Clinical characteristics, methods of treatment and outcome in School Refusal have been investigated. School refusal/phobia has been reported in the literature not to be a true clinical entity with a uniform aetiology, psychopathology, course, prognosis and treatment, but rather a collection of symptoms or a syndrome occurring against the background of a variety of psychiatric disorders. Aetiological and precipitating factors also vary with age, psychosocial level of development and personality factors in the individual child, family structure and function, and the school setting. Data were collected retrospectively from 20 cases treated at the Child and Family Unit, Red Cross War Memorial Children's Hospital, Cape Town during a specific time period. Analysis of the data revealed a gender distribution of 11 boys and 9 girls; 1 girl, 5 - 8 years old and 11 boys and 8 girls 9 - 13 years old. One Asian, no Black, 13 Coloured and 6 White children were represented. A large section of the sample population represented the lower socio-economic group as determined by parental qualification and occupation. Most of the families tended to consist of more than 2 children (5 member families). Family dysfunction was recorded in all but one case, with evidence of a recognizable psychiatric disorder also recorded quite frequently in the nuclear family members. Educational difficulties were recorded in a third of the sample together with below average total IQ scores in virtually all the subjects evaluated. The bulk of referrals were from medical practitioners and relatively few from schools. Refusal to attend school was of relatively short duration in three-quarters of the sample. Most of the cases were first time school refusers. Accompanying symptoms or problems were mainly anxiety or depression - related whereas significant associated events were mainly family - oriented. Psychiatric disorders diagnosed most often were anxiety and affective disorders with overlap of the 2 conditions recorded in half the sample. Response to treatment was positive in two thirds of the sample and a combination of treatment methods proved to be the most successful treatment plan. School refusal as investigated in this study, was well represented in a population of children treated at a Child Psychiatric Out-Patient Unit. A high rate of resemblance on various aspects of school refusal was recorded between the study sample and reports in the literature reviewed.

<p>This thesis presents research documenting the effectiveness of computer-assisted cognitive remediation for patients with mood disorders. The first chapter provides an overview of cognitive impairment in patients with bipolar disorder (BD) and major depressive disorder (MDD), and a concise review of cognitive remediation in patients with schizophrenia, where the efficacy of these interventions has been reasonably well studied. The results of an analysis comparing neuropsychological test performance in patients with BD, MDD, and healthy controls is presented in Chapter 2, where we show a similar degree of deficit in both patient groups on processing speed, working memory, and mental flexibility tasks, and a greater degree of deficit in patients with BD on delayed recall and verbal fluency tasks. In Chapter 3 we present the results of our primary analysis examining the effectiveness of CACR for patients with BD and MDD; we show significant improvement on neuropsychological tests of working memory and delayed memory following remediation, and positive associations between improvement in neuropsychological test performance, and improvement in subjectively-rated cognitive and psychosocial functioning. Finally, in Chapter 4 we present functional neuroimaging evidence that shows increased activation following cognitive remediation in frontal control regions supporting working memory and in the right hippocampus supporting recollection memory. Although behavioural performance on the corresponding tasks was stable, the observation of increased activation in frontal and medial temporal brain regions following remediation is in line with our finding of improvement on neuropsychological tests of working memory and delayed recall post-training. Taken together, the results presented in this thesis provide convergent behavioural and neural evidence to demonstrate the efficacy of computer-assisted cognitive remediation for patients with mood disorders. These novel findings contribute to a growing body of literature that shows cognitive remediation to be an effective cognitive management strategy across a range of psychiatric and neurological disorders.</p> / Doctor of Philosophy (PhD)

<p>Autism Spectrum Disorder (ASD) is a heterogeneous disorder with a high burden of suffering and economic cost to society. The current Thesis represents a systematic attempt to investigate ASD heterogeneity, as it relates to the measurement and classification of the clinical phenotype. The Thesis integrates information from multiple constructs (symptoms, traits, behaviours), methods (factor analysis, cluster analysis, and factor mixture modeling), populations (clinical and high-risk samples) and time points (at diagnosis and at age 6) for the investigation of the underlying structure of the ASD phenotype in young children. The Thesis consists of four interrelated empirical studies and one Editorial. Results can be organized into three overarching themes: 1) in preschool children with ASD core diagnostic symptoms (social communication deficits and repetitive behaviours) appear to overlap with other emotional/behavioural problems (attention, withdrawal, anxiety, aggression, emotional reactivity); 2) along the heterogeneous autism spectrum there appear to be distinct, relatively homogeneous subgroups of children; on average, children across these subgroups differ in their levels of symptom severity, adaptive skills, and emotional/behavioural problems; 3) the underlying structure of the ASD symptom phenotype changes as children grow and develop. Thesis findings lend support to a much-needed shift in our conceptual and methodological approach to the study of measurement and classification of autism pathology: that is, instead of a set of categorical symptoms that present early in childhood and remain static over the life span, ASD might be better understood as a complex and dynamic disorder, structured on both categorical and dimensional constructs that vary not only across individuals at any given point, but also within individuals across time.</p> / Doctor of Philosophy (PhD)

published_or_final_version / Social Work / Master / Master of Social Work

In 1919, Morita Shōma first published his theories on the nature of a disorder he called shinkeishitsu. While it was often translated as “neurasthenia” after the definition of George Miller Beard (1869), Morita himself maintained that it was a nervous disorder with symptoms that included a range of ailments. Anything from physical and mental fatigue, headaches, heart palpitations, insomnia, nausea, or even dizziness could be a symptom of shinkeishitsu. The treatment that Morita recommended for this disorder was a combination of what is now considered behavior modification therapy, self-assessment, and meditation. After his death, this treatment came to be known as Morita Therapy, and it has persisted as a form of therapy for a variety of nervous disorders to the present day. In this thesis, I will demonstrate how Morita, through his education and connection with western psychiatrics, adapted Western mental health concepts to the Japanese context. At the same time, however, Morita attempted to extend concepts of mental illness that he considered to be Japanese culture-bound syndromes--specifically shinkeishitsu, which in addition to symptoms of neurasthenia caused patients to exhibit signs of obsessive-compulsive or perfectionist tendencies and a social phobia known as taijin kyōfushō. Morita Therapy exemplifies the general trends of psychiatric healthcare in the prewar period; the medicalization of nervous disorders and his interaction with the larger psychiatric community demonstrates how Japanese psychiatrists attempted to take part in the international discourse on mental health and wellness. / text

以高壓液態色層分析(HPLC)螢光測定生化分析同時量測背側縫合核及紋狀體中Tryp tophan、5-HT和5-HIAA，獲知Apomorphine(3.0mg/kg) 腹腔注射後30分鐘同時提高 了5-HT約合成及代謝，支持Apomorphine 透過黑質的自我接受器而影響背側縫合核 及紋狀體5-HT系統的假說。 Apomorphine 5 ug及8 ug直接打入老鼠紋狀體中，都排除紋狀體DA突觸前接受器參 與Apomorphine 影響5-HT系統的可能性，同時也符合以前DA突觸後接受器不參與Ap omorphine 對5-HT影響的結果。 把GABA的專一性拮抗劑Picrotoxin在不引起肌肉痙攣的劑量下(4mg/kg)打入老鼠體 內，能阻止Apomorphine 在背側縫合核及紋狀體中對Tryptophan、5-HT和5-HIAA的 影響，顯示GABA也參與了Apomorphine 對5-HT的影響。

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