Treating bipolar disorder in pregnancy

2017 ◽  
Vol 41 (S1) ◽  
pp. S761-S761
Author(s):  
C. Solana ◽  
S. Nascimento ◽  
M. Mendes ◽  
M. Duarte
Keyword(s):  
Decision Making ◽  
Bipolar Disorder ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Bipolar Disorders ◽  
Clinical Effectiveness ◽  
Clinical Decision ◽  
Mood Stabilizers ◽  
Long Term Treatment ◽  
Mixed Features

IntroductionBipolar disorder is a chronic psychiatric illnesses characterized by alternating episodes of mania/hypomania and major depression, or with mixed features. Acute exacerbations and maintenance treatment with appropriate pharmacotherapy are mandatory. Long-term treatment with mood-stabilizing medications is typically required. The incidence of bipolar disorders in women during the primary reproductive years is very high, and the episodes of mania or depression are thought to occur in an estimated 25%–30% of women with bipolar disorder during pregnancy.ObjectivesProvide a clinically focused review of the available information on the effectiveness and safety of the different pharmacotherapies in the treatment of bipolar disorder during pregnancy.MethodsA bibliographic review is made of the pregnancy in bipolar disorder, based on the data published in PubMed.ResultsClinical decision making about the use of mood stabilizers and atypical anti-psychotics by pregnant women can be conceptualized as balancing the competing risks imposed by withholding or stopping pharmacotherapeutic treatment against that of continuing or initiating pharmacotherapy during pregnancy. Some of the most effective pharmacotherapies have been associated with the occurrence of congenital malformations or other adverse neonatal effects in offspring. There is few information about the safety profile and clinical effectiveness of atypical anti-psychotic drugs when used to treat bipolar disorder during pregnancy.ConclusionsTreating women with bipolar disorders during pregnancy is a challenge. There are no uniformly effective or risk-free treatment options. Fully informed decision-making requires the review of the risks of both untreated maternal bipolar disorder and risks associated with potentials interventions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

The ‘Number Needed to Treat’ and the ‘Adjusted NNT’ in Health Care Decision-Making

1998 ◽  
Vol 3 (1) ◽  
pp. 44-49 ◽  
Author(s):  
Jack Dowie
Keyword(s):  
Health Care ◽  
Decision Making ◽  
Evidence Based Medicine ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Population Based ◽  
Number Needed To Treat ◽  
Evidence Based ◽  
Based Medicine

Within ‘evidence-based medicine and health care’ the ‘number needed to treat’ (NNT) has been promoted as the most clinically useful measure of the effectiveness of interventions as established by research. Is the NNT, in either its simple or adjusted form, ‘easily understood’, ‘intuitively meaningful’, ‘clinically useful’ and likely to bring about the substantial improvements in patient care and public health envisaged by those who recommend its use? The key evidence against the NNT is the consistent format effect revealed in studies that present respondents with mathematically-equivalent statements regarding trial results. Problems of understanding aside, trying to overcome the limitations of the simple (major adverse event) NNT by adding an equivalent measure for harm (‘number needed to harm’ NNH) means the NNT loses its key claim to be a single yardstick. Integration of the NNT and NNH, and attempts to take into account the wider consequences of treatment options, can be attempted by either a ‘clinical judgement’ or an analytical route. The former means abandoning the explicit and rigorous transparency urged in evidence-based medicine. The attempt to produce an ‘adjusted’ NNT by an analytical approach has succeeded, but the procedure involves carrying out a prior decision analysis. The calculation of an adjusted NNT from that analysis is a redundant extra step, the only action necessary being comparison of the results for each option and determination of the optimal one. The adjusted NNT has no role in clinical decision-making, defined as requiring patient utilities, because the latter are measurable only on an interval scale and cannot be transformed into a ratio measure (which the adjusted NNT is implied to be). In any case, the NNT always represents the intrusion of population-based reasoning into clinical decision-making.

Clinical Decision Making on Extensive Molar Restorations

2014 ◽  
Vol 39 (6) ◽  
pp. E231-E240 ◽  
Author(s):  
T Laegreid ◽  
NR Gjerdet ◽  
A Johansson ◽  
A-K Johansson
Keyword(s):  
Decision Making ◽  
Clinical Decision Making ◽  
Dietary Habits ◽  
Influencing Factor ◽  
Treatment Options ◽  
Clinical Decision ◽  
Background Information ◽  
Molar Teeth ◽  
Logistic Regressions ◽  
Indirect Technique

SUMMARY Extensive loss of posterior tooth substance, which traditionally was restored with amalgam or indirect restorations, is more commonly being restored with resin-based composite restorations. Using a questionnaire, we aimed to survey dentists' clinical decision making when restoring extensive defects in posterior molar teeth. The questionnaire, which included questions on background information from the dentists, clinical cases with treatment options, and general questions about restoring extensive posterior defects, was sent to 476 dentists. The response rate was 59%. Multiple logistic regressions were used to investigate the different associations. Most of the respondents preferred a direct composite restoration when one cusp was missing, while indirect restorations were most preferred when replacing three or four cusps. Younger dentists and dentists working in the private sector had a greater tendency to choose an indirect technique compared with older colleagues. Generally, the most important influencing factor in clinical decision making was the amount of remaining tooth substance. Factors that appeared to be less important were dental advertisements, use of fluoride, and dietary habits. Female dentists perceived factors such as oral hygiene, patient requests, and economy to be more important than did their male colleagues.

Exploring patient satisfaction of a joint-consultation clinic for trigeminal neuralgia: Enabling improved decision-making

2021 ◽  
pp. 204946372110458
Author(s):  
Jolyon Poole ◽  
Valeria Mercadante ◽  
Sanjeet Singhota ◽  
Karim Nizam ◽  
Joanna M Zakrzewska
Keyword(s):  
Decision Making ◽  
Trigeminal Neuralgia ◽  
Clinical Decision Making ◽  
Response Rate ◽  
Treatment Options ◽  
Rare Condition ◽  
Clinical Decision ◽  
Consultation Clinic ◽  
Level Of Satisfaction ◽  
Paper Survey

Background Trigeminal neuralgia (TN) is a relatively rare condition which has a profound impact not only on the patient but also on those around them. There is no cure for TN, and the management of the condition is complex. The most effective forms of treatment are either through medication, neurosurgery, or combination of the two. Each option has risks and implications for the patient. As with all clinical decisions, it is important for patients to understand and be fully informed of the treatments available to them. A London UK unit adopted a joint-consultation clinic approach where the patient meets with both physician and neurosurgeon at the same time to discuss treatment options. The purpose of this evaluation is to understand patients’ level of satisfaction with the joint-consultation clinic and evaluate utilisation of a clinical decision-making tool. Method Patients who had attended the joint-consultation clinic over a period of 12 months were invited to participate in a telephone or paper survey (N = 55). Responses were analysed using descriptive statistics and thematic analysis. Results Forty-one patients (77% response rate) participated in the survey, and the results were overwhelmingly positive for the joint-consultation clinic regarding satisfaction. The benefits were broad ranging including increased understanding, collaboration and confidence in decision-making. Conclusions A joint-consultation clinic comprising a neurosurgeon and a physician for the treatment of TN is valued by patients who become better informed and able to make decisions about their care. Positive application of clinical decision-making aids in this situation offers potential across specialities.

A 52-Year-Old Man With Progressive Weakness and Incontinence

2021 ◽  
pp. 194187442110395
Author(s):  
Ayse Altintas ◽  
Ayca Ersen Danyeli ◽  
Subutay Berke Bozkurt ◽  
Sanem Pinar Uysal ◽  
Sergin Akpek ◽  
...  
Keyword(s):  
Decision Making ◽  
Urinary Retention ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Diagnostic Testing ◽  
Clinical Decision ◽  
Diagnostic Tools ◽  
Progressive Weakness ◽  
Over Time

Here we report a challenging case of a 52-year-old man presenting with subacute constipation, urinary retention, impotence, absent Achilles reflexes, and hypoesthesia in S2-S5 dermatomes. We review the clinical decision-making as the symptoms evolved and diagnostic testing changed over time. Once the diagnosis is settled, we discuss the sign and symptoms, additional diagnostic tools, treatment options and prognosis.

Interactive Video Assists in Clinical Decision Making

1998 ◽  
Vol 37 (02) ◽  
pp. 201-205 ◽  
Author(s):  
B. E. Waitzfelder ◽  
E. P. Gramlich
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Interactive Video ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Treatment Decision ◽  
Clinical Decision ◽  
Medical Decision ◽  
Treatment Decision Making ◽  
Interactive Videodisk

AbstractThe Hawaii Quality and Cost Consortium began a project in 1993 to implement and evaluate interactive videodisk programs to assist in clinical decision-making for breast cancer. Communication problems between physicians and patients, limitations of available outcomes data and varying preferences of individual patients can result in treatment outcomes that are less than satisfactory. Shared Decision-making Programs (SDPs) were developed by the Foundation for Informed Medical Decision Making (FIMDM) in Hanover, New Hampshire, to assist in the treatment decision-making process. Utilizing interactive videodisks, the programs provide patients with clear, unbiased information about available treatment options. With this information, patients can become more active participants in making treatment decisions. The SDPs for breast cancer were implemented at two sites in Hawaii. Evaluation data from 103 patients overwhelmingly indicate that patients find the programs clear, balanced and very good or excellent in terms of the amount of information presented and overall rating.

Partnerships with Patients: The Pros and Cons of Shared Clinical Decision-Making

1997 ◽  
Vol 2 (2) ◽  
pp. 112-121 ◽  
Author(s):  
Angela Coulter
Keyword(s):  
Decision Making ◽  
Shared Decision Making ◽  
Information Needs ◽  
Clinical Decision Making ◽  
Treatment Options ◽  
Clinical Decision ◽  
Treatment Decisions ◽  
Medical Decision ◽  
Shared Decision ◽  
Pros And Cons

The traditional style of medical decision-making in which doctors take sole responsibility for treatment decisions is being challenged. Attempts are being made to promote shared decision-making in which patients are given the opportunity to express their values and preferences and to participate in decisions about their care. Critics of shared decision-making argue that most patients do not want to participate in decisions; that revealing the uncertainties inherent in medical care could be harmful; that it is not feasible to provide information about the potential risks and benefits of all treatment options; and that increasing patient involvement in decision-making will lead to greater demand for unnecessary, costly or harmful procedures which could undermine the equitable allocation of health care resources. This article examines the evidence for and against these claims. There is considerable evidence that patients want more information and greater involvement, although knowledge about the circumstances in which shared decision-making should be encouraged, and the effects of doing so, is sparse. There is an urgent need for more research into patients' information needs and preferences and for the development and evaluation of decision-support mechanisms to enable patients to become informed participants in treatment decisions.

Treatment of bipolar depression

CNS Spectrums ◽  
2013 ◽  
Vol 18 (4) ◽  
pp. 177-187 ◽  
Author(s):  
Laura Musetti ◽  
Claudia Del Grande ◽  
Donatella Marazziti ◽  
Liliana Dell'Osso
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Treatment Options ◽  
Mood Stabilizers ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Increased Risk ◽  
Long Term Treatment ◽  
Antidepressant Use

Depressive symptoms and episodes dominate the long-term course of bipolar disorder and are associated with high levels of disability and an increased risk of suicide. However, the treatment of bipolar depression has been poorly investigated in comparison with that of manic episodes and unipolar major depressive disorder. The goal of treatment in bipolar depression is not only to achieve full remission of acute symptoms, but also to avoid long-term mood destabilization and to prevent relapses. A depressive presentation of bipolar disorder may often delay the appropriate management and, thus, worsen the long-term outcome. In these cases, an accurate screening for diagnostic indicators of a possible bipolar course of the illness should guide the therapeutic choices, and lead to prognostic improvement. Antidepressant use is still the most controversial issue in the treatment of bipolar depression. Despite inconclusive evidence of efficacy and tolerability, this class of agents is commonly prescribed in acute and long-term treatment, often in combination with mood stabilizers. In this article, we review available treatment options for bipolar depression, and we shall provide some suggestions for the management of the different presentations of depression in the course of bipolar disorder.

Sign in / Sign up

Export Citation Format

Share Document