D.Cur. / In South Africa, mood disorders, specifically depression, accounts for the most psychiatric related hospital admissions. The total cost (overt and hidden) of mood disorders that result from lost productivity, can be estimated at billions of rand per year. In addition to economic costs, depression can carry great personal costs because of the social stigma associated with the diagnosis and treatment of a 'mental illness'. This stigma likely plays a big role in women' reluctance to seek, accept and adhere to treatment. The potential savings to be derived from the appropriate treatment of women suffering from depression are socially and economically significant. The focus in this thesis has been on women suffering from depression as it is estimated that at least twenty five percent of women will suffer from a major depressive episode in their life. Based on the problem statement that was included in this thesis, the researcher asked the following questions: 'What is the phenomena that constitutes the restoration process of women suffering from depression? Which processes contribute to the restoration process of women suffering from depression and facilitate these women's quest for mental health as an integral part of wholeness? How can an approach to provide quality care to women suffering from depression be described?" The primary purpose of this thesis was thus to explore and describe the processes contributing to the restoration process of women suffering from depression, in order to develop a mental health nursing approach that will provide quality care to women suffering from depression in their continuous quest for mental health. The psychiatric nurse specialist then developed and described guidelines to operationalise the approach that contributes to quality care of women suffering from depression in mental health nursing. The paradigmatic basis of this study was based on the Nursing for the Whole Person Theory (Oral Roberts University, Anna Vaughn School of Nursing, 1990:136-142) as used by the Rand Afrikaans University. This theory is based on a Judea-Christian philosophy.

Demuestra mediante el estudio, evolución y análisis de un caso clínico la teoría propuesta por Jorge Castelló Blanco (2005) acerca del constructo de dependencia emocional. El tipo de investigación fue un estudio de caso de tipo único. Así, se evaluó a una mujer de 36 años diagnosticada por un profesional de la salud mental con depresión mayor. Las técnicas de recolección de información e instrumntos utilizados fueron ; observación de conducta , entrevista y anamesis de la evaluada, Inventario de Cociente Emocional Baron ICE, Inventario de personalidad Neo Pi-R, Inventario Clínico Multiaxial Millon II, Inventario de Dependencia Emocional-IDE, Entrevista Clínica para la Dependencia Emocional y se incluyó tambien una entrevista a una persona allegada a la evaluada . Los resultados obtenidos en este caso permitieron ejmplificar la Teoría de Castelló (2005) y sus distintos aspectos acerca de la dependencia emocional. Igualmente, se descartó el diagnóstico de depresión mayor para ser reemplazado por el de dependencia emocional. / The aim of this research was to exemplify, by the study, development and analysis of a clinical case, the theory proposed by Jorge Castelló Blasco (2005) about the construct of emotional dependence. The type of research was a single type case. Therefore, a 36- year-old woman, who was diagnosed with major depression by a health professional, was evaluated. The techniques for collecting information and instruments used were: Subject´s behavior observation, interview and anamnesis, BarOn Quotient Emotional Inventory, Revised Neo Pi-R Inventory, Millon Clinical Multiaxial Inventory II, Emotional Dependency Inventory – IDE, Emotional Dependence Clinical Interview and an interview to a close person. The results obtained allows us to exemplify Castello´s theory (2005) and its aspects about the emotional dependency. In adittion, the diagnosis of major depression was replaced by the emotional dependence diagnosis. / Tesis

Depression is the most common psychological sequela associated with stroke, affecting approximately 33% of stroke survivors (Hackett, Yapa, Parag, & Anderson, 2005) with corresponding impacts on spouses, partners, or other informal caregivers (Han & Haley, 1999; Low, Payne, & Roderick, 1999). Although stroke is more common in older persons, persons of all ages are at risk for stroke and especially post-stroke depression (Centers for Disease Control and Prevention [CDC], 2007; Barker-Collo, 2007; Hughes, Giobbie-Hurder, Weaver, Kubal, & Henderson, 1999). One of the factors which could explain increased risk of depression is "biographical disruption" (Bury, 1982), which happens when couples experience chronic illnesses that are developmentally off schedule or unexpected (Faircloth, Boylstei, Rittman, Young, & Gubrium, 2004; Pound, Gompertz, & Ebrahim, 1998; Roding, Lindstrom, Malms, & Ohman, 2003). The goal of this dissertation study was to examine modifiable factors associated with depression in stroke survivor-spouse dyads, including the potential moderating effects of biographical disruption. This goal was accomplished by pursuing three specific aims: (1) investigating the extent to which dyad-level factors are associated with current depression in stroke survivor-spouse dyads, above and beyond the influence of individual-level factors; (2) investigating the extent to which biographical disruption associated with stroke moderates the strength of association between individual and dyad-level factors and depression; and (3) exploring additional individual- and dyad-level features of disruption from stroke not included in the structured portion of the interview, and to explore how the experience of stroke may be different for couples in different developmental stages of life. Thirty-two recent stroke survivor-spouse dyads were interviewed using a combination of standardized measures and semi-structured interviews. Results showed that several dyad-level factors such as relationship quality, illness appraisal, and coping patterns were significant predictors of depression for survivors and spouses. The presence of biographical disruption did not statistically moderate these relationships, although the qualitative aspect of the study uncovered many aspects of disruption not addressed in the structured interview and the illness experience was clearly unique for couples in different developmental stages. These results have relevance for the development of effective interventions for post-stroke depression in couples, and are encouraging with respect to operationalizing and measuring the notion of biographical disruption from chronic illness across the lifespan.

The Hamilton Rating Scale for Depression (HRS), a 17-item observer-rated scale, was first developed in 1960 to assess the severity of depressive symptomatology in patients diagnosed as suffering from depression. The HRS has since demonstrated high inter-rater reliability (with coefficients ranging from .87 to .94), and has proven useful in measuring changes of severity following treatment.

The preponderance of females in the depressed population is a well established fact. Various hypotheses for this fact are reviewed and the hypothesis that females accepting the feminine role will be more likely to become depressed during their middle years than a more androgenous woman is submitted. To support this hypothesis a study was designed utilizing a Clinical group consisting of females, 35 to 50 experiencing depression and undergoing treatment for depression at one of three mental health centers and a Non-clinical group consisting of women, same age group, not experiencing depression and who had never undergone treatment for depression. Each subject was asked to complete a questionnaire to measure depression and femininity. Results of this study support the hypothesis that depression in middle-aged females is related to the degree of their acceptance of the traditional feminine role. Depression as defined and measured by Beck's Depression Inventory was positively correlated with femininity as measured by Bern's Sex-Role Inventory. The Pearson correlation coefficient for these two measures was .62 (p < .001), indicating that 38% of the variance in depression scores can be accounted for by the sex-role variable.

No description available.

Thesis (PhD)--Stellenbosch University, 2014. / ENGLISH ABSTRACT: The growing burden of mental illnesses in low- and middle-income countries, such as Uganda, necessitates effective interventions to promote mental and social well-being among their populations. Mood disorders contribute more substantially to the global burden of mental illnesses than do other forms of mental disorders. The substantial global burden of mental illnesses is projected to grow more rapidly in low- and middle-income countries than in high-income countries in the future. Because experiences of and responses to mood disorders are invariably patterned by social and cultural contexts, as argued in the growing field of cross-cultural psychiatry, health care systems, especially in low- and middle-income countries, need to design and deliver culturally relevant interventions that effectively deal with this problem. However, there is generally a paucity of suitable evidence to guide the planning and delivery of such interventions in countries like Uganda. As a response to the apparent knowledge and research gaps regarding experiences of mood disorders and care in Western Uganda, I conducted a qualitative study involving outpatients and their care providers, that is, outpatients’ families, psychiatric health workers, religious healers and traditional healers. Using purposive and snow ball sampling techniques, I selected participants, that is, outpatients as well as psychiatric health workers, outpatients’ families, religious healers and traditional healers involved in the care of the outpatients from the Mbarara Regional Referral Hospital (MRRH) and the “Greater Mbarara” region, respectively. The aim of this study is to explore explanatory models that outpatients and care providers in Western Uganda use in responding to mood disorders. I analysed the data collected in the fieldwork using ATLAS.ti 6.2, a computer-software programme designed to support qualitative data analysis. Results from the study indicate that outpatients and their care providers hold complex, diverse and contradictory explanatory models regarding mood disorders and care, which are shaped by their unique social and cultural contexts. Additionally, poor relationships and communication between patients and their care providers, especially between outpatients and psychiatric health workers, are strongly evident; structural barriers significantly hinder the provision and utilisation of care; care is generally inadequate, although it is conceptualised broadly to include biomedical, popular and folk treatments; and outpatients generally exhibit inconsequential (weak) agency in managing distress, which is primarily caused by mood disorders and care-seeking challenges. The results of the current study suggest several implications regarding mental health practice, training, policy and research. / AFRIKAANSE OPSOMMING: Weens die toenemende geestesiektelas in lae- en middelinkomstelande soos Uganda word intervensies vereis om die geestelike en maatskaplike welsyn van die bevolkings van daardie lande te bevorder. Gemoedsteurings maak ’n groter deel van die wêreldwye geestesiektelas uit as ander vorme van geestesongesteldheid. Die beduidende wêreldwye geestesiektelas sal in die toekoms na verwagting vinniger in lae- en middelinkomstelande as in hoë-inkomstelande toeneem. Aangesien ervarings van én reaksies op gemoedsteurings meestal deur maatskaplike en kulturele kontekste beïnvloed word, soos die groeiende dissipline van transkulturele psigiatrie beweer, moet gesondheidsorgstelsels, veral dié in lae- en middelinkomstelande, kultureel tersaaklike intervensies ontwerp en voorsien wat hierdie probleem doeltreffend hanteer. Tog is daar oor die algemeen ’n skaarste aan geskikte bewyse om die beplanning en voorsiening van sulke intervensies in lande soos Uganda te rig. In antwoord op die klaarblyklike kennis- en navorsingsleemtes met betrekking tot ervarings van gemoedsteurings en sorg in Wes-Uganda het ek ’n kwalitatiewe studie onder buitepasiënte en hul versorgers – met ander woorde hul familie, psigiatriese gesondheidswerkers, geloofsgenesers en tradisionele genesers – onderneem. Die steekproef het bestaan uit pasiënte en hul familielede, psigiatriese gesondheidswerkers sowel as geloofs- en tradisionele genesers wat gemoeid is met die versorging van buitepasiënte by die streeksverwysingshospitaal Mbarara (MRRH) én in die Mbarara-distrik onderskeidelik. Die doel met die studie was om te verken watter verklarende modelle pasiënte en versorgers in Wes-Uganda gebruik om op gemoedsteurings te reageer. Die data wat met die veldwerk ingesamel is, is ontleed met behulp van die rekenaarsagteware ATLAS.ti 6.2, wat ontwerp is om kwalitatiewe dataontleding te ondersteun. Die resultate van die studie toon dat buitepasiënte en hul versorgers oor komplekse, uiteenlopende en teenstellende verklarende modelle met betrekking tot gemoedsteurings en sorg beskik, wat deur hul unieke maatskaplike en kulturele kontekste gevorm word. My navorsing dui daarop dat swak verhoudings en kommunikasie tussen pasiënte en hul versorgers, veral tussen buitepasiënte en psigiatriese gesondheidswerkers, aan die orde van die dag is; dat strukturele versperrings die voorsiening en benutting van sorg beduidend verhinder; dat sorg oor die algemeen onvoldoende is, hoewel dit volgens die algemene begrip biomediese, populêre én volksbehandelings insluit, en dat buitepasiënte meestal ontoereikende (swak) vermoëns toon om nood wat uit gemoedsteurings en uitdagings in die soeke na sorg spruit, te hanteer. Die studie sit uiteindelik ook verskeie belangrike implikasies vir geestesgesondheidspraktyke, -opleiding, -beleid en -navorsing uiteen.

Aquesta tesi es planteja com a objectiu principal identificar, en pacients amb trastorn depressiu major (TDM), característiques neuroanatòmiques, tant a nivell neuroestructural com neurofuncional, que es puguin relacionar amb variables clíniques, d'evolució i de resposta a tractament i per tant, constituir fenotips de neuroimatge. Amb aquesta finalitat hem estudiat la relació entre les dades obtingudes mitjançant ressonància magnètica (RM) i variables com el subtipus depressiu (depressió amb malenconia i depressió comòrbida a trastorn obsessiu-compulsiu (TOC)), el nombre de recaigudes, el temps fins a la remissió o la resposta a tractament. Aquesta tesis doctoral consta de tres estudis principals: PRIMER ESTUDI: Es va estudiar un grup de pacients amb TDM que apareixia en el decurs d'un TOC, comparant-los amb un grup de pacients amb TOC pur. Es va deteminar que els primers presentaven una major reducció de l'escorça orbito-frontal medial (EOFm) i un patró de correlacions amb altres estructures que els diferenciava clarament dels subjectes amb TOC pur. Publicació: N Cardoner, C Soriano-Mas, J Pujol, P Alonso, B Harrison, J Deus, R Hernández-Ribas, JM Menchón, J Vallejo. Brain structural correlates of depressive comorbidity in obsessive-compulsive disorder. Neuroimage 2007; 38: 413-421 Factor d’impacte = 5,937. JCR 2010 = 1r quartil, 1r decil, número 1/14 (Neuroimatge). SEGON ESTUDI: Es va estudiar de forma transversal un grup de 70 pacients amb depressió malenconiosa, comparant-los amb una mostra de controls sans. Es van trobar reduccions de substància gris (SG) en l'ínsula esquerra i increment de la substància blanca (SB) en l'àrea troncoencefálica superior. Posteriorment es va realitzar el seguiment longitudinal d'aquests pacients, obtenint-se, en 30 dels 70 pacients inclosos en l'estudi transversal, una segona RM al cap de 7 anys. La SB de l'àrea troncoencefálica superior va mostrar una evolució temporal diferencial entre els pacients depressius i els controls sans, mostrant una disminució de volum en els primers i un increment en els segons. El decrement de SG en ambdues ínsules es va relacionar amb el nombre de recaigudes durant el seguiment. Publicació: C Soriano-Mas, R Hernández-Ribas, J Pujol, M Urretavizcaya, J Deus, B Harrison, H Ortiz, M López-Solà, JM Menchón, N Cardoner. Cross-Sectional and Longitudinal Assessment of Structural Brain Alterations in Melancholic Depression. Biological Psychiatry 2011; 69:318-325 Factor d’impacte = 8,674. JCR 2010 = 1r quartil, 1r decil, número 4/128 (Psiquiatria). TERCER ESTUDI: Es va estudiar mitjançant RM funcional (RMf) una mostra de pacients amb TDM amb la finalitat de determinar els correlats neurofuncionals de la resposta al tractament actiu mitjançant estimulació magnètica transcranial repetitiva (EMTr), comparant-lo amb un grup de subjectes que rebien EMTr placebo. Es va relacionar la resposta clínica a EMTr amb l'activitat en l'escorça cingulada anterior (CCA), l’EOFm esquerra, l'escorça frontal medial (EFm) dreta i el putamen ventro-caudal esquerre. Publicació: R Hernández-Ribas, J Deus, J Pujol, C Segalàs, J Vallejo, JM Menchón, N Cardoner, C Soriano-Mas. Identifying Brain Imaging Correlates of Clinical Response to Repetitive Transcranial Magnetic Stimulation (rTMS) in Major Depression. Brain Stimulation (en premsa) Factor de impacto = 4,964. JCR 2010 = 1r quartil, número 41/239 (Neurociències). VALORACIÓ GLOBAL: En concordança amb les hipòtesis i els objectius del present treball, s’han descrit un conjunt d’alteracions neuroestructurals i neurofuncionals que es poden considerar correlats neurals d’aspectes clínics com el subtipus depressiu, d’aspectes evolutius com el nombre de recurrències clíniques, o d’aspectes relacionats amb la resposta al tractament antidepressiu. Aquests correlats es podrien considerar, segons el nostre criteri, com a fenotips de neuroimatge, ja que s’associen a característiques concretes del trastorn depressiu major i ens permeten diferenciar entre grups/subgrups de pacients. / MAGNETIC RESONANCE IMAGING STUDY OF NEURAL BASIS OF MAJOR DEPRESSIVE DISORDER: FOCUS ON SYMPTOMS, LONGITUDINAL COURSE AND RESPONSE TO TREATMENT SUMMARY: Main objective: To identify brain imaging correlates of clinical, outcome and treatment response variables in patients with major depressive disorder (MDD). FIRST STUDY 72 obsessive-compulsive patients (OCD) with (n=33) or without (n=39) MDD, and 72 control subjects (CS) were assessed. OCD with MDD showed a larger reduction of medial orbitofrontal cortex (mOFC) gray matter (GM) volume. Both OCD groups showed distinct correlations of mOFC GM volume with other brain regions. Publication: N Cardoner, C Soriano-Mas, J Pujol, P Alonso, B Harrison, J Deus, R Hernández-Ribas, JM Menchón, J Vallejo. Brain structural correlates of depressive comorbidity in obsessive-compulsive disorder. Neuroimage 2007; 38: 413-421 SECOND STUDY Whole-brain magnetic resonance images (MRI) were collected from 70 melancholic inpatients and 40 CS. A subset of 30 patients and 20 CS were rescanned after a 7-year period. In cross-sectional assessment, melancholic patients showed GM reductions in the left insula and white matter (WM) increases in the upper brainstem tegmentum. In longitudinal assessment, WM of the upper brainstem tegmentum showed a different temporal evolution between groups. Bilateral GM insulae reductions were associated with the number of relapses. Publication: C Soriano-Mas, R Hernández-Ribas, J Pujol, M Urretavizcaya, J Deus, B Harrison, H Ortiz, M López-Solà, JM Menchón, N Cardoner. Cross-Sectional and Longitudinal Assessment of Structural Brain Alterations in Melancholic Depression. Biological Psychiatry 2011; 69:318-325 THIRD STUDY Twenty-one MDD patients received active or sham repetitive Transcranial Magnetic Stimulation (rTMS) on the left dorsolateral prefrontal cortex. In the active rTMS group, clinical response was correlated to smaller pre-treatment deactivations in the anterior cingulate, the left medial orbitofrontal and the right middle frontal cortices, and to larger activations in the left ventral-caudal putamen. Publication: R Hernández-Ribas, J Deus, J Pujol, C Segalàs, J Vallejo, JM Menchón, N Cardoner, C Soriano-Mas. Identifying Brain Imaging Correlates of Clinical Response to Repetitive Transcranial Magnetic Stimulation (rTMS) in Major Depression. Brain Stimulation (in press) COMMENT In our research, we found brain imaging changes related to variables such as depressive subtype, number of clinical relapses or response to treatment. These imaging correlates could be considered as neuroimaging phenotypes.

Thesis (Ph. D.)--State University of New York at Binghamton, Department of Psychology, Clinical Psychology, 2009. / Includes bibliographical references.

No description available.