Bipolar depression: criteria for treatment selection, definition of refractoriness, and treatment options

2003 ◽  
Vol 5 (2) ◽  
pp. 85-97 ◽  
Author(s):  
Lakshmi N Yatham ◽  
Joseph R Calabrese ◽  
Vivek Kusumakar
Keyword(s):  
Bipolar Depression ◽  
Treatment Options ◽  
Treatment Selection ◽  
Definition Of

scholarly journals The CINP Guidelines on the Definition and Evidence-Based Interventions for Treatment-Resistant Bipolar Disorder

2019 ◽  
Vol 23 (4) ◽  
pp. 230-256 ◽  
Author(s):  
Konstantinos N Fountoulakis ◽  
Lakshmi N Yatham ◽  
Heinz Grunze ◽  
Eduard Vieta ◽  
Allan H Young ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Treatment Options ◽  
Treatment Resistance ◽  
Maintenance Phase ◽  
Evidence Based ◽  
Treatment Resistant ◽  
Evidence Based Treatment ◽  
Significant Disability ◽  
Definition Of

Abstract Background Resistant bipolar disorder is a major mental health problem related to significant disability and overall cost. The aim of the current study was to perform a systematic review of the literature concerning (1) the definition of treatment resistance in bipolar disorder, (2) its clinical and (3) neurobiological correlates, and (4) the evidence-based treatment options for treatment-resistant bipolar disorder and for eventually developing guidelines for the treatment of this condition Materials and Methods The PRISMA method was used to identify all published papers relevant to the definition of treatment resistance in bipolar disorder and the associated evidence-based treatment options. The MEDLINE was searched to April 22, 2018. Results Criteria were developed for the identification of resistance in bipolar disorder concerning all phases. The search of the literature identified all published studies concerning treatment options. The data were classified according to strength, and separate guidelines regarding resistant acute mania, acute bipolar depression, and the maintenance phase were developed. Discussion The definition of resistance in bipolar disorder is by itself difficult due to the complexity of the clinical picture, course, and treatment options. The current guidelines are the first, to our knowledge, developed specifically for the treatment of resistant bipolar disorder patients, and they also include an operationalized definition of treatment resistance. They were based on a thorough and deep search of the literature and utilize as much as possible an evidence-based approach.

Co-Occurring Mood Problems in Autism Spectrum Disorder

2020 ◽  
pp. 27-51
Author(s):  
Virginia Carter Leno ◽  
Emily Simonoff
Keyword(s):  
Autism Spectrum Disorder ◽  
Service Use ◽  
Bipolar Depression ◽  
Behavioral Therapy ◽  
Treatment Options ◽  
Public Health Problem ◽  
Bipolar Disorders ◽  
Unipolar Depression ◽  
Autism Spectrum ◽  
Spectrum Disorder

Recent evidence suggests that individuals with autism spectrum disorder (ASD) experience depression at rates approximately four times greater than the general population. Co-occurring mood problems, including depressive and bipolar disorders, are associated with negative outcomes such as lower quality of life, increased adaptive behavior impairments, and greater service use. This chapter discusses what is known about the presentation of unipolar and bipolar depression in people with ASD and describes challenges to establishing sound prevalence estimates of mood disorders in ASD as they relate to methodological design issues and diagnostic assessment practices. It also provides an overview of potential vulnerability factors in the development of depression in this population; these areas of vulnerability include characteristics such as chronological age, cognitive ability, and ASD symptom severity, as well as those individual differences that may represent more direct mechanisms, for example, maladaptive coping styles, attentional biases, social reward profiles, and predisposition to rumination. The current research on interventions specifically designed to treat mood in people with ASD is very limited. However, promising treatments include adapted cognitive behavioral therapy and mindfulness-based approaches. Though most of this chapter focuses on unipolar depression in ASD as the more well-studied mood disorder, the chapter also summarizes the small research base on bipolar disorder in the context of ASD. It ends with a call for improved screening, assessment, and evidence-based treatment options to address this significant public health problem in this special population.

Rash and Mucositis Associated With Mycoplasma pneumoniae and Chlamydophila pneumoniae: A Recurrence of MIRM?

2020 ◽  
Author(s):  
Danielle Brazel ◽  
Brooke Kulp ◽  
Geoanna Bautista ◽  
Andrew Bonwit
Keyword(s):  
Mycoplasma Pneumoniae ◽  
Treatment Options ◽  
Specific Treatment ◽  
Corticosteroid Treatment ◽  
Stevens Johnson Syndrome ◽  
First Case ◽  
Johnson Syndrome ◽  
Vesicular Rash ◽  
Recurrent Aphthous Ulcers ◽  
Definition Of

Abstract Introduction A new concept has come to light recently, that is, Mycoplasma-induced rash and mucositis (MIRM). Here, we report the first case of recurrent rash, mucositis, and conjunctivitis involving Mycoplasma pneumoniae and C. pneumoniae that fits under the criteria of what is currently defined as MIRM. Case Presentation A patient aged 12 years with a history of recurrent aphthous ulcers presented in 2013 with worsening oral lesions, conjunctivitis, and vesicular rash. Her respiratory polymerase chain reaction (PCR) panel was positive for M. pneumoniae. She was diagnosed with Stevens-Johnson syndrome (SJS) secondary to M. pneumoniae and treated with a macrolide, acyclovir, and intravenous immunoglobulin (IVIG). The same patient returned 3 years later with an identical constellation of symptoms, at which time her PCR was positive for C. pneumoniae. In addition to IVIG and a macrolide, a corticosteroid treatment was administered. Discussion Here, we present the case of a pediatric patient with a recurrence of mucocutaneous disease that is more consistent with MIRM than the proposed SJS or erythema multiforme (EM) documented via histology. Our patient’s symptoms were controlled with azithromycin and IVIG and, in the second episode, with corticosteroids as well. This case adds to that of Mayor-Ibarguren et al, providing further evidence that C. pneumonia may also be a trigger for MIRM. Patients will benefit from expanding the definition of MIRM, as the pathogenesis differs from SJS and EM and could result in more specific treatment options.

scholarly journals Rare Treatments for Rare Dyslipidemias: New Perspectives in the Treatment of Homozygous Familial Hypercholesterolemia (HoFH) and Familial Chylomicronemia Syndrome (FCS)

2021 ◽  
Vol 23 (11) ◽  
Author(s):  
Laura D’Erasmo ◽  
Simone Bini ◽  
Marcello Arca
Keyword(s):  
Familial Hypercholesterolemia ◽  
Treatment Options ◽  
New Drugs ◽  
Lipid Lowering ◽  
Homozygous Familial Hypercholesterolemia ◽  
Published Evidence ◽  
Novel Drugs ◽  
Life Threatening ◽  
History Of ◽  
Definition Of

Abstract Purpose of Review This review aims to summarize the most recent published literature concerning lomitapide and volanesorsen that are approved for the use in HoFH and FCS patients, respectively. Moreover, it will briefly revise the published evidence on novel, non-approved treatments that are under evaluation for the management of these rare forms of dyslipidemias Recent Findings The definition of rare dyslipidemias identifies a large number of severe disorders of lipid metabolism of genetic origin. Among them were homozygous familial hypercholesterolemia (HoFH) (OMIM #143890) and familial chylomicronemia syndrome (FCS) (OMIM #238600), which are characterized by a markedly impaired cholesterol- and triglyceride-containing lipoproteins metabolism. They are being particularly associated with poor health outcomes and quality of life. Considering the severity of these diseases, common lipid-lowering drugs are often ineffective or do not allow to achieve the recommended lipid targets to prevent the development of complications. Nowadays, several new drugs have been found to effectively treat HoFH and FCS with an acceptable safety profile. Summary Treating patients with HoFH and FCS remains very challenging. However, novel treatment options are emerging and might be considered in addition to conventional therapy for managing these diseases. These novel drugs will possibly change the natural history of these two rare and life-threatening diseases.

scholarly journals Computational Analysis of the Pulmonary Arteries in Congenital Heart Disease: A Review of the Methods and Results

2021 ◽  
Vol 2021 ◽  
pp. 1-10
Author(s):  
M. Conijn ◽  
G. J. Krings
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Boundary Conditions ◽  
Congenital Heart ◽  
Treatment Options ◽  
Pulmonary Arteries ◽  
Original Research ◽  
Numerical Studies ◽  
Computational Fluid Dynamics Cfd ◽  
Definition Of

With the help of computational fluid dynamics (CFD), hemodynamics of the pulmonary arteries (PA’s) can be studied in detail and varying physiological circumstances and treatment options can be simulated. This offers the opportunity to improve the diagnostics and treatment of PA stenosis in biventricular congenital heart disease (CHD). The aim of this review was to evaluate the methods of computational studies for PA’s in biventricular CHD and the level of validation of the numerical outcomes. A total of 34 original research papers were selected. The literature showed a great variety in the used methods for (re) construction of the geometry as well as definition of the boundary conditions and numerical setup. There were 10 different methods identified to define inlet boundary conditions and 17 for outlet boundary conditions. A total of nine papers verified their CFD outcomes by comparing results to clinical data or by an experimental mock loop. The diversity in used methods and the low level of validation of the outcomes result in uncertainties regarding the reliability of numerical studies. This limits the current clinical utility of CFD for the study of PA flow in CHD. Standardization and validation of the methods are therefore recommended.

Study of ten anatomical variants of the foot and ankle

1996 ◽  
Vol 86 (11) ◽  
pp. 532-537 ◽  
Author(s):  
DM Chaney ◽  
MS Lee ◽  
MA Khan ◽  
WA Krueger ◽  
VJ Mandracchia ◽  
...  
Keyword(s):  
Sample Size ◽  
Treatment Options ◽  
Total Sample ◽  
Occurrence Rate ◽  
Anatomical Variants ◽  
Flexor Digitorum Brevis ◽  
Physician Awareness ◽  
Definition Of ◽  
Flexor Digitorum ◽  
The University

This study examined the occurrence rate of ten lower extremity anatomical variants occurring over a 6-year period from 1988 to 1994 in a sample range of 166 to 279 cadavers at the University of Osteopathic Medicine and Health Sciences. Literature review of these anomalies shows similar findings for all presented structures with the exception of two. The peroneus quartus muscle was found to be significantly less prevalent than previous studies have indicated. This difference may be attributed to the larger sample size used in this study or differences of interpretation of the definition of the peroneus quartus muscle. Additionally, the flexor digitorum brevis tendon to the fifth digit was found to be absent much more than Sarrafian reports in a total sample size of 926. The importance of these anatomical variants, both in surgery and while using advanced diagnostic imaging such as computed tomography and magnetic resonance imaging, should be realized by the podiatric physician. Awareness of these variants will decrease confusion when considering treatment options.

A Bayesian method to estimate the optimal threshold of a marker used to select patients' treatment

2019 ◽  
Vol 29 (1) ◽  
pp. 29-43
Author(s):  
Yoann Blangero ◽  
Muriel Rabilloud ◽  
René Ecochard ◽  
Fabien Subtil
Keyword(s):  
Utility Function ◽  
Expected Utility ◽  
Treatment Options ◽  
Growth Factor Receptor ◽  
Credible Interval ◽  
Optimal Threshold ◽  
Selection Marker ◽  
Large Sample Size ◽  
Marker Distribution ◽  
Definition Of

The use of a quantitative treatment selection marker to choose between two treatment options requires the estimate of an optimal threshold above which one of these two treatments is preferred. Herein, the optimal threshold expression is based on the definition of a utility function which aims to quantify the expected utility of the population (e.g. life expectancy, quality of life) by taking into account both efficacy (success or failure) and toxicity of each treatment option. Therefore, the optimal threshold is the marker value that maximizes the expected utility of the population. A method modelling the marker distribution in patient subgroups defined by the received treatment and the outcome is proposed to calculate the parameters of the utility function so as to estimate the optimal threshold and its 95% credible interval using the Bayesian inference. The simulation study found that the method had low bias and coverage probability close to 95% in multiple settings, but also the need of large sample size to estimate the optimal threshold in some settings. The method is then applied to the PETACC-8 trial that compares the efficacy of chemotherapy with a combined chemotherapy + anti-epidermal growth factor receptor in stage III colorectal cancer.

scholarly journals Arthroscopic Excision of Intra-Articular Osteoid Osteoma at the Elbow

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Taku Hatta ◽  
Masami Hosaka ◽  
Munenori Watanuki ◽  
Toshihisa Yano ◽  
Shinichirou Yoshida ◽  
...  
Keyword(s):  
Osteoid Osteoma ◽  
Treatment Options ◽  
Elbow Flexion ◽  
Arthroscopic Treatment ◽  
En Bloc ◽  
Invasive Approach ◽  
Arthroscopic Excision ◽  
Flexion Extension ◽  
Definition Of

Osteoid osteoma (OO) apparent in the intra-articular region of the elbow is very rare. Although computed tomography-guided excision and radiofrequency ablation have been recognized as useful treatment options, arthroscopic excision has recently received focus as an alternative strategy for lesions close to neurovascular structures or intra- and juxta-articular lesions. We herein report a 17-year-old female who underwent arthroscopic treatment for intra-articular OO located at the olecranon/coronoid fossa. Her symptoms included elbow pain that was exacerbated at night and contracture of elbow flexion-extension, and she was diagnosed with intra-articular OO after 12 months of symptomatic history. Arthroscopically, thorough synovectomy for both the anterior and posterior aspects of the joint enabled definition of the tumor margin with hyperemic alteration and excision of the lesion as an en bloc specimen. At the 12-month follow-up, the patient had no recurrence of elbow limitation or pain. This case report describes the advantages of arthroscopic treatment, including a low-invasive approach and easy accessibility to the whole intra-articular space, which can provide clear visualization of the tumorous lesion.

scholarly journals Bipolar Affective Disorder and Migraine

2012 ◽  
Vol 2012 ◽  
pp. 1-3 ◽  
Author(s):  
Birk Engmann
Keyword(s):  
Bipolar Disorder ◽  
Bipolar Depression ◽  
Treatment Options ◽  
Bipolar Affective Disorder ◽  
Mood Stabilizer ◽  
High Rate ◽  
First Choice ◽  
Bipolar Ii ◽  
Behavioural Factors ◽  
The Relationship

This paper consists of a case history and an overview of the relationship, aetiology, and treatment of comorbid bipolar disorder migraine patients. A MEDLINE literature search was used. Terms for the search were bipolar disorder bipolar depression, mania, migraine, mood stabilizer. Bipolar disorder and migraine cooccur at a relatively high rate. Bipolar II patients seem to have a higher risk of comorbid migraine than bipolar I patients have. The literature on the common roots of migraine and bipolar disorder, including both genetic and neuropathological approaches, is broadly discussed. Moreover, bipolar disorder and migraine are often combined with a variety of other affective disorders, and, furthermore, behavioural factors also play a role in the origin and course of the diseases. Approach to treatment options is also difficult. Several papers point out possible remedies, for example, valproate, topiramate, which acts on both diseases, but no first-choice treatments have been agreed upon yet.

A real world multicenter study of first (1L) and second (2L) line treatment patterns and outcomes in advanced pancreatic cancer (APC).

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 476-476 ◽  
Author(s):  
Winson Y. Cheung ◽  
Hanbo Zhang ◽  
Patricia A. Tang ◽  
Jennifer L. Spratlin ◽  
Richard M. Lee-Ying ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Real World ◽  
Treatment Options ◽  
Locally Advanced ◽  
Advanced Pancreatic Cancer ◽  
Tumor Location ◽  
Treatment Patterns ◽  
Treatment Selection ◽  
Multi Agent ◽  
Practice Methods

476 Background: FOLFIRINOX (FFX), gemcitabine plus nab-paclitaxel (GN), and gemcitabine (gem) are 3 publicly funded and available treatment options for locally advanced (LAPC) and metastatic pancreatic cancer (MPC) in Canada since 2014. Without head-to-head trials that directly compare all 3 regimens, treatment selection and outcomes in 1L and 2L remain poorly characterized in routine clinical practice. Methods: Data from 4 tertiary, 8 regional, and 28 community hospitals in Canada were pooled. LAPC and MPC patients diagnosed from 2014 onwards and who received at least 1 line of systemic therapy were included. Analyses were conducted to identify predictors of treatment choice and to determine the relationship between treatment patterns and overall survival (OS) from APC diagnosis to death. Results: We identified 279 eligible patients. Median age was 64 (IQR 56-69) years, 55% were men, and 46% were ECOG ≥2. There were 27% LAPC and 73% MPC. In the 1L setting, FFX and GN were given in 44% and 41% of patients, respectively, and gem in 15%. GN was the preferred multi-agent therapy in worse ECOG patients (66% in ECOG 2+ vs 21% in ECOG 0, p = .001) and in more recently diagnosed cases (63% in 2016 vs 25% in 2014, p = .001). 1L treatment selection was not influenced by other baseline characteristics, such as age, sex, tumor location, or LAPC vs MPC status (all p > 0.05). A total of 91 patients proceeded to subsequent therapies, of whom 55 (60%), 27 (30%), and 9 (10%) had received 1L FFX, GN, and gem, respectively. In the 2L setting, GN after 1L FFX (41/55; 75%) and fluoropyrimidine (FP) after 1L GN (21/27; 78%) were the most common sequential approaches. Patients who underwent 2L therapy had better OS than those who did not (13 vs 7 months, p = .001). After adjusting for confounders, receipt of 1L FFX plus 2L GN or 1L GN plus 2L FP resulted in improved OS when compared to other treatment sequences (HR 0.43, 95%CI 0.28-0.67, p = 0.001 and HR 0.57, 95%CI 0.39-0.83, p = 0.004, respectively). Conclusions: One third of APC patients receive 2L therapy, highlighting the feasibility of 2L trials. Use of 1L multi-agent therapy followed by 2L non-cross-resistant regimens represents a reasonable treatment strategy for APC in the real world.

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