scholarly journals Influence of the first episode duration on further course of bipolar disorder

2011 ◽  
Vol 64 (9-10) ◽  
pp. 466-469 ◽  
Author(s):  
Vladimir Knezevic ◽  
Aleksandra Nedic
Keyword(s):  
Bipolar Disorder ◽  
Medical Records ◽  
First Episode ◽  
Modest Contribution ◽  
Significant Difference ◽  
High Prevalence ◽  
Episode Duration ◽  
Bipolar Patients ◽  
Treatment Prognosis

Introduction. Bipolar disorder has been continuously studied due to its high prevalence and incidence. The aim of this study was to explore the influence of duration of the first episode of bipolar disorder on the further course of this disorder. Material and Methods. The research was conducted as a retrospective-prospective, naturalistic study, which included 65 bipolar patients admitted to the hospital. We used Student?s t-test in addition to descriptive parameters, mean, median and standard deviation. We followed the 5-year course of the disorder after the first episode. Results. Having examined the medical records of the first episode and five-year follow-up of the course of the disease we found a statistically significant difference (2 vs 1.54; df=120; p<0.05) in the number of episodes following the first episode between the patients whose first episode was longer than 2 months and the patients whose first episode was shorter than 2 months. In addition, we found a statistically significant difference (55.42 vs 42.3; df=120; p<0.05) in duration of episodes that followed the first episode between the patients whose first episode was longer than 2 months and the patients whose first episode was shorter than 2 months. Discussion. Since these results are in accordance with the literature, we ought to point out the possibility of developing chronic syndromes in patients with longer first episodes. Conclusion. This study is a modest contribution to the trend of studying bipolar disorder. Better knowledge of the course would enable better treatment, prognosis and outcome of this disorder.

Baseline and prodromal characteristics of first- versus multiple-episode mania in a French cohort of bipolar patients

2011 ◽  
Vol 27 (8) ◽  
pp. 557-562 ◽  
Author(s):  
J.-M. Azorin ◽  
A. Kaladjian ◽  
M. Adida ◽  
E. Fakra ◽  
E. Hantouche ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Suicide Attempts ◽  
Correct Diagnosis ◽  
Manic Episode ◽  
Psychotic Symptoms ◽  
First Episode ◽  
Prodromal Phase ◽  
Multiple Episode ◽  
Patients At Risk ◽  
Bipolar Patients

AbstractObjective:To identify some of the main features of bipolar disorder for both first-episode (FE) mania and the preceding prodromal phase, in order to increase earlier recognition.Methods:One thousand and ninety manic patients (FE=81, multiple-episodes [ME]=1009) were assessed for clinical and temperamental characteristics.Results:Compared to ME, FE patients reported more psychotic and less depressive symptoms but were comparable with respect to temperamental measures and comorbid anxiety. The following independent variables were associated with FE mania: a shorter delay before correct diagnosis, greater substance use, being not divorced, greater stressors before current mania, a prior diagnosis of an anxiety disorder, lower levels of depression during index manic episode, and more suicide attempts in the past year.Conclusion:In FE patients, the diagnosis of mania may be overlooked, as they present with more psychotic symptoms than ME patients. The prodromal phase is characterised by high levels of stress, suicide attempts, anxiety disorders and alcohol or substance abuse. Data suggest to consider these prodromes as harmful consequences of temperamental predispositions to bipolar disorder that may concur to precipitate mania onset. Their occurrence should therefore incite clinicians to screen for the presence of such predispositions, in order to identify patients at risk of FE mania.

scholarly journals RETROSPECTIVE ANALYSIS OF EVENTS OF DEATH AT HOME AMONG PATIENTS UNDER FOLLOW-UP OBSERVATION

2018 ◽  
Vol 35 (1) ◽  
pp. 68-74
Author(s):  
Ya P Sandakov
Keyword(s):  
Cardiovascular Diseases ◽  
Medical Records ◽  
Emergency Calls ◽  
Significant Difference ◽  
Duration Of Disease ◽  
The Moment ◽  
Age Of Death ◽  
At Home

Aim. To study the peculiarities of asking for medical care by patients from among those dead at home, who had been under follow-up observation. Materials and methods. The data, received from ambulatory medical records of 100 dead at home patients with follow-up, were analyzed using the methods of descriptive and inductive statistics. Results. A mean age of death was 74.9 ± 13.4 years, men - 65.8 ± 14.1 years, women - 79.2 ± 10.9 years. Cardiovascular diseases were the cause of follow-up observation in 78 % of cases and the cause of death in 85 %; in 30 % of patients the disease was detected while carrying out prophylactic medical examination. A mean duration of disease by the moment of death was 13.0 ± 8.0 years, among pensioners 13.7 ± 8.5 years, in able-bodied persons 9.6 ± 4.3 years. A mean duration of follow-up observation was 9.2 ± 5.8 years. An average number of planned visits was 2.8 ± 0.89, but the number of real visits during the last year of follow-up observation was 2.4 ± 1.2. Disability was registered in 77.6 % of patients, concomitant diseases - in all patients. For the last year, exacerbations were recorded in 92 % of patients, emergency calls - in 80 %, hospitalization events - 52 %, including 55.8 % - urgent ones. Conclusions. The absence of significant difference regarding the duration of disease between pensioners and able-bodied patients (т = 0.16, р = 1.43) as well as the absence of correlation between the age and duration of disease (χ2 = 0.19, p = 0.2) indirectly prove the influence of duration of disease on its outcome, but not the age. Attendance, characterizing clinical loyalty to treatment, does not depend on age (χ2 = -0.19, р = 0.18), sex (т = 1.0, р = 0.32), way of detecting disease (f = 0.9, p = 0.4), class of main disease (f = 0.91, p = 0.44), duration of disease (χ2 = -0.13, р = 0.49), exacerbations (χ2 = -0.17, р = 0.24), concomitant diseases (χ2 = 0.006, р = 0.9). The number of emergency calls, hospitalizations, urgent hospitalizations does not depend on duration of follow-up observation, regularity and number of real visits to a doctor (p > 0.05) that indicates unsatisfactory quality of follow-up observation.

scholarly journals A Prospective Comparison of Bipolar I and II Subjects With and Without Comorbid Alcohol Dependence From the COGA Dataset

2020 ◽  
Vol 11 ◽  
Author(s):  
Ulrich W. Preuss ◽  
M. N. Hesselbrock ◽  
V. M. Hesselbrock
Keyword(s):  
Bipolar Disorder ◽  
Alcohol Use ◽  
Alcohol Dependence ◽  
Collaborative Study ◽  
Structured Interviews ◽  
Prospective Comparison ◽  
Bipolar Ii ◽  
Bipolar Patients ◽  
Alcohol Dependent

Objective: Comorbidity of alcohol use disorders in bipolar subjects is high as indicated by epidemiological and clinical studies. Though a more severe course of bipolar disorder in subjects with comorbid alcohol dependence has been reported, fewer studies considered the longitudinal course of alcohol dependence in bipolar subjects and the prospective course of comorbid bipolar II subjects. Beside baseline analysis, longitudinal data of the COGA (Collaborative Study on Genetics in Alcoholism) were used to evaluate the course of bipolar I and II disordered subjects with and without comorbid alcohol dependence over more than 5 years of follow-up.Methods: Characteristics of bipolar disorder, alcohol dependence and comorbid psychiatric disorders were assessed using semi-structured interviews (SSAGA) at baseline and at a 5-year follow-up. Two hundred twenty-eight bipolar I and II patients were subdivided into groups with and without comorbid alcohol dependence.Results: Of the 152 bipolar I and 76 bipolar II patients, 172 (75, 4%) had a comorbid diagnosis of alcohol dependence. Bipolar I patients with alcohol dependence, in particular women, had a more severe course of bipolar disorder, worse social functioning and more suicidal behavior than all other groups of subjects during the 5-year follow-up. In contrast, alcohol dependence improved significantly in both comorbid bipolar I and II individuals during this time.Conclusions: A 5-year prospective evaluation of bipolar patients with and without alcohol dependence confirmed previous investigations suggesting a more severe course of bipolar disorder in comorbid bipolar I individuals, whereas bipolar II individuals were less severely impaired by comorbid alcohol use disorder. While severity of alcohol dependence improved during this time in comorbid alcohol-dependent bipolar I patients, the unfavorable outcome for these individuals might be due to the higher comorbidity with personality and other substance use disorders which, together with alcohol dependence, eventually lead to poorer symptomatic and functional clinical outcomes.

Bipolar Disorder and Suicide: 10 Years Follow-up/retrospective Survey/

2009 ◽  
Vol 24 (S1) ◽  
pp. 1-1
Author(s):  
D. Breznoscakova ◽  
E. Palova ◽  
J. Dragasek ◽  
K. Losonciova ◽  
J. Uhrin
Keyword(s):  
Bipolar Disorder ◽  
Depressive Episode ◽  
Suicide Risk ◽  
First Episode ◽  
Retrospective Case ◽  
Suicidal Thoughts ◽  
Adequate Treatment ◽  
Retrospective Survey ◽  
Naturalistic Condition

Introduction:Bipolar disorder (BD) is chronic psychiatric disorder by mood swings, symptoms of BD are serious and life-threating. Suicide risk in patients with BD is 25-50%, more frequent during depressive episode (Compton,2000) but with adequate treatment suicide risk can be presented in nearby 50% of patients only (Goodwin, Jamison,2006). Despite these facts data about the changes of treatment habits over the longer period of time under naturalistic condition are lacking.The aim of study:To assess presence of suicidal thoughts and attempts in inpatients with BD and follow-up changes of treatment with lithium over the period of time.Patients and methods:It was retrospective survey of in-patient's files hospitalized at the 1st Dept. of Psychiatry, UPJS, Kosice (1997-2007) with typical limitations for retrospective case survey. All patients had diagnosis of BD (DSM-IV), n=125 (67% of women and 33% of men). We discovered changes in suicidal behaviour with/without treatment of lithium.Results:The first episode was depressive in 62% of patients, average number of episodes: 8,2. There was trend of decrease in use of lithium over the time (68% vs 84% in men, 29% vs 60% in women). The suicidal thoughts were more frequent during depressive episode (in 50% of women and 18% of men). Suicidal thoughts and attempts were 3 times more frequent in women vs men with BD. Suicidal attempts were 4 times more frequent in women with treatment with lithium vs without lithium.

Tear Rates of the Ipsilateral ACL Graft and the Contralateral Native ACL Are Similar following ACL Reconstruction

2020 ◽  
Author(s):  
Nadia Nastassia Ifran ◽  
Ying Ren Mok ◽  
Lingaraj Krishna
Keyword(s):  
Acl Reconstruction ◽  
Medical Records ◽  
Cruciate Ligament ◽  
Acl Graft ◽  
Increased Risk ◽  
Significant Difference ◽  
The Mean ◽  
Anterior Cruciate ◽  
Mean Time

AbstractThe aim of the study is to compare the tear rates of ipsilateral anterior cruciate ligament (ACL) grafts and the contralateral native ACL as well as to investigate the correlation of gender, age at time of surgery, and body mass index (BMI) with the occurrence of these injuries. The medical records of 751 patients who underwent ACL reconstruction surgery with follow-up periods of 2 to 7 years were retrospectively analyzed. Survival analyses of ipsilateral ACL grafts and contralateral native ACL were performed. Univariate and multivariate logistic regression analyses were performed to identify risk factors that were associated with these injuries. The tear rates of the ipsilateral ACL graft and contralateral ACL were 5.86 and 6.66%, respectively with no significant difference between groups (p = 0.998). The mean time of tears of the ipsilateral ACL and contralateral ACL was also similar (p = 0.977) at 2.64 and 2.78 years, respectively after surgery. Both the odds of sustaining an ipsilateral ACL graft and contralateral ACL tear were also significantly decreased by 0.10 (p = 0.003) and 0.14 (p = 0.000), respectively, for every 1-year increase in age at which the reconstruction was performed. However, graft type, gender, and BMI were not associated with an increased risk of these injuries. There was no difference between tear rates of ipsilateral ACL graft and contralateral ACL following ACL reconstruction. Patients who undergo ACL reconstruction at a young age are at an increased risk of both ipsilateral graft and contralateral ACL rupture after an ACL reconstruction. Patients who are young and more likely to return to competitive sports should be counselled of the risks and advised to not neglect the rehabilitation of the contralateral knee during the immediate and back to sports period of recovery. This is a Level III, retrospective cohort study.

Outcome, complication and follow-up of patients with esophageal foreign body impaction: an academic institute’s 15 years of experience

2020 ◽  
Vol 33 (5) ◽  
Author(s):  
Seyed Farzad Marashi Nia ◽  
Mohamad Aghaie Meybodi ◽  
Richard Sutton ◽  
Ajay Bansal ◽  
Mojtaba Olyaee ◽  
...  
Keyword(s):  
Foreign Body ◽  
Adverse Events ◽  
Medical Center ◽  
Endoscopic Management ◽  
First Episode ◽  
Esophageal Foreign Body ◽  
Significant Difference ◽  
Foreign Body Impaction ◽  
Push And Pull

Summary Esophageal foreign body impaction (EFBI) is a gastrointestinal emergency, mostly requiring endoscopic management. The aim of this study is to evaluate the epidemiology, adverse events, and outcomes of patients following the episode of EFBI. All esophagogastroduodenoscopy (EGD) reports of admitted patients for EFBI at the University of Kansas Medical Center between 2003 and 2018 were retrospectively reviewed. Of 204 patients, who met the inclusion criteria, 60% were male and the mean age was 54.7 ± 17.7 years. The encounter was the first episode of EFBI in 76% of cases. EGD in less than 24 hours of patients’ admission was required in 79% of cases. The distal esophagus was the most common site of impaction (44%). Push and pull techniques were used in 38 and 35.2% of cases, respectively, while 11% were managed by a combination of both techniques. Structural causes were the most common etiologic findings including benign strictures and stenosis in 21.5% of patients, followed by Schatzki’s ring (7.8%) and hiatal hernia (6.9%). Of all cases, 45% did follow-up in up to 1 year, and biopsy was done in 34% of cases. Out of 43 patients who had endoscopic findings suspicious for eosinophilic esophagitis (EoE), the diagnosis was confirmed by pathology in 37. The rate of recurrence EFBI was significantly higher in patients with EoE (P &lt; 0.001). EFBI-related esophageal adverse events (AEs) occurred in 4.9% of cases. Cardiovascular and pulmonary AEs occurred in 1.5 and 2.9%, respectively. Logistic regression did not find any predictor for AEs occurrence. EFBI managed very well with endoscopic treatments. Despite the emerging data about the safety of the push technique, there are still concerns regarding its adverse events especially the risk of perforations. Our study shows no significant difference in adverse events between different types of techniques.

scholarly journals PP029 Hospitalizations And Costs In Bipolar Disorder Patients Initiating Long-acting Injectable Antipsychotics

2017 ◽  
Vol 33 (S1) ◽  
pp. 83-83
Author(s):  
Mallik Greene ◽  
Tingjian Yan ◽  
Eunice Chang ◽  
Ann Hartry ◽  
Michael Broder
Keyword(s):  
Bipolar Disorder ◽  
Reference Group ◽  
Cohort Analysis ◽  
Linear Regression Models ◽  
Inpatient Hospitalization ◽  
Inpatient Hospitalizations ◽  
Long Acting ◽  
Bipolar Patients ◽  
The Impact

INTRODUCTION:Existing studies have not investigated the effectiveness of one long-acting injectable antipsychotic (LAI) versus another in preventing hospitalizations among patients with bipolar disorder (BD). This study was conducted to compare all-cause inpatient healthcare utilization and associated costs among BD patients who initiated LAIs.METHODS:This retrospective cohort analysis used the Truven Health Analytics MarketScan® Commercial and Medicaid claims database. Bipolar patients >18 years with at least one claim for one of the following LAIs were identified between 1 January 2013 and 30 June 2014 (identification period): aripiprazole, haloperidol, paliperidone, and risperidone. The first day of initiating an LAI was considered the index date. Logistic regression and generalized linear regression models were conducted to estimate risk of inpatient hospitalization and associated costs during the 1-year follow up.RESULTS:A total of 1,540 BD patients initiated an LAI: 14.5 percent aripiprazole, 16.3 percent risperidone, 21.0 percent haloperidol, and 48.1 percent paliperidone. With the aripiprazole cohort as the reference group, the odds of having any inpatient hospitalizations were significantly higher in haloperidol [Odds Ratio, OR (95 percent Confidence Interval, CI): 1.49 (1.01 - 2.19)] and risperidone [1.78 (1.19 - 2.66)] cohorts. The paliperidone cohort also had a higher risk of having a hospitalization than aripiprazole, but the difference was not statistically significant (p>.05). Among LAI initiators having any inpatient hospitalizations, the adjusted mean all-cause inpatient costs were lowest in the aripiprazole cohort (USD26,002), followed by risperidone (USD27,937), haloperidol (USD30,411), and paliperidone (USD33,240). However, the cost difference was not statistically significant.CONCLUSIONS:Our study findings highlight the value of aripiprazole in reducing all-cause inpatient hospitalizations and associated costs among patients with BD during the 1-year follow-up. It is worthwhile to note that bipolar diagnoses were identified from healthcare claims coded for reimbursement purposes, thus misclassification was possible. Future studies are warranted to understand the impact of LAI use in a longer period of time.

scholarly journals Incidence of bipolar affective disorder in three UK cities

2005 ◽  
Vol 186 (2) ◽  
pp. 126-131 ◽  
Author(s):  
Tuhina Lloyd ◽  
Noel Kennedy ◽  
Paul Fearon ◽  
James Kirkbride ◽  
Rosemarie Mallett ◽  
...  
Keyword(s):  
Bipolar Disorder ◽  
Affective Disorder ◽  
Ethnic Groups ◽  
Bipolar Affective Disorder ◽  
Incidence Rates ◽  
First Episode ◽  
Minority Ethnic Groups ◽  
Incidence Studies ◽  
Significant Difference ◽  
Minority Ethnic

BackgroundThere has been a relative dearth of epidemiological research into bipolar affective disorder. Furthermore, incidence studies of bipolar disorder have been predominantly retrospective and most only included hospital admission cases.AimsTo determine the incidence of operationally defined bipolar disorder in three areas of the UK and to investigate any differences in gender and ethnicity.MethodAll patients who contacted mental health services with first-episode psychosis or non-psychotic mania between September 1997 and August 1999 were identified and diagnosed according to ICD–10 criteria. Incidence rates of bipolar affective disorder were standardised for age and stratified by gender and ethnic group across the three areas.ResultsThe incidence rate per 100 000 per year in south-east London was over twice that in Nottingham and Bristol. There was no significant difference in the rates of disorder in men and women. Incidence rates of bipolar disorder in the combined Black and minority ethnic groups in all three areas were significantly higher than those of the comparison White groups.ConclusionsThe incidence of bipolar disorder was higher in south-east London than in the other two areas, and was higher among Black and minority ethnic groups than in the White population.

Accuracy of register- and record-based bipolar I disorder diagnoses in Finland; a study of twins

2000 ◽  
Vol 12 (3) ◽  
pp. 106-109 ◽  
Author(s):  
T. Kieseppä ◽  
T. Partonen ◽  
J. Kaprio ◽  
J. Lönnqvist
Keyword(s):  
Bipolar Disorder ◽  
Hospital Discharge ◽  
Medical Records ◽  
Diagnostic Procedures ◽  
Hospital Discharge Register ◽  
Bipolar I Disorder ◽  
Best Estimate ◽  
National Hospital Discharge Register ◽  
Opposite Sex

ABSTRACTRegisters have been widely used in schizophrenia studies. For bipolar disorder, the use has been more limited and no studies exist concerning accuracy of bipolar I diagnoses in registers. We have collected an unselected twin sample for a study of bipolar I disorder. We report here the diagnostic procedures and accuracy of bipolar I diagnoses in a nation-wide hospital discharge registry. We evaluated also the accuracy of the medical record-based best-estimate diagnoses, comparing these with the SCID interview diagnoses. From the National Hospital Discharge Register we identified all like-sex twins, born 1940-1957, (N=42), and all like- or opposite-sex twins, born 1961-1969, (N=15), who had at least once a diagnosis of bipolar I disorder. The best-estimate diagnoses based on medical records, and were made by two doctors blind to each other, and according to DSM-IV-criteria. Diag-noses were then confirmed by SCID interviews, with the mi-nimum follow-up time after the first admission being 6 years. The accuracy of bipolar diagnoses in the register was 92% and 87%, accordingly. When comparing the best-estimate diagnoses to SCID interview diagnoses, there was one false positive case in the first sample, 3.4% [95% CI 0.1% to 7.8%], and none in the second sample. Our study shows that a diagnosis of bipolar I disorder in the hospital discharge register, or if based only on medical records, is highly reliable and stable. These results strengthen the usefulness of regis-ters also in bipolar disorder.

Prevalence and clinical consequences of cytomegalovirus DNA in the aqueous humour and corneal transplants

2018 ◽  
Vol 103 (5) ◽  
pp. 666-671 ◽  
Author(s):  
Ching-Hsi Hsiao ◽  
Yih-Shiou Hwang ◽  
Wen-Yu Chuang ◽  
David H K Ma ◽  
Lung-Kun Yeh ◽  
...  
Keyword(s):  
Medical Records ◽  
Graft Failure ◽  
Corneal Transplantation ◽  
Diagnostic Value ◽  
Pcr Analysis ◽  
High Prevalence ◽  
Corneal Transplants ◽  
Clinical Consequences ◽  
Patients At Risk

AimTo determine the prevalence and clinical consequences of cytomegalovirus (CMV) DNA in the aqueous and corneal tissues obtained at the time of corneal transplantation to evaluate the diagnostic value of PCR analysis in identifying patients at risk of postkeratoplasty CMV endotheliitis.MethodsThirty patients who underwent corneal transplantation were included in 2011. The aqueous, excised recipient corneas and donor corneoscleral rims were analysed by PCR for the presence of CMV DNA. The medical records of the patients were retrospectively reviewed and linked with PCR results.ResultsCMV DNA was detected in three (10%) aqueous, eight (26.7%) recipient corneas and six (20.0%) donor corneas obtained during keratoplasty from the 30 patients. Postoperatively, four patients, who had CMV DNA in either aqueous (3) or recipient cornea (1), were diagnosed with CMV endotheliitis based on clinical features and repeat aqueous tapping for real-time PCR analysis. At the median 60.5 months follow-up, 8 (72.7%), including 4 with postkeratoplasty CMV endotheliitis, of the 11 patients with CMV positivity in any one sample had graft failure, while 9 (47.3%) of the 19 patients without evidence of CMV DNA experienced graft failure.ConclusionsWe found a relatively high prevalence of CMV DNA in the aqueous and corneas obtained during keratoplasty. All the patients who had CMV positivity in aqueous developed CMV endotheliitis postoperatively and experienced graft failure eventually. Aqueous tapping at the time of corneal transplantation for PCR analysis may help to improve the diagnosis and follow-up management of postkeratoplasty CMV endotheliitis.

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