Early screening for the post intensive care syndrome in a tertiary ICU follow-up clinic in the Eastern Cape
- Authors: van der Merwe, Elizabeth
- Date: 2024-04
- Subjects: Critical care medicine , Post-traumatic stress disorder -- Patients , Psychology, Pathological
- Language: English
- Type: Doctral theses , text
- Identifier: http://hdl.handle.net/10948/63915 , vital:73626
- Description: The Post ICU Syndrome (PICS) is defined as a constellation of new or worsened impairments in physical, cognitive, and/or psychological health which persist after critical care discharge. These deficits are more related to the patients’ intensive care unit (ICU) stay rather than to their original ICU admission diagnosis. Between 25-50% of critical care survivors suffer from PICS. There is a paucity of research on PICS in South Africa (SA). The primary objective of this study is to describe the incidence and co-occurrence of PICS symptoms, as well as the changes in instrumental activities of daily living and life roles in ICU survivors.The study was conducted in a multidisciplinary tertiary ICU in the Eastern Cape. Inclusion criteria were respiratory support for ≥ 48 hours, or a shocked state, and/or organ failure requiring ICU stay for 48 hours. Patients were assessed at six weeks and six months after hospital discharge. Physical impairment was measured by the six-minute walk test and ICU-acquired weakness by the Medical Research Council scale. Instrumental activities of daily living score and employment/educational status were determined. The Hospital Anxiety and Depression Scale and Impact of Event Scale-Revised questionnaires were used as screening tools for significant psychological symptoms. Screening for neurocognitive impairment was performed with the NeuroScreen application and compared to a matched control group. The Short Form-36 Health-Related Quality of Life questionnaire (HRQOL) was used to determine quality of life at baseline and study visits. 107 patients, half of whom had COVID-19, completed the six-month follow-up. Six months after hospital discharge, six out of ten patients were affected by PICS, five out of every ten suffered from physical impairment, four out of every ten reported significant psychological symptoms, with three out of every ten affected by both. Three out of ten experienced significant chronic pain. Overall, six out of every ten patients experienced significant psychological symptoms at either one or both study visits. Only one in ten had psychological symptoms in isolation at six months. Six out of every ten patients reported a significantly lower health-related quality of life at six months as compared to their baseline. Three out of every ten patients had not returned to their previous remunerative work, studying or home making. Neurocognitive impairment in this cohort was not verified, and this may have been due to the selection of the control group. However, there was a significant improvement in neurocognitive functioning from the six-week to the six-month study visits. Only 15% of patients received rehabilitation therapy after hospital discharge. Female sex, a higher co-morbidity score and an admission diagnosis of trauma were predictors of PICS symptoms. COVID-19 was not found to be associated with a higher incidence of PICS. , Thesis (D.Phil) -- Faculty of Health Science, School of Behavioural & Lifestyle Sciences, 2024
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- Date Issued: 2024-04
'Show and tell': a discursive analysis of women's written accounts of their self-injuring practices
- Authors: Morison, Tracy
- Date: 2006
- Subjects: Self-injurious behavior , Psychology, Pathological
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:3026 , http://hdl.handle.net/10962/d1002535 , Self-injurious behavior , Psychology, Pathological
- Description: Self-injuring is a practice that involves self-administered damage to one’s body, most commonly cutting of the skin on the forearms. (The practice is distinguished from other intentional and in/direct self-harmful or self-damaging behaviours that cause bodily harm). Dominant psychiatric, psychological or medical approaches construct self-injuring as deviant, socially unacceptable or abnormal behaviour that is indicative of more or less severe psychopathology, and importantly as a stereotypically female practice. This research is conducted within a post-essentialist framework and views self-injuring, and the injured body, as discursively constituted as well as a cultural and political act. It therefore moves away from pathologising discourses in which those who self-injure typically find themselves and their own accounts of their behaviour invalidated and silenced. Instead, the mental health perspective is viewed as one party among many that may contribute to the conceptualisation of ‘self-injuring’ practices as socially meaningful and thus self-injuring is critically interpreted without reliance on a medical model of ‘normalcy’. As part of attempts to challenge medical models and cultural ideals of normalcy, this research presents a critical discursive analysis of a series of narratives provided by 5 female participants in which they record their own experiences, feelings and thoughts related to their practices of selfinjuring. It makes use of critical discourse analytic methodology to identify certain characteristics of these narratives as representations of larger collective meaning systems. It analyses the ways in which self-injuring is constructed in women’s stories of their self-injuring experiences, focusing particularly on the subject positions available in these discourses, as well as their ideological effects. The analysis focuses particularly on constructions of the body and subject positions as they enable or undermines the self-injuring subject’s agency. Finally, it attempts to determine the limitations of certain accounts of self-injuring, pursuing multiple meanings of self-injuring and illuminating new dimensions of talk on self-injuring and novel ways of conceptualising and understanding the practice.
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- Date Issued: 2006
Disturbing the neighbours: an investigation into the relationship between psychopathology and social formations
- Authors: Collins, Anthony
- Date: 1995
- Subjects: Freud, Sigmund, 1856-1939 , Winnicott, D. W. (Donald Woods), 1896-1971 , Social psychiatry , Social psychology , Psychology, Pathological , Frankfurt school of sociology , Political psychology
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:2953 , http://hdl.handle.net/10962/d1002462 , Freud, Sigmund, 1856-1939 , Winnicott, D. W. (Donald Woods), 1896-1971 , Social psychiatry , Social psychology , Psychology, Pathological , Frankfurt school of sociology , Political psychology
- Description: This work attempts to confront certain political problems created by the individualistic bias in psychoanalytic thinking, and the resulting failure to adequately theorise the importance of social processes. The thesis traces the origins of intrapsychic thinking to Freud's initial move from the seduction theory to the Oedipal theory. This development is offered as a prototype for the debates between conceptualisations of childhood traumatisation as a social problem of actual abuse occurring within dermed power relations, and theories which locate pathology purely within internal conflicts occurring inside the individual. Several criticisms of this shift are offered, and it s impact on later theory is considered. Here a contrast is offered between the theoretical approaches of Melanie Klein and Donald Winnicott, arguing for the usefulness of Winnicott's emphasis on environmental factors within psychodynamic theory. The impact of these theoretical approaches is illustrated through a critical evaluation of Freud's case study of Judge Schreber. Additional historical material is brought in to show the importance of environmental considerations ignored by Freud, and contrasting psychodynamic readings of the case are offered. As an alternative to purely intrapsychic approaches, a reinterpretation of certain strands of Critical Theory is then presented. Adorno's theory of the Authoritarian Personality and Marcuse' s concept of One-Dimensional Man are extended using Winnicott's formulations concerning psychological development. This leads to an examination of the question of the relationship between social structure and individual consciousness. Post-structuralist accounts of language and the construction of identity are explored. These are then developed drawing on theories of ideology, language and consciousness, integrating these with Winnicott's developmental theory to offer an alternative psychodynamic understanding of the relationship between social process and psychopathology. An attempt is made to reformulate - the notions of consciousness and the unconscious in terms of the possibilities and difficulties of representation within available social symbolic codes. In conclusion the it is argued that psychology needs to integrate critical social theory and contemporary understandings of the social construction of consciousness in order to become a meaning force in positive social transformation.
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- Date Issued: 1995
The interpersonal dimension of psychopathology
- Authors: O'Dowd, S A
- Date: 1987
- Subjects: Psychology, Pathological
- Language: English
- Type: Thesis , Masters , MA
- Identifier: vital:2910 , http://hdl.handle.net/10962/d1002075
- Description: It is argued that two large groups of disorders can be distinguished in the field of psychopathology, (1) which divide between them the psychoses, neuroses and personality disorders; ( 2) the dynamics of which are those of Klein's paranoid-schizoid and depressive positions, respectively; and (3) which are distinguished by nine basic contrasts in symptomatology and dynamics, all of which are expressive of the opposition self-centred/other-centred. These three hypotheses form the interpersonal model of psychopathology, and are supported by argument from works of Foulds, Jung, Abraham, Fairbairn, Klein, Angyal, Winnicott and Heidegger. It is suggested that the interpersonal model can facilitate the dialogue between psychoanalysis and phenomenology
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- Date Issued: 1987