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Dissertations / Theses on the topic 'Psychiatry'
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1
Hanrath, Sabine. "Zwischen "Euthanasie" und Psychiatriereform : Anstaltspsychiatrie in Westfalen und Brandenburg - ein deutsch-deutscher Vergleich (1945-1964) /." Paderborn : Schöningh, 2002. http://catalogue.bnf.fr/ark:/12148/cb389024447.
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Kattan, Wid. "Psychiatry residents' attitudes towards spirituality in psychiatry." Thesis, McGill University, 2012. http://digitool.Library.McGill.CA:80/R/?func=dbin-jump-full&object_id=110642.
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There is an increasing awareness of the importance of spirituality in mental health as reflected in the addition of the category "religious or spiritual problem" in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) and the inclusion of knowledge of spirituality amongst the training objectives for psychiatry residents outlined by the Royal College of Physicians and Surgeons of Canada. However, a survey of Canadian psychiatry residency programs indicated that minimal training was offered in this area (Grabovac & Ganesan, 2003). The present study explored psychiatry residents' attitudes regarding spirituality in psychiatry, and their interest in further learning on the topic. A total of 45 of 70 residents at one program completed the questionnaire. Most residents believed spirituality could have both positive (95%) and negative (80%) relationships to mental health. Although 91% felt it was appropriate to inquire about spirituality, only 72.7% endorsed actually addressing patients' spiritual problems. This discrepancy may be related to residents' varying opinions and comfort levels surrounding controversial issues. Although 84.4% reported feeling comfortable asking patients about spirituality, many had concerns about offending patients (48%) and about the ethical implications of such inquiry (55.6%). A majority of residents (61.8%) had not received any training in spirituality and medicine during medical school, and 80% said they would like to learn more on the subject. These results suggest that educational initiatives surrounding spirituality in psychiatry should be implemented.Il y a une hausse de l'importance accordé à la spiritualité dans le domaine de la santé mental. Ceci est reflété par l'addition de la catégorie « problème religieux ou spirituel » dans le Manuel diagnostique et statistique des troubles mentaux (DSM-IV-TR) et l'intégration de la connaissance de la spiritualité parmi les objectifs d'apprentissage pour les résidents psychiatriques décrit par Le Collège royal des médecins et chirurgiens du Canada. Par contre, une enquête faite au sein des Programmes de résidence psychiatrique canadienne indique qu'une formation minime était offerte dans ce domaine (Grabovac & Ganesan, 2003). L'étude qui suit examine l'attitude des résidents psychiatriques à propos de la spiritualité dans la psychiatrie et leurs intérêts à connaitre plus sur le sujet. Un totale de 45 de 70 résidents dans un programme ont complété le questionnaire. La plupart des résidents croyaient que la spiritualité pouvait avoir des effets positifs (95%) ainsi que négatifs (80%) sur la santé mentale. Malgré que 91% considèrent que se renseigner à propos de la spiritualité est approprié, seulement 72.7% endossent de s'occuper réellement les problèmes de spiritualité du patient. Cette contradiction peut être attribuée aux opinions variées et au confort qu'ont les résidents envers des sujets controversés. Bien que 84.4% disent être confortable à demander aux patients à propos de leur spiritualité, plusieurs craignaient offenser les patients (48%) et conséquences de ces questions (55.6%). Une majorité des résidents (61.8%) n'avaient pas reçu une formation en spiritualité et médicine pendant leurs études en médecine et 80% disaient qu'ils aimeraient apprendre plus sur le sujet. Ces résultats suggèrent que les initiatives éducatives autour de la spiritualité en psychiatrie devraient être mises en œuvre.
3
Harvey, Diane D. (Diane Dawn). "Longitudinal Evaluation of a Child/Adolescent Psychiatric Program." Thesis, University of North Texas, 1994. https://digital.library.unt.edu/ark:/67531/metadc277736/.
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Children and adolescent psychiatric inpatients (n = 25) versus staff (n = 35) milieu perceptions were measured with the Ward Atmosphere Scale (WAS) Form K (Kids). The perceptions were compared with previous data collected in 1981, 1982, and 1984 on the same unit. The 1993 staff and patients continued to perceive the unit as a therapeutic environment despite recent restrictions on length of stay due to health care reform. The views of the staff and patients were found to be divergent but less so than in previous years. Additionally, the more seriously ill a patient was determined to be, the more negatively he or she perceived the environment. Differences in perceptions between day shift versus night shift and administrative versus non-administrative staff were also found and discussed. Staff perceptions versus their ideal conceptions were also investigated and compared with those of the 1984 staff. The 1994 staff was found to more closely approximate their ideals than the 1984 staff.
4
Germann, Urs. "Psychiatrie und Strafjustiz : Entstehung, Praxis und Ausdifferenzierung der forensischen Psychiatrie in der deutschsprachigen Schweiz 1850-1950 /." Zürich : Chronos, 2004. http://bvbr.bib-bvb.de:8991/F?func=service&doc_library=BVB01&doc_number=012799908&line_number=0001&func_code=DB_RECORDS&service_type=MEDIA.
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Pillay, Nivendhiren. "Psychiatric consultation-liaison at Dr George Mukhari Hospital in Ga-Rankuwa between January- December 2009." Thesis, University of Limpopo (Medunsa Campus), 2010. http://hdl.handle.net/10386/461.
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Thesis (M Med (Psychiatry))--University of Limpopo (Medunsa Campus), 2010.The aim of the study was to establish a profile of psychiatric illnesses that are encountered during consultation-liaison (C-L) psychiatry and to describe interventions undertaken. The objective was to identify referral patterns, establish the referral rate, and to profile the diagnoses & describe the actions taken by the consulting doctor. This was a retrospective cross-sectional descriptive study conducted on all inpatients that were referred to psychiatry from other disciplines in the hospital for the 12 month period January to December 2009. The study was conducted at Dr George Mukhari Hospital, which is a tertiary psychiatric unit which caters for mental health care users in the Garankuwa , Soshanguve and Mabopane region. The study found that the referral rate to psychiatric C-L services was lower than at other institutions. Amongst the referred patients, there was a high incidence of organic brain syndrome diagnoses, but a low rate of depression. The study proposed further investigation into the reasons behind the low rate of referral and low rate of depression, so as to improve C-L service delivery in the hospital.
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Walden, Rachel R. "Evidence-Based Psychiatry." Digital Commons @ East Tennessee State University, 2015. https://dc.etsu.edu/etsu-works/8838.
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Grecu, Iulus. "The Eras of Psychiatry." The University of Arizona, 2018. http://hdl.handle.net/10150/626583.
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Smith, Kendal. "The History of Psychiatry." The University of Arizona, 2018. http://hdl.handle.net/10150/626599.
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Murdoch, Emma Louise Annabel. "Madness, psychiatry and anti-psychiatry in English and French women's writing and film." Thesis, University of Birmingham, 2017. http://etheses.bham.ac.uk//id/eprint/7676/.
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This thesis examines the theme of women’s madness in the 1960s and 1970s through the works of four English and French writers and film-makers: Chantal Akerman, Emma Santos, Jane Arden and Mary Barnes. It examines how these four writers and film-makers inscribe madness into their texts from a sociological angle, presenting the texts and films discussed as socio-historical artefacts while analysing each writer and film-maker’s representation of women’s madness. Inspired by psychologist Phyllis Chesler, who argues that madness is tied to socially defined gender roles and used to demarcate violations of expected gendered behaviour, this research analyses various manifestations of ‘madness’ from the everyday madness of Chantal Akerman, to psychiatrically incarcerated madness in the texts of Emma Santos, to madness influenced by anti-psychiatry through the works of Jane Arden, to complete immersion in anti-psychiatry with Mary Barnes. The interdisciplinary and cross-cultural nature of this thesis combines fields from both English and French studies, from the study of female writers and film-makers, psychoanalytic theory, the history of psychiatry and how they intersect with gender combined with contemporary feminist writings of philosophy, psychology, and theology.
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Al, Awam Khaled. "The study of biomarkers for psychiatric disorders and their potential application in clinical and forensic psychiatry." Thesis, Swansea University, 2013. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.678476.
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Henderson, Scott. "Studies in social psychiatry and epidemiology of mental disorders." Thesis, Canberra, ACT : The Australian National University, 1991. http://hdl.handle.net/1885/141557.
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Ramirez, Adriana. "Young Adults in General Psychiatry." Doctoral thesis, Uppsala universitet, Psykiatri, Akademiska sjukhuset, 2011. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-151504.
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Mental illness is common, and usually starts early in life. However, the majority of those affected never seek mental health care. The overall aim of this thesis was to increase knowledge about help-seeking young adults with mental illness in order to improve diagnostic procedures in clinical psychiatry. A group of young adult psychiatric out-patients (n=217) were consecutively invited to participate in the study between October 2002 and September 2003. Altogether 200 (92%) agreed to participate. Among them, there were 161 (80%) women and 39 (20%) men. Participants’ mean age was 22.4±1.9 years. All participants were carefully and comprehensively assessed with respect to axes I, II, IV and V in the DSM-IV. Psychiatric disorders and personality disorders were assessed using the Structured Clinical Interview for DSM-IV for axis I disorders and the Structured Clinical Interview for DSM-IV for axis II disorders. Psychosocial and environmental problems (axis IV) were evaluated through structured interviewing by a social worker and by self-assessment with a questionnaire. Professional and patient ratings on the Global Assessment of Functioning scale were compared before and after treatment. Patients also reported on the Swedish universities Scales of Personality, the Child and Adolescent Psychiatric Screening Inventory-Retrospect and the Coddington’s life event scale. Taken together, the young adult, psychiatric outpatients were characterized by an early onset of their mental disorders, by co-morbidity, by being female and by having mood or anxiety disorders. There were no significant differences between self-referred and those referred by medical professionals according to either number of current or lifetime diagnoses. Childhood onset of depression was associated with more severe symptoms, more psychosocial risk factors, and more childhood developmental delays. Axis IV psychosocial stress categories were related to the presence of axis I disorders, personality disorders, co-morbidity, and impaired functioning. Agreement between patients’ and professionals’ ratings on the GAF scale was good before treatment and excellent after treatment. In summary, the findings suggest that direct self-referral to specialized psychiatric care does not seem to be associated with overutilization of such care. Childhood onset of depression is associated with a more complex illness. The revised axis IV according to DSM-IV seems to have concurrent validity, but is still hampered by limited reliability. And finally, the results support the usefulness of the self-report GAF instrument for measuring outcome in psychiatric care.
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Abdelrahman, Mahmoud Abdelwahab. "Medicine, psychiatry and human rights." Thesis, Cardiff University, 1986. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.277686.
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Ihara, Hiroshi. "Dysexecutive syndrome in clinical psychiatry." Thesis, University of Cambridge, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.620993.
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Bazin, Yoann. "L’institutionnalisation des pratiques organisationnelles : le cas du diagnostic en psychiatrie." Thesis, Paris, CNAM, 2011. http://www.theses.fr/2011CNAM0779/document.
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Cette thèse étudie le phénomène d’institutionnalisation des pratiques organisationnelles avec pour terrain d’observation le diagnostic en psychiatrie. Fondamentalement attaché à l’organisation comme objet d’étude, nous chercherons à répondre à une question de recherche qui y est profondément ancrée : Quels sont les phénomènes organisationnels qui participent de l’institutionnalisation des pratiques au quotidien ? Notre travail aura alors pour ambition de se confronter à trois difficultés principales : théorique, épistémologique et empirique. Dans un premier temps, il s’agira de clarifier conceptuellement la notion de pratique organisationnelle. En effet, si le practice turn est maintenant déjà bien engagé en Sciences de gestion, nous sommes encore loin d’une théorie qui, sans être unifiée, aurait au moins posé une définition claire de son concept central. Nous proposerons une revue de littérature problématisée des travaux portant sur la pratique qui posera l’institutionnalisation comme leur acte de naissance. Cela débouchera sur une grille de lecture de ces manières de faire instituées que sont les pratiques. Dans un deuxième temps, il nous faudra nous confronter à une difficulté épistémologique. La pratique, objet d’étude classique en anthropologie comme en sociologie, est un élément de la vie sociale qu’il est complexe de saisir au travers des catégories théoriques classiques. Il faudra interroger plus encore la notion de pratique pour comprendre comment sortir de l’impasse épistémologique que constitue le projet de construction d’une théorie de la pratique. Nous verrons en quoi c’est une théorie de la logique pratique qui sera notre véritable projet, et plus particulièrement l’origine historique de cette pratique et sa transmission quotidienne. Dans un troisième temps, il s’agira d’aborder le terrain d’observation fort de toutes ces exigences. Au-delà des difficultés classiques de l’étude empirique, c’est la restitution d’une compréhension pratique fine, fruit de plusieurs mois d’immersion, qu’il faudra être capable de transmettre. Afin de laisser au terrain son foisonnement et de ne pas le réduire à un ensemble d’observations directement capturées dans un cadre théorique, nous ferons le choix d’une synthèse scénarisée qui condensera quatre semaines de la vie du service. C’est une solution stylistique qui nous permettra de rendre compte d’un terrain débordant toujours le prisme particulier qui est le nôtre : l’institutionnalisation des pratiques organisationnellesThis PhD thesis analyses the institutionalization of organizational practices with the psychiatric diagnostic as a field of study. Fundamentally attached to the organization as an empirical object, we will try to answer a research question deeply rooted in it: what are the organizational phenomenons involved in the daily institutionalization of practices? Our work will tackle three mains issues: theoretical, epistemological and empirical.In a first time, we will clarify the concept of organizational practice. If the practice turn is now well engaged in Organization Studies, scholars are still far from a theory that would have given a clear definition of its central concept. We will provide a review of the literature on practice that considers the process of institutionalization as its birth. This will lead to a grid analyzing the multiple institutionalized ways of doing that are practices.In a second time, we will address an epistemological issue. Practices, classical empirical objects in sociology and anthropology, are central elements of the social life that cannot be easily captured through classical theoretical categories. We will have to go further in the concept in order to get out of the epistemological dead-end that the elaboration of a theory of practice is. In fact, it is a theory of practical logic that will be our real project, and precisely, the historical origins of this practice and its daily transmission.In a third time, we will face our field study loaded with these requirements. Behind classical methodological difficulties, it is the restitution of a fine-grained practical understanding produced by several months of immersion that will be challenging. In order to respect the field’s abundance and to not reduce it to a series of observations seen through a theoretical lens, we choose to present a scenarized synthesis that will condense our six-months study into a four-weeks story of a psychiatric department in a teaching hospital. This stylistic solution will allow us to account for a field that always overwhelms our perspective: the institutionalization of organizational practices
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Favreau, Marie-Diane Lucie. "The pre-shrinking of psychiatry : sociological insights on the psychiatric consumer/survivor movement (1970-1992) /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC IP addresses, 1999. http://wwwlib.umi.com/cr/ucsd/fullcit?p9935449.
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Hiltunen, P. (Pirkko). "Yleissairaalapsykiatrinen konsultaatio Suomessa:yleissairaalapsykiatriseen konsultaatioon ohjautuvat työikäiset ja vanhukset." Doctoral thesis, University of Oulu, 1999. http://urn.fi/urn:isbn:951425466X.
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Abstract
General hospital psychiatry operates between the somatic and
psychiatric approaches concerning the treatment of patients, combining
knowledge from both somatic and psychiatric medicine. To establish
its position, the general hospital psychiatry has to specify its
role and means when rendering services.
This study revealed how consultation had been arranged in
six Finnish polyclinics of general hospitals. The goal was to find
out which types of patients were referred to the consultation of
the general hospital psychiatry and the extent of collaboration
of the consulting psychiatrist with colleagues from other medical
disciplines. Moreover, the focus of attention was on whether there were
operational differences between the polyclinics of the University
Hospital of Oulu and other hospitals. The work was also addressed
to probing operational differences, if any, pertaining to people under
or over 65. Additionally, one aspect to be clarified was how requests
for psychogeriatric consultations and the responses of the consulting
psychiatrists had developed during the five years period of the
study.
This study was part of a broad European Consultation Liaison
Working Group effort aimed at clarifying the organization of general
hospital psychiatry in 56 units in 11 European countries. The Finnish
material consisted of 1255 patients, of whom 202 were over 65. The
research methods applied here were psychiatric interviewing of clinical
patients, and filling in of data collection forms following the
instructions of the ECLW Group.
The current work revealed that the number of psychiatric consultations
was less than expected considering the incidence of psychiatric
symptoms among somatically ill patients. Of the general hospital
patients, elderly people were especially underrepresented. More
than 90% of the patients who had a psychiatric consultation
were diagnosed with a psychiatric problem. Thus the general hospital
made available psychiatric treatment via psychiatric consultation,
with a recommendation for future psychiatric care for more than
half of the patients. However, one third of the patients under 65 and
quarter of those above that age had already had on going psychiatric
treatment. In view of this type of situation the position of the
general hospital appears problematic. The object of consultation was
in 90% of the cases the patients themselves, but in Oulu,
almost half of the consultations were due to the personnel of the
somatic disciplines in charge of the of the patients. The action
mode in separate general hospitals was connected to established
traditions, although the history of general hospital psychiatry
is short and faces constraints put forward by the somatic hospitals.
Collaboration between psychiatric and somatic disciplines was facing
increasing difficulties during the five years observation period,
probably due to economic recession.
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White, Andrew William. "Frequent use of psychiatric emergency services : a multilevel approach /." View online ; access limited to URI, 2007. http://0-digitalcommons.uri.edu.helin.uri.edu/dissertations/AAI3277011.
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Fleckner, Uta. "Emanuel Mendel (1839 - 1907) : Leben und Werk eines Psychiaters im Deutschland der Jahrhundertwende /." Diss., [Berlin? : s.n.], 1994. http://bibpurl.oclc.org/web/31645.
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White, A. J. "The use of investigations in psychiatry." Thesis, University of Southampton, 1987. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.381269.
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Sin, Jessica M. 1975. "Essays in the philosophy of psychiatry." Thesis, Massachusetts Institute of Technology, 2007. http://hdl.handle.net/1721.1/41696.
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Thesis (Ph. D.)--Massachusetts Institute of Technology, Dept. of Linguistics and Philosophy, 2007.Includes bibliographical references (p. 83-88).
This dissertation consists of three chapters in which I address metaphysical and epistemological issues that arise in psychiatry, with particular attention paid to anti-psychiatric concerns. In Chapter 1, I consider three versions of anti-realism about psychiatric illness. I argue that Szasz's version of anti-realism should be rejected because it rests on a misunderstanding of illnesses more generally. Although I do not offer any clear refutations of labeling theory or cultural relativism, I point out the serious disadvantages of holding either view. I argue that in the absence of compelling reasons to endorse either labeling theory or cultural relativism, we are within our rights to remain realists about psychiatric illness. In Chapter 2, I address an epistemological concern that the scientific legitimacy of psychiatric taxonomy is compromised by the role that value judgments play in the study of mental disorders. I claim that this worry presupposes a view of science according to which objective observation and theory construction would not even be possible. I argue that, on a revised understanding of science proposed by Helen Longino, a scientifically legitimate psychiatric taxonomy is within our reach. Finally, in Chapter 3, I turn to the metaphysical problem of providing an account of disorders. An important part of a realist view of mental disorders includes an account of disorders. I claim that in light of available evidence of the heterogeneity of disorders, it is unlikely that disorders share an essence, and I argue that previous attempts to provide a Lockean account of disorders fail for this reason. I propose instead that disorders are homeostatic property cluster kinds of the sort first described by Richard Boyd.
by Jessica Sin.
Ph.D.
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Polaha, Jodi. "Telebehavioral Health and Psychiatry: A Primer." Digital Commons @ East Tennessee State University, 2009. https://dc.etsu.edu/etsu-works/6697.
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Lorentzos, Michelle Sarah. "The Psychiatry of Paediatric Movement Disorders." Thesis, The University of Sydney, 2019. http://hdl.handle.net/2123/20602.
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I compared the rate of psychiatric comorbidity in children with Non-tic movement disorders to children with tics and TS. In addition, this PhD explores whether children with Non-tic movement disorders have elevated rates of psychiatry compared to other hospital populations, including Emergency patients and other Neurology patients, as well as a healthy community control group. My hypothesis was that children with Non-tic movement disorders would have rates of psychiatric comorbidities that are similar to children with tics and TS.To examine this hypothesis, I recruited children between the ages of 5 and 16 years from Neurology clinics at The Children’s Hospital at Westmead, Australia, and Great Ormond Street Hospital, United Kingdom, for the following two movement disorder groups: tic movement disorder cohort (consisting of patients with tics and Tourette Syndrome, n=158) and Non-tic movement disorder cohort, (consisting of patients with all other movement disorders, n=102). An additional 137 patients were recruited for two clinical control groups: the Emergency department control cohort (n=100) and the Neurology control cohort including children with peripheral neuropathy or epilepsy (n=37). In addition, data from 10,438 British children were included as a retrospective community control. All patients were screened for psychiatric comorbidities using the Development and Wellbeing Assessment Tool (DAWBA). My primary outcome was that the difference in the rate of psychiatric comorbidity in the Non-tic cohort (39.2%) and the Tic cohort (41.8%) was not statically significant. Importantly, the rate of psychiatric comorbidity in the Non-tic cohort was more than four times the rate of psychiatric diagnosis observed in the large retrospective community cohort (9.5%) (p<0.00001). This is the largest study to date exploring psychiatry in children with paediatric dystonia (n=66) and psychiatric comorbidities occurred in 33.3% of these patients. In conclusion, this study recognises that children with non-tic movement disorders are just as vulnerable to psychiatric comorbidities as children with tics and TS. This new evidence may encourage clinicians to consider screening for psychiatric comorbidities in their movement disorder patients, therefore allowing for earlier diagnosis and treatment.
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Lin, Jennifer. "Towards A New Paradigm in Psychiatry." ScholarWorks@UNO, 2019. https://scholarworks.uno.edu/honors_theses/132.
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The reductionist tenets of the biomedical model of mental illness generate research methods and clinical practices that neglect significant cultural elements of mental illness. The biomedical model is reductionist because it assumes a view of the mind that lends itself to biological reductionism. Developing a more holistic model of mental illness requires replacing the accepted view of mind with a new one. In this paper, research demonstrating the significance of culture to mental illness will be reviewed in order to illuminate the flaws of the biomedical model. The extended mind theory will be analyzed and discussed as a potential basis for the development of a new paradigm within psychiatry, one which transcends the reductionist tendencies of the biomedical model.
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Richter, Elisabeth. "Johann Christian August Heinroth (1773-1843) als forensischer Psychiater." Doctoral thesis, Universitätsbibliothek Leipzig, 2012. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-89207.
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Die vorliegende Publikationspromotion setzt sich mit dem forensisch-psychiatrischen Werk und Schaffen des ersten abendländischen Lehrstuhlinhabers für Psychiatrie und Begründers der Leipziger Universitätspsychiatrie Johann Christian August Heinroth (1773-1843) zu Beginn des 19. Jahrhunderts auseinander. Die Schwerpunkte dabei sind dessen eigene Gutachtertätigkeit und sein Konzept der Zurechnungsfähigkeit.
Anhand ausgewählter Schriften wurde eine textnahe Lektüre durchgeführt, um Heinroth losgelöst von Kontexten und Kategorien direkt verstehen zu können.
Es ließ sich rekonstruieren, dass Heinroth durch philosophisches Denken und ganzheitliche Problemlösungsstrategien nicht nur der in seiner Zeit verbreiteten Exkulpationsneigung und der Instrumentalisierung psychischer Erkrankungen entschieden entgegen tritt, sondern auch, wenngleich er dieselben nicht überwindet, dennoch konstruktive Lösungsansätze für forensisch-psychiatrische Debatten findet und damit eine Bereicherung auch für aktuelle neurowissenschaftliche Diskussionen darstellt.
Durch die Tiefendarstellung eines Zeitgenossen wird so ein Beitrag zur Vervollständigung der Geschichte der Forensischen Psychiatrie geleistet.
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Gilbody, Simon Martin. "Outcomes measurement in psychiatry : a critical review of patient based outcomes measurement in psychiatric research and practice." Thesis, University of York, 2001. http://etheses.whiterose.ac.uk/9753/.
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Navarro, Trujillo Rodrigo. "Association of inflammation markers in young adult patients with Obsessive-compulsive disorder." Thesis, Uppsala universitet, Institutionen för medicinsk biokemi och mikrobiologi, 2018. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-355094.
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Background: Previous studies have shown that patients with obsessive-compulsive disorder (OCD) have elevated interleukin and chemokine levels in plasma. The purpose of this study was to investigate and validate whether a group of cytokines and chemokines are elevated in a cohort of young adult OCD patients. Methods: A total of 43 patients (11 male/32 female) and 45 controls (15 male/30 female) with OCD were included in the study. The subjects were assessed with the Structured Clinical Interview for DSM-IV Axis I Disorders- Clinical Version or Mini-International Neuropsychiatric Interview. The control group was screened with the Alcohol Use Disorders Identification Test. Proximity extension assay (PEA) was used to measure plasma levels of IL-6, IL-8, MIP-1α, and IL-10. Results: A factor analysis for the cytokines was performed and logistic regression analysis revealed that the cytokines as a group have a significant association for OCD (P=0.031, OR: 2.2) and IL-8 was the cytokine with the highest significance (P=0.007) for the patient group. Conclusion: These findings suggest that this group of cytokines are associated with OCD diagnosis and strengthens previous findings of immune activity in the etiology of OCD. Therefore cytokines and chemokines could have an active role in the etiology of OCD and PEA could be useful in the search for biomarkers.
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Kelly, Brendan D. "Custody, care and criminality : clinical aspects of forensic psychiatric institutionalisation in late nineteenth- and early twentieth-century Ireland." Thesis, University of Northampton, 2011. http://nectar.northampton.ac.uk/8866/.
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Valeková, Ivana. "Psychiatrická léčebna Újlak." Master's thesis, Vysoké učení technické v Brně. Fakulta architektury, 2014. http://www.nusl.cz/ntk/nusl-216100.
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The aim was to design a new conception for both new building of psychiatric hospital and psychiatric cure on the other hand. Site is based in Velke Zaluzie, villacee in the southwestern Slovakia. Placed in site of historically protected park with a dominant building of the Old Esterhazy Mansion uses principles from moder psychiatry and space modularity to ideal inter-building connections. With high sustainability aspect a new organisation of the site was created on the whole area of the park with new functions for existing buildinge and less dominant based structure od psychiatric hospital.
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Iliopoulos, J. G. "Foucault's critical psychiatry and the spirit of the Enlightenment : a historico-philosophical study of psychiatry and its limits." Thesis, University College London (University of London), 2013. http://discovery.ucl.ac.uk/1381747/.
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My thesis revolves around three axes: the Foucauldian critical-historical method, its relationship with enlightenment critique and the way this critique is implemented in Foucault’s seminal work, History of Madness. Foucault’s exploration of the origins of psychiatry applies his own theories of power, truth and reason and draws on Kant’s philosophy, shedding new light on the way we perceive the birth and development of psychiatric practice. Following Foucault’s adoption of ‘limit attitude’, which investigates the limits of our thinking as points of disruption and renewal of established frames of reference, the thesis aims to dispel the widely accepted belief that psychiatry represents the triumph of rationalism by somehow conquering madness and turning it into an object of neutral, scientific perception. A history of limits examines the birth of psychiatry in its full complexity: in the late eighteenth century, doctors were not simply rationalists but also alienists, philosophers of finitude who recognized madness as an experience at the limits of reason, introducing a discourse which conditioned the formation of psychiatry as a type of medical activity. Since that event, the same type of recognition, the same anthropological confrontation with madness has persisted beneath the calm development of psychiatric rationality, undermining the supposed linearity, absolute authority and steady progress of psychiatric positivism. Foucault’s critique foregrounds this anthropological problematic as indispensable for psychiatry, encouraging psychiatrists to become aware of the epistemological limitations of their practice, and also to review the ethical and political issues which madness introduces into the apparent neutrality of current psychiatric discourse.
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Sexton, Claire Elizabeth. "In vivo brain changes in late-life depression." Thesis, University of Oxford, 2011. http://ora.ox.ac.uk/objects/uuid:5d943d86-ec8b-4dd5-be4a-3ec2ab084bc3.
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Late-life depression (LLD) is common illness, frequently associated with neuropsychological impairment. Disruption of frontal-subcortical and limbic networks may play a key role in LLD and can be examined using magnetic resonance imaging (MRI). Grey matter (GM) can be examined using T1-weighted MRI, white matter (WM) using diffusion tensor imaging (DTI), and functional connectivity using resting-state functional MRI (fMRI). To clarify the roles of GM, WM and functional connectivity in LLD, systematic reviews and meta-analyses of T1-weighted MRI, DTI and resting-state fMRI studies of depression were performed. The literature provided evidence for GM and WM abnormalities within frontal-subcortical and limbic networks, and increased functional connectivity within the default-mode network, in depression. To examine whether results gained from different techniques are complementary, multi-modal MRI was used to compare GM, WM and functional connectivity between thirty-six participants with LLD and twenty-five control participants. WM integrity was widely reduced in LLD, without significant group differences in GM or functional connectivity. To investigate whether neuropsychological deficits represent independent processes with specific neural correlates, or whether they can be explained by a core deficit, the relationships between neuropsychological and MRI measures were explored. Executive function and processing speed were found to represent core deficits that contribute to impairment in other domains; and impaired performance was correlated with reduced frontal WM integrity. Episodic memory deficits were dependent on executive function and processing speed; and associated with reduced frontal and hippocampal WM integrity. The relationships between age at onset, severity and MRI measures of GM, WM and functional connectivity were also investigated. Later onset was associated with reduced WM integrity, in line with the vascular hypothesis. Earlier onset was associated with greater duration of illness and reduced hippocampal volume, consistent with the glucocorticoid cascade hypothesis. Severity was not associated with any MRI measure. This thesis strongly supports the hypothesis that WM abnormalities in frontal-subcortical and limbic networks play a key role in LLD, with abnormalities related to neuropsychological impairment and compatible with the vascular hypothesis.
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Andersson, Liselotte, and Päivi Jakum. "Inte som i Gökboet : sjuksköterskors beskrivningar av omvårdnadsprocessen inom den rättspsykiatriska vården : en kvalitativ studie." Thesis, University West, Department of Nursing, Health and Culture, 2009. http://urn.kb.se/resolve?urn=urn:nbn:se:hv:diva-1564.
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Forensic psyhiatric care protects the society by giving patients care to diminish risks of serious crimes. In their work the nurses use different care methods to help and support the patient in managing his or her life situation. To clarify how a group of nurses describe the nursing process in forensic psychiatric care. A qualitative study based on interviews. Six nurses were interviewed about their work in four different forensic psychiatric care units. The nursing process in is divided into four categories: evaluation, planning, implementation and assessment. The results are based on the way the interviewed nurses described the essential roles of nurse-patient relationship and structured routines in nursing process. The study also shows some specific difficulties in nursing work, for example the mental dysfunctions of patients, the level of competence among staff and the patients need for social interaction and existence beyond their specific needs.
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Steinmetz, Marie Rosa Hilde. "Eine Werkbiografie über Christa Kohler (1928-2004): Psychotherapeutische und sozialpsychiatrische Forschung und Praxis in der DDR." Doctoral thesis, Universitätsbibliothek Leipzig, 2014. http://nbn-resolving.de/urn:nbn:de:bsz:15-qucosa-153425.
Full textAbstract:
Die vorliegende Arbeit befasst sich mit dem wissenschaftlichen Werk der DDR Psychiaterin Christa Kohler (1928 – 2004). Fokussiert werden dabei ihre Habilitationsschrift zu sozialpsychiatrischen Problemen bei Neurosen und Psychosen in der zweiten Lebenshälfte sowie ihr selbstständig erarbeitetes Konzept der „Kommunikativen Psychotherapie“. Die Forschungsarbeit Kohlers wird unter Berücksichtigung von themenrelevanter Literatur, Interviews mit Zeitzeugen und Archivmaterialien analysiert und bewertet. Dabei wird auch die Person Kohlers beleuchtet und ihre Arbeit in den wissenschaftshistorischen Kontext eingeordnet.
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De, Nadai Alessandro S. "Psychosocial Mechanisms of Outcome in Pediatric Psychiatry." Scholar Commons, 2017. http://scholarcommons.usf.edu/etd/6826.
Full textAbstract:
Nearly half of all youths experience a mental health disorder at some point during childhood (Merikangas et al., 2010). Pediatric psychopathology is associated with a substantial amount of impairment in the school, social, and home domains, and such symptoms can have adverse impacts on subsequent development (Beauchaine & Hinshaw, 2013; Patel, Flisher, Hetrick, & McGorry, 2007). Fortunately, a number of medications have demonstrated efficacy in treating a number of mental health conditions (Martin, Scahill, & Kratochvil, 2010). Despite these demonstrated effects, treatment response is often incomplete, and the mechanisms by which pharmacotherapy lead to behavior change are not well understood. However, research in pediatric psychopharmacology has often not considered the role of psychosocial variables, despite their promise to explain much variance in psychiatric outcomes and the robust influence they have demonstrated in psychotherapy-based behavior change (e.g., Shirk & Karver, 2011). This study investigated the role of four psychosocial variables in treatment outcome in pediatric psychiatric practice: medication adherence, therapeutic alliance, motivation for behavior change, and expectancies for positive treatment outcome. Surprising patterns of effects were found, with psychosocial variables being associated with both decreases and increases in symptomology depending on the circumstance (e.g., externalizing behavior), and many inconsistencies were observed among these patterns. While psychosocial variables are often portrayed as having uniformly positive impacts on treatment, their role in pediatric psychiatry may not be as straightforward as is commonly depicted in other diseases and therapeutic approaches. In particular, the nature of their effects on outcome may vary across symptom presentations and intervention approaches. Based on these findings, recommendations for clinical practice and future research are discussed which affect all patients, researchers, and medical providers who participate in pediatric psychiatric treatment.
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Slade, Tim Psychiatry Faculty of Medicine UNSW. "Using epidemiology to inform classification in psychiatry." Awarded by:University of New South Wales. Psychiatry, 2002. http://handle.unsw.edu.au/1959.4/19059.
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Classification systems in psychiatry are a work in progress. Therefore, continued efforts to improve their validity are necessary. Epidemiology provides a scientific method to assess the extent of psychiatric morbidity in community populations. However, data from epidemiological surveys have also contributed, either directly or indirectly, to many changes in the classification systems. Recent reviews of the current state of psychiatric classification indicate four unresolved issues: 1) the presence of two differing classification systems, 2) the role of the clinical significance criterion in differentiating psychopathology from normality, 3) the relationship of the exclusion criteria to the co-occurrence of psychiatric disorder pairs, and 4) the relative validity of categorical versus dimensional conceptualizations of psychiatric disorders. The current thesis examines these four unresolved issues, using data from a large-scale epidemiological survey of psychiatric disorders. With regard to GAD, differences in diagnostic criteria between DSM-IV and ICD-10 resulted in different types of cases identified, despite similarities in prevalence. The DSM-IV diagnostic criterion for clinical significance impacted, albeit to different degrees, on the prevalence, health service use and impairment of five disorders. The exclusion criteria in both DSM-IV and ICD-10 were significantly related to the patterns of co-occurrence found in the data. Using the example of depression, symptoms were more consistent with a dimensional rather than a categorical structure. A specific research agenda is proposed, the aim of which is to provide possible avenues of research that may benefit revisions to classification systems and the conduct of epidemiological surveys. This research agenda contains a number of suggestions. Future revisions will benefit from an explicit understanding of the differences between the classification systems. Better definitions of the concepts of clinical significance and psychiatric disorder are required. The co-occurrence of disorder pairs in epidemiological data informs understanding of the exclusion criteria, but the validity of these criteria relies on different data. Dimensional models of classification may yield more information than categorical models, and methods for incorporating them in large-scale surveys are proposed. It is concluded that epidemiological data should continue to play a significant part in the refinement of psychiatric classification.
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Williams, Jenny, and n/a. "Ethics in acute psychiatry : a case study." University of Canberra. Professional & Community Education, 1996. http://erl.canberra.edu.au./public/adt-AUC20061110.143655.
Full textAbstract:
This workplace study examined the every day ethical dilemmas of a multidisciplinary
team in one acute psychiatric setting and the social factors affecting their moral domain
of practice. The research design was a case study involving both qualitative and
quantitative data. The context that shaped the team's process of ethical dilemma
identification was conceptualised for the purpose of this research within a systems
theory framework of interrelated factors at a societal, organisational and clinical level
with ethics theory pervading the entire scene.
The findings indicated that dilemmas arose in situations concerning patient care, team
strain, and limited resources with the most common dilemma across disciplines arising
from lack of community resources. Further findings suggested that clinicians were
aware of various forces shaping practice but these ideas were not well connected
conceptually.
Staff felt wary of identifying ethical dilemmas because they were unsure of the process
and sensed a reticence in the unit's social processes around negotiation and problem
solving. Important social factors that were perceived to affect their abilities around
ethical dilemma identification included rational economics, professional socialisation,
medical-legal monopoly with a concomitant use of the ethic of justice, and managerial
strategies. The concept of transference and countertransference issues within the
staffing group was explored.
These results are useful for the team to understand the nature of their own particular
dilemmas and what factors constrain and enhance their abilities to identify dilemmas.
Other health care settings may find that replication of the research results in a similar
way may raise awareness of their moral situation. Generalisability at a theoretical level
contributes to the current research agenda in applied ethics about the effect of context in
the ethical domain of clinical practice.
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Halpin, Michael. "Huntington disease : death, psychiatry and health services." Thesis, University of British Columbia, 2009. http://hdl.handle.net/2429/22490.
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Huntington Disease (HD) is a genetic, degenerative neurological illness that affects mood, cognition and motor movement. Complications from the disease result in death 10 to 15 years post-diagnosis. However, individuals may be aware that they have HD years before the development of the most severe effects. Drawing on in-depth, qualitative interviews with 20 individuals with HD and 10 informal caregivers, this thesis explores the salient experiences that occur outside of predictive genetic testing. Findings emerged in four areas; namely, attitudes towards death and suicide, experiences with psychiatry, interactions with health services and bureaucracies, and the needs and experiences of caregivers. Participant accounts also form the basis for a number of health services recommendations, including trajectory-specific support groups and the need for disability benefits that are sensitive to the realities of HD. The thesis also explores the numerous ambiguities that HD creates for conceptual categories, specifically in
relation to diagnosis, death and illness experience.
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Homberger, Margaret Alissa. "Wrongful confinement and Victorian psychiatry, 1840-1880." Thesis, Queen Mary, University of London, 2001. http://qmro.qmul.ac.uk/xmlui/handle/123456789/28851.
Full textAbstract:
Victorian society witnessed a transformation in the understanding and treatment of psychological disorders. The expansion of nosologies or classifications of lunacy was one measure hailed by psychological physicians as indicative of their mastery over madness. Yet between the 1840s and the 1870s the introduction of moral insanity and monomania to established classificatory systems undercut the medical authority of physicians and challenged their desired cultural stature as benevolent and authoritative agents of cure. Far from consolidating medical authority, these `partial' forms of lunacy (which were detected in the emotions rather than the intellect) paradoxically heightened anxiety about the ease with which eccentric or sane individuals could be wrongfully incarcerated in lunatic asylums. This dissertation examines the themes, motifs and defining issues of wrongful incarceration as they were discussed in Parliament, national and regional newspapers, medical and literary journals, and novels and short stories. Discussing in detail several infamous `cases' of wrongful confinement, it traces the ways in which anxieties were formulated, expressed and negotiated. The public outcry over cultural representations of wrongful confinement generated heated reactions from physicians and lunacy law reformers. The most contentious discussions centred on the manner in which notions of humanity and benevolence, and tyranny and liberty, were marshalled to influence public opinion. These debates represented not solely a legal conflict centring the claim to treatment and authority over the alleged lunatic, but more dramatically a battle for the public's good opinion. As important as medico-legal trials and their consequent rulings was the contested appropriateness of sentiment; this was manifested in words and images utilised to exacerbate or contain anxiety. The wrongful confinement controversy constitutes an important (though largely overlooked) episode in the history of English nineteenth-century psychiatry; formatively altering perceptions of the profession of mental science in the Victorian period.
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Rackett, Tim. "Transcultural psychiatry and the truth of racism." Thesis, Birkbeck (University of London), 1995. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.318650.
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This thesis examines contemporary British transcultural psychiatry and the consequences of its practices for multi-cultural populations in metropolitan situations. It uses a combined methodology of conceptuaL textual analyses and participant observation, to explore how transcultural psychiatry constructs relationships between culture and mental disorders. In particular it examines the complexity of defining normality and pathology in this area. The intellectual origins of transcultural psychiatry in the context of colonial medical practice are explored with two aims in mind. First to show historically how the present-day theories and practices of transcultural psychiatry came into being. Second, to present an alternative picture to that painted of transcultural psychiatry by its critics. The critics see it as a racist ideology and form of domination that is forced to repeat colonial oppression in post-colonial situations. A series of case studies of key colonial psychiatrists, Laubscher, Corothers and Octave MannonL is presented to explore the logics and models of transcultural psychiatry. This exploration shows how the status and nature of transcultural psychiatry is far more intricate and ambiguous than its critics moral and political understanding can allow. This is underscored by a detailed examination of the thought of the first anti-racist revolutionary cultural psychiatrist Frantz Fanon. The role of Fanon's ideas in shaping contemporary transcultural psychiatry is explored. Ironically, Fanon's models inspire both the anti-racist ethics of transcultural psychiatry and those who are radically opposed to any psychiatric intervention. Fieldwork observations of transcultural clinicalpractice and its alternatives point to the complexity of the ways in which ethicaL political and intellectual models are used when psychiatrists attempt to tell the truth about racism and madness in society and cure the suffering of ethnic patients
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Mills, China. "Globalising disorders : encounters with psychiatry in India." Thesis, Manchester Metropolitan University, 2012. http://e-space.mmu.ac.uk/314032/.
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Amid calls from the World Health Organization (WHO) and Global Mental Health to ‘scale up’ psychiatric treatments, globally, there are other calls (sometimes from those who have received those treatments), to abolish psychiatric diagnostic systems and to acknowledge the harm caused by some medications. This thesis elaborates a space for these arguments to encounter and to be encountered by each other. This is a thesis about encounters; about psychiatry’s encounters with the global South; about research encounters in India with mental health Non-Governmental Organisations (NGOs); and about colonial encounters more generally. Drawing on analysis of interviews and visits to a range of mental health support provision in India, this thesis traces some conceptual and material mechanisms by which psychiatry travels - across borders - into increasing domains of everyday experience, and across geographical borders, into low and middle-income countries. It explores the claims of Global Mental Health, ‘to make mental health for all a reality’, as being particular mechanisms of psychiatrization - ones that may employ similar codifications to those of colonial discourse. Global Mental Health and WHO mental health policy often mobilise psychiatric interventions in response to a ‘crisis’ or an ‘emergency’ in mental health, globally. Yet while this current incitement suggests an abnormal deviation from a normal order, mental illness may also be read as a ‘normal’ reaction to the (dis)order of globalisation. Nevertheless, in making the claim that mental health problems, such as Depression, are a ‘normal’ response to inequitable market relations in the global South, may also be normative, as it glosses over a simultaneous globalisation; that of bio-psychiatric explanations of distress. Thus, while Global Mental Health marks an explicit making political of psychiatry through its conceptualisation of mental health as key to an agenda of international development, it simultaneously disavows psychiatry as political through its universal application of psychiatric technologies. To claim the universality of psychiatric diagnoses is different from making the claim that distress, manifest in myriad forms, is universal. This is because psychiatric frameworks are mediators of that distress, they provide but one way of understanding yet they are often framed as being the ‘truth’, globally. 4 Reading Global Mental Health psychopolitically, then, enables an engagement with the double process through which conditions of inequality and alienation may become internalised –how inequality may come to play on the body, to be made flesh. This move occurs alongside another process that reads the mechanisms by which socio-economic crisis comes to be rearticulated and reconfigured as individual crisis, as mental illness. To read Global Mental Health as a colonial discourse is to trace how particular knowledge is mobilised in the creation of a space for psychiatric ‘subject peoples’, a global space. This research traces some of these ‘on the ground’, often powerful, techniques of recruiting subjects and fixing them. It also interrogates the knowledge base of Global Mental Health to create a space to read this alongside alternative ways of knowing; specifically psychiatric user/survivor and critical psychiatry critiques. This works to explore how psychiatry encounters difference (both within the global North and South), and to (re)think how Global Mental Health might be encountered differently. This thesis thus explores how the colonial relation is mobilised within psychiatric treatment in order to think through how the violence of colonialism may enable a re-thinking of contemporary forms of psychiatric treatment as being violent, the violence of psychiatrization - violence in the name of ‘treatment’. Using the post-colonial theory of Frantz Fanon, Ashis Nandy and Homi Bhabha, as conceptual tools, alongside research encounters (interviews, ethnographic field work, policy documents) in India, enables exploration of how psychiatrization may allow relationships of domination and resistance to continue after formal colonialism has ended. It also enables engagement with how strategies of resistance to colonialism may be read alongside and used to illuminate resistance to psychiatry – resistance that may be secret, sly, covered up. This research concludes by attending to emerging counter-hegemonic ways of knowing distress, epistemologies of the South, in order to creatively re-think the work of Global Mental Health and psychiatry in countries of the global South. To imagine a global mental health that attends to the heterogeneity and complexity of local, indigenous ways of knowing distress, that rethinks issues of consent – specifically around the use of psychiatric terminology and the provision of non-medical (and non-‘western’) spaces 5 of healing, and that recognises psychiatry as one of many approaches, questioning whether it can, or should, be global.
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Swartz, Leslie. "Aspects of culture in South African psychiatry." Doctoral thesis, University of Cape Town, 1989. http://hdl.handle.net/11427/15869.
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Bibliography: pages 351-389.A review of the South African psychiatric literature reveals that the concept of culture is commonly reified. It is also used by the South African state to legitimate apartheid. The concept of cultural relativism, though often associated with liberal views internationally, is linked with state policies in South Africa. Some South African social scientists, therefore, strongly question the notion of relativism. This reaction unfortunately does not engage with the social reality of the widespread perception of cultural differences, in psychiatric settings and elsewhere. Issues of race and culture in psychiatric practice were explored in a psychiatry department of a liberal South African university. Observation of ward-rounds in a psychiatric casualty (emergency) facility over six months revealed that, as elsewhere in the world, a major cultural factor influencing clinicians is the relationship between psychiatry and general medicine. A cultural understanding of South African psychiatry must take account of this relationship. Ward-rounds in a facility treating Black psychiatric patients were observed over fifteen months. Black and white clinicians in these rounds were often in conflict over constructions of the concept of culture. Some appeared deeply ambivalent about cultural relativism. Psychiatric registrars (residents) attached to the department under study participated in loosely structured interviews exploring issues of race and culture in their work. They also responded to vignettes dealing with white, coloured and Black patients. Registrars felt uncomfortable about the role of the concept of cultural difference in affecting the welfare of Black patients, and in maintaining discrimination. Their own socialisation as practitioners in an individualising and medicalising discipline seems a major factor contributing to their ongoing reproduction of this discrimination. The study reveals the importance of exploring the views and experiences of practitioners. South African work focussing on the need for fundamental change in mental health care has generally glossed over details of extant practice. This dissertation shows, however, that a major site for mobilisation for change in South African mental health-care must be the psychiatric institution itself.
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VITALI, ERIKA. "Precision medicine in psychiatry: pharmacogenetics of antidepressants." Doctoral thesis, Università degli studi di Brescia, 2023. https://hdl.handle.net/11379/570187.
Full textAbstract:
La depressione maggiore (DM) è una patologia altamente invalidante che colpisce circa 300 milioni di persone nel mondo. Nonostante siano state sviluppate numerose terapie farmacologiche per il trattamento della DM, ad oggi la percentuale di successo dei farmaci antidepressivi è piuttosto bassa. Infatti, solo il 30% dei pazienti risponde adeguatamente al primo trattamento antidepressivo, mentre una percentuale simile non risponde neppure dopo numerosi interventi farmacologici e sviluppa una depressione resistente ai trattamenti (TRD).
Negli ultimi anni, numerosi studi hanno esaminato il ruolo della genetica nella risposta agli antidepressivi e le potenzialità della possibile implementazione della farmacogenetica (PGx) nella pratica clinica, al fine di ottimizzare la risposta ai trattamenti farmacologici, sia in termini di sicurezza che di efficacia terapeutica. Tuttavia, i risultati ad oggi disponibili sono ancora contrastanti e ulteriori studi sono necessari per comprendere meglio il possibile impatto della PGx nel trattamento della DM.
Lo scopo primario di questa tesi – che comprende 5 studi principali – è quello di approfondire il ruolo della PGx nel trattamento della DM, attraverso un approccio sia clinico che molecolare, e comprendere meglio il contributo delle varianti geniche nei meccanismi causativi della TRD.
Nel primo studio è stato descritto lo sviluppo di un test di PGx che fornisce informazioni potenzialmente utili al fine di indirizzare verso il miglior trattamento antidepressivo per ogni paziente, sulla base del background genetico individuale. Infatti, combinando linee guida e specifiche informazioni di PGx (sia di farmacocinetica che farmacodinamica) presenti in letteratura, è stato sviluppato un algoritmo che, in base al profilo genetico del paziente, classifica gli antidepressivi prescrivibili in tre categorie: “da utilizzare come prima scelta”, “da utilizzare con attenzione” e “da utilizzare con estrema attenzione”. L’utilità clinica del test nel predire correttamente la risposta agli antidepressivi è stata successivamente valutata in un secondo studio qui descritto, che ha evidenziato la capacità dell’algoritmo nell’identificare correttamente i trattamenti antidepressivi che hanno maggiore probabilità di fallire in uno specifico paziente.
Nel terzo e nel quarto studio sono state effettuate valutazioni preliminari sul ruolo di geni candidati, noti per il loro coinvolgimento nella PGx degli antidepressivi, nello sviluppo della TRD. In particolare, il terzo studio si è focalizzato su geni con un ruolo ben noto nella PGx degli antidepressivi, ovvero alcuni membri della famiglia dei citocromi P450 e il trasportatore della serotonina SLC6A4. Questa analisi ha rivelato una maggiore probabilità di sviluppare resistenza agli antidepressivi tra gli individui caratterizzati da un metabolismo “ultrarapido” del citocromo CYP2C19. Sempre al fine di caratterizzare i meccanismi genetici alla base della TRD, il quarto studio si è focalizzato su ulteriori varianti geniche precedentemente associate alla risposta agli antidepressivi presenti nel database PharmGKB, rivelando un’associazione significativa tra quattro polimorfismi a singolo nucleotide nei geni HTR2A, GNB3, PAPLN e la TRD.
L’ultimo studio riportato in questa tesi aveva come scopo la valutazione di possibili alterazioni della lunghezza dei telomeri dei leucociti nei pazienti con TRD (affetti da DM o da disturbo bipolare). I risultati ottenuti hanno rivelato un accorciamento dei telomeri in presenza di TRD, in confronto ad individui di controllo, non affetti da patologie psichiatriche.
In conclusione, i risultati ottenuti da questo lavoro supportano l’implementazione della PGx nel trattamento della DM ed evidenziano la necessità di ulteriori studi per comprendere i meccanismi alla base dello sviluppo della TRD, in un’ottica di un’applicazione della medicina di precisione in psichiatria.Major Depressive Disorder (MDD) is a severe and debilitating disease affecting approximately 300 million people worldwide. Although several efforts have been made to develop pharmacological therapies for MDD, the success rate of treatments performed with currently available antidepressants (ADs) is low. Specifically, adequate response to the first AD treatment is observed in approximately 30% of patients, and a similar proportion do not achieve remission even after several pharmacological interventions and are defined as affected by Treatment Resistant Depression (TRD). In the last years, novel pharmacogenetic (PGx) approaches have been developed with, at least in part, contrasting results concerning their efficacy, highlighting the need for further investigations to fully elucidate their contribution in driving treatment choice in MDD. In this context, the main purpose of this work – comprised of 5 main analyses – is to provide additional insights into the potential role of PGx in MDD treatment, using both clinical and molecular approaches, and to elucidate the genetics underpinnings of TRD. The first analysis focuses on the development of a non-commercial PGx test able to address clinical decision-making toward the best AD treatment for each patient depending on specific genetic information. Relying on customized PGx guidelines and taking into account the patient’s genetic background (pharmacokinetics- and pharmacodynamics-related genes), our PGx algorithm classified the most widely used ADs in Italy in three categories: “use as first choice”, “use with caution”, and “use with extreme caution”. The clinical usefulness of our PGx algorithm in predicting response to AD treatment has been evaluated in the second analysis described here, which confirmed the ability of the PGx test in correctly identifying ADs that have a higher likelihood of treatment failure in a specific patient. The third and fourth analyses aimed to carry out a preliminary evaluation regarding the role of pre-selected candidate genes, previously associated with AD response, in TRD. In particular, the former focused on variants with a known role in PGx of ADs, such as members of the cytochrome P450 family and the serotonin transporter coding gene SLC6A4, revealing a significant association between the CYP2C19 ultrarapid metabolizer phenotype and TRD. The latter of these studies followed a similar approach and focused on genetic variants with a low level of evidence of association with AD response in the PharmGKB database, revealing a significant association between TRD and four single nucleotide polymorphisms in HTR2A, GNB3, and PAPLN. The fifth analysis reported here aimed at assessing leukocyte telomere length (LTL) in treatment-resistant patients diagnosed with MDD or bipolar disorder. Results revealed a generally shorter LTL in these patients compared with non-psychiatric controls. In conclusion, results obtained in this PhD thesis work further confirm the usefulness of PGx in MDD treatment and highlight the need for additional efforts aimed at a better understanding of the genetic background underlying TRD and at translating research findings into treatment optimization and drug resistance prevention strategies in the clinical practice.
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Kapila, Shruti. "The making of colonial psychiatry Bombay presidency, 1849-1940 /." Thesis, Online version, 2002. http://ethos.bl.uk/OrderDetails.do?did=1&uin=uk.bl.ethos.269728.
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Charet, Raymond Matthew. "A Civilisation Without Insanity? Psychiatry, Dianetics and the Birth of Scientology." Thesis, The University of Sydney, 2015. http://hdl.handle.net/2123/14892.
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With his development of Dianetics, Scientology founder L. Ron Hubbard was presenting the first criticism of the profession of psychiatry as a whole, in many ways pre-empting by a decade the later emergence in the 1960s of what has come to be referred to as the anti-psychiatric movement. Previous critics had either sought to bring about reform of the profession or objected to specific practices. Rather than adopting this approach, Hubbard drew inspiration from these separate criticisms and brought them all together within a single work. Hubbard’s 1950 book Dianetics: The Modern Science of Mental Health, presented a summary of the full range of criticism that had been levelled at American psychiatric practice over the preceding half century. This study locates the emergence of Dianetics and Scientology against a backdrop of professional and popular criticism of psychiatry. It also explores how American society contributed in significant ways to the fundamental ideas behind Dianetics, how Hubbard sought to validate his new ‘science of the mind’ in both professional practice and popular culture, and how this validation was rejected professionally but nevertheless found an accommodating niche with the American public. Exploring how and why this was the case form the core of this study. After establishing the methodological framework within which this exploration takes place, the opening chapter presents a summary of modern Scientology’s criticisms of psychiatry approximately sixty years after the tradition was founded. The discussion then turns to a broad survey of the state of American psychiatric practice in the decades immediately preceding Hubbard’s writing, presenting a picture of a profession undergoing both external challenges and internal shifts in emphasis, with the rise of psychotherapy and psychoanalysis as talk-based alternatives to physical treatment. Following this, the work moves to an examination of the popular alternatives to traditional psychiatric practice such as New Thought and self-help, as well as locating the emergence of these alternatives from previous psychiatric explorations. From here, attention shifts to a discussion of Hubbard’s life and the development of his ideas, primarily using official Scientology sources for the insights they provide into the arguably hagiographical elements of religious biography in seeking to establish his assertion of superior authority. The process by which Hubbard claimed to develop his ideas and the foundation of the early organisation which supported their dissemination are also examined. The contents of Dianetics: The Modern Science of Mental Health are then presented and analysed, and finally, the study presents a discussion of the reception afforded Dianetics on its publication in May 1950. This study demonstrates that Hubbard’s ideas emerged in part from a culture of criticism of psychiatry in a fluid professional landscape. In his criticism, however, Hubbard was at pains to present his own alternative as a more effective, more scientific, and ultimately more ‘workable’ alternative to previous forms of mental health treatment. That some found his promises of ubbard’s ideas emerged from as culturegreater functionality to be fulfilled in their exploration of Dianetics is demonstrated by the survival of its ideas in the modern practice of Scientology over sixty years later. Likewise, the marginalisation of Dianetics and Scientology throughout their history suggests that Hubbard’s ideas failed to find a wide constituency, or, alternately, confirms Hubbard’s hypothesis that the mainstream mental health professions have conspired to suppress what he held to be the most effective form of mental health treatment ever discovered.
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Foged, Christian. "Development of radioligands for emission tomography imaging of dopamine D1 and benzodiazepine receptors /." Stockholm, 1997. http://diss.kib.ki.se/1997/91-628-2618-2/.
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Mokitimi, Stella. "Child and adolescent mental health services in the Western Cape of South Africa: policy evaluation, situational analysis, stakeholder perspectives, and implications for health policy implementation." Doctoral thesis, Faculty of Health Sciences, 2021. http://hdl.handle.net/11427/33866.
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In spite of the need for child and adolescent mental health (CAMH) services across the globe, very little has been done to develop and strengthen CAMH in low- and middle-income countries (LMIC). South Africa is an example of an LMIC where CAMH services have been very limited as a result of various potential factors, including the legacy of apartheid, stigma associated with mental health, and lack of priority of CAMH. In this thesis, we set out to generate an evidence-base about CAMH services in one South African province to inform service strengthening across the full healthcare system through policy development and implementation. We proposed that a comprehensive understanding of specific services requires a multilevel exploration of ‘hardware' (structural) and ‘software' (social) elements in the health systems that support these services. We started by reviewing the CAMH policy landscape with an analysis of the current state of policy development and implementation at national and provincial levels in all nine provinces of South Africa. Using the Walt and Gilson policy analysis triangle (1994), we examined the content, context, processes and actors involved in mental health or CAMH-specific policies. We then evaluated the hardware and software elements of CAMHS in the Western Cape Province by performing a situational analysis using the WHO-AIMS version 2.2 of 2005 (Brief version) adapted for the South African context and to CAMHS. We proceeded to seek the perspectives of stakeholders within the province – firstly a SWOT analysis with senior stakeholders, and secondly, qualitative analysis of the perspectives of grassroots service providers, and of parents/caregivers and adolescent service users. We collected information from these stakeholder groups through a stakeholder engagement workshop, focus group discussions and semi-structured individual interviews. Using the World Health Organization (WHO) (2007) and Gilson (2012) health systems frameworks, we reviewed both the hardware and the software elements of CAMH services and concluded with a synthesis of findings to provide a set of recommendations for policy development and service strengthening based on the evidence generated. In terms of service delivery, findings showed that child and adolescent mental health services (CAMHS) in the Western Cape were provided at all levels of care (primary, secondary and tertiary) and, at least at inpatient and outpatient level, based on catchment/geographical service areas. However, CAMHS were still limited and were provided under very resource-constrained conditions by inadequately trained service providers. In terms of the health workforce, CAMHS were provided by a range of professionals including child & adolescent psychiatrists, general psychiatrists, medical officers, clinical psychologists, social workers, mental health nurses, occupational therapists, and speech and language therapists. However, multidisciplinary expertise and psychosocial interventions were only available in specialist CAMHS at tertiary level of care. In addition, the specialist services were all based in the City of Cape Town, with no direct access to specialist CAMHS at secondary levels of care or in any of the rural districts of the province. Health information systems were not fit-for-purposes to generate disaggregated data on under-18-yearolds, thus made it extremely difficult to provide a comprehensive view of CAMHS in the province. In terms of access to essential medicines, basic classes of psychiatric medications were available at all levels of care, but not consistently so. An exploration of financing showed that no ring-fenced or disaggregated budgets were available for CAMHS, thus making it impossible to comment on the appropriateness of funding for the mental health needs of children and adolescents. In terms of leadership and governance, a national CAMH policy existed, but no implementation plans had been developed since the publication of the CAMH policy in 2003. Our findings highlighted a lack of dedicated CAMH leadership and governance in the province. We argued that the absence of a clear CAMH leadership structure also explained why provincial plans and strategies had not been developed and implemented over the last two decades. A very consistent finding from our data was a need for a dedicated provincial lead for CAMH. We concluded the thesis with hardware and software recommendations for policy implementation, service development, training and research.
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Gilfillan, Katherine Verne. "Heroin detoxification during pregnancy: a systematic review and retrospective study of management of heroin addiction in pregnancy." Master's thesis, University of Cape Town, 2012. http://hdl.handle.net/11427/10539.
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Includes bibliographical references.There is a general consensus that methadone maintenance is the gold standard in the management of pregnant heroin users. However, in South African state hospitals, methadone withdrawal is the routine procedure offered to these patients, as methadone maintenance programmes are unavailable in the public sector.
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Mayers, Patricia Margaret. "The lived experience of persons with chronic fatigue syndrome : a qualitative phenomenological study." Master's thesis, University of Cape Town, 2000. http://hdl.handle.net/11427/11106.
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Bibliography : leaves 99-111.This phenomenological study examined the lived experience of persons who suffer from Chronic Fatigue Syndrome (CFS). Research into this condition has to date concentrated on causality and coping strategies and there is limited knowledge of the experiences of sufferers of this condition. In-depth interviews were conducted with five participants who met the criteria for the diagnosis of CFS. The interviews were tape-recorded, transcribed verbatim and analysed, coding for thematic content.
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Erica, Breuer. "Using Theory of Change to design and evaluate complex mental health interventions in low and middle income countries: the case of PRIME." Doctoral thesis, University of Cape Town, 2018. http://hdl.handle.net/11427/29501.
Full textAbstract:
Background: Many health interventions are complex and consist of several interacting components (Medical Research Council 2008). These components include multiple causal strands, outcomes and levels of governance and may result in unexpected outcomes and non-linear change (Glouberman and Zimmerman 2002). As such they present challenges to the design and evaluation of complex health interventions. Although broad theoretical guidance has been developed by the UK Medical Research Council (MRC) (Craig, Dieppe et al. 2008), it contains little practical guidance and has been criticised for not including theory driven approaches to evaluation such as Theory of Change (ToC) (Anderson 2008). De Silva, Breuer et al. (2014) have proposed that ToC may complement the MRC guidance on complex health interventions. Methods: This study explores how ToC can strengthen the design and evaluation of complex health interventions using the example of The Programme for Improving Mental Health Care (PRIME). PRIME is a research programme which aimed to develop, implement and evaluate the integration of mental health into primary health in districts or sub-districts in Ethiopia, India, Nepal, South Africa and Uganda. A ToC approach was used in addition to other approaches to design and evaluate these complex mental health interventions. Firstly, I conducted a systematic review to determine the extent to which ToC has been used to design and evaluate public health interventions. Secondly, I compared the process of developing the ToC between all five PRIME countries and reflected on the value of ToC workshops using a framework analysis of workshop documentation and interviews with facilitators. Thirdly, I explored the development of the ToCs within the programme as a whole and the implications for the development of the intervention and the choice of evaluation methods. Fourthly, I presented a ToC for the integration of mental health care in low and middle income countries. Fifthly, I demonstrated how ToC can be used as a framework for a qualitative comparative analysis of process and outcome data using longitudinal data from 10 PRIME implementation facilities in Nepal. Lastly, I provide a set of 10 key lessons learned from PRIME in the application of ToC to complex mental health interventions. Results I found that the ToC approach has been used for the design and evaluation of public health interventions since the 1990s. However, there is a lack of clear description of the use of ToC in the literature on public health interventions and inconsistency in how it is used. In applying the ToC approach to PRIME, I found that facilitators reported that ToC workshops were a valuable way to develop ToCs and that different stakeholders at the workshop contribute different types of information to the ToC process. Hierarchies within the health system are an important consideration for ToC workshops as power dynamics are likely to influence the functioning of the group. In addition, I found that the development of a cross country ToC can result in a programme theory which is relevant for complex multilevel intervention in different contexts. This ToC can provide a framework to map contextually relevant interventions and can be used to complement other intervention development approaches. The ToC can also be used to ensure indicators for all the short-, medium- and long-term outcomes are identified. However, combining process and outcome data analysis using the ToC is not straightforward. Qualitative Comparative Analysis (QCA) can be used to analyse process and outcome data in a single analysis in health services research. Conclusion: ToC can be used to strengthen the design and evaluation of complex health interventions and can be used to complement the MRC guidance in the design and evaluation of complex health interventions.
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Saban, Amina. "The association betweeen psychopathology and substance use in young people." Doctoral thesis, University of Cape Town, 2011. http://hdl.handle.net/11427/12248.
Full textAbstract:
Includes abstract.Includes bibliographical references.
The co-occurrence of problematic substance use and non-substance use psychopathology is very common in psychiatry, and is generally referred to as comorbidity. The phenomenon has been the subject of debate and widespread research, yet remains poorly understood. The thesis aimed to examine the association between psychopathology and substance use in young people in South African settings, to determine the nature and prevalence of comorbidity, and to identify sociodemographic factors that might influence the associations, as well as the influence of comorbidity on substance use treatment outcomes.