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By re-examining the epistemological foundations upon which the ego-centric clinical construct of insight in psychosis rests, research conducted with the narratives of patients who participated in the clinical project, Psychosis and Culture: The Role of Spaces of Negotiation (Between Patients, Families, and Practitioners) During Consultation was aimed to explore and formulate a socio-centric model of insight construction more sensitive to patients' intersubjective and cultural milieus. Collected interviews---conducted with recently diagnosed psychotic patients using the Turning Point Interview (TPI) grid---were approached from a phenomenological and hermeneutical perspective in order to illustrate the processual manner in which patients' insight (into the cause and reason of illness) was the cognitive and epistemic derivative of dialogical relations with other persons set within a socio-cultural matrix. The results of this research indicate that the production of patients' insight in psychosis is an inherently intersubjective and dialogic phenomenon which, in the clinical context, occurs at two points of juncture: (1) a synchronic juncture where the patient is interpellated by the clinician and hence positioned as a speaking subject, and (2) a diachronic juncture where the patient, as a result of having been called into a speaking position, constructs and authors a narrative account of significant events related to his/her illness experience based on biographical memory. Insight was shown to consist of 3 stages: (1) Detection of alteration of lived experience, (2) Causal attribution, and (3) Global construction of meaning . Each stage was shown to form the intersubjective and dialogic basis for the production of a subjectively meaningful account of insight, using the lifeworid of the patients and the patients' entourage as subjective frames of reference.

Background: Coronary heart disease (CHD) is a leading cause of death in Canada; however, physical activity (PA) has been shown to reduce mortality. Unfortunately, CHD patients are not engaging in enough PA. Purpose: To explore the association of the environmental variables (a) rurality, (b) access to PA opportunities, and (c) community socio-economic status (SES) with PA in CHD patients 3 months after discharge? And how does task self-efficacy may mediate these associations Results: Regressions showed that task self-efficacy predicted PA; however rurality, and SES did not predict PA at 3 months, nor did access to PA opportunities with the exclusion of pools. The lack of associations required no mediational analyses to be performed, except for pools, which demonstrated no mediational influence from self-efficacy. Conclusion: While task self-efficacy was a key PA correlate, there were no associations between the environment and PA (with the exclusion of access to pools).

The purpose of this study was to monitor and compare levels of anxiety, depression, satisfaction and knowledge in male coronary patients and their spouses, throughout the patients stay in hospital and at one, three and six months following discharge from the hospital. A programme of in-hospital educative-supportive counselling was introduced to determine whether it significantly affected reactions. The study design took the form of a randomized controlled trial. The counselling was provided to couples during four 30 minute sessions by a coronary care unit registered nurse. Findings from the study provide evidence to support the overall contention that this simple programme confers additional benefits over and above the usual management regime. These benefits include statistically significant reductions in reported anxiety and depression, and increases in satisfaction and knowledge in both partners. The programme of support was simple and easy to implement, requiring little investment in training personnel and none in additional staff, finances or other resources. It is concluded that in-hospital counselling for coronary patients and partners is therapeutically effective and efficient. Proposals are made for practice change and recommendations are given for the direction of future research.

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Based on ten experiments, this thesis examines representational neglect in brain damaged patients and in matched controls.  The patients sometimes show a specific deficit in visual imaging:  neglected one half of their mental representations.  Although several studies addressed the issue of visuo-perceptual neglect, the representational defect is underinvestigated.  Only a few standardized tests are available for its detention and assessment, and therefore rarely it is diagnosed in clinical practise or investigated in experimental work.  In this thesis some new tests to investigate representational neglect are proposed.  Moreover, representational neglect is evaluated in different sensory modalities (visual, tactile as well as within the personal domain) to address the issue of supramodality or plurimodality of this deficit.