Second-generation antipsychotics (SGAs) are prescribed for treatment of psychosis. A major side effect of SGAs is an increased risk of metabolic syndrome (MetS) with symptoms of hypertension, hyperlipidemia, hyperglycemia, and truncal obesity. A clinic in the northeastern United States was not screening patients for MetS when being treated with SGAs. The purpose of this project was to educate staff on MetS risk factors, signs, symptoms, and patient management with a goal to improve their knowledge of MetS. Lewin's change theory provided a conceptual framework for the project. The project question explored the development and evaluation of an educational module on MetS increased staff knowledge. Educational content was guided by current literature and the American Psychiatric Association and American Diabetic Association practice guidelines. Five expert panel members, consisting of 3 psychiatrists, an advance practice nurse, and a registered nurse reviewed the education program and evaluated content using a Likert-type questionnaire. Expert panel evaluations indicated that the module content contained useful clinical information on MetS screening for patients on SGAs. After panel review, the program was presented to 7 clinic staff. Pretest and posttest questionnaires asked 10 multiple choice questions and results were compared. Questions on SGA side effects, MetS complications, prevalence, baseline assessment measures, lab work, and needed collaboration were answered correctly by 6 of the participants pretest and all questions after receiving the education program. The project has the potential to promote positive social change through staff education on MetS screening for patients, thus improving patient outcomes.

ABSTRACT OF THE THESIS MANDALA SPRINGS by Juleen Collins Florida International University, 2018 Miami, Florida Professor Debra Dean, Major Professor MANDALA SPRINGS is the small town setting for a story that explores the nature of secrets, lies, revelations, and the damage each can cause. The narrative follows Bodhi MacLachlan, a young woman who struggles with Borderline Personality Disorder, back to the psychiatric hospital where she has resided in-patient multiple times. The long-term association with her psychiatrist becomes complicated when she reveals details of her affair with a secretive man. Meanwhile, she becomes obsessed with uncovering the mysteries of the relationship between a new patient, Scott, and his much younger sister, Ollie, to whom he is guardian. As Bodhi proceeds, she unintentionally but irreparably damages her relationships with each of these characters. Ultimately, she must come to terms with the consequences of her actions. To reflect the complicated, upside down world of psychiatric illness, the story is written in the hybrid form of a playscript-novel.

The purpose of this qualitative study was to understand the meaning of formerly homeless Veteran’s male relationships to better understand their participation in intervention programs relying on interpersonal support. Interpretive phenomenological analysis was used to interpret five semi-structured interviews with previously homeless Veterans between the ages of 45-65 with serious mental illness. These men were participating in a peer-support based housing program. Analysis yielded the following five major themes and fourteen subordinate themes: Internalized Role Conflict i) internal conflict, Masculinity as a Barrieri) restricted emotions between men, ii) pride, iii) dominance, and iv) fear of other men, Building Supportive Relationships between Men i) negotiating masculinity, and ii) balancing power in men’s relationships, Experience Accepting Support i) de-shaming, ii) emotional relief, and iii) insight. Experience Giving Support i) strengthen self by supporting other man, and ii) use personal experience to support other men. Implications for providers and programs are discussed, as well as areas for future research.

Philosophiae Doctor - PhD / The aim of the study was to develop guidelines for social workers to be spiritually sensitive in their mental health practice. Spirituality in Namibia is an important part of the culture of the individuals that are served by social workers, as well as other caring professionals. For many, spirituality influences how they perceive their world. Spirituality is an important strength for individuals to manage their life challenges and for Namibians living with mental illness, spirituality is a source of comfort and strength during the recovery treatment process. However, the researcher determined that there is scant literature on the conceptualisation and utilisation of spirituality in the Namibian social work context and specifically among social work professionals’ practice with mentally-ill patients. Consequently, case studies were conducted to explore how Namibian social workers understand and utilise spirituality in their mental health practice, with the aim to develop guidelines for the practice. The research process was conducted in two phases. Phase one focussed on informationgathering through a scoping review, as well as two case studies through in-depth individual interviews. After the completion of the first phase of analysis, the data from the scoping review and the interviews were shared with the participants for the development of the guidelines. Phase two comprised two 1-day workshops for the purpose of developing guidelines for practice. The draft guidelines developed in the first 1-day workshop were forwarded for review to African experts in spirituality and social work from the University of the Witwatersrand and the Nelson Mandela University. The research participants for both the in-depth individual interviews and the workshops were social work practitioners who were or had been employed at the two mental health hospitals in Namibia. A purposive, non-probability sampling method was employed to select the participants for the research sample.

No description available.

The history of the care of the mentally ill in Britain, which has been broadly reflected in Western Australia since 1826, can be conveniently, if simplistically divided into a number of epochs. Each epoch is characterised by a particular focus or paradigm of clinical management, which prevails over a period of time but is then followed by a comparatively short period of rapid change to a new paradigm. Such changes are shaped by a number of forces, but three categories can be readily identified. These are: concepts of mental illness; reactions of administrative systems and the attitudes of medical practitioners. As the concept of the nature of mental illness has changed, succeeding epochs have evolved to a more humane and enlightened approach to the mentally ill. Nevertheless, each management paradigm has failed to deliver the expected 'cures' and the consequent reduction in the burden of illness. Each has been replaced by a new and radically different paradigm, often at enormous cost, but there has been no progressive evolution towards a system that incorporates measures that have proven value. In recent years 'Community Care', has failed in such a manner that there have been strong arguments that it should be abandoned. At the same time there is evidence that a new paradigm 'Primary Care Psychiatry' is emerging as government policy. The challenge is to preserve the best elements of community care and integrate Primary Care Psychiatry into the broader framework. The best chance of achieving this is to develop a gradual, evolutionary process, built on consensus between psychiatrists, general practitioners and administrators. / The purposes of the present research are threefold: to develop a conceptual model for an optimal community based mental health service. Then by examining the views of general practitioners, psychiatrists and administrators, determine the degree of congruence of these views. This is achieved by a qualitative study comprising extended interviews with 24 GPs, 15 psychiatrists and 11 administrators. This approach is chosen over a more broadly based, structured questionnaire approach for two reasons. Firstly, the views expressed in informal face to face interviews are more likely to be true expressions of opinion, especially when these are critical. Secondly, by using a comparatively unstructured approach, the stakeholders are able to express views on issues that they consider important. Finally, the areas of consensus and disagreement are analysed and recommendations made on strategies to develop a plan for a practical, viable service in a local area.

Abstract not available

Psychostimulant dependence is a major public health issue in many parts of the world associated with a wide range of psychological, medical and social problems. Psychosocial interventions are the mainstay of treatment for psychostimulant problems, although their effectiveness is compromised by poor uptake and compliance. Despite increasing knowledge of the neurobiological consequences of psychostimulant use, no medications to date have been any more successful than placebo in reducing psychostimulant use in dependent patients. Modafinil is a non-amphetamine type psychostimulant that may have potential as an agonist pharmacotherapy for psychostimulant dependence. The aim of this thesis was to examine the safety, efficacy and cost-effectiveness of modafinil 200 mg/day over ten weeks plus a four session brief CBT intervention for methamphetamine and cocaine dependence through two concurrent randomised placebo controlled trials. There were no statistically significant differences between modafinil and placebo in treatment retention, medication adherence, psychostimulant abstinence, psychostimulant craving or severity of psychostimulant dependence. Methamphetamine-dependent subjects tended to provide more illicit psychostimulant negative urine samples while in treatment than those who received placebo. There appeared to be a reduction in self-reported days of psychostimulant use among methamphetamine-dependent subjects who received modafinil compared to placebo, but the effect size was too small to be statistically significant in this sample. The reduction in self-reported psychostimulant use did reach statistical significance in methamphetamine-dependent subjects with no other substance dependence. Uptake of counselling was the most significant predictor of reduced psychostimulant use post treatment, and the addition of counselling improved the cost-effectiveness of modafinil relative to placebo. Modafinil appeared to be safe, well-tolerated, and non-reinforcing in this treatment population. Compared to placebo, there was a significant increase in weight in subjects who completed the 10-week course of treatment, and a significant decrease in systolic blood pressure in methamphetamine-dependent subjects who received modafinil. The results support further trials of modafinil in methamphetamine-dependent patients, although future trials in cocaine-dependent patients from this treatment population were not likely to be viable. Modafinil appeared to be modestly effective in reducing, but not stopping, methamphetamine use in selected patients. Multi-centre trials with larger sample sizes, and measures sensitive enough to detect quantitative changes in psychostimulant use would be needed to confirm the findings. Blood pressure and weight may be important indicators of clinical outcome, and warrant particular attention in future trials, particularly given the cardio-toxicity of both methamphetamine and cocaine. Strategies to enhance medication adherence including a higher dose and counselling adherence are recommended to improve outcomes. Given the predominance of behavioural and psychosocial factors in psychostimulant dependence, it is likely that the role of medications such as modafinil will be as an adjunct to psychosocial therapy.

The notion of recovery from mental illness has become a significant force in mental health policy, practice and literature. As a process, recovery can been described as the lived experience of personal growth and search for meaning after the onset of mental illness. The following phenomenological inquiry seeks to understand the meaning of day-to-day activities for 13 people in recovery from mental illness. In the recovery literature there has recently been a growing interest in the everyday aspects of recovery. Routine interactions between people and the human and non-human environment have been recognised as being significant in the recovery process. Additionally, there has been a call within occupational therapy literature for research focused on exploring the experience and meaning of different forms of occupation. This study aims to address and add to these areas of interest within the current literature. Recovery narratives were collected from the participants in two phases, using an open ended conversational style of interview. The first phase focused on gathering stories that reflected the lived experience of recovery for eight participants. The recorded interviews were transcribed and analysed using the hermeneutic philosophy of Martin Heidegger. In the second phase of interviewing a further five participants shared their stories. In this round the conversations were focused on some of the dynamics of activity and recovery that had emerged as broad themes in the first phase. This allowed further depth to be added to the data and subsequent analysis. The interpretation focused on descriptions of engagement in activity during different periods of the participants’ recovery journeys. It was important to dwell with the stories and allow themes of experience and meaning to emerge. Particular phrases and words were highlighted and their meaning explored if they showed something of the participants’ lived experience. Through a process of writing, reflecting and re-writing the findings were refined and clarified over time. Everyday activity was found to be an important medium for change as well as a recovery outcome in itself. Findings add to existing understandings about occupation as a medium for healing and transformation within the context of recovery from mental illness. In particular, the study highlights the dynamics at play in different modes of doing and the way in which carers can influence the experience and meaning of activity.

What might it mean to attempt to figure theatre as thought? More specifically, what possible relations hold between theatre and epistemology - that area of philosophy concerned with theories of knowledge? This study is a series of cross-disciplinary engagements that seek to articulate some of the relations between theatre, performance, and epistemology, to investigate performance as a 'deployed logic' in relation to those disciplines concerned with discovering and generating knowledge. For some thinkers in the continental tradition, the very thought of writing about the relations between performance and the anachronistic; hasn't the idea of 'performance' undermined most of the central tenets of the discourse concerned with knowledge and the Real, with truth and falsity? This, of course, remains an open question, one pursued in this work. The thesis draws on a diverse series of wide-ranging examples in order to relate the inquiry to current work being done in philosophy and performance studies, but notes the theoretical incompleteness of studies relating theatre and performance to conceptions of knowledge.It attempts to fill a void in the literature by offering analyses that think the relations between dramatic and philosophical activity. In short, it hopes to re-open the dialogue between performance and epistemology by showing how philosophy regularly attempts to expunge its foundational elements from its imaginary. / Doctor of Philosophy (PhD)