attention deficit, anxiety and relational problems affecting their social skills and overall functioning. Academic achievement was reduced. The attention problems were widespread, but only a minority fulfilled the diagnostic criteria of Attentiondeficit/ hyperactivity disorder. Increased prevalence of anxiety symptoms and disorders may be due to a number of factors, comprising both biological/neuroendocrine and psychosocial mechanisms. The peer problems and deficits in social skills may indicate specific difficulties in relating and adjusting to others, with deficits in comprehending the subtle cues of social relations. The implication of thought problems reported by teachers is unclear. Adolescents with birth weight ≤ 1000 g showed a tendency towards more psychiatric disorders than those with birth weight between 1000 and 1500 g. The lack of gender differences demonstrates that prematurity exceeds the usual effect of gender regarding vulnerability for developing psychiatric symptoms.</p><p>We found that the VLBW adolescents perceived self-esteem and quality of life as others did at the age of 14. However, parents reported functional disadvantages and reduced quality of life measures for their adolescents. The parents worried more for their children’s functioning and well-being, especially if the child had a psychiatric disorder or cerebral palsy. Still, being born VLBW did not influence the warmth in the parent-child relationship, nor did the parents have more mental health problems.</p><p>As the association between VLBW and psychiatric problems could not be explained by SES or the parents’ mental health, a biological cause-effect relationship seems plausible. The frequency of cerebral MRI abnormalities was higher in the VLBW group than in the control group. Furthermore, ADHD symptoms were associated with white matter reduction and thinning of the corpus callosum, while other psychiatric symptoms were not associated with MRI abnormalities. These results support the hypothesis of a specific (“pure”) type of ADHD with a dominant neurological aetiology, while interacting psychosocial experiences play a minor part. Our study indicates that being born VLBW involves a biological vulnerability with increased risk of psychiatric symptoms.</p><p><b>SGA adolescents</b></p><p>Although every fifth SGA adolescent had psychiatric symptoms, assessed by interview, the prevalence of symptoms and disorders did not differ significantly from controls. Yet, screening questionnaires displayed more behavioural problems, lowered social competence and a tendency towards attention deficit/hyperactivity. Teachers reported withdrawal and thought problems, while academic performance did not differ from controls. Boys had more attention and externalizing problems than girls.</p><p>Generally, on psychiatric measures, the term SGA group seemed to fall inbetween the VLBW and the control group, resembling the control group more than the VLBW group.</p><p>The SGA adolescents and their parents reported self-esteem and quality of life as in the control group. Being born SGA at term did not influence the warmth in the parent-child relationship, and the parents did not have more mental health problems than others. The frequency of cerebral MRI abnormalities in the SGA group did not differ from the control group, and no associations were found between psychiatric symptoms and MRI abnormalities.</p> / Paper V reprinted with kind permission of Elsevier, sciencedirect.com

<p>The subjects were 130 male prisoners in Swedish jails were examined by SCID and the diagnoses given in terms of DSM-IV. The most common mental disorder was drug abuse. On Axis II several personality disorders were diagnosed. Personality assessments were made by KSP. High scores were mainly found for e.g. impulsiveness, sensation seeking, aggression and low scores in socialisation.</p><p>MAO assays were performed in 99 male criminal offenders and in 60 non-criminal volunteers. Offenders had lower MAO activity than controls also with the confounding factor smoking under control. It is proposed that platelet MAO is linked to personality traits, which can predispose for criminality. </p><p>For testing the existence of combinations of vulnerability factors, a configuration frequency analysis (CFA) was used. The criteria which formed the basis for the subgrouping were; MAO activity below or above –0.5 SD of the mean (L and H), the presence or absence of an Axis I disorder (= drug abuse) (Y/N), the presence or absence of an Axis II disorder (Y/N), or the presence or absence of an Axis I and II disorder (Y/N). In this way eight subgroups were formed. Two significant "types" were found among the criminals: One was characterised by low platelet MAO activity, Cluster B personality diagnosis as well as Drug Abuse Disorder diagnosis (LYY); and the other by a pattern of normal platelet MAO activity, no Cluster B personality disorder, and no Drug Disorder diagnosis (HNN). Also two "antitypes", occurring less frequent than expected, were identified; LYN and LNY. Thus, the aggregation of certain risk factors in the same individual has been shown to contribute to the development of criminal behaviour.</p><p>The subgroups HNN, LYN, LNY and LYY were then analysed for a variety of criminological factors. There was a difference in mean age between the subgroups, the HNN being lowest. Economical crimes were more common at an early criminal debut and crimes involving violence at an adult debut. The HNN subgroup had a lower number of crimes and times spent in jail than the other subgroups. More than 50% of the clients in all groups had previously been sentenced to Reformatory.</p>

<p>The overall aim of the present thesis was three-fold. The overall aim of the present thesis was three-fold. The first was to study occupational performance in individuals with severe mental disorders and their experiences of occupational therapy, the second to study experienced burden of family caregivers and the third to test the validity and the homogeneity of assessment tools in this area. The samples consisted of individuals with severe mental disorders participating in organised occupations (n= 112), occupational therapy records (n=64), occupational therapists working in mental health care (n=7) and family caregivers of individuals with severe mental disorders (n=256). Data were collected by questionnaires, structured and narrative interviews, observations and occupational therapy records. Individuals with severe mental disorders reported problems related to leisure and work activities and the occupational therapists recorded problems concerning how to organise and structure occupational performance. Individuals functioning on a high cognitive level experienced problems related to work and productive activities. Participation in occupational therapy strengthened their confidence in their own ability. The "Experience of Occupational Performance Questionnaire" (EOPQ) was developed from data on the experiences of women participating in occupational therapy. A principal component analysis gave seven factors with acceptable homogeneity. There is a need for assessment tools to evaluate occupational therapy. The EOPQ represents an attempt to fulfil this need. Family caregivers experienced limitations of daily activities as a burden. The ability to perform daily activities was studied from three perspectives, the individuals’, the occupational therapists’, and the experienced burden of the family caregivers. These perspectives are complementary and thus necessary for planning and implementation of individually adapted occupational therapy as well as for the evaluation of outcomes.</p>

The subjects were 130 male prisoners in Swedish jails were examined by SCID and the diagnoses given in terms of DSM-IV. The most common mental disorder was drug abuse. On Axis II several personality disorders were diagnosed. Personality assessments were made by KSP. High scores were mainly found for e.g. impulsiveness, sensation seeking, aggression and low scores in socialisation. MAO assays were performed in 99 male criminal offenders and in 60 non-criminal volunteers. Offenders had lower MAO activity than controls also with the confounding factor smoking under control. It is proposed that platelet MAO is linked to personality traits, which can predispose for criminality. For testing the existence of combinations of vulnerability factors, a configuration frequency analysis (CFA) was used. The criteria which formed the basis for the subgrouping were; MAO activity below or above –0.5 SD of the mean (L and H), the presence or absence of an Axis I disorder (= drug abuse) (Y/N), the presence or absence of an Axis II disorder (Y/N), or the presence or absence of an Axis I and II disorder (Y/N). In this way eight subgroups were formed. Two significant "types" were found among the criminals: One was characterised by low platelet MAO activity, Cluster B personality diagnosis as well as Drug Abuse Disorder diagnosis (LYY); and the other by a pattern of normal platelet MAO activity, no Cluster B personality disorder, and no Drug Disorder diagnosis (HNN). Also two "antitypes", occurring less frequent than expected, were identified; LYN and LNY. Thus, the aggregation of certain risk factors in the same individual has been shown to contribute to the development of criminal behaviour. The subgroups HNN, LYN, LNY and LYY were then analysed for a variety of criminological factors. There was a difference in mean age between the subgroups, the HNN being lowest. Economical crimes were more common at an early criminal debut and crimes involving violence at an adult debut. The HNN subgroup had a lower number of crimes and times spent in jail than the other subgroups. More than 50% of the clients in all groups had previously been sentenced to Reformatory.

The overall aim of the present thesis was three-fold. The overall aim of the present thesis was three-fold. The first was to study occupational performance in individuals with severe mental disorders and their experiences of occupational therapy, the second to study experienced burden of family caregivers and the third to test the validity and the homogeneity of assessment tools in this area. The samples consisted of individuals with severe mental disorders participating in organised occupations (n= 112), occupational therapy records (n=64), occupational therapists working in mental health care (n=7) and family caregivers of individuals with severe mental disorders (n=256). Data were collected by questionnaires, structured and narrative interviews, observations and occupational therapy records. Individuals with severe mental disorders reported problems related to leisure and work activities and the occupational therapists recorded problems concerning how to organise and structure occupational performance. Individuals functioning on a high cognitive level experienced problems related to work and productive activities. Participation in occupational therapy strengthened their confidence in their own ability. The "Experience of Occupational Performance Questionnaire" (EOPQ) was developed from data on the experiences of women participating in occupational therapy. A principal component analysis gave seven factors with acceptable homogeneity. There is a need for assessment tools to evaluate occupational therapy. The EOPQ represents an attempt to fulfil this need. Family caregivers experienced limitations of daily activities as a burden. The ability to perform daily activities was studied from three perspectives, the individuals’, the occupational therapists’, and the experienced burden of the family caregivers. These perspectives are complementary and thus necessary for planning and implementation of individually adapted occupational therapy as well as for the evaluation of outcomes.