Background: Bipolar disorder begins during adolescence but often escapes diagnosis at this time because episodes are misinterpreted with other psychiatric disorders. Lithium, carbamazepine, valproate, and other drugs are used for the treatment of acute episodes and maintain treatment of bipolar disorders. Aims: To compare the efficacy of Valproate vs. Lithium in the long-term treatment of patients with subtypes of bipolar disorders. Method: 120 patients with more than two episodes of BD (according to DSM-IV) in a longitudinal, comparative and randomized clinical trial, for 2 years (104 weeks) divided in two equal parallel-groups with open label pre-randomized phase. Primary outcome measure was time to relapse/recurrence of any mood episodes. Survival analyses (Kaplan-Mayer and Cox Proportional Hazard) were used for statistical analysis. Results: Cumulative survival for valproate's group was S(104)=0.3570, (35.70% and lithium's group S(104)=0.3136, (31,36%). Valporate is superior to lithium for the treatment of non classic BD I (Log Rank 0.0309, p=0.0100). Valproate prolongs median survival time with 11±9 and mean survival time to 7±4 weeks more than lithium. Treatment with lithium has 20.4% higher relative risk for relapse/recurrence than treatment with valproate Vp (β = 0.186, p = 0.434). Valproate is superior for the treatment of BD with psychiatric comorbidity (Log Rank =0.0007. p=0.0026). Conclusions: We found that valproate is significantly more effective than lithium in prophylactic treatment of bipolar I disorders in non-classic subtype and in bipolar disorder with psychiatric comorbidity.
Patients with Factitious Disorder with Psychological Symptoms require more admissions at all ages. Their somatic episodes have a lower average length of hospitalization, although Cases remain at a Psychiatric Inpatients Unit double time that other patients and they visit double number of physicians. This frequent use of hospital cares supports the importance of an early identification of factitious symptoms.
To determine the impact of maternal depression in children.The study sample included 24 depressed women and 14 control mothers who each had a 3 – 5 y.o. child. The subjects had been selected on the basis of a screening health questionnaire and a follow-up interview. Mothers and children were observed in their homes for 2 hours on 2 occasions within a month. Child disorders were assessed at these visits and scored according to the number of areas in which children showed dysfunction in eating, sleeping, and relationships with peers. All mothers were re interviewed and revisited 6 months later.Results:There were children with emotional and behavioural problems in the depressed group than in the control group. Children of depressed mothers commonly had eating difficulties, problems in relationships with peers or parents, and poor attention with over activity. However, there was no difference in sleep problems, mood disturbances, general intellectual levels, or language comprehension between children from the study group and the control group.At the 6 month follow-up, 14 depressed mothers had recovered, whereas 10 were still depressed. Children of recovered mothers were somewhat less disturbed than those whose mothers were still depressed but more disturbed than children of non depressed mothers.Depressed mothers appeared to be less responsive to their children than nondepressed mothers. Children of depressed mothers were more often distressed than children of nondepressed mothers.There was a wide variation in the quality of mother – child interaction within the depressed group.
Objectives. The aims of our study were to classify the reasons for psychiatric treatment dropout. Materials and methods. 300 patients diagnosed with schizophrenia and bipolar I disorders who had discontinued psychiatric treatment were questioned about the reasons for discontinuation during 2014. Reasons included the report of the patient and conclusions drawn by the psychiatrists based on the whole context of the patient's life and family reports. The study sample included only patients with at least two hospital admissions, in order to make sure they had some experience with psychiatric disorders, psychiatric treatment and were under specialized treatment, thus a confirmed diagnosis.Results. The first reason of dropout is reported as follows: 36.6% of dropout results due to lack of insight; 31.7% due to side effects; 8.4% for economic reasons; 23.3% after significant improvement of the symptoms. 79% of subjects revealed that the second reason is related to family care and support. This derives from two main causes: 42% because of continuous poor family support, related to the socioeconomic status, and 37% due to decrease in family support, mainly as a result of parents' loss or aging, or emigration of siblings. Conclusions. Dropout of psychiatric treatment brings a lot of challenges for the mental health system. Many of the factors are changeable. Dropout factors vary from disorder-related to socialrelated issues. Primary reasons are related to the disorders and medication; family-related causes seem to be very important factors that influence dropout from psychiatric treatment. Professional workers and family care should be better oriented for an overall better mental health care.
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