Mindfulness and Acceptance-Based Group Therapy: An Uncontrolled Pragmatic Pre-Post Pilot Study in a Heterogeneous Population of Female Prisoners.

The rate of females imprisoned worldwide has increased by more than 50% during the last two decades, with recent figures suggesting that, worldwide, the female prison population may still be increasing at a faster rate than males. Despite prevalence rates for psychiatric conditions among female prisoners being significantly higher than males, there is a particular lack of programs specifically designed for women. This preliminary study evaluates the initial effectiveness of a mindfulness and acceptance-based group program in an uncontrolled pragmatic pilot study of a heterogeneous group of incarcerated women with a range of mental health issues. Participants were 59 incarcerated women who engaged in a 10-session group program. Outcome measures comprised the Acceptance and Action Questionnaire-II, Depression Anxiety and Stress Scale, Mindfulness Attention Awareness Scale, and three screening tools derived from the full version of the Patient Health Questionnaire (PHQ-9), to measure depression, binge eating (Patient Health Questionnaire-Binge Eating Disorder [PHQ-ED]), and somatoform disorders (PHQ-15). Results of linear mixed modelling showed improvements in mindfulness and acceptance, and reductions in depression, anxiety, and somatoform symptoms. Furthermore, acceptance and commitment therapy (ACT) was shown to be an acceptable and feasible intervention for female Indigenous Australian prisoners. A mindfulness and acceptance-based group approach appears to be feasible and acceptable in a prison environment for a female prisoners with a range of mental health symptomatology.

Predictors of relapse in problem gambling: a prospective cohort study.

To explore the variation of predictors of relapse in treatment and support seeking gamblers. A prospective cohort study with 158 treatment and support seeking problem gamblers in South Australia. Key measures were selected using a consensus process with international experts in problem gambling and related addictions. The outcome measures were Victorian Gambling Screen (VGS) and behaviours related to gambling. Potential predictors were gambling related cognitions and urge, emotional disturbance, social support, sensation seeking traits, and levels of work and social functioning. Mean age of participants was 44 years (SD = 12.92 years) and 85 (54 %) were male. Median time for participants enrollment in the study was 8.38 months (IQR = 2.57 months). Patterns of completed measures for points in time included 116 (73.4 %) with at least a 3 month follow-up. Using generalised mixed-effects regression models we found gambling related urge was significantly associated with relapse in problem gambling as measured by VGS (OR 1.29; 95 % CI 1.12-1.49) and gambling behaviours (OR 1.16; 95 % CI 1.06-1.27). Gambling related cognitions were also significantly associated with VGS (OR 1.06; 95 % CI 1.01-1.12). There is consistent association between urge to gamble and relapse in problem gambling but estimates for other potential predictors may have been attenuated because of methodological limitations. This study also highlighted the challenges presented from a cohort study of treatment and support seeking problem gamblers.

The influence of depression and other co-occurring conditions on treatment outcomes for problem gamblers: a cohort study.

OBJECTIVE: To examine the influence of co-occurring conditions on gambling treatment outcomes. DESIGN, SETTING AND PARTICIPANTS: Prospective cohort study of problem gamblers. Participants were recruited from consecutive referrals to a gambling therapy service in 2008. Inclusion criteria were: (i) assessed as a problem gambler based on a screening interview including DSM-IV criteria for pathological gambling, and (ii) suitable for admission to a treatment program. Cognitive-behavioural therapy was based on graded exposure-to-gambling urge. One-to-one treatment was conducted with 1-hour sessions weekly for up to 12 weeks. MAIN OUTCOME MEASURES: Problem gambling screening and co-occurring conditions including depression, anxiety and alcohol use. RESULTS: Of 127 problem gamblers, 69 were males (54%), mean age was 43.09 years, and 65 (51%) reported a duration of problem gambling greater than 5 years. Median time for participants' enrolment in the study was 8.9 months. Results from mixed effects logistic regression analysis indicated that individuals with higher depression levels had a greater likelihood (13% increase in odds [95% CI, 1%-25%]) of problem gambling during treatment and at follow-up. CONCLUSION: Addressing depression may be associated with improved treatment outcomes in problem gambling; conversely, treatment of problem gambling improves affective instability. We therefore recommend a dual approach that treats both depression and problem gambling.

Understanding alcohol misuse and comorbid psychiatric disorders.

PURPOSE OF REVIEW: This review examines the relationship between alcohol misuse and comorbid psychiatric disorders, and the treatment of these comorbid disorders. In the past, the literature was dominated by papers describing prevalence, clinical services and comorbidity with schizophrenia. It is now advancing into areas such as the relationship between alcohol misuse and the anxiety disorders, affective disorders and eating disorders, and considering the diagnostic paradigm. Knowledge is also emerging about the influences of genetics and adverse effects over different stages of the life cycle in the development of these disorders. RECENT FINDINGS: Recent studies have examined the relationships between alcohol dependence and psychiatric illness, particularly anxiety and depression, but also subthreshold conditions. Childhood trauma, having parents with substance dependence and genetic factors influence the development of alcohol and comorbid psychiatric disorders. There is a genetic contribution to suicidal behaviour in alcohol-dependent patients. Early diagnosis is important. Alcohol Use Disorders Identification Test scores on admission to psychiatric hospital were found to correlate with suicidal ideation and behaviour. In patients with alcohol use disorders, treatment for depression works better after a period of abstinence. Abstinence alone can help for anxiety disorders. High-intensity services had better outcomes for this comorbid population than less intensive services. SUMMARY: Depression in patients with alcohol use disorders cannot be ignored. Treatment of depression alone will not help the alcohol use problems. All psychiatric inpatients should be screened for alcohol use disorders as part of their risk assessment. Research is focusing more on examining the complexities of these disorders, but there are no specific pharmacotherapies to treat particular comorbid conditions.