The prevalence of smoking among individuals living with mental illness is high. The purpose of this study was to describe the knowledge, confidence, attitudes, training, nursing practice, perceived overall ability, interest and demographics of psychiatric/mental health nurses regarding tobacco use among psychiatric inpatients. A non-experimental descriptive correlational cross-sectional design was used. Sixty surveys were returned with an overall response rate of 39%. A minority of nurses were knowledgeable about the “5As” of smoking cessation, (Ask about smoking, Advise to quit, Assess readiness to quit, Assist with quitting, Arrange follow-up), a well known intervention framework. Most psychiatric/mental health nurses were confident about assisting patients with tobacco use and attitudes toward intervention were more positive than reported in the literature. However, actual tobacco-related nursing practice was sub-optimal. Minimal tobacco-related training during entry level into nursing practice may be one reason for this situation. Nurses require systemic support to enhance tobacco-related nursing practice.

Up where the dog barks (creation). Sitting around the table of a secret municipal council, a mayor and his aldermen, outraged by the village idiot's stupidity, are planning his death. On a beautiful spring's morning, they kidnap him and throw him in a isolated well, whose opening they carefully seal afterwards. Three days later, however, screams are heard from the bottom of the idiot's pit. Contaminated within their own cadastre by the innocent's cries, the villagers, one after another, will have to tell their story: their rural madness, hidden within their common unawareness. Then, without knowing it, it is with the dispossessed's eloquence that they will be caught inside short narratives with no beginning or end---many frames in movement---that will constitute a sole account since all determined by the same disturbing rumour. / The rhetoric of the idiot (criticism). In the shadow of the madman, literary character extremely fascinating lately, the idiot silently cradles himself. Many times portrayed in the works of various authors, its problem seems to differ from the "illuminated"'s. Often aphasic or having a poor vocabulary, the idiot is, in most cases, only described. However, some authors have been able to give him a voice, usually in a strongly poetic prose. Among these writers, William Faulkner ( The Sound and the Fury), Anne Hebert (Les fous de Bassan) and Suzanne Jacob (Laura Laur) distinguish themselves by letting the characters such as the idiot or the simple minded assume control, to a certain extent, of the narration in their fiction. Indeed, it will be the tools of the new rhetoric (rhetoric reconciled of the figures and the argumentation) as apprehended by Michel Meyer in his several works that will be used for the analysis of the three narrations. It will then be possible to investigate the necessary assimilation of the sense and the argumentation within what could be called a project common to the three authors.

No description available.

Past research on attitudes toward the mentally ill has produced conflicting results, due in part to methodological problems. The present study examined this issue using a more sophisticated design. Randomly, 600 residents of Delaware County Indiana were chosen from the telephone directory to be the recipients of a mail survey. Of these, 206 responded, yielding a return rate of 34.5%. Each subject was randomly assigned to either the experimental group that read a case vignette which described a hypothetical mental patient, or the control group which read about a medically ill patient. In both conditions there were three levels of severity of behavior. Thus, three cases described hypothetical patients labeled as mentally ill with a range of severity of psychopathology, and three described comparably behaving medical controls. It was found that the mentally ill were rejected significantly more than medical controls at each level of severity. Respondents also rated the mentally ill as less predictable, and having less hopeful outcomes, than the medical controls. In addition, beliefs about mental illness were not sufficient to account for all rejection. Finally, no demographic characteristics of the population were found to significantly correlate with rejection. / Department of Psychological Science

The prevalence of smoking among individuals living with mental illness is high. The purpose of this study was to describe the knowledge, confidence, attitudes, training, nursing practice, perceived overall ability, interest and demographics of psychiatric/mental health nurses regarding tobacco use among psychiatric inpatients. A non-experimental descriptive correlational cross-sectional design was used. Sixty surveys were returned with an overall response rate of 39%. A minority of nurses were knowledgeable about the “5As” of smoking cessation, (Ask about smoking, Advise to quit, Assess readiness to quit, Assist with quitting, Arrange follow-up), a well known intervention framework. Most psychiatric/mental health nurses were confident about assisting patients with tobacco use and attitudes toward intervention were more positive than reported in the literature. However, actual tobacco-related nursing practice was sub-optimal. Minimal tobacco-related training during entry level into nursing practice may be one reason for this situation. Nurses require systemic support to enhance tobacco-related nursing practice.

Many deprived and abused children living in the care system have had life experiences that have pushed the boundaries of their knowledge, endurance and ability to cope to the limit and beyond. Psychotherapy with these children can be very stressful and the 'ordinary acceptable environment' (Hartman 1939) can be replaced by an environment of extreme threat and hostility. The normal boundaries of work may be questioned and the normal structure of psychoanalytic technique may be difficult to maintain. The aim of this research is to examine how these children and young people present in the consulting room and the impact this has upon clinical practice. In this study I describe in detail my work with five children, each with a history of abuse and deprivation and living in foster care. These children present extremely problematic behaviour which is difficult to manage and understand. I describe the psychic reality of these children and explore the difficult process of bringing about psychic change. When working with these children it is necessary to think about the impact of each child's history upon his/her development. The psychotherapist's task is to provide an environment which will enable the child to develop a more secure and flexible frame of mind in which toxic internal representations are replaced with more benign internal representations of the self and more benign internal object relationships. In doing this, the therapist has to simultaneously acknowledge both the patient's separation and intrusive anxieties and has to maintain contact with the patient, whilst also allowing the necessary distance to develop between the therapist and the patient to enable his/her interventions to be of benefit. In trying to achieve this task, I suggest that it is useful for the therapist to think about the therapeutic management of the clinical process.

The arguments in the literature for and against "mental illness", are shown to founder on the lack of a thorough analysis of the sense of "illness" itself. Such an analysis is developed in the present study in three main stages. STAGE ONE: The ordinary use of "dysfunction" is examined. The term is shown to imply a particular kind of value judgement, derived, in respect of objects, from the purposes of living things for them. STAGE TWO: The sense of "illness" is interpreted from examples of physical illness by comparing and contrasting it with "dysfunction". An important logical link with "action" is identified, which provides an interpretation of the particular kind of negative evaluation implied by "illness". The relationship between "illness" and "disease" is examined in terms of this negative evaluation. STAGE THREE: The results of stage two are generalised from "physical illness" to "mental illness" by way of the notion of "action". "Mental illness" is examined as illustrated by examples of four main kinds of condition - organic psychosis, neurosis, addiction and functional psychosis. In respect of the first of these, "mental illness" is shown to be similar in its logical properties to "physical illness"; in respect of the remaining three, it is shown to be different, but in three quite distinct ways. In each case, however, the properties of "mental illness" are derived consistently with the interpretation of "illness" developed from examples of physical illness in stage two. "Mental illness" and "physical illness" are thus shown to be logically equivalent. In a concluding section, the implications of this result for the debate about "mental illness" are examined.

The role of serotonin (51M) in the physiological regulation of AVP secretion is controversial. Neuroanatomical studies, largely in rats but also in human brains, have suggested that 5HT may have a direct modulatory effect on magnocellular vasopressin (AVP) secretion. Pharmacological and neurophysiological studies in animals have provided further evidence to support this and suggest that increase in 5HT neurotransmission leads to a rise in plasma AVP and that 5HT may be important in osmoregulated AVP secretion Studies investigating the importance of 511T as a modulator of AVP release in humans have not be undertaken. Indirect evidence of a putative role derives from the occurrence of hyponatraemia, and possible inappropriate AVP secretion,associated with the clinical use of drugs, particularly antidepressants, which have effects on 5HT neurotransmission. In addition there has been some suggestion that AVP secretion may be abnormal in depression where there is a putative abnormality of the 5HT nervous system. This research has approached the study of anatomical and physiological relationships between 5HT and AVP in 3 ways. Firstly through studies in normal man, secondly by studies in depressed patients, as a putative disease model of 5HT neurotransmission, and thirdly to more extensively explore the effect of pharmacological manipulation of 5HT neurotransmission using an animal model of osmoregulation. Studies in man found no evidence that 7 days treatment with a 5HT reuptake inhibitor (Fluoxetine) had a significant effect on osmoregulated AVP secretion. Studies in elderly depressed patients showed that there was an apparent deficiency of osmoregulated AVP secretion with normal ageing but found no evidence that either moderate depressive il lness, or treatment of the depression with Fluoxetine, had significant effect on water balance. Studies in the rat model of osmoregulation showed that acute 5HT reuptake inhibition stimulated basal AVP secretion and increased the osmotic sensitivity of AVP secretion but had no effect on the osmotic threshold of secretion. Chronic treatment (21 days) with the reuptake inhibitor had no significant effect on basal AVP secretion or on the osmotic threshold but significantly decreased the osmotic sensitivity of AVP secretion. Studies with the 5HT2/5HTIc antagonist, Ritanserin, and the 5HT2 agonist, DOI, suggested that this modulatory effect was not mediated through these receptor subtypes. Autoradiographic studies identified a low density of 5HT2 and 5HTIa receptors in the vicinity of the magnocellular neurons of the rat hypothalamus. The results suggested that 5HT modulates AVP secretion indirectly, possibly by inhibition of inhibitory afferent stimuli. This is of little physiological consequencien the normal rat and probably in healthy man where there is rapid accommodation and autoregulation. In situations where there is a dysfunction of the normal adaptive mechanisms such as in depression,the role of 5HT may be more important and occasionally may lead to severe hyponatraemia.

This thesis addresses the growing number of inmates with a mental illness in correctional facilities in Canada which continues to attract public attention and concern. Several explanations have been put forward to explain the rise in the number of inmates with a mental illness. These include: the deinstitutionalization of the mentally ill that began in the 1970’s, lack of treatment availability for those released into the community, and criminalization of persons with a mental illness by the justice system. The increasing numbers of persons with a mental illness in the correctional system has led to serious concerns about the capacity of this system to manage, treat, and rehabilitate individuals with a mental illness. Lack of proper treatment, management, rehabilitation and monitored discharge means that inmates with serious mental illness are more likely to come into contact with the criminal justice system more frequently. This thesis examines the incidence seriously mentally ill offenders and their propensity to recontact. Three hundred and ninety eight face-to-face assessments were conducted using the Resident Assessment Instrument-Mental Health 2.0 (RAI-MH) and from total scores from the Level of Service Inventory Ontario Revision (LSI-OR). These assessments were conducted in 14 Ontario Provincial Correctional facilities during the years 2005-2008. Bivariate and multivariate regression analysis was conducted to assess recontact rates for serious mentally disordered and non-mentally disordered offenders. With regards to recontact, no differences were revealed between the seriously mentally ill offender and non-mentally ill offender. This null finding on recontact is very surprising given the current literature on the seriously mentally ill. An additional finding revealed that for offenders with or without a serious mental illness, having a higher score on the scale of criminogenic tendencies (LSI-OR) increased rates for recontact. Another surprising finding is that seriously mentally ill offenders were more likely to commit minor crimes upon release, rather than violent crimes as current literature suggests. A more accurate research tool, as well as a larger sample size, will be required to assess the validity of these results. The implications of the negative outcome with respect to recontact and issues of identifiable risk factors for recidivism for both seriously mentally ill and non-mentally ill inmate populations are discussed in relation to outcomes in terms of both improvements to Corrections policy and theories of criminology. It is important to continue research in this area, to determine the true gravity of the incidence and recontact rates of mentally ill offenders.

Thesis (PhD)--University of South Australia, 2000