Balanced efficacy, safety, and tolerability recommendations for the clinical management of bipolar disorder

Objective:  To provide practical and clinically meaningful treatment recommendations that amalgamate clinical experience and research findings for each phase of bipolar disorder.

Methods:  A comprehensive search of the literature was undertaken using electronic database search engines (Medline, PubMed, Cochrane reviews) using key words (e.g., bipolar depression, mania, treatment). All relevant randomised controlled trials were examined, along with review papers, meta-analyses, and book chapters known to the authors. In addition, the recommendations from accompanying papers in this supplement have been distilled and captured in the form of summary boxes. The findings, in conjunction with the clinical experience of international researchers and clinicians who are practiced in treating mood disorders, formed the basis of the treatment recommendations within this paper.

Results:  Balancing clinical experience with evidence informed and lead to the development of practical clinical recommendations that emphasise the importance of safety and tolerability alongside efficacy in the clinical management of bipolar disorder.

Conclusions:  The current paper summarises the treatment recommendations relating to each phase of bipolar disorder while providing additional, evidence-based, practical insights. Medication-related side effects and monitoring strategies highlight the importance of safety and tolerability considerations, which, along with efficacy information, should be given equal merit.

Detecting and managing depressed patients : palliative care nurses' self-efficacy and perceived barriers to care

Background: Depression is a highly prevalent yet under-recognized and under-treated psychiatric illness in patients receiving palliative care. Nurses are the front-line health care professionals in these settings and are well-positioned to detect depressive symptoms and initiate pathways to care. Previous research suggests, however, that nurses' confidence and skills in relation to this task are low, and there appear to be a number of barriers within these settings that may impede nurses' engagement in this process.

Methods: To further investigate these factors, a quantitative study was carried out with 69 palliative care nurses from three palliative care services in Australia.

Results: A number of issues were identified, including the need for further training in the signs and symptoms of depression, issues around discussing depression with patients and their family members, and difficulty differentiating depressive symptoms from grief.

Conclusion: These findings provide insight into specific areas in which palliative care nurses would benefit from further training to improve detection rates for depression in this vulnerable population.

An investigation of the efficacy of a novel ocular lubricant

Objective: To investigate the efficacy of a novel ocular lubricant compared with a commercially marketed ocular lubricant in a group of noncontact lens wearers currently using over-the-counter products for the management of symptoms of moderate to severe dry eye.

Methods: This was a prospective, double-masked study that randomized 110 subjects in a ratio of 1:1 to receive a novel ocular lubricant (test group) or a marketed ocular lubricant (control group). Subjects were instructed to instill the lubricant eye drops at least three times daily. After enrollment, subjects were evaluated at baseline and at 7 and 30 days. They were also required to complete a series of home-based subjective questionnaires after 15 days. Main outcomes were subjective symptoms and objective clinical assessment at 7 and 30 days.

Results: The test group had higher overall comfort ratings than the control group (P = 0.012). Seventy-one percent of the test group and 57% of the control group said the drops used “somewhat” or “definitely” improved ocular comfort; 62% of the test group had greater end-of-day comfort compared with 45% of the control group (P = 0.015). There were no between-group differences in visual acuity, tear quality or quantity, corneal staining, conjunctival staining, or bulbar and limbal conjunctival hyperemia.

Conclusions: The novel ocular lubricant offers equivalent or superior comfort compared with a marketed lubricant eye drop. Objective clinical outcomes were not statistically significantly different between the two groups.

The impact of self-efficacy and perceived system efficacy on effectiveness of virtual training systems

This study developed and tested a research model which examined the impact of user perceptions of self-efficacy (SE) and virtual environment (VE) efficacy on the effectiveness of VE training systems. The model distinguishes between the perceptions of one’s own capability to perform trained tasks effectively and the perceptions of system performance, regarding the established parameters from literature. Specifically, the model posits that user perceptions will have positive effects on task performance and memory. Seventy-six adults participated in a VE in a controlled experiment, designed to empirically test the model. Each participant performed a series of object assembly tasks. The task involved selecting, rotating, releasing, inserting and manipulating 3D objects. Initially, the results of factor analysis demonstrated dimensionality of two user perception measures and produced a set of empirical validated factors underlining the VE efficacy. The results of regression analysis revealed that SE had a significant positive effect on perceived VE efficacy. No significant effects were found of perceptions on performance and memory. Furthermore, the study provided insights into the relationships between the perception measures and performance measures for assessing the efficacy of VE training systems. The study also addressed how well users learn, perform, adapt to and perceive the VE training, which provides valuable insight into the system efficacy.
Research and practical implications are presented at the end of the paper.

Collective hypnosis

This digital creative output is a 'poetry soundtrack', an audio work comprised of original poetry, music, and sound design.

Making meaning from collective apologies : Australia's apology to its indigenous peoples

This article considers the meaning of intergroup apologies for their recipients. Our research examined Indigenous people’s responses to the 2008 Australian apology to Aboriginal and Torres Strait Islander peoples forcibly removed from their families under previous governments (the Stolen Generations). We interviewed Indigenous men (n=10) and women (n=22) about their attitudes toward the apology and forgiveness. To cover the breadth of Indigenous responses to the Australian apology, we sought out participants from diverse geographic, cultural, and occupational contexts across Australia. After pooling the transcripts and entering them into NVivo, we identified key concepts and themes. Participants expressed positive, negative, and mixed views toward the apology and forgiveness. A dominant theme emerged as participants indicated that for the apology to be truly meaningful, there needed to be action commensurate with the emotion of the apology. Though participants indicated that the apology promoted reconciliation, this was not true for forgiveness. We conclude by discussing implications of these findings for theoretical models of intergroup apology.

Efficacy and adverse effects of venlafaxine in children and adolescents with ADHD : a systematic review of non-controlled and controlled trials

Attention deficit hyperactivity disorder (ADHD) is a common psychiatric disorder in children and adolescents. Stimulants are commonly prescribed for ADHD management. There is clinical trial evidence that some medications with noradrenergic properties such as atomoxetine are effective. It is of theoretical and practical importance if other agents with noradrenergic properties display a comparable pattern of efficacy.
This paper is a systematic review of the efficacy and safety of venlafaxine for treating children and adolescents with ADHD. MEDLINE, Google scholar, Scopus, and Web of science (ISI) databases were electronically searched in July 2012, updated on November 2012. Time and language of publication were not exclusion criteria. Efficacy outcomes were assessed by a valid and reliable parent- and/or teacher-reported instrument to evaluate clinical symptoms. Adverse effects were also evaluated.

There were three uncontrolled trials and only two double blind controlled clinical trials. Venlafaxine appeared effective for treating ADHD. The rates of some adverse effects of venlafaxine were less than those documented for methylphenidate.

While one of the two small controlled trials did not find difference between venlafaxine ad methylphenidate, the other trial reported lower efficacy for venlafaxine. Headache, insomnia, and nausea were among the most common adverse effects.

This systematic review provides preliminary support that venlafaxine may have short term utility in treating ADHD in children and adolescents. However, before recommending venlafaxine for treatment, more robust and larger clinical trials, in particular providing evidence of its long-term efficacy, safety and tolerability are required.