Thesis (Ph.D.)--Tufts University, 2002. / Adviser: Robin Kanarek. Submitted to the Dept. of Psychology. Includes bibliographical references (leaves 125-134). Access restricted to members of the Tufts University community. Also available via the World Wide Web;

Tez (Tıpta Uzmanlık) - Süleyman Demirel Üniversitesi, Tıp Fakültesi, Psikiyatri Anabilim Dalı, 2005. / Bibliyografya var.

Dissertation (Ph.D.)--The University of North Carolina at Greensboro, 2009. / Directed by Susan Letvak; submitted to the Dept. of Nursing. Title from PDF t.p. (viewed May 11, 2010). Includes bibliographical references (p. 135-153).

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Major Depressive Disorder (MDD) is exceedingly prevalent and considered to be one of the leading cause of disability worldwide. Depression is also a heterogeneous disorder characterized by complex diagnotic approaches with a lack of diagnostic biomarker, an inconsistent response to treatment, no established mechanism, and affecting multiple physiological systems such as endocrine, immunological and cardiovasular as well. <p><p>The growing impact of the analysis of complex signals on biology and medicine is fundamentally changing our view of living organisms, physiological systems, and disease processes. In this endeavour, the basic challenge is to reveal how the coordinated, dynamical behavior of cells and tissues at the macroscopic level, emerges from the vast number of random molecular interactions at the microscopic level. In this way, the fundamental questions could be: (i) how physiological systems function as a whole, (ii) how they transduce and process dynamical information, (iii) how they respond to external stimuli, and mostly (iv), how they change during a pathological processus.<p><p>These challenges are of interest from a number of perspectives including basic modeling of physiology and practical bedside approaches to medical and risk stratification. <p><p>The general purpose of this thesis, therefore, is to study physiological time series to provide a new understanding of sleep dynamics in health, specifically as they apply to the pathological condition of MDD. More precisely: (1) to quantitatively characterize the complex, nonlinear behaviour of cardiovascular (ECG) and electroencephalographic (EEG) time series during sleep, in health and in MDD. This project will test the hypotheses that both the sleep EEG and ECG detects reorganization in the system dynamics in patient suffering from depression. (2) To develop new diagnostic and prognostic tests for MDD, by detecting and extracting “hidden information” in the ECG and EEG datasets.<p><p>Three different methods are introduced in this thesis for the analysis of dynamical systems. The first one, detrended fluctuation analysis, can reveal the presence of long-term correlations ("memory" in the physiological system) even when embedded in non-stationary time series. Graph theoretical measures were then applied to test whether disrupting an optimal pattern ["small-world network"] of functional brain connectivity underlies depression. Finally, multiscale entropy method, which is aimed at quantifying the complexity of the systems' output resulting from the presence of irregular structures on multiple scales, was applied on the ECG signal.<p><p>The results indicate that healthy physiologic systems, measured through the EEG and the ECG signals, are the most complex. According to the decomplexification theory, the depressive disease model exhibits a loss of system complexity, with potential important applications in the development and testing of basic physiologic models, of new diagnostic and prognostic tools in psychiatry, and of clinical risk stratification. / Doctorat en Sciences médicales / info:eu-repo/semantics/nonPublished

The experience of mental disorders while part of humanity, reveal inequities that are inhumane due to a lack of quality clinical service provisions globally. In Haiti, a formalized mental healthcare infrastructure developed after the 2010 earthquake where emerging dissemination and implementation studies demonstrated the potential for treatment utilization within recently established primary care. Partners in Health (PIH) and Zanmi Lasante (ZL) the frontline healthcare team have coordinated with the Haitian Ministry of Health to lead this initiative. A community-based mental healthcare system has proven to be sustainable through a task-sharing model, which delivers mental healthcare for common mental disorders (CMDs), severe mental disorders (SMDs), and neurological conditions (NCs)–with specific care pathways for major depression, psychotic disorders, and epilepsy. The extent to which patient mental healthcare are evaluated in lower-middle income countries (LMICs) like Haiti, however, have been limited. The primary aim of this study was to therefore evaluate patterns of mental disorders and to assess current patient care priorities in Haiti. The present study, builds upon previous literature by examining the continuum of mental disorders. A latent class analysis provides a data-driven approach to examine features of mental disorders to inform clinical treatment and best practices. EHR data from PIH and ZL were obtained from patients (N=914) who met criterion for a primary diagnosis and had completed mental health evaluations that were assessed at 13 sites in Haiti from 2016-2018. Known characteristics of mental disorders include the patient’s primary diagnosis, mood symptoms such as depression and suicidality, and the level of functional impairment. Accordingly, each were included as an LCA model indicator. Post-hoc multinomial logistic regression (MLR) models predicted mental health class selection and correlates based on the descriptive and clinical symptom variables. Results suggested there are six distinct mental health subgroups, that were distinguished by functional impairment: class 1a “common mental disorders– none to low functional impairment” (11.5%), class 2a “severe mental disorders–none to low functional impairment” (4.9%), class 3a “neurological conditions–none to low functional impairment” (11.1%), class 4b “common mental disorders–high functional impairment” (38.62%), class 5b “severe mental disorders–high functional impairment” (13.02%), and class 6b “neurological conditions–high functional impairment” (20.9%). MLR model 1 revealed CMDs were 2–3 times more likely female and received psychosocial interventions more often, and by comparison SMDs and NCs typically received psychiatric medication. MLR model 2 included patient’s clinical symptoms, that suggested severe CMDs with high functional impairment were somewhat more likely depressed when compared to other LCA subgroups. Although, in all likelihood this finding was probably attributed to CMDs including mild to severe forms of major depression, whereas SMDs were mostly psychotic disorder and bipolar disorder. Taken together, the most frequent primary diagnosis included: 1) major depressive disorder (60.3%) and generalized anxiety disorder (27.2%) for CMDs, 2) psychotic spectrum disorders (47.6%) and bipolar disorder (23.7%) for SMDs, and 3) epilepsy (88.8%) for NCs. Patients were infrequently diagnosed with co-occurring psychological disorders. The varied mental health disorder subgroups that participated in psychotherapy and psychiatric medication management, demonstrate such mental health treatments for Haitian’s are feasible and acceptable. While the present analysis was exploratory, LCA provides potential tools for treatment specification and best practices. The WHODAS, a measure of functional impairment, may be useful as a screening tool for triage, and primary outcome to determine patient improvement. Mental healthcare pathways based on results should expand to include women’s mental health and bipolar disorder. These findings are generalizable due to the data being from a community sample and directly from EHRs with inclusion criterion that was not limited by diagnostic specification, symptom severity, or co–occurring disorders. Overall, there is a vast need for mental health services that are broadly accessible for CMDs, SMDs, and NCs. This study highlights, specific clinical training and supervision needs, and the necessity for increased nursing, psychiatry, and neurology collaboration in Haiti. There is hope that healthcare expansion will strengthen and continue to empower communities in Haiti.

Bipolar disorder is characterized by disruptions in mood and affect that occur not only during mood episodes, but during euthymic periods as well. At the same time, sensitivity of the behavioral activation system (BAS) has been implicated in the disorder and is a risk marker for it. Less clear is the relationship between BAS sensitivity and positive affect, particularly lower level facets of positive affect. The aim of the present study was to examine the relationship between positive affect and vulnerability for mania as assessed using BAS sensitivity. Specifically, the link between daily levels and fluctuations of positive affect and baseline BAS sensitivity was examined. Following the hierarchical model of affect, this study also assessed the relationship between BAS sensitivity and the distinct facets of positive affect. Finally, this study examined whether BAS sensitivity moderates associations between daily rewards and positive affect. Undergraduates (N = 265) from a large university in the South were recruited to complete measures of BAS sensitivity, affect, and mood symptoms at baseline. Using ecological momentary assessment (EMA), participants completed daily surveys assessing affect and engagement with rewarding situations. An exploratory factory analysis revealed a four factor structure of positive affect, consisting of Serenity, Joviality, Attentiveness, and Self-Assurance. Greater daily levels of overall positive affect, as well as the lower order facets of Joviality, Self-Assurance, and Attentiveness, were predicted by heightened BAS sensitivity. In contrast, the facet of Serenity demonstrated minimal associations with BAS sensitivity. The study findings support a multi-faceted structure of positive affect and suggest that certain facets may be more closely related to risk for bipolar disorder. Specifically, Joviality and Self-Assurance may represent maladaptive forms of positive affect, whereas Serenity may function as a protective element against bipolar disorder.

Text in English / Literature notes an increase in the number of children and adolescents diagnosed with bipolar disorder. Several challenges faced by clinicians who diagnose and treat early-onset bipolar disorder have been discussed with particular emphasis being placed on its pharmacological management. The contributions made by psychologists including psychosocial interventions, have been explored in this regard; however, there still exists a paucity of voices in the field of psychology that discuss the experiences surrounding the management of this disorder. Most studies on early-onset bipolar disorder do not distinguish between childhood and adolescent presentations. Adolescence has been recognized herein, as a distinct developmental and transitional phase and thus, it forms the basis of this inquiry. This qualitative study thus explores clinical psychologists’ experiences ofmanaging adolescents diagnosed with bipolar disorder and will be approached from a social constructionist perspective which was selected as a means of exploring the meanings that individuals attribute to their experiences as they engage with others in their environment. A literature review evaluated the current available literature on juvenile bipolar disorder. Clinical psychologists in private practices were interviewed using semi-structured interviews. The participants were selected using purposive sampling. Two pilot studies were used to pre-test the study. One participant took part in pilot study 1 and one in pilot study 2. Thereafter, four semi-structured interviews were held with four participants who took part in the main study. Themes were drawn from the data and were explored using thematic content analysis. An analysis of the themes revealed several shared experiences in clinical psychologists’ management of juvenile bipolar disorder which were similar to what is reflected in the current available literature on early-onset bipolar disorder. / Psychology / M.A. (Clinical Psychology)

Text in Afrikaans / Binne die tradisionele christelike westerse samelewing waarin ons leef is daar diskoerse en meta-narratiewe wat dikteer wat van ons as huweliksmaats verwag word. Ons is dikwels onbewus van hoe hierdie verwagtinge, rolle en eise wat aan ons gestel word, deur verskillende diskoerse en stories tot stand gekom het. Die spesifieke lewenstorie en omstandlghede van die indiwidu(e) word meestal in die proses geignoreer, byvoorbeeld die saamleef met 'n huweliksmaat wat "gediagnoseer" is as iemand met 'n "bipolêre gemoedsversteuring", bring noodwendig omstandighede mee wat vir die meeste mense onuithoudbaar mag wees. Hierdie studie vertel die storie van 'n persoon wie daarin kon slaag om ten spyte van hierdie "omstandighede", sy storie so te kon herskryf dat hy steeds met hierdie persoon suksesvol binne die huwelik kan saamleef. Die studie fokus op 'n persoon, wie se lewe op grond van die christelike narratief leef, se belewing van die saamleef met 'n persoon met 'n "bipolere gemoedsversteuring". Die algemene doel van die studie was om aan die deelnemer 'n geleentheid te skep om sy belewinge in die saamleef van 'n persoon met 'n "bipolêre gemoedsversteuring" te kon deel. 'n Spesifieke fokus is geplaas om die rol wat christelike spiritualiteit speel in die verwerking en hantering daarvan, te beskryf. Daar is ook aan die persoon geleentheid gegee om op grond van sy belewlnge en verstaan van christenskap, aanbevelings te maak aan die professlone!e gemeenskap, die geloofsgemeenskap en aan huweliksmaats wat met soortgelyke omstandighede meet saamleef. Die navorslng is vanuit 'n postmoderne diskoers-oogpunt aangepak en op 'n kwalitatiewe wyse uitgevoer by wyse van 'n gevallestudle. Die deelnemer se storie is deur middel van sosiale konstruksieteorie en 'n narratiewe terapeutiese benadering, gedekonstrueer. Dit was duidelik vanuit die studie dat die funksie wat mense se spirituele oortuiginge en hul belewing daarvan in hul lewens verrig, in berekening gebring moet word in die terapeutiese proses. Wanneer kliënte belangrike besluite moet neem, moet die invloed van geloofsoortuiginge in die besluitnemingsproses in berekening gebring word. / Practical Theology / M. Th. - (Pastoral Theology)

Bipolar mood disorder has been traditionally researched, explored, and explained from a modernistic, psychiatric perspective. The purpose of this study is to explicate an alternative description for bipolar mood disorder, from a postmodern perspective. The widely accepted psychiatric knowledge focuses on the signs and symptoms of the disorder, pharmacological treatments, and manualised psychotherapies. This thesis shifts the focus from an intrapsychic, deficit perspective towards one which is inclusive of surrounding discourses and patterned relationships. The social constructionist research approach is followed, utilising vignette and thematic analyses for textual deconstruction and reconstruction. In addition to these data analyses, discourses were analysed using the actual text of the co-researchers. This allowed for a thorough explication of the ways in which discourses shape the construct bipolar mood disorder. From these analyses, emergent themes were then distilled and compared to the existing body of literature in the bipolar mood spectrum field of study. Process models were generated to depict the various pertinent aspects of the social construction of bipolar mood disorder. This research has value for the treating professional, allowing for a broader, more inclusive discourse perspective to add to the already established medical model view. Further, this research gives credence to the voice of the person who has been diagnosed with the illness. This research may also contribute to the epistemological debates within modernist and postmodernist paradigms. Key words: Bipolar mood disorder, medical model, pharmacology, mania, depression, psychiatry, psychotherapy, titrating power relations, expert, problem determined systems, belonging, problems of therapy and therapeutic problems, vignette analysis, people as meaning generating beings, context, reflexivity, self-reflection, multiple realities, positivism, social constructionist epistemology, qualitative research, process model. / Psychology / D. Litt. et Phil. (Psychology)