A number of women continue to smoke in pregnancy despite the associated risks to their health and that of their unborn child. Little is known about their attitudes towards the smoking cessation support which is available to them and this thesis used a Theory of Planned Behaviour (TPB) approach to investigate this further. Study One was a qualitative investigation designed to elicit pregnant women's views about NHS Stop Smoking Services and Nicotine Replacement Therapy (NRT). Interviews were conducted with 18 pregnant smokers, recent quitters and new mothers who smoked in pregnancy, and 18 health professionals working in smoking cessation services. A number of behavioural, normative and control beliefs were generated with respect to these behaviours. As there is evidence for inconsistent smoking cessation advice giving in pregnancy and a lack of confidence amongst health professionals in this area, a theory-based resource to facilitate the communication of smoking cessation information in pregnancy was developed in Study Two and tested in an exploratory randomised controlled trial. The 22 second year medical students who viewed the theory-based resource in preparation for a mock interview were not significantly better at eliciting the salient smoking cessation beliefs of the simulated patient (mean score 8.41) than the 18 second year medical students who received a standard information resource (mean score 7.67). However, the resource showed potential to facilitate the delivery of a more patient centred interview and is worthy of further testing. The themes generated in Study One were used to inform the development of a TPB questionnaire to predict NRT use in pregnancy (NRTP-LF) in Study Three. This questionnaire was completed by 100 pregnant smokers who were recruited from antenatal clinics and Stop Smoking Services. The NRTP-LF significantly predicted intention to use NRT in pregnancy, explaining 41.1% of the variance in the outcome variable, justifying the creation of a short form version of it (NRTPSF). In Study Four, the NRTP-SF was tested on a further sample of 204 pregnant smokers recruited from antenatal clinics and Stop Smoking Services and was also shown to have predictive validity with respect to intention to use NRT in pregnancy. It also significantly predicted interest in participation in a trial testing the efficacy and safety of NRT use in pregnancy. It is envisaged that the theory-based communication resource and the NRTP-SF could have practical utility in health care settings and the potential to increase smoking cessation service use and quit rates in pregnancy.

The literature has struggled to reach an acceptable definition for the construct of impulsivity. Different models have variously suggested that the crux of the impulsivity construct lies in lack of planning, difficulties in concentration, failure of inhibition or attraction to sensation or immediate reward. More recently, research has suggested that impulsivity is increased in conditions of extreme affect, either positive or negative. The development of a novel measure of affective impulsivity, termed the UPPS-P Impulsive Behaviour Questionnaire, has enabled quantitative investigation of the construct. In spite of difficulties in defining impulsivity, there is a broad consensus as to the clinical utility of the construct. It has been shown to be highly predictive of a wide range of so-called impulsive behaviours, which include suicide, binge eating and substance use. At the same time, impulsivity is also an important trans-diagnostic construct. Trait impulsivity is elevated in many psychiatric disorders, including borderline personality disorder and attention deficit hyperactivity disorder. There is also strong evidence that both state and trait impulsivity are elevated in bipolar disorder, and that this elevation may explain a number of common comorbidities and behaviours found within the disorder. The thesis begins with a review of the literature, examining six key perspectives on impulsivity and their corresponding measures within Chapter One. Chapter Three also explores the construct and measurement of emotion-mediated, affective impulsivity. The literature linking impulsivity to behaviour in both clinical and non-clinical samples is reviewed within Chapter Two. Within Chapter Four the evidence supporting continuum models of psychiatric disorder is introduced, with particular discussion of the bipolar spectrum. Chapter Five brings together the preceding chapters, reviewing the literature supporting an interaction between psychiatric disorder, affect, impulsivity and behaviour. The first study of this thesis, a cross-sectional questionnaire study which can be found in Chapter Six, looked to extend these findings by exploring the presence and role of impulsivity in a wider bipolar spectrum sample. Experience of extreme positive mood state, as measured by the Mood Disorder Questionnaire, was found to relate to increased trait impulsivity and elevated engagement in a range of impulsive behaviour. A structural equation model demonstrated that impulsivity could be separated into cognitive and affective components, with affective impulsivity a key predictor of impulsive behaviour. Affective impulsivity was also shown to moderate the relationship between extreme mood experience and impulsive behaviour. The second study, found in Chapter Seven, used semi-structured interviews and thematic analysis to develop an understanding of the individual’s experience of impulsivity and impulsive behaviour. The themes arising from these data (preparatory set, influence of the environment and others, intense emotional state, (lack of) agency, premonitory urge, reflexive action and sensation seeking) suggested that context plays an important role in the prediction of impulsive behaviour, with the physical and social environment of the individual an important factor in their behaviour. Results also supported the validity of the affective impulsivity construct. Individuals described their emotional state as having a large impact upon their decision to act impulsively, either using behaviour as a tool to moderate their affective state or experiencing cognitive difficulties as a result of it. Finally, data suggested a link between impulsivity and loss of control. Models were developed which indicate the presence of a ‘risky mood state’ in which individuals feel unable to control or predict their behaviour. Together the studies highlight the complexity of impulsivity, and the importance of a wide variety of other factors related to the construct. This is particularly true of affective state, which was seen through both studies to have a large impact on both the occurrence and experience of impulsivity and impulsive behaviour. The studies support the validity of the bipolar spectrum, with similar experiences found in our sample as in clinical samples. The finding that impulsivity is related to a wide range of high-risk behaviours, and that many of these behaviours are ego-syntonic, has important implications for the treatment of impulsivity.

Previous studies have shown that dietary supplementation of curcumin or omega-3 polyunsaturated fatty acids (PUFAs) such as docosahexaenoic acid can reduce behavioural deficits and β-amyloid (Aβ) pathology in several models of Alzheimer’s disease (AD), including Tg2576 mice. However, no study to date had examined the effect of omega-3 PUFA and curcumin co-supplementation on behaviour or β-amyloid pathology in mouse models of AD. Further to this, no study to date had examined the effect of longitudinal omega-3 PUFA or curcumin supplementation provided from an early age before significant pathological development in the Tg2576 model. This was deemed important since human studies have suggested that lifelong dietary choices before disease development are an important factor in disease risk. Finally, although a plethora of studies has examined the effect of omega-3 PUFA supplementation, none has accurately examined its effect against an appropriate control diet. For example, some control diets contained differential levels of fatty acids such as excess total fat and omega-6 PUFAs. Such differences in the control diet may have contributed to the observed beneficial effects of dietary omega-3 PUFA supplementation, particularly since these dietary factors can exacerbate pathological processes related to AD. Using this experimental design, chapter 3 found longitudinal dietary supplementation of omega-3 PUFA docosahexaenoic acid (DHA) from an early age in Tg2576 mice provided some protection from cognitive decline that was limited to later but not early stages of pathology. In contrast to previous reports however, Aβ pathology was unaltered by DHA supplementation. Providing DHA supplementation from an even earlier age, chapter 4 showed that DHA reduced behavioural deficits at an early age (prior to Aβ pathology), although interestingly, these effects were less robust at the later age. Chapter 5 examined longitudinal supplementation of curcumin, fish oil containing omega-3 PUFAs (DHA and eicosapentaenoic acid, EPA) and their co-supplementation from an early age in Tg2576 mice. The results consistently revealed no beneficial effects of dietary supplementation on behaviour or Aβ pathological measures. The findings from this thesis indicate that dietary supplementation of DHA relative to a suitable control diet can provide only limited protection against behavioural deficits in Tg2576 mice. In contrast, fish oil supplementation containing omega-3 PUFAs DHA and EPA provided no protection, indicating that DHA monotherapy may be a more advisable treatment. The null effects of curcumin supplementation at earlier stages relative to previous studies suggest that curcumin may only be effective during advanced stages of pathology, although further investigation is needed. Finally, the null effects of curcumin and fish oil/omega-3 PUFA co-supplementation suggest that this is not an optimal intervention strategy in reducing Aβ-induced changes.

Objective: There is emerging evidence that exercise may modify disease progression and improve function in a number of neurodegenerative diseases, but this has not been systematically studied in Huntington.s disease (HD). The purpose of this study was to evaluate feasibility, acceptability and benefits of an exercise programme in people with HD. Methods: Using a randomised controlled trial design, 25 participants with manifest HD were allocated to either intervention (home-based exercise; n=13) or control (usual care;n=12) groups. Participants were assessed at baseline and eight weeks later. Eleven participants from the exercise and 10 from the control group completed the intervention study. The primary outcome was gait variability (stride time coefficient of variation (CV)). Secondary outcomes included other measures of gait, disease-specific motor scale and measures of balance, muscle strength, mobility and community walking, functional performance in ADL and quality of life. These measures were included to reflect a range of physical impairments and activity limitations seen in people with HD. Analysis of covariance was used to compare follow-up scores across groups after adjustment for differences at baseline. Effect sizes were calculated for outcome measures based on differences in change scores between groups. Process interviews were conducted at the end of the study to determine acceptability of the intervention to participants. Cross sectional investigation of outcome measures was undertaken initially to investigate discriminant and concurrent validity as well as test re-test reliability and minimal detectable change (MDC95) along the broad spectrum of the disease. Baseline data from 25 participants with manifest HD (who went on to participate in the intervention), in addition to data from 17 individuals with pre-manifest HD and 25 healthy controls were analysed. This data was of use in interpreting the results from the interventional study. In particular, the MDC95 data helped in determining of whether any statistical significant changes due to the intervention are clinically meaningful. Results: Measures of gait variability, some measures of balance, community walking and measures of functional performance in ADL were able to distinguish between people with manifest HD and pre-manifest HD as well as between people with pre-manifest HD and healthy controls suggesting good discriminant validity. All these outcomes had also good concurrent validity with a disease specific motor score. The test re-tests reliability scores for the majority of the outcomes were high and the MDC95 scores were low, suggesting that the individual variability on these outcomes were low. Adherence rates to the exercise programme were high (78.8% of participants reported completion of at least 78% of the prescribed sessions). Participants in the intervention group demonstrated significant improvement in stride time CV (95% CI (-11.5, -0.6))based on complete case analysis. Significant differences between groups were also observed in the disease-specific motor scale and in measures of balance, mobility,community walking and functional performance in ADL, but not muscle strength and health-related quality of life. Effect sizes were large (>0.8) for the majority of the outcomes. The magnitude of the change as a result of the exercise intervention exceeded the calculated MDC95 values for some of the outcomes, which suggest that most of the observed changes are clinically meaningful. Qualitative feedback from the participants who completed the exercise programme suggested high levels of acceptability with positive impact on general health and mobility. Participants identified barriers and facilitators that affected performing the exercises at home and described management strategies that helped adherence to the exercise programme. Conclusions: This study was the first systematic trial to demonstrate that a short-term structured exercise programme is acceptable and can be safely delivered in a home environment; achieve good adherence; and positively affect body function and activity in people with HD. The sensitivity of the outcomes as determined in the cross-sectional study, to mobility deficits the in pre-manifest HD group is important. These outcomes has the potential to be used in future studies of exercise interventions in the premanifest stage which aim to target such deficits early in the disease life cycle, before they begin to impact on a person.s ability to participate in the community. Overall the data presented from this study provides a platform for further investigations to extend these findings about the role of exercise and physical activity in people with HD. Larger and more detailed studies are needed to replicate findings from this study in othercontexts and variations in dose.

INTRODUCTION: Psychiatric disorders are among the most common illnesses in children. Most psychiatric disorders begin in childhood but most children with psychiatric symptoms receive delayed or no treatment. A resilience-based strategy for at-risk children in primary care, such as enhancing childhood sports participation, could be an effective and feasible early intervention. Existing literature demonstrates an association between sports participation and mental health in adolescents and adults, and that exercise can improve depressive symptoms. There are few studies on the link between mental health and sports participation in children under twelve. OBJECTIVE: Since sports participation could be a simple and potentially available intervention for mental health, we investigated the association between sports participation in children ages 6-11 and measures of psychiatric impairment. METHODS: We performed linear regression analyses between measures of psychiatric symptoms (total number of CBCL/6-18 syndrome scale elevations and individual syndrome scale elevations) and sports participation as measured by the number of parent-reported sports, with demographic factors as covariates. RESULTS: The association between sport count and number of CBCL syndrome scale elevations was not significant (p = 0.638). However, we found a significant association between fewer numbers of sports reported and higher T-scores on the Withdrawn/Depressed CBCL syndrome scale (p = 0.019) and was also significant for age (p = 0.003) and ethnicity (p = 0.037). CONCLUSION: Playing one or fewer sports during childhood is associated with higher withdrawn/depressive symptoms in school-age children. This replicates earlier findings which suggest that sports participation may be protective for child mental health.

Thesis (Ph.D.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / The purpose of this research was to determine, using the 2[14C]deoxyglucose autoradiographic method, the local cerebral metabolic rates for glucose (LCMRglu) after the administration of morphine or saline in rats escaping from acute or chronic footshock or exposed to conditioned stress. All animals were given morphine (4mg/kg, sc) or saline 7 days, 3 days and 10 minutes prior to the tracer injection. The effects of stimulation in the acute and chronic footshock studies revealed that an identical noxious stimulus may not have similar effects on functional cerebral activity if there are differences in experience with the str1xsor. The results of the conditioned stress experiment demonstrate that simply placing an animal in an environment previously associated with footshock is sufficient to elicit changes in LCMRglu. The effects of morphine in the control and acute footshock experiments were similar in that nearly all of the 73 analyzed brain regions (99% and 93%, respectively) showed decreases in LCMRg1u. Morphine, however, caused fewer decreases (56%) in the chronic footshock study. Interestingly, the percentage of structures showing decreases in the conditioned stress study (79%) was approximately halfway between the effects seen in the two footshock studies. Morphine in the presence of acute footshock, compared to acute footshock alone, caused significant decreases in elements of the limbic telencephalon, basal forebrain and thalamic midline (paraventricular and paratenial nuclei). On the other hand, morphine did not cause any significant decreases in these structures (or others) in the chronic footshock study. Rather, the combination of morphine and chronic footshock, compared to morphine alone, caused significant increases in several brainstem structures previously implicated in opioid analgesia: the locus coeruleus, gigantocellular reticular nucleus and raphe magnus. Additionally, significant effects were seen in basal ganglia structures which are normally associated with the motor system. The effects seen in these structures, along with the significant effect demonstrated in the parafasicular thalamic nucleus, suggest that morphine works to attenuate pain in animals exposed to chronic footshock via neural networks responsible for sensorimotor reactions to pain. Alternatively, animals exposed to chronic footshock may have developed tolerance to the effects of morphine. The effects of morphine, however, in the chronic footshock experiment are much different from those seen in the acute footshock study where morphine acts primarily in limbic structures and midline thalamus to attenuate the affective reaction to pain. / 2031-01-01

A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in the branch of Psychiatry Johannesburg, 2014 / BACKGROUND: Sexual offences against children have been an escalating problem in South Africa. Several international studies have found links between mental illness and sexual offenders. However, very little has been published on forensic psychiatric observation populations charged with sexual offences. South African studies have neither reported on mental illness and sexual offences against children, nor on forensic psychiatric observation of individuals charged with sexual offences against children. AIMS: To determine the demographic and clinical characteristics, and outcomes of the observation process, in a population charged with sexual offences against minors, referred for forensic psychiatric observation. OBJECTIVES: To measure the number of individuals admitted to a forensic psychiatric unit for observation, for any charge of a sexual offence against a minor, over a three year period; to determine their demographic profiles; to determine the number assessed to be fit to stand trial and criminally responsible, and the number not fit to stand trial and/or not criminally responsible; to determine if associations exist between the reasons for referral and outcomes in terms of fitness and responsibility; and to ascertain whether mental disorders were present in these individuals. METHODS: This study took the form of a retrospective record review at Sterkfontein Hospital from January 2007 to December 2009. It included all individuals charged with a sexual offence against a minor. Data was collected from the Criminal Procedure Act reports and clinical files. RESULTS: Rape was the commonest charge. More than half the sample was found fit to stand trial and criminally responsible. However, a high number of psychiatric diagnoses were made, of which substance-related disorders and intellectual impairment represented the majority of diagnoses. CONCLUSIONS: Among individuals referred for forensic psychiatric observation, charged with sexual offences against minors, rape was the commonest charge. Most of these individuals were found fit to stand trial and/or criminally responsible. However, a significant number were diagnosed with mental disorders. It is recommended that they receive special rehabilitation and psycho-education into their psychiatric conditions and the consequences thereof.

Thesis (M.S.)--Boston University, 1951

People with Parkinson's disease report high levels of non-motor symptoms, including anxiety and depression, that are difficult to treat pharmacologically. Mindfulness-based interventions have been shown to be effective in other long-term conditions. This pilot study explored how a mindfulness-based intervention may have had an effect and for whom, with a view to informing future studies. Volunteers were randomised to a remote delivery, eight-week mindfulness cognitive behavioural group therapy intervention (n=40) or wait-list (n=38), and measures for psychological outcomes and putative mediators were taken at baseline, 4 weeks, 8 weeks and 20-week follow-up. The study showed that all the outcome measures changed in a positive health direction in the intervention group. The intervention had a small effect on decentering (d=.36) and acceptance (d=.27) by mid-point, before depression at 8 weeks (d=-.28) and anxiety at follow-up (d=-.29), indicating an indirect effect between trial arm and levels of distress. Mediation and moderation analysis were conducted using PROCESS, time-lagging the mediators to the outcome variables, but no combined or individual indirect effects had confidence intervals entirely above or below zero, thus mediation cannot be confirmed. When the end of intervention mediators were analysed with the follow-up levels of anxiety and depression, there is evidence of inconsistent mediation, or possible suppression effects. Moderation analysis revealed that the effect on anxiety levels was moderated by gender, with women benefitting more from the mindfulness intervention. Moderated mediation analysis also indicated that the effect of the trial arm on levels of acceptance was conditional by age and time since diagnosis, and the effect of trial arm on levels of mindfulness skills by age, meaning that younger, newly-diagnosed patients were more able to increase mindfulness skills and acceptance.

Developmental prosopagnosia (DP) is a condition associated with severe difficulties recognising familiar faces, which occurs in individuals with normal intelligence, typical low-level vision, and in the absence of manifest brain injuries. The neuro-cognitive origins of DP are still debated. Cognitive accounts have attributed face recognition deficits to reduced holistic processing of faces (i.e., whereby individual features of faces are integrated into a unified perceptual whole), and mnemonic difficulties, whereby prosopagnosics may be able to form accurate percepts, but are unable to maintain those percepts over time. At the neurological level, differences have been reported in the structural and functional connectivity of occipito-temporal regions which include face selective areas. Chapter 2 of this thesis investigated facial emotion recognition in DP and revealed widespread difficulties recognising facial emotion in individuals with apperceptive profiles of DP (i.e., DPs exhibiting difficulties forming view-invariant structural descriptions of faces at early stages of encoding). Chapter 3 explored body recognition in DP and found evidence of impaired body and object recognition in DP individuals. Moreover, the lack of relationship between observers' object and body recognition performances suggested that body and object recognition impairments in DP may co-occur independently. Chapter 4 investigated the susceptibility to the composite face illusion in two independent samples of individuals with DP and failed to show evidence of diminished composite face effects in both samples. Finally, Chapter 5 considered the contribution of perceptual encoding and short term face memory in DP using a delayed match-to-sample task and found that recognition impairments in prosopagnosics were insensitive to changes in retention interval and viewing angle, supporting an apperceptive characterisation of DP. The implications of these findings for the characterisation of DP and for understanding its underlying cognitive mechanisms, are discussed in Chapter 6.