Thèses sur le sujet « Morbidité (psychologie) »

Huysmans est un romancier du XIXème siècle ayant appartenu au courant naturaliste dont la figure de proue n'était autre que celle d’Émile Zola. Cependant, son univers littéraire prendra ses distances par rapport aux canons du roman naturaliste pour explorer d'autres voies souterraines se caractérisant par la singularité et l'originalité. Il sera ainsi classé parmi les romanciers les plus représentatifs du mouvement "décadentiste", à travers notamment son roman phare " À rebours", dit "le roman de la névrose." Michel Houellebecq est un romancier français du XX-XXIème siècle, connu pour aborder, dans ses romans, des thématiques sensibles en rapport essentiellement avec le déclin de la civilisation occidentale. Ses romans (d' "Extension du domaine de la lutte" à "Sérotonine") sont axés notamment sur une analyse froide et objective de l'état de la société française (donc, par extension, occidentale) contemporaine via la mise en scène de personnages affaiblis tant psychiquement que physiquement, projetés dans une société rongée par un libéralisme sauvage et avec laquelle ils n'arrivent plus à interagir. La comparaison entre les univers littéraires des deux auteurs se fera à travers le prisme de la morbidité. En effet, tant chez Michel Houellebecq que Joris-Karl Huysmans, la morbidité c'est-à-dire les diverses manifestations de la maladie (qu'elle soit de nature psychique ou physique) est un facteur déterminant dans la construction de leurs intrigues. De plus, un mal-être récurrent semble tirailler sans cesse les personnages des deux auteurs si bien qu'il a tendance à influer directement sur leur rapport avec leurs environnements immédiats. Ainsi, leur perception du temps, de l'espace, de l'art, de la morale semble constamment imprégnée par un pessimisme permanent
The poetics of morbidity in Joris-Karl Huysmans and Michel Houellebecq novels.Joris-Karl Huysmans is a XIX th Century novelist having belonged to the naturalistic trend whose figurehead is no one other than Emile Zola's. However, his literary universe will distance itself compared to the standards of naturalistic novel to explore other underground routes characterized by peculiarity and originality, it will be then classified among the most representative novelists of the ‘decadentist' movement through, in particular his touchstone novel ‘À rebours' said ‘neurosis novel'. Michel Houellebecq is a French novelist of the XX-XXIth century, known to address, in his novels, sensitive issues related mainly to the decline of western civilization. His novels (from "whatever" to "serotonine") are focused in particular on cold and objective analysis on the contemporary French society state (thus by western extension) via the staging of weakened characters both psychically and physically, projected in a society consumed by wild liberalism and with which they cannot interact. Comparisons between the literary universes of the two authors will be done through the prism of morbidity. Indeed, both in Michel Houellebecq and Joris-Karl Huysmans, morbidity that is the diverse manifestations of the disease (whether psychic or physical) the determining factor in the construction of their intrigues. Furthermore, a recurrent malaise seems pulling constantly the characters of both authors so that it tends to influence directly their relation with their immediate environments. Therefore, their perception of time, space, art, morality seems constantly impregnated with permanent pessimism

Introduction. L’usage problématique d’Internet est un comportement à risque qui présente des critères communs avec les addictions. L’addiction à Internet a été investiguée et définie par Young qui a créé un outil de mesure encore valide aujourd’hui : l’Internet Addiction Test (1998). Les adolescents et les jeunes adultes sont considérés comme une population particulièrement à risque. L’objectif de ce travail de recherche est d’étudier les déterminants cliniques de l’usage problématique d’Internet chez l’adolescent et le jeune adulte.Méthodes. Participants. Trois échantillons seront constitués : (i) 998 adolescents et jeunes adultes (âge moyen de 17,89, ±3,83) ; (ii) 602 adolescents (15,12, ±1,23) ; (iii) 59 adolescents suivis en pédopsychiatrie (15,78, ±1,35). Outils et procédure. Les sujets ont rempli en auto-évaluation des échelles concernant l’usage et l’addiction à Internet, aux jeux vidéo, aux jeux de hasard et d’argent (jeu pathologique), à l’alimentation, l’usage de substances psychoactives (tabac, alcool, cannabis), l’exploration des traits de personnalité, des troubles anxio-dépressifs et la probabilité d’un trouble déficitaire de l’attention avec ou sans hyperactivité (TDA/H).Résultats. La première étude auprès des adolescents et jeunes adultes a permis de catégoriser l’usage d’Internet et des autres usages et addictions selon l’âge et le genre. Les usages d’Internet et des jeux vidéo diminuent avec l’âge, alors que les consommations de substances psychoactives (tabac, alcool) augmentent. La deuxième étude s’intéresse plus spécifiquement à l’usage d’Internet et à sa relation avec les traits de personnalité. Elle met en évidence que les sujets avec usage problématique d’Internet présentent des scores bas en Ouverture, Agréabilité et Caractère consciencieux témoignant de leur disposition à plus de conformisme, d’antagonisme et d’impulsivité. La troisième étude auprès des adolescents concerne les liens entre l’usage d’Internet et les troubles anxio-dépressifs. Les résultats indiquent que les adolescents avec usage problématique d’Internet présentent davantage de symptômes dépressifs et anxieux. La quatrième étude montre que, pour les adolescents avec risque de TDA/H, l’usage d’Internet est davantage problématique. La cinquième étude qui s’appuie sur une technique d’approche en clusters intégrant les facteurs cliniques, propose plusieurs profils d’usagers d’Internet. Parmi les 7 profils retrouvés, 3 concernent des sujets avec usage problématique d’Internet : (i) sans troubles associés pour le premier, en dehors du trouble du jeu vidéo ; (ii) avec des addictions aux substances psychoactives et comportementales pour le second ; (iii) avec des troubles anxio-dépressifs prévalents pour le troisième. La sixième étude analyse l’usage problématique d’Internet des adolescents suivis sur un plan clinique. Ils présentent un usage problématique d’Internet associé à un jeu pathologique (jeux de hasard et d’argent), mais peu d’usage des jeux vidéo. Par rapport aux autres adolescents, ils présentent davantage d’addictions, ainsi que de troubles anxio-dépressifs et de TDA/H. Cependant, si l’on tient compte seulement des sujets avec usage problématique d’Internet, les différences de consommations et de niveau de TDA/H ne sont plus prégnantes.Discussion et conclusion. Ce travail confirme l’intérêt de l’étude des caractéristiques cliniques comme facteurs contributifs à l’usage problématique d’Internet. Il existe des similitudes psychopathologiques de l’usage problématique d’Internet avec les autres addictions aux substances psychoactives et comportementales qui vont dans le sens de l’intégration de l’addiction à Internet dans les classifications internationales. Cette recherche a également permis l’identification de profils pour lesquels la fonction de l’addiction serait potentiellement différente. Cela ouvre des pistes pour des axes de recherche, de prise en charge et de prévention de l’usage problématique d’Internet
Introduction. Problematic Internet use is a risky behavior that shares a number of criteria with other addictions. Internet addiction was investigated and defined by Young, who created a measurement tool that is still valid today: the Internet Addiction Test (1998). Adolescents and young adults are considered to be particularly at risk. The objective of this research work is to study the clinical factors of problematic Internet use in adolescents and young adults.Methods. Participants. Three samples were constituted: (i) 998 adolescents and young adults (average age 17.89, ± 3.83); (ii) 602 adolescents (15.12, ± 1.23); (iii) 59 adolescents attending child psychiatry centers (15.78, ± 1.35). Material and procedure. Subjects completed self-report instruments related to Internet use and addiction, video game addiction, gambling (gambling disorder), food addiction, substance use (tobacco, alcohol, cannabis), personality traits, anxiety and mood disorders, and the probability of attention deficit disorder with or without hyperactivity (ADHD).Results. The first study with adolescents and young adults categorized Internet use and other uses and addictions by age and gender. Internet and video game use declined with age, while the use of psychoactive substances (tobacco, alcohol) increased. The second study focused more specifically on Internet use and its relationship to personality traits. It revealed that subjects with problematic Internet use had low scores on Openness, Agreeableness and Conscientiousness, reflecting their tendency to be more conformist, antagonistic and impulsive. The third study with adolescents examined the links between Internet use and anxiety and mood disorders. The results indicate that adolescents with problematic Internet use had more depressive and anxiety symptoms. The fourth study shows that adolescents at risk of ADHD had a more problematic use of the Internet. The fifth study, based on a cluster analysis of the clinical factors, identified 7 profiles of Internet users. Of these, 3 concerned subjects with problematic Internet use: (i) without associated disorders, apart from gaming disorder; (ii) with addictions to psychoactive substances and behavioral addictions; (iii) with prevalent anxiety and mood disorders. The sixth study analyzed the problematic use of the Internet by adolescents receiving clinical care. They had a problematic Internet use associated with gambling disorder, but little use of video games. Compared to other adolescents, they had more addictions, as well as anxiety-depressive disorders and ADHD. However, if we only consider subjects with problematic Internet use, the differences in consumption and ADHD levels are no longer significant.Discussion and conclusion. This work confirms the value of studying clinical characteristics as factors contributing to problematic Internet use. There are psychopathological similarities between problematic Internet use and other drugs and behavioral addictions, thus supporting the inclusion of Internet addiction in international classifications. This research also identified profiles in which the addiction could be serve different functions. This opens up avenues for research, care and prevention of problematic Internet use

This study was designed to identify the nature and prevalence of personality disorder within a secondary care day service and, in addition, to investigate the extent to which personality disorder was co-morbid with both Axis I and trauma symptomatology. A cross sectional survey design was used, and a total of 51 participants completed the Millon Clinical Multiaxial Inventory III, the Trauma Symptom Inventory and the SCL-90-R. The results revealed that 55 per cent of the clinical population met the study's criteria for a personality disorder, a finding that is broadly line with previous research. When these data were collapsed into the three DSM IV personality clusters, 47 per cent met criteria for the Anxious-Fearful cluster, 22 per cent for the Dramatic-Erratic cluster and eight per cent for the Odd-Eccentric cluster. The results disconfirmed the study's first hypothesis which predicted that participants meeting personality disorder criteria would have a greater level of Axis I symptomatology than other participants. This finding indicates that the two diagnostic Axes may be independent, suggesting that personality disordered individuals have an additional set of distinct needs which may not be addressed adequately by a symptomfocused approach. The results supported the second hypothesis, demonstrating that participants with a personality disorder were significantly more likely to achieve caseness on the PTSD and Self-dysfunction TSI trauma scales. Of the three personality disorder clusters, only those in the Dramatic-Erratic group were found to be significantly more likely to achieve trauma caseness. These findings lend qualified support to previous research indicating that Borderline patients have particularly high levels of trauma history. The methodological limitations are discussed, as are the implications for future research and clinical practice.

Objectives: We examined the psychological consequences of termination of pregnancy for fetal abnormality (TOPFA). The impact of individual coping styles as well as a number of obstetric factors were assessed to determine their relevance in relation to the psychological impact of this event Additionally, when faced with health related decisions, individuals will have an idea about the level of input or control they wish to take (control preference).We aim to explore whether disparity between an individual’s control preference and their perceived levels of control in relation to a) their decision to terminate and b) by which method increased their levels of distress. Design, Setting & Sample: A cross-sectional cohort study was performed on a community sample of 122 women who had terminated a pregnancy for fetal abnormality. Methods & Outcome Measures; The construct of control preference for health related decisions was assessed in the context of a TOPFA. This, obstetric factors, social support, and coping style (predictor variables) were used to investigate psychological outcome on standardised questionnaires which measured depression, anxiety, grief, and post-traumatic symptoms. Four parallel hierarchical regression models were developed. Results: Termination of pregnancy for fetal abnormality is associated with a range of symptoms on standardised measures of psychological morbidity. Clinically relevant determinants included social support and a range of coping styles, namely: denial, behavioural disengagement, self-blame and acceptance (protective). Conclusion: Coping is a psychological construct of significant importance within the context of TOPFA. Behavioural disengagement, denial and self-blame all predict worse outcome. In contrast good social support and coping through acceptance predict better outcome on standardised questionnaires which measured depression, anxiety, grief, and post-traumatic symptoms.

Bibliography: leaves 150-167.
A broad age-range community study was undertaken to estimate the base-line prevalence of mental disorder in the adult population of Mamre. The study further undertook to investigate a possible association between mental disorder and specified socio-demographic variables; to obtain basic information on health care utilization and attitudes to health services currently available in Mamre; and to investigate the validity of the Self Reporting Questionnaire (SRQ) (Harding et al., 1980) as a first-stage screen in a community sample in the South African context. The general population of Mamre, a "coloured" community of approximately 5000 and presently undergoing transition from rural to urban status, was selected for study as there was an indication of a high rate of mental disorder among clinic attenders (Miller et al., 1991). Using a cross-sectional descriptive study, prevalence was estimated in a two-stage design in which the SRQ was selected as the first-stage screen and the Present State Examination (PSE, 9th ed.) (Winget al. 1974) as the second-stage criterion or gold standard. Both instruments have been used extensively in Africa (Parry, 1992), and both have been translated into Afrikaans.

The mild head inured population accounts for 80 per cent of all head injuries and whilst research has identified no neurological abnormalities, this population still report to experience functional impairment. The current study set out to explore the biopsychosocial factors that could exacerbate the symptoms of mild head injury. In this respect, the study looks at the relationship between post concussion symptoms, social ability, psychological morbidity and coping style using the Rivermead Post-concussion symptoms Questionnaire, the Multidimensional Scale of Perceived Social Support, the Hospital Anxiety and Depression Scale and the COPE questionnaire. Questionnaires were sent out to 138 individuals at 6 months post injury to identify relationships between coping style, post concussion symptoms, social support and psychological morbidity. 32 respondents completed and returned the questionnaires. Post concussion symptoms were positively related to social support, depression and anxiety. Active coping was found to be negatively related to post concussion symptoms whereas emotion focused and avoidant coping were positively associated with post concussion symptoms. The results of the study suggest that in order to improve symptoms of mild head injury practitioners must address symptoms of depression and anxiety, in addition to promoting a more productive coping style.

Transportation-related collisions are ubiquitous and often traumatic. Identifying post-collision psychological distress and the characteristics of the collision survivor that lead to distress are vital to the development of early and appropriate interventions. The goals of this study were: 1) to use a questionnaire as opposed to a typical diagnostic interview, 2) to confirm that psychological distress is present in currently hospitalized transportation-related collision survivors, 3) to confirm that different types of distress co-occur, 4) to determine if distress is more likely to occur in those who have had prior distress, and 5) to explore the relationship between symptoms of distress and perception of control by self, others, and God/Higher Power of past, present, and future collision-related events. Subjects were 100 English speaking adult inpatients, 16 years and older, who were less than 3 weeks post-injury, and receiving some rehabilitation. Participants completed a questionnaire which included the Center for Epidemiologic Studies Depression Scale (CES-D), Beck Anxiety Inventory (BAI), and Davidson Trauma Scale (DTS) as well as questions regarding demographics, details of the collision/injury, alcohol/drug use, pain, past and present stressors, social support, and perceptions of life change. Information about head injury and collision-concurrent alcohol and/or drug use was collected from the patient's medical chart. Compared to other traumatic experiences (e.g., physical/sexual abuse, war combat), transportation-related collisions share the characteristics of being sudden, unexpected, relatively brief in duration, and potentially lethal. Prior studies used diagnostic interviews to identify psychological distress in post hospitalized collision survivors. This study used questionnaire-based depression, anxiety, and trauma symptom inventories in a currently hospitalized sample and included head injured patients. As hypothesized there was a significant correlation between the CES-D total score and the BAI total score [Hypothesis 1], the DTS total score [Hypothesis 2], and collision concurrent alcohol and/or drug use (as indicated by medical chart records or score on the CAGE) [Hypothesis 3]. Further, there was a significant correlation between the patient's self-reported history of depression, anxiety, or stress reaction and CES-D, BAI, and DTS total scores, respectively [Hypothesis 4]. Also as hypothesized, perceived personal control of the past "events that caused the collision" was significantly correlated with the CES-D total score [Hypothesis 5] while perceived control of the present "life in general right now" was negatively correlated to the CES-D total score [Hypothesis 6]. Contrary to hypothesis, perceived control of the present "recovery process right now" was not correlated to the CES-D total score [Hypothesis 6] nor was perceived control of the future "preventing a collision like this from happening...again" [Hypothesis 7]. Perception of control by "others" of the present "recovery process right now" was negatively correlated to the CES-D total score. Results support the theory that perceived personal control of past traumatic events increases the likelihood of psychological distress. Some evidence of post traumatic growth was found.

Rationale. Alcohol use disorders (AUDs) and tobacco dependence are frequently identified as co-morbid. Although less than 20% of the general population smokes, over 80% of people with AUDs are considered daily smokers. In fact, people with AUDs are more likely to die from smoking-related health issues, than from alcohol related health issues. Surprisingly, there is very little evidence that alcohol and nicotine are concurrently self-administered in pre-clinical models. We hypothesized that low doses of nicotine that enhancing responding for other rewards would be self-administered and enhance self-administration of alcohol. Objective. The goal of this study was to determine if low-doses of nicotine, typically not self-administered alone, would promote alcohol self-administration in a concurrent access paradigm. Method. Alcohol preferring rats (females) were requested from the University of Indiana Medical School breeding facility. They were randomly assigned to one of three groups – NIC-Alone, ALC-Alone, or ALC+NIC. All rats were fluid restricted and shaped to lick for water at two sipper tubes that could record lick responses and deliver aliquiots of fluid into the sipper tube via a solenoid valve. After shaping, rats were instrumented for IV self-administration. During self-administration tests, rats in the ALC-Alone received access to oral ethanol (15% v/v) for meeting the schedule of reinforcement at one sipper tube (e.g., right) and saline infusions for meeting the schedule of reinforcement at the other sipper tube (e.g., left). The NIC-Alone group received IV nicotine infusions (15 ug/kg/inf) and oral licorice (1%) for meeting the schedule of reinforcement at one sipper tube (e.g., left) and oral water for meeting the schedule of reinforcement at the other sipper tube (e.g., right). The ALC+NIC group received IV nicotine and oral licorice for meeting the schedule of reinforcement on the left sipper, and oral ethanol for meeting the schedule of reinforcement on the right sipper. Price manipulations for nicotine were performed by adjusting the schedule of reinforcement on the sipper associated with nicotine infusions. Results. During acquisition, nicotine did not enhance alcohol self-administration – alcohol intake was comparable between ALC-Alone and ALC+NIC rats. In addition, alcohol did not enhance nicotine self-administration as responding for NIC was comparable between ALC+NIC and NIC-Alone rats. However, when the price of nicotine was manipulated, alcohol created a greater demand for nicotine, as indicated by higher rates of nicotine consumption with increases in price. Manipulating the price of nicotine did not alter demand for alcohol. Conclusion. The interaction between alcohol and nicotine reinforcers may depend on changes in demand for nicotine. Future studies should investigate whether demand for alcohol is altered by concurrently available nicotine infusions. *the first and second authors contributed equally to this project

Objective: Polycystic ovary syndrome (PCOS) is a multidimensional endocrine disorder and the leading female infertility. PCOS is characterized as a clustering of clinical concerns, which include hyperandrogenism, obesity, and menstrual abnormalities/infertility. These characteristics were examined with regard to their impact on women's psychosocial concerns and health related quality of life. Design: Cross-sectional, correlational Setting: Private endocrinology practice in the rural Southeastern U.S. Participants: The study sample consisted of 126 women with PCOS. Methods: Convenience sampling yielded 126 subjects who met the diagnosis for PCOS, underwent laboratory testing and physical assessment, completed psychological and quality of life survey instruments and were included in data analysis. Results: Results of multiple regression analyses, controlling for demographic covariates, were completed on markers of hyperandrogenism, obesity and current fertility intent. Findings revealed hirsutism was significantly related to increased symptoms of anxiety and somatization and decreased quality of life among women with PCOS, while elevated androgen levels were significantly related to decreased quality of life. Current fertility intent significantly impacted symptoms related to interpersonal sensitivity, anxiety, psychoticism, and the global symptom severity index. Specifically, women not currently trying to conceive had higher levels of these psychological symptom outcomes. Conclusion/Implications for nursing practice: Women with PCOS are at elevated risk for psychological distress, and psychological symptoms appear to increase with increasing severity of PCOS symptoms. Women not currently trying to conceive appear to be at higher risk for psychological distress and lower quality of life.

Includes bibliographical references.
This study reports upon the point prevalence of possible minor psychiatric morbidity in students attending the Student Health Service at the University of Cape Town. It also establishes the prevalence of exposure to trauma, Posttraumatic Stress Disorder and substance abuse (alcohol and drugs) and assesses adjustment to university as well as financial and academic coping. Relationships amongst variables of interest are examined. The study establishes, also, a detection rate of minor psychiatric morbidity by medical personnel. The findings of this study are related to mental health services for students at the University of Cape Town as a whole. Using a cross-sectional design, a questionnaire containing the Self-Reporting Questionnaire (SRQ-25) was administered to students attending the general health services of the Student Health Service over a 3 week period (N=515). Since this is a pilot study, no second stage criterion was administered. Clinical staff (nurses and doctors) attending to the student sample were asked to complete a brief questionnaire. Data was analysed using descriptive statistics and chi-square analysis.

Background: The scope of postpartum pelvic dysfunction and perineal trauma is under-researched. Instrumental vaginal delivery or 3rd/4th degree tears were recognised risk factors for pelvic/perineal dysfunction; caesarean delivery was not implicated. Aims: • To analyse obstetrical/biological factors associated with pelvic dysfunction after caesarean or non-instrumental vaginal delivery • To compare these associations between groups after determining frequencies • To evaluate severity of pelvic/perineal dysfunction, including quantifying maternal perception of the psychosocial impact Participants and Methods: 284 primiparae (184 caesarean, 100 vaginally delivered) had domiciliary, in-depth medical interviews using structured and open questioning. Results: Caesarean (elective, emergency) vs. vaginally delivered were compared: Stress incontinence manifested in 60/184 (33%, 33%) vs. 54/100 (54%), anal incontinence in 94/184 (53%, 50%) vs. 44/100 (44%), dyspareunia in 50/184 (28%, 27%) vs. 46/100 (46%), haemorrhoids in 3/184 (2%) vs. 5/100 (5%) and double incontinence with dyspareunia in 33/284 (14%, 10% vs. 12%). Sixty sustained perineal trauma. Delivery mode and non-labour factors were predictors. Severity was evaluated by devising a psychosocial measure tailored to maternal functioning. New faecal incontinence necessitated continuous perineal protection in two pre-labour caesarean and one vaginally delivered mother. Severe dysphoria was associated with incontinence (p=0.038, OR 2.334, CI 1.049, 5.192), dyspareunia (p=0.005, OR 2.231, CI 1.272, 3.914) and post-caesarean wound problems (p=0.022, OR 3.620, CI 1.203, 10.896). Incontinence impaired leisure activities (p=0.036, OR 2.165, CI 1.051, 4.463) and employment (p=0.023, OR 1.912, CI 1.093, 3.345); caesarean mode affected social-networking (p=0.018, OR 2.438, CI 1.166, 5.099) and employment (p=0.031, OR 1.967, CI 1.064, 3.636). Conclusions: Pelvic/perineal dysfunction was: ▪ Predicted by caesarean or non-instrumental vaginal delivery, with anal incontinence being more prevalent post-caesarean ▪ Comparable following elective or emergency caesarean ▪ Associated with severe and quantifiable biopsychosocial maternal morbidity.

Research has demonstrated that problem gambling is associated with substance and alcohol abuse (Petry, Stinson, & Grant, 2005), participation in criminal activities (McCorkle, 2002; Meyer & Stadler, 1999), and involvement in the criminal justice system (NORC, 1999). This study assessed problem gambling and its relation to crime and substance use within a population in which these risk factors are compounded: Adults mandated to participate in drug and DUI courts. Results indicate that the prevalence and severity of problem gambling may be higher within this population than any other. Furthermore, the results of qualitative and quantitative analyses converged to highlight that gambling, crime and substance use are interrelated behaviors, as each may lead to and/or reinforce the other. These findings suggest that problem gambling is a salient issue among substance-abusing offenders and that resources should be dedicated to screening those involved with the criminal justice system for problem gambling, establishing evidence based best practices in the prevention and treatment of problem gambling within this population, and that such practices may incorporate components addressing gambling, crime, and substance use.

Den sociala ångesten många känner i olika situationer kan leda till undvikande, isolering och ibland även kompliceras av depressiva symtom och/eller alkoholanvändning. Huruvida ett samband mellan dessa problem kan visa sig i 16-17 årsåldern undersöktes genom en enkät om nedstämdhet, alkoholanvändning och social ångest. Resultatet visade att nedstämdhet hade en inverkan på grad av social ångest hos båda könen. Dock var tjejer i högre grad än killar mer nedstämda. Tjejer som drack mindre uppvisade en högre grad av social ångest. Alkoholanvändning hängde inte ihop med killars hantering av social ångest. Resultatet tyder på att samband mellan variablerna kan visa sig tidigt. Därför borde resurser sättas in tidigt för att förhindra en negativ utveckling, så att personer kan fungera i samhället.

The social anxiety many people feel in different situations can lead to avoidance, isolation and be complicated with depressive symptoms and/or alcoholuse. Whether it’s possible to find relationships between these syndromes in age 16-17 was investigated through a survey about depression, alcoholuse and social anxiety. The result showed that depression had an impact on level of social anxiety for both sexes. Gals were more depressed than guys, though. Gals who drank less had a higher level of social anxiety. Alcoholuse had no impact in coping with social anxiety for guys. The result showes a connection between the variables that can be seen early. Therefore, resources should be available to prevent a negative development, so that people can function in society.

Background: Little is known about the experience and psychological outcomes for women who experience emergency peripartum hysterectomy (EPH). The objective of this study was to explore women's experiences of EPH and to determine if women who experience EPH were more likely to experience mental health sequelae. Methods: This mixed method design involved a quantitative and a qualitative phase. The quantitative phase used a retrospective cohort design. Women were sampled through on-line communities, including an EPH support group, and a larger website for mothers. Women completed on-line surveys covering sociodemographic, obstetric/gynecological/ and psychiatric information, including screens for depression and Post-Traumatic Stress Disorder (PTSD). Logistic regression was used to calculate the independent risk that exposure to EPH has on screening positive for PTSD. Participants from the EPH support group who completed the on-line interview were then selected to participate in the second phase. In-depth telephone interviews were conducted and analyzed using Constant Comparative Analysis. Results: 74 exposed women and 355 non-exposed women completed the survey. In the adjusted logistic regression model, women who experienced EPH were over 6 times more likely to screen positive for current PTSD compared to women who did not experience EPH (adjusted Relative Risk (aRR): 6.76; 95% CI: 4.24, 8.88). When women recalled their psychological state at 6 months postpartum, exposed women were 11 times more likely to screen positive for current PTSD (aRR: 11.35; 95% CI: 8.43, 12.95). In the qualitative phase, 15 women participated and 7 major themes were identified: fear, pain, death and dying, numbness or delay in emotional reaction, bonding with baby, communication and the need for information. A major finding is the need for additional follow-up visits to address the emotional after-effects and to fill in gaps in women's understanding and memory of what had occurred. Conclusion: Understanding women's experiences and sequelae can help providers address not only women's initial complications but provide needed long-term support.

Chapter 2 evaluates the effectiveness of two simple and widely applied self-report psychometric questionnaires: the 12-item General Health Questionnaire (GHQ-12) and Beck Depression Inventory (BDI) in detecting psychological morbidity after miscarriage. Both GHQ-12 and BDI demonstrated satisfactory psychometric properties and both questionnaires were found to be effective in detecting general psychiatric disorders and depression respectively.
Chapter 3 reports the application of GHQ-12 and BDI in assessing the psychological well-being of 280 miscarrying women over a one-year longitudinal course after the loss. The psychometric outcomes were also compared with a community cohort unexposed to pregnancy loss. The study confirmed that although psychological distress reduces over time, the psychological impact following miscarriage is significant and could be enduring. Patients who were more distressed immediately after miscarriage continued to be at a higher risk of psychological morbidity at a later stage.
Chapter 4 assesses the possible underlying risk factors associated with psychological morbidity following miscarriage over a one-year longitudinal course. It has demonstrated that while a poor marital dyad and psychological distress experienced immediately after miscarriage are consistent predisposing factors, some obstetric variables such as the type of medical management, a history of abortion and prior ultrasound evidence of fetal viability contribute to the development of psychological morbidity at various time points along its evolutionary course.
Chapter 5 reports a randomised controlled trial involving 280 miscarrying women in assessing the effectiveness of a psychological counselling programme in reduction of psychological morbidity. A 30% reduction in the proportion of patients with psychological morbidity was found three months after miscarriage in the counselling group, suggesting a potential clinical beneficial effect, albeit not statistically significant. This potential effect was more profound for selected patients who were initially more distressed after miscarriage.
Chapter 6 reports our exploratory findings of the psychological reaction of 83 male partners after miscarriage and it reports the gender differences over a one-year longitudinal course. A significant proportion of men were found to report psychological distress and depressive symptoms immediately after miscarriage. When compared with their female partners, the psychological impact was less intense and less enduring.
Chapter 7 concludes the thesis and proposes directions for future research.
Miscarriage (spontaneous abortion) is the most common complication of pregnancy with 15-20% of clinically recognised pregnancies aborting spontaneously. It is also one of the commonest gynaecological conditions leading to hospitalisation, accounting for more than 10% of gynaecological admissions in Hong Kong. The common occurrence and the procedural simplicity involved in the medical management, however, may tend to obscure its psychological impact. While emerging evidence has suggested that miscarriage could be associated with significant and possibly enduring psychological consequences, many questions remain unanswered, such as how to detect and screen for psychological morbidity after miscarriage; how long the symptoms last or when do they resolve; what are the underlying risk factors throughout its longitudinal course; what is the psychological impact on the male partner; and whether psychological intervention is helpful. In addition, nearly all studies have been conducted in Caucasian societies with the effect on other ethnic groups remaining largely unexplored.
This thesis specifically addresses the following aspects in assessing and managing psychological morbidity following miscarriage: Chapter 1 firstly introduces the clinical aspects of miscarriage, including the definition, incidence, risk factors, clinical manifestations and the current management options. It then discusses the current evidence available on the psychological aspects of miscarriage and outlines the deficiency in current knowledge. Finally, the hypotheses for this thesis are proposed.
Lok Hung Ingrid.
"May 2006."
Source: Dissertation Abstracts International, Volume: 68-03, Section: B, page: 1567.
Thesis (M.D.)--Chinese University of Hong Kong, 2006.
Includes bibliographical references (p. 248-276).
Electronic reproduction. Hong Kong : Chinese University of Hong Kong, [2012] System requirements: Adobe Acrobat Reader. Available via World Wide Web.
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Le présent projet doctoral a pour objectif d'évaluer l'effet des troubles de l'humeur et anxieux sur la sensibilité de certaines méthodes d'investigation cardiovasculaire, ainsi que sur la morbidité cardiaque et la mortalité générale. Plus spécifiquement, la présente thèse sert à évaluer l'impact des troubles anxieux sur les résultats d'examens diagnostiques de l'ischémie myocardique, obtenus à l'aide de deux méthodes d'investigation différentes. Elle permet également d'évaluer si la présence d'anxiété influence la performance des patients lors de leur test à l'effort, ainsi que la réactivité cardiovasculaire de ces patients en réponse à l'activité physique. Dans un deuxième temps, cette thèse a pour but l'examen des relations prospectives des troubles de l'humeur et des troubles anxieux avec l'occurrence des événements cardiovasculaires majeurs et avec la mortalité générale. De façon à mettre en contexte et à rendre compte du travail effectué et des résultats obtenus, la thèse est divisée en cinq chapitres. Le premier chapitre sert à situer le lecteur par rapport à la problématique relative aux maladies cardiovasculaires et à faire état des résultats antérieurement rapportés, pertinents aux objectifs de recherche. Les limites attribuables à ces études antérieures, les objectifs, ainsi que les hypothèses de la thèse y sont également exposés. Le deuxième chapitre relate quant à lui les méthodologies exhaustives utilisées aux fins des deux études dont il est par la suite question aux chapitres trois et quatre. Finalement, une discussion générale concernant les principaux résultats de la thèse, les implications cliniques associées, les forces et faiblesses des deux études effectuées, l'état des connaissances quant au traitement des troubles de l'humeur et anxieux chez les patients cardiaques et des pistes de recherches futures constituent le cinquième et dernier chapitre. De façon globale, les résultats exposés dans le premier article indiquent que la présence des troubles anxieux, lors de l'ajustement du modèle statistique en fonction des troubles de l'humeur, n'influencerait pas le dépistage de l'ischémie myocardique à l'aide de l'ECG. Aussi, les patients anxieux performeraient de façon équivalente aux patients sans trouble d'anxiété lors du test à l'effort. Les troubles anxieux seraient toutefois associés à une réactivité cardiovasculaire amoindrie et ce, même lors de l'ajustement du modèle en fonction de la présence des troubles de l'humeur. Considérés de façon globale, les résultats antérieurement présentés par notre équipe, ainsi que ceux présentés de la cadre du premier article permettent de penser que les pratiques de référence des patients à des fins d'investigation cardiovasculaire devraient être adaptées en fonction de la présence des troubles de l'humeur chez les patients concernés, alors que la présence des troubles anxieux importerait peu. Ils suggèrent également que les troubles anxieux seraient associés à un dérèglement au niveau du système nerveux autonome. Les intervenants médicaux devraient donc considérer à la fois le traitement des atteintes psychiatriques et autonomes lors du choix des méthodes d'intervention curatives et/ou préventives au niveau cardiovasculaire. Quant aux résultats rapportés dans le cadre du deuxième article, ils suggèrent de façon générale que les patients présentant un trouble de l'humeur seraient significativement plus à risques de mortalité au cours des neuf années suivant leur évaluation psychiatrique, que les patients non dépressifs au niveau de base. De plus, les troubles de l'humeur seraient particulièrement nocifs pour les patients sans MCV au niveau de base, puisqu'ils augmenteraient leurs risques de mortalité générale de plus de quatre fois et ce, indépendamment de la présence des troubles anxieux et d'autres importants facteurs de risques non traditionnels des maladies chroniques telles que le cancer et les MCV. De leur côté, les troubles anxieux considérés en ajustant le modèle d'analyse en fonction des troubles de l'humeur ne constitueraient pas un facteur de risque significatif quant à l'incidence de la mortalité et ce, peu importe le statut cardiaque des patients. Ceci suggère que le dépistage et la prise en charge des troubles de l'humeur, plutôt que des troubles anxieux, doivent impérativement être améliorés et faire partie intégrante des pratiques médicales en contexte de soins primaires et tertiaires. Ainsi, à la fois les professionnels médicaux et les professionnels de la santé mentale se doivent de travailler de façon conjointe afin d'être en mesure d'identifier les patients présentant un risque médical élevé et surtout, afin d'être en mesure de fournir à ces patients les services préventifs et curatifs appropriés. ______________________________________________________________________________ MOTS-CLÉS DE L’AUTEUR : Troubles de l'humeur, Troubles anxieux, Dépistage, Ischémie myocardique, ECG, SPECT, Morbidité cardiovasculaire, Mortalité, Maladie coronarienne artérielle

There is a paucity of research on the mental health of asylum-seekers, particularly in comparison with refugee and migrant populations. Yet asylum-seekers occupy a vulnerable place in our community. After applying for a protection visa upon arrival in the host country, asylum-seekers frequently endure uncertainty for a protracted period as they traverse the Refugee Determination Process (RDP). The RDP in Australia and other Western countries can take years. Furthermore, asylum-seekers face psychosocial difficulties including numerous barriers to employment and access to health services, which can precipitate or perpetuate mental health problems. Despite this, little research has been undertaken with asylum-seekers negotiating the RDP, particularly studies employing a prospective design.