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  • About
  • The Global ETD Search service is a free service for researchers to find electronic theses and dissertations. This service is provided by the Networked Digital Library of Theses and Dissertations.
    Our metadata is collected from universities around the world. If you manage a university/consortium/country archive and want to be added, details can be found on the NDLTD website.

The residual dimension: a study of residual syndromes in veterans with chronic psychiatric illness.

Jilek, Wolfgang G. 1966 (has links)
A review of psychiatric classifications in use throughout the world (STENGEL, 1960) reveals that only four out of 38 diagnostic systems provide a classif1ing label for a condition as familiar to clinicians as the schizophrenic residual, or "defect", state.+ The Diagnostic and Statistical Manual ot the A.M.A. (1952) reserves the term Schizophrenic reaction, residual type, for "those patients who, after a definite psychotic, schizophrenic reaction, have improved sutficiently to be able to get along in the community, but who continue to show recognizable residual disturbance of thinking, affectivity, and/or behavior." [...]

Biochemical pharmacology of harmaline in the rat.

Villeneuve, Andre. 1966 (has links)
Harmala alkaloids have attracted the interest of many investigators on account of their effect on the extrapyramidal system, their hallucinogenic properties, their inhibitory activity on monoamine oxidase and the hypothetical role of related compounds in mental illness. [...]

Evoked response pattern and recovery cycles in human subjects.

Nazif, Abdel. A. 1963 (has links)
By definition evoked potentials are "the detectable electrical changes in the brain in response to deliberate stimulation of any part of the nervous system” (16). The importance of recording human brain responses to controlled sensory stimuli is well recognized. These responses represent, in fact, the end product of a long series of events in the nervous system from the peripheral receptor organs, through many interneurones and relay stations, up to the cortical neurons which participate in their production. Any change, physiological, chemical or pathological, occurring anywhere along their paths may be reflected in the recorded evoked responses. It is conceivable, therefore, that the study of these electrophysiological data can yield useful information about the functional state of the nervous system.

Schneiderian first-rank symptoms in schizophrenia and methamphetamine psychosis: a comparative study

Shelly, James Bradly 2015 (has links)
Includes bibliographical references Objective: To determine the occurrence and associations of Schneiderian first-rank symptoms in patients diagnosed with schizophrenia and methamphetamine psychosis using structured clinical interviews for DSM-IV (SCID-I). Method: Data from SCID-I interviews collected on two samples of patients, diagnosed with schizophrenia and with methamphetamine psychosis, as part of two separate research projects, was retrieved from the respective databases and compared. The two groups were compared on the presence of any one first rank symptom, those who had two first-rank symptoms, and those who had more than two first-rank symptoms. We calculated the prevalence of different first-rank symptoms in schizophrenia and methamphetamine psychosis. We further performed a logistic regression and calculated adjusted and unadjusted odds ratios for the association between first-rank symptoms and diagnosis. Results: One hundred and two patients fulfilled inclusion criteria for the study, 33 from the methamphetamine psychosis sample, and 69 from the schizophrenia sample. Prevalence of one, two, and more than two first-rank symptoms in the methamphetamine psychosis and schizophrenia groups was calculated as 69.6% and 69.7%, 21.2% and 20.3 %, and 27.3% and 27.5% respectively. After adjusting for covariates, thought broadcasting occurred significantly more often in patients with schizophrenia compared to those with methamphetamine psychosis (Odds ratio=3.61; 95% CI: 1.26-10.33; p<0.05). In turn, the odds of having auditory hallucinations in the form of voices conversing was significantly lower in patients with schizophrenia compared to those with methamphetamine psychosis (Odds ratio=0.27; 95% CI: 0.1-0.75; p<0.05). We found no significant association between any other first-rank symptoms as measured by the SCID-I and a diagnosis of schizophrenia or methamphetamine psychosis. Conclusion: The symptom of thought broadcasting was significantly more likely to occur in patients diagnosed with schizophrenia than in patients diagnosed with methamphetamine psychosis. Auditory hallucinations of voices heard conversing was significantly less likely to occur in patients with schizophrenia than in those with methamphetamine psychosis. Overall, there was a significant overlap of first-rank symptoms and a diagnosis of either schizophrenia or methamphetamine psychosis, but this study did not show that patients with a diagnosis of schizophrenia are more likely to have first-rank symptoms when compared to those with methamphetamine psychosis.

Evidence-based screening, brief intervention and referral to treatment for substance-using adolescents with delinquent-type behaviours

Carney, Tara 2014 (has links)
Includes bibliographical references. Background: Both substance use and delinquent-type behaviours are prevalent among adolescents in Cape Town, South Africa. However, early interventions in developed countries for adolescents with similar problems are not available in many low and middle income countries, including South Africa. This is a concern as providing evidence-based interventions that address these dual behavioural problems may prevent their progression. There is thus a need for identifying and understanding the kinds of interventions that would be able to address both of these problems Aim: The aim of this thesis is to identify an evidence-based intervention for reducing adolescent substance use and delinquent-type behaviours and adapt it for use among adolescents in Cape Town, South Africa. Method: This study comprised six parts. Study I utilised a longitudinal data set to examine the association between substance use and delinquent-type behaviours, as well as the trajectory of these behaviours among school-going adolescents in Cape Town. As one needs to know how to identify adolescents who would benefit from such an intervention, Study II identified suitable screening tools for identifying these adolescents. While screening tools are generally brief instruments to identify problems with substance use, assessment instruments for those adolescents who screen positive would more comprehensively assist in the further evaluation of their problem behaviours, as well as measure other risk factors for substance use and delinquent-type behaviour. Study III therefore tested and adapted assessment tools for those adolescents who screen positive for substance use and delinquent-type behaviour. The next step was to identify a suitable evidence-based brief intervention that addressed substance use and delinquent-type behaviours in an integrated manner. Study IV consisted of a systematic review and meta-analysis to identify such an intervention. As only studies from developed countries were included in the review, the final two studies concentrated on adapting the intervention identified in Study IV with service providers and adolescents in focus groups 6. Study V consisted of a cultural adaptation which tested the ecological validity of the identified brief intervention in Cape Town communities. Study VI was a content adaptation that modified the brief intervention for adolescents in this context, and to include a focus on delinquent-type behaviours. Results: The final result is a screening, brief intervention and referral to treatment (SBIRT) package that is ready to be tested for efficacy on substance use and delinquent type behavioural outcomes. Each study contributes to the different components that make up this package. The results from the longitudinal study indicated that while substance use is not predictive of delinquent-type behaviours, these two behaviours co-occur at different stages of adolescence. In addition, adolescents that smoked and were delinquent were at significantly higher risk of engaging in later delinquent-type behaviour. This suggests that it would be efficient to address the two risk behaviours simultaneously using an integrated intervention. The GAIN-SS was identified as an easy-to-use and psychometrically sound short screener for identifying adolescents with both problems who may benefit from a brief intervention. The comprehensive assessment tool developed for use if an adolescent screens positive and may therefore be eligible for such a brief intervention, measured the following core domains: substance use, delinquency, parenting practices, peer substance use and readiness to change. These were modified based on both adolescent participants? and experts? recommendations. Following assessment, Teen Intervene was identified as the brief intervention which was the most effective in reducing early adolescent substance use and consequences related to substance use. While this promising intervention addresses substance use and behavioural outcomes broadly, it did not do so in an integrated and comprehensive manner. Teen Intervene was also only tested in one population, and the results of the qualitative studies (V and VI) were therefore helpful in the adaptation of the intervention. Qualitative work found that the context that adolescents in the study have been exposed to within their home setting, school and community, as well as their relationships with people within these settings, influence their engagement in risk behaviours. Therefore ensuring ecological validity is important when modifying the identified intervention for use in Cape Town. The intervention was expanded to include a focus on delinquent-type behaviours and a handbook was developed for adolescents that contained information from the, skills-building exercises, as well as goal setting from the original intervention for the individual adolescent. Recommendations for the implementation of this intervention showed that the types of recruitment strategies in place may affect the uptake of services, and organisational factors (organisational readiness, staff issues, available resources) may affect the delivery of intervention services. Such issues should be taken into account before implementation takes place. Conclusion: This thesis is one of the first to investigate the relationship between substance use and delinquent-type behaviours in a developing country setting. It describes the identification of an SBIRT package for substance use and delinquent type behaviours among adolescents, and how these were adapted to develop an integrated intervention that addresses both of these problems. This adapted intervention may provide an option of tailor-made services for adolescents in disadvantaged communities in Cape Town, where adolescents are often affected by a host of social problems but where a lack of resources are available to address these problems. The contextual and content-based adaptation processes highlighted the importance of working with adolescents directly to ensure that the intervention adequately addressed the local context as well as the specific issues that they face, at their level of understanding. The engagement of service providers, who may be trained to deliver this integrated intervention package, was also important to address possible challenges that could occur while delivering the intervention. The next steps in the process would be to implement the adapted version of the intervention to iron out some of the potential implementation issues that were alluded to above, and ultimately to assess its efficacy in addressing the very real social conditions described in Chapter 1.

Psychological trauma and posttraumatic stress disorder in a South African birth cohort study

Koen, Nastassja 2015 (has links)
Psychological trauma - including exposure to intimate partner violence (IPV) - is highly prevalent in South Africa, and may result in posttraumatic stress disorder (PTSD) in a subset of individuals. Pregnant women and new mothers are particularly vulnerable; and trauma exposure and PTSD in this sub-group may be associated with a number of adverse maternal-child sequelae including poor birth outcomes and impaired infant neurodevelopment. Risk factors for psychological trauma exposure, and for subsequent PTSD, are likely to include environmental and genetic influences. Given the high burden of trauma and related disorders, the unique genetic ancestry, and the relative paucity of empirical data, further work in South African populations is warranted. This thesis aimed to investigate a number of questions about trauma and PTSD in the Drakenstein Child Health Study (an ongoing South African birth cohort study), including their risk factors, their impact on infant birth anthropometry and development, and their genetic correlations. This thesis includes five publications, all presenting data from the Drakenstein Child Health Study. Pregnant women were recruited from two clinics in the Drakenstein sub-district - a peri-urban community outside Cape Town, Western Cape. Sociodemographic characteristics; psychosocial risk factors (including depression, stressful life events, psychological distress and alcohol and substance misuse); trauma exposure (childhood trauma, IPV and lifetime trauma); and PTSD were assessed using validated and reliable self-reported questionnaires, as well as diagnostic psychiatric interviews.

Effects of bipolar disorder on intrinsic brain networks

Starke, Jonathan Alan 2016 (has links)
Introduction: Bipolar disorder (BD) is a brain network disorder that affects cognitive and emotional functioning, and is associated with prefrontal and/or limbic dysfunction. Functional Magnetic Resonance Imaging (fMRI) allows identification of intrinsic brain networks (IBN), like the default mode network (DMN) and executive control network (ECN), which are consistent with previously established functional and anatomical relationships within the brain. Analysing the functional connectivity (integrity, extent and inter-relationships) of these networks, allows a deeper understanding of brain function in health and disease. In BD, there are functional connectivity changes in the DMN, ECN and cerebellar network (CERN). We evaluate IBN in BD, to explore changes in the functional connectivity between the cerebellum, fronto-cortical and paralimbic regions. Methods: Data from 14 BD subjects and 10 control subjects was analysed after fMRI. Changes were evaluated in 3 IBN (DMN, ECN and CERN) using an FMRIB Software Library (FSL) pipeline: MELODIC/ICA-AROMA, dual-regression, randomise and Local False Discovery Rate (FDR) to identify changes in functional connectivity bipolar subjects compared to controls. Results: Subjects with BD showed decreased connectivity between the CERN and a cluster in the right precuneus; and between the ECN and a cluster in the left OFC. There was also increased connectivity between the ECN and a cluster in the left temporal pole. No connectivity changes involving the DMN were identified. Voxels within the clusters were significant at p < 0.05 with local FDR. Peaks within the clusters remained significant after further Bonferroni correction for multiple comparisons (p < 0.017). Conclusion: The finding of altered functional connectivity in BD, in networks and regions involved in cognitive/emotional processes, highlights its complex neurobiology, and suggests that abnormal connectivity may help to explain the clinical picture. These findings should be replicated with larger samples, but may represent a further advance in understanding the role of functional connectivity in the pathology of BD, and contribute to laying the foundation for functional neuroimaging as a diagnostic tool in psychiatry.

Inpatient referrals to consultation-liaison psychiatry at a tertiary hospital in South Africa

Torline, John Ross 2016 (has links)
Introduction. Consultation-liaison psychiatry is the subspeciality that provides for the psychiatric assessment and management of patients in a hospital setting, serving as an interface between psychiatry and other medical disciplines. This study aimed to provide an analysis of the Consultation-liaison psychiatry service at Groote Schuur Hospital. It was hypothesised that the hospital has a large burden of psychiatric illness amongst inpatients with unique characteristics and high rates of referrals related to HIV, alcohol and methamphetamine use. Methods. A retrospective review was performed of all inpatients referred for psychiatric consultation from other departments over a period of thirteen months. Patients referred by the emergency medical and surgical departments were excluded from this study, as they are seen by the department of emergency psychiatry. Results. A total of 452 patients (males n=174; females n=278) between the ages of 12 and 90 years were consulted, with the majority of the patients (82%, n=360) belonging to the age group of 18 to 59 years (mean age of 37 years). The referral rate to Consultation-liaison psychiatry was 0.95% (when combined with emergency psychiatry referrals the combined referral rate was 4.7%). Most referrals were from the department of medicine (56%, n=252), with the highest number of medical subspeciality referrals from neurology (6%, n=29). Request of a general review (69%) of current psychiatric symptoms (87%) occurred most frequently. The most common symptoms noted by the referring non-psychiatrist were mood symptoms (n=159; 36%), followed by suicidal behaviour (23%, n=102) and behavioural problems (21%, n=94). The mean number of psychiatric diagnoses following assessment was one (SD 1; 0:5), and most patients were assigned a definitive diagnosis (78%, n=342). Alcohol use disorder was diagnosed in 9% (n=41). Methamphetamine use was identified in 5% (n=22) of patients, with the majority being diagnosed with methamphetamine abuse. The use of other substances was identified in 9% (n=38). The HIV status was confirmed positive in 16% (n=70), with the majority of this group being female (67%). Most subjects had psychosocial and environmental problems (55%, n=249). Registrars performed a mean number of one consultation and the majority of patients were seen within 24 hours of the referral. Medication was initiated in 31% (n=139) of cases. The majority (65%, n=292) of patients were discharged from psychiatric care, and 14% (n=61) required admission to an inpatient psychiatric unit. Conclusion. The combined referral rate (consultation-liaison and emergency psychiatry) compares favourably to that of high-income countries, and is higher than any other published studies of this nature in low-income and middle-income countries. There was no substantial agreement between psychiatrist and non-psychiatrist diagnoses. As expected, mood disorders were the most common diagnoses, with only fair agreement between psychiatrist and non-psychiatrist clinicians. A high proportion of referred patients were substance users, but methamphetamine rates were lower than expected and the rate of HIV was higher than anticipated. The results presented here may facilitate improvements in the practice of Consultation-liaison psychiatry.

The newer anticonvulsants in the treatment of generalised anxiety disorder: a systematic review and meta-analysis

Koller, Anthony 2016 (has links)
Generalised anxiety disorder (GAD) is a common, chronic and debilitating mental disorder impairing quality of life and functioning. The 1st line treatments for GAD include the selective serotonergic reuptake inhibitors (SSRIs) and the selective serotonergic noradrenergic reuptake inhibitors (SNRIs). However, they have rates of non-response ranging from 25 to 40%. There is justification to search for new and more efficacious GAD medication. It has hypothesised anticonvulsants possess anxiolytic properties based on animal studies and epilepsy trials. There is inconsistent evidence that anticonvulsants are efficacious in GAD. It was considered useful and timely to investigate this further. The newer anticonvulsants (felbamate, gabapentin, lamotrigine, levetiracetam, oxcarbazepine, pregabalin, tiagabine, topiramate and zonisamide) were investigated as they were considered to have a more benign side effect profile and fewer drug interactions than older anticonvulsants. This study is a systematic review and meta-analysis of the newer anticonvulsants in the treatment of GAD. The main objective was to use randomised controlled trial (RCT) data to estimate efficacy of the newer anticonvulsants in GAD. using A search strategy was designed and three separate searches conducted by the Cochrane Depression Anxiety and Neurosis Group of the Cochrane Collaboration Depression, Anxiety and Neurosis Controlled Trials Register (CCDANCTR) and clinicaltrials.gov (the last search in May 2013). An updated, independent, search was conducted in May 2016 with no additional citations retrieved. 287 citations were retrieved and screened in total. Two independent raters assessed citations using the abstracts and selected trials that satisfied the inclusion criteria. 12 RCTs were included with eight using pregabalin and four using tiagabine. A single rater collated data from RCTs assisted by Covidence Systematic Review Software. All statistical analyses were performed using Review Manager. A random effects meta-analysis was performed expressing summary statistics as effect estimates with 95% confidence intervals (CI). There were 4001 participants in total with 2516 in the anticonvulsant group and 1485 in the placebo. Primary outcomes were reduction in symptom severity using the Hamilton Anxiety Rating Scale (HAM-A) and treatment response using the Clinical Global Impressions Scale-Improvement item (CGI-I). Secondary outcome was medication acceptability. Reduction of symptom severity on the HAM-A for: the anticonvulsant group (pregabalin and tiagabine combined) was significantly favourable with a mean difference (MD) of -2.10 ([-2.83, -1.36] 95% CI); pregabalin was significantly favourable (MD -2.86 [-3.52, -2.21] 95% CI) tiagabine was statistically insignificant (MD - 0.58 [-1.41, 0.25] 95% CI). The risk ratio (RR) of treatment response using the CGI-I (RR >1 favours the anticonvulsant) for: the anticonvulsant group was significantly favourable (RR 1.23 [1.12, 1.35] 95% CI); pregabalin was significantly favourable (RR 1.35 [1.21, 1.50] 95% CI) tiagabine was statistically insignificant (RR 1.09 [0.98, 1.22] 95% CI). The RR of treatment acceptability (RR >1 favoured placebo) for: the anticonvulsant group was significantly unfavourable (RR 1.49 [1.18, 1.88] 95% CI); pregabalin was statistically insignificant (RR 1.23 [0.92, 1.65] 95% CI) tiagabine was significantly unfavourable (RR 1.95 [1.29, 2.93] 95% CI). In conclusion, this systematic review of the newer anticonvulsants included only RCTs of pregabalin and tiagabine. The main finding was that pregabalin showed significant efficacy in reducing symptom severity and improving treatment response in GAD. Tiagabine failed to show significant efficacy in primary outcomes. Further work is needed to better clarify the place of the newer anticonvulsants in the treatment armamentarium of GAD.

A retrospective analysis of factors used to assess fitness to stand trial in adult male defendants referred for psychiatric observation

Jacobson, Candice 2017 (has links)
Background. A court orders a forensic observation of a defendant to determine a defendant's fitness to stand trial and/or ability to appreciate wrongfulness of action (criminal responsibility) at the time of the alleged offence. Fitness to stand trial is the focus of this review rather than criminal responsibility. In this instance, the court requests an expert to determine whether the defendant's current mental state would significantly impair his or her ability to participate meaningfully in his or her own trial. In South Africa, this process involves multiple assessments by a multidisciplinary forensic psychiatry team in a dedicated forensic psychiatry unit. However, at present no standardised format has been adopted for such an evaluation, the findings of which may have dire consequences for the individual being assessed. Furthermore, there is a paucity of current literature on fitness to stand trial evaluation. Objectives. To establish whether fitness to stand trial is adequately assessed in the Western Cape, South Africa. A further objective is to establish whether mental illness is the sole factor that differentiates defendants fit to stand trial from those who are found not fit to stand trial, and whether defendants with mental illness are less likely to be asked the relevant questions to determine fitness to stand trial than those without mental illness. Methods. A descriptive, retrospective review was conducted (via the application of a checklist) of clinical records of the last 100 male defendants' ≥18 years of age admitted to the Valkenberg Hospital Forensic Psychiatry Unit prior to March 2015. Results. 30 defendants (30%) were found to have a psychiatric diagnosis. Of the 30 defendants, all were noted to have a serious mental illness (mostly psychotic disorder or cognitive impairment) and were found not fit to stand trial. Seventy (70%) of the defendants were found fit to stand trial by the expert panel. From the findings, it was noted that the forensic team asked and recorded the necessary factors to determine fitness to stand trial in 56% of the study population (based on frequency of responses: n = 894), with 32% of questions not appearing to have been addressed at all (especially those pertaining to role players in court and a defendant's understanding of his rights). Furthermore, various questions appeared to have been indirectly addressed in fewer than 50% of defendants. No significant difference was noted in how the forensic team conducted its assessments between those defendants found to have a serious mental illness and those without serious mental illness. Conclusion. The results of the study suggest the need for a more in-depth review of the forensic evaluation process in the Western Cape to further ascertain the benefits of using a checklist during the evaluation process. Furthermore, additional research would assist in determining the factors contributing to a number of questions not having been addressed and the consequences thereof.

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