Psychiatry - Theses
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ItemA comparison of homocysteine levels in first episode psychosis patients and age matched controls( 2007)Elevated serum homocysteine concentrations are neurotoxic and are strongly implicated as a risk factor for neuropsychiatric disease (Fabender, Mielke, Bertsch, & Hennerici, 1999; Kim & Pae, 1996; Kruman et al., 2000; Reutens & Sachdev, 2002). This study compares homocysteine levels in early stages psychosis patients and healthy controls. Data from 48 healthy controls were compared with 50 previously diagnosed psychosis patients, 15-25 years, and with a gender ratio males: females 7:3. Patients were outpatients or inpatients at ORYGEN Youth Health, with a diagnosis of first episode of psychosis defined as daily psychotic symptoms lasting longer than a week that could not be explained by other means such as “drug-induced” or “organic”. All subjects were interviewed to collect information relating to family psychotic history. A possible history of psychotic disease in control subjects was tested using the SCID Psych Screening Module, drug use recorded using Alcohol Use Disorders Identification Test (AUDIT) (for alcohol use), The Modified Fagerström Tolerance Questionnaire (mFTQ) (for smoking), Opiate Treatment Index (OTI) (for opiate-type drugs). Dietary and medication histories were also taken. Blood tests were performed to determine serum homocysteine, serum folate, red blood cell folate and serum vitamin B12 levels. An independent sample t test to compare homocysteine levels in patients and controls was performed. Serum homocysteine levels were significantly higher for patients (M = 12.9, S.D. = 3.6) than controls (M = 11.1, S.D. = 2.7) (t(96) = 2.7, p = 0.007, two-tailed). After General Linear Model (GLM) analysis it was found that group (patients or controls), and not serum folate, vitamin B12 and the T allele of MTHFR C677 polymorphism had significant effect on homocysteine levels. Thus a number of factors that may increase homocysteine levels were ruled out. Although it was not possible to obtain a complete data set for some factors (alcohol, smoking and caffeine consumption) (a weakness of the study), strengths included consecutive recruitment, minimisation of selection bias, good matching for age and gender between patients and controls, and the consideration of (serum) folate and (serum) vitamin B12 as potential confounding variables. A number of other studies have found significantly increased homocysteine levels in young patients compared with controls, particularly males. Most related studies favoured the homocysteine-psychosis link. The probability of symptomatic recovery is very high (80-90%) after treatment for first episode psychosis (Robinson et al., 1999) and delayed treatment, but prolonged duration of treatment is associated with poorer response in treatment and worse outcome (Malla & Norman, 2002). This justifies studying homocysteine levels and cognitive function in that first period of psychosis. This research offers evidence for the importance of serum homocysteine levels as showing involvement in the etiology of psychosis. Lowering homocysteine may have a beneficial effect on symptoms and cognitive dysfunction in psychotic illness. Two randomised controlled trials have demonstrated benefit in psychotic illness of giving folate and consequently reducing homocysteine.(Godfrey & Toone, 1990; Levine et al., 2006b). Benefits of taking folate were found in both trials for both cognition and psychotic symptoms. By reducing homocysteine levels early in the illness, some of the excess cardiovascular mortality may be prevented. Secondary prevention of CVD does not appear to influence outcome (Hermann, Herrmann, & Obeid, 2007), so the right time to intervene and reduce risk would appear to be early in the course of psychosis. Additionally, by lowering homocysteine cognitive functioning and psychotic symptoms may be improved (Levine et al., 2006b).
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ItemWhat are the special characteristics of families who provide long term care for children of parents with mental illness?( 2003)This project investigated characteristics relating to family functioning and attitudes to mental illness, and caregiving, which distinguish families choosing to care for children of parents with mental illness (CPMI) from families who choose not to but do care for other children (NCPMI), and from families not involved in the adoptive care system (COMM). Welfare agencies seeking long term home based care for children of parents with mental illness (among other groups of children) report that potential caregivers are concerned about the child’s genetic risk, and the requirement that they facilitate access visits with the birth parent. Consequently it is more difficult to recruit caregivers to care for children of parents with mental illness. Previous studies found that families who adopt children with special needs had family systems that were flexible and able to adapt to changing needs, and in which family members felt close to one another. It was not known if the functioning of families who care for children of parents with mental illness would differ from other family groups. Nor was it known if these families would differ in motivation to be caregivers and attitudes to mental illness from other family groups. Forty four families completed a questionnaire providing background information, and a family functioning questionnaire which included the FACES II measure (Family Adaptability and Cohesion Evaluation Scale) and questions assessing level of altruism, and tendency to respond in a socially desirable manner. Data from the FACES II measure was used to classify families according to the Circumplex Model of Marital and Family Systems. Q-methodology was used to assess participants’ attitudes to eight issues related to the research question: mental illness, children of parents with mental illness, parents having a mental illness, family environment, motivation to be caregivers, ongoing contact between child in care and parent, approval of others when deciding to be a caregiver, and flexibility in deciding to accept a certain child for placement. The Q-method required participants to rate 42 statements (a Q-set), concerning these issues, according to a fixed distribution, from statements with which they strongly agreed to statements with which they strongly disagreed. Participants could also give open-ended responses to questions addressing the same issues in a semi-structured interview. The CPMI group were found to have a lower level of income and education than the other two groups, and were more likely to be full time caregivers. Both caregiver groups were unlikely to have children of their own. The profiles of the three groups on the cohesion and flexibility sub-scales of FACES II were similar. The classification of the family groups on the Circumplex model showed that the CPMI group were located in the balanced and mid-range levels of the model more so than the other two groups. Responses to the Q-sort and interview questions suggested that the CPMI families were more understanding of mental illness, and of the needs of the children and capacity of their parents. It is suggested that future studies increase the number of participants, and investigate in more detail the factors which motivate families who provide long term care for children of parents with mental illness.
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ItemCulture and stigma towards mental illness: a comparison of general and psychiatric nurses of Chinese and Anglo-Australian backgrounds( 2007)A sample of 208 nurses (a response rate of 63%) participated in a study by responding to a questionnaire comprising of 170 items which examined nurses’ attitudes towards mental illness, and the association between contact, cultural values, general and practice stigma. General stigma refers to attitudes towards the mentally ill while practice stigma is informed from differential clinical practice approaches towards the care of two case vignettes describing a patient with mental illness and one with diabetes. Subjects were recruited using the snowballing technique and comprised of nurses (83 Anglo Psychiatric, 41 Anglo General, 49 Chinese Psychiatric and 35 Chinese General) currently practising in Victoria. Age ranged from 21 to 65 years. Principal components analyses were conducted on items to develop subscales related to individualism and collectivism, contact types, general and practice stigma. Analyses of variance and covariance were conducted to examine differences between nurse type and ethnicity and respectively, to account for possible differences in background, contact and in the case of practice stigma, general stigma. The key findings revealed differences according to nurse type and ethnicity in several of the subscales. Psychiatric nurses endorsed a higher level of contact than general nurses with mentally ill people on the variables ‘Contact Through Work Situation’, ‘Patient Help Nurses’ and ‘External Socialisation with Patient’, but not on the variable ‘Relative With Mental Illness’. By virtue of more contact, psychiatric nurses also endorsed less general stigma than general nurses, assessed by results from analysing social distancing, but not by negative stereotyping of people with mental illness. With respect to practice stigma, while care and satisfaction did not differ according to patient type and nurse type, psychiatric nurses expressed less authoritarianism and negativity than general nurses towards the mental illness case than general nurses while lesser differences between nurse types were evident for the diabetes case. Chinese nurses when compared with Anglo-Australian nurses, endorsed more highly collectivist values measured by the variables ‘Ingroup Interdependence’ and ‘Ingroup Role Concern’ but there was no difference in individualist values. This may reflect acculturation towards Western values but also retention of Chinese values, interpreted in the light of other results on cultural affiliation, as a bicultural position. Chinese nurses endorsed more highly general stigma towards the mentally ill than Anglo nurses when statistically controlling for differences in background demographics and contact factors. Nursing satisfaction did not differ in ethnicity and patient type. Chinese nurses endorsed more highly care and authoritarianism in their clinical practice approaches than Anglo-Australian nurses, although there was no significant interaction effect between ethnicity and patient type on care and authoritarianism. Chinese nurses endorsed more highly negativity than Anglo-Australian nurses for the mental illness case than the diabetes case, an effect later shown to be mediated by differences in general stigma between the two ethnic groups. Within the Chinese sample, higher contact was associated with lower differential negativity for the mental illness than the diabetes case. Several path analyses suggested Chinese values influenced differential negativity, mediated by general stigma and prior diversified contact with people having a mental illness. It may be concluded from these results that practice stigma is related to cultural values but the relationship is mediated by general stigma and contact. What aspect of the Chinese values specifically correlates with general stigma remains a question for further research, but several possibilities are discussed.