scholarly journals Acute and long-term treatment of mania

2008 ◽  
Vol 10 (2) ◽  
pp. 165-179 ◽  
Keyword(s):  
Correct Diagnosis ◽  
Evidence Base ◽  
Term Treatment ◽  
Acute Mania ◽  
Compulsory Admission ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Treatment ◽  
Treatment Refractory

The treatment of mania starts with a correct diagnosis and elementary measures to prevent risks for the patient, relatives, and others. Sometimes, compulsory admission and treatment may be required for a few days. Patients with psychotic or mixed mania may be more difficult to treat. At the present time, there is solid evidence supporting the use of lithium, the anticonvulsants valproate and carbamazepine, and the antipsychotics chlorpromazine, haloperidol, risperidone, olanzapine, quetiapine, ziprasidone, aripiprazole, and asenapine in acute mania, and some evidence supporting the use of clozapine or electroconvulsive therapy in treatment-refractory cases. However, in clinical practice, combination therapy is the rule rather than the exception. The treatment of acute mania deserves a long-term view, and the evidence base for some treatments may be stronger than for others. When taking decisions about treatment, tolerability should also be a major concern, as differences in safety and tolerability may exceed differences in efficacy for most compounds. Psychoeducation of patients and caregivers is a powerful tool that should be used in combination with medication for optimal long-term outcome. Functional recovery should be the ultimate goal.

scholarly journals Sex differences in traumatic brain injury: a multi-dimensional exploration in genes, hormones, cells, individuals, and society

2019 ◽  
Vol 5 (1) ◽  
Author(s):  
Cheng Ma ◽  
Xin Wu ◽  
Xiaotian Shen ◽  
Yanbo Yang ◽  
Zhouqing Chen ◽  
...  
Keyword(s):  
Traumatic Brain Injury ◽  
Cognitive Impairment ◽  
Brain Injury ◽  
Treatment Options ◽  
Term Treatment ◽  
Neuroprotective Effects ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Treatment

Abstract Traumatic brain injury (TBI) is exceptionally prevalent in society and often imposes a massive burden on patients’ families and poor prognosis. The evidence reviewed here suggests that gender can influence clinical outcomes of TBI in many aspects, ranges from patients’ mortality and short-term outcome to their long-term outcome, as well as the incidence of cognitive impairment. We mainly focused on the causes and mechanisms underlying the differences between male and female after TBI, from both biological and sociological views. As it turns out that multiple factors contribute to the gender differences after TBI, not merely the perspective of gender and sex hormones. Centered on this, we discussed how female steroid hormones exert neuroprotective effects through the anti-inflammatory and antioxidant mechanism, along with the cognitive impairment and the social integration problems it caused. As to the treatment, both instant and long-term treatment of TBI requires adjustments according to gender. A further study with more focus on this topic is therefore suggested to provide better treatment options for these patients.

Arthroscopic treatment of fragmented coronoid process with severe elbow incongruity

2013 ◽  
Vol 26 (01) ◽  
pp. 27-33 ◽  
Author(s):  
E. de Bakker ◽  
D. Van Vynckt ◽  
E. Coppieters ◽  
H. van Bree ◽  
B. Van Ryssen ◽  
...  
Keyword(s):  
Clinical Signs ◽  
Case Series ◽  
Term Treatment ◽  
Coronoid Process ◽  
Heavy Exercise ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Treatment

SummaryThe purpose of this study was to investigate the long-term treatment results of fragmented coronoid process (FCP) in joints with a radio-ulnar step greater than 3 mm. Treatment of these patients only consisted of fragment removal, without correction of the incongruity.The eight Bernese Mountain Dogs (11 joints) included in this study showed obvious clinical signs of elbow disease and were diagnosed with severe elbow incongruity and concomitant FCP in the time period from 1999–2003. At that time, elbow radiography, computed tomography, and arthroscopy were performed. The mean follow-up period was 5.6 years. The follow-up consisted of a telephone questionnaire combined with a clinical and radiographic re-evaluation at our clinic.The questionnaire revealed that all dogs were either free of lameness or only lame following heavy exercise. One dog sporadically required medication after heavy exercise. The owner satisfaction rate was 100%. The clinical re-evaluation did not reveal any signs of pain or lameness in all cases. Range-of- motion was decreased in nine of the 11 elbows. Radiographs revealed an increase in severity of osteoarthritis in every case.In this case series, arthroscopic fragment removal without treatment of incongruity was demonstrated to be a valuable treatment option and may provide a satisfactory long-term outcome.

333 THE LONG-TERM TREATMENT OUTCOMES OF ESOPHAGEAL SCC WITH MM/SM1 INVASION AFTER ENDOSCOPIC RESECTION

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Sakiko Naito ◽  
Toshiyuki Yoshio ◽  
Shoichi Yoshimizu ◽  
Akiyoshi Ishiyama ◽  
Tomohiro Tsuchida ◽  
...  
Keyword(s):  
Survival Rate ◽  
Endoscopic Resection ◽  
Term Treatment ◽  
Additional Treatment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Treatment ◽  
Additional Therapy ◽  
Cause Specific Survival

Abstract   Resent advances in endoscopic resection (ER) provide us increasing chances for resecting esophageal SCC with muscularis mucosae (MM) and submucosal (SM) invasion. We perform additional therapy such as chemoradiotherapy (CRT) or esophagectomy considering the risk of metastasis and patient’s condition. However, there is only a few reports about long-term outcome after ER for such cases. Methods We retrospectively studied 188 case of esophageal SCC with pathological MM invasion resected by ER (161 cases) and SM1(27 cases) from 2005 to 2016 in Cancer Institute Hospital. We recommended CRT or esophagectomy as additional treatment for the cases which had lymphovascular invasion (LVI) or DI (droplet infiltration) considering patients’ conditions. Median observation period of them were 71 months. Results The SM1 cases had significantly higher rate of LVI than the MM cases. Of 161 MM cases, 2 cases had recurrence, however, they are alive after CRT or CRT following esophagectomy. Of 27 SM1 cases, 3 cases had LN recurrence, underwent RT or CRT or CRT following esophagectomy, one case died of esophageal SCC and the others survive. The rate of metastatic cases was higher in SM1 than that in MM. Overall survival rate in 5 years were 89.8% in MM and 81.8% in SM1. Cause specific survival rate in 5 years were 100% in both MM and SM1. Conclusion The long-term outcomes of ER for MM/SM1 invasive esophageal SCC was good with appropriate additional therapy which we should perform in high risk cases for LN metastasis considering patients’ condition.

Treatment optimization: The long-term perspective in bipolar disorder

2011 ◽  
Vol 26 (S2) ◽  
pp. 2216-2216
Author(s):  
M. Bauer ◽  
P. Ritter ◽  
A. Pfennig
Keyword(s):  
Bipolar Disorder ◽  
Large Scale ◽  
Functional Disability ◽  
Term Treatment ◽  
Documentation System ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Combination Treatments ◽  
Long Term Treatment

Bipolar disorder is for most patients a life-long illness, associated with a recurrent, chronic course, and functional disability. Primary treatment goals are to stabilize the patient and prevent recurrence of episodes and suicide.Although bipolar disorder has traditionally been regarded as an illness with good prognosis and most patients returning to normal functioning when a mood episode is over, several longitudinal studies suggest that the long-term outcome is less favorable than previously thought. Combinations of drugs are frequently used in clinical practice for mood stabilization, especially for those who have not responded to monotherapy. Although combination treatments are commonly administered, full interepisode recovery is not achieved in all patients, and as a consequence, bipolar disorder is one of the leading causes of disability.Among clinicians and in international guidelines, lithium is widely considered as the ‘gold standard’ for long-term treatment. The choice of treatments is undergoing considerable change as new treatments are available, anticonvulsants and atypical antipsychotics are taking a more prominent position. However, the evidence available for the newer treatment options including the various combination treatments varies greatly.The episodic nature of bipolar disorder requires prophylactic long-term treatment. Many previous worthwhile treatment effects of available mood stabilizing agents and psychotherapeutic interventions on major outcomes in bipolar disorder are only of moderate size and therefore require large-scale studies. Such trials to investigate longer-term outcomes are logistically challenging and expensive, and therefore only feasible within a multisite and multinational approach based on a common documentation system of the illness course.

Perceptions of the Use of Compulsory Detention in Treatment of People with Eating Disorders

2005 ◽  
Vol 96 (3) ◽  
pp. 701-706 ◽  
Author(s):  
J. T. Newton ◽  
Himali Patel ◽  
Seema Shah ◽  
Peter Sturmey
Keyword(s):  
Eating Disorders ◽  
Term Treatment ◽  
Three Dimensions ◽  
Psychological State ◽  
Psychological Outcome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Treatment ◽  
Main Effects

To examine the perceived acceptability of compulsory detention in treatment of an individual with severe anorexia nervosa amongst a sample of members of the general population, 151 participants read vignettes describing the compulsory detention of a female patient with a Body Mass Index of 12.4. The vignettes systematically varied along three dimensions: patients' reaction, immediate outcome (psychological state), and long-term outcome (attendance at out-patient appointments). Acceptability was measured using the Treatment Evaluation Inventory. There were significant main effects of psychological outcome and the long-term treatment outcome. The main effect of the patients' reaction to the detention was not significant, but there was a significant interaction for psychological outcome and long-term outcome, such that good attendance at out-patient appointments increased ratings of acceptability more markedly when a good psychological outcome had been secured. The outcome of treatment exerts a strong influence on ratings of acceptability. Individuals who have no direct experience with eating disorders endorse treatments that are effective irrespective of the patients' feelings about the treatment.

75 LONG-TERM OUTCOME OF LAPAROSCOPIC HELLER–DOR OPERATION: RESULTS AT A MEDIAN 20-YEAR FOLLOW UP.

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
A Costantini ◽  
R Salvador ◽  
L Provenzano ◽  
G Capovilla ◽  
L Nicoletti ◽  
...  
Keyword(s):  
Symptom Control ◽  
Combined Treatment ◽  
Esophageal Achalasia ◽  
Term Treatment ◽  
Barium Swallow ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Treatment

Abstract   Since its introduction in 1993, Laparoscopic Heller-Dor (LHD) operation has been the gold standard treatment for esophageal achalasia. Little is known, however, of the natural story of the operated patients in the long run. The aim of this study was to assess the long-term outcome of patients who underwent LHD more than 20 years ago, in order to provide benchmark data to which new techniques should compare. Methods All the patients who underwent LHD from 1992 to 1999 at our Institution were evaluated. Patients with previous endoscopic treatment with pneumatic dilations (PD) or Botox were included, whereas patients with previous myotomy were ruled out. Symptoms were prospectively collected and scored using a detailed questionnaire. Barium swallow, endoscopy and manometry were performed before and 6–12 months after the operation, when also pH-metry was performed. Endoscopy was then suggested every 2 years. Treatment failure was defined as a postoperative symptom score > 10th percentile of the preoperative score (i.e. > 8) or the need for further treatment. Results Eighty-seven patients with a minimum 10-year follow-up were evaluated (median f/u 20 years). One patient died for esophageal cancer 11.5 years after LHD; 8 patients died 11–24 years after LHD for unrelated causes. All were highly satisfied with the results of the operation. Symptoms recurred in 23 patients (26.4%) 1 month to 13.5 years after LHD: all received 1 to 6 PD, effective in 16: 3 required revisional myotomy and 3 need periodic PD. Good long-term outcome was recorded in 73.6% of patients, and in 92% with combined treatment. Post-operative reflux (pH and/or endoscopy-proven) developed in 10 patients only (11.5%). Conclusion LHD can durably relieve symptoms in the majority of patients, though some of them may require complementary PD to maintain effective symptom control. LHD confirms to be an excellent long-term treatment for achalasia and these results represent the reference point for all other treatments.

scholarly journals Long term outcome of thermal anterior capsulotomy for chronic, treatment refractory depression

2010 ◽  
Vol 82 (6) ◽  
pp. 594-600 ◽  
Author(s):  
D. Christmas ◽  
M. S. Eljamel ◽  
S. Butler ◽  
H. Hazari ◽  
R. MacVicar ◽  
...  
Keyword(s):  
Chronic Treatment ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Refractory Depression ◽  
Treatment Refractory ◽  
Anterior Capsulotomy

scholarly journals Long-Term Treatment Outcome of Progressive Mycobacterium avium Complex Pulmonary Disease

2020 ◽  
Vol 9 (5) ◽  
pp. 1315 ◽  
Author(s):  
Kiyoharu Fukushima ◽  
Seigo Kitada ◽  
Yuko Abe ◽  
Yuji Yamamoto ◽  
Takanori Matsuki ◽  
...  
Keyword(s):  
Pulmonary Disease ◽  
Mycobacterium Avium ◽  
Mycobacterium Avium Complex ◽  
Refractory Disease ◽  
Multidrug Therapy ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Long Term Treatment ◽  
Standardized Treatment

Background: Multidrug therapy is essential for preventing respiratory failure in patients with highly progressive Mycobacterium avium complex pulmonary disease (MAC-PD). However, the prognosis and long-term outcome following combination therapy is poorly understood. Methods: We retrospectively evaluated the clinical characteristics and long-term outcomes in patients with chemo-naïve progressive MAC-PD, hospitalized for first-line multidrug therapy. Results: Among 125 patients, 86 (68.8%) received standardized treatment (rifampicin, ethambutol, clarithromycin), 25 (20.0%) received a fluoroquinolone (FQ)-containing regimen, and 53 (42.4%) received aminoglycoside injection. The sputum conversion rate was 80.0%, and was independently associated with standardized treatment. The incidence of refractory disease (45.6%) was independently and negatively associated with standardized regimen and aminoglycoside use. Choice of an FQ-containing regimen was not associated with positive outcome. Clarithromycin resistance occurred in 16.8% and was independently associated with refractory disease. MAC-PD-associated death occurred in 3.3% of patients with non-cavitary nodular bronchiectasis (NB) and 21.3% with cavitary MAC-PD over a median follow-up period of 56.4 months. The rates of MAC-PD-associated death were comparable between cavitary-NB and fibrocavitary disease. Concurrent chronic pulmonary aspergillosis (CPA) occurred in 13 (17.3%) patients with cavitary MAC-PD, and age, diabetes mellitus, and CPA were independent risk factors for mortality. Conclusions: Standardized intensive multidrug treatment reduces disease progression and persistence in progressive MAC-PD. Cavitary NB may differ from, rather than being just an advanced stage of, non-cavitary NB. The high incidence and significant mortality of CPA in cavitary MAC-PD highlight the need for early diagnosis and treatment.

Clinical Outcomes of Ambulatory Acute Exacerbations of Chronic Bronchitis with Older versus Newer Antimicrobials

2002 ◽  
Vol 36 (6) ◽  
pp. 975-980 ◽  
Author(s):  
Karl J Madaras-Kelly ◽  
Stephanie B Magdanz ◽  
Christopher K Johnson ◽  
Sandra G Jue
Keyword(s):  
Chronic Bronchitis ◽  
Term Treatment ◽  
Cure Rate ◽  
Term Outcome ◽  
Long Term Treatment ◽  
Acute Exacerbations ◽  
Short And Long Term ◽  
Traditional Therapies ◽  
Cure Rates

OBJECTIVE: To determine whether the cure rate was similar between traditional and newer antibiotics in the treatment of acute exacerbations of chronic bronchitis (AECB), to determine whether antibiotic selection during the first AECB of the season influences the frequency of subsequent AECB, and to identify variables associated with poor short- and long-term treatment outcome. METHODS: A retrospective analysis of subjects seen for management of their first seasonal AECB was conducted. Subjects were stratified into traditional therapies (n = 95) or newer therapies (n = 101) by antibiotic prescription. RESULTS: There was no difference in initial cure rates between older versus newer antibiotics (93% vs. 95%; p = 0.48). There was no difference in the number of subjects that remained AECB-free for 6 months after initial treatment with older versus newer antibiotic regimens (34% vs. 28%; p = 0.37). Oxygen initiation or increased dose (OR 10.9; 95% CI 1.4 to 84.2; p = 0.02) was the only variable independently associated with lack of AECB resolution. Nonsmoking status trended toward an association with remaining AECB-free at 180 days (OR 0.39; 95% CI 0.15 to 1.01; p = 0.053). CONCLUSIONS: The use of older versus newer antibiotics did not independently predict short-term outcome or future AECB.

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