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Background: Health care settings are generally regarded as stress inducing environments. Stress can alter the immune response, impair wound healing and create a greater risk for asthma, diabetes, gastrointestinal disorder and myocardial infarction. Beginning in the 1980s and 1990s, there has been increasing interest in healing environments and evidence-based design concepts. Yet, there has been little progress developing healing environments and using evidence-based design for psychiatric inpatient units, a uniquely stressful environment. Psychiatric units today continue to use designs such as caged in outdoor patio areas that resemble facilities that incarcerate rather than facilities which reduce stress and facilitate healing. The purpose of this systematic literature review was to identify design features that are evidence-based which can be used to create an optimal inpatient psychiatric patient room by: (1) analyzing the research literature for evidence of architectural and design elements that could be used in the inpatient psychiatric care setting to reduce stress and improve the well-being; (2) identifying design elements that are consistent with accreditation and licensing standards for inpatient psychiatric units; and (3) designing a psychiatric inpatient room that has evidence-based elements to reduce stress and improve well-being. Methods: A systematic literature review was conducted to identify factors in the inpatient healthcare environment that support an optimal healing environment. The PICO question for this review was what design factors in the inpatient healthcare environment support an optimal healing environment? A search of five databases and a hand search of reference lists were conducted. The search included studies from 1980 to the present, original research conducted on inpatient units with adult patients that investigated an intervention with an outcome that promotes a healing environment. Experimental, quasi-experimental, non-experimental, systematic literature reviews and expert opinions were sought and evaluated using a scale to analyze scientific rigor and research quality. Results: A total of 6,874 articles were identified in the search. Seventy-six articles were eligible for full text screening. After review of the full text, 38 articles were determined to be eligible for evidence analysis. After removing 11 inadmissible articles due to poor quality, 27 articles were included in the final synthesis. The search found research on eight hospital design features which may support optimal healing environments: artwork (n = 7), building configuration (n = 2), finish materials (n = 7), interior details (n = 6), lighting (n = 11), nature and view (n = 8), noise (n = 10), room configuration (n = 6). More than 50% of the research on optimal healing environments used quasi-experimental and non-experimental designs with rare use of experimental research designs. Overall, the quality of the research on optimal healing environments is not high, but results were reasonably consistent across studies. Conclusions: Evidence suggests seven design features for healing inpatient psychiatric environments, including: (a) single rooms, (b) calm, naturalistic and domestic artwork or photographs, (c) east facing windows, (d) plants, (e) acoustic ceiling tiles, (f) patient rooms removed from noise producing unit areas and (g) a window view of nature. These seven recommendations were examined for consistency with existing Arizona statutes and industry standards for behavioral health care environments. Recommendations found to be inconsistent with these statutes and standards were modified to reach congruency with the statutes and guidelines, and then an evidence-based design of a psychiatric inpatient room design was formulated and is illustrated. Future research on interventions to create healing environments at the greatest scientific rigor is needed along with measurement techniques to quantify stress responses to the environment.

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The transition from the apartheid rule to a new democracy in South Africa has been accompanied by a vision of a national health care system that is based on the principles of universal primary health care. This vision opens up access to provision of mental health to everyone. This means that nurses, as gate-keepers of primary health care, have had to be trained in identification and management of minor mental health problems that are presented in their community clinics as well as health centres. For the current study, the need for such training was identified by an intern psychologist placed in one of the clinics in the area of KwaDedangendlale Valley of a Thousand Hills. His work in the area alerted him to the shortcomings of the nurses in both identification and management of what was perceived to be mental health problems. These shortcomings included the nurses' inability to identity and hence properly refer patients who needed the intervention of a professional mental health specialist. From this, a training programme which also included a reorientation process to deal with negative attitudes that are usually levied against the mentally ill was undertaken. Reorientation in this context was based on the assumption that prior to training nurses had a particular world view or position towards the provision of health care, which was identified to be biomedical and this training sought to re-orientate them towards the provision of a more holistic care which is inclusive of psycho social aspect of functioning The follow up to that training and reorientation programme was an evaluation component. This sought to ascertain whether after training, nurses were better equipped to identify and manage mental health problems. Further to that, the researcher sought to identify whether their attitudes had improved, such that they would be willing to deal with patients who presented with minor psychiatric problems. The objective of the current study is to present results of the evaluation component that was undertaken after training. This evaluation took into consideration both the process undertaken during training and the outcome of the reorientation process itself. Process evaluation focused on what makes a programme successful or unsuccessful. This included how the training was undertaken, i.e. manner of instruction etc. Outcome evaluation focused on establishing how good the programme was and whether it managed to provide desired outcomes i.e. change in nurses' attitudes. The Physician's Belief Scale (Ashworth, Williamson & Montano, 1984) was used for both the pre and post evaluation of the nurses' attitudes. The results revealed that before training, nurses had limited knowledge of mental health problems and as a consequence of this limited knowledge they developed negative attitudes towards provision of mental health care. One of the unexpected results of the study was the response of one of the groups of the nurses trained to the integrative manner of instruction. Their response highlighted the importance of understanding the influence of the padagogy on knowledge transmission and acquisition. Nurses reported to be accustomed to harsh pedagogical methods, used during formal nursing training. This kind of pedagogy was viewed as disempowering, as well as somewhat disrespectful, and hence, the much as the friendly and warm atmosphere presented by the facilitators in the current study was viewed as a welcomed change and an empowering process. Most importantly, one was also alerted to the importance of providing ongoing support to health care professionals after being trained. As Petersen (2000) has cautioned that should there be no additional mentoring or support, nurses would be likely to revert to their usuaVold styles of dealing with their patients' problems, given that the training does not necessarily change their environments. They would still be pressured to see large numbers of patients within a limited time period. And because of this, it becomes easier to just prescribing medication than to explore issues that are psychological in nature. / Thesis (M.A.)-University of KwaZulu-Natal, Durban, 2008.

Brain and behavioural disorders represent a leading cause of morbidity and suffering worldwide. The 'fierce' mouse has a spontaneous deletion of Nr2e1 that results in a complex phenotype that includes cortical hypoplasia and socially abnormal behaviours. Notably, functional protein and regulatory equivalency of mouse and human NR2E1 has been established. Furthermore, human studies implicate the genomic region containing NR2E1 in mental illness, although a role for NR2E1 in humans is currently unknown. Here, I integrate mouse models and human molecular genetics to understand the involvement of NR2E1 in human brain-behaviour development. First, we test the hypothesis that the spontaneous 'fierce' deletion involves onlyNr2el. It was demonstrated that the 'fierce' mutation results in the loss of all Nr2e1 exons without affecting neighbouring genes. Next, the hypothesis that some humans with cortical malformations will harbour NR2E1 mutations was tested by sequencing the coding, untranslated, splice-site, proximal promoter, and evolutionarily conserved regions of this gene in 60 subjects with microcephaly. Four candidate regulatory mutations were identified. To help interpret these findings, the genomic architecture and molecular evolution of NR2E1 were characterized in 94ethnically-diverse humans and 13 non-human primates, which indicated strong functional constraint. Finally, the hypothesis that some humans with behavioural and psychiatric disorders will harbour mutations in NR2E1 was tested by sequencing the regions outlined above in 126humans with impulsive-aggressive disorders, bipolar disorder, or schizophrenia. Eleven candidate regulatory mutations were identified. Taken together, the findings presented in this thesis are consistent with the proposal that non-coding regulatory mutations may be important to the pathogenesis of brain-behavioural disorders in some humans.

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Attention deficit/hyperactivity disorder (ADHD) frequently co-occurs with language disorders including reading disabilities (RD) and language impairment (LI). Results from recent genetic studies have implicated Cadherin 13 (CDH13) and Contactin Associated Protein-like 2 (CNTNAP2) as ADHD and LI candidate genes, respectively. Studies have also indicated genomic regions of overlap between ADHD and reading disability (RD), suggesting a shared genetic etiology for both disorders. In the present study, we conducted a family based association analysis to investigate whether CDH13 and CNTNAP2 genes are associated with ADHD, RD and language ability in ADHD and RD samples. Although we found several trends for associations between CDH13, CNTNAP2 and ADHD and language measures, none would remain significant following corrections for multiple tests. However, the study represents the first time CDH13 and CNTNAP2 have been studied for a relationship with language in ADHD/RD samples. Further studies employing larger sample sizes are necessary to confirm our findings.