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The Black Dog Institute

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The Black Dog Institute s Contribution to the Assessment and Management of Mood Disorders in Rural Areas. ACRRM Conference, October 2008. Gordon Parker, Executive ... – PowerPoint PPT presentation

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Title: The Black Dog Institute


1
The Black Dog Institutes Contribution to the
Assessment and Management of Mood Disorders in
Rural Areas. ACRRM Conference, October 2008.
  • Gordon Parker, Executive Director, Black Dog
    Institute, and Scientia Professor, UNSW.

2
Mood Disorders.
  • Distributed widely
  • Deadly
  • Disabling
  • Discriminating
  • Detection problems
  • Dumbed down in a Dimensional model

3
Distributed Widely?
  • Lifetime chance of a mood disorder
  • 25 for women
  • 15 for men

4
Deadly?
  • Lifetime chance of suicide 15.
  • Of those who commit suicide, at least 80 are
    depressed.

5
Disabling
  • A study undertaken by the World Health
    Organization, Harvard University and World Bank
    established that depression was the most
    disabling and Bipolar Disorder the 6th most
    disabling of all medical and psychiatric
    conditions.
  • Why? Young onset, repeated and often lengthy
    episodes.
  • How? Not getting to work and difficulty in
    working if at work.

6
Discriminating?
  • General destigmatization.
  • Lack of appreciation by non-sufferers.
  • Employers particularly those that are
    downsizing.
  • Insurance companies.

7
Detection Problems.
  • Depression commonly undetected.
  • 80 of those with Bipolar Disorders miss
    receiving the correct diagnosis. If received
    10-15 years after onset. Failure to detect leads
    to collateral damage.
  • Why?
  • Denial, pride, stoicism (esp in males, rural
    regions)
  • Failure to screen and ask sub-typing questions.

8
Dumbed Down by a Dimensional Model.
  • While we argue that there are several distinct
    types of depressions, and that the differing
    types respond quite differently to differing
    treatments, ours is not the dominant view.
  • Instead, a dimensional single cause view
    dominates.

9
Dumbed down?
  • Depression is an it and it is then
    interpreted as sufficient to dictate treatment.
  • Treatment is then shaped more by the
    practitioners discipline and training than by
    characteristics of the disorder (i.e. the patient
    is fitted to the practitioners treatment model
    rather than the treatment being fitted to
    characteristics of the depressive condition).

10
Imagine if.
  • We treated major breathlessness according to a
    similar model..

11
The Black Dog Institute.
  • Structure
  • Function
  • Models
  • Strategies

12
Institute building
13
Courtyard
14
Organisational Model

15
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16
Depressive Disorders Multiple Types
17
Depressions
  • Some (e.g. psychotic depression, melancholic
    depression) are categorical diseases, others
    more environmental reflecting stressors alone, or
    in conjunction with certain personality styles.

18
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19
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20
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21
NEUROTRANSMITTER
CLINICAL FEATURE
DEPRESSIVE SUB-TYPE
Psychotic features
Psychotic depression
DA
Psychomotor disturbance
NA
Melancholia
Depressed mood
Non-melancholic depression
5-HT
22
By Contrast.
  • A range of non-melancholic disorders reflecting
    the impact of certain stressors on certain
    personality styles.

23
Stressors Contributing to Non-Melancholic
Depression.
  • Acute reactive scenarios where affront to
    individuals self-esteem. Stress itself or
    stress may build on earlier stressors key and
    lock phenomenon.
  • Chronic stressors are ones that undermine the
    individuals self-esteem in an ongoing way.

24
An ICONnoclastic Neuronal Line-up Relevant to
the Non-melancholic Depressive Disorders
25
Meaningful conditions?
  • The Bipolar Disorders ups and downs, with
    melancholic depression in the down phases.

Mania
Hypomania
Melancholia
26
Bipolar Disorder Some Facts.
  • Up to 6 lifetime risk in the general population.
  • Onset generally in adolescence years 10-12 of
    high school the highest risk period.

27
Depression Clinic
28
The BDI Clinic.
  • Initial assessment involves the computerised MAP,
    which provides
  • Socio-demographic details
  • Lifetime and current details on depression,
    anxiety and family.
  • Life history of risk (medical and non-medical)
    factors personality profile
  • Details on all previous treatments
  • Diagnostic algorithms to determine (a)
    melancholic vs non-melancholic, and (b) bipolar
    vs unipolar.
  • Then interview by intake psychiatrist, who
    presents history to consultant psychiatrist.
    Patient reinterviewed by both to clarify
    diagnosis and management plan (with or without
    relatives).
  • Detailed letter to referring practitioner.
  • Review at 12 weeks.

29
Clinical Services
  • Impact weighted to new onset and treatment
    resistant disorders. Paradigm change to
    diagnosis and management in 80 of referrals.
  • Reviews show substantive improvement, high
    satisfaction with service and facility ambience.
    Too successful in terms of waiting list. Costly.
  • Thus, establishment of MAP centres in Sydney and
    rural areas.

30
Mood Assessment Program-MAP
  • Computerised assessment and diagnostic tool for
    patients with mood disorders
  • Based on BDI model of depression
  • Identifies depression, subtypes it (including
    bipolar), defines personality style and
    identifies comorbid anxiety diagnoses

31
Specific Aims of the MAP
  • To assist with the sub-typing of depressive
    disorders (e.g. psychotic, melancholic or
    non-melancholic depression)
  • To improve the detection, and therefore
    treatment, of bipolar disorder
  • To identify relevant factors that are likely to
    have contributed to the onset or maintenance of
    the disorder (e.g. stressful events, personality,
    anxiety conditions, drug or alcohol use)

32
PILOT MAP Centres
  • Pilot MAP Centres are opening around the state in
    a range of settings
  • These centres are testing the acceptance of the
    MAP as a credible tool in diagnosis and
    management of depression and bipolar
  • First MAP centre opened end October 07 already
    over MAP 1,000 assessments completed
  • Positive feedback received from referring
    clinicians

33
GP Education Programs
34
GP Education Website
35
Workshops for GPs and GP registrars
  • Demystifying Depression Managing Depression in
    General Practice.
  • Troubled Teens Managing Adolescent Mood
    Disorders in General Practice.
  • Ups and Downs An Introduction to Managing
    Bipolar Disorder
  • Psychological Treatments of Depression
  • Psychological Toolkit
  • Making the Most of Mental Health Care Plans
  • The Psychological Treatment Team GPs,
    Psychologists and Others
  • Dealing with Life-Threatening Depressions
  • Dealing with Difficult Consultations In General
    Practice
  • All fully accredited by the RACGP and ACRRM

36
BDI Bush Bash 2008
  • Bowral Tulip Festival
  • Deniliquin Ute Muster
  • Andrew Johns walk
  • Tamworth Bush Bash Depression
  • Between 5-9 November, 2008, the Institute will
    be visiting Tamworth to conduct a range of
    programs in Tamworth. The theme of the pilot
    Black Dog Institute initiative is Lets talk
    about depression. During the visit, the Institute
    will undertake
  • Public forums on mood disorders and happiness
  • School Talks
  • Rural Ambassador presentations
  • Picnic information sessions
  • Workshops for health professionals.

37
Black Dog Institute Bus
38
Andrew Johns Walks for the Black Dog
39
Website
40
Online Self-testing
MOOD ELEVATION
MYSTICISM
  • More confident
  • See things in new light
  • Creative ideas plans
  • Things vivid/crystal clear
  • Spend more money
  • Increased libido
  • Lots of coincidences
  • Feel at one with nature
  • See special meaning in
  • things
  • Mystical experiences

DISINHIBITION
IRRITABILITY
  • Talk over people
  • Feel angry
  • Thoughts race
  • Feel irritated
  • Say outrageous things
  • Feel high as a kite
  • Laugh more
  • Do outrageous things

41
Online Bipolar Disorder Educational Program
42
Online Depression Education Program
43
The Horses for Courses Model.
  • Logic
  • What type of mood disorder does this person
    have?
  • What are its underlying causes?
  • Given such information, what management
    strategies will be appropriate for this person at
    this time?

44
Our Community Initiatives
  • Consumer Community Resource Centre

45
Institute Books
46
Institute Books
47
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48
06 v 07 v 08 Website Statistics
49
Less Discriminating?
  • Changes in Australia relatively unique
  • Largely reflective of several overlapping
    strategies
  • Committed organizations.
  • Political investment (Economic argument)
  • The stories of prominent people (especially
    politicians and sportsmen).
  • The stories of everyday heroes (our books).
  • Conferences like this.

50
Supporters
51
Thus, our Model
  • There are differing meaningful conditions.
  • Using a non-specific approach (i.e. drugs for all
    depressions, counselling for all
    depressions), some people will be
    under-treated and others over-treated.
  • The differing conditions benefit from differing
    therapeutic approaches.
  • Thus, the need to identify those differing mood
    disorders.
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