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Parkinson’s disease (PD) is characterized by motor dysfunction and multiple non-motor symptoms. Though motor/non-motor interactions are common, the lines of research focusing on motor and non-motor symptoms mainly remain separate. The present studies assessed interactions between several motor aspects of PD (impaired gait, side of motor-symptom onset, tremor, motor-symptom severity) and non-motor symptoms (cognition, anxiety, self-perceived stigma) in non-demented individuals with idiopathic PD. Study 1 examined cognitive and motor performance during dual tasking, specifically executive function while walking. The impact of dual tasking on walking (speed, stride frequency) was greater for PD (N=19) than NC participants (N=13). The PD group had fewer set-shifts than NC on dual tasking, and demonstrated greater cognitive variability on dual tasking. Study 2 considered mechanisms of visuospatial dysfunction in PD (N=79) by assessing how side of motor-symptom onset (left versus right) and cognition (attention, executive function) affect spatial judgment on a dynamic line bisection task. In contrast to a rightward-biased parietal-neglect pattern, the PD group showed a leftward bias that occurred when attention was directed to the left side of space, regardless of side of onset. The extent and variability of bias correlated with frontally-mediated neuropsychological performance for PD but not NC (N=67). Both results suggested frontal-attentional rather than parietal-neglect mechanisms of spatial bias. Study 3 assessed how motor symptoms contribute to self-reported anxiety on the Beck Anxiety Inventory (BAI). Factor analysis identified a five-item PD motor factor, which correlated with motor-symptom severity and mediated the difference on BAI total scores between PD (N=100) and NC (N=74). Removal of the motor-factor items (e.g., “hands trembling”) significantly reduced BAI scores for PD relative to NC and reduced the size of the correlation between the BAI and motor-symptom severity. Study 4 examined the contributions of motor and non-motor symptoms to self-perceived stigma in PD (N=362). Contrary to expectations, perceived stigma was not predicted by motor symptoms but rather by depression and, for men only, by younger age. These studies provide insight into interactions that occur between motor and non-motor symptoms in PD in multiple aspects of daily function, highlighting potential avenues for future research and intervention.

Background: The lack of adherence to drug therapy is a major problem; it can contribute to significant deterioration of disease and increased health-care costs. Improving medication adherence is a big challenge; there is no simple solution to the problem. It is thus essential to improve our knowledge of non-adherence (NA) and its causes. Aims: The aims of the thesis were to study the influence of gender and psychological distress on self-reported, intentional and unintentional non-adherent behaviour, and to investigate the reasons for NA. Methods: A population-based study that included a postal questionnaire was carried out in a cross-section of the general Swedish population (n=7,985, aged 18-84 years). The response rate was 61.1% (n=4,875) and current prescription drug use was reported by 2,802 participants. The questionnaire covered use of prescription drugs, NA to the drug regimens, reasons for NA, economic status, attitudes to drugs, and the presence of somatic or mental problems, and also included the Hospital Anxiety and Depression Scale questionnaire. Results: The results showed differences in various self-reported non-adherent behaviour patterns and reasons for NA between the genders. In most cases, these remained after controlling for confounders such as socioeconomic factors and attitudes to drugs that are known to differ between women and men. Associations were also found between symptoms of anxiety and/or depression and the presence of intentional or unintentional non-adherent behaviour (with a stronger average association for intentional NA), and between anxiety/depression and some of the reasons given for NA, e.g. adverse drug reactions (ADRs). Conclusions: Although it was not possible to confirm causal relationships, this thesis emphasises the effects of gender and psychological distress on NA. In summary, both gender and anxiety and/or depression influenced non-adherent behaviour and the reasons given for NA. For instance, ADRs seemed to influence the decision not to take the drug as prescribed, especially among women and participants under psychological distress. It is suggested that a deep understanding of the causes of NA and of the impact of gender and psychological distress on the outcomes would help those aiming to improve adherence to prescribed medication.

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Within the field of developmental psychopathology, research has repeatedly demonstrated that there are multiple complex and dynamic pathways originating in childhood that may lead to the development of internalizing and externalizing problems among adolescents. However, additional research is needed that examines the unique and concurrent contributions among child-, parent-, and family-level risk and resilience factors during childhood that may be associated with internalizing and externalizing problems in adolescence. To address this gap, the current study utilized a person-centered approach to identify profiles of risk and resilience factors among youth in middle childhood (ages 10-12) characterized by the quality and quantity of (a) child-level factors (i.e., temperamental features, executive functioning abilities); (b) parent-level factors (i.e., parental acceptance, control, disciplinary style); and (c) family-level factors (i.e., family cohesion, conflict, organization) among a sample of 775 participants (Aim 1). The study also examined internalizing and externalizing symptom profiles in adolescence (age 16) by identifying subgroups of youth characterized by the quality and quantity of internalizing and externalizing problems within each of the identified childhood risk profiles (Aim 2). Lastly, the study investigated transitions from childhood risk profiles to adolescent symptom profiles (Aim 3). Results demonstrated that a four-class model best fit the data in regard to childhood risk profiles, with classes of youth most saliently characterized by (a) accepting parents, (b) controlling parents, (c) disengaged parents, and (d) chaotic homes. With regard to adolescent internalizing and externalizing symptom profiles, results indicated a three-class model best fit the data and included classes distinguished by the presence of (a) low symptoms, (b) moderate symptoms, and (c) high internalizing and moderate externalizing symptoms. Most youth from the four childhood risk profiles transitioned to the low symptom profile at age 16; however, youth from the chaotic home profile were more likely to transition into one of the two higher-level symptom profiles. Findings enhance our understanding of risk and resilience by identifying distinct childhood risk profiles and corresponding adolescent symptom profiles. These findings will have implications for both prevention and treatment efforts that target specific risk factors within each risk profile. / Psychology

No / Dementia is common in older people admitted to acute hospitals. There are concerns about the quality of care they receive. Behavioural and psychiatric symptoms of dementia (BPSD) seem to be particularly challenging for hospital staff. Aims To define the prevalence of BPSD and explore their clinical associations. Method Longitudinal cohort study of 230 people with dementia, aged over 70, admitted to hospital for acute medical illness, and assessed for BPSD at admission and every 4 (± 1) days until discharge. Other measures included length of stay, care quality indicators, adverse events and mortality. Results Participants were very impaired; 46% at Functional Assessment Staging Scale (FAST) stage 6d or above (doubly incontinent), 75% had BPSD, and 43% had some BPSD that were moderately/severely troubling to staff. Most common were aggression (57%), activity disturbance (44%), sleep disturbance (42%) and anxiety (35%). Conclusions We found that BPSD are very common in older people admitted to an acute hospital. Patients and staff would benefit from more specialist psychiatric support.

Doctor of Clinical Psychology / Obsessive-compulsive (OC) symptoms occur in a variety of clinical conditions, but the underlying pathogenesis of these symptoms remains elusive. Few neuropsychological investigations have compared idiopathic Obsessive-Compulsive Disorder (OCD) with patient groups where OC symptoms are acquired. The present study investigated the neuropsychological correlates of OC symptoms in OCD and frontotemporal dementia (FTD), a neurodegenerative illness in which OC symptoms are often acquired. Neuroimaging in OCD has consistently implicated the frontal-striatal-thalamic circuit, particularly the orbitofrontal cortex and basal ganglia. These areas overlap considerably with the sites of cerebral pathology found in FTD. OCD has been associated with a number of neuropsychological deficits, with most consistent findings pointing towards impaired executive function (EF), and less commonly reported deficits in visual memory and visuospatial ability. The neuropsychological hallmark of FTD is deficits in EF. However in both OCD and FTD, the relationship between cognitive deficits and OC symptoms remains unclear. Further, the extent to which OC symptoms are comparable between the groups is ambiguous. Part I of the present study compared 19 OCD subjects to 20 age, education and IQ-matched healthy controls on a battery of neuropsychological tests of all major cognitive domains with emphasis on EF. A measure of Theory of Mind (ToM) thought to be sensitive to orbitofrontal function was also administered. OCD subjects performed worse than controls on a measure of visual memory, visuospatial reasoning and on only one measure of EF. OCD symptom subtypes, as measured by the Obsessive-Compulsive Inventory (OCI), were not correlated with any cognitive deficits. No group differences in ToM were found. It is suggested that prior research has overestimated the severity and significance of EF deficits in OCD. Part II of the study compared 9 FTD participants with 10 matched healthy controls on the same neuropsychological test battery and OC symptom measures. In addition, a measure of compulsive behaviours used in neurological populations was administered to carers. While the incidence of OC symptoms was comparable to reports in previous studies (78%), the OCI was not sensitive in the detection of OC symptoms in FTD. The similarities and differences in OC symptoms between the two patient groups are discussed.

Doctor of Clinical Psychology / Obsessive-compulsive (OC) symptoms occur in a variety of clinical conditions, but the underlying pathogenesis of these symptoms remains elusive. Few neuropsychological investigations have compared idiopathic Obsessive-Compulsive Disorder (OCD) with patient groups where OC symptoms are acquired. The present study investigated the neuropsychological correlates of OC symptoms in OCD and frontotemporal dementia (FTD), a neurodegenerative illness in which OC symptoms are often acquired. Neuroimaging in OCD has consistently implicated the frontal-striatal-thalamic circuit, particularly the orbitofrontal cortex and basal ganglia. These areas overlap considerably with the sites of cerebral pathology found in FTD. OCD has been associated with a number of neuropsychological deficits, with most consistent findings pointing towards impaired executive function (EF), and less commonly reported deficits in visual memory and visuospatial ability. The neuropsychological hallmark of FTD is deficits in EF. However in both OCD and FTD, the relationship between cognitive deficits and OC symptoms remains unclear. Further, the extent to which OC symptoms are comparable between the groups is ambiguous. Part I of the present study compared 19 OCD subjects to 20 age, education and IQ-matched healthy controls on a battery of neuropsychological tests of all major cognitive domains with emphasis on EF. A measure of Theory of Mind (ToM) thought to be sensitive to orbitofrontal function was also administered. OCD subjects performed worse than controls on a measure of visual memory, visuospatial reasoning and on only one measure of EF. OCD symptom subtypes, as measured by the Obsessive-Compulsive Inventory (OCI), were not correlated with any cognitive deficits. No group differences in ToM were found. It is suggested that prior research has overestimated the severity and significance of EF deficits in OCD. Part II of the study compared 9 FTD participants with 10 matched healthy controls on the same neuropsychological test battery and OC symptom measures. In addition, a measure of compulsive behaviours used in neurological populations was administered to carers. While the incidence of OC symptoms was comparable to reports in previous studies (78%), the OCI was not sensitive in the detection of OC symptoms in FTD. The similarities and differences in OC symptoms between the two patient groups are discussed.

Bakgrund: Hjärtinfarkt bedöms vara den ledande dödsorsaken världen över. Trots att fler män än kvinnor insjuknar i hjärtinfarkt är dödligheten bland kvinnor högre. Bilden av hjärt- kärlsjukdom har länge präglats av ett manligt perspektiv vilket är en livshotande inställning som leder till att kvinnors symtom inte tas på allvar. Syfte: Syftet med studien var att beskriva kvinnors upplevelser av symtomen vid hjärtinfarkt. Metod: En litteraturöversikt där elva  artiklar från databaserna CINAHL Complete och PubMed granskats och analyserats. Resultat: De vanligaste symtomen hos kvinnor med hjärtinfarkt var smärta, fatique, andningspåverkan, gastrointestinala besvär och kroppstemperaturförändringar. Många kvinnor hade svårt att förstå och relatera sina symtom och blev inte tagna på allvar i vården. Det fanns en tydlig frustration då symtomen i många fall inte överensstämde med de symtomförväntningar som fanns. Slutsats: Litteraturöversikten lyfter fram kvinnors symtom vid hjärtinfarkt och bidrar till att skapa en förståelse för kvinnans tankemönster vid vårdsökandet. Hjärtinfarkt ska inte baseras på kön utan på kliniska fynd. Genom att vidga en större förståelse för hur kvinnor tolkar sina symtom kan vårdpersonal förbättra utgången för kvinnor med hjärtinfarkt. / Background: Myocardial infarction is considered to be the leading cause of death worldwide. Although the number of cases is higher in men, the mortality rate is higher amongst women. The image of cardiovascular disease has long been characterized by a male perspective, which is a life-threatening attitude that leads to women's symptoms not being taken seriously. Aim: The aim of this study was to describe women’s experiences of myocardial infarction symptoms. Method: A literature study where eleven articles from the databases CINAHL Complete and PubMed were reviewed and analyzed. Results: The most common symptoms in women with myocardial infarction were pain, fatigue, respiratory distress, indigestion and body temperature changes. Many women had a hard time understanding and relating their symptoms to cause and were hence not taken seriously in care. There was a clear frustration as the symptoms in many cases did not match the expectations that existed. Conclusion: This literature review highlights women’s symptoms of myocardial infarction and helps to create an understanding of the woman's thought patterns when seeking care. Assessment of myocardial infarction should not be based on gender but on clinical findings. By broadening a greater understanding of how women interpret their symptoms, healthcare professionals can improve the outcome for women with myocardial infarction.