Transcript Document

“On the Level”
A community based intervention for individuals
with Bipolar Affective Disorder (BPAD)
Daniel Flynn, Senior Clinical Psychologist, Mary Kells, Clinical Psychologist,
Maria O’ Sullivan, Psychologist in Clinical Training, Gráinne Kearney, Volunteer Clinical Psychology Assistant
Department of Clinical Psychology,
North Lee Adult Mental Health Service
Evidence-Based Practice:
NICE Guidelines
Healthcare professionals should assist clients with
Bipolar Affective Disorder by:
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Building a therapeutic relationship
Advising on careful & regular self-monitoring of
symptoms (including early warning signs &
triggers)
Managing lifestyle
(e.g. sleep hygiene & work patterns)
Developing coping strategies (1.1.1.3)3
Key aims of the Programme
Phase 4- Next Steps
 Understand and discuss what BPAD is
 Identify early warning signs for episodes
 Develop behavioural and cognitive strategies
for managing both depression and mania
 Deal with stressful events that can trigger episodes
 Monitor and understand mood symptoms
 Play an active part in their ongoing recovery
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Delivery: Extend to 10 sessions (due to
time pressure phase 3)
Manual: Further refinement based on
feedback
Research: Introduction of waiting list group
Proposed: Ongoing support group and
family education group - survey attendees.
and relapse prevention
Inclusion Criteria
The treatment of BPAD is based primarily on
psychotropic medication to reduce the severity of
problems, stabilise mood and prevent relapse…
However a range of psychological and psychosocial
interventions can also have a significant impact in the
short and long term (1.4 + 1.5)3
• Currently attending North Lee Adult Mental
How the programme evolved:
Phase 1: September – October 2009 (Pilot)
Phase 2: November 2009 –February 2010
Phase 3: March 2010 – May 2010
Phase 4: Due to commence
Introductory Workshop:
Health Services (open to all sectors within
North Lee)
• Primary diagnosis of BPAD
• Mood currently stable.
Provided on an as-required basis (Day
therapy programme, St. Michael’s unit)
Referral Process:
Practice-Based Evidence
Logistics of providing psychological support to
individuals with BPAD: Demand exceeds available
supply of individual therapy sessions.
Focus group: Patients reported:
• “BPAD is not talked about”
• “Feeling isolated”
• “Not realising other people were
experiencing similar episodes”
Changes
Step by Step
Referral options
• Referral form to be completed by members of
treatment team. OR
• Self-referral & referral form signed by consultant
Processing referrals
• On receipt of referral, individuals contacted
and informed of when next group is likely to
commence (letter copied to consultant)
All groups are closed.
The Journey:
Phase 1 - Pilot based on ‘Keeping your balance’
programme & supplementary materials.
• Participants: 6 already attending individual therapy
• Evaluation: Focus group
• Attrition: 4 completed programme.
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Evidence into practice
Research to date has shown that group interventions
using a CBT framework as an adjunct to traditional
treatment for BPAD are beneficial in regard to relapse
prevention, enhancement of treatment for residual
depressive symptoms, and improvement in
functionality. Furthermore they may also be a cost
effective way of delivering psychosocial
treatments.1,4,5
What is the On the Level group?
The ‘On the Level’ group is a skills training
programme offering persons with a diagnosis of
BPAD an adjunct to their existing treatment. The
programme is based on cognitive behavioural
therapy (CBT), which aims to support individuals
with bipolar disorder in monitoring, examining
and changing thinking and behaviour that can be
associated with extreme mood states.
Phase 2 - Revised programme content based on
feedback from pilot.
• Evaluation: Introduced pre- & post- measures
• Participants: 7 commenced programme
• Attrition: 3 completed programme
• Reasons: 2 moved counties, 1 hospitalized, 1
infrequent attendee not present for final session.
Phase 3
• Developed information leaflet
(approved by communications office)
• Manual devised for programme
• Evaluation: Ongoing assessment
(BDI-II6 Altman Mania Rating Scale7)
• Participants: 9 pre-assessment, 7 commenced group
• Attrition: 4 completed programme
• Reasons: 2 hospitalized, 1 infrequent attendee.
Pre-group assessment
• Meeting with group facilitator.
• Evaluating individual needs.
• Battery of measures (BDI-II, Altman Mania
Rating Scale),
•Consent to participate in research
(Protocol in development)
References:
1. Castle, D., Berk, M., Berk, L., Lauder, S., Chamberlain, J. and Gilbert, M.
(2007) Pilot of group intervention for bipolar disorder, International
Journal of Psychiatry in Clinical Practice, Vol. 11, No. 4.
2. Centre for Clinical Interventions () Keeping your Balance Programme.
3. National Institute for Health and Clinical Excellence (2006) Bipolar
disorder: The management of bipolar disorder in adults, children and
adolescents, in primary and secondary care. UK, National Collaborating
Centre for Mental Health.
4. Patelis-Siotis, I., Trevor Young, L., Robb, J., Marriott, M., Bieling, P., Cox,
L. and Joffe, R. (2001) Group cognitive behavioural therapy for bipolar
disorder: a feasibility and effectiveness study. Journal of Affective
Disorders, Vol. 65.
5. Zaretsky, A., Rizvi, S., and Parikh, S. (2007). How well do Psychosocial
Interventions work in Bipolar Disorder? The Canadian Journal of
Psychiatry, Vol. 52, No. 1.
6. Beck , A.T., Steer, R.A. and Brown, G.K. (1996) Beck Depression Inventory
II, Psychological Corporation, USA.
7. Altman, E. Hedeker, D. Peterson, J.L. and Davis J.M. (1997) The Altman
Self rating Scale. Biological Psychiatry, 42 pp. 948 -955