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Thesis (Ed.M.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

Cerebrovascular disease is one of the leading causes of death among persons aged 50 and above and when a stroke does not result in death, it can cause residual cognitive, motor and behavioural disabilities. Emotional effects of brain injury range from reduced quality of life to various neuropsychiatric disturbances and are of great interest in the South African context and throughout the world as they pose a major obstacle to the rehabilitation process. This study explored the relationship between emotion processing, neuropsychiatric symptoms and quality of life specifically, how they operate following a cerebrovascular accident. In order to achieve this, an adult population of high functioning stroke survivors completed the emotion processing scale (EPS), Minnesota Multiphasic Personality Inventory (MMPI-2) and comprehensive quality of life inventory (ComQOL-A5) and a factor analysis provided statistical evidence suggestive of intercorrelations among the variables. The results lent support to this theoretical relationship and determined the structure of this relationship as follows: The satisfaction with quality of life after a stroke that relates to traditional masculine or feminine roles, when not fulfilled, related to neuropsychiatric symptoms of general maladjustment i.e. schizophrenia and psychopathic deviate. The second factor encompassed symptoms of general anxiety both internally and externally directed: Internally directed anxiety included symptoms of hypochondriasis and hysterical conversion, while externally directed anxiety included neuropsychiatric symptoms of paranoia. The third factor was associated with mood modulation in that elevated mood connected to neuropsychiatric symptoms of hypomania and depressed mood connected to symptoms of depression and social introversion. Finally, emotion processing and psychasthenia made up the last principal component, namely emotion modulation. This meant that avoidance of emotional iv content, suppression of emotion, unprocessed emotion etc. related to neuropsychiatric symptoms of obsessions or compulsions. High functioning stroke survivors’ behaviours were thus characterised by general maladjustment, anxiety, and symptoms related to mood and emotion modulation. This study underlies the importance of diagnosing, treating and monitoring stroke survivors’ emotional alterations and suggests the usefulness of its application in clinical settings to evaluate the effectiveness of treatments or more general interventions to improve the neuropsychiatric sequelae and quality of life of stroke survivors. Improved understanding of these constructs from the stroke survivor’s perspective has obvious impact for the therapeutic interventions inherent in stroke rehabilitation and as such, contributes towards the fields of neuropsychology, neuropsychotherapy and the social sciences.

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Orientador: Florindo Stella / Banca: Sebastião Gobbi / Banca: Maria José D'Elboux Diogo / Resumo: Este estudo teve como objetivo analisar se o perfil de atividade física desenvolvido por pacientes com demência apresenta benefício na redução dos distúrbios neuropsiquiátricos e no desgaste mental dos cuidadores. Também foram analisadas as associações entre o perfil de atividade física desenvolvido pelos cuidadores na redução dos sintomas de ansiedade e de depressão. Foram estudados 118 sujeitos (59 pacientes com demência de Alzheimer, demência vascular e demência mista, e os 59 respectivos cuidadores). Os participantes foram recrutados no Ambulatório de Psiquiatria Geriátrica, Hospital das Clínicas, UNICAMP. Para coleta dos dados, foram utilizados os seguintes instrumentos: a) paciente - Inventário Neuropsiquiátrico - NPI (CUMMINGS et al., 1994) e o Mini-Questionário do Sono - MQS (ZOMER et al., 1985); b) cuidadores - Inventário Neuropsiquiátrico - NPI (CUMMINGS et al., 1994), o Mini- Questionário do Sono (ZOMER et al., 1985) e a Escala de Ansiedade e Depressão (ZIGMOND & SNAITH 1983). Ambos os grupos foram inquiridos quanto à prática de exercícios físicos mensurada pelo Questionário Baecke Modificado para Idosos - QBMI (VOORRIPS et al., 1991). A análise dos dados consistiu do teste U-Mann Whitney e da análise de regressão linear, do tipo stepwise. Admitiu-se nível de significância de 5% (p<0.05). Todos os participantes foram classificados em dois perfis de atividade física (segundo o QBMI): a) participantes com um perfil de menor atividade física; b) participantes com um perfil de maior atividade física. Os resultados indicaram que os pacientes com demência de Alzheimer, com perfil de maior atividade física apresentavam menos distúrbios neuropsiquiátricos e causavam menor desgaste mental no seu cuidador. Os pacientes com demência vascular, cujos cuidadores realizavam atividades aeróbias tinham um sono melhor. Os cuidadores de pacientes com demência mista e que tinham um perfil de maior atividade. / Abstract: This cross-sectional study aimed analyzing if the physical activity profile, developed by patients with dementia, would benefit the reduction of neuropsychiatric disorders and the mental burden of the carers. The associations between the physical activity profile developed by the carers in the reduction of mental burden and symptoms of anxiety and depression were analyzed. There were studied 118 subjects were studied (59 patients with Alzheimer dementia, vascular dementia and mixed dementia, and their 59 carers). The participants were recruited in the Clinic of Geriatric Psychiatry, Hospital das Clínicas, UNICAMP. To collect data, the following tools were used: a) patient - Neuropsychiatric Inventory - NPI (CUMMINGS et al., 1994) and the Mini-Sleep Questionnaire - MSQ (ZOMER et al., 1985); b) carers - Neuropsychiatric Inventory - NPI (CUMMINGS et al., 1994), the Mini-Sleep Questionnaire - MSQ (ZOMER et al., 1985) and the Anxiety and Depression Scale (ZIGMOND & SNAITH 1983). Both groups were asked about the practice of physical activities measured by the Modified Baecke Questionnaire for Older Adults - MBQOA (VOORRIPS et al., 1991). To analyze data, the test U-Mann Whitney was used as well as the linear regression stepwise. The meaning level 5% (p<0.05) was accepted. All the participants were classified in two physical activity profiles (according to MBQOA): a) participants who presented a low physical activity profile; b) participants with a high physical activity profile. The results showed that the patients with Alzheimer dementia, with a high physical activity profile, presented less neuropsychiatric disorders and caused less mental burden on their carers. The patients with vascular dementia, whose carers practiced aerobic activities, had a better sleep. Also, the carers of patients with mixed dementia and who had a high physical activity profile suffered less mental burden with their patients. / Mestre

Background: Efavirenz is associated with transient neuropsychiatric manifestations but the impact on neurocognition is unknown. Genetically determined black South Africans who are slow metabolizers of efavirenz may be at risk of toxicity. This study describes neuropsychiatric and neurocognitive manifestations of South African children with suspected efavirenz neurotoxicity. Method: This retrospective study describes clinical features of 12 children with suspected efavirenz neurotoxicity (2008 – 2014). Results: Twelve children were referred (aged 3 years 4 months to 12 years, mean 7 years 8 months; 8 indigenous African (black) and 4 mixed ancestry). Six had acute neuropsychiatric manifestations after 2-8 weeks (mean 5 weeks) on efavirenz including drowsiness, seizures, sleep disturbances, behavioural changes, ataxia and slurred speech. Symptoms resolved over a few weeks in four. Two black children were phenotypically slow metabolizers with high plasma efavirenz concentrations above normal range resulting in discontinuation of efavirenz. Nine children had neurocognitive concerns potentially exacerbated by long-term efavirenz (6-72 months therapy; mean 31 months), and showed poor performance in all neurocognitive domains. Conclusion: Efavirenz causes transient neuropsychiatric adverse effects and may contribute to poor longterm neurocognitive outcomes in HIV-infected children. Genetically slow metabolizers are at risk of neurotoxicity. Prospective studies comparing efavirenz-treated and efavirenz-naïve children are needed.

Diagnoser är ett sätt för samhället att beskriva och gränssätta vad som är normalt och socialt accepterat. Diagnos är även en social konstruktion som oftast utifrån ett samhällsperspektiv har en negativ inverkan. Människor sätter etiketter på de med diagnosen och oftast är det i negativ bemärkelse och man accepterar inte det avvikande beteendet som diagnosen förklarar. Syftet med denna studie är att ta reda på hur vuxna med diagnos upplever för- och nackdelar med sin diagnos. Med den kvalitativa metoden har semistrukturerade intervjuer genomförts. Tre personer har deltagit i studien och delat med sig om sina upplevelser kring deras neuropsykiatriska diagnoser. Alla tre har en ADHD-problematik, en har även diagnosen Asperger. Studiens resultat visar hur dessa upplever sina diagnoser och visar att de anser att det är bättre att få diagnosen än att leva i ovisshet av vad det är som gör att de beter sig på ett visst sätt. En av intervjupersonerna sa "Jag vet många som skäms över att de har det här och jag vet många som utnyttjar sin situation dessutom och det tycker jag inte om. För en diagnos är en diagnos. Det är en funktionsnedsättning men det handlar om vad du själv gör av den". / Diagnose is a way for society to describe and limit what is normal and socially acceptable. Diagnosis is also a social construction that often has a negative impact. People put labels on those with a diagnose and it is usually in a negative way and does not accept the deviant behavior that explains the diagnose. The purpose of this essay is to find out how adults with a diagnose experience benefits and cons of their diagnose. With the qualitative method has a semi-structured interviews been done. Three people have participated in the study and shared their experience about their neuropsychiatric diagnose. All three have a ADHD problem, one person have also been diagnose with Asperger. The result demonstrate how they feel about their diagnose and show that the belive it is better to be diagnose, than to live in uncertainty about what it is that make them behave in a certain way. One of the interviewed said "I know many who are ashamed that they have their diagnose and I also know who take advantage of their situation too, and that I don’t like. For a diagnose is a diagnose. It is a disability bit it’s about what you make of it"’

The purpose of this essay is to examine how professional conditions relate to the work with students who display neuropsychiatric difficulties in school. Furthermore, the authors of this essay wish to provide insight of which possibilities and limitations professionals experience in their joint work with students who display neuropsychiatric difficulties. The empirical material for the essay draws upon a qualitative method in the form of semi structured interviews with professionals who are in daily contact with students with neuropsychiatric difficulties. The empirical material has been analyzed with the help of previous related research together with the concepts of collaboration theory and acting according to Lipsky´s theory of street-level bureaucracy. The results show that the professionals ability to act in cases of students who display neuropsychiatric difficulties is affected by various forms of collaboration. The essay also suggests there are no considerable differences in task-design and in supporting a student with neuropsychiatric diagnosis compared to a student who only display similar symptoms and behavior. However, an established diagnosis might be favorable and can facilitate better conditions to act in situations concerning students with neuropsychiatric difficulties.

Abstract Background: Previous studies show that ADHD is associated with lower educational attainment, lower level of employment and increased risk for stressful life events. No previous studie was found that compared conditions before and after diagnosis was set. The aim of this study was to examin if a neuropsychiatric diagnostic assessment and support afterward had any impact on the life situation for adult persons with ADHD regarding occupational outcome, economical status and social support. Method: A sample of 214 adults participated in the study. Data were collected from the participants’ medical records. Statistical analyses were applied to identify possible changes before and after a neuropsychiatric examination. Results: Changes were seen in occupational outcome, economical outcome and in the help received from the community before and after the examination. Conclusions: Neuropsychiatric examinitions starts a process that could lead to a better socialeconomical situation for the person with ADHD.