EVIDENCE ON THE NEED TO FOSTER SPIRITUAL VALUES AND WELL-BEING IN THE MANAGEMENT OF BIPOLAR DISORDERS
Russell F. D'Souza
Objective: The increasing awareness of the basic need of all human beings for a source of meaning that is greater than one's self. This growth in this awareness is driven by our practical goal of reducing disability and improved function from mental disorders and by the heart felt wishes of the suffering patients, for their therapists to recognize the need for self transcendence. Study the need to achieve well being for bipolar patients.
Consider the evidence of spiritual values for patients in supporting them find meaning beyond the illness and set backs that they have to cope with.
Method: Review the science of well-being and the under pinning of the neurobiology of well being. Fostering and exercising the branches of mental self governance measured as character traits in the Temperament and Character Inventory that are associated with well-being. The particular exercising of the self transcendental character trait by adding the important dimension of existential, spiritual resources and positive emotions brings significant positive outcomes to demoralization enhancing well being and function.
Results: The evidence currently suggest there has been little or no improvement whatsoever in the average levels of life satisfaction in patients as a result of the introduction of psychotropic drugs or manulaised forms of psychotherapy to the present time. Recent work on well being has shown that it is possible to improve well being and reducing disability in general population as well as in most if not all mental disorders and in particular bipolar disorders. The particular exercising of the self transcendental character trait by adding the important dimension of existential, spiritual resources and positive emotions brings significant positive outcomes to demoralization enhancing well being and function. Evidence from RCT in Bipolar Disorder patients receiving an adjunct spiritually augmented well-being CBT therapy demonstrated evidence of significant positive well-being and inter- episodal function compared to the control group.
Conclusions: Fostering of spiritual values and well-being is crucial for management of Bipolar Disorders in order that patients are able to achieve new meaning and purpose beyond the catastrophic affects of the illness in order that they might maximize their reintegration in life's journey with in the constrains that the disorder might impose on them. In doing so the Bipolar Clinicians have the opportunity to recognize a broader understanding of what it is to be a human being. Some thing bipolar patients want. Fostering Spiritual values and well-being incorporates the longitudinal blend of physics and philosophy, the practical and the spiritual, venerable Eastern Wisdom and the cutting edge western science with the evidence of dynamic results.
Educational objectives:
Learn the need for psychiatrists and mental health professionals to consider the need for happiness and positive emotions besides the need to reduce bipolar disorder and distress in their patients.
The place of Positive emotions in achieving well-being
Understanding the Science of well-being
Aware of the neurobiology of well-being
Well-being therapies- evidence available
AN OPEN RANDOMIZED CONTROLLED STUDY COMPARING THE SPIRITUALLY AUGMENTED CBT AND CBT IN A COHORT OF DEPRESSED PATIENTS
Russell D'Souza, Umit Agis
Aim: To compare the long term outcomes of CBT and SACBT administered to a cohort of depressed patients who received pharmacotherapy in the phase 1 part of the study.
Method: Thirty-three patients from the continuing care program Box Hill who were diagnosed with major depression and took part in part 1 of a double blind randomized controlled study being treated with serteraline & venelafaxione where followed into a phase 2 which involved being randomly allocated to 2 groups a CBT group and an SACBT group. Both received 16 sessions of treatment. 16 patients received SACBT by clinicians of the continuing care program who had received training and supervision in the application of SACBT. 17 patients received CBT from clinicians who were competent in administering CBT. Patients were assessed at base line at the onset of being randomized and fortnightly for 3 months and then monthly for 2 months followed by an assessment at 6 months and 12 months by an independent research officer. The Montgomery Asberger Depression Rating scale and the Quality of Life ion depression scale where used as assessment tools and relapse events were recorded
Results: The results found that there was no significant difference between SACBT and CBT up to the 3 month assessment on the MADRS but there was significant superiority on the QoL recorded in the SACBT Cohort, At 12 months there was significant improvement with the SACBT group over the CBT group with 14 patients and 7 patients achieving remission in the SACBT and CBT respectively. There were more relapses in the CBT group at 12 months.
Conclusion: The results of this study inferred that SACBT was superior to conventional CBT in longer term and in quality of life dimensions. This study replicates earlier studies that found the addition of a existential component in therapy had superior outcomes in depressed patients. Further studies replicating this study will be required.
PHYSICAL ILLNESS AND ACCESS TO MEDICAL SERVICES IN PEOPLE WITH SCHIZOPHRENIA
Mario Maj
The physical well-being of people with schizophrenia is remarkably neglected. Physical illnesses in these people are under diagnosed and under treated. A recent study in Australia showed that, although people with schizophrenia suffer more frequently from cardiovascular problems than the general population, they receive catheter much more rarely. People with schizophrenia have been also reported to be less likely than the general population to receive HbA1c and cholesterol monitoring, to receive a retinal examination for diabetes screening, and to be treated for osteoporosis. They have been also found to be more likely to be treated for physical illnesses only when the latter become life threatening. Among the factors contributing to this under diagnosis and under treatment of physical illnesses in people with schizophrenia are a low motivation of patients and their relatives to access medical services, the isolation of psychiatric services from other medical facilities, and a tendency of psychiatrists to overlook physical health problems in their patients. However, the most important factor is likely to be the stigma surrounding schizophrenia. The neglect of physical health in people with schizophrenia should be regarded as an expression of discrimination and disregard for their dignity and their rights as human beings and citizens. Due to the lack of prevention and intervention strategies, people with schizophrenia and their families bear the costs of the mental disorder and those of the concomitant physical illnesses, which can exacerbate psychopathological manifestations and impair the subjects’ ability to adhere to treatment. Access to physical health care of the same quality as that available to the rest of the population should be considered a basic right of people with schizophrenia and a crucial dimension on which their quality of life has to be evaluated.
WHY DO MENTAL HEALTH SERVICES LOOK WORSE AS THEY GET BETTER – AN AUSTRALIAN PERSPECTIVE
Bruce Singh
There has arisen a fundamental paradox since the implementation of the National Mental Health Policy in Australia in 1992 namely the growing dissonance between mental health professionals and the general public on the success or otherwise of the strategy. This presentation makes explicit the overt and covert assumptions about serious mental illness and its treatment on which the policy was based. The reality in regard to those assumptions that the past 15 years have revealed are then discussed. Acceptance of these realities is necessary if we are to achieve a more coherent approach to mental health. These issues are relevant to reform of mental health services in other countries.
