Background: Individuals with end-stage kidney disease need dialysis or a kidney transplant. Kidney transplantation from a living donor is the preferred treatment. Live kidney donor transplantation, however, is an invasive surgery performed on a healthy individual for the benefit of another person. Therefore, donors should be fully informed of the risks involved in donation. The medical outcomes for kidney donors are well known, however, the research investigating the psychosocial impact of donation is limited. Understanding the psychosocial outcome of living kidney donation would promote informed consent, allow donors to plan their postoperative recovery period, and guide the development of services that maintain the long-term health of donors. Aims: This study aimed to investigate the postoperative quality of life of live kidney donors, to investigate which variables predict postoperative psychosocial outcome, with particular interest in the variable of coping style and to gather information regarding how individuals decide to become living kidney donors and how satisfied they are with their pre- and postoperative care. Methods: Living kidney donors at Glasgow Western Infirmary, Manchester Royal Infirmary and St. James’ Hospital, Leeds were asked to complete a preoperative assessment consisting of the SF-36, HADS, COPE and The Donor Decision Control Scale. Four weeks postoperative, donors were asked to again complete these questionnaires, and in addition The Living Donor Survey. Results: -­‐ 48 -­‐ Complete data was available for thirteen donors. The results indicate that live kidney donation had a significant adverse affect on the physical wellbeing of the donors; the postoperative scores on the PCS and all of the corresponding domains were significantly lower and with a large effect size. Five (38%) of the donors experienced postoperative complications, three of whom were readmitted to hospital. With respect to psychological wellbeing, donors’ scores on the MCS did not differ significantly from their preoperative scores. With respect to anxiety, for the group as a whole, postoperative HADS anxiety scores were lower and the severity and prevalence of anxiety symptoms reduced. For depression there was only a marginal increase in HADS depression scores. Analysis of each individual’s outcomes indicated that there was a marked difference in the impact of donation. The results suggest that poor psychosocial outcome following donation was marginally associated with relying on mental disengagement as a coping strategy. Improved outcome in the postoperative period was associated with seeking social support Conclusions: The physical health of donors is adversely affected by live kidney donation. Four weeks postoperatively live kidney donors report their physical health as being worse than those with long-standing illness. The psychological wellbeing of the majority of donors appears to be largely unaffected by live kidney donation. However, a minority of donors report a poorer psychological wellbeing following donation. Individuals who use active coping strategies have higher postoperative MCS scores, reflecting better psychological wellbeing. However, this conclusion should be interpreted with caution due the small sample size and therefore the possibility of a type I error.

Objectives: To carry out a preliminary exploration and measurement of therapy expectancy and motivation in adults with intellectual disabilities through the development and psychometric evaluation of the Therapy Expectation and Motivation Measure (TEAMM). Design: The initial scale development phase combined top-down theory driven and bottom-up data driven processes to identify TEAMM items and format. The subsequent scale evaluation phase piloted the TEAMM and used correlational analyses to evaluate reliability and validity. Method: Six adults with intellectual disabilities took part in semi-structured interviews about therapy expectancy and motivation in order to identify TEAMM items. A further 22 participants piloted the measure for psychometric evaluation. Results: Preliminary psychometric evaluation confirmed that the TEAMM has acceptable test-retest reliability and internal consistency. Assessment of construct validity found a strong and positive relationship with a measure of general self-efficacy. Client expectations of therapy were largely positive and congruent with therapy as a goal-oriented process in which they will be an active participant. However, a number of individuals were unclear about the reason for referral and felt a low level of involvement in the process. Client and carer perceptions of referral understanding were significantly different. Conclusions: The TEAMM may help clinicians to identify potential barriers to engagement in therapy and find ways of enhancing the therapeutic experience of adults with an intellectual disability. Further psychometric evaluation of the TEAMM with larger samples is required to confirm the factorial structure of the scale and enhance its clinical utility.

Abstract Introduction: Deficits in planning and prospective memory are common after brain injury and contribute to difficulties participating in everyday activities. Recent research has suggested that using non-contingent auditory alerts may facilitate a ‘goal-review’ process and improve performance on tasks that make demands on executive functions. This study investigated whether combining alerts with a brief goal management training (GMT) programme would improve performance on a complex virtual reality task. Method: Twenty individuals with evidence of executive impairment completed two versions of the Removals Task, one trial with auditory alerts following a GMT session, and the other trial in standard, non-alerted conditions. Nineteen healthy controls were recruited to complete the task with no alerts or GMT. Results: The brain-injury group were significantly poorer than the controls on some measures of the task in non-alerted conditions. GMT and auditory alerts did not improve performance (though a sub-group analyses revealed improvement for 6 participants on one task measure). Discussion: Ceiling effects, brevity of the GMT procedure and paradoxical effects of the alerts on the measures are discussed as some possible reasons for failure to find significant differences. Sensitivity of the Removals Task to detect executive impairment and its efficacy as a potential cognitive rehabilitative assessment tool is investigated in light of differing findings between studies. Conclusion: The Removals Task revealed differences in performance between individuals with executive dysfunction and healthy controls on some measures. While a sub-group of participants did show improvement in the alerted condition for one measure, GMT and auditory alerts failed to improve performance in the brain-injury group on the majority of task measures. Limitations of the current study are acknowledged and recommendations for future research are given.

It has long been recognised that many people with poorly controlled epilepsy suffer from significant inter-ictal psychosocial problems. Yet there is little consensus on appropriate treatment for such difficulties. It is argued that this has been due to an overconcentration on seizure control in treatment practice and a lack of professional agreement on potential aetiological factors or of consistent appropriate definitions of psychological and social difficulties. Recent research on patients' perceptions of their condition has indicated that such perceptions may be a more potent predictor of psychosocial functioning than objective information such as seizure type or frequency. If such perceptions were found to vary in a consistent and predictable manner, this would have considerable assessment and treatment implications. Analysis was made of the literature on patient perceptions. Four main conceptual areas were implicated: The perceived social effects of epilepsy, the perceived physical effects of epilepsy, perceived control over epilepsy and its effects, and knowledge of epilepsy. From this analysis a hypothetical `perception of epilepsy' model was developed: From this, it was suggested that patients' perceptions vary between `adaptive' perceptions, and `maladaptive' perceptions. It was proposed that `adaptive' perceptions were typified by good knowledge, high efficacy beliefs, high perceived control over seizures and health related behaviours, low fear of seizures and low perceived social limitations imposed by epilepsy. Conversely, `maladaptive' beliefs were typified by poor knowledge, low efficacy beliefs, external control beliefs, high perceived social limitations and high fear of seizures. It was hypothesised that if this model proved to be valid, the more maladaptive an individual's perception, the greater the psychosocial risk. A further supplementary hypothesis was made concerning `underadaptive' perceptions which, it was speculated, would result in passivity and dependency.

Seventy, GP-referred, sleep-onset insomniacs were randomly assigned to either progressive relaxation, stimulus control, paradoxical intention, placebo or no treatment control groups. Following baseline assessment of sleep pattern and quality subjects received 8 weeks of treatment, comprising 4 weeks under counterdemand and 4 weeks under positive demand instruction to control for demand characteristics and expectancy effects. A further 14 patients were allocated consecutively to a tailored therapy condition as a development of the main study. Measures of treatment process and outcome were obtained from self-report instruments validated against objective monitoring via the `Somtrak

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Introduction: Non-engagement with treatment is a familiar problem for health services and has been identified as a particularly important issue for those who experience psychosis. The therapeutic relationship between service-users and clinicians is considered to be crucial to good engagement. The extent to which requirements of engagement with treatments and mental health services represent a threat to the individual’s autonomy is a potential factor in non-engagement. Reactance theory has attempted to explain this phenomenon. However, relationships are complex and reactance theory does not reflect this. The exploration of narratives is an opportunity to develop an understanding of the intricacies of these therapeutic relationships. Methods : Interviews were conducted with 11 participants who were recovering from an episode of psychosis. Narrative Analysis of the transcripts was undertaken. During the process interpretation of the transcripts required the introduction of Dialogical Self Theory. Results: Three self-positions were identified through which participant’s narrated their experiences. Defiant, Subordinate and Reflective-Conciliatory positions were described. Discussion: Narratives surrounding recovery and engagement with services can appear complex, contradictory and fragmented. They are narrated by different self-positions. This understanding of the complexity of narratives may be helpful in guiding clinicians in maintaining a wider awareness of the multidimensional nature of individuals’ understandings of their experiences of recovery and relationships with services.

This review considers prevalence rates, risk factors, neuropsychological profiles and behavioural and socioemotional problems associated with specific learning disabilities in arithmetic and reading. Both arithmetic and reading difficulties can arise from environmental, genetic, neurological and congenital factors. Consequently, a thorough assessment using neuropsychological and behavioural measures and scanning techniques can be necessary to identify the likely cause for appropriate remediation and intervention. There is increasing evidence for three main subcategories of learning disabilities which approximate closely to the ICD-10 (1992) classification of specific reading, arithmetical and mixed scholastic disorders. The different prevalence rates and disparities in research finding on associated behavioural and socioemotional difficulties children in these subcategories experience probably reflect the arbitrary nature of the definition criteria and the various tests and measures used, some with unstandardised or outdataed norms. Future research is needed using strict definition criteria and reliable and standardised tests and measures to help clarify these issues to improve remediation for these children.

This thesis examines and describes children's and adolescent's responses to burn injuries, with a specific focus on traumatic responses. Fifty five children, adolescents and their parents took part in this longitudinal study, a recruitment rate of 35% of the total population. All of the children had sustained accidental burn injuries of varying severity at least one month before their first assessment. Children were aged between three and eighteen years, and the mean age was seven years. Children under 6 years were not personally assessed. Parents reported on these children using the Child Behaviour Checklist (CBCL), and the Posttraumatic Stress Reaction Index- parent version (PTS-RI). Children over six years took part in the Diagnostic Interview for Children and Adolescents (DICA), and completed the Impact of Events Scale (IES), the Children's Posttraumatic Stress Reaction Index (C-PTS-RI), the Fear Survey Schedule (FSS) and the Depression Self-Rating Scale (DSRS). Parents of these children also completed DICA, the PTS-RI and the CBCL. At six months, all procedures were repeated. Generally, children and adolescents adjusted well following their burn injuries. Traumatic symptoms had been experienced by over half the children, with intrusive symptoms most common. 14% had a PTSD diagnosis at some time since their burn injury. A quarter of the children were reported to have general borderline or clinical behavioural problems using the CBCL. Over half the children reported symptoms of depression. The results are described with reference to the existing literature on children's traumatic responses and children's responses to burn injuries. It is suggested that there may be a "normal" acute trauma response following burn injury. Theory surrounding children's response to burn injury is examined and directions for a new theory encompassing trauma and injury in the context of development are proposed. The methodological limitations to the study are discussed and recommendations are made.

Braking and acceleration expose car passengers to complex fore-and-aft and pitch motions that can cause carsickness, with the effect depending on the visual scene. Previous studies in various motion environments have suggested that external viewing reduces motion sickness relative to internal viewing or wearing a blindfold however the influences of motion and vision on motion sickness are thought to be interactive. The types of motion for which a visual scene can and cannot modify sickness are yet to be established. The aim of this research was to advance understanding of the effect of the visual scene on motion sickness caused by fore-and-aft oscillation, combinations of fore-and-aft and pitch oscillation, and pitch oscillations. The first experiment investigated the effect of the visual scene on motion sickness caused by low frequency low magnitude fore-and-aft oscillation. Six groups of 20 subjects experienced one of six visual scenes: an internal view of shapes; an external view of shapes; an external view of horizontal lines; a ‘real’ three-dimensional external view; no view (blindfolded); or an internal collimated view of shapes. Variations in the visual scene had no significant effect on motion sickness caused by 0.1 Hz fore-and-aft oscillation with an acceleration magnitude of 0.89 ms-2 r.m.s. The absence of an influence of vision differs from the effects of the visual scene on motion sickness in cars and coaches and suggested that carsickness is not solely caused by low frequency fore-and-aft acceleration. In a second experiment, six groups of 20 subjects were exposed to 0.1 Hz fore-and-aft oscillation combined with 0.1 Hz pitch oscillation with a peak pitch displacement of 3.69°. For three groups of subjects, the pitch displacement was 180° out-of-phase with the fore-and-aft displacement, such that the resultant peak acceleration acting on subjects in the fore-and-aft direction was 1.89 ms-2. The other three groups of subjects experienced the same fore-and-aft and pitch oscillations, but presented out-of-phase so that the peak fore-and-aft acceleration of ±1.26 ms-2 r.m.s. was partially offset by the pitch displacement of ±3.69°. Each subject experienced one of three viewing conditions from the first experiment: internal, blindfolded or external. The visual scene influenced the motion sickness caused by combined fore-and-aft and pitch oscillation regardless of whether pitch motion was in-phase or out-of-phase with the fore-and-aft motion: there was less sickness with an external forward view than with either an internal view or a blindfold. The effect of the phase between the fore-and-aft and pitch motion depended on the visual scene: the phase influenced motion sickness with a blindfold and with internal viewing but not with external viewing. The effect of internal, blindfold and external viewing on motion sickness caused by 0.1, 0.2 and 0.4 Hz pitch oscillation was investigated in a third experiment with 180 subjects, 20 subjects in 9 conditions. The visual scene influenced motion sickness similarly with 0.1, 0.2, and 0.4 Hz pitch oscillation: external viewing reduced motion sickness relative to internal viewing. There was no significant effect of pitch oscillation frequency. Experimental results suggest that there is no effect of the visual scene on motion sickness caused by fore-and-aft oscillation but the visual scene is influential when pitch motion is part or all of the motion stimulus. The effect of the visual scene on motion sickness cannot be predicted without specifying the motion stimulus causing sickness. Unlike previous models of motion sickness, a conceptual model is suggested in which the expected visual signal is defined for a given vestibular input. The model predicts that external viewing reduces motion sickness relative to internal or blindfolded conditions when sickness is caused by motions inclusive of pitch oscillation. Model predictions for the effect of the visual scene on motion sickness caused by other directions of oscillation are considered.