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Objective: Borderline personality disorder (BPD) is frequently accompanied by low mood, the features of which may satisfy the diagnostic criteria for major depressive disorder (MDD). Treatment of depressive symptoms in the absence of BPD-appropriate treatment is less effective and may cause iatrogenic harm. This paper briefly reviews the co-occurrence of BPD and depressive disorder and suggests ways of differentiating these disorders and optimising treatment within the Australian Mental Health context.Conclusions: Depressive symptoms are present in the majority of people with BPD. To address the difficulty differentiating clinically distinct MDD from depressive symptoms that are integral to BPD psychopathology, it is suggested that depressive symptoms arising from a primary diagnosis of BPD (i) may exhibit transience and be stress reactive, (ii) lack a robust clinical response to antidepressant medication and/or electroconvulsive treatment and (iii) are responsive to BPD-appropriate psychotherapy. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper is to evaluate the accuracy of a new genotyping test (Antidepressant PredictAR) in assigning patients as likely 'poor', 'rapid' or 'normal' metabolizers of antidepressant drugs. Method: Eighty-nine patients were clinically assigned (on the basis of their historical response to antidepressant drugs) as 'poor', 'rapid' or 'normal' metabolizers and comparison was then made to their test-based 2D6 and C19 genotyping status reports. Results: The overall capacity of the test to allocate patients to four differing phenotypic categories reporting for the genotyping test was not significant in relation to either C19 or 2D6 analyses. However, the C19 test did appear to have some capacity to identify rapid metabolizers, and we note how we then sought to manage such patients clinically. Conclusions: The test may have some capacity to identify patients with a rapid metabolizing profile. Any further advantages were not identified by this study, whether reflecting methodological and/or assay limitations. [ABSTRACT FROM AUTHOR]

Objective: The aim of this paper was to review the large US National Institute of Mental Health-sponsored depression intervention effectiveness study, STAR*D, in order to evaluate critically its relevance for Australasian clinicians. Conclusions: STAR*D is a landmark study which tried to address issues of effectiveness rather than efficacy, of a number of interventions for depression. However, methodological shortcomings limit the utility of the study in informing Australasian clinical practice. [ABSTRACT FROM AUTHOR]

Objective: Deficiencies in Australia’s mental health systems persist despite over a decade of mental health reform. Recent developments in e-health provide the opportunity to facilitate health reform and improve services. This paper presents preliminary findings from the implementation of a comprehensive e-health system, called RecoveryRoad , which was designed to augment the routine clinical treatment of depression. Methods: Depressed patients (n = 144) were referred to RecoveryRoad from a public hospital and public and private clinics in Perth, Western Australia. Online features included secure e-consultations, progress monitoring questionnaires, psychoeducation and evidence-based therapy. Treating clinicians had online access to patients’ progress monitoring outcomes and e-consultations. There were two types of adherence reminders: automated email reminders and personalized case management delivered by email and telephone. Results: Adherence to the system was high (from 53% to 84%, depending on the modality of reminder), and self-reported medication adherence was over 90%. Average depression severity declined from severe to mild by the eighth session, a large effect (d = 1.0). Both clinicians and patients were generally satisfied with the programme and reported that it improved clinician–patient relationships. Clinicians also reported that it helped patients to better manage depression. Conclusions: Preliminary findings support the feasibility of comprehensive e-health systems in enhancing the delivery of mental health care. [ABSTRACT FROM AUTHOR]

Objectives: Australian research has identified that there are significant variations between service providers in terms of clinical management of patients with comparable presenting problems. Internal audits within the facility at Royal Brisbane and Women's Hospital revealed that these variations occurred between wards, treating teams and psychiatric consultants. Given the increasing emphasis on evidence-based practice, it was decided that the literature should be reviewed to determine what the standard of care should be. The paper then examines how clinical pathways for psychosis and for depression were developed and how they eventually evolved into an acute inpatient pathway. It identifies the framework used and examines important aspects relating to the adaptation of these frameworks to mental health issues. The process for the development and implementation of the clinical pathway is discussed. Recommendations for their future use in a mental health setting are also presented.Conclusions: Mental Health care is complex. For this reason, mental health clinical pathways have to remain flexible and innovative. With the present project, it was found that the pathways were not suited for specific diagnoses so that they evolved into a single acute inpatient pathway. [ABSTRACT FROM AUTHOR]

Objective:Throughout the Asia Pacific region, there is an urgent need to reduce the burden of depression by increasing depression awareness, reducing stigma and dismantling those social barriers that prevent full participation by people with depression. This paper describes the development and early achievements of the Australian depression initiative,beyondblue.Methods:A review of the key priorities ofbeyondblue andtheir impacts during the first three years of operation (2001−03).Results:Key achievements include: the degree of national recognition ofbeyondblue; size and scope of media impact; growth in website utilisation; increased reporting of the community's recognition of people with depression; genuine reforms in life insurance and income protection; development of a new national consumer and carer organisation; establishment of major population-based preventative and early intervention programs; system-wide reform of primary care-based mental health services; national educational program uptake by general practitioners; and, development of key awareness and intervention programs for use in schools and the workplace.Conclusions:In its first three years of operation,beyondbluehas had a major impact on depression awareness in Australia and demonstrable gains have been made in reducing stigma and major social barriers. A pre-existing national mental health policy and implementation plan, a substantial funding base and participation by key political, media and community leaders have been essential elements of its short-term success. Its longer-term impact will now depend on more sustainable community and business partnerships as well as the growth of a more influential consumer and carer voice. [ABSTRACT FROM AUTHOR]