Brin F. S. Grenyer

Prevalence and precipitants of aggression in psychiatric inpatient units

Objective: Aggression is a significant clinical problem in psychiatric facilities. The present study reviews data on aggression collected from psychiatric inpatient units in order to determine prevalence and causal factors. Method: Data on aggressive incidents were gathered from four adult psychiatric units in the Illawarra, Australia. Information obtained included diagnosis, causal factors and patient sociodemographic characteristics. Results: During the 18-month period, a total of 1269 psychiatric patients were admitted and 174 patients (13.7%) were recorded as being aggressive. Patients with bipolar affective disorder and schizophrenia had a 2.81 and 1.96 significantly increased risk of aggression, respectively, while depression and adjustment disorder conferred a significantly lower risk. Aggression was most likely to occur within 2 days of admission and length of stay was greater for aggressive than non-aggressive patients. The greater number of incidents occurred on day shift. Most patients who displayed aggression did so on one occasion, but a small proportion of total patients (6.0%) accounted for a large number of incidents (71.0%). High-risk patients were identified as those who were under 32 years of age, were actively psychotic, detained and known to have a history of aggression and substance misuse. The most frequent form of aggression was physical and staff were most often the victims. Conclusions: These results have important implications for predicting and thereby reducing inpatient aggression. Organisations need to ensure aggression management strategies are in place and periodically identify and assess the level of risk for workers.

Fish oil supplementation in the treatment of major depression: A randomised double-blind placebo-controlled trial

Dietary deficiencies in essential omega-3 polyunsaturated fatty acids derived from fish are associated with depression and some fish oils may have therapeutic benefits. We aimed to determine whether taking tuna fish oil confers any additional benefit to conventional outpatient treatment for major depression. A randomized double-blind placebo-controlled four-month trial comparing tuna fish oil versus placebo was conducted on 83 outpatients with major depression. Despite large reductions in depression there were no significant differences at any assessment time point between patients receiving fish oil compared to placebo. Red blood cell incorporation of fatty acids indicated good compliance with oil supplementation, although this sample was not initially deficient in omega-3s. This particular dose and type of fish oil conferred no additional benefit to conventional treatment of depression in this sample. Future studies could target participants with pre-existing omega-3 deficiency and appraise alternate enriched types and higher doses of omega-3 supplementation.

Low plasma vitamin E levels in major depression: diet or disease?

Objective: Levels of vitamin E have been reported to be lower in patients suffering major depression, but whether this is due to inadequate dietary intake or the pathophysiology of depression is not known, and was the subject of the present study.Setting: Wollongong, Australia.Methods: Plasma vitamin E (α-tocopherol) was measured in 49 adults with major depression, age (mean±s.d.): 47±12 y. In a subset (n=19) usual dietary intake of vitamin E was determined by diet history.Results: Subjects had significantly lower plasma α-tocopherol (4.71±0.13 μmol/mmol cholesterol) than has previously been reported for healthy Australians, and plasma α-tocopherol was inversely related to depression score (by Beck Depression Inventory) (r=−0.367, P<0.009). Diet analysis indicated that 89% of subjects met or exceeded the recommended intake for vitamin E, and dietary intake was not related to plasma α-tocopherol level in this subset.Conclusion: These findings suggest that plasma levels of α-tocopherol are lower in depression, but this is not likely to be the result of inability to meet recommended dietary intake.Sponsorship: This study was supported in part by the Clover Corporation and the Australian Research Council.

Tuna fishmeal as a source of DHA for n−3 PUFA enrichment of pork, chicken, and eggs

Enriching foods with long-chain n−3 PUFA (LC n−3 PUFA) is an important approach to increasing the dietary intake of these beneficial nutrients. Enrichment of meat and eggs can be achieved by adding flaxseed, fish oil, or fishmeal to pig or poultry feeds. However, utilization of these sources, particularly fishmeal, has been limited by concerns about adverse effects on sensory qualities. In this study, we evaluated the use of PorcOmegaTM (POM), a stabilized tuna fishmeal formulation, as a source of DHA for enrichment of pork and poultry products. Pigs, broilers, and laying hens were fed rations containing varying levels of POM for varying time periods, and its impact on the LC n−3 PUFA content and sensory qualities of cooked meat and eggs was examined. Pork and chicken products, including chops, sausages, and eggs, with substantially increased (up to sevenfold) levels of LC n−3 PUFA (predominantly DHA) were achieved by including up to 10% POM in rations. The increases were retained after cooking. Some sensory deficits were noted when using higher levels of POM (exceeding 15% in meat and 10% in eggs). However, at modest rates of feeding (5–10% POM), palatable meat and eggs were obtained with worthwhile levels of enrichment. The fishmeal feeding strategy used in this study offers a viable means of producing a range of alternative dietary sources of LC n−3 PUFA.

Borderline Personality or Complex Posttraumatic Stress Disorder? An Update on the Controversy

There remains controversy surrounding the nature of the relationship between borderline personality disorder and posttraumatic stress disorder, with strong arguments that it would be more accurate and less stigmatizing for the former to be considered a trauma spectrum disorder. This article reviews the major criticisms of the DSM-IV diagnosis of borderline personality disorder that have fueled this controversy, including the absence of an etiology for the disorder, which is widely believed to be associated with early traumatic experiences. Also reviewed are recent attempts to redefine the disorder as a trauma spectrum variant based on the apparent overlap in symptomatology, rates of diagnostic comorbidity, and the prevalence of early trauma in individuals with a borderline diagnosis. The conceptual and theoretical problems for these reformulations are discussed, with particular reference to discrepancies in theoretical orientation, confusion of risk with causation, and the different foci of interventions for borderline personality disorder and posttraumatic stress disorder.

Fear of Intimacy in Women: Relationship between Attachment Styles and Depressive Symptoms

Background: Preoccupied and fearful attachment have both been associated with depressive symptoms, but it is unclear which attachment style is primarily associated with major depression. While preoccupied attachment denotes a focus on relationships as a source of self-validation, fearful attachment involves an avoidance of relationships for fear of rejection. Present research aims to investigate the relative influence of fearful and preoccupied attachments on self-reported depressive symptoms within both a student and a clinical sample and to examine these associations separately for male and female participants. Sampling and Methods: All participants completed the Relationship Questionnaire and the Beck Depression Inventory. Study 1 assessed attachment ratings and self-reported severity of depression for 71 patients diagnosed with major depression. Study 2 similarly assessed 245 university students, and study 3 compared attachment ratings of the two samples. Results: Both Pearson correlations and partial correlations were examined for both samples. Fearful attachment was associated with self-reported depression severity for females with depression, but attachment styles were unrelated to depression severity for males with depression (study 1). For female university students, both fearful and preoccupied attachment styles were significantly related to depression severity, but again there were no associations for male university students when partial correlations were utilised (study 2). Study 3 revealed significantly higher levels of fearful attachment for women with depression compared with female university students and no significant differences for males overall. Conclusions: For females, the avoidance of intimacy for fear of rejection was associated with a broad spectrum of depressive symptoms. Results highlight gender differences in depressive experiences, and have implications for research into the effects of fearful attachment on social support and the therapeutic alliance. Limitations to this study include the reliance on self-report measures of attachment and depression severity, the small number of male participants in the clinical sample, and the use of a cross-sectional rather than longitudinal design.

Mastering relationship conflicts : discoveries in theory, research, and practice

Mastery as a Central Ingredient in Psychotherapy A Theory of Mastery Through Psychotherapy Mastery and Current Trends in Psychotherapy The Mastery Scale Method Reliability and Validity of the Mastery Scale How Psychotherapists Help Patients Develop Mastery Mastery and Interpersonal Relations Mastery and Different Client Populations - Depression, Personality Disorders, and Substance Dependence The Process of Mastery - Present Status and Future Directions.

BIOPSYCHOSOCIAL CHANGES ASSOCIATED WITH CESSATION OF CANNABIS USE: A SINGLE CASE STUDY OF ACUTE AND CHRONIC COGNITIVE EFFECTS, WITHDRAWAL AND TREATMENT

A 35 year old male was cognitively assessed prior to cessation of 18 years of daily cannabis use and monitored for several weeks post cessation. Brain event-related potential (ERP) measures of selective attention reflecting a difficulty in filtering out complex irrelevant information showed no indication of improvement over 6 weeks of abstinence. In contrast, when tested in the acutely intoxicated state prior to cessation of use, a dramatic normalisation of the ERP signature of this individual was observed. A treatment program based on supportive-expressive psychotherapy was administered and depression, anxiety and general psychological health were monitored over the course of withdrawal from cannabis.

The influence of interpersonal factors on the speed of recovery from major depression

Abstract Previous research has established that a subsample of depressed patients may experience an early positive response to psychotherapy. The preconditions of this phenomenon were studied in 62 depressed adults receiving 16 weekly sessions of supportive–expressive dynamic psychotherapy. One third of the sample experienced an early rapid response (ERR), defined as a reduction of at least 50% of their intake Beck Depression Inventory score by Week 6. Despite equivalent ratings of working alliance between ERR and non-ERR patients, the former were five times more likely to recover. Pretherapy characteristics of depressed patients less likely to rapidly respond included a lower interpersonal mastery, a more domineering interpersonal style, and greater social isolation and attachment fears concerning intimacy. As a whole, these findings suggest that ERR and non-ERR patients present with dissimilar interpersonal patterns, requiring different psychotherapeutic approaches.

Impact of separation anxiety on psychotherapy outcomes for adults with anxiety disorders

Anxiety is highly prevalent in the community, and despite improvements in therapy a significant proportion of people tend to relapse, or remain significantly symptomatic. Theorists have proposed that untreated attachment anxieties and separation conflicts emerge from childhood development to be pervasive problems in adulthood. This study aimed to investigate the influence of juvenile and concurrent adult separation anxiety on psychotherapy outcomes. It was hypothesised that separation anxiety impedes therapy progress. A sample of 154 adults with a DSM-IV anxiety disorder received eight weekly sessions of group cognitive-behaviour therapy. In addition to intake and termination measures of anxiety and depression, participants also completed measures of juvenile and adult separation anxiety and the influence of these on outcomes was studied. Higher adult separation anxiety was associated with a greater likelihood of anxiety and comorbid depression remaining unremitted at termination of treatment. Higher juvenile separation anxiety was only associated with a greater likelihood of still being comorbidly depressed at termination of treatment. The findings of this study highlight the need to modify conventional exposure-based CBT treatments, and provide psychodynamic treatments that address attachment anxieties and separation conflicts.