Thesis (PhD (Psychiatry))--University of Stellenbosch, 2005. / Many gaps remain in our current state of knowledge about the epidemiology, phenomenology, neurobiology, and psychopharmacology of posttraumatic stress disorder (PTSD) in children and adolescents. Empirical evidence, particularly in non-Western settings, is sparse and there is little convergent understanding of the interrelationship of epidemiological factors, PTSD symptom expression, full and partial syndromes, disorders comorbid with PTSD, and pharmacotherapeutic interventions. Clinicians are faced with the difficult task of treating this often complicated and debilitating disorder in youth in the absence of data from well-controlled clinical trials. The studies detailed here are a point of departure for understanding the confluence that exists between epidemiological, phenomenological, and pharmacotherapeutic aspects of adolescent PTSD. Two studies were conducted to investigate the prevalence and effects of violence exposure and PTSD, clinical and functional correlates of full and partial syndromes, and associated gender differences in school and clinic samples, respectively. Two preliminary open-label trials assessed the efficacy and safety of a selective serotonin reuptake inhibitor (SSRI) in adolescents with at least moderate severity PTSD. The results indicate that (i) partial PTSD is a common nosological entity in adolescents, (ii) gender-related differences in PTSD, even if not manifest in differences in prevalence (i.e., in the rates of trauma exposure and full and partial PTSD), may well manifest in symptom expression (i.e., higher symptom burden in girls), associated morbidity, and functional impairment, and (iii) SSRIs may be effective in treating core PTSD symptoms in this age group. While not yet demonstrated, the partial subtype may have similar biological underpinnings to full PTSD in adolescents and may benefit from similar pharmacotherapeutic interventions. This is an area deserving of further investigation. Controlled SSRI data are needed to establish if these should be agents of choice for paediatric PTSD.

Thesis (PhD)--Stellenbosch University, 2000. / ENGLISH ABSTRACT: The objective of this study was to investigate and compare the effectiveness of a combined exposure and cognitive restructuring programme versus exposure only in the treatment of social phobia. The 44 participants in the study met the DSM-IV diagnostic criteria for social phobia at pre-treatment assessment, and presented mainly with general interactional social fears. They were allocated to a group which received a combined exposure and cognitive restructuring treatment (n = 15), a group treated with exposure only (n = 15), and a waiting-list control group (n = 14). For treatment purposes, both treatment groups were subdivided into two smaller groups of 7 and 8 participants each. The effects and differential effects of the treatments were compared in terms of four broad categories of variables: target phobia variables (anxiety/avoidance/escape in relation to a specific target phobia), social phobia variables (associated with the degree, nature, aspects and/or consequences of social phobia), cognitive variables (thought functionality, fear-of-negative-evaluation, and attentional bias), and severity of depression. Participants were individually assessed before treatment, immediately after treatment, and at follow-up after three months. Treatment were conducted by two co-therapists in 12 weekly group sessions of two hours each. Compared to a waiting-list control condition, both treated groups showed a significant improvement of the target phobia variables at post-treatment and, with the exception of target phobia anxiety for the exposure only condition, the significant effects were maintained at follow-up after three months. As for the social phobia variables, cognitive restructuring and exposure combined showed a significantly larger improvement compared to the waiting-list control condition on four of the variables (social phobia avoidance, social phobia observation anxiety, social phobia general symptomatology, and social phobia disturbance/disablement), and these significant effects were maintained at follow-up. The exposure only group showed significantly larger effects on only two variables (social phobia avoidance and social phobia disturbance/disablement) and only the effects on social phobia avoidance were maintained for the followup period of three months. With regard to the cognitive variables, the combined treatment led to significanly larger improvements in thought functionality compared to the waiting-list control condition and these effects were maintained at follow-up. No other significant differences between the effects of any of the treatments and the waiting-list control condition were demonstrated at post-treatment or at follow-up on any of the cognitive variables. Only the combined treatment resulted in significantly larger reductions in the severity of depression, The effects were maintained for the follow-up period of three months. Compared to the waiting-list control condition, the combined treatment resulted in improvement over a broader spectrum of social phobia symptomatology than exposure only at post-treatment and follow-up. The two treatments were also directly compared in terms of their effects on each of the dependent variables and the differences were largely insignificant at both post-treatment and follow-up. Only in terms of thought functionality tentative indications of a possible larger effect for the combined treatment were found. However, if this was the case, the differences were cancelled out at follow-up. It seems that both the combined treatment and exposure only were effective treatments for social phobia and that the combined treatment might have demonstrated slightly better results. These findings support the emerging view that the most important cognitive-behavioral treatments of social phobia do not differ greatly in terms of efficacy. It also offer support for the view of prominent researchers on social phobia outcome, namely that treatment effects are less dependent on procedural variations than on other critical elements, such as the length and frequency of treatment sessions, and exposure to the critical elements of patients' social fears. / AFRIKAANSE OPSOMMING: Die doel van hierdie studie was om die effektiwiteit van 'n gekombineerde blootstelling en kognitiewe herstruktureringsprogram teenoor blootstelling alleen in die behandeling van sosiale fobie te ondersoek en te vergelyk. Die 44 deelnemers aan die studie het voor behandeling aan die DSM-IV diagnostiese kriteria vir sosiale fobie voldoen en met oorwegend algemene interaksionele vrese gepresenteer. Hulle is verdeel in 'n groep wat met kognitiewe herstrukturering en blootstelling gekombineerd behandel is (n = 15), 'n groep wat slegs blootstelling ontvang het (n = 15), en 'n waglys-kontrolegroep (n = 14). Vir behandelingsdoeleindes is die behandelingsgroepe in twee subgroepe van onderskeidelik 7 en 8 deelnemers elk verdeel. Die effekte en differensiële effekte van die behandelings is in terme van die volgende vier breë kategorieë veranderlikes ondersoek: teikenfobie-veranderlikes (angslvermyding/ontsnapping ten opsigte van 'n spesifieke fobie), sosialefobie-veranderlikes (wat verband hou met die graad, aard, aspekte en/of gevolge van sosiale fobie), kognitiewe veranderlikes (gedagte-funksionaliteit, vrees-vir-negatiewe-evaluasie en aandagsverdraaiing), en graad van depressie. Deelnemers is individueel beoordeel voor behandeling, onmiddellik na afloop daarvan en na 'n 3- maande-opvolgperiode. Behandeling deur twee ko-terapeute het in 12 weeklikse groepsessies van twee uur elk geskied. In vergelyking met die waglys-kontrolekondisie, het beide behandelings tot 'n beduidende verbetering van die teikenfobie-veranderlikes by nameting gelei en, met uitsondering van teikenfobie-angs by die blootstellingsbehandeling, is die beduidende effekte vir 'n opvolgperiode van drie maande volgehou. Wat die sosialefobie-veranderlikes betref, het kognitiewe herstrukturering plus blootstelling 'n beduidend groter verbetering in vergelyking met die waglys-kontrolekondisie op vier veranderlikes (sosialefobievermyding, sosialefobie-observasie-angs, sosialefobie-algemenesimptomato/ogie, en sosialefobieongemak/ belemmering) tot gevolg gehad en is die beduidende effekte vir 'n opvolgperiode van drie maande volgehou. Daarenteen het die blootstellingsgroep slegs ten opsigte van twee veranderlikes (sosialefobie-vermyding en sosialefobie-ongemak/belemmering) tot beduidend groter effekte aanleiding gegee, waarvan die effekte net op een van die twee veranderlikes (sosialefobie-vermyding) vir 'n opvolgperiode van drie maande in stand gehou is. Ten opsigte van die kognitiewe veranderlikes, het kognitiewe herstrukturering plus blootstelling, in vergelyking met die waglys-kontrolekondisie, tot 'n beduidende verbetering van gedagte-funksionaliteit gelei wat vir 'n opvolgperiode van drie maande in stand gehou is. Geen ander beduidende verskille tussen die effekte van behandelings en die waglys-kontrolekondisie is vir enige van die ander kognitiewe veranderlikes by nameting of opvolg gedemonstreer nie. Slegs die gekombineerde behandeling het tot beduidend groter verlagings van die graad van depressie gelei wat vir 'n opvolgperiode van drie maande gehandhaaf is. In vergelyking met die waglys-kontrolekondisie, het die gekombineerde behandeling dus tot 'n beduidende verbetering oor 'n breër basis van sosialefobie-simptomatologie as blootstelling alleen by nameting en opvolg aanleiding gegee. Die twee behandelings is ook direk met mekaar in terme van effekte op elkeen van die afhanklike veranderlikes vergelyk en die verskille was by nameting en opvolg grootliks onbeduidend. Dit is slegs ten opsigte van gedagte-funksionaliteit dat daar tentatiewe aanduidings was dat die gekombineerde behandeling moontlik 'n beduidend groter verbeterende effek as blootstelling alleen kon gehad het, maar indien dit so was, was hierdie verskille by die opvolgmeting reeds uitgewis. Dit wil dus voorkom asof beide die gekombineerde behandeling en blootstelling alleen effektiewe behandelings vir sosiale fobie was en dat eersgenoemde dalk effens beter resultate kon gelewer het. Hierdie resultate ondersteun die standpunt wat tans besig is om op grond van navorsing te ontwikkel, naamlik dat daar nie betekenisvolle groot verskille in die effektiwiteit van die belangrikste kognitiefgedragsterapeutiese behandelings van sosiale fobie is nie. Dit bied ook steun vir die standpunt van prominente navorsers op die gebied van sosiale fobie uitkomsnavorsing dat behandelingseffek minder afhang van verskille in prosedure-variasies as van ander kritieke elemente, soos byvoorbeeld die lengte en frekwensie van die behandelingsessies en blootstelling aan die kritieke elemente van die sosiale vrese.

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No description available.

The motivation for this study is the increase of treatment needs of heroin dependents at SANCA, (South African National Council of Alcohol and Drug Abuse) Witbank. SANCA Witbank wants to ensure that the most effective treatment can be supplied. Research goals are to:  Do a literature study of out-patient treatment programmes.  Assess the needs of heroin out-patient dependents with regard to out-patient treatment programmes.  Make recommendations with regard to out-patient treatment programmes for heroin dependents. It was an exploratory research subject and the data collection methods were qualitative and quantitative. Interview schedules were used as research tools. Schedule B was completed by the researcher with heroin dependents that visited SANCA Witbank for the period 31 January 2005 to 4 February 2005. Schedule A was completed by the researcher with personnel of SANCA out-patient clinics and the questions were discussed and completed telephonically. The conclusion is that the treatment programme of SANCA Witbank is in line with the rest of the drug dependent field and only minimal recommendations were made. / Social Work / MA(SS)(MENTAL HEALTH)

Background: Diabetes is an increasing global health problem and this puts high demands on the health care system. Patients with diabetes demand continuous treatment and monitoring in order to control the disease and avoid complications. Adherence to recommended treatment was important in order for the treatment to give positive effect. In this context adherence was defined as the extent to which the patients follow medical instructions.Aim: The aim of this study was to identify factors that can affect the adherence to recommended treatment among patients with type 1 and type 2 diabetes. Method: The study was a cross-sectional study with a quantitative method. A questionnaire was administered to 150 respondents at the diabetes clinic of Mulago hospital in Kampala, Uganda. Patients diagnosed with both type 1 and type 2 diabetes were included in the study. Result: Out of 150 participants 48 (32%) did not take their drugs as prescribed and 80 (53.3%) did not follow any recommended diet. Main reason for non-adherence to the treatment was reported as financial problems. 118 (78.7%) of the respondents had participated in some kind of diabetes education, still 67 patients (44.7%) reported that they did not have enough knowledge about their diabetes diagnosis. The results show that those with knowledge about their diabetes diagnosis also take their medication to a higher extent (46%) than those who reported lack of knowledge (22%). Conclusion: Factors that affect the adherence was identified as poverty, lack of knowledge, non-access to medications, the use of alternative medicines and non-access to health care. Further studies about adherence to treatment among diabetes patients are of importance in order to improve the diabetes care and come up with solutions to a growing global health problem.

Syftet med studien var att belysa professionellas uppfattning om och  erfarenhetav multipelt substansbrukssyndrom samt deras tankar om hur problematiken s hanteras och åtgärdas för att skapa positiv förändring hos klienter. Till studi användes kvalitativ metod med utgångspunkt från hermeneutike Semistrukturerade intervjuer genomfördes med fem respondenter från två oli verksamheter. Studiens teoretiska utgångspunkt är West’s (2006) motivationsteo PRIME. Studiens andra teoretiska utgångspunkt är Von Wright’s (201 pedagogiska rekonstruktion av G.H. Meads teori om  människo intersubjektivitet. Resultatet visade att respondenterna kände till diagnossystem DSM-5. De definierade multipelt substansbrukssyndrom som blandmissbru Resultatet visade också att de professionella ser varje klient som unik. Bå motivations- och behandlingsarbetet var individanpassat och såg liknande ut v  ett enskilt missbruk eller beroende. Dock var problematiken mer komple eftersom det har fört med sig allvarligare konsekvenser. Respondentern erfarenhet var att de ofta möter klienter med multipelt substansbrukssyndrom.

Innovative pre-treatment methods applied to anaerobic digestion (AD) have developed to enhance the methane yields of food waste. This study investigates hydrodynamic cavitation, which induce disintegration of biomass through microbubble formations, impact on food waste solubilisation and methane production during following AD. Two different sub-streams of food waste (before and after the digestion) pre-treated by hydrodynamic cavitation were evaluated in lab scale for its potential for implementation in a full scale practise. First, the optimum condition for the hydrodynamic cavitation device was determined based on the solids and chemical changes in the food waste. The exposure time was referred to as the number of cycles that the sample was recirculated through the cavitation inducer’s region. The optimal cycles were later tested as a pre-treatment step in a BMP test and semi-CSTR lab scale operation. The tests showed that sufficient impact from the hydrodynamic cavitation was achieved by 20 cavitation cycles. Due to the pre-treatment, food waste solubilisation increased, up to 400% and 48% in terms of turbidity and sCOD measurements, respectively. In the BMP test, the treated samples improved the methane yield by 9-13%, where the digested food waste increased its kinetic constant by 60%. Fresh food waste was then processed in the semi-CSTR operation and the methane yield was increased by up to 17% with hydrodynamic cavitation for two reference periods. These promising results suggest that the hydrodynamic cavitation can be implemented for full scale production with food waste.

The aims of the present study were threefold: firstly, to further the understanding of the psychological response to heart disease; secondly, to consider the differences in the ways in which doctors and patients perceive heart disease; and thirdly, to consider how the doctor, patient, and condition interact within the illness process over a period of time. The nature of coronary heart disease (CHD) was considered, and the influence of psychological variables in CHD was discussed. Psychological factors in illness were examined, with particular emphasis on health beliefs, illness behaviour, compliance, and the doctor-patient relationship. Conclusions were drawn that to understand the illness process in heart disease, doctor, patient, and condition must be considered together, in an interactional framework. Two pilot studies were performed. The first study found that heart patients' health beliefs differed from a normal population. The second pilot study, with raised cholesterol patients, suggested the existence of five major components of the illness process: illness perception, illness effect, health orientation, doctor-patient relationship, and compliance. The main study considered groups of heart and cholesterol patients (experimental groups) and a group of general outpatients (control group), over a four-to-six month period. Patients were interviewed and given a questionnaire concerning their feelings regarding their condition. Doctors and judges also completed similar questionnaires. Results indicate that cholesterol patients rate superior coping to the other groups, and both experimental groups were higher than controls with regard to patient understanding, responsibility for health, and communication with doctor. Findings suggests alterations should be made in current conceptualization of illness behaviour. and that patient and doctor assessment of condition severity were found to be unrelated to illness behaviour. Doctor and patient perception of patient behaviour were found to be discrepant. Modifications in the treatment of heart and cholesterol patients are suggested.

No description available.