Familial risk and environmental stress promote the development of alcohol dependence. We investigated whether a positive family history of alcoholism affects the neuroendocrine response to a standardized laboratory stress test in healthy subjects without alcohol use disorders. Twenty-four high-risk subjects with a paternal history of alcoholism (PHA) and 16 family history negative (FHN) controls were evaluated. Psychosocial stress was induced by having subjects deliver a 5-min speech and mental arithmetics in front of an audience on separate days, after drinking either placebo or ethanol (0.6 g/kg) in a randomized sequence. Adrenocorticotropin (ACTH) was measured in 10 plasma samples covering up to 75 min after the stress test. Plasma arginine vasopressin (AVP) was determined before the stressor, at the time of maximum ACTH secretion, and at 75 min after stress onset. The stress test induced a phasic increase in ACTH secretion. At the time of maximum ACTH, AVP was significantly increased in relation to baseline. Compared to placebo, alcohol administration significantly attenuated maximum ACTH concentration in PHA but not FHN subjects, and decreased AVP measured in the same samples in PHA but not FHN subjects. We conclude that activation of the hypothalamic–pituitary–adrenal system by psychosocial stress is accompanied by an increase in peripheral plasma AVP levels. Secretion of both ACTH and AVP suggest that alcohol attenuates the stress response selectively in PHA but not FHN subjects. This might imply some short-term positive alcohol effect in sons of alcoholics, but also constitute a mechanism by which their risk to develop alcohol use disorders is increased.

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Text in Afrikaans / In this study an instrument is suggested for implementation by the Educational Psychologist to design a support programme, aimed at handling family members' stress where a child has sustained a brain injury. Attention was paid to the phenomenon "brain injured child" to ascertain demands and needs (physical, cognitive, psychological and emotional). Specific note was taken of the toll on each family member in their observance, experience, assistance and giving· meaning to the child. Reference was made to existing support programmes for such family members from the acute care phase to the final acceptance and readjustment of the family. With this study the need for a continuous support programme and the contents of such a programme was addressed. Using these guidelines the Educational Psychologist will be able to prepare the family for the stress possibilities in dealing with the brain injured child. / Met hierdie studie is 'n instrument daargestel vir die ontwerp van 'n hulpverleningsprogram vir gebruik deur die Opvoedkundige Sielkundige. Hierdie hulpprogram het as doel, die hantering van stres, deur die gesin van 'n kind, wat 'n breinbesering opgedoen het. In die studie is aandag gegee aan die tipiese gedrag wat oor die algemeen van 'n breinbeseerde kind verwag kan word. Daar is ook gepoog om te bepaal hoe elke lid van die gesin die breinbeseerde kind beleef, aan hom betekenis gee, en hom probeer help ten opsigte van die eise (fisiek en emosioneel) wat hy stel. Verder is daar gekyk na bestaande hulpverlening (gerig op die hantering van stres) aan die gesinslede van 'n breinbeseerde kind vanaf die akute versorgingsfase tot en met die aanpassing en herorganisering van die gesin. Met hierdie studie is 'n behoefte aan 'n kontinue hulpverleningsprogram en die inhoud van so 'n program by gesinslede aangespreek. Aan die hand van die riglyne sal die Opvoedkundige Sielkundige 'n gesin kan voorberei op die stres wat hulle ten opsigte van die hantering van 'n breinbeseerde kind te wagte kan wees. / Psychology of Education / M. Ed. (Voorligting)

It has been suggested that psychosocial stress influences situational fluctuations of tic frequency. However, evidence from experimental studies is lacking. The current study investigated the effects of the Trier Social Stress Test (TSST-C) on tic frequency in 31 children and adolescents with tic disorders. A relaxation and a concentration situation served as control conditions. Patients were asked either to suppress their tics or to “tic freely.” Physiological measures of stress were measured throughout the experiment. The TSST-C elicited a clear stress response with elevated levels of saliva cortisol, increased heart rate, and a larger number of skin conductance responses. During relaxation and concentration, the instruction to suppress tics reduced the number of tics, whereas during stress, the number of tics was low, regardless of the given instruction. Our study suggests that the stress might result in a situational decrease of tic frequency.

Text in Afrikaans / In this study an instrument is suggested for implementation by the Educational Psychologist to design a support programme, aimed at handling family members' stress where a child has sustained a brain injury. Attention was paid to the phenomenon "brain injured child" to ascertain demands and needs (physical, cognitive, psychological and emotional). Specific note was taken of the toll on each family member in their observance, experience, assistance and giving· meaning to the child. Reference was made to existing support programmes for such family members from the acute care phase to the final acceptance and readjustment of the family. With this study the need for a continuous support programme and the contents of such a programme was addressed. Using these guidelines the Educational Psychologist will be able to prepare the family for the stress possibilities in dealing with the brain injured child. / Met hierdie studie is 'n instrument daargestel vir die ontwerp van 'n hulpverleningsprogram vir gebruik deur die Opvoedkundige Sielkundige. Hierdie hulpprogram het as doel, die hantering van stres, deur die gesin van 'n kind, wat 'n breinbesering opgedoen het. In die studie is aandag gegee aan die tipiese gedrag wat oor die algemeen van 'n breinbeseerde kind verwag kan word. Daar is ook gepoog om te bepaal hoe elke lid van die gesin die breinbeseerde kind beleef, aan hom betekenis gee, en hom probeer help ten opsigte van die eise (fisiek en emosioneel) wat hy stel. Verder is daar gekyk na bestaande hulpverlening (gerig op die hantering van stres) aan die gesinslede van 'n breinbeseerde kind vanaf die akute versorgingsfase tot en met die aanpassing en herorganisering van die gesin. Met hierdie studie is 'n behoefte aan 'n kontinue hulpverleningsprogram en die inhoud van so 'n program by gesinslede aangespreek. Aan die hand van die riglyne sal die Opvoedkundige Sielkundige 'n gesin kan voorberei op die stres wat hulle ten opsigte van die hantering van 'n breinbeseerde kind te wagte kan wees. / Psychology of Education / M. Ed. (Voorligting)

Background: Antenatal Psychosocial Assessment (APA) has recently been introduced into routine antenatal care, but the ways in which maternity service providers assess and respond to maternal stress are subject of debate. There is a lack of consensus on the instrument(s) of choice and lack of evidence regarding appropriate interventions. Further, national guidelines have not kept apace with the conceptual shift from ‘postnatal depression’ to ‘perinatal anxiety and depression’. Adopting the Medical Research Council Complex Interventions Framework, the ARMS research aimed to inform the development of interventions that support women who are experiencing, or at risk of, mild-moderate mental health disorder in pregnancy. Methods: A mixed methods approach was adopted. In the quantitative element (Study Part 1) participants (n=191) completed a questionnaire when attending for their first formal antenatal appointment, using a procedure and materials that had been previously tested in a pilot study. Details including mental health assessment and referrals were obtained from their health records, following delivery. In the qualitative element (Study Part 2) a sub-sample of women (n=22) experiencing high levels of maternal stress took part in up to three serial in-depth interviews during pregnancy and the early postnatal period.Findings: Maternal stress was found to be common. Using the Edinburgh Postnatal Depression Scale (EPDS) threshold of ≥10, approximately 1 in 4 women were classed as high depression (halving to 1 in 8 at the more conservative threshold of ≥13). Almost 1 in 3 women were classed as high anxiety, using the state scale of the State-Trait Anxiety Inventory (STAI-S, threshold ≥41), compared with 1 in 5 using the two-item GAD (threshold ≥3). Fewer than half of the women identified as high anxiety were identified by both measures. Factor analyses of the symptom measures were consistent with wider literature suggesting a three-item anxiety component of the EPDS; however, concurrent validation using regression analyses did not indicate that the EPDS could be used as an anxiety case finding instrument. Women reported that maternal stress had significant impact on their lives that may not be captured with existing clinical approaches. Women commonly found it difficult to self-assess severity of maternal stress and the assessment process could itself act as an intervention. The research provided the first validation of the depression case finding questions in UK clinical practice. The Whooley items completed in clinical practice identified only half of the possible cases identified by the EPDS, at both commonly adopted EPDS thresholds. Inclusion of the Arroll 'help' question as a criterion improved specificity of the assessment completed in clinical practice but substantially compromised sensitivity, missing 9 in 10 possible cases. Women’s mental health history and treatment history were similarly under-reported, particularly concerning anxiety. APA was introduced into routine clinical practice without attention to topics of relevance to women, context of disclosure or to provision of adequate resources for consistently responding to identified need. Women experiencing, or at risk of, mild-moderate disorder were thus usually ineligible for further support. Implications: Care pathways are needed that encompass both assessing and responding to maternal stress, where communication with health professionals, subsequent referral and management are addressed. The development, implementation and evaluation of low-cost resources embedded in such pathways are a priority and the research presented in the thesis offers a foundation on which to build.

It has been suggested that psychosocial stress influences situational fluctuations of tic frequency. However, evidence from experimental studies is lacking. The current study investigated the effects of the Trier Social Stress Test (TSST-C) on tic frequency in 31 children and adolescents with tic disorders. A relaxation and a concentration situation served as control conditions. Patients were asked either to suppress their tics or to “tic freely.” Physiological measures of stress were measured throughout the experiment. The TSST-C elicited a clear stress response with elevated levels of saliva cortisol, increased heart rate, and a larger number of skin conductance responses. During relaxation and concentration, the instruction to suppress tics reduced the number of tics, whereas during stress, the number of tics was low, regardless of the given instruction. Our study suggests that the stress might result in a situational decrease of tic frequency.