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Douglas KM, Groves S, Crowe MT, Inder ML, Jordan J, Carlyle D, Wells H, Beaglehole B, Mulder R, Lacey C, Luty SE, Eggleston K, Frampton CMA, Bowie CR, Porter RJ. A randomised controlled trial of psychotherapy and cognitive remediation to target cognition in mood disorders. Acta Psychiatr Scand 2022; 145:278-292. [PMID: 34800298 DOI: 10.1111/acps.13387] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Revised: 11/04/2021] [Accepted: 11/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To examine the impact of a treatment package combining Interpersonal and Social Rhythm Therapy (IPSRT) and cognitive remediation (CR), vs IPSRT alone, on cognition, functioning, and mood disturbance outcomes in mood disorders. METHODS A pragmatic randomised controlled trial in adults with bipolar disorder (BD) or major depressive disorder (MDD), recently discharged from mental health services in Christchurch, New Zealand, with subjective cognitive difficulties. Individuals were randomised to a 12-month course of IPSRT with CR (IPSRT-CR), or without CR (IPSRT). In IPSRT-CR, CR was incorporated into therapy sessions from approximately session 5 and continued for 12 sessions. The primary outcome was change in Global Cognition (baseline to 12 months). RESULTS Sixty-eight individuals (BD n = 26, MDD n = 42; full/partial remission n = 39) were randomised to receive IPSRT-CR or IPSRT (both n = 34). Across treatment arms, individuals received an average of 23 IPSRT sessions. Change in Global Cognition did not differ between arms from baseline to treatment-end (12 months). Psychosocial functioning and longitudinal depression symptoms improved significantly more in the IPSRT compared with IPSRT-CR arm over 12 months, and all measures of functioning and mood symptoms showed moderate effect size differences favouring IPSRT (0.41-0.60). At 18 months, small to moderate, non-significant benefits (0.26-0.47) of IPSRT vs IPSRT-CR were found on functioning and mood outcomes. CONCLUSIONS Combining two psychological therapies to target symptomatic and cognitive/functional recovery may reduce the effect of IPSRT, which has implications for treatment planning in clinical practice and for CR trials in mood disorders.
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Affiliation(s)
- Katie M Douglas
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Samantha Groves
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Older Persons' Specialist Health and Rehabilitation Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Marie T Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree L Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Dave Carlyle
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Hayley Wells
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Ben Beaglehole
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Roger Mulder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Cameron Lacey
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Suzanne E Luty
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Kate Eggleston
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | | | | | - Richard J Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.,Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Douglas KM, Inder ML, Crowe MT, Jordan J, Carlye D, Lacey C, Beaglehole B, Mulder R, Eggleston K, Donovan KA, Frampton CMA, Bowie CR, Porter RJ. Randomised controlled trial of Interpersonal and Social Rhythm Therapy and group-based Cognitive Remediation versus Interpersonal and Social Rhythm Therapy alone for mood disorders: study protocol. BMC Psychiatry 2022; 22:115. [PMID: 35164720 PMCID: PMC8845377 DOI: 10.1186/s12888-022-03747-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Individuals with mood disorders frequently experience cognitive impairment, which impacts on the long-term trajectory of the disorders, including being associated with persisting difficulties in occupational and psychosocial functioning, residual mood symptoms, and relapse. Current first-line treatments for mood disorders do little to improve cognitive function. Targeting cognition in clinical research is thus considered a priority. This protocol outlines a prospectively-registered randomised controlled trial (RCT) which examines the impact of adding group-based Cognitive Remediation (CR) to Interpersonal and Social Rhythm Therapy (IPSRT-CR) for individuals with mood disorders. METHODS This is a pragmatic, two-arm, single-blinded RCT comparing IPSRT-CR with IPSRT alone for adults (n = 100) with mood disorders (Major Depressive Disorder or Bipolar Disorder) with subjective cognitive difficulties, on discharge from Specialist Mental Health Services in Christchurch, New Zealand. Both treatment arms will receive a 12-month course of individual IPSRT (full dose = 24 sessions). At 6 months, randomisation to receive, or not, an 8-week group-based CR programme (Action-based Cognitive Remediation - New Zealand) will occur. The primary outcome will be change in Global Cognition between 6 and 12 months (treatment-end) in IPSRT-CR versus IPSRT alone. Secondary outcomes will be change in cognitive, functional, and mood outcomes at 6, 12, 18, and 24 months from baseline and exploratory outcomes include change in quality of life, medication adherence, rumination, and inflammatory markers between treatment arms. Outcome analyses will use an intention-to-treat approach. Sub-group analyses will assess the impact of baseline features on CR treatment response. Participants' experiences of their mood disorder, including treatment, will be examined using qualitative analysis. DISCUSSION This will be the first RCT to combine group-based CR with an evidence-based psychotherapy for adults with mood disorders. The trial may provide valuable information regarding how we can help promote long-term recovery from mood disorders. Many issues have been considered in developing this protocol, including: recruitment of the spectrum of mood disorders, screening for cognitive impairment, dose and timing of the CR intervention, choice of comparator treatment, and choice of outcome measures. TRIAL REGISTRATION Australian and New Zealand Clinical Trials Registry, ACTRN12619001080112 . Registered on 6 August 2019.
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Affiliation(s)
- Katie M. Douglas
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Maree L. Inder
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie T. Crowe
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Jennifer Jordan
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Dave Carlye
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Cameron Lacey
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.29980.3a0000 0004 1936 7830Māori Indigenous Health Institute, University of Otago, Christchurch, New Zealand
| | - Ben Beaglehole
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Roger Mulder
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Kate Eggleston
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Katherine A. Donovan
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Christopher M. A. Frampton
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Christopher R. Bowie
- grid.410356.50000 0004 1936 8331Department of Psychology, Queen’s University, Kingston, ON Canada
| | - Richard J. Porter
- grid.29980.3a0000 0004 1936 7830Department of Psychological Medicine, University of Otago, Christchurch, New Zealand ,grid.410864.f0000 0001 0040 0934Specialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Averill IRE, Beaglehole B, Douglas KM, Jordan J, Crowe MT, Inder M, Lacey CJ, Frampton CM, Bowie CR, Porter RJ. Activation therapy for the treatment of inpatients with depression - protocol for a randomised control trial compared to treatment as usual. BMC Psychiatry 2019; 19:52. [PMID: 30709391 PMCID: PMC6359820 DOI: 10.1186/s12888-019-2038-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Accepted: 01/25/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Inpatients with depression have a poor long term outcome with high rates of suicide, high levels of morbidity and frequent re-admission. Current treatment often relies on pharmacological intervention and focuses on observation to maintain safety. There is significant neurocognitive deficit which is linked to poor functional outcomes. As a consequence, there is a need for novel psychotherapeutic interventions that seek to address these concerns. METHODS We combined cognitive activation and behavioural activation to create activation therapy (AT) for the treatment of inpatient depression and conducted a small open label study which demonstrated acceptability and feasibility. We propose a randomised controlled trial which will compare treatment as usual (TAU) with TAU plus activation therapy for adult inpatients with a major depressive episode. The behavioural activation component involves therapist guided re-engagement with previously or potentially rewarding activities. The cognitive activation aspect utilises computer based exercises which have been shown to improve cognitive function. DISCUSSION The proposed randomised controlled trial will examine whether or not the addition of this therapy to TAU will result in a reduced re-hospitalisation rate at 12 weeks post discharge. Subjective change in activation and objectively measured change in activity levels will be rated, and the extent of change to neurocognition will be assessed. TRIAL REGISTRATION Unique trial number: U1111-1190-9517. Australian New Zealand Clinical Trials Registry (ANZCTR) number: ACTRN12617000024347p .
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Affiliation(s)
- Ian R. E. Averill
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand ,0000 0001 0040 0934grid.410864.fSpecialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Ben Beaglehole
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand ,0000 0001 0040 0934grid.410864.fSpecialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
| | - Katie M. Douglas
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Jennifer Jordan
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Marie T. Crowe
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Maree Inder
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Cameron J. Lacey
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Christopher M. Frampton
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand
| | - Christopher R. Bowie
- 0000 0004 1936 8331grid.410356.5Department of Psychology, Queen’s University, Kingston, Canada
| | - Richard J. Porter
- 0000 0004 1936 7830grid.29980.3aDepartment of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, 8140 New Zealand ,0000 0001 0040 0934grid.410864.fSpecialist Mental Health Services, Canterbury District Health Board, Christchurch, New Zealand
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Inder ML, Crowe MT, Moor S, Carter JD, Luty SE, Frampton CM, Joyce PR. Three-year follow-up after psychotherapy for young people with bipolar disorder. Bipolar Disord 2017; 20:441-447. [PMID: 29271072 DOI: 10.1111/bdi.12582] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 10/21/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVES (1) To examine the differences between interpersonal and social rhythm therapy (IPSRT) and specialist supportive care (SSC) in the longer term impacts of IPSRT and SSC on cumulative depression and mania symptoms over a further 78-week follow-up period post treatment. (2) To calculate the survival time before recurrence of a new mood episode over the 3-year period. METHODS One hundred young people with bipolar disorder aged between 15 and 36 years who had been randomized to treatment with either IPSRT or SSC for 78 weeks were followed up for a subsequent 78 weeks. The Longitudinal Interval Follow-up Evaluation was completed at 26-week intervals. A Mann-Whitney U test was used to determine if there were significant differences between therapy types and a Kaplan-Meier survival analysis was used to determine time to recurrence. Cox regression was used to assess the association between time to relapse and therapy type. RESULTS There were no significant differences between therapies at each of the data points for either depression or mania scores. The mean change in depression and mania in both groups was significantly different for all three follow-up data points. The actuarial cumulative recurrence rates were 53% for IPSRT and 49% for SSC. There was no significant difference between the groups in time to recurrence. CONCLUSIONS While there were no significant differences between the two therapies, there was an overall reduction in symptoms in both therapies. There may be sustained benefits in providing intensive psychotherapies in conjunction with pharmacotherapy for young people with bipolar disorder.
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Affiliation(s)
- Maree L Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie T Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Stephanie Moor
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Janet D Carter
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Suzanne E Luty
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | | | - Peter R Joyce
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Whitehead LC, Crowe MT, Carter JD, Maskill VR, Carlyle D, Bugge C, Frampton CMA. A nurse-led education and cognitive behaviour therapy-based intervention among adults with uncontrolled type 2 diabetes: A randomised controlled trial. J Eval Clin Pract 2017; 23:821-829. [PMID: 28397334 DOI: 10.1111/jep.12725] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 12/23/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Diabetes mellitus is associated with significant morbidity, mortality, and escalating health care costs. Research has consistently demonstrated the importance of glycaemic control in delaying the onset, and decreasing the incidence, of both the short-term and long-term complications of diabetes. Although glycaemic control is difficult to achieve and challenging to maintain, it is key to reducing negative disease outcomes. The aim of this study was to determine whether a nurse-led educational intervention alone or a nurse-led intervention using education and acceptance and commitment therapy (ACT) was effective in reducing hemoglobin A1c (HbA1c ) in people living with uncontrolled type 2 diabetes compared to usual care. METHODS Adults over the age of 18 years, with a confirmed diagnosis of type 2 diabetes and HbA1c outside of the recommended range (4%-7%, 20-53 mmol/mol) for 12 months or more, were eligible to participate. Participants were randomised to either a nurse-led education intervention, a nurse-led education plus ACT intervention, or a usual care. One hundred and eighteen participants completed baseline data collection (N = 34 education group, N = 39 education plus ACT, N = 45 control group). An intention to treat analysis was used. RESULTS A statistically significant reduction in HbA1c in the education intervention group was found (P = .011 [7.48, 8.14]). At 6 months, HbA1c was reduced in both intervention groups (education group -0.21 and education and ACT group -0.04) and increased in the control group (+0.32). A positive change in HbA1c (HbA1c reduced) was noted in 50 participants overall. Twice as many participants in the intervention groups demonstrated an improvement as compared to the control group (56% of the education group, 51% education plus ACT, and 24% control group. CONCLUSIONS At 6 months post intervention, HbA1c was reduced in both intervention groups with a greater reduction noted in the nurse-led education intervention.
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Affiliation(s)
- Lisa C Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Marie T Crowe
- Centre for Postgraduate Nursing Studies & Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Janet D Carter
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Virginia R Maskill
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Dave Carlyle
- School of Health Sciences, University of Otago, Christchurch, New Zealand
| | - Carol Bugge
- School of Health Sciences, University of Stirling, Stirling, UK
| | - Chris M A Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Whitehead LC, Crowe MT, Carter JD, Maskill VR, Carlyle D, Bugge C, Frampton CMA. A nurse-led interdisciplinary approach to promote self-management of type 2 diabetes: a process evaluation of post-intervention experiences. J Eval Clin Pract 2017; 23:264-271. [PMID: 27417302 DOI: 10.1111/jep.12594] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2016] [Revised: 06/07/2016] [Accepted: 06/08/2016] [Indexed: 11/28/2022]
Abstract
RATIONALE, AIMS AND OBJECTIVES Self-management of type 2 diabetes through diet, exercise and for many medications, are vital in achieving and maintaining glycaemic control in type 2 diabetes. A number of interventions have been designed to improve self-management, but the outcomes of these are rarely explored from a qualitative angle and even fewer through a process evaluation. METHOD A process evaluation was conducted using a qualitative design with participants randomized to an intervention. Seventy-three people living with type 2 diabetes and hyperglycaemia for a minimum of 1 year, randomized to one of two interventions (n = 34 to an education intervention and n = 39 to an education and acceptance and commitment therapy intervention) completed stage one of the process evaluation, immediately following the intervention through written feedback guided by open-ended questions. A purposive sample of 27 participants completed semi-structured interviews at 3 and 6 months post intervention. Interview data were transcribed and data analysed using a thematic analysis. RESULTS The majority of participants described an increase in knowledge around diabetes self-management and an increased sense of personal responsibility. Participants also described changes in self-management activities and reflected on the challenges in instigating and maintaining change to improve diabetes management. CONCLUSION The complexities of implementing change in daily life to improve glycaemic control indicate the need for ongoing support post intervention, which may increase and maintain the effectiveness of the intervention.
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Affiliation(s)
- Lisa C Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Australia
| | - Marie T Crowe
- Centre for Postgraduate Nursing Studies, Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Janet D Carter
- Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Virginia R Maskill
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Dave Carlyle
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Carol Bugge
- School of Health Sciences, University of Stirling, Stirling, UK
| | - Chris M A Frampton
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Whitehead LC, Unahi K, Burrell B, Crowe MT. The Experience of Fatigue Across Long-Term Conditions: A Qualitative Meta-Synthesis. J Pain Symptom Manage 2016; 52:131-143.e1. [PMID: 27233142 DOI: 10.1016/j.jpainsymman.2016.02.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 01/24/2016] [Accepted: 02/05/2016] [Indexed: 11/30/2022]
Abstract
CONTEXT Fatigue is a common and debilitating symptom associated with many long-term conditions and is reported to cause significant levels of distress for those individuals. There is a substantial body of literature related to the nature of fatigue; however, this has not been drawn together and compared across conditions. OBJECTIVES The aim of this review was to synthesize data on the nature of fatigue across long-term conditions. METHODS The review was designed as a qualitative meta-synthesis and followed the Joanna Briggs Institute guidelines for synthesizing qualitative research. The following databases were searched for the period January 1980 to January 2016, Ovid (Medline, Embase, CINAHL, and PsycINFO) and manual searching from the reference lists from articles identified by electronic search. Fifty-seven studies were included in the review, and findings related to the nature of fatigue were extracted and findings meta-synthesized. RESULTS The perceived nature of fatigue across long-term conditions was encompassed in one synthesis; the fatigue experience is without precedent, with four categories: a different fatigue to any experienced before, the intensity of fatigue is overwhelming, the trajectory of fatigue, and impact on sleep and sleep disturbance. Just over half of the participants in the included studies were diagnosed with cancer. Patterns in the experience of fatigue by condition were found for cancer-related fatigue and post-stroke fatigue where data were able to be synthesized. CONCLUSION Although similarities in the nature of the fatigue experienced were found across conditions, differences were also evident and could be mapped for cancer-related fatigue and post-stroke fatigue. Further qualitative research on the experience of fatigue across a wide range of chronic conditions would further contribute to understanding similarities and differences across conditions and inform both research and practice in relation to assessment and management.
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Affiliation(s)
- Lisa C Whitehead
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia.
| | - Kirstin Unahi
- Southern District Health Board, Dunedin, New Zealand
| | - Beverley Burrell
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand
| | - Marie T Crowe
- Centre for Postgraduate Nursing Studies, University of Otago, Christchurch, New Zealand; Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Abstract
OBJECTIVES Given the sensitivity of individuals with mood disorders to circadian disruption, transmeridian travel would likely be a high-risk endeavour leading to onset or relapses in mood. A systematic review was undertaken to identify the evidence of the impact of transmeridian travel on people with mood disorders. METHODS Databases search included the following: CINAHL, MEDLINE, PsycINFO and manual searching using the keywords jetlag, transmeridian travel, circadian rhythm disruption, mood disorder, bipolar, major depression, seasonal affective disorder, depression, mania and hypomania. RESULTS Only three studies were identified that related to transmeridian travel and jetlag in people with mood disorders. There is some suggestion that transmeridian travel does appear to precipitate mood episodes with an increased rate of episodes of depression with westward compared with an increased rate of manic/hypomanic episodes with eastward travel. Individuals with a previous history of mood disorder appear to be more vulnerable if adherence to medication is compromised. CONCLUSION Given the limited evidence that transmeridian travel precipitates mood episodes, this poses difficulties in identifying suitable ways to mitigate the effects of transmeridian travel in mood disorders. However, in the absence of mood-specific guidelines, some guidance can be given based on our current understanding of the relevance of circadian disruption to both jetlag and mood disorders. Further research is required to identify more focused strategies to mitigate the impact of transmeridian travel for individuals with mood disorders.
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Affiliation(s)
- Maree L Inder
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Marie T Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
| | - Richard Porter
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Inder ML, Crowe MT, Luty SE, Carter JD, Moor S, Frampton CM, Joyce PR. Prospective rates of suicide attempts and nonsuicidal self-injury by young people with bipolar disorder participating in a psychotherapy study. Aust N Z J Psychiatry 2016; 50:167-73. [PMID: 26698820 DOI: 10.1177/0004867415622268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Bipolar disorder is a chronic relapsing disorder associated with high rates of suicide, suicide attempts and nonsuicidal self-injury. The study aimed to prospectively identify the rates of suicide attempts and nonsuicidal self-injury in young people participating in an adjunctive randomised controlled psychotherapy for bipolar disorder and to identify differences in individuals who engaged in nonsuicidal self-injury, made suicide attempts or did both. METHOD In all, 100 participants aged 15-36 years with bipolar disorder received 78 weeks of psychotherapy and were followed up for a further 78 weeks. Data were collected using the Longitudinal Interval Follow-up Evaluation. RESULTS Suicide attempts reduced from 11% at baseline to 1% at the end of follow-up (week 156). Similarly, self-harm reduced from 15% at baseline to 7% at the end of follow-up. Individuals who engaged in both nonsuicidal self-injury and made suicide attempts differed from those with who only made suicide attempts, engaged in nonsuicidal self-injury or did neither. They were characterised by a younger age of illness onset and higher comorbidity. CONCLUSION Adjunctive intensive psychotherapy may be effective in reducing suicide attempts and nonsuicidal self-injury and warrants further attention. Particular attention needs to be paid to individuals with early age of onset of bipolar disorder.
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Affiliation(s)
- Maree L Inder
- Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand
| | - Marie T Crowe
- Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand
| | - Suzanne E Luty
- Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand
| | - Janet D Carter
- Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand Department of Psychology, University of Canterbury, Christchurch, New Zealand
| | - Stephanie Moor
- Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand
| | - Christopher M Frampton
- Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand
| | - Peter R Joyce
- Department of Psychological Medicine, University of Otago - Christchurch, Christchurch, New Zealand
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Carter JD, Crowe MT, Jordan J, McIntosh VVW, Frampton C, Joyce PR. Predictors of response to CBT and IPT for depression; the contribution of therapy process. Behav Res Ther 2015; 74:72-9. [PMID: 26432173 DOI: 10.1016/j.brat.2015.09.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Revised: 09/12/2015] [Accepted: 09/15/2015] [Indexed: 11/12/2022]
Abstract
Little is known about the factors that contribute to a positive psychotherapy outcome. There is still considerable debate as to whether specific factors (e.g. severity of symptoms, comorbidity) or nonspecific factors (e.g. alliance, therapy process) are most important in influencing outcome. This study examined the additional contribution that therapeutic process and alliance made to previously identified specific predictors of response to CBT and IPT for depression over the course of therapy. The previously identified specific factors were belief that childhood reasons caused the depression, recurrent depression, perceptions about how logical therapy was and comorbid personality disorder symptoms. One hundred and sixty five adult outpatients with major depression were treated for depression in a randomised clinical trial examining predictors of response to Cognitive Behavior Therapy and Interpersonal Psychotherapy. All therapy sessions were audiorecorded to enable objective ratings of therapeutic process and alliance. Process factors - patient psychic distress, patient participation and patient alliance had the strongest associations with outcome. The early and middle stage of therapy process did not account for any additional variance other than that previously identified by the patient predictors, however, at the end stage of therapy process contributed a further 14%.
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Affiliation(s)
- Janet D Carter
- Department of Psychology, University of Canterbury, Private Bag 4800, Christchurch, New Zealand.
| | - Marie T Crowe
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand.
| | - Jennifer Jordan
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand.
| | - Virginia V W McIntosh
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand.
| | - Christopher Frampton
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand.
| | - Peter R Joyce
- Department of Psychological Medicine, University of Otago, PO Box 4345, Christchurch, New Zealand.
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Inder ML, Crowe MT, Luty SE, Carter JD, Moor S, Frampton CM, Joyce PR. Randomized, controlled trial of Interpersonal and Social Rhythm Therapy for young people with bipolar disorder. Bipolar Disord 2015; 17:128-38. [PMID: 25346391 DOI: 10.1111/bdi.12273] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 08/14/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVE This randomized, controlled clinical trial compared the effect of interpersonal and social rhythm therapy (IPSRT) to that of specialist supportive care (SSC) on depressive outcomes (primary), social functioning, and mania outcomes over 26-78 weeks in young people with bipolar disorder receiving psychopharmacological treatment. METHODS Subjects were aged 15-36 years, recruited from a range of sources, and the patient groups included bipolar I disorder, bipolar II disorder, and bipolar disorder not otherwise specified. Exclusion criteria were minimal. Outcome measures were the Longitudinal Interval Follow-up Evaluation and the Social Adjustment Scale. Paired-sample t-tests were used to determine the significance of change from baseline to outcome period. Analyses of covariance were used to determine the impact of therapy, impact of lifetime and current comorbidity, interaction between comorbidity and therapy, and impact of age at study entry on depression. RESULTS A group of 100 participants were randomized to IPSRT (n = 49) or SSC (n = 51). The majority had bipolar I disorder (78%) and were female (76%), with high levels of comorbidity. After treatment, both groups had improved depressive symptoms, social functioning, and manic symptoms. Contrary to our hypothesis, there was no significant difference between therapies. There was no impact of lifetime or current Axis I comorbidity or age at study entry. There was a relative impact of SSC for patients with current substance use disorder. CONCLUSIONS IPSRT and SSC used as an adjunct to pharmacotherapy appear to be effective in reducing depressive and manic symptoms and improving social functioning in adolescents and young adults with bipolar disorder and high rates of comorbidity. Identifying effective treatments that particularly address depressive symptoms is important in reducing the burden of bipolar disorder.
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Affiliation(s)
- Maree L Inder
- Department of Psychological Medicine, University of Otago, Christchurch
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Crowe MT. Treating recurrent mood disorders seriously. N Z Med J 2014; 127:9-11. [PMID: 25399036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Affiliation(s)
- Marie T Crowe
- Department of Psychological Medicine, University of Otago - Christchurch, PO Box 4345, Christchurch 8140, New Zealand.
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Vierck E, Porter RJ, Luty SE, Moor S, Crowe MT, Carter JD, Inder ML, Joyce PR. Further evidence for slow binocular rivalry rate as a trait marker for bipolar disorder. Aust N Z J Psychiatry 2013; 47:371-9. [PMID: 23341474 DOI: 10.1177/0004867412474105] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Binocular rivalry refers to a situation where contradictory information is presented simultaneously to the same location of each eye. This leads to the alternation of images every few seconds. The rate of alternation between images has been shown to be slower in euthymic participants with bipolar disorder than in healthy controls. The alternation rate is not uniformly slowed in bipolar disorder patients and may be influenced by clinical variables. The present study examined whether bipolar disorder patients have slower alternation rates, examined the influence of depression and explored the role of clinical variables and cognitive functions on alternation rate. METHOD Ninety-six patients with bipolar disorder and 24 control participants took part in the study. Current mood status and binocular rivalry performance were analysed with nonparametric tests. A slow and a normal alternation group were created by median split. We subsequently explored the distribution of several clinical variables across these groups. Further, we investigated associations between alternation rate and various cognitive functions, such as visual processing, memory, attention and general motor speed. RESULTS The median alternation rate was significantly slower for participants with bipolar disorder type I (0.39 Hz) and for participants with bipolar spectrum disorder (0.43 Hz) than for control participants (0.47 Hz). Depression had no effect on alternation rate. There were no differences between participants with bipolar disorder type I and type II and in regard to medication regime and predominance of one rivalry image. There were also no differences in regard to the clinical variables and no significant associations between alternation rate and the cognitive functions explored. CONCLUSION We replicated a slowing in alternation rate in some bipolar disorder participants. The alternation rate was not affected by depressed mood or any of the other factors explored, which supports views of binocular rivalry rates as a trait marker in bipolar disorder.
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Affiliation(s)
- Esther Vierck
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand.
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Abstract
The majority of patients with bipolar disorder have onset prior to twenty years with early onset associated with increased impairment. Despite this, little attention has been given to the psychosocial developmental impact of this disorder. This qualitative study explored the impact of having bipolar disorder on the development of a sense of self and identity. Key findings from this qualitative study identified that for these participants, bipolar disorder had a significant impact in the area of self and identity development. Bipolar disorder created experiences of confusion, contradiction, and self doubt which made it difficult for these participants to establish continuity in their sense of self. Their lives were characterized by disruption and discontinuity and by external definitions of self based on their illness. Developing a more integrated self and identity was deemed possible through self-acceptance and incorporating different aspects of themselves. These findings would suggest that it is critical to view bipolar disorder within a psychosocial developmental framework and consider the impact on the development of self and identity. A focus on the specific areas of impact and targeting interventions that facilitate acceptance and integration thus promoting self and identity development would be recommended.
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Affiliation(s)
- Maree L Inder
- Department of Psychological Medicine, University of Otago Christchurch, Christchurch, New Zealand.
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Abstract
AIM This paper presents a literature review conducted to establish what was already known about critical reflection in the nursing literature and what work had been done on using a critical social theory framework as the basis for critical reflection. BACKGROUND Critical thinking emerged as a significant aspect of nursing education and practice in the late 1980s. It has been promoted as a means by which issues in clinical practice can be examined through a systematic process of exploration and reasoning. Traditionally, critical thinking has commonly involved an attempt to link practice with theory using a scenario or exemplar from practice to illustrate a practice dilemma. This process is often constructed as a retrospective narrative of events. This paper provides a deconstructive-reconstructive approach that differs from some traditional approaches by taking a critical social theory perspective with an emphasis on improving practice. METHODS The nursing literature reviewed was accessed through Cumulative Index of Nursing and Allied Health Literature (CINAHL). The search was restricted to English language and published between 1995 and 2005. Based on these findings, we developed a postgraduate advanced mental health nursing programme. FINDINGS There were 490 articles related to 'nursing' and 'critical thinking'; 34 articles related to 'nursing' and 'critical reflection'; 23 articles related to 'nursing' and 'critical social theory'; 15 articles related to 'mental health nursing' and 'critical thinking'; and two articles related to 'mental health nursing' and 'critical reflection'. In the programme we developed based on these findings, students were facilitated to deconstruct concepts and knowledge integral to their own practice. In the reconstructive phase, students implement a change project in clinical practice, supported by a mentor. CONCLUSION The deconstructive-reconstructive approach to the development of critical thinking skills provides advanced practitioner with the opportunity to integrate practice, theory and research.
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Affiliation(s)
- Marie T Crowe
- Associate Professor, Department of Psychological Medicine, Christchurch School of Medicine and Health Sciences, Christchurch, New Zealand.
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Abstract
PURPOSE To assess the use of percutaneous endovascular stent insertion in the management of superior vena cava (SVC) occlusion. METHODS Percutaneous endovascular stent insertion was attempted in 13 patients, age range 20-72 (mean 55.5) years, with symptomatic total occlusion of the SVC. Twelve patients had known malignant disease of the thorax. The other patient (age 20) had chronic SVC obstruction, the cause of which was unknown at the time of the procedure. There was initial angiographic assessment and removal of thrombus by thrombolysis (10 patients) and/or clot aspiration (3 patients). Following successful lysis or aspiration, single or multiple endovascular stents were inserted. RESULTS The inability to cross the lesion with a guidewire prevented stent insertion in 2 patients (15.4%). There was primary success in the remaining 11 patients (84.6%), with associated symptomatic relief. Some recurrence of symptoms occurred in 5 of the 11 patients (45.5%) after a time interval ranging from 14 to 183 days. In all cases of symptomatic recurrence, patency was reestablished with further thrombolysis and/or further stent insertion. All successfully treated patients have since died. All 11 patients remained symptomatically free of SVC occlusion until death, with postprocedure survival ranging from 5 to 243 days. CONCLUSION The percutaneous management of complete SVC occlusion with thrombolysis and/or clot aspiration followed by stent insertion is safe and effective, giving sustained symptomatic relief.
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Affiliation(s)
- M T Crowe
- Department of Diagnostic Radiology, Royal Hallamshire Hospital, Sheffield, England
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