Now is a time of dramatic change in mental health care as the world is witnessing a proliferation of research into the genetics of mental disorders. Despite several genetic test developments there is a paucity of qualitative research exploring the issues concerning its potential future introduction. This inspired my primary research question: What are the main implications regarding the developments being made in genetic testing for mental disorders in terms of their proposed introduction in a clinical setting? This was investigated through 33 semi-structured interviews with a range of psychiatric professionals from a single NHS trust location in the South West of England. As research has demonstrated that different medical professionals consider issues in mental health care in different ways (Colombo, et al. 2003 ; Fulford and Colombo, 2004) participants’ personal constructs of mental disorder were examined to see if their accounts of the tests differed on the basis of their unique conceptualisations of mental distress. An additional component feature in this research relates to what these developments may ultimately represent or provide psychiatry and mental health care as a result of being able to consider mental disorders in terms of underlying biology. Historically there has been a persistent attempt to determine the underlying genetic components of mental distress, however, this always seems to fail or the next big development is always ‘just around the corner’ - this observation is considered when the major developments in psychiatric genetics are examined in light of the sociological field of the ‘promissory nature of science’ (Borup, et al. 2006) - I suggest that the developments in genetic testing for mental distress represent an iconic continuation of this process. Interview transcripts were subjected to thematic analysis and five themes were developed that cover aspects such as how the tests’ introduction will alter perceptions in mental health care, issues concerning the tests’ practical impact, their possible shortcomings, and how they may alter clinical practice. My findings indicate that, in the majority of themes, personal approaches to mental disorder do appear to influence participants’ accounts of the tests. The overall trend is that if an interviewee personally endorsed a biological approach to understanding mental disorder they would be willing to see the tests used in clinical practice. There were two areas of thematic agreement between all psychiatric professionals regardless of their conceptualisations of mental disorder. These concerned the impacts genetic testing could have on different aspects of the legitimacy of mental disorders and the significance of using the tests to aid in treatment rather than diagnosis. Implications of my thematic findings for patient groups, mental health services, and policy makers are discussed.

Despite the widespread prevalence of bombing in Iraq, no study has investigated its psychological impact on civilians. This thesis aimed to address this gap in the literature. Four studies were conducted consequently using civilians in Iraq. The first study aimed to explore the subjective experience in response to the bombing attack. A qualitative approach was taken and twenty semi-structured interviews were employed and analysed using Interpretative Phenomenological Analysis (IPA). This identified seven categories including interpersonal relationships, loss of self, changes in attachment, shattering of world assumptions. Subsequent studies were then conducted to understand these themes as possible predictors of PTSD and psychiatric comorbidity in regards to bombing attacks. The second study was a prospective longitudinal design aimed to investigate the trajectory of PTSD symptoms, psychiatric comorbidity, and attachment styles among survivors. It also aimed to examine the role of a variety of variables, namely shattering of world assumptions, altered self-capacity, perceived social support to predict PTSD and psychiatric comorbidity. One hundred and eighty Iraqi civilians were recruited and assessed approximately 1 month and 5 months after their experience of being in a bombing attack using a battery of questionnaires. A control group data (n=178) of people who had not been exposed to a bombing was also collected. Results indicated that 19.4% and 57.2% of the participants met the screening criteria for partial and full PTSD symptoms at T1, which declined overtime. The bombing group displayed significantly higher rates of psychiatric comorbidity and insecure attachment than the control group. After controlling for the severity of bombing attack, controllability of events and affect dysregulation significantly predicted both PTSD and psychiatric co-morbidity symptoms. None of these dimensions predicted PTSD and psychiatric co-morbidity at T2. The complementary study 3 looked further at selected predictors indicated by the findings of study 1, namely death anxiety, coping strategies, religious coping and meaning in life. This study employed a longitudinal design in which 185 participants were recruited and assessed approximately 2 months and 7 months after bombing using a package of self-report questionnaires. Results indicated that religious coping and cognitive avoidance had a significant role to play in predicting PTSD and psychiatric comorbidity shortly after the bombing. Death anxiety was also emerged another picture in predicting PTSD and psychiatric comorbidity through mediators, namely religious coping and searching for meaning in life. Literature showed that PTSD and psychological distress are treatable after people had received various forms of professional and personal strategies. Study 4 employed mixed methods in order to provide further understanding regarding the helpful coping strategies that participants had attempted to use to manage their psychological distress. Six participants (n=3 recovered well, n=3 still struggle) were recruited for the qualitative phase and 243 for the quantitative. Social support was found as the most frequent and helpful strategy to manage post-bombing distress, followed by avoiding thinking about the bombing and religious strategies. Different psycho-social factors that hinder or foster recovery between participants were also highlighted. In conclusion, the findings confirmed related studies that, following bombing, there is a high risk that victims develop PTSD and psychiatric co-morbidity symptoms which decline to some extent over time. A variety of factors, such as social support and religious strategies were identified as helpful. However, these were also related to the victims’ prior attachment strategies. Implications for assisting victims and the population of Iraq are offered, in particular the need to support families and friends (social networks) in the context of very limited professional sources of support in a country where terrorism is rife.

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More than 20 million people in the United States have survived a completed or attempted rape in their lifetimes, and approximately 22.5 million people have problematic substance use. The interplay between these two issues is complex: a history of sexual assault predicts substance abuse and, conversely, substance abuse increases sexual assault risk. This secondary analysis of the Virginia Twin Study of Psychiatric and Substance Use Disorders data for White female-female twins (n=1,497) examines the role of multiple traumas in the sexual assault/substance abuse association. Structural models were used to examine pathways between child sexual abuse (CSA), other traumas, familial factors, social support, psychiatric disorders, and substance abuse. The models also integrate the ACE twin design to estimate genetic, shared environment, and individual-specific environment contributions to liability for psychiatric disorders and substance abuse. Study findings support an interplay between childhood trauma, development of substance abuse and psychiatric disorders, and risks for adult victimization. The findings also support assertions that multiple traumas may increase likelihood for substance abuse and psychiatric disorders, and that these disorders predict risk of adult sexual assault. Across all ACE models, both genetics and common environment produced consistently large estimates of influence on liability for substance abuse. Individual-specific environment played a smaller role but was also often significant, and the pathways from trauma variables to both psychiatric disorders and substance abuse tended to be strong. This supports an interaction between genes and environment/experience in which genetic predisposition, though present, may or may not be activated depending on life experiences. Study findings underscore the need for integrated services for clients with history of multiple traumas and for clients with trauma history and substance abuse or psychiatric disorders. / text

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A review of the research literature concerning the role of the social network in health and illness has indicated little attention to studying the social networks of psychiatric patients. Even less attention has been given to the study of veteran psychiatric patients. In an effort to understand more about the supportive or non-supportive aspects of social networks, an exploratory study of 224 male veteran psychiatric patients was conducted in two settings--a general hospital and a large psychiatric hospital. A description of the social networks as perceived by the patients themselves was obtained through semi-structured interviews. Network analysis was used to examine the characteristics of veteran psychiatric patients' personal networks within the social context of needing assistance or support for psychosocial problems. Some aspects of network structure, such as size and availability of family-kin members, were addressed, as well as the nature and quality of network links. Findings indicated that patients had an ample number of family-kin sources to turn to for assistance but chose to turn to only a small number (three or less) of informal sources, including nuclear family, kin, or friends. Formal sources of support were found to play a predominate part in the networks of veteran psychiatric patients. Both the immediate family and institutions were considered to be important sources of help in times of need but a great deal of ambivalence was evident concerning the use of them. A factor analysis of the data identified five social network patterns. Three multiplex patterns emerged in which patients were likely to turn primarily to the nuclear family, to kin, or to significant others for support. Two other patterns were identified--an Anomie Pattern and a Self Versus Institution Pattern--in which neither informal nor formal sources were considered by patients to be sources of support. A stepwise regression was also performed to determine the relationship of selected background variables to choice of support pattern. The variables found to be potentially important predictors of the patterns were marital status, living situation, diagnosis, religious preference, religious practice, age, and history of previous treatment. Conclusions of the study have both clinical and theoretical importance. Findings point to the need for not only reviving or expanding the supportive functions of veteran psychiatric patients' networks, but in some instances the necessity of assisting patients in establishing new personal networks.

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Background: Cannabis among patients admitted in psychiatric units is higher than the general population and this has been shown in various countries where studies on cannabis use have been undertaken. Such an observation has been made by psychiatrists in South Africa and the association between cannabis use and psychotic presentation among these patients has also been observed. Cannabis use by patients with severe or chronic medical illnesses to ameliorate the symptoms of such illnesses has been documented in the literature. A study to explore use of cannabis among psychiatric inpatients as well as medical patients was undertaken. Purpose: The purpose of this study was to firstly determine the prevalence of cannabis use in psychiatric patients admitted to an acute admissions unit in King Edward VIII Hospital and to correlate it with the psychiatric diagnosis. Secondly, it was to compare the cannabis use in psychiatric patients admitted to an acute admissions unit to patients admitted in a medical ward at King Edward VIII Hospital. Thirdly, to assess self reporting of cannabis use by psychiatric and medical patients. Methods: A case control study was conducted at King Edward VIII Hospital, Durban, where cannabis use among 64 subjects included in the study admitted in a psychiatric ward was compared with a control group of 63 control subjects admitted in a medical ward. Both groups were tested for urinary cannabinoids and a questionnaire was filled. The questionnaire contained demographic details as well as a question on use of substances including cannabis. Results: 17 subjects (26.6%) in the study group tested positive for urinary cannabinoids and 2 subjects (3.2%) in the control group tested positive. Cannabis use was significantly higher among males when compared to females in both the study group and the control group. Only 7 subjects in the study group reported cannabis use and out of those 7 subjects, 4 subjects tested positive for urinary cannabinoids. The commonest diagnosis among the study group subjects were the psychotic disorders and schizophrenia being the most common psychotic disorder. Conclusion: Cannabis use is significantly higher among psychiatric patients as compared to medical patients and it is probably higher than in the general population. Self reporting of cannabis use among psychiatric patients is low and unreliable and psychiatrists treating these patients must continue to use objective measures such as objective testing as well as collateral information to determine such use. In this study most subjects who tested positive for urine cannabis were likely to have a psychotic disorder and tended to be of younger age groups. The low prevalence of cannabis use in the control group makes it unlikely that there was a significant number of subjects in this group who were using cannabis for medicinal purposes. / Thesis (M.Med.)-University of KwaZulu-Natal, Durban, 2008.

The aim of the research was to explore the subjective experience of patients admitted to a psychiatric hospital. Sub-aims were to explore how these experiences relate to self management, stress and psychological well-being. This study was motivated by research literature that documents a wide variety of negative experiences by patients. A recent psychiatric patient survey conducted in England and Wales (Mind, 2004) found that more than 50% of respondents indicated that hospital surroundings had not helped their recovery. In fact, close to a third of those thought that it had a detrimental effect on their health. Wood and Pistrang (2004) found that psychiatric patients often represent a lower status, marginalized group in society and thus their views are often not taken into account in mainstream research. These results, however, were overwhelmingly based on research conducted in an American or European context. The South African context is unique in the sense of our political, economic and social issues that influence people's perceptions. In relation to other developing and developed nations little research has been done. The research was conducted at a large Psychiatric hospital in Pretoria South Africa. An availability sample of five adults from the hospital was used. A qualitative case study method design was used. Data were obtained through interviews and analysed using Interpretive Phenomenological Analysis (PA) (Smith, 1996; Smith et al., 1997, 1999) Using the IPA method the data was analysed to extract significant or relevant points related to the research topic. These themes were then collated with themes that occur in other accounts and from there tested against the hypothesised outcomes of the investigation. Positive experiences and negative experiences were identified as the main themes; these were each divided into sub themes. The negative experiences related primarily to interaction with hospital staff and -environment, while positive experiences primarily related to effective treatment. Implications of results are that patient experiences and perceptions may be more influential for long term psychological wellbeing than has been acknowledged by care givers within larger mental healthcare facilities. It was concluded that many if not all of the results of previous studies were confirmed. Additionally this study recognised that singular positive experiences may to a greater degree influence patients recovery and maintenance than a combination of negative experiences. Recommendations following from the findings include further studies to assess enhanced interpersonal skills training for nursing staff, and greater community based care facilities. / Thesis (M.A. (Clinical Psychology))--North-West University, Potchefstroom Campus, 2006.