Bakgrund: Barn med neuropsykiatriska funktionsnedsättningar (NPF) är i behov av stöd och det centrala är att känna sig sedd i hälso- och sjukvården. Skolsköterskans primära uppgift är att stödja och stärka till välbefinnande genom att vara närvarande, lyssna och inge hopp i samtalet. Syfte: Att beskriva skolsköterskans upplevelse av att stödja och stärka elever i skolan med neuropsykiatriska funktionsnedsättningar Metod: I studien användes en kvalitativ metod med induktiv ansats där åtta intervjuer analyserades med kvalitativ innehållsanalys. Resultat: Ur analysen framkom två huvudkategorier; Att inge trygghet och hopp genom tillgänglighet och samtal och Genom samverkan med andra utvecklas ett starkare stöd, med fem tillhörande underkategorier. Slutsats: Skolsköterskans stöd leder till att eleverna med NPF känner sig stärkta i sin situation vilket ger ökat hopp och tro på framtiden. Att hjälpa eleverna att främja dess sunda och friska beteenden medverkar till att elevernas skyddsfaktorer stärks. Genom samtal och lyhördhet stärks eleverna att lära sig ta egna beslut och växa som individer. Ett bra teamsamarbete bidrar till större möjlighet att främja hälsa och förebygga ohälsa för elever med NPF / Background: Children with neuropsychiatric disabilities (NPF) are in need of support and importance to be seen in the health care sector in school. The primary duty of the school nurse is to ensure that the students are in wellbeing. School nurses are supporting and strengthening the good of health by being present, listening and giving hope in the dialogue. Purpose: Describing school nurse's experience of supporting and strengthening students with neuropsychiatric disabilities Method: The study used a qualitative method with inductive approach where eight interviews were analyzed with qualitative content analysis. Result: Two major categories emerged from the analysis; Entering security and hope through accessibility and conversation and Strengthening cooperation with others, with five belonging subcategories. Conclusion: The school nurse's support in school leads the neuropsychiatric disabilities students feeling stronger in their situation, which gives greater hope and faith in the future. Helping students to promote their health and healthy behaviors helps to strengthen the students' protection factors. Through dialogue and responsiveness, students are strengthened to learn to make their own decisions and grow as individuals. Good teamwork contributes to greater opportunities for promoting health and preventing illness for students with neuropsychiatric disabilities.

I denna uppsats intervjuas fem unga kvinnor om sina erfarenheter av att delta i separatistiska grupper av och för kvinnor och icke-binära med neuropsykiatriska funktionsnedsättningar (NPF). Studiens syfte är att bidra med kunskap om vad unga kvinnor med NPF kan få ut av att delta i en separatistisk samtalsgrupp, för att på så sätt synliggöra deras erfarenheter samt öka kunskapen om målgruppens möjligheter att förbättra sin livskvalité genom att stärka sig själva. Forskningsfrågan handlar därmed om vilka funktioner deltagandet i en separatistisk grupp kan fylla för kvinnor med NPF, givet deras livssituationer samt den position de befinner sig i som kvinnor med icke-normativa funktionssätt. Studien bygger på fem halvstrukturerade intervjuer som analyserats enligt tematisk analysmetod. Det teoretiska ramverket byggs upp kring utgångspunkter och begrepp inom fälten intersektionalitet och empowerment. Resultatet visar att informanterna har delat känslor av utanförskap och avvikelse; både i relation till sina könsroller och i relation till sina funktionssätt, vilket också kan förstås som maktlöshet. Denna maktlöshet förklaras genom intersektionalitet som att informanterna, i egenskap av att vara kvinnor med NPF, tillhör sociala kategorier som underordnas i jämförelse med andra sociala kategorier, vilket också tycks få en negativ inverkan på deras liv. Mot denna bakgrund har informanterna därför sökt sig till separatistiska grupper med en förhoppning om att finna en förstående gemenskap samt öka kunskapen om sina livssituationer. Informanternas deltagande i grupperna kan även förstås ur ett empowermentperspektiv. Dels som empowerment i egenskap av motmakt och dels empowerment som emotionellt stärkande process. Vad denna studie visar är således att deltagandet i en separatistisk grupp kan fylla olika stärkande funktioner. Dels möjliggörs, genom deltagandet, empowerment i form av motmakt - då den separatistiska gruppen blir en arena för reflektion, lärande och handling samt en trygg och stärkande gemenskap och samhörighet. Dels möjliggörs emotionell empowerment, genom att samhörigheten bidrar till ett ökat engagemang för målgruppen, till förbättrad självbild, till ökat mod samt till en lust att fortsätta engagera sig - det vill säga till en högre nivå av emotionell energi. / In this paper, five young women are being interviewed about their experiences of participating in separatist groups for women and non-binary with neuropsychiatric disabilities (NPF). The purpose of this study is to contribute with knowledge of what young women with NPF can gain from participating in a separatist conversation group; thus to visualizing their experiences and raising awareness of the target group's ability to strengthen themselves. The research question is about addressing the functions of participating in a separatist group, given the target group’s life situations and their social position as women with a non-normative way of functioning. The study is based upon five semi-structured interviews, analyzed according to the thematic method of analysis. The theoretical framework is built around terms and perspectives in the fields of intersectionality and empowerment. The result shows that the informers have shared feelings of exclusion and deviation; both in relation to their gender roles and in relation to their ways of functioning, which can also be understood as powerlessness. This powerlessness, explained through intersectionality, points out that the informers, as in being women with NPF, belong to social categories that subordinate to other social categories, which also seems to have a negative impact on their lives. Against this background, the informers have searched for separatist groups, in hope to find an understanding community and to increase knowledge about their life situations. To participate in these groups can also be understood from an empowerment perspective. Partly as empowerment in the meaning of counter-power, and partly as empowerment as an emotionally strengthening process. What this study shows is therefore that participation in a separatist group can fill different strengthening functions. Through participating in a group, empowerment in the form of counter-power is made possible; thus the separatist group becomes an arena for reflection, learning and action as well as a safe and strengthening community and togetherness. Secondly, emotional empowerment is made possible by the fact that the togetherness contributes to increased commitment, to improved self-image, to increased courage and to a desire to continue to engage - in other words; to a higher level of emotional energy.

Submitted by Ellen Lirani Silva (ellen.cindy@gmail.com) on 2018-08-23T19:45:20Z No. of bitstreams: 1 tese_doutorado_EllenLiraniSilva.pdf: 1964030 bytes, checksum: 2837f403aa831161190972cdb1c95319 (MD5) / Approved for entry into archive by Adriana Aparecida Puerta null (dripuerta@rc.unesp.br) on 2018-08-24T11:45:33Z (GMT) No. of bitstreams: 1 liranisilva_e_dr_rcla.pdf: 1964030 bytes, checksum: 2837f403aa831161190972cdb1c95319 (MD5) / Made available in DSpace on 2018-08-24T11:45:33Z (GMT). No. of bitstreams: 1 liranisilva_e_dr_rcla.pdf: 1964030 bytes, checksum: 2837f403aa831161190972cdb1c95319 (MD5) Previous issue date: 2018-07-03 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) / Introdução: A presente tese de Doutorado é composta por dois estudos. O objetivo do Estudo #1 foi investigar a associação entre domínios do andar (com e sem tarefa dupla) e domínios cognitivos e neuropsiquiátricos de pacientes com DP (DP). O objetivo do Estudo #2 foi investigar os efeitos de uma intervenção de atividades rítmicas e dança no andar, funções cognitivas e aspectos neuropsiquiátricos de pacientes com DP e a manutenção de benefícios após um período de follow up (5 meses). Materiais e método: O Estudo #1 contou com a participação de 87 pacientes com DP. Após avaliação clínica e anamnese, os pacientes foram avaliados quanto ao andar (com e sem tarefa dupla), funções cognitivas e aspectos neuropsiquiátricos. A partir das avaliações, dois modelos foram elaborados: i) modelo do andar formado por 16 características espaço-temporais do andar, distribuídos em cinco domínios (pace, variabilidade, ritmo, assimetria e controle postural); ii) modelo de aspectos cognitivos e neuropsiquiátricos formado por 10 testes, distribuídos em sete domínios (cognição global, memória, função executiva, atenção, memória de trabalho, habilidade visuoespacial, neuropsiquiátrico ). O Estudo #2 contou com a participação de 86 pacientes com DP que foram distribuídos randomicamente em dois grupos: grupo de atividades rítmicas (DPd) e dança e grupo convívio (DPc). As atividades do grupo DPd foram realizadas com base em diferentes estilos, com progressão tanto em mudanças do ambiente como em complexidade dos movimentos. O grupo DPc participou de atividades divididas em três etapas: i) palestras e discussões sobre a DP, sem nenhuma sobrecarga cognitiva e motora; ii) atividades de voz; iii) atividades de disfagia. Ambas as intervenções ocorreram durante 6 meses, 3 vezes por semana, com 1 hora por sessão. O mesmo protocolo de avaliações do Estudo #1 foi utilizado no Estudo #2. As avaliações foram conduzidas, antes e após o período de intervenção (6 meses), e 5 meses após um período sem intervenção. Resultados (Estudo #1): Foram verificadas associações entre domínios cognitivos e do andar, especialmente entre o domínio pace, cognição global, atenção e memória. Ainda, foi verificada uma maior capacidade de predição do domínio pace em condição de tarefa dupla, onde os domínios cognição global e atenção, juntamente com as variáveis de controle do estudo, explicaram em 42% da variância dos dados. Resultados (Estudo #2): Os pacientes do grupo DPd apresentaram diminuição da assimetria durante o andar livre no momento follow up em comparação ao momento pós. Ainda, a intervenção de atividades rítmicas e dança foi capaz de evitar a progressão de características do andar com tarefa dupla relacionada ao domínio pace, enquanto os pacientes do grupo DPc apresentaram piora dessas características ao longo do estudo. Quanto aos aspectos cognitivos, foi observada piora na atenção dos pacientes do grupo DPc, mas não para o grupo DPd. No entanto, apenas o grupo DPc apresentou benefícios na cognição global. Conclusão: Domínios do andar estão associados a domínios cognitivos de pacientes com DP, mas, para o presente estudo, não com domínios neuropsiquiátricos. O domínio pace (andar com tarefa dupla) apresentou o melhor modelo preditivo do estudo, que foi composto pelos domínios cognição global e atenção. Em relação a intervenção proposta no Estudo #2, a intervenção de atividades rítmicas e dança é capaz de beneficiar características discretas do andar e promover a manutenção de alguns aspectos do andar, cognitivos e neuropsiquiátricos. / Introduction: This PhD thesis consists of two studies. The aim of the Study #1 was to investigate the association between gait domains (with and without dual task) and cognitive and neuropsychiatric domains of patients with Parkinson’s disease (PD). The aim of the St udy #2 was to investigate the effects of a rhythm activities and dance intervention on gait, cognitive function and neuropsychiatric aspects of patients with PD, as well as the retention of benefits after a follow up period (5 months). Methods: Study #1 in volved the participation of 87 patients with PD. A fter clinical assessment, gait (with and without dual task), cognition and neuropsychiatric aspects were assessed. Gait, cognition and neuropsychiatric aspects were summarized in two models: i) a gait model with 16 spatial - temporal gait characteristics, described by five domains (pace, variability, rhythm, asymmetry and postural control); ii) a cognitive and neuropsychiatric model with 10 assessments organized in seven domains (global cognition, memory, exec utive function, attention, working memory, visuospatial ability and neuropsychiatric). Study #2 involved 86 patients with PD which were allocated in two groups: rhythm activities and dance intervention group (PDd) and socializing group (PDs). Activities of the PDd group were structured based on different styles of dance, with progression in the environment and movement complexity. Activities of t he PDs group were organized in three phases: i) talks and discussion about PD, with low cognitive or motor impact ; ii) voice activities; iii) activities focused in dysphagia. Both interventions were conducted during 6 months, three time s per week, one hour per session. The testing protocol of Study #2 was the same of the Study #1. All assessments were conducted befor e, immediately after the intervention and after a 5 - month follow up. Results (Study 1): Cognitive domains were associated with gait, specially between pace domain and global cognition, attention and memory domain s . Also, a great capacity of prediction was observed for pace domain under dual task , where global cognition and attention, with control variables , explained 42% of the data variance. Results (Study #2): There was a decrease in gait asymmetry (without dual task) at follow up moment compare d to post intervention for the PDd group. Also, the intervention of rhythm activities and dance was effective to prevent the progression of gait with dual task, specially related to pace domain. The PDs group worsened these gait characteristics during the study. In relation to cognitive aspects, the PDs, but not the PDd, worsened attention. Also, the PDs improved global cognition. Conclusion: Gait d omains are associated to cognitive domains in patients with PD, but not to neuropsychiatric domain. Pace domain (with du al task) had the best predictive model of the study, which was composed by global cognition and attention domains. The rhythm activities and dance intervention was effective to benefit discreet gait characteristics and prevent the progression of some gait, cognitive and neuropsychiatric aspects.

Transtornos de humor tais como a depressão e a ansiedade estão entre as desordens psiquiátricas mais comuns na atualidade, com tendência de aumento do número de casos, assim como vêm ocorrendo nas últimas décadas. O Transtorno Depressivo Maior (TDM), uma desordem psiquiátrica dispendiosa e ameaçadora da vida, afeta profunda e negativamente a qualidade de vida dos indivíduos afetados e irá atingir até 20% da população em algum momento ao longo de sua existência. Porém, a descrição de sua patofisiologia segue incompleta e o principal pré-requisito para controlar a doença é entender de forma detalhada as alterações moleculares e comportamentais que a acompanham. O estresse social, como um dos principais indutores da depressão, tem sido alvo de estudos tanto clínicos quanto pré-clínicos, servindo também como um mecanismo laboratorial que auxilia pesquisadores a rastrear alterações moleculares e comportamentais dessa doença. Recentemente, sem deixar de lado as demais hipóteses, o sistema imunológico através de respostas inflamatórias, tem recebido atenção crescente e é investigado por ser potencialmente um indutor e/ou facilitador de estados depressivos, contribuindo para a patofisiologia da depressão. Além disso, considerando que o estresse não afeta a todos os indivíduos da mesma maneira, a compreensão das diferenças individuais que podem resultar em resiliência pode auxiliar pesquisadores quanto aos fatores que afetam o desenvolvimento ou não do transtorno na população. Esta tese é composta por dois artigos, e visa investigar em um modelo pré-clínico, a contribuição do estresse social por subordinação (do inglês, social defeat – SD) ao comportamento tipo-depressivo, relacionando-o com inflamação. No primeiro artigo foi revisada a literatura mais recente sobre a contribuição do SD para a ativação microglial, o principal elemento neuroinflamatório do sistema nervoso central (SNC), e sua relação com o desenvolvimento dos comportamentos tipo-ansioso e tipo-depressivo. No segundo artigo investigou-se o papel de um estressor social contínuo (21 dias consecutivos de derrota social crônica) em um grupo de ratos Wistar adultos, relacionando respostas comportamentais a alterações de marcadores imunológicos periféricos e a duas estratégias de coping. O modelo de estresse por derrota social tem sido utilizado em diversos estudos de transtornos psiquiátricos e é uma das principais formas de indução de estados tipo-depressivos em animais de laboratório. Ademais, vêm demonstrando ser útil na indução de alterações do sistema 11 imunológico, tanto centrais quanto periféricas. Exposição ao estresse por derrota social induz em células microgliais um estado de hiperativação que, dependendo do tempo de exposição, pode levar ao desenvolvimento de desordens psiquiátricas como a ansiedade e a depressão. Além disso, o protocolo de 21 dias de derrota social contínua revelou dois estilos comportamentais em ratos Wistar. As estratégias de coping passivo e ativo observadas estão relacionadas a vulnerabilidade e a resiliência, respectivamente, e foram correlacionadas com distintos perfis imunológicos periféricos. Animais resilientes apresentam comportamentos e perfil imunológico periférico que os protegem do desenvolvimento de psicopatologias associadas ao estresse. / Humor disorders such as depression and anxiety are among the currently most common disorders, with a trend to an increasing number of cases, like in the past few decades. Major Depressive Disorder (MDD) is an expensive and life-threatening psychiatric disorder that profoundly and negatively affects individual´s quality of life and will affect up to 20% of the population at some point throughout life. However, the pathophysiology of MDD remains incompletely described, and a detailed description of its molecular and behavioral alterations is one of the core prerequisites for disease control. Social stress, one of the main inducers of depression, has been the subject of both clinical and preclinical studies, and has been used as a laboratory tool to help researchers track molecular and behavioral changes of this disease. Recently, without leaving other hypotheses aside, the immune system through inflammatory responses has received increasing attention and is investigated as a potential contributor in the pathophysiology of depression. Furthermore, considering that stress does not affect all individuals to de same extend, understanding individual differences that can turn into resilience may help researchers unravel the factors that influence the development of this disorder in the population. The present dissertation is composed of two articles, aiming to investigate in a preclinical model the contribution of social defeat stress (SD) to depressive-like behavior and correlate it to inflammation. In the first article, we reviewed the most recent literature on the contribution of SD to microglial activation, the main neuroinflammatory element of the central nervous system (CNS), and its relation to the development of anxiety and depressive-like behaviors. In the second paper, we investigated the role of a continuous social stressor (21 consecutive days of chronic social defeat) in a group of adult male Wistar rats, relating behavioral responses and two different coping strategies to changes in peripheral immune markers. The social defeat stress model has been used in several studies of psychiatric disorders and is one of the main forms to induce depressive-like states in laboratory animals. Additionally, it has been shown to be useful in inducing central and peripheral immune alterations. Exposure to stress due to social defeat induces microglial cells into a state of hyperactivation that, depending on the time of exposure, can lead to the development of psychiatric disorders such as anxiety and depression. Furthermore, the 21-day protocol of continuous social defeat revealed two behavioral 13 styles in Wistar rats. The observed passive and active coping strategies are related to vulnerability and resilience, respectively, and have been correlated with different peripheral immunological profiles. Resilient animals present behaviors and a peripheral immune profile that protect them from the development of stress-associated psychopathologies.

Transtornos de humor tais como a depressão e a ansiedade estão entre as desordens psiquiátricas mais comuns na atualidade, com tendência de aumento do número de casos, assim como vêm ocorrendo nas últimas décadas. O Transtorno Depressivo Maior (TDM), uma desordem psiquiátrica dispendiosa e ameaçadora da vida, afeta profunda e negativamente a qualidade de vida dos indivíduos afetados e irá atingir até 20% da população em algum momento ao longo de sua existência. Porém, a descrição de sua patofisiologia segue incompleta e o principal pré-requisito para controlar a doença é entender de forma detalhada as alterações moleculares e comportamentais que a acompanham. O estresse social, como um dos principais indutores da depressão, tem sido alvo de estudos tanto clínicos quanto pré-clínicos, servindo também como um mecanismo laboratorial que auxilia pesquisadores a rastrear alterações moleculares e comportamentais dessa doença. Recentemente, sem deixar de lado as demais hipóteses, o sistema imunológico através de respostas inflamatórias, tem recebido atenção crescente e é investigado por ser potencialmente um indutor e/ou facilitador de estados depressivos, contribuindo para a patofisiologia da depressão. Além disso, considerando que o estresse não afeta a todos os indivíduos da mesma maneira, a compreensão das diferenças individuais que podem resultar em resiliência pode auxiliar pesquisadores quanto aos fatores que afetam o desenvolvimento ou não do transtorno na população. Esta tese é composta por dois artigos, e visa investigar em um modelo pré-clínico, a contribuição do estresse social por subordinação (do inglês, social defeat – SD) ao comportamento tipo-depressivo, relacionando-o com inflamação. No primeiro artigo foi revisada a literatura mais recente sobre a contribuição do SD para a ativação microglial, o principal elemento neuroinflamatório do sistema nervoso central (SNC), e sua relação com o desenvolvimento dos comportamentos tipo-ansioso e tipo-depressivo. No segundo artigo investigou-se o papel de um estressor social contínuo (21 dias consecutivos de derrota social crônica) em um grupo de ratos Wistar adultos, relacionando respostas comportamentais a alterações de marcadores imunológicos periféricos e a duas estratégias de coping. O modelo de estresse por derrota social tem sido utilizado em diversos estudos de transtornos psiquiátricos e é uma das principais formas de indução de estados tipo-depressivos em animais de laboratório. Ademais, vêm demonstrando ser útil na indução de alterações do sistema 11 imunológico, tanto centrais quanto periféricas. Exposição ao estresse por derrota social induz em células microgliais um estado de hiperativação que, dependendo do tempo de exposição, pode levar ao desenvolvimento de desordens psiquiátricas como a ansiedade e a depressão. Além disso, o protocolo de 21 dias de derrota social contínua revelou dois estilos comportamentais em ratos Wistar. As estratégias de coping passivo e ativo observadas estão relacionadas a vulnerabilidade e a resiliência, respectivamente, e foram correlacionadas com distintos perfis imunológicos periféricos. Animais resilientes apresentam comportamentos e perfil imunológico periférico que os protegem do desenvolvimento de psicopatologias associadas ao estresse. / Humor disorders such as depression and anxiety are among the currently most common disorders, with a trend to an increasing number of cases, like in the past few decades. Major Depressive Disorder (MDD) is an expensive and life-threatening psychiatric disorder that profoundly and negatively affects individual´s quality of life and will affect up to 20% of the population at some point throughout life. However, the pathophysiology of MDD remains incompletely described, and a detailed description of its molecular and behavioral alterations is one of the core prerequisites for disease control. Social stress, one of the main inducers of depression, has been the subject of both clinical and preclinical studies, and has been used as a laboratory tool to help researchers track molecular and behavioral changes of this disease. Recently, without leaving other hypotheses aside, the immune system through inflammatory responses has received increasing attention and is investigated as a potential contributor in the pathophysiology of depression. Furthermore, considering that stress does not affect all individuals to de same extend, understanding individual differences that can turn into resilience may help researchers unravel the factors that influence the development of this disorder in the population. The present dissertation is composed of two articles, aiming to investigate in a preclinical model the contribution of social defeat stress (SD) to depressive-like behavior and correlate it to inflammation. In the first article, we reviewed the most recent literature on the contribution of SD to microglial activation, the main neuroinflammatory element of the central nervous system (CNS), and its relation to the development of anxiety and depressive-like behaviors. In the second paper, we investigated the role of a continuous social stressor (21 consecutive days of chronic social defeat) in a group of adult male Wistar rats, relating behavioral responses and two different coping strategies to changes in peripheral immune markers. The social defeat stress model has been used in several studies of psychiatric disorders and is one of the main forms to induce depressive-like states in laboratory animals. Additionally, it has been shown to be useful in inducing central and peripheral immune alterations. Exposure to stress due to social defeat induces microglial cells into a state of hyperactivation that, depending on the time of exposure, can lead to the development of psychiatric disorders such as anxiety and depression. Furthermore, the 21-day protocol of continuous social defeat revealed two behavioral 13 styles in Wistar rats. The observed passive and active coping strategies are related to vulnerability and resilience, respectively, and have been correlated with different peripheral immunological profiles. Resilient animals present behaviors and a peripheral immune profile that protect them from the development of stress-associated psychopathologies.

This study aims to investigate how pedagogical picture books intended for inclusion represents children with neuropsychiatric disabilities. This is investigated through in-depth analysis of four books dealing with the subject from different approaches, recommended by state libraries and the specialised educational authority. The study also aims to pay attention to the available material and to highlight what kind of image of divergent children that is beeing communicated to pre-school children and what consequences this may have. The results of the analysis may be useful in the selection of inclusion material and how the books can be practised in a norm-critical and socio-cultural approach.

Interest in research for the relationship between physical activity and cognition among children and adolescents has increased substantially in recent years. The positive effects of physical activity appear to be particularly important for students with neuropsychiatric disability. Physical activity within the classroom is an area that so far has been relatively unexplored. The purpose of this study is to investigate both students with neuropsychiatric disability and their teachers' experiences of daily physical activity during an implementation period of an exercise program inside the classroom and how it affects the study situation, The purpose is also to identify obstacles and opportunities for implementation of daily physical activity inside the classroom for student with neuropsychiatric disability.  Based on the purpose of the study, we have investigated whether daily physical activity in school can be a special educational tool in the work of students with neuropsychiatric disabilities. An intervention with daily physical activity inside classrooms was conducted over four consecutive weeks in two groups at two different schools. Teachers and their students estimated experiences of daily physical activity were collected through surveys before and after intervention as well as through logbooks during intervention. The results show that students and teachers have predominantly estimated positive experiences of daily physical activity in the classroom. The main positive change in students and teachers’ estimation is the students' completion of tasks. The transition between movement activity and other classroom teaching and the poor physical condition of some students are perceived by the teachers as an obstacle for implementation of physical activity within the classroom.  Safety and harmony in the group, as well as clear and simple instructions, are important prerequisites for implementation. This study's conclusion is that daily physical activity in the classroom is perceived positively by teachers and students and has a predominantly positive impact on the study situation for students with neuropsychiatric disability and therefore can be a special educational tool. / Intresset inom forskningen för förhållandet mellan fysisk aktivitet och kognition bland barn och ungdomar har ökat kraftigt de senaste åren. Den fysiska aktivitetens positiva effekter verkar vara särskilt betydelsefullt för elever med neuropsykiatrisk funktionsnedsättning, NPF. Fysisk aktivitet i klassrummet är ett område som ännu så länge är relativt outforskat. Studiens syfte är att undersöka såväl elever med neuropsykiatrisk funktionsnedsättning samt deras lärares upplevelser av daglig fysisk aktivitet under en implementeringsperiod av rörelseprogram i klassrummet och hur det påverkar studiesituationen. Vidare är syftet att kartlägga hinder och möjligheter för daglig fysisk aktivitet i klassrummet för elever med neuropsykiatrisk funktionsnedsättning. Utifrån studiens syfte har vi undersökt om daglig fysisk aktivitet i skolan kan vara ett specialpedagogiskt verktyg i arbetet med elever med neuropsykiatrisk funktionsnedsättning. En intervention med daglig fysisk aktivitet i klassrummet genomfördes under fyra sammanhängande veckor i två grupper på två olika skolor. Lärares och elevers skattade upplevelser av den dagliga fysiska aktiviteten samlades in genom enkäter före och efter intervention samt genom loggböcker under intervention. Resultaten visar att elever och lärare har övervägande positiva skattade upplevelser av daglig fysisk aktivitet i klassrummet. Den främsta förändringen inom elever och lärares skattning är elevernas färdigställande av uppgifter. Övergångarna mellan rörelseaktiviteten och övrig undervisning i klassrummet samt vissa elevers dåliga fysiska kondition uppfattas av lärarna som hinder. Trygghet och harmoni i gruppen, samt tydliga och enkla instruktioner är viktiga förutsättningar för genomförandet. Studiens slutsats är att daglig fysisk aktivitet i klassrummet skattas positivt av lärare och elever, samt att det i vår studie verkar ha en övervägande positiv påverkan på studiesituationen för flertalet elever. Därigenom är det möjligt att daglig fysisk aktivitet i klassrummet kan vara ett specialpedagogiskt verktyg.

The aim of this study was to investigate the relationship between noncognitive symptoms and premorbid temperament in a group with Alzheimer’s disease. The relationship between premorbid temperament and noncognitive symptoms can be used to understand symptom susceptibility and risk, caregiver burdens, as well as providing insights into the neuroanatomical substrates of temperament and noncognitive behaviour. Sixty-three primary caregivers of Alzheimer’s patients fulfilled the eligibility criteria for this study. Information regarding the noncognitive symptoms and premorbid temperament was procured from the primary caregivers. In fifty-one cases, a secondary caregiver also provided information about the premorbid temperament of the Alzheimer’s patient. The latter was obtained to enhance the reliability of retrospective data. The Behaviour Rating Scale for Dementia, the Formal Characteristics of Behaviour-Temperament Inventory, and the Blessed Dementia scale were used to elicit data on noncognitive symptomatology, premorbid temperament, and current cognitive status, respectively. ii Noncognitive symptoms were grouped into two clusters namely neuropsychiatric and neurobehavioural disturbances. The neuropsychiatric cluster included mood and psychotic symptoms and the neurobehavioural cluster included vegetative and overall behavioural dysregulatory symptoms. Results showed that there is a wide spectrum of noncognitive symptom manifestation in patients’ profiles and that the neurobehavioural dysregulatory symptoms are more common than the neuropsychiatric symptoms in this Alzheimer’s cohort. With regard to symptom manifestation and cognitive status, a Pearson product moment correlational analysis showed that a lower level of cognitive functioning is significantly associated with aggressive episodes and a higher level of cognitive functioning with manifestations of depressive symptoms. In terms of interrater concordance on premorbid temperament ratings, intraclass correlations were significant for five of the six temperament domains, thus indicating a reliable estimate of premorbid disposition. Canonical correlational analysis yielded two significant variates. The first variate indicated that Alzheimer’s disease patients with a proclivity for aggressive behaviours and general behavioural deregulation but lower depressive profiles, were premorbidly more emotionally reactive, had low sensory thresholds (high sensitivity), and greater cognitive deficit. The second variate showed that patients with Alzheimer’s disease who tended to manifest with depressive and dysregulatory behaviour appear to have been premorbidly perseverative in temperament with a low sensory threshold (high sensitivity) and the tendency to maintain and attain a low level of activity (stimulation). Taken together, the significant variates revealed a dimensional relationship between depressive symptoms, aggressive symptoms, and behavioural dysregulation; and sensory sensitivity, emotional reactivity, perseverance, and activity, with cognitive status serving as a moderating variable. In conclusion, the study indicated a dimensional relationship between specific premorbid temperament traits and noncognitive symptoms, thereby highlighting the possible predictive influence of premorbid temperament on noncognitive manifestations in Alzheimer’s disease patients. / Thesis (PhD (Psychology))--University of Pretoria, 2005. / Psychology / unrestricted

Transtornos de humor tais como a depressão e a ansiedade estão entre as desordens psiquiátricas mais comuns na atualidade, com tendência de aumento do número de casos, assim como vêm ocorrendo nas últimas décadas. O Transtorno Depressivo Maior (TDM), uma desordem psiquiátrica dispendiosa e ameaçadora da vida, afeta profunda e negativamente a qualidade de vida dos indivíduos afetados e irá atingir até 20% da população em algum momento ao longo de sua existência. Porém, a descrição de sua patofisiologia segue incompleta e o principal pré-requisito para controlar a doença é entender de forma detalhada as alterações moleculares e comportamentais que a acompanham. O estresse social, como um dos principais indutores da depressão, tem sido alvo de estudos tanto clínicos quanto pré-clínicos, servindo também como um mecanismo laboratorial que auxilia pesquisadores a rastrear alterações moleculares e comportamentais dessa doença. Recentemente, sem deixar de lado as demais hipóteses, o sistema imunológico através de respostas inflamatórias, tem recebido atenção crescente e é investigado por ser potencialmente um indutor e/ou facilitador de estados depressivos, contribuindo para a patofisiologia da depressão. Além disso, considerando que o estresse não afeta a todos os indivíduos da mesma maneira, a compreensão das diferenças individuais que podem resultar em resiliência pode auxiliar pesquisadores quanto aos fatores que afetam o desenvolvimento ou não do transtorno na população. Esta tese é composta por dois artigos, e visa investigar em um modelo pré-clínico, a contribuição do estresse social por subordinação (do inglês, social defeat – SD) ao comportamento tipo-depressivo, relacionando-o com inflamação. No primeiro artigo foi revisada a literatura mais recente sobre a contribuição do SD para a ativação microglial, o principal elemento neuroinflamatório do sistema nervoso central (SNC), e sua relação com o desenvolvimento dos comportamentos tipo-ansioso e tipo-depressivo. No segundo artigo investigou-se o papel de um estressor social contínuo (21 dias consecutivos de derrota social crônica) em um grupo de ratos Wistar adultos, relacionando respostas comportamentais a alterações de marcadores imunológicos periféricos e a duas estratégias de coping. O modelo de estresse por derrota social tem sido utilizado em diversos estudos de transtornos psiquiátricos e é uma das principais formas de indução de estados tipo-depressivos em animais de laboratório. Ademais, vêm demonstrando ser útil na indução de alterações do sistema 11 imunológico, tanto centrais quanto periféricas. Exposição ao estresse por derrota social induz em células microgliais um estado de hiperativação que, dependendo do tempo de exposição, pode levar ao desenvolvimento de desordens psiquiátricas como a ansiedade e a depressão. Além disso, o protocolo de 21 dias de derrota social contínua revelou dois estilos comportamentais em ratos Wistar. As estratégias de coping passivo e ativo observadas estão relacionadas a vulnerabilidade e a resiliência, respectivamente, e foram correlacionadas com distintos perfis imunológicos periféricos. Animais resilientes apresentam comportamentos e perfil imunológico periférico que os protegem do desenvolvimento de psicopatologias associadas ao estresse. / Humor disorders such as depression and anxiety are among the currently most common disorders, with a trend to an increasing number of cases, like in the past few decades. Major Depressive Disorder (MDD) is an expensive and life-threatening psychiatric disorder that profoundly and negatively affects individual´s quality of life and will affect up to 20% of the population at some point throughout life. However, the pathophysiology of MDD remains incompletely described, and a detailed description of its molecular and behavioral alterations is one of the core prerequisites for disease control. Social stress, one of the main inducers of depression, has been the subject of both clinical and preclinical studies, and has been used as a laboratory tool to help researchers track molecular and behavioral changes of this disease. Recently, without leaving other hypotheses aside, the immune system through inflammatory responses has received increasing attention and is investigated as a potential contributor in the pathophysiology of depression. Furthermore, considering that stress does not affect all individuals to de same extend, understanding individual differences that can turn into resilience may help researchers unravel the factors that influence the development of this disorder in the population. The present dissertation is composed of two articles, aiming to investigate in a preclinical model the contribution of social defeat stress (SD) to depressive-like behavior and correlate it to inflammation. In the first article, we reviewed the most recent literature on the contribution of SD to microglial activation, the main neuroinflammatory element of the central nervous system (CNS), and its relation to the development of anxiety and depressive-like behaviors. In the second paper, we investigated the role of a continuous social stressor (21 consecutive days of chronic social defeat) in a group of adult male Wistar rats, relating behavioral responses and two different coping strategies to changes in peripheral immune markers. The social defeat stress model has been used in several studies of psychiatric disorders and is one of the main forms to induce depressive-like states in laboratory animals. Additionally, it has been shown to be useful in inducing central and peripheral immune alterations. Exposure to stress due to social defeat induces microglial cells into a state of hyperactivation that, depending on the time of exposure, can lead to the development of psychiatric disorders such as anxiety and depression. Furthermore, the 21-day protocol of continuous social defeat revealed two behavioral 13 styles in Wistar rats. The observed passive and active coping strategies are related to vulnerability and resilience, respectively, and have been correlated with different peripheral immunological profiles. Resilient animals present behaviors and a peripheral immune profile that protect them from the development of stress-associated psychopathologies.

There are various health promotion and preventive measures that can be done in schools. Creating accessible learning environments is such a way. In this qualitative study interviews are made with professionals in School Health Teams on what they think is important in the process of creating accessible learning environments for pupils with neuropsychiatric disorders. The results show that the different perspectives as well as the way in which the different professionals work in Student Health Teams affect the orientation of the work in Student Health Teams. It affects whether the efforts become general or individual and whether they become promotion, prevention or remedial action. The Lundin model - the pyramid of change (2017) that describes a possible way of running an accessibility work has proved to be partly in line with the informants' percep-tions. I have revised the model to include the National Agency for Education's definition of ac-cessible learning environments that also include socially and educationally accessible learning environment. The results show the need to raise the level of knowledge of the staff and the need to work with their core values because they affect the way the teachers treat pupils, and the op-portunities to make the school more accessible physically, pedagogically and socially. The study also shows practical examples of ways of making the learning environment accessible and that efforts that are good for students with neuropsychiatric disorders are good for all students. Suc-cessful perspectives for the work with accessible learning environments have proven to be a re-lational perspective and a salutogenic perspective. What all occupational groups emphasized was the importance of relationships and creating structure and comprehensibility for students with neuropsychiatric disorders, as well as for all other pupils. The empirical material is grouped under three themes: Awareness and approach, Accessible learning environments - in practice and Di-lemmas and governance. These themes also show that the revised model also needs to include dynamic aspects of change work as well as dilemmas and governance. The result also shows the need to obtain views from more types of informants such as pupils, teachers, principals and other staff.