No description available.

Mental disorders are among the most prevalent of chronic diseases, and high rates of these disorders have been consistently found in jails and prisons. This study was a retrospective case series that described the population of adults charged with a criminal offense who were court ordered to undergo a psychiatric assessment within the Medical Legal Service in Santiago, Chile from 2005-2006. Chi-square tests were used to assess differences in the distribution of variables by sex and by criminal responsibility. Exploratory analyses using polytomous logistic regression were conducted in order to assess variables that might be predictive of the outcome of criminal responsibility as recommended by the psychiatrist. Of the evaluated offenders, approximately 84% were considered by a psychiatrist to be criminally responsible for their crime, 7% were regarded as having diminished criminal responsibility, 4% were considered to be not criminally responsible for their crime, and 4% were cases where criminal responsibility was not applicable. The following variables were found to be significant in the exploratory model: sex, age, occupational status, psychiatric pathology, recommendation of treatment, and recommendation of hospitalization. An offender determined by the psychiatrist to have a psychiatric pathology had the highest increase in odds of being considered to have diminished criminal responsibility or of being considered not criminally responsible. Results from this investigation will contribute to international knowledge about forensic psychiatry and mental health in Latin America. / Thesis (Master, Community Health & Epidemiology) -- Queen's University, 2008-09-23 12:52:55.423

Schizophrenia is a debilitating psychiatric disorder with high heritability. Genome wide association studies (GWASs) have identified association between schizophrenia and an intronic single nucleotide polymorphism (SNP) in zinc finger domain containing 804A (ZNF804A). The biological functions of ZNF804A are largely unknown. Thus, the aim of this thesis was to determine the function of ZNF804A. Yeast two-hybrid (Y2H) screens were used to determine the protein binding partners of ZNF804A in the brain. This identified ZNF804A interacted with transcription factors (zinc finger protein 40 (ZNF40); trans-acting transcription factor 1 (Sp1) and basic helix-loop-helix family, member e40 (Bhlhe40)) and regulators of pre-mRNA splicing, including RNA binding protein, fox-1 and -2 (Rbfox1 and RBFOX2) and neuro-oncological ventral antigen 2 (NOVA2). Therefore, we hypothesised that, via interactions with its protein binding partners, ZNF804A may have a role in regulating transcription and pre-mRNA splicing. Exon arrays were used to determine the effects of ZNF804A knockdown on gene expression in SH-SY5Y neuroblastoma cells. Enrichment analysis on the differentially expressed or spliced genes indicated a significant effect of ZNF804A knockdown on genes involved in nervous system development, particularly synaptic contact and axon guidance. Among the most significantly differentially expressed genes were the known schizophrenia susceptibility genes reelin (RELN) and neuropeptide Y (NPY). Several alternative splicing events were confirmed empirically, including increased exclusion of exon 11a of enabled homolog (ENAH). Consistent with our hypothesis, splicing of exon 11a of ENAH is known to be regulated by RBFOX2. In complementary experiments, exon arrays were used to identify differentially expressed genes in a stable cell line expressing myc-ZNF804A. Enrichment analysis on the differentially expressed genes indicated an over-representation of genes involved in the regulation of epithelial to mesenchymal transition and receptor-mediated axon growth repulsion. Among the genes with the largest fold changes in expression was a gene implicated in synapse development: secreted protein acidic and rich in cysteine (SPARC). Enrichment analysis of the alternatively spliced genes indicated a significant effect of myc-ZNF804A over-expression on genes involved in cell-matrix interactions. These data suggest that ZNF804A regulates the expression of genes implicated in processes underlying schizophrenia pathology, and provide the first evidence that ZNF804A may be involved in the regulation of alternative splicing.

No description available.

The focus of this study was to explore the film image of the mental health professional (MHP) in importance of this study is founded upon the assumption that many film viewers' perceptions and expectations of the mental health profession and the process of psychotherapy and counseling are influenced by these film images.A total of seventeen films were identified. Of these, eight were randomly selected for a content analysis. A prevailing film image of the MHP and MHP's client was obtained. Following the content analysis, the films selected were further analyzed using a hermeneutic approach, which is a further development of phenomenolical theories. The study was descriptive in nature and, therefore, no statistical analyses were employed.The results of this study found that the film image of the MHP in current films is more negative than previous researchers have discovered. This image iscontemporary Hollywood feature length films. They explored within the social and political context of the 1980s, and associations are made among perceptions of authority figures, gender of film MHPs, and techniques employed by film MHPs. Recommendations are made for future researchers. / Department of Counseling Psychology and Guidance Services

Emotional distress is common after stroke and has a negative impact on rehabilitation outcome. The aim of this thesis was to identify factors relating to emotional distress after stroke to inform future interventions. This thesis developed a theoretical framework to guide the study of emotional distress and included stroke and demographic characteristics, background information, disability (personal and extended activities of daily living and aphasia) and psychosocial factors (coping, locus of control and social support). This thesis consisted of three studies. The first study developed and validated the Stroke Cognitions Questionnaire Revised (SCQR), as previous studies used cognitions assessments not appropriate for this population. The SCQR assesses the frequency of positive and negative stroke-related cognitions. The scale was developed from treatment notes of depressed stroke patients. The scale had high internal consistency, inter-rater and test retest reliability, and concurrent validity. Depression (Beck Depression Inventory; BDI) was characterized by a preponderance of negative cognitions and, to a lesser extent, a decrement in positive cognitions. This supports the cognitive model of depression. The second study evaluated factors that predicted the severity of depression in a sample of 112 depressed patients recruited to a randomised controlled trial of cognitive behaviour therapy between one and six months post-stroke. Communication impairment (Sheffield Screening Test for Acquired Language Disorders; SST) at recruitment was predictive of severe depression (BDI) at recruitment. Patients with greater communication impairment (SST) and a more external locus of control (Recovery Locus of Control Scale; RLOC) at recruitment were more likely to remain depressed at six months follow-up. Patients who remained depressed at follow-up were more severely depressed at recruitment. The main study of this thesis evaluated the proposed theoretical framework of emotional distress. In a prospective longitudinal study, 100 patients were recruited from hospital at one month post-stroke and assessed on communication (SST), personal activities of daily living (ADL; Barthel Index), distress (Visual Analogue Mood Scales, Visual Analogue Self-Esteem Scale and Stroke Aphasic Depression Questionnaire). Patients who were not aphasic completed additional assessments of distress (Hospital Anxiety and Depression Scale, Beck Depression Inventory II), recovery locus of control (RLOC), coping (Brief COPE) and cognitions (SCQR). Patients were reassessed on the same measures at six months (n=92), in addition to extended ADL (Extended ADL Index) and social support (Significant Others Scale; SOS). Communication impairment and dependence in personal ADL were predictive of distress at one month. Communication impairment and dependence in extended ADL were predictive of distress at six months. In non aphasic patients, externality of locus of control was also predictive of distress at one months and six months and actual social support was predictive of distress at six months. The relationship between coping and distress was mediated by locus of control. Distress remained persistent at six months post-stroke. The factors found to predict distress (communication impairment, recovery locus of control and activity level) will help identify patients at risk of distress. Also, this demonstrates the need to include aphasic patients. The risk factors are amenable to psychological intervention, such as cognitive behaviour therapy and coping skills training. Future research should evaluate the proposed interventions.

This study provides the result of a doctorate research into the impact of existential psychotherapeutic interventions with people experiencing chronic eating disorders. The results indicate that positive outcomes are correlated to therapeutic interventions which concentrate on the clients own perception of control and choice over their own eating habits. The research aim was to explore both the effects and the effectiveness of existential therapy in altering the individuals subjective interpretation of their Self when they are deeply immersed in the experience of disordered eating. Interventions went beyond the cognitive-behavioural approaches into the implementation of existential psychotherapy which helped individuals to explore the existential concerns of life, choice, hope, social inclusion and love within the context of their own sense of Being. This focus led to an improvement in all study subjects and a reduction in the use of mental health resources. All individuals entered the study following assessment criteria which included chronicity, lengthy use of mental health services and past therapeutic interventions. Three diagnostic criteria were included, Anorexia Nervosa, Bulimia Nervosa and Morbid Obesity. Data presented in the study supported the original premise that all three eating disorders share underlying similarities and justify the inclusion of the diagnostic criteria of morbid obesity within the study. Therapy was either in closed groups or individual and consisted of a fixed number of one-hour sessions. Therapeutic techniques included cognitive-behavioural therapy and person-centred counselling focusing on self-esteem and self-assertion, as well as an existential focus on dualistic perception of the mind/body, the conscious sense of the present and the affective bond with food itself. A series of therapeutic phases were structured to demonstrate the progress from interventions in self-esteem and self-assertion to existential concerns and principles. Taking therapy beyond cognitive-behavioural techniques involved the application of Yaloms' (1980) and Strasser and Strassers' (1997) Existential Therapy and an exploration of Duker and Slades' (1988) concepts of the fragmentation of the sense of Self in individuals experiencing eating disorders. The research demonstrated important differences between the professional perception of appropriate eating and alteration in weight as successful clinical outcomes, and the clients’ dependency on disordered eating as a source of release from interacting with others. Mental health interventions were perceived by clients as attempts to stop such a release without providing a substitute. A clear sense of loss was presented by all study subjects when eating was controlled by others. In most cases disordered eating was habitual and the emotional effects of raised or lowered glucose levels gave a sense of numbness and nothingness which was actively pursued. This was also attained when disordered eating was combined with other self-harm behaviours. Mental health practitioners inadvertently prevented the attainment of a sense of numbness by their focus on eating and body weight. The encouragement of food regimes causes increased anxiety for all clients leading to poor compliance levels. The research results have the potential to impact on mental health education and clinical services as the data indicates that individuals with disordered eating gain more benefit when the therapeutic focus is less on restoring appropriate eating habits and more on the individuals sense of Self; the importance of food intake as a source of escape from others and escape from the internal awareness of Self.

Background: Asthma now affects up to 10% of pregnant women in high income countries and international prevalence is rising. It is already one of the commonest chronic diseases that can complicate pregnancy and previous studies have raised concern that women with asthma have increased pregnancy risks. Precise estimates of the magnitude of these risks and the extent to which they may differ by asthma severity and asthma exacerbation rates, have not been determined. Aim: The overall aim of this thesis was to investigate the impact of asthma and asthma therapies on pregnancy and perinatal outcomes in the general female population. Methods: The Health Improvement Network primary care database from the United Kingdom was used to develop a dataset of women matched to their liveborn children and all data on these pregnancies and on pregnancies ending in stillbirth, miscarriage or therapeutic abortion, were extracted for analysis. Three separate studies were carried out using the developed dataset. First, a cohort design was used to compare fertility rates of women with and without asthma or other allergic disease. Secondly, a cross-sectional design was used to compare risks of adverse pregnancy outcomes and obstetric complications in women with and without asthma. Thirdly, a case-control design was used to compare the risk of congenital malformation in children born to women with and without asthma, and to assess whether asthma medications are teratogenic. Results: A study population of 1,059,246 women was obtained and pregnancies ending in 268,601 matched live births, 986 stillbirths, 35,272 miscarriages and 37,118 therapeutic abortions were identified. Women with asthma or other allergic disease had similar fertility rates (live births per 1,000 person-years) to women in the general population. Women with asthma also had a similar risk of pregnancy ending in stillbirth (Odds Ratio (OR)=1.04, 95% confidence interval (CI) 0.86-1.24)) or therapeutic abortion (OR=0.95, 95%CI 0.92-0.99), but had a small relative increase in risk of pregnancy ending in miscarriage (OR=1.10, 95%CI 1.06-1.13), compared with women without asthma. Risks of most obstetric complications were similar in women with and without asthma, regardless of asthma severity or acute exacerbations, with the exception of increased risks of antepartum haemorrhage (OR=1.20, 95%CI 1.08-1.34), postpartum haemorrhage (OR=1.38, 95%CI 1.21-1.57), depression in pregnancy (OR=1.52, 95%CI 1.36-1.69), caesarean section delivery (OR=1.11, 95%CI 1.07-1.16), preterm delivery (OR=1.15, 95%CI 1.06-1.24) and low birth weight (OR=1.18, 95%CI 1.05-1.32) in their offspring. Compared with children born to mothers without asthma, children born to mothers with asthma had a small increased risk of major congenital malformation (OR=1.10, 95%CI 1.01-1.20), however, this was not found for mothers with currently treated asthma (OR=1.06, 95%CI 0.94-1.20). Gestational exposure to asthma medications was safe apart from cromones which may increase the risk of musculoskeletal malformation. Conclusions: These findings indicate that women with asthma do not have substantially increased risks associated with pregnancy or with perinatal outcomes. Treatment with asthma medications before pregnancy and during gestation also appear to be safe for the mother and for the unborn child, providing support for the current practice of optimal pharmacological management of asthma in women of childbearing age.

While PTSD results in various symptomatology, key characteristics concern a sense of being "stuck" on the trauma which keeps the person reliving it through thoughts, feelings and images and a need to avoid anything which reminds them of the trauma. Such avoidance is suggested to prevent the opportunity for processing and integrating the distressing material. One key clinical question is how to help the person work through their trauma without them becoming overwhelmed by trauma symptoms? Eye Movement Desensitisation and Reprocessing (EMDR) is a relatively new technique that has been reported to help PTSD sufferers reduce the intensity and intrusiveness of traumatic thoughts and images. Despite the growing clinical evidence of the effectiveness of EMDR, a strong debate exists within the research literature regarding its empirical and theoretical validity. One aspect of this dissertation is an experimental study looking at the role of eye movements in Eye Movement Desensitisation and Reprocessing and testing a working memory model of "distress reduction". Of course not everyone who experiences a traumatic event will go on to develop PTSD. An often neglected area of trauma investigation is how some individuals experience positive change and personal growth as a result of their traumatic experiences. This is an area that is now beginning to receive some attention and has been termed Posttraumatic Growth (PTG). The move away from looking exclusively at the impact of trauma to consider how people who have experienced trauma might construct a more positive understanding of themselves in the light of the trauma forms the main section of this dissertation. This exploratory study uses personal experience narratives of posttraumatic growth.

The thesis examines the emergence of anti-psychiatry since the early 1960s, addressing two questions: 1. Why did anti-psychiatry emerge at this time? 2. How influential is anti-psychiatry today? Anti -psychiatry was found not to consist of one identifiable set of' proposals, but a shifting package of views. One factor remains consistent across versions of anti-psychiatry: criticism of medicalisation of mental disorder. Anti-psychiatry emerged during the 1960s for two reasons: a) Psychiatrists had adopted positivistic conceptualisations of human disorder, which reduced psychiatric patients to 'malfunctioning machines'. Anti-psychiatry restored the patient's subjectivity to the centre of psychiatric practice, b) The mid-twentieth century saw the expansion of state planning and a reduced emphasis upon individual liberty. Anti-psychiatry was part of the counter- culture, which criticised the welfare' state as a machine for producing 'normality'/conformity. 1960s Anti -psychiatry was more libertarian than Marxist. By the 1970s, anti-psychiatry divided into two distinct forms: radical psychotherapy and Marxist anti-therapy. Versions of Marxist anti-therapy fail to propose alternatives to therapy which are not themselves therapeutic or paratherapeutic. This problem derives from excessive reliance upon Szasz's libertarian critique which is flawed. Anti-psychiatry is less influential today; having suffered from academic criticism and failed to offer solutions to the problems posed by 'community care’. It competes with critiques which are pro-democracy, rather than anti- medicine. Italian reforms provide one possible model. MIND's mental health campaigns are democratically rather than anti -psychiatrically based. The user movement includes both anti -psychiatry c users and democratically-minded ones". Democratisation of mental health provision is complicated by the continuing need for expert professionals and some compulsory treatment, and by problems inherent within the user movement. However, democracy rather than anti-psychiatry now offers the best basis for political critiques of psychiatry.