Armed conflict, guerrilla warfare, and political violence have contributed to the burden of disease and disability, especially among civilian populations of Peru. The effects of war and political violence can be long lasting and can determine the capacity of people to reconstruct their lives long after wars have ended. The current project is a cross-sectional, qualitative, follow-up study among Quechua populations of the South Central Peruvian highlands who were exposed to twenty years of protracted violence between1980-2000. The previous study was conducted by Pedersen et al (2008) and revealed that of all respondents who had been exposed to violence, one in four (N=92) reported symptoms compatible with the DSM-III-R diagnosis of PTSD. However, due to the absence of mental health services in the province, it was virtually impossible to refer those cases for treatment and follow-up. It has been ten years since the first survey, and a subsample of the number of PTSD positive cases that were detected in 2000, were relocated and interviewed to elicit narratives on the experiences of distress, mental illness, coping and resilience for Quechua individuals of this highland region. The study was conducted in Ayacucho, Peru in four rural communities as well as one urban setting. Semi-structured interviews were carried out with 17 informants who met the compatibility of PTSD in 2000, half of whom continued to have PTSD symptoms in 2011. The findings indicate that individuals express more distress about the tremendous difficulties of surviving in the present day than about the trauma symptoms of the war. Findings suggest that although informants continued to have symptoms of distress, they found resilience in certain community resources, including social, cultural and economic resources. The data reveals that postwar psychosocial health cannot be separated from the broader political and economic structures. / Les conflits armés, la guérilla, et la violence politique ont contribué à les repensions de fléaux, la morbidité au niveau de pertes en vies humaines et les incapacités, surtout parmi les populations civiles du Pérou. Les effets de la guerre et de la violence politique peuvent languir et permet de déterminer la capacité des gens à reconstruire leur vie longtemps après la fin des guerres. Le projet en cours est une étude de suivi, transversale, qualitative chez les populations quechua des hautes terres de South Central Pérou qui ont été exposées à vingt ans de violence entre 1980-2000. Le but de l'étude était d'obtenir des récits sur les expériences de détresses, la maladie mentale, l'adaptation et la résilience des personnes quechua de cette région montagneuse. L'étude a été menée à Ayacucho, au Pérou dans quatre communautés rurales ainsi que d'un milieu urbain. Des entrevues semi-structurées ont été menées par 17 informateurs qui ont rencontré la compatibilité de stress post-traumatique en 2000, dont la moitié ont continué à avoir des symptômes de PTSD. Les résultats indiquent que les individus expriment plus de détresse due aux énormes difficultés de survie a l'époque actuelle contrairement aux symptômes de traumatisme de la guerre. Les résultats suggèrent que, bien que les informateurs ont continué à avoir des symptômes de détresse, ils ont trouvé un support morale aux niveau des ressources communautaires, sociales, culturelles et économiques mis à leur disposition. Les données révèlent que la sante psychosociale d'après-guerre ne peut pas être séparée des structures politiques et économiques.

Background. The comorbidity between psychotic illness and substance abuse is associated with negative outcomes. To better treat substance use in psychosis it is necessary to identify factors specifically promoting substance use in this population, particularly aspects of psychotic illness which may exacerbate substance use. Purpose. to identify whether early-life inattention-hyperactivity and deficits in reward processing could qualify as common factors underlying the comorbidity of psychotic illness and cannabis abuse. Methods. We conducted the following four experiments: 1. The ability of childhood symptoms of ADHD measured using retrospective parental report (Child Behavior Checklist) to predict cannabis-use outcomes in first episode psychosis (FEP). 2. Associations between self-reported anticipatory pleasure and cannabis use in psychosis patients and controls. 3. The effect of cannabis on daily activities and functional measures and on behavioural exertion for rewarding stimuli in psychosis patients and controls with cannabis use. 4. Examining physiological response to pleasant and cannabis images using event-related potentials (ERP), facial expressivity, and galvanic skin response in controls and psychosis patients with cannabis use. Results. 1. Higher levels of inattention symptoms in childhood predicted lifetime cannabis-use disorder and inability to maintain abstinence from cannabis in FEP. 2-4. Psychosis patients showed reward deficits on several measures including: self-reported reward response, engagement in effortful daily activities, behavioural exertion to seek pleasant stimuli, and sustained processing of pleasant stimuli as measured with the late positive potential (LPP) of the ERP. When comparing subjects' response to pleasant stimuli versus cannabis stimuli, control cannabis users showed a significant bias towards pleasant images on all measures, whereas patients showed similar response to both pleasant and cannabis stimuli on most measures. Reduced response on several of the measures on which patients showed a deficit was associated with greater cannabis use: self-reported reward response, behavioral exertion to seek pleasant stimuli, and LPP response to pleasant stimuli. Conclusions and significance. 1. Our finding that childhood inattention is associated with subsequent cannabis in FEP when complemented by studies showing these symptoms are more prevalent in subjects who later develop psychotic disorders is consistent with childhood inattention being a marker for shared vulnerability to develop both psychotic and substance-use disorders. 2-4. Deficits in reward processing are present in individuals with psychotic disorders and some of these deficits may predispose individuals to use cannabis more heavily. If these findings are further developed they could inform treatments targeted for substance use in populations with psychosis. / Introduction. La comorbidité entre les troubles psychotiques et l'abus de substances est associée à une évolution négative. Pour mieux traiter l'abus de substance dans la psychose, il est nécessaire d'identifier les facteurs spécifiques qui augmentent la prévalence de consommation de substances dans cette population, particulièrement les aspects du trouble psychotique qui pourraient exacerber la consommation de substances. Objectifs. Identifier si des symptômes d'hyperactivité-inattention durant l'enfance et des déficits dans les processus de récompense pourraient se qualifier comme des facteurs communs sous-jacents de la comorbidité des troubles psychotiques et de la consommation du cannabis. Méthodes. Nous avons fait les quatre expériences suivantes : 1. L'utilisation des symptômes de TDAH mesurés de façon rétrospective en utilisant un rapport des parents (Child Behavior Checklist) pour prédire la consommation de cannabis chez les premiers épisodes psychotiques (PEP). 2. L'association entre le plaisir anticipé rapporté et la consommation de cannabis chez les patients psychotiques et les contrôles. 3. L'examen de la réponse physiologique à des images plaisantes et de cannabis en utilisant les potentiels évoqués cérébraux (ERP), l'expressivité faciale et la conductivité de la peau chez les contrôles et les patients psychotiques qui consomment du cannabis. 4. L'effet du cannabis sur les activités quotidiennes, les mesures fonctionnelles et l'effortcomportemental pour des stimuli de récompense chez les patients psychotiques et les contrôles qui consomment du cannabis. Résultats. 1. Plus de symptômes d'inattention durant l'enfance prédirait un trouble de consommation du cannabis et l'inaptitude de rester abstinent pour le cannabis chez les PEP. 2-4. Les patients psychotiques démontrent des déficits de récompense sur plusieurs mesures incluant : la réponse rapportée de récompense, l'engagement dans des activités quotidiennes qui demandent de l'effort, l'effort exercé pour rechercher des stimuli plaisants et le traitement prolongé des stimuli plaisants tel que mesuré avec le potentiel retardé positif (LPP) de l'ERP. Lorsque l'on compare la réponse des sujets pour les stimuli plaisants versus les stimuli de cannabis, les consommateurs de cannabis contrôles ont démontré un biais significatif envers les images plaisantes sur toutes les mesures, alors que les patients ont démontré une réponse similaire sur les stimuli plaisants et de cannabis sur la plupart des mesures. Une réponse diminuée sur plusieurs mesures sur lesquelles les patients ont démontré un déficit était associée avec une consommation plus grande de cannabis : la réponse rapportée de récompense, l'effort comportemental pour rechercher des stimuli plaisants et la réponse LPP aux stimuli plaisants.Conclusions et signification. 1. Nos résultats concernant l'inattention durant l'enfance associée à une consommation subséquente du cannabis chez les PEP, lorsque complémentés par les études qui démontrent que ces symptômes sont plus prévalent chez les sujets qui développent plus tard des troubles psychotiques, sont consistants avec les symptômes d'inattention durant l'enfance qui sont déterminants dans la vulnérabilité à développer des troubles psychotiques et de consommation de substances. 2-4. Des déficits dans les processus de récompense sont présents chez les individus avec des troubles psychotiques et certains de ces déficits pourraient prédisposer les individus à consommer du cannabis de façon plus importante. Si ces résultats sont plus amplement développés, ils pourront donner des pistes de traitement pour la consommation de substances dans les populations psychotiques.

<p> This research introduced and studied a new response style construct, co-distraction. Co-distraction refers to diversion of attention from emotional problems to a neutral or pleasant stimulus within a dyadic relationship. It is characterized by discussing or engaging in neutral or pleasant activities, mutual encouragement to discuss or engage in neutral or pleasant activities, and a focus on positive feelings. It was hypothesized that co-distraction would serve a protective function by relating positively to friendship quality and negatively to depression and anxiety. </p><p> Participants were undergraduate college students who were recruited and tested online. They completed questionnaires measuring rumination, distraction, co-rumination, co-distraction, depression, anxiety, and friendship quality. In describing co-rumination, co-distraction, and friendship quality, participants reported on their relationship with their closest same-sex friend. Due to large differences in sample sizes between males (<i>N</i> = 40) and females (<i>N</i> = 138) as well as previously found gender differences on response style and emotional distress variables, the genders were studied separately in statistical analyses. </p><p> Results for co-distraction were as follows: (a) co-distraction scores had high reliability (alpha = .93), (b) co-distraction was positively correlated with positive friendship quality for females but not for males; (c) co-distraction was unrelated to emotional distress for both genders; and (d) it correlated positively with distraction and co-rumination for both genders. As predicted, rumination correlated positively with depression and anxiety, whereas distraction correlated negatively with anxiety for males only. Unexpectedly, co-rumination correlated negatively with one measure of depression for males and was unrelated to emotional distress for females. Distraction was positively correlated with co-rumination for males but was unrelated to co-rumination for females. All told, results were partly consistent with response styles theory. </p><p> In general, predicted gender differences were not obtained, and many results ran counter to expectation. The findings were discussed in light of the sample's highly diverse composition, and they emphasize the importance of taking into account culture when studying associations between response styles and outcomes of emotional distress and friendship quality. Implications for theory and for psychotherapy practice with depressed and anxious clients were discussed. Limitations and directions for future research were considered. </p>

No description available.

Objective: In this study, the effectiveness of the modified Recovery Workbook as a psychoeducational tool for facilitating recovery in persons with serious mental illness was examined. Methods: The study was a multi-center, prospective, single-blinded, randomized controlled trial. A total of 33 people receiving Assertive Community Treatment (ACT) services participated in the study. For 12 weeks, a control group continued receiving their usual treatment as determined by the ACT team, and an intervention group received the Recovery Workbook training in addition to the normal standard of care from the ACT team. Groups were compared using t-tests for continuous measures and chi-squared analyses with correction for continuity of dichotomous measures, as appropriate. The overall effects of the Recovery Workbook Training on individuals’ perceived level of hope, empowerment, knowledge, and quality of life were measured using a repeated measures analysis of variance (ANOVA). Team (PCCC-MHS/Frontenac) and group (experimental/control) were the between-subject factors, and time of testing (initial, final) was the within subject factor. Results: Participation in the Recovery Workbook was associated with significant change in participants’ perceived sense of hope, empowerment, and goal and success orientation. These associations remained significant when commensurate demographic variables were controlled for. Conclusions: This study is the first randomized controlled trial of a recovery-based psychoeducational intervention in persons with serious mental illness, and opens a new chapter of evidence-based practice for implementing recovery in mental health service delivery. / Thesis (Master, Rehabilitation Science) -- Queen's University, 2007-08-01 11:55:02.924

No description available.

This dissertation develops a meaning oriented model of the relationship between culture and the subjective experience of psychosis, by analyzing interviews and other ethnographic data collected over the course of a 12 month fieldwork in Istanbul, Turkey. The theoretic framework for the study is introduced on the basis of detailed discussions of the notion of schizophrenia, the questions of Turkey and Turkish identity, and the basic theories of semiotics. Derived from the theoretic framework, four principles are then proposed as fundamental features of the relationship between culture, meaning systems, subjectivity and psychosis, as follows. (1) the inseparability of the notions of subject, culture, and meaning system.(2) the simultaneous synchronicity and diachnoricity of sign systems. (3) the heteroglossic nature of private associative networks and narratives. (4) the conglomerate composition of subjective autobiographical narratives. Based on these principles, an analytic approach is then developed and applied towards in-depth cultural semiotic analyses of data collected from interviews with three psychotic inpatients, their families and their clinicians. The results of the analyses demonstrate strong evidence for an interrelational model of culture, meaning, subjectivity and psychosis, as well as a fundamental presence of diachronic modality in patterns of association and networks of meaning in patients' discursive efforts to re-establish psychic wholeness and self-identity. Based on these findings and in reference to the earlier theoretical principles, the results are formalized to conclude three principal modes of 'continuity': (1) the mutual continuity of private experience and collective meaning, which reflects the importance of understanding private psychological and subjective phenomena as contextualizated processes always embedded within collective systems of meaning and power, such as culture and politics. (2) the continuity of psychotic and non-psychotic modes of subjectivity, which further highlights the embeddedness of psychotic models of experience and behavior in local systems of meaning and power. (3) the continuity of systems in time, which highlights the temporal dimension of private and collective modes of experience, and thus emphasizes the significance of considering not only private life histories, but also local historical and political trajectories in clinical and intellectual assessment of subjective and psychological experiences such as psychosis.

Mental illness is characterized by alterations in thinking, mood and behavior and is associated with significant distress and impaired functioning. Many mental illnesses and medications used in their treatment, can in some way impair fitness-to-drive. / This thesis comprises two independent but complementary articles. In the first article, the authors review the most recent literature on fitness-to-drive amongst individuals with mental illness, including those using psychotropic medications. In the second article, the authors assess current attitudes, practices, and knowledge of Canadian psychiatrists concerning driving safety amongst individuals with mental illness using a nation wide cross-sectional survey based on a random sample of practicing Canadian psychiatrists.

Background: The anterior cingulate cortex (ACC), orbito-frontal cortex (OFC) and basal ganglia have been implicated in the neurobiology of pathological aggression. They are thought to be the structures involved in top-down regulation of impulses from the limbic system. This study aimed at identifying neuroanatomical correlates of impulsive aggression in healthy children. Methods: Data from 193 representative 6-18 year-old healthy children were obtained from the NIH MRI Study of Normal Brain Development after a blinded quality control (1). Cortical thickness and subcortical volumes were obtained with automated software. Aggression levels were measured with the Aggressive Behavior scale (AGG) of the Child Behavior Checklist (CBCL). AGG scores were regressed against cortical thickness and basal ganglia volumes using first and second-order linear models while controlling for age, gender, scanner site and total brain volume. 'Gender by AGG' interactions were analyzed. Whole brain random field theory corrections for multiple comparisons were implemented.Results: There were positive associations between bilateral striatal volumes and AGG scores (right: r=0.238, p=0.001; left: r=0.188, p=0.01). A significant association was found with right ACC and subgenual ACC cortical thickness in a second-order linear model (p < 0.05, corrected). High AGG scores were associated with a relatively thin right ACC cortex. An 'AGG by gender' interaction trend was found in bilateral OFC and ACC associations with AGG scores. Conclusion: This study shows the existence of relationships between impulsive aggression in healthy children and the structure of the striatum and right ACC. It also suggests the existence of gender specific patterns of association in OFC/ACC grey matter. These results may guide research on oppositional-defiant and conduct disorders.KEYWORDS: Aggression, Cortical Thickness, Anterior Cingulate Cortex, Orbito-Frontal Cortex, Striatum, Magnetic Resonance Imaging (MRI) / Contexte: Le cortex cingulaire antérieur (CCA), le cortex orbito-frontal (COF) et les noyaux gris centraux ont été identifiés dans les recherches sur la neurobiologie de l'agressivité pathologique. Ces structures seraient impliquées dans la régulation 'top-down' des impulsions produites dans le système limbique. Le but de cette étude était d'identifier les corrélations neuroanatomiques de l'agressivité impulsive chez les enfants en santé ayant un développement normal. Méthodologie: Les données de 193 sujets de 6 à 18 ans ont été obtenues de l'étude NIH MRI Study of Normal Brain Development après un contrôle visuel de qualité des données (1). L'épaisseur corticale et les volumes sous-corticaux ont été obtenus avec des programmes automatisés. Le niveau d'agressivité a été mesuré avec l'échelle de comportements agressifs (AGG) obtenue du questionnaire Child Behavior Checklist. Les scores de AGG ont été analysés en régression linéaire avec l'épaisseur corticale et le volume des noyaux gris centraux en utilisant des modèles de premier et de deuxième ordre, et en contrôlant pour les effets de l'âge, du sexe, du numéro de scanner et du volume cérébral total. L'interaction 'AGG X sexe' a aussi été analysée. Une correction statistique de type random field theory pour comparaisons multiples a été appliquée aux résultats.Résultats: Une association positive a été trouvée entre les scores de AGG et le volume du striatum bilatéralement (droite: r=0.238, p=0.001; gauche: r=0.188, p=0.01). Une association significative était aussi présente entre AGG et l'épaisseur corticale du CCA droit et du CCA sous-géniculé droit dans un modèle linéaire de deuxième ordre (p < 0.05, corrigé). Les scores AGG élevés étaient associés à un CCA droit relativement mince. Une tendance d'association entre l'épaisseur corticale et l'interaction 'AGG X sexe' a aussi été trouvée dans le COF et le CCA bilatéralement. Conclusion: Cette étude démontre l'existence d'une relation entre l'agressivité impulsive chez les enfants en santé et la structure anatomique du striatum, ainsi que du CCA droit. Elle suggère également l'existence de patterns d'associations spécifiques au sexe dans la matière grise du COF et du CCA. Ces résultats pourraient guider la recherche clinique sur le trouble oppositionnel avec provocation et le trouble des conduites. MOTS CLÉS: Agressivité, Épaisseur corticale, Cortex cingulaire antérieur, Cortex orbito-frontal, Striatum, Imagerie par résonance magnétique (IRM)

This mixed method pilot study examined whether the treatment of adults with Attention-Deficit/Hyperactivity Disorder (ADHD) would have an impact on marital relationships and family functioning. Eight patients receiving treatment from an adult ADHD Research Program and their spouses completed two questionnaires measuring marital adjustment and family functioning prior to and following 12 weeks of treatment. Follow-up semi-structured qualitative interviews were conducted with five of the couples. Quantitative results indicated that adults with ADHD observed an improvement in marital relationships following treatment. However, spouses did not observe a significant change. Neither adults with ADHD, nor their spouses reported family functioning changing as a result of treatment. The qualitative interviews suggested that adults with ADHD were more likely to describe their relationships as improving, whereas spouses were more cautious in their interpretation of their relationships following treatment. Neither adults with ADHD, nor their spouses reported changes in family functioning following treatment. In general, both adults with ADHD and their spouses supported the use of multimodal treatment for the treatment of ADHD. / Cette étude pilote utilise une méthode mixte pour examiner si le traitement d'un partenaire ayant le trouble de déficit de l'attention avec ou sans hyperactivité (TDAH) avait un effet sur les relations conjugales et fonctionnement de la famille. Huit patients qui ont reçu le traitement du programme de recherche du TDAH et leurs conjoints ont terminé deux questionnaires, qui mesurent l'état de leur relation conjugale et le fonctionnement de la famille, avant et après 12 semaines du traitement. Des entretiens semi-structurés ont été complétés avec cinq couples. Le résultat quantitatif suggère que les adultes avec le TDAH montrent des améliorations à leurs relations conjugales. Mais, leurs conjoints n'avaient pas observé cette amélioration. Ni les adultes avec le TDAH et ni leurs conjoints ont observé un changement dans le fonctionnement de la famille. Les entretiens qualitatifs suggèrent que les adultes avec le TDAH étaient plus susceptibles de décrire que leurs relations améliorent, mais les conjoints étaient plus prudents avec leurs interprétations de leurs relations après le traitement. Ni les adultes avec le TDAH et ni leurs conjoints ont observé un changement dans le fonctionnement de la famille après le traitement. En général, les adultes avec le TDAH et leurs conjoints soutenues utilisé un traitement multimodale pour le traitement du TDAH.