The current thesis explored diagnosis and rehabilitation of deficits in memory and language, using a multiple neuropsychological case study design. Broadly, the work evaluated the use of cognitive theory to diagnose patients’ clinical presentations and inform rehabilitation methods, and explored how outcomes from these interventions can be used to test cognitive theory in turn. This bi-directional link was explored in two ways: Firstly, theoretically-motivated groupings of word stimuli (e.g. ‘neighbourhoods’) were used to evaluate patterns of post-therapy generalisation, testing hypothesised associations between types of word stimuli. Secondly, the work identified proposed links between cognitive functions, using rehabilitation to test the validity, and nature, of these associations. The thesis is therefore comprised of two parts: Part 1 explored ‘neighbourhood’ effects in language and how they might be used to direct generalised improvement following rehabilitation (Chapters 2, 3, 4 and 5) and Part 2 evaluated associations and dissociations of functions in the cognitive architecture, across therapeutic and experimental contexts (Chapters 6 and 7). The work demonstrated that using theoretically-driven stimuli sets in rehabilitation can maximise generalised improvements following language treatment, and detailed how rehabilitation can be harnessed to test the integrity of associations between cognitive functions in the context of multiple deficits.

Background: The central nervous system is frequently affected in children with inherited metabolic disorders (IMD). The causes of the brain insult are incompletely understood, and novel methods are required for disease diagnosis and monitoring response to novel therapies. Aims & Methods: The study aimed to improve understanding of the pathogenesis of IMD-related neurodegeneration, and to identify potential disease biomarkers in specific IMD, by directly investigating alterations in brain tissue metabolite profiles using non-invasive in vivo magnetic resonance spectroscopy (MRS) in conjunction with conventional MRI brain scans. Results: MRI/MRS studies were performed on over 300 children. Normal brain metabolite profiles were established from a standard comparator cohort. A detailed quality analysis enabled combination of data from different scanner systems. Non-standard brain metabolites were detected in 2.3% of children. Metabolite-based methods of disease progression monitoring were evaluated in Hunter Syndrome. Mechanisms leading to strokes in patients with propionic acidaemia and to learning difficulties and epilepsy in argininosuccinic aciduria were explored using brain tissue metabolite profiling. Conclusions: Non-invasive in vivo brain tissue metabolite profiling is achievable using quantitative magnetic resonance spectroscopy in the routine clinical paediatric setting, and has utility in disease diagnostics, in monitoring disease progression and in investigating disease pathogenesis.

This research study explores the importance of psychological factors in the delivery of care to individuals who are sex offenders and may have a learning disability. This is achieved through two different ways. A literature has been undertaken to question what the psychological impact is to those working with sex offenders. Findings showed that several potential harmful effects exist, which can be increased or reduced through a selection of moderating and protective factors. The authenticity of these outcomes is restricted by various methodological limitations which are described. The empirical study explores staff attitudes to working with sex offenders who have a learning disability. This cross-sectional study showed the importance of a staffs qualification, emotional response and level of burnout in determining their attitudes. Clinical implications, methodological limitations and future studies are provided. Finally a brief public domain paper provides a summary of these papers and offers recommendations for clinical practice.

Submitted by Gilvan Almeida (gilvan.almeida@icict.fiocruz.br) on 2016-09-26T14:06:08Z No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 195.pdf: 5339099 bytes, checksum: d9ca506e388421c1078030a326fcef31 (MD5) / Approved for entry into archive by Barata Manoel (msbarata@coc.fiocruz.br) on 2016-10-13T19:12:21Z (GMT) No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 195.pdf: 5339099 bytes, checksum: d9ca506e388421c1078030a326fcef31 (MD5) / Made available in DSpace on 2016-10-13T19:12:21Z (GMT). No. of bitstreams: 2 license.txt: 1748 bytes, checksum: 8a4605be74aa9ea9d79846c1fba20a33 (MD5) 195.pdf: 5339099 bytes, checksum: d9ca506e388421c1078030a326fcef31 (MD5) Previous issue date: 2014 / Fundação Oswaldo Cruz. Casa de Oswaldo Cruz. Rio de Janeiro, RJ, Brasil. / A partir da publicação do DSM III (Diagnostic and Statistical Manual of Mental Disorders) pela Associação Americana de Psiquiatria nos anos de 1980, consolida-se no cenário internacional uma vertente da psiquiatria norte-americana denominada Psiquiatria Biológica. Neste trabalho, pretendemos analisar o modo como esta vertente psiquiátrica se desenvolve no Programa de Ansiedade e Depressão do Instituto de Psiquiatria da UFRJ (IPUB/UFRJ). Este Programa surge em 1984 e continua a existir até os dias de hoje. Ele se mostra relevante para nosso estudo por possuir, desde a fundação, a orientação da vertente biológica em suas pesquisas e por reunir importantes representantes desta vertente no cenário psiquiátrico fluminense, bem como por se situar no IPUB, instituição de grande representatividade junto ao meio psiquiátrico do Rio de Janeiro e, em certa medida, do Brasil. Para tanto, realizamos entrevistas com seus integrantes e analisamos uma série denominada Série Psicofarmacologia, publicada pelo Programa de Ansiedade e Depressão com o intuito de apresentar suas pesquisas. Esta Série é publicada no Jornal Brasileiro de Psiquiatria entre os anos de 1992 e 1998. O recorte temporal da nossa pesquisa compreende o período de 1984 a 1998. O ano de 1984 foi escolhido como marco inicial por ser o momento de fundação do Programa de Ansiedade e Depressão; o ano de 1998 foi selecionado como data limite de nossa análise por ser o momento em que o grupo de pesquisa do Programa se subdividiu e deu origem a mais dois outros programas e, ainda, por ser também o momento em que a Série Psicofarmacologia se extingue o que acreditamos ter relação com a divisão do grupo de pesquisa. Desse modo, nossa pesquisa visa contribuir para a compreensão das bases sobre as quais os discursos da Psiquiatria Biológica se sustentam e se inserem neste contexto institucional específico. / The publication of the DSM III (Diagnostic and Statistical Manual of Mental Disorders) by American Psychiatric Association, in 1980, has consolidated in the international scene an aspect of american psychiatry, called Biological Psychiatry. In this work, we intend to examine how the Biological Psychiatry has been developed in Anxiety and Depression Program of the Institute of Psychiatry at UFRJ (IPUB / UFRJ), Rio de Janeiro. This Program appears in 1984 and continues to exist until now. It is relevant to our study because (a) since its foundation, the Anxiety and Depression Program has followed the orientation of Biological Psychiatry in its researches and (b) because it gathers important representatives of this orientation in Rio psychiatric setting; it is relevant too because (c) this Program is situated in IPUB/UFRJ, an institution that has a large representation in the psychiatric setting of Rio de Janeiro and, to some extent, Brazil. To this end, we have made interviews with its members and analyzed a series of papers called psychopharmacology Series, published by the Anxiety and Depression Program in order to present its researches. This Series is published in the Brazilian Psychiatry Journal between 1992 and 1998. Our research covers the period between 1984 and 1998. The year of 1984 has been chosen as the starting point of this research because it was when the Anxiety and Depression Program has been founded; and the year of 1998 was selected as the final date for our analysis because in this year the Program research group was subdivided and gave rise to two other Programs; it was chosen also because, in this same year, the Psychopharmacology Series has been extinguished - what we believe related to the division of the research group. Thus, our research aims contribute to a better comprehension of the foundations in which the Biological Psychiatry discourses get support in this particular institutional context.

Fire-fighters are subject to attacks in the field. This idiographic Pheno-Cognitive Analysis (PCA) studies a fireman’s cognitive experience of a Critical Incident (CI) when he is attacked by dangerous dogs during an intervention. The PCA method, created for this research, extends the Elicitation Interview (EI), yields a first-person narrative of the subject’s experience out of his episodic memory, and semantically elicits 460 Cognitive Operations and four patterns of Cognitive Trajectories. Their variations in shape (Intra-Variability) and occurrence (Inter-Variability) are analysed. A model of Decision-Making-in-Action (DMA), and five Metacognitive Skills providing Peritraumatic Resilience (PTR) are revealed. Epistemological limits are discussed.

Volume one represents the research component of the qualification, and is comprised of a conceptual literature review and a qualitative research paper. The conceptual review analysed a small sample of the qualitative literature on couplehood and dementia. The analysis used Dialogic/Performance Analysis (Reissman, 2008) to provide critical commentary about the implications of participant voice, linguistic features and context in research papers, and how these may uncover possible narratives that are embedded in the literature. Implications of embedded narratives have been discussed. The research portion is a piece of qualitative research that used Interpretative Phenomenological Analysis. The theoretical underpinning is that of Systemic psychology. Three couples were recruited (the husbands were all diagnosed with dementia). The couples have been presented as case studies showing themes that emerged between the partners in the couples. The discussion focuses on the perceptions of continuity/discontinuity in the relationship and shared and unshared narratives. Clinical implications and directions for future research have been proposed. Volume two represents the clinical aspects of this qualification and is comprised of five clinical case reports: A case study using dual formulation, a small scale service-related research (service evaluation), single-case experimental design, case study and the abstract from an oral presentation.

This thesis explores policy and service delivery for adolescent and young adult or ‘transition age’ mental health service users aged 16-25 across different jurisdictions in the UK and Australia. The study explores the implications that policy formulation and implementation have for service delivery in these different contextual settings; and examines how young people (who are at a vulnerable stage developmentally in terms of mental health), have their access to services affected by the existing policy framework. A policy analysis was conducted along with qualitative interviews in six case sites (three in the UK and three in Australia). The thesis adopted a critical realist approach using a laminated cross-sectional interview strategy that was developed to include interviews with national policy makers; local policy makers and service managers; staff working within services; and the young people whom were accessing services as the recipients of policy. Findings from this thesis explore how young people use risk escalation as a way of managing delays to treatment and how practitioners identify particular difficulties for young people transitioning in services when they are due to ‘step up’ into more acute services, or ‘step down’ to a less intensive service. The thesis explores the implications and unintended consequences for young people of policy including processes of ‘cost-shunting’ and ‘resource envy’ at local and national levels. Finally, the thesis offers some learning for systems working to support 16-25 year olds through demonstrating the importance of the dual role of ‘curing’ and ‘caring’ in mental health services.

Made available in DSpace on 2016-04-25T20:22:56Z (GMT). No. of bitstreams: 1 Leandro Alberto de Paiva Siqueira.pdf: 3521197 bytes, checksum: 69a587110b1ceae987343d261e25189e (MD5) Previous issue date: 2009-10-16 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Beginning in the 1990s, diverse habits, conducts, and daily-life behaviors, when practised in excess, in an uncontrolled or repetitive manner began to be biologized by psychiatry and progressively included in diagnostic manuals of mental disorders. Generically known by the term compulsions, these "new mental disorders" group together thoughts and desires that provoke discomfort, fear, and anxiety the activities whose engagement brings pleasure such as playing, eating, buying, doing physical exercise, working, sex, surfing the internet, using substances that alter perception, relationships, and religion. The emergency of compulsions as a new "epidemic" to be combatted against occurred at the same that psychiatry went through a reformulating process of its practices and knowledge thanks to new computo-informational technologies, the development of modern psychopharmaceuticals, and the incorporation of the contents regarding the mental and human behavior produced by the neurosciences. This research aims to trace a genealogy of compulsions in order to problematize dispositifs of power that operate subjects at the moment when disciplinary societies, analyzed by Michel Foucault, come to be overlapped by control societies, as pointed out by Gilles Deleuze. In this change, the asylum no longer is the principal economy of power in the formatation of subjectivities, in order to be substituted by technologies that operate in open air and result in normalizations of the normal. They are technologies that combine subjections and machinic servitudes, promoting processes of (in)dividuation, and take place on an environment by means of flows of mental health that convokes the policing of "disfunctions", the auto-vigilance of behaviors and conducts, and the formation of organized groupings of carriers of disorders. Understood as unfoldings of neoliberal governamentality, compulsions are configured as one more dispositif of an "era of moderation and moderates" and of the proliferation of the sensations of liberty / A partir dos anos 1990, diversos hábitos, condutas e comportamentos da vida cotidiana, quando praticados em excesso, de maneira descontrolada ou repetitiva passaram a ser biologizados pela psiquiatria e progressivamente incluídos em manuais de diagnósticos de transtornos mentais. Conhecidos genericamente pelo termo compulsões, estes novos transtornos mentais reúnem desde pensamentos e desejos que provocam desconforto, medo e ansiedade a atividades cujo engajamento traz prazer como jogar, comer, comprar, fazer exercícios físicos, trabalhar, sexo, navegar na Internet, usar substâncias que alterem a percepção, relacionamentos e religião. A emergência das compulsões como nova epidemia a ser combatida ocorreu simultaneamente à psiquiatria passar por um processo de reformulação de suas práticas e conhecimentos graças às novas tecnologias computoinformacionais, ao desenvolvimento de modernos psicofármacos e à incorporação de conteúdos sobre o mental e o comportamento humano produzidos pelas neurociências. Esta pesquisa visa traçar uma genealogia das compulsões a fim de problematizar dispositivos de poder que operam assujeitamentos no momento em que as sociedades disciplinares, analisadas por Michel Foucault, passam a ser sobrepostas pelas sociedades de controle, como apontou Gilles Deleuze. Neste deslocamento, o manicômio deixa de ser a principal economia de poder na formatação de subjetividades, para ser substituído por tecnologias que operam a céu aberto e procedem a normalizações do normal. São tecnologias que combinam sujeições e servidões maquínicas, promovendo processos de (in)dividuação, e incidem sobre o ambiente por meio de fluxos da saúde mental que convocam ao policiamento de disfunções , à autovigilância de comportamentos e condutas e à formação de agrupamentos organizados de portadores de transtornos. Entendidas como desdobramentos da governamentalidade neoliberal, as compulsões configuram-se como mais um dispositivo de uma era da moderação e dos moderados em meio à proliferação de sensações de liberdade

Made available in DSpace on 2016-04-26T14:57:49Z (GMT). No. of bitstreams: 1 Leandro Alberto de Paiva Siqueira.pdf: 3521197 bytes, checksum: 69a587110b1ceae987343d261e25189e (MD5) Previous issue date: 2009-10-16 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / Beginning in the 1990s, diverse habits, conducts, and daily-life behaviors, when practised in excess, in an uncontrolled or repetitive manner began to be biologized by psychiatry and progressively included in diagnostic manuals of mental disorders. Generically known by the term compulsions, these "new mental disorders" group together thoughts and desires that provoke discomfort, fear, and anxiety the activities whose engagement brings pleasure such as playing, eating, buying, doing physical exercise, working, sex, surfing the internet, using substances that alter perception, relationships, and religion. The emergency of compulsions as a new "epidemic" to be combatted against occurred at the same that psychiatry went through a reformulating process of its practices and knowledge thanks to new computo-informational technologies, the development of modern psychopharmaceuticals, and the incorporation of the contents regarding the mental and human behavior produced by the neurosciences. This research aims to trace a genealogy of compulsions in order to problematize dispositifs of power that operate subjects at the moment when disciplinary societies, analyzed by Michel Foucault, come to be overlapped by control societies, as pointed out by Gilles Deleuze. In this change, the asylum no longer is the principal economy of power in the formatation of subjectivities, in order to be substituted by technologies that operate in open air and result in normalizations of the normal. They are technologies that combine subjections and machinic servitudes, promoting processes of (in)dividuation, and take place on an environment by means of flows of mental health that convokes the policing of "disfunctions", the auto-vigilance of behaviors and conducts, and the formation of organized groupings of carriers of disorders. Understood as unfoldings of neoliberal governamentality, compulsions are configured as one more dispositif of an "era of moderation and moderates" and of the proliferation of the sensations of liberty / A partir dos anos 1990, diversos hábitos, condutas e comportamentos da vida cotidiana, quando praticados em excesso, de maneira descontrolada ou repetitiva passaram a ser biologizados pela psiquiatria e progressivamente incluídos em manuais de diagnósticos de transtornos mentais. Conhecidos genericamente pelo termo compulsões, estes novos transtornos mentais reúnem desde pensamentos e desejos que provocam desconforto, medo e ansiedade a atividades cujo engajamento traz prazer como jogar, comer, comprar, fazer exercícios físicos, trabalhar, sexo, navegar na Internet, usar substâncias que alterem a percepção, relacionamentos e religião. A emergência das compulsões como nova epidemia a ser combatida ocorreu simultaneamente à psiquiatria passar por um processo de reformulação de suas práticas e conhecimentos graças às novas tecnologias computoinformacionais, ao desenvolvimento de modernos psicofármacos e à incorporação de conteúdos sobre o mental e o comportamento humano produzidos pelas neurociências. Esta pesquisa visa traçar uma genealogia das compulsões a fim de problematizar dispositivos de poder que operam assujeitamentos no momento em que as sociedades disciplinares, analisadas por Michel Foucault, passam a ser sobrepostas pelas sociedades de controle, como apontou Gilles Deleuze. Neste deslocamento, o manicômio deixa de ser a principal economia de poder na formatação de subjetividades, para ser substituído por tecnologias que operam a céu aberto e procedem a normalizações do normal. São tecnologias que combinam sujeições e servidões maquínicas, promovendo processos de (in)dividuação, e incidem sobre o ambiente por meio de fluxos da saúde mental que convocam ao policiamento de disfunções , à autovigilância de comportamentos e condutas e à formação de agrupamentos organizados de portadores de transtornos. Entendidas como desdobramentos da governamentalidade neoliberal, as compulsões configuram-se como mais um dispositivo de uma era da moderação e dos moderados em meio à proliferação de sensações de liberdade

Family members are themselves affected by the impact of Acquired Brain Injury (ABI) upon their relatives and they play an important role in the rehabilitation and long term support required. The study aims to understand how families are impacted and their views on the formal and informal support received directly or indirectly as a consequence of the ABI. To date there has been very little research undertaken by social workers in relation to ABI and/or the experience of family members. A mixed methods research design was employed to capture the lived experience of family members of people with ABI. The results of the quantitative and qualitative data were triangulated against the literature. An online survey was completed by 110 relatives of people with an ABI, seeking their experience of the condition, its impact upon their lives and their views of services. The results of the survey were collated and organised in SPSS (version 24). Non-parametric Spearman's Rho Correlations (non-parametric test) were performed upon the results. In-depth, semi-structured interviews were conducted with 16 family members of people with severe ABI to ascertain the family members' experience of their relatives' condition, its impact upon them and their views of the associated formal and informal support received. Inductive thematic analysis of the transcribed interview data was undertaken to identify themes. The quantitative element of the research identified strong correlations between the relative's assessment of the invisible impairments suffered by those with an ABI (cognitive, executive, behavioural and emotional difficulties) and lack of insight. This correlation was not present in relation to physical impairment. It was observed that increased loss of insight and behavioural difficulties were strongly correlated with loss of friendships by the non-injured family member. The results of the inductive thematic analysis identified 7 themes which were: 1: The Context 2: The All-Encompassing Challenge 3: Family Loss and Grief 4: The Unavoidable Burden 5: The Poor Experience of Support 6: Positive Support and Change 7: The Curator of Narrative The research identified that family members' experience is complex and enduring, encompassing most aspects of life, and is affected by the context in which it occurs as well as by formal and informal support structures. The particular nature of the grief and loss experienced by families is ambiguous, develops over time and leads to ambivalent feelings for family members who perceive no option but to remain involved. Informal and formal support frequently fails to take account of the reality and complexity of the condition and fails to integrate the relative by recognising their own losses and trauma. Relatives' views on the services received identified significant gaps in practitioner knowledge, most especially of those aspects of life that were of most concern to them, the invisible impairments and issues with insight. Practitioners that were valued were more likely to be specialists in the condition and practiced as “expert companions” supporting the relative to develop a new “neuro-narrative” to reconstruct their identity in the face of their ongoing grief. The specific nature of the condition requires such an approach if input is to be effective. Greater understanding of the complex lived experience of family members may support more effective responses to both them and the individual with ABI, integrating services and families to improve quality-of-life. As ABI is a process with changes to functioning developing over time, the information and knowledge required by loving and supportive relatives needs to be created with them, being person-, family-, injury-and-context-specific.