Major depressive disorder (MDD) constitutes the most commonly diagnosed mental illness affecting 16% of the population. Reduction in serotonergic tone is the most widely accepted etiological hypothesis for MDD and antidepressant treatments enhance serotonin (5-hydroxytryptamine, 5-HT) neurotransmission. Negative regulation of serotonergic raphe neurons is mediated by somatodendritic 5-HT1A autoreceptors, which are increased in depressed suicides and become down-regulated before antidepressants take effect. I hypothesized that genetic variations in regulatory regions of this receptor that dictate its expression, could contribute to predisposition to depression and treatment responsiveness. I initially addressed the basal mechanisms of human 5-HT1A receptor gene regulation using transient transfections with luciferase reporter constructs of 5' flanking sequences. A region between -1624 and -1550 by displayed strong repressor activity and contained at least three repressor elements: a consensus RE-1 and two copies of a novel dual repressor element (DRE). By yeast one-hybrid screening we identified a novel calcium-regulated repressor (Freud-1) that binds to DRE to reduce basal 5-HT1A receptor expression in neurons. Using an inhibitor of histone deacetylase (HDAC), we have demonstrated that Freud-1 mediates HDAC-independent repression in neuronal 5-HT1A positive cells, while REST or other DRE binding proteins recruit HDAC-dependant mechanisms to silence the receptor in non-neuronal 5-HT1A-negative cells. I also searched for sequence variations in 5-HT1A regulatory regions that may associate with depression. Further downstream from this region, we have identified a functional C(-1019)G polymorphism in the human 5-HT1A promoter that associates with major depression and completed suicide. The occurrence of the G allele at -1019 by prevents binding and repression by specific transcription factors NUDR and Hes5, identified by yeast one hybrid approach, and results in de-repression of the 5-HT1A receptor gene and hence, may contribute to the predisposition to depression. In conclusion, I have identified important transcriptional regulatory elements and proteins of the 5-HT1A gene implicated in serotonin neurotransmission, and characterized the mechanism of a new functional 5-HT1A promoter polymorphism involved in both suicide and MDD. This study may provide an improved marker for diagnosis and treatment of depression and provide a model for correlation between polymorphisms, gene expression and mental illnesses.

No description available.

Le diagnostic d'hyperactivite (ou TDAH) releve de la sphere medicale, mais son application concrete est souvent amorcee et developee par des enseignants et/ou des professionnels scolaires. La prescription de medicaments, dont le plus connu est sans doute le Ritalin, pose plusieurs problemes supplementaires. Les effets a court terme peuvent s'averer plutot serieux et les effets a long terme ne sont pas entierement clairs. D'autre part, la medicalisation du probleme peut nous amener a croire qu'il s'agit d'un probleme ou d'un desordre dont souffre cet individu. Il est pertinent de tenter de comprendre les variables institutionnelles qui peuvent entrer en jeu, notamment l'importance que revet l'ordre dans le cadre scolaire. L'appui theorique qui sous-tend cette approche pour etudier la categorisation d'hyperactif est ti'e de deux theories principales: la theorie de la construction sociale de la realite et la theorie de l'etiquetage. Dans un premier temps, nous examinons la construction des categories en general, notamment les categories de deviance. Cela nous permet d'extrapoler sur la construction de la categorie d'hyperactivite. Dans un deuxieme temps, nous etudions le processus d'etiquetage tel que decrit par Schur (1971) en tentant d'appliquer ce processus au processus d'etiquetage d'un enfant comme etant hyperactif. (Abstract shortened by UMI.)

The purpose of this study was to examine whether impaired smooth pursuit tracking, which has consistently been found in studies of adult schizophrenics, also characterizes adolescents with this disorder. Volumetric brain imaging (MRI) of specific regions thought to be implicated in disordered tracking (i.e., the frontal eye fields and cerebellar vermis), Wisconsin Card Sorting performance (i.e., WCST; a test considered to index frontal lobe functioning), and a measure of the integrity of visual-vestibular interaction were also assessed to examine the possibility of co-occurrence of deficits across patients in order to provide a better understanding of the correlates of impaired smooth pursuit tracking in this disorder. Subjects included 12 adolescents with schizophrenia (6 males, 6 females; mean age = 17.7 years) who were compared to 12 gender- and age-matched normal controls (mean age = 17.1 years). A surprising absence of group differences was found on standard, computer-quantified measures of smooth pursuit tracking (i.e., root mean-square error, gain, and saccades). However, post-hoc analyses using a visual (non-automated) rating scale revealed that the lack of group differences resulted from both controls and patients displaying high rates of impaired tracking. Although analyses of brain volumetrics revealed no overall group differences, two patient sub-groups were identified based on impairments on the WCST and the visual-vestibular index, providing indirect evidence of frontal and cerebellar involvement in these sub-groups, respectively. These results question the usefulness of smooth pursuit tracking impairment in discriminating individuals with schizophrenia from normals at this young age, and are interpreted as providing indirect support for the neurodevelopmental hypothesis of schizophrenia. The need for further studies of smooth pursuit tracking in this population, using a multiparameter approach, is highlighted.

Clinical wisdom suggests that adults with histories of childhood trauma will have difficulty engaging in psychotherapy. I examined the relationship between early childhood trauma and treatment response in the form of rate of symptom decline among a group of 202 adults recruited into the longitudinal Austen Riggs Center Follow-Along Study. Participants were recruited at admission to the hospital and provided extensive demographic and clinical data at baseline, including retrospective recall of childhood traumatic experiences using the Traumatic Antecedents Interview (TAI) and narrative responses to the Relationship Anecdote Paradigm (RAP) used to generate ratings on the Social Cognition and Object Relations Scale (SCORS). Participant symptoms were assessed at baseline and again every six to eight months for up to four years using the Symptom Checklist-90-Revised (SCL-90-R). Hierarchical Linear Modeling (HLM) was used to perform growth curve modeling of the symptom change data, which demonstrated an overall linear rate of decline and significant unexplained variability. The hypothesis that degree of childhood trauma would predict rates of symptom change failed to receive support, as did other related hypotheses. Only participant age predicted differences in rates of symptom decline, with younger participants' symptoms declining more rapidly than those of older participants. The findings indicate the following: (1) symptom severity tends to decline linearly after hospital admission, (2) individual rates of symptom change vary considerably, and (3) rates of symptom decline may slow as people age. Implications for clinical research and practice are discussed.

Wandering, a common behavior exhibited by the confused elderly (Mayer and Darby, 1991; Monsour and Robb, 1982), poses a significant problem to the individual, to the family, and to care providers. The research supporting the effectiveness of various interventions in managing wandering behavior indicates that simple procedures and environmental modifications may be used to good effect. It is unclear, however, which interventions are being utilized in the nursing home setting (Fisher, Fink, and Loomis, 1993), and which interventions are the most economically practical. This study had three main goals. The first was to obtain descriptive data on the problem of wandering in the nursing home setting, including the prevalence of wandering, the reasons why it is considered a problem, and the interventions used to manage it. The second goal was to determine whether or not specific factors, such as staff-to-patient ratio, exercise and activities reduce the problem of wandering. The final goal was to compare the problem and management of wandering behavior on traditional nursing units and specialized Alzheimer's units. The nursing director of each skilled nursing facility in the Commonwealth of Massachusetts (N = 584) was asked in writing to complete a survey regarding the problem of wandering in his/her facility. The total number of surveys returned was 197 or 37.81%. Data were analyzed by means of descriptive statistics, correlational procedures, ANOVAs, and regression analyses. The prevalence of wandering behavior in the nursing home setting was found to be 11.6% on traditional units and 52.71% on Alzheimer's units. Important information was gained on the use and effectiveness of various strategies in the management of wandering behavior. Moreover, it was determined that certain interventions were not used because the facilities were unaware of them or lacked the money and staff to implement them. Regression analyses determined that the percent of wanderers and the use of psychoactive medication were significant predictors of the degree to which wandering is viewed as a problem. Finally, Alzheimer's units were found to offer a unique and valuable setting for the care of wanderers. Explanations for these results as well as the limitations of the study were discussed.

Diagnostic classification systems are designed to identify clinical conditions that produce significant decrements in functional status. Historically, there has been a tendency to consider conditions that fall below threshold levels as temporary phenomena that do not interfere with daily functioning. However, dismissing subthreshold symptoms may be particularly problematic for older adults. The present study examined the relationship between depression, anxiety, and decrements in functional status among older adults using both continuous and categorical diagnostic approaches. One hundred veterans were recruited from the Veterans Health Study, a longitudinal investigation of male veterans' health. Participants completed screening measures of depression, anxiety, functional status, medical comorbidity, and the SCID anxiety and mood modules. One-quarter of the sample met DSM-IV criteria for one of the targeted mood or anxiety disorders. Continuous and categorical measures of depression were significantly related to decrements in functional status above and beyond comorbid medical conditions. A significant association was found between anxiety symptoms (per continuous measure) and decrements in functional status. This finding suggests that anxious symptoms are related to decrements in work, self-care, and leisure activities. Moreover, the results indicate that continuous measures of anxiety that focus on severity of symptoms rather than the presence or absence of a disorder, may be a more appropriate for assessing late-life anxiety. Health care professionals who treat older adults should not dismiss anxious or depressive symptoms among frail older adults as merely a natural outcome of aging or disease. Efforts to reduce decrements in functional status experienced by older adults with anxious and depressive symptoms should focus on educating health care providers to recognize and treat the full spectrum of anxiety and depressive syndromes.

Background: Despite the movement in global mental health that advocates for task-sharing, few studies have investigated the experiences of facility-based counsellors (FBCs) who provide a psychosocial intervention for mental illness in primary healthcare. Project MIND, a cluster-randomized controlled trial at 24 primary healthcare facilities in the Western Cape, trained FBCs to deliver a threesession evidence-based intervention for patients with a common mental disorder. Therefore, project MIND presents an opportunity to address a gap in the literature by exploring the experiences and needs of FBCs delivering a psychosocial intervention. Aims & Objectives: The overall aim of this study is to explore the experiences of FBCs working on Project MIND in the dedicated (training and adding a counsellor to the chronic disease team) and designated (training and using existing counsellor from the chronic disease team) intervention arms. Specific objectives included: (1) exploring the barriers and challenges that FBCs experienced while delivering a psychosocial intervention; (2) exploring FBCs' perceptions of regular structured supervision, debriefing and in-service training for improving micro-counselling skills; and (3) eliciting suggestions from the FBCs for future scale up of counselling services in primary healthcare settings. Methods: A qualitative study was conducted among FBCs delivering the project MIND psychosocial intervention (N=18). All interviews were conducted by an independent qualitative interviewer in a private room at the primary healthcare facilities. Interviews were audio-recorded and transcribed verbatim. NVivo 12 was used to store data and facilitate analysis using the Framework Approach. Results: Findings of the study were grouped according to four main themes. The first theme focused on FBCs' perceptions of the benefits of the project MIND training. Several perceived benefits were reported such as having a better understanding about mental illness particularly depression, enhanced counselling skills and transferability of skills to other daily duties in the healthcare facility. Role-playing stood out as a key training component to assess counselling readiness. The second theme focused on barriers and facilitators related to the implementation of the project MIND intervention. Designated FBCs reported competing task demands as a barrier to implementing the MIND intervention compared to designated FBCs. Further, most designated counsellors reported feeling marginalized in the facility due to their lowly status. Other barriers reported which impacted on their motivation to implement the MIND intervention by both dedicated and designated FBCs were low remuneration, a lack of counselling space, and a lack of privacy and confidentiality. Regarding facilitators to implementing the MIND intervention, experiencing first-hand how well patients were able to solve some of their problems using the problem-solving method and taking responsibility for their health motivated FBCs to implement the MIND intervention. In addition, the MIND intervention aided FCBs with solving their own problems which enhanced their belief in the effectiveness of the intervention. The third theme dealt with how FBCs perceive the clinical supervision and debriefing provided by project MIND. Regular structured supervision, debriefing and in-service training delivered by a registered psychological counsellor, a novel approach, was perceived as beneficial to all FBCs as it provided them with a means to reassess and improve their counselling skills. Further, role-playing was reported as an effective method for rehearsing their counselling skills and enhancing quality of intervention delivery. Fidelity feedback through audio-recorded counselling sessions was highlighted as feasible. Considerations around space, location (distance), a lack of privacy, and scheduling were mentioned. The fourth and final theme focused on FBCs' recommendations for improving the project MIND training, supervision and debriefing model, and implementation. FBCs recommended that more time should be allocated for role-playing and skills rehearsal exercises during training to test their counselling skills and readiness. There were some suggestions that the amount of training hours per day should be reduced as it might aid FBCs to remain focused and retain information. Regarding supervision, a few FBCs recommended incorporating occasional peer group supervision and debriefing to benefit from shared experienced. Other recommendations were adding content related to substance use to the intervention and including management in training. Conclusion: Regular structured supervision, debriefing and in-service training provided by a Registered Counsellor are both feasible and beneficial for improving micro-counselling skills and the quality of intervention delivery among FBCs delivering a psychosocial intervention. Considerations for scaling up FBC-led psychosocial interventions should involve addressing barriers such as limited counselling space, remuneration, and marginalization.

No description available.

As the need for psychosocial interventions in mental healthcare in the United States continues to be a relevant issue, music therapists can provide music interventions to address a variety of mental health objectives. The American Music Therapy Association (2013) requires that the use of such interventions must be part of evidence-based practice. As research shows low levels of evidence for psychiatric music therapy overall (Silverman, 2010a), and there are mixed perceptions of music therapy in mental healthcare (Choi, 1997; Silverman, 2006, 2010d) there is a need to continue to increase consistency of music therapy interventions and levels of evidence in music therapy research with mental health populations. Therefore, the purpose of this study was to (a) to identify possible trends in research design, participant population, and music therapy intervention techniques used in music therapy research studies with mental health populations published in The Arts in Psychotherapy, Journal of Music Therapy, and Music Therapy Perspectives the last 15 years (2000-2015), and (b) identify how these trends might apply to future music therapy research and clinical practice. Data about the publication, research design, and therapeutic process of studies (N = 42) were obtained. Data were analyzed and organized into tables, and sums and percentages were calculated. Results saw low levels of articles fitting inclusion criteria with a large percentage of studies being conducted by the same author. The most frequently studied participant populations included those with substance-abuse and addicted disorders (n = 10) and psychiatric inpatients (n = 10). The most frequently studied music therapy intervention techniques were lyric analysis (n = 17), music listening (n = 16), and songwriting (n =15). Potential explanations for findings, limitations, and suggestions for future research and clinical practice are discussed. / A Thesis submitted to the College of Music in partial fulfillment of the requirements for the degree of Master of Music. / Summer Semester 2015. / July 10, 2015. / descriptive analysis, mental health, music therapy, psychiatric music therapy, qualitative research, quantitative research / Includes bibliographical references. / Jayne M. Standley, Professor Directing Thesis; Dianne Gregory, Committee Member; Kimberly VanWeelden, Committee Member.