Search

Most of the research on treatment approaches for acute ischemic stroke have focused on the effect of thrombolysis (IVT) and thrombectomy (EVT) on survival and functional outcomes. Little is known about the cognitive outcomes after IVT and EVT following acute ischemic stroke. The objective of this systematic review was to determine the differential cognitive and functional outcomes following thrombolysis or thrombectomy after mild to severe ischemic stroke in adults. Data was sourced using seven online databases. The SITS Registry was also searched as well as the grey literature in the form of Open Grey and Google Scholar. Initially, 1,040 articles were identified from 2000-2020. After screening full text papers, a total of 7 articles were eligible for data synthesis. Cognitive impairment on the Montreal Cognitive Assessment (MoCA) at 90 days post stroke was evident in patients who received either IVT or EVT. On tasks of executive function in particular the Trail Making Test, impaired performance was observed for EVT at 90 days and 365 days post stroke and IVT at 180 days post-stroke. A higher percentage of patients treated with EVT achieved functional independence on activities of daily living on the Barthel Index (BI) at 90 days and 2190 days post stroke, compared to those treated with IVT.  The current empirical study examined predictors of post-acute memory impairment and the relative contributions of alcohol (intoxication at time of injury and history of problematic alcohol use) on memory during the post- acute recovery stage after Traumatic Brain Injury (TBI). Case files from 303 individuals admitted to inpatient neuro-rehabilitation after single incident TBI were reviewed. Approximately 40% had a documented history of problematic alcohol use and around one third were intoxicated at time of injury. Using hierarchical regression analyses, older age and history of problematic alcohol use significantly predicted poorer performance on measures of immediate memory and global memory. Having a high skilled occupation significantly predicted better performance on the immediate and delayed memory index on the RBANS. Both history of problematic alcohol use and intoxication at time injury provided a significant and unique contribution to the prediction of global memory performance on the RBMT in the post-acute recovery stage after TBI (F (9,167) = 6.24, p < .001), albeit accounting for a small variance. Being intoxicated at time of injury resulted in more intact global memory in this mild to severe TBI sample. Clinical implications and limitations are discussed.

A systematic review in chapter one examined the prevalence of insomnia and poor sleep quality within the prison population. The review synthesised the findings from twelve studies from various prisons internationally between 2014 and 2020. Wideranging prevalence rates were found from studies utilising self-report measures of sleep quality. Despite limitations in the literature reviewed, including the use of inconsistent parameters of standardised measures, the results suggest that the prevalence of insomnia and poor sleep quality in the prison population is higher than the general population. The review indicated an increase in the quantity and quality of studies compared to previous reviews. Areas for further research are discussed and recommendations for adequate identification and intervention of insomnia in prisons. An empirical study in chapter two explored the sleep quality and wellbeing of people in recovery from substance addiction, compared to a control sample. Fiftynine participants in recovery from substance addiction and fifty-seven comparison group participants were recruited and completed a battery of self-report measures on sleep quality, anxiety, depression and quality of life. Results indicated that the recovery group had significantly poorer reported measures in all areas. However, anxiety was found to be the biggest predictor of poor sleep across both participant groups. Clinical implications, considerations for future research and limitations of the study are discussed. The third and final chapter considers the theoretical, research and clinical implications that arose from the first two papers. A short reflective summary concludes the thesis.

Systematic review: Aim: The aim of this study was to conduct a systematic review to explore how attachment style is related to symptoms and functioning in early psychosis, specifically the At-Risk Mental State and First-episode Psychosis. Methods: A PRISMA-guided systematic search was conducted in PsycInfo, SCOPUS, and Web of Science between 1st January 1995 and 12th July 2019. The search was limited to original research that assessed attachment in participants who presented as At-Risk Mental State or First episode Psychosis. Results: Nine papers were included. Secure attachment was positively associated with better functioning in early psychosis. Mixed results were observed regarding the relationship between attachment and clinical symptoms in cross-sectional studies. Longitudinal research highlighted a significant association between higher levels of secure attachment and improved clinical outcomes in early psychosis. Conclusions: Cross-sectionally, the link between attachment and clinical symptoms appears tenuous in At-Risk Mental State and First-episode Psychosis. However, in longitudinal research, there was evidence of a stronger relationship between attachment and recovery from psychotic symptomatology. Clinical recommendations include interventions that enhance the development of secure relational patterns in At-Risk Mental State and First-episode Psychosis to promote long-term recovery. Future research recommendations include the creation of a standardised, reliable and validated measure of attachment in populations with psychosis. Large scale research project: Purpose: This study sought to investigate whether the experience of childhood trauma increases the likelihood that individuals with psychosis will be motivated to drink alcohol as an avoidant coping strategy and adopt a ‘sealing over’ recovery style. Method: Seventy-two participants with a diagnosis of a psychotic disorder completed assessments of childhood trauma, drinking motives, recovery style, and alcohol use. Results: Overall current alcohol use was low but 34.8% of respondents reported a history of alcohol-related problems. Childhood emotional abuse predicted motivation to drink alcohol to cope and a history of alcohol-related problems. The relationship between emotional abuse and history of alcohol-related problems was fully mediated by motivation to drink alcohol to cope. Recovery style was not observed to be related to any key variables. Conclusions: Findings highlight the need to routinely assess childhood trauma in clinical practice and to consider the impact of emotional abuse upon coping strategies in individuals with psychosis during treatment. Theoretical implications and recommendations for future research are suggested.

Background: In order to develop reliable preventive measures for heavy drinking, investigating the cognitive differences present in heavy drinkers may be crucial. The focus of this thesis is on impulsivity, executive function and attentional bias for alcohol. The thesis is formed by three parts; the first (Study 1) investigates how these mechanisms could be trained using neuropsychological tasks in order to reduce alcohol consumption. The second (Studies 2 and 3), focuses on applying those findings to the understanding and use of implementation intentions to reduce alcohol consumption. The third (Studies 4 and 5), focusses on the impact of impaired cognition in heavy drinkers in terms of violent offending. Study 1: A systematic review and meta-analysis to establish whether training heavy drinkers in cognitive tasks designed to improve impulsivity, executive control and biased attention for alcohol reduces subsequent alcohol consumption. Nine studies reported in eight papers met the inclusion criteria. There was a small effect of completion of cognitive tasks on reducing alcohol consumption. Study 2: An fMRI investigation conducted on 32 heavy drinkers using neuroimaging paradigms to assess the impact on alcohol consumption of including an implementation intention into the instructions of two cognitive training tasks. Results show a marked reduction in alcohol consumption. Study 3: Applying implementation intentions directly targeting alcohol behaviour to a heavy drinking population and investigating how facets of executive function, impulsivity and attentional bias mediate the effect of this intervention on alcohol consumption. Results show a significant reduction in alcohol consumption by implementation intentions proving their effectiveness for heavy drinkers. Study 4: A multi-dimensional investigation of impulsivity, executive function and attentional bias applying findings from the heavy drinking literature to a violent heavy drinking population using a combination of self-report measures and neuropsychological tasks. Results suggest that violent heavy drinkers show greater deficits in impulsivity than non-violent heavy drinkers and have approach and avoidance conflict tendencies similar to that of dependant alcohol users. Study 5: A large-scale study employing longitudinal data of sanctioned offenders, their criminogenic needs assessments and contact with criminal justice agencies to assess whether alcohol-using offenders have higher rates of prior violent offending than abstinent offenders. Results indicated higher rates of violent offending in alcohol using offenders. The difference was particularly pronounced in women, who had prior violent offending rates at three times higher than their gender-matched counterparts. Conclusions: This thesis has generated some important findings. Firstly, current neuropsychological measures of impulsivity, executive function and attentional bias are not specific enough to detect change brought about by brief alcohol interventions. Secondly, implementation intention formations are highly effective at reducing alcohol consumption in heavy drinkers. Thirdly, violent offending is likely influenced by the same cognitive deficits as heavy drinking. This has implications for future research that should enable better understanding, inform more effective neuropsychological identification measures of these cognitive facets and attempt to replicate the alcohol consumption reduction reported.

This thesis describes medical aspects of the expeditions of the Heroic Age of Antarctic exploration (1895-1922). It is divided into three sections. Section 1 describes the drugs and medical equipment taken to the Antarctic by these expeditions. There is an introductory discussion followed by papers on ophthalmic drugs, injections, inhalations and suppositories, oral drugs and topical preparations. Sledging medical cases are considered separately. Brandy was often used as a medicine and the medical uses of alcohol are described. Some expeditions took what were described as “medical comforts”. This term was sometimes used as a euphemism for alcoholic beverages but, in fact, encompassed a wide range of foods for invalids. Burroughs Wellcome and Co. supplied many of the expeditions with drugs and their medical chests. They used the expedition link in their advertising and the relationship between the expeditions and drug companies is described. Section 2 describes some of the medical problems encountered. The most serious problems were scurvy and a condition often called “polar anaemia”, which seems to be the same as a condition known at the time as “ship beriberi” and what is now described as “wet beriberi”. The controversy as to whether Captain Scott and his colleagues died of scurvy is also discussed. Other problems included frostbite and snow blindness. At least 11 general anaesthetics were given, including two for amputation of frostbitten toes. Psychological problems were common and there was some serious psychiatric illness including alcohol abuse. Section 3 describes the doctors and some of the research that they carried out. The most common research done by doctors was bacteriological. Most doctors collected biological data on the explorers including weights and haemoglobin measurements. This was largely for health monitoring but one doctor pursued physiological research. Three doctors and a medical student studied geology.