Dissertations / Theses on the topic 'Mental Diagnosis'

For years research has demonstrated a varying incidence of medical disorders manifesting with psychiatric symptoms. A relatively conservative estimate of such so called "medical masquerades" is around 10%. It is important to ascertain whether health care professionals are aware of possible medical masquerades perhaps most especially in a mental health center outpatient setting where non-medically trained clinicians are the first line therapists for treatment in the majority of cases. This study set about to find out how aware three types of health care clinicians (psychiatrists, nonpsychiatrically trained medical doctors, and non-medically trained mental health psychotherapists) are of the prevalence of medical masquerades, and whether these three types of clinicians perform differently on three types of clinical vignettes (psychiatric, somatoform, and medical masquerades). Results revealed that all health care professionals surveyed are aware that there are a percentage of medical masquerades in the clinical population. Results also revealed that the three types of clinicians performed differently on the case vignettes.

Contrary to the long-held assumptions, borderline personality disorder (BPD) is now considered a treatable disorder. Timely assessment has been recognised as one of the key treatment enablers and basic assessment standards have been stipulated by the UK’s National Institute for Health and Clinical Excellence (NICE). The current study was the first to have specifically investigated the quality of the diagnostic process in light of the government recommendations. Interpretative phenomenological analysis was used to analyse semi-structured interviews with eight adult female service users about their lived experiences with the original diagnostic disclosure of BPD. Five master themes and several subthemes featured in the majority of the participants’ experience: a) answer with a question mark; b) if only…; c) BPD like a star sign; d) star signs are not enough; it’s what happens afterwards!; e) being at the mercy of the system. Most participants’ experiences suggested that the original diagnostic process was largely negative and did not follow the national guidelines. Nevertheless, a minority of positive views also emerged. The findings are discussed with reference to the existing literature, whilst also detailing the study’s limitations, clinical and research implications.

Section A reviews the clinical and risk implications of dual diagnosis along with the treatment context. The value of gathering firsthand accounts of service users to inform the planning and delivery of healthcare is touched on. The second part of the paper centres on theories of motivation and how they might be applied to help explain low rates of dual diagnosis treatment uptake and engagement. Finally, gaps in the literature are highlighted with recommendations for further research. Section B There is an emerging evidence base to support the use of integrated approaches that treat co-existing mental health and substance use disorders simultaneously. However, low rates of treatment uptake and engagement remain a concern. To address this, it would seem important to understand dual diagnosis treatment motivation and engagement, an area that has received little attention from the research community. The aim of this study was to explore service users’ and clinicians' understandings of how treatment motivation and its relationship with treatment engagement relate specifically to people with dual diagnosis. Transcripts from semi-structured interviews with four service users and four clinicians were analysed using narrative methodology. The study suggests that the factors underpinning treatment motivation and engagement among people viewed as having dual diagnosis are similar to those thought to be associated with addictions and mental health disorders generally although their relative influence and interaction effect might be different. It is suggested that negative perceptions of services, difficulties with trust, and therapeutic relationship are particularly important issues among dual diagnosis populations. Clinical and theoretical implications of the study are discussed in relation to the literature as well as recommendations for future research. Section C: Critical Appraisal. This paper provides a general overview of narrative research, including strengths and limitations as they relate to this study. With reference to the literature, clinical and theoretical implications are elaborated along with recommendations for future research. The author’s critical self-reflections regarding the process of initiating, carrying out and completing the study are highlighted. Following this, there is a section on the ethical considerations of the study. Finally, the measures taken to ensure the quality of the study and maximise internal consistency are presented.

Brugha and his colleagues in this issue raise important questions about the validity of standardized diagnostic interviews of mental disorders, such as the Composite International Diagnostic Interview (CIDI) (WHO, 1990). Although their concerns refer predominantly to the use of such instruments in epidemiological research, the authors' conclusions also have significant implications for diagnostic assessments in clinical practice and research. We agree with Brugha et al. that the inflexible approach to questioning used in standardized interviews can lead to an increased risk of invalidity with regard to some diagnoses. We also agree that the use of more semi-structured clinical questions has the potential to address this problem. However, we disagree with Brugha et al. in several other respects.

The Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised (DSM-III-R) published by the American Psychiatric Association (APA) in 1987 is currently the primary tool used by counselors in clinical settings for diagnosing clients' psychological and behavioral problems. Beginning with the third edition of the manual (DSM-III; APA, 1968) a multiaxial process for diagnosis was introduced to encourage a biopsychosocial perspective of client's problems.This study was designed to investigate if alterations in diagnosis on Axis IV and V could further encourage a biopsychosocial perspective. It was designed to imitate the rapid diagnostic process that takes place in many clinical settings. In the present study, the criterion for a biopsychosocial perspective was the maintenance of neutral perceptions and unbiased hypothesis-testing strategies following diagnosis of a client.Twenty-four counseling psychology trainees participated in the study. The counselor trainees diagnosed a client after listening to approximately 20 minutes of an audio-tape of an initial assessment interview. The 12 counselor trainees in the control group diagnosed the client using the standard multiaxial format for diagnosis. The 12 counselor trainees in the experimental group diagnosed the client using an alternative format which encouraged a focus on positive aspects of the client and the client's environment.The counselor trainees completed the Impression Formation Questionnaire to assess their perceptions of the client. They then wrote 12 questions they would ask the client in the next counseling session. These questions constituted their hypothesis-testing strategies for their diagnoses on Axis I and Axis II.The counselor trainees in both groups maintained primarily neutral perceptions of the client as measured by the IFQ. The counselor trainees in both groups favored confirmatory hypothesis-testing strategies when assigned to groups based on their hypothesis-testing strategy score (p < .05).The results of this study indicated that the standard and alternative multiaxial formats for diagnosis may encourage neutral perceptions of a client when counselors must diagnose the client based on very little information. Neither format for diagnosis was successful, however, in discouraging a biased, confirmatory search for information.
Department of Counseling Psychology and Guidance Services

Psychiatric diagnosis is used to categorise and treat mental health problems in the UK yet is widely criticised for struggling to convincingly categorise the experience of distress and that it is socially constructed from the culmination of historical and cultural interactions. Service-user accounts are varied and there is a paucity of qualitative research that considers the positive and negative effects of labelling. To understand identity construction in the context of a psychiatric diagnosis, the present study recruited 16 participants from a service-user research group and five focus groups were conducted. Transcripts were studied using Foucauldian Discourse Analysis. Two major identities were detected ‘illness identity’ and ‘recovery identity’. Participants drew on multiple and competing discourses and which placed them in the position of patient and/or survivor. Medical discourses were dominant throughout the focus groups and were used in a way to convey the fluidity of the identity and how they related to their diagnosis. The study’s limitations are discussed, together with implications for clinical practice and future research.

The present series of investigations examined the diagnostic accuracy of the Cognitive Examination (CAMCOG) from the Cambridge Mental Disorders of the Elderly Examination (CAMDEX) in the differential diagnosis of various dementing conditions. Specifically, this study examined: (a) the degree to which the CAMCOG would differentiate normal individuals from patients with Alzheimer's Disease (AD) and from those suffering from non-AD dementing conditions, (b) the extent to which the CAMCOG would distinguish between patients suffering from organic dementing conditions, those having functional psychiatric disorders, and normal persons, and (c) whether the CAMCOG would offer an improvement in diagnostic accuracy over a widely used screening instrument (i.e., the Mini-Mental Status Examination, MMSE) when attempting to differentially diagnose dementing patients and normal cohorts.A review of the literature was presented with an emphasis on the difficulties in establishing differential diagnosis, inaccuracies in diagnosis, the importance of improved diagnostic accuracy, and the use of neuropsychological measures in the assessment and diagnosis of patients suffering from dementing illnesses. Further, research relevant to ancillary diagnostic techniques, the various neuropsychologicalapproaches used in evaluating and diagnosing mental disorders in the elderly, and studies investigating the utility of specific cognitive/neuropsychological measures in the differential diagnosis of dementing diseases was presented.The results of these investigations revealed that the CAMCOG provides excellent diagnostic sensitivity and specificity when differentiating normal persons from clinically diagnosed AD patients and when distinguishing between individuals with an organic-dementing condition and normal adults. The CAMCOG was found to be less effective in differentiating AD and non-AD dementia patients and in distinguishing between patients suffering from organic dementia versus specified psychiatric disorders. Finally, the CAMCOG demonstrated a slight improvement in diagnostic accuracy over the Mini-Mental Status Examination. These results were discussed in terms of their support for the utility of the CAMCOG as an excellent screening measure when used to differentiate patients suffering from various dementia-producing disease states and normal persons.
Department of Educational Psychology

Brugha and his colleagues in this issue raise important questions about the validity of standardized diagnostic interviews of mental disorders, such as the Composite International Diagnostic Interview (CIDI) (WHO, 1990). Although their concerns refer predominantly to the use of such instruments in epidemiological research, the authors' conclusions also have significant implications for diagnostic assessments in clinical practice and research. We agree with Brugha et al. that the inflexible approach to questioning used in standardized interviews can lead to an increased risk of invalidity with regard to some diagnoses. We also agree that the use of more semi-structured clinical questions has the potential to address this problem. However, we disagree with Brugha et al. in several other respects.

Cognitive theory of depression predicts that the illness is associated with an information processing bias that interprets ambiguous information in a mood-congruent or depressive fashion. This negative interpretative bias may serve as a vulnerability factor or maintenance mechanism for a depressive illness. The majority of studies investigating such interpretative biases rely primarily on subjective experimental methodologies (eg., evaluative feedback and self-report) that are vulnerable to experimenter demand effects, response selection biases, and the influence of autobiographical memories. In addition, the results from these studies have been mixed, leading to no firm evidence for the existence of a depression-linked interpretative bias for ambiguous material. In order to avoid the limitations that have plagued subjective research, the present study utilised two of the most promising objective physiological measures of assessing interpretation: the Rapid Serial Viewing Presentation (RSVP) procedure and the affective modulation of the human eye blink reflex. The modified RSVP experiment recorded the reaction time of participants reading a textual scenario that was composed of an opening ambiguous sentence and various emotionally valenced continuations. Interpretation of the ambiguous sentence could be inferred from the reaction time as comprehension latency is inversely related to perceived plausibility. The affective modulation experiment recorded the blink amplitudes of participants startled while performing an imagery task. Blink amplitudes are augmented by negative stimuli and inhibited by hedonic stimuli. Thus, the affective interpretation of ambiguous stimuli could be inferred from the size of the recorded blink response. The results of both experiments did not support the predictions made by cognitive theory. There was no difference in the reaction time responses to the various textual stimuli between 2 depressed outpatients and healthy controls. However, antidepressant medication did have an influence upon the ability of patients to correctly judge the plausibility of the emotionally valenced continuation sentences. With regard to the eye blink experiment, there was also no difference between the depressed outpatients and the controls in terms of size of blink amplitude to the various categories of affective stimuli. Depressive, ambiguous, and distorted stimuli did not augment blink amplitudes in healthy controls or depressed patients without social anxiety disorder. However, depressed patients with a comorbid diagnosis of social anxiety disorder did react to the ambiguous stimuli in an aversive and anxious manner as indicated by increased blink amplitudes. This may be due to the social aspect of the experimental context, which engenders fears of evaluation and performance anxiety. The eye blink procedure can therefore be compromised by group selection, as the comorbidity of anxiety and depression can confound the investigation of depression-linked interpretative biases. In addition, the failure of depressive stimuli to augment blink amplitudes may render the procedure insensitive to the selection of such biases

This study examined the clinical utility of the recently released National Institute of Mental Health's (NIMH) research domain criteria (RDoC) by replicating and extending earlier work by using a demographically novel sample. Information retrieval and natural language processing of archival clinical records was used to achieve two main objectives: (1) estimate how well the RDoC domains match language used by clinicians by creating domain scores and (2) examine the differences between the DSM's and RDoC's ability to predict treatment outcome using these domain scores and DSM diagnoses. The social systems RDoC category was found to be the strongest predictor of treatment outcome across all diagnostic measures.

Background. Diagnosing major depression in the medically ill is difficult because of the overlap of somatic symptoms between the two entities. No studies have examined this issue in advanced HIV disease. Methods. Male subjects with a CD4 count ≤200 were recruited from a specialised outpatient HIV treatment centre. They completed a 30 minute questionnaire and then participated in a diagnostic interview with an HIV psychiatrist. Results. Eight (19.0%) of 42 subjects were diagnosed with major depression. Both inclusive and exclusive approaches to the diagnosis increased the prevalence to 21.4%. Predictive items on the self-report depression scales were inserted in a logistic regression. Four items pertaining to self-worth, discouragement, crying and irritability were left in the model. All somatic items were excluded. Conclusion. This study is an important first step in devising a self-report instrument that would be useful in detecting clinical depression in patients with advanced HIV disease.

Dual Diagnosis (DD) refers to the co-existence of a Severe Mental Illness (SMI) and a Substance Use Disorder (SUD) in the same individual. The comorbid prevalence of these two diagnoses is very common, with Schizophrenia (SZ), Bipolar Disorder (BD), and Major Depressive Disorder (MDD) as the three most prevalent SMI among patients with SUD. The co-existence of SUD and these SMIs includes several clinical characteristics, related to evolution and prognosis, which may complicate a patient`s recovery from both disorders. However, nowadays there is an evident need to carry out studies that provide both theoretical and practical knowledge transferable to the clinical management of patients with DD. The present study aimed, as the first objective, to study personality characteristics in a sample of patients with SUD taking into account their comorbid SMI. We evaluated a sample of 104 male patients undergoing SUD treatment, considered in three groups according to the comorbid SMI: SZ+ Group (SUD and SZ; N=37), BD+ Group (SUD and BD, N=32), and MDD+ Group (SUD and MDD; N=35). Two instruments were used to measure personality, the Cloninger's Temperament and Character Inventory-Revised (TCI-R) and the Zuckerman-Kuhlman Personality Questionnarie (ZKPQ), both based on psychobiological models. In addition, we explored the influence of the SMI in the relationship among personality and clinical variables related to both SUD and SMI diagnoses. Our second objective was to explore the influence of DD in the coping strategies used in relation to addiction treatment. SUD treatment represents a challenging situation for all patients, but given DD clinical complications, we studied the possible differential profile in the coping strategies used between patients with SZ+ (the most prevalent diagnosis in our sample) and SUD only. To elucidate the influence of comorbidity, a sample of 89 male patients undergoing treatment for addiction was included and distributed in two groups: SZ+ Group (SUD and SZ; N=39) and SUD Group (SUD only; N=43); these patients were assessed using the Coping Strategies Inventory (CS) from Tobin and completed an exhaustive clinical evaluation as well. The main personality results indicate that patients with SZ+ are characterized by an increased anxiety and fear of uncertainty (high Harm Avoidance from the TCI-R), difficulties in persevering when facing frustration and fatigue (lower Persistence from TCI-R), and the preference for solitary activities or small groups (lower Sociability from ZKPQ). Our findings suggest that patients with SZ+ are the ones who would especially need strategies to manage negative expectations and anxiety, motivational strategies, and if possible, a gradual incorporation to the group therapy sessions used during SUD treatment. Regarding personality characteristics for patients with BD+, these are characterized by an exploratory activity in response to novel stimulation, being more impulsive, getting easily bored, and by the willingness to experiment strong emotions for the sake of these types of experiences (high Novelty Seeking from the TCI-R and Impulsivity- Sensation Seeking from the ZKPQ). In addition, BD+ diagnosis is highlighted by a higher level of worries, fears, tension, and general emotional upset (high Neuroticism-Anxiety from the ZKPQ). Therefore, patients with BD+ are the ones who would require a therapeutic approach which emphasizes impulsivity management, as well as, achieving the general activity and stimulation they require. Finally, considering patients with MDD+, these are characterized by being more pragmatic, realistic, having an unstable self-image, and an erratic world-view (lower Self-transcendence from the TCI-R). Taking also into account that in previous studies a lower Self-transcendence is linked to worse general well-being and dropping-out SUD treatment, it may be suggested that interventions with MDD+ patients could benefit from therapeutic strategies that aim to increase creativity and spirituality, which are both associated with a higher Self-transcendence. With regards to the main relationships founded among personality and SUD and SMI clinical variables, we observed that such relationships are also influenced by the type of comorbid SMI. Results from the TCI-R indicate that higher scores in Novelty Seeking for patients with BD+ are related to a higher severity of addiction. Harm Avoidance is only linked to clinical variables for patients with SZ+, with a higher Harm Avoidance in patients having a greater presence of negative symptoms and general psychopathology. While Persistence did not show any clinical implications for none of the groups, Self- transcendence only showed clinical implications for the MDD+ group, in which a later age of SUD onset is associated with a lower Self-transcendence. Regarding results from the ZKPQ, we observed a positive relationship between Neuroticism-Anxiety and manic symptoms for patients with BD+, and the number of suicide attempts for patients with SZ+. Lastly, a higher Sociability is related to a later age of SUD onset for patients with SZ+, and to a later age of SMI onset for patients with MDD+. The study about coping strategies using the CSI in patients with SZ+, revealed that they are less likely to employ Engagement Strategies (Problem Solving and Social Support) and they have a lower self-perceived capacity to cope with treatment, compared with patients with SUD only. Among patients with SZ+, a major use of the Problem Solving strategy is related to a later age of SUD onset, and the self-perceived capacity to cope with treatment is negatively linked to severity of addiction and to positive symptoms. According to normative data, both groups (SUD and SZ+) use the Disengagement Strategy of Self-Criticism frequently; although the use of Self-Criticism was lower for patients with SZ+. Additionally, a higher use of Self-Criticism is related to a higher daily amount of medications for the SZ+ group. Hence, the presence of DD is associated with a lower use of active coping strategies and points to the need of training problem solving strategies, as well as, abilities to seek for social support during SUD treatment of patients with SZ+. Working on these two strategies could potentially improve treatment adherence and therapeutic outcomes. In conclusion, the findings of this thesis showed that patients with DD have different personality characteristics depending on their comorbid SMI diagnosis. Moreover, the relationship among personality and SUD and SMI clinical variables is also influenced by the type of SMI. Our findings extend to the DD field previous data about personality dimensions as potential endophenotypes for SZ (high Harm Avoidance) and BD (high impulsivity). Likewise, we observed the potential endophenotypes for developing an addiction (high Novelty Seeking and Impulsivity-Sensation Seeking, which are suggested especially for alcohol SUD) in polydrug users, regardless of the main SUD´s substance and adding nuances according to the comorbid SMI. On the other hand, a lower use of active coping strategies in relation to addiction treatment for patients with SZ+ extends to the DD field previous observations done in patients with SUD only and with SZ. Our data point to the potential usefulness of working different aspects, related to personality and coping, during DD treatment considering the comorbid SMI. However, future research is needed to advance in those lines of research, as well as, to overcome the limitations of our work. Additional studies should include a clinical, personality, and coping assessment, and longitudinal measures combined with objective data such as genetic polymorphisms and functional neuroimaging.
El concepto de Patología Dual (PD) hace referencia a la concurrencia de un Trastorno Mental (TM) y un Trastorno por Uso de Sustancias (TUS) en una misma persona. La prevalencia conjunta de estos dos diagnósticos es muy frecuente, siendo los tres TM severos comórbidos más prevalentes en pacientes con TUS la Esquizofrenia (SZ), el Trastorno Bipolar (TB) y el Trastorno Depresivo Mayor (TDM). La coexistencia del TUS y estos TMs conlleva una serie de características clínicas, de evolución y pronóstico, que dificultan la recuperación del paciente en ambos trastornos. Sin embargo, en la actualidad existe una necesidad evidente de realizar estudios que aporten tanto conocimiento teórico como trasladable al manejo clínico de los pacientes con PD. El presente trabajo se propuso, como primer objetivo, estudiar las características de personalidad en una muestra de pacientes con TUS atendiendo al diagnóstico de TM severo comórbido. Evaluamos una muestra de 104 pacientes hombres en tratamiento para el TUS, considerados en tres grupos según el diagnóstico de TM severo comórbido: Grupo SZ+ (TUS y SZ; N=37), Grupo TB+ (TUS y TB; N=32) y Grupo TDM+ (TUS y TDM; N=35). Se utilizaron dos instrumentos de medición de la personalidad, el Temperament and Character Inventory-Revised (TCI-R) de Cloninger y el Zuckerman-Kuhlman Personality Questionnarie (ZKPQ), ambos basados en modelos psicobiológicos. Además, se exploró la influencia del TM en la relación entre personalidad y variables clínicas tanto del TUS como del TM. Nuestro segundo objetivo consistió en explorar la influencia de la PD en las estrategias de afrontamiento utilizadas en relación al tratamiento de la adicción. El tratamiento para el TUS representa un desafío para todos los pacientes, pero dadas las complicaciones clínicas de la PD se estudió el posible perfil diferencial de las estrategias de afrontamiento entre pacientes con SZ+ (diagnóstico más prevalente en nuestra muestra) y con sólo TUS. Para elucidar la influencia de la comorbilidad, se incluyó una muestra de 89 pacientes hombres en tratamiento para la adicción considerados en dos grupos: Grupo SZ+ (TUS y SZ; N=39) y Grupo TUS (N=43), a quienes se les aplicó el Coping Strategies Inventory (CSI) de Tobin junto con una exhaustiva evaluación clínica. Los principales resultados sobre personalidad indican que los pacientes con SZ+ destacan por una mayor ansiedad y temor a la incertidumbre (elevada Evitación del Riesgo del TCI-R), dificultad para perseverar ante la frustración y la fatiga (menor Persistencia del TCI-R) y preferencia por actividades en solitario o en grupos pequeños (menor Sociabilidad del ZKPQ). Nuestros hallazgos sugieren que los pacientes con SZ+ son quienes necesitarían especialmente de estrategias de manejo de expectativas negativas y ansiedad, de estrategias motivacionales y, siempre que sea posible, una incorporación paulatina a las sesiones grupales utilizadas durante el tratamiento para el TUS. Respecto a las características de personalidad de los pacientes con TB+, éstos destacan por la excitación frente a estímulos novedosos, ser más impulsivos, aburrirse fácilmente y poseer una necesidad de experimentar sensaciones fuertes por el mero hecho de vivirlas (elevadas Búsqueda de Novedad del TCI- R e Impulsividad-Búsqueda de Sensaciones del ZKPQ). Además, el diagnóstico de TB+ destaca por un mayor nivel de preocupaciones, miedos, tensión y malestar general (elevado Neuroticismo-Ansiedad del ZKPQ). Por tanto, serían especialmente los pacientes con TB+ quienes requieren de un énfasis terapéutico en el manejo de la impulsividad y en la búsqueda de la activación y estimulación que necesitan. Finalmente atendiendo a pacientes con TDM+, éstos se caracterizan por ser más pragmáticos, realistas, poseer una imagen más inestable de sí mismos y una visión más errática del mundo (menor Trascendencia del TCI-R). Considerando además que en estudios previos se ha relacionado una menor Trascendencia con peor bienestar general y con el abandono del tratamiento para el TUS, cabe sugerir que las intervenciones con estos pacientes se podrían beneficiar de incluir estrategias terapéuticas que incrementen la creatividad y la espiritualidad, ambas asociadas a una mayor Trascendencia. Respecto a las principales relaciones encontradas entre personalidad y variables clínicas del TUS y del TM, observamos que éstas también se hallan influenciadas por el tipo de TM severo comórbido. Los resultados del TCI-R indican que las puntuaciones superiores en Búsqueda de Novedad de los pacientes con TB+ se asocian a una mayor gravedad de la adicción. La Evitación del Riesgo sólo se relacionó con variables clínicas en pacientes con SZ+, siendo ésta más elevada cuanto mayor es la presencia de síntomas psicóticos negativos y de psicopatología general. Mientras que la Persistencia no mostró relaciones con variables clínicas en ningún grupo, la Trascendencia sólo mostró implicaciones clínicas en el grupo con TDM+, en el cual, una mayor edad de inicio del TUS se asoció a una menor Trascendencia. Respecto a los datos aportados por el ZKPQ, observamos una relación positiva entre el Neuroticismo-Ansiedad y la presencia de síntomas maníacos en pacientes con TB+, así como con la cantidad de intentos de suicidio en pacientes con SZ+. Finalmente, una mayor Sociabilidad se relaciona con una edad más tardía de inicio del TUS en pacientes con SZ+ y de inicio del TM en pacientes con TDM+. El estudio de estrategias de afrontamiento mediante el CSI en pacientes con SZ+ mostró que éstos utilizan con menor frecuencia estrategias de Manejo Adecuado del problema (Resolución de Problemas y Apoyo Social), y perciben que tienen menor capacidad para afrontar el tratamiento respecto a pacientes con sólo TUS. En pacientes con SZ+ un mayor uso de la estrategia de Resolución de Problemas se relaciona con una edad de inicio de TUS más tardía, y la capacidad para afrontar el tratamiento se asocia negativamente a la gravedad de la adicción y a los síntomas psicóticos positivos. Según baremos normativos ambos grupos (TUS y SZ+) recurrían muy frecuentemente a la estrategia de Manejo Inadecuado de Autocrítica, aunque su uso era menor en pacientes con SZ+. Además, una mayor Autocrítica se relaciona con más cantidad diaria de medicación en SZ+. Por tanto, la presencia de PD se vincula a un afrontamiento del tratamiento para la adicción menos activo y apunta a la necesidad de entrenar a los pacientes con SZ+ en el uso de estrategias de resolución de problemas y búsqueda de apoyo social durante su tratamiento para el TUS, pudiendo ello mejorar tanto la adherencia como la respuesta terapéutica. Como conclusión, los hallazgos de esta tesis muestran que los pacientes con PD difieren en las características de personalidad según su diagnóstico de TM severo comórbido. Además, la relación entre la personalidad y las variables clínicas del TUS y TM también se halla modulada por el tipo de TM. Nuestros resultados extienden al ámbito de la PD los datos previos sobre dimensiones de personalidad como posibles endofenotipos de la SZ (elevada Evitación del Riesgo) y del TB (elevada impulsividad). Así mismo, los posibles endofenotipos de personalidad para el desarrollo de la adicción (elevadas Búsqueda de Novedad e Impulsividad-Búsqueda de Sensaciones, que se sugieren especialmente para el TUS por alcohol) los observamos en pacientes policonsumidores, con independencia del tipo de sustancia principal del TUS, añadiendo matices según el TM severo comórbido. Por otra parte, el menor uso de estrategias de afrontamiento activas en relación al tratamiento de la adicción en pacientes con SZ+ extiende al ámbito de la PD observaciones previas realizadas en pacientes con TUS y con SZ. Los datos apuntan a la posible utilidad de trabajar aspectos diferenciales, relacionados con la personalidad y el afrontamiento, durante el tratamiento de la PD atendiendo al TM severo comórbido. Sin embargo, para poder progresar en esta área y superar las limitaciones de nuestros estudios, se requieren futuras investigaciones que, junto con la evaluación clínica, de personalidad y afrontamiento, incluyan registros longitudinales y medidas objetivas como polimorfismos genéticos y de neuroimagen funcional.

Recent publicity has focused on the problems created by the usage of illicit drugs in the community. The growing use of illicit drugs throughout the Grampians region and the lack of resources and professional services available to regional and rural areas raise many questions as to treatment options and the accessibility and appropriateness of drug and alcohol and mental health services. Despite the fact that mental health professionals in rural/regional areas are expected to deliver the most appropriate care to individuals with a comorbid drug and alcohol and psychiatric disorder, a number of these rural/regional mental health professionals have limited preparation and experience in dealing with dual diagnosis issues. This phenomenological study focuses on the area of dual diagnosis, specifically the experiences of health professionals who care for clients diagnosed with a serious mental illness and a coexisting drug and alcohol disorder. Results are described in the form of four themes, which emerged from data collected during in-depth interviews with 13 mental health professionals who care for clients with a dual diagnosis. The themes captured in this research will be described using metaphors as headings. The first theme Sink or swim represents mental health professionals’ initial preparation to care for this group of complex clientele. Treading water symbolises mental health professionals’ endeavours to keep their head above water and reflects on their feelings while endeavouring to do so. Rowing against the tide describes mental health professionals’ understanding of clients’ drug misuse, which impacts greatly on the level of care.
Master of Nursing

Mothers who have children with a previous Asperger's syndrome diagnosis had to go through a process to maintain or obtain services for their child when the fifth edition of the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) removed the diagnosis. Prior to and since the release of the DSM-5 in 2013, there has been an expression of concern in the literature about how this diagnostic change would affect services for children with a previous Asperger's syndrome diagnosis. Current research has not sufficiently explored the experiences mothers have had with this process. The purpose of this hermeneutical phenomenological study was to explore the experiences of mothers since this diagnostic change. Data were collected and saturation was reached at 6 participants using semistructured interviews. Interpretive phenomenological analysis was used to interpret the experiences of these mothers which produced 3 main themes related to the process of obtaining a new diagnosis, insurance-funded services, and educationally-funded services. The results included both subthemes and superordinate themes that highlighted the need for more stakeholder education, difficulty navigating systems, the need for advocacy, concerns about new diagnoses and loss of services, and the public's perception and the stigma associated with the Asperger's syndrome diagnosis both before and after this diagnostic change. Study results may assist with improving counselors and other stakeholder's knowledge about the importance of the mothers' experiences when there is a diagnostic change of this nature. Also, counselor educators can instill the importance of diagnostic accuracy and supporting all stakeholders when teaching new counselors.

The purpose of this study was to explore heterosexual bias in the diagnosis and treatment of gay males. Two hundred-fifty (134 males and 116 females) mental health professionals from the Division of Psychotherapy (29) of the American Psychological Association participated in the study. Participants were randomly assigned to one of two case history conditions, which presented a 35-year-old male seeking therapy. Both conditions were equivalent with regards to the presenting problem (i.e., diagnostic symptoms) with the exception of his significant other (i.e., gay vs. non-gay condition). Potential bias was measured through a diagnostic rating Likert scale and a treatment plan questionnaire. Other independent variables that could potentially have an effect on diagnostic ratings were explored, such as gender, year of graduation, and theoretical orientation of the respondents. Results of the statistical analyses failed to confirm evidence of heterosexual bias. Implications for further research and training are discussed.

Thesis (MSc)--University of Stellenbosch, 2000.
ENGLISH ABSTRACT: Malingering is the intentional production or exaggeration of symptoms for personal gain in the context of external incentives. Due to the absence of objective symptoms, depression may represent a relatively attractive option for malingerers. Existing approaches to distinguish between depressive symptoms and possible malingering often use time-consuming psychometric tests or unreliable interview techniques. Short screening tests for malingering may be a practicable alternative and recently South African cut-off scores on tests for malingering were determined for a student sample. The purpose of this study was to establish South African cut-off scores for persons with a diagnosis of depression on screening instruments for malingering. Fifty-one subjects with a diagnosis of depression (measured by the Zung Depression Scale) were randomly ascribed to one of two groups: an experimental group of 25 subjects (instructed to simulate symptoms based on a malingering case scenario) and a control group of 26 subjects (instructed to do their best in the tests). No incentive was provided to the subjects. Each subject completed the 21-item verbal memory forced choice test (FCT), the Rey IS-item test (Rey IS-item), the dot-counting test (DCT), the Word Recognition test (WR) that is part of the Alzheimer Disease Assessment Scale Cognitive Battery (ADAS-Cog) and the Structured Inventory of Malingered Symptomatology (SIMS). The WR test correctly classified 74.5% of subjects with a sensitivity of 93%. The FCT, with a cut-off of> 15.5, correctly classified 72.5% of subjects. A regression equation was computed by combining the FCT, DCT and SIMS. This correctly classified 74.5% of patients with a sensitivity of 69%. The DCT accurately identified 64% of the malingerers using a cut-off score of> 65.57. The Rey15-item test showed poor results and does not seem to be useful as a screening instrument. The WR test shows promise as a screening instrument for malingering. Combining tests when screening for malingering proved to be an effective way to distinguish between malingering of depressive symptoms and real symptoms. The results of this study will help provide guidelines to mental health workers on how to diagnose malingering in patients with depression more objectively.
AFRIKAANSE OPSOMMING: Malingering is die opsetlike nabootsing of oordrywing van simptome vir persoonlike gewin in die konteks van eksterne vergoeding. As gevolg van die subjektiewe aard van simptome, kan depressie 'n relatief aantreklike opsie wees wanneer psigiatriese kondisies gesimuleer word. Bestaande maniere om te onderskei tussen werklike depressiewe simptome en moontlike malingering, gebruik tydrowende psigometriese toetse of onbetroubare onderhoudstegnieke. Kort siftingstoetse vir malingering kan 'n praktiese altenatief wees en onlangse Suid-Afrikaanse afsnypunte op toetse vir malingering is bepaal vir 'n studentesteekproef. Die doel van hierdie studie was om Suid-Afrikaanse afsnypunte te verkry vir malingeringstoetse vir mense met 'n diagnose van depressie. Een en vyftig subjekte met 'n diagnose van depressie (gemeet deur die Zung Depressieskaal) is ewekansig toegewys aan een van twee groepe: 'n eksperimentele groep van 25 subjekte (met die opdrag om simptome te simuleer op grond van 'n malingering-scenario) en 'n kontrolegroep van 26 subjekte (met die opdrag om hulle bes te doen in die toetse). Geen vergoeding is aan proefpersone gebied nie. Elke subjek het die 21-item verbal memory forced choice test (FfC), die Rey 15-item test (Rey IS-item), die dot-counting test (DCT), die Word Recognition test (WR) wat deel vorm van die Alzheimer Disease Assessment Scale Cognitive Battery (ADAS-Cog) en die Structured Inventory of Malingered Symptomatology (SIMS) voltooi. Die WR het 74.5% van die subjekte korrek geklasifiseer met 'n sensitiwiteit van 93%. Die FCT, met 'n afsnypunt van <15.5, het 72.5% van die subjekte korrek geklassifiseer. 'n Regressie-vergelyking is bereken deur 'n kombinering van die FCT, DCT en SIMS. Dit het 74.5% van die subjekte korrek geklassifiseer met 'n sensitiwiteit van 69%. Die DeT kon 64% van die malingeerders akkuraat identifiseer deur gebruik te maak van 'n afsnypunt van> 65.57. Die Rey IS-item toets het swak resultate getoon en blyk nie bruikbaar te wees as 'n siftingstoets nie. Die WR toon potensiaal as In siftingstoets vir malingering. Die kombinering van toetse wanneer pasiënte gesif word vir malingering blyk 'n effektiewe manier te wees om te onderskei tussen die malingering van depressiewe simptome en werklike simptome. Die resultate van hierdie studie kan help om riglyne te skep vir geestesgesondheidswerkers oor hoe om malingering van depressie meer objektief te diagnoseer.

Orientador: Cláudio Eduardo Muller Banzato
Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas
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Resumo: Introdução: A despeito de sucessivas revisões dos sistemas classificatórios psiquiátricos enfatizarem a necessidade de que suas categorias diagnósticas e eles próprios sejam dotados de validade, não apenas o êxito obtido em relação a tal propósito é questionável, mas é incerto, também, o próprio significado dado ao atributo validade na nosologia psiquiátrica. Objetivo: No presente trabalho são examinadas as vicissitudes relativas ao entendimento e manejo da noção de validade no referido domínio, ao tempo em que também são oferecidas sugestões quanto a como melhor tratá-la. Método e resultados: A análise inicialmente realizada é dirigida à determinação da inteligibilidade e do quão dissonante são as descrições dadas à noção de validade na nosologia psiquiátrica, bem como à vasta terminologia a ela paralelamente relacionada. Uma vez reconhecida a vastidão e instabilidade semântica que afetam a terminologia relacionada ao termo validade, bem como o limitado tratamento teórico dado a este atributo na nosologia psiquiátrica, é empreendido um esforço em favor do reconhecimento de concepções específicas de validade nos programas investigativos existentes em tal campo. As quatro diferentes concepções da validade reconhecidas - aqui nomeadas concepção realista, concepção utilitarista, concepção psicométrica e concepção taxonômica - são então analisadas em suas potencialidade e limitações, bem como em relação à possibilidade de mútua redução. Concluindo-se que cada uma das concepções de validade reconhecidas não apenas têm méritos e restrições que lhes são inerentes, mas, também, que tais concepções de validade não são redutíveis entre si, é proposta uma visão pragmática para a noção de validade na nosologia psiquiátrica. Segundo tal visão, as concepções de validade que se opte por implementar, com os diferentes tipos de informações que carreiam, devem ser cuidadosamente acomodadas aos interesses científicos vigentes em determinado momento. Por fim e a título de melhor sistematização conceitual para as concepções de validade anteriormente reconhecidas e examinadas, é proposta sua inscrição sob duas noções de validade semanticamente mais básicas e abrangentes, reconhecidas por Claire Pouncey e por ela nomeadas validade diagnóstica e validade nosológica. Cada uma das concepções de validade anteriormente discutidas são, então, apresentadas como casos das noções de validade diagnóstica e validade nosológica, ou, pelo menos, como passíveis de serem lidos por seu intermédio
Abstract: Background: Successive reviews of psychiatric classificatory systems emphasize the need of validity for their diagnostic categories and for the classificatory systems themselves. However, it is not only arguable that success has been attained in this regard, but the very meaning of validity within psychiatric nosology seems to be uncertain. Aim: To examine the shortcomings concerning what is meant and on how to employ the notion of validity within psychiatric nosology, as well as suggesting how to better deal with that attribute in the aforementioned context. Method and results: The first analysis performed in this thesis aims at determining how intelligible and how dissonant are the descriptions given to the notion of validity within psychiatric nosology, as well as the broad related terminology. Once it is recognized that the terminology related to the notion of validity is both broad and semantically unstable, and that the theoretical treatment given to that attribute in psychiatric nosology is superficial, an effort is undertaken in order to expose particular conceptions of validity present in research programs in that field. Four conceptions of validity are recognized - here named realist conception, utilitarist conception, psychometric conception and taxonomic conception - and then analyzed as regards their virtues, limitations and liability to mutual reduction. After showing that each of these conceptions of validity has its strengths and limitations, and that they are not reducible to each other, a pragmatic view of the notion of validity in psychiatric nosology is proposed. Accordingly, any conception of validity adopted - conveying different sorts of information - must fit to the scientific interests at stake. Finally, aiming at an improved conceptual systematization to the conceptions of validity previously recognized and examined, it is proposed that they should be viewed as cases of two broader and more basic notions of validity from a semantic point of view - both of them recognized by Claire Pouncey and named nosologic validity and diagnostic validity. Each of the conceptions of validity previously discussed are then presented as particular cases of the notions of diagnostic validity and diagnostic validity, or, at least, as amenable to be read through their lens
Doutorado
Saude Mental
Doutor em Ciências Médicas

Personality disorder has been and continues to be a contested diagnosis. Those who attract this form of diagnosis have been particularly vulnerable to the effects of stigma and have tended to be excluded from service provision. This thesis provides an examination of how recent developments in law, policy and practice have impacted upon the status of personality disorder as a diagnosis of exclusion in Scotland. The theoretical framework that provides this thesis with its structure is derived from the post-empiricist approach proposed by Derek Layder. This approach seeks to contextualise emergent inductive findings within a broader historical and contemporary analysis. In the case of this research the broader context consists of the interplay between mental health law, policy and practice in the field of mental health and the diagnosis of personality disorder more specifically. The empirical enquiry at the core of this thesis is based upon an analysis of the views, beliefs and expectations of front-line staff (psychiatrists and social workers qualified as mental health officers) involved in the process of assessment and service provision. In addition to front-line staff (n = 27) a range of key informants who were in a position to shed light on the strategic imperatives underpinning recent developments in law and policy were also interviewed. This analysis is contextualised within a review of key developments in law and policy that have particular significance for anyone who may attract a diagnosis of personality disorder. Despite the ostensibly inclusive approach towards those who may attract a diagnosis of personality disorder evident within the Mental Health (Care and Treatment) (Scotland) Act 2003, the reality is a highly selective and very limited inclusion of those who attract this form of diagnosis. The effective inclusion of those who may attract a diagnosis of personality disorder has been obstructed by several key impediments: 1: an insufficiently robust policy framework to drive forward the process of inclusion; 2: residual ambivalence towards the legitimacy of the diagnosis of personality disorder itself and the legitimacy of the claims made upon services by those who may attract a diagnosis of personality disorder; 3: insufficient and inadequately focused resources; 4: service structures that have not been redesigned sufficiently to engage successfully with service users who may attract a diagnosis of personality disorder. As a consequence of these impediments to inclusion, the majority of those who may attract a diagnosis of personality disorder in Scotland are likely to continue to face high levels of marginalisation and exclusion.

Mental major illness, including psychotic disorders and mood disorders, has been linked to early prenatal/childhood factors and subsequent behavioral health concerns. For example, Watson et al. (1999) found that maternal illness and extreme stress during pregnancy disrupts fetal brain development, increasing the likelihood of depression or schizophrenia in later life. Research has also shown a dose-response effect between the number of adverse childhood experiences (ACEs) and mental health outcomes, with increasing ACEs linked to more severe mental health problems and suicide attempts (Merrick et al., 2017). Persons with major mental illness, like schizophrenia or bipolar disorder, are also at increased risk of suicidal and self-harm behaviors (Happell et al., 2012; Morden et al., 2009). These individuals also demonstrate a higher rate of substance use (Linszen et al., 1995) that often contributes to poor medical health (Dixon et al., 2000; Jeste et al., 1996). The current study sought to differentiate adolescents with and without major mental illness (i.e., psychotic or mood disorders) by investigating a sample of youth who were in a residential treatment facility for sexually abusive behaviors (N = 296). Data related to participants’ prenatal/birth concerns, ACE scores, history of suicide attempts and self-harm, and use of alcohol, tobacco, marijuana, and inhalants were gathered from archival records. Results indicated that there were a number of adolescents diagnosed with a psychotic disorder (n = 33) or mood disorder (n = 189). Two separate logistic regressions assisted with differentiating adolescents with and without psychotic or mood disorders using the specified predictors. A significant model (χ2 = 94.910, Nagelkerke’s R2 = 0.412, p < 0.001) correctly classified 76.4% of participants with a mood disorder. Adolescents with a mood disorder were 4 times as likely to have had prenatal or birth concerns (OR: 4.404, p < 0.001), and were significantly more likely to have higher ACE scores (OR: 1.148, p =.024). Further, those with a mood disorder were 2.5 times as likely to have self-harmed (OR: 2.673, p=.009), and approximately 23 times more likely to have attempted suicide (OR: 22.858, p=.003). Another significant model (χ2 = 29.842, Nagelkerke’s R2 = 0.210, p < 0.001) correctly classified 88.3% of participants with a psychotic disorder. Adolescents with a psychotic disorder diagnosis were significantly more likely to have higher ACE scores (OR: 1.237, p =.020), and were 4 times as likely to have a self-harm history (OR: 4.474, p=.005) compared to those without a psychotic disorder. Results indicate that prenatal/birth concerns appear to be a significant factor for those who are diagnosed with a mood disorder, but not with a psychotic disorder. Also, those with mood disorders, but not psychotic disorders, were more likely to have attempted suicide. Adolescents with either a mood or psychotic disorder both tended to self-harm and have experienced more ACEs. Interestingly, substance use was not higher among adolescents with mood or psychotic disorders, despite predictions and previous research findings.

This thesis was written to fulfil the requirements of the University’s Doctorate in Clinical Psychology. The thesis is made up of three sections: a review of the research literature focused on service users’ experience of psychiatric diagnosis, an empirical paper exploring clinicians’ perceptions of the diagnosis of Bipolar Disorder and an executive summary outlining the study designed for dissemination in clinical practice. The literature review identified four important aspects of mental health diagnosis for service users: whether service users wanted to be told about their diagnosis, the communication of the diagnosis, positive aspects of being given a psychiatric diagnosis and disadvantages of receiving a psychiatric diagnosis. Accuracy, timing and communication of diagnostic feedback were all thought to be important for service users receiving a mental health diagnosis, whilst fostering hope was paramount in positive experiences. The review concluded that service users held a wide variety of different perceptions of psychiatric diagnosis and recommended that clinicians were offered specific training on feeding back a mental health diagnosis to service users. The empirical paper used Q-methodology to explore the subjective viewpoints of mental health clinicians on the diagnosis of Bipolar Disorder. This study noted the mixed literature on the use of the diagnostic label in mental health services and aimed to explore whether clinical practice mirrored the previous research. A total of 19 mental health clinicians completed Q-sorts in which they were asked to rank statements about the diagnostic label of Bipolar Disorder. Three main factors emerged: (1) Seeing the person and their experience, (2) Promoting quality through standardised processes and (3) Understanding the function of diagnostic labels. All three factors agreed that sufficient time should be taken to assess for Bipolar Disorder and that communication using purely the diagnostic label was not helpful. Holding different perspectives on the diagnosis of Bipolar Disorder is likely to make it difficult to provide consistent, high-quality care for service users and it was suggested that services may benefit from better integration of these viewpoints moving forward. The executive summary outlines an overview of the empirical paper that can be disseminated to mental health services.

This study tested whether participants exposed to a vignette describing an individual experiencing symptoms of depression, which included only the specific diagnosis label of "depression," would report significantly less stigmatized responses than participants exposed to an otherwise identical vignette which included only the non-specific diagnosis label "mental illness." The study is grounded in past research on stigmatization of mental illness and is informed by three theoretical frameworks, the social identity perspective, attribution theory, and labeling theory. Participants were randomly assigned to read one of the two alternate vignettes, then respond to a series of measures testing desire for social distance, negative emotion (affective reaction), beliefs about people with mental illness, and perceived dangerousness of the character in response to the vignette they viewed. The results showed that labelling the character in the vignettes as struggling with "mental illness" did lead to greater perceived dangerousness of the character described, although labelling did not lead to more stigmatization in any of the other measures. This research demonstrated that people tend to consider a character in a vignette as less trustworthy and more of a risk based solely on the label "mental illness." The experiment also tested if people who have had a personal relationship with someone who has experienced mental illness will have less stigmatized responses to mental illness vignettes, but no significant difference was shown. Overall, the results imply that use of specific language in communication labelling an individual as experiencing a mental health condition is less stigmatizing than non-specific language and may improve chances for successful treatment-seeking and future patient outcomes.

The purpose of this study was to examine the diagnostic and classification accuracy of placement decisions for Mildly/Educably Mentally Handicapped (M/EMH) children in British Columbia. Evidence from the United States suggests that classification decisions are often made on the basis of idiosyncratic student behaviours and the subjective opinions of educators, not on the basis of empirical evidence. Although Canadian special education practice is often based on that of the U.S., no major study of the accuracy of diagnosis and classification has been undertaken in this country. Based on a review of the literature, internationally accepted criteria for the diagnosis and classification of M/EMH students were formulated. In addition, variables that might influence the use of these criteria were identified. Elementary age students from two metropolitan Vancouver school districts who had been suspected of being M/EMH during a two-year period served as subjects (n=106). Of these 57 were classififed as M/EMH and 49 were classified as regular education. An evaluation of IQ, adaptive behaviour, reading and arithmetic achievement, maladaption, and visual and hearing acuity was performed for each subject. Preliminary data analyses permitted the formation of an achievement composite score and the pooling of subjects from the two districts. Using an internationally accepted two-factor diagnostic model, analyses were performed to investigate the classification accuracy for the sample. Cut-off criteria used with the two-factor model were adjusted to those of both the American Association for Mental Deficiency and the draft B.C. Special Education Guidelines. Where subjects could not be confirmed by the application of these models, sources of classification error were identified. Next, a series of discriminant function analyses, each representing a historical step in the development of diagnostic and classification models, were performed and the classification accuracy of each examined. Finally, a full model of all measured variables was examined using both a forced discriminant function procedure and a step-wise technique. The findings suggested that a combination of the adaptive behaviour, IQ, and achievement variables provided the highest classification accuracy. This result is consistent with much of the research from the U.S. IQ scores were found to consistently dominate classification decisions. In addition, academic achievement proved to be a valid predictor, either in combination with social adaptation or maladaption. However, maladaptive behaviour, whenever entered with social adaptation, overwhelmed the latter as a descriminator of group membership. The highest classification rate for the total sample was 92.0% for the combination of adaptive behaviour, IQ, and academic achievement. Although visual and hearing acuity were not found to be related to group membership, it was discovered that testing for these variables was not occurring in the districts studied in accordance with accepted best practice. A disproportionate number of M/EMH students proved to be untestable using school-based audiological and visual sweep testing techniques. In cases of untestability, the assumption that the child can see and hear within normal tolerances appears to be made, and efforts to use alternative testing procedures are not pursued. In addition, visual and hearing testing appears to occur after the administration of standardized cognitive tests, and not before, as best practices would dictate. The principal contributions of this research are (1) that it is the first major study of diagnostic and classification accuracy with a Canadian M/EMH population, (2) that it advises the inclusion of academic achievement as a domain of adaptive behaviour based on empirical evidence of the importance of that variable in diagnosing M/EMH, and (3) it examines the role of auditory and visual acuity testing in M/EMH diagnosis and classification.
Education, Faculty of
Educational and Counselling Psychology, and Special Education (ECPS), Department of
Graduate

Comorbidity between Axis I mental disorders and substance use disorders range from 5%--60% (Farrell, 1998; Fowler, 1998). It has been suggested that dually diagnosed patients are inadequately treated for both disorders and that they are problematic from a diagnostic, clinical management and economic perspective. Dual Diagnosis (DD) maybe associated with a number of issues including increased aggression, increased non-compliance with medication (Swartz, 1998), and exacerbated psychopathology (Tomasson, 1997). However, contradictory evidence has also been found (Leon, 1998), which suggests that patients with DD may be a higher functioning population of mentally ill patients. The objectives of the present study were to determine the prevalence and clinical characteristics of dual diagnosis patients in a chronic psychiatric population. A sample of 217 patients with schizophrenia spectrum disorders was randomly sampled from the psychiatric facilities of the Montreal General Hospital. Almost half of the sample presented with comorbid addictive disorders; the most common drugs abused were alcohol, cannabis and cocaine. Those patients who had a lifetime diagnosis of substance abuse or dependence were more likely to be male, had a more severe course of psychiatric illness, higher rates of psychiatric symptomology, were more likely to be tobacco smokers and had higher rates of non-compliance with psychiatric medications. Further analyses revealed lower levels of social support and more legal problems in patients with DD, all of which may negatively impact on the quality of care for dual diagnosis patients in the clinical setting.

The use of systems that span many knowledge domains is becoming more common as technology advances, requiring expert-performance in a domain from users who are usually not experts in that domain. This study examined a means of communicating expertise (in system operation and fault diagnosis) to non-experts and furthering the understanding of expert mental models. It has been suggested that conceptions of abstract models of system-functions distinguish expert performance from non-expert performance (Hanisch, Kramer, and Hulin, 1991). This study examined the effects on performance of augmenting a simple control panel device with a model of the functions of the device, interacting with the model, and augmenting the device with graphically superimposed procedural indicators (directions). The five augmented display conditions studied were: Device Only, Device + Model, Device + Procedural Indicators, Interactive Model, and Interactive Model + Procedural Indicators. The device and displays were presented on a PC workstation. Performance measures (speed and accuracy) and subjective measures (questionnaires, NASA TLX, and structured interviews) were collected. It was expected that participants who interact with the device + procedural indicators would exhibit the shortest performance time and least errors; however, those who interacted with the simplest display (device only) were fastest and exhibited the least errors. Results of this study are discussed in terms of building a mental model and identifying situations that require a mental model.
Ph. D.

Research in several domains has revealed that when individuals are asked to estimate the probability that their judgments are correct, they reveal an overconfidence effect. Judgments produced in decision environments such as psychodiagnosis, which are by their nature ambiguous and complex, appear to be most vulnerable to overconfidence. By implication, this phenomenon threatens the validity of clinical judgment and subjects clients to risks of flawed diagnoses and unsuitable treatments.
In an effort to identify variables implicated in judgment confidence and overconfidence, this study examined the relationship between four different inferential biases (dispositionalism, confirmationism, truncated data search, and narrow problem formulation) and diagnostic confidence in the context of a psychological assessment task. A second aspect of this study examined the effect of clinical experience on psychodiagnostic confidence. Thirty-six clinicians (18 experienced professionals and 18 clinical trainees) were individually presented a written client casefile, which was segmented and serially presented, to read and clinically interpret aloud. Analyses of participants' verbal protocols revealed that one of the four inferential biases studied (i.e., dispositionalism) accounted for a significant proportion of the variance in psychodiagnostic confidence scores. The author concludes that other clinician variables likely moderate the relationship between particular heuristics and judgment confidence. Regarding the second hypothesis, the data revealed no difference between experienced clinicians and clinical trainees in the degrees of psychodiagnostic confidence manifested in their verbal protocols.
The author proposes that effective remedies to overconfidence begin in training programs that lead students through problem-solving experiences that can invalidate facile, premature, and dubious diagnostic judgments. The author delineates a number of strategies that may be used by educators to achieve this end.

Autistic traits are associated with frequent psychological distress and everyday functional challenges. Some individuals with autistic traits “camouflage” these traits during social interactions by effortfully engaging in “typical” social behaviors. Camouflaging seems to be especially common in autistic girls and women. Emerging evidence proposes a role for camouflaging behaviors in poorer mental health and daily functioning. Furthermore, camouflaging efforts may delay receipt of a proper diagnosis and access to appropriate mental health care. Despite their clinical significance, camouflaging efforts remain difficult to quantify, and the mechanisms and impacts of camouflaging are poorly understood. This study aimed to compare multiple methods of quantifying camouflaging, investigate potential mechanisms of camouflaging, and describe mental health implications of camouflaging behaviors.The sample included 66 women (M age = 25:2 years, SD = 6:4; M IQ = 114, SD = 11) who reported social challenges and scored high on a measure of broad autistic traits. A minority (n = 22) had previously received an autism diagnosis. A majority reported significant anxiety, depression, or suicidality. Camouflaging was quantified using three methods: one self-report questionnaire (CAT-Q), and two discrepancy-based methods that contrasted presentation of autistic traits during the ADOS-2 with measures of less-visible autistic traits (AQ, TASIT-S). Analyses showed that the discrepancy-based measures agreed with each other, but not with the self-report measure of camouflaging. Regression analyses showed camouflaging scores were poorly predicted by age, IQ, performance on executive functioning tasks, and self-reported social cognitive abilities. Regression models including clinician-rated and self-reported autistic traits showed that autistic traits on the SRS-2, and camouflaging efforts on the CAT-Q, modestly but significantly predicted psychological distress and functional challenges. Finally, clinician-administered and self-report diagnostic measures demonstrated only fair or poorer agreement with each other in this unique sample that includes women with elevated self-reported camouflaging.Results emphasize the clinical significance of the camouflaging construct, which may predict mental health difficulties in individuals with autistic traits better than conventional autism measures. Quantifying camouflaging remains challenging as various proposed measures disagree with each other. Disagreement on diagnostic classification between measures underscores the importance of comprehensive, multi-method assessment of mental health in women who report difficulties fitting into social situations and who may be camouflaging significant autistic traits.

Thesis (Ph. D.)--Ohio State University, 2005.
Title from first page of PDF file. Document formatted into pages; contains xii, 168 p.; also includes graphics (some col.) Includes bibliographical references (p. 152-168). Available online via OhioLINK's ETD Center

A differential diagnosis between head injury and depression is critical to ensure proper treatment and appropriate interventions. Knowledge about this can only aid counseling psychologists' work with this population and, identifying a measure that can assist in this process is essential. The purpose of this study is to measure the utility of the Dean — Woodcock Neuropsychological Assessment System (D-WNAS) in distinguishing individuals with head injury from those who have a primary diagnosis of depression, and general neurological impairment. Participants included 433 adults (222 males, 211 females) between the ages 20-55 years of age (mean = 35.3 years, SD = 10.97 years) from the Midwestern United States. During the individual's treatment in the neuropsychological laboratory, each person was administered the following: the Dean-Woodcock Structured Interview (Dean & Woodcock, 1999), mental status exam, the Woodcock Johnson — Revised Tests of Cognitive Ability (WJ-R COG; Woodcock & Johnson, 1989b), the Woodcock Johnson — Revised Tests of Achievement (WJ-R ACH; Woodcock & Johnson, 1989a), and the Dean-Woodcock Sensory Motor Battery (DWSMB; Dean & Woodcock, 1999). This study indicates that responses to D-WNAS can be used to reliably classify adults into groups of depression, head injury, and general neuropsychological impairment. In particular, responses to the D-WSMB portion of the D-WNAS can be used to reliably classify adults into groups of depression, head injury, and general neuropsychological impairment. Classification results revealed that the original grouped cases were classified with 62.6 % (p < .001) accuracy and with 73.2% overall accuracy when the head injury and general neurological impairment groups were combined and compared to depression and normative groups. The WJ-R COG and WJ-R ACH were not as reliable as the D-WSMB at predicting group membership.
Department of Counseling Psychology and Guidance Services

In recent years there has been a significant increase in the number of people with a 'learning disability' also receiving a diagnosis of 'mental illness'. This shift in practice, heralded as scientific progress, has not been placed under close scrutiny. The aim of the current study was to explore the impact of this recent extension of medicalised accounts on people with a 'learning disability'. A discursive psychological approach was adopted to examine how seven people with a dual diagnosis negotiated and managed their ascribed identities during interviews. The initial research questions focused on the implications of subtle operations of power for individuals with a dual diagnosis, however on examination of the data it became apparent that this phenomenon was clearly evident in the research interviews conducted for the present study. The focus of the analysis was then directed at the sequential and procedural structure of the interviews, as an illustration of how they may be understood as an artefact of asymmetrical social roles and identities. This shift allowed for a greater focus on how the participants constructed their relationships with professionals, using their interaction with the interviewer as psychologist as an exemplar. The results provide further support for findings that individuals cast as questionable utilise strategies for accounting that indicate that they are vastly more 'competent' and 'rational' than they are credited for by the 'psy'-complex. The participants' construction and negotiation of their membership to social categories demonstrates that their identities are not fixed, but instead are occasioned and contestable, and dependent on the local institutional context. A further feature of the analysis highlights the politics that surrounds talk, displayed by the participants' construction of talk with a psychologist as 'helpful', as opposed to other forms of talk, such as talk that serves to challenge, as'unhelpful'. The findings call into question the probity of applying a conceptual framework that locates assumed pathology in individuals already deemed to be wholly impaired. Furthermore, the study highlights the necessity for psychologists, policy makers and researchers to investigate the interactional nature of so called 'impairment', and to explore their roles in creating and perpetuating oppressive practices. Potential avenues for further action are discussed

This study explores the dual diagnosis substance abuse phenomenon within the context of Vancouver area mental health boarding homes. The target population consisted of thirty-nine mental health boarding homes used by Greater Vancouver Mental Health Services, Mental Health Residental Services. An attempt was made to survey directors (n=37), staff (n=unknown), and residents (n = 422), to: estimate the prevalence of dual diagnosis substance abuse within these homes; look for associations between substance use/abuse and the demographic characteristics of staff, directors, and residents; examine boarding home policies; and to establish what, if any, services should be developed. Questionnaires were completed by twenty-nine directors (78%), twenty staff members (% unknown), and ten residents (3%), from twenty-nine boarding homes with a total resident population of 358. Results indicated that one hundred and fifteen residents (32%) consumed alcohol, and 57 residents (16%) had consumed alcohol during a specified two week period. Only eight residents (2%) out of a potential 358 (from four different facilities) reportedly had substance related problems during the specified two week period. However, substance abuse was identified in eleven facilities (38%), without referrence to the two week time limitation. Further, staff and directors from fifteen facilities (52%) had at some time tried to get help for a resident with a substance abuse problem. Thus, while very few residents reportedly had dual diagnosis substance abuse problems, a considerably greater number of boarding homes reportedly had problems related to dual diagnosis substance abuse. Twenty-four directors (86%) and thirteen staff (68%) were interested in receiving a workshop on dual diagnosis substance abuse. It is the recommendation of this author that a drug education program/workshop for boarding home directors and staff be developed through the Greater Vancouver Mental Health Services "dual diagnosis program."
Arts, Faculty of
Social Work, School of
Graduate

Background: Child homicide represents 11.5% of all homicides and parents are perpetrators in about 67% of all cases. Of parents who kill their children fathers have been found to more often be the perpetrator (filicide) in all age groups except in neonaticides, where mothers are nearly always responsible. Women have been found to be over-represented in rates of filicide. Diagnoses of mental illness (MI) have been found as a moderating variable for mothers who kill older children. The aim of the present study was to explore the conditions, processes and contexts that contribute to the development of maternal filicide (MF) in MI mothers. Method: Four mothers with a diagnosis of MI were interviewed using constructivist grounded theory methods to produce theorising about the development of MF. Due to the sensitivity of the research topic, the vulnerability of the population and the need to ensure support for study participants, the study design included only those mothers still receiving care from secure hospital services (N=30). Findings: The present study produced grounded theorising of a process of Disintegrating Security in a number of sequentially related domains: social, economic, relational and psychological as contributing to MF. Consistent with other research on filicide mothers with a diagnosis of MI, mothers were active in caring for their children but became hopeless and suicidal, believing that their own suicide would leave their children alone in a cruel and dangerous world. Conclusions: Mothers committed filicide in a perverse act of maternal love rather than out of anger, or as part of prolonged child abuse. A detailed account of the development of MF in MI mothers has been produced. The findings could be important to increase the understanding of MF for mental health professionals working with filicide mothers, surviving family members and mothers themselves.

This work is born out of previous research, conducted by this researcher, into the effects of psychiatric labelling on individuals thus differentiated. Informed by the investigative thrust of phenomenological inquiry, it is the aim herein to provide an illumination of the dramatic confrontation of the labelled individual with the classificatory branding that is his or her label. The question asked is: What is the experience of the labelled individual, and how does the label function as a ‘scientific fact’ (Kiesler, 2000) suffused within his being? In answering these questions, the researcher aims to abandon his own expectations, as is fitting with the phenomenological method, and to devote his sympathies entirely to the subjective disclosures which, it is hoped, the participants will offer. On this point, an obvious tension exists insofar as expectation and hypothesis necessarily constitute the inception of any research endeavour; and so, the notion of a complete bracketing of assumption and anticipation seems methodologically vague. The explorative impetus within this dissertation aims towards an elucidation of the effect of psychiatric diagnosis on the labelled individual, in terms of the individual’s experience of being-with-others. The impact of the offering of the label upon the individual’s interpersonal and intersubjective presence will be explored so as to establish whether psychiatric labelling unfolds as a disconnection of the individual from his co-existence with others.

Past literature has showed that there have been several misdiagnosis of mental illness due to client’s delays in speech or introspection caused by an intellectual disability. It is believed that the intellectual disability is either interfering with the proper mental health diagnosis or a mental health diagnosis is unnecessarily being added to an intellectual disability. The study used a qualitative design that asked four psychiatrists on how they are treating their clients with an intellectual disability in addition to their mental illness. The interview guide asks about the difficulty in diagnosing individuals with a mental illness and a co-occurring intellectual disability. The proportion of clients also having an intellectual disability and co-occurring mental illness ranged from 5 to 20%. The problems that psychiatrists are running into are the fact that patients are not being correctly diagnosed before the age of 18 and are not able to get the resources that are needed, such as Inland Regional services.

Diagnosing post-traumatic stress disorder (PTSD) is challenging and is currently, diagnosis through self-administered checklists. Because a diagnosis of PTSD can open up significant benefits to compensation, education, and medical care, people can tailor their responses to the checklist to help ensure a diagnosis of PTSD. The purpose of the study was to examine the utility of the quantitative electroencephalograph for diagnosing PTSD. Frequency and presence of biomarkers and alpha brain wave symmetry in the frontal and parietal lobes were examined. Research questions involved examining the presence of alpha wave imbalance across the frontal lobe and between the right and left parietal lobes. A secondary data analysis was conducted using data from 108 subjects; these data included records from those with and without a PTSD diagnosis. The results of logistic regression showed that 63% of the clients diagnosed with PTSD were correctly identified and between 7% and 8% of the variance in PTSD was accounted for by frontal lobe asymmetry. The parietal lobe imbalance correctly classified PTSD in 59% of the patients and it identified 3.5–4.9% of the variance, suggesting that asymmetry in the frontal and parietal lobes should not be used as the primary method for diagnosing PTSD. Implications for social change include identifying an objective diagnostic tool that can potentially decrease the possibility of inaccurate diagnoses based on self-reported symptoms. This could lead to eliminating some of the shame and embarrassment veterans and first responders feel toward seeking help for PTSD.

This online analogue study examined psychologists' current mental health diagnoses disclosure practices to children. Specifically, this dissertation investigated participants' self reported likelihood to disclose mental health diagnoses in relation to both psychologist (i.e., clinical services provided and years of clinical service) and client (culture, age, cognitive ability) characteristics. Forty-seven certified American Board of Professional Psychology (ABPP) Psychologists were recruited via email listserv for this research. Participants rated their likelihood to disclose mental health diagnoses to vignettes depicting children with varying demographic characteristics: culture, age, and cognitive ability. Participants also responded to open-ended questions exploring their current mental health diagnosis disclosure practices, including the impact of specific diagnoses on disclosure. Analyses of open-ended questions revealed that psychologists consider the following factors in their decision to disclose diagnoses: (1) child characteristics (i.e., age, culture, cognitive ability, maturity, developmental and functioning level), (2) support (family, social, therapeutic relationship), (3) personal beliefs about disclosure, (4) diagnostic characteristics (e.g., prevalence, public familiarity, current biological evidence, stigma), (5) how to provide a supportive disclosure (e.g., kid friendly language), and (6) potential benefits. Combined open-ended and quantitative results provide empirical support suggesting that psychologists, like psychiatrists and pediatricians, are more likely to disclose diagnoses to: (a) children of an American culture than those of a Chinese-American culture, (b) older (16 years old) children rather than younger children (6 years old), and (c) children with an intellectual ability in the Superior Range rather than those with an IQ in the Borderline Range. Psychologists' years of clinical experience also significantly predicted their disclosure practice. Psychologists with between 13-31 years clinical experience reported more diagnosis disclosure to children than did participants with 32 years or more of clinical service when presented with a client who was of an American decent, 16 years old, or had an intellectual ability in the Superior Range. The services that psychologists provide (i.e., counseling, diagnostic evaluations, or both) did not significantly predict disclosure practices. Taken together, the findings of this study may be the first step to facilitate the development of evidenced based guidelines for the disclosure of mental health diagnoses to children.

BACKGROUND: Methamphetamine (MA) use disorder in individuals with severe mental disorders (SMDs) has significant impact on clinical presentation and care. Although treatments exist, these are met by significant challenges. Notably, brief treatments for MA use within the general population have been feasible, acceptable and effective. An individualized, integrated treatment for MA use within a psychiatric inpatient setting would allow adjustment of the treatment according to individual patient needs. It is important to understand the patient needs and potential service barriers to care before formulating a treatment. This study begins to address this gap by seeking to understand the views of healthcare providers on a brief treatment to address MA use among patients with a dual diagnosis. METHODS: Thirteen key stakeholders working with patients with mental disorders including severe mental disorders and co morbid MA use were interviewed using an open-ended semi- structured interview schedule designed to explore their views on a brief treatment for MA use among patients with a dual diagnosis. Interviews were transcribed and the framework approach was used to conduct data analysis. RESULTS: Numerous themes emerged from the data. First, there are multiple risk factors for MA use. Second, this use has a significant impact on multiple aspects of patient presentation and care including individual impacts, family impacts, and impact on care. Third, although treatments for MA use disorders exist, these have significant challenges at multiple levels. Lastly, the integration of a modified brief treatment for MA use in patients with dual diagnosis would be possible if it was adjusted to patient-specific needs within the existing system and if the team adapting the treatment were cognizant of existing and potential challenges. CONCLUSIONS: The adaptation and integration of a brief treatment for MA use among patients with severe mental disorders was considered possible and even necessary if existing and potential challenges were carefully addressed.

In North America, ethnic minority patients are at high risk for misdiagnosis of psychosis. A number of care models are in use for delivery of mental health services in multicultural settings, cultural consultation being one. Research on how these models address bias in diagnosis however remains sparse. We analyzed data from a cultural consultation service to determin e the frequency of re-diagnoses and associated factors, and describe the reasoning process used in resolving uncertainty of a psychosis diagnosis. Re-diagnoses occurred in 49% of cases and was more likely in recent immigrants and persons of non-Black ethnicity. A 3-step reasoning process was identified: (1) problematizing the original diagnosis; (2) explaining symptoms in terms of biomedical, psychological or social processes; (3) confirming or re-interpreting the diagnosis of a psychotic disorder. This process sheds light on psychiatric reasoning in complex cases and can be used in refining cultural competence training and service delivery.
En Amérique du Nord, les patients issus de minorités ethniques sont à haut risque de diagnostic erroné de la psychose. Un certain nombre de modèles de soins sont en cours d'utilisation pour la fourniture de services de santé mentale dans un environnement multiculturel, de consultation culturelle en être un. La recherche sur la façon dont l'adresse biais de ces modèles dans le diagnostic reste cependant rare. Nous avons analysé les données d'un service de consultation culturelle de déterminer la fréquence de ré-diagnostics et les facteurs associés, et de décrire le processus de raisonnement utilisé dans la résolution de l'incertitude d'un diagnostic de psychose. Re-diagnostics eu lieu dans 49% des cas et était plus élevée chez les immigrants récents et les personnes d'origine ethnique non-Noire. Un processus de raisonnement en 3 étapes a été identifié: (1) problématiser le diagnostic initial, (2) expliquer les symptômes en termes de recherche biomédicale, les processus psychologiques ou sociaux, (3) de confirmer ou de ré-interpréter le diagnostic d'un trouble psychotique. Ce processus met en lumière le raisonnement psychiatriques dans les cas complexes et peuvent être utilisés dans le raffinage de formation des compétences culturelles et la prestation des services. fr

This thesis provides a comprehensive criticism of the current models of understanding and caring for the mentally ill in a western context. I will outline the debates surrounding the conceptualization, diagnosis and treatment of mental illness. The western, psychiatric, biologically based understanding of mental illness is the dominant model of understanding and treating mental illness, despite the evidence that it encompasses an incomplete understanding of the causation and nature of mental illness. I will outline the difficulties in the creation of a cohesive definition of mental illness, including philosophical and cultural perspectives. I will examine the impact of historical, societal and capital pressures on the creation of these definitions. I will describe the practical issues and ethical tensions inherent when a definition or diagnosis of mental illness is created and taken up by mental health practitioners, who use this definition to develop treatment plans for the mentally ill. I will conclude that these issues result in a system of conflicting values which leads to less than ideal care for a uniquely vulnerable population. In this light, I conclude that the exclusive use of the DSM diagnoses as an objective basis for the creation of treatment plans is ethically questionable. I call for a new model of professional practice based on individualized treatment and primarily I call for a reduced focus on diagnosis in the care of the mentally ill.
Cette thèse propose une critique complet des modèles actuels de compréhension et d'empathie pour les malades mentaux dans un contexte occidental. Je vais chercher à décrire la compréhension actuelle de l'Ouest et débats entourant le diagnostic et le traitement de la maladie mentale. Le western, psychiatrique, la compréhension fondée sur la biologie de la maladie mentale est augmentation de la prévalence et de l'influence dans le monde. Cependant, je vais montrer que d'autres modèles et de leurs les traitements associés ont le potentiel, et le font souvent, générer améliorée résultats. Je crois que ce que j'appelle le modèle occidental medical de la maladie mentale englobe une compréhension incomplète de la causalité et le traitement de la maladie mentale. Je vais mettre en lumière les problèmes pratiques et des tensions éthiques inhérentes quand une définition ou le diagnostic de la maladie mentale est créé et utilise par les praticiens de santé mentale , qui utilisent cette définition à élaborer des plans de traitement pour les malades mentaux. Je exposer les difficultés dans la création d'une définition cohérente de la maladie mentale, y compris les perspectives philosophiques et culturels. Je vais examiner l'impact des pressions sociétales sur la création de ces définitions. Je vais conclure que le modèle occidental répandue médical, tout en étant utile en tant qu'outil, est imparfait comme une approche exclusive de soins de santé mentale. Cette faiblesse est observé lorsque l'on prend note de la variation incroyable dans le diagnostic et l'expérience de la maladie mentale chez les individus. Dans cette optique, je conclus que l'exclusivité, l'utilisation aveugle des diagnostics comme une base objective pour la création de plans de traitement est éthiquement discutable. Je suggeste à un nouveau modèle de pratique professionnelle basée sur le traitement individualisé et je demande une moindre accent sur le diagnostic dans la prise en charge des malades mentaux.

A literature review in Section A reviews the conceptual and empirical literature with regard to the usefulness and challenges inherent in applying recovery approaches in secure services, with a particular focus on women with a diagnosis of personality disorder. Section B. Background: Some studies have suggested that recovery approaches could be facilitated in secure mental health services despite a number of inherent tensions. However, none have explored if this applies to women with a diagnosis of personality disorder in secure care. A group whose needs have historically been overlooked, and can present with complex care-seeking behaviours. Aims. To explore how staff working with these women understand and apply recovery approaches in secure units. Method. Eleven multidisciplinary staff members working in a medium-secure unit in the UK participated in in-depth interviews. The data was analysed using grounded theory. Results. A preliminary model was generated, which comprised of five categories: secure base, balancing tensions, therapeutic relationship, initiating recovery, and nurturing recovery. These appeared to interact and influence each other throughout the recovery process. Conclusions. Staff are required to continually balance a number of tensions and as such they need a secure base from which to explore the service-users’ unique recovery process through the medium of collaborative therapeutic relationships. Staff sharing a recovery ethos that is embedded in the culture of a conducive environment, and is supported by supervision and teamwork, fosters the actualisation of recovery principles of empowerment, identity formation, and hope. Section C provides a critical appraisal of the study as well as a personal reflection on what was learnt through the process of the conducting the study.

Dorothy Smith (1987) says investigations often begin with ‘a feeling of uneasiness’. Smith’s insistence of the importance of starting with women’s standpoint, to redress the way in which women’s lives have been negated or neglected in research, informs the methodological premise of this inquiry. The unease that prompted this project emerged in conversations I had with women diagnosed with a psychiatric disorder whilst working as a practitioner at a women’s health centre. The frequency with which the discourses of biomedicine figured in these women’s narrated experiences engendered a collective commitment to make problematic ‘living with a label’. Loosely connected as mental health service recipients, the women I researched with are often positioned as ‘subject’ to an objective medical gaze. Disrupting dichotomies that these women are accustomed to in clinical settings, and destabilising notions of neutral and detached research, our investigations were contingent, reflexive and relational. Recognising that all were intrinsic to the knowledge production processes, this project was cast in the feminist ‘with’, rather than the ‘on’. Together we explored how women read and respond to a psychiatric diagnosis in their daily lives, to generate understandings that can be used by the women who joined this project. This included close consideration of social relations shaping the lived actualities these women described, and their agency in sustaining and unsettling these.Acknowledging these women’s capacity to have expertise not only as reporters, but as theorists too, experience and analysis were conflated in our explorations of ‘living with a label’. Congruent with feminist philosophy, our methodology had a praxis orientation as well, ‘to produce different knowledge and to produce knowledge differently’ as Patti Lather (2001) suggests. The attendant opportunities to research the process of researching and contemplate how we might participate in change-oriented activities were thus integral to this project. Our experience of researching together, and allowing the ‘researched’ room to know and act, produced possibilities, and also created conundrums, perhaps less frequently encountered in more conventional research – all of which gave rise to celebration!