Previous research has suggested that adult attachment disturbance is related to maladaptic interaction patterns and personality disorder constructs. Specifically, research indicates that those with attachment disturbance are significantly more likely to meet criteria for a number of personality disorders, including borderline personality disorder, narcissistic personality disorder, and antisocial personality disorder. The purpose of this study was to investigate the associations between adult attachment and the new dimensional model of personality disorders scheduled to be released in the Diagnostic and Statistical Manual for Mental Health Diosrders (5th ed.) in spring 2013. Participants completed the Schedule for Adaptive and Nonadaptive Personality (SNAP) to measure dimensional personality functioning and the Experiences in Close Relationships (ECR-R) and the Attachment Prototypes to measure adult attachment patterns. Additionally, select scales from the Personality Assessment Inventory (PAI) and the Five Factor Model (FFM) will be utilized as secondary measures of personality patterns. The results suggest strong associations between adult attachment orientations and specific maladaptive personality characteristics.

The induction of phenylketonuria in mice through the use of excess dietary phenylalanine is an area in which limited research has been done. This study intends to pursue further work in this area, more specifically, to study the effects of excess dietary phenylalanine and the phenylalanine analogue A.P.B.A. (2-amino-3-phenyl butanoic acid) (7) on brain serotonin and brain norepinephrine. In addition, the effects of these two compounds on the incidence of audiogenic seizures will be explored.

Clinicians and researchers have traditionally viewed eating disorders (EDs) as disorders of adolescence and early adulthood; however, mounting evidence suggests these debilitating disorders also occur in older women (those 30 years of age and older). Unfortunately, the vast majority of research conducted on EDs has ignored older age groups, making it difficult to determine whether older women represent a distinct group among those with EDs. In order to address this limitation I conducted two separate, but related, studies designed to explore the experiences of older Canadian women with EDs and whether this group differs from younger women with EDs in meaningful ways. Study 1 explored how a treatment seeking sample of women ages 30 years and older diagnosed with an ED (N=14) experience their ED and the precipitating factors of ED episodes among this age group using qualitative framework analysis. Study 2 examined the differences in ED severity, symptomatology, comorbidities, and quality of life between women under the age of 30 (younger women; n=338) and those 30 years and older (older women; n=98) in a treatment-seeking sample using quantitative methods. Across both studies the core ED experiences and symptoms of older women were not significantly different from those of younger women. However, differences emerged that suggest older women with EDs are somewhat less severe in terms of their ED symptomatology and comorbid mental disorders, yet older women with EDs may face some unique challenges and consequences that set them apart from their younger counterparts. These results are discussed in the context of previous research understanding the relationship between aging, mental health, and emotional regulation. In sum, the current thesis suggests treatment for older women with EDs should incorporate interventions designed to address the core symptoms of EDs, improve healthy emotion regulation skills, reduce shame, address the consequences for the patients’ families and partners, and treat the multitude of physical health complications seen in this group. Moreover, greater awareness should be brought to the occurrence of EDs in older age groups in order to reduce shame, stigma, and improve early detection of and treatment for EDs among this population.Clinicians and researchers have traditionally viewed eating disorders (EDs) as disorders of adolescence and early adulthood; however, mounting evidence suggests these debilitating disorders also occur in older women (those 30 years of age and older). Unfortunately, the vast majority of research conducted on EDs has ignored older age groups, making it difficult to determine whether older women represent a distinct group among those with EDs. In order to address this limitation I conducted two separate, but related, studies designed to explore the experiences of older Canadian women with EDs and whether this group differs from younger women with EDs in meaningful ways. Study 1 explored how a treatment seeking sample of women ages 30 years and older diagnosed with an ED (N=14) experience their ED and the precipitating factors of ED episodes among this age group using qualitative framework analysis. Study 2 examined the differences in ED severity, symptomatology, comorbidities, and quality of life between women under the age of 30 (younger women; n=338) and those 30 years and older (older women; n=98) in a treatment-seeking sample using quantitative methods. Across both studies the core ED experiences and symptoms of older women were not significantly different from those of younger women. However, differences emerged that suggest older women with EDs are somewhat less severe in terms of their ED symptomatology and comorbid mental disorders, yet older women with EDs may face some unique challenges and consequences that set them apart from their younger counterparts. These results are discussed in the context of previous research understanding the relationship between aging, mental health, and emotional regulation. In sum, the current thesis suggests treatment for older women with EDs should incorporate interventions designed to address the core symptoms of EDs, improve healthy emotion regulation skills, reduce shame, address the consequences for the patients’ families and partners, and treat the multitude of physical health complications seen in this group. Moreover, greater awareness should be brought to the occurrence of EDs in older age groups in order to reduce shame, stigma, and improve early detection of and treatment for EDs among this population. / May 2016

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Psychiatry, Johannesburg, September 2013 / Objective: Anecdotal evidence suggests that substance use is a significant problem among psychiatric patients admitted to Chris Hani Baragwanath Academic Hospital. The purpose of this study was to investigate the prevalence of substance use, the type of substance used and the socio-demographic and clinical factors associated with substance use among a group of psychiatric inpatients. Method: This study was a retrospective record review of all patients admitted to the psychiatric wards at Chris Hani Baragwanath Academic Hospital between the periods of July and December 2008. Results: Substance use was 4.8 (95% CI:2.7-8.4) times more likely among male subjects (p<0.001), 4.1 times (95%CI: 1.8-9.3) more likely in subjects aged 18-30 years compared to older patients (p=0.001), 3 times (95% CI: 1.2-7.4) more likely in subjects who were single (p=0.001), 1.9 (95% CI:1.4-2.7) times more likely in subjects who did not have children (p<0.001), and 1.5 (95% CI:1.2-2.1) times more likely in subjects with a psychotic disorder (p=0.004) compared to those with a mood disorder. Mood and psychotic disorders were compared and only the past psychiatric history was found to be significantly associated with psychotic disorders. Conclusion: Male gender was found to be significantly associated with substance use. Alcohol and cannabis were the most common substances used and polysubstance use also was a common occurrence. These findings have implications for preventative measures, psychiatric practice and specialized care for dual diagnosis patients.

A Research Project Submitted in partial fulfilment of the requirements for the Master of Science Degree in Epidemiology and Biostatistics / Background: There is evidence suggesting a considerably high prevalence of malnutrition in Zimbabwe. However, there is little evidence available to suggest the factors that may be associated with malnutrition in the local context. Objectives: This study investigates the distribution of malnutrition and the factors associated with each of three types of malnutrition (stunting, wasting and underweight) among Zimbabwean children aged 0-59 months for the period 2010/2011 Methods: The study makes use of the Zimbabwean Demographic and Health Survey (ZDHS) data from the 2010/11 survey. SaTScan software was used to identify clustering of malnutrition outcomes at the time of data collection. Binary Logistic regression for survey data was used to determine factors associated with each type of malnutrition, while unconstrained Generalised Ordered Logistic (GOLOGIT) regression for survey data was used to determine the factors associated with a four-level ordinal malnutrition variable, generated by summing up all the types of malnutrition a child had at the time of data collection. Bayesian hierarchical spatial models were built in INLA to incorporate spatial autocorrelation in the modelling of malnutrition. Results: Factors associated with at least two types of malnutrition in this study were mother’s body mass index (BMI), mother’s breastfeeding status, child’s sex, age group, birth weight category and twin status as well as household’s wealth index. There was a consistent observation that female children were at a less risk for malnutrition than males and also that higher birth weight was protective of malnutrition. There was no clustering of malnutrition outcomes. The spatial random components that were added to the Bayesian hierarchical models did not improve any of the models. Conclusion: The findings from this study are consistent with findings from other researches and identify the factors associated with each of the common types of malnutrition. In addition the study reveals that there was no particular spatial distribution of malnutrition outcomes at the time of data collection. The study suggests further investigation of the effects of dietary diversity and mothers’ decision making power on malnutrition. Zimbabwean policy makers can make use of the findings from this study to provide evidence on which to base nutritional programmes in the country.

A report on a study submitted to the Department of Speech Pathology, Faculty of Arts. University of The Witwatersrand, Johannesburg in Partial fulfilment of the requirements for the Degree of Masters of Arts in Speech Pathology, Johannesburg, 1998. / This study was designed to examine the incidence of dysphagia in a group of fifty diabetic patients. The interrelationship between dysphagia and other complications of diabetes was examined. These included neuropathy, orthostatic dysfunction, renal dysfunction and respiratory disorders. Issues such as type of diabetes, patient age and age of onset were addressed. The utility and sensitivity of an interview schedule devised by the researcher was critically evaluated. Data were obtained through the administration of a standardized open-ended interview schedule coupled with an examination of the patients' hospital files. Results were interpreted and tabulated by the researcher. Results revealed that a significant proportion of diabetic patients are experiencing swallowing difficulties within all three phases of the swallow process. It is postulated that the cause of the dysphagia may be due to severe autonomic neuropathy and consequent vagal denervation. The highest incidence of dysphagia appeared to be amongst Type I diabetics who developed diabetes before the age of forty. The interview schedule was thus able to detect those patients experiencing dysphagia. However it was found to be unsuccessful in determining the severity of the problem. Clinical implications for both the Speech Therapist and the Medical team are discussed. Suggestions for future research are put forward.

A research report submitted to the Faculty of Health Sciences, University of Witwatersrand , in partial fulfillment of the requirements for the degree of Master in the branch of Psychiatry / The aim of this report was to establish the profile of all the patients with borderline personality disorder admitted to the Acute Inpatient Psychiatric Assessment Unit at the Helen Joseph Hospital over the course of one year. A retrospective record review was conducted to investigate the prevalence, demographics, reasons for admission, treatment and length of stay of the group of patients that was selected based on discharge diagnosis and DSM-IV-TR criteria, that were admitted throughout the course of 2010. The follow-up plan upon discharge was also reviewed. Statistical data analysis revealed findings mainly in keeping with international norms. The length of stay of patients with borderline personality disorder exceeded the average length of stay of all the patients in the ward in 2010, which illustrates that these patients are above-average users of resources. Patients with borderline personality disorder were shown in the review to be extremely inconsistent with regards to scheduled follow up plans, however significantly used emergency services at the hospital. Implementation of targeted prevention and early intervention strategies, based on systematised programs such as dialectical behavioural therapy and mentalisation-based therapy, may be useful in addressing this. This report supports further research into the utilisation of services available for patients with borderline personality disorder in the wider context of both psychiatric and psychological interventions in Southern Gauteng.

This study aims to determine the number of patients secluded over a specified period, provide a profile of patients that are likely to be secluded, and to ascertain the reasons for seclusion. Seclusion in the psychiatric context can be defined as the involuntary confinement of an agitated, unstable person alone in a contained, controlled environment. There are differing views on seclusion and consequently this has presented clinicians with an ethical dilemma. Significant morbidity and mortality have been associated with seclusion. In light of this, alternatives to seclusion have been explored. No data exists in South Africa on rates of seclusion for psychiatric purposes, and consequently neither the need for seclusion nor alternatives to seclusion have been explored. The study is a retrospective review of patients secluded at Sterkfontein Hospital, a tertiary psychiatric hospital, over a six month period. Data was collected from clinical records at Sterkfontein Hospital. RESULTS: 112 patients were secluded over the 6 month period. Users were secluded for a total of 59415.5 hours and on 4814 separate occasions. 84.8% of the users secluded were male. The mean age of users secluded was 29years. Just over half the users (52%) were secluded for their own safety and 40% of users were secluded for aggression (either physical or verbal). The commonest diagnosis was Schizophrenia (31.4%) followed by Cognitive Impairment (20.6%) and Bipolar Mood Disorder (13.7%). The most commonly used medication was Sodium Valproate (17%), followed by Haloperidol (11%) and Risperidone (11%). CONCLUSION: Younger male patients with psychosis were most likely to be secluded. More research should be conducted locally to compare seclusion in terms of rates and patient profiles so that we may improve seclusion practices.

No description available.

Sleep research with adults with learning disabilities has been limited. This study considered the sleep problems experienced by adults with learning disabilities in two main sections, a survey and an intervention. The survey assessed the prevalence, nature and range of sleep problems experienced by adults with learning disabilities who live at home with their families, and investigated the relationship between sleep problems and daytime behaviour disturbance. The intervention part of the study considered whether daytime behaviour difficulties reduced following a successful sleep intervention, and whether carer stress was influenced by an improvement in sleep problems. Individuals with learning disabilities who live at home with their families had prevalence figures for sleep problems higher than those experienced by the general population. The relationship between sleep and behaviour problems was highly specific with settling problems predicting hyperactivity, lethargy, irritability and the overall score on behavioural measures. The interventions did not provide substantial evidence that sleep and behaviour were related, with only one of six participants demonstrating a decrease in behaviour problems following an improvement in sleep. Carer stress did not significantly reduce as a result of the intervention. The study has provided prevalence rates of sleep problems for a population which has not been previously studied. It concludes that the relationship between sleep and behaviour definitive conclusions can be drawn. The efficacy of behavioural interventions was demonstrated, and the clinical and theoretical implications of the results were considered.