Dr Conor Farren's presentation the relationship between alcohol and mental health issues, including depression, in Ireland. Dr Farren is a Consultant Psychiatrist at St Patrick’s University Hospital and a Senior Clinical Lecturer at Trinity College Dublin.
This presentation was given at Alcohol Action Ireland's conference, Facing 'The Fear': Alcohol and Mental Health in Ireland, on November 20, 2013.
Professional Risk Assessment: Suicide and Self Harm RiskDr Gemma Russell
Presentation delivered to Lifeworks Australia as part of their professional development in 2013.
Specifically discusses how to conduct a comprehensive risk assessment and the implications for different levels of risk. Also highlights, ethical and legal responsibilities of the practitioner.
Dr Philip McGarry's presentation on alchool’s impact on mental health in Northern Ireland. Dr McGarry is a Consultant Psychiatrist at the Mater Hospital in Belfast and was Chair of the Royal College of Psychiatrists in Norther Ireland from 2009 to 2013.
This presentation was given at Alcohol Action Ireland's conference, Facing 'The Fear': Alcohol and Mental Health in Ireland, on November 20, 2013.
Dr Bobby Smyth's presentation about current trends in alcohol consumption among young people in Ireland and the impact drinking is having on their mental health. Dr Smyth is a Consultant Child and Adolescent Psychiatrist with the HSE, Senior Clinical Lecturer with the Department of Public Health & Primary Care in Trinity College Dublin, and a board member of Alcohol Action Ireland.
This presentation was given at Alcohol Action Ireland's conference, Facing 'The Fear': Alcohol and Mental Health in Ireland, on November 20, 2013.
Professional Risk Assessment: Suicide and Self Harm RiskDr Gemma Russell
Presentation delivered to Lifeworks Australia as part of their professional development in 2013.
Specifically discusses how to conduct a comprehensive risk assessment and the implications for different levels of risk. Also highlights, ethical and legal responsibilities of the practitioner.
Dr Philip McGarry's presentation on alchool’s impact on mental health in Northern Ireland. Dr McGarry is a Consultant Psychiatrist at the Mater Hospital in Belfast and was Chair of the Royal College of Psychiatrists in Norther Ireland from 2009 to 2013.
This presentation was given at Alcohol Action Ireland's conference, Facing 'The Fear': Alcohol and Mental Health in Ireland, on November 20, 2013.
Dr Bobby Smyth's presentation about current trends in alcohol consumption among young people in Ireland and the impact drinking is having on their mental health. Dr Smyth is a Consultant Child and Adolescent Psychiatrist with the HSE, Senior Clinical Lecturer with the Department of Public Health & Primary Care in Trinity College Dublin, and a board member of Alcohol Action Ireland.
This presentation was given at Alcohol Action Ireland's conference, Facing 'The Fear': Alcohol and Mental Health in Ireland, on November 20, 2013.
The Impact of Alcohol on Self-harm and Suicide in Ireland - New Insights.AlcoholActionIreland
Prof Ella Arensman's presentation about the impact of alcohol on self-harm and suicide in Ireland, providing new insights from recently collected data. Prof Arensman is Director of Research with the National Suicide Research Foundation and Adjunct Professor with the Department of Epidemiology and Public Health, University College Cork.
This presentation was given at Alcohol Action Ireland's conference, Facing 'The Fear': Alcohol and Mental Health in Ireland, on November 20, 2013.
Prof Peter Anderson: Substance Use, Policy and Practice, Institute of Health and Society at Newcastle University and Professor, Alcohol and Health, Faculty of Health, Medicine and Life Sciences at Maastricht University, Netherlands.
Dr Amanda Fitzgerald, UCD School of Psychology and co-author of Headstrong’s My World Survey, a National Study of Youth Mental Health, at Alcohol Action Ireland's conference "Time Please... For Change"
Dr Jean Long of the Health Research Board speaks about alcohol trends and public attitudes at Alcohol Action Ireland's conference "Time Please... For Change".
suicide - a public health problem
history, global scenario, Indian scenario, etiology, risk factors. protective factors, suicide in adolescents, treatment, prevention, recommendations
Psychiatric Disorders in Chemically Dependent Individuals - October 2012Dawn Farm
This program provides an overview of co-occurring addiction and psychiatric illness, including standard diagnostic criteria, individual considerations for determining the appropriate course of treatment, available treatment interventions, and the perspectives of both the addict and the treatment provider on addiction and psychiatric illness. It is presented by Dr. Patrick Gibbons, LMSW, DO; Adjunct Clinical Instructor in Psychiatry at the University of Michigan; Medical Director of the WCHO Community Crisis Response Team; consultant with Pain Management Solutions in Ann Arbor; Medical Director of the Michigan Health Professionals Recovery Program, and Medical Director of Dawn Farm. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
objectives are understanding the scop of substance abuse in the elderly and realize the future implications of substance abuse in the baby bommer cohorot and understanding the definition of alcohol dependance and how to recognize them and much more
welcome to :
http://www.ethanolabuse.com
DR CONSTANT MOUTON - COULD DUAL DIAGNOSIS BE THE KEY TO PERSONALISED TREATMEN...iCAADEvents
As our knowledge about addiction is increasing the association between mental illness and addiction is better understood. The controversy about the appropriateness of the term Dual Diagnosis to describe such a heterogeneous group of patients has sparked a debate on treatment and assessment models. It highlighted the fact that as far as treatment modalities are concerned, one size might just not fit all. Dr Mouton reviews current knowledge on comorbidity in the addiction field. Focusing on more than psychiatric comorbidity, he also looks at physical, social, psychological, spiritual and cultural components affected by addiction. Describing the role of the psychiatrist in addiction care he poses the questions: What if dual diagnosis is actually the key to better understanding of our patients? What if this knowledge leads to more individualised treatments? And are we ready for personalised treatment in the addiction field?
The recognition of bipolar disorder in primary careNick Stafford
Bipolar disorder and the complexities of screening and diagnosis in primary care. How more accurate detection and an integrated care pathway with secondary care can improve the diagnosis and outcome of the treatment of the disorder.
A lecture by Dr Imran Waheed, Consultant Psychiatrist, outlining the approach towards the diagnosis and management of schizophrenia, with particular reference to primary care. Delivered in March 2013 in Birmingham, UK.
Alcohol Action Ireland recommends that excise duty on all alcohol products be increased in Budget 2016 so that the price of alcohol is set at a level that reflects its significant health, social, and economic impacts; the wide range of harm its consumption causes to others; the costs borne by the State and, ultimately, the taxpayer. We also recommend the introduction of a social responsibility levy on the alcohol industry, which currently makes no direct contribution to addressing the considerable financial burden the consumption of its products places on the State.
Model-based appraisal of minimum unit pricing for alcohol in the Republic of ...AlcoholActionIreland
In 2013, the Department of Health, in conjunction with Northern Ireland, commissioned the Sheffield Alcohol Research Group (SARG) at the University of Sheffield to conduct a health impact assessment as part of the process of developing a legislative basis for minimum unit pricing. The health impact assessment studied the impact of different minimum prices on a range of areas such as health, crime and likely economic impact.
Key findings from a report, prepared for the HSE by Dr Ann Hope, Department of Public Health and Primary Care, Trinity College, Dublin. The report outlines alcohol harm's to others in Ireland, where the burden of alcohol related harm is often experienced by those around the drinker, be they family member, friend, co-worker or innocent ‘bystander’.
Alcohol Action Ireland's Pre-Budget Submission 2014 calls for the introduction of minimum pricing. Minimum pricing has the potential to significantly reduce alcohol-related harm in Ireland, resulting in a reduction of the substantial costs incurred by the State and the number of lives lost due to alcohol in Ireland every year.
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
Follow us on: Pinterest
Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
263778731218 Abortion Clinic /Pills In Harare ,sisternakatoto
263778731218 Abortion Clinic /Pills In Harare ,ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group ABORTION WOMEN’S CLINIC +27730423979 IN women clinic we believe that every woman should be able to make choices in her pregnancy. Our job is to provide compassionate care, safety,affordable and confidential services. That’s why we have won the trust from all generations of women all over the world. we use non surgical method(Abortion pills) to terminate…Dr.LISA +27730423979women Clinic is committed to providing the highest quality of obstetrical and gynecological care to women of all ages. Our dedicated staff aim to treat each patient and her health concerns with compassion and respect.Our dedicated group of receptionists, nurses, and physicians have worked together as a teamof receptionists, nurses, and physicians have worked together as a team wwww.lisywomensclinic.co.za/
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
HOT NEW PRODUCT! BIG SALES FAST SHIPPING NOW FROM CHINA!! EU KU DB BK substit...GL Anaacs
Contact us if you are interested:
Email / Skype : kefaya1771@gmail.com
Threema: PXHY5PDH
New BATCH Ku !!! MUCH IN DEMAND FAST SALE EVERY BATCH HAPPY GOOD EFFECT BIG BATCH !
Contact me on Threema or skype to start big business!!
Hot-sale products:
NEW HOT EUTYLONE WHITE CRYSTAL!!
5cl-adba precursor (semi finished )
5cl-adba raw materials
ADBB precursor (semi finished )
ADBB raw materials
APVP powder
5fadb/4f-adb
Jwh018 / Jwh210
Eutylone crystal
Protonitazene (hydrochloride) CAS: 119276-01-6
Flubrotizolam CAS: 57801-95-3
Metonitazene CAS: 14680-51-4
Payment terms: Western Union,MoneyGram,Bitcoin or USDT.
Deliver Time: Usually 7-15days
Shipping method: FedEx, TNT, DHL,UPS etc.Our deliveries are 100% safe, fast, reliable and discreet.
Samples will be sent for your evaluation!If you are interested in, please contact me, let's talk details.
We specializes in exporting high quality Research chemical, medical intermediate, Pharmaceutical chemicals and so on. Products are exported to USA, Canada, France, Korea, Japan,Russia, Southeast Asia and other countries.
2. Bacchus discovered the juice of the
grape and introduced it to mankind,
stilling thereby each grief that mortals
suffer from . . . sorrow's antidote.
Euripides, 407 BC, The Bacchae
3.
4.
5.
6.
7.
8.
9. Alcohol in Ireland
4th highest in EU, 11.5 L/alc/adult/annum
Highest binge drinking in Europe: 34%
EU average: 10%
Increased consumption by 17% in 1996-2005, tapered
since then.
Increased alcohol related deaths to 1775 in 10 years:
100% increase
Alcoholic liver disease: 147% increase in 10 years
Alcohol related diseases/injuries: 90% increase in 10
years
10. Interaction between Mood and
Alcohol
About 6% of the population suffers from alcohol
dependence (M>F), 7% from alcohol abuse, and
8% from heavy alcohol consumption.
About 8% of the population currently suffer from
a depressive disorder. 1-2% suffer from a bipolar
disorder.
Currently about 4% of the population suffer from
both an alcohol problem and a mood problem.
11. Mood Effects of Alcohol
Intoxication:
pleasant alteration in mood,
diminution in anxiety symptoms.
Depression caused by the alcohol:
hours later,
the next day,
a few days later.
For some alcoholics:
a certain amount of alcohol to get depressed,
only get depressed on one occasion out of 10 or 20,
dependent upon the overall mood before drinking.
Suicidal Ideas:
Alcohol can bring them on,
can make suicidal ideas more intense
disinhibited enough to try suicide, wouldn’t while sober
12. Effect of abstinence
At presentation, 40% of alcoholics have major depression;
50% have significant anxiety symptoms; 15% have manic
or elation symptoms
After 4 weeks of sobriety, the incidence of depression
goes down to 10%, the incidence of anxiety goes down to
15% and the incidence of mania goes down to <5%.
13. Alcohol and Suicide
25% of suicides solely attributable to alcohol
Alcohol present in 58% of completed suicides in Ireland
(Bedford et al., 2007)
International norm 38%
93% of those under 30 years in Ireland
Alcohol present in 41% of episodes of deliberate self harm
14. Alcohol Related Mortality Rate per 100,000
1970 - 2000
12
rates per 100,000
10
8
Suicide
6
Alcohol Consumption
4
2
0
1970
1975
1980
1985
1990
1995
2000
15. Reasons for depression in sobriety
Alcohol withdrawal can produce significant anxiety
symptoms.
Craving can present as depression.
Coping with the effects of a long period of drinking –
financial, relationship, work problems.
Immaturity of coping skills.
16. Anxiety and Alcohol
Social anxiety can lead to development of alcohol use disorder
Alcohol withdrawal is a significant cause of anxiety
Trying to deal with alcohol, trying to change, can cause anxiety.
Heavy drinkers often drink to overcome an underlying anxiety
Generalised anxiety
Panic disorder
Phobia
OCD
Craving for alcohol can present as anxiety;
Anxiety can cause craving.
17.
18. The U Turn: Sections
Why you need this book:
Self-understanding
Negative emotions and how they hurt us:
Anger
Jealousy and envy
Depression: experience and escape
Fear and anxiety
Criticism and hatred
19. •The fundamentals of self-belief
Self belief and inferiority
Personality and projection
Talking and communication
•The importance of relationships
Intent
Power
•The reason for it all
Joy and purpose
20. The Dual Diagnosis Program at
St Patrick’s University Hospital.
The program consists of:
Lectures, both general and specific for the program,
Video session, specific for the program
Individual therapy sessions
AA and Dual Recovery groups.
Group treatments:
Relapse prevention
Dual Diagnosis
1st Step
Recovery plan
Discussion Group
Full time program consisting of 3 parts:
- Assessment with detoxification and mood stabilisation;
- Engagement with full or modified in patient program;
- Aftercare for up to 6 months post discharge.
Farren and McElroy, J Affect Disorder
2008, 106: 265-272
21. FIRESIDE
Follow up.
Interrelationship of diagnoses: can’t improve in
one without the other.
Relapse Prevention.
Education: Lectures, Videos, and Discussions.
Stabilization of withdrawal and mood:
pharmacotherapy before and during program.
Individuation of program. Flexibility for
retention proposes.
Diagnostic equivalence. Both diagnoses
emphasised.
Empowerment: Individual responsibility.
Farren and McElroy, J Affect Disorder
2008, 106: 265-272
22. Demographics
Depression
(N=101) (M= 54, F=47)
Bipolar
(N=88) (M=43, F=45)
Age
44.7
41.6
Education
14.0
13.7
Length of stay
37.1 **
46.5 **
Previous admissions
1*
1.7 *
F. Hx of alcohol abuse
59.4%
67%
F. Hx of psychiatric disorder
49.5%**
69.3%**
Suicide attempt
29.7%
34.1%
Illegal drug use
23.8%
34.1%
Prescription drug abuse
24.8%
29.5%
* p<0.05
** p<0.01
23. Mood Disorder Symptoms
Depression - BDI
30
25
20
15
10
5
0
ar
ye
2
on
th
6
m
ge
ha
r
D
isc
Ba
se
l
in
e
Depression
BPAD
Farren CK, Snee L , McElroy S:
J Stud Alcohol Drugs,
2011, 72: 872-880
25. Drinking Outcomes:
Self Report
Drinking Days
Units per Drinking Day
45
40
35
30
25
20
15
10
5
0
Depression
BPAD
14
12
10
8
6
4
2
0
Depression
BPAD
Baseline
Baseline 6 months 1 Year
2 Year
6
1 Year
Months
2 year
26. Drinking Outcomes
Depre ssion
Base
3 mths
Bipolar
6mths
2 years
Baseline 3 mths
6 mths
2 years
No. drink
days
40.96
5.46
37.39
6.32
Units per
day
11.55
3.92
12.28
6.68
Abstinent
0%
57.3 %
0%
70.3%
50.7%
60.2%
49.3%
53.7 %
27. Predictive Relapse Factors at 3 Months.
B
S.E
Exp (B)
95%C.I for EXP(B)
Lower-upper
Sig.
Organised aftercare on discharge
2.200
.466
.111
.045-.277
<.01
BAI on admission
-.040
.020
.961
.924-.998
<.05.
.062
.030
1.064
1.001-1.128
<.05
Family psych history
-.660
.418
.517
.228-1.172
N.S
BDI score at admission
-.040
.026
.961
.910-1.022
N.S
Unemployed
2.241
1.718
.106
.004-3.620
N.S
Audit score at admission
Farren and McElroy,
Alcohol and Alcoholism,
2010, 45 (6): 527-533.
28. Predictive Relapse Factors at 6 Months.
B
Organised aftercare on
discharge
BAI on admission
Audit score on admission
Family psychiatric history
BDI score Discharge
OCDS score on admission
DAST score on admission
Drug History
S.E
Exp (B)
95%C.I for EXP(B)
Lower-upper
Sig.
1.766
.459
.171
.070-.421
<.01
-.010
.017
.990
.958-1.02
N.S
.060
.030
1.06
1.01-1.13
<.05
-.813
.414
.444
.197-1.00
<.05
.036
.027
1.04
.984-1.09
N.S
-.040
.031
.961
.903-1.02
N.S
-.061
.053
.941
.848-1.04
1.417
.653
4.13
1.15-14.8
N.S
<.05
Farren and McElroy,
Alcohol and Alcoholism,
2010, 45 (6): 527-533.
29. 5-year follow up of AUD with
Affective Disorder
Total Sample
Baseline
n = 205
3 months
n = 196
6 months
n = 155
2 years
n = 144
5 years
n =114
% abstinent
–
66.3%
55.2%
45.1%
51.8%
No. of drink days
39
3.5
7.9
7.6
10.9
12.1
22.2
3
–
3.8
–
5.3
7
5.7
5.5
28.8%
25.5%
–
–
–
7%
2.8%
1.8%
3.5%
Variable
Units per day
AUDIT
Illegal drug use
Pres. misuse
Of those who
% Light
Drinkers
were non-
abstinent at
3 months
93.8 %
5 years
Light Drinkers
Abstinence
53.6%
39.3%
Farren, Murphy and McElroy,
Alcoholism: Clinical and Experimental Research:
In Press
30. Supportive Text Messaging For Depression And Comorbid
Alcohol Use Disorder:
Single-blind Randomised Trial
Mobile phone text message technology has the potential to improve
outcomes for patients with depression and co-morbid
Alcohol Use Disorder (AUD).
Aims
To perform a randomised rater-blinded trial to explore the effects of
supportive text messages on mood and abstinence outcomes for patients
with depression and co-morbid AUD.
Agyapong V, Ahern S, McLoughlin D, Farren CK
J Affect Disorder, 2012
31. Methods
Participants (n=54) with a DSM IV diagnosis of unipolar depression and
AUD
Completion of the in-patient dual diagnosis treatment programme
Randomised to receive twice daily supportive text messages (n = 26) or a
fortnightly thank you text message (n = 28) for three months.
Primary outcome measures were :
Beck’s Depression Inventory (BDI-II) scores and
Cumulative Abstinence Duration (CAD) in days at three months.
Trial registration: NCT0137868.
32. Sample Messages
Monitor changes in your mood; develop a list of personal
warning signs
If you are having a good day, share your joy with others. If you
are having a bad day, share it with others and accept their help.
Stick to your treatment plan; take your medication as prescribed
and keep your appointments.
Keep Sobriety as a number one priority and you will reach your
goals.
Make a list of 5 people you can call if you are craving. Make sure
you carry their numbers with you all the time.
AA meetings are crucial; attend regularly; if you don’t like a
particular AA meeting, shop around until you find one that suits
you.
36. The Setting
Inpatient 4-week rehabilitation programme, based at
St Patrick’s University Hospital.
Patients were recruited from the inpatient group,
following detoxification and initiation onto the
Alcohol and Chemical Dependence Programme.
The programme consists of education groups,
individual therapy sessions, self help groups, plus
educational lectures.
A comparison group of cognitive computer exercises
was used as a placebo, for a similar number of sessions.
This consisted of basic mental arithmetic exercises.
37. The Therapy
5 X 50 minute therapy sessions were developed using
the CBT manual for Project MATCH as a basis.
Topics covered include:
an interactive exploration of emotions relating to
triggers for drinking episodes;
inaccurate thinking associated with AUD;
feelings around alcohol use, and the development of
strategies to deal with distressing feelings;
education about relapse, prevention strategies;
craving induction and craving reduction strategies
38. Each session had an appropriate case history presented to
the patient, based upon their original allocation to a
personal drinking pattern.
At the end of each session, the patient was given
standardised feedback via computer about their answers to
questions,
Also given specific therapeutic instructions via computer
regarding what would be helpful for their recovery.
Both groups were followed for 3 months after discharge,
with measurement of drinking outcomes.
39. Typical CCBT Programme Screens
Types of Drinkers: Reasons for Drinking
90
80
Social
Drinker
Interpersonal
Conflict
70
60
50
40
30
20
10
0
Testing
Personal Emotional Drinker
Control Drinker
40. FIGURE 1
APPROACHED
(n = 102)
Ineligible (n = 22)
Declined (n = 25)
RANDOMISED
(n = 55)
INTERVENTION
(n = 31)
EXCLUDED FROM ANALYSIS (n = 11)
Did not complete protocol
Discharged AMA (n = 2)
Early discharge (n = 2)
60% completion of protocol (n = 1)
Computer issues (n = 3)
Withdrawal from study
Withdrew (n = 1)
Insufficient information for analysis (n = 2)
INCLUDED IN
ANALYSIS
(n = 20)
CONTROL
(n = 24)
EXCLUDED FROM ANALYSIS (n = 9)
Did not complete protocol
Withdrew (n = 3)
Early discharge (n = 2)
Computer issues (n = 1)
Ineligible
Depression diagnosis (n =1)
Change of Tx programme (n =2)
INCLUDED IN
ANALYSIS
(n = 15)
)
41. No. of Drinking Days
70
60.63
60
51.27
Days
50
40
Baseline
30
3 months
20
10
8.56
3
0
CCBT group
Control group
42. Units per Drinking Day
30
25
24.34
23.08
Units
20
Baseline
15
3 months
10
5.94
5
0
CCBT group
4.79
Control group
43. Alcohol Misuse and Diabetes
Alcohol Misuse is the Diabetes of Psychiatry
They are both your “Friends for Life”
They are managed not cured.
They should be managed under 3 headings:
Diabetes
Complications
Oral Meds: Antabuse, Anti-craving
Anti-craving Injection
Diet
Recovery Activity: e.g. AA
Exercise
Behavioral
Oral Meds
Insulin Injection
Medical
Alcohol Misuse
Avoidance of Risk: e.g. Pubs
CV Disease
Anxiety
PV Disease
Depression
Diabetic coma
Bipolar Disorder