‘Repercussions’: Literary gaming for increasing awareness of mental health support

Seriøse spill og andre typer medier kan brukes til å utdanne spillere. I denne masteroppgaven utforsket forfatteren hvordan et litterært spill kan hjelpe til med å øke bevisstheten om mental helsestøtte for en venn i nød. Sammen med denne eksegesen skapte forfatteren det interaktive fiksjon- og litterære spillet 'Repercussions', som lar spilleren utforske ulike måter å samhandle med en venn som sliter med psykisk helse, på en trygg og ikke-dømmende måte. Dette seriøse spillet er rettet mot en tenårings- til ung voksen demografisk gruppe som kan lære hvordan deres støtte til en venn kan ha en betydelig påvirkning på deres liv gjennom et vennlig og ikke-dømmende spillmiljø. For å lage dette spillet har flere psykiske helse spill, bøker og serier blitt analysert i sak-studier, samt en rekke interaktive former for medier. Selv om historien er fiksjon, ble en klinisk psykolog konsultert under opprettelsen av spillet for en mer realistisk fortelling. Som et resultat av forskningen, forsøker spillet som er skapt å gi den målrettede demografiske gruppen et trygt miljø å utforske, lære og gjøre feil i. Fortellingen inkluderer hverdagslige oppgaver og opplevelser for å gjøre det til en oppslukende opplevelse. Spillets visuelle uttrykk er fargerikt og lyst, og viser en likhet med en visuell roman. Grafikken, lyden, fortellingen og de interaktive elementene jobber sammenhengende for å skape et rom som gir spilleren muligheten til å komme forbi deres psykologiske forsvar og lære hvordan deres velmente handlinger kan mottas annerledes av noen som har gjennomgått en traumatisk opplevelse. Spillet lærer hvordan et individ kan være en bedre venn.Serious games and other types of media can be used to educate the audience. In this master’s graduation project, the author explored how a literary game can help raise awareness about mental health support for a friend in distress. Together with this exegesis, the author created the interactive fiction and literary game ‘Repercussions’ that allows the player to explore different ways of interacting with a friend who is struggling with mental health in a safe and non-judgemental way. This serious game is targeted at a teenage to young adult demographic who can learn how their support to a friend can make a significant impact on their lives in a friendly and non-judgemental environment. For the creation of this game, multiple mental health games, books, and series have been analysed in case studies, as well as a set of interactive forms of media. Though the story is purely fictional, a clinical psychologist was consulted during the creation of the game for a more realistic narrative. As a result of the research, the game created attempts to give the target demographic a safe environment to explore, learn, and make mistakes. The narrative includes mundane tasks and experiences to make it an immersive experience. The visuals of the game are colourful, and light, and show a resemblance to a visual novel. The graphics, sound, narrative, and interactive elements all work together to create a space that gives the player the possibility to move past their psychological defence and learn how their well-intended actions can be received differently from someone who has been through a traumatic experience. The game teaches how to be a better friend.Mastergradsoppgave i digital kulturDIKULT350MAHF-DIKU

Evidence-based pharmacotherapy of panic disorder

This paper reviews the literature on the pharmacotherapy of panic disorder, in order to address the questions (1) what is the first-line pharmacotherapy of choice for panic disorder?, (2) for how long should maintenance pharmacotherapy be continued, and (3) what is the optimal approach to the treatment-refractory patient with panic disorder. A MEDLINE search (1966-2003) was undertaken to collate randomized controlled trials of pharmacotherapy in panic disorder. A review of the evidence indicates that SSRIs are currently the first line agent of choice in panic disorder, and that pharmacotherapy should be continued for at least 1 year. There has been relatively little research on the pharmacotherapy of treatment-refractory panic disorder, and this area requires future attentio

Implementing practice guidelines for anxiety disorders in secondary mental health care: a case study

Contains fulltext : 102611.pdf (publisher's version ) (Open Access)Background: Recent years have seen the large-scale development of clinical practice guidelines for mental disorders in several countries. In the Netherlands, more than ten multidisciplinary guidelines for mental health care have been developed since 2003. The first dealt with the treatment of anxiety disorders. An important question was whether it is feasible to implement these guidelines because implementing practice guidelines is often difficult. Although several implementation interventions have proven effective, there seems to be no ready-made strategy that works in all circumstances. Case description: The Dutch multidisciplinary guidelines for anxiety disorders were implemented in a community mental health care centre, located in the east of the Netherlands. The centre provides secondary outpatient care. The unit within the centre that specializes in the treatment of anxiety disorders has 16 team members with diverse professional backgrounds. Important steps in the process of implementing the guidelines were analysing the care provided before start of the implementation to determine the goals for improvement, and analysing the context and target group for implementation. Based on these analyses, a tailor-made multifaceted implementation strategy was developed that combined the reorganization of the care process, the development of instruction materials, the organization of educational meetings and the use of continuous quality circles to improve adherence to guidelines. Discussion and evaluation: Significant improvements in adherence rates were made in the aspect of care that was targeted for change. An increase was found in the number of patients being provided with recommended forms of psychotherapeutic treatment, ranging from 43% to 54% (p < 0.01). The delivery of adequate pharmacological treatment was not explicitly targeted for change remained constant. Conclusion: The case study presented here shows that the implementation of practice guidelines for anxiety disorders in mental health care is feasible. Based on the results of our study, the implementation model used offers a useful approach to guideline implementation. By describing the exact steps that were followed in detail and providing some of the tools that were used in the study, we hope the replication of this implementation methodology is made more practical for others in the future.10 p

Ubiquitination of Aquaporin-2 in the Kidney

Ubiquitination is known to be important for endocytosis and lysosomal degradation of aquaporin-2 (AQP2). Ubiquitin (Ub) is covalently attached to the lysine residue of the substrate proteins and activation and attachment of Ub to a target protein is mediated by the action of three enzymes (i.e., E1, E2, and E3). In particular, E3 Ub-protein ligases are known to have substrate specificity. This minireview will discuss the ubiquitination of AQP2 and identification of potential E3 Ub-protein ligases for 1-deamino-8-D-arginine vasopressin (dDAVP)-dependent AQP2 regulation

Factors contributing to the recognition of anxiety and depression in general practice

Background: Adequate recognition of anxiety and depression by general practitioners (GPs) can be improved. Research on factors that are associated with recognition is limited and shows mixed results. The aim of this study was to explore which patient and GP characteristics are associated with recognition of anxiety and depression. Methods: We performed a secondary analysis on data from 444 patients who were recruited for a randomized trial. Recognition of anxiety and depression was defined in terms of information in the medical records, in patients who screened positive on the extended Kessler 10 (EK-10). A total of 10 patient and GP characteristics, measured at baseline, were tested and included in a multilevel regression model to examine their impact on recognition. Results: Patients who reported a perceived need for psychological care (OR = 2.54, 95% CI 1.60–4.03) and those with higher 4DSQ distress scores (OR = 1.03; 95% CI 1.00–1.07) were more likely to be recognized. In addition, patients’ anxiety or depression was less likely to be recognized when GPs were less confident in their abilities to identify depression (OR = 0.97; 95% CI 0.95–0.99). Patients’ age, chronic medical condition, somatisation, severity of anxiety and depression, and functional status were not associated with the recognition of anxiety and depression. Conclusions: There is room for improvement of the recognition of anxiety and depression. Quality improvement activities that focus on increasing GPs’ confidence in the ability to identify symptoms of distress, anxiety and depression, as part of care according to guidelines, may improve recognition

Paternal age and risk of autism in an ethnically diverse non-industrialized setting: Aruba

Objective: The aim of this study was to examine paternal age in relation to risk of autism spectrum disorders (ASDs) in a setting other than the industrialized west. Design: A case-control study of Aruban-born children (1990-2003). Cases (N = 95) were identified at the Child and Adolescent Psychiatry Clinic, the only such clinic in Aruba; gender and age matched controls (N = 347) were gathered from public health records. Parental age was defined categorically (≤29, 30-39, 40-49, ≥50y). The analysis was made, using conditional logistic regression. Results: Advanced paternal age was associated with increased risk of ASDs in offspring. In comparison to the youngest paternal age group (≤29y), risk of autism increased 2.18 times for children born from fathers in their thirties, 2.71 times for fathers in their forties, and 3.22 thereafter. Conclusion: This study, part of the first epidemiologic study of autism in the Caribbean, contributes additional evidence, from a distinctive sociocultural setting, of the risk of ASD associated with increased paternal age. © 2012 van Balkom et al

Thirty-Year Case Study Showing a Negative Relationship Between Population and Reproductive Indices of Eastern Wild Turkeys in Georgia

Some Eastern wild turkey (Meleagris gallopavo silvestris) studies have interpreted low reproductive success in an established population as support for the idea that as populations stabilize reproduction decreases. However, no study has previously documented a negative relationship between population size and reproductive success for the wild turkey. Thus, we examined the hypothesis that reproduction (poults/hen) decreased as population size (turkeys seen/hour) increased in Georgia. Using 30 years of data collected by two independent survey methods, linear regression analysis indicated a negative relationship between population size and reproduction (r2 = 0.6389, P ≤ 0.001) for wild turkeys in Georgia from 1979 through 2008. Findings of a negative relationship such as in our case study adds more information and justification for researchers to further investigate the potential mechanisms of density–dependent processes in turkey reproduction through designed experiments with controls