An exploration of pharmacological and psychological interventions in patients with treatment-resistant affective disorders

Abstract

Preface:
The Mood and Anxiety Disorder Service in Southampton is a regional specialist
service for patients with complex and usually treatment-resistant affective disorders, which accepts referrals mainly from secondary care mental health services. Professor David Baldwin is the lead consultant for this service. He has clinical and research expertise in the identification, assessment and treatment of depressive illness and anxiety disorders, and is the lead author of evidence-based treatment guidelines for anxiety disorders.
I have worked with Professor David Baldwin since 2008. Through his encouragement and support, I have undertaken a series of pharmacological and psychological interventions in patients with treatment-resistant affective disorders. My dual aims were to examine treatment recommendations within the Service, and to investigate the potential feasibility, effectiveness, and acceptability of non-pharmacological treatment options for groups of patients with severe treatment-resistant depression or generalised anxiety disorder (GAD): partly in the hope that this might inform the development of additional treatment interventions within the local services.
Inspection of the medical records of patients referred to the tertiary services in
Southampton allowed an examination of currently offered pharmacological and psychological treatments. I realized that for most patients, and often over long periods of treatment in secondary care mental health services, there had been a lack of non-pharmacological treatments options apart from cognitive behaviour therapy (CBT). This thesis includes a description of patients referred to the Service, including their demographic and clinical characteristics, and current and recommended treatments: and an account of the effectiveness and acceptability of two non-pharmacological group interventions, namely mindfulness-based CBT in patients with highly recurrent unipolar depressive disorder, and Yogic breathing in patients with treatment resistant GA.

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Identifiers

ORCID for David Baldwin: orcid.org/0000-0003-3343-0907

ORCID for Matthew Garner: orcid.org/0000-0001-9481-2226

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