Research has focused extensively on the negative health effects of inadequate Mg intake, but the extent of the problem of deficiency deserves further exploration. The notion that U.S. adults consume an inadequate amount of magnesium, leading to increased risk for chronic diseases such as depression, is plausible. National Health and Nutrition Examination Surveys (NHANES), which are large, cross-sectional, population-based data sets that assess the health and nutritional status of U.S. adults and children, indicate over half the adult population does not consume adequate amounts of magnesium based on the estimated average requirement (EAR) established by the Institute of Medicine. Using 2007 to 2010 NHANES data we found 54% of adults do not meet the EAR, confirming results from earlier surveys. As a result of this finding, a review exploring the factors impacting magnesium consumption over time and the adequacy of current intake in U.S. adults was conducted. Changes in agricultural processes that reduce magnesium levels in crops combined with the increasing consumption of processed foods containing little to no magnesium have led to a decrease in mean daily intake by 200-300 mg per day over the past century. However, population-based studies show a steady and consistent recovery in magnesium intake in U.S. adults over the past several decades. A simple, rapid, accurate test for whole body Mg status is lacking and, although population-based studies have limitations, continued monitoring of Mg consumption is essential to determine whether this positive trend continues. In the meantime, since the health consequences of inadequate magnesium are well established, there are no reported cases of hypermagnesemia from food alone, and magnesium is found in healthy foods adults should consume more often, there are few reasons not to encourage increased magnesium intake. Cross-sectional and prospective trials in other countries report an association between magnesium intake and symptoms of depression. Depression is a chronic disease affecting a significant portion of the U.S. population. Magnesium plays a role in many of the pathways involved in the pathophysiology of depression and is found in several enzymes, hormones, and neurotransmitters. Depression and magnesium are both associated with systemic inflammation. Current treatment options for depression are limited by efficacy, cost, availability, side effects, and acceptability to patients. As a result of the need for additional treatment options, interest in the role of magnesium in modulating depressive symptoms has grown. We used the NHANES 2007-2010 data to examine this relationship in U.S. adults and found a significant association between very low magnesium intake and symptoms of depression (RR=1.16; 95% confidence interval (CI) 1.06, 1.30; P=0.03). Whether inadequate magnesium leads to increased risk for depression or depression results in poor dietary intake is not known. To test whether supplementation with over-the-counter magnesium chloride improves symptoms of depression, an open-label, blocked, randomized, cross-over trial was carried out in outpatient primary care clinics on 126 adults (mean age 52; 38% male) diagnosed with, and currently experiencing, mild-to-moderate symptoms. Consumption of magnesium chloride tablets for 6 weeks resulted in a clinically significant net improvement in depression (Patient Health Questionnaire-9) scores of -6.0 points (95% CI -7.9, -4.2; P<0.001) and net improvement in anxiety (Generalized Anxiety Disorders-7) scores of -4.5 points (95% CI -6.6, -2.4; P<0.001). Effects were observed regardless of age, gender, baseline magnesium levels, baseline severity of depression, or use of antidepressant treatments. It worked quickly, was well tolerated, and is much safer and less expensive than conventional treatments with medication. Magnesium supplements are effective for mild-to-moderate depression and are an additional treatment option for patients suffering from depression.

Class of 2015 Abstract / Objectives: Pharmacists’ level of training and experience in psychiatric pharmacy were compared for: 1) self-perceived preparedness to provide pharmacotherapy services; and 2) perceived barriers to providing services to individuals with psychiatric disorders. Methods: This study used data from an internet-based questionnaire. Respondents were divided into 2 groups: 1) completed the Arizona Pharmacy Association’s Psychiatric Certificate Program, and/or Board Certified in Psychiatric Pharmacy, and/or College of Psychiatric and Neurologic Pharmacists member, and/or completed a PGY2 psychiatric pharmacy residency; and 2) no specialized training/experience in psychiatric pharmacy. A Mann-Whitney U analysis was used to compare the scaled responses for each group. A Bonferroni alpha correction was use in the case of multiple tests. Results: Compared to pharmacists without training/experience in psychiatry (N = 235), respondents with specialized training/experience in psychiatry pharmacy (N = 38) reported more frequent interactions with psychiatric patients and provided more counseling/drug information, monitoring for adverse drug reactions, recommending non-pharmacological treatments, screening for treatment issues, and making therapeutic recommendations (p < 0.05). Trained pharmacists in psychiatry reported being more prepared to provide all pharmacotherapy services (p = 0.003), except in addressing non-adherence, utilizing online resources, and providing pharmacotherapy services to patients with attention deficit-hyperactivity disorder. They reported fewer barriers (α = 0.005) except for time to provide services, having a private consultation area, and reimbursement for patient care activities. Conclusions: This study found that responding pharmacists without psychiatric training/experience may need additional education/training post-graduation and that they perceive more barriers in providing services to this population.

M.Cur. (Psychiatric Mental Health Nursing) / Psychiatric nursing is seen as a high-stress profession. The demands of caring for others, especially those who suffer from acute and chronic mental health impairment, can be extremely stressful (Lin, Probst & Hsu, 2010:2343). Psychiatric nurses run a high risk for being exposed to aggression in the work environment. The aggression that they experience is not only from hostile and aggressive mental health care users, but also from fellow colleagues. Aggression in the work environment has an overt negative psychological effect on the nurse (Yildirim, 2009:509; Bimenyimana, Poggenpoel, Myburgh & Van Niekerk, 2009:5). The aim of the research study was to explore and describe the lived experience of psychiatric nurses of aggression amongst colleagues in the work environment. A second aim was to formulate guidelines on assisting psychiatric nurses and their colleagues in order to facilitate their own mental health. The research design of the study is qualitative, explorative, descriptive and contextual in nature (Maphorisa, Poggenpoel & Myburgh, 2002:24). This qualitative approach created an opportunity to discover the phenomena of the lived experiences of psychiatric nurses of aggression amongst colleagues. The research study was conducted in two phases. In the first phase, data was collected by means of conducting in-depth phenomenological interviews, naïve sketches, observations and field notes until data saturation was achieved. In the second phase, guidelines, recommendations, challenges and a summary were formulated to address the lived experience of the psychiatric nurses of aggression amongst colleagues in the work environment. During data collection, the following question was asked in the in-depth phenomenological interviews and naive sketches, “What is your experience of aggression amongst colleagues in the work environment?” Tesch’s (Creswell, 2004:256) open coding method and an independent coder were used during data analysis.

M.Cur. / In the out-patient section of the Adolescent Unit at Tara, The H Moross Centre, certain problem areas were identified. In this section, adolescents with mostly behaviour problems are evaluated and where necessary, family therapy service is rendered or the patient may be admitted depending on the type and severity of the problem. The problems experienced in this section became very pressing due to the uneven ratio between the demand for the service and the availability of staff. At the centre of these problems lies the issue of resistance in the family towards change, resulting in broken appointments and premature termination of therapy. A lot of time is also wasted by faulty referrals and data gathering 1s in itself, very time-consuming. A new nursing need emerged out of these problems. Firstly, the emotional preparation of the family and, secondly, as part of her role as member of the therapeutic team, to gather relevant data which will aid the development of an adequate diagnosis of the family. A post was created on an experimental basis for the nurse to conduct an initial interview with families at home. At the same time it was decided to evaluate the effectiveness of this home visit through an empirical study to justify this service.

D.Cur. / The overall objective of this research study was the development of a psychiatric nursing science model that will provide a theoretical framework to facilitate the mental health of women exposed to continuous intimate partner abuse. In this thesis continuous intimate partner abuse will also refer to an abusive relationship. Violence against women is a global pandemic that costs the health and lives of more women than malaria, traffic, accidents and war combined (Holm 2000:12). It is stated that around the world at least one woman in every three has been beaten, coerced into sex or otherwise abused in her lifetime. Most often the abuser is a member of her own family. There are a few support structures in place in the rural communities for these women. For many women who have been abused health workers are the main and often the only point of contact with public services which may be able to offer support and information. Yet victims of violence who seek care from health professionals often have needs that providers do not ask about and do not know how to address. A theory generative research design was applied during the conduct of this study. The research project was carried out in four steps of theory generation. Step one dealt with concept analysis which was divided into two sub-steps concept identification and concept definition. During the process of the subiv vii step of concept identification, a qualitative research strategy, which is explorative, descriptive and contextual was used to reveal the true experiences of women in abusive relationships. A purposive sample of 10 women in abusive relationships in the Eastern Cape meeting the selection criteria was utilised. In-depth semi-structured phenomenological interviews were used as a method of data collection.

Magister Curationis - MCur / Background: Mental illness has become more common than many other diseases such as heart disease, cancer or diabetes. Aggression or violence by patients towards psychiatric nurses is a global issue. These nurses, therefore, face the huge challenge of providing nursing care to aggressive psychiatric patients. Without the necessary knowledge and skills, the nurses are vulnerable to all kinds of injuries, given the time spent managing aggressive patients. Purpose and objectives: The purpose of the study was to determine the level of knowledge and skills that professional nurses possess to manage the aggression of psychiatric patients. The objective of the study was to ascertain whether the knowledge and skills of professional nurses were sufficient to manage aggressive psychiatric patients. Method: A quantitative approach and descriptive design was used to conduct this study at a Psychiatric Hospital in the Western Cape, South Africa. The target population consisted of 149 professional nurses employed at the Psychiatric Hospital. The sample for the study was all-inclusive i.e. all professional nurses employed at the hospital. Only 70 participants were available for the study. Structured questionnaires were distributed to the participants for data collection and the response rate was 77% (n=54). Data analysis was done with the aid of a statistician using a Statistical Package for Social Science, version 22, and nominal as well as ordinal data was analysed using descriptive analysis. The process and purpose of the study was explained to the participants, who gave their consent, prior to the distributing of the questionnaires. The researcher obtained permission from the necessary authorities before commencing with the study. Findings: The study found that nurses were more likely to be exposed to verbal aggression as opposed to sexual aggression. It also revealed that nurses with less years of experience had more knowledge than their counterparts who had more years of experience in same position. Furthermore, the study revealed that those who had training in aggression management reported that the training did not meet their needs. Overall, the findings revealed that nurses had a fair knowledge of managing aggressive psychiatric patients. The overall findings also revealed that professional nurses had the required skills to manage aggressive patients. Recommendations: There is a need for on-going in-service training and refresher courses in the management of aggression. There should also be a needs analysis before commencing with these training courses which should be made compulsory for all staff to attend. Further studies should be conducted on the different categories of nurses, and other disciplines within nursing, to ascertain their knowledge of the management of aggression. Qualitative studies should also be conducted on nurses‟ experience of aggression in different settings.

Class of 2005 Abstract / Objectives: The purpose of this study was to determine the demographics of co-morbid disorders and drug abuse characteristics of patients admitted to an inpatient facility for detoxification and treatment of chemical dependency to characterize the treatment programs including the psychiatric medication usage and prescribing patterns and to identify differences between men and women. Methods: Criteria inclusion for admittance included a diagnosis of chemical dependence at Sierra Tucson Behavioral Health Hospital during the time of January through June 2004. Patients were admitted to that were diagnosed with a chemical dependency, identified using a past hospital census. Charts of previously discharged patients were obtained from the medical records department of the institution. Specific variables from each chart were extracted for further analysis utilizing a data form. Results: 285 (170 women and 115) men chemically dependent patients that were admitted during the six-month study period. In this patient population there was a high incidence, 76.84%, of co-morbid psychiatric conditions. The most frequently abused drugs in men were alcohol, nicotine, and cocaine. The most frequently abused drugs in women were alcohol, nicotine, and opiates. Men and women were most frequently placed on a librium based alcohol detoxification program, and secondly a buprenorphine based opiate detoxification program. There was statistical significant improvement in the of Beck Depression Inventory scale (BDI), Beck Hopelessness scale (BHS), and Global Assessment Function (GAF) scores at admit and discharge and a downward trend in Clinical Institute Withdrawal Assessment (CIWA) and Clinical Opiate Withdrawal (COW) scores. Implications: There was a high incidence of co-morbid psychiatric conditions such as depression and anxiety that were present in both genders. In men, Attention Deficit and Hyperactivity Disorder/ Attention Deficit Disorder (ADHD/ADD) was an additional common condition observed, while in women eating disorders were observed. The treatments provided led to an overall improvement in GAF, BDI, BHS, CIWA and COW scores indicating effectiveness of the treatment program.

Abstract Traumatic Brain Injury (TBI) is a global epidemic (Schwarzbold et al., 2008). According to Brey (2006), a brain injury occurs every 21 second in the United States, which results in 1.5 million head injuries annually. The purpose of this project was to educate psychiatric personnel regarding the needs of the TBI population and to measure learning and retention. This is a quality improvement project that utilized a pretest and posttest design with an educational intervention. The intervention was administered electronically via Microsoft PowerPoint. Results were measured with the Wilcoxon Signed Rank Test. A total of 17 participants completed the pretest and posttest, and 11 completed the second posttest; the second posttest administered six weeks after the initial posttest. The results show that knowledge increased from pretest to posttest, (p < 0.05), however, retention of the material did not occur per test results, (p ≥ 0.05). There is no other research to compare to these results. Therefore, more research and educational intervention are needed to educate psychiatric personnel regarding the needs of the TBI patient.

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. / Medicine, Faculty of / Medical Genetics, Department of / Graduate

Depression is the leading cause of disability in the United States. Insufficient evidence is available about the types of follow-up care that may be most effective. The purpose of this quantitative, retrospective cohort study was to determine whether remission of depression symptoms was associated with recommended follow-up care when controlling for age, gender, and number of previous episodes of depression, and whether symptom reduction was more likely for those who completed a course of treatment from a mental health specialist in comparison to those who were treated by their primary care providers (PCPs) when controlling for the same variables. The theoretical framework for this study was Reingold's theory of outbreak investigations. Existing was retrieved from Geisinger Health System's electronic health record. The following covariates were evaluated for their effects on the re lationship between positive depression screening and follow-up care: baseline (initial) depression screening score, date of service, age, gender, consecutive depression screening score, date of consecutive depression screening, outcomes, and documented previous history of depression. Retrospective cohort data from 1,246 patients were collected from the study site and analyzed using descriptive statistics, t tests, ANOVAs, and multiple linear regression. Findings showed that PCP-initiated medication change and referral to community health were significantly associated with successful intervention. Findings may be used to encourage routine depression screening and increase positive health outcomes for patients with depression.