Depressive Disorders

Major Depressive Disorder (MDD) is also known as clinical depression or unipolar depression and refers to distinct episodes of depression lasting >2 weeks and having a negative impact on everyday functioning. Criteria include;

  • Depressed mood for 2 weeks, with or without anhedonia… PLUS 4 of the following
    • Insomnia/Hypersomnia
    • Significant weight loss or gain
    • Fatigue
    • Poor concentration
    • Agitation or psychomotor retardation
    • Worthlessness or guilt
    • Recurrent thoughts of death, suicidal ideation, attempt or plan
    • Impairment or distress
  • Exclude or
  • Exclude medical or substance abuse rxns, must not be better accounted for by any other diagnosis…
  • Specifies:
    • W/ Anxious distress
    • W/ Mixed Features manic or hypomanic sx),
    • W/ Melancholic features
    • W/ Atypical features (eating excessively, seeping, a “leaden” feeling in the limbs, or being sensitive to rejection)
    • W/ Peripartum onset
    • W/ Seasonal pattern (occurs usually in winter… assoc w/ low levels of sunlight)

Screen for bipolar affective disorder  a low may have a high in the past and completely change the way we treat wit medications

Lifetime risk of M:F; 10-25%:5-12%,
nb1. men can develop symptoms prior to puberty, whereas women may develop symptoms from puberty til middle age…
nb2. 50+ the risk equilibrates M=F

Causes, onset and course of depression

– Depression is common, affecting ~20% of Australians over a lifetime… Depression is a word often used to describe feelings of sadness and grief that all people experience at times. However, for a person to be clinically diagnosed with a depressive disorder, his or her symptoms are usually much more intense and must have been present for at least 2 weeks… Depression is commonly accompanied by feelings o anxiety or agitation. Bereavement following death of a loved one is not considered a psychiatric illness  however one must carefully evaluation whether the symptoms have gone beyond grief and into a state of depression (which cannot co-exist with bereavement…
– Persistent complex bereavement disorder is not recognised as an illness yet but is being considered for further study… it consists of impaired functioning following a death of at least a year for adults and six months for children…
– People may experience depression as a result of any one or more of a range of factors including; Biochemistry, physical stress, chronic or sustained illness, seasonal influences, genetic predispositon, life stressors, personality factors…
– Depression may have acute or gradual onset and can be experienced at any time over the course of a person’s life…

 

Difficulties in diagnosis.

– Depression can be difficult to diagnose as people present complaining of physical problems that obscure psychiatric diagnosis. Depressive disorders often coexist with, and may be secondary to other medical disorders… particularly high rates of depression are found in people with alcohol related disorders, eating disorders, schozophrenia and somatoform disorders (vague physical complaints with no physical basis). Determining which disorder is primary and which is secondary is often a difficult task.

– Many of the people clinicians care for, both young and old are at risk of developing depression due to long standing physical illness and disability, further depression can present as early signs of dementia. It is important then for clinicans to remain alert to this possibility.

Goals for managing person’s experience of epression

  • Developing a relatonship based on empathy and trust
  • Promoting a person’s positive self regard
  • Promote positive health behavours… including medication compliance and healty lifestyle choices,
  • Promoting person’s engagement with social and support networks
  • Ensuring effective collaboration with other relevant service providers through effective working relationships and communication
  • Support and promotion of self care activities for families and carers of person with depression.

Frequently assess, document and manage risk for suicide and self har…

Associated disorders

  • Persistent depressive disorder (aka dysthymia), diagnosed when mood disturbance occurs for >2 years in adults…
  • Cyclothymic disorder: chronic disorder >2 years of alternating periods of low and high moods that are less severe than major depression or mania. It can be described as a mild form of bipolar…
  • Premenstrual Dysphoric Disorder – newly places in DSMV, at least 5 symptoms overall present before onset of menses, wit decrease or disappearance by onset of menses. At least one or more of the following: lability, irritability, depressed mood, anxiety/tension. at least one or more for the following as well: decreased interest, concentration difficulty, lethargy, change in appetite, sleeping too much or too little, overwhelmed, physical symptoms such as breast tenderness, bloating or weight gain.
  • Dysruptive mood dysregulation disorder: Diagnosis of children up to 12 y.o wo present with persistent irritability and frequent episodes of extreme behavioural dyscontrol…Children with this diagnosis often develop unipolar depression or anxiety disorders in adulthood, rather than bipolar conditions…
  • Substance/Medication induced depressive disorder…
  • Depressive disorder due to other medical condtitio

Maryborough Airdisplay

We were in for a treat after work today when the RAAF Roulettes pulled into Maryborough to perform an aerial display over the airstrip in preparation for the Townsville Airshow 2016. Although I only heard about it yesterday, the event was advertised in the local newspaper pulling a large crowd. We were allowed to stand on the tarmac and watch standing next to one of the PC9’s piloted by the commentator. The PC-9A’s flown today are apparently soon to be replaced by the amazing PC-21.

I took a few shots, and there’s a great youtube video (better than anything I’ve taken) here:

Goal setting and Review

While learning about rehabilitation and health management plans today I came across a fairly straightforward process for goal-setting that can be applied to virtually all aspects of learning new skills. I think this is a workflow we can all strive to achieve in our own lives when it comes to achieve complex tasks. The key is to break the main outcome down into specific, measurable, achievable, realistic and time limited goals.

goal_setting-and-review
Whether it’s a weight loss programme, quitting smoking or learning how to fly – the general gist of the suggested workflow is that sticking to a plan works far better than random misguided activity.

Goal setting in the sky could be akin to setting incremental minimums, maximums or times to perform a set at tasks.

Try it sometime.

Situational Awareness in Aviation

Situational awareness is the perception of the elements in the environment within a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future…

Put simply;
– What’s happened (past)
– What’s happening (present)
– What might happen (future)

Skilled pilots are better able to acquire and maintain their situational awareness. The skill is best  learned through a composite of training, feedback and self reflection. The following is a compilation of tips to help pilots focus on developing situational awareness.

Starting with you:

  • Mentally tough people are better focused and able to forge ahead, pilots should focus on the things that work.
  • Pilots that have ‘mental baggage’ such as financial stress, personal difficulties can be taken on-board… and may detract from mental resources dedicated for the task of flying… particular problematic when an emergency arises or the patient becomes task saturated.
  • Exercise and good nutrition help pilots to think clearly and make good decisions… aim for 30-60 mins of dedicated exercise each day.
    – Fatigue
    – Avoid drugs and alcohol
    – Fed and Hydrated
    – Avoid stress
  • There is a connection between personal confidence and performance (i.e. competence and command) as a pilot

Pre-Flight Planning and Preparation:

  •  Give oneself time to plan ahead and ask what-if, and have a plan for every what-if… even short flights can be planned up to a week in advance in accordance with route, NOTAMS, weather, terrain etc.
  • Prepare maps, charts, relevant runways
  • Clean the windscreen – avoid focal traps!

In-Flight Routine:

  •  Stay ahead of the aircraft and plan for tasks to be performed such as setting new frequencies before transition points. Rushing and doing things at the last can lead to delay and increased errors.
  • Avoid becoming fixated on a single task or distractions
  • Scan outside and be vigilant
    • Beware of ’empty field myopia’ phenomenon – where the eyes adopt a natural rest position when there’s ‘nothing perceptibly seen’… this can be avoided by  regular forced checks with changes focus in the field from near to far!
    • Most pilots tend to scan only out the front of their aircraft whereas dangers can come from all angles..
  • Beyond ‘see and avoid’ … build a model of the situation.
    • Always ask the question “do I have the full picture”
    • Listen out for other aircraft in the area
    • Note real-time weather factors (wind direction and strength, cloud, storms), time and place, fuel levels.

Debrief:

  • Review data from GPS or other video/audio recording devices.
  • Write notes on every flight compiling also pre-flight notes.
  • Be as thorough as possible in recalling and reconstructing how a situation occurred, this can also help generate an understanding of the gaps in your own knowledge!

Lesson 7. Flight Circuits II

Airport: Hervey Bay Aerodrome
Instructor: BS , Briefing time (hr): 0
Time to take off: 8:15 Runway: 29
Time to land: 9:15 Runway: 29          Total Engine time: 1.0 Approx. Fuel ____
Wx: Wx at aerodrome (Approx time of AWIS call 8:00): Cloud clear <1200, Wind Direction variable 340 – 350 N, Wind Strength 13 kts , Temp 22.4oC, Dewpoint -, Rainfall last 10 mins nil, Wind types -, Visibility >10km,  Humidity 60%, QNH 1012, Changes in Wx Conditions, BOM daily wx obs: Temps Min (°C) 13.2, Max (°C) __, Rain (mm) 0, Evap __, Sun __, [[Max daily wind gust: Dir __, Spd (km/h) __, Time (local) __]] [[9:00am record: Temp (°C) 24.1, RH (%) 57, Cloud -, Dir N, Spd (km/h) 17, MSLP (hPA) 1022.4]], [[3:00pm record: Temp (°C) __, RH (%) __, Cloud __ , Dir __, Spd (km/h) __, MSLP (hPa) __]] http://www.bom.gov.au/climate/dwo/IDCJDW4056.latest.shtml
barometric

TAF YHBA 072111Z 0800/0812

36008KT CAVOK

FM080100 36012KT CAVOK

RMK

T 25 26 25 22 Q 1021 1019 1017 1018

METAR YHBA 080400Z AUTO 36012KT 9999 // NCD 25/17 Q1018

RMK RF00.0/000.0

 

Goals: Review previous lesson and optimise operation of aircraft… Downwind checks, operating minimums (1/2 balance ball, +10/10 heading, Vref +5 kts -0 kts, +150 ft of set altitudes, main wheels first), maintain consistent tracking, pre-landing checklist, emergency engine cut off routine practice

Briefing discussion: Home-study on circuits and own notes, no formal briefing necessary as one was due to practice the circuit pattern and improve on skills.
Tasks: pre-flight checks, oil and fuel check, wheel chocks, start-up procedures and checks, radios, take-off, climbing, descent, turns, preflight briefing (re-aborted take-off procedure), touch’n’go x5, final landing.
Notes:

Aircraft checked over, noted fuel ~60-65L of fuel by dipstick, plenty for the PA-28 that burns ~35L / hour. Noticed large areas of eroded tarmac beneath the wing, apparently due to previous fuel-leaks that weren’t adequately cleaned up (the fuel eats the tarmac?).

Initial start-up checks ran smoothly, but for the sake of time establish a routine to work with for start up. Waited ~5 mins on the tarmac prior to departure to allow commercial operations right of way – ~4 aircraft one SeaAir en-route to Lady Elliot, one caravan bound for Bundaberg, another that used runway 11 alternatively to get a marginally faster route out of the airspace… seemed bizarre but manageable as the tailwind was about 10 knots at the time. Then there was the local parachute group that took off in no time and we were clear to take off.
Rolling start from the mid-runway point. Took off tracking the middle of the runway.
– first circuit seemed rough, especially re-engaging the BUMFISH and having too much speed on the descent… must ensure to check the speed before engaging flaps. Approach was good nicely controlled but to the left. Landing was flat, to the left of the runway and beyond the numbers, all three wheels simultaneously touched without bleeding off the speed for a nosewheel.
– second and third circuits improved marginally with a better control of speed, height and centreline landings… approaches are less flat but when trying to pitch the nose up on engine-out one balloons the aircraft and still comes down relatively flat.
– fourth and fifth landings were much improved, finally getting the nose-up enough and the runway more centre-line… the last approach was still too fast and ballooned but still corrected, one needs to work on getting the speed low enough to stall just at the right moment.

A lesson learned here was that although the weather conditions seemed to be more of a challenge (especially for keeping the runway straight on approach) you have got to remain ‘ahead’ of the aircraft and make small but const and adjustments to maintain the accuracy of landing. Get used to lining the runway up and heading straight for the numbers – avoiding over and undershooting the runway.

Emergency procedure for an engine cut out were demonstrated and practiced after touch-and-go takeoff at ~500 ft (I can’t remember which circuit these were on). The nose-down, glide-speed, select field, flaps as necessary to reach the field routine has to be practiced to become automatic in the event of a sudden engine failure… This reminds me to watch the film Sully, apparently it’s a great movie full of insight into the split-second decision making necessary.

My radio calls need to improve with stringing things together in the right order
– E.g. “Hervey Bay traffic, KEP, on base, runway two-nine, Hervey Bay… {pause} touch and go”…
– It’s a simple glitch but probably annoying to listen to…
– ensure positional accuracy… “early, mid or late” in the leg … e.g. “late downwind”, or “turning into base leg”
– any clarification over the radio were addressed by instructor where necessary…

And again with the theme of split second decision making… After the 4th circuit a microlight that did not seem to be oriented to the circuit or other aircraft (such as us) came within hundreds of feet of us requiring an evasive manoeuvre (executed by instructor). This was a very dangerous situation that will have to be reported, considered from all angles, and discussed with the other aircraft operator. I take this as an early hard lesson in situational awareness highlighting just how important it is to look out the window, pay attention to the radio calls and make ample radio calls to let other people know where you are at.

I look forward to next week!
Radios: YHBA AWIS 134.9, general

Loving Vincent.

One film that appears absolutely mesmerising in conception and execution is currently being constructed depicting Van Gough’s life and works called Loving Vincent… what  – appears to be a form of docudrama.

Upon completion, the entire film will be a painted masterpiece featuring a framerate of 12 paintings per second with 120 of Van Gough’s own painting being incorporated into the film… For the first fully painted film, the artists pull no stops by emulating his unique style of post-Impressionist era oil-canvas painting led by a team of 85 dedicated artists partially funded by a Kickstarter campaign.

Since it’s public showcase in February 2016 I haven’t heard much else about how production is going – but I look forward to following up on it as time goes by.

Checkout the project’s website:
http://lovingvincent.com/