Zinberg's Interaction Model implies that the content of a drug-induced experience is a function of the pharmacological properties of the drug, the set (the user’s characteristics e.g. motivation and personality), and the setting (the physical and social context). The current research investigated the function of the set and setting and their role in shaping the psychological effects of 3,4-methylenedioxmethamphetamine (MDMA), as well as their role in reducing the risk of drug abuse. An online survey was distributed among adult MDMA polydrug users (n = 158) and MDMA-naïve controls (alcohol, nicotine and cannabis users, n = 138). Participants answered questions regarding their pattern of drug use, their motivation for MDMA use and the setting (e.g. clubbing, home with friends), as well as the subjective effects of MDMA. Participants also completed a range of self-report measures of self-reflection and insight, emotional intelligence, and personality, as well as a drug dependency measure. MDMA users displayed higher levels of self-reflection and insight, openness to new experience and lower levels of neuroticism and conscientiousness, in comparison to the control group. The significant predictors of self-reflection and insight were openness, emotional intelligence, MDMA use, extraversion and neuroticism. When the analysis was rerun only for the MDMA group, the significant predictors of self-reflection and insight were openness, emotional intelligence and self-insight effects of MDMA. High levels of self-reported negative effects of MDMA were predictors of a problematic drug use. These findings suggest that there might be a relationship between MDMA use and higher levels of self-reflection and insight; however, longitudinal studies are required to further investigate the causality of this relationship. The results add to existing evidence that MDMA has potential for altering emotional experiences. Further research utilising a prospective design is warranted.

Polypharmacy, or the concurrent use of multiple medications, is associated with detrimental outcomes for patients and has gathered increasing attention within the scientific clinical literature. Pediatric populations warrant special consideration for the practice of polypharmacy, as medication effects are more pronounced in youth and adverse effects may have a lasting impact on development. This dissertation study examined psychotropic prescribing practices in a sample of adolescents who have engaged in sexually abusive behaviors, a subset of justice-involved youth who are at risk for polypharmacy. General prescribing trends were examined, and a principle components analysis involving variables associated with risk of polypharmacy was conducted. Results indicated that polypharmacy was common, with many youth being prescribed medications at a young age. Use of risky medications such as antipsychotics was also prevalent, even for individuals without psychosis. Analyses suggested that behavioral issues, trauma and residential instability, and complex psychological concerns were significantly associated with polypharmacy outcomes. Clinical implications of findings are discussed.

Background: People with intellectual disability are more likely than the general population to be prescribed psychotropic agents. The most common indications include treatment of a psychiatric disorder and management of behaviours that challenge. Aim: The study aimed to assess the prescribing patterns of psychotropic medication to outpatients with intellectual disability at a psychiatric hospital. Setting: Alexandra hospital outpatient clinic, Cape Town. Methods: This was a retrospective folder and prescription chart review. Folders of all new patients (103) seen between January 2018 and August 2019 were examined at two points, the initial appointment and again at six months. The information was examined against the World Psychiatric Association (WPA) and the National Institute for Health and Care Excellence (NICE) guidelines for prescribing in people with intellectual disability. Results: psychotropic medication was prescribed to 88% of patients. Antipsychotics accounted for more than 56% of the medication prescribed and was used mainly to manage behaviours that challenge. Clinicians at Alexandra hospital followed prescribing guidelines to some extent; however, more still needs to be done to ensure best practice and care. Conclusion: This review revealed a few shortcomings in meeting prescribing guidelines by clinicians at Alexandra hospital. Measures to address these shortcomings could be the inclusion of medication review schedules and standardised forms for clerking and monitoring of side effects in patient files, the use of behavioural strategies as the primary management of behaviours that challenge, and the performance of regular clinical practice audits.

Abstract available in the Journal of the American Psychiatric Nurses Association.

<p>Several classes of psychotropic medications are known to produce neurological side effects. It has long been recognized that antipsychotic drugs classically block the D₂ subtype of DA receptors inducing a range of acute and subacute extrapyramidal syndromes (EPS), including parkinsonism and akathisia, as well as chronic syndromes such as tardive dyskinesia. More recently, SSRI-type drugs, which, as the name suggests, inhibit the serotonin transporter (SERT), and have been found to induce a similar profile of EPS. It is unclear how medications with such different pharmacological actions can produce similar neurological side effects. The goal of this thesis was to study the neurochemical alterations induced by antipsychotic and SSRI medications, with a specific focus on the nigrostriatal pathway, the causative location of parkinsonism.</p> <p>Environmental enrichment and exercise (EE) has been shown to have protective effects in various neurological settings. In the first experiment, we studied the changes induced by SERT inhibition compared to those induced by a non-pharmacological form of therapy, namely, environmental enrichment with exercise. The SSRI, fluoxetine (FLX) significantly reduced the levels of tyrosine hydroxylase (TH) and phosphorylated glycogen synthase kinase-3β (pGSK-3β-inactive), while increasing phosphorylated TH (pTH) in the striatum (STR). EE also reduced TH and increased pTH, but contrary to FLX, it significantly increased striatal pGSK-3β protein expression.</p> <p>Microglia, the brain’s primary immune cells, have been implicated in several neuroinflammatory conditions, including Parkinson’s disease. The purpose of the second experiment was to explore the modulatory effects of microglia on neuroleptic-induced changes in the nigrostriatal system. The typical antipsychotic, haloperidol (HAL), did not affect the overall levels of TH, though it did induce a robust increase in pTH. The microglial NADPH oxidase inhibitor, apocynin (APO), significantly attenuated this increase in pTH. HAL also induced a significant increase in striatal pGSK-3β, while apocynin, rather surprisingly, induced a stark decrease in pGSK-3β protein expression.</p> <p>The results of this thesis indicate that both pTH and pGSK-3β are intriguing markers to study in the context of dopamine neurotransmission. In addition, EE proved to be a valuable modality in which to compare the downstream effects of pharmacological treatment. It is also clear that microglia fulfill an undefined, but fascinating role as modulators of neural transmission.</p> / Master of Science in Medical Sciences (MSMS)

In this investigation the chemistry of three southern African plants used for medicinal purposes was investigated. The plants were Dioscorea dregeana, Avonia rhodesica and Equisetum ramossisimum. Extracts of all three of these plants have been found to be active on the central nervous system. The structures of the compounds isolated were determined by using 1H and 13C n.m.r., i.f., UV-VIS, - mass spectroscopy and chemical methods. D. dregeana yielded two alkaloids and three aromatic compounds. A. rhodesica contained a large amount of wax which was analysed by GC-MS and its distribution and physical nature on the surface of the leaves was determined by SEM (scanning electron microscopy). This plant also contained two sterols. Equisetum ramossisimum extracts contained a carotenoid and several porphyrins, as well as large amounts of silica. A DTSA X-ray microanalysis system (which was a component of the scanning electron microscope) was used to determine the distribution of silica in the stem. / Thesis (M.Sc.)-University of Natal, Durban, 1998.

The purpose of this study was to identify barriers to psychotropic adherence regimens in clients with Severe and Persistent Mental Illness (SPMI). Medication non-adherence perpetuates the cycle of psychotic episodes, which leads to rehospitalization, incarceration, and homelessness.

The overall aim of this study was to investigate the association between family structure in childhood and mental health problems in young adulthood. A prospective cohort study was conducted with 481,777 individuals with complete follow-up information, which was obtained from national registers in Sweden. Individuals who were living with only one biological parent at age 17 were compared with those who grew up with two parents with regard to retrieval of prescribed psychotropic drugs at age 35. The association was examined by Cox regression analyses with equal survival time for all individuals included in the analyses. The results demonstrated a higher risk for retrieval of psychotropic medicines among the individuals who grew up with only one parent, with hazard ratio of 1,21 (95%CI: 1,19-1,23). The multivariate analyses showed that a part of the association was explained by familial and individual factors, namely parents’ country of origin, area of residence, parents’ and the individual’s educational attainment, receipt of social benefits and parents’ history of psychiatric disorder. The results indicated that the increased risk of mental health problems among individuals who grew up with only one parent might be accounted for by various psychological, social and economic factors associated to parental separation.

published_or_final_version / Social Work / Master / Master of Social Work

L'objectif principal de ce mémoire est d'évaluer le rôle modérateur de trois traits de personnalité, soit l'estime de soi, le sentiment de cohésion, ainsi que le centre de contrôle interne sur la relation entre les conditions de l'organisation du travail et la consommation d'alcool à risque, ainsi que la consommation de médicaments psychotropes des travailleurs canadiens. Les données sur lesquelles nous nous sommes basés proviennent de l'Enquête Nationale sur la Santé de la Population (ENSP) de Statistique Canada. Celle-ci a été conduite à des intervalles de deux ans, de l’année 1994 jusqu'à l’année 2003, et comprend ainsi cinq cycles longitudinaux. Les analyses multiniveaux que nous avons effectuées nous ont permises d’identifier cinq variables des conditions de l'organisation du travail qui s’associent de manière significative à la consommation d'alcool à risque, soit l’utilisation des compétences qui augmente de 7% le risque de faire partie du groupe de consommation d’alcool à risque par un travailleur, les demandes psychologiques qui augmentent ce risque de 69%, et les travailleurs confrontés à un horaire de travail irrégulier qui consomment 61% plus d’alcool à risque que les travailleurs qui ont un horaire de travail régulier. Inversement, l’insécurité d’emploi réduit de 12% le risque de faire partie du groupe de consommation d’alcool à risque, et les travailleurs bénéficiant d’un soutien social au travail courent 5% moins de risque de consommation d’alcool à risque. Pour ce qui est des médicaments psychotropes, nos analyses multiniveaux nous ont permises d’identifier deux variables des conditions de l’organisation du travail qui y sont associées de manière significative. Il s’agit de l’utilisation des compétences qui augmente de 8% le risque de faire partie du groupe de consommation de médicaments psychotropes, alors que le nombre d’heures travaillées diminue de 1% ce risque. En ce qui concerne les traits de personnalité, l’estime de soi augmente de 17% le risque de consommation d’alcool à risque, alors que le sentiment de cohésion diminue de 1% ce risque. L’estime de soi joue un rôle modérateur faible entre les conditions de l’organisation du travail et la consommation d’alcool à risque, puisque celle-ci diminue de 3% l’effet pathogène des demandes physiques imposées sur les travailleurs sur leur consommation d’alcool à risque. Pour ce qui est des médicaments psychotropes, nos résultats indiquent que l’estime de soi diminue de 4% le risque de consommation de médicaments psychotropes, le centre de contrôle interne diminue de 9% ce risque, et le sentiment de cohésion quant à lui, diminue ce risque de 3%. D’ailleurs, aucun trait de personnalité ne joue un rôle modérateur entre les conditions de l’organisation du travail et la consommation de médicaments psychotropes. / The main objective of this master's thesis is to determine the moderator effect of personality traits (self esteem, sens of cohesion, sens of control) on the relationship between work organization conditions, and risky alcohol consumption, as well as psychotropic medication consumption by canadian workers. In order to conduct our project, we relied on data that came from five cycles of the National Population Health Survey (NPHS). This survery was conducted at a two year interval, spanning from the year 1994 until 2003, and includes five longitudinal cycles. The multilevel analyis we performed, allowed us to identify five work organization conditions that increase the risk of risky alcohol consumption.Skill utilisation increases by 7% the risk of being part of a risky alcohol consumption group, while psychological demands increase risky alcohol consumption by 69%, and workers confronted to an irregular work schedule consume 61% more risky alcohol. However, job insecurity decerases by 12% the risk of being part of a risky alcohol consumption group, and workers that enjoy social support at work have a 5% lesser risk of being part of a risky alcohol consumption group. As for psychotropic medications consumption, our multilevel analysis allowed us to identify two work organization conditions that are associated in a significant manner to the psychotropic medication consumption. Skill utilisation at work increases by 8% the risk of being part of a pscyhotropic medication consumption group, while the number of hours worked decreases by 1% the risk of being part of a psychotropic medication consumption group. As for personnality traits, our results indicate that self esteem increases by 17% the risk of risky alcohol consumption, while sense of cohesion decreases by 1% this risk. In addition, self esteem plays a moderator role by diminuishing by 3% the pathologic impact of physical demands at work on risky alcohol consumption. Concerning psychotropic medications consumption, our results indicate that self esteem diminuishes by 4% the risk of psychotropic medications consumption, sense of control diminuishes by 9% the risk of psychotropic medications consumption, and sense of cohesion diminuishes by 3% this risk. In addition, none of the personnality traits plays a moderator role between work’s organization’s conditions and psychotropic medications consumption.