THE ROLE OF FAMILY EDUCATION IN REDUCTION OF RELAPSES IN BMD-I
Dr Mohammad Reza Fayyazi Bordbar, Dr Atefeh Soltanifar
Mashhad University of Medical Sciences
Introduction: Relapse of major psychiatric disorder such as BMD is a major source for individual, familial & social disease border.
Aim: Important objective of the preset study was to evaluate the effect of family education on annual relapse of BMD-I.
Methods: 60 patients with BMD-I who were hospitalized in Ibn-e-sina Psychiatric hospital of Mashhad were randomized to 2 groups. In One group families of patients received the education about the Psychiatric disorder, type and duration of treatment & aggravating factors. In the other groups, families didn't receive the education. Follow – up of patients was dose for one year, in 3 months intervals, in terms of treatment compliance, psychiatric visits, occupational, academic, interpersonal & individual function. The data was analyzed using SPSS software with t-test and Man – withy test.
Results: 57 patients completed the trial. In the group who received the education, there were 4 cases with relapse (%13.7) and in the control group 9 cases (%31.58) experienced relapse of the disorder. Those results showed the significant difference between 2 groups in terms of relapse rate (p = 0/006). The group with education had the mean time of 11.41 months with using medications. This mean was 9.14 months in the control group (p = 0/000). There was also a significant difference between 2 groups in terms of psychiatric visit, interpersonal, occupational and individual functions.
Conclusion: Family education for Iranian patients with major psychiatric disorder such as BMD-I in the time of patients discharge from hospital can be helpful in reducing the relapse rate of these disorders.
CREDENTIALING MENTAL HEALTH NURSES
Ms Marilyn Gendek
Australian College of Mental Health Nurses
Context: Nurses practising mental health nursing in Australia are not required to hold specialist qualifications. As with other health professions, regulation of nursing through legislation still currently occurs at a state and territory level. This has left remnants of past education and regulation contexts that are no longer meaningful for specialist practice. However, recent primary mental health care funding initiatives have highlighted the need for a national standard of recognition for specialist mental health nurses.
Objectives: To explain the Credential for Practice Program conducted by the Australian College of Mental Health Nurses (ACMHN) which certifies specialist mental health nurses.
Key Messages: A credentialed mental health nurse has undertaken a process of validation of qualifications, experience and ongoing professional development.
For consumers and other health professionals, credentialing identifies a specialist in mental health nursing
Conclusion: The ACMHN has been credentialing mental health nurses since 2004. The underlying purposes are quality practice, public protection and professional accountability.
PSYCHOLOGICAL INTERVENTIONS USED IN A METROPOLITAN CRISIS PSYCHIATRIC ASSESSMENT AND TREATMENT (CAT) SERVICE
Dr Kaveh Monshat, Mr Lou Capobianco, Ms Gail Kohrsen, Ms Glenys Curry, Mr Nick Gaynor, Ms Silvana Nittoli
Austin Health
Background: Triage, emergency and crisis community psychiatric care clinicians employ a variety of psychological techniques critical to patient engagement, alleviation of distress and resolution of potentially violent or self-destructive mental states. The techniques are poorly studied.
Aim: To conduct a pilot study cataloguing the range of psychotherapeutic interventions employed by the staff of an acute community mental illness triage and response team operating within a metropolitan area.
Methods: Clinicians were provided with a form on which they self-reported the duration, location and types of psychotherapeutic intervention used as well as details of what was actually discussed with patients.
Results: A total of 51 care episodes were catalogued. On average, clinicians spent 74% of their total contact time with patients focussed on psychological interventions. A wide range of strategies, drawing on a broad theoretical base was found to be in common usage. Aside from general approaches aiding engagement and miscellaneous psychotherapeutic techniques employed as indicated, the psychological interventions used may be classified into the following groups: meta-strategies (“treatment about the treatment”), critical, practical, CBT and supportive.
Conclusions: The vast majority of patient contact time is spent in the delivery of psychological interventions. Acute community care clinicians employ a wide variety of psychological interventions. Further study and classification of approaches used, as well as empirical investigation of the effectiveness of specific methods may help provide guidance in better training clinicians for an acute community care role.
THE RISE AND RISE OF TELEPSYCHIATRY IN SOUTH AUSTRALIA
Dr Daniel Mosler, Dr George Hyde, Dr Ken Fielke, Ms Kellyann Afrin
Rural and Remote Mental Health Service of South Australia
Introduction: The rural mental health service described in this poster has developed since its inception in 1996 into a psychiatric service dedicated to managing the challenges of developing models of care across great distances. Based on a consultation-liaison model, utilising the resources of a 23 bed inpatient unit, 6 outlying metropolitan inpatient beds and an integrated triage and liaison service, this rural mental health service has developed a functional system of care which has become embraced by the key stakeholders involved with the service. The management of community-based clients is centered around a 24-hour telephone triage and liaison service associated closely with the Telepsychiatry service.
Aim: This poster aims to demonstrate the growth and development of Telepsychiatry in this service as part of the integrated model of care that will continue to remain a focus for the statewide country mental health network.
Method: Statistical analysis of key components of the Telepsychiatry service has been undertaken in order to demonstrate the mechanism by which expansion of the service has led to an impact on the wider rural sector.
Results: A growth in the availability and utility of Telepsychiatry has led to further acceptance of this medium as an effective and credible resource for general practitioners, community mental health teams and the broader statewide country health network, as they manage clients with mental health disorders in a rural setting.
Conclusions: The resultant impact of the establishment of this model of care on the rural sector can be observed by the following graphical representations of key aspects of the service.
HUMAN VALUES EDUCATION
Mrs Suma Parahakaran
Institute of Sathya Sai Education for Human Values
The purpose of the study conducted in 2004 was to confirms the role ‘Human Values’ (Love, Right Conduct, Peace, Non Violence and Truth) play in the formation of Character Development relative to attitude and behaviour of students and the school climate in Thailand. Human Values is necessary for nation building and is the key to sustenance of Global peace in today's world of unrest.
The significant issue in this study is the effect of School Climate on Character Development of students. The study presents the relationship between school climate and character development according to perceptions of students (young adolescents aged 10–18 years), teachers and parents in the province of Lobpuri at the Sathya Sai School and the Institute of Sathya Sai Education for Human Excellence.
A bivariate analysis indicated a strong relationship between school climate and character development of students. Data analysis revealed that if the aim of the school objectives are to draw values from within the students, through the process of educare, then students and teachers’ and parents’ joint efforts help strengthen the school climate further as correlation analysis indicated positive linear relationships that is, (r=.761∗∗)(p < 0.01), for students, teachers (r = 653∗)(p < 0.01) and parents (r=.824∗∗)(p < 0.01) perceptions.
The research indicated that the human values program is effective as shown by previous research (Jumsai 2003) that documented, provided empirical evidence and clarified the effectiveness of the human values program.
EARLY COGNITIVE RESPONSE TO TREATMENT IN FIRST EPISODE PSYCHOSIS
Dr Renata Schoeman, Dr Bonga Chiliza, Prof Robin Emsley
University of Stellenbosch, Cape Town, South Africa
Background and aims: Cognitive impairment is well documented in schizophrenia, and improves to some extent with treatment. Early cognitive changes in response to antipsychotic treatment are not well documented. We assessed early (12 wk) cognitive changes and their relationships to psychopathology in 20 patients in an interim analysis of an ongoing study.
Methods: Patients with a first episode of schizophrenia underwent MATRICS Consensus Cognitive Battery assessment at baseline, 4 and 12 wks. PANSS ratings were completed. Treatment with low doses of oral and depot flupenthixol was commenced.
Results: The sample consisted of 4 females and 16 males, with an average age of 21,22 years. The mean modal dose of flupenthixol was 10 mg 2 weekly IMI. Two patients were withdrawn due to side-effects. The average premorbid IQ of the sample was on the 91st percentile as estimated by the Vocabulary subtest of the WAISS. Early changes in attention and concentration from baseline were present. Other cognitive domains (speed of processing, working memory, and visual learning) also improved and was correlated with changes in PANSS scores.
Conclusion: Low doses of a long-acting conventional antipsychotic are effective in improving some aspects of cognitive function after a first episode of schizophrenia. The response was rapid, and coincided with improvement in positive symptoms. The failure of previous studies to demonstrate cognitive benefits of conventional antipsychotics may have been related to excessive doses being prescribed.
SIDE EFFECTS OF SECOND GENERATION ANTIPSYCHOTICS: THE EXPERIENCE, VIEWS AND MONITORING PRACTICES OF AUSTRALIAN CHILD PSYCHIATRISTS
Dr Nerissa Soh, Prof Garry Walter, Ms Amy DeLaroche, Dr Glenn Hunt, A/Prof Michelle Cleary, Prof Gin Malhi, Prof Tim Lambert, A/Prof Christoph Correll, Prof Joseph Rey
University of Sydney and Northern Sydney Central Coast Health
Introduction: There is increasing use of second generation antipsychotics (SGAs) in children and adolescents, and growing recognition of the side effects that may ensue, but there is a lack of local data about these side effects and how they are monitored.
Aim: To ascertain the experience, views and monitoring practices of Australian child psychiatrists regarding the metabolic and other side effects of SGAs.
Method: A 19-item questionnaire was posted to all members of the RANZCP Faculty of Child and Adolescent Psychiatry living in Australia.
Results: 126 out of 290 child psychiatrists (43%) returned a useable survey. SGAs are commonly prescribed for a range of disorders. The majority of respondents expressed a high level of concern regarding weight gain and other metabolic side effects. Weight gain was the most frequently observed and monitored side effect in clinical practice. Other side effects were observed and monitored to a variable extent. Notably, monitoring practices did not parallel psychiatrists’ reported level of concern or knowledge regarding weight gain and metabolic side effects, nor coincide with published recommendations.
Conclusions: Further research is required into the use, efficacy, side effects and monitoring of SGAs in children and adolescents, and there is a need to ensure that monitoring guidelines are implemented in clinical practice. This need is heightened by the likelihood that our data on clinicians’ practice, which is based on their perceptions, may overestimate what actually occurs.
ASSESSMENT OF PSYCHIATRIC DISORDERS IN BREAST CANCER PATIENTS AFTER MASTECTOMY
Dr Vyacheslav Sushko
Odessa State Medical University
Background: Psychiatric disorders in breast cancer patients can also be caused by treatment, especially if the treatment is disfiguring. Thus, despite its benefit to the patient, mastectomy may produce more psychiatric disorders than the disease that prompt it.
Aims: The purpose of the present study was to investigate the psychiatric diagnosis in breast cancer patients after mastectomy at the Odessa Regional Cancer Hospital.
Methods: Ninety-six patients with a diagnosis of breast cancer entered the study between 2006 and 2007. All participants were assessed before and after 2 weeks of the completion of the mastectomy in a common protocol via a psychiatric interview, standardized psychological tests (Hospital Anxiety and Depression Scale (HADS), a 14-item self-assessment questionnaire). Patients with psychiatric disorders have received traditional treatment. The diagnosis of cancer had been disclosed to all patients.
Results: The analyses showed psychiatric disorders were diagnosed before mastectomy in sixty-one breast cancer patients (depressed mood in 34.4%, anxious mood in 19,7%, mixed emotional features in 29,5%), major depression in 10 patients (16,4%). The psychiatric disorders were diagnosed after mastectomy in ninety-six breast cancer patients (depressed mood in 23%, anxious mood in 19,8%, mixed emotional features in 20,9%), major depression in 33 patients (36,3%).
Conclusion: Women with breast cancer suffer from considerable stress related to the diagnosis and mastectomy. The adjustment disorders are a major cause of suffering among patients with breast cancer after mastectomy and are highly correlated with poor quality of life.
DEVELOPING AN ATTACHMENT-BASED INTERVENTION FOR PATIENTS IDENTIFIED AS ‘DIFFICULT’ OR ‘FREQUENT ATTENDERS’ IN SECONDARY CARE
Dr Tad Tietze
St Vincent's Mental Health
Patients of secondary care medical services who are considered “difficult”, “frequent attenders” or service “overutilisers” have suboptimal medical outcomes as well as creating disproportionate burden and adversely affecting treating team morale. A significant body of literature has built on the findings of Attachment Theory to understand problematic illness behaviour and patient-clinician relationships as an outcome of insecure patient attachment styles.
It was aimed to develop a novel, attachment-based intervention with tailored management plans to help treating teams and patients collaborate to improve clinical care.
A review of the literature on attachment, abnormal illness behaviour and “difficult” patients served as the basis for the design of an intervention.
A pilot study was designed, utilising six-month attachment-based care plans, for implementation through Consultation-Liaison Psychiatry services. Implementation required liaison with, and promotion to, various medical teams within the hospital. Complexities and challenges in implementing the pilot are described, including gaining acceptance for a model that emphasises preventative measures over crisis management and involving non-mental health clinicians in psychological interventions.
Attachment theory offers novel potential solutions to problems of patient-treating team relationships, especially in terms of ameliorating or preventing problem interactions that impede clinical care. Further piloting will allow the care plans to be refined and preliminary conclusions on their utility to be drawn.
SIZE AND SHAPE ALTERATIONS TO THE CORPUS CALLOSUM IN BIPOLAR AFFECTIVE DISORDER
Dr Mark Walterfang1, Prof Gin Malhi 2, Dr Amanda Wood 3, Prof David Reutens 3, Dr Jian Chen 3, Ms Sarah Barton 3, Dr Murat Yucel 4, Dr Dennis Velakoulis 4, Prof Christos Pantelis 4
1Melbourne Neuropsychiatry Centre
2University of Sydney
3Monash Medical Centre
4University of Melbourne
Background: Callosal structural and functional alterations have been demonstrated in a range of neuropsychiatric illnesses, including bipolar disorder, but no study has examined regional callosal thickness in this phenotype.
Objective: To examine callosal size and shape in a well-defined group of bipolar affective disorder patients and controls.
Participants: The participants included 24 patients with DSM-IV bipolar I disorder and 24 matched healthy controls.
Design: The corpus callosum was extracted from mid-callosal images from T1-weighted magnetic resonance scans on all participants, and callosal area, length, bending angle and regional callosal thickness measures were computed from these images.
Results: The callosum was thinner in the bipolar group overall, with a disproportionately reduced thickness in the splenium. Psychotic and non-psychotic patients did not differ, although patients without a family history of mood disorders had a thinner callosum.
Conclusions: Callosal reductions are present in established bipolar disorder, and affect posterior regions more than anterior regions. This may reflect a primary disturbance to myelination, or a secondary effect of grey matter changes.
