Psychological management of unipolar depression

Objective: To be used in conjunction with 'Pharmacological management of unipolar depression' [Malhi et al. Acta Psychiatr Scand 2013;127(Suppl. 443):6-23] and 'Lifestyle management of unipolar depression' [Berk et al. Acta Psychiatr Scand 2013;127(Suppl. 443):38-54]. To provide clinically relevant recommendations for the use of psychological treatments in depression derived from a literature review. Method: Medical databases including MEDLINE and PubMed were searched for pertinent literature, with an emphasis on recent publications. Results: Structured psychological treatments such as cognitive behaviour therapy and interpersonal therapy (IPT) have a robust evidence base for efficacy in treating depression, even in severe cases of depression. However, they may not offer benefit as quickly as antidepressants, and maximal efficacy requires well-trained and experienced therapists. These therapies are effective across the lifespan and may be preferred where it is desired to avoid pharmacotherapy. In some instances, combination with pharmacotherapy may enhance outcome. Psychological therapy may have more enduring protective effects than medication and be effective in relapse prevention. Newer structured psychological therapies such as mindfulness-based cognitive therapy and acceptance and commitment therapy lack an extensive outcome literature, but the few published studies yielding positive outcomes suggest they should be considered options for treatment. Conclusion: Cognitive behaviour therapy and IPT can be effective in alleviating acute depression for all levels of severity and in maintaining improvement. Psychological treatments for depression have demonstrated efficacy across the lifespan and may present a preferred treatment option in some groups, for example, children and adolescents and women who are pregnant or postnatal. © 2013 John Wiley & Sons A/S. Published by Blackwell Publishing Ltd.

An RCT to evaluate the utility of a clinical protocol for staff in the management of behavioral and psychological symptoms of dementia in residential aged-care settings

Objectives: Behavioral and psychological symptoms of dementia (BPSD) cause significant stress and distress to both aged-care residents and staff. This study evaluated a training program to assist staff to manage BPSD in residential care. Method: A randomised controlled trial (RCT) was employed. The study was included in the Australian and New Zealand Clinical Trial Register residential care facilities. Staff (n = 204) and residents (n = 187) were from 16 residential care facilities. Facilities were recruited and randomly assigned to four staff training conditions: (1) training in the use of a BPSD-structured clinical protocol, plus external clinical support, (2) a workshop on BPSD, plus external clinical support, (3) training in the use of the structured clinical protocol alone, and (4) care as usual. Staff and resident outcome measures were obtained pre-intervention, three months and six months post-intervention. The primary outcome was changes in BPSD, measured using the Cohen-Mansfield Agitation Inventory (CMAI) as well as frequency and duration of challenging behaviors. Secondary outcomes were changes in staff adjustment. Results: There were improvements in challenging behaviors for both intervention conditions that included training in the BPSD instrument, but these were not maintained in the condition without clinical support. The training/support condition resulted in sustained improvements in both staff and resident variables, whereas the other conditions only led to improvement in some of the measured variables. Conclusion: These results demonstrate the effectiveness of the BPSD protocol in reducing BPSD and improving staff self-efficacy and stress.

Psychological impact of receiving genetic risk information for breast cancer, with and without lifestyle information

The psychological impact of receiving hypothetical genetic risk information for breast cancer, with and without lifestyle information, was investigated. The psychological responses included in the study were drawn from three theories of behaviour change and included perceived risk, beliefs in health behaviours, motivations to change health behaviours, and use of coping strategies. Vignettes were used to present hypothetical risk information to 198 female university students. Results indicated that lifestyle information had an impact on psychological measures, in particular, increased beliefs in health behaviours, increased motivation for exercise, and decreased rational problem solving. Suggestions for future research are discussed.

Perceptions of fairness in the psychological contracts of allied health professionals

Purpose-The purpose of this paper is to investigate the relationships between components of the psychological contract, organisational justice, and negative affectivity (NA), with key employee outcomes (i.e. organisational commitment, job satisfaction, depression, and psychological distress) among allied health professionals. Design/methodology/approach-In total, 134 (response rate of 46 per cent) Australian allied health professional completed a questionnaire. Findings-Multiple regressions revealed that higher NA was associated with lower organisational commitment, lower job satisfaction, and higher levels of depression. The psychological contract variable, breach, was associated with depression. Informational justice was associated with organisational commitment. Distributive justice was associated with job satisfaction. Research limitations/implications-This research is limited by its cross-sectional design and that the data were self-reported. The results obtained suggest the potential utility of collecting longitudinal data to replicate and extend the results. Practical implications-While NA may be beyond management control, it may be ameliorated by attention to improving communication of management decisions and by sensitivity to the elements implicit in psychological contracts. The negative consequences of contract breach may be offset by informational and distributive justice. Originality/value-This study is one of the first to examine multiple measures of the psychological contract in addition to organisational justice and NA. Further, this study adds to the literature for allied health professionals, where little is known about factors contributing to their turnover.

Ongoing challenges responding to behavioural and psychological symptoms of dementia

BACKGROUND: Mid- to late-stage dementia is often characterized by behavioural and psychological symptoms, including, but not limited to physical and verbal aggression. INTRODUCTION: Although there is a considerable research about the prevalence, aetiology, and management of behavioural and psychological symptoms of dementia, there is limited research about the experience of caring for people with such symptoms in long-term aged care facilities. AIM: The aims of the study were to describe: (i) nurses' experiences of caring for people with behavioural and psychological symptoms of dementia in long-term aged care facilities, and (ii) strategies nurses used to deal with these symptoms. METHODS: A qualitative exploratory and descriptive design, involving focus group interviews with 30 nurses from three long-term aged care units in Australia. The transcripts were analysed using inductive content analysis. RESULTS: The findings revealed five interrelated themes: (i) working under difficult conditions, (ii) behavioural and psychological symptoms of dementia: an everyday encounter, (iii) making sense of behavioural and psychological symptoms of dementia, (iv) attempting to manage behavioural and psychological symptoms of dementia, and (v) feeling undervalued. CONCLUSION: This study highlighted the difficult conditions under which nurses worked and the complexity of caring for individuals who have behavioural and psychological symptoms of dementia. IMPLICATIONS FOR NURSING AND HEALTH POLICY: Organizational efforts to enhance the quality of care for individuals with behavioural and psychological symptoms of dementia in long-term aged care facilities should extend beyond staff education to heed nurses' concerns about organizational barriers to interpersonal care.

Numerical modeling and analysis for forming process of dual-phase 980 steel exposed to infrared local heating

A recent experiment confirmed that the infrared (IR) local heating method drastically reduces springback of dual-phase (DP) 980 sheets. In the experiment, only the plastic deformation zone of the sheets was locally heated using condensed IR heating. The heated sheets were then deformed by V-bending or 2D-draw bending. Although the experimental observation proved the merit of using the IR local heating to reduce springback, numerical modeling has not been reported. Numerical modeling has been required to predict springback and improve the understanding of the forming process. This paper presents a numerical modeling for V-bending and 2D-draw bending of DP 980 sheets exposed to the IR local heating with the finite element method (FEM). For describing the thermo-mechanical behavior of the DP 980 sheet, a flow stress model which includes a function of temperature and effective plastic strain was newly implemented into Euler-backward stress integration method. The numerical analysis shows that the IR local heating reduces the level of stress in the deformation zone, although it heats only the limited areas, and then it reduces the springback. The simulation also provides a support that the local heating method has an advantage of shape accuracy over the method to heat the material as a whole in V-bending. The simulated results of the springback in both V-bending and 2D-draw bending also show good predictions.

Serving in Bosnia made me appreciate living in Bristol: stressful experiences, attitudes, and psychological needs of members of the United Kingdom Armed Forces

Peacekeeping operations form an increasing part of the role of the U.K. Armed Forces. This study identified perceived needs for training before such operations, experiences of stress during deployments, beliefs and attitudes regarding psychological support and debriefing on return, general attitudes toward peacekeeping duties, and positive aspects of the peacekeeping role. Although nearly all peacekeepers were exposed to a variety of experiences, most perceived stress came from professional difficulties and frustrations with the occupational role of being a peacekeeper, rather than from dangerous situations. The exception was a significant fear of land mines. For many, peacekeeping had a positive impact on soldiers' lives, most commonly an appreciation of "things back home." Respondents' opinions about the peacekeeping experience vary greatly. Additional training addressing and exploring potential conflicts between the traditional role of the soldier and the role of the peacekeeper may be useful.

Do military peacekeepers want to talk about their experiences? Perceived psychological support of UK military peacekeepers on return from deployment

Background: Little is known about what support the United Kingdom (UK) armed forces require when they return from operations. Aims: To investigate the perceived psychological support requirements for service personnel on peacekeeping deployments when they return home from operations and examine their views on the requirement for formal psychological debriefings. Methods: A retrospective cohort study examined the perceived psychological needs of 1202 UK peacekeepers on return from deployment. Participants were sent a questionnaire asking about their perceived needs relating to peacekeeping deployments from April 1991 to October 2000. Results: Results indicate that about two-thirds of peacekeepers spoke about their experiences. Most turned to informal networks, such as peers and family members, for support. Those who were highly distressed reported talking to medical and welfare services. Overall, speaking about experiences was associated with less psychological distress. Additionally, two thirds of the sample was in favour of a formalised psychological debriefing on return to the UK. Conclusions: This study suggests that most peacekeepers do not require formalised interventions on homecoming and that more distressed personnel are already accessing formalised support mechanisms. Additionally social support from peers and family appears useful and the UK military should foster all appropriate possibilities for such support. Declaration of Interest: The Stage 1 study was funded by the US Department of Defence (DoD) and the follow up study by the Medical Research Counsel (MRC). Neither the DoD nor MRC had any input into the design, conduct, analysis or reporting of the study. The views expressed are not those of any US or UK governmental organisation. We thank Mr Nick Blatchley of MOD for help in identifying the cohorts.

Studying mathematics teacher education: analysing the process of task variation on learning

Self-study of variations to task design offers a way of analysing how learning takes place. Over several years, variations were made to improve an assessment task completed by final-year teacher candidates in a primary mathematics teacher education subject. This article describes how alterations to a task informed on-going developments in self-study of one assessment task employed in an online subject. Analysis of my journal, notes from conversations with colleagues, teacher candidates’ work on the task and responses to online forums, and survey data inspired variations focused on better exploration of key concepts involved in the task, raising of focal awareness, developing a stronger professional eye in the students and the author, adaptations for multiple curriculum levels, and explorations of dual teacher–student perspectives. The overall challenge has been to support teacher candidates to learn to design effective open-ended tasks with a critical professional eye. Descriptions of the changes made to the task and the development of my own professional eye as a consequence of the application of self-study are included. Data show that variations to the task increased teacher candidates’ understanding of mathematics problem posing and generated pedagogical insights for task design.

Framing the socialisation process of the DBA candidate: what can universities offer and what should candidates bring?

In Australia, the Doctorate of Business Administration (DBA) remains a popular program but considerable anguish persists within the university sector over just what it is offering students. In this article, we use the process of postgraduate socialisation to understand how candidates, supervisors and administrators navigate pathways to successful completion and offering of a DBA program. We identify four modes of knowledge applicable to the DBA and suggest that universities and candidates may draw on one another’s cultural capital to determine which mode(s) can be offered. We also illustrate how candidates exercise agency through their cultural and social capital as they move through the program. We present a conceptual framework to help guide future research, and resource allocation on the DBA.

Stochastic optimization models for energy management in carbonization process of carbon fiber production

Industrial producers face the task of optimizing production process in an attempt to achieve the desired quality such as mechanical properties with the lowest energy consumption. In industrial carbon fiber production, the fibers are processed in bundles containing (batches) several thousand filaments and consequently the energy optimization will be a stochastic process as it involves uncertainty, imprecision or randomness. This paper presents a stochastic optimization model to reduce energy consumption a given range of desired mechanical properties. Several processing condition sets are developed and for each set of conditions, 50 samples of fiber are analyzed for their tensile strength and modulus. The energy consumption during production of the samples is carefully monitored on the processing equipment. Then, five standard distribution functions are examined to determine those which can best describe the distribution of mechanical properties of filaments. To verify the distribution goodness of fit and correlation statistics, the Kolmogorov-Smirnov test is used. In order to estimate the selected distribution (Weibull) parameters, the maximum likelihood, least square and genetic algorithm methods are compared. An array of factors including the sample size, the confidence level, and relative error of estimated parameters are used for evaluating the tensile strength and modulus properties. The energy consumption and N2 gas cost are modeled by Convex Hull method. Finally, in order to optimize the carbon fiber production quality and its energy consumption and total cost, mixed integer linear programming is utilized. The results show that using the stochastic optimization models, we are able to predict the production quality in a given range and minimize the energy consumption of its industrial process.

Staff compliance with protocols to improve the management of behavioral and psychological symptoms of dementia

Using data from a larger study investigating the effectiveness of a structured clinical protocol to manage individuals in residential facilities who experience behavioral and psychological symptoms of dementia (BPSD), the current study investigated whether external clinical support in using the protocol with specific residents increased compliance in its use, over and above only providing a generic workshop about the protocol and management of BPSD. Results indicated that provision of the workshop, in addition to clinical support, was associated with significantly higher compliance. However, compliance was only found to be related to positive outcomes when staff received the generic workshop and not clinical support. When clinical support was provided, compliance was not related to outcomes or worse outcomes. These findings, when considered in the context of the results of the larger trial, suggest that the relationship among clinical support, compliance with BPSD protocols, and clinical outcomes for residents and staff is complex and needs further investigation.