Principal Investigator: Mitchell
A common cause of relapse in the management of Bipolar Disorder is
poor medication adherence – which correlates with low levels of acceptance
of illness and high levels of denial. While several psychosocial treatments
have been developed for Bipolar Disorder, they do not focus upon the difficulties
in acceptance of, and adaptation to illness. We have developed a novel psychological
intervention for Bipolar Disorder, modified from schema-focused cognitive therapy,
and commenced a pilot evaluation (funded by Rotary) of its efficacy, using a
randomised controlled trial (comparing to treatment as usual). Once this trial
is completed, further interventions will be tested, after determining the predictors
of optimal response and identifying the critical components of therapy.
Principal Investigator: Parker
A secondary hypothesis of our central study is that aetiological non-melancholic
disorder distinction made by the Personality Measure is supported by differential
treatment response. Indirect testing will occur in our case panel and other
studies, but direct testing will involve a randomised controlled study comparing
differing interventions (standard and ones under development) for principal
non-melancholic sub-groups sub-divided on the basis of their temperament and
personality style. Key results will shape further intervention studies.
Principal Investigator: Austin
The impact of antidepressants in pregnancy has been of great concern to both women and clinicians. There is now evidence that mild and short-lived withdrawal symptoms can arise in a small proportion of infants. However the degree of exposure in pregnancy and the impact on longer-term neurobehavioural outcomes is not so well documented. This study based at the Royal Hospital for Women in Sydney is examining these questions and a multicentre study is now being planned to increase recruitment capacity.
Principal Investigator: Wilhelm
Depression is the second highest cause of medical morbidity (behind
heart disease) and most cases are seen in general practice. Undetected cases
of depression cause increased medical and psychiatric morbidity, use of unnecessary
investigations. We pursue several different case-finding strategies, including
use of the DMI-10 measure.
Principal Investigator: Wilhelm
Deliberate self harm (DSH) accounts for 1-5% of public hospital admissions
but follow-up is challenging. Causes are being studied.
Principal Investigator: Parker
Cognitive Behavioural Therapy (CBT) involves teaching people skills and strategies to manage negative thoughts and behaviours that are associated with depression. CBT has been studied for over 20 years, and there is good evidence that it is effective as a treatment for depression. However, researchers are still not sure how CBT works in helping depression. Mindfulness Based Cognitive Therapy (MBCT) is a new variant of CBT, which involves teaching people to make simple shifts in their awareness of thoughts, feelings and bodily sensations. MBCT has been shown to be effective in preventing relapse, but has not yet been used as a treatment for depression. This study will compare group MBCT and CBT as treatments for depression, and examine how these treatments work.
Principal Investigator: Parker
The purpose of this study is to develop a standardised assessment measure
which might be used by general practitioners and other health practitioners
to develop a diagnostic and formulation template to assist management decisions.
Principal Investigator: Wilhelm
Patients with a mix of depression and multiple somatic complaints have
multiple attendances in general practice and hospital outpatient clinics and
generate multiple medical investigations. Previous studies have identified such
patients as more likely to have a depressive or anxiety disorder, often neither
recognised nor treated. We propose to test a particular intervention in an innovative
treatment comparison study.
Principal Investigator: Multiple studies with differing Principal
Investigators
Most researchers are involved in undertaking Randomised Controlled
Trials (RCTs) of antidepressant and mood stabiliser medications designed and
sponsored by various pharmaceutical companies. A number of the researchers are
on Australian and International advisory bodies for the development of new drugs.
Principal Investigator: Wilhelm
Our study of sex differences in the expression of depression led to
qualitative focus group studies and models for examining how men and women cope
with depression. We will study a novel intervention (the use of narrative) to
invoke mastery. If the writing technique proves effective, we will test other
techniques (eg problem solving and other self-mastery techniques), building
on work demonstrating the importance of patient choice.
Principal Investigator: Im Quah-Smith
Acupuncture has been used for the treatment of mental health problems for over one thousand years. In this case we are exploring the effectiveness of laser acupuncture in the treatment of depression. Medical acupuncturists use both needle and laser acupuncture as their treatment modalities. Laser acupuncture is both pain free and has no risk of infection. The treatment series involves laser acupuncture twice weekly for 4 weeks then once weekly for another 4 weeks. After that,
follow up questionnaires are to be completed at 4 weeks and 12 weeks after the last laser acupuncture. The participants will be streamed into either a placebo laser or real laser intervention. Those who receive placebo will be invited back for real laser acupuncture treatment. Participants have to be off their antidepressant medication and/or herbals for at least one month, and not had acupuncture for at least 3 months.
Principal Investigator: Parker
In addition to involvement in large RCTs, three small studies will
pursue our clinical observations, examining
Principal Investigator: Loo
Mild brain stimulation (also know as direct current stimulation, DCS) is a potential alternative to medication and electroconvulsive therapy for depressed patients. Very weak currents are used to stimulate the brain through the scalp. The stimulation is painless with no known serious side effects. Subjects will be fully awake and alert during the 20 minute treatment. tDCS is currently being offered as a treatment in research studies by the University of NSW, at the Black Dog Institute building, on site of Prince of Wales Hospital, Sydney. The study is particularly suitable for those seeking an alternative to medication or who are unable to tolerate medications or ECT.
Principal Investigator: Manicavasagar
An innovative maintenance treatment for Bipolar Disorder is now being offered that aims to reduce relapse of bipolar episodes as well as reduce levels of stress and anxiety. Mindfulness meditation has been shown to reduce rates of relapse in unipolar depression but this has yet to be investigated in bipolar disorder.
The program involves random allocation to either mindfulness-based cognitive therapy or treatment as usual (with the addition of bipolar education material). The therapy will be conducted in a group run by psychologists and is held on a weekly basis for 8 weeks in Randwick.
Principal Investigator: Parker
Identification of depression may be confounded in patients with a medical
illness by the presence of illness-related factors. The 10-item Depression in
the Medically Ill [DMI-10] instrument is a self-report measure designed for
use in this population. Numerous studies of its properties are being undertaken.
Principal Investigator: Sachdev
The vagus nerve connects the brain to visceral organs such as the heart,
lungs and the gastrointestinal tract. It carries a large amount of information
from the body organs to the brain that has an impact on limbic activity Stimulation
of the Vagus Nerve has been known for some time to control epilepsy. More recent
studies have shown that such stimulation can help depression as well. Two studies
of VNS for resistant depression have been conducted in the United Sates, and
a trial was recently started in Europe. The efficacy of this treatment remains
to be established, but if successful, it will be great advance in the management
of very treatment-resistant patients. We plan an open label, non-randomized,
single-arm, longitudinal study of up to 25 patients, following them for 18 weeks
in the first instance, and for a lengthier period for those who choose to remain
in the study.
Page last updated: 1-Jul-2008
Depression and Bipolar Disorder Information Australia - Black Dog Institute.
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