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FP03-4 Effects of a Newly Formed Meditation Based Awareness Training (MBAT) Program on Psychological Wellbeing: A Controlled Trial
Oral presentations / Asian Journal of Psychiatry 4S1 (2011) S1–S39
S31
FP03. Depression, Mood disorder & Meditation
autonomic arousal, (ii) improves attention, and (iii) improves the quality of sleep.
FP03-1 Deep Brain Stimulation (DBS) in the Management of Patients with Highly Refractory Depression
FP03-3 A Randomised Trial of Mental Silence Orientated Meditation for Work-related Stress, Anxiety and Depressive Feelings
P. Fitzgerald1 , R. Bittar2 , R. Segrave1 , K. Hoy1 . 1 MAPrc, Monash University School of Psychology and Psychiatry and the Alfred, 2 Neurosurgery, Royal Melbourne Hospital and Melbourne University, Melbourne, VIC, Australia
R. Manocha. Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
Free paper session
Objective: A substantial proportion of patients with major depressive disorder do not respond to standard treatments. A proportion of these patients remain severely depressed despite repeated trials of medication, the use of electroconvulsive therapy and other innovative therapies. Deep brain stimulation (DBS) has been developed as an alternative intervention which involves the placement of stimulating electrodes in targeted brain regions to try and ameliorate depressive symptomatology. The objective of the presentation will be briefly overview the development of DBS applications for depression and present the results of an initial trial of nucleus accumbens DBS. Methods: A small group of patients (n = 5) with severe treatment resistant depression underwent bilateral placement of DBS electrodes in the nucleus accumbens. Stimulation was adjusted in each patient to achieve maximum therapeutic response and the patients followed for a minimum of 12 months. Results: DBS stimulation to the nucleus accumbens produces a clear pattern of mood alteration intra-operatively, during the post operative initial stimulation period and longer term. Mood improvement with DBS can be substantial and persist over long periods of time. Differences as well as similarities in clinical response between patients will be discussed. Conclusions: DBS has the potential to offer substantive symptom relief to a group of patients with persistent severe depressive disorders. Further research in larger clinical samples is required to define the role of this treatment and its efficacy. FP03-2 Psychophysiology of Yoga-based Relaxation Techniques: An Overview P. Subramanya, S. Telles. Indian Council of Medical Research, Center for Advanced Research in Yoga and Neurophysiology, Swami Vivekananda Yoga Research Foundation, Bangalore, India A yoga practice [called cyclic meditation (CM)] derived from ancient yoga texts consists of cycles of yoga postures interspersed with periods of supine rest. Practicing CM reduced psychophysiological arousal based on a decrease in oxygen consumption and minute ventilation, changes in the heart rate variability suggestive of a shift in the sympathovagal balance towards vagal dominance. However, these changes occurred simultaneously with a decreased latency and increased amplitude in the P300 auditory oddball task. The prolonged latencies of evoked potentials generated within the cerebral cortex after the practice of CM, supported the idea of cortical inhibition. The practice of CM improved the performance in memory scores and decreased state anxiety. The CM program has also been shown to decrease occupational stress levels and baseline autonomic arousal. Moreover, CM improved performance in psychomotor tasks which requires selective attention, concentration, visual scanning abilities, and a repetitive motor response. The practice of CM during the day time has been shown to increase the percentage of slow wave sleep in the subsequent night. However, these findings support the idea that meditation is a training in awareness which when practiced over long periods, produces definite changes in perception, attention, cognition and in psychophysiological measures. The above findings suggest that CM practice (i) reduces
Objective: To compare the effects of two different conceptual definitions of meditation for the management of stress in full time workers. Materials and Methods: A double-blind randomized controlled trial of meditation using sahaja yoga, a mental silence orientated form of meditation, as management strategy for work stress compared to both meditation as relaxation and a (no treatment) waiting list control was conducted. 178 full time workers were recruited. They completed measures of stress (the psychological strain questionnaire), anxiety (the state trait anxiety questionnaire) and depressive symptoms (the profile of mood states) pre and post intervention. Baseline scores indicated that the sample was significantly more distressed than the comparable population data. At the completion of the 8 week intervention subjects were reassessed. Results: The protocol analysis demonstrated that the mental silence orientated form of meditation was significantly more effective than relaxation or no treatment. After adjusting the data for the primary outcomes on the basis of intention to treat (LOCF), these improvements were significant for measures of stress and depressive symptoms but not anxiety. Only the mental silence orientated group demonstrated significant changes in their perception of personal and environmental resources available to help coping. Conclusion: This approach to meditation is a specifically effective strategy for reducing stress and improving mental health. FP03-4 Effects of a Newly Formed Meditation Based Awareness Training (MBAT) Program on Psychological Wellbeing: A Controlled Trial E. Shonin1,2 , W. Van Gordon1,2 , E. Sundin1 , L. Horgan1 . 1 Division of Psychology, Nottingham Trent University, 2 The Awake to Wisdom Foundation, Nottingham, UK Introduction: Mindfulness has been practiced in the Eastern world for more than 25 centuries but has only recently become popular in the West. Today, therapeutic interventions such as ‘Mindfulness Based Stress Reduction’ are used within Western health services and have proven to be successful techniques for reducing stress and depression. A limitation however is that they tend to apply the practices of mindfulness in an ‘out of context’ manner. Newly formed Meditation Based Awareness Training (MBAT), on the other hand, includes a composite array of ‘spiritual-based’ trainings, which are traditionally assumed to enhance the cultivation of a more sustainable quality of wellbeing. Aim: The purpose of this program is to design, implement, and evaluate MBAT as an approach to meditation and mindfulness that can be adapted to meet the needs of various populations. Methods: In the current phase, MBAT was developed for a general population sample wanting to increase their levels of wellbeing. By way of controlled comparison trial, participants of the study undertook an 8-week MBAT program and comparisons were made with a control group on perceived psychological wellbeing (depression, anxiety, anger management and stress). Results: Participants who undertook MBAT showed a significant improvement in psychological wellbeing compared to controls. Conclusion: Findings support the position that a more traditionally congruent yet still non-secular approach to meditation as a clinical intervention can be efficacious. In a second phase, MBAT will be
S32
Oral presentations / Asian Journal of Psychiatry 4S1 (2011) S1–S39
adapted to populations with specific needs, e.g. trauma victims and forensic inmates. FP03-5 Improving the Identification and Management of Mood Disorders in Developing Countries I. Blignault1,2 , V. Manicavasagar1,3 , G. Parker1,3 , C. Wijeratne3,4 , A. Sumathipala5 . 1 Black Dog Institute, Randwick, 2 School of Public Health & Community Medicine, 3 School of Psychiatry, University of New South Wales, Sydney, 4 Academic Department of Old Age Psychiatry, Prince of Wales Hospital, Randwick, NSW, Australia; 5 Institute of Research & Development, Colombo, Sri Lanka The Black Dog Institute is a not-for-profit organization supported by the NSW Department of Health and the University of New South Wales. The Institute offers expertise in mood disorders (depression and bipolar disorder) via research, professional education and training, clinical services and population health approaches. In 2007, the Institute received funding through a bequest to conduct a program for improving the mental health outcomes in developing countries. This program that was developed incorporated two phases: the first involved developing and delivering an intensive educational course aimed at senior clinicians from developing countries in the AsiaPacific region; and the second involved collaborating with those clinicians and their organizations to implement population-based mental health interventions in situ. Fourteen clinicians from four countries participated in our first program in 2008, including eight clinicians from different organisations in Sri Lanka. Subsequently, the Institute collaborated with those clinicians and project partners on a suite of Phase 2 projects, including their National Program for Community Based Mental Health Care which was launched in March 2009. Evaluations of Phase 1 and Phase 2 activities and reports from participants and partners organisations attest to the success of this program in achieving its aims. This paper will report on the achievements and challenges of this Australia – Sri Lanka collaboration and the lessons learned; from the point of view of Black Dog Institute, the senior partner organisation in Sri Lanka – the Institute of Research & Development, and our ‘cultural broker’, an Australian psychiatrist of Sri Lankan heritage. FP03-6 Depression Management in Patients with Chronic Diseases by the General Practitioners in England A. Yohannes1 , M. Hann2 , B. Sibbald2 . 1 Health Professions, Manchester Metropolitan University, 2 The University of Manchester, Manchester, Virgin Islands (U.K.) Aims: We examined factors associated with the management of depression by general practitioners (GPs), using case vignettes, in patients with chronic obstructive pulmonary disease (COPD), severe osteoarthritis and depressive symptoms alone. Methods: We surveyed a random sample of general practitioners (N = 3,956) in England using a postal questionnaire. The questionnaire explored how GPs would approach the management of emotional distress in patients with and without a chronic condition and gauged their views of and experiences with depression in patients with COPD. Results: 864 completed responses were received (22%). In the vignettes, a significantly greater percentage of GPs reported that they would explore or offer the diagnosis of depression in a patient with COPD (95.4%) compared with patients with either severe osteoarthritis (88.3%) or depressive symptoms alone (86.3%). The only significant predictor of the diagnosis of depression was that GPs in training practices were 1.6 times more likely to diagnose depression in patients with osteoarthritis than GPs in non-training practices [95% C.I. (1.1, 2.5); p = 0.024]. There were no significant differences in the percentage of GPs who would pursue a diagnosis
of depression by either age group, gender, contract type (provider, salaried, other) or level of deprivation. Conclusion: The majority of the general practitioners in this study were able to identify depression from the vignettes in patients with chronic diseases. GPs in training practices are most likely to diagnose depression in patients with osteoarthritis compared to GPs in non-training practices. Further research is required. Free paper session FP04. Child, Adolescent, Intervention & Education FP04-1 Role of Music Therapy in Tension Headache V. Sinha, K.C. Gurnani. Psychiatry, S.N. Medical College, Agra, India Introduction: Headache is one of the most common medical complaints with one year period prevalence of 90% and a lifetime prevalence of 78% in general adult population. Tension headache is the most common type of primary headache (82%). A significant proportion of patients respond to pharmacotherapy with multiple relapses. Apart from pharmacotherapy, various alternative therapy have been tried to reduce the burden of headache patients, music therapy is one of them. Aims and Objectives: to study the effect of music theray as an adjuvant treatment modality in patients suffering from tension headache. Method and Material: 40 randomly selected patients meeting the criteria for tension headache according to HIS(International Headache society) were enrolled after informed consent. The subjects were divided randomly in two groups, one receiving pharmacotherapy and the other group was exposed to music therapy sessions for the next six months along with pharmacotherapy. The subjects were assessed on Headache Index, Visual Analogue Scale, side-effect profile and were asked to maintain Headache diary. Results: Significant decline in Headache Index as well as Visual analogue scale was observed at the end of six months in subjects getting music therapy adjunct to pharmacotherapy. Conclusion: Music therapy can be used as a cost-effective, safe adjunct to pharmacotherapy for rapid decline in pain and improved functioning in patients with tension headache. FP04-2 Medical Students’ Mental Health Status at the Beginning of the First Year Study of Two Different Selection Processes M.S.B. Yusoff1 , A.F. Abdul Rahim1 , A.A. Baba2 , S.B. Ismail3 , A.R. Esa4 . 1 Medical Education Department, 2 Department of Medicine, 3 Family Medicine Department, Universiti Sains Malaysia, 4 Community Medicine, Universiti Sultan Zainal Abidin, Kota Bharu, Malaysia Objective: This study attempted to look at mental health status of medical students from two different selection processes at the beginning of the first year of study. Methodology: Comparative cross-sectional study was done between two batches of first year medical students; one group underwent selection process merely based on academic merit (academic session 2008/2009) and another group underwent selection process based on academic merit, psychometric assessment and interview performance (academic session 2009/2010). The general mental health status among the medical students was measured by the 12-item General Health Questionnaire (GHQ-12). Data was collected at the beginning of the first year of study. Statistical analysis was done using SPSS version 18. Results: The prevalence of distressed medical students in the 2008/2009 and 2009/2010 batches were 26.29% and 14.3% respectively. The mean GHQ score and the percentage of distressed medical students at the beginning of the course were significantly
S31
FP03. Depression, Mood disorder & Meditation
autonomic arousal, (ii) improves attention, and (iii) improves the quality of sleep.
FP03-1 Deep Brain Stimulation (DBS) in the Management of Patients with Highly Refractory Depression
FP03-3 A Randomised Trial of Mental Silence Orientated Meditation for Work-related Stress, Anxiety and Depressive Feelings
P. Fitzgerald1 , R. Bittar2 , R. Segrave1 , K. Hoy1 . 1 MAPrc, Monash University School of Psychology and Psychiatry and the Alfred, 2 Neurosurgery, Royal Melbourne Hospital and Melbourne University, Melbourne, VIC, Australia
R. Manocha. Discipline of Psychiatry, Sydney Medical School, University of Sydney, Sydney, NSW, Australia
Free paper session
Objective: A substantial proportion of patients with major depressive disorder do not respond to standard treatments. A proportion of these patients remain severely depressed despite repeated trials of medication, the use of electroconvulsive therapy and other innovative therapies. Deep brain stimulation (DBS) has been developed as an alternative intervention which involves the placement of stimulating electrodes in targeted brain regions to try and ameliorate depressive symptomatology. The objective of the presentation will be briefly overview the development of DBS applications for depression and present the results of an initial trial of nucleus accumbens DBS. Methods: A small group of patients (n = 5) with severe treatment resistant depression underwent bilateral placement of DBS electrodes in the nucleus accumbens. Stimulation was adjusted in each patient to achieve maximum therapeutic response and the patients followed for a minimum of 12 months. Results: DBS stimulation to the nucleus accumbens produces a clear pattern of mood alteration intra-operatively, during the post operative initial stimulation period and longer term. Mood improvement with DBS can be substantial and persist over long periods of time. Differences as well as similarities in clinical response between patients will be discussed. Conclusions: DBS has the potential to offer substantive symptom relief to a group of patients with persistent severe depressive disorders. Further research in larger clinical samples is required to define the role of this treatment and its efficacy. FP03-2 Psychophysiology of Yoga-based Relaxation Techniques: An Overview P. Subramanya, S. Telles. Indian Council of Medical Research, Center for Advanced Research in Yoga and Neurophysiology, Swami Vivekananda Yoga Research Foundation, Bangalore, India A yoga practice [called cyclic meditation (CM)] derived from ancient yoga texts consists of cycles of yoga postures interspersed with periods of supine rest. Practicing CM reduced psychophysiological arousal based on a decrease in oxygen consumption and minute ventilation, changes in the heart rate variability suggestive of a shift in the sympathovagal balance towards vagal dominance. However, these changes occurred simultaneously with a decreased latency and increased amplitude in the P300 auditory oddball task. The prolonged latencies of evoked potentials generated within the cerebral cortex after the practice of CM, supported the idea of cortical inhibition. The practice of CM improved the performance in memory scores and decreased state anxiety. The CM program has also been shown to decrease occupational stress levels and baseline autonomic arousal. Moreover, CM improved performance in psychomotor tasks which requires selective attention, concentration, visual scanning abilities, and a repetitive motor response. The practice of CM during the day time has been shown to increase the percentage of slow wave sleep in the subsequent night. However, these findings support the idea that meditation is a training in awareness which when practiced over long periods, produces definite changes in perception, attention, cognition and in psychophysiological measures. The above findings suggest that CM practice (i) reduces
Objective: To compare the effects of two different conceptual definitions of meditation for the management of stress in full time workers. Materials and Methods: A double-blind randomized controlled trial of meditation using sahaja yoga, a mental silence orientated form of meditation, as management strategy for work stress compared to both meditation as relaxation and a (no treatment) waiting list control was conducted. 178 full time workers were recruited. They completed measures of stress (the psychological strain questionnaire), anxiety (the state trait anxiety questionnaire) and depressive symptoms (the profile of mood states) pre and post intervention. Baseline scores indicated that the sample was significantly more distressed than the comparable population data. At the completion of the 8 week intervention subjects were reassessed. Results: The protocol analysis demonstrated that the mental silence orientated form of meditation was significantly more effective than relaxation or no treatment. After adjusting the data for the primary outcomes on the basis of intention to treat (LOCF), these improvements were significant for measures of stress and depressive symptoms but not anxiety. Only the mental silence orientated group demonstrated significant changes in their perception of personal and environmental resources available to help coping. Conclusion: This approach to meditation is a specifically effective strategy for reducing stress and improving mental health. FP03-4 Effects of a Newly Formed Meditation Based Awareness Training (MBAT) Program on Psychological Wellbeing: A Controlled Trial E. Shonin1,2 , W. Van Gordon1,2 , E. Sundin1 , L. Horgan1 . 1 Division of Psychology, Nottingham Trent University, 2 The Awake to Wisdom Foundation, Nottingham, UK Introduction: Mindfulness has been practiced in the Eastern world for more than 25 centuries but has only recently become popular in the West. Today, therapeutic interventions such as ‘Mindfulness Based Stress Reduction’ are used within Western health services and have proven to be successful techniques for reducing stress and depression. A limitation however is that they tend to apply the practices of mindfulness in an ‘out of context’ manner. Newly formed Meditation Based Awareness Training (MBAT), on the other hand, includes a composite array of ‘spiritual-based’ trainings, which are traditionally assumed to enhance the cultivation of a more sustainable quality of wellbeing. Aim: The purpose of this program is to design, implement, and evaluate MBAT as an approach to meditation and mindfulness that can be adapted to meet the needs of various populations. Methods: In the current phase, MBAT was developed for a general population sample wanting to increase their levels of wellbeing. By way of controlled comparison trial, participants of the study undertook an 8-week MBAT program and comparisons were made with a control group on perceived psychological wellbeing (depression, anxiety, anger management and stress). Results: Participants who undertook MBAT showed a significant improvement in psychological wellbeing compared to controls. Conclusion: Findings support the position that a more traditionally congruent yet still non-secular approach to meditation as a clinical intervention can be efficacious. In a second phase, MBAT will be
S32
Oral presentations / Asian Journal of Psychiatry 4S1 (2011) S1–S39
adapted to populations with specific needs, e.g. trauma victims and forensic inmates. FP03-5 Improving the Identification and Management of Mood Disorders in Developing Countries I. Blignault1,2 , V. Manicavasagar1,3 , G. Parker1,3 , C. Wijeratne3,4 , A. Sumathipala5 . 1 Black Dog Institute, Randwick, 2 School of Public Health & Community Medicine, 3 School of Psychiatry, University of New South Wales, Sydney, 4 Academic Department of Old Age Psychiatry, Prince of Wales Hospital, Randwick, NSW, Australia; 5 Institute of Research & Development, Colombo, Sri Lanka The Black Dog Institute is a not-for-profit organization supported by the NSW Department of Health and the University of New South Wales. The Institute offers expertise in mood disorders (depression and bipolar disorder) via research, professional education and training, clinical services and population health approaches. In 2007, the Institute received funding through a bequest to conduct a program for improving the mental health outcomes in developing countries. This program that was developed incorporated two phases: the first involved developing and delivering an intensive educational course aimed at senior clinicians from developing countries in the AsiaPacific region; and the second involved collaborating with those clinicians and their organizations to implement population-based mental health interventions in situ. Fourteen clinicians from four countries participated in our first program in 2008, including eight clinicians from different organisations in Sri Lanka. Subsequently, the Institute collaborated with those clinicians and project partners on a suite of Phase 2 projects, including their National Program for Community Based Mental Health Care which was launched in March 2009. Evaluations of Phase 1 and Phase 2 activities and reports from participants and partners organisations attest to the success of this program in achieving its aims. This paper will report on the achievements and challenges of this Australia – Sri Lanka collaboration and the lessons learned; from the point of view of Black Dog Institute, the senior partner organisation in Sri Lanka – the Institute of Research & Development, and our ‘cultural broker’, an Australian psychiatrist of Sri Lankan heritage. FP03-6 Depression Management in Patients with Chronic Diseases by the General Practitioners in England A. Yohannes1 , M. Hann2 , B. Sibbald2 . 1 Health Professions, Manchester Metropolitan University, 2 The University of Manchester, Manchester, Virgin Islands (U.K.) Aims: We examined factors associated with the management of depression by general practitioners (GPs), using case vignettes, in patients with chronic obstructive pulmonary disease (COPD), severe osteoarthritis and depressive symptoms alone. Methods: We surveyed a random sample of general practitioners (N = 3,956) in England using a postal questionnaire. The questionnaire explored how GPs would approach the management of emotional distress in patients with and without a chronic condition and gauged their views of and experiences with depression in patients with COPD. Results: 864 completed responses were received (22%). In the vignettes, a significantly greater percentage of GPs reported that they would explore or offer the diagnosis of depression in a patient with COPD (95.4%) compared with patients with either severe osteoarthritis (88.3%) or depressive symptoms alone (86.3%). The only significant predictor of the diagnosis of depression was that GPs in training practices were 1.6 times more likely to diagnose depression in patients with osteoarthritis than GPs in non-training practices [95% C.I. (1.1, 2.5); p = 0.024]. There were no significant differences in the percentage of GPs who would pursue a diagnosis
of depression by either age group, gender, contract type (provider, salaried, other) or level of deprivation. Conclusion: The majority of the general practitioners in this study were able to identify depression from the vignettes in patients with chronic diseases. GPs in training practices are most likely to diagnose depression in patients with osteoarthritis compared to GPs in non-training practices. Further research is required. Free paper session FP04. Child, Adolescent, Intervention & Education FP04-1 Role of Music Therapy in Tension Headache V. Sinha, K.C. Gurnani. Psychiatry, S.N. Medical College, Agra, India Introduction: Headache is one of the most common medical complaints with one year period prevalence of 90% and a lifetime prevalence of 78% in general adult population. Tension headache is the most common type of primary headache (82%). A significant proportion of patients respond to pharmacotherapy with multiple relapses. Apart from pharmacotherapy, various alternative therapy have been tried to reduce the burden of headache patients, music therapy is one of them. Aims and Objectives: to study the effect of music theray as an adjuvant treatment modality in patients suffering from tension headache. Method and Material: 40 randomly selected patients meeting the criteria for tension headache according to HIS(International Headache society) were enrolled after informed consent. The subjects were divided randomly in two groups, one receiving pharmacotherapy and the other group was exposed to music therapy sessions for the next six months along with pharmacotherapy. The subjects were assessed on Headache Index, Visual Analogue Scale, side-effect profile and were asked to maintain Headache diary. Results: Significant decline in Headache Index as well as Visual analogue scale was observed at the end of six months in subjects getting music therapy adjunct to pharmacotherapy. Conclusion: Music therapy can be used as a cost-effective, safe adjunct to pharmacotherapy for rapid decline in pain and improved functioning in patients with tension headache. FP04-2 Medical Students’ Mental Health Status at the Beginning of the First Year Study of Two Different Selection Processes M.S.B. Yusoff1 , A.F. Abdul Rahim1 , A.A. Baba2 , S.B. Ismail3 , A.R. Esa4 . 1 Medical Education Department, 2 Department of Medicine, 3 Family Medicine Department, Universiti Sains Malaysia, 4 Community Medicine, Universiti Sultan Zainal Abidin, Kota Bharu, Malaysia Objective: This study attempted to look at mental health status of medical students from two different selection processes at the beginning of the first year of study. Methodology: Comparative cross-sectional study was done between two batches of first year medical students; one group underwent selection process merely based on academic merit (academic session 2008/2009) and another group underwent selection process based on academic merit, psychometric assessment and interview performance (academic session 2009/2010). The general mental health status among the medical students was measured by the 12-item General Health Questionnaire (GHQ-12). Data was collected at the beginning of the first year of study. Statistical analysis was done using SPSS version 18. Results: The prevalence of distressed medical students in the 2008/2009 and 2009/2010 batches were 26.29% and 14.3% respectively. The mean GHQ score and the percentage of distressed medical students at the beginning of the course were significantly