A Dissertation submitted to the Faculty of Medicine in part fulfilment of the requirements for the Degree of Master of Medicine in Psychiatry at the University of the Witwatersrand. / The motivation for undertaking this study stems from the confusion that reigns in the literature regarding the relationship between personality, personality traits and dysthymic disorder. A large body of theorists ancl researchers still claim a definite association between dysthymia and personality. Their views arose to an extent from the concept of dysthymia as it developed through the past few decades. Dysthymia grew out of the concept of depressive neurosis which had a stronger basis in personality pathology. other terms like neurotic depression and depressive reaction preceded depressive neurosis. with the advent of DSM-III and DSM-III-R, dysthymia was moved from the neuroses to the mood disorders category. The DSM-IV Mood Disorders Work Group has also reinforced the classification of dysthymia with mood disorders. The Work Group has embarked on research to determine the symptomatology that should be used for the diagnosis of dysthymia. It is proposed that cognitive, functional and vegetative symptoms be included in DSM-IV to further entrench dysthymia as an affective disorder and extricate it from the personality disorders. / Andrew Chakane 2018

Thesis (M.Sc. (Med.))--University of the Witwatersrand, Faculty of Health Sciences, 1997.

A dissertation submitted to the Faculty of health sciences, University of the Witwatersrand, Johannesburg, in fulfillment of the requirements for the degree of Master of Science (Med) / Physiological anxiety symptoms are experienced as an overwhelming panic attack when the person cognitively interprets them as such. Fear is the emotion initiating the cognitive perception of personal doom which becomes largely influential on the future process of a sufferer's panic disorder. (Abbreviation abstract) / AC2017

A research report submitted to the Faculty of Medicine, University of the Witwatersrand Medical School, in partial fulfilment of the requirements for the Degree Masters of Medicine in the branch of Psychiatry, Johannesburg, August, 2015 / Introduction Pharmacotherapy is a key component in the management of bipolar disorder. Whilst one might aim for fewer agents, not all patients with bipolar disorder can be stabilized with monotherapy and combination treatment (polypharmacy) is increasingly used to manage patients in clinical practice. Mood stabilizers have traditionally been prescribed as monotherapy, however the use of atypical antipsychotic agents is seen in clinical practice with various such agents approved for such usage. Combination treatment with an antipsychotic, preferably an atypical antipsychotic together with a standard mood stabilizer is also noted in clinical practice as well as recommended by guidelines. Bipolar patients managed in a specialist psychiatric setting have a greater chance of being managed with polypharmacy than in a general practice setting. The use of polypharmacy may also be attributed to receiving treatment in an academic environment. This current study was based on the application of diagnostic criteria and principles of the Diagnostic and Statistical Manual of Mental Disorders version IV TR (DSM IV TR), published by the American Psychiatric Association and The International Classification of Diseases version 10 (ICD 10), published by the World Health Organisation. Aims The study aims to describe the range and frequency of medications used in the management of bipolar bisorder in a specific setting as well as describe the nature and frequency of monotherapy versus polypharmacy use. Hypothesis The study hypothesized that the majority of patients attending the specialist / academic psychiatric outpatient clinic at Tara Hospital would be prescribed polypharmacy and that antipsychotics (typical or atypical) would be prescribed in combination with standard mood stabilizers in the majority of cases. Method The study took the form of a retrospective patient file review. The clinical files were for patients attending the Tara Hospital psychiatric outpatient clinic. The files of every patient who attended the clinic at least once in 2009 were screened and included in the study where the recorded ICD 10 code corresponded with a bipolar disorder subtype or a single manic or hypomanic episode. Where the recording of the ICD 10 code was missing or incomplete further scrutiny of the clinical notes enabled the researcher to establish a diagnosis of bipolar disorder using the ICD 10 and/ or DSM IV TR diagnostic criteria and therefore include the patient file in the study. Other necessary information was obtained by reviewing clinical notes as well as the prescription written on the last patient visit for 2009. Results The study found that the majority of patients (93.8%) were prescribed polypharmacy, with 3.2 the mean number of psychotropic medications prescribed per patient. Lithium was prescribed in 34.3% of patients. Sodium valproate was prescribed in 37.1% of patients. Eighty three point eight percent (83.8%) of the patients were prescribed at least one standard mood stabilizer. The atypical antipsychotics (46.6%) were prescribed more frequently than the typical antipsychotics (16.5%). Lamotrigine (31.8%) was the preferred novel anticonvulsant and the selective serotonin reuptake inhibitors (SSRI’s) were the most commonly prescribed antidepressant (28.9%). Clonazepam (26.8%) was the most frequently prescribed benzodiazepine add-on. The use of combination treatment to manage bipolar disorder was the rule rather than the exception. There was however much variety in the combinations used with no particular combination being prescribed in the majority of patients. Forty seven percent (47%) of the combinations used included a standard mood stabilizer and a typical or atypical antipsychotic. Conclusion The current study provides preliminary data on the prescribing patterns in bipolar disorder in a specialist psychiatric clinic within an academic complex in South Africa. The findings are in keeping with international studies and highlights that polypharmacy and combination treatment in the management of bipolar disorder is the norm in such settings. There is a large variation in clinician practices and much variety seen in the combinations of medications used to treat bipolar disorder despite the availability and use of treatment guidelines. This is perhaps because bipolar disorder is such a complex disorder and that most of the treatment recommendations are based on limited data. Treatment guidelines have emerged in order to attempt to standardize treatment and provide clinicians with algorithms to utilize and apply research findings in daily clinical practice. Further study into the effective prescribing principles for bipolar disorder is necessary.

A dissertation submitted to the Faculty of Humanities in partial fulfilment of the requirements of the degree of Master of Arts Organisational Psychology University of the Witwatersrand March 2016 / Emergency first responders such as firefighters are exposed to higher levels of traumatic events through the course of their work. Accordingly, chances of such exposure resulting in negative psychological consequences are elevated. Previous research implicates the experience of trauma incident(s) and other organisational factors, among other factors, as causes of the development of consequences such as posttraumatic stress disorder and the variance thereof. However, research exploring these implications is limited. As a result, firefighters in the Emergency Medical Services were surveyed in the attempt to identify experiences of posttraumatic stress symptoms resulting from history of exposure to work-related traumatic events, perceived life threat during those incidents, general work-related stress and their perceived organisational support. The purpose of this study was to explore the predictive relationship PTSD symptoms and four predictors namely; perceived life threat, perceived organisational support, history of trauma and job-related stress, among Johannesburg firefighters. The sample was drawn from the City of Johannesburg Emergency Medical Services. A sample (N=100) of trauma-exposed firefighters was recruited for the study. Participants were recruited using a non-probability, convenience sampling strategy in which participation in the study was voluntary. The sample was made of 89 male participants and 11 female participants. All variables included in the study were measured using self-report instruments. Participants completed a demographic questionnaire to gather information pertaining to gender, age, organisational tenure and race. The following questionnaires were used to ascertain scores for the predictor variables: Survey of perceived Organisational Support, General Work Stress scale, Life Threat scale and a self-developed history of trauma scale. The Revised Impact of Event scale was used to measure the firefighters’ experience of PTSD related symptoms. Participants reported an average score of 29 on the IES-R scale indicating a stress reaction with the possibility of posttraumatic stress disorder. However, using a multiple regression analysis, this present study found that the four predictor variables explored did not have a substantial impact on the development of PTSD among firefighters. Secondary analyses were conducted to explore the individual association between each independent variable and PTSD. The results are reported. Overall, the results yielded suggest that there are other factors that exert a greater impact on the development of PTSD among firefighters. Future research among firefighters could focus on exploring other risk and protective factors associated with the development of PTSD. Alternatively, if this study is to be replicated, the researcher could employ a longitudinal, qualitative approach to explore the predictive relationship between history of trauma, perceived life threat, perceived organisational support, work-related stress and PTSD related symptoms. KEYWORDS: Post-traumatic stress disorder, perceived life threat, perceived organisational support, job-related stress, history of trauma

dissertation submitted to the Faculty of Health Sciences, School of Therapeutic Sciences, University of the Witwatersrand, Johannesburg, in fulfilment of the requirements for the degree of Master of Science in Occupational Therapy Johannesburg, 2017 / Parents of children who have sensory modulation disorder (SMD) and who have sensory over-responsiveness (SOR) themselves may display mal-adaptive self-regulatory strategies, contributing to elevated stress levels. The purpose of the study is to determine the perceived stress levels and sensory self-regulatory strategies of mothers of children with SMD, who presented with SOR themselves. A twelve-week stress management programme using a sensory modulation-based approach was developed and implemented with a sample of five mothers with SOR. The quasi-experimental pre-test post-test design required the participants to complete the Parenting Stress Index-4 Short Form and a sensory self-regulatory questionnaire. The effectiveness of the programme was assessed by determining change in perceived stress and self-regulatory behaviours immediately after and three months following the programme. Although no statistically significant change was found, clinically relevant change with large effect sizes was evident in the scores for parental distress, difficult child, total stress, and self-regulatory behaviour after the intervention period. Further clinical change was found for parental distress, difficult child and parent child dysfunctional interaction with moderate effect sizes after the follow up period. The results of this study indicate the importance of addressing the mother’s stress levels, in addition to treating their child with SMD. / MT2017

Boston University. University Professors Program Senior theses. / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-02

For complex traits, population genetic studies ask: to what extent do genetic variation and environmental variation influence, determine and predict phenotypic variation? More specifically, researchers ask two questions. First, how much of the phenotypic variation is genetic in origin? Second, if the genetic component of a trait has been ascertained, then by what mechanisms do the causal variants contribute to the genetic variation that impacts on the phenotype? Previous studies have indicated a polygenic structure for many complex traits, which means that the genetic variation in those traits is the result of the cumulative effect from hundreds or even thousands of genetic variants. To further decipher the polygenic genetic architecture of a complex trait, genetic studies aim to identify the number, the location in the genome, and the distribution of the effect sizes of causal variants, as well as their individual and interacting effects. Linkage analysis and genome-wide association studies (GWAS), either based on single variants or sets of variants categorized by functional annotations, can be applied to map the potentially causal variants in the genome. The identification of disease-associated loci, however, is only the starting point in identifying causal variants. Causal variants are usually difficult to distinguish from the large number of variants in linkage disequilibrium (LD) within the associated loci, and may be in incomplete LD with genotyped variants. Computational prediction integrated with multi-level ‘Omic’ data will help the prioritization of candidate causal variants, which then become important targets for experimental validation (Chapter 1). Major depressive disorder (MDD) is a complex trait, contributes the second most important burden to global disease. Both genetic and environmental components have been suggested for this disorder in previous studies, although a clear partitioning of the contribution of each component and the identification of major contributing components is yet to be achieved. In efforts to map causal genetic variants, genome-wide association studies of MDD have identified few significant associations so far. The polygenic architecture combined with the widespread clinical and genetic heterogeneity of MDD between populations may impede the identification of causal variants (Chapter 2). In this thesis, I will present three studies; the first study estimated the proportions of the phenotypic variation that are genetic or familial environmental in origin in two depression definitions(chapter 3), followed by two studies where distinct (non- GWAS) methods were used to identify candidate causal genetic variants for MDD (chapter 4,5). In detail, in chapter 3, a variance component analysis was applied to GS:SFHS (Generation Scotland: Scottish Family Health Study) to investigate the relative genetic and environmental contributions to diagnosed major depressive disorder (MDD) and self-declared depression (SDD). Models for MDD and SDD that simultaneously included genetic and environmental effects suggested that narrow-sense heritability could be inflated by the environments shared by nuclear family members. The most parsimonious models selected for both MDD and SDD included SNP and pedigree-associated genetic effects and the effect of the common environment of couples. In chapter 4, I integrated pathway analysis and multi-level regional heritability analyses in a pipeline designed to identify MDD-associated pathways. The pipeline was applied to two independent GWAS studies (GS:SFHS and PGC1-MDD). The NETRIN1 signalling pathway showed the most consistent association with MDD across the two samples. Polygenic risk scores (PRSs) from this pathway showed predictive accuracy better than whole-genome PRSs when using AUC statistics, logistic regression and the linear mixed model. In chapter 5, genome-wide Haplotype-block-based regional heritability mapping (HRHM) was applied to identify haplotype blocks significantly contributing to MDD. A haplotype block across a 24kb region within the TOX2 gene reached genotype-wide significance in GS:SFHS. Single-SNP and haplotype based association tests were used to localize the association signal within the region identified by HRHM, and demonstrated that five out of nine genotyped SNPs and two haplotypes were significantly associated with MDD. The results were replicated in the UK-Ireland group in PGC2-MDD. The brain expression of TOX2 and brain-specific LncRNA RP1-269M15.3 were also significantly regulated by MDD-associated SNPs within the identified haplotype block. The three studies highlight the value of the application of multiple population genetics and bioinformatics methods to multiple family-based and population-based cohorts in identification of risk factors for MDD.

Degree of Master of Medicine in Orthopaedic surgery Department of Orthopaedics Faculty of Health Sciences University of Witwatersrand / The hand is an intricate and important body appendage which plays a vital role in our activities of daily living. Flexor tendon injuries to the hand make up a large amount of patients seen at hospitals all over the world. Hand injuries are quite common and contribute to approximately 28% of injuries to the human body. A prospective study was conducted, with patients who had sustained flexor tendon hand injuries. The patients who presented to Chris Hani Baragwanath Academic Hospital from 02 March 2015 to 29 July 2015 were included in the study. The aim of this study was to document and identify the causes (mechanism of injury) and demographic details of patients presenting with flexor tendon injuries at Chris Hani Baragwanath Academic Hospital hands unit. There were 96 patients in the study, with 80 being right hand dominant and 16 being left hand dominant. Zones II and zones III were the most common flexor zones affected (27 each). There was also a significant amount of zone V injuries (23). Zone IV was the least common zone affected (5). The results also showed that the most common injury to flexor tendons of the hands occurred in young adult males, the majority of whom were unemployed. This disproves our hypothesis, as it was hypothesised that most injuries would occur in the work place. This study was undertaken in an attempt to reduce the incidence and frequency of hand injuries in our community, by assessing the common causes and patient particulars of flexor tendon injuries. This information can now be used to teach awareness which now can be used in the work place. / MT2017

A consistent gap in previous studies was sexuality education and sexual orientation, as well as how to disseminate the sexual education material in a format that would be useful to individuals with IDD, parents, and caregivers. This biographical study addresses the understanding of sexuality and sexual orientation of an individual with intellectual developmental disorder (IDD), as reported by his parents. Data were collected through face-to-face interviews, documents, and social media sites belonging to the participants. The theoretical framework for this study was social constructivism; a thematic analysis was used for data analysis. The six themes that emerged from this research study include: lack of certainty and confusion about disability; early childhood peer interaction, sexual education, exploration and bullying; family communication and supportive family structure; coming out; and, social media, privacy, and safety. Theme identification indicated that parents, caretakers, and individuals with IDD need more information including scripted, detailed sexuality and sexual orientation education, support in understanding and navigating social media dating sites, and information on dating etiquette. Findings may contribute to social change by providing a foundation for sexual education curricula to support the needs of individuals diagnosed with IDD.