Ph.D., Faculty of Health Sciences, University of the Witwatersrand, 2011 / Introduction: An increasingly important role for spirituality has been observed in health, mental health and psychiatry. In South Africa it has become particularly apparent in how the Western scientific biomedical model has increasingly been regarded as only one approach in parallel to local African traditional faith and healing practices. It is currently important for local psychiatrists themselves to consider from within the discipline, as to what they would judge the role of spirituality to be in specialist psychiatric practice and teaching. Methods: This study is an explorative, descriptive, contextual, phenomenological and theorygenerating qualitative investigation. In-depth, semi-structured interviews with individual academic specialist psychiatrists affiliated to a local South African university were conducted as primary data source. Considering selected journal articles from a review of the international literature as secondary data items, the content of the conducted interviews was subsequently compared and integrated with the content of the literature on the subject. A layered grounded analysis was made of the interview and literature content. Final categories of concepts were identified from the integrated content, as well as one single core concept for model construction. The elements of the core concept were defined by determining their dictionary (denotative) and subject (connotative) meaning. Essential and related criteria were established for the definition of each element. A practice-orientated model was developed based on the defined single core concept. The steps adopted for the construction of the model referred in particular to the methodology for nursing theory development. Results: The local interviews and the international literature revealed a strong consensus that the role of spirituality should be incorporated into the current approach to local specialist psychiatry, mainly because of its important role in the lives of people in general. Incorporation of this role should, however, only be considered within the parameters of the professional and ethical scope of the discipline, and with all faith traditions and belief systems accommodated equally. The model accounted for the two-fold nature of this central core concept, by drawing an analogy with the comparable counterbalanced two-directional transportation systems of large trees, to describe the structure and relationships of the elements of the concept. The model was operationalised, providing guidelines for its implementation in different practice and training scenarios. Discussion: The model may contribute to the acknowledgement of, and participation in, the discourse on the place of spirituality in local psychiatry, clinical medicine, health and mental health. Defining terminology, specifically what exactly “spirituality” and “religion” would mean in a particular scenario and for the study, proved to be one of the most critical elements of this investigation. Appropriate guidelines for clinical care, for ethical practice and training, and for the referral of patients to relevant spiritual professionals are necessary. Academic institutions in South Africa may have to reconsider their approach to the training of specialist psychiatry and of clinical medicine in general, in order to account for the currently increasingly important role of defined spirituality in local practice and training.

A dissertation submitted to the Faculty of Medicine in Part Fulfilment of the Requirements for the Degree of Master of Medicine in Psychiatry at the University of the Witwatersrand / Ninety-one patients referred for observation were evaluated by means of a data sheet which covered demographic, forensic and psychiatric data, as well as special investigations performed during the admission period. A significant number of patients (P = 0,005) involved in crimes of theft were found to be psychotic. A significant number of patients (P = 0,(24) involved in murder/attempted murder/culpable homicide were found to be apsychotic. None of the special investigations had a significant bearing on the diagnosis or legal destiny of the patient. it is clear that we should have a high index of suspicion towards psychosis in those patients who were allegedly involved in crimes against property and in particular crimes of theft. Special investigations should only be performed where there is a clear clinical indication. This approach wiII save considerable time and money without compromising the assessment. / Andrew Chakane 2019

Aims: The aim of this thesis was firstly, to prospectively examine cognitive function in relation to epilepsy, with event-related potential (ERP) and neuropsychological assessments, over a one year period. Secondly, to investigate whether electrophysiological measures have some predictive value for behavioural outcomes. Methods: A methodology development study investigated optimal stimulus and recording parameters for the mismatch negativity (MMN). A prospective epilepsy study included investigation of a healthy control group, groups of patients with: primary generalised seizures (PGS), focal with secondary generalised seizures (FSG) or focal seizures (FS) and a chronic pain group undergoing anti-epileptic drug (AED) therapy. Assessments were conducted over the course of 12 months: at baseline (session 1), 6-months follow-up (session 2) and 12- months follow-up (session 3). ERP measures included the MMN, P3b and P3a. Neuropsychology measures were obtained using visual reaction time, spatial working memory, planning, word list learning, perseverative function, story recall memory and word list learning tests. Cross-sectional analyses of data obtained at sessions 1 and 2 were carried out to investigate group differences at the different time points. Longitudinal analyses were carried out to investigate the effect of time on behavioural and ERP changes in relation to the different groups. Finally, the predictive value of baseline ERPs for behavioural outcomes at one year follow-up was explored. Results: The methodology development study demonstrated that a reading task with duration increment tones yielded the most replicable MMNs in healthy controls. The clinical study demonstrated significant changes in some ERP components obtained from standard oddball, dual target oddball and novel sounds tasks, between controls and seizure groups -some of which were only apparent at session 3. Although the seizure groups showed evidence of significant impairments in aspects of behavioural performance, there was no significant progressive deterioration over time. Moreover, although the pain group showed similar behavioural impairments, in contrast to the seizure groups, they showed significant improvements in some aspects of performance over time. Conclusion: An MMN recording protocol was established for use with the subsequent prospective clinical study. The prospective epilepsy study revealed functional cognitive changes that may be linked to the nature of pathophysiology underlying different seizure types.

The aim of the current thesis was to explore sexual knowledge and risk in the assessment and treatment of adolescent males with intellectual developmental disorders (IDD), who display harmful sexual behaviour (HSB). A variety of methods were used in this undertaking, including a systematic review, a single case study, a critique of a psychometric measure and two empirical studies. The findings of the systematic review indicated that although the identified/assessed risk variables related to recidivism were found to be similar in cases and controls, some were found to be more prevalent for sexual offenders with IDD. However, it was difficult to draw any firm conclusions due to inconsistencies in findings and limitations in the methodological quality of included studies. The case study detailed the assessment and treatment of an adolescent male with limited cognitive ability and a history of harmful sexual behaviour. The assessment highlighted the utility of the integrated theories of sexual offending, and how his adverse early life experiences and developmental trauma disorder may have negatively impacted on his attachments, social and self-regulation skills, low-self-esteem and the development of his harmful sexual behaviour. The post-intervention assessment highlighted the client had made some positive shifts within his identified treatment targets, although there was still room for improvement with regards to his level of socio-sexual knowledge, his ability to self-regulate and his tendency to engage in aggressive and rule-breaking behaviours. In the critique of the Knowledge Test and Quick Quiz components of the Assessment of Sexual Knowledge –ASK (Butler, Leighton & Galea, 2003) the Knowledge Test measure demonstrated some good psychometric properties and had undergone extensive research and robust testing with individuals with IDD during its development. However, weaknesses of the measure considered were its lack of normative data, the ambiguous wording of some items, and limited empirical research regarding the tool’s effectiveness in measuring sexual knowledge across different populations of individuals with IDD. The empirical research consisted of two studies. In the first study a questionnaire adapted from the Knowledge Test of the Assessment of Sexual Knowledge – ASK, was tested for its ability to accurately measure sexual knowledge in adolescent males with and without IDD and their counterparts who display harmful sexual behaviour. Tests examining both the reliability and validity of the adapted measure suggested its psychometric properties were promising. The second study sought to explore whether there were differences in sexual knowledge in adolescents with and without IDD and their counterparts who display harmful sexual behaviour (HSB). Significant differences were observed between groups. In the HSB groups, adolescents with IDD experienced significantly higher rates of sexual victimisation than No IDD adolescents. For those with IDD the HSB group were 12 times more likely to view sexually explicit material than the Non HSB group. The findings suggested that a lack of sexual knowledge might not be a contributory factor in why some young people with IDD go on to display harmful sexual behaviour.

This thesis aims to provide a broad overview of contemporary challenges in relation to sexual offending, with specific focus being placed on the need to balance the public’s perceptions of those convicted of sexual offences with the reality of their offence patterns, to determine what risk society really faces from these individuals. In doing this, it incorporates diverse methods, including a systematic review, an empirical research study, an individual case study and a critique of a psychometric measure. Following a general introduction in Chapter 1, Chapter 2 presents a systematic evaluation of 13 studies investigating public perceptions of sexual offenders, with specific focus on comparing public demographic variables as predictors of these attitudes. It was found that overall; the public’s perceptions were negative, with beliefs about high recidivism rates amongst other misperceptions. Demographic characteristics were shown to be inconsistent in predicting punitive judgments. Level of educational attainment was the only demographic variable investigated that was consistently associated, with higher levels of education resulting in more positive perceptions. In Chapter 3, the offence patterns of repeat sexual offenders are investigated, including an analysis of whether this population escalate, de-escalate or remain stable over time. The results indicate an overall pattern of stability, indicating that sexual recidivists commit the same category of offence from one offence to the next. However, escalation was also common, a finding that warrants further exploration. Chapter 4 explores the factors that contribute to the onset and escalation of the offence behaviours of a repeat sexual offender, through the use of psychological formulation. Results indicated that a different set of risk factors contributed to the onset of the client’s offending compared to those that contributed to escalation. Chapter 5 evaluates the Community Attitudes Toward Sex Offenders (CATSO) scale (Church, Wakeman, Miller, Clements, & Sun, 2008), an assessment measure used in Chapter 2. Finally, Chapter 6 provides a discussion and conclusion to the thesis, drawing together the implications of the research.

The role of violent video games (VVG) in increasing levels of aggression in players is a topic that has been debated for decades. While a simple cause and effect relationship is not present, it is apparent from the literature that VVGs do have a relationship with elevated levels of aggression within some players. The first chapter of this Thesis presents a systematic review of the literature focusing on additional factors included in the research to explain this finding. However, a lack of standardisation in both measurement and reporting of results making interpretation difficult. The second chapter provides a critique of the non-experimental methods used within video game (VG) research. The third chapter focuses on a non-experimental study which highlighted the differences in aggression, motivations for playing, empathy, and personality in a group of VVG players. The final chapter presents the results of a service evaluation of the management of VGs within a high secure psychiatric hospital, which highlighted the real-world implication of an unclear literature base. The conclusions of this thesis highlight the variation in the quality of the literature available and stresses the need to conduct research with targeted populations, both VG players and clinically populations, to fully understand the relationship between engaging in VVG and increased aggression.

Growing evidence suggests that the Salience Network, anchored on the bilateral anterior insula and dorsal anterior cingulate cortex plays a key role in the pathophysiology of schizophrenia. However, several questions regarding the exact nature of these abnormalities in schizophrenia remain unanswered. This thesis examines the neurobiological basis of Salience Network dysfunction in patients with schizophrenia. Specifically, in this work, we use multi-modal neuroimaging techniques to investigate abnormalities in the functioning, connectivity and neurochemistry of the Salience Network in schizophrenia. Chapter 1 introduces the concept of schizophrenia as a disorder of salience and the role of the Salience Network in this context. Chapter 2 describes participant recruitment, data collection and the neuroimaging techniques used in this work. Chapters 3 to 5 present the results from three research studies. In the first study, using functional Magnetic Resonance Imaging (fMRI) and Magnetoencephalography (MEG), we investigate regional brain activity in response to a task designed to engage the Salience Network. We report evidence demonstrating inefficient cerebral recruitment in patients with schizophrenia i.e. aberrant activity in task positive and task negative brain regions; along with reduced beta response to relevant stimuli in the Salience Network. These findings are reported in chapter 3. In chapter 4, we use high resolution 7T Magnetic Resonance Spectroscopy (MRS) and demonstrate that neurochemical abnormalities in schizophrenia vary between patients depending on their clinical status. Specifically, we show that glutathione and glutamate concentrations in the Anterior Cingulate Cortex are prominently reduced in patients with residual schizophrenia. We also provide evidence linking two popular neurochemical theories of schizophrenia – the NMDA receptor hypofunction hypothesis and the theory of oxidative stress. Chapter 5 explores the question of disrupted effective connectivity within the Salience Network in schizophrenia using resting-state fMRI. In this chapter, we report abnormalities in effective connectivity within the Salience Network in patients with schizophrenia. We also demonstrate that these aberrant causal interactions are related to the neurochemical abnormalities reported in chapter 4. Finally, in Chapter 6, we discuss the significance and translational potential of these findings and offer recommendations for future work. Overall, using a multimodal imaging study design and a wide range of measures, this thesis reports novel findings which further our understanding of Salience Network dysfunction in schizophrenia and provides a good foundation for future research studies in this area.

Anaesthesia Information Management System (AIMS) is an automated record keeping system that imports and stores patient’s vital signs information from a physiological monitor in real-time. However, only a handful of studies have examined the effect of automated record keeping system on anaesthetists’ cognitive performance. Therefore, the current thesis aims to evaluate AIMS in terms of anaesthetists’ attitude (Study 1) and its effect on their cognitive performance (Study 2). Study 1, a questionnaire study examined anaesthetists’ trust and acceptance of AIMS. Forty-two anaesthetists at Tuen Mun Hospital (TMH) and Po Oi hospitals (POH) have completed a self-reported questionnaire. Results found that anaesthetists generally adopted a positive attitude toward AIMS. They exhibited a high level of trust and acceptance of AIMS. Also, they perceived AIMS as highly useful and relevant to their job. Study 2, a simulation study compared AIMS with manual record keeping on anaesthetists’ vigilance, situation awareness (SA) and mental workload. 20 anaesthetists at TMH were randomly assigned to two conditions: (1) AIMS and (2) Manual. Each participant received a 45-minute scenario in a full-scale simulation. Participants were asked to take over a case of general anaesthesia and perform record keeping. Results showed that AIMS did not impair anaesthetists’ vigilance and SA. In addition, it reduced anaesthetists’ mental workload and enabled them to spend less time on record keeping task. The current thesis provides an evaluation of AIMS by using a human factors approach. It contributes to the understanding on the effect of AIMS on anaesthetist’ in terms of attitude and cognitive performance. Based on the evaluation, we generate some recommendation for designers and hospitals to address the limitation of AIMS in interface designs and to increase anaesthetists’ acceptance of AIMS.

The authentic leadership model posits that authentic leaders can foster personal development of their subordinates in order to produce better job outcomes. The current study has investigated authentic leadership using the job demands and resources (JD-R) approach to examine how leaders’ authenticity can empower employees in terms of resources-building (e.g. PsyCap, supervisor support); and to examine how these resources can offset negative stressors (e.g. work overload, emotional demands) so that employees may achieve a peak psychological state of flow (Bakker, 2005, 2008) and better job performances. To date, very few studies have tried to explain authentic leader behaviors in the JD-R model which is posited to be widely applicable to different work contexts, let alone studies of such type conducted in Chinese organizations. The current study consists of Study One and Study Two. The major purpose of Study One is to examine the reliability and validity of the authentic leadership and the work-related flow scale in Chinese organizational settings. The major purpose of Study Two is to test the hypotheses of the overall research model using Chinese working samples. Study One was conducted among Chinese workers in Shanghai (N=135). Confirmatory factor analysis was carried out for the reliability and validity of the authentic leadership and the work-related flow scale. Results confirmed that authentic leadership is best to be depicted as a second-order construct and the Cronbach’s alpha is .94 for the overall instrument. In addition, results also demonstrated that work-related flow has good reliability (Cronbach’s alpha is .96) and construct validity as a three-factor construct. Study Two aimed to test the proposed research model of the current study. 869 self-reported questionnaires were successfully collected from organizations in Shanghai. Performance was rated by employees’ supervisors to avoid common method bias. Structural equation modeling methods were adopted for data analyses. Results supported most of the hypotheses. Supervisor support (job resource) and PsyCap (personal resource) mediate the relationships between authentic leadership and two job outcomes (work-related flow, performance). Work overload and emotional demands moderate the positive indirect effects of authentic leadership on the job outcomes through supervisor support and PsyCap. This study has several contributions. First, it has provided a more comprehensive explanation of leadership and the consequent followers’ work behaviors via the JD-R approach. Second, it has linked the similarities in the JD-R model and the flow literature, which were previously studied in separate fields, demonstrating that high flow experience can be obtained only when resources become salient under high demands. Last but not least, the study has provided practical implications on leadership trainings and employee development programs, by pointing out several solutions of organizational improvement for the top management teams.

Previous research on mere ownership effect has shown that merely possessing an object results in enhanced evaluation of that object (Beggan, 1992), when compared with unowned (Belk, 1988; Dittmar, 1992; Prelinger, 1959) or others-owned object (Nesselroade et al., 1999). Since people see their possessions as an extension of their self-identities (Belk, 1988), it is suggested that making self-enhancing judgments about possessions would satisfy owners' desires to maintain positive self-image. Extending the traditional mere ownership effect, this thesis examined whether people perceive having endowed the positive features of the product upon acquiring its ownership prior to its actual use, using essential oil products as stimuli objects. It is hypothesized that the proposed mere ownership effect would occur only when participants are motivated to self-enhance; and when the functional value of the owned object is congruent to the participants' own cultural value. A cross-cultural experiment was conducted in the United States and Hong Kong, with 93 American students and 99 Hong Kong students. Participants in both cultural groups were presented an essential oil product which was claimed to have a therapeutic function of enhancing one's holistic mode of thinking. Given that holistic thinking ability is valued in Asian culture compared to American culture, the oil's functional value is congruent to the cultural value of the Hong Kong participants relative to the American participants. Results showed that HK participants, who are motivated to enhance their holistic thinking ability, reported higher self-perceived efficacy in holistic thinking once they merely owned the ""holistic"" essential oils. This self-enhancing tendency did not happen in the American samples whose cultural orientation does not emphasize the importance of holism; and in participants who were not motivated to enhance their holistic thinking ability. The findings have important implications in understanding the circumstances in which this new form of the mere ownership effect might occur.