Depression Treatment: A Randomised Controlled Trial of the Flinders Program™ of Chronic Condition Management in Vietnam Veterans With Co-Morbid Alcohol Misuse, and Psychiatric and Medical Conditions.

A randomised controlled trial of the Flinders Program™ of chronic condition management in Vietnam veterans with co-morbid alcohol misuse, and psychiatric and medical conditions.

Filed under: Depression Treatment

Aust N Z J Psychiatry. 2013 Jan 10;
Battersby MW, Beattie J, Pols RG, Smith DP, Condon J, Blunden S

Objective:To evaluate the efficacy of the Flinders Program™ of chronic condition management on alcohol use, psychosocial well-being and quality of life in Vietnam veterans with alcohol misuse.Method:This 9-month wait-list, randomised controlled trial used the Alcohol Use Disorders Identification Test (AUDIT) score ? 8 as the entry criterion. Intervention veterans received the Flinders Program plus usual care and controls received usual care. The primary outcome measure was AUDIT score at baseline, 3, 6 and 9 months. Secondary measures included quality of life, alcohol dependence (DSM-IV), anxiety and depression. All measures were repeated at variable trial end dates between 9 and 18 months in the intervention group.Results:Randomisation resulted in 46 intervention and 31 control participants. Intent-to-treat analyses showed AUDIT scores improved significantly from baseline to 9-month follow-up (p = 0.039) in the intervention group compared to control group. The control group had 1.46 times the risk of alcohol dependence than the intervention group at 9 months (p = 0.027). There were no significant differences between groups for secondary measures. Within-group analyses showed that both groups significantly improved in AUDIT (p < 0.001), anxiety and depression (p < 0.01), anger (p < 0.001), and post-traumatic stress (p < 0.01). Improvements in AUDIT (p < 0.001) and alcohol dependence were maintained in the intervention group to 18 months.Conclusions:Use of the Flinders Program in addition to usual care resulted in reduced alcohol use, reduced alcohol dependence, and global clinical improvement in Vietnam veterans with risky alcohol behaviours and chronic mental health problems. The findings demonstrate that the Flinders Program provides a structured framework for delivering self-management support, case management and coordinated care for people with chronic conditions. This clinical approach has the potential to bridge the gap between physical and mental illness service delivery for people with long-term conditions in Australia. HubMed – depression


Cognitive appraisals, objectivity and coping in ambulance workers: a pilot study.

Filed under: Depression Treatment

Emerg Med J. 2013 Jan 10;
Shepherd L, Wild J

OBJECTIVES: Ambulance workers are regularly exposed to call-outs, which are potentially psychologically traumatic. The ability to remain objective and make adaptive appraisals during call-outs may be beneficial to this at-risk population. This pilot study investigated the links between cognitive appraisals, objectivity and coping in ambulance workers. METHODS: Forty-five ambulance workers from the London Ambulance Service, UK, were studied. Trauma exposure, post-traumatic stress disorder and depression symptoms were assessed using self-report measures. Positive and negative appraisals were measured in relation to two previous call-outs: one during which they coped well and one during which they did not. RESULTS: Enhanced coping was associated with making more positive appraisals during the call-out. Better coping was also related to greater levels of objectivity during these call-outs. Coping less well was associated with the use of more negative appraisals during the call-out. CONCLUSIONS: Ambulance workers may benefit from psychological interventions, which focus on cognitive reappraisal and enhancing objectivity to improve coping and resilience.
HubMed – depression


A latent class analysis of psychological disturbance in Parkinson’s disease.

Filed under: Depression Treatment

Int J Geriatr Psychiatry. 2013 Jan 11;
Zahodne LB, Marsiske M, Bowers D

OBJECTIVE: Psychological symptoms are common in Parkinson’s disease (PD). Psychological symptoms do not respond to psychotropic medications as well in patients with PD as in patients with psychiatric illnesses who do not have PD. Evidence that PD patients can be classified into distinct psychological symptom subgroups is conflicting. This study sought to examine potential psychological heterogeneity in PD with a broader range of instruments than has been used in previous studies. METHODS: A comprehensive battery of psychological measures assessing dysphoria, apathy, anhedonia, anxiety, and negative affect was administered to 95 PD patients without global cognitive impairment. Latent class analysis was used to identify subgroups of patients based on continuous variables derived from the psychological battery. Multinomial regression was used to examine predictors of classification. RESULTS: The latent class analysis identified three subgroups with incremental levels of psychopathology across most symptom domains. One exception was a greater level of affective flattening in the “psychologically healthy” group compared with the “moderate symptoms” group. Greater motor dysfunction and less education were associated with greater severity of psychological symptoms. CONCLUSIONS: These results support high psychological co-morbidity in PD, which complicates the treatment of individual symptoms. In addition, emotional blunting and anhedonia may be less indicative of widespread psychological distress than anxiety, dysphoria, and cognitive aspects of apathy. Clinicians should be aware that PD patients with greater motor dysfunction and less education are at greater risk not only for depression but also for a variety of other psychological symptoms that may not be routinely assessed. Copyright © 2013 John Wiley & Sons, Ltd.
HubMed – depression


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