The lived experience of caring for someone with bipolar disorder: A qualitative study

Being a close family or friend of someone with bipolar disorder (BD) can lead to experiences of increased stress, anxiety and depressive symptoms related to the burden of caring. However, the lived experience of being a carer for a person with BD has not received significant research attention. This study aimed to gain further insight into the experiences of individuals in an informal caring role for someone with BD and determine what additional information and support these people need to take care of both themselves and the person they are caring for. Fifteen qualitative interviews were carried out with carers discussing their lived experiences with utilising coping strategies and supporting someone with BD. Following the interviews, thematic analysis was used to identify five key themes. These themes were: Separation of the person and the disorder, carer health and coping strategies, unpredictability and variability of symptoms, carer disillusionment and silencing, and story sharing and support needs. Overall, the findings highlighted the need for increased in-person and online support specifically tailored for carers with loved ones experiencing BD.

Outcomes of Parent-Child Interaction Therapy (PCIT) for families presenting with child maltreatment: A systematic review

BACKGROUND

The developmental consequences of childhood trauma for young children are extensive and impact a diverse range of areas. Young children require treatments that consider their developmental stage and are inclusive of caregiver involvement. Parent-Child Interaction Therapy (PCIT), with its dyadic focus and developmental sensitivity, is uniquely positioned to offer therapeutic support to young children and their families.

AIM

The current study aimed to conduct a systematic review of the current literature on PCIT and trauma and determine treatment outcomes for children and caregivers.

METHOD

A systematic review of five electronic databases was undertaken. Studies that utilized PCIT to treat a population who had experienced trauma were included in the review regardless of study design.

RESULTS

PCIT was used to treat a population who had experienced trauma in 40 studies. PCIT was an effective treatment in improving a variety of child and parent outcomes in this population including reduced parenting stress, child behavior problems, child trauma symptoms, parental mental health concerns, negative parenting strategies, and reducing potential risk of recidivism of abuse and neglect. These findings should be taken with caution given attrition rates and potential for bias in the study samples.

DISCUSSION

Clinicians should consider PCIT as a potential treatment for children who have experienced trauma and their families. Future research should incorporate corroborative sources of information, assessment of caregiver and child trauma symptoms, examination of permanency outcomes, and consider standardization of PCIT modifications for child trauma to determine treatment in this population of children.

Indigeneity and Likelihood of Discharge to Psychiatric Hospital in an Australian Deliberate Self-Poisoning Hospital-Treated Cohort

Hospital-treated self-harm rates for Aboriginal and Torres Strait Islander (Indigenous) people are at least double those for other Australians. Despite this, limited research has explored the relationship between Indigeneity and the clinical management of hospital-treated deliberate self-harm. A retrospective clinical cohort study (2003-2012) at a regional referral centre (NSW) for deliberate self-poisoning was used to explore the magnitude and direction of the relationship between Indigeneity and discharge destination (psychiatric hospital vs. other) using a series of logistic regressions. There were 149 (4%) Indigenous and 3697 (96%) non-Indigenous deliberate self-poisoning admissions during the study period. One-third (31%) were referred to the psychiatric hospital at discharge; Indigenous 21% (n = 32) vs. non-Indigenous 32% (n = 1175). Those who identified as Indigenous were less likely to be discharged to the psychiatric hospital, OR 0.59 (0.40-0.87) at the univariate level, with little change after sequential adjustment; and AOR 0.34 (0.21-0.73) in the fully adjusted model. The Indigenous cohort had a lower likelihood of psychiatric hospital discharge even after adjustment for variables associated with discharge to the psychiatric hospital highlighting the need for further investigation of the reasons accounting for this differential pattern of clinical management and the effectiveness of differential after-care allocation.

Group-Delivered Enhanced Cognitive Behavior Therapy: A Focus on a Young Adult Woman With Bulimia Nervosa

Enhanced Cognitive Behavioral Therapy (CBT-E) is an evidence-based treatment for bulimia nervosa (BN), which can be delivered individually or in a group format. This case study describes a young adult female’s progress through a CBT-E group program at an Australian community outpatient eating disorder service. She completed 20 sessions over 10 weeks. The client was administered measures for eating disorder symptoms, depression, anxiety, stress, stage of change, and clinical impairment at pre- and posttreatment. She improved on global eating disorder symptoms, food restriction, eating concern, and her stage of change. Her weight and shape concerns remained unchanged. Her levels of depression, anxiety, and stress significantly increased after treatment, highlighting the need for concurrent treatment for these comorbidities. These results support the developing literature on the efficacy of CBT-E for BN and describe in detail the progress of an individual, including their progress and challenges within a group intervention.

A Mobile Phone-Based Healthy Lifestyle Monitoring Tool for People With Mental Health Problems (MyHealthPA): Development and Pilot Testing

Background

People with mental health disorders live, on average, 20 years less than those without, often because of poor physical health including cardiovascular disease (CVD). Evidence-based interventions are required to reduce this lifespan gap.

Objective

This study aimed to develop, test, and evaluate a mobile phone–based lifestyle program (MyHealthPA) to help people with mental health problems improve key health risk behaviors and reduce their risk of CVD.

Methods

The development of MyHealthPA occurred in 3 stages: (1) scoping of the literature, (2) a survey (n=251) among people with and without the experience of mental health problems, and (3) program development informed by stages 1 and 2. A small pilot trial among young people with and without mental health disorders was also conducted. Participants completed a baseline assessment and were given access to the MyHealthPA program for a period of 8 weeks. They were then asked to complete an end-of-treatment assessment and a follow-up assessment 1 month later.

Results

In the study, 28 young people aged 19 to 25 years were recruited to the pilot trial. Of these, 12 (12/28, 43%) had been previously diagnosed with a mental illness. Overall, 12 participants (12/28, 43%) completed the end-of-treatment assessment and 6 (6/28, 21%) completed the follow-up assessment. Small improvements in fruit and vegetable consumption, level of physical activity, alcohol use, and mood were found between baseline and end of treatment and follow-up, particularly among people with experience of mental health issues. Most participants (history of mental illness: 4/7, 57%; no history of mental illness: 3/5, 60%) reported the program had above average usability; however, only 29% (2/7, no history of mental illness) to 40% (2/5, history of mental illness) of participants reported that they would like to use the program frequently and would recommend it to other young people. Participants also identified a number of ways in which the program could be improved.

Conclusions

This study describes the formative research and process of planning that formed the development of MyHealthPA and the evidence base underpinning the approach. The MyHealthPA program represents an innovative approach to CVD risk reduction among people with mental health problems. MyHealthPA appears to be an acceptable, easy-to-use, and potentially effective mHealth intervention to assist young people with mental illness to monitor risk factors for CVD. However, ways in which the program could be improved for future testing and dissemination were identified and discussed.

Bipolar Affective Disorder and Dissociation

In isolation, bipolar disorder and dissociation can place adolescents at risk of self-harm or suicide. However, when these are combined, they place an adolescent at serious risk of self-harming behavior or suicide completion. It appears from the scarcity in the literature to be rare for adolescents to have the combination of bipolar disorder and dissociation. This article outlines the case of an older adolescent girl with a comorbid combination. This case study highlights how the comorbidity of bipolar disorder and dissociation increases a patient's lethality risk and how both disorders may contribute to the volatile destabilization of the other. Risk management strategies are proposed in relation to the assessment of risk and preparedness for discharge from inpatient facilities.

Psychoform and somatoform dissociation in a clinical sample of Australian adolescents

Psychoform dissociation has been researched more than somatoform dissociation. The Somatoform Dissociation Questionnaire (SDQ-20), a commonly used adult measure of somatoform dissociation, is increasingly being used with adolescents internationally. We compared psychoform and somatoform dissociation in a mixed clinical adolescent sample. A total of 71 adolescents (12-18 years old) attending Australian community mental health and counseling services completed the SDQ-20 and the Adolescent Dissociative Experiences Scale, a commonly used measure of adolescent psychoform dissociation. The participants' treating clinicians provided participants' demographic details and mental health diagnoses. We found that 41% of participants reported high levels of psychoform dissociation and 21% reported high levels of somatoform dissociation. Both dissociation types were positively correlated. Neither was significantly related to participants' age, gender, or mental health diagnoses. Participants with more than 1 Axis I mental health diagnosis had higher levels of somatoform dissociation than participants with only 1 or no Axis I mental health diagnosis. This study is the first to examine somatoform dissociation in Australian adolescents and enables initial international comparisons.

Using Narrative Therapy to Treat Eating Disorder Not Otherwise Specified

Eating disorders have proved resistant to therapy with high relapse rates. Enhanced cognitive behavior therapy (CBT-E) is the favored treatment of choice but has been criticized for placing a similar emphasis on controlling eating behavior as the psychopathology it seeks to counter. In contrast, narrative therapy focuses on the development of an anti-eating disorder lifestyle and values. Evidence for this approach primarily consists of informal case study material. This case study describes a 28-year-old woman with a recurring history of anorexia nervosa, who self-referred to a university psychology clinic, due to fears of imminent relapse. The client received 10 sessions of narrative therapy and made significant progress in externalizing her eating disorder, in lessening her adherence to the ascetic values underpinning it, and in developing/expressing her non-eating disorder character and values. This case study provides evidence of the potential effectiveness of narrative therapy and contains valuable learning for clinicians regarding its implementation.

Exposure and Response Prevention in the Treatment of Distressing and Repugnant Thoughts and Images

Repugnant thoughts are often described as intrusive and distressing thoughts that are not acceptable to one’s own, and society’s, morals and values. They can occur in a small number of sufferers with obsessive-compulsive disorder. The following case study describes a young woman who experienced a number of distressing and repugnant thoughts and images. Her presenting most distressing obsessive thought was about committing suicide when she had no desire or intent to do so; however, her most repugnant thoughts centered around thoughts of harming her children. Psychological treatment sessions initially focused on psychoeducation and relaxation to prepare the client for more intense therapy. Exposure and response prevention methods were then used in a graded exposure method to help the client confront her feared obsessions and to help the client to overcome her subsequent strong emotional responses. Following 11 psychological treatment sessions, the client demonstrated significant improvements, including decreased distress from her obsessions, as well as a general decline in stress and anxiety.

Increased plasma d-lactic acid associated with impaired memory in rats

AIM

d-Lactic acidosis is associated with memory impairment in humans. Recent research indicates that d-lactic acid may inhibit the supply of energy from astrocytes to neurons involved with memory formation. However, little is known about the effects of increased hind-gut fermentation due to changes in diet on circulating lactic acid concentrations and memory.

METHOD

Thirty-six male Wistar rats were fed three dietary treatments: a commercial rat and mouse chow, a soluble carbohydrate based diet or a fermentable carbohydrate based diet. The parameters estimating memory were examined by employing the object recognition test. Physical parameters of fermentation including hind-gut and plasma lactic acid concentrations were examined after sacrifice, either 3 or 21h after feeding.

RESULTS

Increased fermentation in the hind-gut of rats, indicated by lower caecum pH, was associated with increased plasma l-lactic acid (r=-0.41, p=0.020) and d-lactic acid (r=-0.33, p=0.087). Memory, being able to discriminate between a familiar and a novel object during the object recognition test, was reduced with increasing plasma d-lactic acid (r=-0.51, p=0.021).

CONCLUSIONS

Memory impairment was associated with alterations in plasma d-lactic acid following the fermentation of carbohydrate in the hind-gut. Further work is still required to determine whether these effects are mediated centrally or via direct connections through the enteric nervous system.

Confusion Between Depression and Autism in a High Functioning Child

Autism is a diagnosis characterized by social and communication impairments. Onset of autism occurs before the age of 3. However, there can be delays in identification, diagnosis, and treatment. A number of symptoms of autism overlap with other childhood mental health disorders, often accounting for a delay in correct diagnosis. The following case highlights how a high-functioning female child with autism was misdiagnosed as having depression at a relatively late age. Clinicians with high-functioning child clients, who appear to have a flat affect and social isolation, are advised to be aware of the possibility of autism in such presentations. Issues around differentiating the diagnosis between depression and autism in children will be discussed, along with assessment and treatment of this particular case.

The changing face of bipolar disorder: adolescence to adulthood

Over the past decade, there has been greater acceptance of the existence of bipolar disorder (BD) in adolescents. The onset of BD during this period severely affects the acquisition of key developmental skills. Debate around diagnosis, comorbidity and treatment is strong and little is known about the long-term impact BD has on an adolescents as they approach adulthood, from both illness and functional perspectives. A review of psychological and medical databases using the search terms ''adolescent onset'', ''pediatric onset'', ''juvenile onset'', ''bipolar disorder'', ''course'' and ''outcome'' was conducted. Emphasis was placed on the information available from studies, which have described the outcome of adolescent onset BD either prospectively, retrospectively, or both. Twelve studies were identified that focused on the long-term course of adolescent onset BD. Findings on the course and outcomes are conflicting. These studies are from few centres or research groups and have small sample sizes, varied methodologies and relatively brief follow-up durations. There are few studies available on the course and outcome of adolescent onset BD. Although there seems to be less controversy in this age group compared to the prepubertal age group, there remains a need for prospective studies of large systematically ascertained samples.

Long chain omega-3 polyunsaturated fatty acids in the treatment of psychiatric illnesses in children and adolescents

OBJECTIVE

Long chain omega-3 polyunsaturated fatty acids (LCn-3PUFA) are in increasing use in the general population to treat health problems. The objective of the current article is to review the evidence for the rationale and benefit of LCn-3PUFA in the treatment of common psychiatric disorders in children and adolescents.

METHODS

A search of Psychlit, PubMed and Cochrane Databases was conducted using the terms child, adolescent, bipolar, depression, psychosis, first-episode psychosis, schizophrenia, attention deficit hyperactivity disorder (ADHD), autism, psychiatric, omega-3, n-3, docosahexaenoic acid and eicosapentaenoic acid. Further studies were identified from the bibliographies of published reviews.

RESULTS

One small randomized controlled trial with LCn-3PUFA supplementation in depression in children found a small beneficial effect over placebo. Four placebo-controlled trials showed uncertain benefit of LCn-3PUFA for ADHD. Single placebo-controlled trials showed no benefit in autism or bipolar disorder. There is an absence of studies examining benefit for first-episode psychosis or schizophrenia in children and adolescents.

CONCLUSIONS

While children and adolescents are receiving LCn-3PUFA for a range of psychiatric indications, there is only evidence of likely benefit for unipolar depression.

Anxiety and aggression associated with the fermentation of carbohydrates in the hindgut of rats

Lactic acid accumulation in the caecum and colon resulting from the fermentation of carbohydrates can lead to deleterious effects in ruminant and monogastric animals, including humans. In the present study, we examined the behavioural effects of two types of commonly consumed foods: soluble and fermentable carbohydrates (FCs). Thirty-six male Wistar rats were fed either a commercial rat and mouse chow, a soluble carbohydrate (SC)-based diet or an FC-based diet. Social interaction, anxiety, aggression and locomotor activity were examined by employing a social interaction test and a light/dark emergence test, while physical parameters of hindgut fermentation were examined after sacrifice, either 3 or 21 h after feeding. Results showed that anxiety (spending less time in the light compartment during the light/dark emergence test) and aggression (increased fighting during the social interaction test) were increased following raised concentrations of fermentation end products, such as lactic acid and volatile fatty acids (VFAs) in the caecum of rats. These associations occurred regardless of dopamine and 5-HT concentrations in the prefrontal cortex (PFC) and provide evidence supporting a general effect of FCs on behaviour. Possible mechanisms of action along with similarities between a rat and human model of acidosis are discussed.