Major depressive disorder (MDD) is among the most common mental health problems in the U.S. and the world. A significant portion of patients with MDD do not respond to current antidepressant medications and are considered treatment-resistant. Current antidepressant therapies have a late onset of action that causes significant challenges when treating patients with suicidal ideation. In the past two decades, there has been significant interest in the anesthetic drug ketamine as an antidepressant. Evidence suggests that ketamine is effective even in treatment-resistant patients, with rapid onset of benefits observed hours after administration. The U.S. Food and Drug Administration has recently approved a nasal spray containing the S-enantiomer of ketamine, or esketamine, as an antidepressant therapy. This thesis reviewed the literature on both ketamine and esketamine as antidepressants, with a focus on the two most commonly used routes of administration, intravenous infusion and intranasal administration. This study concludes that both ketamine and esketamine have robust and rapid antidepressant effects. Both formulations are safe and well tolerated by patients, with transient, nonserious side effects easily managed and monitored by healthcare providers. Further research should focus on broadening the availability of ketamine and esketamine to patients.

This research study sought to test the effectiveness of using art therapy, specifically altered book-making, to decrease traumatic grief symptoms in children and adolescents. The study hypothesized that altered book-making with children and adolescents, who had experienced traumatic loss, would be effective in decreasing traumatic grief symptoms. The six-week/six-session treatment design used a single group pre/post-test, utilizing the UCLA PTSD-RI and an open-ended post-research survey. The population involved in the research were children and adolescents who had experienced the death of a family member through traumatic means, such as homicide or suicide, within the past five years. Four participants began the study, and three participant, completed both pre and post-test. The overall outcome of the study supported the researcher's hypothesis— participants reported increased understanding of grief responses, emotion identification, and self-reflection. Through altered book-making, participants also reported a decrease in anger, trauma symptoms and dissociation. / A Thesis submitted to the Department of Art Education in partial fulfillment of the requirements for the degree of Master of Science. / Summer Semester 2015. / June 30, 2015. / adolescents, altered book, art therapy, children, grief, traumatic loss / Includes bibliographical references. / David Gussak, Professor Directing Thesis; Marcia Rosal, Committee Member; Theresa Van Lith, Committee Member.

Through conceptualizing migration as a social process, this dissertation examines the role of social support among urban migrants. Existing research examining social support is often framed in North American or European contexts and ignores its connectivity with migration or mobility. There remains critical opportunity for research to examine how social support paradigms function in Low and Middle Income Countries (LMICs) and from the perspective of urban migrants, including refugees and economic migrants. By expanding the frame of both migration and social support research, this dissertation endeavors to enrich the empirical knowledge surrounding the role of social support among urban migrants. To accomplish this, this dissertation examines the intersection of trauma, social support, and depression among two urban migrant populations. Through its integration of data from female Syrian refuges in Jordan and male economic migrants in Kazakhstan, this dissertation aims to describe social support, potentially traumatic events (PTEs), and depressive symptomology; identify the direct association of social support and depressive symptomology, and; examine the moderating role of social support on depressive symptomology related to PTEs. This dissertation is guided by the Push-Pull Theory, the Stress-Buffering Hypothesis, and van Brenda’s conceptualization of resilience. Findings from this dissertation suggest that social support plays a critical role, both directly and indirectly, in influencing outcomes of depressive symptomology. Findings have several implications for social support measurement and direct practice of mental health clinicians, as well as informing how community-based interventions and mental-health policies within LMICs can integrate social support within their resiliency frameworks.

Includes bibliographical references / There are still no diagnostic criteria for a spectrum of neurocognitive disorders (ND) secondary to HIV infection for children. The American Academy of Neurology (AAN) proposes guidelines for assessment of HIV associated neurocognitive disorders (HAND) in HIV infected adults. A cross-sectional clinical cohort study was initiated in Cape Town, in which 120 participants, including a HIV negative healthy control group for comparison, completed clinical and neurocognitive assessments. HIV infected children were either stable on antiretroviral treatment (ART) for a minimum of 6 months or ART naïve. Neuroimaging was completed on 105 children in the cohort study. We compared 75 children vertically infected with HIV aged 6 to 16 years, including both children on antiretroviral therapy (ART) and ART-naïve, with 30 matched controls using diffusion tensor imaging (DTI) measures. We then used the detailed neurocognitive battery; an assessment of adaptive functioning and the AAN system for diagnosing ND to establish whether this system could detect a spectrum of ND in HIV infected older children and adolescents. When comparing HIV uninfected children to HIV infected children this DTI study found damaged neuronal microstructure in the HIV infected children. Significant associations were found between failing first line ART regimen, socio-demographic factors, nutritional-hematological status, HIV-relevant clinical variables, cognitive functioning and white matter integrity in children stable on ART. Children with a clinical diagnosis of encephalopathy (HIVE) had greater white matter damage when compared ART treated children without encephalopathy. DTI also found significant myelin loss in ART naïve children when compared with ART treated children. Using the AAN criteria for HAND, we found that 45.35% of the HIV infected children had a ND. ART naïve slow progressors, who receive limited attention from heath care service s, as they are thought to be 'well', were found to have neurocognitive impairment and white matter microstructural damage. HIV infected children were also more likely to have impaired competence in various domains of functioning. The current findings also underline the possible association of first line treatment failure with white matter brain dysfunction in children on ART. Despite the use of ART and improved virological control with immune reconstitution, there were still a significant percentage of children in this study who were found to have ND. Our findings also suggest that children on ART remain at risk for developing CNS disease, and that this risk extends to physically well ARV naïve slow progressors. The AAN HAND criteria designed for adults was able to identify children and adolescents with important functional cognitive impairments who don't fit criteria for HIVE and would therefore not have been identified otherwise.

BACKGROUND: Demand for mental health services, especially for clinical high-risk and early psychosis, has increased, creating a need for new solutions to increase access to and quality of care. Smartphones and mobile technology are potential tools to support coordinated specialty care (CSC) for early psychosis, given their potential to augment the six core roles of care: case management and team leadership, recovery-oriented psychotherapy, medication management, support for employment and education, coordination with primary care services, and family education and support. Such digital tools could enhance patient care and mitigate challenges for CSC. However, the services smartphones are offering specifically for coordinated specialty care and the level of evidence are unknown. OBJECTIVE: This thesis consists of three phases: 1) to review the published literature on smartphone technology to enhance care for patients with prodromal and early course psychosis and schizophrenia, 2) to create technology implementation guidelines for coordinated specialty care programs, and 3) to assess the framework created in phase two by implementing it at diverse sites across the country. METHODS: Phase I involved a systematic literature search conducted on August 16 and 17, 2019 which used PubMed, EMBASE, Web of Sciences, and PsycINFO electronic databases. All eligible studies were reviewed and screened based on inclusion and exclusion criteria. Phase II was guided by the results discovered in phase I and consisted of modifying the Replicating Effective Programs framework to create a CSC focused model. Phase III entailed the implementation of the framework at eight coordinated specialty care programs in the United States. Findings from each visit guide improvements for the framework. RESULTS: The search conducted in phase I uncovered 388 unique results, of which 21 eligible studies on 16 unique app platforms were identified. Feasibility studies showed high user engagement and interest among patients, monitoring studies demonstrated correlations between app assessments and clinical outcomes, and intervention studies indicated that these apps have the potential to advance care. The AACCS framework was developed in phase II which is composed of five stages: 1) Assess (e.g. identifying access to and comfort with technology), 2) Align (e.g. understanding aspects of coordinated specialty care that technology can augment), 3) Connect (e.g. customizing technology to the needs of patients and clinicians), 4) Care (e.g. implementing the digital tools into treatment), and 5) Sustain (e.g. creating sustainable technology-enabled mental health services). As phase III is ongoing, only results from the first few site visits are shared. Site 1, an amalgamation of three distinct programs, showcased that access to technology was not a barrier, however other aspects necessary for successful technology implementation were missing, such as access to high-speed internet and adequate technology training. Although staff members reported low confidence with technology, they all believed in the potential of technology to assist with all six key roles of CSC. CONCLUSION: The published literature on smartphone apps for prodromal and first-episode psychosis is small but is growing exponentially. Although the research results and protocols for app studies do not align well with all key roles of coordinated specialty care, high rates of adoption and feasibility suggest the potential for future efforts. The findings from the literature review guided the creation of the AACCS framework. This framework is intended to assist CSC programs in the identification of clinical targets to be augmented with digital tools. Implementation of the AACCS framework at many sites highlighted a need for digital literacy training for both patients and staff members. Technology has the unique potential to reduce staff workload, support CSC efforts, and expand the reach of early course psychosis care by erasing distance.

The purpose of this study was to investigate the existence of stigma related to mental health illnesses among music therapy students at a large southeastern public university. A survey of nineteen stigma-related questions was designed and distributed to seventy-six music therapy students. Forty-four surveys were collected (57.9%) and analyzed. The survey consisted of four demographic questions and fifteen stigma related statements. Statements were related to one of three components of stigma: prejudice, stereotype, and discrimination. Respondents answered each statement based on the extent to which they agreed or disagreed to each item on a five-point, Likert-type scale. Results indicated that music therapy students tended to disagree with stigma-related statements. These results may suggest a lower perceived stigma towards mental health illnesses among music therapy students. Understanding the prevalence of stigma on mental health among music therapy students provides implications for future music therapists and current music therapists working in mental or behavioral health settings to provide more adequate experiences for individuals with mental illness. Music therapists can help challenge the stigma related to mental health, a major barrier for those wishing to seek treatment with mental illness. / A Thesis submitted to the College of Music in partial fulfillment of the Master of Music. / Spring Semester 2016. / April 12, 2016. / mental health, mental illness, music therapy, public stigma, self-stigma / Includes bibliographical references. / Lori Gooding, Professor Directing Thesis; Jayne Standley, Committee Member; Alice-Ann Darrow, Committee Member.

The purpose of this study was to examine the relationship between Instagram use and body image concerns among female university students and to test whether appearance-related comparisons on Instagram mediated this relationship. A direct relationship between Instagram use and body image concerns was not found, but appearance-related comparisons on Instagram mediated the relationship. The results suggest that Instagram negatively affects the body image of users who engage in appearance-related comparisons. Another purpose of this study was to determine the role of intrasexual competitiveness for mates and to test whether individual differences in competitiveness influenced individual tendencies to engage in appearance-related comparisons on Instagram. Results showed a significant positive relationship between intrasexual competitiveness for mates and appearance-related comparisons on Instagram. Furthermore, appearance-related comparisons mediated the relationship between Instagram use and drive for thinness. Future studies should consider exploring the relationship between intrasexual competitiveness for mates, social media use, and body image concerns using experimental designs. / A Thesis submitted to the School of Communication in partial fulfillment of the requirements for the degree of Master of Arts. / Summer Semester 2016. / July 27, 2016. / Body Image, Body Image Concerns, Instagram, Media Effects, Social Comparisons, Social Media / Includes bibliographical references. / Laura M. Arpan, Professor Directing Thesis; Arthur A. Raney, Committee Member; Russell B. Clayton, Committee Member.

NEUROHURRICANE is a collection of poems that attempts to answer the question of how mental illness can affect relationships, and how two people can figure out how to love each other in a healthy way when they are both mentally ill.

As the incidence of major depressive disorders continues to rise, the need for depression screening in primary care is imperative. The objective of this quality improvement (QI) project is to increase depression screening and enhance the current referral process in an urban primary care setting in the southeast United States. To achieve a projected increase in identified depression within the current and future adult patient population, workflow processes have been restructured to incorporate consistent depression screening using the Patient Health Questionnaire-2 (PHQ-2) and -9 (PHQ-9). Revised clerical workflow processes include initiating PHQ-9 questionnaires for all new patients, while clinical workflow processes include conducting PHQ-2 questionnaires for all established patients. Scores on the PHQ-9 indicating moderate levels of depression will trigger primary care provider (PCP) notification. Providers offer three treatment options including Behavioral Health Care Navigator Services (BHCN), self-referral to a mental health care provider, or treatment by PCP. Data will be collected to determine the number of PHQ-9 questionnaires given to “New Patients” at check-in, PHQ-2 questionnaires conducted by clinical staff, PHQ-9 scores of 10 or greater, BHCN referrals placed, patients who elected self-referral, and completed initial mental health appointments with differentiation between BHCN scheduled appointments and self-referred appointments. This QI project is currently undergoing implementation with no outcomes to report, however, data collected during analysis is expected to reveal an increase in patients diagnosed with moderate to major depressive disorders and an increase in completed initial mental health appointments.

The incarceration of mentally ill youth is a serious problem not receiving the same attention as in adults. In this study, we examine the level of prior service utilization in incarcerated youth versus youth receiving community mental health services. We randomly recruited youth from middle South Carolina served by a local community mental health center (CMHC; n = 60), hospitalized in the state adolescent inpatient program (n = 50), and incarcerated in the S.C. Dept. of Juvenile Justice facilities (n = 75). We used a Services History to evaluate episodes of prior utilization of mental health, social service, educational, residential, and volunteer services, as well as the DISC-PC 2.3 to evaluate DSM-III-R diagnoses and symptoms and the CBCL and YSR to evaluate behavioral symptomatology. Incarcerated, hospitalized, and CMHC youth utilized similar levels of educational services and social services. Incarcerated youth had a significantly lower lifetime utilization of outpatient and acute mental health services and significantly higher utilization of out-of-home residential services than the other groups. These services utilization variables, along with gender and age, significantly distinguish incarcerated youth from the clinical groups, with clinical variables not serving to significantly distinguish them. Our results indicate the need to develop programs to prevent the entry of mentally ill/emotionally disturbed youth into the juvenile justice system. Youth who are at risk for incarceration may benefit from intensive mental health services to prevent out-of-home placement and later incarceration.