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1
Agboola, Shade. "Smoking relapse prevention : abstinence, relapse, current practice and effective interventions." Thesis, University of Nottingham, 2017. http://eprints.nottingham.ac.uk/43623/.
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Smoking remains a major cause of morbidity and mortality. In 2013/2014, 454,700 hospital admissions in the UK amongst persons 35 years and over were estimated to be attributable to smoking. This accounts for 4 per cent of all hospital admissions in this age group. In 2013, 17% (78,200) of all deaths in adults aged 35 and over were estimated to be caused by smoking[1]. Reducing smoking therefore, remains a major priority for governments and health systems like the UK National Health Service (NHS). Following the publication of the Government’s White Paper, Smoking Kills[2] in 1998, a comprehensive tobacco control strategy was implemented. This strategy was aimed at reducing uptake of smoking and increasing quitting among existing smokers, and involved a combination of population tobacco control interventions (such as price rises, an advertising ban and smoke-free legislation) combined with treatment for dependent smokers through the NHS. A Tobacco Control Plan for England was also produced in 2011 which explained the government’s strategy to reduce smoking through the new public health system[3]. This plan outlined commitments to implement legislation to end display of tobacco in shops, to encourage smokers to quit and remaining quit by using effective forms of support and implementing a policy of using tax to maintain the high price of tobacco. Effective forms of support may be behavioural, pharmacological or a combination of both[3]. In the UK, support is often delivered by stop smoking services (SSS), although smokers, who wish to, may obtain smoking cessation medication from their GP[4]. These SSS have been shown to be cost effective, but the majority, 85% of smokers attending the services, have relapsed by one year. The nature of nicotine addiction means that smoking is a chronic relapsing condition[5], with many smokers unable to sustain abstinence. Smoking relapse rates can be extremely high (up to 90% in the first 3 months)[6], and only 3%-5% of unsupported/untreated quitters maintain their quit attempt for 6 months or longer[7]. This high relapse rate reflects the addictive nature of cigarette smoking and underscores the importance of finding effective relapse prevention interventions for use in routine practice, which can be delivered alongside or after acute cessation has ended. There is no universally accepted definition of what interventions to prevent relapse to smoking (relapse prevention interventions - RPIs) should comprise; many smoking cessation programmes simply modify the content of existing, cessation-orientated support and deliver these as relapse prevention[8]. The paucity of information regarding provision of smoking relapse prevention is in contrast to the wide availability of evidence for the use of acute cessation treatments which has grown rapidly over recent decades. A variety of effective treatments now exist which can increase the chances of stopping smoking up to fourfold compared with no support[9], but research suggests that relapse prevention interventions and treatments are not as widely known or even used. At the time the research was conceived, there was very little information about the effectiveness of RPIs. A number of studies had investigated effectiveness of behavioural support, pharmacotherapies, and combination treatments, as forms of relapse prevention or maintenance treatment, and one Cochrane Review[8] found no evidence for the effectiveness of behavioural RPIs, but this may have been because the review combined smoking outcomes obtained at different follow-up time points after quitting and this may have obscured real effects of RPIs. The review found insufficient evidence for the effectiveness of extended treatment with bupropion and weak evidence for the effectiveness of nicotine replacement therapy for relapse prevention. There was, therefore, a need to examine current literature and synthesize data from a wide variety of studies, using a different approach from that used in the Cochrane Review to enhance interpretation of findings. In addition to ascertaining whether or not RPIs are effective, there was also a need to explore feasibility of provision within local Smoking Cessation Services. No study had explored feasibility of provision of RPIs within Stop Smoking Services, and whether these interventions would be acceptable to smokers trying to quit, mainly because the use of relapse prevention interventions in a local smoking cessation service was not only relatively new and unproven, there was also no information regarding smokers’ perceptions of relapse prevention interventions Abstinence and relapse during a quit process is still poorly understood, especially relapse after the use of a smoking cessation aid. A few studies had investigated patterns of relapse and abstinence in smokers who quit smoking unaided and two reviews[7 10] found that the majority of relapse occurred in the first two weeks of starting a quit attempt. The majority of smokers who wish to quit smoking use some form of evidence based treatment. It was therefore important to explore patterns of relapse in smokers who have attempted to quit smoking with the aid of a smoking cessation treatment. The work presented here is for the degree of PhD by publication and is based upon five publications in high quality peer reviewed journals between 2009 and 2015. I am the lead author on four of the included papers and the final and corresponding author on one paper. The research forms a coherent body of work informing the evidence base on smoking relapse prevention interventions (RPIs). This has contributed to the evidence base around four key aspects of smoking relapse prevention: knowledge, views and beliefs, effectiveness of smoking relapse prevention interventions, feasibility of delivery of RPIs within UK Stop Smoking Services, and abstinence and relapse patterns amongst smokers who quit smoking with the aid of a pharmacological smoking cessation treatment. Systematic reviews, meta-analysis, quantitative research and qualitative research were used to generate the data which supported the exploration of the four themes outlined below. Specifically, the published works have identified: • Knowledge, Understanding, Views and Beliefs: there was no shared understanding of what relapse prevention meant to Stop Smoking Service professionals or the kinds of interventions that should be used for this, but a willingness to provide such treatments was apparent. (Agboola SA, Coleman, T and McNeill, A. (2009). Relapse prevention in UK Stop Smoking Services: a qualitative study of health professionals' views and beliefs. BMC Health Services Research. 9:67 and Agboola SA, Coleman TJ, Leonardi-Bee J, McEwen A and McNeill A (2010). Provision of relapse prevention interventions in UK NHS Stop Smoking Services: a survey. BMC Health Services Research 10:214) • Effectiveness of smoking relapse prevention interventions: A pooled analysis of randomized controlled trials of nicotine replacement therapy, bupropion and varenicline showed that these interventions are effective for relapse prevention. A meta-analysis of four studies of nicotine replacement therapy found that smokers who used NRT for relapse prevention were 1.56 times more likely to remain abstinent at six months follow-up compared to placebo (95% confidence interval 1.16 to 2.11). A pooled analysis of four studies of bupropion showed evidence for effectiveness at long term follow-up (12 to 18 months) with an odds ratio of 1.49 (95% confidence interval 1.10 to 2.01). A single study of varenicline also demonstrated evidence for effectiveness for relapse prevention. (Agboola S, McNeill A, Coleman T and Leonardi-Bee, J (2010). A systematic review of the effectiveness of smoking relapse prevention interventions for abstinent smokers.Addiction 105, 1362–1380) This was the first time that RPIs had been proven effective, and now that there appeared to be evidence of efficacy, it was appropriate to investigate feasibility of introducing these into routine clinical practice (next study). • Feasibility of delivering relapse prevention: A study investigating the feasibility, uptake and acceptability of offering nicotine replacement therapy (NRT) as a relapse prevention intervention (RPI) within UK Stop Smoking Services, showed that NRT can be added to existing treatment protocols, and that of 260 SSS clients who were eligible and offered this intervention, 44% (95% confidence interval 38% to 50%) accepted the offer. • Abstinence and relapse patterns: A pooled analysis of 19 trials of varenicline showed that varenicline recruits smokers into abstinence following the target quit date to a greater extent than placebo (point prevalence abstinence increased from 32% [95% confidence interval 25% to 40%] in week two to 54% [95% confidence interval 48% to 61%] in week 12). A higher immediate relapse rate following varenicline treatment discontinuation was also observed, which implied that there would be smokers who would benefit from a longer course of treatment.
2
Malkus, Amy J. "Relapse Prevention Manual." Digital Commons @ East Tennessee State University, 2002. https://dc.etsu.edu/etsu-works/4700.
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3
Caravati, Paula Ciavarella. "Obesity Relapse in Women." Diss., Virginia Tech, 2001. http://hdl.handle.net/10919/26817.
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Obesity and relapse after dieting pose a significant threat to an increasing number of adults in this country. Resistance to treatment and high relapse rates make this problem frustrating for patients and practitioners. There is limited research on relapse causation; research on social and life circumstance factors is uncommon. Given the limitations of existing research, the purpose of this study was to investigate the natural course of obesity relapse. A purposive sample of eight obese women, ages 31-57, was selected. All of the women relapsed at least one or more times throughout their lives. A qualitative study design was used to examine and integrate their attributions for relapse.
The qualitative paradigm was selected because it allowed for an inclusive study of relapse without confining the investigation to a predetermined set of responses. Information was gathered on contributory factors: physical, social and psychological, but not limited to these areas. These factors were reported in a case study format. Verbatim quotes were used to provide descriptive information and insight into individual cases. Cases were analyzed for main attributions; key words and phrases were used to develop categories. Common themes were derived from these categories and examined across the cases.
Conventional wisdom about the factors, which contribute to obesity relapse, was challenged by this research study. Excess calories and decreased physical activity were not the only conditions that were contributory to the respondentsâ relapses. Diverse social and psychological issues often combined with physical factors to dominate the respondentsâ attributions. The relapse attribution themes commonly represented in the case studies included: the impact of food restriction, the impact of having personal choice taken away, negative emotions, physiological factors, lifestyle demands and the return to familiar food habits.
Based on this study, it is recommended that obesity practitioners consider assessment and treatment modalities that are holistic. A paradigm shift away from traditional approaches may be a necessary step in providing more effective treatment. Additional research, which focuses on life circumstances and obesity relapse, is needed.Ph. D.
4
Klein, Jeffery Lane. "Attributional style and alcoholic relapse /." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 1997. http://wwwlib.umi.com/cr/ucsd/fullcit?p9804031.
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Bowersox, Nicholas W. "Treatment Attrition and Relapse Readmission in Psychiatric Inpatients: Predictors of Treatment Engagement and Psychiatric Relapse." [Milwaukee, Wis.] : e-Publications@Marquette, 2009. http://epublications.marquette.edu/dissertations_mu/18.
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Paseman, Wallace W. "Relapse Prevention Using Mobile Electronic Media." Thesis, State University of New York Empire State College, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10278346.
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Morrison, Fraser. "Predictors of relapse in alcohol dependence." Thesis, University of Edinburgh, 2008. http://hdl.handle.net/1842/24999.
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Relapse rates following treatment for alcohol dependence are high, and efforts to prevent relapse are an integral part of treatment. Outcome studies have reported relapse rates of 65% within one year of treatment, with the majority relapsing within less than three months. Many factors have been studied as potential predictors of relapse in alcohol dependence, such as psychiatric disorder. Fifty four residents in an inpatient alcohol detoxification unit were tested on measures of memory and executive functioning, mood, self efficacy, quality of life, and liver function at the end of a seven to ten day stay in the unit. These patients were then followed up three months later via a telephone interview to ascertain the number of days drinking alcohol during this period. The sample of the study contained individuals at the severe end of the range of alcohol dependence, a group that has been largely neglected throughout the literature. Low mood during detoxification was found to predict number of days drinking in the three months following discharge. Executive dysfunction was also associated with relapse to a lesser extent. Low mood appears to be a significant barrier to ability to remain abstinent from alcohol following a period of detoxification. Interventions to reduce depression may have a beneficial effect in reducing relapse rates in individuals at the severe end of the range of alcohol dependence.
8
Ramo, Danielle Elizabeth. "Developmental models of substance abuse relapse." Diss., Connect to a 24 p. preview or request complete full text in PDF format. Access restricted to UC campuses, 2008. http://wwwlib.umi.com/cr/ucsd/fullcit?p3297587.
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Thesis (Ph. D.)--University of California, San Diego and San Diego State University, 2008.Title from first page of PDF file (viewed April 28, 2008). Available via ProQuest Digital Dissertations. Vita. Includes bibliographical references.
9
Byrne, Susan Mary. "Weight maintenance and relapse in obesity." Thesis, University of Oxford, 2001. http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.393355.
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Gumley, Andrew Ian. "Psychological aspects of relapse in schizophrenia." Thesis, University of Stirling, 2002. http://hdl.handle.net/1893/12115.
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Following a review of the relevant literature a Cognitive Behavioural treatment protocol for the prevention of relapse in schizophrenia is presented. This treatment protocol is investigated in a 12-month non-blind randomised controlled trial comparing Cognitive Behavioural Therapy and Treatment as Usual (CBT + TAU) versus Treatment as Usual (TAU) alone. Three studies of treatment outcome are described: relapse and admission, remission and social functioning, and psychological distress. 144 participants with a DSM-IV Schizophrenia spectrum disorder were randomised to receive either CBT + TAU (n = 72) or TAU alone (n = 72). 11 participants dropped out (6 from CBT + TAU, 5 from TAU alone) leaving a completers sample of 133. Participants were assessed at entry, 12-weeks, 26-weeks, and 52 weeks. CBT was delivered over two stages: a 5-session engagement phase which was provided between entry and 12-weeks, and a targeted CBT phase which was delivered on the appearance of early signs of relapse. Over 12-months CBT + TAU was associated with significant reductions in relapse and admission rate. The clinical significance of the reduced relapse and admission rate amongst the CBT + TAU group was investigated. First, receipt of CBT + TAU was associated with improved rates of remission over 12-months. Second, clinically significant improvements in social functioning were investigated. Again, receipt of CBT + TAU was associated with clinically significant improvements in prosocial activities. However, receipt of CBT + TAU was not associated with improvements in psychological distress over 12-months. The theory underpinning the cognitive behavioural treatment protocol predicted that negative appraisals of self and psychosis represent a cognitive vulnerability to relapse. This hypothesis was investigated during the present 2 Abstract study. After controlling for clinical, treatment and demographic variables, negative appraisals of self and entrapment in psychosis were associated with increased vulnerability to relapse, whilst negative appraisals of self were associated with reduced duration to relapse. Finally, an explorative study of changes in negative appraisals of psychosis and self over time, which were associated with relapsers versus non-relapsers from the TAU alone group, was conducted. This study found a strong association between the experience of relapse, increasing negative appraisals of psychosis and self, and the development of psychological co-morbidity in schizophrenia. Results of treatment outcome and theoretical analyses are discussed in terms of their relevance to the further development of psychological models and treatments for psychosis.
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Westrup, Darrah. "Experiential avoidance and alcohol dependence relapse." Morgantown, W. Va. : [West Virginia University Libraries], 1999. http://etd.wvu.edu/templates/showETD.cfm?recnum=868.
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Thesis (Ph. D.)--West Virginia University, 1999.Title from document title page. Document formatted into pages; contains vi, 76 p. Vita. Includes abstract. Includes bibliographical references (p. 59-67).
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Keim, Rebecca. "Treatment-Induced Breast Cancer Dormancy and Relapse." VCU Scholars Compass, 2014. http://scholarscompass.vcu.edu/etd/3500.
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When breast tumor cells encounter stress due to cancer therapies, they may enter a dormant state, escaping from treatment-induced apoptosis. Dormant cells may eventually regain proliferative capabilities and cause recurrent metastatic disease, which is the leading cause of mortality in breast cancer patients. We sought to determine if a high dose of radiation therapy (RT) or combined chemo-immunotherapy, with and without the blockade of autophagy by chloroquine (CQ), could overcome treatment-induced tumor dormancy or relapse. We found that autophagy contributes in part to treatment-induced tumor dormancy. We also found that three therapeutic strategies were successful in inhibiting or preventing tumor relapse. These include: 18Gy/day RT, chemotherapy combined with the blockade of autophagy, and combined chemo-immunotherapy. Follow-up studies are needed to determine the feasibility of preventing tumor relapse by prolonging tumor dormancy versus eliminating dormant tumor cells.
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Gortner, Eric Tomas. "Cognitive-behavioral treatment for depression : relapse prevention /." Thesis, Connect to this title online; UW restricted, 1999. http://hdl.handle.net/1773/9041.
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Kennedy, Kelsey Marie. "The Relapse Cycles of Female Methamphetamine Users." Thesis, The University of Arizona, 2015. http://hdl.handle.net/10150/579257.
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Methamphetamine use, especially in rural populations, has vast implications on the community and the individuals that comprise it. It has been found that men and women display diverse methamphetamine habits as well as varied effectiveness in treatment. Due to the higher intake and drug-seeking behavior of female methamphetamine users, this qualitative study focused on the relapse and quitting cycles of women in rural Wyoming. Through analysis of forty five semi-structured interviews, it was found that the five major themes of relationships, health, treatment, Department of Corrections, and lifestyle were the most prevalent indicators of becoming clean or relapsing for female methamphetamine users. Furthermore, it was found that women who were pregnant or who had moved away from their home displayed extensive periods of staying clean. By targeting triggers and understanding the reasons behind chronic quitting behaviors, a more comprehensive and individualized treatment plan can be implemented for women struggling with methamphetamine addiction.
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Buckman, J. E. J. "Depression : can we predict who will relapse?" Thesis, University College London (University of London), 2014. http://discovery.ucl.ac.uk/1447475/.
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This thesis addresses risk factors and proposed mechanisms to explain relapse to depression. Volume 1 comprises three parts: Part 1 is a literature review consisting of meta-reviews of systematic and non-systematic reviews of studies reporting on risk factors for relapse to depression, and a systematic-review of neuroimaging and experimental studies investigating risk factors for relapse and potential mechanisms of action of these risk factors. The reviews found that only residual symptoms of depression at the end of treatment and childhood maltreatment were sufficiently evidenced as predictors of relapse and neither have great clinical utility. A number of psychological and neuropsychological factors were suggested to play a role in conferring risk for relapse. Considering the inter-relationships between these factors the reviews were used to propose a conceptual framework which may be used to help guide future research into relapse to depression in adults. Part 2 is an empirical paper in which data were analysed from service users of a primary care mental health service to identify risk factors for relapse and for the presence of residual symptoms, and survival analysis methods were used to determine when relapses occur most often and what factors impact survival. In addition, a prospective cohort study was formed to investigate the relationship between cognitive control and depressive symptoms. The findings confirmed that cognitive control can be used to predict residual symptoms of depression post-treatment and therefore potentially to predict relapse. Part 3 is a critical appraisal focussing on the theoretical reasons as to why studying relapse in a manner as used in the prospective study is so important and discusses the logistical difficulties conducting such research in the current context of NHS services and of the D.Clin.Psy research project. Methodological decisions made that impacted upon the research process are discussed and reflective conclusions are offered.
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Thieneman, Allison F. "A Beacon of Hope: Inoculating Against Relapse." UKnowledge, 2017. https://uknowledge.uky.edu/comm_etds/57.
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Inoculation is a robust theory applied to a variety of health behaviors. Social marketing is designed to change behavior by applying marketing tactics in the context of social change. This study combines inoculation theory with social marketing in the context of substance abuse disorders to promote long-term recovery. This is a pilot project that specifically focuses on the Beacon House, a residential recovery treatment center in Louisville, Kentucky. With the growing drug problem in America, it is necessary to implement effective recovery strategies in treatment programs. The social marketing plan focuses on the target audience to outline potential barriers, motivators, and competition to remaining in long-term recovery. Three intervention strategies were developed as part of the project: a core inoculation message, booster messages, and refusal skills training. These strategies utilize inoculation messages in various ways to address the complexity of long-term recovery. While this study focuses on the Beacon House treatment facility, the concepts can be applied to similar treatment centers.
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Lisowski, Chantal Louise. "The use of the cognitive-behavioral relapse model in understanding individuals with relapse in inhalant abuse, a preliminary study." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 2000. http://www.collectionscanada.ca/obj/s4/f2/dsk1/tape3/PQDD_0027/MQ51742.pdf.
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Scotch, Allison. "EFFECTS OF BODY MASS INDEX ON RELAPSE RISK IN PEDIATRIC HODGKIN LYMPHOMA PATIENTS." Thesis, The University of Arizona, 2015. http://hdl.handle.net/10150/539825.
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A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.Background. Rates of childhood obesity in the United States have risen dramatically in recent decades, with more than 31% of children currently classified as overweight or obese. This raises concerns about the effects of weight on outcomes for pediatric illness, including cancer. There is some evidence of poorer outcomes for pediatric leukemia patients who are overweight or obese, and studies in adults have suggested negative impacts of obesity in numerous cancer types. To date, there are no studies investigating outcomes in overweight and obese children with Hodgkin lymphoma (HL). Our hypothesis was that higher body mass index (BMI) at diagnosis is associated with increased risk for HL relapse. Methods. We conducted a retrospective cohort study of 101 pediatric HL patients treated between 1980 and 2010 at Phoenix Children’s Hospital, a large pediatric oncology referral center in the Southwestern United States. Data was abstracted from electronic and paper medical charts as well as survival clinic follow‐up records. We performed logistic regression and conducted a survival analysis to test whether body mass index (BMI) at diagnosis was associated with time to disease relapse. For this pilot study, we conducted a primary analysis as well as several exploratory secondary analyses with the goal of generating hypotheses to be tested in future large studies of this population. Results. In the primary analysis comparing underweight and normal children to overweight and obese children, none of the patient characteristics – sex, race, age, clinical risk level, or radiation status – were significantly associated with BMI group. In the univariate analysis of HL relapse, children in the overweight/obese group had an increased unadjusted odds ratio of 1.58 (95% CI: 0.50‐5.28), but this was not statistically significant. Exploratory analyses categorizing BMI groups in various ways also suggested an association between increased BMI and risk for HL relapse, though this failed to reach statistical significance. No potential confounders were associated with HL relapse except radiation status (p=0.004), although we were unable to calculate an odds ratio due to a lack of patients in some subgroups. In the survival analysis, radiation was the only variable significantly associated with time to HL relapse. Kaplan‐Meier curves of relapse‐free survival time did not show a significant difference between BMI groups in the primary analysis, but secondary analyses suggested a nonsignificant trend toward decreased long‐term disease‐free survival in patients with higher BMI. Discussion. The relatively small sample size for this pilot study precluded demonstration of statistically significant differences in HL relapse risk or time to relapse between BMI groups. However, exploratory analyses suggested a trend toward increased risk for relapse and shorter disease‐free survival in patients with higher BMI, and these results merit further investigation in larger studies. Multi‐center collaborative studies will be required to attain sufficient sample sizes to accurately assess clinical prognosis in this patient population. Improving our understanding of how BMI affects pediatric cancer outcomes is an important step toward identifying patients at increased risk and determining how best to individualize treatment and monitoring plans for overweight and obese children.
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Rackham, Erin L. "Understanding Relapse in Self-Perceived Problematic Pornography Users." BYU ScholarsArchive, 2020. https://scholarsarchive.byu.edu/etd/8655.
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This study explored reasons for relapse among a sample of 938 self-identified problematic pornography users. A combination of numeric content analysis and qualitative coding of responses to an open-ended question about pornography relapse revealed six main categories of reasons for relapse. The mental, emotional, and relational categories were then analyzed in detail, and this analysis revealed significant overlap of responses from the emotional and relational categories. Hence, a new category of relational-emotional reasons for relapse was created and analyzed. The findings from this study highlight the complex interactions of different types of factors driving relapse in self-perceived problematic pornography users and future research and clinical applications are discussed.
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Hill, Rebecca Maree. "Biological mechanisms of disease relapse in childhood medulloblastoma." Thesis, University of Newcastle upon Tyne, 2015. http://hdl.handle.net/10443/2796.
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Over 30% of patients diagnosed with a medulloblastoma experience disease recurrence. Relapse is almost universally fatal, only infants who receive delayed radiotherapy at disease recurrence typically survive long term. Consequently relapse is the single leading cause of mortality disease-wide. Improved understanding of medulloblastoma at diagnosis has led to the identification of four distinct molecular subgroups with differing biology and outcome. These comprise of medulloblastomas associated with WNT and SHH pathway disruption (MBWNT and MBSHH respectively), and Group 3 and Group 4 tumours (MBGroup3 and MBGroup4). In contrast, very little is understood about the disease at recurrence, and at present there are only two published studies interrogating the biology of relapsed medulloblastoma. However, improved understanding of the biology at relapse is critical to improving treatment. Events at disease relapse could be explored as therapeutic targets or, if predictive of disease recurrence, provide an opportunity to escalate upfront therapy with the aim of preventing relapse. This study compiled a cohort of medulloblastoma tumours sampled at relapse (n=29), paired with their diagnostic counterparts. All clinicopathological and molecular features, with an established relationship to disease prognosis at diagnosis, were interrogated in this paired relapse cohort. With the exception of molecular subgroup, all features investigated displayed evidence of alteration and predominantly acquisition at recurrence. Most strikingly, the emergence of combined p53-MYC defects was commonly observed at relapse and these features were associated with locally aggressive, rapidly progressive disease following relapse. Through collaborative work, this discovery was explored further, with the development of a novel GTML/Trp53 KI/KI mouse model which faithfully recapitulated the clinicopathological and molecular features of the p53-MYC human tumours, and demonstrated the dependency of tumourigenesis and maintenance on this genetic interaction. Moreover, therapeutic inhibition of Aurora A kinase using MLN8237 in these mouse tumours led to degradation of MYCN, tumour reduction and prolonged survival. v A novel genome-wide DNA methylation analysis was next undertaken in the paired relapse cohort, focusing on MBGroup4 tumours, to interrogate maintained and acquired DNA methylation events between diagnosis and relapse, which may play a role in tumour development. Individual CpG sites on the Infinium DNA methylation 450K array were assessed for changes in their DNA methylation status between diagnosis and relapse. Fifteen candidate genes demonstrated tumour-specific methylation states that emerged at relapse and correlated with gene expression. The T-box and Homeobox gene families accounted for 8/15 (53%) candidates identified. Both these families are reportedly important for tumour development in other cancers. In addition, several studies suggest that epigenetic mechanisms, such as DNA methylation, play a regulatory role in their gene expression. Finally, a large cohort of medulloblastoma tumours (n=206), sampled at diagnosis, from patients who are known to go on and recur, was assembled to investigate any subgroup-specific patterns and timings of relapse. MBWNT rarely relapsed, whereas MBSHH frequently relapsed at both local and distant sites, but were the tumour subgroup most readily salvaged by radiotherapy in patients who were not treated with craniospinal irradiation (CSI) at diagnosis (8/12, 67%). Both MBGroup3 and MBGroup4 were widely metastatic at recurrence (34/41 (83%) and 52/61 (85%)) but contrastingly MBGroup3 relapsed quickly (p=0.0022), whereas MBGroup4 relapsed more slowly (p=0.0008). In patients who did not receive upfront CSI, MYC amplification at diagnosis was associated with rapid disease progression after relapse (p=0.0003). No diagnostic feature was significantly associated with time to death following relapse in the cohort of patients who received upfront CSI. This finding was supported by data from the paired relapse cohort where, in patients who received upfront CSI, it was the biological features of the tumour at relapse and not diagnosis, which were associated with disease course. In summary, this study has discovered emergent combined p53-MYC defects at medulloblastoma relapse which are associated with disease behaviour, identified potentially epigenetically regulated candidate genes in relapsed MBGroup4 tumours, and shown that the patterns of disease relapse are associated with radiotherapy and molecular subgroup. Together these findings demonstrate that medulloblastoma tumour biology is significantly different at relapse and that the timings and location of vi disease recurrence should be considered in the context of molecular subgroup and treatment. Biopsy at disease recurrence is now essential to validate and expand on these novel findings, interrogate all molecular subgroups at disease recurrence, and translate these discoveries into improved outcomes for the patients suffering from this devastating diagnosis.
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Orejarena, Maria Juliana. "Neurobiological mechanisms involved in MDMA-Seeking behaviour and relapse." Doctoral thesis, Universitat Pompeu Fabra, 2010. http://hdl.handle.net/10803/7229.
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(+) 3,4-metilendioximetanfetamina (MDMA), popularmente conocida como "éxtasis", es una droga susceptible de producir adicción en algunos individuos. Actualmente es consumida principalmente por adolescentes y jóvenes. Los particulares efectos psicoactivos inducidos por la MDMA, permiten distinguirlo de manera clara de otros psicoestimulantes o compuestos alucinógenos. Esta droga actúa principalmente activando el sistema dopaminérgico y serotonérgico en los circuitos neurales de placer. Sin embargo, los mecanismos neurobiológicos implicados en las propiedades adictivas de esta droga no han sido aún esclarecidos. El trabajo presentado en esta Tesis Doctoral ha puesto de manifiesto algunos aspectos claves de estos procesos que eran desconocidos hasta el momento. Hemos encontrado que el receptor de serotonina 5-HT 2A participa de forma critica en las propiedades reforzantes de la MDMA, contrario a lo observado en el caso de otros psicoestimulantes. Además, el bloqueo farmacológico de este receptor puede prevenir la reinstauración de la búsqueda de la MDMA, desencadenada por un estímulo o clave previamente asociado a su consumo. Estos efectos pueden ser debidos al bloqueo del control excitatorio que normalmente ejercen estos receptores sobre los niveles de dopamina en estructuras mesolímbicas, como ha sido revelado en nuestros estudios de microdiálisis. Hemos demostrado también que la MDMA puede actuar como clave interoceptiva y desencadenar la recaída a la búsqueda y consumo de cocaína. Adicionalmente, nuestros estudios han mostrado que tanto la activación del sistema dopaminérgico mesolímbico, como los cambios en la expresión génica en diferentes ´areas cerebrales que ocurren tras la administración de la MDMA, dependen de si el sujeto participa de manera activa en el consumo de esta droga, o si por el contrario la recibe de forma pasiva. En conclusión, este trabajo resalta la importancia de los procesos de aprendizaje y memoria sobre las propiedades reforzantes/recompensantes de la MDMA. Además, nuestras investigaciones aportan nuevas evidencias en relación a la participación del sistema serotonérgico en la búsqueda y recaída al consumo de esta droga.(+) 3,4-methylenedioxymethamphetamine (MDMA), commonly known as "ecstasy", is currently a highly consumed drug with liability to produce addiction in some individuals. MDMA induces unique psychoactive effects that clearly distinguish it from hallucinogenic or psychostimulant drugs. MDMA mainly enhances the activity of both the serotonergic and the dopaminergic system in the esolimbic brain reward pathways. However, the neurobiological mechanisms underlying its possible addictive properties are still not fully understood. In the present work, we have contributed to this subject by establishing that the serotonin 5-HT2A receptor, in contrast to what has been observed for other drugs of abuse, is critical for MDMA-induced reinforcement. Moreover, the pharmacological blockade of this receptor can prevent cue-induced relapse. This effect is possibly mediated by its excitatory control over basal and MDMA-induced increase in midbrain dopamine, as supported by our microdialysis data. Furthermore, we have also shown that MDMA can act as an interoceptive cue to induce relapse to cocaine-seeking behaviour. Additionally, we demonstrated differential changes at the level of the dopaminergic brain reward pathway and gene expression changes in different brain areas, following self-administeredMDMAin comparison to passive administration. These results underpin the impact of a learning component in the rewarding/reinforcing properties of MDMA, and provide new evidence for the serotonergic involvement in MDMA-seeking behavior and relapse.
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Kim, Janet Heejung. "Cyclooxygenase-2 Expression in Post-Mastectomy Chest Wall Relapse." Yale University, 2006. http://ymtdl.med.yale.edu/theses/available/etd-06282006-104942/.
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The purpose of this study was to assess the prognostic significance and clinical correlations of cyclooxgenase-2 expression (COX) in a cohort of patients treated with radiation (RT) for post-mastectomy chest wall relapse (PMCWR). Between 1975 and 1999, 113 patients were treated for isolated PMCWR. All patients were treated with biopsy and/or excision of the CWR followed by RT. Median follow-up was 10 years. All clinical data including demographics, pathology, staging, receptor status, HER-2/neu status, and adjuvant therapy were entered into a computerized database. Paraffin-embedded CWR specimens were retrieved from 42 patients, of which 38 were evaluated, created into a tissue microarray, stained by immunohistochemical methods for COX, and graded 0-3+. A score of 2-3+ was considered positive. Overall survival from original diagnosis for the entire cohort was 44% at 10 years. Survival rate after chest wall recurrence was 28% at 10 years. The distant metastasis-free survival rate after CWR was 40% at 10 years. Local-regional control of disease was achieved in 79% at 10 years after CWR. COX was considered positive in 13 of 38 cases. COX was inversely correlated with ER (p= .045) and PR (p = .028), and positively correlated with HER-2/neu (p =.003). COX was also associated with a shorter time to PMCWR. The distant metastasis-free rate for COX negative patients was 70% at 10 years, compared with 31% at 10 years for COX-2 positive patients (p = 0.029). COX positive had a poorer local-regional progression-free rate of 19% at 10 years, compared with 81% at 10 years for COX negative (p = 0.003). Outcome following RT for PMCWR is relatively poor. Positive COX correlated with other markers of poor outcome including a shorter time to local relapse, negative ER/PR and positive Her-2/neu status. Positive COX correlated with higher distant metastasis and lower local-regional control of disease. If confirmed with larger studies, these data have implications with respect to the concurrent use of COX-2 inhibitors and radiation for PMCWR.
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Bridgforth, Myra Binns. "Relapse prevention with adolescent substance abusers and their families." Thesis, This resource online, 1988. http://scholar.lib.vt.edu/theses/available/etd-04272010-020325/.
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Bennetto, Luke Peter. "The relationship between relapse and disability in multiple sclerosis." Thesis, University of Bristol, 2007. http://hdl.handle.net/1983/cc5ea79a-c3b1-4c8f-b859-52d47f531394.
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The relationship between relapse and disability in multiple sclerosis is unclear. Whilst natural history studies have confirmed the disabling effects of insidious disease progression they have suggested that relapse, the clinically defining feature of the majority of cases multiple sclerosis, is largely unrelated to disability. However the major therapeutic strategies currently in use against multiple sclerosis are known only to ameliorate relapses and their ability to prevent long term disability is not presently based on evidence but faith in a long presumed, but unproven relationship between relapse, disease progression and disability.
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Gollan, Jackie K. "Posttreatment predictors of depression relapse following cognitive behavior therapy /." Thesis, Connect to this title online; UW restricted, 2000. http://hdl.handle.net/1773/9005.
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Pistolese, Anthony. "Rotational relapse of the mandibular incisors after Begg treatment." Thesis, The University of Sydney, 1988. http://hdl.handle.net/2123/4664.
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Pritchard, Duncan. "Models and treatment relapse and a pilot prevention intervention." Thesis, Bangor University, 2015. https://research.bangor.ac.uk/portal/en/theses/models-and-treatment-relapse-and-a-pilot-prevention-intervention(a8096325-39b5-4ce2-9648-5d73bde1ed14).html.
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Children and young people with intellectual and developmental disabilities (IDD) often present problem behaviours such as aggression and disruption. These behaviours can be successfully treated using Applied Behaviour Analysis (ABA). Unfortunately, despite effective treatment, the relapse of problem behaviour is common, especially when treatment integrity is not maintained. Behavioural Momentum Theory (BMT) suggests that the relapse of problem behaviour is likely to be greater if the behaviour has been reinforced at high rates. Chapter 1 provides an introduction into BMT, treatment relapse, and role-play training and its effect on treatment integrity. Chapter 2 presents a more detailed discussion of BMT and a review of three treatment relapse models (i.e., reinstatement, resurgence and renewal). Chapter 3 reports the results of two reinstatement and resurgence experiments that evaluated the effects of alternating rates of reinforcement on attention-maintained problem behaviour presented by a 16-year-old male with IDD. The two experiments demonstrated that that high rates of reinforcement can lead to greater magnitudes of treatment relapse. Chapter 4 describes a renewal experiment, again using alternating rates of reinforcement, that demonstrated similar findings. Chapter 5 reports the results of a long-term staff training programme that demonstrated that residential staff maintained high levels of treatment integrity following role-play training based on standardised scenarios than staff who received training via traditional methods. Chapter 6 discusses the implications of BMT and treatment relapse for practitioners and provides suggestions for future research.
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Ching, Martin. "Cephalometric evaluation of mandibular relapse following vertical subsigmoid osteotomy /." Title page, contents and summary only, 1995. http://web4.library.adelaide.edu.au/theses/09DM/09dmc5389.pdf.
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Lo, Cheuk-long Matthew, and 盧卓朗. "Patients' subjective views on relapse in psychosis : a qualitative study." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2014. http://hdl.handle.net/10722/206579.
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Introduction: This study explored the subjective experience of relapse of psychosis from the patients’ perspective and the meanings they attach to the relapse, their prevention and their perception of risk of relapse.
Method: A qualitative methodology was used based on a semi-structure interview. Audio tapes were transcribed verbatim and two researchers participated in a content analysis that identified five major themes: meaning of relapse, perceived risk of relapse in the future, views on antipsychotic medication, subjective risk and protective factors of relapse and the cost of having psychosis.
Results: Patients’ view of relapse was similar to those held by psychiatrists, however, patients had a broader definition of the criteria of relapse, extending from family support to medication discontinuation. Their major concerns were the side effects and the independence of antipsychotic medication.
Conclusion: Ideas about what constitutes relapse need to take into account the patients’ views and experiences in order to further improve and develop relevant intervention of relapse prevention in early psychosis.published_or_final_version
Psychological Medicine
Master
Master of Psychological Medicine
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Smith, Andrew Lawrence. "Pregnancy and Multiple Sclerosis: Risk of Unplanned Pregnancy, Drug Exposure In Utero, Relapse while Attempting Conception, and Post-Partum Relapse by Anesthesia Choice." Case Western Reserve University School of Graduate Studies / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=case1498749393114796.
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Witkiewitz, Katie. "Predicting alcohol relapse using nonlinear dynamics and growth mixture modeling /." Thesis, Connect to this title online; UW restricted, 2005. http://hdl.handle.net/1773/9047.
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Quigley, Brian David. "Diagnostic relapse in Borderline Personality Disorder: risk and protective factors." Diss., Texas A&M University, 2003. http://hdl.handle.net/1969.1/1237.
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Borderline Personality Disorder (BPD) is one of the more common personality disorder diagnoses observed in psychiatric inpatients and outpatients. Previous studies have found that individuals with BPD may be expected to experience difficulties throughout their lifetimes and they may repeatedly return for psychological treatment. Whereas previous studies have attempted to identify various factors related to relapse in other chronically recurring disorders such as depression, schizophrenia, and substance abuse, studies examining factors associated with relapse in BPD, and personality disorders in general, are absent from the scientific literature. This exploratory study examined whether specific risk and protective factors (dynamic and/or static) identified from the general relapse literature were associated with diagnostic relapse in BPD. Results revealed that variables related to an increased likelihood for BPD relapse included: substance abuse or Major Depressive Disorder, higher Neuroticism, and lower Conscientiousness. In addition, having a steady work or school status after remission was found to protect against a BPD relapse in the presence of various risk factors. Although this study has several limitations, these results provide some of the first insights to the processes of relapse and continued remission in BPD patients. Continued research efforts in this area can help to identify individuals who are at a greater risk for BPD relapse and potentially to design effective relapse-prevention strategies for the treatment of BPD.
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Erb, Suzanne Marie. "A study of relapse to cocaine seeking in the rat." Thesis, National Library of Canada = Bibliothèque nationale du Canada, 1997. http://www.collectionscanada.ca/obj/s4/f2/dsk3/ftp04/mq25968.pdf.
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Hing, Norman Richard. "Cephalometric evaluation of mandibular relapse following bilateral sagittal split osteotomy /." Title page, contents and summary only, 1989. http://web4.library.adelaide.edu.au/theses/09DM/09dmh663.pdf.
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Fung, Cheung-tim. "Recovery from chronic drug abuse : lifestyle change in relapse prevention /." View the Table of Contents & Abstract, 2007. http://sunzi.lib.hku.hk/hkuto/record/B38656735.
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Ip, Yuen-nar Yon. "Implicit cognition in the prediction of relapse among heroin addicts." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2002. http://hub.hku.hk/bib/B29740344.
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Chan, Kin-yi Ivy, and 陳健儀. "A study of determinants of relapse in psychotropic substance abuse." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 1995. http://hub.hku.hk/bib/B31250038.
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Hui, Lai-ming Christy, and 許麗明. "Predictors of relapse in first-episode schizophrenia and related psychosis." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2009. http://hub.hku.hk/bib/B41634081.
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馮祥添 and Cheung-tim Fung. "Recovery from chronic drug abuse: lifestyle change in relapse prevention." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2007. http://hub.hku.hk/bib/B45015752.
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Gomes, Machado Leandro dos Santos Maria Jose. "Mechanisms of relapse in rheumatoid arthritis following B-lymphocyte depletion." Thesis, University College London (University of London), 2007. http://discovery.ucl.ac.uk/1446429/.
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An open label trial of B-lymphocyte depletion therapy (BLDT) based on rituximab in 5 patients with rheumatoid arthritis, initiated in 1998, had shown that this therapy was associated with major clinical improvement. B-lymphocyte repopulation had occurred before relapse in all patients and, interestingly, it had not been always associated with relapse. This thesis starts with an extension of the initial open label trial to 22 patients with results suggesting a dose response to rituximab. Further follow up of these and an additional 18 patients revealed that, although all patients eventually relapsed, as in the previous small study, relapse could occur either at the time of B-lymphocyte repopulation of the peripheral blood or at a variable time after this time point, up to almost 3 years. Re-treatment with BLDT was found to be well tolerated and effective. Upon re-treatment, patients usually repeated the same pattern of relapse. Disease-associated autoantibodies, rheumatoid factor of immunoglobulin A, G and M classes and antibodies to cyclic citrullinated peptides, fell in all patients following BLDT but only decreased significantly in those who responded to treatment. Comparison with changes observed in total immunoglobulin levels and anti-microbial antibodies, suggested a specific effect on autoantibodies. Relapse was almost always preceded or associated with a rise in autoantibody levels, particularly rheumatoid factor of immunoglobulin M isotype, and was more closely associated with a rise in autoantibody levels than with the presence of B lymphocytes per se. B-lymphocyte stimulator (BLyS) serum levels increased following BLDT. Levels decreased following B-lymphocyte repopulation but tended to be lower at the time of repopulation in the group of patients who relapsed at this time point. Immunophenotyping of peripheral blood B lymphocytes showed that depletion was major but not complete and that it involved all B-lymphocyte subpopulations. It suggested that a quantitative threshold of depletion needed to be reached for patients to respond to therapy. B-lymphocyte repopulation occurred mainly from naive cells with immature B lymphocytes present in increased numbers and frequency. Patients who relapsed at the time of B-lymphocyte repopulation tended to show increased frequency and increased numbers of circulating memory B lymphocytes at the time of repopulation. Immunophenotyping studies of bone marrow aspirates in 6 patients, 3 months after treatment with BLDT, showed that the frequency of cells of B-lymphocyte lineage at this time point varied between patients. The variable relationships between the frequencies of more immature and more mature B-lymphocyte precursors in the samples suggested different degrees of depletion. Samples from patients who relapsed the earliest showed a pattern suggesting less efficient depletion. In conclusion, the results presented here suggest that relapse following BLDT in patients with rheumatoid arthritis can be attributed to incomplete depletion of pathogenic B-lymphocyte clones, persistence of long-lived plasma cells producing pathogenic autoantibodies or to a combination of both. This will contribute to hypothesis-based development of B-lymphocyte targeting therapies.
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Carter, Alexander James. "Struggling to hold addiction treatment talk and relapse in mind." Doctoral thesis, University of Cape Town, 2014. http://hdl.handle.net/11427/12761.
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Includes bibliographical references.Addiction is a common problem, as is relapse. People often struggle to come to terms with and manage the intoxicating effects of substances and consequently need treatment. This dissertation focusses on treatment talk as it relates to addiction counselling in a residential setting in order to understand relapse and the addict’s return to treatment. Current treatment approaches that address addiction comprise several evidence-based approaches and yet relapse rates remain high. Attempts to explain this phenomenon are varied and interventions tend to have a disease model approach in common with one another. Neurobiological and psychological theories of addiction are examined to understand this treatment conceptualization and consider its efficacy as a means of directing counselling interventions. Mentalization theory and critical discourse theory are used as a discursive lens in an attempt to understand these interventions and consider their shortcomings. In order to approach the question of relapse and addiction treatment, twenty interviews were conducted with clients and their counsellors - 10 dyads - who had completed residential addiction treatment for relapse. Counsellors and clients were interviewed and asked about their treatment experience, either as a client or clinician respectively. Both sets of participants were also asked about counselling as a relapse prevention intervention. Focus on the counselling relationship was in order to elicit talk about mental states related to treatment for addiction and relapse.
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Sockel, Katja, Rainer Ordemann, Bonin Malte von, Steffen Jahn, Gabriele Prange-Krex, Gerhard Ehninger, and Frank Kroschinsky. "Hip Pain in Medulloblastoma as First Symptom of Extraneural Relapse." Karger, 2011. https://tud.qucosa.de/id/qucosa%3A71633.
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Medulloblastoma is a common malignant brain tumor in childhood, but a rare disease amongst adults. The tendency to metastasize along cerebrospinal fluid pathways is well known. Extraneural metastases represent only a small number of recurrences and are associated with a poor outcome. Encouraging results of high-dose chemotherapy followed by autologous stem cell transplantation were reported previously in children with recurrent malignant brain tumors.
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Hui, Lai-ming Christy. "Predictors of relapse in first-episode schizophrenia and related psychosis." Click to view the E-thesis via HKUTO, 2009. http://sunzi.lib.hku.hk/hkuto/record/B41634081.
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Lettner, Ronda. "Chemical dependency and relapse prevention having fun instead of abstinence /." Online version, 2000. http://www.uwstout.edu/lib/thesis/2000/2000lettnerr.pdf.
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Chan, Kin-yi Ivy. "A study of determinants of relapse in psychotropic substance abuse /." Hong Kong : University of Hong Kong, 1995. http://sunzi.lib.hku.hk/hkuto/record.jsp?B19470757.
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Crocker, Steven M. "Hypnosis as an adjunct in the treatment of alcohol relapse." Online access for everyone, 2004. http://www.dissertations.wsu.edu/Dissertations/Fall2004/S%5FCrocker%5F122904.pdf.
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Druschke, Hannelore [Verfasser]. "Hyperferritinämie als prädiktiver Faktor für Hepatitis-C-Relapse / Hannelore Druschke." Ulm : Universität Ulm. Medizinische Fakultät, 2012. http://d-nb.info/1023728648/34.
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Thrailkill, Eric A. "Examining the Effects of Reinforcement Context on Relapse of Observing." DigitalCommons@USU, 2011. https://digitalcommons.usu.edu/etd/875.
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Attentional biases occur with various psychological disorders, including drugaddiction and anxiety. Conditioned reinforcement likely plays a role in maintainingattentional biases to stimuli associated with reinforcement for unwanted behavior. Theobserving-response procedure is considered a model of attending as reflected byresponding maintained by conditioned reinforcement. Effects of primary reinforcement on the persistence of observing have been studied in the framework of behavioral momentum theory. Studies have shown observing-responses to be more resistant tochange in contexts arranging relatively higher rates of primary reinforcement. Recently, behavioral momentum theory has been extended to describe the effects of primary reinforcement context in relapse phenomena. The present thesis aimed to extend research on the resistance to change of observing to animal models of relapse. Pigeons responded on a two-component multiple schedule of observing-response procedures. In a rich component, observing responses produced stimuli correlated with a high rate of variableinterval (VI) food reinforcement (Rich S+). In a lean component, observing responses produced stimuli correlated with a low rate of VI food reinforcement (Lean S+). Following stable performance, responding was extinguished by removing food and S+ presentations. After extinction, relapse was assessed by reinstatement tests consisting of response-independent presentations of food or S+. Replicating earlier results, observingand food-key responding was more resistant to extinction in the Rich component. Food reinstatement had no systematic effect on extinguished food- and observing-key responding. However, S+ reinstatement resulted in relapse of extinguished observingand food-key responding. Relapse during S+ reinstatement was greater in the Rich component than the Lean component. Reinstatement of responding by S+ presentations resulted in a greater overall increase in responding on the food-key relative to the observing-key. This result suggests that an important functional relationship between the presence of S+ stimuli and increased rates of primary reinforcement for food key responding remained intact during extinction. The results show that observing is susceptible to relapse, and the magnitude of relapse depends on baseline primary reinforcement rate in a context.
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Chua, Hannah Daile P. "Cleft maxillary distraction versus orthognathic surgery clinical morbidities and surgical relapse /." Click to view the E-thesis via HKUTO, 2004. http://sunzi.lib.hku.hk/hkuto/record/B31954352.
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Huang, Hai-yen. "The role of coping style and need for closure in relapse." Thesis, The University of Hong Kong (Pokfulam, Hong Kong), 2000. http://hub.hku.hk/bib/B29726888.
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