Background: Severe mental illnesses (SMI) cause significant impairment for those living with the illnesses and often rely on caregivers for the ongoing care. Available evidence suggests that individuals responsible for caregiving may get distressed due to the caregiving experience, a phenomenon researchers call caregiver burden. Following the shift to community-centered mental health services, several studies on caregiving burden have been conducted in high income countries (HIC). However, there remains scarcity of data on the subject in SubSaharan Africa including Malawi. Therefore, the present study investigated the prevalence and associated factors of caregiving burden among caregivers of individuals with SMI at St John of God Hospitaller Services (SJOGHS) in Mzuzu-Malawi. Methods: The study adopted a hospital based cross sectional study. Recruitment took place at two outpatient departments of SJOGHS. Informal caregivers who were 18 years and above were asked to participate. The study recruited 139 caregivers and two research assistants approached participants at the waiting area. Caregivers who gave consent were asked questions about their caregiving activities using the Zarit Burden Interview (ZBI) (maximum score, 88). Data analysis was done using frequency distributions and descriptive statistics. The study used non-parametric tests such as a chi-square on all categorical measurements to test associations between variables and parametric tests such as t test on all continuous variables. The unadjusted and adjusted associations between socio-demographic factors and caregiving burden was conducted using logistic regression models. Results: On average, most caregivers experienced mild to moderate caregiving burden on the ZBI score (31.5 ± 16.7). In the adjusted model after controlling for caregivers’ gender, caregivers’ age, level of education, social support, care recipients’ age and care recipients’ gender, only caregivers’ age, social support and care recipients’ age remained significantly associated with caregiving burden. Older caregivers were more likely to experience caregiving burden than younger caregivers (OR=1.03, 95% CI 1.00-1.06), caregivers with social support were 71 % less likely to develop caregiving burden than those without social support (OR=0.29, 95% CI 0.14-0.62) and caregivers of older care recipients were less likely to experience caregiving burden than those of younger care recipients (OR=0.26, 95% CI 0.11-0.64). v Conclusion: Even though the caregiving burden found in this study was low compared to other previous studies in some arguably developed countries such as Iran and Turkey, it remains high in other developing countries such as Ghana and Nigeria. The low burden in this study, could be attributed to several factors and context in which the study was conducted. One such factor is the routine psychoeducation that the hospital often conducts for caregivers during the subsequent monthly reviews of their care recipients. An important follow up would be to investigate caregiving burden among caregivers who are unable to access the services at SJOGHS. The results of this study are important to guide policy in the formation of effective community programs that may assist mitigate the burden of informal caregivers. Finally, to understand the importance and implications of informal caregiving, further studies are needed in Malawi.

Indiana University-Purdue University Indianapolis (IUPUI) / Formal thought disorder (FTD) is a debilitating symptom of psychosis. It is linked to functional deficits and generally demonstrates poor response to interventions. Metacognition has emerged as a potential therapeutic target that may be effective in reducing FTD, as metacognitive deficits and FTD both arise from disruptions in associative thought processes. This study’s primary aim was to determine whether FTD could be reduced with metacognitive therapy. Pre-post changes in FTD severity were assessed using clinician-rated and automated measures in 20 individuals with psychotic disorders who received 12 sessions of evidence-based metacognitive therapy. We also examined whether reductions in FTD were larger when assessed with automated instruments versus clinician-rated measures. Aim two compared associations between FTD and three outcome variables (social functioning, role functioning, metacognition) across FTD-measurement approach. Results indicated that automated FTD, but not clinician-rated FTD, was significantly reduced post-intervention. This effect was more robust within a subsample exhibiting greater levels of FTD. Strength of associations between FTD and outcome variables did not differ across FTD measurement approach. These findings provide initial evidence that a targeted metacognitive intervention can reduce FTD. Effects were strongest for automated instruments, which may be more sensitive to detecting change; however, differences in measurement type did not extend to associations with selected outcome variables. This study provides preliminary support for future efforts to reduce FTD. Large-scale studies with longer intervention periods may further our understanding of the effectiveness of metacognitive intervention on FTD.

No description available.

Rationale: Psychotic disorders such as schizophrenia are often accompanied by high rates of cigarette smoking, reduced quit success, and high relapse rates, negatively affecting patient outcomes. However, the mechanisms underlying altered relapse-like behaviors in individuals diagnosed with psychosis are poorly understood. Objectives: The present study analyzed changes in extinction and reinstatement of nicotine conditioned place preference (CPP) and resulting changes in brain-derived neurotrophic factor (BDNF) in a novel heritable rodent model of psychosis, demonstrating increased dopamine D2 receptor sensitivity, to explore mechanisms contributing to changes in relapse-like behaviors. Methods: Male and female offspring of two neonatal quinpirole-treated (QQ) and two neonatal saline-treated (SS) Sprague-Dawley rats (F1 generation) were tested on an extended CPP paradigm to analyze extinction and nicotine-primed reinstatement. Brain tissue was analyzed 60 min after the last nicotine injection for BDNF response in the ventral tegmental area (VTA), the infralimbic (IfL) and prelimbic (PrL) cortices. Results: F1 generation QQ offspring demonstrated delayed extinction and more robust reinstatement compared to SS control animals. In addition, QQ animals demonstrated an enhanced BDNF response to nicotine in the VTA, IfL and Prl cortices compared to SS offspring. Conclusions: This study is the first to demonstrate altered relapse-like behavior in a heritable rodent model with relevance to comorbid drug abuse and psychosis. This altered pattern of behavior is hypothesized to be related to elevated activity-dependent BDNF in brain areas associated with drug reinforcement during conditioning that persists through the extinction phase, rendering aberrantly salient drug associations resistant to extinction and enhancing relapse vulnerability.

Nicotine has been indicated as a prevalent drug for substance abuse comorbidities in mental illness. Tobacco use is elevated in those suffering from psychiatric disorders, most notably in schizophrenia (SZ), where a three-to-five fold increase in usage compared to the general population is observed. Our laboratory has established a rodent model of psychosis. In this model, male and female rats are neonatally treated with quinpirole (NQ), a dopamine (DA) D2-like agonist for 21 days postpartum, resulting in lifelong supersensitization of the DAD2 receptor. Increases in dopamine D2 receptor sensitivity is a hallmark of psychosis. Interestingly, the dopamine D2 receptor forms a triple mutual inhibitor heteromer in the dorsal striatum with the adenosine A(2A) and metabotropic glutamate receptor type 5 (mGlu5), such that stimulation of the A(2A) or mGlu5 receptor results in decreased dopamine D2 signaling. The present study was designed to analyze the role of the mGlu5 receptor in a behavioral task involved in testing the associative aspects of rewarding drugs known as conditioned place preference (CPP). CPP is a behavioral task in which animals are conditioned with a reinforcing drug to prefer a particular environmental context. Male and female rats were neonatally treated with saline (NS) or quinpirole from postnatal day (P) 1 to 21. From P41-51, which is mid-adolescence in a rat, all rats were behaviorally tested on CPP. Results revealed that compared to NS rats, NQ animals administered nicotine demonstrated enhanced CPP, replicating our past work. Groups receiving a positive allosteric modulator to mGlu5, which results in stimulation of the mGlu5 receptor, reduced the enhanced rewarding effects of nicotine in CPP for NQ treated rats equal to control levels. Brain tissue was analyzed for brain-derived neurotropic factor (BDNF), a neurotrophin involved in cell growth, as well cell adhesion molecule cadherin-13 in the ventral tegmental area (VTA), which is a brain area rich in dopamine cell bodies. Results revealed elevations of BDNF in NQ-treated rats given nicotine compared to all other groups, and a sex difference in the increase in cadherin-13, with female NQ rats given nicotine demonstrating increases compared to all other groups. These effects were blocked by the mGlu5 receptor positive allosteric modulator. In addition, we analyzed phospho-p70S6 kinase in the nucleus accumbens (NAcc), which is the dopamine neuronal terminal region in the VTA mitigating drug reward. The NQ group given nicotine demonstrated significant increases in NAcc P70S6 kinase compared to all other groups, suggesting increased synaptic growth, which was also blocked by the positive allosteric modulator to mGlu5. Taken together, these results elucidate mGlu5 as a drug target for reducing the rewarding effects of nicotine via CDPPB administration in a model of substance abuse in psychosis.

This dissertation sought to characterize the association between urbanicity and incidence of first-episode psychosis (FEP) in Chile by using data from national registries, including a national FEP registry, as well as other health and social databases. Numerous large, well-controlled studies from Northern European countries (e.g., Denmark) have found that being born or brought up in urban environments increases the odds of developing psychosis. Given the strength and consistency of these findings over decades, the urbanicity-psychosis association is considered one of the fundamental epidemiologic findings on environment and psychosis, and full-fledged research programs have been examining potential mechanisms. Yet it now appears that the association may not be universal. Studies from some European countries, Latin America, and China have reported null results. These findings have started to change our understanding of the urbanicity-psychosis association and have raised important questions regarding how the association works in understudied, lesser-resourced settings. Chile, with its unique juxtaposition of substantial infrastructure (national registries) and shared challenges with other Latin American countries, offers an unprecedented context for developing such research. Accordingly, the specific aims of this dissertation were to 1) conduct a qualitative systematic literature review on the definitions of urbanicity and community-level social factors in the context of psychosis research, 2) examine whether urbanicity at birth and at admission is associated with increased risk of FEP, and 3) examine the moderation effects of social deprivation in the association between urbanicity and incidence of FEP.

Yes / Cochrane Incentive Grant from the National Institute for Health Research (NIHR)

Sleep disturbances have been widely endorsed by individuals at heightened risk for developing psychosis. Nascent findings in clinical high-risk (CHR) individuals indicate that sleep disturbances are associated with heightened CHR symptoms over time. Sleep is also vital for neural plasticity and other processes relating to human functioning. Verbal episodic memory is highly susceptible to sleep loss and is also notable for its discriminative utility in predicting likelihood of remission and long-term functional outcomes among CHR individuals. The current study aims to extend current literature on psychosis risk by examining the potential for sleep to moderate the relationship between CHR status and performance on a task targeting verbal episodic memory in a multi-site community sample of non-help-seeking young adults. As an exploratory aim, we also examined whether verbal episodic memory or verbal working memory would mediate the relationship between sleep and three outcome measures of clinical high-risk symptom severity in CHR and non-CHR groups: social functioning, positive symptoms, and negative symptoms. Results indicate that in community participants, episodic verbal memory task performance does not differ between CHR and non-CHR individuals. No interaction between group status and sleep quality in predicting episodic verbal memory task performance was detected. Additionally, direct effects of poor sleep on increased severity of positive symptoms, negative symptoms, and poorer social functioning were detected in non-CHR individuals, whereas poor sleep only had a direct effect on increased negative symptom expression in CHR individuals. These findings highlight sleep as a modifiable treatment target, relevant to early psychosis and broader mental well-being in young adulthood. / Psychology

Psychosis encompasses a constellation of symptoms that have far-reaching social, physical and functional consequences for sufferers. One of the key clinical concerns in the management of psychotic illnesses is the risk of suicide, which is greatest in the early stages of psychosis. Hopelessness is consistently associated with risk for suicide but as a concept it is not well defined and is not specific enough to be of use in prediction of suicide. Future-directed thinking, particularly regarding positive future events, constitutes an aspect of hopelessness that is closely associated with risk for suicide. This study employed the Future Thinking Task to investigate whether future-directed thinking in first episode psychosis is significantly different from that of matched controls in performance or content, and to clarify the nature of its association with suicide risk in this patient group. In addition, the association of future-directed thinking with the negative symptoms of psychosis was investigated. The results showed that individuals with psychosis were impaired in future-directed thinking globally, particularly with respect to the coming year. Specific deficits were shown in the domains of relations with other people and personal development and understanding. Associations were shown between future-directed thinking and suicide, and reduced positive future-directed thinking was shown to be strongly associated with increased severity of negative symptoms. The results suggest avenues for novel interventions to improve hopelessness, suicide risk and the severity of negative symptoms in psychotic illness, and thereby improve functional outcomes.

There is little understanding of marijuana use by psychiatric patients, specifically regarding the issue why they continue smoking marijuana in spite of the negative consequences, such as being readmitted to psychiatric hospitals due to a diagnosis called marijuana–induced psychosis. Therefore, it is important to understand why psychiatric patients continue to use marijuana, despite experiencing its negative effects on their condition. From the above background, the researcher identified the need to explore and describe the perceptions of psychiatric patients regarding marijuana use in Potchefstroom, North–West Province. The exploration and description of these psychiatric patients' perceptions regarding marijuana use will provide insight into more appropriate care and treatment in order to reduce the readmissions of psychiatric patients due to marijuana–induced psychosis. A qualitative, exploratory, descriptive and contextual research design was followed in order to give 'voice' to the perceptions of psychiatric patients regarding marijuana use. Purposive sampling was utilised to identify participants who complied with the set selection criteria. The sample size was determined by data saturation, which was reached after ten individual interviews with psychiatric patients. Unstructured individual interviews were utilised to gather data after written approval from the research ethics committee of the North–West University (Potchefstroom campus), North–West Provincial Department of Health, the clinical manager of the psychiatric hospital where data were collected, as well as from the psychiatric patients. After the co–coder and the researcher of the study analysed the data independently, a meeting was scheduled to reach consensus on the categories and subcategories that emerged from the data. The findings of this study indicated perceptions that psychiatric patients have on: the use of marijuana, the negative effects of marijuana use, marijuana use and mental illness, and stopping the use of marijuana. From this results it seems that although some patients realise that stopping the use of marijuana might be difficult, some patients want to walk the extra mile by helping other people to stop smoking marijuana. It is of specific interest that psychiatric patients seem to expect external groups to take responsibility on their behalf to terminate the use of marijuana, namely: foreigners, the police and the Rastafarians. From the findings, literature and the conclusions of this study, recommendations in the fields of nursing education, nursing research as well as nursing practice were made. / Thesis (M.Cur.)--North-West University, Potchefstroom Campus, 2011.