Thesis advisor: Ann W. Burgess / Purpose: The purpose of this descriptive phenomenological study was to understand the lived experience of Black emerging adults with psychotic disorders who have community violence exposure (CVE). The aims included understanding how Black emerging adults with psychotic disorders described the experience of community violence in their lives. A secondary aim was to understand how these individuals described how their experience of community violence has impacted their ability to attain goals that are consistent with emerging adulthood.Background: CVE is a public health crisis. Black emerging adults are at an increased risk of CVE and having a psychotic disorder. CVE and psychotic disorders can cause an increased burden on life. While there is research examining the impact of CVE on mental health and research examining the effects of trauma on psychotic disorders, there is limited qualitative work in Black emerging adults with psychotic disorders and CVE. Method: This study was guided by Husserl's descriptive phenomenology philosophy, and Giorgi's descriptive psychological phenomenological approach guided data collection and analysis. Eleven participants were recruited through purposive sampling. Participants had to have a psychotic disorder, report CVE, identify as Black or African-American, and be between 18 and 29. Interviews were conducted individually with each participant to understand their experiences of CVE. Using bracketing, the data was coded and analyzed. Rigor and trustworthiness were ensured by using Lincoln and Guba's criteria for credibility, confirmability, dependability, and transferability. Results: The sample consisted of eleven participants, ranging in age from 21 to 28, with an average age of 24.6. Six identified as male, four identified as female, and one participant identified as transgender and non-binary/non-conforming. All participants identified as non-Hispanic Black/African-American and had a primary psychotic disorder. Four themes were identified: (1) CVE results in a range of emotional responses, (2) CVE results in a range of behavioral responses, (3) CVE causes disruptions in life and relationships, and (4) participants aspire for a better life without a clear pathway. These four themes represent the lived experiences of CVE in these Black emerging adults who have psychotic disorders in Boston, MA. The themes shed light on the consequences CVE had in their lives. Conclusion: Utilizing descriptive phenomenology created a comprehensive understanding of the experience of the phenomenon of CVE in Black emerging adults with a psychotic disorder. The results illuminated the complex nature CVE has on their life and mental health. Future research should focus on quantitative studies to explore the impact of CVE on various health, social, and psychological outcomes. / Thesis (PhD) — Boston College, 2024. / Submitted to: Boston College. Connell School of Nursing. / Discipline: Nursing.

by Mak Wing Fun, Ingrid. / Thesis (M.Phil.)--Chinese University of Hong Kong, 1998. / Includes bibliographical references (leaves 58-64). / Questionnaire also in Chinese. / Abstract --- p.ii / Acknowledgments --- p.iii / Table of Contents --- p.iv / List of Tables --- p.vii / List of Appendix --- p.viii / CHAPTER / Chapter 1 --- Introduction And Literature Review --- p.1 / Adherence(Compliance) --- p.1 / Pattern of Non-adherence --- p.1 / Health Belief Model and Adherence-Related Attitudes --- p.2 / Non-adherence and Psychiatric Disorder --- p.2 / Drug Adherence and Affective Disorder --- p.3 / Bipolar Disorder and Lithium --- p.3 / Methods for Assessing Adherence --- p.4 / Clinical Factors Associated with Lithium Non-adherence --- p.6 / Drug Adherence of Hong Kong Chinese Patients with Affective Disorder --- p.9 / Individual Factors --- p.10 / Attitude and Belief --- p.10 / Health Locus of Control --- p.15 / Socio-Cultural Factors --- p.15 / Explanatory Model --- p.15 / Illness Attribution --- p.16 / Attitude Towards Western Medication --- p.17 / Somatisation and Social Stigma --- p.18 / Family Support --- p.20 / Purposes of the Study --- p.22 / Chapter 2 --- Method --- p.23 / Subjects --- p.23 / Outcome Measures --- p.24 / side Effect Measure --- p.25 / Attitude Measures --- p.26 / Support Measure --- p.27 / Mood State Measure --- p.27 / Memory Function Measure --- p.28 / Procedure --- p.28 / Chapter 3 --- Results --- p.29 / Non-Adherence Rate --- p.29 / Intercorrelations of Adherence Measures --- p.30 / Mean Lithium Level and Adherence Status --- p.31 / The Reliability of the Instruments --- p.33 / Comparison of Fully Adherent and Non-adherent Patients --- p.34 / Discriminant Analysis --- p.39 / Comparison of the Patients' Attitudes and Social Support by the Number of Non- adherence Criteria Met --- p.40 / Comparison of Patients' Attitudes and Perceived Support by Patient's Self-report of Adherence --- p.43 / Comparison of Patients' Attitudes and Perceived Support by Family Member's Report of Adherence --- p.45 / Comparison of Patients' Attitudes and Perceived Support by Case Psychiatrist's Report of Adherence --- p.47 / Chapter 4 --- Discussion --- p.49 / Single vs. Multiple Criteria. --- p.49 / Predicting Non-adherence --- p.51 / Other Variables Associated --- p.53 / Limitations of the Study and Recommendations --- p.56 / Chapter 5 --- References --- p.58 / Chapter 6 --- Appendix --- p.65

Bakgrund: Tidigare forskning visar att patienter med psykossjukdomar får ett negativt bemötande i den somatiska slutenvården. Sjuksköterskors fördomar och bristande kunskap är något som kan inverka på omvårdnaden, en inställning som präglar samhället i stort både i nutid och historiskt sett. Förutsättningar för en personcentrerad omvårdnad innebär en relation av tillit och trygghet något som sjuksköterskor ofta saknar kunskap och erfarenhet att tillgodose i mötet med patienter med psykossjukdomar. Syfte: Att ur ett sjuksköterskeperspektiv beskriva upplevelser av att bemöta patienter med psykossjukdom inom den somatiska slutenvården. Metod: En litteraturöversikt har gjorts för att belysa hur sjuksköterskor upplever bemötandet av patienter med psykossjukdom inom den somatiska slutenvården. Resultatet baserar sig på tolv vetenskapliga artiklar varav sju var kvalitativa och fem kvantitativa vilka analyserades enligt Fribergs (2012) metod för resultatanalys. Resultat: Resultatet tyder på att sjuksköterskor upplever brister i kunskap, erfarenhet, stöd och tid. Negativa inställningar som frustration och rädsla är vanligt förekommande. Slutsats: Sjuksköterskor efterlyser en vidare utbildning i psykiatrisk omvårdnad för att undanröja negativa attityder i bemötandet av patienter med psykossjukdomar. Även tidsbrist upplevs som ett betydande problem i omvårdnaden. / Background: Previous research shows that patients with psychotic illnesses receive a negative attitude in somatic inpatient care. Nurses´ prejudices and lack of knowledge is something that can affect the care. This attitude characterizes society in general, both today and historically. Preconditions for a person-centered care implies a relationship of trust and confidence. Nurses often lack the knowledge and experience to accommodate in the meeting with patients with psychotic illnesses. Objectives: From a nurse perspective describe nurses’ experiences of encounters with patients with psychotic illness in somatic inpatient care. Methods: A literature review was used to highlight nurses' perceived treatment of patients with psychotic illness in somatic inpatient care. The results are based on the twelve peer-reviewed articles, seven were qualitative and five were quantitative, these were analyzed according to Friberg (2012) method for analysis of results. Results: The results show that nurses are experiencing gaps in knowledge, experience, support and time. Negative attitudes such as frustration and fear are common. Conclusions: Nurses request increased education in psychiatric nursing to eliminate the negative attitudes in treatment of patients with psychotic illnesses. Lack of time is also considered to be a significant problem in nursing.

Patients with schizophrenia are normally treated with one of several antipsychotic medications that differ from one another in the areas of the brain they affect including the dorsal striatum, a subcortical section of the forebrain, and the prefrontal cortex (PFC), located in the anterior part of the frontal lobes. Two different tests of implicit memory, the probabilistic classification learning (PCL) and the Iowa gambling task (IGT), have been shown to rely on the dorsal striatum and the PFC, respectively. Studies have previously shown that patients with schizophrenia treated with antipsychotics that affect the dorsal striatum (e.g., risperidone), have altered performance on the PCL, and those treated with antipsychotics that affect the PFC (e.g., clozapine), have altered performance on the IGT. We tested the hypothesis that patients with schizophrenia treated with olanzapine would have a poorer performance on the IGT, but not the PCL, when compared with controls. This study aimed to clarify conflicting results from prior experiments observing the effects of olanzapine on implicit memory in people with schizophrenia. We also hypothesized that performance of patients taking aripiprazole would be comparable to those taking risperidone, or an FGA; however, we were unable to recruit a sufficient amount of participants to test this hypothesis. Patients with schizophrenia, a mental disorder characterized by a breakdown in relation between thoughts, emotion, and behavior, treated with olanzapine were recruited through local psychiatric clinics or using a newspaper ad. Administration of the Brief Psychiatric Rating Scale (BPRS) and the Mini Mental State Examination (MMSE) preceded a brief questionnaire of demographic information. Participants were tested on the PCL and the IGT using a personal computer. Results revealed poorer performance on both the MMSE and BPRS for patients when compared with controls. Patients taking olanzapine were impaired in learning the PCL but not the IGT when compared with controls. Results suggest that olanzapine acts on the PFC to augment IGT performance but further studies are needed. / Thesis (Master, Neuroscience Studies) -- Queen's University, 2013-07-23 15:09:21.55

Despite a consensus that psychosocial adversity plays a role in the onset of psychosis, the nature of this role and the underlying neurobiological mechanisms remain unclear. This study examined the complex relationship between perceived ethnic discrimination (PED) and paranoid ideation and its mediating factors, in individuals with Attenuated Psychotic Syndrome (APS) using a virtual reality paradigm to objectively quantify paranoia. Secondly, a sensory gating deficit, indexed by P50 Event Related Potential (ERP) abnormalities was examined, and the combined effect of electrophysiological sensory gating deficits and psycho-social adversity on the development of psychosis was explored. Results showed that perceived maternal neglect and antipathy in childhood, PED and perceived social support were key factors in young adults with APS. Also PED was positively correlated with persecutory paranoia. Furthermore, individuals with APS displayed sensory gating impairments. Therefore, perceived exposure to adverse experiences and sensory gating deficits observed in individuals with APS are present before the first episode and are consistent with current biopsychosocial models in which early psychosocial stress, later psychosocial adversity and neurocognitive functioning plays a key role in the development of psychosis.

Neuregulin 1 (NRG1) is a growth factor implicated in neurodevelopment and postnatal maintenance of synaptic circuits. Its gene has been associated with schizophrenia, and the expression of the type I isoform (NRG1tyI) is increased in patients’ brains. Earlier behavioural phenotyping of mice over-expressing NRG1tyI revealed impairment in hippocampus-dependent spatial working memory. This present work investigates the effects of increased NRG1tyI expression on hippocampal network functioning in these mice. Fast network oscillations, specifically at gamma frequencies, were studied in CA3 hippocampal slices in a carbachol model using cellular and extracellular microelectrode recording techniques. The peak frequency of field potential oscillations was significantly reduced in slices from NRG1tyI mice compared to wild-type littermates. In addition, NRG1tyI mouse slices were more prone to develop epileptiform activity. During rhythmic activity, the balance of phasic excitation and inhibition was significantly altered in principal cells of NRG1tyI mice. Inhibitory synaptic input was more sustained, while excitatory synaptic currents were kinetically unchanged but larger and more variable in amplitude. Together, these data suggest altered functioning of the GABAergic inhibitory circuits that generate and maintain gamma oscillations. Because parvalbumin-expressing (PV+) interneurons are a major target of NRG1 signalling, the inhibition from PV+ interneurons to pyramidal cells was examined next. Channelrhodopsin-2-mediated photostimulation of PV+ cell axons failed to show changes in GABAergic inhibition of CA3 pyramidal cells in NRG1tyI mice. However, synaptic miniature glutamatergic neurotransmission was reduced in identified PV+ basket cells (BCs) and axo-axonic cells (AACs) but not in pyramidal cells. The change was expressed postsynaptically, affecting NMDA receptor- but not AMPA receptor-mediated currents. The data suggest that NRG1tyI over-expression results in alterations in PV+ interneuron types, particularly at the glutamatergic synapses that excite these cells. These changes and the altered gamma oscillations are already evident in late adolescence — before the age at which cognitive deficits are detectable.

Induktiv intervjustudie med syfte att beskriva vilka erfarenheter sjuksköterskor verksamma inom somatisk vård har av att vårda personer med psykossjukdom. Resultatet visar att sjuksköterskor inom den somatiska vården har relativt mycket erfarenhet av att vårda personer med psykossjukdom. Den specifika psykiatriska kompetensen uppfattades otilräcklig och vårdandet innebar ofta känslosamma möten.

>Magister Scientiae - MSc / INTRODUCTION: Sustained attention is known to be dysfunctional in psychotic disorders. Sustained attention is the ability to remain focused on a specific time-locked stimulus within a task. We aimed to determine whether there are specific group differences between CON and three psychotic disorders: SCZ, MPD and BPD, then to determine differences between these psychotic disorders. This included differences in behavioural performance and prominent electrophysiological event-related potential (ERP) wave components during cueing and target processing of a visual sustained attention task. Further we aimed to characterize ERP waveform component relationships across and within these groups for demographics, substance use, behavioural performance, and clinical variables, the last limited to the psychotic groups. Lastly, we investigated the effects of prescribed medications on ERP wave components within the psychotic groups. METHODOLOGY: 103 participants (29 schizophrenia (SCZ), 28 bipolar disorder with a history of psychosis (BPD), 21 methamphetamine-induced psychotic disorder (MPD), and 30 controls (CON)) underwent electroencephalography (EEG) record while completing a visual continuous performance task. Participants were presented with 60 trials with three consecutive S’s, the presentation of the third S required a behavioural response. Prominent ERP waveform components were extracted from cues and target stimulus. Group differences were determined by ANOVA with Bonferroni post-hoc correction or multivariate Kruskal-Wallis test dependent on data distribution. Relationships between ERP wave components were determined appropriate with Spearman’s Rank order correlation analyses. RESULTS: (1) MPD reported higher use of substances compared to CON, SCZ and BPD. SCZ behavioural performance was poorer compared to CON which was shown by their longer response times, reduced accuracy and increased errors of omission. Clinically, MPD was found to have a shorter duration of illness compared to SCZ. Then SCZ was found to have more positive symptoms compared to BPD whereas BPD had more negative symptoms compared to SCZ. For the first cue, wave component differences were found only over the left hemisphere, for P100 amplitude over the frontal cortex, P300 amplitude over the central cortex, and N170 amplitude over the parietal cortex. For the presentation of the second cue, differences noted for all groups were localised to the frontal and central brain regions, for P100 and N170 ERP waveforms. For the target stimulus wave component differences were found over the prefrontal, frontal and parietal brain regions, within CON, SCZ, BPD and MPD. (2) For the first cue, education positively correlated with the N170 left parietal amplitude in CON and P300 right parietal amplitude in MPD. During the second cue, the left parietal N170 latency in SCZ correlated positively with education and the left central P300 latency correlated negatively with education in MPD. The age on the day of testing correlated positively with the target left frontal P300 latency in MPD. For the first cue, substance use positively correlated with the left and right parietal P300 latency and negatively for the right parietal P100 amplitude in SCZ. In MPD, a negative correlation was noted across left and right prefrontal N170 and P300 amplitudes, and positive correlation for the left prefrontal P300 latency in MPD. For the target stimulus, correlations were evident for the left and right parietal N70, N170 amplitudes, P300 latency, the right parietal P100 amplitude and left central P300 latency in SCZ. For the first cue, in SCZ PANSS total score correlated positively with left and right central P300 amplitudes and the left parietal P300 amplitude. For the second cue; in MPD, the PANSS negative symptom score, positively correlated with the P100 and N170 left parietal amplitude, left and right parietal P150 amplitude, left central and right parietal P300 amplitude. For the target, the Hamilton depression rating scale correlated positively with the left and right frontal P300 amplitude in MPD and then negatively with the right parietal P300 amplitude in SCZ. Behavioural performance in CON, positively correlated with the left parietal N70, P100, P150 and N170 amplitude the number of correct responses, and left central N170 amplitude. While the number of impulsive responses correlated negatively with the left parietal N70, P100, P150 and N170 and the left central N170 amplitude of CON. For the second cue, behavioural performance was related to the fronto-parietal relationship across all groups. For the target stimulus, impulsive responses positively correlated with the left parietal N70 latency in SCZ. Overall response time negatively correlated with the right parietal P300 latency for SCZ. (3) Medication was found to affect ERP wave components during the sustained visual attention task. For the first cue FGA’s increased the left central P100 amplitude in both SCZ and BPD and decreased the left parietal P100 amplitude in SCZ only. The use of antipsychotics increased the right parietal N70 and left central P100 amplitudes in BPD, specifically the right prefrontal N170 amplitude was increased with the use of SGA’s. Then clozapine use increased the left frontal P100 amplitude in SCZ. For the second cue, SGA’s decreased the right parietal P150 amplitude in SCZ but in MPD the right parietal P150 amplitude was increased with haloperidol use, and FGA. SGA’s increased the left parietal P300 latency in BPD and sodium valproate decreased the left prefrontal P300 latency. For the target stimulus, SGA’s decreased the right parietal P100, P150 and left parietal P150 amplitudes and increased the left central P300 latency in BPD. CONCLUSION: (1) sustained attentional performance is poorer in SCZ. Our study adds to previous studies showing attention processing deficits in SCZ, are evident during cueing of a sustained attention tasks; (2) substance use was found to slow cognitive processing, education improved executive function and information processing, and symptom severity was associated with dysfunction of prefrontal and frontal cortices; (3) antipsychotic medication was related to improved processing of salient information. These data support the current literature and provide novel insights to the attentional processing deficits during cueing in the psychotic disorders.

>Magister Scientiae - MSc / Introduction: Sustained attention is known to be dysfunctional in psychotic disorders. Sustained attention is the ability to remain focused on a specific time-locked stimulus within a task. We aimed to determine whether there are specific group differences between CON and three psychotic disorders: SCZ, MPD and BPD, then to determine differences between these psychotic disorders. This included differences in behavioural performance and prominent electrophysiological event-related potential (ERP) wave components during cueing and target processing of a visual sustained attention task. Further we aimed to characterize ERP waveform component relationships across and within these groups for demographics, substance use, behavioural performance, and clinical variables, the last limited to the psychotic groups. Lastly, we investigated the effects of prescribed medications on ERP wave components within the psychotic groups. Methodology: 103 participants (29 schizophrenia (SCZ), 28 bipolar disorder with a history of psychosis (BPD), 21 methamphetamine-induced psychotic disorder (MPD), and 30 controls (CON)) underwent electroencephalography (EEG) record while completing a visual continuous performance task. Participants were presented with 60 trials with three consecutive S’s, the presentation of the third S required a behavioural response. Prominent ERP waveform components were extracted from cues and target stimulus. Group differences were determined by ANOVA with Bonferroni post-hoc correction or multivariate Kruskal-Wallis test dependent on data distribution. Relationships between ERP wave components were determined appropriate with Spearman’s Rank order correlation analyses.

Introductions: The aim of the study is to investigate art therapists’ experiences of what is working in the treatment of patients with psychotic disorders.  Issues: What interventions art therapists use in clinical work with patients with psychotic disorders? How is the art therapeutic method significance for the psychotherapeutic treatment?  Method: The study is based on semistructured interviews with five art therapists with experience of treatment with patients in psychotic disorders. The interviews were recorded and then processed using thematic analysis. Result: The result describes five art therapists' experiences of what characterizes the treatment with patients in psychotic disorders. Two main themes emerged in the study with three respectively four subtopic. The interventions applied by the art therapist´s own involvement in the artcreations, it´s supportive interventions ant it´s proposed themes. The other theme is important factors in the treatment; such as visualizing and processing the patients inner experiences, it´s path to verbalization, it´s aid in reality orientation and reliefing effect from psychotic suffering. Discussion: The result is discussed based on the art therapists’ experiences of what is active in the work with patients in psychotic disorders. Interventions and important factors are discussed in relation to different theoretical frameworks of reference. Thoughts on the method are addressed, and that more research is required in the art therapeutic field to consolidate the importance of the method in treatment of patients in psychotic disorders, not least based on requirements for evidence.