Treatment of Depression and Bipolar Disorder

2017 ◽  
pp. 45-68
Author(s):  
Moira Rynn ◽  
Paul Crits-Christoph ◽  
David Brent ◽  
Robert Findling ◽  
Karen Dineen Wagner
Keyword(s):  
Chronic Condition ◽  
Young Patients ◽  
Mood States ◽  
Current Status ◽  
Limited Data ◽  
Simultaneous Treatment ◽  
Rational Form ◽  
Treatment Of Depression ◽  
Number Of Patients ◽  
Combination Pharmacotherapy

This chapter reviews the current status of the adult literature on mood disorder treatments for both psychosocial and psychopharmacological treatments. This is followed by an appraisal of the same treatment for adolescents. The chapter finds that there are only limited data from methodologically rigorous trials in pediatric bipolarity. Evidence suggests that monotherapy using certain drugs may be useful in the treatment of young patients with mania and related mood states. A consistent theme from the extant literature is that a substantial number of patients do not respond to all types of monotherapy. Therefore, investigators have begun to explore combination pharmacotherapy. It seems that simultaneous treatment with more than one agent may be a rational form of intervention for some patients. Pediatric bipolarity is a chronic condition associated with substantial dysfunction and suffering. There are few methodologically sound pharmacological treatment studies, thus more research on this topic is sorely needed.

Hämophilie-Zentrum Bonn 1980 – 2009

2011 ◽  
Vol 31 (S 01) ◽  
pp. S4-S10 ◽  
Author(s):  
I. Besmens ◽  
H.-H. Brackmann ◽  
J. Oldenburg
Keyword(s):  
Young Patients ◽  
Severe Form ◽  
Coagulation Disorder ◽  
Care Providers ◽  
Long Distance ◽  
Patient Age ◽  
Patient Âgé ◽  
Number Of Patients ◽  
Clotting Disorder ◽  
Regional Character

SummaryThe Bonn Haemophilia Care Center provides patient care on a superregional level. The centre’s large service area is, in part, due to the introduction of haemophilia home treatment and related to this the individualized prophylaxis in children and adults by Egli and Brack-mann in Bonn in the early 1970s, that represented a milestone in German haemophilia therapy. Epidemiologic patient data from the two selected time points, 1980 and 2009, are evaluated to illustrate the change in the composition of the patient clientele. In 1980 a total of 639 patients were treated at the Bonn Haemophilia Center. 529 patients exhibited a severe form and 110 a non-severe form of the respective clotting disorder. In 2009 the Bonn Haemophilia Center took care for a total of 837 patients. There were 445 patients who suffered from a severe form of the considered clotting disorder while 392 showed a non-severe course. The number of less severely affected patients has increased significantly in 2009. Patients in 1980 were predominantly suffering from a severe form and most had to travel more than 150 km from their homes to the treatment center. In 2009 the number of patients living a medium-long distance from the care provider has significantly increased while the number of patients living more than 150km from the center has decreased. Comparing 2009 to 1980 a growth of the center’s regional character becomes apparent, especially when patient age and severity of the coagulation disorder are taken into consideration. The regional character was more strongly pronounced with milder disease severity and lower patient age. Due to the existence of well established primary haemophilia care in CCCs in Germany, the trend for the recent years is that the proportion of young patients that choose haemophilia care providers closer to their homes is increasing.

scholarly journals Current status of vascular access in Japan—from Dialysis Access Symposium 2017

2019 ◽  
Vol 20 (1_suppl) ◽  
pp. 38-44
Author(s):  
Mizuya Fukasawa
Keyword(s):  
Vascular Access ◽  
Current Status ◽  
Good Survival ◽  
Chronic Glomerulonephritis ◽  
Dialysis Access ◽  
Dialysis Patients ◽  
Survival Prognosis ◽  
Access Methods ◽  
Number Of Patients ◽  
Wide Range

At the second Dialysis Access Symposium held in Nagoya, Japan, a proposal was made to investigate the differences in vascular access methods used in different countries. In this article, we describe the management of vascular access in Japan. The Japanese population is rapidly aging, and the proportion of elderly patients on dialysis is also increasing. There were 325,000 dialysis patients in Japan at the end of 2015, of whom 65.1% were aged 65 years or above. The number of patients with diabetic nephropathy or nephrosclerosis as the underlying condition is also increasing, whereas the number with chronic glomerulonephritis is steadily decreasing. The Japanese health insurance system enables patients to undergo medical treatment at almost no out-of-pocket cost. Percutaneous transluminal angioplasty suffers from a severe device lag compared with other countries, but although there are limitations on permitted devices, the use of those that have been authorized is covered by medical insurance. One important point that is unique to Japan is that vascular access is performed and managed by doctors involved in dialysis across a wide range of disciplines, including nephrologists, surgeons, and urologists. This may be one factor contributing to the good survival prognosis of Japanese dialysis patients.

IDIOPATHIC PULMONARY HEMOSIDEROSIS

PEDIATRICS ◽  
1957 ◽  
Vol 19 (6) ◽  
pp. 1101-1108
Author(s):  
Konrad H. Soergel
Keyword(s):  
Young Patients ◽  
Review Of The Literature ◽  
Mild Form ◽  
Pathogenetic Mechanism ◽  
Diagnostic Measures ◽  
Pulmonary Hemosiderosis ◽  
Number Of Patients ◽  
Antihistaminic Drugs ◽  
Idiopathic Pulmonary Hemosiderosis ◽  
Better Than

Two fatal cases of idiopathic pulmonary hemosiderosis are reported. A review of the literature shows the prognosis of this disease to be, at least in young patients, somewhat better than generally thought. A positive diagnosis in the living patient is possible with the help of certain diagnostic measures which are discussed. Increasing familiarity with the rather typical manifestations of this disorder may lead to the discovery of a larger number of patients who have a mild form of the disease. The value of splenectomy and therapy with adrenocorticotropin and cortisone is still questionable, but further trials are necessary, possibly together with the use of antihistaminic drugs. Intermittent increases in pressure in the pulmonary circulation, due to a defective vasomotor control, appears to be the most likely pathogenetic mechanism but more investigations are needed to arrive at any positive conclusion.

scholarly journals Treatment-emergent hypomania possibly associated with over-the-counter supplements

2017 ◽  
Vol 7 (4) ◽  
pp. 160-163
Author(s):  
William Olsufka ◽  
Mary-Ann Abraham
Keyword(s):  
Adverse Effects ◽  
Alternative Medicine ◽  
Complementary And Alternative Medicine ◽  
Safety Profile ◽  
General Public ◽  
Scientific Evidence ◽  
Western World ◽  
Over The Counter ◽  
Treatment Of Depression ◽  
Number Of Patients

Abstract The use of complementary and alternative medicine (CAM) is gaining popularity in the Western world. Among the general public, CAM is often perceived to be associated with less stigma, fewer adverse effects, and may be more affordable. A number of patients utilize CAM for the treatment of depression; however, as there is limited scientific evidence, the safety profile of these supplements are largely unknown. In this case, a 42-year-old man developed hypomania approximately 1 week after S-adenosylmethionine (SAMe) and 5-hydroxytryptophan (5-HTP) therapy was initiated for depression. The combination of SAMe and 5-HTP can potentially induce hypomanic episodes.

scholarly journals A Current Microbiological Picture of Mycobacterium Isolates from Istanbul, Turkey

2020 ◽  
Vol 69 (2) ◽  
pp. 185-191
Author(s):  
BILGE SUMBUL ◽  
MEHMET ZIYA DOYMAZ
Keyword(s):  
Multidrug Resistant ◽  
Mycobacterium Abscessus ◽  
Diagnostic Methods ◽  
Current Status ◽  
Clinical Samples ◽  
Mycobacterium Fortuitum ◽  
Mycobacterium Species ◽  
Full Spectrum ◽  
Number Of Patients ◽  
Lowenstein Jensen

Despite advances in diagnosis and treatment, tuberculosis (TB) continues to be one of the essential health problems throughout the world. Turkey is considered to be endemic for TB. In this study, we analyzed the distribution of Mycobacterium species, compare the diagnostic methods, and susceptibilities to anti-tuberculosis drugs of TB isolates. The aim was to document the current status and to provide a frame of reference for future studies. In this study, 278 Mycobacterium species isolated from 7,480 patients between September 2015 and June 2019 were included. Löwenstein-Jensen medium (LJ) and MGIT 960 were used for the isolation of strains. Susceptibility to 1st-line anti-tuberculosis drugs was determined. Positivity rates in clinical samples were as follows: 1.4% for direct microscopic acid-fast bacilli (AFB) detection, 3.4% for growth on the LJ, and 3.7% for growth on MGIT-960. Two hundred thirty-three isolates were identified as Mycobacterium tuberculosis complex (MTBC) and 45 were non-tuberculous mycobacteria (NTMs). Eleven of the NTMs (24.4%) were Mycobacterium fortuitum group isolates, and eight NTMs (17.7%) were Mycobacterium abscessus complex isolates. A number of patients diagnosed with tuberculosis peaked twice between the ages of 20–31 and 60–71. A hundred and eighty-two MTBC isolates (78.1%) were susceptible to all 1st-line anti-tuberculosis drugs, while 51 isolates (21.9%) were resistant to at least one drug tested. The multidrug-resistant tuberculosis rate was 13.7% among resistant strains and 3% in all strains. The liquid cultures were better for detection of both MTBC and NTMs isolates. The data demonstrate that MTBC continues to be challenge for this country and indicates the need for continued surveillance and full-spectrum services of mycobacteriology laboratory and infectious diseases.

scholarly journals Deep Learning: A New Horizon for Personalized Treatment of Depression?

2018 ◽  
Vol 16 (1) ◽  
Author(s):  
David Benrimoh ◽  
Robert Fratila ◽  
Sonia Israel ◽  
Kelly Perlman
Keyword(s):  
Deep Learning ◽  
Decision Aid ◽  
Clinical Decision Making ◽  
Clinical Decision ◽  
Personalized Care ◽  
Treatment Of Depression ◽  
Number Of Patients ◽  
Treatment Plans ◽  
Patient Responses ◽  
Deep Learning Model

Globally, depression affects 300 million people and is projected be the leading cause of disability by 2030. While different patients are known to benefit from different therapies, there is no principled way for clinicians to predict individual patient responses or side effect profiles. A form of machine learning based on artificial neural networks, deep learning, might be useful for generating a predictive model that could aid in clinical decision making. Such a model’s primary outcomes would be to help clinicians select the most effective treatment plans and mitigate adverse side effects, allowing doctors to provide greater personalized care to a larger number of patients. In this commentary, we discuss the need for personalization of depression treatment and how a deep learning model might be used to construct a clinical decision aid.

scholarly journals Use of long acting antipsychotics and relationship to newly diagnosed bipolar disorder: a pragmatic longitudinal study based on a Canadian health registry

2020 ◽  
Vol 10 ◽  
pp. 204512532095711
Author(s):  
Emmanuel Stip ◽  
Syed Javaid ◽  
Jonathan Bayard-Diotte ◽  
Karim Abdel Aziz ◽  
Danilo Arnone
Keyword(s):  
Bipolar Disorder ◽  
Newly Diagnosed ◽  
Limited Data ◽  
Major Depressive ◽  
Haloperidol Decanoate ◽  
Number Of Patients ◽  
Prescribing Trends ◽  
Canadian Health ◽  
Long Acting ◽  
Health Registry

Background: There is limited data from large naturalistic studies to inform prescribing of long-acting injectable medication (LAIs). Guidance is particularly rare in the case of primary mood disorders. Methods: This study describes prescribing trends of LAIs in 3879 patients in Quebec, Canada, over a period of 4 years. Health register data from the Quebec provincial health plan were reviewed. Results: In this specific registry, 32% of patients who received LAIs drugs for schizophrenia had a confirmed diagnosis of bipolar disorder and 17% had a diagnosis of major depressive disorder. Non-schizophrenia syndromes were preferentially prescribed risperidone long-acting antipsychotic, whereas patients with schizophrenia were prescribed an excess of haloperidol decanoate. Patients with non-schizophrenia disorders prescribed long-acting antipsychotics were more frequently treated in primary care compared with patients with schizophrenia. Conclusion: Data from a large number of patients treated naturalistically in Quebec with long-acting antipsychotics suggests that these compounds, prescribed to treat symptoms of schizophrenia and schizoaffective disorders, were maintained when mood symptoms emerged, even in cases when the diagnosis changed to bipolar disorder. This pragmatic study supports the need to explore this intervention as potential treatment for affective disorders.

scholarly journals Frequency of AIP Gene Mutations in Young Patients With Acromegaly: A Registry-Based Study

2014 ◽  
Vol 99 (12) ◽  
pp. E2789-E2793 ◽  
Author(s):  
Christof Schöfl ◽  
Jürgen Honegger ◽  
Michael Droste ◽  
Martin Grussendorf ◽  
Reinhard Finke ◽  
...  
Keyword(s):  
Family History ◽  
Direct Sequencing ◽  
Positive Family History ◽  
Young Patients ◽  
Gene Mutations ◽  
Interacting Protein ◽  
Aryl Hydrocarbon ◽  
Number Of Patients ◽  
The Individual ◽  
Aip Gene

Context: Familial and sporadic GH-secreting pituitary adenomas are associated with mutations in the aryl hydrocarbon receptor-interacting protein (AIP) gene. Patients with an AIP mutation (AIPmut) tend to have more aggressive tumors occurring at a younger age. Objective: The objective of the study was to investigate the frequency of AIPmut in patients diagnosed at 30 years of age or younger. Design: The German Acromegaly Registry database (1795 patients in 58 centers) was screened for patients diagnosed with acromegaly at 30 years of age or younger (329 patients). Sixteen centers participated and 91 patients consented to AIPmut analysis. Intervention: DNA was analyzed by direct sequencing and multiplex ligation dependent probe amplification Main outcome Measures: The number of patients with AIPmut was measured. Results: Five patients had either a mutation (c.490C>T, c.844C>T, and c.911G>A, three males) or gross deletions of exons 1 and 2 of the AIP gene (n = 2, one female). The overall frequency of an AIPmut was 5.5%, and 2.3% or 2.4% in patients with an apparently sporadic adenoma or macroadenoma, respectively. By contrast, three of four patients (75%) with a positive family history were tested positive for an AIPmut. Except for a positive family history, there were no significant differences between patients with and without an AIPmut. Conclusions: The frequency of AIPmut in this registry-based cohort of young patients with acromegaly is lower than previously reported. Patients with a positive family history should be tested for an AIPmut, whereas young patients without an apparent family history should be screened, depending on the individual cost to benefit ratio.

scholarly journals First month of the epidemic caused by COVID-19 in Italy: current status and real-time outbreak development forecast

2020 ◽  
Vol 5 (1) ◽  
Author(s):  
Rosario Megna
Keyword(s):  
Real Time ◽  
Forecast Model ◽  
Current Status ◽  
Logistic Distribution ◽  
Infected People ◽  
The North ◽  
Number Of Patients ◽  
Heavy Burden ◽  
Novel Coronavirus ◽  
Health Organization

Abstract Background The first outbreak of COVID-19 in Italy occurred during the second half of February 2020 in some areas in the North of the country. Due to the high contagiousness of the infection, further spread by asymptomatic people, Italy has become in a few weeks the country with the greatest number of infected people in the world. The large number of severe cases among infected people in Italy led to the hospitalization of thousands of patients, with a heavy burden on the National Health Service. Methods We analyzed data provided daily by Italian Authorities for the period from 24 February 2020 to 30 March 2020. Considering such information, we developed a forecast model in real-time, based on the cumulative log-logistic distribution. Results A total of 101,739 infected individuals were confirmed until 30 March 2020, of which 14,620 recovered or discharged, and 11,591 deaths. Until the same date patients quarantined at home were 43,752, whereas hospitalized patients were 31,776, of which 3981 in intensive care. The active cases (i.e. the number of patients not yet recovered until that date) were 75,528. The forecast model estimated a number of infected persons for Italy of 234,000 about, and a duration of the epidemic of approximately 4 months. Conclusions One month after the first outbreaks there seemed to be the first signs of a decrease in the number of infections, showing that we could be now facing the descending phase of the epidemic. The forecast obtained thanks to our model could be used by decision-makers to implement coordinative and collaborative efforts in order to control the epidemic. The pandemic due to novel Coronavirus must be a warning for all countries worldwide, regarding a rapid and complete dissemination of information, surveillance, health organization, and cooperation among the states.

scholarly journals Prospective evaluation of multitarget treatment of pediatric patients with helical intensity-modulated radiotherapy

2020 ◽  
Vol 196 (12) ◽  
pp. 1103-1115
Author(s):  
Maria-Elena A. Salfelder ◽  
Kerstin A. Kessel ◽  
Uwe Thiel ◽  
Stefan Burdach ◽  
Severin Kampfer ◽  
...  
Keyword(s):  
Survival Rate ◽  
Side Effects ◽  
Survival Rates ◽  
Young Patients ◽  
Intensity Modulated Radiotherapy ◽  
High Survival ◽  
Single Target ◽  
Number Of Patients ◽  
Grade 3

Abstract Background and purpose Radiotherapy (RT) is persistently gaining significance in the treatment of pediatric tumors. However, individual features of a growing body and multifocal stages complicate this approach. Tomotherapy offers advantages in the treatment of anatomically complex tumors with low risks of side effects. Here we report on toxicity incidence and outcome of tomotherapy with a focus on multitarget RT (mtRT). Materials and methods From 2008 to 2017, 38 children diagnosed with sarcoma were treated with tomotherapy. The median age was 15 years (6–19 years). Toxicity was graded according to the Common Terminology Criteria for Adverse Events v.4.03 and classified into symptoms during RT, acutely (0–6 months) and late (>6 months) after RT, and long-term sideeffects (>24 months). Results The main histologies were Ewing sarcoma (n = 23 [61%]) and alveolar rhabdomyosarcoma (n = 5 [13%]). RT was performed with a median total dose of 54 Gy (40.5–66.0 Gy) and a single dose of 2 Gy (1.80–2.27 Gy). Twenty patients (53%) received mtRT. Median follow-up was 29.7 months (95% confidence interval 15.3–48.2 months) with a 5-year survival of 55.2% (±9.5%). The 5‑year survival rate of patients with mtRT (n = 20) was 37.1 ± 13.2%, while patients who received single-target RT (n = 18) had a 5-year survival rate of 75 ± 10.8%. Severe toxicities (grade 3 and 4) emerged in 14 patients (70%) with mtRT and 7 patients (39%) with single-target RT. Two non-hematological grade 4 toxicities occurred during RT: one mucositis and one radiodermatitis. After mtRT 5 patients had grade 3 toxicities acute and after single-target RT 4 patients. One patient had acute non-hematological grade 4 toxicities (gastritis, pericarditis, and pericardial effusion) after mtRT. Severe late effects of RT occurred in 2 patients after mtRT and in none of the single-target RT patients. No severe long-term side effects appeared. Conclusion Our results showed acceptable levels of acute and late toxicities, considering the highly advanced diseases and multimodal treatment. Hence, tomotherapy is a feasible treatment method for young patients with anatomically complex tumors or multiple targets. Especially mtRT is a promising and innovative treatment approach for pediatric sarcomas, delivering unexpectedly high survival rates for patients with multifocal Ewing sarcomas in this study, whereby the limited number of patients should invariably be considered in the interpretation.

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