Bias in emerging biomarkers for bipolar disorder

BACKGROUND: To date no comprehensive evaluation has appraised the likelihood of bias or the strength of the evidence of peripheral biomarkers for bipolar disorder (BD). Here we performed an umbrella review of meta-analyses of peripheral non-genetic biomarkers for BD. METHOD: The Pubmed/Medline, EMBASE and PsycInfo electronic databases were searched up to May 2015. Two independent authors conducted searches, examined references for eligibility, and extracted data. Meta-analyses in any language examining peripheral non-genetic biomarkers in participants with BD (across different mood states) compared to unaffected controls were included. RESULTS: Six references, which examined 13 biomarkers across 20 meta-analyses (5474 BD cases and 4823 healthy controls) met inclusion criteria. Evidence for excess of significance bias (i.e. bias favoring publication of 'positive' nominally significant results) was observed in 11 meta-analyses. Heterogeneity was high for (I 2 ⩾ 50%) 16 meta-analyses. Only two biomarkers met criteria for suggestive evidence namely the soluble IL-2 receptor and morning cortisol. The median power of included studies, using the effect size of the largest dataset as the plausible true effect size of each meta-analysis, was 15.3%. CONCLUSIONS: Our findings suggest that there is an excess of statistically significant results in the literature of peripheral biomarkers for BD. Selective publication of 'positive' results and selective reporting of outcomes are possible mechanisms.

Maximizing desistance: adding therapeutic jurisprudence and human rights to the mix

The law can be a systemically induced decision point for offenders and can act to help or hinder desistance. Desistance can be described as a change process that may be initiated by decisive momentum, supported by intervention, and maintained through re-entry, culminating in a citizen with full rights and responsibilities. Desistance within courts, corrections, and beyond is maximized by applying the law in a therapeutic manner. In common, desistance, therapeutic jurisprudence, and human rights support offender autonomy and well-being. The intersections between the three models have been explored to propose a normative framework that provides principles and offers strategies to address therapeutic legal rules, legal procedures, and the role of psycholegal actors and offenders in initiating, supporting, and maintaining desistance.

Applicability of the dual pathway model in normal and overweight binge eaters

Binge eating is a significant problem in both eating disordered and community populations alike. Extensive support exists for the dual pathway model of binge eating in both adolescent and adult clinical and nonclinical populations. However, the restrained eating pathway to binge eating in particular has failed to be confirmed in some studies. In particular, the dual pathway model may not be applicable to overweight binge eaters. The current study examined the applicability of the dual pathway model in a sample of healthy and overweight binge eaters. A total of 260 (115 healthy weight; 145 overweight or obese) adult binge eaters completed an online survey. Mediation analyses indicated support for both the dietary restraint and negative affect pathways in the healthy weight sample but only the latter pathway was supported in the overweight sample. Therefore, the full dual pathway model may only be applicable to healthy weight binge eaters.

Obsessive compulsive disorder : integration of cognitive-behaviour therapy and clinical psychology care into the primary care context

In primary care, evidence-based psychological treatments for obsessive compulsive disorder (OCD), such as cognitive behaviour therapy (CBT), have not been readily available. We aimed to develop models of care for OCD that account for barriers to access and can be integrated into general practice settings. Multiple methodologies and sources were utilised, including literature reviews, a reference group, focus groups, interviews and questionnaire responses from consumers, psychologists and/or GPs. It was found that there were similarities and some differences among stakeholders in attitudes and knowledge about OCD, and views about treatment and assessment in primary care. Three models of care for patients with OCD were developed and integrated into a treatment program operating through a division of general practice. Participating GPs preferred referral to a specialist clinic, irrespective of participation in an educational program about OCD. Based on these findings, it is suggested that effective integration of specialist CBT treatments for OCD into primary care is possible if the needs and views of all stakeholders are accounted for.

Gratitude : a basis for positive psychology interventions with a clinical population

This thesis includes a literature review that summarises the types of psychological research that have been conducted into gratitude, including the research conceptualising and developing assessments around it and exploring its associations with wellbeing, personality, social interaction, and health. The review focuses specifically on the research examining the relationship of gratitude to anxiety, depression and sleep, providing an outline of current theories about the relationship of positive affect to wellbeing, and a summary of the evidence to date. It is noted that there is comparatively little research on the impact of gratitude on anxiety and sleep but promising findings about the role of gratitude in the treatment of depression. Taken together, it is argued, the current research supported the need for trials of gratitude interventions specifically with clinical populations. Finally, the review looks at the literature of experimental interventions using gratitude. Particular emphasis is given to what has been learnt through these trials that might guide the focus and design of future research.

There follows the report of a randomized wait-list controlled pre-post trial of a gratitude diary intended to extend the research into the efficacy of gratitude diaries in the treatment of clinical populations with depression, anxiety and sleep difficulties. It was hypothesised that after completing a brief gratitude diary for three weeks, participants would have lower scores on measures of depression, anxiety, and perceived sleep difficulties, and higher scores on a measure of life satisfaction. These results were also expected to be evident at three-week follow-up. In a randomised waitlist-controlled trial with repeated measures pre-, post- and follow-up design, participants (N=109, from Australia) aged 18-64 years with a current self-reported diagnosis of an anxiety disorder and/or depression, took part in a self-help study via the internet. After completing the diary participants had lower scores on measures of depression, anxiety and perceived sleep difficulties and higher scores on a measure of subjective wellbeing than immediately pre-intervention. In addition, they had improved scores on a measure of stress. At three-week follow-up scores on depression and perceived sleep difficulties were no longer significantly different from pre-intervention, however improvements for subjective wellbeing and stress at post-intervention were maintained. At follow-up scores for anxiety had not only been maintained but had improved significantly beyond post-intervention results. This trial provides support for the use of gratitude diaries as a short-term intervention with a clinical population. Different patterns of anxiety and depression scores raise the possibility that gratitude interventions work differently to address depression and anxiety symptoms and provide support for the idea that gratitude interventions may have sustainable effects on anxiety symptoms.

Assessing the clinical competence of psychology students through Objective Structured Clinical Examinations (OSCEs): student and staff views

Objective Structured Clinical Examinations (OSCEs) are a well-known, reliable, and valid assessment method used across the healthcare sector. In the present study, we applied OSCEs in three units within professional postgraduate psychology courses, with the broad aims of identifying staff and student perceptions of the assessment. At the conclusion of each OSCE, staff and students completed a feedback questionnaire that contained both scaled and open-ended questions. Results suggest that clinical psychology OSCEs can be stressful for students, but are also well regarded. Both staff and students felt that the OSCEs were realistic, valid, and aligned well with professional practice. Students reported differences in the way in which they prepared for the OSCEs compared with a written exam or other form of assessment, while staff noted that models of OSCE development must be flexible, to adequately assess the objectives of individual units. Further, because they can be a costly exercise, OSCEs need to be applied judiciously within the tertiary sector.

An analysis of clinical handover miscommunication using a language and social psychology approach

Clinical handover is a key communication event in patient care and a major contributing factor in adverse events in hospitals. Current research on handover emphasizes communication skills training. We investigate the intergroup context and systemic factors of the hospital environment that also affect handover. We explore the responses of 707 health professionals about handover practice. We invoke Coupland and colleagues’ integrative model of “miscommunication” to interpret these. Results support the model. Responses reflect a lack of communication competency, intergroup group relations, and the hidden ideology of the health care system. Health professionals in hospitals are often unaware of the socio-structural element in health care and so cannot bring about cultural change. We suggest that clinicians work with communication and interdisciplinary scholars to bring about system improvement.

Specialisation within specialisation? Thoughts on the content of contemporary forensic psychology programs

This paper provides details of, and the rationale for, a Doctorate of Forensic Psychology recently developed at Deakin University, Melbourne, Australia. The course prioritises training in psycho-legal issues with children and young people. In discussing this program, the presenters identify two issue  that guided the development of the program. The first concerns the need to delineate forensic content from that in clinical programs, while still maintaining appropriate focus on the skills needed to work effectively in forensic settings. The second addresses the need for courses to acknowledge the marked diversity among forensic clientele and to develop competencies that lead to effective work practices with these sub-groups. In constructing the Deakin forensic program, it was noted that forensic psychologists required an increasing degree of expertise in the procedural and substantive aspects of the legal system. The authors propose that as forensic psychology gains momentum as a discrete area of expertise, there is an increasing need for practitioners to have a sound understanding of the legal institutions and practices they work under, as well as being able to apply specialist knowledge to particular sub-groups. This paper discusses these issues, and outlines how the authors sought to address them in their course curriculum.

Human rights and forensic psychology

Objectives. Human rights serve to orientate practitioners to the necessary conditions for a minimally worthwhile life for service users, the prerequisites for a life of dignity and a chance at happiness, and the opportunity to incorporate into their life plans cherished values and goals. In this introduction to the special section paper, I discuss the basic concept of human rights and outline their relevance for clinical practice with offenders.

Method. I explore the core values associated with human rights and suggest that one of their primary functions is to protect the internal and external conditions of individuals' agency and their pursuit of better lives.

Conclusion. I briefly outline the three articles comprising this special section of LCP on human rights that address issues of risk, therapeutic jurisprudence, and the rights of detained persons.

Evolutionary psychology and the rehabilitation of offenders : constraints and consequences

The mainstream view in criminology and correctional psychology is that evolutionary perspectives have little to offer researchers or practitioners and may in fact lead to overly reductionist and crude responses to the complex issue of crime and its consequences. However, in our view all the major evolutionary approaches to the explanation of human behavior have something of value to contribute, with niche construction providing a particularly useful lens upon crime and its management. In this paper we analyze the concept of rehabilitation and describe the key features of effective rehabilitation. We argue that niche construction is responsive to the cognitive versatility and behavioral flexibility of human beings and can also accommodate the important role of social and cultural scaffolding in the rehabilitation process.

Measuring self-care in chronic heart failure : a review of the psychometric properties of clinical instruments

Background : Improved self-care skills and behaviors are an important outcome of patient education and counseling. Both researchers and health professionals need to utilize instruments that are reliable and valid at measuring this outcome to advance our understanding as to the efficacy of clinical practice directed toward improving self-care.

Objective : The aim of this study was to identify instruments that measure chronic heart failure (CHF) self-care and demonstrate their psychometric properties.

Methods : A search of Medline, Cumulative Index to Nursing and Allied Health Literature, Medline, PsycArticles, Psychology and Behavioral Sciences Collection, and PsycINFO databases elucidated studies published between January 1980 and February 2009 that measure CHF self-care. The clinical instruments selected were disease-specific measures of CHF self-care behaviors that are promoted in best practice guidelines. Only instruments that reported estimates of reliability and validity were included in this review. Psychometric properties of the instruments were evaluated according to practice guidelines.

Results : The literature search identified 14 instruments published in peer-reviewed journals that measured constructs that predict or correlate to self-care rather than self-care itself. Only 2 disease-specific measures of self-care were identified (Self-care Heart Failure Index [SCHFI] and European Heart Failure Self-care Behavior Scale [EHFScBS]) that have undergone rigorous psychometric testing in CHF populations. Five aspects of validity had been demonstrated with EHFScBS, and 6 aspects of validity had been demonstrated with SCHFI. Two of 3 aspects of reliability have been demonstrated in both instruments.

Conclusion : Only 2 reliable and valid tools have been developed to specifically measure CHF self-care. Further use of these instruments in the research arena may reduce gaps in our understanding of CHF self-care and further shape clinical practice directed at improving it.