The focus of this study is to investigate what images of Sweden are transmitted in the novel The road to Ithaca (1994), by the Uruguayan author Carlos Liscano. The study focuses on the first half part of the novel for this taking place in Stockholm, Sweden, in the early nineties. The aim is to investigate by what literary strategies and literary subgenres the images of Sweden are transmitted.    The theoretical framework applied derives from studies of the literary genre of the picaresque novel and its bufonesco mood, such as the literary strategies irony and laconism. For the analysis Mieke Bal´s concept of focalization and semantic axes are used.      The study shows that in Sweden there are parallel worlds to the official world of the welfare state; in the shadow side of society there are the metecos, unwanted residents: the undocumented and the mentally ill. Through a picaresque and ironic style, the author shows that Sweden is a neat, clean, but culturally hermetic society; almost perfect on the surface, but with a lot of hidden “trash” beneath.    The welfare state of Sweden seams benevolent in its integrative intention, but is, at the same time, blind, or even worse, disinterested in the new reality of the country; that of the welfare state in dissolution and Sweden as a Tower of Babel.

Many athletes incorporate high training volumes and limited recovery periods into their training regimes. This may disrupt the fragile balance and the accumulation of exercise stress may exceed an athlete's finite capacity of resistance. A state of elevated fatigue, increased mood disturbance and decreased exercise performance can result. This is commonly known as overreaching and if increased training and limited recovery is continued, it is believed that the more serious state of overtraining may develop. This is relatively commonly experienced in athletes, however little scientific investigation has been conducted to determine the characteristics and underlying mechanisms. The overall aim of this thesis was to gain a greater understanding of the state of overreaching and to specifically provide new information on potential markers of this state as well as possible mechanisms. To study the cumulative effects of exercise stress and subsequent recovery on performance changes, fatigue indicators and possible mechanisms, the training of endurance cyclists was systematically controlled and monitored in two separate investigations. A number of variables were assessed including performance, physiological, biochemical, psychological, immunological and hormonal variables. In addition heart rate variability and serotonergic responsiveness were also assessed. Some of the more pertinent effects of overreaching included an increase in heart rate variability, a reduction in carbohydrate oxidation, an increase in serotonergic responsiveness and a reduction in stress hormone concentrations. These results suggest that autonomic imbalance in combination with decreased hormonal release appears to be related to the decline in performance and elevated fatigue apparent in overreached athletes. Additionally it also appears that alterations in the hypothalamic-pituitary adrenal axis may occur in overreached athletes.

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Typescript (photocopy).

Thesis (M.S.)--Uniformed Services University of the Health Sciences, 2005. / Running title: Seasonal affective disorder and melanopsin. Typescript (photocopy).

Dans ce travail de thèse, nous avons évalué les effets neurotoxiques multigénérationnels de l’exposition des mères F0 gestantes et allaitantes aux polychlorobiphényles non-dioxin-like indicateurs (PCB-NDLi), à un profil mimant l'exposition humaine à partir de poissons contaminés, sur le développement et le comportement, y compris les réponses émotionnelles et les interactions sociales, des deux générations F1 et F2 des souris mâles et femelles, à différentes phases de leur ontogenèse. Deux faibles doses des PCB-NDLi : (i) la DJT, qui est de 10 ng/kg/j, et (ii) une dose environnementale de 1000 ng/kg/j, ont été administrés par accès libre aux souris mères F0. En fonction de la modalité d’exposition des parents F1 aux PCB, 4 groupes de génération F2 ont été obtenus, en croisant (i) des pères F1 exposés à des mères F1 non exposées, (ii) des mères F1 exposées à des pères F1 non exposés, (iii) des deux parents F1 exposés, ou (iv) des deux parents F1 non exposés (témoins), aux PCB en période périnatale. Nos résultats ont montré que les mâles adultes de la génération F1 ont manifesté un comportement dépressif-like ; alors que les mâles F2, issus uniquement des pères F1 exposés aux PCB, ont exhibé un comportement anti-dépressif-like, ce que suggère que l’exposition périnatale des souris F1 aux PCB-NDLi a induit une altération multigénérationnelle d’origine parentale du comportement de la résignation, et ce d’une façon sexe dépendante. De même, une altération sexe-dépendante de l’anxiété, a été détectée chez la génération F1 exposées durant la période périnatale aux PCB-NDLi comme uniquement les souris mâles d’âge moyen F1 ont développé un phénotype anxieux qui a été transmis aux souris mâles d’âge moyen F2, via leurs pères F1. En outre, une altération multigénérationnelle du comportement social a été détectée chez les souris mâles et femelles F1 et F2. D’une façon remarquable, chez la génération F2, des altérations comportementales dépendantes à la fois du sexe et de la dose, ont été trouvées, malgré l’absence d’effets chez leurs parents F1, effets qui dépendaient également de l’origine parentale, tels que la diminution significative du niveau de la préférence pour la nouveauté sociale chez les souris mâles F2, issues uniquement des mères F1 périnatallement exposées à la dose 10 ng/kg de PCB. Le dosage des biomarqueurs chez les souris d’âge moyen de la génération F1 a révélé une altération de nombreux paramètres biochimiques, y compris une augmentation du niveau de corticostérone et de l’activité de l’acétylcholinestérase / In this study, we evaluated the multigenerational neurotoxic effects of gestational and lactational exposure of F0 female mice to a representative mixture of the six indicator non-dioxin-like-polychlorinated biphenyls (NDL-PCBs) at environmentally low doses, a profile that closely mimics human exposure to contaminated fish. The tolerable day intake (TDI) of 10 ng/kg/day and a higher environmental dose of 1000 ng/kg/day were administered by free access to F0 mothers during pregnancy and lactation. Afterwards, the development and behavior, including emotional responses and social interactions, of the two F1 and F2 generations of Swiss male and female mice at different phases of their ontogenesis, were assessed. Depending on the mode of exposure of F1 parents to PCBs, four F2 generation groups were obtained by crossing (i) F1 fathers perinatally exposed with unexposed F1 mothers, (ii) F1 mothers perinatally exposed with unexposed F1 fathers, (iii) both F1 parents perinatally exposed, or (iv) both F1 parents perinatally unexposed (controls), to PCBs. Our results showed that F1 adult males showed depressive-like behavior whereas F2 adult males, coming from F1 mothers, perinatally exposed to PCBs, exhibited anti-depressive-like behavior. This result suggested an induction of a multigenerational alteration that was of parental origin, on the resignation behavior in a sex-dependent manner. Similarly, sex-selective anxious behavior was detected in F1 middle-aged males perinatally exposed to PCBs, which was transmissible to F2 middle-aged males, via their F1 fathers. Furthermore, a multigenerational alteration of social behavior was found in F1 and F2 male and female mice. Remarkably, some behavioral alterations in F2 generation were found, despite of the absence of effects in their F1 parents, such as a significant decrease in the level of preference for social novelty in F2 male mice, coming from F1 mothers perinataly exposed to 10 ng/kg of NDL-PCBs. The biomarker assays in F1 middle-aged mice revealed an alteration in many biochemical markers, including increased corticosterone levels and acetylcholinesterase activity in male as well as females.

Le Trouble Déficit de l’Attention Hyperactivité (TDAH) est un trouble du neurodéveloppement associant des symptômes d’inattention, d’hyperactivité et/ou d’impulsivité. Fréquemment, le tableau clinique est marqué par une labilité émotionnelle pouvant se manifester sous différentes formes jusqu’à parfois s’agencer en un véritable syndrome : le Trouble Disruptif avec Dysrégulation Emotionnelle, récemment inclus dans le DSM-5. La labilité émotionnelle est-elle un symptôme du TDAH ou de troubles comorbides ? Est-elle caractéristique d’un tableau clinique du TDAH ? Ce travail de thèse propose d’étudier le profil psychopathologique associé à la labilité émotionnelle sous différentes approches, catégorielle et dimensionnelle, et à deux périodes clés du développement de l’enfant atteint de TDAH, l’âge préscolaire et l’âge scolaire. Quatre études composent ce travail de thèse : les trois premières en milieu clinique et la dernière en population générale. Les résultats ont indiqué que la labilité émotionnelle d’un point de vue dimensionnel mais également catégoriel au travers du diagnostic de Trouble Disruptif avec Dysrégulation Emotionnelle, était associée à des symptômes plus sévères et un retentissement fonctionnel plus important à l’âge préscolaire et scolaire. L’approche dimensionnelle s’est montrée plus pertinente pour identifier les enfants avec labilité émotionnelle ayant des besoins spéciaux de prises en charge au-delà de celle du TDAH. De plus, la labilité émotionnelle et l’irritabilité ont semblé être associées à des tableaux cliniques différents. Ces résultats suggèrent l’intérêt de l’évaluation de la labilité émotionnelle et des manifestations associées dans le diagnostic du TDAH chez l’enfant. Une approche clinique fine, à la fois quantitative et qualitative, semble prometteuse dans la prévention des formes prodromiques de TDAH et dans le pronostic de ce trouble afin de proposer des interventions adaptées afin d’infléchir de potentielles trajectoires développementales à risques. / Attention Deficit Hyperactivity disorder is a neurodevelopmental disorder characterized by inattentive, hyperactive and/or impulsive symptoms. Emotional lability is frequently associated with the disorder. It can cover several manifestations. These manifestations are sometimes that serious that there are parts of a disorder: the Disruptive Mood Dysregulation Disorder recently added to the DSM-5. Is emotional lability a core symptom of ADHD or one of a comorbid disorder? Is it featured with different symptoms and functional impairment in children with ADHD? This PhD work tried to provide elements to respond to these questions assessing the psychopathological profile associated with emotional lability as a categorical and dimensional feature at two crucial developmental periods: the preschool and the school aged. Four studies are part of this PhD work: three in clinical population and one in general population. Results emphasized that emotional lability is associated with more severe symptoms and functional impairment in both preschool a school aged children. Results were similar when emotional lability was assessed as a dimensional feature and as a categorical feature. Nevertheless, the dimensional approach of emotional lability seemed relevant identifying children with ADHD and emotional lability that were at special need for interventions, beyond the ADHD one. Moreover, emotional lability and irritability seemed associated with different clinical outcomes. These results suggested the value of the emotional lability assessment and of its others manifestations in the ADHD diagnosis in children. A qualitative and quantitative approach seems promising in preventing prodromal ADHD and in its prognostic. This might serve targeting adapted interventions in order to inflect potential harmful developmental trajectories.

This study explored the Object Relations of a sample of 45 subjects who were using alcohol and were diagnosed with co-morbid Depressive or Bipolar disorders and/or Personality disorders. All subjects were receiving treatment at a government psychiatric hospital in South Africa. The similarities and differences in the Object Relations of these individuals were identified. A biographical questionnaire, the Alcohol Use Disorder Test (AUDIT), which was used as a screening measure, and the Bells Object Relations and Reality Testing Inventory (BORRTI) were administered to obtain information from a purposive sample. Descriptive and inferential statistics were used to analyse the results of the assessment measures. Analysis of the BORRTI data indicated a high rate of depressive and personality disorders within this sample. Results of the sub-sample (n=29) whose scores were included in the Pearson’s Correlation Coefficient analysis indicate that higher levels of alcohol consumption result in increased levels of hallucinations and delusions. Other correlations were identified between high levels of alcohol consumption and heightened levels of reality distortions and more uncertainty in the perceptions of these individuals. Significant differences in the scores of the male and female participants were identified. With the female participants, the higher the level of alcohol consumption, the lower the individuals scored in terms of pathological levels of egocentricity, uncertain perceptions, insecure attachments, alienation, social incompetence as well as hallucinations and delusions. Alternatively, in the male sample, higher levels of alcohol consumption result in increased hallucinations and delusions, reality distortions, uncertainty in perceptions, alienation, social incompetence and egocentricity. / Psychology / M.A. (Research Psychology)

Background Polypharmacy is often prescribed for bipolar disorder, yet medication non-adherence remains a serious problem. This study investigated the regularity in the daily dosage taken of mood stabilizers and second generation antipsychotics. Methods Daily self-reported data on medications taken and mood were available from 241 patients with a diagnosis of bipolar disorder who received treatment as usual. Patients who took the same mood stabilizer or second generation antipsychotic for ≥ 100 days were included. Approximate entropy was used to determine serial regularity in daily dosage taken. Generalized estimating equations were used to estimate if demographic or clinical variables were associated with regularity. Results There were 422 analysis periods available from the 241 patients. Patients took drugs on 84.4% of days. Considerable irregularity was found, mostly due to single-day omissions and dosage changes. Drug holidays (missing 3 or more consecutive days) were found in 35.8% of the analysis periods. Irregularity was associated with an increasing total number of psychotropic drugs taken (p = 0.009), the pill burden (p = 0.026), and the percent of days depressed (p = 0.049). Conclusion Despite low missing percent of days, daily drug dosage may be irregular primarily due to single day omissions and dosage changes. Drug holidays are common. Physicians should expect to see partial adherence in clinical practice, especially with complex drug regimens. Daily dosage irregularity may impact the continuity of drug action, contribute to individual variation in treatment response, and needs further study.

This study investigates the connection between different pathophysiological processes in mitochondria and psychopathological symptoms in patients with bipolar disorder. Changes in activity of selected components of the respiratory chain and overall respiratory rate of mitochondria were analyzed in patients with bipolar disorder when compared to healthy controls. Diagnostic scales and questionnaires, high-resolution respirometry, radiochemical and spectroscopic methods were used. 37 patients with a diagnosis of bipolar disorder (F31) and 21 healthy volunteers were involved in the study. Statistical analysis included the methods of parametric and nonparametric analysis, factor analysis, one-way analysis of variance and linear regression analysis. Obtained results revealed that cellular energetics plays a great role in the pathophysiology of bipolar disorder. There was a mild difference between different mitochondrial enzymes activity in patients within manic phases and depressive phases of the disease. Changes in mitochondrial respiration in patients with BD as compared to healthy controls were also shown. Mitochondrial respiration indexes for patients with BD in remission as compared to healthy controls were altered in accordance with the previous phase of the disease. Association between the...

Chronic kidney disease (CKD) patients have compromised health related quality of life (HRQOL) by several reasons. This study aimed to evaluate HRQOL on hemodialysis (HD) and peritoneal dialysis (PD) patients and to identify HRQOL associated factors. Methods: We conducted a transversal study with 215 patients on HD and 58 on PD between July and September 2013, in Sergipe, Brazil. HRQOL was assessed using the Kidney Disease Quality of Life Short Form Instrument- 1.3 (KDQOL-SF), consisting of two cores: specific (KDCS) and generic (RAND-36). Additionally demographic and clinical variables directly related to CKD, factors such as mood, sleep disorders and sexual dysfunction were evaluated through specific instruments. Results: Patients had a mean age of 51 years (SD ± 15.4), mostly men (62%), with low educational (72%) and economic (95%) levels. There was no difference related to HRQOL among dialysis modalities, only PD patients felt more stimulated by caring staff than that on HD (p<0.01). The prevalence of depressive (29%) and anxiety (30%) symptoms, poor quality of sleep (56%), excessive daytime sleepiness (43%) and male (48%) and female (76%) sexual dysfunction were high. Multiple linear regression showed that depressive (R= -0.39 p<0.01, R= -0.48 p<0.01) and anxiety (R = -0.41 p <0.01, R = -0.27 p <0.01) symptoms were independently associated with KDCS and RAND-36. Confirmatory factorial analysis models confirmed the association of mood disorders with low HRQOL. High prevalence of anxiety (30%) and depressive symptoms (29%) were revealed. Conclusion: Patients on HD and PD showed no differences in HRQOL. Mood disorders are independently associated with low HRQOL, with high prevalence of anxiety and depressive symptoms in dialysis patients. / Portadores de doença renal crônica (DRC) possuem comprometimento da qualidade de vida relacionada à saúde (QVRS) por diversas razões. Este estudo objetivou avaliar QVRS de pacientes em hemodiálise (HD) e diálise peritoneal (DP) e identificar fatores a ela associados. Casuística e Método: Estudo transversal realizado entre julho e setembro de 2013 com 215 pacientes em HD e 58 em DP, em Sergipe, Brasil. Avaliou-se a QVRS através do questionário Kidney Disease Quality of Life Instrument- Short Form 1.3 (KDQOL-SF), composto por dois núcleos: específico (KDCS) e genérico (RAND-36). Além de variáveis demográficas e clínicas diretamente relacionadas a DRC, foram avaliados fatores como distúrbios de humor, sono e disfunções sexuais através de instrumentos específicos. Resultados: Os pacientes possuíam em média 51 anos (desvio-padrão±15,4), eram na maioria homens (62%), com níveis educacional (72%) e econômico (95%) baixos. Não se evidenciaram diferenças relacionadas à QVRS entre as modalidades dialíticas, apenas pacientes em DP se sentiram mais estimulados pela equipe cuidadora que os em HD (p<0,01). As prevalências de sintomas depressivos (29%), sintomas ansiosos (30%), baixa qualidade de sono (56%), sonolência diurna excessiva (43%) e disfunções sexuais masculina (48%) e feminina (76%) foram altas. Análise por regressão linear múltipla mostrou que sintomas depressivos (R= -0,39 p<0,01; R= -0,48 p<0,01) e ansiosos (R= -0,41 p<0,01; R= -0,27 p<0,01) foram fatores independentemente associados aos núcleos KDCS e RAND-36. Modelos de análise fatorial corroboraram a associação dos distúrbios de humor com baixa QVRS. Evidenciou-se alta prevalência de sintomas ansiosos (30%) e depressivos (29%). Conclusão: Pacientes em HD e DP não apresentaram diferenças na percepção de QVRS. Os distúrbios de humor foram fatores independentemente associados à baixa QVRS, com alta prevalência de sintomas ansiosos e depressivos em pacientes em diálise.