Please read the abstract in the section, 00front, of this document / Thesis (D Phil (Psychotherapy))--University of Pretoria, 2007. / Psychology / unrestricted

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Despite wide agreement in the systemic field that therapists should take a non-blaming stance, historically there has been little exploration of how this stance is achieved in practice. The difficulty in knowing how to put ‘non-blaming’ into practice is further heightened by competing models of intervention with families affected by psychosis. This study contributes to a body of literature that is concerned with how complex issues of morality are achieved dialogically by considering how family therapists manage the tension of intervening to promote change whilst maintaining a multi-partial, non-blaming stance. Two therapies carried out with families affected by psychosis are analysed using the methods of Conversation Analysis (CA) and Membership Categorization Analysis (MCA). In both therapies the sequences examined are drawn from the second session of therapy where explicit blaming events occur. By examining blaming events chronologically through the course of a session the study shows how the rules about the way blame is talked about are achieved interactionally. The analysis demonstrates that systemic theory’s emphasis on the importance of being non-blaming is grounded in a sophisticated understanding of the threat blame poses to co-operation and agreement. In both therapies, the delicacy and ambiguity with which blame is treated serves to enable the conversation to continue without withdrawal. However the cost of ambiguity is a possible misunderstanding of the intent of the speaker. The resulting misalignment, where it continues over several turns and sequences, leads to explicit blame becoming relevant as a solution to a redundant pattern of interaction. The findings indicate that the management of blame requires both the exploration of blame and its interruption when emotions and conflict run high. The former enables understanding and movement towards therapeutic goals while the latter is necessary to promote therapeutic and family alliances. An unintended consequence of the injunction to be non- blaming might be the premature closing down of topics, militating against problem resolution. The study concludes that CA and MCA offer a wealth of knowledge about mundane conversational practices that can be applied fruitfully to systemic therapy process research, teaching and supervision.

There has been concern about the impact of cannabis use on the onset, course and relapse of psychosis. Evidence from retrospective and a small number of prospective studies has suggested that cannabis use may precipitate a latent psychosis, exacerbate psychotic symptoms and increase the likelihood of psychotic relapse. The purpose of the current study was to examine the influence of cannabis use on psychotic symptom exacerbation and relapse within the stress vulnerability-coping model of psychosis. Two studies were conducted. The influence of cannabis use on the onset and course of psychosis was retrospectively examined in the first study. The second study prospectively examined the influence of cannabis use on psychotic symptom exacerbation and relapse over a 6-month period. The influence of the severity of psychotic symptoms on a relapse in cannabis use was also explored. Eighty-four participants were assessed at admission, 81 of whom were followed up for a 6-month period. Measures consisted of structured diagnostic interviews and self-report measures of stress, medication compliance, family functioning, premorbid adjustment, quality of life, substance use and psychotic symptoms. The onset of cannabis use clearly preceded the onset of psychosis. Cannabis use was predictive of the severity of psychotic and general psychopathology symptoms at admission. Both the frequency and quantity of cannabis use was predictive of time to psychotic relapse over the 6-month follow up period. Psychotic symptom severity was predictive of a substantial increase in the quantity but not the frequency of cannabis use. Cannabis use was related to the onset, course and relapse of psychosis.

Thesis (M. Soc. Sc.)--University of Hong Kong, 2003.

Thesis (DClinPsychol)--Salomons Centre. BLDSC no. DX230085.

Motivation Impairments of attention and memory are detectable in early psychosis, and often result in severe, longstanding functional impairments. Pharmacological interventions for cognitive impairments have been largely unsuccessful. The current study aims to explore the effects of aerobic exercise and mind-body exercise (yoga) on cognitive functioning and clinical symptoms in female patients with early psychosis. The potential neuromechanism underlying the clinical consequences was also investigated. Methods Female patients (n=120) diagnosed with schizophrenia spectrum disorders, brief psychosis, psychosis NOS, or delusional disorder (according to SCID) were recruited from three hospital/clinic sites. They were randomized into integrated yoga therapy group, aerobic exercise programme group, and waiting list as the control group. Both interventions were held three times weekly. At baseline and at 12 weeks, clinical symptoms, cognitive functions, quality of life and fitness levels were assessed in all participants, and completed structural MRI data were collected in 58 patients. Repeated measures ANOVA and ANCOVA analyses of the clinical, cognitive, quality of life and fitness data were compared between baseline and at 12 weeks among the three groups. Post-hoc Bonferroni test was used for comparing between two groups. Structural MRI data was analyzed by FreeSurfer V5.1 and Qdec V1.4 to calculate the brain volume and cortical thickness. Results Completed clinical and cognitive data were collected in 85 patients, and completed MRI imaging data of good quality were collected in 39 patients. No significant differences in age, education years, and duration of the illness at baseline were observed among the three groups. Both yoga and aerobic exercise groups demonstrated significant improvements in verbal encoding (p<0.01), short-term memory (p<0.05), long-term memory (p<0.01), and working memory (p<0.01) with moderate to large effect sizes compared to control groups. The yoga group showed significantly enhanced attention and concentration (p<0.05). Both yoga and aerobic exercise significantly improved overall clinical symptoms (p<0.05) and depressive symptoms (p<0.05) after 12 weeks. Significant increases were observed in the thickness of the left superior frontal gyrus and the right inferior frontal gyrus (pars triangularis) in the aerobic exercise group. Significant increases were observed in the volume of the postcentral gyrus and the posterior corpus callosum in the yoga group. There was a statistically significant correlation between improvements in working memory and changes in the postcentral gyrus (r=0.54, p<0.01) after controlling for the multiple comparisons with a Bonferroni adjusted alpha level. Discussion Both types of exercise improved memory in early psychosis patients, with yoga having a superior effect on attention than aerobic exercise. Observed increments in the cortical thicknesses and volume may indicate improved neurogenesis. Significance There have been few systematic clinical trial studying exercise and psychosis, and none of them has explored the effects of exercise in female patients with early stage psychosis. The present study indicates possible interventions for cognitive impairments in the patients with early psychosis, which are non-invasive and mostly safe. The application of yoga and aerobic exercise as adjunct treatments to treat psychosis in the clinical setting should be advocated. / published_or_final_version / Psychiatry / Doctoral / Doctor of Philosophy

Objective: The current study aimed to examine the psychological distress of family caregivers of patients with psychosis following a stress-coping model as well as a self-regulation model. Methods: A cross-sectional correlational study was conducted in a psychiatric out-patient clinic of a local hospital. 26 caregivers were recruited. Associations among their psychological distress, appraisal of caregiving experience, illness perception, coping style and care burden were explored. Results: Psychological distress was found to be significantly correlated to negative appraisal of caregiving, perceived consequences on patient, perceived consequences on relative, perceived control by relative and care burden. Preliminary analysis showed that a combination of four factors, including negative appraisal of caregiving, perceived consequences on relative, perceived control by relative and care burden, significantly predicted psychological distress (〖R 〗^2= 0.36, F(4,21) = 2.97, p < 0.05). Among the predictors, negative appraisal of caregiving was the single strongest predictor of distress (〖R 〗^2 = 0.28, F(1,24) = 9.18, p < 0.01). Conclusion: The psychological wellbeing of family caregivers were influenced by both factors suggested by the stress-coping model and the self-regulation model. Findings from the present study provided preliminary evidence for developing caregiver-centered intervention that focused on appraisal of caregiving experience and illness perception in order to reduce the distress of caregivers. Further studies would be recommended to explore and differentiate the impact of appraisal of caregiving, coping style and illness perception on psychological distress in the caregiving experience for patients with psychosis. / published_or_final_version / Psychological Medicine / Master / Master of Psychological Medicine

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Title page, table of contents and abstract only. The complete thesis in print form is available from the University of Adelaide Library. / Employing a combination of ethnographic and clinical methodology, this study aims to explore the psychocultural dimensions of recovery from first episode psychotic illness in a Javanese setting, specifically Yogyakarta. Although the rate of recovery was comparable with that in developing countites, the thesis argues that psychocultural factors play a role in promoting recovery from psychosis. / http://proxy.library.adelaide.edu.au/login?url= http://library.adelaide.edu.au/cgi-bin/Pwebrecon.cgi?BBID=1277708 / Thesis (Ph.D.) -- University of Adelaide, School of Medicine, 2006