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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ItemSemantic change in psychiatric categories: the case of DSM-III( 2007)Psychiatric terminology has undergone a number of significant shifts over time. These have reflected broader social circumstances surrounding mental illness. One of the biggest upheavals was publication of the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III) in 1980, which created a strictly defined categorical system of diagnostic labels. A framework from historical sociolinguistics, proposed by Weinreich, Labov and Herzog (1968), has been used to investigate this change. Three terms were analysed in detail – Schizophrenia, Bipolar Disorder and Panic Disorder – and were found to have very different histories leading up to DSM-III. The Weinreich et al. framework is evaluated for its utility in this type of complex semantic change, and is found to be effective with some minor modifications. Broader effects of language on shaping perceptions of mental illness are also briefly sketched.
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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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ItemMasculinities in local contexts: structural, individual and cultural interdependencies( 2006-06)Knowledge of the terms sex and gender has important political, health and equity considerations. This thesis investigates the macrostructural assertions of Connell’s social theory of gender which is fundamentally concerned with demonstrating the relational and hierarchical nature of gender. A major criticism of the theory has been its lack of account of the individual and the ways in which gender is performed in local settings. Therefore, investigation primarily concerns whether Connell’s macrostructural theory is explicable in local social contexts. A theoretical critique and reframing of the theory lead to articulating the interdependency between structural, cultural and individual factors. By explicitly stating Connell’s implicit assertions, what becomes evident is that people’s gendered relations are interrelated with beliefs which are held personally and shared culturally. Specifically, a major theoretical impasse is overcome when recognising that the “ideology of supremacy” of a dominative masculinity is necessarily interdependent with the structural relations of power. From here I have suggested that there are particular patterns of these structures and beliefs which can be seen in macrostructural terms, but also in local settings. These hypotheses are reframed into social network terms for an empirical investigation of Connell’s theory in local contexts. To determine whether the predicted hypotheses for Connell’s theory occur at greater than chance levels, a particular type of statistical model for social networks, called exponential random graph (p*) models, is employed. Importantly, such models utilize a methodological approach which specifically acknowledges the interdependency of structural, individual and cultural factors, thus aligning Connell’s theory with the method of investigation. Primarily, Connell’s theory is concerned with differing configurations of masculinity, and for this reason my focus is predominantly on males and their relations with one another. To this end, two general local settings were chosen to explore these issues – secondary schools and all-male elite-level (AFL) sporting teams. Social network models were used to examine the relations between masculinities in six schools and four AFL clubs. Importantly, Connell has suggested that local contexts are likely to differ from one another in the degree to which they support gendered relations of power. Results for schools and clubs vary considerably from one another in the ways in which they provide local level support for Connell’s theory. Significantly though, there are some contexts which do show support for Connell’s theory. That such evidence can be found to endorse specifically defined local-level predictions for Connell’s theory, even when controlling for complex micro-level social structures, and also for other individual level effects, and still produce statistically significant effects supporting these predictions suggests that support is not trivial. There is strong evidence that attitudes towards masculinity can be an important organising principle in the emergence of hierarchy, not universally, but in some contexts. It can be concluded that gender relations tend to operate in ways predicted by Connell’s theory, though local context is particularly important. The specific findings from local social contexts do have wider implications for Connell’s theory, including how hierarchy in gender can be tied to other structures of power, where femininities fit into the theory, a more precise account of hegemony and an exploration of the impact culture has in local settings.
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ItemThe effects of immigration and resettlement on the mental health of South-Asian communities in Melbourne( 2006-02)This research explores the relationship between immigration experiences and psychological well-being within the Indian and Bangladeshi communities in metropolitan Melbourne, Australia. The researcher conducted individual in-depth interviews with thirty-eight adult Australian permanent residents/citizens born in India and Bangladesh with the aim of examining personal post-migration accounts of adjustment, acculturation and coping in a foreign society and the effect on their mental health. Through qualitative analysis, the personal experiences and stories of South-Asian migrants and the psychological consequences of resettlement in Australia are explored. The study investigated coping strategies and psychosocial protective mechanisms and explored factors relevant to both successful and unsuccessful resettlement, and their relationship to psychological well-being. The results indicated that social and emotional disconnection, isolation and alienation, lack of recognition of professional skills, experiences of racism and discrimination, cultural incongruity, feelings of cultural uprooting and inadequate English language competency, all may contribute to psychological distress, difficulties in adjustment to life in Australia and in some cases, repatriation to the country of origin.
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ItemThe experience of depression: women's perspectives( 2002-12)Reports from epidemiological survey data identify that twice as many women than men suffer with depression over the life cycle. From reviewing the broad research literature, it appears that many studies focus on only one aspect of a bio-psychosocial model and, do not consider how these aspects interact. (For complete abstract open document)
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ItemHuman steady-state visually evoked potential topography and attention( 2004-12)This work began with a review of visual spatial selective attention, from a behavioural perspective with particular emphasis placed upon the spotlight model. To complement the behavioural review, the physiological aspects of the visual system were studied to find possible loci of the spotlight. The literature pointed to the pulvinar nucleus of the thalamus, interacting with the parietal and frontal cortices. Some experimental work examined relationships between visual spatial selective attention and event-related potentials (ERPs) recorded from the scalp. The second section of this thesis reviewed the ERP measures relating specifically to the visual modality for their possible application in a visual attentional task. This yielded two independent findings. First, the Probe-ERP paradigm comprising an attentional task being performed by the subject, with a separate stimulus to probe the unused resources within the system. Second, the steady-state evoked response, with the stimulus presented as a small sinusoidal variation around a mean level of contrast. The combination of the Probe-ERP paradigm and the steady-state visually evoked potential (SSVEP) warranted experimental evaluation.
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ItemThe creative process: A phenomenological and psychometric investigation of artistic creativity( 2005-08)Although a variety of approaches have been adopted to researching creativity, the phenomenology of creativity has not been well-represented in the literature. This constitutes a significant obstacle to achieving a comprehensive, satisfactory model of the creative process. The current thesis aimed to provide a systematic analysis of the phenomenology of artistic creativity. The thesis also attempted to integrate the analysis of phenomenological aspects of artistic creativity with the more established approaches of creativity-personality and creativity-psychopathology research. Specifically, the research investigated whether the phenomenology of artistic creativity varies in relation to features of personality and psychopathology.
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ItemA prospective study of the relationship between stress, coping and the onset of psychosis in a high risk group( 2005-06)The experience of stress and associated coping responses are often described as playing an important role in the onset of schizophrenia and other psychotic disorders. Despite widespread acceptance of this model, there is little empirical evidence to support such a relationship. This is partly due to a lack of well-designed prospective studies of the onset of psychotic disorders that incorporate different aspects of the stress and coping process. The relatively recent development of validated and reliable criteria for identifying young people at high-risk (UHR) of developing psychosis has enabled the process of onset of psychotic illnesses to be studied more closely than was previously possible. It has also opened the way to the development and evaluation of preventive interventions. This longitudinal study aimed to compare the experiences of stress and coping between a UHR cohort (N = 143) and a group of young people without mental health concerns (HC group, N = 32). In addition, the contribution of stress and coping in the development of acute psychosis in a subgroup of the UHR cohort (UHR-P, n = 18) was also investigated.
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ItemSelf-ambivalence in obsessive-compulsive disorder( 2005-01)According to the cognitive model, Obsessive-compulsive disorder (OCD) is maintained by various belief factors such as an inflated sense of responsibility, perfectionism and an overestimation about the importance of thoughts. Despite much support for this hypothesis, there is a lack of understanding about the role of self-concept in the maintenance or treatment of OCD. Guidano and Liotti (1983) suggest that individuals who are ambivalent about their self-worth, personal morality and lovability use perfectionistic and obsessive compulsive behaviours to continuously restore self-esteem. This thesis develops a model of OCD that integrates self-ambivalence in the cognitive model of OCD. (For complete abstract open document)