Thesis (M.S.)--University of Michigan, 1978.

Thesis (M.S.)--University of Michigan, 1986.

Previous research on the mental health of firefighters has shown that they are at a greater risk than the majority of the population to develop various mental disorders, such as depression, anxiety, alcohol abuse, suicidal ideation, and post-traumatic stress disorder. However, very little research has been done on the repetitive cumulative exposure to trauma that is associated with their career, which may lead to elevated levels of mental disorders that may not be detected in one testing. In this study, a series of assessments will be given to a sample of urban firefighters every year for the entirety of their career. The data collected in this study will be analyzed at each testing date using simple regressions, and then the data will be analyzed using time series analysis. The results of this study predict that as a career in the fire service progresses, as age increases, as the average hours of sleep decrease, as their rank within the department rises, as the number or critical incidents attended, and as the number of critical incident stress debriefings attended increase, all of the mental disorders measures will increase. Not only do the simple regressions show evidence of an increased aptitude for mental illness, but also the time series analysis will show that the mental illnesses continue to amplify throughout a career in the fire service. The results of this study could have massive implications for the fire service’s treatment of mental health stigmatization.

Bakgrund: Patienter med en allvarlig psykisk störning isolerades tidigare från samhället. En historisk sammanfattning belyser detta och en beskrivning ges av den psykiatriska behandlingen från medeltiden fram till idag. Begreppen psykisk sjukdom, psykisk störning, allvarlig psykisk störning samt psykiskt funktionshinder beskrivs. Sjuksköterskans omvårdnadsarbete och omvårdnadsproblem inom psykiatrin återges i en resumé. Syfte: Syftet är att belysa patienters upplevelser av att leva med allvarlig psykisk störning. Metod: En litteraturöversikt där resultatdelen baseras på nio kvalitativa vetenskapliga artiklar och en kvantitativ vetenskaplig artikel, publicerade mellan 2002-2012. Resultat: Resultatet mynnade i sex teman: ensamhet, vardagen, omgivningens attityder, självstigma och skam, vårdpersonals bemötande och patientrollen. Diskussion: Resultatdelens olika teman diskuteras. Ett resonemang förs med anknytning till Kari Martinsens omsorgsfilosofi gällande ensamhetens konsekvenser, gemenskapens betydelse, samt hur attityder gällande psykisk störning påverkar självbilden. Interaktionen mellan nämnda områden belyses, slutligen debatteras personliga erfarenheter gällande faktorer som är betydelsefulla för ett ökat välbefinnande. / Background: Patients with serious mental disorder have through history been isolated from the rest of the society. An historical summary of psychiatric treatment from The Middle Ages until today are presented. Concepts such as mental illness, psychiatric disorder, serious mental illness and mental disabilities are described. A recap of the nursing in psychiatric care is given as well as problems attached to nursing in this field. Aim: The aim is to illuminate patients´ experiences of living with serious mental disorder. Methods: A literature review based on nine qualitative scientific articles and one quantitative scientific article published between the years 2002-2012. Results: The result showed six themes: loneliness, every-day, surrounding attitudes, self stigma and shame, the response from health professionals and the role as a patient. Discussions: Themes that emerged in the result are here discussed. The authors connect the themes to Kari Martinsen´s philosophy of caring and a reason is held about the consequences of loneliness, the importance of being part of a community and the impact that attitudes surrounding mental illness have on the self-image. The interaction between the areas is illustrated and finally we debate which factors who are of importance for increased well-being.

This research focuses on pushing forward the understanding of mental disorders portrayals in games, more specifically social anxiety, which still lies as a marginalized topic in this medium. In order to understand honest manifestations of social anxiety in games, the first step is to conduct a close reading of games made by people who suffer from this mental disorder. A collection of five indie games, all of autobiographical nature and featuring social anxiety as an important part of their text, was put together for this analysis. This was done embracing the need to address the representational complexity, in order to tap into such a nuanced and elusive topic as social anxiety, not to identify rights or wrongs, but to engage in a discussion of how experiences are represented in games by people directly affected by this mental disorder. Individual experiences also contribute to expand interpretations and to identify additional keys of social anxiety representation. This is done by reaching informants, people living with a comorbid mental illnesses or disorders, that face or had faced social anxiety, and assess their perspectives through an experiential workshop. This work intends to further explore the practice of game design as mediator of experiences, contributing to both deepen the knowledge of game design and explore nuances of individual experiences present in autobiographical games and how this relates to perspectives of other people living with social anxiety. By combining the games and informants perspectives it is possible to structure a debate about game design patterns based on the findings of the game analysis and further elaborated with the nuanced perceptions gathered from informants. The knowledge acquired through this work is a step towards understanding of how games can represent, in an honest and non-stereotypical way, mental disorders, starting with social anxiety and, hopefully, contribute to spark other studies to broaden the spectrum of how the complexity of adverse mental conditions can be more respectfully addressed in games.

Schizophrenia is a neurodevelopmental disorder affecting 1% of the general population. Dysfunction of the prefrontal cortex (PFC) is associated with the etiology of schizophrenia. Moreover, a substantial deficit of GAD1mRNA in schizophrenic PFC has been reported by different groups. However, the underlying molecular mechanisms are still unclear. Interestingly, epigenetic factors such as histone modifications and DNA methylation could be involved in the pathogenesis of schizophrenia during the maturation of the PFC. In my work, I identified potential epigenetic changes in schizophrenic PFC and developmental changes of epigenetic marks in normal human PFC. Furthermore, mouse and neuronal precursor cell models were used to confirm and investigate the molecular mechanisms of the epigenetic changes in human PFC. My initial work examined whether chromatin immunoprecipitation can be applied to human postmortem brain. I used micrococcal nuclease (MNase)-digested chromatin instead of cross-linked and sonicated chromatin for further immunoprecipitation with specific anti-methyl histone antibodies. Surprisingly, the integrity of mono-nucleosomes was still maintained at least 30 hrs after death. Moreover, differences of histone methylation at different genomic loci were detectable and were preserved within a wide range of autolysis times and tissue pH values. Interestingly, MNase-treated chromatin is more efficient for subsequent immunoprecipitation than crosslinked and sonicated chromatin. During the second part of my dissertation work, I profiled histone methylation at GABAergic gene loci during human prefrontal development. Moreover, a microarray analysis was used to screen which histone methyltransferase (HMT) could be involved in histone methylation during human prefrontal development. Mixed-lineage leukemia 1 (MLL1), an HMT for methylation at histone H3 lysine 4 (H3K4), appears to be the best candidate after interpreting microarray results. Indeed, decreased methylation of histone H3 lysine 4 at a subset of GABAergic gene loci occurred in Mll1 mutant mice. Interestingly, clozapine, but not haloperidol, increased levels of trimethyl H3K4 (H3K4me3) and Mll1 occupancy at the GAD1 promoter. I profiled histone methylation and gene expression for GAD1 in schizophrenics and their matched controls. Interestingly, there are deficits of GAD1 mRNA levels and GAD1 H3K4me3 in female schizophrenics. Furthermore, I was also interested in whether the changes of GAD1 chromatin structure could contribute to cortical pathology in schizophrenics with GAD1 SNPs. Remarkably, homozygous risk alleles for schizophrenia at the 5’ end of the GAD1 gene are associated with a deficit of GAD1 mRNA levels together with decreased GAD1 H3K4me3 and increased GAD1H3K27me3 in schizophrenics. Finally, I shifted focus on whether DNA methylation at the GAD1 promoter could contribute to a deficit of GAD1 mRNA in schizophrenia. However, no reproducible techniques are available for extracting genomic DNA specifically from GABAergic neurons in human brain. Therefore, I used an alternative approach that is based on immunoprecipitation of mononucleosomes with anti-methyl-histone antibodies differentiating between sites of active and silenced gene expression. The methylation frequencies of CpG dinucleotides at the GAD1 proximal promoter and intron 2 were determined from two chromatin fractions (H3K4me3 and H3K27me3) separately. Consistently, the proximal promoter region of GAD1 is more resistant to methylation in comparison to intron 2 of GAD1 in either open or repressive chromatin fractions. Interestingly, overall higher levels of DNA methylation were seen in repressive chromatin than in open chromatin. Surprisingly, schizophrenic subjects showed a significant decrease of DNA methylation at the GAD1proximal promoter from repressive chromatin. Taken together, my work has advanced our knowledge of epigenetic mechanisms in human prefrontal development and the potential link to the etiology of schizophrenia. It could eventually provide a new approach for the treatment of schizophrenia, especially in the regulation of methylation at histone H3 lysine 4.

Due to the continuous growth of patients with mental disorders, it has been a strenuous job to look after each patient and tailor the appropriate treatments for them on time. The thesis proposes a design science framework in the form of an IT artefact to prioritize the patients with mental disorders, considering the severity of the situation. The IT arte-fact will be using expert’s knowledge to design a self-assessment screen-ing tool that will evaluate the criticality of a patient’s mental health. This tool will also incorporate the psychometric scale DSM-5 Self-Rated Level 1 Cross-Cutting Symptom Measure, Adult electronically to de-termine what will be the next stage in the process of patients’ treat-ments. The process of prioritizing patients is prolonged and remains to be tedious at the hospital and also there is always a possibility of miss-ing some information while carrying out the job manually. The self-assessment system will serve two goals. It will shorten the initial screen-ing process and also the likelihood of any human error. The system is not meant to replace healthcare professionals but to build a bridge be-tween the patients and the doctors to make everyone’s life more orga-nized. The results indicate that it is possible to create a framework and the relevant prototype with the help of expert’s knowledge that can prioritize patients with mental disorders. It also demonstrates that the system can digitalize DSM-5 Self-Rated Level 1 Cross-Cutting Symp-tom Measure, Adult scale to determine possible problem domains for further diagnosis.

Submitted by Tatiana Lima (tatianasl@ufba.br) on 2017-02-07T18:25:47Z No. of bitstreams: 1 Pessoa, Indira Vita.pdf: 7736145 bytes, checksum: 383536e31f6997ffde98e965b87f9d8c (MD5) / Approved for entry into archive by Tatiana Lima (tatianasl@ufba.br) on 2017-02-15T19:06:08Z (GMT) No. of bitstreams: 1 Pessoa, Indira Vita.pdf: 7736145 bytes, checksum: 383536e31f6997ffde98e965b87f9d8c (MD5) / Made available in DSpace on 2017-02-15T19:06:08Z (GMT). No. of bitstreams: 1 Pessoa, Indira Vita.pdf: 7736145 bytes, checksum: 383536e31f6997ffde98e965b87f9d8c (MD5) / A música sempre foi um elemento importante da experiência humana. Nos cuidados à saúde mental, sons, harmonias, instrumentos musicais e ritmos são utilizados como forma de tratamento complementar para vários problemas psicológicos, ajudando a pessoa ou grupo com relação ao desenvolvimento, à comunicação, ao relacionamento, à aprendizagem, à mobilização, à expressão e à organização física, mental ou social. Por isso a música pode ser utilizada como estratégia para o empoderamento de usuários dos serviços de saúde mental. Esta pesquisa traz evidências sobre isso e teve como resultado o livro digital “ALLEGRO”, voltado para profissionais de saúde e gestores dos Centros de Atenção Psicossocial (CAPS). O livro contém informações e reflexões sobre a música como estratégia terapêutica, bem como um conjunto de condicionantes, práticas, técnicas e ações. A abordagem metodológica foi a exploratória, de caráter qualitativo, por meio de pesquisa bibliográfica e de campo, utilizando-se da observação, de entrevistas e de análise de documentos. Destaca-se como resultado o fato de que o bom emprego dessa tecnologia pode despertar o interesse e trazer informações que estimulem gestores e profissionais de saúde a levarem a música para o ambiente de cuidado em saúde mental, o que pode gerar impactos econômicos e sociais tanto para os CAPS quanto para os usuários dos serviços e seus familiares. / Music has always been a key element in mankind experiences. Throughout the mental health care, sounds, harmonies, musical instruments and rhythms have been used as a way of com-plementing treatment to many psychological problems, helping the person or related group on their development, communication, relationship, learning process, mobilization, expression, and social, mental and physical organization. Therefore, music may be applied as a strategy of empowerment for mental health service patients. This research brings evidence about this and resulted in the digital book "ALLEGRO", which is oriented towards healthcare professionals and managers of Psychosocial Care Centers (CAPS). The book incorporates informations and considerations about music as a therapeutic strategy, as well as a union between conditioning factors, practices, techniques and actions. The methodology approach has been the explana-tion, of qualitative nature, through bibliographic and field research, employing documents observations, interviews and analysis. It is highlighted as a result the fact that good use of this social technology can spark interest and bring information to encourage CAPS’s managers and healthcare professionals to take the music to the environment of care in mental health, which can lead to economic and social impacts for CAPS as well as mental health patients and their families.

Submitted by Maria Creuza Silva (mariakreuza@yahoo.com.br) on 2013-05-14T13:47:26Z No. of bitstreams: 1 Tese Eliane Sales. 2009.pdf: 1048115 bytes, checksum: 8d0649e6a5b1c164e8e4e6745ed1a3e7 (MD5) / Approved for entry into archive by Maria Creuza Silva(mariakreuza@yahoo.com.br) on 2013-05-14T13:47:48Z (GMT) No. of bitstreams: 1 Tese Eliane Sales. 2009.pdf: 1048115 bytes, checksum: 8d0649e6a5b1c164e8e4e6745ed1a3e7 (MD5) / Made available in DSpace on 2013-05-14T13:47:48Z (GMT). No. of bitstreams: 1 Tese Eliane Sales. 2009.pdf: 1048115 bytes, checksum: 8d0649e6a5b1c164e8e4e6745ed1a3e7 (MD5) Previous issue date: 2009 / Esta tese apresenta o resultado da investigação sobre assédio moral no trabalho e Transtornos Mentais Comuns TMC entre trabalhadores de uma empresa do setor de serviços, especializada em serviços de limpeza. Nesta pesquisa foram desenvolvidos três estudos em forma de artigos. O primeiro de corte transversal, de caráter exploratório, para análise da prevalência de assédio moral no trabalho na população estudada. Foram identificadas também, condições de maior vulnerabilidade social entre os sujeitos expostos ao assédio moral. A definição de caso foi feita a partir do uso do Questionário de Atos Negativos QuAN, uma versão brasileira do Negative Acts Questionnaire NAQ, a partir da referência de exposição semanal ou diária. O segundo artigo, correspondeu a um estudo exploratório realizado a partir da aplicação do QuAN, com vistas a analisar os atos negativos mais frequentemente relatados e as médias de respostas positivas aos atos, conforme o status sócio-demográfico e ocupacional dos trabalhadores. Apresentou-se ainda, o perfil dos sujeitos considerados perpetradores. O terceiro estudo, com desenho tipo corte transversal, de caráter confirmatório objetivou verificar a associação entre assédio moral no trabalho e Transtorno Mentais Comuns. Para estabelecer a variável dependente utilizou-se o Self Report Questionnaire-20 SRQ-20. Os resultados das análises procedidas nos três artigos, apontam para uma prevalência elevada de assédio entre os trabalhadores, compatível com achados de pesquisas de base populacional. Os atos negativos direcionados ao campo profissional foram referidos mais frequentemente. Observou-se por fim, uma forte associação entre assédio moral no trabalho e transtornos mentais comuns, mesmo quando ajustada por fatores sócio-demográficos e ocupacionais. Evidenciou-se que o tempo na empresa pode implicar em maiores chances dos indivíduos assediados apresentarem TMC. A discussão sobre a ocorrência e o impacto do assédio moral no trabalho na saúde mental dos trabalhadores deve ser fomentada com vista à busca de soluções para um problema que já se delineia como questão de saúde pública no Brasil. / Salvador

The study aimed to analyze the association between exposure to violence and the presence of mental disorder in the population aged 18 or more in the neighborhood of Benedito Bentes, Maceió / Alagoas. Epidemiological population-based study of analytical and cross-section, with a pure probability sample of 872 people in a cluster sampling. Data collection in the period from january 26 to march 2, 2015, with residents interviewed in the referenced households. The sociodemographic questionnaire, the Mini International Neuropsychiatric Interview and the Instrument Socioeconomic Stratum were used. The ethical aspects are met. Was obtained prior approval from the Ethics Committee of the Federal University of Alagoas, opinion n.º 608 613. We used the statistical package IBM Statistical Package for Social Sciences (S.P.S.S.) for Windows version 17.0, for statistical analysis, with a 95% confidence interval. In the results, 74.9% of respondents were female, 73.7% of blacks, 7.4 years of study average. The violence against children was prevalent in 12.4%, violence in adulthood by 19.6%, witnessing violence in life and 50.5% triple exposure to violence in 4.1%. Violence in childhood and in adulthood occurred mostly in the victim's home. Suffer violence in childhood was associated with lower socioeconomic status. The non-nuclear family structure was a protective factor for violence in childhood, adulthood or triple. Exposure to violence in childhood was associated with most disorders, with five times more likely to panic attack symptoms with limited; sexual violence in childhood was associated with four times the suicide risk of chances. Suffer violence as an adult was associated with a greater number of disorders, with six times more likely to abuse alcohol. Witnessing violence was associated with some of the disorders, with less force in the associations except substance dependence, with six times more likely. The triple exposure to violence was associated with fewer disorders than those who have experienced violence in adulthood; however, the combinations were more intense, thereby indicating whether the dose- response effect. Most outbreaks of violence demonstrated association with risk of suicide. Victims of sexual violence in childhood or adulthood had more than three times as likely to more risk of suicide. The posttraumatic stress disorder (PTSD) has been associated with sexual violence in adulthood, with ratio greater chances to eight times; there were no significant associations between sexual violence in childhood and PTSD. Exposure to violence was associated with higher chances of manifestation of disorders and suicide risk. There is a pressing need for early identification of victims of violence to offer appropriate psychosocial support. Violence should be a condition investigated in people with disorders history. Managers and health professionals articulated with other sectors need to discuss in amplified form the interrelationship between violence and mental health field in order to propose convergent interventions to local needs. / Fundação de Amparo a Pesquisa do Estado de Alagoas / O estudo teve por objetivo analisar a associação entre exposição à violência e presença de transtorno mental na população com 18 anos ou mais do bairro Benedito Bentes, Maceió/Alagoas. Estudo epidemiológico de base populacional, com caráter analítico e corte transversal, amostra probabilística simples com 872 pessoas, amostragem por conglomerados. Coleta de dados no período de 26 de janeiro a 2 de março de 2015, com entrevistados residentes nos domicílios referenciados. Foram utilizados o Questionário Sociodemográfico, o Mini International Neuropsychiatric Interview e o Instrumento do Estrato Socioeconômico. Os aspectos éticos foram atendidos. Obteve-se aprovação prévia do Comitê de Ética em Pesquisa da Universidade Federal de Alagoas, parecer n.º 608.613. Utilizou-se o pacote estatístico IBM Statistical Package for the Social Sciences (S.P.S.S.) para Windows versão 17.0, para análises estatísticas, com intervalo de confiança de 95%. Nos resultados, 74,9% dos entrevistados são do sexo feminino, 73,7% da raça negra, média de estudo de 7,4 anos. A violência na infância foi prevalente em 12,4%, violência na vida adulta em 19,6%, testemunhar violência na vida em 50,5% e tríplice exposição à violência em 4,1%. A violência na infância bem como na vida adulta ocorreu em sua maioria no domicílio da vítima. Sofrer violência na infância associou-se a estrato socioeconômico mais baixo. A configuração familiar não nuclear foi fator de proteção para a violência na infância, na vida adulta ou tríplice. A exposição à violência na infância esteve associada à maioria dos transtornos, com cinco vezes mais chances para ataque de pânico com sintomas limitados; a violência sexual na infância associou-se a quatro vezes mais de chances de risco de suicídio. Sofrer violência quando adulto associou-se a um maior número de transtornos, com seis vezes mais chances para abuso de álcool. Testemunhar violência associou- se com alguns dos transtornos, com menor força nas associações, exceto dependência de substâncias, com seis vezes mais chances. A tríplice exposição à violência associou-se a um menor número de transtornos em comparação aos que sofreram violência na vida adulta; no entanto, as associações foram mais intensas, evidenciando-se assim o efeito dose-resposta. A maioria das manifestações de violência demonstrou associação com risco de suicídio. As vítimas de violência sexual na infância ou na vida adulta tiveram mais que o triplo de chances a mais para risco de suicídio. O transtorno de estresse pós-traumático (TEPT) esteve associado a sofrer violência sexual na vida adulta, com razão de chances superior a oito vezes; não foram encontradas associações significativas entre sofrer violência sexual na infância e TEPT. A exposição à violência esteve associada a maiores chances de manifestação de transtornos e risco de suicídio. É premente a necessidade de identificação precoce das vítimas de violência com oferta de suporte psicossocial adequado. A violência deve ser uma condição investigada em pessoas com histórico de transtornos. Gestores e profissionais de saúde articulados com outros setores necessitam discutir de maneira ampliada a inter-relação entre violência e o campo da saúde mental, a fim de propor intervenções convergentes com as necessidades locais.