Alcohol is one of the most common drugs of choice among adolescents. Normally, the method of consumption is drinking large quantities of alcohol in short periods of time, otherwise known as “binge drinking.” Corticotropin releasing factor (CRF) stress peptide producing cells in central nucleus of the amygdala (CeA) has been implicated in behavioral responses to stress and addiction. The goals of this thesis were to determine the effects of voluntary binge drinking in adolescence and vapor-induced alcohol dependence in adulthood on CRF cells in the CeA. These studies were done using an operant model of voluntary binge drinking in rodents in which adolescent animals are allowed to orally self-administer sweetened alcohol intermittently (or sweetened water for controls) during early adolescence. The current findings demonstrate that binge drinking during adolescence decreases the number of CRF-ir cells in the CeA. This decrease in cell number is long-term, lasting well into adulthood and dependence does not exacerbate this effect. A second goal was to determine whether certain behaviors could be used as a predictive measure for adolescent binge drinking. The current findings indicated that frequency of self-grooming, can be used as a predictive measure for adolescent binge drinking. Specifically, increased frequency of self-grooming predicts lower alcohol self administration during adolescence.

This study investigated associations among different parental psychopathology dimensions and child functioning. Mothers and fathers of preschoolers with behavior problems (n = 132) completed psychopathology questionnaires when children were 3 years old. Children’s externalizing, internalizing, and social problems, academic achievement, and cognitive ability were assessed at annual home visits from age 3 to 6. In general, maternal psychopathology symptoms were associated with mothers’ reports of externalizing, internalizing, and social problems at age 3 and 6. Additionally, paternal psychopathology symptoms were associated with fathers’ reports of externalizing and internalizing problems at age 3 and 6. Mothers with more elevated psychopathology symptom dimensions had children with more mother-reported and father- reported externalizing and internalizing problems, and lower social competence at age 3 and age 6. Fathers with more elevated psychopathology symptom dimensions had children with more mother-reported internalizing problems at age 3 and 6. Only a few parental psychopathology dimensions (maternal ADHD and Cluster A symptoms, and paternal ADHD, depression, and antisocial symptoms) emerged as unique predictors of child functioning at age 3 and 6. These findings suggest that most types of mothers’ and fathers’ psychopathology may play a role in the behavioral, social, and emotional outcome of preschoolers with behavior problems.

Bakgrund: Det finns flera faktorer som påverkar compliance, bland annat stigmatisering, kognition och hälsolitteracitet. Bristande compliance är vanligt förekommande hos patienter med psykisk sjukdom och kan leda till allvarliga konsekvenser, såsom svåra insjuknanden, försämrad livskvalitet och suicid. Metoder som förbättrar compliance kan ha stor betydelse för både patienter och närstående samt kan möjliggöra att hälso- och sjukvårdens resurser kan användas mer kostnadseffektivt.Syfte: Att beskriva metoder som kan förbättra compliance hos patienter med psykisk sjukdom.Metod: Integrativ litteraturstudie valdes som design. Sökningar på artiklar som uppfyllde syftet gjordes i databaserna CINAHL och PubMed, där 16 kvantitativa artiklar identifierades. Dataanalysen utfördes med Whittemore & Knalf's metod som inkluderar datareduktion, data-översikt, data-jämförelse och data-slutsats.Resultat: Studien resulterade i tre huvudkategorier: beteendeterapier, hälsopedagogik och eHälsa och deras underkategorier. Beteendeterapier inkluderade MI, KBT, KBT i kombination och positiv psykologisk terapi (PPI). Identifierade hälsopedagogiska metoder var psykoedukation i kombination samt CAE- och EDU-utbildning. eHälsa resulterade i SMS-påminnelser och smartphone-applikationer.Slutsats: Kombinerade hälsopedagogiska och beteendeinterventioner riktade till patienter och närstående i deras hemmiljö samt gruppinterventioner har bevisat god effekt på compliance. Gruppbehandling kan ge sekundära effekter på exempelvis stigmatisering och social interaktion. Interventioner, givna av specialistsjuksköterskor, är särskilt framgångsrika. Flera av metoderna är kostnadseffektiva och kräver bara några dagars utbildning för att behärska.  Nyckelord: compliance, förbättra, metoder, psykisk sjukdom / Bakground: There are several factors that can affect compliance, including stigma, cognition and health literacy. Non-compliance is common in patients with mental disorders and can lead to serious consequences, such as severe illnesses, impaired quality of life and suicide. Methods that improve compliance can be of great importance for both patients and relatives and can enable healthcare resources to be used more cost-effectively. Aim: The aim of this study was to describe methods that can improve compliance in patients with mental disorders. Method: The study was conducted as an integrative literature review. Searches for articles that met the objective were made in the databases CINAHL and PubMed, 16 quantitative articles were identified. The data analysis was performed by Whittemore & Knalf's method which includes data reduction, data overview, data comparison and data conclusion. Results: The study resulted in three main categories;: behavioral therapies, health education and eHealth and their subcategories. Behavioral therapies included MI, KBT, KBT in combination and positive psychological therapy (PPI). Identified health education methods were psychoeducation in combination, CAE- and EDU-education. eHealth resultad in mobile text messaging and smartphone-applications.Conclusion: Combined health educational and behavioral interventions aimed at patients and relatives, in their home environment as well as group interventions, have proven efficacy on compliance. Group treatment can have secondary effects on, for example, stigma and social interaction. Interventions, given by specialist nurses, are particularly succesful. Several of the methods are cost-effective and require only a few days of training to master.  Keywords: compliance, improve, mental disorders, methods

Purpose: Despite the wide usage of World Health Organization Disability Assessment Schedule II (WHODAS 2.0) in psychiatry research and clinical practice, there was limited knowledge on its proxy reliability among people with mental disorders. This paper aimed to compare the 12-item WHODAS 2.0 responses of adult patients with mental disorders to their family caregivers. Methods: In this study, 205 pairs of patients with mental disorders and primary family caregivers were consecutively recruited from one inpatient mental health department in a large hospital in China. All participants completed the 12-item version WHODAS 2.0 to assess patients’ functioning in the 30 days prior to the hospitalization. Measurement invariance, including configural, metric and scalar invariance, was tested across patient and proxy groups, using multi-group confirmatory factor analysis. Agreement between patients and proxies was examined by paired Wilcoxon tests and intraclass correlation coefficients (ICC). Subgroup analyses for proxy reliability were conducted within strata of proxy kinship and patient psychiatric diagnosis. Results: The 12-item WHODAS 2.0 achieved configural, metric and partial scalar invariance across patient and proxy groups. Unsatisfactory consistency was found for most items (ICC < 0.75, P < 0.05), especially for items on Cognition, Getting along, Life activities, and Participation in society (ICC < 0.4, P < 0.05). Spouses agreed with patients more often than parents (ICC ≥ 0.4, P < 0.05). The paired Wilcoxon tests found that impairment of patients with psychotic disorders tended to be overestimated by proxies while proxies tended to underestimate impairment of patients with mood disorders. Conclusion: Our study reveals inconsistency between self and proxy reports in the 12-item WHODAS 2.0 among adult patients with mental disorders. When proxy reports is needed, spouses are preferred than parents. We should be aware of proxies’ impairment overestimation among patients with psychotic disorders and underestimation among patients with mood disorders.

This study examined maternal depression status from month 1 to 36 after birth using data from the NICHD Study of Early Child Care and Youth Development. Maternal depression was assessed with the Center of Epidemiological Studies Depression Scale. The prevalence of maternal depression was highest at 1 month, decreased at 6 months, and then kept fairly stable to 36 months. The prevalence was higher in blacks than other races, in 18-24 than 25-46 years old, and in single mothers than non-single mothers. Mothers with better physical health, social support, or employed had a lower prevalence than their counterparts. Mothers in poverty, receiving public assistance, or who had more parental stress had a higher prevalence. Social support and parental stress had a statistically significant relationship with maternal depression even after adjusting for other variables. In conclusion, this longitudinal study found that several maternal, child, and family factors were associated with maternal depression.

Suicide is a significant public health concern worldwide and the 10th leading cause of death in the United States. Risk factors for suicide include depression, anxiety, hopelessness, and previous suicide attempts, among others. Some vulnerable groups may have unique risk factors that exacerbate suicide risk; for instance, college students experience academic stress, and individuals with chronic illnesses, such as fibromyalgia and cancer, face persistent health complications. However, protective characteristics, such as self-compassion, may reduce suicide risk. Comprised of self-kindness, mindfulness, and common humanity, self-compassion is beneficially associated with mental and physical health, and to the task of suicide prevention. As such, we examined the relation between self-compassion and suicidal behavior, and the potential parallel mediating effects of depression, anxiety, and hopelessness across four samples (community, N = 632; collegiate, N = 338; fibromyalgia, N = 508; cancer, N = 241). Across all four samples, the combined effect of depression, anxiety, and hopelessness mediated the relation between self-compassion and suicidal behavior. Our findings provide support for the notion that self-compassion has a beneficial association with suicidal behavior directly, as well as indirectly via its influence on the suicide risk factors of depression, anxiety, and hopelessness. Increasing self-compassion through interventions such as Compassion-Focused Therapy and Mindful Self-Compassion may not only increase self-compassion, but may also facilitate adaptive coping, particularly in times of distress, that ameliorates symptoms of psychopathology and suicide risk. Future prospective, longitudinal studies, and randomized control trials, are needed to examine causal effects of self-compassion on emotional dysfunction and suicidal behavior.

Background: E-cigarettes, also known as electronic nicotine delivery systems (ENDS), are the second most used tobacco product in the US. Cigarette smoking, alcohol, and tobacco use, which contribute to a large portion of disease burden caused by substance use disorders (SUDs), have all been shown to be associated with ENDS use. The co-occurrence of mental disorders and SUDs is well established despite unclear causality. Understanding the associations between e-cigarette use, substance use, and mental health disorders is imperative to understanding the full impact of ENDS use. The aim of our study is to examine these associations in Tennessee, where the prevalence of cigarette smokers and drug overdose deaths is higher than the national average. Methods: We used cross-sectional data from the 2021 Behavioral Risk Factor Surveillance System a nationally representative U.S. telephone-based survey of adults aged 18 years, and extracted data for Tennessee (n=4,788). Logistic regression analysis was conducted to test the association between cigarette use, substance use, depression, and ENDS use. We controlled for income, race, educational status, health insurance status, race/ethnic minority status, and age. Results: Overall, 6.7% (n=320) of participants in our sample reported ENDS use. Results of our logistic regression model revealed that cigarette use (OR=2.58, 95% CI, 1.99,3.44), depression (OR=2.33, 95% CI, 1.82, 2.98), alcohol use (OR =2.50, 95% CI, 1.96, 3.20), male gender (OR =1.30, 95% CI, 1.02, 1.60), and no health insurance (OR =1.48, 95% CI, 1.02, 2.15) were associated with ENDS use, while race/ethnic minority status, low income, and non-completion of high school were not associated with ENDS use. Conclusion: Our results showed that cigarette use, alcohol use, and depression were associated with ENDS use in Tennessee after controlling for common confounders. Our results corroborate other studies that show a strong association between ENDS use, co-occurring substance use disorders, and mental disorders. This cross-sectional study from a sample in Tennessee can serve as the basis for future longitudinal research in this population.

The 40 Hz auditory steady state response (ASSR) is an EEG response of local neural synchrony that is evoked by the repeated presentation of a 40 Hz click train. While the principal cortical generators of this response appear to be the bilateral primary auditory cortices as they show the largest phase locking and evoked power, other regions across the cortical mantle synchronize too, including the prefrontal cortex (PFC) that receives input from the primary auditory cortex and is involved in higher order cognitive functions. In schizophrenia, it is hypothesized that NMDA-mediated disruption in PFC function contributes to cognitive deficits including working memory and executive function. In rodents, NMDA antagonists reliably disrupt set shifting, a working memory task linked to PFC function. It is however not known if NMDA antagonism would disrupt the 40 Hz ASSR in PFC. In the following study, we equipped a group of female SD rats with epidural electrodes targeting the PFC (2.5 mm anterior and 0.8 mm lateral to bregma) and the primary auditory cortex (4.5 mm caudal, 7.5 mm lateral and 3.5 mm ventral to bregma). Two epidural screw electrodes on cerebellum served as ground and reference. After recovery from surgery and acclimation, rats were pretreated with small to modest doses of the NMDA antagonist MK801 (0.025, 0.05 and 0.1 mpk) or saline (1 ml/kg, sc) in a cross-over design, tethered to EEG cables and the EEG signal was amplified and acquired (Signal 7.0; CED1401 Micro 3). Trains of square waves (~ 1 ms duration; 40/s) were generated and played through the house speakers at ~ 65 dB SPL. EEG was acquired as 4 s sweeps while the click train played between 1-2 s of each sweep; 75 trials were recorded from each subject. Sixty minutes after vehicle treatment, robust EEG entrainment was noted in both the temporal cortex as well as the PFC. As expected, the EEG signal power from the temporal cortex was notably larger compared to the PFC. Nevertheless, both regions showed clear 40 Hz entrainment to click trains. However, MK801 effect on the 40 Hz ASSR was disparate across the two regions. In the prefrontal cortex, the intertrial coherence (ITC) of the 40 Hz ASSR was strongly disrupted by MK801 at all doses (P<0.001; Dunnett’s test). Evoked power was significantly reduced only at the highest dose (P<0.0001). In primary auditory cortex, relative to vehicle treatment, evoked power showed a significant increase after 0.025 mpk and 0.05 mpk dose but declined significantly after the 0.1 mpk dose (P<0.05). However, ITC was unaffected (P>0.05). These results indicate that gamma neural synchrony in the PFC is more vulnerable to NMDA antagonist- mediated disruption, as compared to the primary auditory cortex. Moreover, it suggests that executive and cognitive functions may be more readily compromised by NMDA-mediated transmission disturbance even as auditory processing is enhanced or unaffected.

Virtual Reality is a technology that has long held society's interest, but has only recently began to reach a critical mass of everyday consumers. The idea of modern VR can be traced back decades, but because of the limitations of the technology (both hardware and software), we are only now exploring its potential. At present, VR can be used for tele-surgery, PTSD therapy, social training, professional meetings, conferences, and much more. It is no longer just an expensive gimmick to go on a momentary field trip; it is a tool, and as with the automobile, personal computer, and smartphone, it will only evolve as more and more adopt and utilize it in various ways. It can provide a three dimensional interface where only two dimensions were previously possible. It can allow us to express ourselves to one another in new ways regardless of the distance between individuals. It has astronomical potential, but with this potential we must first understand what makes it adoptable and attractive to the average consumer. The interaction with technology is often times the bottleneck through which the public either adopts or abandons that technology. The goal of this project is to explore user immerision and emotion during a VR experience centered around creating a virtual world. We also aimed to explore if the naturality of the user interface had any effect on user experience. Very limited user testing was available, however a small user group conducted in depth testing and feedback. While our sample size is small, the users were able to test the system and show that there is a positive correlation between influence on the virtual environment and a positive user emotional experience (immersion, empowerment, etc.), along with a few unexpected emotions (anxiety). We present the system developed, the user study, and proposed extensions for fruitful directions for this work by which a future project may continue the study.

Bakgrund: Patienter med svår psykisk sjukdom (SMI) visar på större frekvens av samsjuklighet och mortalitet än övrig population. Fördomar finns i samhället och hos hälso-och sjukvårdspersonal vilket kan leda till underdiagnostisering och ökat lidande för patienten. Om patient med SMI tar till sig samhällets stigmatisering uppkommer självstigmatisering som ytterligare försvårar situationen för patienten. Syfte: Att belysa patienters erfarenheter av somatisk vård vid samtidig svår psykisk sjukdom. Metod: Studien är en allmän litteraturstudie. Resultat: Analysen resulterade i en identifiering av tre kategorier; erfarenheter av bemötande, erfarenheter av att leva med svår psykisk sjukdom och erfarenheter av att skilja på somatiska och psykiska besvär. Relationen mellan patient och personal inom hälso- och sjukvården beskrevs både kunna öka eller minska tillit, följsamhet och patientens självkänsla. Patienter prioriterade oftast den psykiska hälsan före den fysiska. Slutsats: Patienter med SMI är i behov av kontinuitet i vården och en personcentrerad omvårdnad för en helhetssyn, inte sjukdom för sjukdom. Patienterna beskrev bemötandet inom somatisk vård som viktigt, bemötandet kunde både bidra till engagemang eller passivitet. Sjuksköterskor behöver ökad kunskap om samsjuklighet och vikten av personcentrering. / Background: Patients with severe mental illness (SMI) show a greater frequency of co-morbidity and mortality than the rest of the population. Prejudices exist in society and among healthcare professionals, which can lead to underdiagnosis and increase suffering for the patient. If a patient with SMI takes on society's stigmatization, selfstigma arises, which further complicates the situation for the patient. Aim: To shed light on patients' experiences of somatic care with concurrent severe mental illness. Method: The study is a general literature review. Result: The analysis carried out in an identification of three categories; experiences of treatment, experiences of living with severe mental illness and experiences of differentiating between somatic and psychological problems. The relationship between patient and staff in healthcare was described as able to increase or decrease trust, compliance, and the patient's selfesteem. Patients usually prioritized mental health over physical health. Conclusion: Patients with SMI need continuity of care and person-centered care for a holistic view, not disease by disease. The patients described the treatment within somatic care as important, the treatment could both contribute to commitment or passivity. Nurse sneed increased knowledge about co-morbidity and the importance of personcenteredness.