Online mindfulness-based intervention for late-stage bipolar disorder: pilot evidence for feasibility and effectiveness

OBJECTIVES: People in the late stage of bipolar disorder (BD) experience elevated relapse rates and poorer quality of life (QoL) compared with those in the early stages. Existing psychological interventions also appear less effective in this group. To address this need, we developed a new online mindfulness-based intervention targeting quality of life (QoL) in late stage BD. Here, we report on an open pilot trial of ORBIT (online, recovery-focused, bipolar individual therapy). METHODS: Inclusion criteria were: self-reported primary diagnosis of BD, six or more episodes of BD, under the care of a medical practitioner, access to the internet, proficient in English, 18-65 years of age. Primary outcome was change (baseline - post-treatment) on the Brief QoL.BD (Michalak and Murray, 2010). Secondary outcomes were depression, anxiety, and stress measured on the DASS scales (Lovibond and Lovibond, 1993). RESULTS: Twenty-six people consented to participate (Age M=46.6 years, SD=12.9, and 75% female). Ten participants were lost to follow-up (38.5% attrition). Statistically significant improvement in QoL was found for the completers, t(15)=2.88, 95% CI:.89-5.98, p=.011, (Cohen׳s dz=.72, partial η(2)=.36), and the intent-to-treat sample t(25)=2.65, 95% CI:.47-3.76, (Cohen׳s dz=.52; partial η(2)=.22). A non-significant trend towards improvement was found on the DASS anxiety scale (p=.06) in both completer and intent-to-treat samples, but change on depression and stress did not approach significance. LIMITATIONS: This was an open trial with no comparison group, so measured improvements may not be due to specific elements of the intervention. Structured diagnostic assessments were not conducted, and interpretation of effectiveness was limited by substantial attrition. CONCLUSION: Online delivery of mindfulness-based psychological therapy for late stage BD appears feasible and effective, and ORBIT warrants full development. Modifications suggested by the pilot study include increasing the 3 weeks duration of the intervention, adding cautions about the impact of extended meditations, and addition of coaching support/monitoring to optimise engagement.

Associations of obsessive-compulsive symptoms with clinical and neurocognitive features in schizophrenia according to stage of illness

This study aimed to investigate the association of obsessive-compulsive symptoms with clinical and neurocognitive features in patients with schizophrenia. This study enrolled 163 people with schizophrenia who were receiving risperidone monotherapy. Comorbid obsessive-compulsive symptoms were assessed using the Yale-Brown Obsessive-Compulsive Scale, and subjects with a score ≥ 10 constituted the obsessive-compulsive symptom group (n=30, 18.4%). The learning index was significantly higher in patients with obsessive-compulsive symptoms than in those without such symptoms after adjusting for age, stage (early and chronic), duration of illness, and CDSS score. However, there was no significant interaction between obsessive-compulsive symptoms and stage of illness. Scores on Positive and Negative Syndrome Scale, Calgary Depression Scale for Schizophrenia, and Beck Depression Inventory were significantly higher in the obsessive-compulsive symptom group. In addition, the Subjective Well-being under Neuroleptic Treatment score was significantly lower in the obsessive-compulsive symptom group. In conclusion, comorbid obsessive-compulsive symptoms in patients with schizophrenia were associated with a higher learning ability without a significant interaction with stage of illness. However, schizophrenia patients with obsessive-compulsive symptoms had more severe psychotic and depressive symptoms and poorer quality of life.

Validation of the personal wellbeing index for people with end stage kidney disease

The quality of life of people with end stage kidney disease (ESKD) has traditionally been measured using instruments that emphasise objective health status. The present study validates an alternative measure, the Personal Wellbeing Index (PWI), which measures subjective wellbeing. An Australian ESKD sample (N = 172, Mean age = 64.04, SD = 14.82) completed the PWI as well as health-specific quality of life measures. The PWI was subject to confirmatory factor analysis, and a series of regressions and between-group comparisons were performed to reveal that it is a psychometrically appropriate measure for this sample. The PWI and health-specific measures each yield different and complementary results. Thus, the PWI is proposed as a complement to existing health-related quality of life tools, in order to broaden understanding of the patient’s subjective experience. The resulting profile is argued to better inform targeted interventions to improve the quality of life of people with ESKD.

A new two-stage fuzzy inference system-based approach to prioritize failures in failure mode and effect analysis

This paper presents a new Fuzzy Inference System (FIS)-based Risk Priority Number (RPN) model for the prioritization of failures in Failure Mode and Effect Analysis (FMEA). In FMEA, the monotonicity property of the RPN scores is important. To maintain the monotonicity property of an FIS-based RPN model, a complete and monotonically-ordered fuzzy rule base is necessary. However, it is impractical to gather all (potentially a large number of) fuzzy rules from FMEA users. In this paper, we introduce a new two-stage approach to reduce the number of fuzzy rules that needs to be gathered, and to satisfy the monotonicity property. In stage-1, a Genetic Algorithm (GA) is used to search for a small set of fuzzy rules to be gathered from FMEA users. In stage-2, the remaining fuzzy rules are deduced approximately by a monotonicity-preserving similarity reasoning scheme. The monotonicity property is exploited as additional qualitative information for constructing the FIS-based RPN model. To assess the effectiveness of the proposed approach, a real case study with information collected from a semiconductor manufacturing plant is conducted. The outcomes indicate that the proposed approach is effective in developing an FIS-based RPN model with only a small set of fuzzy rules, which is able to satisfy the monotonicity property for prioritization of failures in FMEA.

SUMLOW: Early design-stage sketching of UML diagrams on an e-whiteboard

Most visual diagramming tools provide point-and-click construction of computer-drawn diagram elements using a conventional desktop computer and mouse. SUMLOW is a unified modelling language (UML) diagramming tool that uses an electronic whiteboard (E-whiteboard) and sketching-based user interface to support collaborative software design. SUMLOW allows designers to sketch UML constructs, mixing different UML diagram elements, diagram annotations, and hand-drawn text. A key novelty of the tool is the preservation of hand-drawn diagrams and support for manipulation of these sketches using pen-based actions. Sketched diagrams can be automatically 'formalized' into computer-recognized and -drawn UML diagrams and then exported to a third party CASE tool for further extension and use. We describe the motivation for SUMLOW, illustrate the use of the tool to sketch various UML diagram types, describe its key architecture abstractions and implementation approaches, and report on two evaluations of the toolset. We hope that our experiences will be useful for others developing sketching-based design tools or those looking to leverage pen-based interfaces in software applications.