Master of Science / School of Family Studies and Human Services / Jared A. Durtschi / Depression is a pervasive mental health concern; thus, it is important to identify modifiable risk factors associated with reducing depressive symptoms across time. Using 1,946 married and cohabiting German couples assessed annually across 4 years from the Panel Analysis of Intimate Relationships and Family Dynamics (Pairfam) study, we tested if shifts across time in sexual satisfaction and relationship satisfaction were linked with expected shifts in trajectories of depressive symptoms using dyadic time-varying covariate growth models. For both men and women, higher sexual and relationship satisfaction scores across time were significantly associated with decreasing their own depressive symptom trajectories across time, but only relationship satisfaction was linked with a shift in their partners’ trajectories of depressive symptoms. Potential clinical implications from these results include the treatment of depressive symptoms by making changes across time in their own relationship satisfaction and sexual satisfaction.

Background: Heart failure (HF) is a complex, costly and debilitating chronic health condition. Symptom recognition and self-care are crucial components of heart failure management; however, many HF patients struggle to perform these behaviors and skills at a proficient level. A transitional care program in the Southwest provides services to heart failure patients. A primary program aim is to help facilitate enhanced symptom recognition and self-care among heart failure patients. This project focuses on the assessment of the impact of such a transitional care program on HF patients' ability to perform symptom recognition and self-care. Methods: Demographic questionnaires were distributed to collect socioeconomic data and clinical characteristics of participants. A pre and post SCHFI survey was completed by participants, and analysis of data performed using a paired t-test. Results: The 15 participants were primarily Hispanic, elderly, and male. The majority of participants reported an annual income less than $10,000, lived in close proximity to the transitional care clinic, reported living with family and/or friends, and had at least one additional comorbidity. There was improvement in self-care maintenance scores following the initial transitional care encounter; however, participants did not achieve self-care adequacy in this domain. Participants also did not achieve self-care adequacy in self-management. Self-confidence scores improved to reach adequacy following the initial transitional care encounter; however, results were not statistically significant. Conclusion: With the complexities of HF self-management, it is not alarming that these patients have continued to struggle with symptom recognition and self-care. Recommendations are made for future research and interventions.

Ce travail s’articule autour du constat de l’hétérogénéité phénotypique des conduitessuicidaires conjointement à celui de l’existence de nombreux facteurs de validité nosologique.En suivant la méthode du symptôme candidat, nous avons pu montrer que la distribution del’âge à la première tentative de suicide (TS) était une mixture de deux distributionsgaussiennes. Ce symptôme candidat nous a permis de délimiter deux sous groupes distincts depatients en terme de caractéristiques cliniques. Parallèlement, l’exploration des dysfonctionscognitives de patients suicidants nous a permis de proposer un deuxième symptôme candidat :le déficit de l’inhibition cognitive. Enfin, grâce à l’analyse en composante principale d’uninstrument de mesure de la léthalité suicidaire, nous avons pu montrer que la sous dimensionde léthalité « implémentation du patient » constituait un symptôme candidat du fait de sesliens probables avec l’intentionnalité suicidaire, deux dimensions intriquées et déterminantesdans la genèse de conduites suicidaires. Notre contribution a la validation nosologique desconduites suicidaires concerne les résultats obtenus à partir de l’étude d’une population depatients bipolaires au sein de laquelle l’héritabilité des conduites suicidaires est apparuindépendante de celle du trouble bipolaire de l’humeur. Enfin, au sein d’une populationépidémiologique psychiatrique martiniquaise homogène sur le plan ethnique, 18% despatients avaient des antécédents de TS. Ce chiffre est inférieur à celui mesuré au sein d’étudesmenées en population cliniques majoritairement caucasiennes et conforte l’idée d’une « hyposuicidalité» dans les populations d’origine africaine. / This work starts with the report of the phenotypic heterogeneity of suicidal behavior jointly tothat of the existence of several nosological validity factors. While following the candidatesymptom approach, we could show that the distribution of the age at first suicide attempt(SA) was a mixture of two Gaussian distributions. This candidate symptom enabled us todelimit two distinct groups of patients in term of clinical characteristics. In parallel, theexploration of the cognitive dysfunctions among suicidal patients enabled us to propose asecond candidate symptom: the impaired cognitive inhibition. Lastly, by the study of asuicidal lethality scale, we could show that the “patient’s implementation” represented acandidate symptom because of its probable relationship with suicidal intent, two intricate anddetermining dimensions in the genesis of suicidal behavior. Our contribution to thenosological validation of suicidal behavior relates to the results obtained from the study of apopulation of bipolar patients within whom the heritability of suicidal behavior appearedindependent of that of the bipolar disorder. Lastly, among an Afro-Caribbeanepidemiological psychiatric sample, 18% of the patients had a history of SA. This rate islower than that measured within studies conducted among mainly Caucasian clinical samplesand strengthen the idea of a “hypo-suicidality” in the populations of African origin.

Pour Freud et Lacan, la psychose n'est pas un état déficitaire. Le texte de Schreber demeure un traité paradigmatique, aujourd'hui encore inégalé.Le délire paranoïaque est une tentative de guérison pour le premier. Un essai de rigueur pour le second. Reste la question épineuse du transfert psychotique. Freud ne croit pas le psychotique capable de transfert analytique, Lacan pense au début que le transfert est susceptible de provoquer un déclenchement, et que, par ailleurs, le psychotique a l'objet a dans sa poche. Freud continua à recevoir des psychotiques tout en dissuadant ses disciples de le faire. Lacan, qui connut la psychose avant la psychanalyse, avance que le psychanalyste ne doit pas reculer devant la psychose. Le sujet psychotique qui reste en dehors de tout lien social établi peut-il être accueilli par le discours analytique ? C'est cela que nous examinons dans cette thèse. Si le sujet ne guérit pas de sa psychose, peut-il inventer dans la cure des suppléances pour y faire face ? Il n’existe pas de solution générale, mais une approche des contingences. Pas de garantie donc, mais peut-être le désir de l'analyste… / For Freud and Lacan psychosis is not a deficiency. Nowadays, Schreber’s text still remains an unequalled paradigmatic treatise. For Freud, paranoid delirium is an attempt at recovery, and for Lacan it is an attempt to analyze severe logic. The thorny question of psychotic transference still remains. Freud does not believe that a psychotic patient is capable of analytical transference. Lacan thinks that at the beginning, the transference is likely to provoke a trigged of, furthermore the psychotic has the object a in his pocket. Freud continued seeing psychotic patients even though he dissuaded his students from doing so. Lacan, who psychosis before psychoanalysis, suggests that the analyst should not draw back in the face of psychosis. Can the psychotic subject, which stays out of every social bond established, be received by analytical speech? This is what we examine throughout the thesis. If the subject is not cured of his psychosis, can he invent substitutes within the treatment in order to deal with it? Thus, there is no general solution but rather a contingency approach which can betaken. There is no guarantee but there might be the analyst’s desire…

The purpose of this study is to develop a technique by which a physician may use a predetermined data base to derive a preliminary diagnosis for a patient with a given set of symptoms. The technique will not yield an absolute diagnosis, but rather will point the way to a set of most likely diseases upon which the physician may concentrate his efforts. There will be no reliance upon a data base compiled from poorly kept medical records with non-standardization of terminology. While this study produces a workable tool for the physician to use in the process of medical diagnosis, the ultimate responsibility for the patient's welfare must still rest with the physician.

There is overwhelming evidence that the presence of secondary gain is an independent predictor of both performance validity and neuropsychological test outcomes. In addition, studies have demonstrated that genuine cognitive and/or psychological conditions can influence performance validity testing, both in the presence and absence of secondary gain. However, few studies have examined these factors in a large sample of academic accommodation seeking college students. The current study examined base rates of symptom validity test failure, the possibility of a “Near-Pass” intermediate group on symptom validity tests, the influence of diagnoses on performance indicators, and whether performance validity differed for “Near-Pass” patients relative to those who pass and those who fail performance validity indicators.

Chemotherapy induced peripheral neuropathy (CIPN) is a common side effect of several chemotherapy drugs used for the treatment of many common malignancies. CIPN is both under-assessed and underreported and few self-report tools exist that measure CIPN. Existing instruments do not evaluate all of the multi-dimensional characteristics of neuropathic symptoms; intensity, distress, timing, and characteristics. The purpose of this descriptive, cross-sectional study was to develop and psychometrically evaluate a new self - report tool for CIPN, the Chemotherapy Induced Peripheral Neuropathy Assessment Tool (CIPNAT). Interviews with 15 patients with known CIPN guided development of the CIPNAT. The CIPNAT is a 69 item self-report tool which measures CIPN, including characteristics, intensity, distress, frequency, and interference with usual activities. Content validity was evaluated by a panel of experts and revisions were made to the CIPNAT based on those results. The CIPNAT was administered to 167 patients on chemotherapy at H. Lee Moffitt Cancer Center and a two physician medical oncology practice in Tampa, Florida. The Functional Assessment of Cancer Therapy-Neurotoxicity scale (FACT/GOG-Ntx), another self-report tool for CIPN was also administered. Correlations between the CIPNAT and the FACT/GOG-Ntx were evaluated. Differences between a group of 40 patients getting non-neurotoxic chemotherapy and a group of 127 patients getting neurotoxic chemotherapy were also examined. Test-retest reliability was evaluated by administering the CIPNAT a second time to a subgroup of 30 patients and correlating the results. Correlation with a measure of the same concept indicated that scores between the CIPNAT and the FACT-Ntx were strong (r =.73, p=.000, n=127).Differences between the two contrasting groups were significant (p = .000), supporting validity. High test-retest correlations (r =.921, p=.000) demonstrated reliability. Cronbach's alpha for the total CIPNAT (alpha=.945), the symptom experience scale (alpha =.927) and the interference scale (alpha=.897) demonstrated high internal consistency reliability. Confirmatory factor analysis of neuropathic symptoms indicated the presence of two underlying factors, sensory symptoms and motor symptoms. Confirmatory factor analysis of the interference scale also indicated two underlying factors, activities requiring manual dexterity and general activities. These results provide strong evidence of the validity and reliability of the CIPNAT.

<p>Syftet med detta arbete är att genom litteraturstudier och en empirisk undersökning få en bättre insikt i vad DAMP är och vad det kan innebära för elever med denna diagnos. Jag vill även ta reda på vad skolans ansvar är och hur lärare i skolan kan hjälpa och underlätta för elever med dessa svårigheter. </p><p>Arbetet består av två delar, varav den första är en litteraturgenomgång där olika forskares syn och åsikter om DAMP är presenterade och sammanställda. Den andra delen består av en undersökande del där intervjuer med fyra olika lärare, om deras kunskaper om hur lärare kan underlätta för DAMP-elever, presenteras. </p><p>Genom litteraturen och den empiriska undersökningen har det framkommit att DAMP är ett osynligt handikapp som kan bero på många olika faktorer, av vilka forskarna inte är riktigt överens om. För ett stort antal barn innebär DAMP en mängd olika svårigheter som de behöver hjälp och stöd för att kunna hantera. Det finns inte heller några specifika åtgärder som man kan tillämpa på samtliga barn med dessa svårigheter. Man måste hela tiden se till den enskilda individens behov och förutsättningar och utefter det komma fram till vad som passar bäst för den enskilda eleven. Genom kunskap och med hjärta och hjärna i samspel kan man hjälpa barn med särskilda svårigheter. Det gäller bara att vara lyhörd och öppen för deras behov och att anpassa sig efter vad de behöver.</p>

<p>Syftet med föreliggande empiriska studie var att undersöka och beskriva i vilken omfattning individer behandlade med hemodialys rapporterar symtom på depression. Författarna ville även redogöra för den utsträckning antidepressiva läkemedel ordinerats samt om det existerade några könsskillnader i depressionssymtom och i ordinerad antidepressiv behandling. Studien baserades på ett bekvämlighetsurval från 11 geografiskt spridda dialysenheter i Sverige. Urvalet bestod av 222 patienter som mötte inklusionskriterierna (behärska svenska språket tillräckligt bra för att förstå frågorna i enkäten, genomgått hemodialys behandling i minst 6 månader samt vara 18 år fyllda) varav 141 patienter fullföljde undersökningen. Dessa 141 deltagare fick fylla i den förkortade versionen av CES-D formuläret, ett självskattnings instrument där den egna mentala hälsan skattas. Resultatet visade att drygt en tredjedel av hemodialyspatienterna hade depressionssymtom och endast 12 patienter av 50 med depressionssymtom var ordinerade antidepressiv behandling. Emellertid visade inte föreliggande studie några signifikanta könsskillnader gällande depressionssymtom eller i ordinerad farmakologisk behandling. Författarna drar slutsatsen att depression är vanligt bland hemodialyspatienter. Därför är det viktigt att utbilda både vårdgivare och närstående för att de ska kunna se tecken på depressionssymtom i ett tidigt skede, eftersom rätt behandling kan öka dessa patienters livskvalitet och samtidigt vara kostnadsbesparande för sjukvården</p> / <p>The aim of the present empirical study was to investigate and describe in which extent individuals treated with hemodialysis reported symptoms of depression. The authors also wanted to describe in which extent antidepressant medicine was prescribed. Also if there existed any differences between males and females in depressive symptoms and if there was any divergence in treatment with anti depressive medicals. The study was based on a convenience sample from 11 geographical spread dialys units in Sweden. The sample consisted of 222 patients whom fulfilled the inclusion criterias (they had to have a good knowledge of the Swedish language so they could understand the questionnaire, at least six months of dialysis treatment experience and be at least 18 years old) of whom 141 carried out the study. These 141 participants filled out the short version of the CES-D form, a self report form where the mental health was estimated. The result showed that one third of the hemodialysis patients had symptoms of depression and only 12 patients of 50 had treatment with antidepressant medicine. However the study did not show any significant differences between male and female regarding depressive state and treatment with anti depressive medicine. The authors conclude that depressive symptoms are common among hemodialysis patients. That is why it is important to educate nurses and relatives so they can learn how to see signs of depressive symptoms as early as possible. Right treatment could then increase hemodialysis patients quality of life and also save money for the hospitals.</p>

<p>Syfte och frågeställningar:</p><p>Syftet med studien är att utifrån ett könsperspektiv undersöka stress hos elever. Detta ville vi ta reda på genom att besvara följande frågeställningar: Vad är stress för elever, upplever de stress i skolan, hur hanterar de stress samt hur vanligt är psykosomatiska symptom hos elever?</p><p>Metod:</p><p>Undersökningen är en studie som utförts med hjälp av enkäter med både fasta och öppna svarsalternativ. Enkätundersökningen genomfördes på två gymnasieskolor på det Samhällsvetenskapliga programmet år 3 där 103 elever ingick i urvalsgruppen. Fördelningen mellan flickorna och pojkarna var 71 respektive 32. Inget externt bortfall fanns då alla utdelade enkäter även samlades in. Dock var totalt 41 elever frånvarande vid undersökningstillfällena, dessa elever inkluderades inte i vår studie.</p><p>Bearbetning av resultaten gjordes i statistikprogrammet SPSS. Tre tester användes, dessa var ett Chi-2 test, ett Spearman´s korrelationstest samt ett Mann-Whitney U test. Signifikansnivån sattes till p<0,05 och tendens till en skillnad sattes till 0,05< p <0,1.</p><p>Resultat:</p><p>Majoriteten av de tillfrågade eleverna, 75, svarade att stress var brist på tid i kombination med mycket skolarbete. Andelen av pojkarna och flickorna som upplevde stress i skolan var 84,4 procent respektive 97,2 procentprocent. Det vanligaste sättet att hantera stress på var enligt eleverna att prioritera/planera sitt skolarbete. Andelen av pojkarna och flickorna som hade problemfokuserad coping var 43 procent respektive 67 procent. Andelen elever som hade emotionsfokuserad coping var 57 procent av pojkarna och 33 procent av flickorna. Det förelåg en signifikant skillnad mellan kön där flickor angett en högre svarsfrekvens på alla psykosomatiska symptom förutom känna sig nervös och känna obehag inför skolan.</p><p>Slutsats:</p><p>Vår slutsats är att en stor andel av de tillfrågade eleverna upplevde skolan som en stressfaktor. Det fanns en signifikant skillnad där fler flickorna upplevde stress i jämförelse med pojkarna. Studien visade på att hantering av stress skiljde sig åt mellan könen där pojkar använde sig av en emotionsfokuserad copingstrategi och flickorna en problemfokuserad copingstrategi. Vidare fanns det ett samband mellan stress och psykosomatiska symptom. Detta visade sig genom att ju oftare eleverna var stressade desto oftare upplevde de även psykosomatiska symptom</p>