Late-life depression (LLD) is common illness, frequently associated with neuropsychological impairment. Disruption of frontal-subcortical and limbic networks may play a key role in LLD and can be examined using magnetic resonance imaging (MRI). Grey matter (GM) can be examined using T1-weighted MRI, white matter (WM) using diffusion tensor imaging (DTI), and functional connectivity using resting-state functional MRI (fMRI). To clarify the roles of GM, WM and functional connectivity in LLD, systematic reviews and meta-analyses of T1-weighted MRI, DTI and resting-state fMRI studies of depression were performed. The literature provided evidence for GM and WM abnormalities within frontal-subcortical and limbic networks, and increased functional connectivity within the default-mode network, in depression. To examine whether results gained from different techniques are complementary, multi-modal MRI was used to compare GM, WM and functional connectivity between thirty-six participants with LLD and twenty-five control participants. WM integrity was widely reduced in LLD, without significant group differences in GM or functional connectivity. To investigate whether neuropsychological deficits represent independent processes with specific neural correlates, or whether they can be explained by a core deficit, the relationships between neuropsychological and MRI measures were explored. Executive function and processing speed were found to represent core deficits that contribute to impairment in other domains; and impaired performance was correlated with reduced frontal WM integrity. Episodic memory deficits were dependent on executive function and processing speed; and associated with reduced frontal and hippocampal WM integrity. The relationships between age at onset, severity and MRI measures of GM, WM and functional connectivity were also investigated. Later onset was associated with reduced WM integrity, in line with the vascular hypothesis. Earlier onset was associated with greater duration of illness and reduced hippocampal volume, consistent with the glucocorticoid cascade hypothesis. Severity was not associated with any MRI measure. This thesis strongly supports the hypothesis that WM abnormalities in frontal-subcortical and limbic networks play a key role in LLD, with abnormalities related to neuropsychological impairment and compatible with the vascular hypothesis.

Thesis (PhD (Psychiatry))--University of Stellenbsoch, 2005. / Background: Obsessive-compulsive disorder (OCD) is a neuropsychiatric condition characterized by significant heterogeneity. It has been suggested that classification of OCD into more homogeneous subtypes, and identification of their associations with etiological factors (e.g. genetic variants, or psychological trauma), and outcome (e.g. disability and treatment response), may be useful. The identified subtypes are not definitive yet and continue to be subject to revision. The overall objective of this dissertation was to assess comprehensively a sample of OCD patients, and to use cluster analytic methods to delineate valid OCD subtypes. Methods: Patients meeting DSM-IV criteria for a primary diagnosis of OCD (N=261) on the Structured Clinical Interview for Axis I Disorders - Patient Version (SCID-I/P), with ages ranging from 16 to 71, took part in the study. The newly developed Structured Clinical Interview for the Diagnosis of putative Obsessive-Compulsive Spectrum Disorders (SCIDOCSD) was administered to assess OCD-related conditions not covered by the SCID-I/P. OCD subtyping, based on OCD symptomatology (assessed with the Yale-Brown Obsessive- Compulsive Symptom Checklist [YBOCS-CL]), and based on comorbidity with the OCD spectrum of disorders (assessed with the SCID-OCSD), proceeded along the following lines: Firstly, latent class cluster analysis (LCA), a categorical analogue to traditional factor analysis (FA), and with many advantages compared to FA, was implemented with the (nine) most frequently endorsed OC symptoms. Secondly, in an attempt to remedy some of the limitations of the LCA (e.g. increased potential for computational instability when additional indicators / symptoms were included), cluster analyses (Ward’s method) were performed on all of the items of the YBOCS-CL and SCID-OCSD, respectively, for all OCD patients. The associations of cluster scores with demographic variables (age, gender), clinical variables (age of onset, obsessive-compulsive symptom severity and dimensions, level of insight, temperament, childhood trauma, treatment response) and genotypes were then examined, using Spearman correlation coefficients, one-way analysis of variance (ANOVA), and Mann- Whitney U-tests, where appropriate. Results: The findings suggested that increased presentation of symptoms characteristic of each of the clusters of cases was associated with specific demographic and clinical characteristics, which substantiated the presence of distinct clinical subtypes of OCD. Cluster analysis of the 45 selected items of the YBOCS-CL in this sample of OCD patients identified 6 separate clusters; these clusters were labelled “Contamination fears / washing”, “Hoarding / collecting”, “Symmetry / ordering / counting / arranging / repeating”, “Sexual”, “Somatic, religious and diverse” and “Harm-related”. Increased presentation of symptoms characteristic of each of the clusters was associated with specific demographic, clinical and, in some cases, genetic characteristics. Of note, the findings indicated the L/L (met/met) genotype of COMT Val158Met polymorphism plays a major role in the increased manifestation of sexual, somatic, religious and diverse, and harm-related symptoms of OCD, as such contributing to the relatively limited data on OC symptom subtypes and genetics. However, the fact that the associated features did not clearly and uniquely differentiate clusters and that clusters were significantly correlated with one another suggested that the delineation of the OCD complex into OC symptom clusters is not the only way to approach the heterogeneity characteristic of OCD. Nevertheless, the significant comorbidity with OCSD’s in the identified clusters (e.g. tics associated with sexual obsessions / compulsions) highlighted the significant relationship of OCD with the OCSD’s. This again raised the question about the way in which the OCSD’s “fit” with the standard OC symptomatology outlined in the YBOCS-CL. A cluster analysis of OCSD’s in OCD patients identified a Tourette’s syndrome / tics subtype of OCD (part of the so-called “reward deficiency” cluster), as well as an impulsivity subtype, and a somatic subtype – each associated with specific clinical and demographic variables. Here, a significant relationship between the identified clusters and the investigated dopaminergic and serotonergic polymorphisms was not found, suggesting that variants in other genes in these systems should also be explored. Conclusion: The main finding was that OCD is indeed a heterogeneous disorder that may be subtyped into different symptom dimensions. The identified OCD subtypes with their associated features were to a large extent consistent with previously published data. However, in contrast to factor analysis, LCA provided a novel, appropriate and advantageous statistical analysis strategy for the data. Furthermore, to our knowledge, the attempt to classifiy OCD according to comorbid OCSD’s was the first cluster analysis based on a prospective comprehensive interview investigating a range of OCSD’s. As such, although the dimensional structure of OCD is still not entirely understood, the categorization of our OCD patients into different groups and the investigation of their respective features have gone beyond the literature and thus add another dimension to the increasing efforts to fully delineate OCD subtypes.

This study was concerned with the planning of a curriculum for training occupational therapists in Nigeria. In doing so, both theoretical and practical matters were considered. First, the thesis identifies the need for occupational therapists in Nigeria, and, based on a literature review, theoretical perspectives and issues about curriculum, and about professional education are gathered and discussed. Secondly, the research for the study was conducted through different practical means. The first part of the research was directed at all the occupational therapists in Nigeria seeking facts and opinions on the occupational therapy situation in the country. A mail questionnaire composed of structured and open-ended questions was used. The second study attempted to find out international perspectives on the training of occupational therapists through a mail questionnaire using open-ended questions, directed at the World Federation of Occupational Therapists, Occupational Therapy Associations in several countries, and all occupational therapy training schools in the United Kingdom. This was followed by a third piece of research in which a case study of the policies and practices of two occupational therapy training programmes in Scotland was carried out, using interviews. ii The findings in these investigations and the issues and arguments derived from the literature on curriculum theory and professional education were considered against the background of Nigeria. The discussion was used to develop principles and to suggest a curriculum for the training of occupational therapists in Nigeria. The study offered some suggestions for future monitoring of the programme and areas of future research in Nigeria

Thesis (Ph.D.) -- University of Western Sydney, 2004. / "A thesis presented to the School of Management, College of Law and Business, University of Western Sydney for the degree of Doctor of Philosophy" Bibliography : leaves 202-230.

M.A. (Clinical Psychology) / Please refer to full text to view abstract

This thesis combines a theoretical perspective and a methodological technique in order to clarify the concept of negotiation. The theoretical perspective represents a merging of a formal analysis as suggested by Georg Simmel and Erving Goffman and an interactional emphasis upon reciprocity of actions as proposed by Herbert Blumer. Accordingly, a methodological scheme was constructed to examine negotiations in terms of their forms and content.

<p>Four experiments were undertaken to identify properties of differential reinforcement relevant to response differentiation. Differential reinforcement was given for the length of "runs" of pigeons' key pecks, the length of a run being defined as the number of responses on a key preceding a spatially different terminal response.</p> <p>In Experiment I, a criterion run-length was assigned each subject and each subject was reinforced only following emission of a run-length which exceeded its criterion. Criterion run-lengths of 5, 10 and 20 responses were assigned to different groups. Mean run-lengths (N) were related to criteria (n) by a power function:N = 2.63 n^0.69. The fractional exponent of this function implies that the proportion of responses exceeding criterion was lower for higher criterion values. Because reinforced response values were confined to an extreme of the dis tribution, a lower proportion of reinforced response values indicated a greater difference between the distribution of values of the response emitted by a subject and the distribution of values reinforced. Since higher criterion values produced higher asymptotic mean run-lengths, the differential between emitted and reinforced run-lengths was also related to asymptotic run-length.</p> <p>A similar relationship between mean run-length and the proportion of responses exceeding a criterion was obtained in Experiments II and III. These experiments used a differential reinforcement paradigm in which thecriterion was continuously adjusted for each subject so that a constant proportion of its distribution of run-lengths exceeded its criterion. In Experiment II, the proportion of the distribution exceeding the criterion was set at 15%, 30% or 45%, for different groups. However, only a random half of the run-lengths exceeding the criterion for animals in the 30% group, and one-third of those for the 45% group were actually reinforced, so that the overall probability of reinforcement was constant at 0.15 for all groups. Increases in the mean length of runs were obtained for all groups, with the 15% group exhibiting a more rapid change and a higher asymptotic mean run-length than the 30% group, which in turn exceeded the 45% group.</p> <p>In Experiment III, pigeons were reinforced only for run-lengths in the most extreme 30% of their run-length distributions. One group received reinforcement for a random half of these run-lengths, while others received reinforcement for all of the run-lengths in this range. The relative extremeness of run-lengths selected for reinforcement was therefore constant (30%) 'vhile the overall probability of reinforcement was either 0.30 or 0.15. Increases in mean run-length were obtained, but no differences in the rate of change or asymptotic mean run-length were found between groups.</p> <p>The results of Experiments II and III suggest that the relative extremeness of run-lengths selected for reinforcement, that is the differential between emitted and reinforced run-lengths, determines the rate and extent of changes in values of a response. The relationship between the relative extremeness of reinforced response values and the rate and extent of changes in emitted response values was further</p> <p>demonstrated in Experiment IV. Reinforcement was provided for a fixed area of the distribution of run-lengths closest to a specified target value. For one group, the area of the distribution reinforced was 15%, while another group was reinforced for a random half of run-lengths in the closest 30% to the target. Reinforcement probability was thus held constant at 0.15. Mean run-lengths changed in the direction of the target at a rate dependent on the difference between the mean run-length and the target run-length. An asymptote was reached (rate of change = 0) when mean run-length approached the target value (differential = 0). The relationship between asymptotic mean run-length and target run-length was nearly linear for both 15% and 30% groups.</p> <p>The results of this series of experiments were discussed in terms of a hypotnetical differentiation process emphasizing the differential between the central tendencies of the distributions of emitted and reinforced response values, expressed in percentage units. When a differential exists, a change in the distribution of response values occurs in a direction which tends to reduce the differential, and at a rate proportional to the magnitude of the differential. When no differential exists, no change occurs. Since change in many dynamic response properties is resisted in a way which suggests an opponent process (e.g.iLaw of Least Effort), the asymptote reached after differential reinforcement represents an equilibrium between differential reinforcement and its opponent process. The increased effectiveness of differential reinforcement when relatively more extreme response values are reinforced would thus not only result in greater rates of change, but would also overcome the resistance of the opponent process to a greater extent,shifting the equilibrium point to a higher value.</p> / Doctor of Philosophy (PhD)

This thesis provides a broad and diverse investigation into the field of psychological treatment for child molesters. A range of methods including a systematic review, a single case study and a primary phenomenological investigation were used to explore issues in the field. Following an introduction in Chapter 1, Chapter 2 reviews the effectiveness of psychological treatment for reducing recidivism in child molesters. The results indicate that recidivism among treated and untreated child molesters is yet to consistently and clearly differ and that the treatment outcome literature is obstructed by weak studies using suboptimal scientific designs. In Chapter 3 the aetiology of a child molester’s offending is formulated using the Pathways Model of child abuse (Ward & Siegert, 2002). Treatment sessions addressing areas of criminogenic need are outlined and the impact of the sessions is determined using systems of clinical change on psychometric measures. The results indicate improvements in some of the targeted areas however these were not sufficient to indicate clinically significant changes on both systems used. Chapter 4 explores the lived experience of a sexual preference for children in a sample of five child molesters using the principles of Interpretive Phenomenological Analysis. Four themes were identified. (1) It Creates a Battle for Me, (2) I’m Always Going to Have These Thoughts, (3) There’s No Help Out There and (4) My Interest in Children is More Than Just Sexual. The results have implications for clinical practice and are discussed in the context of directions for further research. Chapter 5 evaluates the Sex with Children scale (Marshall, 1995) which was used as an assessment measure in Chapter 3. Finally, Chapter 6 provides a discussion and close to the thesis drawing together the implications of the research.

Background: Antisocial personality is characterised by impulsive behaviour and a pervasive disregard for the rights of others. Its consequences are often debilitating and its presentation poses considerable treatment challenges. While it may be associated with a range of neuropsychological deficits, the literature is often contradictory and no research has examined their effect on treatment. Method: A systematic review of the neuropsychological literature on male adults with antisocial personality was conducted to facilitate generation of hypotheses. Pooled evidence from 132 studies suggested robust cognitive deficits in motor regulation, affect recognition, and concept formation. Findings were less consistent for other functions and differences between operationalisations of the antisocial personality were present. To further investigate the neurocognitive deficits and examine their effect on treatment, the Cambridge Neuropsychological Assessment Battery (CANTAB) was administered on 102 adult male offenders (divided into those with antisocial vs. other personality disorders) and on 20 healthy controls in a between-subjects design. Two operationalisations were examined in parallel for the first time: Antisocial Personality Disorder (ASPD) and psychopathy. Progress in treatment was measured using a two-part, standardised instrument – the Progress Rating Schedule (PRS) – developed systematically via thematic analysis as part of the project. Results: ASPD demonstrated impairments in executive, memory, attentional, and visual processing functions while psychopathy showed primarily executive but overall milder deficits. Impairments in motor regulation, set-shifting, working memory, and visual perception appeared present in the antisocial personality (ASPD and psychopathy) but not offenders with other personality disorders. Regarding progress in treatment, the PRS showed good reliability (intra-class correlations: 0.63-0.92; internal consistency: 0.77-0.87) and concurrent and predictive validity. However, cognitive difficulties predicted outcomes only to a limited extent. In ASPD, fronto-temporal deficits predicted poorer progress through the forensic pathway. However, higher risk-taking (Cambridge Gambling Task) predicted better outcomes while intellectual functioning and presence of psychopathy mediated some effects. In psychopathy, only visual short-term memory and planning predicted progress; impairments in the former predicted slower progress but there were inconsistencies for the latter. Conclusions: A range of neuropsychological deficits appeared to characterise the antisocial personality and some may have adverse effects on progress in treatment. Further research is required in other, larger samples and cognitive functions not included in the CANTAB to confirm and extend these findings.

Offender characteristics are considered important in the prediction of future risk of re-offending and response to treatment. The psychiatric classification of offenders can therefore be an important variable influencing decision making. Although the relationship between personality disorder and offending is established in the literature, the relationship is complex. Recidivism of any type, particularly serious further offending that is violent or sexual in nature, has far reaching implications on the victims, the perpetrator, the criminal justice system and wider society. The identification and management of individuals with personality disorder is a priority for both mental health professionals and the criminal justice system. The overall aim of this thesis is to examine the relationship between personality disorder and further offending in adult forensic populations (prison and probation). Chapter one presents a general introduction to the topic. Chapter two presents a literature review following a systematic approach and poses the question: Is personality disorder associated with recidivism? The findings are generally supportive of the view that some personality disorders are associated with a greater likelihood of recidivism. The limited good quality research available indicates the need for further research. Chapter three presents a critique of a screening tool for personality disorder, the Standardised Assessment of Personality: Abbreviated Scale (SAPAS). It highlights that despite some shortcomings, the SAPAS is a simple, brief and useful first-stage screening tool for personality disorder that possesses adequate psychometric properties. It is proposed that a combined screening approach, using the SAPAS and Offender Assessment System Personality Disorder (OASys PD) screen, is necessary to improve the detection of antisocial cases, particularly in forensic populations. In Chapter four an exploratory cohort study examines personality disorder in a UK sample of offenders, that have committed a further serious sexual or violent offence, whilst under the active supervision of the London Probation Trust. The study investigated the prevalence and type of personality disorders using the SAPAS and OASys PD screen. Comparisons were made between serious further offence (SFO) offenders with and without personality disorder, and within the SFO group by type of SFO (violent or sexual). The SAPAS and OASys PD screen were also explored in relation to their ability to predict group membership (SFO vs. non-SFO). The study identified that personality disorder prevalence was higher in SFO offenders, particularly antisocial traits, and that the OASys PD and OASys risk of harm (RoH) classification are significant variables for predicting group membership. The study has added to the knowledge base and understanding of SFO offenders and has implications for the practice of Offender Managers/Supervisors in UK prisons and probation units. The findings support the efficacy of the screening approach used in the Offender Personality Disorder Pathway (DOH/NOMS, 2012), London Pathways Project. A single case study is presented in Chapter five which evaluates the utility of psychological therapy with a man on Licence, presenting with traits of antisocial personality disorder. The difficulties associated with working with this client group are considered. In Chapter six a discussion of the work presented concludes the thesis. Overall, the thesis identifies some interesting findings in relation to the prevalence of personality disorder in SFO offenders and the utility of some key tools used in the assessment of offenders in probation/prison, and how these could be used in relation to risk management.