Case Studies in Bipolar Depression: Best Practices for the Outpatient

CNS Spectrums ◽  
2007 ◽  
Vol 12 (S20) ◽  
pp. 4-13
Author(s):  
Paul E. Keck ◽  
Roger S. McIntyre ◽  
Richard C. Shelton
Keyword(s):  
Best Practices ◽  
Bipolar Depression ◽  
Preventive Treatment ◽  
Term Treatment ◽  
Case Examples ◽  
Long Term Treatment ◽  
Bipolar Patients ◽  
Term Management ◽  
Depressive States

Clinicians are fairly comfortable with the management of acute mania because of the abundance of research studies available. However, there are several important aspects of bipolar disorder that the field has been far less successful with, including management of acute and preventive treatment of bipolar depression, comorbid illnesses, and break-through depression in the context of long-term treatment. There is tremendous complexity in the various symptoms and behavioral dimensions associated with bipolar depression. To facilitate understanding of bipolar depression, this article focuses on treating and managing the bipolar outpatient at risk for a depressive relapse. The discussion poses several challenges associated with bipolar depression and addresses the morbidity of depressive states as well as acute and long-term management of this disorder. The best practices for the varying clinical states of bipolar depressive disorder will be demonstrated through two case examples of patients struggling with disturbances common in bipolar patients.

scholarly journals MANAGEMENT OF ENDOCRINE DISEASE: Atypical femoral fractures: risks and benefits of long-term treatment of osteoporosis with anti-resorptive therapy

2018 ◽  
Vol 178 (3) ◽  
pp. R81-R87 ◽  
Author(s):  
Robert A Adler
Keyword(s):  
Osteoporotic Fracture ◽  
Femoral Fractures ◽  
Osteoporosis Treatment ◽  
Term Treatment ◽  
Atypical Femoral Fractures ◽  
Treatment Of Osteoporosis ◽  
Endocrine Disease ◽  
Long Term Treatment ◽  
Term Management

Modern osteoporosis treatment began in the mid-1990s with the approval of amino-bisphosphonates, anti-resorptive agents that have been shown to decrease osteoporotic fracture risk by about half. In 2005, the first cases of atypical femoral fractures (AFF), occurring in the shaft of the femur, were reported. Since then, more cases have been found, leading to great concern among patients and a dramatic decrease in bisphosphonate prescribing. The pathogenesis and incidence of AFF are reviewed herein. Management and an approach to prevention or early detection of AFF are also provided. Denosumab, a more recently approved anti-resorptive medication has also been associated with AFF. Long-term management of osteoporosis and prevention of fracture are challenging in light of this serious but uncommon side effect, yet with an aging population osteoporotic fracture is destined to increase in frequency.

Long-Term Management of Generalized Pustular Psoriasis with Infliximab: Case Series

2008 ◽  
Vol 12 (4) ◽  
pp. 184-188 ◽  
Author(s):  
Shannon B. Routhouska ◽  
Pranav B. Sheth ◽  
Neil J. Korman
Keyword(s):  
Case Reports ◽  
Case Series ◽  
Term Treatment ◽  
Pustular Psoriasis ◽  
Short Term Treatment ◽  
Long Term Treatment ◽  
Generalized Pustular Psoriasis ◽  
Factor Α ◽  
Term Management

Background: Infliximab, a tumor necrosis factor α antagonist, has recently been shown to be successful for the short-term treatment of generalized pustular psoriasis (GPP) in multiple case reports. Objective: The goal of this case series was to assess the efficacy of the longer-term management of GPP with infliximab. Methods: Three patients with severe GPP were followed to assess the efficacy of long-term treatment with infliximab. Results: Infliximab therapy was more efficacious with infusion every 6 to 8 weeks in combination with methotrexate. Conclusion: Infliximab may be efficacious for some patients for the long-term management of GPP. Maintaining a strict infliximab infusion schedule and concomitant methotrexate therapy may decrease infusion reactions and increase efficacy.

Typical and atypical antipsychotics in bipolar disorder

2000 ◽  
Vol 12 (3) ◽  
pp. 115-119 ◽  
Author(s):  
R.W. Licht
Keyword(s):  
Bipolar Disorder ◽  
Atypical Antipsychotics ◽  
Treatment Guidelines ◽  
Bipolar Depression ◽  
Term Treatment ◽  
Advantages And Disadvantages ◽  
Long Term Treatment ◽  
Randomised Controlled ◽  
Typical Antipsychotics

ABSTRACTBackground: In clinical practice, typical antipsychotics are widely used in the treatment of bipolar disorder, albeit in treatment guidelines often considered as adjunctive agents only. Recently, focus has shifted towards the use of atypical antipsychotics. This paper reviews the advantages and disadvantages associated with the use of antipsychotics in bipolar disorder.Methods: Randomised controlled trials (RCTs) were selected for review. A few review articles were also cited.Results: Typical antipsychotics, at least some of them, are powerful antimanics, beneficial for severe agitation in particular. However, in the long term treatment, typical antipsychics may precipitate depression. Among the atypical antipsychotics, both risperidone and olanzapine are clearly antimanic alternatives, although olanzapine is the best studied. Clozapine seems to be useful when other treatments fail to work.Conclusions: Antipsychotics are beneficial for some clinical presentations of mania. To minimize side effets, atypical agents should be preferred before typical agents, unless parenteral administration is needed. Despite the lack of RCTs, antipsychotics also seem to be useful as adjunctive agents in the treatment of psychotic bipolar depression. For the long term treatment of bipolar disorder, typical antipsychotics should be used only under certain circumstances. The place of atypical antipsychotics in the long term treatment of bipolar disorder remains to be studied.

Long-Term Treatment of Patients with Recurrent Unipolar Major Depression: Evidence to Clinical Practice

CNS Spectrums ◽  
2006 ◽  
Vol 11 (S15) ◽  
pp. 4-5 ◽  
Author(s):  
Martin B. Keller
Keyword(s):  
Treatment Strategies ◽  
Patient Characteristics ◽  
Evidence Base ◽  
Term Treatment ◽  
Recurrent Depression ◽  
Long Term Treatment ◽  
Risk Factors For Recurrence ◽  
The Individual ◽  
Term Management

Major depressive disorder (MDD) is almost exclusively recurrent. The vast majority of patients who experience one episode of MDD will eventually experience at least one more episode during their lifetime. The recurrent nature of MDD increases the burden to both the individual and society. Hence, it is imperative that treatment strategies focus on achieving remission acutely, as well as maintaining of remission and preventing recurrence. The articles in this supplement are based on presentations and a dialogue among a group of experts who convened for a roundtable discussion on improving long-term outcomes with antidepressant therapy.Improving long-term treatment of MDD begins with understanding the clinical course of recurrent depression and the ability to recognize those patients who are at greatest risk for recurrence. James H. Kocsis, MD, reviews the course of recurrent depression, emphasizing the tendency for it to progressively worsen. He also discusses patient characteristics and other risk factors for recurrence as well as current recommendations for long-term management of recurrent depression.Although long-term antidepressant maintenance treatment studies are somewhat limited in number, they provide the evidence base that shapes existing guidelines for long-term management of recurrent depression. Michael E. Thase, MD, examines this evidence for the different classes of antidepressants. In addition, Thase reviews evidence for the efficacy of psychotherapy and discusses its potentially important role in long-term depression management.

Long-term management of gout

2016 ◽  
Author(s):  
Fernando Perez-Ruiz ◽  
Irati Urionagüena ◽  
Sandra P. Chinchilla
Keyword(s):  
Structural Damage ◽  
Serum Urate ◽  
Term Treatment ◽  
Lifestyle Changes ◽  
Long Term Treatment ◽  
Patient Reported ◽  
Concomitant Medications ◽  
Urate Lowering Treatment ◽  
Term Management

Long-term management of gout comprises several aspects. Although in the short term, prophylaxis and treatment of acute episodes of inflammation are of great importance, the milestone for the long-term management of gout is targeted, sustained, and long-term control of hyperuricaemia. Treating to target subsaturating serum urate (SUA) levels, which may be initially dependent on the severity of the disease in the individual patient, is associated with a progressive reduction to no episodes of acute inflammation, regression and disappearance of subcutaneous and articular monosodium urate deposits and associated chronic inflammation, and improvement in patient-reported, health-related quality of life. Early and effective urate-lowering treatment to target levels will also prevent the development of structural damage. Urate-lowering treatment includes any measure intending to reduce SUA levels to target: lifestyle changes, modifications of concomitant medications favouring hyperuricaemia, and urate-lowering medications (ULMs). Availability of ULMs is variable worldwide, and prescription should be judicious, according to approved labels, and always considering associated health conditions and concomitant medications. Effectiveness and safety should be periodically monitored. Long-term treatment of gout still remains suboptimal in the twenty-first century. As practising clinicians, we cannot afford to neglect a ‘curable disease’.

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